HUD-VASH

R E S O U R C E G U I D E

for Permanent Housing

and Clinical Care
TABLE OF CONTENTS

Acknowledgements...........................................................................................................................................................1

Contributing Authors.........................................................................................................................................................2

Introduction..........................................................................................................................................................................3

PART 1: HUD-VASH IN PRINCIPLE AND PRACTICE

Chapter 1:Overview of the HUD-VASH Program................................................................................................................. 11

Chapter 2: How to Develop a HUD-VASH Project Plan...................................................................................................... 17

Chapter 3: Is HUD-VASH the Right Program........................................................................................................................... 25

Chapter 4: All aboutVouchers....................................................................................................................................................... 34

Chapter 5: Case Management – The Key to HUD-VASH Success.................................................................................. 51

Chapter 6: Challengesto Housing Stability for HomelessVeterans............................................................................ 66

Chapter 7: Toolsfor Supervision andTraining........................................................................................................................ 75

Part 2: CLINICAL ISSUES AND SUPPORT

Introduction: Creating a Full System of Response to End Homelessness amongVeterans............................. 84

Chapter 1: Homelessness Prevention........................................................................................................................................ 89

Chapter 2: Treating Co-Occurring Disorders within HUD-VASH: Evidence-Based Approaches..................... 96

Chapter 3: Case Management Integration with Psychiatry andOther Mental Health Services..................109

Chapter 4: Case Management Integration with Primary Care.....................................................................................118

Chapter 5: Trauma-Informed Care.............................................................................................................................................127

Chapter 6: Supported Employment and Supported Education for HomelessVeteransin HUD-VASH....135

Chapter 7:Violence and PartnerViolence amongVeterans Enrolled in HUD-VASH..........................................146

Chapter 8: Peer Support in HUD-VASH...................................................................................................................................153

Chapter 9: HUD-VASH and HOUSING FIRST..........................................................................................................................170

Chapter 10:Working withVBA to Assist ClientsinObtaining Benefits....................................................................182

Answer Guide forQuick Check!Questions............................................................................................................................189

Appendix A: Assessments & Housing Stabilization Plan

Appendix B: Program Resources

Appendix C: VA Forms 
H U D - V A S H R E S O U R C E G U I D E 1 
2 H U D - V A S H R E S O U R C E G U I D E

CONTRIBUTING AUTHORS

(in alphabetical order)

Howard Burchman

Housing Innovations LLC

Allison Calabro

Veterans Benefits Administration

Department of Veterans Affairs

Roger Casey, Ph.D., L.C.S.W. 

VA National Center on Homelessness Among Veterans

VA Central Office

Matthew Chinman, Ph.D. 

VA National Center on Homelessness Among Veterans

VA Pittsburgh Health Care System

RAND Corporation

Richard Cho

Corporation for Supportive Housing

Marsha Ellison, Ph.D., M.S.W.

VA National Center on Homelessness Among Veterans

Edith Nourse Rogers Memorial Veterans Hospital

University of Massachusetts Medical School

Mark A. Engelhardt, M.S., M.S.W., A.C.S.W. 

VA National Center on Homelessness Among Veterans

College of Behavioral & Community Sciences

University of South Florida

Gordon J. Hannah, Ph.D. 

VA Pittsburgh Health Care System

Erin Healy

Corporation for Supportive Housing

David Kalman, Ph.D. 

University of Massachusetts Medical School

Vince Kane, M.S.W. 

VA National Center on Homelessness Among Veterans

VA Central Office

John Kuhn, M.S.W., M.P.H. 

VA National Center on Homelessness Among Veterans

Supportive Services for Veteran Families

VA Central Office

Anthony Love

United States Interagency Council on Homelessness

Kerry Makin-Byrd, Ph.D. 

VA Palo Alto Health Care System

Stanford University School of Medicine

Sharon McCarthy, Ph.D., M.B.A., M.S.W. 

VA Pittsburgh Health Care System

Emily Clark Muñoz

VA National Center on Homelessness Among Veterans

Edith Nourse Rogers Memorial Veterans Hospital

Lisa M. Najavits, Ph.D. 

VA National Center on Homelessness Among Veterans

VA Boston Health Care System

Boston University School of Medicine

Harvard Medical School

Thomas O’Toole, M.D. 

VA National Center on Homelessness Among Veterans

Providence VA Medical Center

Alpert Medical School, Brown University

Stephanie Rodrigues, Ph.D. 

Edith Nourse Rogers Memorial Veterans Hospital

University of Massachusetts Medical School

Leon Sawh, M.P.H. 

VA National Center on Homelessness Among Veterans

Edith Nourse Rogers Memorial Veterans Hospital

University of Massachusetts Medical School

University of Massachusetts Lowell

David Smelson, Psy.D. 

VA National Center on Homelessness Among Veterans

Edith Nourse Rogers Memorial Veterans Hospital

University of Massachusetts Medical School

Debbie Thiele

Corporation for Supportive Housing

Christine Timko, Ph.D. 

VA Palo Alto Health Care System

Stanford University School of Medicine

Sam Tsemberis, Ph.D.

Pathways to Housing

Columbia University Medical Center

Suzanne Wagner, M.S., L.M.S.W.

Housing Innovations LLC

Andrea White, M.S., L.M.S.W. 

Housing Innovations LLC

Michal Wilson, M.D. 

VA National Center on Homelessness Among Veterans

VA Central Office

Douglas Ziedonis, M.D., M.P.H. 

University of Massachusetts Medical School

UMass Memorial Health Care
H U D - V A S H R E S O U R C E G U I D E 3 

Part 1 Introduction: A Guide to Using the 

HUD-VASH Resource Guide

This HUD-VASH Resource Guide for Permanent

Housing and Clinical Care was developed to provide

a resource for those who serve our country’s most

vulnerable and chronically homeless Veterans

through the HUD-VASH Program. HUD-VASH

is a critical element of the VA’s Five Year Plan

to End Veteran Homelessness and of Opening

Doors: Federal Strategic Plan to Prevent and End

Homelessness.

Part 1 of the HUD-VASH Resource Guide for 

Permanent Housing and Clinical Care is a guide to the

program that includes Veteran eligibility, program

management, and housing stabilization work with

landlords and housing authorities. Part 2 provides

an overview of evidence-based practices for HUDVASH and includes Housing First; coordination with

clinical services; understanding trauma and violence;

and accessing benefits, education, and employment.

Since the issues of housing, mental health, and

addiction are interrelated, you will see some

overlapping interventions used for simultaneous

treatment of a multitude of issues. For example,

Motivational Enhancement Therapy, Motivational

Interviewing, and Critical Time Intervention are

described in both Part 1 and Part 2.

The HUD-VASH Resource Guide for Permanent 

Housing and Clinical Care is a comprehensive guide

to implementing a HUD-VASH program. It covers

every aspect of HUD-VASH and related practices

and programs. Knowing where to begin may seem

overwhelming at first glance. In order to help you

approach the Resource Guide in a way that is most

useful to you, we have provided the following selfadministered quizzes. The quizzes are customized

for each of the key VA members of any HUD-VASH

team: Supervisors, Case Managers, and Peer Support

Specialists. We encourage you to complete the quiz

that most closely matches your role on the HUDVASH team. This will provide you with a baseline

for your own understanding of HUD-VASH. Each

quiz has an answer key that offers recommended

chapters to read. Use these suggested readings to

develop your own personalized curriculum.

We hope you will find the toolkit useful in your

everyday work with your clients and appreciate all

of the work that you do to help move homeless

Veterans off the streets and into secure and stable

housing.

Quiz Instructions

1) Choose the quiz for the role that most closely

matches your role on the HUD-VASH team.

(You might also choose to take more than one

quiz to more broadly test your familiarity with

HUD-VASH.)

2) Take the quiz, noting your answers in writing.

3) Locate the corresponding answer key for your

quiz and assess your results.

4) Start your reading of the Resource Guide with

the chapters that are suggested for questions

that you may have answered incorrectly.

5) Review other sections of the Resource

Guide that are suggested readings for items

that you may have answered correctly but

weren’t completely sure about. Consider

additional reading even for those questions

that you answered correctly to ensure a full

understanding of the topic area covered in the

quiz for your particular role in HUD-VASH.

6) Review other sections of the Resource Guide

for the most comprehensive understanding of

HUD-VASH.

I N T R O D U C T I O N :

A Guide to Using the HUD-VASH Resource Guide
4 H U D - V A S H R E S O U R C E G U I D E

Baseline Quiz for Supervisors

1) Which of the following are the primary targets for

HUD-VASH?

a. Chronically homeless Veterans

b. Veterans who are at risk of being evicted from

their housing

c. Veterans returning from OIF/OEF

d. Veterans leaving the Grant and Per Diem

program

e. All of the above

2) True or False: Veterans with untreated mental

illness and addiction issues will fail in HUD-VASH

because there is no“carrot”of receiving housing

after meeting recovery goals.

3) Which of the following describes a key purpose of

supervision and training in HUD-VASH?

a. To ensure that program staff have sufficient

clinical knowledge

b. To make administrative program improvements

c. To provide support to staff as they encounter

obstacles and experience setbacks in their work

d. All of the above

4) True or False: One example of a HUD-VASH team

meeting is a case conference where challenging

issues with clients can be raised and discussed.

5) Which of the following is NOT the primary

responsibility of a Peer Support Specialist on a

HUD-VASH team?

a. Sharing personal accounts of recovery

b. Helping Veterans access free and low-cost

community resources

c. Conducting a housing and services needs

assessment

d. Accompanying Veterans to clinical

appointments

6) True or False: It is the local housing authority’s

responsibility to ensure that participating

landlords are content with the HUD-VASH

Program.

7) HUD-VASH Housing Choice Vouchers expire after

how many days?

a. 30

b. 60

c. 90

d. 120

e. They do not expire.

8) Trauma refers to the experience, threat, or

witnessing of physical harm. Which of the

following describes a trauma that a HUD-VASH

Veteran may have experienced?

a. Military combat

b. Childhood abuse

c. Military sexual abuse

d. Terrorist attack

e. All of the above

9) Motivational Enhancement Therapy (MET) is

a brief therapy based upon the Motivational

Interviewing (MI) approach to counseling. MET

is designed to enhance client motivation by

helping clients to resolve their ambivalence

about addressing and ultimately changing their

problem behaviors. The fundamentals of MET

can be remembered through the acronym OARS. 

Which of the following is NOT an example of

the fundamental skills of MET? Do you know the

correct skill to complete the acronym?

a. Open-ended questions

b. Affirmations

c. Resisting negativity

d. Summarizing
H U D - V A S H R E S O U R C E G U I D E 5 

10) True or False: Research has not been able to

reliably distinguish those who will or will not

succeed in employment.

Answer Key: Baseline Quiz for Supervisors

# Answer Suggested Toolkit Reading

1

A: HUD-VASH is designed to serve our country’s most

vulnerable veterans, many of whom are chronically homeless

(disabled with extended periods of homelessness). This may

include some OEF/OIF Veterans, but they are not the primary

target population for HUD-VASH. Many OEF/OIF may be served

through VA’s new Homeless Prevention program, Supportive

Services for Veteran Families

Part 1, Chapter 3

Provides eligibility requirements and

instructions for determining if

HUD-VASH is the right program for a

Veteran

2

FALSE: Fortunately for staff, providing a Veteran who is

homeless with a rent-subsidized furnished apartment with few

strings attached serves as an excellent way to achieve trust and

begin a healing, collaborative relationship.

Part 2, Chapter 9

Explains the principles of

Housing First

3

C: To provide support to staff as they encounter obstacles

and setbacks in their work. Program staff should ensure good

communication with clinical providers, but they do not have

primary responsibility for clinical knowledge. Administrative

program improvements are best addressed by a project team

consisting of 6-10 members.

Part 1, Chapter 7

Will outline supervision in

HUD-VASH

4

FALSE: Team meetings are different from case conferences in

that they focus more on the administrative and systemic issues

that arise in the work. They offer opportunities for staff to share

resources and best practices while engaging in team building.

Part 1, Chapter 7

Outlines the roles and responsibilities of

the HUD-VASH team

5

C: It is the primary responsibility of the Case Manager to

conduct the Housing and Services Needs Assessment. The Peer

Support Specialist may support the Case Manager in doing so.

Part 2, Chapter 8

Will tell you everything you ever wanted

to know about incorporating peer

support into your team

6 FALSE: Regular meetings with landlords are critical parts of the

Case Manager’s responsibilities in housing stabilization.

Part 1, Chapter 6

Provides important information

about the unique focus on housing

stabilization in HUD-VASH
6 H U D - V A S H R E S O U R C E G U I D E

7

D: 120 days. Standard Housing Choice Vouchers expire after 60

days, but HUD-VASH vouchers are automatically extended to

120 days. Veterans with disabilities may request an extension

beyond 120 days if their disability is impairing their ability to

find housing.

Part 1, Chapter 4

Provides details about Housing Choice

Vouchers and working with your public

housing authority partners

8

E: All of the above. It is important for the HUD-VASH team to be

educated in Trauma Informed Care (TIC) because of the myriad

of possible traumas homeless Veterans may have experienced

in their lives.

Part 2, Chapter 5

Has great information for making sure

your HUD-VASH team provides TIC

9

C: The fundamental skills of MET can be remembered through

the acronym, OARS: Opened-ended questions; Affirmations;

Reflective listening; and Summarizing.

Part 2, Chapter 2

Describes the treatment approaches for

mental illness and drug dependency

10

TRUE: The guiding principle behind employment for HUDVASH participants is that everyone who wants to work or learn

should be encouraged and supported in that endeavor.

Part 2, Chapter 6

Offers guidelines for linking to and

providing employment & education

services

Baseline Quiz for Case Managers

1) The starting point of a Housing First approach

to HUD-VASH case management is to ask the

Veteran a number of questions that will put him

or her in a decision-making role by soliciting

information about his or her housing needs.

Which of the following is NOT a good example of

a question that puts the Veteran in the decisionmaking role?

a. Would you like a studio or one-bedroom

apartment?

b. Why do you feel you are ready to live in an

apartment?

c. Are there other people in your life that you

want to live with?

d. What type of household items do you need?

e. All of these questions put the Veteran in a

decision-making role.

2) True or False: In HUD-VASH, it is the landlord’s

responsibility to educate the Veteran about

expectations of tenancy and maintaining a home.

3) True or False: Veterans are expected to attend

regular meetings with Case Managers at the VA.

4) Which of the following is NOT an important

time to reach out and connect with a Veteran’s

landlord?

a. Upon initial move-in

b. On the 10th of each month

c. When the Veteran is experiencing behavior

changes

d. When you cannot reach the Veteran after

repeated attempts to visit his or her apartment

e. All of the above are important times to connect

with landlords.

5) All HUD-VASH participants must be linked to a

Patient Aligned Care Team (PACT) within the VA.

Which of the following is NOT true about PACTs?

a. They include 1-3 primary care providers, an RN,

LPN, health technicians, and nursing assistants.
H U D - V A S H R E S O U R C E G U I D E 7 

b. The teams are augmented by social workers,

nutritionists, pharmacists, and behavioralists.

c. They serve as a first stop for urgent or emergent

medical needs.

d. They reduce emergency department visits and

preventable hospitalizations.

e. All of the above are true.

6) True or False: Case managers should not help

Veterans find a job until they are in recovery.

7) Home visits are key interventions that help

prevent housing crises before they occur. Which

of the following is NOT a good practice for home

visits?

a. Check for hoarding and other unsanitary

conditions.

b. Check utility connections.

c. Surprise the Veteran occasionally to find

out what’s really going on in the Veteran’s

apartment.

d. Look for evidence of non-lease holders that

may be living in the unit.

e. All are good practices for home visits.

8) Which of the following is true about the “Total

Tenant Payment?”

a. It is generally 30% of a Veteran’s adjusted

income.

b. It includes both rent and utilities.

c. It is paid to the landlord.

d. It is calculated by the housing authority.

e. All of the above.

9) Risk factors for partner violence include which of

the following?

a. A history of previous abuse

b. Victimization

c. Criminal history

d. All of the above

10) True or False: While relatively non-specific, sleep

is often one of the earliest signs of a worsening

in one’s mental state.

Answer Key: Baseline Quiz for Case Managers

# Answer Suggested Toolkit Reading

1

B: The Housing First approach does not question readiness

to live in housing. It assumes that the Veteran has a right to

housing. The Case Manager’s questions should be focused on

understanding the housing features in which the Veteran is

interested. 

Part 2, Chapter 9

Explains the principles of

Housing First

2

FALSE: In HUD-VASH, the Case Manager has the primary

responsibility for educating the Veteran about expectations of

tenancy and maintaining a home. This is an integral, ongoing

facet of a case management approach that is based in housing

stabilization.

Part 1, Chapter 6

Provides important information

about the unique focus on housing

stabilization in HUD-VASH
8 H U D - V A S H R E S O U R C E G U I D E

3

FALSE: Case Management is provided in the home as well as

agency offices and other community settings. Once a Veteran

is housed, the Case Manager is consistently monitoring for

and assisting the Veteran with problems that can jeopardize

ongoing tenancy. In the initial months of tenancy, the case

manager should make regular home visits -weekly at first- to

make sure that the transition is going smoothly.

Part 1, Chapter 5

Is your guide to Case Management:

The Key to HUD-VASH Success

4

E: All of the above are important times to connect with

landlords. If no issue is occurring, a check-in on the 10th of each

month is most helpful because this is when landlords issue “10

day notices to comply or vacate”for issues other non-payment

of rent.

Part 1, Chapter 5

Is your guide to Case Management:

The Key to HUD-VASH Success

5 E: All of the above are true.

Part 2, Chapter 4

Explains the integration of Case

Management with Primary Care

6

FALSE: The guiding principle behind employment for HUDVASH participants is that everyone who wants to work or learn

should be encouraged and supported in that endeavor.

Part 2, Chapter 6

Will help you provide services and link

Veterans to supported education and

employment

7

C: Surprise home visits should only be done if there are

concerns that a client is in danger or hurt and only after all

other ways to contact the client have been exhausted.

Part 1, Chapter 5

Is your guide to Case Management:

The Key to HUD-VASH Success

8

E: All of the above. It is important for Case Managers to have a

clear understanding of the way housing choice vouchers work

in HUD-VASH.

Part 1, Chapter 4

Provides details about Housing Choice

Vouchers and working with housing

authority partners

9

D: All of the above. Case Managers are well-placed to be the

“first responders”to address family issues, broadly, and partner

violence, specifically.

Part 2, Chapter 7

Explains violence and partner violence

among Veterans

10

TRUE: The Case Manager can bring significant value to the

treatment process by making observations in the field that

might otherwise go unnoticed. 

Part 2, Chapter 3

Shows you how Case Management

integrates with Mental Health Services
H U D - V A S H R E S O U R C E G U I D E 9 

Baseline Quiz for Peer Support Specialists

1) True or False: In HUD-VASH, the housing is tied

directly to treatment. If a Veteran does not comply

with treatment, s/he will likely lose housing

privileges.

2) Which of the following is true about the role of

a Peer Support Specialist (PSS) in a HUD-VASH

program?

a. The PSS is usually a volunteer.

b. The PSS is an untrained staff member that

assists other members of the team.

c. The PSS’s primary responsibility is to assist

Veterans with getting to appointments.

d. The PSS is a full member of the staff team who

participates in HUD-VASH team meetings and

clinical case conferences.

3) Which of the following entities pays rent to

landlords in HUD-VASH?

a. Housing authorities

b. VASH supervisors

c. Veterans

d. VASH Case Managers

4) True or False: Veterans are allowed to decline

involvement with a HUD-VASH Peer Support

Specialist if they choose.

5) Veterans with disabilities who are interested

in taking classes can qualify for educational

accommodations. Some examples of these

accommodations include

a. Being allowed to tape record classes.

b. Being provided both with written and verbal

instructions.

c. Extended time for test taking.

d. Access to quiet spaces for test-taking .

e. All of the above.

6) True or False: Peer Certification means that

the Peer Support Specialist can perform case

management.

7) True or False: Because HUD-VASH Veterans have

been homeless for long periods of time, many

will need a harsher, confrontational style when

dealing with substance use disorders. 

8) True or False: The goal of Relapse Prevention

is to teach the Veteran how to anticipate and

cope with“triggers”such as moods, thoughts or

situations that increase the risk of using.

9) A key role for a PSS is to lead groups for Veterans.

Which of the following is NOT a good example of

a PSS-led group:

a. Unstructured peer support groups

b. Vet-to-Vet groups

c. AA/NA groups

d. AA groups

e. All of the above are good examples of PSS-led

groups.

10) Which of the following is NOT a typical Peer

Support Specialist activity on a HUD-VASH team?

a. Advocating for Veterans on their caseload

b. Sharing personal wellness and relapse

prevention strategies

c. Taking Veterans to their favorite place of

worship

d. Helping Veterans with job applications

e. None of the above is a typical activity for a

Peer Support Specialist.
10 H U D - V A S H R E S O U R C E G U I D E

Answer Key: Baseline Quiz for Peer Support Specialists

# Answer Suggested Toolkit Reading

1 FALSE: In HUD-VASH, housing loss occurs only for lease

violations, not for treatment non-compliance or hospitalization.

Part 2, Chapter 9

Explains the principles of

Housing First

2 D: The Peer Support Specialist is a paid, trained member of the

HUD-VASH team with many important roles.

Part 2, Chapter 8

Is your guide to Peer Support in

HUD-VASH

3

B &D: The Veteran pays approximately 30% of their income to

the landlord, and the Housing Authority pays the remainder up

to a pre-determined amount.

Part1, Chapter 4

Provides details about Housing Choice

Vouchers and working with your

housing authority partners

4 TRUE: The Housing First approach puts the Veteran at the

center of decision-making.

Part 2, Chapter 8

Is your guide to Peer Support in

HUD-VASH

5

E: All of the above. Many Veterans, especially young adults

returning from the OIF/OEF conflicts will have an interest in

using their GI Bill benefits to further their education.

Part 2, Chapter 6

Will help you provide services and link

Veterans to supported education and

employment

6 FALSE: Peer Certification means that PSS services are

reimbursable by state Medicaid programs.

Part 2, Chapter 8

Is your guide to Peer Support in

HUD-VASH

7

FALSE: Use of a harsh confrontational style can backfire when

working with people who have had trauma that occurred

under conditions of harsh confrontation.

Part 2, Chapter 5

Will help you learn the importance of

Trauma-Informed Care

8

TRUE: Understanding treatment approaches can help PSSs

reinforce the work Veterans have done with any other

treatment providers they may have.

Part 2, Chapter 2

Describes Treatment Approaches

for Mental Illness and Chemical

Dependency

9

E: All of the above. PSSs should consult with their colleagues,

supervisors, and Veterans about which groups would be the

most useful to lead in a particular HUD-VASH program.

Part 2, Chapter 8

Is your guide to Peer Support in

HUD-VASH

10 C: Advocacy, sharing personal experiences, and assisting with

employment and education are all examples of activities that a

Peer Support Specialist might engage in.

Part 2, Chapter 8

Is your guide to Peer Support in

HUD-VASH
H U D - V A S H R E S O U R C E G U I D E 11 

and affordable permanent housing of his or her

choosing. Case management services promote

housing stability and support recoveries from

physical and mental illnesses and substance use

disorders.  As the program’s primary goal is to end

homelessness and promote housing stability, HUDVASH does not require a set period of sobriety in

order for a Veteran to be considered eligible for the

program, nor does non-compliance with HUD-VASH

case management services necessarily lead to loss

of the housing voucher. However, it is expected that

a Veteran remain in case management, even with

possible fluctuations in the Veteran’s living situation

and treatment participation. Thus, a Veteran

enrolled in HUD-VASH who relapses to substance

abuse and re-enters treatment would not necessarily

be discharged from HUD-VASH case management;

in fact, such case management provides important

continuity of care and an opportunity to assist the

Veteran in his or her recovery.

“Case management provides important

continuity of care and an opportunity to assist

the Veteran in his or her recovery.”

Every Veteran enrolled in the HUD-VASH program is

assigned a Case Manager. Together, they develop a

Housing Stabilization Plan, a recovery-focused plan

that identifies housing needs and sets treatment

goals requiring active participation from the Veteran. 

In order to be successful, the Housing Stabilization

Plan must reflect each Veteran’s individual needs. 

The Veteran and the Case Manager will review and

revise the Housing Stabilization Plan on a regular

basis to meet the changing clinical and psychosocial

needs of HUD-VASH clients. It is critical that the

Veteran client participate in this process and endorse

each iteration of the Housing Stabilization Plan.

What’s in This Chapter?

HUD-VASH is a unique partnership between

the Department of Veterans Affairs (VA) and the

Department of Housing and Urban Development

(HUD) that provides long-term case management,

supportive services, and permanent housing

support for chronically homeless Veterans. Using

a Housing First approach, the HUD-VA Supportive

Housing (HUD-VASH) program combines Housing

Choice Voucher (HCV) rental assistance with case

management and clinical services provided by VA.

In this chapter you will learn

• Who is eligible for HUD-VASH;

• The structure of the HUD-VASH program;

• Basics about housing vouchers;

• Basics about HUD-VASH VA services; and

• The process by which a Veteran moves from

chronic homelessness to housing stability as

part of the HUD-VASH program.

What is HUD-VASH?

In 1992, VA and HUD established the HUD-VASH

program to serve the neediest, most vulnerable

homeless Veterans and their immediate families. VA

provides case management and eligibility screening

services, while HUD allocates permanent housing

subsidies from its“Housing Choice”program. The

primary goal of this joint program is to move

Veterans and their families out of homelessness. 

A key component of the program is VA’s case

management services. These services are designed

to improve the Veteran’s physical and mental health

and enhance the Veteran’s ability to live in safe

PART 1 C H A P T E R 1

Overview of the HUD-VASH Program
12 H U D - V A S H R E S O U R C E G U I D E
H U D - V A S H R E S O U R C E G U I D E 13 

Who is eligible for HUD-VASH? 

There are two components to HUD-VASH program

eligibility – VA requirements and Public Housing

Authority (PHA) guidelines.

Veterans meet VA requirements when they

• Are eligible for VA Health Care Services,

• Require case management services in order to

obtain and sustain independent community

housing, and

• Meet the McKinney-Vento Act definition of

homelessness by either

u Lacking a fixed, regular, adequate nighttime

residence, or

u Identifying as his or her primary residence

a shelter, welfare hotel, transitional or

temporary housing facility, or public or

private place not designed for, or ordinarily

used as, a regular sleeping accommodation.

The fulldefinitionofhomelessness asusedby theHUDVASHprogramcanbe foundathttp://portal.hud.gov/

hudportal/HUD?src=/program_offices/comm_planning/

homeless/lawsandregs/mckv

The HUD-VASH program targets VA’s most vulnerable

homeless Veterans, including those with medical,

mental health and or substance use disorders. Its

primary target population is the Veteran who has

experienced multiple episodes of homelessness,

is suffering from mental health and/or medical

complications, has been homeless four or more

times in the prior three years, or who has been

continuously homeless for one year or longer.

VA considers both single Veteran applicants and

Veterans with dependent family members. However,

since HUD-VASH is designed for the homeless

Veteran, the household must include the eligible

Veteran and cannot include any family members

with a Lifetime Sexual Offender Registry status.

The PHA guidelines become important once the

Veteran’s eligibility has been favorably determined

by VA and he or she is approved by the HUD-VASH

Case Manager. At that time, the Veteran must

complete a PHA application and follow the PHA’s

guidelines to obtain housing. The PHA will expect

proof of a qualifying income level, and will also

expect participating Veterans to follow the landlord’s

tenancy expectations. 

What does “recovery” mean? 

Recovery, as part of HUD-VASH, is defined as “any 

type of work put into achieving independent living and 

community stability by actively addressing areas that 

have contributed to, or have been concurrent with, 

homelessness.” Recovery requires an assessment

of the Veteran’s life, including areas that have been

affected by the identified problem(s), and creates

a progression toward restoring elements that are

most significant to the Veteran. Recovery includes

not only the things that must be done to resolve

physical ailments, mental illnesses, and substance

use disorders, but also the problems that have arisen

from these issues. It also includes things such as

getting involved in activities in the community that

are of interest to the Veteran – examples include

attending cultural events, volunteering, participating

in church activities, or exercising.

How long does it take to obtain housing? 

Length of time will vary depending on the Veteran’s

history, the area where housing is being sought,

availability of landlord housing stock, and the

landlord’s willingness to rent to individuals with a

Housing Choice Section 8 voucher. Issues such as

credit history may also impact the amount of time it

will take to obtain housing. 

Where can Veterans in HUD-VASH live?

Because Veterans enrolled in HUD-VASH must

participate in case management by a VA HUD-VASH

Case Manager in order to retain the housing voucher,

proximity to VA services should be a primary

consideration, as lack of participation may result

in PHA invalidating use of the voucher. Therefore,

Veterans must live within a reasonable distance from

a VA facility–so that both the Case Manager and

the Veteran can easily travel back and forth without

any undue travel burden. Although level of service
14 H U D - V A S H R E S O U R C E G U I D E

intensity will ultimately be determined by the

Veteran’s needs, HUD-VASH clients can expect active

participation in case management to require three

contacts per month. These contacts will occur when

Case Managers visit the Veteran at home and when

the Veteran travels to the VA facility for primary care

and specialty care as indicated. HUD-VASH Veterans

can live anywhere they are able to consistently meet

these requirements. 

What is portability and what does it mean 

for the Veteran?

Portability allows a Veteran to live outside of the

jurisdiction of the PHA where the vouchers were

allocated, within certain limits. Portability can allow

a Veteran to live in a suburb or small town outside of

the immediate area where the VA facility is located. 

However, since Veterans in the HUD-VASH program

must have VA HUD-VASH Case Managers, and must

participate in the case management program, the

Veteran must still live within a reasonable traveling

distance to the facility where the Case Manager is

located without causing significant travel burden. 

After meeting this requirement, Veterans may live in

any apartment or other housing unit that meets PHA

standards, is affordable with the voucher, and has a

landlord willing to rent to the Veteran.

Unlike many Section 8 vouchers, which require

residence in an initial area for a year or more, HUDVASH vouchers are portable from the beginning,

which allows the Veteran the flexibility to choose a

suitable community from the outset.

It is also possible for the Veteran to move outside

of their original VA’s service area. In this case, the

original HUD-VASH Case Manager should help the

Veteran determine if it is possible to enter into the

HUD-VASH program in the new service area. The VA

where the Veteran wishes to live must have

1) an open or vacant voucher for the Veteran to

use, and 2) the ability to provide the necessary case

management services outlined in the Veteran’s

Housing Stabilization Plan. Thus, HUD-VASH

programs must work together to plan and arrange

the move, and the Veteran must also have the

resources to move.

What services do Veterans receive in the 

HUD-VASH program?

Veterans are offered the services they need for

recovery from homelessness. This includes referrals

to VA primary care as well as services, including

mental health or substance abuse treatment

services, income assistance, employment supports,

disability benefits, and credit repair and skills for

money management. HUD-VASH Case Managers

will help the Veteran locate and secure housing,

navigate PHA procedures, agree to a tenancy

contract, and plan the move. Skill training, clinical

assessments, advocacy, and linkages to other

community supports and service providers may also

be provided. After housing is secured, the Veteran

may receive assistance with landlord and PHA

procedures, planning for the move, and community

re-introduction–as he or she reconnects with family

and friends, finds cultural opportunities, explores

spiritual organizations, and develops new interests,

activities, and relationships. Case management

services are intended to be available for the Veteran

after being housed–assisting with adjustment to the

community and maintaining connections to needed

treatment, benefit and vocational services. Intensity

and frequency of services are adjusted based on

the unique needs of the Veteran. Services should be

provided in the Veteran’s home at least monthly.

How long does the HUD-VASH program 

last?

HUD-VASH lasts as long as the Veteran needs the

program to last. The time is variable and depends

on the Veteran’s functional and economic abilities. 

Veterans who no longer need case management

to function, yet feel they need to continue with the

voucher portion of the program, may work with their

Case Manager to discontinue case management. If

the Case Manager agrees that case management

is no longer needed, then the Veteran can stop

this portion of the program but continue with the

voucher without penalty.
H U D - V A S H R E S O U R C E G U I D E 15 
16 H U D - V A S H R E S O U R C E G U I D E

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your basic knowledge about

HUD-VASH.

1) The HUD-VASH program was designed to meet

the needs of the most vulnerable homeless

Veterans.

2) HUD-VASH eligibility is based on a number of

housing readiness factors.

3) Families are eligible for HUD-VASH.

4) Recovery, for this program, means working

toward maintaining housing and community

stability by actively addressing the areas that

have contributed to homelessness or have been

concurrent with homelessness.

5) Housing vouchers expire in one month and

cannot be transferred to other jurisdictions.
H U D - V A S H R E S O U R C E G U I D E 17 

What’s in This Chapter?

In many ways, implementing HUD-VASH creates

a need for change to current program practices. 

Making these changes requires a project plan and

oversight by a project team.

In this chapter you will learn

• How to form a project team,

• How to develop a project quality improvement

plan, and

• How to monitor the project and continuously

improve the program.

After reading this chapter, you will be able to pursue

a concrete process of translating ideas into practice,

thereby maximizing the quality of your HUD-VASH

program.

Introduction to Using this Resource Guide

As you read through the following chapters of the

HUD-VASH Resource Guide for Permanent Housing 

and Clinical Care, you will see descriptions of

practices that you are already using. You may also

read about practices that are different from how

your individual program currently operates. There

are Key Practices sections at the end of chapters

4 through 8 which summarize the major practice

recommendations from each chapter. Give special

consideration to practice recommendations that

differ from your current practice. Our hope is that

some of the differences between this Resource 

Guide’s description of practices and your current

practices will spark ideas about how your program

could be improved. Ideas for program improvement

are wonderful; however, ideas do not benefit

the lives of the Veterans we serve until they are

brought into practice. The purpose of this chapter

is to provide you with a concrete process that your

particular HUD-VASH program can follow in order

to bring these ideas into practice. This process

includes forming a project team to identify areas

for improvement, create an action plan, monitor

the project, and establish a process to continually

improve the program. 

Form a Project Team

While individual Case Managers may be able to

implement some of the ideas in this Resource 

Guide on their own, significant improvement

in your program will only occur if changes are

implemented systematically across your program. 

Changing how an entire program functions is

not an easy task. Thus, we strongly recommend

the formation of a project team to take on this

task. Appointing a project team and giving them

a mandate to implement program improvements

creates accountability that increases the chances

that changes will actually occur. It also spreads

the work of changing a program over a number

of staff members so that no single staff member is

overburdened with the effort.

Your project team should be large enough so that

the work can be divided up in pieces that will

not be overly burdensome on team members,

but small enough that every team member can

meaningfully participate. Groups with six to ten

members generally work well. Teams that are much

larger than this tend to be less efficient. It is always

possible to break teams into smaller sub-groups to

tackle smaller tasks. You may need to bring more

people into the team once you are underway or

replace some individuals who will naturally become

less involved as the project evolves.

PART 1 C H A P T E R 2

How to Develop a HUD-VASH Project Plan
18 H U D - V A S H R E S O U R C E G U I D E

When considering the makeup of your team, look

for a good mix of thinkers and doers. It is helpful

to include staff with a range of experience. More

experienced staff members have more knowledge of

how your program currently operates and will better

understand the resources and constraints within

your VA. Newer staff members, however, bring new

perspectives and see new possibilities. Newer staff

members also gain valuable skills working alongside

more experienced colleagues. To form a team that is

enthusiastic and motivated, recruiting volunteers is

preferable to assigning a team. 

Once team members have been selected,

leadership roles should be decided. We recommend

designating a chair to set meeting agendas and

facilitate meetings. You may also want to designate

an assistant chairperson to lead in the chairperson’s

absence and a secretary to take and distribute

meeting minutes. 

Establish a Team Process

Once your team is formed, it should meet regularly. 

We recommend meeting every two weeks. 

Meeting less frequently than this tends to undercut

momentum. Meeting more frequently tends not to

be productive because team members have not had

time to do enough work to merit discussion. There

may be periods during the project where it may

make sense to meet more or less often depending

on circumstances. A regular meeting time cuts

down on time spent scheduling meetings and helps

ensure that staff will be available to meet.

Building accountability into your team process is

important for keeping your project moving. Without

accountability, team members will end up putting

time into their other work responsibilities for which

they are accountable. There are several ways to

build in accountability. One way is to have the team

announce their project goals to program leadership,

the entire staff, and/or the administration. The more

public the announcement is, the more accountable

staff will be for meeting those goals. Another

important accountability tool is meeting minutes. 

Meeting minutes help keep track of who agreed to

do what, by when, and foster accountability within

the team. They also help keep team members who

miss meetings up to date. Finally, it is helpful to

have a mechanism for staff to report the team’s work

to program leadership on a regular (monthly) basis. 

This can either be an oral update given at a regularly

scheduled meeting and/or brief written reports

submitted at regular intervals.

Choose a Focus

It is not possible to change everything at once. In

fact, it is often more effective to start small and build

upon success. This Resource Guide may provide you

with many ideas on how your program could be

improved. We recommend that you choose only

one or two changes to implement initially. Once

these changes are successfully up and running, you

can then move on to other improvements. This

process of identifying areas for improvement and

then implementing changes to address these areas

can become an ongoing part of your program. Such

a process is called Continuous Quality Improvement

(CQI) and is a requirement for CARF accreditation. 

It may be that after reading the Resource Guide, your

program’s staff clearly agrees on what programmatic

change would be most beneficial to the Veterans

in your HUD-VASH program. If so, we encourage

you to trust the collective wisdom of your staff. 

If there is no consensus among your staff, we

encourage your project team to think carefully

about this before proposing a change. It may be

helpful to systematically review each section of this

Resource Guide and identify discrepancies between

your current practices and the recommendations

provided throughout this document. These

discrepancies may suggest possible program

improvements for your project team to consider. Pay

particular attention to the Key Practices identified

at the end of chapters 4 through 8. The Program 

Improvement Tool may be helpful in organizing this

information. An example of a completed Program

Improvement Tool can be found on the following

page.

Once you have compiled a list of potential program

changes, you will need to prioritize this list to

decide what to address first. You can prioritize each

potential improvement using a “high”,“medium”,

“low”scale after considering the following factors:
H U D - V A S H R E S O U R C E G U I D E 19 

• Impact: What change will yield the biggest

positive impact for Veterans served in your

program?

• Evidence base: What change will help move the

program to better match the evidence base?

• Fit: Does the practice described in this Resource 

Guide make sense in your VA with the Veterans

that you serve? For example, what makes sense

in an urban environment may not work in a rural

setting.

• Capacity: Capacity refers to resources (e.g.,

staff, skills, training, and facilities). Do you have

the resources to devote to making the change? 

Even with resources, do you have the authority

to change the current practice?

• Difficulty: Which changes have the highest

probability of success? How long will it take

to implement each change? Sometimes it is

best to accomplish a small goal in order to

build momentum for future changes that are

more ambitious. We recommend that you pick

something for your first project that you are

confident you can successfully complete in

three months or less.

Record the rationale for your prioritization of each

potential improvement so that you can compare

rankings and explain them to others.

Program Improvement Tool

Section Suggestion Current Practice Possible 

Improvements

Priority Rationale for Priority

Housing

Level

Case

Management

Develop longer term

plan – look at nonimmediate needs such

as education, career

goals, social/family reconnections, recovery

and wellness

Once Veteran is

stabilized in housing,

contact with Veteran

typically diminishes

substantially before

a long term plan

is firmly in place. 

Other Veterans with

immediate needs

take priority, so long

term planning never

occurs.

Begin discussion of

long term goals in

Phase 1 to help build

Veteran’s motivation

for change and growth. 

Require long term

goals in Housing

Stabilization Plan. 

Review these goals and

progress towards them

in all case conferences.

Create a resource list

specifically targeting

education and careers

to help case managers

link Veterans to

relevant community

resources in these

areas.

Medium

High

This potentially has a big

impact for Veterans and is

in line with motivational

interviewing; however, it

will be time consuming

for Case Managers and

will require supervisor

monitoring.

This could be modestly

to very helpful for

Veterans, depending on

the identified resources. 

Although this involves

a modest amount

of upfront work and

some ongoing work to

maintain, it would not

add substantially to Case

Managers’workload.
20 H U D - V A S H R E S O U R C E G U I D E

Program Improvement Tool

Section Suggestion Current Practice Possible 

Improvements

Priority Rationale for Priority

Create a Plan

Once your team reaches consensus on a project

focus, it is important to move quickly into planning. 

Team members need to see that this project is

more than discussion of appealing ideas in an

endless series of meetings–that it is a process that

can lead to concrete programmatic changes and

improvements in Veterans’ lives. Teams will remain

motivated if these connections are evident and will

lose momentum if progress stalls. Detailed plans are

important to the success of program improvements. 

Without them, details can fall through the cracks,

reducing the effectiveness of your work. Although

planning takes time, it is very important. The time

you spend on creating a clear plan saves time and

resources later, while also increasing your chances

of reaching better outcomes for Veterans. You can

also use a detailed plan to help you monitor what’s

working or not working well so adjustments can be

made to improve your program’s functions.

To develop your project plan, you will make a

detailed list of all the activities that will need to take

place in order to bring about the change. Project

activities may include securing additional resources,

changing program policies and procedures,

recruiting new staff, training staff in an evidencebased practice, etc. For example, if you plan to use

Peer Specialists, you will need plans to recruit, train,

and supervise these Peers. You may also need to

factor in transportation arrangements for activities. 

Creating a project plan now can help you ensure that

you’re ready to implement a change. The project

plan ensures that you’re staying on track. The details

of a project plan include
H U D - V A S H R E S O U R C E G U I D E 21 

• Descriptions of all types of activities needed

to effectively prepare for implementation,

including administrative tasks, policies and

procedures, training, creation of materials,

recruitment, and evaluation

• Timelines and due dates for activities

• Task delegations, including specifying who is

responsible for each activity

• Resource needs and options for obtaining them

The Project Planning Tool on the following page

may be helpful in organizing this information.

Project Planning Tool

Activities By when will this 

be done? When will 

this occur?

Who is responsible? Are any resources needed? 

Where will you get them?

Date Completed

Monitor Your Plan

The best project plan in the world is only helpful if it

is followed. In order to ensure that your project plan

is followed, we recommend that you consider how

to monitor its implementation before putting it into

action. Understanding how well you implemented

program changes gives you a more complete picture

of whether or not these changes are contributing to

better outcomes for the Veterans you serve. It can

also show you immediate and important places to

make midcourse corrections that will help improve

your program’s operation.

• Have your team look back at each activity listed

in your completed project planning tool and ask

• How will we know if this activity occurred?

• How will we determine whether this activity was

performed well?

• When will we monitor this activity?

• Who will be responsible for monitoring this

activity?

The answers to these questions do not need to

be complicated. For example, meeting minutes

and attendance records can be used to verify that
22 H U D - V A S H R E S O U R C E G U I D E

meetings, classes, or trainings took place. Final,

approved copies of documents can be used to

verify that changes were made to policies and

procedures. Many evidence-based practices include

fidelity measures that can be used to determine the

success of a program’s implementation. You may

also choose to use Veteran satisfaction surveys,

interviews, or focus groups with either Veterans or

program staff to determine the quality with which

activities are implemented. The Project Monitoring 

Tool on the following page is helpful for organizing

this information. 

In addition to monitoring each activity in your plan,

it is also important to think about monitoring the

impact of your overall project. How will you know

whether your project is working overall? What

will be the impact on Veteran outcomes? Will your

project improve housing stability, employment,

sobriety, social support, or Veteran satisfaction

with services? Think about the ways in which

you will measure its impact, how you will get that

information, and how often you should review it to

make sure your program is on track. 

Project Monitoring Tool

Activities Monitoring Method When will monitoring 

occur?

Who is responsible?
H U D - V A S H R E S O U R C E G U I D E 23 

Continuous Quality Improvement

As you monitor the implementation of your project

plan, it’s important to take time to review the

information that you are collecting to see what

should be fine-tuned to make things work better. 

A common business strategy, called Continuous

Quality Improvement, or CQI, can help you do

this. Continuous quality improvement means that

feedback is collected from evaluation information

and considered on a regular basis in order to

improve program quality.

A process to review such information should be

scheduled at regular intervals. The review meeting

should focus on making sense of the data you have

collected to monitor your project. The meeting

can also focus on problem solving. For example, if

you are being prevented from executing an activity

in your project plan, you may bring this issue to

the review meeting and have members help you

brainstorm possible solutions. Another example

may be that you get input at these meetings about

making a decision on whether to continue or change

course following the execution of an activity from

the project plan. Consider monthly, in-person

reports to program leadership.

In sum, the purpose of these meetings is to

• Find out whether your project plan is on track or

in need of revision,

• Make sense of the data collected to monitor

your plan and decide on next steps,

• Provide input to fine tune and revise the project

plan or tasks along the way, and

• Provide encouragement and recognition to the

project team.

Once your project is up and running, your review

process should also consider the overall impact of

your project. Have Veterans benefited from the

changes you have implemented? 

Once you have collected information on the project’s

impact, you are ready to make the decision about its

future. There are essentially three options:

1) CONTINUE. If the results indicate the project

is working as hoped, then continuing it is

the right choice. To do this, it will be important

to ensure that the new practices introduced

by your project become part of the routine

operations of your program. This means you

may need to think about

• Resource availability (are there adequate

resources to continue?),

• Dissemination (how will relevant staff,

including future new staff, be made aware of

it?), and

• Training (how do we ensure that staff have all

the information they need to make this part of

their routine?).

2) MODIFY. If the new practices showed

potential, but did not go exactly as intended

(either not totally implemented as planned

and/or lacking all the desired impacts), then it

may need to be modified. This means that

the project team should come together to think

about revising the project plan, implementing

further changes, and then monitoring and

evaluating it again.

3) DISCONTINUE. If the project was

implemented well, but did not have any of the

desired impacts, then the right choice may be

to discontinue it and try something else

altogether. You may want to re-visit the ideas

in your completed Program Improvement Tool.

By repeating the process outlined in this chapter,

HUD-VASH programs will move their programs closer

to the recommended HUD-VASH model described in

this guide and, in so doing, realize better outcomes

for the Veterans that they serve. 

Now that you have an idea of the process to use

with this guide, look through the following chapters

and consider how your existing program can be

improved. Use the Program Improvement Tool

on page 20 and in the Appendix to record your

thoughts.
24 H U D - V A S H R E S O U R C E G U I D E

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about Creating

a Project Plan. 

1) Appointing a project team prevents any one staff

member from becoming overburdened with the

effort.

2) Groups with 2-3 team members usually work well.

3) The project team should be made up of the most

experienced staff members.

4) Project teams are more successful when staff

members volunteer to participate.

5) One example of a plan element is task delegation.

6) Veteran satisfaction surveys are one way to

monitor progress on a project plan.

Are you an Expert? Answer these questions on your

own or with other members of your team. 

1) Your team may have many program

improvements that it would like to make. What

are some important steps for prioritizing which

will be addressed first?

2) Imagine that your team is finding that once

a Veteran is housed, long term planning

never seems to occur because other Veterans’

immediate needs take priority. What possible

improvements could your team make to better

address long term planning?

3) Securing additional resources is one example of

an activity that makes program improvements. 

What are some others?
H U D - V A S H R E S O U R C E G U I D E 25 

After reading this chapter, you will have a clear sense

of how to“screen-in”those most in need of HUDVASH. You will also have concrete assessment tools

to use in your daily work.

Who is eligible for HUD-VASH? 

The HUD-VASH program targets the most vulnerable,

most needy, and chronically homeless Veterans in

our country–those who, but for long-term housing

assistance and supportive services–would not be

able to successfully exit homelessness. It targets

those Veterans that are in and out of shelters,

emergency rooms, and inpatient mental health

treatment programs; and those who have not

been able to achieve stable long term housing

and, as a result, are unable to fully engage in

treatment services or maintain steady, safe housing.

Eligibility for HUD-VASH, therefore, avoids the

usual preconditions that often prevent chronically

homeless Veterans from entering housing programs

or obtaining other forms of housing assistance. The

only screening criteria that apply to HUD-VASH

applicants are outlined below.

What’s in This Chapter? 

HUD-VASH is a limited resource with unique

features that enables the VA and HUD to serve

the most vulnerable, most needy (in need of long

term psychiatric and medical services to maintain

housing), and chronically homeless Veterans

with tools never before available. Determining

which Veterans are best suited for HUD-VASH is an

important part of ensuring that these resources go

to their highest and best use.

In this chapter you will learn

• Methods for assessing both housing

requirements and clinical service needs,

including how to conduct a Comprehensive

HUD-VASH Assessment;

• HUD-VASH screening criteria;

• Standards for HUD-VASH enrollment; and

• Alternate Veteran-specific housing resources, if

applicable.

Maximum Screening Criteria for HUD-VASH

Homeless Status Family Status VA Status PHA Status

HUD-VASH“screens in”the

most vulnerable homeless,

many of whom meet HUD’s

definition of chronically

homeless. All must meet the

HUD/McKinney-Vento Act

definition of homeless. *

HUD-VASH serves individual

Veterans and those with

dependent family members.

HUD-VASH does not require

treatment. Veterans must

have eligible discharge

status, be eligible for VA

medical services, and be

willing to meet regularly with

a Case Manager.

HUD-VASH eliminates all

PHA screening except for

the prohibition on Veterans

or family members who are

lifetime registered sexual

offenders.

PART 1 C H A P T E R 3

Is HUD-VASH the Right Program?

Eligibility and Assessment
26 H U D - V A S H R E S O U R C E G U I D E

* The Federal Definition of Homelessness can be

found at http://portal.hud.gov/hudportal/HUD?

src=/topics/homelessness/definition

The Housing and Services Needs 

Assessment 

To determine which Veterans truly need HUD-VASH

and which Veterans would be better served through

other housing options, jurisdictions should use

a Housing and Services Needs Assessment. This

Housing and Services Needs Assessment should be

conducted in two parts. First, housing needs and

service needs should be evaluated as two separate

but interrelated domains. Second, the Veteran’s own

preferences must be considered. 

HOUSING REQUIREMENTS AND SERVICE NEEDS

When assessing housing needs, it will be helpful to

consider the following questions. Please note the

importance of identifying the number of dependent

family members that will be included in the housing

unit (see footnote on page 27).

1) What is the Veteran’s current housing situation

(i.e. is the Veteran homeless, precariously

housed, doubled up, in own housing but facing

housing loss/eviction, or stably housed)?

2) What has been the Veteran’s history or pattern

of housing stability/instability? If the Veteran is

currently homeless, how long has the Veteran

experienced homelessness? If the Veteran

has a history of homelessness, how many

times and how recently has the Veteran been

homeless?

3) What is the Veteran’s track record and

experience with having an apartment,

maintaining a home, and/or paying rent?

When determining what level of service intensity is

most appropriate to help the Veteran achieve his or

her recovery goals, ask the following:

1) Does the Veteran have complex service needs

or health conditions (e.g. serious mental illness,

substance use disorder) or multiple barriers

to independent living? Does the Veteran

need service supports connected to housing

indefinitely in order to exit homelessness?

2) Does the Veteran have non-chronic service

needs that, with appropriate treatment or

services, could be overcome or managed?

3) Does the Veteran have few or minor service

needs, but is otherwise able-bodied and

employable?

The Housing and Services Needs Assessment can

also incorporate a bio-psycho-social approach that

evaluates the Veteran’s ability to meet tenancy

obligations. Standard tenancy obligations that may

be important to consider are listed below.

• Payment of rent and utilities

• Allowing other tenants the peaceful enjoyment

of their homes

• Maintaining a safe and healthy living

environment

• Not engaging in violence or criminal activity

• Allowing only those on the lease to live in the

unit

• Complying with all other lease requirements

and building rules

It is important for the Veteran and the Case

Manager to consider the comprehensive picture

of responsibilities and obligations and to explore

how these align with the Veteran’s treatment and

recovery goals. Ensuring that the Veteran tenant

remains stably housed is the core of housing

stabilization case management work. 

Once the Housing and Services Needs Assessment

has been completed, use the following chart to

determine the most appropriate housing option.
H U D - V A S H R E S O U R C E G U I D E 27 

Targeting Veterans for HUD-VASH

 vs. other VA programs should involve a

consideration of housing needs 

and service needs as two separate

but interrelated domains.

HOUSING NEEDS

Low

Veteran is currently and

stably housed (rents or

owns home or resides in

with family members),

though may have

occasional problems

paying housing costs

Moderate

Veteran is currently

housed, at imminent

risk of housing loss

due to eviction,

has had history

of housing crises/

homelessness,

or is housed in a

temporary setting

High

Veteran is currently

homeless and has had

history of housing

instability and

homelessness

SERVICE NEEDS

Low

Veteran is able-bodied, connected

to workforce, and few barriers to

employment, self-sufficiency, and

activities of daily living

Standard VA

Services/Benefits

Supportive

Services for

Veteran Families

Supportive

Services for

Veteran Families

Moderate

Veteran has some barriers to

employment, self-sufficiency, or

activities of daily living, which can

be overcome or attenuated through

services and treatment

VA Treatment

Services

Supportive

Services for

Veteran Families

or Grant and Per

Diem

Supportive

Services for

Veteran Families

or Grant and Per

Diem

High

Veteran has multiple and complex

barriers to employment, selfsufficiency, and activities of daily

living, such that services are needed

on an ongoing basis

VA Patient-Centered

Health Home

HUD-VASH HUD-VASH

CLIENT PREFERENCES

When matching clients with housing options, it

is critical to consider not only what each Veteran

needs, but also what he or she wants. Explore

motivations, preconceived notions, fears, or

limitations behind certain preferences (e.g., the

Veteran may only be considering one neighborhood

because that is the only area where he or she

knows the public transportation system). Consider

solutions to these problems, or ways that the Case

Manager or Peer Support Specialist might help

introduce alternatives. However, in the end, when

considering the Veteran’s preferences, remember

that failure to meet defined bottom-line needs can

result in failed housing arrangements.

Some of the key housing features to discuss with the

Veteran are

• Location,

• Household composition (including pets)1

,

• Size and type of unit desired,

• Transportation needs,

• Environmental or ADA (or other“reasonable”)

accommodations required (e.g., elevator, ramp),

• Safety/security features, especially in cases that

involve a history of violence or abuse,

• Proximity to supports/significant other/services/

children’s schools, and

• Availability of support“attached”to the housing.

Ask the Veteran to rank his or her top three

preferences and explain his or her most important

needs to help you understand where the Veteran is

willing to compromise and what the “dealbreakers”

are.

1 It is very important that the entire household that will be living with the Veteran be identified at the time of referral to the PHA to assure that an appropriate unit size is identified and because the limitations on PHA screening refer to

all members of the family referred to the PHA.
28 H U D - V A S H R E S O U R C E G U I D E

Some people may be hard to engage in the housing

conversation, especially those who have been

homeless for a long time or have who have had bad

experiences with other service providers. Strategies

for drawing the Veteran into the discussion include

• engaging in repeated, non-intrusive patterns of

interaction;

• respecting boundaries;

• allowing time for trust to develop;

• listening to what the Veteran wants;

• creating space for information to unfold over

time;

• assisting the Veteran with plans, services, and

resources to meet identified needs;

• clearly explaining how you can be helpful; and

• remaining patient yet persistent.

Is HUD-VASH the right program? 

Following screening and the Housing and Needs

Assessment, the Veteran’s application should be

considered in light of the larger objectives of the

program. HUD-VASH is intended to rapidly house

the most vulnerable Veterans. Given the imminent

goal of ending homelessness among Veterans

and with nearly 67,495 Veterans experiencing

homelessness on a single night in January 2011

(2011 HUDPoint in Time (PIT) count), other housing

options besides HUD-VASH are also needed to

achieve this goal. These options include

• Homeless Domiciliary Residential Treatment

programs (short term treatment; average length

of stay is 100 days),

• Grant and Per Diem (transitional housing),

• Supportive Services for Veteran Families

(homeless prevention and rapid re-housing),

and

• Other VA treatment, health, and employment

services and benefits.

Conducting a Comprehensive HUD-VASH 

Assessment

Once the Case Manager has an understanding

of the Veteran’s housing and services needs and

preferences, the Case Manager will conduct

the Comprehensive HUD-VASH Assessment. A

completed Comprehensive HUD-VASH Assessment

will provide deeper understanding of how the

Veteran functions in several key areas that relate to

housing stability, identified by practitioners of the

Critical Time Intervention (CTI) model, a practice with

proven utility for reducing homelessness

(www.criticaltime.org).

Stable housing is critical to the achievement of

other life goals; if possible, the housing plan should

be aligned accordingly. For Veterans who are

entering the HUD-VASH program with their families,

this discussion often needs to also center around

opportunities they’d like to have for their children. 

The Comprehensive HUD-VASH Assessment begins

with questions aimed at understanding the Veteran’s

current goals and preferences. As the assessment

progresses, it engages the client and his or her family

in a discussion of goals, hopes, and aspirations

over the next five to ten years. Case Managers

should help Veterans consider these questions,

develop reasonable plans to further these goals, and

reinforce a focus on the future. All too often, people

are so busy attending to immediate needs that a

connection to longer-term goals and dreams that

helps build motivation for change and growth is lost.
H U D - V A S H R E S O U R C E G U I D E 29 

Comprehensive HUD-VASH Assessment 

Housing and Homelessness History – Last 5 years

Name/Location Type Start End Date Leaseholder Reason for 

Leaving

•	 Restrictions on location? Y or N Explanation

•	 Ever evicted from public or subsidized housing? Y or N

•	 Ever in foster care? Y or N

•	 Barriers to housing stability? e.g., trouble budgeting, visitors create problems, involved in illegal activity, no

experience as lease holder, history of violence

•	 Housing plan

•	 Housing goals

•	 Motivation to obtain/maintain housing

Employment History – Last 5 Years

Employer Position/Title Wage Start End Reason for 

Leaving

•	 Employment goals

•	 Currently receiving services?

•	 Services needed to access or maintain employment

•	 Motivation to obtain employment
30 H U D - V A S H R E S O U R C E G U I D E

Comprehensive HUD-VASH Assessment 

Benefits and Entitlements

Income Receiving Amt and 

End Date

Income Source Amt and 

End Date

Unemployment Income General Assistance

Supplemental Security Income (SSI) Retirement from Social Security

Social Security Disability Income (SSDI) Child Support

Veteran’s Disability Payment Alimony or other spousal support

Private Disability Insurance Unemployment Insurance

Worker’s Compensation Veteran’s Pension

TANF Other (list):

•	 Plan to apply for or maintain income benefits

Noncash Benefits Y or N

Food Stamps Y or N TANF Child Care Services Y or N

Medicaid Y or N TANF Transportation Services Y or N

Medicare Y or N Other TANF-funded Services Y or N

State Children’s Health Insurance Pgm Y or N WIC Y or N

Private Health Insurance Y or N Other: (list) Y or N

•	 Plan to apply for or maintain noncash benefits

•	 Barriers to Obtaining/Maintaining Entitlements:

Debts

•	 Credit status/score

•	 Plan to pay off debts

•	 Barriers to pay off debts

•	 Services needed – pick list

•	 Motivation to resolve credit/debt issues

•	 Goals

Legal

•	 Current probation/parole Status

•	 Name of PO:_______________ Date supervision ends ________________

•	 Felony history last 5 years

•	 Incarceration history – last 10 years

•	 Current involvement – e.g., engaging in criminal activity, current legal proceedings, outstanding warrants,

subject to order of protection, etc.

•	 Child support enforcement status

•	 Services needed

•	 Motivation to resolve legal issues
H U D - V A S H R E S O U R C E G U I D E 31 

Comprehensive HUD-VASH Assessment 

Education History

•	 Highest Grade Completed: Some HS HS Diploma or GED Some College Associate’s Degree 

Bachelor Degree Technical Certification - Field: _____________ 

Other

•	 Current status In school Applying

•	 Education Goals

•	 Services Desired

Physical and Behavioral Health (including Trauma-related illnesses)

•	 Diagnosis: Medical, Mental Health, Substance Abuse, Mental Retardation – Include all axes

•	 Severity of each illness

•	 Treatment history for each diagnosis

•	 Names and contact info for all current service providers - Name, Organization, Phone #

•	 Describe how health issues impact housing stability

paying rent disruptive behavior hoarding noise visitors

Other: ________________________________________________________ . . .

. . . . .

•	 Current medications

•	 Adherence to medication regimen: Almost Always Sometimes Never

•	 If substance abuse diagnosis, current status and impact on functioning

Actively using and not a problem Actively using and a problem Reducing use

Abstinent: Date of Sobriety mm/dd/yy

•	 Frequency of Use: Daily Several Times Per Week Once a Week Less than 1X a Week

•	 Hospitalizations in last 3-5 years: dates, reasons, hospital names

•	 Detox in last 3 years: number of inpatient detox stays

•	 Services needed

•	 Motivation to use services:

•	 Current stage of change: pre-contemplation, contemplation, preparation, action, or maintenance

•	 Include narrative explanation

Family/Dependent Children

•	 Domestic violence/abuse history

•	 School attendance/performance of children

•	 Child custody

•	 Child care arrangements

•	 Special needs

•	 Children’s services (foster care) Involvement – status, worker name and contact

•	 Current services providers and contact information

•	 Services needed

•	 Motivation to use services
32 H U D - V A S H R E S O U R C E G U I D E

Comprehensive HUD-VASH Assessment 

Independent Living Skills/ Supports

•	 Status of ID for all household members

•	 Nature of social and familial relationships – identify supports and significant others, also identify negative

influences and relationships

•	 History of seeking and using help/assistance

•	 Independent Living Skills Score

1 - Mostly Independent 2 - Needs Help Sometimes

3 - Needs Help Most of the Time 4 - Always Needs Assistance

1. Paying bills 1-4

2. Budgeting 1-4

3. Maintaining entitlements and other paper work 1-4

4. Maintaining a home 1-4

5. Preparing/obtaining meals 1-4

6. Travelling 1-4

7. Personal care/hygiene 1-4

8. English proficiency 1-4

9. Awareness of needs and knowing when to seek help 1-4

10. Able to access help when needed 1-4

11. Managing health/behavioral health needs and services, etc. 1-4

12. Taking medications 1-4

13. Keeping appointments 1-4

14. Discriminating danger/asserting and protecting self 1-4

Total score on Independent Living Skills (Range 14-56)

•	 Ability and motivation to improve skills:

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about whether

HUD-VASH is the right program for particular types

of Veterans. 

1) Under Fair Housing laws, PHAs must adhere to the

same screening criteria for HUD-VASH as they do

for all other housing voucher recipients.

2) The VA has recently adopted a 10-Year Plan to End

Veteran Homelessness.

3) Homelessness is defined by the local housing

authority.

4) If a Veteran has high service needs but low

housing needs, the Veteran may be better served

by a patient-centered medical home (or health

home) than HUD-VASH.

5) Understanding tenancy obligations is important

for the Case Manager.
H U D - V A S H R E S O U R C E G U I D E 33 

Are you an Expert? Answer these questions on your

own or with other members of your team. 

1) Can you name three Veteran-specific housing

programs?

2) What are the key housing-related questions to ask

when performing a Housing and Services Needs

Assessment?

3) If a Veteran came to the VA seeking assistance

from HUD-VASH because he had just lost his job

and was unable to continue paying rent, what

responses could you provide?

4) What are the key housing features to discuss with

a Veteran before searching for an apartment? 
34 H U D - V A S H R E S O U R C E G U I D E

What’s in This Chapter?

The responsibility of the HUD-VASH program,

including voucher allocation and geographic

distribution, is shared by the U.S. Departments of

Housing and Urban Development and Veterans

Affairs. Thus, this partnership represents interagency

cooperation at the highest level. While the oversight

of HUD-VASH is dependent upon an alliance at the

federal executive level, the successful operation

of HUD-VASH is dependent upon functional

relationships at the local level. Additionally,

collaboration between individual Veterans

Administration Medical Centers (VAMCs) and local

Public Housing Authorities (PHAs) is also critical to

the success of the program. While VAMCs receive

additional staffing for HUD-VASH, PHAs do not. 

Therefore, VA HUD-VASH team members will need

to take on the responsibility of learning to navigate

through PHA’s—getting to know staff, learning PHA

lingo, becoming familiar with PHA practices and

rules—in order to best help the Veterans they serve.

In this chapter you will learn

• How the housing subsidy provided in HUDVASH works, including key functions such as

housing inspections, rent calculations, voucher

portability, and payment standards;

• How to support HUD-VASH applications with

proper documentation; and

• How to manage reasonable accommodations

for Veterans with disabilities.

PART 1 C H A P T E R 4

All about Vouchers

After reading this chapter, you will have working

knowledge of PHA rules and requirements, which

will enable you to engage your PHA partners and

support Veterans in meeting requirements for their

housing vouchers. 

Introduction to Housing Choice Vouchers

Veterans participating in the HUD-VASH program

will receive a long-term housing subsidy through

HUD’s Housing Choice Voucher Program (HCV). This

program is the successor to the ‘Section 8’program,

and is often called by that prior name. 

The HCV program is administered locally by

public housing authorities (PHAs). The PHAs are

responsible for conducting the intake process for

eligible families, verifying income and calculating

subsidy amounts, inspecting units to assure that

they meet quality standards, and processing subsidy

payments to landlords. The PHAs also conduct

annual income re-verifications and housing unit reinspections.

HCVs are primarily used to provide tenant-based

rental assistance. HUD provides the difference

between an affordable tenant payment (usually 30%

of adjusted income) and the cost of decent, standard

housing in the community. 

VA and the PHA have separate criteria for

determining both initial and continuing eligibility. 

The following chart summarizes the roles and

responsibilities as a Veteran goes through the

application process and then transitions to longterm housing assistance.
H U D - V A S H R E S O U R C E G U I D E 35 

ELIGIBILITY DETERMINATION SUMMARY

ISSUE ROLE (Primary Responsibility Indicated by Shaded Area)

VA PHA

Priority of 

Assistance

Program assignment and assistance priority is determined by

VA.

Participating PHAs have no

role in determining priority of

assistance, homeless status, VA

eligibility, or service intensity

requirements.

Homeless Status

The VA will evaluate the Veteran’s homeless status using the

definition of‘homeless’ in the McKinney-Vento Act, 42 U.S.C.

11302.

Health Care 

Eligibility 

Determination

The VA determines whether the Veteran is eligible for health

care services from the Department of Veterans Affairs.

Eligibility Based 

on Service Record 

and Discharge 

Status

The VA determines whether the Veteran is eligible based on

the nature of the separation from active duty. Requires DD214.

Case 

Management 

Needs

The VA determines whether the Veteran is willing to

participate in case management services provided by the VA. 

Failure to participate in case management can be grounds

for the VA to terminate or deny the Veteran’s participation in

HUD-VASH. If the VA determines that the Veteran no longer

requires case management services, the Veteran can continue

to receive the HUD-VASH housing subsidy.

Income Threshold

HUD-VASH Case Managers should discuss income eligibility

requirements prior to application with the PHA. This

discussion should include consideration of disability/

education/caregiver support benefits, etc., as well as any other

subsidies, and should also set realistic goals for budgeting.

The PHAs are responsible for

doing the intake process for

eligible families, verifying

income, and calculating subsidy

amounts. PHA may deem the 

applicant ineligible if the 

income threshold is exceeded.

Sexual Offender 

Status

Case Managers should work with the Veteran and his or

her family to ensure that these issues are addressed before

application to PHA in order to streamline process.

PHA must refuse application if

any member of the household is

subject to a lifetime registration

under a sex offender registration

program in any state. If the

registered sex offender is a family

member other than the eligible

Veteran, assistance can be

provided if that family member is

permanently removed from the

household. Neither the Veteran

nor any member of his/her

household may be listed on any

lifetime sexual offender registry.
36 H U D - V A S H R E S O U R C E G U I D E

Accommodation 

Suitability 

Determination

Housing search is facilitated by the Case Manager and/or the

Peer Support Specialist, keeping HUD occupancy standards

in mind. The Case Manager and the Veteran should evaluate

potential housing units while considering recovery and

treatment goals.

The PHA is responsible for

inspecting units to ensure that

they meet quality standards.

The PHAs also conduct annual

income re-verifications and reinspections of housing units.

Tenancy 

Obligations

VA Case Managers should be familiar with the obligations of

tenancy, be a secondary point of contact for landlords, and

help Veteran develop money management skills and pay his/

her share of the rent.

The PHA processes subsidy

payments to landlords. In order

to receive the housing subsidy,

the Veteran must abide by the

terms of the lease and pay his/

her share of the rent. When

this does not occur, the PHA

determines whether or not the

Veteran continues in the Housing

Choice Voucher program.

Adding Residents 

to the Housing 

Unit

Case Managers should advise Veterans that the standards

PHAs use to screen participants for initial application to HUDVASH are much different than the normal PHA screening

criteria. Thus, it is very important to work with the Veteran to

identify family members who might eventually plan to live in

the housing.

Family members who do not

meet the normal PHA screening

criteria will not be allowed to

join the family later, except in

cases of birth, adoption, or courtawarded child custody. Although

HUD substantially changed

the requirements for program

intake, it left intact all provisions

that permit PHAs to terminate

program beneficiaries.

The VA has primary responsibility for determining

eligibility to the HUD-VASH program, which includes

• Determining whether the Veteran’s discharge

from the armed forces meets eligibility

requirements;

• Determining whether the Veteran is eligible for

health care services from the Department of

Veterans Affairs;

• Determining whether the Veteran is homeless,

according to the definition set forth by the

McKinney-Vento Act; and

• Determining whether the Veteran is willing

to participate in case management services

provided by the VA. 

Failure to participate in case management can be

grounds for the VA to terminate or deny the Veteran’s

participation in HUD-VASH. If the VA determines that

the Veteran no longer requires case management

services, the Veteran can continue to receive the

HUD-VASH housing subsidy. In such cases, the

Case Manager should notify the PHA that case

management is no longer required by the Veteran

but his/her eligibility for a housing voucher remains

unchanged. If the PHA has a voucher available in its

regular HCV program, the PHA can offer that voucher

to the Veteran and open up the HUD-VASH voucher

for another homeless Veteran. Veterans who are 

being converted from a HUD-VASH Voucher to a 

traditional Housing Choice Voucher do not have 

to be placed on a waiting list; they are already 
H U D - V A S H R E S O U R C E G U I D E 37 

‘participant’ in the HCV program and can receive the

next available voucher from the PHA. 

The VA has sole responsibility for making these

determinations. Participating PHAs have no role in

determining homeless status or in establishing any

priorities for assistance. 

Upon initial referral to the PHA for participation in

HUD-VASH, the PHA may only deny assistance for

two reasons:

1) The family exceeds the income threshold, or

2) A member of the household is subject to a

lifetime registration under a state sex offender

registration program. If the registered sex

offender is a family member other than the

eligible Veteran, assistance can be provided if

that family member is permanently removed

from the household. Neither the Veteran nor

any member of his/her household may be

listed on a lifetime sexual offender registry in

any state.

In tenant-based rental assistance, the Veteran has

the opportunity to choose a housing unit of his

or her choice in the community, provided the unit

meets the following requirements:

• Units must meet Housing Quality Standards

(HQS) established by HUD. The unit must be

inspected by the PHA initially and on an annual

basis thereafter. If a unit does not meet the HQS

standards, the landlord can make improvements

and request a re-inspection.

• The rent charged for the unit must be

determined by the PHA to be reasonable.

• “Reasonable”means that the rent is comparable

to that charged for similar non-luxury housing in

a similar location with similar amenities. 

• The unit must be affordable to the Veteran. 

Under the HCV program the Veteran will receive

a subsidy limited to a ‘payment standard’

established by the PHA based on HUD’s Fair

Market Rent guidelines. The housing subsidy

can be no greater than the difference between

the PHA’s Payment Standard and the Veteran’s

required rent payment (the tenant’s rent

payment is explained in the following pages). 

• The landlord must be willing to rent to the

Veteran after whatever screening the landlord

normally performs. Additionally, the landlord

must be willing to enter into a lease with the

Veteran, and this lease must adhere to the terms

required by the PHA.

In order to receive the housing subsidy, the Veteran

must abide by the terms of the lease and pay his/

her share of the rent. Significant and/or repeated

lease violations, including failure to make monthly

rent payments, can potentially lead to eviction (only

permitted upon court order) and termination from

the Housing Choice Voucher program by the PHA.
38 H U D - V A S H R E S O U R C E G U I D E

Securing Housing Assistance under HUDVASH

The flow chart presented below outlines the process

for securing housing assistance through the HUDVASH program. The point of entry is always through

the Department of Veterans Affairs; the VA will refer

eligible Veterans to the PHA for processing.

Figure 1: HUD-VASH Housing Process

Eligible Veteran 

is referred to 

HUD-VASH by 

provider or self

Within 15 

days

Conduct formal 

intake, Veteran is 

admitted into 

HUD-VASH

Within 30 

days

Voucher issued 

by PHA

Within 14 

days

Meet with 

Veteran to 

discuss plan for 

housing search

Veteran views at 

least one unit

Within 30 

days

Veteran locates 

unit, unit passes 

PHA inspection, 

Veteran signs 

lease, moves in

Within 120 

days

Conduct home 

visit

Within 7 

days

Conduct at least 

two home visits

Within 30 

days

Conduct at least 

one home visit 

per month 

thereafter
H U D - V A S H R E S O U R C E G U I D E 39 

Public Housing Authority Documentation

PHAs are required to obtain verification of

information provided by applicants for HCVs.

Identity Verification

The PHA must obtain a Social Security Number (SSN)

for all household members. Original documents

issued by the VA providing the name and SSN of

the Veteran will satisfy the PHA SSN documentation

requirement. Acceptable SSN documentation

includes

• Original SSN card issued by the Social Security

Administration;

• Original SSA-issued document which contains

the name and SSN of the individual; or

• Original document issued by a federal, state, or

local government agency which contains the

name and SSN of the individual.

Income Verification

PHAs must next verify the income of the Veteran

and the Veteran’s family in order to determine

whether they meet the income limitations for the

program. The income limitation applies only to the

initial application to enter the program. HUD has

detailed rules regarding which sources of income

(both earned and benefit income) must be included

when determining income eligibility. HUD-VASH

Case Managers should stay abreast of policy changes

and alterations to available benefits. For example,

as of May 2010, HUD has determined that benefits

received under the VA’s Incentive Therapy (IT) and

Compensated Work Therapy (CWT) programs must

be counted as part of the Veteran’s income. 

HUD-VASH Case Managers can expedite the process

of determining and verifying income by PHAs. 

HUD rules allow PHAs to accept original third party

verification of income supplied by applicants for

HCVs. To ensure that Veterans experience minimal

delays in processing, it is recommended that HUDVASH Case Managers assist Veterans in assembling

documentation (from third party sources). This will

expedite processing by the PHA, which, in turn, will

expedite the housing search.

Understanding the Housing Subsidy 

Provided under HUD-VASH

Veterans enrolled in HUD-VASH receive a Housing

Choice Voucher (HCV). Receipt of a HCV requires

that Veterans abide by the terms of their lease,

including rent, otherwise known as the ‘Total Tenant

Payment’. In the HCV program the Total Tenant 

Payment is the greatest of

• 10% of the Veteran’s family’s gross income,

• 30% of the Veteran’s family’s adjusted income, or

• Welfare assistance grant for housing expenses.

Additionally, PHAs have the option of requiring a

minimum rent. The minimum rent would apply

when the Total Tenant Payment (calculated above)

is less than the minimum rent. For example, if the

Veteran had no reportable income and, therefore,

no required rental payment, the PHA would charge

the minimum rent. The minimum rent may not

exceed $50. Veterans whose inability to pay the

rent is based upon a hardship which is likely to be

permanent can apply to the PHA for a hardship 

exemption to the minimum rent.

Hardship Requests

PHAs are required to grant exemptions to the

minimum rent when the Veteran is unable to pay the

rent due to long-term financial hardship. Examples

of financial hardship can include

• Risk of eviction because of difficulty paying the

minimum rent;

• A decrease in earned income resulting from job

loss, reduction in hours, etc.;

• Lag in benefits as Veteran waits for eligibility

determination for federal, state, or local

assistance programs; or
40 H U D - V A S H R E S O U R C E G U I D E

• A death in the family or other change in

household composition accompanied by a

reduction in family income.

When a Veteran requests a hardship exemption, the

PHA must

• Temporarily suspend the minimum rent charge

and adjust the subsidy payment for the Veteran. 

This is effective on the 1st of the month following

the change in the Veteran’s circumstance.

• Evaluate the hardship exemption and determine

whether it is long-term or temporary. The PHA

is not required to grant an exemption to the

minimum rent if it finds that the hardship is

temporary. If the PHA finds that the hardship

is temporary, the minimum rent is reinstated

retroactively to the date of suspension. The PHA

must offer a reasonable repayment agreement

for the minimum rent charges accumulated

during the suspension.

Maximum Subsidy in the HCV Program

HUD will never provide a subsidy greater than the

difference between the payment standard for a unit

of appropriate size for the Veteran’s family and the

total tenant payment paid by the Veteran. HUD

establishes a Fair Market Rent (FMR) schedule for

all metropolitan and non-metropolitan areas in

the country. This is considered to be the cost of

standard, non-luxury housing (including necessary

utilities) in the community. Each PHA is allowed to

establish a payment standard between 90% and

110% of the FMRs in the community. 

While a lower payment standard will allow the PHA

to subsidize more units in the community, it may,

however, also make it more difficult for program

participants to find suitable housing. A higher

payment standard will make more units available for

the program, but it may also result in fewer families

being served through the program.

The maximum subsidy is the difference between the

payment standard for the appropriate unit size (or

the unit size actually rented – if the unit is smaller

than the participant would have been eligible for)

and the Total Tenant Payment by the Veteran. 

The Housing Choice Voucher Program Guidebook 

(http://www.hud.gov/offices/adm/hudclips/

guidebooks/7420.10G/) provides a step by step 

guide to documentation requirements for verifying 

income, assets and deductions from income at the 

end of Chapter 5. Case Managers should review 

the requirements and assist Veterans in assembling 

the materials required by the PHAs.

Income Adjustments in the HCV Program

HUD allows 5 deductions to gross income. It is

important that Veterans access all the income

adjustments to which they are entitled. These

adjustments will, in most cases, reduce the Total

Tenant Payment and, therefore, decrease the

amount of money the Veteran has to pay ‘out of

pocket’to cover his or her housing costs. Two of

the adjustments apply to all households in the HCV

program; three are limited to households headed by

persons with disabilities. These adjustments are as

follows:

• All households are eligible for a dependent 

deduction of $480 per year per dependent. 

Dependents are persons under 18 years of

age or full time students. Foster children are

not considered dependents and neither the

household head nor co-head can qualify as a

dependent. Each dependent in the household

qualifies for the $480 per year deduction.

• Households are allowed to deduct‘reasonable’ 

childcare expenses. Childcare is provided

for when it is necessary to allow an eligible

household member to work or to attend an

educational program focused on increasing

job skills/employability. By ‘reasonable,’HUD

means that the costs should not exceed those

incurred by typical households for child care. 

The deduction for childcare cannot exceed the

earnings through employment of the household

member taking the deduction.

• Households headed by an elderly or disabled 

person are entitled to an annual income

deduction of $400. Only one deduction of

$400 is permitted for each eligible household. 
H U D - V A S H R E S O U R C E G U I D E 41 

Elderly is defined as 62 and over; if the Veteran

is disabled according to HUD’s definition, the

household is also eligible for the deduction.

• Elderly or Disabled households are allowed to

deduct‘excess medical expenses.’ These are

expenses that are in excess of 3% of their annual

gross income. Although the household must be

elderly or disabled to qualify for this deduction,

all medical expenses of all household members

are considered. 

Medical expenses include

• services of a physician or other health care

professional,

• services of a hospital or health care facility,

• medical insurance premiums (including

payments under Medicare),

• prescription and non-prescription medications,

• dental expenses,

• eyeglasses and eye examinations,

• live-in or periodic medical care assistance

(visiting nurses or care attendants),

• medical or health products or apparatus, and

• periodic payments on medical bills.

• Disability expenses can be deducted to the

extent that they exceed 3% of annual income. 

This deduction is intended to permit the

disabled person or other family member to

work. Therefore, this deduction cannot exceed

the amount of income generated by the family

member who is working. Disability expenses

cannot include any expense reimbursed

through insurance or any other source. 

Disability expenses, for example, often include

cost of a care attendant or auxiliary apparatus

that enables a household member, and the

disabled member, to work.

• When a household qualifies for both medical 

and disability expense deductions, the

allowable deduction amount is the amount by

which the combined expenses exceed 3% of

annual income.

Many of the allowable deductions for childcare,

medical expenses, and disability expenses will apply

to homeless Veterans receiving assistance through

HUD-VASH. These deductions can substantially

decrease the amount of money the Veteran will have

to expend each month for housing. It is important

that Case Managers review the deductions,

determine whether the Veteran qualifies for any of

the deductions, and assist the Veteran in obtaining

third party documentation. PHAs are only required

to accept as deductions expenses that are fully

documented by third party sources. 

Housing Persons with Disabilities

In addition to deductions in income for the

calculation of tenant contribution to housing

costs, Veterans with disabilities are eligible for

additional kinds of assistance in the HCV program. 

This includes the right to have the services of

a ‘live-in aide’, the right to request reasonable

accommodations in order to participate in the

program, and eligibility for the earned income

disregard benefit.  As HUD-VASH targets Veterans

who often have severe mental, physical, and/or

substance use disorders, many of these Veterans

will be considered disabled by HUD. IF HUD

determines that the applicant is disabled, he or she

may need to use the special allowances for persons

with disabilities in order to participate in the HCV

program.

Defining “Disability” for the HCV Program

• PHAs are likely to follow the ‘letter of the law’

in terms of determining whether a Veteran is

disabled for the purposes of the HCV program. 

Therefore, this section details the definition

of a person with disabilities according to HUD

program regulations. 

Definitions for the Housing Choice Voucher program

are found in the federal regulations at 24 CFR

5.403,“Definitions.” The definition of a ‘person with

disabilities’means a person who

1) Has a disability, as defined in the Social

Security regulations (42 U.S.C. 423), as

an “inability to engage in any substantial

gainful activity by reason of any medically

determinable physical or mental impairment
42 H U D - V A S H R E S O U R C E G U I D E

which can be expected to result in death, or

which has lasted, or can be expected to last,

for a continuous period of not less than 12

months”; or 

2) Is determined to have a physical, mental, or

emotional impairment that

(A) Is expected to be of long-continued and

indefinite duration,

(B) Substantially impedes ability to live

independently,

(C) Is of such a nature that the ability to live

independently could be improved by more

suitable housing conditions, or

3) Has a developmental disability, as defined

in federal regulations, 42 U.S.C. 6001, that

is severe, chronic, persistent after early

childhood, likely to continue indefinitely,

and which results in functional limitations in

multiple areas of major life activities. 

When the Social Security Agency (SSA) disability

determination applies, it includes anyone who

receives Supplemental Security Income (SSI) or

Social Security Disability Income (SSDI). Individuals

with this designation automatically receive a

disability determination in the HCV program. When

the second case applies, a state licensed clinician

must provide signed certification that a Veteran has

a physical, mental, or emotional impairment that

meets the three criteria above—duration, severity of

impact on independent living, and the potential for

substantial increase in function with improvements

in housing situation.

The definition of disabilities for the Housing Choice

Voucher program also goes on to state that it:

1) “Does not exclude persons who have the disease 

of Acquired Immunodeficiency Syndrome (AIDS) 

or any conditions arising from the etiologic agent 

for Acquired Immunodeficiency Syndrome;

2) For purposes of qualifying for low-income 

housing, does not include a person whose 

disability is based solely on any drug or alcohol 

dependence; and

3) Uses 24 CFR 8.3 to define individual with 

handicaps as any person with a physical or 

mental impairment that substantially limits 

one or more major life activities. For purposes 

of reasonable accommodations and program 

accessibility, “major life activities” means 

functions such as caring for one’s self, performing 

manual tasks, walking, seeing, hearing, speaking, 

breathing, learning and working. 

Persons with disabilities are entitled to additional

benefits to assist in accessing housing through the

HCV program and, under certain circumstances,

are eligible for a special incentive for increasing

their income through employment. Please see the

section below on serving veterans with disabilities

through HUD-VASH. 

Live-in Aides

Many Veterans with disabilities will require

the services of a live-in aide in order to live

independently in the community. HUD defines‘livein aide’ (24 CFR 5.403) as “a person who resides with 

persons with disabilities and who is (1) determined to 

be essential to the care and well-being of the persons; 

(2) is not obligated to support the persons; and (3) 

would not be living in the unit except to provide the 

necessary supportive services.” 

Family members can be classified as‘live-in aides’

provided they meet the requirements of the

definition. For example, the spouse of a Veteran is

not likely to meet the definition of a ‘live-in aide,’

because he or she would generally be obligated

to support the Veteran, and would be living in the

unit regardless of the need to provide necessary

supportive services. However, a parent would not be

considered obligated to support the Veteran, and, in

that case, might not be living in the unit were it not

for the need to provide supportive services. A parent

in those circumstances would meet the definition

of a ‘live-in aide’. The income of individuals meeting

the definition of‘live-in aide’ is not counted when

determining household income and calculating

subsidy benefits under HCV. Additionally, the PHA

must subsidize a unit with sufficient bedrooms

so that, at a minimum, the Veteran and the live-in

aide are able to occupy separate bedrooms. It is

important, however, to note that changes in VA

caregiver assistance laws and updates to caregiver

support programs may result in alterations to these
H U D - V A S H R E S O U R C E G U I D E 43 

criteria. Spouses and other family members may

now be eligible for caregiver assistance benefits,

and this should be considered in light of these

regulations.

Special Program Provisions for Disabled Persons

There are two very important program provisions

that assist people with disabilities in the HCV

program:

• The ‘Earned Income Disregard,’providing

incentives for persons with disabilities to obtain

employment income; and

• ‘Reasonable Accommodations,’ allowing special

provisions for people with disabilities in order

to obtain equal access to federal assistance

programs.

Earned Income Disallowance for Persons with 

Disabilities 

Because the HCV subsidy decreases as income

increases, Earned Income Disallowance for Persons

with Disabilities was created to abolish the

disincentive to increase income by working. Earned

Income Disallowance allows persons with disabilities

the opportunity to have a steady level of subsidy

during the initial period following their return to

employment.

In order to be eligible for this benefit, the Veteran

must be a person with a disability. Additionally,

the Veteran’s increase in income must be a result of

employment – additional income from benefits does 

not qualify for the benefit. Finally, the increase in

income must fit into one of the following categories:

• An increase in income for a person with a

disability who had been unemployed for a year

or more prior to current employment; or

• An increase in income as a result of participation

in an economic self-sufficiency or other job

training program; or

• An increase in income due to employment

during or within 6 months of receiving benefits

from Temporary Assistance to Needy Families

(TANF).

When those conditions are met, the following

benefits may apply.

• For a period of 12 months, starting with the

increase in income resulting from employment,

100% of the additional earned income is

disregarded for HCV benefit calculation. 

Therefore, the housing subsidy is not reduced as

a result of the increase in employment income

for a full year. 

• Starting at the one year anniversary of increased

income due to employment, and for the next

12 months, only 50% of the additional income

earned from employment is considered in HCV

benefit calculation.

• The benefit starts at the time of employment,

and not when the PHA does the income

recertification.

• Should there be an interruption in the period

of employment the benefit is suspended until

earned income again increases. However,

there is a 48 month time limit on the benefit. 

Once a Veteran begins to obtain this benefit,

all eligibility for the benefit will expire after 4

years. Therefore, if the 48 month period elapses

without the Veteran exhausting the 12 month

100% disregard or the second 12 months of 50%

disregard, he or she will lose eligibility for the

balance of the benefit.

Reasonable Accommodations for Persons with 

Disabilities

Section 504 of the Rehabilitation Act of 1973 (as

amended) prohibits discrimination under any

program or activity receiving federal financial

assistance solely on the basis of a disability. The rule

requires that recipients of federal funds (PHAs in

this instance) ensure that individuals with disability

receive an equal opportunity to participate in

programs and services in the most integrated

setting.

Reasonable accommodation: A“reasonable

accommodation”is a change, adaptation or

modification to a policy, program, service, or

workplace that will allow a qualified person with

a disability to participate fully in a program,

take advantage of a service, or perform a job. 
44 H U D - V A S H R E S O U R C E G U I D E

Reasonable accommodations may include, for

example, those which are necessary in order

for the person with a disability to use and enjoy

a dwelling, including public and common use

spaces. Since persons with disabilities may have

special needs due to their disabilities, in some

cases, simply treating them exactly the same as

others may not ensure that they have an equal

opportunity to use and enjoy a dwelling.

Definition of “individual with disabilities” 

under Section 504: any person who has physical

or mental impairments that substantially limits

one or more major life activities has a record

of having such impairments, or is regarded as

having such impairments. According to the PHA

Guidebook, the list of impairments is long and

includes learning disabilities, diabetes, alcoholism,

emotional illness, cancer, heart disease, AIDS,

etc. It does not include current, illegal use of or

addiction to a controlled substance. 

Limitations on reasonable accommodations: 

PHAs are not required to take any actions which

would result in a fundamental alteration in

the nature of the program or undue financial

or administrative burden. PHAs are, however,

required to provide any accommodation

that would not result in an undue financial or

administrative burden or that would not create a

fundamental alteration of the assistance program.

Examples of Reasonable Accommodations for 

Disabled Veterans in HUD-VASH

Application Process

• Additional time to supply information to the

PHA

• PHA briefing on the Housing Choice Voucher

Program provided in accessible format or

location

• Accepting a household whose members might

not meet the PHAs definition of a ‘family’ if the

additional person(s) are important to the care

and well-being of a person with disabilities

Housing Search

• Additional time for the housing search (beyond

the minimum 120 day initial term)

• A higher payment standard (for an accessible

unit or a unit located near transportation

needed to access services). The PHA can

approve up to 110% of the Fair Market Rent; the

HUD Field Office can approve requests for rents

between 110 and 120% of the Fair Market Rents.

• Permission to rent from immediate

family members – however, a reasonable

accommodation cannot be requested to lease

from a family member who will also be residing

in the same housing unit.

• Permission to rent‘types’of housing such as

congregate housing or manufactured housing

that is not otherwise permitted under the PHA

Plan – this can include rental assistance for

manufactured housing unit that is owned by the

Veteran.

• A larger unit in order to accommodate a live-in

aide1

Leasing Process

• Service animals being permitted to reside in the

unit even if there is a ‘no pets’policy

• Reasonable modifications to an apartment

needed to obtain full enjoyment of a dwelling

• Assigned parking spaces for people with

disabilities; requesting assistance or

modifications to procedures around the disposal

of refuse to assist a person with disabilities

Relationship Between Reasonable 

Accommodation and Disability:

In order to show that a requested accommodation

may be necessary, there must be an identifiable

relationship, between the requested

accommodation and the individual’s disability.

1

 PHAs are required to consider a person to be a live-in aide if: (1) the person is 

determined by the PHA to be essential to the care and well-being of a Veteran 

who is disabled; (2) the live-in aide is not obligated to support the Veteran; and 

(3) the live-in aide would not be living in the unit expect to provide the supportive services.
H U D - V A S H R E S O U R C E G U I D E 45 

PHA Verification:

PHAs may verify a Veteran’s disability only to the

extent necessary to ensure that applicants are

qualified to reside in the housing for which they are

applying and that applicants who have requested

a reasonable accommodation have a need for the

requested accommodation. A PHA may require

documentation of the manifestation of the disability

that causes a need for a specific accommodation.

A PHA may not

• Require applicants to provide access to

confidential medical records, or

• Inquire into the specific nature of the disability.

Although there is no requirement that reasonable

accommodations requests be made in writing, it is

generally preferable to maintain a written record. 

Requests to PHAs for reasonable accommodations

should include the following:

• Statement that the request is being made

because the Veteran has a disability;

• Explanation of the type of accommodation

that is being requested (e.g., an increase

in the payment standard, a larger unit to

accommodate a live-in aide, etc.);

• Explanation of the relationship between the

accommodation requested and the Veteran’s

disability.

The rights of persons with disabilities to obtain equal

access to HUD benefit programs are enforced by

HUD’s Office of Fair Housing and Equal Opportunity. 

Veterans who appear to be experiencing

discrimination in housing because of disability or

any other proscribed reasons may obtain assistance

from Fair Housing Agencies. These agencies can

be located through an on-line searchable database

found at http://www.fairhousing.com/index.cfm?

method=agency.search.

Termination from the Housing Choice 

Voucher Program

In implementing the HUD-VASH program, HUD

sought to eliminate the barriers to housing homeless

Veterans that could result from the application of the

screening and local priorities that accompany the

regular HCV program. As a consequence, HUD only

permits PHAs – at program intake – to screen out

Veterans whose incomes are too high or when listed

on lifetime sexual offender registries.

Although HUD substantially changed the

requirements for program intake, it left intact all

provisions that permit PHAs to terminate program

beneficiaries. It is extremely important that HUDVASH Case Managers work with Veterans to ensure

that they understand all obligations of tenancy. 

These obligations include occupying the unit

for the term of the lease, making monthly rent

payments, not interfering with other residents’ ‘quiet

enjoyment’of their housing, not causing damage to

the property, not engaging in criminal activity, and

not committing violations of federal, state or local

laws that directly relate to occupancy of the housing.

HCV is a lease-based program and landlords may

only evict a resident through an appropriate courtordered action. The PHA must be provided a copy

of any eviction notice. The PHA can terminate

assistance when a Veteran has been evicted from a

unit or when there are serious and repeated lease

violations.

However, prior to terminating any HCV participant,

PHAs must provide the opportunity for an‘informal

review or hearing.’ PHAs have two hearing

processes:

• Informal reviews which permit applicants to

request reviews of decisions made by PHAs, and

• Informal hearings which permit participants in

HCV to appeal decisions regarding their benefits

or their termination from the program.

PHAs must provide notice to Veterans of their 

right to informal reviews or hearings. This notice 

must be made in writing and must include

• Statement of reasons for the decision,

• Statement that the Veteran can request an

informal review/hearing if not in agreement

with the PHA decision, and

• Deadline for requesting an informal review/

hearing.
46 H U D - V A S H R E S O U R C E G U I D E

The process by which the PHA will conduct an 

informal review/hearing is specified in the PHA 

plan. HUD requires the following:

• The informal hearing cannot be conducted by

the person who made the decision under review

or a subordinate of that person;

• The Veteran must be given the opportunity

to present written or oral objections to the

decision;

• The PHA must promptly notify the Veteran

of its final decision after the informal review,

including a written statement of the reasons for

the final decision.

The Veteran is entitled to representation (legal

or otherwise), but the PHA is not responsible for

paying for this representation. In making its decision

under the informal review/hearing, the PHA must

consider‘mitigating circumstances related to the

disability of a family member.’ Any decision by

the PHA is subject to consideration of reasonable

accommodations. Should the Veteran be terminated

as a result of alcohol or substance use, the PHA may

require evidence of participation in a rehabilitation

program as a condition for receiving continued HCV

assistance. VA Case Managers can appear at these

hearings as representatives for the Veterans.

Establishing Positive Working Relations 

with Public Housing Authorities

PHAs across the country have been highly

supportive in the implementation of the HUDVASH program and supporting the goal of ending

homelessness among Veterans. As the program

expands, additional PHAs are becoming involved. 

It should be noted that while the VA has additional

staff resources to address the needs of homeless

Veterans, PHAs have not experienced similar

increases in staffing. Accordingly, it is recommended

that HUD-VASH Case Managers take affirmative

steps to facilitate Veterans in accessing the HCV

program and in maintaining occupancy. In short, do

as much work to support the PHA as possible. Case

Managers can assemble eligibility and verification

documentation to relieve the burden on PHA staff.
H U D - V A S H R E S O U R C E G U I D E 47 

STEPS TO ESTABLISH SUCCESSFUL RELATIONSHIPS WITH

PUBLIC HOUSING AUTHORITIES

STEP BENEFIT

Have a kick-off meeting between the VA and

PHA whenever a new PHA enters the HUD-VASH

program.

Opportunity to establish shared knowledge of:

	PHA requirements

	Process for issuing a voucher

	Process for submitting a request for

tenancy approval (RTA)

	HQS inspection requirements

Encourage the PHA to designate a single staff

member to handle HUD-VASH program

Opportunity to maximize coordination and optimize

outcomes

Become familiar with HUD’s housing quality

standards (HQS) to ensure that when request for

tenancy approvals are submitted, the units will

be approved. 

Opportunity to streamline process:

	VA Case Manager or peer worker can assist

the Veteran in identifying units that are not

likely to pass inspection, thereby avoiding

unnecessary inspections.

Maintain regular contact with PHA counterparts. 

This could include a bi-weekly or monthly

meeting or weekly conference call between the

PHA and VA. 

Opportunity to maintain open lines of

communication:

	Review cases with outstanding vouchers

	Troubleshoot when Veterans under lease

are experiencing problems.

	Provide a regular forum to address any

issues regarding PHA policies or VA needs.

Designate the VA Case Manager as second party

to be contacted by the PHA. 

	Ensures that all communication between

the PHA and the VA will be shared with the

Case Manager. 

	In the event that the PHA needs to take

any action, the Case Manager will know

in advance and can assist in resolving any

problems.

REMEMBER: Non-encrypted, client-specific emails cannot be exchanged between the VA and the PHA. 

However, some PHAs have established shared drive arrangements where a master log of all HUD-VASH

clients is maintained, providing the current status of the HUD-VASH application. In other cases, all

applications should be reviewed by the PHA/VA in a weekly coordination call.
48 H U D - V A S H R E S O U R C E G U I D E

Understanding the Public Housing 

Authority Administrative Plan

HUD requires that PHAs adopt written

Administrative Plans that set forth local policies for

program administration. The plans must conform

to HUD regulations and identify the PHA’s policies

in areas in which HUD allows the PHAs discretion to

set local policy. HUD also requires that the plans be

consistent with the local jurisdiction’s Consolidated

Plan, which sets forth general policies and plans for

affordable housing and community development.

There are a number of items in the PHA plan that

could affect access to HCV by homeless Veterans. 

However, it should be noted that, in virtually all

cases when a Veteran is a person with disabilities, a

reasonable accommodation can be requested that

would supersede the requirements of the plan. For

example, PHAs are required to adopt a definition

of what group of persons would quality as a ‘family.’ 

If the Veteran is disabled and there is a person(s)

deemed important to the Veteran’s care and wellbeing, and documented by a medical provider,

then the PHA, as a reasonable accommodation,

would allow the Veteran and the other person(s) to

constitute a family.

PHA REGULATIONS

PHA PLAN REQUIREMENTS THAT CAN AFFECT HOMELESS VETERANS

	Family definition: PHAs must adopt a definition to describe what groups of persons may qualify as a ‘family.’

	Subsidy standards: PHA’s must establish subsidy standards for determining the number of bedrooms needed for

families of different sizes and compositions.

	Absence from unit: Families may be absent from their units for brief periods and continue to receive rental

assistance. The PHAs administrative plan establishes how long the family may be absent from the unit before assistance

isterminated. The PHA may set its policy for any length of absence up to the maximum of 180 days permitted by HUD. 

Absence meansthat no member of the family shown on the lease isresiding in the unit. If the PHA setsthe time period at

lessthan 180 days, a reasonable accommodation can be requested for up to the 180-day maximum.

	Payment standards: PHAs may set payment standards from 90% to 110% of the published Fair Market Rent (FMR)

for each unit size. Note that a higher payment standard may be requested as a reasonable accommodation.

	Policies on the use of special housing types: ‘Special housing types’ include homeownership, single room

occupancy, congregate housing, shared housing, group homes, cooperative housing, and space rentals for

manufactured housing owned by the family. HUD requires that PHAs allow special housing types if needed as a

reasonable accommodation.

	Minimum rents: PHAs may set a minimum rent, which HUD allows to range from $0 to $50/month. PHAs must also

establish the process for requesting and granting hardship exemptions to the minimum rents.

PHA PLAN ACTIONS THAT CAN ASSIST HOMELESS VETERANS

	Classify disabled homeless Veterans as constituting an‘essential local housing need’: Generally speaking, the HCV

program is targeted toward very low income families (under 50% of Area Median Income (AMI)) or extremely low

income families (under 30% of AMI). However, in the administrative plan, PHA’s may adopt a local policy of serving

additional low income families (under 80% of AMI) to address essential local housing needs. Some Veterans receiving

full service-connected disability payments will have incomes that are above the very low income (50% AMI) level, but

below the low income (80% AMI) level. PHAs could determine that disabled Veterans constitute an essential local

housing need; allowing Veterans to enter the program under the ‘low income’ category would allow fully disabled

Veterans to be served through HUD-VASH.

	Accept form DD-214 as verification: Veterans occasionally experience delays in obtaining a voucher because of

missing documentation for Social Security numbers and birth certificates. This prolongs the period of time the

Veteran remains homeless.
H U D - V A S H R E S O U R C E G U I D E 49 

Portability of HUD-VASH Vouchers

Another key element of choice in the Housing

Choice Voucher program is‘portability.’ Under the

regular HCV program, any eligible family that has

been issued a voucher may use it to lease a unit

anywhere in the United States where there is a PHA

operating a HCV program. This portability provision

continues in the HUD-VASH program, but since

HUD-VASH requires the participation of both a PHA

and a VAMC, there are some differences between

portability in HUD-VASH and the regular HCV

program.

Veterans are able to move their HUD-VASH

voucher–provided that they remain within the

jurisdiction of a VAMC that has the reasonable

capacity to provide case management. There are

two different portability scenarios in the HUD-VASH

program.

Scenario 1: Moving within the jurisdiction of the 

servicing VAMC

Eligible Veterans may live anywhere within the

jurisdiction of the servicing VAMC. They are not

required to locate a unit within the jurisdiction of

the issuing PHA. If they elect to move to a unit that

is within the jurisdiction of the VAMC, but outside of

the issuing PHA’s jurisdiction, they can move their

voucher to that new location. The PHA into whose

jurisdiction the Veteran is moving will administer

the voucher and bill the issuing PHA for the costs of

providing the housing voucher. The Veteran must,

however, locate in an area that is within a reasonable

distance from the VAMC so that case management

services can be effectively provided.

In this scenario, the actual subsidy received by the

Veteran will be based on the payment standard in

effect at the PHA in whose jurisdiction the housing

unit is located. Additionally, if the Veteran is a

voucher holder, but has not executed a lease on a

HCV-assisted unit, his/her family will have to meet

the income standard in the jurisdiction in which the

unit is located. If the Veteran’s household is already

under lease in a HCV supported unit, income limits

no longer apply.

There is no requirement to live for one year

in any given location. If the Veteran is under

lease, however, he/she can only move upon the

completion of the lease term or if the landlord

agrees to terminate the lease.

Scenario 2: Long distance moves – outside of the 

jurisdiction of the VAMC

Veterans can move their vouchers to new

jurisdictions. However, if they are moving outside

of the jurisdiction of the issuing VAMC, the VAMC

in the jurisdiction to which they plan to move must

have available case management and a HUD-VASH

voucher slot. This can be confirmed by the VA. If the

VA has the capacity to provide case management

at the new location, the Veteran can relocate to

that jurisdiction and enroll in that HUD-VASH

program. As in Scenario 1, the subsidy level will

be based on the payment standard at the PHA in

whose jurisdiction the housing unit is located. Also,

if the Veteran is not yet under lease in the original

jurisdiction, the income limits in the new PHA will be

used to determine if the Veteran is income-eligible

for the program.

Key Practices

• Assist Veterans in assembling third party

documentation concerning PHA eligibility

requirements, income, and any income

deductions for which the Veteran may qualify.

• Determine whether each Veteran needs and

qualifies for any of the special provisions for

disabled persons and, if so, assist the Veteran

in assembling required documentation and

requesting appropriate accommodations.

• Train VA case managers in HUD’s Housing

Quality Standards (HQS) to avoid unnecessary

inspections.

• Establish positive relations with PHAs through:

• Kickoff meetings with new PHAs,

• Regularly scheduled meetings and/or

conference calls with PHA counterparts,

• Consistent designations of VA Case Managers

as second party to be contacted by PHA, and

• Establishing processes with the PHA

for coordinating review of HUD-VASH

applications.
50 H U D - V A S H R E S O U R C E G U I D E

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about HUDVASH housing vouchers.

1) HQS stands for Housing Quality Survey.

2) Payment Standards limit the amount of rent a

landlord can charge.

3) PHA screening for HUD-VASH may include

criminal history for drug use.

4) Original documents issued by the VA providing

the name and social security number of the

Veteran will satisfy the PHA’s social security

number documentation requirement.

5) To reduce delays in processing, PHAs will assist

Veterans in assembling documentation (from

third party sources) that demonstrates income.

6) PHAs may require payment of a minimum rent

even if a Veteran has no income.

7) HUD uses the Social Security Administration’s

definition of disability.

8) Portability is the ability of someone with a

voucher to move into a different housing

authority jurisdiction and still receive subsidy.

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) Apartments must pass PHA inspection prior to

lease-up. How frequently must they be inspected

thereafter?

2) What are the five types of deductions to gross

income HUD allows?

3) What is an example of a “reasonable

accommodation”for a Veteran with a disability?

4) What is one action a PHA must take regarding

informal hearings?

5) How can your VA team establish a successful

relationship with your local public housing

authority?
H U D - V A S H R E S O U R C E G U I D E 51 

What’s in This Chapter?

A sustainable exit from homelessness is unlikely

without case management. Without the Case

Manager, affordable housing cannot be connected

to clinical services. While the Case Manager serves

in a practical capacity to encourage housing stability

and troubleshoot some of the factors that may

threaten it, the Case Manager also plays a larger role

for the Veteran, as the person who offers meaningful

assistance when needed.

In this chapter, you will learn

• What case management means and

encompasses in the context of the HUD-VASH

program;

• How HUD-VASH case management draws on the

successes of both the Critical Time Intervention

and Housing First approaches; and

• How case management changes through the

different phases of the housing stabilization

process.

After reading this chapter, you should understand

the role of case management through the lens of

housing stabilization and how to employ proven

practices for a successful case management

approach.

Housing Stabilization Services using 

Critical Time Intervention (CTI) and 

Housing First

The HUD-VASH Case Management approach is

informed by both evidence-based housing practices

and evidence-based counseling techniques. 

However, it differs from other services in that the

work is focused on housing stabilization–as the

primary goal of HUD-VASH Case Management is to

help eligible Veterans, and their dependents when

applicable, obtain and maintain permanent housing. 

Thus, the role of the HUD-VASH Case Manager is

fundamentally organized around housing access

and sustained recovery tasks that include access, 

engagement in treatment and other supportive

services, as clinically indicated.

Case Managers begin the process of housing

stabilization by engaging the Veteran in a

discussion of his/her housing needs and living

preferences, simultaneously exploring the Veteran’s

goals, strengths and limitations. As the Housing

Assessment is being completed, the HUD-VASH

Case Manager begins to consider potential service

opportunities, resource allocations, and possible

obstacles to housing stability. The resulting Housing

Stabilization Plan is based on the combination of this

information (see Appendix A). The Case Manager

uses the Housing Needs Assessment and the

Housing Stabilization Plan to shepherd the Veteran

through the administrative process of securing

housing.

During this and all other phases of housing

stabilization, HUD-VASH Case Managers consistently

monitor for problems that can jeopardize tenancy. 

Thus, the Housing Stabilization Plan should be

updated regularly, incorporating the Veteran’s

needs and goals while also establishing connections

between goal achievement and corresponding

recovery supports. This approach to case

management incorporates principles and practices

from two proven housing practices, Critical Time

Intervention (CTI) and Housing First, while using

the Stages of Change paradigm and Motivational

Interviewing techniques.

PART 1 C H A P T E R 5

Case Management–The Key to HUD-VASH Success
52 H U D - V A S H R E S O U R C E G U I D E

Critical Time Intervention (CTI) Overview1

CTI is a proven practice that assists housing

stabilization by strengthening a client’s long-term

ties to community services and social supports

such as family and friends. The case management

approach is housing-focused and connected to the

client’s life goals. CTI is broadly applicable–it has

been implemented for single adults as well as for

families with children; it has also been used with

clients transitioning to community-based housing

from a variety of homeless and institutional settings.

Core principles and practices of CTI: 

• Focused assessments: Within HUD-VASH, the

Case Manager addresses one to three priority

areas, identified from six treatment areas. The

priorities are determined by urgency and

severity of threat to long-term housing stability,

and are addressed in a manner that ensures

access to care and support. The six primary

treatment areas include housing, health/

mental health, substance use, life skills, financial

management, and family intervention.

• CTI is meant to be time-limited: Although

duration of CTI can vary depending on

the needs of the client, transition to other

community supports is typically provided for 

nine months.

• Phased Services: CTI is organized into three

3-month phases of decreasing intensity: 1)

Transition to the community, 2) Try out, and 3)

Termination/Transfer of care.

• Connections to mainstream resources and 

supports: In order to decrease service intensity,

CTI requires that strong connections be

established between the service recipient and

community-based resources that will continue

to address his or her ongoing needs. 

From CTI, HUD-VASH case management adopts

focused assessments and case management planning

that directs prioritiestoward housing-related needs. 

CTI’sfocus on connections with community-based

resources and supportsis also central to HUD-VASH

case management. Additional information on CTI can

be found at www.criticaltime.org.

Housing First Overview2 

Housing First is another proven approach that

maintains an immediate and primary focus on

helping homeless people quickly access and

then sustain permanent housing. As opposed to

programs that work with clients only before they are

housed, to help them to become ‘housing ready’, the

Housing First approach helps clients find housing

and then provides services for as long as necessary

to ensure residential stability. Services are provided

in the home, at agency offices, and, when necessary,

in the community. Housing First programs can

be single-site or scatter-site. Many permanent

supportive housing programs have adopted the

Housing First approach. 

Housing First programs share critical elements:

• Rapid access to housing

• Low or no thresholds for acceptance

• Housing stabilization and improved well-being

as the primary goals of services

• Services are focused on helping clients meet

lease obligations and changing the behaviors

that create tenancy problems

• Substance use is addressed through a harm

reduction approach where the focus on

engagement and promoting safety

• Housing is not contingent on compliance with

services – instead, participants must comply

with a standard lease agreement and are

provided with the services and supports that are

necessary to help them become successful

Using the Housing First framework, HUD-VASH case

management incorporates a rapid housing approach

with low threshold eligibility requirements. For

example, HUD-VASH does not require a set period

of sobriety in order for a Veteran to be considered

eligible for the program. Veterans with active

substance use disorders, or a history of substance

abuse, are considered for the program.3

The only

1

For more detailed information on CTI, visit www.criticaltime.org

2 For more detailed information on Housing First, go to the

http://www.nrepp.samhsa.gov/

3 Department of Veterans Affairs, 2009. VHA Handbook 1162.05. HUD-VASH

Program. Washington, DC, 2.
H U D - V A S H R E S O U R C E G U I D E 53 

other threshold criteria for HUD-VASH concerns

income requirements, sex offender status, and

willingness to participate in case management. 

Similar to Housing First, HUD-VASH is focused on

housing retention and improved well-being. 

The following chart illustrates the major tenets

of each model of care. Shaded areas represent

significant incorporation into the HUD-VASH case

management philosophy.

HUD-VASH Case Management Incorporates Principles from Proven Models of Care

SHADED AREAS REPRESENT THOSE PRACTICES THAT HAVE BEEN INCORPORATED

MOST SIGNIFICANTLY INTO HUD-VASH CASE MANAGEMENT

CTI Housing First

GOAL

Assist housing stability by strengthening

long-term ties to community services,

family, and friends

Housing stabilization and improved

well-being

ELIGIBILITY CRITERIA Willingness to participate in case

management Low or no threshold for services

SERVICE FOCUS

Using ongoing needs assessments,

address 1-3 areas at a time, determined

by urgency of threat to long-term

housing stability

House rapidly; help clients meet lease

obligations and change behaviors that

create tenancy problems or housing

barriers.

TIMING AND/OR DURATION OF

SERVICES Case management is time-limited

Case management lasts as long as

necessary to facilitate rapid placement

in permanent housing and to sustain

long-term housing

CASE MANAGEMENT PRIORITIES Housing-related needs Compliance with terms of rental

agreement

DETERMINATION OF SERVICE INTENSITY

CTI work is organized into phases of

decreasing intensity with ultimate goal

of transitioning to community support

Service delivery and intensity is

determined by what a client needs in

order to comply with a standard lease

agreement

SUBSTANCE ABUSE PARAMETERS

Substance abuse may be addressed as

part of one of the priority treatment

areas.

No required period of sobriety prior to

housing; substance use is addressed

through a harm reduction approach

COMPLIANCE Must be compliant with services and

treatment supports Must be compliant with terms of lease

LONG-TERM PLAN

Establish solid connections with

community-based resources and

supports that can address ongoing

needs

Maintain housing
54 H U D - V A S H R E S O U R C E G U I D E

Stages of Change Overview4

The Stages of Change framework was developed by

observing and identifying the naturalstagesthrough

which people move asthey make changes on their

own, without professional intervention. Because the

Stages begin before a person has made a decision to

change a particular behavior, it is especially relevant

for HUD-VASH Case Managers asthey acknowledge

that their clients may be in denial of certain problem

behaviors. 

The model identifies which interventions will be most

effective at each stage to help a person move forward

in the process of change. The model also seesrelapse

to the problem behavior as a part of the process and

normalizessetbacks. The Stages of Change model

has been particularly effective in treating clients with

substance use disorders, but can be applied to other

problem behaviors as well. The stages described below

are used to achieve these goals.

The Stages of Change and Recovery are 

• Pre-contemplation: unaware that problem

exists, no plan for change

4

 Prochaska, DiClemente and Norcross, 1992. In Search of How People Change: 

Applications to Addictive Behaviors.

• Contemplation: aware the problem exists and

thinking about options for change

• Preparation: motivation is building for change

and the person is starting to think about the

specific plan for changing (e.g., setting a “quit”

date)

• Action/Early Recovery: person is beginning to

make change and has maintained it for less than

6 months

• Middle Recovery: person nears six months of

consistent behavioral change

• Maintenance: change has been sustained for

at least 6 months; client is now working towards

achieving other goals

The Stages of Change model will be particularly

helpful when working with Veterans who are having

trouble with their housing situation, but are not

ready to make a change. Chapter 6, “Challenges to

Housing Stability for Homeless Veterans,” discusses

this model’s application in greater depth. 

The diagram below illustrates the Stages of Change

and Recovery. 
H U D - V A S H R E S O U R C E G U I D E 55 

Motivational Interviewing Overview

A key role of the HUD-VASH Case Manager is to

building motivation for change. Thus, Motivational

Interviewing techniques are often used in

conjunction with the Stages of Change model

described above. For those who have experienced

homelessness or other setbacks in life, hope and

motivation may be sapped. Motivational techniques

focus on creating a partnership with the client and

eliciting and amplifying the person’s own reasons to

change. According to Miller and Rollnick, 

“Motivational interviewing is a directive, clientcentered counseling style for eliciting behavior 

change by helping clients to explore and resolve 

ambivalence. Compared with nondirective 

counseling, it is more focused and goal-directed. 

The examination and resolution of ambivalence 

is its central purpose, and the counselor is 

intentionally directive in pursuing this goal.” 5

“There are ... specific and trainable therapist 

behaviors that are a characteristic of the 

motivational interviewing style. Foremost among 

these are 

• Seeking to understand the person’s frame of 

reference, particularly via reflective listening; 

• Expressing acceptance and affirmation;

• Eliciting and selectively reinforcing the client’s 

own self motivational statements, expressions 

of problem recognition, concerns, desires, 

intention and ability to change;

• Monitoring the client’s degree of readiness to 

change, and ensuring that resistance is not 

generated by jumping ahead of the client; and

• Affirming the client’s freedom of choice and 

self-direction.” 6

Comprehensive information on using Motivational

Interviewing with HUD-VASH clients can be found in

Part 2 of this Resource Guide).

Overview of Housing Stabilization 

Planning 

Once the Housing Assessment has been completed

(see Chapter 3) and the Veteran is ready to enter the

HUD-VASH program, the next step is to create the

Housing Stabilization Plan. 

Development of the Housing Stabilization Plan 

The Initial Housing Stabilization Plan should be

developed as soon as the Veteran is admitted to the

HUD-VASH program. 

The Veteran’s motivation to achieve the goals in the

plan is increased when the work in the near term

relates to his/her long-term aspirations and plans.

Thus, the Housing Plan should include the Veteran’s

long-term housing and life goals and all current

work should be related to the achievement of the

long-term plan. 

• The Initial Housing Stabilization Plan/PreVoucher Phase focuses on tasks that need to be

completed to submit the Voucher application

to the PHA (the Pre-Voucher Level of Case

Management). This includes gathering proper

proof of identification, proof of income and

assets, and identification of housing preferences

(location, type of unit), etc. More information on

vouchers is located in Chapter 4.

• The Updated Housing Stabilization Plan/

Voucher Phase: The Plan should be updated

once the voucher is issued to include location

of a housing unit as well as plans for obtaining

furniture, providing a security deposit, turning

on utilities, applying for benefits, etc.

• The Updated Housing Stabilization Plan/ 

Housed Phase: the Housing Stabilization Plan

should be updated once a housing unit has

been secured and a move-in date has been

scheduled. The updated plan should identify

the next set of goals for the transition (e.g.,

enrolling children in school, finding a place of

worship, connecting with AA or NA groups, etc.). 

This marks the start of CTI Phase 1: Transition to

Community. 

5 Rollnick S., & Miller, W.R. (1995).  What is motivational interviewing?  Behavioural and Cognitive Psychotherapy, 23, 325-334.

6 Rollnick and Miller. (1995).
56 H U D - V A S H R E S O U R C E G U I D E

CTI provides a structure for assisting people at

a critical point of intervention–when they are

transitioning to community-based housing. The

HUD-VASH Case Manager is very involved in the

Transition to Community phase of CTI, however as

the Veteran becomes more comfortable, the Case

Manager’s involvement begins to decrease, which

marks the beginning of CTI Phase 2: Try-Out, where

the Veteran begins accessing community-based

resources on his/her own. During this time, the

Veteran relies increasingly on community-based,

mainstream resources and supports that the HUDVASH Case Manager helped the Veteran identify and

connect with during the Transition to Community

Phase. In CTI Phase 3: Transfer of Care, the HUDVASH Case Manager has successfully transferred

care to other community-based providers and the

Veteran has successfully demonstrated the ability to

access these supports on his/her own. 

The plan should be updated every three months

after the Veteran’s move to the housing unit,

paralleling the 3 phases of CTI:

1) Transition to the Community

2) Try-Out Phase

3) Termination/Transfer of Care or Step Down

Setting Goals

Using the principles of CTI, the Housing Stabilization

Plan is focused on goals that are set by the Veteran

and the Case Manager that address the Veteran’s

most pressing needs. In the initial Housing

Stabilization Plan, these goals should reflect the

focus on the causes of the current housing crisis and

prior instances of housing instability. Reviewing the

housing assessment, especially the housing history

and causes of homelessness, can help the Case

Manager identify whatshould be included in the plan. 

The connection of short-term goals to long-term

goals is essential for building motivation. For

example, budgeting can be linked to the desire

to save for a gift for a child or loved one, a new TV

or computer, or another item that represents the

Veteran’s longer-term goals.

Following the CTI model, goals should be easily

classifiable into one of the following areas, each of

which is critical for making a successful transition to

community living:

• Housing Access and Retention

• Income, Employment and Finances

• Health and Mental Health

• Substance Use

• Life Skills and Supports

• Family and Friends

Each goal should have a target date for completion

and a list of associated tasks. Some of these tasks

will be the responsibility of the Veteran, and some

will fall to the Case Manager. For both parties, the

steps toward achieving goals should be clearly

defined and measurable. It is helpful to choose

between one and three goals for each Veteran at any

given time.

A note about community-based

resources and supports

In most cases, achievement of the goals in 

the Housing Stabilization Plan will require 

connections to other resources, supports, and 

services in the community–beyond what the VA 

can provide. Identifying community resources 

and linking the Veteran’s household to them is 

a critical task and one that can be very timeconsuming for the Case Manager. 

The HUD-VASH program encourages the Case 

Manager to arrange linkages to community 

resources, as this is critical to ensuring housing 

stability. For example, if a member of the 

household has no health insurance, but has a 

chronic medical condition, medical costs can 

make it difficult to make rent payments. Thus, 

linking the family with the State Health Insurance 

Program may provide critical financial relief. 

The HUD-VASH Case Manager is encouraged to 

assemble a central list of community resources 

and services which can be expanded and 

updated over time. 
H U D - V A S H R E S O U R C E G U I D E 57 

Monitoring and Updating the Housing Plan

The Housing Stabilization Plan should be updated

at least every 3 months. This is an adaptation of

CTI that sets time frames for accomplishing the

work that needs to be done. This also allows the

Case Manager and the Veteran to be motivated by

progress and successes to date. As the transition to

housing is stressful on many levels, new needs and

issues often emerge that have not been identified

in earlier assessments. Linking each Veteran with

community-based resources requires time, attention,

and deliberate care. As some connections grow

and take shape, others may not be a good fit. 

Therefore, the Case Manager may need to adjust

the plan accordingly. Updating the plan involves

reviewing goals and tasks from the last plan,

recording progress to date, and noting barriers to

success. This also requires an update of the housing

assessment to identify changes in status. When the

plan is updated, goals may be revised, completed

or discontinued; time frames should be adjusted as

appropriate. Additionally, there may be a need to

secure new services or resources, or to intervene to

improve the effectiveness of linkages that have been

made. 

A note about expectations for

goal attainment

The process of goal achievement will not likely be 

linear; there will be progress, setbacks and revisions 

along the way. Using Motivational Interviewing 

techniques can help resolve ambivalence about 

change and build forward motion.

Case Management after the Veteran Has 

Obtained the Voucher

Securing Housing 

Upon receiving a voucher from the PHA, the

Veteran must then proceed to secure housing in the

community. The Veteran must find a unit

• Where rent is affordable with the subsidy,

• That meets the Veteran’s preferences, and

• Where the owner of the property is willing to

rent to the Veteran and to accept the lease

terms required by the PHA.

In addition, the Veteran must acquire sufficient

resources to cover deposits for rent and utilities and

for furnishing the unit.

The diagram below illustrates the steps that must be

completed.
58 H U D - V A S H R E S O U R C E G U I D E

120-Day Clock, Extensions and Re-Referral

In the HUD-VASH program, the Veteran has a

maximum of 120 days in which to locate a unit and

submit a Request for Tenancy Approval (RTA). Once

the RTA has been submitted to the PHA, the 120-day

‘clock’ is suspended until the PHA inspects and either

approves or disapproves the unit.

If the Veteran is unable to secure housing in the 120-

day search period and requests an extension, PHAs

follow the procedure specified in their respective

Administrative Plans. HUD does not require PHAs

to grant extensions, and some do not. In the regular

HCV program, applicants who are not able to locate

a unit lose the opportunity for the subsidy, and the

voucher is offered to the next household on the

waiting list. 

(If the Veteran is disabled and unable to find a

rental unit for reasons related to his or her disability,

then a reasonable accommodations request for an

extension would have to be approved by the PHA.)

In the HUD-VASH program, Veterans do not go onto

a PHA waiting list. Depending on the availability of

HUD-VASH vouchers at a local VA, Veterans may be

placed on an‘interest list’until a HUD-VASH voucher

is available. The VA has sole authority over which

Veterans will be referred to its partner PHA. This

applies to both initial referrals and re-referrals of

Veterans who are terminated for any reason. Rereferral is at the discretion of the VA Case Manager,

if it is determined to be appropriate for ending

homelessness for the Veteran. Upon re-referral,

as on initial referral, PHA screening is limited to

lifetime registry on sexual offender lists and income

eligibility for Housing Choice Vouchers. Veterans can

be re-referred if they were unable to locate housing

in the 120-day search period, if they were evicted,

and even if they have outstanding debts to the PHA

or another housing provider. 

If a Veteran is re-referred, the PHA will need to do all

the work required to issue a new voucher. For this

reason, it often makes more sense for the PHA to

grant an extension to the Veteran or not terminate

Veterans from the voucher program, even if this is

an exception to their general policy. It is important

for HUD-VASH staff to discuss this situation with the

PHA to create the most efficient system for both the

housing authority and the Veteran.

In situations when the Veteran is not able to

locate suitable housing, Case Managers should

assess why the Veteran has been unable to locate

housing. Additional resources should be devoted to

supporting the search process. Also, Case Managers

should examine whether an alternative type of

housing would be more appropriate for the Veteran. 

If the need for additional search time exists, it should

be discussed in joint meetings with the PHA.

Understanding Utilities

In calculating gross rents for units leased through

HCV, PHAs must consider utilities that the tenant will

pay as well as the contract rent to the owner. The

request for tenancy approval must specify which

utilities are the responsibility of the tenant, and

which are included in the rent. Each PHA is required

to establish a utility allowance schedule (based on

the utility costs of energy-conserving households

occupying similar units in the community) to cover

reasonable allowances for tenant-paid utilities. The

amount of subsidy that can be provided to cover

contract rent is diminished by the utility allowance

for non-landlord provided utilities. Furthermore,

utility allowances that are based on‘energyconserving’households often do not cover all

expenses that Veterans will face, especially as they

adjust to having a place of their own.

Veterans are responsible for paying for non-landlord

provided utilities. An interruption in utility service

because of a Veteran’s failure to pay is considered a

breach of the obligations under the HCV program. 

HUD-VASH Case Managers should assist Veterans in

controlling utility costs in the initial search process

to ensure low ongoing costs. Utility costs should be

assessed as part of the housing search process, and

some units that appear affordable will not be after

utilities are factored into monthly costs. Formerly

homeless Veterans have very limited resources and

can be financially overwhelmed by utility costs. 

First preference should be given to housing in which

all utilities are included in the rent. This is something

that can be negotiated with landlords. When
H U D - V A S H R E S O U R C E G U I D E 59 

angling for utility inclusion in monthly rent, stress

to the landlord that the HCV subsidy provides a

guaranteed income, and that the tenant is a Veteran. 

Veterans should also consider new affordable

housing developed with support from HUD or

low-income housing tax credits. Newly-developed

housing will almost always have a higher level of

energy efficiency.

Later on in this chapter, you will find an overview of

other types of HUD assistance and a discussion of

housing location considerations.

Working with Landlords

Both the landlord and the Case Manager have a

vested interest in the Veteran’s ability to maintain

housing. This means that the landlord can be

confident in regular rent payments, an adequately

maintained unit, and no complaints from other

tenants. For the VA, stable housing means an end

to homelessness and the opportunity to help the

Veteran build positive momentum from the stability

that decent, affordable housing can provide.

In the HCV program, HUD provides subsidies to

make housing affordable, but relies on the private

sector to provide the housing. Property owners can

be small landlords that own a few housing units,

larger property owners, developers and owners

of affordable housing, and non-profit community

development organizations. The HCV program

provides property owners with the opportunity

to select tenants who they feel will meet the

obligations of tenancy.

Although HUD eliminated the screening procedures

that PHAs use for the regular HCV program, there

are no similar prohibitions against landlords using

credit checks, criminal background checks, or other

forms of screening, provided it is non-discriminatory. 

Some landlords may be reluctant to rent to program

participants because of past housing history and

concerns that the tenancy will be problematic. 

Some Veterans will need additional assistance

locating housing that meets their preferences

and landlords willing to rent to them. There are a

number of resources that HUD-VASH Case Managers

can use to identify property owners who might be

willing to rent to formerly homeless Veterans. These

include

• Property owners who participate in Continuum 

of Care Homeless Assistance Programs. The

Continuum of Care (CoC) programs,supported

by HUD, frequently rely on private property

ownersto provide permanent and transitional

housing. These landlords are already willing to

rent to homeless people, receive government

subsidies, and have their propertiesinspected

by government agencies. Each CoC has a lead

contact. In the event theVA Case Manager does

not have existing relations with local CoCs,

http://www.hudhre.info/index.cfm?do=viewCocContacts

provides contact information for all CoCs in the

country.

• References from landlords who are currently 

participating in HUD-VASH. It is important to

maintain positive relations with landlords who

participate in HUD-VASH for many reasons. If

their experiences are positive, these landlords

might be willing to serve as references, rent to

other Veterans, or refer other property owners

for participation in the program.

• Affordable housing developers. HUD, as

well as state and local governments, provide

substantial support to the development of

affordable housing through grants, low-interest

loans and tax credits. In return, developers are

generally required to rent the housing to low- or

moderate-income households for a specified

period of time. Since these developers are

required to rent to low-income families, the

presence of a long-term subsidy such as HUDVASH can help them fulfill their obligations

while maintaining adequate revenue. Each

municipality has a community development

agency and state governments have housing

finance and/or community development

agencies. These agencies should be able to

provide a listing of, and all contact information

for, all affordable housing that they have

supported.
60 H U D - V A S H R E S O U R C E G U I D E

• PHAs. PHAs will generally maintain lists of

landlords who have been willing to participate

in the regular HCV program. These landlords

have experience meeting HCV requirements

and providing housing to HCV-eligible

households. In areas where the housing market

has been impacted by the financial recession,

there is strong landlord interest in participation.

Clinical Practice in Support of Positive Relations 

with Landlords

The exit from homelessness, and the transition

to housing, can be very stressful. For example,

some people lack knowledge and skills regarding

housekeeping. Others experience extreme

loneliness when they finally close the apartment

door that separates them from the rest of the world. 

Still others quickly come to realize that their housing

is a valuable commodity that potentially could be

traded or exchanged. 

Figure 1 Summary of Strategies to Secure Landlord Involvement

The active involvement of the HUD-VASH Case

Manager–especially in the period immediately

following placement in housing–is critical to

ensuring housing stability. In the initial months of

occupancy, there should be regular weekly home

visits to monitor the transition and troubleshoot

potential issues. The Case Manager should assess

housekeeping skills, identify whether the Veteran

needs additional supports such as a home attendant

or live-in aide, and determine if the Veteran is

meeting the obligations of tenancy. 

It is also recommended that the Case Manager

maintain regular contact with the landlord,

especially in the first months of occupancy. Regular

phone calls, on or about the 10th of the month when

rent should have been paid, should be made to the

landlord. It’s generally sufficient to initiate contact;

if the landlord has any problems with the Veteran,

he/she will probably bring them up. Case Managers

need only report that they are ‘touching base’to see

if there are any problems or if there is anything they

can do to help. 
H U D - V A S H R E S O U R C E G U I D E 61 

Issues to Consider in Housing Location

Access to transportation is crucial. Veterans will

need to be able to access services from the VA and

other community-based providers.

Case Managers should consider clustering

apartments–searching for and placing veterans in

units in the same, or adjacent, housing complexes. 

Clustered housing can assist the Case Manager by

making it easier and more efficient to conduct home

visits. Furthermore, the presence of other Veterans

nearby could be helpful in maintaining housing

stability. Loneliness could lead the Veteran to

engage in harmful behaviors that may cause him/her

to lose the housing unit. Clustering apartments can

help forestall this.

Landlords should be informed of the role of Case

Managers, and should be encouraged to use them

as a resource to assist in resolving problems. Case

Managers should stress that, if problems arise, their

role is to intervene long before a landlord reaches

the point of considering terminating a tenancy. Case

Managers should become familiar with the terms of

each lease, and continually reinforce the obligations

of tenancy with the Veteran. 

HOUSING LOCATION VS. NEEDS CHECKLIST

YES NO HOUSING NEED CONSIDERATION

Is the unit close to the VA where the Veteran will be receiving services? Is

transportation readily available, convenient, and affordable?

ACCESSIBILITY

Is unit located close to, or within convenient distance of public transportation

to, the community-based providers with whom the Veteran might be meeting?

Does the Veteran want to live close to family or other supports that may be

helpful in maintaining recovery? Does the unit fulfill this preference? COMMUNITY

Is the unit itself in a location where the Veteran might have used drugs or

engaged in other negative behaviors?

LOCATION Is the unit near a location where the Veteran might have ‘hung out’with old

associates? Is there a risk that the apartment might become a new hang-out

location?

Additional Resources for Housing Location

A widely used on-line resource to assist households

holding vouchers is called‘Go Section 8’which

can be found at: http://www2.gosection8.com/. 

The extent of the listings varies from locality to

locality, but, in general, this is a useful, free resource. 

Units listed will be within applicable Fair Market

Rents (FMRs) and the listing provides information

on housing type and amenities. Frequently,

photographs are included. 

Other Resources:

• State housing finance agencies. These

agencies are responsible for distributing Low

Income Housing Tax Credits to developers

of affordable housing. They maintain lists of

tax credit-supported housing. Each of these

developments provides high quality housing

at rents that are affordable to voucher holders. 

Each development will have its own policies for

screening eligible tenants, and some VA Case

Managers have reported difficulty in accessing

this housing for homeless Veterans. However,

given that the housing is of good quality and

energy efficient, it is worthwhile to pursue these

developments as a possible housing resource.

• Community development organizations. 

There are non-profit community development

organizations in most metropolitan areas. 
62 H U D - V A S H R E S O U R C E G U I D E

They use HUD and local resources to develop

and operate affordable housing. They can

be identified by contacting local municipal

governments (community development/

revitalization agencies). These organizations

should be sympathetic to the goals of the HUDVASH program and understand the value of the

housing subsidy.

Assisting with Community Integration

Once the Veteran has housing, the primary focus

of HUD-VASH case management is to reduce the

difficulty associated with community transition.

While connecting the Veteran to needed

community-based treatment services is a primary

goal of HUD-VASH, this is framed in the context of

housing stability. CTI has proven effective in helping

individuals from a variety of institutional settings,

such as emergency shelters, psychiatric hospitals,

and jails/prisons, transition into permanent housing. 

Key principles of CTI assessments include prioritizing

needs and setting goals, as discussed in previous

sections. Additionally, the model focuses on

connecting clients to mainstream resources and

reducing the intensity of case management as the

Veteran begins to rely on community-based services

and supports. As such, CTI-driven Case Management

work is organized into phases of decreasing service

intensity, guided by the extent of the Veteran’s ability

to effectively engage other systems. The following

section describes the focus and tasks for each of the

three phases of CTI.

Phase 1: Transition to the Community

Once the Veteran is under lease and in HUD-VASH,

the focus is on the transition to the new unit and

neighborhood. While getting a new home is

generally thought to be a positive experience, it is

also almost always stressful. Thus, the Case Manager

needs to be especially active in monitoring the

Veteran’s adjustment. At a minimum, this usually

means weekly contact and visits to the home at least

twice during the first month of tenancy.

During this phase, the Case Manager helps the

Veteran set up the home and learn about the

neighborhood, also ensuring that basic needs

are being met (e.g., banking arrangements,

transportation, grocery shopping, child care,

etc). During this time, the Case Manager is also

monitoring any problems that could jeopardize

tenancy. While this list of behaviors is long, the Case

Manager looks for problems with rent or money,

behavior issues (noise, conflicts with neighbors, lots

of visitors), and unkempt units. As neighborhood

and local services will be essential in ensuring

integration and housing stability, preliminary

identification of community resources should occur,

and initial referrals and connections should be made.

Phase 1 Case Manager Role and Tasks

• Continue engagement

• Update Housing Assessment with housing

information and, particularly, with risks to

housing stability

• Adjust the Housing Stabilization Plan

• Assist with setting up home and getting settled

in community

• Begin intensive, assertive outreach to develop

linkages to community resources 

• With Veteran consent, establish working

relationship with landlord

• Evaluate the Veteran’s living skills and begin

steps to improve areas of limited experience/

knowledge

• Support the “settling in”process. Make sure

the Veteran knows how to deal with repairs,

complaints and other problems in the unit 

• Provide education about tenancy rights,

responsibilities, and expectations

• Model negotiation skills 

• Monitor safety in the household – especially

in cases with histories of domestic violence,

child abuse/neglect, other violence, or suicidal/

homicidal ideologies

• Meet at least weekly

Phase 2: Practicing/Try-Out Phase

The Practicing/Try-Out Phase begins about three

months after a Veteran is housed. He or she has
H U D - V A S H R E S O U R C E G U I D E 63 

settled in and is meeting the basic needs of the

household. He or she has been connected to

community-based resources, and now the Case

Manager is evaluating how these supports are

working and whether interventions are needed. The

Case Manager is in contact with both the Veteran

and the service providers to help support these

connections. The Case Manager is also updating his

or her assessment of the Veteran and the Housing

Plan as goals are achieved and new needs emerge.

In this phase, the Case Manager is working with the

Veteran on living independently and adjusting to

a new role in the community. While some people

will still need assistance making a schedule and

planning and organizing tasks and time, others will

be ready to start to plan for goals unrelated directly

to housing, such as going back to school, training

for a new career or getting into or re-connecting a

relationship.

Still others may be experiencing problems

maintaining their housing. Within 3 months,

problems like getting behind on rent, having too

many loud parties, collecting items that cause health

hazards, and other threats to housing stability may

be emerging. The Case Manager must be frank

about the risks posed by these behaviors, framing

them in terms of continued tenancy, and should

help the Veteran by discussing options for resolving

problem behaviors and maintaining the unit.

Phase 2 Case Manager Role and Tasks

• Update Assessment, Housing Barriers and

Housing Stabilization Plan

• Monitor and solidify linkages to community

resources–this might include legal assistance,

schools for children, religious/spiritual

connections, community treatment and support

systems

• Adjust linkages and make new referrals as

needed

• Keep in contact with other community-based

service providers and have joint service

planning meetings as authorized by the Veteran 

• Keep in touch with landlords and monitor

for threats to housing stability, including late

rent payments, problem visitors, etc. Where

problems exist, work to help the Veteran adjust

behaviors. Use Motivational Interviewing,

and link desired changes in the short-term to

achievement of long-term goals.

• Promote independent living skills

• Verify banking procedures and income stream,

discuss financial management, reinforce

tenancy obligations

• Check-in regarding utility payments and other

additional financial responsibilities

• Conduct regular meetings with Veteran to

monitor progress and solidity of connections. 

Visit the Veteran at home at least monthly, and,

unless the Veteran does not need support at

that level, check in weekly by phone.

• Develop longer-term plan. Consider less acute

needs such as education planning, career goals,

and planning for the future.

Phase 3: Step Down/Transfer of Care/Termination

As the Veteran stabilizes, he or she will become less

reliant on the Case Manager and more connected

to community resources. As this occurs, it may be

possible to reduce the frequency and intensity of

services. This will happen at different points for

different people; however, for many, after about six

months of stable housing, it may be possible to start

stepping down the level of service. 

Even if it is appropriate to ease into a less central

role, it is essential that the Case Manager is still

aware of the Veteran’s situation. He or she is still

vigilant for threats to housing stability and continues

to update the plan accordingly. The Case Manager

is also checking on the depth and breadth of

community involvement, making adjustments, and

providing new referrals as needed. If the Veteran is

interested in pursuing other recovery goals, the Case

Manager should provide guidance and support. 

In some cases, the Case Manager and the Veteran

may agree that case management services are no

longer needed. Indeed, this represents success, as

the HUD-VASH Handbook states that graduation
64 H U D - V A S H R E S O U R C E G U I D E

from case management is a program goal.7When

the Case Manager also agrees that housing stability

is no longer dependent upon VASH services, the

Veteran can continue to receive the voucher alone.

If the PHA has another voucher available, one that

does not include a case management services

allocation, they may choose to switch the Veteran

to that voucher, thereby freeing up a HUD-VASH

voucher for another homeless Veteran. A number of

PHAs have ‘graduated’HUD-VASH holders to regular

vouchers. 

Veterans who transition from a HUD-VASH voucher

to a regular voucher do not have to be on the PHA’s

waiting list. As a current participant in the HCV

program, they can transfer to the next available

voucher.

Phase 3 Case Manager Role and Tasks

• Update Assessment Housing Barriers and

Housing Plan

• Maintain regular, if less frequent, contact with

the Veteran

• Fine-tune linkages and make new referrals as

needed

• Begin or continue to address other non-housing

related issues, such as career and education

goals, social or family re-connections, recovery

and wellness

• Continue to monitor risks and threats to housing

stability; continue to check in with the landlord

• As appropriate, terminate case management

services with the client. This includes a

review of the Veteran’s progress planning for

continued housing stability. Termination can

be difficult for both the Veteran and the Case

Manager. It is important to acknowledge

the loss and recognize the value of the joint

accomplishment. Supervisors will need to help

Case Managers with these transitions during the

supervision and case conferencing processes. 

Key Practices

Housing Stabilization Plan

• Set one to three goals based on the highest

priority threats to housing stability identified for

each Veteran from the six primary CTI treatment

areas (housing, health/mental health, substance

use, life skills, financial, and family intervention)

• Ensure goals have target dates

• Include clearly defined tasks needed to achieve

goals for both Veteran and Case Manager

Phase 1: Transition to the Community 

• Maintain weekly contact with Veterans in the

first month, including at least two home visits

• Check-in with landlords around the 10th of the

month

• Evaluate and build independent living skills,

including housekeeping skills and other skills

required to meet obligations of tenancy

• Create personalized lists of community

resources with Veterans to build community

connections

Phase 2: Practicing/Try Out Phase

• Conduct monthly home visits and maintain

weekly contact, unless unneeded by Veteran

• Monitor Veterans’use of community supports

and intervene if necessary

A note on discharge from case management

The case management model is meant to be 

flexible and adjust according to the Veteran’s needs 

over time. Services may continue if a Veteran 

enters treatment and, in fact, the HUD-VASH Case 

Manager functions as an important bridge, ensuring 

continuity of care. Deciding to terminate case 

management should be made in consultation with 

the Case Manager’s supervisor; other VA mental 

health or Homeless Patient Aligned Care team 

staff staff, as indicated; and the VISN Homeless 

Coordinator. 

7 Department of Veterans Affairs (2009). VHA Handbook 1162.05. HUD-VASH

Program Manual. Washington DC, 16.
H U D - V A S H R E S O U R C E G U I D E 65 

• Update Housing Stabilization Plan with progress

on goals and notes on barriers and include

longer term plans to reflect transition to new

phase

Phase 3: Step Down/Transfer of Care/Termination

• Reduce frequency of services as warranted

• Update Housing Stabilization Plan with progress

on goals and notes on barriers and include nonhousing related goals and plans (e.g. career and

education goals, social/family re-connections,

recovery and wellness)

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about HUDVASH case management. 

1) The HUD-VASH case management approach

differs from other service modalities in that

the goal of services is focused on housing

stabilization.

2) HUD-VASH case management helps people find

homes and then provides services for as long as

necessary to ensure residential stability.

3) Case Managers should rarely go to a Veteran’s

home in order to protect privacy.

4) Critical Time Intervention (CTI) can be used with

families as well as single adults.

5) In Housing First approaches such as HUD-VASH,

housing is not contingent upon compliance with

services.

6) The Stages of Change approach sees relapse to

the problem behavior as a part of the process and

normalizes setbacks.

7) According to Miller and Rollnick,“Motivational

interviewing is a top-down approach that offers

professional decision-making for those who

would otherwise not be able to make decisions

for themselves.”

8) A housing stabilization plan should be developed

within the first 6 months of a Veteran moving into

housing.

9) It is helpful for the Veteran and Case Manager to 

choose between one and three goals.

10) Although HUD eliminated most screening

criteria for Veterans to receive vouchers, there

are no similar prohibitions against landlords

using credit and criminal background checks.

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) Can you name three of the four principles of

Critical Time Intervention?

2) What are some of the critical elements of Housing

First and why are they important in HUD-VASH

case management practices?

3) Which stages of change occur prior to Action &

Early Recovery?

4) Identify a time when you used a motivational

interviewing style.

5) How is a Housing Stabilization Plan developed? 

How will you incorporate this practice into your

HUD-VASH case management work?

6) What are some resources that might help to

identify property owners who might be willing to

rent to formerly homeless Veterans?

7) What are some ways a Case Manager can address

safety during home visits?

8) What are the three phases of CTI? What are some

of the key practices your team can implement in

each of these stages?
66 H U D - V A S H R E S O U R C E G U I D E

What’s in This Chapter?

Permanent supportive housing is the most

promising solution for ending chronic homelessness. 

Chronically homeless Veterans–including those

who cycle between streets and shelters; who are

frequently, episodically homeless; and who are

struggling with physical or mental health problems–

have been repeatedly failed by other housing

programs, traditional services systems, and stopgap assistance. HUD-VASH’s primary goal is to help

Veterans with these experiences succeed in housing.

In this chapter you will learn how to

• Identify barriers to housing;

• Recognize, prevent, and ameliorate recoverybased threats to housing stability;

• Build motivation through the stages of change;

and

• Work proactively with Veterans and their

landlords to ensure continued tenancy.

After reading this chapter, you will be able to identify

barriers to housing before they happen and know

how to work proactively with Veterans and their

landlords to prevent evictions.

Introduction to Housing Stability Barriers

Once a Veteran is housed, the focus shifts from

obtaining a residence to maintaining it. There

are a variety of reasons and circumstances that a

household’s tenancy may be threatened. These

include

PART 1 C H A P T E R 6

Challenges to Housing Stability for Homeless Veterans

• Nonpayment of rent: In HUD-VASH, the tenant

is responsible for paying 30% of income or

the minimum rent (unless a waiver has been

granted);

• Disrupting the peaceful enjoyment of other

residents by making noise, having problem

visitors, and/or engaging in criminal activity;

and

• Health and safety issues, such as hoarding, lack

of sanitary conditions, utility shutoff.

Reasons for these problems include 

• Inability to pay utilities due to limited income;

• Financial management problems;

• Limited experience as a lease holder and

inability to meet, or unfamiliarity with, tenancy

obligations;

• Lack of skills requisite for the activities of daily

living;

• Cognitive impairments – trouble remembering,

disorganization, trouble with dates;

• Medical, mental health (including PTSD) or

substance use issues;

• Unforeseen expenses/emergencies, such as

medical bills or car problems.

Preventing Housing Instability

As Case Managers are working with Veterans to

access and maintain housing, a few key interventions

can help to prevent housing crises before they

occur. The following chart outlines important Case

Manager tasks.
H U D - V A S H R E S O U R C E G U I D E 67 

CRITICAL TASKS FOR PREVENTING HOUSING INSTABILITY

DOMAIN CASE MANAGER TASKS

PLANNING 	Create a detailed Housing Stabilization plan.

AWARENESS

	Make home visits at least monthly but more frequently at first and in cases of

housing instability.

HOME MAINTENANCE

	Provide education about maintaining a home – repairs, cleaning, etc.

	Arrange or provide life skills training.

	If help is required to maintain personal or environmental hygienic standards,

arrange support such as home health aides.

LANDLORD-TENANT 

MEDIATION

	Keep in contact with landlords as authorized by the Veteran. Preferably,

arrange that landlords will contact VASH Case Managers whenever there are

problems with rent or other lease violations.

	Provide education about expectations of tenancy and what the lease says and

means.

INCOME AND FINANCIAL 

MANAGEMENT

	Focus on increasing/sustaining income by assisting with job applications,

benefits, and entitlements. 

	Review or help create household budgets; connect with financial literacy

services.

	If needed, help arrange representative payee and/or direct vendor

arrangements whereby the rent is paid by someone else or is automatically

paid out of entitlements checks or bank account. 

RECOVERY

	Maintain connections to treatment, services and support systems to ensure

services are provided.

	Communicate with primary care and mental health providers.

As part of the housing assessment discussed in

Chapter 4, the housing history is an important tool in

revealing past housing maintenance problems and

exploring the Veteran’s experience as a lease holder

(in some cases, this may be very limited). 

Frank conversations with the Veteran around

reasons for past housing loss, and ways to prevent

future problems, are critical in creating the Housing

Stabilization Plan (described in detail in Chapter 5). 

However, among chronically homeless Veterans, it

is also not uncommon to find limited experience as

a lease holder. Younger Veterans, especially those

from recent conflicts, may have very little experience

living independently. In these cases, it is better to

err on the side of providing more education about

tenancy requirements. 

Additionally, ensuring connections to peer and/or

community support programs can help promote

housing stability. Case Managers should use all

the resources at their disposal to strengthen the
68 H U D - V A S H R E S O U R C E G U I D E

Veteran’s foundations in both tenancy obligations

and, if applicable, recovery and treatment goals.

Overcoming Barriers

When, despite all efforts, the Veteran’s ability

to maintain housing is in imminent danger, the

response should be rapid and prompt. Regular

ongoing contact with the Veteran, and with the

landlord, if possible, can help with identifying

problems before they become crises. Home visits

often provide a wealth of information that an office

visit cannot–illuminating underlying issues, and

assisting with early identification of problems. 

Dual Focus: The Behavior and the Veteran’s Goals

Threats to housing stability present immediate

problems (danger of eviction due to rent arrears,

failure to maintain hygiene standards, etc.) with

complex underlying causes (delay in benefits

payments, relapse to drug abuse, mental health

symptoms). In order to ensure that the Veteran

retains his or her housing, the Case Manager

must engage the Veteran on two fronts: first, with

a philosophy of damage control and a focus on

stopping or changing the problem behavior, no

matter what its origin; and second, in a pro-active

exploration of the underlying reasons and causes. 

This assessment will involve considering the

Veteran’s own self-identified goals, re-evaluating

the Housing Stabilization Plan, considering

intensification or modification of clinical services

and/or peer support, and linking the Veteran to

resources and supports that will help prevent similar

problems.

For example, if the problem is rent arrears, the Case 

Manager should 

1) focus on working to arrange a repayment

agreement,

2) work with Veteran to develop actionable ways

to stick to the plan,

3) link these actions with the Veteran’s own

recovery goals using the Housing Stabilization

Plan,

4) continue to build motivation for the needed

change, and

5) work to consider and understand underlying

causes for the rent arrears, as this will help

determine which interventions might be

helpful. For example, if the cause of the arrears

is over-spending due to manic behavior caused

by Bipolar Disorder, a budget or representative

payee arrangement may be the first step

to resolving the issue. This may also be an

opportunity to help the Veteran consider

mental health services to get treatment for

the mania, especially if it has caused other

problems or interferes with achieving other

goals (like saving for a computer, furthering

educational goals). Case Managers are always

looking for ways to link the Veteran’s goals

to recommended services. However, even if

mental health treatment is not accepted and

as long as there is a plan to ensure the rent is

paid–the Veteran can still be stably housed.

Stages of Change and Building Motivation

In addressing obstacles to housing stability, the

Stages of Change (SOC) model provides a useful

framework for thinking about how to motivate the

Veteran for change. SOC identifies the stages people

normally go through as they change problem

behavior. It differs from other interventions in its

emphasis on“pre-change”stages of the process. The

Stages of Change framework recognizes change as a

non-linear process with setbacks and relapses; these

are considered opportunities to learn.
H U D - V A S H R E S O U R C E G U I D E 69 

The Stages of Change model is outlined below.

THE STAGES OF CHANGE

STAGE VIEWPOINT/CHARACTERISTIC

PRE-CONTEMPLATION “No problem exists”

CONTEMPLATION “A problem may exist”

PREPARATION “A problem exists; I might consider doing something about it”

ACTION Choosing alternate behaviors

MAINTENANCE After the first six months of choosing alternate behaviors in the action phase,

behavior becomes more habitual, and maintenance phase begins

RELAPSE Presented as a normal part of the process and an opportunity to learn. After

relapse, Veteran motivation to change may be at any of the first three phases.

Case management is most effective when

interventions match the client’s stage of readiness. 

In assessing a person’s readiness for change, Case

Managers should have the Veteran identify pros

and cons across the spectrum of action. With the

Case Manager, the Veteran should name and list the

advantages and disadvantages for change–as well

as the advantages and disadvantages of maintaining

the status quo. By eliciting the Veteran’s own

motivations, and striving to understand the Veteran’s

decision criteria, the Case Manager can link needed

changes with the Veteran’s goals, thus building

motivation. While external forces may seem to drive

or compel change, lasting changes require internal

motivations. To facilitate this, the Case Manager’s

key tasks are listening and exploring as HUD-VASH

participants identify their own reasons to do the

work required for recovery.

HUD-VASH links housing to health care and other

resources, yet often people are not ready to utilize all

of the supportive services to make changes. When

a homeless individual is not ready to make changes,

he or she may be resistant to outside advocacy for

a certain change. As humans, we naturally work to

maximize our options, and when someone else lists

the reasons to adopt or reject a certain behavior,

we may resent a perceived limitation of choices. 

Instead, an effective intervention may be to gently

and non-judgmentally raise awareness of how

certain choices interfere with personal goals.

Using the rent arrears example, the Case Manager

might reflect,“Spending so much money on clothes

seems to be giving you trouble with your rent. Are

there other saving goals that it’s interfering with?” 

While the Stages of Change framework was

developed around addictive behaviors, practitioners

have successfully used it for issues such as

medication adherence, benefits, and entitlements.

Ongoing Efforts

Resolving barriers to housing stability will be an

ongoing part of the work with some Veterans. 

Updating the Housing Barriers Assessments and

Stabilization Plans keeps the focus on this critical

aspect of the work. Understanding the Veteran’s

perspective on needed changes helps the worker to

intervene more effectively. Continuing to connect

behavioral changes to housing maintenance and

achieving other self-identified goals will help build

the Veteran’s motivation for change. 
70 H U D - V A S H R E S O U R C E G U I D E

Case Studies

The following case studies describe a variety of

situations in which housing stability is threatened. 

For each case, the Case Manager’s short-and longterm interventions are described. 

Case Study: Rent in Arrears

George is a man in his 60’s who has been in housing

for six months. He came to HUD-VASH from a shelter

and you were able to help him get his VA pension

and then find an apartment. He had a few problems

with his rent in the first few months but you helped

him work it out. The bank will now send the check

directly to the landlord and he was able to pay his

arrears through assistance from a local church.

George likes his apartment and has promised to

do better. He tells you things are good and, in fact,

he has begun seeing his family again. His children

are grown and he is happy to have contact with

his children again, so he can enjoy time with his

grandchildren.

On a recent visit, you are surprised to find out from

the landlord he is 2 months behind on his rent.

George explained that his son needed money for a

car repair and he could not refuse. He is apologetic,

and in order to stay ahead, he wants you to help him

get some back rent money from his church.

George’s Long-Term Goal: A normal life in the 

community, a role in his family

Short-Term Tasks: 

• Help stabilize the crisis (eviction): help negotiate

a repayment agreement with the landlord,

seek emergency financial assistance and/or get

George legal assistance 

• Connect paying his rent to his goal of a normal

life in the community

Long-Term Tasks: 

• Work with George on planning expenses,

including both rent and an emergency fund

• Develop a budget

Case Study: Noise Complaints

Joyce lives in an apartment with her three small

children. She keeps to herself, does not talk to any

of her neighbors, and is always with her children.

Although Joyce is quiet, her neighbors report

hearing screaming at night, and are complaining to

the landlord that Joyce is“just strange.” Additionally,

the school has contacted the HUD-VASH Case

Manager to report that that the two older children

are sleepy during the day.

Joyce is angry about the complaints. She says she

has problems sleeping and often wakes up with bad

dreams. She is worried that, if she takes medication

to help her sleep more deeply, she might not hear

her children if they need her. Now, not only does she

fear that she will have to move, but she is thinking of

home-schooling her children.

Joyce’s Long-Term Goal: A good life with her children

Short-Term Tasks: 

• Discuss the issues that are jeopardizing housing

and threatening Joyce’s long-term goals: always

being tired, not sleeping, not being able to care

for and protect her children, the complaints

from the neighbors that put housing at risk

• Help Joyce negotiate with the landlord for some

time to resolve the problems

• Educate her on options for sleep disorders

and traumatic dreams. Explain that there are

services and treatments that can help her sleep

better. Explore the possibility of mental health

treatment

Long-Term Tasks: 

• Explore whether she is interested in connecting

with other mothers with similar experiences

• Explore options for day care or baby-sitting for

the youngest child so that Joyce can get a break

during the day

Case Study: Utility Shutoff and Unkempt Unit

Joe moved into his apartment after completing

drug treatment. He had been doing pretty well–
H U D - V A S H R E S O U R C E G U I D E 71 

going consistently to treatment and to Narcotics

Anonymous meetings. He decorated his apartment

and talked about getting a job. But now, after about

6 months in housing, things have begun to change.

He talks about moving on with his life. He has a

girlfriend and wants to spend more time with her.

He has been seeing some of his old buddies and

hanging out with them in a bar. He explains that

alcohol is not his drug of choice, so it is okay to drink.

He wants to put homelessness behind him.

Yet, when you visit him in his apartment, the

electricity is shut off and the apartment is a mess. 

He wants you to leave.

Joe’s Long-Term Goals: A home, a job, a relationship

Short-Term Tasks:

• Reiterate your role to help Veterans maintain

stable housing and reach their goals

• Address the immediate crisis of the electricity

being shut off by trying to get emergency

financial assistance or agreeing to the utility

company’s payment plan

• Try to connect with him and what he is

interested in now; frame his goals in terms

of what is most important to him now–his

relationship

Long-Term Tasks: 

• Acknowledge that goals change; ask what is

working for him. Focus on current housing and

relationship goals 

• Discuss whether he is happy in his apartment

and how he got so behind on utilities

• Ask whether he sees the drinking as related to

his problems paying utility bills. Assess whether

he has reasons to stop or reduce alcohol

consumption; raise awareness of how drinking

creates problems for him. 

• If he wants to stay in the unit, assist with

developing a plan to pay all bills

Case Study: Health and Safety

Teresa was moving from one family member’s

house to another. She last lived with her sister, who

had also taken care of her children while she was

deployed to Afghanistan. When she could no longer

stay with her sister, she was given a hotel room by

the family shelter system. They helped her get into

the HUD-VASH program.

Now, Teresa is tired and ashamed of her situation.

She gets her kids to school, but is home with the

baby by herself all day. She naps a lot. The house is

a mess–food on the couch, dirty carpets, and wet

diapers on the counters. The landlord is complaining.

She says she is doing the best she can.

Teresa’s Goal: A home and a life with her children

Short-Term Tasks: 

• Work with the landlord to establish a timeframe

to cure the violation

• Addressthe issue that puts housing at risk: not

maintaining the environmental hygiene standards

of the apartment. Provide assistance/training with

initial cleaning, provide cleaning supplies and

instructions, assessrisk to the children.

• Connect to goals and assess if the apartment is

working for her

Long-Term Tasks: 

• Acknowledge Teresa’s sadness and all that has

transpired in her life; offer support

• Provide education about treatment, peer

support, and other types of support groups;

normalize her feelings

• Identify after-school programs, activities, and/

or enrichment opportunitiesthat will keep her

children active and engaged and give her a break

Case Study: Occupancy and Noise Violations

Jack lived in an encampment for many years. He was

seen as a leader there, often helping the other guys

with medical care and benefits. He accepted housing

after he got sick, but he still misses the camp. He is

doing well in housing and is liked by the landlord

and his neighbors.
72 H U D - V A S H R E S O U R C E G U I D E

He often has people staying with him. They don’t

usually stay long and, at first, everyone ignored it.

Now, however, there is a woman staying with him who

drinks and can be loud. She insultsthe neighbors, and

when she told the landlord thatshe now livesthere,

the landlord decided he had enough.Jack is angry;

hisfriend has no place to go. Doesn’t anyone else

understand what it islike to have no place to go?

Jack’s Goal: A home and friends

Short-Term Tasks:

• Determine whether the lease violation

(increased occupancy) puts Jack at immediate

risk. Review the tenancy laws and educate

him on rules for occupancy and timeframe for

visitors.

• Work with landlord to establish a timeframe to

fix the violation

• Review process and implications for voucher of

getting someone added to the lease

Long-Term Tasks: 

• Discuss what Jack’s goals are in this particular

relationship. Are he and the woman trying to

establish or strengthen a romantic relationship

by living together? What does he want in the

long term?

• Identify options related to the goals that have

been established. Weigh out positives and

negatives of each option. Make a plan.

• Address his loneliness and loss of role as a leader

in the camp. Offer options to continue serving

others and holding a leadership role; explore a

peer support role or volunteering.

Case Study: Criminal Activity

Phillip has been struggling. Engaged in an ongoing

cycle of drug use and detox, and being in and out of

treatment, he has been using more lately. His phone

is out of service; he sold some of his furniture; and,

on your last visit, he did not answer the door. Now

the landlord tells you that people are dealing out of

the apartment, and the landlord wants Phillip out.

Phillip says he does not want to lose his housing.

Phillip’s Goal: Keep his housing

Short-Term Tasks:

• Ensure that landlord has made tenant aware of

allegations

• Assess risk; do not go to the apartment alone. 

Police escort may be necessary.

• When you meet, reinforce and use the

requirements of the lease and the subsidy.

Explain that, if proven, thisis groundsfor eviction.

• If Phillip is picked up on criminal charges,

provide support, identify treatment options, and

connect with a lawyer. Also, explore alternate

or Veteran-specific courts and jail diversion

treatment programs.

Long-Term Tasks: 

• If not arrested, provide support, identify treatment

options, identify path to alternate housing

• Reconnect Phillip to his long-term goals and

dreams 

• Consider project-based permanent supportive

housing with more security

Case Study: Health and Safety: Hoarding

Howard has been homeless for a long time, but

even while living in a shelter he maintained

several storage spaces. He worked hard to sort

his belongings to move into housing, but now

everything is starting to pile up again. He is even

finding furniture on the street and moving it into

his apartment. The landlord is alarmed–he visited

Howard in the apartment and found the rooms filled

with furniture and newspapers. Food was spoiling on

the tables and there was a terrible smell. Howard is

worried. He called you to say that the landlord wants

him out but he doesn’t know why.

Howard’s Goal: Stay in his home 

Short-Term Tasks: 

• Negotiate with landlord to establish a timeframe

to fix the violation. Ensure the landlord notifies

the tenant. If the landlord is not a good choice,

use the subsidy administrator or a supervisor.
H U D - V A S H R E S O U R C E G U I D E 73 

• Establish that Howard’s goal is to keep his

apartment. Educate him on the expectations of

tenancy and the requirements for keeping his

housing subsidy.

• Assess Howard’s ability to sort the accumulated

belongings, provide assistance if needed, and, if

required, enlist adult protective services, heavy duty

cleaners, or cliniciansfor psychiatric assessments

Long-Term Tasks:

• Establish regular visits by HUD-VASH worker

and/or community agencies to monitor in future

Case Study: Utility in Arrears and Substance Use

Elliot has a service-connected disability. He has

a serious back injury and has been on painkillers

forsome time. Elliot hastried physical therapy,

acupuncture, and hypnosis as well as more

conventional treatments. He has complained of pain

since he first came into housing, butsomething has

changed. He calls you to check in, butsays he istoo

tired for a home visit. You finally do get to visit him and

he seems dazed. He has no food in the refrigerator,

and, during the visit, it becomes clear that he is behind

on his electric bill. He reportsthat he rarely leaves

the house. You suspect he hasincreased his pain

medication, and that thisis where his money is going.

Elliot’s Goal: Manage pain safely to maximize his 

ability to create the life he wants

Short-Term Tasks: 

• Help Elliot address the utility bill. Work with him

to negotiate a payment plan with the utility

company. Educate him on the expectations of

tenancy and the consequences of discontinued

utilities. 

• Offer assistance by making a plan to get food

delivered by connecting Elliot with services such

as Meals On Wheels, etc.

Long-Term Tasks:

• Re-establish goal of housing maintenance.

While working together, assess Elliot’s ability

to function and whether or not he is putting

himself at risk.

• Address the back pain issues. Reconnect with

treating physician, request pain consult. Offer

alternatives to address pain issues.

Key Practices

• Enhance Veterans’motivation

• Assess Veterans’readiness to change and

use motivational techniques consistent with

Veterans’stage of change

• Explain link between current activities and

Veterans’ long term goals to help maintain

motivation 

• Discuss reasons for past housing loss; identify

highest priority threats to housing stability

• Provide Veterans with education about

expectations of tenancy

• Where needed, help Veterans create household

budgetsor connectthemwithfinancial literacy

services

• Where needed, arrange representative payee

and/or direct vendor arrangements to pay rent

Test Your Knowledge

Quick Check: Answer“true or false”to the following

statements to check your knowledge about

challenges to housing stability. 

1) The Housing Authority should educate Veterans

about maintaining a home.

2) Case Managers can help prevent housing

instability by doing home visits weekly at first and

at least monthly ongoing.

3) Gently raising awareness in a non-judgmental

way of how behaviors interfere with personal

goals can be an effective intervention.

4) Continuing to connect behavioral changes to

maintaining housing may cause a Veteran to

reject services.

5) Arranging for a representative payee provides

a crutch for a Veteran that doesn’t allow him or

her opportunity to take charge of his or her own

housing stability. 
74 H U D - V A S H R E S O U R C E G U I D E

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) What are some key reasons and circumstances

that a household’s tenancy might be threatened?

2) If a Veteran fails to pay rent and instead has given

money to a family member, what responses can

the Case Manager have to prevent loss of housing

and help the Veteran make better decisions?

3) Review the case studies in this chapter with your

team and talk through the short-term and longterm tasks you might implement.
H U D - V A S H R E S O U R C E G U I D E 75 

What’s in This Chapter?

Supervision in HUD-VASH requires an understanding

of a multitude of disciplines and practices as well

as team structures and training opportunities that

can help you continue to improve your HUD-VASH

program.

In this chapter, you will learn

• The purposes and how-to’s of HUD-VASH

supervision and training;

• How to set-up and manage team meetings,

case conferences, and clinical consultation; and

about

• Opportunities to work with Network Homeless

Coordinators.

As a supervisor, this chapter will provide you with

a set of tools from which to develop the structure

and approach for your HUD-VASH team. In concert

with many other chapters from this Resource Guide,

you will gain a comprehensive understanding of the

work of the VA in HUD-VASH and specific tools for

leading its success.

Introduction

Good supervision and training are essential for Case

Managers in their efforts to help Veterans remain

housed and to achieve their other goals. The tools

and forms introduced in previous sections of this

manual can help supervisors to structure their

individual and group work with staff as well as to

identify needs that should inform the development

of staff training programs. 

Training and supervision should be mutually

reinforcing and neither intervention alone is

sufficient to ensure good outcomes. While it can be

helpful to send staff to training, if the concepts are

not reinforced and translated into specific practices

that the worker is able to implement, the full value of

the training will not be realized. At the same time,

supervisors face many competing demands and

supervision can often be the first thing that goes to

the bottom of the list. Managers and administrators

must reinforce that supervision is important and

ensure that supervisors are trained and supported to

find the time to provide it. 

Purposes and Goals of Supervision

The primary purposes of supervision and training

can be broadly conceptualized as follows:

1) To ensure that organizational, program

and client goals are achieved through

administrative oversight of tasks,

2) To provide education and information to

staff that builds their skills and knowledge

to perform their jobs more effectively and to

develop professionally, and

3) To provide support to staff as they encounter

obstacles and experience setbacks in their

work, and assist them in setting goals for future

performance and professional development.

Supervising staff in housing stabilization services

delivery requires that supervisors understand the

tasks involved in locating housing as well as the

requirements and conditions of a Veteran’s tenancy. 

PART 1 C H A P T E R 7

Tools for Supervision and Training
76 H U D - V A S H R E S O U R C E G U I D E

Assigning Caseloads

Supervisors should consider staff expertise and

client needs when assigning cases. During the

housing search and right after move-in, a Veteran

and his or her family will likely need extra support

as they transition from homelessness. Some clients/

families will have chronic, serious issues that will

present complicated clinical challenges for the long

haul. 

The CTI model advocates that workers have a

mix of case assignments. As much as possible,

they should be working with some clients in early

stages of transition and some with more residential

stability, as well as handling some higher- and some

lower-need assignments. This provides staff with

opportunities to see success as well as grapple with

more complex needs. 

Supervision and Training Tools

A variety of tools are available to supervise and

train staff. The most common method is through

individual meetings with Case Managers. Case

conferences, which are a form of group supervision,

allow staff to think and work together and provide

an opportunity for them to learn from each other. 

Team meetings provide a vehicle to deal with

administrative tasks efficiently, share resources, and

identify ongoing program development needs as

well as systems and resource issues that impact the

service. 

Clinical consultation from a psychiatrist, licensed

clinical social worker, psychologist or other seasoned

clinician can be an invaluable resource for case

consultation and staff training. Many Veterans,

particularly those who have been chronically

homeless, present some of the most complicated

clinical challenges workers will face. 

Group trainings and conferences can be efficient

ways to share information with larger groups of

staff. However, as noted above, reinforcing concepts

and skills learned in trainings on the job is a critical

function of other supervisory activities. 

Individual Supervisory Meetings

Weekly individual meetings with each Case Manager

are recommended, but, at a minimum, meetings

should be held bi-weekly. The primary purpose

of this meeting is to review progress on service/

housing stabilization plans with the Veterans on the

worker’s individual caseload. The supervisor can use

the CTI Phase Tracking Form (on the next page) to

see how the Veteran is moving through the phases

and achieving goals. In order to ensure stability and

prevent crises before they occur, each household

should be discussed at least monthly in individual

supervision or a case conference. 

Individual supervision focuses on helping the Case

Manager understand his or her role and to plan

interventions with Veterans and their families. The

supervisor helps staff decide how to link changes

in behaviors to client goals and aspirations. For

example, a Veteran may be more motivated to take

medications as prescribed if the medication is linked

to getting or keeping a job or something else that

the Veteran has identified as important to him or her. 

Finally, individual supervision focuses on the

administrative aspects of the work, ensuring that

Housing Stabilization Plans and Assessments are

updated on schedule and that other documentation

and contact requirements are met.

Phase Tracking 

The CTI Phase Tracking Form on the next page is

a useful tool for Case Managers and supervisors

to see client progress, or lack thereof, and to focus

supervision.
H U D - V A S H R E S O U R C E G U I D E 77 

CTI Phase Tracking Form

CTI Worker Name: . .

Supervisor Name: . . . .

CTI worker: Take latest updated copy of form whenever you go into the field. 

Supervisor: Keep form updated, make copies for staff, bring to all supervision meetings for reference during case

review, remind CTI workers of upcoming transitions, and monitor whether CTI workers make their phase treatment

plans on time. 

Goal Areas: Identify the 3 primary areas of focus for each phase using the goal numbers below.

Goals: 1. Housing 2. Income 3. Health/Mental Health Treatment 

4. Substance Use 5. Family Intervention 6. Independent Living Skills/Supports

Veteran PreHousing

Date

Enrolled

PreHousing

Goals

(from list

above)

Phase 

I Start

Date

Goals

(from

list

above)

Phase 

II

Start

Date

Goals

(from

list

above)

Phase 

III

Start

Date

Goals

(from

list

above)

Case 

Closed

Date

Joseph Small 1/6/09 2 4 4/17 2 4 7/21 1 4 10/16 1 4 1/28/10

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

25.

25.

Housed

1 1 5 5
78 H U D - V A S H R E S O U R C E G U I D E

Sample Case Manager Job Description for the 

Delivery of Housing Stabilization Services using 

Critical Time Intervention1

DUTIES AND RESPONSIBILITIES:

The primary responsibility of the HUD-VASH Case

Manager is to assist each Veteran and their families

participating in the HUD-VASH program to access

and maintain both housing and needed services

and supports that will assist them to stabilize in their

communities. The HUD-VASH program is committed

to serving chronically homeless and vulnerable

Veterans and each case manager is charged with

increasing access to the program for this population.

As a member of the team, the HUD-VASH Case

Manager will carry a caseload of approximately

twenty-five to thirty five assigned Veterans and

their families who have been identified as meeting

the criteria for HUD-VASH services. HUD-VASH case

management services will be guided by the tenets

of Critical Time Intervention (CTI) as well as other

evidence based practices and will include, but not

be limited to, the following activities: engagement,

building rapport, assessment, service and support

referrals, housing access, and follow-up housing

stabilization and retention services. Responsibilities

will also include keeping accurate records as well as

working as an advocate for the individuals on the

caseload in order to obtain appropriate services, care

and housing.

HUD-VASH Case Management

1) Establish ongoing relationships with chronically 

homeless, VASH-eligible Veterans, utilizing 

motivational interviewing techniques and proactive engagement strategies

a. Maintain regular contact with identified

Veterans and their families

b. Identify housing preferences and barriers to

access and retention

c. Identify issues of concern/need and address as

appropriate

d. Discuss short and long-term goals with

individual, develop and document plan to

meet them

e. Begin the housing planning process with each

Veteran

2) Establish eligibility for the HUD-VASH program

a. Verify the Veteran’s Status, eligibility for VA

medical care, need for case management

services

b. Follow the process for referrals, evaluation, and

admission to the HUD-VASH Program, ensuring

that eligible Veterans and their families are

placed into the program

c. Continue to provide appropriate treatment and

supportive services to the potential HUD-VASH

Program participants, assisting the Veteran in

the PHA issuance of the rental voucher process

d. Provide housing search assistance to the HUDVASH Participants with vouchers

3) Conduct assessment, referral; provide follow-up 

services to individuals in appropriate treatment, 

supportive and other programs both VA-based 

and in the community.

a. Learn about the Veteran’s (and family’s, if

applicable) treatment, housing and support

history. Discuss what worked, what didn’t, and

why.

b. Identify and prioritize needed services and

target most appropriate options

c. Assess barriers to housing stability and target

interventions accordingly 

d. Develop a plan to access housing, services and

supports. Actively involve the Veteran in the

assessment and development of the housing

plan.

4) Work with individual to reach identified goals 

emphasizing self-determination, responsibility 

and respect. 

a. Assist Veteran (family) with housing location,

ID, benefits, income, employment, education,

health, legal and other issues to support stable

tenancy and life goals 1

Adapted from the Department of Veterans Affairs, VHA Handbook 1162.05.

HUD-VASH Program. Washington, DC: 2009.
H U D - V A S H R E S O U R C E G U I D E 79 

b. Advocate for Veteran’s (family’s) needs as

necessary within larger system of services and

supports

c. Arrange, coordinate care, and provide direct

clinical services and support

5) Once appropriate placement is achieved, utilize 

the three-phase Critical Time Intervention 

model to work with Veteran (family) and service 

providers to maximize support, community 

integration, and housing stability. 

a. With the Veteran (family): Maintain close

contact with Veteran throughout transition to

housing, including visiting the new home, and

assist the Veteran (family) in becoming familiar

with the new community.

i. Provide direct services to the Veteran

(family) while working to connect each with

both VA and community resources

ii. Provide direct mental health and substance

use counseling within the scope of the

practice and role as case manager

iii. Meet regularly with landlords, PHAs and

tenants to ensure a safe living environment

and address any tenancy and/or subsidy

issues

iv. Provide crisis prevention and management

services as need to maintain the Veteran

(and family) safely in the community

v. Monitor physical and mental health and

substance use status and stability

vi. Regularly discuss changes in psychiatric

symptoms and/ or triggers for substance use

vii. Provide access to treatment resources and

encourage re-entry into treatment

viii. Work to improve life and tenancy skills by

participating with Veterans in their new

housing arrangements 

ix. Provide education on life skills such as:

credit, repair, financial literacy, shopping,

and maintaining a household, safety and

tenancy requirements

x. Facilitate Veteran’s (family’s) participation in

employment and training both within the

VA and other community resources

xi. Remain accessible and responsive to the

Veteran and their families maintaining a

focus on HUD-VASH plan

xii. Discuss Veteran’s concerns, fears, and

frustrations, and work to resolve or alleviate

while challenging the individual (family) to

address these potential obstacles of his/her

long-term goals

xiii. Make intensive efforts to locate missing

clients

b. Work with the VAMC and Community providers

and supports: carefully coordinate these

linkages

i. Meet together with the Veteran (family) and

providers to adjust the service plan. The

plan is to be adjusted at 3 month intervals

documenting progress towards greater

independence and housing stability.

ii. Monitor linkages to ensure follow-through

and success or challenges. Intervene, when

necessary, and advocate on behalf of the

Veteran (and family) to fill gaps in services.

iii. Arrange for or provide transportation for

necessary appointments

iv. Educate the providers about the HUDVASH Case Manager’s role with the Veteran

(family)

v. Share information with the providers

and supports as appropriate respecting

confidentiality

vi. Establish and encourage ongoing

communication between landlords, PHA,

VAMC, community providers, and supports

vii. Observe and test the housing stabilization

service plan. Update accordingly.

viii. Be prepared to step-down the case

management services as Veterans and

their families are more able to use other

resources and increase independence
80 H U D - V A S H R E S O U R C E G U I D E

ix. Make a plan for decreased services or

transfer to non-HUD-VASH subsidies not

requiring Case Management Services

6) Document in a timely and accurate manner in the 

HUD-VASH file and the NEPEC system. 

7) Develop a broad familiarity of available 

treatment and supports that may be available to 

Veterans and their families. Ensure that all of the 

HUD-VASH team has access to identified resources 

to support all Veterans participaing in the HUDVASH program.

a. Visit behavioral health treatment sites both

within the VA system and in the community

and know how to access them

b. Know the behavioral health services available

for persons with various needs, i.e. crises,

medical complications, substance abuse issues,

chronic/low demand

c. Attend ongoing training to learn new ideas in

assisting persons with mental illness, substance

abuse issues, and co-occurring disorders

d. Develop expertise in assisting Veterans with

benefits, legal, employment and educational

opportunities

e. Establish expertise in working with families,

both living together and apart

8) Follow all Veterans Administration policies and 

procedures to maintain professional standards of 

the HUD-VASH program, safety of staff and those 

we serve.

a. Participate as a full team member

b. Maintain strong relationships with community

resources

9) Participate in staff meetings, case conferences 

and individual supervision.

a. Consult with Supervisor and team on strategies

for serving Veterans and their families

10) Maintain collaborative relationships with HUDVASH team and VA staff, other service providers, 

and professional behavior toward the public.

Clinical Consultation

Ongoing support from a senior clinician is helpful

with assessment and service and treatment

planning. Many Veterans and their families have

complicated lives that include substance use

disorders, PTSD, depression and other mental

health problems as well as medical conditions that

require ongoing treatment, sometimes all at once. 

A senior clinician can consult with staff to ensure

that the Veteran is getting coordinated care and

provide advice on ongoing assessments and service

planning. 

The clinical consultant does not replace the case

management supervisor; rather, this position

supports and trains the team and may even provide

some direct services in particularly difficult cases

or when there are concerns about risk of suicide,

violence, domestic violence, and/or child abuse. A

clinical consultant may be assigned to the team

part-time. This position can also assist in evaluating

fidelity to the CTI model and assisting with ongoing

program development. 

Working with the Network Homeless 

Coordinators (NHC)

Each Network Homeless Coordinator (NHC) has VISNlevel responsibility for oversight and monitoring of

the HUD-VASH Programs in their VISN. The NHC is a

resource for Case Managers and Supervisors.

According to the VHA Handbook for HUD-VASH, 

the NHC is responsible for

• Ensuring HUD-VASH Programs are monitored

and evaluated as prescribed by established VA

medical center policies;

• Reviewing North East Program Evaluation

Center (NEPEC) results and other evaluation

data (HUD-VASH Dashboard) and working with

VA medical centers;
H U D - V A S H R E S O U R C E G U I D E 81 

• Assisting HUD-VASH Case Managers to develop

thresholds, clinical indicators, program

monitors, and corrective actions, when

necessary;

• Working with VA medical centers and HUDVASH Case Managers, along with Quality and

Performance Management staff, to include

HUD-VASH Programs in risk management and

reporting systems;

• Reviewing HUD-VASH Programs’ critical

incidents and initiating appropriate

investigation and follow-up activities in

collaboration with the respective medical

center;

• Providing support, guidance, and advice to

HUD-VASH Case Managers through regular

communications, including site visits, to

facilitate mentoring, problem solving, and

compliance.”11

Case Conferences

The CTI approach strongly recommends the use

of weekly case conferences in which the whole

team meets and reviews cases that have been preselected through weekly supervision or ongoing

supervisory monitoring. The purpose of the case

conference is to improve staff knowledge and skills

in helping Veterans access and maintain housing

and achieve their goals. The focus is on assessment,

service planning and developing creative case

management interventions. Case conferences are

generally 1 – 1.5 hours in length, allowing time

for discussion of 2-4 cases. Preferably, the clinical

consultant is at the case conferencing meetings. 

NHC’s can also be invited to case conferences, to

consult especially on cases where there have been

critical incidents. 

Cases with multiple or unusual obstacles to housing

stability–both successful and unsuccessful–are

presented by the relevant Case Manager. The whole

team engages in problem-solving and/or identifying

best practices and lessons learned through the

process. 

It can be useful to select cases for review based

on commonality or diversity across barriers to

housing stability. Priorities for case review include

households that have

• Rent arrears,

• Poor living conditions,

• Multiple crises,

• Problems with nuisance or criminal behavior,

and/or 

• Children with poor school attendance.

Outline for Case Conference Presentation

I. Current challenges and reason case was

selected for presentation

II. Relevant information from the Housing

Stability and Barriers Assessment

III. Efforts made to address the challenges

IV. Questions and discussion with the group

V. Resolution on next steps

Team Meetings

Team meetings are different from case conferences

in that they focus more on the administrative and

systemic issues that arise in the work. In these

meetings, the team can look at overall progress and

identify themes and common barriers in the work. 

Team meetings also provide an opportunity for staff

to share resources and information with the rest of

the team, identify best practices and plan how to

respond to challenges that cut across case loads. 

Ongoing program and resource development is also

a function of these meetings. 

At team meetings, it is useful for the supervisor to

review the whole team’s caseload with the total

number of people at each Phase of CTI. It is also

useful to review clients who are in crisis, especially

to identify needs for clinical consultations and brief

team members who may be needed to intervene or

provide back up. Finally, debriefing critical incidents

can be an agenda item for team meetings. 

These meetings also have a support and teambuilding function. They can be great forums to

recognize staff successes, build cohesion, and
82 H U D - V A S H R E S O U R C E G U I D E

reinforce shared aims and values. Finally, team

meetings can be used to identify staff training needs

and resources for professional development.

Learning through Observation: Modeling 

and Role-Plays

A very effective way for staff to learn new skills and

approaches is to observe other staff in interactions

with clients. Supervisors can meet with workers

together with Veterans (and their families) to model

various skills and interventions. This is especially

helpful for new workers or staff who are new to

providing services in the home or in the community

(off VAMC grounds). 

Using role-plays where the staff person takes

the client role and the supervisor assumes the

Case Manager role can be useful to help prepare

for meetings with the client, especially when a

challenging meeting is anticipated. After the role

play, the staff person and the supervisor would

review the strategies used by the supervisor during

the role-play and reflect on how that affected the

client’s reactions. 

Group Trainings and In-services

All staff will need to be oriented to the HUD-VASH

case management model as well as the voucher

issue processes at the local Housing Authority.

Additionally, trainings are recommended in the

following areas, as they address critical skills and

areas of expertise HUD-VASH Case Managers need to

be effective in their practice:

• Housing location strategies

• Working with landlords to support the Veteran’s

housing stability

• Critical Time Intervention

• Stages of Change

• Motivational Interviewing

• Housing First and Rapid Re-housing

• Trauma-informed services

• Accessing benefits and entitlements

• Conducting risk and suicide assessments

• Child abuse and neglect – especially the

requirements for mandated reporters in your

State

• Trainings by the Network Homeless

Coordinators on local initiatives, coordinating

with the local homeless Continuum of Care

system, and improving program performance

Key Practices

• Assign Case Mangers a mixed caseload with

cases at different stages and of varying

complexity

• Conduct individual supervision with each Case

Manager weekly or biweekly, reviewing housing

plans, assessments, and contacts for each case

at least monthly

• Hold weekly case conferences to discuss 2

to 4 preselected cases and invite any clinical

consultants

• Hold regular team meetings to address

administrative or systemic issues

• Use modeling and role-plays to improve Case

Managers Skills’

• Provide group trainings and in-services

on critical topics to build Case Managers’ 

knowledge and skills

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about HUDVASH supervision.

1) Case conferences are a form of group supervision

in which the team discusses specific cases

whether they are working on them or not.

2) Weekly meetings with each Case Manager are

recommended.

3) HUD-VASH caseloads never exceed a 1:10 staff to

client ratio.
H U D - V A S H R E S O U R C E G U I D E 83 

4) Adding clinical consultation from a psychiatrist

or other clinician to the team can complicate the

group dynamic and should be avoided when

possible.

5) The Network Homeless Coordinators are

resources for Case Managers and Supervisors.

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) What are some of the purposes of supervision and

training?

2) What qualifications are you seeking in a Case

Manager? What should be in the job description

for this role?

3) What kinds of things do you anticipate reviewing

with Case Managers in individual weekly

meetings? How do these topics differ from

those you might have on an agenda for a team

meeting?

4) What responsibilities do Network Homeless

Coordinators have that can be an enhancement

to your team?

5) Providing group trainings and in-services is

critical to building Case Manager knowledge and

skills. What topics should be covered in trainings?
84 H U D - V A S H R E S O U R C E G U I D E

The Big Picture: A System of Response to 

Prevent and End Homelessness

In Part 1, we took a close look at many aspects of

HUD-VASH: eligibility, targeting, administrative

processes, and housing stability strategies. Before

diving into Part 2, which focuses on prevention and

clinical issues, it is useful to step back and examine

how VASH fits within a larger, coordinated and

targeted set of services and housing interventions

that the VA and its community-based partners

are developing to prevent and end homelessness

among Veterans. We refer to this larger set of

interventions as a ‘system of response.’

What is a System of Response?

A system of response is a fully coordinated and

comprehensive approach to ending and preventing

homelessness at the local or community level. A

system of response is meant to replace the ad

hoc, uncoordinated, and haphazard services that

actually perpetuate, rather than end, homelessness.

Unfortunately, this stopgap service administration

often characterizes much of what is available in

communities for Veterans experiencing or facing

homelessness. In contrast, a functioning system

of response actively seeks and identifies Veterans

experiencing and facing homelessness. As these

Veterans are incorporated into the system, they

are provided with immediate and appropriate

assistance. These interventions may help them avoid

housing crises or enable them to exit homelessness

permanantly. 

PART 2 C L I N I C A L I S S U E S A N D S U P P O R T

Creating a Full System of Response to End Homelessness

among Veterans

There are three essential components of a 

community system of response:

1) Coordinated systems of outreach and inreach that make it possible to identify Veterans

experiencing, or at-risk for, homelessness across

a wide variety of settings and institutions

2) A full range of housing options, service 

interventions, and differentiated responses 

that is tailorable to Veterans experiencing

different levels and forms of homelessness

(chronic/episodic, short-term, new entry, at-risk

due to institutional discharge, and at-risk due

to housing loss)

3) Coordinated methods for matching 

individuals to the appropriate interventions

based on urgency of homelessness/housing

crisis and level of needs (e.g., see chart of

Housing and Service Needs in Chapter 3)

A SYSTEM OF RESPONSE IS...

Coordinated. It includes systems of outreach and in-reach

to identify Veterans experiencing, or at risk for, homelessness

across a wide variety of settings and institutions.

Resource rich. It includes a full range of services for

Veterans experiencing different levels and forms of

homelessness.

Systematic yet tailorable. Response options are linked

to a coordinated methodology for matching individuals

to appropriate interventions based on urgency of

homelessness/housing crisis and level of needs.
H U D - V A S H R E S O U R C E G U I D E 85 

Coordinated Outreach/In-Reach to 

Identify Homeless Veterans

Veterans experiencing homelessness, or who are

at risk for homelessness, are less likely to already

be engaged with VA services than their stablyhoused counterparts. Therefore, community

systems of response must have coordinated and

comprehensive approaches to identifying homeless

and at-risk Veterans across a wide variety of settings.

(see Figure 1). These settings include

• Traditional homeless assistance settings such as

homeless shelters, streets, drop-in centers, food

pantries;

• Institutional settings like hospitals, detox

facilities, substance abuse treatment programs,

courts, jails and prisons; and

• The community, particularly neighborhoods

characterized by high rates of poverty, housing

loss and evictions.

Different Patterns of Homelessness 

Require Differentiated Responses

A system of response, with its full range of housing

options and support services, provides the

breadth and depth of resources necessary to tailor

interventions for differing patterns of homelessness.

Matching clients with appropriate support programs

requires a fundamental understanding of the scope

and nature of their experiences with homelessness,

which are often categorized into three types:

transitional, episodic, and chronic homelessness.

Transitional homelessness usually occurs once,

for a short period of time. Exits from transitional

homelessness usually require minimal assistance.

However, this does represent a potentially

preventable service failure for a vulnerable client. 

Transitional homelessness is, then, most easily

addressed by engaging at-risk individuals with proactive service delivery.

Episodic homelessness is characterized by

multiple or repeated periods of housing instability. 

Episodically homeless Veterans are likely to also be

involved in other systems with set entry or release

periods, such as inpatient psychiatric or treatment

programs, the criminal justice system, or limitedstay housing shelters. The Veteran who is cyclically

or episodically homeless lacks either the skills or

resources to create or execute a long-term solution

on his or her own, or any such plans are interrupted

by crisis or an immediate short-term housing

opportunity.

Chronic homelessness is often described as being

semi-permanent. Veterans who are chronically

homeless have been without fixed or regular shelter

for a prolonged period of time and may have

become resigned to homelessness as a lifestyle or

routine.

PATTERN CHARACTERISTICS STRATEGY

Transitionally Homeless

Experience homelessness once,

only for a short period of time, and

leave on their own with little or no

assistance

	Prevent entry into homelessness

Episodically Homeless

Multiple, repeated periods of

homelessness. Characterized by

intense periods of involvement with

public service systems (jails, hospitals,

other crisis services settings)

	Rapid re-housing

	Transitional housing

	Permanent supportive housing

Chronically Homeless

Homelessness is a long-term or semipermanent state. Unable or unwilling

to exit homelessness without

intervention.

	Permanent supportive housing
86 H U D - V A S H R E S O U R C E G U I D E

Full Range of Housing and Service 

Interventions

Veterans who are experiencing, or who are at risk

for, homelessness need different types and levels

of housing assistance and supportive services

to avoid or exit homelessness permanently. A

complete community system of response for ending

homelessness among Veterans must address a

comprehensive range of needs. Thus, it requires

a full spectrum of proven housing and services

interventions. These include

• Permanent supportive housing (e.g., HUDVASH). Permanent supportive housing is

comprised of full subsidies for permanent

housing that are linked to wrap-around case

management services. Permanent supportive

housing is designed for chronically homeless

and high-needs Veterans, especially those with

complex behavioral health issues, co-occurring

mental health and substance use disorders, and/

or physical disabilities. Communities need not

one, but several types, of permanent supportive

housing options in order to meet the needs of

eligible Veterans. This may include both singlesite and scattered-site housing, models of care

that focus on Housing First, programs that

incorporate jail diversion, etc.

• Critical Time Intervention (CTI). CTI is a model

of fully-subsidized permanent housing in which

the housing voucher is linked to time-limited,

phased case management services designed

to help homeless Veterans with less-disabling

mental health conditions to build and navigate

a services network on their own. 

• Transitional Housing. Short-term (less than

2 years) residential programs with on-site

therapeutic, recovery-oriented, or self-help

services can help Veterans gradually develop the

skills they need to live independently.

• Rapid Re-housing. When a Veteran and his

or her family has just lost housing, financial

assistance and services can be provided for

quick relocation to safe, stable housing. In this

model, clients are also provided with transitional

supports to help them retain housing.

• Homelessness Prevention. Short-term

financial and case management assistance can

be provided when Veterans and their families

are in precarious housing settings, have been

discharged from institutions or hospitalizations

to a changed housing situation, etc. Prevention

itself involves services along the full spectrum of

supports, including connecting with estranged

family members, relocation to more stable

housing, behavioral health interventions, etc.

• Patient-Centered Health Homes. In this model

of comprehensive and coordinated health care,

primary health/medical, behavioral health,

and other supportive services are combined

for Veterans with chronic and complex health

conditions who, if not provided with these

comprehensive services, may face homelessness

in the future. 

• Standard VA Services and Benefits. The

standard set of benefits and quality medical

services provided by the VA are the first line of

defense against Veteran homelessness.

Matching Individuals and Families to 

Appropriate Interventions

The final component of a community system of

response involves tools and methods for matching

Veterans to appropriate levels of need. For instance,

HUD-VASH supportive housing is best suited for

high-need, chronically homeless Veterans who need

the long-term, low-demand support and assistance

that this model provides. Transitional housing may

work well for individuals who are able to overcome

personal barriers and become employable, but

not for those who have chronic mental health

challenges. If communities target interventions to

the wrong levels of need, they run the risks of having

less positive outcomes and wasting scarce resources. 

Figure 3 presents ways these interventions“map”to

different levels of housing and service needs and

outlines how to match individuals to appropriate

interventions.
H U D - V A S H R E S O U R C E G U I D E 87 

FIGURE 1. OUTREACH / IN-REACH TO ENGAGE VETERANS EXPERIENCING OR

AT-RISK OF HOMELSSSNESS

Prior Era Veterans Experiencing

Chronic Homelessness

Homeless Veterans from Prior

Conflicts/Era

OEF/OIF Veterans Experiencing

Homelessness

OEF/OIF Veterans At-Risk of

Homelessness

FIGURE 2. THE FULL RANGE OF INTERVENTIONS FOR ENDING AND PREVENTING

HOMELESSNESS AMONG VETERANS

FEDERAL 

POLICY

Supportive Services for 

Veteran Families

Grant and 

per diem

Program

HUD-VASH

HOUSING 

SERVICES 

AND MODELS

Standard VA 

Services and 

Benefits

PatientCentered 

Health Home

Homeless 

Prevention

Rapid ReHousing

Permanent 

Supportive 

Housing

KEY 

PRACTICES

Timely approvals

of applications for

VA benefits and

services

High-quality

and professional

services

Identification

of housing and

services needs

and possible

referral to other

services

Coordinated,

wrap-around

holistic health

model including

primary and

behavioral

health services

and other

social services

supports

Assistance

with eviction

prevention

or

prevention

of housing

loss through

shortterm cash

assistance,

legal

assistance,

and shortterm service

supports

Rapid

placement

into housing

through

shortterm cash

assistance

Very shortterm service

supports to

help ensure

transition to

housing

Short-term

(<2 years)

residential

model

Services

emphasizing

self-help,

substance

use

counseling,

mental health

counseling,

and

employment

services

Peer supports

Single-site and

scattered-site

models

Housing First

Long-term

high-touch,

voluntary

intensive case

management

services

Motivational

interviewing

and other EBPs

Eviction

prevention

Rehabilitative

services

Peer supports

Temporary

Supportive

Housing
88 H U D - V A S H R E S O U R C E G U I D E

Are you an Expert? Answer these questions on

your own or with other members of your team.

1) What are some examples of universal prevention

activities?

2) Which groups might benefit most from targeted

prevention efforts?

3) What are some situations a Veteran may face

that would be considered“at immediate risk”for

homelessness?

4) What resources are available for formerly

incarcerated Veterans? Why is it important to have

programs targeted for this population?

5) Surveys of individuals experiencing homelessness

show an inverse relationship between homeless

status and educational attainment. What VA

education and benefits resources does your team

need to know about to help Veterans who are at

risk of homelessness?

FIGURE 3. MATCHING HOUSING NEEDS AND SERVICES NEEDS 

 WITH APPROPRIATE INTERVENTIONS

Targeting Veterans for

HUD-VASH

vs. other VA programs should

involve a consideration of

housing needs

and service needs

as two separate

but interrelated domains.

HOUSING NEEDS

LOW MODERATE HIGH

Veteran is currently and stably

housed (rents or owns home or

resides with family members),

though may have occasional

problems paying housing costs

Veteran is currently

housed at imminent

risk of housing loss due

to eviction, has had

history of housing crises/

homelessness, or is

housed in a temporary

setting

Veteran is currently

homeless and has had

history of housing

instability and

homelessness

SERVICE NEEDS

LOW

Veteran is ablebodied, connected

to workforce, and

few barriers to

employment, selfsufficiency, and

activities of daily living

Standard VA Services/Benefits Supportive Services for

Veteran Families

Supportive Services for

Veteran Families

MODERATE

Veteran has

some barriers to

employment, selfsufficiency, or activities

of daily living, which

can be overcome or

attenuated through

services and treatment

VA treatment services

Supportive Services for

Veteran Families or Grant

and Per Diem

Supportive Services for

Veteran Families or Grant

and Per Diem

HIGH

Veteran has multiple 

and complex barriers 

to employment, 

self-sufficiency, and 

activities of daily 

living, such that 

services are needed 

on an ongoing basis

VA Patient-Centered Health 

Home HUD-VASH HUD-VASH
H U D - V A S H R E S O U R C E G U I D E 89 

What’s in This Chapter?

The concepts of housing stabilization and

homelessness prevention share many of the same

techniques and case management practices. In this

chapter, you will explore how these concepts work

together, and you will become familiar with how

each of these relates to specific nature of Veteran

homelessness and to its unique solutions.

After reading this chapter, you will also be familiar

with prevention programs and activities that

you can use to help Veterans who are at risk for

homelessness.

The Need for Veteran-specific Homeless 

Prevention Services

The need for Veteran-specific homelessness

prevention services is underscored by a body of

evidence with several main findings:

• One in ten low-income Veterans experiences

homelessness each year (HUD, 2009),

• An estimated 2.3 million Veteran households in

rental housing had low (defined as less than 80

percent of area median income [AMI]) incomes

in 2005, and

• Of these 2.3 million tenant Veteran households

with low incomes, 1.3 million of these

households had very low incomes (less than

50 percent of AMI), placing them at high

risk for housing instability (U.S. Government

Accountability Office [GAO], 2007).

To address this, the U.S. Congress authorized two

VA-led homelessness prevention programs–the

Veterans’Homelessness Prevention Demonstration

(VHPD) Program, and the Supportive Services for

Veteran Families (SSVF) Program.

Conceptual Framework for Preventing 

Homelessness

VA, together with other federal, state, and

community agencies, and along with the private

sector, provides a diverse array of homelessness

prevention services. These often include economic

assistance for those in financial need; medical,

psychiatric, and substance abuse care; housing

programs; and employment, legal, and other

services to help vulnerable Veterans. These programs

and services are often referred to as universal 

prevention activities.

Prevention, or shutting the “front door”to

homelessness, is widely recognized as a necessary

component of any strategy to end homelessness

(National Alliance to End Homelessness, 2000).

However, the difficulties inherent in implementing

effective prevention initiatives (Shinn, Baumohl,

& Hopper, 2001) keep programs focused on

accommodating those who have already lost

their housing. Furthermore, even at maximum

effectiveness, no program can prevent all

homelessness. However, when a preventionoriented policy framework is cast aside, the result

may be the institutionalization of homelessness. 

So stated Lindblom (1991) nearly 20 years ago. As

explained by Burt and colleagues (2005, p. iv),

“To close the front door of entry into homelessness, 

the central challenge of prevention is targeting 

our efforts toward those people that will become 

homeless without the intervention. Providing 

prevention assistance to people who would not 

otherwise become homeless is an inefficient use of 

limited homelessness dollars.”

Stressing the use of proven interventions in the

manner that is most effective, this model uses a

continuum of housing instability to explain which

PART 2 C H A P T E R 1

Homelessness Prevention
90 H U D - V A S H R E S O U R C E G U I D E

evidence-based interventions are most appropriate

at various stages of progress. To ensure that

prevention activities are both efficient and effective,

resources should be directed toward three levels of

prevention: primary, secondary, and tertiary.

Primary prevention activities are targeted at

households who are at risk of homelessness,

but when they are still in their current–housed–

situation. By targeting at-risk individuals or Veteranled households before they actually become

unsheltered, new cases of homelessness can be

prevented.

Secondary prevention activities assist those who

are imminently homeless by quickly addressing

the household’s housing instability. Secondary

prevention techniques are aimed at Veterans or

Veteran-led households, especially during exits from

inpatient or residential treatment services, other

institutions, or temporary housing. Shelter diversion

might also be applied to families or individuals who

present either to the VA or to local continuum of care

providers for emergency shelter.

Tertiary prevention activities reduce the impact of a

household’s existing housing instability and create

opportunities for stable housing. Tertiary prevention

practices focus on the currently homeless Veteran

or the Veteran who receives housing and other

supports through VA or from other communitybased providers. These households may require a

more intense level of intervention to access and

maintain stable housing, and may require primary

prevention interventions upon housing location.

Although this chapter focuses on primary and

secondary prevention interventions, universal

prevention activities, such as assisting with receipt

of entitlements, play an important role in creating a

service plan for at-risk Veterans. For such programs,

The National Resource Directory is a valuable

resource: www.nationalresourcedirectory.gov.

Targeting Veterans for Homelessness 

Prevention Interventions

Identifying Veterans in need of targeted

interventions is a fundamental task for homelessness

prevention efforts. Groups who could benefit

most from such focused prevention efforts include

personnel returning from OEF/OIF; Veterans in

inpatient settings; Veterans who are separating

from a military service involuntarily due to physical

or emotional trauma; Veterans receiving substance

abuse and mental health treatment; Veterans living

in the community who are receiving non-VA services;

and Veterans in transition from acute or residential

care to outpatient services.

An essential aspect of VA’s targeting efforts involves

the development and maintenance of ties between

VA and the community. Stronger community

relations, and collaboration with communitybased homeless programs, significantly improves

coordination of care. These same approaches may

also improve ability to identify at-risk Veterans

who present for services at community programs

(McGuire, Rosenheck, & Burnette, 2002; Rosenheck,

Resnick, & Morrissey, 2003).

VA-led primary prevention centers around Veterans

for whom homelessness is considered an immediate

risk. Interventions include provision of short-term

assistance, such as referral to VA services; resolution

of issues with family members or others involved

with the current housing instability; short-term rent,

mortgage, and utility assistance; and/or tenantlandlord mediation. These interventions will enable

a large number of households to maintain their

housing stability with time-limited assistance in

an efficient and cost-effective manner (Culhane &

Metraux, 2008).

Under VA’s definition, for a Veteran and

accompanying dependents to be considered“at

immediate risk”of becoming homeless, they must

be living at or below fifty percent of the AMI. They

must also meet at least one or more of the following

criteria:

• Imminent loss of housing, occurring when the

household is (a) facing immediate housing loss

and lacking the resources and support networks

needed to find other housing; (b) facing eviction

within 14 days; (c) living in a hotel or motel

and lacking the resources to stay for more than

14 days; (d) living doubled-up and needing to

leave within 14 days; and (e) living in housing

that has been condemned or is in foreclosure.

The Homeless Emergency Assistance and Rapid
H U D - V A S H R E S O U R C E G U I D E 91 

Transition to Housing (HEARTH) Act, signed in

May 2009, has expanded HUD’s definition of

homelessness to include these imminent risk

conditions.

• History of housing instability, including (a)

lacking a history of living independently on

a consistent basis; (b) having experienced

persistent instability, which will continue

because of disability, health or mental health

problems; addiction, abuse, or multiple barriers

to employment; and (c) having recently had a

traumatic event has resulted housing instability.

• Imminent transition related to program or 

institutional discharge or domestic violence 

situation, including (a) fleeing or attempting to

flee domestic violence, without the resources

to achieve housing stability; (b) leaving an

institution (or engaged with courts), without a

plan or the means to achieve stable housing;

and (c) having completed a transitional housing

or residential rehabilitation program, but

needing time-limited supportive services to

prevent a return to homelessness.

Secondary prevention strategies target very lowincome Veterans, and their families, after they have

become homeless. Interventions among this group

stress rapid re-housing, diversion from a shelter,

etc., and actively work towards resolving conflicts

that have exacerbated a fragile situation. Secondary

prevention involves working with landlords, family

members, employers, etc., with the goal of returning

people to prior housing arrangements–where they

will also receive support services–whenever possible.

When return to a prior housing arrangement is

not possible due to personal safety or other issues,

rapid re-housing efforts will be initiated, including

short-term housing subsidies; rent, mortgage, and

utility assistance; mediation or negotiation with

landlords, including lease co-signing or security

deposit arrangements; avoiding school truancy and

working with school systems if relocated, etc. Case

management and financial assistance will be used

as a bridge to help Veterans move into and establish

residence in affordable permanent housing. When

necessary, these services may also be used to

link eligible Veterans and their families into other

subsidized supportive housing programs, such as

HUD-VASH.

Both primary and secondary prevention strategies

require a thorough assessment of family needs,

including particular attention to a sustainability plan,

as rapid re-housing and prevention interventions are

inherently short-term. Planning must address longterm needs underlying current housing instability so

that the precipitating crisis does not recur.

VA Program Options Available to Case 

Managers

The VA has embarked on several prevention-focused

initiatives designed to specifically augment primary

and secondary prevention strategies.

Supportive Services for Veteran Families (SSVF)

Public Law 110-387 authorized VA to develop the

Supportive Services for Veteran Families (SSVF)

Program. Under the SSVF Program, VA awards grants

to private non-profit organizations and consumer

cooperatives that provide supportive services to

very low-income Veteran families residing in, or

transitioning to, permanent housing. Grantees are

required to provide outreach, case management,

and VA benefits assistance; they must also provide or

coordinate efforts to obtain other entitlements (e.g.,

subsidies from state or local assistance programs)

and to connect the Veteran family with community

services. In addition, grantees have the option

of providing temporary financial assistance to

participants, which may include third party payment

for rent, utility payments, security deposits, moving

costs, child care, transportation subsidies, and

emergency supplies. 

The program’s objective is housing stability via

short-term, focused interventions. Consistent with

the Housing First approach’s core philosophy that

permanent housing creates an environment in

which other issues can be addressed, even if this

occurs after exiting the program, SSVF promotes

concrete steps toward stability. Individual SSVF case

management plans should focus on meeting those

needs.

SSVF supports both primary and secondary

prevention activities; however, each grantee is

required to spend the bulk of their funds on rapid
92 H U D - V A S H R E S O U R C E G U I D E

re-housing. This requirement is due in part to the

challenges faced in effectively targeting at-risk –

but housed – Veterans. As described earlier, the

literature indicates that, although certain groups

are at higher risk, existing targeting techniques

cannot consistently identify who needs this service;

that is, even the most astute case worker cannot

determine who will become homeless without SSVF

assistance. The National Center on Homelessness

Among Veterans seeks to develop those targeting

techniques through an analysis of SSVF outcomes

and HUD’s experience with the Homelessness

Prevention and Rapid re-housing Program (HPRP).

Although not a mandatory component of the

SSVF program, most grantees have elected to offer

financial assistance. This financial assistance can

take a variety of forms: rental assistance, utility

payments, security deposits, moving costs, child

care, transportation expenses, and emergency

supplies. Consistent with the mission of SSVF as a

focused, time-limited intervention, these payments

are limited both in the amount of dollars that are

available (a maximum of 30% of any grant) and the

length of time that they can be offered to any family.

Whenever practical, grantees are encouraged

to include co-payments by participants when

financial assistance is provided. Sustainability plans

are also an essential part of any plan that offers

financial support. The most basic question that

will need to be addressed is how the family will

manage the expense (whether it is rent, the utilities,

transportation, or child care) once the SSVF financial

support is no longer available.

The objective of SSVF is to achieve housing stability

over the shortest time possible. Part of the initial

assessment will be determining if the family needs

long-term, ongoing assistance and would be better

served by a permanent supportive housing program,

such as HUD-VASH.

Further information about SSVF can be found at

www.va.gov/HOMELESS/SSVF.asp.

The National Call Center for Homeless Veterans 

(NCCHV)

The VA has estabilished a National Call Center for

Homeless Veterans hotline to ensure that homeless

Veterans or Veterans at risk for homelessness have

free, 24/7 access to trained counselors. The hotline

is intended to assist homeless Veterans and their

families, VA Medical Centers, federal, state and local

partners, community agencies, service providers,

and others in the community.  Veterans who are

homeless, or who are facing a housing crisis, can

seek assistance by calling (877)424-3838.

Criminal Justice Programs: Health Care for ReEntry Veterans (HCRV) and Veterans Justice 

Outreach Initiative (VJO)

Approximately 9 percent of persons in jail or prisons

in the United States are Veterans, amounting to

well over 200,000 incarcerated Veterans nationwide

(Greenberg & Rosenheck, 2008a; Greenberg &

Rosenheck, 2008b; National GAINS Center, 2008;

Noonan & Mumola, 2007). These numbers are

likely to rise as Veterans return from Afghanistan

and Iraq; this cohort of Veterans is at higher risk for

incarceration due to high rates of substance use

disorders, psychiatric disorders (e.g., trauma, PTSD,

depression), and domestic violence. Most Veterans

in jail are there for non-violent offenses (McGuire,

2007). However, Veterans face longer sentences than

other arrestees for some types of offenses (Noonan

& Mumola, 2007). At least 15-16 percent of inmates

are homeless (Greenberg & Rosenheck, 2008; McNiel,

Binder, & Robinson, 2005), including significant

numbers of Veterans; when these incarcerated

Veterans are released from custody, they are at

particular risk for homelessness (McGuire, 2007).

Complicating service delivery to this group is

the high proportion of sex offenders. According

to the U.S. Department of Justice, 23 percent of

the Veterans incarcerated in state facilities had

committed a sexual offense, compared to 9 percent

of non-Veterans. Sex offenders face a variety of

barriers to housing, employment, and other benefits.

A further challenge in serving this group is that

38 percent received other than honorable military

discharges, potentially limiting their eligibility for VA

services (Noonan & Mumola, 2007).

The Health Care for Re-entry Veterans (HCRV)

Program is designed to address the community reentry needs of incarcerated Veterans.  HCRV’s goals

are to prevent homelessness; reduce the impact of

medical, psychiatric, and substance abuse problems
H U D - V A S H R E S O U R C E G U I D E 93 

upon community re-adjustment; and decrease the

likelihood of re-incarceration.  HCRV staff reach out

to Veterans within six months of release from U.S.

state and federal prisons. The goal of this clinical

outreach is to connect Veterans with appropriate VA

services, especially homeless prevention programs

and mental health and substance use services. The

VA’s close cooperation with state Departments of

Correction, and with the U.S. Departments of Justice

(Bureau of Prisons, Bureau of Justice Statistics),

Labor, and Health and Human Services (Office of

Child Support Enforcement [OCSE]), have been

critical for the successful implementation of the

program. 

The Veteran Justice Outreach (VJO) initiative seeks

to avoid the unnecessary criminalization of mental

illness and extended incarceration among Veterans

by ensuring that eligible justice-involved Veterans

have timely access to VHA mental health and

substance abuse services when clinically indicated

and other VA services and benefits as appropriate.

Each VA medical center has been asked to designate

a facility-based Veterans’Justice Outreach Specialist,

responsible for direct outreach, assessment, and case

management for justice-involved Veterans in local

courts and jails, and liaison with local justice system

partners.  For a list of VJO contacts, check the VA’s

webpage at www.va.gov/HOMELESS/VJO.asp.

In addition, mainstream services can provide

valuable aid. LawHelp, found at www.lawhelp.org, helps

low and moderate income people find free legal

aid programs in their communities, and answers

to questions about their legal rights. Legal help for

military members, Veterans, and their families can be

found at http://statesidelegal.org.

Other Intervention Activities

Although this chapter focuses on primary and

secondary prevention interventions, universal

prevention activities such as entitlements play an

important role in creating a service plan for atrisk Veterans. The National Resource Directory is a

valuable resource for such programs at

www.nationalresourcedirectory.gov.

Income Benefits

There are a broad range of mainstream income

benefits available to assist Veterans and their

family members. While typically considered

universal prevention activities, these benefits also

play an important role in primary and secondary

prevention. As such, they often need to be a part of

homelessness prevention and exit strategies.

The Veterans Benefits Administration (VBA) has 57

Homeless Veterans Outreach Coordinators (HVOC)

nationwide at VBA Regional Offices. The HVOCs

provide information and assistance on VA benefits

and services, including eligibility criteria and

procedures for filing compensation and/or pension

claims. They provide outreach to homeless Veterans

at shelters and stand downs, through state and

local community partners, and in other areas where

homeless Veterans may be located. 

Securing Social Security benefits provides

dependable assistance for those who are aged or

disabled, yet this can often be a difficult and timeconsuming process. According to the SSI/SSDI

Outreach Access and Recovery (SOAR) initiative,

“Supplemental Security Income (SSI) and Social 

Security Disability Insurance (SSDI) are disability 

income benefits administered by the Social 

Security Administration (SSA) that also provide 

Medicaid and/or Medicare health insurance to 

individuals who are eligible. The application 

process for SSI/SSDI is complicated and difficult 

to navigate. Nationally, about 37 percent of 

individuals who apply for these benefits are 

approved on initial application and appeals take 

an average of two years to complete.

For people who are homeless or who are returning 

to the community from institutions (jails, prisons 

or hospitals), access to these programs can 

be extremely challenging. Approval on initial 

application for people who are homeless and 

who have no one to assist them is only about 10-

15 percent. For those who have a mental illness, 

substance use issues, or co-occurring disorders that 

impair cognition, the application process is even 

more difficult – yet accessing these benefits is often 

a critical first step in recovery.” 
94 H U D - V A S H R E S O U R C E G U I D E

To find contactsfor local SOAR initiatives, check their

website at http://www.prainc.com/SOAR/

Employment, Vocational, and Educational 

Rehabilitation 

Shaheen and Rio (2007, p. 341) also emphasize

the importance of facilitating employment

opportunities; they point out that helping locate

employment“is an unrecognized and underutilized

practice for preventing and ending homelessness.”

Although Veterans who are homeless, or at risk

for homelessness, often face a variety of personal,

programmatic, and systemic reasons that may

prevent them from working, employment has been

found to be key to both residential stability and to

recovery of mental health among people with SMI.

The VA’s Compensated Work Therapy (CWT) program

provides vocational assistance, job development,

job placement, and on-going supports to improve

employment outcomes among homeless Veterans. 

Vocational Rehabilitation Specialists (VRS) are

integrated into Health Care for Homeless Veterans

(HCHV), Grant and Per Diem (GPD), HUD-VASH,

Domiciliary Care for Homeless Veterans (DCHV),

Healthcare for Re-Entry Veterans (HCRV), and

the Veterans Justice Outreach Initiative (VJO)

treatment teams for the purpose of providing

community-based vocational and employment

services. Vocational and employment services for

homeless Veterans are based on the principles of

rapid engagement, customized job development,

and competitive community placement, and are

coupled with on-going supports for employment

maintenance.

There is also a clear link between educational

engagement and residential stability. Surveys of

individuals experiencing homelessness show an

inverse relationship between homeless status

and educational attainment. The link between

educational attainment and later income, well

established for the civilian population, is also

consistent for people with SMI. Successful

educational engagement contributes to greater

community integration and participation. The

support of Veterans’ education goals has long been

a priority for VA, going back to the original G.I. Bill.

This commitment was strengthened by the Post9/11 Veteran’s Educational Assistance Act of 2009,

which authoized financial support for education

and housing. Its benefits include tuition and fees, a

monthly housing allowance, and an annual stipend

for books and supplies to Veterans with at least 90

days of aggregate service on or after September 11,

2001, and honorable discharge.

However, Veterans who are homeless and who have

SMI may have difficulty taking advantage of their

G.I. Bill benefits. Studies show that these Veterans

need special assistance to navigate the process of

receiving benefits, enrolling in school, handling their

symptoms, finding housing on campus, and dealing

with other educational challenges. Such assistance

can be found in the recovery-based programs of

supported education services. Like supported

employment, supported education is implemented

in natural community settings (community colleges,

adult education programs), the support is not

time-limited, clinical and vocational services are

integrated, and goals are driven by the person’s

choice.

When Veterans with psychiatric and other disabilities

choose to pursue an educational goal, supported

education can provide the assistance necessary to

enter and succeed in community-based educational

programs at secondary or postsecondary levels.

The goals of supported education include

improving a Veteran’s literacy, study skills, and time

management skills; supporting the Veteran as he or

she navigates the educational environment; helping

with applications and financial assistance; and

improving attitude and motivation (Collins, Bybee,

& Mowbray, 1998). Any comprehensive approach to

homelessness prevention will include a supported

education component.

Discharge Planning 

Effective discharge planning from institutions

of care (e.g., criminal justice system, inpatient

psychiatric and substance abuse facilities) is a critical

component of preventing homelessness (Backer,

Howard, & Moran, 2007). One study found that

homeless adults with chronic medical problems

who were provided housing and case management
H U D - V A S H R E S O U R C E G U I D E 95 

following a hospital discharge had fewer subsequent

hospital stays and emergency visits compared

to those receiving standard care (Sadowski, Kee,

VanderWeele, & Buchanan, 2009). Veterans being

discharged from VA care should be systematically

screened for homelessness risk; Veterans who screen

positive should be consistently referred to an array

of preventive interventions matched to their level of

need.

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about

homelessness prevention. 

1) One in 10 poor Veterans experience homelessness

each year.

2) Unfortunately, there are currently no VA-funded

homelessness prevention programs.

3) The central challenge of prevention is targeting

efforts toward those people that will become

homeless without the intervention.

4) One example of being“at immediate risk”of

becoming homeless is losing a job.

5) The objective of the Supportive Services for

Veteran Families (SSVF) program is to achieve

stability through a short-term, focused

intervention.

6) In SSVF, each grantee is required to spend the

bulk of their funds on education and job training

for“at-risk”Veterans.

7) The National Call Center for homeless Veterans is

24/7 hotline with access to trained counselors.

8) Approximately 9 percent of persons in jail or 

prisons in the United States are Veterans.

9) The Health Care for Re-entry Veterans (HCRV)

program begins engagement with Veterans

immediately upon exit from jail or prison.

10) Nationally, only about 37 percent of individuals

who apply for social security benefits are

approved on initial application and appeals take

an average of two years to complete.

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) What are some examples of universal prevention

activities?

2) Which groups might benefit most from targeted

prevention efforts?

3) What are some situations a Veteran may face

that would be considered“at immediate risk”for

homelessness?

4) What resources are available for formerly

incarcerated Veterans? Why is it important to have

programs targeted for this population?

5) Surveys of individuals experiencing homelessness

show an inverse relationship between homeless

status and educational attainment. What VA

education and benefits resources does your team

need to know about to help Veterans who are at

risk of homelessness?
96 H U D - V A S H R E S O U R C E G U I D E

What’s in This Chapter?

There is a high rate of co-occurring substance

abuse and mental health disorders among Veterans

enrolled in HUD-VASH. When the HUD-VASH team is

familiar with strategies for engaging individuals with

co-occurring disorders, it may help Veterans on their

caseloads accomplish their recovery goals.

In this chapter, you will be presented with an

overview of the evidence-based practices for

treating mental illness, substance abuse, and cooccurring disorders, including

• Motivational Enhancement Therapy,

• Relapse Prevention,

• Twelve-Step Facilitation,

• Cognitive-Behavioral Therapy,

• Social Skills Training, and

• Assertive Community Treatment.

After reading this chapter, you will have a basic

understanding of the evidence-based approaches to

treatment for people with co-occurring disorders.

Introduction 

As a HUD-VASH Case Manager, it is highly likely that

you will encounter Veterans whose transition from

homelessness is further complicated by mental

health and/or substance use disorders. In fact,

recent data from the HUD-VASH program suggests

that 64% of Veterans who apply to the program

suffer from alcohol abuse or dependence, and

that over two thirds have at least one psychiatric

diagnosis (O’Connell, Kasprow, & Rosenheck,

2010). As the ability to maintain housing is related

to successful recovery from mental health and

PART 2 C H A P T E R 2 :

Treating Co-Occurring Disorders Within HUD-VASH: 

Evidence-Based Approaches 

substance use disorders, and as there is a high rate

of co-occurring substance abuse and mental illness

(COD) among Veterans enrolled in the HUD-VASH

program, you may find it helpful to be familiar with

the behavioral treatment approaches that have

consistently demonstrated their effectiveness in

helping people with mental illness and substance

abuse accomplish their recovery goals. Such

services are referred to as Evidence-Based 

Practices (SAMHSA, 2010). For the past 30 years,

addictions researchers and mental health treatment

providers have been developing and testing various

therapeutic approaches and clinical interventions

to better assist individuals suffering from mental

illness, substance abuse, or COD. In this section, we

will review the evidence-based practices that have

been found to be most effective in treating this

population.

Mental illness and substance abuse are commonly

observed among the homeless population and

have been recognized as important contributing

factors to chronic homelessness, especially when

these conditions co-occur (North et al, 1996). 

According to national data, approximately 45% of

homeless Veterans suffer from a mental illness and

(with considerable overlap) more than 70% suffer

from alcohol or drug problems (VA, 2010). The

most commonly observed mental health problems

include mood disorders, PTSD, and schizophrenia,

while the most common substances of abuse include

nicotine, alcohol, marijuana, cocaine, and heroin

(Mares & Rosenheck, 2006). Furthermore, many

Veterans are polysubstance users, meaning that

they use cocaine and/or other drugs, drink alcohol,

and smoke cigarettes concurrently. Furthermore,

approximately half of all individuals with Serious

Mental Illnesses (SMI), such as schizophrenia and

bipolar disorder, have also been diagnosed with
H U D - V A S H R E S O U R C E G U I D E 97 

a lifetime substance use disorder; of these, 30%

also meet the diagnostic criteria for a current

substance use disorder (Regier, et al, 1990; Essock,

et al, 2006). In a survey conducted by O’Toole and

colleagues (2003), both homeless Veterans and

non-Veterans had high rates of substance abuse;

however, homeless Veterans were significantly more

likely to have a chronic medical condition as well

as two or more mental health conditions. Even

so, when compared with homeless non-Veterans

who participated in the survey, homeless Veterans

were significantly less likely to access care from a

community clinic. 

Individuals who suffer from co-occurring disorders

are also less likely to adhere to their prescribed

treatment regimens (Dobscha, et al, 1999), and a

recent study found that even relatively infrequent

substance use (approximately 5-7 days of use per

month) among individuals with mental health

problems resulted in significantly greater treatment

discontinuation (Smelson et al, 2006). Furthermore,

another study found that patients who fail to

connect to outpatient services after discharge from

inpatient treatment are at a higher risk for recidivism

(Dixon et al, 2009), and, unfortunately, estimates

suggest that less than half of all discharged

psychiatric patients ever successfully transition

to outpatient care (Boyer, 1997; Nuttbrock, et

al., 1997). Ultimately, this service fragmentation

leads to increased“revolving-door”service usage.

This stopgap service access, including cycling

back and forth among shelters, using emergency

and inpatient treatment services as primary care,

and receiving little or no continuity for care postdischarge, contributes to poor treatment outcomes

(Prince, 2006; Weiden et al, 2004). Furthermore,

homeless Veterans, particularly those meeting the

HUD definition of chronic homelessness, tend to use

more costly acute services rather than outpatient

and preventive treatment services. This is due,

in large part, to disengagement in programs of

continuing care (North & Smith, 1993; Padgett,

Struening, & Andrews, 1990). Moreover, Veterans

who have most recently experienced homelessness

have been found to be less likely to use preventive

services than non-homeless Veterans (McGuire

& Rosenheck, 2005), ultimately leading to higher

treatment costs (Rosenheck & Seibyl, 1998). 

Sadly, the co-occurrence of mental health and

substance use disorders often results in psychiatric

symptom exacerbation, including an increased

risk of suicide (Soyka, et al, 2001). Often, as

substance abuse worsens, psychiatric symptoms

worsen, which, in turn, causes an increased use of

illicit substances in an attempt to cope with the

intensity of heightened mental health symptoms. 

Additionally, chronic, heavy substance abuse also

leads to legal problems; medical problems (including

a greater risk for HIV) and acquisition of hepatitis

and other infectious diseases; violence; housing

instability; homelessness; and a greater burden on

families, all of which contribute to higher treatment

costs (Canton et al, 1994; Cuffel et al, 1994; Haywood

et al, 1995; Rosenberg et al, 2001; Serper et al, 1995;

Smelson et al 2002; Essock et al, 2006). 

Given the high prevalence of mental illness,

substance abuse, COD, and chronic medical

conditions among homeless Veterans, as well as the

high rates of service fragmentation in the treatment

of homeless Veterans suffering from these illnesses,

equipping HUD-VASH Case Managers with proven,

evidence-based case management approaches, as

well as the clinical tools to properly assess and treat

mental health issues, is of the utmost importance. 

This is particularly true when working with Veterans

in HUD-VASH who are suffering from SMI, as

substance abuse is the most common psychiatric comorbidity among this population (Brunette, Mueser,

& Drake, 2004; Adams, et al, 2007).

Evidence-Based Practices for Treating 

Mental Illness, Substance Abuse and

Co-Occurring Disorders 

As you work with Veterans enrolled in the HUDVASH program who have the illnesses and disorders

mentioned in the previous section, it will be helpful

to have a general understanding of some of the

evidence-based practices used to treat substance

abuse and mental illness. In this section, we will

briefly discuss some of these approaches. As

an exhaustive description of all evidence-based

practices used to treat mental illness and substance

abuse is beyond the scope of this Resource Guide,
98 H U D - V A S H R E S O U R C E G U I D E

readers are strongly encouraged to visit the

Substance Abuse and Mental Health Services

Administration website www.samhsa.gov for further

information.

MOTIVATIONAL ENHANCEMENT THERAPY (MET)

MET is a brief therapy designed to enhance

motivation by helping clients resolve ambivalence

about addressing and ultimately changing their

problem behaviors (i.e., substance abuse). MET is

derived from the Motivational Interviewing (MI)

counseling approach developed by Drs. William

Miller and Stephen Rollnick. MI is built on the

idea that each client approaches treatment at a

different–and fluid–level of readiness to change

behaviors and/or address symptoms associated with

mental illness. MET techniques are also designed

to enhance counselor-client rapport and, for this

reason, are particularly useful during initial sessions,

when client ambivalence may be about treatment

itself. The acronym“OARS”is used to identify the

fundamental skills of MET: Open-ended questions,

Affirming, Reflective listening, and Summarizing. 

OARS

Open-ended questions

Open-ended questions are questions that are

designed to encourage clients to elaborate about

their thoughts and feelings and offerdetails about

their situations. Open-ended questions, in other

words, stand in opposition to questions that ask

for a simple “yes”or“no”response. Open-ended

questions should not sound judgmental. For

example, unless the client has expressed concern

about his/her drinking, the question,“What do

you intend to do about your drinking?”will only

elicit client resistance. On the other hand, openended questions are designed to help create

internal motivation for change. Questions that

sound judgmental will only cause clients to resist

their treatment provider’s influence. More is said

about how to deal with resistance below.

Affirming

Affirmations are a way of validating a client’s

experiences or feelings, and also indicate that you

are present and focused. However, it is important

to note that this does not simply mean agreeing

with everything he/she says. To be effective,

affirmations need to be genuine. Examples of

affirmative responses include, “That must have 

been very hard for you” or “I really respect how hard 

you are struggling to overcome your drug problem.” 

The inclusion of affirmations into your counseling

style is essential during treatment and can be

particularly helpful when working with Veterans

who are more difficult to treat. Affirmations are

useful for

• Reducing Veteran hopelessness and

discouragement,

• Reducing therapist hopelessness and

discouragement,

• Building rapport, and

• Reinforcing progress.

Reflective Listening

Reflective listening is considered to be one

of the cornerstones of MET. Using reflective

listening during sessions with your Veterans

is a way for you to show that you are carefully

listening. Reflective statements may be followed

by questions like, “Am I understanding correctly? 

Is there anything I’m not getting?” to demonstrate

the importance you place on accurately

understanding what the Veteran you are working

with is saying (i.e., his/her perspective) and to

model an openness to the relationship. Reflective

listening statements also tend to spontaneously

elicit elaborations from the client without the

need to directly ask a question. It is certainly

appropriate to ask questions; however, Case

Managers who mix questions with reflective

statements will be more likely to create a better

conversational flow, whereas those who only

ask questions to advance a discussion may

unwittingly create a passive Veteran (i.e., one

who simply answers one question and then waits

for the next). There are several different types of

reflections:
H U D - V A S H R E S O U R C E G U I D E 99 

• Simple reflections, which accurately mirror a

Veteran’s thoughts or feelings, and are further

subdivided into four types:

1) Repetition: a literal repetition of a Veteran’s

statement

2) Rephrasing: restating the Veteran’s statement

in new words

3) Paraphrasing: a more complex form of

rephrasing that captures more than one

thought or feeling

4) Continuing the paragraph: inferring about an

underlying thought, feeling or event;

• Double-sided reflections, in which the clinican

restates both sides of an issue with which the

Veteran is struggling; and

• Amplified reflections, which are slightly

overstated in order to make a point.

Summarizing 

The purpose of a summary isfor you, asthe

Case Manager, to reflect general understanding. 

Essentially, thisisreflecting on a largerscale. To use

a metaphor, instead of reflecting on a particular

tree, you are reflecting on an entire stand of trees

(or even the forest). For example, after 10 minutes

of discussion about a variety of interconnected

topics(e.g., arguments with a landlord and coworkers, heavy alcohol use, PTSD symptoms), you

may want to considersummarizing the discussion

in order to help the Veteran make connections

between them. Thus, you mightsay,

“We’ve talked about a few things in the past 

10 minutes or so and what I’m hearing is that 

you have concerns about your relationships 

with some people at work and with your 

landlord. And that makes sense to me. These are 

important people in your life even if you might 

wish they weren’t at this point. You also told me 

about your flashbacks in the past week and how 

upset they’ve been making you. I also know from 

what you just told me that you’re feeling more 

like starting to drink again. If you did go back to 

drinking, how do you think it would affect these 

other problems?” 

It is often helpful to

• Conclude a summary with an open-ended

question designed to help make connections

between the topics, and to

• Word questions in a non-judgmental way. 

An example of a more problematic wording

of the question is, “What makes you think 

drinking would help you in this situation?” The

implicit judgment contained in the question

is likely to cause the Veteran to feel criticized

and, therefore, close off rather than open up

the discussion.

In general, summaries serve four functions:

1) To begin or end a session with an overview that

allows the Veteran to reflect on what has been

discussed. This helps to lend coherence and

continuity to treatment. It can be particularly

effective as a form of agenda setting at the

beginning of each session;

2) To transition to another stage of treatment (see

the section on key questions);

3) To establish focus when the conversation has

become unfocused; and

4) To organize a collection of statements of a

particular type (e.g., consequences of drinking).

The acronym“REDS”identifies four additional MET

techniques: Roll with Resistance, Express Empathy,

Develop Discrepancy, and Support Self-efficacy. 

Each of these techniques is discussed briefly below.

REDS

Roll with resistance 

Miller and Rollnick suggest that confronting

clients who are unwilling to change often leads

to an argument instead of a helpful, therapeutic

interaction. Rather than confronting any

resistance presented by a Veteran, MET suggests

that you encourage the Veteran’s personal power

and individual responsibility using strategies of

reflecting, shifting focus, and granting autonomy.

• Reflect: Therapists can respond to resistance

with simple, empathic reflections. For example,
100 H U D - V A S H R E S O U R C E G U I D E

when initiating treatment with a Veteran who

is unhappy about addressing substance abuse,

you can respond with a statement such as, “You 

are pretty upset at being forced into treatment.”

• Shift focus: “We don’t have to decide today 

whether you are an addict or not. We just need to 

try to work on some ways to make your life better.”

• Grant autonomy: “Only you can decide whether 

to keep drinking or not; I just want to help you 

make the best decision possible.”

Express empathy 

Empathy is a powerful predictor of positive

outcomes in both mental health and substance

abuse treatment. It is not uncommon to become

frustrated when a Veteran you are working with

denies, rationalizes, or minimizes a problem or

his/her responsibility for it. However, in these

situations, providers should attempt to appreciate

the pain, frustration, and shame that often

motivates these forms of resistance.

Develop discrepancy 

According to the MI approach, internal motivation

to change is achieved when a client recognizes

the discrepancy between his/her current

problematic behavior and his/her values. Thus,

your task is to ask questions that help the Veteran

clarify these values and recognize behaviors

that violate these standards. These discussions

will prompt the Veteran to make his or her own

argument for changing current behavior. These

discussions can also lead to the creation and

development of change strategies.

Support self-efficacy 

Due to the hardships they’ve faced, many

Veterans on your caseload will have little sense

of self-efficacy (i.e., little confidence in their own

power to make changes in their lives). Thus, an

important task for you as the Case Manager is

to help clients identify sources of self-efficacy. 

For example, providers should ask Veterans

about successful efforts they have previously

made in their lives to change problematic

behaviors. Maybe they once quit drinking for a

few months; maybe they maintained adherence

to a medication plan for psychiatric symptoms

or successfully resolved a problem with a family

member or friend by calmly talking it out. You

should ask questions that help Veterans identify

these successes, indicating that they do have

the ability to change things. You should also

help Veterans on your caseload recognize

the discrepancy between their values and

their problematic behaviors. By helping them

recognize their own power to change themselves

for the better, you promote your clients’ internal

motivation to change.

RELAPSE PREVENTION

The goal of Relapse Prevention [RP] is to teach the

Veteran how to anticipate and cope with“triggers”–

i.e., moods, thoughts or situations that increase the

risk of using (Marlatt & Donovan, 2005). Relapse

Prevention (Marlatt & Gordon, 1985) was developed

from a combination of cognitive-behavioral and

social learning models. The cognitive component

assumes that, if people attribute a relapse to factors

that are internal, global and/or uncontrollable, the

risk for relapse is heightened. On the other hand,

if your client views a lapse as external, unstable,

and controllable, then the likelihood of a relapse is

decreased. 

The social component of RP works to reconcile

the guilt, shame, and hopelessness that is often

triggered by the juxtaposition between the Veteran’s

previous ability to abstain from alcohol and/or

drugs and the present lapse behavior. RP combines

behavioral skills training with cognitive interventions

designed to prevent or limit the occurrence

of relapse. Psychoeducation is an important

component of RP, as both the provider and the client

must identify expectations.

Treatment using RP begins with the assessment

of potential interpersonal, intrapersonal,

environmental, and physiological risks for

relapse (Marlatt, 1996). When incorporating the

Stages of Changes methodology, RP emphasizes

abstinence from substances when in the action or

maintenance stages of recovery. RP interventions

include teaching the Veteran how to use effective

coping strategies and how to enhance self-efficacy
H U D - V A S H R E S O U R C E G U I D E 101 

through the visualization of successful outcomes in

high-risk situations. RP can be particularly useful

in identifying early warning signs and high-risk

situations among Veterans diagnosed with COD. For

example, the exercise of identifying and role-playing

high-risk situations with Veterans can enhance

self-efficacy and skill development. As Veterans

practice specific adaptive coping responses as part of

treatment, they may gain confidence in their abilities

to successfully handle similar high-risk situationsin

the future.

TWELVE-STEP FACILITATION (TSF)

As you work with Veterans in HUD-VASH who are

also diagnosed with mental illness, substance abuse,

or COD, you might want to consider becoming

acquainted with the philosophy and practice of

TSF, if you are not already. TSF is an evidence-based

practice that, through groups such as Alcoholics

Anonymous (AA) and other Twelve-Step recovery

programs (Narcotics Anonymous, Gamblers

Anonymous, and Nicotine Anonymous), has been

an essential component in recovery from substance

use and other addictions for over fifty years. Twelvestep groups are fellowships of men and women

who meet to share perspectives on the negative

consequences of addictions. These individuals

help one another navigate the recovery process by

providing a sponsor to serve as a companion and

mentor on the journey to sobriety. Participation is

free of charge, and the only criterion for membership

is a commitment to stop a specific addictive

behavior. Different types of twelve-step groups

(e.g., open meetings, step meetings, women-only

meetings) are held in cities and towns across the

United States. For more information about NA/AA

and other 12-step groups, please visit: Alcoholics

Anonymous http://www.aa.org/ and Narcotics

Anonymous http://www.na.org/. There is also a

therapy manual available (Nowinski et al, 1995), and

a training website (Sholomskas & Carroll 2006).

COGNITIVE-BEHAVIORAL THERAPY (CBT)

CBT is based on the assumption that negative

feelings result from dysfunctional thoughts, beliefs,

and assumptions about the self, the future, and the

world. Veterans may exhibit these negative feelings

in the form of explicit, verbal self-statements, or with

“silent assumptions.” Silent assumptions may vary

depending on the different symptomatology of each

Veteran; however, when reinforced, these beliefs

manifest in ways that are extreme extensions of the

mental health disorder.

For example, Veterans suffering from depression

tend to believe they deserve to fail or be rejected,

and often believe that putting any effort towards

something positive will result in disappointment

and humiliation. They are increasingly likely to be

pessimistic and self-critical, expecting failure and–

when things don’t work out exactly as hoped–give

DYSFUNCTIONAL COGNITIVE SCHEMAS

ARBITRARY INFERENCE Drawing inappropriate conclusions based on faulty, insufficient,

or contradictory information

CATASTROPHIZING Minor disappointments are turned into major catastrophes

ALL-OR-NONE THINKING The world is viewed in absolute, mutually exclusive terms

PERSONALIZATION Relating external events to oneself without the presence of any

evidence to justify the belief

DISQUALIFYING THE POSITIVE Positive experiences are rejected because they are trivial or undeserved

EMOTIONAL REASONING “All negative emotions reflect the true state of the world”
102 H U D - V A S H R E S O U R C E G U I D E

up or blame themselves. The result is resignation,

learned helplessness, chronically low task

persistence, and frustration intolerance. 

This perpetual reinforcement of negative beliefs

surfaces differently when the client is diagnosed

with a personality disorder, and variance is

based on the nature and extent of the disorder. 

Manifestations may include attachment issues–

over- or under-valuing emotional connections

with others–distorted views about entitlement or

responsibility, or extreme issues with trust.

CBT interventions are designed to help clients

identify and alter problematic thoughts and

assumptions when they arise, as well as to guide an

examination of underlying“cognitive schemas”. 

According to Beck, schemas can be thought of as

cognitive templates through which information is

processed and interpreted. 

To address and further understand the root causes

of such negative thoughts and assumptions, you

can ask Veterans with whom you are working to

explain the circumstances of how the event or belief

in question could actually take place. Depending

on psychiatric symptoms and the severity of these

symptoms, responses to these questions will vary. 

However, the next step is to work with the Veteran to

examine the evidence available to support or refute

the belief in question, and to ask whether or not

there is any chance of exercising positive influence

on the outcome. The treatment team can also

encourage use of a thought diary. In the thought

diary, the Veteran can record beliefs about specific

scenarios and the negative thoughts and emotions

that follow. This exercise provides both you and

the Veteran with an opportunity to review thought

processes and patterns, discuss the likelihood of

occurrence, and develop strategies for managing

such thoughts when they arise.

SOCIAL SKILLS TRAINING [SST]

Social Skills Training [SST] was initially developed

in the 1970’s for individuals who needed help with

community integration, relationship development,

and comfort in social situations (Bellack, 2004;

Mueser & Bellack, 2007). Based on social learning

principles, SST is not discussion-based—rather,

it focuses on rehearsing behavior. SST involves

teaching clients essential interpersonal skills by

breaking complex behaviors down into simpler,

easier-to-understand components (Bellack, 2004;

Mueser & Bellack, 2007). The Case Manager, or

other member of the treatment team, can teach

the Veteran how to perform these simpler steps

through role-plays and, once the Veteran has

mastered these simpler tasks, combine them so that

the Veteran can perform the desired, more complex

behavior. Throughout this process, providers will

give feedback, reinforce success, and repeat until the

Veteran feels more confident and more comfortable

(Bellack, 2004). SST can play an important role in

the day-to-day functioning of formerly homeless

Veterans suffering from mental illness, substance

abuse, and COD, especially as they transition from

residential care to community living.

Treating Co-Occurring Psychiatric and 

Substance Use Disorders

As many individuals suffering from mental illness

also abuse controlled or illicit substances, a number

of integrated psychosocial treatment models

using evidence-based approaches have been

developed to address co-occurring mental health

and substance use disorders (Ziedonis et al, 2005). 

Many models, especially those that were developed

as part of a research study, are indicated for specific

pairings of mental health and substance use

disorders – for example, co-occurring depression

and cocaine addiction (Nunes et al, 2005). However,

other approaches have a broader focus, and are

applicable across a variety of mental health and

substance abuse combinations. Since these broader

approaches assume that individuals within certain

diagnostic clusters can be treated with the same

intervention, or set of approaches, we believe that

they more closely address the “real world”needs

of Veterans in HUD-VASH. As your team chooses

treatment models for use with your clients, and

for additional continuing education or training

opportunities, it may be helpful to remember that

many of these approaches have been manualized

for easy implementation and to promote model

fidelity. Many co-occurring disorders treatment

models are more similar then different, and often
H U D - V A S H R E S O U R C E G U I D E 103 

include a combination of the treatment approaches

highlighted in the previous section. A brief list

of some of the currently-available co-occurring

disorders treatment manuals is below.

AVAILABLE PSYCHOSOCIAL CO-OCCURRING 

DISORDERS TREATMENT MANUALS

Seeking Safety (Natjavits, 1992)

Cognitive-Behavioral Therapy (Cuffel, 1994)

Dual Recovery Therapy (Ziedonis, 1997)

Motivational Enhancement Therapy (Carey, 2006)

Behavioral Substance Abuse Treatment for Serious

Mental Illness (Bellack et al., 2006)

Maintaining Independence and Sobriety Through

Systems Integration Outreach and Networking

[MISSION] (Smelson et al., 2007)

MISSION-VET (Smelson et al., 2011)

Using an integrated treatment approach–in which

both the mental health issue and substance use

disorder are treated simultaneously and by the

same clinician or treatment provider–is preferable

(Ziedonis, 2004; Essock et al., 2006; McHugo et al.,

2006; Drake et al., 2008). The creation of a single

treatment plan, executed together by the Veteran

and a single provider, echoes the concerted

approach of simultaneously addressing co-occurring

mental health and substance use disorders.

A significantly less desirable alternative is a

concurrent but non-integrated treatment

approach, in which mental health or substance

abuse problems are treated simultaneously, but by

different providers (Mueser, et al, 2003, pp. 17). This

latter approach is often marked by disorganized

communication, ineffective care coordination, and

multiple competing treatment plans. 

Consistent with existing therapeutic models that

manage both substance abuse and psychiatric

conditions simultaneously, several researchers

(Bellack et al, 2002; Drake et al, 1998; Shaner et al,

1997; Ziedonis, 1997; and Minkoff et al, 1989) have

developed integrated models that incorporate the

use of MI and MET with clients suffering from cooccurring disorders to better facilitate treatment

engagement. Others have integrated motivational

enhancement approaches with cognitive behavioral

therapies, while others have integrated MET with

case management approaches, such as CTI, to meet

the unique needs of individuals diagnosed with

COD (Smelson et al., 2007; Smelson et al., 2011). 

These models promote the facilitation of treatment

engagement by providing the client with service

linkages to useful community resources.

Blending Assertive Community 

Approaches with Mental Health and/or 

Substance Abuse Treatment

It can be especially difficult to engage people

with mental health and substance use disorders

in recovery. This is further complicated by mental

health care systems that are not equipped to provide

integrated care for those suffering from COD. The

gap in treatment resources is being addressed,

however, by researchers who have demonstrated the

success of blended approaches. For example, Bellack

blended Social Skills Training [SST], Motivational

Interviewing [MI] and Relapse Prevention [RP]

to treat substance abuse in people with severe

and persistent mental illness (Bellack, 2001). In a

randomized clinical trial (RCT), Bellack’s structured,

integrated behavioral treatment model (BTSAS) was

found to be significantly more effective than a nonstructured control treatment in keeping patients

engaged in treatment and abstinent from illicit

substances. Similarly, Ziedonis and colleagues found

that their Dual Recovery Therapy [DRT] approach

for cocaine addiction, which also combined RP, SST

and MET into an integrated model of treatment,

was more effective than a control treatment in

engaging patients in both individual and group

treatment, retaining patients in treatment, reducing

the number of psychiatric re-hospitalizations, and

demonstrating reduced cocaine use among those

who received DRT when compared to those who

received services in the control condition (Ziedonis &

Fisher, 1994; Ziedonis et al, 1997; Ziedonis & Trudeau,

1997; Ziedonis et al, 1998; Ziedonis & Stern, 2000).

Along these lines, several investigators have

developed and examined the effectiveness of

integrated treatment approaches that focus
104 H U D - V A S H R E S O U R C E G U I D E

especially on the challenges of treatment

engagement. However, it was found that highly

individualized services, when provided directly to

consumers in their own homes or communities,

improved outcomes for patients transitioning to

community living. As the successes of mobile

outreach teams and service delivery in situ become

apparent, components of Assertive Community

Treatment, or ACT (Stein & Test, 1980), were

integrated into blended approaches for co-occurring

disorders treament. Systematic combination of

ACT’s locally-based services with other treatment

techniques has enabled Case Managers to meet the

needs of clients whose recovery goals have not been

adequately addressed by more traditional treatment

approaches (Bellack et al, 2010; Drake et al, 2001;

Smelson et al, 2007).

Unsurprisingly, the use of ACT-based models,

such as Critical Time Intervention (CTI), have been

found to be successful in assisting individuals

during the critical transition from institutional care

to outpatient treatment, and also in preventing

recurrent homelessness among persons with SMI

(Susser, et al, 1997). CTI is different from traditional

case management within the VA in that it is timelimited (often nine months, although others have

shortened the schedule of services), and was

specifically designed to help homeless clients

suffering from mental illness who are transitioning

from institutional care to community living. It also

provides these individuals with the “critical”support

required to prevent recurrent homelessness. See the

table below for a comparison of CTI and traditional

case management.

CTI Traditional Case 

Management

Focus on intervention at a

“critical time”(for example, the

transition from the institution

to the community)

No specific focus on

critical transitions

Time-limited Open-ended

Focus on prevention of

recurrent homelessness and

continuity of care

Focus on

comprehensive

array of service

needs

Dixon and colleagues (2009) found a three-month

version of CTI to be helpful in promoting continuity

of care for individuals with SMI post discharge

from psychiatric hospitalization. When using CTI

in combination with other treatment approaches,

it is essential to initiate CTI while the client is still

receiving inpatient services in order to demonstrate

utility and establish a rapport with the client while

s/he is in a stable environment.

Investigators have also found the combination of

CTI and co-occurring disorders treatment to be

successful in reducing alcohol use to intoxication,

increasing both inpatient and outpatient treatment

attendance, engaging clients in substance abuse

and mental health treatment services, and

preventing psychiatric re-hospitalizations (Smelson

et al, 2007; Smelson et al, 2010). Based on these

findings, Smelson and colleagues developed the

Maintaining Independence and Sobriety through

Systems Integration, Outreach and Networking for

Veterans (MISSION-VET) approach, released in early

2011, and available on the VA’s National Center on

Homelessness Among Veterans website http://

www.va.gov/HOMELESS/NationalCenter.asp. The

MISSION-VET approach was designed specifically

for formerly homeless Veterans with COD who are

transitioning from VA or VA-supported residential

care to a new housing placement in the community,

such as those housing placements provided through

the HUD-VASH program. 

Both the individual treatment components and

the integrated treatment models described in

this chapter will serve as valuable resources for

treating Veterans with mental illness, substance

abuse, and COD. While we did not review all of the

evidence-based practices, we did highlight some

of the evidence-based practices we felt might be

most useful for Veterans in the HUD-VASH program. 

For more information and review of additional

evidence-based practices, please visit SAMHSA’s

National Registry of Evidence-based Programs

and practices http://nrepp.samhsa.gov/. While

the use of these evidence-based practices will not

address every issue faced by the Veterans on your

caseload, we encourage you to consider the use of

multiple approaches simultaneously, such as those

combinations used in BTSAS, DRT and MISSIONVET models, as these integrated treatment models
H U D - V A S H R E S O U R C E G U I D E 105 

increase the likelihood that more of the Veteran’s

service and care coordination needs will be met. 

Additionally, it is essential for the services provided

by the HUD-VASH Case Manager to be compatible

with the goals of the Veteran receiving care. For

example, while outcomes such as abstinence or

reduced drug use, fewer reported psychological

symptoms, and fewer inpatient hospitalizations are

ideal, newer treatment paradigms also encourage

Case Managers and other providers to pay more

attention to the attainment of non-traditional

outcomes such as independence, employment, and

higher levels of satisfaction with the relationships in

their lives (Drake et al, 2001).

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Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about

evidence-based practices for people with cooccurring disorders. 

1) The most commonly observed mental health

problems among homeless Veterans include

mood disorders, PTSD, and schizophrenia.

2) Among homeless Veterans, the most

commonly observed substance of abuse is

methamphetamine. 

3) Chronically homeless Veterans are surprisingly

well connected to outpatient and preventive

treatment services.

4) Motivational Enhancement Therapy (MET) is

built on the idea that each client approaches

treatment at different levels of readiness to

change behavior and/or address the symptoms

associated with their mental illness.

5) “Am I understanding correctly?”is a question

that demonstrates MET’s open-ended questions

technique.
108 H U D - V A S H R E S O U R C E G U I D E

6) Rolling with resistance is a MET technique

exemplified by this statement,“We don’t have to

decide today whether you are an addict; we just

need to try to work on some ways to make your

life better.”

7) The goal of Relapse Prevention is to teach

the Veteran how to anticipate and cope with

“triggers”(i.e., moods, thoughts or situations that

increase the risk of using).

8) Twelve-step groups cost only five dollars per

session to attend.

9) Veterans who are depressed are move likely to

be pessimistic and self-critical. 

10) Role playing is a technique used in Social Skills

Training.

11) The advantage of a broad-based diagnostic

treatment intervention is that it more closely

addresses the “real world”needs of Veterans in

HUD-VASH.

12) New treatment paradigms encourage Case

Managers and other providers to pay more

attention to the attainment of non-traditional

outcomes such as independence, employment,

and higher levels of satisfaction with the

relationships in their lives.

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) Motivational Enhancement Therapy’s

fundamental skills are open-ended questions,

affirmation, reflective listening, and summarizing.

Can you name an example of each of these

techniques?

2) It is not uncommon for you as the provider to

become frustrated when a Veteran with whom

you are working rationalizes or minimizes a

problem or his/her responsibility for it. What are

some techniques you can use to actively engage

Veterans in addressing this kind of behavior

without ostracizing them from treatment?

3) What are some examples of dysfunctional

cognitive schemas and what are some ways that

providers can respond to these types of thoughts

and assumptions?

4) What psychosocial co-occurring disorders

treatment manuals are available for further

reference in understanding and addressing cooccurring disorders?
H U D - V A S H R E S O U R C E G U I D E 109 

What’s in This Chapter?

Case Managers and Peer Support Specialists can

provide psychiatrists and other mental health

providers with invaluable insights into the daily

living of the Veterans they serve.

In this chapter you will learn

• How to facilitate psychiatric and other mental

health services;

• How to support adherence to mental health

treatment plans; and

• Tools for avoiding and managing crises.

After reading this chapter, you will know how to

take a proactive approach to supporting the work

of treatment providers working with HUD-VASH

Veterans on your caseload.

Importance of the Case Manager

A significant percentage of the Veterans in the HUDVASH program will be involved in mental health

treatment of one form or another. An effective and

well-integrated Case Manager can have a profound

impact on the Veteran’s successful recovery from

acute mental health disorders.

Within an interdisciplinary team, it is common for the

each member to have a different type of relationship

with the client, and each type of relationship will

have a different basis for communication. If, for

instance, the pain of a service-connected injury is

PART 2 C H A P T E R 3 :

Case Management Integration with Psychiatry and Other

Mental Health Services

played down to a primary care provider, the Peer

Support Specialist might know that this is because

this Veteran, who is in active recovery from a

narcotics addiction, wants to avoid being prescribed

a drug with a street value. Similarly, a psychiatrist

who is working with the Veteran on cognitive

behavioral therapy for severe depression will have

a different understanding of the Veteran’s thought

processes than, for example, even a 12-step sponsor.

Although the Veteran is the common concern, each

member of a treatment team receives different

types of information, at varying levels of depth, in a

different way. 

At the center of all of these relationships is the

Veteran’s Case Manager, who will often be viewed by

the Veteran as a confidant, an ally, and an advocate.

Equally important is the Case Manager’s role as an

honest broker–serving as a liaison among different

members of the treatment team and providing clear,

accurate information. By appropriately participating

in, and augmenting the relationship between, the

Veteran and the psychiatrist (or other mental health

provider), the Case Manager can potentially improve

the diagnostic database, allow for earlier recognition

of emerging problems, modify intervention

strategies, and improve adherence to the prescribed

treatment regimen. The Case Manager can extend

the view and awareness of the treating mental

health professional, and can help convey important

information on behalf of the Veteran.

By working as a team, the variety of perspectives and

observations can be incorporated into a broader and

more complete picture of the Veteran’s world than

any one clinician alone could formulate.
110 H U D - V A S H R E S O U R C E G U I D E

CASE MANAGER COMMUNICATION CAN ENHANCE THE PROVIDER-VETERAN RELATIONSHIP 

TREATMENT OBJECTIVE CASE MANAGER’S ROLE OUTCOME

Support the Veteran’s

treatment and recovery

needs

Communicate important

information on behalf of

the Veteran when needed

Improve diagnostic database for clinicians by

communicating concerns, observations, information

Allow for earlier recognition of emerging problems

by keeping treatment team informed about Veteran’s

lifestyle, work, education, housing—including goals,

achievements, setbacks

Reinforce and inform

the Provider’s treatment

plan

Convey own observations,

concerns, information 

Extend view and awareness of treating mental health

professional

Improve Veteran’s adherence to prescribed treatment

strategies

Help modify intervention strategies

“The Case Manager’s observations and relationship to the Veteran can provide ongoing assistance in 

achieving the therapeutic goals of the mental health treatment plan...”

Obtaining History

The ability to accurately diagnose an illness or

understand a situation is directly related to the

amount and quality of information obtained through

history and examination. 

In mental health care, history is vital:

	Many symptoms are chronic, but still wax and 

wane over time

	Course of symptoms defines and distinguishes one 

mental health syndrome from another, yet the 

course is not always evident or expressible

	Symptoms often do not lend themselves to direct 

examination, verification, etc.

Obtaining a good history is essential but not 

always simple, especially if the only source of 

information is the patient. Human beings strive

for some form of order or understanding. Events

are put on timelines, connections are made–and, in

some cases, causality is inferred in order to“make

sense”out of what is happening. This is one strategy

by which an internal sense of mastery, or control,

can be achieved. In order to help communicate

information to others, it is internally edited and

formatted. The connections that are made, the

theories that are generated, and the organization

that is developed serve clear functions; however,

this framework also limits the degree to which a

person can provide a truly objective, unaltered,

factual history. The Veteran patient will edit and

select information based on what he/she perceives

as important and relevant and, depending on the

skill of the clinician and the Veteran’s perception,

may also provide history with intent to please or

satisfy the interviewer. This can be especially true

when the issues are highly personal for the Veteran,

or when he or she feels that there is a lot at stake–
H U D - V A S H R E S O U R C E G U I D E 111 

in these cases, treatment team members, or even

the same clinician on different visits, may receive

different amounts of spontaneous information

about the Veteran’s subjective experiences and

opinions. Assumptions on the part of the Veteran

concerning the relative role, interest and expertise

of the listener also factor into this variance. Timelimited appointments with psychiatrists and nurse

practitioners may convey that only certain factual

material is to be discussed; this may also positively

reinforce certain disclosures and responses, while

having the opposite effect on others. This is not to be

confused with withholding, malingering, or falsifying

information–rather, it is a limitation shared, to some

degree, by all historians.

When the challenge of providing unaltered,

uninterpreted, factual information is coupled with

the inherent subjectivity of many questions and

symptoms in mental health, it is easy to see why an

account of an illness or problem may sound quite

different at different times and to different listeners,

and might vary still more from what an outside

observer would witness. 

Case Managers Can Help Diffuse Some of the Limitations of

Formal Mental Health History

DOMAIN DESCRIPTION CASE MANAGER TASKS

ESTABLISHING AN

UNDERSTANDING OF THE

VETERAN’S “NORMAL”

Changes in sleep, appetite, energy,

social engagement, interest in hobbies,

cleanliness, and tolerance of stimuli are

but a few items of significance within a

typical psychiatric history. While there

is some normal variation in all of these

areas, they are also prone to disruption

and potentially amenable to intervention

if they are pieced together and evaluated

appropriately.

	Note baseline levels

	Note changes

	In addition to what is reported at intake, the Case Manager can

make comments, observations 

	Ask follow-up questions as appropriate; work to elicit

additional information that could be vital to the mental health

provider

ACTIVITIES OF DAILY

LIVING

Seeing the Veteran in his or her home

or in a community setting can provide

information that isn’t available in an office

visit

	Look for consistency between what is reported and what is

observed

	Pay close attention even during casual conversations, as this is

when important details might emerge

SYMPTOM FOCUS

During a diagnostic interview or

medication appointment, problems and

symptoms are typically the focus

	Engage the Veteran on hopes, fears, dreams, goals

	Reinforce the value of these, and use them to help the mental

health provider give context to the treatment plan

TROUBLESHOOTING

Forgetfulness, embarrassment, concerns

about consequences can lead to

less-than-accurate reporting clinical

appointments. Dangerous medication

interactions are a concern, as are

undisclosed or inaccurately explained

lifestyle habits that lower the efficacy of

certain medication s (i.e., relationship

between nicotine and antipsychotics)

	Explore over-the-counter medication use, use of herbal or

vitamin supplements, etc., with the Veteran

	Compare observations with documented history, medication

record, etc.

	Convey discrepancies

As outlined above, seeing the Veteran in his or

her home, or in a community setting, can provide

information that isn’t available in an office visit. Is the

home grossly unkempt, suggesting apathy, or is it

overly fastidious, suggesting compulsive cleaning? 

Are beer cans or wine bottles lying around, and is

this consistent with reported use? Are windows or

the T.V. covered, suggesting paranoid fears? Not
112 H U D - V A S H R E S O U R C E G U I D E

everything is obvious, even when viewed directly,

but by noting the condition of the home, of the

Veteran, and how he or she seems to be interacting

with the environment, the Case Manager can be the

eyes of the treating mental health professional and

augment the reported history with additional facts

and details. 

In addition to direct observation, the nature of the

Case Manager’s interactions with the Veteran can be

a vehicle for obtaining information that may be not

disclosed to a mental health provider. High anxiety,

worsening depression, emerging psychosis, or

developing mania can impair insight and judgment,

making it difficult for Veterans suffering from these

issues to observe themselves and convey their

experiences. For example, a person may describe

sleep habits very differently when responding to a

closed question in a structured interview during a

scheduled appointment than when asked about the

same issues in a more conversational way. 

It is common for a Veteran patient to attempt to

conform to the provider’s style and needs during a

diagnostic interview or medication appointment.

Problems and symptoms are typically the focus. In

a meeting with a Case Manager, however, the tone

is typically more conversational and less formal. 

It is more likely for hopes, fears, and wishes to be

part of the discussion. It cannot be immediately

assumed that one interaction is inherently superior

to the other, but if disparate or unique reporting

is identified, additional efforts to gain clarity and

accuracy can be pursued. Obtaining information

that may vary from that reported to the psychiatrist

is not only of potential value to the psychiatrist,

but is also of value to the Veteran, as it allows for

the most accurate clinical picture and appropriate

treatment. The take-home point is not to assume

consistency in all reporting and to consult the

medical record frequently and maintain open

communication with others on the treatment team. 

An accurate history is not just important in the early

stages of care, but remains vital to the monitoring

of stability and treatment effectiveness. The Case

Manager’s observations and relationship to the

Veteran can provide ongoing assistance to the

therapeutic goals of the mental health treatment

plan. Indeed, in some cases, specific assessment

tools can also be utilized between scheduled

appointments to improve the disease monitoring

process. A number of surveys and questionnaires

exist for various psychiatric illnesses which can

provide a measure of symptom severity that the

primary treatment team may find useful in guiding

treatment. One example is an instrument used in

depression care management, the Beck Depression

Inventory (BDI). It is a Veteran-completed

questionnaire that can assist in symptom and

response tracking vis-à-vis the treatment course. 

While the principal treating provider should be

consulted and local policies should be considered

prior to administering any specific instrument, when

indicated, the Case Manager can help ensure that

measures are completed and the results relayed

in a timely manner. Field interventions, such

as the completion of a questionnaire, can make

appointments with prescribing providers more

efficient, and, in some cases, can potentially allow for

timely interim medication adjustments. 

Facilitating Treatment 

With adequate information, a mental health

professional should be able to generate a diagnosis

and prescribe a treatment. At subsequent visits, the

success of the treatment is evaluated and, if needed,

an adjustment is made to the regimen. Occasionally,

a lack of response or a unique response to treatment

may trigger reconsideration of a diagnosis. The

ability to follow the prescribed treatment plan is,

therefore, important for two reasons: it may be of

value to the Veteran in light of his or her recovery

goals, and it may re-inform the clinician’s opinion of

the condition itself.

A provider may prescribe medications but also

commonly make recommendations and suggestions

for lifestyle changes. These may involve exercise,

education, hobbies, or volunteer projects, or

may center around nutrition plans or a nighttime

routine for sleep (sleep hygiene). Apart from

issues of more clear resistance to the treatment,

which will are covered later, there can be some

very real challenges with translating these lifestyle

recommendations into actions. The Case Manager

should review the provider’s recommendations

in common language, and should revisit the “new

habits”often.
H U D - V A S H R E S O U R C E G U I D E 113 

In addition to potential implementation challenges,

there may also be barriers in understanding what

the treatment recommendations actually are. 

Memory difficulties, problems with attention,

and language barriers are all common in patients

receiving mental health care. Some patients may

also have very concrete thought process and be

unable to generalize or comprehend figures of

speech. While most providers try to use appropriate

language to ensure that their recommendations are

understood by the patient, it is still quite possible for

parts of the explanation to be forgotten, and certain

points“lost in translation.”Repeatedly reviewing

all recommendations in a non-hurried, concrete

manner, using different explanations and examples,

if necessary, can be a tremendous help to everyone.

As the Veteran, clinician, and Case Manager reach

an agreed-upon understanding of the treatment

plan, the recommendations should be reviewed

in light of the Veteran’s actual environment. 

A recommendation to get exercise may be

compromised by the lack of a nearby gym as well as

by preconceptions about what constitutes exercise. 

This may not be expressed to the recommending

provider at the time of the appointment, and it

may fall to the Case Manager to isolate the issue,

discuss it, and find a solution. If no alternative can be

identified, the Case Manager and the clinician can

discuss a timely plan modification.

Along the same lines, providing information about

the Veteran’s actual environment and lifestyle

can be very helpful to the mental health provider,

and can allow the clinician to make treatment

recommendations that fall within the scope of the

Veteran’s abilities and environmental limitations. 

Cooking skills, or lack thereof; disposable income;

access to transportation; proximity to community

resources; and other realities of the Veteran’s habits

and behavior are all potentially important. When the

Veteran does not or cannot communicate important

lifestyle information, the Case Manager can fill in the

blanks for the mental health provider. 

Frank conversations about what parts of the

treatment plan the Veteran is actually implementing,

in a manner that does not convey displeasure or

disappointment, can provide insight into what

elements of the treatment plan are working, and

which can be improved. Relating lifestyle changes

to potential medication issues is often a critical

step in engaging the Veteran. Explaining that it is

impossible to determine which symptom is a side

effect of medication, and which is a side effect of

poor nutrition or poor sleep hygiene, for example,

is an important step in facilitating the Veteran’s

investment in his or her own treatment. 

It may also be helpful to explain that most providers

begin with the lowest-risk medications and

treatments, but often these require more lifestyle

changes on the part of the Veteran. If treatment

fails due to implementation barriers–for instance,

a Veteran’s inability to follow a schedule that helps

determine whether or not a medication is disrupting

sleep–a second-line medication or treatment

strategy, with more potential side effects, may be

the result. Furthermore, each step toward treatment

compliance is an opportunity for esteem-elevating

self sufficiency.

Case Managers should be proactive in seeking their

own understanding so they can be assets to clients

and to treatment teams. When Case Managers ask

for clarification of words, meanings of certain terms,

etc., during joint meetings with the Veteran and

the provider, it serves all parties–eliminating both

the barrier to implementation and the hesitation of

inquiry.

Supporting Adherence 

A high percentage of both mental health and

general medical patients have poor adherence

to a medication regimen as ordered by a treating

provider. Poor understanding of risks and

benefits from treatment, fear of side effects, actual

experience of side effects, forgetfulness, confusion,

nonchalance, and, in some cases, a potential

secondary gain from medication diversion, are

some potential causes for non-adherence. Being

aware, being inquisitive, and being responsive can

help improve medication adherence and treatment

success.

The informed consent process, the risk descriptions

in pharmaceutical packaging, advertising, and

information from the internet can all make the

potential risks of treatment seem overwhelming

and out of proportion to the potential benefits. 
114 H U D - V A S H R E S O U R C E G U I D E

If concerns about potential side effects are an

identified issue for a Veteran, it can be very helpful

to clarify the concerns, actual risk, and what the

response would be. Are the feared side-effects

common or very rare? Are they reversible? Are

they time-limited? What is the plan if the feared

side effects actually emerge? Exploring these items

with the Veteran can, at times, alleviate concerns.

Any further issues that emerge, or perhaps a

concession to a more informed risk-benefit analysis,

that emerges, can be used in follow-up with

the prescribing provider so that, if necessary, an

alternative agent can be utilized. 

Many of the same points are relevant when side

effects do emerge, and even more so when they limit

adherence. Psychiatric medications, especially those

that fall into certain pharmacological categories, can

negatively impact sleep, energy, appetite, weight,

bowel functioning, physical movement, muscle

control, and sexual functioning. While this is an

incomplete list, it does demonstrate why a Veteran

might consider ad hoc treatment discontinuation. 

It is good practice for Case Managers to become

familiar with the most common and, potentially, the

most severe, side effects of their clients’medications.

Analysis of medication side effects can be tricky, as

many side effects are very similar to the symptoms

of the illnessesthey are designed to treat. Other

effects can be influenced by, for instance, whether

or not the medication istaken on a full or empty

stomach, or if it istaken in combination with other

agents(including other prescribed, over-the-counter,

and/or herbal preparations). The key point isto be

aware that medication discontinuation is a common

phenomenon, and the sooner it isrecognized, and the

rationale behind what it identified, the better. Some

Veterans may be reluctant to spontaneously bring

up problemssuch assexual dysfunction,so tact is

necessary in eliciting information that the prescribing

provider can use to modify treatment.

Case Managers Can Help Support Medication Adherence

PATIENT/CLIENT CONCERN OPPORTUNITY FOR SUPPORT 

Concerns about potential side

effects

	Work to help clarify actual risk and potential response

	Are feared side-effects common or very rare?

o	 Are they reversible or time-limited?

o	 What is medical plan if side effects to emerge?

Actual experience of side

effects

	Become familiar with most common and potentially most severe side effects of

common psychiatric medications, and of your clients’medications

	Introduce reminders for or investigate mitigating factors: full stomach, empty

stomach, with food, etc.

	Be aware that some Veterans may not bring up problems like sexual dysfunction, etc.;

be discreet and tactful

	Prescribing provider may be able to adjust dose, modify schedule, add an antidote

med, etc.

Abrupt medication stoppage 	Check in regularly with Veteran and ask about medication adherence, problems,

concerns, etc.

Memory problems, confusion,

scheduling problems

	Help provide pill boxes and assist with filling if necessary; observe if there are meds

whose supplies change abnormally quickly or slowly

	Consider bubble-packed medications if there is a higher need for supervision
H U D - V A S H R E S O U R C E G U I D E 115 

By becoming aware of a medication issue, the

prescribing provider may be able to adjust the dose,

modify the schedule, add an antidote medication,

suggest behavioralstrategies, or provide education

that can allow the Veteran to continue with treatment. 

In other cases, the treatment may need to be changed

more dramatically, but having information in a timely

manner is key to relapse prevention orsymptom

exacerbation caused by medication non-adherence.

In most cases, a short time off treatment will not

trigger an exacerbation, but if the Veteran stops his

or her meds soon after having them prescribed–and

it is not known for several weeks–serious problems

could arise. Similarly, the abrupt cessation of

certain meds, including some antidepressants and

anti-anxiety medications, can trigger withdrawal

symptoms that can, at times, be quite uncomfortable

and severe. High rebound anxiety, insomnia, and

seizures are some potential complications of abrupt

medication withdrawal.

In the case of memory problems or confusion,

additional tools may aid the Veteran in adhering to

the treatment regimen. Pill boxes can be helpful,

but many patients will either struggle with filling

the box correctly or may actively defeat the pill box

by accessing meds early–or in excess–in order to

achieve a desired effect. The latter is more likely to

occur with substances of abuse such as tranquilizers

and pain medications. Observing the Veteran’s

supply of medication, and comparing it with

prescription instructions, could signal the need for

a higher degree of medication supervision. In this

case, there are options such as prefilled pill boxes,

bubble-packed medications, or other, more secure,

medications of medication delivery.

Crisis Avoidance/Management

The treatment prognosis is best when the diagnosis/

diagnoses is/are accurate, the treatment plan is

comprehensive and well-developed, the Veteran is

adherent and conscientious, and the Case Manager

and treatment team are involved and aware.

However, even in an ideal situation, decompensation

may still occur due to medical conditions or status

changes, changes in environmental stressors, or

natural progression of an illness.

While symptom control is important as far as

mitigating the patient’s pain, suffering, or mental

anguish, and also because of the variety of possible

negative social consequences, there is evidence

that, in a variety of conditions, the long-term course

and prognosis worsens with each recurrence. 

Extended periods of psychosis may reduce baseline

functioning; each manic and depressive episode can

increase the risk for subsequent episodes. It is also

widely known that suicide risk is elevated in a variety

of psychiatric conditions. 

Remission and recovery are always the goals, and

may be realistic outcomes in many cases. However,

recovery may not equate to a complete absence of

symptoms. In spite of aggressive management of

symptoms and conditions, treatment results may be

incomplete. If the patient has adapted to symptoms

over time, and has appropriate supports, he or she

may still be able to function very effectively, despite

symptoms. Lingering paranoia or hallucinations,

suboptimal mood stability, or residual anxiety may

be realities of daily life for some Veterans.

Recognizing this reality, and working to understand

the specifics of the client’s condition, are important

for optimal functioning and for effective case

management. The Case Manager should prioritize

communication with the treating clinician and

should maintain familiarity with the Veteran’s

baseline status. The severity of baseline symptoms

can impact individual goals and outcomes, but

stable symptoms typically do not cause the same

level of distress and risk as acutely worsening

symptoms–even if the severity appears less

pronounced in the latter.

Thus, it is clear that effective monitoring for

worsening symptoms is dependent upon a good

understanding of the Veteran’s functioning at

baseline and an awareness of several key indicating

factors.

While relatively non-specific, sleep is often one of the

earliest signs of a declining management of mental

illness. Depending on the condition(s) being treated,

the threshold for intervention may vary; establishing

expectations or guidelines from the clinician can be

helpful in addressing sleep difficulties. For certain

patients with bipolar illness, even short periods of

sleeplessness may quickly lead to severe mania and
116 H U D - V A S H R E S O U R C E G U I D E

may warrant a rapid appointment or intervention. 

Gaining a sense from the Veteran and the provider

about the sleep patterns and expectations can be

very helpful. 

In addition to sleep, changesin appetite, energy,

grooming and participation in activities may also be

signs of a change in status. AVeteran may report

symptoms(loss of appetite, poorsleep, etc.), but there

may also be observed signs(e.g. unkempt appearance,

talking louder or faster) of which theVeteran is not

aware. As aVeteran gets more depressed, he orshe

may cease certain activities, become more delayed in

responses, or become more irritable. In a developing

manic episode, aVeteran may become more talkative

and energetic. He orshe may present as enthusiastic,

playful or irritable. More sexual or religiousreferences

may be present in speech or behavior, and risky

or frivolous behavior may begin to manifest itself. 

Psychosis can begin as withdrawal, disorganization,

or poor attention astheVeteran respondsto paranoid

concerns, has difficulty processing information, or is

distracted by hallucinations. 

A negative change is always a stress that can trigger

further worsening. For example, a reduction in

income or a new medical problem can lead to worry,

sleeplessness, and mood instability, which may

precipitate substance misuse or other problems,

which can quickly multiply. Although the cause

and effect relationships can often be unclear, when

social stressors mount, there is a definite possibility

that psychiatric stability is, at a minimum, at risk to

deteriorate.

The preceding signs are an incomplete list, but they

speak to the value the Case Manager can bring to

the treatment process by making observations in the

field that might otherwise go unnoticed. In all cases,

suicidal thinking can develop and any statements of

hopelessness or references to dying should not be

ignored and need follow-up. With some Veterans, it

may be useful to have candid discussions concerning

their past patterns and what tend to be their earliest

signs and symptoms. A person may struggle to

recognize emerging difficulties during an acute

exacerbation of their illness, but may still be able to

comment on past experiences and collaborate on an

action plan at a time of relative stability.

Not every observed behavior is a warning sign, but

vigilance, observance, and communication with the

clinical team can facilitate interventions that may

halt emerging problems. 

Case Managers Can Help Monitor

Psychiatric Status

SYMPTOMS SIGNS

Changes in sleep

patterns Social withdrawal

Changes in energy level Unkempt appearance

Appetite differences Changes in speech and vocal

patterns

Expressed changes in

mental status/ mood Delayed responses

Be aware; note changes; 

exchange information 

to treatment provider. 

Pay particular attention 

to social stressors and 

negative developments 

in the Veteran’s life. 

Become as familiar 

as possible with the 

Veteran’s baseline 

mental health status, 

including characteristics 

and patterns in activities 

of daily living when 

symptoms are wellmanaged. 

Marked increase in energy,

talking

Irritability

Increase in sexual or religious

references in speech and

behavior

Increased risk-taking or frivolous

behavior

Withdrawal, disorganization, poor

attention span, distraction

There will be times when a Case Manager is

confronted with an acute and unexpected crisis in

the field. A clear understanding of the specific local

protocols, emergency services and response system

is vital in such cases as resources and statutes vary

greatly across communities. 

The potential benefits a Case Manager can bring

to the mental health care of a Veteran are, in many

ways, predicated upon good communication

between the Case Manager, the Veteran, and

other mental health providers. There will be

some variation in the particulars concerning the
H U D - V A S H R E S O U R C E G U I D E 117 

relationship between the mental health provider

and the Case Manager, depending on local structure;

yet, regardless of the model, the Case Manager

and the clinician should be in close contact. If

the Case Manager can attend appointments with

the Veteran, this is a valuable tool. Joint meetings

can reinforce the concept of team-based care,

deepen care coordination, and help eliminate

miscommunication. In addition to bringing another

source of information to the appointment, the

Case Manager can also observe the relationship

the Veteran has with the mental health provider

and witness the Veteran’s ability to express him or

her self in that setting. If the Veteran is unable, for

whatever reason, to articulate issues or concerns,

the Case Manager can assist in the moment, but can

also work with the Veteran between visits to improve

communication and self-sufficiency skills.

Along these lines, it can be helpful for the Case

Manager to initiate an open discussion with the

client and the clinician around how to best be of

assistance during, and in between, appointments. 

As with all efforts, the goal is for a Veteran-centric

approach that matches the intensity of the

intervention with the needs of the Veteran, while

concurrently moving the Veteran toward increasing

levels of independence. 

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about

integrating your work with psychiatry and other

mental health services.

1) Veterans are likely to share the same information

with each team member and treatment provider

they encounter.

2) A provider may prescribe medications but may

also commonly make recommendations and

suggestions for life change.

3) Case Managers can assist with treatment

adherence by translating the recommendations

of providers into actions for Veterans.

4) Cooking skills, disposable income, access to

transportation, and the proximity to community

resources are all important pieces of information

for a Case Manager to be aware of but are

irrelevant to the provision of treatment.

5) It is good for Case Managers to become familiar

with the most common and potentially most

severe side effects of the medications their clients

are taking.

6) Once a Veteran has been taking medication

consistently for 6 weeks, s/he is likely to continue

indefinitely.

7) While remission and recovery are the goals

for some patients, even in the best possible

scenarios, recovery may not equate to a complete

absence of symptoms.

8) Withdrawal, disorganization, or responsesto

paranoid concerns can be signs of developing

psychosis.

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) What are some items of significance within a

typical psychiatric history?

2) The Case Manager should be proactive in

seeking his or her own clarity about treatment

recommendations so they can be an asset to

their clients. What are some ways Case Managers

can be sure they fully understand the treatment

prescribed for individual Veterans?

3) Not every observed behavior is a warning sign,

but vigilance, observance, and communication

with the clinical team can potentially allow for

interventions that can halt an emerging problem.

What types of behaviors might represent negative

changesto baseline behavior thatshould be

discussed with treatment providers?

4) There will be times when a Case Manager is

confronted with an acute and unexpected crisis

in the field. What local protocols, emergency

services, and response systems does your team

need to know in order to address these crises?
118 H U D - V A S H R E S O U R C E G U I D E

What’s in This Chapter?

Once a formerly homeless Veteran obtains stable

housing, a number of previously unknown and

unaddressed health conditions may surface. When

a homeless Veteran enters the HUD-VASH program,

it is entirely possible that he or she may have

limited or no experience accessing civilian Veterans

Administration (VA) health care, civilian primary care,

and/or non-acute ambulatory care.

In this chapter you will learn about medical

conditions associated with homelessness, clinical

resources available through the VA, and strategies

for communicating with clinical providers.

After reading this chapter, you should be

comfortable identifying early warning signs and

symptoms and helping Veterans navigate the

healthcare system.

Overview

In many ways, keeping homeless Veterans in housing

is as challenging, if not more so, than placing them. 

Drug and alcohol relapses, relationship problems,

mental health issues, difficulty managing finances,

and other day-to-day challenges can make housing

maintenance a daunting task, and one in which

HUD-VASH Case Managers play a critical role. 

However, it is important that this role not be viewed

in isolation of other VA resources that can also

advance the shared goals of stabilizing clients in

permanent supportive housing.

PART 2 C H A P T E R 4 :

Case Management Integration with Primary Care

In this chapter, we review

• medical complications associated with

homelessness and how these issues often present

and translate into health care needs;

• programs and initiatives within VA that may

serve as resources for Case Managers, specifically

Patient Aligned Care Teams (PACT), Primary Care–

Mental Health Integration, and telehealth case

management;

• key observations, signs and symptoms that, if

noticed by the Case Manager, might indicate

something of clinical significance; and

• best approaches for integrating and

communicating with Primary Care Provider teams

within VA medical centers/CBOC’s.

Considering the high prevalence of chronic diseases

in this population, the often-deferred and/or oftendelayed primary and preventive care services;

the unavailability of heath care while homeless;

and the ongoing role health care plays in helping

individuals stay in permanent housing, the role of

the Case Manager is critically important. Indeed,

community-based case management provides a

unique opportunity to identify risk factors, look out

for signs and symptoms, raise concerns, and facilitate

care of un- and undertreated medical and mental

health conditions that could, if untreated, precipitate

a return to homelessness.
H U D - V A S H R E S O U R C E G U I D E 119 

Case Managers: Key Points to Remember

Availability = Demand

Among HUD-VASH clients, many medical conditions may have gone untreated

for extended periods of time. Unstable shelter, active use of drugs or alcohol,

and competing medical needs often obstruct medical care. Once stable

housing is obtained, there is often a pent-up demand for medical care.

Limited experience with selfadvocacy

When a Veteran is overwhelmed by the system and/or physical or mental health

issues, medical treatment priorities, as determined by health care providers,

may not always reflect the needs and priorities of the Veteran. This may result

in fragmented care and dissatisfaction. 

Triage dilemma

Many unattended medical needs are associated with not having a regular

source of care (Gallagher et al, 1997). When the Veteran then enters into the

health care system, these multiple morbidities (mental illnesses, substance use,

and acute and chronic medical problems) often create a triaging dilemma.

A stable environment can become a 

medically permissive one

“Housing First”models, where the receipt of stable housing is used as a vehicle,

not a prerequisite, for achieving recovery goals, mental health services (if

accepted), and economic support/self-sustainment, may require more assertive

efforts to provide integrated and comprehensive care, particularly if stable

housing makes it easier or safer to use drugs or alcohol at pre-homeless levels

(Kertesz et al, 2009).

Unaccustomed to a preventive care 

lifestyle

Case Managers should take any opportunity to provide preventive care, engage

the Veteran in behavioral changes that promote recovery goals, and dehabituate dependence on emergency services for medical care.

Unfamiliarity with health care system 

in general or with civilian health care 

providers

When a homeless Veteran enters HUD-VASH, it is entirely possible that he or

she has limited or no experience accessing civilian VA, civilian primary, and/or

non-acute ambulatory care. Veterans may not know what to expect, what is

available, or what they may need.

Medical Complications of Homelessness

The average age at death for a homeless person is

47. Cancer and heart disease are the most common

causes of death for the 45-64 year age group–a rate

that isthree times as high asthat of the general

population (Brickner et al, 1990). Homelessindividuals

in a younger demographic are more likely to die from

infections,such as HIV/AIDS, or from trauma.

While there are many conditions, both acute and

chronic, that threaten the health and well-being of

the homeless population, in general, the relationship

between health and homelessness has been

described within three contexts:

• Medical issues that precede and contribute to

homelessness;

• Medical problems that are complications of

homelessness; and

• Illnesses or conditions that are harder to treat

or manage because of the patient’s itinerancy

(Hwang et al, 1997). 
120 H U D - V A S H R E S O U R C E G U I D E

MEDICAL COMORBIDITES AND HOMELESSNESS

Conditions that precede, 

accelerate, or contribute to 

homelessness

	Mental illnesses such as depression, schizophrenia, and bipolar disorder

have long been reported as precipitants of homelessness (Institute of

Medicine, Committee on Health Care for Homeless People, 1988)

	Drug and alcohol addictions (Jenks, 1995)

Conditions that are 

consequences of homelessness

	Frostbite, trench foot, hypothermia, hyperthermia as results of exposure

to the elements; often, these are exacerbated in intemperate zones when

shlter demand exceeds capacity

	Parasitic infestations (scabies, bed bugs, lice, fleas)

	Increased exposure to transmission of airborne illnesses, especially

tuberculosis, in overcrowded shelter conditions

	Weakened immune system function

	Increased risk of trauma (women are particularly vulnerable) (Kushel et

al, 2003).

Conditions that are complicated 

by homelessness

	Chronic diseases that require continuous monitoring and medication,

such as diabetes (managing insulin-dependent diabetes while living in

a dusk-to-dawn emergency shelter presents significant obstacles, not

only in storing and securing medications, but also in managing multiple

injections in the context of an unstable, erratic, and usually suboptimal

food availability)

	Wound care: wound care is seriously compromised by inadequate

hygiene in many sheltering arrangements as well as by the dependent

edema that is a result of prolonged standing and walking

Unsurprisingly, homeless persons also utilize

acute level health services at very high rates. In

one survey, over 40% had used the emergency

department at least once for care in the previous

year; more disturbingly, 7.9% accounted for 54.5%

of all visits (Kushel et al, 2002). In a national survey

of homeless persons, one out of four indicated that

they had been hospitalized annually (Kushel et

al, 2001) and, in a study of homeless persons who

accessed New York City hospitals, their average

length of stay was 36% longer per admission than

non-homeless individuals (Salit et al, 1998). 

Indeed, previous research has consistently shown

that unstable sheltering arrangements (i.e. residing

in an emergency shelter or in an unsheltered

arrangement) are associated with high rates and

inappropriate use of emergency departments

(Kushel et al, 2002; O’Toole et al, 1999a; O’Toole et al,

1999b). In contrast, homeless persons in more stable

sheltering arrangements are 2.4 times more likely

to access care and receive care for chronic medical

problems (O’Toole et al, 1999b). 

As part of the benefits and opportunities afforded by

permanent supportive housing, Case Managers can

help Veterans

• learn to navigate the health system,

• advocate for their own ongoing care needs,

• transition from reliance on acute and emergency

servicesto use of primary care, and
H U D - V A S H R E S O U R C E G U I D E 121 

• engage in preventive care and chronic disease

management.

Navigating the Health Care System: The 

Role of Primary Care 

Primary care, and, specifically, primary care tailored

to the needs of homeless or formerly homeless

persons, provides a unique opportunity to

comprehensively address some of the service gaps

and vulnerabilities in homeless health care. It also

provides a platform from which to engage homeless

persons in an array of services over a continuum of

time and needs. However, long-term homelessness

(>2 years), competing needs, such as food, clothing,

and finding shelter, and social isolation are all

associated with not having a regular source of

care (Gallagher et al, 1997). Additionally, multiple

morbidities common among homeless persons,

including mental illnesses, substance use, and

acute and chronic medical problems, often create a

triaging dilemma, whereby care may be fragmented

and conditions not prioritized to reflect the priorities

and preferences of the patient. This also can

override any opportunity to provide preventive care

and engage the person in behavioral changes.

As a result, when a homeless Veteran enters into

HUD-VASH housing, it may be entirely possible that

he or she has limited or no experience accessing

primary and/or nonacute ambulatory care and may

not necessarily know what is available or what they

need. This is obviously important when considering

• the high prevalence of chronic diseases in this

population;

• the often deferred and delayed primary and

preventive services not available while homeless

and;

• very importantly, the ongoing role health care

plays in helping individuals stay in permanent

supportive housing.

Clinical Services and Resources within VA

Knowing where to go when advocating for a client,

and knowing what clinical resources are available

when problems arise, is clearly essential in the case

management of at-risk HUD-VASH clients. Aligning

the resources and services of VA with the health

care needs of your clients can advance your shared

recovery goals.

There are several initiatives within VA primary care

that are available, or are being developed, that aim

to improve access and coordination of care within

VA. Some of them include the patient centered

medical home or PACT (Patient Aligned Care Teams),

the Integrated Primary Care-Mental Health initiative,

and the CCHT/Telehealth program. 
122 H U D - V A S H R E S O U R C E G U I D E

WORKING WITH PRIMARY CARE

RESOURCE/

COMPOSITION OBJECTIVES REFERRAL/CONTACT

PACT (Patient Aligned

Care Team)

	1-3 primary care

providers (PCP’s), a

team RN, LPN, health

technicians, nursing

assistants

	Augmented by social

workers, nutritionists,

pharmacists,

behavioralists, etc.

	Provide comprehensive, continuous, and coordinated care to

Veterans

	Coordinate chronic disease management, improve treatment

outcomes

	Serve as a first stop for urgent or emergent medical needs,

thereby reducing emergency department visits and preventable

hospitalizations

	Increase patient and staff satisfaction

	Engage client in primary care

All HUD-VASH clients

must be linked to a PACT.

It is critical that the HUD-VASH client is assigned to one of these PACT teams and that team is used as a touchstone for

engaging a client in primary care, coordinating any chronic disease management, and using as well as using it as a first stop

access point for any urgent or emergent needs

PRIMARY CARE—

MENTAL HEALTH

INTEGRATED CARE

Care teams typically

include social workers,

psychologists, and

sometimes psychiatrists

	Embed mental health care teams in Primary Care

	Increase the accessibility and availability of mental health

services within VA, especially for individuals with specific, timelimited, non-severe mental health presentations (depression,

anxiety)

	Eliminate traditional referral process

	Provide an outlet for individuals who feel stigmatized seeking

mental health care through traditional channels

	Engage treatment-resistant clients

	Introduce individual to time-limited cognitive behavioral

therapy

	Facilitate determination of most appropriate treatment with

primary care and mental health team

Accessing this resource

can typically be either

directly with that

provider team or via the

assigned PACT team

CASE MANAGEMENT/

TELEHEALTH

RN-level case

management and

home-based telehealth

technology

	Use technology to provide ongoing monitoring and assessment

of chronic conditions

	Intensive monitoring can inform and modify care plans

before conditions worsen to the point of needing to go to the

emergency department or to be hospitalized. 

	Equipment conveys health information electronically; RN follows

up with patient prior to patient becoming symptomatic or

deterioration of condition

Patients with difficult-tomanage chronic diseases

such as diabetes,

congestive heart failure,

etc.
H U D - V A S H R E S O U R C E G U I D E 123 

Communicating with the Clinical Team

It is uniformly accepted that good communication

is critical to effective, timely, and coordinated care. 

However, often the professional and service-driven

“silos”in which we operate make this communication

difficult. Yet, the Case Manager can always work to

improve communication, as, ultimately, this will

better serve the Veteran.

First, HUD-VASH Case Managers are part of the

clinical team and have an integral role in the care of

the Veteran. Being part of the clinic team means that

releases of information or other restrictions are not

needed in conveying information to and from the

provider and PACT team. 

Second, it is critical to reiterate that identifying

contacts within the PACT or other clinical services

team, and establishing channels for communication,

should take place before a crisis occurs. Typically, the

RN on the PACT team is a good point of contact (s/

he is often more readily available for consult than

the lead physician). Alternatively, some PACT teams

may instead have the primary care provider (PCP) or

health tech as the point of contact. 

There are several ways to establish regular contact 

with the clinic team. Meeting with the team as

part of their weekly meeting or daily clinic huddle

is another opportunity to convey any concerns

or update them on a client’s progress. Another

approach chosen by some Case Managers is to

accompany the patient to the clinic visit. This

provides an opportunity for the Case Manager

to both advocate for the Veteran and to listen to

the primary care treatment plan. When members

of the clinic team meet with the Veteran, it also

increases the Veteran’s sense of treatment unity and

cooperation, enhancing trust and conveying the

sense that there truly is a team working on behalf of

the individual.

None of these approaches is exclusive of another,

and they often complement each other. The key is

to establish what communication channel works

best for everyone in advance of a crisis, typically by

meeting with the team and asking which approach

is mutually convenient.

Third, it is important to feel comfortable conveying

not only direct observations and reported

symptoms, but also less concrete concerns. Again,

the HUD-VASH Case Manager is in the unique

position of being able to observe the client in

contexts that are not readily apparent during a

clinic visit. Using this vantage point to observe,

gather data, and form impressions of the Veteran’s

functioning that may contribute to the care team’s

ability to assess symptoms and create treatment

plans is invaluable, as it brings to the clinical

encounter a perspective not typically available.

Finally, it is also important to recognize that

functional communication is a two-way process and

that Case Managers may be asked by the care team

to follow up with the patient regarding care plans or

assessments, emphasize actions steps or behaviors

that were encouraged in the clinic appointment,

or facilitate compliance with a given treatment or

medication. 

Eliciting Clinically Relevant Information–What to 

Ask your Client

Many behaviors and symptoms can suggest more

serious underlying problems that, if left untreated,

could lead to worsening mental and physical health,

precipitate a relapse, and or ultimately jeopardize

one’s ability to stay housed. Case Managers are

often in a unique position to ask about and observe

behaviors that clients might not otherwise find

significant or feel comfortable reporting. Case

Managers should remain vigilant and in close

communication with the primary care team when

• The client reports feeling down, depressed, 

anxious or becomes socially withdrawn. 

These may all be signs and symptoms of an

underlying depression or anxiety disorder that

may become more evident when the client does

not have to navigate soup kitchens, emergency

shelters and other programs or offices to meet

their daily sustenance needs. Alternatively, the

Case Manager might observe the client present

with pressured speech, report little to no sleep,

and/or speak in grandiose terms. This could

suggest hypomania as part of bipolar disorder.
124 H U D - V A S H R E S O U R C E G U I D E

• The client complains of pain. This is

particularly common when a Veteran with

a long-term drug or alcohol abuse pattern

becomes sober and no longer has the effects

of substances to mask or block the pain

or injury. It is important to be vigilant and

responsive, as untreated pain can often lead

to relapse, and there are a variety of pain

management treatments available, including

non-pharmaceutical alternatives.

• The client skips or stops taking medication. 

Many conditions require chronic medication

dosing in order be controlled, yet it is often

difficult to convey these physiological reasons

for compliance. This is especially true when

the client may not recognize an immediate

or direct benefit from the medication. Some

medications must build up in a client’s system

in order to have a noted effect, particularly antidepressants; other medications have subtle or

unrecognized effects. As disussed earlier, the

client may be trying to alleviate medication side

effects (for example, diuretics cause increased

urination and may cause erectile dysfunction).

Cost may also be an issue, especially if full VA

benefits are still pending; when certain drugs

are not on the VA formulary, pharmacy access

or co-pay could be a barrier to treatment

adherence.

• The client reports hypersomnolence, lack of 

energy, and/or constant fatigue. While these

symptoms can be associated with a depressive

disorder or other mental health condition, they

can also be associated signs and symptoms for

conditions like congestive heart failure, anemia,

substance abuse relapse, or endocrine disorders

such as hypothyroidism or new onset/poorly

controlled diabetes. Often, this will require

a medical evaluation, including bloodwork. 

The sooner the primary care team is aware of

presenting symptoms, the sooner the work-up

can begin. 

• There are significant changes to eating habits 

or diet. When a Veteran locates and receives

permanent housing, it also represents a daily

lifestyle change with decreased emphasis on

walking and transit, greater food security and

autonomy, and decreased reliance on soup

kitchens for support. Alternatively, weight

loss and/or poor appetites may suggest

limited availability or access to food and

income resources, depression or anxiety, acute

conditions such as a cancer, or chronic medical

conditions such as liver disease and cirrhosis. 

While the client may not think much of these

changes, a clinical work-up can rule out more

serious explanations and to address potential

complications.

• The Veteran regularly misses appointments 

or meetings. While occasional forgetfulness

may be expected, a developing pattern of this 

may suggest a downward trend in motivation

or treatment engagement. This relationship

is particularly well-established with drug or

alcohol abuse relapses, when, often, the client

starts missing meetings, avoiding the Case

Manager, or ignoring the PCP or other team

members. If the Veteran is in the throes of a

relapse, he or she may not be fully cognizant of

the threats to health and housing constituted by

this behavior.

• There is difficulty engaging the Veteran in 

health maintenance and preventive health 

care. For many Veterans, in their“former”

unsheltered lives, going to a clinic or hospital

is only done in the case of sickness or injury. 

Primary and preventive care was not a priority,

especially in the context of also trying to secure

housing, get food, stay safe, etc. Now, with

permanent, supportive housing, many homeless

Veterans need to rethink what seeking health

care means. Case Managers should advocate,

encourage, and facilitate interaction with the

primary care team that includes screening

for high blood pressure, diabetes and other

chronic diseases; screening for tuberculosis,

colon, prostate, breast, and cervical cancers;

immunizations and vaccinations against

seasonal influenza, H1N1, tetanus, and other

conditions. 
H U D - V A S H R E S O U R C E G U I D E 125 

KEY POINTS

	Releases of information or other restrictions are not

needed when conveying information among provider,

PACT team, and Case Manager

	Establish communication before a crisis occurs

	Meet with the PACT team or accompany client to clinic

visit to further establish rapport

	Feel comfortable communicating observations,

symptoms, and concerns

	Work with PACT team to also understand how you can

help support them

	Be proactive–monitor, observing, and routinely ask

about changing signs, symptoms, and behaviors

	Trust your instincts–use what may not seem or feel

right as a starting point for further investigation

References

Brickner, P. W., Scharer, L. K., Conanan, B. A., Savarese,

M., & Scanlan, B. C. (Eds.). (1990). Under the safety net. 

New York: WW Norton & Company.

Bonilla, D. L., Kabeya, H., Henn, J., Kramer, V. L., &

Kosoy, M. Y. (2009). Bartonella quintana in body lice

and head lice from homeless persons, San Francisco,

California, USA. Emerging Infectious Diseases, 15(6),

912.

Gallagher, T. C., Andersen, R. M., Koegel, P., & Gelberg,

L. (1997). Determinants of regular source of care

among homeless adults in Los Angeles. Medical Care, 

35(8), 814-830.

Hwang, S. W., Orav, E. J., O’Connell, J. J., Lebow, J. M.,

& Brennan, T. A. (1997). Causes of death in homeless

adults in Boston. Annals of Internal Medicine, 126(8),

625.

Institute of Medicine, Committee on Health Care for

Homeless People. (1988). Homelessness, health and

human needs. Washington, DC: National Academy

Press.

Jenks, C. (1995). The Homeless: Cambridge, MA:

Harvard University Press.

Kertesz, S. G., Crouch, K., Milby, J. B., Cusimano, R. E.,

& Schumacher, J. E. (2009). Housing first for homeless

persons with active addiction: Are we overreaching?

Milbank Quarterly, 87(2), 495-534.

Kushel, M. B., Evans, J. L., Perry, S., Robertson, M. J.,

& Moss, A. R. (2003). No door to lock: victimization

among homeless and marginally housed persons.

Archives of Internal Medicine, 163(20), 2492-2499.

Kushel, M. B., Perry, S., Bangsberg, D., Clark, R., &

Moss, A. R. (2002). Emergency department use

among the homeless and marginally housed: results

from a community-based study. American Journal of 

Public Health, 92(5), 778.

Kushel, M. B., Vittinghoff, E., & Haas, J. S. (2001).

Factors associated with the health care utilization of

homeless persons. JAMA: the Journal of the American 

Medical Association, 285(2), 200.

O’Toole, T. P., Gibbon, J. L., Hanusa, B. H., & Fine, M. J.

(1999a). Preferences for sites of care among urban

homeless and housed poor adults. Journal of General 

internal medicine, 14(10), 599-605.

O’Toole, T. P., Gibbon, J. L., Hanusa, B. H., & Fine, M.

J. (1999b). Utilization of health care services among

subgroups of urban homeless and housed poor.

Journal of Health Politics, Policy and Law, 24(1), 91.

Salit, S. A., Kuhn, E. M., Hartz, A. J., Vu, J. M., & Mosso,

A. L. (1998). Hospitalization costs associated with

homelessness in New York City. New England Journal 

of Medicine, 338(24), 1734-1740.

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about

integrating your worth with primary care. 

1) The average age of death for a homeless person

is 47.

2) The rate of death from cancer and heart disease

for Veterans 45-64 years of age is three times as

high as that of the general population.

3) Health care provides the platform on which to

engage homeless persons in an array of services

over a continuum of time and needs.
126 H U D - V A S H R E S O U R C E G U I D E

4) All HUD-VASH participants must be linked to a

Patient Aligned Care Team (PACT).

5) PACTs serve as a first stop for urgent or emergent

medical needs.

6) TELEHEALTH is a hot line for Veterans

experiencing medical emergencies.

7) Releases of information are needed for conveying

information to and from the provider and the

PACT team.

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) The relationship between health and

homelessness has been described within three

contexts: medical issues that precede and

contribute to homelessness; medical problems

that are complications of homelessness; and

illnesses or conditions that are harder to treat or

manage because of the patient’s moving from

place to place. What are some examples of each

of these?

2) Multiple morbidities including mental illnesses,

substance use, and acute and chronic medical

problems, often create a triaging dilemma,

whereby the care may be fragmented. How

can your team prioritize the preferences of the

Veteran in these instances?

3) The professional“silos”in which providers operate

can make communication difficult. Further, who

to talk to and when can be elusive and frustrating.

What steps can your team make to improve

and enhance communication among all care

providers to better serve Veterans?

4) Many behaviors and symptoms can suggest

more serious underlying problems that, if left

untreated, could lead to worsening mental and

physical health. What are some of the things to

watch for to prevent a worsening in health?
H U D - V A S H R E S O U R C E G U I D E 127 

What’s in This Chapter?

Trauma-Informed Care is an important consideration

for Case Managers as combat stress and trauma

reactions are especially prevalent. The more

providers are aware of trauma and its impacts,

the better able they are to encourage appropriate

treatments and promote recovery.

In this chapter you will learn

• How to recognize trauma,

• Its impacts,

• Psychiatric disorders that can directly arise from

trauma, and

• The differences between Trauma-Informed Care

and Trauma-Specific Treatment.

After you read this chapter, you will be able to

incorporate Trauma-Informed Care into your

approach to serving Veterans in HUD-VASH

What is it and why does it matter?

In the past decade, the term“trauma-informed care”

(TIC) has become a central component of treatment

services for all vulnerable populations, including

Veterans and the homeless. As reactions to trauma

involve a host of behavioral, psychological, and

physical reactions, acknowledging it can have

important impacts on treatment planning and

delivery. When Case Managers are aware of trauma–

and familiar with the intentional and subconscious

ways people may cope–the more promptly and

comprehensively they can respond.

“Trauma”refers to the experience, threat, or

witnessing of physical harm (American Psychiatric

Association, 2004). It includes various types of

experiences such as military combat, military sexual

trauma, terrorist attacks such as 9/11, serious car

accidents, natural disasters (hurricanes, tornadoes),

major medical illnesses and injuries, childhood

physical or sexual abuse, assault and violence. Most

Americans (about 61% of males and 51% of females)

experience one or more traumas during their

lifetime (Kessler, Berglund, Demler, Jin, Merikangas

& Walters, 2005), but it is important to remember

that trauma is as universal as it is common–and

potentially even more so–in other parts of the world

(Kessler, 2000). Beyond the risk for trauma that is

inherent in interactions with other people and the

environment, there are also particular stressors

related to military service.

”Trauma, especially when untreated, can have 

severe negative impacts on a person’s physical and 

emotional well-being. Trauma has been linked to 

hallucinations and delusions, depression, suicidal 

tendencies, chronic anxiety, hostility, interpersonal 

sensitivity (i.e. poor “social skills”), somatization 

(i.e. “chronic fatigue syndrome”), eating disorders, 

and dissociation.” (Witness Justice, 2010). 

Trauma is important because it can have varied and

major effects on an individual’s functioning. Trauma

victims are at a much higher risk for co-occurring

mental health and substance use disorders, violence

victimization and perpetration, self-injury, and other

coping mechanisms–all with devastating human,

social, and economic consequences. Trauma has

been linked to social, emotional, and cognitive

impairments, disease, disability, serious social

problems, and premature death (Witness Justice,

2010).

There are also important contextual factors that can

impact how a person responds to trauma. These

include gender differences, cultural sensitivities or

traditions, response delays (i.e., some people may

PART 2 C H A P T E R 5 : T R A U M A - I N F O R M E D C A R E

Considerations for Homeless Veterans Enrolled in HUD-VASH
128 H U D - V A S H R E S O U R C E G U I D E

react months or years after the traumatic event),

single versus repeated traumas (how many times

it occurred), age at time of trauma (child versus

adult), the biological impact of trauma (mind-body

connections), and how others reacted (family,

community, colleagues, and society at large). Thus,

it is important to remember that, while certain types

of traumas may appear similar enough to categorize

(loss of a soldier in combat; car accidents), each

event may have quite a different impact depending

on the individual and the context.

There are several key psychiatric disorders that can

directly arise from trauma, typically in a minority of

clients. These are outlined below.

TRAUMA-RELATED PSYCHIATRIC DISORDERS

MENTAL ILLNESS CHARACTERISTICS

ACUTE STRESS DISORDER

(Occurs during, or up to 4-6 weeks

following, trauma)

Symptomatology varies, but may include

	Sense of numbing or detachment

	Reduced awareness of surroundings, or being in a “daze”

	Difficulty recalling important aspects of the trauma

	Feelings of being unreal

	Anxiety

	Avoiding reminders of the trauma

	Re-experiencing the trauma through flashbacks or nightmares

	Significant decline in functioning

POST-TRAUMATIC 

STRESS DISORDER

(PTSD)

(Diagnosed only four weeks or more after

the trauma, thus indicating a persistence

of trauma-related symptoms that do not

diminish with time)

Includes many symptoms associated with acute stress disorder, as well as

others. In general, the symptoms fall into three main categories:

	Re-experiencing the trauma, including flashbacks, nightmares, and/

or intense physical and emotional“triggering”when reminded of the

trauma)

	Avoidance of reminders of the trauma

Intense arousal (e.g., difficulty sleeping, anger outbursts, startle

reactions)

DISSOCIATIVE DISORDERS

	Occur in small percentage of the population after exposure to extreme

and chronic trauma, such as repeated childhood or prisoner-of-war

trauma experiences

	Marked by changes to consciousness, memory, identity, or perception

	Client may have major memory gaps or feel unreal

	In severe cases, dissociative identity disorder may be present,

characterized by the presence of“alters”(different personalities) within

the self. The client may be unaware, or unable to control, switching

between them.
H U D - V A S H R E S O U R C E G U I D E 129 

A major element of trauma-informed care is to

educate all staff on the importance of trauma. 

According to the National Center for TraumaInformed Care,

“When a human service program takes the step 

to become trauma-informed, every part of its 

organization, management, and service delivery 

system is assessed and potentially modified to 

include a basic understanding of how trauma 

impacts the life of an individual seeking services.” 

Case Management Specifics for

Trauma-Informed Care

	Train all staff in basics of trauma education (rates,

impact of trauma, how to interact with traumatized

clients)

	Take steps to avoid re-triggering trauma (e.g.,

restraints, isolation, coercion)

	Create advance directives of how to manage intense

emotions (i.e., concrete plans of what to do if the client

becomes agitated, such as who s/he will talk to, what

strategies help to calm the person, etc.)

	Elicit input from survivors of trauma on how to design

services that are trauma-sensitive

	Focus on dynamics that empower the traumatized

client, such as offering choices, expressing compassion,

listening

	Learn strategies for helping clients realize and

understand how some behavioral patterns may have

developed from trauma

	Modify policies to respect trauma sensitivity (e.g.,

a client may need lights on at night in residential

treatment)

Case Example

Jason is a returning Veteran from OIF, who

is currently in residential care at VA due to

homelessness and multiple psychiatric problems. 

He struggles with substance dependence that arose

about six months after returning home from Iraq

(primarily alcohol, but also misuse of prescription

medications).

Jason was exposed to multiple traumas during

his deployment, including seeing a fellow soldier,

Bill, die in a blast from an improvised explosive

device. Jason was nearby and was almost killed

himself. He reports that he has felt“dead inside” ever

since losing Bill, who was a good friend. While still

deployed, he volunteered for the most dangerous

assignments, not caring if he lived or died. Upon

his return, his wife and children seemed afraid of

him, as he would burst into angry episodes over

small things, such as someone not putting things

away correctly. Before this deployment, Jason had

been an easy-going, quiet person, but they felt they

barely recognized him now. His wife told him to get

treatment or she would leave him; Jason refused

and moved out. Without a job, he ended up on the

streets, where he became a low-level worker for a

drug dealer to try to earn some money. An outreach

worker from VA talked him into trying to get into VA

care. During an intake interview, he was diagnosed

with posttraumatic stress disorder, substance

dependence (alcohol), dysthymia, and intermittent

explosive disorder. He became increasingly isolated

and withdrawn, feeling hopeless that anything could

make a difference.

Now in residential care at the VA, he is required

to attend treatment as a condition of receiving

temporary housing. While initially withdrawn,

distrusting, and somewhat paranoid, as he settled in

and became more comfortable, he began to open

up. He started sharing a bit in groups and was able

to connect with a counselor whom he trusted. The

counselor helped Jason understand the impact

of trauma on his life, and helped him see how his

misuse of alcohol and prescription medications

had been a way to try to cope with trauma-related

symptoms. He says,

“My counselor got it, even when I didn’t, that 

trauma had played a huge role in how I ended 

up homeless and at the bottom. I kept blaming 

myself, but my counselor helped me see that the 

traumas I had been through had festered inside 

me and affected everything I did, yet I never dealt 

with them or even acknowledged how important 

they were. My counselor was kind, and moved 

slowly, pacing to what I was able to do at any time 

and never pushing or judging me.” 
130 H U D - V A S H R E S O U R C E G U I D E

Jason ultimately entered individual treatment with a

VA therapist specializing in PTSD care, with whom he

continued to work on his substance dependence. He

gradually learned new coping skills and engaged in

family therapy. Ultimately, about three years after he

left home, he was able to re-unite with his family and

move back in with them.

Case questions:

1) How did trauma play a role in Jason’s problems?

2) What helped him to recover?

3) What elements of trauma-informed care do you

notice in his treatment?

4) Arethereotherthingshis counselor couldhavedone

to create a trauma-sensitive treatment experience?

5) When you work with clients, how much do you

practice trauma-informed care? What could you do

differently to increase this aspect?

Case discussion: Jason is typical of some returning

Veterans in in that he was exposed to trauma during

a deployment and developed a substance use

disorder after coming home. His family problems,

homelessness, and multiple psychiatric problems

are also representative of some of the more severe

clients. His hopelessness, sleep problems, difficulty

taking care of himself, and downward spiral are all

typical trauma-related problemsthat are magnified

in the context ofsubstance dependence and other

psychiatric disorders. Yet Jason is a successstory in

several ways:

• A VA outreach worker was able to engage him

into treatment, even amid Jason’s significant

distrust and isolation.

• Jason’s counselor used a trauma-informed

approach focusing on building trust, pacing,

and education about trauma and related

problems.

• Jason was referred to a VA PTSD specialist for

treatment of the PTSD, and, eventually, when

ready, to family therapy to help re-unite him

with his family.

In sum, a trauma-sensitive approach helped

Jason engage in recovery and, in conjunction

with specialized treatment for PTSD, substance

dependence, homelessness, and family problems, he

was able to make significant progress. 

Trauma-Informed Versus Trauma-Specific 

Services

It is important for the Case Manager to be able

to distinguish between trauma-informed care

considerations and trauma-specific mental health

interventions. As the Case Manager, your primary

responsibilities are to avoid ruling trauma out as a

possibility, even if unshared or uncommunicated;

to view symptom and behavior changes in light of

potential traumatic responses; and to be able to

make pro-active, prompt referrals for Veterans who

need more targeted evaluations and treatment.

Case Managers offer trauma-informed services;

clinicians and mental health professionals offer

trauma-specfic interventions. The program goal

should be for all counselors to be trauma-informed,

while specific members of the treatment team will

specialize in trauma-specific interventions. 

• Trauma-informed services are grounded in

basic principles of awareness. All HUD-VASH

staff should be knowledgeable about trauma

symptoms and the impact of trauma on clients’

lives. Case Managers and otherstaff should be

able to implement basic skillssuch as grounding,

trauma screening, and to know how and when to

refer clients out forspecialized help. An example

of a model that is used in VA for trauma education

is Seeking Safety [Najavits].

• Trauma-specific services are administered

when a smaller number of staff become traumacompetent, in that they are able to effectively

treat trauma-related disorders, such as PTSD,

using evidence-based models. Some of these

interventions require specific training in

order to perform them with adequate fidelity.
H U D - V A S H R E S O U R C E G U I D E 131 

Examples of trauma-therapy models that are

used in VA include Prolonged Exposure (Foa,

2007), Cognitive Processing Therapy (Resick,

2007), and Eye Movement Desensitization and

Reprocessing (Shapiro, 1999).

Without specific training, program staff can

sometimes do harm if they try to treat traumarelated disorders without adequate preparation

and training. “First, do no harm”remains the central

principle of all treatment. Thus, although traumaspecific therapy models can be very helpful (they

are PTSD evidence-based therapies), they require

specialized training. For example, in VA, prolonged

exposure therapy is often used for PTSD treatment,

yet requires extensive training, monitoring, and

careful implementation. The Case Managershould

prioritize linking a Veteran who may be suffering from

trauma response disorders with a clinical evaluation,

and should support the clinician’streatment plan.

Trauma-Informed Care Considerations

Style of interaction 

A key element of trauma-informed care is interacting

with the client in ways that promote the best

response possible. According to Walser, within the

therapeutic relationship, it may also be important

to place less emphasis on confrontation and more

on tolerance of the problem. Many individuals

who treat substance use disorders can use a harsh

confrontational style. They can draw the line in a

very specific way and say things like,“You need to

get yourself together,”or“You need to stop doing

this.” When counseling clients who are working

through traumatic stresses, it is important to

remember that the trauma may have occurred

under conditions of harsh confrontation, so that the

intervention itself might trigger the very responses it

is aimed to alleviate. It is important to consider the

style of interaction in order to avoid problems within

the therapeutic relationship and avoid treatment

roadblocks.

On the other side of a confrontational style is one

that incorporates misguided sympathy. There are

clinicians and therapists who feel that their patients

have had too many traumas, and over-sympathize

with them. It may be difficult for some therapists

to hold clients responsible for doing homework or

engaging in the responsible actions necessary for

working through triggers and toward recovery.

If harsh confrontation is on one end of the spectrum,

and misguided sympathy is on the other, HUD-VASH

team members may have most success using a soft

confrontational style that expresses confidence in

the Veteran’s ability to take responsibility for parts of

his or her own recovery. (http://www.ncptsd.va.gov/

ptsd101/modules/Walser_SA_Transcript.pdf)

The importance of culture and gender

It is also important to be sensitive to how culture

and gender may play a role in how trauma is

perceived, addressed, and treated. For example,

culture and gender may affect whether an individual

is able to identify trauma symptoms as“legitimate”

(e.g., in some cultures psychological problems are

considered more taboo to discuss than in others);

may affect how symptoms are expressed (e.g., as

emotional versus more physical in nature); may

affect co-morbidity (e.g., the likelihood of using

certain substances as ways of coping with trauma

symptoms); and may affect treatment response

(e.g., whether the counselor is aware of cultural

and gender subgroup issues). Thus, counselors are

encouraged to seek training in cultural, diversity,

and gender-based issues so as to provide the most

compassionate care possible to Veterans who are

often of various different subgroups.
132 H U D - V A S H R E S O U R C E G U I D E

KEY ELEMENTS OF TRAUMA-INFORMED 

CARE FOR COUNSELORS

	Anticipate proceeding slowly with a client who is

diagnosed with or has trauma-related symptoms. 

Consider the effect of a trauma history on the client’s

current emotional state, such as an increased level of

fear or irritability.

	Develop a plan for increased safety where warranted.

	Establish both perceived and real trust.

	Respond more to the client’s behavior than to his/her

words.

	Limit questioning about details of trauma.

	Recognize that trauma injures an individual’s capacity

for attachment. The establishment of a trusting

treatment relationship will be a goal of treatment, not

a starting point.

	Recognize the importance of one’s own trauma

history and counter-transference.

	Help the client learn to de-escalate intense emotions.

	Help the client to link trauma and substance abuse.

	Provide psychoeducation about trauma and

substance abuse.

	Teach coping skills to control trauma symptoms.

	Recognize that trauma/substance abuse treatment

clients may have a more difficult time in treatment,

and that treatment for trauma may be long term,

especially for those who have a history of serious

trauma.

	Help the client access long-term treatment, if needed,

and refer to trauma experts for trauma exploratory

work.

*Reprinted from SAMHSA’s Treatment Improvement 

Protocol: Trauma and Substance Abuse (in press). 

Consensus panel chairs: Lisa M. Najavits, PhD and Linda 

B. Cottler, PhD, MPH

Trauma Related Resources 

• VA National Center for PTSD (http://ptsd.va.gov). 

This site is provided by the US Department of

Veterans Affairs to offer education and materials

related to trauma and PTSD. It also includes the

PILOTS database (the world’s largest literature

base on PTSD and related disorders).

• Witness Justice (http://witnessjustice.org).

Created by survivors for survivors. Their mission

is to provide support and advocacy for victims

of violence and trauma.

• National Center for Trauma-Informed Care

(http://mentalhealth.samhsa.gov/nctic). Site

developed by the Substance Abuse Mental

Health Services Administration to provide

resources for trauma-informed care.

• National Child Traumatic Stress Network (http://

www.nctsnet.org). Joint effort by university,

government, and community agencies to

provide materials, education, and resources

to improve care for traumatized children and

families.

• International Society for Traumatic Stress

Studies (http://www.istss.org). Professional

society devoted to science, practice, and policy

related to trauma and PTSD.

• International Society for the Study of

Dissociation (http://www.issd.org). Professional

society devoted to science, practice, and policy

related to trauma and dissociation.

• Sidran Foundation (http://www.sidran.org). 

Provides information related to recovery from

traumatic stress (including PTSD), dissociative

disorders, and co-occurring issues, such as

addictions, self injury, and suicidality.

• National Resource Center on Domestic Violence

(http://www.vawnet.org). An online resource

for advocates working to end domestic violence,

sexual assault, and other violence.

• EMDR International Association (http://www.

emdria.org) and EMDR Humanitarian Assistance

Program (http://www.emdrhap.org). The first

of these, EMDRIA, is a membership organization

of mental health professionals dedicated to the
H U D - V A S H R E S O U R C E G U I D E 133 

highest standards of excellence and integrity

in EMDR (eye movement desensitization and

reprocessing therapy for trauma and PTSD). 

The second, EMDRHAP, is a global network of

clinicians who travel anywhere there is a need

to stop suffering and prevent the after-effects

of trauma and violence. Their primary focus

is on training local therapists within crisis or

underserved communities to treat trauma using

EMDR (Eye Movement Desensitization and

Reprocessing).

• Seeking Safety (http://www.seekingsafety.org). 

Offersresources on trauma and substance abuse,

including general information as well as material

to implement the Seeking Safety model. 

References

American Psychiatric Association. (1994). Diagnostic 

and statistical manual of mental disorders IV.

Washington, DC: American Psychiatric Association.

Fallot, R. D. and M. Harris, Eds. (2001). Using Trauma 

Theory to Design Service Systems. New Directions for 

Mental Health Services. San Francisco, Jossey-Bass.

Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007).

Prolonged exposure therapy for PTSD: Emotional 

processing of traumatic experiences: Therapist guide:

Oxford University Press, USA.

Kessler, R. C. (2000). Posttraumatic stress disorder:

The burden to the individual and to society. Journal 

of Clinical Psychiatry, 61(Suppl 5), 4-14.

Kessler, R. C., Berglund, P., Demler, O., Jin, R.,

Merikangas, K. R., & Walters, E. E. (2005). Lifetime

prevalence and age-of-onset distributions of DSMIV disorders in the National Comorbidity Survey

Replication. Archives of General Psychiatry, 62(6), 593.

Najavits, L. M. (2002). Seeking safety: A Treatment 

Manual for ptsd and Substance Abuse. New York:

Guilford Press.

Shapiro, F. (1999). Eye movement desensitization

and reprocessing (emdr) and the anxiety disorders:

Clinical and research implications of an integrated

psychotherapy treatment. Journal of Anxiety 

Disorders, 13, 35-67.

Resick P.A., Monson C.M. and Chard K.M. (2007)

Cognitive processing therapy: Veteran/Military version.

Washington, DC: Department of Veterans’Affairs

Stamm, B. H., J. M. Rudolph, et al. (1996).

Psychometric review of Stressful Life Experiences 

Screening. Measurement of Stress, Trauma and 

Adaptation. B. H. Stamm. Lutherville, MD, Sidran.

Weathers, F. W., B. T. Litz, et al. (1993). The PTSD 

Checklist (PCL): Reliability, validity, and diagnostic 

utility. Paper presented at the International Society

for Traumatic Stress Studies, San Antonio, TX.

Witness Justice (2010). Trauma is the common

denominator, healing is the common goal. Accessed

November 16, 2010 from Witness Justice, http://

www.witnessjustice.org/health/trauma.cfm

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about TraumaInformed Care.

1) Trauma is common.

2) Trauma refers to the direct experience of physical

harm. Experiences in which physical harm is

witnessed or threatened are referred to as

“secondary trauma.”

3) Trauma victims are at a much higher risk for cooccurring mental health and substance abuse

disorders.

4) Psychiatric disorders can directly arise from

trauma.

5) Only senior level staff should be educated on the

importance of trauma.

6) Counselors who interact with traumatized clients

should limit questioning about details of the

trauma.

7) Once a Case Manager is trauma-informed, she or

he can provide trauma-specific treatment.

8) Trauma-informed care also emphasizes sensitivity

to culture and gender.
134 H U D - V A S H R E S O U R C E G U I D E

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) Psychiatric disorders that can directly arise

from trauma include acute stress disorder,

post-traumatic stress disorder, and dissociative

disorders. How are these disorders similar and/or

different?

2) What are some specific examples of TraumaInformed-Care?

3) Review the case example on page 129 and

answer the questions that follow. Then review the

case discussion to see how your responses align

with those in the Resource Guide.

4) What are some of the differences between

trauma-informed services and trauma-specific

services?

5) A number of trauma related resources are

available for HUD-VASH teams. What are they and

which will you utilize in your program?
H U D - V A S H R E S O U R C E G U I D E 135 

What’s in This Chapter?

HUD-VASH teams have the opportunity to facilitate

employment and education goals for the Veterans

they serve. In some areas, these services are

provided by specialized practitioners, so the first

step is always to link Veterans to these resources. 

However, if these resources aren’t available, Case

Managers will need to take the lead on supporting

Veterans’ education and employment goals.

In this chapter you will learn

• What opportunities exist to address

employment obstacles,

• Particular VA programs that assist in

employment,

• The principles and practices of supported

employment and education,

• Skills needed for assisting Veterans in pursuing

employment, and

• Ways to support the educational goals of

Veterans.

After reading this chapter, you will be able to

promote the employment and education of Veterans

on your caseload.

Introduction

As a Case Manager, you have the opportunity to

strengthen the recoveries of homeless Veterans by

offering supportive services in multiple domains. 

Your commitment to their housing stability also

includes helping them develop and plan for

increasingly independent and fulfilling lives. Part of

this includes income and financial planning, job skills

development, and other goals that are directly tied

to supported education and employment goals.

As important as the Case Manager’s role is,

Supported Education and Supported Employment

are specialized fields for practitioners, and so the

first step is always to link your clients to these

resources when possible. If dedicated resources

aren’t available, then your own ability to apply

the principles outlined in this chapter will be very

helpful to the Veteran. Regardless of whether you,

or another provider, take the lead on supporting

your client’s education and employment goals, the

guiding principle remains the same: everyone who

wants to work or learn should be encouraged and

supported in that endeavor, and you should draw

on VA and community resources to help you provide

that support.

PRIORITIES FOR HUD-VASH CASE MANAGERS 

WHOSE CLIENTS HAVE A GOAL TO WORK OR

GO TO SCHOOL

	Acknowledge, believe in, and support an expressed

desire to work or go to school

	Link clients to existing resources at VA

	Link clients to community resources

	Integrate the Veterans employment or education goal

with their mental health team

	Serve as liaison for a working or matriculated Veteran

with members of care team

Supported Employment

With increasing housing stability may come

increasing opportunities to work and to enjoy the

related material and psychological benefits. These

PART 2 C H A P T E R 6 :

Supported Employment and Supported Education for 

Homeless Veterans in HUD-VASH
136 H U D - V A S H R E S O U R C E G U I D E

may be especially important, yet previously elusive,

to Veterans who were homeless. As a Case Manager,

you can encourage Veterans to seek employment

or work toward educational goals; you also have an

opportunity to facilitate these goals. As you begin to

think about your client’s education or employment

goals, some issues will likely arise, as outlined below.

WHAT MIGHT CASE MANAGERS EXPECT FROM VETERANS

WHO EXPRESS A DESIRE TO WORK?

CHALLENGE REFERRAL/OPPORTUNITY

	Spotty or remote work history 	Skills assessments, even if not based on employment history, may highlight

previously unidentified skills

	Specific work programs at VA can help establish a work history

	Reluctance to try to work again if

they have been unsuccessful in the

past

	Mental health integration can help work through psychological barriers

	Transitional work and other programs may help build confidence

	Identification of what made those attempts unsuccessful (active addiction? No

permanent residence? Uncontrolled symptoms?) and action plans to emphasize

what is different this time

	Prior criminal justice involvement

or other gaps in employment

histories

	Check out the Bazelon Center for Mental Health Law (http://www.bazelon.org/)

to learn about what potential employers can and can’t ask about mental health

history and/or prior problems with the law.

	Limited resources to prepare

for job search and competition,

including unfamiliarity with

technology (relevant for both job

search and job skills), clothing and

personal hygiene, interpersonal

skills, paperwork or application

difficulties, etc.

	State Department of Labor

	One Stop Career Centers

	Non-profits who offer clothing and support for people entering the workforce;

for example, Dress for Success and Career Gear provide professional clothing free

of charge (www.dressforsuccess.org, for women; www.careergear.org, for men).

Career Gear even has a retention program focused on maintaining job skills and

continuing professional development. It will provide interview suits from head

to toe for disadvantaged job seekers.

	Investigate VFW or American Legion posts who may have special programs for

helping with these issues

	High job turnover/job maintenance

problems

	Identification of what contributed to keeping jobs in the past; emphasize what

is different now. Create action plans to address issues and provide follow-along

support. 

	Difficulties interacting with coworkers or supervisors	Social skills coaching

	Case Manager or Mental Health team consultation with employer, etc.

	When difficulties stem from military experiences and a feeling of being

misunderstood or judged, linking the Veteran to positive supports with other

Veterans, other individuals in recovery, and/or community supports may

help (12-step programs, mental health support groups, Patriot Guard Riders,

community sports, etc., or re-exploration of VA job programs)

(Chart continued on next page)
H U D - V A S H R E S O U R C E G U I D E 137 

	Relapses or medical issues

related to mental health status or

substance use disorders

	Case Manager’s continuous communication with integrated primary care and

mental health team can prevent, explain, monitor, ameliorate effects of mental

health/substance abuse relapses on job and on employer

	Need to manage symptoms from

either mental illness or side effects

from medications while on the job

	Primary care and mental health involvement is key! Encourage Veteran to share

job goals with staff during medication reviews, keep detailed notes of side

effects, etc.

	Work with MH counselors and/or with Veteran on grounding and meditation

techniques to assist with anxiety/flashback symptoms; encourage Veteran to use

principles from therapy; help MH counselors understand problems to better plan

interventions

	Benefit deterrents 	Be knowledgeable; work through benefits discussions with Veteran. 

	Get benefits counseling from the Social Security Administration or the Veterans

Benefits Administration.

	Need for reasonable job

accommodations due to disability,

illness, etc.

	Check out the Job Accommodation Network: www.askjan.org

	Family care issues 	Case Manager can help with benefits (child care expense offset of income for

benefit planning purposes); during voucher planning, live-in family caregivers

may be eligible for inclusion in housing; aides for disabled or elderly individuals

may also be included

	Social work and other resource referrals to help individuals plan day care, adult

care, home health, etc.

	Difficulty navigating logistics

(transportation issues, etc.)

	When the Veteran’s residence shifted and changed, he/she may have felt“able”

to work in a variety of different places. However, this may have also exacerbated

difficulties maintaining a regular job. A fixed residence may seem to limit

possibilities: help Veteran consider employment opportunities when choosing

a community in which to live (is community close to public transportation, what

is available around those public transit lines, does the neighborhood itself have

possibilities, etc.)

	Work with Veteran to learn and utilize public transportation, carpool, etc. 

WHAT MIGHT CASE MANAGERS EXPECT FROM VETERANS

WHO EXPRESS A DESIRE TO WORK?

CHALLENGE REFERRAL/OPPORTUNITY

(Chart continued from previous page)

Although these barriers can be formidable, in the

last thirty years, great strides have been made in the

knowledge and application of interventions that

contribute to successful work outcomes. The VA has

embraced many of these principles and programs. 

HUD-VASH Case Managers can take advantage of

these VA programs on behalf of the Veterans they

serve, and they can adopt many principles in their

own interactions with Veterans. These opportunities

to provide or to link Veterans to VA employment

supports are described below.
138 H U D - V A S H R E S O U R C E G U I D E

VA RESOURCE GUIDE

PROGRAM LOCAL AVAILABILITY REQUIREMENTS

Vocational 

Rehab (Chapter 

31)/ VetSuccess

http://www.vba.va.gov/bln/vre 	Service-connected disability of at least 10% within 12 years of rating

	Honorable discharge

After assessment and determination of an employment handicap, a vocational rehabilitation counselor will work

with the Veteran to develop a suitable employment goal and a rehabilitation plan to achieve that goal. The plan

will describe the services and resources the VA will provide to assist the Veteran in achieving his/her goals. Goals

will involve one of five tracks of VA services including: (1) reemployment (with a former) employer; (2) direct job

placement; (3) self-employment; (4) training or education to achieve employment goals; or (5) independent living

services. The VR counselor or Case Manager will work with the Veteran to implement the plan.

Compensated 

Work Therapy 

(CWT) Program

http://www.cwt.va.gov/

LOCATIONS:

http://www.cwt.va.gov/cwt/

locations.asp

	Service-connected disability

	Mental or physical impairment

	Substance abuse diagnosis in active recovery (abstinence)

	Clinical stability

	Referral is necessary—obtain someone privileged at a VAMC for

vocational services

The CWT program’s mission is to provide realistic and meaningful vocational opportunities to Veterans; encouraging

successful reintegration into the community at the Veterans’highest functional level. To achieve this mission, CWT

staff will match an individual Veteran’s vocational strengths and areas of interest to employment opportunities with

local businesses and industries in many occupational sectors. CWT programs develop an individual rehabilitation

plan for each Veteran and provide a wide range of support services such as vocational case management and

workplace supports to the Veteran at CWT locations.

Transitional 

Work (TW)

Transitional Work (TW), a pre-employment vocational assessment and experience program that operates in the

VA medical center and in local community businesses. TW participants are screened and assessed by vocational

rehabilitation staff and matched to a work assignment for a limited time as deemed clinically appropriate. TW work

assignments are not jobs that the Veteran competes for with the rest of the labor force. Rather, the job is typically

arranged between the VAMC and the employer and the VA will fill the job with a rotating set of workers. The

emphasis is more on paid employment activity rather than a competitive job in the traditional sense, with hourly

payments made to the Veteran by the VA and not by the employer. Veterans participating in TW are not considered

employees of the VA or the participating company, and receive no traditional employee benefits. Veterans at the

work assignment are supervised by work site staff. The same job expectations are imposed on the Veteran as would

be of non-CWT workers in the company. CWT work assignments can be considered to be a “temp to hire”program

allowing a company to pre-screen Veterans, observing them in action before making a decision on whether to

hire them permanently. CWT provides employers a source for temporary and permanent workers or a means for

completing work on a piece rate or job rate basis. 

Enrollment 

in Supported 

Employment 

Program

http://www.cwt.va.gov/locations.asp

(Select the state and facility of interest; there will

be information that indicates which programs are

available at that location, and contact information.)

	Psychosis or serious mental illness

	Need highest level of assistance and support

In the SE model, the job is owned by the employee through a contractual arrangement with the employer, who

pays the Veteran directly; SE follow-up may continue indefinitely, but generally participation and supports are

phased out after the Veteran is able to maintain employment independently. CWT supported employment is

modeled after the evidence-based approach called Individual Placement and Support (IPS) developed by the

Dartmouth Psychiatric Rehabilitation Center and adopted for national roll-out in the VA in 2004. The VA SE model

utilizes the fundamental principles of the IPS model, including integration of an employment specialist with the

clinical team, rapid job development, placement based on client preferences and skills, and no mandatory prevocational assessment or work experience. SE is available to all regardless of prior work history or clinical status,

support and follow-up is provided indefinitely and in varying intensities as needed, there is a very low caseload

ratio for employment specialists, and specialists are expected to work closely with employers (when approved by

the Veteran) for job development and problem solving including negotiation for accommodations. Supported

employment is designed to be delivered by a full-time employment specialist that is part of a clinical team that

embraces employment objectives.
H U D - V A S H R E S O U R C E G U I D E 139 

What can HUD-VASH Case Managers Do to 

Support Veterans’ Employment Goals?

While referral to VA Chapter 31, CWT or SE may

be best, this is not always feasible. However,

short of access to a fully-trained employment

specialist, a review of supported employment

principles and practices can be useful to a HUDVASH Case Manager whose aim is to promote the

employment of Veterans on their caseload. These

SE principles and practices, described below, 

are adapted from Swanson, Becker, Drake and

Merrens (2008), Supported Employment, A Practical 

Guide for Practitioners and Supervisors (Dartmouth

Psychiatric Research Center). Additional and more

detailed information on supported employment

can be found in the recently released Toolkit

by the Substance Abuse and Mental Health

Services Administration (SAMHSA), on“Supported

Employment: Training Frontline Staff” http://

download.ncadi.samhsa.gov/ken/pdf/toolkits/

employment/SE_Training_Frontline_Staff.pdf

SUPPORTED EMPLOYMENT IN PRINCIPLE AND IN PRACTICE

PRINICIPLE PRACTICE

Zero exclusion. Research has not been able to reliably distinguish

those who will or will not succeed in employment. Anyone who

has a stated wish to work is deserving of help to achieve this goal

irrespective of their current clinical status or past work history.

Case Managers should embrace their clients’desire for employment

and support.

Integration of vocational and treatment services. Frequent

communication is needed between employment specialists and the

health care treatment team in order to apply a consistent, hopeful

message about work and to problem solve clinical issues that may

relate to work success, such as timing of appointments, or control

of psychiatric symptoms or dealing with side effects of medication

when on the job.

Connect the Veteran’s primary care provider (PACT team, MH

caseworker, social worker) and their work program. If there is no

work program available, serve as the liaison between the Veteran and

the primary care provider to help with managing meds, interruptions

in work due to appointments, etc. Troubleshoot. Be encouraging:

a treatment team unified behind a Veteran is a huge asset, and

promotes self-worth and motivation.

Competitive employment. Jobs should be obtained in the

competitive economy (not sheltered work or segregated placements

for people with disabilities) and pay at least minimum wage.

HUD-VASH clients are recovering from homelessness. They have

faced formidable challenges and they are survivors. Don’t let past

difficulties limit them.

Benefits planning. Veterans and their helpers must think through

and obtain reliable information on the potential impact of income

on any disability benefits, many people with serious mental illness

will restrict their work for fear of losing health insurance or having

benefits reduced. 

Candid conversations about milestones in income achievement and

what they mean for benefits may be necessary. At those junctures,

Case Managers should help clients determine their own goals: how

do they want to live in society? What is their income potential? What

might change that now or later?

Rapid job search. Job search based on Veteran preferences should

begin shortly after or within a few weeks of determining the Veteran

has a goal to work. Veterans can seek jobs without pre-employment

training or formal assessment, or job readiness skill development. 

The job search should be tied to a simple vocational profile that may

specify the Veteran’s preferred industry sectors, the type of job skills

s/he has and/or the number of hours per week desired. 

Strike while the iron is hot! Use the Veteran’s enthusiasm to maintain

momentum. Don’t wait. 

Follow-along supports. Veterans with mental illness or substance

abuse may need support of varying intensities for a very long time in

order to succeed. In SE “cases” can remain open indefinitely. 

Continue to coordinate with the PCP/MH teams, and continue to

monitor your client’s progress. You are in this together and for the

long haul. Continue to get updates on employers and new employer

contact information, encourage updates to resumes, etc.

Veteran preferences. Key tenets of SE are recovery, choice and

self-determination. Client preferences are always taken into

consideration and given primary value when making decisions

about what jobs are sought, how many hours are worked, how SE

services are provided and whether or not to disclose one’s disability

on the job. 

Facilitate the Veteran’s goals. Opening the door to stable housing

may, in turn, open the doors to other life changes, but the Veteran’s

goals are our first priority.
140 H U D - V A S H R E S O U R C E G U I D E

Putting these seven supported employment

principles into practice will require several skills. 

Some of these will be novel to traditional Case

Managers and social workers and may require new

or additional training; others will be familiar, as they

are central to Case Manager practice. In general, you

will be using several types of skills:

• Interpersonal, as you interview, assess, and

develop a relationship with your client;

• Occupational, as you either link your clients with

employment programs or help them search for,

identify, and apply for jobs; and

• Managerial, as you troubleshoot, act as a liaison,

and remain involved to help your client sustain

employment. 

Interpersonal skills: Remember that, while

interviews with clients should be focused and goaloriented, the first priority is to develop a trusting

relationship. When Case Managers use openended questions, active listening, and paraphrasing

techniques, they create an environment that is

conducive to building rapport and communicating

openly. Always convey respect, hope, and a positive

attitude, while being careful to not give advice,

convey judgment or paternalism, or argue with

the client. Your approach should be individualized

and strengths-based. It may be helpful to consider

incorporating Motivational Interviewing techniques,

as they have been shown to be highly successful in

creating behavioral changes in other domains. There

is some initial evidence that using these techniques

can help to move Veterans past resistance to work

and to a willingness to try working. Case Managers

are encouraged to seek more information on MI. 

(http://www.motivationalinterview.org)

Occupational skills: Traditional supported

employment specialists spend a great deal of time

in the community–developing job leads, working

closely with employers, visiting job sites, and being

very involved with their clients on the job. While

this level of intensity is not feasible for HUD-VASH

Case Managers, by incorporating community

employment resources, demonstrating general job

search techniques, and linking the Veteran to other

services, the Case Manager and the Veteran can work

together to create their own supported employment

team. As you go, focus on building skills that enable

the Veteran to become increasingly involved in his or

her own job search:

• Help Veterans develop employment goals

that are in line with their life situations. Case

Managers can help Veterans identify skills,

interests, or particular aptitudes for certain types

of work; determine the employment setting that

is most conducive to recovery and/or current

abilities; and set reasonable goals for work

schedules. Efforts to match the Veteran’s current

skills with the most suitable employment

options result in better job satisfaction and

tenure; for example, an outdoor job may be

better suited to a Veteran who is unprepared to

work in formal business setting. 

• Maintain momentum. SAMHSA indicates

that job finding is“where the rubber hits

road”(Module 3, p4)–to maintain a Veteran’s

motivation to work, the job search should begin

as soon as possible. 

• Use community resources. Case Managers can

use community resources to help Veterans

identify a job lead, such as the local state

department of labor career centers, the state

agency for vocational rehabilitation, and

community groups such as the local chamber

of commerce. These groups can provide free

assistance with developing a resume and

learning how to interview. Job leads can also

be found among personal and family contacts,

previous employers, and other standard job

search mechanisms such as the Internet and

local advertisements. 

• Work with the Veteran to determine how much

help the Veteran needs. Discuss whether or not

you will be working directly with the employer

once a job lead has been located (often

appreciated by the employer), or behind the

scenes, providing guidance and support as the

Veteran moves forward with the job application

and interview phase. Reassess this often, as it

may change as the Veteran continues to develop

skills and become increasingly involved in the

process. 
H U D - V A S H R E S O U R C E G U I D E 141 

Management skills that incorporate 

individualized job support: There is a tremendous

accomplishment in getting a job; however the

next stage of supported employment is of equal or

greater importance–keeping the job. Employment

specialists need to be able to provide a wide

variety of follow-along job supports that are highly

individualized, flexible and creative. Some job

support examples include developing a successful

transportation strategy; assisting with negotiating

for reasonable accommodations with the employer;

figuring out how to handle disclosure; managing

symptoms on the job; assistance with organizing

workload and keeping track of assignments; handson job coaching at the job; handling disagreements

or problematic interactions with co-workers or

supervisors; providing morning phone calls to

help encourage the Veteran to get ready for work;

communicating with the clinical team about needed

medication adjustments; handling paychecks and

budgets; and problem solving with employers. 

When Case Managers do not have a full Supported

Employment team to assist, there are resources that

may help them tackle these problems.

HELPFUL JOB SUPPORT RESOURCES

	Job accommodation network: http://askjan.org

	Boston University Center for Psychiatric

Rehabilitation: http://www.bu.edu/cpr

	Supported Employment at the Dartmouth

Psychiatric Rehabilitation Center: 

http://www.dartmouth.edu/~ips/

	Benefits counseling:

http://www.ssa.gov/work/WIPA.html

Helping Veterans with Co-Occurring 

Disorders

The principles of supported employment apply

equally to Veterans with co-occurring substance

abuse/mental health problems. However, some

special considerations may be needed for these

Veterans. First, the Veteran’s job profile should

include information about substance use–for

example, what substances are used and how often,

status of recovery and recovery stability, presence

or absence of supports in their recovery from

addictions, relapse triggers, etc. It will be important

to choose jobs that support recovery (some jobs, for

example, in drug stores or restaurants, may provide

greater temptation to relapse). Communication

with a treatment team can be essential to arranging

for sufficient supports and interventions to prevent

relapses. Ongoing supports may require special

attention to prevent and attend to relapse issues. 

Like treating anyone with a mental illness, take

setbacks in stride while continuing to take note of

any accomplishments or gains. Share your belief and

hope that the client can get more out of life. 

Supported Education

Many Veterans, especially young adults from the OIF/

OEF conflicts, will have an interest in using their GI

Bill benefits to further their education. The recent

“Post-9/11 GI Bill”provides increased educational

tuition benefits, housing stipends, and payments for

books and computers for Veterans who meet certain

eligibility criteria (www. gibill.va.gov). Additionally,

educational benefit programs exist for Veterans from

prior wars and for those who wish to transfer their

benefits to dependents or other family members. 

There may also be scholarships and other benefit

programs available from local or state institutions,

Veterans Organizations such as the American Legion,

and non-profit organizations. For example, the

Wounded Warrior Project offers campus support and

employment services, and other reputable Veterancentric 501c3 organizations may provide financial or

other supports. 

Yet while there may be seem to be many

possibilities, many Veterans, especially those with

substance abuse and/or mental illness and/or who

are recovering from homelessness, the process may

seem overwhelming, especially when there are other

formidable barriers to achieving these goals.
142 H U D - V A S H R E S O U R C E G U I D E

WHAT OBSTACLES OR DIFFICULTIES MIGHT CASE 

MANAGERS EXPECT TO ENCOUNTER AS THEY HELP 

CLIENTS PURSUE EDUCATIONAL GOALS?

	Difficult adjustments back to civilian life, in general,

and to college life, in particular

	Lack of knowledge about benefits and how to use

them, including part-time or full-time student status,

out-of-pocket expenses, benefit delays, etc.

	Difficulties accessing or completing eligibility

paperwork

	Differences in VA Education Benefits and Post-9/11 GI

Bill

	Confusion regarding benefit itself and what it covers

	Differences in Post-9/11 GI Bill and GI Bill and

education benefits for Veterans from prior conflicts

	Feelings of isolation or stigmatization on campus

due to age differences, military experiences, trouble

reintegrating into“normal” campus life, disabilities

	Symptom management difficulties and their

effects on course demands (i.e., hearing loss due to

explosions or bombs, PTSD or other mental health

symptoms; difficulty concentrating due to TBI)

	Lack of knowledge or uncertainty about considering

and selecting a college or program

In order to help Veterans navigate the multi-faceted

pathways to benefit receipt, matriculation, and

academic success, Case Managers can incorporate

the principles of supported education. As a

testament to its utility and potential, SAMHSA

considers supported education an“emerging”

evidenced-based practice for people with serious

mental illness. 

The seven principles of supported employment

described can be applied similarly by HUD-VASH

Case Managers when Veterans indicate having

an interest or goal to further their education. For

example, integration of education support services

with clinical treatment will be important; Veteran

preferences in education should always be solicited

and followed; any Veteran’s wish for education

should be respected without requiring extensive

educational assessments or testing. However, there

are some adaptations for education settings.

In addition to the adaptations represented in the

following table, there are several areas of emphasis:

• Interface with the campus system and 

acquire support on campus. Similar to

working with an employer, providing supported

education entails making contact with the

school that the Veteran has chosen. Most

supported education specialists contact

and get information or assistance from staff

members of administrative departments such as

admissions, financial aid, or the registrar. While

Case Managers may also do, or facilitate, this

kind of pro-active contact with campus services,

it is also valuable to attempt to set up an

advocate or support person on campus. Many

schools have Veterans Affairs specialists who

can help navigate these procedures or answer

questions; many schools have orientation

sessions, and many also have Student Veterans

Organizations. Additionally, there may be

programs specifically aimed at non-traditional

students, who also may be older, with families,

etc., that may provide a welcome environment

of mutual support. Medical support or special

considerations should go through the school’s

student disability services office, which will be

able to provide information and procedural

explanations when an accommodation is

needed. Educational accommodations can

include a note-taker in class, being allowed

to tape record classes, being provided both

written and verbal instructions, extended time

for test taking, or access to quiet spaces or

small groups for test-taking and for classes. It

may become necessary to make contact with

specific instructors or professors to negotiate

accommodations or to problem solve if the

Veteran is having trouble in a particular class. 

• Choosing an educational goal and college 

readiness assessment. Some Veterans may

know exactly what they want to get out of

continuing their education; others have never

been asked or have clearly thought about their

career goals and the educational planning
H U D - V A S H R E S O U R C E G U I D E 143 

ADAPTATIONS OF SUPPORTED EMPLOYMENT PRINCIPLES FOR SUPPORTING EDUCATIONAL GOALS

SUPPORTED EMPLOYMENT PRINCIPLE SUPPORTED EMPLOYMENT ADAPTATION

Zero exclusion. Research has not been able to

reliably distinguish those who will or will not

succeed in employment. Anyone who has a stated

wish to work is deserving of help to achieve this goal

irrespective of their current clinical status or past

work history.

Any Veteran’s wish for education should be respected without

requiring extensive educational assessments or tests

Integration of vocational and treatment services. 

Frequent communication is needed between

employment specialists and the health care

treatment team in order to apply a consistent,

hopeful message about work and to problem solve

clinical issues that may relate to work success, such

as timing of appointments, or control of psychiatric

symptoms or dealing with side effects of medication

when on the job.

Integrate education support services with clinical treatment team,

especially around medications and other symptoms that may affect

work or require accommodations. 

Competitive employment. Jobs should be obtained

in the competitive economy (not sheltered work or

segregated placements for people with disabilities)

and pay at least minimum wage.

Believe in your client’s educational goals. Remember that a large

part of military service is learning on the job, and that your clients’

educational base may be extensive, if informal. Acknowledge the

breadth of their experiences as a way to encourage and motivate them

to achieve formal academic objectives. 

Benefits planning. Veterans and their helpers must

think through and obtain reliable information on

the potential impact of income on any disability

benefits, many people with serious mental illness

will restrict their work for fear of losing health

insurance or having benefits reduced. 

Research has shown that benefits counseling is important, but

more from the aspect of helping Veterans understand their different

educational benefits and by facilitating and encouraging the

application for and acquisition of these benefits. 

Rapid job search. Job search based on Veteran

preferences should begin shortly after or within

a few weeks of determining the Veteran has a

goal to work. Veterans can seek jobs without preemployment training or formal assessment, or job

readiness skill development. The job search should

be tied to a simple vocational profile that may

specify the Veteran’s preferred industry sectors, the

type of job skills s/he has and/or the number of

hours per week desired. 

Adapt this to follow the semester schedule or academic calendar

of higher education; plan ahead, as initial planning of education

goals, and the associated career objectives, can require more intense

consideration than an entry-level job. Many colleges will have preenrollment entry assessments that can let the Veteran know whether/

which college readiness classes may be needed. A significant part of

the educational goal setting will be on determining the number of

classes in which the Veteran should enroll, or even whether to enroll as

a part-time or full time student. Many Veterans going back to school

will do best by trying a small credit load at first. 

Follow-along supports. Veterans with mental illness

or substance abuse may need support of varying

intensities for a very long time in order to succeed. 

In SE “cases” can remain open indefinitely. 

Like supported employment, on-going support will be needed to

help the Veteran stay and succeed in school. Regular and periodic

“check-ins” are needed to find out how the Veteran is doing and to be

pro-active about identifying emerging problems. The need for support

and advocacy will vary in intensity and may be diminished over time. 

Prior programs have shown that supported education services tend to

be used most intensively in the first year and finish by the end of the

second year of enrollment.
144 H U D - V A S H R E S O U R C E G U I D E

related to achieving those goals. The Boston

University model of“choosing” an education

goal, or goal-setting, refers to an“exploration of 

past experiences in school and work, identification 

of vocational interests, examination of skill 

and support needs in making the change, 

brainstorming options, research into potential 

occupations, and environment and decision 

making” (Yim, Nicolellis and Fahey, 2002 p.76). 

Many colleges will have pre-enrollment entry

assessments that can let the Veteran know

whether and which college readiness classes

may be needed. A significant part of the

educational goal-setting will be determining the

number of classes in which the Veteran should

enroll, or even whether to enroll as a part-time

or full time student. Many Veterans going back

to school will do best by trying a small credit

load at first. 

• Accessing GI Bill benefits. Although the GI

Bill provides many benefits, Veterans may need

assistance in deciding whether to use the GI Bill

or other VA supports. They may also need help

with successfully applying for and receiving

benefits. Often information on the GI Bill can be

confusing and hard to access.

• Ongoing education monitoring and support. 

Like supported employment, on-going support

will be needed to help the Veteran stay and

succeed in school. Regular and periodic “checkins” are needed to find out how the Veteran is

doing and to be pro-active about identifying

emerging problems. The need for support

and advocacy will vary in intensity and may

be diminished over time. Prior programs have

shown that supported education services tend

to be used most intensively in the first year

and finish by the end of the second year of

enrollment.

References

Swanson, S., Becker, D., Drake, R., & Merrens, M.

(2008). Supported employment: A practical guide for 

practitioners and supervisors: Dartmouth Psychiatric

Research Center.

Yim, Nicolellis and Fahey (2002),“Massachusetts

Mobile Support Programs”. In Mowbray, C., Brown,

K., Furlong-Norman, K., & Soydan, A. (Eds.) Supported 

Education and Psychiatric Rehabilitation: Models 

and Methods MD: Int’l Assoc. of Psychosocial

Rehabilitation Services, p.76.

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about

supported employment and education.

1) The HUD-VASH commitment to housing stability

includes facilitating the goals of supported

employment and education.

2) If a Veteran is feeling reluctant to try to work

again if he or she has been unsuccessful in the

past, transitional work programs may help build

confidence.

3) When a Veteran has difficulty interacting with

co-workers or supervisors, it may be useful to

get the Veteran’s permission to interact with the

supervisor.

4) The Job Accommodations Network provides job

placement services.

5) Transitional Work is a pre-employment program

that places Veterans with employers on a

temporary and permanent basis to complete

work on a piece rate basis.

6) When considering employment options, Veterans

and their Case Managers must think through

and obtain reliable information on the potential

impact of income on any disability benefits.

7) Case Managers should think through substance

and abuse issues when helping a Veteran to find

employment. For example, Veterans in recovery

might find that some jobs in drug stores or

restaurants may provide greater temptation to

relapse.

8) Many schools have Veterans Affairs specialist

who can help navigate procedures and answer

questions.

9) A large part of military services is learning on the

job. HUD-VASH Veterans’ educational base may be

extensive, if informal.
H U D - V A S H R E S O U R C E G U I D E 145 

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) What are some resources outside of the VA

that can prepare Veterans for job search and

competition?

2) The VA offers at least four employment support

programs that Case Managers can link Veterans

to: VetSuccess, Compensated Work Therapy

Program, Transitional Work, and Supported

Employment Program. Which might be a good fit

for the Veterans on your caseload?

3) VetSuccess, a vocational rehab program, works

with Veterans on what five tracks?

4) A treatment team unified behind a Veteran is a

huge asset. How can your HUD-VASH program

integrate supported employment and education

with a Veteran’s other providers?

5) Where can HUD-VASH teams go for a list of

helpful job support resources?

6) What obstacles might Case Managers expect to

encounter as they help clients pursue educational

goals?
146 H U D - V A S H R E S O U R C E G U I D E

What’s in This Chapter?

As HUD-VASH Case Managers help families transition

from homelessness, it is important to be aware of the

threat of violence, particularly partner violence.

In this chapter you will learn

• How to understand and assess the risk for

violence and partner violence,

• Characteristics of partner violence,

• How to address violence when children are

housed with the Veteran,

• The importance of a safety plan.

After reading this chapter, you will be able to provide

support to Veterans on your caseload who are either

perpetrators of violence, victims of violence, or both.

Overview

Case Managers are well-placed to be the “first

responders”to address family issues, broadly, and

partner violence, specifically. Case Managers are

skilled at providing on-the-ground services and are

well-acquainted with the multiple stressors of their

clients’ lives.

Family issues are critical when working with

Veterans, especially those who are recovering from

homelessness. Homeless Veterans consistently

mention family reconciliation as one of their main

concerns; Case Managers may find that up to onehalf of their clients have been involved in partner

violence (Institute for Women’s Policy Research,

1997). 

PART 2 C H A P T E R 7

Violence and Partner Violence Among Veterans

Enrolled in HUD-VASH

Individuals who are at risk for homelessness, or who

are homeless, may already be struggling with risk

factors for violence, including a history of previous

abuse, victimization, or criminal history; current

substance abuse; anger management problems,

and/or social isolation. Also, violence escalation

is more likely when clients are experiencing other

stressors, such as homelessness, worry over financial

resources, lack of educational or vocational skills,

and psychiatric or substance use problems–all of

which may be especially relevant to HUD-VASH

clients.

As HUD-VASH Case Managers help families transition

from homelessness, or individuals start new chapters

in their lives, it is important to be aware of the threat

of violence, particularly partner violence. Partner

violence occurs between two people who are or

were romantically involved, and can include physical

violence (such as punching and beating), sexual

violence (such as rape, sodomy), and psychological

violence (such as threats, stalking, and intimidation)

(CDC, 2009a). Partner violence is typically mutual,

with men and women being both perpetrators and

victims, although males are more likely than females

to inflict injury on their partners (as reviewed by

Dutton & Nicholls, 2005). 

Victimization by partner violence is associated

with a host of negative consequences, including

physical injury, psychiatric problems, and chronic

health concerns. This chapter provides a brief

overview of partner violence and its risk factors. 

Recommendations for assessing partner violence

and treatment options are also reviewed.

Case Managers can provide support to clients who

are either perpetrators or victims of violence (or

both) in a number of ways. Case Managers can make

client referrals to a psychologist and/or a family

violence advocate. They can also make housing
H U D - V A S H R E S O U R C E G U I D E 147 

recommendations and facilitate relations between

the client and community supports (e.g. setting up a

joint meeting between the Case Manager, the client,

and the family advocate). 

Risk Assessment with Your Clients

A number of risk factors for partner violence

perpetration and victimization have been identified

(CDC, 2009b); these can be assessed as part of a

typical clinical intake interview. Risk factors include

historical factors such as the client’s own previous

abuse, victimization, and criminal history. Current

factors that commonly co-occur with partner

violence include substance use, trouble controlling

anger, and social isolation. 

It should also be noted that clients are sometimes

more likely to endorse ‘mild’forms of psychological

aggression, such as shouting, swearing, and

insulting their partner, before endorsement of more

severe forms of aggression, such as physical or

sexual violence. Although most people engage in

psychological aggression at least once in the course

of a lifetime, these behaviors can escalate over

time and have been shown to predict or predate

physical aggression (Murphy & O’Leary, 1989). This

aggression escalation is more likely when clients are

experiencing other stressors, such as homelessness,

low financial and educational resources, and

psychiatric or substance use problems. 

Endorsement of any of the risk factors reviewed

below could indicate increased risk for partner

violence perpetration or victimization. Although

violence assessment is a critical component of each

interview, it is especially crucial when a client has

endorsed one or more of the risk factors. 

CLINICAL INTAKE INTERVIEW RISK FACTORS ASSESSMENT

CURRENT RISK FACTORS HISTORICAL RISK FACTORS

Low financial resources Victim of physical or sexual abuse

Young age Witnessed partner violence as a child

Heavy substance use Substance use in adolescence

Trouble controlling anger Criminal behavior in adolescence

Belief in strict gender roles (on individual or cultural

level)

History of aggression (e.g. reports getting into

physical fights with peers or partners)

High relationship conflict (multiple separations and

reunifications, report many conflicts and fights)

NOTES:

One partner is economically dependent on the

other

Social isolation

Easy access to alcohol, drugs, and/or firearms
148 H U D - V A S H R E S O U R C E G U I D E

When Dependent Children are Housed with the 

Veteran...

In addition to the negative consequences of partner

violence for the victim, the impact of partner

violence on children cannot be overstated. Violent

homes are more likely to include children than

non-violent homes (Rennison & Welchans, 2002),

and the majority of violent incidents in family

homes are witnessed by children (Hutchinson &

Hirschel, 2001). Witnessing partner violence is

associated with both internalizing and externalizing

problems in childhood, as well as academic and

health problems for the child (Graham-Bermann, &

Seng, 2005; Kernic et al., 2002). Further, children in

homes with partner violence are more likely to be

abused (Edelson, 1999). A child abuse assessment

should be completed when Case Managers suspect

that partner violence is occurring. After the family

is housed, Case Managers will support the family

though this understandably stressful transition.

During this time period, Case Managers can inquire

about child adjustment, typical parenting discipline

strategies, and how the couple is getting along

in an effort to learn more about how the family

is adjusting to their new home and how they are

dealing with conflicts as they arise.

Assessments

It is important to note that assessment success

is not the disclosure of partner violence. Rather,

success is the development of a relationship that

is compassionate and trusting. Partner violence

perpetrators and victims may be understandably

reluctant to discuss their relationship difficulties

with a relative stranger. Indeed, it is difficult for any

of us to admit that we are having trouble and need

help. With compassionate and neutral questions

that demonstrate caring and interest in the client,

the Case Manager can facilitate a relationship that

increases the likelihood of disclosure over time.

• Know the laws: Before assessing family

violence, a Case Manager should be up-to-date

on state reporting laws and should privately

review rules of confidentiality with the client,

explaining what must be reported, when, etc.,

especially if there are children involved.

• Demonstrate willingness to address the 

issue: Case Managers can demonstrate that

they are aware of family violence and that they

are supportive of victimization and perpetration

disclosure, including displaying posters that

address violence and providing freely-available

literature on violence that demonstrates

receptiveness (Bacchus et al, 2003). 

• Provide privacy: Disclosure is also more likely

during individual conversations with the client

in a private room (Thackeray et al, 2007).

• Be attentive, compassionate, and concerned: 

Clients are more likely to feel comfortable

disclosing when providers are attentive,

compassionate, and concerned (Bacchus et

al, 2003). Of course, all Case Managers aim

to demonstrate these qualities, but it can be

difficult given large caseloads and limited time

for the violence assessment.

A partner violence assessment can be brief, with

time allowed for further discussion, and should

include a few key components. It is recommended

that Case Managers develop a list of local referrals

for domestic abuse shelters, anger management

training, and professionals specializing in violence

victimization and perpetration before beginning a

partner violence assessment.

Although there is conflicting evidence on whether

women are at increased risk for partner violence

during pregnancy, victimization during pregnancy

is associated with a host of serious consequences

for both the woman and the fetus (Jasinski, 2004). 

The partner violence assessment for victimization

recommended by the American Congress of

Obstetricians and Gynecologists includes many of

the components described above. They suggest the

following script: “Because violence is so common in 

many women’s lives and because there is help available 

for women being abused, I now ask every patient about 

domestic violence: 1) Within the past year, or since 

you have been pregnant, have you been hit, slapped, 

kicked or otherwise physically hurt by someone? 2) Are 

you in a relationship with a person who threatens or 

physically hurts you? 3) Has anyone forced you to have 

sexual activities that made you feel uncomfortable?”
H U D - V A S H R E S O U R C E G U I D E 149 

VIOLENCE ASSESSMENT STRATEGIES

1. Begin with normalizing statements that frame why

you are asking about violence. 

2. Ask open-ended questions about situations that may

result in partner violence. 

3. Ask about specific behaviors. The CDC offers a

full compendium of partner violence assessment

measures, titled Measuring Intimate Partner Violence 

Victimization and Perpetration: A Compendium of 

Assessment Tools, at no cost on their website (http://

www.cdc.gov/ncipc/dvp/Compendium/Measuring_

IPV_Victimization_and_Perpetration.htm). This

compendium includes various measures that list

specific behaviors and can be used to assess violence. 

4. If partner violence victimization is disclosed, the

Case Manager should make appropriate referrals

to local shelters, psychologists, and primary care

physicians. Law enforcement involvement should

also be discussed with the client. Calling the National

Domestic Violence Hotline at 800-799-SAFE with the

client can be an important first step to identifying

local resources for the client.

5. If partner violence perpetration is disclosed, referrals

to psychologists, psychiatrists, and couples therapists

specializing in partner violence are recommended.

Local domestic violence shelters may lead groups for

abusers as well. 

6. Assess for child abuse if appropriate.

When partner violence victimization or fear of

the partner is disclosed, a safety plan should be

developed with the client. Safety plans are best

discussed and prepared between the client and a

trained family violence advocate. Safety plans are

discussed here in brief to provide an overview of the

important issues that should be discussed. When

clients are entering a new housing situation, a safety

plan can help them feel safe and more equipped to

address the risk for violent conflict in a new location.

WHY A SAFETY PLAN?

1. Safety plans can help clients develop safety strategies

that can be used during a potentially violent incident.

2. Safety plans can help develop a course of action if a

client decides to leave the relationship or the house.

3. More elaborate safety plans may include an

identification of ways to stay safe both within the

client’s home and in public.

4. Safety plans may address the increased risk of

violence while using drugs or alcohol and prompt

the client to anticipate these risks before engaging in

substance use.

5. A less immediate, but equally important way of

improving clients’safety can include helping clients

improve their ability to make their own income,

through job training or education, which in turn

may reduce their risk of violence victimization in the

future (Farmer & Tiefenthaler, 1997).

Interventions

Two common and effective interventions that Case

Managers may consider with clients who have both

housing and violence-related problems are reviewed

below. Behavioral Couples Therapy is a treatment

originally designed to address alcoholism, but has

been shown to improve relationship functioning

(O’Farrell & Fals-Stewart, 2006). Anger Management

is an intervention designed to prevent and decrease

anger and interpersonal violence (Reilly & Shopshire,

2002; Reilly et al, 2002).

Behavioral Couples Therapy (BCT)

BCT was created based on two fundamental beliefs:

that a non-drinking partner can reward abstinence,

and that risk of relapse is lower when relationship

quality is increased. BCT is typically 12 sessions long

and addresses both the alcohol and relationship

issues. First, drinking-focused sessions include

• a daily “trust discussion”in which the patient

states that he or she will stay abstinent that

day and the partner expresses support for the

patient’s effort,
150 H U D - V A S H R E S O U R C E G U I D E

• a Recovery Contract with a calendar to record

12-step meetings attended,

• helping the non-drinking partner to identify

behaviors that may trigger or enable the

client’s excessive drinking and decrease those

behaviors, and

• helping the couple decrease the patient’s

exposure to alcohol.

Second, relationship-focused sessions address issues

related to increasing positive feelings between

the couple and engaging in activities together.

Communication training is also an important activity

aimed at supporting the relationship.

Anger Management for Substance Abuse and 

Mental Health Clients

Anger Management for Substance Abuse and Mental

Health Clients is a manualized treatment developed

by Dr. Patrick Reilly and colleagues. The manual

and the accompanying participant workbook are

published by SAMHSA and freely available on the

web at http://kap.samhsa.gov/products/manuals/

pdfs/anger2.pdf. The purpose of the intervention is

to help a patient learn to manage anger effectively,

to stop violence or the threat of violence, and to

teach a patient to manage anger without resorting

to violence and adopt alternatives to violence. The

“active ingredients”of this intervention are learning

to recognize internal and external anger cues, use of

time-outs, relaxation training (counterconditioning),

cognitive restructuring, communication skills,

and development and use of a personal violenceprevention plan.

In studies at the San Francisco Veterans Affairs

Medical Center, using a 12-week form of the

intervention with substance use disorder patients,

anger, violence, and substance use were significantly

reduced between the beginning and the end

of treatment, and these improvements were

maintained 3 months later. Decreased levels of anger

and violence were also associated with abstinence.

The intervention was effective with patients who

had been abusing a variety of substances; with

patients having a co-occurring psychiatric disorder,

and those who were taking psychiatric medications;

with both men and women; and with patients from

different age and racial/ethnic groups. Patients were

satisfied with the intervention and attendance at

sessions was good.

Working with Family Members

Family involvement in Veteran mental health

services is a national priority (VHA Directive

2006-041). In 2003, the President’s New Freedom

Commission called for family-centered service

and treatments. This spotlight on the importance

of family involvement was championed in the VA

Secretary’s New Mental Health Strategic Plan (2004).

Specifically, this plan called for“Veteran and family

care that is recovery-oriented, high quality, and

maximizes the delivery of evidence based practices.” 

The Office of Mental Health Services’VHA Handbook

1160.01, Uniform Mental Health Services in VA Medical 

Centers and Clinics, reiterated this commitment to

incorporating families, stating that the Veteran’s

principal mental health provider should incorporate

family into coordination and development of the

treatment plan, and, when appropriate and with the

Veteran’s consent, should maintain communication

with the family regarding the treatment plan.

Understandably, many providers do not have

previous experience working with families. Given

the significant clinical skill that Case Managers bring

to the job, incorporation of family members can be

eased with the following suggestions.

• Family relationships can be conflictual and

change with time. Veterans may not be

interested in contacting family when they enter

services, but may feel differently as treatment

and housing progress. Given significant

evidence that family involvement in treatment is

associated with improved treatment outcomes

in a variety of psychological disorders, Case

Managers are encouraged to discuss potential

family involvement throughout treatment.

• When Veterans begin treatment, they may

be unsure about how to reconcile with their

familyies. Providers can ease this process

by slowly incorporating the family into the

treatment.
H U D - V A S H R E S O U R C E G U I D E 151 

• Releases of information do not need to mean

that the Veteran allows family members access

to all information. Releases of information can

be one-way (the provider will listen to the family

members but not disclose any information) or

limited (e.g., providers will talk about housing

and family meetings with family members but

will not discuss a Veteran’s substance use).

• Veterans may have children who are still minors,

and thus may face child care and child support

issues. Further, Veterans may have conflicted

feelings about reuniting with their children–on

one hand, hoping to be a part of the child’s life,

and, on the other, concern about whether they

will be able to provide for the child in the way

they would like to. Providers are encouraged

to discuss and validate these concerns with the

Veteran. Noting that reconciliation can be a

slow, rewarding, and difficult process will help

prepare a Veteran for the inevitable bumps in

the road.

For more information on working with newly

returning Veterans and their families, please see

Makin-Byrd, Gifford, McCutcheon, & Glynn (in

press).

In summary, partner violence is a crime of concern

among homeless Veterans and others served at

HUD-VASH. Not only is partner violence associated

with negative consequences for the victim, but

partner violence is harmful to children who observe

it in the home as well. Various proximal and

historical risk factors are associated with partner

violence and can serve as clues to the risk of violence

perpetration and victimization among clients. Case

Managers are in a unique and important position to

both assess violence with their clients and impact

their clients’safety through multiple mechanisms,

including referrals for education, housing,

psychological help, and family violence advocacy.

References

Bacchus, L., Mezey, G., & Bewley, S. (2003).

Experiences of seeking help from health

professionals in a sample of women who

experienced domestic violence. Health & Social Care 

in the Community, 11(1), 10-18.

Center for Disease Control and Prevention (CDC,

2009a). Intimate Partner Violence Factsheet [online].

[cited 2010 May 2].Available from URL:

http://www.cdc.gov/violenceprevention/pdf/IPV_factsheet-a.pdf

Center for Disease Control and Prevention

(CDC, 2009b). Intimate Partner Violence: Risk

and Protective Factors [online]. [cited 2010 May

2]. Available from URL: http://www.cdc.gov/

violenceprevention/intimatepartnerviolence/

Dutton, D.G. & Nicholls, T.L. (2005). The gender

paradigm in domestic violence research and theory:

Part 1-The conflict of theory and data. Aggression and 

Violent Behavior, 10(6), 680-714.

Graham-Bermann, S.A. & Seng, J. (2005). Violence

exposure and traumatic stress symptoms as

additional predictors of health problems in high-risk

children. The Journal of Pediatrics, 146 (3), 349-354.

Edleson, J. L. (1999). Children’s witnessing of adult

domestic violence. Journal of Interpersonal Violence, 

14(8), 839-870.

Farmer, A. & Tiefenthaler, J. (1997). An economic

analysis of domestic violence. Review of Social 

Economy, 55(3), 337-358.

Hutchison, I.W., & Hirschel, J. D. (2001). The effects of

children’s presence on woman abuse. Violence and 

Victims, 16, 3-17.

Jasinski, J. (2004) Pregnancy and domestic violence:

a review of the literature. Trauma, Violence, & Abuse, 

5(1), 47-64.

Institute for Women’s Policy Research.“Domestic

Violence and Welfare Receipt,”1997. IWPR Welfare

Reform Network News, Issue No. 4, April. Washington

DC.: Institute for Women’s Policy Research.

Kernic, M.A., Holt, V.L., Wolf, M.E., McKnight, B.,

Huebner, C.E. & Rivara, F.P. (2002). Academic and

school health issues among children exposed

to maternal intimate partner abuse. Archives of 

Pediatrics and Adolescent Medicine, 156(6), 549-555.

Makin-Byrd, K., Gifford, E., McCutcheon, S., & Glynn,

S. (in press). Family and couples treatment for newly

returning Veterans. Professional Psychology: Research 

and Practice.
152 H U D - V A S H R E S O U R C E G U I D E

Murphy, C. & O’Leary, D. (1989). Psychological

violence predicts physical violence in early marriage.

Journal of Consulting & Clinical Psychology, 57(5), 579-

582.

O’Farrell, T. J. & Fals-Stewart, W. (2006). Behavioral 

Couples Therapy for Alcoholism and Drug Abuse. New

York, NY: Guilford Press.

Reilly, P.M. & Shopshire, M.S. (2002). Anger

management for substance abuse and mental health

clients: A cognitive-behavioral therapy manual.

DHHS Pub. No. (SMA) 02-3756. Rockville, MD: Center

for Substance Abuse Treatment, Substance Abuse

and Mental Health Services Administration.

Reilly, P.M., Shopshire, M.S., Durazzo, T.C., & Campbell,

T.A. (2002). Anger management for substance abuse

and mental health clients: Participant workbook.

DHHS Pub. No. (SMA) 02-3662. Rockville, MD: Center

for Substance Abuse Treatment, Substance Abuse

and Mental Health Services Administration.

Rennison, C. M., & Welchans, S. (2000). Intimate

partner violence (Special report).Washington, DC:

U.S. Bureau of Justice Statistics, National Institute of

Justice (NCJ 178247).

Thackeray, J., Stelzner, S., Downs, S.M., & Miller, C.

(2007). Screening for intimate partner violence: The

impact of screener and screening environment on

victim comfort. Journal of Interpersonal Violence, 

22(6), 659-670.

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about violence

and partner violence among Veterans. 

1) Case Managers may find that up to one-half

of their clients have been involved in partner

violence.

2) Risk factors for partner violence perpetration and

victimization should be determined in a separate

assessment process following program intake.

3) Individuals who endorse “mild”forms of

psychological aggression such as shouting,

swearing, and insulting their partner are not likely

to endorse more severe forms of aggression such

as physical and sexual violence.

4) Assessment success is not the disclosure of

partner violence; it is the development of a

relationship that is compassionate and trusting.

5) Case Managers should not discuss family violence

with Veterans unless they suspect that it is

occurring.

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) What are some common risk factors for violence?

2) What are some things a Case Manager can inquire

about to determine how children are doing after

a family is housed?

3) It is recommended that HUD-VASH teams

develop a list of local referrals for domestic

violence shelters, anger management training,

and professionals specializing in violence. When

should this be done and what resources exist in

your community?

4) What are some of the reasons to develop a safety

plan?

5) Two common and effective interventions that

Case Managers may consider with clients who

have both housing and violence-related problems

are behavioral Couples Therapy and Anger

Management for Substance Abuse and Mental

Health Clients. What techniques do each of these

interventions promote that your team can use?

6) Many providers do not have previous experience

working with families. What are some ways that

family members can be incorporated into case

management?
H U D - V A S H R E S O U R C E G U I D E 153 

What’s in This Chapter?

Peer Support Specialists (PSS) and Peer Support

Technicians (PST), used here interchangeably, are

paraprofessionals who publicly self-identify as

having a mental illness and/or are in recovery from

substance dependency. This chapter is intended

for those who serve on a HUD-VASH team as a Peer

Support Specialist and those who will be working

alongside and supervising PSSs.

In this chapter you will become familiar with

• How to hire, train, and supervise a PSS,

• The differences and similarities between the

work of the PSS and the Case Manager,

• Peer group topics, and

• Examples of peer support in action.

After reading this chapter, you will know the benefits

of peer support and how to incorporate a Peer

Support Specialist into your HUD-VASH team.

Introduction

Of all the resources available to help the HUDVASH Treatment Team further the recovery goals of

Veterans recovering from homelessness, one of the

most important may be the Peer Support Specialist.

The Department of Veterans Affairs (VA) is currently

implementing recommendations from the

President’s New Freedom Commission for the care

of people with serious mental illness (DHHS, 2003).

The Commission’s 2003 report concluded that

recovery-oriented systems that focus on high-quality

services and evidence-based practices improve

both the accessibility and quality of health care. To

operationalize the Commission’s report, VA created

PART 2 C H A P T E R 8

Peer Support in HUD-VASH

an action agenda (DVA, 2003) and a Mental Health

Strategic Plan (VHA, 2004). The Strategic Plan calls

for use of peer support within VA and includes a

specific recommendation to hire Veterans as Peer/

Mental Health para-professionals.

Known within VA as Peer Support Specialists (PSSs)

or Peer Support Technicians (PSTs), these paraprofessionals, in contrast with traditional staff, are

publicly identified as being in active recovery from

mental illness. Like addiction treatment counselors

who themselves have experienced addiction,

PSSs draw upon their lived experiences to share

“been there, done that” empathy, insights, and

skills. They serve as role models, inculcate hope,

engage patients in treatment, and help patients

access supportive programs, supportive social

networks and other peers, and community resources

(Chinman et al., 2006; Simpson & House, 2002;

Solomon, 2004). A review of PSS research (Chinman

et al., 2006; Davidson, Chinman et al., 1999) shows

that PSTs can reduce inpatient utilization, substance

use, social isolation, and symptoms by modeling

community living, enhancing social networks, and

improving Veterans’treatment adherence and

participation. Additional studies have shown that

PSTs can be deployed with no detrimental effects,

yielding clinical outcomes equivalent to non-PST

staff.

In 2007, in a letter to State Medicaid Directors, the

Centers for Medicare & Medicaid Services (CMS)

stated that peer support–specifically, the type

of peer support that is provided by a PSS–is an

“evidence-based mental health model of care”. 12

12 http://www.medicaid.gov/Federal-PolicyGuidance/Federal-Policy-Guidance.html
154 H U D - V A S H R E S O U R C E G U I D E

In 2005, VA began funding PSS positions across its

national health care system. By August 2007, a total

of 91 had been hired. That number increased to 123

by April 2008 and to 237 by April of 2010. While the

PSSs work in many different areas–MHICM, PRRTPs,

general mental health clinics–HUD-VASH leadership

is now recommending that they be deployed within

HUD-VASH teams.

This chapter is intended for those who may be

soon serving on HUD-VASH teams as Peer Support

Specialists (PSS) and those who would be working

alongside and supervising PSSs. This chapter

provides information about what a PSS role could

be in HUD-VASH and how the PSS could work with

the HUD-VASH Case Manager. This chapter also

highlights how the PSS could serve as a role model

and as a source of encouragement and support to

Veterans receiving HUD-VASH services.

Case examples are included to illustrate how PSSs

could facilitate discussions on topics of particular

concern to HUD-VASH Veterans, or how the

PSS continues to meet with Veterans regularly

even once they have fully integrated into the

community in which they live. It also includes special

considerations that are unique to the role of the PSS.

Overview of Potential Peer Support 

Specialist’s Responsibilities

During the often lengthy and difficult process

of rebuilding a life in the community, Veterans

receiving HUD-VASH services can benefit greatly

from the support of someone with similar

experiences–someone who can offer advice and

empathy when the Veteran faces challenges along

the way. In addition to being a Veteran themselves,

each PSS deployed within HUD-VASH will likely

have recovered from challenges (homelessness,

unemployment, substance abuse, and mental

illness) similar to those faced by the Veterans with

whom they are working. Each will also have received

training specific to serving as a PSS. PSSs advocate

for the Veterans on their caseload, share wellness

and relapse prevention strategies, and provide

practical supports to improve socialization and

community life skills. The unique mix of camaraderie

and leadership empowers Veterans to self-determine

their own recovery goals. PSSs would be full staff

members on the HUD-VASH team; as such, their role

would be as central no matter what stage a Veteran

is in within HUD-VASH services. For example, PSSs

can facilitate weekly peer support group sessions

prior to a Veteran receiving a voucher. In that case,

these sessions could present opportunities for

rapport-building, discussions of the upcoming

transition, and assessments of anticipated practical

supports, while introducing and emphasizing selfcare and socialization skills. PSSs who have not

facilitated groups before should look to the HUDVASH Case Manager (CM) or Clinical Supervisor as

models, or they may request training to help them

develop confidence and skills as a group leader.

If service delivery is initiated after the Veteran has

transitioned to the community with their voucher,

the PSS could address the same topics as they

become relevant to the Veteran in one-to-one

conversations. Peers meet with the Veteran, often in

the Veteran’s new place of residence, ensuring that

the Veteran is utilizing the appropriate supports

(including community mental health and substance

abuse treatment programs, 12-step meetings, and

vocational/educational rehabilitation services). If

the Veteran is not using these supports, PSSs can

facilitate the process by accompanying Veterans to

12-step meetings or by assertively bringing them to

their appointments. In their“check in”sessions with

Veterans, PSSs can reinforce the work Veterans have

done with any other treatment providers they may

have.

Implications of the “Critical Time 

Intervention” Model

HUD-VASH teams are increasingly being asked to use

the tested model of“Critical Time Intervention”(CTI)

case management. This approach offers different

types of support to the Veteran in different phases

of the transition to community life. The three distinct

phases of care are (1) Transition to community (the

initial phase of intense support), (2) Try-Out (in

which the Veteran accepts increasing responsibility

for maintaining a healthy approach to life), and

(3) Transfer of care (in which the Veteran relies

increasingly on community supports rather than the
H U D - V A S H R E S O U R C E G U I D E 155 

HUD-VASH team, and the case management part of

HUD-VASH program comes to an end). Consistent

with the CTI approach, the team gradually reduces

its frequency of contact with the Veteran over the

course of the intervention to reinforce the use

of community supports and independent living.

Therefore, peer support must be provided in a way

that fosters independence and focuses on helping

the Veteran learn self-advocacy skills and establish

connections in the community that he/she can

maintain independently (see Table 1 below for

details). In order to accomplish this, the PSSs ought

to work in close collaboration with the HUD-VASH

CM. Both the PSS and CM have the mutual goal of

ensuring that Veterans assigned to their team have

the resources and skills they need to achieve the

goals they have set for themselves as well as for

continued growth in their recovery.

In the Transition to Community Phase, 

the PSS:

In the Try-Out Phase, the PSS: In the Transfer of Care Phase, the PSS:

• Meets with the Veteran periodically to

establish rapport and encourage the

Veteran in the changes he or she is

making

• Provides input on the HUD-VASH

Housing Stabilization plan

• Conducts group or individual peer

support sessions on topics related to

the transition to healthy living in a

community setting

• Works with the HUD-VASH CM to

identify community resources essential

for successful community integration

• If a Veteran is being discharged

with the case management portion

of HUD-VASH, PSSs can assist with

executing a discharge plan and help

the Veteran overcome barriers that

arise in using key community supports,

including accompanying the Veteran

to appointments and meetings when

helpful

• Continues to facilitate linkages that

have already been established, helping

the Veteran think through and resolve

obstacles and challenges

• Identifies any gaps in support system,

barriers in accessing services, or areas

where the Veteran needs more support,

and works with the CM and other

providers to address these gaps

• Celebrates the Veteran’s ability to

maintain goals in healthy living and

puts relapses or slips in perspective

• Reflects (with the Veteran) on work

that has been accomplished thus

far and acknowledges the reduction

or end of participation in case

management portion of the HUDVASH program

• Reminds Veteran of supports that have

been established, says goodbye, and

wishes the Veteran the best of luck in

continued recovery

Working Effectively in a HUD-VASH 

Treatment Team

The number of PSSs who are hired on any one HUDVASH team may ultimately impact how PSSs are

used. Although the numbers of PSSs to be hired is

not known now, one possibility is that each HUDVASH team could hire a small number of PSSs (1-3).

Therefore, one option is to replicate what has been

done with other case management teams in VA

(e.g., MHICM) and have the PSSs be “floaters”who

work with many Veterans as an additional support

to Case Managers. In this scenario, there are some

different ways it could be decided that a particular

PSS works with a particular Veteran. For example, the

PSSs, along with Case Managers, could be the ones

to decide which Veterans would benefit from the

additional support. PSSs are often called upon when

Overview of the Peer Support Specialist’s Responsibilities, by CTI Phase
156 H U D - V A S H R E S O U R C E G U I D E

Case Managers are having a difficult time engaging

a Veteran, specifically because the PSSs and the

Veterans“speak the same language.”Alternatively,

Veterans may seek out a particular PSS as a result of

a chance meeting or upon a referral from another

Veteran in the HUD-VASH program. Such initiation

of contact is acceptable, but the PSS and Case

Manager should still discuss the issue first before

confirming that it is an acceptable assignment for

the PSS. Regardless of how the contact between

Veterans and PSSs is initiated, when a PSS discusses

issues of clinical significance (i.e., issues that relate

to the Veteran’s mental health or substance abuse

recovery) with Veterans who are assigned to a HUDVASH Case Manager, the PSS must encourage each

Veteran to relay any relevant information to the Case

Manager to whom that Veteran is assigned, as this is

often information critical to recovery.

After it is decided that a Veteran will work with a

PSS, for the PSSs to work effectively with HUD-VASH

Case Managers, it is critical that they both share

information with one another about the contact

they have with the Veteran they share. These

communications help team members support each

other’s work and track evolving issues that may

require special intervention. The PSS may tell the CM

that the Veteran has been seeing drug-using friends

at their old haunts, or a CM may tell the PSS that a

Veteran has been shy and nervous about going to

AA meetings and asks the PSS to offer to attend a

meeting with that Veteran. At supervision meetings

with a Clinical Supervisor, or earlier if necessary,

the PSS/CM pair should share any serious problems

on which they would like guidance or assistance,

preferably at an early enough stage to plan an

intervention.

Veterans are informed at the outset of their

participation that information is shared among

HUD-VASH team members to better facilitate their

care. Therefore, depending on the issues to be

addressed and the preferences of each Veteran,

PSSs and CMs may meet with the Veteran together

or separately. When the PSS and CM meet with the

Veteran separately, the authors suggest that the

PSS and CM meet and discuss their observations

and concerns regarding the Veteran. By working

together smoothly, PSSs and CMs can enhance their

effectiveness and ensure each Veteran enrolled in

HUD-VASH is receiving consistent messages and

support. Within individual pairings of PSSs and CMs,

many roles and responsibilities are shared, with each

person offering his or her skills and perspectives

to assist the Veteran in achieving important goals.

Each person, however, also has areas of primary

responsibility (see the Table 2,“Responsibilities/

Roles of the HUD-VASH Peer Support Specialist

and Case Manager”). For instance, the HUD-VASH

CM takes the lead in the developing the Housing

Stabilization plan, but the plan should reflect the

PSS’s input. While CMs ensure that the appropriate

12-step supports are in place, it is the PSS who

actually accompanies Veterans to meetings if

necessary. When one staff person assumes a primary

role in a certain area, the other provides assistance

and can serve as a backup when that staff person is

temporarily unable to fulfill that duty (for example,

due to absence or sickness).
H U D - V A S H R E S O U R C E G U I D E 157 

Primary Responsibility of PSS, with 

Input from the CM

Primary Responsibility of CM, with 

Input from the PSS

Responsibilities Shared by the CM 

and PSS

• Share with Veterans their story of

how they overcame homelessness to

promote hope

• Help Veterans advocate for themselves

with providers and ensure effective

two-way communications

• Recreational planning and modeling

healthy living using free or low-cost

community resources

• Linkage to community mental health

and substance abuse recovery

programs (NA/AA)

• Accompany Veterans to clinical

appointments, job interviews,

recreational activities, and self-help

group meetings

• Increase motivation toward recovery

goals

• Develop Housing Stabilization Plan

• Conduct the Comprehensive Housing

Assessment

• Orientation/introduction to HUDVASH, transition to community, and

discharge plans

• Management of process to secure

voucher

• Management of clinical crises

• Identify, monitor, and provide referrals

for trauma-related symptoms

• Provide vocational/educational

supports as needed: interview skills

training, resume building, linkages to

education and training programs

• Facilitate linkage to other clinical

services

• Communicate with clinical service

providers

• Review and work through benefits and

entitlements issues (Social Security

Income and Social Security Disability)

• Weekly team meetings of HUD-VASH

staff

• Linkage to needed community

services, including vocational/

educational supports and traumarelated treatment resources

• Assistance with finding and

maintaining housing

• Communication with landlords

• Ongoing monitoring of symptoms,

psychoeducation and training in

symptom management, coping skills,

medication compliance, problem

solving, and relapse prevention

• Transportation assistance

• Provide support during job stresses

• Provide support during clinical crises

• Refer out as appropriate during

exacerbation of symptoms

How Peer Support Specialists can help

Role of the Peer Suppot Specialist

Orientation to the HUD-VASH Program

Once the Veteran has been determined eligible

and has expressed interest in the HUD-VASH

program, it would be extremely helpful if a PSS

was involved, along with a CM, in introducing the

Veteran to details of HUD-VASH and conducting

the Comprehensive Housing Assessment. The

assessment is an important first step in HUD-VASH

as it is an opportunity for the HUD-VASH team to

learn about the Veteran’s goals, barriers, strengths,

hopes, and interests as well as the Veteran’s triggers,

coping skills, and available supports; establishing

the foundation for a healthy working relationship

between the Veteran and HUD-VASH staff; building

the Veteran’s understanding of the program and

what to expect; encouraging hope by letting the

Veteran know that he or she will have both support

in meeting obstacles that may arise – as well as

people who will cheer and celebrate as goals are

met. The PSS can have a key role in the assessment

process by being an effective bridge, helping to

explain the details of HUD-VASH to the Veteran and

clarifying for the Case Manager the preferences of

the Veteran.

During these initial meetings, the PSS must explain

the PSS’s role, as many Veterans may not be familiar

with the PSS position. The PSS and the CM together

should explain how the PSS’s role is different than

the CM’s and offer to help clarify any aspects of the

PSS’s role that the Veteran might not understand. In

general, Veterans appear to be relatively comfortable

with the informal nature of the relationship with

Responsibilities/ Roles of the HUD-VASH Peer Support Specialist and Case Manager
158 H U D - V A S H R E S O U R C E G U I D E

the PSS. Sometimes, however, establishing rapport

with a Veteran enrolled in the HUD-VASH program

will take some extra work. Also, in past deployments

of PSSs, some Veterans have expressed hesitancy

in working with the PSSs. While this has been a

minority of situations, Veterans should be allowed to

decline involvement with PSSs if they so choose.

Providing Input into the Housing Stabilization 

Plan

While HUD-VASH staff will likely have administrative

responsibility to create the Housing Stabilization

Plan for each Veteran entering HUD-VASH, it will

be helpful for PSSs to have input into this plan. The

PSS’s input is coordinated through the CM assigned

to the Veteran. This input reflects insights gained

from informal contacts, observing the Veteran’s

behavior in group sessions, and from information

learned from regular team meetings. The PSS can

offer personal insights and observations about

the Veteran and his or her needs. For example, the

PSS might feel that a particular apartment might

or might not be a good fit for a particular Veteran

(e.g., proximity to former drug using friends) and

could share this recommendation and the reasoning

behind it. The Veteran and the HUD-VASH CM should

take these insights into account as they finalize the

plan. When conflicts arise between the PSS and CM

regarding the care of a Veteran enrolled in HUDVASH, the issue should be raised with the Clinical

Supervisor, who works with each party to provide

guidance and resolve the conflict. One important

component of the Housing Stabilization Plan is that

both CMs and Veterans are supposed to commit to

certain tasks in support of each of the goals specified

in the plan. PSSs should also be included and could

commit to various tasks as well.

Conducting Peer Support Groups for the Early 

Stages of HUD-VASH

One role that PSSs can play very well is to lead

groups for Veterans. There are many different

types of groups that PSSs could run, including

unstructured peer support groups, Vet-to-Vet

groups, or NA/AA groups. However, one particular

group format that is a good fit for Veterans

entering into HUD-VASH is the peer support groups

associated with the MISSION-VET program. MISSIONVet is a tested program specifically developed to

target the mental health, substance abuse and

related issues facing homeless Veterans through

assertive outreach, psycho-education and linkages

to community-based resources, and peer support.

The group sessions were designed to be held by

the PSS weekly for approximately 60-90 minutes.

The 11 topics (see Peer-led Sessions table) have

been identified by PSSs from past MISSION projects

as having particular relevance to those Veterans

preparing for independent community living.

These group discussions can serve several purposes.

The first is to provide an opportunity for Veterans to

socialize with other Veterans who are facing many

of the same issues. A key challenge for homeless

Veterans with possible mental illness and drug and

alcohol problems is social isolation. In particular,

Veterans who have drug and alcohol history may

need to start building a completely new social

network of persons who do not use substances.

Second, the weekly peer-led sessions offer Veterans

a forum to air their concerns, fears, questions, and

hopes in a safe environment, knowing that they

will not be judged and knowing that their peers

(both the HUD-VASH PSS and their fellow Veterans)

will support them. These sessions also offer a

chance to begin work on developing some of the

skills and achieving some of the goals specified in

the Housing Stabilization Plan. This group would

probably be most helpful for Veterans who are

early on in the HUD-VASH program, either while

they are going through the voucher process, while

they are looking for housing after the voucher was

issued, or even soon after the Veteran was housed.

Alternatively, these same sessions, using the same

11 topic areas, could be delivered in a one-on-one

meeting between a newly housed Veteran and

a PSS at the Veteran’s residence. These peer-led

sessions would similarly allow the Veteran to air any

concerns with living arrangements or adjustment

to the community, ask additional questions, and

express their future hopes in a comfortable, relaxed

environment free of judgment and full of support.

The PSS could then identify problems and relay

information back to the team.
H U D - V A S H R E S O U R C E G U I D E 159 

1. Willingness

2. Self-acceptance and

respect

3. Gratitude

4. Humility

5. Dealing with frustration

6. Handling painful

situations

7. Significance of honesty

8. Courage

9. Patience

10. Medicine maintenance

11. Making a good thing last

Providing Ongoing Support in the Community

PSSs often offer individual support to the Veteran

in areas that overlap with the support provided

by the HUD-VASH CM. This includes offering

support in getting and maintaining safe housing,

sustaining recovery from substance abuse,

managing mental health symptoms, obtaining

gainful employment, and achieving educational

goals. The type of support that PSSs offer can be

practical and/or emotional; for example, they might

offer to accompany Veterans to initial mental health

appointments, bring them to AA or NA meetings, tell

them what to expect in their pursuit of housing, or

offer advice and support as Veterans try to reconnect

with their families. Below are descriptions of specific

experience-based competencies that PSSs have,

and real case examples of how PSSs applied those

competencies.

• Reducing Fear - Achieving life goals requires

overcoming fear of failure and fear of the

unknown. Having been homeless and through

institutional treatment, Veterans might doubt

their ability to succeed on their own, to remain

sober, and to adjust to work and other aspects

of community life with which they have

become unfamiliar. Veterans might also fear

taking medications or being stigmatized in

the community as a result of their conditions

or treatment. Having been through similar

experiences, PSSs are able to provide emotional

support and practical advice for facing these

challenges. A Veteran might call because he

or she had a “drug dream,”had a fight with a

spouse or partner, or is simply feeling the urge

to use drugs.

Peer Support Session Topics From MISSION-VET

• Accompanying Veterans. Another way in

which PSSs can provide practical support to

Veterans is to accompany them to their first

appointments, as they learn unfamiliar public

transportation systems, or when they need

to buy groceries or shop for clothes. The PSS

continues to accompany Veterans on these

activities until they are comfortable doing such

tasks on their own. For example, a PSS who has

shopped for a child before might accompany a

Veteran who is trying to reunite with his family

to help him buy clothes for his children. This

support can be especially critical in times when

the Veteran stumbles on his or her recovery

path. The PSS can provide moral support if the

Veteran experiences psychiatric symptoms

requiring hospitalization, or by accompanying

him/her to a detoxification facility if he or she

begins using again.

• Promoting a healthy lifestyle. A healthy

lifestyle includes eating well, getting enough

sleep, and exercising regularly. Sleep, exercise,

and nutrition can all play a positive role in

relieving stress and improving mood, while

smoking and caffeine might have negative

impacts. While recognizing that“old habits die

hard,”the PSS can help to promote healthy

lifestyles with new habits of self-care.

Peer Support in Action: Example 1

“Isaac” was so debilitated by his co-occurring mental 

illness, drug addiction, and alcoholism that he could 

not by himself take the necessary steps to secure 

housing, even though he had already secured a 

voucher through HUD-VASH. Now, Isaac faced the 

possibility of having his voucher removed after he 

relapsed, and in a panic he called the PSS for help. By 

facilitating access to resources, the PSS was able to find 

Isaac a secure house located close to the VA hospital, 

where the HUD-VASH team could monitor and support 

him during this critical time. With this new housing 

placement arranged by his PSS, he was able to easily 

acquire his medications, get mental health counseling 

and treatment, and take care of other VA-related 

business. Throughout this process, his PSS provided 

encouragement, support, reassurance, and positive 

feedback to help Isaac overcome his paralyzing fear 

and to take the necessary steps back to a positive 

lifestyle.
160 H U D - V A S H R E S O U R C E G U I D E

• Socializing. For Veterans who are transitioning

back into the community, having drug-free

social events in which to participate and

friends with whom to spend time can have a

positive impact upon recovery. Eventually, HUDVASH case management will be scaled back;

therefore, developing positive and drug-free

social relationships can become an important

source of support after that part of the program

ends. In general, PSSs can share ways that

worked for them as they were developing new

friends in the community. This could involve

taking classes, volunteering, joining clubs, or

participating in religious institutions. What

is important is that the PSSs learn what the

Veteran is interested in and then help him or

her participate, even accompanying the Veteran

the first few times. If applicable, one avenue

for socialization upon which the PSS can rely

is AA and NA social events, because these

Peer Support in Action: Example 2

“Ricardo” had recently secured housing in the 

community through HUD-VASH. However, one month 

after he had gotten his own housing, he relapsed and 

was in danger of becoming homeless again because 

he had stopped paying his portion of the rent. Ricardo 

was spending a great deal of time on the street, 

stopped eating and bathing, and could not hold 

down a job. His PSS arranged a face-to-face meeting 

with him and talked to him about his weight loss, 

disheveled appearance, and inattention to personal 

hygiene. His PSS asked him directly, “What do you need 

to get back on the road to recovery?” This meeting 

with his PSS helped Ricardo realize that before he 

could make more progress, he needed to understand 

the reasons that he fell off his path to recovery in the 

first place. Ricardo acknowledged that he had gotten 

comfortable with his present condition and stopped 

putting in the necessary work to maintain his recovery. 

Once Ricardo determined to pursue a healthy way 

of life, his PSS helped link him to a detoxification 

program. His PSS also helped educate him about the 

importance of hydration, selecting healthy foods, 

avoiding unhealthy foods, monitoring caloric intake, 

and exercising. With ongoing peer support, Ricardo 

began reclaiming his recovery by attending programs, 

taking classes, and seeing his family. 

events tend to be larger and better established,

offering Veterans recovering from substance

abuse in the program certainty that the event

will be well-attended and thus worth their time.

Such 12-step events might include dances or

other enjoyable activities. At times, PSSs may

also set up small, informal social events for

Veterans on their caseload. For example, a PSS

might get together with three or four Veterans

to eat pizza and play pool, each chipping in if

another Veteran who attends does not have

enough money to participate. Especially as

Veterans return to work, social events are more

likely to be successful on evening or weekend

hours. Ideally, the work schedules of PSSs will

include some evenings and weekends. Indeed,

one of the hallmarks of peer support is that it

is generally available when more traditional

services are limited and when Veterans are most

in need of natural support and opportunities

for social connectedness. Although PSSs have a

working schedule that mostly follows“normal

business hours,” employing a mechanism that

allows them to use “comp time”to shift their

working hours, when necessary, is useful.

However, PSSs also tend to have natural contact

with Veterans during nights and weekends

since they often participate in the same type of

activities as a part of their own personal lives

(for example, going to AA or NA meetings/

activities, church, and grocery shopping).

• Achieving goals. As someone who has had

experiences similar to those of the Veterans

enrolled in the HUD-VASH program, the PSS

often has excellent insight into what can be

considered realistic goals for Veterans to set

and achieve. Veterans who are really struggling

might have goals that seem trivial to an

outsider, but which are understood by those

who have experienced similar struggles. For

example, a person who is feeling extremely

depressed might have as a goal to smile three

times per day or to go out in public twice a week

and talk to someone. Of course, PSSs should

help set goals as high as the Veteran wishes,

with shorter-term objectives being developed

in the interim. Most likely, the goals will center

around the pursuit and maintenance of housing
H U D - V A S H R E S O U R C E G U I D E 161 

as specified in the Housing Stabilization Plan.

After goals are set, it is important for the PSS to

regularly check in on the status of those goals in

order to ensure progress.

Peer Support in Action: Example 3

“Earl” faced a financial barrier to consistently paying 

his portion of his rent. He had accumulated many fines 

over the years and could not pay them on the salary 

he earned at his current job. His assigned PSS had also 

experienced a struggle with outstanding fines and 

explained to Earl how he had set paying off his fines as 

a goal and decided to quit smoking as a way of saving 

money to pay off those fines so he could get his license 

back. Using the eight dollars a day he had spent on 

cigarettes, the PSS was able to slowly pay off his fines 

and more consistently pay his portion of his rent. Even 

now that he has paid off his fines, he has decided to 

no longer smoke cigarettes. The PSS’s sharing of his 

personal experiences showed Earl that the barrier he 

faced was not an insurmountable problem, helped 

motivate Earl to seek a better paying job with the 

VA, and also modeled healthy behavior (smoking 

cessation). Through perseverance, Earl got that VA job 

and was finally able to pay off his fines.

• Working. As someone undertakes the

responsibilities of a full-time job after

experiences similar to those of the Veterans

currently enrolled in the HUD-VASH program,

the PSS is a natural role model for providing

support to a Veteran who is considering

returning to work, trying to find the right job,

or adjusting to working life. Many Veterans in

the HUD-VASH program have extensive criminal

records and limited work experience; therefore,

they often have difficulty finding a job or have

to start out working in less desirable positions.

The role of the PSS is to reinforce the work

that the staff from the HUD-VASH team does

in preparing Veterans for work–teaching them

how to address questions that interviewers

might have about their pasts, stressing the need

for punctuality and showing up for work every

day, or helping them cope with unpleasant work

experiences.

Peer Support in Action: Example 4

Marcus lost a well- paying job with the VA when he 

relapsed to cocaine use. He asked for support from 

his PSS, who understood first-hand the impact of 

losing a good job. Other opportunities for Marcus 

were very limited, and his PSS offered to help Marcus 

find a temporary job at a nursing home where he had 

previously worked. The pay for this job was much lower 

than Marcus’s previous position at the VA, and Marcus 

was not sure he could get by on the reduced income. 

In fact, he almost did lose his apartment, but his PSS 

helped him keep his head up, pointing out that the 

job in the nursing home was “a step down in wages, 

but a step up in humility.” His PSS also encouraged 

him to learn from his experience, suggesting that “he 

was being tested on the little things before he could 

go back to the bigger things.” This particular PSS drew 

from his own experience working at the nursing home 

for nine dollars an hour, explaining to Marcus the 

new perspective he had gained. He told Marcus, “you 

must have gratitude for what you are accomplishing 

now,” rather than dwelling on the past. “You depleted 

your 401K to get high, and you’re not going to get 

that back,” he said. Yet he helped Marcus realize that 

he would have to take things slowly in rebuilding his 

finances and helped him use his limited income to 

his advantage. The PSS also worked with Marcus to 

develop a budget that took into account his reduced 

wages. After reducing his spending to account for his 

reduced wages, Marcus was able to consistently pay his 

rent and keep his apartment. 

• Addressing Stigma. While reports indicate

that mental illness and substance abuse

problems are widespread, stigma continues to

be a prominent problem for individuals with

those disorders during recovery (Corrigan,

2004; NAMI, 2010) and has been linked to an

increased risk for negative outcomes, which

include reduced employability, imprisonment,

and homelessness (Browne, 2007; Corrigan, et

al., 2007; McNiel, et al., 2005). As such, stigma

is a barrier that may impede treatment and

recovery goals integral to the HUD-VASH

program. Traditionally, stigmatization has been

defined as the process by which individuals

who lack certain characteristics or traits belittle

other individuals who have them (Piner & Kahle,
162 H U D - V A S H R E S O U R C E G U I D E

1984); however, stigma has further been broken

down into two critical components: public and

self-stigma. Public stigma occurs when there is

a reaction toward a specific group of individuals

who share a negatively viewed trait (Corrigan,

2004), while self-stigma results from one’s own

reactions toward oneself due to membership in

a stigmatized group (Corrigan & Watson, 2002).

Moreover, self-stigma has been associated with

decreases in self-esteem and self-efficacy, which

may hinder motivation toward participation

in activities that would promote recovery

(Corrigan, et al., 2006), such as applying for a

job or approaching a landlord for a housing

application after one or more failed attempts.

Although public and self-stigma can be viewed

as separate, it is important that PSSs consider

both, as each of these components often acts

together and builds upon each other. For

example, if a Veteran with COD encounters a

landlord who is hesitant to rent to them due

to their diagnoses (public stigma), he/she may

internalize this stigma (self-stigma), which

in turn may negatively impact perceptions

of his/her own capabilities and decrease his/

her motivation toward approaching another

landlord with a new housing application.

However, PSSs who can identify with“their”

Veterans may provide an essential safeguard

that helps prevent the negative consequences

of stigma cited above by using two key

strategies: contact and education (Corrigan,

2004).

Contact. Contact usually involves face-toface interactions with individuals from the

stigmatized group and has sometimes been

paired with brief education programs that have

been associated with changes in stigmatizing

behavior (Corrigan, 2004). Unique to the PSS

model is the opportunity to combat selfstigma in Veterans struggling with recovery by

providing regular contact with a positive role

model. This has two benefits. First, participating

Veterans have an opportunity to witness that

another Veteran with a mental illness and

substance abuse disorder can be successful

(dispelling the myth that this group cannot

succeed). Second, Veterans can learn concrete

strategies from those who have faced and

successfully overcome the challenges of stigma

while working toward recovery.

Education. Having direct access to a contact or

role model that they can turn to may not only

serve to combat negative reactions toward

the self, but may replace these same reactions

with hope. Furthermore, PSSs can share the

knowledge that they acquired through their

own similar experiences to educate the Veteran

on how to best approach these and other

similar situations in which the Veteran feels

stigmatized. In this way, PSSs can help divert

otherwise potentially debilitating outcomes

associated with stigma. PSSs are encouraged to

check in with Veterans to assess and address any

issues surrounding stigma that may ultimately

impede recovery, as they may not always be

directly reported by the Veteran. In addition, as

Veterans make their way through the HUD-VASH

program, they will experience varying degrees

of progress in comparison to other Veterans.

PSSs are encouraged to monitor and address

any situations involving stigma among Veterans

in order to promote a safe environment where

each Veteran can continue to share, grow, and

progress comfortably at his/her own pace. Due

to their unique role, PSSs are also encouraged

to monitor and address any issues regarding

stigma that may impede their own recovery with

a source of support outside the program.

Training Peer Support Specialists

PSSs receive training from a number of sources.

Some of the day-to-day informal training of PSSs

comes from supervision regularly provided as part of

the HUD-VASH program. The formal training in which

the PSS participates should include internal training

on program issues and operating procedures,

certifications required by PSS’s VA or affiliated/

employing homeless program, as well as training

for consumer-providers on mental health and COD

provided by an outside agency. Additionally, PSSs

have identified other areas in which training would

be helpful and for which further training venues are

being identified and/or developed.
H U D - V A S H R E S O U R C E G U I D E 163 

Internal Training

In addition to basic orientation (such as

timekeeping) offered to both CMs and PSS s, the

HUD-VASH program will need to provide training

to PSSs on a number of topics relevant to their job,

including

• Confidentiality policies,

• Research and documentation policies,

• Crisis management, and

• Expectations of the position.

VA Stance on Training of PSSs

Currently, PSS’s hired as official VA“Peer Support

Technicians”2 are required to“demonstrate

competency”within one year of their hire. This

could involve either taking and passing one of the

approved peer certification courses mentioned

above or passing the competency assessment

developed by the VA. To support the training of

VA Peer Support Technicians, the VA’s Office of

Mental Health Services, Psychosocial Rehabilitation

Section, will soon be releasing the VA’s Peer Support

Training Manual. The manual was adapted from

the 2007 National Association of Peer Specialists

(NAPS) Training Manual with input from peer

support practitioners across the United States. The

manual will focus on the Peer Support Technicians’

competencies, which were derived from a synthesis

of six prominent peer training and certification

programs in the United States. It is anticipated that

various staff all across the VA will use this Manual to

develop a course for peer training.

Third-Party Training Nationwide

Currently, training for PSSs varies widely across

the country in breadth, scope, and length,

ranging from 30 hours to 28 weeks. One of the

most highly regarded training programs is the

curriculum developed through the Georgia Peer

Support Certification Project. The Georgia program

2 The current designation for PSSs in VA is Peer Support Technicians. However, the VA will soon be announcing the official creation of the Peer Support Specialist, or PSS, position. After that,

the VA will have two peer positions, the PSTs and the PSSs. The

PSSs will be more trained, have more experience, and receive a

higher salary than PSTs.

is a comprehensive, classroom-based, 40-hour,

30-module curriculum covering peer support,

psychosocial rehabilitation and recovery, the impact

of diagnosis on self-image, effective communication

skills, and the basics of documentation. In addition,

the Depression and Bipolar Support Alliance

(DBSA), which works in collaboration with staff from

the Georgia Peer Support Certification Program,

provides an on-site, classroom-based, 40-hour

training program. Both training programs include an

exam that requires a minimum score of 80 percent in

order to pass the course.

Most existing programs offer at least 40 hours (a

useful minimum standard for peer training) and

include an exam. Other nationally recognized

programs that have trained peers are Consumer

Connections of the Mental Health Association in

New Jersey, Recovery Innovations in Pennsylvania

and Arizona, and the Transformation Center in

Massachusetts. In addition, Katz and Salzer (2006)

of the University of Pennsylvania Collaborative on

Community Integration summarized the details

of 13 peer training programs, all of which“certify”

peers. Peer certification means that their services

are reimbursable by state Medicaid programs. Many

states, including Georgia, Arizona, Iowa, Michigan,

North Carolina, Washington, Pennsylvania, District

of Columbia, Wisconsin, Hawai’i, and Florida hire

certified peers. Previous PSSs have also participated

in the extensive training program offered through

consumer-run programs affiliated with the University

of Massachusetts Medical School and other agencies.

Training on the Critical Time Intervention (CTI) 

Model

Previous PSSs have also participated in training

offered by the CTI Project at the Mailman School

of Public Health of Columbia University. Given that

this model is being viewed as central to the HUDVASH program, this training is particularly helpful

in ensuring that PSSs are able to work smoothly

with CMs, with a common understanding of the

foundations of this type of intervention for Veterans

with co-occurring mental illness and substance

abuse disorders.
164 H U D - V A S H R E S O U R C E G U I D E

Training for PSSs and Clinical Supervisors

PSSs and their supervisors should pursue continuing

education. The VA offers a yearly conference for all

PSSs and their supervisors. The National Association

of Peer Specialists, Inc. (NAPS), a private, nonprofit organization dedicated to peer support in

mental health systems, offers an annual conference

(see http://www.naops.org/). The U.S. Psychiatric

Rehabilitation Association also sponsors a national

conference and other training opportunities for

peers (see http://www.iapsrs.org/).

Hiring Peer Support Specialists

Hiring and deploying PSSs can be complicated.

Many HUD-VASH staff persons–i.e., the individuals

who would be serving alongside a PSS–will not be

familiar with PSSs. The information presented below

serves as a guide for HUD-VASH teams as they are

establishing the structure of the PSS role. However,

it should be noted that there is more than one way

to create an effective and sustainable PSS program.

A PSS’s job also may evolve over time–the job in its

first year may look quite different two years later,

but both may be equally effective. Our goal is to

provide some general guidelines for hiring and

deploying PSSs, though we wish to emphasize that

staff development programs should be flexible,

responsive to the organization and its customers,

incorporate the ideas, and meet the needs of all

employees. Working to get the input of employees

involved (other HUD-VASH CMs and leaders) on how

to structure the PSS role will go a long way to secure

the full buy-in and support of leadership and staff.

The following represents a first step towards guiding

policy and practice development for those wishing

to hire PSSs in HUD-VASH.

1) Hiring criteria: What are appropriate hiring criteria 

for PSS?

• Is a certain type of mental illnessrequired, or not?

• Should the PSS be free ofsubstance use? For how

long?

• Should the PSS not have been hospitalized for

some period of time?

• How should the above be documented?

• Is hiring“from within”a good practice or not?

It is essential for administrators to understand

that the Americans with Disabilities Act prohibits

employers from asking applicants about their

medical/psychiatric conditions or history. Rather,

the hiring criteria for PSS should be based on

the knowledge, skills, abilities, and personal

characteristics required to perform the duties of the

position (examples of key competencies required by

VA can be found below).

Position descriptions and recruitment

announcementsshould describe the population

served and the expectation that the Peers will utilize

their own recovery experiences as a means of rolemodeling successful community integration and

providing peersupport to foster achievement of

Veterans’recovery goals. The VA already has a position

description for a GS-5 (Peer Support Technician) and

willsoon be developing one for a GS-5-7-9 (Peer

Support Specialist). Employment application forms

and interview questionsshould be carefully designed

to elicit the necessary information to determine if the

applicant’straining and personal experiences have

afforded them the knowledge and skills necessary to

successfully perform the duties of a PSS (examples

ofsome suggested interview questionsfor the PSS

position description are below).

It is generally recommended that organizations

aggressively recruit individuals who are not

currently, or who have not recently, received mental

health services from the same organization in which

they would be employed. Most organizations do not

strictly prohibit this, and the negative impacts of

doing so are minimized in large organizations where

PSSs can be employed in a program that is remote

from where they have recently received or currently

receive their own mental health services. Should the

selected candidate be one who currently receives

services from the same organization, it is generally

advised they make every effort to distance their

personal service providers from their supervisor and

direct co-workers. Under no circumstances should

a supervisor also be that person’s mental health

services provider. PSS training and certification

programs may have criteria that specify the need

for particular types of diagnoses and/ or periods

of sobriety or non-hospitalization; however, such

criteria cannot legally be applied directly in the

hiring process.
H U D - V A S H R E S O U R C E G U I D E 165 

Domain Skills & Competencies

Personal Self-Development 

Development of personal story

Personal strengths

Managing personal recovery

Facing one’s personal fears

Managing one’s own self-talk and combating negative self-talk.

Recovery

Components of recovery

Stages of recovery

Peer support role in PSR

Peer Support Principles

Being a role model

Instilling hope

Being an advocate

Principal duties of peer support staff

Cultural Competence Understanding how roles of ethnicity, race, spirituality, gender, sexual orientation, local

community and other sub-cultures may influence recovery.

Communications Skills

Effective listening & asking questions skills

Communication styles (pass/agg/assert.), and Verbal and Nonverbal communication

Conflict resolution skills

Group Facilitation Skills Basic understanding of group dynamics and interactions

How to use support groups

Addressing Stigma Managing internalized stigma

Understanding Illness Major psychiatric conditions in DSM IV

Recovery Tools

Using recovery workbooks and other self help instruments

Problem solving, using solution focused strategies

Telling your personal recovery story, being mindful of who you’re addressing

Knowing community resources

Self-help groups

Writing recovery goals & plans

Motivating people to use their dissatisfaction with their lives as an opportunity to create

the one they’d like.

Teaching how to manage self-talk and combating negative self-talk

Facing one’s fears

Professional Development & 

Workplace Skills

Ethics

Boundary issues and dual relationships

Working effectively with professionals on an interdisciplinary team

Working with your supervisor

Managing Crisis and 

Emergency Situations

Early warning signs and symptoms that an illness is worsening

Crisis prevention, using resources early

Competencies for VA Peer Support Technicians
166 H U D - V A S H R E S O U R C E G U I D E

2) Confidentiality: Is there a different level of 

confidentiality for PSSs than for other service 

providers? Does everything that gets stated to a PSS 

by a Veteran automatically get transmitted to the 

rest of the team?

PSS are members of a treatment team. As such,

they are expected to help the Veteran share

information with the rest of the team that is

pertinent to the team’s effort to support the

Veteran’s treatment/recovery goals. In the case

of critical information conveyed in peer support

groups (which are confidential by their nature),

the PSS would generally raise discussion with

the Veteran outside of the peer support meeting

as a means of processing with the Veteran the

value and importance of including the team in

addressing the issue. Should the Veteran refuse to

share information with the team that is deemed

vital to their safety, the PSS would be expected

to inform the Veteran that they must (and will)

convey such information to the team anyway.

3) Fraternization: Can PSSs spend time with their 

Veterans after hours? What are the boundaries of 

Veterans and PSSs giving money to each other? Can 

a PSS buy a Veteran a cup of coffee or not?

PSSs are staff of the mental health system in

which they are employed, and any organizational

policies regarding financial transactions, intimate

relationships, etc. that apply to other providers

would also apply to the PSS. The fact that PSS may

more often live, socialize, attend meetings, etc.,

where Veterans are likely to be does not change

organizational policies designed to protect both

the mental health system employee and the

Veterans served by that system.

Most all friendships outside of the work

environment have the potential to influence

behaviors within the work setting and should

therefore be avoided. PSSs are, however, likely

to have more social contact with Veterans

than traditional healthcare providers, as peers

have a more mutual relationship with Veterans

in the context of their work. It is therefore

recommended that there be a safe environment

for PSSs to discuss these situations with their

supervisor as they may arise, to include assistance

with discussing healthy boundaries with Veterans.

Like all employees (and perhaps even more

so), it is important that PSS balance and have a

healthy separation between work and personal

life. Where a strong personal friendship may have

previously been established between a PSS and

a new Veteran coming into the program, the

PSS (as would be expected of a Case Manager

as well), should disclose this relationship with

the clinical supervisor, and every effort should

be made to assign that Veteran to a different

PSS. Where assignment to another PSS is not

possible, the employee and the supervisor should

discuss appropriate boundaries to minimize

real or perceived conflicts of interest that could

jeopardize the PSS/ Veteran relationship and goals

of the program.

4) Supervision/performance appraisal: How does a 

supervisor appraise performance of a PSS?

Performance standards for PSSs should be

developed based on the work of the position,

as with any other staff member. In the case of

PSS, the supervisor’s appraisal should focus on

the PSS’s effectiveness in developing supportive

relationships with Veterans that foster successful

personal and community integration skills and

the development of natural supports.

5) Sick leave policy: One of the top concerns 

organizations may have about PSS is what will 

happen if the PSS relapses. Should special sick leave 

policies be in place for them?

The sick leave policy should be no different

for a PSS than for any other employee.

Employers should not probe for personal

medical information, nor require medical

documentation beyond existing organizational

policies that apply to all employees. A PSS, like

other employees, should be oriented, as a part

of general employment orientation, to rights

and responsibilities under the American’s with

Disabilities Act. As such, they should be advised

that they may wish to identify themselves as

persons with a disability/disabilities who require

accommodation. If this is the case, it would be

advisable for supervisors to consult with their

human resources office or organization’s legal

counsel.
H U D - V A S H R E S O U R C E G U I D E 167 

6) Disclosure of mental health status: To what extent 

is a PSS required to disclose his/her personal history 

of mental illness/addictions in the context of their 

work with Veterans?

Unlike more traditional mental health providers,

such as social workers, psychologists, etc.

who may also be (and disclose their personal

experience as) consumers of mental health

services, the unique role of the PSS requires

them to do so. Their training as a PSS should

comprehensively address how to utilize their

own experiences effectively, so as to connect

with, empathize with, and support Veterans.

PSS training also generally includes learning

to“tell one’s story”from a recovery versus an

illness perspective, and how to ensure that their

self-disclosure is pertinent to the situation and

does not dominate the conversation. Under no

circumstances should a PSS feel compelled to

disclose aspects of personal experiences that he

or she feels uncomfortable sharing.

Sample interview questions pertinent to PSS 

position:

1) The position you have applied for is a Peer

Support Specialist. Please describe what you

believe a peer support specialist’s role should

be and what you would envision yourself doing

in this role. Give an example of how you have

provided this type of service in the past.

2) Please share a couple of specific examples of

progress you’ve made in personal and/or work

life where you experienced a setback or challenge

and then turned the situation around to a positive

outcome.

3) Please provide specific examples of how you have

provided informal or formal support to one or

more of your peers.

4) Please discuss a specific time when you had

to negotiate with a group of people to obtain

their cooperation. Tell us specifically who you

negotiated with and what the outcome was. What

did you learn from the situation?

5) Think of a time when you had to communicate

something that you knew the other person

did not want to hear. How did you go about

communicating it? What was the outcome?

6) Please describe a time when you assumed a

leadership role (in any context). What sort of

problems came up? What did you learn about

yourself?

7) What was the most recent skill that you set out to

learn? How did you go about it?

8) Give an example of an important goal that you

have set for yourself in the past. What did you do

to reach it? How did you measure your success in

reaching that goal?

9) On a scale of 0 (lowest) to 10 (highest), please rate

your personal knowledge in the following areas

and give examples of how you have acquired and

utilized this knowledge:

Knowledge of community resources _________

Knowledge about mental health and addiction

problems _________

Knowledge of the VA Healthcare System ________

Knowledge of recovery issues and processes

_________

10) How does being a peer support specialist in the

HUD-VASH program fit in with your life goals for

yourself? Please be specific.

References

Browne, G. (2007). Schizophrenia housing and

supportive relationships. International Journal of 

Mental Health Nursing,16(2), 73-80.

Chinman, M., Young, A.S., Hassell, J., Davidson, L.

(2006). Toward the implementation of mental health

consumer provider services. Journal of Behavioral 

Health Services and Research, 33, 176–195.

Corrigan, P. W. (2004). Target-specific stigma change:

A strategy for impacting mental illness stigma.

Psychiatric Rehabilitation Journal, 28(2), 113-121.

Corrigan, P. W., Larson, J. E., & Kuwabara, S. A.

(2007). Mental illness stigma and the fundamental

components of supported employment.

Rehabilitation Psychology, 52(4), 451-457.
168 H U D - V A S H R E S O U R C E G U I D E

Corrigan, P. W., & Watson, A. C. (2002). The paradox

of self-stigma and mental illness. Clinical Psychology: 

Science and Practice, 9(1), 35-53.

Corrigan, P. W., Watson, A. C., & Barr, L. (2006). The

self stigma of mental illness: Implications for selfesteem and self-efficacy. Journal of Social and Clinical 

Psychology, 25(8), 875-884.

Davidson, L., Chinman, M., Kloos, B., Weingarten, R.,

Stayner, D., & Tebes, J. (1999). Peer support among

individuals with severe mental illness: A review

of the evidence. Clinical Psychology: Science and 

Practice, 6(2), 165-187.

Department of Health and Human Services,

President’s New Freedom Commission on Mental

Health. (2003). Achieving the Promise: Transforming 

Mental Health Care in America. Rockville, MD:

Department of Health and Human Services,

President’s New Freedom Commission on Mental

Health, SMA-03-3832.

Department of Veterans Affairs. (2003). Achieving the 

Promise: Transforming Mental Health Care in the VA.

Washington, DC.

Katz, J. & Salzer, M. (2006). Certified Peer Specialist

Training Program Descriptions. Philadelphia,

PA: University of Pennsylvania Collaborative on

Community Integration. Retrieved November 2, 2010

from http://www.med.upenn.edu/psych/RRTC.html

McNiel, D. E., Binder, R. L., & Robinson, J. C. (2005).

Incarceration associated with homelessness,

mental disorder, and co-occurring substance abuse.

Psychiatric Services, 56(7), 840-846.

National Alliance on Mental Illness. (2010). What is 

mental illness: Mental illness facts. Retrieved May 12,

2010, from www.nami.org

Piner, K. E., & Kahle, L. R. (1984). Adapting to the

stigmatizing label of mental illness: Foregone but

not forgotten. Journal of Personality and Social 

Psychology, 47(4), 805-811.

What is mental illness: Mental Illness Facts (2010).

RetrievedOctober 27, 2010 from http://www.nami.org/

template.cfm?section=about_mental_illness

Simpson, EL. & House, A.O. (2002). Involving users

in the delivery and evaluation of mental health

services: systematic review. British Medical Journal, 

325, 1265–1270.

Solomon, P. (2004). Peer support/peer provided

services underlying processes, benefits, and critical

ingredients. Psychiatric Rehabilitation Journal, 27,

392–401.

Veterans Health Administration, Mental Health

Strategic Plan Workgroup, Mental Health Strategic

Health Care Group. (2004). A Comprehensive VHA 

Strategic Plan for Mental Health Services–Revised.

Washington, DC.

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about peer

support.

1) HUD-VASH leadership is recommending that

Peer Support Specialists be deployed within

HUD-VASH teams.

2) Centers for Medicare and Medicaid Services

stated that peer support –specifically the type

of peer support that is provided by a PSS – is an

“evidenced-based mental health model of care.”

3) The role of PSS is not incorporated until a

Veteran has moved into housing.

4) While Case Managers often make home visits,

PSSs do not engage with Veterans in their

homes.

5) PSSs can accompany Veterans to 12-step

sessions and reinforce the work Veterans have

done with any other treatment providers they

may have.

6) Each HUD-VASH team is limited to one PSS.

7) PSSs are often called upon when Case Managers

are having a difficult time engaging a Veteran.

8) When a PSS discusses issues of clinical

significance with Veterans, the PSS should

encourage the Veteran to also share this

information with the Case Manager.
H U D - V A S H R E S O U R C E G U I D E 169 

9) When conflicts arise between the PSS and the

Case Manager regarding the care of a Veteran,

the issue should be raised with the Supervisor.

10) Most friendships outside the work environment

have the potential to influence behaviors

within the work setting and should therefore be

avoided. PSSs are, however, likely to have more

social contact with Veterans than traditional

healthcare providers and should discuss how

to establish healthy boundaries with their

supervisors.

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) Keeping roles and communication clear between

Case Managers and PSS requires dedicated effort.

Can you name a number of activities that the two

might share? Which activities are exclusive to a

Case Manager? Which are primarily handled by a

PSS?

2) One role that PSSs can play very well is to lead

groups for Veterans. What types of groups might a

PSS lead on your team?

3) MISSION-Vet is a tested program specifically

developed to target the mental health, substance

abuse and related issues facing homeless

Veterans through assertive outreach, psychoeducation, linkages to community-based

resources, and peer support. What are some

peer support session topics recommended by

MISSION-Vet?

4) One of the hallmarks of peer support is that it is

generally available when more traditional services

are limited and when Veterans are most in need

of natural support and opportunities for social

connectedness. How can the role of the PSS on

your team be structured to be available when

other supports are not? 

5) Take a second look at the examples of peer

support in action at the end of this chapter and

discuss them with your team members.

6) What types of stigma exist for homeless people

and people in recovery? How can PSSs help

to address stigma, and how can they protect

themselves from its negative consequences?

7) What kinds of internal and national training and

conferences are available for the PSSs on your

team?

8) Hiring and deploying PSS can be complicated

because many HUD-VASH staff persons will not

be familiar with PSSs. How will your team hire

a PSS and establish the structure of this unique

role?
170 H U D - V A S H R E S O U R C E G U I D E

What’s in This Chapter?

Pathways Housing First (PHF) is a nationally

recognized evidence-based intervention that is

effective in stablizing housing for individuals with

complex histories of homelessness and multiple

physical or mental health challenges to independent

living.

In this chapter you will learn

• The principles of Pathways Housing First,

• How Housing First is critical to the principles of

HUD-VASH,

• How PHF differs from from traditional models,

and

• How to implement PHF as part of your HUDVASH program.

After reading this chapter, you will be able to apply

many of the approaches and values of Pathways

Housing First to your HUD-VASH program.

Overview

The main purpose of this chapter is to explain how

Pathways Housing First (PHF), also referred to as HF,

and HUD-VASH fit together, and how this synergy

furthers both housing and recovery goals. 

The central principle of PHF is that housing is not

dependent upon a certain recovery threshold. 

Instead, individuals with mental or physical health

care problems, who also may be suffering from

substance use disorders, can use safe, stable,

permanent housing as a platform from which to

begin to pursue recovery or independent living

goals. PHF does link clients with flexible supports

PART 2 C H A P T E R 9

HUD-VASH and HOUSING FIRST

and treatment services, but these are secondary to

shelter. In this model, housing is the first priority.

This chapter will describe how the HUD-VASH

program and HUD-VASH Treatment Teams can

implement and operate both housing and clinical

services through a consumer choice model such as

Housing First.

What is Housing First?

Housing First is a recovery-oriented, costeffective approach to ending homelessness. What

differentiates a Housing First approach from other

strategies to end homelessness is that there is an

immediate and primary focus on helping homeless

individuals and families quickly access and sustain

permanent housing. Within VA, Housing First centers

on providing the most needy, most vulnerable

homeless Veterans–who also have very low incomes,

limited social resources, and serious, persistent

issues that may include mental health and or

medical complications–with housing quickly, then

providing treatment and other supportive services

as needed. This approach has the benefit of being

consistent with what most people experiencing

homelessness want and seek help to achieve;

Housing First programs provide housing first and

services second. The program is based on the belief

that housing is a basic human right, particularly for

those who have committed their lives to serving

their country. An offer of independent, permanent

housing must be made without strings attached. 

PHF, as it relates to HUD-VASH, holds that homeless

Veterans with physical and mental health issues,

including substance use disorders, require the

fundamental safety and security that permanent

housing provides, without first having to“earn”or
H U D - V A S H R E S O U R C E G U I D E 171 

prove a readiness for housing by complying with or

completing other treatment programs.

In addition to providing immediate accessto safe,

permanent housing, HF also offersthe opportunity to

connect with community-based, flexible support and

treatmentservicesthrough a case management or

multi-disciplinary team approach. Such services need

to be responsive to the individual and unique needs

and goals of each Veteran. Thisfundamentalshift to a

person-driven (Veteran-centric), rather than a systemdriven, approach providesthe foundation for the

program’ssuccess and for an individual’srecovery.

Why Use the Pathways Housing First 

Model for HUD-VASH? 

Pathway Housing First (PHF) is a nationally

recognized evidence-based intervention1 that

is effective in stabilizing housing situations for

individuals with complex medical histories and

prolonged experiences of homelessness. It is an

especially promising model for use with homeless

Veterans in particular, whose willingness to accept

assistance may be further complicated by strong

survival instincts, tremendous personal pride, an

uncompromising sense of self-determination, and a

tendency to consider hardship within the context of

the extremes of military service. Rather than asking 

a Veteran to compromise a sense of autonomy to

accommodate larger bureaucratic systems, PHF

embraces this resiliency by honoring the desire to

live in a housing unit of one’s own choice and by

providing services that support independent living.

Although at one point Veterans may have followed

orders without question for the good of this nation,

they now need individually tailorable, responsive

services that can accommodate the direction and

pace of their own recoveries. This approach is

fundamental to PHF.

A key feature of PHF is that the program does not

mandate participation in psychiatric treatment or

necessitate sobriety as a condition for obtaining

and maintaining housing. In eliminating these

prerequisites, the PHF approach removes what

can, to the most vulnerable homeless Veterans, be

1 For more detailed information the evidence basis of Housing

First, go to the http://www.nrepp.samhsa.gov/.

insurmountable barriers. This is consistent with the

HUD-VASH eligibility criteria–none of which include

a set period of sobriety or absence of substance

abuse history. In fact, through adopting a lowbarrier approach to substance use as opposed to an

abstinence based model, PHF has successfully tested

the hypothesis that Veterans can move directly

from homelessness into independent apartment

living though the use of flexible, team-based

support services. Based on previous research, it is

expected that more than 80% of homeless Veterans

–regardless of the severity of their mental health

condition and addictions–can remain stably housed

using the PHF program (Tsemberis et al, 2004).

PHF Program Model Development

PHF was designed in response to the requests of

homeless individuals who expressed, as priorities,

a single occupancy unit (for individuals without

dependents) in a normal, community setting. An

invitation to be placed in a home of one’s own has

proven to be an offer of enormous value that many

who are living on the streets or in shelters find

irresistible. We now know that the limited success

of previous offers that bundle housing, services,

and treatment together has more to do with what is

being offered and less to do with one’s mental health

condition.

Traditional approaches

The PHF program model was born out of frustration

with, and stands in stark contrast to, traditional

approaches to homeless services in which treatment

requirements and expectations of consumer

stability have interfered with ending an individual’s

experience of homelessness. The underlying

philosophy of traditional approaches is that change

must occur at the individual consumer level before

transition to permanent housing. Within traditional

approaches, consumers must‘graduate’through a

series of placements–typically starting with dropin centers or shelters, moving through transitional

housing, and, finally, into permanent housing–by

demonstrating treatment compliance, psychiatric
172 H U D - V A S H R E S O U R C E G U I D E

stability, and abstinence from substance abuse as

depicted in Figure 1 (Henwood et al, 2010).

Within this stepwise approach, if a client relapses,

becomes unstable, or chooses not to follow rules

necessary for congregate living, he or she must leave

the program and/or become institutionalized, which,

by default, entails sacrificing their current living

situation and the prospect of permanent housing.

Within the approach, the motivation for change is

believed to come from the promise of permanent

housing. Yet, this structurally endorsed incentive

creates a high stakes proposition, in which an end

to homelessness depends upon an individual’s

ability to manage conditions that, by nature, are

difficult to overcome and are often recurring. This

may help explain why traditional service approaches

have had only limited success addressing chronic

homelessness.2

Figure 1. Traditional approach: a housing continuum in which housing independence 

housing increases as consumers demonstrate compliance, stability, and 

abstinence.

PHF’s revised approach

In contrast, PHF starts with immediate access to

permanent, scattered-site housing. There are

three eligibility conditions: in addition to paying

30 percent of their income towards rent, Veterans

must allow regular staff visits to their apartment,

and agree to the terms and conditions of a standard

lease with full tenant rights. The model attempts to

avoid leveraging permanent housing in exchange

for participation in treatment, and therefore creates

a fundamental separation between permanent

housing and clinical services. The use of such

leverage can compromise a Veteran’s strong sense

of self-determination and autonomy and may

increase the likelihood of blanket service refusal.

In separating services, PHF effectively replaces the

discussion of“earning”housing with the idea of a

right to housing, as depicted in figure 2.

2

For more information on the problem of chronic homelessness, go to U.S. Department of Housing and Urban Development, (2007). The Annual Homeless Assessment Report to

Congress, Washington, DC.
H U D - V A S H R E S O U R C E G U I D E 173 

Four Essential PHF Program Principles 

While offering a simple, straightforward solution

to the issue of homelessness, the PHF program is

a complex community mental health intervention

that includes both a housing program and a services

component. The program has numerous operational

and administrative dimensions and protocols that

are well defined.3 The focus here is to present four of

the key program principles upon which this effective

intervention is based:

1) Veteran-driven services

2) Separation and coordination of housing and

case management/clinical services

3) Recovery orientation

4) Community integration

1) Veteran-driven Services

PHF’s empirical basis and cost-effectiveness4

,

which has driven its rapid growth and

Figure 2. Housing First is a model that bypasses a housing continuum and provides immediate 

access to independent, permanent housing with flexible support services.

dissemination, often overshadows the

consumer-driven service approach that has been

the key to its success. Yet one of the reasons

that PHF is so appealing to Veterans is that it

places the Veteran in charge of the decision

making. In contrast, most programs they have

encountered in their pursuit of housing have

been characterized by numerous rulesregarding

treatment,sobriety, curfews, overnight guests

and other requirements. The PHF program puts

the Veteran in control of the decisions-making

process and supportsthe Veteran ass/he learns

how to manage his or her own life.

 Moving In. The starting point of the program

is to ask Veterans what they want; the program

begins by honoring and fulfilling the request that

most people who are homeless say they want

first —“A place of my own to live.”(However, if

the Veteran said he/she would like to live in a

program with other Vets, the program would

help them to apply.) From the start, the Veteran

is making the decisions through staff questions,

such as:

• Do you have a preference for neighborhood? 

• Would you like a studio or a one bedroom? 

3

For more information see Tsemberis, S. (2010.) Housing First. 

Minnesota, Hazelton.

4 For more information on the cost-effectiveness, see
174 H U D - V A S H R E S O U R C E G U I D E

• Are there other people in your life that you

want to live with? What about pets? 

• What type of furniture and household items

can we provide?

In the PHF program, the Veteran is not enrolled in

the program and placed into a vacant bed. Instead,

Veteransshould enter the program,set up their

homes, and begin to build a life around their home.

 Ongoing support. Honoring choice does not

end with providing Veterans with apartments;

ongoing services must also be “Veteran-driven,”

which requires creative, flexible staff – both

administrative and direct service providers –

that can work to accommodate Veterans’needs.

Fortunately for such staff, providing a Veteran

who is homeless with a rent-subsidized furnished

apartment with few strings attached serves as

an excellent way to achieve trust and begin a

healing, collaborative relationship. That is, this

offer of housing creates an opportunity, sets a

precedent, and serves as an example for how all

subsequent services will be provided. 

2. Separation and Coordination of Housing and 

Case Management/Clinical Services

To be part of the PHF program, in addition

to paying a percent of their income toward

rent (which typically consists of VA benefits or

Supplemental Security Income), Veterans must

agree to only two conditions:

1) The terms and conditions of a standard lease

with full tenant rights [housing component].

2) Regular staff visits to their apartment [services

component].

While functionally separate, both the housing

and services components of the program must

communicate and be well-coordinated as

described below.

 Housing/Property Management. Given that

the PHF program has a housing component,

property management staff are essential. A

major part of their responsibility is renting

available units on the open market from private

landlords, which eliminates the need for lengthy

project planning and construction. It is crucial

to have the rental stipend or voucher in place

before the program begins, or to have systems

in place to expedite this process in order to

guarantee immediate access to housing – a

hallmark of the PHF approach.

 The VASH Demonstration Project in the District 

of Columbia showed that the average time from 

referral to lease-up with a place to live can be 

reduced from 6 months to 1 month through

Re-engineering housing eligibility and the leasing 

process, and Interagency cooperation and 

database sharing. The HCV application process 

was expedited through administrative support, 

such as collecting required documentation 

across governmental agencies (e.g. identification, 

eligibility, etc.); deputizing additional housing 

inspectors and appropriating funds for furniture 

and housing essentials. This allowed homeless 

Veterans to move in to their respective apartments 

within a month after initial engagement. 

In addition, while HUD vouchers may fund

rent payments, property management staff are

responsible for making sure landlords receive

their rent as well as invoicing Veterans for their

portion of the rent. The program may offer to

become a Veteran’s representative payee or offer

other budgeting services to help ensure that

bills are paid. Although program guidelines

may vary regarding who can be designated

as the representative payee, clinical, housing,

and administrative services should be well

coordinated to ensure a Veteran’s rent is being

paid. Finally, property management staff must

address ongoing maintenance issues by holding

landlords responsible for maintaining their

apartments and negotiating repair costs in the

event of damages caused by the Veteran.

Support Services. Flexible support services

are provided through a model that matches a

Veteran’s need and for which funding can be

secured. Given Veterans’ complex services needs,

often services are provided through a multidisciplinary team approach such as Assertive

Community Treatment (ACT) or an intensive case

management (ICM) team.
H U D - V A S H R E S O U R C E G U I D E 175 

• Teams are located off-site, but are available oncall 24 hours a day, 7 days a week.

• Most services are provided in the community,

at a Veteran’s apartment, workplace, or

neighborhood. 

The choice of ACT or ICM teams is based on

current best practices within mental health

services and is limited by availability and

sustainability of funding. The Veterans Integrated

Service Network (VISN) and VA homeless

programs will need to assess available resources

vis-a-vis the needs of the Veterans when

implementing an assertive or intensive model,

matching the frequency and intensity of services

with the needs of the Veteran. The addition of VA

substance abuse specialists and cross training in

co-occurring disorders is also a key ingredient to

any HUD-VASH Housing First team.

At its core, however, PHF support services need

to be flexible and promote Veteran choice.

This has resulted in PHF’s incorporation of peer

support specialists in provider roles. Peer services

are especially important since they help reduce

inherent power differentials between Veterans

and providers; this also provides consumers

a hopeful reminder that recovery is possible.

Integrating primary care and or mental health

services through the VAMC, usually a nurse

practitioner, has also become a priority given

the prevalence of multiple and chronic physical

health conditions.

In addition, as Veterans move through recovery,

they may need fewer services. This can be

accomplished by using an ACT step-down team

or an enhanced case management team. This

flexible adjustment process provides a better

match between the Veteran and his or her service

needs, increases program capacity, and reduces

cost. When the Veteran is fully recovered, there

is a complete separation of housing and services,

because at this point, the Veteran continues to

live in the apartment with no need for program

services. The services component may simply

be simply discontinued, avoiding the need for a

potentially disruptive move. 

Coordination of Program Components. Within

PHF programs, housing loss occurs only for lease

violations, not for treatment non-compliance

or hospitalization. Some Veterans may lose

their apartment after they relapse, stop paying

bills, and are evicted by the landlord. However,

because the housing component is separate

from the clinical component, the Veteran who is

separated from an apartment is not separated

from the team’s services; eviction from an

apartment does not mean being discharged

from the program. Rather than an end to the

relationship, a Veteran’s eviction becomes a

learning opportunity on how to avoid future

mistakes. Program staff continue to work with

the Veteran through a housing loss, preventing a

return to homelessness and ensuring continuity

of care through crises.

Similarly, if a Veteran needs psychiatric inpatient

treatment, he or she enters the VAMC, local

hospital, or crisis stabilization unit, and upon

discharge, returns home to the apartment. By

separating the criteria for getting and keeping

housing from a consumer’s treatment status

(yet maintaining a close ongoing relationship

between these two components), HF programs

help prevent the recurrence of homelessness

when Veterans relapse into substance abuse

or a psychiatric crisis. When necessary, team

members can provide intensive treatment or

facilitate admission to a hospital to address the

clinical crisis – there is no need for eviction; after

treatment, the person simply returns home.

3. Recovery Orientation

The PHF approach embodies a recovery

orientation that is now the cornerstone of mental

health service reform (New Freedom Commission

on Mental Health, 2003). The rise of the recovery

movement itself can be understood as addressing

long held misconceptions that serious mental

illness is a lifelong, crippling, degenerative

condition (Hopper, 2007). Instead, research has

shown that recovery is not only a possibility, but

a reasonably attainable goal for persons with

serious mental illness (Harding et al, 1987). 
176 H U D - V A S H R E S O U R C E G U I D E

The PHF approach and value base embraces

many aspects that are central to the recovery

movement (Onken et al, 2007), including the

following principles:

• Hope-instilling practice is crucial

• Relationships are foundational

• Opportunities/choices/options really matter

• Peer support and recovery role models are of

primary importance

• People need knowledge and skills to selfmanage their condition

• An emphasis on holistic wellness and positive

lifestyle is healing

The PHF recovery orientation means that once

Veterans have housing, they should continue

to choose the type, sequence and intensity of

services as much as possible (Salvers et al, 2007).

Providers use a harm reduction approach when

addressing substance use and mental health issues

and incorporate a“stages of change”model within

treatment (Prochaska et al, 1992), which recognizes

that Veterans may choose to address different

problems at different timesin different ways.

While staff encourages increased participation

in mental health treatment and supports a

decrease in substance abuse, they must develop

a non-judgmental stance since Veterans are not

required to accept any formal clinical services

such as taking psychiatric medication, seeing

a psychiatrist, or working with a substance use

specialist. Instead, Veterans choose their own

treatment options and then learn whether these

choices result in a life they value. Staff must learn

to partner and collaborate with Veterans as they

experiment with personal decision making, which

constitutes a trauma-informed approach in which

Veterans are empowered to regain a sense of

control and security in their lives.

4. Community Integration

Government policies and judicial court decisions

support the idea of recovery through a trend

toward community integration and societal

accommodation.5 The PHF accomplishes this

5

 Consider ADA, 1990; DHHS, 2003; Olmstead v. L.C., 1999

by providing housing in the form of scatteredsite apartments, rather than congregate or

institutional settings, and by providing flexible

supports in a Veteran’s apartment, workplace,

or neighborhood) rather than limiting access

to facility-based settings. In short, the various

settings for implementing the PHF program are

not based on the campus of VAMC’s, transitional

living in a VA Grant Per Diem Program, licensed

residential treatment, or large congregate living

facilities in the community with restrictive

admission criteria; instead they are the same

apartments available to any other person in the

community.

Housing. Within the PHF program, Veterans

have the same rights and responsibilities as all

other tenants holding a standard lease. They

are required to pay a percent of their income in

rent. While Veteran-choice drives the provision

of housing (location, type, etc.), housing

and neighborhood choices are restricted by

affordability and suitability of available units. 

To ensure the integration of Veterans into the

community, particularly those with psychiatric

disabilities, the program limits leases to no more 

than 20% of the units in any one building so as not

to create a ‘mental health’building. Apartments

are rented at fair market value and meet HUD’s

Housing Quality standards.

Services. Veterans agree to meet with program

staff several times a month, including home visits,

in order to maintain communication and identify

any problems associated with independent living.

Program staff encourage and foster normative

relationships with landlords, neighbors, family,

and other naturalsupport networksthat promote

community living, with servicestailored to the

individual needs of each Veteran. A typical home

visit consists of a conversation between the Veteran

and the staff that provides an opportunity to assess

the Veteran’s environment and general wellbeing,

and, most importantly,servicesto maintain open

channels of communication. Staff offer assistance

with any domain the Veteran wishesto address

from apartment repairs, to finding a job, to

mending broken ties with family members. 
H U D - V A S H R E S O U R C E G U I D E 177 

PHF Program Operations

While the PHF program principles outlined above

describe much of the program, there are several

important operational considerations worth

highlighting, including home visits, the role of the

clinical team in housing, and the use of interim

housing.

Home Visits

The home visit representsthe heart and soul of

the program. It is a targeted clinical intervention

where important communication takes place and

where the change happens — in Veterans’and their

families own environments. There is a lack of formal

boundaries when making a home visit, and therefore

it is essential that the staff always maintains clinical

and ethical boundaries. Making a home visit provides

an opportunity to make innumerable observations

about a Veteran’slife. In some ways, it is a very

intimate experience, in that it allows a member of

the treatment team accessto the very center of the

Veteran’slife. Staff not only ask about, but actually

observe, how a Veteran is managing and maintaining

the living space; bedrooms, bathrooms and kitchens

can provide enormous amounts of data to the trained

observer. 

Scheduling

In many ways, the home visit really starts before

the actual visit. It begins as a discussion with the

Veteran, and it continues while working out a time

that is convenient for the Veteran. Spontaneous

home visits should only be done if there are

concerns that a client is in danger or hurt, and only

after all other ways to contact the client have been

exhausted.Building relationships, after all, takes

time—especially when some Veterans are suspicious

of a team’s motives and are convinced that the team

has the power to take the apartment away (the team

does not have that power).

Providing Services

Home visits often include the provision of services

such as medication delivery, counseling, and

nuts-and-bolts activities. Much of the routine

conversation during a home visit centers around

specific clinical services, instrumental or housing

needs, scheduling new or follow-up appointments,

family issues, safety, financial management,

transportation, shopping and other areas discussed

at length during the development of the treatment

plan. During the early phases of the program

Veterans may deny problems or troubling issues

they are facing. To foster trust, team members

must convey acceptance and concern—not 

judgment. Home visits can create an opportunity

to connect and work on developing a deeper and

more authentic relationship. To do this, HUD-VASH

team members must be focused but not hurried or

rushed. It is important to realize that

• Veterans will not open up and ask for help

unless they first trust the staff member, and 

• Unless Veterans trust the staff member, they

may not be home when the visit occures.

One of the interesting things about a home visit,

however, is the way it creates a shift in power

dynamics between client and staff. The home visit,

after all, occurs on the Veteran’s own turf. This,

coupled with the PHF program philosophy that does

not mandate participation in treatment as condition

for keeping housing, poses an interesting challenge

for the team member: Veterans will only welcome

or tolerate a visit as long as they find it useful or

engaging.

Gathering information 

Successful home visits provide staff with an excellent

opportunity to assess how someone is doing, as well

as examine the condition of the apartment. Team

members can learn an enormous amount about

Veterans by carefully observing their living space.

• What is the meaning of the empty wine bottles

on the kitchen counter?

• Who are the people in that new picture taped to

the fridge?

• The shoes in the doorway are of a different size,

who do they belong to?

• There are still no pictures hanging from these

walls...does the person feel at home?

• Is that a new crack in the wall near the window?
178 H U D - V A S H R E S O U R C E G U I D E

The information obtained during a routine home

visit can stored, noted, asked about, used as a

baseline for the client’s modus operandi, or serve as a

reason to intervene. Answers to these questions will

inform the way the team approaches the client. This

information is also crucial to preventing a possible

housing crisis.

Clinical Team’s Role in Housing

The clinical team works closely with the housing

agency to ensure that an appropriate apartment

is located. The clinical team attends every

meeting, accompanies the client when he or she

views apartments, and—after the client selects

an apartment—the clinical team works with the

housing authority to expedite the lease signing. 

It is usually the clinical team that ensures that the

apartment is fully furnished and is equipped with all

that is needed, along with the set up of all utilities,

prior to the client’s move-in day. As previously

mentioned, it is helpful to have agreements with

furniture providers or local furniture banks for

specific furniture packages. This ensures that

furnishing the apartment does not slow the movein process. The clinical team also ensures that the

client’s rent is paid on time every month, and the

team works with the client to establish a monthly

budget so that all utilities are paid in full on their

due date. At times, this may make it necessary to

become the client’s representative payee if he or

she is having difficulty prioritizing rent and utility

payments.

Although the clinical and housing services provided

to clients under the PHF model are separate, they are

also complementary.  It is essential for the housing

staff and clinical staff to meet on at least a weekly

basis, because it usually takes both teams to address

problems as they arise. A frequent occurrence in an

apartment is that something will break, such as a

window, stove, or light switch. The clinical team or

the client then alerts the housing staff, who then

works with the building manager and the client

to set up a time for this repair. This can go very

smoothly if the teams are working well together,

or it can become a great source of frustration and

difficulty for the client if the housing and clinical

teams are not well coordinated.

Another area requiring close communication is

the tracking and reporting of responsibilities to

governing authorities and funding agencies. The

best way to do this is by maintaining frequent,

clear communication between housing and clinical

services. The need for seamless coordination cannot

be emphasized enough. Clinical and housing staff

must be open with each other about their concerns

and priorities, and both teams must be committed

to Housing First and client-driven care.

The Housing Process and Use of Interim Housing

One important part of the initial intake process

involves determining the client’s housing

preferences. This is accomplished during the

interview or by completing a housing preferences

form that helps the client convey to staff what he

or she likes and needs in an apartment. The client

is asked about neighborhood location preferences,

whether he or she needs special accommodations

(such as grab bars in the bathroom), whether the

ground floor or upper floor is preferred, and about

other matters that will enable staff to help the client

adjust to the new unit. Often, both the housing

specialist (the staff person responsible for locating

units) and a clinical staff member meet the client

to discuss housing preferences. This information

guides the search for the unit. 

Clients are informed that, once a unit is found, they

will be shown the unit to ensure it is acceptable to

them before they commit to signing a lease. They

are also informed that the unit will be furnished

and they get to select the furniture, and they are

given information concerning utilities and other

household and lease issues.

Clients are provided with a time frame for the

completion of the activities. The time frame

provides an estimate of how long it takes to find a

unit, meet the landlord, sign a lease, order furniture

and complete all the other steps between intake

and the move-in date. This time frame explains the

process and helps clients mange their expectations

about the process. In general, the entire process

takes between two and six weeks.

Landlords sometimes request interviews with

prospective tenants. In these cases, the staff

prepares the client for the interview by posing
H U D - V A S H R E S O U R C E G U I D E 179 

possible questions and reviewing the type of

information the client should or should not disclose

to the landlord.

Finding a safe, affordable apartment typically takes

about two weeks, and clients are assured that

they do not have to take the first apartment they

are shown. They are usually given two or three

apartments from which to choose, however, more

often than not, clients select the first unit they are

shown. 

The use of interim housing is recommended when

working with clients who are literally homeless and

staying on the streets or in parks, train stations or

other public places. Interim housing is also useful

when the referring institution is a jail or prison and

the client is about to be released.

Ideally, immediately after the client agrees to

enroll in the PHF program, the ACT or ICM team is

prepared to take steps and help the client exit from

homelessness that same day. This can be easily

and effectively accomplished if the program has

an established relationship or agreement with the

local YM/YWCA, motel, or other short-term housing

setting and can pay for the client to stay in such

interim housing until an apartment is secured. This

type of interim housing has several advantages:

• The client gets some rest and begins to feel

better.

• Team members gain the client’s confidence that

this PHF program can make things happen.

• Team members are viewed as trustworthy

because they are true to their word.

• The client begins to believe that things might

really change.

• Team members can easily locate the client the

next day for follow up. 

During this interim period, team members meet

frequently with the new client to ensure that

day-to-day needs are met. They address health

issues; apply for benefits, identifications, or other

needed documents; clear outstanding warrants

or other legal issues; and attend to any number

of other matters that need to be addressed given

the enormity of the impending transition. While

preparing for move-in day, discussions and activities

usually focus on plans and expectations about the

new place, choosing and purchasing furniture,

utilities, neighborhood amenities, safety, shopping,

transportation, anticipation about people clients

need to contact, or clients’ concern about those left

behind.

Interim housing is not an essential component of

the program, and it may not be necessary if the

client who is homeless is referred from an institution

such as a psychiatric hospital or shelter. In these

instances, it is possible to enroll the client into the

program and begin the search for an apartment. The

client can leave the institution with the PHF team,

see and choose an apartment, and return to stay

in the institution during the brief period that the

apartment is prepared.

Conclusion

The success of the Housing First approach has

resulted in its endorsement by the US Interagency

Council on the Homeless, which include 15 federal

agencies and several advocacy groups. In June 2010

the Council unveiled the nation’s Five Year Strategic

Plan to Prevent and End Homelessness (Opening

Doors, 2010), with secretaries Donavan (HUD),

Sibelius (HHS), and Shinseki (VA) presenting the plan.

Secretary Shinseki’s pledge to end homelessness

for Veterans during the next five years included

implementing Housing First as one of five major

strategies endorsed by the Council.

The Housing First component of the HUD-VASH

program is a natural evolution in a VA recoveryoriented program, since Veterans essentially drive

their own care by utilizing the permanent Housing

Choice Vouchers and accessing an array of services

offered by HUD-VASH Case Managers, the local

area VA Medical Center, or other community-based

services. In order to end chronic homelessness

among Veterans, the Housing First program will

target those Veterans most in need of permanent

housing, with co-occurring mental health and

substance use disorders. 

The VA HUD-VASH program will be expanded into

a model that implements the key features of an

Assertive Community Treatment (ACT) Model, or

Intensive Case Management Model including an

offer of treatment and vocational/employment
180 H U D - V A S H R E S O U R C E G U I D E

opportunities based on the preferences and needs of

the Veteran over time. This will require organizational

strategic planning, training and technical assistance

at the Veterans Integrated Systems Network (VISN)

level and local VAMC levels with support from the

National Center on Homelessness among Veterans.

Through cooperation between HUD and VA, a

Housing First approach can be realized for Veterans,

many of whom have been homeless for years

and who have been diagnosed with psychiatric

disabilities, addiction disorders, acute and chronic

health problems. In order to guarantee success, the

program must adhere to fidelity to the PHF program

model. 

The program is committed to providing permanent

housing and supports and is designed in a manner

that provides each Veteran with multiple chances

to succeed. The foundation of the program’s

success is rooted in its Veteran-driven approach. It

is extremely successful in engaging Veterans since

it offers housing and services on the Veteran’s

terms: it provides almost immediate access to one’s

own apartment without requiring treatment and

sobriety as a prerequisite for housing. A well-trained,

recovery-focused HUD-VASH case management

and/or clinical support staff makes frequent house

calls and supports the client to achieve their selfstated goals. While some Veterans move into their

first apartment and manage well from the onset,

others may need to live in two or three apartments

before they can manage their lives and their housing

effectively. The program does not give up; it makes a

long term commitment to do everything possible to

help the person leave homelessness and begin their

journey of recovery.

References

Deegan, P. E. (1992). The Independent Living

Movement and people with psychiatric disabilities:

taking back control over our own lives. Psychosocial 

Rehabilitation Journal, 15, 3-19.

Harding, C., Zubin, J., & Strauss, J. (1987). Chronicity

in schizophrenia: Fact, partial fact, or artifact?

Hospital and Community Psychiatry, 38, 477-486.

Henwood, B.F., Stanhope, V., & Padgett, D.K. (2010).

The role of housing: A comparison of front-line

provider views in Housing First and traditional

programs. Administration and Policy in Mental Health 

and Mental Health Services Research, on-line, June.

Hopper, K. (2007). Rethinking social recovery in

schizophrenia: What a capabilities approach might

offer. Social Science & Medicine, 65, 868-879.

New Freedom Commission on Mental Health. (2003).

Achieving the promise: Transforming mental health 

care in America. Final Report. DHHS Pub. No. SMA-03-

3832. Rockville, MD: U. S. Department of Health and

Human Services.

Onken, S. J., Craig, C. M., Ridgway, P., Ralph, R. O.,

& Cook, J. A. (2007). An analysis of the definitions

and elements of recovery: a review of the literature.

Psychiatric Rehabilitation Journal, 31(1), 9-22.

Prochaska, J. O., & DiClemente, C. C. (1992). Stages

of change in the modification of problem behaviors.

Progress in Behavior Modification, 28, 183-218.

Salyers, M. P., & Tsemberis, S. (2007). ACT and

recovery: integrating evidence-based practice

and recovery orientation on assertive community

treatment teams. Community Mental Health Journal, 

43(6), 619-641.

Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing

First, consumer choice, and harm reduction for

homeless individuals with a dual diagnosis. American 

Journal of Public Health, 94(4), 651-656.

U.S. Department of Housing and Urban

Development, (2007). The Annual Homeless

Assessment Report to Congress, Washington, DC.

United States Interagency Council on Homelessness.

(2010). Opening Doors Federal Strategic Plan to 

Prevent and End Homelessness. Washington, DC.

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about

Pathways Housing First.

1) An offer of independent, permanent housing

must be made without strings attached, and

without expectations that Veterans must first

demonstrate that they have earned this right to

housing.
H U D - V A S H R E S O U R C E G U I D E 181 

2) Once housed, PHF gradually begins to require

participation in psychiatric treatment and/or

sobriety as a condition of keeping housing.

3) It is expected that more than 80% of homeless

Veterans—regardless of the severity of their

mental health condition and addictions—can

remain stably housed using the PHF program.

4) The PHF model requires only two conditions in

addition to paying rent 1) regular staff visits to the

apartment and 2) the terms and conditions of a

standard lease with full tenant rights.

5) Peer services are especially important in PHF

because they help to reduce inherent power

differentials between Veterans and providers.

6) The PHF approach embraces many aspects that

are central to the recovery movement.

7) PHF limits leases to no more than 20 percent of

the units in any one building.

8) Some Veterans may need to live in two or three

apartments before they can manage their lives

and their housing effectively.

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) The PHF model was born out of frustration

with and stands in stark contrast to traditional

approaches to homeless services in which

treatment requirements and expectations of

consumer stability have interfered with ending

an individual’s experience of homelessness. How

does the underlying philosophy of traditional

approaches differ from that of PHF?

2) What are four key program principles of Pathways

Housing First?

3) In many ways, the home visit is the “heart and

soul of the program.”What are some concrete

practices that can make home visits a tool in

recovery and housing stabilization?

4) The PHF model strives to help clients exit from

homelessness the same day they enroll in the

program. This can be easily and effectively

accomplished by having established relationships

with nonprofits and businesses that provide

nightly lodging. What are some of the advantages

to this interim housing?
182 H U D - V A S H R E S O U R C E G U I D E

What’s in This Chapter?

There are a number of benefits that HUD-VASH

Veterans may be entitled, but are not receiving,

because of the instability of their lives while

homeless.

In this chapter you will learn

• The different types of benefits,

• Which forms are needed for claims,

• How to file a claim, and

• What the Post 9-11 GI Bill and other GI Bills

cover.

After reading this chapter, you will be familiar with

the benefits for which Veterans on your caseload

may be eligible, and you will be better prepared to

help them access these benefits.

Getting Connected with VA Benefits

Homelessness among Veterans is a recognized issue

accross the nation, and the Department of Veterans

Affairs (VA) has a duty to provide assistance to this

population in need. VA has an obligation to ensure

that Veterans who are homeless have access to VA

benefits and are receiving the benefits they have

earned. 

VA provides several different benefits, such as

financial assistance based on service-connected

disabilities or need, employment services, housing

assistance through a VA-guaranteed loan, and

education/training. The purpose of this chapter

is to provide key information and resources on

VA benefits to aid in ending and preventing

homelessness among Veterans.

PART 2 C H A P T E R 1 0

Working with VBA to assist Clients in Obtaining Benefits

What are the needs and interests of the Veteran 

who is experiencing homelessness?

• Income and financial support

• Employment and vocational services

• Housing assistance through a home loan

guarantee or refinancing

• Education and training

Income and Financial Support

Compensation Benefits

Disability compensation is a tax-free monthly benefit

paid to Veterans for disabilities, diseases, or injuries

that happened during, or were aggravated by, active

military service. The Veteran’s discharge must have

been under other than dishonorable conditions. The

monthly amount paid is determined by the Veteran’s

level of disability. 

Please see compensation benefit rate tables at

http://www.vba.va.gov/bln/21/rates/. 

Pension Benefits

Pension is an income-based monthly benefit paid to

Veterans with honorable wartime service who are

age 65 or older or who are permanently and totally

disabled due to disability that is not related to military

service. The Veteran’s discharge must have been

under other than dishonorable conditions conditions.

Compensation benefit rate tables are available at

http://www.vba.va.gov/bln/21/rates/.

VA Forms to Claim Compensation and/or Pension 

Benefits

Links to these forms are provided below for Veterans

who choose to complete the forms in hard copy,

whether via computer or by hand. The VONAPP
H U D - V A S H R E S O U R C E G U I D E 183 

link, also below, is the link to an online benefits

application portal. Each of these applications, along

with instructions, is also available in the appendix of

this Resource Guide.

VA Form 21-526 - Compensation and/or Pension

http://www.vba.va.gov/pubs/forms/vba-21-526-are.pdf

VA Form 21-526 EZ - Compensation only; see page

one of the form for the EZ criteria

http://www.vba.va.gov/pubs/forms/VBA-21-526EZARE.pdf

VA Form 21-527 - Pension only

http://www.vba.va.gov/pubs/forms/VBA-21-527-

ARE.pdf

VA Form 21-527EZ – Pension only; please see page

one of the form for the EZ criteria

http://www.vba.va.gov/pubs/forms/VBA-21-527-

ARE.pdf

VA Online Application (VONAPP) – Compensation

and/or Pension

https://www.ebenefits.va.gov/

If the claimant has already filed an initial claim for

compensation, he/she may use VA Form 21-4138, 

Statement in Support of Claim, or any sheet of paper

to do the following: 

• Claim new conditions for service-connection,

• Reopen a previous claim, and/or

• Include VA Form 21-4142, Authorization and 

Consent to Release Information to the Department 

of Veterans Affairs, in order to allow the Regional

Office to request records from a private facility.

This form is available at

http://www.vba.va.gov/pubs/forms/VBA-21-4142-ARE.pdf

and in the appendix of this Resource Guide

VA Form 21-4138 can be found at

http://www.vba.va.gov/pubs/forms/vba-21-4138-are.pdf;

it is also included in the appendix at the back of this

Resource Guide.

The following documents may be submitted with 

the application/claim:

• Original or certified copy of the Veteran’s

DD-214 or official separation or discharge

documents

• Medical evidence (doctor or hospital reports)

• VA Form 21-4142, Authorization and Consent 

to Release Information to the Department of 

Veterans Affairs, used for the Regional Office to

request records from a private facility with the

claimant’s permission

• Dependency records (marriage and/or children’s

birth certificates)

• Service treatment records and other military

documents

• Statements from the Veteran, witnesses, family

members, etc. to support the claim

• Any other information in support of the claim

Ways to file a VA claim:

1) Apply online with the Veterans On-Line

Application (VONAPP) through the eBenefits

portal at http://www.ebenefits.va.gov.

2) Another option is to complete the application

or claim and submit it to the nearest VA

Regional Office, either in person or by mail. A

list of locations is available at

http://www.vba.va.gov/bln/21/ro/rocontacts.htm.

If you choose to mail your paperwork, click on

the links under“VA Regional Office.” 

3) Call 1-800-827-1000 for assistance.

4) Visit a VA Medical Center, clinic, or Vet Center. 

5) Contact a Veterans Service Organization.

6) Contactthe State/TerritoryVeteransAffairsOffices.

Employment and Vocational Services

Vocational Rehabilitation and Employment 

(VR&E) VetSuccess Program (Chapter 31)

The VR&E VetSuccess program assists Veterans

with service-connected disabilities to prepare for,

find, and keep suitable jobs. For Veterans with

service-connected disabilities so severe that they
184 H U D - V A S H R E S O U R C E G U I D E

cannot immediately consider work, VetSuccess

offers services to improve their ability to live as

independently as possible. It is sometimes referred

to as the Chapter 31 program.

Eligibility

To receive an evaluation for vocational rehabilitation

services, a Veteran must

• Have received, or eventually receive, an other

than dishonorable discharge, and

• Have a VA service-connected disability rating of

at least 10% or a memorandum rating of 20% or

more.

The law generally provides for a 12-year basic period

of eligibility in which services may be used. The 12-

year period begins on the latter of these dates:

• Date of separation from active military duty or

• Date the veteran was first notified of a serviceconnected disability rating

How to apply for Vocational Rehabilitation 

services:

1) Apply online with the Veterans On-Line

Application (VONAPP) through the eBenefits

portal at http://www.ebenefits.va.gov.

2) Complete and submit VA Form 28-1900,

Disabled Veterans Application for Vocational 

Rehabilitation, http://www.vba.va.gov/pubs/

forms/VBA-28-1900-ARE.pdf, which is also

located in the appendix in the back of this

Resource Guide. This can be submitted online,

in person, or by mail. Mailing addresses are

available at

http://www.vba.va.gov/vba/benefits/offices.asp

by clicking on the claimant’s state of residency.

Process

A Veteran who is eligible for an evaluation under

Chapter 31 and has applied for services must receive

an appointment with a Vocational Rehabilitation

Counselor (VRC). A Comprehensive Evaluation is

completed with the VRC that includes

• A full assessment of the Veteran’s interests,

aptitudes, and abilities to determine whether

the Veteran is“entitled”to VR&E services,

• An assessment of whether service-connected

disabilities impair the Veteran’s ability to find

and/or hold a job using the occupational skills

already attained, and

• Vocational exploration and goal development.

The VRC will help a Veteran found not to be

entitled to services to locate other resources that

address any rehabilitation and employment needs

identified during the evaluation. Referral to other

resources may include state vocational rehabilitation

programs; Department of Labor employment

programs for disabled veterans; state, federal or local

agencies providing services for employment or small

business development; internet-based resources for

rehabilitation and employment; and information

about applying for financial aid.

Housing Assistance through a Home Loan 

Guaranty or Refinancing

Home Loan Guaranty Service

The VA Home Loan Guaranty program helps eligible

Veterans purchase, retain, and adapt homes. VAguaranteed loans are made by private lenders,

such as banks, savings and loan associations, and

mortgage companies. When the loan is approved,

VA will guarantee part of it, which protects the

lender against loss up to the amount guaranteed by

VA.

Eight Basic Steps for a Veteran to Obtain a VABacked Home Loan:

1) Find a realtor with whom to work.

2) Locate a lending institution that participates in

the VA program.

3) Apply and obtain a Certificate of Eligibility.

This can be completed online via eBenefits ,

through the lender, or by mailing VA Form 26-

1880, Request for a Certificate of Eligibility, to the

Eligibility Center in Winston Salem, NC.

4) Find a home to buy. The purchase and sales

agreement should contain a “VA option clause”
H U D - V A S H R E S O U R C E G U I D E 185 

and an“escape”from the contract without

penalty in case the Veteran can’t get a VA loan.

5) Formally apply to the lender for a VAbacked loan. The lender will complete a loan

application and gather the needed documents

such as pay stubs and bank statements.

6) The lender orders a VA appraisal and begins to

“process” all the credit and income information. 

(VA’s appraisal is not a home inspection or a

guaranty of value. It’s just an estimate of the

market value on the date of the inspection.

Although the appraiser does look for obviously

needed repairs, VA doesn’t guarantee the

condition of the house. The appraiser, who is

licensed, is not a VA employee.)

7) The lending institution reviews the appraisal

and all the documentation of credit, income,

and assets. The lender then decides whether

the loan should be granted.

8) Finally, the closing takes place and the

property is transferred. The lender chooses a

title company, an attorney, or one of their own

representatives to conduct the closing. This

person will coordinate the date and time.

If the Veteran has any questions during the process

that the lender can’t answer, the Veteran may

contact VA at his/her closest regional loan center.

How to apply for home loan guaranty services:

1) Apply online. Go to the eBenefits portal

(http://www.ebenefits.va.gov) and click on

the My eBenefits tab towards the top, on the

left side.  It will open a screen with several

benefit areas.  On the bottom right of the

screen is the Housing tab.  You will need

login credentials to request a Certificate of

Eligibility (COE).  If you have them, enter

your Username and Password, if you need to

request login credentials, you can simply click

on the “Request/Activate a DoD Self-Service

Logon” link which is shown below the area

where you logon.

2) Apply through the lender. In many cases,

lenders can obtain a Certificate online in

minutes.

3) Apply by mail. Use VA Form 1880, http://

www.vba.va.gov/pubs/forms/vba-26-1880-are.pdf,

and return it to the address shown on the

form. The form is also available at the back of

this Resource Guide; however, if you would like

a form mailed to you, call 1-888-244-6711 and

follow the prompts for Eligibility.

Refinancing

Veterans with conventional home loans have

options for refinancing to a VA-guaranteed home

loan. Veterans who wish to refinance their subprime

or conventional mortgage may do so for up to 100

pct of the value of the property. The loan limit is

$417,000. High cost counties have even higher

maximum loan limits. VA County Loan Limits can be

found at http://www.benefits.va.gov/homeloans/. 

Qualified Veterans can refinance through VA, which

allows for savings on interest costs and avoids

foreclosure. A VA refinancing loan also may help a

Veteran who is facing a big payment increase.

Education and Training

1) Post 9/11 GI Bill (Chapter 33)

2) Montgomery GI Bill – Active Duty (MGIB-AD)

3) Montgomery GI Bill – Selected Reserve

(MGIB-SR)

4) Reserve Educational Assistance Program

(REAP)

5) Survivors’ and Dependents’ Education

Assistance (DEA)

1) Post 9/11 GI Bill (Chapter 33)

The Post-9/11 GI Bill provides financial support for

education and housing to individuals with at least

90 days of aggregate service on or after September

11, 2001, or individuals discharged with a serviceconnected disability after 30 days. Veterans must

have received an honorable discharge to be eligible

for the Post-9/11 GI Bill.

The Post-9/11 GI Bill will pay the individual’s tuition

based upon the highest in-state tuition charged by

a public educational institution in the state where
186 H U D - V A S H R E S O U R C E G U I D E

the school is located. The amount of support that an

individual may qualify for depends on where they

live and what type of degree they are pursuing.

This Post 9-11 GI Bill will pay eligible individuals:

• Tuition & fees directly to the school not to

exceed the maximum in-state tuition & fees at a

public Institution of Higher Learning. See chart

listing maximum in-state tuition rates

• For more expensive tuition, a program exists

which may help to reimburse the difference. This

program is called the “Yellow Ribbon Program”.

• A monthly housing allowance based on the

Basic Allowance for Housing for an E-5 with

dependents at the location of the school.

• An annual books & supplies stipend of $1,000

paid proportionately based on enrollment.

• A one-time rural benefit payment for eligible

individuals.

Please refer to the Post 9/11 GI Bill website for

updates and information on the upcoming changes

to the Post 9/11 GI Bill program. 

2) Montgomery GI Bill – Active Duty (MGIB–AD)

The MGIB program provides up to 36 months

of education benefits. This benefit may be

used for degree and certificate programs, flight

training, apprenticeship/on-the-job training and

correspondence courses. Remedial, deficiency, and

refresher courses may be approved under certain

circumstances. Generally, benefits are payable for 10

yearsfollowing your release from active duty. This

program is also commonly known as Chapter 30.

The monthly benefit paid to the individual is

based on the type of training he/she takes, length

of his/her service, his/her category, and if DOD

put extra money in his/her MGIB Fund (called

“kickers”). The individual usually has 10 years to

use his/her MGIB benefits, but the time limit can

be less, in some cases, and longer under certain

circumstances.

3) Montgomery GI Bill – Selected Reserve

(MGIB–SR)

The MGIB-SR program may be available to an

individual if he/she is a member of the Selected

Reserve. The Selected Reserve includes the Army

Reserve, Navy Reserve, Air Force Reserve, Marine

Corps Reserve and Coast Guard Reserve, and the

Army National Guard and the Air National Guard.

The individual may use this education assistance

program for degree programs, certificate or

correspondence courses, cooperative training,

independent study programs, apprenticeship/

on-the-job training, and vocational flight training

programs. Remedial, refresher and deficiency

training are available under certain circumstances.

Eligibility for this program is determined by the

Selected Reserve components. VA makes the

payments for this program.

The individual may be entitled to receive up to 36

months of education benefits. Eligibility for the

program normally ends on the day the individual

leaves the Selected Reserves.

To qualify, the individual must meet the 

following requirements:

• Has a six-year obligation to serve in the Selected

Reserve signed after June 30, 1985. If he/she

is an officer, he/she must have agreed to serve

six years in addition to the original obligation.

For some types of training, it is necessary to

have a six-year commitment that begins after

September 30, 1990;

• Complete initial active duty for training (IADT);

• Meet the requirement to receive a high school

diploma or equivalency certificate before

completing IADT. (the individual may not use

12 hours toward a college degree to meet this

requirement);

• Remain in good standing while serving in an

active Selected Reserve unit. The individual will

also retain MGIB - SR eligibility if he/she was

discharged from Selected Reserve service due to

a disability that was not caused by misconduct.

The individual’s eligibility period may be

extended if he/she is ordered to active duty.
H U D - V A S H R E S O U R C E G U I D E 187 

4) Reserve Educational Assistance Program (REAP)

REAP was established as a part of the Ronald

W. Reagan National Defense Authorization

Act for Fiscal Year 2005. It is a Department of

Defense education benefit program designed

to provide educational assistance to members

of the Reserve components called or ordered

to active duty in response to a war or national

emergency (contingency operation) as declared

by the President or Congress. This program makes

certain reservists who were activated for at least

90 days after September 11, 2001 either eligible

for education benefits or eligible for increased

benefits.

5) Survivors’ and Dependents’ Education 

Assistance (DEA)

Dependents’ Educational Assistance provides

education and training opportunities to eligible

dependents of certain Veterans. The program

offers up to 45 months of education benefits.

These benefits may be used for degree and

certificate programs, apprenticeship, and on-thejob training. If the individual is a spouse, he/she

may take a correspondence course. Remedial,

deficiency, and refresher courses may be

approved under certain circumstances.

Eligibile individuals must be the son, daughter, or 

spouse of

• A Veteran who died or is permanently and

totally disabled as the result of a serviceconnected disability. The disability must arise

out of active service in the Armed Forces.

• A Veteran who died from any cause while such

service-connected disability was in existence.

• A Servicemember missing in action or captured

in line of duty by a hostile force.

• A Servicemember forcibly detained or interned

in line of duty by a foreign government or

power.

• A Servicemember who is hospitalized or

receiving outpatient treatment for a service

connected permanent and total disability and

is likely to be discharged for that disability. This

change is effective December 23, 2006.

VA Forms for Education Benefits

VA Form 22-1990, Application for VA Education 

Benefits

http://www.vba.va.gov/pubs/forms/vba-22-1990-

are.pdf

You may also complete and submit your application

form online at www.gibill.va.gov. Click “Apply

Online”; other resources are also available

VA Form 22-5490, Dependents’ Application for VA 

Education Benefits

http://www.vba.va.gov/pubs/forms/vba-22-5490-

are.pdf

You may also complete and submit your application

form online at www.gibill.va.gov.

Rate tablesfor most education benefits can be found

at http://www.gibill.va.gov/resources/benefits_resources/

rate_tables.html

Additional Assistance

VBA Veterans Homeless Outreach Program:

Veterans experiencing homelessness and Veterans

transitioning out of incarceration are the primary

beneficiaries of the VBA’s Homeless Veterans

Outreach program. To reach a VBA Homeless

Veterans Outreach Coordinator, call VBA’s National

Call Center at 1-800-827-1000.

VBA’s National Call Center

1-800-827-1000

eBenefits

EBenefits is an online, self-service portal for Service

Members and Veterans to access their personalized

DoD and VA information.

Some key features of eBenefits include

• Check the status of compensation and/or

pension claims,

• View payment history of received VA benefits,

• Obtain or submit an application for the home

loan certificate of eligibility,
188 H U D - V A S H R E S O U R C E G U I D E

• Access MyHealtheVet directly from eBenefits

and vice versa,

• Access and retrieve copies of official military

personnel records to include DD-214’s and

active/reserve orders.

Veterans may receive a premium eBenefits account

at any VA Regional Office by presenting two forms

of identification. A premium account can also be

obtained through the in-person-authentication

process for a MyHealtheVet account at VA medical

facilities. 

Test Your Knowledge!

Quick Check: Answer“true or false”to the following

statements to check your knowledge about working

with VBA to assist clients in obtaining benefits.

1) VA has an obligation to ensure Veterans are

receiving accessto VA benefits and are receiving

the benefitsthey have earned.

2) Disability compensation is a tax-free monthly

benefit paid to Veteransfor disabilities, diseases,

or injuriesthat happened or were aggravated by

active military service.

3) Veterans become eligible for pension benefits

at age 60.

4) Veterans who are dishonorably discharged are

eligible to receive an evaluation for vocational

rehabilitation services. 

5) Vocational rehabilitation services are sometimes

referred to as Chapter 51.

6) The VA Home Loan Guaranty program helps

eligible Veterans purchase, retain and adapt

homes.

7) The Montgomery GI Bill has provisions for both

Active Duty and Selected Reserve Veterans.

8) EBenefitsis an online,self-service portal for

Service Members and Veteransto accesstheir

personalized DoD andVA information.

Are you an Expert? Answer these questions on your

own or with other members of your team.

1) What are the steps to filing a VA claim?

2) What are some ways that the Post-9/11/GI Bill is

similar and different from other GI Bills?

3) What are some of the key features of eBenefits?
H U D - V A S H R E S O U R C E G U I D E 189 

QUICK CHECK ANSWER GUIDE

Part 1 Chapter 1 Part 1 Chapter 6 Part 2 Chapter 3 Part 2 Chapter 8

# Answer # Answer # Answer 1 TRUE

1 TRUE 1 TRUE 1 FALSE 2 TRUE

2 FALSE 2 TRUE 2 TRUE 3 FALSE

3 FALSE 3 FALSE 3 TRUE 4 FALSE

4 TRUE 4 FALSE 4 FALSE 5 TRUE

5 TRUE 5 TRUE 5 TRUE 6 FALSE

6 TRUE Part 2 Introduction 6 FALSE 7 TRUE

7 TRUE # Answer 7 TRUE 8 TRUE

8 TRUE 1 TRUE 8 TRUE 9 TRUE

Part 1 Chapter 2 2 FALSE Part 2 Chapter 4 10 TRUE

# Answer 3 TRUE # Answer Part 2 Chapter 9

1 FALSE 4 FALSE 1 TRUE 1 TRUE

2 FALSE 5 TRUE 2 TRUE 2 FALSE

3 FALSE 6 FALSE 3 TRUE 3 TRUE

4 TRUE 7 TRUE 4 TRUE 4 TRUE

5 TRUE 8 TRUE 5 TRUE 5 TRUE

TRUE

Part 1 Chapter 3 9 FALSE 6 TRUE 6 TRUE

# Answer 10 TRUE 7 FALSE 7 TRUE

1 FALSE Part 2 Chapter 1 Part 2 Chapter 5 8 TRUE

2 TRUE # Answer # Answer Part 2 Chapter 10

3 FALSE 1 TRUE 1 TRUE 1 TRUE

4 TRUE 2 FALSE 2 FALSE 2 TRUE

5 FALSE 3 TRUE 3 TRUE 3 FALSE

6 TRUE 4 FALSE 4 TRUE 4 FALSE

7 TRUE 5 TRUE 5 FALSE 5 FALSE

8 TRUE 6 FALSE 6 TRUE 6 TRUE

Part 1 Chapter 4 7 TRUE 7 FALSE 7 TRUE

# Answer 8 TRUE 8 TRUE 8 TRUE

1 TRUE 9 FALSE Part 2 Chapter 6

2 TRUE 10 TRUE # Answer

3 FALSE Part 2 Chapter 2 1 TRUE

4 TRUE # Answer 2 TRUE

5 TRUE 1 TRUE 3 TRUE

6 TRUE 2 FALSE 4 TRUE

7 FALSE 3 TRUE 5 FALSE

8 FALSE 4 TRUE 6 TRUE

9 TRUE 5 FALSE 7 TRUE

10 TRUE 6 TRUE 8 TRUE

Part 1 Chapter 5 7 TRUE 9 TRUE

# Answer 8 FALSE Part 2 Chapter 7

1 FALSE 9 TRUE # Answer

2 TRUE 10 TRUE 1 TRUE

3 TRUE 11 TRUE 2 FALSE

4 FALSE 12 TRUE 3 FALSE

5 FALSE 4 TRUE

5 FALSE
190 H U D - V A S H R E S O U R C E G U I D E

APPENDIX A

Comprehensive HUD-VASH Assessment 

Housing and Homelessness History – Last 5 years

Name/Location Type Start End Date Leaseholder Reason for 

Leaving

•	 Restrictions on location? Y or N Explanation

•	 Ever evicted from public or subsidized housing? Y or N

•	 Ever in foster care? Y or N

•	 Barriers to housing stability? e.g., trouble budgeting, visitors create problems, involved in illegal activity, no

experience as lease holder, history of violence

•	 Housing plan

•	 Housing goals

•	 Motivation to obtain/maintain Housing

Employment History – Last 5 Years

Employer Position/Title Wage Start End Reason for 

Leaving

•	 Employment goals

•	 Currently receiving services?

•	 Services needed to access or maintain employment

•	 Motivation to obtain employment
H U D - V A S H R E S O U R C E G U I D E 191 

Comprehensive HUD-VASH Assessment 

Benefits and Entitlements

Income Receiving Amt and 

End Date

Income Source Amt and 

End Date

Unemployment Income General Assistance

Supplemental Security Income (SSI) Retirement from Social Security

Social Security Disability Income (SSDI) Child Support

Veteran’s Disability Payment Alimony or other spousal support

Private Disability Insurance Unemployment Insurance

Worker’s Compensation Veteran’s Pension

TANF Other (list):

•	 Plan to apply for or maintain income benefits

Noncash Benefits Y or N

Food Stamps Y or N TANF Child Care Services Y or N

Medicaid Y or N TANF Transportation Services Y or N

Medicare Y or N Other TANF-funded Services Y or N

State Children’s Health Insurance Pgm Y or N WIC Y or N

Private Health Insurance Y or N Other: (list) Y or N

•	 Plan to apply for or maintain noncash benefits

•	 Barriers to Obtaining/Maintaining Entitlements:

Debts

•	 Credit status/score

•	 Plan to pay off debts

•	 Barriers to pay off debts

•	 Services needed – pick list

•	 Motivation to resolve credit/debt issues

•	 Goals

Legal

•	 Current probation/parole Status

•	 Name of PO:_______________ Date supervision ends ________________

•	 Felony history last 5 years

•	 Incarceration history – last 10 years

•	 Current involvement – e.g., engaging in criminal activity, current legal proceedings, outstanding warrants,

subject to order of protection, etc.

•	 Child support enforcement status

•	 Services needed

•	 Motivation to resolve legal issues
192 H U D - V A S H R E S O U R C E G U I D E

Comprehensive HUD-VASH Assessment 

Education History

•	 Highest Grade Completed: Some HS HS Diploma or GED Some College Associate’s Degree 

Bachelor Degree Technical Certification - Field: _____________ 

Other

•	 Current status In school Applying

•	 Education Goals

•	 Services Desired

Physical and Behavioral Health (including Trauma-related illnesses)

•	 Diagnosis: Medical, Mental Health, Substance Abuse, Mental Retardation – Include all axes

•	 Severity of each illness

•	 Treatment history for each diagnosis

•	 Names and contact info for all current service providers - Name, Organization, Phone #

•	 Describe how health issues impact housing stability

paying rent disruptive behavior hoarding noise visitors

Other: ________________________________________________________ . . .

. . . . .

•	 Current medications

•	 Adherence to medication regimen: Almost Always Sometimes Never

•	 If substance abuse diagnosis, current status and impact on functioning

Actively using and not a problem Actively using and a problem Reducing use

Abstinent: Date of Sobriety mm/dd/yy

•	 Frequency of Use: Daily Several Times Per Week Once a Week Less than 1X a Week

•	 Hospitalizations in last 3-5 years: dates, reasons, hospital names

•	 Detox in last 3 years: number of inpatient detox stays

•	 Services needed

•	 Motivation to use services:

•	 Current stage of change: pre-contemplation, contemplation, preparation, action, or maintenance

•	 Include narrative explanation

Family/Dependent Children

•	 Domestic violence/abuse history

•	 School attendance/performance of children

•	 Child custody

•	 Child care arrangements

•	 Special needs

•	 Children’s services (foster care) Involvement – status, worker name and contact

•	 Current services providers and contact information

•	 Services needed

•	 Motivation to use services
H U D - V A S H R E S O U R C E G U I D E 193 

Comprehensive HUD-VASH Assessment 

Independent Living Skills/ Supports

•	 Status of ID for all household members

•	 Nature of social and familial relationships – identify supports and significant others, also identify negative

influences and relationships

•	 History of seeking and using help/assistance

•	 Independent Living Skills Score

1 - Mostly Independent 2 - Needs Help Sometimes

3 - Needs Help Most of the Time 4 - Always Needs Assistance

1. Paying bills 1-4

2. Budgeting 1-4

3. Maintaining entitlements and other paper work 1-4

4. Maintaining a home 1-4

5. Preparing/obtaining meals 1-4

6. Travelling 1-4

7. Personal care/hygiene 1-4

8. English proficiency 1-4

9. Awareness of needs and knowing when to seek help 1-4

10. Able to access help when needed 1-4

11. Managing health/behavioral health needs and services, etc. 1-4

12. Taking medications 1-4

13. Keeping appointments 1-4

14. Discriminating danger/asserting and protecting self 1-4

Total score on Independent Living Skills (Range 14-56)

•	 Ability and motivation to improve skills:
194 H U D - V A S H R E S O U R C E G U I D E

Housing Stabilization Plan

Type of Plan: Initial Plan Update Date of Plan: From _______ to _________

Phase of Work: Housing Planning (Pre-Move) Phase 1: Transition

Phase 2: Try Out Phase 3: Transfer of Care/Termination

Goals from Previous Housing Plan (If applicable) Status/Achievements and Barriers

1

2

3

Long-Term Goal – What type of living situation does the Veterans envision for him/herself in 5 years, 10 years? :

Goals (for this assistance period)

Target 

Completion 

Date (mo/yr)

Case Manager Tasks Veteran Tasks

Goal 1: 1.

2.

3.

1.

2.

3.

Check Area:

Housing Financial Health/Mental Health

Substance Use Family and Friends Life Skills

Goal 2: 1.

2.

3.

1.

2.

3.

Check Area:

Housing Financial Health/Mental Health

Substance Use Family and Friends Life Skills

Goal 3: 1.

2.

3.

1.

2.

3.

Check Area:

Housing Financial Health/Mental Health

Substance Use Family and Friends Life Skills

Case Manager Name: Date:

Case Manager Signature: Date:

Veteran Name: Date:

Veteran Signature:

Supervisor Name: Date:

Supervisor Signature: Date:
H U D - V A S H R E S O U R C E G U I D E 195 

Housing Barriers Assessment

This assessment aimsto capture some common housing stability barriersfacing homeless people and those at risk of

homelessness. Some information may be unknown or people may refuse to answer. Thisisto be expected, although

it would be preferable to have as much information as possible. The housing barriers screen can be used to develop

the Housing Stabilization Plansfor each household and for re-assessmentsfor those that receive ongoing assistance.

Income 

	No income

	Has income but it’s below 30% of AMI

	Recent decrease in income

	Receiving unemployment or other income that is

time-limited

	Sanctioned or timed out on TANF

Debts/Expenses

	Monthly obligations exceed monthly income

	Poor credit history

	Currently in bankruptcy

	Debts to the utility company

Employment

	No High School Diploma or GED

	Unemployed

	Currently in temporary or seasonal job

	Inconsistent work history – gaps in employment or

frequent changes in jobs

	Lacks adequate transportation

Legal Issues

	Child support enforcement

	On parole

	On probation

	History of incarceration

	Felony within last 5 years

	Restrictions on housing location – e.g., sex

offender, order of protection for DV

	Outstanding warrant(s)

Housing History

	Homeless in the last 12 months

	Multiple episodes of homelessness

	Chronically homeless

	One or two legal evictions

	More than 2 evictions

	Never had own lease

	Lack of rental history of more than 1 year

	Does not have landlord references

	History of eviction from subsidized housing

	History of institutional care – e.g., state hospital, foster

care, prison

Family Status

	Custody of 3 children 

	Custody of 4 or more children

	1 or more custodial children < age of 5

	Single adult under age 22

	Head of household under 25 years old with

children or pregnant

	Current/past involvement with foster care

	Unmet child care needs

	Domestic violence survivor

	History of violence

	Has child with special needs

Children not attending school regularly

Health/Disability

	Chronic physical illness

	Health crisis, detox or hospitalization in past year

	One disabling condition such as mental illness, SA

	Multiple disabling conditions

	Disabling condition has negatively affected housing

stability

	Not in treatment for ongoing health issue(s)

Supports/Independent Living Skills

	No or limited support networks

	History of being unable/ unwilling to seek help

	Hoards

	Engaged in ongoing abusive relationship

	Limited English proficiency/literacy

	Never had driver’s license

	Any household member is lacking Government

Issued ID
196 H U D - V A S H R E S O U R C E G U I D E

APPENDIX B

Sample Case Manager Job Description 

for the Delivery of Housing Stabilization 

Services using Critical Time Intervention1

DUTIES AND RESPONSIBILITIES:

The primary responsibility of the HUD-VASH case

manager is to assist each Veteran and their families

participating in the HUD-VASH program to access

and maintain both housing and needed services

and supports that will assist them to stabilize in their

communities. The HUD-VASH program is committed

to serving chronically homeless and vulnerable

Veterans and each case manager is charged with

increasing access to the program for this population.

As a member of the team, the HUD-VASH case

manager will carry a caseload of approximately

twenty five to thirty five assigned Veterans and

their families who have been identified as meeting

the criteria for HUD-VASH services. HUD-VASH case

management services will be guided by the tenets

of Critical Time Intervention (CTI) as well as other

evidence based practices and will include, but not

be limited to the following activities: engagement,

building rapport, assessment, service and support

referrals, housing access, and follow-up housing

stabilization and retention services. Responsibilities

will also include keeping accurate records as well as

working as an advocate for the individuals on the

caseload in order to obtain appropriate services, care

and housing.

HUD-VASH Case Management

1) Establish ongoing relationships with

chronically homeless, VASH eligible Veterans,

utilizing motivational interviewing techniques

and pro-active engagement strategies

a. Maintain regular contact with identified

Veterans and their families.

b. Identify housing preferences and barriers to

access and retention

c. Identify issues of concern/need and address

as appropriate

1

 Adapted from the Department of Veterans Affairs, VHA Handbook 1162.05. 

HUD-VASH Program. Washington, DC: 2009.

d. Discuss short and long-term goals with

individual, develop and document plan to

meet them

e. Begin the housing planning process with

each Veteran

2) Establish eligibility for the HUD-VASH program

a. Verify the Veteran’s Status, eligibility for VA

medical care, need for case management

services

b. Follow the process for referrals, evaluation,

and admission to the HUD-VASH Program,

ensuring that eligible Veterans and their

families are placed into the program.

c. Continue to provide appropriate treatment

and supportive services to the potential

HUD-VASH Program participants, assisting

the Veteran in the PHA issuance of the rental

voucher process.

d. Provide housing search assistance to the

HUD-VASH Participants with vouchers.

3) Conduct assessment, referral and provide

follow-up services to individuals in appropriate

treatment, supportive and other programs

both VA based and in the community.

a. Learn about the Veteran’s (and family’s, if

applicable) treatment, housing and support

history. Discuss what worked, what didn’t

and why.

b. dentify and prioritize needed services and

target most appropriate options.

c. Assess barriers to housing stability and

target interventions accordingly. 

d. Develop a plan to access housing, services

and supports. Actively involve the Veteran

in the assessment and development of the

housing plan.

4) Work with individual to reach identified goals

emphasizing self-determination, responsibility

and respect.

a. Assist Veteran (family) with Housing

location, ID, benefits, income, employment,
H U D - V A S H R E S O U R C E G U I D E 197 

education, health, legal and other issues to

support stable tenancy and life goals.

b. Advocate for Veteran’s (family’s) needs as

necessary within larger system of services

and supports.

c. Arrange, coordinate care, and provide direct

clinical services and support.

5) Once appropriate placement is achieved,

utilize the three-phase critical time

intervention model to work with Veteran

(family) and service providers to maximize

support community integration and housing

stability.

a. With the Veteran (family): Maintain close

contact with Veteran throughout their

transition to housing, including visiting the

Veteran in their new home, and assisting the

Veteran (family) in becoming familiar with

their new community.

i. Provide direct services to the Veteran

(family) while working to connect each

with both VA and community resources.

ii. Provide direct mental health and

substance use counseling within the

scope of the practice and role as case

manager.

iii. Meet regularly with landlords, PHAs

and tenants to ensure a safe living

environment and address any tenancy

and/or subsidy issues.

iv. Provide crisis prevention and

management services as need to

maintain the Veteran (and family) safely

in the community.

v. Monitor physical and mental health and

substance use status and stability.

vi. Regularly discuss changes in psychiatric

symptoms and/ or triggers for substance

use

vii. Provide access to treatment resources

and encourage re-entry into treatment.

viii. Work to improve life and tenancy skills

by participating with Veterans in their

new housing arrangements. 

ix. Provide education on life skills such as:

credit repair, financial literacy, shopping

and maintaining a household, safety

and tenancy requirements.

x. Facilitate Veterans participation in

employment and training both within

the VA and other community resources.

xi. Remain accessible and responsive to the

Veteran and their families maintaining a

focus on HUD-VASH plan

xii. Discuss Veteran’s concerns, fears, and

frustrations, and work to resolve or

alleviate while challenging the individual

(family) to addressthese potential

obstacles of his/her long-term goals.

xiii. Make intensive efforts to locate missing

clients.

b. Work with the VAMC and Community

providers and supports: carefully coordinate

these linkages.

i. Meet together with the Veteran (family)

and providers to adjust the service

plan. The plan is to be adjusted at 3

month intervals documenting progress

towards greater independence and

housing stability.

ii. Monitor linkages to ensure it is

happening and the success or

challenges. Intervene, when necessary

and advocate on behalf of the Veteran

(and family) to fill gaps in services.

iii. Arrange for or provide transportation

for necessary appointments.

iv. Educate the providers about the HUDVASH case manager’s role with the

Veteran and their family.

v. Share information with the providers

and supports as appropriate respecting

confidentiality.

vi. Establish and encourage ongoing

communication between landlords,

PHA, VAMC, community providers, and

supports.
198 H U D - V A S H R E S O U R C E G U I D E

vii. Observe and test the housing stabilization

service plan. Update accordingly.

viii. Be prepared to step-down the case

management services as Veterans and

their families are more able to use other

resources and increase independence.

ix. Make a plan for decreased services or

transfer to non-HUD-VASH subsidies not

requiring Case Management Services.

6) Document in a timely and accurate manner in

the HUD-VASH file and the NEPEC system.

7) Develop a broad familiarity of available

treatment and supports that may be available

to Veterans and their families. Ensure that

all of the HUD-VASH team has access to the

resources developed to support all Veterans

participating in the HUD-VASH program.

a. Visit behavioral health treatment sites both

within the VA system and in the community

and know how to access them.

b. Know the behavioral health services

available for persons with various needs,

i.e. crises, medical complications, substance

abuse issues chronic/low demand.

c. Attend ongoing training to learn new ideas

in assisting persons with mental illness,

substance abuse issues, and co-occurring

disorders.

d. Develop expertise in assisting Veterans with

benefits, legal, employment and educational

opportunities.

e. Establish expertise in working with families,

both living together and apart.

8) Follow all Veterans Administration policies and

procedures to maintain professional standards

of the HUD-VASH program, safety of staff and

those we serve.

a. Participate as a full team member

b. Maintain strong relationships with

community resources

9) Participate in staff meetings, case conferences

and individual supervision.

a. Consult with Supervisor and team on strategies

forservingVeterans and their families.

10) Maintain collaborative relationships with

HUD-VASH team and VA staff, other service

providers, and professional behavior toward

the public.

Sample interview questions pertinent to PSS 

position:

1) The position you have applied for is a Peer

Support Specialist. Please describe what you

believe a peer support specialist’s role should

be and what you would envision yourself doing

in this role. Give an example of how you have

provided this type of service in the past.

2) Please share a couple of specific examples of

progress you’ve made in personal and/or work

life where you experienced a setback or challenge

and then turned the situation around to a positive

outcome.

3) Please provide specific examples of how you have

provided informal or formal support to one or

more of your peers.

4) Please discuss a specific time when you had

to negotiate with a group of people to obtain

their cooperation. Tell us specifically who you

negotiated with and what the outcome was. What

did you learn from the situation?

5) Think of a time when you had to communicate

something that you knew the other person

did not want to hear. How did you go about

communicating it? What was the outcome?

6) Please describe a time when you assumed a

leadership role (in any context). What sort of

problems came up? What did you learn about

yourself?

7) What was the most recent skill that you set out to

learn? How did you go about it?

8) Give an example of an important goal that you

have set for yourself in the past. What did you do

to reach it? How did you measure your success in

reaching that goal?

9) On a scale of 0 (lowest) to 10 (highest), please rate

your personal knowledge in the following areas
H U D - V A S H R E S O U R C E G U I D E 199 

and give examples of how you have acquired and

utilized this knowledge:

Knowledge of community resources_________

Knowledge about mental health and addiction

problems_________

Knowledge of the VA Healthcare System_________

Knowledge of recovery issues and processes

_________

10) How does being a peer support specialist in the

HUD-VASH program fit in with your life goals

for yourself? Please be specific.
200 H U D - V A S H R E S O U R C E G U I D E

Program Improvement Tool

Section Suggestion Current Practice Possible 

Improvements

Priority Rationale for Priority
H U D - V A S H R E S O U R C E G U I D E 201 

Project Planning Tool

Activities By when will this 

be done? When will 

this occur?

Who is responsible? Are any resources needed? 

Where will you get them?

Date Completed
202 H U D - V A S H R E S O U R C E G U I D E

Project Monitoring Tool

Activities Monitoring Method When will monitoring 

occur?

Who is responsible?
H U D - V A S H R E S O U R C E G U I D E 203 

While these forms are publicly available, their inclusion here 

is intended to help the HUD-VASH team maintain momentum 

in connecting Veterans with the benefits and entitlements 

that may affect housing payments, disability claims, caregiver 

benefits, etc.

APPENDIX C
204 H U D - V A S H R E S O U R C E G U I D E

FULLY DEVELOPED CLAIM NOTICE (Notice to Claimants of Information and Evidence Necessary to Substantiate a 

Claim for VA Disability Live Compensation)

VA Form FEB 2010 21-526EZ

WHAT THE EVIDENCE MUST SHOW TO SUPPORT YOUR CLAIM

 

Generally, veterans are eligible to receive compensation for disabilities related to military service. 

To support a claim for service connection, the evidence must show: 

 

 1. You had an injury in military service, or a disease that began in or was made permanently worse 

 during military service, or there was an event in service that caused an injury or disease; AND 

 2. You have a current physical or mental disability. This may be shown by medical evidence or by lay 

 evidence of persistent and recurrent symptoms of disability that are visible or observable; AND 

 3. A relationship exists between your current disability and an injury, disease, symptoms, or event in 

 military service. Medical records or medical opinions are generally required to establish this relationship. 

 However, under certain circumstances, VA may presume that certain current disabilities were caused 

 by service, even if there is no specific evidence proving this in your particular claim. The cause of a 

 disability is presumed for the following veterans who have certain diseases: 

 ● Former prisoners of war; 

 

 ● Veterans who have certain chronic or tropical diseases that become evident within a specific 

 period of time after discharge from service; 

 

 ● Veterans who were exposed to ionizing radiation, mustard gas, or Lewisite while in service; 

 

 ● Veterans who were exposed to certain herbicides, such as by serving in Vietnam; or 

 

 ● Veterans who served in the Southwest Asia theater of operations during the Gulf War. 

 

Thank you for participating in the Department of Veterans Affairs (VA) Fully Developed Claim Program. VA established the 

Fully Developed Claim Program to expeditiously process claims certified by the claimant or his/her representative as meeting 

the Fully Developed Claim criteria. 

 

Fully Developed Claim Criteria:

 1. For the purposes of this notice, your claim must be a rating-related claim for live compensation 

 (original, secondary, and increased disability service connection claims only) submitted on VA 

 Form 21-526EZ, Fully Developed Claim (Compensation). 

 

 2. You must submit, with your claim, the Fully Developed Claim Certification signed and dated by you or 

 your authorized representative. 

 

 3. You must submit with the Fully Developed Claim Certification: 

 ● All, if any, relevant, private medical treatment records for the disabilities you are claiming 

 and an identification of any treatment records from a Federal treatment facility such as a VA 

 medical center. 

 

 ● For Guard and Reserve members, any and all Service Treatment and Personnel Records in the 

 custody of your Unit(s). 

 

 ● If claiming dependents, a completed VA Form 21-686c, Declaration of Status of Dependents. 

 

 4. You must report for any VA medical examinations VA determines are necessary to decide your claim. 

 

Note: VA forms are available at www.va.gov/vaforms

 

This notice is applicable to any and all conditions claimed for service connection with your Fully Developed Claim. Upon 

receipt of the Fully Developed Claim Certification, we will expedite your claim under the Fully Developed Claim Program. If it

is determined that your claim does not meet the Fully Developed Claim criteria we will process your claim through our 

standard claim process. 

Page 1
H U D - V A S H R E S O U R C E G U I D E 205 

To support a claim for compensation based upon an additional disability that was caused or aggravated by a serviceconnected disability, the evidence must show: 

 

 ● You currently have a physical or mental disability shown by medical evidence, in addition to your 

 service-connected disability; AND 

 

 ● Your service-connected disability either caused or aggravated your additional disability. Medical 

 records or medical opinions are required to establish this relationship. However, VA may presume 

 service-connection for cardiovascular disease developing in a claimant with a certain service-connected 

 amputation(s) of one or both lower extremities. 

 

If VA previously granted service connection for your disability and you are seeking an increased evaluation of your 

service-connected disability, we need medical or lay evidence to show a worsening or increase in severity and the effect that 

worsening or increase has on your employment and daily life. 

 

To support a claim for service connection based upon a period of active duty for training, the evidence must show: ● You were disabled during active duty for training due to disease or injury incurred or aggravated 

 in the line of duty; AND 

 ● You have a current physical or mental disability. This may be shown by medical evidence or by lay

 evidence of persistent and recurrent symptoms of disability that are visible or observable; AND 

 ● There is a relationship between your current disability and the disease or injury incurred or aggravated

 during active duty for training. Medical records or medical opinions are generally required to establish 

 this relationship. 

To support a claim for service connection based upon a period of inactive duty training, the evidence must show: ● You were disabled due to an injury incurred or aggravated during inactive duty training or suffered 

 an acute myocardial infarction, cardiac arrest, or cerebrovascular accident during inactive duty 

 training; AND 

 

 ● You have a current physical or mental disability. This may be shown by medical evidence or by lay 

 evidence of persistent and recurrent symptoms of disability that are visible or observable; AND 

 

 ● There is a relationship between your current disability and your inactive duty training. Medical records or

 medical opinions are generally required to establish this relationship. 

 

HOW VA DETERMINES THE DISABILITY RATING

 

When we find disabilities to be service connected, we assign a disability rating. That rating can be changed if there 

are changes in your condition. Depending on the disability involved, we will assign a rating from 0 percent to as 

much as 100 percent. VA uses a schedule for evaluating disabilities that is published as title 38, Code of Federal 

Regulations, Part 4. In rare cases, we can assign a disability level other than the levels found in the schedule for a specific 

condition if your impairment is not adequately covered by the schedule. 

 

We consider evidence of the following in determining disability rating: 

 

 ● Nature and symptoms of the condition; 

 

 ● Severity and duration of the symptoms; and 

 

 ● Impact of the condition and symptoms on employment. 

 

Examples of evidence that you should tell us about or give to us that may affect how we assign a disability evaluation include

the following: 

 

 ● Information about on-going treatment records, including VA or other Federal treatment 

 records, you have not previously told us about; 

 

 ● Social Security determinations; 

 

 ● Statements from employers as to job performance, lost time, or other information regarding 

 how your condition(s) affect your ability to work; or 

 

 ● Statements discussing your disability symptoms from people who have witnessed how the 

 symptoms affect you. 

 

 

 

 Page 2
206 H U D - V A S H R E S O U R C E G U I D E

Page 3

 

HOW VA DETERMINES THE EFFECTIVE DATE 

If we grant your claim, the beginning date of your entitlement or increased entitlement to benefits will generally be based on

the following factors: 

● When we received your claim; 

● When the evidence shows a level of disability that supports a certain rating under the 

 rating schedule or other applicable standards. 

If you filed your claim with VA within one year of your separation from the military, entitlement will be from the day 

following the day you left the military. 

Generally, payments are effective from the first of the month following the date of your entitlement or increased 

entitlement based on the above criteria. 

Examples of evidence that you should tell us about or give to us that may affect how we determine the effective date 

of any benefits we give you on your claim include the following: 

● Information about continuous treatment or when treatment began;

● Service treatment records in your possession that you may not have sent us; or 

● Reports of treatment for your condition while attending training in the Guard or Reserve. 

 

HOW VA WILL HELP YOU OBTAIN EVIDENCE FOR YOUR CLAIM 

Fully Developed Claim Process

 

In order for you to participate in the Fully Developed Claim Program, you must obtain records and provide them to VA. VA 

will provide a medical examination for you, or get a medical opinion, if we determine it is necessary to decide your claim. For 

this program, VA will only obtain service treatment records, and Federal treatment records when you identify them. If you 

serve or previously served in the Guard or Reserves, you must contact your unit to find out if they still maintain custody of

your service records (including your medical records). If your unit currently has custody of your service records (including 

your medical records), you must get a complete copy of these records and provide them to VA. 

If it is determined that other records exist, and VA needs the records to decide your claim, or if you do not provide us with 

your National Guard or Reserve records as described above, then your claim will not be processed as an Fully Developed 

Claim. Your claim will be processed in our standard claim process. 

Standard Claim Process

 

VA is responsible for getting relevant records from any Federal agency that you adequately identify and authorize VA to 

obtain. These may include records from the military, VA medical centers (including private facilities where VA authorized 

treatment), or the Social Security Administration. VA will provide a medical examination for you, or get a medical opinion, if 

we determine it is necessary to decide your claim. 

 

VA will make every reasonable effort to obtain relevant records not held by a Federal agency that you adequately identify and

authorize VA to obtain. These may include records from State or local governments, and privately held evidence and 

information you tell us about (such as private doctor or hospital records), or current or former employers. 

WHAT YOU NEED TO DO

 

You must submit all relevant evidence in your possession and provide VA information sufficient to enable VA to obtain all 

relevant evidence not in your possession. 

 

Fully Developed Claim Process

 

If you provide VA information sufficient to enable VA to obtain relevant service treatment records and Federal treatment 

records, if any, and you give VA all other records relevant to your claim, the claim may be decided under the Fully Developed 

Claim Process. This means that, if you are aware of relevant records that are not in your possession, you should obtain them 

and provide them to VA in order to participate in the Fully Developed Claim Process. 

 

If your claim involves a disability that you had before entering service and that was made worse by service, please provide 

any information or evidence in your possession regarding the health condition that existed before your entry into service. 
H U D - V A S H R E S O U R C E G U I D E 207 

WHAT YOU NEED TO DO (Continued) 

Standard Claim Process

 

If you know of evidence not in your possession and want VA to try to get it for you, you must give VA enough information 

about the evidence so that we can request it from the person or agency that has it. If the holder of the evidence declines to 

give it to VA, asks for a fee to provide it, or otherwise cannot get the evidence, VA will notify you and provide you with an 

opportunity to submit the information or evidence. It is your responsibility to make sure we receive all requested

records that are not in the possession of a Federal department or agency.

 

If your claim involves a disability that you had before entering service and that was made worse by service, please provide 

any information or evidence in your possession regarding the health condition that existed before your entry into service.

 

WHEN YOU SHOULD SEND WHAT WE NEED 

 

Fully Developed Claim Process

 

Send the information and evidence with the Fully Developed Claim Certification. For this program, you must obtain and 

submit any and all Service Treatment and Personnel Records in the custody of your Guard or Reserve Unit. If we decide your 

claim before one year from the date we receive this claim, you will still have the remainder of the one-year period to submit 

additional information or evidence necessary to support your claim. 

 

Standard Claim Process

 

We strongly encourage you to send any information or evidence as soon as you can. If we do not hear from you, we may 

make a decision on your claim after 30 days. However, you have up to one year from the date we receive this claim to 

submit the information and evidence necessary to support your claim. If we decide your claim before one year from the date 

we receive this claim, you will still have the remainder of the one-year period to submit additional information or evidence 

necessary to support your claim.

Page 4
208 H U D - V A S H R E S O U R C E G U I D E

VA FORM

FEB 2010 21-526EZ

4. SEX

12E. PLACE OF SEPARATION

FEMALE

3. DATE OF BIRTH

MALE

2. SOCIAL SECURITY NUMBER

FULLY DEVELOPED CLAIM 

(COMPENSATION)

OMB Control No. 2900-0747 

Respondent Burden: 25 minutes

VA DATE STAMP 

(DO NOT WRITE IN THIS SPACE)

 IMPORTANT: Please read the Privacy Act and Respondent Burden on the back before completing the form. 

 SECTION I: TO BE COMPLETED BY VETERAN

7A. CURRENT ADDRESS

5. HAVE YOU EVER FILED A CLAIM WITH VA?

(If "Yes," provide your file number 

in Item 6) 

City

Street address, rural route, or P.O. Box

Cell phone

Evening 

7B. TELEPHONE NUMBERS (Include Area Code)

Daytime 

8A. PREFERRED E-MAIL ADDRESS (If applicable)

YES NO

6. VA FILE NUMBER

10. LIST VA MEDICAL CENTERS WHERE YOU RECEIVED TREATMENT FOR YOUR CLAIMED DISABILITY(IES) AND PROVIDE TREATMENT DATES

8B. ALTERNATE E-MAIL ADDRESS (If applicable)

YES

NO

11A. DID YOU SERVE UNDER ANOTHER NAME? 11B. PLEASE LIST OTHER NAME(S) YOU SERVED UNDER 

 mo

(If "No," go to Item 12A)

(If "Yes," go to Item 11B)

12A. I ENTERED MY MOST RECENT PERIOD OF 

 ACTIVE SERVICE ON

YES NO

13A. ARE YOU CURRENTLY ACTIVATED TO FEDERAL ACTIVE DUTY UNDER THE 

 AUTHORITY OF TITLE 10, U.S.C. (National Guard)?

14B. WHAT IS THE TELEPHONE 

 NUMBER OF YOUR CURRENT 

 UNIT? (Include Area Code)

(If "Yes," provide date of activation in Item 13B)

13B. DATE OF ACTIVATION

14A. WHAT IS THE NAME AND ADDRESS OF YOUR RESERVE/NATIONAL GUARD UNIT?

12C. RELEASE DATE OR ANTICIPATED DATE 

 OF RELEASE FROM ACTIVE DUTY

12B. BRANCH OF SERVICE

 SECTION II: SERVICE INFORMATION

12D. DID YOU SERVE IN A COMBAT ZONE SINCE 9-11-2001?

YES NO

1. VETERAN'S NAME (Last, first, middle)

 15B. I PREVIOUSLY ENTERED ACTIVE SERVICE ON

YES

NO

15A. DO YOU HAVE ADDITIONAL PERIODS OF ACTIVE SERVICE? 

(If "No," go to Item 16A)

(If "Yes," go to Item 15B)

Page 5

9. WHAT DISABILITIES ARE YOU CLAIMING?

A. NAME AND LOCATION OF VA MEDICAL CENTER B. DATE(S) OF TREATMENT

Apt. number 

State ZIP Code Country 

day yr

 mo day yr

 mo day yr
H U D - V A S H R E S O U R C E G U I D E 209 

I certify and authorize the release of information. I certify that the statements in this document are true and complete to the best of my knowledge. I 

authorize any person or entity, including but not limited to any organization, service provider, employer, or government agency, to give the 

Department of Veterans Affairs any information about me except protected health information, and I waive any privilege which makes the 

information confidential.

24B. PRINTED NAME AND ADDRESS OF WITNESS

PRIVACY ACT NOTICE: The form will be used to determine allowance to compensation benefits (38 U.S.C. 5101). The responses you submit are considered 

confidential (38 U.S.C. 5701). VA may disclose the information that you provide, including Social Security numbers, outside VA if the disclosure is authorized under 

the Privacy Act, including the routine uses identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation 

and Employment Records - VA, published in the Federal Register. The requested information is considered relevant and necessary to determine maximum benefits 

under the law. Information submitted is subject to verification through computer matching programs with other agencies. VA may make a "routine use" disclosure for: 

civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States, litigation in 

which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel 

administration. Your obligation to respond is required in order to obtain or retain benefits. Information that you furnish may be utilized in computer matching programs 

with other Federal or state agencies for the purpose of determining your eligibility to receive VA benefits, as well as to collect any amount owed to the United States by 

virtue of your participation in any benefit program administered by the Department of Veterans Affairs. Social Security information: You are required to provide the 

Social Security number requested under 38 U.S.C. 5101(c)(1). VA may disclose Social Security numbers as authorized under the Privacy Act, and, specifically may 

disclose them for purposes stated above.

 SECTION VI: WITNESSES TO SIGNATURE

 SECTION V: CERTIFICATIONS AND SIGNATURE

23A. SIGNATURE OF WITNESS (If claimant signed above using an "X")

24A. SIGNATURE OF WITNESS (If claimant signed above using an "X")

22B. DATE SIGNED

23B. PRINTED NAME AND ADDRESS OF WITNESS

22A. YOUR SIGNATURE (Do NOT print)

VA FORM 21-526EZ, FEB 2010

RESPONDENT BURDEN: We need this information to determine your eligibility for compensation. Title 38, United States Code, allows us to ask for this 

information. We estimate that you will need an average of 25 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or 

sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not 

displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you 

can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

18.

 SECTION IV: DIRECT DEPOSIT INFORMATION

 19. ACCOUNT NUMBER (Please check the appropriate box and provide the account number, if applicable)

Generally, all Federal payments are required to be made by electronic funds transfer (EFT), also called Direct Deposit. Please attach a voided personal 

check or deposit slip or provide the information requested below in Items 19, 20 and 21 to enroll in Direct Deposit. If you do not have a bank account, we 

will give you a waiver from Direct Deposit, just check the box below in Item 19. The Treasury Department is working to make bank accounts available in 

such situations. Once these accounts are available, you will be able to decide whether you wish to sign-up for one of the accounts or continue to receive 

a paper check. You can also request a waiver if you have other circumstances that you feel would cause a hardship if you enrolled in Direct Deposit. 

You can write to: Department of Veterans Affairs, 125 S. Main Street, Suite B, Muskogee, OK 74401-7004, and give us a brief description of why you do 

not wish to participate in Direct Deposit. 

 SECTION III: MILITARY PAY

If you receive both military retired pay and VA compensation, some of the amount you get may be recouped by VA, or, in the case of Voluntary 

Separation Incentive (VSI), by the Department of Defense. 

21. ROUTING OR TRANSIT NUMBER (The first nine numbers located at the bottom left of your check)

CHECKING SAVINGS

20. NAME OF FINANCIAL INSTITUTION (Please provide the name of the bank where you want your direct deposit)

IMPORTANT: Unless you check the box in Item 18 below, you are telling us that you are choosing to receive VA compensation instead of military 

retired pay, if it is determined you are entitled to both benefits. If you are awarded military retired pay prior to compensation, we will reduce your 

retired pay by that amount. VA will notify the Military Retired Pay Center of all benefit changes. 

No, I do not want VA compensation in lieu of military retired pay.

YES

16A. DO YOU RECEIVE RETIRED PAY?

NO

17A. DID YOU RECEIVE ANY TYPE OF SEPARATION/SEVERANCE PAY?

YES NO

(If "Yes," complete Item 16B) 

(If "Yes," complete Items 17B and 17C) 

 16B. TYPE OF RETIRED PAY?

17B. LIST AMOUNT (If known)

LONGEVITY

TDRL

DISABILITY

17C. LIST TYPE (If known)

I CERTIFY THAT I DO NOT HAVE AN ACCOUNT 

WITH A FINANCIAL INSTITUTION OR CERTIFIED 

PAYMENT AGENT

Page 6
210 H U D - V A S H R E S O U R C E G U I D E

Your signature on this response will not affect: 

 

 ● Whether or not you are entitled to VA benefits;

 

 ● The amount of benefits to which you may be entitled; 

 

 ● The assistance VA will provide you in obtaining evidence to support your claim; or 

 

 ● The date any benefits will begin if your claim is granted. 

 

I have enclosed all the information or evidence that will support my claim to include identifying records from Federal treating 

facilities, or I have no information or evidence to give VA to support my claim. Please decide my claim as soon as possible.

Page 7

FULLY DEVELOPED CLAIM CERTIFICATION 

(COMPENSATION)

VA FORM 21-526EZ, FEB 2010

Date

Claim Number

Name

Social Security Number

 Claimant/Representative's Signature Date
H U D - V A S H R E S O U R C E G U I D E 211 

VA Form 

FEB 2010

21-527EZ Page 1

WHAT THE EVIDENCE MUST SHOW TO SUPPORT YOUR CLAIM 

To support your claim for nonservice-connected pension, the evidence must show: 1. You met certain minimum requirements regarding active military service during a period of war. 

 Generally, those requirements involve: 

 90 days of consecutive service, at least one day of which was during a period of war; OR 

90 days of combined service during at least one period of war; 

(Note: If your service began after September 7, 1980, additional length-of-service requirements may apply, typically

requiring two years of continuous service or completion of active-duty obligation) OR any length of active military service with a discharge due to a service-connected disability. 2. You are age 65 or older or are permanently and totally disabled. You are considered permanently and totally 

 disabled if medical evidence shows you are: 

 A patient in a nursing home for long-term care; OR 

Receiving Social Security disability benefits; OR 

Unemployable due to a disability reasonably certain to continue throughout your lifetime; OR 

Suffering from a disability that is reasonably certain to continue throughout your lifetime that would 

make it impossible for an average person to follow a substantially gainful occupation; OR 

Suffering from a disease or disorder that VA determines causes persons who have that disease or 

disorder to be permanently and totally disabled. 

3. Your net worth and income do not exceed certain requirements. 

FULLY DEVELOPED CLAIM NOTICE (Notice to Claimants of Information and Evidence Necessary to Substantiate a Claim for

 VA Non-Service Connected Live Pension)

Thank you for participating in the Department of Veterans Affairs (VA) Fully Developed Claim Program. VA established the 

Fully Developed Claim Program to expeditiously process claims certified by the claimant or his/her representative as meeting 

the Fully Developed Claim criteria. 

 

Fully Developed Claim Criteria:

 1. For purposes of this notice, your claim must be a rating-related claim for live pension submitted on 

 VA Form 21-527EZ, Fully Developed Claim (Pension). 

2. You must submit, with your claim, the Fully Developed Claim Certification signed and dated by you or 

 your authorized representative. 

3. You must submit with the Fully Developed Claim Certification: 

 All necessary income and net-worth information. 

 

All, if any, relevant, private medical treatment records, and an identification of any 

treatment records from a Federal treatment facility such as a VA medical center. 

For Special Monthly Pension claims, a completed VA Form 21-2680, Examination for 

Housebound Status or Permanent Need for Regular Aid and Attendance, or if claiming 

Special Monthly Pension based on nursing home attendance, a VA Form 21-0779, 

Request for Nursing Home Information in Connection with Claim for Aid and Attendance. 

If claiming dependents, a completed VA Form 21-686c, Declaration of Status of Dependents. 4. You must report for any VA medical examinations VA determines necessary to decide your claim. 

Note: VA forms are available at www.va.gov/vaforms. 

This notice is applicable to your Fully Developed Claim for non-service connected live pension. Upon receipt of the Fully 

Developed Claim Certification, we will expedite your claim under the Fully Developed Claim Program. If it is determined that 

your claim does not meet the Fully Developed Claim criteria we will process your claim through our standard claim process. 
212 H U D - V A S H R E S O U R C E G U I D E

Page 2

HOW VA WILL HELP YOU OBTAIN EVIDENCE FOR YOUR CLAIM 

 

Fully Developed Claim Process

 

VA will provide a medical examination for you, or get a medical opinion, if we determine it is necessary to decide your claim.

For this program, VA will only obtain Federal treatment records when you identify them. You must obtain all other records 

and provide them to VA. 

 

If it is determined that other records exist, and VA needs the records to decide your claim, then your claim will not be 

processed as a Fully Developed Claim. Your claim will be processed in our standard claim process. 

 

Standard Claim Process

 

VA is responsible for getting relevant records from any Federal agency that you adequately identify and authorize VA to 

obtain. These may include records from the military, VA medical centers (including private facilities where VA authorized 

treatment), or the Social Security Administration. VA will provide a medical examination for you, or get a medical opinion, if 

we determine it is necessary to decide your claim. 

 

VA will make every reasonable effort to obtain relevant records not held by a Federal agency that you adequately identify and

authorize VA to obtain. These may include records from State or local governments, any privately held evidence and 

information you tell us about (such as private doctor or hospital records), or current or former employers. 

 

WHAT THE EVIDENCE MUST SHOW TO SUPPORT YOUR CLAIM (Continued) 

To support a claim for increased disability pension benefits based on the need for aid and attendance, 

the evidence must show: 

 

You have corrected vision of 5/200 or less in both eyes; OR 

 

You have contraction of the concentric visual field to 5 degrees or less; OR 

 

You are a patient in a nursing home due to mental or physical incapacity; OR 

 

You require the aid of another person in order to perform personal functions required in everyday 

living, such as bathing, feeding, dressing yourself, attending to the wants of nature, adjusting 

prosthetic devices, or protecting yourself from the hazards of your daily environment; OR 

 

You are bedridden, in that your disability requires that you remain in bed apart from any 

prescribed course of convalescence or treatment. 

 

To support your claim for increased disability pension benefits based on being housebound, the evidence 

must show: 

 

You have a single permanent disability evaluated as 100 percent disabling; AND another disability, 

or disabilities, evaluated as 60 percent or more disabling; OR 

 

You have a single permanent disability evaluated as 100 percent disabling; AND due to such disability, 

you are permanently and substantially confined to your immediate premises; OR 

 

You were granted pension based on being 65 or older AND have a disability evaluated as at least 

60 percent disabling. 

 

 

HOW VA DETERMINES THE EFFECTIVE DATE

 

If we grant your claim, the beginning date of your entitlement will generally be based on when we received your 

claim. 

 

Higher levels of nonservice-connected pension may be assigned for disabilities that affect your ability to perform certain 

activities of daily living or the ability to leave your home. Higher levels of pension may be effective from the date the medical 

evidence first shows entitlement. 

 
H U D - V A S H R E S O U R C E G U I D E 213 

Page 3

 

WHEN YOU SHOULD SEND WHAT WE NEED

 

Fully Developed Claim Process

 

Send the information and evidence with the Fully Developed Claim Certification. If we decide your claim before one year from 

the date we receive this claim, you will still have the remainder of the one-year period to submit additional information or 

evidence necessary to support your claim. 

 

Standard Claim Process

 

We strongly encourage you to send any information or evidence as soon as you can. If we do not hear from you, we may 

make a decision on your claim after 30 days. However, you have up to one year from the date we receive this claim to submit 

the information and evidence necessary to support your claim. If we decide your claim before one year from the date we 

receive this claim, you will still have the remainder of the one-year period to submit additional information or evidence 

necessary to support your claim. 

WHAT YOU NEED TO DO 

You must submit all relevant evidence in your possession and provide VA information sufficient to enable VA to obtain all 

relevant evidence not in your possession 

 

Fully Developed Claim Process

 

If you provide VA information sufficient to enable VA to obtain relevant Federal treatment records and you give VA all other 

records relevant to your claim, the claim may be decided under the Fully Developed Claim Process. This means that, if you 

are aware of relevant records that are not in your possession, you should obtain them and provide them to VA in order to 

participate in the Fully Developed Claim Process. 

 

Standard Claim Process

 

If you know of evidence not in your possession and want VA to try to get it for you, you must give VA enough information 

about the evidence so that we can request it from the person or agency that has it. If the holder of the evidence declines to 

give it to VA, asks for a fee to provide it, or otherwise cannot get the evidence, VA will notify you and provide you with an 

opportunity to submit the information or evidence. It is your responsibility to make sure we receive all requested records that 

are not in the possession of a Federal department or agency.
214 H U D - V A S H R E S O U R C E G U I D E

VA FORM 

FEB 2010 21-527EZ

B. DATE BEGAN 

4. SEX

16C. LIST TYPE (If known)

MALE FEMALE

2. SOCIAL SECURITY NUMBER 3. DATE OF BIRTH 

FULLY DEVELOPED CLAIM 

 (PENSION) 

OMB Control No. 2900-0747 

Respondent Burden: 25 minutes

VA DATE STAMP 

(DO NOT WRITE IN THIS SPACE)

IMPORTANT: Please read the Privacy Act and Respondent Burden on the back before completing the form.

This claim must be submitted along with the attached, "Express Claim Certification." 

SECTION I: TO BE COMPLETED BY VETERAN

7A. CURRENT ADDRESS

5. HAVE YOU EVER FILED A CLAIM WITH VA?

(If "Yes," provide your file number in Item 6) 

City State ZIP Code Country

Street address, rural route, or P.O. Box Apt. number 

Cell phone

Evening 

7B. TELEPHONE NUMBERS (Include Area Code)

Daytime 

8A. PREFERRED E-MAIL ADDRESS (If applicable)

YES NO

6. VA FILE NUMBER

B. DATE(S) OF TREATMENT

10. LIST VA MEDICAL CENTERS WHERE YOU RECEIVED TREATMENT FOR YOUR CLAIMED DISABILITY(IES) AND PROVIDE TREATMENT DATES

9. WHAT DISABILITY(IES) PREVENTS YOU FROM WORKING AND DATE DISABILITY(IES) BEGAN

YES NO

11A. DID YOU SERVE UNDER ANOTHER NAME? 11B. PLEASE LIST OTHER NAME(S) YOU SERVED UNDER 

(If "Yes," go to Item 11B) (If "No," go to Item 12A)

12A. I ENTERED MY MOST RECENT PERIOD OF 

ACTIVE SERVICE ON 

YES NO

13A. ARE YOU CURRENTLY ACTIVATED TO FEDERAL ACTIVE DUTY UNDER THE 

AUTHORITY OF TITLE 10, U.S.C. (National Guard)?

14B. WHAT IS THE TELEPHONE 

NUMBER OF YOUR CURRENT 

UNIT? (Include Area Code)

(If "Yes,"complete Items 16B and 16C)

13B. DATE OF ACTIVATION

14A. WHAT IS THE NAME AND ADDRESS OF YOUR RESERVE/NATIONAL GUARD UNIT?

15A. DO YOU HAVE ADDITIONAL PERIODS OF ACTIVE SERVICE? 

16A. DID YOU RECEIVE ANY TYPE OF SEPARATION/SEVERANCE/RETIRED PAY? 

12C. RELEASE DATE OR ANTICIPATED DATE 

OF RELEASE FROM ACTIVE DUTY

12B. BRANCH OF SERVICE

 SECTION III: WORK HISTORY

12D. DID YOU SERVE IN A COMBAT ZONE SINCE 9-11-2001?

YES NO

1. VETERAN'S NAME (Last, first, middle)

15B. I PREVIOUSLY ENTERED ACTIVE SERVICE ON

YES

NO (If "No," go to Item 16A)

(If "Yes," go to Item 15B)

Page 4

A. DISABILITY(IES)

A. NAME AND LOCATION OF VA MEDICAL CENTER

12E. PLACE OF SEPARATION

YES NO (If "Yes," provide date of activation in Item 13B)

8B. ALTERNATE E-MAIL ADDRESS (If applicable)

 SECTION II: SERVICE INFORMATION

16B. LIST AMOUNT (If known)

IN THE TABLE BELOW, TELL US ABOUT ALL OF YOUR EMPLOYMENT, INCLUDING SELF-EMPLOYMENT, FOR ONE YEAR BEFORE YOU 

BECAME DISABLED TO THE PRESENT. 

17F. WHAT WERE YOUR 

TOTAL ANNUAL 

EARNINGS?

17A. WHAT WAS THE NAME AND 

ADDRESS OF YOUR EMPLOYER?

17B. WHAT WAS YOUR 

JOB TITLE?

17C. WHEN DID 

YOUR WORK 

BEGIN?

17D. WHEN DID 

YOUR WORK 

END?

$

$

$

17E. HOW MANY 

DAYS WERE LOST 

DUE TO DISABILITY?
H U D - V A S H R E S O U R C E G U I D E 215 

18A. MONTHLY INCOME (GROSS MONTHLY AMOUNTS (If no income was received from a particular source, write "0" or "none." DO NOT LEAVE BLANK) 

VA FORM 21-527EZ, FEB 2010 Page 5

VETERAN SPOUSE

$ $

SOURCE

SOCIAL SECURITY

U.S. CIVIL SERVICE

U.S. RAILROAD RETIREMENT

BLACK LUNG BENEFITS

MILITARY RETIREMENT

OTHER (Show source below)

18B. ANNUAL INCOME (If no income was received from a particular source, write "0" or "none." DO NOT LEAVE ANY ITEMS BLANK) 

SPOUSE

ALL OTHER (Show source below) 

VETERAN

$ $

SOURCE

GROSS WAGES FROM ALL 

EMPLOYMENT

TOTAL INTEREST AND DIVIDENDS

ALL OTHER (Show source below) 

 NOTE: Report last calendar year (January through December) income in the left-hand column and current year income in the 

right-hand column.

VETERAN SPOUSE

$ $

SOURCE

CASH/NON-INTEREST-BEARING BANK 

ACCOUNTS

INTEREST-BEARING BANK ACCOUNTS

IRA'S, KEOGH PLANS, ETC.

STOCKS, BONDS, MUTUAL FUNDS, ETC.

REAL PROPERTY (Not your home) 

ALL OTHER PROPERTY

18C. NET WORTH (If no income was received from a particular source, write "0" or "none." DO NOT LEAVE ANY ITEMS BLANK) 

 SECTION III: INCOME VERIFICATION

 SECTION V: MEDICAL, LEGAL OR OTHER UNREIMBURSED EXPENSES

Family medical expenses and certain other expenses actually paid by you may be deductible from your income. Show the amount of unreimbursed medical expenses, 

including the Medicare deduction, you paid for yourself or relatives who are members of your household. Also, show unreimbursed last illness and burial expenses and 

educational or vocational rehabilitation expenses you paid. Last illness and burial expenses are unreimbursed amounts paid by you for the last illness and burial of a spouse or 

child at any time prior to the end of the year following the year of death. Educational or vocational rehabilitation expenses are amounts paid for courses of education, including 

tuition, fees, and materials. Show medical, legal or other expenses you paid because of a disability for which civilian disability benefits have been awarded. When determining 

your income, we may be able to deduct them from the disability benefits for the year in which the expenses are paid. Do not include any expenses for which you were 

reimbursed. If more space is needed continue on page 6 or attach a separate sheet. 

19E. Disability or relationship 

of person for whom 

expenses paid 

19A. Amount paid by you 19B. Date paid

19C. Purpose 

(Doctor's fees, hospital 

charges, attorney fees, etc.)

19D. Paid to 

(Name of doctor, hospital, 

pharmacy, etc.) 
216 H U D - V A S H R E S O U R C E G U I D E

Page 6

 SECTION VI: DIRECT DEPOSIT INFORMATION

21. ACCOUNT NUMBER (Please check the appropriate box and provide the account number, if applicable)

Generally, all Federal payments are required to be made by electronic funds transfer (EFT), also called Direct Deposit. Please attach a voided personal 

check or deposit slip or provide the information requested below in Items 21, 22 and 23 to enroll in Direct Deposit. If you do not have a bank account, we 

will give you a waiver from Direct Deposit, just check the box below in Item 21. The Treasury Department is working to make bank accounts available in 

such situations. Once these accounts are available, you will be able to decide whether you wish to sign-up for one of the accounts or continue to receive 

a paper check. You can also request a waiver if you have other circumstances that you feel would cause a hardship if you enrolled in Direct Deposit. 

You can write to: Department of Veterans Affairs, 125 S. Main Street, Suite B, Muskogee, OK 74401-7004, and give us a brief description of why you do 

not wish to participate in Direct Deposit. 

23. ROUTING OR TRANSIT NUMBER (The first nine numbers located 

at the bottom left of your check)

CHECKING SAVINGS

22. NAME OF FINANCIAL INSTITUTION (Please provide the name of 

the bank where you want your direct deposit)

I CERTIFY THAT I DO NOT HAVE AN ACCOUNT 

WITH A FINANCIAL INSTITUTION OR CERTIFIED 

PAYMENT AGENT

I certify and authorize the release of information. I certify that the statements in this document are true and complete to the best of my 

knowledge. I authorize any person or entity, including but not limited to any organization, service provider, employer, or government 

agency, to give the Department of Veterans Affairs any information about me except protected health information, and I waive any 

privilege which makes the information confidential. 

26B. PRINTED NAME AND ADDRESS OF WITNESS

PRIVACY ACT NOTICE: The form will be used to determine allowance to pension benefits (38 U.S.C. 5101). The responses you submit are considered confidential

(38 U.S.C. 5701). VA may disclose the information that you provide, including Social Security numbers, outside VA if the disclosure is authorized under the Privacy

Act, including the routine uses identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and

Employment Records - VA, published in the Federal Register. The requested information is considered relevant and necessary to determine maximum benefits under

the law. Information submitted is subject to verification through computer matching programs with other agencies. VA may make a "routine use" disclosure for: civil or

criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States, litigation in which

the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel

administration. Your obligation to respond is required in order to obtain or retain benefits. Information that you furnish may be utilized in computer matching programs

with other Federal or state agencies for the purpose of determining your eligibility to receive VA benefits, as well as to collect any amount owed to the United States by

virtue of your participation in any benefit program administered by the Department of Veterans Affairs. Social Security information: You are required to provide the

Social Security number requested under 38 U.S.C. 5101(c)(1). VA may disclose Social Security numbers as authorized under the Privacy Act, and, specifically may

disclose them for purposes stated above.

 SECTION VIII: WITNESSES TO SIGNATURE

 SECTION VII: CERTIFICATIONS AND SIGNATURE

25A. SIGNATURE OF WITNESS (If claimant signed above using an "X")

26A. SIGNATURE OF WITNESS (If claimant signed above using an "X")

24B. DATE SIGNED

25B. PRINTED NAME AND ADDRESS OF WITNESS

24A. YOUR SIGNATURE (Do NOT print)

RESPONDENT BURDEN: We need this information to determine your eligibility for pension. Title 38, United States Code, allows us to ask for this information. We

estimate that you will need an average of 25 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection

of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid

OMB control numbers can be located on the OMB Internet Page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you can call

1-800-827-1000 to get information on where to send comments or suggestions about this form.

 SECTION V: MEDICAL, LEGAL OR OTHER UNREIMBURSED EXPENSES (Continued) 

20E. Disability or relationship 

of person for whom 

expenses paid 

20A. Amount paid by you 20B. Date paid 

20C. Purpose 

(Doctor's fees, hospital 

charges, attorney fees, etc.) 

20D. Paid to 

(Name of doctor, hospital, 

pharmacy, etc.)

VA FORM 21-527EZ, FEB 2010
H U D - V A S H R E S O U R C E G U I D E 217 

Your signature on this response will not affect: 

 

Whether or not you are entitled to VA benefits; 

 

The amount of benefits to which you may be entitled; 

 

The assistance VA will provide you in obtaining evidence to support your claim; or 

 

The date any benefits will begin if your claim is granted. 

 

I have enclosed all the information or evidence that will support my claim to include identifying records from Federal treating 

facilities, or I have no information or evidence to give VA to support my claim. Please decide my claim as soon as possible.

Page 7

FULLY DEVELOPED CLAIM CERTIFICATION 

(PENSION)

VA FORM 21-527EZ, FEB 2010 

Claimant/Representative's Signature Date

Name

Claim Number

Social Security Number

Date
218 H U D - V A S H R E S O U R C E G U I D E

VA FORM 

AUG 2011 21-4138 

OMB Approved No. 2900-0075 

Respondent Burden: 15 minutes

EXISTING STOCKS OF VA FORM 21-4138, AUG 2004, 

WILL BE USED

 SOCIAL SECURITY NO.

STATEMENT IN SUPPORT OF CLAIM

 VA FILE NO.

C/CSS -

 FIRST NAME - MIDDLE NAME - LAST NAME OF VETERAN (Type or print)

The following statement is made in connection with a claim for benefits in the case of the above-named veteran:

I CERTIFY THAT the statements on this form are true and correct to the best of my knowledge and belief.

SIGNATURE DATE SIGNED

 ADDRESS

 DAYTIME EVENING

TELEPHONE NUMBERS (Include Area Code)

PENALTY: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact, 

knowing it to be false.

PRIVACY ACT INFORMATION: The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, 

Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to 

the United States, litigation in which the United States is a party or has an interest, the administration of VA Programs and delivery of VA benefits, verification of identity and status, and 

personnel administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA, 

published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. VA uses your SSN to identify your claim file. Providing your SSN will help ensure that 

your records are properly associated with your claim file. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. 

The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal Statute of law in effect prior to January 1, 1975, and 

still in effect. The requested information is considered relevant and necessary to determine maximum benefits under the law. The responses you submit are considered confidential (38 U.S.C. 

5701). Information submitted is subject to verification through computer matching programs with other agencies. 

RESPONDENT BURDEN: We need this information to obtain evidence in support of your claim for benefits (38 U.S.C. 501(a) and (b)). Title 38, United States Code, allows us to ask for this 

information. We estimate that you will need an average of 15 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of 

information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be 

located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this 

form.

CONTINUE ON REVERSE
H U D - V A S H R E S O U R C E G U I D E 219 

The following statement is made in connection with a claim for benefits in the case of the above-named veteran:

VA FORM 21-4138, AUG 2011
220 H U D - V A S H R E S O U R C E G U I D E

INFORMATION AND INSTRUCTIONS 

FOR COMPLETING THE APPLICATION FOR VA EDUCATION BENEFITS

APPLICATION FOR VA EDUCATION BENEFITS 

(VA FORM 22-1990)

22-1990 SUPERSEDES VA FORM 22-1990, OCT 2010, 

WHICH WILL NOT BE USED.

VA FORM 

MAR 2011

Do not use this form to apply for Vocational Rehabilitation and Employment benefits (chapter 31 of title 38, U.S. Code), Dependents Educational Assistance benefits (chapter 35 of title 38, U.S. Code), Transfer of Entitlement, or National Call to Service (section 510 of title 

10, U.S. Code). These benefits require different application forms that can be completed on-line and printed at www.va.gov/vaforms or 

can be obtained from the nearest VA regional office. They may also be available where you received this application. 

INTERNET VERSION AVAILABLE - You may complete and submit this application on-line at www.gibill.va.gov. Click "Apply On Line" and select the "Education" option. 

VA VOCATIONAL AND EDUCATIONAL COUNSELING HELP AVAILABLE - If you need help planning your individual educational and career goals, VA offers a wide range of counseling services to help you make these decisions. Services include educational 

and vocational guidance and such testing as necessary for you to develop a greater understanding of your skills, talents, and interests. For 

further information on VA counseling, call VA toll-free at 1-888-GI-BILL-1 (1-888-442-4551) or TDD at (800) 829-4833. 

NOTE: The numbers on the instructions match the item numbers on the application. Items not mentioned are self-explanatory. 

 Part II

(This section provides an overview of the general eligibility requirements for various education programs. Additional requirements not listed 

on this form may be necessary.) 

ITEM 9A. You may be eligible for benefits under the Post-9/11 GI Bill, also referred to as chapter 33, if you served at least 90 aggregate days on active duty (excluding entry level and skill training) after September 10, 2001. You may also qualify if you were discharged due to a service-connected disability after serving at least 30 continuous days on active duty after September 10, 2001. 

ITEM 9B. You may be eligible for the Montgomery GI Bill, also referred to as MGIB or chapter 30, if you served on active duty and meet 

certain conditions. NOTE: You do not have to be on active duty to apply for benefits under this program. You must meet any one of the 

following conditions (there are additional requirements): 

You first entered service on or after July 1, 1985, and you didn't decline this benefit at your initial entry into service 

 OR

You entered service (or agreed to delayed entry) before January 1, 1977, and you have educational assistance entitlement remaining under the Vietnam Era GI Bill (also known as "chapter 34") 

 OR

You were voluntarily separated under the Voluntary Separation Incentive (VSI) or Special Separation Benefit (SSB) programs and had 

your military pay reduced by $1,200 

 OR

You were involuntarily separated from active duty after February 2, 1991, 

 OR

You were on active duty and a participant in the Post-Vietnam Era Veterans' Educational Assistance Program (VEAP) program on or before 

October 9, 1996, or you first entered the National Guard under title 32, U.S. Code, between July 1, 1985, and November 28, 1989, you elected chapter 30 benefits between October 9, 1996, and October 8, 1997, and you paid $1,200 

 OR

You were on active duty and eligible for VEAP benefits on October 9, 1996, you elected chapter 30 benefits between November 1, 2000, 

and October 31, 2001, and you paid $2,700. 

ITEM 9C. You may be eligible for the Montgomery GI Bill - Selected Reserve Educational Assistance Program, also known as MGIB-SR or chapter 1606, if you are a member of the Selected Reserve and meet certain requirements, including a 6-year commitment. (The 

Departments of Defense and Homeland Security determine eligibility for this program.) 

To expedite processing, attach a copy of your DD 2384, Selected Reserve Educational Assistance Program (GI BILL) Notice of Basic 

Eligibility. This form is also called a "NOBE." Your reserve unit should have issued this notice to you when you became eligible for the Montgomery GI Bill - Selected Reserve Educational Assistance Program. If you are unable to locate your copy, request a duplicate from 

your reserve unit.

Use this form to apply for educational assistance under the following benefit programs: 

 • Post- 9/11 GI Bill chapter 33 of title 38, U.S. Code 

 

 • Montgomery GI Bill (MGIB) chapter 30 of title 38, U.S.Code

 

 • Montgomery GI Bill - Selected Reserve (MGIB-SR) chapter 1606 of title 10, U.S. Code 

 • Reserve Educational Assistance Program (REAP) chapter 1607 of title 10, U.S. Code 

 • Post-Vietnam Era Veterans' Educational Assistance Program (VEAP) chapter 32 of title 38, U.S. Code, or section 901 or section 903 of Public Law 96-342 
H U D - V A S H R E S O U R C E G U I D E 221 

ITEM 9D. You may be eligible for benefits under the Reserve Educational Assistance Program (REAP), also known as chapter 1607, if 

you are a member of the Ready Reserve and were called or ordered to active service to support a contingency operation for at least 90 

consecutive days on or after September 11, 2001. (The Department of Defense and Homeland Security determine eligibility for this 

program.)

Attach a copy of any notice of eligibility to this program that you have received from your service component. Also, attach a copy of your 

orders showing you were called up to active service. If you do not have a copy of your orders, request a duplicate from your unit. 

ITEM 9E. You may be eligible for benefits under the Post-Vietnam Era Veterans' Educational Assistance Program (VEAP), also known as 

Chapter 32, if your service began on or after January 1, 1977, and before July 1, 1985, and you contributed to a VEAP account. 

You may be eligible for benefits under the Post-Vietnam Era Non-Contributory Veterans' Educational Assistance Program, also known as 

"Non-Contributory VEAP" or Section 903", if your service began on or after November 30, 1980, and before October 1, 1981, and your 

branch of service paid contributions into your VEAP account.

ITEM 9F. If you are eligible for MGIB, MGIB-SR, OR REAP, you must elect to give up eligibility under the program for which you are 

eligible in order to receive benefits under the Post-9/11 GI Bill (chapter 33). If you are eligible for more than one of the programs listed 

(MGIB, MGIB-SR, and REAP), you are only required to give up one of the programs for which you are eligible in order to receive benefits 

under the Post-9/11 GI Bill. You may not receive more than a total of 48 months of benefits under two or more programs. If you elect 

chapter 33 in lieu of chapter 30, your months of entitlement under chapter 33 will be limited to the number of months of entitlement 

remaining under chapter 30 on the effective date of your election. However, if you completely exhaust your entitlement under chapter 30 

before the effective date of your chapter 33 election, you may receive up to 12 additional months of benefits under chapter 33. If you wish to 

elect to receive benefits under the Post-9/11 GI Bill, check the box next to the program (only check one box) you are giving up.

NOTE: An election to give up benefits under an existing program and receive benefits under the Post-9/11 GI Bill is IRREVOCABLE. You 

should carefully consider your decision before completing this section. If you need more information to make a choice, you should visit our 

website at www.gibill.va.gov or call our toll-free customer service number at 1-888-GIBILL-1 (1-888-442-4551). 

 PART III

ITEM 10A. Self explanatory, except for the following items:

"Vocational Flight Training." You must already have a private pilot's license. If you are taking an Airline Transport Pilot course, you must 

have a valid first-class medical certificate on the date that you enter training. For all other flight courses, you must have a valid second-class 

medical certificate on the date that you enter training. 

"National Test Reimbursement." You can be reimbursed for the cost of approved tests for admission to, or credit at, institutions of higher 

learning. 

"Licensing or Certification Test Reimbursement." A licensing test is a test offered by a state, local, or federal agency that is required by law 

to practice an occupation. A certification test is a test designed to provide affirmation of an individual's qualifications in a specific 

occupation. Examples include EMT, CPA, MCSE, CCNP, etc. 

"Tuition Assistance Top-Up" This benefit is payable only under MGIB and the Post-9/11 GI Bill programs. You can receive benefits to pay 

you for the difference between what the military pays with Tuition Assistance (TA) and the total costs of these courses. 

 PART VIII

QUESTIONS ARE ONLY FOR APPLICANTS WHOSE SERVICE BEGAN BEFORE JANUARY 1, 1977, (or delayed entry before January 2, 

1978). If you are currently married or if you have children under age 18 (under age 23 if in school), you should complete and return VA 

Form 21-686c. If your children are in school, you should also complete and return VA Form 21-674 for each child. If your parent(s) are 

dependent on you for financial support, you should complete and return VA Form 21-509. These forms may require additional 

documentation. VA cannot pay any additional benefits for dependents without properly completed forms and documentation. You can find 

VA forms 21-686c, 21-674, and 21-509 on-line at www.va.gov/vaforms.

ADDITIONAL HELP 

If you need more help in completing this application, call VA TOLL FREE at 1-888-GI-BILL-1 (1-888-442-4551). If you are hearing 

impaired, call us toll-free at 1-800-829-4833. You can also get education assistance after normal business hours at our education Internet site 

www.gibill.va.gov. HOW TO FILE YOUR CLAIM

Be sure to do the following: 

(A) If you have selected a school or training establishment:

Step 1: Mail the completed application to the VA Regional Processing Office for the region of that school's physical address. See next page 

for the addresses of these VA Regional Processing Offices. 

Step 2: Tell the veterans certifying official at your school or training establishment that you have applied for VA education benefits. Ask 

him or her to send your enrollment information using VA Form 22-1999, Enrollment Certification, or its electronic version. 

Step 3: Wait for VA to process your application and notify you of its decision concerning your eligibility for education benefits. 

(B) If you haven't selected a school or training establishment:

Step 1: Mail the completed application to the VA Regional Processing Office for the region of your home address. See next page for the 

addresses of these VA Regional Processing Offices. 

Step 2: Wait for VA to process your application and notify you of its decision concerning your eligibility for education benefits.

VA FORM 22-1990, MAR 2011
222 H U D - V A S H R E S O U R C E G U I D E

Central Region: 

VA Regional Office 

P.O. Box 66830 

St. Louis, MO 63166-6830

GA 

US Virgin Islands APO/FPO AA

IA 

KY 

MT 

TN

IL 

MI 

NE 

WI

IN 

MN 

ND 

WY

AZ 

LA 

OK 

WA

AR 

ID 

NV 

UT

CO 

KS 

MO 

SD

AL 

HI 

NM 

TX 

Guam

Eastern Region: 

VA Regional Office 

P.O. Box 4616 

Buffalo, NY 14240-4616

Serves the following states:

Western Region: 

VA Regional Office 

P.O. Box 8888 

Muskogee, OK 74402-8888

Southern Region: 

VA Regional Office 

P.O. Box 100022 

Decatur, GA 30031-7022

Serves the following states:

Privacy Act Notice: The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy 

Act of 1974 or title 38, Code of Federal Regulations, section 1.576 for routine uses (e.g., VA sends educational forms or letters with a veteran's 

identifying information to the veteran's school or training establishment to (1) assist the veteran in the completion of claims forms or (2) for the VA to 

obtain further information as may be necessary from the school for the VA to properly process the veteran's education claim or to monitor his or her 

progress during training) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation 

and Employment Records - VA, and published in the Federal Register. Your obligation to respond is required to obtain or retain education benefits. 

Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. The VA will not 

deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law enacted 

before January 1, 1975, and still in effect. The requested information is considered relevant and necessary to determine the maximum benefits under 

the law. While you do not have to respond, VA cannot process your claim for education assistance unless the information is furnished as required by 

existing law (38 U.S.C. 3471). The responses you submit are considered confidential (38 U.S.C. 5701). Any information provided by applicants, 

recipients, and others may be subject to verification through computer matching programs with other agencies. 

SC

Respondent Burden: We need this information to determine your eligibility for education benefits (38 U.S.C. 3471). Title 38, United States Code, 

allows us to ask for this information. We estimate that you will need an average of 15 minutes to review the instructions, find the information, and 

complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB (Office of Management and Budget) control number 

is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located 

on the OMB Internet Page at http://www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send 

comments or suggestions about this form. 

CT 

MD 

NY 

VT

DE 

MA 

OH 

VA

ME 

NJ 

RI 

Foreign Schools

DC 

NH 

PA 

WV

Serves the following states:

Serves the following states:

AK 

CA 

MS 

OR 

Philippines

FL 

PR

NC

APO/FPO AP

VA FORM 22-1990, MAR 2011
H U D - V A S H R E S O U R C E G U I D E 223 

22-1990

APPLICATION FOR VA EDUCATION BENEFITS 

(See attached Information and Instructions)

PART II - EDUCATION BENEFIT BEING APPLIED FOR See instructions for benefit eligibility criteria

INTERNET VERSION AVAILABLE - You may complete and send your application over the Internet at: www.gibill.va.gov

SUPERSEDES VA FORM 22-1990, OCT 2010, 

WHICH WILL NOT BE USED.

VA FORM 

MAR 2011

PAGE 1 OF 4

 1. SOCIAL SECURITY NUMBER OF APPLICANT

MALE

OMB Control No. 2900-0154 

Respondent Burden: 15 minutes

FEMALE

 4. NAME (First, Middle Initial, Last)

Account Number

Savings

VA DATE STAMP 

(Do Not Write In This Space)

City, State, ZIP Code

 5. APPLICANT'S ADDRESS

 2. SEX OF APPLICANT 3. APPLICANT'S DATE OF BIRTH

 8. PLEASE PROVIDE THE NAME, ADDRESS, AND PHONE NUMBER OF SOMEONE WHO WILL ALWAYS KNOW WHERE YOU CAN BE REACHED

Primary:

Routing or Transit Number

Checking

Account Type

 7. DIRECT DEPOSIT (Attach a voided personal check or provide the following information. Direct Deposit is not available for VEAP)

PART III - TYPE AND PROGRAM OF EDUCATION OR TRAINING

Day Year

Apt./Unit Number

Secondary:

Number and Street

 10A. TYPE OF EDUCATION OR TRAINING (See instructions for additional information)

9A. Chapter 33 - Post-9/11 GI Bill (Complete 9F if you are eligible for chapter 30, chapter 1606, or chapter 1607)

9B. Chapter 30 - Montgomery GI Bill Educational Assistance Program (MGIB)

9C. Chapter 1606 - Montgomery GI Bill - Selected Reserve Educational Assistance Program (MGIB-SR) 

A. NAME B. ADDRESS C. PHONE NUMBER

9D. Chapter 1607 - Reserve Educational Assistance Program (REAP) 

PART I - APPLICANT INFORMATION

 6B. APPLICANT'S E-MAIL ADDRESS (If applicable) 

LICENSING OR CERTIFICATION TEST REIMBURSEMENT 

(MCSE, CCNA, EMT, NCLEX, ETC.)

CORRESPONDENCE

COLLEGE OR OTHER SCHOOL (Including on-line courses)

TUITION ASSISTANCE TOP-UP 

(Chapter 30 & 33 only)

NATIONAL TEST REIMBURSEMENT (SAT, CLEP, ETC.)

VOCATIONAL FLIGHT TRAINING

APPRENTICESHIP OR ON-THE-JOB

 6A. APPLICANT'S TELEPHONE NUMBERS (Include Area Code) 

Month

9E. Chapter 32 or Section 903 - Post-Vietnam Era Veterans' Educational Assistance Program (VEAP)

I elect to receive chapter 33 education benefits in lieu of the education benefit checked below, effective

I understand that my election is irrevocable and may not be changed. (Check only one)

Chapter 30 - Montgomery GI Bill Educational Assistance Program (MGIB)

9F. By electing Chapter 33, I acknowledge that I understand the following: 

 • I may not receive more than a total of 48 months of benefits under two or more programs.

 • If electing chapter 33 in lieu of chapter 30, my months of entitlement under chapter 33 will be limited to the number of 

months of entitlement remaining under chapter 30 on the effective date of my election. However, if I completely exhaust 

my entitlement under chapter 30 before the effective date of my chapter 33 election, I may receive up to 12 additional 

months of benefits under chapter 33.

 • My election is irrevocable and may not be changed.

Chapter 1607 - Reserve Educational Assistance Program (REAP)

Chapter 1606 - Montgomery GI Bill - Selected Reserve Educational Assistance Program (MGIB-SR)

(date)
224 H U D - V A S H R E S O U R C E G U I D E

8/15/2007

1/18/2005

9/26/2000

PAGE 2 OF 4

10B. PROVIDE THE FULL NAME AND ADDRESS OF THE SCHOOL, IF KNOWN (Skip this item if you are only applying for National Test Reimbursement, Licensing 

and Certification Test Reimbursement, or Tuition Assistance Top-Up)

10C. PLEASE SPECIFY YOUR EDUCATIONAL OR CAREER OBJECTIVE, IF KNOWN (e.g. Bachelor of Arts in Accounting, welding certificate, police officer, etc.)

YES NO

PART V - EDUCATION AND EMPLOYMENT INFORMATION

NOTE: It will help VA process your claim if you send a copy of the following: 

 DD Form 214 (Member 4) for all periods of active duty service (excluding active duty for training) 

 DD Form 2384, Notice of Basic Eligibility (NOBE) if applying for Chapter 1606 

 Copies of orders if activated from the guard/reserves

14B. DO YOU HOLD ANY FAA FLIGHT CERTIFICATES? (If "Yes," specify each 

certificate in Part IX, Remarks)

SOCIAL SECURITY NUMBER OF APPLICANT

(Please provide a copy of your DD Form 214 (Member 4) when issued)

14C. EDUCATION AFTER HIGH SCHOOL (Including apprenticeship, on-the-job training, and flight training)

11. ARE YOU NOW ON ACTIVE DUTY? (Do not check "Yes" if you are currently on drilling status in the the Selected Reserve, or if you 

are on active duty for training)

YES NO

C. SERVICE COMPONENT (USN, 

USAF, USAR, ARNG, ETC.) B. DATE SEPARATED D. SERVICE STATUS (Active duty, drilling reservist, IRR, etc.)

E. WERE YOU INVOLUNTARILY CALLED TO 

ACTIVE DUTY FOR THIS PERIOD? A. DATE ENTERED 

PART IV - SERVICE INFORMATION

DATE:

12. ARE YOU NOW ON TERMINAL LEAVE JUST BEFORE DISCHARGE?

14A. DID YOU RECEIVE A HIGH SCHOOL DIPLOMA OR HIGH SCHOOL 

EQUIVALENCY CERTIFICATE? (If "Yes" provide date)

YES NO

13. PLEASE COMPLETE THE FOLLOWING FOR EACH PERIOD OF MILITARY SERVICE

YES NO

DEGREE, DIPLOMA, 

OR CERTIFICATE 

RECEIVED

DATES OF TRAINING

FROM TO

MAJOR FIELD 

OR COURSE OF STUDY

NAME AND LOCATION OF 

COLLEGE OR OTHER 

TRAINING PROVIDER

NUMBER AND TYPE 

OF HOURS (Semester, 

Quarter, or Clock)

(EXAMPLE)

USMC

9/24/2004

8/14/2007

Present

USMCR DRILLING

ACTIVE DUTY YES

ACTIVE DUTY

N/A

USMC NO

VA FORM 22-1990, MAR 2011
H U D - V A S H R E S O U R C E G U I D E 225 

 18. WERE YOU COMMISSIONED AS THE RESULT OF A SENIOR ROTC (Reserve Officers Training Corps) 

 SCHOLARSHIP? If you received your commission through a non-scholarship program, check "No." If 

 "Yes," provide the date of your commission and the amount of your scholarship for each school year you 

 were in the Senior ROTC program. Don't report your monthly subsistence allowance (stipend). 

ACTIVE DUTY KICKER

Date of Commission

 21. FOR ACTIVE DUTY CLAIMANTS ONLY: ARE YOU RECEIVING, OR DO YOU ANTICIPATE RECEIVING, ANY MONEY 

 (INCLUDING BUT NOT LIMITED TO FEDERAL TUITION ASSISTANCE) FROM THE ARMED FORCES OR PUBLIC 

 HEALTH SERVICE FOR THE COURSE FOR WHICH YOU HAVE APPLIED TO THE VA FOR EDUCATION BENEFITS? 

 IF YOU RECEIVE SUCH BENEFITS DURING ANY PART OF YOUR TRAINING, CHECK "YES." NOTE: IF YOU ARE 

 ONLY APPLYING FOR TUITION ASSISTANCE TOP-UP, CHECK NO IN THIS ITEM.

 17. IF YOU GRADUATED FROM A MILITARY SERVICE ACADEMY, SPECIFY THE YEAR YOU GRADUATED AND 

 RECEIVED YOUR COMMISSION.

 19. ARE YOU CURRENTLY PARTICIPATING IN A SENIOR ROTC SCHOLARSHIP PROGRAM THAT PAYS FOR YOUR 

 TUITION, FEES, BOOKS AND SUPPLIES UNDER SECTION 2107 OF TITLE 10, U.S. CODE?

Graduation Year

 16. DO YOU QUALIFY FOR A KICKER (sometimes called a "College Fund") BASED ON YOUR MILITARY SERVICE? 

 (Kickers are additional amounts contributed by DOD to an education fund). If you qualify for a kicker, it will help 

 VA process your claim if you submit a copy of the kicker contract. Reserve kicker contracts must include the 

 amount and effective date.

Scholarship Amounts:

Year: Amount:

Year:

Year: Amount:

Year:

Year:

Amount:

Amount:

Amount:

14D. EMPLOYMENT (Only complete if you held a license or journeyman rating to practice a profession)

EMPLOYMENT NUMBERS OF MONTHS WORKED LICENSE OR RATING

AFTER MILITARY SERVICE

PRINCIPAL OCCUPATION

BEFORE MILITARY SERVICE

PART VI - ENTITLEMENT TO AND USAGE OF ADDITIONAL TYPES OF ASSISTANCE

NO

NO

RESERVE KICKER

YES

YES

YES NO

YES NO

 15. DID YOU MAKE ADDITIONAL CONTRIBUTIONS (UP TO $600.00) TO INCREASE THE AMOUNT OF YOUR MONTHLY 

 BENEFITS? IF "YES," IT WILL HELP VA PROCESS YOUR CLAIM IF YOU SUBMIT ANY EVIDENCE YOU HAVE TO 

 SUPPORT YOUR CLAIM (e.g., cash collection voucher, leave and earnings statement(s), receipt voucher, etc.)

 22. FOR CIVILIAN EMPLOYEES OF THE U.S. GOVERNMENT ONLY: ARE YOU RECEIVING, OR DO YOU ANTICIPATE 

 RECEIVING, ANY MONEY (INCLUDING, BUT NOT LIMITED TO, THE GOVERNMENT EMPLOYEES TRAINING ACT) 

 FROM YOUR AGENCY FOR THE SAME PERIOD FOR WHICH YOU HAVE APPLIED TO THE VA FOR EDUCATION 

 BENEFITS? IF YOU WILL RECEIVE SUCH BENEFITS DURING ANY PART OF YOUR TRAINING, CHECK "YES."

YES NO

 20. IF YOU HAD A PERIOD OF ACTIVE DUTY THAT THE DEPARTMENT OF DEFENSE COUNTS FOR PURPOSES OF 

 REPAYING AN EDUCATION LOAN, CHECK "YES". SHOW THE PERIOD OF ACTIVE DUTY THAT THE MILITARY 

 CONSIDERS AS BEING USED FOR THE PURPOSES OF REPAYING THIS EDUCATION LOAN IN PART IX "REMARKS".

YES NO

YES NO

YES NO

SOCIAL SECURITY NUMBER OF APPLICANT

VA FORM 22-1990, MAR 2011 PAGE 3 OF 4
226 H U D - V A S H R E S O U R C E G U I D E

NOTE : Only complete this section if you have military service before January 1, 1977 (or delayed entry before January 2, 1978). See instructions.

PAGE 4 OF 4

NOTE: The most current information on VA education benefits is available online at www.gibill.va.gov

If you would like to receive a printed pamphlet check here.

26A. SIGNATURE OF APPLICANT (DO NOT PRINT)

PART VIII - MARITAL AND DEPENDENCY STATUS

26B. DATE SIGNED

 I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief. If on active duty, I also certify 

 that I have consulted with an Education Service Officer (ESO) regarding my education program.

PART X - CERTIFICATION AND SIGNATURE OF APPLICANT

YES NO

24. DO YOU HAVE ANY CHILDREN WHO ARE UNDER AGE 18, OR OVER 18 BUT UNDER AGE 23, NOT MARRIED AND ATTENDING SCHOOL, OR OF 

 ANY AGE PERMANENTLY HELPLESS FOR MENTAL OR PHYSICAL REASONS?

SOCIAL SECURITY NUMBER OF APPLICANT

PART IX - REMARKS 

(If more space is needed, please attach a separate sheet of paper. Be sure to include your name and social security number on each sheet)

YES NO

23. ARE YOU MARRIED?

PART VII - INFORMATION ON VA EDUCATION BENEFITS

YES NO

APPLICATION SUBMISSION REMINDERS

Did you remember to ........ 

 

 Write your social security number on each page? 

 Write your complete mailing address? 

 Attach all supporting documents (e.g. voided check, orders, DD214, kicker contract, NOBE, cash

 collection voucher, etc.)?

 

IF SO, PLEASE SIGN AND DATE THE APPLICATION BELOW

 PENALTY - Willful false statements as to a material fact in a claim for education benefits is a punishable offense and may result in the 

 forfeiture of these or other benefits and in criminal penalties.

 25. DO YOU HAVE A PARENT WHO IS DEPENDENT UPON YOU FOR FINANCIAL SUPPORT?

VA FORM 22-1990, MAR 2011
H U D - V A S H R E S O U R C E G U I D E 227 

ACCOUNT NUMBER

22-5490

 DEPENDENTS' APPLICATION FOR VA EDUCATION BENEFITS 

(Under Provisions of chapters 33 and 35, of title 38,U.S.C.)

VA FORM 

OCT 2010

 6. TELEPHONE NUMBER(S) (Including Area Code)

OMB Approved No. 2900-0098 

Respondent Burden: 30 minutes

 9. PLEASE PROVIDE THE NAME, ADDRESS, AND TELEPHONE NUMBER OF SOMEONE WHO WILL ALWAYS KNOW WHERE YOU CAN BE REACHED

2. SEX OF APPLICANT 

4. NAME (FIRST-MIDDLE-LAST)

ROUTING OR TRANSIT NUMBER

7. E-MAIL ADDRESS (If applicable)

17. DO YOU OR THE QUALIFYING INDIVIDUAL ON WHOSE ACCOUNT YOU ARE CLAIMING BENEFITS HAVE AN OUTSTANDING FELONY AND/OR WARRANT?

PART I - APPLICANT INFORMATION

3. DATE OF BIRTH 

5. CURRENT MAILING ADDRESS (Number and street or rural route, city or P.O., State and ZIP Code) 

1. SOCIAL SECURITY NUMBER 

11. SOCIAL SECURITY NUMBER OR VA FILE NUMBER

14. DATE OF DEATH OR DATE LISTED AS 

 MISSING IN ACTION OR P.O.W. 

PART II - QUALIFYING INDIVIDUAL INFORMATION

PART III - BENEFIT AND TYPE OF EDUCATION OR TRAINING

 VA DATE STAMP 

(For VA Use Only)

12. BRANCH OF SERVICE

SPOUSE SURVIVING SPOUSE

SECONDARY

SAVINGS

YES NO

15. IS QUALIFYING INDIVIDUAL CURRENTLY ON ACTIVE DUTY?

SUPERSEDES VA FORM 22-5490, DEC 2009, 

WHICH WILL NOT BE USED.

FEMALE

INTERNET VERSION AVAILABLE - You may complete and submit your application online at: www.gibill.va.gov

10. NAME OF INDIVIDUAL ON WHOSE ACCOUNT BENEFITS ARE BEING CLAIMED (FIRST- MIDDLE -LAST)

MALE

8. DIRECT DEPOSIT (Attach a voided personal check or provide the following information. Direct Deposit is not available for DEA benefit payments)

ADOPTED CHILD

PRIMARY

CHILD STEPCHILD

16. YOUR RELATIONSHIP TO QUALIFYING INDIVIDUAL

13. DATE OF BIRTH

18B. CHAPTER 33 - POST-9/11 GI BILL MARINE GUNNERY 

SERGEANT JOHN DAVID FRY SCHOLARSHIP 

(FRY SCHOLARSHIP) 

ACCOUNT TYPE

CHECKING

A. NAME B. ADDRESS C. TELEPHONE NUMBER (Include Area Code)

YES NO

COLLEGE OR OTHER SCHOOL

INSTITUTION OF HIGHER LEARNING

18A. CHAPTER 35 - SURVIVORS' AND DEPENDENTS' EDUCATIONAL ASSISTANCE 

PROGRAM (DEA)

APPRENTICESHIP OR OTHER ON-THE-JOB TRAINING

FARM COOPERATIVE

LICENSING OR CERTIFICATION TEST

NATIONAL ADMISSION EXAMS OR NATIONAL EXAMS FOR CREDIT

CORRESPONDENCE COURSE (Spouse or Surviving Spouse only)

LICENSING OR CERTIFICATION TEST

PAGE 1
228 H U D - V A S H R E S O U R C E G U I D E

IMPORTANT: You may not receive payments of Dependency and Indemnity Compensation (DIC) or Pension and you may not be claimed as a 

dependent in a compensation claim while receiving Survivors' and Dependents' Educational Assistance (DEA). CAREFULLY READ THE 

INSTRUCTIONS BEFORE COMPLETING THIS ELECTION BLOCK. YOU ARE STRONGLY ENCOURAGED TO DISCUSS YOUR ELECTION WITH A 

VA COUNSELOR.

(If "Yes," please provide date of remarriage)

22. IF YOU ARE THE SPOUSE OF A DISABLED VETERAN, IS A DIVORCE OR ANNULMENT PENDING?

PART VI - APPLICANT'S MILITARY SERVICE INFORMATION 

(Note: Chapter 35 benefits are not payable while an eligible person is on active duty) 

 29. SOCIAL SECURITY NUMBER OF INDIVIDUAL ON WHOSE ACCOUNT YOU PREVIOUSLY CLAIMED BENEFITS

PART IV - DEA APPLICANT AND ELECTION INFORMATION 

(Fry Scholarship Applicants, Skip to Part V)

 25. IF YOU ARE THE SURVIVING SPOUSE OF A DECEASED VETERAN, HAVE YOU REMARRIED SINCE HIS OR HER DEATH?

YES NO

21. DATE YOU WILL BEGIN SCHOOL OR TRAINING 

19. NAME AND ADDRESS OF SCHOOL OR TRAINING FACILITY (Number and street or rural route, city or P.O., State and ZIP Code)

20. SPECIFY YOUR EDUCATION OR CAREER OBJECTIVE, IF KNOWN (e.g., Bachelor of Arts in Accounting, Welding Certificate, Police Officer ) 

SOCIAL SECURITY NUMBER OF APPLICANT

 24. ARE YOU A HANDICAPPED CHILD, SPOUSE, OR SURVIVING 

 SPOUSE SEEKING SPECIALIZED VOCATIONAL TRAINING? 

 

 23. ARE YOU A HANDICAPPED CHILD (14 YEARS OR OLDER), SPOUSE, OR 

 SURVIVING SPOUSE SEEKING SPECIAL RESTORATIVE TRAINING? 

 

YES NO YES NO

SECTION II - ELECTION (CHILD APPLICANTS ONLY)

YES NO

SECTION I - APPLICANT INFORMATION

 26. I CERTIFY that I understand the effects of an election to receive DEA benefits and I elect to receive such benefits on the following date:

G. OTHER (Specify benefit(s)

D. VETERANS EDUCATION ASSISTANCE BASED ON YOUR OWN SERVICE SPECIFY BENEFIT(S):

B. DEPENDENTS' INDEMNITY COMPENSATION (DIC)

E. VETERANS EDUCATION ASSISTANCE BASED ON SOMEONE ELSE'S SERVICE 

 SPECIFY BENEFIT(S) BY CHECKING APPLICABLE BOX BELOW AND COMPLETE ITEMS 28 AND 29 

TRANSFERRED ENTITLEMENT

C. VOCATIONAL REHABILITATION BENEFITS (Chapter 31)

IMPORTANT: Complete Items 28 and 29 only if you checked block "E" in Item 27

CHAPTER 35 - SURVIVORS' AND DEPENDENTS' EDUCATIONAL ASSISTANCE PROGRAM (DEA)

CHAPTER 33 - POST-9/11 GI BILL MARINE GUNNERY SERGEANT DAVID FRY SCHOLARSHIP

A. DISABILITY COMPENSATION OR PENSION

F. NONE

 27. PRIOR TO THIS APPLICATION, HAVE YOU EVER APPLIED FOR OR RECEIVED ANY OF THE FOLLOWING VA BENEFITS? (Check all appropriate boxes)

 30. HAVE YOU EVER SERVED ON ACTIVE DUTY IN THE ARMED FORCES? (If "No," skip to Part VII)

PART V - APPLICATION HISTORY

31. INFORMATION ABOUT YOUR PERIOD(S) OF ACTIVE DUTY

 28. NAME OF INDIVIDUAL ON WHOSE ACCOUNT YOU PREVIOUSLY CLAIMED BENEFITS (First, Middle, Last)

YES NO

PAGE 2

A. DATE ENTERED ACTIVE DUTY D. CHARACTER OF DISCHARGE B. DATE SEPARATED FROM 

ACTIVE DUTY

C. BRANCH OF SERVICE OR 

RESERVE OR GUARD 

COMPONENT

MONTH DAY YEAR

MONTH DAY YEAR

MONTH DAY YEAR
H U D - V A S H R E S O U R C E G U I D E 229 

35. CURRENT AND PAST EMPLOYMENT

 I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief.

DID YOU REMEMBER TO:

PART VII - EDUCATION, TRAINING, AND EMPLOYMENT

36B. SOURCE OF EDUCATIONAL ASSISTANCE FROM GOVERNMENT 

 EMPLOYMENT 

 39B. DATE SIGNED 

 37. REMARKS (If more space is needed, please attach a separate sheet of paper. Be sure to include name and social security number on each sheet) 

 PENALTY: Willfully false statements as to a material fact in a claim for education benefits is a punishable offense and may result in the forfeiture of these or other 

 benefits and in criminal penalties. 

SIGN HERE 

IN INK

PART IX - CERTIFICATION AND SIGNATURE OF APPLICANT 

 33. DATE

PART VIII - REMARKS, REMINDERS AND VA EDUCATION BENEFITS PAMPHLET

34B. NAME AND 

LOCATION OF SCHOOL 

(City and State) TO

SECTION II - EMPLOYMENT

 32. CHECK THE APPROPRIATE BOX AND ENTER THE DATE IN ITEM 33

34C. DATES OF TRAINING

GRADUATED FROM HIGH SCHOOL

EXPECT TO GRADUATE FROM HIGH SCHOOL

NEVER ATTENDED HIGH SCHOOL

AWARDED GED 

FROM

34E. DEGREE, 

DIPLOMA, OR 

CERTIFICATE 

RECEIVED 

OTHER 

(Specify)

DISCONTINUED HIGH SCHOOL 

34D. NUMBER OF 

SEMESTER, 

QUARTER, OR CLOCK 

HOURS COMPLETED 

34F. MAJOR FIELD OR 

COURSE OF STUDY 

34A. 

TYPE OF 

SCHOOL

HIGH SCHOOL

COLLEGE

VOCATIONAL 

OR TRADE

SECTION I - REMARKS

 38. THE MOST CURRENT INFORMATION ON VA EDUCATION BENEFITS IS AVAILABLE ONLINE AT www.gibill.va.gov IF YOU WOULD LIKE A COPY OF THE VA

 EDUCATION BENEFITS PAMPHLET PLEASE CHECK THE BOX. 

D. LICENSE OR RATING

NOTE: Complete Item 36 only if you are a civilian employee of the U.S. Government

A. EMPLOYER B. JOB TITLE C. NUMBER OF MONTHS 

EMPLOYED

SECTION III - VA EDUCATION BENEFITS PAMPHLET

 39A. SIGNATURE OF APPLICANT (DO NOT PRINT)

SECTION II - REMINDERS

YES NO

 36A. DO YOU EXPECT TO RECEIVE FUNDS FROM YOUR AGENCY OR 

 DEPARTMENT FOR THE SAME COURSES FOR WHICH YOU EXPECT TO 

 RECEIVE VA EDUCATIONAL ASSISTANCE? (If "Yes," complete Item 36B) 

PAGE 3

SECTION I - EDUCATION & TRAINING

SOCIAL SECURITY NUMBER OF APPLICANT

WRITE YOUR SOCIAL SECURITY NUMBER ON EACH PAGE

WRITE YOUR COMPLETE MAILING ADDRESS

ATTACH SUPPORTING DOCUMENTS (e.g., birth certificate, marriage license, DD214, etc.)



VA FORM 22-5490, OCT 2010
230 H U D - V A S H R E S O U R C E G U I D E

Use this form to apply for educational assistance under the following benefit programs: 

 

 Survivors' and Dependents' Educational Assistance Program (DEA) (chapter 35 of title 38, U.S. Code) 

 

 Post-9/11 GI Bill Marine Gunnery Sergeant John David Fry Scholarship (Fry Scholarship) 

 (chapter 33 of title 38, U.S. Code) 

(Please detach at perforation and retain this information for future reference)

INFORMATION AND INSTRUCTIONS FOR COMPLETING THE 

 DEPENDENTS' APPLICATION FOR VA EDUCATION BENEFITS 

(VA FORM 22-5490) 

VA FORM 

OCT 2010 22-5490 SUPERSEDES VA FORM 22-5490, DEC 2009, WHICH WILL NOT BE USED.

Do not use this form to apply for Veterans' education assistance based on your own service (chapters 30, 32, 33, 1606, or 1607) or 

vocational rehabilitation benefits (chapter 31). To apply for veterans' education assistance based on your own service, use VA Form 

22-1990. To apply for vocational rehabilitation benefits, use VA Form 28-1900. 

INTERNET VERSION AVAILABLE - You may complete and submit this application on-line at www.gibill.va.gov. Click on "GI Bill: 

Apply for Benefits." 

 

VA VOCATIONAL AND EDUCATIONAL COUNSELING HELP AVAILABLE - VA offers a wide range of services to assist you in 

planning your educational and/or career goals. Services include educational and vocational guidance and testing to develop a greater 

understanding of your skills, talents, and interests. For more information on VA counseling, call VA toll-free at 1-888-GIBILL-1 

(1-888-442-4551) or TDD at 1-800-829-4833.

NOTE: The number on the instructions match the item numbers on this application. Items not mentioned are self-explanatory. 

 

ITEM 17. You will not be eligible to receive benefits for any period for which you or the qualifying individual on whose account you are 

claiming benefits has an outstanding felony warrant. Any benefits paid to you for such period will result in an overpayment and be 

subject to collection.

 

ITEM 18.

18A. Select the benefit for which you are applying.

To qualify for Survivors' and Dependents' Educational Assistance (DEA) you must be either - 

 

 (1) The spouse or child of a veteran who is permanently and totally disabled as a result of a service-connected disability. 

 (2) The spouse or child of an individual on active duty who has been listed as missing in action, captured in line of duty 

 by hostile force, forcibly detained or interned in line of duty by hostile force, or forcibly detained or interned in line of 

 duty by foreign government or power for more than 90 days. 

 (3) The surviving spouse or child of a veteran who died of a service-connected disability or who dies while a 

 service- connected disability was rated permanent and total in nature. 

 (4) The spouse or child of an individual on active duty for which the evidence shows that the individual is hospitalized 

 for receiving outpatient medical care services or treatment; has a total disability permanent in nature incurred or 

 aggravated in the line of duty in the active military, naval, or air service; and the serviceperson is likely to be 

 discharged or released from such service for such disability. 

 

Eligibility for DEA will be terminated in the event that VA determines that the individual on whose account benefits are claimed is no 

longer totally disabled or VA is notified that the individual is no longer listed as captured, missing in action, or forcibly detained. 

 

18B. To qualify for the Fry Scholarship, you must be the child of an individual who after September 10, 2001, died in the line of duty 

while serving on active duty as a member of the Armed Forces.

 

18A. & 18B. Types of education or training programs are self-explanatory, except for the following -

 

"Licensing or Certification Test." A licensing test is a test offered by a state, local, or federal agency that is required by law to practice 

an occupation. A certification test is a test designed to provide affirmation of an individual's qualifications in a specific occupation. 

 

"National Admission Exam or National Exam for Credit." Individuals eligible to receive benefits under the Survivors' and Dependents' 

Educational Assistance program may be reimbursed for the cost of approved tests for admission to or credit at institutions of higher 

learning. 

 

"Correspondence." Only spouses and surviving spouses eligible for the Survivors' and Dependents' Educational Assistance program 

may receive benefits for correspondence training. Payments for correspondence courses are made quarterly after VA receives a 

certification showing the number of lessons completed. For more information on correspondence courses, please visit our website at 

www.gibill.va.gov. 
H U D - V A S H R E S O U R C E G U I D E 231 

INFORMATION AND INSTRUCTIONS (Continued)

ITEMS 23 and 24. Any individual eligible under the Survivors' and Dependents' Educational Assistance program may receive Special 

Restorative Training or Specialized Vocational Training if a VA counselor determines that a specialized program is needed to overcome 

the effects of a physical or mental handicap. To be eligible for receipt of specialized training, the disability must prevent you from 

pursuing an educational program. Examples of Special Restorative Training include speech and voice correction, language retraining, 

lip reading, and Braille reading and writing. Specialized Vocational Training consists of specialized courses leading to a suitable 

vocational objective.

 

ITEM 26. Your election to receive Survivors' and Dependents' Educational Assistance (DEA) is final and cannot be changed. This 

means that payments of compensation, pension, and Dependents' Indemnity Compensation (DIC) will be terminated upon issuance of 

a DEA benefit payment. If you are planning to pursue a program of education for more than 45 months, you should consider deferring 

receipt of DEA benefits. We strongly recommend that you discuss your education or training plans with a VA counselor before making a 

decision. If you decide to elect benefits under DEA, indicate the date from which you wish your DEA payments to begin.

 

Step 3: Wait for VA to process your application and notify you of its decision concerning your eligibility for education benefits.

ADDITIONAL HELP COMPLETING APPLICATION

(B) If you have not selected a school or training establishment: 

If you need additional help completing this application or you want information about our work-study program, call VA tollfree at 1-888-GIBILL-1 (1-888-442-4551). If you are hearing impaired, call us toll-free at 1-800-829-4833. You can also 

get more information about education assistance from our education Internet site at www.gibill.va.gov.

Step 1: Mail the completed application to the VA Regional Processing Office for the region of your home address. Check next 

page for the post office box address for these offices.

 

(A) If you have selected a school or training establishment:

Step 2: Wait for VA to process your application and notify you of its decision concerning your eligibility for education benefits.

Step 1: Mail the completed application to the VA Regional Processing Office for the region of that school's physical address.

See reverse for the addresses of these VA Regional Processing Offices. 

 

Step 2: Tell the veterans certifying official at your school or training establishment that you have applied for VA education benefits. 

Ask him or her to submit your enrollment information using VA Form 22-1999, Enrollment Certification, or its electronic version. 

HOW TO FILE YOUR CLAIM

Be sure to do the following:
232 H U D - V A S H R E S O U R C E G U I D E

Western Region: 

VA Regional Office 

P. O. Box 8888 

Muskogee, OK 74402-8888

SERVES THE FOLLOWING STATES

Southern Region: 

VA Regional Office 

P. O. Box 100022 

Decatur, GA 30031-7022

SERVES THE FOLLOWING STATES

Foreign 

Schools 

Eastern Region: 

VA Regional Office 

P. O. Box 4616 

Buffalo, NY 14240-4616

CT DE DC ME

MD MA NH NJ

NY OH PA RI

VT VA WV

AK AL AR AZ FL GA

PR

SC

US Virgin 

Islands

NC

Philippines

OR

CA HI ID LA

MS

TX WA

OK

SERVES THE FOLLOWING STATES

NM NV

PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any source other than what has been authorized 

under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., awards of benefits) as identified in the VA 

system of records, 58VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records - VA, published in 

the Federal Register. Your obligation to respond is required to obtain education benefits. Giving us your SSN account information is voluntary. 

Refusal to provide your SSN by itself will not result in the denial of benefits. VA will not deny an individual benefits for refusing to provide his or 

her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect. The requested 

information is considered relevant and necessary to determine the maximum benefits allowable under the law. While you do not have to respond, 

VA cannot process your claim for benefits unless the information is furnished as required by existing law (38 U.S.C. 3513). The responses you 

submit are considered confidential (38 U.S.C. 5701). Information submitted is subject to verification through computer matching programs with 

other agencies.

RESPONDENT BURDEN: We need this information to determine your eligibility for education benefits (38 U.S.C. 3513). Title 38 U.S.C. allows 

us to ask for this information. We estimate that you will need an average of 30 minutes to review the instructions, find the information, and 

complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not 

required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet 

Page at http://www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-888-GI-BILL-1 (1-888-442-4551) to get information on where to 

send comments or suggestions about this form. 

Central Region: 

VA Regional Office 

P. O. Box 66830 

St. Louis, MO 63166-6830

CO IA IL IN

KS KY MI MN

MO MT NE ND

SD TN WI

SERVES THE FOLLOWING STATES

WY

APO/FPO AA 

UT

Guam APO/FPO AP

VA FORM 22-5490, OCT 2010
H U D - V A S H R E S O U R C E G U I D E 233 

13. IF YOU ARE NOW WORKING (Enter the following information for your current job)

12. SERVICE INFORMATION (Enter the following information for each period of active duty. Show ALL active duty)

OMB Approved No. 2900-0009 

Respondent Burden: 15 minutes

DISABLED VETERANS APPLICATION FOR VOCATIONAL REHABILITATION 

(Chapter 31, Title 38, U.S.C.)

PURPOSE OF VOCATIONAL REHABILITATION: Vocational Rehabilitation provides services and assistance to certain veterans with disabilities 

to get and keep a suitable job. If employment is not reasonably feasible, vocational rehabilitation may be able to provide services to support veterans 

with disabilities to achieve maximum independence in their daily living activities. 

IMPORTANT: To see if you should fill out this form, please read the information on back.

VA FORM 

JUN 2011 28-1900 SUPERSEDES VA FORM 28-1900, NOV 2010, 

WHICH WILL NOT BE USED.

 1. FIRST, MIDDLE, LAST NAME OF VETERAN 2. SOCIAL SECURITY NO. 3. VA FILE NO. (If different, from Item 2)

 5A. MAILING ADDRESS (No. and street or rural route, City, State and ZIP Code)

 4. DATE OF BIRTH 

 (Month, Day, Year)

 7. EVENING TELEPHONE NO. 

 (Include Area Code)

 6. DAYTIME TELEPHONE NO. 

 (Include Area Code)

 8. VA OFFICE WHERE RECORDS ARE 

 LOCATED

 9. NUMBER OF YEARS OF EDUCATION

 10. IF YOU ARE MOVING WITHIN THE NEXT 30 DAYS,

 GIVE US YOUR NEW ADDRESS

 11. LIST ANY PREVIOUS VOCATIONAL REHABILITATION 

 PROGRAMS YOU HAVE BEEN IN AND GIVE THE 

 DATES (Include both VA and non-VA programs)

 DO NOT WRITE IN THIS SPACE 

(VA DATE STAMP)

PROGRAM DATE

 18A. SIGNATURE OF APPLICANT (Do not print) (Sign in ink) 18B. DATE SIGNED

I HEREBY CERTIFY THAT the information I have entered on this form is true and complete to the best of my knowledge and belief. 

I realize that making willful false statements concerning a material fact in a claim of vocational rehabilitation benefits is a punishable 

offense that may result in fine or imprisonment or both.

SERVICE NUMBER 

(Prefix and suffix)

(A)

BRANCH OF SERVICE 

(B)

DATE ENTERED 

ACTIVE DUTY 

(C)

DATE LEFT 

ACTIVE DUTY 

(D)

TYPE OF SEPARATION 

OR DISCHARGE 

(E)

 A. NAME AND ADDRESS OF EMPLOYER B. DUTIES OF YOUR JOB C. MONTHLY SALARY OR WAGES

 14. IF YOU ARE NOW HOSPITALIZED, WHAT IS THE NAME AND ADDRESS OF YOUR HOSPITAL?

 15A. WHAT IS YOUR DISABILITY RATING? 15B. WHAT IS THE NATURE OF YOUR DISABILITY (DISABILITIES)?

 16. DID YOU SERVE IN: (Check appropriate box(es))

 5B. E-MAIL ADDRESS OF VETERAN (If, available)

WORLD WAR II

POST WORLD WAR II ERA

KOREAN CONFLICT

VIETNAM

POST KOREAN CONFLICT

POST VIETNAM

GULF WAR

OPERATION IRAQI FREEDOM

OPERATION ENDURING FREEDOM

17. DISABLED TRANSITION 

ASSISTANCE PROGRAM 

(DTAP)?

YES NO 
234 H U D - V A S H R E S O U R C E G U I D E

VOCATIONAL REHABILITATION FOR SERVICE-DISABLED VETERANS

TO APPLY OR RECEIVE INFORMATION AND ASSISTANCE:

EVALUATION : If you have a VA combined service-connected disability rating of 10 percent or more and you apply 

for vocational rehabilitation, we will provide you a comprehensive evaluation. During this evaluation, a VA 

counselor will work with you to answer a variety of questions. Such as:

 

1. Do you meet the basic entitlement requirements? 

2. Are you within the time limit for receiving this benefit? (This is generally 12 years from the date VA notified you 

 that you had at least a 10% service-connected disability.) 

 

PLANNING AND COUNSELING: Your counselor must first determine that you meet the entitlement requirements and an 

employment or independent living goal is reasonably feasible. Then your counselor will help you develop a plan of services 

and assistance to assist you to reach your employment goal. Counseling will be available throughout your program to help 

you with problems that may arise. 

 

REHABILITATION SERVICES: Not all vocational rehabilitation programs involve training. You may only need employment 

services to help you get a suitable job. If a VA counselor determines that you need training to reach your vocational goal, 

your VA counselor will also determine the number of months of training you need. You may train in a vocational school, a 

special rehabilitation facility, an apprenticeship program, other on-job training position, a college, or a university. 

 

If training is appropriate, VA will provide medical and dental care treatment, employment assistance to get and keep a 

suitable job, and other services you may need. If a vocational goal is not currently feasible for you, VA may provide services 

and assistance to improve your capacity for living independently. 

 

SUPPORT: VA may pay for tuition, fees, books, equipment, tools, or other supplies you need to succeed in your program. 

During your program, you may qualify for a monthly subsistence allowance to help you meet your living expenses. The 

allowance you receive depends on your type of training, rate of attendance, and number of dependents. You will receive 

this allowance in addition to any VA compensation or military retired pay you may receive. 

 

PRIVACY ACT: The VA will not disclose information collected on this form to any source other than what has been 

authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e. VA needs the 

information this form requests to help determine your eligibility to the benefit) as identified in the VA system of records, 

58VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records, published in 

the Federal Register. Your obligation to respond is required to obtain benefits. Giving us your Social Security Number (SSN) 

information is mandatory. Applicants are required to provide their SSN under Title 38 USC 5101 (c) (1). The VA will not deny 

an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal 

Statute of law in effect prior to January 1, 1975, and still in effect.

 

RESPONDENT BURDEN: We need this information in order for veterans with compensable service-connected disabilities 

to apply for vocational rehabilitation under title 38, U.S.C. chapter 31. We estimate that you will need an average of 15 

minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of 

information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if 

this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at 

http://www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send 

comments or suggestions about this form.

• To apply, submit this completed application to the nearest VA office.

• You may obtain information and assistance from any VA office or on line at 

http://www.vba.va.gov/bln/vre/index.htm.

• Local representative of veteran's service organizations and the American Red Cross also 

have information and forms available.

VA FORM 28-1900, JUN 2011
H U D - V A S H R E S O U R C E G U I D E 235 

REQUEST FOR A CERTIFICATE OF ELIGIBILITY

MAIL COMPLETED APPLICATION TO:

 NOTE: Please read information on reverse before completing this form. If additional space is required, attach a separate sheet.

1. NAME OF VETERAN (First, Middle, Last) 2. DATE OF BIRTH

OMB Control No. 2900-0086 

Respondent Burden: 15 minutes

MILITARY SERVICE (SEE INSTRUCTIONS FOR PROOF OF SERVICE ON THE NEXT PAGE)

VA FORM 

SEP 2011 26-1880 SUPERSEDES VA FORM 26-1880, MAR 2011, 

WHICH WILL NOT BE USED.

8A. WERE YOU DISCHARGED, RETIRED, OR SEPARATED FROM SERVICE BECAUSE OF DISABILITY?

PREVIOUS VA LOANS (SEE INSTRUCTIONS ON THE NEXT PAGE - Attach a separate sheet if information for all homes will not fit in Item 10)

IMPORTANT: Please provide your dates of service. In

many cases eligibility can be established based on data in 

VA systems. However, it is recommended that proof of 

service be provided, if readily available. Proof of service 

 is required for persons who entered service after 

September 7, 1980 and were discharged after serving less 

than 2 years.

Atlanta Regional Loan Center 

Attn: COE (262) 

P. O. Box 100034 

Decatur, GA 30031

FOR VA USE ONLY

COE REF. NO.

3. SOCIAL SECURITY NUMBER

5. DAYTIME TELEPHONE NUMBER

4B. NAME(S) USED DURING MILITARY SERVICE (If different from name in Item 1)

(If "Yes," complete Item 4B)

4A. DID YOU SERVE UNDER ANOTHER NAME?

YES NO

8B. VA CLAIM NUMBER (If known)

7B. MAIL CERTIFICATE OF ELIGIBILITY TO: (Complete ONLY if the Certificate is

 to be mailed to an address different from the one listed in Item 7A.)

7A. ADDRESS (Number and street or rural route, city or P.O., State and ZIP Code)

6. E-MAIL ADDRESS (If applicable)

YES NO

9A. ARE YOU CURRENTLY ON ACTIVE DUTY? (If you currently serving on active duty, leave the "Date Separated" field blank.)

YES NO

9C. RESERVE OR NATIONAL GUARD SERVICE 

 Include any periods of Active Duty for Training

 (ADT) or Active Guard Reserve service. Do not

 include any activation for duty under Title 10 

 U.S.C. (e.g. Reserve or Guard unit mobilized.)

9B. ACTIVE SERVICE - Do not include any periods

 of Active Duty for Training or Active Guard Reserve 

 service. Do include any activation for duty under 

 Title 10 U.S.C. (e.g. Reserve or Guard unit mobilized.)

BRANCH OF 

SERVICE

SERVICE NUMBER 

(if different from 

Social Security Number)

OFFICER OR 

ENLISTED

DATE 

SEPARATED DATE ENTERED

10A. DO YOU NOW OWN ANY HOME(S) PURCHASED OR 

 REFINANCED WITH A VA-GUARANTEED LOAN?

YES (If "Yes," complete Items 10B through 10D)

NO (If "No," skip to Item 14)

NOT APPLICABLE (NA) - I HAVE NEVER OBTAINED A 

VA-GUARANTEED HOME LOAN (If "NA," skip to Item 14)

10B. DATE OF LOAN 

 (Month and Year)

10C. STREET ADDRESS 10D. CITY AND STATE

11A. ARE YOU APPLYING FOR THE ONE-TIME ONLY

 RESTORATION OF ENTITLEMENT TO PURCHASE

 ANOTHER HOME?

YES NO (If "Yes," complete Items 11B through 11D)

11B. DATE OF LOAN 11C. STREET ADDRESS 11D. CITY AND STATE

 (Month and Year)

12B. DATE OF LOAN 12C. STREET ADDRESS 12D. CITY AND STATE

 (Month and Year)

13B. DATE OF LOAN 13C. STREET ADDRESS 13D. CITY AND STATE

 (Month and Year)

13A. ARE YOU REFINANCING AN EXISTING VA LOAN TO 

 OBTAIN A LOWER INTEREST RATE WITHOUT

 RECEIVING ANY CASH PROCEEDS (IRRRL)?

12A. ARE YOU APPLYING FOR A RESTORATION OF 

 ENTITLEMENT TO OBTAIN A REGULAR (CASH-OUT)

 REFINANCE ON YOUR CURRENT HOME?

YES NO (If "Yes," complete Items 12B through 12D)

YES NO (If "Yes," complete Items 13B through 13D)

I CERTIFY THAT the statements in this document are true and complete to the best of my knowledge.

14A. SIGNATURE OF VETERAN (Do NOT print) 14B. DATE SIGNED

FEDERAL STATUTES PROVIDE SEVERE PENALTIES FOR FRAUD, INTENTIONAL MISREPRESENTATION, CRIMINAL CONNIVANCE OR 

CONSPIRACY PURPOSED TO INFLUENCE THE ISSUANCE OF ANY GUARANTY OR INSURANCE BY THE SECRETARY OF VETERANS AFFAIRS

FOR VA USE ONLY (Please do not write below this line)

DATE RETURNED

REASON(S) FOR RETURN
236 H U D - V A S H R E S O U R C E G U I D E

INSTRUCTIONS FOR VA FORM 26-1880

PRIVACY ACT NOTICE - VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 

or Title 38, Code of Federal Regulations 1.576 for routine uses (for example: the authorized release of information to Congress when requested for statistical purposes) 

identified in the VA system of records, 55VA26, Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing 

Applicant Records, and Vendee Loan Applicant Records - VA, and published in the Federal Register. Your obligation to respond is required in order to determine the 

qualifications for a loan.

Item 1 - Tell us your complete name, as you would like it to appear on your Certificate of Eligibility (COE).

Item 4B - If you served under another name, provide the name as it appears on your discharge certificate (DD Form 214). 

Item 7 - You can have your Certiticate of Eligibility sent to you at your current mailing address, or directly to your lender, or to any mailing address you provide in Item 

7B. 

Item 8B - In most cases, your VA claim number is the same as your Social Security Number. If you are not sure of your VA claim number, leave this field blank.

Item 9 - NOTE - Cases involving other than honorable discharges will usually require further development by VA. This is necessary to determine if the service was 

under other than dishonorable conditions.

Item 9A - If you are currently serving on regular active duty, eligibility can usually be established based on data in VA systems. However, in some situations you may 

be asked to provide a statement of service signed by, or by direction of, the adjutant, personnel officer, or commander of your unit or higher headquarters. The statement 

may be in any format; usually a standard or bulleted memo is sufficient. It should identify you by name and social security number, and provide: (1) your date of entry 

on your current active duty period and (2) the duration of any time lost (or a statement noting there has been no lost time). Generally this should be on military 

lettherhead.

RESPONDENT BURDEN - This information is needed to help determine a veteran's qualifications for a VA guaranteed home loan. Title 38, U.S.C., section 

3702, authorizes collection of this information. We estimate that you will need an average of 15 minutes to review the instructions, find the information, and 

complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a 

collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/

PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

VA FORM 26-1880, SEP 2011

A. YOUR IDENTIFYING INFORMATION

B. MILITARY SERVICE

Item 9B - Active Service (not including Active Duty Training or Active Guard Reserve service) - the best evidence to show your service is your discharge certificate 

(DD Form 214) showing active duty dates and type of discharge. If you were separated after October 1, 1979, the DD214 was issued in several parts (copies). We are 

required to have a copy showing the character of service (Item 24) and the narrative reason for separation (Item 28). We prefer the MEMBER-4 copy, however, we can 

accept any copy that contains these items. The copy number is shown on the bottom right of the form. We don't need the original; a photocopy is acceptable. Any 

Veterans Services Representative in the nearest Department of Veterans Affairs office or center will assist you in securing necessary proof of military service.

Item 9C - National Guard Service: You may submit NGB Form 22, Report of Separation and Record of Service, or NGB Form 23, Retirement Points Accounting, or 

their equivalent. We are required to have a copy showing character of service.

Selected Reserve Service (Including Active Duty Training and Active Guard Reserve) - You may submit (Including Active Duty Training and Active Guard 

Reserve) a copy of your latest annual retirement points statement and evidence of honorable service. There is no single form used by the Reserves similar to the DD 

Form 214 or NGB Form 22. The following forms are commonly used, but others may be acceptable:

Army Reserve DARP FM 249-2E 

Naval Reserve NRPC 1070-124 

Air Force Reserve AF 526 

Marine Corps Reserve NA VMC 798 

Coast Guard Reserve CG 4174 or 4175

If you are still serving in the Selected Reserves or the National Guard, you must include an original statement of service signed by, or by the direction of, the adjutant, 

personnel officer, or commander of your unit or higher headquarters showing your date of entry and the length of time that you have been a member of the Selected 

Reserves. At least 6 years of honorable service must be documented.

C. PREVIOUS VA LOANS

Items 10 through 14. Your eligibility is reusable depending on the circumstances. Normally, if you have paid off your prior VA loan and no longer own the home, you 

can have your used eligibility restored for additional use. Also, on a one-time only basis, you may have your eligibility restored if your prior VA loan has been paid in 

full but you still own the home. Normally VA receives notification that a loan has been paid. In some instances, it may be necessary to include evidence that a previous 

VA loan has been paid in full. Evidence can be in the form of a paid-in-full statement from the former lender, a satisfaction of mortgage from the clerk of court in the 

county where the home is located, or a copy of the HUD-1 settlement statement completed in connection with a sale of the home or refinance of the prior loan. Many 

counties post public documents (like the satisfaction of mortgage) online.

Item 11A. One-Time Restoration. If you have paid off your VA loan, but still own the home purchased with that loan, you may apply for a one-time only restoration 

of your entitlement in order to purchase another home that will be your primary residence. Once you have used your one-time restoration, you must sell all homes 

before any other entitlement can be restored.

Item 12A. Regular (cash-out) Refinance. You may refinance your current VA or non-VA loan in order to pay off the mortgage and/or other liens of record on the 

home. This type of refinance requires an appraisal and credit qualifying.

Item 13A. Interest Rate Reduction Refinancing Loan (IRRRL). You may refinance the balance of your current VA loan in order to obtain a lower interest rate, or 

convert a VA adjustable rate mortgage to a fixed rate. The new loan may not exceed the sum of the outstanding balance on the existing VA loan, plus allowable fees 

and closing costs, including VA funding fee and up to 2 discount points. You may also add up to $6,000 of energy efficiency improvements into the loan. A certificate 

of eligibility is not required for IRRRL. Instead, a Prior Loan Validation, obtained through our online system WebLGY can be used in lieu of a COE. Presently, this 

application is only available to lenders. In WebLGY, a lender can select Eligibility from the toolbar and then Prior Loan Validation. Enter the veteran's Social Security 

Number and Last Name. The system will then, in most cases, pull up the veteran's active loan information. Print the prior Loan Validation screen and use it in lieu of 

the COE.

NOTE - A reservist or member of the National Guard can be called to active duty under either of two legal authorities. Title 10 U.S. Code covers those who are ordered 

to regular active duty under federal call up. Reservists may also be called to active service under the authority of Title 32 U.S. Code. Service covered under Title 32 U.

S. Code includes basic training (Initial Active Duty for Training or IADT) annual training, as well as certain types of full-time duty may be called Active Guard 

Reserve, Active Duty for Special Work. Full-time National Guard Duty or Active Duty Support. Service under Title 10 U.S. Code is qualifying active duty for the VA 

Home Loan Benefit. Active service under Title 32 U.S. Code, however, does NOT qualify under the active duty requirements. Service under Title 32 U.S. Code can be 

used to meet the 6-year requirement to qualify as a member of the Selected Reserve or National Guard.
H U D - V A S H R E S O U R C E G U I D E 237 

INFORMATION AND INSTRUCTIONS FOR COMPLETING THE 

VETERAN'S APPLICATION FOR 

 COMPENSATION AND/OR PENSION

Frequently Asked Questions 

 

For what do I use VA Form 21-526? 

 

Use VA Form 21-526 to apply for compensation and/or pension benefits. 

 

Should I apply for compensation or pension benefits?

 

You should apply for compensation benefits if: 

You currently have a disability that is the result of an injury, disease, 

or an event in military service. 

You should apply for pension benefits if all of the following are true: 

 

You are age 65 or older or are permanently and totally disabled. 

You served on active duty with at least one day during a period of war. 

 

Your income and net worth does not exceed certain limits. Visit our website, 

http://www.vba.va.gov/bln/21/rates for the maximum yearly income we allow. 

 

Note: Attach current medical evidence showing that you are permanently and totally disabled. 

IMPORTANT: If you are a veteran who is age 65 or older, or determined to be disabled by the Social Security 

Administration, you DO NOT have to submit medical evidence with your application unless you are filing for special 

monthly pension. Special monthly pension is an allowance that may be paid to individuals who, due to mental or 

physical disability, require the assistance of another person to perform the basic activities of daily living, or their 

ability to leave home is very limited.

 

May I apply electronically? 

 

To file a claim for VA compensation or pension electronically, please complete and submit VA Form 21-526, 

Veteran's Application for Compensation and/or Pension, using VONAPP. The VONAPP (Veterans On Line 

Application) website is an official U.S. Department of Veterans Affairs (VA) website that enables service members, 

veterans and their beneficiaries, and other designated individuals to apply for benefits using the Internet. You can 

apply online at our website, http://vabenefits.vba.va.gov/vonapp/main.asp. 

 

What parts of the form should I complete? 

 

You should complete only the parts related to the benefit for which you are applying: 

 If you are applying for compensation ONLY, skip parts VII, VIII, IX, X. 

 

If you are applying for pension, complete the ENTIRE form. 

If you need more space to answer a question or have a comment about a specific item on this 

form, please place it in Part XIII, Item 45, "Remarks." Please identify your answer or 

comment by the part and item number.

IMPORTANT- Please read the information below carefully to help you complete this form more quickly and 

accurately. Some parts of the form also contain notes or specific instructions for completing that part.

PAGE 1 21-526 VA FORM 

SEP 2009 

SUPERSEDES VA FORM 21-526, JAN 2004, WHICH 

WILL NOT BE USED.
238 H U D - V A S H R E S O U R C E G U I D E PAGE 2

Where can I get help? 

 

You can ask VA to help you fill out the form by contacting a regional office or call center. Before you contact us, make sure 

you gather the necessary materials and complete as much of the form as you can. You can contact VA in the following 

ways: 

 

By internet: https://iris.va.gov 

 

In person: You can locate the address of the closest regional office on the 

website http://www.va.gov/directory or in your telephone book blue pages under 

"United States Government, Veterans" 

 

By telephone: Please call one of the following telephone numbers: 

1-800-827-1000 

1-800-829-4833 (Hearing Impaired TDD line) 

1-412-395-6272 (If living outside the U.S.) 

 

You can also contact a county or national veterans' service organization (VSO) representative to help you with your claim. If 

you want to use a representative to help you, consult your local telephone book to contact a particular VSO or 

contact the closest VA office. Depending on the type of representative you want to designate, we will send you one of the 

following forms: 

 

VA Form 21-22, Appointment of Veterans Service Organization as Claimant's Representative 

 

VA Form 21-22A, Appointment of Individual as Claimant's Representative 

 

What should I do when I have finished my application? 

 

You should provide your signature in Part XII, Item 42A. Be sure to sign every form you fill out 

before you send it to us. If you don't sign the form, VA will return it for you to sign, and it will 

take longer for us to process.

 

Attach any materials that support and explain your claim. 

 

Mail or take your application to the closest VA regional office. VA regional office addresses are 

available on the internet at http://www.va.gov/directory 

 

Do I need to keep a copy of my application? 

 

It is important that you keep a copy of all completed forms and materials you give to VA. 

 

Social Security and Supplemental Security Income Benefits 

Social Security and Supplemental Security Income are two Federal programs that help people with disabilities. While these 

programs are different in many ways, the Social Security Administration (SSA) administers both programs. If you think you 

have a disabling condition, you may qualify for benefits under one or both of these programs and should contact Social 

Security. 

How can I contact SSA if I have questions?

You can find answers to most questions and file a claim online at www.socialsecurity.gov. Specific information is available 

for active duty military, veterans, and their families at www.socialsecurity.gov/woundedwarriors. 

 

You can also contact SSA in the following ways: 

 

By phone: (Monday-Friday, 7 a.m. - 7 p.m. EST) at one of the following toll-free numbers: 

 1-800-772-1213 

 1-800-325-0778 (TTY if you are deaf or hard of hearing) 

 

By mail or in person: You can locate the address of the Social Security office nearest to you in your 

telephone book blue pages under "United States Government, Social Security Administration".
H U D - V A S H R E S O U R C E G U I D E 239 

PAGE 3

SPECIFIC INSTRUCTIONS FOR VA FORM 21-526 

Part II - Nature and History of Service-Related Disability(ies)

 

What disabilities should I list? 

List the disease(s) or medical condition(s) that form the basis of your claim for service connected compensation. Be as 

specific as you can. Indicate the approximate date the disability began and the place of treatment. 

 

Do I have to include any records with this claim form? 

If you have records that support your claim, you should attach them to this form. VA will help you obtain records by 

requesting them from the person, company, or agency that has them. On this form you must tell us the name and 

address of the person, company or agency that has these records, the approximate time frame covered by them, and the 

condition for which you were treated. If you received treatment from a non-VA health care provider complete the 

attached VA Form 21-4142, Authorization and Consent to Release Information to the Department of Veterans Affairs 

(VA). We will use this form to request these records. Due to Privacy Act regulations, please use only one source of 

information (Item 7) on each form, as some medical offices will not accept the forms otherwise, which may cause a 

delay in processing your claim. Additional 21-4142 forms can be obtained from the VA forms website at 

www.va.gov/vaforms. 

 

Part III - Active Duty Service Information 

 

Do I need to include my active duty service information?

Please provide the information for each period of active duty (provide a copy of your DD214 or other separation 

papers for all periods of active duty service). 

 

Part IV - Reserve and National Guard Service Information 

 

What If I have Reserve or National Guard Service? 

This section tells us if you were a member of the Reserve or National Guard. Complete information for each period of 

Reserve and National Guard service. Provide a copy of your DD214 or other separation papers for all periods of active 

service. 

 

Part V - Military Retired/Severance Pay 

 

What If I have received or will receive military pay?

This section asks about your military severance or separation pay, the type, and the amount. If you currently receive 

military retired pay, we may reduce your retired pay by the amount of any compensation that we award. It is to your 

advantage because VA compensation is not taxable while retired pay is taxable. However, if you wish to receive 

military retired pay rather than VA compensation, you must check the box in Item 25. Some veterans receive various 

readjustment, separation, or severance pay from service departments which may be recouped in full or in part from VA 

benefit payments. 

 

Part VI - Marital and Dependency Information 

 

Who can I count as a dependent spouse? 

A spouse is a person of the opposite sex who is married to the veteran (authority: 38 U.S.C. subsection 101(31)). The 

marriage must be valid under the law of the place where the parties resided at the time of marriage, or the law of the 

place where the parties resided when the right to benefits occurred. 

Note: It is important that you provide your marital history and that of your spouse.

 

Who can be recognized as a dependent child? 

VA recognizes the veteran's biological child, adopted child, and stepchild. However, the child must be unmarried and: 

 

under the age of 18, or 

 

at least 18 but under 23 and pursuing an approved course of education, or 

 

permanently incapable of self support before reaching the age of 18.
240 H U D - V A S H R E S O U R C E G U I D E

PRIVACY ACT INFORMATION: The VA will not disclose information collected on this form to any source other than what has been 

authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law 

enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States, litigation 

in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity 

and status, and personnel administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and 

Vocational Rehabilitation and Employment Records - VA, published in the Federal Register. Your obligation to respond is voluntary; however, no 

allowance of compensation or pension may be granted unless this form is completed fully as required by law. Giving us you and your 

dependents' Social Security numbers is mandatory. Applicants are required to provide their SSN and the SSN of any dependents for whom benefits 

are claimed under Title 38 USC 5101 (c)(1). The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure 

of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect. The requested information is considered 

relevant and necessary to determine maximum benefits under the law. Information submitted is subject to verification through computer 

matching programs with other Federal or state agencies. Income and employment information furnished by you will be compared with 

information obtained by VA from the Secretary of Health and Human Services or the Secretary of the Treasury under clause (viii) of section 

6103(1)(7)(D) of the Internal Revenue Code of 1986. 

 

RESPONDENT BURDEN: We need this information to determine your eligibility for compensation and/or pension (38 U.S.C. 5101). Title 38, 

United States Code, allows us to ask for this information. We estimate that you will need an average of 1 hour to review the instructions, find the 

information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is 

displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers 

can be located on the OMB Internet Page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA . If desired, you can call 

1-800-827-1000 to get information on where to send comments or suggestions about this form. 

PAGE 4

SPECIFIC INSTRUCTIONS FOR VA FORM 21-526 (Continued) 

Part VII - Non-Service Connected Pension 

This section asks you to provide the disabilities that prevent you from working. We also ask you to tell us if you 

require the regular assistance of another person, if you are housebound, if you are in a nursing home, if you are in 

receipt of Social Security, or if you have applied for Medicaid. 

 

Part VIII - Income Information

This section asks you to provide specific information about the monthly income you and your dependants receive from 

all sources. Report the gross amount you receive monthly before deductions are taken out for taxes, health care, 

insurance, etc. Do not leave any blank boxes in this section! Complete each box with either a dollar figure, "0", or 

"none." If you expect to receive payment, but you don't know how much it will be, write "Unknown" in the space. If 

you are not sure about a particular type of income, report it and provide a full explanation of its source. If you are 

receiving monthly benefits from any source and have a copy of your most recent award letter, please include a copy of 

the letter with your application. 

 

Part IX - Net Worth 

 

This section asks you to provide specific information about your net worth and that of your dependents. Do not leave 

any blank boxes in this section! Complete each box with either a dollar figure, "0", or "none." 

 

Net worth is the market value of all interest and rights in any kind of property, after subtracting any mortgages 

and other claims against the property. List all assets except the house in which you live, any reasonable area of 

land on which it sits, and those items you use everyday, such as your vehicle, clothing and furniture. 

Clearly indicate if you and your spouse jointly share assets (such as money in a joint checking account). Report the 

value of farms or buildings that you or a dependent owns as "real property." 

 

You must disclose all financial transactions that involve a transfer of assets, even if the transaction occurred prior to 

the date of your application for VA pension. A gift of property or a sale below the property's value to a relative 

residing in the same household does not reduce net worth. Likewise, a gift of property to someone other than a relative 

residing in your household does not reduce net worth unless it is clear that you have relinquished all rights of 

ownership, including the right to control the property. 

 

Part X - Medical, Legal or Other Expenses 

 

When determining your eligibility for pension, we may be able to deduct unreimbursed medical expenses from your 

income for the year in which the expenses are paid. Report the amount of unreimbursed medical expenses, including 

the Medicare deductions you paid (out-of-pocket) for yourself or relatives you are under an obligation to support. 

Also, show medical, legal, or other expenses you paid because of a disability for which civilian disability benefits 

have been awarded. Do not report any expenses you did not pay or expenses for which you were or will be 

reimbursed. 
H U D - V A S H R E S O U R C E G U I D E 241 

PART I - VETERAN'S INFORMATION 

PART II - NATURE AND HISTORY OF SERVICE-RELATED DISABILITY(IES) - If you need more space please use Item 45, "Remarks"

(DO NOT WRITE IN THIS SPACE) 

(VA DATE STAMP)

OMB Control No. 2900-0001 

Respondent Burden: 1 hour 

VETERAN'S APPLICATION FOR COMPENSATION AND/OR PENSION

4D. IF YOU SERVED UNDER ANOTHER NAME, GIVE NAME AND PERIOD DURING WHICH YOU SERVED AND SERVICE NO. 

 IMPORTANT - Read information and instructions carefully before completing the form. Type, print, 

 or write plainly. 

4C. SPOUSE'S SOCIAL SECURITY NO.

5. MAILING ADDRESS (Number and street or rural route, city or P.O., State and ZIP Code) 

VA FORM 

SEP 2009 21-526

 6. TELEPHONE NUMBER(S) (Include Area Code)

10A. HAVE YOU EVER FILED A CLAIM FOR COMPENSATION FROM 

THE OFFICE OF WORKERS' COMPENSATION PROGRAMS?

(Formerly the U.S. Bureau of Employees Compensation) 

A. DAYTIME

4B. VA FILE NUMBER (If applicable) 

7. E - MAIL ADDRESS (If applicable) 

COMPENSATION

YES NO

9. SEX

1. FOR WHAT BENEFIT ARE YOU APPLYING?

10C. FOR WHAT DISABILITY ARE YOU RECEIVING 

BENEFITS?

MALE

B. EVENING C. CELL

SUPERSEDES VA FORM 21-526, JAN 2004, WHICH PAGE 5

WILL NOT BE USED.

2. HAVE YOU PREVIOUSLY APPLIED FOR ANY VA BENEFIT(S)? (Check applicable box) 

FEMALE

PENSION OTHER (Specify)

10B. WHEN WAS THE CLAIM FILED?

(Mo., day, yr.) 

3. FIRST, MIDDLE, LAST NAME OF VETERAN

COMPENSATION PENSION BOTH COMPENSATION AND PENSION

 11. PLEASE PROVIDE NATURE OF SICKNESS, DISEASE, OR INJURIES FOR WHICH THIS CLAIM IS MADE; DATE EACH BEGAN; AND PLACE OF TREATMENT

14. ARE YOU CLAIMING A DISABILITY RELATED TO AGENT ORANGE OR 

 OTHER HERBICIDE EXPOSURE? (If "Yes," list disability(ies) below) 

17. ARE YOU CLAIMING A DISABILITY RELATED TO IONIZING RADIATION 

 EXPOSURE? (If 'Yes," list disability(ies) below)

YES NO

12A. ARE YOU NOW OR HAVE YOU RECEIVED TREATMENT 

 OR DOMICILIARY CARE AT A VA MEDICAL FACILITY?

 12B. DATES OF TREATMENT/CARE 12C. NAME AND ADDRESS OF VA MEDICAL FACILITY 

 (If you need more space use Item 45, "Remarks")

YES NO (If "Yes,"complete Items 12B &12C)

18. ARE YOU CLAIMING A DISABILITY RELATED TO AN ENVIRONMENTAL HAZARD EXPOSURE DURING THE GULF WAR? (If "Yes," list disability(ies) below) 

YES NO

15. ARE YOU CLAIMING A DISABILITY RELATED TO ASBESTOS 

 EXPOSURE? (If "Yes," list disability(ies) below) 

YES NO

16. ARE YOU CLAIMING A DISABILITY RELATED TO MUSTARD GAS 

 EXPOSURE? (If "Yes," list disability(ies) below) 

YES NO YES NO

A. LIST DISABILITY(IES) B. DATE BEGAN C. PLACE OF TREATMENT

 YOU MUST SIGN AND PRINT YOUR NAME AND DATE THIS FORM IN ITEMS 42A THRU 42C ON PAGE 10.

13A. HAVE YOU EVER BEEN A PRISONER OF WAR? 13B. NAME OF COUNTRY 13C. DATES OF CONFINEMENT

FROM TO

YES NO (If "Yes," complete Items 13B and 13C)

4A. VETERAN'S SOCIAL SECURITY NO.

8A. DATE OF BIRTH (Month, day, year) 8B. PLACE OF BIRTH

(If "Yes," complete Items 10B & 10C)

Month Day Year
242 H U D - V A S H R E S O U R C E G U I D E

PART III - ACTIVE DUTY SERVICE INFORMATION

PART IV - RESERVE AND NATIONAL GUARD SERVICE INFORMATION

PART VI - MARITAL AND DEPENDENCY INFORMATION

PART V - MILITARY RETIRED/SEVERANCE PAY

(If "Yes,"complete Item 27F)

27D. NUMBER OF TIMES YOUR 

PRESENT SPOUSE HAS 

BEEN MARRIED (To include current marriage) 

$

 27G. DO YOU LIVE TOGETHER?

27J. AMOUNT YOU CONTRIBUTE TO YOUR 

SPOUSE'S MONTHLY SUPPORT

 25. NO, I DO NOT WANT VA COMPENSATION IN LIEU OF MILITARY RETIRED PAY

(Check box, if applicable)

IMPORTANT - Unless you check the box in Item 25 below, you are telling us that you are choosing to receive VA compensation instead of military retired pay, if it is 

determined you are entitled to both benefits. If you are awarded military retired pay prior to compensation, we will reduce your retired pay by the amount of any 

compensation that you are awarded. VA will notify the Military Retired Pay Center of all benefit changes. If you receive both military retired pay and VA compensation, 

some of the amount you receive may be recouped by VA, or, in the case of Voluntary Separation Incentive (VSI), by the Department of Defense. 

27C. NUMBER OF TIMES YOU 

HAVE BEEN MARRIED

(To include current marriage)

DIVORCED NEVER MARRIED (If never married, skip to Item 30)

27H. REASON FOR SEPARATION (For example, 

marital problems, job requirements, health, etc.) 

C27E. IS YOUR SPOUSE ALSO A VETERAN?

 27K. HOW WERE YOU MARRIED?

27B. SPOUSES'S BIRTHDATE (Mo., day, yr.)

YES NO (If "No,"complete Items 27H thru 27J)

CLERGYMAN OR AUTHORIZED 

PUBLIC OFFICIAL

YES NO

27I. PRESENT ADDRESS OF SPOUSE

27F. SPOUSE'S VA FILE NUMBER (If any)

PAGE 6

 27A. MARITAL STATUS (If married, complete Items 27B thru 29D)

PROXY

MARRIED WIDOWED

OTHER (Explain) 

COMMON-LAW

TRIBAL

DATE PLACE

19D. BRANCH OF 

SERVICE 19B. SERVICE NUMBER 

20A. ENTERED INTO SERVICE

20B. SERVICE NUMBER 

DATE PLACE

20C. SEPARATED FROM SERVICE 20D. SERVICE STATUS 

(Reserve, National Guard)

DATE PLACE

22B. RESERVE STATUS

YES NO BRANCH

ACTIVE

DATE PLACE

19C. SEPARATED FROM SERVICE

21. IF DISABILITY OCCURRED DURING ACTIVE OR INACTIVE DUTY 

FOR TRAINING, GIVE BRANCH OF SERVICE AND DATE OF 

OCCURRENCE

22A. ARE YOU NOW A MEMBER OF THE RESERVES OR 

NATIONAL GUARD? IF SO, GIVE THE BRANCH 

OF SERVICE

22C. NAME, ADDRESS AND PHONE NO. OF RESERVE OR NATIONAL GUARD UNIT (If additional space is needed, use Item 45 "Remarks")

RESERVE 

OBLIGATION

YES NO

23B. WILL YOU RECEIVE MILITARY RETIRED PAY IN THE 

FUTURE? (If "Yes," explain, i.e. Future Reserve/National Guard Retirement, Pending MEB/PEB) 

24. RETIRED STATUS

$

26. HAVE YOU EVER APPLIED FOR OR RECEIVED DISABILITY SEVERANCE/SEPARATION PAY, OR ANY OTHER LUMP SUM PAYMENT FROM THE ARMED FORCES? 

 (If "Yes," list type, amount, date it was received, and the branch of service below)

YES NO

DISABLED 

RETIRED LIST

23C. BRANCH OF 

SERVICE

RETIRED

 NOTE: Enter complete information for each period of Reserves and National Guard service. Attach any separation papers you have.

TEMPORARY DISABILITY 

RETIRED LIST

YES NO

23A. ARE YOU RECEIVING MILITARY 

RETIRED PAY? (If "Yes," complete Items 23C & 23D) 

 NOTE: Please complete the information for each period of active duty. Attach DD214 or other separation papers for all periods of 

 active duty. If you do not have your DD214 form or other separation papers, check the box.

20E. GRADE, RANK OR 

RATING, ORGANIZATION 

19A. ENTERED INTO SERVICE 19E. GRADE, RANK OR 

RATING, ORGANIZATION 

 YOU MUST SIGN AND PRINT YOUR NAME AND DATE THIS FORM IN ITEMS 42A THRU 42C ON PAGE 10.

23D. MONTHLY 

AMOUNT

INACTIVE
H U D - V A S H R E S O U R C E G U I D E 243 

PART VII - NON-SERVICE CONNECTED PENSION (If you need additional space use Item 45 "Remarks") 

34B. NAME AND COMPLETE MAILING ADDRESS OF THE FACILITY 

33. DO YOU NEED THE REGULAR ASSISTANCE OF ANOTHER PERSON OR ARE

YOU GENERALLY CONFINED TO YOUR IMMEDIATE PREMISES? 

 

30A. NAME OF CHILD 

(First, middle initial, last) 

30C. SOCIAL SECURITY 

NUMBER 

DEPENDENCY - Dependent Children Information (If you need additional space, use Item 45 "Remarks")

30D. CHECK EACH APPLICABLE CATEGORY 30B. DATE & PLACE OF 

BIRTH 

(City, state or country) 

 31C. MONTHLY AMOUNT YOU 

CONTRIBUTE TO 

CHILD'S SUPPORT

34D. DOES MEDICAID COVER ALL OR PART OF YOUR NURSING 

HOME COSTS OR HAVE YOU APPLIED AND NOT 

 RECEIVED A DECISION?

(If "YES,"complete 

Items 34B thru 34D) 

34C. HAVE YOU APPLIED FOR 

MEDICAID?

YES NO

YES NO

$

NOTE: You may submit a statement by an official of the nursing home that tells us that you are a patient in the nursing home because of a physical or 

mental disability. The statement should include the monthly charge you are paying out-of-pocket for your care. 

NOTE: You do not have to submit medical evidence or list disabilities if you are age 65 or older, unless you are housebound, or require 

the regular assistance of another person.

PART VI - MARITAL AND DEPENDENCY INFORMATION - CONTINUED (If you need additional space, use Item 45 "Remarks")

BIOLOGICAL 

CHILD 

PREVIOUSLY 

MARRIED

ADOPTED

 31A. NAME(S) OF ANY CHILD(REN) NOT 

IN YOUR CUSTODY

31B. NAME AND ADDRESS OF 

 PERSON HAVING CUSTODY

YES APPLIED - NOT RECEIVED DECISION

PAGE 7

 NURSING HOME INFORMATION

34E. ARE YOU RECEIVING SUPPLEMENTAL SOCIAL SECURITY INCOME (SSI) 

OR HAVE YOU APPLIED FOR SSI BUT NO DECISION HAS BEEN MADE?

 Place:

YES NO

 FURNISH THE FOLLOWING INFORMATION FOR EACH OF YOUR DEPENDENT CHILDREN WHO DO NOT LIVE WITH YOU

28A. DATE AND PLACE OF MARRIAGE 28C. TERMINATED 

(Death, Divorce) 

28D. DATE AND PLACE TERMINATED 

28B. TO WHOM MARRIED 

 MONTH, YEAR CITY, STATE MONTH, YEAR CITY, STATE

FURNISH THE FOLLOWING INFORMATION ABOUT EACH PREVIOUS MARRIAGE OF YOUR PRESENT SPOUSE (IF NOT APPLICABLE, WRITE "N/A")

29A. DATE AND PLACE OF MARRIAGE 29C. TERMINATED 

(Death, Divorce) 

29D. DATE AND PLACE TERMINATED 

29B. TO WHOM MARRIED 

 MONTH, YEAR CITY, STATE MONTH, YEAR CITY, STATE

$

 YOU MUST SIGN AND PRINT YOUR NAME AND DATE THIS FORM IN ITEMS 42A THRU 42C ON PAGE 10.

(Month, day, year)

 Place:

(Month, day, year)

 Place:

(Month, day, year)

SERIOUSLY 

DISABLED 

BEFORE AGE 18

STEPCHILD

18-23 YRS. 

OLD AND IN 

SCHOOL

34A. ARE YOU NOW IN A NURSING HOME?

32. WHAT DISABILITIES PREVENT YOU FROM WORKING? (List below) 

YES NO

 FURNISH THE FOLLOWING INFORMATION FOR EACH OF YOUR DEPENDENT CHILDREN 

 FURNISH THE FOLLOWING INFORMATION ABOUT EACH OF YOUR MARRIAGES (IF NOT APPLICABLE, WRITE "N/A")

NO APPLIED - NOT RECEIVED DECISION
244 H U D - V A S H R E S O U R C E G U I D E

36B. WILL YOU RECEIVE ANY INCOME FROM 

THE OPERATION OF A FARM WITHIN 12 

MONTHS OF THE DAY YOU SIGN THIS 

FORM? YES NO

PAGE 8

PART IX - NET WORTH (Provide specific information about the net worth of you and your dependents) 

CHILD(REN) (Provide the first, middle initial, and last name) 

NOTE: Report the total income before deductions for taxes, insurance, etc. If you do not receive any payments from one of the 

sources that we list, write "0" or "None" in the space. If you are receiving monthly benefits, give us a copy of your most recent award 

letter. This will help us determine the amount of benefits you should be paid. Payments from any source will be counted, unless the 

law says that they don't need to be counted. 

NOTE: For Items 37A-37F provide amounts. If none, write "0" OR "NONE." Do not leave blank spaces.

NAME

37A.

37B.

Cash, non-interest 

bearing bank accounts 

Stocks, bonds, and 

mutual funds 

37C. Retirement accounts

(IRAs, Keogh Plans, etc.) 

Value of business assets 

Interest bearing bank 

accounts, certificates of 

deposit (CDs) 

NAME

37D.

VETERAN SPOUSE NAME SOURCE 

37E.

ITEM 

NO.

Real property 

(not your home) 37F.

VETERAN SPOUSE 

CHILD(REN) (Provide the first, middle initial, and last name) 

NAME NAME NAME SOURCES OF 

RECURRING MONTHLY 

INCOME 

Social Security 

ITEM 

NO.

35A.

35B.

35C.

35D.

U.S. Civil Service 

U.S. Railroad Retirement 

Military Retired Pay 

35F. Other (Interest, dividends, 

or one-time payments) 

MONTHLY INCOME - Provide the income that you and your dependents receive every month. For items 35A -35F, if none, 

write "0" or "NONE." Do not leave blank spaces.

 YOU MUST SIGN AND PRINT YOUR NAME AND DATE THIS FORM IN ITEMS 42A THRU 42C ON PAGE 10.

36C. DO YOU THINK YOUR INCOME WILL CHANGE 

IN THE NEXT 12 MONTHS? (If "Yes," explain below) 

36A. WILL YOU RECEIVE ANY INCOME FROM 

RENTAL PROPERTY OR FROM THE 

 OPERATION OF A BUSINESS WITHIN 12 

 MONTHS OF THE DAY YOU SIGN THIS FORM?

NET WORTH is the market value of all interest and rights in any kind of property after subtracting any mortgages or other claims 

against the property. However, net worth does not include the house you live in or a reasonable area of land it sits on. Net worth also 

does not include the value of personal items such as your vehicle, clothing, and furniture.

YES NO

35E. Black Lung Benefits 

YES NO

PART VIII - INCOME INFORMATION (Provide the income you received from all sources)
H U D - V A S H R E S O U R C E G U I D E 245 

(Account Number)

Generally, all Federal payments are required to be made by electronic funds transfer (EFT), also called direct deposit. 

Please attach a voided personal check or deposit slip or provide the information requested below in Items 39, 40, and 41 

to enroll in direct deposit. If you do not have a bank account you can receive a waiver from direct deposit, by checking the 

box below in Item 39. You can also request a waiver if you have other circumstances that you feel would cause you a 

hardship to be enrolled in direct deposit. You can write to: Department of Veterans Affairs, 125 S. Main Street Suite B, 

Muskogee, OK 74401-7004, and give us a brief description of why you do not wish to participate in direct deposit. 

PAGE 9

41. ROUTING OR TRANSIT NUMBER (The first nine numbers located at the bottom left of your check or savings deposit slip)

SAVINGS

PART XI - DIRECT DEPOSIT

38A. AMOUNT YOU PAID 

38C. PURPOSE 

(Doctor's fees, hospital charges, 

attorney fees, etc.) 

38E. PERSON FOR WHOM EXPENSE 

PAID (Self, spouse, child)

38B. DATE 

PAID 

(Month, year) 

38D. PAID TO 

(Name of doctor, hospital, pharmacy, attorney, etc.) 

PART X - MEDICAL, LEGAL, OR OTHER EXPENSES 

IMPORTANT - Complete items 38A through 38E only if you are applying for nonservice connected pension.

MEDICAL, LEGAL OR OTHER EXPENSES - Family medical expenses you actually paid (out-of-pocket) may be deducted from your income. Show the 

amount of unreimbursed medical expenses you paid for dependents you are under an obligation to support. Also, show medical, legal, or other expenses 

you paid because of a disability for which civilian disability benefits have been awarded. When determining your income, we may be able to increase 

benefits for the year in which the expenses are paid. Do not include any expenses for which you were reimbursed. Be sure to include the Medicare 

deduction. If more space is needed, you may use Item 45, "Remarks" or attach a separate sheet.

I certify that I do not have an account 

with a financial institution or certified 

payment agent 

(Account Number)

CHECKING

39. ACCOUNT NUMBER (Please check the appropriate box and provide the account number, if applicable)

40. NAME OF FINANCIAL INSTITUTION (Please provide the name of the bank where you want your direct deposit to go)

 YOU MUST SIGN AND PRINT YOUR NAME AND DATE THIS FORM IN ITEMS 42A THRU 42C ON PAGE 10.
246 H U D - V A S H R E S O U R C E G U I D E

PART XIII - REMARKS (Use this space for any additional statements that you would like to make

 concerning your application for Compensation and/or Pension) 

PART XII - CERTIFICATION, AUTHORIZATION, AND SIGNATURE(S)

45. REMARKS (If you need more space you may attach a separate sheet of paper) 

PAGE 10

 YOU MUST SIGN AND PRINT YOUR NAME AND DATE THIS FORM IN ITEMS 42A THRU 42C ON THIS PAGE.

44A. SIGNATURE OF WITNESS (Do not print)

IMPORTANT - If you sign with an "X", then you must have 2 people witness your signature. They must then print their names and addresses and sign the 

form.

44B. PRINTED NAME AND ADDRESS OF WITNESS

 42B. VETERAN'S PRINTED NAME 

43A. SIGNATURE OF WITNESS (Do not print)

42C. DATE SIGNED

43B. PRINTED NAME AND ADDRESS OF WITNESS

I certify that the statements in this document are true and complete to the best of my knowledge and belief. I authorize any person or entity, including but not 

limited to any organization, service provider, employer or government agency, to give the Department of Veterans Affairs any information about me except 

protected health information, and I waive any privilege which makes the information confidential.

42A. VETERAN'S SIGNATURE (Do not print) (Please sign in ink)

PENALTY - The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement 

or evidence of a material fact, knowing it to be false, or for the fraudulent acceptance of any payment to which you are not entitled. 
H U D - V A S H R E S O U R C E G U I D E 247 

7C. CONDITION(S) 

(List illness, injury, etc. 

pertinent to your claim)

IF YOU HAVE ANY QUESTIONS ABOUT THIS FORM, CALL VA TOLL-FREE AT 1-800-827-1000 

(TDD 1-800-829-4833 FOR HEARING IMPAIRED).

SECTION II - SOURCE OF INFORMATION

VA FORM 

SEP 2009 21-4142 SUPERSEDES VA FORM 21-4142, MAY 2004, WHICH WILL NOT BE USED.

1. LAST NAME - FIRST NAME - MIDDLE NAME OF VETERAN (Type or print)

3. CLAIMANT'S NAME (If other than Veteran) LAST NAME, FIRST, MIDDLE 

5. RELATIONSHIP OF CLAIMANT TO VETERAN

7A. LIST THE NAME AND ADDRESS OF THE SOURCE SUCH AS A PHYSICIAN, 

HOSPITAL, ETC. (Include ZIP Codes, and also a telephone number, if available)

7B. DATE(S) OF TREATMENT, 

HOSPITALIZATIONS, OFFICE 

VISITS, DISCHARGE FROM 

TREATMENT OR CARE, ETC 

(Include month and year)

2. VETERAN'S VA FILE NUMBER

4. VETERAN'S SOCIAL SECURITY NUMBER

6. CLAIMANT'S SOCIAL SECURITY NUMBER

8. COMMENTS:

YOU MUST SIGN AND DATE THIS FORM ON PAGE 2 AND CHECK THE APPROPRIATE BLOCK IN ITEM 9C.

AUTHORIZATION AND CONSENT TO RELEASE INFORMATION TO THE 

DEPARTMENT OF VETERANS AFFAIRS (VA)

OMB Approved No. 2900-0001 

Respondent Burden: 5 Minutes.

RESPONDENT BURDEN: We need this information to obtain your treatment records. Title 38, United States Code, allows us to ask for this information. We estimate 

that you will need an average of 5 minutes to review the instructions, find the information and complete this form. VA cannot conduct or sponsor a collection of 

information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid 

OMB control numbers can be located on the OMB Internet Page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you can call 

1-800-827-1000 to get information on where to send comments or suggestions about this form.

SECTION I - VETERAN/CLAIMANT IDENTIFICATION

PAGE 1
248 H U D - V A S H R E S O U R C E G U I D E

the source shown in Item 7A to release or disclose any information or records 

relating to the diagnosis, treatment or other therapy for the condition(s) of drug abuse, alcoholism or alcohol abuse, infection with the 

human immunodeficiency virus (HIV), sickle cell anemia or psychotherapy notes. IF MY CONSENT TO THIS INFORMATION IS 

LIMITED, THE LIMITATION IS WRITTEN HERE:

9A. Privacy Act Notice: The VA will not disclose information collected on this form to any source other than what has been authorized under the 

Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional 

communications, epidemiological or research studies, the collection of money owed to the United States, litigation in which the United States is a party 

or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel administration) as 

identified in the VA system of records, 58VA21/22/28 Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - 

VA, published in the Federal Register. Your obligation to respond is voluntary. However, if the information including your Social Security Number 

(SSN) is not furnished completely or accurately, the health care provider to which this authorization is addressed may not be able to identify and locate 

your records, and provided a copy to VA. VA uses your SSN to identify your claim file. Providing your SSN will help ensure that your records are 

properly associated with your claim file. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in 

the denial of benefits. The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by 

Federal Statute of law in effect prior to January 1, 1975, and still in effect.

11B. DATE

READ ALL PARAGRAPHS CAREFULLY BEFORE SIGNING. YOU MUST CHECK THE APPROPRIATE STATEMENT 

UNDERLINED IN PARENTHESES IN PARAGRAPH 9C.

11C. MAILING ADDRESS OF WITNESS

11A. SIGNATURE OF WITNESS

10D. MAILING ADDRESS (Number and Street or rural route, city, or P.O. State and ZIP Code) 10E. TELEPHONE NUMBER (Include Area Code)

10A. SIGNATURE OF VETERAN/CLAIMANT OR LEGAL REPRESENTATIVE 10B. RELATIONSHIP TO VETERAN/CLAIMANT 

(If other than self, please provide full name, title, 

organization, city, State and ZIP Code. All court 

appointments must include docket number, county 

and State)

10C. DATE

PAGE 2

SECTION III - CONSENT TO RELEASE INFORMATION

The signature and address of a person who either knows the person signing this form or is satisfied as to that person's identity is 

requested below. This is not required by VA but may be required by the source of the information.

9B. I, the undersigned, hereby authorize the hospital, physician or other health care provider or health plan shown in Item 7A to release any information 

that may have been obtained in connection with a physical, psychological or psychiatric examination or treatment, with the understanding that VA will 

use this information in determining my eligibility to veterans benefits I have claimed. I understand that the health care provider or health plan identified 

in Item 7A who is being asked to provide the Veterans Benefits Administration with records under this authorization may not require me to execute this 

authorization before it will, or will continue to, provide me with treatment, payment for health care, enrollment in a health plan, or eligibility for 

benefits provided by it. I understand that once my health care provider sends this information to VA under this authorization, the information will no 

longer be protected by the HIPAA Privacy Rule, but will be protected by the Federal Privacy Act, 5 USC 552a, and VA may disclose this information 

as authorized by law. I also understand that I may revoke this authorization, at anytime (except to the extent that the health care provider has already 

released information to VA under this authorization) by notifying the health care provider shown in Item 7A. Please contact the VA Regional Office 

handling your claim or the Board of Veterans' Appeals, if an appeal is pending, regarding such action. If you do not revoke this authorization, it will 

automatically end 180 days from the date you sign and date the form (Item 10C).

9C. I (AUTHORIZE) (DO NOT AUTHORIZE)

VA FORM 21-4142, SEP 2009
H U D - V A S H R E S O U R C E G U I D E 249 

D. What is special monthly pension?

VA may pay a higher rate of disability pension to a veteran

who is blind, a patient in a nursing home, otherwise needs

regular aid and attendance, or who is permanently

confined to his or her home because of a disability. If you

wish to apply for this benefit, check "Yes" for Item 24.

E. What medical evidence should I submit?

Furnish current medical evidence showing that you are

permanently and totally disabled.

Note: If you are age 65 or older or determined to be

disabled by the Social Security Administration, you do not

have to submit medical evidence with your application

unless you are claiming special monthly pension.

If you wish to claim special monthly pension and are not

in a nursing home, furnish a statement from your doctor

showing the extent of your disabilities. If you are in a

nursing home, attach a statement signed by an official of

the nursing home showing the date you were admitted to

the nursing home, the level of care you receive, and

whether Medicaid covers all or part of your nursing home

costs.

If you want help getting existing medical records, you

may complete VA Form 21-4142, Authorization and

Consent to Release Information to the Department of

Veterans Affairs (VA). By signing VA Form 21-4142, you

authorize any doctors, hospitals, or caregivers that have

treated you to release information about your treatment to

VA. You do not need to complete this form for any

treatment you received at a VA facility. If you need a copy

of this form, you may contact VA as shown under Item A,

or download the form from our website at

http://www.va.gov/vaforms/.

F. How do I complete my application?

Print all answers clearly. If you must write the answers do

so very clearly and plainly. If an answer is "none" or "0,"

write that. Your answer to every question is important to

help us complete your claim. If you do not know the

answer, write "unknown." For additional space, use Item

42, "Remarks," or attach a separate sheet, indicating the

item number to which the answers apply. Make sure you

sign and date this application (Items 38 and 39).

EXISTING STOCKS OF VA FORM 21-527, General Instructions Page 1

FEB 1999, WILL BE USED. 21-527 VA FORMJUN 2004

Benefits may only be paid from the date of receipt of your

application in VA unless you were incapacitated because

of a disability which prevented you from filing a claim for

a period of at least 30 days beginning with the date you

became permanently and totally disabled. If you want this

claim considered as a claim for retroactive payment, so

indicate in Item 42, “Remarks,” and identify the specific

disability which prevented you from filing.

VA pays disability pension based on the amount of income

that the veteran and family receive and the number of

dependents in the family. This is based on law. VA must

include as income all sources that federal law specifies.

You can find out what the current income limitations and

rates of benefits are by contacting your nearest VA office.

At least part of your active duty was during a

wartime period.

You are permanently and totally disabled (but not as

a result of your military service).

Your income is limited.

You should apply for pension benefits if all of the following

are true:

C. What is disability pension and how does VA decide

what I will or will not receive?

Use VA Form 21-527 to apply for disability pension if you

have previously filed a claim for compensation and/or

pension. If you have not filed a claim for compensation or

pension previously, you must use VA Form 21-526,

Veteran’s Application for Compensation and/or Pension.

B. What do I use VA Form 21-527 for?

If you have questions about this form, how to fill it out, or

about benefits, contact your nearest VA regional office.

You can locate the address of the nearest regional office in

your telephone book blue pages under "United States

Government, Veterans" or call 1-800-827-1000 (Hearing

Impaired TDD line 1-800-829-4833). You may also

contact VA by Internet at

http://www.vba.va.gov/benefits/address.htm.

A. How can I contact VA if I have questions?

Note: Read very carefully, detach, and keep these instructions for your reference.

GENERAL INSTRUCTIONS

FOR INCOME-NET WORTH AND EMPLOYMENT STATEMENT

VA FORM 21-527
250 H U D - V A S H R E S O U R C E G U I D E

VA Form 21-22, Appointment of Veterans Service

Organization as Claimant’s Representative, or VA Form

22A, Appointment of Individual as Claimant’s

Representative. You may also download these forms

at http://www.va.gov/vaforms/. If you have already

designated a representative, no further action is required

on your part.

I. What if I believe that VA has made an error

in processing or deciding my benefits?

You can ask for a personal hearing at any time during the

processing of your claim. That means you can ask for the

hearing while VA is processing your claim or after VA

has made a decision. You should contact the nearest VA

office and tell them that you want a personal hearing on

your case. Someone in the local VA office will arrange a

time and a place for your hearing. At this hearing, you can

bring witnesses. VA will record whatever you and your

witnesses say during the hearing and include it in the

official record. VA will furnish the hearing room and

officials, and prepare a transcript of the hearing. VA

cannot pay your expenses or the expenses of anyone you

want to bring with you to the hearing.

General Instructions Page 2

Privacy Act Notice: The VA will not disclose information collected on this form to any source other than what has been

authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., civil or

criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money

owed to the United States, litigation in which the United States is a party or has an interest, the administration of VA

programs and delivery of VA benefits, verification of identity and status, and personnel administration) as identified in the

VA system of records, 58VA21/22 Compensation, Pension, Education, and Rehabilitation Records - VA, and published in

the Federal Register. Your obligation to respond is required to obtain or retain benefits. Giving us your SSN account

information is mandatory. Applicants are required to provide their SSN under Title 38 USC 5101 (c) (1). The VA will not

deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal

Statute of law in effect prior to January 1, 1975, and still in effect. The requested information is considered relevant and

necessary to determine maximum benefits under the law. The responses you submit are considered confidential

(38 U. S. C. 5701). Information that you furnish may be utilized in computer matching programs with other Federal or state

agencies for the purpose of determining your eligibility to receive VA benefits, as well as to collect any amount owed to the

United States by virtue of your participation in any benefit program administered by the Department of Veterans Affairs.

If you want to use a representative to help you with your

application, contact the nearest VA office. Depending on

the type of representative you want to designate, we will

send you one of the following forms:

A representative can be an accredited member of an

accredited organization or other service organization that

the Secretary of Veterans Affairs recognizes, an agent

recognized by VA, or a licensed lawyer. Agents and

attorneys can charge you for services that you get from

them only after the Board of Veterans’ Appeals (BVA)

gives you their final decision about your application. That

means you can use an attorney during any stage of your

application for benefits. However, the agent or attorney

cannot charge you for services unless you are trying to

resolve a dispute with VA after BVA has made a decision

about your claim.

H. How can I assign someone to act as my

representative?

When you have completed this application mail it or take

it to a VA regional office. Be sure to attach any materials

that support and explain your claim. Also, make a

photocopy of your application and everything that you

submit to VA before you mail it.

G. What do I do when I have completed my

application?

VA FORM 21-527, JUN 2004
H U D - V A S H R E S O U R C E G U I D E 251 

INCOME-NET WORTH AND EMPLOYMENT STATEMENT

VA FORM 21-527

Please read the attached "General Instructions" before you fill out this form.

Evening

SECTION

I

1. What is your name?

4. What is your address?

City

3. What is your VA file number?

5. What are your telephone numbers?

 (Include Area Code)

Daytime

(DO NOT WRITE IN THIS SPACE)

6. What is your e-mail address?

OMB Approved No. 2900-0002

Respondent Burden: 1 hour

First Middle Last Suffix (If applicable)

Tell us

about

you

State ZIP Code Country 

Street address, Rural Route, or P.O. Box Apt. number

2. What is your Social Security number?

Tell us

about

your

marriage

SECTION

II

8. When were you married?

(If "Yes," answer Item 13b also)

7. What is your marital status?

mo day yr

9. Where did you get married? (city/state or country)

11. When is your spouse's birthday?

13a. Is your spouse also a veteran?

mo day yr

First Middle Last

12. What is your spouse's Social Security number?

13b. What is your spouse's VA file number (If any)?

NOTE: You

should

provide a

copy of your

marriage

certificate

10. What is your spouse's name?

(If you are divorced, widowed or never married, skip to Section III)

VA FORM

JUN 2004 21-527 EXISTING STOCKS OF VA FORM 21-527, Page 1 FEB 1999 WILL BE USED

14. Do you live with your spouse?

15. What is your spouse's address?

City

Street address, Rural Route, or P.O. Box Apt. number

State ZIP Code Country 

(If "No," answer Items 15 through 17 also. If "Yes," skip to Section III.)

16. Tell us why you are not living with your

 spouse. 

17. How much do you contribute monthly to your

 spouse's support?

Married Divorced Widowed Never Married

Yes No

Yes No

$
252 H U D - V A S H R E S O U R C E G U I D E

Tell us about

any previous

marriages

 Page 2

Your spouse's previous marriages

You must furnish complete information about all your and your present spouse's previous

marriages. If you need additional space, please attach a separate sheet of paper providing the

requested information about the marriages.

Your previous marriages

18b. Date of

 Marriage

mo day yr

mo day yr

18c. Place

(city/state or country)

18d. To whom

 married

(first, middle initial, last

 name)

18e. Date marriage

 ended

mo day yr

mo day yr

18f. Place

(city/state or country)

18g. How marriage

 ended

(death, divorce)

19a. How many times has your current spouse been married?

19b. Date of

 Marriage

mo day yr

mo day yr

19c. Place 19d. To whom

 married

19e. Date marriage

 ended

mo day yr

mo day yr

19f. Place 19g. How marriage

 ended

SECTION

III

18a. How many times have you been married?

Tell us about

your

unmarried

children

VA recognizes your biological children, adopted children, and stepchildren as dependents.

These children must be unmarried and:

SECTION

IV

under age 18, or

between 18 and 23 and pursuing an approved course of education, or

of any age if they became permanently unable to support themselves before

reaching age 18.

If you need additional space, please attach a separate sheet of paper providing the

requested information about each child.

Note: You should provide a

copy of the public record of

birth for each child or a copy

of the court record of adoption

for each adopted child.

"Seriously disabled" (Item 21h) means that the child became permanently unable to

support himself/herself before reaching age 18. Furnish a statement from an attending

physician or other medical evidence which shows the nature and extent of the physical

or mental impairment.

20. Do you have any dependent children?

Yes No (If "No," skip to Section V)

(city/state or country) (first, middle initial,

last name)

(city/state or country) (death, divorce)

VA FORM 21-527, JUN 2004
H U D - V A S H R E S O U R C E G U I D E 253 

SECTION IV Tell us about your unmarried children (continued)

 Page 3

21a. Name of child

(First, middle initial,

Last)

21b. Date and place

of birth (City/State

or Country)

Tell us about the children listed above who don't live with you.

22a. Name of child

 (first, middle initial, last)

22b. Child's Complete Address 22c. Name of person the child

 lives with (if applicable)

22d. Monthly amount

 you contribute to

 child's support

Tell us

about your

disability

and

background

SECTION

V

23a. What disability(ies) prevent you from working?

25c. What is the name and complete mailing

 address of the facility or doctor?

Ended

(If "No," answer

Item 26b also)

25a. Are you now, or have you recently been

 hospitalized or given outpatient or home-

 based care?

Began

25b. Tell us the dates of the recent

 hospitalization or care.

26c. Were you self-employed before becoming

 totally disabled?

24. Are you claiming a special monthly pension

 because you need the regular assistance of another

 person, are blind, nearly blind, or having severe

 visual problems, or are housebound?

(If "Yes," answer

Items 26d and 26e also)

26a. Are you now employed? 26b. When did you last work?

26d. What kind of work did you do?

(If "Yes," answer

Items 25b and 25c also)

26e. Are you still self-employed? 26f. What kind of work do you do now?

23b. When did the disability(ies) begin?

21c. Social Security

Number

$

$

$

mo day yr

mo day yr

mo day yr

mo day yr

21i. Child

previously

married

21h.

Seriously

disabled

21g. 18 -

23 yrs old

and in

school

21f.

Stepchild

21e.

Adopted

21d.

Biological

mo day yr

(If "Yes," answer Item

26f also)

mo day yr

mo day yr

Yes No Yes No

Yes No

Yes No

Yes No

VA FORM 21-527, JUN 2004
254 H U D - V A S H R E S O U R C E G U I D E

SECTION V Tell us about your disability and background (continued)

Page 4

27b. List the other training or experience you have and any certificates that you hold.

27a. Check the highest year of education you completed:

Grade school:

College:

Tell us

your work

history

SECTION

VI

28a. What was the name and

 address of your employer?

28d. When did

 your work

 end?

28b. What was

 your job

 title?

28c. When did

 your work

 begin?

28f. What were your

 total annual

 earnings?

28e. How many

 days were

 lost due to

 disability?

$

$

$

mo day yr mo day yr

mo day yr mo day yr

mo day yr mo day yr

In the table below, tell us about all of your employment, including selfemployment, for one year before you became disabled to the present.

Tell us if

you are

in a

nursing

home

SECTION

VII

29b. What is the name and complete mailing

 address of the facility?

(If "Yes," answer Item 29b also)

29c. Does Medicaid cover all or part of

 your nursing home costs?

(If "No," answer Item 29d also)

To get your claim

processed faster,

provide a statement

by an official of the

nursing home that

tells us that you are

a patient in the

nursing home

because of a

physical or mental

disability and tells

us the amount you

pay out-of-pocket

for your care.

29a. Are you now in a nursing home?

29d. Have you applied for Medicaid?

1 2 3 4 5 6 7 8 9 10 11 12

1 2 3 4 Over 4

Yes No

Yes No Yes No

VA FORM 21-527, JUN 2004
H U D - V A S H R E S O U R C E G U I D E 255 

Tell us the

net worth

of you and

your

dependents

SECTION

VIII

 Page 5

VA cannot pay you pension if your net worth is sizeable. Net worth is the market value of all interest

and rights you have in any kind of property less any mortgages or other claims against the property.

However, net worth does not include the house you live in or a reasonable area of land it sits on. Net

worth also does not include the value of personal things you use everyday like your vehicle, clothing,

and furniture. If property is owned jointly by yourself and your spouse, report one-half of the total

value held jointly for each of you. You must report net worth for yourself and all persons for whom

you are claiming benefits.

Source Veteran

30a.

30b.

30c.

Spouse

Child(ren)

30f.

30e.

Name: Name: Name:

30d.

Cash, bank

accounts,

certificates of

deposit (CDs)

IRAs, Keogh

Plans, etc.

Stocks, bonds,

mutual funds

All other property

Real property (not

your home)

Value of business

assets

(first, middle initial, last) (first, middle initial, last) (first, middle initial, last)

Payments from any

source will be counted,

unless the law says

that they don't need to

be counted. Report all

income, and VA will

determine any amount

that does not count.

SECTION

IX Report the total amounts before you take out deductions for taxes, insurance, etc.

Do not report the same information in both tables.

If you expect to receive a payment, but you don't know how much it will be, write "Unknown" in

the space.

If you do not receive any payments from one of the sources that we list, write "0" or "None" in the

space.

If you are receiving monthly benefits, give us a copy of your most recent award letter. This will

help us determine the amount of benefits you should be paid.

31. Have you claimed or are you receiving disability benefits from the Social Security Administration

 (SSA)?

Tell us

about the

income of

you and

your

dependents

For Items 30a through 30f, provide the amounts. If none, write "0" or "None."

 Yes No

VA FORM 21-527, JUN 2004
256 H U D - V A S H R E S O U R C E G U I D E

SECTION IX Tell us about the income of you and your dependents (continued)

Monthly Income - Tell us the income you and your dependents receive every month

Sources of

recurring monthly

income

Spouse

Name:

Veteran

Child(ren)

Name: Name:

32g.

32f.

32e.

32c.

32b.

32a.

Sources of income

for the next 12

months

Expected income for the next 12 months - Tell us about other income for you and your dependents

Veteran Spouse

Name: Name: Name:

Child(ren)

33a.

33b.

33c.

33d.

32d.

Black Lung

Benefits

U.S. Railroad

Retirement

U.S. Civil Service

Social Security

Military

Retirement

Other income

received monthly

(Please write

source below)

Supplemental

Security Income

(SSI)/Public

Assistance

Gross wages and

salary

Total interest and

dividends

Worker's

compensation or

unemployment

compensation

Other income

expected

(Please write

source below)

(first, middle initial, last) (first, middle initial, last)

(first, middle initial, last) (first, middle initial, last) (first, middle initial, last)

(first, middle initial, last)

VA FORM 21-527, JUN 2004 Page 6
H U D - V A S H R E S O U R C E G U I D E 257 

SECTION X

34a. Amount paid by

you

34e. Disability or

relationship of person for

whom expenses paid

Tell us about

medical, legal or

other

unreimbursed

expenses

34b. Date Paid 34c. Purpose

(Doctor's fees, hospital

charges, attorney fees,

etc.)

34d. Paid to

(Name of doctor, hospital,

pharmacy, etc.)

Family medical expenses and certain other expenses actually paid by you may be deductible from your income.

Show the amount of unreimbursed medical expenses, including the Medicare deduction, you paid for yourself or

relatives who are members of your household. Also, show unreimbursed last illness and burial expenses and

educational or vocational rehabilitation expenses you paid. Last illness and burial expenses are unreimbursed

amounts paid by you for the last illness and burial of a spouse or child at any time prior to the end of the year

following the year of death. Educational or vocational rehabilitation expenses are amounts paid for courses of

education, including tuition, fees, and materials. Show medical, legal or other expenses you paid because of a

disability for which civilian disability benefits have been awarded. When determining your income, we may be

able to deduct them from the disability benefits for the year in which the expenses are paid. Do not include any

expenses for which you were reimbursed. If more space is needed attach a separate sheet.

All Federal payments beginning January 2, 1999, must be made by electronic funds transfer (EFT) also called

Direct Deposit. Please attach a voided personal check or deposit slip or provide the information requested below in

Items 35, 36 and 37 to enroll in Direct Deposit. If you do not have a bank account we will give you a waiver from

Direct Deposit, just check the box below in Item 35. The Treasury Department is working on making bank

accounts available to you. Once these accounts are available, you will be able to decide whether you wish to signup for one of the accounts or continue to receive a paper check. You can also request a waiver if you have other

circumstances that you feel would cause you a hardship to be enrolled in Direct Deposit. You can write to:

Department of Veterans Affairs, 125 S. Main Street Suite B, Muskogee OK 74401-7004, and give us a brief

description of why you do not wish to participate in Direct Deposit.

If benefits are

awarded we will need more

information in order to

process any payments to

you. Please read the

paragraph starting

with, "All Federal

payments..." and then

either:

36. Name of financial institution

37. Routing or transit number

Account number

35. Account number (Please check the appropriate box and provide that account number, if applicable)

 Page 7

1.

I certify that I do not have an account with a financial

institution or certified payment agent Savings

Checking

SECTION

XI

Give us direct

deposit information

mo day yr

mo day yr

mo day yr

mo day yr

$

Attach a voided

check, or

2. Answer Items

35-37 to the right.

$

$

$

VA FORM 21-527, JUN 2004
258 H U D - V A S H R E S O U R C E G U I D E

Give us

your

signature

Remarks - Use this

space for any

additional

statements

that you would like

to make concerning

your application.

I certify and authorize the release of information:

I certify that the statements in this document are true and complete to the best of my knowledge. I

authorize any person or entity, including but not limited to any organization, service provider,

employer, or government agency, to give the Department of Veterans Affairs any information about

me except protected health information, and I waive any privilege which makes the information

confidential.

38. Your signature

40b. Printed name and address of witness

39. Today's date

40a.

41a. 41b. Printed name and address of witness

1.

IMPORTANT

Penalty: The law provides

severe penalties which

include fine or

imprisonment, or both,

for the willful submission

of any statement or

evidence of a material fact,

knowing it to be false, or

for the fraudulent

acceptance of any payment

which you are not entitled

to.

42.

 Page 8

SECTION

XIII

SECTION

XII

Read the box that starts,

"I certify and authorize

the release of

information:"

2. Sign the box that

says, "Your signature."

3. If you sign with an "X,"

then you must have 2

people you know

witness you as you sign.

They must then sign the

form and print their

names and addresses

also.

Remarks (If you need more space to answer a question or have a comment about a specific item

number on this form please identify your answer or statement by the part and item number)

mo day yr

Signature of witness (If claimant

signed above using an "X")

Signature of witness (If claimant

signed above using an "X")

VA FORM 21-527, JUN 2004