ending veteran homelessness: where are we now?

Ending Veteran Homelessness:WHERE ARE WE NOW?

May 19, 2016

Presented by:Baylee Crone, National Coalition for Homeless VeteransLeon Winston, Swords to PlowsharesMegan Zottarelli, Swords to Plowshares

© Swords to Plowshares 2016

Agenda

Where are we now in our goal to prevent and end veteran homelessness?

This online seminar will discuss:

1. Veteran populations most at risk of experiencing homelessness andhealth outcomes

2. The national and community picture of efforts in the last five years

3. Systematic responses in place throughout communities

4. Strategies moving forward to address the unmet needs


Presenters

Baylee Crone, Executive Director, National Coalition for Homeless Veterans (NCHV)

Leon Winston, Chief Operating Officer, Swords to Plowshares

Megan Zottarelli, Senior Analyst, Institute for Veteran Policy at Swords to Plowshares


Homeless Veterans by the Numbers

Veterans:

9.5% of the U.S. adult population, but

11.4% of the adult sheltered population.

47,725 veterans homeless on any given night in January 2015.

36% decline since 2010.

Representing 11% of all homeless adults.

PIT Count, 2015


Sheltered vs. Unsheltered:

34% unsheltered

66% sheltered

2015 HMIS Data


States

1 in 3 homeless veterans are in California and Florida


Risk Factors: A Conceptual Model


Risk and Protective Factors

Protective Factors

Despite higher levels of education compared to non-veteran homelesspopulations, and a higher rate of past family cohesion (including ahigher likelihood to be or have been married), some studies showthese are not protective factors against homelessness.

Some studies cite veterans with stronger and more stable familiesare more likely to be negatively affected by the trauma ofdeployment.

Women veterans: married women veterans less likely to experiencehomelessness.

Access to a VA service-connected disability payments found to be aprotective factor against homelessness.

(Tessler 2002; Washington 2010; Balshem et al. 2011)


Poverty Correlation

Veterans are less likely to be poor, but

poor veterans are more likely to

become homeless than non-veterans.

2 times as likely to

become homeless

when compared to

non-veterans.

3 times as likely to become

homeless when compared to

non-veterans.

1–2% of all women veterans,

13–15% of women veterans

living in poverty will

experience homelessness

over the course of a year.

Veteran men living in poverty: Women veterans living in poverty:

Fargo et al. (2012). Prevalence and risk of homelessness among US Veterans. Preventing Chronic Disease, 9, 110–112.


Chronic Homelessness vs. Episodic

Chronic HomelessnessUnaccompanied individual with disabling condition who has been homeless for 1

continuous year or 4+ times (adding up to 12 months total with at least seven nights

in between) within 3 years. (HUD, 2016)

16.8% of individuals experiencing homelessness are chronically homeless.

Psychiatric disability, substance abuse, medical co- morbidities more prevalent

within chronically homeless population than episodically or transitionally

homeless.

Episodic HomelessnessUnstably housed and recurrent problems with housing, experiencing an episode of homelessness is “a separate, distinct, and sustained stay on the streets and/or in a homeless emergency shelter.”

(Kertesz, et al., 2005; Burt, et al., 2001; Kuhn & Culhane, 1998)


Homeless Populations

Aging Homeless Veterans Homeless veterans are most likely to be between the ages of 51 and 61 (43%)

and Post-Vietnam or Vietnam era.

Number of homeless veterans over the age of 55 is projected to increase

dramatically over the next 10 to 15 years.

Older homeless veterans:

Have excess and age-adjusted mortality as well as increased suicide

risk.

Have a more rapid disease course, leading to earlier morbidity.

Place increased demands (vs. non-homeless older veterans) on a health

system, accessing primary, mental health, and substance abuse care

more frequently.

Culhane, D., Metraux, S., Byrne, T., Stino, M., & Bainbridge, J. The Age Structure of Contemporary Homelessness. 2013. Psychiatric Services 67:4, April2016: “Increased Mortality Among Older Veterans Admitted to VA Homelessness Programs” . Journals of Gerontology: Soc Sci,: J Gerontol B PsycholSci Soc Sci, 2016, Vol. 00, No. 00, 1–7.



Women

4 times as likely to be homeless as non-veteran women

Account for 10% of homeless veterans

Disproportionately more at risk for homelessness than male peers

Compared with men, homeless women veterans…

Bern and Fargo, 2016; Tsai, Rosenheck, and Kane, 2014; Tsai et al, 2014; Washington et al., 2010; Hamilton 2014

Are less likely to:

Be chronically homeless

Be unsheltered

Have a history of incarceration

Be disabled

Have a substance use disorder

Are more likely to:

Be younger and more frequently

Iraq and Afghanistan era

Have dependent children

Have higher rates of

unemployment

Have higher rates of military

sexual trauma



Racial and Ethnic Minority VeteransMinority veterans are 3 times more likely to become homeless than non-

veterans.

39% of all homeless veterans are African American, despite only accounting for 10.4% of the U.S. veteran population.

For women, there are increased odds of homelessness among women veterans who identify as black.

11% are Hispanic/Latino, despite only accounting for 3.4% of the U.S. veteran population.



Veterans with Bad PaperVeterans with bad paper discharges are at up to 7 times the risk of

homelessness as other veterans.

In San Diego, a 2014 survey found that 17.1% of unsheltered

veterans had bad paper discharges.

In Houston, a 2014 survey found that 2 out of every 3 unsheltered

veterans had bad-paper discharges.

VA eligibility standards exclude these veterans from health care,

disability compensation, and adequate homeless assistance.

A.V. Gundlapalli et al., 2015; Stephen Metraux et al., 2013; “Underserved: How the VA Wrongfully Excludes Veterans with Bad Paper”: https://www.swords-to-plowshares.org/sites/default/files/Underserved.pdf

https://www.swords-to-plowshares.org/sites/default/files/Underserved.pdf



Younger veterans

Veterans aged 18-30 more than twice as

likely to be homeless compared to same

aged non-veterans.

Iraq/Afghanistan-era veterans are at a

higher risk for homelessness than previous

generations of veterans.

NCHV, 2016; DOL, 2015


Health Outcomes

1. Older than their chronological age.

2. Rapid disease course and pre-

disposed for a variety of health

issues.

3. Health conditions are more

prevalent in homeless veterans

than they are in homeless non-

veterans, and these rates increase

as time spent in homelessness

increases.

4. Increased mortality and suicide risk

among older homeless veterans.

5. Mean age of death: 51

36.6%

41.9%

42.4%

52.5%

67.4%

Anxiety

Drug abuse/use

Alcohol abuse

Alcohol dependence

Depressive disorder

VHA, Homeless Registry contacts new assessments 2012


Resource Constraints

1. Institutional Circuit:

Higher rates of

hospitalizations, use of

psychiatric institutions,

detox facilities.

2. Cyclical patterns of

incarceration.

3. Dept. of Public Works

costs.Photo: San Francisco Chronicle

Part IINATIONAL AND COMMUNITY EFFORTS: WHERE ARE WE NOW?

May 19, 2016

Presented by:Baylee Crone, Executive Director,National Coalition for Homeless Veterans


The National Coalition for Homeless Veterans (NCHV)

NCHV’s MissionNCHV’s mission: NCHV is the leading national membership organization shaping policy andproviding knowledge, resources, and awareness to organizations serving homeless and at-risk vets.

NCHV’s VisionThrough advocacy and public education we enhance, sustain growth, and improve a system

of care so that no vet needs to experience homelessness.

NCHV’s HistoryNow in our 26th year, we were founded by a small group of community-based service

providers who were troubled by the disproportionately large percentage of homeless

people who were veterans, and the lack of veteran-specific programs to help them. We

opened our Washington, D.C., office in 1993 in order to work more closely with Congress

and Executive Branch agencies to ensure the inclusion of veterans in federal assistance

programs.


Who NCHV Serves

Community Partners Invested in Social

Services

Groups Serving Veterans

Groups Serving Homeless and

At-Risk Persons

Homeless Veteran Service Providers


An Early Commitment to Ending Veteran Homelessness

Early 1990s – Mid 2000s NCHV helped draft the Grant and Per

Diem (GPD) program as a way forcommunity providers to work withthe Department of Veteran Affairs(VA) to help veterans get off thestreets.

The first Stand Down grants aremade to offer a “hand up” out ofhomelessness.

The Department of Labor (DOL)starts the Homeless VeteransReintegration Program (HVRP) tohelp homeless veterans connect togainful employment.


The Beginning of the Five Year Plan…

“Until we reach a day when not a

single veteran sleeps on our

nation’s streets, our work remains

unfinished.”

President Barack Obama, March 2009


USICH and the Federal Strategic Plan

Driving Principles Homelessness is unacceptable.

No “homeless people.”

Invest in solutions.

Homelessness is solvable; we’ve learned a lot about whatworks.

Homelessness can be prevented.

Strength in collaboration.

Original Goals1. Finish the job of ending chronic homelessness in five years;

2. Prevent and end homelessness among Veterans in five years;

3. Prevent and end homelessness for families, youth, andchildren in ten years; and

4. Set a path to ending all types of homelessness.


The Commitment from the U.S. Department of Veterans Affairs

“We are making great progress in the rescue

mission, but we must work harder to succeed in the prevention phase of our

mission …

That is the only way we’ll truly end veteran homelessness.”

Gen. Eric Shinseki, Former U.S. Secretary of Veterans Affairs

May 30, 2012

NCHV Annual Conference


Buy-In from other Agencies, including DOL and HUD

“We are absolutelycommitted to SecretaryShinseki’s vision of endingveteran homelessness, andwe are prepared to providethe housing resources heneeds.”

June 2011NCHV Annual Conference

“As you all well know, the homelessness challenge — forveterans and others – doesn't exist in a vacuum. It can'tbe separated from employment, health care, educationand an array of other support services... To successfullytackle a problem this great, we need to work togetherand achieve synergy, imploding stovepipes and buildinga whole greater than the sum of our parts.”

May 2014NCHV Annual Conference


Buy-In Resourcing

Development of the Supportive Services for Veteran FamiliesProgram (SSVF).

Growth of HUD-VA Supportive Housing (HUD-VASH): HUD awardedfunding for approximately 10,000 HUD-VASH vouchers each year in2008-2010 and 2012-2015. In 2011 and 2016, allocations were lowerbut still significant.

Continuation of the Grant and Per Diem (GPD) program: VA fundedmore than 650 funded projects in FY 2014.

Continuation of the Homeless Veterans Reintegration Program(HVRP): Continued appropriation at slightly over $38 million.

Buy-In Translates to Resourcing:The Cornerstone Programs


After the Five Year Plan: The Continued Federal Commitment


Revisiting Opening Doors…

In 2015, new USICH Executive Director Matthew Doherty updatedthe Federal Strategic Plan to End and Prevent Homelessness withcritical information and needed changes.

Major goals: Prevent and end homelessness among Veterans in 2015.

Finish the job of ending chronic homelessness in 2017.

Prevent and end homelessness for families, youth, and childrenin 2020.

Set a path to ending all types of homelessness.


…Deepening and Expanding Reach…

SSVF Growth In 2015, VA had awarded $300 million in 319 individual SSVF grants

to organizations in all 50 states, the District of Columbia, Puerto Rico,and the Virgin Islands.

HUD-VASH Growth Through FY 2016, HUD has awarded more than 86,000 HUD-VASH

vouchers.

GPD Stability The maintenance level of funding for current GPD beds is $250

million. The program must be modernized in order to keep pace withthe department’s goal to end and prevent veteran homelessness.

HVRP Stability The HVRP program is currently authorized at $50 million through FY

2016, yet is underfunded by about $12 million.


…Creating Community…

Employment

Health Care

Treatment

Legal Services

Veteran Homelessness

Affordable HousingPrevention


…Creating Community…

Employment

Health Care

Treatment

Legal Services

Affordable HousingPrevention

EndingVeteran

Homelessness


Mayors Challenge

The Mayor’s Challenge started with the National League of Cities,and was later adopted by the First Lady’s Joining Forces Initiativeand HUD.

Five Core Strategies

Establish leadership and decision making.

Set clear numerical goals and timelines.

Create accountability.

Employ core, evidence-based strategies.

Have a common plan.

Principles

Housing First.

Services as needed.

Employment is critical.

No veteran is left behind.

The Commitment

To date, 880 leaders have committed to theMayor’s Challenge with HUD, including:

• 699 mayors,

• 9 governors, and

• 172 county and city officials.


Mayors Challenge

California MayorsMayor Harvey Hall - BakersfieldMayor Sam Storey - CapitolaMayor Matt Hall - CarlsbadMayor George N. Cretekos -ClearwaterMayor Lee Haydu - Del MarMayor Teresa Barth - EncinitasMayor Lisa Yarbrough-Gauthier -East Palo AltoMayor Bill Harrison - FremontMayor Ashley Swearengin - FresnoMayor Acquanetta Warren -FontanaMayor Paula Perotte - GoletaMayor Art Madrid - La MesaMayor Mary Sessom - Lemon GroveMayor John Marchand - LivermoreMayor Robert Garcia - Long Beach

Mayor Eric Garcetti - Los AngelesMayor Jean Quan -OaklandMayor Jim Wood -OceansideMayor Karen Holman -Palo AltoMayor Luis Molina -PattersonCity Manager Ken Irwin -PattersonMayor Richard D. O'Brien -RiverbankMayor Rusty Bailey -RiversideMayor Kevin Johnson -SacramentoMayor Kevin Faulconer -San Diego

Mayor Edwin M. Lee - San FranciscoMayor Chuck Reed - San JoseMayor Jan Marx - San Luis ObispoMayor Helene Schneider –Santa BarbaraDave Cortese - Santa Clara CountyMayor Cynthia Matthews –Santa CruzBoard of Supervisors Chairperson Zack Friend - Santa Cruz CountyMayor Jim Reed - Scotts ValleyMayor (Dr.) Nancy A. Bilicich -WatsonvilleMayor Lindsey Horvath –West HollywoodMayor Christopher Cabaldon –West SacramentoMayor John Buckland - Yuba


25 Cities Communities


Zero: 2016


Where Are We Now?

Zero: 2016


Many Communities have Reached Functional Zero Systems! Albany, NY Montgomery County, MD Connecticut New Orleans, LA Cumberland

County/Fayetteville, NC Philadelphia, PA Daytona Beach/Volusia

County, FL Reading/Berks County, PA Des Moines, IA Rochester, NY Flagler County, FL Rockford, IL Houston, TX

San Antonio, TX La Cruces, NM Saratoga Springs, NY Lancaster City and County, PA Schenectady, NY Las Vegas, NV Syracuse, NY Lynn, MA Troy, NY Mississippi Gulfport/Gulf Coast

Regional CoC Virginia Mobile, AL Winston-Salem, NC

Zero: 2016


Meeting the Federal definition of “functional zero” does NOT meanno veteran will experience homelessness! In fact, USIC describes it as:

Federal Definition of “Functional Zero”

“An end to homelessness does not mean that no one will ever experience a housing crisisagain. Changing economic realities, the unpredictability of life, and unsafe orunwelcoming family environments may create situations where individuals, families, oryouth could experience, re-experience, or be at risk of homelessness. An end tohomelessness means that every community will have a systematic response in place thatensures homelessness is prevented whenever possible or is otherwise a rare, brief, andnon-recurring experience.”

According to USICH, the goal is that every community will have thecapacity to: Quickly identify and engage people at risk of and experiencing homelessness.

Intervene to prevent the loss of housing and divert people from entering thehomelessness services system.

Provide immediate access to shelter and crisis services, without barriers to entry,while permanent stable housing and appropriate supports are being secured.

When homelessness does occur, quickly connect people to housing assistance andservices—tailored to their unique needs and strengths—to help them achieve andmaintain stable housing.

Part IIISTRATEGIES TO END VETERAN HOMELESSNESS

May 19, 2016

Presented by:Leon Winston, COO, Swords to Plowshares


Strategies to End Veteran Homelessness

Veteran homelessness will not end, but

instances can be less common, episodic, and

of a short duration.

Chronic veteran homelessness can be ended.

Keys to success are the right intervention at

the right time, all tied to the availability of

adequate targeted resources.


Moving to a Crisis Response Model

Strategies/Best Practices Adoption of Housing First Protocols

Homeless Veteran Registry and Coordinated Entry

Resources/Program Components Homelessness Prevention (SSVF)

Income Supports (VBA/SOAR)and Employment (HVRP) *

Rapid Re-Housing (SSVF)

Bridge and Stabilization Housing/Safe Havens (GPD, HCHV)

Services Intensive Transitional Housing (GPD)

Permanent Supportive Housing (HUD VASH and CoC)

Affordable Housing Availability

*Single greatest predictor of homelessness is poverty



Housing First No preconditions to being offered permanent housing.

Housing is considered a human right, not a reward.

Does not mean “Housing Only” but services are voluntary.

In some instances, stabilization or bridge housing may be needed as permanent housing

options are developed, documentation obtained, etc.

Veteran Registry By-name list that is updated regularly of every homeless veteran in your community.

Vulnerability Index or other triage/assessment tool.

Prioritization for resources such as HUD VASH, based upon need.

Coordinated Entry Homeless and at-risk veterans should not have to find their way onto multiple waiting lists.

Veterans are referred directly to the most appropriate intervention.

Requires a coordinated effort across local government, non profit and federal partners.

Sharing of information, via appropriate authorization for the Release of Information (ROI).


AT RISK

VETERAN/

FAMILY

HOMELESS

VETERAN/

FAMILY

Outreach/Intake

Triage and Assessment

Case Manager and Navigator

Assignment

Referrals (warm hand off)

VETERAN REGISTRY

COORDINATED ENTRY

Homelessness Prevention

Employment & Training

Benefits Acquisition

Rapid (Re)housing

Permanent Supportive HousingEmergency/Stabilization/

Transitional Housing

Affordable Permanent Housing

External Ancillary Services

CBOC/VAMC

Credit Counseling

Child Care

Legal Aide

Community Outpatient Tx

etc

Internal Ancillary Services

Eviction Prevention

Housing Acquisition

Representative Payee

Temporary financial assistance

Leon Winston February 2011

A Crisis Response System




Rapid-Rehousing

Streamline response to end homelessness for veterans and families

quickly.

No near-term return to street/shelter.

No housing readiness restrictions.

Preventative Services for Veterans and Families

Focus on identifying and resolving barriers to maintaining housing.

Greatest predictor of homelessness is poverty. Access to entitlements

and employment services is critical.

Integrated crisis response triage and referral to other needed

supports.



Adapting the Transitional Housing Model

VA Grant Per Diem (GPD) is permanently authorized by congress,

and is here to stay.

Changes are occurring, including use of GPD beds for ‘bridge

housing’, meaning shorter stays as a bridge to permanent housing

outcomes.

Utilization of very low barrier and shorter term Safe Haven and

Stabilization programs.

Services Intensive GPD Transitional Housing offered as an option to

homeless veterans, not a requirement before being assisted with

finding permanent housing.

Many Transitional Housing Programs will undoubtedly see ‘right-

sizing’ occurring. The VA does look at bed-utilization and is

reviewing ways to ‘re-boot’ the program.



Single-site Permanent Supportive HousingHousing projects where significant numbers of high need, chronically

homeless veterans can be offered permanent housing.

Population:

Typical veteran tenant at Swords is poly-

diagnosed, ages 45-70, with serious age-

related illnesses appearing 10-15 years

earlier.

Often not adequately served by HUD

VASH, as they cannot compete in regular

rental markets or have difficulty

remaining housed over time

Some veterans with certain Mental

Health issues may find this setting to be

too stimulating and other options will be

needed.

Benefits:

Tenants have access to flexible array of

comprehensive services on-site.

Offers ability to age in place

Economies of scale

Resource Needs:

Sufficient numbers of dedicated units.

On-site 24 hour support of multi-disciplinary

teams.

Dedicated sources for services funding.

Leon Winston: Remarks to the CA Senate Joint Oversight Committee re VHHP 5 Jan 2016: http://svet.senate.ca.gov/sites/svet.senate.ca.gov/files/leon_winston_chief_operating_officer_swords_to_plowshares_testimony.pdf



More Thoughtful Use of Resources

Surge of federal resources in the beginning of the five year plan.

Some localized conditions weren’t taken into consideration

when these resources were deployed.

Federal resources should be flexible enough to meet local

conditions and leverage local strategic planning.

Crisis Response Model

The right intervention at the right time. Rather than manage

homelessness, we need to ensure targeted interventions and

resources continue to flow and be coordinated.

Requires a sustained commitment.


Acronyms

GPD: VA Grant & Per Diem Program (Transitional Housing)

HCHV: VA Healthcare for Homeless Veterans (Residential)

SSVF: VA Support Services for Veteran Families (Rapid Re Housing and Homelessness Prevention)

VAMC: Veteran Affairs Medical Center

CBOC: VA Community Based Outpatient Clinic

HUD VASH: HUD VA Supportive Housing

HVRP: DOL Homeless Veteran Reintegration Program (Employment)

VBA: Veterans Benefits Administration (Disability and Pensions)

SOAR: SSI/SSDI Outreach, Access & Recovery (expedited access)


Ending Veteran Homelessness: Where are we now?

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Thank You for Attending

Copyright © 2016 by Swords to PlowsharesAll rights reserved, including the right of reproduction in whole or in part in any form.

Swords to Plowshares

Institute for Veteran Policy

1060 Howard StreetSan Francisco, CA 94103

Leon [email protected]

Megan ZottarelliSenior [email protected]

ending veteran homelessness: where are we now?

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