Housing Interventions
& Practices


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 two linked promising practice models that are operating in the VA Boston HCHV Program – the Care Coordination, Advocacy, Treatment, and Connections to Housing (CATCH) program and the Trauma-Informed Care (TIC) Integration Initiative. Lessons learned from Boston HCHV’s experience in working to adopt a trauma-informed approach will be used to develop an enhanced model to pilot at two VA medical centers.

CATCH – a model intervention for our most vulnerable Veterans experiencing homelessness

Established in 2013 CATCH serves Veterans experiencing homelessness who have high needs and treatment costs and face complex challenges in obtaining and retaining housing, often due to chronic serious mental illness and/or substance use. CATCH is a three-year program that devotes the first two years to moving the Veteran to stable housing and the third to ensuring the Veteran can live independently with strong connections to VA and community resources and supports. Longitudinal analyses of emergency department/urgent care (ED/UC) visits and admissions costs for Veterans enrolled in CATCH between fiscal years 2014 and 2019 showed a 48% decrease in ED/UC visits and a 41% decrease in admissions costs after the first year of enrollment. Five years after enrollment average admissions costs had fallen by 81%, from $156,856 to $29,392. CATCH not only offers a pathway to hope for Veterans who have fallen by the wayside but also, as these results clearly show, pays for itself over time. CATCH will be replicated at two medical centers beginning in fiscal year 2023.

Trauma-Informed Care Integration Initiative – a model for incorporating trauma-informed care principles into homeless programs

CATCH uses a trauma-informed approach to care that aligns with the Trauma-informed Care (TIC) Integration Initiative launched in 2017 to incorporate trauma-informed care principles into programming and policy across the Boston Medical Center’s homeless programs. This work is guided by a multi-disciplinary, multi-level TIC Task Force and a plan developed through a trauma-informed organizational capacity assessment. The overall goal is to make a trauma-informed approach a common thread across programs, while allowing each program to “customize” the approach for their particular missions and goals. This model will be replicated along with the CATCH program at two medical center sites.


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


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.


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.