Beyond these outcome measures, VA has three process goals: to increase (1) the number of community-based beds for homeless veterans, (2) VA facilities’ efforts to coordinate with other providers of homeless services, and (3) the number of homeless veterans treated in VA’s health care system. VA also provides medical, mental health, substance abuse, and social services to homeless veterans through its mainstream health care programs. HCHV staff also serve as case managers for homeless veterans. The DCHV program focuses on rehabilitation. VA’s Role in Providing Health Services

While VA has expanded its homeless programs and community partnerships, it continues to be a provider of medical, mental health, and substance abuse services to homeless veterans through its general health care programs. Effectiveness of VA Homeless Programs Is Unclear

Although NEPEC collects extensive data, VA has little information about the effectiveness of its homeless programs. Homeless program sites submit primarily descriptive data about veterans and program characteristics. These data are of limited use in assessing program effectiveness, however, because no follow-up information is obtained after a veteran is discharged from a residential or DCHV treatment program. As a result, VA does not know whether veterans served by its homeless programs remain employed or stably housed. Program managers use this information to monitor and compare program sites. These measures reflect four different categories of information about sites: (1) program structure (for example, the average number of days veterans spend in residential treatment and the average number of unique veterans served by each clinical staff member); (2) patient characteristics (for example, the percentage of veterans served who were not literally homeless at the time of intake and the percentage of veterans served who were diagnosed with a serious mental illness or substance abuse disorder); (3) program process measures which indicate how the program operates (for example, percentage of veterans served who were contacted by outreach and the percentage of veterans inappropriately placed in residential treatment); and (4) status at discharge (for example, percentages of veterans who report being housed and employed at discharge). Many questions remain unanswered, but several broad themes have emerged from these efforts. Experts agree that the continuum of care for the homeless must include a range of housing and treatment options, and that flexibility is needed to match homeless persons to appropriate services. Because the homeless have diverse needs and local resources vary, flexibility is needed in serving individuals and in arranging partnerships among organizations. We made this change. To describe the programs and approaches used by VA to assist homeless veterans, we obtained documents from VA headquarters and NEPEC that identified and provided detailed information about VA’s homeless efforts. To determine what VA knows about the effectiveness of its homeless programs, we reviewed NEPEC reports issued since the inception of VA’s homeless programs. Supported Housing. Comprehensive Homeless Centers (CHC). 10. 5. 6. 11. 12. Housed at discharge.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the effectiveness of efforts to assist homeless veterans, focusing on: (1) describing the Department of Veterans Affairs (VA) homeless programs; (2) determining what VA knows about the effectiveness of its homeless programs; and (3) examining promising approaches aimed at different groups of homeless veterans.

What GAO Found

GAO noted that: (1) VA's homeless assistance and treatment programs address diverse needs of homeless veterans by providing services such as case management, employment assistance, and transitional housing; (2) VA also provides medical, mental health, substance abuse, and social services to homeless veterans through its hospitals, outpatient clinics, and other health care facilities; (3) because of resource constraints and legislative mandates, VA expanded its homeless veterans efforts by better aligning itself with other federal departments, state and local government agencies, and community-based organizations; (4) the goal of this effort is to develop a continuum of care for the homeless--that is, to identify or create options for addressing the full array of housing, health, and service needs of this population; (5) VA has little information about the effectiveness of its homeless programs; (6) VA has relied on the Northeast Program Evaluation Center (NEPEC) to gather and report information about its homeless programs; (7) each of VA's homeless program sites routinely submits extensive data, mostly related to client characteristics and operations at individual program sites; (8) these data are used primarily to provide program managers with information about service delivery and are of limited use in assessing program effectiveness; (9) to evaluate effectiveness, information must be gathered about intended program results; (10) the outcome measures that NEPEC uses focus on housing, employment, and changes in substance abuse and mental health at the time veterans are discharged from VA's homeless programs; (11) little is known about whether veterans served by VA's homeless programs remain housed or employed, or whether they instead relapse into homelessness; (12) many questions about how to treat homelessness remain unanswered; and (13) experts agree, however, that a comprehensive continuum of care for the homeless--such as that which VA is striving to achieve--should include a range of housing and service alternatives, with specific approaches at any one site reflecting local needs and local resources.