Supportive Services for Veteran Families (SSVF)

A Housing First Approach to Preventing and Ending Homelessness

Among Veterans

Tom Albanese, Abt Associates

Marge Wherley, Abt Associates

Patti Holland, TAC

Key Components of SSVF

• Outreach Services • Case Management Services • Assistance in Obtaining VA Benefits • Assistance in Obtaining and Coordinating Other Public

Benefits• Other Supportive Services• Temporary Financial Assistance

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Homelessness

Prevention

(Category 1)

Rapid

Re-Housing

(Categories 2 & 3)

Homeless(street, shelter)

HEARTH Act & SSVF Programs: Relevance to CoC Performance

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Homelessness Prevention

• Prevent first time and repeat (literal) homelessness• Prevent recurrence of housing crisis

Rapid Re-Housing

• End homelessness• Reduce time spent homeless• Increase job and income growth• Prevent recurrence of homelessness

VA Policy

Support a “Housing First” model in addressing and ending homelessness.

Housing First approaches emphasize rapid stabilization in permanent housing as central focus

of intervention.

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Housing First Principles:A source of inspiration…and challenge

• Homelessness is a housing problem• Housing is a right – not a reward• Consumer choice • Everyone is ‘housing ready’ – programs must

be ‘consumer ready’• End housing crisis and stabilize in permanent

housing first…THEN address other needed and desired services directly or through linkage

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Housing First: Critical Elements

• Goal: permanent housing as quickly as possible• Housing

– Consumer choice– Permanent (i.e., not time limited, consumer holds lease)– Not contingent on service participation and compliance

• Services – Consumer choice– Provided primarily following housing placement– Flexible and responsive to needs and preferences– May be time limited or long term (or some combination)

• Success = staying housed and not becoming or returning to literal homelessness

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Housing First (and SSVF) Challenge

Provide the right resources to the right people at the right point in time

for the right amount of time.

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Challenging Assumptions:“Housing Readiness”

Assumption: People need to be “ready” before moving into permanent housing.• Adequate and sustained income source • Comprehensive psycho-social assessment completed with

all key issues identified and plan to address each • Disability, mental health and substance use issues are

acknowledged, addressed and under control• Demonstrated competence in all skills necessary for

permanent housing

Stems from good intention of not wanting people to fail – but research does not support

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Challenging Assumptions:“Housing Readiness”

Challenging the Assumption:• Overwhelming evidence shows positive outcomes

for households with range of barriers with HF approach, such as:– Obtaining and maintaining housing– Reduced or stabilized substance use that did not

negatively impact housing– Increased service participation– Increase in perceived choice

• Even so…many providers still reluctant to consider housing first as viable approach for “their client”

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Challenging Assumptions:“Housing Readiness”

• “Housing Ready” often means clean, sober and treatment compliant– One main reason individuals remain chronically

homeless is reluctance of traditional programs to provide housing to consumers who refuse treatment and/or are actively using (Bridges and Barriers to Housing for

Chronically Homeless Street Dwellers, T. Mechede 2004)– There is little evidence that treating substance abuse

and mental health problems prevents homelessness (Preventing and Alleviating Homelessness – Prevention Approaches, MaryBeth Shinn)

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Challenging Assumptions:“Housing Readiness”

• Service providers and homeless individuals and families often disagree on needs.– Service providers often express concern with service

needs, individuals and families stress need for housing (Bridges and Barriers to Housing for Chronically Homeless Street Dwellers, T. Mechede 2004)

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Challenging Assumptions:“Housing Readiness”

• In Vivo Learning:– Developing and applying new skills is often situation-

specific– Using a skill in one setting does not guarantee person

will use it, or know how to use it, in a different setting– Delivering SSVF services to participants in their living

environment and community is essential for successful housing retention

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Challenging Assumptions:“Housing Stability”

Assumption:

“Housing stability” can only be achieved by households who have the means to readily pay for their housing costs now and in future.

Challenging the Assumption:– Majority of very low income households pay more than 50%

of their income for housing and do not become literally homeless

– Majority who become literally homeless regain housing with limited help and do not become literally homeless again

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Challenging Assumptions:“Housing Stability”

• Determining future ability to pay housing costs and establishing “housing stabilization” plans:– SSVF assisted households typically pay more than

30% of income towards rent, remain low/very low income, and may need to ‘double up’ in future

– Lack of identified current/future means to pay housing costs = program challenge; not reason to ‘screen out’ applicants

– Must work with each SSVF household to develop plan right for them – no magic formula

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Voluntary Services

• SSVF services meet a specific goal or need– goal the Veteran wants to address, not necessarily what staff feel s/he needs

• Referrals made are mutually agreed upon and stem from Veteran’s choices

• Information, education and informed choice– SSVF staff provide information on services and

resources that are available, educate on possible benefits and ‘downside’ of services, assist the Veteran in making an informed choice

• Foster real world expectations and consequences15

Voluntary Services

• This does not mean….– SSVF staff cannot offer suggestions, ask Veteran to

do something or initiate uninvited contact– Staff do not intervene, even when very real and

serious health or safety risks exist– Participants will never take action to change their

circumstances if not ‘encouraged’– Participants will always ‘take the money and run”– Staff have to tolerate abusive treatment from

participants and can never discharge from the program for disruptive or dangerous behavior

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Housing First in Practice:From Crisis Response to Housing Stability

Crisis focus = Housing– No housing (literally homeless) OR – Imminent risk of literal homelessness (imminent loss of

housing and no other housing options, resources, support)

Two Step Process:

Step 1: Crisis intervention and resolution

Step 2: Housing stabilization17

Housing First in Practice:Step 1: Crisis Response

Goal: Identify and address immediate housing need

– Crisis Assessment– Triage and immediate housing plan

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Housing First in Practice: Step 1: Crisis Response

Crisis Assessment:• Focus: Persons experiencing a housing crisis

– Immediate needs may or may not be met• What are we trying to figure out?

– Immediate & short-term housing needs and SSVF intervention to assure needs are met

– Basic characteristics necessary to know who’s being assisted and immediate needs

– Any safe, immediate options besides emergency shelter?

– Plan for tonight and near term

Housing First in Practice:Step 1: Crisis Response

• Assessment tool, process– Tool should be staff and participant friendly– Standardized, but also serves as conversation guide– Focuses on housing issues, is not a comprehensive

assessment of needs

• Staff training and supervision– Specific content, training during orientation period– Observation as training component– On-going review and supervision

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Housing First in Practice: Step 1: Crisis Response

• Let’s use an analogy – someone shows up at an E.R. in crisis due to diabetes– No time for in-depth assessment of patient’s overall needs or compliance

with diabetes care– RN does a few quick diagnostic lab tests to confirm diabetes with blood

sugar out of control– ER team immediately begins to stabilize the patient’s condition– Once crisis is resolved and patient is temporarily stabilized, further

assessment may be done– Based on this additional assessment, hospital team sends patient home

with discharge orders, including referrals if needed – There may be some follow up calls or a visiting RN to check on if patient

is feeling ok, no current symptoms, understands discharge plan– But, in the end – the ER has no actual control over the patient’s future

diabetes care or whether there will be future hospital visits

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Housing First in Practice: Step 2: Housing Stabilization

Goal: Identify and implement plan to maintain current housing or obtain new housing

– Housing stability assessment– Housing stability plan (‘reasonable’)– Progressive engagement with flexible SSVF

services– Service linkage

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Housing First in Practice:Step 2: Housing Stabilization

Housing Stability Assessment: • Focus: Persons experiencing a housing crisis whose

immediate housing needs are met• What are we trying to figure out?

– Prevention: whether can be stabilized in current housing or needs relocation assistance

– Additional characteristics and relevant background (housing, health, AOD, education, etc.)

– Barriers impacting ability to obtain/maintain housing• Tenant screening barriers (if need to obtain

housing)• Retention barriers

– Least amount of intervention needed to resolve and, if possible, prevent return to crisis

Housing First in Practice:Step 2: Housing Stabilization

Housing Stability Plan:• Progressive plan to increase stability and

prevent future housing crisis– Flexible, progressive SSVF services and temporary

financial assistance– Linkages and referrals to address other identified

immediate and long-term needs

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Housing First:Tips

• Engage, collaborate with larger community services and Continuum of Care system

• Train staff on other CoC/community resources and programs to ensure best “fit” for participant

• Be clear about what SSVF can do & what it cannot do – with staff and participants

• Maximize SSVF: design flexible program services that can vary in type/level/duration based on need

• Periodically revisit program design • Incorporate eligibility recertification (required every

3 months) and other milestones in case plan

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Housing First:Tips

• Use best practices: harm reduction, motivational interviewing, skills teaching, resource development

• If unsure and/or if there are not other resources to refer applicants with greater needs: better to err on side of ‘screening in’ vs. ‘screening out’

• Develop and cultivate landlord relationships & housing options

• Train staff on other community-based and mainstream resources to ensure needs are met post-SSVF

• Use assessment to identify system gaps• Staff training and supervision

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Time for a Break!

We will resume the presentation

in precisely 15 minutes.

If you haven’t already downloaded the SSVF Eligibility Screening Disposition Form, please do

so before the next presentation.

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