Deficiencies in VA Homeless Program Intake Documentation, Suicide Risk Assessment, and Care Coordination Processes

The OIG conducted a national review to evaluate the alignment of information related to mental health, substance use disorder (SUD), and suicide risk treatment needs within the Veterans Health Administration’s (VHA’s) Homeless Operations Management and Evaluation System (HOMES) data collection system and electronic health record (EHR). The OIG also assessed homeless program staff’s adherence to suicide risk screening procedures and care coordination.

Homeless program staff did not document the HOMES Assessment in 42 percent of patient EHRs, which limited access to important clinical information among clinicians outside of VA homeless programs.

The OIG found that 85 percent of patient EHRs included a suicide risk screening at the time of the HOMES Assessment or in the 30 days prior, as required. However, VHA has not implemented processes to ensure that staff complete the required suicide risk procedures, including risk mitigation, in response to HOMES-identified risk of self-harm.

Homeless program staff did not document care coordination as outlined in VA homeless program policy. The OIG found that 35 percent of patients with HOMES-identified treatment needs, who were interested in participating in treatment, had EHR documentation of care coordination related to those treatment needs. VHA homeless program strategic goals include coordinating care to address veterans’ mental health and SUD needs; however, VHA has not delineated responsibility for ensuring care coordination, resulting in a lack of oversight and risk of patients not receiving needed mental health and SUD treatment.

The OIG made four recommendations to the Under Secretary for Health related to consistent EHR documentation of HOMES clinical information, suicide risk screening at intake, suicide risk screening in response to danger of self-harm identified in the HOMES Assessment, and documentation of mental health and SUD care coordination.