1. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness Recent and Ongoing Research on Policies and Programs to Prevent and End Homelessness Among Veterans Tom Byrne Solutions 2013 National Conference on State and Local Housing Policy September 16, 2013 Atlanta, GA

2. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness OVERVIEW About the National Center Quick overview of homelessness among Veterans Research on HUD-VASH 1.DC HUD-VASH Pilot 2.14 Site Housing First Demonstration 3.3. HUD-VASH Exiter Study Other Research

3. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness ABOUT THE NATIONAL CENTER Started in 2009 Develops and disseminates evidence- based policies, programs and best practices in support of VA’s 5-year Plan to End Homelessness Among Veterans Policy Analysis Model Development & Implementation Education & Dissemination Research & Methodology Core Activities www.endveteranhomelessness.org

4. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness OVERVIEW OF HOMELESSNESS AMONG VETERANS Veterans comprise about 13% of all homeless adults 1 in 150 veterans experience homelessness over course of a year 1 in 10 veterans in poverty experience homelessness over the course of a year Four states (California, New York, Florida & Texas) account for nearly half of all homeless veterans Source: 2012 Annual Homeless Assessment Report to Congress

5. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness HUD-VASH OVERVIEW HUD-VA Supportive Housing (HUD-VASH) – collaborative effort between the VA and HUD: – HUD provides Section 8 Housing Choice Voucher – VA provides case management services Designed to target the most vulnerable, chronically homeless Veterans Over 45,000 vouchers allocated to date Housing First approach being implemented in all 100+ HUD-VASH

6. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness 1. DC HUD-VASH Pilot Study* Intended to determine feasibility of a Housing First model in HUD-VASH Compared two groups of Veterans who were admitted to HUD-VASH – Standard VASH case management—Linear model “Treatment as Usual” – Housing First Group—Case Management provided by DCDHS using *For full results See Montgomery et al. (2013). Housing Chronically Homeless Veterans: Evaluating the Efficacy of a Housing First Approach to HUD-VASH. Journal of Community Psychology.

7. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness 1. DC HUD-VASH Pilot Study VAMC-administered Vouchers VAMC-based outreach teams Case management services through VAMC staff 25:1 Clean/sober not required CM assists with housing search Housing search occurred after voucher issued Step model DCDHS-administered Vouchers Targeting/outreach using Vulnerability Index Case management through DCDHS staff (ACT capable) Clean/sober not required Maintained database of pre- inspected apartments Voucher issued at time of lease signing Housing First

8. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness HOUSING PROCESS Average time to placement (days)

9. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness COST: URGENT CARE 9

10. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness COST: INPATIENT MENTAL HEALTH 10

11. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness OUTCOMES: HOUSING RETENTION Housing First (N = 107) Treatment as Usual (N = 70) N%N% Veterans Currently Housed*9998.0%5985.5% Housing Status Housed with a HUD-VASH voucher9891.6%5578.6% Housed with ongoing subsidy00.0%34.3% Housed with no ongoing subsidy10.9%11.4% Prison/Jail10.9%22.9% Deceased65.6%11.4% Unknown10.9%811.4% * % Excludes deceased Veterans

12. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness 1. DC HUD-VASH PILOT: SUMMARY Evidence for Housing First in the VA: – Targeting of vulnerable, chronic Veterans is possible and this population can maintain housing – Rapid placement into housing – Reduced proportion of Veterans using ER and inpatient MH services – High housing retention rates 98% after 1 year

13. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness 14-site Housing First demonstration began in FY 2012 – 50 vouchers/site set aside for Housing First Study compared Veterans served in Housing First HUD-VASH to Veterans receiving TAU HUD-VASH at the same VA facilities with respect to: – Demographics – Targeting – Process time 2. VA HOUSING FIRST DEMONSTRATION

14. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness Early results indicate Housing First approach is successfully targeting more chronically homeless and more vulnerable Veterans than VASH TAU – Chronically homeless Veterans (95% in Housing First vs. 60% in Treatment As Usual) – History of Incarceration (74% in Housing First vs. 63% in Treatment as Usual) – Housing First Veterans also have lower levels of education, higher levels of unemployment/disability, and are more likely to be unmarried 2. VA HOUSING FIRST DEMONSTRATION

15. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness Despite serving a more vulnerable/high need group, little difference between Housing First and TAU in terms of time to housing placement (~3 months from admission to move in) Next Steps for Study – More Extensive Evaluation Including: VHA service utilization / cost Long-term outcomes / retention Individual site-level analyses (contract vs. VA staff) 2. VA HOUSING FIRST DEMONSTRATION

16. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness 3. HUD-VASH EXITER STUDY Robust evidence showing high retention rates (~85%) in PSH Little evidence about those who exit PSH and why they exit Multi-site HUD-VASH exiter study will examine: – Barriers to accessing housing – Causes of exit from VASH – Destinations of those who exit VASH – Practices that lead to long-term housing stability and well- being

17. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness OTHER ONGOING RESEARCH A.SSVF Evaluation B.Pathways Into Homelessness and Risk Factors for Homelessness C.Homelessness Analytics Application www.homelessnessanalytics.org www.homelessnessanalytics.org

18. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness A. SSVF OVERVIEW Funds community- based organizations to provide homelessness prevention and rapid rehousing services to veteran households Short-term assistance to maintain/obtain housing “But for” intervention

19. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness Returns to Homelessness Post SSVF Exit: Prevention 1 Year Singles: 10.8% Families: 6.8%

20. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness Returns to Homelessness Post SSVF Exit: Rapid Re-housing 1 Year Singles: 15.7% Families: 10.1%

21. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness B. PATHWAYS AND RISK FACTORS Risk factors for homelessness among a cohort of OEF/OIF era Veterans 1 – Moderate increase in risk of homelessness among those deployed to OEF/OIF (compared to those not deployed) – Among OEF/OIF vets PTSD associated with increased risk of homelessness Pathways Into Homelessness Among Iraq and Afghanistan Veterans (Ongoing qualitative study of premilitary, military and post military risk factors for homelessness) Universal screen for risk of homelessness 2 1-Metraux, S. et al. (forthcoming). Risk factors for becoming homeless among a cohort of veterans who served in the era of the Iraq and Afghanistan conflicts. Am. J. Pub. Health. 2. Montgomery, AE. Et al. (forthcoming). Universal Screening for Homelessness and Risk for Homelessness in the Veterans Health Administration. Am. J. Pub. Health

22. C. HOMELESSNESS ANALYTICS APPLICATION www.homelessnessanalytics.org www.homelessnessanalytics.org

23. The National Center on Homelessness Among Veterans Promoting data-driven, evidence-based solutions to end Veteran homelessness THANK YOU Tom Byrne byrnet@sp2.upenn.edu www.endveteranhomelessness.org www.homelessnessanalytics.org