1. 1 Department of Veterans AffairsHomeless Veterans Program Overview July 14, 2011

2. Veteran Homelessness It was reported in the CHALENG 2009 Annual Report there were 107,000 homeless Veterans on any given night (count from 2008). The 2010 Veteran Homelessness: Supplemental Report to the 2009 Annual Homeless Assessment Report (AHAR) to Congress estimates that on any given night 75,609 Veterans were homeless (count from 2009). VA is the nation’s largest single provider of homeless treatment and benefits assistance services to homeless Veterans. In Fiscal Year (FY) 2010 approximately 121,277 Veterans were served in VHA’s Specialized Homeless Programs. FEB 2011: 85,757 Veterans Served in Specialized Homeless Programs This is not just a VA issue. Many Federal, State, Local, and Tribal governments/agencies along with community based non profits and faith-based organizations will have a role to play. All VISNs are required to synchronize their plans with others. In April 2010, VISN and medical center leadership were provided guidance from the Deputy Under Secretary for Health for Operations and Management for the development and implementation of local plans to end and to prevent Veteran homelessness. *CHALENG 2009 Annual Report 2

3. 3 Defining Homelessness A Homeless Veteran*: Lacks a fixed, regular, and adequate nighttime residence; Or resides in a public or privately operated shelter or institution; Or resides in a place not designed for use as a regular sleeping accommodation for human beings. A Chronically Homeless Veteran: Has been continuously homeless for 1 year or more or has had at least 4 episodes of homelessness in the past 3 years. The Average Homeless Veteran: served in the post-Vietnam era (1975-1990) is 51, male, single, and almost equally likely to be African-American or Caucasian is unemployed and has an income of less than $125 per week At the time of contact with the VA, the average homeless Veteran is living either outdoors or in a shelter and suffers from medical and mental health/substance use disorders. Minority Veterans are overrepresented (53% of total) in the homeless population. Female Veterans are the fastest growing segment of the homeless population. * Currently defined by Department of Housing and Urban Development (HUD)

4. Source: NEPEC HCHV Form X and DCHV Form Z, 10/1/09-8/31/10 Includes Healthcare for Homeless Veterans (HCHV) Outreach and Domiciliary Care for Homeless Veterans (DCHV) Admissions 4 Selected Demographic Characteristics of VA Homeless Program Clients (FY10)

5. Plan to End Homelessness Among Veterans 5

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7. Outreach/Education Message and Accomplishments Outreach is an essential component of our plan to end homelessness among our Veterans. Outreach workers engage people in the community who are living on the streets and assist them to acquire appropriate services and housing. Veterans Health Administration (VHA) provides homeless outreach at all 153 Medical Centers. In February 2010, funding was deployed to the field for an additional 33 HCHV Outreach Workers to supplement the efforts of the current 340 HCHV Outreach Workers. VA will continue efforts to identify and contact homeless Veterans, improve access to services, create new connections both within and outside VA medical centers, and educate health care providers and Veterans regarding VA homeless services and benefits. 7

8. Health Care for Homeless Veterans (HCHV) 42,275 intake assessments with 88,244 Veterans treated by HCHV staff (12% increase from FY 09) Introduced the Low Demand/Safe Haven demonstration model 217 Stand Downs (12.5% from FY 09) 174 community-based programs under 1,583 operational beds; including 927 residential treatment beds; 636 beds for Emergency Housing, and 20 beds in the Safe Haven pilot program. The central goal of HCHV programs are to reduce homelessness among Veterans by conducting outreach to those who are the most vulnerable and are not currently receiving services and engaging them in treatment and rehabilitative programs. The Contract Residential Treatment Program ensures that Veterans with serious mental health diagnoses can be placed in community-based programs which provide quality housing and services. 8

9. National Call Center for Homeless Veterans (NCCHV) The NCCHV was created to ensure that homeless Veterans or Veterans at-risk for homelessness have free, 24/7 access to trained responders. The call center is intended to assist homeless Veterans and their families, VA Medical Centers, federal, state and local partners, community agencies, service providers and others in the community. The phone number is 1-877-4AID VET (1-877-424-3838). Since it began in March, 2010: Approximately 34,776 total calls 28,821 have identified themselves as Veterans 16,674 Veterans identified as “at risk of homelessness” and seeking help 8,904 identified themselves as homeless 18,146 were transferred to a VA Facility Homeless Program point of contact for assistance and linkages Contact: Holly.Hirsel@va.gov for more information 9

10. Homeless Prevention Message and Accomplishments The most economically efficient way to end homelessness is to prevent its occurrence. Unlike VA’s traditional homeless programs which focused on the treatment and rehabilitation of the individual Veteran, prevention of homelessness addresses those Veterans and their families who are at immediate risk for becoming homeless or have recently become homeless. Risk of homelessness is highest among the poor: 1 in 10 poor adults and children experience homelessness each year (Burt, 2005). GAO reports that in 2005, over 1.3 million Veteran households earned less than 50% of the area median income. In FY 2010 22,077 “new” homeless Veterans (had not sought homeless services in the previous 2 years) were treated in a VA specialized homeless program. In 2007, VA began providing outreach services for Veterans reentering their communities from incarceration. In 2009, VA began outreach to justice-involved Veterans in jails and courts to prevent them falling into homelessness. Supportive Services for Veterans and Families (SSVF) program 10

11. Health Care for Reentry Veterans Services and Resources (HCRV) The HCRV program is designed to address the community re-entry needs of incarcerated Veterans. The HCRV's goals are to prevent homelessness, reduce the impact of medical, psychiatric, and substance abuse problems upon community re-adjustment, and decrease the likelihood of re-incarceration for those leaving prison. 44 full- time re-entry specialists seeing Veterans in 955 of 1,319 prisons across the country From Aug. 2007-Oct. 2010 approximately 24,925 Re-Entry Veterans have been seen, with 9,326 seen in FY10 alone 11

12. Veteran Justice Outreach Initiative (VJO) The purpose of the Veteran Justice Outreach Initiative (VJO) initiative is to avoid the unnecessary criminalization of mental illness and extended incarceration among Veterans by ensuring that eligible justice-involved Veterans have timely access to VHA mental health and substance abuse services when clinically indicated, and other VA services and benefits as appropriate. Justice Outreach (law enforcement, jails, courts) 6,451 Veterans seen in VJO FY 10: 46 full-time specialists funded FY11: Additional 79 full-time specialist funded There are approximately 50 operational Veteran Courts (more than double the number for FY 2010) that VA VJO Staff participate with 12

13. Supportive Services Grants for Low Income Veterans and Families (SSVF) This program was authorized by Public Law 110-387 and will provide supportive services to very low-income Veteran families in or transitioning to permanent housing. Funds will be granted to private non-profit organizations and consumer cooperatives who will assist very low-income Veteran families by providing a range of supportive services designed to promote housing stability. Final Rule published and out for public comment December 2010 Grants to be awarded Summer 2011 13

14. Treatment Message and Accomplishments Homeless Veterans suffer from high rates of mental and physical health problems often exacerbated by their living conditions. Our strategy includes both existing and emerging forms of treatment of homelessness and its related clinical issues (e.g., substance use disorders, serious mental illness, vocational obstacles). As of September 30, 2010 VA has provided residential treatment to more than 32,000 homeless Veterans. Domiciliary Care for Homeless Veterans (DCHV) program has served approximately 8,380 Veterans. 75% of Veterans receiving Outpatient Mental Health Treatment have experienced an episode or more of homelessness. In Q3 FY 2010, VA deployed HCHV contract funding for the provision of Low Demand/Safe Haven programs as a demonstration project. The Safe Haven’s model provides a transitional residence for hard to reach homeless persons with mental illness and substance use problems. The low-demand, non-intrusive environment is designed to re-establish trust and eventually re-engage the homeless person in needed treatment services and transitional and permanent housing options. Selected sites: metro-Boston, Bronx, Philadelphia, and Bay Pines. By end of Q1, FY 2011, it is anticipated that 105 beds will be operational at these locations. 14

15. Domiciliary Care for Homeless Veterans (DCHV) Program that provides time-limited residential treatment to homeless Veterans with health care and social-vocational deficits. DCHV programs provide homeless Veterans access to medical, psychiatric, and substance use disorder treatment in addition to social and vocational rehabilitation programs. 2,400 beds for homeless Veterans Provided residential rehabilitation treatment to over 6,000 homeless Veterans with almost 40 percent of those returning back to work In FY 11 $33M to develop 5 new sites 5 Sites (Denver, Philadelphia, Atlanta, San Diego, Miami) VA provided time-limited residential rehabilitation and treatment for homeless Veterans 15

16. Homeless Veterans Dental Program The mission of the Homeless Veteran Dental Program is to increase the accessibility of quality dental care to homeless Veteran patients and to help assure success in VA-sponsored and VA partnership homeless rehabilitation programs throughout the United States. 107 facilities are currently participating in the Initiative that provides focused dental care to homeless Veterans enrolled in transitional housing or residential treatment programs, specifically Veterans in the programs listed in Directive 2009-039: ELIGIBILITY GUIDELINES FOR A ONE-TIME COURSE OF DENTAL CARE FOR CERTAIN HOMELESS AND OTHER ENROLLED VETERANS. 16

17. 17 Income and Benefits Message and Accomplishments Many homeless people are unable to work due to a disability, or are unable to quickly earn enough to afford rent. The sooner a minimal income is obtained, the sooner a new home is possible. This strategy includes a multi-pronged effort aimed at improving financial opportunities for Veterans, including, at minimum, vocational training and enhanced access to benefits. Veterans Benefits Administration (VBA) provides services for homeless Veterans at all 56 regional offices. The number of homeless Veterans claims’ received during FY 2009 (6,285) increased by 9.06% from FY 2008 (5,715). Assistance is also provided to Veteran homeowners who may be in foreclosure. VA continues to partner with the Social Security Administration (SSA) to expedite claims for Social Security Disability and with state and local governments for other types of economic assistance to Veterans

18. Employment Message and Accomplishments VA’s Work programs provide paid work experience and vocational assistance services to approximately 50,000 Veterans each year, including 6,000 OEF/OIF Veterans. These services are integrated into the Veteran’s overall mental health treatment plan. Veterans in VA’s work programs earned in excess of $50 million during their participation. VA partners with Department of Labor (DoL) and local, state, and community agencies to identify vocational training, educational opportunities. In FY 2011, approximately 400 Vocational specialists will be hired to assist homeless Veterans in obtaining vocational training, education, and employment. In FY 2011, Veterans Justice Outreach (VJO) and Health Care for Re-Entry Veterans (HCRV) Specialists will work with DoL’s newly funded Incarcerated Veterans Transition Program (IVTP) grantees to connect justice-involved Veterans with vocational skills training and employment resources. 18

19. Housing and Supportive Services Message and Accomplishments Supportive Services help Veterans and families stabilize following a successful housing placement and provide the supports necessary to ensure that they are able to sustain their housing and access other community-based services. For Veterans that have been chronically homeless, such supports need to be ongoing, readily accessible, and attached to housing. VA is moving from a transitional housing service model to a permanent housing services model. This strategy includes: the expansion of vouchers and beds, efforts to create new housing resources in the community, efforts to connect with community agencies to provide supportive services. VA provides transitional and permanent housing solutions for Veterans through the HUD-VASH program, Grant and Per Diem Program and Health Care for Homeless Veterans Contract Residential Care program. Local VA Medical Centers are encouraged to partner with community agencies that implement the “Housing First” model. The goal of "housing first" is to immediately house people who are homeless. Housing comes first no matter what is going on in one's life, and the housing is flexible and independent so that people get housed easily and stay housed. 19

20. Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) Program A collaborative program between HUD and VA where eligible homeless Veterans receive VA provided case management and supportive services to support stability and recovery from physical and mental health, substance use, and functional concerns contributing to or resulting from of homelessness. The program goals include promoting maximal Veteran recovery and independence to sustain permanent housing in the community for the Veteran and the Veteran’s family. Approximately 30,000 Housing Choice Vouchers currently in use All VISNs met the FY10 Performance Measure target of 73% of FY08/FY09 vouchers under lease (Veterans housed) More than 5,800 family members were housed through this program last year 20

21. Homeless Providers Grant and Per Diem Program (GPD) Allows VA to award grants to community-based agencies to create transitional housing programs and offer per diem payments. The purpose is to promote the development and provision of supportive housing and/or supportive services with the goal of helping homeless Veterans achieve residential stability, increase their skill levels and/or income, and obtain greater self-determination. GPD-funded projects offer communities a way to help homeless Veterans with housing and services while assisting VA medical Centers by augmenting or supplementing care. GPD offered both Capital and “Per Diem Only” grant awards $41 million awarded to community-based agencies $26 million in Capital funds $15 million in “Per Diem Only” awards Approximately 12,000 beds Operationalized 971 additional transitional housing beds in FY10 21

22. 22 Community Partnerships Message and Accomplishments There has been a great deal of emphasis placed on building partnerships. This is especially true when serving homeless Veterans. This strategy is a cornerstone of the entire Plan to End Homelessness Among Veterans, and includes substantial new efforts to create partnerships with community and local governmental agencies to enhance opportunities and services for homeless Veterans. VA has strengthened their partnerships with community service providers: Nationwide, there are now nearly 4,000 interagency collaboration agreements in place. These agreements have aided the VA in extending outreach services to 2,418 sites such as shelters, soup kitchens, safe havens, welfare offices or other locations where homeless persons may be located and have spurred the development of additional housing resources. This has led to improved coordination of services and the development of innovative strategies to address the needs of homeless Veterans. GPD partners with over 500 agencies to provide transitional housing services. VA continues to foster interagency collaboration with: United States Interagency Council on Homelessness (USICH), HUD, DoL, Education, Health & Human Services (HHS), Department of Justice (DoJ), and others.

24. Second phase launched November: Online tracking tool (HOMES) capable of both patient data entry and data analysis, is expected to be available in November 2010

25. Third phase will allow for data capture from other federal partners such as HUD, community partners and others23

26. Contact Information Nancy Campbell, MSW, LISWDirector HUD-VASH Programs Nancy.Campbell2@va.gov Teresa Pittman, LCSW HUD-VASH Program Analyst Teresa.Pittman@va.gov Robert Hallett, National Coordinator, Health Care for Homeless Veterans Robert.Hallett@va.gov Virginia Raney, LCSW Clinical Program Manager, VA Homeless Programs Virginia.Raney@va.gov VA Homeless Website http://www1.va.gov/homeless/ USICH Website http://www.usich.gov/ 13July2011 24