Thread by @StefanKertesz

1/There is a *reason* that the decline in Veterans experiencing homelessness is that steep.

It reflects the adoption Housing First approaches, as well as could be done, by @DeptVetAffairs

Anyone who wants to see our research on strengths & weaknesses of this work, see 🧵

2/Bear in mind that our work considered Housing First with “eyes open” as I had raised relevant questions as to what it can deliver, most especially where addiction is part of the picture pubmed.ncbi.nlm.nih.gov/19523126/

3/However, on whole and despite the very real challenges that will happen when housing people with serious mental illness and addiction challenge, the data have been reassuring as to potential for success, like this pubmed.ncbi.nlm.nih.gov/21285095/

4/The actual work by case management staff to get a person into a unit is serious, demanding, and logistically hard because of the rental market and bureaucracy ps.psychiatryonline.org/doi/full/10.11…

5/We interviewed ~ 170 VA personnel in 8 VA med centers to assess fidelity to the Housing First model 2012-14: high fidelity for emphasis on permanent housing without precondition, less so for harm reduction, middling for strength of supportive services - pubmed.ncbi.nlm.nih.gov/28481597/

6/Like any and every complex organizational undertaking, Housing First can be done well or less so. We found the best fidelity to Housing First when the leadership, middle management and the VA medical center as a whole aligned efforts: link.springer.com/article/10.100…

7/I have seen egregious attempts to argue that the approach used by VA actually did not work.

Please look at the graph.

Any large piece of work can be done well or poorly. That is why we take it seriously.

But don’t ignore results! /fin