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VA Homeless Programs

 

Domiciliary Low Demand Model

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Domiciliary Low Demand Model

Low Demand Homeless Programs have played an important role in ending homelessness among our nation's Veterans. Low Demand Programs provide an effective alternative to Veterans who cannot stay clean and sober, or Veterans who have difficulty being fully compliant with their mental health care. Low Demand Homeless Programs are recovery programs that:

  • Provide supportive housing and rely on harm reduction practices
  • Serve hard-to-reach and hard-to-engage chronically homeless Veterans diagnosed with severe mental illness and/or substance use disorders
  • Do not require sobriety or compliance with treatment for admission or continued stay
  • Serve Veterans who have not been able comply with other homeless programs that require being clean and sober for admission and continued stay and full compliance with mental health care

The Domiciliary Care Program is the Department of Veterans Affairs oldest health care program. Domiciliaries provide a 24-hours-per-day, 7 days-per-week (24/7) structured and supportive residential environment as a part of the rehabilitative treatment regime. Domiciliary Care for Homeless Veterans (DCHV) provides a residential level of treatment for a homeless Veteran population. In 2015, VA launched the Low Demand Model in a Domiciliary in one location (West Los Angeles VA Medical Center).  Initially, the program opened with 30 beds. The program was expanded to 60 beds in June of 2016.

Domiciliary Low Demand Model for Homeless Veterans

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Domiciliary Care Program Bridge Housing with a Low Demand Approach

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The attached presentation provides an overview of major of the steps to start a Domiciliary based Low Demand Program

 
 

Low Demand Programs provide an effective link between street homelessness and permanent supportive housing. The Ward Family Foundation (2005) conducted a national survey of 79 Safe Havens. This review indicated that Safe Havens effectively engage and retain residents, with over half of residents successfully transitioning into some type of permanent housing program.

Ward Family Foundation Report 2005: Safe Haven Programs; Analysis of Strategies and Operating Practices

In 2016, the evaluation of the Domiciliary Low Demand Model Development Initiative yielded the following results:

  • Targeting -In FY 2016, sixty-eight per cent of the admissions were identified as chronically homeless and fifty-seven per cent were identified as having a mental illness or substance use problem.
  • Program Completion -In FY 2016, forty-nine per cent of the eighty-five discharged Veterans achieved successful completion and eleven per cent achieved partial successful completion of the program. Eleven percent were asked to leave for concerns about threats, violence, or repeated substance use. Twenty-five percent left the program.

The data on targeting and program completion ranks favorably with other Low Demand Programs.

Olivet, J., McGraw, S., Grandin, M., & Bassuk, E. L. (2010). Staffing challenges and strategies for organizations serving individuals who have experienced chronic homelessness. The Journal of Behavioral Health Services and Research, 37(2), 226–238.

Gerber, E. R., Haradon, S., & Phinney, R. (2008). Reforming the system of care: A review of the literature on housing and service arrangements for homeless populations. University of Michigan Center for Local, State, and Urban Policy. Policy Report, 12, 1–12.

The Domiciliary Low Demand Program at the West Los Angeles VA Medical Center operated for two years and achieved results consistent with other Low Demand Homeless Programs. The initiative played a role in introducing the national Domiciliary and Residential Rehabilitation Programs to the concepts of low demand/low barrier programs.

The Domiciliary Low Demand Program was required to comply with all requirements of the MH RRTP Handbook (December 22, 2012) in addition to specific guidance provided by the VA National Center on Homelessness among Veterans:

  • Serve hard-to-reach homeless persons with severe mental illnesses who are on the streets and have been unable or unwilling to participate in supportive services
  • Provide and encourage use of supportive services with a primary focus of preparing the Veteran to transition successfully to permanent supportive housing
  • Operate as a low demand facility where participants have access to needed services but were not required to utilize them within the confines of requirements specified in the MH RRTP Handbook
  • In keeping with low demand/harm reduction approaches, residents were not required to maintain sobriety or treatment compliance as a condition of admission or continued stay
  • The program was required to have a primary focus of transitioning and providing the bio-psychosocial support to move the veteran to permanent supportive housing.

2001: Established by Homeless Veterans Comprehensive Assistance Act of 2001, 38 U.S.C., PL 107-95

Domiciliary Low demand Model: An Implementation Framework (A step by step guide for starting and managing a Domiciliary Low Demand model using an Implementation Science Framework)

Domiciliary Low Demand Model Development Initiative Summary

POC

For information on VA Domiciliaries and Residential Rehabilitation Programs including starting a Low Demand Program in a Domiciliary contact: Jamie Ploppert Jamie.Ploppert2@va.gov

For information regarding the Domiciliary Low Demand Model  contact: Paul Smits psmits@usf.edu

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