Veteran Small External Change Package 2 0

Zero: 2016 Change Package
Veteran Action Collaborative (Small)
September 2016
Aim: The Veteran Action Collaborative seeks to accelerate

an end to veteran homelessness in 13 communities
while helping at least 5 communities reach functional zero and
at least 3 communities to reach the threshold for a
robust coordinated entry system by December 31, 2016.
Primary drivers:
Aim:
5 communities at
FZ and
3 communities at
robust CE by
Dec 31, 2016
Reducing Inflow
Accelerating Housing
Placements
Integrating GPD
Building a Robust CES
1) Outcome measures
Three-pronged
measurement strategy
# of actively homeless veterans

# of permanent housing placements
# of veterans being marked inactive
# of veterans newly identified
# of veterans returning from housed
# of veterans returning from inactive
2) Systems measures
# of days from ID to housing
Robust CES scorecard score
3) Driver- & PDSA-specific
process measures
Secondary Drivers
Diversion
Primary Driver
Reducing Inflow
Prevention
Retention and supportive

services for permanent
housing placements
Upstream Interventions
Primary driver
Reducing Inflow
Measures:
Some communities will never reach functional zero without

better understanding the reasons for homelessness in their
community and decreasing the number of veterans that enter
their homeless system each month

Getting Started
Establish a refined understanding of scenarios in which
veterans are entering the homeless system by evaluating the
following data points for the last 90 days
Based on data consider which drivers and corresponding

change ideas would be best to focus on
Data Points
Secondary Drivers to Reduce Inflow
Diversion, Prevention
# of veterans returned from housed
Retention and Supportive Services, Prevention
Referrals sources and previous interaction with services
Primary driver
Reducing Inflow
Measures:

community and decreasing the number of veterans that become
homeless each month.
Secondary driver
Diversion
Change Ideas
Train frontline staff conducting intakes and assessments

at CES entry points in the Conflict Resolution Approach, a
conversational approach to diverting individuals towards
other options for re-stabilizing housing. As presented in
the diversion overview, these staff are differentiated from
those doing coordinated assessment, making these
separate but coordinated processes.
Implement use of shared diversion and prevention tool to
screen and implement standard protocols across all entry
points.

Bright Spots
Cleveland
Tacoma, Washington
Resources
Prevention targeting
101
Diversion Overview
SSVF Prevention
Screening Toolkit
NAEH Assessment
Tool
Primary driver
Reducing Inflow
Secondary driver
Diversion
Measures:
Bright Spots
Resources
Change Ideas
Create small flexible pool to be used as one time and

targeted financial support to assist those being diverted
from shelter in securing permanent housing.
Implementing
Systematic Diversion
Cleveland, OH
Tacoma, Washington
Cleveland
Presentation
Primary driver
Reducing Inflow
Secondary driver
Prevention
Change Ideas
List all of the entry points/points of assessment for veterans into

your system and programs currently providing prevention resources.
Set SSVF acuity thresholds for prevention resources and allocation in
community plan based on veteran data from by-name list..
Track names and data of those receiving prevention resources and the %
that ends up entering homeless system.
Measures:
Bright Spots
Resources
SSVF Prevention
Screening Toolkit
NAEH Assessment
Tool
Risk Factors for
Veterans
101
Primary driver
Reducing Inflow
Secondary driver
Prevention
Change Ideas
Use SSVF data to advocate for resources: # of clients that meet stage 1
(initial eligibility threshold) screening but not stage 2 targeting (prioritization)
Create additional pool of flexible funding to provide support to those at risk

of losing permanent housing to reduce loss of permanent housing and
inflow of individuals into the system.
Measures:
Bright Spots
Resources
SSVF Prevention
Screening Toolkit
NAEH Assessment
Tool
Risk Factors for
Veterans
101
Primary driver
Reducing Inflow
understanding the reasons for homelessness in their community
and decreasing the number of veterans that become homeless
each month.
Secondary driver
Retention and supportive services after

housing placement - Scattered Site
Change Ideas
Implement critical-time intervention program model for

after clients move into housing.
Create ROI to gain client consent to allow property
manager to contact social worker if problems arise.
Ensure 24 hour or standard response to client crisis or
property management complaint.
Use mediation to resolve conflict between the property
manager and client and avoid evictions.
Measure(s):
Bright Spots
Los Angeles, CA
Jacksonville, FL
Resources
Critical Time
Intervention
Innovation
Warning: do try these ideas unless you are a cutting edge innovator!
These are fully untested ideas that are floating around the thought
stream and ready to be pulled down and tested with the right
community.
Untested Change Ideas
Areas Needing Innovation
Contact VISN homeless program coordinator to pull GPD

intakes for the last 90 days and evaluate referral sources.
1.
2.
Use the veteran survey tool to interview a group of

veterans assessed over the last 90 days and evaluate
the data.
Pull VA program intake and referral data and evaluate
prior program touches.
Evaluating Inflow
Secondary drivers
Primary driver
Accelerating
Housing Placements
Access to affordable rental

units
Targeted and adequate
housing resources
Coordination between
veteran-serving organizations
Primary driver
Accelerating Housing Placements
Measures:
Even with the major investment of federal resources, we must build

# of new rental units identified
systems to find rental units that are affordable at the level of the
# of veterans on HUD-VASH waitlist
subsidy and find landlords willing to rent to veterans with troubled Avg # of days from voucher issuance
rental histories.
to lease-up
Secondary driver
Access to affordable rental units
Change Ideas
Bright Spots
Create ROI and secure client consent to allow property

manager to contact social workers if problems arise in order
to inspire confidence in renting to veterans.
Create shared materials that can be used by housing locators
while doing outreach to ensure consistent and effective
messaging that facilitates renting to veterans.
Train housing locators in landlord outreach and engagement
practices to build capacity and skills to engage and secure
rental units for veterans.
Resources
Housing Navigator
Tool
Los Angeles
Landlord Toolkit
Primary driver
Measures:

rental histories.
to lease-up
Secondary driver
Change Ideas
Hire housing locators with backgrounds or experience in real

estate.
Implement a Broker Program in which real estate brokers can
be given commission upon housing location for clients.
(please note: special permission must be granted from
regional coordinator)
Outsource the navigation and housing location in partnership
with volunteer organizations like a rotary club.
Bright Spots
Richmond
Resources
Housing Navigator
Tool
Landlord Toolkit
Primary driver
Measures:

rental histories.
to lease-up
Secondary driver
Change Ideas
Identify landlord champions and convene small (size of meeting is

correlated with better outcomes) groups of landlords to share about
veteran programs and benefits of working with them.
Establish clear and central points of contact for interested landlords or
available units.
Local PHA takes leadership role and uses Extraordinary Admin Funding to
staff landlord outreach and coordination of available units
Create a 24-hour hotline for landlords to call if tenant issue or crisis arises
Create shared standards with veteran providers around quick and

consistent response to available units
Bright Spots
San Diego
Click this link
New York
Resources
Landlord Toolkit
Primary driver
Measures:

Avg # of days from voucher issuance
subsidy and find landlords willing to rent to veterans with troubled
to lease-up
rental histories.
Secondary driver
Change Ideas
Approach landlords like donors or customers

and frame conversation in terms of their
interests.
Incentivize landlords to rent to veterans
through a shared funding pool
Create a landlord mitigation fund to cover
potential repair costs and unpaid rent
Publicly and regularly recognize landlords who
rent to veterans in your homeless system
Bright Spots
San Diego:
Click this link
Resources
Landlord Toolkit
Risk Mitigation Fund
Examples
Primary driver
Measures:

rental histories.
to lease-up
Secondary driver
Change Ideas
Build relationships and trust with potential landlords by

attending apartment association meetings and other settings
where landlords are already meeting together.
Housing locators begin housing search process at point of
program entry
Bright Spots
San Diego:
Click this link
Honolulu
Roanoke
Resources
Landlord Toolkit
Housing Navigator
Tool
Primary driver

Making improvements to the housing placement process is critical
to reach functional zero. It requires new process efficiencies and
new resources to optimize available housing and services.
Secondary driver
housing resources
Measures:
% of community PSH dedicated to
non-health care eligible veterans
Bright Spots
Resources
San Diego:
Click this link
Landlord Toolkit
Change Ideas
Establish PHA dedicated housing resources to non-health care

eligible veterans
Evaluate the current process of referral into VA-funded resources
and look for opportunities to better target and optimize housing
and services based on by-name list data
Use the VA Gaps Analysis tool to understand the gaps in housing
resources against the projected need. (Remember to plug in the
data from your by-name list!) Use this data to quantify and
advocate for needed resources.
Risk Mitigation Fund

Examples
Primary driver

Secondary driver
housing resources
Measures:
% of community PSH dedicated to
non-health care eligible veterans
Bright Spots
Change Ideas
Implement move-on strategies to free up VASH and PSH services

and subsidies.
Resources
Primary driver
Measures:


Secondary driver
Coordination between veteran-serving
organizations and services
Change Ideas
Ensure that all veteran-serving organizations meet regularly to

review shared data informing an ongoing discussion of
strategies for improvement towards collective goals.
Set agency-level goals that are mutually supportive and align
to the community goals set.
Enroll every eligible veteran on your by-name list into SSVF to
streamline process of service delivery short-term and longer
term.
Bright Spots
Honolulu, HI
Resources
Primary driver

Measures:
Secondary driver
Coordination between veteran-serving
organizations and services
Bright Spots
Change Ideas
When appropriate, explore collaboration with SSVF staff to

provide navigation and housing location services to VASH
clients.
Resources
Innovation
community.
Convene a regular housing locator meeting to share effective
practices and available units

Real estate investment models focused on
securing units to be leased with VA - subsidies
Secondary drivers
Local buy-in and leadership
Primary driver
Integrating GPD
Coordinated entry and

by-name list integration
Bridge housing model
Data-driven conversion to other

models
Housing Focused Program and
Culture
Sequencing:
1.
Local buy-in and

leadership
Primary driver
Integrating GPD (Grant and Per Diem)

VA-funded transitional housing programs are a substantial
resource in many communities. If integrated into the broader
system, these programs can serve as a launch pad for
permanent housing and a community hub for quickly
connecting veterans to services.
Measures:
% of exits to PH (Performance)
Avg length of stay
Monthly occupancy rate
Getting Started
To identify areas for improvement, work with
the local VAMC to pull the following data
points for the last 90 days in aggregate and by
agency:
1.
2.
3.
% of exits to PH,
Average length of stay
To understand opportunity for improvement and

changes create a matrix of GPD programs with:
1.
2.
3.
# of beds for each agency/program

Program/service types (treatment, back to work,
bridge, etc.)
Built environment (individual units, carve-out beds
in shelter, etc.) to understand opportunities for
conversion to other models.
Primary driver

Secondary driver(s)
Local buy-in and
leadership
Change Ideas
Contact local GPD liaison, Homeless Network Coordinators

and Homeless Medical Center Coordinator to plan initial
engagement.
Engage GPD agency-level leadership one on one to
understand concerns about making changes to program
models.
Convene multiple GPD agency-level leaders to build will
and collective commitment to making improvements and
changes to GPD programs.
Measures:
Avg length of stay
Bright Spots
Washington D.C.
Ann Arbor
Denver
Resources
VA letter of support
for GPD
improvements
Primary driver

Secondary driver(s)
Local buy-in and
leadership
Change Ideas
Frame conversation with GPD providers in terms of the

vital role their programs can plan as part of the
coordinated system. Promote providers seeing their
programs as launching pads to permanent housing and
acting as hubs in connecting veterans to services
Engage providers about implementing a housing focused,
housing first approach using case studies from peers as
evidence of effectiveness.
Measures:
Avg length of stay
Bright Spots
Washington D.C.
Ann Arbor
Denver
Resources
VA letter of support
for GPD
improvements
Primary driver

Secondary driver
Coordinated entry and
BNL integration
Change Ideas
Ensure GPD program data is a part of the by-name list

through staff inputting data into HMIS. If HMIS is not
capable of hosting the BNL, create a reporting
mechanism with the BNL manager.
Map process by which veterans are referred and
targeted for referral to GPD and coordination and
connection to other VA services, Ensure there is a
consistent community-wide process.
Measures:
Avg length of stay
Bright Spots
Washington D.C.
Ann Arbor, MI
Philadelphia, PA
Denver, CO
Resources
Primary driver

Secondary driver
Implementing bridge
housing model
Change Ideas
Create processes to ensure veterans have a housing plan

in place and subsidy secured when entering GPD
program with no more than 90-day timeline for exit.
Ensure low barriers for veterans entering GPD and limited
program requirements.
Create housing first and housing-focused culture and
mindset with program staff.
Measures:
Avg length of stay
Bright Spots
Honolulu (US Vets)
Resources
VA Guidance in Using
GPD as Bridge
Housing
Guidance on
Changes to Scope of
Service
Primary driver

Secondary driver
Implementing bridge
housing model
Change Ideas
Avg length of stay
Bright Spots
Collaborate with VA housing programs to provide bridge

housing resource and exit veterans from GPD beds quickly.
In mixed congregant settings, have community meetings to
introduce new veterans and openly discuss issues that may
arise as a result of mixed needs. For instance veterans
focused on substance abuse treatment alongside of those
in bridge beds that allow for substance use.
Measures:
Honolulu (US Vets)
Resources
Primary driver

Secondary driver
Data-driven conversion
to other models
Measures:
Avg length of stay
Bright Spots
Resources
Change Ideas
Converting beds to project-based HUD-VASH in

partnership with a local PHA
New York City
VA/HUD Guidance
VA Guidelines for TIP
Primary driver

Secondary driver
Housing Focused
Program and Culture
Measures:
Avg length of stay
Bright Spots
Change Ideas
Immediately after intake a permanent housing plan with

timeline is established for every veteran. Housing plans are
revisited throughout stay and at every point of clinical and
other services received.
Staff are trained in housing first practices and mindset. This
is reiterated at the point of hiring.
Honolulu, US Vets
Resources
Primary driver

Secondary driver
Housing Focused
Program and Culture
Measures:
Avg length of stay
Change Ideas
Create a housing focused culture by putting up signage in

the facility promoting the use of housing plans. (i.e. whats
your housing plan?)
At weekly meetings with veterans living in GPD, have a
standing item on housing plans, celebrate and reward those
moving forward
Bright Spots
Honolulu, US Vets
Resources
Primary driver

Secondary driver
Housing Focused
Program and Culture
Measures:
Avg length of stay
Bright Spots
Change Ideas
Divide responsibilities so that case managers are solely

focused on navigating clients through permanent housing
plan. Have other staff assigned to clinical and employment
services, administrative tasks and housing location.
Case managers focus with veterans on external resources
available in the community to reduce dependance on GPD
program for support, connection and community.
Honolulu, US Vets
Resources
Innovation
community.
Create funding pool through private philanthropy or local

public dollars to supplement additional staff to provide
supportive services after veterans move into permanent
housing.
1.
2.
Review and understand data about exits from GPD

and evaluate with staff to understand causes of exits
to housing other than permanent.
Identify common attributes of clients not exiting to
permanent housing and target interventions to this
group still in GPD.
Employment strategies
Long-term housing stability
Secondary driver
System coverage
Primary driver
Robust CES
Understanding and using data
Effective and client-centered

service coordination
Leadership

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Zero: 2016 Change Package

Veteran Action Collaborative (Small)

Aim: The Veteran Action Collaborative seeks to accelerate

Building a Robust CES

# of actively homeless veterans

Retention and supportive

Some communities will never reach functional zero without

# of veterans newly identified

Based on data consider which drivers and corresponding

Secondary Drivers to Reduce Inflow

# of veterans newly identified

# of veterans returned from housed

Retention and Supportive Services, Prevention

Referrals sources and previous interaction with services

Some communities will never reach functional zero without

Train frontline staff conducting intakes and assessments

# of veterans newly identified

Create small flexible pool to be used as one time and

List all of the entry points/points of assessment for veterans into

Create additional pool of flexible funding to provide support to those at risk

Retention and supportive services after

Implement critical-time intervention program model for

Areas Needing Innovation

Contact VISN homeless program coordinator to pull GPD

Use the veteran survey tool to interview a group of

Access to affordable rental

Accelerating Housing Placements

Even with the major investment of federal resources, we must build

Access to affordable rental units

Create ROI and secure client consent to allow property

Accelerating Housing Placements

Even with the major investment of federal resources, we must build

Access to affordable rental units

Hire housing locators with backgrounds or experience in real

Accelerating Housing Placements

Even with the major investment of federal resources, we must build

Access to affordable rental units

Identify landlord champions and convene small (size of meeting is

Create shared standards with veteran providers around quick and

Accelerating Housing Placements

# of permanent housing placements

Access to affordable rental units

Approach landlords like donors or customers

Accelerating Housing Placements

Even with the major investment of federal resources, we must build

Build relationships and trust with potential landlords by

Accelerating Housing Placements

Establish PHA dedicated housing resources to non-health care

Risk Mitigation Fund

Accelerating Housing Placements

Implement move-on strategies to free up VASH and PSH services

Accelerating Housing Placements

# of permanent housing placements

Ensure that all veteran-serving organizations meet regularly to

Accelerating Housing Placements

When appropriate, explore collaboration with SSVF staff to

Areas Needing Innovation

Coordinated entry and

Data-driven conversion to other

Local buy-in and

Integrating GPD (Grant and Per Diem)

To understand opportunity for improvement and

# of beds for each agency/program