Ending Veterans Homelessness: HUD-VASH Makes Housing First a Priority

In October 2012, the U.S. Department of Veterans Affairs(VA) made Housing First the official policy of the Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program, which combines rental assistance from HUD with case management and other services from VA. We recently spoke with Vince Kane, Director of VA’s National Center on Homelessness Among Veterans (the Center), about how VA decided to adopt Housing First, what VA has learned about implementing this approach within the HUD-VASH program, and using a Housing First approach in other VA programs.

Housing First differs from prior approaches and models of care that require Veterans to complete treatment or demonstrate “housing readiness” before being given the chance to live independently in permanent housing. Instead, Housing First centers on providing Veterans experiencing homelessness with housing as quickly as possible. Treatment and other supportive services are then provided as needed to assist Veterans with maintaining housing and improving their quality of life. This intervention places permanent housing with supports at the foundation for success and stability, including better access and outcomes with treatment services. The Housing First model minimizes barriers to recovery and focuses on access, rapid engagement, and then sustainment of community-based permanent housing. That means that Veterans can move from the streets or shelters directly into permanent housing as quickly and safely as possible. Housing First helps VA focus HUD-VASH on Veterans experiencing the most significant challenges to housing stability, including chronic homelessness, severe mental illness and other significant barriers.

Mr. Kane described how VA’s decision to adopt Housing First grew out of a focus on outcomes and solutions. He recalled, “[how Secretary Shinseki, Secretary Donovan, and USICH Executive Director Barbara Poppe] asked, ‘What are the evidence-based and emerging best practices that are recovery-focused and allow us to rapidly engage and sustain housing for Veterans?’” As a first step, the Center initiated a demonstration project in the District of Columbia in 2009 to assess the impact of Housing First compared to treatment as usual within HUD-VASH. Findings showed that Housing First:

  • engaged more Veterans experiencing chronic homelessness;
  • dramatically reduced time to housing placement;
  • improved housing retention rates (98 percent remained housed for a year in Housing First compared with 86 percent otherwise); and
  • significantly reduced emergency room visits and unscheduled acute hospital stays. 

These results suggested that Housing First would improve outcomes for all Veterans served by the HUD-VASH program. Mr. Kane refers to adopting Housing First for HUD-VASH as a “game-changer service delivery model.” He added, “This change in program policy is consistent with the federal strategic plan [Opening Doors], and VA Secretary Shinseki believes it is our most effective resource to reach our 2015 goal to end Veterans homelessness.”

In addition to the change in policy, VA continues to innovate and support practitioners in the field with tools and know-how to support implementation. VA surveyed VA Medical Centers about implementing Housing First for HUD-VASH, and provided targeted training based on those survey results on the core components of Housing First and ways to use the approach with the HUD-VASH program. The survey included a self-evaluation for each VA Medical Center on its adoption of Housing First, as well as the timeliness of access to housing, symptom stabilization, use of emergency and medical and mental health services, quality of life, and long-term housing stabilization of Veterans enrolled. In response, the Center is developing curriculum on key strategies of Housing First and an online course for VA and non-VA providers to learn more about the approach. Clinicians will receive Continuing Medical Education (CME) credits for completing the course, which will open to the public in early June 2013.

In 2012, the Center, in consultation with Dr. Sam Tsemberis of Pathways to Housing, launched a 36-month evaluation of a service-enhanced implementation of Housing First in 14 HUD-VASH program sites, to identify outcomes and lessons learned. These communities included: Bay Pines, Boston, Chicago, Dallas, District of Columbia, Denver, Detroit, Los Angeles, New Orleans, New York Harbor and Bronx, Philadelphia, Portland, San Francisco, and Syracuse. Through this effort, VA is building Assertive Community Treatment teams—multidisciplinary teams of health care, mental health treatment, vocational assistance, and job development providers—who together wrap the appropriate services around HUD-VASH participants to ensure stable housing and improve health and quality of life. The Veterans Health Administration (VHA) Homeless Program Office provided funding for this effort and the Center is evaluating its impact on outcomes for the Veterans served.

Beyond HUD-VASH, VA’s Transition-In-Place models within the Grant Per Diem (GPD) program offers Veterans access to housing and support services, with the expectation that services disengage when no longer needed, allowing the participant to remain stably housed. This approach is intended to increase the speed of Veterans moving from transitional to permanent housing and promote housing stability, instead of requiring Veterans to move out after using VA services. Transitional housing GPD programs are also exploring how Housing First principles apply to their programs. On May 8, USICH and the National Coalition for Homeless Veterans are hosting a webinar about using Housing First as a clinical practice in transitional housing programs under GPD. See the registration link below.

With the demonstrated success of Housing First, Mr. Kane mentioned that VA is continuing to examine other opportunities for Housing First to guide efforts to end Veterans homelessness. “Since 2011, by nature and design, Supportive Services for Veteran Families (SSVF) has made Housing First a focus and priority. With $300M proposed in the President’s Fiscal Year 2014 Budget to fund SSVF, a prioritization on collaborative community based housing stability will remain a hallmark of VA’s transformational efforts to end Veteran homelessness.”

VA continues to capture lessons learned from Housing First and apply them to its programs, as it leads the way in efforts to end homelessness among Veterans.

Learn more about HUD-VASH and Housing First

Read the breakdown of targeted homeless assistance funding for programs like HUD-VASH in the President’s FY 2014 Budget Proposal

Want a quick way to know if a program is Housing First? Access the Housing First Checklist.

Open Doors to Innovation and join the webinar on May 8, 2013 hosted by USICH and the National Coalition for Homeless Veterans on using the Housing First model as a clinical practice that can be adopted for transitional housing programs. Learn more about the webinar and register.