Housing Interventions
& Practices

CARE COORDINATION, ADVOCACY, TREATMENT, AND CONNECTIONS TO HOUSING (CATCH) PROGRAM

Across VA homeless programs, there is an emphasis on engaging and providing services to vulnerable Veterans who are chronically homeless or at risk of homelessness with serious health and mental health diagnoses. There is also ongoing concern to address the needs of Veterans who have high rates of emergency department/urgent care (ED/UC) use and hospitalization. It is in this context that NCHAV and the National Health Care for Homeless Veterans (HCHV) Program in the VA Homeless Programs Office (HPO) are collaborating to replicate the VA Boston HCHV Program – Care Coordination, Advocacy, Treatment, and Connections to Housing (CATCH) program.

HOUSING FIRST

Housing First is an evidence-based supportive housing model that first emerged in 2000. It emphasizes permanent supportive housing to end homelessness and values flexibility, individualized supports, client choice and autonomy. This approach provides individuals who are experiencing homelessness with permanent housing as quickly as possible and supportive services as needed. Housing First contrasts with the linear staircase approach to housing, where individuals experiencing homelessness would begin in emergency shelters, then gradually transition to permanent housing based on their levels of success within subsequent service support programs requiring treatment and sobriety.

In 2010 and 2011 NCHAV developed and implemented a Housing First model for the U.S. Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program at 18 sites around the country. We provided training and technical assistance and conducted fidelity reviews. An evaluation found that the initiative successfully reduced time to housing placement from 235 to 35 days, significantly lowered emergency room use, and increased housing retention rates as compared to Veterans enrolled in a treatment first program.

In October 2012, the Housing First model was transitioned to VA Homeless Program operations for incorporation into the HUD-VASH program nationwide.

You can find more information about the Housing First approach within VA homeless programs below.

Housing Chronically Homeless Veterans: Evaluating the Efficacy of a Housing First Approach to HUD-VASH.

Montgomery AE, Hill LL, Kane V, Culhane DP. Journal of Community Psychology. 2013 Mar; 41(4): 505-514. (doi: 10.1002/jcop.21554

Housing first on a large scale: Fidelity strengths and challenges in the VA's HUD-VASH program.

Kertesz SG, Austin EL, Holmes SK, DeRussy AJ, Van Deusen Lukas C, Pollio DE.Psychol Serv. 2017 May;14(2):118-128. doi: 10.1037/ser0000123.

Frits, B. (Ed.). (2021). Proceedings from VA National Center on Homelessness Among Veterans Homeless Evidence and Research Synthesis Roundtable Series: Where are we with Housing First?

Homeless Evidence and Research Synthesis (HERS) Roundtable Proceedings: Where are we with Housing First?, August 16, 2021

SAFE HAVENS

A Safe Haven is a 24-hour/7-days-a week community-based early recovery model of supportive housing that serves hard-to-reach and hard-to-engage Veterans with severe mental illness and/or substance use problems who are living on the street and have been unable or unwilling to participate in traditional treatment and supportive services. This model, consistent with principles of Housing First, does not require sobriety or full compliance with treatment for admission or continued stay in the program. Safe Havens were initially authorized by the McKinney-Vento Act of 1994.

The Safe Haven model provides a housing environment that is safe, sanitary, flexible, and stable. The small facilities, typically with 25 beds or fewer, provide a low-demand, non-intrusive setting designed to re-establish trust and re-engage residents in treatment services and permanent housing options.

In FY 2010, NCHAV established a Safe Haven model development initiative in collaboration with partners at the University of South Florida that could be replicated throughout the VA to address the special needs of chronically homeless Veterans. We initially tested the model with community-based partners at five sites. In 2013 the VA Homeless Programs office funded 15 additional sites. During this initial period more than 700 Veterans were served. Over 55% of the Veterans who exited the program moved into stable housing. Upon discharge, 63% were receiving VA benefits or had pending applications and 67% were receiving non-VA benefits or had pending applications. Service linkages with VA and non-VA providers were in place for most of the Veterans following discharge: 62% for alcohol treatment, 64% for drug treatment, 76% for mental health treatment, and 85% for medical treatment.

The VA Homeless Program Office now has over 24 contracted Safe Haven programs with community-based homeless service providers.

GRANT & PER DIEM LOW DEMAND

The Grant & Per Diem (GPD) Low-Demand program offers VA funded GPD providers an opportunity to revise their program designs using a low demand/harm reduction model to better accommodate chronically homeless Veterans who cannot stay clean and sober or who have difficulty being fully compliant with their mental health care. Low Demand programs do not require sobriety or compliance with mental health/substance use treatment as a condition of admission or continued stay. Demands are kept to a minimum; the environment of care is as non-intrusive as possible to foster trust between staff and residents; rules focus on staff and resident safety; and case management, education, and treatment services are offered and highly encouraged, but are not a condition of admission or continued stay.

Developing specialized programs to accommodate chronically homeless Veterans who have difficulty with compliance in traditional homeless programs became a high priority in 2009 as VA developed plans to end homelessness among Veterans. In 2014, NCHAV partnered with the national GPD Program in the VA Homeless Programs Office and staff affiliates from the University of South Florida (USF) to develop an implementation process for a low demand program specifically tailored to GPD providers. The first site became operational in March 2015. We continue to offer training and technical assistance to providers through USF via biweekly calls and teleconferencing and individual consultation as needed. Fidelity assessments are conducted annually to help ensure that the model is being implemented as intended.

In FY 2022, 82 GPD providers used the low demand model, serving 1,836 Veterans. Upon exiting the program, 61.7% were discharged to permanent housing. Fidelity data indicate that the Low Demand model is being implementing as intended.