The Homeless Patient Aligned Care Team (H-PACT) program is a coordinated “medical home” specifically tailored to the needs of Veterans experiencing homelessness. Staffed by interdisciplinary teams of doctors, nurses, and case managers, the program serves as a conduit for treatment engagement and involvement in VA Homeless Programs and VA clinical services and supports through a “no wrong door” policy. H-PACT care teams provide medical care, case management, housing, and social services assistance to help Veterans obtain and stay in permanent housing, thereby reducing emergency department use and hospitalizations and improving chronic disease management.

NCHAV first piloted the H-PACT model in 2012. By 2015, nearly 16,000 patients were enrolled in an H-PACT at one of 51 sites across the country. The initiative was subsequently incorporated into program operations and has successfully engaged some of the most challenging, complex, and chronically disenfranchised patients with the VA health system, reflected in very high rates of primary care, specialty care, mental health, and homeless program use. As a result, the program has reduced emergency department use and hospitalizations by 25 percent. It has also helped Veterans secure and maintain housing, contributing in a very important way to meeting the goal of ending Veteran homelessness.

Relevant journal articles attesting to H-PACT’s effectiveness are listed below.

• Dual Use and Hospital Admissions among Veterans Enrolled in the VA’s Homeless Patient Aligned Care Team. Trivedi AN, Jiang L, Johnson EE, Lima JC, Flores M, O’Toole TP., Health Serv Res. 2018 Dec;53 Suppl 3:5219-5237. doi: 10.1111/1475-6773.13034. Epub 2018 Aug 27.
• Population-Tailored Care for Homeless Veterans and Acute Care Use, Cost, and Satisfaction: A Prospective Quasi-Experimental Trial. O’Toole TP, Johnson EE, Borgia M, Noack A, Yoon J, Gehlert E, Lo J. Prev Chronic Dis. 2018 Feb 15;15:E23. doi: 10.5888/pcd15.170311.
• Patient-aligned Care Team Engagement to Connect Veterans Experiencing Homelessness With Appropriate Health Care. Gundlapalli AV, Redd A, Bolton D, Vanneman ME, Carter ME, Johnson E, Samore MH, Fargo JD, O’Toole TP. Med Care. 2017 Sep;55 Suppl 9 Suppl 2:S104-S110. doi: 10.1097/MLR.0000000000000770.
• Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program. O’Toole TP, Johnson EE, Aiello R, Kane V, Pape L., Prev Chronic Dis. 2016 Mar 31;13:E44. doi: 10.5888/pcd13.150567.

For additional information on H-PACTs, please click the HPACT button or contact us.

Pilot to Standardize Occupational Therapy (OT) Workflow, Intake Screening, Referral, and Workload Capture:

A major area of focus for the VA Homeless Programs Office (HPO) is to enhance targeted services to address the needs of high-acuity and vulnerable populations, including Veterans who are older. Adults experiencing homelessness are at increased risk for geriatric syndromes, making an older person likely to present with the age-related functional difficulties of a person 20 years older. Early identification of age-related housing barriers can enable appropriate housing placement and the initiation of housing supports, modifications, treatment, and other interventions to circumvent future crises. For this reason, some HUD-VASH teams have added occupational therapists to their staff. As of February 2022, HPO funded 49 full-time and part-time OT positions across 35 of the 139 HUD-VASH parent facilities. However, identification of an appropriate scope and depth of OT activity is critical considering the limited number and capacity of OT providers and the multitude of valuable services they can provide.

For more information about the pilot, lessons learned, and considerations for next steps, please contact us.

NCHAV has collaborated with subject matter experts in Motivational Interviewing (MI) to develop an evidence-based learning model to support VA Homeless Staff in improving MI skills. This is done by reinforcing an evidence-based treatment in unconventional environments, fostering supportive relationships with Veterans, enhancing engagement techniques, and integrating best practices to strengthen Veterans’ motivation and commitment to explore and overcome ambivalence to make positive change. The goal is for Homeless Program Staff to develop methods and knowledge that will enhance their clinical skills, contributing to effective strategies for engaging Veterans who are experiencing homelessness.

Motivational Interviewing is the first intervention developed that also has an associated training. The training program consists of two virtual modules, each lasting five hours, along with four 75-minute Community of Practice (CoP) sessions and two individual coaching sessions. Homeless Program Staff dedicate at least 18 hours over 8-10 weeks for this training experience and must complete role-play recordings as well as pre- and post-evaluations.

*Note: The training is still in its early production stages, but if you’d like more information on Motivational Interviewing or possibly want to get involved in the training, please contact us.