[Senate Hearing 111-748]
[From the U.S. Government Publishing Office]
S. Hrg. 111-748
HEARING ON VA'S PLAN FOR ENDING HOMELESSNESS AMONG VETERANS
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
MARCH 24, 2010
__________
Printed for the use of the Committee on Veterans' Affairs
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senate
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COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Lindsey O. Graham, South Carolina
Bernard Sanders, (I) Vermont Johnny Isakson, Georgia
Sherrod Brown, Ohio Roger F. Wicker, Mississippi
Jim Webb, Virginia Mike Johanns, Nebraska
Jon Tester, Montana Scott P. Brown, Massachusetts
Mark Begich, Alaska
Roland W. Burris, Illinois
Arlen Specter, Pennsylvania
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
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March 24, 2010
SENATORS
Page
Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii........ 1
Burr, Hon. Richard, Ranking Member, U.S. Senator from North
Carolina....................................................... 2
Tester, Hon. Jon, U.S. Senator from Montana...................... 4
Murray, Hon. Patty, U.S. Senator from Washington................. 37
WITNESSES
Dougherty, Pete, Director, Homeless Programs, U.S. Department of
Veterans Affairs; accompanied by Lisa Pape, Acting Director,
Mental Health Homeless and Residential Rehabilitation Treatment
Programs....................................................... 5
Prepared statement........................................... 7
Response to written questions submitted by:
Hon. Daniel K. Akaka....................................... 12
Hon. Jim Webb.............................................. 18
Hon. Roland W. Burris...................................... 20
Hon. Mike Johanns.......................................... 22
Response to request for data on Suicide in Women Veterans by
Hon. Patty Murray.......................................... 39
Jefferson, Hon. Raymond M., Assistant Secretary for Veterans'
Employment and Training, U.S. Department of Labor.............. 22
Prepared statement........................................... 23
Johnston, Mark, Deputy Assistant Secretary for Special Needs,
U.S. Department of Housing and Urban Development............... 26
Prepared statement........................................... 28
Response to written questions submitted by:
Hon. Daniel K. Akaka....................................... 31
Hon. Jim Webb.............................................. 32
Shipman, Arnold, U.S. Air Force Veteran.......................... 59
Prepared statement........................................... 61
Response to post-hearing questions submitted by Hon. Daniel
K. Akaka................................................... 62
Miller, Sandra A., Program Director, Homeless Veteran Residential
Services, Philadelphia Veterans Multi-Service & Education
Center......................................................... 62
Prepared statement........................................... 64
Response to post-hearing questions submitted by Hon. Daniel
K. Akaka................................................... 69
Tsemberis, Sam, Ph.D., Founder and CEO, Pathways to Housing, Inc. 70
Prepared statement........................................... 72
Post-hearing questions submitted by Hon. Daniel K. Akaka..... 77
APPENDIX
Parnell, Dennis, President and Chief Executive Officer, The
Healing Place of Wake County; prepared statement............... 79
Post-hearing questions submitted by Hon. Daniel K. Akaka..... 81
Ryan, Patrick, Vice Chair, Board of Directors, National Coalition
for Homeless Veterans; prepared statement...................... 82
Response to post-hearing questions submitted by Hon. Daniel
K. Akaka................................................... 85
HEARING ON VA'S PLAN FOR ENDING HOMELESSNESS AMONG VETERANS
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WEDNESDAY, MARCH 24, 2010
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:30 a.m., in
room 418, Russell Senate Office Building, Hon. Daniel K. Akaka,
Chairman of the Committee, presiding.
Present: Senators Akaka, Murray, Tester, and Burr.
OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,
U.S. SENATOR FROM HAWAII
Chairman Akaka. Aloha and good morning, everyone. The
Senate Committee on Veterans' Affairs will come to order.
Today the Committee will hear testimony about the VA's 5-
year plan and the collective efforts of the Federal Government
to end homelessness among veterans. We will also hear from
individuals who have worked to end homelessness among veterans
for many years.
Earlier this month the VA announced approximately 107,000
veterans were homeless on any given night in 2009. In 2008 that
number was 131,000. While the reduction is good news, there are
still too many veterans without a place to call home.
Homelessness for any American is a very difficult thing, but
for an individual who has answered the call to duty, it is not
unacceptable.
There are many challenges that veterans face which can lead
to homelessness such as health concerns including mental health
problems, economic issues, and a lack of access to safe
housing. But these challenges are not new.
The central question is, what do we need to do now to try
to address and resolve these issues so that we can keep from
having to face this problem a decade from now.
Congress has been actively working on this issue for over
20 years. As Chairman of the Committee, I stand ready to do my
part in supporting efforts to bring it to an end.
I am pleased that the Committee, with Senator Murray
playing a leadership role, recently approved legislation to
enhance the programs and services for homeless veterans and to
expand services for homeless women veterans and veterans who
have care for minor dependent children.
This legislation, which presents another important step in
our collective efforts, will be brought before the Senate in
future. In order to be successful in any plan to end
homelessness among veterans, we must recognize that a
significant number of homeless veterans suffer from mental
health issues.
VA estimates that more than half of all homeless veterans
have a serious psychiatric diagnosis. Many others are addicted
to drugs and alcohol. Providing these veterans with an
alternative to living on the street is a challenge.
We must fully understand the needs of these veterans, the
resources needed to assist them and be committed to meeting
their needs.
I applaud Secretary Shinseki for the dedication to the task
of ending homelessness among veterans. But as we will hear
today, VA cannot do it alone. If we, as a Nation, are to
achieve this goal, we must leave no stone unturned when trying
to help veterans in need.
Today's hearing gives us a chance to better understand the
current situation with an eye toward fixing what is not working
and expanding what is working. I thank all of our witnesses for
being here today to help us in this effort.
And now I would like to call on our Ranking Member, Senator
Burr, for his opening statement.
Senator Burr.
STATEMENT OF HON. RICHARD BURR, RANKING MEMBER,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. Thank you, Mr. Chairman, and aloha.
Chairman Akaka. Aloha.
Senator Burr. More importantly thank you for calling this
hearing and I welcome our witnesses from the VA and from around
the country.
There are few issues that we care more deeply about than
making sure that we end homelessness among those who wore our
Nation's uniform.
The present Secretary has set an ambitious goal to end
homelessness in 5 years. It is going to be tough, but I am
committed to work toward that goal.
According to the VA, 107,000 veterans were homeless on any
given night last year including an estimated 15,089 in my State
of North Carolina. Although those numbers represent an
improvement over prior years, we still have much work to do.
Let there be no mistake, however. The goal is not just to
end homelessness in 5 years. It is also to make sure that the
solutions are sustainable beyond the 5-year period. I have said
it many times before; the only way to end homelessness is to
ensure that it never begins in the first place.
Prevention is the key. We must develop successful programs
to target the estimated 27,000 veterans who are at risk of
falling into that cycle every single year. We must also think
smarter about where and how we invest in homelessness programs.
Too often in the past we have been happy to point at the
dollars we have thrown at the problem, without any real
accountability for results, or an understanding of how public
and private resources could better coordinate services with
each other.
I believe we have some models of success out there that
provide us with a promising path forward. I am pleased that Mr.
Dennis Parnell, President of the Healing Place of Wake County,
NC, accepted the invitation to testify today. I think you will
find their data riveting.
Through its public/private partnerships, the Healing Place
is able to boast of a sobriety recovery rate of over 68 percent
1 year after. That success rate is three times the national
average. And this success leads directly to the Healing Place's
stellar record in reducing homelessness in the county. Not too
many counties can claim that statistic.
Today, I am anxious to hear about the Secretary's plan to
move forward. No doubt his plan will require Congress'
involvement.
Unfortunately, I have been disappointed about the
Administration's collaboration with us thus far. Last October,
the Committee held a hearing on Comprehensive Homeless
Legislation, S. 1547, but received no official views from VA on
the bill.
In the absence of any views, the Committee marked up the
legislation in January with the expectation that VA would be
providing us with a greater understanding of how it fits in
with the Secretary's plan. Five months and multiple inquiries
later, we received the views last night, giving my staff no
opportunity to do a thorough analysis of the information. Of
course, this is not the first time VA waits until the 11th hour
to provide responses to inquiries they have had for months.
This is also not the first time I have mentioned this problem,
and I will continue to do so. I do not understand the delay.
Why does it take VA 5 months to provide Congress with the
crucial information we need to do the best job we can for our
veterans?
If in fact I go through the Secretary's blueprint and I
find that this is another round of us throwing more money to
programs that we cannot justify the outcome of, then we will
need to figure out what the appropriate legislative action is
after that. But I had committed to the Secretary to work with
him because he assured me that we have a fresh, new pathway to
get there.
The bottom line is we need to get this right. There is too
much at stake. We need to make sure all the information we need
to allocate resources in the most effective way possible is in
fact delivered.
Mr. Chairman, I will work aggressively with you and through
the witnesses that we have today to try to find out the answers
to these questions.
I once again welcome our witnesses and I thank the Chairman
for his indulgence.
Chairman Akaka. Thank you so much, Senator Burr. We will
look forward to working together on this problem.
I want to welcome the witnesses on our first panel. Each
has had an important role in ending homelessness among
veterans.
Many agencies are required to work in partnerships if there
is ever going to be homelessness among veterans. Too often in
the past the collaboration between agencies who should have
been working together just did not exist but I am hopeful this
is no longer the case. It certainly does not appear to be today
especially with the make up of our first panel.
First, we have Pete Dougherty, Director of the Office of
Homeless Veterans Programs at the Department of Veterans
Affairs. I would like to note that Mr. Dougherty was a staff
member of this Committee during the early 1990s.
Welcome back, Mr. Dougherty.
Mr. Dougherty is accompanied by Lisa Pape, Acting Director
for Mental Health Homeless and Residential Rehabilitation
Treatment Programs.
Second, we have Hon. Raymond Jefferson, Assistant Secretary
of Veterans' Employment and Training Service at the Department
of Labor.
Then we have Mark Johnston, Deputy Assistant Secretary for
Special Needs at the Department of Housing and Urban
Development.
I thank you all for being here this morning. Your full
testimony will appear in the record.
Before I call on Mr. Dougherty to begin and proceed with
his testimony, I am going to call on Senator Tester for any
opening remarks he may have.
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator Tester. Thank you, Mr. Chairman and Ranking Member
Burr. I appreciate your having this hearing. I think this is a
very, very critically important issue.
I want to welcome Assistant Secretary Jefferson. Ray, we
still need to get you out to Montana to show you the sights and
the veterans that are out there and the challenges that they
face; and the same goes for everybody else on the panel too.
Come and we will put you to work and show you the challenges we
face in rural America from a Montana perspective.
As you know, statistically in rural America veterans
represent about 11 percent of the population. Montana is the
fourth largest State. We have 104,000 veterans; 147,000 square
miles. Senator Begich beats me on that, but we are not far
behind.
I do applaud Secretary Shinseki's call to end homelessness
among veteran populations. This is the right goal. It
absolutely is the right time to do that. We have to get the
economy moving again and we have to make sure these folks are
getting the health services and job training skills they need.
If we focus just on the shelter portion or just on the
mental health or substance abuse portion or just on the job
training portion, we are going to come up short, and you guys
know that.
It takes all of these services delivered together in an
integrated way to get the veteran off the street and make sure
he does not end up back on the street.
So I am pleased to see that HUD, VA, and the Labor
Department are all here on the same panel. As we move along
this morning, I want to remind folks that by some estimates 7
percent of homeless veterans on any given night are in rural or
frontier areas of our country. Some studies have it at 5
percent. In either case, I do not think any of us want these
folks to be forgotten about.
The reality is that folks in rural areas are going to be
harder to reach and it's harder to get key services and
resources to them. That is why homelessness in rural parts of
this country--the homeless--are referred to as the hidden
homeless.
With that, Mr. Chairman, I want to thank you very, very
much for having this hearing. I look forward to each witness's
presentation and we will have a good hearing.
Chairman Akaka. Thank you very much, Senator Tester.
I will now call on Mr. Pete Dougherty for your statement.
Please proceed.
STATEMENT OF PETE DOUGHERTY, DIRECTOR, HOMELESS PROGRAMS,
OFFICE OF PUBLIC & INTERGOVERNMENTAL AFFAIRS, U.S. DEPARTMENT
OF VETERANS AFFAIRS; ACCOMPANIED BY LISA PAPE, ACTING DIRECTOR,
MENTAL HEALTH HOMELESS AND RESIDENTIAL REHABILITATION TREATMENT
PROGRAMS
Mr. Dougherty. Thank you, Mr. Chairman.
On behalf of the Secretary Shinseki, let me thank you and
the Committee for the opportunity to review our plans to end
homelessness among our Nation's veterans. As you have
indicated, I am here and pleased to be with Lisa Pape.
Now is the time to end homelessness among veterans. We owe
every man and women who has worn our Nation's military uniform
no less.
As has been stated, the number of homeless veterans have
gone down, but as you also indicated, and we agree, that any
homeless veteran who is seeking services needs to have us and
this government help them.
This is an ambitious project. It requires a significant
amount of resources. Our health care budget for next year is
proposed to have $3.4 billion for core medical care and
assistance and nearly $800 million in targeted programs that
assist homeless veterans.
We are taking a no-wrong-door approach as we do this. We
are trying to make sure that every veteran seeking services has
access regardless of the hour or their condition. We anticipate
that we will provide direct care and prevention assistance to
more than 500,000 veterans over the next 5 years.
We are very concerned and we are constantly monitoring what
we are doing. Our approach has been to be much more
collaborative, much more diverse in the way we approach this
problem.
But we have looked at what we have done in the past and we
have completed a study that said that when you look at contract
residential care, when you look at our in-patient care programs
for homeless veterans and you look at our transitional housing
programs, that veterans who complete those programs that about
80 percent are appropriately housed a year after they complete
programs. That is good success.
We have opened a national call and referral center for
homeless veterans. We are working in partnership with the
National Suicide Prevention Hot Line. That call center is
really addressing the needs of that veteran whether they are in
urban America or rural America, whether they are a service
provider or a veteran themselves seeking services.
The idea is to have an immediate ability to contact us and
to get us to respond to that veteran's need. We will continue
to actively engage with communities in outreach events. Many of
them called stand downs.
Last year over 48,000 homeless veterans and their family
members came and sought services not just from VA and not just
for my colleagues at this table but from community groups and
organizations who could help across the country.
We have a number of staff, about 350 staff who work in our
health care for homeless veterans' program. That staff is going
out and reaching about 40,000 homeless veterans. They go into
soup kitchens and places like that.
As we approach this, as Senator Burr reminded us, we have
to be more collaborative in the way we do this. Part of what we
are going to do is we are going to outstation 20 substance
abuse treatment specialists in community programs to get the
programs to the veteran as opposed to the veteran having to
come to us.
We are expanding contract residential care and expect to
have about 5000 veterans who will get contract residential care
so that when you contact us we have an immediate place for you
to go to.
Homelessness also has been a problem for veterans who have
dental care problems. Under our plan we are doing things to
address and expect about 20,000 veterans who will get dental
care treatment. This is very important both for their physical
health but it is also very important to get back into gainful
employment which is what the hope of many of them are.
We are expanding our opportunities to work with prosecutors
and judges to expand efforts to work with veterans who are
engaged in the criminal justice system and those who are
exiting prisons. We are adding 46 full-time veterans' justice
outreach specialists to assist veterans in treatment courts and
veterans who are in drug courts.
We are adding to the 39 health care for re-entry
specialists who are working on prerelease outreach and post-
release case management. We expect about 12,500 will be aided
by this effort.
We are taking what are called our compensated work therapy
program which is really a hospital-based program. And we are
going to transfer it and put those staff into the community to
help veterans get gainful employment in the community again. We
expect about 2500 veterans will get assisted by that next year.
We are making significant efforts to go out and offer
funding to community groups and organizations on prevention
services. As you and others have noted, prevention is where we
have to be as well. We have to get to a prevention effort that
will stop homelessness from ever beginning and we are looking
forward to doing that.
I will defer to Mark Johnston to talk a little bit more
about HUD-VASH. We know that is very important and in the
remaining time let me also just say that we understand that
getting benefits and assistance is important.
It is not just about getting a check; for many it is about
getting back into gainful employment. So it is using my
vocation rehabilitation benefits. It is about getting education
services, going back to school, for many of these veterans.
There are opportunities. We look forward to the opportunity to
continue with our partners at this table, plus the U.S.
Interagency Council, but more importantly, at the local level
with thousands of groups who have come and helped us.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Dougherty follows:]
Prepared Statement of Pete Dougherty, Director, Homeless Programs, U.S.
Department of Veterans Affairs
Chairman Akaka, Ranking Member Burr, Distinguished Members of the
Senate Committee on Veterans' Affairs. Thank you for this opportunity
to discuss the most ambitious plan ever undertaken to effectively end
homelessness among our Nation's Veterans. Today I am accompanied by
Lisa Pape, Acting Director Mental Health Homeless and Residential
Rehabilitation Treatment Programs.
Homelessness among Veterans is a tragedy. While much has happened
over the last several decades to address this problem, some Veterans
still have no place to lay their head at night. Over the past 23 years
the number and percentage of Veterans in the homeless population has
gone down dramatically but our job is far from finished. We are making
progress; data demonstrate that the number of homeless Veterans
continues to decline because of the aggressive efforts by the
Department of Veterans Affairs (VA) and its partners, including local
and community organizations as well as state and Federal programs. Six
years ago, 195,000 homeless Veterans lived on the streets of America;
today, 107,000 do. VA has a strong track record in helping homeless
Veterans. A study completed several years ago found approximately 80
percent of Veterans who complete a VA program are successfully housed
in permanent housing 1 year after treatment. We have invested $500
million on specific homeless housing programs this year. We are moving
in the right direction to remove this blot on our consciences, but we
have more work to do.
VA's major homeless-specific programs constitute the largest
integrated network of homeless treatment and assistance services for
Veterans in the country. These programs provide a continuum of care for
homeless Veterans, providing treatment, rehabilitation, and supportive
services that assist homeless Veterans in addressing health, mental
health and psychosocial issues. VA also offers a full range of support
necessary to end the cycle of homelessness by providing education,
claims assistance, jobs, and health care, in addition to safe housing.
Effectively addressing homelessness requires breaking the downward
spiral that leads Veterans into homelessness.
Veteran homelessness, at its root, is primarily a health care
issue, as many homeless Veterans are heavily burdened with depression
and substance abuse. VA's budget includes $4.2 billion in 2011 to
prevent and reduce homelessness among Veterans--over $3.4 billion for
core medical services and $799 million for specific homeless programs
and expanded medical programs. This same budget includes an additional
investment of $294 million in programs and new initiatives to reduce
the cycle of homelessness, which represents a 55 percent increase over
program funding for 2010. .
Our strategy for ending homelessness is to create a collaborative
approach focusing on prevention and ensuring there is ``no wrong door''
for a Veteran seeking service. VA's philosophy of ``no wrong door''
means that all Veterans seeking to avoid or escape from homelessness
must have easy access to programs and services regardless of the hour.
Any door a Veteran visits--a medical center, a regional office, or a
community organization--must offer them assistance.
VA is expanding its existing programs and developing new
initiatives to prevent Veterans from becoming homeless and to
aggressively help those who already are. We will do this by providing
housing, offering health care and benefits, enhancing employment
opportunities, and creating residential stability for more than 500,000
Veterans. This further expansion will begin in fiscal year (FY) 2011
and continue through FY 2014, subject to the availability of
appropriations. Specifically, we will:
Increase the number and variety of housing options
including permanent, transitional, contracted, community-operated, and
VA-operated;
Provide more supportive services through partnerships to
prevent homelessness, improve employability, and increase independent
living for Veterans; and
Improve access to VA and community based mental health,
substance abuse, and support services.
Over the next 5 years, our focus on ending Veteran homelessness is
built upon six strategic pillars. First, we must aggressively reach out
to and educate Veterans--both those who are homeless and those who are
at risk of becoming homeless--and others about our programs, finding
those who are already homeless and those who are at risk for
homelessness. Second, we must ensure treatment options are available,
whether for primary, specialty or mental health care, including care
for substance use disorders. Third, we will bolster our efforts to
prevent homelessness. Without a prevention strategy, effectively
closing the front door into homelessness, we will only continue
responding after Veterans become homeless and therefore continue to
manage the problem. Fourth, we will increase housing opportunities and
provide appropriate supportive services tailored to the needs of each
Veteran. Fifth, we will provide greater financial and employment
support to Veterans, and work to improve benefits delivery for this
vulnerable population. And finally, we will continue expanding our
community partnerships, because our success in this venture is
impossible without them. My testimony will describe our efforts in each
of these areas.
outreach and education
Our outreach and education initiatives must be led by a national
effort to offer Veterans and others a way to contact us at any time.
Veterans, particularly those in crisis, will benefit from our new
National Call Center for Homeless Veterans. The Center will work in
partnership with the highly successful National Suicide Prevention
Hotline (operated in cooperation with the Substance Abuse and Mental
Health Services Administration, SAMHSA, available at 1-800-273-TALK).
The Call Center is operational, and Veterans and others who call (1-
877-4AID VET, or 1-877-424-3838) can receive specific referrals to VA
and other community services to meet their immediate needs. We expect
to nationally announce this program within the next couple of months,
and we anticipate tens of thousands of Veterans, community
organizations, family members and community providers will contact us
for prompt and appropriate information. In cases where a Veteran is in
crisis, this Call Center will ensure Veterans are placed in direct
contact with a person who can speak to and provide them immediate
assistance.
We will continue expanding our outreach by engaging our community
partners and supporting their efforts, as well as our own. An excellent
example of our collaboration with community organizations are the Stand
Down events VA has held for years. In 2009, VA participated in almost
200 events in 46 states, including the District of Columbia and Puerto
Rico, reaching more than 42,000 Veterans, more than 4,600 spouses, and
almost 1,200 children of Veterans; the highest totals we have ever
recorded. This performance represented a 40 percent increase in
outreach to Veterans from the previous year.
These efforts will also complement one of the most tried and true
methods for helping homeless Veterans: sending staff to the streets and
shelters to find them. There may be no more effective approach than
meeting face-to-face, looking someone in the eye, and telling them you
are there to help. Many Veterans, particularly those who have battled
chronic homelessness, need skillful and repeated attempts to bring them
the care they need. Along with our community partners, VA has 348 staff
members engaged in this outreach every day, looking under bridges and
in bread lines and visiting parks and parishes to find Veterans in
need. The commitment and compassion these people display to those who
have served America should stand as a model for us all, and VA will
continue to support their vital work.
treatment
VA recognizes that a plan to end Veteran homelessness will not be
effective without a comprehensive suite of services for those with
chronic and persistent health and mental health problems. This includes
primary, specialty, and mental health care programs responsive to the
needs of homeless Veterans. In 2009, VA had approximately 2,000
residential rehabilitation treatment beds specifically identified for
homeless Veterans. We will expand our residential treatment capacity
for homeless Veterans by establishing five new domiciliary care
programs for homeless Veterans in areas where there are large numbers
of Veterans without proximate access to our current infrastructure. VA
expects to establish approximately 200 new residential treatment beds
next year alone.
Veterans who are homeless often struggle with substance abuse. More
than 60 percent of homeless Veterans have a substance use disorder
which, if untreated, can keep them from returning to or sustaining
independent living and gainful employment. As part of our 2011 budget,
VA will enhance opportunities for Veterans to access these needed
services in the community and help those who have achieved sobriety to
maintain it by deploying an additional 20 community-based dual
diagnosis clinicians. We expect this will help thousands more Veterans
receive needed treatment in their communities. We will also integrate
substance use and dual diagnosis expertise into 75 of our homeless
Veteran case management teams to provide substance use services to
Veterans and prevent relapse. We know that too many Veterans, even
after they have completed employment or educational assistance
programs, struggle to maintain stable lives because of continuing
problems with sobriety. We would like to work with the Committee to try
to develop a proposal that will help these Veterans finally overcome
these challenges.
Homeless Veterans, particularly the chronically homeless, often
face health problems associated with inadequate dental care. These
Veterans are at significantly greater risk for tooth and gum diseases
that can impact their physical health, in some cases with serious
health consequences. Moreover, the ability to return to gainful
employment can be severely impacted when Veterans are afraid to smile
or open their mouths to speak. VA often provides dental care for
homeless Veterans through contracted care with private dentists. VA
expects that as many as 20,000 homeless Veterans will receive dental
care services this year. VA is currently authorized to provide a one-
time dental visit to homeless Veterans who have remained in a VA
domiciliary care program or a community program under the grant and per
diem program for at least 60 days. At this time, this benefit does not
apply to Veterans benefiting from the Housing and Urban Development
(HUD)-VA Supportive Housing (HUD-VASH) program. This is increasingly a
point of concern for Veterans and VA community partners, and we look
forward to working with you to determine an appropriate remedy.
We are rapidly increasing resources at each VA medical center to
enhance our community partnerships and expand opportunities for
comprehensive residential care for Veterans by offering an immediate
admission when a homeless Veteran with health care needs seeks our
assistance. Approximately $23 million has been allocated in FY 2010 to
expand our community-based contract housing program, and we expect that
as many as 4,800 Veterans will be placed into contract residential care
this fiscal year. Though beginning there, we know that many will
transition into one of our other programs for homeless Veterans. No
matter the setting, our first priority is to assist those Veterans
seeking help to escape from the street and improve their lives.
VA's continuum of care for homeless Veterans includes services for
special populations, such as women and families, who may be at greater
risk for homelessness. Programs targeted for women Veterans range from
temporary and transitional housing to permanent housing with supportive
services. VA has made women Veterans a funding priority in our Homeless
Providers Grant & Per Diem program since 2007, and we have funded more
than 220 programs with specific capacity to serve women. Since 2004, VA
has provided seven special needs grants focused on additional services
for women Veterans. Six of these programs are capable of supporting
women with dependent children. The HUD-VASH Program provides permanent
housing for homeless Veterans and their families with VA supportive
services. Currently, 11 percent of Veterans who have received HUD-VASH
vouchers are women. VA estimates that approximately 1,530 children live
with their Veteran parent in HUD-VASH housing.
prevention
Preventing homelessness under our 5-year plan will require a wide
variety of efforts. One of our best efforts is our work with
prosecutors and judges, as well as Veterans exiting prisons. VA now has
at least a part-time Veterans Justice Outreach Specialist identified at
each VA medical center. Forty-six of these outreach specialists are in
full-time positions. These Specialists provide direct linkage to
Veterans in treatment courts, including Veterans Courts. The 46 Veteran
Justice Outreach Specialists being hired this year will work directly
with Veterans in the criminal justice system to provide them
appropriate care and services. We expect to help more than 7,500
Veterans through this program in 2010. Additionally, the Health Care
for Re-entry Veterans (HCRV) program was developed to provide pre-
release outreach, assessment, and brief term post-release case
management services for incarcerated Veterans released from state and
Federal prisons. The goal of the program is to promote successful
community integration of Veterans by engaging them upon release in
appropriate treatment and rehabilitation programs that will help them
prevent homelessness, readjust to community life, and desist from
commission of new crimes or parole or probation violations. The 39 HCRV
Specialists have met with nearly 5,000 Veterans to aid their transition
from prisons.
VA's 2011 budget will support clinical environments through the
Compensated Work Therapy Program, and VA will offer community-based
staff that will target supportive therapeutic opportunities for
Veterans with significant health problems. Providing these services in
community settings will make these services available for Veterans in
locations that will encourage participation and enhance community
opportunities. While hospital-based support services will continue
serving Veterans, VA estimates that as many as 48,000 additional
Veterans will benefit from this new approach.
We also are creating comprehensive efforts involving grants to
community partners to provide supportive services to low-income
Veterans and their families, including those making 50 percent or less
of the area's median income. VA aims to improve very low-income Veteran
families' housing stability through grantees (private non-profit
organizations and consumer cooperatives) providing eligible Veteran
families with outreach, case management, and assistance in obtaining VA
and other benefits, which may include: health care services, financial
planning services, transportation services, housing counseling
services, legal services, child care services, and others. In addition,
grantees may also provide time-limited payments to third parties (such
as landlords, utility companies, moving companies, and licensed child
care providers) if these payments help Veterans' families stay in or
acquire permanent housing on a sustainable basis. This is critical to
our efforts to end homelessness among Veterans. VA has draft
regulations under review and we hope to publish them for public comment
in time to allow us to issue a notice of funding availability early
next calendar year.
Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF)
Veterans currently represent almost five percent of the population
receiving VA benefits in its specialized homeless programs. This group
tends to be younger, and women represent a greater proportion as well.
It is imperative we act now to prevent this group from becoming
chronically homeless and to ensure others of this generation do not
become homeless either. Congress has asked VA, HUD and the Department
of Labor to collaborate on a multi-site demonstration project to
explore ways the Federal Government can do more to offer early
intervention and to prevent homelessness among those returning from
OEF/OIF. This collaborative effort will provide comprehensive community
services for Veterans and families and intensive case management so
that Veterans receive needed health care and benefits. VA continues to
work with HUD to help determine sites that will receive funds for
community-based intervention services for Veterans and their families.
We are hopeful that HUD will be ready to announce the locations that
will be funded within 60 days.
We know from past experience that homelessness among Veterans peaks
7-10 years after military service, and we are conducting aggressive
early intervention now to ensure OEF/OIF Veterans do not have that same
experience. Our current efforts have reached nearly 3,800 OEF/OIF
Veterans, more than 1,100 of whom have sought homeless specific housing
or treatment services. Since 2003, VA has expedited 28,000 claims for
compensation and pension for Veterans who are homeless or at-risk of
homelessness.
Another prevention strategy VA is pursuing is a national homeless
registry. This database will help us better track and monitor
prevention, homeless response and treatment outcomes. It will provide a
real-time data system that will identify all Veterans who have
requested assistance and the programs and services in which they are
engaged. This will in turn help us determine the effectiveness of our
efforts. Our plan is to build on existing database systems, like the
Homeless Management Information System (HMIS) currently operated by
HUD, and to extend the database for use with our Federal partners.
housing opportunities
While VA has many options for providing Veterans with housing
assistance, the sentinel piece of these efforts is the HUD-VASH
program. I cannot say enough about the positive aspects of HUD-VASH; it
is literally ending homelessness for Veterans. This program is the
Nation's largest permanent housing initiative for Veterans. Under this
initiative, HUD provides permanent housing through housing choice
vouchers to hundreds of local public housing authorities. VA provides
dedicated case management services to Veterans living in those units to
promote and maintain recovery, housing stability and independent
living. We began this effort about 20 months ago, and as of February
2010, more than 19,000 Veterans have been accepted into the HUD-VASH
program; more than 16,000 have received a housing voucher, and 10,600
formerly homeless Veterans are now housed through these efforts. Our
case managers are working with the other 5,000 to locate and secure
housing. VA is working closely with HUD to see that the funding
Congress provided for an additional 10,000 vouchers is available as
soon as possible.
Seventeen years ago, VA first offered funding to community and
faith-based service organizations, as well as state and local
governments, to provide transitional housing for homeless Veterans.
Since then, VA has continued expanding transitional housing
opportunities, and it now operates one or more programs in all 50
states, the District of Columbia, Puerto Rico, and Guam. Since 2007,
approximately 15.6 percent of the projects receiving VA funds and 14.5
percent of the total funding were designed to help rural Veterans.
These initiatives have provided 397 beds for rural homeless Veterans.
All together, there are more than 600 transitional housing programs,
and there are two pending ``notices of funding availability'' that we
expect will add more than 2,200 new units. These notices include
targets to increase opportunities to service women Veterans and
Veterans residing on tribal lands. The application deadline is March
31, 2010. This program has served almost 100,000 Veterans since it
began, and we expect as many as 20,000 Veterans will benefit from
transitional housing in FY 2010. This program helps Veterans find
temporary housing (i.e., less than 2 years) and assists many Veterans
in returning to independent living and gainful employment.
financial and employment support
Veterans who are homeless and those at-risk of homelessness often
need economic help. Many have service-connected disabilities, and many
combat Veterans are eligible for pension, vocational rehabilitation, or
foreclosure assistance, among other benefits. Veterans struggling with
homelessness often face challenges with maintaining gainful employment.
Many Veterans who have been homeless have gone years without a steady
job, and many have physical and mental health issues that require
participation in a therapeutic rehabilitative environment before
seeking employment.
Homeless Veterans and those at risk of being homeless need economic
assistance. Many have service-connected disabilities and many are war-
era Veterans eligible for pension. In addition to compensation and
pension benefits and services, many Veterans need education, vocational
rehabilitation and employment and foreclosure assistance.
Getting earned benefits to all Veterans is important. For homeless
Veterans and those at risk, these benefits can make the difference in
avoiding homelessness or exiting from it.
The Veterans Benefits Administration (VBA) is actively pursuing the
engagement of individuals upon entrance into military service and
throughout their military career so that they are fully aware of their
entitlement upon discharge. Additionally, VBA is coordinating with the
Veterans Health Administration's health efforts and collaborating with
our community partnerships to timely identify and process homeless
Veterans' benefits claims. Each VA regional office has a homeless
Veteran coordinator designated to control and expedite the processing
of homeless Veteran claims. In FY 2009, VBA received 6,285 claims from
homeless Veterans and completed 5,888 homeless Veteran claims.
partnerships
VA has long maintained close working relationships with Federal
partners, such as HUD, the Department of Labor (DOL), the Department of
Defense, the Department of Health and Human Services, the Small
Business Administration, the U.S. Interagency Council on Homelessness,
and others, as well as state, local and tribal governments in its
efforts to combat Veteran homelessness. Veterans Service Organizations
also fill a critical role, as do community- and faith-based
organizations and the business community. One example of these efforts
is our work to develop better connections with prosecutors and judges
in the criminal justice system. Another is the Homeless Veterans
Reintegration Program (HVRP), which involves collaboration with DOL.
Through this initiative, DOL's Veterans Employment and Training Service
(VETS) offers funding to community groups to help Veterans return to
gainful employment. VA contributes and works closely with DOL to
provide needed health care and benefits. Veterans benefit because their
health and benefits needs are addressed in complement with their
employment opportunities. We are happy to continue partnering with DOL,
and we look forward to working with them as they develop new proposals
to fund programs benefiting women Veterans, Veterans with families, and
formerly incarcerated Veterans.
VA is also partnering with several Federal agencies in an effort to
improve the utilization of HUD-VASH vouchers and to reach Veterans who
are chronically homeless. Under the leadership of the U.S. Interagency
Council on Homelessness and the White House Office of Urban Affairs, VA
along with HUD, HHS, the Department of Justice and the Department of
Labor will develop an interagency initiative that will bring the full
arsenal of their resources to bear on the problem of homelessness. This
initiative will not only target and house the most vulnerable Veterans
that are chronically homeless, but it will also link them to
employment, benefits and services to address other needs, including
child support payments.
conclusion
The President's FY 2011 budget and FY 2012 advanced appropriation
request for the VA will provide us with the resources necessary to
transform VA into a 21st Century organization and to ensure we provide
timely access to benefits and high quality care to our Veterans over
their lifetimes. Our Nation's Veterans experience higher than average
rates of homelessness, depression, substance abuse, and suicides; many
also suffer from joblessness.
The time to end homelessness among Veterans is now. With your help,
we will effectively end homelessness for all Veterans who will seek or
accept services from us. We owe every man and woman who wore our
Nation's military uniforms no less.
Mr. Chairman this concludes my testimony. I am happy to respond to
any questions your or the Committee may wish to ask.
______
Response to Post-Hearing Questions Submitted by Hon. Daniel K. Akaka to
Pete Dougherty, Director, Office of Homeless Veterans Programs, U.S.
Department of Veterans Affairs
Question 1. There are some critics out there that do not believe VA
is equipped to end homelessness for the seriously mentally ill
Veterans. How would you respond to this claim and how does the 5 year
plan specifically address this population?
Response. The Department of Veterans Affairs (VA) is committed to
ending homelessness among all Veterans. The Five Year Plan to End
Homelessness includes significant enhancements focused on improving the
treatment services VA provides to homeless Veterans and specifically
homeless Veterans with serious mental illness (SMI). In this fiscal
year, the Department of Housing and Urban Development-VA Supported
Housing (HUD-VASH) has enhanced funding for case management services.
This enhancement has enabled VA to decrease VA caseloads from 35:1 to
25:1 which allows case managers to provide more frequent and more
intense services to homeless Veterans with SMI and Veterans with
families. VA has also enhanced services to ensure that the Veterans who
have been chronically homeless, continuously homeless for one year or
who have had four or more episodes of homeless in the prior three
years, receive timely access to the program. Additionally, VA has added
over 80 addiction specialists to the HUD-VASH case management teams to
better meet the needs of Veterans with co-occurring mental health and
substance use treatment needs. In fiscal year (FY) 2011, vocational
specialists will be added to the homeless outreach and case management
teams to provide supported employment services, an evidence-based
vocational service for individuals suffering from SMI. The current plan
is to enhance every HUD-VASH team with vocational specialist.
To further address the needs of homeless Veterans with SMI, VA has
enhanced Healthcare for Homeless Veterans (HCHV) contract residential
treatment beds with supportive services designed to help engage the
hard-to-reach, hard-to-engage homeless, and at-risk Veterans by
providing temporary housing as an alternative to shelter care. VA has
also increased funding for transitional housing through the Grant and
Per Diem (GPD) program, which provides transitional housing to meet the
needs of homeless Veterans with SMI. Moreover, VA's FY 2011 budget
funds five new Residential Rehabilitation and Treatment Programs (MH
RRTP) in large metropolitan communities, so that Veterans with more
intensive treatment needs can receive services in their local
communities.
The VA National Center on Homelessness Among Veterans is supporting
a demonstration project in 16 Veterans Integrated Service Networks
(VISNs) that combines homeless services with rural health intensive
case management teams to better address the needs of homeless Veterans
in rural communities who also suffer from a SMI. If proven effective,
VA plans to expand this demonstration project to additional sites in
future years.
VA has significantly expanded mental health services in recent
years to promote greater access to services and to ensure that Veterans
receive evidence-based treatments that promote recovery. These efforts
have enhanced VA's ability to meet the needs of Veterans with SMI, many
of whom are homeless and/or at risk for becoming homeless. VA has
funded Rural Mental Health Intensive Case Management (MHICM RURAL)
teams and expanded existing Mental Health Intensive Case Management
(MHICM) teams. VA has also implemented Psychosocial Rehabilitation and
Recovery Centers (PRRC) to provide a therapeutic and supportive
learning environment for Veterans with SMI. In its residential and
mainstream mental health services, VA has sought to codify and
implement best practices at mental health programs throughout the
country, thereby strengthening efforts to successfully treat the
chronically homeless who are more likely to struggle with SMI. National
policies on suicide prevention and medication management have improved
safety, while the new Uniform Mental Health Services Handbook has
expanded access by mandating that all Veterans, wherever they obtain
care in the Veterans Health Administration (VHA), have access to needed
mental health services.
Question 2. HUD and VA should be commended for the level of
coordination and cooperation they've had in getting HUD-VASH vouchers
distributed to housing authorities with quick guidance on program rules
and regulations. Unfortunately that same level of cooperation isn't
playing out in many communities where housing authorities (PHAs) and
VAMCs are simply not leasing up vouchers as quickly as they should.
What can we do to improve lease-up rates for these vouchers? Should
PHAs and VAMCs be required to have a memorandum of understanding in
order to be awarded vouchers? For communities that are using HUD-VASH
very successfully, how can we better get their story shared with other
communities?
Response. Both HUD and VA are committed to promoting timely access
to permanent supportive housing through HUD-VASH. Both agencies are
working closely together and enacting several key initiatives to
improve access to HUD-VASH. VA has established performance monitors
that promote timely hiring of case managers and timely lease-up rates
of awarded vouchers by medical centers. Medical Centers that are
deficient have been asked to provide performance improvement plans.
Both HUD and VA have conducted consultative site visits with
communities experiencing implementation delays. These visits have
assisted in reducing barriers and promoting greater coordination
between VA, Public Housing Authorities (PHA) and community partners. VA
plans to continue this process through FY 2010. VA is also looking for
ways to streamline the referral process as part of this improved
coordination for all sites. VA and HUD have added a performance
component to the voucher award allocation process for 2010 that
incentivizes high performers and challenges low performers to increase
their productivity as a pre-condition to receiving additional vouchers.
VA and HUD are also encouraging targeted project-based developments in
communities where there are difficulties securing safe, affordable
housing and where there is capacity to rapidly establish a project-
based program for Veterans. VA and HUD will continue to conduct
training for both VA case managers and for PHA staff. Four Regional
trainings are planned for this year, and VA and HUD will continue to
conduct satellite broadcasts for staff. In response to extreme
situations, VA and HUD have also reassigned PHAs and contracted out
case management services in an effort to improve lease-up rates.
In FY 2010, VA is promoting the utilization of a Housing First
Model in several large cities. Housing First promotes rapid and direct
placement of homeless individuals and their families into housing
emphasis, and offers treatment and supportive services with variable
intensity and frequency as an integrated component of the service. The
Housing First approach represents a change from linear models that seek
to prepare individuals for permanent housing by requiring completion of
treatment in residential rehabilitation or transitional housing, and
often require demonstrated sobriety before moving into permanent
independent housing.
The question of whether there should be a required memorandum of
understanding between the VA medical center and PHA has been raised.
Both agencies believe that this is not necessary, and may, in some
cases, even impede timely access. What is most critical is an ongoing
dialog between the VA case management team and the PHA to mutually
define targets, identify areas for improvement and monitor progress.
In an effort to share successful programs and best practices with
other PHAs, VA and HUD sponsored a workshop on this topic at the
national HUD-VASH training held in June 2009. Similar workshops will be
held at the upcoming regional training sessions. In addition, VA and
HUD plan to conduct site visits at four of the top-performing HUD-VASH
sites, for the specific purpose of identifying the policies and
practices that have created the positive results we are hoping to
achieve at all sites. The information learned from these sessions will
be distributed to all HUD-VASH sites in the form of a ``best
practices'' document.
Question 3. Please elaborate on the residential rehabilitation
treatment and domiciliary care programs for homeless Veterans?
Response. Mental Health Residential Rehabilitative Treatment
Services Programs (MH RRTP) provide residential rehabilitative and
clinical care to eligible Veterans who have a wide range of medical,
psychiatric, and substance use illnesses. MH RRTPs are designed to
provide comprehensive treatment and rehabilitative services meant to
decrease reliance upon more resource-intensive forms of treatment and
improve the quality of the Veteran's functioning. The residential
component promotes personal responsibility and self-care lifestyle
changes in a milieu that provides opportunities to practice and master
new skills. Many Veterans require treatment for illnesses that are
severe enough to warrant residential rehabilitative care. These
illnesses adversely impact the Veteran's vocational, educational,
social functioning and housing conditions. VA operates a wide range of
mental health and substance use disorder residential programs under the
Mental Health Residential Rehabilitation Treatment Program (MH RRTP)
continuum. Currently there are 236 MH RRTP programs with over 8400
beds. FY 2009, the MH RRTPs served approximately 34,000 Veterans of
which approximately 60 percent were homeless Veterans. FY 2009 outcome
data on Veterans discharged from the DCHV and Compensated Work Therapy
(CWT/TR) programs indicate that 55.6 percent and 73 percent,
respectively, are housed, either in an apartment, a room or a house.
Domiciliary Care for Homeless Veterans (DCHVs) Programs are MH
RRTPs that provide a residential level of care specifically for
homeless Veterans in a structured and supportive rehabilitative
treatment environment.
The Domiciliary Care for Homeless Veterans (DCHV) program provides
homeless Veterans with 24 hour-per-day, 7 day-per-week (24/7), time-
limited residential rehabilitation and treatment services to include
care for medical health, psychiatric health, substance use disorders
and sobriety maintenance support. These programs also provide
medication management; social and vocational rehabilitation; and
include work-for-pay programs.
The mission and goals of the DCHV Program are to: 1) address the
co-occurring disorders and complex psychosocial barriers that
contribute to homelessness among Veterans; 2) improve Veterans' health
status, employment performance and access to basic social and material
resources; 3) reduce overall reliance on costly VA inpatient services,
and, most importantly; 4) reduce homelessness by preparing Veterans
for, and facilitating their transition to, appropriate community
housing. From the program's inception in 1987 to the end of FY 2009,
more than 98,000 episodes of treatment have been provided. A three-
month post-discharge outcome study of the DCHV program showed that
program participation was found to be associated with improvement in
all areas of mental health and community adjustment in particular;
increases in social contact with friends and family and increases in
income primarily from earnings from employment. Among Veterans
discharged from DCHV treatment in FY 2009, 71 percent were noted to
have improvements in financial status. In FY 2008, the average monthly
earnings, among Veterans participating in CWT/TR working either part
time or full-time, were approximately $800/month.
Over six thousand episodes of DCHV care (n=6,311) were completed
during FY 2009, nearly 400 more episodes than in FY 2008. The mean age
of Veterans receiving treatment is 49.6 years and 4.9 percent were
women (n=309 females). Half of Veterans in DCHV programs served during
the Post-Vietnam Era, nearly one-third served during the Vietnam Era
and 17.1 percent served during the Persian Gulf Era. Of particular
note, 69 Veterans reported service in Afghanistan and 278 Veterans
reported serving in Iraq, or 5.5 percent of the total Veterans admitted
to DCHV. The proportion of White Veterans was 48.5 percent, with 43.6
percent African American Veterans and 5.0 percent Hispanic Veterans.
Fourteen percent of Veterans entering the program were homeless for
less than one month, 47.4 percent were homeless between one to eleven
months; 27.3 percent were homeless for a year or more and 11.8 percent
of Veterans were considered to be at risk of homelessness.
Monitoring data indicate that ninety percent of Veterans discharged
from the DCHV Program in FY 2009 had a substance use disorder and over
half had both alcohol and drug problems. In addition, over two-thirds
(68 percent) of participant Veterans had a diagnosis of a serious
mental illness, and 61 percent had both a serious mental illness and a
substance use disorder. As the mean age of Veterans in the program has
increased over the years, so has the proportion of Veterans with
serious medical conditions. In FY 2009, Veterans were diagnosed with
the following medical conditions: orthopedic problems (42 percent),
hypertension (37.7 percent), liver disease (22.3 percent),
gastrointestinal problems (17.9 percent) and diabetes (11.8 percent).
The average length of stay in FY 2009 was approximately three and a
half months and nearly three-quarters of Veterans successfully
completed the program. Over 80 percent of Veterans were discharged to
an appropriate community environment after completing their DCHV
treatment. Nearly one-third (30.5 percent) went to live in their own
apartment, room or house and an additional 25.1 percent were discharged
to a stable arrangement in an apartment, room or house of a family
member or friend. While the majority of Veterans were housed at
discharge, 26.7 percent continued to receive additional treatment
either in a halfway house or transitional housing program, a hospital
or nursing home, or another domiciliary program. Twenty-two percent of
veterans were able to secure part-time or full-time employment at the
time of their discharge. One quarter of Veterans were unemployed and
23.6 percent were retired or disabled. An additional 18.1 percent had
arrangements to participate in a VA work therapy program such as
Compensated Work Therapy (CWT) or Incentive Therapy (IT). Data is not
currently available on the number of Veterans that return to DCHV
treatment; however, data are available on Veterans discharged from DCHV
treatment who are re-admitted to an acute VA inpatient psychiatric bed
section. During FY 2009 5.2 percent of Veterans were re-admitted to an
acute VA inpatient psychiatric bed section 30 days following their DCHV
discharge. Data from VA's administrative file, the Monthly Program Cost
Report indicates that the average cost per episode of treatment in the
DCHV program during FY 2009 was $20,653. Approximately 6 percent of
Veterans participating in VA's HUD--VASH program were referred by a MH
RRTP including a DCHV program. Housing affordability will vary
depending on the local housing market and availability of housing.
Other factors to consider include the local economy and the
availability of good paying full-time jobs. There are creative ways
that VA assists Veterans in obtaining affordable housing including
sharing apartments with other Veterans, placements in the Oxford House
model, and referrals to VA's HUD-VASH program. VA continues to forge
relationships with community non-profit organizations to build
affordable and permanent housing specifically for Veterans.
Currently there are 42 DCHV sites with a total of 2,152 operational
beds located in all 21 VISNs. VA is planning to develop five additional
new 40-bed DCHV programs in large metropolitan locations.
Question 4. How does VA measure the success of its many homeless
Veteran programs?
Response. VA will measure the success of its homeless Veteran
programs by the consistent reduction of the number of homeless
Veterans. The ultimate success for the VA homeless programs is when a
formerly homeless Veteran is able to live as independently and self-
sufficiently as possible in a community of his or her choosing.
Veterans living in shelters or sleeping on a couch in others' housing
are still homeless, and ending that homelessness requires placing those
Veterans in permanent housing, with access to any treatment or other
supportive services they require. There are other, more program-
specific goals related to outreach, residential treatment, access and
sustaining mental health and primary care, employment and accessing
benefits both inside and outside of the VA. The ultimate goal is to
eliminate Veteran homeless by assisting homeless and at-risk Veterans
in obtaining stable, safe, and affordable housing. Through stable,
safe, and affordable housing, Veterans will reach their highest level
of recovery, enjoying an improved quality of life and functioning at
the Veteran's highest possible level.
The VA Homeless Program Office has a robust and comprehensive data
collection system overseen by the Northeast Program Evaluation Center
(NEPEC) located at New Haven VA Medical Center. This office has been
providing homeless program evaluation for the past 20 years. A broad
array of information about homeless Veterans and the care they receive
from VHA homeless programs is collected, analyzed, and published in
quarterly and annual reports. The categories of data collected include
the following: Program Structure and Resources (e.g., number and type
of treatment beds, occupancy rate, staffing information), Veteran
Characteristics (e.g., demographics, psychosocial, psychiatric,
vocational, legal history), Process Data (e.g., number of Veterans
treated, type, frequency, and intensity of services provided), and
Discharge and Post-Discharge Outcomes (e.g., length of stay, discharge
to independent housing, sobriety at discharge and follow-up,
readmission rates to inpatient psychiatry).
Information about homeless Veterans and the services they receive
is collected at numerous time points, including at first contact
through outreach, at admission to a homeless program, at variable
intervals while receiving care within certain programs (e.g., Housing
and Urban Development-VA Supported Housing (HUD-VASH)), at discharge
from a homeless program, and at follow-up intervals for Veterans
discharged from certain homeless programs (e.g., Grant & Per Diem (GPD)
Program). This information is collected via multiple methods, including
online data collection managed by NEPEC, manual completion of surveys
and forms that are submitted to NEPEC, and information sharing between
NEPEC and the VISN Support Services Center (VSSC).
In most cases, a VA employee completes a survey or online form
related to the homeless Veteran and services he/she received. This
information is Veteran-specific and is submitted to NEPEC where it is
compiled into quarterly and annual reports at the national, VISN, and
medical center levels. In cases where the Veteran is providing direct
feedback about services received, the Veteran completes the form and
submits it to a VA employee in a sealed envelope who submits it to
NEPEC. This information is utilized at all levels to review, analyze
and make adjustments in programming and services as needed.
Consistent with VA's goal of establishing a homeless registry and a
data management system capable of generating real time reports, the
office has been developing a web based data entry system that will be
designed to be Veteran-centric. The new data system will generate
reports that describe both Veteran-specific episodes of care data and
program-specific information. The data management system will also be
used to help populate a more comprehensive Homeless Registry so VA will
have the capacity to monitor on an ongoing basis treatment outcomes of
Veterans who have fallen into homelessness or who were identified as at
risk for homelessness and received supportive services from VA or other
community partners. The first phase of the data management system will
be available in May 2010.
One of the most exciting aspects of this new data management system
is the real-time nature of the data. In the past, national program
reports lagged after the end of the fiscal year. With this first phase
of the registry and data management system, the Homeless Program Office
can answer questions related to its programs with data up to the
previous completed month. For example, in the first half of FY 2010, 53
percent of Veterans who discharged from GPD obtained stable,
independent housing. VA has not historically collected actual income
levels at admission and discharge, but future phases of the registry
will include this data and enable specific evaluation of improvement in
income over the course of treatment in a VA homeless program.
The first phase of the homeless registry and data management system
focused on internal VA data. Future phases will include data sharing
agreements with other national agencies in order to incorporate
critical data on homeless services and resources that the Veteran
receives outside of VA. Extended discussion has occurred with HUD
regarding the compatibility between the Homeless Registry and HUD's
Homeless Management Information System (HMIS), with plans to connect
these two systems so that the HMIS data can be reflected in the VA
Homeless Registry and vice versa. There are challenges still to
overcome in this endeavor, primarily related to the fact that the HMIS
does not include individual-specific data, whereas the ability to
reflect Veteran-specific data is crucial to the functioning of the
Homeless Registry.
Question 5. Unfortunately, not all stories about the HUD-VASH
program are positive. Occasionally there are reports about an area
being awarded an increase in vouchers, but within a year, less than
half of them were used. With the significant increases recently in the
number of vouchers awarded across the country, what obstacles do VA's
case managers face when trying to locate and secure housing for
Veterans?
Response. The most significant challenges to VA case managers
include assisting Veterans with security deposits, utility deposits,
down payments for first and last month rents, and obtaining the
essentials to move into housing (bedding, tableware, furniture, etc.).
Related concerns include assisting Veterans with credit restoration so
they can be more attractive candidates for landlords. In addition, many
veterans have accrued large amounts of child support arrearage incurred
while the veteran was homeless, in a phase of active addiction, or
otherwise untreated for a serious mental illness. For incarcerated
veterans, growing arrears from unpaid child support can be particularly
challenging to their ability to reintegrate in the community. In some
large metropolitan communities, limited availability of safe,
accessible housing stock has contributed to delays in lease up rates;
however, this is not a large scale concern and HUD and VA are working
with those communities to explore options to maximize HUD-VASH
implementation.
Recently HUD has awarded funding for Homelessness Prevention and
Rapid Re-Housing (HPRP) which does encourage the use of these funds to
assist Veterans in HUD-VASH. Access to these funds has not been
uniform, however, and the two agencies are developing strategies to
maximize access to these resources. Enhancing access to these funds or
similar funding will improve lease-up rates in the HUD-VASH program.
Question 6. A few of the witnesses on the second panel believe that
VA has good programs, yet, they are not as successful as they could be
due to poor implementation at the local level. What kind of oversight
do you and your staff conduct regularly to ensure proper implementation
of the programs
Response. VA agrees that its homeless programs are effective and
that the level of cooperation and coordination between Federal and
community partners is high, but notes there are outliers who are under
performing. To address these issues, VA and HUD have been conducting
joint satellite broadcast training and providing information to the
field to promote more timely implementation and compliance with
programmatic goals. The VA Homeless program office has established
metrics to monitor medical center performance related to the Five Year
Plan. Currently, the HUD-VASH monitor is reviewed with the VISN
Directors in their quarterly meetings with the Deputy Under Secretary
for Health for Operations and Management. VA and HUD have conducted
site visits with underperforming communities, and both agencies have
monthly calls to assist with questions and concerns related to
implementation. As HUD-VASH continues to grow, VA and HUD are planning
to provide more focused technical assistance to the field to improve
timely access and compliance with program goals, and both agencies plan
to continue joint site visits to promote more timely and coordinated
access to services. VA, HUD and US ICH are also working closely
together to develop strategies for enhancing coordination of programs
serving homeless Veterans.
For the past 20 years, VA has been conducting program evaluations
for its homeless services. Within this reporting structure VA has been
able to identify service utilization for homeless Veterans who have
accessed VA funded programs such as Outreach, Residential
Rehabilitation and Treatment, Grant and Per Diem, HUD-VASH and VA
Contract housing. In addition, VA is developing a registry that will be
designed to identify service utilization of Veterans both inside and
outside of the VA.. Once complete, the registry will promote VA's
capacity to track service utilization and outcomes for our Veterans who
have fallen into homelessness.
Question 7. What challenges do you face when trying to execute your
department's homeless Veteran programs in conjunction with another
agency's programs?
Response. The level of cooperation between the VA's homeless
Veterans programs and other agencies programs has been remarkable. Our
most significant partners are the United States Departments of Housing
and Urban Development (HUD) and the Department of Labor (DOL). Some
challenges are the result of the different cycles of times for notices
of funding availability (NOFA), but these are modest in comparison to
the added strength in collaboration between agencies that provides to
all programs serving homeless Veterans. One specific challenge relates
to the At-Risk Pilot for recently discharged Veterans, a significant
percentage of whom are Operation Iraqi Freedom (OIF)/Operation Enduring
Freedom (OEF) Veterans, and their families. While VA and HUD have
worked closely for months to determine the locations which should
receive HUD funding for the pilot, the VA cannot recruit staff until
HUD makes their announcement.
We are also developing a working relationship with the Department
of Health and Human Services (HHS) to address findings from the most
recent CHALENG survey (Please see response to question 3, Senator
Burris), completed by service providers, advocates and Veterans
themselves, who identified assistance with family related issues
including assistance with child support, child care and family
reunification as unmet needs. Currently HHS's Office of Child Support
Enforcement, the American Bar Association, and the VA have formed a
collaborative effort in nine major cities to address unresolved child
support issues that may impact the Veteran's ability to obtain and
retain employment.
Question 8. HUD's homeless programs have embraced the Housing First
model, in which homeless individuals have access to housing first and
then providing services as needed. A growing body of research has
validated this model and the media is reporting on it more frequently.
This model differs from a more linear approach Veterans housing
programs take, in which individuals are expected to first demonstrate
their ``ready'' for housing. Can you describe the differences and
similarities in the two Department's approaches? Does the VA intend to
encourage the homeless providers it supports to utilize a housing first
approach?
Response. Until the enhancement of HUD-VASH in 2008 with 10,000
vouchers, VA was not fully engaged with permanent supportive housing
models, but focused on residential treatment and transitional housing
models. With the growth of HUD-VASH, VA has been meeting with HUD and
the community to explore enhancing its current practices to be more
supportive of permanent supportive housing models, including ``Housing
First''. Housing First is a widely applied service approach
encompassing a broad range of treatment and supportive services offered
to individuals who are homeless. Housing First promotes rapid and
direct placement of homeless individuals (in some cases with
accompanying family members) into housing, and offers treatment and
supportive services with variable intensity and frequency as an
integrated component of the service. In some programs, for example, 24
hour Assertive Community Treatment coverage is offered, but only
minimal (twice monthly) participation is required. The Housing First
approach represents a change from linear models that seek to prepare
individuals for permanent housing by requiring completion of treatment
in residential rehabilitation or transitional housing, (e.g., VA's
Homeless Providers Grant and Per Diem program), and often require, as
well, achievement of sobriety, before moving into permanent independent
housing. VA is aware that Housing First is a proven best practice for
the chronic homeless population who present with serious mental illness
and VA is working with HUD and select communities to evaluate how it
can adapt this approach for Veterans seen in HUD-VASH.
Question 9. The Committee is concerned about outreach and
identification of homeless Veterans who are eligible for HUD-VASH
vouchers. We understand that many VAMCs are identifying potential VASH
recipients from Grant and Per Diem programs, and that by doing so they
are failing to serve the chronically homeless Veteran who is still out
on the street and has been for a very long time. Is data available for
how many VASH voucher holders came directly from a Grant and Per Diem
program? How can the Department encourage VAMCs to better identify
chronically homeless Veterans who may not be currently accessing VA
services?
Response. VA understands the importance of targeting homeless
Veterans who are currently on the streets and in shelters. In a
memorandum to the field regarding HUD-VASH funding for FY 2010, VA has
made it very clear that targeting chronically street homeless and
Veterans who are in emergency shelters is critically important, and
that each medical center must target our most vulnerable, chronically
homeless Veterans who also have the most acute needs. Additionally,
each VA medical center must make every effort to coordinate with our
community partners, especially the local Continuum of Care, to identify
this most vulnerable population with referrals to HUD-VASH. Referrals
from the community into HUD-VASH are vital to meeting our goals, so
every effort must be made to enhance these partnerships. VA is
currently in the process of revising its HUD-VASH evaluation tool so
that data regarding the sources of the referral will be gathered and
monitored.
VA has a full continuum of treatment and supportive services where
homeless Veterans with SMI can receive services including specialized
Residential Rehabilitation and Treatment Programs and Grant and Per
Diem (GPD) Programs. Many of the Veterans served in these programs were
referred from the streets and shelters. Based on preliminary program
evaluation data for HUD-VASH, approximately 30 percent were referred to
HUD-VASH from VA transitional housing and treatment programs
(Residential Rehabilitation and Grant and Per Diem).
Many specialized GPD programs focus on homeless Veterans with
substance use issues, mental health disorders, chronically homeless
Veterans, and chronically mentally ill Veterans. Services provided to
these clients include substance use disorder education and treatment,
relapse prevention, cognitive-behavioral therapy, other individual
psychotherapy, Veteran-to-Veteran peer support groups, recreational
activities, case management, vocational assessment and computer
training. GPD providers who have successfully housed chronically
homeless Veterans for many years understand the special needs of this
population including a preference for living in Veteran-specific
housing, among their peers. Providers work closely with VA medical
centers to share their experiences in working with this population.
Question 10. In the 110th Congress this Committee passed
legislation (S. 2162, The Veterans' Mental Health and Other Care
Improvements Act), which became law in September 2008. Among other
provisions, the bill authorizes the VA Secretary to provide grants to
community organizations to provide supportive services to homeless
Veterans. Can you please update us on the distribution of those
funds?''
Response. The Supportive Services for Veteran Families (SSVF)
program currently has published proposed rules in the Federal Register.
The public comment period for these proposed rules closed on June 4,
2010. The VA is currently evaluating these comments. In order to
disseminate information about this new program, VA has awarded a
technical assistance contract to the Corporation for Supported Housing
(CSH). CSH is currently working with the VA on a plan that will educate
and assist potential grant applicants who may want to apply for the
SSVF program funding. Before the end of the calendar year, VA expects
to have final regulations approved and issue a notice of funding
availability (NOFA).
Through the Supportive Services Grants VA will offer funding to
non-profit organizations to work with Veterans and their families in
order to maintain them in their current housing and to help them gain
permanent housing. These community-based programs will offer eligible
Veterans and their families' limited rental assistance, child care
services, employment training, emergency supplies, case management and
referral services, such as linkages to primary and specialty care
services, as well as other community entitlement and supportive
services.
______
Response to Post-Hearing Questions Submitted by Hon. Jim Webb to Pete
Dougherty, Director, Office of Homeless Veterans Programs, U.S.
Department of Veterans Affairs
Secretary Shinseki, according to VA's Director of Homelessness, as
of February 10, 2010, more than 19,000 Veterans have been accepted into
the HUD-VA Supported Housing (HUD-VASH) program; more than 16,000 have
received a housing voucher, and 10,600 formerly homeless Veterans are
now housed through these efforts.
Question 1. How many of those 19,000 Veterans subsequently no
longer need vouchers because they were able to raise their income to a
level sufficient to lead an independent life?
Response. It is important to note that all of the 19,000 homeless
Veterans accepted into HUD-VASH case management services were recently
identified as homeless and have been admitted into the program within
the past 24 months. As part of the admission process, VA assures that
the Veteran meet eligibility requirements for homelessness while the
Public Housing Authority (PHA) determines if they meet income
eligibility requirements. Once it is determined that the Veterans meet
income eligibility requirements, they are issued a housing voucher and
the VA case manager works with them to place them into housing. Of the
19,000 Veterans admitted into HUD-VASH, only 10,600 were placed in
housing as of the end of February. It is important to note that some
Veterans admitted and housed through HUD-VASH no longer need the
support of HUD-VASH and are able to move into more independent housing
allowing the voucher to be re-issued to another Veteran.
HUD-VASH is in the early stages of implementation and there is
insufficient data for a meaningful response on the average length of
support through the voucher program or to identify how many vouchers
have been returned. The evaluation plan is designed to answer this type
of questions at a later date. In addition, as the following discussion
covers, Veterans using the voucher program have serious challenges, and
rapid progress toward no longer needing the voucher should not be a
program goal. In general, sustained housing through HUD-VASH or other
permanent housing is a primary goal.
HUD-VASH is a joint program between the Department of Veteran
Affairs (VA) and the Department of Housing and Urban Development; its
goal is to move Veterans and their families out of homelessness and
into permanent housing with case management services as needed. VA
provides case management services, and HUD provides permanent housing
subsidies to homeless Veterans and their families, as defined by the
McKinney Act, Title 42, United States Code, Section 11302. VA screens
homeless Veterans for program eligibility. HUD allocates rental
subsidies from its ``Housing Choice'' program, which is administered by
the Office of Public and Indian Housing. VA case management services
are a core component of the program, designed to improve the Veteran's
physical and mental health, and to enhance the Veteran's ability to
live in safe, affordable permanent housing in a community chosen by the
Veteran.
The target population for HUD-VASH includes homeless Veterans with
disabilities that require ongoing case management services to help them
obtain and remain in permanent housing. The 19,000 Veterans accepted
for case management services have been deemed clinically eligible for
the program and work with VA to submit a formal application to the
local Public Housing Authority, which determines financial eligibility
for the program. All 19,000 accepted for case management are thought to
need the voucher to achieve housing, and case management services to
ensure ongoing connection to treatment and other supports. Veterans
entering into HUD-VASH do have significant disabilities and are
anticipated to require ongoing supports to live in the community. As a
result, Veteran participants in HUD-VASH are not expected to begin
functioning completely independently within a short time; Veterans with
time-limited or less serious needs are referred for services in other
VA programs without the long-term orientation of HUD-VASH.
Question 2. What is the average length of time a voucher is needed
by a HUD-VASH recipient?
Response. HUD-VASH is in the early stages of implementation and
there is insufficient data for a meaningful response on the average
length of utilization of vouchers. The evaluation plan is designed to
answer this question at a later date. Veterans entering into HUD-VASH
do have significant disabilities and are anticipated to require ongoing
supports to live in the community.
Question 3. What is the average per capita cost of a homeless
Veteran in the HUD-VASH program?
Response. The average per capita cost of VA case management
services is approximately $4,500. The cost of VA health care services
for Veterans in HUD-VASH is likely to vary significantly and is not
tracked by the HUD-VASH program, as Veteran participants are eligible
for this care regardless of their participation in HUD-VASH. Annual
costs associated with the vouchers themselves are borne by HUD.
Question 4. Please describe the additional supportive services the
VA intends to use to transition Veterans off HUD-VASH.
Response. VA will provide additional supportive services to assist
Veterans moving from HUD-VASH to independent living in the community,
including vocational rehabilitation services with case management,
traditional mental health and primary care services, and the
facilitation of access to VA benefits. Some Veterans may also qualify
for VA and/or community based prevention services designed to assist
individuals rapidly return to independent housing in the community.
These time-limited supportive services can include case management,
financial assistance, child care, vocational training and
transportation.
Question 5. What are the average costs, by state, of providing
support to homeless Veterans through established group housing shelter
programs as, for instance, the New England Center for the Homeless?''
Response. We cannot answer this question as phrased, since VA does
not have direct access to cost data from non-VA programs. We can
provide costs for VA programs that provide housing as well as a broad
array of other VA services to help the Veteran end homelessness.
VA funds community-based transitional housing programs through its
Grant and Per Diem program. Grant and Per Diem support can help defray
operational costs for community-based programs that have been awarded
grants. Capital grants can help enable providers to acquire or renovate
physical facilities for use as transitional housing. The per diem
component pays for operational costs (services, utilities, etc) based
on the provider's cost per Veteran per day. In accordance with current
regulations, VA can pay up to $34.40 per day in per diem funds. Costs
are calculated based on budgets submitted by the grantee. Currently,
the average rate paid nationally is approximately $31.00. This equates
to an estimated $1,000 per month, per Veteran. Data for average costs
by state for VA's Grant and Per Diem Programs could be obtained by June
1, 2010.
______
Response to Post-Hearing Questions Submitted by Hon. Roland W. Burris
to Pete Dougherty, Director, Office of Homeless Veterans Programs, U.S.
Department of Veterans Affairs
Question 1. Mr. Dougherty I am following Senator Tester's
questions. I would also be very interested in seeing your plan to
address Veteran homelessness in rural areas, as it is developed.
Response. VA remains concerned about the needs of all homeless
Veterans in both urban and rural settings. The Grant and Per Diem
Program has funded more than 600 projects across the country of which
approximately 16 percent of the projects funded and 15 percent of the
funds awarded have gone to programs that serve Veterans in rural areas.
Additionally, VA targeted funding to states that did not have an
operational Grant and Per Diem Program, of which the majority were
rural states. VA awarded funds to create one or more operational
programs in each state.
VA's most recent Grant and Per Diem funding round is targeted to
programs that would operate on tribal lands. HUD-VASH is another
program that addresses Veteran homelessness. Both HUD and VA have
increased resources for permanent housing with case management into our
rural communities. Additionally, VA's homeless programs work
collaboratively with VA's Office of Rural Health by conducting
demonstration projects to enhance homeless and mental health services.
Readjustment Counseling Services are also being expanded in rural
sites. New centers are being established and mobile teams are being
deployed to assist with outreach and engagement of our homeless and at-
risk for homelessness population.
Question 2. Mr. Dougherty, I am sure many of the homeless Veterans
that you are working to identify do not even have basic identifying
documentation. Could you elaborate on how you verify Veteran status?
Does this process impede speedy access to services?
Response. While documentation of Veteran status is an issue for
benefits and services, VA's approach has been to engage all persons who
identify themselves as Veterans and seek documentation as soon as
possible. The vast majority of Veterans who seek our services have
utilized VA services in the past. VA does all it can to expedite
verification for those who have not been seen previously. If a Veteran
has not been seen within the Veterans Health Administration within the
past three years, a request is made to the Veterans Benefits
Administration to determine Veteran eligibility.
Question 3. Mr. Dougherty, I understand that some significant steps
have been taken federally in terms of interagency communication, but I
was hoping you could elaborate on how this cooperation filters down to
the local VISNs? What type of coordination of services is occurring on
the local level? Is there any way that you track the services that
homeless Veterans are receiving from multiple providers?
Response. VA at the highest levels has been an active part of that
national effort. VA collaborates at all levels; Federal, regional and
local. VA is an active participant of the US Interagency Council on
Homelessness (USICH). USICH is the Federal coordinating body that works
tirelessly to coordinate efforts across departmental lines to improve
the delivery of meaningful services to all homeless people.
All of VA's 21 Veterans Integrated Service Networks (VISNs) has a
Network Homeless Coordinator who is responsible for coordinating
homeless services at the regional levels. Part of their
responsibilities include building partnerships with community
organizations, coordination of services within the VISNs and ensuring
continuity of information regarding homeless Veterans both within the
VA and with community partners. Additionally, each medical center has a
Health Care for Homeless Veteran coordinator who is responsible for
coordination of care for homeless Veterans which includes connections
to community agencies. At the local level VA works closely with local
government, community agencies, philanthropic organizations and Vet
Centers and regional offices that assist Veterans.
In 1993, VA launched Project Community Homeless Assessment Local
Education Networking Groups (CHALENG) for Veterans. CHALENG is a
program designed to enhance the continuum of services for homeless
Veterans provided by local VA healthcare facilities and their
surrounding community service agencies. The guiding principle behind
Project CHALENG is that the VA must work closely with the local
community to identify needed services and then deliver the full
spectrum of services required to help homeless Veterans reach their
potential. Project CHALENG fosters collaborative planning by bringing
VA together with community agencies and other Federal, state, and local
government programs. This cooperation raises awareness of homeless
Veterans' needs, and spurs planning to meet those needs. Meeting the
goals of Project CHALENG requires each VA medical center to:
Assess the needs of homeless Veterans living in the area;
Assess community needs in coordination with
representatives from state and local governments, appropriate Federal
departments and agencies and non-governmental community organizations
that serve the homeless population;
Identify the needs of homeless Veterans with a focus on
healthcare, education, training, employment, shelter, counseling, and
outreach;
Assess the extent to which homeless Veterans' needs are
being met;
Develop a list of all homeless services in the local area;
Encourage the development of coordinated services;
Take action to meet the needs of homeless Veterans;
Educate homeless Veterans about non-VA resources that are
available in the community to meet their needs.
For the past 20 years, VA has been conducting program evaluations
for its homeless services. Within this reporting structure VA has been
able to identify service utilization for homeless Veterans who have
accessed VA funded programs such as Outreach, Residential
Rehabilitation and Treatment, Grant and Per Diem, HUD-VASH, and VA
Contract housing. In addition, VA is developing a registry that will be
designed to identify service utilization of Veterans both inside and
outside of the VA. Once complete, the registry will promote VA's
capacity to track service utilization and outcomes for our Veterans who
have fallen into homelessness.
Question 4. Mr. Dougherty, I understand that the St. Leo's
Residence, run by Catholic Charities, is the only operational project
under the Loan Guarantee for Multifamily Transitional Housing Program.
They are providing outstanding service to Homeless Veterans in Chicago.
However, as you may be aware, the design of this particular pilot
program presents challenges in securing operational funding. I
understand that you have been in talks with the facility about options
going forward; could you give me an update on the full range of options
being considered?
Response. VA worked to create transitional housing opportunities
for homeless Veterans under the Multi-family Housing Loan Guarantee
Program for a decade. VA tested the pilot as Congress directed and
found it to be an ineffective method to create housing options for
Veterans. VA wrote the Senate Veteran Affairs Committee in January 2009
stating that the effort was ineffective and VA would no longer pursue
this project. As you noted, the only loan guarantee made was to
Catholic Charities in Chicago. That program has worked hard to meet its
obligations under the terms of the agreement, and there have been a
number of discussions to see if their existing agreement can be
modified to allow changes that will positively affect Veterans in that
housing program.
VA would be happy to meet with you to review the possible options
and will keep you apprised of any change that may need to be made to
the existing agreement.
______
Response to Post-Hearing Questions Submitted by Hon. Mike Johanns to
Pete Dougherty, Director, Office of Homeless Veterans Programs, U.S.
Department of Veterans Affairs
Question 1. Let me say that I appreciate the aggressive approach
both agencies are cooperatively taking to tackle the national problem
of Veteran homelessness. In particular, the HUD-Veterans Affairs
supportive Housing (HUD-VASH) program [manages housing vouchers for
Veterans] will play an important role in ending homelessness among
Veterans that Secretary Shinseki is striving for. But ending
homelessness among Veterans will require that the programs described in
your testimonies reach all sectors of our societies.
Response. VA fully concurs that if we are to end Veteran
homelessness, VA must have services that reach all sectors of our
society to promote access to VA services in both rural and urban
settings. As the plan continues to be implemented, VA will be
monitoring its impact and making adjustments to ensure that all
Veterans who are homeless or at-risk for homelessness have access to VA
services.
Chairman Akaka. Thank you very much.
Mr. Jefferson, please proceed with your testimony.
STATEMENT OF RAYMOND M. JEFFERSON, ASSISTANT SECRETARY FOR
VETERANS' EMPLOYMENT AND TRAINING, U.S. DEPARTMENT OF LABOR
Mr. Jefferson. Yes. Chairman Akaka, Ranking Member Burr,
Senator Murray, Senator Tester. Aloha.
Chairman Akaka. Aloha.
Mr. Jefferson. Two weeks ago I had the privilege of
welcoming the Honor Flight at National Airport, welcoming
several of our World War II veterans to the Nation's Capital,
and to shake the hand of a Pearl Harbor survivor. It was an
inspiring reminder of the honor and privilege we have as vets
to serve this community and the importance of providing them
with the very best programs and services.
I am grateful today to show what we are doing at the
Department of Labor's VETS and in collaboration with our
partners to help end veterans' homelessness.
Veterans are a priority of Secretary Solis and a priority
of the Department of Labor. We are fully integrated into the
Secretary's goal of good jobs for everyone and keeping veterans
and their families in the middle class.
VETS. We provide expertise and assistance to assist and
prepare veterans to obtain meaningful careers, to maximize
their employment opportunities, and to protect their employment
rights. We do that in close partnership with stakeholders and
other government agencies like those represented here at the
table, HUD, VA, HHS, and DOD.
Three words symbolize the approach we are taking at VETS to
help end veterans' homelessness: excellence, innovation, and
transformation. I would like to share four examples of those.
The first example is prevention. Our transition assistance
program (TAP) currently has a module on preventing homelessness
where for those 142,000 members who go through it, we do a
diagnostic to help assess their risk factor for being homeless
and then connecting them with resources if they are at risk to
prevent them from becoming homeless.
I am currently doing a review of that module to see how it
can be strengthened and improved as part of our TAP
modernization process.
Number 2, let us talk about action. We have our Homeless
Veterans' Reintegration Program. The only Federal nationwide
program that focuses on the employment of homeless veterans.
Right now, with our budget for fiscal year 2010 of $36
million, we are serving around 21,000 homeless veterans through
that program. What we do is we provide them with the training
and services to prepare them to obtain meaningful careers.
A significant new undertaking is identifying the best
practices to serve homeless women veterans and homeless
veterans with families. The old models and ways of doing that
are not effective. We have learned that from the 60 listening
sessions that the Women's Bureau has held with homeless women
veterans.
So, we are taking $5 million to fund about 25 grantees this
year to determine which best practices serve homeless women
veterans and to get those women into meaningful careers. Next
year, we will continue funding those same 25 grantees.
Additionally we have a program for incarcerated veterans.
This is a population that is at tremendous risk of becoming
homeless when they transition from incarceration back into the
workforce.
We are taking $4 million to serve 1500 incarcerated
veterans through 12 sites this year to prepare them to make a
successful transition back into the labor force and we will
continue funding those grantees next year as well.
The final thing which I would like to talk about is the
importance of connecting the supply with the demand; connecting
our formerly homeless veterans, veterans who are transitioning
through these programs with employers.
We are developing relationships with the largest private
sector organizations in the country to have access to those
CEOs and senior executives who make the hiring decisions so
that they are aware of the reasons to hire a veteran and how to
hire a veteran so that our VETS team members, the local
veterans' employment representative in the field, have access
to more opportunities for homeless veterans and can help
expedite and accelerate their return to meaningful employment.
We feel that this recent cover on Fortune magazine, the
``New Face of Business Leadership in America''--a veteran--is
indicative of where we are going and how we are going to get
there. It is effectively communicating the message of what
veterans offer to companies and employers in America.
We are grateful to be here as a part of this hearing and
look forward to your questions.
[The prepared statement of Mr. Jefferson follows:]
Prepared Statement of Hon. Raymond M. Jefferson, Assistant Secretary
for Veterans' Employment and Training, U.S. Department of Labor
Chairman Akaka, Ranking Member Burr, and Members of the Committee:
I am pleased to appear before you today to discuss how the Department
of Labor's Veterans' Employment and Training Service (VETS) fulfills
its mission of supporting the Department of Veterans' Affairs (VA) goal
of ending Veteran homelessness in five years.
Every day, we are reminded of the tremendous sacrifices made by our
Servicemembers and their families. As this latest generation of
Veterans returns home, we want to make sure that they can have a home .
. . when they come home. One way that we can honor their sacrifices is
by providing them with the best services and programs our Nation has to
offer and making sure they have a home. Ending homelessness means both
obtaining a home and obtaining a job--which is why we are committed to
providing a path to employment with family-sustaining wages.
The Department of Labor has made helping Veterans a priority. VETS'
programs support Secretary Solis's vision of ``Good Jobs for Everyone''
by helping homeless Veterans get into middle class and maintain
stability. VETS works closely with the Department of Defense (DOD), the
VA, and the Department of Housing and Urban Development (HUD) to help
Veterans reach this goal through seamless employment assistance.
Seamless employment assistance will, in turn, require close
collaboration, enhanced communication, and sustained, purposeful
action. It's going to take all of us working together, sharing best
practices, and developing innovative solutions to challenging problems.
vets missions
We accomplish our mission through three distinct functions:
employment and training programs; transition assistance services; and
enforcement of relevant Federal laws. I have testified before this
Committee on my five aspirations. One of those is helping
Servicemembers transition seamlessly into meaningful employment and
careers while emphasizing success in high-growth and emerging
industries such as clean energy and health care. While we normally
think of assistance for Servicemembers as they leave the military and
transition to civilian employment, we must also look at homeless
Veterans as they transition back into employment.
homeless veterans vision
Secretary Solis shares Secretary Shinseki's vision of ultimately
eliminating homelessness among our Nation's Veterans. We have
strengthened our interagency collaboration at all levels to mobilize
for this important and necessary goal.
We are drawing upon the expertise and resources of the highest
levels of the executive branch. For example, the deputy secretaries of
DOL, VA, Health and Human Services (HHS), and HUD are pulling together
and meeting regularly to increase the collaborative efforts of their
departments toward the goal of ending Veteran homelessness. Among other
initiatives, the departments have agreed to:
Share data on how their programs serve the Veteran
homeless population.
Consider how best to provide outreach to Tribal
communities, through ideas generated by a DOL-led working group.
Provide information to each department's grantees
regarding how Veterans served by those grants can determine if they are
eligible for VA services and how they can access those services.
Share draft Solicitations for Grant Applications (SGA) and
Notices of Funding Availability between the departments to ensure
alignment of efforts.
- For example, DOL has shared its draft SGA with VA for the
Incarcerated Veterans Transition Program (IVTP), which provides
employment services to veterans who have recently been
incarcerated, including those who are at risk of becoming
homeless. DOL will also provide VA with an early view of its
initial IVTP applicant rankings in order to incorporate VA
input.
Identify ways to link VA Supportive Services grants to the
VA/HUD homeless prevention pilot program and ways to involve HHS in
that effort.
homeless veteran reintegration program (hvrp)
VETS' major program to tackle the problem of Veteran homelessness
is the Homeless Veterans Reintegration Program (HVRP). This is the only
Federal nationwide program focusing exclusively on employment of
Veterans who are homeless. HVRP provides employment and training
services to help homeless Veterans with the skills and opportunities
they need to gain meaningful employment and turn around their lives.
HVRP grants are awarded competitively to state and local workforce
investment boards, state agencies, local public agencies, and private
non-profit organizations, including faith-based organizations and
neighborhood partnerships. HVRP grantees provide an array of services
utilizing a holistic case management approach that directly assists
homeless Veterans and provides training services to help them to
successfully transition into the labor force. Homeless Veterans receive
occupational, classroom, and on-the-job training as well as job search
and placement assistance, including follow-up services.
Grantees provide additional services by networking with Federal,
State, and local resources for Veteran support programs. This includes
working with Federal, State, and local agencies such as the VA, HUD,
the Social Security Administration, the local Continuum of Care
agencies and organizations, State Workforce Agencies, and local One-
Stop Career Centers.
VETS requested a total of $41,330,000 in Fiscal Year (FY) 2011 for
HVRP, an increase of $5 million (14 percent) over the FY 2010 funding
level. In Program Year (PY) 2010, which will begin in July 2010, HVRP
expects to serve 21,000 homeless Veterans. VETS plans to serve 25,000
homeless Veterans in PY 2011.
For PY 2009, $26,330,000 was appropriated for HVRP, a 13 percent
increase over PY 2008. HVRP grantees will serve 15,500 homeless
Veterans in PY 2009. During PY 2008, HVRP grantees served 13,700
homeless Veterans. The employment placement rate was 67.4 percent. The
cost for serving this hard-to-serve population was $1,500 per
participant and $2,600 per placement. In PY 2009, VETS awarded a total
of 98 HVRP grants, including third-year funding for two cooperative
agreements to assist in developing the HVRP National Technical
Assistance Center. The Center provides technical assistance to current
grantees, potential grant applicants, and the public; gathers grantee
best practices; conducts employment-related research on homeless
Veterans; carries out regional grantee training sessions and self-
employment boot camps; and performs outreach to the employer community
in order to increase job opportunities for Veterans.
homeless women veterans
A major new undertaking in HVRP is a separate grant initiative to
serve the needs of homeless women Veterans and homeless Veterans with
families, a population that is on the rise and in need of specialized
services. In PY 2010, we will use up to $5 million of the $10 million
increase appropriated to HVRP in FY 2010 for this program to provide
customized employment services. We expect to fund about 25 grantees in
PY 2010. We requested an additional $5 million in the FY 2011 budget to
provide continued funding for the homeless women Veterans initiative.
VETS is collaborating with DOL's Women's Bureau, which has already
conducted 28 moderated listening sessions nationwide with formerly and
currently homeless women Veterans to identify the causes and the
solutions for homelessness among women Veterans. The findings from
these sessions are available on the Women's Bureau Web site at: http://
www.dol.gov/wb/programs/listeningsessions.htm.
We also conducted a national listening session with service
providers, VA, HUD, and other government agencies to begin identifying
the best practices for serving homeless women Veterans and homeless
Veterans with families. We will continue to identify such practices and
disseminate them to service providers throughout the Nation.
incarcerated veterans
The Incarcerated Veterans Transition Program (IVTP) provides
employment services to assist in reintegrating incarcerated and/or
transitioning incarcerated veterans, who are at risk of becoming
homeless, into meaningful employment within the labor force.
Through the program, VETS will continue its efforts to help
incarcerated Veterans and will coordinate these efforts with the VA. Of
the $36 million for HVRP in FY 2010, VETS plans to use $4 million for
IVTP, which will serve approximately 1,500 Veterans through 12 grants.
We plan to continue this program at that level in FY 2011.
additional activities
Of note to this hearing, the DOL Transition Assistance Program
Employment Workshop addresses homelessness prevention. This module
includes a presentation on general risk factors for homelessness, a
self-assessment to help determine individual risk, and contact
information for preventative assistance associated with homelessness.
VETS also utilizes a portion of HVRP funds to support stand down
activities. A stand down is an event held in a local community where a
variety of social services are provided to homeless Veterans. Stand
down organizers partner with local business and social service
providers to provide critical services such as: showers and haircuts;
meals; legal advice; medical and dental examinations and treatment; and
information on Veterans' benefits and opportunities for employment and
training.
Stand down events are a gateway for many homeless Veterans into a
structured housing and reintegration program. VETS funds HVRP eligible
entities (that do not have a competitive HVRP grant) to support a stand
down event. During FY 2009, VETS awarded over $540,000 in non-
competitive grants for 66 stand down events that provided direct
assistance to 9,600 homeless Veterans.
Finally, there is also tremendous potential and opportunity for
increasing engagement with employers to increase the hiring of
Veterans. This involves communicating the value proposition for hiring
Veterans more effectively, making the hiring process more convenient
and efficient, and developing hiring partnerships. VETS is also
developing new relationships with major private sector organizations to
enlist their advice and support to increase Veterans' hiring.
closing
In closing, I'd like to recount my experience from earlier this
month, when I had the privilege of meeting the Honor Flight at Reagan
National Airport and welcoming many of our country's WWII Veterans to
our Nation's Capitol. When I shook the hand of a Pearl Harbor survivor,
I was reminded of the honor and privilege we have at VETS to serve
America's Veterans.
Thank you again for your unwavering commitment to Veterans and for
the support that you've been providing to us.
I appreciate the opportunity to testify before you today and look
forward to answering your questions.
Chairman Akaka. Thank you very much, Mr. Jefferson.
Now we will hear from Mr. Johnston.
STATEMENT OF MARK JOHNSTON, DEPUTY ASSISTANT SECRETARY FOR
SPECIAL NEEDS, U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
Mr. Johnston. Chairman Akaka, Ranking Member Burr, Senator
Murray, I am pleased to be here on behalf of Secretary Donovan
and the U.S. Department of Housing and Urban Development. I
oversee the Department's efforts to confront the housing and
service needs of homeless persons and of veterans.
As President Obama has said, ``Too many who once wore our
Nation's uniform now sleep in our Nation's streets.''
As we know, Secretary Shinseki has announced the Department
of Veterans Affairs' plans for ending homelessness among
veterans. HUD fully supports these efforts. In fact, in HUD's
2011 budget HUD has just four priority performance goals. One
is veterans' homelessness. This performance goal is shared with
the Department of Veterans Affairs--to end homelessness among
veterans.
To help achieve this goal, HUD will provide housing and
needed supports to homeless veterans through the following
initiatives which I will briefly summarize.
First, targeted homeless grants. In December 2009, we
awarded nearly $1.4 billion to well over 6400 projects locally
to serve homeless persons including veterans.
It is important to note that veterans are eligible for all
of HUD's homeless assistance programs, and HUD emphasizes the
importance of serving veterans in our grant application. As a
result, one in ten persons served by HUD targeted homeless
programs is a veteran.
HUD-VASH. The Congress has provided $75 million in 2008, in
2009, and in 2010 for this program: the HUD-Veterans Affairs
Supported Housing Program.
Through this partnership, HUD and VA will be providing
permanent housing and services for approximately 30,000
homeless veterans and their families, including veterans who
have been returning from Iraq and Afghanistan.
HUD and VA want to focus this year on making the 30,000
vouchers already appropriated to be used very effectively and
very efficiently. The stimulus's Homelessness Prevention and
Rapid Re-housing program which we refer to as HPRP is a great
resource that can be used to prevent homelessness including
veterans.
It is a $1.5 billion program that can do two things. It can
prevent homelessness for persons, including veterans, by
providing resources such as rental assistance, security
deposits, and case management and can also assist people who
have fallen into homelessness to rapidly re-house them into
conventional housing.
The HPRP program can and does serve homeless veterans.
Funds can be used for these various resources, and one thing
that we have been touting is to connect this with HUD-VASH so
that when a veteran is having a tough time saving the funds for
a security deposit, for instance, or utility assistance, they
can use the HPRP program and we have been actively touting that
with our various grantees around the country.
The recently enacted Homeless Emergency Assistance and
Rapid Transition to Housing Act, or HEARTH Act, provides
unprecedented flexibility to confronting homelessness.
This Act consolidates HUD's various competitive programs
into a single, streamlined, flexible program which we will be
implementing in 2011. The program requires that all
stakeholders, including veterans' organizations, determine how
the funds should be used.
HUD's 2009 Appropriations Act provides the department with
$10 million for a demonstration program to prevent homelessness
among veterans. HUD is working with the VA and the Department
of Labor on this initiative. We will be conducting evaluation
on this demonstration, and the three agencies will be sharing
the results widely with organizations that serve veterans.
HUD's Secretary Donovan, in addition to being the Secretary
of our department, is also currently the Chairman of the U.S.
Interagency Council on Homelessness. He has met with Secretary
Shinseki, the former Chair of the Council, to discuss the needs
of homeless veterans and how our agencies can work
collaboratively to solve this problem.
The Council is developing the Federal plan to end
homelessness which is due to Congress on May 20. The Council
has been reaching out to a variety of stakeholders of which
there have been many participants, including those who are
homeless veterans. This effort will further ensure a Federal-
wide focus on ending homelessness among veterans.
Finally, each year HUD collects information from
communities nationwide on homelessness, develops a detailed
report and submits this to Congress as the Annual Homeless
Assessment Report.
Similarly, HUD is working closely with the VA this year on
collecting data and developing a special report on veteran
homelessness which will be issued later this year.
In closing, I want to reiterate my and the Department's
desire to truly end homelessness among veterans.
Thank you very much.
[The prepared statement of Mr. Johnston follows:]
Prepared Statement of Mark Johnston, Assistant Secretary for Community
Planning and Development, U.S. Department of Housing and Urban
Development
introduction
Chairman Akaka, Ranking member Burr, Members of the Committee, I am
pleased to be here today to represent the Department of Housing and
Urban Development. My name is Mark Johnston, the Deputy Assistant
Secretary for Special Needs. I oversee the Department's efforts to
confront the housing and service needs of homeless persons and of
veterans.
This responsibility includes confronting the specific needs of our
country's homeless veterans and their families. As President Obama has
said, ``Too many who once wore our Nation's uniform now sleep in our
Nation's streets.'' Secretary Shinseki has announced the Department of
Veterans Affairs' plans for ending homelessness among veterans. HUD
fully supports these efforts. In fact, in HUD's 2011 Budget, HUD has
four priority performance goals. One is Veterans Homelessness. This
performance goal is shared with the Department of Veterans Affairs (VA)
to end homelessness among veterans. The joint efforts will reduce the
number of homeless veterans from the estimated 131,000 in fiscal year
2009 to 59,000 in fiscal year 2012. To help achieve this goal, HUD will
provide housing and needed supports to homeless veterans through the
Department's targeted homeless assistance programs, as well as through
mainstream HUD resources.
The Department administers a variety of programs that can house
veterans. These include the Housing Choice Voucher Program, Public
Housing, HOME Investment Partnerships, and the Community Development
Block Grant (CDBG) program. These programs, by statute, provide great
flexibility so that communities can use these Federal resources to meet
their local needs, including the needs of their veterans. In addition
to these programs, Congress has authorized a variety of targeted
programs for special needs populations, including for persons who are
homeless.
Unfortunately, veterans are well represented in the homeless
population. HUD is committed to serving homeless veterans and
recognizes that Congress charges HUD to serve all homeless groups.
HUD's homeless assistance programs serve single individuals as well as
families with children. Our programs serve persons who are disabled,
including those who are impaired by substance abuse, severe mental
illness and physical disabilities as well as persons who are not
disabled. HUD provides an array of housing and supportive services to
all homeless groups, including homeless veterans.
targeted hud homeless assistance grants
In December 2009, HUD competitively awarded approximately $1.4
billion in targeted homeless assistance renewal grants. A record 6,445
renewal projects received awards. It is important to note that veterans
are eligible for all of our homeless assistance programs and HUD
emphasizes the importance of serving veterans in its grant application.
Communities may submit veteran-specific projects or projects that
support a general homeless population that includes veterans. In this
competition, HUD awarded 1,372 projects that serve veterans, either as
a veteran-specific project or more typically as a project that serves
veterans among other persons. Overall, 1 in 10 persons served by HUD's
targeted homeless programs is a veteran.
To underscore our continued commitment to serve homeless veterans,
we have highlighted veterans in our annual planning and application
process. In the annual grant application we encourage organizations
that represent homeless veterans to be at the planning table. Because
of HUD's emphasis, communities have active homeless veteran
representation. We also require that communities identify the number of
homeless persons who are veterans so that each community can more
effectively address their needs.
hud-vash
The Congress provided $75 million in 2008, 2009 and 2010 for the
HUD-Veterans Affairs Supportive Housing Program, called HUD-VASH. The
program combines HUD Housing Choice Voucher rental assistance
(administered through HUD's Office of Public and Indian Housing) for
homeless veterans with case management and clinical services provided
by the Department of Veterans Affairs (VA) at its medical centers in
the community. Through this partnership, HUD and VA will provide
permanent housing and services for approximately 30,000 homeless
veterans and their family members, including veterans who have become
homeless after serving in Iraq and Afghanistan. HUD and VA are working
to get the vouchers out on the street and leased up. We're making good
progress on this between our agencies and with housing authorities and
VA medical centers, and want to focus this next year on making sure
that the 30,000 HUD-VASH vouchers already appropriated are being
efficiently and effectively used.
recovery reinvestment act (arra) funding
ARRA provides unprecedented funding to HUD and other Federal
agencies to directly confront the very difficult economic times in
which we live. Overall HUD is responsible for $13.6 billion in ARRA
funds for housing and community development. The ARRA Homelessness
Prevention and Rapid Re-Housing Program (HPRP) is specifically targeted
to confront homelessness. HPRP provides $1.5 billion to communities
nationwide. These funds were awarded to States, metropolitan cities,
urban counties and territories.
The funds are now being used by grantees and sub-grantees,
including non-profit organizations, to provide an array of prevention
assistance to persons, including veterans, who but for this assistance
would need to go to a homeless shelter. The program is also being used
to rapidly re-house persons who have become homeless. Program funds can
be used to provide financial assistance (e.g., rental assistance and
security deposits) and housing stabilization services (e.g., case
management, legal services, and housing search). The HPRP funding
notice expressly references that the program can serve homeless
veterans and that program funds can be used to provide to homeless
veterans with security deposits and HUD-VASH can be used for long-term
rental assistance. To date, well over 150,000 persons have been
assisted through HPRP.
HPRP represents a unique opportunity for communities. This
significant level of funding--which equals the approximate level of
funding historically appropriated by Congress for all of HUD's other
homeless programs combined--will enable communities to re-shape their
local homeless systems. For the first time, communities now have
targeted funding to prevent homelessness. In the past, virtually all of
HUD's homeless-related programs could only assist persons after they
became homeless. These funds have the potential to assist persons at
risk, including veterans, stay in their homes rather than be relegated
to moving themselves and their families to emergency shelters, or
worse, the streets. HPRP also will allow communities to significantly
reduce the time that veterans and others must stay in emergency
shelters, as HPRP can be used to immediately re-house persons in
conventional housing and also provide temporary supports such as case
management to help ensure housing stability. These two components--
homelessness prevention and rapid re-housing--have been the missing
links in each communities' Continuum of Care system. Communities now
have the tools they need to effectively confront homelessness.
Importantly, the new approaches that communities implement with HPRP
will have the potential to be carried on, thanks to legislation passed
by the Congress and enacted by the President on May 20, 2009.
new hud homeless programs
The recently enacted Homeless Emergency Assistance and Rapid
Transition to Housing Act (HEARTH) provides unprecedented flexibility
to confronting homelessness. The Act consolidates HUD's existing
competitive homeless programs into a single, streamlined program, the
Continuum of Care Program. The program requires that all stakeholders--
including veterans organizations--determine how the funds should be
used. The law also reforms the Emergency Shelter Grants program into
the Emergency Solutions Grant (ESG) program. The new ESG will provide
for flexible prevention and rapid re-housing responses to
homelessness--similar to the Stimulus HPRP program--so that veterans
and others who are either at risk or who literally become homeless may
receive assistance. Finally, the legislation provides for the Rural
Housing Stability Assistance Program to provide targeted assistance to
rural areas. HEARTH includes as a selection criterion for grant award,
which is the extent to which the applicant addresses the needs of all
subpopulations, which includes veterans.
veteran homeless prevention demonstration
The 2009 Appropriations Act provides HUD with $10 million for a
demonstration program to prevent homelessness among veterans as part of
the appropriation for HUD's homelessness programs. HUD is working with
the VA and the Department of Labor to design and implement this
initiative. Urban and rural sites will be selected. The demonstration
funds may be used to provide both housing and services to prevent
veterans and their families from becoming homeless or to reduce the
length of time veterans and their families are homeless. HUD intends to
conduct an evaluation of this demonstration, with funds provided for by
the Congress, and then share the results widely through HUD's technical
assistance resources to organizations serving veterans. The findings
from this effort will help inform future initiatives to prevent
homelessness among veterans, as we agree with the Congress that
homeless prevention needs to be a key element to solve this problem.
interagency collaboration on homeless veterans issues
Secretary Shaun Donovan is the current Chair of the U.S.
Interagency Council on Homelessness (USICH). He has met with VA
Secretary Shinseki to discuss the needs of homeless veterans and how
our agencies can work collaboratively to solve this problem.
The Interagency Council on Homelessness is developing the Federal
Plan to End Homelessness, which is due to Congress on May 20, 2010. The
Council has been reaching out to a variety of stakeholders, including
those who serve homeless veterans. This effort will further ensure a
Federal-wide focus on ending homelessness among veterans.
Historically HUD and VA have been involved in several
collaborations related to homelessness among veterans. The agencies are
currently working together in implementing and operating HUD-VASH.
Another joint initiative involved reducing chronic homelessness, in
which HUD provided the housing assistance and the VA and the Department
of Health and Human Services provided support services to chronically
homeless persons. Finally, I serve as an ex-officio member of the
Secretary of VA's Advisory Committee on Homeless Veterans, which is
focused on ending homelessness among veterans.
technical assistance
To coordinate veterans' efforts within HUD, to reach out to
veterans organizations, and to help individual veterans, HUD
established the HUD Veterans Resource Center. The Center, headed by a
veteran, has a 1-800 number to take calls from veterans and to help
address their individual needs. The Resource Center works with each
veteran to connect them to resources in their own community.
HUD's Homelessness Resource Exchange (located at www.HUDHRE.info)
is HUD's one-stop shop for information and resources for people and
organizations who want to help persons who are homeless or at risk of
becoming homeless. It provides an overview of HUD homeless and housing
programs, our national homeless assistance competition, technical
assistance information, and more.
The HUDHRE has a number of materials that address homeless veterans
issues. For example, HUD dedicated approximately $350,000 to enhance
the capacity of organizations that do or want to specifically focus on
serving homeless veterans, update existing technical assistance
materials, and coordinate with VA's homeless planning networks. As a
result, we developed two technical assistance guidebooks, available on
the Web site. The first guidebook, Coordinating Resources and
Developing Strategies to Address the Needs of Homeless Veterans,
describes programs serving veterans that are effectively coordinating
HUD homeless funding with other resources. The second guidebook, A
Place at the Table: Homeless Veterans and Local Homeless Assistance
Planning Networks, describes the successful participation of ten
veterans' organizations in their local Continuums of Care.
Additionally, we have held national conference calls and workshops to
provide training and assistance to organizations that are serving, or
planning to serve, homeless veterans.
Finally, each year HUD collects information from communities
nationwide on homelessness and develops a detailed report on of
homelessness and submits that to the Congress. This report helps inform
the Congress, the Administration, and communities nationwide on the
nature and extent of homelessness in America so that we collectively
can more effectively confront the problem. Similarly, HUD is working
closely with the VA on collecting data and developing a special report
on veteran homelessness, which will be issued later this year.
conclusion
In closing, I want to reiterate my and HUD's desire and commitment
to help end homelessness among our veterans by working effectively with
our Federal, state, tribal and local partners.
______
Response to Post-Hearing Questions Submitted by Hon. Daniel K. Akaka to
Mark Johnston, Deputy Assistant Secretary for Special Needs, U.S.
Department of Housing and Urban Development
Question 1. Once a veteran is successfully placed in permanent
housing using a HUD-VASH voucher, what assistance is available so he or
she can become independent of the voucher?
Response. Assistance is provided through the VA's case management
services, which involve regular meetings with mental health and primary
care providers that assist Veterans in improving their well-being, as
well as accessing needed treatment services. VA case managers work with
Veterans on adjustment to community living addressing issues and
provide supports for money management, time management and maximizing
quality of life issues. The VA case managers also work with Veterans
Benefits Office, Department of Labor and other Federal partners to
address access to benefits and employment opportunities for veterans in
HUD-VASH. VA case managers also help the Veteran address family
reunification so they can fully reintegrate back into the community.
Question 2. On average, how long does it take to place a veteran in
permanent housing once the veteran is determined to be eligible for a
HUD-VASH voucher?
Response. It takes an average of three months to place an eligible
veteran in permanent housing. Placing a veteran in housing continues to
be challenging for several reasons. Poor credit histories, lack of
funding for security and utility deposits, delayed or multiple
inspections, and in some areas, the availability of suitable affordable
housing can cause the leasing process to be lengthy. HUD and the VA
continue to work with case managers and Public Housing Authority (PHA)
staff to identify solutions for speeding up the leasing process.
Question 3. What challenges do you each face when trying to execute
your department's homeless veteran programs in conjunction with another
agency's programs?
Response. To date, the VA and HUD have prevented potential
challenges arising through regular planning and administrative
meetings, ongoing email and phone conversations, as well as joint
efforts to coordinate activities in the field. Within HUD, staff from
the Housing Choice Voucher Programs (HCVP) and Special Needs Assistance
Programs (SNAPs) have contributed their expertise to the development
and implementation of the program. Both HCVP and SNAPs staff have
worked with VA staff to establish shared goals, as well as common
metrics and milestones to ensure our goals are achieved.
A few sites have struggled with the coordination of program
activities at a local level. Communication between the local VA case
managers and the PHA staff is crucial to successful administration of
this program. To ensure that strong partnerships exist among PHAs and
VA medical centers (VAMCs) at all sites, VA and HUD will continue
conducting site visits, satellite broadcasts and joint training
sessions for both PHAs and VA case managers. Meetings to address
problems at low-performing sites will be held with staff attending from
HUD and VA headquarters, agency field offices, PHAs, VAMCs, and
Continuums of Care.
The VA and HUD are also working toward establishing a data sharing
agreement to allow the agencies to share data on homeless veterans and
the veterans served. Improved data-sharing mechanisms will enable
agencies to more effectively monitor the program's implementation.
Question 4. HUD and VA should be commended for the level of
coordination and cooperation they've had in getting HUD-VASH vouchers
distributed to housing authorities with quick guidance on program rules
and regulations. Unfortunately that same level of cooperation isn't
playing out in many communities where housing authorities (PHAs) and
VAMCs are simply not leasing up vouchers as quickly as they should.
What can we do to improve lease-up rates for these vouchers? Should
PHAs and VAMCs be required to have a memorandum of understanding in
order to be awarded vouchers? For communities that are using HUD-VASH
very successfully, how can we better get their story shared with other
communities?
Response. Due to the ongoing monitoring of site performance, HUD
and VA are acutely aware of low-performing sites and the communities in
which improved coordination is needed among PHAs and VAMCs. The
agencies have developed joint and agency-specific strategies to improve
lease-up rates and strengthen cooperation among community partners.
From the outset of HUD-VASH implementation, HUD and VA have shared
information on a monthly basis in order to monitor outcomes and
identify areas for improvement. The agencies together have recognized
sites in which problems exist with coordination and lease-up rates.
Field visits to low-performing sites will help identify and resolve
implementation issues, and the agencies will facilitate meetings among
community partners to address issues and establish corrective action
plans or performance improvement plans.
Other measures to improve lease-up rates include taking into
consideration the past performance of VAMCs and PHAs when allocating
2010 awards. Capacity-building efforts will continue for new and
existing sites through satellite broadcasts and regional trainings for
PHAs and VA case managers. In addition, approximately 300 vouchers will
be set aside as project-based vouchers (PBV) for communities in which
safe, affordable housing for veterans is more difficult to secure. The
criteria for determining the distribution of the PBV set-aside vouchers
will include sites' ability to make units available for occupancy in
the least amount of time. HUD and VA also will continue to consider
transferring vouchers from low-performing PHAs to other PHAs nearby, as
well as the contracting out of case management services.
For HUD, field offices will continue to play a critical role in
monitoring the program's implementation at a local level by issuing
monthly status reports, reviewing with headquarters the information
received from HUD-VASH reports, and contacting low-performing PHAs on a
monthly basis. In addition, HUD will enable HUD-VASH participants to
have access to financial assistance for security deposits available
through the Homelessness Prevention and Rapid Re-Housing Program
(HPRP). HUD will also aim to increase the number of referrals from
Continuum of Care service providers, which receive funds through HUD's
homeless assistance programs.
A requirement for PHAs and VAMCs to sign memorandums of
understanding has been considered; however, both agencies believe that
this is not necessary and in some cases may impede the program's timely
implementation. It is critical, however, that the VAMCs and PHAs of
low-performing sites work together to strengthen collaboration, define
shared targets, monitor progress, and identify areas for improvement.
In recognition of the well-performing sites, HUD and VA sponsored a
workshop on successes and best practices at the national HUD-VASH
training in June 2009. Similar workshops will be held at the regional
training sessions, and site visits will be conducted at four of the
top-performing sites to gather more information on best practices. A
best-practices document subsequently will be developed and distributed
that highlights recommended procedures and the positive outcomes that
all sites should aim to achieve. Success stories will also be published
on the HUD and VA Web sites.
______
Response to Post-Hearing Questions Submitted by Hon. Jim Webb to Mark
Johnston, Deputy Assistant Secretary for Special Needs, U.S. Department
of Housing and Urban Development
Secretary Donovan, according to the VA's Director of Homelessness,
as of February 10, 2010, more than 19,000 veterans have been accepted
into the HUD-VA Supported Housing (HUD-VASH) program; more than 16,000
have received a housing voucher, and 10,600 formerly homeless veterans
are now housed through these efforts.
Question 1. How many of those 19,000 veterans subsequently no
longer need vouchers because they were able to raise their income to a
level sufficient to lead an independent life?
Response. HUD ran a point-in-time query on all HUD-VASH veterans
housed in February 2010 and found that approximately 0.8 percent were
able to pay the full amount of rent at that time. The query did not
take into consideration how long veterans had been enrolled in HUD-
VASH. The primary sources of income for the majority of veterans are
pensions and social security, and approximately 60 percent of those we
have served to date are elderly or disabled. Therefore we expect that a
significant number of veterans will need housing assistance for many
years.
The HUD-VASH program has been designed for those veterans and their
families that are homeless due to mental and physical disabilities.
Participating veterans receive ongoing case management through the VA
in order to secure access to mental and physical health services, as
well as safe, affordable housing. VA case managers have determined that
the 19,000 veterans accepted for the HUD-VASH program are clinically
eligible for the program and that vouchers are needed by the veterans
in order to secure permanent housing. Therefore, it is a hope, but not
an expectation, for such veterans to achieve self-sufficiency and be
able to live independently without housing assistance in the short
term.
Particularly with the funding allocated in FY 2010, the veterans
that participate are likely to be those that HUD considers to be
chronically homeless. As defined in the 2009 Continuum of Care NOFA, a
chronically homeless person is an unaccompanied homeless individual
with a disabling condition who has either been continuously homeless
for a year or more OR has had at least four episodes of homelessness in
the past three years. The term ``homeless'' refers to a person sleeping
in a place not meant for human habitation (e.g., living on the
streets), in an emergency homeless shelter, or in a Safe Haven as
defined by HUD. A disabling condition is defined as: (1) a disability
as defined in Section 223 of the Social Security Act; (2) a physical,
mental, or emotional impairment which is expected to be of long-
continued and indefinite duration, substantially impedes an
individual's ability to live independently, and of such a nature that
the disability could be improved by more suitable conditions; (3) a
developmental disability as defined in Section 102 of the Developmental
Disabilities Assistance and Bill of Rights Act; (4) the disease of
acquired immunodeficiency syndrome or any conditions arising from the
etiological agency for acquired immunodeficiency syndrome; or (5) a
diagnosable substance abuse disorder.
Question 2. What is the average length of time a voucher is needed
by a HUD-VASH recipient?
Response. HUD-VASH is in the beginning stages of implementation,
and only preliminary data exists on the average length of stay of
participating veterans. However, HUD ran a query on homeless families
that have participated in the broader Section 8 Housing Choice Voucher
program, which targets all low-income families and not just veterans.
HUD found that the average length of assistance for a family that was
homeless at the time of admission is 861 days. However, we do not have
data that identifies the reason families leave the program. Potential
reasons could include the family achieving self-sufficiency, as well as
termination of assistance due to the violation of lease requirements or
other family obligations, which could result in the family returning to
homelessness.
Question 3. What is the average per capita cost of a homeless
veteran in the HUD-VASH program?
Response. The average cost of a VASH voucher on a yearly basis is
$6,444, and the average cost of case management services per veteran is
approximately $4,500. The total direct cost per year is approximately
$11,000 per veteran.
Question 4. Please describe the additional supportive services the
VA intends to use to transition veterans off HUD-VASH.
Response. The VA intends to provide vocational rehabilitation
services with case management, as well as traditional mental health and
primary care services and access to VA benefits. Some veterans may also
qualify for VA and/or community-based prevention services designed to
assist individuals to rapidly return to independent living. These time-
limited services include case management, financial assistance, child
care, vocational training, and transportation assistance.
Question 5. What are the average costs, by state, of providing
support to homeless veterans through established group housing shelter
programs as, for instance, the New England Center for the Homeless?''
Response. There is no readily available cost information on group
housing shelter costs for veterans. However, the VA funds transitional
housing programs through its Grant and Per Diem program for community
agencies providing services to homeless Veterans. The Per Diem portion
pays for operational costs, such as services and utilities, based on
cost per veteran per day. VA pays up to $34.40 per day per veteran
housed, in accordance with current regulations. Costs are calculated
based on budgets submitted by the grantee. Currently, the average rate
paid nationally is approximately $31, which equates to an estimated
$1,000 per month per veteran.
Chairman Akaka. Thank you very much, Mr. Johnston.
When we started talking ending homelessness among veterans,
it is important to know the size of the problem. However, VA
and HUD have two very different figures for how many of our
Nation's veterans are homeless at any given night in a year.
Would you, Mr. Dougherty and Mr. Johnston, please explain
your departments' numbers and why there is such a large
difference?
Mr. Dougherty, we will start with you.
Mr. Dougherty. Mr. Chairman, I do not think the numbers are
really as far apart as they may appear. Sometimes it is the
reporting cycle that we are reporting in.
One of the things--I think Mark will back me up--as we are
moving forward, our Secretaries have talked about having one
single reporting system.
The Department of Housing and Urban Development has a
requirement to go out and identify homelessness in America and
to identify veterans among that population. So we have been
working collaboratively with HUD so that as we do this in the
future we are going to use simply one number.
The number that we use is really largely based upon what
HUD reports through its continuance of care along with some
additional information that we have. What we want to do, as
Mark mentioned a moment ago, is we want to make sure that we
have all the ``Ts'' crossed and all the ``Is'' dotted in the
right places to make sure we have a good count.
But I think our numbers are within a very small percentage
as we report year to year in the last few years.
Chairman Akaka. Mr. Johnston.
Mr. Johnston. Just to briefly elaborate on that, the figure
that HUD has for homeless veterans is 135,000. That is based on
January 2008 data. The data that is provided by Pete Dougherty
and the VA is a little bit more recent.
Our numbers for 2009 will be submitted in the annual report
to Congress in June. So that will be an update. Then later in
the year, in other words, later this summer, we will have the
2010 figures. I certainly agree with Pete that the difference
is relatively minor and it really is a reporting period
difference I think.
Chairman Akaka. Thank you.
This question is for all of the panelists. What is your
department's perception of the Housing First approach to
assisting the chronically mentally ill, homeless veteran
population?
Mr. Johnston. I will begin.
Chairman Akaka. Mr. Johnston.
Mr. Johnston. HUD absolutely supports the concept. We have
been using it across the country for a number of years. In
fact, one of our first permanent housing programs, Shelter Plus
Care, which was created in 1992, was based on housing first.
That is the model that we see being implemented across the
country for most of our projects. The notion, of course, being
you take a homeless client where they are, wherever that is,
and help move them into housing and address the various issues
that they have got.
We did a study about 2 years ago on this and found about 84
percent of persons who were chronically homeless, who moved
into permanent housing were there a year later.
It is not to say there is not an effort to make sure that
happens by having good, strong supportive services in place but
it certainly can and should happen.
Mr. Dougherty. Mr. Chairman, both our secretaries, the
Secretary of HUD and the Secretary of Veterans' Affairs, have
met. We have talked about this.
It is certainly a significant change for our department
from where we were years ago. When we first had some vouchers
with HUD, it was really predicated on a veteran who had already
been in a long course of treatment and probably would be what
we might refer to as patient compliant before they would be
able to get in.
We do not have that kind of restriction today. We are
looking more and more on how we can get that placement faster
because we do agree there is an effective way to provide this
service to veterans but it is a corporate shift change for us
to get to that point.
Mr. Jefferson. Chairman Akaka, I would just say one of the
Labor Department's commitments, sir, is just to make sure that
these service providers have easy access and frequent access to
our employment representatives and our disabled veteran
outreach program specialists.
So whether these homeless veterans in Housing First need
case management or access to the employment opportunities in
their area our DVOPs, LVERs, and employment representatives are
there to provide the employment piece of that transformation.
Chairman Akaka. Thank you very much, Mr. Jefferson.
Let me call on our Ranking Member, Senator Burr, for his
questions.
Senator Burr. Thank you, Mr. Chairman.
Mr. Dougherty, will we be here 5 years from today only
talking about prevention programs?
Mr. Dougherty. Mr. Burr, I do not think we will be only
talking about prevention programs because just as we would face
in any other health problem, there will be veterans who,
because of mental illness, substance abuse problems, and other
things including not having enough support, will show up and
become homeless.
Senator Burr. Do you believe that the Secretary's blueprint
provides the flexibility as time goes on for us to change the
programs to reflect any changes in population?
Mr. Dougherty. Mr. Burr, you are asking an excellent
question. Lisa Pape and I talk regularly and one of the things
we talk about is that there is not a 5-year plan at this point.
There is a fourth-year and 6-month plan that requires that
every month we look at what we are doing, how effective we are
at getting the services out there and what we can do to make
shifts if we are not meeting that.
Senator Burr. Let me encourage both of you. Where you can
share that thought process, that matrix with Congress, it would
be extremely helpful because, as I said in my opening
statement, we have been starved for information on this plan.
We would like to be a full-fledged partner. I know Senator
Murray invested a tremendous amount of time and passion into
the issue. I think you leave us out and then suggest, well,
just trust us.
Mark, you made a statement that one of the programs was to
take the money, consolidate it, and let everybody decide how to
use it, meaning the stakeholders. Well, I am not sure that is
necessarily the right way; and I take for granted that I only
heard you at face value for what you said. But I think
everything we say, we have got to understand it here in a
different fashion. And the goal here is not about process, it
is about outcome. It is about reaching the goal which, as I
said, is going to be very difficult for us to do.
Let me ask you, Mr. Dougherty. From a standpoint of your
numbers or HUD numbers, is there any outside validation of
those numbers?
Mr. Johnston. I will start. These numbers are not from HUD.
These numbers are from the communities. So we aggregate them
from every city and county in America.
Senator Burr. OK.
Mr. Dougherty. We rely a lot on that. Also as we report
through each of our sites, we also look at if there are good
local studies. Sometimes universities and others do some
studies like that.
The other is that the process that we use is called the
CHALENG meeting process. This past year we had about 15,000
people who came, including more than 10,000 currently and
formerly homeless veterans. So we think we are getting good
information as to what is needed and what kinds of services.
That really is helping to drive us as to where we need to go.
We are listening to the consumer who needs our help.
Senator Burr. Let me ask about the plan in a slightly
different say. How many programs, if any, are not going to be
funded that have been funded in the past?
Mr. Dougherty. The only program that we had before that we
are no longer actively pursuing is the Multi-Family Housing
Loan Guarantee Program. We simply tried it. It was passed by
Congress. We tried that for a number of years. We found that it
just did not meet the need. It did not serve the veterans that
needed to be served. We wrote Congress last year saying we were
no longer going to pursue that program.
Senator Burr. So incorporated in the blueprint are how many
new programs that did not exist last year?
Mr. Dougherty. There are several new programs. I do not
know if I can tell you off the top of my head all of them. But
obviously we have a call and referral center we think is very
important.
Obviously our continued efforts with HUD are a very
important way to address this issue because we have to address
that veteran, as I said in the opening statement, where they
are. Some of them need an emergency sort of assistance.
We are increasing contract care. We are increasing contract
care in places that we did not have it before because, as
Senator Tester pointed out as well, if you are in rural
America, you may not have a big homeless program somewhere. But
that does not mean that a veteran who needs to get off the
street; VA should be able to provide some service to get that
veteran off the street.
Senator Burr. That is extremely helpful. The question is
what then supports that effort to make sure that this becomes a
permanent experience versus only a temporary triumph.
I guess I am looking for specific measures that you have
identified that are incorporated in these programs that would
lead me to believe we are going to have a different outcome
versus just a deep commitment which is typically a financial
commitment to the problem.
Mr. Dougherty. Right. I think the answer to that in large
part is that you have to be responsive to the veteran when they
first need our care services. Otherwise, they are never going
to come to us until they are so sick and so disabled that the
cost to treat them is much more significant, much more intense.
That is why the effort at prevention and going for
supportive services before that veteran ever becomes homeless
is where we really need to be more focused on.
We are going to do the things we have done in the past and
do them effectively but we are also going to do a better job of
trying to stop that from ever happening in partnership with the
folks at this table.
Senator Burr. I appreciate that answer and my time has
expired. But let me say this that I think it even starts
earlier than when you get it and it is a debate that we have in
this Committee with VA overall, and that is when you look at
our veterans that have medical needs, not all of them physical,
their willingness to participate at the earliest possible point
is not always there, and we accept the fact that we offer it;
and if they do not utilize it, then that is their
responsibility, until they end up as a focus of you.
I think that we collectively have to begin to look at how
we provide those early programs on the health care side in a
different way that attracts participation, does not allow us to
have individuals that a year later, 2 years later end up with
you trying to deal with all the manifestations that they are
dealing with; and the lack of a roof over their head is one of
the major contributors then.
I thank the chair.
Chairman Akaka. Thank you very much, Senator Burr.
Senator Murray.
STATEMENT OF HON. PATTY MURRAY,
U.S. SENATOR FROM WASHINGTON
Senator Murray. Thank you very much, Mr. Chairman. I
appreciate your having this hearing today.
Mr. Dougherty, in your testimony, you noted that
homelessness is primarily a health care issue. Given that the
VA is planning to expand access to more non-service-connected
disabled veterans with moderate incomes and to actually
increase the number of presumptive diseases like Agent Orange,
can you tell us whether or not the VA actually has the capacity
now to address the needs of all those veterans or do we need to
be looking at additional resources?
Mr. Dougherty. I am not sure I know the total answer to
your question. I do believe that when it comes to veterans who
are homeless that we think we are well positioned to take care
of those veterans as they come to us.
One of the things, as we look toward going to prevention,
we are looking more and more to align the Benefits
Administration with this because I think, as Senator Burr just
noted a moment ago, one of the things that we think is very
important is we need to be more in the wellness business and
less in the serious health care problem business.
The wellness issue is going to be addressed by catching it
at the earliest stage.
Senator Murray. Right. I know that we are going to be
increasing the number of veterans, which I applaud you in
doing. I just want to make sure you are staying in touch with
us to make sure that we have got the resources to be able to
deal with that issue and see that happen.
Mr. Dougherty. The 2011 budget I think addresses that
adequately; yes, ma'am.
Senator Murray. Does the VA have an estimate of how many of
their veterans tried to or accessed the VA for care before they
return to homelessness?
Mr. Dougherty. No, we do not have a very good estimate of
how many of them tried and did not. That is one of the things
that the Call Center and this registry we are working on is
going to be able to do for us. It is going to tell us when
veterans are doing that, and one of the things that we are
doing with HUD in trying to align more of the information that
they have is trying to get a better handle on who is out there
and who has not been served.
Senator Murray. When will we be able to see information
back on that?
Mr. Dougherty. I think this summer we are going to work on
this report.
Ms. Pape. We hope the registry starts phasing in during the
summer, and hopefully will be fully operational sometime before
the beginning of the fiscal year 2011.
Senator Murray. OK. I also wanted to ask you, Mr.
Dougherty, how the VA validates a program out in the community
before allowing them to provide service to veterans?
Mr. Dougherty. In our traditional housing program, what we
do is we not only run you through a grant application process
but then before you actually provide services to veterans we
come on-site. We meet with you. We look at your financial
ability to provide services. We look at the physical facilities
that you have. We look at the service plan that you have for
veterans.
Then and only then do we approve you for payment. Then we
come back on an annual basis in a formal way, yet we are
informally in those programs year around.
Senator Murray. OK. Secretary Jefferson, in the next panel
a veteran is going to testify about how he fell into a life of
drug dealing and later using while he was trying to get a job
as a mechanic. We have a lot of veterans transitioning home to
a tough economy and falling into the same kind of traps.
How are we going to work better with our communities to
help create partnerships or apprenticeships or other ways for
our veterans to get back into the workforce?
Mr. Jefferson. One of the things that we are doing is
engaging with our DVOPs and LVERs. So, making sure our
employment representatives around America, as they are working
with veterans, when they identify that there is a need for
mental health support and services, that they can effectively
refer them to the VA or to other health providers. That is one.
Number 2, we think, is just making sure that we increase
the opportunities that this community has available to it.
So we are developing some employer engagement and outreach
partnerships now that will increase substantially the
opportunities that we can provide for veterans and that is an
area which I am placing a very high priority on during my
tenure.
By increasing the demand for veterans, we can accelerate
them finding meaningful careers, not just jobs.
Senator Murray. Because that is a really important part of
this.
Mr. Jefferson. Absolutely, Senator Murray.
We can have all of the best HVRP grantees, the best
preparatory programs, but if when these veterans step out to
find meaningful employment, there are no jobs for them, then
they are going to become demoralized, and they will move into
that downward spiral.
Senator Murray. Mr. Johnston, I am almost out of time. But
I do want to submit some questions to you about the HUD-VASH
program. As we put that out there, communities are using it
really well, others are not, and as a result, veterans are not
getting access to it.
I want to ask you about that and especially how it is being
implemented here in DC with some of the private contractors,
making sure that HUD stays in touch with them and confirming
that veterans are continuing to get that despite it being
contracted out.
So I will submit those questions to you because I have run
out of time.
Mr. Chairman, before I yield I did just want to say to the
world in general that I am a little frustrated with the
bureaucracy and the delay surrounding the release of the
suicide rates for female veterans by the VA.
My office has been in touch with the VA. We are trying to
get a better understanding of the depth of this really serious
issue facing female veterans today and the lack of transparency
that we are experiencing is really frustrating me.
We have the suicide rate for male veterans and are getting
hopefully accurate information on that. But we also need to
know what is happening to women and how they are being
affected. I have asked for this information and I have not been
able to get it, so I am going to be pursuing that.
[The information requested during the hearing follows:]
Response to Senator Murray's Request for Data on
Suicide in Women Veterans
highlights
The Department of Veterans Affairs (VA) is fully committed
to preventing suicide among all Veterans. The Secretary and the Under
Secretary for Health have ensured that this is a top priority for the
Veterans Health Administration (VHA).
Accordingly, VHA has established an extensive national
program, including collection and analysis of one of the richest
collections of data available on suicide rates among Veterans in the
context of the best available national and state data.
Specifically, VA utilizes three data sources: 1) Data from
all states collected by the Centers for Disease Control and Prevention
National Death Index; data are available currently through FY 2007; 2)
Data from 16 states with more detail on Veteran status--the Centers for
Disease Control and Prevention National Death Index, National Violent
Death Reporting System, VetPop; 3) Data collected by VA's network of
Suicide Prevention Coordinators on known suicide attempts and deaths
among those using VHA health care services.
Using these data, VA calculates indices of suicide risk
that are also used by all suicide researchers nationally and
internationally--Suicide Rates and Standardized Mortality Ratios. These
are explained in more detail in the following discussion.
VA's health system uses this data not just for research
but focuses keenly on using the data to create and continuously improve
suicide prevention programs that are spelled out in the ``VHA Strategic
Plan for Suicide Prevention FY 2009--2010,'' which was developed in
response to the recommendations of the Secretary's Blue Ribbon Panel on
Suicide Prevention to ``prepare a single document that details the
comprehensive suicide prevention strategic plan . . . in order to
facilitate more efficient review of suicide prevention progress.'' Data
demonstrate initial success in VA's efforts to prevent suicide,
although more work needs to be done.
Suicide rates among women are far lower than among men.
Although data show no evidence of a rise in suicide rates women
Veterans who use VHA services, VA is exerting every effort to intervene
before problems worsen. Since suicide among women (including Veterans)
is a rare event, shifts in annual suicide rates (Rate/100,000/Year)
reflect only small numbers of incidents.
discussion
We received two requests with regard to data on suicide in women
Veterans. The first two responses address each of these requests. In
addition, we want to place these data in context: VA is totally
committed to preventing suicide among all Veterans. The VHA Strategic
Plan for Suicide Prevention is a living document of initiatives to be
implemented by October 1, 2010 based on the US National Strategy for
Suicide Prevention and recommendations or requirements from the
National Strategy, the Institute of Medicine (IOM) Report, ``Reducing
Suicide: A National Imperative'', the VHA Comprehensive Mental Health
Strategy Strategic Plan, the Joshua Omvig Veterans Suicide Prevention
Act, and the report of the Secretary's Blue Ribbon Work Group on
Suicide Prevention.
Although the data presented show no evidence of a rise in suicide
rates for women Veterans who use Veterans Health Administration
services, the time to begin prevention efforts is now, not after
waiting until rates could rise at some future time. VA has an extensive
program of suicide prevention efforts, guided by a VA Strategic Plan
for Suicide Prevention. Those efforts will be discussed further after
providing the information that directly addresses Senator Murray's
requests:
Request 1. The first request was for overall data on suicide rates
among women Veterans. The following table shows information through FY
2007, which is the most recent year for which data have been released
by the Centers for Disease Control (CDC).
Response. To track suicide mortality over time, we use suicide
rates--rather than the absolute number of suicide deaths per year--
because they account for differences in the size of the at-risk
population; for example, 10 deaths in a group of 100 would have much
different meaning than 10 deaths in a group of 100,000. This approach
is the standard for work nationally and internationally that explores
suicidality; VA uses this approach because it is the standard and
because it does provide a clearer picture of how much risk there is of
suicide in a designated population. The suicide rate is the number of
suicide deaths per 100,000. It is calculated as (# of suicide deaths/
total time at risk of having an observed suicide)*100,000. Total risk
time is not necessarily the number of individuals who received VHA
services, as some patients may have died from other causes in the year
or may not have had their first VHA use until halfway through the year.
Table 1 below presents suicide rates for women Veterans who have
used VHA health care, and breaks down the data by age group, after
showing the overall rate for each year from FY 2001 to FY 2007, the
most recent year for which data are available from the Centers for
Disease Control, the national governmental site that collects
information on deaths and causes of death. Overall suicide rates among
women receiving VHA health services ranged from 9.8/100,000 in FY 2003
to 13.7/100,000 in FY 2005. The rate observed in the most recent year
for which data are available (FY 2007) was that same as in the initial
year (FY 2001), being 10.6/100,000. It is also important to note that
these rates of suicide are dramatically lower than rates for male
Veterans, as is true for the US population as a whole.
Table 1._Suicide Rates Among VHA Health Care Utilizers: FY
2001-2007
Rate/100,000/Year
The Standardized Mortality Ratio (SMR), also shown in Table 1, is
another standard tool used in epidemiologic analyses for comparing
mortality rates among populations, in terms of their relationship to a
standard population. VA also uses this index because it is commonly
accepted as the best analysis to consider differential risk of death by
suicide across different populations. The SMR is related to two rates:
that of the population of interest and that of individuals with similar
characteristics (here, sex and age) in the standard population (here,
the general US population). SMRs are calculated as follows. We assess
the number of suicide deaths observed among women Veterans (overall and
by age group) relative to the number of suicide deaths that would be
expected in this group if their rates of suicide mortality were
identical to those among women in the general US population. The ratio
of the number of observed to the number of expected suicide deaths is
the SMR.
In these analyses, we present SMRs among women receiving VHA health
services, from fiscal years 2001-2006, both overall and for specific
age categories. CDC does not yet have FY 2007 data available for the US
population, and so Standardized Mortality Ratios are not calculated for
FY 2007. The SMRs can be interpreted as follows: for FY 2001, among
women Veterans receiving care in the VHA, suicide risks were 90%
greater than for women in the general population. For FY 2006, among
women Veterans receiving care in the VHA, suicide risks were 73%
greater than for women in the general population.
We note that suicide is a rare event compared to other causes of
mortality and that there may be substantial instability in calculated
rates over time without extremely large denominators. Small differences
in the number of suicides may result in large differences in the
calculated rate per 100,000 person years of risk time. We note that, as
compared to analyses specific to men receiving VHA services, rates
among women patients have greater variability across years, although
they are always markedly lower than male rates. For this reason,
calculated SMRs may vary substantially over time, particularly where
the population for that age group is smaller in size.
Request 2. The second request asked that data from the National
Violent Death Reporting System (NVDRS) be broken out for women Veterans
alone, such that suicide rates for women Veterans who are users vs.
non-users of Veterans Health Administration health care can be
compared.
Response. Comparable data for all Veterans, without gender broken
out, have recently been reported by VA. The following information
addresses this second request.
Table 2._Estimated Suicide Rates per 100,000 among Female VHA
Users and VHA Non-Users in the National Violent Death Reporting
System (NVDRS) States,* 2004-2007
----------------------------------------------------------------------------------------------------------------
Suicide Rates
-------------------------------
2004 2005 2006 2007
----------------------------------------------------------------------------------------------------------------
VHA Users....................................................................... 11.30 11.57 8.12 13.96
VHA Non-Users................................................................... 10.63 10.90 9.85 11.61
----------------------------------------------------------------------------------------------------------------
Data sources: VHA National Patient Care Data base, Centers for Disease Control and Prevention National Death
Index, National Violent Death Reporting System, VetPop 2008
* For 2005-2007, data were available for 16 NVDRS states. These included Alaska, Colorado, Georgia, Kentucky,
Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South
Carolina, Utah, Virginia, and Wisconsin. However, for 2004, data were available for only 13 states (the above
states, excluding Kentucky, New Mexico, and Utah.)
Table 2 presents suicide rates. In 2004 through 2007, in data
reported by the 16 NVDRS states, suicide rates among female VHA
patients ranged from 8.12 (in 2006) to 13.96 per 100,000 (in 2007).
Among women Veterans who did not receive VHA services, estimated rates
ranged from 9.85 (in 2006) to 11.61 per 100,000 (in 2007). In three of
the four years, suicide rates among female VA patients were somewhat
higher than among women Veterans who did not receive VHA services,
though in all years, rates were fairly close. It should be noted that
female Veterans who use VHA care have higher rates of mental and
physical illness, which can be risk factors for suicide, than women
Veterans who do not use VHA care.
The reader is again cautioned that these rates are based on small
numbers of rare events. Although there is a fair degree of variability
in the reported rates from one year to the next, this is based on a
small sample with a very low number of suicides (e.g., 9 deaths by
suicide of women Veterans who used VHA services in 2006). Second the
rates reported in this second table reflect only those states included
in the NVDRS reporting database, so the rates for the VHA Users are
slightly different from those reports in Table 1A, which includes data
from all 50 states.
Request 3. VHA Suicide Prevention Program and Strategic Plan
Highlights
Response. Every Veteran suicide is a tragic outcome and, regardless
of the numbers or rates, one Veteran suicide is too many. We feel the
responsibility to continue to spread the word throughout VA that
``Suicide Prevention is Everyone's Business''. Even though we
understand why some may be at increased risk, we are continuing to
investigate and are proactively taking action based on what we already
know, with the goal of eliminating suicides among Veterans. VA has a
national Strategic Plan for Suicide Prevention. This lays out the
philosophical framework for our prevention efforts and also defines
specific programs and actions that have potential to reduce the risk of
death suicide among Veterans.
The VHA Strategic Plan for Suicide Prevention FY 2009--2010 was
developed in response to the recommendations of the Secretary's Blue
Ribbon Panel on Suicide Prevention to ``prepare a single document that
details the comprehensive suicide prevention strategic plan . . . in
order to facilitate more efficient review of suicide prevention
progress.'' The VHA Strategic Plan for Suicide Prevention is a living
document of initiatives to be implemented by October 1, 2010 based on
the US National Strategy for Suicide Prevention and recommendations or
requirements from the National Strategy, the Institute of Medicine
(IOM) Report, ``Reducing Suicide: A National Imperative'', the VHA
Comprehensive Mental Health Strategy Strategic Plan, the Joshua Omvig
Veterans Suicide Prevention Act, and the report of the Secretary's Blue
Ribbon Work Group on Suicide Prevention. The Strategic Plan includes 67
elements. Of these, 33 have been implemented, 27 are in the process of
being implemented, and 7 are new elements being developed.
Current Initiatives
The VA's basic strategy for suicide prevention can be
conceptualized as a pyramid. At the base is early prevention of any
Veteran with a mental health disorder from becoming so distressed that
suicide is considered as an option. This requires ready access to high
quality mental health (and other health care) services made available
to anyone with a need. Ideally needs will be identified at the earliest
possible time and treatment will be provided at that early point. At
the next level of intervention, those with identifiably higher risk of
suicide need additional intensity of services, for example through
programs designed to help individuals and families engage in care and
to address suicide prevention in those higher risk patients. Finally,
those who are at imminent risk of suicide need urgent care available
immediately, care that can rescue the Veteran from a suicidal crisis
and get them into intensive services addressing their specific needs.
Some of the initiatives that have proven to be very effective in our
efforts include:
Enhancement of overall VA mental health services:
Over the last five years, and with renewed commitment by
the current Administration, VA has implemented a comprehensive Mental
Health Strategic Plan and is now actively implementing the VHA Handbook
Uniform Mental Health Services In VA medical centers And Clinics.
As part of these transformative efforts, VA has added
almost 6,000 mental health providers, for a total of just over 20,000
providers as of March, 2009.
Also as part of these efforts, access to care has met a
standard unmatched in the rest of US health care; those who are newly
seeking mental health care are seen for full evaluation and the start
of treatment implementation within 15 days of referral, at a level of
96% across the VA system.
VA has integrated mental health services into its primary
care system, so that mental health providers are part of the primary
care team and mental health care can very often be delivered in that
octet, where patients have been shown to be most likely to bring mental
health concerns. Referral to mental health specialty care is still
fully available when that level of care is identified as the
appropriate setting of care.
Screening and assessment processes have been set up in
primary care to assist in the early identification of patients with
mental health problems. When patients screen positive, further
evaluation can occur immediately in the primary care setting. If a
patient screens positive for depression or PTSD, a full evaluation of
possible suicidal risk also is mandated and provided.
To help staff understand how excellent mental health
services are also good suicide prevention strategies, VA has taken
numerous educational efforts:
- Sponsored three Suicide Prevention Days to increase
awareness of the problem and co-sponsored 2 conferences on
suicide prevention with the Department of Defense for
clinicians in both systems.
- Sponsors public service announcements, web sites and
display ads designed to inform Veterans and their family
members of the VA Suicide Prevention Hotline (1-800-273-TALK/
8255).
- Distributes brochures, wallet cards, bumper magnets, key
chains and stress balls to Veterans, their families and VA
employees to promote awareness of the Hotline number and
educate its employees, the community and Veterans about how to
identify and help those who may be at risk.
- VHA Suicide Prevention Coordinators are required to do
outreach activities in all of their local communities and are
able to provide a Community version of Operation S.A.V.E. to
returning Veterans and family groups, Veterans Service
Organizations or other community groups as desired.
- Family psycho-educational materials have been developed
including information sheets intended to serve as guides for
adults to use when taking with children about a suicide attempt
in the family and family ACE (Ask, Care, Escort) card.
Services for Veterans Identified as at Increased Risk for Suicide:
Employee education programs such as Operation S.A.V.E. (a
VA specific suicide awareness program) and a web-based clinical
training module have been mandated for VA employees. S.A.V.E. refers
to: know the Signs of Suicidal thinking, Ask the questions, Verify the
experience with the Veteran, and Expedite or Escort to help. This is
designed to increase awareness among all staff who may come in contact
with Veterans--not just mental health service providers--of factors
indicating possible suicidal risk. As the S.A.V.E. acronym lays out,
the training also guides staffing actions to take when a Veteran is
identified as potential suicidal.
Each VA Medical Center has a suicide prevention
coordinator or team. The coordinators and their teams ensure that the
Veteran receives the appropriate services. Calls from VA's Suicide
Prevention Hotline (discussed in detail below) are referred to the
coordinators, who follow up with Veterans and coordinate care.
Patients who have been identified as being at high risk
receive an enhanced level of care, including missed appointment follow-
ups, safety planning, weekly follow-up visits, and care plans that
directly address their suicidality. A chart ``flagging'' system for
those at risk has been developed to assure continuity of care and
provide awareness among care-givers.
Reporting and tracking systems have been established in
order to learn more about Veterans who may be at risk and help
determine areas of concentration for intervention. Continual analysis
of reports and VA data has led to 3 recent information letters to the
field:
- Each of the mental health conditions increases the risk of
suicide, but the effect of PTSD may be related separately from
it's co-occurrence with other conditions
- Chart diagnoses associated with Traumatic Brain Injury are
associated with increased risks of suicide, even after
controlling for co-occurring mental health conditions
- Some, but not all, chart diagnoses associated with chronic
pain are associated with increased risks of suicide, even after
controlling for co-occurring mental health conditions
Services for Veterans in Suicidal Crisis:
A 24/7 Suicide Prevention Hotline. Veterans call the
national suicide prevention hotline number 1-800-273-TALK and then
``push 1'' to reach a trained VA professional who can deal with any
immediate crisis. More than 245,000 callers have called the hotline and
over 144,000 of these callers have identified themselves as Veterans or
family members or friends of Veterans. There have been over 7,000
rescues of actively suicidal Veterans to date.
An on-line Chat Service was initiated in July 2009 and to
date there have been almost 4,000 chatters that have utilized the
Service. Several of them have been referred to the Hotline for
immediate care.
Despite all of the above efforts, VA recognizes that ongoing
research is needed to expand our knowledge and inform our continuous
efforts to improve suicide prevention services. We are proud of what we
do now, but can never be satisfied as long as there are Veterans who
commit suicide; the more we can learn, the more we will be able to do:
The development of two centers devoted to research,
education and clinical practice in the area of suicide prevention. The
VA VISN 2 Center of Excellence in Canandaigua, NY develops and tests
clinical and public health intervention strategies for suicide
prevention. The VA VISN 19 MIRECC in Denver, CO focuses on: 1) clinical
conditions and neurobiological underpinnings that can lead to increased
suicide risk; 2) the implementation of interventions aimed at
decreasing negative outcomes; and 3) training future leaders in the
area of VA suicide prevention.
Suicide prevention research is challenging for many
reasons, however scientists are attacking the problem through
epidemiology studies to identify risk and protective factors;
prevention interventions, and biological research examining
VA researchers are also engaged in efforts to assure
safety plans are in place for participants in research, including
coordination with the VA National Suicide Hotline and standardized
assessments for suicidality
A recent comprehensive review concluded that intensive
education of physicians and restricting access to lethal means had
substantial evidence for preventing suicide.
In order to explore the impact of Safety Planning in VA
emergency department settings, a clinical demonstration program has
been initiated. This project has includes the use of Acute Service
Coordinators who help veterans negotiate the transition from urgent to
sub-acute care.
Other approaches needing further research include:
screening programs, media education, and public education. Structured
cognitive therapy (CBT) approaches for those who are suicidal, or
suicide attempters, and education of what are often called community
``gatekeepers'', and means restriction initiatives (e.g., gun locks,
blister packaging medications) show promise.
Finally, VA seeks to be a leader in contributing to a public health
approach to suicide prevention in America.
VA's Hotline Call Center gets more than 20% of all calls
to the National Lifeline and provides the only national suicide chat
service.
VA's Media Campaign has provided access to the National
Suicide Crisis Line number to innumerable Americans.
Suicide Prevention Coordinator Outreach work has touched
innumerable community members and VA employees and employee families.
Chairman Akaka. Thank you very much. We will pursue that
with you.
Senator Tester.
Senator Tester. Thank you, Mr. Chairman.
Secretary Jefferson, I appreciate what you said about
making sure that veterans at risk of homelessness have access
to the offices of DVOP and the local veterans' reps. I want to
give you an example of how hard it is in a place like Montana.
We have six DVOP and LVR staff in Montana to serve a State
with 147,000 miles. That means less than one full-time staffer
for each of the eight biggest cities, and there is a whole lot
more to Montana than just the eight biggest cities where
veterans reside. And no full-time staff for any of the seven
Indian reservations in the State.
Would you want to address that issue from your perspective
and its adequacy?
Mr. Jefferson. Yes, sir. After the November 18 hearing, one
of the things we talked about was getting out into rural
America to learn more about the issues firsthand. We reached
out to your office and to Senator Begich to go ahead and set
that up. We had a trip to Alaska, which was very informative.
Sir, at the last hearing I talked about a concept that we
had to provide boots on the ground in rural America and to
provide better services. Although we are not ready to announce
anything publicly, we have made some significant progress on a
way to get more capacity to actually provide greater services
to rural America--a rural outreach initiative.
So, in the next few months I am optimistic that we will be
able to share something more about that. We have identified the
gap and are working to finalize a demonstration project to deal
exactly with the issues that you have raised, sir.
Senator Tester. So you would agree that there are now gaps
and we are not serving to the level even close to what needs to
be served in rural America?
Mr. Jefferson. Sir, I feel that there is a significant gap
between the services which are needed to provide coverage to
rural America and what we have now.
Senator Tester. We look forward to the proposals in the
next few months.
You know, when we talk about homeless vets, I had a hearing
in Montana with Secretary Peake a couple of years ago, and we
had a veteran come to the hearing who said he just came out of
the woods. He had been there for 20 years.
After further questioning, we found out that he literally
just came out of the woods after being there for 20 years.
We have a lot of folks out there in rural America living in
abandoned farm buildings, in the woods. The question is--Mr.
Dougherty, you have said you have standouts; you have the DVOP
folks and the LVR folks.
How do you find them? I mean there are a lot of homeless
folks who are not veterans. How do you find them? How do you
get to the folks who need help?
Mr. Jefferson. Sir, one element of this demonstration
project that we are working on is engaging with individuals,
groups and communities in that local area who would know where
the veterans are, what parts of the town, what parts of the
environment where folks aggregate even if they are individuals.
So that is an element.
This demonstration project is to actually get into the
heart of rural America to access those veterans.
Senator Tester. That is exactly right. That question
reverts back to your other answer. I mean I think we have got a
big issue. Rural America has a high percentage of folks who
sign up for the military. A lot of those folks go right back to
rural America when they get done with the military.
The same thing with Indian reservations. A high percentage
of those folks sign up, and they go back. Many of them were in
leadership positions. There has got to be some way for all
three of the folks here to address the issue that is not being
addressed. I really do look forward to the pilot project.
I want to talk a little bit about the numbers that were put
forth. 135,000, and then if my memory serves me correctly, one
of you three had written and said that the number of homeless
is going down.
Is that correct?
Mr. Dougherty. Correct.
Senator Tester. By how much?
Mr. Dougherty. Our estimate for last year was 107,000 on
any given night. The year before the estimate was a 131,000.
Senator Tester. Do you anticipate that number continuing at
that rate?
Mr. Dougherty. Yes, sir. It will have to.
Senator Tester. Mr. Johnston, you talked about the numbers
from communities and counties. Who gives you the numbers?
Mr. Johnston. We have an approach called continuum of care
where all of the stakeholders within any community, and for
Montana, it is the entire State working together. It includes
city agencies that relate to homelessness such as health
agencies, employment agencies, housing agencies. It includes
nonprofits, foundations, any organization or person that
touches the issue of homelessness. They get together on a
regular basis to identify where homeless people are and what
their needs are.
Senator Tester. My time has expired but I am just going to
ask one question. Do you feel comfortable that you are getting
the numbers? A lot of these agencies do not do much work in
rural America. We are talking about places where there are far
more cows than there are people.
Do you feel comfortable you are getting the numbers you
need out of those areas?
Mr. Johnston. It is not a science, clearly. I have been
working on this issue for several decades.
Senator Tester. Because a lot of those agencies do not do
much in rural America.
Mr. Johnston. Right. The nonprofits are really the backbone
of HUD's programs. About 90 percent of our funds go to local
nonprofit organizations.
Part of the consolidated program I referred to, there is a
new rural housing stability program we are also launching
because of the frustration that you are citing that in rural
communities they feel like HUD's homeless dollars do not always
get to where they need to go.
So, in 2011 communities will have a choice about using the
consolidated program or a rural housing stability program to
focus on rural America.
Senator Tester. OK. I think the key is finding them and
getting them help.
Thank you all for your testimony.
Thank you, Mr. Chairman.
Chairman Akaka. We will have a second round of questions
here.
Mr. Johnston, in your testimony you stated that the HUD-
VASH program combines HUD housing choice voucher rental
assistance for homeless veterans with case management and
clinical services provided by VA at its medical centers in the
community.
I am building on what Senator Tester said on this. My
question is what happens if there is not a VA medical center in
the veteran community?
Mr. Johnston. To be honest, I think the best answer is
going to come from Pete on this. We allocate the Section 8
vouchers and the VA provides the case management, but it is not
just through the VA medical hospital.
Do you mind if I defer part of that answer to Mr.
Dougherty?
Chairman Akaka. Mr. Dougherty.
Mr. Dougherty. Mr. Chairman, although it is connected to
the VA medical center it is not that it has got to be connected
to a VA hospital. Many of these staff work out of community-
based clinics and other locations. It is to have a person who
is part of the medical care system who is providing the case
management.
So I think what you will find from year one to year two is
the vouchers are getting into a lot of more smaller
communities, and I think what you will find when HUD comes out
with round three is that we are getting into more communities
as well.
It is not just that the vouchers are concentrated in or
near VA medical centers; many of them are far distances away.
Chairman Akaka. Secretary Jefferson, are there any
obstacles to working with homeless veterans once they have been
accepted into the HUD-VASH program? If so, how do you believe
the obstacles can be removed?
Mr. Jefferson. Senator, I think one of the things that we
have learned from the listening sessions with homeless women
veterans is recognizing that the best practices for serving the
women veterans are different from the male veterans, and we
need to incorporate those best practices.
Some specific examples are: counselors who are female,
trained in military sexual trauma, trained in domestic violence
and physical abuse, trained in substance abuse, and are, again,
female; the need to incorporate child care; and also access to
educational opportunities once those children are of age to go
to school.
So, as we look at the services need for the homeless women
veterans, we need to incorporate those best practices into what
the larger veteran service providers are offering.
Chairman Akaka. Mr. Dougherty, your testimony states that
we know from past experience that homelessness among veterans
peaks 7 to 10 years after military service. Can you elaborate
on VA's plans to prevent homelessness of current servicemembers
7 to 10 years from now?
Mr. Dougherty. Yes. Mr. Chairman, that is, in fact,
historically what we have seen. Of course, that is before we
got into the present conflict and before we began working on an
active intervention.
As I remind myself all the time regarding Vietnam veterans,
VA probably saw one in ten in the first few years after the
veteran came for any kind of services on the health care side.
Now we are seeing about 40 percent of veterans who served in
Iraq and Afghanistan.
We are making a deliberate attempt to--as you know because
you have done this--to help us provide medical services and
services for them, and we are actively reaching out to do that.
The collaborative effort that we are working on with the
Department of Housing and Urban Development for those at risk
of recently discharged veterans, we think is going to do a much
better job because our care coordination staff and our Vet
Center staff are going to be, before that veteran becomes
homeless, able to hook that veteran into services that we can
provide and housing and support assistance that HUD will be
able to provide for them.
So, although historically that has been the case, I am
looking for that trend to change radically moving forward.
Chairman Akaka. Secretary Jefferson, how does DOL evaluate
and measure the effectiveness of HVRP grantees and how are the
results used in determining subsequent grants?
Mr. Jefferson. Thank you, Senator. We look at the entered
employment rate as well as the retention rate; and choosing
2009 as an example, we served about 15,500 homeless veterans
and had an entered employment rate of about 67 percent. So
roughly two-thirds of those veterans going through the program
were able to find meaningful careers, meaningful employment.
We also monitor all of our grantees, and when grantees are
not performing at the level of which they could, they are first
put on a performance plan. We try to work with them to get them
back up to a high level of performance. And there is a
monitoring component.
We currently have about a 67 percent success rate of
entered employment for the community we serve.
Chairman Akaka. Do you believe there is any value in using
HVRP grants in conjunction with efforts to prevent homelessness
among veterans or in assisting veterans who just recently are
no longer homeless?
Mr. Jefferson. Yes, Senator. We are collaborating already
with Housing and Urban Development and Department of Veterans
Affairs in working on the initiative to prevent veterans'
homelessness.
One of the ways we will provide that is by making sure
employment representatives are involved with the sites where we
are doing these demonstration projects.
Chairman Akaka. Thank you.
Senator Burr.
Senator Burr. One question, Mr. Chairman and Mr. Dougherty.
What key legislative provisions will need to be enacted to
incorporate the Secretary's 5-year plan?
Mr. Dougherty. Senator, most of the legislative authority
we think we already have. There is one thing that we are
looking to try to do, and that is around sober living housing.
One of the things we have found is that many veterans who
have been homeless have substance abuse problems. Many of them
are returning to gainful employment but they are limited in
their income and their ability to live independently in
communities.
There was some legislative authority back in Public Law
102-54. We think that what we need to do is also try to figure
out how we can get more of that kind of housing out there
because for many of those veterans, sobriety is something that
if maintained, gets them stronger and then gives them the
ability to live independently within their income.
Many of these veterans when they first go back to work have
very limited income, and over time their income level rises.
So, one of the things that we are looking to work with you and
the Committee on is how do we get more of that kind of housing
availability, which has very low start-up cost and does not
have an ongoing cost to VA.
Senator Burr. Thank you, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Burr.
Senator Tester.
Senator Tester. Thank you, Mr. Chairman.
Assistant Secretary Jefferson, in the last round of
questioning, you intimated that there would be in the next few
months a rural outreach program announced. Do you anticipate
that to be before the Fourth of July?
Mr. Jefferson. Sir, I cannot make that commitment. I will
just tell you that we are working very hard to bring the
relevant partners in that together. We are looking at
everything from metrics, operationalizing, and execution. It is
one of my top priorities.
Senator Tester. If it is one of your top priorities, I
anticipate, I mean--I think it is something that is critically
important and would go a step further to say, when you make
that announcement, I would love to have you do it in Montana
where you would have a willing audience.
Mr. Jefferson. Sir, we are always excited to work closely
with your office.
Senator Tester. I want to talk about competitive grants
just for a second. Each of you is responsible for running large
competitive grant programs to service homeless vets. This is
for each one of you: how do you compare grant proposals with
regard to rural States versus urban areas?
Who wants to start? Pete?
Mr. Dougherty. Yes. Senator, what we do is we look at what
the need is. When our transitional housing grants first came
about, it was deliberately designed to give rural communities
an advantage, or at least not to have a disadvantage in
applying.
There is what I like to refer to as an intensity of need.
You are from a very rural State. If you have 20 homeless
veterans in New York City probably no one would care. If you
have 20 homeless veterans in Missoula, people are really
concerned and want us to do something about it.
So we fund many small grants; many of our programs are
small. You do not have to have a 50-bed program in order to get
funding from us.
In rural areas, with our current Notice of Funding
Availability, it allows us, as was mentioned before, to serve
tribal programs. One of the things that we have done is we have
targeted tribal lands, programs on tribal lands to help meet
that need.
So, in that case, you need to have a passing grade, and you
will not be at a competitive disadvantage by having to hire a
high cost grant writer.
Senator Tester. Secretary Jefferson, would you want to
respond to that question?
Mr. Jefferson. Sir, just a few quick thoughts. One is very
candidly, with the resources we had we did not have the ability
to create a grant program that would target just rural
communities, which is how this demonstration program came out;
and through partnerships I believe we are going to have the
capacity to provide services there.
Based upon the awareness we have of the needs in rural
America, which I want to thank you for sharing a lot of those
over the past few months, we will be looking at that when we
make grant decisions for the current grants that we have.
Senator Tester. Mr. Johnston.
Mr. Johnston. In our competitive programs, by law need is
one of the selection factors. We have performance as another
key element. We have found and we have compared this over years
that rural communities do just as well in the competition as
all areas do in the country.
Nonetheless, given the perception and concern that rural
areas are not getting enough, this new rural housing stability
competitive program will provide more resources in rural areas.
Senator Tester. I appreciate your answers. I would also say
that the numbers in rural areas are not there because it is
rural. So when these grants go out--and I have just as much
empathy for the veteran that is living in an urban center as I
do out in the woods in Montana. They both have their issues.
They both have their problems. I just want to make sure that we
do not forget about them.
Mr. Johnston.
Mr. Johnston. Just one quick observation. We have another
program that is not competitive. It is a formula program and it
can be used flexibly for homeless prevention so that in rural
communities where you may not be living on the streets because
it just would not happen there or there is not a shelter, you
can use homeless prevention funds to serve that person.
Senator Tester. Do the folks in rural America know about
it?
Mr. Johnston. They do. The problem in the past was it had
been limited. It had been a very, very small program. Our
request this year significantly increases the size of that
program.
Senator Tester. Thank you, Mr. Chairman.
I want to thank the work each and every one of you do. I
appreciate it.
Chairman Akaka. Thank you very much, Senator Tester.
I want to thank this first panel. I urge that you continue
this discussion on the homeless amongst yourselves and to be in
touch with us as we look into it and discuss the details of the
VA's 5-year plan.
We also want to join together with you to bring this about.
As Senator Burr has mentioned, we are looking at outcomes and
that is very, very important to all of us.
So thank you. This has been a valuable hearing for us.
Thank you for your contributions.
Now I would like to welcome the witnesses on our second
panel.
Arnold Shipman, U.S. Air Force Veteran. Dennis H. Parnell,
President/CEO, The Healing Place of Wake County. Sandra A.
Miller, Program Director, Homeless Veteran Residential
Services, Philadelphia Veterans Multi-Service & Education
Center. Patrick Ryan, Vice Chair, Board of Directors, National
Coalition for Homeless Veterans. Sam Tsemberis, Ph.D., Founder
and CEO, Pathways to Housing, Inc.
Mr. Shipman, would you please begin with your testimony.
STATEMENT OF ARNOLD SHIPMAN, U.S. AIR FORCE VETERAN
Mr. Shipman. Good morning, Senator Akaka, Ranking Member
Burr.
My name is Arnold Shipman and I am a 49 year-old Air Force
veteran and homeless from Baltimore, MD. I joined the Air Force
in June 1978 right after high school. My specific job
assignment in the Air Force was as a Security Police Customs
Inspector. I went from Eglin Air Force Base in Florida to
Okinawa, Japan and finally to Dover Air Force Base in Delaware.
It was at Dover Air Force Base where the realities of life
took a heavy toll on a then twenty-one year old young man. Part
of my job was inspecting the body bags of women, children and
babies who died under the hand of Reverend Jim Jones in
Jonestown. There were women, children and babies who died in
this horrible and tragic chapter of our history. Their lives
had not even begun. This had a powerful and profound effect
upon me.
After my military career was over, I returned to my home in
Baltimore. Thus began a series of menial jobs while waiting to
pursue a career as a diesel mechanic. It was during this time
that my life began to seriously spiral out of control.
Cocaine was becoming very popular. Several of my friends
were selling cocaine. Because there was nothing else happening
for me, I began to sell this. The money was rolling in and I
thought this could make me forget my experiences at Dover AFB.
I thought this could make me happy. It was a momentary respite.
Outwardly, I portrayed someone who was happy, someone who
had his life together and was functioning as a normal person.
Inwardly, I was a mess. Nothing fulfilled me no matter what I
did.
It was at this point that I began to use drugs. Not the
cocaine I had been selling, but heroin. This is a more deadly
drug and its most devastating effects soon became very apparent
to me.
Now began the endless incarcerations and the increased drug
use. It seemed each time someone close to me died, my mother,
my father, my two sisters and my brother; it only whetted my
appetite for more drugs. As I reflect upon that period in my
life, any excuse would have done. It was as if I was on a
runaway train taking me to the darkest places of life.
It was during this time in a damp jail cell, alone, at
night, by myself I remembered a place I had heard of earlier. A
place called MCVET-Maryland Center for Veteran's Education and
Training. A place where help could be had if one wanted it.
I thought about how life had not gone very well for me so
far and anything might be better than what I had been used to.
Thinking I had nothing to lose and maybe everything to gain, I
decided to enter the program and was accepted.
That was one of the best decisions I have ever made in my
life. The structure which was sorely missing immediately was
found. The support I needed I accepted. The guidance I sought
was provided.
Since being in the program, I have begun to clean up the
wreckage of my past, piece by piece and inch by inch. I am also
working on my degree in radiology. I am also a part of the
``Back On My Feet'' running program and recently completed my
first marathon in October 2009 which was 26.2 miles. I am in
training for the annual 5k/10k race in May and was featured in
the national magazine which focused on my training for the
marathon and the recovery that I am going through. And now I
have the opportunity of a lifetime to address a U.S. Senate
committee. I could not have imagined the changes my life would
take.
I feel truly blessed. None of these accomplishments would
have been possible for me without the MCVET program. They have
provided me structure along with a positive support system
which has allowed me to excel. They have helped me to address
the issues which fed my addiction which I am overcoming. They
have inspired me to be the best.
So, I thank the Committee. Thank you, Chairman Akaka. Thank
you Ranking Member Burr.
In conclusion, I would also like to thank Colonel Charles
Williams and the staff at MCVET. The opportunities they
provided for me and other homeless veterans and other veterans
in need have been unsurpassed. Thank you.
[The prepared statement of Mr. Shipman follows:]
Prepared Statement of Arnold Shipman, Air Force Veteran
My name is Arnold Shipman and I am a 49 year-old African-American
male, Air Force veteran and homeless. I live in Baltimore, Maryland.
I joined the Air Force in June 1978 immediately after completing
high school. My specific job assignment was as a Security Police
Custom's Inspector. I went from Eglin Air Force Base in Florida to
Okinawa, Japan and finally to Dover Air Force Base in Delaware.
It was at Dover Air Force Base where the realities of life took a
heavy toll on a then, twenty-one year old young man. Part of my job was
inspecting the body bags of those who the Rev. Jim Jones murdered in
Jonestown. There were women, children and babies who died in this
horrible and tragic chapter of our history. Their lives had not even
begun. This had a profound affect upon me.
After my military career was over, I returned to my home in
Baltimore, MD. Thus began a series of menial jobs while waiting to
pursue a career as a diesel mechanic. It was during this time that my
life began to seriously spiral out of control.
Cocaine was becoming very popular. Several of my friends were
selling cocaine. Because there was nothing else happening for me, I
began selling cocaine. The money was rolling in and I thought this
could make me forget my experiences at Dover AFB. I thought this could
make me happy. It was a momentary respite.
Outwardly, I portrayed someone who was happy, someone who had his
life together and was functioning as a normal person. Inwardly, I was a
mess. Nothing fulfilled me no matter what I did.
It was at this point that I began to use drugs. Not the cocaine I
had been selling, but heroin. This is a more deadly drug and it's most
devastating effects soon became very apparent to me.
Now began the endless incarcerations and the increased drug use. It
seems each time someone close to me died, my mother, my father, my two
sisters and my brother, it only whetted my appetite for more drugs. As
I reflect upon that period in my life, any excuse would have done. It
was as if I was on a runaway train taking me to the darkest places of
life.
It was during this time in a damp jail cell, alone, at night, by my
self I remembered a place I had heard of earlier. A place called MCVET-
Maryland Center for Veteran's Education and Training. A place where
help could be had if one wanted it.
I thought about how life had not gone very well for me so far and
anything might be better than what I was doing. Thinking I had nothing
to lose and maybe, everything to gain, I decided to enter the program
there and was accepted.
That was one of the best decisions I have ever made in my life. The
structure which was sorely missing immediately was found. The support I
needed I accepted. The guidance I sought was provided.
Since being in the program, I have begun to clean up the wreckage
of my past, piece by piece and inch by inch. I am working on my
Associate Degree in Radiology. I am also a part of the ``Back On My
Feet'' running team and recently completed my first marathon which was
26.2 miles. I am in training for the annual 5k/10k MCVET race in May.
In December 2009, I was featured in the national magazine ``Urbanite'',
which focused on my training for the marathon. And now I have the
opportunity of a lifetime, to address a U.S. Senate Committee. I could
not have imagined the changes my life would take.
I feel truly blessed. None of these accomplishments would have been
possible for me without the MCVET program. They have provided me
structure along with a positive support system which has allowed me to
excel. They have helped me to address the issues which fed my addiction
which I am overcoming. They have inspired me to be the best.
Many thanks go to Col. Williams and the staff at MCVET. The
opportunities they provided for me, homeless veterans and other
veterans in need has been unsurpassed.
______
Response to Post-Hearing Questions Submitted by Hon. Daniel K. Akaka to
Arnold Shipman, U.S. Air Force Veteran
Question 1. Other than the briefing you received from MCVET while
you were incarcerated, do you remember any other outreach efforts
regarding programs and benefits for veterans after you left the
military?
Response. There were detox clinics at the VA hospitals in
Philadelphia and Baltimore. Their primary purpose was removing drugs
from your system. The programs lasted for approximately five (5) which
included two (2) counseling sessions.
There was also a twenty-eight (28) day civilian program. It did not
provide any structure or attempt to address the problems which led to
my addiction. No counseling was provided.
From my experience, addicts just do not want to open up and talk
about what's really troubling them in front of other people. As a
result, they become frustrated and return to a life of active
addiction.
I feel that structure is the key, just like what we received while
we were in basic training. This is why I am so adamant about the MCVET
program. The structure that I had lost was found at MCVET's. It has
enabled me to remain clean and sober longer than I ever have, including
my incarcerations. Because I used while I was locked up.
Question 2. How do you think you situation might have been
different if you were placed in an apartment first, with no requirement
for you to be clean and sober?
Response. My situation might be different given the fact that if I
was not required to be clean and sober, I might be dead. It seems like
without that requirement, it would be a haven for me and other addicts
to use drugs. I was not homeless when I started using drugs. I became
homeless because I was using drugs. Using drugs caused my life to
become unmanageable. I was no longer a productive member of society. No
program, apartment, room, car or anything else would have worked if
there was no requirement for staying clean. As the literature in
Narcotics Anonymous states, ``staying clean must come first.''
Question 3. Based on your experiences, do you believe there are any
simple changes that can be done immediately to improve the services and
programs available to assist our homeless veteran population and what
are they?
Response. I think more money should be allocated to assist homeless
veteran and other veterans in need. This would have an immediate effect
and could be life saving.
Chairman Akaka. Thank you very much, Mr. Shipman.
Ms. Miller.
STATEMENT OF SANDRA A. MILLER, PROGRAM DIRECTOR, HOMELESS
VETERAN RESIDENTIAL SERVICES, PHILADELPHIA VETERANS MULTI-
SERVICE & EDUCATION CENTER
Ms. Miller. Good morning, Mr. Chairman, Ranking Member
Burr. I am Sandy Miller, and I am the Program Director of
Residential Services for The Philadelphia Veterans Multi-
Service & Education Center. On behalf of our Executive
Director, Marsha Four, our Board of Directors and our entire
staff, I would like to thank you for the opportunity to provide
comment here today.
Our executive director and I were present at the summit
when Secretary Shinseki unveiled the VA's Five-Year Plan to End
Homelessness. We respect the attention and energy that both he
and President Obama have committed to this cause.
We at our agency, however, do have some serious concerns,
and it may be cynical on our part, but we see a very real
obstacle. Remember, we were here 10 years ago when the 10-year
plan was introduced and we are still today.
The obstacle I mentioned is a large bureaucracy of the
Department of Veterans Affairs. On one hand we have the Central
Office, the VISNs, and the medical centers; on the other hand
we have directors, managers, supervisors, a myriad of chiefs,
program staff, triads, quadrads, and on and on.
If every person at the Department of Veterans Affairs at
every level is not held accountable to these tasks, we will
never accomplish it. There must be program measures in place at
every level from the lowest person working in the kitchen of
the VA medical center all the way up to the highest-ranking
members at central office. Every level of the VA must be held
accountable.
Resources must find their way to those of us who are in the
trenches, boots on the ground. Receiving our first VA homeless
grant per diem awards in 1996, we established the foundation
for our comprehensive homeless veteran programs.
These programs include The Perimeter, a day service center;
LZ2, a 95-bed transitional facility for male veterans; the Mary
E. Walker House, a 30-bed facility for female veterans; in
addition to HUD and DOL grants which have resulted in 40
housing units under HUD and a number of HVRP grants.
We are here to restate our concerns so they are not lost in
the shuffle.
Day service centers reach deep into homeless veteran
population still on the streets and in the shelters of our
cities and towns. They are the portal from the streets and
shelters to substance abuse treatment, job training and
placement, VA benefits, VA mental and medical health, placement
in jobs and transitional facilities. These day drop-in centers
are the first step to ending veteran homelessness.
At the multi-service center for our day service center we
receive--are you ready for this?--$4.30 per hour to provide
services for these homeless veterans and that is only for the
period of time that that veteran is physically on site.
The services and assistance that we have to provide to
these veterans go on long after that veteran leaves us. It is
for this reason alone that many service centers have either
closed or never opened after receiving their funding through
grant and per diem.
We would like to suggest the creation of service center
staffing and operational grants much like those special needs
grants at the VA. Senators, we have been holding onto this
mission for far too long by our fingertips. We need help.
Nonprofits have long struggled with the process used to
justify the receipt of per diem payments through the VA.
Although the amount of per diem has increased over the years,
the documentation requirements have created a significant
burden on these small nonprofits.
We argue that without the upkeep and solvency of the parent
agency, the per diem programs could not function because they
are inexplicably part of the parent agency.
Grantees are paid based on past accounted and audited
expenses, not on anticipated expenses for the operating year in
which the per diem will be paid. We suggest that the VA
consider payment in much the same way, for example, that HUD
does, whereas funds are allocated and drawn down throughout the
year with a reconciliation done at the end of the year.
We cannot enhance services or hire additional staff if we
are unable to access the dollars of the increased per diem to
pay for them. The current process leaves the agency in a
situation where we do not have the money to do any advanced or
real-time enhancements to our programs.
In the past some very successful programs identified a need
for increased bed capacity. These existing programs requested
additional beds under the per diem only grant process and were
able to increase their bed capacity.
The original grant and the PDO were issued under separate
times so therefore they have separate project numbers. These
two project numbers are attached to the same program with the
same expenses, utilizing the same staff. The only difference is
the increase in bed capacity.
We believe that these programs must be treated as one and
the two project numbers merged.
As with any change, we understand oversight is key. With
the requirement for intensive annual inspections by the VA on
all grant and per diem programs, we do not see any diminished
ability if the VA was to provide this oversight and we feel
that oversight of these programs should have no effect on how
we are funded.
HUD-VASH and MHICM. HUD-VASH truly is a perfect marriage.
We at the local level have seen one very large gap and that is
that some of our veterans are not able to access VASH. They are
too sick for one program yet not sick enough for another.
With not being eligible for the MHICM program, the Mental
Health Intensive Case Management--again this is something we
are seeing locally--these veterans who are not qualified for
one or too sick for one and not sick enough for the other will
slip through the cracks.
We believe that a coordination of MHICM and HUD-VASH for
these special veterans could benefit them in providing them
with a fighting chance at obtaining independent housing and
happiness too.
In closing, can we end veterans living on the streets or in
boxes, cars, shelters, vacant buildings? We do not know the
answer but we know that we are going to keep on trying to do
our best to be part of any solution. Eventually this does make
a difference. It certainly does to the veteran who finds her
way home.
Thank you.
[The prepared statement of Ms. Miller follows:]
Prepared Statement of Sandra A. Miller, Program Director, Homeless
Veteran Residential Services, The Philadelphia Veterans Multi-Service &
Education Center, Inc.
Good morning Mr. Chairman, Ranking Member Burr, and Distinguished
Members of this Committee. As introduced, I am Sandy Miller, and
although I am Chair of the Homeless Veterans Committee of Vietnam
Veterans of America, I am here today as the Program Director of
Residential Services for The Philadelphia Veterans Multi-Service &
Education Center. On behalf of our Executive Director, Marsha Four, our
Board of Directors and our entire staff, I would like to thank you for
giving our agency the opportunity to offer comments on the VA Plan to
End Homelessness in Five Years.
After all these years of effort, energy, and attention to this
issue on the part of Congress, the VA, veteran advocates, veteran
service organizations, and non-profit organizations the disturbing
situation of life for homeless veterans endures. Can we bring an end to
veterans living on the streets or in boxes, cars, shelters, vacant
buildings? None of us can answer that question but we can try. There
will always be those who choose this way of life . . . there always
have been . . . from the beginning of time. We can, however, offer and
assist those who seek a different way of existing in the short time we
have all been granted, but they can't make it on their own. They just
can't make it out of the darkness alone. And we can continue to try to
find an effective and efficient way to help those who are helping these
veterans.
The Philadelphia Veterans Multi-Service & Education Center is one
of the non-profit organizations that has been working toward this end
for over thirty years. We received our first two of many VA Homeless
Grant and Per Diem (HGPD) awards in 1996. Though always providing for
the homeless veterans who found their way to our agency, in 1996, we
established the foundation of our comprehensive homeless veteran
programs that also made use of HUD and DOL grants. Today these programs
include: The Perimeter, a day long comprehensive, day service program;
LZ II, a ninety-five (95) bed transitional residential program for male
veterans; The Mary E. Walker House, a thirty (30) bed transitional
residential program for female veterans; a thirty (30) unit Veteran
only Shelter Plus Care Program; a ten (10) unit Veteran only HUD
McKinney Supported Housing Program; ARRA 2009 funding from the city of
Philadelphia for Rapid Re-Housing for veterans; and a number of DOL
grant to include Homeless Veteran Reintegration Program grants (HVRP).
While our comments today may well be seen as a rehash of previously
mentioned concerns, we are here to re-state them so they are not lost
in the current massive movement to bring additional services and help
to homeless veterans. PVMSEC has worked in this field and inside the
grant programs of VA, HUD and Labor for so long, that we have
identified over time the gaps, shortfalls, and enhancements that can
only be known by those who utilize the system on the ground.
There are a number of Congressional bills to assist homeless
veterans, improve or enhance programs for them, or initiate new
opportunities in both this Committee and the House Veterans' Affairs
Committee. We are all anxious for these to move as quickly as possible,
but we also understanding, however, the need to allow enough input to
make the provisions of each as comprehensive and responsive to the need
as possible. And so we are here.
numbers
With the increasing number of new veterans joining the ranks of the
homeless veterans, it is puzzling that two years ago the VA estimated
that 154,000 were homeless, last fall the number was 131,000, and most
recently it was stated that the number has dropped to 107,000 homeless
veterans on any given night. Those of us working in this arena are a
bit confused because we have not seen a decrease in the number of
homeless veterans we are seeing and assisting in our programs.
day service centers: the door to the inside
One of the most effective front line outreach operations funded by
VA HGPD is the Day Service Center, sometimes referred to as a Drop-In-
Center. As mentioned earlier, The Philadelphia Veterans Multi-Service &
Education Center operates a Day Service Center in center city
Philadelphia. We are committed to this program but our agency stretches
itself and its staff almost beyond its limit in order to keep the
program afloat. Few even remain in the HGPD system due to the limited
per diem funding support.
These service centers are unique and indispensable as a resource
for VA contact with homeless veterans. These Service Centers reach deep
into the homeless veteran population that are still on the streets and
in the shelters of our cities and towns. They are the portal from the
streets and shelters to substance abuse treatment, job placement, job
training, VA benefits, VA medical and mental health care and treatment,
homeless domiciliary placement, and transitional housing. They are the
first step to independent living. They can be the first step to ending
homelessness. But this can only happen if they are able to operate in
an effective environment.
Under the VA HGPD program non-profits receive per diem at rates
based on an hourly calculation per diem ($4.30) for the actual time
that the homeless veteran is actually on site in the center. This
amount may cover the cost of the coffee and food that the veterans
receive but it does not come close to paying for the professional staff
that must provide the assistance and comprehensive services that must
be continued on his/her behalf, long after they leave the facility. An
example, our homeless veteran daily case load is fifty-seventy (50-70)
and our annual unique veteran count is approximately 900. As one can
well imagine the needs of these veterans are great and demands an
enormous amount of time, energy, and manpower in order to be effective
and successful. Their problems are complicated by years of abuse on
many levels of life experience.
It is for this reason, the lack of sufficient operational funding,
that many service centers for homeless veterans have either closed or
never opened after being funded by VA HGPD. The VA acknowledges and
understands that this problem exists. This is a tremendous loss to the
outreach efforts so important in connecting the homeless veterans with
the VA.
The reality is that most city and municipality social services do
not have the knowledge or capacity to provide appropriate supportive
services that directly involve the treatment, care, and entitlements of
veterans. It is for this reason that these homeless veteran service
centers are so vital. These service centers desperately need help and
attention. They are an integral part of the outreach and first line
contact with homeless veterans that is, in fact, so essential as part
of the Secretary's 5 Year Plan. Service Center programs are challenging
and staff intensive. But they are one of the raw conduits out of
homelessness in many cases.
We believe that it is possible to create ``Service Center Staffing/
Operational'' grants, much like the VA ``Special Needs'' grants.
Passing the legislation to establish this funding stream/resource
shouldn't take a year to figure out. ``Special Needs'' grants have been
doing it for years. And we can't wait too much longer. We have been
holding on to this mission by our fingernails for a long time. Without
serious and speedy activation of staffing grants the result may well be
the demise of these critically needed services centers.
We cannot lose these valuable front line, ``on the streets'',
service center outreach programs. They are the heartthrob of VA
homeless veteran programs; the first hand offered too many of the
homeless veterans who are on the streets and in the shelter system of
our cities.
a united front: mhicm and hud-vash
HUD-VASH: the vision of a perfect marriage. Like all unions,
however, nothing is perfect and for those who work inside the program,
it is evolving. But The Center would like to bring forward a situation
that identifies a very real gap in services for a group of our homeless
veterans that don't seem to fit anywhere else in the system. These are
the homeless veterans who are diagnosed with significant mental health
problems (i.e. schizophrenia) but do not meet the criteria for
placement in the VA Mental Health Intensive Case Management (MHICM)
program. (MHICM eligibility criteria requires >30 days or >=3 episodes
of psychiatric hospitalization, a diagnosis of schizophrenia or bipolar
disorder, and living within 60 miles of a VA hospital.)
Though HUD-VASH and its case management are a significant
improvement and source of continuous support for many of the homeless
veterans, it is not intensive enough for those homeless veterans with a
level of significant mental health illness. So therein lies the
dilemma. Not ``sick enough'' . . . ``too sick.'' They fit nowhere. They
have not been ruled incompetent. They are left to find apartments in
the community with no case management or organized support. These
homeless veterans are now the forgotten. They are left with little
chance for success and they will continuously recycle into and out of
homelessness for the rest of their lives. The Center believes the VA
could establish a coordination of MICHM and HUD-VASH for this ``special
needs'' population of homeless veteran. They need to have a fighting
chance at independent happiness too.
service support for other veteran programs
There are agencies in this country that bring support, services,
and housing to homeless veterans. They often times do this with little
financial assistance from the outside. There are even some HUD programs
that are developed for homeless veterans (i.e. Shelter Plus Care) that
do not provide operational dollars. We are hoping that some
consideration will be made to provide grant dollars through the HGPD
program to these veteran specific programs. This will enable them to
hire appropriate staff for case management. Without this possible
assistance and resource, the full opportunity of these homeless veteran
programs will be lost.
va per diem programs
Non-profits have long struggled with the process used to justify
the receipt of the per diem payments from VA Homeless Grant and Per
Diem (HGPD) program. Although the amount of the per diem money received
per veteran per day provided has increased over time, the requirement
documentation to meet a 100% cost expense has created a significant
burden on non-profits.
unallowable expenses
The collateral expenses of a HGPD program often can be incurred by
a non-profit agency and even require discretionary dollars to pay for
them. This occurs because of certain restrictions on allowable
expenses. This is especially true if the HGPD program is not located on
the site of the home agency. We argue, though, that without the up keep
and solvency of the parent agency the per diem program could not
function because, in truth, the program is linked inexplicably to the
parent agency. The HGPD program could not exist without the home agency
and therefore some of the expenses of the agency must be directly
allowable as expenses to the program. We believe it should be at the
discretion of the non-profit agency as to how much administrative
expenses are incurred to cover the cost of the program.
``fee for service''
In actuality, HGPD is ``fee for service.'' One difference is that
it is not set up as a contract agreement as utilized in the past by the
VA where agencies were paid as contractors. Today's methodology works
on the approach that grantees are paid based on past accounted and
audited expenses, not anticipated expenses.
Though not a popular resolve some non-profit agencies as asking,
``Why aren't our programs seen as ``fee for service'' operations
instead of a reimbursement?'' This option would, it seems, place the
existing and future grant awardees in a per diem program much like that
of the past programs which were paid as contractors. But this option is
one that is discussed due to the frustration in obtaining the correct
amount of per diem based on actual program expenses.
determination of per diem rates
Currently, the per diem amount that non-profits receive is based on
the previous year expenses as defined in its annual audit. It is not
based on anticipated expenses for the operating year in which the per
diem will be paid. This causes the program to fall short in meeting its
expenses for the agency's operating year. For this reason, we believe
it is a reasonable suggestion that VA consider the distribution of per
diem payments in much the same way that other Federal agencies operate.
One solution to consider would be to set up HGPD disbursements in a
``draw down'' account similar to the system utilized by the U.S.
Department of Housing and Urban Development, whereby agencies submit
their projected budgets, are allocated the funds, and draw down on the
allocated funds throughout the year. At the end of year reconciliations
and adjustments as made.
Payments need to be based on actual anticipated budgetary expenses,
not based on past year expenses. We cannot enhance services or hire
additional necessary staff before we are able to access the dollars of
increased per diem to pay for them. It sets in place a vicious cycle of
need. (The agencies have a set per diem; they need more staff; they
haven't shown it as an expense on the approved per diem they are
receiving, so they can't afford to hire new staff because they don't
have the money to do so.) This process leaves the program and the
agency at a clear disadvantage because they do not have the money to do
any advanced or ``real time'' enhancements to the program. To do so
would place them at high risk and this action could be suicidal for a
small non-profit. It places them at risk with creditors or, the agency
has to reach into its line of credit at the bank. This action could
result in paying in pay interest on the use of its line of credit until
they can be approved for higher per diem. This interest is then an
added expense to the program . . . a cost they cannot recoup.
S. 1547, The Zero Tolerance for Veterans Homelessness Act of 2009,
introduced by Mr. Reed, provides for a much needed and greatly
anticipated study on per diem payments. This study will include all
aspects relating to the methodology used in making per diem payments.
The bill also calls for the development of an improved method for
adequately reimbursing grantees for services provided to homeless
veterans. Non profits across the country anxiously await the results of
this study and long overdue improved ``reimbursement for services''
method of allocating per diem dollars.
As with any change, oversight is the key to the success or failure
of the programs. There is already a process for defined oversight in
regard to annual inspections, services offered, and goals attained in
place. With the requirement for intensive annual inspections by the VA
on all GPD programs, we do not see any potential diminished ability by
the VA in the oversight of the programs. The method by which funds are
paid should have no effect on the VA's ability to provide oversight.
consolidation of va hgpd project numbers
In the past, some very successful VA HGPD residential programs
identified a need for increased bed capacity due to a clear
identification of increased need for program admission. These existing
programs requested additional beds under a VA HGPD ``Per Diem Only''
(PDO) grant process and were awarded the ability to increase the
overall number of program beds.
The original HGPD grant and the PDO grant were awarded at different
times; hence, they have separate and different VA ``project numbers.''
These two project numbers are attached to the same program with the
same expenses and the same staff. The only difference it has brought to
the program is an increase in bed capacity. Here's where it gets
convoluted and tricky.
VA policy states that everything related to the one program must be
divided out by a percentage based on the number of beds attached to the
two project numbers. This includes the request for per diem amounts and
the entire budgeted expenses of the entire program. Every bed in the
one program has been assigned to one of the two project numbers. For
the purpose of billing the VA at the end of each month, each veteran
must be tracked on a daily basis, indicating the bed he/she was
assigned on that particular day. And this must be done because when the
audit was done for the one program to determine the level of per diem
the agency can receive, it was identified that the per diem per day for
the two project numbers was different. Not only is this a very time
consuming process on the reporting side, all expenses for the one
program on the bookkeeping side of the agency have to be calculated by
percentage. This also makes it extremely difficult to request increased
per diem.
We believe that if a single program has two different project
numbers based solely on an approved expansion without change to the
program, that program should be treated as a whole and the two projects
numbers should be merged. This is the only fair way to work with the
non-profit. To do so would allow an agency to function in a more
efficient manner, have access to an appropriate and true per diem
structure, and reduce the paper work for the VA HGPD offices.
the five year plan to end homelessness among veterans
I have spent some time highlighting a number of areas that PVMSEC
feels need attention or change. In actuality we have struggled with
them for years. Because you have asked us here to testify, we are
trusting in your serious consideration of our thoughts. We would
certainly discuss these ideas further if you would like.
Our agency had several staff who were present at the summit when
Secretary Shinseki revealed the VA's Five Year Plan to End
Homelessness. We respect the attention and energy that both he and
President Obama have committed to eliminating homelessness among
veterans.
It is a plan of wide scope. And if it's deliverable it will make a
tremendous impact on the lives of thousands of homeless veterans. The
Secretary had a team of extremely experienced and knowledgeable staff
that worked on the development of this comprehensive document. They
embraced the Secretary's priority of this issue and the immediacy of
the need.
Needless to say, we have serious doubts and concerns if the plan
will meet the expectations of Secretary Shinseki. It may be cynical on
our part but not only do we see a very real obstacle stretching across
the road to this plan . . . we were also around about ten years ago
when there was another edict to end homelessness in ten years. And here
we are today . . . still working on the issue.
The obstacle I mentioned was the large bureaucracy of the VA. On
one hand we have the stratus of the Central Office, the VISNs, and the
medical centers. On the other we have the agency's layer upon layer of
directors, managers, supervisors, chiefs of staff, chiefs of social
work, chief of patient services, chiefs of psychiatry, chiefs of
psychology, program staff, triads, quadrads, and on and on.
If everyone at all these various levels doesn't buy-in to the plan
or doesn't seriously create a place for it in their own priority list
it will just linger until five years have past us by. If the urgency of
this address isn't made tangible, it may lose its kick. Perhaps it
should be on the list of annual performance measures and position
evaluations from top to bottom. We don't know the answer but we know we
are going to try . . . and keep on trying to do our best to be a part
of any solution that will help. Eventually, this does make a
difference. It certainly does to the veteran who finds her way home.
______
Response to Post-Hearing Questions Submitted by Honorable Daniel K.
Akaka to Sandra A. Miller, Program Director, Homeless Residential
Services, Philadelphia Veterans Multi-Service and Education Center
Question 1. If VA used a ``draw down'' method similar to HUD's, as
your testimony suggests, what is the difference between--what your
center receives annually from the grant and per diem programs--and what
your center would be allocated if it submitted a projected budget?
Response. The major difference between what and how we receive
payment from the VA and how we recommend being paid through a ``draw
down'' method is that our monies would be immediately available to us.
Currently, it can take weeks or even months to receive our payments,
which causes us, and we are sure other non-profits, to have to tap into
our ``line of credit'' with our banking institution. The fees
associated with this practice are not able to be charged back as an
expense to the program. In some instances, by not receiving our funding
in a timely manner, we find it difficult to meet payroll or pay other
bills necessary to the overall operation of the program and agency. By
having our funds allocated and available ``up front,'' we will be able
to access the funds necessary to keep the agency operating. It is our
opinion that, if in fact our budget has been reviewed and approved,
then we should be able to access those funds without delay. This would
allow for the hiring of staff to provide enhancements to the program.
With the current method of basing our budget on past year expenses and
not on projected year expenses puts agencies in a very dangerous
position. We are unable to hire new staff to enhance our programs
because we can't include projected expenses, only those expenses
incurred in the previous year.
Question 2. In your testimony you mention that about 10 years ago
there was a plea to end homelessness, yet we are still talking about it
today. What do you believe can be done to overcome the obstacle, which
you refer to as the large bureaucracy of the VA, in order to finally
achieve our goal?
Response. Every level of the VA must be held accountable if the 5
Year Plan is to succeed. It is our suggestion that Performance Measures
be included that would provide qualitative measurable goals. The
success of the 5 Year Plan lies in hands of the local medical centers
and their staff, not in the hands of Central Office. Mandates can be
handed down, directing VA employees on what the plan is, but if the
local medical centers and their directors do not totally buy in to it,
it will not happen. There needs to be accountability, not only from top
to bottom, but bottom to top and every level in between.
Question 3. You stated in your written testimony that you believe
that it is possible to create ``Service Center Staffing/Operational''
grants to cover the staffing costs at the veterans homeless centers.
Have you had discussions with members of VA with regard to implementing
these types of grants, and if so, what has been the outcome of those
conversations?
Response. Our agency has had conversation with Mr. Dougherty at
Central Office regarding the creation of Service Center Staffing/
Operational Grants. In conversation with both Mr. Dougherty and Mr.
Casey, it is our understanding that there needs to legislative action
in order to permit these grants through OMB.
Question 4. Based on your experiences, do you believe there are any
simple changes that can be done immediately to improve the services and
programs available to assist our homeless veteran population and what
are they?
Response. We believe one of the quickest and easiest ``fixes,''
aside from the ``draw down'' method and creating Service Center Grants,
would be to take per diem only projects awarded as expansions of
existing capital grants and grandfather them in with the original
capital grants. This would eliminate the cumbersome and labor intensive
process whereby each PDO associated with a capital grant must be
presented as separate line items in the agency budget. These are the
same programs utilizing the same staff and services, yet all expenses
must be reported out by percentage. An example would be our
transitional residence, which started out with 50 beds, increased its'
bed capacity to 95 beds through per diem only, and then increased it
again to 125 through another per diem only grant. Each resident must be
tracked by bed every day because, depending on where their room is the
per diem received could be either $28.27 or $27.85 or $34.40 per day.
All three has separate Project Numbers, when in fact, they should be
grandfathered into the capital grant and operate under one single
project number.
Chairman Akaka. Thank you very much.
Now we will hear from Dr. Tsemberis.
STATEMENT OF SAM TSEMBERIS, Ph.D., FOUNDER AND CEO, PATHWAYS TO
HOUSING, INC.
Mr. Tsemberis. Thank you very much, Mr. Chairman and
Senator. It is an honor to be here and I hope my testimony is
helpful to informing this conversation.
I am the founder and CEO of a nonprofit called Pathways to
Housing, started in New York City. We currently operate
programs in Washington, DC, Philadelphia, PA, and Burlington,
VT. We are providing technical assistance to about 20 cities
across the country now.
One of the reasons our program has expanded so quickly is
that we initially pioneered the Housing First approach. It has
received a lot of attention and there is a lot of evidence
supporting the usefulness of this approach both in studies by
HUD and the Veterans Administration, formally studies published
in 17 cities.
In my testimony I hope to provide some information about
how Housing First, as a program, practice, and philosophy could
maybe address some of the components of the proposed 5-year
plan of the Veterans Administration.
I have to say that it is commendable that the VA has come
up with a 5-year plan as opposed to a 10-year plan--shows a
kind of urgency and also signals that it is actually doable,
that this conversation about the multiple needs of veterans
with psychiatric disabilities, addiction disorders, employment,
and, of course, homelessness in some ways has been an elusive
and very complex challenge.
The manner which we have found our way through it was not
through our own resources but when we engaged with the people
we were surveying in order to come up with a solution.
Housing First is essentially a ground-up solution where the
homeless person drives the program. When you study the myriad
of problems that we are looking at, the sequencing of these
problems, the timeframe in which they are handled is hugely
important.
For example, when you are looking at homelessness, mental
illness, addiction, just those three, the solution for homeless
is quite different than the solution for mental illness and
addiction. They are not on the same timeframe.
Homelessness can be ended immediately. Addiction and mental
illness require a much longer timeframe. People who are
homeless know this. People who suffer with these conditions
know this. The system that has served these complex needs for
years has not really completely adopted this approach yet.
There is still an enormous investment in transition--
getting people cured of their addiction or mental illness prior
to receiving housing--that has kept people in a homeless
service system; expensive, multiple uses of acute-care services
with no solution to their homelessness.
So, the timeframe is important and the sequence in which
you provide services and housing is key.
We, of course, have taken the direction from our clients
and said what is it that you want? Every client we deal with
says I want a place to live, a place of my own first. And that
is the direction that we take. Housing First is really that
person's first choice in service.
The next sequence of services, whether it is mental health
or family re-connection or employment, is also driven by that
person.
What we provide is the case management support so that once
the person is housed they are continuously able to direct their
own program to recovery.
Here is what we have learned in doing it this way. People
are much more capable than we ever imagined possible.
Seeing someone on the street who is vulnerable and
disheveled, poor, desperate, and afraid, that person looks
completely different the day after they are put into housing.
That person surviving on the street requires the
resourcefulness to know where they can get a meal, where
services are available, who they can trust on the street, all
of those skills invisible to the passer-by are actually there
and intact and serve the person well once they move into
housing.
One of the fears I think in adopting a Housing First
approach is how can this person possibly manage in housing? The
answer is over and over again they manage extremely well. They
need the support.
Let me emphasize that Housing First is not about housing.
It is about the relationship with the homeless person in a way
that engages them with the services that they want first.
Housing first. Then all of the other services follow.
One of the challenges I think in the Veterans
Administration is that it is a hierarchical organization. While
running a military requires a hierarchical approach and
following orders, excellence in mental health services and most
of the evidence-based practice suggest that the best way to do
a mental health service is to have the client drive the
service.
This is an enormous culture change challenge to the VA in
terms of allowing veterans to dictate the sequence and
intensity of the services they seek. But to offer them in any
other way would mostly generate refusals on behalf of the
veterans.
Someone who has served as a veteran is not going to accept
services that are an insult to their dignity, their honor, or
their capabilities which they have proven already and
demonstrated for their country, to then have to come and accept
social services at a level that is demeaning and in a way an
insult to their capability.
So, the philosophy and culture is important in terms of how
successful you are in engaging these services.
The investment has been another part of the surprise.
Investment in transitional preparatory services is expensive
and does not lead to permanent housing very often. In studies
that we have done in randomized controlled trial studies
published in the American Journal of Public Health--all of this
is in my testimony and on our Web site--people who are going
through the treatment first approach end up being permanently
housed about 40 percent of the time.
When you house someone directly from the street and offer
services to support their staying in housing, that percentage
jumps up to 80 percent of the time.
In the HUD studies, sponsored by HUD, and the VA study as
part of the chronic homelessness initiative in 2003, that 85
percent housing stability number is the same number that the
researchers who conducted those studies found.
[The prepared statement of Mr. Tsemberis follows:]
Prepared Statement of Sam Tsemberis, Ph.D., Founder and CEO,
Pathways to Housing, Inc.
www.pathwaystohousing.org
pathways housing first: program description
Pathways Housing First is a humane, highly effective and cost
efficient consumer driven, evidence-based program that ends
homelessness for people diagnosed with psychiatric disabilities and/or
addiction disorders. In 2007, this program successfully completed peer
review and is listed on HHS/SAMHSA's National Registry of Evidence-
Based Programs and Practices.
The Pathways' Housing First program is based on a philosophy that
emphasizes consumer choice, rehabilitation, and recovery. Housing First
is designed to address the needs of homeless individuals from the
consumers' perspective, encouraging program participants to define
their own needs and goals. The program provides what most consumers
identify as their primary need--immediate access to housing (a place of
their own, a place to call home).
Independent, affordable apartments rented from community landlords
is by far the most preferred housing option of all people who are
homeless. Units are rented very quickly from the available housing
rental market in normal integrated community settings by using rent
subsidies such as Section 8 vouchers, shelter plus care funds or other
permanent housing rent stipend. The program uses a `scatter site'
approach never renting more than 20% of the total number of units in a
building. Program participants pay 30% of their income (usually SSI)
toward their share of the rent. Thus supported housing program has a
remarkably quick startup: it takes about 3 months from the time a
program is funded to hire the support staff and begin moving people
into apartments.
The program successfully removes the traditional barriers to
housing for people who have disabilities. Notably, it does not place
conditions such as achieving a period of sobriety or mandatory
participation in psychiatric treatment as a precondition to housing.
The program is especially effective with people who are chronically
homeless and cycling through expensive acute care services such as
emergency rooms, shelters, hospitals, police and jails.
It is important to note that cycling through these acute care
services is very costly and yet completely ineffectively for ending
homelessness. By addressing the homelessness problem first and
providing the person with a place to live and then the support services
need to succeed in that housing we have been able to achieve enormous
success in both ending homelessness and helping people with their
recovery. And the cost of this permanent supported housing program--a
section 8 voucher (or its' equivalent) and the support services
component is significantly less than the cost of keeping the person in
a hospital bed, jail cell, or even city shelter.
The clinical and support services of this program ensure that
housing is found quickly and that it can be successfully maintained.
The services include both clinical or case management staff and housing
staff. We have found that housing is itself a stabilizing factor for
program participants and allows them to move in the direction of
treatment. The program fosters a sense of home (not simply providing
housing) and belonging; being part of a building, neighborhood and
community as well as a member of a treatment and support team. The way
that the housing is integrated into the community promotes community
integration, and empowers participants to define their own paths to
recovery.
The Pathways Housing First program addresses housing and clinical
issues as separate but coordinated domains. By providing housing first,
the program effectively addresses a person's homelessness. By providing
program participants with an apartment of their own and then, once safe
and secure, they work with the support services team to address their
other problems such as addiction, mental health, employment and so on.
The program requires that all program participants agree to a home
visit by a member of the support services team at a minimum of once a
week. This visit assures the health and safety of the program
participant and is the setting for developing the treatment and
rehabilitation service plan.
Treatment and support services are provided by an Assertive
Community Treatment (ACT) team [comprised of social workers, nurses,
psychiatrists, employment specialists, substance abuse counselors, peer
counselors, and other professionals] or an Intensive Case Management
(ICM) team that provides support services but may broker other services
including mental health, health, substance abuse treatment, supported
employment, education, health and wellness to community based
providers. ACT is the preferred support for persons with severe mental
illness and ICM teams can be used for tenants with moderate mental
health needs. ICM support can also be used when programs have a smaller
census (less than 40 clients) and are not well suited to sustaining the
staffing pattern of an ACT team. The housing component is always a
community based apartment or equivalent depending on the housing stock
available in the community and whether the participant is single,
couple or family. The type and intensity of support services being
provided to the participants is adjusted to meet their needs.
Over time, as individuals recover they can be referred to
community-based providers that deliver needed services. Upon
graduation, consumers do not have to transition into another housing
program. They are already living in their own apartment with the
subsidy still available if they need it. The only thing that changes at
graduation is that the support services are reduced or eliminated
altogether and the person continues to live in the building and
community to which they are accustomed.
The most remarkable and exciting discovery of this Housing First
program concerns what we have learned about the capabilities of people
who are homeless and have multiple disabling conditions. We have found
that when given the right housing and support services people who we
had previously considered `hard to reach,' ` hard to house,' and `not
housing ready' are in fact capable of making and managing a home,
successfully participating in treatment, reuniting with families, and
getting a job. This remarkable success of the program's participants is
the main reason that in a relatively short 10 year span, the Pathways
Housing First program has grown from a small local program operating in
one city to an internationally replicated model in hundreds of cities.
research studies and demonstrated effectiveness
There is an ever-growing body of research evidence for the
effectiveness of the Pathways' Housing First program for ending
homelessness, promoting housing stability, improving quality of life,
reducing acute care service use and reducing costs. Results from some
of the larger studies are summarized below.
I. Greater Housing Retention
Studies have shown that Housing First participants achieve
stable housing faster & spend more time in stable
housing.
1) A randomized controlled trial of persons who were literally
homeless showed that after one year, participants in Housing First
(experimental) spent 85% of their time stably housed, compared with
less than 25% for participants in the services-as-usual group (control)
(Tsemberis, Gulcur, & Nakae, 2004). After two years, Housing First
participants still spent approximately 80% of their time stably housed,
compared with only 30% for the control group (see Figure 1). Housing
First tenants also reduced the proportion of time they spent homeless
from approximately 55% at baseline to 12% at one year, and less than 5%
after two years (see Figure 2). Reductions in homelessness were
significantly slower and less drastic for the control group, who were
homeless approximately 50% of the time at baseline, 27% at one year,
and 25% after two years (Tsemberis, Gulcur, & Nakae, 2004).
Figure 1. Proportion of Time Spent in Stable Housing
Figure 2. Proportion of Time Spent Homeless
2) A randomized controlled trial of long-term shelter stayers found
that participants assigned to Housing First obtained permanent,
independent housing at higher rates than a services-as-usual control
group. The majority of consumers housed by both Housing First agencies
retained their housing over the course of four years with 78% of
participants in the Pathways Housing First program remaining housed
over that period (Stefancic & Tsemberis, 2007).
3) A randomized controlled trial in Chicago found that 60% of
persons in Housing First were stably housed at 18 months, compared with
only 15% of persons assigned to usual care (Sadowski, 2008; Bendixen,
2008).
4) Archival data was used to compare rates of housing retention for
Housing First tenants to those of tenants in New York supportive
housing programs that required treatment and sobriety as a precondition
to housing. After five years, 88% of participants in the Housing First
program remained housed, compared to 47% of participants in more
traditional housing programs (Tsemberis & Eisenberg, 2000).
5) A cross-site study of programs funded by HUD, SAMHSA, VA and HHS
and coordinated by the US Interagency Council on the Homeless (called
the Collaborative Initiative to End Chronic Homeless) demonstrated that
high housing retention rates could be achieved across the diverse
contexts of the 11 cities funded by this initiative. At least seven of
the eleven programs funded used the Pathways' Housing First model and
approximately 80% of clients were stably housed after 1 year
(Rosenheck, 2007).
6) A HUD cross-site study of six Housing First programs found that
84% of Housing First participants were in permanent housing at baseline
and 1 year later (HUD, 2007).
II. Reductions in Service Use
Studies have demonstrated that Housing First is associated
with decreased use of emergency room visits,
hospitalizations, incarcerations, and shelter
stays, making Housing First a lower cost, more
effective approach than traditional programs.
1) A randomized controlled trial found that persons assigned to
Housing First spent significantly less time in psychiatric hospitals
compared to participants assigned to services-as-usual (Gulcur et al.,
2003).
2) A randomized controlled trial in Chicago found that persons in
Housing First ``used half as many nursing home days and were nearly two
times less likely to be hospitalized or use emergency rooms'' as
compared to a usual care group over 18 months (Sadowski, 2008;
Bendixen, 2008.).
3) A pre-post study in Denver documented reductions in
institutional acute care subsequent to enrollment in Housing First.
Housing First clients decreased emergency room use by 73%, inpatient
stays by 66%, detox use by 82%, and incarceration by 76% (Perlman &
Parvensky, 2006).
4) A pre-post study in Rhode Island documented decreases in
hospital and jail stays, as well as emergency room visits, subsequent
to clients' enrollment in Housing First. ``In the year prior to
entering supported housing, the formerly chronically homeless
individuals spent a combined total of 534 nights in hospitals, 919
nights in jail, and had 177 emergency room visits. In contrast, the
newly housed individuals had a combined total of only 149 nights in
hospitals, 149 jail nights, and 75 emergency room visits in the first
year of housing'' (Hirsch & Glasser, 2007).
5) A pre-post study in Seattle, documented reductions in various
services subsequent to enrollment in one of two Housing First programs.
Compared to 1 year prior to admission, Housing First participants in
one program decreased jail bookings by 52%, jail days by 45%,
admissions to a sobering center by 96%, EMS paramedic interventions by
20% and visits to a medical center by 33% (DESC, 2007). Participants in
the other Housing First program reduced medical respite days by 100%,
inpatient visits to a medical center by 83%, emergency room visits by
74%, jail days by 18%, and admissions to a sobering center by 97%
(Srebnik, 2007).
6) A pre-post study of Housing First in Massachusetts demonstrated
that, compared to the year prior to enrollment, in the year after
enrollment in Housing First, inpatient hospitalizations were reduced by
77% and emergency room visits by 83% (Meschede, 2007).
III. Decreased Costs
Studies have shown that Housing First is associated with
decreased costs.
1) A randomized controlled trial of persons who were literally
homeless showed that, from baseline to 2-year follow-up, participants
in Housing First accrued significantly lower supportive housing and
services costs than participants in services-as-usual (Gulcur et al.,
2003).
2) A pre-post study in Denver estimated that enrollment in Housing
First was associated with a net cost savings of $4,745 per person per
year (Perlman & Parvensky, 2006).
3) A pre-post study in Rhode Island estimated that enrollment in
Housing First was associated with a net cost savings of $8,839 per
person per year (Hirsch & Glasser, 2008).
4) A pre-post study in Seattle estimated that enrollment in two of
their Housing First programs was associated with an aggregate reduction
in cost of services used by $1.7 million and $1.5 million, respectively
(DESC, 2007; Srebnik, 2007).
5) A randomized controlled trial in Chicago concluded that ``health
care savings far exceed the costs of the Housing [First] intervention''
(The National AIDS Housing Coalition, 2008).
In all there are more than 35 cost studies on this model, all
showing similar results.
IV. Improvements in Quality of Life & Other Outcomes
Studies find that Housing First is associated with greater
consumer choice, greater satisfaction, improved
quality of life, and improvements in other clinical
and personal domains.
1) A randomized controlled trial found that participants assigned
to Housing First reported higher ratings of perceived choice compared
to those in services-as-usual (Greenwood et al., 2005). Although
program assignment did not have a direct effect on psychiatric
symptoms, perceived choice significantly accounted for a decrease in
psychiatric symptoms and this relationship was partially mediated by
mastery (perceptions of personal control).
2) A qualitative study found that participants living in their own
apartments through Housing First reported experiencing conditions that
are indicative of a stable home that fosters a sense of control, allows
for the enactment of daily routines, imparts a sense of privacy, and
provides a foundation from which consumers can engage in identity
construction (Padgett, 2007).
3) A Rhode Island study found that 93% of clients reported being
``Very Dissatisfied'' with their housing situation the year before
entering their apartment. By contrast, 78% of clients reported being
``Very Satisfied'' and 12% ``Somewhat Satisfied'' with their housing
situation at the time of first interviews . . . While homeless, nearly
half of participants rated their health as ``Poor'' or ``Very Poor''
and two-thirds of participants said that physical or mental health
disabilities had limited their ability to interact with those they felt
close to. Once in the program nearly half rated their health as ``Good
or ``Very Good'' and only one third felt that their disabilities
limited their social interaction (Hirsch & Glasser, YEAR).
4) A Housing First program in Massachusetts found that ``overall
quality of life improved dramatically for all Housing First residents
after leaving the shelter, including increased sense of independence,
control of their lives, and satisfaction with their housing''
(Meschede, 2007).
5) Compared to participants in community residences, those in
supported housing (Housing First and another supported housing program)
reported greater satisfaction in terms of autonomy and economic
viability over 18 months (Siegel, Samuels, Tang, Berg, Jones, & Hopper,
2006).
6) A qualitative study of participants in a randomized controlled
trial found that, for most Housing First clients, entering housing
after a long period of homelessness was associated with improvements in
several psychological aspects of integration (e.g., a sense of fitting
in and belonging) as well as feelings of being ``normal'' or part of
the mainstream human experience (Yanos et al., 2004).
7) An evaluation in Philadelphia compared participants in Housing
First to a group of persons receiving services but no housing. Of the
participants in Housing First, 79% showed improvement in mental health
(comparison group 20%), 57% showed improvement on substance use
(comparison group 15%) and 84% showed improvement on overall life
status (comparison group 50%) (Dunbeck, 2006).
conclusions
The Housing First model has been replicated in over 40 cities
throughout the U.S. and it is included as a program component in most
city and county plan to end chronic homelessness.
Housing First is a consumer-centered approach that ends
homelessness for individuals who have remained homeless for years. From
the point of engagement, it empowers consumers to make choices, develop
self-determination, and begin their individual journeys toward recovery
and community integration.
Housing First has a 18-year track record of success. It
results in better outcomes at significantly lower costs, creating a
significant return on investment relative to other programs.
Practically speaking, the program has a very quick startup
time since housing is rented from the existing rental market.
Additionally, the program is extremely efficient in housing tenants,
moving a person from homelessness into housing in two weeks, on
average.
Housing First eliminates costly transitional housing and
treatment services that are aimed at preparing consumers to become
``housing ready''. The average cost of running a Housing First program
is between $15,000 to $22,000 per person per year, depending on the
intensity of services offered and local housing market rents. This cost
compares very favorably with the cost of emergency room visits, jail
stays, hospital stays, emergency shelter stays, and even the service
and societal costs associated with street homelessness.
Housing First promotes consumer choice, while encouraging
use of mental health and other services. The provision of housing
provides the environmental stability for consumers to participate in
other services.
Most importantly, the transformation of moving from
homelessness into a home of one's own inspires physical and mental
well-being and ignites hope in persons who had felt hopeless for years.
References
Bendixen, A. (2008). Chicago Housing for Health Cost Analyses.
Paper presented at the Third National Housing and HIV/AIDS Research
Summit, Baltimore, Maryland.
Dunbeck, D. (July, 2006). Housing Chronically Homeless People:
Housing First Programs in Philadelphia, National Alliance to End
Homelessness Annual Conference, Washington, DC.
Greenwood, R. M., Shaefer-McDaniel, N.J., Winkel, G., & Tsemberis,
S.J. (2005). Decreasing psychiatric symptoms by increasing choice in
services for adults with histories of homelessness. American Journal of
Community Psychology, 36 (3/4), 223-238.
Gulcur, L., Stefancic, A., Shinn, M., Tsemberis, S., & Fischer, S.
N. (2003). Housing, hospitalization, and cost outcomes for homeless
individuals with psychiatric disabilities participating in Continuum of
Care and Housing First programmes. Journal of Community and Applied
Social Psychology, 13, 171-186.
Hirsch, E., & Glasser, I. (2008). Rhode Island's Housing First
Program: Year 1 Evaluation Executive Summary. Available online at:
http://www.rihomeless.com/Press%20Releases/
Housing%20First%20Rhode%20Island%20Report%20-%20Ex%20Summary.pdf.
Meschede, T. (2004). Bridges and barriers to housing for
chronically homeless street dwellers: The effects of medical and
substance abuse services on housing attainment. Retrieved February 14,
2007, from http://www.mccormack.umb.edu/csp/publications/
bridgesandbarriers.pdf.
The National AIDS Housing Coalition. (2008). HIV/AIDS Housing: A
Sound Investment of Public Resources.
Padgett, D.K. (2007). There is no place like (a) home: Ontological
security among persons with serious mental illness in the United
States. Social Science and Medicine, 64(9), 1925-1936.
Perlman, J., & Parvensky, J. (2006, December 11). Denver Housing
First Collaborative. Cost benefit analysis and program outcomes report.
Denver, CO: Colorado Coalition for the Homeless. Retrieved October 29,
2007, from http://www.shnny.org/documents/FinalDHFCCostStudy.pdf.
Sadowski, L. (2008). Chicago Housing for Health Partnership:
Background, Methods & Preliminary Findings. Paper presented at the
Third National Housing and HIV/AIDS Research Summit, Baltimore,
Maryland.
Siegel, C.E., Samuels, J., Tang, D., Berg, I., Jones, K., Hopper,
K. (2006). Tenant outcomes in supported housing and community
residences in New York City. Psychiatric Services, 57(7), 982-991.
Stefancic, A., & Tsemberis, S. (2007). Housing First for long-term
shelter dwellers with psychiatric disabilities in a suburban county: A
four-year study of housing access and retention. Journal of Primary
Prevention, 28(3/4), 265-279.
Tsemberis, S., & Eisenberg, R.F. (2000). Pathways to Housing:
Supported Housing for street-dwelling homeless individuals with
psychiatric disabilities. Psychiatric Services, 51 (4), 487-493.
Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing First,
consumer choice, and harm reduction for homeless individuals with a
dual diagnosis. American Journal of Public Health, 94 (4), 651-656.
U.S. Department of Housing & Urban Development (July, 2007). The
Applicability of Housing First Models to Homeless Persons with Serious
Mental Illness: Final Report Available online at http://
www.huduser.org/Publications/pdf/hsgfirst.pdf.
Yanos, P. T., Barrow, S. M., & Tsemberis, S. (2004). Community
integration in the early phase of housing among homeless persons
diagnosed with severe mental illness: Successes and challenges.
Community Mental Health Journal, 40(2), 133-150.
______
Post-Hearing Questions Submitted by Hon. Daniel K. Akaka to Sam
Tsemberis, Ph.D., Founder and CEO, Pathways to Housing, Inc.
Question 1. How soon after a person is placed in permanent housing
under the Housing First Model, does a member of the support services
team make a home visit?
FOLLOW UP: What happens if a person does not honor the agreement to
accept these home visits?
Question 2. Once a person is placed in permanent housing, where can
that person go for supportive services in the time between the weekly
home visits by a member of the supportive services team?
Question 3. Based on your experiences, do you believe there are any
simple changes that can be done immediately to improve the services and
programs available to assist our homeless veteran population and what
are they?
[Responses were not received within the Committee's
timeframe for publication.]
Chairman Akaka. Thank you.
Ladies and gentlemen, I am very sorry but I must interrupt
this hearing now. Committees are allowed to meet while the
Senate is in session based on the unanimous consent of the
Members.
This is a standard procedural agreement that is always
permitted. However, there has been an objection on the floor to
allow most committees, including our Committee, to meet.
I am very disappointed that we are forced to so abruptly
close, missing the opportunity to voice your concerns and
priorities. I hope that we can soon return to work we all
support, and that is helping veterans.
But I want to thank you very much for appearing today for
sharing your insights with us. We will have post-hearing
questions.
Senator Burr. Mr. Chairman, could I be recognized for a
unanimous consent request that the two witnesses who have not
had an opportunity to speak that their full testimony be
included in the record and that upon adjournment of this
hearing we go into a roundtable discussion with the remainder
of our panelists so that we can offer in an unofficial capacity
questions. The roundtable is not in breach of I think the
meetings of any of the Committees. The Committee can hold a
roundtable at any point and I would make a unanimous consent
request that we do that.
Chairman Akaka. Senator Burr, I feel like you do but I do
not think we should move to a roundtable discussion. I am sorry
to say. There is no unanimous consent to continue the hearing
so we will adjourn. The testimony of the witnesses unable to
appear will be in the Appendix.
This hearing is adjourned.
[Whereupon, at 11:05 a.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Dennis H. Parnell, President/CEO,
The Healing Place of Wake County
``The Healing Place Model--Ending Veteran Homelessness through
a Community Based Public/Private Partnership''
Mr. Chairman and Members of the Committee, Thank you for the
opportunity to speak to you this morning about the treatment needs of
homeless veterans suffering from the ravages of alcohol and other drug
disorders (AOD) and specifically about the provision of successful,
community based, cost effective recovery services across the United
States.
background statistics on the nature & severity of the problem
National Coalition for Homeless Veterans
a. The VA estimates that 107,000 veterans are homeless on any given
night. Approximately twice that many experience homelessness over the
course of a year. Only eight percent of the general population can
claim veteran status, but nearly one-fifth of the homeless population
are veterans.
b. In addition to the complex set of factors influencing all
homelessness--extreme shortage of affordable housing, livable income
and access to health care--a large number of displaced and at-risk
veterans live with lingering effects of Post Traumatic Stress Disorder
(PTSD) and alcohol and other drug disorders (AOD), which are compounded
by a lack of family and social support networks.
c. Veterans need a coordinated effort that provides secure housing,
nutritional meals, basic physical health care, treatment and continuing
care for alcohol and other drug disorders, mental health counseling,
personal development and empowerment. Additionally, veterans need job
assessment, training and placement assistance. NCHV strongly believes
that all programs to assist homeless veterans must focus on helping
them obtain and sustain employment.
Providing a Proven Solution
The Healing Place model has a 20+ year history of providing
innovative rehabilitative services to homeless individuals with severe
alcohol and other drug disorders including veterans of many distant and
recent conflicts. The truly remarkable aspect of this model is the
extraordinary program success--over 68% recovery rate a year after
completing the program. The fully loaded costs for everyone in the
program are less than $30/day.
Early History
It all began in Jefferson County, Kentucky in 1989 when the
Jefferson County Medical Society took over the operation of a shelter
in Louisville and hired a Vietnam Veteran with a Masters Degree in
Social Work as the fledgling program's first Executive Director.
Together they began to craft a unique social model that targeted the
specific population of homeless individuals with severe alcohol and
other drug disorders. By utilizing and combining the knowledge base,
resources and talents of the medical, social work and alcohol and other
drug treatment fields they were able to establish a truly unique and
holistic approach to a difficult and solution resistant social problem.
In 1998 the success of the program was recognized on a national level
and was honored by the public/private partnership between the Health
Resource and Services Administration and the U.S. Department of Health
& Human Services as a ``Model That Works.'' This opened the door for a
concerted effort to begin to replicate the success of the original
model.
Replication of the Model
Around this same time in Raleigh, NC an effort was undertaken by
individuals from the public and private sectors to find answers to
similar problems in Wake County, North Carolina. When the efforts and
success of the Louisville Healing Place Model was discovered,
stakeholders and organizers of this community launched a successful
campaign to bring an exact replication to North Carolina. The original
lure of the model was the fact that Louisville was able to demonstrate
a 66% success rate (66% of program graduates were sober a year after
completion) and that the facility was able to be operated at a fully
loaded cost of $25 per person per day.
In 2001 a 165 bed facility for men was opened in Wake County. A 100
bed women's facility followed in 2006. The impressive success and
outcomes of the original model was carefully tracked and equally
matched by ``The Healing Place of Wake County'' (THPWC). Current
statistics show that more than 68% of clients who complete the program
are sober one year later (three times the national average). The
combined fully loaded cost of operating both the Men's and Women's
facilities is less than $30 per person per day. This is compared to a
rate of over $70 a day just to be housed in the Wake County jail. In
addition to sobriety outcomes, the overall success of the program is
also measured by its contribution to the reduction of homelessness in
Wake County. While these numbers continue to grow in surrounding areas
and indeed for the most part around the country, in Wake County the
numbers tell a compelling story of success:
A Reason for Success--The Social Model Program
The Healing Place uses what is known as a ``social model'' recovery
program that originated in California in the 1940s. These programs are
regaining popularity due to unusually high success rates and
extraordinarily low operating costs. The Healing Place model is an
advanced and modern example of this type of programming.
This peer led program places a high value on an individual's own
experience and places responsibility for recovery on the infusion of
hope through shared experience, mutual respect, responsibility for the
welfare of each other and program advancement directly tied to
individual effort. Advancement through the multi-tiered program is
carefully designed in progressive stages which match the natural
intrinsic rewards of success with an individual's increasing efforts to
help themselves and each other. People who were previously estranged
from society and each other find themselves forming a community of
``sober survivors.'' Optimism replaces cynicism, empowerment replaces
entitlement and hope replaces hopelessness.
A full continuum of services starts with a non-medical Detox unit
that is open 24/7 and a ``wet shelter'' that accepts individuals that
are intoxicated or high. This low threshold of engagement is a key
component of the overall success of the program and insures that
services are provided ``on demand''--no waiting list! These entry
points provide an opportunity to mix people who have not yet made a
decision to stop drinking or using with a larger number of people who
have begun the process of change or are even further along in their
shared commitment to remain clean and sober. This powerful influence is
the force that perpetuates hope and begins movement into and throughout
the entire program and process. It takes about eight months to complete
our program at which time the man or woman has a place to live, a job
and is on the journey in recovery.
Complete Continuum & Coordination of Services
As an individual progresses and moves through the program a wide
range of services are continually added, matching the individual's
readiness, willingness and ability to effectively utilize these
services.
A vast array of local community partnerships fill in any perceived
gaps in services and round out the complete continuum. An example of
these types of partnerships include; local VA services, Vocational
Rehabilitation, Hospitals, County & City Agencies, Housing Partners,
Community and State Colleges, Employers, Drug Courts & Legal Services,
Arts & Entertainment Organizations, Sports Complexes, Civic Groups and
many others. In essence, it comprises the power and resources of the
entire local community.
The Possibilities for the Future
We believe that homelessness among veterans and other citizens can
be conquered both effectively and efficiently through best practice
methods, community organization and maximizing readily available
resources. Our immediate objective is to assist communities across
North Carolina, and Virginia to develop and build a statewide network
of this model. We have already assisted in the development of a working
replication in Richmond, Virginia and we are working on startups in
Fayetteville, NC, Norfolk VA and Lynchburg, VA. We will continue to
evaluate and improve them, and then in partnership with The Healing
Place in Louisville, Kentucky help other communities and states
replicate this continuing success. We will continue to work with
stakeholders such as the VA and other providers, especially those in
underserved communities, to improve and expand AOD services to veterans
and their families.
I invite you to visit The Healing Place of Wake County. You will be
amazed before you are half way through the visit!
______
Post-Hearing Questions Submitted by Hon. Daniel K. Akaka to Dennis
Parnell, President and Chief Executive Officer, The Healing Place of
Wake County
Question 1. Based on your experiences, do you believe there are any
simple changes that can be done immediately to improve the services and
programs available to assist our homeless veteran population and what
are they?
[Responses were not received within the Committee's
timeframe for publication.]
------
Prepared Statement of Patrick Ryan, Vice Chair, Board of Directors,
National Coalition for Homeless Veterans
Chairman Senator Akaka, Ranking Member Senator Burr, and
Distinguished Members of the Committee: The National Coalition for
Homeless Veterans (NCHV) is honored to appear before this Committee
today to comment on ending veterans' homelessness.
For 20 years, NCHV has worked diligently to serve as the Nation's
primary liaison between the community- and faith-based organizations
that help homeless veterans, the Congress, and the Federal agencies
that are invested in the campaign to end veteran homelessness in the
United States. Department of Veterans Affairs (VA) officials have
testified before the Congress that this partnership, despite
considerable financial pressures due to war and economic uncertainty,
is largely responsible for the phenomenal reduction in the number of
homeless veterans on the streets of America each night--from about
250,000 in FY 2004 to 107,000 today, according to the annual VA
Community Homelessness Assessment, Local Education and Networking
Groups (CHALENG) Reports.
Through the efforts of VA and the U.S. Department of Labor, some of
the most innovative and successful grant programs in the Federal
arsenal have jointly nourished a nationwide, community-based homeless
veteran assistance network that provides transitional housing and
services support for more than 100,000 veterans each year. The U.S.
Department of Housing and Urban Development has become the third
critical partner in this campaign through the HUD-VA Supportive Housing
Program (HUD-VASH) for veterans with serious mental illness and other
disabilities, and by incentivizing the inclusion of homeless and
extreme low-income veterans in local Continuum of Care funding
applications.
The success of these Federal agencies and the community- and faith-
based service partners NCHV represents over the last five years offers
proof that the campaign to end veteran homelessness can be won. The
President has established this as a priority of his Administration; and
VA Secretary Eric Shinseki is mobilizing his Department to strengthen
its intervention programs and expand its support of local prevention
strategies through his Five-Year Plan to End Homelessness Among
Veterans. This plan will strengthen the services offered to veterans
and their families in an unprecedented fashion by effectively engaging
community partners and supports for all those who are in need of
assistance.
On November 3-5, 2009, the Department of Veterans Affairs hosted a
three-day summit focused on ending veterans' homelessness. During this
historic event, Secretary Eric Shinseki boldly stated that ``My name is
Shinseki, and I am here to end veteran homelessness.'' This declaration
shows the level of commitment and dedication to the serious problem of
veteran homelessness.
The most noticeable recurring theme throughout the three-day
program was the need to strengthen VA's partnership with other Federal
agencies and the community- and faith-based service providers that have
helped reduce veteran homelessness by more than 50 percent in the last
five years. With more than 3,500 points of access to assistance
available to veterans today that did not exist 35 years ago, VA can
continue to serve those veterans who are homeless.
Our understanding of the VA's plan to end homelessness in five
years is based on a presentation of the ``basic framework'' of the plan
made by Mr. Peter Dougherty, Director of the VA Homeless Programs
Office, and Mr. Paul Smits, Associate Chief Consultant for Homeless and
Residential Rehabilitation and Treatment Services for the Veterans
Health Administration, on the final day of the summit.
The plan will have six ``strategic pillars.'' Included among those
are four that have been in development for more than two decades--
outreach, treatment, employment and benefits, and community
partnerships--and two that represent new areas of engagement--
prevention, and housing and supportive services for low-income
veterans.
NCHV feels that these pillars are good starting points, but it is
vital that VA knows the key to successfully ending homelessness among
veterans in five years is through the relationships and connections of
each community. Before offering our suggestions on what else VA and the
Federal Government should be doing, we believe it's important to
reflect for a moment on the history of the homeless veteran assistance
movement NCHV represents, because it speaks volumes about why we are
assembled in this room . . . and the reasonableness of VA Secretary
Shinseki's ambitious vision of ending veteran homelessness in five
years.
In the past nine years VA has quadrupled its investment in the
Homeless Providers Grant and Per Diem Program from slightly more than
120 programs to nearly 500 across the country.
The Homeless Veterans' Reintegration Program has more than tripled
in capacity to serve homeless veterans and has become one of the most
successful employment assistance programs in the Department of Labor
portfolio.
Under technical assistance grants and cooperative agreements with
both those agencies, NCHV has provided program guidance, access to
resources, and vital communications to more than 2,100 community- and
faith-based service providers from Seattle to Puerto Rico, from Maine
to the island of Guam.
Health Care for Homeless Veterans coordinators, women veteran
coordinators, and OEF/OIF specialists have been placed at virtually
every VA medical center and most VA Regional Benefits Offices.
HUD and VA have allocated 20,000 HUD-VASH vouchers to veterans with
serious mental and physical disabilities, with another 10,000 expected
to become available next year.
Five years ago, the VA CHALENG report estimated as many as 250,000
veterans slept on the streets of America each night. Today, that number
stands at 107,000--more than a 50% reduction despite the fact the
number of contact points in the CHALENG process has more than tripled
during that time.
We offer the following additional thoughts on what NCHV sees as
necessary steps to enable the Federal Government to end homelessness
among veterans in five years:
1. VA needs to clearly identify gaps in the availability of
transitional and permanent housing in communities with homeless
veterans and make it a priority to build capacity in those communities
using existing authorities. New York, Boston, Chicago, and Los Angeles
have large gaps between the demand for transitional housing and the
number of facilities available. Although the numbers are smaller, there
are equally compelling gaps in many small and medium-sized communities
and on Indian tribal lands. VA and its community-based partners cannot
address these gaps without an immediate legislative change to the Grant
and Per Diem Program.
2. VA needs to examine outreach, referral and admission policies at
every VA medical center to ensure that these policies are collaborative
and consistent with the goal of ending homelessness. This means a
significant increase in the Office of VA Homeless Programs oversight
capability.
3. VA needs to revise its program rules so that veterans who are
seeking admission to a domiciliary or grant and per diem program are
immediately admitted even if eligibility has not yet been determined.
If a veteran is seeking to enter a program on a Friday evening, VA
rules should authorize admission and reimbursement, even if it later
turns out the veteran is ineligible for VA support.
4. VA should convene an open meeting with community-based
organizations serving homeless veterans no later than the end of May
2010 to discuss ideas about how VA could immediately alter program
rules and policies to permit greater flexibility in the use of grant
funds.
5. The Federal Government needs to take immediate steps to
stimulate the creation of additional permanent housing for homeless
veterans, including project basing for Section 8 rental housing
vouchers.
6. VA and HUD should adopt a plan so that eligible veterans who
qualify for Section 8 rental housing vouchers are housed in 30 days or
less. More vouchers without an assurance that they can be used is not
going to solve the housing problem.
7. Congress and VA, working with the Office of Management and
Budget, should agree on an immediate action plan to eliminate internal
and external roadblocks and procedural delays in the award of enhanced-
use leases to groups seeking to house homeless veterans. The current
process takes too long and national objectives such as ending
homelessness are often met with resistance by local opposition.
8. The Federal Government needs to work intensively to eliminate
seams and build bridges between the various programs that provide funds
to serve homeless veterans. This will require the active collaboration
of a number of Department Secretaries who share Secretary Shinseki's
and the President's desire to address this issue in an urgent manner.
9. VA needs to refocus its homeless program performance measures on
increasing the overall number of veterans who are served by these
programs, not just how many vouchers have been distributed this year.
Congress can assist this change by demanding more timely and
comprehensive program performance information.
10. It is clear from published research that early intervention can
dramatically reduce the effects of traumatic stress and subsequent
PTSD. As noted earlier in our testimony, mental illness is a
significant contributor to veteran homelessness. This Committee should
regularly monitor the Department of Defense's ability to provide mental
health services by military health personnel to servicemembers who have
experienced traumatic stress. Although Admiral Mullen and others have
acknowledged the need to heal soldiers and Marines who have experienced
such stress, it would be very useful to compare the Defense
Department's capacity to respond to servicemembers in a timely fashion
with that of the Department of Veterans Affairs,
NCHV has on several occasions acknowledged the leadership role of
the Committee in this noble campaign. We know it is your leadership
that brings us to this moment in history--Never before have we, as a
nation at war, been better prepared to ensure that those who sacrifice
some measure of their lives to serve in the military have the support
they need to enjoy the peace and prosperity they have helped protect
and preserve. The Homeless Veterans and Other Health Care Authorities
Act of 2010 lays the foundation on which we as a nation can wage a
successful assault on veteran homelessness and fulfill the Secretary's
Five-Year Plan.
homeless veterans and other health care authorities act of 2010
For several years the homeless veteran assistance movement NCHV
represents has realized there can be no end to veteran homelessness
until we, as a Nation, develop a strategy to address the needs of our
former guardians before they become homeless--victims of health and
economic misfortunes they cannot overcome without assistance.
The causes of all homelessness can be grouped into three primary
categories: health issues; economic issues; and lack of access to safe,
affordable housing for low and extreme-low income families in most
American communities. This has been a chronic problem since the birth
of the Great Society during the Johnson administration.
The additional stressors veterans experience are prolonged
separation from family and social support networks while engaging in
extremely stressful training and occupational assignments; war-related
illnesses and disabilities--both mental and physical; and the
difficulty of many to transfer military occupational skills into the
civilian workforce.
NCHV believes the Homeless Veterans and Other Health Care
Authorities Act of 2010, introduced by Senator Patty Murray--and
unanimously supported by this Committee--has the potential to set this
Nation on course to finally achieve victory in the campaign to end
veteran homelessness in the United States.
Victory in this campaign requires success on two fronts: effective,
economical intervention strategies that help men and women rise above
adversity to regain control of their lives; and prevention strategies
that empower communities to support our wounded warriors and their
families before they lose their ability to cope with stressors beyond
their control.
We believe the Homeless Veterans and Other Health Care Authorities
Act addresses needs on both fronts.
As written, the Act calls for the Secretary of Veterans
Affairs to study the method of reimbursing GPD community providers for
their program expenses and report to Congress, within one year, his
recommendations for revising the payment system. VA estimated that the
current per diem payment of $34.40 covers no more than 20-30% of the
cost of services provided by grant recipients. Because the current
formula provides such a low level of financial support, there is
inadequate VA presence in many large cities where tens of thousands of
homeless veterans live. Rural homelessness is more difficult to track,
but it's easy to see that few VA-supported programs exist in rural
locations. The best way to address this gap would be to authorize the
Secretary to provide grant assistance to all eligible organizations on
a program cost basis rather than a per diem basis, and authorize the
Secretary to provide differing levels of support to programs in high
cost areas and in areas where there are significant gaps in services
for veterans.
This new authority could be time-limited if the Congress wanted to
more closely examine the effect of such a change. To tell VA it needs
to take a year to prepare a report, which would then be considered for
up to two years by the next Congress, is to guarantee little progress
in many parts of the country where VA-supported programs are sorely
lacking. NCHV has been advocating this change since 2006. The Act calls
for an increase in the annual GPD authorization to $200 million,
beginning in FY 2010, which could provide additional funds for outreach
through community-based veteran service centers and mobile service vans
for rural areas, while continuing to increase the bed capacity of VA's
community-based partners. These outreach initiatives will likely play a
pivotal role as the VA's veteran homelessness prevention strategy moves
forward.
Instructs the Secretary to establish a program to prevent
veteran homelessness. The Act provides authorization for up to $50
million annually to provide supportive services for low-income veterans
to reduce their risks of becoming homeless, and to help those who are
homeless find housing. Provisions include short- to medium-term rental
assistance, poor credit history repair, housing search and relocation
assistance, and help with security and utilities deposits. For many of
the Nation's 630,000 veterans living in extreme poverty (at or below
50% of the Federal poverty level), this aid could mean the difference
between achieving stability and continuing on the downward spiral into
homelessness.
Develops the Homeless Veterans Management Information
System. This system would collect the essential information needed to
determine how many veterans requested and received hosing assistance
and for what length of time the assistance was given. This information
will play a vital role in developing housing and services in future
years.
Provides for the expansion of HUD-VASH to a total of
60,000 housing vouchers for veterans with serious mental and emotional
illnesses, other disabilities, and extreme low-income veteran families
that will need additional services to remain housed. According to an
analysis of data by the National Alliance to End Homelessness, about
63,000 veterans can be classified as chronically homeless. This Act
would, therefore, effectively end chronic veteran homelessness within
the next five years.
Establishes within HUD a Special Assistant for Veterans
Affairs to ensure veterans have access to housing and homeless
assistance programs funded by the Department.
Modernizes the extremely important and successful VA Grant
and Per Diem Program (GPD) to allow for the utilization of innovative
project funding strategies--including the use of matching funds from
other private or public sources to facilitate and hasten project
development.
Requires the Secretary of Veterans Affairs to submit a
comprehensive plan to end veterans' homelessness. Not only would this
plan list the current programs offered to assist homeless veterans, it
would also lay the groundwork for evaluating the effectiveness of those
programs.
Creates a program, authorized at $10 million through FY
2014, to provide employment assistance and child care to women veterans
and veterans with dependent children. This would allow the growing
number of women veterans to have access to employment and training
opportunities that they are currently lacking.
Expands the Grant and Per Diem Program by including male
homeless veterans with minor dependents as a new category. Community-
based organizations continue to see the number of male veterans with
dependent children growing; by expanding the GPD to serve this
population directly, many more veterans and their families could be
assisted.
in summation,
As we move forward on this effort to end veterans homelessness, I
want to thank you for your support helping those men and women who have
served this country in their time of greatest need. The progress we
made has been commendable but our work will not be done until there are
no veterans left on the streets.
The Homeless Veterans and Other Health Care Authorities Act of 2010
lays the foundation of the work that lies ahead. From the increase in
the number of HUD-VASH vouchers, and the ability to provide supportive
services for low-income and women veterans, to the improvement and
expansion of the GPD program and reimbursement process, this bill
provide real opportunities to move the PLAN into ACTION and fulfill the
historic mission to end homelessness among America's former guardians
in five years.
______
Response to Post-Hearing Questions Submitted by Hon. Daniel K. Akaka to
Patrick Ryan, Vice Chair, Board of Directors, National Coalition for
Homeless Veterans
Question 1. You mentioned in your written testimony that VA and its
community-based partners cannot--address gaps in the availability of
transitional and permanent housing--in communities with homeless
veterans--without an immediate legislative change to the Grant and Per
Diem Program. Can you please tell us specifically what particular
legislative changes you are referring to?
Response. As currently written, 38 U.S.C. section 2012(a) sets a
maximum payment to a provider at a little over $34 per day, which is
slightly more than $1,000 per month. VA estimates this amount is not
more than 30% of the cost of providing care in most areas of the
country. Because the current formula provides such a low level of
financial support, there is inadequate VA presence in many large cities
where tens of thousands of homeless veterans live. Rural homelessness
is more difficult to track, but it's easy to see that few VA-supported
programs exist in rural locations. The best way to address this gap
would be to authorize the Secretary to provide payments to eligible
organizations on a program cost basis rather than a per diem basis, and
authorize the Secretary to provide differing levels of support to
programs in high cost areas and in areas where there are significant
gaps in services for veterans.
Although the per diem program was never intended to reimburse for
the full cost of care, a ``percentage of cost'' based reimbursement
formula would give the Secretary greater flexibility and could lead to
the establishment of transitional housing programs where none exist
today. The language contained in section 3 of H.R. 4810, 111th
Congress, is one way of addressing this issue.
A second problem with the current formula is the effect it has on
smaller community-based organizations. In order to provide services,
these organizations incur certain fixed costs, especially employee
salaries. However, if the planned number of veterans is lower than the
program's maximum, its funding from the VA is reduced. This result is
perceived as unfair by service providers, who are used to grant
programs that use a ``percentage of cost'' reimbursement funding
formula.
Question 2. Can you help the Committee reconcile the excellent
testimony of our first panel of witnesses with the statements of this
panel about the distinctly different approaches to ending homelessness
among seriously mentally ill veterans?
Response. While each of these agencies focus on their different
areas, it is key to remember that all of the programs administered by
these agencies (DOL, HUD, and VA) relate to a person's ability to get
and maintain housing. However, the veteran's need for health care
(including mental health services) and employment services must also be
addressed if we want to achieve lasting change in the lives of veterans
who were homeless.
Question 3. In your testimony, you touched on several steps
necessary to enable the Federal Government to end homelessness among
veterans in five years. Based on your experience on the issue of
homeless veterans when you were with the House Committee on Veterans'
Affairs, what do you see as the major roadblocks that need to be
overcome to make real progress?
Response.
A. VA could be more open and collaborative. There is a basic lack
of current, publicly available data about the number of programs
serving homeless veterans. VA should develop and post this information
on a public Web site and solicit suggestions on how to address gaps in
services. If VA clearly identified gaps in the availability of
transitional and permanent housing in communities with homeless
veterans, it would be easier for communities and local organizations to
take action to build capacity. Large cities such as New York, Boston,
Chicago, and Los Angeles have significant gaps between the demand for
transitional housing and the number of facilities available. Gaps also
exist in many small and medium-sized communities and on Indian tribal
lands. Focusing on those gaps and addressing them is the only way to
end homelessness. For FY 2010, VA received an additional $50 million in
construction funds to make vacant building available to house homeless
veterans, but there has been little consultation with veterans'
advocates about how this money can be spent most effectively.
B. HUD, Labor, and other Departments need to work with a far
greater sense of urgency to eliminate seams and build bridges between
the various Federal programs that serve homeless veterans. It is
remarkable, for instance, that money provided to HUD in the 2009
appropriation process for homelessness prevention pilot has still not
been made available. Several NCHV members have been urging HUD to take
immediate steps to stimulate the creation of additional permanent
housing for homeless veterans, including project basing for Section 8
rental housing vouchers, but HUD has not affirmatively issued guidance
on this subject. VA should adopt an immediate action plan to eliminate
roadblocks and procedural delays in the award of enhanced-use leases to
groups seeking to house homeless veterans. If HVRP is as successful as
Labor claims, why aren't even more funds devoted to it? The Interagency
Council on Homelessness (ICH) needs to be far more action-oriented.
C. The Office of VA Homeless Programs needs additional resources to
more closely monitor outreach, referral, and admission policies at
every VA medical center to ensure that these policies are collaborative
and consistent with the goal of ending homelessness.
D. To demonstrate its commitment to ending homelessness, VA and the
other members of the ICH should convene an open meeting with community-
based organizations serving homeless veterans no later than the end of
May 2010 to discuss ideas about how these Departments could immediately
alter program rules and policies to permit greater flexibility in the
use of grant funds to serve homeless veterans.
E. It is clear that mental illness is a significant contributor to
veteran homelessness, and that early intervention can dramatically
reduce the effects of traumatic stress and subsequent PTSD among
servicemembers . The Congress or some other impartial body should
monitor closely the Defense Department's capacity to respond to
servicemembers with incipient mental illness in a timely fashion.
Question 4. Based on your experiences, do you believe there are any
simple changes that can be done immediately to improve the services and
programs available to assist our homeless veteran population and what
are they?
Response. In my opinion, the VA's Office of Homeless Programs is
well-led, but its resources are stretched. It would be useful if it had
additional resources so that it could be more proactive. For example,
additional resources could be used to provide more extensive employee
awareness training so that all VA employees understood how they can
play a role in ending homelessness among veterans. The Office also
needs internal authority and additional resources to more closely
monitor outreach, referral, and admission policies at every VA medical
center to ensure that these policies are collaborative and consistent
with the goal of ending homelessness.