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Executive Director Poppe’s Keynote at National Forum on Homelessness Among Veterans

12/7/10                                                                     

Good morning. It is an honor to be here and I am very excited about the conversations that will take place over the next two days, which are absolutely critical to ensuring that we prevent and end Veterans homelessness by 2015.

My remarks are laid out to describe the mission we are all undertaking together. I’m going to start by reviewing Opening Doors; I will underscore the importance of committing to Housing First strategies; the significance of collecting good data; and finally, emphasize the importance of collaboration – it is the only we will achieve ZERO by 2015.

Before I go on, I want to share just a little about why I believe we are on the right path towards preventing and ending homelessness for our nation’s Veterans. I arrived in Washington, DC over one year ago with more than two decades worth of non-profit experience working on homelessness with housing-related organizations. Prior to accepting the call to lead USICH, 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 USICH demonstration projects to address chronic homelessness in 2002.  Like all of the demonstration programs, we had a special focus on Veterans and worked with the VA as an integral partner.  Using Housing First practices, we were able to get men and women who had lived on the streets for years, into their own apartment and connect them with the services and healthcare they needed to rebuild their lives.

As grateful as we were for the federal funding, it was frustrating to be expected to collaborate and break down local barriers when our federal partners had no interest in addressing the federal barriers, which made it difficult to provide the integrated services and housing that our clients needed.

Today, we gather in response to President Obama’s call to break down silos and end homelessness.  Nowhere is our obligation to our citizens, and to our Veterans who have defended our Nation, more important, more visible, or more necessary than in our commitment to end homelessness. Now more than ever, we need federal leadership to set out clear goals, timeframes, and strategies to ensure that local communities have a real partner in Washington.
The VA has demonstrated real leadership and commitment in this fight, but we recognize that the VA alone won’t end homelessness. It is all of our responsibility. And the only way we are going to get to zero by 2015 is if all of us in this room and the folks back home in your communities work together to make it a reality. You were invited here today because you are integral to our success.

Opening Doors Overview

With the help of many of you in this audience, on June 22nd we launched Opening Doors at a White House event headlined by four cabinet secretaries and the head of the Domestic Policy Council.  Could I see a show of hands of those who have had a chance to read this Plan? Thank you! You join more than 200,000 others who have downloaded the plan on our website.

Opening Doors is based on the vision that no one should experience homelessness. No one should be without a safe, stable place to call home. This vision was articulated by President Obama when he stated that “it is simply unacceptable for individuals, children, families and our nation’s Veterans to be faced with homelessness in this country.”

It is a vision that is shared by the Cabinet Secretaries that make up USICH. It has been an incredible privilege to work with and see first-hand the tremendous leadership by Secretaries Shinseki, Solis, Donovan, and Sebelius. Their vision is why we are here today with the most comprehensive plan to address homelessness for all populations in the history of our nation.

This trying period we are in, presents both opportunities and challenges. Now more than ever, federal leadership is needed to set out clear goals, timeframes, and strategies to ensure that local communities have a real partner in Washington. And that’s what Opening Doors does. A fiscally prudent government response is imperative—local, state, and federal governments cannot afford to invest in anything but the most evidence-based, cost-effective strategies.  That’s why Opening Doors only includes those strategies that have been working for several years at the local level.

Opening Doors represents a dramatic shift in our approach.  It is based on the idea that solving homelessness requires that people access MAINSTREAM resources effectively and sufficiently to meet their needs and avoid homelessness. Mainstream programs are designed for people regardless of their housing status, programs like VA general benefits, Medicaid, TANF, Supplemental Nutrition Assistance, and Education. To date, the “federal plan” to address homelessness is by default defined by a set of TARGETED programs – like HUD Continuum of Care grants, Labor’s HVRP, and VA Grant Per Diem programs – rarely well coordinated. The new plan places PREVENTION at the center and brings MAINSTREAM  resources to bear. In our shift to mainstream resources, we are moving to where the dollars are. We need more resources on the table if we are truly to move the needle on homelessness. Especially, on Veterans homelessness.

Opening Doors has four bold goals:

First, we will finish the job of ending chronic homelessness in five years. By bringing permanent supportive housing to scale, we’ve reduced the number of people experiencing chronic homelessness nationally by one-third in the last five years. Permanent supportive housing rebuilds people’s lives, and is a far wiser investment of scarce public resources than cycling through emergency rooms, jails, and detox facilities.

Second, as Secretary Shinseki boldly articulated at this conference last year, we will prevent and end homelessness for America’s Veterans and their families by 2015.

Third, we will prevent and end homelessness for families, youth, and children in ten years.

Fourth and finally, Opening Doors sets a path of ending all types of homelessness.

Opening Doors outlines 10 objectives and 52 comprehensive strategies. As I learned in Ohio and have seen across the country, there is not a “one-size-fits all” plan. We must – and will -- consider regional opportunities and challenges when acting with our community partners at local and state levels.

Four goals. Ten objectives. Fifty-Two strategies. And Five areas of focus.

  • First - Federal leadership and collaboration
  • Second - Housing, housing and housing
  • Third - Increasing income and employment
  • Fourth - Improving health and stability
  • And lastly- Re-tooling the homeless crisis response system

Let’s start with leadership and collaboration. When the President is talking about ending homelessness, and Cabinet Secretaries are talking about ending homelessness, and the Chairman of the Joint Chiefs of Staff Admiral Mullen is talking about ending homelessness, people are going to start to think it’s possible to end homelessness and that we should.

It is absolutely critical for us to gain more visibility on Veterans homelessness. Together, we need to raise the public profile and increase the public’s understanding of the men and women who experience homelessnsess. And YOU are our ambassadors. During this holiday season and throughout 2011, I urge you to promote the solutions we are discussing over the next two days back home in your communities.

The first theme of the plan is federal leadership and collaboration. The second is housing, housing, housing.
People who are homeless need homes. Affordable housing. For many persons living in poverty, the lack of stable housing leads to costly cycling through crisis-driven systems like foster care, emergency rooms, psychiatric hospitals, emergency domestic violence shelters, detox centers, and jails. Stable housing provides an ideal launching pad for the delivery of health care and other social services focused on improving outcomes for individuals and families.

HUD Secretary Donovan is a tremendous leader on this issue and is doing all he can to get the federal government back in the business of affordable housing. You will have the opportunity to hear from Secretary Donovan tomorrow and learn more about efforts being done on this front - both through new investments and better targeting of existing assisted and public housing. This will not happen all at once, not with this economy and this deficit, but we know it needs to be a central part of ending homelessness.

Included in this area is the call for more permanent supportive housing for people who need that intensive combination of housing and supports to stabilize and succeed. HUD-VASH is a tremendous resource that can be deployed to solve chronic homelessness among Veterans. Committing to Housing First practices is also integral to the success of the Plan. More on this later.

The third theme of the Plan is employment and income.

Everyone needs a home they can afford. The best defense against homelessness is a good paying job. All of us will agree, employing our Veterans is crucial and there is a ton of work that needs to be done in this area. As you heard earlier, Secretary Solis is committed to ensuring that the Department of Labor is a leader in creating opportunities for Veterans to get the training and support they need to improve their skills in order to compete for well paying jobs.  We must meet their unique needs as we implement best practices in employment strategies and fully coordinate with housing and healthcare.
So as we work on employment, we need to continue to improve access to the income supports that are available to Veterans who have low incomes. Veterans are citizens first, and they and their families should also be linked to mainstream programs that they are eligible for.  These programs are proven to be prescriptive to preventing homelessness for individuals and families who are at risk of homelessness, and can speed up their exit out of it.  I will discuss federal collaborative efforts on this in a minute.

The fourth theme is health and stability. Secretary Sebelius is our tireless leader on this.

Health reform generally, Medicaid expansion in particular, is the secret weapon in the fight against homelessness. My first few months in DC were a roller coaster ride for health reform. Would it pass? Wouldn’t it pass? But then in March, the seemingly impossible happened - Congress passed and President Obama signed into law the Health Reform bill. The passage of the Affordable Care Act in March put an incredible lift in our efforts to prevent and end homelessness.

Health reform offers new economic security - individuals and families are significantly less likely to be made bankrupt, or enter into a downward economic spiral, when they have health insurance.

For the first time ever, all poor single adults will become eligible for Medicaid. They will have access to health care before they get sick, which will prevent some people from becoming homeless. People with mental illness and substance use disorders, who are disproportionately represented among the chronically homeless, will especially benefit by the improvements that will come with the implementation of parity. No longer can insurance companies exclude treatment of these disorders from the coverage offerings. Medicaid expansion will increase overall health for vulnerable populations.

So what does this mean for Veterans? Well I’m glad you asked.  The VA provides outstanding care to eligible Veterans who need health services.  However, what about that Veterans family if they experience a health crisis?  What about that Veteran who is not eligible for VA care?  Well, what I said previously about more accessible care, applies to the Veteran’s family or to that Veteran who is not eligible for VA healthcare. It’s hard to imagine a Veteran making his or her way out of homelessness if his or her family cannot get the healthcare they need.

The fifth and final theme of the Plan is re-tooling the homeless crisis response system.

Local crisis response systems of care should be developed and must focus on housing stabilization (not just providing emergency shelter and outreach). These community based systems must offer alternatives to shelter admission whenever possible, make shelter available to all who need it, and result in quick housing placement and housing retention. Temporary residential programs (shelters, transitional housing, VA grant and per diem programs, VA domiciliary, adult rehab centers, etc.) are an integral part of the crisis response system.

To maximize such a system, these programs must be efficient and effective in helping Veterans experiencing homelessness successfully and quickly achieve the outcome of long-term housing.   Strong collaboration between VA services and  community based providers, as well as programming to create a pathway to permanent housing is critical. To ensure all Veterans can leave the streets, temporary residential programs must be readily accessible to Veterans of all configurations and reduce barriers to admission.

Realigning the homelessness assistance system to reflect what we have learned about how best to serve families and single individuals, including Veterans, is an urgent priority in Opening Doors.  As a part of last year’s Recovery Act, the federal government took the necessary first step to make this a reality. The creation of the Homelessness Prevention and Rapid Re-Housing program (HPRP) and enactment of HEARTH will give communities a broader range of interventions. We also anticipate the Support Services for Veterans Families (SSVF) grant will provide communities with additional interventions specifically targeting Veterans and their families.

HPRP has paved the way for us to change the homeless system. Instead of shuffling people through shelters and transitional housing, HPRP is keeping people in their homes, while quickly returning others to the stable, permanent housing they need. We need Supportive Services for Veterans Families to do the same thing for Veterans and their families. Communities that retool their crisis response systems with a focus on prevention and rapid re-housing will achieve greater success in housing Veterans.

So that’s the federal plan in five easy pieces: collaborative leadership, housing, income, health and re-tooling the homeless crisis response system.

Housing First

I would like to discuss why we need to adopt Housing First practices.

Housing First models of supportive housing minimize barriers to housing access or pre-conditions of housing readiness, sobriety, or engagement in treatment. Participants move directly from the streets and shelters into permanent housing.  Individualized supportive services help residents maintain housing stability and improvements in the quality of their life.

These low barrier practices seek to “screen in” rather than “screen out” and end homelessness for people with the greatest barriers to housing success.
Evaluations of Housing First permanent supportive housing have demonstrated significant improvements in housing stability and reductions in days of homelessness. And when it comes to cost-effectiveness there is no better strategy for the ever tightening state and local social services budget. The reductions in the utilization and costs of public services from emergency shelter, hospital emergency room and inpatient care, sobering centers, and jails are substantial.

For instance:
In Seattle, Housing First supportive housing was shown to reduce Medicaid costs by 41 percent and reduce sobering center admissions by 87 percent. Average total costs reduced more than 75 percent after one year.

In the federal Collaborative Initiative to Help End Chronic Homelessness – a demonstration program at 11 sites across the country - 95 percent of participants were in independent housing after one year. Average costs for health care and treatment were reduced by about half. The largest decline was associated with costs for inpatient hospital care.

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-occurring chemical dependency – the very profile of most chronically homeless veterans. 
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 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."

And this is exactly where all of us in this room come in. The nation needs to tackle this head on to avoid a homeless crisis among older 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. We must adopt Housing First as a best practice in our communities, it is the only way we are going to get to ZERO.

Importance of accurate PIT Counts

While we actually know quite a bit about the causes and circumstances of veterans that experience homelessness, data on the number of homeless veterans has fluctuated from year to year and across data sources.  This is largely due to inconsistencies in the way data is captured.  As a result, the Federal government is moving towards use of HUD’s Point in Time process as the principal data source to understand changes in trends and measure the country’s progress towards ending homelessness. 

HUD uses information from the local PIT counts in the congressionally-mandated Annual Homeless Assessment Report (AHAR). This report is meant to capture the number of people experiencing homelessness and the effectiveness of Federal programs and policies in decreasing those numbers.   The Council will be using the PIT data to measure progress against the goals outlined in Opening Doors – including our goal to end veterans homelessness.
HUD requires communities to complete PIT count minimally every two years during the last week of January.  2011 is a required year, and it is the FIRST year that HUD is requiring communities to obtain Veteran status as part of their unsheltered count – also referred to as the “street” count.  In other words, we have a very significant opportunity ahead of us to capture strong baseline data.  Therefore, it is critical that all providers and especially all of you here today – whether receiving HUD resources or not – participate in PIT planning and implementation.  It is particularly critical that local VA staff and VA-contracted service providers participate in the housing inventory and PIT count.  

You will notice several messages going out from HUD, the VA, and USICH over the coming days that offer more information on this opportunity.  Most importantly, we encourage the VA staff and VA-contracted service providers to coordinate their efforts with your local Continuums of Care (and vice versa), who are responsible for organizing the count.  Support is always needed on the night of the count, but your input will also be critical during the planning phase.  For example, VA staff and providers can help continuums review their project lists to ensure all VA providers that have targeted homeless assistance programs are included in the count. 

Continuums may also need help understanding how to phrase questions about military experience that elicit more accurate responses.  And, we’ve also found that the outreach conducted to veterans experiencing homelessness  on the night of the count is often better received when it’s coming from another veteran.   So to everyone in this room, please commit to being part of this important event. 

Collaboration
So committing to Housing First is the first key take away from my remarks, good data through an accurate PIT count in January is the second, and third takeaway is the importance of collaboration. Collaboration, as you well know, is hard work. Sometimes it is easier just to say, “I’ll do it myself.” But collaboration is critical for ending homelessness. Here’s why.

People experiencing or most at risk of homelessness are first and foremost people. They are people in a heightened state of need and the situations that threaten them with homelessness are varied and complex. Their challenges are not neatly divided into discreet problems. Getting a child to school is tied to transportation is tied to a work schedule is tied to health. Those of you in the audience who work on the front lines of homelessness, know how much work it takes to navigate the systems to help your clients get what they need. Better that these systems work together on behalf of your clients.

At the federal level, you can see the progress we have made on collaborating and breaking down silos across the government by just looking at this conference’s agenda. We have three Cabinet Secretaries and representatives from HUD, Labor, VA, HHS, and Education on a variety of panels. And soon after I complete my remarks, you will hear from two of my key partners at the VA, Lisa Pape and Dr. Susan Angell.

At the last Council meeting in November, the Council charged its agencies to collaborate and develop a plan of action to increase access to mainstream and targeted programs for Veterans and their families. Last week, we launched an interactive website for all of the key Veterans stakeholders to provide input on the improvements needed for Veterans to access mainstream benefits. If you haven’t had a chance, please visit it and tell everyone in your networks. The site is – USICH.USERVOICE.COM. USICH also hosted a webcast last month with Council member agencies to educate our key stakeholders on our plans and initiatives to end Veterans homelessness.

And in relation to Opening Doors, USICH is facilitating collaborative efforts on a signature initiative with the VA, HUD, Labor, HHS, and other partners to align resources for greater effectiveness by bringing together programs that would otherwise operate separately. Right here in DC, and you’ll hear more about it later today, how federal, local and community collaboration has resulted in quick and stable housing for the most vulnerable Veterans in the District. Through this interagency collaboration, Veterans receiving a VASH voucher have been able to move into housing on average in 2 weeks as opposed to over the 100 days it takes in many other communities.

By testing models of local/federal collaboration on behalf of Veterans, the lessons learned can be applied in other communities.

This federal interagency collaboration is only one piece of the puzzle. We are asking communities across the country to be active partners -- with one another and with us as we implement Opening Doors

This involves interagency collaboration at the federal regional level, state level, and in local communities. I can’t stress it enough, collaborating at the local level is absolutely vital. This involves bringing all of the key players to the table – Ten Year Plan leaders and State Interagency councils, VA staff, public housing authorities, state and local officials, service providers, the faith based community, philanthropy, and housing developers and property managers. VA Medical Center and local Continuum of Cares get together and share your plans. Coordinate your activities.

We all understand that we can’t do this alone. Preventing and ending homelessness is an “all hands on deck” objective. We must remove barriers and use our resources collaboratively.

In all of my years working to end homelessness, I have never been more hopeful that we are on the right collective path.  It comes down to commitment – not just by the President, the Administration, Congress, your respective Governors – it is up to you. We must commit to Housing First practices, we need to everyone to do a good count in January, and by working together we will prevent and end Veterans homelessness.

Your actions matter, your perseverance matters, your quest to be as efficient and effective with the available resources matters.

I look forward to working with all of you over the next 1,429 days as we finish the mission that Secretary Shinseki first set out for us last year – to get to ZERO by 2015. Thank you for serving our Veterans and thank you for being our partners in this mission!