Attachment 13 - HUD-VASH- Housing First Principles.pdf

VHA Homeless Program Office ● HUD-VASH: Housing First Principles ●03/03/2017

The Housing and Urban Development-VA Supportive Housing (HUD-VASH) Program is required to operate using the principles of Housing First.

Housing First is an evidence-based practice that seeks to rapidly house Veterans in a low-barrier case management program while providing supportive services that help Veterans stay housed. Housing First does not require treatment completion or sobriety prior to housing the individual. There are eight principles of Housing First, which are based on the belief that housing is a basic human right.

This is in contrast to the belief that people need to earn or prove that they are deserving of housing by engaging in treatment for mental illness or substance use. Additionally, there should be choice in options for housing locations and supportive services. Services that are provided should focus on supporting the Veteran’s recovery and individual goals.

1. Housing as a basic human right. Housing is not offered as a reward or incentive for treatment compliance or sobriety. It is offered as a right. There is no requirement that a Veterans be "housing ready” for admission to HUD-VASH. Veterans must have a need for case management and supportive services to successfully maintain housing. Given the many barriers chronically and highly vulnerable homeless Veterans face, HUD-VASH prioritizes these Veterans for admission. Veterans can move from the streets directly into housing and are provided wrap around services to help maintain housing.

2. Respect, warmth, and compassion for all Veterans. Creating an environment that is respectful and welcoming to Veterans helps develop healthy, positive, and future-oriented

Housing and Urban Development-VA Supportive Housing (HUD-VASH): Housing First Principles

VHA Homeless Programs

This document provides an overview of the key principles of the Housing First model. Housing First is the official policy of the HUD-VASH Program. Adoption of these principles ensures that chronically homeless and highly vulnerable homeless Veterans are provided opportunities to rapidly exit homelessness and maintain housing.

Operational Planning Hub

PURPOSE

BACKGROUND

EIGHT PRINCIPLES OF HOUSING FIRST

http://vhaindwebsim.v11.med.va.gov/hub2/hp/index.html http://vhaindwebsim.v11.med.va.gov/hub2/hp/index.html relationships. Being welcoming to Veterans is vital to creating a respectful, warm, and compassionate setting for Veterans. Setting this environment includes one’s non-verbal communication as well as what is said. Attending to verbal and non-verbal communication and attitudes, HUD-VASH staff can help Veterans feel important and valued.

3. A commitment to Veterans. HUD-VASH targets the chronically homeless and most vulnerable Veterans for services. Many of these Veterans have been isolated for long periods, and may also be accustomed to working with multiple service providers or agencies. Delivering a consistent message of commitment to the Veterans’ success, as defined by the Veterans themselves, is critical to building a relationship and showing one’s commitment to helping the Veteran succeed in the program.

4. Scattered site housing. Scattered site housing allows Veterans to live in communities of their choice, increases independence, and decreases stigmatization. When Veterans select an apartment that reflects their preferences for a neighborhood, they are more invested in their housing. Apartments need to be at fair market rates and pass Housing Quality Standards (HQS) inspections. Moving from the streets directly into housing can result in positive changes for Veterans. Investment in one’s apartment, to make it a home, motivates a desire to keep the housing. Some Veterans may begin to work on sobriety or seek treatment for mental illness as a way of improving health and increasing success with maintaining housing.

5. Separation of housing and services. Providing case management and supportive services in Veterans’ homes, communities, or workplaces can assist Veterans with community integration. Clinical issues should be presented as separate from housing. While supportive services may be focused on how decisions and actions can result in lease violations, the outcomes of such violations need to be enforced by the landlord or public housing authority (PHA), as with any other tenant in the neighborhood. Veterans should not feel pressured to engage in certain clinical care, such as substance use disorder (SUD) treatment, as a condition to retaining housing. HUD-VASH case management teams must work with Veterans to understand the possible consequences of their actions. The level of clinical engagement different Veterans are willing to accept may vary. Consequently it is important that Veterans’ choice be respected. It is important to provide continuity of clinical care during a housing crisis and continuity of housing stability during a clinical crisis.

6. Veteran choice and self-determination. Housing First promotes the belief that those who are homeless know what their needs are and have preferences about their lives and recovery will look like. The Veteran’s self-determination and needs drive the case management and supportive services provided to him/her. HUD-VASH case management teams encourage Veterans and support them in identifying and selecting their priorities. Assisting Veterans with making their own decisions, and at times seeing the consequences of such decisions, is vital for self-sufficiency.

7. Recovery orientation. Recovery is the process that Veterans go through to be able to live, work, learn, and participate in their communities. Housing Stability Plans should not be based solely on clinical assessments of Veterans’ needs, but also on their identified goals. When Veterans create their own goals, it promotes continued motivation and engagement in case management to achieve those goals. HUD-VASH staff can support these goals by continually instilling hope that recovery is possible.

8. Harm reduction. Harm reduction is an umbrella term for interventions aiming to reduce problematic effects of behaviors. Although harm reduction was originally and most commonly associated with substance use, it is increasingly applied to other behavioral disorders. This client-centered approach uses multiple strategies, including abstinence, to help Veterans manage their addictions and mental illnesses. Harm reduction does not attempt to minimize or ignore the real dangers associated with maladaptive behaviors and choices. Instead, it focuses on reducing negative consequences. There is no single strategy or list of guaranteed interventions. Harm reduction requires creativity and inventiveness.

One major difference between harm reduction and abstinence-based programs is how the therapeutic progress is defined. For example, at the beginning of a therapy session, a harm reduction practitioner may ask a Veteran first how much alcohol he/she drinks per day. If the Veteran reported consuming 10 alcoholic drinks every day, then reducing consumption to five drinks a day would be a therapeutic success. If the Veteran’s goal was to abstain from alcohol, the practitioner would continue to work with the Veteran to troubleshoot problematic areas and develop other coping skills. If the Veteran’s goal was to avoid blacking out, and five drinks would keep his/her blood alcohol level below the risk of blacking out, then treatment would be a success. While the practitioner and the Veteran may continue to explore any other negative consequences that he/she would prefer to avoid, ultimately the Veteran’s goal has been met.

When a harm reduction model is used effectively, though not an absolute goal, the approach can well lend itself to the Veteran’s subsequent and eventual consideration of abstinence.

*These principles were adapted from Tsemberis, Ph.D., S, Housing first: the Pathways model to end homelessness with mental illness and addiction City Center: first ed, Vol .1. Minnesota;