Homelessness: Demand for Services to Homeless Veterans Exceeds VA Program
Capacity (Letter Report, 02/23/94, GAO/HEHS-94-98).

Veterans are generally believed to be about one-third of the homeless
population in the United States; on any given night, up to 250,000 of an
estimated 600,000 homeless persons living on the streets or in shelters
may be veterans.  Virtually all of these veterans are men, many of whom
suffer from mental illness or drug and alcohol problems.  The capacity
of Department of Veterans Affairs (VA) programs to serve these homeless
veterans, however, falls far short of the demand for such services.
Further, VA services for homeless veterans are nonexistent in many areas
of the country.  Every VA medical center is required to assess the needs
of homeless veterans, determine the availability of VA and other
services in its area, and establish plans to meet those needs in
coordination with public and private providers.  VA has not done these
assessments and has yet to set specific target dates.  If VA is to
address the medical and social needs of homeless veterans nationwide,
existing substance abuse, mental health, and housing programs will need
to be substantially expanded and enhanced.  VA may need to open new
beds, hire more staff, contract with private providers of health
care/housing, and either renovate buildings or allow private homeless
groups to do so to provide temporary housing.  In an era of tight
federal budgets, however, increasing services for the homeless could
force cutbacks in services to other veterans.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-94-98
     TITLE:  Homelessness: Demand for Services to Homeless Veterans 
             Exceeds VA Program Capacity
      DATE:  02/23/94
   SUBJECT:  Veterans benefits
             Homelessness
             Health care services
             Housing programs
             Veterans employment programs
             Community health services
             Disadvantaged persons
             Interagency relations
             Non-government enterprises
             Veterans hospitals
IDENTIFIER:  All Volunteer Force
             VA Homeless Chronically Mentally Ill Veterans Program
             VA Domiciliary Care for Homeless Veterans Program
             VA Compensated Work Therapy Program
             VA Compensated Work Therapy/Therapeutic Residence Program
             VA Shelter for Homeless Veterans Through Acquired Property 
             Sales Program
             Boston (MA)
             Dallas (TX)
             Flint (MI)
             Huntington (WV)
             Minneapolis (MN)
             Pensacola (FL)
             San Francisco (CA)
             District of Columbia
             
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Cover
================================================================ COVER


Report to the Chairman, Committee on Veterans' Affairs, U.S.  Senate

February 1994

HOMELESSNESS - DEMAND FOR SERVICES
TO HOMELESS VETERANS EXCEEDS VA
PROGRAM CAPACITY

GAO/HEHS-94-98

Homeless Veterans


Abbreviations
=============================================================== ABBREV

  ACC - Associated Catholic Charities
  AIDS - acquired immunodeficiency syndrome
  CARE - Community, Alliance, Resource, Environment, Inc. 
  CCNV - Community for Creative Non-Violence
  CHC - Comprehensive Homeless Center
  COH - Coalition on Homeless
  COHHO - Coalition of Housing and Homeless Organizations
  CWT - Compensated Work Therapy
  CWT/TR - Compensated Work Therapy/Therapeutic Residence
  DAV - Disabled American Veterans
  DCHV - Domiciliary Care for Homeless Veterans
  DLF - Dallas Life Foundation
  DRC - day resource center
  FCFH - First Call for Help
  GCCMHS - Genesee County Community Mental Health Services
  GCVHF - Gulf Coast Veterans Homeless Foundation
  HCH - Health Care for the Homeless
  HCHP - Health Care for the Homeless Project
  HCHV - Health Care for Homeless Veterans
  HCMI - Homeless Chronically Mentally Ill
  HERO - Homeless Empowerment Registry Organization
  HHCT - Homeless Health Care Team
  HIV - human immunodeficiency virus
  HUD - Department of Housing and Urban Development
  HUD-VASH - HUD/VA Supported Housing
  NESHV - New England Shelter for Homeless Veterans
  NVOP - National Veterans Outreach Program
  OVA - Office of Veterans' Affairs
  PATH - Pensacola Area Transitional Housing
  PSP - People Serving People
  RSL - Red Shield Lodge
  SOME - So Others Might Eat
  SSA - Social Security Administration
  TR - Therapeutic Residence
  UGM - Union Gospel Mission
  VA - Department of Veterans Affairs
  VAMC - VA Medical Center
  VBA - Veterans Benefits Administration
  VBC - Veterans Benefits Clearinghouse
  VC - Vet Center
  VHA - Veterans Health Administration
  VSO - Veterans Services Organization

Letter
=============================================================== LETTER


B-252965

February 23, 1994

The Honorable John D.  Rockefeller IV
Chairman, Committee on Veterans' Affairs
United States Senate

Dear Mr.  Chairman: 

In February 1993, you requested that we review certain Department of
Veterans Affairs (VA) activities related to homeless veterans. 
Specifically, you asked us to (1) determine the extent to which VA
staff interact with federal, state, local, and private organizations
that provide services for homeless veterans in selected locations,
(2) evaluate VA's discharge planning efforts for homeless patients at
VA medical facilities in the locations we visited, and (3) review
VA's progress in implementing section 107 of Public Law 102-405
requiring, among other things, a comprehensive assessment of the
needs of homeless veterans. 

Veterans are generally considered to constitute about one-third of
the homeless population in the United States.  No one knows the exact
number of homeless individuals.  However, on any given night in the
United States, an estimated 500,000 to 600,000 homeless people live
on the streets or in shelters,\1 and 150,000 to 250,000 of these are
believed to be veterans.\2 According to VA officials, 98 percent of
all homeless veterans are male, 40 percent suffer from serious mental
illness, and, with considerable overlap, about half suffer from
alcohol or other drug abuse.  In addition, about 10 percent of
homeless veterans suffer from post-traumatic stress disorder.\3 The
over-representation of veterans among homeless persons is specific to
younger veterans who served in the All Volunteer Force (AVF). 
Differences in socio-economic and psychiatric risk factors for
homelessness partially explain this vulnerability, and seem to
reflect recruitment processes during the early years of the AVF.\4

We conducted our work at VA's central office and at eight localities
across the country--Boston, Massachusetts; Dallas, Texas; Flint,
Michigan; Huntington, West Virginia; Minneapolis, Minnesota;
Pensacola, Florida; San Francisco, California; and Washington, D.C. 
These locations were selected, in part, to encompass both urban and
rural population centers, diverse climates, and different levels of
VA presence. 

To determine what VA is doing to coordinate its efforts with those of
federal, state, local, and private organizations that provide
services for homeless veterans, we interviewed numerous officials
representing each of these entities.  To evaluate VA's discharge
planning efforts for patients at VA medical facilities, we (1)
interviewed VA officials and non-VA service providers to obtain
information about homeless veterans released from VA medical
facilities and (2) reviewed medical and other treatment files of
homeless veterans to determine the extent of discharge planning
performed by VA staff.  We also interviewed VA central office
officials to determine the progress VA has made to comply with the
provisions of Public Law 102-405. 

The scope of our work and methodology are discussed in more detail in
appendix I, and a summary of the information gathered during our work
in the eight localities visited appears in appendixes II through IX. 


--------------------
\1 Martha R.  Burt and Barbara S.  Cohen, America's Homeless: 
Numbers, Characteristics, and Programs That Serve Them, Washington,
D.C.:  The Urban Institute (1989). 

\2 1991-1992 Annual Report of the Interagency Council on the
Homeless, Federal Progress Toward Ending Homelessness, Washington,
D.C., p.  226. 

\3 Post-traumatic stress disorder is a psychiatric difficulty, with
symptoms such as nightmares, intrusive recollections or memories,
flashbacks, anxiety, or sudden reactions after exposure to traumatic
conditions. 

\4 Health Care for Homeless Veterans Programs:  The Fifth Annual
Progress Report, Department of Veterans Affairs, p.  App A-1. 


   BACKGROUND
------------------------------------------------------------ Letter :1

In July 1987, the 100th Congress responded to the problems of
homelessness by enacting several laws addressing different aspects of
the problem.  The most comprehensive of these was the Stewart B. 
McKinney Homeless Assistance Act (P.L.  100-77).  The McKinney Act
recognized the role of VA in addressing the problem, but several of
the other statutes enacted at that time created programs in
VA--Homeless Chronically Mentally Ill (HCMI) and Domiciliary Care for
Homeless Veterans (DCHV)--specifically targeting homeless veterans. 

Previous legislative actions had addressed the food and shelter needs
of the homeless, but before 1987 little had been done to address the
causes of homelessness or the diverse needs of the homeless.  The
McKinney Act was a response to both the urgency of the homelessness
crisis and the growing numbers of homeless. 

The HCMI program, administered by VA's Veterans Health Administration
(VHA), was initially established and funded through Public Laws 100-6
and 100-322, and is designed to meet the needs of homeless veterans
with chronic mental health problems.\5 VA initially funded 43 HCMI
programs in 26 states and the District of Columbia.  Under these
programs, which now number 57, outreach staff and case managers work
with community providers on the streets, in soup kitchens, and in
shelters to locate homeless mentally ill veterans who need care. 
Those veterans found to meet VA's eligibility criteria receive direct
clinical care that includes medical and psychiatric assessment and
treatment, substance abuse treatment, job counseling, and crisis
intervention.\6

Following assessment, some veterans are placed in community-based
residential treatment programs such as halfway houses or psychiatric
residential treatment centers for psychiatric care, alcohol and drug
abuse dependency, and rehabilitation.  These placements are made
through contracts funded by VA.  VA case managers monitor and
supervise care provided to these veterans in the residential
treatment programs. 

The DCHV program, initially authorized under Public Law 100-71, was
established as a specialized treatment component in the existing
domiciliary care program administered by VHA.  This clinical program
provides less intensive care than a hospital or nursing home, but a
higher level than received in community residential care settings. 
The program's purpose is to use VA medical facilities to provide
primary health care, mental health care, and social services to
homeless veterans.  VA has established domiciliary care programs for
homeless veterans at 31 sites around the country. 

VHA has undertaken several other initiatives to assist homeless
veterans, including joint ventures with two federal agencies--the
Department of Housing and Urban Development (HUD) and the Social
Security Administration (SSA).  The HUD-VA supported housing
(HUD-VASH) initiative is designed to provide permanent housing and
ongoing treatment to the harder-to-serve homeless mentally ill
veterans and those suffering from substance abuse disorders.  The
SSA-VA initiative is a joint outreach effort to assist homeless
veterans in obtaining any social security benefits to which they may
be entitled. 

VHA also conducts Compensated Work Therapy (CWT) and Compensated Work
Therapy/Therapeutic Residence (CWT/TR) programs that include
work-for-pay and supervised residential housing.  The CWT and CWT/TR
programs provide homeless veterans and other veterans an environment
that promotes sobriety and responsibility while focusing on
vocational rehabilitation.  The emphasis in this program is to help
veterans develop or relearn life skills and good work habits.  These
include meeting work schedules, learning to work with others, and
performing the routine duties of everyday living. 

VHA vet centers are designed to assist Vietnam-era, Persian Gulf, and
other post-Vietnam conflict veterans readjust to civilian life.  Vet
centers are generally located in urban areas, which makes them
accessible to homeless veterans.  Each of the 202 vet centers has
identified a homeless coordinator who, as a collateral duty, is
responsible for ensuring outreach, counseling, and referral for
homeless veterans. 

Homeless veterans can also receive medical services at 171 VA
hospitals.  These services include inpatient and outpatient medical,
mental, and substance abuse treatment.  In addition, homeless
veterans can access long-term health programs such as domiciliary and
nursing home care.  VHA has appointed homeless coordinators at 161 VA
hospitals. 

The Veterans Benefits Administration (VBA) has designated homeless
coordinators in its 58 regional offices.  However, individuals
assigned this role perform it as a collateral duty that is
accomplished in conjunction with other activities.  VBA policy also
permits regional offices to assign personnel in the local community
to conduct outreach in homeless shelters and other areas where the
homeless congregate.  Conducting outreach increases the opportunity
for VBA staff to identify homeless veterans and assist them in
obtaining any veterans' benefits to which they are entitled. 

VA's Shelter for Homeless Veterans Through Acquired Property Sales
Program was authorized in 1987 under section 9 of the Veterans' Home
Loan Program Improvements and Property Rehabilitation Act.  This
program allows organizations working on behalf of the homeless to
purchase VA-acquired property.  The law was extended by the Homeless
Veterans Comprehensive Service Programs Act of 1992, which allows VA
to lease, lease with an option to purchase, or donate VA-acquired
properties to nonprofit organizations, veterans' organizations, and
others for the purpose of sheltering homeless veterans and their
families.  VA medical centers can also obtain VA-acquired properties
for specially funded homeless veterans treatment programs, including
the CWT/TR and HCMI programs. 

As of January 1994, VA had over 12,100 properties available for
purchase through the Acquired Property Sales program at discounts
ranging from 5 to 50 percent of the listed sales price of the
property.  However, from July 1988 to December 1993, only 49
properties had been purchased from VA by homeless assistance
organizations.  In March 1993, VA initiated a 3 year test of leasing
properties to eligible organizations.  No more than 50 properties
will be placed in this program nationwide. 

Public Law 102-405, approved October 9, 1992, requires VA, among
other things, to assess all programs developed by its facilities that
have been designed to assist homeless veterans.  In carrying out this
provision of the law, each medical center director is required to
list and describe public and private programs that assist the
homeless in the area concerned, assess the needs of homeless veterans
living in the area served by the center, and encourage the
development of a plan to coordinate the provision of services to
homeless veterans among area public and private programs. 


--------------------
\5 Some HCMI programs use a broader name--Health Care for Homeless
Veterans (HCHV)--as an umbrella term to (1) describe their various
homeless programs including HCMI and (2) to avoid use of the term
"chronically mentally ill." For clarity and consistency in this
report, we use the term HCMI to describe this program in all
locations. 

\6 The HCMI program serves homeless veterans who have severely
limited resources and who suffer from severe psychiatric and
substance abuse disorders. 


   RESULTS IN BRIEF
------------------------------------------------------------ Letter :2

VA staff assigned to homeless activities in Boston and Dallas closely
coordinate with federal, state, local, and private organizations that
deal with homelessness.  In these locations, VA has a wide range of
facilities and programs, including medical centers, veterans benefits
offices, and HCMI, DCHV, CWT and CWT/TR programs.  VA staff in these
programs (1) work with community providers, (2) conduct outreach to
identify and assist homeless veterans, and (3) participate in local
coalition meetings.  Conversely, in Flint there is no medical center
or other VA facility in the immediate area.  As a result, no VA
outreach is being performed to identify homeless veterans and there
is no coordination with community providers.  The extent to which VA
interacted with providers at other locations we visited depended on
many factors, including (1) the magnitude of the homeless problem in
the community, (2) the number of VA facilities or homeless programs
operating in the area, and (3) the priority that local VA officials
assigned to VA's work with the homeless. 

VA's current programs constitute a small portion of what is likely
needed to fully address the needs of the homeless veteran population. 
Local communities provide emergency services of food, clothing, and
shelter to veterans who are part of the overall homeless population,
and VA concentrates its efforts on (1) serving these veterans'
medical needs, (2) serving a limited number of homeless in its HCMI,
DCHV, and other programs designed to address homelessness, (3)
providing monetary benefits to those who are eligible, and (4)
linking homeless veterans with assistance available from other
sources in the community.  But the demand for services to homeless
veterans far exceeds VA program capacity.  For example, in fiscal
year 1992, VA's HCMI and DCHV residential programs served about 5,500
veterans.  Approximately 16,200 additional contacts, with no
residential care, were made with veterans under the HCMI program. 
Further, from August 1992 through December 1993, approximately 368
veterans received housing under the HUD-VASH program,\7 and in fiscal
year 1993, about 6,600 veterans received job training through the CWT
and CWT/TR programs.\8 There are an estimated 150,000 to 250,000
veterans in need.  However, in an era of tight budget constraints,
enhancing the services for the homeless could require curtailing
services to other veterans. 

Prior to release of a patient from a VA medical center, HCMI, or DCHV
program, VA staff are expected to refer the veteran to other VA or
community providers when further care is needed, and follow up with
veterans after discharge to monitor their post-treatment status.  VA
staff generally referred patients who were about to leave a medical
center to other VA and community providers.  But staff seldom
monitored the veterans' progress after release from VA inpatient
facilities. 

VA has made little progress in compiling a comprehensive inventory of
the needs of the homeless veteran population as required by Public
Law 102-405.  VA officials recognize this and are developing a model
to guide the medical center and regional benefits office directors'
efforts to (1) determine the needs of homeless veterans and (2)
develop a plan of action to meet those needs.  VA estimates that its
report on these efforts will be issued by the summer of 1995. 


--------------------
\7 An additional 74 veterans nationwide have vouchers but have not
located an apartment for rent. 

\8 VA does not know how many of the approximately 6,600 veterans are
homeless. 


   VA'S OUTREACH AND COORDINATION
   WITH HOMELESS SERVICE PROVIDERS
   VARIES BY COMMUNITY
------------------------------------------------------------ Letter :3

VA's outreach and coordination with community providers in the
locations that we visited varies widely.  Effective outreach and
coordination between VA and non-VA homeless providers helps ensure
that resources are used as effectively as possible and that as many
veterans as possible receive the services they need.  In two of the
eight locations visited (Boston and Dallas), we found relatively high
VA involvement in the community in that VA staff were actively
working to (1) cultivate good working relationships with the
community and its service providers, (2) routinely conduct outreach
to homeless veterans at local facilities, and (3) participate in
local homeless coalition meetings and activities. 

Factors resulting in positive VA involvement in these locations
included medical center management's support of homeless initiatives
and strong personal commitment by VA staff members to help the
homeless.  Conversely, in two locations, VA's outreach and
coordination was minimal because it either lacked a presence in the
area (Flint), or its staff saw these functions as futile since VA or
community resources were already filled to capacity with walk-in and
referral clients alone (Pensacola).  Outreach and coordination
efforts in Huntington, Minneapolis, San Francisco, and Washington,
D.C., were between these two extremes. 

In Dallas and Boston, VA homeless program personnel are part of the
community's response to homelessness through their active
participation in local coalition meetings and activities that address
homelessness.  In addition, they performed regular outreach visits to
major homeless providers, including shelters, to maintain working
relationships and to identify veterans who need VA services.  They
also accepted referrals from other providers when homeless veterans
were eligible for VA services and referred veterans to community
homeless providers.  In general, the community providers that we
visited were aware that VA was attempting to identify and assist the
homeless veterans and knew how to access VA programs. 

In Washington, D.C., VA outreach is performed at the location of many
local providers; however, overall coordination activities are not as
comprehensive as those in Boston and Dallas.  Coordination between VA
staff and local providers in Washington, D.C., consists of monthly
HCMI staff visits to about 15 providers' facilities (the number of
monthly visits varies among the providers) and participating in
several locally sponsored events for the homeless such as a stand
down\9 and an event to assist the homeless during the tenth
anniversary of the Vietnam War Memorial.  Further, VA officials
participate in several local coalitions for the homeless.  Most
community providers told us that they have little or no knowledge
about VA's homeless programs.  Rather, they rely on two or three VA
staff for information when needed. 

In San Francisco, VA's outreach and coordination is fairly limited
and not very visible.  VA staff regularly visit five homeless
providers but do not conduct extensive outreach to veterans in the
community.  As a consequence, the local providers we met with did not
consider VA part of the homeless community and did not view it as a
significant player in the fight against homelessness. 

Before July 1993, VA's outreach and coordination with the Minneapolis
community was performed by staff from the veterans benefits office
and the vet center.  They (1) conducted outreach to local shelters to
identify homeless veterans who were eligible for VA benefits and
needed readjustment counseling and (2) participated in bimonthly
meetings with public and private homeless and health care providers. 
In July 1993, the medical center instituted a homeless program.  VA
staff also participated in a stand down held in Minneapolis in August
1993. 

VA's outreach and coordination with local service providers in
Huntington, West Virginia, is performed by the veterans benefits
office and vet center homeless coordinators who periodically visit
Huntington's homeless providers.  The medical center director told us
that the needs of homeless veterans in Huntington are addressed on a
case-by-case basis and that because the city is small and VA and
community providers are close to each other, coordination works well. 
Officials representing the community providers we met with generally
agreed that they have been able to coordinate effectively with VA. 

VA coordination with community providers in Pensacola is minimal.  VA
personnel are not part of the local homeless coalition and are not
performing outreach to local providers or to veterans.  VA personnel
told us that this lack of outreach is due to limited resources.  In
their opinion, VA and non-VA resources to house and treat the
homeless fall short of the demand, and not enough resources exist to
help walk-in and referral clients.  Thus, they believe that
performing outreach in this environment is futile.  VA does not have
a medical center in Pensacola but does have an outpatient clinic, a
veterans benefits office, and a vet center. 

VA has no presence in Flint and only minimal communication exists
between the nearest VA medical center, which is about 35 miles away
in Saginaw, Michigan, and the community homeless service providers in
Flint.  Further, providers in Flint told us that they are reluctant
to refer homeless veterans to the VA medical center in Saginaw
because (1) many do not have access to transportation and VA does not
provide any, (2) they cannot be sure that veterans will actually
receive treatment at the medical center, and (3) the possibility
exists that veterans might be stranded in Saginaw without care or
transportation back to Flint.  As a result, homeless veterans
generally do not have access to VA services, and they rely on
community resources to meet their needs. 


--------------------
\9 A stand down is a locally sponsored 2- or 3- day event during
which homeless veterans gather at one location and receive food,
clothing, health care, and various other services from VA- and
non-VA-sponsored sources. 


   DEMAND FOR HOMELESS SERVICES
   EXCEEDS VA PROGRAM CAPACITY
------------------------------------------------------------ Letter :4

VA does not have a comprehensive nationwide program to either help
prevent veterans from becoming homeless or take homeless veterans off
the streets.  VA concentrates its homeless efforts on (1) serving the
medical and psychological needs of homeless veterans at its medical
centers, (2) serving homeless veterans in a limited number of
geographic locations through programs designed to address
homelessness, (3) providing monetary benefits to homeless veterans
who are eligible, and (4) linking homeless veterans with assistance
available from other sources in the community.  While some social
services, such as housing and job training, are available to homeless
veterans in some locations, in the areas we visited, homeless
programs are either unavailable or too small to meet the need.  But
homeless veterans are not exclusively the responsibility of VA. 
Veterans are part of the homeless population that all of the non-VA
homeless programs (federal, state, public, and private) are designed
to assist.  Table 1 contains a summary of VA programs that assist the
homeless in the eight locations we visited. 



                                     Table 1
                     
                        VA Programs at Selected Locations

                                            HUD-      CWT-CWT/
Location            VAMC\a  HCMI    DCHV    VASH      TR          VC\b    VBARO\
------------------  ------  ------  ------  --------  ----------  ------  ------
Boston              X       X       X\c\    X\c\      X\d         X       X

Dallas              X       X       X       X         X           X       X\e

Flint               N/A     N/A     N/A     N/A       N/A         N/A     N/A

Huntington          X       N/A     N/A     N/A       N/A         X       X

Minneapolis         X       X       N/A     N/A       N/A         X\f     X\f

Pensacola           X\g     N/A     N/A     N/A       N/A         X       X\g\

San Francisco       X       X       X\h     X         X           X       X\i

Washington          X       X       N/A     X         X\j         X       X
--------------------------------------------------------------------------------
N/A--Not available. 

\a VA medical center. 

\b Vet center. 

\c The DCHV and HUD-VASH programs are located at the Bedford VA
Medical Center in Bedford, Massachusetts. 

\d CWT and CWT/TR programs are located at medical centers in both
Boston and Bedford, Massachusetts. 

\e The VBA regional office is located in Waco, Texas.  A regional
office staff person is assigned full time to the HCMI program in
Dallas. 

\f The VC and the VBA regional office are located in St.  Paul,
Minnesota. 

\g The VA medical facility is an outpatient clinic and a VBA benefits
office is located at the clinic. 

\h The DCHV is located in Palo Alto, California. 

\i The VBA regional office is located in Oakland, California. 

\j The CWT program has no therapeutic residences (TRs) and is not
part of the homeless initiatives in Washington, D.C. 


      VA MEDICAL CENTERS
---------------------------------------------------------- Letter :4.1

All veterans who meet eligibility requirements are entitled to
medical services provided through VA's 171 hospitals.  Veterans with
incomes below $19,408 are generally given priority for medical care
over veterans with higher incomes.  In addition to the medical
services provided, many of these centers also provide treatment for
psychiatric illness and substance abuse--services needed by many
homeless veterans.  For example, of VA's approximately 1 million
fiscal year 1992 inpatient discharges, 115,000 were from inpatient
substance abuse treatment programs and 110,000 were from inpatient
treatment of mental illness.  More than 95 percent of the veterans
discharged from the substance abuse programs were classified as poor. 
However, no precise data exists on how many of the veterans
discharged from these two programs were homeless.  Of the seven
medical centers we visited, all provided some type of psychiatric
care and substance abuse treatment. 

VA central office requires staff at VA medical facilities to identify
homeless veterans who received treatment and report the number of
such cases to the central office.  But during 1992, VA central office
stopped accumulating this information because the process being used
to gather it was too cumbersome. 


      HCMI AND DCHV PROGRAMS
---------------------------------------------------------- Letter :4.2

VA's HCMI and DCHV programs are designed to assist homeless veterans
who suffer from psychiatric, substance abuse, and medical problems. 
These programs require participants to take part in activities to
address mental illness, drug and alcohol abuse, and other problems
related to their homelessness.  Participants may also receive
counseling, vocational assistance, housing and employment help, and
discharge planning as required. 

HCMI programs are located at 57 VA medical facilities,\10 and DCHV
programs are available at 31 VA medical facilities.  Twelve of these
facilities have both HCMI and DCHV programs.  During fiscal year
1992, the residential component of the HCMI program served about
2,700 veterans and the DCHV program treated approximately 2,800
veterans.  Approximately 16,200 additional veterans were served by
HCMI staff and received services such as medical and psychiatric
assessment, substance abuse treatment, and job counseling. 

In the eight locations that we visited, five had HCMI programs and
two had DCHV programs.  All available beds in both programs were
consistently filled, and waiting times ranged from a few days to as
long as 8 weeks.  For example, in San Francisco, the HCMI program has
11 contract beds to serve an estimated 2,000 to 3,300 homeless
veterans.  We were told that veterans seeking help who meet the
program eligibility requirements may wait up to 2 months before they
are admitted to the HCMI residential program.  The situation is
similar in Washington, D.C.  Its HCMI program has an average of 11
contract beds to serve an estimated 3,300 to 6,700 homeless veterans. 
We were told that eligible veterans may wait up to 6 weeks before
admission to this program.  The waiting times for the 17 HCMI beds in
Dallas ranged up to 2 months and up to 2 weeks for the 8 beds in
Boston.  Waiting times for the DCHV program ranged from about 3 to 4
weeks in Dallas.  Waiting times often do not accurately reflect
homeless veterans' needs in an area because in some cases veterans
may not meet VA program admission requirements, or veterans may not
trust VA or want VA services. 


--------------------
\10 Seven of these 57 HCMI locations do not provide residential
treatment. 


   HUD-VASH
------------------------------------------------------------ Letter :5

During fiscal year 1992, HUD provided $17.9 million for about 600
housing vouchers to support the HUD-VASH initiative.  These housing
vouchers are subsidies to be used by homeless veterans to pay all or
part of their monthly rent.  VA distributed the vouchers among 19
locations.\11 The subsidy will cover that portion of the rent that
exceeds 30 percent of the veteran's income.  Veterans with no income
will have their rent fully subsidized, up to the local rental payment
standard (determined by locally standardized fair market rental
rates).  Eventually, veterans whose incomes increase may not be
qualified for continued rental subsidy. 

In the locations we visited, VA received a total of 118 vouchers--32
in Bedford, 27 in Dallas, 31 in San Francisco, and 28 in Washington,
D.C.  Since August 1992, VA has placed 73 veterans in housing--22 in
Bedford, 14 in Dallas, 20 in San Francisco, and 17 in Washington,
D.C.  Another 29 veterans received vouchers but have not found an
apartment.  As of December 1993, 16 vouchers remain to be assigned to
veterans. 

To be eligible for the HUD-VASH program, VA requires that veterans

  must have been homeless for 30 or more days before their initial
     contact with the HCMI or the DCHV program and must live in a
     shelter or on the street (exceptions are allowed in some cases
     to reduce the 30-day requirement);

  must have a major substance abuse or psychiatric disorder resulting
     in significant disability;

  must have participated in the outreach/assessment, acute treatment,
     or residential phases of the HCMI or DCHV programs;

  demonstrate an interest in changing their lifestyle and in
     returning to work or to some other socially productive activity;
     and

  be prepared to make a long-term commitment to participate in a VA
     program of community-based treatment, rehabilitation, and
     supported housing. 

The 16 vouchers remain undistributed primarily because of the efforts
needed to prepare homeless veterans for independent living.  It is
often very difficult for these veterans to reach and maintain a sober
and motivated condition.  Relapses into substance abuse often occur,
and the veteran must receive additional treatment.  In addition,
veterans must have some source of income to meet living expenses
other than rent.  This is often difficult to achieve for veterans who
have not worked and are not receiving Social Security income or other
benefits or whose benefits are insufficient to meet their needs. 
This is especially important in localities where general public
assistance is not available. 


--------------------
\11 HUD-VASH programs are located in American Lake, Washington; Bay
Pines, Florida; Bedford, Massachusetts; Brooklyn, New York;
Cincinnati and Cleveland, Ohio; Dallas, Texas; Little Rock, Arkansas;
Loma Linda, California; Manhattan, New York; New Orleans, Louisiana;
Nashville, Tennessee; San Antonio, Texas; San Diego and San
Francisco, California; Tucson, Arizona; Washington, D.C.; West Haven,
Connecticut; and West Los Angeles, California. 


      CWT AND CWT/TR
---------------------------------------------------------- Letter :5.1

The CWT program (also known as Veterans Industries) is conducted at
68 VA medical facilities.  It emphasizes vocational assessment,
rehabilitation, and improved work skills and habits through both
workshops and employment.  Under this program, VA contracts with
private industry and the public sector to secure work for disabled
veterans and uses the work as a therapeutic tool to improve the
veterans' functional levels and mental and physical health.  In
Bedford and Dallas, the work is performed in both VA facilities and
in contractors' work space.  The work assigned usually involves
manual tasks such as assembling packing boxes or preparing material
for shipment.  In fiscal year 1993, about 6,600 veterans participated
in the CWT and CWT/TR programs nationwide.  VA does not know how many
of these veterans are homeless. 

VA has established 21 CWT/TRs\12 that provide housing for veterans
while they work in the CWT program.\13 While in these residences,
veterans use a portion of their CWT wages to cover rent, utilities,
and food costs and practice activities of daily living to regain the
skills necessary for greater independence.  In the cities we visited,
Boston and Dallas have purchased homes for veterans that are
designated as therapeutic residences.  In Boston, VA purchased two
houses with a capacity of 22 veterans and, in Dallas, VA purchased
four houses with a capacity of 20 veterans.  Neither Bedford nor San
Francisco had acquired properties for their CWT/TR programs as of
January 1994. 


--------------------
\12 CWT/TR programs are located in Albany, New York; American Lake,
Washington; Atlanta, Georgia; Battle Creek, Michigan; Bedford,
Massachusetts; Boston, Massachusetts; Cleveland, Ohio; Dallas, Texas;
Ft.  Meade, South Dakota; Hampton, Virginia; Kansas City, Missouri;
Knoxville, Iowa; Lebanon, Pennsylvania; Little Rock, Arkansas; North
Chicago, Illinois; Northampton, Massachusetts; Oklahoma City,
Oklahoma; Palo Alto, California; Pittsburgh, Pennsylvania; San
Francisco, California; and Topeka, Kansas. 

\13 As of January 1994, five of the CWT/TR sites had not purchased or
rented any properties to house veterans. 


      VET CENTERS
---------------------------------------------------------- Letter :5.2

Vet center staff provide outreach, counseling, and referral services
to homeless veterans.  The staff in the Boston and Minneapolis Vet
Centers conduct regular outreach to homeless providers in the
community to identify and assist homeless veterans.  Specifically,
they have (1) developed working relationships with service providers,
(2) coordinated VA homeless activities with local providers, and (3)
identified and assisted homeless veterans. 

In Dallas, a vet center staff member visits one homeless service
provider and conducts outreach to veterans on the streets once a
week.  The staff of the Huntington Vet Center conduct limited
outreach specifically directed toward homeless individuals but do
interact with churches and other organizations that work with the
homeless.  The Pensacola Vet Center staff have established a close
working relationship with one local organization that focuses its
efforts on assisting homeless veterans.  In Washington, D.C., vet
center staff coordinate with community organizations and local
universities to assist veterans, including the homeless.  Staff at
the vet center in San Francisco do not regularly visit homeless
service providers or perform consistent outreach in the community to
identify and assist homeless veterans. 


      VBA REGIONAL OFFICES
---------------------------------------------------------- Letter :5.3

In 1986, the VBA established an Outreach and Public Information
Program to ensure that homeless veterans were aware of and had access
to VA benefits and services.  In 1991, in response to the large
number of homeless veterans, the VBA enhanced its homeless outreach
program.  It directed every VBA regional office to designate staff to
regularly contact homeless service providers in the community,
disseminate information about VA services to the homeless at local
service providers and at other areas where the homeless congregate,
and conduct other activities that will enable VBA to identify and
provide services and benefits to homeless veterans. 

VBA regional office staff in Minneapolis and Dallas (staff assigned
from the St.  Paul, Minnesota, and Waco, Texas, Regional Offices)
make a concerted effort to identify and assist homeless veterans. 
These staff work closely with service providers and visit major
homeless shelters in their communities.  In Boston, VBA staff perform
outreach and provide direct services to veterans at one major
shelter.  Staff are stationed at VA medical centers in the region and
attend meetings of the Boston Homeless Steering Committee.  In
Washington, D.C., VBA staff do not perform outreach but interact with
service providers by phone to maintain a working relationship and to
elicit referrals of homeless veterans.  Until June 1993, the VBA
regional office in Oakland (the regional office relocated from San
Francisco in 1993) dedicated one staff member to conduct outreach on
the streets of San Francisco to identify and assist homeless
veterans.  However, because of staffing constraints, the regional
office eliminated the position and currently does not perform any
activities specifically for homeless veterans.  Likewise, the
Pensacola regional benefits office performs no outreach to homeless
veterans. 


   VA DISCHARGE PLANNING FOR
   HOMELESS VETERANS NEEDS
   IMPROVEMENT
------------------------------------------------------------ Letter :6

Planning for the successful discharge of a homeless veteran from a VA
medical center is an essential element of good patient care. 
Discharge planning begins at the time a veteran is admitted for care
and includes an assessment of the patient's self-care needs upon
discharge, patient education, and coordination with community
providers to ensure that basic services such as food, clothing,
shelter, and continued nursing and medical services will be available
to the veteran.  However, our review of the patient files of 82
homeless veterans showed that discharge planning at the medical
centers and HCMI and DCHV programs we visited needs improvement.  VA
staff at each location generally told the veterans where to go to
obtain needed services upon discharge from the program.  However, the
files often did not reflect whether VA monitored the veterans'
post-treatment status.  VA officials told us that while they would
like to conduct follow-up activities, they are hampered by such
factors as inadequate staffing, difficulties in maintaining contact
with homeless veterans, and resistance by some veterans to continued
VA involvement in their lives. 


   VA ASSESSMENTS OF THE NEEDS OF
   HOMELESS VETERANS ARE NOT BEING
   PERFORMED
------------------------------------------------------------ Letter :7

VA has made limited progress in complying with the requirements of
section 107 of Public Law 102-405.  In August 1993, VA provided the
Senate and House of Representatives Committees on Veterans Affairs
with a report entitled Services for Homeless Veterans.  This report
discussed programs developed by VA's medical centers designed to
assist homeless veterans.  It addressed specially funded as well as
locally developed programs with an emphasis on VA's efforts to
collaborate with community providers and organizations.  But as of
January 1994, VA had not (1) identified public and private homeless
programs;\14 (2) determined homeless veterans' needs; or (3)
encouraged the development of a coordination plan with local
providers, as required by Public Law 102-405. 

VA officials acknowledge that more needs to be done to meet the
requirement of the law.  In November 1993, VA's central office staff
began discussions that focused on creating a model to assist medical
center and regional office directors in determining the needs of
homeless veterans in their communities.  The Associate Director of
VA's Policy, Programs, and Operations in its Mental Health and
Behavioral Sciences Service told us that the medical center and
regional office directors would use the model to develop a plan of
action to meet those needs.  On February 10, 1994, after reviewing a
draft of this report, VA provided us with estimates indicating that
the model could be developed and distributed to all medical center
and regional office directors by the winter of 1994-1995 and that a
final report could be issued in the summer of 1995.  Specific target
dates were not established. 


--------------------
\14 VA has contracted with the National Coalition for Homeless
Veterans to develop a comprehensive list of all providers of services
to homeless veterans.  But, as previously stated, veterans are served
by all homeless providers and VA should obtain a comprehensive list
of all community organizations that serve the homeless. 


   CONCLUSION
------------------------------------------------------------ Letter :8

Despite the good faith efforts of VA program staff, the capacity of
VA's programs to serve homeless veterans is far short of the demand
for such services.  Further, VA services for homeless veterans are
not available in many localities in the United States.  While the
immediate food, shelter, and clothing requirements of these veterans
are generally served by community providers, the substance abuse,
mental health, and housing problems confronting them are not easily
addressed by either VA or the community.  In fact, the inability of
local VA facilities to accommodate all of the veterans who are in
need continually hinders VA's outreach programs. 

Under Public Law 102-405, every VA medical center is required to
conduct assessments of homeless veterans' needs, determine the
availability of VA and other services in their respective areas, and
encourage the development of plans to address those needs in
coordination with public and private providers.  VA has not performed
these assessments and while general time frames have been proposed,
no specific target dates have been set.  Until it makes and analyzes
comprehensive needs assessments, VA cannot accurately state what the
demands on its health care system will be if it is to adequately
address homeless veterans' issues. 

Given the sheer numbers of veterans who are homeless, if VA is to
become actively involved on a nationwide basis to deal with the
medical and social concerns of these individuals, existing substance
abuse, mental health, and housing programs will need to be
substantially expanded and enhanced.  Such action could require VA to
open new beds, hire more staff, contract with private providers of
health care/housing, and either renovate buildings or allow private
homeless organizations to do so to provide temporary housing or
domiciliary care.  However, in an era of tight budget constraints,
enhancing the services for the homeless could require curtailing
services to other veterans. 


   RECOMMENDATION
------------------------------------------------------------ Letter :9

We recommend that the Secretary of Veterans Affairs direct the Under
Secretary for Health to initiate, without delay, the assessments
required under section 107 of Public Law 102-405 and establish a firm
date for completion of the assessments and submission of the results
to the Senate and House Committees on Veterans' Affairs. 


---------------------------------------------------------- Letter :9.1

As requested by your staff, we did not ask for VA's written comments
on a draft of this report.  However, we discussed it with VA program
officials and incorporated their comments where appropriate. 

Copies of this report are being sent to appropriate congressional
committees, the Secretary of Veterans Affairs, and other interested
parties.  We will also make copies available to others upon request. 
If you or your staff have any questions about this report, please
contact David P.  Baine, Director, Federal Health Care Delivery
Issues, at (202) 512-7101.  Other major contributors are listed in
appendix X. 

Sincerely yours,

Janet L.  Shikles
Assistant Comptroller General


SCOPE AND METHODOLOGY
=========================================================== Appendix I

On February 17, 1993, the Chairman of the Senate Committee on
Veterans' Affairs asked us to review certain Department of Veterans
Affairs activities related to homeless veterans.  The Chairman noted
that VA, other federal, State, and local agencies, as well as private
organizations, provide assistance to homeless people, including
veterans, but that homelessness continues as a national problem of
great magnitude.  The Chairman requested that we specifically focus
on (1) the extent to which VA staff interact with VA and other
homeless programs in various locations, (2) VA's discharge planning
efforts to prevent veterans from being discharged to the streets, and
(3) VA's progress in implementing section 107 of Public Law 102-405,
requiring, among other things, a comprehensive assessment of the
needs of homeless veterans. 

In conducting our review, we interviewed key management officials and
obtained relevant information at VA's central office, Washington,
D.C., visited eight locations in the United States to identify local,
as well as VA responses to homelessness, and reviewed a limited
number of case files for homeless veterans discharged from seven VA
medical centers, four HCMI residential treatment programs, and two
DCHV programs.  We conducted audit work in the following locations: 
Boston, Massachusetts;\1 Dallas, Texas; Flint, Michigan; Huntington,
West Virginia; Minneapolis, Minnesota; Pensacola, Florida; San
Francisco, California; and Washington, D.C.  We selected these
locations primarily because they have diverse climate conditions,
differing levels of VA presence in the community, both urban and
rural population centers, and geographic dispersion. 

To determine the extent of coordination between VA and other homeless
service providers, we interviewed officials from VA and major non-VA
organizations in the eight locations visited.  Non-VA personnel
interviewed included representatives from city and county governments
and entities, local homeless coalitions, shelters, soup kitchens,
veteran service organizations, private treatment and case management
providers, and medical and psychiatric care associations.  From these
meetings we determined the efforts being made in the community to
address homelessness issues; the estimated number of homeless
veterans in the area; the non-VA community's knowledge of VA
programs; the extent to which VA performs outreach and makes
referrals to community providers; VA's involvement in community
planning, coalitions, and activities; and the extent to which VA has
coordinated the discharges of homeless veterans from its programs
with community providers. 

VA officials interviewed included those representing the following
programs and entities: 

  medical center and social work services,

  Health Care for Homeless Veterans,

  Domiciliary Care of Homeless Veterans,

  Comprehensive Homeless Center (CHC),

  Compensated Work Therapy/Therapeutic Residences,

  vet centers,

  Veterans Benefits Administration regional offices,

  Housing and Urban Development/VA Supported Housing, and

  Social Security Administration-VA Joint Outreach Initiative. 

From these meetings, we determined the scope of each VA homeless
program in the area; VA staff knowledge of other federal, state, and
local (both government and private) homeless efforts; the extent to
which VA staff coordinate with other homeless providers and outreach
to homeless veterans in the area; and VA's discharge planning
efforts. 

During our visits to VA medical centers, HCMI, and DCHV sites, we
reviewed individual case records to assess discharge planning efforts
by VA personnel.  We determined whether the files contained
documentation showing that the veterans received discharge planning
and referrals to other VA and non-VA homeless programs.  We also
looked for documentation that VA staff made follow-up contacts with
veterans after release from VA programs.  In total, we reviewed 82
case files selected randomly from discharges made from April 1, 1992,
to March 30, 1993. 

The progress VA was making to comply with the provisions of section
107 of Public Law 102-405 was determined through interviews with VA
central office officials. 


--------------------
\1 In Boston, we conducted audit work at two VA medical centers in
close proximity--Boston and Bedford--to review homeless programs that
they jointly conduct to provide services to homeless veterans from
the Boston area. 


PROGRAMS TO ADDRESS HOMELESSNESS
IN BOSTON, MASSACHUSETTS
========================================================== Appendix II


   I.  EXTENT OF HOMELESSNESS
-------------------------------------------------------- Appendix II:1

Each year the city's Emergency Shelter Commission conducts a survey
of the homeless in Boston, including adults and children in locations
such as emergency and transitional shelters, detoxification units,
and mental health facilities, as well as those on the streets.  The
December 1993 survey determined that the homeless population was
4,809 compared to 4,411 in December 1992.  The homeless veteran
population, local and federal officials believe, accounts for about
one-third (1,500) of the total homeless population. 


   II.  LOCAL MANDATES TO PROTECT
   THE HOMELESS
-------------------------------------------------------- Appendix II:2

For several years Boston city officials, especially under former
Mayor Raymond Flynn and current Mayor Thomas Menino, have made a
commitment that no individual will go without (1) a bed in a warm
place, (2) transportation to shelter, (3) adequate health care, and
(4) food simply because they are poor.  When all shelter space is
exhausted during adverse winter conditions, the city's policy is to
rent motel rooms for the homeless. 


   III.  VA SERVICES PROVIDED TO
   HOMELESS VETERANS
-------------------------------------------------------- Appendix II:3

VA, through its Boston and Bedford medical centers, the Veterans
Benefits Administration regional office, and the Readjustment
Counseling Service Vet Center, all play an active role in the Boston
area dealing with homeless veterans.  VA also funds two CWT and
CWT/TR programs, an HCMI, a DCHV, and a HUD-VASH program between the
two medical centers. 

The Boston area has two VA medical centers in close
proximity--Bedford and Boston.  The Boston VA Medical Center provides
medical care.  The Bedford VA is a psychiatric facility and offers a
6-month treatment program and a work therapy environment.  In
addition to offering services to the homeless, the medical centers
have homeless coordinators and staff who provide outreach to the
major shelters in Boston. 

Staff from the Boston Vet Center conduct outreach for homeless
veterans at the New England Shelter for Homeless Veterans (NESHV) and
work with the staff of another smaller shelter.  Services the vet
center staff provide the homeless include individual and group
counseling, medical assessments, case management, and referrals to
other VA and community programs. 

The Boston VBA homeless coordinator interacts with all major shelter
providers as well as with VA medical center staff who conduct
outreach.  Further, the VBA has benefits counselors at both the
Boston and Bedford Medical Centers to whom social workers refer
homeless veterans.  A VBA official estimated that they served about
230 homeless veterans in fiscal year 1993.  However, the estimate
reflects only those veterans who indicated that they were homeless. 
Veterans are not asked if they are homeless when they seek VBA
assistance. 

Boston VA Medical Center's CWT and CWT/TR programs serve homeless and
other veterans who have substance abuse problems.  Boston received
initial funding for this program from VA's central office in fiscal
year 1990.  In February 1991 and January 1992, Boston purchased two
houses to be used for therapeutic residences through VA's central
office funding.  The residences house 22 veterans who are involved
with treatment that sometimes exceeds 1 year.  While in the program,
the veterans receive housing and are offered transitional employment. 
While working and living at the residences, they are expected to use
the VA medical center's outpatient substance abuse clinic. 

Bedford's CWT/TR program first received funding from VA's central
office in fiscal year 1991.  However, the Bedford VA has operated a
CWT program using its own operating funds for more than 30 years. 
Currently, about 250 veterans participate in these programs each week
and work at public- and private-sector jobs.  Participation in the
program usually lasts for about 4 months.  As of January 1994,
Bedford had not acquired housing properties for its CWT/TR program. 

In fiscal year 1987, VA began funding an HCMI program at the Boston
VA Medical Center.  The residential treatment segment of this program
currently has eight beds. 

In February 1991, the medical center expanded the mission of the HCMI
program to include permanent affordable housing assistance to the
homeless.  To be eligible, veterans must have a general or honorable
discharge, stay in shelters, on the street or its equivalent, or be
in transitional or rehabilitative placements because of their
homeless status.  The center recruits participants through intensive
outreach services at the many shelters and soup kitchens in Boston's
downtown area and along public transit feeder paths.  Another major
referral source are peers of homeless veterans who are presently
involved in, or who have already accomplished their housing goals
through this group process.  The Boston VA staff screen approximately
40 veterans per month.  During fiscal year 1993, the staff assisted
117 veterans in obtaining permanent subsidized housing. 

In a joint initiative with HUD, VA helps chronically mentally ill and
substance abusing veterans find and secure permanent housing
supported, in part, by HUD Section 8 rental assistance vouchers.  VA
also provides these veterans with longer term clinical support and
case management in permanent housing.  The Bedford VA operates the
program.  The director issued the first of 32 vouchers in January
1993.  As of December 1993, 27 vouchers had been awarded.  The
program allows families to stay together and has an active waiting
list of 20 veterans. 

In 1989, the Bedford and Boston medical centers jointly proposed a
domiciliary program to get the homeless veterans in Boston off the
streets.  The maximum length of time a veteran can stay in the
program is 6 months.  The first 2 months provide education, family
therapy, and coping skills.  The last 4 months primarily involve
participation in the CWT program as well as trying to find housing in
the community.  Program candidates must have at least 30 days of
abstinence from drugs or alcohol before entering the program, so
Bedford established a transitional house in Leominster.  This allows
staff to evaluate individuals on the waiting list to ensure that they
are substance free before they enter the program.  The waiting list
varies, but when we reviewed the program, it contained the names of
21 people.  The program has 40 operating beds.  In fiscal year 1993,
116 homeless veterans participated in the program. 


   IV.  VA'S OUTREACH/COORDINATION
   WITH LOCAL ORGANIZATIONS
   SERVING THE HOMELESS
-------------------------------------------------------- Appendix II:4

VA's outreach and coordination in the Boston community of providers
to the homeless consist of the following: 

  Regular visits to all of the major shelters in Boston by staff from
     the Boston Medical Center as well as periodic visits to the
     smaller shelters.  Vet center staff also regularly visit a major
     Boston shelter. 

  Periodic visits by VA staff to non-VA service providers outside of
     Boston's city limits to make them aware of VA's services to the
     homeless. 

  Assignment of a nurse and a social worker to the New England
     Shelter for Homeless Veterans to evaluate homeless veterans and
     make appropriate referrals to either medical or social services. 

  Participation on the Homeless Steering Committee.  The committee's
     objectives include (1) providing a forum for sharing information
     about services available in the community; (2) providing
     interagency collaboration, support, and coordination on issues
     concerning homelessness; and (3) sharing staff development and
     educational materials on homelessness.  Committee members
     include representatives from VA, the city of Boston, the state
     of Massachusetts, and officials from the major shelters.  The
     committee meets once a month at different locations in the city,
     including various shelters, and periodically has guest speakers. 
     The New England Shelter for Homeless Veterans is a major
     provider that is not currently a member. 

  Participation in a 3-day stand down in August 1993, which attracted
     more than 600 homeless veterans. 


   V.  COMMUNITY PROGRAMS TO AID
   THE HOMELESS
-------------------------------------------------------- Appendix II:5

Boston has numerous local government and nongovernment programs to
aid the homeless.  Programs include city-funded shelters as well as
private organizations that provide food, shelter, and medical and
mental health treatment.  Since January 1984, $116 million of
federal, state, city, and private funds have been spent to assist the
homeless.  Since 1986, Boston's shelter budget has increased by more
than 600 percent. 

The city of Boston funds numerous as well as diverse types of
shelters.  The shelters are predominantly for adults, although a
significant number of beds are set aside for families.  From 1983 to
1992, the number of shelter beds increased from 957 to 3,661.  The
totals include 2,008 adult and 636 family emergency shelter beds. 
The remaining 1,017 units represent transitional housing and
single-room occupancy facilities. 

While Boston has many shelters, two stand out because of the number
of homeless they shelter and feed:  the Pine Street Inn and the Long
Island Shelter, both of which we visited. 

The Pine Street Inn and its ancillary locations provided, as of 1992,
38 percent of the emergency shelter beds in Boston.  It serves both
adult men and women and is considered as a wet facility (i.e., a
shelter that serves guests who are under the influence of alcohol but
are not disruptive to other guests).  Every day guests receive two
meals a day--breakfast and dinner.  In addition, a noon meal is
served to some guests who remain during the day for special programs;
most are required to leave during the day, except during bad weather. 
During 1992, Pine Street served an average of 2,068 meals per day. 
The Inn also provides guests with health care and clothing.  In
addition, counselors are available to work directly with guests,
especially for referrals to employment and housing agencies. 
Further, Pine Street uses its outreach van to provide food and
beverages to the homeless on the streets every night.  Vans also
provide transportation daily to area hospitals and detoxification
centers.  They are also used to help guests get to housing and social
service agencies. 

The Long Island Shelter and its ancillary facilities provided, as of
1992, 34 percent of the emergency shelter beds in Boston.  It
shelters adult men and women and, periodically, some families.  It is
considered a wet facility.  Similar to Pine Street Inn, guests using
the shelter receive two meals a day and are expected to leave during
the day unless they are enrolled in special programs or the weather
is bad.  A variety of services are offered, including case
management, clinical services, work rehabilitation, and employment
services.  Further, vans provide emergency transportation throughout
the night.  The vans travel Boston's streets to ensure safe access to
a shelter for all homeless people during the winter months. 

In addition, Boston has many publicly and privately operated shelters
at locations throughout the city where people can get lodging and
food.  The following are examples of the range of facilities
available to the city's homeless veterans. 


      ST.  FRANCIS HOUSE
------------------------------------------------------ Appendix II:5.1

St.  Francis House is a primary provider of lunch for the homeless
and poor in Boston, serving 500 people daily.  Other services include
providing both physical and mental health care, substance abuse
recovery, and employment service programs. 


      BOSTON HEALTH CARE FOR THE
      HOMELESS
------------------------------------------------------ Appendix II:5.2

The program, founded in 1985, provides access to health care for all
homeless people in the Boston area.  The Robert Wood Johnson
Foundation and the Pew Charitable Trust originally funded this
program as one of 19 national demonstration programs.  Physicians,
nurse practitioners, and case workers deliver care at more than 40
sites, including shelters, soup kitchens, hospitals, and motels.  In
1992, the program treated around 6,000 individuals.  It is
administered by Boston's Trustees of Health and Hospitals and
supported by a variety of public and private funding sources. 


      BOSTON VETERANS SERVICES
      DEPARTMENT
------------------------------------------------------ Appendix II:5.3

The program is a one-stop center for veterans and their dependents. 
Massachusetts General Law, chapter 115, reorganized the program in
1946 to offer a variety of services to homeless veterans in Boston
and other Massachusetts communities.  Veterans can receive either
financial or medical assistance or both.  According to program
officials, Massachusetts is one of only a few states that offers
direct financial assistance to veterans.  During fiscal year 1993,
the Boston office served 1,224 homeless veterans and provided them
with about $124,000 in assistance. 


      NEW ENGLAND SHELTER FOR
      HOMELESS VETERANS
------------------------------------------------------ Appendix II:5.4

NESHV deals exclusively with homeless veterans, was the first shelter
of its kind in the nation, and has served as a model for other
veteran shelters around the country.  The shelter began its operation
in January 1990 and is operated under the guiding principle of
"veteran helping veteran." The shelter provides beds, meals, and
attempts to heal the physical and psychological wounds of veterans. 
It serves veterans regardless of their type of military discharge. 
The shelter, however, has strict sobriety rules; every veteran must
remain sober to stay at the shelter.  Veterans may stay at the
shelter as long as they are trying to improve their situation through
education, training, or work.  Services available include counseling,
substance abuse treatment, job training and placement, housing
placement, optometry, dental care, and legal assistance. 

NESHV currently has 100 permanent beds.  During winter months they
add 30 emergency temporary beds.  By the spring of 1994, construction
is expected to be completed on 59 single room occupancy units.  The
units will be available to veterans who have secured a steady income
while in the shelter program.  These veterans will have to pay 25
percent of their earnings for a permanent residence on site.  No time
limit exists on how long the veterans can stay in the units. 


      VETERANS BENEFITS
      CLEARINGHOUSE (VBC)
------------------------------------------------------ Appendix II:5.5

The VBC, a not-for-profit, community-based organization created in
1977 by a group of Vietnam-era veterans, was established to serve
veterans of color.  Its programs are designed to develop a long-term
plan for each homeless veteran that includes taking a homeless
individual from the shelters through the housing phases of
single-room occupancy units, apartments, and eventually home
ownership.  As part of the long-term plan, VBC provides (1) community
outreach to veterans living in shelters and the streets, (2) training
programs, and (3) counseling for post-traumatic stress disorder and
agent orange problems.  VBC also offers housing assistance through an
18-room single residency independent living unit as well as 30 units
of affordable housing.  Rent is one-third of a veteran's income. 


      OTHER FEDERAL AGENCIES'
      EFFORTS TO ASSIST THE
      HOMELESS
------------------------------------------------------ Appendix II:5.6

In fiscal year 1993, the Department of Labor selected NESHV as the
program manager for its Homeless Reintegration project.  The program
is designed to expedite the reintegration of homeless veterans into
the labor force.  The purpose of the program is to (1) establish
contact and open communications channels with homeless veterans, (2)
help homeless veterans take advantage of the other social service
benefits for which they are eligible, and (3) assist them in
reentering the job market. 


   VI.  VA DISCHARGE PLANNING FOR
   HOMELESS VETERANS
-------------------------------------------------------- Appendix II:6

Our review of medical records for 10 homeless veterans from the
Boston and Bedford Medical Centers and 10 records of clients of the
HCMI and DCHV programs showed that before a veteran's release from a
VA facility, VA staff generally referred the veteran to a VA or
non-VA program or facility.  But, there was limited documentation in
the files that there was any actual coordination between the VA staff
and the potential services provider.  Only four records showed any
evidence that VA maintained contact with the veterans after they were
released from a VA program. 


PROGRAMS TO ADDRESS HOMELESSNESS
IN DALLAS, TEXAS
========================================================= Appendix III


   I.  EXTENT OF HOMELESSNESS
------------------------------------------------------- Appendix III:1

Local service providers in Dallas estimate the homeless population to
range from 3,000 to 9,000.  Assuming veterans represent one-third of
the homeless population,\1 between 1,000 to 3,000 homeless veterans
live in Dallas.  The homeless are visible, and they gather under
bridges and in the central business district.  Solving the homeless
problem has become a major political issue in Dallas. 


--------------------
\1 The 1991-1992 Annual Report of the Interagency Council on the
Homeless states that studies indicate that about one-third of the
adult homeless population in the United States has served in the
armed services, p.  226. 


   II.  LOCAL MANDATES TO PROTECT
   THE HOMELESS
------------------------------------------------------- Appendix III:2

The city has standard operating procedures for protecting the
homeless during inclement weather.  Severe weather conditions are
defined as temperatures below 32 degrees, a windchill index of 0
degrees or lower, or heat advisories issued by the National Weather
Service.  The standard operating procedures describe how government
officials should respond to meet the emergency shelter and
transportation needs of the homeless during severe weather
conditions.  Specifically, city officials may (1) arrange for
additional space at nearby recreation centers or the Day Resource
Center (DRC), (2) evacuate occupants from endangered areas, and (3)
provide transportation to alternate shelter sites. 


   III.  VA SERVICES PROVIDED TO
   HOMELESS VETERANS
------------------------------------------------------- Appendix III:3

VA serves homeless veterans in Dallas through the Dallas VA Medical
Center, the VBA regional office in Waco, and special homeless
programs, including HCMI and the residential component, DCHV,
HUD-VASH, CWT and CWT/TR, SSA-VA joint outreach initiative, and the
Comprehensive Homeless Center (CHC).  VA has no current data on how
many homeless veterans the Dallas VA Medical Center has served. 
During fiscal year 1993, 197 homeless veterans were served by the VBA
regional office in Waco.  The HCMI residential component has 17 beds
and serves approximately 100 veterans per year; the DCHV program has
40 beds and serves approximately 144 veterans per year; the HUD-VASH
program has 27 vouchers for section 8 housing, of which 23 had been
distributed by December 1993; the CWT and CWT/TR programs served 278
veterans in 1993, of which 263 were homeless when they entered
training; and from November 1991, to June 1993, 268 claims for social
security benefits were made under the SSA-VA joint outreach
initiative. 

The Dallas VA has one of only two CHCs established in the United
States.  CHCs are coordinating units that merge all of VA's
homeless-specific programs in a given area under a single
organizational framework to eliminate duplication of effort and
streamline services for homeless veterans.  In Dallas, the CHC
consists of a council of clinicians, social workers, and other staff
working in homeless programs that ensures continuity in the homeless
programs, deals with administrative issues across program components,
and shares information about homeless veterans in one or more of VA's
programs.  The CHC also has one part-time staff to oversee the
administration and management of programmatic units to ensure (1)
efficient use of physical and staff resources and (2) delivery of
services to homeless veterans in a well-coordinated, high-quality
manner.  The CHC director also ensures that strategic planning occurs
to meet the future needs of the homeless veteran population. 

Dallas has one vet center that is only peripherally involved in
serving homeless veterans.  The vet center is located in north
Dallas, away from the downtown area, and staff perform limited
outreach to homeless veterans.  A vet center staff member visits one
service provider and conducts outreach on the streets once a week to
identify and assist homeless veterans. 


   IV.  VA'S OUTREACH/COORDINATION
   WITH LOCAL ORGANIZATIONS
   SERVING THE HOMELESS
------------------------------------------------------- Appendix III:4

VA's outreach and coordination with the Dallas community of providers
to the homeless consist of

  representation at monthly meetings of the local coalition of
     homeless service providers to discuss homelessness issues;

  regular visits to five major service providers to maintain working
     relationships with community providers and identify homeless
     veterans; and

  program activities located at the city-operated DRC.  VA is more
     accessible and better able to serve veterans by locating its
     staff offices at the center, which is close to where the
     homeless congregate. 


   V.  COMMUNITY PROGRAMS TO AID
   THE HOMELESS
------------------------------------------------------- Appendix III:5

Food and clothing for the homeless are available from community
providers, but based on a local official's estimate there are only
about 2,000 shelter beds for all of the homeless in Dallas.  This
represents a shortfall of between 1,000 and 7,000 beds.  The City of
Dallas Homeless Health Care Team (HHCT) offers health care services
at 16 locations where homeless people congregate.\2 Day and evening
hours are offered at both stationary and mobile sites for better
accessibility.  Medical treatment is also provided at Parkland
Memorial Hospital.  However, local providers told us that the
community is unable to meet the demand for inpatient drug, alcohol,
and mental health treatment. 

We visited the following organizations that serve the homeless in
Dallas.  They were identified to us as major service providers in the
community but not the only providers in the area. 


--------------------
\2 The HHCT was established in 1987 under a federal grant from the
Department of Health and Human Services. 


      DALLAS LIFE FOUNDATION
----------------------------------------------------- Appendix III:5.1

The Dallas Life Foundation (DLF) is the largest shelter for the
homeless in Dallas.  DLF has a capacity of 500 beds but currently
operates 400 beds.  It shelters, on average, about 300 people nightly
and serves three meals a day.  Other services offered by DLF to the
homeless include free clothing, an adult library, and a children's
learning center.  DLF accommodates regular clinical visits from the
HHCT.  Clients can reside at DLF indefinitely.  However, to stay
beyond 7 days, the person must be engaged in some activity that will
improve his or her life's situation.  Clients are also required to
attend chapel every evening. 


      SALVATION ARMY
----------------------------------------------------- Appendix III:5.2

The Salvation Army has three facilities in Dallas--a division
headquarters, an adult rehabilitation center, and a social services
center.  The Salvation Army social service center has about 450 beds
and provides social work and supportive services for the homeless. 
Services offered by the Salvation Army include shelter care for men,
women, and children, a substance abuse program with long-range
rehabilitation treatment, and a detoxification unit.  The Salvation
Army also provides its residents with three meals daily, clothing,
and transportation, if needed.  Salvation Army services are only
available as long as the homeless are interested in improving their
lives.  The Salvation Army also facilitates regular clinical visits
from the Dallas Homeless Health Care Team. 


      AUSTIN STREET SHELTER
----------------------------------------------------- Appendix III:5.3

Austin Street Shelter provides temporary lodging for about 300
homeless people every night.  Austin Street Shelter also provides
clothing, and residents receive an evening meal from area churches or
other service organizations.  Other services that the Austin Street
Shelter offers include Alcoholics Anonymous meetings; counseling
sessions for Emotions Anonymous; and a day shelter (Monday through
Saturday) for women, children, elderly men, and those unable to work. 


      UNION GOSPEL MISSION (UGM)
----------------------------------------------------- Appendix III:5.4

UGM has been serving the homeless in Dallas for more than 40 years
and, in 1986, decided to serve men only.  The two primary programs
for the homeless are the overnight shelter and rehabilitation center. 
UGM provides food and clothing for its residents, and its shelter has
a 105-bed capacity.  The shelter is available to those who agree to
attend evening chapel.  Exemptions from chapel services are given to
residents who are working during service hours.  While UGM serves the
needs of the homeless, it is also interested in rehabilitating the
homeless through a religion-based rehabilitation program. 


      THE STEWPOT
----------------------------------------------------- Appendix III:5.5

The Stewpot serves about 80,000 meals per year and has a dental
clinic that provides about 15,000 dental treatments to more than
2,500 patients annually.  The homeless can also participate in the
Stewpot's mail service and representative payee program to help
manage their income.  The Stewpot operates a daytime shelter for the
homeless during the week. 

The Stewpot also established a homeless prevention program that
includes assisting with rent and utility payments, a food pantry, and
financial planning.  Finally, The Stewpot has youth and children
programs that offer activities such as educational and recreational
opportunities, summer day camp, explorer scouting program, and a
college scholarship fund. 


      TRINITY MINISTRY TO THE POOR
----------------------------------------------------- Appendix III:5.6

Trinity Ministry to the Poor is a multi-purpose center that offers
the homeless a variety of services.  For example, the Ministry
operates a day shelter that offers haircuts, shower facilities, and a
soup kitchen that provides approximately 132,000 meals annually.  In
addition, Trinity Ministry to the Poor runs a work program that
provides the homeless with employment services such as job training,
counseling, and searches. 

Other programs the Ministry offers include a family stabilization
program for women and families to enable them to reenter mainstream
society.  It also provides crisis emergency services to assist those
with immediate needs, such as suicide prevention, and efforts to
avoid homelessness. 


      COMMUNITY OUTREACH COALITION
----------------------------------------------------- Appendix III:5.7

The Community Outreach Coalition is the primary source of psychiatric
services for the homeless in Dallas.  The Coalition, which has four
caseworkers, maintains clinics at five locations in the city and
conducts outreach on the streets and under bridges where the homeless
congregate. 


      DALLAS COUNTY
----------------------------------------------------- Appendix III:5.8

Dallas County has one full-time social worker who conducts outreach
to identify and assist the homeless.  The staff member performs
outreach at several community providers and makes about 700 to 800
contacts with homeless people each month. 


      VETERANS SERVICES
      ORGANIZATIONS
----------------------------------------------------- Appendix III:5.9

The Disabled American Veterans (DAV) and the American GI Forum were
identified as two major veterans services organizations (VSOs)
working with the homeless in Dallas.  The DAV provides clothing and
transportation to homeless veterans.  It also refers veterans to
community providers for additional services.  The American GI Forum
of the United States, founded in 1948, is the nation's largest
organized group of American military veterans of Hispanic descent. 
The Forum's primary role is an advocate for all American veterans. 
In Dallas, the Forum has received federal funding to operate the
National Veterans Outreach Program (NVOP) and the Vietnam Veterans
Family Counseling program.  Through the NVOP, veterans receive job
training and placement, case management, and referrals to other
service providers.  To qualify, veterans must be one of the
following:  (1) a Vietnam veteran, (2) a Vietnam-era veteran, (3)
disabled, (4) discharged within the past 4 years, or (5) an active
reservist for at least 1 day during Desert Storm.  The Vietnam
Veterans Family Counseling program is available to Vietnam veterans
who served in or near Vietnam between 1961 and 1972.  This program
offers a full array of counseling services, including post-traumatic
stress disorder; substance abuse; individual, family, marital,
support groups; and therapy groups.  The Forum provides direct
assistance to eligible veterans and refers other veterans, including
the homeless, to community providers. 


      CITY OF DALLAS DAY RESOURCE
      CENTER
---------------------------------------------------- Appendix III:5.10

The city operates a DRC to serve the homeless Monday through Friday
between 9 a.m.  and 5 p.m.  The DRC (1) provides laundry and shower
facilities for the homeless and (2) houses programs of several
agencies that offer a variety of services to the homeless.  These
services include case management and referral services and access to
health care professionals, social security staff, and VA personnel. 


      DALLAS ASSOCIATION OF
      SERVICES TO THE HOMELESS
---------------------------------------------------- Appendix III:5.11

The Dallas Association of Services to the Homeless is a coalition of
community providers founded to promote humane services for the
homeless by educating the community and public officials about
homelessness issues.  The association also strives to foster
communications and cooperation among agencies serving the homeless. 
Most of the major providers we visited are members of this
association, including VA. 


   VI.  VA DISCHARGE PLANNING FOR
   HOMELESS VETERANS
------------------------------------------------------- Appendix III:6

Our review of 13 patient treatment files showed that in 12 cases
homeless veterans about to be discharged from the Dallas VA Medical
Center, HCMI, and DCHV were being referred to other providers for
services.  However, VA staff did not consistently monitor the
veterans' progress once they were released from the VA medical center
or homeless program.  Only four records showed any evidence that VA
maintained contact with the veterans after they were released from a
VA program. 


PROGRAMS TO ADDRESS HOMELESSNESS
IN
FLINT, MICHIGAN
========================================================== Appendix IV


   I.  EXTENT OF HOMELESSNESS
-------------------------------------------------------- Appendix IV:1

Based on statistics compiled by the Hamilton Family Health Center,
Flint's homeless population numbers between 5,000 and 7,000.  A
6-year-old survey performed by the Veterans of Foreign Wars found
that about 38 percent of these individuals are veterans.  However, no
studies have been conducted to determine a more exact number.  One
service provider believes that Flint's homeless problem is largely
attributable to the downsizing of General Motors--Genesee County's
largest employer (about 40,000 jobs lost).  In addition,
approximately 2 years ago, state officials discontinued General
Assistance for single people without dependents.  This action
affected 110,000 people statewide and increased homelessness,
particularly among males.  The homeless are not readily visible on
the streets of Flint.  However, many of Flint's homeless double up
with friends or relatives or occupy Flint's abandoned houses.  In
1992, the annual average unemployment rate for Flint was 20 percent
compared to the national average of 7.4 percent. 


   II.  LOCAL MANDATES TO PROTECT
   THE HOMELESS
-------------------------------------------------------- Appendix IV:2

The city's housing specialist told us that Flint does not have any
formal written mandates or procedures to protect the homeless during
periods of extreme weather conditions.  He further stated that
community service providers, city human relations personnel, and law
enforcement officials work together to ensure that no one is without
shelter during severe weather conditions. 


   III.  VA SERVICES PROVIDED TO
   HOMELESS VETERANS
-------------------------------------------------------- Appendix IV:3

VA has no facilities in Flint so the area's homeless veterans depend
on non-VA service providers for medical services as well as food,
shelter, and clothing.  Neighboring cities with VA medical centers
include Saginaw, Ann Arbor, Allen Park, and Battle Creek, Michigan,
which are about 35 to 100 miles from Flint. 


   IV.  VA'S OUTREACH/COORDINATION
   WITH LOCAL ORGANIZATIONS
   SERVING THE HOMELESS
-------------------------------------------------------- Appendix IV:4

VA agencies in surrounding cities do not perform outreach to homeless
veterans or coordinate with service providers in Flint, according to
non-VA community officials. 


   V.  COMMUNITY PROGRAMS TO AID
   THE HOMELESS
-------------------------------------------------------- Appendix IV:5

Food and clothing are available to Flint's homeless in adequate
quantities, according to local providers.  However, providers believe
that there are not enough shelter beds for those in need. 
Specifically, a total of 175 shelter beds are available for single
males and an additional 26 beds for single women, but not enough to
meet the need.  In addition, there are no shelters for two-parent
families that desire to stay together as a unit. 

Generally, emergency medical treatment is available for the homeless. 
However, sustained ongoing care for the homeless is almost
nonexistent.  Community officials noted that Flint is a medically
underserved community because it is difficult to recruit or attract
doctors to the area.  Flint also has a shortage of substance abuse
programs for the homeless.  Those that are available have long
waiting lists. 

We visited the following organizations that serve the homeless in
Flint.  They were identified to us as major service providers in the
community, but not the only providers in the area. 


      VISTA DROP-IN CENTER
------------------------------------------------------ Appendix IV:5.1

The Vista Drop-In Center was established in August 1985 to draw the
homeless away from Flint's downtown area.  It is a daytime drop-in
center (not a residential facility) that offers counseling,
structured activities, and shower and laundry facilities.  It does
not serve meals other than bread and doughnuts that are donated to
the facility by a local vendor twice a week.  The center averages 100
visitors per day. 


      CARRIAGE TOWN MISSION
------------------------------------------------------ Appendix IV:5.2

The Carriage Town Mission provides shelter, food, clothing, and
spiritual guidance to the homeless.  It has a 33-bed emergency
shelter for men (clients are limited to 30 days per year), a 50-bed
emergency shelter for women and children, a 6-week transitional
housing program for women and children, a day room that is used for
overnight shelter for an additional 10 to 12 men in winter months,
and one family apartment.  In addition, it provides a daily evening
meal to an average of 184 individuals after they attend the required
chapel service. 


      COMMUNITY, ALLIANCE,
      RESOURCE, ENVIRONMENT, INC. 
      (CARE)
------------------------------------------------------ Appendix IV:5.3

CARE provides outpatient substance abuse treatment, group therapy for
relapse prevention, and prevention workshops for both men and women. 
During fiscal year 1993, CARE served 503 chronically dependent, dual
diagnosis clients.  In addition, CARE has a homeless shelter that
currently houses eight women. 


      HAMILTON FAMILY HEALTH
      CENTERS, INC. 
------------------------------------------------------ Appendix IV:5.4

The Hamilton Family Health Center (a McKinney fund grantee) is one of
Flint's main medical and dental treatment facilities for the
homeless.  It provides services on site and through its mobile
medical team.  The center serves about 6,000 people annually
(approximately 17,000 visits). 


      HURLEY HOSPITAL
------------------------------------------------------ Appendix IV:5.5

Hurley Hospital is another of Flint's main medical treatment
facilities for the homeless.  However, recent budget constraints
caused the hospital to close its detoxification unit to homeless
patients.  Now, only homeless people who are considered to be
homicidal or suicidal will be admitted to this unit. 


      GENESEE COUNTY COMMUNITY
      MENTAL HEALTH SERVICES
      (GCCMHS)
------------------------------------------------------ Appendix IV:5.6

GCCMHS received McKinney funds in November 1987 to initiate a
homeless adult outreach program for the mentally ill.  It has 35
inpatient beds for acute treatment of mental health disorders and is
Flint's main mental health treatment facility for the homeless. 
However, like Hurley Hospital, GCCMHS has implemented strict
admission criteria, requiring that the homeless be homicidal or
suicidal.  In addition, GCCMHS requires that clients be drug- and
alcohol-free before admittance. 


      PERSONAL AND PSYCHOLOGICAL
      GROWTH
------------------------------------------------------ Appendix IV:5.7

Personal and Psychological Growth is a private outpatient mental
health facility that provides psychological counseling to the
homeless as part of a contract it maintains with the Hamilton Family
Health Center. 


      NORTH END SOUP KITCHEN
------------------------------------------------------ Appendix IV:5.8

The North End Soup Kitchen serves a hot meal 7 days a week to anyone. 
The soup kitchen is Flint's largest on-site feeding place and serves
an average of 225 people per day.  It also provides sandwiches
(approximately 350 daily) to the homeless at two off-site locations. 


      TRANSITION HOUSE
------------------------------------------------------ Appendix IV:5.9

Under a contract with the Hamilton Family Health Center, Transition
House provides residential services for alcoholics and other
substance abusers.  It operates a 37-bed, 60-day residential
treatment program at no cost to the client.  This program currently
has a 3-week waiting list. 


      VETERANS INFORMATION CENTER
----------------------------------------------------- Appendix IV:5.10

The Veterans Information Center is a Genesee County-funded agency
that assists veterans in applying for educational benefits and other
entitlements.  The center is not affiliated with VA. 


      VETERANS SERVICE
      ORGANIZATIONS
----------------------------------------------------- Appendix IV:5.11

Representatives of the Veterans of Foreign Wars and the Disabled
American Veterans--two of the largest veteran service organizations
in Flint--provide various services to veterans but do not focus on
homeless veterans' issues. 


      HOMELESS EMPOWERMENT
      REGISTRY ORGANIZATION (HERO)
----------------------------------------------------- Appendix IV:5.12

HERO was established in March 1992 to match homeless and unemployed
individuals with volunteer community mentors.  These partnerships
offer training opportunities, assistance with life skills, and other
supportive services.  HERO participants meet weekly.  As of January
1994, the local organization had a capacity of 25 clients, based on
the current number of mentors available. 


   VI.  VA DISCHARGE PLANNING FOR
   HOMELESS VETERANS
-------------------------------------------------------- Appendix IV:6

According to some community providers, VA medical centers frequently
discharge veterans to the streets without follow-up.  Two community
officials told us that they visited the Ann Arbor, Battle Creek, and
Saginaw VA Medical Center Directors and Chiefs of Staff in 1987 to
improve discharge planning for veterans.  The officials said they
asked VA to contact GCCMHS when veterans from Genesee County were
about to be discharged; although the VA representatives were
receptive, improvements have not been made, and veterans are still
being discharged to the streets. 


PROGRAMS TO ADDRESS HOMELESSNESS
IN HUNTINGTON, WEST VIRGINIA
=========================================================== Appendix V


   I.  EXTENT OF HOMELESSNESS
--------------------------------------------------------- Appendix V:1

In January 1993, 206 homeless people were identified in Huntington,
West Virginia.  However, this is a very transient population because
approximately 800 different people used homeless services in each of
the past 3 years.  The number of homeless people has grown; in 1986,
the city had 120 to 180 homeless people.  The local VA medical center
estimates that about one-third of the homeless are veterans. 

Most of the homeless in Huntington are from West Virginia, but some
are from Kentucky and Ohio.  Huntington has one of the greatest
concentrations of homelessness in the state and is in a rural area
that has experienced severe economic difficulties for the past 30
years.  In 1992, West Virginia had the highest unemployment rate in
the country, at 11.3 percent compared to the national rate of 7.4
percent.  Unemployment is the primary cause of homelessness in
Huntington. 


   II.  LOCAL MANDATES TO PROTECT
   THE HOMELESS
--------------------------------------------------------- Appendix V:2

Under a 1983 State Supreme Court Decision, the West Virginia
Department of Health and Human Resources is required to provide
shelter, food, and medical care for the homeless.  The Department
accomplishes this in Huntington through contracts with organizations
that provide the required assistance.  But, if the demand for
services exceeds the supply, the Department will provide vouchers to
community providers to purchase any needed services. 


   III.  VA SERVICES PROVIDED TO
   HOMELESS VETERANS
--------------------------------------------------------- Appendix V:3

The Huntington VA Medical Center does not have any programs
specifically designed to serve the homeless, but it serves the
medical needs of these veterans when they seek assistance.  The VBA
regional office also has a homeless coordinator who works with local
providers to determine if any homeless veterans are eligible for
veterans benefits.  While Huntington has a vet center, staff conduct
limited outreach specifically aimed toward homeless veterans.  Staff
do, however, interact with churches and other community organizations
that work with the homeless. 

VA social work staff at the Huntington Medical Center refer homeless
veterans to other VA programs such as the DCHV programs located at
the medical centers in Martinsburg, West Virginia and Mountain Home,
Tennessee.  However, these programs are several hundred miles away
from Huntington.  To help overcome this problem, the Huntington VA
Medical Center will pay for veterans' bus transportation to these
other VA facilities.  During fiscal year 1993, the social work
service worked with 28 veterans who identified themselves as
homeless. 

The Huntington VA Medical Center, in October 1993, submitted a
proposal to VA's Central Office to establish an HCMI program.  A
similar proposal was denied in 1992, but the medical center expects
to receive funding for its most current application.  Under its
proposal, the medical center plans to use staff for outreach and case
management of homeless veterans. 


   IV.  VA'S OUTREACH/COORDINATION
   WITH LOCAL ORGANIZATIONS
   SERVING THE HOMELESS
--------------------------------------------------------- Appendix V:4

According to the Huntington VA Medical Center Director, the center's
outreach activities for homeless veterans are limited.  However,
these veterans are served when they seek assistance from the center. 
The Director stated that he does not believe that Huntington has a
large homeless veteran population and that activities for the
homeless are well coordinated at the local level.  The Director
expected that coordination efforts will improve once the medical
center is approved for and implements the HCMI program.  Through the
program, the medical center will establish a case management system
with outreach performed by the social work staff at the vet center. 
Currently VA's only outreach to local service providers is performed
by the VBA regional office's homeless coordinator, who regularly
interacts with the Cabell-Huntington Coalition for the Homeless, and
the vet center homeless coordinator who visits the Huntington City
Mission. 


   V.  COMMUNITY PROGRAMS TO AID
   THE HOMELESS
--------------------------------------------------------- Appendix V:5

Generally, Huntington has sufficient resources to feed, clothe, and
house the homeless as well as to meet their other medical and social
needs.  Huntington is unique because VA and community providers are
close to each other.  The VBA, Cabell-Huntington Coalition for the
Homeless, vet center, Prestera Center, Information and Referral
Service, Huntington City Mission, and State Department of Veterans
Affairs office are all in downtown Huntington.  Only the VA medical
center is not.  As a result, agencies assisting the homeless know
about the services available from either VA or community providers. 
Some of these organizations and their responsibilities are discussed
below. 


      CABELL-HUNTINGTON COALITION
      FOR THE HOMELESS
------------------------------------------------------- Appendix V:5.1

The Cabell-Huntington Coalition began in 1986 and comprises local
providers such as Valley Health Systems, the Information and Referral
Service, and the State's Health and Human Resources Department.  Its
goal is to develop comprehensive, permanent solutions to homelessness
in the area.  It also operates Harmony House in downtown Huntington,
which provides "one-stop shopping" for the homeless.  The concept of
the coalition is to provide all supporting services at one easily
accessible site.  Services available include case management, primary
health care, mental health and substance abuse counseling, life
skills training, housing counseling, transportation, personal care
items, and clothing.  Several state and local agencies working in
conjunction with the coalition, such as the State Department of
Health and Human Resources, Information and Referral Service, Valley
Health Systems, and the Prestera Center, provide services.  Veterans
eligible for VA health care are referred to the local VA medical
center because the coalition has limited resources. 

In addition to providing the above-mentioned services, the coalition
maintains 53 single-room occupancy housing units and is planning to
add another 47 units.  Further, it has a 12-unit apartment complex
used by individuals with mental health problems who need to reside in
supervised living conditions.  The units are considered permanent
housing.  Therefore, the residents can stay in the units until they
either want to leave or are evicted. 


      HUNTINGTON CITY MISSION
------------------------------------------------------- Appendix V:5.2

The Huntington City Mission is an interdenominational, private,
nonprofit organization that operates the only shelter in the
Huntington area.  It is a wet shelter and serves anyone who maintains
reasonable behavior and is not a threat to other clients.  Each
night, 125 to 150 homeless people, including approximately 20
families and 30 women, are sheltered in the mission's three buildings
located in downtown Huntington.  The mission also serves meals at the
shelter.  During peak demand periods in the winter, people may have
to sleep on the floor.  In extreme conditions when no further room is
available at the shelter, the mission seeks assistance from other
local agencies that can arrange for individuals to be housed in local
motels or transported to shelters in other parts of the state. 

Other services available at the mission include free clothing,
transportation, children's summer day program, medical care, food
baskets for residents outside the mission, and mental health
counseling.  Daily living services, especially for families, include
diapers, formula, baby food, milk, as well as personal hygiene items. 


      PRESTERA CENTER
------------------------------------------------------- Appendix V:5.3

Prestera Center in downtown Huntington is 1 of 14 community
behavioral centers in West Virginia.  The center contracts with the
West Virginia Department of Health and Human Resources to provide a
variety of services for children and adults with mental illness,
including those who are homeless.  These services include intensive
case management, supported housing programs, psychological
rehabilitation programs, and community service programs. 
Additionally, the center has contracts with the Vet Center in
Huntington and the VBA regional office to conduct psychological
evaluations of eligible veterans.  The center has had an outreach
case manager at Harmony House since 1987 to assist in identifying
homeless people with substance abuse and mental illness problems. 
Further, the center assists the Huntington State Hospital in planning
for the discharge of all new clients.  Discharge planning focuses on
the services offered at Prestera.  These services include case
management, housing, employment counseling, day treatment services,
as well as advocacy to secure other resources, such as Social
Security Income Disability Insurance. 


      INFORMATION AND REFERRAL
      SERVICE
------------------------------------------------------- Appendix V:5.4

The Information and Referral Service links people with human service
needs such as food, shelter, and medical care to agencies that
provide such services.  The service's activities include (1) helping
people identify their needs; (2) providing comprehensive information
to the community about existing resources; and (3) advocating
coordination and cooperation in planning for, and providing, needed
human services.  The service is located in the public library in
Huntington. 


      STATE DEPARTMENT OF VETERANS
      AFFAIRS
------------------------------------------------------- Appendix V:5.5

The State Department of Veterans Affairs has 16 field offices around
the state, including one in downtown Huntington.  One of the
Department's functions is to process applications for the
Barboursville State Veterans Home that is located near Huntington. 
Department staff also coordinate with the local VA medical center and
refer eligible veterans to the DCHV program in Martinsburg, West
Virginia.  Additionally, staff help veterans file claims for VA
benefits. 

The Barboursville State Veterans Home, opened in 1981, is a
domiciliary that provides care to a maximum of 190 ambulatory
veterans who can attend to their own personal needs.  It has strict
rules against alcohol and drug use.  Residents contribute 50 percent
of their monthly income to the home and, in return, receive food and
shelter.  Medical treatment is not provided. 


   VI.  VA DISCHARGE PLANNING FOR
   HOMELESS VETERANS
--------------------------------------------------------- Appendix V:6

Our review of the medical records for 10 homeless veterans being
discharged from the Huntington VA Medical Center showed that VA
personnel generally referred a veteran to a VA or non-VA treatment
program or facility.  But there was limited documentation in the
files that would indicate whether there was any actual coordination
between the VA staff and service providers to whom the veteran was
referred.  Only two records showed any evidence that VA maintained
contact with the veterans after they were released from a VA program. 
One VA official, however, stated that follow-up is inherent when a
veteran is discharged to a nursing home or residential care facility,
and that follow-up will be expanded when the HCMI program is up and
running. 


PROGRAMS TO ADDRESS HOMELESSNESS
IN MINNEAPOLIS, MINNESOTA
========================================================== Appendix VI


   I.  EXTENT OF HOMELESSNESS
-------------------------------------------------------- Appendix VI:1

In October 1991, the Wilder Research Center of the Wilder Foundation,
a tax-exempt publicly supported organization, performed a survey to
determine the number of homeless adults and children in the
Minneapolis/St.  Paul area.\1 Their survey projected that in
Minneapolis/St.  Paul 2,177 people were homeless, consisting of 1,302
in emergency shelters, 218 in battered womens' shelters, and 657 in
transitional housing.  Homeless veterans were projected to represent
20 percent, or 435 of the 2,177 homeless population.  The survey also
identified another 89 individuals living on the streets of which 33,
or 37 percent, identified themselves as veterans. 

Surveys of emergency shelter use conducted quarterly by Minnesota's
Department of Jobs and Training indicate that shelter use increased
from 1,300 clients in November 1991 to 1,741 clients in May 1993. 

Many of Minneapolis's homeless are from out of state.  The greatest
need for shelter in the Hennepin County area, which includes the city
of Minneapolis, occurs during the summer months when families migrate
to the Minneapolis area looking for a better life.  During the summer
of 1993, Hennepin County shelters were receiving as many as 260
requests per day over capacity.  Because of the demand, the state
instituted a rationing policy by prohibiting the use of the
state-funded shelters by undocumented workers.  The county expects an
increase in demand for shelter space over the next few years,
especially by families. 


--------------------
\1 The Wilder Foundation Survey did not separately break out
information for Minneapolis. 


   II.  LOCAL MANDATES TO PROTECT
   THE HOMELESS
-------------------------------------------------------- Appendix VI:2

Hennepin County requires that shelter be provided to all who seek it
between October 15 and March 15.  When the shelters are full, the
county uses budget-rate hotels and motels to house the homeless. 


   III.  VA SERVICES PROVIDED TO
   HOMELESS VETERANS
-------------------------------------------------------- Appendix VI:3

VA serves homeless veterans in the Minneapolis area through its
medical center, VBA regional office, a vet center, and an HCMI
program.  Until the HCMI program was instituted in July 1993, only
the VBA regional office and the vet center had an active role in
interacting with community homeless providers. 


      VBA REGIONAL OFFICE
------------------------------------------------------ Appendix VI:3.1

In 1987, officials at the VBA regional office determined that
homelessness among veterans in the Minneapolis area was a problem and
that homeless veterans needed help.  As a result, they established an
outreach function and staffed it with a benefits counselor who
visited the major shelters in the Minneapolis area and four other
locations 5 days a week.  The counselor made veterans aware of VBA
benefits as well as benefits available through community resource
agencies, such as the Minnesota Department of Veteran Affairs.  He
also referred and facilitated the transfer of those veterans needing
medical help from local shelters to the Minneapolis VA Medical
Center. 

During 1992, VBA management and the counselor agreed to change some
of the locations visited in the outreach effort.  As a result, weekly
visits were limited to locations in the Minneapolis/St.  Paul area. 
Visits to the outside communities were basically stopped because they
were not resulting in the identification of homeless veterans. 
According to the counselor, he had about 1,560 contacts with homeless
veterans during fiscal year 1992. 


      VET CENTER
------------------------------------------------------ Appendix VI:3.2

Officials from the vet center have been involved with helping
homeless veterans for about 14 years.  The center was chartered in
1979 and in that year established outreach activities at two
shelters.  The staff informs the homeless of federal services
available and offers them the opportunity for readjustment
counseling.  The staff continues outreach for the homeless at various
shelters in the area and provides readjustment counseling when
necessary. 

In 1989, the vet center director in St.  Paul, in conjunction with
the St.  Cloud VA Medical Center, which is about 70 miles from
Minneapolis, implemented a work therapy program at the medical
center.  This was done because of the lack of homeless assistance
programs in the Minneapolis/St.  Paul area.  The St.  Cloud Medical
Center also formalized a work therapy program for the veterans at a
food processing plant in Cold Spring, Minnesota, about 20 miles from
St.  Cloud.  The veterans are psychologically screened at the medical
center for 30 days before they are allowed to go to work at the
plant.  According to the vet center director, the employment program
has worked well.  The veterans have been able to save money and move
into housing on their own volition. 


      HCMI PROGRAM
------------------------------------------------------ Appendix VI:3.3

The HCMI program became operational in July 1993 as the result of a
joint proposal between the Minneapolis Medical Center and the VBA
regional office.  HCMI staff conduct outreach to veterans at various
shelters to identify their needs and make appropriate referrals to
either community or VA resources.  From July 1 through September 30,
1993, the staff enrolled 46 veterans in the program. 

HCMI staff provide case management services to the homeless who are
on the street through continuous contacts and referral to appropriate
resources.  They also manage the cases of the homeless whom they have
referred to the medical center for medical treatment or chemical
dependency.  Further, the staff manages the cases of individuals
enrolled in a transitional housing program. 

In 1992, the Minneapolis VA allowed a community nonprofit agency, the
Transitional Housing for Veterans Council, to lease a building on the
medical center grounds to provide temporary housing to homeless
veterans.  The VA medical center rehabilitated the building with its
own funds.  In January 1993, the rehabilitation was completed and the
building provided a capacity of 13 beds.  In July 1993, the HCMI
staff began contracting with the Transitional Housing organization to
serve veterans participating in the program.  From July 1 through
September 30, 1993, the HCMI staff has placed 20 veterans in the
facility. 


   IV.  VA'S OUTREACH/COORDINATION
   WITH LOCAL ORGANIZATIONS
   SERVING THE HOMELESS
-------------------------------------------------------- Appendix VI:4

VA's outreach and coordination with community providers in the
Minneapolis area primarily involve the VBA benefits counselor and
officials from the vet center.  However, since July 1993, a health
care nurse and a substance abuse counselor from the HCMI program have
accompanied the VBA benefits counselor on his visits to the shelters. 
Specific outreach and coordination activities of these individuals
consist of the following: 

  The VBA benefits counselor participates in the local Poverty
     Information Network, which meets bimonthly and includes public
     and private homeless and health care providers.  The meetings
     are used for information gathering and sharing.  They provide
     information to assist VA in serving the needs of homeless
     veterans. 

  The VBA benefits counselor regularly interacts with the Hennepin
     County Medical Center and the Hennepin County Health Care for
     the Homeless project and discusses the issues of homeless
     veterans with various groups. 

  The vet center staff meets with state and county officials to share
     information on services available to homeless veterans.  Formal
     monthly meetings were discontinued in 1992 because all providers
     knew about the VA programs. 

  The vet center participated in the Minneapolis Stand Down conducted
     in August 1993.  According to the Minneapolis Medical Center
     director, the VA medical center, the VBA regional office, the
     vet center, the state, the veterans service organizations, the
     military, and church groups effectively coordinated efforts for
     the event. 

In contrast, the Minneapolis VA Medical Center Director told us that
the medical center has not coordinated with agencies at the county
level who fund all the public shelters because he was not familiar
with the role played by the county.  The director stated that
establishing a steering committee with all parties involved with the
homeless might be a positive step for more effective coordination. 
The HCMI outreach team will also improve coordination at the county
level. 


   V.  COMMUNITY PROGRAMS TO AID
   THE HOMELESS
-------------------------------------------------------- Appendix VI:5

Minneapolis has many local government and nongovernment programs to
aid the homeless.  Programs include county-funded shelters and
organizations as well as private organizations that provide food,
shelter, medical, and mental health treatment.  Further, there is a
strong sense of community response to help the poor and disadvantaged
especially from major companies doing business in the area. 


      COUNTY-FUNDED SHELTERS
------------------------------------------------------ Appendix VI:5.1

Hennepin County funds about 880 emergency shelter beds in numerous
shelters in Minneapolis.  The shelters are predominantly for single
adults, who use about 600 of the beds.  But, many shelters also offer
specific accommodations for families, including those with children. 
In fact, about 280 beds are set aside for these families.  People
Serving People is the predominant county shelter.  It accounts for
more than 70 percent of the county's beds in Minneapolis. 


      PEOPLE SERVING PEOPLE (PSP)
------------------------------------------------------ Appendix VI:5.2

PSP was established in 1982 to help single men who had chronic
alcoholic and chemical dependency problems.  As the homeless
population grew and more services were required, the agency began
providing board and lodging on an emergency basis.  PSP now serves
single men and childless couples, as well as families, and has 640
beds.  The shelter will house only those individuals who are sober,
can care for themselves, and are not a threat to themselves or
others. 

PSP operates several programs to help the homeless.  The Rapid Exit
Program helps the homeless find housing.  Case managers set up
appointments for clients and may actually take them to the housing
location.  PSP also offers social, recreational, and tutorial
programs for children.  Other services include legal aid, medical
clinics, and access to mental health services. 


      COUNTY ORGANIZATIONS
------------------------------------------------------ Appendix VI:5.3

In addition to the county-funded shelters, the county offers other
services to help homeless people with mental or physical health
problems or who need financial assistance. 


      HENNEPIN COUNTY HEALTH CARE
      FOR THE HOMELESS PROJECT
------------------------------------------------------ Appendix VI:5.4

This project provides health care services to homeless people through
11 health clinics in emergency shelters, drop-in centers, and other
community based facilities in the downtown Minneapolis area.  When
clinic staff encounter a veteran, they first determine if he or she
is eligible for VA services.  If eligible, they will refer the
veteran to the VA medical center if he or she has medical, chemical
dependency, or psychological problems.  The project served 4,311
homeless individuals in fiscal year 1993.  According to the project's
supervisor, not all clients identify themselves as veterans and the
questions asked by program staff to elicit this information are not
achieving their intended results.  Consequently, the project's
supervisor could only specifically identify about 30 homeless
veterans served during fiscal year 1993.  These clients had indicated
that they had access to VA medical care. 


      HENNEPIN COUNTY ACCESS UNIT
------------------------------------------------------ Appendix VI:5.5

This unit provides outreach and social services to homeless adults
with special needs due to emotional, mental, developmental, or
physical impairments.  It also serves those who are chemically
dependent or socially dysfunctional.  Services include emergency
housing to those in need who do not qualify for or receive economic
assistance and referral to crisis intervention and detoxification
programs conducted in the community.  Outreach occurs at 14 community
sites in Minneapolis, including the major shelters and drop-in
centers. 


      STATE ORGANIZATIONS
      ASSISTING THE HOMELESS
------------------------------------------------------ Appendix VI:5.6

The state of Minnesota has a local veteran service office in each
county in the state.  County service officers counsel and assist
veterans and their families to obtain maximum benefits available to
them through state and federal programs, including VA medical
centers.  The Hennepin County Service Officer coordinates with VA and
refers veterans to the Minneapolis VA Medical Center. 


      PRIVATE EFFORTS TO ASSIST
      THE HOMELESS
------------------------------------------------------ Appendix VI:5.7

Minneapolis has several private organizations that feed and house the
homeless.  Private shelters provide approximately 260 beds and
supplement the 880 beds funded by the county.  These shelters are
primarily associated with religious organizations and serve both
veterans and nonveterans. 

In addition to these shelters, Minneapolis has two primary
organizations that feed the homeless.  Loaves and Fishes Too serves
from 380 to 600 evening meals per day.  Sharing and Caring Hands
serves meals to as many as 900 people during the day, starting with
breakfast.  Both organizations receive generous contributions from
the business community and foundations.  Some companies donate 5
percent of their pre-tax profit to such causes. 

To meet the need for more housing, Sharing and Caring Hands is
undertaking a $6-million fundraising effort to build 24 units of
transitional housing for women and children and another 32 units just
for women.  When we visited in August 1993, close to $3 million had
already been raised.  Further, the organization spends approximately
$300,000 per year on housing the homeless in private hotels. 


   VI.  VA DISCHARGE PLANNING FOR
   HOMELESS VETERANS
-------------------------------------------------------- Appendix VI:6

Our review of medical files for 10 homeless veterans discharged from
the Minneapolis VA Medical Center showed that VA personnel generally
told them about either a VA or non-VA program or facility.  But,
there was limited documentation in the files that would indicate
whether there was any actual contact or coordination between the VA
staff and the potential service providers to arrange for shelter or
care for the veteran once he or she was released from the medical
center.  None of the records showed evidence that VA maintained
contact with the veterans after they were released from a VA program. 


PROGRAMS TO ADDRESS HOMELESSNESS
IN PENSACOLA, FLORIDA
========================================================= Appendix VII


   I.  EXTENT OF HOMELESSNESS
------------------------------------------------------- Appendix VII:1

A survey conducted by the Escambia Coalition on the Homeless, Inc.,
identified 951 documented cases of homelessness in Pensacola in June
1990.  However, VA and non-VA personnel involved with Pensacola's
homeless have differing opinions on the extent of the problem.  Their
estimates range from 100 to 1,000 on any given night (Pensacola's
general population is 59,000).  Both groups estimate that veterans
represent more than 30 percent of the homeless population. 


   II.  LOCAL MANDATES TO PROTECT
   THE HOMELESS
------------------------------------------------------- Appendix VII:2

Pensacola does not have any local mandates to protect the homeless
from extreme weather conditions, according to city police and fire
department officials. 


   III.  VA SERVICES PROVIDED TO
   HOMELESS VETERANS
------------------------------------------------------- Appendix VII:3

VA does not have any programs specifically designed for the homeless
in Pensacola.  It does, however, provide a variety of services to
eligible veterans through an outpatient clinic, veterans benefits
office, and a vet center.  Specifically, the VA outpatient clinic
provides medical, substance abuse, and mental health treatment on an
outpatient basis; the veterans benefits office provides assistance in
filing benefits claims and appeals; and the vet center, which has
served more than 3,600 veterans since it opened in December 1985,
provides readjustment counseling, employment counseling, and social
work services.  At the vet center, one of the counselors serves as a
homeless coordinator. 


   IV.  VA'S OUTREACH/COORDINATION
   WITH LOCAL ORGANIZATIONS
   SERVING THE HOMELESS
------------------------------------------------------- Appendix VII:4

VA depends on the community to provide needs such as inpatient
medical care, shelter, food, and clothing to homeless veterans. 
Further, local VA staff perform minimal outreach to homeless veterans
and, in general, only coordinate with community homeless providers on
a case-by-case basis.  For example, vet center officials contact the
Salvation Army to request temporary shelter for veterans awaiting a
vacancy in a VA homeless program such as the DCHV program at the VA
medical center in Biloxi, Mississippi.  Vet center staff have
established a close working relationship with one local organization
that focuses its efforts on assisting homeless veterans. 


   V.  COMMUNITY PROGRAMS TO AID
   THE HOMELESS
------------------------------------------------------- Appendix VII:5

Food and clothing are readily available to Pensacola's homeless. 
However, there are not enough shelter beds, substance abuse, mental
health, or psychiatric treatment facilities in the community to meet
the demand.  For example, there are about 175 beds available from the
homeless service providers we visited.  But access to many of them is
restricted by requirements that the clients be sober, drug free,
and/or male. 

We visited the following organizations that serve Pensacola's
homeless population.  These organizations include the largest service
providers in the area, according to both VA and non-VA officials. 
However, they are not the only service providers in the community. 


      LOAVES AND FISHES
----------------------------------------------------- Appendix VII:5.1

Loaves and Fishes is a nonprofit, spiritually based organization that
started as a soup kitchen.  However, Loaves and Fishes has evolved
into a multifaceted provider offering the following services
specifically for families with minor children:  (1) 10 rooms for
24-hour emergency shelter, (2) seven properties for long-term
transitional housing, and (3) a parent/child center that focuses on
parenting skills.  In addition, Loaves and Fishes provides breakfast
and dinner Monday through Saturday (lunch is served for residents
only), clothing, showers, and limited medical treatment to any
homeless individual on request. 


      UNITED MINISTRIES
----------------------------------------------------- Appendix VII:5.2

United Ministries, is a nonprofit, spiritually based organization
that is an outgrowth of Loaves and Fishes.  United Ministries
provides assistance in paying rent and utilities for families with
minor children.  Thus, their clients are generally not homeless. 


      SALVATION ARMY
----------------------------------------------------- Appendix VII:5.3

The Salvation Army maintains one of Pensacola's largest shelters.  It
supports approximately 45 beds--36 for men, 7 for women--and 1 unit
available for a whole family.  The Salvation Army basically has two
programs to aid homeless men and women--the Red Shield Lodge (RSL)
program and the Pensacola Area Transitional Housing (PATH) program. 
The RSL program provides immediate, short-term assistance/housing to
10 individuals for up to 3 days.  The PATH program is a 90-day
transitional housing program that helps individuals return to
mainstream society.  PATH provides life management programs,
vocational and educational assistance, and various support services
for 26 clients.  To participate, clients must be referred by a social
service organization, have proper identification, and be sober and
drug free. 


      WATERFRONT RESCUE MISSION
----------------------------------------------------- Appendix VII:5.4

The Waterfront Rescue Mission is another of Pensacola's largest
shelters and is open 24 hours per day, 365 days a year.  The mission
is spiritually based and provides overnight shelter and three meals a
day for male clients.  Clients are generally allowed to stay only 1
night per month at the shelter.  However, if the client is making an
effort to better himself or herself, seeks employment, and adheres to
the mission's religious setting, he or she is allowed to stay from 1
night to several weeks.  The mission averages 20 clients per night
but is often at its capacity of 60.  It also offers a 12-week alcohol
and drug rehabilitation program at its New Hope Home in Gulf Breeze,
Florida (with a capacity of 36).  In addition, the mission recently
started an 18-bed women's shelter at another location. 


      GULF COAST VETERANS HOMELESS
      FOUNDATION (GCVHF)
----------------------------------------------------- Appendix VII:5.5

GCVHF provides transitional housing for homeless veterans.  The
foundation currently operates a long-term, male-only residence that
houses six individuals--its capacity.  In addition, the foundation is
in the process of acquiring two other properties that will provide
long-term housing for an additional 24 individuals (one of these
properties may also accommodate females).  In addition to shelter,
GCVHF provides food, personal care items, clothing, and substance
abuse and mental health care. 


      FIRST CALL FOR HELP (FCFH)
----------------------------------------------------- Appendix VII:5.6

FCFH, a United Way organization, is an information and referral
service whose primary function is to connect homeless people with the
appropriate service or agency that can assist them.  In addition,
FCFH has a contract with Florida's state welfare agency to (1) help
prevent families from being split and children placed in foster care
and (2) provide case management for low-income families. 


      VETERANS SERVICE
      ORGANIZATIONS
----------------------------------------------------- Appendix VII:5.7

Pensacola's veterans service organizations, including the Vietnam
Veterans of Northwest Florida, Inc., Veterans of Foreign Wars,
Disabled American Veterans, and, Military Order of the Purple Heart,
provide readjustment and support services to veterans.  However, they
do not focus on homeless veterans issues, such as shelter. 


      LOCAL GOVERNMENT AGENCIES
----------------------------------------------------- Appendix VII:5.8

Local government officials from agencies, such as the Area Housing
Commission, HUD, and the Neighborhood Enterprise Foundation, Inc.  (a
government contractor), told us that their focus is on low-income
housing residents--not homeless individuals. 


   VI.  VA DISCHARGE PLANNING FOR
   HOMELESS VETERANS
------------------------------------------------------- Appendix VII:6

Because VA has no inpatient services or homeless programs in
Pensacola, discharge planning is not an issue. 


PROGRAMS TO ADDRESS HOMELESSNESS
IN
SAN FRANCISCO, CALIFORNIA
======================================================== Appendix VIII


   I.  EXTENT OF HOMELESSNESS
------------------------------------------------------ Appendix VIII:1

Local San Francisco providers and city officials estimate the number
of homeless to be in the range of 6,000 to 10,000.  Assuming that
veterans represent about one-third of the homeless population,\1
between 2,000 and 3,300 homeless veterans live in San Francisco. 

Although the city spends about $46 million annually on homelessness
issues, the homeless remain a visible and significant problem in San
Francisco.  A homeless person dies about every 3 days in San
Francisco, and homelessness is a highly charged political issue in
the city.  Some local advocates for the homeless believe that the
mayor's homeless policies have unnecessarily restricted the homeless
and do not address the problems associated with homelessness.  They
cite the police department's practice of issuing citations for
offenses, such as aggressive panhandling, trespassing, and sleeping
in public parks between 10 p.m.  and 6 a.m., as evidence of this
situation. 


--------------------
\1 The 1991-1992 Annual Report of the Interagency Council on the
Homeless states that studies indicate that about one-third of the
adult homeless population in the United States has served in the
armed services, p.  226. 


   II.  LOCAL MANDATES TO PROTECT
   THE HOMELESS
------------------------------------------------------ Appendix VIII:2

No local ordinances or regulations exist that direct the city of San
Francisco to assist the homeless during adverse weather conditions. 


   III.  VA SERVICES PROVIDED TO
   HOMELESS VETERANS
------------------------------------------------------ Appendix VIII:3

VA serves homeless veterans in San Francisco through the San
Francisco VA Medical Center, the VBA regional office in Oakland, and
special homeless programs, including HCMI and its residential
component, CWT and CWT/TR, and HUD-VASH.  A medical center
official estimates that the center serves approximately 100 homeless
veterans each month.  During fiscal year 1993, 81 homeless veterans
were served by the VBA regional office in Oakland.  In addition, the
HCMI residential component has 11 beds and serves approximately 47
veterans per year; the HUD-VASH program has 31 vouchers for section 8
housing, of which 29 have been distributed; and in 1993, the CWT and
CWT/TR programs served 27 veterans, all of whom were homeless at the
time they entered training. 

San Francisco has one vet center, located downtown, that provides an
avenue for homeless veterans to access VA services.  While vet center
staff do not conduct outreach, they assist homeless veterans who
visit the center and refer them to other VA and non-VA providers as
appropriate.  The nearest DCHV that serves homeless veterans from San
Francisco is located in Palo Alto, California. 


   IV.  VA'S OUTREACH/COORDINATION
   WITH LOCAL ORGANIZATIONS
   SERVING THE HOMELESS
------------------------------------------------------ Appendix VIII:4

VA's outreach and coordination with the San Francisco community of
providers to the homeless consist of

  regular HCMI staff visits to five community service providers for
     the homeless to maintain working relationships with community
     providers and identify homeless veterans;

  participation in stand downs for homeless veterans; and

  representation at meetings of the San Francisco Council on
     Homelessness (a coalition of providers). 


   V.  COMMUNITY PROGRAMS TO AID
   THE HOMELESS
------------------------------------------------------ Appendix VIII:5

Food and clothing are available at numerous sites throughout San
Francisco.  However, demand for shelter beds far exceeds supply.  As
of October 1992, San Francisco had about 1,400 shelter beds for the
homeless.  Based on a local survey, between April 1992 and March
1993, community shelters turned away an average of 14,575 people each
month. 

The homeless can obtain primary medical care for the city's Health
Care for the Homeless (HCH)\2 program and the San Francisco
Department of Public Health.  HCH provides primary health care
services at six community clinics.  It also operates a mobile van
that provides health and social services and referrals to homeless
who are located in parks, food lines, and other places where they
congregate.  The homeless can also obtain health care such as
emergency treatment and mental health services at San Francisco
General Hospital.  However, the demand for mental health and
substance abuse programs is greater than the supply. 

We visited the following organizations that serve the homeless in San
Francisco.  They were identified to us as major service providers in
the community, but not the only providers in the area. 


--------------------
\2 The Health Care for the Homeless Program was established in 1985
and funded by the Robert Wood Johnson Foundation.  It is now funded
under the McKinney Homeless Assistance Act.  Beyond primary health
care, the program offers homeless clients mental health care and
counseling, substance abuse prevention education and outpatient
treatment, and human immunodeficiency virus (HIV) education and
treatment services. 


      SWORDS TO PLOWSHARES
---------------------------------------------------- Appendix VIII:5.1

Swords to Plowshares is a veterans' rights organization that has been
serving veterans, free of charge, in San Francisco since 1974.  It
offers a wide range of services to veterans such as employment
counseling, legal assistance, counseling services for post-traumatic
stress disorder, alcohol and drug abuse, and other mental health
problems.  It also assists veterans by providing information and
referral services, case management, outreach activities, and
advocacy. 

Swords to Plowshares has applied for and received several federal
grants to provide services to veterans.  It receives funding from (1)
HUD to perform non-residential case management services and (2) the
Department of Labor (two Job Training Partnership Act grants) to
provide job counseling and placement services for the economically
disadvantaged.  It has also received a grant from Labor, under the
Homeless Veterans Reintegration Projects, to provide employment
services to homeless veterans.  Swords to Plowshares has a contract
with VA to provide residential treatment in the HCMI program.  The
residential treatment program has six beds.  It has also contracted
with VA to provide lodging and treatment services in halfway houses
for veterans with substance abuse problems. 


      MCMILLAN DROP-IN CENTER
---------------------------------------------------- Appendix VIII:5.2

The McMillan Drop-in Center was established in 1992 to provide the
homeless a refuge from the streets.  It is open 24 hours a day, 7
days a week.  The maximum occupancy is 50, but as many as 300 clients
visit the drop-in center each day.  At McMillan, a homeless
individual may rest up to 16 hours in 1 of its 28 beds.  McMillan
also has a shower facility and provides food on a limited basis. 


      CENTRAL CITY HOSPITALITY
      HOUSE
---------------------------------------------------- Appendix VIII:5.3

Central City Hospitality House opened in 1967 to serve the people of
the Tenderloin community in San Francisco.  It provides a full array
of programs and services for the youth, homeless, and others in the
Tenderloin.  Its homeless adult services include a drop-in center,
emergency shelter program, job readiness and placement, health
screening, and a mail and message service.  The Hospitality House
publishes a community newspaper--The Tenderloin Times.  The Times has
a circulation of about 15,000 and is printed in English, Cambodian,
and Vietnamese.  The Hospitality House also operates the Tenderloin
Self-Help Center. 


      TENDERLOIN SELF-HELP CENTER
---------------------------------------------------- Appendix VIII:5.4

The Tenderloin Self-Help Center offers homeless adults social
services such as crisis intervention, individual counseling, and
support groups.  Their activities focus on substance abuse, job
seeking/keeping skills, acquired immunodeficiency syndrome (AIDS),
and sexual orientation issues.  Center staff also help eligible
individuals gain access to government entitlement programs. 


      ST.  ANTHONY FOUNDATION
---------------------------------------------------- Appendix VIII:5.5

St.  Anthony Foundation is a private, multiservice agency that
serves, through a variety of ways, the needs of people in the
Tenderloin community of San Francisco.  It provides the homeless with
basic necessities such as clothing, shower facilities, access to a
laundry room, and food.  It also maintains an overnight shelter for
40 females and operates a medical clinic, staffed with three
full-time physicians, with specialized programs for clients in need
of podiatry and AIDS care. 

In addition, the foundation offers several rehabilitation programs
for any homeless individual who desires to return to mainstream
society.  One rehabilitation program includes a 4- to 6-month drug
and alcohol treatment program located at a 375-acre dairy farm, where
clients work and receive individual and group counseling. 


      MULTISERVICE CENTERS
---------------------------------------------------- Appendix VIII:5.6

The City of San Francisco funds two multiservice centers for the
homeless that are operated under contract by private organizations. 
Multiservice Center-North, operated by Episcopal Community Services,
offers a wide range of services for homeless men and women.  These
services include a health clinic, shower facility, day drop-in
center, meals for clients, donated snacks, and 315 shelter beds. 

Multiservice Center-South is operated by the St.  Vincent De Paul
Society of San Francisco.  It is an all-male facility that maintains
232 beds.  Of these beds, 122 are allocated to social workers for use
by their clients.  Clients receive case management services while
participating for up to 6 months in programs that consist of
vocational rehabilitation and job placement services.  Also included
are mental health treatment and substance abuse counseling.  Of the
remaining 110 beds, 55 are available each evening for overnight
shelter, and the remaining 55 beds are used for other specific
purposes. 


      SALVATION ARMY - HARBOR
      LIGHT CENTER
---------------------------------------------------- Appendix VIII:5.7

Harbor Light Center offers services and treatment to male and female
substance abusers.  The center has 109 beds, including 27 beds in a
detoxification facility and 10 beds for HIV/AIDS clients.  In
addition, it operates a 28-day intensive substance abuse treatment
program, and a 6- to 12-month recovery program.  The center provides
services such as voluntary chapel, Alcoholics Anonymous meetings,
after-care sessions (for relapse prevention), alumni activities that
involve clients who have successfully completed center programs, and
employment services. 


      GLIDE MEMORIAL CHURCH
---------------------------------------------------- Appendix VIII:5.8

Glide Memorial is a multiservice center that provides a variety of
services for the homeless in the Tenderloin community of San
Francisco.  These services are free and include a youth and families
program, computer training, HIV/AIDS outreach education and support,
women's services, substance abuse prevention, treatment, and
recovery, and a jobs and life skills program.  Glide Memorial
operates a large food program that serves three meals daily-- more
than 1 million meals a year.  In addition, it also conducts several
community activities for homeless adults and children each year. 


      MARTIN DEPORRES
---------------------------------------------------- Appendix VIII:5.9

Martin dePorres serves two meals daily to the homeless. 
Approximately 300 to 500 breakfast meals and between 700 to 2,000
lunches are served daily.  These numbers vary greatly because the
demand is much greater at the end of the month.  Martin dePorres also
has a shower facility and operates an informal daytime drop-in center
for the homeless to have a safe place to visit during the day. 


      COALITION ON HOMELESSNESS
      (COH)
--------------------------------------------------- Appendix VIII:5.10

The COH was established in 1987 to work for change in city policies
and practices affecting homeless people.  The coalition has more than
120 members, including representatives from more than 60 service
providers, legal assistance and community agencies, housing
developers, and neighborhood and religious associations.  The
coalition publishes a monthly newspaper, The Street Sheet, that is
distributed (30,000 copies) by homeless people.  The newspaper is
intended to increase public awareness of homeless issues and is sold
for a $1 donation per copy.  The coalition considers selling the
newspaper a viable alternative to panhandling and the homeless keep
the proceeds of their sales. 


      HOMELESS VETERANS ACTION
      COMMITTEE
--------------------------------------------------- Appendix VIII:5.11

The Homeless Veterans Action Committee was established in November
1990 to provide advocacy for homeless veterans.  The committee also
provides homeless veterans with blankets, food, clothing, and
transportation.  In addition, Committee members conduct outreach on
the streets, parks, and other places where the homeless congregate to
identify and assist homeless veterans. 


      SAN FRANCISCO COUNTY
      VETERANS SERVICE OFFICE
      (VSO)
--------------------------------------------------- Appendix VIII:5.12

The VSO works as an advocate for veterans by providing direct
assistance in obtaining benefits to which they are entitled.  The
VSO, through its telephone network with VA, helps veterans who have
lost or misplaced their discharge papers obtain discharge
verification.  Telephonic verification of a veterans' discharge takes
about 10 minutes--by mail verification takes about 3 weeks.  In
addition, the VSO works closely with the San Francisco Department of
Social Services to assist veterans who may be eligible for social
security benefits.  The VSO serves approximately 300 veterans each
month and has assisted more than 800 homeless veterans since the
office opened in February 1993. 

The VSO also offers a representative payee program to veterans.  This
program allows the VSO to help veterans, especially those suffering
from substance abuse or mental illness, to manage their income. 
Finally, the VSO provides administrative assistance to veterans
attempting to upgrade their military discharges. 


      DEPARTMENT OF LABOR HOMELESS
      VETERANS REINTEGRATION
      PROJECT
--------------------------------------------------- Appendix VIII:5.13

The Department of Labor provides grants to large municipalities to
support flexible and innovative approaches to help homeless,
unemployed veterans reenter the labor force.  The funded projects
offer employment and training services for the homeless either
directly or by referral to existing resources.  Services provided for
by the grant include job training, remedial education, basic literacy
instruction, job counseling, and referrals. 

In fiscal year 1993, the Department contracted with San Francisco's
Swords to Plowshares program to provide employment and placement
services for homeless veterans.  According to Department officials,
the contract requires Swords to Plowshares to meet the following
goals for the year: 

  reach out to 600 homeless veterans,

  enroll 195 veterans in the Department's program,

  find employment for 90 program participants, and

  find housing for 60 program participants. 


      TRAVELER'S AID
--------------------------------------------------- Appendix VIII:5.14

In 1991, San Francisco was awarded a federal grant\3 to assist the
homeless population residing in or around public transit facilities. 
Under the grant, Traveler's Aid was awarded a contract by the San
Francisco Department of Public Health to participate in a federal
interagency demonstration project aimed at meeting the immediate and
long-term needs of the homeless.  The resultant Traveler's
Aid-Transbay outreach project offers the following homeless services: 
outreach, intensive case management, referrals, advocacy, and
counseling.  About 2,100 to 2,300 homeless clients receive these
services annually.  Although no data are collected, one official
estimated that approximately 30 percent of Traveler's Aid's clients
are homeless veterans. 


--------------------
\3 The Federal Interagency Council on the Homeless, the Department of
Health and Human Services, HUD, the Department of Labor, and the
Department of Agriculture are participating with the Department of
Transportation in the review and approval, funding, monitoring, and
evaluation of the projects. 


   VI.  VA DISCHARGE PLANNING FOR
   HOMELESS VETERANS
------------------------------------------------------ Appendix VIII:6

Our review of 19 patient treatment files showed that in 17 cases
homeless veterans about to be discharged from the San Francisco VA
Medical Center and HCMI were referred to other providers for
services.  However, VA staff did not consistently monitor the
veterans' progress once they were released from the VA medical
center, and none of the medical center records showed any evidence
that staff maintained contact with the veterans after discharge. 
Conversely, all 10 of the records we reviewed of veterans served by
the HCMI program showed follow-up and regular contact by VA personnel
after the clients left the program.  In these cases, the HCMI staff
appeared to provide a social support network for the veterans. 


PROGRAMS TO ADDRESS HOMELESSNESS
IN WASHINGTON, D.C. 
========================================================== Appendix IX


   I.  EXTENT OF HOMELESSNESS
-------------------------------------------------------- Appendix IX:1

Local providers and homeless agencies in Washington, D.C., estimate
the homeless population to be in the range of 10,000 to 20,000. 
Assuming that veterans represent about one-third of the homeless
population,\1 between 3,300 and 6,700 homeless veterans live in the
District.  During the past 5 years, the District government has spent
approximately $100 million in local and federal funds to address the
issue of homelessness.  Because District government officials believe
the current effort has not reduced or prevented homelessness, the
city is modifying its homeless program. 


--------------------
\1 The 1991-1992 Annual Report of the Interagency Council on the
Homeless states that studies indicate that about one-third of the
adult homeless population in the United States has served in the
armed services, p.  226. 


   II.  LOCAL MANDATES TO PROTECT
   THE HOMELESS
-------------------------------------------------------- Appendix IX:2

D.C.  Law 7-204, the Frigid Temperature Protection Amendment Act of
1988, ensures protection for homeless people when the temperature
falls below 26 degrees.  The mayor is authorized to open any District
building in order to comply with the provisions of this act. 
However, the District currently provides hypothermia assistance when
the temperature falls below 32 degrees.  Further, city employees and
volunteers patrol the streets and areas frequented by the homeless to
offer homeless persons access to medical assistance, food, and
clothing. 


   III.  VA SERVICES PROVIDED TO
   HOMELESS VETERANS
-------------------------------------------------------- Appendix IX:3

VA serves homeless veterans in Washington, D.C., through the
Washington VA Medical Center, the VBA regional office, and special
homeless programs, including HCMI and its residential component and
HUD-VASH.  VA has no current data on how many homeless veterans the
Washington, D.C., VA Medical Center has served.  During fiscal year
1993, the VBA regional office in Washington, D.C., served 62 homeless
veterans; the HCMI residential component provided an average of 11
beds and served approximately 56 veterans; and the HUD-VASH program
has 28 vouchers for section 8 housing, of which 23 have been
distributed as of December 1993. 

Washington, D.C., has one vet center, centrally located in the
District, that provides an avenue for homeless veterans to gain
access to VA services.  Outreach to homeless veterans is limited, and
staff primarily rely on others to identify and refer veterans to the
office.  The vet center staff coordinate with community organizations
and local universities to assist veterans, including the homeless. 


   IV.  VA'S OUTREACH/COORDINATION
   WITH LOCAL ORGANIZATIONS
   SERVING THE HOMELESS
-------------------------------------------------------- Appendix IX:4

VA's outreach and coordination in the Washington, D.C., community of
providers to the homeless consist of

  representation at meetings of several local coalitions for the
     homeless,

  regular visits to 15 community service providers and organizations
     for the homeless to maintain working relationships with
     community providers and identify homeless veterans,

  regular visits by HCMI staff to non-VA service providers in nearby
     communities to identify and assist homeless veterans, and

  participation in local events for the homeless and homeless
     veterans such as a stand down conducted in June 1992 that served
     about 40 homeless veterans. 


   V.  COMMUNITY PROGRAMS TO AID
   THE HOMELESS
-------------------------------------------------------- Appendix IX:5

Most services for the homeless are provided by local community
providers.  The District of Columbia contracts out to private
providers for its homeless services, including food, shelter beds,
and health care. 

A community organization, the Coalition of Housing and Homeless
Organizations (COHHO), exists in Washington, D.C., to address
homeless issues.  COHHO is a group of 70 nonprofit organizations and
homeless individuals that seeks to improve housing and supportive
services for all homeless and nearly homeless people in the District. 

Food and clothing are available at numerous sites throughout the
District and more than 5,000 shelter beds are available to the
homeless.  The city contracts out to local providers for almost 1,400
emergency shelter beds for single men and women, and the Community
for Creative Non-Violence (CCNV) operates an additional 1,400 shelter
beds.  But the demand for shelter beds is greater than the supply,
which forces some individuals to sleep on the streets. 

The Health Care for the Homeless Project, Inc.  (HCHP)\2

provides primary health care services at 11 stationary clinics and
operates one mobile van.  The homeless may obtain emergency medical
services at D.C.  General Hospital.  The city is responsible for but
cannot meet the demand for mental health services.  Consequently,
some homeless mentally ill are on the streets with no place to go
because they cannot get the help they need. 

We visited the following organizations that deal with the homeless in
Washington, D.C.  They were identified to us as major service
providers in the community, but not the only service providers in the
area. 


--------------------
\2 The HCHP was established in 1985 and was originally funded by the
Robert Wood Johnson Foundation.  It is currently supported by grants
from the Department of Health and Human Services, the District of
Columbia, and private sources. 


      CENTRAL UNION MISSION
------------------------------------------------------ Appendix IX:5.1

The Central Union Mission has been serving the homeless in
Washington, D.C., for 108 years.  The two primary programs for the
homeless are the overnight shelter and rehabilitation.  The mission's
overnight program provides 58 shelter beds each evening for men and
serves meals to both its long-term rehabilitation clients and
overnight guests.  Clothing is also available for anyone who needs
it.  While the mission provides for the basic needs of its homeless
clients, it also attempts to improve the lives of the homeless
through its religion-based rehabilitation program. 


      COALITION FOR THE HOMELESS
------------------------------------------------------ Appendix IX:5.2

The Coalition for the Homeless provides residential and social
services to the homeless.  For example, each night over 300 homeless
men may receive shelter and food at the coalition's emergency
shelters.  Other services provided by the coalition include
transitional housing, family shelters, single-room occupancy
facilities, and a substance abuse treatment program.  The coalition
also provides comprehensive case management services for clients at
each of its facilities. 


      COMMUNITY FOR CREATIVE
      NON-VIOLENCE (CCNV)
------------------------------------------------------ Appendix IX:5.3

CCNV is a 1,400-bed homeless shelter facility serving about 2,500
meals daily.  It offers its clients shower and laundry facilities,
clothing, primary health care, and other services.  In addition, it
offers medical treatment in an infirmary, mental health counseling,
dental services, legal services, job counseling, and benefits
counseling.  It also conducts a drug and alcohol recovery program and
maintains a library for its clients. 


      SO OTHERS MIGHT EAT (SOME)
------------------------------------------------------ Appendix IX:5.4

SOME offers a full array of services to more than 1,500 clients
(homeless or poor) each day.  For example, SOME serves over 1,200
meals daily and provides clothing and shower facilities to anyone in
need.  It also provides medical and dental care to 9,000 people
annually.  Through its social services activities and rehabilitative
programs, SOME helps the homeless improve their lives.  In SOME's
rehabilitative programs, the homeless can (1) participate in a 90-day
residential program designed to make them job ready and prepared for
independent living, (2) receive 90-day residential treatment for
substance abuse, and (3) obtain outpatient treatment for mental
illness.  Day services include group and individual counseling,
meals, life skills training, educational program, and recreation. 


      ASSOCIATED CATHOLIC
      CHARITIES (ACC)
------------------------------------------------------ Appendix IX:5.5

ACC provides assistance to the homeless and others requiring its
services in Washington, D.C., and five suburban counties in Maryland. 
ACC receives funding from the District of Columbia to provide
overnight shelter for the homeless in the city.  ACC operates four
shelters (Randall, Martin Luther King, Crummel, and Mt.  Vernon) in
the District that serve a total of about 600 homeless people each
evening.  Shelters for the homeless constitute approximately 40
percent of ACC's programs.  ACC also offers adoption services, foster
care, and refugee assistance. 


      OFFICE OF VETERANS' AFFAIRS
      (OVA)
------------------------------------------------------ Appendix IX:5.6

The District of Columbia Department of Human Services helps veterans
through the OVA, which acts as an advocate and assists veterans in
filing benefits claims and provides other services as appropriate. 
OVA staff also conduct outreach to homeless veterans and participate
in local homeless providers meetings.  The office is collocated with
the VBA regional office in Washington, D.C., and OVA staff work with
VA personnel and are familiar with VA's homeless program activities. 


   VI.  VA DISCHARGE PLANNING FOR
   HOMELESS VETERANS
-------------------------------------------------------- Appendix IX:6

Our review of 10 patient treatment files showed that in 9 cases
homeless veterans about to be discharged from the Washington, D.C.,
VA Medical Center and HCMI were referred to other providers for
services.  However, VA staff did not consistently monitor the
veterans' progress once they were released from the VA medical center
or homeless program.  Only four records showed any evidence that VA
maintained contact with the veterans after they were discharged. 


MAJOR CONTRIBUTORS TO THIS REPORT
=========================================================== Appendix X

HEALTH, EDUCATION, AND HUMAN
SERVICES DIVISION,
WASHINGTON, D.C. 

Flora H.  Milans, Associate Director, (202) 512-7120
James A.  Carlan, Assistant Director, (202) 512-7120
W.  Stuart Fleishman, Evaluator-in-Charge
Timothy E.  Hall, Evaluator

BOSTON REGIONAL OFFICE

Robert D.  Dee, Regional Assistant Manager
Richard C.  LaMore, Site Senior
Arthur T.  Merriam, Jr., Evaluator

NORFOLK REGIONAL OFFICE

Steve J.  Fox, Regional Assistant Manager
William L.  Mathers, Regional Assignment Manager
Dawn R.  Godfrey, Evaluator

