Prevention’s Place in a Community System of Response to Homelessness among Veterans

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

2. 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.

3. Understanding Homelessness as a System of “Flows” New Entries into Homelessness Exits from Homelessness Homelessness Returns to Homelessness Prevalence of Homelessness is a function of rate of “flows in”, rate of “flows out,” rate of returns to homelessness, and length of stay

4. 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: • The principle of rapidly connecting people to permanent affordable housing without behavioral/clinical preconditions • 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

5. 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

6. Varying Levels of Persistence Transitionally Homeless represent 80%, but use only 6% of shelter resources Episodically Homeless represent 10%, but use 28% of shelter resources Chronically Homeless represent 10%, but use 66% of shelter resources Source: Kuhn and Culhane (1998)

7. Different Strategies for Different Patterns of Homelessness

8. Decreasing Flows In and Increasing Flows Out Homelessness Prevention Transitionally Homeless Permanent Placements into Housing Rapid Re-housing Episodically Homeless Chronically Homeless Housing Retention Supports

9. Ending Homelessness among Veterans Needs Complete “System of Response” Supportive Services for Veteran Families Grant & Per Diem Program HUD-VASH Patient-Centered Health Home Standard VA Services and Benefits Homeless Prevention Rapid Re-Housing Transitional Housing Permanent Supportive Housing Enhanced “Housing First” Supportive Housing

10. 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

11. Full Coverage of Range of Needs among Homeless and At-Risk Veterans HIGH RAPID REHOUSING OTHER SUPPORTIVE HOUSING HOUSING FIRST SUPPORTIVE HOUSING HOUSING NEEDS HOMELESSNESS PREVENTION TRANSITIONAL HOUSING PATIENT-CENTERED HEALTH HOME STANDARD PACKAGE OF VA SERVICES AND BENEFITS LOW LOW HIGH SERVICES NEEDS

12. Yes. No. The Targeting “Decision-Tree” Enhanced Housing First Supportive Housing Yes. Veterans from Prior Conflicts/Eras (e.g. Vietnam) Chronically Homeless? Permanent Supportive Housing No. Transitional Housing Is disabled, has PTSD, and/or has complex behavioral health needs? Yes. Is unemployed, non-acute mental health or substance use, or other barriers to self-sufficiency? Yes. No. Veterans returning from OEF/OIF Rapid Re-Housing Homeless? Yes. Is disabled, has PTSD, and/or has complex behavioral health needs? Homelessness Prevention No. Yes. Is at-risk of homelessness, precariously or unstably housed? No. Patient-Centered Health Home Is disabled, has PTSD, and/or has complex behavioral health needs? Yes. No. Standard VA services No.

13. 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

14. 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)

15. 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

16. 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

17. Opportunities through SSVF

18. 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

19. 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

20. Multiple Intercept Points for Outreach and “In-Reach” Prior Era Veterans Experiencing Chronic Homelessness Homeless Veterans from Prior Conflicts/Era OEF/OIF Veterans Experiencing Homelessness OEF/OIF Veterans At-Risk of Homelessness

21. 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

22. 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

23. 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

24. For More Information Erin Healy, Associate Director, NY erin.healy@csh.org Jonathan Hunter, Managing Dir., Western Region jonathan.hunter@csh.org Richard Cho, Director, Innovations & Research richard.cho@csh.org