HPACT Is Fighting to Help Homeless Veterans Get Healthy and Housed

The groundbreaking HPACT program offers an integrative approach to treatment, providing a team of professionals who collaborate on care for each Veteran they see. Through HPACT, Veterans have wraparound care with access to medical staff, social workers, mental health and substance use counselors, nurses and homeless program staff. Essentially, it’s a home base for accessing services.

“We’re doing everything we can to deliver the best care we can for Veterans who wouldn’t otherwise have access,” said Dr. Stephen "Brent" Walden, HPACT mental health section chief, VA Greater Los Angeles Healthcare System (VAGLAHS). “We’re really focused on health equity.”

Located in Building 402 on the West LA VA campus, HPACT has a “no wrong door” policy and welcomes all homeless Veterans. There are additional HPACT branches at the Downtown LA and Sepulveda VA Ambulatory Care Centers.

Increasing Accessibility

There are many ways an unhoused Veteran can access HPACT care, including coming directly to Building 402.  

In addition to walk-ins, HPACT receives referrals from different parts of VA including the Community Resource and Referral Center (also known as the Welcome Center) as well as the emergency department. They also work at the emergency shelter program Care, Treatment, and Rehabilitative Services (CTRS) three times a week. Nurse practitioners from the HUD-VASH program, case managers and staff from other homeless programs also funnel Veterans towards HPACT.

Veterans who enter HPACT typically have medical needs in addition to dealing with homelessness (although healthy unhoused Veterans are also encouraged to utilize its services). Many suffer from mental health conditions and multiple chronic diseases such as high blood pressure, diabetes or substance use disorder.

In addition to creating fixed appointments for its Veteran patients, HPACT provides walk-in urgent care Monday through Friday, 7:30 a.m. to 4 p.m.

A Veteran remains within HPACT’s care when they are unhoused, in transitional housing and treatment programs, and even when they move into permanent housing. Graduation to a Patient Aligned Care Team (PACT) clinic is considered when the Veteran is keeping their medical and mental health appointments and is maintaining stable permanent housing.

Mission-Driven Leadership

Medical Director Dr. Brianna Cowan came to HPACT because of her passion for working with vulnerable and underserved populations.

“I’m the first physician in my family and I think something that drew me to being a physician is what a big role we can play in our community and for patients,” Cowan said.

Her brother is an Army officer, so Veterans are near and dear to her heart. “The work is just so meaningful, and our patients are so resilient.”

Providing Crucial Care

HPACT, a national program, was instituted at the West LA VA in 2014.

There is evidence that the HPACT model reduces both emergency room visits and hospitalizations for patients. A 2016 study of 33 VA HPACT facilities found a 19% reduction in emergency department use and a 34.7% reduction in hospitalizations. In addition, the HPACT program uses real-time data analytics to address acute care utilization among its homeless Veterans.

Both Walden and Andy Truong, HPACT social work supervisor, act as consult managers. They talk to Veterans who walk through the clinic doors. “There’s almost like this model of motivational interviewing to see where they are and where they want to go,” Truong said of the process. “They might also share with us what they’re dealing with.”

Meeting Veterans Where They Are

After the initial intake, the team helps each Veteran identify and work towards their individual goals. HPACT’s purpose is to meet the Veteran where they are, wherever that might be. “Sometimes folks aren’t ready to make certain changes and that’s ok,” Walden said.

HPACT is also aligned with VA’s “Housing First” approach to care, which prioritizes stable housing as a first step for Veterans so their other needs can then be addressed. “If the housing piece isn’t in place, it’s very hard to stabilize medical or mental health conditions,” Cowan said.

In addition to providing direct services to Veterans, HPACT is also an educational site for clinicians. The West LA VA location was the recipient of a grant as a center of excellence for interprofessional education. With those funds, HPACT created an interprofessional training program incorporating family nurse practitioner, internal medicine, clinical pharmacy and psychiatry residents.

The Door Is Always Open

“I think what keeps me in this work is that it’s a really special thing to get to witness transformation,” Cowan said. “I wouldn’t ever want to take credit for our patients’ journeys, but it’s nice to be able to connect people to services like housing or helping them stabilize medical or mental health conditions.”

All team members voice their dedication to the important and lifesaving work HPACT is doing. “All of our staff have such a huge heart for our patients,” Cowan said. “This isn’t work that’s about the glory or big bucks, it’s because all of our staff members really do care.”

HPACT’s “no wrong door” policy means they’re accessible to any unhoused Veteran in need, as well as Veterans who are in shelters or unstably housed, and the staff is always there for support. “At the end of the day, we are willing to work as hard as the Veteran is willing to work,” Truong said.

At West LA VA, Veterans can reach HPACT directly by coming into Building 402 between the hours of 7:30 a.m. and 4 p.m. Monday through Friday or through the call center at 877-251-7295. For Veterans in Downtown LA, HPACT hours are 7 a.m. to 3:30 p.m. Monday through Friday and the phone number is 213-253-2677 ext. 24791. For Veterans in North Hills / Sepulveda, HPACT hours are 7:30 a.m. to 4 p.m. Monday through Friday, and the phone number is 818-891-7711 ext. 31270.