Attachment 2 - VHA - Directive 1162.05.pdf

Department of Veterans Affairs VHA DIRECTIVE 1162.05(2) Veterans Health Administration Transmittal Sheet Washington, DC 20420 June 29, 2017

HOUSING AND URBAN DEVELOPMENT DEPARTMENT OF VETERANS AFFAIRS

SUPPORTIVE HOUSING PROGRAM

1. REASON FOR ISSUE: This Veterans Health Administration (VHA) directive revises VHA policy and procedures for implementing the Housing and Urban Development (HUD)-Veterans Affairs Supportive Housing (VASH) Program

2. SUMMARY OF MAJOR CHANGES: Major changes include:

(a) Amendment dated June 24, 2024 removes the language found in paragraph 4.f.(5), 8.e, and 10.a that requires local VA medical facility policies for discharge, including graduation from a HUD VASH. This amendment is required by VHA Notice 2024-08, Suspension of Local Policy Mandates in Overdue VHA National Polices, dated June 24, 2024, which suspends implementation of this local policy mandate.

(b) Paragraph 6: Clarifies the order in which chronically homeless and all other vulnerable homeless Veterans are to be prioritized for admission to HUD-VASH. This is in accordance with HUD Notice CPD-16-11, Notice on Prioritizing Persons Experiencing Chronic Homelessness and Other Vulnerable Homeless Persons in Permanent Supportive Housing. Please visit https://www.hudexchange.info/resources/documents/notice-cpd-16-11-prioritizing-persons-experiencing-chronic-homelessness-and-other-vulnerable-homeless-persons-in-psh.pdf for additional information. NOTE: This linked document is outside VA control and may or may not conform to Section 508 of the Rehabilitation Act.

(c) Paragraph 7: In December 2014, the Consolidated and Further Continuing Appropriations Act of 2015 authorized funding for Tribal HUD-VASH in order to expand HUD-VASH into Indian Country for the first time. This legislation authorized HUD to provide HUD-VASH vouchers from their fiscal year 2015 HUD-VASH allocation to be used on reservations and tribal lands. HUD provided $4 million, which results in approximately 600 HUD-VASH vouchers for Tribal HUD-VASH.

(d) Paragraph 8: Clarifies the process for graduating a Veteran from HUD-VASH who retains their voucher for financial reasons. Additionally, it defines the expectation of case management for a Veteran who has graduated from HUD-VASH case management but still has a HUD-VASH voucher.

(e) Paragraph 9: Establishes what happens when a Veteran exits case management and the voucher is to be relinquished.

(f) Minor edits were made to ensure consistency with VHA Directive 1504, Tribal Housing and Urban Development Veterans Affairs Supportive hOUSING, pending publication.

AMENDED

June 24, 2024 https://www.hudexchange.info/resources/documents/notice-cpd-16-11-prioritizing-persons-experiencing-chronic-homelessness-and-other-vulnerable-homeless-persons-in-psh.pdf https://www.hudexchange.info/resources/documents/notice-cpd-16-11-prioritizing-persons-experiencing-chronic-homelessness-and-other-vulnerable-homeless-persons-in-psh.pdf https://www.hudexchange.info/resources/documents/notice-cpd-16-11-prioritizing-persons-experiencing-chronic-homelessness-and-other-vulnerable-homeless-persons-in-psh.pdf

June 29, 2017 VHA DIRECTIVE 1162.05(2)

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3. RELATED ISSUES: VHA Directive 1162, dated March 25, 2009.

4. RESPONSIBLE OFFICE: The Deputy Under Secretary for Health Operations and Management (10N) is responsible for the contents of this directive. Questions may be directed to the Executive Director, VHA Homeless Services, 202-461-1635.

5. RESCISSIONS: VHA Handbook 1162.05 dated September 14, 2011 is rescinded.

6. RECERTIFICATION: This VHA directive is scheduled for recertification on or before the last working day of June 2022. This VHA directive will continue to serve as national VHA policy until it is recertified or rescinded.

Poonam Alaigh, M.D.

Acting Under Secretary for Health

DISTRIBUTION: Emailed to the VHA Publications Distribution List on July 3, 2017.

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CONTENTS

HOUSING AND URBAN DEVELOPMENT (HUD)–DEPARTMENT OF

VETERANS AFFAIRS SUPPORTIVE HOUSING (VASH) PROGRAM

1. PURPOSE

2. DEFINITIONS

3. POLICY

4. RESPONSIBILITIES

5. PORTABILITY

6. PROGRAM PARTICIPANT TARGETING

7. TRIBAL HUD-VASH

8. GRADUATION FROM HUD-VASH

9. EXITING CASE MANAGEMENT

10. INTERNAL ADMINISTRATION

11. DOCUMENTATION AND HOMELESS OPERATIONS MANAGEMENT AND

EVALUATION SYSTEM (HOMES):

12. REFERENCES

HOUSING AND URBAN DEVELOPMENT-DEPARTMENT OF VETERANS AFFAIRS

SUPPORTIVE HOUSING PROGRAM

1. PURPOSE

This Veterans Health Administration (VHA) directive establishes policy procedures for the Housing and Urban Development (HUD) Department of Veterans Affairs Supportive Housing Program (HUD-VASH) and sets forth the national authority and responsibilities for the Department of Veterans Affairs (VA) portion of administration, monitoring, and oversight of these services. AUTHORITY: 38 United States Code (U.S.C.) 2003(b).

2. DEFINITIONS

a. Acuity. The severity of illness or client condition that indicates the need for the intensity of the subsequent case management intervention.

b. Assertive Community Treatment. Assertive Community Treatment (ACT) is an evidence-based service-rich team approach designed to provide comprehensive, community based mental health treatment, rehabilitation, and support to individuals with serious and persistent mental illness, who have not responded well to traditional treatment program approaches. For additional educational materials and information please visit the following Operational Planning Web site https://iop.med.va.gov/hub2/hp/. NOTE: This is an internal VA Web site not available to the public.

c. Bridge Housing. Transitional housing used as a short-term stay when a Veteran has been offered and accepted a permanent housing intervention (e.g., Supportive Services for Veteran Families [SSVF], HUD-VASH, Housing Coalition/Continuum of Care [CoC]) but is not able to immediately enter the permanent housing. Bridge Housing is generally provided for up to 90 calendar days.

d. Chronically Homeless. HUD-VASH follows the definition of “chronically homeless” from the McKinney-Vento Homeless Assistance Act as amended by S. 896 The Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act, published in the Federal Register on December 4, 2015. Pursuant to 24 CFR 91.5, the definition of “chronically homeless” is as follows:

(1) A “homeless individual with a disability” as defined in section 401(9) of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11360(9)) who:

(a) Lives either in a place not meant for human habitation, a safe haven, or in an emergency shelter; and

(b) Has been homeless and living as described in paragraph (1)(a) of this definition continuously for at least 12 months or on at least 4 separate occasions in the last 3 years, as long as the combined occasions equal at least 12 months and each break in homelessness separating the occasions included at least 7 consecutive nights of not https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fiop.med.va.gov%2Fhub2%2Fhp%2F&data=05%7C02%7C%7Cfbf01ea274aa4d2f6d9708dcf1fbdccf%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C638651311243249397%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=6s1WRd250x5%2B%2BE6aalAKOZpkxKCJO%2BnqxJWRZ39MlZA%3D&reserved=0 living as described in paragraph (1)(a) of this definition. Stays in institutional care facilities for fewer than 90 days will not constitute as a break in homelessness, but rather such stays are included in the 12-month total, as long as the individual was living or residing in a place not meant for human habitation, a safe haven, or an emergency shelter immediately before entering the institutional care facility;

(2) An individual who has been residing in an institutional care facility, including a jail, substance abuse or mental health treatment facility, hospital, or other similar facility, for fewer than 90 days and met all of the criteria in paragraph (1) of this definition, before entering that facility; or

(3) A family with an adult head of household (or if there is no adult in the family, a minor head of household) who meets all of the criteria in paragraph (1) or (2) of this definition, including a family whose composition has fluctuated while the head of household has been homeless or in an institutional care facility if the individual has been living in the facility for fewer than 90 days and had been living in a place not meant for human habitation, a safe haven, or in an emergency shelter immediately before entering the institutional care facility. In order to meet the “chronically homeless” definition, the individual also must have been living as described above continuously for at least 12 months, or on at least four separate occasions in the last 3 years. Each period separating the occasions must include at least 7 nights of living in a situation other than a place not meant for human habitation, in an emergency shelter, or in a safe haven.

(4) Chronically homeless families are families with adult heads of households who meet the definition of a chronically homeless individual. If there is no adult in the family, the family would still be considered chronically homeless if a minor head of household meets all criteria of a chronically homeless individual. A chronically homeless family includes those whose composition has fluctuated while the head of household has been homeless.

d. Community Homeless Assessment, Local Education, and Networking Groups (CHALENG). A VA program designed to enhance the continuum of care for Veterans experiencing homelessness. Each VA medical facility is required to participate in CHALENG on an annual basis. Through CHALENG, VA medical facilities are required to collaborate with the community, other state and Federal partners and stakeholders, and Veteran Service Organizations (VSOs) to identify needs of local Veterans who are homeless. Homeless, and formerly homeless Veterans, also provide input regarding gaps in services.

e. Critical Time Intervention (CTI). CTI is an empirically-supported, time-limited case management model designed to resolve homelessness and minimize adverse outcomes for individuals with mental illness. CTI, a low-barrier model, engages the Veteran through working on the Veteran’s goals. For additional information visit https://iop.med.va.gov/hub2/hp/. NOTE: This is an internal VA Web site not available to the public.

https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fiop.med.va.gov%2Fhub2%2Fhp%2F&data=05%7C02%7C%7Cfbf01ea274aa4d2f6d9708dcf1fbdccf%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C638651311243249397%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=6s1WRd250x5%2B%2BE6aalAKOZpkxKCJO%2BnqxJWRZ39MlZA%3D&reserved=0

f. Harm Reduction. Harm Reduction is a public health model focused on decreasing adverse events by looking to alternative ways to moderate the outcome of behavior or events that cannot be controlled or prevented, while working toward overall health and well-being. See additional information https://iop.med.va.gov/hub2/hp/.

NOTE: This is an internal VA Web site not available to the public.

g. Homeless Veteran. The term homeless veteran means a veteran who is homeless (as that term is defined in subsection (a) or (b) of section 103 of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11302)). See 38 U.S.C. 2002.

The HUD-VASH definition of homeless as defined in 42 U.S.C. 11302 is as follows:

(1) An individual or family who lacks a fixed, regular, and adequate nighttime residence;

(2) An individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus or train station, airport, or camping ground;

(3) An individual or family living in a supervised publicly or privately operated shelter designed to provide temporary living arrangements (including hotels and motels paid for by Federal, State, or local government programs for low-income individuals or by charitable organizations, congregate shelters, and transitional housing);

(4) An individual who resided in a shelter or a place not meant for human habitation and who is exiting an institution where the individual temporarily resided;

(5) An individual or family who:

(a) Will imminently lose their housing, including housing they own, rent, or living in without paying rent, are sharing with others, and rooms in hotels or motels not paid for by Federal, State, or local government programs for low-income individuals or by charitable organizations, as evidenced by:

1. A court order resulting from an eviction action that notifies the individual or family that they must leave within 14 days;

2. The individual or family having a primary nighttime residence that is a room in a hotel or motel and where they lack the resources necessary to reside there for more than 14 days; or

3. Credible evidence indicating the owner or renter of the housing will not allow the individual or family to stay for more than 14 days, and any oral statement from an individual or family seeking homeless assistance found to be credible must be considered credible evidence for purposes of this clause.

(b) Has no subsequent residence identified; and https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fiop.med.va.gov%2Fhub2%2Fhp%2F&data=05%7C02%7C%7Cfbf01ea274aa4d2f6d9708dcf1fbdccf%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C638651311243249397%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=6s1WRd250x5%2B%2BE6aalAKOZpkxKCJO%2BnqxJWRZ39MlZA%3D&reserved=0

(c) Lacks the resources or support networks needed to obtain other permanent housing.

(6) Unaccompanied youth and homeless families with children and youth defined as homeless under other Federal statutes who:

(a) Have experienced a long-term period without living independently in permanent housing,

(b) Have experienced persistent instability as measured by frequent moves over such period, and

(c) Can be expected to continue in such status of an extended period of time because of chronic disabilities, chronic physical health or mental health conditions, substance addiction, histories of domestic violence or childhood abuse, the presence of a child or youth with a disability, or multiple barriers to employment.

(7) Domestic violence and other dangerous or life-threatening conditions.

Notwithstanding any other provision of this section, the Secretary [of HUD] shall consider to be homeless any individual or family who is fleeing, or is attempting to flee domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions in the individual’s or family’s current housing situation, including where the health and safety of children is jeopardized, and who have no other residence and lack the resources or support networks to obtain other permanent housing.

NOTE: The term “homeless” or “homeless individual” does not include any individual imprisoned or otherwise detained pursuant to an Act of Congress or a state law.

h. Homeless Management Information System (HMIS). HMIS is a local information technology system used to collect client-level data and data on the provision of housing and services to homeless individuals and families and persons at risk of homelessness.

i. Homeless Operations Management and Evaluation System (HOMES).

HOMES is VA’s primary platform for collecting intake, progress and outcome information for homeless Veterans as they move through VA’s system of care.

j. Homeless Program Operating Plan. This is a planning tool utilized by VA medical facility homeless program staff members to turn strategies into actions. The tool is used to develop and update plans to maintain or improve homeless program performance measures at the VA medical facility level and develop and update plans to implement national, Veteran Integrated Service Network (VISN), and VA medical facility strategies related to provision of services to Veterans in homeless programs.

k. Housing Choice Voucher (HCV). The HCV program allows very low-income families to choose and lease or purchase safe, decent, and affordable privately-owned rental housing. HCVs allow the Veteran to locate scattered site housing allowing the Veteran choice in their locating of a suitable unit. These vouchers may also be referred as being “tenant-based vouchers.”

l. Housing First. Housing First is an evidence-based clinical practice that centers on rapid housing for homeless people with high service needs, and then provides case management and supportive services to sustain housing. What differentiates a Housing First approach from other strategies is -there is an immediate and primary focus on helping individuals and families quickly access and sustain permanent housing. See additional information https://iop.med.va.gov/hub2/hp/. NOTE: This is an internal VA Web site not available to the public.

m. Housing Specialist. The Housing Specialist is a professional who is responsible for providing assistance to the VA homeless programs acting as a liaison between the public housing authorities (PHA) and the local HUD-VASH Program and in identifying appropriate permanent housing and landlords willing to work with homeless Veterans.

n. HUD-VASH Veteran or Veteran Family. A HUD-VASH Veteran or Veteran family refers to either a single Veteran or a Veteran with a household composed of two or more related persons. It also includes one or more eligible persons living with the Veteran who are determined to be important to the Veteran’s care or well-being. A HUD-VASH or Veteran family also includes the surviving member(s) of a Veteran’s family, described in this definition, who were living with the Veteran in a unit assisted under HUD-VASH at the time of the Veteran’s death. The composition of the household must be approved by the PHA. The family must promptly inform the PHA of the birth, adoption, or court-ordered custody of a child. Other persons may not be added to the household without prior written approval of the owner and the PHA. NOTE: HUD referenced “Family” in their regulations for HUD-VASH (Notice Public and Indian Housing (PIH) 2010-12 HA, http://portal.hud.gov/hudportal/documents/huddoc?id=DOC_9006.pdf. NOTE: This linked document is outside VA control and may or may not conform to Section 508 of the Rehabilitation Act.

NOTE: The partnerships with HUD and PHA require an understanding of their terminology to improve cross agency communication.

o. Intensive Case Management (ICM). ICM is a team-based approach that offers a coordinated and brokered approach -delivering therapeutic services utilizing a strengths-based model of care. For additional information visit https://iop.med.va.gov/hub2/hp/. NOTE: This is an internal VA Web site not available to the public.

p. Linear Model. The Linear Model is a staged treatment approach incentivizing housing and other benefits and requires successful completion of one program before moving to another program with a different level of care in a step-wise series with “housing readiness” as on goal at the end of the last program. The model often includes threshold elements such as –prescribed lengths of sobriety, medication compliance, or treatment completion prior to acceptance into another program. The https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fiop.med.va.gov%2Fhub2%2Fhp%2F&data=05%7C02%7C%7Cfbf01ea274aa4d2f6d9708dcf1fbdccf%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C638651311243249397%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=6s1WRd250x5%2B%2BE6aalAKOZpkxKCJO%2BnqxJWRZ39MlZA%3D&reserved=0 http://portal.hud.gov/hudportal/documents/huddoc?id=DOC_9006.pdf https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fiop.med.va.gov%2Fhub2%2Fhp%2F&data=05%7C02%7C%7Cfbf01ea274aa4d2f6d9708dcf1fbdccf%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C638651311243249397%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=6s1WRd250x5%2B%2BE6aalAKOZpkxKCJO%2BnqxJWRZ39MlZA%3D&reserved=0 model is in contrast to Housing First, which does not require a treatment program prior to housing.

q. Motivational Interviewing (MI). MI is a client-centered and semi-directive clinical engagement approach which attempts to increase the Veteran’s awareness of the potential problems and complications caused, consequences experienced, and risks faced as a result of the harmful behavior in question. Clients are encouraged to envision a better future by considering what might be gained through change, in hopes of increasingly motivating them to achieve it. The discrepancy between how clients want their lives to be versus how they currently are (or between their deeply-held values and their day-to-day behavior) is explored. The reluctance to change is viewed as natural rather than pathological and client self-efficacy and autonomy is supported.

r. Peer Support Specialist. A person with a mental health and/or substance use disorder, who has been trained and certified to help others with these conditions identify and achieve specific life and recovery goals. In HUD-VASH, Peer Support Specialists may also have a personal history of homelessness. In the VA, Peer Support Specialists need to be Veterans.

s. Point in Time Count (PIT). The PIT count is a survey of sheltered and unsheltered homeless persons on a single night in January. HUD requires that Continuums of Care (CoCs) conduct an annual count of homeless persons who are sheltered in emergency shelter, transitional housing, and safe havens on a single night.

Unsheltered counts are encouraged to be done annually with the sheltered count but is only required every other year.

t. Portability. Portability provides Veterans the opportunity to transfer their HCV to live in the community of their choice, within certain limits. In addition to local VA guidelines, Federal Register Notice of May 6, 2008 addresses portability in HUD-VASH.

The Notice can be found by clicking the following link:

https://www.federalregister.gov/documents/2014/06/18/2014-14167/section-8-housing-choice-vouchers-revised-implementation-of-the-hud-va-supportive-housing-program.

NOTE: This linked document is outside VA control and may or may not conform to Section 508 of the Rehabilitation Act.

u. Project-Based Voucher (PBV). PBVs are a component of the PHA’s housing support program. Under the PBV program, a Public Housing Agency (PHA) enters into an assistance contract with the owner of a property for a specified number of units and for a specified term. The assistance is tied to a unit. A family who moves from a PBV unit does not have any right to continued housing assistance unless they are eligible to receive a HCV when one becomes available.

v. Public Housing Agency (PHA). Public housing was established to provide decent and safe rental housing for eligible low-income families, the elderly, and persons with disabilities. A public housing agency (PHA) is a specific city, county, or state agency that receives Federal funds from HUD to administer the Section 8 HCV to provide housing for low-income residents at rents they can afford. Each PHA has https://www.federalregister.gov/documents/2014/06/18/2014-14167/section-8-housing-choice-vouchers-revised-implementation-of-the-hud-va-supportive-housing-program https://www.federalregister.gov/documents/2014/06/18/2014-14167/section-8-housing-choice-vouchers-revised-implementation-of-the-hud-va-supportive-housing-program developed independent operating procedures that must comply with HUD regulations and the law. PHA is responsible for determining eligibility for this program based on income eligibility and lifetime sex offender status.

w. Rural Access Network for Growth Enhancement Team (RANGE). The RANGE program provides intensive case management services to seriously mentally ill (SMI) Veterans residing in rural and small market areas.

x. State. State refers to any of the states of the United States (U.S.), the District of Columbia, the Commonwealth of Puerto Rico, any territory or possession of the U.S., or any agency or instrumentality of a state, exclusive of local governments. The term does not include any Public and Indian Housing agency under the United States Housing Authority of 1937.

y. Substance Use Disorder Specialist. A clinical professional who is responsible for providing expert guidance on Substance Use Disorder (SUD) to the HUD-VASH team, to other providers in the VA medical facility, and in the community. The SUD Specialist also provides assessments and treatment to certain high-risk Veterans who are using substances and provides support and after care to Veterans who have achieved sobriety. It is recommended that the SUD Specialist have a Master’s degree and an independent license.

z. Tribal HUD-VASH. Tribal HUD-VASH is a demonstration program implemented in fiscal year (FY) 2016 to provide HUD-VASH services to eligible Native American Veterans in 26 tribal locations. For additional information on Tribal HUD-VASH please visit https://iop.med.va.gov/hub2/hp/. A copy of the policy document will also be available at the VHA Forms and Publications Web site at http://vaww.va.gov/vhapublications/publications.cfm?Pub=1 upon its publication.

NOTE: These are internal VA Web sites not available to the public.

aa. Veteran. A Veteran is, for the purpose of HUD-VASH, a person whose length of service meets statutory requirements, and who served in the active military, naval, or air service, was discharged or released under conditions other than dishonorable and is eligible for VA health care.

bb. Vulnerable Veteran. A Vulnerable Veteran has:

(1) Underlying chronic medical or mental health conditions that will substantially impact the Veteran’s life expectancy and/or ability to function that cannot be effectively cared for due to their homelessness;

(2) Advanced age and infirmity where the Veteran’s unstable and unstructured homelessness places them at substantial risk for being unable to maintain independent activities of daily living; and/or

(3) Diminished cognitive capabilities that place the Veteran at increased risk of victimization physically, mentally, and/or through exploitation.

https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fiop.med.va.gov%2Fhub2%2Fhp%2F&data=05%7C02%7C%7Cfbf01ea274aa4d2f6d9708dcf1fbdccf%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C638651311243249397%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=6s1WRd250x5%2B%2BE6aalAKOZpkxKCJO%2BnqxJWRZ39MlZA%3D&reserved=0 http://vaww.va.gov/vhapublications/publications.cfm?Pub=1

(4) This definition should be used to help in the assessment and admission of Veterans to the HUD-VASH program.

3. POLICY

a. It is VHA policy for HUD-VASH to provide clinical case management and supportive services to Veterans in HUD-VASH by utilizing the principles of Housing First, a team-based model of care, comprised of multi-disciplinary staff, and shared caseloads. Chronically homeless and other vulnerable homeless Veterans, based on the HUD Prioritization Notice, are admitted to case management to support the ongoing effort to end Veteran homelessness. A coordinated entry process will be performed in conjunction with the CoC(s) where possible.

b. Veterans will be treated with dignity, compassion, and respect as an individual.

Consistent with Federal law and VA policy, Veterans will not be subject to discrimination for any reason, including for reasons of age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, or gender identity or expression.

4. RESPONSIBILITIES

a. The Deputy Under Secretary for Health for Operations and Management, or designee. The Deputy Under Secretary for Health for Operations and Management is responsible for ensuring:

(1) The execution and support to fulfill the operating needs of this directive.

(2) That the regulatory requirements of this directive are being meet and related issues addressed through the appropriate clinical or administrative service.

b. HUD-VASH Program Office, VHA Homeless Program Office, VA Central Office. The HUD-VASH Program Office, VHA Homeless Program Office, VA Central Office is responsible for ensuring:

(1) Coordination with HUD Headquarters is consistent and continual for program implementation and administration.

(2) Appropriated funds for HUD-VASH, including support for VA staff, are distributed to VA medical facilities consistent with public laws, regulations, and VA directives and policies.

(3) Guidance and technical assistance based on relevant VA laws, rules, regulations, directives, and analysis of collected data is provided to VISN offices and VA medical facilities to ensure that HUD-VASH is maintained and sustained to ensure that appropriate services and case management are provided to Veterans.

(4) Quality services, which are in compliance with existing laws and policies, are provided and operated in accordance with this VHA directive.

(5) Providing subject matter expertise, consultation, and technical assistance to the VISN and VA medical facility HUD-VASH Program staff, as needed.

(6) Educating community partners about VA, VHA eligible Veterans, and VA services and resources, along with the statutes and regulations governing VA.

(7) Conducting three monthly calls with HUD-VASH staff: operations, orientation, and clinical. All HUD-VASH staff are expected to participate in the national HUD-VASH operations call.

(a) The operations call provides program nationwide updates and has presentations related to clinical practice, best practices, performance measures safety, ethics etc.

(b) The orientation call provides foundational training opportunities on HUD-VASH topics such as HOMES documentation, working with the PHA, workload, performance measures, the HUD-VASH Directive, etc. to provide staff with essential knowledge needed to achieve desired outcomes.

(c) The clinical call provides training in evidence-based clinical subject matters, such as Housing First, Trauma Informed Care, CTI, and other best practices to promote familiarity and use of these practices. Continuing Education Units (CEU) are frequently available for these clinical calls.

c. HUD-VASH Regional Coordinators. The HUD-VASH Regional Coordinators are responsible for:

(1) Serving as the HUD-VASH subject matter experts and lead points of contact for assigned VISNs.

(2) Ensuring HUD-VASH at each assigned VA medical facility is operating in compliance with existing laws and policies, as well as in accordance with this directive.

(3) Participating in monthly calls with the Network Homeless Coordinators (NHCs) and VA medical facility lead HUD-VASH Program staff to:

(a) Disseminating new information regarding the implementation of HUD-VASH, regularly reviewing performance measures and other data outcomes, and sharing best and innovative practices with the NHC and VA medical facility lead HUD-VASH Program staff.

(b) Providing technical assistance, resources, and support for systemic and consistent deployment of HUD-VASH.

(c) Providing support, guidance, training, and consultation to the NHC and HUD- VASH Program staff to assist with the coordination of services and care.

(d) Providing advocacy and assistance with communicating with HUD to resolve local barriers or clarification of HUD’s “HUD-VASH Operating Requirements” found here, https://www.hudexchange.info/resources/documents/HUD-VASH-Operating- Requirements.pdf. NOTE: This linked document is outside VA control and may or may not conform to Section 508 of the Rehabilitation Act.

(e) Reviewing critical incident issue briefs and initiating appropriate follow-up activities as necessary.

d. VISN Director. Each VISN Director is responsible for:

(1) Supporting the mission to end Veteran homelessness by:

(a) Ensuring resources are in place at each VA medical facility to increase and sustain the progress made on ending Veteran homelessness.

(b) Ensuring each VA medical facility is responsive to Veterans that are homeless or at risk of becoming homeless through the provision of appropriate services, resources, and case management to assist each Veteran to rapidly exit homelessness through permanent supportive housing, or the appropriate clinically indicated services, as determined by the Veteran’s needs.

(c) Ensuring a low return to homelessness through the provision of ongoing supportive services and case management.

(2) Ensuring that HUD-VASH within the VISN is:

(a) Operating in compliance with relevant public law, regulations, VHA policies and procedures, and the guidance put forth in this directive.

(b) Fully implementing and utilizing Housing First and other best and innovative practices as demonstrated through data to improve desired outcomes.

(c) Supporting a multidisciplinary case management team or teams.

(d) Supporting VA medical facility staff working with community partners to achieve and sustain the mission of ending Veteran homelessness.

(e) Meeting established VHA performance and descriptive measures.

(3) Hiring and maintaining sufficient staff to meet the mission of ending Veteran homelessness and providing the appropriate level of clinical engagement to help Veterans move out of homelessness and maintain housing.

(4) Ensuring timely documentation of the prevalence of those who are homeless or at risk of homelessness and timely and accurate entry of required HOMES forms.

HOMES forms are to be updated within three business days of a change in status for the Veteran.

e. Network Homeless Coordinator (NHC). Each NHC has VISN-level https://www.hudexchange.info/resources/documents/HUD-VASH-Operating-Requirements.pdf https://www.hudexchange.info/resources/documents/HUD-VASH-Operating-Requirements.pdf responsibility for oversight and monitoring of HUD-VASH in their respective VISN. Each NHC is responsible for:

(1) Ensuring HUD-VASH is monitored and evaluated for adherence to this directive.

(2) Consulting, collaborating with, and apprising the HUD-VASH Regional Coordinator of any issues or concerns pertaining to the operation of HUD-VASH in their respective VISN.

(3) Providing support, guidance, orientation, training, consultation, and advice to HUD-VASH Program staff through regular communications, including site visits, VISN calls, etc. to facilitate mentoring, problem solving, and compliance.

(4) Confirming staff training for all new HUD-VASH staff has been conducted within 90 calendar days of the initial start date. This includes orientation to HUD-VASH. The facility can do this through self-certification to the Network Homeless Coordinator.

(5) Disseminating new information regarding the implementation of HUD-VASH, regularly reviewing performance measures and other data outcomes, and best and innovative practices.

(6) Assisting medical facilities with assessing their staffing needs when there are new vouchers allocated or staff turnover to support a multidisciplinary team approach.

(7) Reviewing HOMES reports, updated Homeless Operating Plans, Gap Analysis, Homeless Services Scorecard, and other evaluation data to optimize program performance, provide support to VA medical facilities to meet established thresholds, and to develop corrective action plans when necessary.

(8) Reviewing HOMES timeliness reports to ensure required data is entered into HOMES within three business days. If needed, working with the facilities to improve processes for timely entries.

(9) Tracking use of obligated HUD-VASH funds, and ensuring all funds are used for specified purposes.

(10) Working with VA medical facilities and HUD-VASH case management teams, along with Quality Improvement and Performance Management staff, to include HUD- VASH Programs in risk management and reporting systems.

(11) Reviewing HUD-VASH Programs’ critical incidents and initiating appropriate investigation and follow-up activities in collaboration with the respective VA medical facility.

(12) Working strategically with VA and community partners to establish partnerships to reduce barriers and silos, including a common language and understanding of the mission goals, strategies, and plans to achieve and measure the objectives.

f. VA Medical Facility Director. Each VA Medical Facility Director is responsible for:

(1) Supporting the mission to end Veteran homelessness and sustaining the efforts to prevent Veterans from returning to homelessness.

(a) Supporting additional HUD-VASH vouchers where and when the need is evident, based on available data, within the VA medical facility’s catchment area.

(b) Ensuring Housing First and other best and innovative practices are implemented and utilized to rapidly house homeless Veterans.

(c) Sustaining HUD-VASH to include ongoing case management and supportive services in support of program goals.

(d) Engaging with community partners, as needed, to end Veteran homelessness.

(2) Ensuring adequate access to HUD-VASH through timely hiring of facility or contracted staff. Maintaining adequate staffing levels to safely and appropriately provide the necessary clinical services for the vulnerable Veterans served in HUD- VASH. NOTE: For purposes of maintaining adequate staffing the Homeless Program Office generates reports and metrics [timely hiring and assessing needs].

(a) Ensuring that staffing levels are sustained in support of Veteran safety, recovery, and maximum independence within the varied levels of acuity.

(b) Ensuring the expeditious release of an internal candidate if a candidate is selected for a HUD-VASH position.

(c) Ensuring multidisciplinary case management teams are established and sufficiently staffed to provide integrated services to Veterans in HUD-VASH. This includes the ability to provide services in the community and Veterans’ homes. Case management teams must be able to provide comprehensive services to address high acuity needs, physical and mental health diagnoses, SUDs, and other psychosocial needs.

(3) Ensuring VA medical facility staff assigned to HUD-VASH has the appropriate clinical backgrounds, education, and experience necessary to provide community-based case management services. This includes:

(a) Ensuring managers and clinicians are competent to address the complex, often co-occurring severe mental and physical health needs specific to the population served in HUD-VASH.

(b) Ensuring clinicians have the required training, including training available through the VA Talent Management System (TMS).

(4) Providing appropriate administrative support and timely issuance of resources needed to guarantee HUD-VASH is able to safely accomplish its stated mission, goals, and objectives. This includes office space, information technology (IT) equipment (including mobile phones, laptop computers, air cards, or other Wi-Fi access), and car allocations for work in the community and transporting Veterans.

(5) Providing and maintaining program oversight to ensure quality clinical services and compliance with VHA policy and procedures, to include Computerized Patient Record System (CPRS) documentation and workload guidelines.

(6) Ensuring performance improvement activities take place to improve access and sustain Veterans in HUD-VASH.

(7) Providing adequate clinical staff support for assessments to determine the medical and psychiatric needs of Veterans referred to HUD-VASH, including risk management and other clinical and ethical consultations as needed for safe and appropriate clinical care, ongoing case management and supportive services.

(8) Ensuring the timely completion of all mandating reporting, monitoring, evaluation, and accreditation requirements. This includes full-time equivalent (FTE) employee tracking and performance measures.

(9) Ensuring HUD-VASH meets all accreditation requirements, to include The Joint Commission (TJC) and the Commission on Accreditation of Rehabilitation Facilities

(CARF).

(10) Ensuring VA participation in and collaboration with local community endeavors to end homelessness.

(a) Participating in local CoCs strategic planning meetings and PIT Count surveys of homeless individuals.

(b) Engaging in community activities such as Action and Boot Camps, Registry Weeks, Mayor Challenges, the Built for Zero Initiative, and the 25 City Initiative.

(c) Supporting a coordinated entry process for the identification and referral of homeless Veterans.

(11) Verifying VA medical facility staff provides timely and accurate documentation within three business days of Veteran activity in the HOMES database. Staff must regularly use HOMES Reports to verify accuracy of caseloads.

(12) Verifying VA medical facility staff reconcile their data with their partner PHA(s) at least quarterly.

(13) Creating a culture of safety, meaning leadership openly focuses on safety as a top priority, where system-wide learning occurs as to the causes of adverse events are openly shared, where investments are made in the resource and training to ensure safe practices, and where employees freely report and communicate safety concerns.

(a) HUD-VASH is a community based program and the safety concerns raised by staff may differ as a result.

(b) This includes empowering VA employees to identify and report their concerns about patient safety without fear of reprisal.

g. HUD-VASH Program Coordinator. The HUD-VASH Program Coordinator is responsible for:

(1) Supervision of the program including orientation and training, ongoing use of data for purposes of program improvement and staff education, training, and development.

(2) Training for HUD-VASH Staff:

(a) Guaranteeing all HUD-VASH case management staff members have training in Critical Time Intervention (CTI), Assertive Community Treatment (ACT), Motivational Interviewing (MI), Housing First, Low-Demand Model of Care, and other clinical approaches relevant to the population. Training must be completed within 90 calendar days of initial start date.

(b) Monthly clinical calls provided by the HUD-VASH Office are available in TMS and can be accessed for training purposes from the Operational Planning Hub.

(c) Training obtained in and outside of TMS can be uploaded into TMS via the Record Learning Wizard in the Links section. If an internal item is selected, the search option can assist with locating the training by using the exact phrase or keywords. Required fields for external items include description, completion date, completion time, and time.

(d) Documenting that all staff complete appropriate ethics training as required by respective professional licensure or credentialing boards, with an emphasis on dual relationships and conflict of interest circumstances.

(e) Ensuring all orientation processes meet TJC and CARF standards, including the documentation of completion of orientation.

(3) Establishing internal working partnerships to reduce barriers and silos across all homeless and VA medical facility programs to ensure a seamless transition between providers for Veterans served in HUD-VASH.

(4) Engaging in community outreach and developing community partnerships, particularly with the local Homeless CoC.

(5) Coordinating with the local PHA to provide streamlined and timely processes for HUD-VASH voucher utilization. This includes the referral process, voucher issuance, and the leasing process. At minimum, there needs to be a quarterly reconciliation of data between the HUD-VASH Coordinator, or their designee, and the PHA(s) to determine the status of all HUD-VASH vouchers and processing times between referral to the PHA and lease up.

(6) Reconciling voucher status with the PHA, including any vouchers that are marked as graduated, on a minimum of a quarterly basis.

(7) Providing programmatic direction to all staff assigned to HUD-VASH, including case manager, program support, and associated providers.

(8) Assisting in the development of administrative and personnel documents such as position descriptions, functional statements, and performance appraisals.

(9) Establishing and maintaining a process for referral, evaluation, and admission to HUD-VASH to ensure that the most vulnerable Veterans are prioritized. Performing a review of the program process to improve efficiency and further refine the rapid housing process at least annually.

(10) Managing and ensuring an even distribution of caseloads with consideration to the ACT, ICM, and CTI models of care.

(11) Ensuring the implementation of Housing First principles consistently across all HUD-VASH teams.

(12) Supporting a multidisciplinary team model of care wherever possible to expand the provision of support for Veterans to improve stability and housing retention.

(a) Determining current staffing needs as the Veteran population served can change over time. This may be due to a change in the overall acuity of the population, specific needs of the population (such as health needs associated with aging), and number of Veterans sustaining stability and independence over time.

(b) Regularly reassessing team staffing effectiveness to determine changes to the disciplines or level of staffing would improve services as vacancies or opportunities to add new staff occur. Staffing changes are made by submitting the appropriate memorandum request to add, remove or change positions.

(13) Establishing huddles, clinical case reviews, and staff meetings with assignments for follow-up action.

(14) Providing case consultation, especially around high-risk situations.

(15) Conducting appropriate program audits, such as but not limited to:

(a) Chart reviews to ensure documentation meets TJC and CARF standards of care;

(b) Performance measures and descriptive measures;

(c) Frequency of clinical contacts based on the stage of case management being provided; and HOMES data reviews to ensure policy adherence, including that data is entered within three business days.

(16) Coordinating accreditation activities and ensuring compliance with accreditation requirements.

(17) Guaranteeing regular and ongoing reconciliation of data in HOMES against internal tracking mechanisms and with the PHA(s) on the status of vouchers, including those for Veterans who have graduated from case management but maintain a HUD- VASH voucher.

(18) Ensuring effective systems are in place related to personnel, fiscal, acquisition and material management, contracting, and staff vehicles.

(19) Working closely with community partners to eliminate Veteran homelessness.

Establish practices to rapidly identify and assess homeless Veterans for HUD-VASH.

(20) Outreach and Access.

(a) Establishing internal and external partnerships to build functional, cooperative relationships that work seamlessly to enhance HUD-VASH’s efficiency and effectiveness in outreach and service delivery.

(b) Modeling effective Housing First principles.

(c) Establishing procedures with other VA Homeless Programs and with community-based homeless programs to provide assistance to Veterans who are not eligible for HUD-VASH or who are not interested in pursuing HUD-VASH.

(d) Developing relationships with other VA programs to improve access to the full range of health care services needed by homeless Veterans. This is particularly important for vesting physicals, mental health evaluations, and other services utilized by this population.

(e) Have the flexibility to develop innovative practices to reach out to the community and assist homeless Veterans.

1. Non-traditional approaches may include casual dress, irregular tours of duty, the use of office space donated by community agencies, and the coordination of activities with community groups.

2. Staff independence may necessitate medical facilities to recognize additional considerations for program safety, employee security, and job effectiveness (available vehicles for outreach and case management activities, cellular phones, laptop connectivity, additional security services, etc.).

h. Case Management Team. The Case Management Team is responsible for:

(1) Providing outreach services to engage homeless Veterans, especially those who are chronically homeless and are highly vulnerable.

(2) Verifying a Veteran’s status, eligibility for VA health care through the Eligibility Office, family income, and clinical need for program participation.

(3) Accepting referrals for screening and admission to HUD-VASH. Referrals can be received from:

(a) The local CoC, community partners or other community-based stakeholders;

(b) VA’s National Homeless Call Center (1-877-4AID VET or 1-877-424-3838);

(c) Veteran self-referral;

(d) Other VA Homeless Programs; or

(e) Other VA or community medical facilities and programs including CBOCs and Vet Centers.

(4) Screening and conducting an assessment to ensure appropriateness of placement into the program.

(5) Assessing Veterans through comprehensive bio-psychosocial evaluations to determine acuity status.

(6) Admitting Veterans into HUD-VASH. Admission is by clinical decision of HUD- VASH staff, or, if indicated, in more complex situations, with consultation of homeless program leadership or other appropriate service.

(a) Veterans are considered admitted into HUD-VASH when accepted for case management. Admission decisions need to occur within 24 hours or one business day of a completed referral interview with the appropriate documentation in HOMES.

(b) HUD-VASH Programs may be associated with their community in coordinated entry efforts. Utilization of any specialized screening tools for purposes of assessment and admission do not replace documentation requirements in HOMES.

(c) In the case of a two-Veteran household, the individual identified as head of household with the primary need for case management is the voucher holder. If both Veterans require case management, there will be two separate entries in HOMES showing that they are case managed although only one Veteran has a HUD-VASH voucher issued.

(7) Providing appropriate services…