Evaluating a housing first approach in the hud-vash program

Ending homelessness is a national priority, supported by federal agencies and the White House. Permanent supportive housing has been identified as an effective intervention for ending chronic homelessness and the housing first approach has had success in quickly housing individuals and helping them maintain housing stability. To meet the U.S. Department of Veterans Affairs' (VA) goal of ending Veteran homelessness, it collaborated with the U.S. Department of Housing and Urban Development (HUD) to develop HUD-VA Supportive Housing (HUD-VASH), which provides housing vouchers and supportive services to chronically homeless Veterans.

The VA has traditionally followed a “treatment-first” approach to permanent supportive housing – requiring treatment compliance as a perquisite to housing. In contrast, housing is not contingent upon treatment compliance in Housing First. To test the feasibility of Housing First in HUD-VASH, 14 VA sites participated in a demonstration project by administering a portion of HUD-VASH vouchers using a Housing First method. Additional resources and training established Housing First case management teams providing an Assertive Community Treatment (ACT) level of supportive services. The remaining vouchers were administered via treatment as usual.

This presentation describes differences between the service approaches and compares the outcomes for Veterans housed via housing first and those housed via treatment as usual at the 14 sites. Outcomes include time to placement in housing, housing stability, and changes in service utilization (e.g. urgent care, inpatient stays). Lessons learned from this demonstration as well as the VA's ongoing effort to implement Housing First across all sites will be discussed.