Reached functional zero for veteran homelessness in December 2015

Top 12 Lessons Learned from Arlington

1. Past successes breed confidence
2. Leaders must take coordinating initiative
3. Clear communication between leadership and case managers is vital
4. Use Rapid Rehousing to keep Veterans from disappearing
5. Dedicated landlord outreach staff
6. Unified shelter system aligned to the goal
7. Regular reporting to senior leadership
8. Quickly update BNL/HMIS to expedite housing placements
9. Prioritize veterans for housing
10. Transition initiative leader to become sustainability leader
11. Case managers train on and use progressive engagement
12. Continue holding regular leadership and case conferencing meetings after achieving the goal

Before Built for Zero

Prior to joining Built for Zero, Arlington participated in a number of initiatives that gave them confidence they could end veteran homelessness, including:

• Developing and adopting shelter diversion as a new intervention
• Using housing-focused case management to expedite housing placements
• Developing and implementing a housing location service
• Converting transitional housing projects to Rapid Re-housing (RR)

Arlington had also participated in the 100,000 Homes Campaign. In that initiative, they had committed to house 100 vulnerable persons over a 3-year period and housed 104. The combination of these efforts, embracing the federal goals to end homelessness for different sub-groups and the fact that Arlington didn’t have a significant number of homeless veterans gave the community confidence that they could end veteran homelessness. Arlington joined Built for Zero (then called Zero: 2016) in November 2014.

Getting Started

With the community wanting to focus on individual sub-populations, joining Built for Zero was a great vehicle to help Arlington focus on ending veteran homelessness. The leader of the Arlington Continuum of Care, who is a manager in the County’s homeless programs office, led the initiative.
She readily took initiative in a number of ways:

• To kick-start the effort, she reached out to and brought all key stakeholders together
• She also helped clarify the roles that different partners could each play and reached out to them individually to secure or increase their participation
• She attended and actively participated in both the regular leadership and BNL case conferencing meetings. Being in both sets of meetings, while time consuming, helped ensure clear communication and understanding between the two groups. For instance, she clearly communicated decisions made by the leadership group on targeting the most vulnerable veterans at the following case conferencing meetings.
• She regularly interacted with the by-name list group between meetings as issues arose and pressed for quick resolution

Key stakeholders included the CoC, the state (which had significant funding for Rapid Re-housing), SSVF agencies, outreach agencies, and the Arlington County board of supervisors and its housing agency, which serves as the local PHA.

Overcoming Obstacles

Arlington faced and overcame significant obstacles to end veteran homelessness:

• Arlington was losing track of homeless veterans while providers were identifying and securing permanent housing. To overcome this, Arlington started routinely using rapid rehousing resources as a bridge. This enabled veterans to quickly move into stable housing, receive needed services and then continue to live in their unit, using the PSH subsidy when it was ready.
• As Arlington doesn’t have a housing authority, the local HUD office allocated Arlington’s HUD-VASH vouchers to another jurisdiction’s PHA, which would then port the vouchers to Arlington. Unfortunately, this transfer of the vouchers from the PHA to Arlington took as long as a year, stymying progress. Arlington worked with the local HUD office to find another jurisdiction’s PHA, which has been able to transfer vouchers to Arlington in a week’s time, enhancing the ability to more quickly house veterans.
• Stakeholders had different definitions of veteran and didn’t understand that different programs have different veteran eligibility criteria. Most providers had assumed that only one day of active duty qualified a veteran for all VA programs. It wasn’t until later in the initiative that the community as a whole realized that to be eligible for HUDVASH, for instance, a veteran typically has to have been in active duty for at least 2 years. Understanding these differences has helped stakeholders better work together and direct veterans to programs for which they are eligible.

What made a difference?

A number of policy and system changes helped Arlington achieve the goal, including:

• Consistently used SPDAT across the Continuum to determine who should be prioritized and for what form of housing.
• Applied the progressive engagement approach to both homelessness prevention and homelessness to maximize the use of limited resources
• Created a unified shelter system—both shelters used the same forms and housing services plan. The shelter
  operators met to discuss clients and their needs. This coordination enabled the shelter system to be a critical and positive part of the solution to ending veteran homelessness rather than a hindrance.
• Developed a report card for all homeless populations, based on HUD’s performance standards and additional items important to local stakeholders about how the system was functioning to end veteran homelessness. The data used for the report card was already in or is now added (eg Diversion data) into HMIS. Staff also provide the report card to the County’s Executive Committee each month so that leaders are fully aware of an emerging trends and can take necessary action.
• Conducted regular outreach to landlords, both to existing and new ones.
• Created a landlord risk mitigation fund. This helped assure landlords that if they served high risk clients who damaged units they would be compensated. Just having the fund allayed landlord concerns about renting to mentally ill and other disabled homeless persons.

Mid-Course Improvements

At an action camp during the initiative, Arlington recognized the need for more robust landlord outreach efforts if they were going to end veteran homelessness. The landlord housing locator, who was in attendance, agreed to be more aggressive. This resulted in bringing more units on line.

Arlington did not have sufficient PSH for all homeless veterans but realized that many veterans didn’t need PSH because they could succeed with Rapid Rehousing. As such, Arlington established Rapid Rehousing-specific case conferencing for those clients who had been assessed to benefit from Rapid Rehousing. They held 84 case conference sessions in the span of a year—about 1.6 meetings per week—to quickly place veterans into Rapid Rehousing. In addition, Arlington held separate case conference meetings—the equivalent of 1 meeting per week— for veterans who were already in housing to assess their housing stability; these meetings for housed veterans were in addition to regular case management meetings with clients. At the end of each case conferencing meeting, attendees identified specific next steps to take. Both sets of meetings were held when needed –sometimes several in a week and sometimes no meeting was held during the week.

After Achieving Functional Zero

Arlington was approved and announced reaching Functional Zero on Dec 31, 2015. At that time, it was identifying housing units within about 2 months from when a veteran was first found. So, including the 15 days it normally requires to move the client into the unit, veterans can be housed in about 75 days in Arlington.
To maintain functional zero, Arlington takes a proactive approach:

• The leader who led the initiative to end veteran homelessness is now leading the sustainability effort to provide continuity – This leader reviews the by-name list in HMIS daily to both monitor inflow of newly homeless veterans as well as any recidivism of previously housed clients.
• To better understand the needs of each homeless veteran, staff review the information on clients in HMIS, which requires HMIS to be regularly updated.
• Each client is tracked closely and staff regularly ask why— exactly— is this veteran not yet housed and what can we do to expedite their moving into housing?
• Veterans are prioritized— when receiving a VI-SPDAT score, each veteran receives an additional 10 points
• If a veteran needs Rapid Rehousing, he or she is expedited .
• County leaders require monthly updates on sustainability, sending a clear message to staff of the importance to remain vigilant.
• Arlington reached out to their local VA to formalize a clearer communication strategy; the County now has designated points of contact at the VA for specific issues.
• Arlington holds monthly sustainability meetings for three key groups: CoC leadership, all providers, and the byname list team to help ensure regular and focused attention on staying at functional zero. In addition, an integrated services meeting may be added, which involves people that would not ordinarily be at the by-name list or case conferencing table (jails, public benefits staff). The purpose of the integrated services meeting is to strategize on approaches to assist households facing more difficult and nuanced challenges.
• Arlington conducts daily and nightly street outreach to identify new homeless veterans. These veterans have their information quickly entered into HMIS so they can be readily connected to housing. The County and VA staff talk to each other regularly to make sure they both know of the veterans they encounter.

What are the biggest threat to sustain functional zero?

• Because Arlington is adjacent to other cities in the Washington, DC metropolitan area, the County is working with the local VA in Washington, DC to make sure Arlington knows when veterans are on a different jurisdictions’ by-name list but are coming to Arlington to move into housing. Coordination is critical so these veterans moving from other continuums don’t fail to move into housing and become homeless in Arlington.
• There is a real need for case management that is not tied to a particular funding source to address the various kinds of veterans encountered. In particular, chronically homeless veterans in HUD-VASH need more than the monthly case management VA is able to provide. Currently, Arlington has been using supportive services from CoC PSH projects to provide more case management for HUD-VASH clients, which services which could have helped non-VA eligible veterans.
• A final threat is the challenge of continuing to maintain a sense of urgency. Arlington is developing messaging on sustainability that is both simple and continually re-enforced.

What would have been good to have known earlier?

Knowing the following would have enabled Arlington to end veteran homelessness more quickly:

• Understanding the different eligibility standards for serving veterans through different programs.
• Knowing that VA mental health services, even for HUD-VASH clients, can only be provided at the VA hospital.
• Learning earlier that there was a VA ACT team in the DC area that could have been used.

How have efforts on veteran homelessness impacted you work on other populations?

Arlington’s success in ending veteran homelessness has given them confidence to now focus on other sub-populations, including youth. The approach they established for veteran homelessness will take the guess work out of many areas needed to solve homelessness for other groups:

• Have a real-time, by-name-list. Having a by-name list has been imperative to know the extent of the problem and whether progress is being made in ending homelessness in any given month.
• A developed infrastructure for outreach. The outreach team, which operates 7 days a week, geotags locations for ongoing visits. The team also attends by-name list meetings and works closely with staff from (substance abuse) Treatment on Wheels to identify and assist street homeless persons.
• Collaborate to meet people where they are. Outreach and hospital staff collaborate to provide respite beds in an emergency shelter. Creating and providing these beds acknowledges that not everyone is well enough to enter traditional shelter directly from the streets.
• Provide effective case management. Arlington is constantly training and empowering their case managers to integrate proven techniques such as motivational interviewing. In turn, the case managers build trust with clients and provide individualized resource navigation to help them obtain and maintain housing.

These successful approaches and tools used by Arlington in ending veteran homelessness can readily be applied to help other homeless groups.