HUD-VASH Update February 10,2009 Vince Kane, MSW Office of Mental Health Services

1. HUD-VASH Update February 10,2009 Vince Kane, MSW Office of Mental Health Services

2. HUD-VASH Goal: To move veterans and their families out of homelessness. Primary Components: Permanent independent community-based housing. VA case management services, designed to improve the veteran’s health and mental health, and to enhance the veteran’s ability to remain stable, housed, and community-integrated.

3. HUD-VASH • The HUD-VASH Program is a collaborative partnership between the Department of Housing and Urban Development (HUD) and the Department of Veterans Affairs (VA) Supported Housing (VASH) • In this partnership, HUD provides Housing Choice vouchers for permanent housing to homeless veterans while VA provides veterans with case management and supportive services to promote and maintain recovery and housing.

4. HUD- VASH Eligibility • DEFINITIONS Homeless. The HUD VASH definition of homeless is the definition in the McKinney Act, Title 42, United States Code, Section 11302. See 38 USC 2002(1). The definition of “homeless” is as follows: • An individual who lacks a fixed, regular, and adequate nighttime residence, or

5. Homeless Definition, Continued • An individual who has a primary nighttime residence that is: • A supervised publicly or privately operated shelter designed to provide temporary living accommodations including welfare hotels, congregate shelters, and transitional housing for the mentally ill; • An institution that provides a temporary residence for individuals intended to be institutionalized; or • A public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings

6. HUD VASH Eligibility • Veteran-participants in the HUD-VASH Program must meet VA health care eligibility as defined by law and regulation (including enrollment in the VA health care system)

7. HUD VASH Eligibility • Based on historical demographic information, the expected referral population for HUD-VASH are homeless veterans, usually with mental health and addiction disorders • Other homeless veterans with diminished functional capacity and resultant need for case management are also eligible for the program

8. HUD VASH Eligibility Expanded focus goes beyond chronic homelessness and now includes: • Homeless veterans with children • OEF-OIF homeless veterans • Women homeless veterans • Homeless veterans with other medical conditions

9. Principle Sources of Referral • HCHV Outreach Program • Primary contact with homeless veterans • Helps to direct homeless veterans to appropriate services • Other VA Homeless Programs • Residential Treatment Programs • Grant & Per Diem • Other VA Programs • Mental Health programs • Social Work • Primary Care, etc. • Community Agencies • Community agencies may make direct referrals • Community education provides referrals to VA

10. HUD-VASH Outreach • HUD-VASH case managers visit community agencies that provide services to homeless veterans to: • Educate the agency about the HUD-VASH program • Meet with potential program candidates • HUD-VASH case managers work with VA homeless programs to: • Assist veterans who are involved in the VA homeless continuum of care • Determine if the veteran is an appropriate candidate for the program

11. Assessment Process • Confirm eligibility • Assess for suitability • If not housing ready, possible acceptance pending treatment in residential and/or inpatient setting • If not appropriate, alternative treatment plan developed • Determine need for other services to ensure adequate income, skills and support to maintain housing status once placed • Multidisciplinary team to make determination on acceptance

12. Entry Into HUD-VASH • Once accepted, an individualized treatment plan is developed by the case manager and the veteran. • Treatment plan reflects the goals of the veteran, addressing • Potential strengths and • Barriers to maintaining housing placement • Establish process to monitor treatment plan • Parameters of alcohol and drug screening • Frequency of medical and mental health appointments • Assistance with employment and income needs • Resolution of legal and financial issues

13. Case Management Goals • Establish a therapeutic relationship • Provide support for long-term recovery by working toward treatment plan goals • Reassess needs and goals based on changing conditions • Inability to maintain sobriety does not generally lead to discharge from case management if veteran can maintain housing • Veteran may require brief intervention or higher level of care • Foster community integration and independence • Maintain veteran in housing

14. Case Management Work to obtain and sustain stability and functioning Work to obtain items required to secure housing Credit History and Repair Identification (Photo) Driver’s License or other government issued picture ID Birth certificate DD-214 Income

15. Case Management: Credit History Poor credit history delays housing process Landlords require credit history report Lengthy process Begin at first contact to seek credit report Work toward resolving credit history Expense involved Money management and budgeting classes Work with landlords to “vouch” for veteran’s future payment of rent/ utility bills

16. Case Management: Identification Veterans need identification for obtaining voucher and apartment Limiting factors: Income shortage No stable address to receive mail or put on ID Illiteracy – problems with forms/ requests One form of ID requires another – to get birth certificate, need picture ID DD-214 is usually acceptable as one form of ID

17. Case Management: Income Certain level of income is required in order to improve success of veteran in program Not covered by voucher: Security Deposit Utilities Food Furniture Necessities (ex. Soap, towels, sheets, dishes, etc.)

18. Case Management: Income Evaluate Income: Employable? Disabled? How much income/ source Eligible for any income benefits? Social Security Veterans Benefits Service Connected Benefits Non-Service Connected Benefits NSC Pension Food Stamps, etc.

19. Case Management: Income Seek Employment Income Apply for work Apply for Compensated Work Therapy (CWT) program Seek Vocational Rehabilitation, if appropriate VBA VHA State Special Veterans Programs with Labor Department, etc.

20. Case Management: Income Seek Benefits Follow-up on status of benefits claims that are already being processed Apply for benefits that veteran appears to be eligible for Social Security Office visit(s) Meet with Veterans Benefits Officer Assist veteran with getting documents needed to process claim (lengthy and time consuming process)

21. PHA Referral • VA HUD-VASH Case Managers determine veterans to be eligible for the HUD-VASH Program • Veterans have been through assessment, stabilization, treatment and participating in recovery plan development • Veterans have the items they need for the PHA • Identification • Income source(s) • Completed PHA required forms, etc.

22. PHA Referral • Referral is in writing to the PHA from the VA Case Manager • If functionally indicated, the Case Manager assists with: • Completing forms • Transportation • Supporting veteran in meeting PHA and through the PHA process • Addressing obstacles and barriers • Providing organization to the process • Communication between PHA and veteran, etc.

23. Voucher • VA HUD VASH Case Managers determine clinical eligibility • PHA determines if the veteran meets their/ HUD criteria

24. Housing Placement • Alert PHA of referral in writing • As needed, assist veteran in completing and assembling required documentation • Following PHA guidelines, assist veteran in locating suitable housing • Request PHA inspection and approval of selected unit

25. Housing Placement • Assist veteran and landlord to complete lease • Prepare for the move as needed by providing planning assistance and guidance • Turning on utilities • Obtaining furnishings and supplies • Transportation to complete the move

26. Delivery of Services • Coordinate VA and community interventions • Act as a liaison with critical partners • Landlord • Other service providers • Make regular home visits to assess veteran’s ability to maintain themselves in a safe environment that promotes • Sobriety • Physical health • Mental well-being

27. Delivery of Services • Schedule individual and group meetings • Individual sessions will focus on treatment plan and current needs • Group meetings should foster peer support • Provide linkages for • Child care • Medical coverage for family members (ex. Medicaid) • Family therapy • Legal and income assistance programs

28. Continuance • Regular Re-assessment by Case Managers • Revision of treatment plan as: • Goals reached • Treatment needs change • Veteran’s goals change • Veteran becomes more independent • Level of care changes

29. Continuance • Coach and mentor • Monitor and sustain • Goal and outcome focus • Foster independence • Celebrate goal/ outcome completion • Maintain appropriate boundaries and ethics • Support positive growth • Promote healthy choices

30. Completion • Veterans who no longer require case management services may: • Need longer “trial” periods without case management to determine veteran’s ability to manage independently • May have case management services stop following mutual agreement that • Goals and objectives have been met • Veteran has been able to independently sustain housing • Veteran no longer requires supportive case management services

31. Completion Case manager and veteran meet with PHA to discuss termination of case management services • If PHA has alternative voucher they are willing to give to the veteran, then HUD-VASH will get the original voucher back to use with another eligible homeless veteran • If PHA does not have alternative voucher, veteran would continue with HUD-VASH voucher until it was no longer needed

32. HUD VASH Program Updateas of November 2008 4,979 veterans in case management 4,519 veterans referred to Public Housing Authority 3,538 vouchers issued to veterans 1,160 formerly homeless veterans are housed

33. HUD- VASH Expansion OMHS Program officials are working with HUD to collaboratively discuss expansion of the program 10,000+ new vouchers are projected for implementation in late second quarter of 2009 Number of new case managers being finalized