VA Nebraska-Western Iowa Health Care System Veterans & Homelessness August 6-8, 2013

NWIHCS Mission: Honor America’s veterans by providing exceptional health care that improves their health and well-being. 2

Ending Veteran Homelessness Eliminate Veteran homelessness by 2015 Tools to accomplish this goal: 6 Strategic Pillars 5 Year Plan Collaboration Utilization of resources 3

The term "homeless" or "homeless individual or homeless person" includes–– 1. an individual who lacks a fixed, regular, and adequate nighttime residence; and 2. an individual who has a primary nighttime residence that is–– A. 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); B. an institution that provides a temporary residence for individuals intended to be institutionalized; or C. a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings." 4

Overview of Homelessness 62,619 Veterans estimated to be homeless on any given night* Homelessness is often a consequence of multiple psychosocial factors, including unstable family supports, job loss, inadequate job skills, health problems, substance use disorder, or other mental health concerns. Homeless services cannot be provided in isolation. Homeless services must be comprehensive  recovery-oriented,  support physical and mental health stabilization and treatment,  provide substance use disorder treatment,  enhance independent living skills,  address vocational rehabilitation and employment maintenance,  assist with housing searches and placement. *VA Community Homelessness Assessment, Local Education and Networking Group (CHALENG) Annual Report,

Health and Mental Health Needs of Homeless Veterans 66% Alcohol Abuse 51% Drug Abuse 54% Serious Psychiatric Diagnosis 39% Dual Diagnosis 58% Health/Physical 6

National Coalition for Homeless Veterans About 20% of general homeless population are Veterans; Veteran make up only 8 percent of the population Nearly half of homeless Veterans are from the Vietnam Era Two-thirds served at least 3 years and one-third served in a war zone 1.5 million Veterans are at-risk for homelessness 7

VA Five-Year Comprehensive Plan to Eliminate Homelessness Among Veterans VA will expand existing programs and develop new initiatives to prevent Veterans from entering into homelessness and to treat those who are currently homeless.  Increase the number and variety of housing options including permanent, transitional, contracted, community-operated, and VA-operated  Provide more supportive services through partnerships to prevent homelessness, improve employability, and increase independent living for Veterans  Improve access to VA and community based mental health, substance abuse, and support services These program enhancements will provide housing, VA health care and benefits, gainful employment and residential stability to more than 500,000 Veterans 8

Causes of homelessness Extreme shortage of affordable housing Lack of livable income Access to health care PTSD and addiction issues Childhood abuse and poverty Involvement in the legal system 9

VA Five-Year Comprehensive Plan to Eliminate Homelessness Among Veterans The provision of safe housing is fundamental. However, programming must include:  mental health stabilization; substance use disorder treatment services; enhancement of independent living skills; vocational and employment services; and assistance with permanent housing searches and placement. 10

National Research Findings Dennis Culhane & Research Team 30% reduction in use of publicly funded services if a homeless mentally ill person uses service-enriched housing vs. emergency shelters. 33% decrease in the use of medical and mental health services directly attributable to service-enriched housing. NY/NY supportive housing costs 48 % less than emergency housing Corporation for Supportive Housing Summary, May

Strategy to End Homelessness Among Veterans Outreach/ Education Prevention Treatment Housing and Supportive Services Income/ Employment/ Benefits Community Partnerships 12

Homeless Prevention Services Types Universal Prevention Public information regarding the availability of resources/services Medical Treatment Mental Health Treatment Substance Use treatment Economic Benefits Targeted Prevention- Supportive Services for Low Income Families Homelessness Prevention Pilot (HUD-VA) Relapse prevention services Justice Involved Veterans 13 Prevention

Homeless Prevention Services Programs for Justice-Involved Veterans Transitional planning for Veterans discharging from the justice system Veterans Justice Outreach Specialists at each VA medical center Outreach and education for law enforcement Linkage to VA services for Veterans in treatment courts, including Veterans Courts FY 09: 4,500 aided by 39 VHA Re-entry Specialists FY 10: 7,500 Veterans served (HCRV and VJO); staffing enhancements for VJO FY 12: 7,694 Veterans Served. Supportive Services for Low-Income Veteran Families Grants to provide case management and supportive services for low-income Veteran families Services include financial assistance to prevent Veterans falling into homelessness FY 09: Program development FY 10: Award Grants; 5,000 Veterans served 14 Prevention

Homeless Prevention Services HUD-VA Prevention Pilot Collaboration with HUD to provide housing and intensive case management OEF/OIF focus Targeting areas with large numbers of returning Veterans FY 10: Veterans and families served FY 12: 329 Unique Veteran served. Health Care for Homeless Veterans Contract Residential Care An immediate resource at each VA medical center to realize the commitment to “no wrong door” Homelessness prevention and rapid re-housing FY 09: 1,600-2,000 Veterans expected to be served FY 10: 4,800 Veterans served FY 11: 8,141 Veterans served FY 12: 11,402 Veterans served 15 Prevention

Outreach & Education Outreach by VA and community partners  Shelters  Soup Kitchens  Street Outreach  Stand Downs  Justice Outreach and Re-entry Services VA National Homeless Call Center 16 Outreach& uc Outreach & Education

Outreach & Education Homeless Registry Database to track and monitor prevention and treatment outcomes Dual focus: Program performance and outcomes for Veterans FY 09: No registry exists FY 10: 200,000 Veterans entered into registry National Call and Referral Center Resource for homeless Veterans and advocates seeking immediate assistance Linkage to wide array of VA and community resources FY 09: No formal system exists FY 10: 15,000 Veterans served 17 Outreach& uc Outreach & Education

Treatment Access, Access, Access and the “no wrong door policy” Assessment, Comprehensive Treatment and Rehabilitative Treatment includes: Medical care Mental Health Care Substance Abuse Care Dental Care Assessment and development of comprehensive treatment plans for: Psychosocial Issues Family Issues Legal Issues Vocational Issues 18 Treatment

VA Residential Rehabilitation and Treatment Programs VA-operated residential care programs Access to full spectrum of available services, plus in-house programming FY 09: 2,000 residential beds; 5,000 Veterans served FY 10: 5,300 Veterans served Dental Care Enhanced effort to promote dental care for homeless Veterans FY 09: 11,000 Veterans served FY 10: 20,000 Veterans served 19 Treatment

Housing and Supportive Services Provision of transitional and permanent housing with supportive services in collaboration with Federal and Community Partners. Provision of Community based Residential Treatment 20 Housing and Supportive Services

Housing and Supportive Services HUD-VASH Program Nation’s largest supported permanent housing initiative; combines permanent housing with case management and supportive services that promote and maintain recovery and housing stability HUD Housing Choice vouchers VA dedicated case management services FY 09: 20,000 vouchers allocated FY 10: 30,000 vouchers allocated; 22-24,000 Veterans housed FY 12: 48, 183 vouchers allocated. Grant and Per Diem Transitional housing (up to 24 months) and supportive services for homeless Veterans Enhancement will allow grantees to provide additional beds FY 09: 18,000 Veterans served FY 10: 20,000 Veterans served FY 11: 21, 412 Veterans served FY 12: 22, 983 Veterans served 21 Housing and Supportive Services

Income, Employment & Benefits Employment assistance Entitlement assistance  Expanded GI Bill  Social Security Benefits  Veteran’s Compensation and Pension  VRAP Short-term financial assistance  Shallow subsidies through HUD-VASH  General Assistance (GA)  Temporary Assistance to Needy Families (TANF) Vocational Rehabilitation Supportive Employment/CWT 22 Income, Employment & Benefits

Income, Employment & Benefits Supportive Employment/Compensated Work Therapy (CWT) Employment program targeted at Veterans with significant health problems Access to full spectrum of available services, plus in-house programming FY 09: Approximately 5,000 Veterans served FY 10: 5,500 Veterans served Expedited Claims for Homeless Veterans Collaboration with VBA Ensure timely processing of homeless Veterans’ benefits claims FY12: 14,650 Veterans served FY13 (YTD): 10,872 Veterans served Homeless Veteran Reintegration Program (HVRP) Collaboration with Department of Labor Provide Veterans with gainful employment FY 09: 15,000 Veterans served FY 10: 20,250 Veterans served 23 Income, Employment & Benefits

Homeless Services Outreach  Last year provided outreach to 1,422 Veterans last year  109 of these individuals were women  Female Veterans were 8% of uniques 24

Current Programming Contract Residential Housing  22 beds with 12 at Lutheran Home in Omaha and 10 with CenterPointe in Lincoln Grant & Per Diem (136 beds total)  30 in Lincoln at People’s City Mission; 25 in Lincoln at CenterPointe (Transition In Place)  81in Omaha 12 at Salvation Army 25 at Salvation Army (Transition in Place) 16 at Siena/Francis House 4 Stephens Center 26 Christian Worship Center/New Visions 25

Contract Residential and Grant and Per Diem Collaboration with community partners. Referral process. Discharge planning. 26

Current Programming HUD/VASH  315 vouchers  80 vouchers in Lincoln, 225 in Omaha, and 10 in Council Bluffs Veterans Justice Outreach  Working with justice involved Veterans to consider treatment vs. incarceration  Jail outreach 27

HUD VASH Collaboration with community partners. Housing First. Team approach. 28

New Programs Compensated Work Therapy – Transitional Residence  Located on Grand Island Campus with 9 beds Homeless Veterans Supported Employment Program  5 new staff hired to assist homeless Veterans in finding jobs Supported Services for Veterans Families Program  Grant program to help Veterans who are experiencing a housing crisis  Central Nebraska Community Services  Together, Inc (2013 Award)  Will serve Veterans in 22 counties 29

Focus on FY2013 Priorities Expand outreach to unsheltered areas and collaborate with agencies on outreach teams. Continue to implement a Critical Time Intervention Model in HUD/VASH. Implement Housing First across the homeless programs. Locate Community Resource and Referral Center in downtown Omaha. Incorporate primary care services into this clinic. Screen all Veterans receiving care at VA for homelessness or housing crisis's. Actively participate in HUD Point-In-Time counts across the State. Enhance outreach to improve outreach and engagement to Veterans in rural communities. Develop Child Support Assistance for Housing Stabilization. Implement Transition in Place transitional housing model. 30

Questions/Answer Contact information: Linda Twomey   Kerry Miller Loos   LeaAnne Peterson  