PETER H. DOUGHERTY
DIRECTOR, HOMELESS VETERANS PROGRAMS
U.S. DEPARTMENT OF VETERANS AFFAIRS
HOUSE COMMITTEE ON VETERANS AFFAIRS
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
June 24, 1999
Mr. Chairman and Members of the Subcommittee, I want to thank you for your continuing interest in the issue of homelessness among veterans and your efforts to support a variety of assistance programs to improve their lives. Accompanying me this morning is Dr. Robert Rosenheck, VA Director of the Northeast Program Evaluation Center and Professor of Psychiatry and Public Health at Yale University. Also in attendance is Ms. Gay Koerber, Associate Chief Consultant Health Care for Homeless Veterans, and Mr. Roger Casey, Program Manager, Homeless Grant and Per Diem Program, in case there are specific questions the subcommittee needs them to address.
We understand that the focus of this oversight hearing is to gather information on the effectiveness of federal grants to community based organizations as a means of addressing the needs of homeless veterans. In accordance with your wishes,, we will limit much of what we say to the specific topic of this hearing. However, we do want you to know that we believe we have a number of highly effective programs and partnerships that assist many of the estimated quarter million veterans who find themselves homeless in America. Much of that information is included in an attachment, which we ask be made a part of the record.
We want the Committee to recognize the diverse efforts and substantial internal and external collaborations VA has made to improve the lives of those veterans who are homeless. VA medical care and supportive services are offered to homeless veterans with significant collaboration from community service providers. Innovative programs have made more than 175 foreclosed properties available at deep discounts or leased for $1 per year for homeless service providers., and many homeless veterans have had claims expedited. A great internal partnership has been established betweenby ourthe Compensated Work Therapy Program (CWT) and the nation’sour’s national cemeteries that assists many homeless veterans on the journey back to employment with therapeutic work experience at some of our Nation’s most hallowed ground.
VA has one grant program that is specifically designed to assist homeless veterans. The Homeless Providers Grant and Per Diem Program is our effort at bringing the strengths of community- based service providers, state and local governments, native American tribes and veterans service organizations and VA together to work to improve the lives of our Nation’s veterans. This program is viable in the Nation’s largest urban centers and in it’s smallest towns and villages.
The Homeless Providers Grant and Per Diem Program began in this Committeeright here nearly seven years ago when your committee approved legislation authorizing the program. We are here to tell you that tThe Department of Veterans Affairs believes that this program is enablingenables thousands of veterans each year to improve the quality of their lives in ways that were unattainable at the beginning of this decade. This program is bringing thousands of veterans to gainful employment, stable housing, reunification and renewed financial and emotional responsibility with families, and significantly improved health. All these factors make this program worthwhile. In an era in which taxpayers’ investments in government functions are being closely followed, the work of this program is one of the best investments America is making.
As of October 1998, VA had awarded 127 grants to 101 different entities in 39 states and the District of Columbia. We have committed approximately $26 million in grant funding during the past five years, and the President’s FY’2000 Budget funds this program at $31 million. We appreciate thecongressional requirement to increased funding for this program this fiscal year. When all current grantees complete their acquisition, renovation and/or rehabilitation of their property we expect more than 2,700 transitional housing beds for homeless veterans will be created in communities across the Nation. Twelve Fourteenindependent homeless service centers, five mobile service center units which will provide medical care and/or counseling services for homeless veterans, and twenty vans to address transportation needs, have or will come into community service as a result of our grant program.
While tThis Congress is considering whether towill once again consider the desirability to reauthorizeze the Homeless Veterans Service Providers Grant and Per Diem Program, and whether, let us complement this committee in its earlier attempts to allow VA to lift the cap on the number of vans that providers can procure using grant funds. Allowing community groups to be awarded funding for vans is a great way to improve access to services without creating more costly accessible community services. VA supports extension of the program and lifting the cap on use of funds to acquire vans.
Tonight, more than 1,000 veterans will put their heads on pillows in one of nearly three dozen locations across the country at quality facilities supported by VA per diem payments. These community-based programs span our Nation in large cities and small towns. Once many formerly homeless veterans went without hope; now, many. Many now are able to return to their highest functional ing level in independent living arrangements and are once again becoming employed. VA paysthese providers $16 per day for the care and treatment of our homeless veterans. This modest investment is giving us a great opportunity to improve the lives of these veterans. Our homeless service providers are committed to an extremely difficult task with little financial reward.
As you know, the General Accounting Office recently conducted two reviews of homeless programs: "HOMELESSNESS Coordination and Evaluation of Programs Are Essential" [GAO/RCED-99-49] and "HOMELESS VETERANS VA Expands Partnerships, but Homeless Program Effectiveness is Unclear" [GAO/HEHS-99-53]. We believe that those reports generally showed that the programs offered by VA are highly collaborative in their approach and effective in their results. GAO told us that no single treatment program can serve all veterans with equal effectiveness. We agree and believe our programs offer diverse delivery options to provide veterans with the best treatment setting available. These treatment options are essential components in our ability to be effective.
GAO recommended in the latter report that VA initiate a series of program evaluation studies to address the long-term effects. That recommendation was to review positive outcomes and program impact with enhanced follow-up of those veterans who have been through our programs. We concurred. Prior to this recommendation being presented we were taking steps at selected sites to improve our information on long-term program effectiveness. We hope to present information on this topic to the committee in the future.
VA Involvement with other Federal Agencies
VA has been an active participant on the Federal Interagency Council on the Homeless (ICH). As you know Tthe ICH is a working group of the White House Domestic Policy Council housed within the Department of Housing and Urban Development (HUD). ICH’s role is to coordinate the activities of the various Federal agencies and improve our collective response to homelessness in America. ICH is committed to breaking the cycle of homelessness and we are very supportive and involved in its work. The Secretary of Housing and Urban Development (HUD) serves as chair, the Secretary of Health and Human Services (HHS) and the Secretary of Veterans Affairs (VA) serve as co-vice chairs.
One of the most important projects recently undertaken by the ICH is the "National Survey of Homeless Assistance Providers and Clients." The survey conducted by the Census Bureau should be released this summer. We hope this report will answer a number of questions about service availability and utilization and give us rich information about who are the homeless, how often and how long have they been homeless, and what programs and activities were most helpful in getting them out of homelessness. VA has actively participated in the design of the survey and will work with the extensive data that is released from the more than 4,000 individuals who were interviewed.
VA has worked to improve communications with other Federal programs that assist veterans.
The largest programs to assist homeless persons conducted under the McKinney Act isare HUD’s Homeless Assistance Programs. These programs that awards homeless assistance grants for emergency, transitional and permanent housing and supportive services under local continuums of care established at the city or county level in more than 900 jurisdictions. While thisthese programs hashave worked well in many instances, we are continually working with HUD to improve program coordination., a group that is overwhelmingly male.
As a result of a number of discussions with local community organizations and veterans service organizations, we believe it is very important to maintain a high degree of collaboration and high levelexchange of information regarding need, accessibility of services and eligibility of persons to be served by the local community.
The Department of Veterans Affairs is asking for permission to dispose of thirty properties under a pilot program. If this proposal is approved it will allow VA to keep 90% of the sales proceeds for use in support our healthcare mission. Ten percent of the net proceeds would be used to support HUD’s McKinney Act programs. While we believe this is a modest approach, we do think its long-term impact in helping homeless people, including homeless veterans, could be substantial.
The U.S. Department of Labor (DoL) has long been an VA ally in assisting homeless veterans. DoL’s HVRP (Homeless Veterans Reintegration Projects) Program awards small grants to non-profit organizations to assist veterans with training, employment and transportation needs faced by (unemployed) homeless veterans.
DoL requires its grantees to meet with local VA staff so that each may be aware of the capabilities and limitations of the other and to develop some ways to achieve increased cooperation to benefit the veterans both seek to serve.
The Department of Health and Human Services (HHS) has a number of programs that assist homeless veterans. and oOur dDepartment has strong working relationships with their Substance Abuse and Mental Health Services Administration. HHS’s Projects for Assistance in Transition from Homelessness (PATH) provides grants to states that develop comprehensive strategies to address homelessness among persons with mental illnesses in the respective states.
The Public Health Service Act, Part C, Section 522(d) requires the Secretary (of HHS) in making grants using PATH appropriations, to be sure each State in its application is givesng special consideration to entities with a demonstrated effectiveness in serving homeless veterans. I have served for several years as a PATH application reviewer. There has been some excellent cooperation with some states; but other states show little understanding of the services and programs offered by VA and the opportunities to have PATH grantees work more closely with veterans.
We at VA are working closely with staff at HHS to improve communications at the national, state and local levels. We believe this information dissemination at multiple levels is necessary to have the beneficial effect on those veterans who need assistance.
In addition, we have good relationships with the Federal Emergency Management Agency (FEMA) and the Department of Agriculture. Both of these agencies provide food assistance to homeless persons and we have enjoyed the opportunity to exchange ideas regularly. Our community assessments have found food needs that are generally been met. We believe this is, in large part, a result of the collaborative efforts of both agencies.
VA and Community Partnerships
For five years, VA has conducted Community Homelessness Assessment Local Education and Networking Group CHALENG meetings to determine the needs of homeless veterans, establish and update local resource directories and develop local action plans. More than 10,000 persons have attended these meetings and many have worked diligently to improve the lives of veterans in their communities. We shared the information gathered at these meetings with HUD regional managers and encouraged its use by local communities.
VA’s Millennium Project is called: "Stand Down 2000." These community-based efforts strive to offer homeless veterans and family members an entry into a community-wide continuum of services. Based on our past experience, we anticipate that most veterans participating in stand downs will be men (only three to four percent are women). The vast majority of veterans attending stand downs are single, and most come from poor, disadvantaged backgrounds. Homeless veterans tend to be older and more educated than homeless non-veterans are. About 45% of homeless veterans have a serious psychiatric disorder and slightly more than 70% suffer from alcohol or other drug abuse problems. More than half are African American or Hispanic.
VA will support community efforts to hold stand downs and assistance fairs in every state. We hope as that many as 100,000 veterans and their family members will be assisted. This will be done with, hopefully, the help of more than 40,000 volunteers during November 1999 through December 2000. VA has, for more than a decade, been a partner with Veteran Service Organizations, community-based, non-profit service providers and state and local governments to reach out to homeless veterans. VA will continue to work with these groups in coordinating stand downs in the hope that more than 25,000 veterans will access mental and physical health care services for the first time at these stand downs.
We have worked with all major veteran service organizations, as well as the Veterans Organization Homeless Council, the National Coalition for Homeless Veterans, the National Alliance to End Homelessness, the National Law Center on Homelessness and Poverty and other national organizations and offices in an effort to improve the continuum of services for veterans. VA serves as the lead agency to bring the resources of the community to better understand the capability and availability of services for veterans. We do this at meetings with those organizations and with other Federal agencies actively involved in assisting homeless person, including homeless veterans.
VA Activities Under Title V of the McKinney Act
VA surveys all VA medical care facilities and regional offices twice each year to identify unutilized and underutilized property that might be made available to non-profit organizations to serve the homeless.
In January 1999, VA identified 67 unutilized and underutilized properties of which 29 were determined to be suitable for use by homeless providers. The process of identifying Federal properties for use by homeless service providers has been in place, with some modifications, since 1987.
A specific McKinney Act transaction involved a former VA property at North Little Rock, AR that had been reported as excess to the GSA. GSA negotiated a permit with HHS for a homeless provider to use part of this property and VA, as former landholder, agreed to the terms. Ultimately that deal fell through. We have found the McKinney Act requirements and procedures are administratively burdensome and there is more incentive for VA to directly lease its unutilized property to homeless groups that serve veterans rather than relinquish property under the McKinney Act.
VA medical centers (VAMC) have entered into several successful partnerships with non-profit organizations that are providing programs and services for homeless veterans. VAMCs have provided properties to non-profit organizations, under short-term leases and sharing agreements in an effort to expand services for homeless veterans. Examples include VAMCs at Northampton, MA; Northport, NY; Coatesville, PA; Hampton, VA; Richmond, VA; Martinsburg, WV; Chillicothe, OH; St. Louis, MO; Minneapolis, MN; Portland, OR; and West Los Angeles, CA.
In addition, non-profit organizations have received grants pursuant to VA’s Homeless Providers Grant and Per Diem Program to renovate VA properties to serve as supportive housing for homeless veterans. Under VA’s Homeless Providers Grant and Per Diem Program, VA also provides these non-VA organizations with per diem payments (currently $16 per day) to help offset the costs of operational expenses.
VA Conducts Extensive Program Monitoring
VA has the Nation’s most extensive and long standing program of monitoring and evaluating data concerning homeless veterans and the programs that serve them. In 1987, at the request of this Committee, the Northeast Program Evaluation Center (NEPEC) initiated a three-fold evaluation strategy for what was then an unprecedented VA community collaborative program – the original HCMI program.
Under this evaluation plan: (1) all veterans evaluated by the program were systematically assessed to assure that program resources were directed to the intended target population (now almost 30,000 underserved homeless veterans per year); (2) housing, employment, and clinical outcomes were documented for all veterans admitted to community-based residential treatment, the most expensive component of the program; and (3) a detailed outcome study documented housing and employment outcomes after program termination was initiated.
The NEPEC study showed 30% to 40% improvement in psychiatric and substance abuse outcomes, employment rates doubled, and 64% exit from homelessness at the time of program completion. When these veterans were re-interviewed 7.2 months after program completion, they showed even GREATER improvement. A similar effort was mounted for the Domiciliary Care for Homeless Veterans program with similar long-term post-treatment results. Both of these studies have been published in leading medical journals.
After establishing the effectiveness of these basic programs with extensive follow-up studies, VA developed several enhancements to the core program in several areas. These areas include compensated work therapy (CWT), outreach to assure access to Social Security (SSA) benefits, and a collaborative program with HUD that joins VA case management with HUD section 8 Housing Vouchers. Outcome studies demonstrated the long-term effectiveness of the CWT/TR program at reducing substance abuse and increasing employment. The Joint VA-SSA outreach effort conducted in New York City, Brooklyn, Dallas, and Los Angeles almost doubled the percentage of SSI awards made to veterans from 7.19 percent to 12.4 percent of the veterans contacted during the outreach effort.
A recent outcome study showed that, compared to a control group that did not receive benefits, SSA beneficiaries had improved housing and overall satisfaction with life as a result of their receipt of benefits. The outcome of the study also showed no increase in substance abuse, with the exception of tobacco use for SSA recipients. A follow-up study of the HUD-VA supported housing program shows that the benefits of this program were sustained THREE YEARS after program entry. This is the longest follow-up study conducted on any homeless population anywhere.
In addition, VA is a leader in documenting the substantial additional costs of treating homeless veterans with mental illness and in tracking the expenditure of every program dollar to assure maximal efficiency and accountability. Several additional program improvements are planned for implementation during the next the next year. These included transitional housing services for homeless inpatients, a new, more accessible supported employment program, and a special outreach program for homeless female veterans.
Each of these efforts will receive the same scientifically rigorous evaluation that has characterized all components of VA’s homeless initiatives for the past 12 years. Furthermore, NEPEC uses the same clinical measures with the Homeless Grant and Per Diem Program as with all other VA homeless specific programs to assure monitoring consistency. This has allowed us to create a common measuring stick for all of our homeless programs.
VA’s Commitment to Assisting Homeless Veterans Continues
The Department of Veterans Affairs has worked diligently for more than a decade to improve the lives of our Nation’s homeless veterans. The Administration’s budget shows how seriously we are at attempting to break the cycle of homelessness among veterans. This budget seeks wide opportunities to address the solutions with a variety of treatment options. Most of the money will be spent with community services providers providers by doubling the amount of funding under our contract residential care program; providing special programs for homeless woman veterans; expanding our therapeutic work experience under our CWT program; increased support for stand downs; increased program monitoring and evaluation; increased funding for our grants and per diem program.and with community generated practical solutions
We have learned some lessons that have guided us to date:
First. While VA has the most extensive system of services for homeless veterans in America, we cannot and should not try to do it alone. Since the late eighties, we have collaborated with communities and community based homeless service providers.
Second. While there are a number of common patterns, each veteran who has become homeless is like each American who has become successful: their paths are different and the intervention for rehabilitation may take multiple attempts and need multiple treatment options prior to successful completion.
Third. Aggressive involvement with other Federal agencies, state and local governments, Native American Tribal governments, veterans service organizations and tens of thousands of volunteers makes a difference.
Finally, something needs to be said and remembered here today: America has a long and proud tradition of doing everything possible to bring back those wounded on the battlefield. For many of America’s homeless veterans, the battle continues, and they are out there wounded, suffering from mental illness, and substance abuse disorder. Many carry the scars of the wars we sent them off to fight.
We must do all we can to bring every veteran home—our commitment expressed here today continues that tradition. Many homeless veterans on the streets, under bridges and encamped in the woods are desperately hoping that someone is coming to bring them back to safety—to bring them home. That is our commitment to bring all of America’s homeless veterans—home.
With your help and with the help of dedicated staff, veteran specific service providers, veterans service organizations, thousands of volunteers, including a number of AmeriCorps members, we will continue to bring back those in greatest need, treat them with compassion and assist them in enjoying the bounty of the American dream.