HUD-VASH Exit Study - Homeless Veterans
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HUD-VASH Exit Study

OVERVIEW

The HUD-VA Supportive Housing (HUD-VASH) program combines HUD’s housing choice vouchers, administered by public housing authorities (PHAs), with VA case management to offer homeless Veterans permanent supportive housing. The HUD-VASH Exit study, commissioned by HUD and VA, investigated HUD-VASH at four sites: Houston, TX; Los Angeles and Palo Alto, CA; and Philadelphia, PA. The study examined program implementation, the movement of Veterans from homelessness to being housed, and the nature of Veterans’ exits from HUD-VASH. To do this, the research team analyzed administrative data covering 2008 to 2014 at the four sites, and surveyed Veterans and conducted site visits (including interviews with staff and Veterans) between 2011 and 2014. As such the study captures HUD-VASH during a time of transformation. In 2008, HUD-VASH served fewer than 2,000 Veterans. By 2014, HUD-VASH was a major program that housed 53,000 Veterans and had served more than 80,000 Veterans. The study defined three HUD-VASH Veteran groups: (1) stayers (Veterans in the program for at least 600 days), (2) leased-up exiters (Veterans who exited after leasing up), and (3) nonleased exiters (Veterans who exited before accessing housing). “Exit” was defined as leaving VA case management as recorded in VA administrative data by case managers. The study finds that about half of the leased-up exiters left HUD-VASH for positive reasons such as accomplishing their goals or increased income, but that only a quarter of nonleased exiters had positive reasons for exit. Common negative reasons for exit included housing difficulties, loss of contact with the program, illness, incarceration, and non-compliance with program rules. Specific recommendations to ensure continued program effectiveness converge around (1) improving coordination of HUD and VA processes in HUD-VASH sites; (2) targeting financial resources for specific situations such as move-in, threat of eviction, and transitioning out of HUD-VASH; and (3) ensuring continuity of care for Veterans in the program. 

To view the full report, please use the following link: https://www.huduser.gov/portal/sites/default/files/pdf/HUD-VASH-Exit-Study.pdf

Contact: Ann Elizabeth Montgomery, PhD / Ann.Montgomery2@va.gov

See additional research studies related to HUD-VASH below

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Housing Chronically Homeless Veterans: Evaluating the Efficacy of a Housing First Approach to HUD-VASH
Montgomery, A.E., Hill, L.L., Kane, V., Culhane, D.P.
2013
Read Article: http://onlinelibrary.wiley.com/doi/10.1002/jcop.21554/abstract

Abstract

Rapidly placing homeless Veterans with severe mental illness into permanent housing is one important goal of the U.S. Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program; however, no research has tested whether an explicit organizational alignment of this goal with revised practices could improve outcomes. A demonstration project initiated in 2010 to reform housing placement practices in a metropolitan area enabled researchers to compare an explicit “Housing First” program—offering immediate permanent housing without requiring treatment compliance, abstinence, or “housing readiness”—with a treatment-first program for 177 homeless Veterans. The Housing First initiative successfully reduced time to housing placement, from 223 to 35 days, housing retention rates were significantly higher among Housing First tenants, and emergency room use declined significantly among the Housing First cohort. The results suggest that a national Housing First model for the VA would be associated with improved outcomes for Veterans experiencing homelessness.

Contact: Ann Elizabeth Montgomery, PhD / Ann.Montgomery2@va.gov


 Factors Contributing to Eviction from Permanent Supportive Housing
Montgomery, A.E.
November, 2017
Read Article: http://www.sciencedirect.com/science/article/pii/S0149718916301379?via%3Dihub

Abstract

BACKGROUND:  Survey data indicate that eviction (i.e., a forced to move from a rental property by a landlord) may occur in up to 1 of 14 renter households.  Such an involuntary or forced move is associated with both immediate and enduring negative consequences, including ongoing residential mobility, often to neighborhoods with higher levels of poverty and crime1 and into substandard or lower-quality housing. The experience of eviction has been associated with an increased likelihood of depression, poor health, and stress related to parenting as well as the degradation of social support networks.  Eviction may even lead to homelessness: among the 58,000 individuals who access emergency homeless shelters in New York City each night, two-thirds cite eviction as their cause of homelessness.  The immediate impact of eviction tends to persist over time as these households have a diminished ability to access housing. Finally, an effect of involuntary moves is job loss, ultimately resulting in “material hardship,” which has been shown to be ongoing.

The U.S. Department of Housing and Urban Development (HUD)-Veterans Affairs (VA) Supportive Housing (HUD-VASH) program is intended to ensure housing stability for Veterans with a recent history of homelessness who require supportive services to live independently. However, Veterans leave HUD-VASH, and other permanent supportive housing (PSH) programs, for a number of reasons, including eviction. The objective of the present study was to identify correlates of eviction from HUD-VASH—both characteristics of the Veterans and precipitating events, in this case revealed through Veterans’ use of acute care services—that may signal imminent eviction.

METHODS:  The study sample was drawn from Veterans who exited the HUD-VASH program, after being housed, between October 2008 and February 2016 (N=45,834). VA case managers indicated 1 of 13 reasons why Veterans left the program; the cohort for this study included only Veterans who exited HUD-VASH during the observation period and had either been evicted (N=4,684; 10.2%) or left the program because they had accomplished their case management goals (N=15,462; 33.7%). Using Veterans’ electronic medical record data, we assessed their characteristics and potentially precipitating events. This brief describes the relationship between the increasing use of acute care services—inpatient admissions and emergency department visits—proximal to Veterans’ program exits and eviction. Dichotomous variables indicated whether Veterans had 1 inpatient admission or at least 2 emergency department visits during the 61–90, 31–60, and 0–30 days prior to exit.

Using chi-square tests and independent samples t-tests, we assessed differences in the characteristics of Veterans who exited HUD-VASH due to eviction and those who exited after accomplishing their goals. To understand correlates of eviction and potential precipitating events, we conducted a logistic regression analysis in which eviction was the outcome and use of acute care at 3 time periods preceding program exit was the primary predictor variable, controlling for Veterans’ characteristics.

RESULTS:  Approximately 1 in 10 Veterans who left HUD-VASH housing exited due to eviction, a rate slightly higher than that reported in the limited existing research assessing evictions among renter households. Veterans who left HUD-VASH due to eviction were more often male, were not receiving compensation related to a service-connected disability, and had diagnoses of chronic medical conditions, serious mental illness (SMI), and substance use disorder (SUD). The prevalence of suicidal and self-harm behaviors was 7 times higher among evictees than Veterans who left HUD-VASH because they accomplished their goals. Evictees stayed in HUD-VASH an average of about 19 months; the average tenure among those who accomplished their goals was 40% longer.

Compared with Veterans who had accomplished their goals, a significantly larger proportion of Veterans who were evicted had received acute care—inpatient and/or emergency—and more frequently increased their use of acute care as exit approached. Veterans who were evicted were approximately 40% more like likely to have an acute care visit during the 30 days immediately prior to exit compared with 61–90 days prior to exit and had almost 10 times the rate of acute care use as Veterans who accomplished their goals during the 30 days prior to exit.

The results of the logistic regression showed that acute care use predicted evictions from HUD-VASH. Receiving acute care (i.e., either 1 inpatient admission or 2 or more emergency department visits in a 30-day period) at 61–90 days, 31–60 days, and especially 0–30 days prior to exit was associated with an increased risk of eviction: Veterans who received actue care during the 30 days prior to exit had 4.67 the odds of being evicted rather than exiting the program because they accomplished their goals.

DISCUSSION:  The results presented here indicate a number of factors associated with an eviction from HUD-VASH as well as factors that may mitigate this risk, both of which may inform field-based applications to identify imminent eviction among tenants of PSH. Accurately assessing Veterans’ needs, strengths, abilities, and preferences throughout Veterans’ participation in HUD-VASH is important; this study identified a set of characteristics and precipitating events that may increase odds of eviction, which regular assessment could identify as well. Continued assessment throughout Veterans’ participation in HUD-VASH is critical to determine which and how much of the 2 components of HUD-VASH, housing and services, they need. This is particularly important for Veterans who have significant disabilities, are unable to live independently, and may end up in more restrictive housing situations if they are evicted and no longer eligible for a deep housing subsidy.

HUD-VASH has the unique capacity to access a wide range of data related to the Veterans participating in the program at any one time. These data, particularly those that indicate the receipt of acute health care, are recorded in real time and allow providers to address concerns proactively. Findings from the models presented here suggest that specific patterns of health services utilization may predict eviction, likely due to behaviors related to a significant substance use issue that ultimately requires a hospital admission. Precipitating events occurring during the 30 days prior to exit most strongly predicted eviction; while this is somewhat expected, it may not afford care managers or other services provider adequate time to impact the outcome.

Drawing from the conclusions of this research, in July 2017, the VHA National Homeless Program Office and the VHA Support Service Center developed a report to provide visibility to HUD-VASH staff when Veterans are admitted to inpatient and residential settings. The new HUD-VASH Inpatient/Residential Contact and Follow-Up Report identifies Veterans who are housed in HUD-VASH and who have been admitted to or discharged from inpatient or residential settings. The report tracks whether contact with the Veteran has been made during the admission or within 7 days of discharge with the objective of providing “real-time” visibility when Veterans receive acute health care and residential services so that HUD-VASH staff can better address treatment concerns and issues proactively.

For additional information about this report, VHA staff may acces sthe following resources:


Contact: Ann Elizabeth Montgomery, PhD / Ann.Montgomery2@va.gov



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