"Ask the Expert" Welcomes John Kuhn

“Ask the Expert” features an interview with a leading expert on homelessness or co-occurring mental and substance use disorders. The following is an interview with John Kuhn, the Veteran Administration’s national director of Evaluation and the acting director of Homeless Prevention Services.

We are pleased to welcome John Kuhn, the Veteran Administration’s (VA) national director of Evaluation and the acting director for Homeless Prevention Services. For the past three years he has co-authored the VA’s “CHALENG Report,” a community assessment of the needs of homeless veterans. Mr. Kuhn has a BA in psychology from Brown University, a MSW from Columbia University, and a MPH from Rutgers University. He has been working with the homeless for more than 20 years. Prior to joining VA Central Office staff, he directed homeless programs for the VA in New Jersey. He has received various awards including the Mutual of America’s Community Partnership Medal and the Federal Government’s National Performance Review (“The Hammer Award”). Mr. Kuhn has twice been named a Supervisor of The Year by Regional Federal Executive Boards. He testified several times as an expert witness on homelessness before the U.S. House of Representatives, Veterans Affairs Committee. The former Chairman of the House Veterans Affairs Committee had the U.S. flag flown over the Capitol in his honor.

Question: Are you finding the population changing? Are younger veterans becoming homeless?

Answer: Right now the population is aging as most homeless veterans are from the Vietnam and post-Vietnam eras. That is beginning to change as the veterans from Afghanistan and Iraq come in. We anticipate, over time, if the VA, in partnership with our Federal partners, did not work assertively to address their needs that the homeless and at-risk populations we begin to see will be made up increasingly of these individuals. We would also expect to see a larger number of women in the population as women have become a larger part of the military. Fortunately, planning and interventions developed as part of the VA’s Five Year Plan to end homelessness among veterans are anticipating these needs.

Question: How has the VA changed its services to adjust to the current issues of veterans who are homeless?

Answer: The VA is beginning to change its services in a number of ways. These services have evolved based on a number of considerations. We know the population is changing. For instance, as more women have entered military service, there are more women veterans so we’re beginning to develop services targeted to meet the needs of women and families. As we develop new services to meet the needs of this changing population we continue to strengthen our capabilities to meet the needs of existing homeless veterans. Important services the VA developed include HUD-VASH which stands for HUD VA Supportive Housing. HUD-VASH has placed 18,000 veterans and families into permanent housing during the past two years. Interestingly, 11 percent of all those placed are placed with families, as for the first time the VA can offer placement for the veteran and their family HUD-VASH has given the VA a tool to help support and maintain families. Justice programs, such as the Veterans Justice Outreach Program and the Healthcare for Reentry Veterans Program, are recognition that certain groups of veterans are at a higher risk for homelessness. Rather than waiting for the homelessness to occur, the VA is actively outreaching to these veterans as they enter or leave the criminal justice system to provide the services they need for successful community reentry. This benefits the veteran, helping them avoid homelessness, and the community as these efforts can reduce criminal activity and recidivism. The VA is planning further efforts in prevention and will soon announce a prevention/rapid rehousing program that will allow us to treat both the veterans and their families. Prevention/rapid re-housing services will offer case management and financial supports to families at-risk in order to either keep them in their current housing or to keep incidents of homelessness as brief as possible, lessening the traumatic impact of homelessness on the veteran and their families.

Question: SAMHSA has identified “Military Families – Active, Guard, Reserve, and Veteran” as one of its strategic initiatives. What do you feel is one of the most critical steps the Veterans Administration and SAMHSA can take to address this initiative?

Answer: The first is education. Many veterans are unaware of the automatic eligibility for VA services after discharge. By legislation, all veterans returning from Iraq and Afghanistan have five years of eligibility for VA services. Education becomes a critical intervention so these veterans know that they can get assistance when they need it. In addition, SAMHSA and the VA can collaborate on solving homelessness by identifying best practices. Identifying best practices is particularly important for newer approaches where less clinical knowledge is available. For instance, effective prevention requires that resources must be appropriately targeted, and understanding risk factors that can lead to homelessness is vitally important.

Question: What do you see as the unique challenges of providing housing and supportive services for veterans experiencing homelessness? What about for veterans with substance use and mental health disorders?

Answer: Veterans have a variety of needs just as any homeless person does. An important first step is an understanding that homelessness only describes a veterans living condition, it does not describe a unique set of circumstances surrounding that veteran’s individual needs and singular experiences. Meeting these unique needs will require a range of interventions based on that veterans circumstances. Veterans with substance abuse, mental health, employment, family issues, legal issues…will need interventions targeted to address those specific concerns. Housing alone, although critical, will often be insufficient. Providers need to take care to ensure each veteran is assessed individually and that they’re individual needs are addressed.

Question: How has job training for veterans changed during the current economic crisis?

Answer: The VA has a unique program know as the Therapeutic and Supportive Employment Services program that serves more than 50,000 veterans a year. This program, in addition to providing access to vocational training and education, also provides veterans with the opportunity to work, gaining on-the-job training and skills while earning pay. The VA continues to strengthen these programs to meet the needs of the most vulnerable veterans, those with disabilities and serious mental illnesses. The VA is currently funding an expanded supportive employment initiative that will allow VAs around the country to increase caseloads and outreach to veterans in their communities. The VA will be hiring only veterans for this expansion. We’re currently developing the training and processes that will launch this expansion in the current fiscal year.

Question: Has the role of the VA changed over time?

Answer: Homeless services in the VA consist of a variety of dynamic interventions that have changed over time. These changes are based not only on expert advice but also on consumer input. Each year the VA surveys thousands of homeless and formerly homeless veterans and asks them what they think are the most important met and unmet needs that the VA should address. This process is the VA’s Community Homelessness Assessment Local Education and Networking Groups (CHALENG) Program. This input has helped drive VA homeless services in its current direction; one that emphasizes permanent housing, the needs of families, prevention (services that help people maintain housing), and addressing legal service needs.

Question: Are there any recent findings of the Federal Partners Initiative for Chronic Homeless Veterans that we may not have heard about?

Answer: One of the critical lessons the VA has learned is that engagement and supportive housing works. Successful engagement of homeless veterans requires listening to their needs rather than imposing solutions. Understanding veterans, their unique concerns as individuals, and assessing the supports they will need in partnership with providers is a pathway to engagement and ultimately success in developing treatment interventions. Supportive housing provides both the housing and the case management services designed to assist the veteran and their family maintain housing stability. Case management services will change for each individual served. For some, it may mean a more active engagement where veterans receive a range of mental health and medical services either directly, through the case manager, or the case manager acts as a service broker/liaison so that the veteran can receive these services from another provider. In addition, case managers often assist veterans to obtain the benefits and vocational supports, such as job placement assistance, that will provide the income necessary to support housing stability. Case managers also work with families to address domestic issues that may affect both the veterans coping skills and the families ability to function as a unit.

Question: Anything you’d like to add?

Answer: There is no one intervention, even housing, that will address all the needs of every veteran. As every veteran has a unique set of strengths and needs, each veteran will also need a unique intervention to address their particular situation. Understanding and engaging veterans based on this approach, one that emphasizes a partnership between the veteran consumer and provider, is an essential first step to ending homelessness. Maintaining this partnering relationship is critical to preserving gains made by the veteran even after they have moved into housing. It is the VA’s goal to end veteran homelessness within five years. To accomplish this goal, the VA will need to rely on strong community support from providers, researchers, and advocates who have both the experience and knowledge required to develop planning at a national and local level where VA and community resources can work in concert efficiently and collaboratively to provide the most effective interventions available. The VA has begun to rely more and more on these community partnerships to achieve its goal of ending veteran homelessness.

Anyone interested in finding out more about VA specialized homeless programs can find descriptions and resources on the Web at http://www1.va.gov/homeless. Veterans in need of homeless services or others seeking assistance for homeless veterans can call the VA’s toll-free hotline at (877) 424-3838.

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