prevention’s place in a community system of response to homelessness among veterans va homeless...
TRANSCRIPT
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
Jonathan Hunter, Managing Dir., Western Region
Richard Cho, Director, Innovations & Research