Supportive Services for Veteran Families (SSVF)

1. Supportive Services for Veteran Families (SSVF) A Housing First Approach to Preventing and Ending Homelessness Among Veterans Tom Albanese, Abt Associates Marge Wherley, Abt Associates Patti Holland, TAC

2. Key Components of SSVF • Outreach Services • Case Management Services • Assistance in Obtaining VA Benefits • Assistance in Obtaining and Coordinating Other Public Benefits • Other Supportive Services • Temporary Financial Assistance Homeless (street, shelter)

3. HEARTH Act & SSVF Programs: Relevance to CoC Performance

4. VA Policy Support a “Housing First” model in addressing and ending homelessness. Housing First approaches emphasize rapid stabilization in permanent housing as central focus of intervention.

5. Housing First Principles:A source of inspiration…and challenge • Homelessness is a housing problem • Housing is a right – not a reward • Consumer choice • Everyone is ‘housing ready’ – programs must be ‘consumer ready’ • End housing crisis and stabilize in permanent housing first…THEN address other needed and desired services directly or through linkage

6. Housing First: Critical Elements • Goal: permanent housing as quickly as possible • Housing • Consumer choice • Permanent (i.e., not time limited, consumer holds lease) • Not contingent on service participation and compliance • Services • Consumer choice • Provided primarily following housing placement • Flexible and responsive to needs and preferences • May be time limited or long term (or some combination) • Success = staying housed and not becoming or returning to literal homelessness

7. Housing First (and SSVF) Challenge Provide the right resources to the right people at the right point in time for the right amount of time.

8. Challenging Assumptions:“Housing Readiness” Assumption: People need to be “ready” before moving into permanent housing. • Adequate and sustained income source • Comprehensive psycho-social assessment completed with all key issues identified and plan to address each • Disability, mental health and substance use issues are acknowledged, addressed and under control • Demonstrated competence in all skills necessary for permanent housing Stems from good intention of not wanting people to fail – but research does not support

9. Challenging Assumptions:“Housing Readiness” Challenging the Assumption: • Overwhelming evidence shows positive outcomes for households with range of barriers with HF approach, such as: • Obtaining and maintaining housing • Reduced or stabilized substance use that did not negatively impact housing • Increased service participation • Increase in perceived choice • Even so…many providers still reluctant to consider housing first as viable approach for “their client”

10. Challenging Assumptions:“Housing Readiness” • “Housing Ready” often means clean, sober and treatment compliant • One main reason individuals remain chronically homeless is reluctance of traditional programs to provide housing to consumers who refuse treatment and/or are actively using (Bridges and Barriers to Housing for Chronically Homeless Street Dwellers, T. Mechede 2004) • There is little evidence that treating substance abuse and mental health problems prevents homelessness (Preventing and Alleviating Homelessness – Prevention Approaches, MaryBeth Shinn)

11. Challenging Assumptions:“Housing Readiness” • Service providers and homeless individuals and families often disagree on needs. • Service providers often express concern with service needs, individuals and families stress need for housing (Bridges and Barriers to Housing for Chronically Homeless Street Dwellers, T. Mechede 2004)

12. Challenging Assumptions:“Housing Readiness” • In Vivo Learning: • Developing and applying new skills is often situation-specific • Using a skill in one setting does not guarantee person will use it, or know how to use it, in a different setting • Delivering SSVF services to participants in their living environment and community is essential for successful housing retention

13. Challenging Assumptions:“Housing Stability” Assumption: “Housing stability” can only be achieved by households who have the means to readily pay for their housing costs now and in future. Challenging the Assumption: • Majority of very low income households pay more than 50% of their income for housing and do not become literally homeless • Majority who become literally homeless regain housing with limited help and do not become literally homeless again

14. Challenging Assumptions:“Housing Stability” • Determining future ability to pay housing costs and establishing “housing stabilization” plans: • SSVF assisted households typically pay more than 30% of income towards rent, remain low/very low income, and may need to ‘double up’ in future • Lack of identified current/future means to pay housing costs = program challenge; not reason to ‘screen out’ applicants • Must work with each SSVF household to develop plan right for them – no magic formula

15. Voluntary Services • SSVF services meet a specific goal or need– goal the Veteran wants to address, not necessarily what staff feel s/he needs • Referrals made are mutually agreed upon and stem from Veteran’s choices • Information, education and informed choice • SSVF staff provide information on services and resources that are available, educate on possible benefits and ‘downside’ of services, assist the Veteran in making an informed choice • Foster real world expectations and consequences

16. Voluntary Services • This does not mean…. • SSVF staff cannot offer suggestions, ask Veteran to do something or initiate uninvited contact • Staff do not intervene, even when very real and serious health or safety risks exist • Participants will never take action to change their circumstances if not ‘encouraged’ • Participants will always ‘take the money and run” • Staff have to tolerate abusive treatment from participants and can never discharge from the program for disruptive or dangerous behavior

17. Housing First in Practice:From Crisis Response to Housing Stability Crisis focus = Housing • No housing (literally homeless) OR • Imminent risk of literal homelessness (imminent loss of housing and no other housing options, resources, support) Two Step Process: Step 1: Crisis intervention and resolution Step 2: Housing stabilization

18. Housing First in Practice:Step 1: Crisis Response Goal: Identify and address immediate housing need • Crisis Assessment • Triage and immediate housing plan

19. Housing First in Practice: Step 1: Crisis Response Crisis Assessment: • Focus: Persons experiencing a housing crisis • Immediate needs may or may not be met • What are we trying to figure out? • Immediate & short-term housing needs and SSVF intervention to assure needs are met • Basic characteristics necessary to know who’s being assisted and immediate needs • Any safe, immediate options besides emergency shelter? • Plan for tonight and near term

20. Housing First in Practice:Step 1: Crisis Response • Assessment tool, process • Tool should be staff and participant friendly • Standardized, but also serves as conversation guide • Focuses on housing issues, is not a comprehensive assessment of needs • Staff training and supervision • Specific content, training during orientation period • Observation as training component • On-going review and supervision

21. Housing First in Practice: Step 1: Crisis Response • Let’s use an analogy – someone shows up at an E.R. in crisis due to diabetes • No time for in-depth assessment of patient’s overall needs or compliance with diabetes care • RN does a few quick diagnostic lab tests to confirm diabetes with blood sugar out of control • ER team immediately begins to stabilize the patient’s condition • Once crisis is resolved and patient is temporarily stabilized, further assessment may be done • Based on this additional assessment, hospital team sends patient home with discharge orders, including referrals if needed • There may be some follow up calls or a visiting RN to check on if patient is feeling ok, no current symptoms, understands discharge plan • But, in the end – the ER has no actual control over the patient’s future diabetes care or whether there will be future hospital visits

22. Housing First in Practice: Step 2: Housing Stabilization Goal: Identify and implement plan to maintain current housing or obtain new housing • Housing stability assessment • Housing stability plan (‘reasonable’) • Progressive engagement with flexible SSVF services • Service linkage

23. Housing First in Practice:Step 2: Housing Stabilization Housing Stability Assessment: • Focus: Persons experiencing a housing crisis whose immediate housing needs are met • What are we trying to figure out? • Prevention: whether can be stabilized in current housing or needs relocation assistance • Additional characteristics and relevant background (housing, health, AOD, education, etc.) • Barriers impacting ability to obtain/maintain housing • Tenant screening barriers (if need to obtain housing) • Retention barriers • Least amount of intervention needed to resolve and, if possible, prevent return to crisis

24. Housing First in Practice:Step 2: Housing Stabilization Housing Stability Plan: • Progressive plan to increase stability and prevent future housing crisis • Flexible, progressive SSVF services and temporary financial assistance • Linkages and referrals to address other identified immediate and long-term needs

25. Housing First:Tips • Engage, collaborate with larger community services and Continuum of Care system • Train staff on other CoC/community resources and programs to ensure best “fit” for participant • Be clear about what SSVF can do & what it cannot do – with staff and participants • Maximize SSVF: design flexible program services that can vary in type/level/duration based on need • Periodically revisit program design • Incorporate eligibility recertification (required every 3 months) and other milestones in case plan 25

26. Housing First:Tips • Use best practices: harm reduction, motivational interviewing, skills teaching, resource development • If unsure and/or if there are not other resources to refer applicants with greater needs: better to err on side of ‘screening in’ vs. ‘screening out’ • Develop and cultivate landlord relationships & housing options • Train staff on other community-based and mainstream resources to ensure needs are met post-SSVF • Use assessment to identify system gaps • Staff training and supervision 26

27. Time for a Break! We will resume the presentation in precisely 15 minutes. If you haven’t already downloaded the SSVF Eligibility Screening Disposition Form, please do so before the next presentation.