VA Sunshine Healthcare Network (VISN 8)

1. VA Sunshine Healthcare Network (VISN 8) Homeless Program Overview

2. Mission: Honor America’s Veterans by ensuring exceptional health outcomes that improve their well-being. • Vision:To be a Veteran-Centered, integrated health organization ensuring excellent health outcomes and a Culture of Safety through care coordination, research, and education; an organization where people choose to work; an engaged community partner; and responsive to National emergencies. Mission and Vision

3. VA is committed to ending homelessness among Veterans. • Our focus is threefold: • Conducting coordinated outreach to proactively seek out Veterans in need of assistance. • Connecting homeless and at-risk Veterans with housing solutions, health care, community employment services and other required supports. • Collaborating with federal, state and local agencies; employers; housing providers, faith-based and community nonprofits; and others to expand employment and affordable housing options for Veterans exiting homelessness. No Veteran Should Be Without a Place to Call Home

4. Speakers Jeffery Quarles National Director Grant and Per Diem Programs Nikki Barfield VISN 8 Homeless Program Coordinator

5. VISN 8 Footprint • Square Miles: 64,153 • Medical Centers: 7 in FL, 1 in Puerto Rico (all highly accredited) • Community Clinics: 60+ • Vet Centers: 27 • VBA Regional Offices: 2 • National Cemeteries: 9

6. VISN 8 Homeless Program Budget

8. VISN 8 Homeless Programs

9. Sample of Comprehensive Programs • SSVF • HUD-VASH • GPD • HCHV • VJP • Coordinated Entry Specialist

10. Supportive Services for Veteran Families (SSVF) VA awards grants to private non-profit organizations and consumer cooperatives who can provide supportive services to very low-income Veteran families living in or transitioning to permanent housing. Grantees responsible to work with household on what services to provide. Program office provides guidance & oversight.

11. Integrating Care CES Product of Community Planning CoC

12. VISN 8 SSVF Data • 5,271 - Total SSVF Households served (8/31) Homeless Prevention: 1802, Rapid Re-Housing: 3589 • Number of Grantees in VISN 8: 17 • Total Funds in VISN 8 for FY 19: $31,832,175.00 • Note: Disaster relief in Florida, close to 1 million for FY 19 • Successful Rapid Resolution Pilot

13. Housing and Urban Development – Veterans Affairs Supported Housing (HUD-VASH) The Department of Housing and Urban Development and Department of Veterans Affairs Supported Housing (HUD-VASH) Program provides permanent housing and ongoing case management treatment services for homeless Veterans who require these supports to live independently. HUD has allocated “Housing Choice” Section 8 vouchers to Public Housing Authorities (PHAs) throughout the country for eligible homeless Veterans.

14. Policy: It is VHA policy for HUD-VASH to provide clinical case management and supportive services to Veterans in HUD-VASH by utilizing the principles of Housing First, a team-based model of care, comprised of multi-disciplinary staff, and shared caseloads. Chronically homeless and other vulnerable homeless Veterans, based on the HUD Prioritization Notice, are admitted to case management to support the ongoing effort to end Veteran homelessness. A coordinated entry process will be performed in conjunction with the CoC(s) where possible. • Rapidly move homeless Veterans into permanent housing while providing support and case management to help prevent a return to homelessness. • Assist formerly homeless Veterans retain housing and increase their self-sufficiency through support and case management.

15. Current Program Efforts • Exploring the development of project-based HUD-VASH to help address: • Limited access to safe and affordable housing • Needs of sub-populations such as the elderly or seriously mentally ill • FY 2019 HUD-VASH Voucher allocation • Approximately 5,000-5,500 new vouchers

16. HUD-VASH Real Time Data (as of 9/19/19)

17. Grant and Per Diem Program VA's Homeless Providers Grant and Per Diem Program is offered annually (as funding permits) by the Department of Veterans Affairs Health Care for Homeless Veterans (HCHV) Programs to fund community agencies providing services to homeless Veterans. The purpose is to promote the development and provision of supportive housing and/or supportive services with the goal of helping homeless Veterans achieve residential stability, increase their skill levels and/or income, and obtain greater self-determination.

18. Grant and Per Diem (GPD) Mission: GPD provides grants to community-based organizations that provide transitional housing with supportive services. The goal is to help homeless Veterans to achieve residential stability, increase skills/income, and obtain greater self-determination. • Major program transformation to align services with Housing First goals and eliminate overlaps in services • Time-limited awards with periodic reapplication. • Encourage grantees to lower barriers to entry and continuously engage with Veterans. • Implementation of 7 models: • Bridge, Clinical Treatment, Hospital to Housing, Low Demand, Service-Intensive, Transition In Place and Service Center.

19. GPD Models • Bridge – Short stay transitional housing for homeless Veterans that have been offered and accepted a permanent housing intervention but are not able to immediately enter the permanent housing • Clinical Treatment – provides Substance Use Disorder and/Mental Health focused treatment in conjunction with services effective in helping Veterans experiencing homelessness secure permanent housing and increase income through benefits and/or employment • Hospital to Housing – transitional housing model to address the housing and recuperative care needs of homeless Veterans who have been hospitalized (inpatient ) and/or evaluated in an emergency room • Low Demand – model utilizes a low demand/harm reduction strategy to serve homeless Veterans that cannot be reached by traditional homeless programs • Service-Intensive – provides transitional housing and a milieu of services that facilitate individual stabilization and movement to permanent housing • Transition In Place - model offers Veteran residents housing in which support services transition out of the residence over time • Service Centers – Provides services and information to engage and aid homeless Veterans obtain housing and services

20. GPD Data

21. Current GPD Efforts • September 5, 2019 – GPD Case Management Grant Awards Announced • 128 awardees providing 167 case managers • Every VISN and 89 VA medical centers • Grant award is two years, October 1, 2019- September 30, 2021 • Focus of this award is to support housing retention for formerly homeless Veterans and Veterans at risk for homelessness • Anticipate most Veterans will be graduates of GPD and HCHV • Will involve coordination with local programs to ensure smooth transition • Connections with VA and community resources will be important to support housing retention • Services for up to 6 months

22. FY 2020 Activities • Two NOFA’s anticipated for FY 2020: • Per Diem Only • Transition in Place • All grant awards for current transitional housing beds expire at the end of FY 2020 – over 12,000 beds nationwide. • Opportunity for GPD community partners to shift housing models and beds to meet the current needs of their community • Open to existing GPD grantees and new eligible organizations. • NOFA publication expected between Nov – Jan. • Awards would begin October 1, 2020 (FY 2021).

23. Health Care for Homeless Veterans (HCHV) • Outreach is the core of the HCHV program. The central goal is to reduce homelessness among Veterans by conducting outreach to those who are the most vulnerable and not currently receiving services and engaging them in treatment and rehabilitative programs. • Another aspect of HCHV is the Contract Residential Treatment program, which places Veterans with serious mental health diagnoses into quality, community-based, supportive housing.

24. Contracted Emergency Residential Services

25. Veterans Justice Programs (VJP) • The aim of the Veterans Justice Outreach (VJO) program is to avoid the unnecessary criminalization of mental illness and extended incarceration among Veterans by ensuring that eligible, justice-involved Veterans have timely access to Veterans Health Administration (VHA) services, as clinically indicated. • VJO specialists provide direct outreach, assessment and case management for justice-involved Veterans in local courts and jails and liaison with local justice system partners. • VA’s HCRV program is designed to promote success and prevent homelessness among Veterans returning home after incarceration. • Outreach and pre-release assessments services for Veterans in prison • Referrals and linkages to medical, mental health and social services, including employment services on release • Short-term case management assistance on release • VA cannot provide legal services

26. Coordinated Entry Specialist (CES)

27. VA Partnership with CoC • Policy requires all VAMC homeless programs to be fully engaged with each of their local CoCs. • At a minimum, this means participating in a formal decision-making body on decisions that impact Veteran homelessness. • Per VA Legal Counsel, VHA employees are legally permitted to participate and serve on CoC boards. This includes participating fully in the role of a CoC board member. • This POC should have decision-making authority as it relates to the VA’s ability to coordinate housing and services for homeless Veterans with that CoC and also assumes responsibility for communicating CoC goals and priorities to VA leadership.

28. What the Coordinated Entry Specialist Position Is and Is Not Is Is Not Sitting behind a desk. Focused only on VA Medical Center. Maintaining status quo only. Focused on only one homeless program. Traditional clinical VA social worker role. Data entry into HMIS. • Representing the VA out in the community. • Leading efforts to end Veteran homelessness within the community, alongside CoC. • Systems-builder, enhancer, thinker. • Ever changing, varied tasks requiring independent thinking. • Bridging gaps in understanding to create stronger systems of service for homeless Veterans. • Managing multiple priorities. • Collaboratively problem-solving systems issues with community stakeholders.

29. Community Case Conferencing • Successful coordinated entry systems are supported by consistent, inclusive community case conferencing meetings. • Case conferencing allows for case coordination and problem-solving to occur with all community partners who are serving Veterans experiencing homelessness in that community. • Case conferencing also provides an opportunity for the community to collectively make service prioritization decisions. • VAMCs must have at least one person assigned to participate consistently in each CoC’s case conferencing meetings. • This POC is expected to be the bridge of communication and have decision-making authority regarding housing options. • This POC is expected to come prepared to each case conference meeting with the most current client information allowable to share per VACO National Privacy Guidance, Routine Use #30, and other information sharing authorities.

30. Participation in By-Name Lists (BNLs) • BNL is defined as a real-time, up-to-date list of all veterans experiencing homelessness in a given community. • Utilizing a BNL allows communities to know each homeless Veteran by name, while also facilitating timely decisions around how to best assist them with available resources. • Where a CoC has an established BNL, VAMCs must actively participate in its maintenance. • This may include (but is not limited to) updating current housing or homelessness status, current program enrollment status, VA eligibility status, initial identification date, most recent contact date, and pending case management issues as appropriate.

31. Assessment Tools • Our partner CoCs are required by HUD to implement an assessment tool that is expected to be utilized by all community partners in their assessment of homeless individuals, including Veterans. • VAMCs are encouraged to adopt this local assessment tool whenever it is feasible. • Where full adoption with every CoC is not feasible, VAMCS are required to work collaboratively with their CoC to communicate their own internal VA screening and prioritization process so that the VA assessment findings can be incorporated into the larger CoC prioritization system. • This process must be clearly outlined and communicated to all community partners within the CoC providers, ideally through written policy.

32. Dedication of VA Resources • It is required that VAMCs dedicate a portion of available VA resources for their inclusion into the greater pool of homeless service resources accessed by Veterans through CES. • The degree to which VA resources are dedicated is at the discretion of VAMC homeless program leadership. • Where the full dedication of VA resources does not take place, the VAMC must work with the CoC to establish a clear process for making and receiving referrals for veterans screened through coordinate entry. • This process must be clearly outlined and communicated to all community partners within the CoC providers, ideally through written policy.

33. Questions?