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
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
The National Center on Homelessness Among Veterans
Promoting data-driven, evidence-based solutions to end Veteran homelessness
ABOUT THE NATIONAL CENTER
www.endveteranhomelessness.org
• Started in 2009
• Develops and
disseminates evidencebased policies,
programs and best
practices in support of
VA’s 5-year Plan to End
Homelessness Among
Veterans
Core Activities
Policy Analysis
Research &
Methodology
Model
Development &
Implementation
Education &
Dissemination
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
Number of Homeles Veterans On a Single
Night
13% of all homeless adults
80,000
70,000
75,609
76,329
60,000
67,495
62,619
•1 in 10 veterans in poverty
experience homelessness
over the course of a year
50,000
40,000
30,000
20,000
2009
2010
2011
•1 in 150 veterans
experience homelessness
over course of a year
2012
Homeless Veterans
Source: 2012 Annual Homeless Assessment Report to Congress
•Four states (California,
New York, Florida & Texas)
account for nearly half of
all homeless veterans
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
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.
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 preinspected apartments
• Voucher issued at time of
lease signing
• Housing First
The National Center on Homelessness Among Veterans
Promoting data-driven, evidence-based solutions to end Veteran homelessness
HOUSING PROCESS
Average time to placement (days)
250
223
Housing First
200
Treatment as Usual
150
134
100
73
50
25
0
0
Assessment
17
Admission
20
Referral to PHA
33
35
Voucher
Move-in
The National Center on Homelessness Among Veterans
Promoting data-driven, evidence-based solutions to end Veteran homelessness
COST: URGENT CARE
Annualized cost of urgent care per Veteran
$900
$800
$806.93
$799.08
$759.13
Housing First
Treatment as Usual
$700
$660.22
$600
$530.81
$500
$400
$300
$257.41
$200
$100
$Pre-Admission
Interim
Post-Housing
9
The National Center on Homelessness Among Veterans
Promoting data-driven, evidence-based solutions to end Veteran homelessness
COST: INPATIENT MENTAL HEALTH
Annualized cost of inpatient mental health
services per Veteran
$20,000
$19,010.36
Housing First
$18,000
Treatment as Usual
$16,000
$14,133.53
$14,000
$12,000
$10,000
$8,000
$6,000
$4,000
$3,480.82
$2,205.73
$2,000
$2,115.08
$258.64
$Pre-Admission
Interim
Post-Housing
10
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
%
99
98.0%
59
85.5%
Housed with a HUD-VASH voucher
98
91.6%
55
78.6%
Housed with ongoing subsidy
0
0.0%
3
4.3%
Housed with no ongoing subsidy
1
0.9%
1
1.4%
Prison/Jail
1
0.9%
2
2.9%
Deceased
6
5.6%
1
1.4%
Unknown
1
0.9%
8
11.4%
Veterans Currently Housed*
Housing Status
* % Excludes deceased Veterans
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
The National Center on Homelessness Among Veterans
Promoting data-driven, evidence-based solutions to end Veteran homelessness
2. VA HOUSING FIRST DEMONSTRATION
• 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
The National Center on Homelessness Among Veterans
Promoting data-driven, evidence-based solutions to end Veteran homelessness
2. VA HOUSING FIRST DEMONSTRATION
• 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
The National Center on Homelessness Among Veterans
Promoting data-driven, evidence-based solutions to end Veteran homelessness
2. VA HOUSING FIRST DEMONSTRATION
• 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)
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 wellbeing
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
The National Center on Homelessness Among Veterans
Promoting data-driven, evidence-based solutions to end Veteran homelessness
A. SSVF OVERVIEW
319
$300
350
$300
300
$250
250
$200
200
151
$150
$100
150
$100
85
100
$59.5
$50
50
$0
0
FY 2012
FY 2013
Funding
FY 2014
Grantees
Numberof SSVF Grantees
$350
Available SSVF Funds (in millions)
• Funds communitybased organizations to
provide homelessness
prevention and rapid
rehousing services to
veteran households
• Short-term assistance
to maintain/obtain
housing
• “But for” intervention
SSVF Funding and Grantees
The National Center on Homelessness Among Veterans
Promoting data-driven, evidence-based solutions to end Veteran homelessness
Returns to Homelessness Post SSVF Exit:
Prevention
Survival Proportion
Singles
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Families
1 Year
Singles: 10.8%
Families: 6.8%
0
60
120
180
240
300
360
Days since SSVF Exit
420
480
540
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
Survival Proportion
Singles
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Families
1 Year
Singles: 15.7%
Families: 10.1%
0
60
120
180
240
300
360
Days Since SSVF Exit
420
480
540
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
Veterans1
– 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 homelessness2
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
C. HOMELESSNESS ANALYTICS APPLICATION
www.homelessnessanalytics.org
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