Prevention’s Place in a Community System of Response to Homelessness among Veterans VA Homeless Prevention Workshop August 2011.

Prevention’s Place in a Community System of

Response to Homelessness among Veterans

VA Homeless Prevention Workshop

August 2011

Corporation for Supportive Housing

CSH is a national non-profit organization that helps communities create permanent housing

with services to prevent and end homelessness.

CSH advances its mission through advocacy, expertise, innovation, lending, and

grantmaking.

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Understanding Homelessness as a System of “Flows”

Prevalence of Homelessness is a function of rate of “flows in”, rate of “flows out,” rate of returns to homelessness, and length

of stay

New Entries into Homelessness

Exits from Homelessness

Homelessness

Returns to Homelessness

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A Core Philosophy and Model: “Housing First”

Ending homelessness always begins with a home– All forms of help to end homelessness must first solve the

problem of housing housing first

“Housing First” as both a philosophy and a model:1. The principle of rapidly connecting people to permanent

affordable housing without behavioral/clinical preconditions

2. A model of housing linked to multiple, wrap-around services designed to meet complex needs of people who have been (or are headed to become) homeless for very long periods

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Varying Patterns of Homelessness

Transitionally Homeless– Experience homelessness in a single occurrence

lasting only a brief period of time Episodically Homeless

– Experience homelessness as an “institutional circuit”, and cycle between jails, hospitals, and other crisis services along with shelters

Chronically Homeless– Experience homelessness for long periods, often

as a semi-permanent state

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Varying Levels of Persistence

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Cohort Shelter Days Used

Transitional

Episodic

Chronic

Chronically Homeless represent 10%, but use 66% of shelter resources

Episodically Homeless represent 10%, but use 28% of shelter resources

Transitionally Homeless represent 80%, but use only 6% of shelter resources

Source: Kuhn and Culhane (1998)

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Different Strategies for Different Patterns of Homelessness

Pattern Strategy

Transitionally Homeless

Prevent entry into homelessness in the first place

Episodically Homeless

Rapid re-housingTransitional housingPermanent supportive housing

Chronically Homeless

Permanent supportive housing

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Decreasing Flows In and Increasing Flows Out

Homelessness Prevention

Permanent Placements into Housing

Rapid Re-housing

Housing Retention Supports

Transitionally Homeless

EpisodicallyHomeless

ChronicallyHomeless

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Ending Homelessness among Veterans Needs Complete “System of Response”

Patient-Centered

Health Home

Standard VA Services

and Benefits

Rapid Re-Housing

Homeless Prevention

Supportive Services for

Veteran Families

Enhanced “Housing

First” Supportive

Housing

Permanent Supportive

Housing

HUD-VASH

Transitional Housing

Grant & Per Diem Program

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Matching Needs to Interventions

Measure “Needs” along 2 Dimensions: Housing:

– Current housing/homelessness status– Duration of homelessness and housing crisis– Income, employment

Services:– Behavioral and primary health problems, other

complex service needs– Independent living skills– Public system involvement– Social Supports

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Full Coverage of Range of Needs among Homeless and At-Risk Veterans

HOUSING NEEDS

SERVICES NEEDS

LOW HIGH

HIGH

LOW

HOUSING FIRST SUPPORTIVE

HOUSING

TRANSITIONAL HOUSING

RAPID REHOUSING

HOMELESSNESS PREVENTION

PATIENT-CENTERED

HEALTH HOME

STANDARD PACKAGE OF VA SERVICES AND

BENEFITS

OTHER SUPPORTIVE

HOUSING

Is disabled, has PTSD, and/or has complex behavioral health needs?

The Targeting “Decision-Tree”

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Veterans returning

from OEF/OIF

Enhanced Housing First Supportive

Housing

Homeless?

Yes.

No.

Is disabled, has PTSD, and/or has complex behavioral health needs?

Is unemployed, non-acute mental health or substance use, or other barriers to self-sufficiency?

Is disabled, has PTSD, and/or has complex behavioral health needs?

Yes.

No.

Rapid Re-Housing

Transitional Housing

Is at-risk of homelessness, precariously or unstably housed?

Yes.

No.

Yes.

No.

Yes.

No.

Permanent Supportive

Housing

Yes.

No.

Homelessness Prevention

Patient-Centered Health Home

Standard VA services

Chronically Homeless?

Yes.

No.

Veterans from Prior

Conflicts/Eras (e.g. Vietnam)

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Transitional Housing

Best suited for veterans experiencing transitional to episodic homelessness who have moderate service needs and moderate housing needs

With recovery supports and employment services, veterans can become largely self-sufficient

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Permanent Supportive Housing

Most effective model for helping chronically (and episodically) homeless veterans permanently exit homelessness

Suited for veterans with high service needs and high housing needs

Primary focus is increase housing stability as foundation for improved health and reduced use of crisis service systems (Housing First approach)

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Homeless Prevention

Provide targeted assistance to people for whom whose homelessness would be an inevitability “but for” receiving help

Assess situation and immediate/underlying reasons for housing crisis

Counseling/case management to problem-solve conditions that led to housing crisis and short-term financial assistance

May lead to connection to more intensive housing and services interventions

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Rapid Re-housing

Best suited to people newly experiencing homelessness who can maintain housing on their own with moderate to minimal supports

Combines rental assistance (either short-term or long-term) and rental start-up costs coupled with time-limited supportive services

Opportunities through SSVF

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Supportive Services for Veteran Families

Helps to “complete” a community system of response:– Homelessness prevention– Rapid re-housing

Creates opportunity for more coordinated approach to outreach (the “front door” to system of response)

Allows for re-calibration of VASH, GPD, and other housing interventions to fully leverage their strengths to “unclog” homeless system

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SSVF – A New “Front Door” to Homeless Response System

Prevention services replaces shelters as “first stop” and “gateway” to response system:

– Most obvious place for veterans experiencing or at-risk of homelessness to seek help on their own (“walk-ins”)

– Central point of coordination for multiple intercept point outreach/in-reach

– Ideal place for assessing needs/risks and matching/ connection veterans to most appropriate type of help

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Multiple Intercept Points for Outreach and “In-Reach”

Courts Jail/

Prison

Street

Hospital

DetoxAlcohol/

Drug Treatment

Precarious

Housing

Shelter

Psychiatric

Hospital

Prior Era Veterans Experiencing Chronic

Homelessness

Homeless Veterans from Prior Conflicts/Era

OEF/OIF Veterans Experiencing Homelessness

OEF/OIF Veterans At-Risk of Homelessness

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Key Considerations in Homelessness Prevention

Must be targeted to clients who are truly at-risk of homelessness vs. anyone in need

Services plan driven by assessment of situation and problem solving-orientation

Services plus financial assistance

Connection to appropriate permanent housing and services options

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Why Should the VA work with community-based partners?

Not a solo act: Ending homelessness is beyond the capacity of any one public system and government agency

Don’t reinvent the wheel: CBOs often have decades of experience and existing infrastructure for ending homelessness

Expand housing and services options: Increase potential for choice, customization, and matching of needs to models

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Steps to Building a Coordinated System of Response

Summits for ending homelessness – Convene VA and community partners in day-long gathering and knowledge/practice exchange

Cross training for staff – Train housing providers about VA resources and military cultural competency; and train VA staff about housing options and strategies for serving high-needs individuals

Build coordinated “front door” by convening outreach providers and institutional settings that encounter homeless and at-risk veterans

Pursue systems improvement efforts, such as a VASH Housing Placement Boot Camp

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For More Information

Erin Healy, Associate Director, NY

[email protected]

Jonathan Hunter, Managing Dir., Western Region

[email protected]

Richard Cho, Director, Innovations & Research

[email protected]