Above: Dr. Ann Elizabeth Montgomery is an investigator with VA’s National Center on Homelessness Among Veterans. (Photo by Joe De Sciose)
The following is excerpted from a longer interview. To read the full interview, visit VA Research Currents. Also, visit Voices of VA Research to listen to a podcast interview with Dr. Ann Elizabeth Montgomery of VA’s National Center on Homelessness Among Veterans.
Veteran homeless has declined dramatically in recent years, thanks in large part to a variety of steps taken by VA. But the problem is by no means solved.
VA’s National Center on Homelessness Among Veterans spearheads an array of programs aimed at further drawing down the number of Vets without housing. Dr. Ann Elizabeth Montgomery, based in Birmingham, Alabama, has been an investigator with the Center since it started in 2009.
VA Research Currents talked with Montgomery about a study by her group that came out in early 2019 titled “Veterans’ Assignment to Single-Site Versus Scattered-Site Permanent Supportive Housing.” The conversation focused on the HUD-VASH program and the types of living situations it offers Veterans.
The models you looked at in your study involved HUD-VASH [Housing and Urban Development–VA Supportive Housing]. Could you give us a bit of background on this program.
HUD-VASH is the largest permanent supportive housing program in the country, and it’s intended for Veterans who have experienced homelessness and need additional support maintaining housing. It’s been around since the 1990s. There were very few vouchers then, and it’s really ramped up since about 2008.
What HUD-VASH does is provide Housing Choice vouchers—what we used to call Section 8 vouchers. There are now probably around 90,000 to 95,000 HUD-VASH vouchers funded throughout the country, among many more general Housing Choice vouchers that HUD provides. And VA provides supportive services, case management, and health care. That’s how it becomes permanent supportive housing.
The voucher is permanent, and Veterans can take it and look for private-market rental apartments, or what we call “scattered-site apartments,” in the community. The Veterans have to pay only a third of their income toward rent. The voucher pays the rest.
There are also what we call “project-based programs,” where the vouchers stay with the housing unit. So there could be a building that has multiple units, and Veterans can choose to move into one of those units. When a Veteran moves out, the unit becomes vacant, the voucher opens again, and another Veteran can move in.
HUD-VASH and other programs like it are very effective. Studies have found that about 85% of people who move into these permanent supportive programs are able to maintain their housing for a year or more.
It’s also important to note that HUD-VASH takes the Housing First approach. That means if Veterans have substance use or mental health issues or other disabling conditions, they are not required to “fix” those issues before they move into housing. They don’t have to be housing-ready. The underlying philosophy is that once someone gets into housing, that’s a stable platform from which they can live a healthier life, fuller life, and they can address their goals.
Your team reviewed the existing literature on single-site (or project-based) housing versus scattered-site. What emerged as the top pros and cons of these two approaches?
One of the big advantages to single-site housing is that if you have a case manager who is working with, say, 30 people, and they’re spread throughout a large city, that takes a lot of time, because there’s a big focus on having home-based visits. In the single-site model, the Veterans end up having more one-to-one interaction with service providers. Also, there may be less social isolation because you’re living in a building with others who may have similar interests just by virtue of their being fellow Veterans.
On the other hand, some research has found that single-site can be isolating because the Veteran may not feel part of the mainstream community. These programs are supposed to be just like other types of permanent supportive housing, just as if the Veterans were in scattered-site units in the community, but in this model, they are grouped together. It shouldn’t feel like an institution. But there definitely are more staff present than there would be in your own apartment.
“There are some Veterans who really want to be with other Veterans. They feel like they have an important common understanding.”
What have you learned about the social bonding that goes on among Veterans living at the same single site?
There are some Veterans who really want to be with other Veterans. They feel like they have an important common understanding. For some people, that’s really a positive aspect of these single-site programs. Staff gave us examples about how Veterans would take care of each other. The younger Veterans help out the older Veterans. Particularly in these mission-driven single-site programs that are created specifically for Veterans, that’s the message they’re getting: “We’re here for you. We’re here together.”