Ending Veteran Homelessness: Where are we now?

EndingVeteran
Homelessness:
WHERE AREWE NOW?May 19, 2016
Presented by:
Baylee Crone, National Coalition for HomelessVeterans
Leon Winston, Swords to Plowshares
Megan 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 and
health 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

HomelessVeterans 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 homeless
populations, and a higher rate of past family cohesion (including a
higher likelihood to be or have been married), some studies show
these are not protective factors against homelessness.
 Some studies cite veterans with stronger and more stable families
are more likely to be negatively affected by the trauma of
deployment.
 Women veterans: married women veterans less likely to experience
homelessness.
 Access to a VA service-connected disability payments found to be a
protective 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 Homelessness
Unaccompanied 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 Homelessness
Unstably 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 HomelessVeterans
 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, April
2016: “Increased Mortality Among Older Veterans Admitted to VA Homelessness Programs” . Journals of Gerontology: Soc Sci,: J Gerontol B Psychol
Sci 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 MinorityVeterans
Minority 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 Paper
Veterans 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

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 II
NATIONAL AND COMMUNITY
EFFORTS: WHERE AREWE NOW?
May 19, 2016
Presented by:
Baylee Crone, Executive Director,
National Coalition for Homeless
Veterans

The National Coalition for Homeless
Veterans (NCHV)
NCHV’s Mission
NCHV’s mission: NCHV is the leading national membership organization shaping policy and
providing knowledge, resources, and awareness to organizations serving homeless and at-
risk vets.
NCHV’sVision
Through advocacy and public education we enhance, sustain growth, and improve a system
of care so that no vet needs to experience homelessness.
NCHV’s History
Now 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
HomelessVeteran
Service Providers

An Early Commitment to EndingVeteran
Homelessness
Early 1990s – Mid 2000s
 NCHV helped draft the Grant and Per
Diem (GPD) program as a way for
community providers to work with
the Department of Veteran Affairs
(VA) to help veterans get off the
streets.
 The first Stand Down grants are
made to offer a “hand up” out of
homelessness.
 The Department of Labor (DOL)
starts the Homeless Veterans
Reintegration Program (HVRP) to
help homeless veterans connect to
gainful employment.

The Beginning of the FiveYear 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 what
works.
 Homelessness can be prevented.
 Strength in collaboration.
Original Goals
1. 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, and
children in ten years; and
4. Set a path to ending all types of homelessness.

The Commitment from the U.S. Department
ofVeterans 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 absolutely
committed to Secretary
Shinseki’s vision of ending
veteran homelessness, and
we are prepared to provide
the housing resources he
needs.”
June 2011
“As you all well know, the homelessness challenge — for
veterans and others – doesn't exist in a vacuum. It can't
be separated from employment, health care, education
and an array of other support services... To successfully
tackle a problem this great, we need to work together
and achieve synergy, imploding stovepipes and building
a whole greater than the sum of our parts.”
May 2014

Buy-In  Resourcing
 Development of the Supportive Services for Veteran Families
Program (SSVF).
 Growth of HUD-VA Supportive Housing (HUD-VASH): HUD awarded
funding for approximately 10,000 HUD-VASH vouchers each year in
2008-2010 and 2012-2015. In 2011 and 2016, allocations were lower
but still significant.
 Continuation of the Grant and Per Diem (GPD) program: VA funded
more than 650 funded projects in FY 2014.
 Continuation of the Homeless Veterans Reintegration Program
(HVRP): Continued appropriation at slightly over $38 million.
Buy-InTranslates to Resourcing:
The Cornerstone Programs

After the FiveYear Plan:The Continued
Federal Commitment

Revisiting Opening Doors…
In 2015, new USICH Executive Director Matthew Doherty updated
the Federal Strategic Plan to End and Prevent Homelessness with
critical 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 children
in 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 with
the 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
Ending
Veteran
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 Initiative
and 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 the
Mayor’s Challenge with HUD, including:
• 699 mayors,
• 9 governors, and
• 172 county and city officials.

Mayors Challenge
California Mayors
Mayor Harvey Hall - Bakersfield
Mayor Sam Storey - Capitola
Mayor Matt Hall - Carlsbad
Mayor George N. Cretekos -
Clearwater
Mayor Lee Haydu - Del Mar
Mayor Teresa Barth - Encinitas
Mayor Lisa Yarbrough-Gauthier -
East Palo Alto
Mayor Bill Harrison - Fremont
Mayor Ashley Swearengin - Fresno
Mayor Acquanetta Warren -
Fontana
Mayor Paula Perotte - Goleta
Mayor Art Madrid - La Mesa
Mayor Mary Sessom - Lemon
Grove
Mayor John Marchand - Livermore
Mayor Robert Garcia - Long Beach
Mayor Eric Garcetti - Los
Angeles
Mayor Jean Quan -
Oakland
Mayor Jim Wood -
Oceanside
Mayor Karen Holman -
Palo Alto
Mayor Luis Molina -
Patterson
City Manager Ken Irwin -
Patterson
Mayor Richard D. O'Brien -
Riverbank
Mayor Rusty Bailey -
Riverside
Mayor Kevin Johnson -
Sacramento
Mayor Kevin Faulconer -
San Diego
Mayor Edwin M. Lee - San Francisco
Mayor Chuck Reed - San Jose
Mayor Jan Marx - San Luis Obispo
Mayor Helene Schneider –
Santa Barbara
Dave Cortese - Santa Clara County
Mayor Cynthia Matthews –
Santa Cruz
Board of Supervisors Chairperson
Zack Friend - Santa Cruz County
Mayor Jim Reed - Scotts Valley
Mayor (Dr.) Nancy A. Bilicich -
Watsonville
Mayor Lindsey Horvath –
West Hollywood
Mayor Christopher Cabaldon –
West Sacramento
Mayor 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 mean
no 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 crisis
again. Changing economic realities, the unpredictability of life, and unsafe or
unwelcoming family environments may create situations where individuals, families, or
youth could experience, re-experience, or be at risk of homelessness. An end to
homelessness means that every community will have a systematic response in place that
ensures homelessness is prevented whenever possible or is otherwise a rare, brief, and
non-recurring experience.”
According to USICH, the goal is that every community will have the
capacity to:
 Quickly identify and engage people at risk of and experiencing homelessness.
 Intervene to prevent the loss of housing and divert people from entering the
homelessness 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 and
services—tailored to their unique needs and strengths—to help them achieve and
maintain stable housing.

Part III
STRATEGIESTO END
VETERAN HOMELESSNESS
May 19, 2016
Presented by:
Leon Winston, COO,
Swords to Plowshares

Strategies to EndVeteran 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 Housing
Emergency/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 forVeterans 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 theTransitional 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 Housing
Housing 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

MoreThoughtful 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
HUDVASH: 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)

EndingVeteran Homelessness: Where are we now?
Questions?
Please type your questions in the question box on the right of your
webinar’s display.

ThankYou for Attending
Copyright © 2016 by Swords to Plowshares
All rights reserved, including the right of
reproduction in whole or in part in any form.
Swords to Plowshares
Institute forVeteran Policy
1060 Howard Street
San Francisco, CA 94103
Leon Winston
COO
ldw@stp-sf.org
Megan Zottarelli
Senior Analyst
mzottarelli@stp-sf.org

Ending Veteran Homelessness: Where are we now?

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Ending Veteran Homelessness: Where are we now?

Similar to Ending Veteran Homelessness: Where are we now? (14)

More from Swords to Plowshares

More from Swords to Plowshares (20)

Recently uploaded

Recently uploaded (20)

Ending Veteran Homelessness: Where are we now?