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Vermont Veteran ServicesAt the University of VermontSupportive Services for Veteran Families ProgramPolicy and Procedure ManualLast Revised: June 17, 2013

Vermont Veteran Services at UVMSSVF Policy and Procedure ManualRevision HistoryRevision DateAuthor/ContentContributorsNew/Changed Content11/21/2012A. LoweInitial Draft: Outreach, Referrals, Screening, Eligibility,Enrollment, Forms12/21/2012A. LoweEdits to existing content (Forms, Eligibility); add RecordKeeping, Assessments2/20/2013A. LoweEdits to existing content (Forms, Screening, Outreach); addCase Management, TFA/ Re-Certification4/10/2013A. LoweEdits to existing content (Forms, expand Case Management,TFA, Re-Certification); add Re-Certification, DataQuality/HMIS5/16/2013A. LoweEdits to existing content (modify Case Management, TFArequests); add Data Security, Critical Incidents, Grievances,Benefits Coordination, Suspense/Termination5/28/2013A. LoweEdits to existing content (modify Forms, Re-Certification, CaseManagement); add Financial Management, SubcontractedServices6/17/2013A. LoweConsolidate all versions and revisions to datePage iLast Revised June 17, 2013

Vermont Veteran Services at UVMSSVF Policy and Procedure ManualTable of ContentsIntroduction . 1Program Policies and Procedures . 1SSVF Process . 1Outreach, Recruitment, and Referrals. 1Participant Screening and Eligibility Determination. 2Program Enrollment . 5Case Management. 6Financial Assistance . 9Assistance Obtaining Benefits. 13Ongoing Reassessment and Recertification of Eligibility . 14Suspense and Termination of Assistance . 15Recordkeeping. 16Employee Training Plan . 18Internal Monitoring and Evaluation Plan. 18Reporting Requirements. 18Financial Management . 18Subcontracted Services . 19Attachment 1: Forms. 20VVS SSVF Application/Referral Form . 21VVS SSVF Pre-Screening Form. 22SSVF Eligibility Disposition Screening Form. 23Release of Information . 28Participation Agreement. 29VVS SSVF Sample Housing Stabilization Plan (HSP) Cover Sheet. 30VVS SSVF Sample Housing Stabilization Plan (HSP) . 31SSVF Reassessment Form. 32Attachment 2: Process Flow Charts. 34Master Process Flow . 35HUD-VASH Process Flow. 36Page iiLast Revised June 17, 2013

Vermont Veteran Services at UVMSSVF Policy and Procedure ManualIntroductionThis manual documents the policies and procedures that govern the Vermont Veteran Services(VVS) Supportive Services for Veteran Family (SSVF) program at the University of Vermont(UVM). It is intended to provide guidance for management and staff both at UVM, as well as forany subcontractors or vendors who provide services using SSVF program funds.Program Policies and ProceduresSSVF ProcessThe entire VVS SSVF process flow from outreach through exit is summarized in the Master SSVFProcess Flow chart found in the appendix under Attachment 2: Process Flow Charts.Outreach, Recruitment, and ReferralsPolicy StatementVVS SSVF will accept referrals into the program from any external approved source such asprogram partners, state agencies, other SSVF programs, and the VA; from internal VVS programrecruitment; and directly from program candidates. VVS will conduct outreach through internal staffand subcontractor staff to ensure that Vermont veteran families are aware of the program and ableto access its services in a timely manner.Outreach Outreach shall only be conducted by VVS and subcontractor staff who have been trained inappropriate VVS SSVF messages. Outreach shall be targeted at the following key audiences and purposes: Recruitment of potential participants; Education of potential referral sources (e.g., the VA, shelters, food shelves, etc.); Education of community partners (e.g., the VA, housing agencies, CoC, VermontAgency of Human Services, etc.). All materials distributed during outreach must be approved in advance by programmanagement.Referral/Recruitment SourcesExternal ReferralsPotential SSVF program participants may be referred by community partners such as VA providersat the CBOCs or the White River Junction hospital, community housing agencies, the VermontVeteran Outreach Team, community mental health centers, and others. Partners will be providedwith materials describing program requirements and with referral forms. Required information for areferral is participant name and contact information. Pre-screening information is desirable but notrequired.Page 1Last Revised June 17, 2013

Vermont Veteran Services at UVMSSVF Policy and Procedure ManualRecruitmentParticipant recruitment will be conducted via direct outreach by VVS staff. Outreach activities shallbe approved in advance by VVS program management. Outreach can involve direct contact topotential participants at venues such as homeless shelters or food pantries, or at street level. Staffsafety protocols must be observed during all outreach activities.Self ReferralsPotential participants may apply directly for acceptance into the SSVF program by filling out anapplication form (see page 21) or by contacting VVS staff.Participant Screening and Eligibility DeterminationPolicy StatementVVS shall adhere to federal SSVF program policy in making determination of eligibility. VVS shallcreate and use screening instruments such as the Eligibility Screening Disposition Form withtargeting criteria and Prevention Threshold scoring to ensure an appropriate ration of programparticipants is maintained (e.g., 60% Rapid Re-housing to 40% Prevention). VVS programmanagement shall be responsible for reviewing and approving all eligibility determination in order toassure all national and local program goals are achieved.Pre-Screening Pre-screening will be conducted for all potential SSVF program participants (“applicants”)who have applied or been referred to the program. The goal of pre-screening is to do a rapid, low-cost determination of probably programeligibility and to screen out obviously ineligible applicants. Applicants will be contacted by the VVS Program Assistant or Navigator for Pre-screeningwithin two business days of receiving the referral/application. The Pre-screen will be conducted by phone when possible unless there are exceptionalcircumstances (e.g., applicant has no phone availability or a disability that prevents easilyusing a phone). The VVS SSVF Pre-Screen Form (see the Forms section of the Attachments section) will becompleted and retained as a work product of the Pre-Screen interview. The Pre-Screen results will be reviewed with program management and a determination willbe made about whether to screen the applicant out or to continue to the full Screeningprocess within one business day of data collection. All applicants will be contacted within one business day after the Pre-screeningdetermination to notify them of the result and inform them of next steps. Applicants who are screened out will be provided with linkage to non-SSVF services thatmay help address their priority needs as determined in the Pre-Screen process. Applicants who pass the Pre-screen will receive full SSVF Program Screening asdocumented in the Screening section below.Page 2Last Revised June 17, 2013

Vermont Veteran Services at UVMSSVF Policy and Procedure Manual All Pre-screen applicants will be entered into the VVS HMIS application with preenrollment status. The Pre-screen form will be filed for at least one year.Screening Screening will be conducted for all applicants who pass the Pre-screen. The goal of Screening is to determine probable SSVF program eligibility and whether toproceed with eligibility determination. Applicants who pass the Pre-screen will be contacted by the SSVF Program Assistant orNavigator for Screening within three business days of the pass determination. The Screening interview will be conducted by phone whenever possible. The Eligibility Disposition Screening form (see the Forms section of the Attachments section)will be completed as a work product of the Screening process. The Screening results will be reviewed with program management and a determination willbe made about whether to screen the applicant out or to proceed to Eligibilitydetermination. The Screening Targeted Threshold Score for Category 1 (Prevention) is 6. An additionalpoint will be added as a local criterion for Rural households. Rural households are defined asthose residing outside an OMB-designated metropolitan area. In Vermont, the only OMBdesignated metropolitan area includes all of Chittenden county and parts of adjacent GrandIsle and Franklin counties. The Rural Health Grants Eligibility Analyzer will be used todetermine whether specific addresses in Grand Isle and Franklin counties are rural (see thefollowing uralhealthadvisor.aspx?ruralByAddr 1One point shall be added to the Targeting score for any household’s eligibility score if theyreside in any county other than Chittenden, Franklin, or Grand Isle. For applicants inFranklin or Grand Isle, rural designation shall be determined according to the EligibilityAnalyzer, and addresses qualifying for rural health grants shall have one point added to theireligibility score. Residents of Chittenden county shall have no additional points added totheir targeting score. Screening for all housing categories is predicated on determining: Program eligibility; Fit for Category 1, 2, or 3; Likelihood of achieving stable housing within 90 days of enrollment; Relative need (“but for” criterion). All applicants will be contacted within one business day after the Screening determination tonotify them of the result and inform them of next steps. Applicants who are screened out will be provided with linkage to non-SSVF services thatmay help address their priority needs as determined in the Pre-Screening and Screeningprocess.Page 3Last Revised June 17, 2013

Vermont Veteran Services at UVMSSVF Policy and Procedure Manual Applicants who pass the Screening process will be contacted to SSVF program eligibility asdocumented in the Program Eligibility section below. HMIS will be updated with the results of the Screening process outcome. The Homelessness Prevention Eligibility Screening Disposition Form (Exhibit B9) will befiled in the applicant’s file.Program Eligibility Determination Eligibility determination will be conducted for all applicants who pass the Pre-Screen. The goal of Eligibility Determination is to verify that potential participants meet all VA andVVS SSVF requirements for participation in the program. Program Management or designee (e.g., Program Assistant) will assign a Navigator to theEligibility data collection process. Applicants will be contacted by the Program Assistant within one business day of approvalfor eligibility. The eligibility process will be explained to the applicant and the list of requiredinformation will be communicated. The assigned Navigator may assist with or perform thiscommunication. Whenever possible, eligibility information should be collected via phone,mail, e-mail, and fax. Where necessary, a meeting between a Navigator and the applicant willbe scheduled within three business days. The Navigator is responsible for assembling the Eligibility information and ensuringoutstanding information is collected in a timely manner. Target is three business days fromthe eligibility meeting, with the understanding that participants and third parties such asemployers may not reply on a timely basis. Verification of veteran status via DD-214 isrequired. Additional required eligibility documentation shall be collected according to theDocumentation Standards published in the SSVF Program Guide (e.g., B1, B2, B3, B4, B6,depending on the individual’s situation and availability of third party documentation). Once the entire information portfolio is complete, the Navigator is responsible for reviewingthe portfolio and comparing it against the SSVF Documentation Checklist: ParticipantEligibility form (see the Forms section of the Attachments section). Once the Navigator has reviewed the portfolio and filled out the Documentation Checklist,the Eligibility portfolio will be reviewed with program management. The Program Managerwill confirm or revise the Navigator’s assessment. Applicants who are found eligible will be assessed by the Navigator and programmanagement for criteria including Prevention vs. Rapid Re-housing, Threshold score (ifCategory 1, Prevention), need, likelihood of being successfully housed, likelihood ofsustainable stabilization, and overall fit with the program. Program management willdetermine whether the applicant will be enrolled in the program according to criteria thatinclude fit with SSVF program criteria, need, Prevention/Rapid Re-housing ratios, programcapacity, and risk factors such as staff safety, participant safety, or barriers to achieve stablehousing. Program Management and Navigator will sign the SSVF Staff Certification OfEligibility Form (Exhibit B5) as documentation of approval for enrollment.Page 4Last Revised June 17, 2013

Vermont Veteran Services at UVMSSVF Policy and Procedure Manual Applicants who are not deemed eligible or not confirmed for enrollment will be providedwith linkage to non-SSVF services that may help address their priority needs as determinedin the Pre-Screen, Screening, and Eligibility processes. The Eligibility portfolio will be filed for all applicants. HMIS will be updated, and applicantswho are not enrolled will remain in pre-enrollment status. Eligible applicants who are approved for enrollment will be scheduled for enrollment withinthree business days of approval. Program management will assign a Navigator to completethe enrollment process. At time of approval for enrollment, the Navigator or Program Assistant will ensure theapplicant is exited from pre-enrollment status (Provider 927) in HMIS and entered forprogram enrollment (Provider 926).Program EnrollmentWhen an applicant is approved for enrollment and assigned to a Navigator, the Navigator, assistedby the Program Assistant, will schedule and intake meeting within three business days.At the intake meeting, the Navigator will collect all required documentation. Required intakedocumentation includes the following: Signed and dated Participant Consent to Exchange Information;Signed and dated Program Participation Agreement;Completed Housing Stabilization Plan Cover Sheet discussed under HousingStabilization Plans below).The Navigator shall be responsible for assuring that the Participant Satisfaction Survey (ExhibitB10) is sent to participants following enrollment.If Unable to Reach Client The navigator will make attempts to call and schedule the veteran in pre-enrolled status atleast three times. Document all attempts of contact in HMIS under the initial need created for informationand referral. If no response from veteran on the fourth attempt, navigator will set a follow up for 30 daysfor the Program Assistant. Program Assistant will set time aside once a month to cold call the veterans in the “backburner” section. Program Assistant will document the results of the cold calls in HMIS. If veteran is reachedand still needing services they will be passed off for further intake services by the navigator. If the veteran is not reached it will be assumed they are no longer seeking services at thistime.Page 5Last Revised June 17, 2013

Vermont Veteran Services at UVMSSVF Policy and Procedure ManualSSVF Enrollment for HUD-VASH ParticipantsPotential participants already enrolled in the VA HUD-VASH program will be handled by anexception process. If an veteran is already enrolled in the HUD-VASH program, he/she shall bepresumed eligible for SSVF. Case management of these participants shall be provided by the VAHUD-VASH case manager rather than the VVS case manager. The Program Assistant/Navigatorshall coordinate with the appropriate VA HUD-VASH case manager for applicable SSVF servicessuch as security deposit. See the HUD-VASH process flow documented in the appendix underAttachment 2: Process Flow Charts for details of this flow.Case ManagementPolicy StatementVVS SSVF case management services shall be proactive rather than reactive. This means that SSVFcase managers are expected to and shall be measured on aggressively seeking out, contacting,interacting with, and following up with participants to provide “intensive case management.” Sittingback and waiting for SSVF participants to make contact is not acceptable. In addition, casemanagement consists of successfully completing all the activities associated with the work for agiven case, including immediate documentation of service notes in HMIS as reportable evidence ofwork, even if that work is an unsuccessful attempt to contact a participant.VVS is committed to truly “managing” the entire case, not just a client. This means challenging andjustifying all services, not merely providing the maximum “benefit” to each client. TFA, for instance,must be managed based on need, potential individual outcomes, and programmatic outcomes. Inshort, VVS has a higher expectation of performance from all staff and subcontractor who providecase management services than merely talking to clients and helping them apply for benefits.SSVF Program RequirementsThe VVS SSVF program shall adhere to the following requirements for case management asdocumented in 38 CFR 62.31.Grantees must provide case management services that include, at a minimum:(a) Performing a careful assessment of participant functions and developing and monitoring case plans in coordinationwith a formal assessment of supportive services needed, including necessary follow-up activities, to ensure that theparticipant’s needs are adequately addressed;(b) Establishing linkages with appropriate agencies and service providers in the area or community to help participantsobtain needed supportive services;(c) Providing referrals to participants and related activities (such as scheduling appointments for participants) to helpparticipants obtain needed supportive services, such as medical, social, and educational assistance or other supportiveservices to address participants’ identified needs and goals;(d) Deciding how resources are allocated to participants on the basis of need; and(e) Educating participants on issues, including, but not limited to, supportive services availability and participantrights.Page 6Last Revised June 17, 2013

Vermont Veteran Services at UVMSSVF Policy and Procedure ManualScope of Work Case management services including needs assessment, monitoring, follow-up, linkageand/or referral to supportive services, and overall coordination of services shall be providedprimarily by subcontracted case management resources (e.g., the Community ActionProviders, or CAPs). These case management resources will be called “Regional CaseManagers” (RCM) for the purposes of this document. Case management services associated with outreach, education, eligibility determination,VBA/VHA benefit linkage, and veteran-specific issues shall be provided by VVS PeerNavigators. Case management services associated with resource allocation shall be performed by VVSprogram management.Interaction of Navigators and Case ManagersClose coordination between VVS Peer Navigators and Regional Case Managers is critical tosuccessful outcomes for VVS SSVF participants. As noted in the sections on Participant Screening andEligibility Determination and Program Enrollment, the VVS Navigator assumes primary responsibility forclient engagement and interaction in the pre-enrollment phase through program enrollment. Withinthree business days of enrollment, the Navigator will hand off the client household to the RCM.Where possible, the hand-off will be via a meeting between the Navigator, Regional Case Manager,and as many members of the client household as appropriate and possible. Outcomes of the handoff will be:1. Assumption of primary responsibility for case management services by the RCM;2. Updating the Housing Stabilization Plan (HSP) Cover Sheet by the Navigator;3. Creation of HSP detail (i.e., internal case plan) by the RCM that addresses all the issuesidentified in the HSP;4. Ensuring the client record is accessible by the RCM in HMIS.The Navigator will continue to be involved in the following aspects of the client case:NOTE: Participants who receive HUD-VASH services shall have case management provided perHUD-VASH program guidelines to ensure no overlap of services.Needs AssessmentPolicy StatementNeeds assessment is at the heart of case management. All SSVF services shall be linked to adocumented need that relates directly to gaining or retaining stable housing.ProcessIn the process of eligibility and enrollment processing, the Navigator will determine high-level needsfor participant households. These needs will be documented on the Housing Stabilization Plan(HSP) cover sheet. Following the handoff from Navigator to RCM, the RCM will perform in-depthneeds assessment and document these needs in the body of the HSP as discussed in the nextsection.Page 7Last Revised June 17, 2013

Vermont Veteran Services at UVMSSVF Policy and Procedure ManualHousing Stabilization PlansPolicy StatementA completed Housing Stabilization Plan (HSP) is a required element of the SSVF program. TheHSP is intended to be a living document that is updated regularly (a minimum of once per month)to indicate status, progress toward goals, and potential ongoing or new problem areas that must beaddressed to maintain stable housing. The HSP shall explicitly indicate the plan for handling futureexpenses after (in the absence of) SSVF financial assistance.ProceduresEvery household shall have a completed HSP Cover Sheet within three business days of enrollment,and a fully completed HSP (i.e., including detail provided by the RCM) within ten business days ofenrollment.The Navigator will compete the HSP Cover Sheet and upload into HMIS following enrollment. TheHSP Cover Sheet documents major areas of need for the participant household. A sample HSMCover Sheet template is attached in the Forms section of this document. The HSP Cover Sheet is notrequired to be signed before the detail is completed. Once the detail is completed, the participanthead of household must sign and date the HSP.The RCM will add the HSP detail, addressing all the major areas highlighted in the HSP Cover Sheetincluding, at a minimum, Intensive Case Management. Additional components will often includefinancial counseling, income/expense worksheet, budget development, housing search, etc. TheRCM may use their own organizational templates (e.g., an “Individual Service Plan”) for the detail.The HSP detail must be developed in conjunction with and full engagement of the participanthousehold, and signed and dated by the participant head of household or designee as proof ofagreement. Completed and signed HSP detail shall be uploaded into HMIS.HSP detail shall contain specific actionable and measurable outcome objectives. The RCM shallupdate the HCM detail a minimum of once per month and upload into HMIS.Contact and Follow-upSSVF requires that participants receive “intensive case management.” At the beginning ofengagement with a participant, it is expected that RCMs shall contact participants 2-3 times perweek. Difficult or unusually complex cases may require more contact; straightforward cases such asa simple HUD-VASH security deposit may require less.Case management does not require an in-person visit all the time. It is expected that there will bemore face-to-face contact earlier in the engagement, with gradually less physical and more phonecontact in later stages as participants become more stably housed.Case NotesPolicy StatementVVS SSVF recognizes that intensive case management is the most important component of helpingSSVF participants become or remain stably housed. As such, case notes are required as proof thatcase management and other supportive services are being provided to participants. If a service is notdocumented by a note, there is no way of verifying that it was provided. Accordingly, all VVS staffand subcontractors are required to document services with a note in HMIS stating the date ofPage 8Last Revised June 17, 2013

Vermont Veteran Services at UVMSSVF Policy and Procedure Manualservice, nature of service, person and organization providing the service, and duration of service.Note that unsuccessful attempts to provide service, such as an unanswered call or e-mail or a brokenappointment, must be documented by a note as well.Entering Needs, Goals, Services, Service Notes VVS staff and subcontractors shall use the VVS HMIS to document needs and case notes. All notes shall be entered within a Service using the ServicePoint Service Notes feature. Services shall be attached to a Need in ServicePoint. As single Need shall be used wherepossible, and all Services shall be appended to that Need For example, a single “Case/CareManagement” need will be created at the time of enrollment for all participant households,and staff and subcontractors will add a Service to that need for each episode. Service Noteswill be added to that Need. Specific Needs shall be created for separate instances (e.g., months) of Financial Assistance. Details of using ServicePoint for HMIS will be documented separately in a VVS SSVFHMIS User Guide.Exiting Participants Participants shall be exited as soon as an assessment verifies they are no longer eligible, or ifparticipants violate program participation requirements and fail to meet minimum correctiveaction goals. Participants will also be exited upon their formal request to discontinueparticipation in the program. If any person in the supportive services team (e.g., Navigator, RCM, Program Assistant,Program Management) becomes aware that a participant has decided to leave the program,all team members should be notified immediately. Program Management will schedule areview of the case to determine status. Participants shall receive a letter from the VVS SSVF program upon exit to document theirchange of status. The letter shall include the SSVF Exit Survey. At time of exit, the Navigator or Program Assistant shall exit the participant household fromactive status in HMIS and update Service Notes with any final information.Financial AssistancePolicy StatementVVS SSVF is committed to providing timely temporary financial assistance (TFA) where appropriateand where, per SSVF program requirements, veteran families are in danger of losing stable housingbut for the TFA. TFA is to be viewed by all VVS staff and subcontractors as an adjunct to intensivecase management and other supportive services. VVS staff and subcontractors shall ensure thatproviders, partners, and participants alike all understand this TFA policy. TFA shall never bepromised to participants, nor should expectations if TFA ever

Jun 17, 2013 · Vermont Veteran Services at UVM SSVF Policy and Procedure Manual Page 3 Last Revised June 17, 2013 All Pre-screen applicants will be entered into the VVS HMIS application with pre- enrollment status. The Pre-screen form will be filed for at least one year. Screening Screening will