Episode 67: How We Cut Veteran Homelessness By Half with Monica Diaz and Shawn Liu (Pathways Home pt. 7)

Shane Phillips 0:04
Hello! This is the UCLA Housing Voice Podcast, and I'm your host, Shane Phillips. This is the seventh installment in Pathways Home, our series on research into the causes of and solutions to homelessness. Unlike the previous six episodes, this one is not about research. Instead, it's a conversation about practice and implementation, with two senior staff members of the Homeless Programs Office at the US Department of Veterans Affairs, Monica Diaz and Shawn Liu. At different times throughout this series, we've mentioned how the US cut veteran homelessness by more than half since 2009, and this happened at a time when homelessness among the general population has remained essentially flat. We wanted to hear more about what the VA has been doing to buck the trend, and what that might teach us about reducing homelessness for other populations, so we called them up.

If listeners could take just three ideas away from this discussion, I'd want them to be these: First, investing more into services and housing for homeless veterans made a real difference. Money will not solve all of our housing and homelessness problems, but it can certainly solve a lot of them, and the costs really aren't that high. Second, the VA provides a wide array of services, of which homelessness prevention and resolution is only a small part. The VA's integrated services allow them to stay connected to the people they serve in a way you rarely see elsewhere, at least in the US, and that, at its best allows, them to identify problems and mobilize resources to help people faster. And third, our society is imperfect enough to allow tens of thousands of veterans to sleep on our sidewalks and in cars and shelters every night, despite the high esteem we hold them in for their service and sacrifice. If we are flawed enough to abide that, then we should appreciate that we exist in a society where it is tough to get by for many, many people, and where homelessness is possible for a great many people too, veteran or not. And for those reasons, we should be humble enough not to assume the worst of those we see experiencing homelessness — veteran or not. By the same token, if greater care and resources can reduce homelessness among veterans — and it has — then it can work for others too. It is much too soon to be writing anyone off.

I hope you enjoy this conversation. In two weeks, we will be back with the eighth and final episode in the Pathways Home series. The Housing Voice Podcast is a production of the UCLA Lewis Center for Regional Policy Studies with production support from Claudia Bustamante, Gavin Carlson, and Jason Sutedja. As always, you can send comments and questions to shanephillips@ucla.edu. With that, here's our conversation with Monica Diaz and Shawn Liu.

Monica Diaz is Executive Director of the Veteran Homeless Programs Office of the Veterans Health Administration, which is part of the US Department of Veterans Affairs, and Shawn Liu is Director of Communications for the same. They're joining us today for our Pathways Home series to talk about veteran homelessness. Specifically, we're going to talk about lessons learned from the efforts of the VA and its partners that over the past 15 years have led to a roughly 50% decline in the number of US veterans experiencing homelessness on a given night, even as total homelessness numbers have gone up nationwide. Monica and Shawn, thanks for joining us, and welcome to the Housing Voice Podcast.

Monica Diaz 3:51
Thank you for having us.

Shawn Liu 3:52
Yeah, it's great to be here.

Shane Phillips 3:54
My co-host this time is Mike Lens. Hey, Mike.

Michael Lens 3:56
Hey, Shane. Welcome to Shawn and Monica and hello out there to the listening public.

Shane Phillips 4:01
So we always start the show by asking our guests for a tour of their city or somewhere they've lived and want to share with our audience. We were just talking about Florida. Maybe that's where one or both of you would like to talk about. But where do you want to take us and what are we doing while we're there?

Monica Diaz 4:15
If you come to Florida I have to go to Disneyworld, right? So I will say Orlando, Florida is one of the most exciting cities that I've visited, very family oriented, we have a great community. So I will say I will take you to... not only downtown, but, again, definitely Disneyworld so you can enjoy the parks.

Michael Lens 4:34
I'm heading to Disneyland in a month so I am not at all averse to a Disney trip.

Shane Phillips 4:41
We've got plenty of Disney over here, but yeah, it's a different one in Orlando. We've got the original, but you know, original's not always better. Shawn, how about you?

Shawn Liu 4:51
Yeah, so I'm in Jacksonville, Florida. And so if you were hanging out together we're probably going along the beach Jacksonville is nicknamed the First Coast because is we're in Northeast Florida. And if you're coming down, say US 1, I-95.,Jacksonville is literally going to be the first coast you'll encounter when you enter into Florida, and it's just got wonderful beaches. We're also a pretty large city, so we've got some nice metropolitan kind of pockets. We've got a lot of diversity, so many other different ethnicities and cultures. I personally live in, what is functionally — they don't call it that, but functionally Little India. So a lot of really great food, a lot of really great people. And yeah, we're gonna hang out on the beach a lot.

Michael Lens 5:30
Is this ethnic and global diversity of Jacksonville, somewhat recent, or is this a few decades in the making?

Shawn Liu 5:38
You know, that's a really great question. I've been in Jacksonville probably around 15 years now. And I'm originally from Miami, Florida, which is even more cosmopolitan in its diversity. But part of the things that I loved when I first started checking out Jacksonville as a potential place to move was the instant presence of not just diversity, but I'm a mixed race person and seeing a lot of mixed race couples with their mixed race families. That was amazing and really comforting to see.

Michael Lens 6:06
Hmm, not something I would have known I've only been to Jacksonville once, it was probably 20 years ago.

Shawn Liu 6:12
You've got to come on down. Come on over, I guess across the country.

Shane Phillips 6:15
So normally, our interviews are focused on a specific study or report or book, but in this case, we're going to have a more wide ranging conversation about successes and challenges reducing veteran homelessness in the US. But that said, we will start this conversation by looking at a publication, which is the 2023 Annual Homelessness Assessment Report to Congress. The AHAR is published each year by HUD, the Department of Housing and Urban Development, this one in December 2023. Veteran homelessness is the topic of chapter five, but looking first at numbers for the entire US population. This year's Point-in-Time Count estimates that there were 653,100 people experiencing homelessness on a given night in January of 2023, up by 12%, or 70,000 people since 2022. And this is at a level higher than any year since at least 2007. Of those 653,000 people, a little shy of 35,600 were military veterans, which is a 7% increase from the previous year. No one is happy about that increase, of course, but the reason we're having this conversation today is because while the overall point in time count of all people experiencing homelessness is up by about 4%. Since 2009. For veterans, it has gone down by 52%. So cut by more than half. Even in a context of increasing homelessness overall, we've somehow managed to make major progress on housing the nation's veterans. And the hope is that if we can do that for homeless veterans, then we should be able to do that for civilians as well. So we're going to dig in and learn what we can from Monica and Shawn, and their inside knowledge of the VA is programs and partnerships. I think to start we should make sure our listeners are all on the same page about what the Department of Veterans Affairs does, and the roles of the Veterans Health Administration and homeless Veteran Programs Office under its umbrella. Could you share some of the broader context about the mission of the VA and the services it offers, and also how it interfaces with veterans in ways that might make you particularly well suited or motivated to help veterans who are experiencing homelessness?

Monica Diaz 8:35
Sure, VAs mission is one of the best missions, I always say the mission itself motivates all of us. It's basically to fulfilled President Lincoln's promise, right, which was to care for those that serve our nation's military, but not only them also their families, your caregivers and survivors, and as a military spouse, I can relate that myself. We have a very particular structure within the agency, there is three administration's right. One is the Veterans Benefit Administration, which also helps service members transition from the military service and assist the veterans with education, Home Loans, life insurance and other pieces. We also have the National Cemetery Administration, which has again, beautiful efforts, especially providing dignified burial services and they manage over 107 tourists nationwide. And then we have the Veterans Health Administration where our homeless programs is housed. And within the Veterans Health Administration, we are the largest integrated health care network in the United States, which is I found that fascinating and quite a blessing. We have over 1000 healthcare facilities serving 9 million enrolled veterans each year or around that number, as it varies. So it tells you that tells you the capacity, how comprehensive of a system we are right in the largest system in that space and Within that the homeless program, like I mentioned, it's a line on there, the health veteran health administration, but there's a very key piece for that. And it kind of acknowledged that homelessness has an impact in someone's health, right. And within that we are in that health care administration, offering services with other clinical aspects of the health care component in a way that is very holistic in terms of the approach for the veteran, our office is truly dedicated in finding solutions to increase access to permanent housing, we offer programs and services in a very comprehensive portfolio that really focus on not only serving the veteran, but giving it a sense of dignity with that service, a sense of belonging, personal empowerment, which I think makes a huge difference. For me, I found that extremely important for that service, and the portfolio that we provide within that to continue to evolve, right, because the needs of our veterans also evolve. So to meet those, we need to be able to advance and change and adapt. We have right now an operating budget of around $2 billion that Congress has given us which is significant amount of resources, right. And because of that, we're able to provide that wide array of services to address the full range of housing needs that a veteran may have. And you know, that includes being able to fund outreach services, the many times the front door for the VA health care and benefits, we also can fund emergency and transitional housing across the nation, which allows for any veteran that needs a bet today to be able to have that, then we will have over 10 1000s of transitional beds across the country, we also are able to provide short term and long term rental subsidies provide access to permanent housing, in coordination with case management and older wraparound services. And fascinating enough, the budget also allows for even assists veterans in the criminal justice system, which it tells you how comprehensive the portfolio is, we help the veterans within that program to access health care and access the VA system in itself. And we also help veterans gain meaningful employment. That's part of the services that we provide. So with all that said, I think I will just summarize the fact that homeless programs within the VA system is not one service, it's not one program is a comprehensive portfolio of services to meet the individual needs that a veteran may have that is precipitated their homelessness, or to get them out of their homelessness as well. Yeah,

Shane Phillips 12:38
something I hadn't thought about. Definitely something the VA has in common with a lot of the folks we've talked to is homelessness is a relationship to the healthcare system. And how many of the people doing research on homelessness work in health care or psychology, as opposed to housing, for example, and, you know, just kind of realizing here that because of the Veterans Health Administration being, you know, wrapped into this, you don't have the same what we call or some people call a the wrong pocket problem of you know, a city might be responsible for reducing homelessness, but the county is the one who you know, then saves a lot of money because people are not going to the emergency room is often not involved in the criminal justice system as often. By having that all integrated, I can see a real benefit there. And, you know, not that you wouldn't be motivated to anyway. But there's that additional financial motivation of reducing homelessness, actually, in many ways probably helps your bottom line as well. So you can actually provide more health services for the broader institution.

Monica Diaz 13:40
Certainly, I think, because we have that type of comprehensive integrative and interconnected system, it really allows us to provide them the service with a system approach. We're not competing among ourselves or in any way we are actually integrating those because our main goal to win is, is the veteran is the veterans life. Yeah,

Shane Phillips 14:03
I think we'll probably come back to this integrated approach. Moving on now, what should we know about the experiences of veterans themselves that might increase their risk of homelessness? I think an important bit of context here is that while veteran homelessness is way down since 2009, veterans are still slightly more likely to be homeless than the general population, about 20 of every 10,000 US residents was homeless on a given night during the January Point in Time Count. And for veterans, it's about 22 Out of every 10,000. So a bit more. What are some potential explanations for that?

Monica Diaz 14:40
Yeah, that's a great question. Our researchers and the VA National Center on homelessness among veterans which actually is part of the homeless program, office and additional surface as well. They do find veterans do face at elevated risk of homelessness related to the general population. So when you actually look specifically at the members of the military, we see that combat exposure and PTSD are truly associated with a higher risk of homelessness, which is an interesting factor. But when looking at the most recent generations who serve in Iraq and Afghanistan ride, there is some preliminary evidence that the dynamics of their homelessness is perhaps different than they appear to become homeless more quickly after exiting the military as compared to older veterans. So I think what is important to know is that not all veterans are the same. Veterans do enter the military, and like any of us come from different communities, they have, you know, dramatically different experiences while serving and they face also different challenges upon discharge, right. So preliminary risk factors that we also have found include the adverse childhood experience can contribute as well. And interesting enough, during the military experience, we have seen the traumatic experiences whether might be, you know, during combat exposure, or military sexual trauma, those as well are some of the factors that we have seen for some of the veterans contributing factors. And I will say one that probably people don't know a lot about or have heard about is the pay grade while in the military, which is a proxy of socio economic status is also a factor, right. And then the post military factors, which I think is important, as well, that we have seen, according to research, that are contributing situations to homelessness include job loss, financial difficulties, also this illusion of relationship that the veteran may have and that support system. All that said, you know, when I get this add this question, I always add that despite all the research, we at the VA, and in the homeless program offers, we continue to acknowledge that there's a lot more of a deeper analysis and review and exploration that we need to do to become even more clear why veterans, as a group have a higher risk than non veteran. And so there's a lot of work to be done there to even understand them. We always are very sensitive to not box, the veteran in the same characteristics as a group, because they're all different. They all have their own unique experiences as well.

Michael Lens 17:24
Monica, just a point of clarification there. You mentioned PE grade, are you talking about the role of PE within the veteran population? So if you're at a higher pay grade than somebody else, you're less likely to experience homelessness? Or are you talking about, you know, pay in our military overall as being perhaps low enough that that explains some of the elevated homelessness rates that we see in the veteran population compared to the overall population?

Monica Diaz 17:57
Based on the research, it's looking truly at that pay grade while in the military, and comparing each other, you got it. And so that pay grade while in the military, it is a proxy of socioeconomic status. And so because of that, it becomes a factor.

Shawn Liu 18:14
Yeah, my just kind of piggyback on this a little bit. You know, one of the things that our staff across the country experience a lot when they're meeting with veterans, they're predominantly meeting veterans who are enlisted service members, very seldom are they encountering former officers at Outreach locations. So when we say that pay grade is a proxy for socioeconomic status, we're also getting into the whether or not there the functional equivalents of blue collar workers versus white collar workers, are they lieutenants, captains, generals, etc, etc. By and large, the veterans that we're serving are enlisted service members. And that can have some implications, both, as Monica mentioned, pre military service because of the communities that they're coming from, but also after discharge for the communities and the environments that they're discharging to.

Shane Phillips 19:02
Got it. Yeah. And when you said, Monica, that the more recent veterans from Iraq and Afghanistan, for example, were, on average, quicker to become homeless than previous eras. I think, you know, there's maybe many explanations for that. But it seems that just the high cost of housing nowadays compared to the 1970s, or the 1950s, is probably a big factor in that, and at least in that regard, does not have much to do with the programs or the people but just the broader environment. So the first episode of this series was with Greg Coburn, who wrote homelessness is a housing problem, and he concludes his book talking about the story of declining veteran homelessness. He cites a VA white paper from 2014 that evaluates the impact of the VAs ending veteran homelessness initiative up to that point, and in that white paper, the authors say the initiative incorporates six core elements. Those are outreach and education, treatment enhance Income employment and benefits, community partnerships, prevention, and providing housing and supportive services. Greg credits a lot of the VAs success to this comprehensive approach. And so I'd like to dig into some different parts of it. I think it might be best to break this out into two questions. First talking about efforts to help veterans get back into stable housing, what we might call the outflow from homelessness. And second, about preventing them from becoming homeless in the first place, which would be the inflow. So starting with outflow, what did the VA and its partners do to help so many veterans out of homelessness? I realized this is a very big question, but maybe we could just focus on a few programs or a general approach. But what has the VA done differently or maybe been permitted to do differently than other agencies and jurisdictions and organizations who might be working with other unhoused populations?

Shawn Liu 20:55
Yeah, and if it's okay, I'd like to address this in sort of a timeline, maybe just hitting some of the really watershed moments over the last 10 or so years now. They'd be great. Yeah, that it really contributed to our success and our progress. I also want to acknowledge when we think about the concept of partnerships, this is not just VA and Nonprofits and Charities, in many ways, Congress, as Monica mentioned, is a key partner as well, because, as I talked about a lot of the different resources that have been deployed, those are all appropriated funds, right. And so we are really appreciative of Congress and their bipartisan support on veteran homelessness, adding more resources, deploying more stuff, empowering VA even further to provide services for veterans. One of the things I think is that kind of kicks a lot of this off is the expansion of a program that we have, and I apologize, I'm going to do a lot of alphabet soup, but I'm going to try to unpack them as best I can have a program called HUD VASH, at around 2008. HUD VASH is an acronym. It stands for Housing and Urban Development, VA supportive housing, and it's a type of intervention called permanent supportive housing. And what it essentially does is it pairs housing choice vouchers, which provide rental subsidies that make rent affordable for veterans, with VAs case management and supportive services. And 2008 is really the start of a massive expansion of HUD VASH. With I don't have the exact tranche of vouchers initially, but you basically see year over year from 2000, all the way into 2015 2016. Around 10,000 additional vouchers being allocated nationwide. So this massive ramp up of housing subsidies, and really importantly, the associated workforce, the clinical staff to provide programs and services. 2010 rolls around and you get the first federal strategic plan to prevent an end homelessness. It's called opening doors. And it touches on a lot of different strategies and provides for the first time, essentially five year plans to end homelessness. I think, if I remember correctly, it was veteran homelessness and chronic homelessness with the idea that other subpopulations like youth and family would be addressed after we kind of figured out what are the best solutions with veterans and chronic homelessness around 2011. So a year after we have a launch of a program in VA called supportive services for veteran families. And what's really important about this particular program is that it adds much needed capacity for all of the other veterans who might be experiencing homelessness, but don't need heavy and intensive clinical services that are usually provided in HUD VASH, but probably need more support than if they were just spending a little bit of time in an emergency shelter or transitional housing. Interestingly, I know we're on the outflow conversation right now. But supportive services for veteran families actually provides two different types of interventions. One of the most relevant ones associated in this outflow conversation is the concept of rapid rehousing, so short term subsidies with kind of lighter touch, supportive services and case management. But it also provides VA with homeless prevention intervention as well so that as veterans and their family members are at imminent risk of homelessness, we're essentially able to prevent them from becoming homeless. So we're hopefully we'll put a pin in that as we shift gears and talk about the prevention side.

Shane Phillips 24:16
While and we've talked about in previous conversations and research about sort of the way that trauma and other things can accumulate. The longer that you are homeless, you know, it how much more difficult and expensive also it can be to help someone back into stable housing permanently if they've lived on the street or in shelters for years as opposed to weeks or even months.

Shawn Liu 24:39
Absolutely. Absolutely. When we get into 2015 we actually see the launch of something called the Federal criteria and benchmarks to achieve an effective end veteran homelessness now I know that was just a mouthful, but that I know right? If government for the long names and surprising we actually didn't make it into an acronym

Michael Lens 25:00
They just gave up.

Shawn Liu 25:02
But, you know, this is something that's really important because it was one of the first big efforts to essentially operationalize and define what on earth when we mean when we say ending veteran homelessness folks can't because it's audio I'm doing Scarecrow, it's to everybody on the webinar, right? Because up until then, you know, there's a general thought of, well, how low does the number have to go to end veteran homelessness? Right? How low does the number have to be and what the criteria and benchmarks actually do is they provide kind of like an operational picture of how community systems should look and how they should perform, such that not only do they reduce homelessness wherever are prevented wherever possible, but for those who experience homelessness, it's rare, brief and non reoccurring. It doesn't happen that often. It's only for a short time, it's that one time, and it's this concept of housing crises will still happen in you, how's everybody today? Right? So you still need a system to respond to the crises. But you've shifted from managing homelessness to being more rapid crisis response. I want to acknowledge a couple other things on the timeline. For many, many years, one of our oldest interventions has been a transitional housing intervention called grant and per diem, that's definitely another government name. And transitional housing is this concept where it's kind of a longer term temporary setting where folks can say and get a lot of case management supportive services, just want to acknowledge around 2016 2017, we made a massive transformation, acknowledging that veteran homelessness was starting to look differently. As we were driving down the number of veterans experiencing homelessness, the one size fits all approach weren't working. And we are starting to have different pockets of veterans who needed more tailored solutions.

Shane Phillips 26:40
Yeah, that was something that's kind of what I'm hearing here is you start with chronic homelessness and the HUD VASH program. And then you're expanding out to you know, maybe people who still need moderately intensive services, but not at the scale of, you know, supportive housing and wraparound services necessarily, and just kind of building out from there.

Shawn Liu 27:00
Yeah, I want to acknowledge that this point on the timeline, we've seen essentially, I'm bringing us to 2016, 2017. And so we're seeing about a 47% reduction in veteran homelessness from when we kind of start in 2008 2010. But then, as I continue on in this timeline, the progress starts to slow down quite a bit. If you were actually to chart this out, you'd see a steep decline in 2016, and then a shallowing out. We were so distressed by it, we actually gave it a name. We called it the stall, as 2020 comes around. You don't need me to tell you I think we're all repressing these memories. The COVID 19 pandemic happens, and public health emergency takes place. But as a bright spot for that we see a lot of resources, both from an appropriation side for money, but also new authorities that give us the ability to essentially de congregate all of our shelters. Historically, a lot of emergency shelters and transitional housing, were congregate settings, you put a lot of people in a building, that's really dangerous when you have an airborne illness. So a lot of the flexibilities were able allowed us to essentially de congregate and use hotels and motels or other settings to provide that social distancing, that physical distancing, to keep people safe.

Shane Phillips 28:08
Are you talking about VA run shelters and congregate settings?

Shawn Liu 28:13
Absolutely.

Shane Phillips 28:13
Okay, okay. I didn't— I wasn't really even familiar that there were VA shelters.

Shawn Liu 28:18
Yep. Well, so predominantly, less so much emergency shelters. We do have a program the alphabet soup. It's called healthcare for homeless veterans contracted residential services. It functions in many ways and many communities as an emergency shelter. Got it. And then we also have those transitional housing programs, which historically had been congregate settings. Okay, as we get into 2021, and more resources come out specifically the Johnny Isakson and David P. Ro veterans benefits and Improvement Act of 2020 gives us a whole lot of flexibilities, able to appropriate more funds to our transitional housing programs actually gives us amazing flexibilities to provide life saving goods and services to veterans, including rideshare. We haven't talked yet about the different barriers that veterans face when they're homeless and getting housing transportation. Number one, Monica and I live in Florida, Florida was made for the car, right. So we don't have a great public trial, but I'm not putting anyone on blast. And so being able to provide transportation for veterans based on flexibilities from the public health emergency was huge. And then we see a couple other things that I just want to kind of annotate for the timeline. You know, in August 2021, we see the national eviction moratoria end, and we're all kind of on the federal side, a little bit on pins and needles. What's going to happen are we going to see a wave of evictions and potentially new folks, new veterans becoming homeless and in response to that, both in 2022 and again in 2023. utilizing all of those resources that we talked about VA set two goals to house back to back 38,000 homeless veterans over the course of the calendar year in 2022. We ended up housing 40,000 homeless veterans in 2023. We literally just announced at the time of this work porting earlier this week 46,552 veterans. And that brings us essentially to today. I

Shane Phillips 30:06
love that review. And that's super helpful. And again, I think just seeing how things kind of build out and serve different populations over time as you learn more. And we're gonna have to ask about like how some of these learnings have maybe been applied outside of the veteran population. But we'll get there in a little bit. Let's move on to prevention. We all know there is not a fixed population of people experiencing homelessness, either among veterans or civilians. There's not homeless people and non homeless people, there's just people who become homeless for some amount of time, new people are becoming homeless all the time. And so if ending homelessness is the goal, as you said, Shawn, than prevention is really just as important as this after the fact intervention, it has to be both sides. So what has the VA been doing on prevention of veteran homelessness? Yeah,

Shawn Liu 30:53
and I just want to kind of frame this up a little bit from our kind of like public health and the public health perception of prevention, especially from our researchers, they help us learn about three different types of prevention, primary prevention, which generally is about preventing the thing from occurring generally, in the population, secondary prevention, which is really about providing targeted services to those at heightened risk. And then tertiary prevention, which I think for this conversation, we probably actually would associate with the outflow conversation we just had. So I want to focus a little bit on on primary and secondary, but in a way, starting with second, the secondary prevention, as I mentioned a little bit earlier, one of the most important interventions that we've had, has been that supportive services for veteran families program. And just to kind of unpack that a little bit, it is a grant program. So in many ways, we are sending out funds to nonprofit organizations and consumer collaboratives all across the country to provide these services, both Rapid Rehousing, but importantly for this part of our conversation, prevention services, so they're able to identify veterans who are at imminent risk of homelessness, but for this service, they're gonna be in a shelter or on the street.

Shane Phillips 32:03
Do you have a sense for what they're looking for to identify veterans at risk of homelessness?

Shawn Liu 32:07
Yeah, absolutely. So there are a lot of different conceptualizations of imminent risk. And I want to acknowledge that the one that we use and SSVF, I don't have it just handy. And it's a little bit broader than what other programs may do. But they're essentially looking that within 30 days, does this family lack the resources to continue on and within the 30 days are they basically going to be homeless, so that could be things such as you have an eviction, or eviction pending. And in addition to eviction, we've called your friends and family, your network, and they ain't got any money, right? Maybe you might be have just lost your job, or you have some kind of income, but it's not sufficient to navigate, and you can't pay for your own hotel stay. So on top of that, you need shelter. So when you look at all of these situations with these factors in a given situation, we then can kind of make the formulation. Okay, you are at imminent risk, let's get you on our program and get you all these resources.

Shane Phillips 33:05
So it sounds like you really need to have a pretty close relationship with this person or household, as opposed to, you know, I think a challenge we have outside of the veteran population outside the VA is, you know, there's just not a lot of contact between public agencies or community serving organizations or what have you, and people who are at risk either imminently or just kind of ambiently. And I guess, how do you manage? Or how do you maintain that relationship? I'm sure it's, you know, the fact that you have the VA Health Administration, and everything is like a big part of this. But is there more to it that helps you keep in contact and really, I guess, make it clear to the veterans themselves that like you are a resource for them?

Shawn Liu 33:49
Yeah, you're bringing up a really great point primarily, because what you're picking up on is that at a critical point in a veterans life, when they are likely at their most vulnerable, they are being asked to provide a lot of personal information. And I just met you, right, like we're meeting each other for basically first time, I wouldn't necessarily go into a lot of private details. But at these critical moments of the veterans lives, the system kind of demands that they spill the beans on their finances, maybe past traumas or diagnoses. Usually, it's for the purposes of identifying, assessing, and then making referrals to resources. That's a very critical moment. And the essentially the way that we manage that situation is through a lot of training, through hiring the best staff that we possibly can. And then talking about what are those engagement techniques and strategies to ensure psychological safety for the veterans, as they're revealing all of the stuff that we need in order to assess and then refer them to services? It's a tough situation all around and, and putting veteran respect care and their dignity at the forefront is critical.

Michael Lens 34:53
I can't help but to think about comparisons to the general population, you know, throughout this country. session but here specifically for the general population, there's the continuum of care model, to your knowledge, like how does that differ from what you just described? As you know, the state of the art is how in how we manage cases with people experiencing homelessness that we're veterans.

Shawn Liu 35:18
Yeah, in some ways, it's pretty similar. And in some important ways, it's different. When I say it's similar in some ways, a lot of the tools and the toolkits, especially specifically focused on housing interventions, and maybe more case management are the same, we actually even use the same language to describe the different types of tools, permanent supportive housing, transitional housing, emergency shelter, I think a lot of the ways in which it's different are a couple. Number one, since as Monica mentioned, VA is a massive integrated healthcare system, we also actually get to braid in and essentially veterans have greater access to all of the other health care needs or interventions that they may need primary care, substance treatment, mental health treatment, specialty care services, and access to those for non veterans may vary widely, depending on whether a state has done Medicaid expansion or if they have any other local resources as well. And I think we're gonna get to this a little bit later, too. But one of the things that Monica has mentioned earlier, when she talked about VAs mission that I think bears repeating here is that VA is and veterans is one of the few agencies and sub populations where we all have a vested responsibility for the welfare and well being of that sub population, that level of stewardship and responsibility, opens doors and allows us or forces inspires whatever you want it. But it basically is a big driving factor in getting this right, in a way that for better or worse, I don't know that we've seen for other sub populations, whether we're talking about youth or family, singles, women, there's not as much of a stewardship or ownership about the sub populations welfare as we have with veterans.

Michael Lens 37:02
Makes sense.

Shane Phillips 37:02
I kind of interrupted you to ask that question. Was there more you wanted to say on prevention?

Shawn Liu 37:07
Just one thing, and Monica, maybe if you would like to maybe touch on some of the broader kind of interagency work that's been done with prevention?

Monica Diaz 37:15
I actually would like to, before going to that one shot for a second, I think I wanted to cover just two examples in terms of access to prevention, because I heard some of the questions. And I think, you know, one is the building the relationship with the veteran for them to really trust us and engaging with us. And that is a process, right, and how we engage with them to trust us in their most difficult time, we also have the mechanism for the veteran to reach out to us, you know, we have a national call center that it becomes kind of like a preliminary means for the veteran to really ask the first questions when they're struggling, they can call for anything. And it has the ability to allow us to engage them into access to care, if they're at risk of homelessness, or they're struggling. So there's means for them to engage with our system is so big enough, like Sean mentioned, and we've been mentioning so comprehensive that he has that. We also partner very closely, like Sean was indicating with USI CH, and is the Interagency Council for homelessness, right? And our work with them, and also with other stakeholders, including HUD, our partnership within that involves looking at the strategies together, not only at the national level, but what works at the community level. And within that it includes as well a target approach in terms of what prevention looks like when it comes to wraparound services, the services that we provide in terms of orienting the veteran in, in what are some of the steps that they can take to really resolve any crisis at that moment. And so we don't do that all in a silo, we work with them in terms of how do we do this as a national strategy in review, and what resources about that? We also, again, partner very closely with HUD through our HUD VASH program and others, how are we going to do this together? So I do want to highlight that prevention to homeless veterans is not something that we do necessarily only in silos, but we do it in collaboration with them. One of the things that, you know, one of the top strategies is really reducing that house instability, for those that are risks. That includes engagement on employment opportunities, resources, the case management, you know, the integration of services in that regard. And the beauty of how this is effective is like VA has recognized one, we need the resources. In summary, we need the resources and we have them, too. We need the comprehensive system and engagement in three, we need that integrated collaboration with our national partners and inter agency effort. We also applied

Shane Phillips 39:54
so we picked this topic as the concluding interview in the pathways Home Series before Our final summarizing episode anyway, because we want to make sure that we go beyond identifying problems and promising case studies and experiments and talk about a positive story that involves real world large scale implementation. We ultimately want to share a hopeful we can do this kind of message because we believe that that message is correct. But we also of course, need to acknowledge that there are challenges and areas where we may be or should just say are still falling short. One place I think concern is warranted is what Shawn referred to as the stall. While we made incredible progress, reducing veteran homelessness between 2009 and 2016. The reductions have slowed a lot since then, the number of veterans experiencing homelessness had fallen by about 46 47% by 2016. But since then, it's never gotten beyond 55%, below 2009 levels. And that happened in 2022. I suspect that part of the issue here is that as the number of homeless veterans falls, many of those who remain homeless, maybe harder cases and require more intensive help or different kinds of help. There's also the fact that overall, homelessness was also falling between 2009 in 2016, so much more slowly than veteran homelessness. Whereas since that time, overall, homelessness has actually been increasing. And veteran homelessness has continued to decline just a lot more slowly. So there's that added difficulty of of swimming against the tide of broader homelessness trends. Those points aside, though, can you talk about the challenges with continuing to drive down these numbers and tackling that problem of the stall? Sure.

Monica Diaz 41:38
You know, when we look first at the stall, and we think about the primary factors, perhaps that impacted us all, we look at three things. Mainly, we look one of market factors, and we look at for example, the rental costs went up, vacancy rates went down. And those environmental external factors have an impact in terms of the mission of what we're trying to achieve. Right. We also look at what is the focus at the top government level, and in terms of how addressing homelessness and at that time of the stall, I you know, we we can see that we departed in some of the efforts at that time, including the major challenge that which was a big effort when the initiative started, we departed from Housing First at that time as well in terms of reinvigorating those efforts, and then when we went back to getting out of the stall, which you can see that in the numbers, then at the government level, we re-invigorated left first, pertaining to Housing First, we actually went back to some of the basics that we did at the initial initiative when we said we're going to end veteran homelessness and we started more intentional effort. And that way, we also just want to look at the 2023 point in time calls, which you mentioned, the data does show that on a single night in January 2023, there is 35,574 veterans who experience homelessness. Okay. And so as you mentioned, that is an increase of 7.4%. That said, when we look deeper at the data, where is increased happening, right, and we see that 20,067 veterans that were counted at that time, and 2023 are experiencing shelter, homelessness, right. And that is an increase of 2.6%, from 2022. But when we look at the shelter homeless veterans, we see a 14.3% increase, completely different in terms of what is the impact there and is the total is 15,507 on shelter. So looking at that we're currently still analyzing the PIT count data for the reasons of that increase. However, what we know right now is a couple of factors that we do think has a very strong contributing effect. One, I mentioned it earlier, but going into a more detail is the housing affordability. You know, if you look at what the National Low Income Housing Coalition says in their gap report in 2022, only 36 rental homes are affordable and available for extremely low income rental households in the US. That is unbelievable, if you think about in terms of the need of housing and the people that need housing. So that definitely has an impact. Because if we have veterans with subsidies that we can offer the VA or whatever else are in hand, but in their communities, there's not a lot of affordable housing, and that is becoming more more and more of a challenge that creates kind of a bottleneck. We're not going to be able to place as rapidly as we want, the demand becomes more of an issue Ryan. We also see that evictions right now are very similar to what was pre pandemic but we do know that there was a lot of flexibilities are in COVID including the eviction moratorium, which decrease evictions significantly, like I think at historic levels and I don't have the numbers in front of me But it wasn't very significant amount of decrease there. We also said that during COVID, the Inchon tap into this in his earlier response, the communities expand that included VA, we expand that a lot of that emergency response, which happens a lot with shelter capacity and transitional housing for the community that obviously that makes a lot of sense. But when COVID flexibilities and that a lot of the communities deeding have the same type of response anymore, they stop decreasing the utilizations of hotels and motels for example. I will say that when it comes to the common that you mentioned, is that the acuity or the the condition of the veteran may be contributing to it. And I heard you said that in part of your question. From my perspective, and we have a comprehensive system of services. Yes, the demands and the needs of our veterans will always evolve, right. And each community is very different to what that veteran in that community needs. There's always individual factors that include clinical factors and all others, the most prevalent factor tends to be those structural environmental factors like housing, affordability, and others, that becomes truly what drives a reduction.

Michael Lens 46:14
Yeah, and I think that's what the housing research certainly says. And that intersection between housing and homelessness is something that I think we're better and better understanding. So some nuance to that good news might be, you know, or at least one source of it comes from a 2019 article by Brendan o Flaherty in the Journal of housing economics. The article is a pretty comprehensive review of homelessness research, it will be in the show notes for people to look at. But in one section, he points out that, you know, perhaps a lot of the reduction in veteran homelessness may be explained in part by a reduction in veterans generally, he noticed that veteran homelessness fell by 47%, from 2010 to 17. But the number of veterans also declined over that same time period by 27%. And also concurrently, homelessness was fine for the non veteran population as well. So how do you reflect on that critique of like, how much of this is population or demographic change versus, you know, programmatic efficacy?

Shawn Liu 47:19
Yeah, so I had read that article too, and I just want to acknowledge because usually, it's helpful for me to reveal my emotional state as things are going and to be transparent. You know, I read it, and I totally got a little bit defensive, primarily, because earlier in my career, I was a HUD VASH social worker, right. I actually personally housed or at least over 100 veterans, and then led programs that housed 1000s of veterans and now supporting hundreds of 1000s of veterans and, you know, like, I read that is like, what was it all for? Was it for nothing like it just so they I just want to acknowledge my emotional state? And

Shane Phillips 47:53
I should say, I, I can totally understand that reaction. But I also, as I read Oh Flaherty's article, I don't think he's necessarily saying this was a waste. Yeah, it's just, you know, to ask the question, and to point out, I think, a valid nuance in the numbers. And he makes a lot of assumptions, actually. And those assumptions appear reasonable and justifiable, but they could be wrong as

Shawn Liu 48:17
well. Yeah. And I think one of the assumptions that he makes that I would quibble with, and this is very, very, like nitpicky is the age range that he looks at it, I think he in his dataset, he was looking specifically at 18 to 64 year old veterans. And I think the assumption there is a little bit flawed, just because you're over 6465 doesn't mean suddenly, you're housed. And what we're seeing a lot in our own service data is the veterans are getting older with us, our average age is increasing. So I think it is valid to include veterans over 65, especially veterans over in their 80s into the dataset.

Shane Phillips 48:51
And just to add a few things to that. So that trend of increasing age among the unhoused population is something we talked about with Margot Kushel and her survey of homelessness in California, and just to put a number to the different age groups. So in a Flaherty's analysis, and I, I understand why he did it, but I agree, especially in light of the increasing age of people who are seeing experienced homelessness, I think that the full range maybe makes more sense, but he says that from 2010 to 2016, the population of veterans aged 18 to 64, fell by 27%, it was very significant in a pretty short time, the population 65 and over was basically flat, and so average those things out and it's not nearly as large of a decline.

Shawn Liu 49:36
Yeah, and that's largely what I also did I tried to remap his data as well, I saw something similar that the decline in overall veterans wasn't as pronounced from 2010 to 2016. And so in many ways, you might be able to say oh, what actually the interventions did make a difference. You know, I also but as I was mapping it out, saw similar kind of slowdowns both in the reduction of overall Veterans and in the reduction of homeless veterans. I think a couple of things that are missing from that analysis. It took me a while to wrap my head around it. I think one, it's not quite looking at what are the interventions doing? are they managing homelessness and just moving people around? Or are they actively moving people back out of homelessness into permanent housing. And so I'd be curious to know how an analysis factors in housing placement rates, for example, where veterans are exiting year over year to permanent housing, in contrast to inflow, a lot of what we're seeing as net reductions is essentially, VA or community partners being able to house more veterans than who become homeless, and so have those net reductions. The other point and this circles back to something Monica mentioned, right, which was the concept of the rent is getting more pricey, it's as less affordable over the years. I can share this with you a little bit after and if you want to share it with your listeners. Great. I've mapped out a chart correlating the decline in veteran homelessness to the US Department of Housing and Urban Development's average one bedroom fair market rent rate, that's not a perfect one to one correlation to rent prices. It's laggy. It has some other assumptions. But I think for the sake similar to the study, it's a good proxy for the conversation. And when you look at that particular chart from 2010, you see average Fair Market Rents pretty stable. And then around 2016, you start seeing a breakaway, where as veteran homelessness slows down in terms of progress, the rent increases pick up and right around the uptick when we actually saw from 2022 to 2023, and veteran homelessness, you see a massive spike in the fair market rent from 2020 to 2023. So I would also look into the market forces as another part of this picture. That's not just you know, the reduction is in lockstep with the general fewer veterans in America.

Shane Phillips 51:54
Yeah, my my take away from because I look to these numbers a bit as well. And I think there's absolutely something to what a Flaherty observed. And I came across that article, actually, because it was cited by a conservative critic of housing first and these efforts more generally. So I wanted to, you know, take it seriously and learn more about it. And I think I would absolutely agree that a portion of the reduction over the last 15 years is just due to demographic change. Absolutely. But I think it's a very hard case to make that it's the majority of it. I would agree with that. But yeah, I think it's important to raise those critiques because I think they're out there. And there's nothing wrong with being skeptical. Coming back to Greg Coburn, and Clayton Aldrin's book, another argument that they make about the relative success of the VAs efforts is that the public tends to have a positive social construction of veterans. So even if they fallen on hard times, most people believe we have an obligation to help them in return for the service they've given to our country. Unfortunately, and I don't think this is a very controversial view. Many people have a much less charitable spirit when it comes to civilians experiencing homelessness. And that can be a barrier to devoting adequate funding and services to help them in the ways that we've done with veterans. This question is going to be a little bit outside your wheelhouse, but I do think it's an important one and part of our goal here. So I'm curious to hear if you have any thoughts on how that positive social construction or lessons we've learned from the assistance and support we've offered to veterans could be applied to the broader population?

Monica Diaz 53:30
I actually appreciate this question a lot. I think it's a very important question for our country. And I have a lot of thoughts about this. Shawn knows this. Because we have conversations about this particular topic. And I agree with the statement that many times when we think about homeless veterans is better receive when we're trying to help the homeless veterans to get housing, right, because we see them as they have earned that they have given the biggest sacrifice, right. I think for the general public, I think that if we see housing as something that has to be earned, then what they have done to earn it in comparison to what a veteran has done, which is fight for our country, right? There's nothing that can compare to that. So I think we need to start as a country as individuals, perhaps to change our perspective of who deserves housing, and affordable housing, specifically, if it's seen as a right for anybody, just because you're our human and you're in society, and then we will strive as a united society to really provide that. Then I'm not saying I'm giving you a free housing, but I'm saying affordable housing, having the opportunity, by your own means to have affordable housing. And so I think that that's the debate right is affordable housing is something that we see in that nature, if it is that you will construct the systems within your community to to allow that.

Shane Phillips 54:56
And I do appreciate that distinction between just giving people housing versus providing housing that they're still paying for, it's just not so far beyond their means that they actually can't afford it. And, you know, many people would argue that just giving it to people without any payment is like actually the right thing to do. And that's what makes it a real, right. But I think, however you feel about that a lot of people are not anywhere near that view. And so I think what you're talking about is something that's a little more approachable and kind of recognizable as a reasonable position to a broader section of the population.

Monica Diaz 55:32
And that's why I like to say affordable housing, because I think we all can relate to that sentiment, right? Either when you graduate from school through when you're in the other job. And in those moments, all of us wants to be independent, self sufficient, we all want to have the right to afford something right. And I think in a way, homelessness for veterans and VA has constructed because we believe they deserve it, and they have earned us. So I think that for the general population, I think it's not only for them to implement a system structure that's similar to the VA, but it's also to think about affordable housing. And that's the stability of that in a different way, rather than a privilege, something that that can be given. And that can be part of what we do as a society in a more intentional way.

Shane Phillips 56:17
I was thinking about how I would answer this question. And one takeaway for me from the success of the VA, over the past 15 years, and your partners on these efforts, is there's a very strong belief among many people, I think, especially people who live in cities and see, you know, homelessness, on their streets, on their sidewalk on a daily basis. And oftentimes, the people living in those conditions in particular, might have a severe mental illness or substance abuse problems that you know, are not even actually representative of the broader population. And they get these ideas about, you know, quote, unquote, service resistance. And can these people even really be helped? Do they even want help, that kind of thing. And, of course, it's true of some people. But this idea that it's a kind of broad problem, where most people experiencing homelessness don't want to be helped back into housing, and they don't want to live in a home or they're not willing to do what it takes to get there. I think this experience with veteran homelessness really shows that when you do actually put the effort and the resources in, most people are ready to get back into housing. And there's no real reason to believe the same wouldn't be true with the civilian population as well.

Monica Diaz 57:32
That is correct. I think sometimes what we see at the front our industries, a lot of the time is not only for the veteran, but for the general population, the homeless individual with the mental health issues, substance use disorders or others. And I think sometimes there is the assumption that because maybe you offered help once or two, and I just did the Pittcon. Just recently, I had individuals telling me they don't they were not interested in any help. So it is that happens, right. But what I think it is, is the understanding what the more that you do this job to realize that sometimes when someone has live that homelessness experience with their different challenges, it's very hard to see yourself out of that environment, unless someone already sees you out of it is someone who is they're persistent and relentless with offering you help and not giving up on you.

Shane Phillips 58:24
Right. And I think it's worth acknowledging, too, that in many cases, the people who are being offered services have been offered services many times in the past, and we have not actually followed through on our promises. And understandably, a lot of people get to the point where they just don't trust that we're going to come through this time. And so we take their rejection as just like not wanting assistance when it's not in all cases, but in many cases, a very rational response to say, you've offered this many times in the past, it is never delivered, I'm not going to waste my time again, I want to close out here, make sure we end this on a positive note. So Monica and Shawn, tell us what you're excited about in the years to come. What is the VA want to do? What is it plan to do? How do you plan to continue making progress on this ultimate goal of ending veteran homelessness?

Monica Diaz 59:18
Shawn, feel free to jump in on this. You know, I'm excited, obviously, about the mission. But I'm excited about fighting harder for what is right and to make sure that every veteran don't struggle with housing or care. And approaching that more on that system improvement level, making sure every community is able to identify veterans that are experiencing homelessness, that every community has a very agile response. And that includes the shelter capacity, the transitional beds capacity, and where that makes sense to make sure that any veteran that needs a bit today they can have it. We're looking at every community to have the capacity to move veterans quickly to permanent housing, and I know that there's challenges but our job is to think about how to overcome those challenges and working here at the program office and how to break down barriers for that excites me, despite being a big challenge, and also how we can continue to evolve in the resources plans to address prevention. So I get very excited about that, because I do believe that that brings us the inability of decreasing homelessness, I think we can continue to make progress. I think VA has done a great example of what is a system response to homelessness, that I'm very proud. And I just want to continue to enhance that and serve more veterans. And Shawn, I definitely open it up for you, because you are a strong partner in this effort.

Shawn Liu 1:00:42
Yeah. So just to kind of zoom in a little bit, I know we've been in kind of the abstract or the technical realm for a lot, I'm just kind of zooming in to the human level. You know, part of my day job is Director of Communications is getting to tell the stories of the veterans who've made it out who had their military service, who reentered civilian life and who experienced the injustice of homelessness. But thanks to maybe some of the programs that we've talked about today, maybe our community partners, a lot of grit and determination from themselves, and a community that has not given up on them. They're now healthy again, I'm excited for both to be able to hear about and tell more of those stories. But then also getting back into the abstraction, the multiplicative factor of all of those stories, just with more in the more veterans that were able to help and house. The last thing that I'll say is the last couple years with our big goals to house a certain number of veterans right for two years in a row, we've been challenged by the Secretary to house 38,000 homeless veterans to put into context, that's about a number of the seats in Fenway Park. So if you think about Fenway Park filled to the brim with veterans, but then 1000s more on the fields in the dugouts hanging out in the parking lot just because we've been able to house not only 40,000 veterans in 2022, but 46,000 veterans in 2023. It's the stories in the aggregate as well. And the feeling of that impact. Moving from my earlier days is a VA social worker, housing 1015 30 veterans to being part of this mission to house 40,000. I want to see that number get up to 50,000 60,000 veterans housed. Because what that also means is that the number of veterans experiencing homelessness will continue driving down. And more importantly, that's fewer veterans experiencing crises, trauma, the trauma of homelessness, the negative health impacts for homelessness. I'm pumped about that.

Michael Lens 1:02:40
And you should be.

Shane Phillips 1:02:41
All right, Monica and Shawn, thank you for your roles in being a model of what is possible, and thank you for sharing it with us here on the Housing Voice Podcast.

Monica Diaz 1:02:51
Thank you for having us.

Shawn Liu 1:02:52
Yeah, it's been great to be here. Thanks so much.

Shane Phillips 1:02:57
You can read more about the VA's work and research on our website, lewis.ucla.edu. Show notes and a transcript of the interview are there too. The Lewis Center is on the socials, I'm on Twitter at @shanedphillips and Mike is there at @mc_lens. Thanks for listening, we'll see you in two weeks with the last installment of Pathways Home.