Supportive Services for Veteran Families (SSVF) Webinar Series

1. Supportive Services for Veteran Families (SSVF)Webinar Series Developing a Reasonable Plan for SSVF Veteran Families January 19, 2012

2. Presenters Robert Thompson, VA SSVF Regional Coordinator Melany Mondello, Technical Assistance Collaborative Marge Wherley, Abt Associates Stephanie Nagy, Abt Associates

3. Webinar Format • Webinar will last approximately 2 hours • Participants’ phone connections are automatically “muted” due to the high number of callers

4. Submitting Questions During the Webinar • Questions can be submitted via email at SSVF@va.gov • Questions will be answered either individually or through an update to the SSVF Frequently Asked Question resource.

5. SSVF Hot Topics

6. Objectives During this webinar we will review the following: • Requirements for SSVF Veteran Family Plans • Elements of a Reasonable Plan • SSVF Case Examples • Examples of Reasonable Plans

7. What’s Required? • Case managers must adequately address participant’s needs. 62.31 Case management services: “…Developing and monitoring case plans in coordination with a formal assessment of supportive services needed, including necessary follow-up activities, to ensure that the participant’s needs are adequately addressed.”

8. What’s Required? • The plan must address the participants’ future ability to pay bills SSVF has paid: 62.33-34 “…as a condition of providing payments for child care services (or rental assistance, or utilities), the grantee must help the participant develop a reasonable plan to address the participant’s future ability to pay for child care services (or rent or utility payments).”

9. What’s Required? • The plan should address future housing stability if SSVF has assisted the participant to be re-housed or re-located. 62.34 “As a condition of providing a security deposit payment or a utility deposit payment (or moving costs assistance), the grantee must help the participant develop a reasonable plan to address the participant’s future housing stability.”

10. What does “Address” Mean? Synonyms: • Tackle • Focus on • Concentrate on • Deal with • Attend to Antonym: • Ignore

11. A “Reasonable Plan”… ….“Tackles” and “ deals with” the issues contributing to the participant’s homelessness or risk of homelessness …. “ Concentrates” and “Focuses” on the participant’s poverty and personal issues ….Doesnot “ignore” housing barriers

12. A “Reasonable Plan”… …Does not guarantee that every plan will be successful …Does not assure/ensure that participants will no longer be poor or rent-burdened …Does not promise an end to future (longer-term) housing risks, housing crises or homelessness

13. What does the Reasonable Plan Address? • Housing Barriers that are economic/financial and which are currently threatening housing stability • Housing Barriers that are due to a lack of information, a lack of skills, and/or self-defeating patterns of behavior (whether or not those behaviors are associated with a disability) if they are affecting housing stability

14. PART ONE: Addressing Financial/Economic Housing Barriers Start by addressing our common assumptions: • People below 30% of Area Median Income cannot afford housing and • People should not pay more than 30% of their income on rent …Therefore, we should not accept participants with incomes below 30% of AMI unless we can assure them a deep, permanent housing subsidy.

15. Challenging the Assumption Among households who rely primarily on public benefits for income, approximately 10% become homeless in a year. But that also means that 90% do not become homeless—even though only a small percentage have a deep rental subsidy. What? You don’t believe it? Let’s look at an example.

16. Hennepin County, Minnesota 1570 families who entered a homeless shelter between 1/1/08-10/31/09: • 66% had incomes of $0-$499/month • 28% had incomes of $500-$999/month • Only 2% spent 35% or less of their income on housing (i.e. they had a deep rental subsidy) • 93% spent 66-80% of their income on rent • Head of household under age 22: 29% • Head of household age 22-29: 39% • Children age 0-6 years in family: 93%

17. These households were at or below 15% of AMI…and yet: • Rapid Re-Housing Assistance was provided • With help, they found permanent housing within about 30 days AND • 95% did not return to homelessness within 12 months of leaving shelter EVEN THOUGH • Income increases for participants were minimal during 6 months of Rapid Re-Housing services AND EVEN THOUGH • The great majority received neither an initial nor an ongoing rental subsidy

18. Therefore…. It is reasonable to plan that a household can obtain and maintain housing …even if they are extremely low income …even if they cannot and do not secure a deep rental subsidy

19. What is possible for some to achieve may not be reasonable to expect for many Data from the first year of HPRP showed that only 6.2% (of over 200,000 households) increased their income during the program. The vast majority, 70.3%, showed no change in income. 25.7% entered HPRP with no income and 22.6% exited with no income. Is it reasonable to set expectations/goals and develop case plans that focus on a significant increase in income during SSVF?

20. A Reasonable Plan for Addressing Income Barriers The goal is any increase in income that is available to pay rent. Many approaches (especially in combination) can accomplish this: • Secure Additional Benefits: Income supports (e.g. VA Benefits, Disability Lump Sum and Monthly Payments), Energy Assistance, Food Supports, Unemployment Compensation, Workers Compensation (e.g. Payment of medical bills or payouts for permanent partial disability), Earned Income Tax Credit • Increase Earned Income: Temporary Work, Day Labor, Additional Hours, Increased Pay Rate, Overtime/Holiday Work, Advertise to do Odd Jobs • Reduce Expenses: Rent Subsidies, In-Kind Commodities, Budgeting Strategies, Decrease Utility Usage, Subsidized or Relative Childcare; Relocating to a Less Expensive Housing Unit, Home-Sharing.

21. PART TWO: Addressing “personal” housing barriers Start by addressing some common assumptions: • People with personal problems and/or disabilities cannot achieve or maintain stable housing UNLESS • Programs take a holistic approach that addresses and includes all needs in all life areas.

22. Challenging the assumptions: Hennepin County’s Rapid Re-Housing Data 1/07-2/08 • Level 2 Families: Moderate Barriers Chemical Use has resulted in housing loss: 3% Mental Health has resulted in housing loss: 2.9% Domestic Violence has resulted in housing loss: 61.8% Felony: 1.6% • Level 3 Families: Moderately Severe Barriers Chemical Use has resulted in housing loss: 10.0% Mental Health has resulted in housing loss: 36.7% Domestic Violence has resulted in housing loss: 26.3% Felony: 13.3%

23. Hennepin County’s Rapid Re-Housing Data 1/07-2/08 • Level 4 Families: Chronically Homeless Chemical Use has resulted in housing loss: 16.0% Mental Health has resulted in housing loss: 53.5% Domestic Violence has resulted in housing loss: 38.2% Felony: 11.6% • Level 5 Families: Very Severe Housing Barriers Chemical Use has resulted in housing loss: 19.0% Mental Health has resulted in housing loss: 50.00% Domestic Violence has resulted in housing loss: 33.3% Felony: 32.5%

24. #1: The Decision to Assist AUDIENCE POLL How many of you would accept Level 4 Veteran Families (Chronically Homeless) for assistance in your SSVF program? __YES __NO __NOT SURE

25. #2: The Decision to Assist AUDIENCE POLL How many of you would accept Level 5 Veteran Families (Very Severe Housing Barriers) for assistance in your SSVF program? __YES __NO __NOT SURE

26. Rapid Re-Housing Program Components • Initial barrier level assessment, within 3-5 days of shelter admission • Housing search, landlord/lease negotiations, move-in • Housing start-up costs: application fees, security deposit, first month’s rent, moving costs • Landlord and tenant supports for 6 months

27. Rapid Re-Housing: What was NOT provided No rental subsidies were attached to the program. Any subsidies participants were able to secure were obtained via referrals to community programs. No treatment for CD, MH or DV was provided. While treatment was sometimes encouraged, it was not required. Any treatment participants chose was offered via referrals to community programs. The case plan was not focused on resolution or improvement in life areas that were unrelated to getting and keeping housing. A participant could, if they wished, add such goals, but the case plan was not structured around life domains.

28. Rapid Re-Housing Successful Outcomes (No return to homelessness within 12 months of leaving shelter)

29. A Reasonable Plan for Addressing Personal Barriers Goals/Strategy: • Change the environment to reduce demands to a level the participant can manage AND/OR • Teach new skills that allow the participant to manage demands more successfully AND/OR • Reduce behaviors that threaten the participant’s ability to get and keep housing

30. Let’s Talk About Personal Change • Many of our problems can be thought of as “bad habits.” Habits are behaviors, thoughts and emotional reactions that do not require any conscious attention. • Stopping old, bad habits takes more than just willpower; those habits are created, reinforced and sustained by neurotransmitters. Dopamine circuits constantly calculate reward opportunities and drive us toward short-term rewards. • This makes sense from a survival perspective, but doesn’t help much when you’re trying to avoid busting your budget or blowing up at your landlord!

31. More Reasons Why it’s Tough to Change • Stress, whether physical or emotional, activates another neurotransmitter (serotonin) that causes production of more dopamine. Stress thus makes you more likely to go on autopilot—and continue or revert to old habits. • There is a genetic component to this—a deficiency in a particular dopamine receptor—that makes some people more likely to become addicted, obese or suffer from PTSD — i.e. to develop patterns of behavior, thoughts and emotional responses that can be maladaptive but hard to change.

32. And if that’s not enough…. • Lack of exposure to opportunities for rewards in your life generally diminishes drive and motivation (dopamine). Reduced dopamine reduces the excitability of other neurons that are supposed to put the “brake” on drives toward short-term rewards. In other words, if you’ve lacked chances to make your life better, you are more likely to impulsively (and unconsciously) seek immediate gratification. • Short-term “rewards” may be enough to escape a blizzard or eat a meal. But they aren’t enough to assure longer-term housing stability!

33. What does it take to get rid of old, maladaptive habits and form new and better ones? Change beliefs, values and expectations about short vs. long-term rewards Connect the habit to long-term <negative> consequences Pre-plan for high-risk situations where the habit may re-emerge or be reinforced Avoid high-risk situations when possible and have alternative solutions ready if/when the trigger occurs Interact with people who value what we want to value

34. What does it take to get rid of old, maladaptive habits and form new and better ones? Remove secondary gains/reinforcement for maladaptive habits Enrich your lives—creating a reward-rich environment Train competing “good” habits and practice, practice, practice Develop a sense of control Take care of stress: eat and sleep right, pace yourself, develop cognitive flexibility and problem-solving ability

35. And, even then…. • Self-regulation in one domain reduces self-regulation in other domain(s) • In other words, while successfully managing one new habit, you are less able to perform any other new habit. • BTW: providing glucose (sugar) reduces brain fatigue caused by self-regulation of Habit #1 and may help you deal with Habit #2! (But only on a short-term basis.)

36. Why am I telling you all this? • When we, human service people, assess a problem, we want to DO SOMETHING RIGHT NOW! • People cannot change all their maladaptive behavior patterns and bad habits simultaneously (and possibly not even sequentially) in the short-term. It’s a neurological no-brainer! • SSVF is not designed to achieve long-term behavior change—nor are we clinically competent to do so! • So what is a “reasonable plan” to address personal barriers to housing stability?

37. So, What Should You Do? Use reasonable planning principles to address behavior, thoughts and emotional responses that threaten immediate (and, often, long-term) housing stability: • Prioritize — your perspective: Not every problem or need is directly and immediately related to housing stability (e.g. increasing parenting skills—unless the participant has been evicted for the behavior of her/his children). What is most urgent and most relevant from your point of view?

38. So, What Should You Do? (cont.) • Prioritize — based upon the participant’s perspective; Hopefully s/he agrees with you about the most urgent changes needed to stabilize housing, and/or has additional insights about the causes and solutions for the housing crisis. • Select a limited number of priorities (after all, that’s the point of prioritizing!)

39. So, What Should You Do? (cont.) • Gauge the level of expertise needed to achieve priority goals. You are most likely to be effective at providing information about leases and the “soft” expectations of tenancy, teaching basic skills (budgeting, threshold levels of home maintenance, household budgeting, income- enhancing or expense-reducing resources), offering strategies for dealing with conflict between the participant and landlord/tenants, etc. • Develop action steps for the goals you will directly support. What will you do? What will the participant do? When will it happen? How will you both monitor progress?

40. So, What Should You Do? (cont.) • Everything else can and should be: POSTPONED and/or REFERRED TO A COMMUNITY RESOURCE

41. Know your VA and Community Resources! • Know exactly what is offered, by whom • Who has the resources and the expertise? • Know the target population and admission criteria for every relevant service • Know the application process • Know the gatekeepers who can influence the success of a referral • Know the average wait list/time to obtain an appointment

42. Case Scenarios We’re going to consider two actual case scenarios* recently submitted to the Regional Coordinators by SSVF grantees: Case A. Homeless Veteran (Category 2) Case B. Veteran Being Evicted (Category 1) *Where information was not available, it was added (for clarity) and names were changed. The Veteran’s housing situation, barriers, plans and outcomes are real. The “case consultation discussion” is entirely fictitious but represents the kind of team decision-making that any SSVF program can utilize.

43. Case A: Henry In the past year, Henry, age 62, has spent 344 nights in the local homeless shelter. He has zero income. He was referred to SSVF by a Veteran representative at the shelter. During eligibility screening, SSVF verified his status as “Under Honorable Conditions.” His income is below 50% AMI and he is literally homeless (Category 2). He is eligible for SSVF.

44. #1: The Decision to Assist AUDIENCE POLL How many of you would accept Henry for assistance in your SSVF program? __YES __NO

45. If You Voted NO AUDIENCE POLL Why? Pick the answer that was most important to your vote - choose only 1 answer • We don’t work with people who have zero income (screening policy) • We don’t work with people who are experiencing chronic homelessness (screening policy) • I don’t think we can help him within the time limits of SSVF Temporary Financial Assistance

46. #2: How to Assist (What is a Reasonable Plan?) Housing: Is it reasonable to find housing for someone who has zero income? What kind of housing is reasonable? Income: Is it reasonable for Henry to secure income from employment? What public benefits could he reasonably obtain? Can this be accomplished within the limits of SSVF rental assistance? If not, will Henry be homeless again?

47. Goals for the Plan • Housing Goals: Find housing, using SSVF for deposit and “bridge” rental assistance. • Income Goals: • Obtain Section 8 (non-VASH) rental subsidy (Henry is on a waiting list for Section 8) • Obtain VA benefits (Henry has had a VA Compensation and Pension case pending for nearly a year but his case has not advanced) If both goals are met, Henry will have affordable housing and discretionary income. Research continues to show that a permanent housing subsidy is the most effective method of achieving long-term housing stability.

48. Action Steps to Achieve Henry’s Goals • Case manager will contact Housing Authority to identify any means of improving access to Section 8. Henry did not identify himself as a Veteran—this could gain him priority. • Case manager will contact VA to identify status of Comp and Pension case. Case manager will obtain any additional documentation needed. • Case manager will assist Henry to obtain low-cost housing while housing subsidy and VA benefits are pending.

49. Outcomes • Henry received a Section 8 voucher. The voucher was for another city that is still within the SSVF’s catchment area. The case manager assisted in a new housing search, the Housing Authority conducted the housing inspection and the SSVF program provided the security deposit. Henry obtained his housing. • Henry was awarded a Non-Service Related VA Pension of $1,021, beginning December 1.

50. What Additional Supportive Services Could be Offered to Henry to Maintain Housing? With Henry’s consent: • Offer some level of mediation/intervention to landlord, for xxx period of time, in case of conflict, lease violation or non-payment. • Offer tenancy and budgeting supports to Henry, including home visits to look for red flags. • Offer assistance in securing mental health services for Henry -- if needed and wanted.