The National Center on Homelessness Among Veterans
USF is partnering with the Department of Veteran Affairs (VA) and the University of Pennsylvania to establish the National Center on Homelessness Among Veterans. The primary goal of the Center is to develop, promote, and enhance policy, clinical care research, and education to improve homeless services so that Veterans may live as independently and self-sufficiently as possible in a community of their choosing. MHLP faculty serve in leadership roles in the center and advise and collaborate on the primary components of the center: Policy Analysis/Planning, Model Development/Implementation, Education/Dissemination, and Research/Methodology. MHLP will lead the initial study for the Research/Methodology core measuring aspects of housing and housing services for homeless veterans with behavioral healthcare needs.
HOMELESSNESS AMONG WOMEN VETERANS
This video details the growing increases in the number of women serving in the military and accompanying increases in the prevalence of homelessness among women veterans, as well as current efforts by the Department of Veterans Affairs (VA) and the National Center on Homelessness among Veterans to address this problem. As part of this video, viewers are provided information on the full continuum of care for women veterans in the VA, including: health care, transitional and permanent housing, aftercare, mental health treatment and vocational rehabilitation. Information in this video is provided by: psychologists, social workers and others that work with homeless; researchers conducting studies; as well as some of the women veterans who were affected by homelessness and received treatment and support from the VA. This video concludes by providing suggested strategies for preventing and ending homelessness among women veterans who are homeless or are at-risk of experiencing homelessness.
Facts about homelessness among women veterans
- Among women, military service is associated with a three to four times increased likelihood of experiencing homelessness (Gamache, Rosenheck, & Tessler, 2003).
- Among women veterans, several factors have been found to be associated with the experience of homelessness, including: unemployment, disability, positive screens for post-traumatic stress disorder(s), anxiety disorder(s), as well as sexual assault during military service (Washington, Yano, McGuire, Hines, Lee, & Gelberg, 2010).
- While data is limited, the number of women veterans identified as homeless by the VA increased by 141% from fiscal year 2006 (1,380) to fiscal year 2010 (3,328; U.S. Government Accountability Office, 2011)
- Homeless female veterans likely present with different needs compared to homeless male veterans (e.g., gender-related care, treatment for physical and sexual trauma, care for dependent children; Kushel, Evans, Robertson, Moss, 2003; North & Smith, 1993; Wenzel, Koegel, & Gelberg, 2000).
- Although eligible to receive veterans housing (Grant Per Diem and Housing and Urban Development - Veterans Affairs Supportive Housing), women veterans face several barriers to accessing and using these services, including: "lack of awareness about these programs, lack of referrals for temporary housing while awaiting placement in veterans housing, limited housing for women with children, and concerns about personal safety" (U.S. Government Accountability Office, p. 4)
RURAL HOMELESS VETERANS
This video provides an overview of the issues related to homelessness among veterans living in rural areas. Homeless veterans in urban environments may be more visible, but homeless veterans in rural environments have limited access to treatment and support services. This video addresses many issues related to homelessness focusing on rural homeless among veterans. This video presents information regarding: the prevalence of and issues surrounding homelessness, both in general and specific to veterans; aspects of rural homelessness; rural veteran homelessness; promising ways of reaching out to rural homeless veterans; as well as next steps in the Department of Veteran Affairs' efforts to prevent and end homelessness among veterans.
Facts about homelessness in rural areas
- Data reported to the Department of Housing and Urban Development indicates that approximately 7 percent of all persons experiencing homelessness in America were counted in rural and mostly rural areas (Henry & Sermons, 2010)
- The percentage of unsheltered homeless persons in families with children in rural areas is almost double the percent of those in urban areas (Henry & Sermons, 2010)
- The lower capacity for homeless service provider infrastructure in rural areas is one of the largest differences between homelessness in rural versus urban areas (National Alliance to End Homelessness, 2010)
- Permanent supportive housing and transitional housing constitute a greater proportion of the bed inventory in urban areas as compared to rural areas, which largely have emergency shelter beds (Henry & Sermons, 2010)
- USF/ MHLP projects for the National Center:
EVALUATING HOUSING AND HOUSING SERVICES FOR HOMELESS VETERANS
The purpose of this study is to better evaluate community-based housing services for homeless veterans, especially those with problems with mental illnesses and substance use disorders. In order to conduct studies of outcomes of housing and housing services, it is necessary to explicitly define key features of the housing and associated services, to determine criteria that measure these features, and to conduct assessments to describe the housing options. This was accomplished by a comprehensive review of the literature on supported housing and measures used to assess housing and housing services. Then interviews were conducted with VA staff, veterans, and community housing providers to determine important domains and to assess the reliability and validity of the measures of these domains. This study resulted in the domains of Community Resources, Organizational Linkages, Strength and Quality of Services, Number & Variety of Services, Housing and Service Choice/ Veteran-centered care, Admission Requirements, Rules for Tenure in Housing, and Organizational Climate.
Extensive reliability and validity studies were done and the measure was applied to multiple HUD-VASH and Grant & Per Diem throughout Florida and Pennsylvania. Preliminary findings suggest this measure can be helpful both as a management tool, an aid in making policy determinations, and serve as important process information to interpret outcomes from research into homeless Veterans.
USF faculty have served as subject matter experts requires to provide guidance and consultation on existing and proposed statutes, regulations, directives, and other VA and non-VA policies as it relates to homeless services for The National Center on Homelessness Among Veterans, VACO Office of Mental Health Services. They have also evaluated and made recommendations on legislative proposals that impact VA homeless programs in an effort to maintain consistency in VA's overall approach to serving Veterans. Faculty has identified potential areas of collaboration with other federal agencies that would strengthen the continuum of care, while enhancing the efficiency of overall federal efforts. These efforts have included issues such as homelessness prevention, women Veterans who are homeless, rural homelessness, Housing First, Safe Havens, and justice involved Veterans.
MODEL DEVELOPMENT - HOUSING FIRST WITHIN HUD-VASH (VA SUPPORTIVE HOUSING)
USF, in partnership with the National Center VA staff and Pathways to Housing, Inc. (Dr. Sam Tsemberis) will be providing technical assistance to 14+ VA HUD-VASH sites across the country on the development and implementation of the Evidenced-Based Permanent Supportive Housing Model, Housing First, which incorporates an Assertive Community Team . Housing First is a person-centered approach designed to end homelessness and support recovery for Veterans and their families. Housing First provides immediate access to permanent housing through the HUD-VASH program and support services through the VA or contracted community providers to Veterans who have experienced long-term homelessness, are living on the streets or shelters and have a high prevalence of co-occurring mental health and substance use disorders.
Mark Engelhardt and Paul Smits will be taking the lead for USF-FMHI on providing technical assistance that includes program development; the use of the Housing First fidelity scale and on-site review of the VA's assertive community treatment teams and their community partners. The implementation of Housing First is a key element in the VA's plan to end homelessness for Veterans and their families.
JUSTICE SYSTEM INVOLVEMENT
Several projects focus on veterans who are involved in the criminal justice system. Projects include refinement of questions to identify returning service members and veterans in multiple service systems, such as at booking or classification for jail or prison. Identification of veterans is a complex issue given that there is no standard definition of what it means to be a "veteran." Such identification is essential for future research on this population as well as for provision of services (such as mental health, substance abuse and trauma related treatment). Another aspect of our work focuses on the models of peer mentorship used, such as with veterans courts. We are also partnering with teams from two other sites (Los Angeles and Philadelphia) to conduct a study using archival data to describe the service utilization of veterans before and after time spent in jail. This study emphasizes the use of data from both the VA and from a variety of community providers/entities, such as mental health service and criminal justice systems. The overall goal of this program of research is to add what we know about justice involved returning service members and veterans so that policy and services can be designed to meet their needs.
Funding for the VA Safe Haven model development project was designated to develop and implement a Safe Haven model that could be replicated throughout the VA, broadening its homeless continuum of care. Safe Havens were initially authorized by the McKinney-Vento Act of 1994 with funding provided by HUD's Permanent Supportive Housing Program. The primary mission of the first funded programs was to target dually diagnosed chronically homeless individuals who were ineffectively served by traditional homeless programs. HUD initially funded about 300 programs. The 2010 Annual Homeless Assessment Report to Congress (AHAR) indicated that there are only 128 Safe Havens providing a total of only 2,199 year-round beds (HUD, 2011).
The Center has utilized the Safe Haven Tool Kit Manual, Developing and Operating Safe Haven Programs, developed by HUD and the Substance Abuse and Mental Health Services Administration (SAMSHA) as a guide for both VA and community providers.
Researchers with the National Center are conducting fidelity visits with each operational VA Safe Havens approximately six months after the programs begin operating. Activities for each fidelity review include: 1) conducting interviews with VA and Safe Haven staff, 2) touring the facilities, 3) reviewing program materials, and 4) observing program activities.
COMMUNITY RESOURCE AND REFERRAL CENTERS (CRRC)
The VA National Homeless Program Office has provided funding for sixteen Community Resource and Referral Centers (CRRC) in strategically selected urban locations to provide "one-stop-shopping" to serve homeless and at-risk for homelessness Veterans and their families. All of the centers are located in community settings that facilitate access to critical services and supports. The CRRCs have been established in collaboration with local community-based homeless providers and other federal and state partners that provide services to persons who are homeless. The VA is working with these partners who are co-located at the CRRC sites to offer services such as 24/7 outreach/case management, vocational services, financial benefits, and immediate access to primary/behavioral healthcare treatment, shelter, residential care, and housing services. The National Center on Homelessness Among Veterans with USF is providing technical assistance to program sites with the development of the CRRC model, including the development of a program fidelity instrument and mechanisms to track program implementation/service integration.