What I do for a Living

I spend a lot of time in airports, airplanes, hotel lobbies and restaurants alone where I tend to eat at the bar. One of the inevitable questions in these types of environments is “What do you do for a living?”

Sometimes I use the bland “I’m a consultant.” But I have learned that begs more questions about what type of consultant I might possibly be.

Sometimes I say that I teach at York. Like saying “I’m a consultant” this usually leads to questions about what I teach.

See, for a long time I have been avoiding telling people that I work on homelessness, housing and social policy issues. It’s one of those subject matters where lots of people have opinions. I am cool with that. But what I am not cool with is that we seem to have gotten to a place in our society where having a big heart is seen as sufficient qualification for working on homelessness issues. Ending homelessness is hard work that requires specialized skills.

I have nothing against charities. Charities play an important role in meeting immediate needs. Think of a major disaster – hurricane, tornado, flood, earthquake, wild fire. We need charitable responses to provide food, clothing and shelter for a short period of time in each of these unfortunate situations until other responses can take over. Charitable responses are not designed to be long term. And here is a kicker for some – charity has never solved a social problem.

One of the most influential books in the way that I think about homelessness, housing and social policy is called “Poverty’s Bonds” by Patrick Burman. Through his work I like to think of five different levels in responding to these types of issues.

Charity is the bottom rung of the ladder. It does not solve the problem. And yet it is the most pervasive.

Bureaucratic Responding is next up. This examines the hoops that we make people jump through to get their needs met. This isn’t just government. Bureaucratic tendencies are pervasive in most homeless and housing service systems. At its core is a question of eligibility. But this isn’t just about trying to find the right service response. Think of the poor soul who is only eligible for a meal or a bed if they agree to pray to a deity that they may not believe in.

Needs Assessment holds the middle space. I think this is the bare minimum that any service system should aim to hit. I think it is incumbent upon us to ask people what their needs are and try to design services and systems to meet those needs as efficiently and effectively as possible. It is foolish and absurd – not to mention condescending – to think that providers of programs and policy wonks have the answers without talking to the people they are paid to serve.

Community Development is the rung one step removed from the top. Think of this in the true sense of Community Development, not the watered down version offered too often as an illusory olive branch that pretends to involve people in shaping their own community. This is strength based and adaptive. It meets people where they are at and builds capacity based upon their defined community needs.

And then there is Advocacy – the top of the pyramid. This is self-advocacy. It reflects self-determination. There is a heightened sense of awareness that comes with reaching this level, and a respect of the position of personal enlightenment that a person knows not just want they want, but has the fortitude and resolve to advance their agenda independent of outside forces.

But I don’t think we are ready as a society to really embrace these five steps and the consequences of each – especially Needs Assessment and above – as the dominant paradigm for how services should be provided and systems designed. I think the learning and re-profiling that needs to go into escaping a charity model or an approach loaded with cumbersome, unnecessary bureaucracy is too scary for many. We can get there, but it is often one organization and community at a time.

In the meantime when I am really drained or on the precipice of burnout, I admit that I am selfish sometimes and tell a little lie when people ask me what I do for a living. I tell them that I am in the pet insurance business – mainly discharged small lab rodents. It’s a quantity business I tell them. I’d rather hear the opinions of a stranger about the pet insurance business than hear another story of how they volunteer to feed “the homeless” (rather than “homeless people”) by doling out soup and sandwiches or volunteering at their church’s mat program. Or hear their theories about mental illness or addictions or family breakdown or abuse. I don’t want to hear another rant about helping people pull themselves up by their boot straps which is pretty friggin’ hard to do when you don’t even have boots. And I sure as heck don’t want to hear another story about the dude they see on their way to work every single day who panhandles from them. Twice in my life when I have told the truth of what I do for a living on a plane I have had complete strangers grab my hand to engage me in prayer, which freaked me out. I only use this lie when I am at my most tired, but pushing the rock up hill constantly it seems to get people to realized that we need professional responses if we want to end homelessness really wears me out sometimes.

Four Essential Elements of a Comprehensive Performance Measurement System

In human services delivery, there are several effective approaches to performance measurement. My leaning is towards an approach that is comprehensive and system-focused, while remaining client-centred.

A comprehensive approach will have four essential elements:

Identifying the chronically underperforming services.

Identifying the services that can meet performance standards with a little coaching and/or technical assistance.

Identifying outstanding services that not only exceed performance targets, but also have a unified commitment throughout the organization on performance excellence, use of evidence-based practices and a sincere commitment to continuous improvement.

Emphasis on financial stewardship.

Identifying chronically underperforming services to some may seem intuitive. “Haven’t we always known they weren’t very good at meeting the needs of the households they are funded to serve?” While true in some instances, it has also been my experience that a framework will show you that some of these seemingly chronic underperformers actually will do just fine with coaching and technical assistance (they aren’t as bad as you thought). And, it has also been my experience that there are some services that turn out to be chronic underperformers (but with a panache for spin) that you thought only needed a little coaching to operate well.

In an era of limited resources, it is important that we put our emphasis on coaching and technical assistance with those organizations that would benefit from it the most. Outstanding services will need training and professional development too, but not the sort of coaching and technical assistance that other lesser performing organizations will need. And some organizations are so entrenched at doing things poorly that no amount of coaching and technical assistance will help them achieve what is required for funding. Wearing my teacher’s hat, I think of the pupil that has been just passing, but you know they have the potential and aptitude to be a solid B. I will put effort into those cases every chance I get. Or you may think of it as a track coach who believes seconds can be shaved off with some modifications to technique and repetitions to ensure it has stuck.

Too often performance measurement is used solely as a punitive measure. Nay, not so. It is an instrument of recognition and even praise as well. While I am baffled by organizations that set out to “create best practices” (which is impossible) I am not surprised when I see excellence in service delivery. Some of these organizations are the best kept secrets in their community. They don’t have a PR machine or an Executive Director with a penchant for the spotlight to tell peers what they are doing. And that’s okay. Some of what we do in having a performance measurement system has to be about finding ways to acknowledge those who do great things in great ways in a manner that is consistent. It is especially important to look at peer to peer collaboration opportunities and mentorship when some of these performers are identified.

Finally, a comprehensive performance measurement system will place emphasis on financial stewardship. This is the response to whether a system of services is not only doing the right things, but doing the best possible things with the resources available. With ongoing changes in programs and legislation, it would be foolish to ignore this important aspect of performance measurement. But financial stewardship doesn’t mean we just look at dollars and cents. There were far too many places that went to an extreme after, for example, Malcolm Gladwell’s infamous piece on “Million Dollar Murray” appeared in the New Yorker. Financial stewardship is not about reducing our analysis to people as widgets and gidgets. But it is about looking at our units of service, and whether those units of service have a coherent financial foundation to why certain things are done in certain ways.

Aside from an approach that is comprehensive, it is also my ardent belief that it must be system-oriented while maintaining a client-centred perspective. Organizations in human services are funded to serve people, right? Let’s not lose sight of that. But let us not also forget that there are sectors of service. This is different from just analyzing performance based upon what the funding sources are and what the reporting requirements are of that funding. If we have a system orientation we know that all organizations within a sector of service have interconnectivity that cannot be ignored. We should have common performance expectations of, for example, all organizations that provide mobile street outreach; a different set of common performance measures for all organizations that provide shelter; a different set of common performance measures for all organizations that provide drop-in services; a different set of common performance measures for all organizations that provide Housing First; a different set of common performance measures for all organizations that provide Rapid Re-housing; a different set of common performance measures for all organizations that provide permanent supportive housing; etc. We shouldn’t parse out the performance measures to say, for example, if you get funding for mobile street outreach from this funding source then your performance measures are X, but if you get your funding from this funding source then the performance measures are Y. That only weakens the system approach. It is commonality in expectation that can be grounded efficiently in appropriate evidence-based practices, supported by data and routinely monitored for the benefit of each client that interacts with the service. It would be a disservice to the people that we serve if, for example, one shelter offered one approach to services and was monitored to deliver them based upon one set of funding criteria, but another shelter a block away offered much less service and was monitored differently because they had a different funding source.

This type of performance measurement work is currently being done in Detroit. If you are interested in our approach to performance measurement work, let us know and we would be happy to share more with you.

Prioritizing Who Gets Served Next Matters – The Service Prioritization Decision Assistance Tool (SPDAT)

When I led the largest Housing First program in North America, one of the things that bothered me was that we had no defensible way to prioritize who we served next. We dabbled with different instruments and had some stellar research thanks to folks like Toby Druce – but couldn’t quite put our finger on exactly how to prioritize who got served next and why. At least not in a defensible, reliable, consistent and valid way.

Sure, there are some awesome instruments out there like the Vulnerability Index used by Common Ground and now the 100k Homes Campaign (and we are big fans of both); the Camberwell Assessment of Needs; the Outcome Star; the Denver Acuity Scale. But none of these were a perfect fit for the type of Housing First program that I was leading or other Housing First programs that I was familiar with.

One of the first things I started working on when I made the move to OrgCode was to develop the right tool for determining who should get served by what type of housing intervention and why. Being the nerd that I am, I took an inventory of all existing tools that I could get my hands on – hoping that I had just missed something in my previous work. No point re-inventing the wheel. Truth is, not much with credible overlap other than the ones previously mentioned – and even then, too many limitations or shortcomings.

I found a small number of communities and individual practitioners willing to work with us in developing a proper assessment tool for Housing First. Dedicated professionals were found who would implement our drafts, provide detailed feedback, tell us about the associated client interactions and the like. The process was amazing. Repeatedly in the draft stage we heard over and over again how the SPDAT was making them look at their practice differently – from intake through to case planning through to discharge.

In the end, the final version of the SPDAT examines 15 main components for each client. Those 15 components provide a baseline at intake and are tracked throughout the case planning process. The 15 components are:

Self Care & Daily Living Skills

Meaningful Daily Activity

Social Relationships and Networks

Mental Health & Wellness

Physical Health & Wellness

Substance Use

Medication

Personal Administration & Money Management

Personal Responsibility & Motivation

Risk of Personal Harm/Harm to Others

Interaction with Emergency Services

Involvement in High Risk and/or Exploitive Situations

Legal

History of Housing & Homelessness

Managing Tenancy

By using the SPDAT throughout the case planning process, it helps case managers in focusing their attention on those areas where clients are in pre-contemplation or contemplation, and to some degree preparation. It also ensures an ongoing client-centred and strength-based approach to service delivery. Finally, for those clients that are visual learners or have limited literacy and numeracy, the SPDAT provided the opportunity to visually demonstrate their movement – and momentum – in various dimensions of their case plan.

Version 1 of the SPDAT was implemented with thousands of clients across North America. After a year, we asked all practitioners to provide input on how to make the tool better through a detailed survey. After analysis of their comments we tested Version 2 extensively and finally launched the Version 2 in March 2011. Whereas Version 1 was focused exclusively on Housing First, Version 2 now takes into account Rapid Re-housing and more general Housing Help services as well.

There have been several interesting findings relayed to us from people and entire communities using the SPDAT:

Practitioners have been able to make significant transitions from jumping from one crisis to another to planned, logical service delivery through the SPDAT;

Many frontline workers resist the SPDAT for the first few weeks before they finally realize that it improves their job and interactions with clients;

Improved housing choices are put on the table for clients – from independent living through to permanent supportive housing;

Some of the people that previously staff may have thought were really high acuity turn out not to be – and the reverse is also true;

Local service managers and researchers really love how the SPDAT data allows them to meaningfully engage in advocacy, brokering and research and explore other areas for program improvements which are based upon evidence, not hunches or anecdotes;

Team Leaders indicate that they are better able to match the client to the staff person with the right skills to meet their needs; and,

Client outcomes (not just outputs) have significantly improved.

So far in addition to the thousands of clients and dozens of communities & organizations using the SPDAT we have had one Province seek permission to use it and integrate it with their data system, and two States that are in initial discussions with us to make it a standard in service delivery (tres cool!). The tool has also been shared at National Alliance to End Homelessness Conferences in the US and distributed to Service Managers throughout Canada.

The tool has been tested and used with a wide range of populations: youth; substance users; persons with serious and persistent mental illness; Aboriginal people; older adults & seniors; newcomers; families; childless couples; ex-offenders; and people leaving institutionalization. We are confident that given the huge implementation and reliability that the SPDAT represents considerable potential in helping to end homelessness.

The SPDAT is free. No gimmick. No bull. Free. It is our way of giving back. Any organization that chooses to use the SPDAT will get free updates in perpetuity. The only thing we ask is that practitioners are trained on how to successfully use the SPDAT the way it was intended. And even then, training is provided at a very reasonable cost to make the tool as accessible as possible, including webinars and in person workshops.

If you would like to talk more about the SPDAT, get a FREE copy of it or chat about how it can be implemented in your organization or community, please let me know idejong@orgcode.com or 416-698-9700 ext. 2