VA San Diego Healthcare System’s HUD­-VASH Aftercare Team: Preventing Returns to Homelessness

By Shawn Liu, National Homeless Program Manager

July 12, 2023

Introduction

Nationwide, the number of homeless Veterans is continuing to decline, showing a 55% decrease
between 2010 and 2022. What this number does not represent is the Veterans who return to homelessness after obtaining permanent housing through a VA homeless program. There are countless reasons that a Veteran may return to homelessness: losing income, using their limited resources to care for a friend or family member, or experiencing high medical costs themselves, to name a few. Though these Veterans may have initially found a permanent housing situation, they may find themselves needing to reengage with VA homeless programs.

Such was the case at the VA San Diego Health Care System, where, in 2016, it was discovered that many Veterans who had successfully graduated from their local HUD-VASH program later had their Housing Choice Vouchers – which provide them with rental subsidies that make their housing affordable – terminated for administrative reasons. For context, each year, Veterans receiving rental subsidies through HUD-VASH must verify and recertify their family composition and income with their local Public Housing Agency (PHA). This is a routine process that all voucher holders go through to continue receiving subsidies. HUD-VASH case managers often help Veterans with their recertification processes, making sure that forms are filled out correctly and on time. However, Veterans who have graduated from HUD-VASH after successfully completing their case management goals no longer receive the intensive case management services HUD-VASH traditionally provides. So, while these Veterans continue to benefit from the rental subsidies provided by the vouchers, they often do not feel like they can ask for help when it is time for recertification.

In investigating the problem, the homeless program leaders at the San Diego VA discovered that many vouchers were terminated due to minor oversights in recertification paperwork, such as unchecked boxes or missing signatures, or due to minor violations of PHA rules that were easy to resolve. As an alarming result, many of these successfully housed Veterans found themselves facing homelessness again.

In response, over the years that followed, the San Diego VA worked to provide more structured support to HUD-VASH-graduated Veterans during their vulnerable recertification time. These improvements eventually led to the creation of the HUD-VASH Graduate Aftercare Policy and Team.

Practice overview

The Graduate Aftercare Policy’s development started in 2016 with a push from the San Diego VA’s HUD-VASH team to increase regular communication and coordination meetings with 3 PHAs in their catchment area. These increased touchpoints gave the HUD-VASH team increased visibility into housing concerns that participating Veterans faced, such as “pay” or “quit” notices, failed Housing Quality Standards inspections, issues with property managers or neighbors, and mental health crises. With increased visibility into issues that threatened Veterans’ tenancy, the HUD-VASH team was able to provide time-limited case management support to resolve those issues and keep the Veterans housed.

The next improvement happened in 2017 when the San Diego VA’s homeless program leadership moved to standardize their outreach and follow-up processes to their HUD-VASH-graduated Veterans. By the following year, the San Diego VA dedicated 2 HUD-VASH case managers to graduate follow-up, offering a safety net to prevent housing crises and returns to homelessness.

Each year that followed provided more data and evidence in favor of even more support for HUD-VASH graduate Veterans. By 2019, the San Diego VA was able to acquire additional staff positions to create an entire Aftercare Team focused solely on providing aftercare to help HUD-VASH-graduated Veterans maintain their housing. A housing specialist was added to the team to support Veterans when they needed to move residences for voluntary or involuntary circumstances to prevent them from returning to homelessness. A PHA liaison was also added to streamline and increase capacity for weekly coordination with their partner PHAs.

In 2021, the San Diego VA developed and implemented its HUD-VASH Graduate Aftercare Policy to outline the standardized procedures for outreach support for graduated Veterans. This was paired with an additional HUD-VASH Graduation and Discharge Policy which clarified the difference between graduation and traditional program discharges when Veterans would no longer receive rental subsidies.

As San Diego’s HUD-VASH Veterans accomplished their case management goals and prepared for graduation, they were educated on the support the Aftercare Team would provide and when contacts would be made: 90 days, 6 months, and 1 year after graduation, and annually thereafter.

Typically, if a HUD-VASH-graduated Veteran needs short-term intensive support, the Aftercare Team works with them for up to 6 months. If a Veteran needs longer-term support to stabilize housing, they are readmitted to traditional HUD-VASH case management. In the unfortunate event that a Veteran requires intensive case management within 6 months of graduating, they are considered prematurely graduated and their program exit gets canceled. The Veteran gets reassigned to their former HUD-VASH case manager for support.

In addition to their role as short-term case managers, Aftercare Team members provide ongoing training to HUD-VASH staff on best practices and policies for graduation and discharges as well as how to effectively complete voucher recertifications.

Conclusion

The establishment of the San Diego VA HUD-VASH Aftercare Team increased Veteran and staff confidence in the graduation process, as they knew Veterans would be contacted at set intervals and assisted as needed. This also alleviated capacity constraints for case manager caseloads.

San Diego HUD-VASH is a large program. As of June 2023, approximately 1,751 Veterans were housed with rental subsidies. HUD-VASH-graduated Veterans comprised approximately 47% of these vouchers. In fiscal year (FY) 2021, the Aftercare Team assisted with 161 voucher recertifications and made 874 outreach calls. In FY 2022, the Aftercare Team assisted with 378 voucher recertifications and made 1,101 outreach calls. These touchpoints continue to grow as more Veterans graduate from case management.

The impact on housing retention is notable, as PHAs no longer terminate vouchers without consulting with the HUD-VASH PHA liaison. The outreach efforts, combined with short-term case management, have significantly reduced voucher loss and program recidivism. This is critical, as there are significant costs associated with rehousing a Veteran who has returned to homelessness: interim housing for the Veteran, loss of the Veteran’s personal property, reprioritized HUD-VASH and PHA resources, and limited community security deposit assistance. Currently, in San Diego, the cost to rehouse a Veteran is upwards of $6,000. This estimate does not account for HUD-VASH or PHA staffing hours, but reflects the cost related to the security deposit and other moving fees. Most importantly, these aftercare interventions have significantly reduced the negative emotional toll that housing instability can have on Veterans.

Aftercare services can be implemented regardless of the size of the HUD-VASH program. The keystones of the Aftercare Team’s services include regular communication with PHA partners, ongoing outreach efforts to graduated Veterans, and intensive short-term HUD-VASH case management interventions. In San Diego, Aftercare services have been proven to be essential in the prevention of Veteran returns to homelessness.

For more information about this practice, please contact HomelessVets@va.gov.