Abstract：
Permanent Supportive Housing (PSH), which provides subsidies for independent housing and supportive services, is an evidence-based practice that improves health and housing for homeless experienced persons. Though most PSH is scattered-site, that is, housing dispersed throughout the mainstream rental market, project-based PSH offers housing and supportive services in dedicated facilities with on-site services. In 2013, the Veterans Health Administration (VA) at Greater Los Angeles opened a novel project-based PSH program located on a VA campus. To inform plans to expand project-based PSH at this VA, we examined participants\' experiences in this program. We aimed to identify participant characteristics that suggested they were well suited for the planned PSH expansion; to characterize services that participants found valuable in this setting; and to highlight gaps between participants\' needs and PSH services provided.
We performed semi-structured interviews with a convenience sample (n = 24) of participants who had engaged in this project-based PSH program. Interviews asked why participants selected housing on a VA campus and explored valued program characteristics, designs, and services. Using rapid analysis methods, we generated templated summaries of each participant\'s responses across the domains of our interview guide, then used matrix analyses to identify salient themes across the interviews.
Participants appreciated the ease of access to medical and mental health services; however, as services were assumed to be optimized by virtue of co-location with VA healthcare, their PSH providers often did not link them with non-VA social services as assertively as desired. Many participants raised concerns about building safety and on-site substance use. A lack of participant engagement in program oversight, often leading to conflicts with staff and building management, was also highlighted in our interviews.
Given the value placed on ease of access to healthcare, these data suggest the value of this PSH model for persons with healthcare vulnerabilities. Specific recommendations for the planned PSH expansion include: (1) continuation of proximate, open-access healthcare; (2) clear tenant policies; (3) tenant councils for each development; (4) staff knowledgeable of non-VA resources and social services; (5) Veteran-preferred hiring practices by Property/Service management; (6) gender-specific accommodations; and (7) robust 24/7 security on-site.
We performed semi-structured interviews with a convenience sample (n = 24) of participants who had engaged in this project-based PSH program. Interviews asked why participants selected housing on a VA campus and explored valued program characteristics, designs, and services. Using rapid analysis methods, we generated templated summaries of each participant\'s responses across the domains of our interview guide, then used matrix analyses to identify salient themes across the interviews.
Participants appreciated the ease of access to medical and mental health services; however, as services were assumed to be optimized by virtue of co-location with VA healthcare, their PSH providers often did not link them with non-VA social services as assertively as desired. Many participants raised concerns about building safety and on-site substance use. A lack of participant engagement in program oversight, often leading to conflicts with staff and building management, was also highlighted in our interviews.
Given the value placed on ease of access to healthcare, these data suggest the value of this PSH model for persons with healthcare vulnerabilities. Specific recommendations for the planned PSH expansion include: (1) continuation of proximate, open-access healthcare; (2) clear tenant policies; (3) tenant councils for each development; (4) staff knowledgeable of non-VA resources and social services; (5) Veteran-preferred hiring practices by Property/Service management; (6) gender-specific accommodations; and (7) robust 24/7 security on-site.
摘要：
永久支持性住房（PSH），为独立住房和支持服务提供补贴，是一种基于证据的做法，可以改善无家可归的有经验的人的健康和住房。虽然大多数PSH是分散的，也就是说,住房分散在整个主流租赁市场，基于项目的PSH在专用设施中提供住房和支持服务，并提供现场服务。2013年，大洛杉矶地区的退伍军人健康管理局（VA）在VA校园内开设了一项基于项目的新颖PSH计划。要通知计划在本VA扩展基于项目的PSH，我们检查了参与者在这个项目中的经验。我们旨在确定参与者的特征，这些特征表明他们非常适合计划中的PSH扩展；表征参与者在此环境中发现有价值的服务；并强调参与者需求与提供的PSH服务之间的差距。
我们对参与此基于项目的PSH计划的参与者的便利样本（n=24）进行了半结构化访谈。访谈询问为什么参与者在VA校园中选择住房并探索有价值的计划特征，设计,和服务。使用快速分析方法，我们在我们的采访指南的域中生成了每个参与者的回答的模板摘要，然后使用矩阵分析来识别访谈中的突出主题。
与会者对获得医疗和精神卫生服务的便利性表示赞赏；然而，由于服务被认为是通过与VA医疗保健的协同定位来优化的，他们的PSH提供者通常没有像期望的那样自信地将他们与非VA社会服务联系起来.许多与会者对建筑安全和现场物质使用提出了关切。缺乏参与者参与项目监督，经常导致与员工和建筑管理的冲突，在我们的采访中也强调了这一点。
考虑到获得医疗保健的便利性，这些数据表明PSH模型对于有医疗保健漏洞的人的价值.计划中的PSH扩展的具体建议包括：(1)延续近似，开放获取的医疗保健；（2）明确的租户政策；（3）每个开发项目的租户理事会；（4）熟悉非VA资源和社会服务的员工；（5）财产/服务管理部门的退伍军人优先雇用做法；（6）针对性别的住宿；（7）可靠的24/7现场安全。
我们对参与此基于项目的PSH计划的参与者的便利样本（n=24）进行了半结构化访谈。访谈询问为什么参与者在VA校园中选择住房并探索有价值的计划特征，设计,和服务。使用快速分析方法，我们在我们的采访指南的域中生成了每个参与者的回答的模板摘要，然后使用矩阵分析来识别访谈中的突出主题。
与会者对获得医疗和精神卫生服务的便利性表示赞赏；然而，由于服务被认为是通过与VA医疗保健的协同定位来优化的，他们的PSH提供者通常没有像期望的那样自信地将他们与非VA社会服务联系起来.许多与会者对建筑安全和现场物质使用提出了关切。缺乏参与者参与项目监督，经常导致与员工和建筑管理的冲突，在我们的采访中也强调了这一点。
考虑到获得医疗保健的便利性，这些数据表明PSH模型对于有医疗保健漏洞的人的价值.计划中的PSH扩展的具体建议包括：(1)延续近似，开放获取的医疗保健；（2）明确的租户政策；（3）每个开发项目的租户理事会；（4）熟悉非VA资源和社会服务的员工；（5）财产/服务管理部门的退伍军人优先雇用做法；（6）针对性别的住宿；（7）可靠的24/7现场安全。
