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Veterans Homelessness Prevention Demonstration Evaluation - Interim Report
Interim Report
U.S. Department of Housing and Urban Development | Office of Policy Development and Research
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Interim Report
Prepared for:
U.S. Department of Housing and Urban Development Office of Policy Development and Research Washington, D.C.
Prepared by:
Mary Cunningham Martha Burt Jennifer Biess
Dina Emam
The Urban Institute
September 2013
Preface
The federal strategic plan to prevent and end homelessness,Opening Doors, places a high priority on ending homelessness among veterans. One initiative undertaken in pursuit of this goal is the Veterans Homelessness Prevention Demonstration (VHPD), a joint effort of the U.S. Department of Housing and Urban Development (HUD), the U.S. Department of Veterans Affairs (VA), and the U.S. Department of Labor (DOL). The VHPD investigates for the first time prevention and rapid rehousing interventions for U.S. military veterans. The VHPD evaluation is designed to draw lessons from the VHPD experience about how to prevent veterans from becoming homeless,including in particular women, parents,veterans returning from Iraq and Afghanistan, and members of the National Guard and Reserve.
The evaluation interim report finds that the VHPD fills a critical gap in services by offering short-term assistance for veterans who do not require the intensive interventions funded through the VA Grant and Per Diem and HUD-VASH programs and for veterans who need a bridge to receiving more intensive assistance. It also identifies areas for additional effort on the part of grantees (increasing enrollment),
on the part of HUD (improving data elements and standardization of definitions), and on the part of the
federal government in facilitating collaboration between HUD, VA, and DOL in the direct provision of services. Finally, the report highlights the difficulty of effectively targeting the intended clients of prevention and rapid rehousing services-i.e., those who would become or remain homeless but for the assistance,but who nevertheless can be well served with only short- to medium-term assistance.
In addition to providing valuable insights in its own right, the interim report is the foundation for interpreting the final evaluation report, which will assess the impact of VHPD services by surveying VHPD participants when they enter the program and then again 6 months after they leave the program and comparing VHPD clients to selected comparison groups of veterans and non-veterans in terms of housing status.
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
Table o f Contents
Executive Summary ..................................................................................................................................... x
Chapter 1. Introduction ............................................................................................................................... 1
Overview ..................................................................................................................................................1
VHPD Background ....................................................................................................................................1
Overview of the Administration's Plan to End Veteran Homelessness.................................................1
Homelessness Among Veterans: Size of the Problem .......................................................................... 1
Preventing and Ending Homelessness Among Veterans ...................................................................... 4
Introduction to the VHPD Program ...................................................................................................... 4
VHPD Sites ............................................................................................................................................ 6
Overview of the VHPD Evaluation ............................................................................................................ 8
Study Timeline.......................................................................................................................................... 9
Process Study Description ........................................................................................................................ 9
Process Study Data Collection Methods................................................................................................. 11
Program Reconnaissance.................................................................................................................... 11
Site Visits ............................................................................................................................................ 11
Administrative Data Collection (APR and QPR) .................................................................................. 12
Contribution to Knowledge of the Veterans Homelessness Prevention Demonstration Evaluation
Interim Report ........................................................................................................................................ 13
Chapter 2. VHPD Households..............................................................................................................15
Introduction............................................................................................................................................ 15
Program Reach ....................................................................................................................................... 15
Overall Number Served ...................................................................................................................... 15
Veterans Served.................................................................................................................................. 16
Reaching Veteran Target Populations................................................................................................. 16
Profile of Persons Served........................................................................................................................ 23
Demographic Characteristics............................................................................ .................................. 23
Income Level and Employment Status ............................................................................................... 25
Physical and Mental Health Conditions .............................................................................................. 27
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
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Housing Status at Program Entry........................................................................................................ 29
Summary ................................................................................................................................................ 30
Chapter 3. Program Structure, Relationships, and History...................................................................31
Introduction............................................................................................................................................ 31
Community Context ............................................................................................................................... 33
VHPD Grantee Selection Processes ........................................................................................................ 34
VHPD Grantee and Subgrantee Organizations........................................................................................ 35
Models of Program Administration: Division of Responsibilities among Grantee and Subgrantee
Organizations...................................................................................................................................... 37
Working Arrangements Among VHPD, VA,and DOL Agencies............................................................... 38
Framework for Evaluating Partnering Arrangements ......................................................................... 38
Partnership Among VHPD and VA Health Agencies............................................................................ 40
Partnership Among VHPD and DOL Agencies..................................................................................... 43
Summary ................................................................................................................................................ 46
Chapter 4. Implementation: From Outreach to Enrollment .................................................................47
Introduction............................................................................................................................................ 47
Outreach................................................................................................................................................. 47
Public Announcements and Informational Meetings ......................................................................... 48
Hotlines .............................................................................................................................................. 48
In-reach to VA Program Staff .............................................................................................................. 49
Connecting With Homeless and Other Supportive Service Programs ................................................ 49
Outreach to Military Bases................................................................................................................. 49
The Intake Process.................................................................................................................................. 50
The VAMC Screening ..................................................................................................................... ..... 51
The VH PD Grantee Screening............................................................................................................. 52 “But For” ............................................................................................................................................ 53
Sustainability ...................................................................................................................................... 53
Finding Enough Qualifying Veterans................................................................................................... 54
The Enrollment Decision ........................................................................................................................ 55 “But For” Versus Sustainability ........................................................................................................... 55
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
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Urgency Versus Priority Populations .................................................................................................. 55
Summary ................................................................................................................................................ 56
Chapter 5. Implementation: Serving VHPD Households ......................................................................57
Introduction............................................................................................................................................ 57
Housing Assistance and Service Delivery Process .................................................................................. 57
Assessment and Dosage Decisions ..................................................................................................... 57
Recertification .................................................................................................................................... 58
Type, Level, and Duration of Financial Assistance .................................................................................. 60
Prevention Versus Rapid Rehousing................................................................................................... 60
Types of Financial Assistance Used by VHPD Participants .................................................................. 61
Types of Housing Relocation and Stabilization Services Used by VHPD Participants ............................. 62
Outreach and Engagement................................................................................................................. 63
Case Management.............................................................................................................................. 63
Budgeting ........................................................................................................................................... 64
Housing Search and Placement .......................................................................................................... 65
Employment Services ......................................................................................................................... 65
Health Care Services........................................................................................................................... 67
Referrals and Other Supportive Services............................................................................................ 67
Length of Participation in VHPD ............................................................................................................. 67
Barriers to Service Provision........................................... ........................................................................ 69
Size of the Service Area ...................................................................................................................... 69
Accessing VAMC Benefits ................................................................................................................... 70
Inconsistency of Case Management................................................................................................... 70
Summary ................................................................................................................................................ 70
Chapter 6. Data and Tracking.............................................................................................................. 73
Overview ................................................................................................................................................ 73
HUD-Required HMIS Data Collection...................................................................................................... 73
Previous HMIS Experience...................................................................................................................... 74
HMIS Data Entry ..................................................................................................................................... 75
Beyond HUD Requirements: Types of HMIS Data Collected................................................................... 75
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
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Program Use of HMIS ............................................................................................................................. 76
Challenges Collecting and Using HMIS Data ........................................................................................... 78
Summary ................................................................................................................................................ 78
Chapter 7. Early Successes, Outcomes, and Challenges .......................................................................79
Introduction............................................................................................................................................ 79
Early Implementation Successes ............................................................................................................ 79
Designed,Launched,and Implemented VHPD at All Five Sites .......................................................... 79
Addresses a Critical Gap in the Array of Homeless Services Available to Veterans ............................ 79
Identified, Enrolled, and Assisted Hundreds of Veterans and Their Families .....................................80
Engaged and Enrolled Target Populations .......................................................................................... 80
HUD and VA Grantees Developed Partnerships ................................................................................. 80
Grantees and Subgrantees Entered HMIS Data .................................................................................. 80
Year 1Outcomes for Veterans ................................................................................................................ 81
Remaining Program Challenges.............................................................................................................. 83
Unclear if Targeting Veterans at Imminent Risk.................................................................................. 83
Discharge Status Is a Barrier to Enrolling Needy Veterans ........... ...................................................... 84
Uneven VHPD Case Management ...................................................................................................... 84
Challenges Engaging Veterans with Mental Health Issues ................................................................. 84
Size of Service Area Is a Barrier to Service Access and Delivery.........................................................84
Uneven Partnerships With DOL.......................................................................................................... 85
VAMC Vast Structure With Significant Benefits Backlog..................................................................... 85
Grantee and Subgrantee Oversight Structure Loose at Some Sites....................................................85
Some Data Collection Needs Improvement ....................................................................................... 86
Next Steps for the Evaluation ................................................................................................................. 86
List of Appendices ..............................................................................................................................87
Appendix A. Site Summary Memos ........................................................................................................ 89
Appendix A1. Central Texas Site Summary Memo.............................................................................. 90
Appendix A2. San Diego Site Summary Memo.................................................................................103
Appendix A3. Tacoma Site Summary Memo .................................................................................... 116
Appendix A4. Tampa/Hillsborough Site Summary Memo ................................................................ 133
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Appendix AS. Upstate Northern New York Site Summary Memo .................................................... 145
Appendix B. Administrative Data Tables............................................................................................... 157
Appendix C. Assessment Forms............................................................................................................ 163
Appendix C1. VA HOMES Assessment .............................................................................................. 164
Appendix C2. VHPD HMIS Assessment............................................................................................. 177
References ....................................................................................................................................... 185
Definition of Terms ........................................................................................................................... 189
General Terms ...................................................................................................................................... 189
Veteran- and Military-Specific Terms....................................................................................................192
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
Executive Summary
This interim evaluation report describes the first year of the Veterans Homelessness Prevention Demonstration (VHPD). Funded in FY2009, the VHPD is a joint effort of the U.S. Departments of Housing and Urban Development (HUD), Veterans Af fairs (VA), and Labor (DOL) to provide homelessness prevention and rapid rehousing to veterans,especially those returning from conflicts in Afghanistan and Iraq. The VHPD has five sites, with each associated with a military base and a Veterans Affairs Medical Center (VAMC). The sites are in Utica, NY; Tampa Bay,FL; Tacoma, WA; San Diego,CA; and Austin,
Texas. It is the first attempt to investigate homelessness prevention and rapid rehousing services for veterans and their families.
Prevention and rapid rehousing are necessary components in any plan to end homelessness. Veterans are at greater risk of homelessness than comparable non-veterans, with veterans of recent conflicts possibly at higher risk than veterans of earlier conflicts. Further,compared to earlier generations of veterans,service members returning from post-9/11conflicts include more women, parents,and members of the National Guard and Reserve units. Because of this,Congress intended that the VHPD evaluation investigate ways to reach and serve veterans at risk of homelessness among these subgroups.
Evaluation Research Questions
Three questions guide the evaluation research:
1) What are effective ways to identify,reach, and assist veterans who are at risk for homelessness or are experiencing short-term homelessness?
2) Are the services provided through VHPD effective?
3) What are the barriers to providing services?
The evaluation will address these specific questions in relation to two larger policy issues: the feasibility of homelessness prevention and the need for specially adapted programs for veterans. This interim report describes the first year of the VHPD and thus lays the foundation for the outcomes analysis that will be presented in the final report,scheduled to be available in late 2014.
Methods
The VHPD evaluation includes both a process and an outcomes study. The process study is based on multiple site visits, focus groups with clients, and analysis of Annual Performance Report (APR) data. The outcomes study will analyze survey data collected from clients 6 months after they exit the program. It will also use HMIS 1 data and apply statistica I methods to compare housing status of VHPD clients to two different groups: (1) similar veterans who did not participate in VHPD and (2) non-veterans who
received prevention or rapid rehousing assistance through the Homelessness Prevention and Rapid
Rehousing Program (HPRP).
1 Homeless Management Information System
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
Executive Summary
Interim Report Findings
The VHPD fills a critical gap in services by offering short-term assistance for veterans whose needs do not require the intensive interventions funded through the VA Grant and Per Diem and HUD-Veterans Affairs Supportive Housing (VASH) programs or who need a bridge to receiving more intensive assistance. Each VHPD site includes an affiliated VA Medical Center (VAMC), and most programs work with a local Vet Center, which includes outreach specialists who educate veterans and community organizations about VA services and reach out to VHPD target populations. Each site collaborates with local DOL Veterans' Employment and Training Service (VETS), the Disabled Veterans' Outreach Program (DVOP) and the Local Veterans Employment Representative Program (LVER).
Characteristics of Persons Served
In its first year, the five sites served a total of 586 eligible veterans and their families (1,366 people in
574 households). Overall, sites have enrolled fewer veterans, and spent money at a slower rate, than projected. At program entry,most clients (86 percent) were unstably housed or at imminent risk of losing housing; three-quarters of adult clients (veterans and family mem bers) were unemployed; and
38 percent had no income. About 30 percent of persons served reported a mental or physical health condition.
Characteristics of Veterans Served
As noted above,Congress intended the VHPD to reach veterans of recent conflicts, who are younger, more likely to be female and more likely to be parents and members of the National Guard and Reserve. Accordingly,HUD and its partners selected sites with high numbers of soldiers returning from recent conflicts. Characteristics of veterans served by VHPD indicate successful outreach to targeted
subgroups. For example, among VHPD clients, 42 percent had served in the post-9/11era,a much higher proportion than found among all veterans.2 Half of VHPD clients were between the ages of 25 and 44, while only 19 percent of all U.S. veterans fall into this age group. 3 Further,among VHPD clients,
153 (26 percent) were women. This far exceeds the share of women in the tota I population of veterans (8 percent)4 and even among the population of homeless sheltered veterans (9.8 percent).5 VHPD also succeeded in serving families, with 264 (45.1percent) clients in households with children. Only 5 percent of veterans in VHPD had served exclusively as activated National Guard members and Reservists.6 About half of VHPD veterans had served in a war zone and most of these (69 percent) had received hostile or friendly fire.
2 Probably less than 10 percent, based on 2 million deployed and current total veteran population of 22.7 million.
3 Table 1L: VETPOP2011LIVING VETERANS BY AGE GROUP,GENDER, 2010-2040
4 VetPop2007 estimate for 2011.
5 Estimates presented in the 2011AHAR.
6 This proportion is far below the share (approximately 30-40 percent) of National Guard and Reservists among troops deployed in OEF and OIF/OND,but many of these may be veterans of active service and thus counted as such. Thus, in the absence of any data on the proportion of the deployed National Guard and Reserve troops who were also active member veterans, it is impossible to say whether 5 percent represents successful outreach to this target group.
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
Executive Summary
VHPD Services and Length of Program Participation
All five VHPD sites offered homelessness prevention and rapid rehousing services, including financial assistance,case management,and housing search services. Eighty-two percent of client households received prevention services. The remaining client households were already homeless and therefore received rapid rehousing services. Ninety-three percent of households served received financial assistance,including rental assistance (85 percent), utility payments (44 percent), and security/utility deposits (38 percent). Nearly all clients (98 percent) received case management,but only 11percent received housing search and placement assistance and only 2 clients received legal or credit repair services. At the end of the first year, about half of clients had participated for under 60 days and about
44 percent fell in the 61to 180 day range.
Housing Status of Veterans Exiting the Program
Most VHPD clients were either homeless (14 percent) or unstably housed (86 percent) when they entered the program. By the end of the first year,among the 950 clients who had left the program (including veterans and family members), 77 percent were stably housed,2.5 percent were unstably housed, 4 percent were at imminent risk of losing housing, and 1percent were literally homeless. Information was missing for the remaining 15 percent.7
Implementation Challenges
The interim evaluation identified several implementation challenges. Waiting times and case backlogs at VAMCs cause difficulties. For instance, a change in discharge status might be needed before a veteran is eligible for VHPD or a veteran may be able to become self-sustaining if his or her disability status is changed, but VHPD assistance might not last long enough to bridge the period of waiting for a VA decision. VHPD staff in all sites report that they are not well prepared to cope with consequences of trauma,including post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI).
All sites experienced conflicts between the impulse to serve the most needy and the goal of serving target subgroups,such as women, families, and veterans of recent conflicts in Afghanistan and Iraq. VHPD grantees struggled to serve veterans who would be homeless without their assistance while also serving veterans likely to sustain housing on their own after short- or medium-term assistance. At one extreme, San Diego enrolled only clients highly likely to sustain housing on their own after 3 months
of assistance. Consequently,case managers spent most of their time assessing applicants rather than
working with enrolled clients. Further, the sites struggled to serve the entire area assigned to them,a particularly acute problem in New York where VHPD serves a rural and frontier region.
7 Data on leavers from the Tacoma site were missing when this was written, accounting for most of the avera II
missing data. Tacoma data will be available in the evaluation final report.
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
Executive Summary
Recommendations & Conclusions
The report provides recommendations for improving data collection. In particular, the VHPD HMIS does not capture whether a veteran served in particular operations in Afghanistan or Iraq (i.e., Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn) nor does it document a veteran's enrollment in education or training. In addition,the report suggests that the definitions of housing status at program entry and exit may be interpreted and applied differently across the sites. Training to standardize application of the definitions would help with tracking outcomes.
The evaluation interim report suggests some areas for additional effort on the part of grantees (increasing enrollment) and on the part of HUD (improving data elements and standardization of definitions). It also suggests that federal officials need to consider how to better facilitate collaboration between HUD, VA, and DOL in the direct provision of services-if not for the VHPD right now, then in future efforts to link homelessness assistance with employment services. The report also indicates a need for better training and resources to increase the capacity of VHPD sites now-and future veterans' homeless assistance efforts-to cope with consequences of trauma and brain injury. Finally, it highlights the difficulty of effectively targeting the intended clients of prevention and rapid rehousing services, those who would become or remain homeless but for the assistance but who also are well served with only short- to medium-term assistance.
The interim report forms the background for the outcomes analysis that will be presented in the final evaluation report, scheduled to be available in late 2014.
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Overview
Concerned about the increasing risk of homelessness among veterans returning from the wars in Iraq and Afghanistan,Congress authorized the Veterans Homelessness Prevention Demonstration (VHPD), a joint program of the U.S. Department of Housing and Urban Development (HUD), the U.S. Department of Veterans Affairs (VA), and the U.S. Department of Labor (DOL). VHPD is the first homelessness prevention program to explore interventions that are successful in keeping veterans and their families stably housed. This interim report provides early findings from Silber & Associates and the Urban Institute's evaluation of the VHPD. With data collected during program reconnaissance, the first wave of site visits, and program administrative data, the report paints a picture of VHPD program design and implementation during its first year. This chapter provides background on VHPD,including an overview of the Obama administration's plan to end homelessness among veterans, and describes the purpose and methods of the VHPD evaluation.
VHPD Background
Overview of the Administration's Plan to End Veteran Homelessness President Obama has made ending homelessness among veterans a national priority,noting that his administration has a “zero-tolerance” policy for veterans sleeping on the street or in a shelter. His administration's plan to end homelessness,Opening Doors, sets the target of ending homelessness among veterans by 2015. To fulfill this promise, Department of Veterans Affairs Secretary Shinseki
released a five-year plan that outlines key strategies to “bring veterans home.”8 The Plan includes: (1) a Gl Bill to help veterans pursue college;(2) programs that encourage veteran-owned businesses;(3) VA homeless-specific programs;(4) aggressive diagnosis and treatment of psychological disorders; and (5) collaborating with housing agencies to administer permanent housing.9 “Our plan enlarges the scope of VA's efforts to combat homelessness,” said Shinseki. “In the past, VA focused largely on getting homeless veterans off the streets. Our five-year plan aims also at preventing them from ever ending up homeless.”10 As Secretary Shinseki notes, to end homelessness among veterans,policymakers need to help veterans who are currently homeless get back into permanent housing and prevent homelessness among those at risk.
Homelessness Among Veterans: Size of the Problem
Reliable numbers on homeless veterans have been hard to come by,but increasingly are becoming part of HUD's Annual Homeless Assessment Reports (AHARs) to Congress. HUD's 2011AHAR, released in November 2012,provides data from the 2011point-in-time count and persons using shelters during the
2011fiscal year (October 2010 through September 2011),while Volume I of HUD's 2012 AHAR provides
8 U.S. Department ofVeterans Affairs, Office of Public and Intergovernmental Affairs. 2009. "Secretary Shinseki
Details Plan to End Homelessness for Veterans." http://wwwl.va.gov/opa/pressrel/pressrelease.cfm?id=1807.
9 lbid.
10 Ibid.
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
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data from the 2012 point-in-time count. Point-in-time counts reveal that on a single night in January
2012,approximately 62,600 veterans were homeless, with 56 percent staying in emergency shelters or transitional housing programs and the rest living on the street or other places not meant for sleeping U.S. Department of Housing and Urban Development (HUD 2012a, p. 15). This represents a decrease of
17.2 percent from 2009. Analyzing annualized data for the 2011fiscal year from the homeless
management information systems of a nationally representative sample of communities, HUD indicated that some 141,449 veterans used emergency shelter or transitional housing at some time during fiscal year 2011,representing a decrease of 5.5 percent compared to fiscal year 2009, the first year for which these data were reported (HUD 2012b). These estimates, although limited,are improving over time and are widely used by government agencies, advocates,and researchers.
The 2011and 2012 AHAR data also give some sense of how much veterans are overrepresented among homeless people. Veterans comprise only 8 percent of the total U.S. popula tion,but made up 9.9 percent of all homeless persons counted in the January 2012 point-in-time counts (15.9 percent of all single adults) (HUD 2012a), and 9.4 percent of all persons using shelters in 2011(14.4 percent of single
adult shelter users) (HUD 2012b). As is true for the general homeless population, African Americans and Latinos are overrepresented among the sheltered homeless veteran population. Homeless veterans using shelters during 2011were far more likely than the general homeless population to be single individuals (96.5 percent compared to 66 percent) (HUD 2012b).
Today,a majority of sheltered homeless veterans (52 percent) are 51or older-old enough that many are likely to still be struggling with the devastating and enduring effects of serving in Vietnam. Most of the rest (42 percent) are men in mid-life (in 2011,42 percent were age 31to 50) (HUD 2012b). Further, the share of homeless veterans over 50 has been increasing and the share of those ages 31to 50 decreasing between 2009 and 2011; this pattern suggests that already-homeless veterans are getting older. Another small change in the age distribution of sheltered homeless veterans is an increase in those between the ages of 18 and 30, who have gone from 8.4 to 9.1percent of sheltered homeless veterans (HUD 2012b). With upward of 2.3 million people deployed to the wars in Afghanistan and Iraq, more veterans are returning from war than any time since Vietnam (Veterans for Common Sense 2012). A small,vulnerable subset are experiencing homelessness.
The number of women serving in the military has grown significantly in the past decade. Overall, about 8 percent of veterans are women (about 1.8 million women veterans in total) (U.S. Government Accountability Office (GAO) 2011). While women were not allowed to fill combat positions until
recently, the dangerous nature of U.S. military campaigns in the Middle East, Operation Iraqi Freedom
(OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) has left women more exposed to combat situations, such as defending against attacks from insurgents (Patten and Parker
2011). Women are also more likely to experience Military Sexual Trauma (MST), which the Veterans Health Administration (VHA) describes as,“severe or threatening forms of sexual harassment and sexual assault sustained in military service” (Kimerling et al. 2007, p. 2160). MST is too common among women
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
Chapter 1
veterans: a study of VA administrative records found that 22 percent of screened veteran women report
MST (about 29,418 patients) (Kimerling et al. 2007,p. 2160).U
These demographic changes in military composition have implications for homelessness prevention, as research finds that returning women and younger military personnel are at high risk for homelessness when compared to their nonveteran counterparts (HUD and U.S. Department of Veterans Affairs 2011). Among sheltered homeless veterans,9.8 percent were women in 2011,up from 7.5 percent in 2009 (HUD 2012b), providing evidence that women veterans are more likely to be homeless than their representation in the veteran population would suggest.
Homeless veterans are homeless for slightly longer periods than nonveterans (HUD 2012b). There is some evidence that homeless veterans may face more challenges in finding affordable housing than their nonveteran counterparts. HUD's affordable housing programs,for example, are less likely to serve veterans,and veterans are more likely than nonveterans to have unique health needs conditions, such as posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI), that require special attention (GAO 2007). Homeless veterans have high rates of mental illness and substance abuse (U.S. Interagency
Council on Homelessness 2010). These factors contribute to high rates of incarceration among veterans;
at last count, approximately 140,000 veterans were incarcerated (Drug Policy Alliance 2009).
Recent reports show that a small number of veterans who served in OEF/OIF/OND are trickling into homeless shelters across the countryY At last count in 2006, the VA identified 8,200 OEF/OIF/OND veterans as homeless or at risk of homelessness. This number has increased considerably each year; these young veterans are seeking assistance earlier than past cohorts (VA 2006). While the number of OEF/OIF/OND veterans experiencing homelessness is relatively small,some troubling data-including high rates of PTSD and TBI among OEF/OIF/OND veterans-suggest that without homelessness prevention and targeted affordable housing programs,returning veterans may face a high risk of homelessness.
Returning veterans face a host of challenges, including reentering life with friends and family and finding employment (Institute of Medicine (10M) 2010). According to a recent Pew Research Center survey of
1,842 veterans, 44 percent of veterans who served after 9/11 say that reentry was difficult (Morin
2011). The VA faces severe shortages in mental health care professionals and long backlogs for accessing disability benefits,leaving many veterans vulnerable (10M 2010). According to the Bureau of Labor Statistics,veterans also experience higher rates of unemployment: about 12 percent for veterans who served in the military post-9/11compared to about 8 percent for nonveterans (U.S. Department of Labor,Bureau of Labor Statistics (DOL, BLS) 2013). It is not surprising,then,that, as research suggests, veterans are at greater risk of homelessness than their civilian counterparts.
11 This study examined administrative records collected by the Veterans Health Administration (VHA). VHA has a universal screening program for MST. Kimerling and co-authors found that 70 percent of VHA patients were screened for MST.
12 See Definition of Terms for explanation of the meaning of OEF/OIF/OND.
VETERANS HOMELESSNESS PREVENTION DEMONSTRATION EVALUATION INTERIM REPORT
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Preventing and Ending Homelessness Among Veterans
Understanding causes and risk factors for homelessness among veterans is important for developing identification strategies and homelessness prevention programs. Studies find that military service alone does not increase risk for homelessness; but other risk factors-some related to military service, others that present before deployment-contribute to homelessness among veterans (Mares and Rosenheck 2004). Individual risk factors-poverty,education,employability,mental and physical health, substance use, factors related to military service, and incarceration-are associated with higher risk
of homelessness. Structural factors-such as the loss of affordable housing,rising unemployment, unprecedented numbers of foreclosures,and an erosion of the safety net-contribute to homelessness among veterans and the general population alike. In addition,a single event (e.g.,health problem,
job loss, rent burden,eviction) may often precipitate homelessness; these events are difficult to
predict with economic models largely due to lack of data,but also because some of these events are, in fact,unpredictable. When implementing plans to prevent and end homelessness among veterans, policymakers should consider three steps: (1) identifying risk groups;(2) conducting outreach to at- risk veterans,particularly those who served in OEF/OIF/OND; and (3) implementing cost-effective
interventions. VHPD is one program that is attempting to address these three key steps while allowing
policymakers and practitioners to learn about ways to provide comprehensive services to veterans who are homeless or at risk for homelessness.
Introduction to the VHPD Program
Congress authorized the VHPD program to test the efficacy of homelessness prevention and rapid rehousing programs that target veterans. According to HUD,“the purpose of VHPD is to explore ways for the Federal Government to offer early intervention homelessness prevention,primarily to veterans returning from wars in Iraq and Afghanistan” (HUD 2009).
The demonstration is a collaborative effort of three federal agencies: HUD,VA,and DOL. HUD received
$10 million to conduct the demonstration, VA received $5 million to support case management and services, and DOL helps veterans access employment and job training programs through its existing veterans employment specialists located in One-Stop Career Centers (hereafter, One-Stops), but without additional staff or resources. HUD allowed VHPD grantees broad discretion in program design. Local grantees had to decide how to define eligibility,how their programs would identify populations and enroll them in services,and what types of services to provide.
Program Services
VHPD sites are required to spend 65 percent of their grant on housing assistance,but beyond this requirement they have discretion to develop program activities that reflect local need. VHPD grantees and their subgrantees provide a range of financial,case management, and housing location services to homeless households and those at risk of homelessness. VHPD provides short- or medium-term housing assistance (3 to 18 months), including security deposits,rent,rental arrearages (up to 6 months back rent), moving cost assistance, and utilities, as well as case management and referrals to community-
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based services and supportsY Service providers may also use VHPD funds for childcare,credit repair, and transportation expenses. HUD prohibits that VHPD grantees pay mortgage payments or arrears.
Eligible Program Participants
Grantees have discretion in targeting veterans most in need of homelessness prevention and rapid rehousing. HUD requires that the target groups are veterans and veterans with families at risk of homelessness or experiencing short-term homelessness (fewer than 90 days). In addition,HUD requires that the “household must also lack the financial resources and support networks needed to obtain housing or remain in its existing housing” (HUD 2009). HUD advised the grantees to ask, “would this veteran or his/her family be homeless but for this assistance” (HUD 2009). This clause has become known as the “but for” rule. The household must also meet at least one of the following “instability criteria”:
• Short-term homelessness (homeless for fewer than 90 days).
• Rental arrearages (at least 1month behind in rent).
• Pending eviction in 2 weeks.
• Institutional discharge (within 2 weeks from an institution where the person has been a resident for more than 180 days,e.g.,prisons,mental health institutions,or hospitals).
• Condemned housing.
• One month of utility arrears.
• Housing cost burden greater than 50 percent of household income.
• Sudden loss of significant income (defined as greater than 25 percent drop in income).
• Recent traumatic life event (e.g., divorce,death of a spouse, or health crisis) that prevents the household from meeting financial obligations.
• Imminent unemployment.
• Mental health or substance use issue (treatment by time in housing encouraged).
HUD also provided VHPD grantees additional risk factors to consider (e.g., physical disabilities,homeless in the last 12 months, young head of household,overcrowded household) and combat-related risk factors specific to veterans (e.g., PTSD,history of major depression, history of anxiety,multiple deployments,illness/injury either physical or psychological, substance use,and TBI) (HUD 2009).
In addition to HUD's housing-related eligibility criteria,veterans must also be eligible for VA medical benefits to qualify for VHPD. This means they cannot have a dishonorable discharge and they must meet VA-specified terms of service requirements. Veterans from all periods of service are eligible,but HUD is encouraging focused outreach to OEF/OIF/OND veterans. National Guard members and those who served in the reserves are also eligible for VHPD financial assistance and services if they meet terms of service requirements.
13 Per HUD policy, any financial assistance provided for ongoing rent payments are paid directly to the landlord.
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Program Timeline
The Omnibus Appropriations Act of 2009 authorized funding for VHPD (Public Law 111-8,signed into law on March 11, 2009). HUD issued the program notice in July 2010, the selected Continuums of Care (CoC) accepted the program by August 2010 and each submitted a business plan by October 2010. HUD signed the grant agreements by November 2010 (HUD 2009) and the VHPD programs began enrolling clients in March,April, or May of 2011. The program is a 3-year grant and is slated to end January 2014.
VHPD Sites
HUD,in consultation with VA and DOL,selected five military bases and their surrounding communities to participate in VHPD: Camp Pendleton in San Diego,CA (San Diego); Fort Hood in Killeen,Texas (Central Texas); Fort Drum in Watertown, NY (Upstate Northern New York); Joint Base Lewis-McChord
in Tacoma, WA (Tacoma); and MacDill Air Force Base in Tampa, FL (Tampa/Hillsborough). HUD demonstration funds were allocated directly to the largest CoCs in the geographic area covered by the VHPD programs: the City and County of San Diego; Austin/Travis County; Utica/Rome/Oneida County; Tacoma/Lakewood/ Pierce County;and Tampa/Hillsborough County. Appendix A provides in-depth descriptions of each program,including types of services provided and veterans served in the program's first year.
HUD selected sites based on the following criteria: (1) the number of homeless veterans in the geographic area;(2) the number of unique returned OEF/OIF/OND veterans who accessed health care through the VA between FY2002 and first quarter FY2009; (3) the number of homeless veterans reported through the VA's CHALLENG report;(4) the range and diversity of military represented by the selected sites (e.g.,all branches,including the National Guard and Reserves); (5) access to and availability of VA health care; (6) overall geographic distribution;and (7) capacity of the community to carry out the demonstration project (HUD 2009).
HUD awarded each grantee $2 million for a period of three years;grants went to homeless assistance programs in designated CoCs or to the CoC itself, to deliver housing and supportive services in collaboration with VA medical centers and DOL One-Stops.
Central Texas-Fort Hood
The Austin/Travis County CoC selected The Salvation Army (TSA) to run this program, which serves as the VHPD grantee for Central Texas and received HUD's $2 million directly; there are no subgrantees. The VA partner is the Central Texas Veterans Health Care System (CTVHCS), the local agency for the VA,
located in Killeen. The program also involves the Killeen/Heights Vet Center,which helps do outreach for VHPD and other programs serving veterans. The DOL partner in Central Texas is the Texas Veterans Commission, which oversees the work of veteran-specific employment specialists for disabled and other veterans. Each of the three key partners has dedicated staff that work together to operate the VHPD program.