Spiritual Supports for Formerly Unhoused US Veterans: A Quality Improvement Evaluation

To mitigate Veteran homelessness, the US Veterans Health Administration (VHA), through the US Department of Housing and Urban Development-Veteran Affairs Supportive Housing (HUD-VASH) program, provides permanent supportive housing to unhoused Veterans. HUD-VASH has improved housing outcomes for Veteran clients but not necessarily their health and well-being. Offering spiritual support as part of the program may improve these more elusive outcomes; yet the extent to which spiritual support is offered within HUD-VASH is unclear. To explore this question, we conducted a mixed-methods evaluation across VHA's regional network in New England. The evaluation included: (1) a cross-sectional, quantitative web-based survey of Veterans served by HUD-VASH programs and (2) qualitative discipline-based focus groups of VHA providers (chaplains and HUD-VASH staff). We conducted descriptive and bivariate quantitative analyses of survey data and thematic rapid qualitative analysis of focus group data. Our survey response rate was 24.4% (283/1160). Most respondents (74.6%) wanted help with one or more spiritual needs, especially Veterans who identified as non-white, used more services, were newer to the HUD-VASH program, and/or had physical, mental, social, financial, and legal challenges. Our focus groups had 24 VHA staff participants. Staff perceived that spiritual support for Veterans in HUD-VASH is not sufficiently offered and that structural, procedural, and perceptual barriers existed. Integrating findings across our datasets, we found a gap in offering HUD-VASH clients the spiritual support that they desire. Approaches to address this gap might bolster VHA holistic and Veteran-centered care as well as the health and well-being of significantly at-risk Veterans.