Health Care for Homeless Veterans Programs (HCHV) Eileen Devine, LCSW National Director, Health Care for Homeless Veterans June 1, 2017

History Lesson on HCHV and VA Homeless Programs Core Mission: Outreach to Homeless Veterans 1987 Homeless Chronically Mentally Ill (HCMI) Program, a 6-month pilot project established by Public Law (Pub. L.) 100-6, introduced. 1992 VHA Grant & Per Diem Program introduced. 1994 HCMI renamed HCHV. 2008 Congress funds 10,000 HUD-VASH vouchers. 2015 Public Law H.R. 1627 was enacted which modified HCHV authority to allow expanded services to Veterans who do not have a SMI diagnosis.

Components of the HCHV Program HCHV Outreach and Homeless Case Management (HCM) HCHV Permanent Supportive Housing Case Management (PSH) Contracted Residential Services (CRS) Low Demand Safe Havens (LDSH) Community Resource and Referral Centers (CRRC) Stand Downs Lead for VA’s participation in coordinated entry at the VACO level

HCHV Case Management The HCHV Case Management Model consists of two different types of case management: Homeless Case Management (HCM) is initiated through outreach with the focus on providing access to housing resources and monitoring of Veteran involvement with appropriate VA and community-based providers throughout the continuum of services. Homeless Case Management is generally short-term in duration. Permanent Supportive Housing (PSH) Case Management is initiated through VA and/or community partner referrals. PSH Case Management ensures Veterans have access to clinical and social support services necessary to maintain independent housing. PSH Case Management is typically long-term in duration and is not meant for Veterans that are served in the HUD-VASH program.

Contract Residential Services Targets and prioritizes homeless Veterans transitioning from literal street homelessness, Veterans being discharged from institutions, including who recently became homeless and require safe and stable living arrangements while they seek permanent housing. Emphasis is placed on referral and placement in permanent housing or longer term residential programs utilizing VA and/or community resources. Lengths of stay in CERS typically range from 30 to 90 days with the option to extend based on clinical need. NOTE: CRS programs represent a consolidation of existing HCHV contract residential programs, previously designated as either residential treatment (RT) or emergency housing (EH). Since varying levels of supportive services have been present in both, as noted above, this consolidation reflects the range and flexibility of these services as currently constituted.

Low Demand Safe Havens Low Demand Safe Havens (LDSH) are 24-hour staffed transitional residences with private or semi-private accommodations, that target the population of hard-to-reach, chronically homeless Veterans with mental illness and/or substance use problems who require a low-demand environment. The low-demand or non-intrusive environment is designed to re-establish trust and motivate the homeless Veteran to seek needed treatment services and transitional and permanent housing options. Lengths of stay in LDSH programs are typically 6 months with the option to extend based on clinical need. Four model development projects introduced through VA’s National Center on Homelessness among Veterans in July 2010; then expanded to 15 additional sites.

HCHV Contract Residential Programs – Then and Now FY Available beds Available beds (LDSH) Totals HCHV Fiscal Support Veterans Served Exits to Permanent Housing 2009 859   2,847 959 2010 1602 4,140 1278 2011 2304 60 2364 8,129 2613 2012 3265 134 3399 $47,892,963.00 11,496 3863 2013 3598 3732 $74,449,284.00 13,525 4747 2014 3688 373 4061 $74,549,848.00 15,739 6626 2015 3785 460 4245 $97,123,971.00 16,723 7655 2016 3706 440 4146 $97,584,055.00 17,326 7830

Community Resource and Referral Centers CRRCs are a collaborative effort of VA, the community, service providers, and agency partners. The primary goal of the CRRC is to provide rapid and comprehensive homeless services to Veterans who are experiencing homelessness in a “one-stop” environment with the lowest barriers to services possible. The CRRCs are located in 30 strategically selected communities to provide both a refuge from the streets and a central location to engage homeless Veterans in services. CRRCs have been modeled after research that indicates: the creation of provider networks impacts housing gains; service integration leads to improved outcomes; non-restrictive approaches support client engagement and retention in services.

Stand Downs 1-3 day events held by community agencies in partnership with VA. Range of services may include: food, shelter, clothing, health screenings, dental services, legal services, VA and Social Security benefits counseling. In addition, referrals to a variety of other services including medical, mental health and substance abuse treatment, as well as information on housing and employment resources. HCHV staff often serve as the local VA facility Point of Contact (POC) for these events. POCs assist in coordinating the involvement of other VA staff members and outlining their roles in supporting Stand Downs.

VA Medical Center’s role in CES Development of Guidance for VAMCs Areas of Key Focus: Data sharing Case Conferencing and BNL Participation BoS and Rural CoC participation Internal VA Operations Participation on CoC Boards

HCHV Then & Now Program 2008 2016 HCHV funded FTE 335 620 HCHV Outreach (# Veterans Served) 70,870 157,061 CRS Beds 832 4,146 CRS Program (# Veterans Served) 1,600 17,326 Safe Havens (# programs) 22 Safe Havens (# Veterans served) 1,609 CRRCs (# sites) 30 Stand Downs 157 353

Discussion Comments or Questions?