Report, September 2008
The John McDermott House is a transitional housing partnership among the Washington DC Housing Authority, the Department of Veterans Affairs, and the Chesapeake Health Education Program, Inc. – a non-profit corporation. The goal of McDermott House is to provide transitional housing to veterans discharged from the Washington DC VA Medical Center who are on a compensated work therapy program. The McDermott House program goal is to help veterans who have complex social, mental and substance use disorders recover their lives and move to independent living. The program has been operating for 9 years and has seen 248 residents discharged with a variety of outcomes. The average length of stay is 256 days with a median length of stay of 169 days. Analysis of the length of stay data reveal that if a veteran remains in residence for longer than 169 days, he has a 72% chance of successfully completing the program and moving back to a stable community living situation. Implications for serving the homeless population are discussed as well as suggestions for more analysis of the data to determine which variables lead to a successful discharge from this unique transitional housing model.
In 1995, the Department of Housing and Urban Development (HUD) approved a grant for CHEP to provide transitional housing to homeless veterans. This grant successfully operated for four years and at the grant’s conclusion, CHEP initiated a new independent program with its own funds to continue serving homeless veterans. The new initiative brought the establishment of the John McDermott House located at 2422 Ontario Rd NW, in Washington, DC.
The John McDermott House was a unique model which had its origin in a memorandum of understanding between the Washington DC VA Medical Center, the Washington DC Housing Authority (DCHA) and the Chesapeake Health Education Program (CHEP), a non-profit corporation. The impetus for this three way partnership was an effort on the part of Mr. John McDermott who was one of the singers in the nationally renowned “Three Irish Tenors”. He helped prompt the DC Housing Authority to form a working partnership with the VA and the non-profit corporation. Additionally, he dedicated the proceeds of a Washington concert to the establishment of the program. Fittingly, the new model home for homeless veterans was named the John McDermott House.
In October, 1999, the DCHA signed a formal lease with the non-profit (CHEP) to manage a 13-unit apartment building for homeless veterans and the John McDermott house was born. The non-profit agreed to maintain all physical elements of the property except for major structural and mechanical repairs. In addition, CHEP agreed to provide on-site house management 24/7 to insure a safe living environment. The VA agreed to provide clinical and programmatic oversight for the veteran residents and insure a supervised transitional housing environment with support from the VA medical center staff. The goal of McDermott House was to provide affordable housing for 26 homeless veterans enrolled in the VA’s Compensated Work Therapy (CWT). Each veteran was to maintain and share his apartment with another resident and pay a nominal “rent” for the costs incurred to maintain the property. The program’s unique mix of therapeutic assistance, community work-for-pay, and community-based living placed a strong emphasis on an individual’s personal responsibility. Veterans were required to manage their own medication and participate in outpatient care for medication adjustments and other medical services. McDermott House quickly became a safe, drug and alcohol free home that served as a stepping-stone to independent living.
The McDermott House model is unique. There is no other housing program operated by a non-profit organization that formally partners with two separate public agencies and is dedicated exclusively to formerly homeless veterans who are employed through Veterans Industries. This housing site has enjoyed consistency and success since its inception and has been a major resource to the VA hospital in Washington DC. All 26 resident beds are used exclusively for veterans in the Compensated Work Therapy Program (CWT) and are in high demand. With a projected length of stay of 6-8 months, the veterans receive close supervision and support from VA staff and have clear expectations of how their recovery progress should unfold. While there was some concern that the local neighborhood might resist having a transitional house for veterans in their neighborhood, there has been full acceptance of the concept thanks to a careful monitoring of each veterans behavior in the community and periodic communication with the local community groups. All in all, the John McDermott House has been a tremendous success and the expectation is that it will continue to serve veterans who need a safe and positive environment as they recover and reintegrate back into their family and community.
The John McDermott House has accepted a total of 274 veterans into the program since its inception in 1999. There have been 248 discharges through May 31, 2008 with 26 veterans currently in residence. One of the major program components of McDermott House is the absence of a fixed or preconditioned discharge date for any veteran resident. In general, veterans are welcomed to stay in residence between 6 months and one year depending on their work progress in the CWT program and the goals established by the VA support staff who guide the veterans through the program. As with any program that deals with homeless individuals who present with a multitude of substance use disorders and mental problems, there is a wide variability of outcomes depending on how the veteran utilizes the opportunities offered at McDermott House. The basic house rules are quite simple: maintain sobriety, pay a bi-monthly rent, modify behavior to conform to community living, and participate in outpatient follow up as prescribed by the VA. Failure to maintain these basic rules means dismissal from the program. Within this framework, the resident is free to develop his own community reintegration schedule and progress at his own personal pace. As long as periodic assessments reveal a forward progress, the veteran is maintained as a resident.
An examination of the discharge status among all 248 residents who have left McDermott House since it began in 1999 reveal some interesting trends. The average length of stay among all those discharged is 256 days with a range between 1 day and 1,163 days. This equates to an average of 8½ months that a veteran resides at McDermott. While this average seemed to be congruent with the original program expectations, it fails to uncover the outcome or success of each veteran’s individual stay at the McDermott.
Outcome data on individual lengths of stay is displayed on the accompanying table which shows a column on Discharge Category (whether the outcome was a “success” or “failure”) and columns for the number of residents within each of these two categories. From the table it is clear that about half the residents (116) had a “successful” outcome following discharge from McDermott House. Residents either “graduated” from the program and found employment and adequate living conditions, or opted to find their own residence and requested a voluntary discharge. Regardless of the category, the veteran was satisfied with his progress and had achieved and the staff considered to be the attainment of maximum program benefits. On the other hand, about half the residents (114) did not have a successful outcome and were involuntarily discharged due to problems with house rule infractions, substance use relapse, administrative discharge or abandoning the program without sufficient notification. These individuals were classified as “failures” since their outcome was less than expected upon their entry into the program. A few veterans were not considered either success or failures, but were classified as “Miscellaneous” due to death, medical, or other reasons.
From a programmatic point of view, these data were quite consistent with the data from other residential programs for homeless individuals who have a multitude of mental, social, employment, and substance use disorders. A 50% “success” rate is consistent with the current literature as well as anecdotal evidence on transitional housing for homeless persons.
Our analysis, however, examined the outcome data further and uncovered some startling and gratifying results from residents living at McDermott House. Data analysis reveals that the median for length of stay among all the residents is 169 days at McDermott House. This means, that if you rank all the length of stays from least to most, the middle one (with equal number of residents above and equal number of residents below) is resident #124 with a length of stay of 169 days. This is 5½ months of residence versus 8½ months for the group average. If you then analyze the outcome based on the split between those above and those below the median, the results portray a dramatic picture. The accompanying table shows the results. For those residents with less than 169 days at McDermott House, the success rate is only 28% or 32 out of the 116 veterans. Consequently the failure rate is 72% among those who left the program in less than 169 days. On the other hand, if a veteran stayed more than 169 days, he is among the high 72% that are discharged as a success (84 out of 116). Among those who stayed more than 169 days, there is a low 28% failure rate. The data clearly reflect that if a veteran remains at McDermott House for more than 169 days, he has a 72% probability of leaving with a “successful” outcome.
The analysis of outcome data points to fan extremely important finding. The implications not only show the success of McDermott House and how its program is conducted, but offers a critical finding for the treatment community who serve homeless individuals with complex social and mental problems. Given the structure and philosophy of McDermott House, the 169 day threshold seen in the data affirms that residents should remain longer than the classic 2-4 months offered by most insurances and private treatment programs. A longer residence and participation in treatment will greatly solidify the recovery process while an individual locates a permanent living environment and re-learns how to mange his own life and finances in the community. If a veteran withdraws from a program modeled after McDermott House prior to this threshold, he tremendously minimizes his chances of changing any of the previous behavior that may have caused him to become homeless in the first place.
The analysis of outcome data from the 9 years that McDermott House has been operation offers an important picture to anyone seeking to reduce the problem of homelessness in America. This is only the initial cursory look at the data, but demonstrates a remarkable finding. Homeless persons require at least 8½ months of structured residence and program support in a home such as McDermott House to recover and reorient their lives from the devastation of homelessness. This is not about how best to move people through a treatment system, but rather how best can lives be repaired. The McDermott model is a tripartite partnership among two public agencies and one non-profit corporation working together toward a common goal. Thanks to the support of each organization, the residents are the winners in this win-win formula. The next step is to analyze the data on resident success and failure outcome and identify the other variables that go into the equation of each resident’s particular outcome.
The report affirms what is already known: structured intervention reduces homelessness and proactive strategies following hospitalization greatly enhance the chances of success for a previously homeless person. Having veterans return to gainful employment, achieve a higher degree of personal responsibility, and successfully move to permanent housing would have been unavailable to the 248 veterans who resided at McDermott House were it not for a unique partnership between the public and private sector. A new formula that honestly shares the resources of several organizations clearly works to give the residents of McDermott House a more than even chance to recover their lives. Establishing the appropriate linkages to veteran specific services through the VA and making mental health services available, especially for substance use disorders, is a key component to McDermott House’s successful outcomes. Society has allowed an unfair burden to be borne by American servicemen and women and there needs to be direct and focused resources to correct the problem. A program philosophy such as McDermott House provides a unique environment for success, but housing alone will not yield success. The real key to successful outcomes undoubtedly depends on a network of linkages to treatment resources. The extent of linkages and the interplay of residence and treatment was not analyzed in these data. Hopefully, a future analysis will not only suggest a new approach, but will underscore the need for a renewed commitment to seriously and finally solving the plight of homeless veterans in America.