Homeless Veterans: Opportunities Exist to Strengthen Interagency Collaboration and Performance Measurement Procedures

Despite a large decline over the past decade, an estimated 37,000 veterans in the United States experienced homelessness in 2019. GAO was asked to review federal assistance programs for homeless veterans. Among other objectives, this report (1) discusses challenges agencies and service providers cited in implementing selected programs; (2) evaluates how USICH, VA, and HUD collaborate; and (3) reviews selected programs' performance.

GAO analyzed federal guidance and performance data; interviewed VA, DOL, HUD and USICH officials; and met with local VA staff and service providers from selected programs at six sites. Programs were selected based on size (the largest based on funding and veterans served) and the kinds of services they offer; sites were selected for geographic diversity, among other factors. The results of these interviews are not generalizable.

The Departments of Veterans Affairs (VA), Housing and Urban Development (HUD), and Labor (DOL) provide programs aimed at assisting homeless veterans. Local VA staff and service providers—who receive grants from federal agencies—provide services to homeless veterans within their communities. In interviews with GAO, they cited challenges in implementing selected programs:

Staffing shortages. Shortages in VA case managers may limit the number of veterans they are able to serve.

Housing cost and availability. High housing costs and limited stock make it difficult to find affordable housing for homeless veterans.

Transportation limitations . Service providers may cover large geographic areas and limited public transportation strains their ability to provide services.

Steps that VA and other agencies are taking to address these challenges include contracting out for services to address limited staffing, offering rental subsidies for very low-income veterans, and working with community partners to assist with transportation.

Two key federal collaboration mechanisms to address veteran homelessness are a U.S. Interagency Council on Homelessness (USICH) working group to coordinate agencies at the national level and a HUD initiative that coordinates stakeholders at the local level. Both efforts incorporate many leading practices for effective interagency collaboration identified by GAO in prior work. However, local VA staff and service providers stated that they would like additional information—such as on best practices—from VA on how to collaborate more effectively at the local level. While VA has issued some broad guidance, more specific information on effective collaboration on issues such as making referrals and data sharing could better position local VA staff and service providers to aid homeless veterans.

VA and DOL have multiple measures in place to assess the performance of the programs GAO selected for review, and most of the measures met their national targets from 2015 to 2019. The measures incorporated most leading practices for performance measurement—such as having measureable targets. However, DOL does not have a written policy on its process for validating its performance data, and as a result may not have reasonable assurance that these are the most accurate and reliable performance data available. Further, some local VA staff and service providers misunderstood how program data were used in assessing performance while others were unaware of VA's feedback processes on performance measures. Additional clarity and communication about VA's performance measures would help local VA staff and service providers better understand how program data are used to measure—and can be used to improve—performance.

GAO is making three recommendations: VA should provide additional information on how local providers can collaborate; DOL should document data quality validation processes for its homeless veterans program; and VA should clearly communicate with local VA staff and providers about how it measures performance and how to obtain and provide feedback. VA agreed with the recommendations. DOL neither agreed nor disagreed. GAO maintains that DOL should document its data quality processes, as discussed in the report.

More than 37,000 veterans in the United States experienced  homelessness in 2019, according to estimates from the Department of  Housing and Urban Development (HUD). Advocacy groups estimate that  many more veterans may be considered at risk of homelessness. As with  other populations, veterans face greater risk of becoming homeless if  they suffer from economic hardship, poverty, unemployment, or a  substance use disorder. For combat veterans, those factors can be  exacerbated by post-traumatic stress disorder, which may increase the  risk of homelessness.

The federal government assists homeless veterans through a number of  programs funded through the Department of Veterans Affairs (VA), HUD,  and the Department of Labor (DOL). In collaboration with the U.S.

Interagency Council on Homelessness (USICH), VA and HUD have  established initiatives and a working group focused on the goal of ending  veteran homelessness.

While the number of veterans experiencing homelessness declined by  nearly half between 2009 and 2019 according to HUD estimates, policy  makers have raised questions about challenges in implementing federal  assistance programs for veterans and how effective these programs are.  You asked us to review these federal programs.

This report (1) describes challenges agencies and providers reported  experiencing in implementing selected programs; (2) assesses the extent  to which any overlap or duplication exists among programs for homeless  veterans; (3) evaluates how well agencies collaborate with one another to  address veteran homelessness; and (4) reviews what is known about the  performance of selected programs.

We identified homeless assistance programs for veterans by reviewing  agency reports, guidance, and other documentation and past GAO and  Congressional Research Service reports. We selected seven programs  for particular focus in our first and fourth objectives: Housing and Urban  Development-Veterans Affairs Supportive Housing (HUD-VASH); Grant  and Per Diem (GPD); Supportive Services for Veteran Families (SSVF);  Health Care for Homeless Veterans (HCHV); Domiciliary Care for  Homeless Veterans (DCHV); Homeless Veteran Community Employment  Services (HVCES); and the Homeless Veterans’ Reintegration Program  (HVRP). We selected these programs because of their size (largest  programs based on funding and the number of veterans served) and  because they provided a mix of services addressing a variety of needs.  The results of our review of these programs are not generalizable.

For all objectives, we interviewed officials from VA, HUD, DOL, and  USICH. Additionally, we conducted semi-structured interviews with staff  from six VA medical centers (VAMC) for the selected VA programs we  reviewed; six Continuum of Care (CoC) entities; six public housing  agencies (PHA); and 23 service providers across different locations. The  results of these interviews are not generalizable. The locations we visited  were: Atlanta, Georgia; Kansas City, Missouri; Long Island, New York;  Los Angeles, California; Helena, Bozeman, Fort Harrison, and Box Elder,  Montana; and Seattle, Washington. We judgmentally selected these  locations based on several factors, including geographic diversity.

For our first objective on challenges in implementing selected programs,  we interviewed agency officials, VAMCs, service providers, and PHAs.  We also reviewed reports by federal agencies, program documentation,  and available information on trends on homeless veterans and the  general homeless population.

For our second objective on overlap and duplication, we reviewed agency  guidance, program descriptions, and other documentation for all the  homeless assistance programs for veterans that we identified. We  assessed the extent of overlap or duplication among programs using  guidance previously developed by GAO.

For the third objective on how federal agencies collaborate to address  veteran homelessness, we identified two key collaborative mechanisms  by reviewing VA, HUD, and USICH reports, guidance, and other  documentation. We then assessed these efforts against leading  interagency collaboration practices we have identified in previous work.

For the fourth objective on program performance, we obtained from VA  and DOL national performance data for selected programs for fiscal years  2015 to 2019. We assessed the reliability of the data by reviewing them  for obvious errors and inaccuracies and interviewing agency officials  about the systems and methods used to compile the data. We determined  the data included in this report were sufficiently reliable for purposes of  describing program performance. We reviewed VA’s and DOL’s  performance measures and guidance and compared them against  selected leading practices identified in past GAO work. We also  conducted a literature search for VA, HUD, and DOL program evaluations  and reviewed agency evaluation policies. See appendix I for more detail  on our scope and methodology.

We conducted this performance audit from January 2019 to May 2020 in  accordance with generally accepted government auditing standards.  Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings and  conclusions based on our audit objectives.

Background Federal Agencies and Programs that Assist Homeless Veterans

VA, HUD, and DOL are the federal agencies that provide programs  specifically aimed at assisting homeless veterans. They are among the 19  federal member agencies of USICH—an independent establishment  within the Executive Branch charged with coordinating the federal  response to homelessness and creating a national partnership at every  level of government and with the private sector to reduce and end  homelessness nationally. USICH, VA, and HUD have jointly established  criteria and benchmarks to guide communities that are taking action  toward being certified as having ended veteran homelessness. USICH  stated that an end to homelessness does not mean that no one will ever  experience a housing crisis again, but that every community will have a  systematic response in place to prevent homelessness whenever  possible and ensure that homelessness is a rare, brief, and non-recurring  experience. VA, HUD, and USICH coordinate their efforts towards this  goal through a working group, Solving Veterans Homelessness as One,  which was established in 2012.

We identified 16 federal programs that target services specifically to  veterans who are homeless or are at risk of becoming homeless. As  shown in table 1, the programs provide permanent and transitional  housing, health care, employment assistance, and supportive services,  such as assistance with rent, utilities, and moving costs. Twelve of the  programs are administered solely by VA, two are jointly administered by  HUD and VA, and two are administered by DOL. VA’s and HUD’s  homelessness programs follow the principles of “Housing First,” which is  intended to provide housing without any preconditions and barriers to  entry such as sobriety, treatment, or service participation requirements.

The largest of these programs were HUD-VASH, GPD, and SSVF. In  fiscal year 2019, HUD-VASH reported over $1 billion in obligations; GPD  reported obligations of over $234 million; and SSVF reported $380 million  in obligations.

Role of Local VAMCs, Service Providers, and Other Entities

Homeless veterans can access program services in several ways,  including through:

VA Medical Centers (VAMCs). Program services can be provided to  homeless and at-risk veterans at their local VAMCs.

Service providers. Veterans may also obtain services through local,  state, or nonprofit organizations in the community, some of which  receive grants from federal agencies to fund program services.

Public housing agencies (PHAs). Housing vouchers are  administered to homeless veterans by PHAs, which are HUD-funded  city, county, and state agencies.

VAMCs, service providers, and PHAs may coordinate through  Continuums of Care (CoC), which are composed of stakeholders in a  geographical area that, among other things, coordinate to provide  homeless services, apply for grants, set local priorities, and collect  homelessness data for all homeless populations. Each year, HUD  awards CoC program funding competitively to nonprofit organizations,  states, and other local recipients. The CoC is responsible for its operation  and developing and implementing its plan and strategies to prevent and  end homelessness. Additionally, the CoC must choose an entity to  operate the local information system used to collect client-level data and  data on the provision of housing and services to homeless individuals and  families and those at risk of homelessness (referred to as the Homeless  Management Information System). The CoC also designates an entity  that prepares and submits the CoC program application for HUD funding  (referred to as the collaborative applicant).

HUD requires each CoC to establish and operate a centralized or  coordinated assessment system (referred to as Coordinated Entry). This  system may include implementing a “no wrong door” approach in which a  homeless family or individual can show up at any homeless housing and  service provider in a geographic area and get screened for services using  the same assessment tool (see figure 1).

The goal of Coordinated Entry is to ensure that people experiencing a  housing crisis within a CoC are quickly and consistently assessed and  referred for services. HUD officials stated that Coordinated Entry is a  process that was first developed by some CoCs based on best practices.  In 2017, HUD adopted and codified requirements for all CoCs to  participate in Coordinated Entry. That same year, VA published  requirements for VAMCs to participate in Coordinated Entry.

VA and Selected Service Providers Reported Facing Challenges Related to Meeting Veterans’ Needs, Limited VA Staffing, and Other Factors Meeting Veterans’ Needs and Other Factors Create Challenges, According to VA and Service Providers

According to VAMC staff and service providers we interviewed, they  faced challenges serving homeless veterans and those at risk of  becoming homeless due, in part, to the additional level of service and  support that some veterans need. For example:

Substance use and mental illness. Substance use disorders and  mental health issues such as post-traumatic stress disorder (PTSD)  and depression, are among the most complex issues many homeless  veterans face, according to USICH. In 2018, USICH reported that 28  percent of homeless veterans that receive VA-provided health care  have been diagnosed with depression. Thirteen percent have been  diagnosed with PTSD. Further, 19 percent struggle with alcohol abuse  and 20 percent with drug abuse. VAMC staff and service providers  told us that addressing the complex nature of these conditions is often  a challenge for them. For example, one SSVF provider told us that it  is challenging to find housing for veterans with mental health or  substance use disorders; further, HVCES staff at one VAMC told us  that employment programs for the general population may not be  suitable for clients with these disorders. HUD-VASH staff at one  VAMC told us that there are not enough mental health providers in the  VA system. Overall, staff from three VAMCs from the GPD and  HVCES programs, five GPD service providers, and three SSVF  service providers cited challenges related to substance use and  mental illness.

Aging homeless veterans. In 2018, USICH reported that the number  of homeless veterans who were 62 and older increased by 54.3  percent between 2009 and 2016. VA officials told us that this trend  is expected to continue and that this population has increased, in part,  because the services that VA offers are not targeted to aging  veterans. According to VA officials, there is a similar aging trend in the  general veteran population. HUD-VASH staff at three VAMCs,  HVCES staff at one VAMC, and GPD staff at two VAMCs told us that  aging veterans require a higher level of care than what existing  programs may be able to fully address. Some of these veterans may  suffer from ambulatory and cognitive issues and have difficulties living  alone but cannot afford an assisted living arrangement.

HUD-VASH staff at one VAMC we visited told us the VAMC was able to  hire five occupational therapists to assist aging clients with their  specialized needs. Further, VA officials told us that HUD-VASH is  collaborating with VA’s Geriatrics and Extended Care programs office to  explore how aging homeless veterans can be served through other  programs, such as the Medical Foster Home and Community Residential  Care programs. This collaboration would allow VA to provide funding for  services while the HUD-VASH voucher would pay for housing costs. VA  officials also told us that they are working to market HUD-VASH to  developers and funders to increase the development of project-based  HUD-VASH housing. This would give the program a dedicated housing  stock and better serve subpopulations of veterans, such as veterans who  are elderly or suffer from mental illness.

Resistance to program participation. According to HCHV staff at  two VAMCs, HVCES staff at three VAMCs, two PHAs that administer  the HUD-VASH voucher program, and five service providers (two  GPD, two HVRP, and one SSVF), a key challenge in addressing the  needs of homeless veterans is their resistance to participating in a  program, particularly if it places restrictions or requirements on them.  This issue makes it challenging for outreach and treatment teams to  deliver services.

In addition to the challenges cited above, veterans must meet certain  eligibility requirements to participate in homeless assistance programs  which if not met can present challenges to VAMC staff and service  providers when providing veterans with services. For example, veterans  must meet certain criminal history requirements to be eligible for HUD- VASH. HVCES staff from one VAMC, DCHV staff from two VAMCs,  HUD-VASH staff from another VAMC, and three service providers (one  GPD and two SSVF) also told us that it is challenging to find housing and  employment for homeless veterans with legal or criminal problems and  landlords may be resistant to working with them.

One PHA that works with HUD-VASH and one SSVF service provider told  us that a veteran’s ineligibility for VA health care services also presents a  challenge to them. This is because a number of VA homeless programs  require a veteran to be eligible for VA health care benefits as a condition  to enrollment. Generally, veterans are eligible to receive VA health care  benefits if they served in the active military, naval, or air service and were  discharged under conditions other than dishonorable. Therefore,  according to VA officials, veterans with dishonorable discharges cannot  access VA homeless assistance programs and veterans with other-than- honorable discharges may have limited access to them.

In addition to meeting the discharge status requirement, a person must  also meet the definition of “veteran” to be eligible for VA health services.  However, the definition of “veteran” depends on factors including length of  service and if the individual served on active duty or was part of the  National Guard or the Reserves. Therefore, even if an individual has the  appropriate discharge status to be eligible, they may not meet other  eligibility requirements for VA health benefits. One service provider told  us that they have to work on alternative solutions to help veterans that do  not meet eligibility requirements.

In 2017, VA in partnership with HUD implemented a flexibility within the  HUD-VASH program—the HUD-VASH Continuum—which according to  VA officials, will permit PHAs to make up to 15 percent of their total HUD- VASH allocation available to veterans who are ineligible for VA health  care services, with some exceptions. According to VA officials, this  expands the availability of permanent supportive housing to service  members who are not eligible for VA health care. In addition, the House  and Senate are considering bills to expand HUD-VASH eligibility. DOL  has also implemented statutory changes to HVRP eligibility requirements  to provide veterans with better access to job training programs. The  program’s eligibility requirements have been broadened to include  veterans participating in the HUD-VASH, Tribal HUD-VASH, and SSVF  programs, and other veterans that were not previously eligible.

Broader Challenges, Such as Limited VA Staffing and Affordable Housing, Affected Assistance, According to VA and Service Providers

VAMC staff and services providers cited broader challenges—not specific  to veterans or the assistance programs themselves—as impacting their  ability to provide assistance to homeless veterans. Those challenges  include VA staffing issues and external factors, such as the lack of  affordable housing and limited transportation options.

VA staffing shortages. VA officials, HVCES staff at three VAMCs,  and HUD-VASH and DCHV staff at two VAMCs told us they faced  difficulties with recruitment and retention, which have led to persistent  understaffing. For example, staff at four VAMCs for the HUD-VASH,  DCHV, and HVCES programs told us that the hiring and onboarding  process can often take a long time, and by the time an offer is  finalized, qualified applicants have moved on to other jobs. DCHV  staff at two VAMCs and HUD-VASH staff at three VAMCs cited  understaffed human resources offices and a taxing approval process  as contributing factors. HUD-VASH staff from one VAMC told us that it  is difficult to fill some positions because the outreach work requires  extensive travel within large geographic areas. Further, they told us  that in high-cost areas, the VA’s local pay scale is not high enough to  attract new recruits for case manager positions. HUD-VASH staff at  one VAMC indicated that they have not been fully staffed for several  years.

Limited staffing may limit the number of veterans who can be served,  according to VA officials. For example, DCHV program staff at one  VAMC told us that they had to close 83 beds because there is not  enough staff to keep them operational. One PHA working with the  HUD-VASH program told us that VA’s staffing challenges create a  bottleneck of services to clients while staff at one VAMC working with  SSVF told us that high turnover of program staff is disruptive for  clients. Overall, staffing shortages were cited as a challenge by VAMC  staff for several programs: HUD-VASH, DCHV, HCHV, GPD, and  HVCES.

VAMC staff we interviewed have taken some steps to limit the impact  of staffing issues. For example, at one VAMC, staff from the HCHV  and GPD programs have conducted cross-training so they can back  each other up when staffing shortages occur. Two other VAMCs have  brought in staff from other locations to help with the workload or have  developed an action plan to address employee burnout.

Our past work has highlighted VA’s staffing challenges, including  recruiting and retaining clinical staff. For example, we previously  reported that difficulties in recruiting and retaining skilled health care  providers and human resource staff at VAMCs make it difficult to meet  the health care needs of more than 9 million veterans. We have also  previously reported that, in addition to high attrition and increased  workload, human capital shortfalls can lead to burnout among the staff  whose job it is to implement these programs.

Housing cost and availability. Limited and high cost housing  exacerbate the other challenges VAMC staff and service providers  identified. For example, HUD-VASH staff at one VAMC told us that  even with subsidies, it is difficult for veterans to obtain housing  because HUD-VASH vouchers may not be sufficient to cover rent.  HUD-VASH staff from one VAMC and one PHA we interviewed told  us that because housing costs are rising, and housing in metro areas  remains limited, expensive, and competitive, veterans have fewer  housing options available to them. Limited housing was cited as a  challenge by VAMC staff and service providers for HUD-VASH and  SSVF programs in all types of locations—urban, suburban, and rural  areas.

Finding and recruiting landlords is a significant challenge in getting  veterans housed, according to HUD officials, HCHV staff at one VAMC,  HUD-VASH staff from two VAMCs, two PHAs, and five SSVF service  providers. According to HUD-VASH staff from one VAMC and SSVF staff  from another VAMC, the demand for housing exceeds supply and  landlords have few incentives to accept homeless veterans. HUD-VASH  staff from one VAMC, one PHA, and one SSVF service provider also told  us that some landlords perceive veterans to be risky because some have  criminal records or substance use disorders, and may be reticent to work  with them out of fear of incurring damages to their property.

Some service providers have taken steps to create incentives for  landlords to participate in VA’s programs. For example, HUD-VASH staff  at one VAMC told us that local providers may partner to cover moving  fees for veterans and encourage landlords to accept veterans’ housing  vouchers. One PHA has put together landlord forums and is working to  build relationships with landlords in their communities. Another PHA has  held housing tours and fairs to bring landlords and clients together.

VA has also implemented program changes to help address the lack of  affordable housing. For example, the new Shallow Subsidies initiative that  became effective in September 2019, allows SSVF service providers to  provide very low-income veteran families a rental subsidy for a two-year  period without requiring recertification. The two-year period ensures no  reduction in subsidy even if a recipient’s income situation improves within  that time frame and the family is no longer considered very low income.  This provides a strong incentive for employment gains because the  assistance is not dependent on income during this two-year period.

Launched in 2018, VA’s Rapid Resolution initiative is another solution that  is designed to prevent or resolve homelessness by providing immediate  assistance when a veteran enters an emergency shelter system—such as  by offering landlord mediation and conflict resolution, or connecting the  veterans to support networks in other places. According to VA officials,  Rapid Resolution is being implemented through VA’s SSVF program, in  coordination with HUD and USICH.

Limited resources (other than staffing). HUD-VASH staff at one  VAMC told us they are short on equipment like laptops, office  supplies, and office space. Additionally, HUD-VASH staff at another  VAMC told us they do not have access to government cars for work- related travel. One HVRP service provider told us that case managers  do not have enough vehicles to travel long distances or to remote  locations to meet clients. To make up for shortages in resources, one  SSVF service provider told us that it develops partnerships with local  programs to meet the needs of the client. HUD-VASH staff at one  VAMC indicated that they have communicated issues of insufficient  resources to their leadership, but the issues have not been addressed  to date. Resource limitations were cited as a challenge by HUD-VASH  staff from two VAMCs, GPD staff from three VAMCs, DCHV staff at  two VAMCs, HCHV staff at two VAMCs, and four service providers  (two GPD and two HVRP).

Transportation limitations. According to VAMC staff and service  providers, the lack of transportation for veterans is a significant  challenge for some programs. For example, according to DCHV and  HVCES staff at one VAMC, HUD-VASH staff at another VAMC, and  one GPD and two HVRP service providers, some veterans may not  have vehicles or may live in areas with limited public transportation  systems. This makes it difficult for the veterans to access resources,  go to job interviews, or secure transportation for jobs. Some service  providers told us they make alternative arrangements for their clients  to help address these issues. For example, one HVRP service  provider told us they might drive veterans to interviews or arrange for  public transportation. DCHV staff at one VAMC and HVCES staff at  another VAMC told us that they work with community partners to  provide alternatives like shuttle services and bus passes.

Additional challenges related to specific programs we reviewed are  discussed in appendix II.

Homeless Assistance Programs for Veterans Overlap in Services, but Address Different Needs Overlap Exists Among Some Program Services for Homeless Veterans

We reviewed the services provided, eligibility requirements, and  population served by the 16 programs that exclusively target homeless  veterans to identify duplication and overlap. We determined that there is  no duplication among the programs, but identified overlap across some  program services. Specifically, we identified 18 main services that are  commonly offered across the 16 programs and found that at least six of  those services overlap across two or more programs (see figure 2).  However, we also found these programs differed in meaningful ways, for  example in terms of the different types of homeless veterans served or  specialized services or focus. As we have previously reported,  fragmentation, overlap, and duplication exists across the government,  which can present benefits and challenges. Duplication occurs when  two or more programs provide the same services to the same  beneficiaries. Overlap occurs when two or more programs offer similar  services to similar beneficiaries.

As shown in figure 2, 15 of the 16 programs overlap in two or more of the  following services that they offer.

Case management is a process for managing a client’s care that  includes assessing the needs of the veteran and evaluating health  care options and services to ensure those needs are met while  maintaining a primary focus on resolving the veteran’s homelessness  through permanent housing. Eleven programs provide case  management services: HUD-VASH, Tribal HUD-VASH, HCHV,  HCRV, H-PACT, SSVF, GPD, DCHV, CWT-TR, HVRP and VJO.

Supportive services might include providing meals, counseling, child  care, housing assistance, transportation, and other services essential  for achieving and maintaining independent living. Six programs  provide supportive services: HUD-VASH, Tribal HUD-VASH, GPD,  SSVF, HVRP, and Stand Down.

Outreach involves directly contacting veterans in need of homeless  services and connecting them with housing, health care, and  supportive services. Six programs conduct outreach: HCHV, HVRP,  SSVF, CRRCs, VJO, and HCRV.

Referrals are the most common way for homeless veterans to find  out about program services available to them. Referral services  include conducting an assessment of the clients’ needs, connecting  them to the appropriate programs, and following up with the clients as  well as documenting all referral activities. Six programs provide  referral services: HVRP, SSVF, CRRCs, NCCHV, HCRV, and Stand  Down.

Employment services include help with creating job opportunities for  veterans, job searches, interviewing, and other employment  assistance. Three programs provide employment-related services:  HVCES, CWT-TR, and HVRP.

Rental subsidies are offered to veterans through vouchers and  grants, which help subsidize rental costs. Three programs offer rental  subsidies: HUD-VASH, Tribal HUD-VASH, and SSVF.

Although we identified overlap in these services across 15 of the 16  programs, the programs differ in meaningful ways. Specifically, some of  these programs serve specific subpopulations of veterans and some  provide a specialized service that other programs do not offer. For  example, of the 11 programs that offer case management services, one  program provides medical care (H-PACT), while others provide services  in different areas such as transitional housing (GPD), housing subsidies  (HUD-VASH), supportive services (SSVF), preparing veterans for  employment (HVRP) and outreach (HCHV). Other programs that offer  case management services serve unique subpopulations of homeless  veterans such as those with mental health or substance use issues  (CWT-TR and DCHV), American Indians and Alaskan Natives living in or  near reservations or other Indian areas (Tribal HUD-VASH), or justice-  involved veterans in local jails (VJO) and state and federal prisons  (HCRV). According to a VA directive, more than one case manager may  be involved in care planning and service delivery for veterans with  complex needs. In addition, staff at the six VAMC locations we visited  told us that clients may be co-enrolled in more than one program and can  receive case management services from each of those programs. Figure  3 illustrates how case management may overlap across programs, but  each program provides distinct services to the veteran.

Similarly, of the three programs that provide employment services,  HVCES focuses on establishing partnerships with employers to develop  job opportunities for veterans and connect them with community services,  while HVRP helps the veteran prepare to pursue and gain meaningful  employment. The CWT-TR program, on the other hand, focuses on  veterans with more complex issues such as substance use, mental health  issues, and challenges in obtaining or sustaining employment that may  accompany these conditions. Similar meaningful distinctions in  subpopulations of beneficiaries and services exist across the programs  that provide other types of services to homeless veterans that overlap— supportive services, outreach, referrals, and rental subsidies. Additional  information on program differences, including information on program  beneficiaries and services, can be found in appendix II.

Overlap in Program Services Presents Potential Benefits and Challenges

As we previously reported, in some cases it may be appropriate or  beneficial for multiple agencies or entities to be involved in the same  programmatic or policy area due to the complex nature or magnitude of  the effort. Overlapping programs may also facilitate access to services  because persons experiencing homelessness are not steered toward one  specific point of entry and, in contrast, can access services through  several entry points.

However, when multiple programs overlap, there is also a risk of program  administrators making inefficient use of available resources if they do not  coordinate their efforts. For example, according to VA officials, overlap  may result in operational costs if the overlapping services are not  coordinated well. Table 2 describes some of the potential benefits and  challenges of overlap in services for homeless veterans, as identified by  agency officials, VAMC staff, and others we interviewed. Effective  collaboration among agencies and service providers can help address  some of these potential challenges and may help avoid the potential  inefficiency that overlapping services may create.

VAMC staff and service providers told us that they have taken steps to  limit duplication where appropriate. Additionally, they told us that they  collaborate and communicate with each other to avoid or mitigate overlap.  VA has also issued guidance directed at enhancing coordination between  its homeless programs and eliminating or reducing duplication of  services, including the following:

Veterans Health Administration (VHA) Directive 1110.04,  Integrated Case Management Standards of Practice. This  guidance states that case management services should be  coordinated, collaborative, and veteran-centered throughout the VHA.  It also directs case management teams to develop procedures and  processes to support cost effective, high quality case management  across the VAMC to eliminate duplication of services where  appropriate.

VHA Handbook 1162.09, Health Care for Homeless Veterans  Program. Under the HCHV program, program coordinators are  responsible for ensuring coordination of HCHV services with other  homeless programs at the VAMC such as GPD, HUD-VASH, DCHV,  VJO, HCRV, SSVF, and CRRCs.

GPD’s Case Management Services Grant Program, Final Rule.

This final rule stipulates that the case management grant may not be  used for veterans receiving case management from certain other  programs to ensure that there is no duplication of case management  services.

VHA Handbook 1162.01 (1), GPD. This guidance states that GPD  liaisons are to ensure the coordination of care for homeless veterans  in GPD-funded programs by following a plan that clearly delineates  the roles of those responsible for the service provision to reduce  duplication of services.

VHA Handbook 1101.10 (1), Patient Aligned Care Team  Handbook. This guidance directs staff to coordinate care in a manner  that avoids unnecessary duplication.

The following section of this report discusses how federal agencies  collaborate more broadly on implementing federal homelessness  assistance programs for veterans.

Key Federal Efforts Incorporate Many, but Not All, Leading Practices on Collaboration

We identified two key collaborative mechanisms that federal agencies use  to help address veteran homelessness: (1) the Solving Veterans  Homelessness as One (SVHO) working group, which coordinates VA,  HUD, and USICH’s efforts at the national level, and (2) VA’s integration  into Coordinated Entry, which seeks to ensure that homelessness  services are coordinated at the local level. As shown in table 3 and as  discussed in more detail below, both mechanisms follow leading practices  for effective interagency collaboration we have identified in prior work,  with some exceptions.

According to USICH officials, in 2012, USICH convened the SVHO  workgroup to coordinate with HUD and VA on key priorities and maximize  efforts to end veteran homelessness. SVHO serves as an interagency  decision-making body that plans and executes strategic actions through  goal setting, policy gap identification, communication, and action.

The SVHO working group fully followed all seven leading practices for  effective interagency collaboration that we identified in prior work. A  discussion of our assessment follows:

Defining Outcomes and Monitoring Accountability. Ending  veteran homelessness is one of the national goals listed in USICH’s  Federal Strategic Plan to Prevent and End Homelessness. SVHO’s  work is organized to support this goal. USICH reports SVHO’s efforts  in its annual Performance and Accountability Reports. For example,  USICH reported that in fiscal year 2019, SVHO’s efforts led to  supplemental guidance and coaching to help sustain the efforts of  communities that had been certified as having ended veteran  homelessness.

Bridging Organizational Cultures. To operate across agency  boundaries, SVHO members hold regular meetings. During these  meetings, SVHO members have updated one another on each  agency’s efforts, discussed strategic objectives, shared program data,  and coordinated on technical assistance for service providers. SVHO  also held a strategic planning retreat to discuss SVHO’s priorities.

Clarifying Leadership. SVHO has a Strategic Decision and  Coordination Team that serves as the decision-making body and  includes leadership from VA, HUD, and USICH. The team’s decisions  are made by consensus, and the role for facilitating the team rotates  every four months among the three agencies. The Strategic Decision  and Coordination Team’s responsibilities, which include providing  strategic guidance on cross-agency issues, providing joint oversight  and decision-making, and facilitating the approval of decisions from  the individual agencies are outlined in SVHO’s charter.

Clarifying Roles and Responsibilities. The SVHO charter outlines  the roles and responsibilities of the Strategic Decision and  Coordination Team and the Support Team, whose responsibilities  include responding to priority projects and elevating issues requiring  decision and coordination to the Strategic Decision and Coordination  Team.

Including Relevant Participants. SVHO members (USICH, VA, and  HUD) are the relevant participants because they are the agencies  centrally involved in implementing veteran homelessness programs.

Identifying Resources. USICH, VA, and HUD contribute staff  resources to the working group. Representatives from each of the  agencies attend regular SVHO meetings to ensure continuity, provide  the necessary subject matter expertise, and make decisions. SVHO  has also developed resources to facilitate the group’s meetings, such  as agendas to guide discussions.

Updating and Monitoring Written Guidance and Agreements. In  March 2020, SVHO revised its charter to remove outdated information  and to reflect the group’s current structure and operations. The  revised charter describes the purpose of establishing SVHO as a  formal structure for coordination and decision-making (to enable  member agencies to execute joint activities necessary for the goal of  preventing and ending veteran homelessness), SVHO’s structure (the  group is comprised of a leadership team and support team with  various responsibilities), and operating procedures (which involve  holding regular meetings). USICH officials told us it was important to  have an updated charter that solidified the commitments of the  member agencies to the group. VA officials added that updating the  charter would help serve as a reminder of the group’s purpose.

Coordinated Entry is a process designed to help communities prioritize  people who are most in need of assistance by standardizing the  assessment process, defining community-wide prioritization policies, and  coordinating referrals, among other things. HUD established minimal  requirements for Coordinated Entry in a 2012 Continuum of Care  Program Interim Rule. HUD officials said they established additional  requirements in 2017 in coordination with other federal agencies,  including VA. VA also issued a memo in 2017 stating that VAMCs must  be actively engaged in their local Coordinated Entry. Efforts to integrate  VAMCs into Coordinated Entry fully followed five of the seven leading  practices on effective interagency collaboration and partially followed the  other two (Bridging Organizational Cultures and Updating and Monitoring  Written Guidance and Agreements). A discussion of our assessment  follows:

Defining Outcomes and Monitoring Accountability. VA established  requirements for the VAMCs as they integrate into Coordinated Entry,  which include active engagement with the CoC, involvement with case  conferencing, and aligning standardized assessments. VA has a  checklist that VAMCs use to assess their compliance with  Coordinated Entry requirements. According to VA officials, they  monitor VA integration into Coordinated Entry through self- assessment checklists that VAMCs are required to submit monthly  through an internal VA system. VAMCs are also required to submit  monthly operation plans to track their progress.

Bridging Organizational Cultures. As we previously reported,  collaborating agencies should establish ways to operate across  agency boundaries and address their different cultures. VA requires  VAMCs to actively engage with all coordinated entry systems within  their catchment area. VA has provided some guidance to help  VAMCs operate across organizational boundaries as they integrate  into Coordinated Entry, but this guidance is broad in some areas. For  example, it instructs VAMCs to collaborate with local CoC leadership  to establish a clear process for making and receiving referrals and to  share aggregate program data with each of their communities as  needed. But the guidance does not describe steps that VAMCs can  take to do so. In addition, two service providers and staff from two  VAMCs told us that it can be challenging to work with multiple CoCs  because each has their own processes. Additionally, staff from three  VAMCs and one CoC entity told us that staff turnover creates  challenges in their coordinated entry systems, including impeding  relationship-building among partners. VA’s guidance acknowledges  that VAMCs may be working with multiple CoCs, but the guidance  does not provide any best practices to help address this issue, nor  does it expressly address relationship-building in light of staff  turnover.

Clarifying Leadership. As previously discussed, VA oversees the  integration of the VAMCs into Coordinated Entry. Additionally, USICH  and HUD officials told us there was an interagency working group on  Coordinated Entry, where several agencies, including USICH, VA,  and HUD, convened to discuss, among other things, what was  happening in the field and barriers to Coordinated Entry  implementation across all homeless programs, including those for  veterans. HUD officials told us they also worked closely with VA to  fully integrate VAMCs into Coordinated Entry.

Clarifying Roles and Responsibilities. VA issued guidance that  defined VAMCs roles in Coordinated Entry. For example, one or  more representatives must be involved in the community planning  process and in case conferencing, with sufficient knowledge and  decision-making power to actively engage in each activity.

Including Relevant Participants. All homeless assistance  organizations should be involved in Coordinated Entry, according to  HUD guidance. Coordinated Entry includes CoCs, VAMCs, service  providers, and public housing agencies, among others. Staff from one  VAMC, one service provider, and one CoC entity that we spoke with  described their coordinated entry systems as being inclusive of all  relevant stakeholders, including veteran homeless service providers.

Identifying Resources. VA funded 86 Coordinated Entry Specialist  positions through the HCHV program, of which 81 had been filled, as  of January 2020, according to VA officials. Staff from two VAMCs  and two CoCs told us that these new positions play an important role  in VAMCs’ integration into Coordinated Entry because they serve as a  liaison between the CoCs and the VAMCs. Additionally, VA requires  that VAMCs dedicate a portion of VA resources (such as HUD-VASH  vouchers or VA Homeless Program Residential Treatment beds) for  their inclusion into the greater pool of homeless service resources that  are accessed by veterans through Coordinated Entry.

Updating and Monitoring Written Guidance and Agreements. We  previously reported that agencies can strengthen their commitment to  working collaboratively by formally documenting their agreements,  and that those written agreements are most effective when regularly  monitored and updated. As discussed earlier, VA has issued some  guidance to help VAMCs integrate into Coordinated Entry. VA has  also held webinar trainings and issued some program-specific  documents, such as an SSVF Coordinated Entry fact sheet and a  “frequently asked questions” document for HUD-VASH. VA has also  provided technical assistance by request, according to agency  officials. However, as noted earlier, VA’s guidance is broad in some  areas and neither provides best practices to help VAMCs working with  multiple CoCs, nor expressly addresses relationship-building in light of  staff turnover.

VA officials told us they do not have plans to issue additional guidance on  Coordinated Entry because they believe their current guidance provides  sufficient direction. However, several interviewees (staff from three  VAMCs, one service provider, and one PHA) told us they need additional  guidance on Coordinated Entry, specifically about how to better  collaborate among partners. For example, staff from one of the VAMC’s  said that while they understood that implementing Coordinated Entry  required some flexibility, it would be beneficial if VA provided common  parameters that communities could follow.

Further, some VA guidance (such as the “frequently asked questions”  document for HUD-VASH) may not be accessible by all service providers  for VA’s homeless programs because it is stored on the agency’s internal  system (the Homeless Programs Hub) or provided via technical  assistance only upon request. Staff from two VAMCs stated that VA could  better disseminate guidance. Additionally, one service provider and one  PHA told us it would be helpful for VA to share best practices on  collaboration used in other parts of the country. By providing additional  information on how VAMC staff and service providers can collaborate with  local partners, such as best practices, and making available guidance  readily accessible, VA can help ensure that VAMCs and service providers  are able to more effectively collaborate with other local providers to serve  homeless veterans.

Selected Programs Reported Meeting Most Targets, but Some Aspects of Performance Measurement Could Be Strengthened National Data Show Selected Programs Met Most Targets

According to VA officials, since 2011, VA has focused on three primary  outcome measures for the homelessness assistance programs we  selected for review: 1) placement into permanent housing, 2)  employment, and 3) negative exits from programs. DOL developed four  critical measures for HVRP, including the placement rate for total  enrollment, which tracks the total number of program participants  employed in one or more jobs. VA and DOL officials told us they review  their performance measures annually and adjust them as needed.

National level performance data for fiscal years 2015 to 2019 show that  five of the seven selected programs we reviewed have generally met their  performance targets (see table 4). However, two programs, HUD-VASH  and DCHV, have not met some of their targets. Specifically, in four of  the last five years, HUD-VASH did not meet its targets for “percent  housed in HUD-VASH housing” and “percent housed within 90 days.” In  the last two years (2018 and 2019), HUD-VASH did not meet its targets  for “negative exits”; however, VA had decreased the target for those  years (making it more difficult to meet). DCHV did not meet its targets for  “exits to permanent housing” for the last three fiscal years, and “negative  exits” for two of the last five fiscal years.

According to VA officials, factors that have affected VAMCs abilities to  meet HUD-VASH performance targets—some of which are challenges  identified by local VAMC staff and providers that we have discussed  previously—include an insufficient number of case management staff,  which has led to fewer veteran admissions into HUD-VASH and a lack of  safe and affordable housing for veterans. VA officials told us that DCHV  program outcomes have been affected by factors including discharges to  other transitional housing programs (which would not be included under  an exit to permanent housing) and limited affordable housing resources.

To help improve program outcomes for HUD-VASH, VA officials told us  they are focusing on increasing HUD-VASH voucher utilization, such as  by using vouchers for non-Veteran Housing Administration eligible  homeless veterans through the HUD-VASH Continuum program and  expanding project-based HUD-VASH efforts (discussed previously). To  improve DCHV program outcomes, VA officials said they are holding in- depth discussions with DCHV staff to highlight lessons learned from those  VAMCs that are meeting performance targets.

Performance Measurement Reflected Most Leading Practices, but Data Reliability and Communication Could Be Strengthened

The performance measures used for the selected programs we reviewed  reflected most of the attributes of successful performance measures that  we identified in prior work (see table 5). VA’s measures fully reflected all  six of these attributes. DOL’s measures fully reflected five attributes and  partially reflected one, the reliability attribute. Performance measures that  include these attributes are effective in monitoring progress and  determining how well programs are achieving their goals.

A discussion of our assessment of VA’s and DOL’s performance  measures follows:

Clarity. VA’s and DOL’s policies clearly state the names and  descriptions of the performance measures we reviewed. The names  and descriptions are also consistent with the methodologies that were  used to calculate them.

Measureable Target. VA and DOL have established quantifiable,  numerical targets for their performance measures, which allows them  to compare expected and actual results. VA officials told us they  developed the targets for their measures by first obtaining baseline  data and then looking at historical and projected performance. HVRP  service providers identify their own targets during the annual grant  competition process, according to DOL officials. DOL officials told us  they provide some parameters, such as the national targets, to help  providers develop their individual targets.

Objectivity. VA’s and DOL’s performance measurement policies  describe what is expected to be measured (for example, the percent  housed and percent employed). They also indicate which specific  population (veterans) and under what timeframes (the relevant  reporting period).

Baseline and Trend Data. Nearly all the measures have baseline  and trend data for the last five fiscal years. The exceptions are  measures that have been recently discontinued. Having baseline and  trend data allows VA and DOL to monitor changes in program  performance.

Linkage. DOL’s performance measures for HVRP align with one of  DOL’s agency-wide strategic objectives to provide veterans with  resources and tools to gain and maintain employment. DOL officials  told us that information about the measures is communicated to  grantees through local officials, who review a data dashboard created  by DOL officials at headquarters. VA’s performance measures are  aligned with VA’s agency-wide goal to end veteran homelessness, as  outlined in VA’s most recent strategic plan. VA officials told us they  communicate information about the performance measures to the  VAMCs and service providers through scorecards.

Reliability. Measures reflect this attribute when they produce the  same result under similar conditions. Reliability is increased when  verification and validation procedures exist, such as checking  performance data for significant errors by formal evaluation or audit.  VA’s performance measures fully reflected the reliability attribute;  DOL’s measures partially reflected it. VA officials told us they ensure  data quality through the use of validation processes, error messages,  and notifications that appear in real-time as data are entered.  Additionally, there are dedicated program offices that work with the  VAMC’s and service providers to monitor and reconcile data. Finally,  VA’s policies describe steps that should be taken to review and verify  the quality of the data.

DOL officials told us they review HVRP performance data quality at  different levels in the agency (regional and national) and use a data  validation tool to identify potential errors. However, DOL officials  acknowledge limitations with data quality, namely the lack of an electronic  system to compile the data and the potential for human error when  entering data into spreadsheets. Further, HVRP service providers may be  unclear about the data quality steps to take because DOL’s performance  measurement policies provide limited information on data reliability  procedures. DOL officials stated that they have conducted webinar  training on the data validation tool, but acknowledge that no written policy  exits for the data validation process. Without guidance from DOL on the  quality control processes that should be applied to performance data,  service providers may not understand how to improve data quality and  DOL may not have reasonable assurance that these performance data  are the most accurate and reliable available.

While VA’s measures reflected all the selected attributes of successful  performance measures, including communicating linkage, we identified  other areas where communication about these measures is not clear. For  example, staff from three of the VAMCs we interviewed and two service  providers described communication issues related to performance  measures for four programs (HUD-VASH, GPD, HVCES, and DCHV).  These issues included concerns that VA does not understand the realities  on the ground that prevent VAMC staff and service providers from  meeting the measures (such as limited housing availability) and VAMC  staff being unaware they could use performance scorecards to drill down  and learn more about why their performance targets were not met.  Additionally, some VAMC staff and service providers we interviewed do  not fully understand the measures. For example, DCHV and HCHV staff  we interviewed from four VAMCs and three GPD service providers told us  they have felt penalized for transitioning veterans from a VA homeless  assistance program to another program or to substance abuse or mental  health treatment because VA’s performance measures count these  transitions as “negative exits.” According to VA officials, however, there  are only three instances where participant program exits are counted as  negative: 1) when participants are asked to leave for failure to follow  rules; 2) when participants leave for failure to comply with program  requirements; and 3) when participants leave without telling program  staff.

VA officials told us they have implemented processes to obtain quarterly  feedback from VAMCs and service providers—through operation or  actions plans—about the measures, including feedback about not  meeting performance targets. However, HUD-VASH staff from one  VAMC said that they have reported their concerns about not having  information on how to improve performance to VA leadership and GPD  staff from another VAMC and two GPD service providers said they have  reported their concerns about how negative exits are measured, but the  concerns have not been addressed. Additionally, staff from another  VAMC were unaware that VA had a way for them to provide formal  feedback about the performance measures, suggesting that VA’s  feedback process and avenues of communication may lack clarity.

We previously reported that improving the communication of performance  information among staff and stakeholders can enhance or facilitate the  use of performance information by agency managers. Performance  information can be used to identify gaps in performance, improve  organizational processes, and improve performance. Clearer  communication by VA’s Homeless Programs Office about performance  measurement—what performance measures capture and how to obtain  and provide feedback—would help VAMCs and service providers better  understand how their program data are used to measure performance  and therefore how to improve performance, which could also help VA  better assess program outcomes.

Agencies Have Conducted Some Program Evaluations

VA, HUD, and DOL published some annual reports during the last five  fiscal years that monitored the performance of some of the selected  homelessness assistance programs for veterans we reviewed. In  addition, they conducted a limited number of evaluations to assess their  overall effectiveness or impact and conducted other studies that  examined other aspects of the programs, such as characteristics of  program participants. Program evaluations are systematic studies that  use research methods to address specific questions about program  performance.

We identified two program evaluations conducted by or on behalf of HUD  and VA that assessed the impact of HUD-VASH. Published in 2016, the  Family Options study examined how the effects of three types of  programs—permanent housing subsidies (such as HUD-VASH  vouchers), community-based rapid rehousing, and project-based  transitional housing—compared with one another and with the usual care  available to homeless families. Findings from the Family Options study  indicated that giving people experiencing homelessness priority access to  deep permanent housing subsidies, such as housing choice vouchers,  benefitted program participants by improving housing stability. However,  as discussed in the study, heads of households that received permanent  housing subsidies experienced a reduction in employment in comparison  to participants in other programs. The permanent housing subsidy also  cost more than the other programs.

The second study was the HUD-VASH Exit study. Published in 2017,  the study was part of an effort to improve program effectiveness. It  assessed how and why veterans exit the HUD-VASH program, identified  obstacles to their obtaining and maintaining housing with a HUD-VASH  voucher, described the value of services, and identified barriers to  successful collaboration between VA and HUD in administration of the  program. Among other things, the study found that the program was  successful, as demonstrated by high rates of retention in housing, and  that relationships with community partners and the ability to connect  veterans to community resources contributed to successful outcomes.

While the several other studies and reports we identified did not assess  the impact of programs, some did analyze program performance or  outcomes (for example, the agencies’ annual performance plans and  reports), and others assessed specific aspects of the programs (for  example, factors associated with exiting homelessness programs and  characteristics of program participants). VA officials noted that resource  limitations constrain their ability to conduct impact evaluations. However,  they stated that in the future, they plan to evaluate new programs and  models, such as the SSVF’s rapid resolution program (discussed  previously). DOL officials told us they have commissioned an impact  evaluation for HVRP, which is scheduled to be completed in 2022. The  study is assessing the effectiveness of the HVRP program on improving  homeless veterans’ employment outcomes and will build knowledge  about program models including variations.

We found that HUD and DOL have developed plans outlining the  evaluations they plan to conduct and the steps they used to create their  plans, but VA did not. VA’s National Center on Homelessness Among  Veterans, which conducts research and assesses the effectiveness of  VA’s homelessness programs, has an evaluation agenda listed on its  website that describes the Center’s planned studies, but not the steps  taken to develop the agenda and prioritize what studies to conduct. HUD  and DOL have also developed policies describing the steps the agencies  take to ensure evaluation quality and rigor. VA’s National Center on  Homelessness Among Veterans, on the other hand, does not have  written policies on evaluation quality. VA officials told us they ensure the  quality and rigor of the Center’s work by submitting study results for  publication through a peer-reviewed standard scientific protocol,  consistent with other VA research, but had not yet developed formal  written policies as their processes are well known in the Center.  However, the Foundations for Evidence-Based Policymaking Act of  2018—enacted in January 2019—will now require VA and other agencies  to, among other things, designate an evaluation officer who is to establish  and implement an agency evaluation policy and assess the coverage,  quality, methods, consistency, effectiveness, independence, and balance  of the portfolio of evaluations, policy research, and ongoing evaluation  activities of the agency. The Act requires agencies to develop written  annual evaluation plans—that discuss steps taken to develop the plan  such as how studies were prioritized—to be submitted with their annual  performance plan. In June and July 2019, the Office of Management  and Budget released its initial guidance on implementing the Act, and  additional guidance is forthcoming. The Act also includes provisions for  GAO to conduct studies to review agency implementation efforts.

VA, HUD, and USICH have taken significant steps to ensure effective  collaboration between the agencies and among local service providers  when addressing veteran homelessness. However, VA can help local  agency staff and service providers better collaborate by fully incorporating  leading practices for interagency collaboration. More specific and  accessible information on how to collaborate with partners through  Coordinated Entry, including on key activities such as making referrals  and sharing data, could position local VA staff and service providers to  better aid homeless veterans with services at the local level.

Opportunities also exist for the agencies to improve some performance  measurement procedures. Documenting its data quality processes can  help give DOL reasonable assurance that these performance data are the  most accurate and reliable available. Additionally, providing clearer  communication about performance measurement—what the performance  measures capture and how to obtain and provide feedback—can help VA  ensure that VAMCs and service providers have a better understanding of  how their program data are used in measuring performance (and how to improve performance), which may also help VA better assess program  outcomes.

We are making a total of three recommendations, two to VA and one to  DOL. Specifically:  VA’s Under Secretary for Health should provide additional information,  such as best practices, about how VA medical centers and service  providers participating in Coordinated Entry can collaborate with local  partners on key activities (for example, making referrals and sharing data)  and ensure that this information and other resources are accessible to VA  medical center staff and service providers. (Recommendation 1)

The Assistant Secretary for DOL’s Veterans’ Employment and Training  Service should document its data quality validation processes for  performance data for the Homeless Veterans’ Reintegration Program and  disseminate these processes to service providers. (Recommendation 2)

VA’s Under Secretary for Health should clearly communicate with local  VA staff and service providers about how it measures performance and  how to obtain and provide feedback about performance measures.  (Recommendation 3)

We provided a draft of this report to DOL, HUD, USICH and VA for review  and comment. DOL and VA provided written comments, which are  reproduced in appendixes III and IV, respectively. HUD and VA provided  technical comments, which we incorporated as appropriate. A USICH  official stated that USICH did not have concerns with the proposed  recommendations and had no additional comments on the draft.

In its comments, DOL neither agreed nor disagreed with our  recommendation that it document and disseminate its data quality  validation processes for performance data for HVRP (Recommendation  2). DOL stated that it agreed with the importance of data quality validation  processes and noted that it uses a data validation tool (discussed earlier  in our report). In addition, DOL provided new information in its comments  on the draft report, stating that the agency released a user manual and  training video for field staff and grantees on the validation tool and  provided a hyperlink to additional information, including the user manual.  While the user manual outlines the steps for downloading the validation  tool and how to run validation tests, it does not describe what validation  tests are run or the data quality reviews that DOL officials told us  occurred at the regional and national level, as discussed earlier in our  report. Therefore, we maintain our recommendation that DOL document  all of its data quality validation processes for HVRP performance data and  disseminate them to service providers to give the agency reasonable  assurance that its performance data are the most accurate and reliable  available.

VA agreed with our recommendations in its written comments  (Recommendations 1 and 3) and outlined actions it plans to take to  address them, including:

Providing additional information, such as successful strategies, about  how VAMCs and service providers participating in Coordinated Entry  can collaborate with local partners on key activities and enhancing  communication through monthly calls on Coordinated Entry  collaboration, including case conferencing, streamlined referral  processes, and data sharing that will be recorded and accessible any  time by staff.

Clearly communicating with local VA staff and service providers about  how it measures performance and how to obtain and provide  feedback about performance measures.

VA’s target completion date for these actions is May 2021.

In addition, the draft report we originally sent the agencies included  recommendations to VA, HUD, and USICH to revise their SVHO working  group charter. However, the agencies informed GAO that they had issued  a revised charter in late March and VA and HUD provided a copy of the  final charter. Based on our review of the charter, we revised our  discussion of the charter in the report and removed the  recommendations.

We are sending copies of this report to the appropriate congressional  committees, the Secretary of the Department of Veterans Affairs, the  Secretary of the Department of Housing and Urban Development, the  Secretary of the Department of Labor, the Executive Director of the U.S.  Interagency Council on Homelessness, and other interested parties. In  addition, this report will be available at no charge on GAO’s website at  https://www.gao.gov.

If you or your staff have any questions about this report, please contact  me at (202) 512-8678 or cackleya@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on  the last page of this report. GAO staff who made key contributions to this  report are listed in appendix V.

Appendix I: Objectives, Scope, and Methodology

This report focuses on federal programs that provide services to veterans  that are experiencing homelessness or are at risk of being homeless and  their dependents. Our report (1) describes the challenges agencies and  service providers reported experiencing in implementing selected  programs that assist homeless veterans; (2) assesses the extent, if any,  of overlap and duplication among programs; (3) evaluates how well  federal agencies collaborate to address veteran homelessness; and (4)  reviews what is known about the performance of selected programs.

We identified a total of 16 programs that specifically target homeless  veterans by reviewing agency reports, guidance, and other  documentation and past GAO and Congressional Research Service  reports. From these 16 programs, we selected 7 that we focused on for  our first objective on program challenges and our fourth objective on  program performance: Housing and Urban Development-Veterans Affairs  Supportive Housing (HUD-VASH); Grant and Per Diem (GPD);  Supportive Services for Veteran Families (SSVF); Health Care for  Homeless Veterans (HCHV); Domiciliary Care for Homeless Veterans  (DCHV); Homeless Veteran Community Employment Services (HVCES);  and the Homeless Veterans’ Reintegration Program (HVRP). We selected  these programs based on size (largest programs based on funding and  the number of veterans served) and services offered (a mix of programs  addressing a variety of needs). The results of our review of these  programs are not generalizable.

For all objectives, we selected and interviewed representatives from the  following national advocacy organizations for homeless veterans and  other knowledgeable groups to obtain subject matter context: the National  Alliance to End Homelessness; the National Coalition for the Homeless;  the National Coalition for Homeless Veterans; and American Legion. We  judgmentally selected these groups based on their knowledge about  homeless veteran policy issues, their ability to share perspectives on a  variety of homeless veterans’ subpopulations, and their knowledge about  federal homelessness grants. We also interviewed officials from the  Department of Veterans Affairs (VA), Department of Housing and Urban  Development (HUD), Department of Labor (DOL), and the U.S.  Interagency Council on Homelessness (USICH). Additionally, we  conducted semi-structured interviews with staff from local VA medical  centers (VAMCs) and service providers implementing the selected  programs we reviewed; public housing agencies (PHAs) that administer  HUD-VASH vouchers; and Continuum of Care (CoC) entities across  different locations. Specifically, we interviewed staff from six VAMCs  (staff for the HUD-VASH, GPD, SSVF, HCHV, HVCES, and DCHV  programs); six CoC entities; six PHAs; and 23 service providers (eight  GPD providers, seven SSVF providers, two HVRP providers, two  providers that were HVRP, SSVF, and GPD grantees, two providers that  were HVRP and GPD grantees, and two providers that were HVRP and  SSVF grantees). The results of these interviews are not generalizable.  The locations where we conducted these interviews were: Atlanta,  Georgia; Kansas City, Missouri; Long Island, New York; Los Angeles,  California; Helena, Bozeman, Fort Harrison, and Box Elder, Montana; and  Seattle, Washington. We judgmentally selected this sample of sites based  on several factors. To select those locations, we started with the 67  communities that were designated as Priority 1 communities by VA in  2015. We then judgmentally selected six of those communities based on  the following factors: (1) to reflect a mix of communities with high  concentrations of homeless veterans and communities certified as having  ended veteran homelessness; (2) to reflect geographic diversity (a mix of  urban, suburban, and rural locations); (3) proximity of CoCs and VAMCs  (to ensure we could interview both local VAMC staff and service  providers); and (4) the presence of our selected programs (to cover as  many programs as possible).

To identify challenges agencies and service providers reported  experiencing in implementing selected programs, we interviewed agency  officials, VAMCs, service providers, and PHAs. Specifically, we first asked  them a general question about what challenges they face. We then  analyzed their responses to develop a list of challenges. A second analyst  then verified the steps taken to develop the list of challenges. We also  reviewed agency reports, program documentation, and available  information on trends on homeless veterans and the general homeless  population.

To determine the extent of duplication or overlap across programs, we  reviewed agency guidance, program descriptions, and other  documentation to obtain information on program services and  beneficiaries for the 16 veteran homelessness programs we identified,  using the process we described above. We then applied GAO guidance  on duplication and overlap by comparing the programs using the following  definitions: duplication occurs when two or more programs provide the  same services to the same beneficiaries; overlap occurs when two or  more programs offer similar services to similar beneficiaries. To identify  potential benefits and challenges of overlap, we reviewed past GAO  reports, and conducted interviews, as outlined above.

To assess how federal agencies collaborate to address veteran  homelessness, we first identified two collaborative mechanisms—the  Solving Veterans  Homeless as One (SVHO) working group and VA’s  integration into Coordinated Entry—by reviewing agency reports,  guidance, and other documentation and interviewing agency officials.  We then assessed the collaborative efforts against leading interagency  collaboration practices identified in prior GAO work. Specifically, we  assessed the extent to which the SVHO working group and VA integration  into Coordinated Entry used each leading practice using three categories.  “Fully follows” indicates that actions related to a practice reflected most or  all of the issues to consider related to the practice; “partially follows”  indicates that actions related to a practice reflect some, but not all, the  issues to consider related to the practice; and “does not follow” indicates  that there have been no actions taken related to the issues to consider for  the practice. One analyst reviewed the reports, guidance, and other  agency documentation related to the collaborative efforts and made the  initial assessment. A second analyst then reviewed this information to make their own determination about the assessment and reach  consensus with the first analyst.

To determine what is known about the performance of the selected  programs we reviewed, we analyzed national performance data for fiscal  years 2015 to 2019 from VA and DOL. To assess the reliability of those  data, we reviewed the data for obvious errors or inaccuracies by  comparing the data to publicly available data from VA’s and DOL’s annual  performance reports (to the extent the data were published). We also  interviewed VA and DOL officials with knowledge of the systems and  methods used to produce these data. We determined that the data we  included in the report were sufficiently reliable for purposes of describing  program performance for the selected programs we reviewed.

To assess if the performance measures the agencies used are effective  in monitoring progress, we reviewed VA’s and DOL’s performance  measurement guidance. We then compared the measures against  selected leading practices we identified in past GAO work. Specifically,  our prior work identified ten key attributes for successful performance  measures. Measures that include these attributes are effective in  monitoring progress and determining how well programs are achieving  their goals. We selected six attributes relevant to our analysis. We  excluded the remaining four attributes because they are used to assess  agency-wide performance and therefore were not applicable to our  program-specific analysis. We assessed the performance measures as  “fully reflects” if all the performance measures for the selected programs  reflected most or all of the definition of the relevant key attribute; “partially  reflects” if the measures reflected some, but not all, of the definition of the  relevant key attribute; and “does not reflect” if the measures did not reflect  the definition of the relevant key attribute. One analyst reviewed the  performance measures and guidance and made the initial assessment. A  second analyst then reviewed this information to make their own  determination about the assessment and reach consensus with the first  analyst.

To determine the extent to which VA, HUD, and DOL had evaluated  selected programs, we conducted a literature search for studies  conducted during the last five fiscal years. We also obtained program  evaluations from VA, HUD, and DOL. Additionally, we reviewed the  agencies’ evaluation policies and interviewed agency officials to obtain  additional information about the agencies’ program evaluation efforts.

We conducted this performance audit from January 2019 to May 2020 in  accordance with generally accepted government auditing standards.  Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings and  conclusions based on our audit objectives.

Appendix II: Additional Program Information

We identified 16 federal programs that target their services specifically to  veterans who are homeless or are at risk of becoming homeless. These  programs are funded through the Departments of Veterans Affairs (VA),  Housing and Urban Development (HUD) and Labor (DOL). As shown in  table 6, the programs provide permanent and transitional housing, health  care, rehabilitation, employment assistance, and supportive services,  such as assistance with rent, utility, or moving costs. Eligibility  requirements vary by program.

VA’s Grant and Per Diem (GPD) program awards grants to community- based agencies for transitional housing and case management for  homeless veterans. In 2017, VA implemented changes to the program  and, as seen in table 7, the program now has six housing models. Each  model targets a different population of homeless veterans or focuses on  different areas of service.

Some VA medical centers (VAMCs), service providers, and public  housing agencies (PHAs) we interviewed told us the homelessness  programs for veterans we reviewed are working well. Others identified  additional challenges that were specific to individual selected programs  we reviewed, in particular the GPD program that underwent recent  changes. For example, with respect to GPD’s new models, four service  providers and staff from three VAMCs told us that the housing models  and program guidelines are too restrictive and complex, which hinder the  delivery of services. Staff from another VAMC told us that the new  housing models are based on best practices but the implementation is  challenging. For example, one of these models, Bridge Housing,  generally limits the length of stay to 90 days which GPD staff from one  VAMC and one provider told us is not enough time to meet the needs of  some clients. However, VA officials said that veterans are not asked to  leave Bridge Housing after 90 days if the housing plan has not been  executed by this time. According to VA officials, GPD grantees can  provide transitional housing and services to family members of a veteran,  however, the program can only pay per diem for veterans, not their  families. In addition, two GPD service providers told us that the bed  reimbursement rate is inadequate to cover the cost of providing services  to veterans, and GPD staff at one VAMC told us that the existing funding  does not cover the full cost of the program. Despite these cited  challenges, our review of national performance data shows that VA is  generally meeting the performance targets for these six models. Finally,  GPD staff at one VAMC told us that there is a shortage of shelters and  beds in some areas, and as a result, they cannot accommodate all the  homeless veterans that are referred to them.

Appendix III: Comments from the Department of Labor

Appendix IV: Comments from the Department of Veterans Affairs

Appendix V: GAO Contact and Staff Acknowledgments

In addition to the contact named above, Allison Abrams (Assistant  Director), Erika Navarro (Analyst in Charge), Kimberly Bohnet, Emily  Bond, Evelyn Calderon, Lilia Chaidez, Jill Lacey, and Jessica Sandler  made key contributions to this report. Also contributing to this report were  Ryan Cirillo, Ben Licht, Marc Molino, Sarah Veale, James Whitcomb, and  Michael Zose.

About 37,000 veterans were homeless in the U.S. in 2019. The Department of Veterans Affairs and other federal agencies funded programs through local service providers to help homeless veterans find jobs and affordable housing.

But a VA case manager shortage, housing costs and availability, and other challenges may limit the number of veterans these programs can serve. Some of the service providers told us that additional guidance from VA could help them collaborate more effectively at the local level.

Our recommendations to the agencies include one for VA to give service providers more information—e.g., best practices—on collaboration.