VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Integrating Data and Sharing Research to End Veteran
Homelessness
National Alliance to End Homelessness
July 30, 2014
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
HUD-VASH Exit Study Preliminary Findings
~ Project Jointly Funded by HUD & VA
Meagan Cusack
Project Manager, HUD-VASH Exit Study
VA NATIONAL CENTER ON HOMELESSNESS AMONG VETERANS
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
HUD-VASH
HUD-VASH is a permanent supportive housing initiative conducted as an ongoing collaboration between these two agencies:
Department of Housing and Urban Development (HUD) Provides Veterans with Housing Choice Vouchers
US Department of Veterans Affairs (VA) Provides case management and outreach
HUD.gov
58,155 vouchers awarded since 2008
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
HUD-VASH Performance Targets
Measure Target FYTD
HUD-VASH vouchers that result in housing 90% 86.15%
Chronic homeless enrolled in HUD-VASH 65% 72.93%
Veterans housed within 90 days of entry 65% 62.65%
Negative exits 20% 17.75%
Homeless Services Scorecard (National - Report Period: 2014)
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Negative HUD-VASH Exits
• Veteran did not comply with HUD-VASH case management
• Veteran was evicted from his/her HUD-VASH apartment by PHA or landlord and/or had other housing related issues or problems
• Veteran unhappy with HUD-VASH housing
• Veteran cannot be located
Homeless Services Scorecard Data Definitions
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
HUD-VASH Exit Study
Purpose: Identify reasons Veterans leave HUD-VASH prematurely and Veteran characteristics and program experiences that predict premature exit, including:
1) Barriers to accessing housing
2) Frequent causes of program exits
3) Housing destinations of Veterans who exit the program
4) Practices that lead to the long-term housing stabilization and well-being of participants
5) Patterns of exit that can inform efforts to prevent future exits
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Study Site Descriptions Study Site VAMC Public Housing Authorities Vouchers*
Bedford Edith Nourse Rogers Memorial (Bedford) VAMC
Lynn Housing Authority Chelmsford Housing Authority Department of Housing & Community Development
407
Houston Michael E. DeBakey (Houston) VAMC
Houston Housing Authority Harris County Housing Authority
1,370
Los Angeles VA Greater Los Angeles HCS Housing Authority of the County of Los Angeles Housing Authority of the City of Los Angeles
4,025
Palo Alto Palo Alto HCS Housing Authority of the County of San Mateo County of San Joaquin Housing Authority County of Stanislaus Housing Authority County of Monterey Housing Authority Housing Authority of the County Santa Clara Alameda County Housing Authority Santa Cruz County Housing Authority
1,145
Philadelphia Philadelphia VAMC Housing Authority of the City of Camden Philadelphia Housing Authority
620
*Through FY13
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Interview Data* Administrative Data Program Data
Study Group 1: Non-Leased Exiters Discharged before obtaining a lease with the voucher
Study Group 2: Leased-up Exiters Discharged after obtaining a lease with the voucher
Study Group 3: Stayers Obtained a lease with the voucher; leased housing unit with the voucher for 600+ days
*Includes Quantitative and Qualitative Components
Homeless Operations Management and Evaluations Systems (HOMES) Demographic, psychosocial, and health information
VA Medical Records Medical, substance abuse, and mental health diagnoses; frequency of use of VA medical, substance abuse and mental health services during program enrollment ; data on frequency of contact with HUD-VASH staff, and type of services provided
VA Case Management Teams Interviews with local VA case managers and review of Pre-Interview Questionnaire on program elements and program materials
HUD Public Housing Authorities Interviews with local PHAs and review of administrative plan and program materials
Data Collection Overview 1 2 3
Veteran Data
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Preliminary Veteran Sample
Study Site Non-Leased Exiters
Leased-Up Exiters
Stayers Total
Target 40 total exiters 95 135
Bedford 1 5 16 22
Houston 3 6 86 95
Los Angeles 16 25 95 136
Palo Alto 21 22 81 124
Philadelphia 15 23 94 132
Total 56 81 372 509
Data collection will conclude July 31, 2014
Preliminary Interview Data
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
HUD-VASH Enrollment Process
3.73
3.36 3.61
3.93 3.95 4.12 4.04 4.01
4.19
1
2
3
4
5
Enrolling in the HUD-VASHprogram
Submitting applications toPHA*
Providing documentation ofidentity and income to
PHA*
Non-Leased Exiters Leased-Up Exiters Stayers
*Significance ≥.01
Very Difficult
Very Easy
Preliminary Interview Data
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
HUD-VASH Housing Process
1.49 1.6
2.05 1.95 1.85
3.71 3.49
4 4.19
3.73 3.93
3.41
4.08 4.2
3.6
1
2
3
4
5
Finding listingsof available
apartments*
Finding anacceptableapartment
option*
Getting anapartment
inspected byPHA*
Being selectedas a tenant by a
landlord*
Obtainingmoney for rent,security deposit,
moving costs*
Non-Leased Exiters Leased-Up Exiters Stayers
*Significance ≥.01
Very Difficult
Very Easy
Preliminary Interview Data
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Self-Reported Health Status
13%
36%
50%
2% 7%
35%
53%
5% 8%
30%
55%
7%
0%
10%
20%
30%
40%
50%
60%
Poor Fair Good or Very Good Excellent
Non-Leased Exiters Leased-Up Exiters Stayers
Preliminary Interview Data
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Self-Reported Medical and Mental Health
55%
25%
41%
11%
46%
32%
59%
17%
57%
38% 39%
10% 0%
10%
20%
30%
40%
50%
60%
70%
Serious medicalproblems
Hospitalized forserious medical
problems
Serious mentalhealth problems*
Hospitalized forserious mental
health problems
Non-Leased Exiters Leased-Up Exiters Stayers
*Significance ≥.01
Preliminary Interview Data
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
“Troubled or Bothered” by Drugs or Alcohol while Enrolled in HUD-VASH*
66%
20%
5% 2% 7%
56%
19%
10% 7% 9%
68%
19%
10% 3% 1% 0%
10%
20%
30%
40%
50%
60%
70%
80%
Not at all Slightly Moderately Considerably Extremely
Non-Leased Exiters Leased-Up Exiters Stayers
*Significance ≥.01
Preliminary Interview Data
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Self-Reported Drug or Alcohol Treatment while Enrolled in HUD-VASH
9%
14%
4%
0%
17%
10%
5%
15%
6%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Inpatient only Outpatient only Both inpatient andoutpatient
Non-Leased Exiters Leased-Up Exiters Stayers
Preliminary Interview Data
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
0% 10% 20% 30%
Increase in income
Improvement in health, mental health or substance use condition
Difficulty paying rent
Worsening in medical, mental health or substance use condition
Difficulties with HUD-VASH case management/services
Difficulties with housing
Legal trouble
Offer from family or friends to move in to their housing
Leased-Up Exiters Non-Leased Exiters
Main Reason for Exit*
*Significance ≥.05
Neutral Exits
Negative Exits (~62% for both groups)
Preliminary Interview Data
Positive Exits
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Summary of Initial Findings
• Non-Leased Exiters found the enrollment process to be slightly more difficult and the housing process a lot more difficult than those who leased
• There seems to be a relationship, at least descriptively, between mental health and substance use and exiting housing
– Research team will control for other characteristics moving forward
• From Veteran reports, across all categories of exit, “negative” exits account for the same amount (~62%) of exits for those that do not lease and those that do; this rate is much higher than the HUD-VASH performance target and HOMES reports
Preliminary Interview Data
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Next Steps
• Analyze data for national HUD-VASH participants
• Develop study site descriptions and maps
• Analyze full study sample, including analysis of administrative records
• Code and analyze qualitative interviews
Final Report Outline with Preliminary Results September 30, 2014
Final Report December 31, 2014
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Homelessness among Veterans Returning from Afghanistan & Iraq
Stephen Metraux, PhD
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
The number among this generation falling on hard times is rising sharply even as homelessness among veterans of all ages and conflicts has been on the decline, according to the VA. (USA Today 2014)
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Homeless Veterans by Age Group (%)
0
5
10
15
20
25
30
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 andolder
2000
2005
2010
Source: Unduplicated count of all Veterans who completed Form X (an intake form for those receiving services from VA's Health Care for Homeless Veterans Program) in each year from 2000-2010
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
OEF/OIF/OND Vets and VA Housing Services
0
5,000
10,000
15,000
Source: Various VA reports
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
(11,730 Veterans under age 30 in 2012)
Source: HUD’s 2012 Annual Homeless Assessment Report
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
5,694 of 310,685 (1.8%) recent Veterans had records of homelessness
5-year incidence rate of 3.7%
Source: S Metraux et al. “Risk factors for becoming homeless among a cohort of veterans who served in the era of the Iraq and Afghanistan conflicts.” American Journal of Public Health (November 2013).
24
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Iraq and Afghanistan veterans are already turning up on the streets … And over time, the signature wounds of the current conflicts—psychological wounds and traumatic brain injuries—may contribute to higher rates of homelessness. (Iraq & Afghanistan Veterans of America 2009)
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
OEF/OIF deployment was associated with homelessness risk (OR=1.3)
Source: S Metraux et al. “Risk factors for becoming homeless among a cohort of veterans who served in the era of the Iraq and Afghanistan conflicts.” American Journal of Public Health (November 2013).
26
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
PTSD was associated with homelessness risk in OEF/OIF deployed veterans
(OR=1.2 for men & OR=1.6 for women)
18% of recent Vets who left military with a behavioral health disorder comprised 44% of those who became
homeless
Source: S Metraux et al. “Risk factors for becoming homeless among a cohort of veterans who served in the era of the Iraq and Afghanistan conflicts.” American Journal of Public Health (November 2013). 27
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
OEF/OIF/OND Veterans N=15,502
Vietnam Veterans N=19,713
Alcohol Use Disorder (Q44a)
34.0% 41.0%
Drug Use Disorder (44b) 31.3% 30.3%
Alcohol or Drug Disorder (44a or 44b)
46.9% 50.7%
Military-related PTSD (44g)
49.5% 20.4%
Schizophrenia (44d) 1.8% 4.9%
Affective Disorder (44j) 40.8% 35.8%
Experienced Combat (Q19)
73.5 42.8%
Source: VA’s Homeless Management and Evaluation System (HOMES)
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Veterans ages 25 to 34 … experienced significant increases in poverty rates over the [past] decade. (National Center for Veterans Analysis and Statistics, 2011) Though the overall unemployment rate among America's 21m veterans in November (7.4%) was lower than the national rate (8.6%), for veterans of Iraq and Afghanistan it was 11.1%. (Economist 2011)
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
The 44% of recent Veterans in the lowest pay grades accounted for 72% of those who became homeless.
Source: S Metraux et al. “Risk factors for becoming homeless among a cohort of veterans who served in the era of the Iraq and Afghanistan conflicts.” American Journal of Public Health (November 2013).
30
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Among 15,102 homeless veterans who were deployed in Iraq or Afghanistan:
- 40% reported full time work (including military)
- 15% reported part time work
- 12% reported being disabled
as primary work pattern over the previous 3 years.
Source: VA’s Homeless Management and Evaluation System (HOMES)
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Among 15,102 homeless veterans who were deployed in Iraq or Afghanistan:
- 37% reported no income
- 50% reported income under $326
- 70% reported income under $950
over the previous 30 days.
Source: VA’s Homeless Management and Evaluation System (HOMES)
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Other Factors
• Relationships (family, friends, partners)
• Money Management
• Legal Issues
• Military Experiences
• Experience with VA Services
• Transitioning From Military
• Use of Mainstream Services
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Research Agenda • Dynamics of homelessness – numbers and trajectories
• Risk factors for homelessness – service-related and antecedent factors
• Service use patterns in VA and mainstream systems
• Forecasting future demand and services need
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Universal And Repeated Screening For Homelessness And Risk In The Veterans Health Administration
Ann Elizabeth Montgomery, Thomas Byrne, & Jamison Fargo
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Agenda
• Overview of Homelessness Screening Clinical Reminder (HSCR)
• Annual prevalence of homelessness and risk among Veterans responding to the HSCR
– Predictors of positive screens
• Rescreens
– Odds of resolving housing instability
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
HSCR: Primary Questions • For the past 60 days, have you been living in stable housing
that you own, rent, or stay in as part of a household? – Yes Question 2
– No Homeless, refer to VHA Homeless Program
• Are you worried or concerned that in the next 60 days you may not have stable housing that you own, rent, or stay in as part of a household? – Yes At risk, refer to social work services
– No Screener complete (negative)
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
HSCR: Administration Schedule • Administered annually in outpatient primary care clinics,
including mental health and social work – Semi-annual rescreening for Veterans who screen positive
• Exclusions: – Patient already receiving services through VHA Homeless Program
– Patient is long-term resident of nursing home or long-term care facility
– Patient declines screening or is unable to respond
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
October 1, 2012 – September 30, 2013
• 4,307,764 Veterans accessing outpatient care completed the HSCR
– 0.8% screened positive for homelessness
– 1.0% screened positive for risk
– 98.2% screened negative
• 17,720 Veterans responded to a rescreen
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Demographics Characteristics Homeless At Risk Negative
N 36,081 (0.8%) 41,540 (1.0%) 4,230,143 (98.2%)
Gender Female 1.1% 1.6% 97.4%
Male 0.8% 0.9% 98.3%
Age <35 1.7% 1.8% 96.5%
35–44 1.5% 1.9% 96.7%
45–54 1.8% 2.0% 96.1%
66–64 1.3% 1.4% 97.3%
65+ 0.2% 0.3% 99.5%
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Screening Location
0.7%
0.5%
1.1%
0.9%
0.0% 0.5% 1.0% 1.5%
At Risk
Homeless
Not Rural Rural
• 4 of 5 screens take place in primary care
• Rates of positive screens are highest in: – Social work
– Mental health/substance abuse clinics
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Predictors of Initial Positive Screen
• Younger than 60 years
• Male
• Hispanic or Black*
• Service in eras other than OEF/OIF/OND
• No service-connected disability and Medicaid-eligible*
• Responded to the HSCR in settings other than primary care (social work, mental health, substance abuse clinic)*
• Responded to the HSCR in non-rural locations
*More likely to screen positive for homelessness than risk
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Rescreens
• 22.8% of the 77,621 Veterans who screened positive during FY 2013 responded to a subsequent screen 6–12 months after the initial screen
– 80.5% resolved their homelessness
– 87.7% resolved their homelessness risk
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Changes in Screening Disposition
85.0%
5.3%
4.8%
3.0%
1.9%
Resolved housing instability(N=15,060)
Persistently homeless(N=937)
Persistently at-risk(N=849)
Newly homeless(N=530)
Homelessness to risk(N=344)
• Resolved housing instability – positive initial screen and negative rescreen
• Persistently homeless – positive for homelessness on initial screen and rescreen
• Persistently at risk – positive for risk on initial screen and rescreen
• Newly homeless – positive for risk on initial screen and homelessness on rescreen
• Homeless to risk – positive for homelessness on initial screen and positive for risk on rescreen
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Odds of Rescreening Disposition* Characteristics
Persistently Homeless
Persistently At Risk
Newly Homeless
Homeless to Risk
Accept referral + NS + +
Older age - + NS NS
Male + NS NS NS
Black race + + + +
<50% service-connected** + + + +
Screening location Mental health + + NS +
Substance abuse + + + +
Rural location - NS NS NS
*Relative to resolved housing instability; **includes not service-connected/VA pension; NS = not significant
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Future Work • Evaluate comparative effectiveness of interventions to
support Veterans’ resolution of housing instability – Assess effectiveness of the HSCR at linking Veterans with services
and Veterans’ perceptions of the effectiveness
• Medical, mental, and behavioral health comorbidities associated with persistent homelessness and risk
• In-depth analysis of Veterans with repeated positive screens (i.e., 3 or more)
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
SSVF: Year 2 Results and Community Characteristics
Dan Treglia, MPP
Thomas Byrne, PhD
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
SSVF Overview • Prevention and Rapid Rehousing
• Operated through Community-based organizations
• Eligibility criteria targeting those most in need of SSVF assistance
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
FY 2012 FY 2013 FY 2014
US States and Territories Served
40 and DC 49, DC, and Puerto
Rico 50, DC, Puerto Rico,
Virgin Islands
CoC's Served n/a 261 (62%) 375 (89%)
Grantees 85 151 319
Households served 21,111 39,930 n/a
Funding Level
$59,313,413 Actual Expenditures
$99,043,780 Actual Expenditures
$299,056,370 Budgeted
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
SSVF Year 2 Populations
Children 45% of households had at least 1 child
Female Veterans
15% of Veterans were female
OEF/OIF 17% of Veterans served in OEF/OIF
Very low income
Majority (76%) had incomes below 30% of AMI
Disability Slightly more than half had disabling condition
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
SSVF Services
• In community & VA 1.Outreach
• Careful assessment of needs • Housing stability plan
2. Case management
• Health care • VBA benefits (education/vocational,
pensions)
3. Assistance in obtaining VA benefits
• Legal assistance, credit counseling • Income support (e.g. TANF, SNAP, etc.)
4. Assistance in obtaining mainstream benefits
• Rental assistance, utility payments, security deposits, moving costs, emergency supplies, child care, transportation
5. Temporary Financial Assistance
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
http://www.va.gov/HOMELESS/ssvf/docs/SSVFUniversity/SSVF_Annual_Report_FY_2013.pdf Available at :
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Households Served by Assistance Type
Nearly 100,000 (97,979) people served in FY ‘12 & ‘13
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Distribution of Temporary Financial Assistance
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Evaluating Program Outcomes
• Divide exiters by household and assistance type
• Assess “survival rates”
• Regression models to examine Veteran, SSVF program & community factors associated with SSVF outcomes
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Exit Type by Assistance and Household Type
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Survival Curves
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
1 31 61 91 121 151 181 211 241 271 301 331 361
Prevention - Singles Prevention - Families
Rapid Re-housing - Singles Rapid Re-housing Families
One Year Survival Rates
Prevention - Families: 95% Prevention - Singles: 90% RR- Families: 93% RR - Singles: 88%
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Regression: Veteran Characteristics Rapid Rehousing Prevention
Families Singles Families Singles
Age Group (18-30 is reference)
30-44 + +
44-54 + + +
54-61 + + +
62+ +
Male + +
Hispanic
Race (white is reference)
Black +
Other Race
Disabling Condition + +
History of Homelessness + + +
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Regression: Program Factors Rapid Rehousing Prevention
Families Singles Families Singles
Exited in FY 2013 + + + +
Participation length>90 days
Legal services
Housing search services
Rental assistance + +
Security deposit +
Utility payment
Moving costs
Exit destination (compared to temporary with family/friends)
HUD-VASH - - - -
Other permanent - - - -
Other/Unknown - -
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Regression: Community Characteristics
Rapid Rehousing Prevention
Families Singles Families Singles
Median Rent (in $100s)
% Vacant Housing Units -
Percent Renter Households
Percent Rent Burdened Households
VA National Center on Homelessness Among Veterans | U.S. Department of Veterans Affairs
Conclusions and Next Steps • Models did not find any relationship between
community characteristics and SSVF success
• Much greater influence from personal characteristics and programmatic needs
• Advance SSVF evaluation and integrate into the research on Rapid Re-housing
• In depth interviews with Veterans to better understand what’s working and what’s not
Top Related