A collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet a Veteran’s transitional, recovery, sustainability, employment and/or housing retention needs.
Chronically Homeless Veteran:
A Veteran who has been homeless for 12 consecutive months, or four episodes of homelessness in a three-year period that adds up to 12 months. That has a disability, addiction or Posttraumatic Stress Disorder (PTSD) that impact daily living.
By policy, Clinical Staffing, occurs weekly and facilitated by TJH Clinical Manager. The staffing’s purpose is to provide weekly harm reduction and Individual Recovery Plan (IRP) oversight of any Veteran presenting a history or treatment of medical issues or condition, mental health diagnosis or illness, PTSD, Substance Abuse Disorder diagnosis or substance use.
TJH identifies a community as “a feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals” and as the defining characteristic of our mission. A Veteran’s sense of community is their source of empowerment to end homelessness, and by which healthy interactions, healthy connections, and healthy relationships are achieved and sustained.
Continuum of Care:
Has two meanings for TJH:
Continuum of Care (Concept): A concept that integrates systems of care that guides and tracks individuals over time through a comprehensive array of health services; high intensity, low intensity, low-barrier, high-barrier, etc.
Continuum of Care (CoC): A regional or local planning body that coordinates housing and services funding for homeless families and individuals. TJH participates in this planning body and is essential in both networking and in becoming eligible for State and Federal grant funding.
The American Counseling Association (ACA), defines counseling as, “a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.” Counseling is a service that involves helping people make changes in thinking, processing feelings and emotions, and identifying appropriate behavioral patterns.
Essential in making evidence-based decisions, this skill is a practice defined as the objective analysis and evaluation of an issue in order to make a decision and/or form a judgment. TJH has established policies with staff’s ability to “critically think” through the issues and evidence presented as the focal point of each procedure. Critical Thinking does not give staff the permission to change procedures within policies. TJH does expect staff to remember the definitions of Low-Barrier and Harm Reduction as they critically think through challenging situations with Veterans.
A type of homeless service agency which provide temporary residence for homeless individuals and families. Shelters exist to provide residents with safety, hot meals and protection from exposure to the weather. Barriers to enter and remain in shelters are typically restrictive, and will vary depending on the mission and vision of the organization. Providing shelter is the primary focus of these residential centers, with limited (if any) transitional or supportive services offered.
This practice is defined as the careful, precise and wise use of current and best evidence in making decisions. This requires skills in Critical Thinking, so that all relevant and reliable facts and information is appropriately integrated into program expectations and service accountability. It also requires confidence from the decision-maker in their expertise to make decisions and in their ability to evaluate a Veterans capacity to respond to decisions made.
Individually defined and based on a Veteran’s capacity to respond to their individual expectations and community accountability. Financial stability does not necessarily require that a Veteran find and maintain employment. Financial stability may also include receiving and improving disability benefits.
A formal definition of harm reduction refers to “a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors.” This practice, at TJH, combines the use of credentialed mental health professionals to assess and clinically reduce the harmful effects of symptoms, behaviors and issues presented. Using a low-barrier clinical approach, this practice is experienced at TJH by meeting the Veteran with programs and services within their emerging or critical needs.
HCHV: VA Healthcare for Homeless Veterans Program:
“The central goal of the HCHV program is to reduce homelessness among Veterans by conducting outreach to those who are the most vulnerable and who are not currently receiving VA services, and then engaging them in treatment and rehabilitation as well as in other VA programs and non-VA community programs that provide prevention and support services (VHA Handbook 1162.09).” TJH signed a HCHV Contract, five years renewable, with the VA on September 18, 2017. TJH’s VA HCHV Contract Liaison is employed by VA Northern Indiana Health Care System (NIHCS).
A Veteran who is living on the streets, in their car, or with a friend and/or sleeping on a couch and/or in a hotel being paid by someone else, or living in a home unfit for human habitation. A homeless Veteran may also include an at-risk Veteran who is at imminent risk of homelessness, such as being evicted or other conditions that imminently impacts current housing.
Housing First/Rapid Housing (Approach):
A program approach that prioritizes steps to be taken in service delivery for those experiencing homelessness and who are seeking permanent housing. The objective of this approach is to end an individual’s housing condition rapidly, and to use their immediate access to a permanent home as a platform to pursue personal goals and to improve quality of life. This approach is guided by core values that appreciates individual choice and supportive participation, and that basic necessities like food and a place to live are critical first steps to an individual’s recovery. That without the acceptance of individual choice and the assurance of basic lifesaving necessities, successful recovery is unpredictable.
Individually defined and based on a Veteran’s capacity to respond to expectations and community accountability. Independence must include the capacity to care for personal hygiene and health care needs, pay rent and sustain a healthy living environment, and manage daily living activities.
Individual Recovery Plan (IRP):
IRP’s provide both program and service accountability and a layer of harm reduction measures for homeless Veterans transitioning into permanent housing. IRP’s are to include measurable timelines, with initial IRP not to exceed three (3) months. Updates in IRP goals and objects thereafter will not exceed more than one (1) month.
A term used by the VA to measure a Veteran’s access to care. Low-barrier programs or services have limited barriers for entry or discharge through expulsion. Policy and procedures are established to work with Veterans through their recovery and accommodate a broad range of homeless issues and homeless populations.
Overdose Risk Potential (ODP):
Overdose, potential and risk, is taken seriously at TJH and is clinically managed for harm reduction. Individuals assessed to have an OPD outside of TJH scope of practice will be referred for more suitable placement. OPD is measured using the following benchmarks.
High – Use of any or all benzodiazepines, and/or opioids, and/or cocaine and/or alcohol with blackouts over the last 6 months.
Medium – Non-use of any or all benzodiazepines, and/or opioids, and/or cocaine and/or alcohol with blackouts over the last 6 months, but has been used within the last 12 months.
Low – Non-use of any or all benzodiazepines, and/or opioids, and/or cocaine, and/or alcohol with blackouts over the last 12 months.
TJH’s focus is to f rebuild lives not repairing broken lives. Our programs and services operate with the assumption that each Veteran is capable of making their own decisions, and what each of us need most is patience, mercy along with accountability and guidance.
Available assets, possessions or property, relationships and connections, or networks that can be drawn upon by a person or organization in order to reach goals and to function effectively. Examples may include, but not limited to:
VA eligibility to programs and services
Non-VA eligibility to programs and services
Employment; skill sets and experience
Income, or source of income
Medical and mental health
Family and community connections and relationship
Safe Haven (Model):
Using low-barrier concepts in policy and procedures, Safe Havens serve hard-to-reach homeless individuals with severe mental illness and/or substance use problems who are living on the street and have been unable or unwilling to participate in treatment and/or traditional recovery services.
Safety first, then housing, treatment, employment, and connections and relationship building. A core value of Harm Reduction, the safety of Veterans stands at the forefront of our mission to end Veteran homelessness.
Substance abuse is defined by TJH as the use of illegal substances, consumption of alcohol followed by episodes of blackouts and/or the misuse of prescribed medication. Being intoxicated and/or chemically impaired on The Journey Home property is strictly controlled and programmatically managed through the Veteran’s Individual Recovery Plan (IRP). Substance abuse by this definition is considered a harm reduction issue and will be clinically managed by TJH’s Clinical Manager.
At TJH, outreach involves more than the process of finding at-risk Veterans who have limited access to care, services or resources. TJH’s outreach strategies are aimed at connecting Veterans and communities. This includes the identification of both at-risk Veterans and their communities of value, and relies upon the development partners of care who share the same mission, vision and core values. It also involves networking, and connecting Veteran’s to their community and the community to the Veteran.
TJH Programs and Services Veteran:
Are by definition Veterans who are appropriate for TJH mission driven programs and services.
TJH VA HCHV Contracted Services Veteran –
Male Veteran who are affiliated with the VA.
Male Veteran who is classified as homeless, who served within a qualifying time frame in his branch of service, and who has an appropriate discharge status.
Male Veteran who is not a Registered Sexual Offender or pending sexual offending case the courts.
Male Veteran who does not require daily living support and who requires intensive inpatient treatment.
TJH Outreach Program Veteran – Male or female Veteran, or spousal dependent of a Veteran who served for any amount of time with any military branch of the Department of Defense; either active, Reserve or National Guard. This definition also includes service men, women and spousal dependents of the Coast Guard.
Medical, mental or behavioral health care given to an individual for an illness injury, or condition. This service is based upon an individualized plan developed collaboratively with a licensed clinician and/or team and the individual. The objective of “treatment” type services is to eliminate or control adverse symptoms so an individual can function better and to increase well-being and healing.
Male or female who served in the US Military (Army, Navy, Marines, Air Force, or Coast Guard) in either active duty, Reserve, or National Guard.
Veteran Transitional Housing Facility:
Is temporary housing, residential or apartment, with supportive services that transition Veterans into affordable permanent housing. Typically operating with a Housing First/Rapid Housing approach to supportive services, these facilities include agendas that link homeless Veterans to VA and Non-VA programs, treatment, resources and/or relationships that support their transition from homelessness into permanent housing.
Veterans Affairs (VA) Eligible Veteran:
Are Veterans who serve in enlisted or commissioned active duty of any branch of the US Military (Army, Navy, Marines, Air Force, or Coast Guard) for a specified amount of time and were discharged under honorable conditions. National Guard or Reserve, and deployed actively by the President of the United States for a specified amount of time, are also considered VA eligible. State deployment, or deployments ordered by State Governors, do not qualify a Veteran for VA eligibility.