VA's Comprehensive Approach to Ending Homelessness Brought Larger Gains than in the General Population

BACKGROUND:
In 2010, the US Interagency Council on Homelessness, representing 19 federal agencies, including VA, released a plan to reduce homelessness that included the adoption of “Housing First,” which emphasizes rapid, streamlined access to permanent supportive housing along with increasing collaborations and integrating resources for housing, healthcare, employment, and other needs. VA expanded homeless programming to implement this plan: the Ending Veteran Homelessness initiative. This mixed-method analysis compared Veteran homelessness to homelessness in the general population during a 16-year study period, which included these initiatives. Baseline years were 2007-2009, and Action – or programmatic years – were 2010 to 2022. In addition to assessing annual Point-in-Time (PIT) counts for Veteran and general homeless populations, investigators conducted interviews with VHA Homeless Program Office leaders during the Ending Veteran Homelessness initiative.

FINDINGS:

• Over the 13-year active period of Ending Veteran Homelessness, there was a 55% decrease in homelessness among Veterans compared with a 9% decrease among the general population.
  • The PIT count for Veterans increased substantially from 60,998 in 2007 to 74,087 in 2010 before steadily dropping to 33,129 in 2022, a 55% decline from the 2010 peak.
• Interviews with policy leaders suggest that adopting a “Housing First” policy and community partnerships played a significant role in VA outcomes. For example, one policy leader noted: Housing First served as an important counter to the “treatment first” model… which was a long-term obstacle to permanent housing for many Veterans.
• The decline in Veteran homelessness was coupled with substantial growth in housing vouchers, grants to community partner agencies, and growth in VA clinical and social programming to provide homeless-tailored wrap-around services and supports once Veterans were housed.

IMPLICATIONS:

• Study findings describe an important role for health systems in addressing complex social determinants of health, such as homelessness.

LIMITATIONS:

• There may have been additional factors, either internal or external to VA, that might also be drivers of these outcomes that were not identified or assessed.
• Qualitative data were limited to key leadership within the VA Homeless Program Office when this initiative was launched.

AUTHOR/FUNDING INFORMATION:
Dr. O’Toole is Deputy Assistant Under Secretary for Heath; he and Dr. Rudolph (Director) are with HSR’s Center for Innovation in Long-Term Services and Supports (LTSS). Dr. Elnahal serves as VA’s Under Secretary for Health. Ms. Pape is the Senior Advisor in the Deputy USH office, and Mss. Diaz and Dunn are the Executive Director and Deputy Director of the VA Homeless Program Office.

O’Toole T, Pape L, Kane V, Diaz M, Dunn A, Rudolph J, and Elnahal S. Changes in Homelessness among US Veterans after Implementation of the Ending Veteran Homelessness Initiative. JAMA Network Open. January 29, 2024;7(1):e2353778.