ending veteran homelessness: where are we now?
TRANSCRIPT
Ending Veteran Homelessness:WHERE ARE WE NOW?
May 19, 2016
Presented by:Baylee Crone, National Coalition for Homeless VeteransLeon Winston, Swords to PlowsharesMegan Zottarelli, Swords to Plowshares
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Agenda
Where are we now in our goal to prevent and end veteran homelessness?
This online seminar will discuss:
1. Veteran populations most at risk of experiencing homelessness andhealth outcomes
2. The national and community picture of efforts in the last five years
3. Systematic responses in place throughout communities
4. Strategies moving forward to address the unmet needs
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Presenters
Baylee Crone, Executive Director, National Coalition for Homeless Veterans (NCHV)
Leon Winston, Chief Operating Officer, Swords to Plowshares
Megan Zottarelli, Senior Analyst, Institute for Veteran Policy at Swords to Plowshares
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Homeless Veterans by the Numbers
Veterans:
9.5% of the U.S. adult population, but
11.4% of the adult sheltered population.
47,725 veterans homeless on any given night in January 2015.
36% decline since 2010.
Representing 11% of all homeless adults.
PIT Count, 2015
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Risk and Protective Factors
Protective Factors
Despite higher levels of education compared to non-veteran homelesspopulations, and a higher rate of past family cohesion (including ahigher likelihood to be or have been married), some studies showthese are not protective factors against homelessness.
Some studies cite veterans with stronger and more stable familiesare more likely to be negatively affected by the trauma ofdeployment.
Women veterans: married women veterans less likely to experiencehomelessness.
Access to a VA service-connected disability payments found to be aprotective factor against homelessness.
(Tessler 2002; Washington 2010; Balshem et al. 2011)
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Poverty Correlation
Veterans are less likely to be poor, but
poor veterans are more likely to
become homeless than non-veterans.
2 times as likely to
become homeless
when compared to
non-veterans.
3 times as likely to become
homeless when compared to
non-veterans.
1–2% of all women veterans,
13–15% of women veterans
living in poverty will
experience homelessness
over the course of a year.
Veteran men living in poverty: Women veterans living in poverty:
Fargo et al. (2012). Prevalence and risk of homelessness among US Veterans. Preventing Chronic Disease, 9, 110–112.
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Chronic Homelessness vs. Episodic
Chronic HomelessnessUnaccompanied individual with disabling condition who has been homeless for 1
continuous year or 4+ times (adding up to 12 months total with at least seven nights
in between) within 3 years. (HUD, 2016)
16.8% of individuals experiencing homelessness are chronically homeless.
Psychiatric disability, substance abuse, medical co- morbidities more prevalent
within chronically homeless population than episodically or transitionally
homeless.
Episodic HomelessnessUnstably housed and recurrent problems with housing, experiencing an episode of homelessness is “a separate, distinct, and sustained stay on the streets and/or in a homeless emergency shelter.”
(Kertesz, et al., 2005; Burt, et al., 2001; Kuhn & Culhane, 1998)
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Homeless Populations
Aging Homeless Veterans Homeless veterans are most likely to be between the ages of 51 and 61 (43%)
and Post-Vietnam or Vietnam era.
Number of homeless veterans over the age of 55 is projected to increase
dramatically over the next 10 to 15 years.
Older homeless veterans:
Have excess and age-adjusted mortality as well as increased suicide
risk.
Have a more rapid disease course, leading to earlier morbidity.
Place increased demands (vs. non-homeless older veterans) on a health
system, accessing primary, mental health, and substance abuse care
more frequently.
Culhane, D., Metraux, S., Byrne, T., Stino, M., & Bainbridge, J. The Age Structure of Contemporary Homelessness. 2013. Psychiatric Services 67:4, April2016: “Increased Mortality Among Older Veterans Admitted to VA Homelessness Programs” . Journals of Gerontology: Soc Sci,: J Gerontol B PsycholSci Soc Sci, 2016, Vol. 00, No. 00, 1–7.
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Homeless Populations
Women
4 times as likely to be homeless as non-veteran women
Account for 10% of homeless veterans
Disproportionately more at risk for homelessness than male peers
Compared with men, homeless women veterans…
Bern and Fargo, 2016; Tsai, Rosenheck, and Kane, 2014; Tsai et al, 2014; Washington et al., 2010; Hamilton 2014
Are less likely to:
Be chronically homeless
Be unsheltered
Have a history of incarceration
Be disabled
Have a substance use disorder
Are more likely to:
Be younger and more frequently
Iraq and Afghanistan era
Have dependent children
Have higher rates of
unemployment
Have higher rates of military
sexual trauma
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Homeless Populations
Racial and Ethnic Minority VeteransMinority veterans are 3 times more likely to become homeless than non-
veterans.
39% of all homeless veterans are African American, despite only accounting for 10.4% of the U.S. veteran population.
For women, there are increased odds of homelessness among women veterans who identify as black.
11% are Hispanic/Latino, despite only accounting for 3.4% of the U.S. veteran population.
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Homeless Populations
Veterans with Bad PaperVeterans with bad paper discharges are at up to 7 times the risk of
homelessness as other veterans.
In San Diego, a 2014 survey found that 17.1% of unsheltered
veterans had bad paper discharges.
In Houston, a 2014 survey found that 2 out of every 3 unsheltered
veterans had bad-paper discharges.
VA eligibility standards exclude these veterans from health care,
disability compensation, and adequate homeless assistance.
A.V. Gundlapalli et al., 2015; Stephen Metraux et al., 2013; “Underserved: How the VA Wrongfully Excludes Veterans with Bad Paper”: https://www.swords-to-plowshares.org/sites/default/files/Underserved.pdf
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Homeless Populations
Younger veterans
Veterans aged 18-30 more than twice as
likely to be homeless compared to same
aged non-veterans.
Iraq/Afghanistan-era veterans are at a
higher risk for homelessness than previous
generations of veterans.
NCHV, 2016; DOL, 2015
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Health Outcomes
1. Older than their chronological age.
2. Rapid disease course and pre-
disposed for a variety of health
issues.
3. Health conditions are more
prevalent in homeless veterans
than they are in homeless non-
veterans, and these rates increase
as time spent in homelessness
increases.
4. Increased mortality and suicide risk
among older homeless veterans.
5. Mean age of death: 51
36.6%
41.9%
42.4%
52.5%
67.4%
Anxiety
Drug abuse/use
Alcohol abuse
Alcohol dependence
Depressive disorder
VHA, Homeless Registry contacts new assessments 2012
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Resource Constraints
1. Institutional Circuit:
Higher rates of
hospitalizations, use of
psychiatric institutions,
detox facilities.
2. Cyclical patterns of
incarceration.
3. Dept. of Public Works
costs.Photo: San Francisco Chronicle
Part IINATIONAL AND COMMUNITY EFFORTS: WHERE ARE WE NOW?
May 19, 2016
Presented by:Baylee Crone, Executive Director,National Coalition for Homeless Veterans
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The National Coalition for Homeless Veterans (NCHV)
NCHV’s MissionNCHV’s mission: NCHV is the leading national membership organization shaping policy andproviding knowledge, resources, and awareness to organizations serving homeless and at-risk vets.
NCHV’s VisionThrough advocacy and public education we enhance, sustain growth, and improve a system
of care so that no vet needs to experience homelessness.
NCHV’s HistoryNow in our 26th year, we were founded by a small group of community-based service
providers who were troubled by the disproportionately large percentage of homeless
people who were veterans, and the lack of veteran-specific programs to help them. We
opened our Washington, D.C., office in 1993 in order to work more closely with Congress
and Executive Branch agencies to ensure the inclusion of veterans in federal assistance
programs.
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Who NCHV Serves
Community Partners Invested in Social
Services
Groups Serving Veterans
Groups Serving Homeless and
At-Risk Persons
Homeless Veteran Service Providers
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An Early Commitment to Ending Veteran Homelessness
Early 1990s – Mid 2000s NCHV helped draft the Grant and Per
Diem (GPD) program as a way forcommunity providers to work withthe Department of Veteran Affairs(VA) to help veterans get off thestreets.
The first Stand Down grants aremade to offer a “hand up” out ofhomelessness.
The Department of Labor (DOL)starts the Homeless VeteransReintegration Program (HVRP) tohelp homeless veterans connect togainful employment.
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The Beginning of the Five Year Plan…
“Until we reach a day when not a
single veteran sleeps on our
nation’s streets, our work remains
unfinished.”
President Barack Obama, March 2009
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USICH and the Federal Strategic Plan
Driving Principles Homelessness is unacceptable.
No “homeless people.”
Invest in solutions.
Homelessness is solvable; we’ve learned a lot about whatworks.
Homelessness can be prevented.
Strength in collaboration.
Original Goals1. Finish the job of ending chronic homelessness in five years;
2. Prevent and end homelessness among Veterans in five years;
3. Prevent and end homelessness for families, youth, andchildren in ten years; and
4. Set a path to ending all types of homelessness.
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The Commitment from the U.S. Department of Veterans Affairs
“We are making great progress in the rescue
mission, but we must work harder to succeed in the prevention phase of our
mission …
That is the only way we’ll truly end veteran homelessness.”
Gen. Eric Shinseki, Former U.S. Secretary of Veterans Affairs
May 30, 2012
NCHV Annual Conference
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Buy-In from other Agencies, including DOL and HUD
“We are absolutelycommitted to SecretaryShinseki’s vision of endingveteran homelessness, andwe are prepared to providethe housing resources heneeds.”
June 2011NCHV Annual Conference
“As you all well know, the homelessness challenge — forveterans and others – doesn't exist in a vacuum. It can'tbe separated from employment, health care, educationand an array of other support services... To successfullytackle a problem this great, we need to work togetherand achieve synergy, imploding stovepipes and buildinga whole greater than the sum of our parts.”
May 2014NCHV Annual Conference
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Buy-In Resourcing
Development of the Supportive Services for Veteran FamiliesProgram (SSVF).
Growth of HUD-VA Supportive Housing (HUD-VASH): HUD awardedfunding for approximately 10,000 HUD-VASH vouchers each year in2008-2010 and 2012-2015. In 2011 and 2016, allocations were lowerbut still significant.
Continuation of the Grant and Per Diem (GPD) program: VA fundedmore than 650 funded projects in FY 2014.
Continuation of the Homeless Veterans Reintegration Program(HVRP): Continued appropriation at slightly over $38 million.
Buy-In Translates to Resourcing:The Cornerstone Programs
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Revisiting Opening Doors…
In 2015, new USICH Executive Director Matthew Doherty updatedthe Federal Strategic Plan to End and Prevent Homelessness withcritical information and needed changes.
Major goals: Prevent and end homelessness among Veterans in 2015.
Finish the job of ending chronic homelessness in 2017.
Prevent and end homelessness for families, youth, and childrenin 2020.
Set a path to ending all types of homelessness.
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…Deepening and Expanding Reach…
SSVF Growth In 2015, VA had awarded $300 million in 319 individual SSVF grants
to organizations in all 50 states, the District of Columbia, Puerto Rico,and the Virgin Islands.
HUD-VASH Growth Through FY 2016, HUD has awarded more than 86,000 HUD-VASH
vouchers.
GPD Stability The maintenance level of funding for current GPD beds is $250
million. The program must be modernized in order to keep pace withthe department’s goal to end and prevent veteran homelessness.
HVRP Stability The HVRP program is currently authorized at $50 million through FY
2016, yet is underfunded by about $12 million.
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…Creating Community…
Employment
Health Care
Treatment
Legal Services
Veteran Homelessness
Affordable HousingPrevention
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…Creating Community…
Employment
Health Care
Treatment
Legal Services
Affordable HousingPrevention
EndingVeteran
Homelessness
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Mayors Challenge
The Mayor’s Challenge started with the National League of Cities,and was later adopted by the First Lady’s Joining Forces Initiativeand HUD.
Five Core Strategies
Establish leadership and decision making.
Set clear numerical goals and timelines.
Create accountability.
Employ core, evidence-based strategies.
Have a common plan.
Principles
Housing First.
Services as needed.
Employment is critical.
No veteran is left behind.
The Commitment
To date, 880 leaders have committed to theMayor’s Challenge with HUD, including:
• 699 mayors,
• 9 governors, and
• 172 county and city officials.
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Mayors Challenge
California MayorsMayor Harvey Hall - BakersfieldMayor Sam Storey - CapitolaMayor Matt Hall - CarlsbadMayor George N. Cretekos -ClearwaterMayor Lee Haydu - Del MarMayor Teresa Barth - EncinitasMayor Lisa Yarbrough-Gauthier -East Palo AltoMayor Bill Harrison - FremontMayor Ashley Swearengin - FresnoMayor Acquanetta Warren -FontanaMayor Paula Perotte - GoletaMayor Art Madrid - La MesaMayor Mary Sessom - Lemon GroveMayor John Marchand - LivermoreMayor Robert Garcia - Long Beach
Mayor Eric Garcetti - Los AngelesMayor Jean Quan -OaklandMayor Jim Wood -OceansideMayor Karen Holman -Palo AltoMayor Luis Molina -PattersonCity Manager Ken Irwin -PattersonMayor Richard D. O'Brien -RiverbankMayor Rusty Bailey -RiversideMayor Kevin Johnson -SacramentoMayor Kevin Faulconer -San Diego
Mayor Edwin M. Lee - San FranciscoMayor Chuck Reed - San JoseMayor Jan Marx - San Luis ObispoMayor Helene Schneider –Santa BarbaraDave Cortese - Santa Clara CountyMayor Cynthia Matthews –Santa CruzBoard of Supervisors Chairperson Zack Friend - Santa Cruz CountyMayor Jim Reed - Scotts ValleyMayor (Dr.) Nancy A. Bilicich -WatsonvilleMayor Lindsey Horvath –West HollywoodMayor Christopher Cabaldon –West SacramentoMayor John Buckland - Yuba
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Many Communities have Reached Functional Zero Systems! Albany, NY Montgomery County, MD Connecticut New Orleans, LA Cumberland
County/Fayetteville, NC Philadelphia, PA Daytona Beach/Volusia
County, FL Reading/Berks County, PA Des Moines, IA Rochester, NY Flagler County, FL Rockford, IL Houston, TX
San Antonio, TX La Cruces, NM Saratoga Springs, NY Lancaster City and County, PA Schenectady, NY Las Vegas, NV Syracuse, NY Lynn, MA Troy, NY Mississippi Gulfport/Gulf Coast
Regional CoC Virginia Mobile, AL Winston-Salem, NC
Zero: 2016
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Meeting the Federal definition of “functional zero” does NOT meanno veteran will experience homelessness! In fact, USIC describes it as:
Federal Definition of “Functional Zero”
“An end to homelessness does not mean that no one will ever experience a housing crisisagain. Changing economic realities, the unpredictability of life, and unsafe orunwelcoming family environments may create situations where individuals, families, oryouth could experience, re-experience, or be at risk of homelessness. An end tohomelessness means that every community will have a systematic response in place thatensures homelessness is prevented whenever possible or is otherwise a rare, brief, andnon-recurring experience.”
According to USICH, the goal is that every community will have thecapacity to: Quickly identify and engage people at risk of and experiencing homelessness.
Intervene to prevent the loss of housing and divert people from entering thehomelessness services system.
Provide immediate access to shelter and crisis services, without barriers to entry,while permanent stable housing and appropriate supports are being secured.
When homelessness does occur, quickly connect people to housing assistance andservices—tailored to their unique needs and strengths—to help them achieve andmaintain stable housing.
Part IIISTRATEGIES TO END VETERAN HOMELESSNESS
May 19, 2016
Presented by:Leon Winston, COO, Swords to Plowshares
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Strategies to End Veteran Homelessness
Veteran homelessness will not end, but
instances can be less common, episodic, and
of a short duration.
Chronic veteran homelessness can be ended.
Keys to success are the right intervention at
the right time, all tied to the availability of
adequate targeted resources.
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Moving to a Crisis Response Model
Strategies/Best Practices Adoption of Housing First Protocols
Homeless Veteran Registry and Coordinated Entry
Resources/Program Components Homelessness Prevention (SSVF)
Income Supports (VBA/SOAR)and Employment (HVRP) *
Rapid Re-Housing (SSVF)
Bridge and Stabilization Housing/Safe Havens (GPD, HCHV)
Services Intensive Transitional Housing (GPD)
Permanent Supportive Housing (HUD VASH and CoC)
Affordable Housing Availability
*Single greatest predictor of homelessness is poverty
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Strategies to End Veteran Homelessness
Housing First No preconditions to being offered permanent housing.
Housing is considered a human right, not a reward.
Does not mean “Housing Only” but services are voluntary.
In some instances, stabilization or bridge housing may be needed as permanent housing
options are developed, documentation obtained, etc.
Veteran Registry By-name list that is updated regularly of every homeless veteran in your community.
Vulnerability Index or other triage/assessment tool.
Prioritization for resources such as HUD VASH, based upon need.
Coordinated Entry Homeless and at-risk veterans should not have to find their way onto multiple waiting lists.
Veterans are referred directly to the most appropriate intervention.
Requires a coordinated effort across local government, non profit and federal partners.
Sharing of information, via appropriate authorization for the Release of Information (ROI).
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AT RISK
VETERAN/
FAMILY
HOMELESS
VETERAN/
FAMILY
Outreach/Intake
Triage and Assessment
Case Manager and Navigator
Assignment
Referrals (warm hand off)
VETERAN REGISTRY
COORDINATED ENTRY
Homelessness Prevention
Employment & Training
Benefits Acquisition
Rapid (Re)housing
Permanent Supportive HousingEmergency/Stabilization/
Transitional Housing
Affordable Permanent Housing
External Ancillary Services
CBOC/VAMC
Credit Counseling
Child Care
Legal Aide
Community Outpatient Tx
etc
Internal Ancillary Services
Eviction Prevention
Housing Acquisition
Representative Payee
Temporary financial assistance
Leon Winston February 2011
A Crisis Response System
Strategies to End Veteran Homelessness
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Strategies to End Veteran Homelessness
Rapid-Rehousing
Streamline response to end homelessness for veterans and families
quickly.
No near-term return to street/shelter.
No housing readiness restrictions.
Preventative Services for Veterans and Families
Focus on identifying and resolving barriers to maintaining housing.
Greatest predictor of homelessness is poverty. Access to entitlements
and employment services is critical.
Integrated crisis response triage and referral to other needed
supports.
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Strategies to End Veteran Homelessness
Adapting the Transitional Housing Model
VA Grant Per Diem (GPD) is permanently authorized by congress,
and is here to stay.
Changes are occurring, including use of GPD beds for ‘bridge
housing’, meaning shorter stays as a bridge to permanent housing
outcomes.
Utilization of very low barrier and shorter term Safe Haven and
Stabilization programs.
Services Intensive GPD Transitional Housing offered as an option to
homeless veterans, not a requirement before being assisted with
finding permanent housing.
Many Transitional Housing Programs will undoubtedly see ‘right-
sizing’ occurring. The VA does look at bed-utilization and is
reviewing ways to ‘re-boot’ the program.
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Strategies to End Veteran Homelessness
Single-site Permanent Supportive HousingHousing projects where significant numbers of high need, chronically
homeless veterans can be offered permanent housing.
Population:
Typical veteran tenant at Swords is poly-
diagnosed, ages 45-70, with serious age-
related illnesses appearing 10-15 years
earlier.
Often not adequately served by HUD
VASH, as they cannot compete in regular
rental markets or have difficulty
remaining housed over time
Some veterans with certain Mental
Health issues may find this setting to be
too stimulating and other options will be
needed.
Benefits:
Tenants have access to flexible array of
comprehensive services on-site.
Offers ability to age in place
Economies of scale
Resource Needs:
Sufficient numbers of dedicated units.
On-site 24 hour support of multi-disciplinary
teams.
Dedicated sources for services funding.
Leon Winston: Remarks to the CA Senate Joint Oversight Committee re VHHP 5 Jan 2016: http://svet.senate.ca.gov/sites/svet.senate.ca.gov/files/leon_winston_chief_operating_officer_swords_to_plowshares_testimony.pdf
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Strategies to End Veteran Homelessness
More Thoughtful Use of Resources
Surge of federal resources in the beginning of the five year plan.
Some localized conditions weren’t taken into consideration
when these resources were deployed.
Federal resources should be flexible enough to meet local
conditions and leverage local strategic planning.
Crisis Response Model
The right intervention at the right time. Rather than manage
homelessness, we need to ensure targeted interventions and
resources continue to flow and be coordinated.
Requires a sustained commitment.
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Acronyms
GPD: VA Grant & Per Diem Program (Transitional Housing)
HCHV: VA Healthcare for Homeless Veterans (Residential)
SSVF: VA Support Services for Veteran Families (Rapid Re Housing and Homelessness Prevention)
VAMC: Veteran Affairs Medical Center
CBOC: VA Community Based Outpatient Clinic
HUD VASH: HUD VA Supportive Housing
HVRP: DOL Homeless Veteran Reintegration Program (Employment)
VBA: Veterans Benefits Administration (Disability and Pensions)
SOAR: SSI/SSDI Outreach, Access & Recovery (expedited access)
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Ending Veteran Homelessness: Where are we now?
Questions?
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Thank You for Attending
Copyright © 2016 by Swords to PlowsharesAll rights reserved, including the right of reproduction in whole or in part in any form.
Swords to Plowshares
Institute for Veteran Policy
1060 Howard StreetSan Francisco, CA 94103
Leon [email protected]
Megan ZottarelliSenior [email protected]