HAMPTON WORKING FIVE YEAR PLAN FACILITY DIRECTOR FACILITY HOMELESS VETERAN CHAMPION SENIOR HOMELESS VETERAN MANAGER Deanne Seekins, MBA, FACHE Dr. Arul, MD. Chief of Staff Marti Chick-Ebey, LCSW, Homeless Coordinator PURPOSE The VA has developed a comprehensive plan to end Veteran homelessness over the next four years addressing homeless Veterans needs with the no wrong door approach. We will end Veteran homelessness by collaborating with our internal and external partners to increase homeless veteran access to healthcare, income and stable affordable housing. We will also establish goals to prevent Veteran homelessness through rapid-re-housing, supportive services, and emergency crisis response. This document consolidates identified strategic goals at the Federal, State and Local level and is meant to synchronize efforts across agencies including VA. It will serve as the working plan for VA and our Federal, State and Local community partners. MEASURABLE GOALS, OBJECTIVES AND OUTCOMES At a minimum, the Working Five Year Plans should include measurable goals, objectives and outcomes that address and demonstrate the following: Mitigation of VA access barriers for at-risk and homeless veterans HCHV has procedures in place for consultation with inpatient Social Workers and with Domiciliary(DOM) programs to reduce barriers and streamline access to care for homeless veterans across the continuum of settings at Hampton VAMC. We plan to train homeless points of contact in other areas of our hospital, Vet Centers and at Community Based Outpatient Clinics (CBOCs). We will utilize the new HOMES system homeless registry to facilitate national tracking of veterans to ensure that they are engaged in services. Reduction of the number of homeless veterans in respective geographical areas consistent with the target in VA s FY2011 plan to end homelessness among veterans Our primary objective is to decrease the number of Veterans who are homeless in the Hampton VA Medical Center s catchment area with the ultimate goal of eliminating homelessness among Veterans. With the 2010 CHALENG process Hampton estimated that 1225 veterans were homeless. Preliminary data from the 2011 Point in Time count completed by HUD in January 2011 is still pending. Target goal for FY 11 is to decrease the number of Veterans who are homeless by 40 % (identified using VA targets for the VISN) with the expectation that with the FY 12 PIT count the # of homeless Veterans will be less than 735. Increase in homeless Veteran outreach contacts by 10 percent and National Call Center for Homeless Veteran referrals by 20 percent by September 30, 2011 Our current outreach clinicians are working at maximum efficiency and productivity; workload in the past six months is at an all time high and the number of intakes from outreach increased by 29% during 1 St QTR FY 11, when compared to 1st QTR FY2010. Annual target: increase intakes by 15%, hotline calls by 20%. Implementation and expansion of crisis response assistance services for at-risk and homeless veterans at all VHA primary care and mental health entry points The homeless program will educate our internal stakeholders through regular revision and distribution of our resource manual of community homeless resources to all entry points throughout the Medical Center
so that clinicians throughout can readily assist Veterans that may be homeless or at risk of homelessness. HCHV will provide an educational session for Primary care clinic staff on homeless resources and the 5 yr plan and will designate specific homeless POC s in each area to assist with HCHV intake assessments when a homeless Veteran presents for services in Primary Care, ED or MHC by. Implementation and expansion of discharge planning and referral services for at-risk and homeless Veterans on all VAMC residential and inpatient units Recent interventions to expand discharge planning and referral services from Inpatient (Inpt) and MHRRTP programs include: Weekly group on Inpt Psychiatry that reviews both VA and Community Resources for homeless Veterans; Inpt Social Workers (SW) consult with HCHV staff to additionally sign assessments of homeless Veterans admitted to psychiatry to promote consultation; an Intensive publication of DIGMA clinic to inpt and MHRRTP programs to increase internal referrals of homeless Veterans to DIGMA; the addition of a resource library for Dom veterans and clinicians to aid with discharge options; expanded access of homeless veterans to the CWT/TR community residential program; Plan to offer claims assistance on walk-in, and as-needed basis (SOARS trained SW and access to VA claims rep) for inpts and all Dom programs by. Implementation and expansion of 24/7 crisis response and housing assistance for all referred homeless Veterans Current responsiveness is hindered by lack of affordable housing and no 24/7 accessible emergency shelter beds in our communities with wait lists for current resources. HCHV plans to increase its emergency shelter contract beds from 0 to 5 and to also add 3 beds for medical respite by 9/2011. The Medical Center will be adding an emergency 24 hour Social Work on call system that can be accessed for homeless referrals. Hampton VAMC has a significant unmet need for long-term beds for homeless Veterans who lack current or immediate income while waiting disability income; we plan to work with our community providers to target 4 beds of grant and per diem (GPD) housing within a new (GPD) program due to open in the next 6 months. Timely, effective referral assistance systems are in place between VHA facilities, Vet Centers, VA Regional Offices and local NCA offices for at-risk and homeless Veterans by February 15, 2011 The HCHV team has an ongoing telephonic and email referral system for homeless Veterans seen at Vet Centers and VA Regional Offices; the current system is very effective. The Vet Center has a mobile outreach vehicle and collaborates with HCHV and Rural Health Initiative (RHI) staff for community outreach regularly. To assist with homeless burials, HCHV program and/or VBA staff will lead an educational session for Hampton VAMC decedent affairs staff on NCA benefits by ; contact information for assistance with homeless burials will also be provided in our resource manuals. VA LEADERSHIP INVOLVEMENT AND SUPPORT The HCHV Strategic plan was developed based on input from HCHV staff and other stakeholders. Medical Center Leadership hosted a Homeless Summit on January 28, 2011 with our Federal, State and Local community partners. The homeless team meets with our Chief of Mental Health and Behavioral Sciences and our Homeless Champion Dr. Arul, or designee, monthly. Members of our local leadership and Homeless program staff also serve on a governmental committee in Hampton and Newport News that meets to expedite advocacy for the creation of more emergency shelter and day services for the homeless on the Virginia Peninsula. Champion: Dr. Arul, MD. Chief of Staff FEDERAL, STATE AND COMMUNITY PARTNERS INVOLVEMENT Our homeless summit was held on January 28, 2011. Representatives from Wounded Warrior, NCA,
Veterans Service Organizations and all six of our local COC (Continuum of Care committees), were in attendance. This planning group will meet again twice this year to discuss the Medical Centers progress in meeting its expected outcomes as outlined in this plan. At the summit community partners were actively engaged and several made commitments including a pledge to design a centralized employment screening tool to be used by both VA and the Virginia Employment Commission and an agreement for the Virginia Wounded Warrior program to serve as a central information source. Representatives at the summit also agreed to more fully communicate Best Practices across communities and to share contact information. DAV Chapter 4 verbalized a firm plan to submit an application for the current Supportive Services for Low Income Veterans (SSVF) grant that will aid significantly with future prevention efforts. SIX PILLARS IDENTIFIED IN VA S PLAN TO PREVENT AND END HOMELESSNESS (CURRENT SERVICES, GAPS, BARRIERS, OPPORTUNITIES, FISCAL YEAR (FY) 2011 ACTIONS AND METRICS FOR EACH PILLAR) THE IDENTIFIED GOALS AND OBJECTIVES OUTLINED IN THIS PLAN WILL ASSIST THE HAMPTON VA MEDICAL CENTER IN ACCOMPLISHING THE PRIMARY GOAL OF ENDING VETERAN HOMELESSNESS THROUGH INCREASED OUTREACH/EDUCATION ACTIVITIES, COMMUNITY PARTNERSHIPS, PREVENTION AND INCREASED ACCESS TO HOMELESS AND MEDICAL CENTER SERVICES. Outreach /Education Existing Services: Currently, 1.5 HCHV outreach clinicians visit an average of 13 sites in the Hampton Roads region per month; this covers 26% of the geographic and 50% of the population catchment areas. HCHV staff s 6-8 homeless resource fairs or Stand Down s in our region annually, and averages over 45 intakes per month, 35% of these from community outreach. An additional 47% of our catchment area is covered through outreach by Rural Health Initiative (RHI) or Vet Center Mobile outreach vehicle staff. In addition, HCHV staff lead groups, serve on internal VA committees and local Continuum of Care (COC) committees, and meet with Vets that visit our offices as walk-in s. HCHV program staff provided orientation sessions on our 5 Yr Plan at 5 of our 6 COC s with a sixth session planned for the near future. Services for homeless veterans as homeless staff are not always accessible. Decreased accessibility of VA homeless staff to community providers. Internal and external partners require ongoing in-service training to stay abreast of program criteria and enrollment procedures. Transportation in our region is expensive and sometimes untimely for the Veteran. HCHV will need to employ an additional outreach Clinician, on a flexible schedule that includes evenings and weekends, and cross-train other staff to assist with outreach. HCHV will provide annual in service training to VA staff and will increase its attendance at local COC meetings. Develop additional transportation resources through enhanced communication with community partners and potential donors Maintain and expand current level of outreach activity Expand outreach to cover additional evening and weekend hours. Two evening or weekend outreach events per month by. Increase frequency to at least weekly visits, as opposed to twice per month, for each of our current outreach sites in Hampton Roads. Increase Veteran outreach contacts by 15% from FY 10 Pending staffing, add two more outreach visits per month for Virginia Beach and Portsmouth Target: 532 homeless intakes, 1168 unique veterans served.
Increase collaboration with internal partners Pending additional outreach staff, add three outreach sites Increase homeless education/resource material to PCC, MHC, CBOC s and RHI Add year-round outreach site in Hampton, Denbigh area of Newport News and Suffolk or Chesapeake Assure availability of resource materials at all settings 100% of the time. Treatment Services Existing Services: We offer a broad array of treatment services to include outpatient MHC and PTSD clinics, a 160 bed Domiciliary (Dom) with 2 homeless programs (DCHV and General Dom), a residential substance abuse program (DAP), a residential PTSD program, a 4 bed SMI community based program for homeless Veterans, an outpatient substance abuse (SATP), a MHICM (Mental Health Intensive Case Management) Program, a Buprenorphine program, OEF/OIF/OND Case Management, Polytrauma services and a Psychosocial Rehabilitation and Recovery Center (PRRC). The Hampton HCHV Program offers a Homeless Drop-In-Group-Medical-Appointment (DIGMA) Primary Care clinic (with walk-in Mental Health access): the Homeless DIGMA clinic: approximately 200 enrolled at present, 1000 served. Transportation: Some homeless Veterans do not have timely access or transportation to Primary Care Clinics (PCC) and MHC/SUD services. Some Veterans have difficulty transitioning between levels of care and staying engaged in Primary Care and MHC/SUD services Insufficient space and equipment / supplies at DIGMA clinic Homeless Veterans are not knowledgeable of all available VA treatment services. Many programs have lengthy wait lists that are difficult for homeless Veterans to navigate Work with internal and external stakeholders to develop additional transportation resources Develop additional drop-in access to MHC/SUD services and open admission to PRRC to homeless Veterans. Expand DIGMA clinic enrollment; Re-institute direct admissions from Inpatient Psychiatry to Domiciliary. See below Increase HCHV case management access, internal and external education. Expedite discharge planning and identify additional supports to reduce wait list time and retain engagement with veterans on wait lists Ease transition between Increase internal referrals to Increase internal referrals to DIGMA levels of care: Increase homeless Veteran engagement in Domiciliary, Primary Care, Mental Health and DIGMA clinic Relocate DIGMA clinic to space that holds more Veterans; assure dedicated LPN coverage to add 25 internal referrals by Relocate DIGMA clinic to larger room closer to Primary Care and assign dedicated LPN. SUD services. Add additional drop-in groups for MHC and PCT clinics Add two additional groups by Reduce wait list time and increase supports for Veterans on wait lists for Dom or contract treatment Open Psychosocial Rehabilitation Recovery Center enrollment to homeless Veterans Resume Direct admissions from Inpatient Psychiatry to Domiciliary Begin pre-treatment groups for Veterans on DCHV and DCM wait lists Access/leverage emergency housing resources for Veterans on wait lists who lack shelter resources Begin orientation sessions for PRRC for homeless Veterans on inpatient units and in Dom, begin enrollment. Collaborate with Dom screening team and Inpatient Staff regarding direct admissions to Dom to reduce inpatient discharges to uncertain housing by 50% (baseline number collected February and March) All veterans on wait lists to be offered pre-treatment groups and supportive services Assure emergency shelter resources for 90% of Veterans on wait lists Attain temporary emergency housing contract in community 5/1/11
Prevention Services Existing Services: HCHV Clinicians provide coverage to National Call Center. There have been approximately 150 calls to our catchment area since 3/1/10. There is a 1 FTEE VJO Specialist assigned to the homeless programs with established outreach services to at least two local jails. There is extremely limited year round emergency housing in our catchment area and almost no emergency housing for persons with mobility impairments or sex offenders. Many Veterans do not have adequate income to sustain or secure permanent housing; current prevention funds in our area are decreasing. Veterans at risk of homelessness do not request assistance timely to prevent eviction or foreclosure The VJO position covers numerous counties, court systems and jails requiring significant contact with each jurisdiction to establish services Develop emergency housing and medical respite beds Identify community partners to submit SSVF grant application and provide them with needed support. Increase publicity for homeless hotline and other prevention services Expand VJO services to cover Hampton, Newport News, Norfolk, Virginia Beach and Portsmouth communities. Promotion of the National Call center has increased veteran awareness of homeless services Disseminate call center information to community homeless providers and Veterans contacted through outreach Increase call center referrals by 20%, target: 102 9/30/2011 Fully implement VJO program throughout Hampton Roads catchment area Improve access to rapid rehousing and crisis responsiveness for veterans who relapse, need emergency services, and/or discharge prematurely from residential programming Housing/Supportive Services VJO to visit all eligible Veterans in local jails Develop additional contract housing resources Develop a crisis response system for 24/7 responding Increase VJO jail visits by 10% per quarter in FY 11; target: 45 Secure 5 emergency contract housing beds with 24/7 responding for homeless Veterans Activate Social Work 24/7 oncall system within Hampton VAMC Existing Services: There are 76 GPD beds and 4 contract SMI beds in the area; 14 additional GPD beds are under construction and slated to be operational by 6/1/2011. There are 285 HUD-VASH vouchers assigned to this Medical Center. There is no emergency supportive medical respite housing for Veterans with chronic medical illnesses or who are awaiting disability. Some transitional housing providers are not familiar with the Housing First and Harm Reduction Models Programs for families have long wait lists Extremely limited affordable housing in our region; The HUD-VASH program currently has an interest list of nearly 400 Veterans; all current vouchers allocated Develop emergency respite medical beds and/or Grant and Per Diem program with medical respite focus; Healing Place shelter. Facilitate training on the Housing First and Harm reduction models. Develop additional GP&D for families Maximize resources for non HUD-VASH housing Request additional allocation of HUD-VASH vouchers Develop Medical Respite Announce and publicize Three bed medical respite
GP&D or Medical Respite contract program and Emergency housing contract Maximize Non-VA affordable Housing resources Request additional 400 HUD- VASH vouchers to help serve the nearly 400 homeless Veterans on their Interest list Attain Project based voucher program in our region (currently three jurisdictions are applying for project based vouchers). solicitation for medical respite contract Announce/Publicize solicitation for emergency housing contract Distribute resource lists for Oxford and other Recovery Houses to all discharge planners Distribute and follow applications for local SRO s to eligible referral programs. Access CANLINK Supportive Housing for chronically homeless Veterans Screen and orient Veterans on HUD-VASH waitlist and interest list Attain 100 project based vouchers in our region; Hampton, Virginia Beach and Suffolk are submitting applications contract or larger GP&D for medical respite, to be in place by. Five beds of emergency housing to be in place by Keep tally of discharges to Oxford Houses / Recovery Houses to assure that resource is being maximized. DCHV and DCM programs to refer all interested/eligible homeless Veterans to SRO programs; target 4 Veteran admissions by end of FY 11. Five admissions to CANLINK or other permanent housing with assistance from LINK staff. Allocate vouchers to homeless Veterans and assist with housing search, orientation, placement Review proposals and attain leadership support by 2/26/11, vouchers in place 9/11 Income/Employment/Benefits Existing Services: Benefits: Several local Veterans Service Organizations and State Department of Veterans Affairs offices offer claims assistance as does a Peer Support Specialist in the Dom; HCHV and Peer Support staff expedite claims for veterans identified as homeless. Employment: Hampton VAMC has an IT program (35 positions), CWT/TWE program (30 positions), CWT/TR house and a SE (Supportive Employment) program with a capacity of 80. Hampton VRT staff host two job fa irs annually in our Domiciliary and provide job search assistance to include resume writing and interviewing skills classes. Lack of Veteran and staff knowledge of benefit eligibility criteria and claims procedures. Limited access to claims representatives /and SOARS; length of time for benefit approvals may take several months. Extremely limited SE, IT/CWT program Some Veterans past work experience and job skills do not meet the demand of the current job market Launch a widespread educational campaign for both veterans and staff to inform of benefits criteria. Increase access to claims representatives at all entry points, SOARS train staff at all entry points; expedite homeless benefit claims. HSEP (Homeless Supported Employment Program). HCHV will collaborate with community employment training programs and local Colleges/Universities. Lack of Veteran and staff HCHV will lead a class for Dom Dom and inpatient staff will knowledge of benefits programs and claims procedures leading to missed / delayed income & extended homelessness. and inpatient staff on Benefits, assess all homeless admissions for claims eligibility and will initiate VA or SOARS claims quickly At least four additional staff (inpatient, Dom (2), HUD-VASH), outreach) will receive SOARS training certification to assist veterans with Social Security
claims HSEP and VRT Staff to develop employment opportunities in the community to include opportunities for Veterans with felony histories and sex-offenders Develop Community employment opportunities by educating employers about tax credits and financial incentives to benefit companies hiring Veterans Benefits class to occur during Dom orientation Enhance employment opportunities for Veterans in Domiciliary programs Utilize HSEP staff to meet with local Chambers of Commerce to educate about tax incentives and benefits for hiring Veterans All Veterans admitted to Domiciliary programs will complete class by Two job fairs to occur in Dom annually Create list of employers that hire felons and sex-offenders by 4/1/11 Three meetings with Chambers of Commerce or at community job fairs to be held by 9/30 /11 4/1/11 Community Partnerships Existing Services: The HCHV team is actively involved in 6 COC and 3 other community homeless advocacy committees or consortiums, has established relationships the Vet Center VBA with multiple local shelters, and VSO s within the catchment area. Ongoing communication and negotiation is required when requesting services for Homeless Veterans A continuum of homeless services is not easily replicated across a mix of multiple urban, suburban and rural jurisdictions HCHV to facilitate quarterly homeless planning meetings with community partners Foster relationships with COC and multiple external partners Expand community Improve collaboration with Facilitate homeless summit annually partnerships with Federal, State and Local homeless community partners and two quarterly follow-up meetings Facilitate multiple annual CHALENG service providers meetings Host a Contract Interest Meeting and annual GP&D grant training Continue active participation on all 6 COC committees in our region SUMMARY AND THE WAY AHEAD Hampton VA Medical Center has developed this operational plan as an assertive and comprehensive approach to ending Veteran Homelessness. Medical Center Leadership will meet annually with Federal, State and Local partners, COC partners, the NCA VBA and the Vet Centers to accomplish our goal. The Homeless program will host two follow-up summit meetings with community partners to review and evaluate progress toward ending Veteran Homelessness. The HCHV staff will submit data to the HCHV Coordinator to monitor outreach/education efforts and the number of Veterans securing housing and income. It will be the primary responsibility of the HCHV Coordinator to submit monthly reports to the VISN and monitor this operational plan.