These days, most of the news from the Department of Veterans Affairs (VA) isn’t anything to brag about. But amid reports that the hospital system has failed to provide timely care, the VA is also making news as an example of how to accelerate the nation’s race to end homelessness among veterans by 2015.
For over a year now, the VA has been improving its ability to identify veterans at risk of or experiencing homelessness, connect veterans to appropriate services, and learn more about how to target and prioritize interventions.
How? The Homelessness Screening Clinical Reminder, a simple strategy that includes asking two simple questions:
- In the past two months, have you been living in stable housing that you own, rent, or stay in as part of a household?
- Are you worried or concerned that in the next two months you may NOT have stable housing that you own, rent, or stay in as part of a household?
All veterans accessing healthcare services through the Veterans Health Administration receive the screen, which is administered at the point of care (primary care, social work, substance abuse/mental health, and other specialty clinics). Veterans who screen positive for homelessness or risk of homelessness are asked follow-up questions about their current living situation and whether they would accept referrals for services. Responses are stored in the VA’s Corporate Data Warehouse along with additional information captured through their medical records, such as demographics, diagnoses, and services utilization.
According to VA research, during the first year of implementation, more than 4.3 million veterans accessing outpatient healthcare services through the Veterans Health Administration responded to the screen. Among those screened during this period, 0.8 percent reported current homelessness and 1 percent reported imminent risk.
Almost a quarter of veterans were screened at least twice during the first year. During the second screen, over 80 percent responded that their homelessness or homelessness risk was resolved.
What would we learn if child welfare agencies began asking these two simple questions every time a family entered the system?
A strong body of evidence documents the link between inadequate housing and family involvement in the child welfare system and vice versa. One study concluded that homelessness, rather than parental substance abuse or mental illness, is the strongest predictor that children would be placed with relatives or in foster care. Another found that women with histories of homelessness were nearly seven times more likely to have involvement with the child welfare system, compared with low-income, never-homeless women.
Housing stability can reduce child welfare involvement and especially new or continuing out-of-home placement. For some families, inadequate housing is a primary factor in the start of child welfare involvement. For example, a mother who is fleeing domestic violence, has no place to stay, is responding to immense stress, and cannot adequately provide for the basic needs of her child is reported to a child welfare agency.
For families already involved in the child welfare system, housing stability may be enough to end their involvement. For example, a mother who is exiting a residential drug treatment program may have met most of the necessary goals for reuniting with her children, but she needs housing before they can be returned to her.
We know that systems change and the process of coordinating information and services for families involved in both the child welfare and homelessness systems has been a long, slow process. We are continuing to learn about how to target services to the highest-need families and how housing stability and services lead to better outcomes for families.
However unlikely a role model given the current controversy, the VA’s effort to identify and prevent homelessness among veterans still offers a lesson for others. Child welfare agencies can take a big step to improve outcomes by proactively identifying housing instability among families entering the system and connecting them to the services that can keep families together.