Since 1987, homeless veterans in upstate New York have been able to receive help finding housing and employment along with treatment for substance abuse, mental illness and other healthcare issues. But until recently, those who sought such services in the five Veterans Integration Service Network 2 locations found coordination to be lacking. VISN 2's efforts to combat that problem have earned the system the Spirit of Excellence quality award.
"We could see that homeless veterans weren't accessing the broad scope of services that were available," says Robert Van Keuren, coordinator of the program at 256-bed Canandaigua (N.Y.) VA Medical Center. "There were missed opportunities in linking veterans to services at other locations. ... This thing was fractured, broken, siloed, independent, relative to its ability to utilize resources."
So the VISN 2 facilities, which serve 47 counties from Albany to Buffalo, in October 1998 began work to develop an integrative database to match veterans' individual needs with the services the facilities had to offer. This effort to standardize and streamline services into a Continuum of Care for Case Management has shown results: Those discharged to independent housing jumped to 82.2% in 2003 from 45.5% in 1999, while those who found gainful employment rose to 64.2% in 2003 from 38.3% during in 1999. And 95.6% of veterans in a random survey reported satisfaction with the services they received.
This is because problems were being addressed systematically, Van Keuren says. "Here's your housing," he says. "What good is that if you have a substance abuse problem?" Scott Murray, network director of behavioral health services, says that works both ways: "You can do a lot of work with mental health, but unless you take care of vocational services and housing, they will fail." Van Keuren adds the program does not take a one-size-fits-all approach, realizing that independent housing and employment are not always the answers.
"Sometimes the highest and best clinical outcome is for that person to receive some sort of disability pension, maybe to live in supportive housing," he says. "We're dealing with an older, more debilitated population. Often times, I have to educate folks that it's not a bad thing that they didn't go back to work."
The VISN 2 efforts touched judge Douglas Leonard. "It was reaching out to these people in a crisis state in their lives," he says. "These veterans out there who served our country and put their lives on the line, to be put in a condition where they're without a home and the system is so overwhelming to them. For this veterans hospital to reach out and provide a wonderful intervention, I thought it was just great."