Hawaii Progress: Views From an Outsider
Recently, Hawaii released data in their progress towards ending homelessness. Hawaii (the Big Island), Maui and Kauai all posted decreases. Oahu more or less stayed the same, but perhaps because of improved counting methods in their Point in Time Count. As an outsider, I want to focus a bit on what they were able to achieve on the Big Island. Having visited Hilo and Kona several times over the past couple years, I want to share some observations of what I think the difference makers have been to see a greater than 30% reduction there. And if you are unfamiliar with the Hawaii landscape by way of geography and policies, this reduction is truly extraordinary.
Leadership
The Hawaii Community Foundation has made it possible for several leaders from across all of the islands to enhance their leadership, making a multi-year investment in capacity building in that regard. On the Big Island, people from Hope Services went a step beyond this, also availing themselves to leadership training opportunities specifically within the homelessness sector (they came to the Leadership Academy and Master Class offered by OrgCode). The leadership of Hope, along with willing County and community partners, made the brave decision to take risks and do things differently in services rather than waiting for direction or permission from others. It has changed the culture of service delivery in the community, and has provided very clear messaging on the intention of homeless services to end homelessness through housing.
Professional Development
Do what you have always done and get as you have always gotten. To change direction, there has been the promotion and infusion of a learning culture. Throughout the entire organization there has been an unrelenting commitment to learn and implement new practices to yield the outcomes that would be necessary to end homelessness.
Working the Problem
The transition of programs and services to focus on ending homelessness has not been without its challenges. Rather than reverting to old practices or giving up, there has been a desire to figure things out. The people at Hope Services especially seem to embrace that imperfect action trumps perfect planning. They are doers. And when issues have emerged they reach out to other people and resources to gain perspective and figure out a pathway forward, staying true to what they are trying to accomplish.
Lower Barrier Shelter
Gone are the days of many pages of shelter rules. Here are the days of less than ten expectations for a shelter stay. Gone are the days of barriers to shelter that would screen many people out. Here are the days where shelter has a strong housing focus and deliberately tries to engage people with higher needs. Gone are the days of loads of in-house programming. Here are the days when programming stays focused on getting people out of homelessness as fast as possible. Gone are the days of being focused on drug testing. Here are the days of focus on behaviour not exclusion for use.
More Targeted Outreach
Another shift has been from a "contact" based approach to street outreach to a housing-focused approach to street outreach. Across the island the focus is on assisting those with higher acuity in resolving their homelessness. The measure of their success is not how many people that see or connect with, and into measuring success by how much homelessness is resolved.
Reworking the Organization
Within Hope Services - the beacon of homeless and housing supports in my eye on the Big Island - the commitment to end homelessness meant they also had to change the way the organization worked. Policies and procedures changed. Rules for services changed to expectations. Job descriptions changed. Orientation and on-boarding for staff changed. The outward relationship of the organization changed.
Unapologetic and Unrelenting Housing Focus
The purpose of providing a homeless service is to end homelessness. This is lived in practice every single day. There has been a strong movement away from short-term charity to long-term results in ending homelessness through housing. Hope Services in particular is proof positive that you can meet immediate, basic needs while never losing sight of the importance of housing.
I am very proud of my friends and colleagues in Hawaii on turning the corner with homelessness, especially on the Big Island. I will see many of them this week and look forward to giving them the high five they deserve for their homelessness. I am also excited to see the early gains in Maui and Kauai translate into deeper gains over time. And I remain hopeful that Oahu can continue to steer the large homelessness and housing infrastructure there towards the success that is being realized on the neighbour islands.
If You Were Your Successor
What if you were the person that replaced you in your current job?
What would you do differently? Is there something that is occupying your time that you would eliminate from your day to day? Is there something that you should be making a priority that you are not making a priority? Is there a relationship you need to build or fix that you are not attending to - or other relationships that you need to let go of? Is there a new idea or project that you really want to get off the ground but have not been able to operationalize? Is there something that is definitely not working in what you are doing now but you have not been attending to?
All of this begs the question - if you know things that need to change and you ARE in the job currently, why aren't you taking action NOW?
If you had a successor, I suspect you would want that to be a different (better?) version of you. But you don't have to wait for a successor to be different (or better). You have the power to steer a course towards change now, and take the action needed to get there. Perhaps if you take some time to reflect on what your successor should or would do, you can start to steer that course sooner, and take action faster.
3 Main Approaches to Coordinated Entry
As communities work toward establishing a high functioning coordinated entry system for housing, there appears to be some confusion and lack of knowledge on effective models to achieve this aim. Here is a high level overview of the three main approaches.
1. Descending Acuity
This is probably the most common one used. Your community has a list of every person and family that an assessment has been completed with across the community. Using HMIS or some other database, these people and families are ordered from the highest score to the lowest score. Rules have likely been established to deal with tie-breaking scenarios. At set times (weekly is common) a group of providers get together to discuss people on the list and who is next to be housed in a vacancy.
There are a few things that can negatively influence the effectiveness of this approach. One is that it introduces subjectivity into the process when people get together to case conference, which can quickly render the use of an assessment tool moot if the community is not careful. Another potential problem is the time lag of agreeing on a particular person or family and the time it takes to locate them and house them, which can result in vacancy loss. And a final potential problem worth noting is that a community can struggle with how to work through descending acuity while also accounting for other community priorities like addressing chronic homelessness, trying to ensure those that are the sickest are served first, or other potential priorities like addressing longer term stayers or outdoor homelessness.
2. Frequent Service Users
This can be a terrific approach for a community that has decided they would like to first address those individuals and families that use the most services first. Now, this has to be coupled with policy that outlines which services are in scope (just health services, or health and justice services, or health and justice and homeless services, etc.), as well as an understanding of how the frequent service use will be measured (linking databases versus self report is the most dominant debate). In most instances, addressing frequent service users has the greatest potential to demonstrate cost savings in ending homelessness through housing.
But frequent service use also has some potential problems that need to be addressed for it to be effective. For one, some of the most frequent service users by their very nature are currently in facilities that do not render them imminently house-able. For example, the most frequent user may currently be in hospital or in jail. That will beg the question of whether you hold a unit for them or if you go to the next most frequent user on the list. Another potential issue arises if there is a desire to get consent from people to link databases in order to identify frequent service users rather than using self report. This is not always as straight forward as it may seem.
3. Universal System Management
This is the best approach for addressing multiple priorities at once, making the housing process more efficient, and taking as much subjectivity out of the process as possible while leveraging HMIS. In this approach, a community establishes their priorities for different types of housing interventions. Who do we want to offer PSH to first? Who do we want to offer RRH to first? And so on. Then, the community collects an inventory of all of the eligibility requirements for each of those PSH and RRH programs. The community can then be clear, for example, that their top priority for offering a PSH unit is a person who meets the definition of chronic homelessness, who is tri-morbid, who has been homeless for three or more years, and who has a VI-SPDAT score of 13 or higher. This will then generate a list of just those people that meet that group for the top priority. Assuming all of the documentation is in order for each of those people, the list can provided to PSH providers that serve that group that have a vacancy, and they can pick anyone from that list. In this approach, the emergency side of the system (shelters, outreach, drop-ins) are responsible for getting people document ready and putting them on a list, and housing providers are responsible for taking people off the list. There can also be fail safes of assigning people if they are not picked within a certain period of time. And it can generate specific lists for every type of PSH, RRH, TH or any other type of housing intervention that exists in your community. Gone are the days of case conferences and trying to chase people down.
This approach also comes with some problems that need to be resolved. It can be difficult for a community to establish and agree upon priority groups. It can be cumbersome to learn every single eligibility detail for every single housing program, in large part because many providers have unwritten rules. It can be difficult for well intentioned service providers to let go of advocating for specific people to the point where it actually circumvents why coordinated entry is so necessary.
There is no right or wrong approach per se in choosing a model for coordinated entry. What is necessary, however, is that your community has thought through which model is going to be best for you based upon geography, available resources, priorities, and the assessment tool you are using. Each model has pros and cons that need to be thought through carefully. No matter which approach you go, you will need to write out policies and procedures to make it transparent. And, you should think about how you can most easily leverage your existing data in HMIS to achieve this as seamlessly as possible, rather than creating parallel data collection systems.
We are ready to help your community craft and implement any of these models if you need assistance. An investment in our services to help you create the infrastructure can lay the groundwork for a much more effective approach to ending homelessness going forward. And given we have implemented these models in dozens of communities, there is no point in you reinventing the wheel.
Ending Homelessness: Slogan or Policy Proposition with Action?
Ending homelessness. Sounds great. Really hard to do.
When you say it…when people you work with say it…when other organizations say it…when elected officials say it…do they mean it? Do they mean it the way you mean it?
Say it again: ending homelessness.
If I were to ask anyone, “Do you want to end homelessness or do you want to increase homelessness?” the answer is going to be, “End it.”
If I were to ask anyone, “Do you want to end homelessness or do you want to keep managing homelessness?” the answer is also likely to be, “End it.”
Here is the difficult rub: we will never be able to stop all housing instability. Some teenager is always going to get thrown out of their home because of their sexual orientation; some spouse is always going to have to leave their partner because of abuse; some life event or confluence of events will always result in some people being un-housed.
We can end chronic homelessness. That one’s on us. We manufactured it. We failed in policy responses and actions to stop it. The best we can do in all other types of homelessness? Divert people to solutions that do not require use of homeless services. Or if there is no safe and appropriate diversion alternative, make the state of homelessness as infrequent, short and non-recurring as possible.
“Let’s make homelessness infrequent, short in duration and non-recurring” does not have the same slogan magic.
“Let’s end homelessness once household at a time” may be more accurate, but again loses some oomph.
If ending homelessness is translated into policy and put into action, there is a boatload of work that needs to be done in many organizations and communities. Here are the sorts of things you would expect to see if there was a true commitment to end homelessness:
A consistent approach to diverting people away from homeless services whenever it is appropriate and safe to do so;
Street outreach that houses people directly from living outdoors into their own home, and that measures their effectiveness by doing so – and does not measure what they do by contacts or distribution of survival supports;
Drop-ins and day centers that distinguish between helping people get out of homelessness while meeting their basic needs and trying to be a community support to all under-housed people in their neigborhood;
Shelters that have an unrelenting housing focus, keeping stays as short as possible, eliminating any program that prolongs homelessness or is not directly linked into housing acquisition, and which sees all shelter staff regardless of position as a form of housing worker, rather than seeing housing work as solely a specialization within the shelter;
Professionalization of services and equipping staff with the training they need to actually end homelessness;
Investment away from pet projects and any service that does not end homelessness, and into housing programming that works, including supports to people once housed;
Prioritization of financial assistance and supports to people with the deepest needs first;
Investment in professional resources to locate housing at a price point people can afford (they don’t teach real estate in social work schools);
Coordination of services across all service areas working on meeting the needs of people when homeless.
I will go a step further and say that if a community wants to be higher performing at ending homelessness in policy and action, they would consider and implement things like:
Performance based contracting when there are appropriate controls for the types of people that will be housed and supported through various programs;
Consistent, annual investment in core competency training, and staying engaged with the main currents of thought and practice in the field;
Public declaration and sharing of results in the efforts and outcomes of various programs relative to the investment made in each;
Financial incentives and/or a streamlined re-application process for funding for higher performance;
Re-tooling of programming like transitional housing in the traditional sense to bridge housing or rapid re-housing;
Appropriate integration (with privacy controls and consent) across homeless, housing, health, corrections, income support, and child welfare systems;
Stopping investment in prevention programming unless the household has been homeless before and/or has the characteristics of existing chronically homeless households;
Ceasing to deliver seasonal sheltering (winter shelter, wet weather shelter, or heat shelters), and instead investing in professionalized housing-focused year round sheltering;
An end to showcasing (and re-traumatizing) past program participants by having them relive and telling their story;
Prioritizing based upon multiple co-occurring factors like chronic homelessness, frequent service use, tri-morbidity, location of homelessness, and acuity score.
Will communities put their money and actions where their mouth is? Will communities or organizations keep saying they are ending homelessness but keep engaging in activities and funding that prove the opposite? Does anybody think delaying implementation of activities and investments that will truly make a difference (maybe to appease the laggard service provider in your community or the politician that loves a particular charity) will help anyone in your community that is chronically homeless achieve the solution to their homelessness any faster? How many more people in your community that are homeless need to die before you actually embrace ending homelessness in policy and action?
5 Thoughts on Street Outreach to Housing
In a few weeks time we are delivering Street Outreach to Housing Training in Tennessee. Here are five thoughts that may encourage you to come and join us, or send others from your community:
1. Encampments are difficult to maintain if you are a person experiencing homelessness. A well organized encampment, when assessed and understood properly, can be a clear sign that the person has a number of organizational and life skills to make the leap directly to housing.
2. Great street outreach to housing work allows you to assist people in moving directly from living outdoors into apartments of their own without even requiring going through coordinated entry, in several instances. The income (once you factor in informal income sources) and resilience of the person can make them a great candidate for accessing housing without needing Rapid ReHousing or Permanent Supportive Housing resources.
3. Technology is your friend in outreach. The measure of great outreach is not how many new people are found each day, or how many contacts are had with people that are already known. It is about selectively and intensively working with a small group of people to resolve their homelessness, not prolonging their homelessness. Google Maps, shared databases, and the ability to take photos is just about all that is necessary to become hyper-organized in street outreach across outreach providers, parks, by-law, etc.
4. Different entities working at cross purposes is a shit show. You need to know how to structure a protocol across different groups like outreach, by-law, police, etc. so that there is measurable accountability of who has the lead in which aspects of the work, when and how to measure service efforts towards housing, and when and under which conditions a response by others (non-outreach staff) may be triggered to remove a camp - and even then, what is the role of outreach staff.
5. When the outreach worker is the conduit to resources it inadvertently results in dependencies and prolonged homelessness. If the outreach worker is not equipped with the right skills for contact with action, then outreach quickly fails. The measure of successful street outreach is not "trust" in and of itself (as some outreach workers claim), but the ability to use skills like Motivational Interviewing and Assertive Engagement to translate trust into the belief that the outreach worker can really resolve their homelessness.
We hope you will consider coming to join us in Tennessee in a few weeks. There are still a few spots. You can register here and get a 15% discount if you use passcode AWESOME
Making Authentic Leadership Work
In the Master Class on Leadership, I teach how to make authentic leadership work. I try to live my leadership from a place of vulnerability and authenticity. Here is how I work hard to try and make that happen.
There are four elements to being authentic in leadership.
Self Awareness
Transparency in Relationships
Fair Minded Consideration
Positive Moral Foundation
Self awareness is trying to understand what your strengths are, without boastfulness. It means you appreciate the talents, wisdom and knowledge that you have coupled with your experience. It also means you know your weaknesses intimately, but do not wallow in self-loathing about them. Weaknesses are an opportunity to figure out how to compliment your skill set with that of others. The last part is perhaps the one that is toughest to learn – how you can and will respond to emotional stimuli. If I am truly self-aware I know what the best possible response to news of all types can and should be, and I diligently and thoughtfully practice that response. As someone with deficits in the whole feelings department, that has been tough for me to really figure out personally, and I have offended people I wish that I hadn’t – and didn’t mean to.
Transparency in relationships is when the leader is open with their own thoughts, values and beliefs not because they expect everyone to fall in line with that and assume the perspective of the leader in those traits, but so that they deepen their understanding and awareness of where the leader is coming from. Transparency is not an exercise in evangelization. But let us be clear, that being transparent opens up a new type of vulnerability that many leaders struggle with when it comes to issues like homelessness that are often moralized. How a leader really feels about homelessness is new territory for a lot of Executive Directors and Presidents of homeless serving organizations.
Fair minded consideration is about seeking out alternative viewpoints than what we might say are the leader’s own natural conclusions. And in so doing, the leader opens up to considering other ways of doing things. When and how are leaders in your community malleable? When have they proven capable of changing direction based upon the opinion of others? Are there any instances when they openly admit that a different approach than their own holds more merit than what they were trying to achieve?
Positive moral foundation is a call to be ethical and distinguish that which can be called “right” and “wrong” from an ethical perspective in the service we do and the decisions we make. When was the last time you and your colleagues or community had a conversation about the ethics of ending homelessness? I am guessing you have been so busy doing the work you have not got around to that in a while (or ever). Probably the best time to do it is sooner rather than later. Maybe why you do this work is completely different than why they do this work – yet you thought you were on the same page.