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Funding

This project was funded by an Intramural Grant from the National Center on Homelessness Among Veterans (NCHAV).

What do We Know?

The VA’s National Homeless Programs Office (HPO) seeks to enhance person-centeredness, care coordination, and system integration across housing and healthcare sectors for homeless-experienced Veterans. The “One Team” approach is a coordinated community-driven strategy to end Veteran homelessness by integrating services, resources, and leadership across all programs and partners on a regional basis.

At this study’s onset in October 2024, HPO’s One Team’s national roll-out was in the “pre-implementation” stage, which included: 1) developing an instructional One Team implementation toolkit in October 2023; 2) showcasing the One Team strategy at an HPO-sponsored conference in Dallas, Texas, in April 2024; and 3) conducting One Team implementation-focused needs assessments with 36 regional teams pre-conference.

New Information Provided by this Study

Our objective was to assist HPO in transitioning the One Team initiative from pre-implementation to implementation status. To do so, we pursued three efforts: 1) working with HPO to refine its One Team Self-Assessment Survey for use by regional teams; 2) leading a 3-step consensus-building process with One Team members across the US to identify essential/non-essential and adaptable elements of the Self-Assessment Survey; 3) conducting focus groups with One Team members across the US to identify successes in and challenges by teams deemed “more” or “less” advanced in implementation* by HPO representatives working closely with them.

Results

Table 1 reports the focus group findings, which are organized by two broad themes: successes and challenges; within each theme, we display which type of teams (“more” and/or “less” advanced) highlighted a sub-theme (in plain font). Successes included: 1) HPO providing helpful learning opportunities; 2) VA and community partners having positive working relationships. Challenges included: 1) staff turnover hindering smooth roll-out; 2) teams lacked information-sharing platforms; 3) gaining buy-in from non-VA team members for the VA-driven One Team approach; 4) lack of clarity on expected outcomes.

Summary / Implications

The early implementation of the One Team was facilitated in locations that had strong national-level support and relational coordination¹ were already in place. Barriers included high staff turnover, which disrupted shared knowledge and team continuity. Additionally, the inability to share information between VA and community partners limited real-time communication and coordinated case management. Some team members perceived One Team as overly VA-driven, signaling opportunities to improve all partners’ engagement and reinforce the initiative’s collaborative intent. Some teams perceived a lack of clarity on expected One Team outcomes as challenges; this perception may reflect a need to shore up top-down communication channels.

These findings point to the need for opportunities that improve relational ties, mutual problem solving, and coordinated action within VA and across VA and community partners. Strengthening communication systems, onboarding processes, role clarity, partner engagement, and front-line informed performance metrics will be essential; such actions would sustain One Team momentum and translate early coordination gains into durable improvements in homeless-experienced Veteran outcomes. As HPO advances to the One Team implementation phase, these findings provide actionable guidance for building a cohesive, data-driven, and relationally grounded national model.

References

1. Gittell J.H., Godfrey M., Thistlethwaite J. (2013). Interprofessional collaborative practice and relational coordination: Improving healthcare through relationships. J Interprof Care. 27(3):210-3. doi: 10.3109/13561820.2012.73056

Successes
Both “More” and “Less” Advanced Teams
HPO provided helpful learning opportunities (i.e., initial training and ongoing technical assistance)
Only “More” Advanced Teams
VA and community partners had positive working relationships
Challenges
Both “More” and “Less” Advanced Teams
Staff turnover hindered smooth roll-out
Only “More” Advanced Teams
Teams lacked information-sharing platforms
Gaining buy-in from non-VA team members for the VA-driven approach
Only “Less” Advanced Teams
Clarity on expected outcomes did not exist

*“More and Less Advanced team” determined by a relative designation based on characteristics of system functioning and consistency in meeting key performance metrics.