Date of Award
Projects: SPU Access Only
Doctor of Nursing Practice (DNP)
Veterans make up about 25% of the homeless population (U.S. Department of Housing and Urban Development [HUD], 2018) and evidence has shown rapid placement into any form of shelter or transitional housing has a greater impact on improving a veteran’s future housing stability (Montgomery, Hill, Kane, & Culhane, 2013). But rapid placement can lead to placement incompatibility due to housing programs lacking staff with healthcare background or lacking assessment tools to appropriately identify complex medical and functional needs of homeless veterans (Hauff & Secor-Turner, 2014). To improve placement compatibility and ensure homeless veterans receive the necessary support to transition out of homelessness, transitional housing programs need a structured assessment tool to assist case managers in determining potential residents’ placement and needs at time of admission.
Problem and Purpose Statement
A local Washington State branch of a global nonprofit charitable organization has several transitional housing programs serving homeless veterans. Case managers cite poor clinical outcomes, such as hospitalizations, as a frequent consequence of inappropriate placement and unmet needs. The purpose of this project was to develop a structured assessment tool to assist the organization’s case managers in determining homeless veterans’ needs and placement.
A literature review was performed for the health domains for which a homeless individual should be evaluated. Input was obtained via a group interview with the transitional housing case managers on which specific tools and screenings should be included within the structured assessment. Appropriate assessment screening tools were obtained and adapted for the homeless veteran population and to meet the programs’ needs. The developed assessment tool was presented in a meeting to the case managers for feedback and revisions before the approved tool was implemented in the transitional housing programs’ admission process. After implementation of the assessment tool, evaluation forms were provided to the case managers and monthly interviews were held to obtain feedback on the feasibility and effectiveness of the tool.
The project received feedback from seven case managers during the pre-implementation meeting on several themes of revision that would improve the usability of the structured assessment tool: (a) customize tool to homeless population by changing wording of questions to meet population norms, and included questions regarding medication access and safe storage; (b) adjust some questions as homeless population commonly distrust assessments and evaluations by either removing or adding disclaimers to questions veterans feel may disqualify them from obtaining housing; and (c) expand the assessment tool into two sections, the referral and initial interview sections, in order to obtain information on medical and functional status based on referring caregiver assessments.
Case managers expressed concerns about workload and decided to replace the current referral/initial interview packet with the developed assessment tool; the case managers noted while the tool was more work at time of admission, they thought it would save work and time later. Case managers recognized multiple uses for the assessment tool beyond the admission process, such as performing assessments during routine case management meetings or to provide accurate medical information for EMS during emergencies.
While part of the assessment tool was not implemented due to the coronavirus pandemic, the case managers verbalized that the assessment tool appeared to be easy to use and the referral section has assisted in identifying needs and issues. Overall, the response to the structured assessment tool was positive in assisting case managers to determine potential residents’ needs and placement at time of admission.
To maintain sustainability, the structured assessment tool was developed with input from the case managers to increase sense of ownership. The structured assessment tool was included in the transitional housing programs’ referral and admission intake packet. The electronic form of the revised assessment tool was provided to the case managers, and they were encouraged to make changes to the tool as needed to better meet their future needs. Case managers were educated on how to use and further develop the assessment tool so they may educate future staff on the usage of the tool.
With improved assessments of potential residents’ needs prior to admission, case managers will be better able to make decisions to provide the appropriate placement and services that may lead to improved housing and health outcomes for homeless veterans. Higher graduation rates of homeless veterans from the housing programs may have a beneficial impact on the funding received from outcome-based grants for transitional housing programs. The structured assessment tool can be expanded to other organizations and housing programs to decrease inappropriate placements and improve outcomes for other homeless individuals.
Wu, Jessica, "A Structured Approach to Assist Case Managers in Determining Appropriate Placement and Services for Homeless Veterans" (2021). Doctor of Nursing Practice (DNP) Scholarly Projects. 25.