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The National Center on Homelessness Among Veterans

     NATIONAL CENTER ON HOMELESSNESS AMONG VETERANS

¹ú²ú¶ÌÊÓƵis a collaborator with the Department of Veteran Affairs (VA) National Center on Homelessness Among Veterans (The Center). The primary goal of the Center is to promote knowledge and solutions to address and prevent homelessness among Veterans through research, program development and education. USF’s Department of Mental Health Law and Policy (MHLP) faculty collaborate on the primary components of NCHAV: Model Development/Implementation, Education/Dissemination and Research/Methodology. MHLP led one of the initial studies for the Research/Methodology core measuring aspects of housing and housing services for Veterans who are experiencing homeless and have behavioral healthcare needs.

For more information, please contact Dr. Scott Young at syoung1@usf.edu.

        Training for Peer Specialists Working in Homeless
                      and Veterans Justice Programs

¹ú²ú¶ÌÊÓƵpartnered with NCHAV to develop a voluntary 20-hour online training curriculum designed to increase the knowledge of Veterans already serving in Peer Specialist positions in homelessness and justice-related programs and to provide a basic curriculum for new employees entering the field. 

The curriculum, hosted by ¹ú²ú¶ÌÊÓƵand constructed in an online modular design, is available and useful in VA and non-VA systems. The modules combine videos, lectures, interviews, and discussions by subject matter experts from VA, the university, community and national leaders, and Veterans.

Upon successful completion, participants receive a certificate of completion from the ¹ú²ú¶ÌÊÓƵ.

        EVALUATING HOUSING AND HOUSING SERVICES FOR
                                 HOMELESS VETERANS

¹ú²ú¶ÌÊÓƵserved as subject matter experts for the Center on a study designed to improve evaluation of community-based housing services for Veterans who were experiencing homelessness, especially those Veterans diagnosed with mental health and substance use disorders. In order to conduct studies of outcomes of housing and housing services, it was necessary to explicitly define key features of the housing and associated services, to determine criteria that measure these features and to conduct assessments to describe the housing options. This was accomplished by a comprehensive review of the literature on supported housing and measures used to assess housing and housing services. Then, interviews were conducted with VA staff, Veterans and community housing providers to determine important domains and to assess the reliability and validity of the measures of these domains. This study resulted in the domains of Community Resources, Organizational Linkages, Strength and Quality of Services, Number and Variety of Services, Housing and Service Choice/ Veteran-Centered Care, Admission Requirements, Rules for Tenure in Housing, and Organizational Climate.

Extensive reliability and validity studies were conducted, and the measure was applied to multiple Department of Housing and Urban Development – VA Supportive Housing (HUD-VASH) and VA’s Homeless Providers Grant & Per Diem (GPD) programs throughout Florida and Pennsylvania. Preliminary findings suggest this measure can be helpful both as a management tool and an aid in making policy recommendations. Additionally, it can measure important process information that can help interpret outcomes from research about Veterans who are experiencing homelessness.

Information on this measure, including its development and psychometrics, are available in the following article: Clark, C, Young, MS, Teague, G, & Rynearson-Moody, S. (2016). Development of a measure of housing and housing services. Community Mental Health Journal, 52, 66-72. doi:10.1007/s10597-015-9969-y

                            ProGRAM iMPLEMENTATION

¹ú²ú¶ÌÊÓƵfaculty serve as subject matter experts to provide guidance and consultation on proposed services and development of pilot programs to provide care to underserved populations. ¹ú²ú¶ÌÊÓƵfaculty continue to evaluate program and proposed model development initiatives that may impact VA homeless programs and Veteran services. The faculty identify potential areas of collaboration with other Federal agencies that strengthen the continuum of care while enhancing the efficiency of overall Federal programs. These efforts have included issues such as homelessness prevention, women Veterans who are homeless, rural homelessness, Housing First, Safe Havens, Low Demand Grant and Per Diem Programs and justice-involved Veterans.

                      MODEL DEVELOPMENT - HOUSING FIRST 
                 WITHIN HUD-VASH (VA SUPPORTIVE HOUSING)

Shortly after the Center was established, ¹ú²ú¶ÌÊÓƵpartnered with Center staff and Pathways to Housing, Inc. to provide technical assistance (TA) to 14+ VA HUD-VASH sites across the country on the development and implementation of the Evidenced-Based Permanent Supportive Housing Model, Housing First incorporates an Assertive Community Team and is a person-centered approach designed to end homelessness and support recovery for Veterans and their families. Housing First provides immediate access to permanent housing through the HUD-VASH program and support services through the VA or contracted community providers to Veterans who have experienced long-term homelessness, are living on the streets or shelters and have a high prevalence of co-occurring mental health and substance use disorders.

¹ú²ú¶ÌÊÓƵfaculty provided TA regarding program development, the use of the Housing First fidelity scale and on-site reviews of the VA's Assertive Community Treatment Teams and their community partners. The implementation of Housing First was a key element in the VA's plan to end homelessness for Veterans and their families.

                   MODEL DEVELOPMENT - SAFE HAVENS

Funding for the VA Safe Haven model development project was designed to develop and implement a low barrier model that could be replicated throughout VA, broadening its homeless continuum of care. Safe Havens were initially authorized by the McKinney-Vento Act of 1994 with funding provided by HUD's Permanent Supportive Housing Program. The primary mission of the first funded programs was to target dually diagnosed chronically homeless individuals who were ineffectively served by traditional homeless programs. The 2010 Annual Homeless Assessment Report to Congress (AHAR) indicated that there are only 128 Safe Havens providing a total of 2,199 year-round beds (HUD, 2011).

The Center utilized the Safe Haven Tool Kit Manual: Developing and Operating Safe Haven Programs, developed by HUD and the Substance Abuse and Mental Health Services Administration (SAMSHA), as a guide for both VA and community providers.

Researchers with the Center conducted on-site or virtual fidelity visits with each operational VA Safe Haven approximately six months after the programs began operating. Activities for each fidelity review included: 1) conducting interviews with VA and Safe Haven staff, 2) touring the facilities, 3) reviewing program materials, and 4) observing program activities. Based on successfully implementing these programs and supporting them with TA via partnership with USF, Safe Havens transitioned from the model development initiative into routine operations such that they are now included among the different housing options that VA routinely offers to Veterans.  

       MODEL DEVELOPMENT - COMMUNITY RESOURCE AND
                              REFERRAL CENTERS (CRRC)

VA’s National Homeless Program Office (HPO) provided funding for 16 Community Resource and Referral Centers (CRRC) in strategically selected urban locations to provide "one-stop-shopping" to serve Veterans and their families who were experiencing homelessness or at-risk. All of the centers were located in community settings that facilitated access to critical services and supports. The CRRCs were established in collaboration with local community-based homeless providers and other Federal and state partners that provide services to persons who are homeless. VA collaborated with these partners who are co-located at the CRRC sites to offer services such as 24/7 outreach/case management, vocational services, financial benefits, and immediate access to primary/behavioral healthcare treatment, shelter, residential care and housing services. The Center partnered with ¹ú²ú¶ÌÊÓƵto provide TA to program sites regarding the development of the CRRC model, including the development of a program fidelity instrument and mechanisms to track program implementation/service integration. After successfully piloted in the National Center’s model development initiative, CRRCs were incorporated into routine operations and became a standard component of VA homeless service offerings.

                 MODEL DEVELOPMENT-Grant & Per Diem–
                                 Low Demand (GPD-LD)

The Grant & Per Diem (GPD) - Low Demand program offers VA-funded GPD providers an opportunity to revise their program designs using a low demand/harm reduction model to better accommodate Veterans who are experiencing homelessness and cannot stay clean and sober, and/or those who have difficulty being fully compliant with their mental health care. Low demand programs do not require sobriety or compliance with mental health/substance use treatment as a condition of admission or continued stay. Demands are kept to a minimum; the environment of care is as non-intrusive as possible to foster trust between staff and residents; rules focus on staff and resident safety, case management, and education Treatment services are offered and highly encouraged, but again, are not a condition of admission or continued stay.

Developing specialized programs to accommodate Veterans who are experiencing homelessness and have compliance difficulties in traditional homeless programs became a high priority in 2009 as VA developed plans to end homelessness among Veterans. In 2014, the Center partnered with the national GPD Program and affiliates from ¹ú²ú¶ÌÊÓƵto develop an implementation process for a low demand program specifically tailored to GPD providers. The first site became operational in March 2015. 

USF, the Center and the National GPD office continue to offer training and technical assistance (TA) through biweekly calls with program staff, program administrators, and GPD liaisons working with these programs. This provides a forum for staff to share successes and challenges, to ask programmatic and operational questions, and to receive input from individuals working with or in similar programs. Individualized TA events, teleconferencing and consultation are provided as needed. Fidelity assessments are conducted annually to help ensure that the model is being implemented as intended and to identify programs needing additional individualized TA. Fidelity results are shared with programs and are reviewed during the biweekly TA calls to help identify relevant topics and to facilitate discussion.

Currently, 82 GPD providers used the Low Demand model, serving 1,836 Veterans. Upon exiting the program, 61.7% were discharged to permanent housing. Annual fidelity data indicate that the Low Demand model is being implemented as intended.