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HOMES User Manual - End Homelessness Among Veterans

1. a Medicaid health insurance program or similar local program L 0 No 1 Yes b Medicare health insurance program or similar local program U 0 No 1 Yes c Temporary Rental Assistance LI 0 No 1 Yes d Homeless Prevention and Rapid Re housing Program HPRP Funds U 0 No L 1 Yes e Veteran Service Organizations LU 0 No L 1 Yes f State Children s Health Insurance Program or similar local program L 0 No L 1 Yes g Supplemental Nutrition Assistance Program SNAP or Food Stamps L 0 No L 1 Yes h Special Supplemental Nutrition Program for Women Infants and Children WIC LI 0 No 1 Yes i Temporary Assistance for Needy Families TANF or similar local program Child Care Services L 0 No 1 Yes L Temporary Assistance for Needy Families TANF or similar local program Transportation 0 No L 1 Yes Omer TANFAunded services LI 0 No L 1 Yes Bus subway train or cab voucher L 0 No L 1 Yes m Other U 0 No 1 Yes Does the Veteran currently have a representative payee or fiduciary L 0 No L 1 Yes LI 99 Case manager omitted item If 24 no or Case Manager omitted item skip to item 25 If yes a Is this person a 1 Family member 2 Friend 3 Landlord 4 Lawyer banker or accountant 5 Mental health provider or other clinician 6 Other 99 Case manager omitted item ng a VI HEALTH CARE STATUS How has this Veteran s community adjustment changed in the
2. Appendix C Acronyms Acronym Term CARF Commission on Accreditation of Rehabilitation Facilities CoC Continuum of Care CPRS Computerized Patient Record System CWT Compensated Work Therapy DCHV Domiciliary Care for Homeless Veterans DOB Date of Birth DRRTP Domiciliary Residential Rehabilitation Treatment Programs Dt Date GA General Assistance GPD Grant and Per Diem HCHV Healthcare for Homeless Veterans HCRV Healthcare for Re entry Veterans HHS Health and Human Services HMIS Homeless Management Information System HOMES Homeless Operations Management and Evaluation System HPRP Homeless Prevention and Rapid Re Housing Program HUD Housing and Urban Development HUD VASH Housing and Urban Development VA Supported Housing IE Internet Explorer IRM Information Resource Management IRMS Information Resource Management Service JCAHO Joint Commission on the Accreditation of Healthcare Organization LOS Length of Stay MH RRTP Mental Health Residential Rehabilitation Treatment Program NEPEC Northeast Program Evaluation Center ODC Online Data Collection PRRTP Psychosocial Residential Rehabilitation Treatment Programs PTSD Post Traumatic Stress Disorder RRTP Residential Rehabilitation Treatment Program SA Substance Abuse SE Supported Employment SHP Supportive Housing Program SNAP Supplemental Nutrition Assistance Program SRO MOD Single Room Occupancy Moderate Rehabilitation Program SSDI Social Security Disability Income
3. 6 COL Colonel Colonel Captain Colonel Rear Admiral Lower 7 BG Brigadier General Brigadier General Half Brigadier General Rear Admiral Upper 8 MG Major General Major General Half Major General 9 LTG Lieutenant General Lieutenant General Vice Admiral Lieutenant General Admiral 10 GEN General General Commandant CG General DRAFT LAST UPDATED APRIL 19 2011 149 VA Homeless Operations Management and Evaluation System HOMES User Manual Appendix G Supplemental Referral Form Worksheet DRAFT LAST UPDATED APRIL 19 2011 150 VA Homeless Operations Management and Evaluation System HOMES User Manual Appendix H HUD VASH A HUD VASH Program Instructions B HUD VASH Entry Form Worksheet Staff member completing this form first and last name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed MmM dWVyY oooooococccccciccnaconinincnnnnn oo n AA EA 1 Veteran s name last name first initial 2 Social Security NUMDET oococcoconcnnconccnnconinnnncnnannnn 0 o eo a Ba a d 3 Date of birth MmM dWVyy oococoococccccccnccnccnnno nono nana o na AI oe pe 4 Did the Veteran enter the HUD VASH program O 0 No 1 Yes 5 Date of entry decision mm dd yy O ie es ee r S If the Veteran did not enter the HUD VASH program answer item 6 only do not complete remainder of form 6 Select the main reaso
4. cccssssscsssscccsssscccessscccsssscccesssscccssccsesscsecesssseccssnaee 136 APPENDIX G SUPPLEMENTAL REFERRAL FORM WORKSHEET 1 cccssssssssssccssssccccsssecssssscccesneee 150 APPENDIX H HUD VASH sissscssciccesccassseastesvescastivstoassscesassecesscauassossocdsetteawssscovecessooscsedseesdssseseacssssscudevonssessededesseses 151 A HUD VASH PROGRAM INSTRUCTIONS cccccccononononononononononononononnnnnnnnnononononononnnonononononononononononononononcnnnnnnnnnnnnns 151 B HUD VASH ENTRY FORM WORKSHEET ccccccconononononononononononononononononononononononononononononononononononononononinincnininnos 151 C HUD VASH MONTHLY STATUS REPORT FORM WORKSHEET ccccccscececececececececececececeeececeseseeeseeeeeeeeeeees 153 D HUD VASH EXIT FORM WORKSHEET cccccccccscscscscscecscececscecscscscecscscscececsescscscscecscseseeessecssseseseseseseseseees 160 APPENDIX I ICH ssscssssssssssssecsiscssasssssssessssssscsssseesoosscssassseessssbscecsasssaasdoesecsasacenns soededscteassssteacoesasscnassaassssssaasseeses 164 A HCH V PROGRAM INSTRUCTIONS ccccccccscscscscccscecscecececececececscecscecscscecscececscacacecscscssscacacacasauseseseseseseseeeses 164 B HCHV ENTRY FORM WORKSHEET cccccccscscscscecececececececececececececececececececececacssecscscecacaseeacauaesuesesssaseeausnaes 164 HCHV EXIT FORM WORKSHEET e a tata ne ada as Sea 165 APPENDIX J RESIDENTIAL TREATMENT ccssssssssssssscsssssccc
5. 04 12 2011 642 04 12 2011 Edit Entry Form View Entry Form 04 13 2011 Edit Exit Form View Exit Form HCHV Program Forms Entered nen Edit Entry Form Exit Date Add Form __ Edit Exit Form 04 12 2011 642 04 13 2011 Edit Entry Form View Entry Form 04 13 2011 Add Exit Form Edit Exit Form View Exit Form HCRV Program Forms Entered No HCRV program forms entered VJO Entry Exit Forms Entered Date of Primary Secondary Entry Date Eat E Mie E Add Progress View Exit Assessment VAMC Form oe Add Form Form 04 12 2011 04 12 2011 Edit Entry Form View Entry Form Add Progress a Edit Exit view Exit Form Form Form Form VJO Progress Reports Entered No VJO Progress Reports entered HUDVASH Entry Exit Forms Entered No HUDVASH program forms entered Add HUDVASH Entry form DRAFT LAST UPDATED APRIL 19 2011 65 VA Homeless Operations Management and Evaluation System HOMES User Manual HCHV Exit Form HOMES Episode Start Date 04 12 2011 Primary VAMC 642 Lead Case Manager N A Secondary VAMC 642 Program Entry Date mm dd yy 04 13 2011 Staff Login First and Last Name Matthew Berman VA Site 3 digit VAMC code plus 2 digit suffix if any 642 Date this form completed mm dd yy 4713 2011 I Veteran Information 1 Veteran s name last name first initial John Smith 2 Social Security Number 887654321 3 Date Of Birth 03 04 1980 o 5 Which is the most important reason
6. 27 What is the total amount of time if any that you have spent in jail or prison during your lifetime Select the response that corresponds with the total amount of time that the Veteran has spent in either jail or prison in his or her lifetime VI Employment and Income Assessment Form 28 Which best describes your employment pattern in the last 3 years Select the response from the drop down list that best reflects the Veteran s employment pattern during the majority of the past three years If the Veteran was employed one and a half years and unemployed for one and a half years choose his or her most recent employment situation 29 How many days did you work for pay in the past 30 days Enter the total number of days that the Veteran worked for pay during the past 30 days Do not include days off e g weekends and holidays Declined If the Veteran declined to answer enter N NO If the Veteran did not work for pay during any of the past 30 days enter 00 30 Did you receive any money in the past 30 days Select the response from the drop down list that best reflects whether the Veteran received any money in the past 30 days NO If a Veteran reports receiving no income from any source in the past 30 days no additional data collection is required YES If yes select each category For items 30a p enter the amount of money that the Veteran received from each of the listed
7. 5 Which is the most important reason why the Veteran ended involvement in HUD VASH case management Select from the drop down list the most important reason why the Veteran ended involvement in HUD VASH case management If a Veteran left for multiple reasons record only the primary reason If selecting response 13 other specify the other reason why the Veteran exited the program in the field provided 6 What is the status of the Veteran s HUD VASH voucher Indicate whether the Veteran will have a HUD VASH voucher that was obtained through the HUD VASH program at the time of program exit by selecting a response from the drop down list If selecting response 7 other specify the other status of the voucher in the field provided DRAFT LAST UPDATED APRIL 19 2011 57 VA Homeless Operations Management and Evaluation System HOMES User Manual III Status at Program Exit HUD VASH Exit Form 7 What is the Veteran s housing arrangement at program exit Select the response from the drop down list that reflects the Veteran s current housing arrangement at the time of program exit 8 What is the zip code of that location Record in the field provided the five digit zip code of the location where the Veteran was living at the time of program exit Unknown If the zip code is unknown enter N 9 Housing Stability How would you describe the Veteran s housing situation at progra
8. VA Specialized Homeless Services 5 Case Management Services a HUD VASH Case Management Services Indicate whether the Veteran requires intensive case management services with permanent housing by selecting a response from the drop down list b HCHV Case Management Services Indicate whether the Veteran requires direct case management services beyond referral to other services by selecting a response from the drop down list 6 Residential Treatment Transitional Housing Select a residential treatment transitional housing program if any that will best meet the needs of the Veteran If item 7 from the drop down list is selected respond to item 53a a What is the status of the referral to Other MH RRTP residential treatment Indicate the status of the referral to Other MH RRTP residential treatment programs by selecting a response from the drop down list 7 Services for Justice Involved Veterans Indicate whether the Veteran requires legal services by selecting a response from the drop down list 8 VA Prevention Services a c Indicate the current status of the referral for programs listed in items 55a c by selecting a response from the drop down list DRAFT LAST UPDATED APRIL 19 2011 40 VA Homeless Operations Management and Evaluation System HOMES User Manual II Referral Plans Referral Form VA Treatment Services 9 VA Emergency Room Indicate whether a r
9. a Medicaid health insurance program or similar local program LI 0 No 1 Yes b Medicare health insurance program or similar local program LI 0 No 1 Yes c Temporary Rental Assistance LI 0 No 1 Yes d Homeless Prevention and Rapid Re housing Program HPRP Funds L 0 No U 1 Yes e Veteran Service Organizations L 0 No U 1 Yes f State Children s Health Insurance Program or similar local program L 0 No U 1 Yes g Supplemental Nutrition Assistance Program SNAP or Food Stamps LI 0 No L 1 Yes h Special Supplemental Nutrition Program for Women Infants and Children WIC LI 0 No L 1 Yes DRAFT LAST UPDATED APRIL 19 2011 162 VA Homeless Operations Management and Evaluation System HOMES User Manual i Temporary Assistance for Needy Families TANF or similar local program Child Care Services L 0 No 1 Yes j Temporary Assistance for Needy Families TANF or similar local program Transportation L 0 No 1 Yes Services k Other TANF funded services LI 0 No L 1 Yes Bus subway train or cab voucher L 0 No L 1 Yes m Other _ 0 No L 1 Yes IV Follow up Arrangements Select the code that best describes clinical treatment arrangements made at program exit 16 Alcohol problems O 0 Nota problem area for this veteran O 1 Problem area for this Veteran but no treatment arrangements made O 2 Vetera
10. Select the response from the drop down list that best reflects where HCRV staff made the initial contact with the Veteran When responding to items 13 and 14 specify how initial contact was made in the field provided Please note that category 13 Special program for homeless Veterans is only to be checked yes if the interview took place at a community program designed to serve only Veterans who are homeless To be considered a special program it must be a place in which other homeless people are not included in the population and where Veterans who have homes are not considered part of the population served If you feel that you have such a program where you interview Veterans call NEPEC so that it can be verified If you do check category 13 please make sure to write the name of the program in the space provided TIT Current Incarceration HCRV Entry Form 8 Is the Veteran currently incarcerated or released less than 10 days ago Select the response from the drop down list that indicates whether the Veteran is currently incarcerated or was released less than 10 days ago If the Veteran is currently incarcerated or was released less than 10 days ago complete the remainder of the form Otherwise leave items 9 25 blank and submit the form 9 Veteran s State or Federal Corrections Identification Number Enter the Veteran s 9 digit State or Federal corrections identification number in the field provid
11. 8b Did the Veteran receive any of the following non cash benefits during the reporting period Select the response from the drop down list that best reflects whether the Veteran received any non cash benefits during the reporting period Unknown Declined If no or the VJO Specialist omitted item skip to item 9 1 13 Indicate whether or not the Veteran received non cash benefits from each of the sources listed in 8b 1 13 during the past 30 days Multiple sources of non cash benefits may be identified DRAFT LAST UPDATED APRIL 19 2011 109 VA Homeless Operations Management and Evaluation System HOMES User Manual IV Current Treatment VJO Progress Form Items 9 14 Select the code that best describes veteran s current treatment in each area 9 Alcohol Problems Select the appropriate response from the drop down list 10 Drug Problems Select the appropriate response from the drop down list 11 Mental Health Problems Other than Drug or Alcohol Select the appropriate response from the drop down list 12 Medical Problems Select the appropriate response from the drop down list 13 Social or Vocational Skills Deficits Select the appropriate response from the drop down list 14 Family Problems Select the appropriate response from the drop down list V Legal Status VJO Progress Form 15 Legal status Since entry into the Treatment Court please
12. 0c ceceeseee eee eeeeees Veteran s name last name first initial ooooooooonnnnnnnnononon Social Security NUMDf ooocococcncncccccncocononconncnnncnnononnncnnnnass Date of birth MmM dWVyy oococoococcccccccncnncnnnnco non nc nnoncnnnonanno Programi Ty Pe Ai Project Code ticas cts Program Name 2 2 2ceceeeeeeceeeeeeeceeeeeeeeeeeeeneeeeseeeeeeeeees 1 Period covered by this report Entry date Code dates mm dd yy Exit date 1a Billable Days LOS and Cost of Care to be completed for GPD HCHV DCHV Unpaid days Billable days LOS o Cost of treatment round to nearest dollar 1b CWT TR Work Earnings Rent Summary only completed for CWT TR Hours worked Total hours worked in CWT since entry to the TR hours _ _ _ Total hours worked in competitive employment since entry to the TR approximate hours _ _ _ Earnings Please round to whole dollar amounts Total net earnings from CWT since entry to the TR _ gt 00 Total net earnings from competitive employment since entry to the TR __ _ 00 Rent Please round to whole dollar amounts Total program fee rent paid since entry to the TR _ __ 0 0 lll Status at Program Exit 2 The Veteran ended residential treatment because 1 Successful completion of the program 2 Successfully completed some components of the program DRAFT LAST UPDATED APRIL 1
13. 4 unrelated adults list number LI 1 Yes L 99 omitted 6e Housing stability How would you describe the Veteran s housing situation L 1 Literally homeless O 2 Imminent risk of losing housing L 3 Unstably housed at risk of losing housing L 4 Stably housed O 5 Don t know 7 Which best describes the Veteran s employment pattern during the reporting period L 0 Full time 40 hrs wk O 6 Military Service O 1 Full time irregular O 7 Retired disability L 2 Part time regular hours Ll 8 Unemployed L 3 Part time irregular day work L 9 Controlled environment e g hospital prison O 4 VA CWT or other vocational training program L 99 VJO Specialist doesn t know omitted item O 5 Student 8a Did the Veteran receive any money during the reporting period _ 0 No O 1 Yes O 99 VJO Specialist doesn t know omitted item DRAFT LAST UPDATED APRIL 19 2011 188 8b VA Homeless Operations Management and Evaluation System HOMES User Manual If item 8a is no or VJO Specialist doesn t know omitted item skip to item 8b If yes list the average monthly amount in each category Please round to whole dollar amounts and note comma placement eg 452 76 should be entered as __ 453 00 Employment include CWT SE Compensation for service connected psychiatric condition Compensation for other service connected condition Non service connected pension Ret
14. 6 Select the main reason why Veteran did not enter the HCRV program Veteran left can no longer locate Veteran no longer in clinical need of program Veteran not interested in program Veteran refused to agree with terms of HCRV case management Since referral Veteran became too ill to participate Veteran s anticipated release date is more than 6 months away Veteran is not eligible for VHA Healthcare Other specify AS Use the instructions below to complete the form General HCRV Entry Form HOMES Episode Start Date Automatically filled based on information collected in HOMES cannot be edited Lead Case Manager n a in Phase 1 of HOMES Automatically filled based on information collected in HOMES cannot be edited DRAFT LAST UPDATED APRIL 19 2011 84 VA Homeless Operations Management and Evaluation System HOMES User Manual General HCRV Entry Form Primary VAMC Automatically filled based on information collected in HOMES cannot be edited Secondary VAMC Automatically filled based on information collected in HOMES cannot be edited Staff Login Automatically filled based on the user information cannot be edited VA Site Automatically filled based on the user information cannot be edited I Veteran Information HCRV Entry Form 1 Veteran s Name Automatically filled based on the Veteran information can only be edite
15. Housing stability How would you describe the Veteran s housing situation at program exit O 1 Literally homeless O 2 Imminent risk of losing housing O 3 Unstably housed at risk of losing housing Ll 4 Stably housed O 5 Don t know With whom will the Veteran be living at program exit 0 No residence 1 Alone 2 With spouse partner or children 3 With parents with siblings or with other family 4 With friends 5 With strangers aaa aa a e 6 Don t know What is the Veteran s arrangement for employment at program exit 0 Disabled or retired Unemployed Actively seeking employment Part time or temporary employment Full time employment VA s IT or CWT VI Other vocational training Unpaid volunteer Student Don t know a tO a Oo ON DOAK WD What is the Veteran s arrangement for receipt of VA financial benefits disability payments or pension at the time of program exit 0 Currently receiving VA benefits and will continue 1 Has pending application for VA financial benefits 2 Is planning to apply for VA financial benefits 3 Is neither receiving nor planning to apply for any VA financial benefits oy Y a 4 Do not know Veteran s status with respect to VA financial benefits DRAFT LAST UPDATED APRIL 19 2011 193 9 10 11 VA Homeless Operations Management and Evaluation System HOMES User Manual What is the Veteran s arrangement for receipt
16. III Status at Program Exit 2 The Veteran ended VJO program involvement because 1 Successful completion of the VJO program 2 Veteran was asked to leave because of violation of VJO program rules 3 Veteran left the program by his her own decision without concurrence of the VJO program Veteran became too menta or physically to complete the program Use the instructions below to complete the form General VJO Exit Form HOMES Episode Start Date Automatically filled based on information collected in HOMES cannot be edited Lead Case Manager n a in Phase 1 of HOMES Automatically filled based on information collected in HOMES cannot be edited Program Entry Date Automatically filled based on information collected in HOMES cannot be edited Primary VAMC Automatically filled based on information collected in HOMES cannot be edited Secondary VAMC Automatically filled based on information collected in HOMES cannot be edited Staff Login Automatically filled based on the user information cannot be edited VA Site Automatically filled based on the user information cannot be edited Form Completion Date Automatically filled based on information collected in HOMES cannot be edited DRAFT LAST UPDATED APRIL 19 2011 112 VA Homeless Operations Management and Evaluation System HOMES User Manual I Veteran Information VJO Exit Form
17. LI 0 No L 1 Yes 32 Do you have any significant outstanding debts If 32 no or Veteran declined interviewer omitted item skip to item 33 If 32 yes please specify debt sources E Ol O O 0 No 1 Yes 98 Veteran decline to answer 99 Interviewer omitted item a housing loans b student loans L 0 No 1 Yes c other loans personal auto etc 0 No 1 Yes d credit card debt 0 No O 1 Yes e child support L 0 No 1 Yes f alimony L 0 No 1 Yes g medical expenses self or dependents L 0 No 1 Yes h fines or other legal obligations 0 No O 1 Yes i outstanding tax bills 0 No I 1 Yes j other specify 0 No 1 Yes 33 Do you currently have a representative payee or fiduciary L 0 No L 1 Yes L 98 Veteran decline to answer L 99 Interviewer omitted item Vil CLINICAL STATUS 34 In the past 30 days would you say your physical health has been LC 0 Excellent O 3 Fair LO 98 Veteran declined to answer O 1 Very Good L 4 Poor 99 Interviewer omitted item O 2 Good 35 How would you describe the health of your teeth and gums LC 0 Excellent O 3 Fair 98 Veteran declined to answer O 1 Very Good LI 4 Poor 99 Interviewer omitted item L 2 Good 36 Has a doctor or nurse ever told you that you have any of the following medical conditions a HIV AIDS LI 0 No L 98 Veteran decline to answer 1 Yes _ 99 Interviewer om
18. Matthew Berman VA Site 3 digit VAMC code plus 2 digit suffix if any ea Date this form completed mm dd yyyy 4713 2011 1 Veteran s name last name first initial ohn Sm 2 Social Security Number 987654321 3 Date Of Birth mm dd yy 03 04 1980 4 Will the Veteran receive VJO services 0 No 1 Yes select M ES If the Veteran will not receive VJO services answer items 6 and 7a and 7b only do not complete remainder of the form Date of program entry decision mm dd yy Select the main reason why Veteran did not enter the VJO program 1 Veteran left can no longer locate eteran no longer in clinical need of program eteran not interested in program eteran refused to agree with terms of VJO case management Since referral Veteran became too ill to participate Veteran is incarcerated and more than 6 months from release date Veteran is not eligible for VHA healthcare Other specify Use the instructions below to complete the form General VJO Entry Form HOMES Episode Start Date Automatically filled based on information collected in HOMES cannot be edited Lead Case Manager n a in Phase 1 of HOMES Automatically filled based on information collected in HOMES cannot be edited Program Entry Date Automatically filled based on information collected in HOMES cannot be edited Primary VAMC Automatically filled based on information collected in
19. VI Employment and Income Assessment Form or disease severe asthma diabetes arthritis related conditions including arthritis rheumatoid arthritis gout lupus or fibromyalgia adult onset cognitive impairments including traumatic brain injury post traumatic distress syndrome dementia and other cognitive related conditions severe headache migraine cancer chronic bronchitis liver condition stroke or emphysema If the response to chronic health condition is yes the chronic health condition must be documented in the Veteran s records Documentation includes written verification from a state licensed professional such as a medical service provider or a health care provider the Social Security Administration or the receipt of a disability check i e SSDI check or VA disability benefit check 37 Do you use tobacco products Select the response from the drop down list that best reflects the Veteran s current use of tobacco products 38 In the past 30 days how many days did you drink alcohol Enter the number of days the Veteran consumed alcohol during the past 30 days Declined Omitted If the Veteran declined to answer or the interviewer omitted the question enter N 39 In the past 30 days how many days did you have at least 5 drinks male or at least 4 drinks female Enter the number of days the Veteran consumed at least five drinks for a male or at least four drinks for a f
20. 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arrangements made 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider ce 4 Veteran s treatment has been arranged with both non VA and VA provider 16 Drug problems 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arrangements made 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider GE 4 Veteran s treatment has been arranged with both non VA and VA provider 17 Mental health problems other than drug or alcohol 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arrangements made 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider sep a fe 4 Veteran s treatment has been arranged with both non VA and VA provider 18 Medical problems O 0 Nota problem area for this veteran 1 Problem area for this Veteran but no treatment arrangements made 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider 19 Social and recreational deficits 0 Nota problem area for this veteran O 1 Problem a
21. 1 Veteran s Name Automatically filled based on the Veteran information can only be edited by NEPEC 2 Social Security Number Automatically filled based on the Veteran information can only be edited by NEPEC 3 Date of Birth Automatically filled based on the Veteran information can only be edited by NEPEC II Treatment Court Episode VJO Exit Form Name of Treatment Court Enter the name of the Treatment Court in the field provided if applicable 1 Period Covered by This Report The program entry date is automatically filled based on information collected in HOMES cannot be edited Record the month day and year that the Veteran exited the VJO program in the field provided III Status at Program Exit VJO Exit Form 2 The Veteran ended VJO program involvement because Identify the reason why the Veteran ended VJO program involvement If a Veteran left for multiple reasons record only the primary reason a If the Veteran ended VJO program involvement because of a rule violation what was the most important reason Select the violation from the drop down list that best describes why involvement was ended If selecting response 3 other specify the other rule violation in the field provided 3 What is the Veteran s housing arrangement at program exit Select the response from the drop down list that reflects the Veteran s current housing arrangement at th
22. 16 Psychiatric hospital acute care 17 Hotel or motel paid for without emergency shelter voucher 18 Emergency shelter including hotel or motel paid for with emergency shelter voucher DRAFT LAST UPDATED APRIL 19 2011 154 21 22 VA Homeless Operations Management and Evaluation System HOMES User Manual 19 Prison jail 20 Place not meant for habitation outdoors automobile truck boat 21 Don t know What is the zip code of that location Code N in 1 space if unknown Is the Veteran living with others at that location L 0 No O 1 Yes LI 99 Case manager omitted item If 20 no or Case Manager omitted item skip to item 21 If yes does the household include a spouse significant other O 0 No Dl 1 Yes LU 99 Case manager omitted item b children under 18 list number c related adults list number d unrelated adults list number V EMPLOYMENT AND INCOME STATUS Which best describes the Veteran s employment pattern in the last 30 days H 0 Full time 40 hrs wk O 6 Military Service O 1 Full time irregular O 7 Retired disability O 2 Part time regular hours O 8 Unemployed O 3 Part time irregular day work O 9 Controlled environment e g hospital prison O 4 VA CWT or other vocational training program 99 Case manager omitted item O 5 Student Did the Veteran receive any money during the past 30 days a EO Yes LI 99 Case manager omitted item If 22 no or Ca
23. 690 Birth HOMES ID Edit Veteran Edit Veteran Contact Information Search for Another Veteran Thomas First Name John SSN 123045678 ssessment Inta orms Entered Date of Assessment Primary VAMC Secondary VAMC Homeless Program Referrals Edit Form View Form f 642 04 10 2012 642 HUD VASH HCHV CM VJO Edit Form View Form Supplemental Referral Forms Entered Date of Assessment Date of Referral Primary VAMC Secondary VAMC Homeless Program Referrals Edit Form 42 642 04 10 2011 04 13 2011 6 HUD VASH GPD HCRV Edit Form View Form Add Supplemental Referral s Residential Program Forms Entered No Residential program forms entered Add Residential Program Entry form HCHV Program Forms Entered No HCHV program forms entered Add HCHV Program Entry form HCRV Program Forms Entered No HCRV program forms entered Add HCRV Entry form VJO En Exit Forms Entered HCRV Entry Form HOMES Episode Start Date 04 10 2011 Primary VAMC 642 Lead Case Manager N A Secondary VAMC 642 Staff Login First and Last Name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed mm dd yy I Veteran Information 1 Veteran s name last name first name as John 2 Social Security Number 3 Date Of Birth 5 Date of program entry decision mm dd yy If the Veteran did not enter the HCRV program answer items 6 and 7 only do not complete 8 25
24. II Pre Engagement Screening Assessment Form May the Pre Engagement Screening be skipped Select a response from the drop down list to indicate whether the pre engagement screening will be skipped for the Veteran YES The Pre Engagement screening may be skipped if the Veteran is already engaged in services NO If no answer item 5 5 Does the Veteran want assistance with any of the following areas For items 5a g select the response that accurately reflects the Veteran s needs a Housing Indicate whether the Veteran is currently homeless by selecting the appropriate response from the drop down list b Financial Hardship Indicate whether the Veteran is currently experiencing financial hardships by selecting the appropriate response from the drop down list c Legal Indicate whether the Veteran currently requires legal assistance by selecting the appropriate response from the drop down list d Access to Healthcare Indicate whether the Veteran currently requires access to healthcare immediate and or long term by selecting the appropriate response from the drop down list e Mental Health Concerns and Substance Abuse Indicate whether the Veteran currently has mental health concerns and or abuses substances by selecting the appropriate response from the drop down list f Self Endangerment Indicate whether the Veteran is currently at risk of self endangerment by selecting the appropriate response from the drop down list
25. Staff Email Matthew Berman va gov Level of Access Access to Add all Programs VA Site Code 04 642 PHILADELPHIA Bg Select from options below 1 Add Edit Veteran s and Form s Operational Reports 1 List of Veterans Referred 2 List of Veterans declined Program Entry 3 List of Veterans Transferred Management Reports 1 Coming Soon Reference and Resource Material 1 Assessment Table of Equivalent Military Ranks 2 Assessment Scoring Guide 3 HUD VASH CMR Scoring Guide for Alcohol Use Assessment 4 HUD VASH CMR Scoring Guide for Drug Use Assessment 5 Inquiries to National Homeless Center 6 Technical Questions VSSC Help Desk Recommended screen resolution is a minimum of 1024 x 768 Instructions for navigating the system can be found in the following sections DRAFT LAST UPDATED APRIL 19 2011 12 VA Homeless Operations Management and Evaluation System HOMES User Manual B Guidelines for Navigating the System and Entering Data 1 Navigating within Forms Users may navigate through individual forms using the mouse or computer keyboard To use the mouse select an item by clicking directly on it To use the keyboard press the TAB key to advance to the next item and the Shift TAB keys to return to the previous item Note that in Internet Explorer the BACKSPACE key is a shortcut for the Back button which returns the user to the previous screen If the user hits the BACKS
26. VA Homeless Operations Management and Evaluation System HOMES User Manual IX Referral Plans Assessment Form 72 Non VA Detoxification Services Indicate whether a referral has been made 73 Non VA Mental Health or Substance Abuse Services Indicate whether a referral has been made X Interviewer Information Assessment Form 74 Main Program Affiliation of Interviewer Indicate the main program affiliation of the interviewer by selecting a response from the drop down list If item 7 other is selected specify the VA affiliation in the field provided 75 How was contact for this interview initiated Select the response from the drop down list that indicates how contact was initiated for the interview If item 27 other is selected specify the non VA contact in the field provided Always give the interviewer credit for outreach when Veterans are seen outside of the medical center For example Veterans seen in the shelter including Veterans pointed out to clinicians by shelter staff should be recorded as outreach For information on how to submit forms please reference Section II B 3 59 VA medical services No 60 VA vocational rehabilitation programs including VA CWT SE No VBA Services 61 Disability compensation No 62 Pension benefits No 63 Education No 64 Loan guaranty No 65 Vocational rehabilitation and employment No 66 Insurance No Non VA services 67 Basic s
27. g Civilian Adjustment Indicate whether the Veteran is currently having difficulty with the adjustment to civilian life by selecting the appropriate response from the drop down list DRAFT LAST UPDATED APRIL 19 2011 22 VA Homeless Operations Management and Evaluation System HOMES User Manual II Pre Engagement Screening Assessment Form 6 Will the Assessment interview be completed Select the response from the drop down list that indicates whether the Assessment interview will be completed for the Veteran YES If the Assessment will be completed respond to item 6c d NO If the Assessment will not be completed respond to items 6a b a If no please indicate main reason Select the response from the drop down list that best reflects why the Assessment interview will not be completed at this time for the Veteran b If no are immediate Non VA Homeless services required Select the response from the drop down list that corresponds with whether non VA homeless services are required for the Veteran c If yes which Non VA homeless service is required For items cl 8 indicate the services that would be satisfy the Veteran s current needs 1 Non VA Emergency Room Select the response from the drop down list that best reflects the Veteran s need for non VA emergency room services 2 Non VA Detoxification Services Select the response from the drop down list that best reflects the Veteran s need for non VA
28. Automatically filled based on information collected in HOMES cannot be edited Secondary VAMC Automatically filled based on information collected in HOMES cannot be edited Most Recent Monthly Status Report Date Automatically filled based on information collected in HOMES cannot be edited Staff Login Automatically filled based on the user information cannot be edited DRAFT LAST UPDATED APRIL 19 2011 56 VA Homeless Operations Management and Evaluation System HOMES User Manual General HUD VASH Exit Form VA Site Automatically filled based on the user information cannot be edited Date This Form Completed Automatically filled based on the current date cannot be edited I Veteran Identification HUD VASH Exit Form 1 Veteran s Name Automatically filled based on the Veteran record can only be edited by NEPEC 2 Social Security Number Automatically filled based on the Veteran record can only be edited by NEPEC 3 Date of Birth Automatically filled based on the Veteran record can only be edited by NEPEC II Reasons for Program Exit HUD VASH Exit Form 4 Date the Veteran Exited the HUD VASH Program Record the month date and year that the Veteran exited the HUD VASH program in the field provided The Program Exit Date is the date on which the decision was made to end HUD VASH case management for this Veteran
29. Do not know Veteran s status with respect to non VA financial benefits Did the Veteran receive any money in the 30 days prior to program exit If 13 no or Case manager omitted item skip to item 14 If 13 yes list the average monthly amount in each category L 0 No O 1 Yes LI 99 Case manager omitted item Please round to whole dollar amounts and note comma placement eg 452 76 should be entered as _ _ 453 00 a Employment include CWT SE Oo he 0 b Compensation for service connected psychiatric condition e a OO c Compensation for other service connected condition n pp Se 20 d Non service connected pension __ _ 00 e Retirement income from Social Security Poo a O20 f Pension from a former job A oe ee Ot 0 g Supplemental Security Income SSI s 0 h Social Security Disability Income SSDI oF E OO i Private disability insurance _ gt _ j Worker s compensation het ee 0 0 k Unemployment insurance O OD Temporary Assistance for Needy Families TANF or similar local program tl 0 0 m General Assistance GA or similar local program A E A A n Child support ___ 0 0 o Alimony or other spousal support A 0 0 p All other sources do not include food stamps _ _ ___ 0 0 Total Amount Total income calculated in HOMES Did the Veteran receive any non cash benefits in the 30 days prior to program exit z ee Yes If 14 no or Case Manag
30. Do you need assistance with claims for disability benefits L 99 Interviewer omitted item Are you unemployed c Legal Examples LI 0 No Do you need help with a legal problem such as civil criminal child support and or 1 Yes custody suspended driver license probation or parole issues L 98 Veteran declined to answer L 99 Interviewer omitted item d Access to Healthcare Examples LI 0 No Are you in need of immediate medical attention or need a referral for a medical O 1 Yes appointment L 98 Veteran declined to answer Do you want VA healthcare but are currently not enrolled for it L 99 Interviewer omitted item e Mental Health Concerns and Substance Abuse Examples O 0 No Do you often feel anxious or depressed O 1 Yes Have you felt you wanted or needed to cut down on your drinking or drug use in L 98 Veteran declined to answer the last year O 99 Interviewer omitted item DRAFT LAST UPDATED APRIL 19 2011 136 VA Homeless Operations Management and Evaluation System HOMES User Manual f Self Endangerment Examples 0 No Do you currently have thoughts of hurting yourself in some way O 1 Yes L 98 Veteran declined to answer O 99 Interviewer omitted item g Civilian Adjustment Examples Are you having difficulty adjusting to civilian life since being discharged from military service L 0 No O 1 Yes L 98 Veteran declined to answer
31. HOMES User Manual Veteran is currently in HUDVASH Program At site 642 Assessment Intake Forms Entered Date of Assessment Primary VAMC PREIS VAMC Homeless Program Referrals EN 04 12 2011 HuD VASH HCHV CM CWT TR v30 Edit Form Supplemental Referral Forms Entered No Supplemental Referral forms entered Add Supplemental Referrals tial ri Or ter i Primary Secondary D Edit Entry View Entry Edit Exit View Exit VAMC VAMC Form orm Add Form Form Form 642 642 04 12 2011 eat Entry Form View Entry Form 04 13 2011 Form Edit Exit Form View Exit Form HCHV Program Forms Entered Date of Assessment Primary VAMC Secondary VAMC VAMC Entry Date Edit Entry Form View Entry Form Exit Date Add Form Edit Exit Form View Exit Form 04 12 2011 04 13 2011 Edit Entry Form View Entry Form 04 13 2011 Add Exit Form Edit Exit Form View Exit Form HCRV Program Forms Entered No HCRV program forms entered VJO Entry Exit Forms Entered Date of Primary Secondary Edit Entry View Entry Add Progress Edit Exit jew Exit Assessment VAMC VAMC Form Form Form Add Form Form m Edit Entry View Entry Add Progress 04 13 2011 Add Exit Edit Exit View Exit Form Form Form y Form Form Form 642 642 09 22 2053 04 12 2011 VJO Progress Reports Entered No VJO Progress Reports entered HUDVASH Entry Exit Forms Entered Date of Primary it Entry View Entry Edit Exit View Exit Assessment VAMC F
32. agencies or enter into contracts with private companies or nonprofit organizations that provide work opportunities for Veterans As part of the program Veterans receive wages commensurate with those for similar work in the community with the goal that ongoing work experience and earnings help Veterans to become self sufficient Other MH RRTP Residential Treatment e g SA RRTP PTSD RRTP General RRTP A MH RRTP provides residential rehabilitative and clinical care to eligible Veterans who have a wide range of problems illnesses or rehabilitative care needs including mental health SUD co morbid medical homelessness vocational educational or social MH RRTP includes Domiciliary Residential Rehabilitation Treatment Programs DRRTP Domiciliary Care for Homeless Veterans DCHV Health Maintenance Domiciliary General Domiciliary General Dom or Psychosocial Residential Rehabilitation Treatment Programs PRRTP Domiciliary PTSD Dom PTSD or Post Traumatic Stress Disorder Residential Rehabilitation Treatment Program PTSD RRTP Domiciliary SA Dom SA or Substance Abuse Residential Rehabilitation Treatment Program SARRTP or CWT TR Congressional Research Services Veterans and Homelessness March 19 2010 3 Congressional Research Services Veterans and Homelessness March 19 2010 VHA Handbook 1162 02 Mental Health Residential Rehabilitation Treatment Program MH RRTP December 22 2010 http www va gov vhapublications ViewPub
33. income as adjusted and occupying permanent housing e g residing in permanent housing scheduled to become a resident of permanent housing within 90 days or having exited permanent housing within the previous 90 days to seek other preferable housing Rapid Re housing The Homeless Prevention and Rapid Re Housing Program HPRP was established by the American Recovery and Reinvestment Act to support homelessness prevention and rapid re housing assistance Financial assistance includes payment of rent or utilities moving costs security deposits and services such as landlord outreach landlord tenant mediation and housing based case management services VA Treatment Services VA Emergency Room Emergency room services can be performed for medical or psychiatric issues VA Detoxification Services Detoxification services support sobriety and provide Veterans with drug and alcohol rehabilitation programs VA Mental Health or Substance Abuse Services Mental health or substance abuse services focus on treatment and rehabilitation Hospitalization may also be part of the treatment regimen VA Medical Services Medical services are offered as part of inpatient and outpatient treatments VA Vocational Rehabilitation Programs including VA CWT SE Vocational rehabilitation programs such as CWT SE help Veterans gain employment Jobs offer skills training and development so that Veterans may become self sufficient CWT SE
34. night 21 In which of the above locations did you sleep last night Use the letter codes a t to indicate where the Veteran slept last night i e the night before the Assessment was completed Declined If the Veteran declined to answer enter 98 Omitted If the interviewer omitted the item enter 99 22 What is the zip code of that location Record the five digit zip code of where the Veteran slept last night in the field provided i e the code indicated in item 12 If the zip code is unknown enter N The zip code is used to identify the former geographic location of Veterans experiencing homelessness or current geographic location of Veterans who are at risk of homelessness 23 Are you living with others at that location Determine whether the Veteran is living with others at the location where the Veteran slept last night Select the response from the drop down list that accurately represents the Veteran s answer YES If the Veteran is living with others answer items 23a d If yes does the household include For items 23a d select a response from the drop down list that best reflects the Veteran s current living situation 23a Spouse Significant Other Select a response from the drop down list that indicates whether DRAFT LAST UPDATED APRIL 19 2011 27 VA Homeless Operations Management and Evaluation System HOMES User Manual V Living Situation Assessme
35. 10 Non VA transitional housing for homeless persons 11 Safe Haven special transitional supportive housing or drop in supportive service center for homeless SMI individuals 12 VA Mental Health Residential Rehabilitation Program MH RATP all types DCHV CWT TR SA RRTP PTSD RRTP General RRTP 13 VA contracted residential treatment programs ATU HWH or HCHV contract 14 Non VA residential treatment program 15 Non psychiatric hospital acute care 16 Psychiatric hospital acute care 17 Hotel or motel paid for without emergency shelter voucher 18 Emergency shelter including hotel or motel paid for with emergency shelter voucher 19 Prison jail 20 Place not meant for habitation outdoors automobile truck boat 21 Don t know a st 0 Ps et Dt tt ag gs a a What is the zip code of that location Code N in 1 space if unknown Housing stability How would you describe the Veteran s housing situation at program exit 1 Literally homeless 2 Imminent risk of losing housing 3 Unstably housed at risk of losing housing 4 Stably housed 5 Don t know a i With whom will the Veteran be living at program exit 0 No residence 1 Alone DRAFT LAST UPDATED APRIL 19 2011 172 7 10 VA Homeless Operations Management and Evaluation System HOMES User Manual a E Ee es 2 2 With spouse partner or children 3 With parents with siblings or with other family 4 With friends 5 W
36. 19 2011 101 VA Homeless Operations Management and Evaluation System HOMES User Manual TIT Current Arrest Court Involvement VJO Entry Form 20 What will the Veteran s status be upon release including after release from corrections halfway house or work release facility Select the response from the drop down list that reflects what the Veteran s status will be upon release including after release from corrections halfway house or work lease facility 21 By the time of the Veteran s release date how long will the current incarceration be including Indicate in the field provided how long the current incarceration will be by the time of the Veteran s release date If the period of incarceration is less than a month use the following codes for 0 14 days enter 0 months for 15 30 days enter 1 month If the value is greater than 11 months please enter it in years and months Ex 12 months 1 year 0 months 15 months 1 year 3 months a Total Time in Jail For item 20a enter in the field provided the total time that was served in jail for the current incarceration Use years and months enter all zeros for none b Total Time in Prison For item 20b enter in the field provided the total time that was served in prison for the current incarceration Use years and months enter all zeros for none IV Pre Arrest Court Involvement VJO Entry Form 22 Before the arrest on date of arrest for the current
37. A e Community agencies not including PHA A f PHA 9 VA health care providers R _ h Non VA health care providers i Landlords face to face visits and telephone ee et How many face to face visits with the Veteran occurred in the Veteran s apartment during the past 30 days IV RESIDENTIAL STATUS What was the Veteran s housing arrangement the last time you had contact with him her during this reporting period Housing owned by Veteran no ongoing housing subsidy Housing owned by Veteran with ongoing housing subsidy Housing rented by Veteran no ongoing housing subsidy Housing rented by Veteran with HUD VASH voucher Housing rented by Veteran with non HUD VASH housing subsidy Permanent housing for formerly homeless persons such as SHP S C or SRO MOD Rehab Staying or living in family member s room apartment or house ON DOA FWD Staying or living in friend s room apartment or house 9 GPD transitional housing 10 Non VA transitional housing for homeless persons 11 Safe Haven special transitional supportive housing or drop in supportive service center for homeless SMI individuals 12 VA Mental Health Residential Rehabilitation Program WH RRTP all types DCHV CWT TR SA RRTP PTSD RRTP General RRTP 13 VA contracted residential treatment programs ATU HWH or HCHV contract 14 Non VA residential treatment program 15 Non psychiatric hospital acute care
38. A HOMES ID is randomly generated and assigned to the Veteran and additional information may now be entered into the system DRAFT LAST UPDATED APRIL 19 2011 15 VA Homeless Operations Management and Evaluation System HOMES User Manual You are currently logged on to the VA HOMES Staff Name Matthew Berman Staff Login DVA vacobermam Staff Email Matthew Berman va gov Level of Access Access to Add all Programs VA site Code WIEN y Search by SSN No Dashes OR L Search by First few letters of Last name or llaskdif First Name OR lace 2 Search by Homes Veteran ID SSN OR Name not found in the system please click on Add new button to add a new Veteran recor Search for Veteran Clear Add New Veteran Add Edit Veteran Homes Veteran ID 0 Last Name First Name Middle Initial Date of Birth E Sex Mj E SSN Type Full SSN Reported M 758932635 Add New Veteran Search for another Veteran Follow the instructions for each item below to create a detailed and accurate Veteran record Name The Veteran s first middle and last name and suffix should be collected to support the unique identification of each person served This information is collected at intake through an interview or forms completed by the Veteran Clinicians should seek to obtain legal names only and avoid aliases or nicknames Enter all available Veteran information into the fields provided
39. Contract Residential Treatment Program Domiciliary Care for Homeless Veterans DRAFT LAST UPDATED APRIL 19 2011 73 VA Homeless Operations Management and Evaluation System HOMES User Manual General Residential Treatment Entry Form Staff Login Automatically filled based on the user information cannot be edited VA Site Automatically filled based on the user information cannot be edited Last Name Automatically filled based on the Veteran information can only be edited by NEPEC First Name Automatically filled based on the Veteran information can only be edited by NEPEC Social Security Number Automatically filled based on the Veteran information can only be edited by NEPEC Date of Birth Automatically filled based on the Veteran information can only be edited by NEPEC HOMES Episode Start Date Automatically filled based on information collected in HOMES cannot be edited Lead Case Manager n a in Phase 1 of HOMES Automatically filled based on information collected in HOMES cannot be edited Primary VAMC Automatically filled based on information collected in HOMES cannot be edited Secondary VAMC Automatically filled based on information collected in HOMES cannot be edited 1 Date of screening decision for residential entry Enter the date of the screening decision for residential entry in the field pr
40. Form 2 The Veteran ended residential treatment because Select from the drop down list the most important reason why the Residential Treatment DRAFT LAST UPDATED APRIL 19 2011 78 VA Homeless Operations Management and Evaluation System HOMES User Manual III Status at Program Exit Residential Treatment Exit Form program was ended for this Veteran If a Veteran left for multiple reasons record only the primary reason 2a If the Veteran ended residential treatment because of a rule violation what was the most important reason Select the most important reason from the drop down list 3 What is the Veteran s housing arrangement at program exit Select the response from the drop down list that reflects the Veteran s current housing arrangement at the time of program exit 4 What is the zip code of that location Record in the field provided the five digit zip code of the location where the Veteran lives at the time of program exit If the zip code is unknown enter N 5 Housing Stability How would you describe the Veteran s housing situation at program exit Determine whether the Veteran is literally homeless imminently losing their housing unstably housed and at risk of losing their housing or stably housed Select the corresponding response from the drop down list Examples of Veterans who are literally homeless include those who are e Living in pla
41. Forms Entered Date of Assessment Date of Referral Primary VAMC Secondary VAMC Homeless Program Referrals Edit Form 04 10 2011 04 13 2011 642 642 HUD VASH GPD HCRV Edit Form View Form Add Supplemental Referral s Residential Program Forms Entered No Residential program forms entered Add Residential Program Entry form HCHV Program Forms Entered No HCHV program forms entered Add HCHV Program Entry form HCRV Program Forms Entered No HCRV program forms entered Add HCRV Entry form VJO Entry Exit Forms Entered DRAFT LAST UPDATED APRIL 19 2011 90 VA Homeless Operations Management and Evaluation System HOMES User Manual HCRV Exit Form HOMES Episode Start Date 04 12 2011 Primary VAMC 642 Lead Case Manager N A Secondary VAMC 642 Program Entry Date 04 12 2011 Staff Login First and Last Name Matthew Berman VA Site 3 digit VAMC code plus 2 digit suffix if any 642 Date this form completed mm dd yy 13 2011 1 Veteran s name last name first initial John Smith 2 Social Security Number 1987654321 3 Date Of Birth 03 04 1980 II Reasons for Program Exit 5 Which is the most important reason why the Veteran ended involvement in HCRV Veteran accomplished his her goals and or obtained access to services and no longer has a need for this program Veteran ending services at this program but will continue at another VA medical center Veteran did not comp
42. HO FH HO OH o Alimony or other spousal support Y E ri y A p All other sources do not include food stamps el lo lo lo lol lol lol lol lol lol lol lol lol lo lo lo Total Amount Total income calculated in HOMES L 0 No L 1 Yes Did the Veteran receive any non cash benefits in the 30 days prior to program exit L 99 VJO Specialist omitted item If 11 no or VJO Specialist omitted item skip to item 12 If 11 yes indicate type s of benefits received a Medicaid health insurance program or similar local program 0 No L 1 Yes b Medicare health insurance program or similar local program LI 0 No 1 Yes c Temporary Rental Assistance LI 0 No L 1 Yes d Homeless Prevention and Rapid Re housing Program HPRP Funds LI 0 No L 1 Yes e Veteran Service Organizations LI 0 No L 1 Yes f State Children s Health Insurance Program or similar local program LI 0 No 1 Yes g Supplemental Nutrition Assistance Program SNAP or Food Stamps L 0 No 1 Yes h Special Supplemental Nutrition Program for Women Infants and Children WIC L 0 No U 1 Yes i Temporary Assistance for Needy Families TANF or similar local program Child Care Services L 0 No U 1 Yes j Temporary Assistance for Needy Families TANF or similar local program Transportation Services L 0 No U 1 Yes k Other TANF funded services LI 0 No L 1 Y
43. HOMES DRAFT LAST UPDATED APRIL 19 2011 135 VA Site 3 digit VAMC code plus 2 digit suffix if any VA Homeless Operations Management and Evaluation System HOMES User Manual Appendix F Assessment Form Worksheet Staff member completing this form first and last name Date of assessment MIM AOV VY ccceeece cece eee eeenee teen enaes I VETERAN IDENTIFICATION Veteran s name last name first initial please print Social Security NUMbe r occ eee e ee eeees Date of birth mm dd yy 0ocoococccccoccnncccnncn nono ncn cnn ON 1 Male 2 Female ll PRE ENGAGEMENT SCREENING May the Pre engagement Screening be skipped If yes skip to item 6 O 0 No O 1 Yes Does the Veteran want assistance with any of the following areas answer the category as yes if the Veteran answers yes to any of the informal probe questions a Housing Examples O 0 No Are you currently homeless O 1 Yes Are you currently living with a family member or friend until you can afford or find a place of your own Have you received an eviction notice or request to leave your current housing L 98 Veteran declined to answer L 99 Interviewer omitted item b Financial Hardship Examples O 0 No Do you need basic assistance like food and clothing O 1 Yes Are you unable to pay your bills O 98 Veteran declined to answer
44. HOMES cannot be edited Secondary VAMC Automatically filled based on information collected in HOMES cannot be edited Staff Login Automatically filled based on the user information cannot be edited VA Site Automatically filled based on the user information cannot be edited DRAFT LAST UPDATED APRIL 19 2011 98 VA Homeless Operations Management and Evaluation System HOMES User Manual I Veteran Information VJO Entry Form 1 Veteran s Name Automatically filled based on the Veteran information can only be edited by NEPEC 2 Social Security Number Automatically filled based on the Veteran information can only be edited by NEPEC 3 Date of Birth Automatically filled based on the Veteran information can only be edited by NEPEC Date this Form Completed Automatically filled based on the current date cannot be edited 4 Will the Veteran receive VJO services Indicate whether the Veteran will receive VJO services by selecting a response from the drop down list 5 Date of Program Entry Decision Record the month day and year of the VJO program entry decision date in the field provided If the Veteran did not enter the VJO program respond to items 6 and 7a and 7b only do not complete the remainder of the form 6 Select the main reason why Veteran did not Enter the VJO program Select the response from the drop do
45. J Residential Treatment A GPD Program Instructions B DCHV Program Instructions C CWT TR Program Instructions D Residential Treatment Entry Form Worksheet Use this form for Veteran entry into the Grant and Per Diem Program GPD HCHV Contract Residential Treatment Program Domiciliary Care for Homeless Veterans DCHV Program or Compensated Work Therapy Transitional Residence CWT TR program Staff member completing this form first and last name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed MIM AO Vy 4 cccccceceteeeeeeeeenees Veteran s name last name first initial Social Security NUMDTF oooococcoccoconccnnnoncnnconinnnnnnns Date Of birth MmM dWVyy ooocococcoccccccccncnccn cnn co nonnnono 1 Date of screening decision for residential entry mm dd yy 2 Is the Veteran entering a residential treatment program L 0 No 1 Yes If YES complete items 3a amp 3b if NO skip to item 4 3a Date of program entry mm dd yy a A EEES ne 3b Residential program L 1 Grant and Per Diem GPD 2 HCHV contract residential treatment program including HCHV Emergency Housing 3 Domiciliary Care for Homeless Veterans DCHV Program 4 Compensated Work Therapy Transitional Residence CWT TR Program 5 Safe Haven special transitional supportive housing or drop in supportive service center for homeles
46. L 0 No J 1 Yes c Are there arrearage or delinquency problems with any current child support orders O 0 No O 1 Yes d If 16c is yes what is the amount owed AA _ Is the Veteran currently in jail If no skip to item 22 O 0 No 1 Yes 0 DRAFT LAST UPDATED APRIL 19 2011 184 0 VA Homeless Operations Management and Evaluation System HOMES User Manual Answer 18 21 only if item 17 is coded YES Does the Veteran have a definite release date 0 No 1 Yes a IF YES what is the definite release date mm dd yy b IF NO what is the earliest date he or she is eligible for release or the earliest expected date of release mm dd yy County and state being released to after court commitment completed County State abbreviate 20 What will the Veteran s status be upon release including after release from corrections halfway house or work release facility 1 under parole or post custody supervision in the community 2 no parole or post custody supervision in the community O 3 unknown or yet to be determined By the time of the Veteran s release date how long will the current incarceration be including if value is less than a month enter 0 months for durations 0 14 days enter 1 month for durations 15 30 days a total time in jail if a portion of the current incarceration was served in jail in year
47. SSI Supplemental Security Income SSN Social Security Number TANF Temporary Assistance for Needy Families TR Transitional Residences VA Veterans Affairs DRAFT LAST UPDATED APRIL 19 2011 127 VA Homeless Operations Management and Evaluation System HOMES User Manual Acronym Guide Acronym Term VAMC Veterans Affairs Medical Center VISN Veterans Integrated Service Network VJO Veterans Justice Outreach VR amp E Vocational Rehabilitation and Employment VSSC Veterans Support Services Center WIC Women Infants and Children DRAFT LAST UPDATED APRIL 19 2011 128 VA Homeless Operations Management and Evaluation System HOMES User Manual Appendix D Referral Program Descriptions Case Management Services HUD VASH Case Management Services The HUD VASH program provides permanent supported housing services to Veterans who are literally homeless and have a psychiatric or substance abuse disorder HUD VASH case management is intensive especially early in a Veteran s involvement with the program The ultimate goal of the program is to offer the homeless Veteran an opportunity to rejoin the mainstream of community life to the fullest extent possible HCHV Case Management Services The HCHV program is primarily an outreach program that serves Veterans who do not visit VAMCs on their own Case management services are targeted at homeless mentally ill Veterans and may include refe
48. VA O 6 Veteran currently receives peer support only e g 12 step other recovery groups 11 Mental health problems other than drug or alcohol 0 Nota problem area for this Veteran 3 Veteran currently receives treatment from non VA provider L 1 Veteran s current treatment is unknown O 4 Veteran currently receives treatment from VA L 2 Veteran currently receives no treatment for O 5 Veteran currently receives treatment from both non VA these problems provider and VA O 6 Veteran currently receives peer support only e g 12 step other recovery groups 12 Medical problems L 0 Not a problem area for this Veteran 3 Veteran currently receives treatment from non VA provider O 1 Veteran s current treatment is unknown O 4 Veteran currently receives treatment from VA O 2 Veteran currently receives no treatment for Ol 5 Veteran currently receives treatment from both non VA these problems provider and VA O 6 Veteran currently receives peer support only e g 12 step other recovery groups 13 Social or vocational skill deficits 0 Nota problem area for this Veteran 3 Veteran currently receives treatment from non VA provider 1 Veteran s current treatment is unknown 4 Veteran currently receives treatment from VA 2 Veteran currently receives no treatment for Ol 5 Veteran currently receives treatment from both non VA these problems provider and VA O 6 Veteran currently receives peer support only e g 12 ste
49. VASH Monthly Status Report Form 20 Is the Veteran living with others at that location Select the response from the drop down list that indicates whether the Veteran is living with others at that location V Employment and Income Status HUD VASH Monthly Status Report Form 21 Which best describes the Veteran s employment pattern in the last 30 days Select the response from the drop down list that best describes the Veteran s employment pattern in the last 30 days If the Veteran was employed two weeks and unemployed for two weeks choose his or her most recent employment situation 22 Did the Veteran receive any money during the past 30 days Select the response from the drop down list that best reflects whether the Veteran received any money in the past 30 days 22a p Enter the average amount of money the Veteran received from each of the sources listed in items 22a p during the past 30 days e Include income from CWT or SE in item 30a e Do not include the cash value of food stamps in any category e Do not include income received through a spouse significant other or other household member in any category e Round all figures to the nearest dollar 23 Did the Veteran receive any non cash benefits during the past 30 days Select the response from the drop down list that best reflects whether the Veteran received any non cash benefits during the past 30 days 23a m Indicate whether or not
50. alcohol i g 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider Medical problems 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider Social and recreational deficits 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider Vocational skill deficits a a 188 9 E g 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider DRAFT LAST UPDATED APRIL 19 2011 168 VA Homeless Operations Management and Evaluation System HOMES User Manual Appendix
51. and Employment The Vocational Rehabilitation and Employment VR amp E VetSuccess program assists Veterans with service connected disabilities to prepare for find and keep suitable jobs Veterans are eligible if they have received a discharge that is other than dishonorable have a service connected disability rating of at least 10 or a memorandum rating of 20 from VA and apply for VR amp E VetSuccess services Insurance Veterans may be eligible for a variety of life insurance policies Non VA Services Basic Services Basic services include food clothing transportation etc These services may come from a variety of programs sources Non VA Housing Housing can be offered to Veterans through agencies and programs not affiliated with VA Non VA Social Vocational Assistance Social assistance helps individuals and families become productive members of society by offering a variety of services including vocational assistance Social services can also relate to food housing healthcare and childcare Non VA Income Resources and Non Cash Benefits Grants and other benefits may be available to Veterans through non VA organizations Supplemental Security Income SSI or Social Security Disability Income SSDI Veterans may be eligible for disability benefits paid under SSI or SSDI both of which are Federal programs providing assistance to people with disability benefits U http www vba va gov bln 2 1 pension vetpen htm
52. and to run reports available there The following information and instructions are provided to help customers properly configure their browsers for optimum use If an error message is received when trying to configure your browser settings contact your local Information Resource Management IRM office When using HOMES please ensure that the Internet Explorer IE window is maximized Close other parts of the IE window such as favorites browser history or Search Some links in HOMES will not operate correctly if these other windows are displayed It is important to have a current browser installed on your PC that supports proxy settings such as Microsoft Internet Explorer IE 6 0 or higher It is strongly recommended that customers using earlier versions of IE upgrade to version 6 0 or higher These instructions focus on IE due to its widespread use throughout VHA and because the VSSC web site is viewed with any versions of Netscape that are currently available Note If you currently use VPN to access a VHA server make sure that VPN is connected first If you are using Windows XP please note the highlighted instructions for XP users at the end of this document If there are any questions about the following instructions please send an e mail message to us using this link http klfmenu med va gov FAQ HD_request asp Browser Configuration Instructions for Users Unable to Access Internet Sites Through a Proxy Server M
53. answer yes if the Veteran has a formal relationship with a payee or fiduciary do not count informal financial advisors or assistants 34 In the past 30 days would you say your physical health has been Select the response from the drop down list that best reflects the physical health of the Veteran during the past 30 days 35 How would you describe the health of your teeth and gums Select the response from the drop down list that best reflects the current health of the Veteran s teeth and gums 36 Has a doctor or nurse ever told you that you have any of the following medical conditions a j Select the response from the drop down list that indicates whether the Veteran has each of the medical conditions listed in items 36a j If the Veteran has any medical conditions not listed in a i enter yes for item j other and specify the condition s in the field provided Note A chronic health condition means a diagnosed condition that is more than three months in duration and is either not curable or has residual effects that limit daily living and require adaptation in function or special assistance Examples of chronic health conditions include but are not limited to heart disease including coronary heart disease angina heart attack and any other kind of heart condition DRAFT LAST UPDATED APRIL 19 2011 31 VA Homeless Operations Management and Evaluation System HOMES User Manual
54. based on information collected in HOMES cannot be edited Date This Form Completed Automatically filled based on the current date cannot be edited 1 Will the Veteran receive HCHV case management services Indicate whether or not the Veteran will receive HCHV case management services by selecting a response from the drop down list 2 Date of Program Entry Decision Record the month day and year of the HCHV program entry decision date in the field provided If the Veteran entered the HCHV case management program skip item 3 3 If the Veteran did not enter program Select the response from the drop down list that identifies the reason why the Veteran did not enter HCHV Case Management If selecting response 8 other specify the other reason why the Veteran did not enter the program in the field provided For information on how to submit forms please reference Section II B 3 DRAFT LAST UPDATED APRIL 19 2011 64 VA Homeless Operations Management and Evaluation System HOMES User Manual 2 HCHV Case Management Exit Form a General Instructions Use this form to document Veteran exit from the HCHV Case Management program See Appendix I for the HCHV Case Management Exit Form Worksheet b When to complete and submit the HCHV Case Management Exit Form This form should be completed and submitted as soon as it is determined that the veteran will exit the HCHV Case Management pro
55. click the Security tab at the top 2 Click the Custom Level button at the bottom of the dialog box 3 Reset custom settings to Medium Medium low or Low 4 Click the Reset button 5 Click Yes to the question Are you sure you want to change the security settings for this zone 6 Click OK to exit all dialog boxes that are open Removing Cached Pages In addition to the above it may be necessary to ensure that all cached of the VSSC web site pages have been removed 1 Click Tools then Internet Options then click the General tab at the top 2 In the Browsing History or Temporary Internet Files section depending on which version of IE you are using click the Settings button DRAFT LAST UPDATED APRIL 19 2011 124 VA Homeless Operations Management and Evaluation System HOMES User Manual 3 Check for newer versions of stored pages please be sure Every time I visit the webpage is checked with a green dot 4 Click the View Files button 5 From the Edit menu choose Select All 6 Depending on the version of IE Right mouse click and choose Delete or use the delete button on the keyboard Click Yes to the question Are you sure you want to delete the selected cookies Entering Your UserID Password Domain Information Some sites have special network configurations that prevent users from being able to reconfigure t
56. come over j When case managers can come to see him her k Whether to participate in services to stay in the place where he or she lives e g groups NA AA Whether or not to attend religious services to stay in the place where he she lives m The food that he she purchases n Whether to lock the room door o To come and go at any time without having to notify people p When to cook meals and what he she can eat q Whether he she lives in a building where other clients live DRAFT LAST UPDATED APRIL 19 2011 152 VA Homeless Operations Management and Evaluation System HOMES User Manual C HUD VASH Monthly Status Report Form Worksheet Staff member completing this form first and last name VA Site 3 digit VAMC code plus 2 digit suffix if any IMPORTANT NOTE Report sequence number and date range for this report are provided on the forms due list that is posted on NEPEC s secure website THIS INFORMATION WILL ALSO BE AUTOMATICALLY FILLED IN HOMES Please make sure that this information matches both the forms due list and HOMES Contact NEPEC with any questions Report Sequence Number ccc eeeeeceeeeeeeee ae eeeeeeereneenetnaes Date Range Covered in this Report Start of Reporting Period mm dd yy c ceceeeeeeetee es End of Reporting Period mm dd yy assesseer This MSR should only include information
57. databases by clicking on the corresponding button Upon selecting a database a new Internet Explorer window will open DRAFT LAST UPDATED APRIL 19 2011 17 VA Homeless Operations Management and Evaluation System HOMES User Manual In the first tab open the drop down list using the mouse and select a VISN by checking the box adjacent to the VISN number Only one VISN may be selected Using the same process select the VAMC s from the drop down list More than one may be selected Click the View Report button to view results of the search Navigate the database using the tools displayed above the database Use the arrow buttons to change pages To search for a Veteran enter the Veteran s name or SSN in the text field Additional options also include saving and exporting data and printing the report Within the database seven Veteran data categories are included These categories are Veteran ID Veteran Name SSN DOB VA Site Dt date Referred and Program Referred To Use the arrows at the next to the category name to sort information alphabetically or numerically Click a Veteran s name to change his or her status DRAFT LAST UPDATED APRIL 19 2011 18 VA Homeless Operations Management and Evaluation System HOMES User Manual Management Reports DRAFT LAST UPDATED APRIL 19 2011 19 VA Homeless Operations Management and Evaluation System HOMES User Manual D Assessment For
58. disruptive behavior and housing problems Problems have persisted for at least one month Abuse 3 Meets criteria for use without impairment plus at least three of the following greater amounts or intervals of use than intended much of time used obtaining or using substance frequent intoxication or withdrawal interferes with other activities important activities given up because of alcohol use continued use despite knowledge of substance related problems marked tolerance characteristic withdrawal symptoms alcohol drugs taken to relieve or avoid withdrawal symptoms For example drinking binges and preoccupation with alcohol have caused client to drop out of job training and non alcohol social activities Dependence 4 Meets criteria for dependence plus related problems are so severe that they make non institutional living difficult For example constant drinking leads to disruptive behavior and inability to pay rent so that client is frequently reported to police and seeking hospitalization Dependence With Institutionalization 5 Scoring Guide for Drug Use Assessment DRAFT LAST UPDATED APRIL 19 2011 158 VA Homeless Operations Management and Evaluation System HOMES User Manual Please rate your client s use of drugs during the last 30 days according to the following scale If the person is in an institution the reporting interval is the time period prior to institutionalization You should w
59. domestic violence situation Veterans who are imminently losing their housing include those who e Are currently housed and not literally homeless e Are imminently losing their housing whether permanent or temporary e Have no subsequent housing options identified and e Lack the resources or support networks needed to retain current housing or obtain temporary or permanent housing Examples of imminent housing loss include e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing from others and rooms in hotels or motels not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Being discharged from a hospital or other institution e Living in housing that has been condemned by housing officials and is no longer considered meant for human habitation Veterans who are unstably housed and at risk of losing their housing include those who e Are currently housed and not literally homeless or imminently losing their housing DRAFT LAST UPDATED APRIL 19 2011 93 VA Homeless Operations Management and Evaluation System HOMES User Manual HI Status at Program Exit HCRV Exit Form e Are experiencing housing instability but may have one or more other temporary housing options and e Lack the resources or support networks to retain or obtain permanent housing Housing instability may be evid
60. eee cos Secondary VAMC Entry Date Edit Entry Form Exit Date Edit Exit Form 04 12 2011 642 04 13 2011 Edit Entry Form View Entry Form 04 13 2011 Add Exit Form Edit Exit Form View Exit Form HCRV Program Forms Entered No HCRV program forms entered VJO Entry Exit Forms Entered Date of Primary Secondary Entry pate Edit Entry View Entry Add Progress View Exit Entry Date Assessment VAMC VAMC Form Form Form Form Edit Entry View Entry Add Progress pear Add Exit Edit Exit View Exit 04 13 2011 Form Form Form Form Form Form 04 12 2011 642 09 12 2011 VJO Progress Reports Entered No VJO Progress Reports entered HUDVASH Entry Exit Forms Entered Date of Primary Secondary Entry Date par E ver Entry Exit Edit Exit View Exit Assessment Add MSR Date Form Form Add MSR bas gt Form 04 12 2011 642 04 12 2011 Edit Entry Form View Entry Form Edit Exit Form View Exit Form DRAFT LAST UPDATED APRIL 19 2011 55 VA Homeless Operations Management and Evaluation System HOMES User Manual HUD VASH Exit Form HOMES Episode Start Date 04 10 2011 Primary VAMC 642 Lead Case Manager N A Secondary VAMC 642 Program Entry Date 04 11 2011 Most Recent Monthly Status Report Date 4 13 2011 Staff Login first and last name Matthew Berman VA Site 3 digit VAMC code plus 2 digit suffix if any 642 Date this form completed mm dd yy 4 43 2011 I Veteran Information 1 V
61. filled based on information collected in HOMES cannot be edited Program Entry Date Automatically filled based on information collect in HOMES cannot be edited Primary VAMC Automatically filled based on information collected in HOMES cannot be edited Secondary VAMC Automatically filled based on information collected in HOMES cannot be edited 1 Period Covered by Report The program entry date is automatically filled based on information collected in HOMES cannot be edited Record the month day and year of the program exit date in the field provided la Billable Days LOS and Cost of Care For item la enter the number of unpaid days billable days LOS and Cost of treatment round to whole dollar amounts in the field provided 1b CWT TR Work Earnings Rent Summary For item 1b enter the number of hours and dollar amounts in the fields provided Hours worked Enter the total hours worked in CWT since entry to the TR Enter the approximate total hours worked in competitive employment since entry to the TR Earnings Enter the total net earnings from CWT since entry to the TR round to whole dollar amounts Enter the total net earnings from competitive employment since entry to the TR round to whole dollar amounts Rent Enter the total program fee rent paid since entry to the TR round to whole dollar amounts III Status at Program Exit Residential Treatment Exit
62. for these programs are entered into HOMES using the following forms and templates e Veteran Record all Veterans contacted by specialized homeless programs e Assessment used by all specialized homeless programs e Program Entry HUD VASH Residential Programs HCHV Case Management HCRV VJO e Progress Update HUD VASH VJO e Program Exit HUD VASH Residential Programs HCHV Case Management HCRV VJO 1 Goals and Objectives HOMES is designed to support VA s mission to end Veteran homelessness by achieving the following goals and objectives e Improve care for homeless Veterans by providing more rapid access to programs e Integrate data collection and reduce duplication of data entry across all VA specialized homeless programs e Provide consistent measurement across all homeless specialty programs e Ensure that Veterans remain engaged in service through increased coordination of care e Enhance VA s capacity to monitor program effectiveness including the utilization and outcome of VA funded services DRAFT LAST UPDATED APRIL 19 2011 2 VA Homeless Operations Management and Evaluation System HOMES User Manual e Provide future compatibility with VA CPRS as well as HUD s Homeless Management Information System HMIS and e Provide data needed for Commission on Accreditation of Rehabilitation Facilities CARE and Joint Commission on the Accreditation of Healthcare Organization JCAHO documentation require
63. for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider Social and recreational deficits 0 Nota problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider Vocational skill deficits 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider a aa a 4 Veteran s treatment has been arranged with both non VA and VA provider V Legal Status Legal status Number of Jail time sanctions incarcerations imposed by VJO program monitoring during entire VJO program episode Do not include arrests incarcerations for new oftenses Code new arrests incarcerations during entire VJO program episode below under18b and 18c DRAFT LAST UPDATED APRIL 19 2011 195 b c VA Homeless Operations Management and Evaluation System HOMES User Manual Number of new arrests during entire VJO program epi
64. health and stability and improve homeless crisis response The plan aims to employ these strategies through strengthened partnerships among VA the Department of Housing and Urban Development HUD the Department of Health and Human Services HHS and the Department of Labor Accurate and timely data are fundamental to the success of these initiatives VA is developing a comprehensive Homeless Registry a data warehouse that tracks and monitors homeless program expansion operation and treatment outcomes The Registry allows real time access to data by VA providers program administrators and medical center VAMC Veterans Integrated Service Network VISN and Central Office VACO leadership to facilitate performance monitoring and decision making The Homeless Operations Management and Evaluation System HOMES is a component of the Registry that VA staff nationwide use to enter update and track homeless Veteran data The data collected through HOMES is used to support VA efforts to prevent and end homelessness B HOMES Overview HOMES is an online data collection system that tracks homeless Veterans as they move through VA s system of care The system streamlines data collection processes and facilitates communication between VA homeless program staff and leadership on the local regional and national levels By providing a centralized data collection system HOMES enables VA to efficiently and effectively collect manage and acc
65. indicate For items 15a c indicate the Veteran s status since entry into the Treatment Court a Number of Jail Time Sanctions Enter in the field provided the total number of jail time sanctions incarcerations imposed by Treatment Specialty Court monitoring during the entire treatment court episode Do not include arrests incarcerations for new offenses b Number of New Arrests during Treatment Court Follow Up Enter the total number of new arrests during the entire treatment court episode in the field provided c Number of New Incarcerations during Treatment Court Follow Up Enter the total number of new incarcerations during the entire treatment court episode in the field provided For information on how to submit forms please reference Section II B 3 DRAFT LAST UPDATED APRIL 19 2011 110 VA Homeless Operations Management and Evaluation System HOMES User Manual 3 VJO Exit Form a General Instructions Use this form to document Veteran exit from the VJO program See Appendix L for the VJO Exit Form Worksheet b When to complete and submit the VJO Exit Form This form should be completed and submitted as soon as it is determined that the Veteran will exit the VJO program c Who may complete and submit the VJO Exit Form Staff members who fill out the VJO Exit Form should be regular staff of the VJO program or staff of another VA mental health program who conduct outreach to courts and correctional fac
66. instructions below to complete the form General Referral Form VA Staff Member Completing Supplemental Referral Automatically generated based on the user information can be edited Site Code Automatically filled based on the user information cannot be edited Date of Assessment Type in the date that the actual form was completed use the mm dd yy format Lead Case Manager n a in Phase 1 of HOMES Enter the name of the LCM assigned to this Veteran Primary VAMC Select from the drop down list the Primary VAMC for this Veteran Secondary VAMC Select from the drop down list the Secondary VAMC for this Veteran I Veteran Identification Referral Form 1 Veteran s Name Automatically filled based on the Veteran s record can only be edited by NEPEC DRAFT LAST UPDATED APRIL 19 2011 39 VA Homeless Operations Management and Evaluation System HOMES User Manual I Veteran Identification Referral Form 2 Social Security Number Automatically filled based on the Veteran s record can only be edited by NEPEC 3 Date of Birth Automatically filled based on the Veteran s record can only be edited by NEPEC 4 Sex Automatically filled based on the Veteran s record can only be edited by NEPEC II Referral Plans Referral Form What are your immediate plans for referral or treatment of the Veteran at this time
67. issues or problems 6 Veteran unhappy with HUD VASH housing O 7 Veteran is no longer financially eligible for a HUD VASH voucher L 8 Veteran is no longer interested in participating in this program 9 Veteran cannot be located 10 Veteran too ill to participate in HUD VASH at this time 11 Veteran is incarcerated 12 Veteran is deceased O 13 Other specify If item 5 12 Veteran is deceased do not complete remainder of this form 6 What is the status of the Veteran s HUD VASH voucher 1 Veteran will continue to use the voucher Veteran exited the program prior to voucher receipt Voucher was denied Voucher expired Voucher was revoked ee at a 2 3 4 5 Veteran voluntarily returned the voucher 6 7 Other please specify ll Status at Program Exit 7 What is the Veteran s housing arrangement at program exit HU 1 Housing owned by Veteran no ongoing housing subsidy 2 Housing owned by Veteran with ongoing housing subsidy 3 Housing rented by Veteran no ongoing housing subsidy O 4 Housing rented by Veteran with HUD VASH voucher DRAFT LAST UPDATED APRIL 19 2011 160 10 11 12 VA Homeless Operations Management and Evaluation System HOMES User Manual 5 Housing rented by Veteran with non HUD VASH housing subsidy 6 Permanent housing for formerly homeless persons such as SHP S C or SRO MOD Rehab 7 Staying or living in family member s room apartm
68. of Assessment mn VAMC peere VAMC Entry Date Edit Entry Form View Entry Form Exit Date Add Form _ Edit Exit Form View Exit Form 04 12 2011 04 13 2011 Edit Entry Form View Entry Form 04 13 2011 Add Exit Form Edit Exit Form View Exit Form HCRV Program Forms Entered No HCRV program forms entered VJO Entry Exit Forms Entered Date of Primary Secondary Entry Date Edit Entry View Entry Add Progress Exit Edit Exit View Exit Assessment VAMC VAMC Form Form Form Date Add Form Form Form Add Progress Add Exit View Exit Form Eorm Form 04 12 2011 642 642 04 12 2011 Edit Entry Form View Entry Form VJO Progress Reports Entered No VJO Progress Reports entered HUDVASH Entry Exit Forms Entered No HUDVASH program forms entered Add HUDVASH Entry form DRAFT LAST UPDATED APRIL 19 2011 111 VA Homeless Operations Management and Evaluation System HOMES User Manual VJO Program Exit Form HOMES Episode Start Date 04 12 2011 Primary VAMC 642 Lead Case Manager N A Secondary VAMC 642 Program Entry Date 04 12 2011 Staff Login First and Last Name hew Berman VA Site 3 digit VAMC code plus 2 digit suffix if any 6 2 Date this form completed mm dd yy 13 2011 Veteran s name last name first initial John Smith Social Security Number 987654321 Date Of Birth 03 04 1980 Name of Treatment Court if applicable 1 Period covered by this report mm dd yy Entry Date Days
69. paying rent are sharing from others and rooms in hotels or motels not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Being discharged from a hospital or other institution e Living in housing that has been condemned by housing officials and is no longer considered meant for human habitation Veterans who are unstably housed and at risk of losing their housing include those who e Are currently housed and not literally homeless or imminently losing their housing e Are experiencing housing instability but may have one or more other temporary housing options and e Lack the resources or support networks to retain or obtain permanent housing Housing instability may be evidenced by e Frequent moves because of economic reasons e Living in the home of another because of economic hardship e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing with others and rooms in hotels or motels not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Living in a hotel or motel not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Living in severely overcrowded housing e Being discharged from a hospital or other institution or e Otherwise living in housing that has characteristics as
70. record with the HOMES ID being the preferred method The HOMES ID is preferred because it uniquely identifies the Veteran and is not Protected Health Information The ID is used in all email notifications DRAFT LAST UPDATED APRIL 19 2011 9 VA Homeless Operations Management and Evaluation System HOMES User Manual C Veteran Contact Information The Veteran s contact information includes the Veteran s address phone number and email This information should be collected upon first contact with the Veteran and updated as necessary Partial information should be recorded if full information is not available Unlike most other forms fields in the Veteran Contact Information may be edited by users other than NEPEC administrators D Assessment Form The Assessment Form is used to gather and document data about the Veteran s status determine the Veteran s needs and identify specific homeless program s that address these needs The pre engagement section of the Assessment Form is used when the interviewing clinician conducts a brief needs Assessment for a Veteran who has been contacted but may not be willing to have a full Assessment or participate in programs If the Veteran agrees to a full Assessment the clinician gathers more detailed information including demographics military background living situation employment income and clinical status The Assessment equips the clinician with the necessary information to formulate pla
71. response from the drop down list DRAFT LAST UPDATED APRIL 19 2011 26 VA Homeless Operations Management and Evaluation System HOMES User Manual V Living Situation Assessment Form 20 During the past 30 days how many days did you sleep in the following kinds of places Ask the Veteran where he or she slept during the last 30 days 1 month Declined Omitted If the Veteran declined to respond or the interviewer omitted the question select the appropriate response from the drop down list 20a t For items 20a t determine and enter the number of days out of 30 the Veteran spent in each of the listed settings Make sure that the responses for 20a t total 30 days unless the Veteran declined to response or the interviewer omitted the question e For items a e select the response that includes the type of housing subsidy if any the Veteran received A housing subsidy may be tenant project or sponsor based and provides ongoing assistance to reduce rent burden This includes either a housing subsidy provided through the HUD VASH program or other housing subsidy Other housing subsidies may include a HUD funded subsidy e g public housing Housing Choice Voucher or Section 8 or other housing subsidy e g state rental assistance voucher e Please note that item 20t places not meant for habitation includes places such as enclosed bus stops ATM buildings and lobbies of buildings which are closed for the
72. the Veteran received non cash benefits from each of the sources listed in items 23a m during the past 30 days Multiple sources of non cash benefits may be identified 24 Does the Veteran currently have a representative payee or fiduciary Indicate whether the Veteran has a representative payee or fiduciary by selecting a response from the drop down list Only answer yes if the Veteran has a formal relationship with a payee or fiduciary do not count informal financial advisors or assistants YES If yes respond to item 24a a Select a response from the drop down list that indentifies who the representative payee or fiduciary is in relation to the Veteran DRAFT LAST UPDATED APRIL 19 2011 52 VA Homeless Operations Management and Evaluation System HOMES User Manual VI Health Care Status HUD VASH Monthly Status Report Form 25 How has this Veteran s community adjustment changed in the past 30 days Select the response from the drop down lists that best describes how the Veteran s community adjustment has changed in the past 30 days 26 Has the Veteran had increased social and or family contacts in the past 30 days Select the response from the drop down list that indicates whether the Veteran has had increased social and or family contacts in the past 30 days 27 Was the Veteran hospitalized for an unscheduled medical condition in the past 30 days Select the response from the dr
73. why the Veteran ended involvement in HCHV case management 1 Veteran accomplished his her goals and or obtained access to services and no longer has a need for this program 2 Veteran required a more intensive level of care than offered at this program 3 Veteran is no longer interested in participating in this program 5 Veteran cannot be located 6 Veteran too ill to participate in HCHV at this time 7 Veteran is incarcerated 8 Veteran is deceased 9 Other specify select Use the instructions below to complete the form General HCHV Case Management Exit Form HOMES Episode Start Date Automatically filled based on information collected in HOMES cannot be edited Lead Case Manager n a in Phase 1 of HOMES Automatically filled based on information collected in HOMES cannot be edited Program Entry Date Automatically filled based on information collect in HOMES cannot be edited Primary VAMC Automatically filled based on information collected in HOMES cannot be edited Secondary VAMC Automatically filled based on information collected in HOMES cannot be edited Staff Login Automatically filled based on the user information cannot be edited VA Site Automatically filled based on the user information cannot be edited Form Completion Date Automatically filled based on information collected in HOMES cannot be edited DRAFT LAST
74. with others answer items d1 4 If yes does the household include For items d1 4 select a response from the drop down list that best reflects the Veteran s current living situation For items d2 4 enter 99 if the item was omitted by the VJO Specialist 1 Spouse Significant Other Select a response from the drop down list that indicates whether the Veteran currently has a spouse or significant other 2 Children Under 18 Determine the number of children under 18 living in this household and enter the number in the provided field If no children under 18 are living at this location enter 0 3 Related Adults Determine the number of related adults currently living in this household and enter the number in the field provided If no related adults are living at this location enter 0 4 Unrelated Adults Determine the number of unrelated adults currently living in this household and enter the number in the field provided If no unrelated adults are living at this location enter 0 6e Housing Stability How would you describe the Veteran s housing situation Determine whether the Veteran is literally homeless imminently losing their housing unstably housed and at risk of losing their housing or stably housed Select the corresponding response from the drop down list Examples of Veterans who are literally homeless include those who are e Living in places not designed for or ordinarily used as a regular sle
75. 1 8 http www benefits va gov homeloans Ip asp I http www vba va gov bln vre index htm DRAFT LAST UPDATED APRIL 19 2011 133 VA Homeless Operations Management and Evaluation System HOMES User Manual Temporary Assistance for Needy Families TANF TANF is designed to help needy families achieve self sufficiency Veterans may qualify for assistance in their state Food Stamps or Supplemental Nutrition Assistance Program SNAP Food stamps and SNAP are designed to provide a means of obtaining food SNAP benefits can be used to purchase food or seeds and plants that produce food General Assistance GA GA programs offer support for people unable to work Financial assistance may be used to cover medical expenses Women Infants and Children WIC Veterans may qualify for WIC a food assistance program that helps pregnant women new mothers and young children eat well and stay healthy Non VA Emergency Room Emergency room care can be for medical or psychiatric issues Non VA Detoxification Services Detoxification services are designed to help treat individuals with a drug or alcohol addiction Non VA Mental Health or Substance Abuse Services Mental health and substance abuse services offer treatment and rehabilitation DRAFT LAST UPDATED APRIL 19 2011 134 VA Homeless Operations Management and Evaluation System HOMES User Manual Appendix E Access Request Form Not applicable in this version of
76. 1 yes indicate type s of benefits received a Medicaid health insurance program or similar local program LI 0 No 1 Yes b Medicare health insurance program or similar local program L 0 No 1 Yes c Temporary Rental Assistance LI 0 No 1 Yes d Homeless Prevention and Rapid Re housing Program HPRP Funds L 0 No U 1 Yes e Veteran Service Organizations L 0 No U 1 Yes f State Children s Health Insurance Program or similar local program L 0 No U 1 Yes g Supplemental Nutrition Assistance Program SNAP or Food Stamps LI 0 No 1 Yes h Special Supplemental Nutrition Program for Women Infants and Children WIC LI 0 No L 1 Yes i Temporary Assistance for Needy Families TANF or similar local program Child Care Services LI 0 No L 1 Yes j Temporary Assistance for Needy Families TANF or similar local program Transportation Services LI 0 No L 1 Yes k Other TANF funded services LI 0 No 1 Yes Bus subway train or cab voucher L 0 No 1 Yes m Other L 0 No O 1 Yes IV Follow up Arrangements Select the code that best describes clinical treatment arrangements made at program exit 12 13 14 Alcohol problems 0 Nota problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider O 3 Veteran
77. 1 Referral from Vet Center 12 Referral from VBA O 13 Referral from VA Homeless Veterans Hotline 1 877 424 3838 By non VA a ea it 14 Street outreach by non VA staff 15 Referral by shelter staff or other community homeless services provider 16 Referral from VA Grant and Per Diem 17 Referral from Non VA Emergency Room 18 Referral from Non VA Community Mental Health Center or clinic 19 Referral from other Federal Agency HUD Dept of Labor HHS By Criminal Justice System L 20 Referred by jail or prison staff O 21 Referred by law enforcement official 22 Referred by Court judge or District Attorney DRAFT LAST UPDATED APRIL 19 2011 147 VA Homeless Operations Management and Evaluation System HOMES User Manual 23 Referred by an attorney e g public defender or defense attorney 24 Referred by probation parole officer By family self or other 25 Referred by family member 26 Self referred 27 Other please specify 99 Interviewer omitted item 0000 Veteran Table of Equivalent Military Ranks Number E Rating Army Air Force Navy CG Marine Corps 1 E 1 Private Airman Basic Seaman Recruit Private 2 E 2 Private E 2 Airman E 2 Seaman Apprentice Private E 2 1 class 3 E 3 Private 1 class Airman 1 class Seaman E 3 Lance Corporal 4 E 4 Specialist Four Senior Airman Pet
78. 1 Veteran s name last name first initial Mohn Smith 2 Social Security Number 987654321 3 Date Of Birth pozos o 5 Date of entry decision mm dd yy If the Veteran did not enter the HUD VASH program answer item 6 only do not complete remainder of form 6 Sea the main reason why Veteran did not enter the HUD VASH program if more than one reason code most important eteran not interested in program e g found alternate housing teran left can no longer locate Veteran refused to agree with the terms of the HUD VASH program Since referral Veteran became too ill to participate teran no longer eligible for the program e g over income teran is incarcerated Veteran did not meet program eligibility requirements Other specify Use the instructions below to complete the form General HUD VASH Entry Form HOMES Episode Start Date Automatically filled based on information collected in HOMES cannot be edited Lead Case Manager n a in Phase 1 of HOMES Automatically filled based on information collected in HOMES cannot be edited Primary VAMC Automatically filled based on information collected in HOMES cannot be edited Secondary VAMC Automatically filled based on information collected in HOMES cannot be edited Staff Login Automatically filled based on the user information cannot be edited VA Site Automatically filled based on the u
79. 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider 21 Vocational skill deficits 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arrangements made 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider ht 9 4 Veteran s treatment has been arranged with both non VA and VA provider DRAFT LAST UPDATED APRIL 19 2011 163 VA Homeless Operations Management and Evaluation System HOMES User Manual Appendix I HCHV A HCHV Program Instructions B HCHV Entry Form Worksheet Staff member completing this form first and last name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed MIM CdVY 1 ceeeeeeeteee eee Veteran s name last name first name 0 0eee Social Security NUMbED cece eee eee e eee eeaaee ees Date of birth MIMV QQY ccccccec teen eee cette a nanancno cnn 1 Will the Veteran receive HCHV case management services 0 No 1 Yes 2 Date of program entry decision mm dd yy ocococcocccccooo o If the Veteran did not enter HCHV case management 3 Select the main reason why Veteran did not enter HCHV case management O 1 Veteran left can no longer locate O 2 Veteran no longer in clinic
80. 6 Select the main reason why Veteran did not enter the HCRV program Veteran left can no longer locate Veteran no longer in clinical need of program Veteran not interested in program Veteran refused to agree with terms of HCRV case management Veteran s anticipated release date is more than 6 months away Veteran is not eligible for VHA Healthcare aa a sO e 4 2 3 4 5 Since referral Veteran became too ill to participate 6 7 8 Other specify Comment Reason Why ll INITIAL CONTACT WITH HCRV PROGRAM 7 Where did HCRV staff make initial contact with this Veteran State prison _ 2 State funded corrections halfway house or work release facility 3 Federal prison 4 Federally funded corrections halfway house or work release facility 5 Local or county jail 6 State jail 7 Re entry treatment court 8 Shelter or temporary housing for homeless 9 Street park outdoors 4 et o fat at 9 a 0 Soup kitchen DRAFT LAST UPDATED APRIL 19 2011 176 8 VA Homeless Operations Management and Evaluation System HOMES User Manual 11 VAMC 12 Vet Center 13 At special program for homeless Veterans specify 14 Other specify ep lil CURRENT INCARCERATION Is the Veteran currently incarcerated or released less than 10 days ago 0 No L 1 Yes If Veteran is currently incarcerated or was released less than 10 days ago complete remainder of form otherwise
81. 7 What race do you most strongly identify with Race is used to count the number of homeless persons who identify themselves within five different racial categories Ask the Veteran which race he or she identifies with most strongly and select the corresponding response from the drop down list Staff observations should not be used to collect information on race Definitions of each of the race categories are as follows 1 American Indian or Alaska Native is a person having origins in any of the original peoples of North and South America including Central America and who maintains tribal affiliation or community attachment 2 Asian is a person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Philippine Islands Thailand and Vietnam 3 Black or African American is a person having origins in any of the black racial groups of Africa Terms such as Haitian can be used in addition to Black or African American 4 Native Hawaiian or Other Pacific Islander is a person having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands 5 White is a person having origins in any of the original peoples of Europe the Middle East or North Africa 8 What ethnicity do you most strongly identify with Ethnicity is used to count the number of homeless p
82. 8 Medical Problems Select the appropriate response from the drop down list 19 Social and Recreational Deficits Select the appropriate response from the drop down list 20 Vocational Skill Deficits Select the appropriate response from the drop down list DRAFT LAST UPDATED APRIL 19 2011 70 VA Homeless Operations Management and Evaluation System HOMES User Manual For information on how to submit forms please reference Section II B 3 DRAFT LAST UPDATED APRIL 19 2011 71 VA Homeless Operations Management and Evaluation System HOMES User Manual H Residential Treatment Forms HCHV Contract GPD DCHV CWT TR 1 Residential Treatment Entry Form a General Instructions Use this form for Veteran entry into the Grant and Per Diem Program GPD HCHV Contract Residential Treatment Program Domiciliary Care for Homeless Veterans DCHV Program or Compensated Work Therapy Transitional Residence CWT TR Program See Appendix J for the Residential Treatment Entry Form Worksheet b When to complete and submit the Residential Treatment Entry Form This form should be completed and submitted as soon as a decision has been made regarding a Veteran s acceptance to the program c Who may complete and submit the Residential Treatment Entry Form A clinician who is familiar with the Veteran s referral and admission decision should complete the Residential Treatment Exit Form Clerks o
83. 8 Staying or living in friend s room apartment or house 9 GPD transitional housing 10 Non VA transitional housing for homeless persons 11 Safe Haven special transitional supportive housing or drop in supportive service center for homeless SMI individuals 12 VA Mental Health Residential Rehabilitation Program MH RRTP all types DCHV CWT TR SA RRTP PTSD RRTP General RRTP 13 VA contracted residential treatment programs ATU HWH or HCHV contract Ff et at at to ti 14 Non VA residential treatment program DRAFT LAST UPDATED APRIL 19 2011 179 10 11 12 VA Homeless Operations Management and Evaluation System HOMES User Manual 15 Non psychiatric hospital acute care 16 Psychiatric hospital acute care 17 Hotel or motel paid for without emergency shelter voucher 18 Emergency shelter including hotel or motel paid for with emergency shelter voucher 19 Prison jail 20 Place not meant for habitation outdoors automobile truck boat 21 Don t know OOOOOUOO What is the zip code of that location Code N in 1 space if unknown Housing stability How would you describe the Veteran s housing situation at program exit O 1 Literally homeless O 2 Imminent risk of losing housing O 3 Unstably housed at risk of losing housing Ll 4 Stably housed O 5 Don t know With whom will the Veteran be living at program exit 0 No residence 1 Alone 2 With spouse partner or childre
84. 9 2011 171 VA Homeless Operations Management and Evaluation System HOMES User Manual 3 Veteran was asked to leave because of violation of program rules or failure to comply with program requirements 4 Veteran required a more intensive level of care than offered at this program 5 Veteran was transferred to another residential program for administrative reasons 6 Veteran left the program by his her own decision without consulting staff 7 Veteran was incarcerated a ca og 8 Veteran is deceased If item 2 8 Veteran is deceased do not complete the remainder of the form 2a 3 4 If the Veteran ended residential treatment because of a rule violation what was the most important reason 1 Threatened actual violence to self or others 2 Use of alcohol or drugs O 3 Curfew violation 4 Other please specify What is the Veteran s housing arrangement at program exit 1 Housing owned by Veteran no ongoing housing subsidy Housing owned by Veteran with ongoing housing subsidy Housing rented by Veteran no ongoing housing subsidy Housing rented by Veteran with HUD VASH voucher Housing rented by Veteran with non HUD VASH housing subsidy Permanent housing for formerly homeless persons Such as SHP S C or SRO MOD Rehab Staying or living in family member s room apartment or house AN Daf WwW DY Staying or living in friend s room apartment or house 9 GPD transitional housing
85. Appendix D for brief descriptions of programs available to Veterans Referral plans are documented in the last sections of the Assessment Form Once the form is submitted an email notification is sent to appropriate program staff alerting them that a referral has been made Program staff can access the Veteran s information in HOMES and evaluate the Veteran for entry into their program DRAFT LAST UPDATED APRIL 19 2011 6 VA Homeless Operations Management and Evaluation System HOMES User Manual While most referrals will result in program entry there may be cases in which a Veteran does not enter the referred program In these cases the referring clinician will receive an email notification The clinician will then work with the Veteran to identify and evaluate alternatives 4 Program Entries and Exits When a referral is made via HOMES staff from the appropriate program receives an email notification A clinician from the referred program then determines whether or not the Veteran will be able to enter the program The program entry decision entry or non entry into the program is documented in HOMES using a Program Entry Form Veterans entering the HUD VASH and VJO programs will also have periodic Progress Reports completed for them When a Veteran exits a program a clinician from the program completes an Exit Form 5 Supplemental Referrals Once an Assessment Form has been submitted and is therefore unavailable for further
86. Date of Birth Enter the month day and year of birth for every Veteran served If a Veteran cannot remember the year of birth ask for his or her age and calculate the approximate year of birth If a Veteran cannot remember the month or day of birth record an approximate date of 01 for month and 01 for day Approximate dates for month and day will allow calculation of a person s age within one year of their actual age Record the appropriate date of birth type in the field provided Date of birth should be collected at intake through an interview or forms completed by the Veteran DRAFT LAST UPDATED APRIL 19 2011 16 VA Homeless Operations Management and Evaluation System HOMES User Manual Gender Select male female or other from the drop down list Gender should be assigned based on the Veteran s self perceived gender identity Ask the Veteran with which gender he or she associates and record the reported gender in the field provided This information is collected at intake through an interview or forms completed by the Veteran Social Security Number Record the Veteran s nine digit SSN in the field provided Confirm the number by retyping it in the field labeled Confirm SSN SSN is a unique identifier crucial for collecting accurate unduplicated information This information is collected at intake through an interview or forms self administered by the Veteran Form Verification and Submission It is cr
87. Homeless Operations Management and Evaluation System HOMES User Manual Phase 1 Submitted by Jones Lang LaSalle April 19 2011 FINAL DRAFT VA Homeless Operations Management and Evaluation System HOMES User Manual Table of Contents De SIN PRODUCTION wiiisicscssstactacsisecestescesecabiadecudes TN 1 Az BACKGROUND coronario A A At 1 Be AOM ES OV RVE oa 1 1 GOALS ANA Objectives Ai 2 2 Advantages to USCIS cua a eao a E aia i 3 3 Future Development and System Enhancement osesseseeeseesseseeerserersresssrreresrsrresesrenrssresrsreerssrerreseseest 3 HOMES PROCESS FLOW vss dcsceseveceuececetesspes duesthsvvesoteasentsst severe dpevontave EErEE ev NRE STE Np EEEREN TAEI E E NERE ESTEE NEon ia 4 Te Pre Engagement Screening vacia is 6 2 Assessment and Episode Initiation iyos reii ai e aa e aaeeio de aaa i SEE 6 3 Program Refera S ci A A ii 6 4 Program Entries nd Exits nonn aen re A ds 7 3 Supplemental Referrals ooo ini toes cd desu seas tseigeasaases tisnssuses ideada 7 6 Key Concepts dnd Terms ss ii A ei 7 Il USING THE HOMES ONLINE SYSTEM csscsscssssssscsssssssessnsscsscscessssssscsssnessssnessessssossesssesessnesoessoes 9 A HOMES ACCESS AND USER ROLES ssecesesicy sheseocesuseatest ir eee aap suede due e a e a E rE iodo 9 By VETERAN RECORD 5 3 5 5 ysctseosseiseesspssstevsnospessovtesiesepasyessonioatesbesseacsontondosvent anche nde E sasveyes 9 VETERAN CONTACT INFORMATION c
88. How many times had the Veteran ever been arrested as an adult or a juvenile Enter in the field provided the number of times the Veteran has been arrested as an adult or as a juvenile before his or her most recent arrest For no arrests enter 00 Unknown Declined If the Veteran does not know or declined to respond enter N The total number cannot exceed 99 NOTE The following warning message will appear if item 25 is greater than 20 arrests Item 25 indicates number of arrests is greater than 20 if correct then continue If this is correct you will confirm by clicking OK or you will correct your response a How many of these arrests occurred in the 1 year prior to the current arrest Enter in the field provided the number of arrests that occurred during the year prior to the current arrest Do not count the current arrest 26 Is the Veteran facing or wanting assistance for the following legal issues a k Indicate whether the Veteran is facing or wanting assistance for the legal issues listed in items 26a k For item k specify the legal issue in the field provided 27 Will the Veteran enter a treatment or specialty court Indicate whether the Veteran will enter a treatment or specialty court by selecting a response from the drop down list If no skip to item 29 27a Name of Treatment Court Enter the name of the treatment court in the field provided 27b Specialty Court Type Select t
89. Is the Veteran facing or wanting assistance for the following legal issues select all that apply a upcoming court hearings O 0 No J 1 Yes DRAFT LAST UPDATED APRIL 19 2011 185 27 27a 27b 28 29 VA Homeless Operations Management and Evaluation System HOMES User Manual b reporting requirements for parole probation or the court L 0 No c employment restrictions O 0 No d outstanding warrants O 0 No e registry or housing requirements O 0 No f impact of long term institutionalization O 0 No g current or recent behavioral safety risk O 0 No h concurrent treatment requirements related to legal status e g DUI sex offender or domestic 0 No violence treatment i frequent jail incarceration O 0 No j non criminal legal issues O 0 No k other specify O 0 No Will the Veteran enter a treatment or specialty court O 0 No If no skip to 29 Name of Treatment Court Specialty Court type aaa aaa a NO oO fF W PD 0 1 Drug Treatment Court Other Specialty Court specify Veterans Treatment Court or Veterans docket Mental Health Treatment Court Domestic Violence Court DUI Court Problem Solving Court Re entry Court O 1 Yes Ll 1 Yes O 1 Yes O 1 Yes Ll 1 Yes O 1 Yes O 1 Yes L 1 Yes L 1 Yes L 1 Yes L 1 Yes Date of Entry to Treatment Court mm dd yy Please indicate the status of clients not entering a Treatment Court ogagdo
90. L 99 Interviewer omitted item Will the assessment interview be completed If yes skip to item 7 a If no please indicate main reason 1 Veteran will not consent to interview 2 Veteran is not interested in any services O 0 No O 1 Yes 3 Veteran is not in need of homeless program services b If no are immediate Non VA homeless services required 0 No 1 Yes If no skip to item 6d c If yes which Non VA homeless service is required Non VA detoxification services Non VA medical services Non VA social vocational assistance Non VA housing Non VA Income Resources ON Oa FR WD Other specify Non VA Emergency Room medical or psychiatric Non VA mental health or substance abuse services O 0 No 1 Yes O 0 No O 1 Yes O 0 No 1 Yes O 0 No O 1 Yes O 0 No 1 Yes O 0 No 1 Yes O 0 No O 1 Yes O 0 No 1 Yes d May we contact you at a later date 0 No 1 Yes in 1 month 2 Yes in 6 months 3 Yes in 1 year 98 Veteran declined to answer es 99 Interviewer omitted item Ill ASSESSMENT INTERVIEW What race do you most strongly identify with L 1 American Indian or Alaskan O 2 Asian O 3 Black or African American 4 Native Hawaiian or Other Pacific Islander What ethnicity do you most strongly identify with L 0 Non Hispanic Non Latino L 1 Hispanic Latino 0000 OO 5 White 6 Don t know 98 Veteran d
91. PACE key while the cursor is in a drop down list the user will be returned to the previous screen If this occurs the user should click the browser s Forward button to return to the form The BACKSPACE key may be used to edit a text field e g date of Assessment date of entry into Grant and Per Diem etc however the cursor must be in the text box that the user wants to edit before hitting the BACKSPACE key If not HOMES may automatically return the user to the last screen visited If this occurs the user should click the Forward button to return to the form 2 Entering Data Enter data into HOMES within 24 hours of conducting an interview or receiving updated information Timely data entry ensures that HOMES users have access to up to date information and fosters data integrity Items with drop down lists can be answered by entering the number of the selected response using the computer keyboard or by selecting the appropriate response using the mouse Text fields should be completed by using the computer keyboard to enter responses directly into the fields provided Search by Homes Veteran ID 98 Veteran declined to answer 99 Interviewer omitted item Required items are denoted by a red asterisks found to the right of a text field or drop down list Required items may not be left blank If the Veteran declined to answer or the interviewer omitted the item select the corresponding response choice If le
92. PDATED APRIL 19 2011 187 VA Homeless Operations Management and Evaluation System HOMES User Manual 11 Safe Haven special transitional supportive housing or drop in supportive service center for homeless SMI individuals 12 VA Mental Health Residential Rehabilitation Program WH RRTP all types DCHV CWT TR SA RRTP PTSD RRTP General RRTP 13 VA contracted residential treatment programs ATU HWH or HCHV contract 14 Non VA residential treatment program 15 Non psychiatric hospital acute care 16 Psychiatric hospital acute care 17 Hotel or motel paid for without emergency shelter voucher 18 Emergency shelter including hotel or motel paid for with emergency shelter voucher 19 Prison jail 20 Place not meant for habitation outdoors automobile truck boat Total Days Total days are automatically calculated in HOMES 6b Where was the Veteran staying the last time you had contact with him her CODE 1 20 99 Code 99 if VJO Specialist omitted tem 6c What is the zip code of that location Code N in 1st space if unknown 6d Is the Veteran living with others at that location O 0 No O 1 Yes L 99 VJO Specialist doesn t know omitted If 6d no or VJO Specialist omitted item skip to item 6e item If yes does the household include 1 spouse significant other O 0 No 2 children under 18 list number 3 related adults list number
93. SH HCRV and VJO programs Administrative support staff other non clinicians may have read only access non VA staff will not have access B Who can input data Input permission is granted by NEPEC to VA specialized homeless program staff of the HCHV HCHV Contract Residential Treatment GPD DCHV CWT TR HUD VASH HCRV and VJO programs C Who can generate reports NEPEC will generate reports to support field staff additionally HOMES data will serve as input to a Homelessness Services Data Cube that is currently in development D What data is shared with HMIS Although there are plans to integrate HOMES data and HMIS data in the Homeless Registry decisions about sharing VA data with HMIS are currently pending E How can I access HOMES if I am in the field HOMES is implemented in a VA intranet site therefore it can be accessed through a laptop PC if a connection to the VA network can be made via VPN software RESCUE Alternatively you can use data entry worksheets and then enter the information into HOMES when you return to the office F When can I stop sending in NEPEC data NEPEC evaluation systems for the VA specialized homeless programs will phase out through attrition That is episodes of care that were started in NEPEC data collection systems HCHV ODC HUD VASH ODC DCHV Form Z and CWT TR Form TR should be completed in those systems all new activity should be recorded in HOMES G Won t HOMES slow down the intake an
94. Track Veteran Progress Evaluate alternatives and make periodic reports in VJO and new referrals HUD VASH 4 Document Veteran status at exit foreach Homeless Program 4 End HOMES Episode if 30 days pass after the completion of all programs at current VAMC Veteran s care switches to new VAMC DRAFT LAST UPDATED APRIL 19 2011 VA Homeless Operations Management and Evaluation System HOMES User Manual 1 Pre Engagement Screening The Pre Engagement Screening is the stage prior to the initiation of a HOMES episode of care This brief screening is completed in instances where a VA clinician has a very brief encounter with a homeless Veteran in the community e g soup kitchen shelter or Stand Down and cannot conduct a full Assessment It is also completed if a Veteran is unwilling to fully engage in specialized VA homeless services The pre engagement screening located within the Assessment Form allows for basic documentation of the Veteran s urgent clinical needs If at a later time the Veteran is interested in participating in treatment then the full Assessment is completed appropriate referrals are made and the HOMES episode begins 2 Assessment and Episode Initiation The Assessment Form is the first form that is completed for a new Veteran and initiates the HOMES episode The full Assessment Interview collects information about the Veteran s background including military service current housing situati
95. UPDATED APRIL 19 2011 66 VA Homeless Operations Management and Evaluation System HOMES User Manual I Veteran Information HCHV Case Management Exit Form 1 Veteran s Name Automatically filled based on the Veteran information can only be edited by NEPEC 2 Social Security Number Automatically filled based on the Veteran information can only be edited by NEPEC 3 Date of Birth Automatically filled based on the Veteran information can only be edited by NEPEC II Reasons for Program Exit HCHV Case Management Exit Form 4 Date HCHV case management ended for this Veteran Record the month day and year that the Veteran exited the HCHV program in the field provided The Program Exit Date is the date on which the decision was made to end HCHV case management for this Veteran 5 Which is the most important reason why the Veteran ended involvement in HCHV case management Select from the drop down list the most important reason why HCHV case management was ended for the Veteran If a Veteran left for multiple reasons record only the primary reason If selecting response 9 other specify the other reason why the Veteran is exiting the program in the field provided HI Status at Program Exit HCHV Case Management Exit Form 6 What is the Veteran s housing arrangement at program exit Select the response from the drop down list that reflects the Veteran s current h
96. about case management provided during this period of time Please keep these dates in mind when completing the form Date of this report MM dd VY ce eeeeee seen ee een eeeaeeeteneeeas I VETERAN IDENTIFICATION 1 Veteran s name last name first initial 2 Social Security NUMber eee eee eee eee ees 3 Date of birth Mm dd yy cece eee neste eee nee eee eee ll HOUSING PROGRESS 4 What is the Veteran s voucher status as of this report O 1 Referral package not yet forwarded to PHA L 2 Referral package forwarded to PHA decision pending including re application following voucher denial revocation expiration etc 3 Voucher has been denied O 4 Voucher has been awarded Veteran has not yet moved into HUD VASH housing O 5 Voucher has been awarded Veteran has moved into HUD VASH housing O 6 Voucher has expired or been revoked O 7 Voucher has been ported locally same medical center different PHA NOTE Answer items 5 14 as applicable based on the Veteran s housing voucher status reported in item 4 5 PHA Number 9 AA123 cece cece cece eect tere eee eee e eee eneeeeeeeeeeeeeeees 6 Date referral package was forwarded to the PHA mm da yy J a DP SS 7 Date voucher was issued by the PHA MM dQ Y cceeeeeeeeeeeeeeeeeeee 5S nao O A 8 Date voucher was denied by the PHA MM dQ yy ooccococcc
97. aid Upon Release Select the response from the drop down list that indicates whether the Veteran has a child support debt due upon release If no skip item 21a a If yes what is the total amount Enter in the field provided the total amount of child support debt IV Pre Incarceration History HCRV Entry Form 22 Before the Veteran s arrest on date of arrest for the current incarceration was s he living in a Select the response from the drop down list that best reflects the Veteran s living situation prior to arrest for the current incarceration When selecting item 7 in another type of housing specify the type of housing in the field provided 23 In the 12 months before the Veteran s arrest on date of arrest for the current incarceration was there a time when s he was homeless living on the street or in a shelter Select the response from the drop down list that best reflects whether the Veteran experienced a period of homelessness living on the street or in a shelter prior to arrest for the current incarceration 24 How old was the Veteran the first time s he was arrested for a crime Enter the Veteran s age the first time he or she was arrest for a crime in the field provided Unknown Declined If the Veteran does not know or declined to respond enter N NOTE The following warning message will appear if item 24 is less than 15 years of age Item 24 indicates age at f
98. ailer or mobile home including own family s or friend s 4 Rooming house hotel or motel 5 On the street or in a homeless shelter 6 In a group living situation or institution such as a hospital halfway house recovery home dormitory etc aggaoaodd 7 In another type of housing specify In the 12 months before the Veteran s arrest on date of arrest for the current incarceration was there a time when s he was homeless living on the street or in a shelter L 0 No 1 Yes How old was the Veteran the first time s he was arrested for a crime Code N if Veteran doesn t know or declined to answer How many times had the Veteran been arrested as an adult or as a juvenile before his her arrest in month year of arrest for the current incarceration enter 00 for none cannot exceed 99 Code N if Veteran doesn t know or declined to answer DRAFT LAST UPDATED APRIL 19 2011 178 VA Homeless Operations Management and Evaluation System HOMES User Manual C HCRV Exit Form Worksheet Staff member completing this form first and last name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed MIM CQ Y c0 cceeceeteeseeeeeeeees I VETERAN INFORMATION dl Veteran s name last name first initial 2 Social Security NUMDeT oococcoccncnnconcncnconinnnnnnnnnonos 3 Date Of birt
99. al benefits 3 Is neither receiving nor planning to apply for any VA financial benefits oe a i et a 4 Do not know Veteran s status with respect to VA financial benefits What is the Veteran s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit 0 Currently receiving non VA benefits and will continue 0g 1 Has pending application for non VA financial benefits 2 Is planning to apply for non VA financial benefits 3 Is neither receiving nor planning to apply for any non VA financial benefits 00d 4 Do not know Veteran s status with respect to non VA financial benefits DRAFT LAST UPDATED APRIL 19 2011 166 13 14 VA Homeless Operations Management and Evaluation System HOMES User Manual Did the Veteran receive any money in the 30 days prior to program exit If 13 no or Case manager omitted item skip to item 14 If 13 yes list the average monthly amount in each category O 0 No Ll 1 Yes LI 99 Case manager omitted item Please round to whole dollar amounts and note comma placement eg 452 76 should be entered as _ _ 453 00 a Employment include CWT SE _ es 0 b Compensation for service connected psychiatric condition i O 0 0 c Compensation for other service connected condition e 0 0 d Non service connected pension A SD 8 e Retirement income from Social Securit
100. al need of program O 3 Veteran not interested in program O 4 Veteran refused to agree with terms of HCHV case management O 5 Since referral Veteran became too ill to participate O 6 Veteran is incarcerated O 7 Veteran did not meet program eligibility requirements O 8 Other specify Comment Reason Why optional DRAFT LAST UPDATED APRIL 19 2011 164 VA Homeless Operations Management and Evaluation System HOMES User Manual C HCHV Exit Form Worksheet Staff member completing this form first and last name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed MIM CQY 0 cceeceeteee eee eeeeees I VETERAN INFORMATION T Veteran s name last name first initial 2 Social Security NUMDeT ooooccococccnconnnnnconinnnnoninnnnnns 3 Date Of birth MmM dWVyy oococoococcccccccncnncnncncnnnnnnnoo ll REASONS FOR PROGRAM EXIT 4 Date HCHV case management ended for this Veteran mm dd yy ig A pr A Ae 5 Which is the most important reason why the Veteran ended involvement in HCHV case management 1 Veteran accomplished his her goals and or obtained access to services and no longer has a need for this O Vaiss required a more intensive level of care than offered at this program O 3 Veteran is no longer interested in participating in this program 5 Veteran cannot be located O 6 Veteran too
101. anges to anew VAMC anew HOMES episode must be initiated DRAFT LAST UPDATED APRIL 19 2011 120 VA Homeless Operations Management and Evaluation System HOMES User Manual Appendix A Homeless Program Staff A NEPEC Contacts and Websites NNEPEC Northeast Program Evaluation Center NEPEC 182 950 Campbell Ave West Haven CT 06516 2700 Main Phone Number 203 932 5711 For questions pertaining to the use of HOMES please contact the following staff Name Extension Program s Wes Kasprow x 3724 Project Director for HCHV GPD HCHV Contract Residential Treatment HUD VASH Cathy Seibyl x 4728 Project Director for CWT TR amp DCHV Fe Seona Conte Name Extension Program s Leslie Cavallaro x 2666 Assessment HCRV VJO Nicole Harelik x 5131 GPD HCHV Contract Residential Treatment Emergency Housing amp Safe Haven Diane Dilella x 5877 HUD VASH Ron Gniadek x 5812 CWT TR DCHV sites Organization Site Link NEPEC Intranet Site http vaww nepec mentalhealth med va gov NEPEC HCHV Secure Site https vhaconnep7 v01 med va gov validhv main aspx NEPEC HUD VASH Secure Site https vhaconnep7 v01 med va gov electronichudvash HOMES Training Site https secure vssc med va gov vahomes_training DRAFT LAST UPDATED APRIL 19 2011 121 VA Homeless Operations Management and Evaluation System HOMES User Manual B National Homeless Program Co
102. ants and Children WIC L 0 No 1 Yes 9 Temporary Assistance for Needy Families TANF or similar local program Child Care Services LI 0 No 1 Yes 10 Temporary Assistance for Needy Families TANF or similar local program Transportation 0 No 1 Yes Services 11 Other TANF funded services L 0 No 1 Yes 12 Bus subway train or cab voucher L 0 No L 1 Yes 13 Other specify L 0 No L 1 Yes DRAFT LAST UPDATED APRIL 19 2011 189 VA Homeless Operations Management and Evaluation System HOMES User Manual IV Current Treatment Please select the code that best describes Veteran s current treatment in each area 9 Alcohol problems Ol 0 Not a problem area for this Veteran 3 Veteran currently receives treatment from non VA provider O 1 Veteran s current treatment is unknown O 4 Veteran currently receives treatment from VA O 2 Veteran currently receives no treatment for O 5 Veteran currently receives treatment from both non VA these problems provider and VA O 6 Veteran currently receives peer support only e g 12 step other recovery groups 10 Drug problems 0 Nota problem area for this Veteran 3 Veteran currently receives treatment from non VA provider L 1 Veteran s current treatment is unknown O 4 Veteran currently receives treatment from VA O 2 Veteran currently receives no treatment for O 5 Veteran currently receives treatment from both non VA these problems provider and
103. anual Loggec In as UvA wecopermam You are currently logged on to the VA HOMES Staff Name Matthew Berman Staff Login DVA vacobermam Staff Email Matthew Berman va gov Access to Add all Programs V04 642 PHILADELPHIA Y Search for Veteran Search by SSN No Dashes OR Level of Access VA Site Code Search by First few letters of Last name or First Name OR Search by Homes Veteran ID Search for Veteran Clear You are currently logged on to the VA HOMES Staff Name Staff Login Staff Email Level of Access Matthew Berman DVA vacobermam Matthew Berman va gov Access to Add all Forms VA Site Code RAMMER x Search by SSN No Dashes OR Search by First few letters of Last name or First Name OR ue Search by Homes Veteran ID Search for Veteran Search Results Veteran ID Last Name First Name Middle Initial _SSN__ Date Of Birth Select Veteran 542 Joeal Billy 000040001 06 25 1966 Select 540 AN COLIN 01 15 1 Select 577 john Select JORDAN sheltie 000100000 01 15 1990 001010002 12 08 1958 View saved but not submitted forms View Saved but not submitted Forms 2 Creating a New Veteran Record HOMES will allow creation of a new Veteran Record only when a search for an existing record is unsuccessful see instructions on searching for a Veteran Record in previous section To create a new record click the Add New Veteran button
104. cacscecacacecssacesseaeasaseuscseaeeeeuseaes 183 C VIO PROGRESS FORM WORKSHEET cccccccsccecescescorcecsevercecescovecesevecesecaceceveveverececacececestvecesevacevevevevercveracaveves 187 Di VIO Exit FORM WORKSHEET innne en a ii 192 DRAFT LAST UPDATED APRIL 19 2011 iii VA Homeless Operations Management and Evaluation System HOMES User Manual I Introduction A Background The Department of Veterans Affairs VA is taking action toward its goal of ending homelessness among our nation s Veterans To achieve this goal VA is helping Veterans acquire safe housing needed treatment services opportunities to return to employment and benefits assistance VA intends to end the cycle of homelessness by preventing Veterans and their families from entering homelessness and by assisting those who are homeless in obtaining safe housing as quickly as possible VA Homeless initiatives have contributed to continue declines in homelessness among Veterans VA strives to further reduce the estimated 76 000 Veterans experiencing homelessness on any given night through strategic and targeted program intervention In 2010 President Obama launched Opening Doors a comprehensive Federal Strategic Plan to Prevent and End Homelessness in the next five years Strategies for achieving the plan s goal are to increase leadership collaboration and civic engagement increase access to stable and affordable housing increase economic security improve
105. ces not designed for or ordinarily used as a regular sleeping accommodation for human beings including a car park abandoned building bus or train station airport or camping ground e n a supervised publicly or privately operated shelter designated to provide temporary living arrangements including hotels and motels paid for by Federal State or local government programs for low income individuals or by charitable organizations congregate shelters and transitional housing for homeless persons e Ina hospital or other institution if the person was sleeping in an emergency shelter or other place not meant for human habitation cars parks streets etc immediately prior to entry into the hospital or institution e Fleeing a domestic violence situation Veterans who are imminently losing their housing include those who e Are currently housed and not literally homeless e Are imminently losing their housing whether permanent or temporary e Have no subsequent housing options identified and e Lack the resources or support networks needed to retain current housing or obtain temporary or permanent housing Examples of imminent housing loss include e Being evicted from a private dwelling unit including housing they own rent or live in DRAFT LAST UPDATED APRIL 19 2011 79 VA Homeless Operations Management and Evaluation System HOMES User Manual III Status at Program Exit Residential Treatment Exit Form without
106. ck the LAN settings button Make sure the boxes Automatically detect settings and Use automatic configuration script are NOT checked e Check the box Use a proxy server e Check the box Bypass proxy server for local addresses If you enable proxies and wish to browse web pages on the VA intranet as well as the internet it is essential that you enable the setting that bypasses the proxy server for intranet sites Access response times to intranet sites can be decreased ten fold by bypassing proxy servers as well as freeing up the pipes and the gateways to perform tasks they were meant to do e Depending on your geographical location enter one of the following addresses into the address box gk west va gov gk cent va gov or gk east va gov See note below e In the Port box type 80 e Click the Advanced button next to the Port box Make sure the proxy address to use and port information that were typed in the previous screen appear in the HTTP box If not enter the information e Check the Use the same proxy server for all protocols box e Type the following information into the Exceptions box va gov and 10 e Click OK to exit all dialog boxes that are open DRAFT LAST UPDATED APRIL 19 2011 126 VA Homeless Operations Management and Evaluation System HOMES User Manual
107. coccccocccinconnn L a A 9 Date voucher was revoked or expired MiM AA yy oooooconccoccccccccccicicin a nao A A 10 Date housing selected by the Veteran MmM dAV yy ooooocococcnconcccocincnccn o nao A APA DRAFT LAST UPDATED APRIL 19 2011 153 11 12 13 14 15 VA Homeless Operations Management and Evaluation System HOMES User Manual Date of Safety Inspection MIM AAV yy ooccoccocccccoccccnoncncnoconononenenanineno 0 A PS Date Housing Assistance Payment HAP Contract signed mm dd yy iec A AA a Date Veteran moved into HUD VASH housing Mm dW yy cooccocccccnnnnla SoS na AA A Date voucher was ported MM dAVyy oooooococcococcccnccncnnoncnconcononononnnnos lll CASE MANAGEMENT CONTACTS Did the Veteran have contact with a HUD VASH clinician either the current HUD VASH case O 0 No 1 Yes manager or another HUD VASH clinician for case management during the past 30 days If item 15 no do not complete the remainder of this form 16 _ co Ote tr Eta EVER EM EEE EEE I How many contacts did you have with the individuals in the following categories on behalf of the Veteran s care in the past 30 days Include contacts by current case manager and former acting HUD VASH clinicians a Veteran face to face visits ARENA b Veteran telephone mail A c Family E E d Non family caregivers e g home health care provider visiting nurse
108. comment field to provide additional details about the Veteran s situation 7 Housing Recovery Plan a Was a Housing Recovery Plan completed and signed by both Veteran and HUD VASH clinician Indicate whether a Housing Recovery Plan has been completed and signed by both the Veteran and a HUD VASH clinician as of the date that the form is completed If a Housing Recovery Plan has been signed enter the date that the plan was signed in item 7b and answer question 8 If a Housing Recovery Plan has not been signed skip item 7b and proceed to item 8 b If yes date the Housing Recovery Plan completed and signed Enter the date that the Housing Recovery Plan was completed and signed in the field provided use the mm dd yy format DRAFT LAST UPDATED APRIL 19 2011 45 VA Homeless Operations Management and Evaluation System HOMES User Manual I Veteran Identification HUD VASH Entry Form 8 Where the Veteran currently lives does he or she have a say in choosing a q For items 8a q select a response from the drop down list that indicates whether the Veteran has a say in choosing the listed items at the location where he or she currently lives For information on how to submit forms please reference Section II B 3 DRAFT LAST UPDATED APRIL 19 2011 46 VA Homeless Operations Management and Evaluation System HOMES User Manual 2 HUD VASH Monthly Status Report Form a General Inst
109. court involvement was the Veteran living in a Select the response from the drop down list that best reflects the Veteran s living situation prior to arrest for the current incarceration If selecting response 7 in another type of housing specify the other type of housing in the field provided 23 In the 12 months before the Veteran s arrest on date of arrest for the current court involvement was there a time when he or she was homeless living on the street or in a shelter Select the response from the drop down list that best reflects whether the Veteran experienced a period of homelessness living on the street or in a shelter in the last 12 months prior to arrest for the current incarceration 24 How old was the Veteran the first time he or she was arrested for a crime Enter the Veteran s age the first time he or she was arrest for a crime in the field provided Unknown Declined If the Veteran does not know or declined to respond enter N NOTE The following warning message will appear if item 24 is less than 15 years of age Item 24 indicates age at first arrest is less than 15 if correct then continue If this is correct you will confirm by clicking OK or you will correct your response DRAFT LAST UPDATED APRIL 19 2011 102 VA Homeless Operations Management and Evaluation System HOMES User Manual IV Pre Arrest Court Involvement VJO Entry Form 25
110. d and no supplemental referrals are made HOMES Episode Start Date The HOMES episode begins on the date that the Assessment Interview is completed This date is documented on the Assessment Form HOMES Veteran ID Every Veteran entered into HOMES is assigned a new Veteran HOMES ID number The HOMES ID is a permanent and unique number generated by the system Primary VAMC A Veteran s Primary VAMC is the facility that they utilize most often DRAFT LAST UPDATED APRIL 19 2011 7 VA Homeless Operations Management and Evaluation System HOMES User Manual Secondary VAMC A Veteran who lives in close proximity to another VAMC may have that VAMC designated in HOMES as a Secondary VAMC where he or she can be treated Services that occur at the Secondary VAMC will be considered within the same HOMES Episode as the primary VAMC DRAFT LAST UPDATED APRIL 19 2011 8 VA Homeless Operations Management and Evaluation System HOMES User Manual II Using the HOMES Online System A HOMES Access and User Roles Program coordinators or designated points of contact should contact NEPEC to identify VA Clinicians who require access to HOMES NEPEC User Request Contacts 203 932 5711 Leslie Cavallaro x2666 HCHV GPD HCRV VJO staff access Diane DiLella x5877 VASH staff access Ron Gniadek x5812 CWT TR and DCHV staff access The primary users of HOMES are described below e VA specialized homeless program clin
111. d by NEPEC 2 Social Security Number Automatically filled based on the Veteran information can only be edited by NEPEC 3 Date of Birth Automatically filled based on the Veteran information can only be edited by NEPEC Date This Form Completed Automatically filled based on information collected in HOMES cannot be edited 4 Did the Veteran enter the HCRV program Indicate whether or not the Veteran entered the HCRV program by selecting a response from the drop down list 5 Date of Program Entry Decision Record the month day and year of program entry decision in the field provided If the Veteran did not enter the HCRV program respond to item 6 only do not complete the remainder of the form 6 Select the main reason why Veteran did not enter the HCRV program Select the response from the drop down list that best reflects why the Veteran did not enter the HCRV program If selecting response 8 other specify the other reason why the Veteran did not enter the program You may use the optional comment field to provide additional details about the Veteran s situation If the Veteran entered the HCRV program skip item 6 DRAFT LAST UPDATED APRIL 19 2011 85 VA Homeless Operations Management and Evaluation System HOMES User Manual II Initial Contact with HCRV Program HCRV Entry Form 7 Where did HCRV staff make initial contact with this Veteran
112. d engaging process with the Veteran No once you are familiar with the data input process this actually can be quicker than paper and pencil or the current ODC method Sharing of information between forms will speed things up even more H Will I still have to input notes in CPRS Yes this first version will require you to cut and paste the HOMES data into a CPRS note as you do now with the ODC Future generations of HOMES will automatically interface with CPRS DRAFT LAST UPDATED APRIL 19 2011 118 VA Homeless Operations Management and Evaluation System HOMES User Manual L The search for a client s SSN shows a matching record but when I click on the select this client link nothing happens To avoid this problem please ensure that 1 the screen resolution on the PC monitor is set to a minimum of 1024 x 768 and 2 no other parts of the Internet Explorer browser such as favorites search browsing history are open and sharing the IE window with the HCHV system 3 the screen is maximized Reference Appendix B for instructions on how to configure browser settings J While entering a form I did something that jumped me out of the form and returned me to the previous screen What do I do Did I lose the form In Internet Explorer the BACKSPACE key is a shortcut for the Back button which returns you to the previous page that was displayed If the cursor is in a drop down field and you hit the BACKSPACE ke
113. d housing Being discharged from a hospital or other institution or Otherwise living in housing that has characteristics associated with instability and an increased risk of homelessness Veterans who are stably housed are in a stable housing situation and not at risk of losing this housing i e do not meet the criteria for any of the other housing response categories 7 Which best describes the Veteran s employment pattern during the reporting period Select the response from the drop down list that best reflects the Veteran s employment pattern during the reporting period If the Veteran was employed two weeks and unemployed for two weeks choose his or her most recent employment situation 8a Did the Veteran receive any money during the reporting period Select the response from the drop down list that best reflects whether the Veteran received money during the reporting period Unknown Omitted If 8a is no or the VJO Specialist doesn t know or omitted the item skip to item 8b 1 16 Enter amount of money that the Veteran received from each of the resources listed in items 8a 1 16 during the reporting period round to whole dollar amounts e Include income from CWT or SE in item al e Do not include the cash value of food stamps in any category e Do not include income received through a spouse significant other or other household member in any category e Round all figures to the nearest dollar
114. dd Exit Form Edit Exit Form View Exit Form HCRV Program Forms Entered No HCRV program forms entered VJO Entry Exit Forms Entered Date of Primary Secondary Entry Date Edit Entry View Entry Add Progress Exit Edit Exit View Exit Assessment VAMC VAMC Form Form Form Date Add Form Form Form Add Progress Add Exit Edit Exit Form Form Form 04 12 2011 642 642 04 12 2011 Edit Entry Form View Entry Form View Exit Form VJO Progress Reports Entered No VJO Progress Reports entered HUDVASH Entry Exit Forms Entered No HUDVASH program forms entered Add HUDVASH Entry form DRAFT LAST UPDATED APRIL 19 2011 76 VA Homeless Operations Management and Evaluation System HOMES User Manual Residential Program Exit Form Use this form to document exit of Veterans from a Grant and Per Diem program GPD HCHV Contract Residential Treatment Program Domiciliary Care for Homeless Veterans DCHV Program or Compensated Work Therapy Transitional Residence CWT TR program HOMES Episode Start Date 04 12 2011 Primary VAMC 642 Lead Case Manager N A Secondary VAMC 642 Program Entry Date 04 13 2011 Staff Login First and Last Name Matthew Berman VA Site 3 digit VAMC code plus 2 digit suffix if any 642 Date this form completed mm dd yy a713 2011 I Veteran Information Veteran s Name last name first initial p r initial Smith Social Security Number 987654321 Date of Bir
115. dd HUD VASH Entry Form button to access the form Veteran History Last Thomas First Name John SSN 123045678 Name Date of te p 03 12 1980 Sex Male r aa Edit Veteran Edit Veteran Contact Information Search for Another Veteran Assessment Intake Forms Entered Date of Assessment Primary VAMC secondary VAMC Homeless Program Referral 04 10 2011 542 642 no A HUD VASH HCHV CM VIO Edit Form y Supplemental Referral Forms Entered No Supplemental Referral forms entered Add Supplemental Referrals Residential Program Forms Entered No Residential program forms entered HCHV Program Forms Entered No HCHY program forms entered i Add HCHV Program Entry form HCRV Program Forms Entered No HCRV program forms entered VJO Entry Exit Forms Entered No VIO program forms entered Add VJO Entry form VJO Progress Reports Entered No VIO Progress Reports entered HUDVASH Entry Exit Forms Entered No HUDVASH program forms entered Add HUDVASH Entry form DRAFT LAST UPDATED APRIL 19 2011 43 VA Homeless Operations Management and Evaluation System HOMES User Manual HUD VASH Entry Form HOMES Episode Start Date 04 12 2011 Primary VAMC 642 Lead Case Manager N A Secondary VAMC 642 Matthew Berman Staff Login First and Last Name VA Site 3 digit VAMC code plus 2 digit suffix if any EA Date this form completed mm dd yy ao
116. detoxification services 3 Non VA Mental Health or Substance Abuse Services Select the response from the drop down list that best reflects the Veteran s need for non VA mental health or substance abuse services A mental health problem may include serious depression serious anxiety hallucinations violent behavior or thoughts of suicide 4 Non VA Medical Services Select the response from the drop down list that best reflects the Veteran s need for non VA medical services 5 Non VA Social Vocational Assistance Select the response from the drop down list that best reflects the Veteran s need for non VA social vocational assistance 6 Non VA Housing Select the response from the drop down list that best reflects the Veteran s need for non VA housing services 7 Non VA Income Resources Select the response from the drop down list that best reflects the Veteran s need for non VA income resources services 8 Other Select the response from the drop down list that best reflects whether the Veteran requires other non VA services Specify the recommended service s for the Veteran in the field provided d May we contact you at a later date Select the response that corresponds with whether the Veteran would like to be contacted at a later date in time DRAFT LAST UPDATED APRIL 19 2011 23 VA Homeless Operations Management and Evaluation System HOMES User Manual TIT Assessment Interview Assessment Form
117. dicates whether the Veteran served during the World War II conflict b Korean War Select the response from the drop down list that indicates whether the Veteran served during the Korean War conflict c Vietnam War Select the response from the drop down list that indicates whether the Veteran served during the Vietnam War conflict d Persian Gulf War Operation Desert Storm Select the response from the drop down list that indicates whether the Veteran served during the Operation Desert Storm conflict e Afghanistan Operation Enduring Freedom Select the response from the drop down list that indicates whether the Veteran served during the Operation Enduring Freedom conflict f Iraq Operation Iraqi Freedom Select the response from the drop down list that indicates whether the Veteran served during the Operation Iraqi Freedom conflict g Iraq Operation New Dawn Select the response from the drop down list that indicates whether the Veteran served during the Operation New Dawn conflict h Other peace keeping operations or military interventions Select the response from the drop down list that indicates whether the Veteran served during other peace keeping operations or military interventions e g Lebanon Panama Somalia Bosnia or Kosovo 19 Did you ever receive hostile or friendly fire in a combat zone Indicate whether the Veteran received hostile or friendly fire in a combat zone by selecting the corresponding
118. dit Veteran Edit Veteran Contact Information Search for Another Veteran Veteran is not currently in any HOMES program Assessment Intake Forms Entered No Assessment Intake forms entered Add Assessment Intake form Supplemental Referral Forms Entered No Supplemental Referral forms entered Residential Program Forms Entered No Residential program forms entered HCHV Program Forms Entered No HCHV program forms entered HCRV Program Forms Entered No HCRV program forms entered VJO Entry Exit Forms Entered No VJO program forms entered VJO Progress Reports Entered No VJO Progress Reports entered HUDVASH Entry Exit Forms Entered No HUDVASH program forms entered DRAFT LAST UPDATED APRIL 19 2011 20 VA Homeless Operations Management and Evaluation System HOMES User Manual Homeless Services Assessment Form VA staff member completing assessment first and last Matthew Berman SSst CSsSSS name Matthew Berman VA Site 3 digit VAMC code plus 2 digit suffix if any Lead Case Manager INA Primary VAMC V04 642 PHILADELPHIA Secondary VAMC LADELPHIA I VETERAN IDENTIFICATION 1 Veteran s name Smith John 2 Social Security number 234567890 3 Date of birth mm dd yy 03 19 1975 4 Sex Male II PRE ENGAGEMENT SCREENING May Pre engagement Screening be skipped 0 No 1 Yes select w 5 Does the Veteran want assistance with any of the f
119. dity checks Upon submission of the form a summary of responses is displayed Users can print the information or copy it to the Windows clipboard so that it can be pasted into CPRS All submissions are final and cannot be edited To make corrections please contact NEPEC contact information available in Appendix A Click the Save but do not submit button to save current progress and finish the form at a later time To return to a saved but not submitted form click on the View saved but not submitted forms button located on the Veteran search page Click the Cancel button to exit the form without saving C Veteran Record 1 Locating an Existing Veteran Record From the HOMES Main Page click 1 Add Edit Veteran s and Form s button This will open the Veteran search page To determine whether a Veteran already has a record in HOMES enter the Veteran s first and or last name SSN and or HOMES Veteran ID in the appropriate fields and click Search for Veteran Matching records will be displayed in a table If the Veteran is listed in the table click the Select button adjacent to the Veteran s name in order to view the Veteran History Screen If the Veteran does not have an existing Veteran record in HOMES follow the instructions in the following section to create a new Veteran record DRAFT LAST UPDATED APRIL 19 2011 14 VA Homeless Operations Management and Evaluation System HOMES User M
120. e O 3 Abuse VIII SATISFACTION 33 Using the scale below please tell us how satisfied the Veteran is with the following 0 1 2 3 4 VERY SOMEWHAT MOSTLY VERY COMPLETELY DISSATISFIED DISSATISFIED SATISFIED SATISFIED SATISFIED a Current accommodations b Safety of living situation c Leisure activities DRAFT LAST UPDATED APRIL 19 2011 157 VA Homeless Operations Management and Evaluation System HOMES User Manual Scoring Guide for Alcohol Use Assessment Please rate your client s use of alcohol during the last 30 days according to the following scale If the person is in an institution the reporting interval is the time period prior to institutionalization You should weight evidence from self report interviews behavioral observations and collateral reports family day center community etc in making this rating Client has not used alcohol during this time interval Abstinent 1 Client has used alcohol during this time interval but there is not evidence of persistent or recurrent social occupational psychological or physical problems related to use and no evidence of recurrent dangerous use Use Without Impairment 2 Client has used alcohol during this time interval and there is evidence of persistent or recurring social occupational psychological or physical problems related to use and no evidence of recurrent dangerous use For example recurrent alcohol use leads to
121. e Veteran received from each of the sources listed in items 10a p during the past 30 days Round to whole dollar amounts e Include income from CWT or SE in item 10a e Do not include the cash value of food stamps in any category e Do not include income received through a spouse significant other or other household member in any category e Round all figures to the nearest dollar 11 Did the Veteran receive any non cash benefits in the 30 days prior to program exit Select the response from the drop down list that indicates whether the Veteran received any non cash benefits in the 30 days prior to program exit a m Indicate whether or not the Veteran received non cash benefits from each of the sources listed in items 15a m during the 30 days prior to program exit Multiple sources of non cash benefits may be identified IV Follow up Arrangements VJO Exit Form Items 12 17 Select the code that best describes clinical treatment arrangements made at program exit 12 Alcohol Problems Select the appropriate response from the drop down list 13 Drug Problems Select the appropriate response from the drop down list 14 Mental Health Problems Other than Drug or Alcohol Select the appropriate response from the drop down list 15 Medical Problems Select the appropriate response from the drop down list 16 Social and Recreational Deficits Select the appropriate respon
122. e are arrearage or delinquency problems with any current child support orders by selecting a response from the drop down list d If 16c is yes what is the amount owed Enter the amount owed in item 16c in the field provided round to whole dollar amounts 17 Is the Veteran currently in jail Indicate whether the Veteran is currently in jail by selecting a response from the drop down list If no skip to item 22 Answer items 18 21 only if item 17 is answered Yes 18 Does the Veteran have a definite release date Select the response from the drop down list that identifies whether the Veteran has a definite release date If the Veteran has a definite release date complete item 17a If the Veteran does not have a definite release date complete item 17b a If YES what is the definite release date Enter the definite release date in item17a use the mm dd yy format b If NO what is the earliest date he or she is eligible for release or the earliest expected date of release Enter the earliest date the Veteran is eligible for release or the earliest expected date of release in 17b use the mm dd yy format 19 County and state being released to after court commitment completed Enter the county name NOT the city or town and state that the Veteran will be released to in the field provided Select the state abbreviation from the drop down list DRAFT LAST UPDATED APRIL
123. e from the drop down list Initiates HOMES path to HUD VASH program entry b HCHV Case Management Services Indicate whether the Veteran requires direct case management services beyond referral to other services by selecting a response from the drop down list Initiates HOMES path to HCHV program entry 53 Residential Treatment Transitional Housing Select a residential treatment transitional housing program if any that will best meet the needs of the Veteran Initiates HOMES path to Residential Treatment program entry If item 7 from the drop down list is selected respond to item 53a 53a What is the status of the referral to Other MH RRTP residential treatment Indicate the status of the referral to Other MH RRTP residential treatment programs by selecting a response from the drop down list 54 Services for Justice Involved Veterans Select a justice program if any that will best meet the needs of the Veteran Initiates HOMES path to HCRV Health Care for Re Entry Veterans or VJO Veteran s Justice Outreach program entry 55 VA Prevention Services a c Indicate the current status of the referral for programs listed in items 55a c by selecting a response from the drop down list VA Treatment Services 56 VA Emergency Room Indicate whether a referral has been made 57 VA Detoxification Services Indicate whether a referral has been made 58 VA Mental Health or Substance Ab
124. e most recent reporting period Unknown Omitted If the VJO Specialist doesn t know omitted the item select 99 from the drop down list and skip to item 7 1 20 For items al 20 determine and enter the number of days the Veteran spent in each of the listed settings Make sure that the responses for a t add up to 30 days for sequence 1 and for remaining progress reports sequence 2 7 time frame is 90 days and 6a 1 20 must DRAFT LAST UPDATED APRIL 19 2011 106 VA Homeless Operations Management and Evaluation System HOMES User Manual III Housing Employment Status VJO Progress Form sum to 90 6b Where was the Veteran staying the last time you had contact with him her Enter the code 1 20 99 in the field provided for the location where the Veteran was staying the last time the VJO Specialist had contact with him or her Omitted If the VJO Specialist omitted the item enter 99 6c What is the zip code of that location Record the five digit zip code of where the Veteran slept last night in the field provided i e the code indicated in item 6b Unknown If the zip code is unknown enter N 6d Is the Veteran living with others at that location Determine whether the Veteran is living with others at the location where the Veteran slept last night Select the response from the drop down list that accurately represents the Veteran s answer If the Veteran is living
125. e remainder of the form 6 Select the main reason why Veteran did not enter the VJO program Veteran left can no longer locate Veteran no longer in clinical need of program Veteran not interested in program Veteran refused to agree with terms of VJO case management Veteran is incarcerated and more than 6 months from release date 4 2 3 4 5 Since referral Veteran became too ill to participate 6 7 Veteran is not eligible for VHA healthcare 8 0 8 50185 9509 Es Tey Other specify Comment Reason Why optional II INITIAL CONTACT WITH VJO PROGRAM 7a Where did VJO staff make initial contact with this Veteran O 1 Local county or state jail 2 Criminal Court 3 Treatment Court specify type in item 7b 4 Civil Court 5 Shelter or temporary housing for homeless 6 Street park outdoors 7 Soup kitchen 8 VAMC O A i A DRAFT LAST UPDATED APRIL 19 2011 183 VA Homeless Operations Management and Evaluation System HOMES User Manual 9 Vet Center 10 Transitional Housing Program e g GPD 11 CMHC Community Mental Health Center 12 Community Hospital 13 At special program for homeless Veterans specify 14 Veteran s current residence 15 State or Federal prison includes corrections halfway house or work release facility 16 Other specify is i a ENEE If item 7a 3 Treatment Court 7b 9a 9b 10 15 16 17 Treatme
126. e time of program exit 4 What is the zip code of that location Record in the field provided the five digit zip code of the location where the Veteran lives at the time of program exit Unknown If the zip code is unknown enter N DRAFT LAST UPDATED APRIL 19 2011 113 VA Homeless Operations Management and Evaluation System HOMES User Manual III Status at Program Exit VJO Exit Form 5 Housing Stability How would you describe the Veteran s housing situation at program exit Determine whether the Veteran is literally homeless imminently losing their housing unstably housed and at risk of losing their housing or stably housed Select the corresponding response from the drop down list Examples of Veterans who are literally homeless include those who are e Living in places not designed for or ordinarily used as a regular sleeping accommodation for human beings including a car park abandoned building bus or train station airport or camping ground e n a supervised publicly or privately operated shelter designated to provide temporary living arrangements including hotels and motels paid for by Federal State or local government programs for low income individuals or by charitable organizations congregate shelters and transitional housing for homeless persons e Ina hospital or other institution if the person was sleeping in an emergency shelter or other place not meant for human habi
127. e within the geographic proximity of the military conflict not participation in combat a World War II L 0 No O 1 Yes L 98 Veteran declined to answer L 99 Interviewer omitted item DRAFT LAST UPDATED APRIL 19 2011 138 VA Homeless Operations Management and Evaluation System HOMES User Manual b Korean War L 0 No L 98 Veteran declined to answer L 99 Interviewer omitted item c Vietnam War 0 No 1 Yes 98 Veteran declined to answer 99 Interviewer omitted item d Persian Gulf War Operation Desert Storm 0 No 1 Yes 98 Veteran declined to answer 99 Interviewer omitted item 0 No 1 Yes 98 Veteran declined to answer 99 Interviewer omitted item e Afghanistan Operation Enduring Freedom 0 No 1 Yes 98 Veteran declined to answer 99 Interviewer omitted item f Iraq Operation Iraqi Freedom g Iraq Operation New Dawn 0 No 1 Yes 98 Veteran declined to answer 99 Interviewer omitted item 0 No 1 Yes 98 Veteran declined to answer 99 Interviewer omitted item h Other peace keeping operations or military interventions such as Lebanon Panama Somalia Bosnia Kosovo ooc0 aad cod aadd Bean real 19 Did you ever receive hostile or friendly fire in a combat zone O 0 No 20 L 98 Veteran declined to answer L 99 Interviewer omitted item V LIVING SITUATION During the past 30 days 1 month how many days did you sleep in Select if Veteran declined to answer or in
128. each to courts and correctional facilities that is consistent with the VJO model as a defined part of their position For VJO correctional facilities include jails but not prisons or federal or state funded correctional halfway houses or work release programs Clerks other non clinicians and non VA staff should not complete this form d Completing the VJO Progress Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Enter the Veteran s SSN first or last name or HOMES Veteran ID and click the Search for Veteran button Locate the appropriate Veteran from the list and click the Select button On the Veteran History Screen click the Add VJO Progress Report button to access the form Veteran is currently in HUDVASH Program At site 642 Assessment Intake Forms Entered 94 12 2011 SE ie VASH HCHV CM CWT TR VIO Edit Form View Form Supplemental Referral Forms Entered No Supplemental Referral forms entered Add Supplemental Referral s Residential Program Forms Entered Date of Program ram Primary Secondary a ma E Entry Edit Exit E Exit 04 12 2011 42 04 12 2011 Edit Entry Form View Entry Form 04 13 2011 Edit Exit Form View Exit Form HCHV Program Forms Entered A Enana Secondary VAMC Entry Date Edit Entry Form Ect Date Add Form__ E 04 12 2011 04 13 2011 Edit Entry Form View Entry Form 04 13 2011 Add Exit Form Edit Exit Form View Exit For
129. eady or willing to receive homeless services O Should a Veteran be referred to a program when it is known that resources within that program are currently limited e g no available vouchers in HUD VASH prior to interview of Veteran Veteran referrals are dependent on the referring clinician s knowledge of the current status of the Veteran and specific program If the clinician determines a referral to a specific program is not a viable option at that point in time an alternative plan should be developed DRAFT LAST UPDATED APRIL 19 2011 119 VA Homeless Operations Management and Evaluation System HOMES User Manual P Can Veterans simultaneously receive services from more one program If so what forms must be completed A Veteran can be in only one residential program at a time HCHV contract residential treatment GPD DCHV CWT TR but a veteran can receive other services concurrently e g a Veteran may be in a GPD program but also receive services from VJO HOMES enables Entry Forms for all programs to which a Veteran has been referred Q Must a Veteran s episode be closed before they are entered into a new program Not necessarily A Veteran may be enrolled in multiple programs at the same VAMC at the same time R Can a Veteran simultaneously receive services from programs at more than one VA medical center VAMC No An episode in HOMES records all services received at a single VAMC when a Veteran s care ch
130. earliest expected date of release mm dd yy County and state being released to County State abbreviate What will be the Veteran s status upon release including after release from corrections halfway house or work release facility 1 under parole or post custody supervision in the community L 2 no parole or post custody supervision in the community E 3 unknown or yet to be determined DRAFT LAST UPDATED APRIL 19 2011 177 20 21 22 23 24 25 VA Homeless Operations Management and Evaluation System HOMES User Manual By the time of the Veteran s release date how long will the current incarceration be including If value is less than a month enter O months for durations 0 14 days enter 1 month for durations 15 30 days a total time in jail if a portion of the current incarceration was served in jail in years and months enter all zeros for none years months b total time in prison in years and months enter all zeros for none years months Does the Veteran have a child support debt due to be paid upon release C 0 No O 1 Yes L 99 Don t know omitted a If yes what is the total amount 0 0 P IV PRE INCARCERATION HISTORY Before the Veteran s arrest on date of arrest for the current incarceration was s he living in a 1 House including own family s or friend s 2 Apartment including own family s or friend s 3 Tr
131. eceive any non cash benefits in the past 30 days g PE Yes If 31 no Veteran declined to answer or Interviewer omitted item Skip to item 32 If 31 yes indicate type s of benefits received L 98 Veteran declined to answer L 99 Interviewer omitted item a Medicaid health insurance program or similar local program LI 0 No L 1 Yes b Medicare health insurance program or similar local program LI 0 No L 1 Yes c Temporary Rental Assistance LI 0 No L 1 Yes d Homeless Prevention and Rapid Re housing Program HPRP Funds LI 0 No L 1 Yes e Veteran Service Organizations LI 0 No 1 Yes f State Children s Health Insurance Program or similar local program LI 0 No 1 Yes g Supplemental Nutrition Assistance Program SNAP or Food Stamps 0 No J 1 Yes DRAFT LAST UPDATED APRIL 19 2011 141 VA Homeless Operations Management and Evaluation System HOMES User Manual h Special Supplemental Nutrition Program for Women Infants and Children WIC L 0 No U 1 Yes i Temporary Assistance for Needy Families TANF or similar local program Child Care Services L 0 No J 1 Yes j Temporary Assistance for Needy Families TANF or similar local program Transportation Services L 0 No U 1 Yes k Other TANF funded services LI 0 No L 1 Yes Bus subway train or cab voucher LI 0 No L 1 Yes m Other
132. eclined to answer 99 Interviewer omitted item 98 Veteran declined to answer 99 Interviewer omitted item DRAFT LAST UPDATED APRIL 19 2011 137 10 11 12 13 14 15 16 17 18 VA Homeless Operations Management and Evaluation System HOMES User Manual 2 Don t know What is your current marital status choose most recent marital status O 1 Married L 4 Separated L 7 Committed relationship partnered 2 Remarried L 5 Divorced L 98 Veteran declined to answer 3 Widowed 6 Never married 99 Interviewer omitted item How many children under the age of 18 do you have Include biological children adopted children stepchildren and foster children If no children code 0 if Veteran refused or interviewer omitted code N If no children or if Veteran refused or interviewer omitted item skip to item 11 a How many of them are in your legal custody full or joint custody How many full years of formal education do you have if refused to answer code N Guidelines Use the following to help determine number of completed years If any years of graduate or professional education have been completed enter 20 years Elementary Middle High School Junior Comm 4 year College Grad Professional 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Enter 20 IV MILITARY HISTORY Identify the years in which you entered and separated from military service favor the longest per
133. economic reasons e Living in the home of another because of economic hardship e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing with others and rooms in hotels or motels not paid for by Federal State or local government programs for low income individuals or by DRAFT LAST UPDATED APRIL 19 2011 68 VA Homeless Operations Management and Evaluation System HOMES User Manual HI Status at Program Exit HCHV Case Management Exit Form charitable organizations e Living in a hotel or motel not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Living in severely overcrowded housing e Being discharged from a hospital or other institution or e Otherwise living in housing that has characteristics associated with instability and an increased risk of homelessness Veterans who are stably housed are in a stable housing situation and not at risk of losing this housing e do not meet the criteria for any of the other housing response categories 9 With whom will the Veteran be living at program exit Indicate who the Veteran was living with at the time of program exit by selecting the corresponding response form the drop down list 10 What is the Veteran s arrangement for employment at program exit Select the response from the drop down list that best describ
134. ed For what type of offense s is the Veteran currently being held 10 Violent Offense Identify whether the Veteran is currently being held for this offense by selecting a response from the drop down list Examples of violent offenses include murder manslaughter assault sexual assault including rape or child molestation robbery and domestic violence 11 Property Offense Identify whether the Veteran is currently being held for this offense by selecting a response from the drop down list Examples of property offenses include burglary breaking and entering larceny motor vehicle theft fraud stolen property arson shoplifting and vandalism 12 Drug Offense Identify whether the Veteran is currently being held for this offense by selecting a response from DRAFT LAST UPDATED APRIL 19 2011 86 VA Homeless Operations Management and Evaluation System HOMES User Manual TIT Current Incarceration HCRV Entry Form the drop down list Examples of drug offenses include possession and trafficking 13 Public Order Offense Identify whether the Veteran is currently being held for this offense by selecting a response from the drop down list Examples of public order offenses include weapons offense prostitution public intoxication disorderly conduct and driving while intoxicated DWI 14 Probation Parole Violation Identify whether the Veteran is currently being held for this of
135. eferral has been made 10 VA Detoxification Services Indicate whether a referral has been made 11 VA Mental Health or Substance Abuse Services Indicate whether a referral has been made 12 VA Medical Services Indicate whether a referral has been made 13 VA Vocational Rehabilitation Programs Indicate whether a referral has been made This includes VA CWT SE VBA Services 14 Disability Compensation Indicate whether a referral has been made 15 Pension Benefits Indicate whether a referral has been made 16 Education Indicate whether a referral has been made 17 Loan Guarantee Indicate whether a referral has been made 18 Vocational Rehabilitation and Employment Indicate whether a referral has been made 19 Insurance Indicate whether a referral has been made Non VA Services 20 Basic Services e g food clothing transportation Indicate whether a referral has been made DRAFT LAST UPDATED APRIL 19 2011 41 VA Homeless Operations Management and Evaluation System HOMES User Manual II Referral Plans Referral Form 21 Non VA Housing Indicate whether a referral has been made 22 Non VA Social Vocational Assistance Indicate whether a referral has been made 23 Non VA Income Resources and Non Cash Benefits a e Indicate whether a referral has been made 24 N
136. egal custody 11 How many full years of formal education do you have Enter the number of full years of formal education the Veteran has had Use the guidelines on the screen to help determine the number of completed years If any years of graduate or professional education have been completed enter 20 Declined Omitted If the Veteran declined to respond or the interviewer omitted the question enter N IV Military History Assessment Form 12 Identify the years in which you entered and separated from military service Identify the years in which the Veteran served in the military for the longest period of time If the Veteran served equal amounts of time in two separate periods favor a period of combat over a period of non combat a What year did you enter military service Enter the year that the Veteran entered military service b What year did you separate from military service Enter the year that the Veteran separated from military service 13 In which branch of the military did you serve the longest Select the military branch from the drop down list in which the Veteran served the longest period of time 14 In which component of the military did you serve the longest Select the component of the military from the drop down list in which the Veteran served the longest period of time 15 What was the rank status of your longest military service Select the ra
137. eight evidence from self report interviews behavioral observations and collateral reports family day center community etc in making this rating Client has not used drugs during this time interval Abstinent 1 Client has used drugs during this time interval but there is not evidence of persistent or recurrent Use Without Impairment 2 social occupational psychological or physical problems related to use and no evidence of recurrent dangerous use Client has used drugs during this time interval and there is evidence of persistent or recurring Abuse 3 social occupational psychological or physical problems related to use and no evidence of recurrent dangerous use For example recurrent drug use leads to disruptive behavior and housing problems Problems have persisted for at least one month Meets criteria for use without impairment plus at least three of the following greater amounts or Dependence 4 intervals of use than intended much of time used obtaining or using substance frequent intoxication or withdrawal interferes with other activities important activities given up because of drug use continued use despite knowledge of substance related problems marked tolerance characteristic withdrawal symptoms drugs taken to relieve or avoid withdrawal symptoms For example binges and preoccupation with drugs have caused client to drop out of job training and non drug social activities Meets criteria for depende
138. emale during the past 30 days Declined Omitted If the Veteran declined to respond or the interviewer omitted the question enter N One drink is considered one shot of hard liquor 1 5 ounces or 120z can bottle of beer or 5oz glass of wine 40 In the past 30 days how many days did you use any illegal street drugs or abuse any prescription medications Enter the number of days the Veteran used any illegal street drugs or abused any prescription medications e g marijuana heroin or methadone barbiturates downers cocaine or crack amphetamines speed hallucinogens like acid or inhalants like glue paint or nitrous oxide during the past 30 days Declined Omitted If the Veteran declined to answer or the interviewer omitted the question enter N 41 In the past 30 days how much were you bothered by cravings or urges to drink alcohol or use drugs Select the response from the drop down list that best reflects the Veteran s experience of DRAFT LAST UPDATED APRIL 19 2011 32 VA Homeless Operations Management and Evaluation System HOMES User Manual VI Employment and Income Assessment Form cravings urges to drink alcohol or use drugs during the past 30 days 42 Have you ever received professional treatment for alcohol or other substance use disorder Select the response from the drop down list that best reflects whether the Veteran has received professional treatme
139. enced by e Frequent moves because of economic reasons e Living in the home of another because of economic hardship e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing with others and rooms in hotels or motels not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Living in a hotel or motel not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Living in severely overcrowded housing e Being discharged from a hospital or other institution or e Otherwise living in housing that has characteristics associated with instability and an increased risk of homelessness Veterans who are stably housed are in a stable housing situation and not at risk of losing this housing i e do not meet the criteria for any of the other housing response categories 9 With whom will the Veteran be living at program exit Indicate who the Veteran was living with at the time of program exit by selecting the corresponding response from the drop down list 10 What is the Veteran s arrangement for employment at program exit Select the response from the drop down list that best describes the Veteran s employment arrangement at the time of program exit e Ifthe Veteran was in vocational training and this training was also a part time job
140. ent Review the clinical rating scale and select the response that corresponds with the Veteran s use of alcohol during the past 30 days by selecting a response from the drop down list A link to the Scoring Guide for Alcohol Use Assessment can be found on the Main Page screen of HOMES 32 Review the clinical rating scale for Veteran s use of illegal drugs in the past 30 days shown above and indicate your Assessment Review the clinical rating scale and indicate your Assessment of the Veteran s use of illegal drugs over during the past 30 days by selecting a response from the drop down list A link to the Scoring Guide for Drug Use Assessment can be found on the Main Page screen of HOMES VIII Satisfaction HUD VASH Monthly Status Report Form 33 Using the scale below please tell us how satisfied the Veteran is with the following 33a c Use the scale displayed within the system to rate how satisfied the Veteran is with the items listed in 33a c Select the response that corresponds with the Veteran s current level of satisfaction For information on how to submit forms please reference Section II B 3 DRAFT LAST UPDATED APRIL 19 2011 54 VA Homeless Operations Management and Evaluation System HOMES User Manual 3 HUD VASH Exit Form a General Instructions Use this form to document Veteran exit from the HUD VASH program See Appendix H for the HUD VASH Exit Fo
141. ent or house 8 Staying or living in friend s room apartment or house 9 GPD transitional housing 10 Non VA transitional housing for homeless persons 11 Safe Haven special transitional supportive housing or drop in supportive service center for homeless SMI individuals 12 VA Mental Health Residential Rehabilitation Program MH RATP all types DCHV CWT TR SA RRTP PTSD RRTP General RRTP 13 VA contracted residential treatment programs ATU HWH or HCHV contract 14 Non VA residential treatment program 15 Non psychiatric hospital acute care 16 Psychiatric hospital acute care 17 Hotel or motel paid for without emergency shelter voucher 18 Emergency shelter including hotel or motel paid for with emergency shelter voucher 19 Prison jail 20 Place not meant for habitation outdoors automobile truck boat 21 Don t know eet at at Pe a O A o What is the zip code of that location Code N in 1 space if unknown Housing stability How would you describe the Veteran s housing situation at program exit O 1 Literally homeless 2 Imminent risk of losing housing 3 Unstably housed at risk of losing housing L 4 Stably housed O 5 Don t know With whom will the Veteran be living at program exit 0 No residence 1 Alone 2 With spouse partner or children 3 With parents with siblings or with other family 4 With friends 5 With strangers Ka a Et 6 Don t know What is the V
142. ential Treatment Entry Formulas 72 2 Residential TreatmentExit Form dic 76 I HERW EORMS EEE T ET E eS A eS S ee ee E 83 Is HERV Entry FOP a Gres a tele ERR E E 83 2 TIGR VERE OLN LAA AET EEE AEE E ln E E E EEEE 90 J NVIJIOFORM 0d un An AA tice Soe Ea SRR is Sea REE T 97 1 VIO Entry Ormond tess diia eii iii 97 2 VIJO Progress Form ieo e E A E E O R N RTEA E E ARSEN e EEOAE ENa 104 3 VIDE NLF OVINE A a e a a a a E e e E E E EE S EE OS 111 IV FREQUENTLY ASKED QUESTIONS ccsssssssssssccssssssccsssseccssssscccssssccccssccscessscscssssccscsssessessececessnees 118 APPENDIX A HOMELESS PROGRAM STAFP ssscccsssscssssscccsssscccsssssccesssccccssceccesssscccsssacccssssssscssseccssseee 121 A gt NEPEC CONTAGTS AND WEBSITES at diia bepesevaetves 121 B NATIONAL HOMELESS PROGRAM CONTACTS cocccocononononononononononononononononononononononononononononononononononononininininininens 122 APPENDIX B INSTRUCTIONS TO CONFIGURE BROWSER SETTINGS u ccssssscsssssccssscecscssscccesseee 123 APPENDIX ACRONYMS wesssccsssonssoseccnssesssoassstccsdecsccssdeetecstucsacsevecsosesdecseousteesoenstesseuendssds in Minsa ondaa cocinera 127 APPENDIX D REFERRAL PROGRAM DESCRIPTIONG cccssssscssssssscesssscccssssccesssscccssssccssssssccesssseccssnee 129 APPENDIX E ACCESS REQUEST FORM cssssccssssssssssssccssssccsssscccssssccccessaccccssncccesssscscsssaccscssssecsssecsessnses 135 APPENDIX F ASSESSMENT FORM WORKSHEET
143. eping accommodation for human beings including a car park abandoned building bus or train station airport DRAFT LAST UPDATED APRIL 19 2011 107 VA Homeless Operations Management and Evaluation System HOMES User Manual III Housing Employment Status VJO Progress Form or camping ground e n a supervised publicly or privately operated shelter designated to provide temporary living arrangements including hotels and motels paid for by Federal State or local government programs for low income individuals or by charitable organizations congregate shelters and transitional housing for homeless persons e Ina hospital or other institution if the person was sleeping in an emergency shelter or other place not meant for human habitation cars parks streets etc immediately prior to entry into the hospital or institution e Fleeing a domestic violence situation Veterans who are imminently losing their housing include those who e Are currently housed and not literally homeless e Are imminently losing their housing whether permanent or temporary e Have no subsequent housing options identified and e Lack the resources or support networks needed to retain current housing or obtain temporary or permanent housing Examples of imminent housing loss include e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing from others and rooms in hotels or mo
144. er omitted item skip to item 15 If 14 yes indicate type s of benefits received LI 99 Case manager omitted item a Medicaid health insurance program or similar local program L 0 No 1 Yes b Medicare health insurance program or similar local program LI 0 No 1 Yes c Temporary Rental Assistance LI 0 No L 1 Yes d Homeless Prevention and Rapid Re housing Program HPRP Funds L 0 No U 1 Yes e Veteran Service Organizations L 0 No U 1 Yes f State Children s Health Insurance Program or similar local program L 0 No U 1 Yes g Supplemental Nutrition Assistance Program SNAP or Food Stamps LI 0 No L 1 Yes h Special Supplemental Nutrition Program for Women Infants and Children WIC LI 0 No L 1 Yes i Temporary Assistance for Needy Families TANF or similar local program Child Care Services LI 0 No L 1 Yes j Temporary Assistance for Needy Families TANF or similar local program Transportation Services LI 0 No L 1 Yes k Other TANF funded services L 0 No 1 Yes Bus subway train or cab voucher L 0 No 1 Yes m Other L 0 No U 1 Yes DRAFT LAST UPDATED APRIL 19 2011 181 VA Homeless Operations Management and Evaluation System HOMES User Manual IV FOLLOW UP ARRANGEMENTS Select the code that best describes clinical treatment arrangements made at program exit 15 Alcohol problems
145. ersons who identify themselves as Hispanic or Latino Ask the Veteran which ethnic background he or she identifies with most strongly and select the corresponding response from the drop down list Staff observations should not be used to determine ethnicity The definition of Hispanic or Latino ethnicity is a person of Cuban Mexican Puerto Rican South or Central American or other Spanish culture of origin regardless of race 9 What is your current marital status Select the response from the drop down list that corresponds with the Veteran s current most recent marital status For example if the Veteran was married and then separated choose separated 10 How many children under the age of 18 do you have Enter the number of the Veteran s children that are under the age of 18 Include biological children adopted children stepchildren and foster children Describe the Veteran s current situation Declined Omitted If the Veteran declined to respond or the interviewer omitted the question enter N DRAFT LAST UPDATED APRIL 19 2011 24 VA Homeless Operations Management and Evaluation System HOMES User Manual III Assessment Interview Assessment Form YES If the Veteran has children under the age of 18 answer item 10a a How many of them are in your legal custody Enter the number of the Veteran s children under the age of 18 who are currently in the Veteran s full or joint l
146. ervices e g food clothing transportation No 68 Non VA housing No 69 Non VA social vocational assistance No 70 Non VA income resources and non cash benefits a SSI or SSDI No b TANF No c Food Stamps or SNAP No d GA General Assistance No e WIC No 71 Non VA Emergency Room medical or psychiatric No 72 Non VA detoxification services No 73 Non VA mental health or substance abuse services No 74 Main program affiliation of interviewer Healthcare for Re entry Veterans HCRV 75 How was contact for this interview initiated Referred by jail or prison staff Copy to ClipBoard Print Return to Veteran History Update Veteran Contact information DRAFT LAST UPDATED APRIL 19 2011 37 VA Homeless Operations Management and Evaluation System HOMES User Manual E Supplemental Referral Form 1 General Instructions The Supplemental Referral Form is used to refer Veterans to other programs The Veteran may be enrolled in more than one program at a time except for residential programs See Appendix G for a copy of the Supplemental Referral Form Worksheet 2 When to complete and submit the Supplemental Referral Form This form is available upon submission of original Assessment and through 30 days after ending a HOMES episode If it is outside this timeframe the clinician will need to initiate a new HOMES episode by completing a new Assessment Form 3 Who may complete and submit the Supplementa
147. es Bus subway train or cab voucher LI 0 No 1 Yes m Other LI 0 No L 1 Yes DRAFT LAST UPDATED APRIL 19 2011 194 VA Homeless Operations Management and Evaluation System HOMES User Manual IV Follow up Arrangements Select the code that best describes clinical treatment arrangements made at program exit 12 13 14 15 16 17 18 Alcohol problems 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider cl i 4 Veteran s treatment has been arranged with both non VA and VA provider Drug problems 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider aaa a 4 Veteran s treatment has been arranged with both non VA and VA provider Mental health problems other than drug or alcohol 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider EEE 4 Veteran s treatment has been arranged with both non VA and VA provider Medical problems L 0 Nota problem area
148. es the Veteran s employment arrangement at the time of program exit e If the Veteran was in vocational training and this training was also a part time job please list this only as vocational training e If more then one category applies choose the response that represents the Veteran s highest level of employment 11 What is the Veteran s arrangement for receipt of VA financial benefits disability payments or pension at the time of program exit Select the response from the drop down list that best describes the Veteran s arrangement for receipt of VA financial benefits disability payments or pensions at the time of program exit 12 What is the Veteran s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit Select the response from the drop down list that best describes the Veteran s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit 13 Did the Veteran receive any money in the 30 days prior to program exit Select the response from the drop down list that indicates whether the Veteran received any money in the 30 days prior to program exit a p Enter the amount of money the Veteran received from each of the sources listed in items 13a p during the past 30 days Please note DRAFT LAST UPDATED APRIL 19 2011 69 VA Homeless Operations Managemen
149. ess homeless Veteran data U S Department of Housing and Urban Development Office of Community Planning and Development 2011 Veteran Homelessness A Supplemental Report to The Annual Homeless Assessment Report to Congress February 2011 U S Interagency Council on Homelessness Opening Doors Federal Strategic Plan to Prevent and End Homelessness 2010 DRAFT LAST UPDATED APRIL 19 2011 1 VA Homeless Operations Management and Evaluation System HOMES User Manual These data will help VA to identify and understand the needs of homeless Veterans and to develop programs and services to address those needs Thus data collection in HOMES is an essential tool for combating Veteran homelessness HOMES provides a single point of data entry that satisfies the requirements of the Northeast Program Evaluation Center NEPEC the Computerized Patient Record System CPRS and Homeless Management Information System HMIS Data Standards Currently data are entered into HOMES for the following homeless case management programs residential treatment programs and services for justice involved Veterans e Housing and Urban Development VA Supported Housing HUD VASH e Healthcare for Homeless Veterans HCHV e Grant and Per Diem GPD e Domiciliary Care for Homeless Veterans DCHV e Compensated Work Therapy Transitional Residences CWT TR e Healthcare for Re entry Veterans HCRV e Veterans Justice Outreach VJO Data
150. eteran s arrangement for employment at program exit 0 Disabled or retired Unemployed Actively seeking employment Part time or temporary employment Full time employment VA s IT or CWT VI Other vocational training Unpaid volunteer Student Don t know NEVE EEE Ey TE ELE O AN DOA A OON What is the Veteran s arrangement for receipt of VA financial benefits disability payments or pension at the time of program exit DRAFT LAST UPDATED APRIL 19 2011 161 13 14 15 VA Homeless Operations Management and Evaluation System HOMES User Manual 0 Currently receiving VA benefits and will continue 1 Has pending application for VA financial benefits 2 Is planning to apply for VA financial benefits 3 Is neither receiving nor planning to apply for any VA financial benefits A E a 4 Do not know Veteran s status with respect to VA financial benefits What is the Veteran s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit 0 Currently receiving non VA benefits and will continue 1 Has pending application for non VA financial benefits 2 Is planning to apply for non VA financial benefits O 3 Is neither receiving nor planning to apply for any non VA financial benefits 4 Do not know Veteran s status with respect to non VA financial benefits Did the Veteran receive any money in the 30 days pri
151. eteran s name last name first initial i homas John 2 Social Security Number 123045678 3 Date Of Birth mm dd yy 0371271980 II Reasons for Program Exit Ls Which is the most important reason why the Veteran ended involvement in HUD VASH case management Veteran accomplished his her goals and or obtained access to services and no longer has a need for this program Veteran transferred to another HUD VASH program site Veteran found chose other housing Veteran did not comply with HUD VASH case management Veteran was evicted from his her HUD VASH apartment by PHA or landlord and or had other housing related issues or problems Veteran unhappy with HUD VASH housing Veteran is no longer financially eligible for a HUD VASH voucher Veteran is no longer interested in participating in this program Veteran cannot be located Veteran too ill to participate in HUD VASH at this time 11 Veteran is incarcerate Veteran is deceased 13 Other please specify 210 ON HU WN be Use the instructions below to complete the form General HUD VASH Exit Form HOMES Episode Start Date Automatically filled based on information collected in HOMES cannot be edited Lead Case Manager n a in Phase 1 of HOMES Automatically filled based on information collected in HOMES cannot be edited Program Entry Date Automatically filled based on information collected in HOMES cannot be edited Primary VAMC
152. f care DRAFT LAST UPDATED APRIL 19 2011 145 VA Homeless Operations Management and Evaluation System HOMES User Manual 60 VA vocational rehabilitation programs O 0 No including VA CWT SE O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care VBA Services 61 Disability compensation O 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 62 Pension benefits _ 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 63 Education L 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 64 Loan guaranty O 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 65 Vocational rehabilitation and employment L 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 66 Insurance L 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care Non VA services 67 Basic services e g food clothing L 0 No transportati
153. fense by selecting a response from the drop down list 15 Other Unspecified Identify whether the Veteran is currently being held for this offense by selecting a response from the drop down list 16 Had the Veteran been drinking any alcohol or was s he under the influence of a drug or drugs at the time of the offense for which s he is now incarcerated Select the response from the drop down list that best reflects whether the Veteran had been drinking alcohol or was under the influence of a drug s at the time of the offense for which he or she is now incarcerated 17 Does the Veteran Have a Definite Release Date Select the response from the drop down list that identifies whether the Veteran has a definite release date If the Veteran has a definite release date complete item 17a If the Veteran does not have a definite release date complete item 17b a If YES what is the release date Enter the definite release date in item 17a use the mm dd yy format b If NO what is the earliest date he or she is eligible for release or the earliest expected date of release Enter the earliest date the Veteran is eligible for release or the earliest expected date of release in item 17b use the mm dd yy format 18 County and State Being Released to Enter the county name NOT the city or town and state that the Veteran will be released to in the field provided Select the state abbreviation fro
154. ferral made will continue monitoring of care Services for Justice Involved Veterans O 1 None L 2 Veterans Justice Outreach VJO LU 3 Healthcare for Re entry Veterans HCRV VA prevention services a HUD VA Pilot O 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care b Supported Service for Veterans Families SSVF O 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care c Rapid Rehousing L 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care VA treatment services Referral made and service initiated no further follow up needed NO 56 VA Emergency Room medical or psychiatric O 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 57 VA detoxification services 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 58 VA mental health or substance abuse services L 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 59 VA medical services L 0 No O LJ Referral made will continue monitoring o
155. for Homeless Veterans Programs the Twenty First Annual Report March 17 2008 4 Ibid 5 Ibid DRAFT LAST UPDATED APRIL 19 2011 129 VA Homeless Operations Management and Evaluation System HOMES User Manual 6 Ibid GPD Transitional Housing The GPD program establishes transitional housing and support services to homeless veterans through partnerships with community nonprofit and local government agencies Per diem payments support ongoing operational support for transitional housing facilities Some community partners may also receive assistance for the construction or renovation of the facilities Veterans entering the GPD program face economic medical substance abuse and psychiatric problems DCHV Residential Treatment The DCHV program offers rehabilitative services for physically and mentally ill or aged homeless Veterans who need assistance but are not in need of the level of care offered by hospitals and nursing homes The program for homeless Veterans is designed to reduce the use of more expensive inpatient treatment improve health status and reduce the likelihood of homelessness through employment and other assistance CWT TR Residential Treatment The CWT program provides work experience and skills to Veterans with disabilities with the intent for them to re enter the workforce and maintain employment on their own Through this program VA may employ Veterans directly find work for Veterans at other federal
156. ft blank the system will display an error message prompting the user to answer the incomplete item As forms are completed built in validity checks are conducted These validity checks are designed to enhance data integrity The following DRAFT LAST UPDATED APRIL 19 2011 13 VA Homeless Operations Management and Evaluation System HOMES User Manual examples demonstrate a pop up error message and an embedded error message indicating that responses within the form are inconsistent and or incomplete Windows Internet Explorer A Please specify the date this form was completed Errors on the page please fix the errors before submitting the form The system is also designed to navigate the user through the form such that required items are answered and items that are not applicable are skipped When these skip patterns appear in a form one or more items may become grayed out and locked i e unanswerable based on a response to a previous item In addition to enhancing data integrity this feature facilitates the data entry process by allowing users to quickly identify and respond to appropriate items 3 Form Submission After entering data into a form the user may submit the form save it for review submission at a later time or cancel the form To submit a form click the Submit button at the end of the form A prompt may appear with instructions for correcting remaining errors identified by the built in vali
157. g oarhowonr referral and linkage to VA and or non VA service provider s no further VJO contact anticipated case management by VJO specialist no court or probation supervision case management by VJO specialist ongoing monitoring by court or probation direct treatment by VJO specialist no court or probation supervision direct treatment by VJO specialist ongoing monitoring by court or probation Other specify DRAFT LAST UPDATED APRIL 19 2011 186 VA Homeless Operations Management and Evaluation System HOMES User Manual C VJO Progress Form Worksheet Staff member completing this form first and last name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed mm dd yy 2 cssseeeeeeeeeees 1 Veteran s name last name first initial 2 Social Security NUMDET oococcocinccnconncnnconinnananinnnnnnos 3 Date of birth MM AA yy ooococcoccccoccnncnccnconcnnnnnnnos 4 Date of VJO Treatment Court entry mm dd yy es pe i o Il Contact with Veteran IMPORTANT NOTE Report sequence number and time period covered in this report are provided on the forms due list that is posted on NEPEC s secure website THIS INFORMATION WILL ALSO BE AUTOMATICALLY FILLED INHOMES Please make sure that this information matches both the forms due list and HOMES Contact NEPEC with any q
158. g two questions Then determine the length of homelessness using the calculation described below 1 When was the last time you had an apartment room or house in which to live for 30 days or more Note to clinician use your judgment when determining what constitutes a regular residence Other people s homes count as a regular residence if the Veteran had a regular sleeping place there could receive mail and was not expected to be only a temporary guest 2 Since that time how long have you spent in a hospital a residential treatment facility or a correctional facility DRAFT LAST UPDATED APRIL 19 2011 29 VA Homeless Operations Management and Evaluation System HOMES User Manual V Living Situation Assessment Form To calculate the length of homelessness subtract the number of days spent in a hospital residential treatment or correctional facility question 2 from the number of days since the Veteran last had a home for 30 days or more question 1 26 How many separate episodes of homelessness have you experienced in the last three years Determine the number of homeless periods the Veteran experienced during the past three years and select the corresponding response from the drop down list If the Veteran is currently homeless include the current episode in this count It may take time and additional questioning to obtain accurate information about instances of homelessness during the past year
159. gram c This form should be completed and submitted as it is determined that the Veteran will exit HCHV case management Who may complete and submit the HCHV Case Management Exit Form An HCHV clinician who is familiar with the Veteran should complete and submit the HCHV Case Management Exit Form Clerks other non clinicians and non VA staff should not complete this form d Completing the HCHV Case Management Exit Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Enter the Veteran s SSN first or last name or HOMES Veteran ID and click the Search for Veteran button Locate the appropriate Veteran from the list and click the Select button On the Veteran History Screen click the Add HCHV Case Management Exit Form button to access the form Veteran is currently in HCHV Program At site 642 Veteran is currently in Residential Program At site 642 Veteran is currently in VJO Program At site 642 Assessment Intake Forms Entered Date of Assessment Primary VAMC Secondary VAMC Homeless Program Referrals __ Edit Form View Form 04 12 2011 642 642 HUD VASH HCHV CM CWT TR VJO Edit Form View Form Supplemental Referral Forms Entered No Supplemental Referral forms entered Add Supplemental Referral s Residential Program Forms Entered Date of Program Primary Secondary Toe View Entry Edit Exit View Exit aA VAMC VAMC E Form Bst Date Add Form _ Form Form 2 add Exit
160. h MmM dWVyy oococoococcccccccncnncnncncnnnnnnoo o ll REASONS FOR PROGRAM EXIT 4 Date HCRV program participation ended for this Veteran 5 What is the most important reason why the Veteran ended involvement in HCRV O 1 Veteran accomplished his her goals and or obtained access to services and no longer has a need for this program 2 Veteran ending services at this program but will continue at another VA medical center Veteran did not comply with HCRV program rules Veteran is no longer interested in participating in this program Veteran released from prison to a geographic area not served by this HCRV program Veteran too ill to participate in HCRV at this time Veteran is incarcerated 3 4 5 6 Veteran cannot be located 7 8 9 Veteran is deceased 4 Ei 201 EME ven 0 Other please specify If item 5 9 Veteran is deceased do not complete remainder of form lll STATUS AT PROGRAM EXIT 6 What is the Veteran s housing arrangement at program exit Housing owned by Veteran no ongoing housing subsidy Housing owned by Veteran with ongoing housing subsidy Housing rented by Veteran no ongoing housing subsidy Housing rented by Veteran with HUD VASH voucher 4 2 3 4 5 Housing rented by Veteran with non HUD VASH housing subsidy 6 Permanent housing for formerly homeless persons such as SHP S C or SRO MOD Rehab 7 Staying or living in family member s room apartment or house
161. he response from the drop down list that indicates the type of specialty court the Veteran is entering If selecting response 7 Other Specialty Court specify the other type in the field provided 28 Date of Entry to Treatment Court Enter the Veteran s date of entry into the treatment court in the field provided use the mm dd yy format 29 Please indicate the status of clients not entering a Treatment Court Select a response from the drop down list that indicates the status of the Veteran not entering a treatment court If selecting response 6 Other specify the other reason why the Veteran is not entering a treatment court in the field provided For information on how to submit forms please reference Section II B 3 DRAFT LAST UPDATED APRIL 19 2011 103 VA Homeless Operations Management and Evaluation System HOMES User Manual 2 VJO Progress Form a General Instructions Use this form to document Veteran progress in the VJO program See Appendix L for the VJO Progress Form Worksheet b When to complete and submit the VJO Progress Form Report 1 is completed 1 month after program entry Report 2 6 months post entry Report 3 1 year post entry report 4 2 years post entry etc c Who may complete and submit the VJO Progress Form Staff members who fill out the VJO Progress Report should be regular staff of the VJO program or staff of another VA mental health program who conduct outr
162. heir browser settings If you are unable to reconfigure your browser settings you can refer to the guidelines provided here to complete the UserID Password Domain fields to access the VSSC web page Please note these prompts need to be completed with your network userid password domain information i e the information you use to logon to your PC each day not your Austin access codes If you need assistance please contact your local Information Resource Management Service IRMS or contact the VSSC KLF Help Desk at http klfmenu med va gov FAQ HD_request asp First box userid Second box password Third box domain First box domain userid please overwrite anything that the system may automatically enter in this first box and type this instead Second box password Browser Configuration Instructions for Users Required to Access Internet Sites Through a Proxy Server Although most of VHA does not use proxies there are still a few sites that do If you are at one of those sites please follow these instructions to configure your browser If you are not sure if this pertains to your site contact your local IRMS Microsoft Internet Explorer IE 6 0 or higher e Open Microsoft IE DRAFT LAST UPDATED APRIL 19 2011 125 VA Homeless Operations Management and Evaluation System HOMES User Manual e Click Tools then Internet Options then click the Connections tab at the top e Cli
163. her family and others on his of her behalf in the past 30 days a i For items 16a i enter in the field provided the number of contacts the clinician had with the Veteran his or her family and others on his or her behalf during the past 30 days include contacts by the current case manager and any former acting HUD VASH clinicians 17 How many face to face visits with the Veteran occurred in the Veteran s apartment during the past 30 days In the field provided enter the number of face to face visits with the Veteran that occurred in the Veteran s apartment during the past 30 days IV Residential Status HUD VASH Monthly Status Report Form 18 What was the Veteran s housing arrangement the last time you had contact with him her during this reporting period Select the response from the drop down list that reflects the Veteran s housing arrangement the last time that contract was had with him or her during this reporting period 19 What is the zip code of that location Record in the field provided the five digit zip code of the location where the Veteran was staying the last time that contact was had with him or her during this reporting period i e the location indicated in item 18 Unknown If the zip code is unknown enter N DRAFT LAST UPDATED APRIL 19 2011 51 VA Homeless Operations Management and Evaluation System HOMES User Manual IV Residential Status HUD
164. hout emergency shelter voucher r Emergency shelter including hotel or motel paid for with emergency shelter voucher s Prison jail t Place not meant for habitation outdoors automobile truck boat Total Days Total days automatically calculated in HOMES 21 In which one of the above locations did you sleep last night Code a t Code 98 if Veteran declined to answer Code 99 if interviewer omitted item 22 What is the zip code of that location Code N in 1 space if unknown 23 Are you living with others at that location If yes does the household include 23a spouse significant other 23b children under 18 list number 23c related adults list number 23d unrelated adults list number O 0 No Ll 1 Yes L 98 Veteran decline to answer L 99 Interviewer omitted item Jo No 1 Yes 24 Housing stability How would you describe your current housing situation O 1 Literally homeless 2 Imminent risk of losing housing 3 Unstably housed at risk of losing housing L 4 Stably housed 5 Don t know 98 Veteran declined to answer 99 Interviewer omitted item If item 24 literally homeless answer item 25 otherwise skip to item 26 25 How long have you been homeless Time homeless is amount of time since client had an apartment room or house to stay in for 30 days or more minus time spent in institutional settings like hospitals or jail priso
165. ical gambling L 0 No 1 Yes d Schizophrenia L 0 No 1 Yes DRAFT LAST UPDATED APRIL 19 2011 143 VA Homeless Operations Management and Evaluation System HOMES User Manual e Other psychotic disorder L 0 No 1 Yes f Bipolar disorder L 0 No 1 Yes g Military related PTSD L 0 No 1 Yes h Non Military related PTSD L 0 No 1 Yes i Anxiety disorder L 0 No 1 Yes j Affective disorder including depression L 0 No 1 Yes k Adjustment disorder L 0 No 1 Yes Nicotine dependence L 0 No 1 Yes m Organic brain syndrome L 0 No L 1 Yes n Personality disorder L 0 No L 1 Yes o Other psychiatric disorder L 0 No L 1 Yes 45a Does this Veteran need psychiatric treatment at this time 0 No 1 Yes 45b Is the Veteran interested and willing to participate in psychiatric treatment 0 No 1 Yes Don t know 46a Does this Veteran need substance abuse treatment at this time 0 No 1 Yes 46b Is the Veteran interested and willing to participate in substance abuse 0 No 1 Yes Don t know treatment 47a Does this Veteran need medical treatment at this time 0 No 1 Yes 47b Is the Veteran interested and willing to participate in medical treatment 0 No 1 1 Yes J Don t know 48a Does this Veteran need case management 0 No 1 Yes 48b Is the Veteran interested and willing to participate in case management 0 No 1 Yes J Don t
166. ically filled based on the Veteran record can only be edited by NEPEC DRAFT LAST UPDATED APRIL 19 2011 49 VA Homeless Operations Management and Evaluation System HOMES User Manual I Veteran Identification HUD VASH Monthly Status Report Form 3 Date of Birth Automatically filled based on the Veteran record can only be edited by NEPEC II Housing Progress HUD VASH Monthly Status Report Form 4 What is the Veteran s voucher status as of this report Indicate whether the Veteran will have a HUD VASH voucher obtained through the HUD VASH program as of the end of the reporting period by selecting a response from the drop down list 5 PHA Number Enter the number of the PHA to which the Veteran s referral package was forwarded e g AA123 6 Date Referral Package was Forwarded to the PHA Enter the date that the referral package was forwarded to the PHA in the fields provided use the mm dd yy format 7 Date Voucher was Issued by the PHA Enter the date that the voucher was issued by the PHA in the field provided use the mm dd yy format 8 Date Voucher was Denied by the PHA Enter the date that the voucher was denied by the PHA in the field provided use the mm dd yy format 9 Date Voucher was Revoked or Expired Enter the date that the voucher was revoked or expired in the field provided use the mm dd yy format 10 Date Housing Selected by
167. icians have the primary responsibility for entering data on all forms that track a Veteran s HOMES episode o Staff have access only to the Veteran Record Veteran Contact Information Assessment and Entry and Exit Forms for the program to which they are assigned however staff may be assigned to more than one program o Inclusion on email notifications regarding program referrals can be specified independently for each staff role e Non clinicians including administrative support staff may access forms as read only NEPEC staff will maintain user access to HOMES and edit submitted data as necessary Please contact NEPEC to make any edits to activity submitted in HOMES B Veteran Record The Veteran record is critical for identifying and tracking Veterans within HOMES The Veteran record includes the Veteran s name Social Security Number SSN date of birth gender and HOMES Veteran ID Name SSN date of birth and gender are collected during the first contact with the Veteran Unlike most other forms fields in the Veteran Record may be edited by users other than NEPEC administrators The HOMES Veteran ID is a computer generated number assigned to each Veteran when the record is created Once the Veteran is entered into HOMES Veteran record information is used to search for and locate the Veteran within the system The HOMES ID and SSN are unique to each Veteran and are the most reliable information to use when searching for a Veteran
168. icrosoft Internet Explorer IE 6 0 or higher 1 Click Tools then Internet Options then click the Connections tab at the top 2 Click the LAN Settings button 3 Make sure Use a proxy server is not checked 4 Click OK 5 Click the Security tab 6 Click the Local Intranet icon to highlight it 7 Click the Sites button 8 Make sure the boxes for all three settings for webs to be included are checked DRAFT LAST UPDATED APRIL 19 2011 123 VA Homeless Operations Management and Evaluation System HOMES User Manual 9 Click the Advanced button 10 Enter http va gov into the Add this Web site to the zone box 11 Click the Add button 12 Repeat steps 10 and 11 for the following web address https va gov note the https which makes this entry different from the one in step 10 13 Click OK twice until back at the Internet Option box 14 Click the Advanced tab 15 Scroll down to the Security section 16 Check the checkbox labeled Enable Integrated Windows Authentication 17 Close and then re open IE Changing Security Settings One of the primary reasons that users cannot get to the VSSC web site or are prompted for the NT UserID is that the security setting on the browser is set too high Following are instructions for adjusting the security level Microsoft Internet Explorer IE 6 0 or higher 1 Click Tools then Internet Options then
169. ilities that is consistent with the VJO model as a defined part of their position For VJO correctional facilities include jails but not prisons or federal or state funded correctional halfway houses or work release programs Clerks other non clinicians and non VA staff should not complete this form d Completing the VJO Exit Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Enter the Veteran s SSN first or last name or HOMES Veteran ID and click the Search for Veteran button Locate the appropriate Veteran from the list and click the Select button On the Veteran History Screen click the Add VJO Exit Form button to access the form Veteran is currently in HCHV Program At site 642 Veteran is currently in Residential Program At site 642 Veteran is currently in VJO Program At site 642 Assessment Intake Forms Entered Date of Assessment Primary VAMC Secondary VAMC _ Homeless Program Referrals __ Edit Form View Form 04 12 2011 642 642 HUD VASH HCHV CM CWT TR VJO Edit Form View Form Supplemental Referral Forms Entered No Supplemental Referral forms entered Add Supplemental Referral s Residential Program Forms Entered Date of Program Primary Secondary eat Entry View Entry Edit Exit View Exit Add Exit Form 04 12 2011 642 42 04 12 2011 Edit Entry Form View Entry Form 04 13 2011 Edit Exit Form View Exit Form HCHV Program Forms Entered Date
170. ill to participate in HCHV at this time 7 Veteran is incarcerated L 8 Veteran is deceased O 9 Other specify If item 5 8 Veteran is deceased do not complete remainder of the form lil STATUS AT PROGRAM EXIT 6 What is the Veteran s housing arrangement at program exit 1 Housing owned by Veteran no ongoing housing subsidy 2 Housing owned by Veteran with ongoing housing subsidy O 3 Housing rented by Veteran no ongoing housing subsidy 4 Housing rented by Veteran with HUD VASH voucher O 5 Housing rented by Veteran with non HUD VASH housing subsidy O 6 Permanent housing for formerly homeless persons such as SHP S C or SRO MOD Rehab O 7 Staying or living in family member s room apartment or house O 8 Staying or living in friend s room apartment or house O 9 GPD transitional housing O 10 Non VA transitional housing for homeless persons 11 Safe Haven special transitional supportive housing or drop in supportive service center for homeless SMI O VA Mana Health Residential Rehabilitation Program MH RATP all types DCHV CWT TR SA RRTP PTSD RRTP General RRTP 13 VA contracted residential treatment programs ATU HWH or HCHV contract 14 Non VA residential treatment program 15 Non psychiatric hospital acute care 16 Psychiatric hospital acute care DRAFT LAST UPDATED APRIL 19 2011 165 10 11 12 VA Homeless Operations Management and Evaluation System HOMES U
171. in vocational training and this training was also a part time job please list this as vocational training e If more than one category applies choose the response that represents the Veteran s highest level of employment 8 What is the Veteran s arrangement for receipt of VA financial benefits disability payments or pension at the time of program exit Select the response from the drop down list that best describes the Veteran s arrangement for receipt of VA financial benefits disability payments or pensions at the time of program exit 9 What is the Veteran s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit Select the response from the drop down list that best describes the Veteran s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit DRAFT LAST UPDATED APRIL 19 2011 115 VA Homeless Operations Management and Evaluation System HOMES User Manual III Status at Program Exit VJO Exit Form 10 Did the Veteran receive any money in the 30 days prior to program exit Select the response from the drop down list that indicates whether the Veteran received any money in the 30 days prior to program exit Ifa Veteran reports receiving no income from any source in the past 30 days no additional data collection is required a p Enter the amount of money th
172. iod of time served if equal time in two separate episodes favor a combat era over a non combat era a What year did you enter military service b What year did you separate from military service In which branch of the military did you serve the longest O 1 Army L 4 Air Force 98 Veteran declined to answer O 2 Navy 5 Coast Guard 99 Interviewer Omitted Item 3 Marines In which component of the military did you serve the longest O 1 Active Duty Regular O 3 Reserves Active O 99 Interviewer Omitted Item O 2 National Guard Active 98 Veteran declined to answer What was the rank status of your longest military service 1 Enlisted 3 Commissioned Officer 99 Interviewer Omitted Item L 2 Warrant Officer L 98 Veteran declined to answer What was the highest rank you achieved during your military tour s of duty E rating of 1 9 for enlisted W rating of 1 5 for Warrant Officer C rating of 1 10 for Commissioned Officer enter N if unknown or Veteran declined to answer See Veteran table of Equivalent Military ranks on Page 13 Are you currently serving in the military on active duty or active in the Reserves or National Guard O 0 No O 2 Active in Reserves L 98 Veteran declined to answer O 1 Active duty in military O 3 Active in National Guard O 99 Interviewer Omitted Item Did you serve in the theatre of operations for any of the following military conflicts This item asks about servic
173. ion System HOMES User Manual III Status at Program Exit VJO Exit Form o e Frequent moves because of economic reasons e Living in the home of another because of economic hardship e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing with others and rooms in hotels or motels not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Living in a hotel or motel not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Living in severely overcrowded housing e Being discharged from a hospital or other institution or e Otherwise living in housing that has characteristics associated with instability and an increased risk of homelessness Veterans who are stably housed are in a stable housing situation and not at risk of losing this housing i e do not meet the criteria for any of the other housing response categories 6 With whom will the Veteran be living at program exit Indicate who the Veteran was living with at the time of program exit by selecting the corresponding response from the drop down list 7 What is the Veteran s arrangement for employment at program exit Select the response from the drop down list that best describes the Veteran s employment arrangement at the time of program exit e Ifthe Veteran was
174. ions Management and Evaluation System HOMES User Manual HI Status at Program Exit HCRV Exit Form 7 What is the zip code of that location Record in the field provided the five digit zip code of the location where the Veteran lives at the time of program exit If the zip code is unknown enter N 8 Housing Stability How would you describe the Veteran s housing situation at program exit Determine whether the Veteran is literally homeless imminently losing their housing unstably housed and at risk of losing their housing or stably housed Select the corresponding response from the drop down list Examples of Veterans who are literally homeless include those who are e Living in places not designed for or ordinarily used as a regular sleeping accommodation for human beings including a car park abandoned building bus or train station airport or camping ground e n a supervised publicly or privately operated shelter designated to provide temporary living arrangements including hotels and motels paid for by Federal State or local government programs for low income individuals or by charitable organizations congregate shelters and transitional housing for homeless persons e Ina hospital or other institution if the person was sleeping in an emergency shelter or other place not meant for human habitation cars parks streets etc immediately prior to entry into the hospital or institution e Fleeing a
175. irement income from Social Security Pension from a former job Supplemental Security Income SSI olni ol a A ol po Social Security Disability Income SSDI 9 Private disability insurance 10 Worker s compensation 11 Unemployment insurance 12 Temporary Assistance for Needy Families TANF or similar local program 13 General Assistance GA or similar local program 14 Child support 15 Alimony or other spousal support 16 All other sources do not include food stamps 0 0 a lee es PIAA A H Hi AH A A RRA RI Total Income Total income calculated in HOMES Did the Veteran receive any of the following non cash benefits during the reporting period If item 8b is no or VJO Specialist omitted item skip to item 9 If yes select each category O 0 No O 1 Yes L 99 VJO Specialist omitted item L 0 No L 1 Yes 2 Medicare health insurance program or similar local program L 0 No L 1 Yes 3 Temporary Rental Assistance L 0 No 1 Yes 4 Homeless Prevention and Rapid Re housing Program HPRP Funds L 0 No 1 Yes 5 Veteran Service Organizations Ll 0 No 1 Yes 6 State Children s Health Insurance Program or similar local program L 0 No L 1 Yes 7 Supplemental Nutrition Assistance Program SNAP or Food Stamps L 0 No 1 Yes 8 Special Supplemental Nutrition Program for Women Inf
176. irst arrest is less than 15 if correct then continue If this is correct you will confirm by clicking OK or you will correct your response DRAFT LAST UPDATED APRIL 19 2011 88 VA Homeless Operations Management and Evaluation System HOMES User Manual IV Pre Incarceration History HCRV Entry Form 25 How many times had the Veteran been arrested as an adult or as a juvenile before his her arrest in month year of arrest for the current incarceration Enter in the fields provided the number of times the Veteran has been arrested as an adult or as a juvenile before his or her most recent arrest For no arrests enter 00 Unknown Declined If the Veteran does not know or declined to respond enter N The total number cannot exceed 99 NOTE The following warning message will appear if item 25 is greater than 20 arrests Item 25 indicates number of arrests is greater than 20 if correct then continue If this is correct you will confirm by clicking OK or you will correct your response For information on how to submit forms please reference Section II B 3 DRAFT LAST UPDATED APRIL 19 2011 89 VA Homeless Operations Management and Evaluation System HOMES User Manual 2 HCRV Exit Form a General Instructions Use this form to document Veteran exit from the HCRV program See Appendix K for the HCRV Exit Form Worksheet b When to complete and submit the HCRV Ex
177. ist 46a Does this Veteran need substance abuse treatment at this time Indicate whether the Veteran is in need of substance abuse treatment at the time of referral by selecting a response from the drop down list 46b Is the Veteran interested and willing to participate in substance abuse treatment Indicate whether the Veteran is interested and willing to participate in substance abuse treatment by selecting a response from the drop down list DRAFT LAST UPDATED APRIL 19 2011 33 VA Homeless Operations Management and Evaluation System HOMES User Manual VIII Clinical Impressions Assessment Form 47a Does this Veteran need medical treatment at this time Indicate whether the Veteran is in need of medical treatment at the time of referral by selecting a response from the drop down list 47b Is the Veteran interested and willing to participate in medical treatment Indicate whether the Veteran is interested and willing to participate in medical treatment by selecting a response from the drop down list 48a Does this Veteran need case management Indicate whether the Veteran is in need of case management at the time of referral by selecting a response from the drop down list 48b Is the Veteran interested and willing to participate in case management treatment Indicate whether the Veteran is interested and willing to participate in case management by selecting a response f
178. it Form This form should be completed and submitted as soon as it is determined that the Veteran will exit the HCRV program c Who may complete and submit the HCRV Exit Form Staff members who fill out the HCRV Exit Form should be regular staff of the HCRV program or staff of another mental health program who conduct outreach to correctional facilities that is consistent with the HCRV model as a defined part of their position Correctional facilities include prisons jails federal or state funded correctional halfway houses or work release programs Clerks other non clinicians and non VA staff should not complete this form d Completing the HCRV Exit Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Enter the Veteran s SSN first or last name or HOMES Veteran ID and click Search for Veteran button Locate the appropriate Veteran from the list and click the Select button On the Veteran History Screen click the Add HCRV Exit Form button to access the form Veteran History Last Thomas First Name John SSN 123045678 Name Date of i Veteran 03 12 1980 Sex Male HOMES 1D 9 Edit Veteran Edit Veteran Contact Information Search for Another Veteran Birth Assessment Intake Forms Entered Date of Assessment Primary VAMC Secondary VAMC Homeless Program Referrals Edit Form 04 10 2011 642 642 HUD VASH HCHV CM VJO Edit Form View Form Supplemental Referral
179. ith strangers 6 Don t know What is the Veteran s arrangement for employment at program exit 0061080480818 OAN DAF OON 0 Disabled or retired Unemployed Actively seeking employment Part time or temporary employment Full time employment VA s IT or CWT VI Other vocational training Unpaid volunteer Student Don t know What is the Veteran s arrangement for receipt of VA financial benefits disability payments or pension at the time of program exit 6 61 48 0 Currently receiving VA benefits and will continue 1 Has pending application for VA financial benefits 2 Is planning to apply for VA financial benefits 3 Is neither receiving nor planning to apply for any VA financial benefits 4 Do not know Veteran s status with respect to VA financial benefits What is the Veteran s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit L 0 Currently receiving non VA benefits and will continue L 1 Has pending application for non VA financial benefits L 2 Is planning to apply for non VA financial benefits L 3 Is neither receiving nor planning to apply for any non VA financial benefits 4 Do not know Veteran s status with respect to non VA financial benefits Did the Veteran receive any money in the 30 days prior to program exit m HE Yes L 99 Case manager omitted item If 10 no or Case manager omitted item
180. itical that the user verifies the Veteran s information in CPRS before adding it to the HOMES system A mistake in this record such as an incorrect SSN will cause problems when the user searches for the Veteran at a later date It may also result in errors on forms that are completed on this Veteran If an error is made contact NEPEC after the Veteran record has been submitted so it may be corrected Contact information can be found in Appendix A The Veteran record is created when the user clicks the Add New Veteran button Ls d a States DEFARTUZNT or VETERANS Arrams VA Hometess OPERATIONS MANAGEMENT AND EVALUATION SYSTEM HOMES gt o Home Manage Access VA Homeless Operations Management and Evaluation System HOMES egged in as DWA vacobermam Add Edit Veteran Homes Veteran ID 687 Last Name John First Name Smith Middle Initial Date of Birth 03 04 1980 Sex Male Mj SSN Type Full SSN Reported SSN 987654321 Confirm SSN 987654321 e Veteran Successfully added updated Save Veteran Information Add Edit Veteran Contact Information View Veteran History Search for another Veteran 3 Tracking Veteran Status Operation Reports Operation reports provide VA staff members with access to three databases List of Veterans Referred List of Veterans not admitted to Program and List of Veterans Transferred From the Main Page screen access one of these
181. itted item b Hepatitis C 0 No U 98 Veteran decline to answer 1 Yes _ 99 Interviewer omitted item c Tuberculosis TB or PPD 0 No L 98 Veteran decline to answer 1 Yes _ 99 Interviewer omitted item d Chronic Obstructive Pulmonary Disease COPD LI 0 No L 98 Veteran decline to answer 1 Yes _ 99 Interviewer omitted item DRAFT LAST UPDATED APRIL 19 2011 142 37 38 39 40 41 42 43 44 VA Homeless Operations Management and Evaluation System HOMES User Manual e Heart disease L 0 No L 98 Veteran decline to answer 1 Yes O 99 Interviewer omitted item f Stroke L 0 No L 98 Veteran decline to answer 1 Yes 99 Interviewer omitted item g Diabetes LI 0 No L 98 Veteran decline to answer 1 Yes _ 99 Interviewer omitted item h Seizures LI 0 No LI 98 Veteran decline to answer 1 Yes _ 99 Interviewer omitted item i Chronic Pain LI 0 No L 98 Veteran decline to answer 1 Yes _ 99 Interviewer omitted item j Other specify 0 No 98 Veteran decline to answer 1 Yes _ 99 Interviewer omitted item Do you use tobacco products No 0o Dl 1 Yes L 98 Veteran decline to answer O 99 Interviewer omitted item In the past 30 days how many days did you drink ANY alcohol code N if Veteran declined or interviewer omitted In the past 30 days how many days did you have at least 5 drinks if you are a ma
182. ividuals or by charitable organizations e Living in a hotel or motel not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Living in severely overcrowded housing e Being discharged from a hospital or other institution or e Otherwise living in housing that has characteristics associated with instability and an increased risk of homelessness Veterans who are stably housed are in a stable housing situation and not at risk of losing this housing i e do not meet the criteria for any of the other housing response categories 10 With whom will the Veteran be living at program exit Indicate who the Veteran was living with at the time of program exit by selecting the corresponding response from the drop down list 11 What is the Veteran s arrangement for employment at program exit Select the response from the drop down list that best describes the Veteran s employment arrangement at the time of program exit e Ifthe Veteran was in vocational training and this training was also a part time job list this as vocational training only e If more then one category applies choose the response that represents the Veteran s highest level of employment 12 What is the Veteran s arrangement for receipt of VA financial benefits disability payments or pension at the time of program exit Select the response from the drop down list that best de
183. know treatment 49a Does the Veteran need assistance with family problems 0 No O 1 Yes 49b Is the Veteran interested and willing to participate in treatment for family O 0 No 1 Yes Don t know problems 50 Is this Veteran a danger to self or others 0 No 1 Yes 51 Is this Veteran in danger from others e g gang violence fleeing domestic 0 No 1 Yes violence IX REFFERAL PLANS What are your immediate plans for referral or treatment of the Veteran at this time VA Specialized Homeless Services 52 Case Management Services a HUD VASH Case Management Services intensive case management with permanent housing 0 None O 1 Yes b HCHV Case Management services direct case management beyond referral to other services 0 None O 1 Yes DRAFT LAST UPDATED APRIL 19 2011 144 53 54 55 VA Homeless Operations Management and Evaluation System HOMES User Manual Residential treatment transitional housing 0 None 1 HCHV Emergency Housing program 2 HCHV Contract Residential Treatment 3 HCHV Safe Haven program 4 GPD transitional housing 5 DCHV residential treatment 6 CWT TR residential treatment 7 Other MH RRTP residential treatment e g SA RRTP PTSD RRTP General RRTP es at a fe eo A If item 53 is 7 Yes 53a What is the status of the referral to Other MH RRTP residential treatment 1 Referral made and service initiated no further follow up needed 2 Re
184. ks other non clinicians and non VA staff should not complete this form d Completing the Residential Treatment Exit Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Enter the Veteran s SSN first or last name or HOMES Veteran ID and click Search for Veteran button Locate the appropriate Veteran from the list and click the Select button On the Veteran History Screen click the Add Residential Treatment Exit Form button to access the form Veteran is currently in HCHV Program At site 642 Veteran is currently in Residential Program At site 642 Veteran is currently in VJO Program At site 642 Assessment Intake Forms Entered Date of Assessment Primary VAMC Secondary VAMC __Homeless Program Referrals __ Edit Form View Form 04 12 2011 642 642 HUD VASH HCHV CM CWT TR VJO Edit Form View Form Supplemental Referral Forms Entered No Supplemental Referral forms entered Add Supplemental Referral s Residential Program Forms Entered Date of Program Primary Secondary gt ES View Entry Edit Exit View Exit Add Exit 04 12 2011 642 42 04 12 2011 Edit Entry Form View Entry Form 04 13 2011 Edit Exit Form View Exit Form Eorm H HCHV Program Forms Entered Date of Assessment mn VAMC peere VAMC Entry Date Edit Entry Form View Entry Form Exit Date Add Form _ Edit Exit Form View Exit Form 04 12 2011 04 13 2011 Edit Entry Form View Entry Form 04 13 2011 A
185. l ooooooooonnnnnnnnn Social Security NUMDfF ooococococcncccccncococonnnncncnncncnconinininns Date of birth MmM dWVyy oooocoococcccccccnconcnncncnncnncnnoncnnnononns Il Reasons for Program Exit Name of Treatment Court if applicable 1 Period covered by this report mm dd yy Entry date Exit date Days Number of days is automatically calculated in HOMES lll Status at Program Exit 2 The Veteran ended VJO program involvement because 1 Successful completion of the VJO program 2 Veteran was asked to leave because of violation of VJO program rules 3 Veteran left the program by his her own decision without concurrence of the VJO program 4 Veteran became too ill mentally or physically to complete the program 5 Discharge status information not available outreach contact only or Veteran is deceased 6 Veteran was transferred to another VJO program for administrative reasons ERE VERE If item 2 5 Discharge status information not available outreach contact only or Veteran is deceased do not complete remainder of the form 2a If the Veteran ended VJO program involvement because of a rule violation what was the most important reason O 1 Threatened actual violence to self or others O 2 Use of alcohol or drugs 3 Other please specify 3 What is the Veteran s housing arrangement at program exit 1 Housing owned by Veteran no ongoing housing subsidy Housi
186. l Referral Form Input permission is granted by NEPEC to the case managers and workers listed in the programs below A VA clinician should complete and submit the form Clerks other non clinicians and non VA staff should not complete this form 4 Completing the Supplemental Referral Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Use the Veteran s SSN first or last name or HOMES Veteran ID to search for the Veteran Select the appropriate Veteran from the list and click the select button After navigating to the Veteran History screen begin completing the Supplemental Referral Form by clicking the Add Supplemental Referral Form button Veteran History Last Thomas First Name John SSN 123045678 Name Date of Veteran irth 03 12 1980 Sex Male HOMES ID a _ Edit Veteran Edit Veteran Contact Information Search for Another Veteran Birth Assessment Intake Forms Entered Date of Assessment Primary VAMC Secondary VAMC Homeless Program Referrals 04 10 2011 642 642 HUD VASH 4 WI Egit Form View Form HCHV CM VIO ES Supplemental Referral Forms Entered No Supplemental Referral forms entered Add Supplemental Referral s Residential Program Forms Entered No Residential program forms entered HCHV Program Forms Entered No HCHV program forms entered Add HCHV Program Entry form HCRV Program Forms Entered No HCRV pr
187. leave items 9 25 blank 9 10 15 16 17 18 19 Veteran s State or Federal Corrections Identification Number For what type of offense s is the Veteran currently being held 10 Violent offense L 0 No 1 Yes Examples Murder manslaughter assault sexual assault including rape or child molestation robbery domestic violence or other violent offense 11 Property offense 0 No L 1 Yes Examples Burglary breaking amp entering larceny motor vehicle theft fraud stolen property arson shoplifting vandalism other property offense 12 Drug offense O 0 No O 1 Yes Examples Possession trafficking other drug offense 13 Public order offense O 0 No O 1 Yes Examples Weapons offense prostitution public intoxication disorderly conduct DWI other public order offense 14 Probation parole violation L 0 No 1 Yes 15 Other unspecified O 0 No 1 Yes Had the Veteran been drinking any alcohol or was s he under the influence of a drug or drugs at the time of the offense for which s he is now incarcerated 0 No 1 Had been drinking alcohol 2 Under the influence of drug s 3 Under the influence of both alcohol and drug s aaa 4 Unknown Does the Veteran have a definite release date L 0 No 1 Yes a IF YES what is the definite release date mm dd yy b IF NO what is the earliest date he or she is eligible for release or the
188. lication asp pub_ID 2354 DRAFT LAST UPDATED APRIL 19 2011 130 VA Homeless Operations Management and Evaluation System HOMES User Manual Services for Justice Involved Veterans Veterans Justice Outreach VJO The purpose of the VJO initiative is to avoid the unnecessary criminalization of mental illness and extended incarceration among Veterans The program is designed to ensure Veterans have timely access to VHA mental health and substance abuse services when clinically indicated as well as access to other VA services and benefits as appropriate Each VAMC has a VJO Specialist who conducts direct outreach Assessment and case management for justice involved Veterans The VJO Specialist also fosters relationships with local justice system partners VJO Specialists will complete the Assessment Form and on Veteran s referred to VJO the Entry Form will be completed at the same time Healthcare for Re entry Veterans HCRV The goal of the HCRV program is to address the community re entry needs of incarcerated Veterans by preventing homelessness reducing the impact of medical psychiatric and substance abuse problems upon community re adjustment and decreasing the likelihood of re incarceration HCRV services include outreach and pre release Assessments services for Veterans in prison referrals and linkages to medical psychiatric and social services and short term case management assistance HCRV Specialists will c
189. liminating the need to enter information in both systems future versions of HOMES will offer more complete integration with CPRS e Coordination of Care HOMES increases the user s ability to coordinate Veteran care internally and externally among programs and across VAMCs HOMES fosters collaboration among stakeholders to improve Veteran care 3 Future Development and System Enhancement HOMES satisfies immediate VA and program specific needs with the opportunity to incorporate future enhancements The current focus is on the activation of HOMES as a case management and evaluation tool for use by staff assigned to VA homeless services Phase 1 was launched in April of 2011 and allows for the integration of data collection for the following programs HUD VASH HCHV Case Management HCHV Contract and Residential Treatment DCHV GPD CWT TR HCRV and VJO Improvements to HOMES will continue in order to capture the full potential of the online data collection system Details of new versions will be announced prior to implementation DRAFT LAST UPDATED APRIL 19 2011 3 VA Homeless Operations Management and Evaluation System HOMES User Manual C HOMES Process Flow HOMES is designed to track and maintain homeless Veteran data as Veterans move through VA s system of care The following diagram illustrates the process flow within HOMES As shown in the diagram this process is initiated when a Veteran in need of homeless services is ide
190. list 20 Vocational Skill Deficits Select the appropriate response from the drop down list For information on how to submit forms please reference Section II B 3 DRAFT LAST UPDATED APRIL 19 2011 96 VA Homeless Operations Management and Evaluation System HOMES User Manual J VJO Forms 1 VJO Entry Form a General Instructions Use this form for Veteran entry into the VJO program See Appendix L for the VJO Entry Form Worksheet b When to complete and submit the VJO Entry Form This form should be completed and submitted as soon as a decision has been made regarding a Veteran s entry into the program c Who may complete and submit the VJO Entry Form Staff members who fill out the VJO entry form should be regular staff of the VJO program or staff of another VA mental health program who conduct outreach to courts and correctional facilities that is consistent with the VJO model as a defined part of their position For VJO correctional facilities include jails but not prisons or federal or state funded correctional halfway houses or work release programs Clerks other non clinicians and non VA staff should not complete this form d Completing the VJO Entry Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Enter the Veteran s SSN first or last name or HOMES Veteran ID and click the Search for Veteran button Locate the appropriate Veteran from
191. list this as vocational training only e If more then one category applies choose the response that represents the Veteran s highest level of employment 11 What is the Veterans arrangement for receipt of VA financial benefits disability payments or pension at the time of program exit Select the response from the drop down list that best describes the Veteran s arrangement for receipt of VA financial benefits disability payments or pensions at the time of program exit DRAFT LAST UPDATED APRIL 19 2011 94 VA Homeless Operations Management and Evaluation System HOMES User Manual HI Status at Program Exit HCRV Exit Form 12 What is the Veterans arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit Select the response from the drop down list that best describes the Veteran s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit 13 Did the Veteran receive any money in the 30 days prior to program exit Select the response from the drop down list that indicates whether the Veteran received any money in the 30 days prior to program exit a p Enter the amount of money the Veteran received from each of the sources listed in items 13a p during the past 30 days Please note e Include income from CWT or SE in item 13a e Do not include the cash value of f
192. llected in HOMES cannot be edited Primary VAMC Automatically filled based on information collected in HOMES cannot be edited Secondary VAMC Automatically filled based on information collected in HOMES cannot be edited Staff Login Automatically filled based on the user information cannot be edited VA Site Automatically filled based on the user information cannot be edited Report Sequence Number Automatically filled based on the placement of the current MSR within the series of all MSRs completed for the Veteran e g the first MSR which covers the 30 days following the Program Entry Date is report sequence 1 cannot be edited Date Range Covered in This Report Automatically filled based on the Program Entry Date and report sequence number cannot be edited Note that the date range covered by this report provides the first and last dates of the reporting period covered by the current MSR Each MSR should only include information about case management provided between the start of the reporting period and end of the reporting period displayed by HOMES Date of This Report Automatically filled based on the current date cannot be edited I Veteran Identification HUD VASH Monthly Status Report Form 1 Veteran s Name Automatically filled based on the Veteran record can only be edited by NEPEC 2 Social Security Number Automat
193. ly with HCRY program rules eteran is no longer interested in participating in this program Veteran released from prison to a geographic area not served by this HCRV program Veteran cannot be located 7 Veteran too ill to participate in HCRY at this time 8 Veteran is incarcerated 9 Veteran is deceased 10 Other please specify select E Use the instructions below to complete the form General HCRV Exit Form HOMES Episode Start Date Automatically filled based on information collected in HOMES cannot be edited Lead Case Manager n a in Phase 1 of HOMES Automatically filled based on information collected in HOMES cannot be edited Program Entry Date Automatically filled based on information collected in HOMES cannot be edited Primary VAMC Automatically filled based on information collected in HOMES cannot be edited Secondary VAMC Automatically filled based on information collected in HOMES cannot be edited Staff Login Automatically filled based on the user information cannot be edited DRAFT LAST UPDATED APRIL 19 2011 91 VA Homeless Operations Management and Evaluation System HOMES User Manual General HCRV Exit Form VA Site Automatically filled based on the user information cannot be edited Form Completion Date Automatically filled based on information collected in HOMES cannot be edited I Veteran Info
194. m HCRV Program Forms Entered No HCRV program forms entered VJO Entry Exit Forms Entered Date of Primary Secondary Entry Dat Edit Entry View Entry Add Progress Edit Exit View Exit Entry Date Assessment VAMC VAMC ats Form Form Form Form Form Edit Enty View Entry Add Proaress F Add Exit Edit Exit View Exit Form Form Form a AA Form Form 04 12 2011 642 642 04 12 2011 VJO Progress Reports Entered No VJO Progress Reports entered HUDVASH Entry Exit Forms Entered Date of Primary Secondary Entry Date Seay View Entry Exit Edit Exit View Exit Assessment VAMC VAMC Form Date Form Form Si A Bad Edit Exit Form View Exit Form 04 12 2011 642 642 fosy 12 2011 Edit Entry Form View Entry Form Form DRAFT LAST UPDATED APRIL 19 2011 104 VA Homeless Operations Management and Evaluation System HOMES User Manual VJO Treatment Court Progress Report Form HOMES Episode Start Date 04 10 2011 Primary VAMC 642 Lead Case Manager N A Secondary VAMC 642 Program Entry Date 04 10 2011 Staff Login first and last name Matthew Berman VA Site 3 digit VAMC code plus 2 digit suffix if any 642 Date this form completed mm dd yy ar3 2011 I Veteran Information 1 Veteran s name last name first initial omas John 2 Social Security Number 123045678 3 Date Of Birth mm dd yy 03 12 1980 4 Date of VJO Treatment Court entry mm dd yy b4710 2011 5 Time period covered in thi
195. m 1 General Instructions The initial form that VA specialized homeless program staff will complete is the Assessment Form A HOMES episode is initiated when a clinician completes and submits the Assessment Form The date this form is completed is the HOMES episode start date See Appendix F for a copy of the Assessment Form Worksheet 2 When to complete and submit the Assessment Form VA specialized homeless program staff should enter the online Assessment Form during or as soon as possible following the completion of the interview 3 Who may complete and submit the Assessment Form An Assessment form is completed by VA specialized homeless program staff Clerks other non clinicians and non VA staff should not complete this form 4 Completing the Assessment Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button on the VA HOMES Main Page Enter the Veteran s SSN first or last name or HOMES Veteran ID and click the Search for Veteran button Locate the appropriate Veteran from the list and click the Select button On the Veteran History Screen click the Add Assessment Intake Form button to access the form After navigating to the Veteran History screen begin completing the Assessment Form by clicking the Add Assessment Intake Form button Veteran History Last Smith First Name John SSN 234567890 Name Date of 03 19 1975 Sex Male Veteran 691 HOMES ID E
196. m exit Determine whether the Veteran was literally homeless imminently losing housing unstably housed and at risk of losing housing or stably housed at the time of program exit Select the response from the drop down list that best describes the Veteran s housing situation Veterans who are literally homeless include those who are e Living in places not designed for or ordinarily used as a regular sleeping accommodation for human beings including a car park abandoned building bus or train station airport or camping ground e In a supervised publicly or privately operated shelter designated to provide temporary living arrangements including hotels and motels paid for by Federal State or local government programs for low income individuals or by charitable organizations congregate shelters and transitional housing for homeless persons e Ina hospital or other institution if the person was sleeping in an emergency shelter or other place not meant for human habitation cars parks streets etc immediately prior to entry into the hospital or institution or e Fleeing a domestic violence situation Veterans who are imminently losing their housing include those who e Are currently housed and not literally homeless e Are imminently losing their housing whether permanent or temporary e Have no subsequent housing options identified and e Lack the resources or support networks needed to retain current housing or obtain tempora
197. m the drop down list 19 What will be the Veteran s status upon release including after release from corrections halfway house or work release facility Select the response from the drop down list that reflects what the Veteran s status will be upon release including after release from corrections halfway house or work release facility DRAFT LAST UPDATED APRIL 19 2011 87 VA Homeless Operations Management and Evaluation System HOMES User Manual TIT Current Incarceration HCRV Entry Form 20 By the time of the Veteran s release date how long will the current incarceration be including Indicate in the field provided how long the current incarceration will be by the time of the Veteran s release date If the period of incarceration is less than a month use the following codes for 0 14 days enter 0 months for 15 30 days enter 1 month If the value is greater than 11 months please enter it in years and months Ex 12 months 1 year 0 months 15 months 1 year 3 months a Total Time in Jail For item 20a enter in the field provided the total time that was served in jail for the current incarceration Use years and months enter all zeros for none b Total Time in Prison For item 20b enter in the field provided the total time that was served in prison for the current incarceration Use years and months enter all zeros for none 21 Does the Veteran Have Child Support Debt to be P
198. men Infants and Children WIC L 0 No U 1 Yes i Temporary Assistance for Needy Families TANF or similar local program Child Care Services L 0 No U 1 Yes j Temporary Assistance for Needy Families TANF or similar local program Transportation Services LI 0 No L 1 Yes k Other TANF funded services LI 0 No L 1 Yes Bus subway train or cab voucher LI 0 No L 1 Yes m Other L 0 No 1 Yes IV FOLLOW UP ARRANGEMENTS Select the code that best describes clinical treatment arrangements made at program exit 15 Alcohol problems O 0 Nota problem area for this veteran O 1 Problem area for this Veteran but no treatment arranged O 2 Veteran s treatment has been arranged with non VA provider DRAFT LAST UPDATED APRIL 19 2011 167 16 17 18 19 20 VA Homeless Operations Management and Evaluation System HOMES User Manual O 0 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider Drug problems EVE EE ey 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider Mental health problems other than drug or
199. ments 2 Advantages to Users Historically VA s specialized homeless programs were monitored and evaluated through the completion of paper or online forms designed for each individual program As a result new forms were completed if a Veteran entered another homeless program or new VAMC This arrangement resulted in data entry redundancy and limited access to Veteran information across programs and medical centers To streamline homeless program data collection eliminate data entry redundancy and facilitate information sharing HOMES was developed HOMES offers many advantages over previous methods of entering and tracking Veteran information including e Access HOMES allows VA homeless staff from different programs at VAMCs across the country to access homeless Veteran information through a single point of entry While access to the secure system is restricted to VA staff involved in the provision and or administration of VA homeless services Veteran records entered into the system can be viewed by all system users Increased access to Veteran information is particularly important for facilitating referrals across programs and medical centers e Efficiency HOMES enables efficient entry management and retrieval of Veteran records Such real time access to data facilitates decision making and allows for expedited referrals across programs and medical centers In addition data entered into HOMES can be cut and pasted into CPRS thus e
200. modification additional program referrals can be made using the Supplemental Referral Form For example a Veteran who was only referred to GPD could be referred to VJO while in residence at the GPD facility should such services be warranted Referrals made using the Supplemental Referral Form enable program entry forms in the same way as referrals made on the original Assessment Additionally Supplemental referrals can be made within 30 days after all programs have been exited prior to the HOMES episode ending However once the HOMES episode ends a clinician will need to initiate a new episode by filling out a new Assessment Form New Assessment forms will pre populate with the information on the most recently submitted Assessment form If the Veteran s care moves to a VAMC that is not his or her primary or secondary VAMC a clinician should fill out exit form s for that Veteran to end the HOMES episode The new episode cannot be initiated until the previous episode is closed 6 Key Concepts and Terms Users should familiarize themselves with key concepts and terms used throughout this document Some of these concepts and terms are new to HOMES The following list of definitions is organized alphabetically HOMES Episode A HOMES episode refers to the period of time during which a Veteran s progress is being tracked in the system The episode begins on the date of the full Assessment Interview and ends 30 days after all programs are exite
201. n 3 With parents with siblings or with other family 4 With friends 5 With strangers aaa a Erg 6 Don t know What is the Veteran s arrangement for employment at program exit 0 Disabled or retired Unemployed Actively seeking employment Part time or temporary employment Full time employment VA s IT or CWT VI Other vocational training Unpaid volunteer Student Don t know es il EEE O AN DOA A OON What is the Veteran s arrangement for receipt of VA financial benefits disability payments or pension at the time of program exit 0 Currently receiving VA benefits and will continue 1 Has pending application for VA financial benefits 2 Is planning to apply for VA financial benefits 3 Is neither receiving nor planning to apply for any VA financial benefits Pe g g 4 Do not know Veteran s status with respect to VA financial benefits What is the Veteran s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit O 0 Currently receiving non VA benefits and will continue L 1 Has pending application for non VA financial benefits O 2 Is planning to apply for non VA financial benefits L 3 Is neither receiving nor planning to apply for any non VA financial benefits DRAFT LAST UPDATED APRIL 19 2011 180 13 14 VA Homeless Operations Management and Evaluation System HOMES User Manual 4
202. n s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit Select the response from the drop down list that best describes the Veteran s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit 10 Did the Veteran receive any money in the 30 days prior to program exit Select the response from the drop down list that indicates whether the Veteran received any money in the 30 days prior to program exit a p Enter the amount of money the Veteran received from each of the sources listed in items 10a p during the past 30 days e Include income from CWT SE in item 10a e Do not include the cash value of food stamps in any category e Do not include income received through a spouse significant other or other household member in any category e Round all figures to the nearest dollar 11 Did the Veteran receive any of the following non cash benefits in the 30 days prior to program exit Select the response from the drop down list that indicates whether the Veteran received any non cash benefits in the 30 days prior to program exit 11a m Indicate whether or not the Veteran received non cash benefits from each of the sources listed in items 11a m during the 30 days prior to program exit Multiple sources of non cash benefits IV Follow up Arrangements Residential Treatment Exit Form Item
203. n or at least 4 drinks if you are a woman One drink is considered one shot of hard liquor 1 502 or 12 ounce can bottle of beer or 5 ounce glass of wine code N if Veteran declined or interviewer omitted In the past 30 days how many days did you use any illegal street drugs or abuse any prescription medications code N if Veteran declined or interviewer omitted Examples marijuana heroin or methadone barbiturates downers cocaine or crack amphetamines speed hallucinogens like acid or inhalants like glue paint or nitrous oxide In the past 30 days how much were you bothered by cravings or urges to drink alcohol or use drugs 0 Not at all O 3 Considerably O 1 Slightly O 4 Extremely L 2 Moderately L 98 Veteran declined to answer 99 Interviewer omitted item L 0 No 1 Yes L 98 Veteran decline to answer LI 99 Interviewer omitted item Have you ever received professional treatment for alcohol or other substance use disorder O 0 No LI 1 Yes LI 98 Veteran decline to answer L 99 Interviewer omitted item Have you ever been hospitalized for a psychiatric problem do not include residential treatment or hospitalization for a substance use problem END OF INTERVIEW QUESTIONS Vill CLINICAL IMPRESSIONS Which of the following treatment concerns apply to this Veteran a Alcohol use disorder L 0 No 1 Yes b Drug use disorder L 0 No 1 Yes c Gambling problem or patholog
204. n during this time 1 At least one night but less than one month L 2 Atleast one month but less than 6 months O 3 At least 6 months but less than 1 year L 4 At least one year but less than 2 years 5 Two years or more Ol 6 Unknown 98 Veteran declined to answer 99 Interviewer omitted item 26 How many separate episodes of homelessness have you experienced in the last three years Include current episode of homelessness O 0 O3 O 1 O 4 Ele 2 L 5 or more L 98 Veteran declined to answer L 99 Interviewer omitted item 27 What is the total amount of time if any that you have spent in jail or prison during your lifetime L 0 None L 1 Less than 1 month 2 Between 1 month and 1 year O 3 More than 1 year L 98 Veteran declined to answer L 99 Interviewer omitted item DRAFT LAST UPDATED APRIL 19 2011 140 VA Homeless Operations Management and Evaluation System HOMES User Manual VI EMPLOYMENT AND INCOME 28 Which best describes your employment pattern in the last 3 years 0 Full time 40 hrs wk 1 Full time irregular 2 Part time regular hours 3 Part time irregular day work 4 VA CWT or other vocational training program 5 Student aaoaaoag A as 29 How many days did you work for pay in the past 30 days Count participation in CWT SE as days worked If none enter 0 If Veteran declined to answer code N 30 Did you receive any money in the
205. n of periodic progress reports These reports are used to document the Veteran s status in areas such as housing health and healthcare employment income and program participation Program progress forms should be entered into HOMES as soon as possible following the end of each reporting period Instructions for the completion of progress forms can be found in Section III DRAFT LAST UPDATED APRIL 19 2011 10 VA Homeless Operations Management and Evaluation System HOMES User Manual H Program Exit Forms Program exit forms are used to record a Veteran s date of exit and assess his or her status upon leaving the program These forms are also used to record whether follow treatment arrangements have been made Program exit forms should be entered into HOMES as soon as possible following the exit of a Veteran from a program Upon submission of an exit form a notification e mail is sent to the Veteran s LCM Instructions for the completion of exit forms can be found in Section III I Reference and Resource Materials HOMES provides reference and resource materials to help guide user response selection during interviews and completion and submission of online forms These materials are accessible through the HOMES Main Page screen The following materials are included e Assessment Table of Equivalent Military Ranks e Assessment Scoring Guide e HUD VASH Scoring Guide for Alcohol Use Assessment e HUD VASH Scoring G
206. n s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider O 4 Veteran s treatment has been arranged with both non VA and VA provider 17 Drug problems 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arrangements made e O 2 Veteran s treatment has been arranged with non VA provider O 3 Veteran s treatment has been arranged with VA provider Ol 4 Veteran s treatment has been arranged with both non VA and VA provider 18 Mental health problems other than drug or alcohol O 0 Nota problem area for this veteran 1 Problem area for this Veteran but no treatment arrangements made O 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider O 4 Veteran s treatment has been arranged with both non VA and VA provider 19 Medical problems 0 Nota problem area for this veteran 1 Problem area for this Veteran but no treatment arrangements made 2 Veteran s treatment has been arranged with non VA provider O 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider 20 Social and recreational deficits 0 Nota problem area for this veteran 1 Problem area for this Veteran but no treatment arrangements made 2 Veteran s treatment has been arranged with non VA provider O
207. n why Veteran did not enter the HUD VASH program if more than one reason code most important _ Veteran not interested in program e g found alternate housing Veteran left can no longer locate Veteran refused to agree with the terms of the HUD VASH program Since referral Veteran became too ill to participate Veteran no longer eligible for the program e g over income Veteran is incarcerated Veteran did not meet program eligibility requirements Other specify Bi IE EME ON DO FW PD Comment Reason Why 7a Was a Housing Recovery Plan completed and signed by both Veteran and HUD VASH clinician If no or omitted skip to item 8 L 0 No L 1 Yes L 99 Omitted 7b If yes date the Housing Recovery Plan completed and signed A Sac eece tare TG Sites atte eae Gated Canoe EE 8 Where the Veteran currently lives does he or she have a say in choosing Code 0 No 1 Yes 9 Not applicable or don t know a The place he she lives b The people he she lives with c Decorating and furnishing d When visitors can come over e Whether to have overnight guests DRAFT LAST UPDATED APRIL 19 2011 151 VA Homeless Operations Management and Evaluation System HOMES User Manual f Who has a key to the place other than the landlord and housemate s g How he she spends the day h Who can come over i When the landlord and super can
208. nce plus related problems are so severe that they make non Dependence With institutional living difficult For example constant drug use leads to disruptive behavior and Institutionalization 5 inability to pay rent so that client is frequently reported to police and seeking hospitalization DRAFT LAST UPDATED APRIL 19 2011 159 VA Homeless Operations Management and Evaluation System HOMES User Manual D HUD VASH Exit Form Worksheet Staff member completing this form first and last name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed MIM CQY 1 0 c eeceetseeeeeeeeeees dl Veteran s name last name first initial 2 Social Security NUMDET ooooococccocccccccnncnconinccnconinnnns 3 Date Of birth MmM dWVyy oocoooococcccccccncnncnncncnnnnnnnn o ll Reasons for Program Exit 4 Date the Veteran exited the HUD VASH program mm dd yy 5 Which is the most important reason why the Veteran ended involvement in HUD VASH case management O 1 Veteran accomplished his her goals and or obtained access to services and no longer has a need for this program 2 Veteran transferred to another HUD VASH program site O 3 Veteran found chose other housing 4 Veteran did not comply with HUD VASH case management O 5 Veteran was evicted from his her HUD VASH apartment by PHA or landlord and or had other housing related
209. ng owned by Veteran with ongoing housing subsidy Housing rented by Veteran no ongoing housing subsidy Housing rented by Veteran with HUD VASH voucher 2 3 4 5 Housing rented by Veteran with non HUD VASH housing subsidy 6 Permanent housing for formerly homeless persons such as SHP S C or SRO MOD Rehab 7 Staying or living in family member s room apartment or house 8 Staying or living in friend s room apartment or house 9 GPD transitional housing 10 Non VA transitional housing for homeless persons sl Et li tf 11 Safe Haven special transitional supportive housing or drop in supportive service center for homeless SMI DRAFT LAST UPDATED APRIL 19 2011 192 VA Homeless Operations Management and Evaluation System HOMES User Manual individuals 12 VA Mental Health Residential Rehabilitation Program MH RATP all types DCHV CWT TR SA RRTP PTSD RRTP General RRTP 13 VA contracted residential treatment programs ATU HWH or HCHV contract 14 Non VA residential treatment program 15 Non psychiatric hospital acute care 16 Psychiatric hospital acute care 17 Hotel or motel paid for without emergency shelter voucher 18 Emergency shelter including hotel or motel paid for with emergency shelter voucher 19 Prison jail 20 Place not meant for habitation outdoors automobile truck boat 21 Don t know it fF 8681481 What is the zip code of that location Code N in 1 space if unknown
210. nk status from the drop down list from the Veteran s longest period of military service 16 What was the highest rank you achieved during your military tour s of duty Enter the highest rank the Veteran achieved during his or her military tour s of duty Refer to the Table of Equivalent Military Ranks to help determine the selection A link to the table can be found on the Main Page screen of HOMES DRAFT LAST UPDATED APRIL 19 2011 VA Homeless Operations Management and Evaluation System HOMES User Manual IV Military History Assessment Form Declined Omitted If the Veteran declined to answer or the interviewer omitted the question enter N 17 Are you currently serving in the military on active duty or active in the Reserves or National Guard Select the response from the drop down list that indicates whether the Veteran is currently serving in the military on active duty or is active in the Reserves or National Guard 18 Did you serve in the theatre of operations for any of the following military conflicts Indicate whether the Veteran served in the theatre of operations for each of the military conflicts listed in items 18a h Note this item asks about service within the geographic proximity of the military conflict not participation in combat participation in conflict is assessed in item 19 a World War II Select the response from the drop down list that in
211. ns and submit referrals to VA homeless programs and services Assessment forms should be entered into HOMES as soon as possible following the completion of the interview Instructions for the completion of the Assessment Form can be found in Section II D E Supplemental Referral Form The Supplemental Referral Form is used to refer Veterans to additional programs after the Assessment has been submitted The form becomes available following the submission of the original Assessment and remains available until 30 days after the Veteran has exited all programs Outside of this timeframe a clinician is required to initiate a new episode within HOMES beginning with the Assessment Form Instructions for the completion of the Supplemental Referral Form can be found in Section II E F Program Entry Forms Program entry forms document whether or not a Veteran enters a program to which he or she was referred If the Veteran enters the program the date of entry and status at program entry are recorded If the Veteran does not enter the program the primary reason for non entry is recorded Program entry forms should be entered into HOMES as soon as possible after an entry decision is made Upon submission of an entry form a notification e mail is sent to the Veteran s LCM with information regarding the entry decision Instructions for the completion of entry forms can be found in Section III G Program Progress Forms HUD VASH and VJO require the completio
212. nt Form the Veteran currently has a spouse or significant other 23b Children Under 18 Determine the number of children under 18 living in this household and enter the number in the field provided If no children under 18 are living at this location enter 0 23c Related Adults Determine the number of related adults currently living in this household and enter the number in the field provided If no related adults are living at this location enter 0 23d Unrelated Adults Determine the number of unrelated adults currently living in this household and enter the number in the field provided If no unrelated adults are living at this location enter 0 24 Housing Stability How would you describe the current housing situation Determine whether the Veteran is literally homeless imminently losing their housing unstably housed and at risk of losing their housing or stably housed Select the corresponding response from the drop down list Examples of Veterans who are literally homeless include those who are e Living in places not designed for or ordinarily used as a regular sleeping accommodation for human beings including a car park abandoned building bus or train station airport or camping ground e n a supervised publicly or privately operated shelter designated to provide temporary living arrangements including hotels and motels paid for by Federal State or local government programs for low inc
213. nt court type 0 Veterans Treatment Court or Veterans docket 1 Drug Treatment Court Mental Health Treatment Court Domestic Violence Court DUI Court Problem Solving Court Re entry Court 0 a N Oo fF W PD Other Specialty Court specify lil CURRENT ARREST COURT INVOLVEMENT Is the Veteran currently involved with jail or courts L 0 No 1 Yes If no skip to item 22 Veteran s Corrections Booking Number Veteran s State Corrections Identification Number For what type of offense s is the Veteran currently arrested or in court 10 Violent offense L 0 No 1 Yes Examples Murder manslaughter assault sexual assault including rape or child molestation robbery domestic violence or other violent offense 11 Property offense L 0 No 1 Yes Examples Burglary breaking amp entering larceny motor vehicle theft fraud stolen property arson shoplifting vandalism other property offense 12 Drug offense O 0 No 1 Yes Examples Possession trafficking other drug offense 13 Public order offense O 0 No O 1 Yes Examples Weapons offense prostitution public intoxication disorderly conduct DWI other public order offense 14 Probation parole violation L 0 No 1 Yes 15 Other unspecified O 0 No J 1 Yes a Is Driving Under the Influence DUI involved in the current case O 0 No O 1 Yes b Is domestic dispute involved in the current case
214. nt for alcohol or other substance use disorder 43 Have you ever been hospitalized for a psychiatric problem Select the response from the drop down list that best reflects whether the Veteran has been hospitalized for a psychiatric problem Do not include residential treatment or hospitalization for a substance use problem END OF INTERVIEW QUESTIONS VII Clinical Impressions Assessment Form 44 Which of the following treatment concerns apply to this Veteran Indicate whether the Veteran has each of the psychiatric diagnoses listed in items 44a o by selecting a response from the drop down list Provide your best estimates using all available information e g personal experience with the Veteran consultation with staff who is familiar with the Veteran etc Items 45 49 Consider all information available at the time of referral and use your clinical judgment in responding Indicate ALL of the services in which the Veteran has stated an interest and willingness to participate 45a Does this Veteran need psychiatric treatment at this time Indicate whether the Veteran is in need of psychiatric treatment at the time of referral by selecting a response from the drop down list 45b Is the Veteran interested and willing to participate in psychiatric treatment Indicate whether the Veteran is interested and willing to participate in psychiatric treatment by selecting a response from the drop down l
215. ntacts To discuss specific homeless program issues not the use of HOMES please contact the following Name Program s Phone Number Vincent Kane Director National Center on Homelessness 215 823 4035 Call Center John H Kuhn Director Prevention Services 908 647 0180 ext 4066 HUD VASH Nancy Campbell Director HUD VASH Program National 843 789 7702 Teresa Pittman HUD VASH Regional Coordinator 202 461 7308 Ann Shahan HUD VASH Regional Coordinator 253 583 1672 Deborah Lee HUD VASH Regional Coordinator 704 638 9000 ext 4011 HCHV Robert G Hallett National Coordinator HCHV Program 781 687 3187 GPD Roger Casey Director GPD 813 979 3570 Chelsea Watson Deputy Director GPD 813 979 3570 Jeff Quarles Clinical Manager GPD 813 979 3570 HCRV amp VJO James F McGuire Director Justice Involved Veterans 310 478 3711 ext 41450 Jessica Blue Howells Deputy Program Manager HCRV 310 478 3711 ext 43759 Sean Clark National Coordinator VJO 202 461 7311 MH RRTP Jamie R Ploppert Acting Director MH RRTP 757 722 9961 ext 1123 DRAFT LAST UPDATED APRIL 19 2011 122 VA Homeless Operations Management and Evaluation System HOMES User Manual Appendix B Instructions to Configure Browser Settings It is critical for customers to have their browser settings properly configured in order to access the VSSC web site
216. ntal Referral Forms Entered No Supplemental Referral forms entered L Add Supplemental Referrals J Residential Program Forms Entered No Residential program forms entered HCHV Program Forms Entered No HCHV program forms entered Add HCHV Program Entry form HCRV Program Forms Entered No HCRV program forms entered VJO Entry Exit Forms Entered No VIO program forms entered Add VJO Entry form VJO Progress Reports Entered No VIO Progress Reports entered HUDVASH Entry Exit Forms Entered No HUDVASH program forms entered Add HUDVASH Entry form J DRAFT LAST UPDATED APRIL 19 2011 62 VA Homeless Operations Management and Evaluation System HOMES User Manual HCHV Entry Form HOMES Episode Start Date 04 12 2011 Primary VAMC 642 Lead Case Manager N A Secondary VAMC 642 Staff Login First and Last Name Matthew Berman VA Site 3 digit VAMC code plus 2 digit suffix if any B o Date this form completed mm dd yy 713 2011 Veteran s name last name first name John Smith Social Security Number 987654321 Date Of Birth o 03 04 1980 select 2 Date of program entry decision mm dd yy If the Veteran did not enter HCHV case management 3 Select the main reason why Veteran did not enter HCHV Case Management 1 Veteran left can no longer locate 2 Veteran no longer in clinical need of program 3 Veteran not interested in program 4 Veteran refused to agree with te
217. ntified A HOMES episode begins when a full Assessment Interview is completed The episode ends 30 days after a Veteran exits all homeless programs or the Veteran s care is provided at a new VAMC On the Assessment referral s are made to appropriate programs and services After referrals are made HOMES tracks the Veteran s transition s into and out of VA homeless programs DRAFT LAST UPDATED APRIL 19 2011 4 VA Homeless Operations Management and Evaluation System HOMES User Manual Figure 1 HOMES Process Flow Diagram HOMES PROCESS FLOW DIAGRAM Awareness of Veteran Homeless Services needs Urgent needs that must be addressed within 24 hours are handled directly by VA staffer who becomes aware of the needs A referral is sent via CPRS to VAMC Homeless Program Staff and the following steps commence Assessment Part 1 Pre engagement Screening If immediate needs are addressed by completing this form the outcome is documented and the process ends If not the process continues with the full interview Assessment Part 2 Full Interview Assign Lead Case Manager End HOMES Episode if e Determine Level of Care immediate needs met e Make Necessary Referrals Homeless Program Entry Forms from referrals made during assessment Residential Programs Other Programs HCHV HUD VASH GPD HCRV DCHV VJO CWT TR L Y If Veteran is accepted into Program If Veteran is NOT accepted into Program 4 4
218. o chicos ceccssetueschcvsecicdussues eb ontsescpnovngstournonieseugnghevanestechedb teach ecencsstensenbevaceres sg cube 10 D ASSESSMENT FOR Mirna a 10 E SUPPLEMENTAL REFERRAL FORM sao oli ote 10 E PROGRAM ENTRY FORMS akerep entenen tar otenesentevedecevsgnnsshsnveve o ASERNE dy doptesst sures re YEER En ETNEN EEN EENE Ees 10 5 PROGRAM PROGRESS FORMS e E R E E A E EN E E a 10 H PROGRAM EXIT FORMS oasa Ainesosia e ees da cuscudts cavZe EEEE VVER EE ds cuvces cs septs DESEE EEE En e EEE doncs ica 11 I REFERENCE AND RESOURCE MATERIA S seie oraaa rearea Spe aneo ESE ea Eea E SaS Ea opre TE SEn ori rE SEEI E PR aui 11 HI INSTRUCTIONS FOR COMPLETING FORMS IN HOMES ssssesssoesesereccesosoesesesocoesosoesesecccoesosoesesecoee 12 As ACCESSINGTHE SYSTEM a 12 B GUIDELINES FOR NAVIGATING THE SYSTEM AND ENTERING DATA cooonocooccnncononononacononnoncnananconononarininnanacanenos 13 L N viga ting within Forms ososi EN E E ETE TETE EE EREE AiE a EEE naoa eeit ais 13 2 ENMENDAR 13 Sic TOMAS UDS O a es 14 Cy VETERAN RECORD 0 Iria 14 i Eoc ting an Existing Veteran Recor d cocina cd dai 14 2 Cr ating a New Veteran Record coi dida 15 Je Tracking Veteran Status iiye seni dai da ita trio ti 17 DD ASSESSMENT FOR Misa i 20 1 General InStr cliiONS 0 A A A A A A A P E IRA a EA EE 20 2 When to complete and submit the Assessment FOTM c ccsssesssssseesesseeseeneesecuceeecuseeceseeseesecaeeecnaseeeeaeeaes 20 3 Who ma
219. of non VA financial benefits disability payments or other support at the time of program exit 0 Currently receiving non VA benefits and will continue 1 Has pending application for non VA financial benefits 2 Is planning to apply for non VA financial benefits O 3 Is neither receiving nor planning to apply for any non VA financial benefits 4 Do not know Veteran s status with respect to non VA financial benefits O 0 No L 1 Yes Did the Veteran receive any money in the 30 days prior to program exit L 99 VJO Specialist omitted item If 10 no or VJO Specialist omitted item skip to item 11 If 10 yes list the average monthly amount in each category Please round to whole dollar amounts and note comma placement eg 452 76 should be entered as _ _ 453 00 a Employment include CWT SE e b Compensation for service connected psychiatric condition c Compensation for other service connected condition d Non service connected pension e Retirement income from Social Security f Pension from a former job g Supplemental Security Income SSI h Social Security Disability Income SSDI i Private disability insurance j Worker s compensation k Unemployment insurance Temporary Assistance for Needy Families TANF or similar local program m General Assistance GA or similar local program n Child support Fl A A A AH Hm A SH Ho HH
220. ogram forms entered VJO Entry Exit Forms Entered No VIO program forms entered Add VJO Entry form VJO Progress Reports Entered No VIO Progress Reports entered HUDVASH Entry Exit Forms Entered No HUDVASH progr m forms entered Add HUDVASH Entry form DRAFT LAST UPDATED APRIL 19 2011 38 VA Homeless Operations Management and Evaluation System HOMES User Manual Supplemental Referral Form NOTE Programs in which Veteran is already enrolled or for which referral is pending are not available for new referral on this form VA staff member completing Referral first and last name Matthew Berman Lead Case Manager WA Primary VAMC PHILADELPHIA Secondary VAMC PHILADELPHIA 1 Veteran s name last name first initial Hohn Smith 2 Social Security number 987654321 3 Date of birth mm dd yy 03 04 1980 4 Sex Male II VA Specialized Homeless Services VA Specialized Homeless Services 5 Case management services 0 None 1 Yes a HUD VASH Case Management Services intensive case management with permanent housing b HCHV Case Management services direct case management beyond referral to other services 6 Residential treatment transitional housing HCHW Emergency Housing program HCHV Contract Residential Treatment 3 HCHV Safe Haven program 4 GPD Transitional Housing 5 6 DCHV Residential Treatment CWT TR Residential Treatment Use the
221. ollowing areas 0 No 1 Yes 98 Veteran declined to answer 99 Interviewer omitted item a Housing Examples b Financial Hardship Examples Use the following instructions to complete the form General Assessment Form VA Staff Member Completing Assessment Automatically generated based on the user information cannot be edited Site Code Automatically filled based on the user information cannot be edited Date of Assessment Type in the date that the actual form was completed use the mm dd yy format Lead Case Manager n a in Phase 1 of HOMES Enter the name of the LCM assigned to this Veteran Primary VAMC Select from the drop down list the Primary VAMC for this Veteran Secondary VAMC Select from the drop down list the Secondary VAMC for this Veteran DRAFT LAST UPDATED APRIL 19 2011 21 VA Homeless Operations Management and Evaluation System HOMES User Manual I Veteran Identification Assessment Form 1 Veteran s Name Automatically filled based on the Veteran s record can only be edited by NEPEC 2 Social Security Number Automatically filled based on the Veteran s record can only be edited by NEPEC 3 Date of Birth Automatically filled based on the Veteran s record can only be edited by NEPEC 4 Sex Automatically filled based on the Veteran s record can only be edited by NEPEC
222. om medical or O 0 No psychiatric O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 72 Non VA detoxification services O 0 No L 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 73 Non VA mental health or substance abuse 0 No services O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care X INTERVIEWER INFORMATION 74 Main program affiliation of interviewer 1 HUD VA Supported Housing HUD VASH 2 Healthcare for Homeless Veterans HCHV O 3 Grant and Per Diem GPD Ol 4 VA MH RRTP Includes all types DCHV CWT TR SA RRTP PTSD RRTP General RRTP O 5 Healthcare for Re entry Veterans HCRV L 6 Veterans Justice Outreach VJO Ol 7 Other VA affiliation 75 How was contact for this interview initiated By VA O 1 Street outreach initiated by VA staff O 2 Justice System outreach initiated by VA staff O 3 Other community outreach by VA staff 4 Contacted at Stand Down O 5 Referral from VA MH RRTP Includes all types DCHV CWT TR SA RRTP PTSD RRTP General RRTP O 6 Referral from VA mental health outpatient unit O 7 Referral from VA substance abuse outpatient unit Ol 8 Referral from VA medical outpatient unit O 9 Referral from VA Emergency Room O 10 Referral from VA inpatient unit 1
223. ome individuals or by charitable organizations congregate shelters and transitional housing for homeless persons e Ina hospital or other institution if the person was sleeping in an emergency shelter or other place not meant for human habitation cars parks streets etc immediately prior to entry into the hospital or institution e Fleeing a domestic violence situation Veterans who are imminently losing their housing include those who e Are currently housed and not literally homeless e Are imminently losing their housing whether permanent or temporary e Have no subsequent housing options identified and e Lack the resources or support networks needed to retain current housing or obtain temporary or permanent housing Examples of imminent housing loss include e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing from others and rooms in hotels or motels not paid for by Federal State or local government programs for low income individuals or by charitable DRAFT LAST UPDATED APRIL 19 2011 28 VA Homeless Operations Management and Evaluation System HOMES User Manual V Living Situation Assessment Form organizations e Being discharged from a hospital or other institution e Living in housing that has been condemned by housing officials and is no longer considered meant for human habitation Veterans who are unstably housed and at ri
224. omplete the Assessment Form and on Veteran s referred to HCRV the Entry Form will be completed at the same time Staff will use the Assessment and Entry worksheets and will enter the data into HOMES when they return to the office as laptops are not allowed in prisons VA Prevention Services HUD VA Pilot The HUD VA pilot program serves Veterans at risk of homelessness The program is designed to provide housing and intensive case management targeting areas with a large number of returning Veterans Supported Service for Veterans Families SSVF The SSVF program offers supportive services to very low income Veteran families residing in or transitioning to permanent housing with the goal of promoting housing stability and preventing at risk families from becoming homeless VA awards grants to private non profit organizations and consumer cooperatives that provide supportive services To receive supportive services under this program one must be a member of a Veteran family e g a single person or a family in which the head of household or the spouse of the head of household is a Veteran very low income e g income does not exceed 50 of area median http www va gov homeless vjo asp l http www va gov HOMELESS Reentry asp 2 http www oregon gov ODVA TASKFORCE reintegration Five Y earPlan PPT pdf ga t DRAFT LAST UPDATED APRIL 19 2011 131 VA Homeless Operations Management and Evaluation System HOMES User Manual
225. on L 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 68 Non VA housing L 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 69 Non VA social vocational assistance L 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 70 Non VA income resources and non cash benefits a SSI or SSDI L 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care b TANF L 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care c Food Stamps or SNAP L 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care d GA General Assistance UO 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care DRAFT LAST UPDATED APRIL 19 2011 146 VA Homeless Operations Management and Evaluation System HOMES User Manual e WIC O 0 No O 1 Referral made and service initiated no further follow up needed O 2 Referral made will continue monitoring of care 71 Non VA Emergency Ro
226. on employment status financial benefits and medical and psychiatric problems Clinical impressions and plans for immediate referral s are documented in the last sections of the Assessment Interview Depending on where the Veteran is interviewed it may be possible for the clinician conducting the Assessment to access HOMES and enter data directly into the system However if the interview is conducted at a location where HOMES is not accessible the clinician should use a paper copy of the form data entry worksheets to record responses and enter the data into HOMES following the interview see Appendix F for the Assessment Form Worksheet Paper forms can be shredded once data is entered into HOMES A HOMES episode is initiated when a full Assessment interview is conducted and the Assessment Form is completed and submitted via HOMES The date of the Assessment is the HOMES episode start date 3 Program Referral s The clinician completing the Assessment makes referrals to programs and services based on information collected in the Assessment Form and his or her clinical evaluation The clinician considers the Veteran s needs and determines an appropriate level of care when making a referral It is possible that the clinician may find that referral to a VA homeless program is not appropriate given the Veteran s current status In such cases the clinician assists the Veteran by coordinating with other VA and or non VA service providers see
227. on VA Emergency Room Medical or Psychiatric Indicate whether a referral has been made 25 Non VA Detoxification Services Indicate whether a referral has been made 26 Non VA Mental Health or Substance Abuse Services Indicate whether a referral has been made For information on how to submit forms please reference Section II B 3 DRAFT LAST UPDATED APRIL 19 2011 42 VA Homeless Operations Management and Evaluation System HOMES User Manual F HUD VASH Forms 1 HUD VASH Entry Form a General Instructions Use this form for Veteran entry into the HUD VASH program See Appendix H for the HUD VASH Entry Form Worksheet b When to complete and submit the HUD VASH Entry Form This form should be completed and submitted as soon as a decision has been made regarding a Veteran s entry into the program c Who may complete and submit the HUD VASH Entry Form A HUD VASH clinician who is familiar with the Veteran should complete and submit the HUD VASH Entry Form Clerks other non clinicians and non VA staff should not complete this form d Completing the HUD VASH Entry Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Enter the Veteran s SSN first or last name or HOMES Veteran ID and click the Search for Veteran button Locate the appropriate Veteran from the list and click the Select button On the Veteran History Screen click the A
228. ood stamps in any category e Do not include income received through a spouse significant other or other household member in any category e Round all figures to the nearest dollar 14 Did the Veteran receive any of the following non cash benefits in the 30 days prior to program exit Select the response from the drop down list that indicates whether the Veteran received any non cash benefits in the 30 days prior to program exit a m Indicate whether or not the Veteran received non cash benefits from each of the sources listed in 14a m during the 30 days prior to program exit Multiple sources of non cash benefits may be identified IV Follow up Arrangements HCRV Exit Form Items 15 20 Select the code that best describes clinical treatment arrangements made at program exit 15 Alcohol Problems Select the appropriate response from the drop down list 16 Drug Problems Select the appropriate response from the drop down list DRAFT LAST UPDATED APRIL 19 2011 95 VA Homeless Operations Management and Evaluation System HOMES User Manual IV Follow up Arrangements HCRV Exit Form 17 Mental Health Problems Other than Drug or Alcohol Select the appropriate response from the drop down list 18 Medical Problems Select the appropriate response from the drop down list 19 Social and Recreational Deficits Select the appropriate response from the drop down
229. op down list that best reflects the Veteran s treatment court type If selecting response 7 other specify the Treatment Court type in the field provided TIT Current Arrest Court Involvement VJO Entry Form 8 Is the Veteran currently involved with jail or court Indicate whether the Veteran is currently involved with jail or courts by selecting a response from the drop down list If no skip to item 22 9a Veteran s Corrections Booking Number Enter the Veteran s 9 digit Corrections identification booking number in the field provided 9b Veteran s State Corrections Identification Number Enter the Veteran s 9 digit State Corrections Identification number in the field provided For what type of offense s is the Veteran currently being held 10 Violent Offense Identify whether the Veteran is currently being held for this offense by selecting a response from the drop down list Examples of violent offenses include murder manslaughter assault sexual assault including rape or child molestation robbery and domestic violence 11 Property Offense Identify whether the Veteran is currently being held for this offense by selecting a response from the drop down list Examples of property offenses include burglary breaking and entering larceny motor vehicle theft fraud stolen property arson shoplifting and vandalism 12 Drug Offense Identify whether the Veteran is curren
230. op down list that indicates whether the Veteran was hospitalized for an unscheduled medical condition in the past 30 days 28 Did the Veteran present to an emergency room for a medical condition in the past 30 days Select the response from the drop down list that indicates whether the Veteran visited the emergency room due to a medical condition in the past 30 days 29 Was the Veteran hospitalized for any mental health condition in the past 30 days Select the response from the drop down list that indicates whether the Veteran was hospitalized for a mental health condition in the past 30 days A mental health condition may include serious depression serious anxiety hallucinations violent behavior and thoughts of suicide 30 Did the Veteran have any emergency room visits related to mental health in the past 30 days Select the response from the drop down list that indicates whether the Veteran had any mental health related visits to the emergency room in the past 30 days A mental health concern may include serious depression serious anxiety hallucinations violent behavior or thoughts of suicide DRAFT LAST UPDATED APRIL 19 2011 53 VA Homeless Operations Management and Evaluation System HOMES User Manual VII Substance Abuse HUD VASH Monthly Status Report Form 31 Review the clinical rating scale for Veteran s use of alcohol in the past 30 days shown above and indicate your Assessm
231. or to program exit If 14 no or Case manager omitted item skip to item 15 If 14 yes list the average monthly amount in each category L 0 No 1 Yes LI 99 Case manager omitted item Please round to whole dollar amounts and note comma placement eg 452 76 should be entered as _ _ 453 00 a Employment include CWT SE __ 00 b Compensation for service connected psychiatric condition A A c Compensation for other service connected condition A A 00 d Non service connected pension ___ 0 0 e Retirement income from Social Security A i O20 f Pension from a former job _ _ ___ 0 0 g Supplemental Security Income SSI _ ____ 20 h Social Security Disability Income SSDI UU ro 0 i Private disability insurance AR A j Workers compensation E ee a 0 k Unemployment insurance oy 00 Temporary Assistance for Needy Families TANF or similar local program Go A a m General Assistance GA or similar local program _ og A AN n Child support ___ 0 0 o Alimony or other spousal support __ 0 0 p All other sources do not include food stamps NA 0 0 Total Amount Total income calculated in HOMES Did the Veteran receive any non cash benefits in the 30 days prior to program exit ae Yes If 15 no or Case Manager omitted item skip to item 16 If 15 yes indicate type s of benefits received LI 99 Case manager omitted item
232. orm Form Add MSR Form Form 642 642 04 12 2011 04 12 2011 Edit Entry Form h View Entry Form E ee lea Exit Form View Exit Form HUD VASH Monthly Status Report REMINDER Information on MSR 2 and beyond is pre populated from the previous MSR please update all items as necessary HOMES Episode Start Date 04 10 2011 Primary VAMC 642 Lead Case Manager N A Secondary VAMC 642 Program Entry Date 04 11 2011 Staff Login First and Last Name VA Site 3 digit VAMC code plus 2 digit suffix if any Report Sequence Number Date Range Covered in this Report Start of Reporting Period mm dd yy 4 2011 End of Reporting Period mm dd yy 5 11 2011 Date of this report mm dd yy m 13 2011 John 1 Veteran s name last name first initial 2 Social Security Number 3 Date Of Birth II HOUSING PROGRESS Use the instructions below to complete the form HUD VASH Monthly Status Report Form General HOMES Episode Start Date Automatically filled based on information collected in HOMES cannot be edited DRAFT LAST UPDATED APRIL 19 2011 48 VA Homeless Operations Management and Evaluation System HOMES User Manual General HUD VASH Monthly Status Report Form Program Entry Date Automatically filled based on information collected in HOMES cannot be edited Lead Case Manager n a in Phase 1 of HOMES Automatically filled based on information co
233. our main function and usefulness is to Veterans who are within 6 months of release By regulation we cannot provide treatment and by policy we are limited to pre release Assessments no earlier than 6 months before release This form should be completed and submitted as soon as a decision has been made regarding a Veteran s entry into the program c Who may complete and submit the HCRV Entry Form Staff members who fill out the HCRV Entry Form should be regular staff of the HCRV program or staff of another mental health program who conduct outreach to correctional facilities that is consistent with the HCRV model as a defined part of their position Correctional facilities include prisons jails federal or state funded correctional halfway houses or work release programs Clerks other non clinicians and non VA staff should not complete this form d Completing the HCRV Entry Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Enter the Veteran s SSN first or last name or HOMES Veteran ID and click Search for Veteran button Locate the appropriate Veteran from the list and click the Select button On the Veteran History Screen click the Add HCRV Entry Form button to access the form DRAFT LAST UPDATED APRIL 19 2011 83 VA Homeless Operations Management and Evaluation System HOMES User Manual Veteran History Last Name Date of 93 12 1980 Sex Male Veteran
234. ousing arrangement at the time of program exit 7 What is the zip code of that location Record in the field provided the five digit zip code of the location where the Veteran lives at the time of program exit If the zip code is unknown enter N 8 Housing Stability How would you describe the Veteran s housing situation at program exit Determine whether the Veteran is literally homeless imminently losing their housing unstably housed and at risk of losing their housing or stably housed Select the corresponding response from the drop down list Examples of Veterans who are literally homeless include those who are DRAFT LAST UPDATED APRIL 19 2011 67 VA Homeless Operations Management and Evaluation System HOMES User Manual HI Status at Program Exit HCHV Case Management Exit Form e Living in places not designed for or ordinarily used as a regular sleeping accommodation for human beings including a car park abandoned building bus or train station airport or camping ground e Ina supervised publicly or privately operated shelter designated to provide temporary living arrangements including hotels and motels paid for by Federal State or local government programs for low income individuals or by charitable organizations congregate shelters and transitional housing for homeless persons e Ina hospital or other institution if the person was sleeping in an emergency shelter or other
235. ovided use the mm dd yy format 2 Is the Veteran entering a residential treatment program Select the response from the drop down list that indicates whether the Veteran is entering a residential treatment program YES If yes complete items 3a and 3b NO If no skip to item 4 DRAFT LAST UPDATED APRIL 19 2011 74 VA Homeless Operations Management and Evaluation System HOMES User Manual General Residential Treatment Entry Form 3a Date of program entry Record the month day and year of residential treatment program entry decision date in the field provided For residential programs this date would represent the first day of residence in the program following residence at any other place Note Any return to a program after a break in treatment completion of the program or termination of the program must be recorded as a new program entry date A definition of what constitutes a break in the treatment depends on the program For example programs that expect to see the same Veteran on a daily or almost daily basis may define a break in treatment as one missed day that was not arranged in advance or three consecutive missed days for any reason Treatment programs that are scheduled less frequently than a daily basis may define a break in treatment as one or more missed weekly sessions 3b Residential Program Type Select the type of residential program the Veteran is entering from the drop do
236. p other recovery groups 14 Family problems 0 Nota problem area for this Veteran 3 Veteran currently receives treatment from non VA provider 1 Veteran s current treatment is unknown 4 Veteran currently receives treatment from VA 2 Veteran currently receives no treatment for O 5 Veteran currently receives treatment from both non VA these problems provider and VA O 6 Veteran currently receives peer support only e g 12 step other recovery groups V Legal Status 15 Legal status Since entry into the Treatment Court please indicate DRAFT LAST UPDATED APRIL 19 2011 190 VA Homeless Operations Management and Evaluation System HOMES User Manual Number of Jail time sanctions incarcerations imposed by Treatment Specialty Court monitoring Do not include new arrests or incarcerations for new offenses Code new arrests and incarcerations below under 15b amp 15c Number of new arrests during treatment court follow up period Number of new incarcerations during treatment court follow up period DRAFT LAST UPDATED APRIL 19 2011 191 VA Homeless Operations Management and Evaluation System HOMES User Manual D VJO Exit Form Worksheet Staff member completing this form first and last name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed MIM CQY 00 c eecceteee eee eeteees Veteran s name last name first initia
237. past 30 days If 30 no Veteran declined to answer or interviewer omitted item Skip to item 31 If 30 yes list the average monthly amount in each category 6 Military Service 7 Retired disability 8 Unemployed 9 Controlled environment e g hospital prison 98 Veteran declined to answer 99 Interviewer omitted item LI 0 No Dl 1 Yes L 98 Veteran declined to answer L 99 Interviewer omitted item Please round to whole dollar amounts and note comma placement eg 452 76 should be entered as _ _ 453 00 a Employment include CWT SE _ es 00 b Compensation for service connected psychiatric condition e ag 0 0 c Compensation for other service connected condition ee 0 0 d Non service connected pension YH ye AO e Retirement income from Social Security De a OA O f Pension from a former job A A UA y g Supplemental Security Income SSI s 00 h Social Security Disability Income SSDI s 00 i Private disability insurance ___ 0 0 j Worker s compensation AAA AA k Unemployment insurance _ es 0 0 Temporary Assistance for Needy Families TANF or similar local program ooo ey O20 m General Assistance GA or similar local program o_o 0 n Child support Bi OD o Alimony or other spousal support Gy 0 p All other sources do not include food stamps gt __ 0 0 Total Amount Total income calculated in HOMES 31 Did you r
238. past 30 days L 1 Greatly worsened L 4 Somewhat improved L 2 Somewhat worsened L 5 Greatly improved L 3 Stayed the same L 99 Case manager omitted item 9 Case manager omitted item LI 99 Case manager omitted item LI 99 Case manager omitted item Has the Veteran had increased social and or family contacts in the past 30 L 0 No days L 1 Yes L19 Was the Veteran hospitalized for an unscheduled medical condition in the past _ 0 No 30 days L 1 Yes Did the Veteran present to an emergency room for a medical condition in the L 0 No past 30 days Ol 1 Yes Was the Veteran hospitalized for any mental health condition in the past 30 L 0 No days L 1 Yes LI 99 Case manager omitted item DRAFT LAST UPDATED APRIL 19 2011 156 VA Homeless Operations Management and Evaluation System HOMES User Manual 30 Did the Veteran have any emergency room visits related to mental health in L 0 No the past 30 days Ol 1 Yes LI 99 Case manager omitted item Vil SUBSTANCE ABUSE 31 Review the clinical rating scale for Veteran s use of alcohol in the past 30 days shown above and indicate your assessment O 1 Abstinence L 4 Dependence O 2 Use without impairment O 5 Severe dependence O 3 Abuse 32 Review the clinical rating scale for Veteran s use of illegal drugs in the past 30 days shown above and indicate your assessment O 1 Abstinence L 4 Dependence O 2 Use without impairment O 5 Severe dependenc
239. place not meant for human habitation cars parks streets etc immediately prior to entry into the hospital or institution e Fleeing a domestic violence situation Veterans who are imminently losing their housing include those who e Are currently housed and not literally homeless e Are imminently losing their housing whether permanent or temporary e Have no subsequent housing options identified and e Lack the resources or support networks needed to retain current housing or obtain temporary or permanent housing Examples of imminent housing loss include e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing from others and rooms in hotels or motels not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Being discharged from a hospital or other institution e Living in housing that has been condemned by housing officials and is no longer considered meant for human habitation Veterans who are unstably housed and at risk of losing their housing include those who e Are currently housed and not literally homeless or imminently losing their housing e Are experiencing housing instability but may have one or more other temporary housing options and e Lack the resources or support networks to retain or obtain permanent housing Housing instability may be evidenced by e Frequent moves because of
240. provides support for Veterans diagnosed with a serious mental illness who might not otherwise find employment VBA Services Disability Compensation Disability benefits are a tax free compensation benefit paid to a Veteran because of injuries that happened or diseases that were contracted while on active duty or exacerbated by active military service Disability compensation may also be paid to certain Veterans disabled from VA health care 13 http www va gov HOMELESS docs Prevention_Fact_Sheet_11 22 10 pdf 14 http www hudhre info documents HPRP_FinancialAssistance pdf 15 http www va gov vhapublications ViewPublication asp pub_ID 1531 16 http www vba va gov bln 21 compensation index htm DRAFT LAST UPDATED APRIL 19 2011 132 VA Homeless Operations Management and Evaluation System HOMES User Manual Pension Benefits Pension benefits are paid to wartime Veterans who have limited or no income and are age 65 or older In order to receive pension benefits under the age of 65 the Veteran must be permanently and totally disabled Veterans who are more seriously disabled may qualify for Aid and Attendance or Housebound benefits Education Veterans may be eligible for education assistance under the Post 9 11 GI Bill Loan Guaranty Veterans may be eligible for a VA backed home loan If a Veteran is not able to make payments on the loan then VA will cover losses the lender might incur Vocational Rehabilitation
241. rea for this Veteran but no treatment arrangements made 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider O 4 Veteran s treatment has been arranged with both non VA and VA provider 20 Vocational skill deficits 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arrangements made 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider A i 4 Veteran s treatment has been arranged with both non VA and VA provider DRAFT LAST UPDATED APRIL 19 2011 182 VA Homeless Operations Management and Evaluation System HOMES User Manual Appendix L VJO A VJO Program Instructions B VJO Entry Form Worksheet Staff member completing this form first and last name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed mm dd yy sssceeeeeeeeeees 1 Veteran s name last name first initial 2 Social Security NUMbEl cece cece reece eee eee eees 3 Date of birth MIM AQYY ccicecce eee te ents tee nee nen een ee 4 Will the Veteran receive VJO services O 0 No O 1 Yes 5 Date of program entry decision mm dd yy If the Veteran will not receive VJO services answer items 7a and 7b only do not complet
242. rm Worksheet b When to complete and submit the HUD VASH Exit Form This form should be completed and submitted as soon as it is determined that the Veteran will exit the HUD VASH program c Who may complete the HUD VASH Exit Form A HUD VASH clinician who is familiar with the Veteran should complete and submit the HUD VASH Exit Form Clerks other non clinicians and non VA staff should not complete this form d Completing the HUD VASH Exit Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Enter the Veteran s SSN first or last name or HOMES Veteran ID and click the Search for Veteran button Locate the appropriate Veteran from the list and click the Select button On the Veteran History Screen click the Add HUD VASH Entry Form button to access the form Veteran is currently in HUDVASH Program At site 642 Assessment Intake Forms Entered 04 94 12 2011 SE HUD VASH HCHV CM CWT TR VJO Edit Form View Form Supplemental Referral Forms Entered No Supplemental Referral forms entered Add Supplemental Referral s Residential Program Forms Entered Date of Program Primary Secondary Edit Entry View Entry a Edit Exit View Exit PAL VAMC VAMC Entry Date le orm Form Exit Date ladd Form Form Form Add Exit Form 04 12 2011 642 642 04 12 2011 Edit Entry Form View Entry Form 04 13 2011 Edit Exit Form View Exit Form HCHV Program Forms Entered Date of Assessment i
243. rmation HCRV Exit Form 1 Veteran s Name Automatically filled based on the Veteran information can only be edited by NEPEC 2 Social Security Number Automatically filled based on the Veteran information can only be edited by NEPEC 3 Date of Birth Automatically filled based on the Veteran information can only be edited by NEPEC II Reasons for Program Exit HCRV Exit Form 4 Date HCRV program participation ended for this Veteran Record the month day and year that the Veteran exited the HCRV program in the field provided 5 Which is the most important reason why the Veteran ended involvement in HCRV Select from the drop down list the most important reason why HCRV case management was ended for this Veteran If a Veteran left for multiple reasons record only the primary reason If selecting response 10 other specify the other reason why the Veteran exited the program in the field provided HI Status at Program Exit HCRV Exit Form 6 What is the Veteran s housing arrangement at program exit Select the response from the drop down list that reflects the Veteran s current housing arrangement at the time of program exit e Please note that item 20 places not meant for habitation includes places such as enclosed bus stops ATM buildings and lobbies of buildings which are closed for the night DRAFT LAST UPDATED APRIL 19 2011 92 VA Homeless Operat
244. rms of HCHV case management 5 Since referral Veteran became too ill to participate 6 Veteran is incarcerated 7 Veteran did not meet program eligibility requirements 8 Other specify Use the instructions below to complete the form General HCHV Case Management Entry Form Staff Login Automatically filled based on the user information cannot be edited VA Site Automatically filled based on the user information cannot be edited Last Name Automatically filled based on the Veteran information can only be edited by NEPEC First Name Automatically filled based on the Veteran information can only be edited by NEPEC Social Security Number Automatically filled based on the Veteran information can only be edited by NEPEC Date of Birth Automatically filled based on the Veteran information can only be edited by NEPEC HOMES Episode Start Date Automatically filled based on information collected in HOMES cannot be edited Lead Case Manager n a in Phase 1 of HOMES Automatically filled based on information collected in HOMES cannot be edited DRAFT LAST UPDATED APRIL 19 2011 63 VA Homeless Operations Management and Evaluation System HOMES User Manual General HCHV Case Management Entry Form Primary VAMC Automatically filled based on information collected in HOMES cannot be edited Secondary VAMC Automatically filled
245. rom the drop down list 49a Does the Veteran need assistance with family problems Indicate whether the Veteran is in need of assistance with family problems at the time of referral by selecting a response from the drop down list 49b Is the Veteran interested and willing to participate in treatment for family problems Indicate whether the Veteran is interested and willing to participate in treatment for family problems by selecting a response from the drop down list 50 Is this Veteran a danger to self or others Indicate whether the Veteran is a danger to him or her self or others by selecting a response from the drop down list 51 Is this Veteran in danger from others Indicate whether the Veteran is in danger from others e g gang violence fleeing domestic violence etc by selecting a response from the drop down list IX Referral Plans Assessment Form What are your immediate plans for referral or treatment of the Veteran at this time Reference Appendix D for brief program descriptions DRAFT LAST UPDATED APRIL 19 2011 34 VA Homeless Operations Management and Evaluation System HOMES User Manual IX Referral Plans Assessment Form VA Specialized Homeless Services 52 Case Management Services a HUD VASH Case Management Services Indicate whether the Veteran requires intensive case management services with permanent housing by selecting a respons
246. rral to VA outpatient mental health programs and residential treatment Residential Treatment Transitional Housing HCHV Emergency Housing Program Emergency Housing is designed to offer immediate short term housing for Veterans While in the program Veterans are assigned to a case manager who works with them to identify their reasons for homelessness and outline next steps in obtaining housing stability HCHV Contract Residential Treatment Contracted services at community based residential treatment facilities include on site group and individual counseling life skills education medication management and a structured environment that reinforces the principles of sober living The intended stay for Veterans in these programs is approximately two months Veterans who have more than 1 000 monthly income live in their own apartment room or house or have no psychiatric or substance abuse disorder may be considered lower priority for this program However there is notable variability with respect to these criteria across sites Clinical judgment may outweigh other considerations For example a Veteran with a psychotic disorder who is about to be evicted may be appropriate for placement even if he is in his own home the day of his Assessment HCHV Safe Haven Program Safe havens provide immediate accessible housing to chronic homeless Veterans Safe havens also provide Veterans with access to other VA resources gt VA Health Care
247. ructions Use this form to submit monthly status reports for Veterans currently enrolled in the HUD VASH program See Appendix H for the HUD VASH Monthly Status Report Form Worksheet b When to complete and submit the HUD VASH Monthly Status Report Form This form should be completed and submitted every 30 days following the Program Entry Date It should be completed as soon as possible following the end of each 30 day reporting period It cannot be completed before the end of the reporting period Note that the first and last dates of the reporting period are automatically calculated and displayed by HOMES see Date Range Covered by this Report below c Who may complete and submit the HUD VASH Monthly Status Report Form A HUD VASH clinician who is familiar with the Veteran should complete and submit the HUD VASH Monthly Status Report Form Clerks other non clinicians and non VA staff should not complete this form d Completing the HUD VASH Monthly Status Report Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Enter the Veteran s SSN first or last name or HOMES Veteran ID and click the Search for Veteran button Locate the appropriate Veteran from the list and click the Select button On the Veteran History Screen click the Add HUD VASH Entry Form button to access the form DRAFT LAST UPDATED APRIL 19 2011 47 VA Homeless Operations Management and Evaluation System
248. ry or permanent housing Examples of imminent housing loss include e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing from others and rooms in hotels or motels not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Being discharged from a hospital or other institution e Living in housing that has been condemned by housing officials and is no longer considered meant for human habitation DRAFT LAST UPDATED APRIL 19 2011 58 VA Homeless Operations Management and Evaluation System HOMES User Manual II Status at Program Exit HUD VASH Exit Form Veterans who are unstably housed and at risk of losing their housing include those who e Are currently housed and not literally homeless or imminently losing their housing e Are experiencing housing instability but may have one or more other temporary housing options and e Lack the resources or support networks to retain or obtain permanent housing Housing instability may be evidenced by e Frequent moves because of economic reasons e Living in the home of another because of economic hardship e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing with others and rooms in hotels or motels not paid for by Federal State or local government programs for low income ind
249. s 12 17 Select the code that best describes clinical treatment arrangements made at program exit 12 Alcohol Problems Select the appropriate response from the drop down list DRAFT LAST UPDATED APRIL 19 2011 81 VA Homeless Operations Management and Evaluation System HOMES User Manual IV Follow up Arrangements Residential Treatment Exit Form 13 Drug Problems Select the appropriate response from the drop down list 14 Mental Health Problems Other than Drug or Alcohol Select the appropriate response from the drop down list 15 Medical Problems Select the appropriate response from the drop down list 16 Social and Recreational Deficits Select the appropriate response from the drop down list 17 Vocational Skill Deficits Select the appropriate response from the drop down list For information on how to submit forms please reference Section III B 3 DRAFT LAST UPDATED APRIL 19 2011 82 VA Homeless Operations Management and Evaluation System HOMES User Manual I HCRV Forms 1 HCRV Entry Form a General Instructions Use this form for Veteran entry into the HCRV program See Appendix K for the HCRV Entry Form Worksheet b When to complete and submit the HCRV Entry Form The HCRV Entry Form is to be completed on Veterans who are within 6 months of release Specialists should make sure that corrections and Veterans know y
250. s SMI individuals If 1 or 2 or 5 chosen in item 3b Program Code Program Name If the Veteran did not enter program 4 Select the main reason why Veteran did not enter a residential program O 1 Veteran left can no longer locate 2 Veteran no longer in clinical need of program O 3 Veteran not interested in program DRAFT LAST UPDATED APRIL 19 2011 169 VA Homeless Operations Management and Evaluation System HOMES User Manual 4 Veteran refused to agree with terms of residential treatment program 5 Since referral Veteran became too ill to participate 6 Bed not available within 72 hours of assessed clinical need 7 Veteran is incarcerated 8 Veteran did not meet program eligibility requirements 9 Other specify es a a es Comment Reason Why optional DRAFT LAST UPDATED APRIL 19 2011 170 VA Homeless Operations Management and Evaluation System HOMES User Manual E Residential Treatment Exit Form Worksheet Use this form to document exit of Veterans from a Grant and Per Diem program GPD HCHV Contract Residential Treatment Program Domiciliary Care for Homeless Veterans DCHV Program or Compensated Work Therapy Transitional Residence CWT TR program Staff member completing this form first and last name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed MIM CQVY
251. s and months enter all zeros for none years months b total time in prison in years and months enter all zeros for none years months IV PRE ARREST COURT INVOLVEMENT 22 Before the arrest on date of arrest for the current court involvement was the Veteran living in a House including own family s or friend s Apartment including own family s or friend s Trailer or mobile home including own family s or friend s Rooming house hotel or motel On the street or in a homeless shelter In a group living situation or institution such as a hospital halfway house recovery home dormitory etc 010 048 NOOR WD In another type of housing specify 23 In the 12 months before the Veteran s arrest on date of arrest for the current court involvement was there a time when s he was homeless living on the street or in a shelter O 0 No 1 Yes 24 How old was the Veteran the first time s he was arrested for a crime If never arrested code 99 Code N if Veteran doesn t know or declined to answer 25 How many times had the Veteran ever been arrested as an adult or a juvenile before his her arrest for the current court involvement enter 0 for none cannot exceed 99 Code N if Veteran doesn t know or declined to answer a How many of these arrests occurred in the 1 year prior to the current arrest do not count the current arrest 26
252. s report ario 2011 5 10 2014 Report sequence 1 4 month post entry Did rti d Date of the last face to face contact with Veteran by VJO Specialist that E provides the basis for current report II Housing Employment Status 6a During the reporting period how many days did the Veteran sleep in the following kinds of places VIO Specialist doesn t know omitted item select from the drop down list and skip to item Use the instructions below to complete the form General VJO Progress Form HOMES Episode Start Date Automatically filled based on information collected in HOMES cannot be edited Lead Case Manager n a in Phase 1 of HOMES Automatically filled based on information collected in HOMES cannot be edited Program Entry Date Automatically filled based on information collected in HOMES cannot be edited Primary VAMC Automatically filled based on information collected in HOMES cannot be edited Secondary VAMC Automatically filled based on information collected in HOMES cannot be edited Staff Login Automatically filled based on the user information cannot be edited VA Site Automatically filled based on the user information cannot be edited DRAFT LAST UPDATED APRIL 19 2011 105 VA Homeless Operations Management and Evaluation System HOMES User Manual I Veteran Information VJO Progress Form 1 Veteran s Name Automa
253. s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider Drug problems 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged O ri O 2 Veteran s treatment has been arranged with non VA provider O 3 Veteran s treatment has been arranged with VA provider O 4 Veteran s treatment has been arranged with both non VA and VA provider Mental health problems other than drug or alcohol 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider EP BEG 4 Veteran s treatment has been arranged with both non VA and VA provider DRAFT LAST UPDATED APRIL 19 2011 174 15 16 17 VA Homeless Operations Management and Evaluation System HOMES User Manual Medical problems O O O O O 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider Social and recreational deficits 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s
254. s whether the Veteran received any non cash benefits in the 30 days prior to program exit a m Indicate whether or not the Veteran received non cash benefits from each of the sources listed in items 15a m during the 30 days prior to program exit Multiple sources of non cash benefits may be identified IV Follow up Arrangements HUD VASH Exit Form Items 16 21 Select the code that best describes clinical treatment arrangements made at program exit 16 Alcohol Problems Select the appropriate response from the drop down list 17 Drug Problems Select the appropriate response from the drop down list DRAFT LAST UPDATED APRIL 19 2011 60 VA Homeless Operations Management and Evaluation System HOMES User Manual IV Follow up Arrangements HUD VASH Exit Form 18 Mental Health Problems Other than Drug or Alcohol Select the appropriate response from the drop down list 19 Medical Problems Select the appropriate response from the drop down list 20 Social and Recreational Deficits Select the appropriate response from the drop down list 21 Vocational Skill Deficits Select the appropriate response from the drop down list For information on how to submit forms please reference Section II B 3 DRAFT LAST UPDATED APRIL 19 2011 61 VA Homeless Operations Management and Evaluation System HOMES User Manual G HCHV Forms 1 HCHV Ca
255. scribes the Veteran s arrangement for receipt of VA financial benefits disability payments or pensions at the time of program exit DRAFT LAST UPDATED APRIL 19 2011 59 VA Homeless Operations Management and Evaluation System HOMES User Manual III Status at Program Exit HUD VASH Exit Form 13 What is the Veteran s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit Select the response from the drop down list that best describes the Veteran s arrangement for receipt of non VA financial benefits disability payments or other support at the time of program exit 14 Did the Veteran receive any money in the 30 days prior to program exit Select the response from the drop down list that indicates whether the Veteran received any money in the 30 days prior to program exit a p Enter the amount of money the Veteran received from each of the sources listed in items 14a p during the past 30 days Please note e Include income from CWT or SE in item 14a e Do not include the cash value of food stamps in any category e Do not include income received through a spouse significant other or other household member in any category e Round all figures to the nearest dollar 15 Did the Veteran receive any of the following non cash benefits in the 30 days prior to program exit Select the response from the drop down list that indicate
256. se Management Entry Form a General Instructions Use this form for Veteran entry into the HCHV Case Management program See Appendix I for the HCHV Case Management Entry Form Worksheet b When to complete and submit the HCHV Case Management Entry Form This form should be completed and submitted as soon as a decision has been made regarding a Veteran s entry into the program c Who may complete and submit the HCHV Case Management Entry Form An HCHV clinician who is familiar with the Veteran should complete and submit the HCHV Case Management Entry Form Clerks other non clinicians and non VA staff should not complete this form d Completing the HCHV Case Management Entry Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Enter the Veteran s SSN first or last name or HOMES Veteran ID and click the Search for Veteran button Locate the appropriate Veteran from the list and click the Select button On the Veteran History Screen click the Add HCHV Case Management Entry Form button to access the form Veteran History NE Thomas First Name John SSN 123045678 lame Date of Birth Z Veteran 03 12 1980 Sex Male HOMES ID Edit Veteran Edit Veteran Contact Information Search for Another Veteran Assessment Intake Forms Entered Date of Assessment Primary VAMC Secondary VAMC APRA 04 10 2011 42 842 HUD VASH HC Egt Fem View Fom HV CM VIO Eg Suppleme
257. se from the drop down list DRAFT LAST UPDATED APRIL 19 2011 116 VA Homeless Operations Management and Evaluation System HOMES User Manual IV Follow up Arrangements VJO Exit Form 17 Vocational Skill Deficits Select the appropriate response from the drop down list V Legal Status VJO Exit Form 18 Legal Status For items 18a c indicate the Veteran s status since entry into the VJO program a Number of Jail Time Sanctions during entire VJO Program episode Enter in the fie provided the total number of jail time sanctions incarcerations imposed by VJO program new offenses b Number of New Arrests during entire VJO program episode Enter the total number new arrests during the entire VJO program episode in the field provided c Number of New Incarcerations during entire VJO program episode Enter the total number of new incarcerations during the entire VJO program episode in the field provided ld monitoring during the entire VJO program episode Do not include arrests incarcerations for of For information on how to submit forms please reference Section II B 3 DRAFT LAST UPDATED APRIL 19 2011 117 VA Homeless Operations Management and Evaluation System HOMES User Manual IV Frequently Asked Questions A Who has access to HOMES VA specialized homeless program clinical staff of the HCHV HCHV Contract Residential Treatment GPD DCHV CWT TR HUD VA
258. se manager omitted item skip to item 23 If 22 yes list the average monthly amount in each category Please round to whole dollar amounts and note comma placement eg 452 76 should be entered as _ _ 453 00 a Employment include CWT SE b Compensation for service connected psychiatric condition c Compensation for other service connected condition d Non service connected pension e Retirement income from Social Security f Pension from a former job g Supplemental Security Income SSI h Social Security Disability Income SSDI i Private disability insurance j Worker s compensation k Unemployment insurance Temporary Assistance for Needy Families TANF or similar local program m General Assistance GA or similar local program n Child support Pl A A AH HGH GH HM AH WH KH HH HH H Y o Alimony or other spousal support Y e a PF p All other sources do not include food stamps Total Amount Total income calculated in HOMES DRAFT LAST UPDATED APRIL 19 2011 155 23 24 25 26 27 28 29 VA Homeless Operations Management and Evaluation System HOMES User Manual Did the Veteran receive any non cash benefits during the past 30 days L 0 No O 1 Yes If 23 no or Case Manager omitted item skip to item 24 If 23 yes indicate type s of benefits received LI 99 Case manager omitted item
259. ser Manual 17 Hotel or motel paid for without emergency shelter voucher 18 Emergency shelter including hotel or motel paid for with emergency shelter voucher 19 Prison jail 20 Place not meant for habitation outdoors automobile truck boat 21 Don t know EE 0H What is the zip code of that location Code N in 1 space if unknown Housing stability How would you describe the Veteran s housing situation at program exit O 1 Literally homeless O 2 Imminent risk of losing housing O 3 Unstably housed at risk of losing housing Ll 4 Stably housed O 5 Don t know With whom will the Veteran be living at program exit 0 No residence 1 Alone 2 With spouse partner or children 3 With parents with siblings or with other family 4 With friends 5 With strangers si es et EEE 6 Don t know What is the Veteran s arrangement for employment at program exit 0 Disabled or retired Unemployed Actively seeking employment Part time or temporary employment Full time employment VA s IT or CWT VI Other vocational training Unpaid volunteer Student Don t know eet st a a at et Oo OAN DAF ON What is the Veteran s arrangement for receipt of VA financial benefits disability payments or pension at the time of program exit 0 Currently receiving VA benefits and will continue 1 Has pending application for VA financial benefits 2 Is planning to apply for VA financi
260. ser information cannot be edited Date This Form Completed Automatically filled based on the current date cannot be edited DRAFT LAST UPDATED APRIL 19 2011 44 VA Homeless Operations Management and Evaluation System HOMES User Manual I Veteran Identification HUD VASH Entry Form 1 Veteran s Name Automatically filled based on the Veteran record can only be edited by NEPEC 2 Social Security Number Automatically filled based on the Veteran record can only be edited by NEPEC 3 Date of Birth Automatically filled based on the Veteran record can only be edited by NEPEC 4 Did the Veteran enter the HUD VASH program Indicate whether or not the Veteran entered the HUD VASH program by selecting a response from the drop down list 5 Date of Entry Decision Record the month day and year of the HUD VASH Program Entry decision date in the field provided If the Veteran did not enter the HUD VASH program answer item 6 only do not complete remainder of the form 6 Select the main reason why Veteran did not enter the HUD VASH program Select the response from the drop down list that best reflects why the Veteran did not enter the HUD VASH program If selecting response 8 other specify the other reason why the Veteran did not enter the program in the field provided If the Veteran entered the HUD VASH program skip item 6 You may use the optional
261. sk of losing their housing include those who e Are currently housed and not literally homeless or imminently losing their housing e Are experiencing housing instability but may have one or more other temporary housing options and e Lack the resources or support networks to retain or obtain permanent housing Housing instability may be evidenced by e Frequent moves because of economic reasons e Living in the home of another because of economic hardship e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing with others and rooms in hotels or motels not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Living in a hotel or motel not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Living in severely overcrowded housing e Being discharged from a hospital or other institution or e Otherwise living in housing that has characteristics associated with instability and an increased risk of homelessness Veterans who are stably housed are in a stable housing situation and not at risk of losing this housing i e do not meet the criteria for any of the other housing response categories 25 How long have you been homeless Please do not take short cuts in completing this item To answer this item ask the Veteran the followin
262. skip to item 11 If 10 yes list the average monthly amount in each category Please round to whole dollar amounts and note comma placement eg 452 76 should be entered as _ _ 453 00 a Employment include CWT SE b Compensation for service connected psychiatric condition c Compensation for other service connected condition d Non service connected pension e Retirement income from Social Security f Pension from a former job g Supplemental Security Income SSI h Social Security Disability Income SSDI i Private disability insurance j Worker s compensation k Unemployment insurance Al A A AM A A A A N Y lo ollo Ja Je fel Jol Jo Ja Je Je lo lol lo lo lo lo lo lo lo lo lo DRAFT LAST UPDATED APRIL 19 2011 1 3 11 VA Homeless Operations Management and Evaluation System HOMES User Manual Temporary Assistance for Needy Families TANF or similar local program Sie ee a 0 0 m General Assistance GA or similar local program s a 0 n Child support o o Alimony or other spousal support Oe 0 p All other sources do not include food stamps DAA A a 0 0 Total Amount Total income calculated in HOMES Did the Veteran receive any non cash benefits in the 30 days prior to program L 0 No exit O 1 Yes LI 99 Case manager omitted item If 11 no or Case Manager omitted item skip to item 12 If 1
263. sociated with instability and an increased risk of homelessness Veterans who are stably housed are in a stable housing situation and not at risk of losing this housing i e do not meet the criteria for any of the other housing response categories 6 With whom will the Veteran be living at program exit Indicate who the Veteran was living with at the time of program exit by selecting the corresponding response from the drop down list 7 What is the Veteran s arrangement for employment at program exit Select the response from the drop down list that best describes the Veteran s employment arrangement at the time of program exit e Ifthe Veteran was in vocational training and this training was also a part time job list this as vocational training e If more then one category applies choose the response that represents the Veteran s DRAFT LAST UPDATED APRIL 19 2011 80 VA Homeless Operations Management and Evaluation System HOMES User Manual III Status at Program Exit Residential Treatment Exit Form highest level of employment 8 What is the Veteran s arrangement for receipt of VA financial benefits disability payments or pension at the time of program exit Select the response from the drop down list that best describes the Veteran s arrangement for receipt of VA financial benefits disability payments or pensions at the time of program exit 9 What is the Vetera
264. sode Number of new incarcerations during entire VJO program episode DRAFT LAST UPDATED APRIL 19 2011 196
265. sources during the past 30 days e Include income from CWT or SE in item 30a e Do not include the cash value of food stamps in any category Do not include income received through a spouse significant other or other household DRAFT LAST UPDATED APRIL 19 2011 30 VA Homeless Operations Management and Evaluation System HOMES User Manual VI Employment and Income Assessment Form member in any category e Round all figures to the nearest dollar 31 Did you receive any non cash benefits in the past 30 days Select the response from the drop down list that best reflects whether the Veteran received any non cash benefits in the past 30 days 31a m If yes select each category For items 30a m determine if the Veteran received any non cash benefits in the past 30 days Veterans may identify multiple sources of non cash benefits 32 Do you have any significant outstanding debts Select the response from the drop down list that best reflects whether the Veteran has any significant outstanding debts a j If yes please specify debt sources For items 32a j indicate for each listed source of debt whether the Veteran has outstanding debt of this type For item j specify the source of debt in the field provided 33 Do you currently have a representative payee or fiduciary Indicate whether the Veteran has a representative payee or fiduciary by selecting a response from the drop down list Only
266. ssssccssnsccccsssccccsscsccscssccesseccsessccecessececcssnees 169 A GPD PROGRAM INSTRUCTIONS cocococononononononononononononononononononononononononononononononononononononononononononononononinononineniness 169 DRAFT LAST UPDATED APRIL 19 2011 ii VA Homeless Operations Management and Evaluation System HOMES User Manual B DCHV PROGRAM INSTRUCTIONS 0 edit 169 C CWT TR PROGRAM INSTRUCTIONS ccccccoconcnonononcnnnnnnnnnnnnnononononnnnnononononononononnnnnononononononononononnnononononcncncnnnnnnos 169 D RESIDENTIAL TREATMENT ENTRY FORM WORKSHEET cccccococcncnononononononononononononononononononononononononononcncninininnos 169 E RESIDENTIAL TREATMENT EXIT FORM WORKSHEET ccccsecesecececececececececececscecececececececececececececececececececess 171 APPENDIX K HORV 5 cisiccssssssecsissssscseesstecsecssicbsucnssossesesssedecteossiescooseecsdsestecsesusvonssensbedseuonsssdevensocesccbsbuassosseseaseseses 176 A HCRV PROGRAM INSTRUCTIONS ices ane r E cae 176 B HCRV ENTRY FORM WORKSHEET cccocccononononononononononononononononononononononononononononononononononononononononononononinininininnns 176 C HCRV EXIT FORM WORKSHEET oococcccccncnonononononononononnnnnnnnnnnnnnnnnnnnnnnnnononononononnnnnnnnnnnononononononononononcnnnnanacinanenes 179 APPENDIX L V J AA RN 183 A VIO PROGRAM INSTRUCTIONS A a a tt iaa Beas eee 183 B VJO ENTRY FORM WORKSHEET ccccccccscscscsccececseececececececececececececececacecacace
267. t and Evaluation System HOMES User Manual III Status at Program Exit HCHV Case Management Exit Form e Include income from CWT or SE in item 13a e Do not include the cash value of food stamps in any category e Do not include income received through a spouse significant other or other household member in any category e Round all figures to the nearest dollar 14 Did the Veteran receive any of the following non cash benefits in the 30 days prior to program exit Select the response from the drop down list that indicates whether the Veteran received any non cash benefits in the 30 days prior to program exit a m Indicate whether or not Veteran received non cash benefits in the past 30 days Multiple sources of non cash benefits may be identified Non cash benefits are important to determine whether Veterans are accessing all mainstream program benefits for which they may be eligible and to ascertain a more complete picture of their economic circumstances IV Follow up Arrangements HCHV Case Management Exit Form Items 15 20 Select the code that best describes clinical treatment arrangements made at program exit 15 Alcohol Problems Select the appropriate response from the drop down list 16 Drug Problems Select the appropriate response from the drop down list 17 Mental Health Problems Other than Drug or Alcohol Select the appropriate response from the drop down list 1
268. tation cars parks streets etc immediately prior to entry into the hospital or institution e Fleeing a domestic violence situation Veterans who are imminently losing their housing include those who e Are currently housed and not literally homeless e Are imminently losing their housing whether permanent or temporary e Have no subsequent housing options identified and e Lack the resources or support networks needed to retain current housing or obtain temporary or permanent housing Examples of imminent housing loss include e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing from others and rooms in hotels or motels not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Being discharged from a hospital or other institution e Living in housing that has been condemned by housing officials and is no longer considered meant for human habitation Veterans who are unstably housed and at risk of losing their housing include those who e Are currently housed and not literally homeless or imminently losing their housing e Are experiencing housing instability but may have one or more other temporary housing options and e Lack the resources or support networks to retain or obtain permanent housing DRAFT LAST UPDATED APRIL 19 2011 114 VA Homeless Operations Management and Evaluat
269. tels not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Being discharged from a hospital or other institution e Living in housing that has been condemned by housing officials and is no longer considered meant for human habitation Veterans who are unstably housed and at risk of losing their housing include those who e Are currently housed and not literally homeless or imminently losing their housing e Are experiencing housing instability but may have one or more other temporary housing options and e Lack the resources or support networks to retain or obtain permanent housing Housing instability may be evidenced by e Frequent moves because of economic reasons e Living in the home of another because of economic hardship e Being evicted from a private dwelling unit including housing they own rent or live in without paying rent are sharing with others and rooms in hotels or motels not paid for by Federal State or local government programs for low income individuals or by charitable organizations e Living in a hotel or motel not paid for by Federal State or local government programs for DRAFT LAST UPDATED APRIL 19 2011 108 VA Homeless Operations Management and Evaluation System HOMES User Manual III Housing Employment Status VJO Progress Form low income individuals or by charitable organizations e Living in severely overcrowde
270. tered Add Residential Program Entry form HCHV Program Forms Entered No HCHV program forms entered Add HCHV Program Entry form HCRV Program Forms Entered No HCRV program forms entered VJO Entry Exit Forms Entered No VJO program forms entered Add VJO Entry form VJO Progress Reports Entered No VJO Progress Reports entered HUDVASH Entry Exit Forms Entered No HUDVASH program forms entered Add HUDVASH Entry form Residential Program Entry Form DCHV Program or Compensated Work Therapy Transitional Residence CWT TR program HOMES Episode Start Date 04 12 2011 Primary VAMC 642 Lead Case Manager N A Secondary VAMC 642 Staff Login First and Last Name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed mm dd yyyy Veteran s Name last name first initial Social Security Number Date Of Birth mm dd yyyy 2 Is the Veteran entering a residential treatment program 0 No 1 Yes select x If YES complete item 3a amp 3b if NO skip to item 4 3a Date of program entry mm dd yy 3b Residential program 1 Grant and Per Diem GPD 2 HCHY contract residential treatment program including HCHV Emergency Housing 3 Domiciliary Care for Homeless Veterans DCHV Program 4 Compensated Work Therap Use the instructions below to complete the form Use this form for Veteran entry into the Grant and Per Diem Program GPD HCHV
271. terviewer the following kinds of places omitted item L 98 Veteran declined to answer L 99 Interviewer omitted item If Veteran declined or interviewer omitted item Skip to item 21 Please make sure that responses to 20 a t add up to 30 days a Housing owned by Veteran no ongoing housing subsidy b Housing owned by Veteran with ongoing housing subsidy c Housing rented by Veteran no ongoing housing subsidy d Housing rented by Veteran with HUD VASH voucher e Housing rented by Veteran with non HUD VASH housing subsidy f Permanent housing for formerly homeless persons Such as SHP S C or SRO MOD Rehab g Staying or living in family member s room apartment or house h Staying or living in a friend s room apartment or house i GPD transitional housing j Non VA transitional housing for homeless persons k Safe Haven special transitional supportive housing or drop in supportive service center for homeless SMI individuals DRAFT LAST UPDATED APRIL 19 2011 139 VA Homeless Operations Management and Evaluation System HOMES User Manual VA MH RRTP all types DCHV CWT TR SA RRTP PTSD RRTP General RRTP m VA contracted residential treatment programs ATU HWH or HCHV contract n Non VA residential treatment program o Non psychiatric hospital acute care p Psychiatric hospital acute care q Hotel or motel paid for wit
272. th 03 04 1980 II Residential Treatment Stay ni type peis contract residential treatment program including HCHV Emergency Housing Program Code Program Name 1 Period covered by this report Code dates mm dd yy Entry Date 047137201 1 Use the instructions below to complete the form I Veteran Information Residential Treatment Exit Form Veteran s Name Automatically filled based on the Veteran information can only be edited by NEPEC Social Security Number Automatically filled based on the Veteran information can only be edited by NEPEC Date of Birth Automatically filled based on the Veteran information can only be edited by NEPEC II Residential Treatment Stay Residential Treatment Exit Form Program Type Automatically filled based on information collected in HOMES cannot be edited Program Code Automatically filled based on information collected in HOMES cannot be edited Program Name Automatically filled based on information collected in HOMES cannot be edited HOMES Episode Start Date Automatically filled based on information collected in HOMES cannot be edited DRAFT LAST UPDATED APRIL 19 2011 77 VA Homeless Operations Management and Evaluation System HOMES User Manual II Residential Treatment Stay Residential Treatment Exit Form Lead Case Manager n a in Phase 1 of HOMES Automatically
273. the Veteran Enter the date that the Veteran selected housing in the field provided use the mm dd yy format 11 Date of Safety Inspection Enter the date of the safety inspection in the field provided use the mm dd yy format 12 Date Housing Assistance Payment HAP Contract signed Enter the date that the Housing Assistance Payment HAP Contract was signed in the field provided use the mm dd yy format DRAFT LAST UPDATED APRIL 19 2011 50 VA Homeless Operations Management and Evaluation System HOMES User Manual II Housing Progress HUD VASH Monthly Status Report Form 13 Date Veteran Moved into HUD VASH Housing Enter the date that the Veteran moved into HUD VASH housing in the field provided use the mm dd yy format 14 Date Voucher was Ported Enter the date that the voucher was ported in the field provided use the mm dd yy format III Case Management Contacts HUD VASH Monthly Status Report Form 15 Did the Veteran have contact with a HUD VASH clinician either the current HUD VASH case manager or another HUD VASH clinician for case management during the past 30 days Select the response from the drop down list that indicates whether the Veteran has had contact with the clinician for case management during the past 30 days either the current HUD VASH case manager or another HUD VASH clinician 16 How many contacts did you have with this Veteran his or
274. the list and click the Select button On the Veteran History Screen click the Add VJO Entry Form button to access the form Veteran History Last Thomas First Name John SSN 123045678 Name Veteran 690 Date of a Birth 03 12 1980 Sex Male HOMES ID Edit Veteran Edit Veteran Contact Information Search for Another Veteran Assessment Intake Forms Entered Date of Assessment Primary VAMC secondary VAMC Homeless Program Referrals Edit Form View Form 04 10 2011 642 642 HUD VASI Est Form View Form H HCHV CM VIO Supplemental Referral Forms Entered No Supplemental Referral forms e Add Supplemental Referrals Residential Program Forms Entered No Residential program forms entered HCHV Program Forms Entered No HCHY program forms entered Add HCHV Program Entry form HCRV Program Forms Entered No HCRV program forms entered VJO Entry Exit Forms Entered No VIO progr m forms entered Add VJO Entry form VJO Progress Reports Entered No VIO Progress Reports entered HUDVASH Entry Exit Forms Entered No HUDVASH program forms entered Add HUDVASH Entry form DRAFT LAST UPDATED APRIL 19 2011 97 VA Homeless Operations Management and Evaluation System HOMES User Manual VJO Entry Form HOMES Episode Start Date 04 12 2011 Primary VAMC 642 Lead Case Manager N A Secondary VAMC 642 Staff Login First and Last Name
275. ther non clinicians and non VA staff should not complete this form d Completing the Residential Treatment Entry Form Search for the Veteran by clicking the 1 Add Edit Veteran s and Form s button Enter the Veteran s SSN first or last name or HOMES Veteran ID and click Search for Veteran button Locate the appropriate Veteran from the list and click the Select button On the Veteran History Screen click the Add Residential Treatment Entry Form button to access the form DRAFT LAST UPDATED APRIL 19 2011 72 VA Homeless Operations Management and Evaluation System HOMES User Manual Veteran History Date of Veteran Birth 12 05 1985 Sex Male Homes 1p 979 Edit Veteran Edit Veteran Contact Information Search for Another Veteran Veteran is not currently in any HOMES program Assessment Intake Forms Entered Last smith kima First Name John SSN 098765432 Date of Primary Secondary propane RE Edit View Assessment VAMC VAMC rera alemento Form Form HUD VASH Case Management Services intensive case management with permanent housing HCHV Case Edit 04 12 2011 642 642 Management services direct case management beyond referral to other services GPD transitional housing parm Veterans Justice Outreach VIO ao Supplemental Referral Forms Entered No Supplemental Referral forms entered Add Supplemental Referral s Residential Program Forms Entered No Residential program forms en
276. tically filled based on the Veteran information can only be edited by NEPEC 2 Social Security Number Automatically filled based on the Veteran information can only be edited by NEPEC 3 Date of Birth Automatically filled based on the Veteran information can only be edited by NEPEC 4 Date of VJO Treatment Court Entry Automatically filled based on information collected in HOMES cannot be edited II Contact with Veteran VJO Progress Form 5 Time Period Covered in This Report Automatically calculated and displayed by HOMES based on the date range Did you have contact with this Veteran during reporting period Select the response from the drop down list that indicates whether the VJO Specialist or designated clinician has had contact with the Veteran during the current reporting period If no is selected the remainder of the form will become inaccessible and the user will be prompted to submit the form Date of the last face to face contact with Veteran by VJO Specialist that provides the basis for current report Enter in the field provided the date of the last face to face contact with the Veteran by the VJO Specialist that provides the basis for the current report III Housing Employment Status VJO Progress Form 6a During the reporting period how many days did the Veteran sleep in the following kinds of places Determine where the Veteran slept during th
277. tly being held for this offense by selecting a response from the drop down list Examples of drug offenses include possession and trafficking 13 Public Order Offense Identify whether the Veteran is currently being held for this offense by selecting a response from the drop down list Examples of public order offenses include weapons offense prostitution public intoxication disorderly conduct and driving while intoxicated DWI 14 Probation Parole Violation Identify whether the Veteran is currently being held for this offense by selecting a response from the drop down list DRAFT LAST UPDATED APRIL 19 2011 100 VA Homeless Operations Management and Evaluation System HOMES User Manual TIT Current Arrest Court Involvement VJO Entry Form 15 Other Unspecified Identify whether the Veteran is currently being held for this offense by selecting a response from the drop down list 16 Current Case a Is Driving Under the Influence DUI involved in the current case Select the response from the drop down list that indicates whether driving under the influence DUI is involved in the Veteran s current case b Is domestic dispute involved in the current case Indicate whether a domestic dispute is involved in the current case by selecting a response from the drop down list c Are there arrearage or delinquency problems with any current child support orders Indicate whether ther
278. treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider Vocational skill deficits a a a 0 Not a problem area for this veteran 1 Problem area for this Veteran but no treatment arranged 2 Veteran s treatment has been arranged with non VA provider 3 Veteran s treatment has been arranged with VA provider 4 Veteran s treatment has been arranged with both non VA and VA provider DRAFT LAST UPDATED APRIL 19 2011 175 VA Homeless Operations Management and Evaluation System HOMES User Manual Appendix K HCRV A HCRV Program Instructions B HCRV Entry Form Worksheet Staff member completing this form first and last name VA Site 3 digit VAMC code plus 2 digit suffix if any Date this form completed MIM CQY 0cseeceeteee eee eeteees I VETERAN INFORMATION 1 Veteran s name last name first initial 2 Social Security NUMbel cceeeeeeeeeeeeeeeeeeeeeee S O O oOo eee a e o 3 Date of birth MIM QQ Y 1 ccceeeee tees eeeeeeeeeeee SS nao ae 4 Did the Veteran enter the HCRV program L 0 No L 1 Yes 5 Date of program entry decision mm dd yy ___ E ayp o ea o If the Veteran did not enter the HCRV program answer items 6 and 7only do not complete 8 25
279. ty Officer 39 class Corporal 5 E 5 Corporal Staff Sergeant Petty Officer 2nd class Sergeant 6 E 6 Sergeant Tech Sergeant Petty Officer 1st class Staff Sergeant 7 E 7 Staff Sergeant Master or First Sergeant Chief Petty Officer Gunnery Sergeant Senior Chief Petty 8 E 8 Master Sergeant Senior Master Sergeant Officer Master Sergeant Master Chief Petty 9 E 9 Sergeant Major Chief Master Sergeant Officer Sergeant Major Table of Warrant Officers Number W Rating Army Air Force Navy CG Marine Corps 1 WO 1 Warrant Officer No Warrant Warrant Officer Warrant Officer 2 CWO 2 Chief Warrant Officer No Warrant Chief Warrant Officer Chief Warrant Officer 3 CWO 3 Chief Warrant Officer No Warrant Chief Warrant Officer Chief Warrant Officer 4 CWO 4 Chief Warrant Officer No Warrant Chief Warrant Officer Chief Warrant Officer 5 CWO 5 Chief Warrant Officer No Warrant Chief Warrant Officer Chief Warrant Officer Table of Commissioned Officers Number C Rating Army Air Force Navy CG Marine Corps 1 2LT Second Lieutenant Second Lieutenant Ensign ENS Second Lieutenant 2 1LT First Lieutenant First Lieutenant Lieutenant Junior Grade First Lieutenant 3 CPT Captain Captain Lieutenant Captain 4 MAJ Major Major Lieutenant Commander Major 5 LTC Lieutenant Colonel Lieutenant Colonel Commander Lieutenant Colonel DRAFT LAST UPDATED APRIL 19 2011 148 VA Homeless Operations Management and Evaluation System HOMES User Manual
280. uestions 5 Time period covered in this report Report sequence Did you have contact with this Veteran during reporting period L 0 No 1 Yes If no do not complete remainder of the form This progress report should only include information about case management provided during the time period covered in this report entered above Please keep these dates in mind when completing the form Date of the last face to face contact with Veteran by VJO Specialist that provides the basis for current report Ill Housing Employment Status 6a During the reporting period how many days did the Veteran sleep in L 99 VJO Specialist doesn t know omitted the following kinds of places item If 6a 99 skip to item 7 Please make sure that responses to 6a 1 20 add up to 90 days 1 Housing owned by Veteran no ongoing housing subsidy 2 Housing owned by Veteran with ongoing housing subsidy 3 Housing rented by Veteran no ongoing housing subsidy 4 Housing rented by Veteran with HUD VASH voucher 5 Housing rented by Veteran with non HUD VASH housing subsidy 6 7 8 9 1 Permanent housing for formerly homeless persons such as SHP S C or SRO MOD Rehab Staying or living in family member s room apartment or house Staying or living in friend s room apartment or house GPD transitional housing 0 Non VA transitional housing for homeless persons DRAFT LAST U
281. uide for Drug Use Assessment e Inquires to National Homeless Center e Technical Questions VSSC Help Desk DRAFT LAST UPDATED APRIL 19 2011 11 VA Homeless Operations Management and Evaluation System HOMES User Manual III Instructions for Completing Forms in HOMES A Accessing the System HOMES is accessed via the secure VA intranet by users registered with NEPEC The URL to access this site is https vaww homes va gov To request access from NEPEC refer to Section II A Users must be connected to the VA network in order to access the site The system automatically recognizes a registered user through the VHA network domain and User ID same ID as on the user s PC at his or her medical center Unauthorized users are shown an error message and denied access to the system The first screen is the Main Page screen The system automatically detects and displays the staff name login ID email address and authorized level of access From this screen the user can access the following items Veterans and Forms Operational Reports Management Reports and Reference and Resource Material Urxan States DEFARTUENT or VETERANS Arras VA HomeLess OPERATIONS MANAGEMENT AND EVALUATION SYSTEM HOMES Home Manage Access Home Logged in as DVAlwacobermam VA Homeless Operations Management and Evaluation System HOMES VA HOMES Main Page Staff Name Matthew Berman Staff Login DVA vacobermam
282. use Services Indicate whether a referral has been made DRAFT LAST UPDATED APRIL 19 2011 35 VA Homeless Operations Management and Evaluation System HOMES User Manual IX Referral Plans Assessment Form 59 VA Medical Services Indicate whether a referral has been made 60 VA Vocational Rehabilitation Programs Indicate whether a referral has been made This includes VA CWT SE VBA Services 61 Disability Compensation Indicate whether a referral has been made 62 Pension Benefits Indicate whether a referral has been made 63 Education Indicate whether a referral has been made 64 Loan Guarantee Indicate whether a referral has been made 65 Vocational Rehabilitation and Employment Indicate whether a referral has been made 66 Insurance Indicate whether a referral has been made Non VA Services 67 Basic Services e g food clothing transportation Indicate whether a referral has been made 68 Non VA Housing Indicate whether a referral has been made 69 Non VA Social Vocational Assistance Indicate whether a referral has been made 70 Non VA Income Resources and Non Cash Benefits a e Indicate whether a referral has been made 71 Non VA Emergency Room Medical or Psychiatric Indicate whether a referral has been made DRAFT LAST UPDATED APRIL 19 2011 36
283. wn list If item 1 2 or 5 is selected in item 3b provide the program code and program name in the field provided 4 Select the main reason why Veteran did not enter a residential program If the Veteran did not enter the Residential Treatment Program select the response from the drop down list that identifies the reason why the Veteran was not entered If selecting response 8 other specify the other reason why the Veteran did not enter the program in the field provided For information on how to submit forms please reference Section II B 3 DRAFT LAST UPDATED APRIL 19 2011 75 VA Homeless Operations Management and Evaluation System HOMES User Manual 2 Residential Treatment Exit Form a General Instructions Use this form for Veteran exit from a Grant and Per Diem Program GPD HCHV Contract Residential Treatment Program Domiciliary Care for Homeless Veterans DCHV Program or Compensated Work Therapy Transitional Residence CWT TR Program See Appendix J for the Residential Treatment Exit Form Worksheet b When to complete and submit the Residential Treatment Exit Form This form should be completed and submitted as soon as it is determined that the veteran will exit the Residential Treatment program c Who may complete and submit the Residential Treatment Exit Form A clinician who is familiar with the Veteran s referral and admission decision should complete the Residential Treatment Exit Form Cler
284. wn list that best reflects why the Veteran did not enter the VJO program If selecting response 8 other specify the other reason why the Veteran did not enter the program in the field provided If the Veteran entered the VJO program skip item 6 II Initial Contact with HCRV Program VJO Entry Form 7a Where did VJO staff make initial contact with this Veteran Select the response from the drop down list that best reflects where VJO staff made the initial contact with the Veteran When responding to items 13 and 16 specify where initial contact was made in the field provided Please note that category 13 Special program for homeless Veterans is only to be checked yes if the interview took place at a community program designed to serve only Veterans who are homeless To be considered a special program it must be a place in which other homeless people are not included in the population and where Veterans who have homes are not considered part of the population served If you feel that you have such a program where you interview Veterans call NEPEC so that it can be verified If you do check category 13 please make sure to write the name of the program in the space provided DRAFT LAST UPDATED APRIL 19 2011 99 VA Homeless Operations Management and Evaluation System HOMES User Manual II Initial Contact with HCRV Program VJO Entry Form 7b Treatment court type Select the response from the dr
285. y the browser will display the previous page If this occurs click the browser s Forward button to return to the form that you were entering Reference Appendix B for instructions on how to configure browser settings K After searching for a client record that I previously added to the system I received a message that there is no match What do I do Contact the appropriate NEPEC staff person see Appendix A who will work with you to determine if an error was made when the client record was entered into the system L What do I do if I realize that a form I submitted contains an error Contact the appropriate NEPEC staff person who will correct the error M When I try to submit an admission record I receive a message that the admission date overlaps with a previous residential program episode What do I do Cancel and return to the client history so that you can view the previous residential episodes and identify the problem Contact the appropriate NEPEC staff person who will work with you to explain the problem and correct any errors if necessary N Should an Assessment be fully conducted if it is already known or quickly discovered that the Veteran is not eligible for VA healthcare Yes Assessments may be done on veterans who may or may not be eligible for VA healthcare Veterans who are not eligible for VA healthcare are still eligible for the Grant amp Per Diem program In addition some Veterans will be contacted but will not be r
286. y S OO f Pension from a former job o aaa 00 g Supplemental Security Income SSI _ gt 00 h Social Security Disability Income SSDI Siaa _ 0 i Private disability insurance A Fes a ee UN j Worker s compensation s 0 k Unemployment insurance os 0 Temporary Assistance for Needy Families TANF or similar local program Bi 0 0 m General Assistance GA or similar local program e 0 0 n Child support MS AO o Alimony or other spousal support _ _g_ 00 p All other sources do not include food stamps C E EE OE Total Amount Total income calculated in HOMES Did the Veteran receive any non cash benefits in the 30 days prior to program exit a 0 No 1 Yes If 14 no or Case Manager omitted item skip to item 15 If 14 yes indicate type s of benefits received L 99 Case manager omitted item a Medicaid health insurance program or similar local program _ 0 No L 1 Yes b Medicare health insurance program or similar local program 0 No L 1 Yes c Temporary Rental Assistance LI 0 No L 1 Yes d Homeless Prevention and Rapid Re housing Program HPRP Funds _ 0 No L 1 Yes e Veteran Service Organizations LI 0 No 1 Yes f State Children s Health Insurance Program or similar local program LI 0 No 1 Yes g Supplemental Nutrition Assistance Program SNAP or Food Stamps L 0 No U 1 Yes h Special Supplemental Nutrition Program for Wo
287. y complete and submit the Assessment Form nsosssesssseeeereerseeeresrseresesresrssresreserrrnsesrensesrees 20 4 Completing the Assessment Form isis aii tye n ae leido 20 Ey SUPPLEMENTAL REFERRAL FORM ira di 38 1 CGONTALIASTUCIONS A a cee de acest gees ia 38 2 When to complete and submit the Supplemental Referral Form nocc 38 3 Who may complete and submit the Supplemental Referral Form 38 DRAFT LAST UPDATED APRIL 19 2011 1 VA Homeless Operations Management and Evaluation System HOMES User Manual 4 Completing the Supplemental Referral FO rmM s seseseseseeeeeeseeerereesrrseresesrresesresrssresrnserrresesressssreees 38 F HUD VASH FORMS ccccccccececccscseececececscececececececseseseececececeescecececececececeeeceeececececececececececececececececeeecececececsss 43 4 HUD VASH Entry FOV go see osa 43 2 HUD VASH Monthly Status Report FOrm e sccccccccccsccsssessecseeseeeseesceescessceseceseceseceaecaaecssecsseeseesseeseeeeeeneees 47 3 HUD VASH EXE FORME a dado att I EE 55 E HCHV FORMS vicodin dates dilatada dd dd covetess voted sy de detach coven died ada cess 62 1 HCHV Case Management Entry FOTM ooooncinnninnnnnnnnnnnnnnonnnono conc ono nn nena nena nnnn ona anne cameron manner nec ne rincon neon anna 62 2 HCHV Case Management Exit FOr is iii daa td i apa idad 65 H RESIDENTIAL TREATMENT FORMS HCHV CONTRACT GPD DCHV CWT TR occccccnnninononnnoncconanannnononoos 72 Ll Resid

HOMES User Manual - End Homelessness Among Veterans

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