Supportive Services for Veteran Families SSVF Webinar Series

Supportive Services for Veteran Families (SSVF) Webinar Series Targeting, Screening and Assessment

VA Introductions And SSVF Hot Topics

How Many Attended the conference and heard this presentation? • This webinar will be a review of key aspects of Targeting, Screening and Assessment for new staff, and • Go deeper into these critical components and services now that your SSVF programs are operational 3

Definition of Terms: • Targeting: Defines the people who are eligible for assistance by your program. Determines every aspect of your program, from outreach to community partnerships. Serves as the basis for screening. • Screening: Process of determining if an applicant meets the SSVF eligibility requirements and program targeting requirements. Determines if applicant will become a program participant. May include prioritizing applicants. • Assessment: Determining the barriers that prevent your applicants or participants from getting and/or keeping housing. Used to plan how to overcome barriers. 4

The Search for the Perfect Tool… • A screening tool is relatively simple to construct (see example on Website). It walks the screener through each of the eligibility criteria defined by the funder and any additional criteria added by the grantee. • There is no universal assessment tool. Assessment depends upon what is relevant to this participant, in this program. This will vary! 5

Targeting Start with SSVF eligibility requirements 1. Veteran household 2. Very low income 3. Occupying permanent housing These are non-negotiable. 6

Targeting (cont. ) Decide if you will add one or more additional criteria to narrow the target population further, such as: • Households that meet the BUT FOR criteria. • Extremely low-income households • Families with a minor child • Chronically homeless or history of chronic homelessness Be sure that you are not setting criteria that require a household to have already resolved personal problems or to agree to work on personal problems while in the program! This is contrary to the SSVF program mission. 7

Targeting (cont. ) • If your targeting is too broad, you may have more applicants than you can assist. – How will you decide? – Do you need VA approval to narrow your targeting? • If your targeting is too narrow, you may have trouble finding sufficient program participants. – Do you need VA approval to broadening your targeting? 8

Screening 1. Does this household meet the SSVF eligibility requirements? What documentation is needed to verify Veteran status, income and housing status? (See the Program Guide for verification and documentation requirements) 9

Screening (cont. ) 2. Does this household meet your program’s additional targeting requirements? How will you verify that additional requirements have been met? 10

Screening (cont. ) 3. Will you give more priority to households whose crisis is more urgent? *Those who have the shortest time to resolve their housing crisis *Those who would be put at the highest risk if the crisis is not resolved (due to vulnerability or situation). 11

Screening (cont. ) 4. Does the household meet any criteria for priority assistance? How will you verify that priority criteria have been met? 12

Screening for vulnerability as a priority • For people experiencing homelessness: Where are you staying now? Can you stay where you are for awhile, or do you need to leave right away? Why do you need to leave? What do you think might happen if you stay? • For people who are trying to keep their current housing: Is there anything special about the location of your home or the kind of housing unit you’re in that is essential for your family? What is essential? Why? If you had to move from your current housing, would this have a bad effect for anyone in your household? Who? In what way? 13

Assessment Controversial! • What do you need to know? • What will you do with the information? • How will you get the information? • When will you obtain the information? • Do you use the information for screening applicants in/out? Or do you use it to determine how to assist participants to achieve housing stability? 14

Assessment (cont. ) • What you assess should be timely and relevant. • Start with assessing the situation. Assessment of the person is not always relevant or timely. • Be aware how your philosophy about the necessity of treatment for all persons with a disability may bias your assessment. Question your assumptions! 15

Assessment (cont. ) • Disability Diagnosis: Why are there so many disabled people in homeless shelters? What is the relationship between a disability diagnosis and homelessness? 16

Disability Diagnosis: Relationship to Homelessness? • Poverty is the primary cause of homelessness. Poverty is both a cause and a result of disability. • Disabled people are 200 -300% more likely to be poor than non-disabled people. • Disabled people are more over-represented among the poor than are ethnic/racial minorities or single parents. • About two-thirds of working age adults who experience long-term poverty have a disability. 17

Disability Diagnosis: Relationship to Homelessness? (cont. ) • A diagnosis names an impairment. • The demands of the environment interact with the impairment. • The result can be an “activity limitation, ” reducing the ability to do a task or activity OR • If more severe, it may result in a “participation restriction, ” causing problems within one or more life areas. 18

International Classification of Functioning, Disability and Health “All aspects of a person’s life (development, participation and environment) are incorporated into the ICF instead of solely focusing on his or her disability. A diagnosis reveals little about one’s functional abilities. Diagnoses are important for defining the cause and prognosis, but… identifying the limitations of function is often the information used to plan and implement interventions. ” 19

An example: Suppose I have an “impairment”--a back injury. I have “activity limitations” that affect tasks such as lifting, standing, bending. I have been able to compensate for my impairment by physical therapy, medications and, most important, having a white collar job. Thus, I have an income that supports housing stability. If I had to get a job requiring physical labor, I would have a “participation restriction. ” I would be unemployed. My degree of disability is directly related to my resources (training, education, experience) and environmental demands (local job market). 20

• So, what does “disability” mean for SSVF programs? 21

Assessing Function and Environmental Demands • What tasks and life situations is this person going to face to get and keep housing? • How much does the person’s impairment limit or restrict their ability to do what is required? • Can the environment be changed so the impairment is less limiting? • Can teaching new skills allow the person to deal with the demands of the environment? • What supports/resources can be used to compensate for the impairment? 22

How is a disability diagnosis used by homelessness programs? • Positive: To help a person understand why s/he has had difficulties To obtain disability income or a job suited to the impairment To develop a plan to minimize activity limitations and participation restrictions by improving skills and supports and/or by changing environmental demands. • Negative: To screen out applicants because of an assumption that they cannot achieve housing stability 23

Assessment: Where to Focus • The immediate housing crisis—what is needed NOW. And: • Tenant Screening Barriers: Barriers that would prevent a decent landlord from agreeing to rent to the person. • Housing Retention Barriers: Barriers that have historically prevented a household from keeping their housing. 24

Assessing Housing Barriers Tenant Screening Barriers • Used by landlords to accept/reject applicants for housing. This practice has grown exponentially as more and more electronic databases have become accessible. • Based upon an assumption that past history predicts future behavior • Focuses on ability to pay the rent, follow the lease, care for the unit, get along with the landlord and other tenants. 25

Assessing Tenant Screening Barriers • Buy a report from a tenant screening agency* or • Conduct your own screening: Consent for Release of Information Free Credit Reports Contact previous landlords, employers. Check public eviction and criminal history databases. *People are highly mobile so there may be many databases to search, each with its own software and access issues. 26

Assessing Housing Barriers Housing Retention Barriers • The patterns behind the Tenant Screening Barriers: the WHY • Used to help the household create a plan for avoiding future housing instability • Assessed when/if the household has a pattern of housing instability that is caused by factors beyond poverty. 27

Assessing Housing Retention Barriers • Interviews, and observations during home visits • Immediate: Information on the current housing crisis. Later: Other retention barrier assessments • Identify financial problems, skill deficits, lack of knowledge, relationship and/or communication problems, impairments, etc. , that affect housing stability • Timely, relevant and respectful. 28

Assessment: Case Scenario A homeless household with 2 children has been accepted by your program and you are completing an assessment before working with the family on a housing plan. The family is staying in a homeless shelter after an eviction for failure to pay rent. Which of the following assessments would you conduct before beginning the Housing Plan? Housing History CD Assessment Criminal History Previous Landlord References Program Evaluation Mental Health Evaluation Children’s School Reports Employment/ Income History 29

What does all this mean for your program? 1. Who do you target? 2. How do you prioritize? 3. How will you make the decision to accept or reject someone who wants and needs your help? 30

1. Who do you target? The household must meet the SSVF eligibility requirements Veteran with discharge status other than dishonorable Income less than 50% of local Area Median Income Living in permanent housing (Category 1, 2, 3) The household must fit within your contract with VA (or, with VA permission, modify the contract) Targets for households with children, income below 30% AMI, chronically homeless or previously chronically homeless, etc. 31

2. Who do you prioritize? • If your program receives more requests and referrals than you can assist, do you have clear criteria for prioritizing whom you will accept? • Are your criteria based upon offering assistance to households who have the most urgent situation? Those who are the most vulnerable if not assisted? 32

Case Scenarios: Prioritizing Homeless Households You have one opening on your caseload. Among the households who are eligible for your SSVF program, which would you prioritize for acceptance? #1: A homeless single-parent family with two elementary school-age children who have been living in their car. #2: A homeless two-parent family with one pre-school child who have been staying in a homeless shelter. #3: A single female who is timing out of transitional housing and has no housing plan or financial resources. 33

Case Scenarios: Prioritizing Prevention You have one opening on your caseload. Among the households who are eligible for your SSVF program, which would you prioritize for acceptance: #1: A single female who will be evicted from her housing in 3 days. She has no resources, plan or support system to keep her housing or relocate. #2: A tenant family with three children whose apartment building is in foreclosure. The tenants have been given 60 days to move out. The family has been looking for housing but they have no funds for the damage deposit. #3: A single male who is being discharged from a hospital after treatment of injuries he received in a fight. He was homeless prior to the hospital admission and has no discharge plan for housing. 34

What criteria did you use to determine which household to prioritize? • • • Time urgency? “Vulnerability”? Children in household? Quick win and move on? Ability to provide resources solely within your SSVF project? • No other agency has responsibility for household? 35

So…… You have your targeting and your prioritizing criteria. And you have a Veteran sitting in your office, asking for assistance. He meets your targeting and priority criteria…. . Now what? 36

Will you really assist everyone who meets your criteria? Tim is a 45 -year old man who suffered a recent Traumatic Brain Injury. He is being released from hospital tomorrow but has no home to return to and no relatives in the state. Tim’s intellectual abilities are limited, his short-term memory is very poor and he has difficulty with activities of daily living. He has poor impulse control and poor judgment. He has no income but an application has been filed for disability benefits. (Tim meets all the eligibility requirements for SSVF. ) ----------------------------------------------- Would you accept Tim for re-housing? 37

Look beyond your program: can your community assist Tim? Start with a detailed assessment: • What services/assistance can you provide to Veteran households to obtain and/or sustain housing? Consider both SSVF funding and your agency’s other services or funding sources. • Look at the VA, public, and private resources available in your community. What can they offer to Veteran households to obtain and/or sustain housing? 38

What resources are you looking for? • Financial Assistance that extends beyond SSVF time limits. Opportunities for disability benefits (SSDI, SSI) public assistance (such as TANF), and housing subsidies (Examples: Section 8, VASH, public housing, subsidized privately-owned housing, etc. ). • Employment-related services. Vocational rehabilitation, Job training, job placement, supported employment. • Specialized resources for people who are unable to live independently without ongoing, longer-term supervision and/or assistance. Disability-specific independent living programs, MA-funded mental health and TBI services (ACT, HCBW, ARMHS), Home Healthcare or PCA services, etc. 39

What do you need to know about your community’s resources? • Would your very low-income homeless Veteran families qualify for their service/assistance? Which SSVF households could they accept? What are their eligibility requirements? What services/assistance can they offer? What are the time limits or financial assistance caps for their service/assistance? How available is their service/assistance (processing time, waiting lists)? • Would some of their families qualify for your assistance? Which ones meet VA eligibility? What do they need and want that your program can offer? 40

Your community affects your ability to assist households with more serious barriers • In a community with few supports for people with very severe barriers, you may be the primary resource; it’s your program or nothing. • In a community with many supports for seriouslyimpaired people, your role may be much more limited but you can help almost anyone. • In your community, what is your role? How many resources can be brought together to assist this household? 41

As a community, you may be able to accept a household with very severe barriers—like Tim • Take referrals from agencies that offer longer-term assistance to people with severe barriers/disabilities. You can provide the housing expertise and immediate, temporary financial assistance they lack. • Make referrals to agencies that offer longer-term assistance to people with severe barriers/disabilities. They can provide the specialized, ongoing supportive services or financial assistance you lack. • Facilitate quick, easy referrals and information-sharing between each other’s programs. Give priority to referrals from agencies that assist households with severe barriers/disabilities. • Work closely with the household and with each other in goal-setting, interventions, etc. Make transitions (SSVF case closings) seamless for the household. 42

There are options for Tim (If he agrees and if the options are available in your community) • • Rehabilitation services Advocacy for disability income Representative Payee Home and Community-Based Waiver (MA) Supervised living facility SSVF Assistance securing housing and services SSVF Temporary Financial Assistance But how many are funded by SSVF or provided by your agency? 43

How do you know when to say yes and when to say no? • Group 1: Not eligible under VA and program eligibility criteria. You must say no. • Group 2: Eligible but another agency/program is more appropriate, available, and acceptable to household. You should say no and refer the household. • Group 3: Eligible but not a good fit; however, there are no other resources in the community to meet the need. You should struggle with decisions about Group 3! There is no easy answer (sigh). 44

Struggling with Group 3 decisions… Consider “alternative harm” scenarios: • If you don’t assist the household to obtain or retain housing, what harm may result? Homelessness is highly disruptive; there are clear risks to inaction. • If you do assist the household, what harm might result? Unless the household needs intensive, specialized or ongoing assistance to protect health and safety, harm is fairly limited. 45

What are the potential risks of helping— or not helping--Tim? • If you don’t assist Tim to find housing, what are the risks to him? What are the potential opportunities if you do assist him? • If you do assist Tim, what are the risks to Tim? • Do the risks of assisting Tim outweigh the benefits of not assisting him? 46

ALWAYS question your assumptions about Group 3! • Households at or below 30% AMI can and do live in housing without ongoing rental subsidies. • People with zero income can and do appeal a denial of public benefits or find employment • Most people with a serious disability do live in the community • People with no experience living independently do learn to live in their own housing, even if they make many mistakes along the way. 47

Do you need to fine-tune your program rather than deny assistance? • Your program design may be dictating who you can assist: staffing, length and intensity of assistance, partnerships, etc. may limit whom you can help. • Can you modify your program so you can assist more vulnerable households with urgent needs? • The very best programs are flexible enough to assist households with medium and high needs. • As expertise grows, so should the challenges you are willing to undertake. 48

Increase program flexibility by being a mini-learning community • Create a climate of passion and competence • Staff training—continuous, broad and deep • Excellent supervision—build skills and discuss the tough questions • Allow staff to try and to fail and to learn from that • Team review of cases, particularly program “failures” • Find and learn from other “best practice” service providers • Regular focus groups with households who succeeded and failed in your program • Review outcome and satisfaction data • Solicit feedback from community partners 49

It’s never going to be easy…. . • And it shouldn’t be. You will always need to use judgment in making decisions about Group 3. • This is inherently a values issue: --As an agency, do you “cream” or do you take those who are seen as hardest-to-serve? --Is your allegiance to your clientele or to your staff and your partner service providers? Will you advocate to others to work outside their comfort level and assist the more challenging households? 50

3. Be sure your intake process has checks and balances • Who should make the decision about accepting or denying a household who meets targeting criteria? • Who reviews that decision? • Is there any reconsideration process? • Will you periodically examine patterns of assistance denials to consider whether the program design needs modification to meet the population’s needs and community’s resources? 51

If your community cannot adequately assist this household…? You still have an obligation! • Document these situations: what is needed and missing. What is the human cost of being unable to provide the assistance that is needed. • Communicate the stories to your local Continuum of Care, local and state decision-makers. • Advocate for resources to fill the gap 52

But how can I assure I don’t get a lot of inappropriate referrals? • Bottom line? You can’t. And you shouldn’t. • A clear and accurate targeting description helps outreach, Veteran households and community agencies know who you can help. But, unfortunately, targeting language can’t do your job. Don’t try to make the community screen people out. • Make sure everyone knows the non-negotiable requirements and what your agency can and can’t offer. Then let them decide whether someone should be directed to your door. 53

THANKS FOR PARTICIPATING IN THIS WEBINAR! The Power. Point will be posted on VA’s SSVF Website: www. va. gov/homeless/ssvf. asp Next month’s national call: December 15, 2011 3: 00 pm – 5: 00 pm 54