{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:05:25Z","timestamp":1787749525375,"version":"build-2784847793"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the sustainment of Housing First (HF) implementation in a permanent supportive housing program for homeless\u2010experienced veterans, 5\u2009years after practice implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study setting<\/jats:title><jats:p>From 2016 to 2017, primary data were collected from providers and veterans in the Department of Housing and Urban Development\u2013VA Supportive Housing (HUD\u2010VASH) program at Los Angeles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>Guided by the integrated sustainability framework, we performed a mixed\u2010methods study to evaluate the sustainment of HF, an evidence\u2010based practice implemented to improve housing outcomes. To assess sustainment, we measured fidelity to HF in six of seven HUD\u2010VASH teams. These data were integrated with qualitative interviews with providers and veterans who described perceived sustainment to HF and contextual factors that supported or impeded sustainment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection<\/jats:title><jats:p>Fidelity to HF at 5\u2009years after practice implementation, as a proxy for sustainment, was quantified via surveys with HUD\u2010VASH teams. HUD\u2010VASH providers (<jats:italic>n<\/jats:italic>\u00a0=\u00a051) and 31 veterans participated in semi\u2010structured interviews. Team\u2010based template analyses were used to develop an emergent understanding of stakeholder perspectives on HF sustainment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal findings<\/jats:title><jats:p>Overall, HUD\u2010VASH teams reported HF sustainment. The lowest fidelity scores were found in the domains of client\u2010to\u2010staff ratios, frequency of client\u2013provider contact, and time to housing. Qualitative findings indicated that outer contextual factors (e.g., housing scarcity) and organizational factors (e.g., staff turnover) impacted HF sustainment. Providers identified changes in leadership and unmet resource needs as impediments to practice sustainment. All stakeholders identified positively with the HF practice and believed that the approach benefited veterans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This snapshot of HF sustainment demonstrates that this practice can be sustained over time. However, strong leadership, organizational resources, and community partnerships are needed. Adaptations to HF in response to outer contextual factors and organizational capacity may result in practice sustainment while allowing for flexibility in service provision.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.13904","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T09:24:20Z","timestamp":1646299460000},"page":"374-384","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Stakeholder perspectives on sustainment of Housing First in a <scp>VA<\/scp> permanent supportive housing program"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4233-5779","authenticated-orcid":false,"given":"Erica Hua","family":"Fletcher","sequence":"first","affiliation":[{"name":"UCLA\/VA Center of Excellence for Veteran Resilience and Recovery UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior  Los Angeles California USA"},{"name":"Health Services Implementation Unit VA Greater Los Angeles, Mental Illness Research, Education, and Clinical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonya","family":"Gabrielian","sequence":"additional","affiliation":[{"name":"UCLA\/VA Center of Excellence for Veteran Resilience and Recovery UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior  Los Angeles California USA"},{"name":"Health Services Implementation Unit VA Greater Los Angeles, Mental Illness Research, Education, and Clinical Center  Los Angeles California USA"},{"name":"HSR&amp;D Center for the Study of Healthcare Innovation, Implementation, and Policy VA Greater Los Angeles  Los Angeles California USA"},{"name":"Department of Psychiatry and Biobehavioral Sciences UCLA David Geffen School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony W. P.","family":"Flynn","sequence":"additional","affiliation":[{"name":"Health Services Implementation Unit VA Greater Los Angeles, Mental Illness Research, Education, and Clinical Center  Los Angeles California USA"},{"name":"Department of Counseling Psychology University of Wisconsin Madison School of Education  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared M.","family":"Greenberg","sequence":"additional","affiliation":[{"name":"UCLA\/VA Center of Excellence for Veteran Resilience and Recovery UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior  Los Angeles California USA"},{"name":"Health Services Implementation Unit VA Greater Los Angeles, Mental Illness Research, Education, and Clinical Center  Los Angeles California USA"},{"name":"HSR&amp;D Center for the Study of Healthcare Innovation, Implementation, and Policy VA Greater Los Angeles  Los Angeles California USA"},{"name":"Department of Psychiatry and Biobehavioral Sciences UCLA David Geffen School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sona","family":"Hovsepian","sequence":"additional","affiliation":[{"name":"VA Greater Los Angeles Healthcare System  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca S.","family":"Oberman","sequence":"additional","affiliation":[{"name":"Health Services Implementation Unit VA Greater Los Angeles, Mental Illness Research, Education, and Clinical Center  Los Angeles California USA"},{"name":"HSR&amp;D Center for the Study of Healthcare Innovation, Implementation, and Policy VA Greater Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander S.","family":"Young","sequence":"additional","affiliation":[{"name":"Health Services Implementation Unit VA Greater Los Angeles, Mental Illness Research, Education, and Clinical Center  Los Angeles California USA"},{"name":"HSR&amp;D Center for the Study of Healthcare Innovation, Implementation, and Policy VA Greater Los Angeles  Los Angeles California USA"},{"name":"Department of Psychiatry and Biobehavioral Sciences UCLA David Geffen School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201300073"},{"key":"e_1_2_8_3_1","unstructured":"TsemberisSHousing first: the pathways model to end homelessness for people with mental illness and addiction. 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