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Executive Director Poppe’s Keynote at HUD-VASH Case Management Models Conference

2/24/10                                                                           

Good morning. It is an honor to speak in front of so many skilled clinicians who provide the vital care day after day to ensure that our Veterans get the best care possible. I recently started in my current position as the Executive Director of the United States Interagency Council on Homelessness.

These are very exciting times for those of us who have worked hard to end homelessness. I arrive here today with a charge by the President to develop a Federal Strategic Plan to prevent and end homelessness. We have a President who is more committed to ending homelessness than any of his predecessors. As you know, Secretary Eric Shinseki and President Obama have a comprehensive plan to end Veterans’ homelessness within five years.  I’m inspired on a daily basis by the great leadership and ideas Secretary Shinseki has brought to the Administration. While the President and Secretary’s leadership is crucial, it is only one element to making this vision a reality. As practitioners, your work and commitment to the Plan’s implementation are as critical as their leadership.

I have more than two decades worth of non-profit experience working on homelessness with housing-related organizations. I began my work on the frontlines as a volunteer who established a shelter for women and children in Cincinnati.  I moved on to be the executive director of Friends of the Homeless in Columbus, Ohio which provided emergency shelter, housing placement, transitional housing, chemical dependency treatment, and vocational training programs for homeless men, women, and families.  At Friends, I worked in conjunction with the Vietnam Veterans of America on a permanent supportive housing project in the early 1990’s.  Immediately prior to my appointment, I served as the Executive Director of the Community Shelter Board which is nationally recognized for its creative collaborations, innovative solutions and quality programs to end homelessness in the Columbus metropolitan area.  During my tenure, our community developed more than 800 units of permanent supportive housing for men and women who had experienced long term homelessness. The Community Shelter Board was the recipient of one of the 11 ICH demonstration projects to address chronic homelessness in 2002.  Our project – the Rebuilding Lives Pact Team Initiative -- worked effectively with the VA Outpatient clinic’s Health Care for Homeless Veterans program as an integral partner.  I have served as a board member and advisory group member of the National Alliance to End Homelessness and the national organizing committee of the Corporation for Supportive Housing.  I was also appointed by Gov. Ted Strickland to the Ohio Interagency Council on Homelessness and Affordable Housing.

I’m also a proud sister of an active Army reservist and my soon to be son-in-law will be serving in Afghanistan by the end of the summer with his Marine unit.   I very much appreciate the daily sacrifices faced by families of active servicemen and women and Veterans families.
It’s my honor to serve my country as the Executive Director of ICH in this time of special focus on better meeting the needs of Veterans.  Thank you for indulging me with time to share my vision for our country and the VA, as well as how I hope you’ll be able to be a part of this vision though the HUD VASH program.

Before I discuss USICH’s role in supporting and monitoring the VA’s five-year plan, I thought it would be helpful to provide a glimpse into what I have seen.
Since 1983, I have continuously been involved in the movement to end homelessness – it is my work and my passion.  It is a movement that seeks to ensure that all Americans have a right to safe and affordable housing.  Too often, this basic human need – the need for a place to call home – is not met.  
As you know, widespread homelessness was not part of the American landscape when I, along with many of you, was growing up in the 60’s and 70’s.  It’s a phenomenon that came to our consciousness in the early 1980’s.  Other than during the Great Depression, homelessness did not occur on any scale in our country. What a sad state that our current generation – my son and daughter’s – believe that homelessness has always been with us.  

As I have labored alongside you and many others in taking care of our Veterans and other homeless populations, I have met thousands of persons – men, women, and children -- who have directly experienced homelessness.  For many, it’s a simple economic situation – they don’t earn enough to pay the rent. For others they have also experienced racism, sexism, classism, and prejudices related to their diseases of AIDS/HIV, mental illness, alcoholism, post-traumatic stress syndrome, and addiction.  For some they have the further burden of a past criminal record.  Even in these difficult economic times, this is still the wealthiest, most powerful country in the world. We all agree that no Veteran should be living on the streets without care and without hope. Each of them deserves a home.

It is their faces, their courage, and their struggles that inspire me to continue as their advocate. And that was what brought me to my current role as executive director that I assumed just three months ago. The mission of the Council is to coordinate the Federal response to homelessness and to create a national partnership at every level of government and with the private sector to reduce and end homelessness in the nation while maximizing the effectiveness of the Federal Government in contributing to the end of homelessness.  Department of Housing and Urban Development Secretary Shaun Donovan is chairman of the Council, which includes 19 Federal agencies.

Secretary Donovan and Secretary Shinseki are very passionate about our mission. Secretary Donovan is tireless in his advocacy for resources and strategic approaches to make housing affordable and available to all.  In fact, it was Secretary’s Donovan’s speech at last summer’s National Alliance to End Homelessness conference that inspired me to seriously consider the opportunity to lead the Council. He said, “Our job now is to house everyone - to prevent and end homelessness. All homelessness.” I’ve met with both of them frequently over the past few months and they bring this passion, vision, and expectation of excellence to every meeting.

Secretary Shinseki is equally as passionate about ending homelessness for all Veterans.  I’ve been inspired by his vision that we succeed in this mission within the next five years.  His vision that the VA delivers a quality system of care is rooted in his belief that every person deserves to be treated with dignity and respect.  I share that fundamental value – everyone deserves to be treated with dignity and respect.
During my tenure at the Council, we will be focusing our work in these seven areas:

  •   Leading the development and implementation of the the first ever Federal Strategic Plan to Prevent and End Homelessness that was mandated by the HEARTH act.  This plan is due to Congress by May 20.

  •   Establishing and maintaining effective, coordinated, and supportive relationships with each Federal agency

  •   Organizing and supporting state/local/communities to effectively implement local plans

  •   Developing means to provide an effective portal to federal programs and initiatives

  •   Establishing and maintaining effective communications with Congress

  •   Aggregating and promoting research/evaluations and manage accountability/results

  •   Establishing effective partnerships with the public and private sector stakeholders

In order to accomplish these goals, I assembled a senior management team as of the first week of February 2010.  The Council has three Deputy Directors who come with a complimentary skill set and areas of expertise. Anthony Love the Deputy Director for National Programs unfortunately can’t be here today, but it’s important to know his name since he not only oversees the work of the agency’s regional coordinators, he is also the lead on Veterans issues. Anthony most recently served as the President and CEO of the Coalition for the Homeless of Houston and Harris County. He recently served on the Board of Directors of the National Coalition for Homeless Veterans and the National Alliance to End Homelessness also recently honored his previous organization and leadership with their Non-Profit sector award in 2009.

When the President took office, the economy was on the brink of a depression. The economic crisis required that we take immediate and extraordinary steps to prevent a further collapse. Not all of these steps were popular, but the President did what was right for our country's future.

Without them, we faced the real prospect of a second Great Depression. A year later, the economy is back from the brink - and is growing again. But as every American family and business knows, we have much more to do so that every American who wants to work can find a job.

Mortgage foreclosure rates around military bases is four times the average. It's hard to keep a job if you're getting deployed every 12 months if you're a national guardsman.There is a significant correlation between the economic downturn and an increase in homelessness.  That is one of the reasons why the President has made passing a jobs bill a top priority. An increase in job growth will go a long way towards reducing homelessness.

Since the beginning of this Administration, President Obama has a made strong commitment to ending homelessness. In fact, he set a lofty but achievable vision of preventing and ending homelessness across all populations, with Veterans as a priority. As a down payment on that vision, President Obama included $1.5 billion in the stimulus bill for the Homelessness Prevention and Rapid Re-Housing program.  Then last May, the President signed into law the HEARTH Act which re-authorized the McKinney Act – it was a day that I was beginning to think would never come.  And has now devoted significant resources toward that vision even during a tightening of not only the federal government’s budget, but among all of us including families and individuals who have been hardest hit by the economic downturn.

Highlighting the importance of ending homelessness to the President and despite the non-security discretionary funding freeze, President Obama’s recent FY 2011 budget request for targeted homeless assistance programs is an 11.5 percent increase over FY 2010 and the LARGEST ever by a President. Furthermore, the proposed FY 2011 budget request for these programs at the VA represents a staggering 49 percent increase. The Budget proposal reflects a strong commitment by the Administration to prevent and end homelessness.

While the budgetary commitment is just one part of this story - this Administration intends to forever change the way our country addresses homelessness.  The Federal Strategic Plan will serve as a roadmap for joint action by Council agencies to guide the development of programs and budget proposals towards a set of measurable targets. The Federal Strategic Plan will reflect interagency agreement on a set of priorities and strategies the agencies will pursue over a five-year period.

The Council is centering its plan on the belief – the moral foundation – “no one should experience homelessness – no one should be without a safe, stable place to call home.” The Council has charged the planning process to align federal resources effectively and appropriately toward four key objectives: 1) finish the job of ending chronic homelessness; 2) prevent and end homelessness among Veterans; 3) prevent and end family, youth, and child homelessness; and 4) set a path to ending all types of homelessness.

Solving homelessness will require that people at risk of or experiencing homelessness are able to access MAINSTREAM resources effectively and sufficiently to meet their needs. To date, the “federal plan” to address homelessness is by default defined by the TARGETED programs.  Today we are embarking on a “strategic plan” that will put at its center PREVENTION of homelessness and bring MAINSTREAM resources to bear to prevent and end homelessness. 

The VA’s five year plan will play a key role in the Federal Strategic Plan. As we move forward with the Federal Strategic Plan, we are committed to collaborative solutions, smart investments, and leveraging mainstream resources. The effectiveness of the Federal Strategic Plan and ultimately its success is dependent upon all of us.  It will take all of us … no one can stand on the sidelines.  That is why we are involving so many in the work of developing the Plan.  Not if, but when, we are successful in implementing the Federal Strategic Plan, I believe it will be an agenda that not only the Obama Administration can rally around, but all of the stakeholders who are involved

I want to take a moment to explain the process of the Federal Strategic Plan to all of you since your awareness and input is vital, our timeline is short, and I’ve only had a full staff for literally two weeks. Ultimately, the 19 member agencies of the Council will be responsible for ratifying the final plan.  In the meantime, there are a number of steps that must be taken prior to ratification:

1. The members of the USICH Senior Policy Council who are guiding the process have so far approved the working framework and development process for the plan. Research is being conducted to assess needs as well as current federal policies and known best practices.
2. Workgroups of federal agency staff are meeting together to focus on goals and strategies for specific populations and areas to be addressed by the Plan.
3. External stakeholders are engaged in the discussion, offering ideas, feedback, research, and best practices. Over 450 consumers, advocates, providers, state and local governments, and representatives from ten-year planning bodies have already partaken in regional forums and meetings, while we envision having nearly 1,000 participate via these meetings and online input by the end of the FSP process.
4. In late March, workgroups will make their preliminary recommendations to the Senior Policy Council.
5. Final recommendations will be made in mid-April. The Senior Policy Council and Office of Management and Budget must approve the Plan before it is forwarded for ratification by the full Council and delivered to Congress.

The May 20th submission to Congress is only the first step in what will be a challenging implementation process.  The key will be the implementation from stakeholders ranging from the advocacy community, state and local, government, and the non-profit and private sectors.

So why am I so hopeful that this plan will be successful?  I have three specific reasons pertaining to the work that you do:

  •   We are building on a foundation of recent success in reducing chronic homelessness.

  •   VA Secretary Shinseki has established a bold mandate – end Veterans homelessness in 5 years.

  •   HEARTH implementation combined with the significant increase in targeted homeless assistance funding is a strategic opportunity to strengthen and strategically re-align community systems of care.

 

I’d like to put a little more substance to “my three reasons to believe” so that you too might become a ‘true believer’.

Point 1:  As we all are well aware, in the last decade, our country made great progress in developing new approaches to tackle chronic homelessness.  We focused our energies on combining housing and supportive services, which in turn has led to reducing the number of chronically ill long-term homeless by nearly a third.  And despite the economic crisis, a recent report by the US Conference of Mayors showed that the number of chronically homeless individuals has remained stable and even declined.  As we move forward with the Federal Strategic Plan to Prevent and End Homelessness, we recognize that permanent supported housing for chronically homeless persons offers considerable potential to address both homelessness in general, as well as better use of health resources. The vast majority of chronically homeless persons have a serious mental illness, substance abuse disorder or physical disability. A recent policy paper prepared for HUD Secretary Donovan lists integrating housing and services to deliver permanent supported housing chronically homeless persons as one of its primary recommendations (Penn Institute for Urban Research, University of Pennsylvania).

There is extensive support for permanent supported housing as the preferred strategy for addressing chronic homelessness.  There are three key research findings that I believe is important for this audience to hear: first, chronically homeless persons constitute a finite and aging population; second, permanent supported housing is effective at promoting residential stability among this population; and third, the cost of providing permanent supported housing can be partially or entirely offset by substantial reductions in the utilization of expensive acute care services such as emergency department visits, inpatient medical or psychiatric hospitalizations, detoxification services, and shelter and jail stays.

An article published two years ago in the Journal of the American Medical Association centered on Seattle's 1811 Eastlake supportive housing project, run by the Downtown Emergency Service Center. The researchers studied 75 of the center's chronically homeless residents - half of whom had serious mental illness and all of whom struggled with alcohol addiction.

In the year before participants in the program entered supportive housing, the 75 residents collectively spent more than 1,200 days in jail, and visited the local medical center more than 1,100 times at a cost to Medicaid of more than $3.5 million.

In the year after participants entered 1811 Eastlake, days spent in jail were cut almost in half. Medicaid costs had dropped by more than 40 percent.

Why?

Because hospital visits had dropped by almost a third.

A separate study in Chicago reached a similar conclusion. Housing assistance provided to homeless patients suffering from HIV/AIDS or other chronic illnesses made medical services that were available so much more effective that the days in the hospital dropped 42 percent, days of required nursing home care dropped 45 percent, and most critically of all, the number of emergency room visits dropped 46 percent.

Furthermore, and this is particularly relevant to chronically homeless Veterans, research has shown that there are positive impacts on reducing or ending substance use.  Once people with histories of substance use achieve sobriety, their living situation is often a factor in their ability to stay clean and sober.  A one-year follow-up study of 201 graduates of the Eden Programs chemical dependency treatment programs in Minneapolis found that 56.6% of those living independently remained sober; 56.5% of those living in a halfway house remained sober; 57.1% of those living in an unsupported SRO remained sober; while 90% of those living in supportive housing remained sober.

And this is exactly where the VA comes in. While the nation needs to act quickly to end chronic homelessness, the VA needs to tackle this head on to avoid a homeless crisis among older Veterans. A number of studies that focus on persons with serious mental illness have concluded that permanent supported housing is more successful than alternative approaches in relation to improving residential stability. More than 80 percent of those placed in permanent supported housing remain in those units. Furthermore, there is a strong cost savings element to this. The cost of supported housing can be offset by expensive medical services such as emergency room visits, residential treatment and inpatient hospitalizations – these are all costs borne by the VA medical system. Cost savings can be used to support less expensive outpatient services IF housing is provided.  There’s a slogan that may be appropriate here “housing is health care”.  It’s important to note, however, that the cost savings are only generated IF the target population is persons with serious mental illness or co-occuring chemical dependency – the very profile of most chronically homeless Veterans.  In many communities this may be a change from the past, but in order to meet the goal of ending homelessness among Veterans we have to shift the paradigm to addressing chronically homeless Veterans.

The resources of the HUD-VASH program could have significant impact if there was targeting of this resource to this population.  More on this later.

Point 2: In November, Secretary Eric Shinseki unveiled his five-year plan framework to end Veteran homelessness. It calls for leveraging the full range of VA housing, service, and benefit resources and expanding collaborations with other federal agencies, State Directors of Veterans Affairs, Veterans Service Organizations, and national, state and local social service providers and community groups.  His goal is to have a “no wrong door” approach so that Veterans who seek assistance directly from VA’s programs, or from community partners or through contract services will be able to access the needed services.  It will also include preventive measures like discharge planning for incarcerated Veterans re-entering society, supportive services for low-income Veterans and their families, a national referral center to link Veterans to local service providers, and the plan calls for expanded efforts for education, jobs, health care, and housing. 

Point 3: Implementation of HEARTH will enable communities to better manage federal resources to prevent and end homelessness through more streamlined funding sources, more local control and creativity, and increased federal investment.  The old school “ESG – aka Emergency Shelter Grant” will become the new school “ESG – Emergency Solutions Grant” which can be used for prevention and rapid re-housing as well as emergency shelter.  There will be a new rural program and a broader definition of who can benefit from these resources.  Smart communities will re-tool their crisis response systems and continue to prioritize permanent housing solutions. These investments in prevention and housing will create long-term savings in the costs of addressing homelessness.

HUD’s Continuum of Care grants provide permanent and transitional housing to homeless persons. Continuum of Care grants are awarded competitively to local programs to meet the needs of their homeless clients.

Community providers are also key stakeholders as we move forward in planning and later implementing the Federal Strategic Plan to Prevent and End Homelessness. While the research on successful practices in implementing plans to end homelessness is limited, but from research and from my personal experience, effective collaboration with community providers holds promise for replication in other places. Re-orienting the Continuum of Care is a major part of this. Ending homelessness involves changes in the ways that providers of homeless assistance do their work – adopting “Housing First” practices like low demand permanent supportive housing and rapid re-housing is essential.   I encourage you to work closely with community providers and participate in the local Continuum of Care.

As I mentioned earlier and it is worth repeating, President Obama’s recent FY 2011 budget request for targeted homeless assistance programs is an 11.5 percent increase over FY 2010 and the LARGEST ever by a President. There are a number of highlights in the President’s budget worth noting and they include:

  To support implementation of the HEARTH Act, the Budget proposes a nearly $200 million increase in homeless assistance funding compared to FY 2010 to increase investment in evidence-based practices, support the shift of local homeless assistance systems to a performance-based orientation, and to better meet the unique needs of rural communities.
  The President’s budget proposal also includes $4.2 billion in 2011 to reduce and help prevent homelessness among Veterans.  That breaks down into $3.4 billion for core medical services and $799 million for specific homeless programs and expanded medical care, which includes $294 million for expanded homeless initiatives. 

At USICH, we are very excited about the comprehensive plan Secretary Shinseki issued last November. We see great opportunities for the five year plan to involve community based organizations, while the Council would facilitate coordination among state and federal agencies to make it successful. It is important that the Plan targets the most difficult to serve Veterans.

And that is where we see HUD-VASH fitting in by providing the critical vouchers as a Housing First approach so that every Veteran has their own roof over their head.  HUD-VASH is essential to achieving the goal of ending homelessness among Veterans.  It is vital that we bridge the gap and focus targeting HUD-VASH for our country’s chronic homeless Veterans and keep them in a permanent home. In my experience, the most effective way to make this happen is to develop strong community partnerships since they, and like many folks in this room are the ones who are working on the front lines to care for them.  Housing First practices have been documented to be most successful at meeting the target population needs and achieving the intended results.
You may be skeptical that this model works.  I know I certainly was having been a provider of abstinence-based transitional housing using a therapeutic community model.  I was however convinced when I saw the successes that were occurring across the country.  One of those who convinced me was Sam Tsemberis, the founder of Pathways to Housing. Their model provides housing in apartments scattered throughout a community. This "scattered site" model fosters a sense of home and self-determination, and it helps speed the reintegration of Pathways’ clients into the community.  Sam challenges skeptics by noting:

"Some people think when you give housing away that you’re actually enabling people as opposed to helping them get better. Our experience has been that the offer of housing first, and then treatment, actually has more effective results in reducing addiction and mental health symptoms, than trying to do it the other way. The other way works for some people, but it hasn’t worked for the people who are chronically homeless."

I have four suggestions to improve local implementation of the HUD VASH Program to be more consistent with a Housing First approach:

First, I highly suggest streamlining and expediting admission to HUD VASH.  This would significantly increase the likelihood that the target population – chronically homeless men and women living on the streets - is able to be served.  There are a few steps to this process: you should analyze the complete flow and determine “non-value added” steps that can be eliminated, analyze documentation requirements and consolidate redundant information, reduce VA steps to admission, work with your housing authority partner to consolidate steps to lease-up, adopt model practices for housing placement and move-in assistance, and monitor “time to” steps to compare with other Housing First programs.

Second, VA case managers should work closely with local street outreach and emergency shelter providers to identify Veterans who are most in need of supportive housing.  The local HMIS system can also be used to identify Veterans with long histories of homelessness as evidenced by repeated or longstanding shelter utilization. 

Third, your program needs to fully adopt a Housing First approach by not requiring sobriety, abstinence, or medication compliance as a pre-condition to admission to HUD VASH. Beyond modifying your program procedures, this may mean that ongoing staff training will be needed to incorporate best practices around housing first. Again, I would encourage you to build relationships with other Housing First practitioners in your community.

Fourth, communities’ progress in serving target population of chronically homeless Veterans must be closely monitored.   The key results should be housing placement, housing retention, and low recidivism. I strongly encourage you to conduct an administrative data match with your local HMIS.  This will help you understand whether you are reaching the target population of chronically homeless Veterans.

To quote my new big boss and the President of these United States, "Those heroes have a home. It's the country they served, the United States of America, and until we reach a day when not a single Veteran sleeps on our nation's streets, our work remains unfinished."

In all of my years working to end homelessness, I have never been more hopeful of the possibility to put an end to it.  Many of us have made sacrifices over the years and toiled many long nights to assist those who so dearly needed our helping hand.  This dream and hope of ending this vicious cycle is within our grasp and that is why my family made the personal sacrifice to have me venture from Ohio to Washington to help the President see this vision through. It comes down to commitment – not just by the President, the Administration, Congress, nor even just the VA,  it is up to each of us – it is up to you. We can only achieve this longstanding goal that all of us have labored for years on – by working together to achieve it.

I’m excited to work with all of you in the weeks, months, and years ahead as we seek to make this dream a reality.

On behalf of the Obama Administration, thank you for all of the hard work you do day after day to make this country a better place for all of us. Thank you very much for listening today. And thank you to Vincent Kane and his team for inviting me to be here.
 

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