Moving the Needle with Reluctant Funders/Politicians

This week we got two separate notes asking for a blog. They are related themes.

In the first note it asked for a blog about when communities have to make tough decisions on funding to move the needle forward. In that community they are taking loads of flak politically and in the media for changing funding to focus on ending homelessness. City Councillors are considering a motion to continue to fund services for another year to allow impacted organizations to transition. This after consultation and community engagement for the past 18 months to prepare for the transition.

In the second note it asked for a blog about what to do when communities have been moving forward to align funding to end homelessness rather than ineffective programs, but that those organizations most impacted have strong political connections, and those politicians are now exerting considerable pressure to reconsider what is best.

MOVE THE NEEDLE!

Consequences suck. Political involvement/interference sucks. Backlash from service providers sucks.

Sometimes “suckage” and “rightness” are directly related. The more “suckage” there is sometimes directly indicates that you are doing the EXACT RIGHT THING.

Service managers and COC leads have a responsibility. The responsibility is to achieve the greatest amount of effectiveness through service providers in the amount of funding available. They are also responsible to ensure that there is monitoring and oversight. When things are awry it is the service manager/COC best positioned to move the community towards system change.

There are good change processes and bad change processes. But let’s face it – change is always hard. What service managers need to appreciate is that the interest of a politician is different than the interest of a service manager. A service manager wants to end homelessness. A politician wants to keep constituencies happy – including non-profit organizations in many instances. Service managers live and breathe data and evidence and best practices. A politican lives and breathes optics, public image, and community engagement. Does that make one right and the other wrong? No. It does, however, means that there is not always alignment.

If you want to figure out how and why the politics of the right and just decision plays out the way it does, answer me this question: on a scale of 1-10, what is my favourite color in the alphabet?

You guessed it – it makes no sense.

In an era of believing (continuously) that we can charge less taxes and get better services, public servant after public servant; CoC lead after CoC lead is being asked to do more and better with less. They research. They go to conferences to learn. They consult. They consult again. They agonize internally on how to go about making huge changes. They educate. They put out information. They host information meetings. The form committees. And then form committees that come out of committees. And still? Politicians seem hell bent on maintaining the status quo or spending even more money to work through the change.

A weak public servant or COC lead caves to the pressure. They continue to fund the status quo. The give up. Change that was meaningful was in their grasp. What they don’t know is that political issues have a cycle. The one year of additional funding is about saving face in the present. Two years from now, political leaders will be patting themselves on the back for the decisions made at your pay grade.

A mentor of mine once pointed out to me that which I see more and more the older and more experienced I become: if you cannot critique content, you critique process. Chins up, my friends. Moving the needle is the bravest thing you will do in your entire careers. And it is the right thing to do. They only want to come up with transition funding or question what you have done because they know you are actually doing the right thing, but they need some political cover.

Yes, the VI-SPDAT & SPDAT Meets HUD’s Coordinated Entry Expectations

As you may already know, the VI-SPDAT and SPDAT (and variations related thereto) on the most widely used assessment tools in homeless services. They also meet all of HUD’s expectations for coordinated entry, if you have read what HUD has recently shared. Let me walk you through it.

HUD says the assessment tool should be phased and situationally applied. If you have attended any training on the VI-SPDAT and SPDAT, you know the situations in which the tools should be applied, when they should be avoided, how to triage, and how to assess further.

HUD says the assessment tools should not result in a homeless household having to tell their story over and over again. We totally agree. There is nothing trauma-informed about a homeless person or family having to re-live their homeless story over and over again. The assessment should follow the person. If you are providing service and assessment using the VI-SPDAT and SPDAT, you know that one of the fundamental aspects of the tools is that the assessment follows the person and is shared across providers.

HUD says the assessment tools should only capture necessary information, and that the information collected should be based upon evidence. The VI-SPDAT and SPDAT rely on almost 300 peer reviewed published pieces of literature, government reports that have a sound methodology, rigorous testing, and a range of data points. They are intended to result in informed, objective understanding of current vulnerability and future risks to housing instability.

HUD says people being surveyed should have the autonomy to refuse to answer questions. Not only does the VI-SPDAT and SPDAT rely upon informed consent to complete, the opening script for the VI-SPDAT and the structure of the questions are clear that participants can skip or refuse any question they do not wish to answer.

HUD says the tools should be person-centered and help inform consumer choices. We totally agree and are frustrated when any community uses the tools incorrectly. The VI-SPDAT and SPDAT provide data. They help inform decision-making. They do NOT make decisions. They do NOT force people into one type of housing or program.

HUD says assessment tools should be culturally competent. Almost 900 different households have been directly involved in the creation of the tools, incorporating a broad range of races and ethnicities. The tools have also considered and involved a range of different experiences as it relates to gender identification, sexual preference, citizenship status, etc.

HUD says the tools should be user-friendly and capable of being applied by non-clinical staff. Both the VI-SPDAT and SPDAT have been created so that non-clinical staff can be used. And because so much of the language of the tools has been informed directly by people experiencing homelessness, the words used and results are intended to be user friendly to program participants.

HUD says assessment tools should provide meaningful recommendations and avoid long waiting lists. The VI-SPDAT and SPDAT recommend the type of housing and support intervention that should be considered. These tools do NOT make decisions, they provide decision assistance (it’s even in the name of the tools!). That decision assistance is data for recommendations and consideration. We also, as anyone knows that attends VI-SPDAT or SPDAT training, are against assessment for assessment sake. Action should follow.

HUD says the tools should be sensitive to persons with lived experience. How is this reflected in the VI-SPDAT and SPDAT? As previously mentioned, people with lived experience have had a direct voice in the creation of the tools. They have also been informed by a broad range of experts to ensure sensitivity to lived experience. Finally, experts in trauma and abuse were retained to review the VI-SPDAT and SPDAT, and inform the components on Trauma and Abuse to help decrease the likelihood of anyone being retraumatized through the experience of being assessed.

VI-SPDAT and Rapid Re-Housing Recommendations

We are reprinting this piece this week from previous content on the OrgCode Facebook page (which you should like by the way). Questions continue to come up on how and why the VI-SPDAT suggests people should be considered for certain groups of people. This attempts to answer that question.

One of the most popular questions we have been asked – especially with the growing use of the VI-SPDAT and the 25 Cities Initiative with homeless veterans – is a repeated variation of “How can rapid re-housing be an effective intervention for…???” – and then finish the sentence with “people unattached to services” and/or “people with a serious mental illness” and/or “people living outside for many years” and/or some variation related thereto.

Before diving too deep into the answer, there are a few important things to address: the purpose and approach to Rapid Re-Housing; the purpose and intent of the VI-SPDAT; the relationship between the VI-SPDAT and SPDAT; and, how it is possible to meet the definition of chronic homelessness yet still be recommended for a Rapid Re-Housing intervention.

In the VI-SPDAT and SPDAT tools, Rapid Re-Housing is seen as a specific type of intervention. Aligned with the overall philosophy of housing first, Rapid Re-Housing focuses on identifying people with a moderate level of needs. These individuals are then provided time limited financial and/or case management assistance, along with assistance accessing housing. Rapid Re-Housing is NOT simply access to an apartment nor is it just a subsidy. Given the flexibility of case management supports within this time-limited period (usually 3-6 months with some possibility for extension), some people will need a light to medium “touch” to stabilize in housing and access other mainstream services.

That said, there is nothing that precludes a case manager in Rapid Re-Housing from providing a more intensive level of support for a shorter period of time to help the person get connected to resources that will support ongoing housing stability. An example might be the person that has serious mental health issues impacting overall wellness, but is not currently connected to mental health resources in the community. A mental health diagnosis or a psychotic episode does not mean a person will necessarily require intensive supports for the rest of her/his life regardless of how they present at time of initial engagement. Everything we know about Mental Health Recovery proves this time and again. However, if a case manager is not trained on how to appropriately provide Rapid Re-Housing supports aligned with best available evidence and current proven practice, they may very well be stymied by the seemingly complex presenting issue(s) and think a more intensive service is required.

One of the other issues we come across is that people fail to understand exactly what the VI-SPDAT and SPDAT assess for, and therefore start making assumptions that are inaccurate. These tools examine current state of vulnerability and future risk of housing instability. They are born from peer reviewed published literature, considerable data, and a large number of government documents. They have been carefully tested and examined to ensure they do what they are supposed to do. Even with that said we sometimes hear things like “But the tool doesn’t examine how engaged they are with current services – and that’s a priority for us”. That may well be a priority – and may even be an appropriate one for your program – but connecting to services and a determination of whether those connections are effective is a function of case management (it gets at the very theory and practice of case management). If/when case management is done well, people that are disconnected from resources and have profound needs are connected to the best available resources in a meaningful way, can and do attach well and get positive outcomes. I stress “outcomes” here because it is not just making a referral or a scattered shot approach to seeing what will stick (that has more to do with how one might measure outputs) – what we want to know is if those attachments make a difference.

It also bears repeating that the VI-SPDAT and SPDAT are intimately related, but are different instruments. The VI-SPDAT is a triage tool. It looks for the presence of an issue. The SPDAT is an assessment tool. It looks at the nuances of the depth and impacts of what is happening in the person or family’s life. We always encourage people that use the VI-SPDAT to also use the SPDAT whenever possible. Why? One of the main reasons is that if you are ever in doubt of the self-reported response or depth of needs reported through the VI-SPDAT, you can explore deeper using other methods in the full SPDAT instrument. The analogy we most often use is this: the VI-SPDAT is the triage station in an emergency room, determining whether or not there really is an issue, the severity of the issue in comparison to all others that have issues at the same time, and the sequence/priority of serving people; the SPDAT is what happens when the physician sees the patient after triage, exploring a complete history, context, co-occurring issues, and the most appropriate treatment pathway. Both the VI-SPDAT and SPDAT inform the work of prioritization. It is providing objective, evidence-driven advice to the assessors on who should be served next and why. If a community had more staff, time, money, housing or other resources than it knew what to do with the matter or prioritization would not be necessary. Both the VI-SPDAT and SPDAT move service providers out of a mentality of first come, first served to a thoughtful, deliberate strategy that objectively determines who needs to be served in which order.

Lastly there is the matter of how a person can meet the definition of chronic homelessness and be recom- mended for Rapid Re-Housing instead of Permanent Supportive Housing or a more intensive intervention. There are several circumstances under which this may occur:

• There is a bottleneck in service delivery, and the individual has met the time requirements of the definition for chronic homelessness because there is a lack of capacity or other deficiencies in the service delivery system, rather than because the individual is dealing with complex, co-occurring issues that impact his or her ability to maintain housing;

• The person has a small number acute issues that seriously impact his or her housing stability, rather than a larger number of complex, co-occurring issues; the cumulative impact of these issues may result in the person meeting the definition of chronic homelessness even though he or she has lower overall acuity.

• Note: Most people that live in your community who are coping with issues like extreme poverty, substance use, or compromised mental health will never experience homelessness – that is a statistical fact, and as such it is better to understand what those individuals are able to do in order to access and stay housed, rather than acting on an assumption that homeless persons with the same characteristics MUST have permanent supportive housing in order to be successful in housing.

What the Data Shows

We have been able to pull comprehensive data from three test-site communities that have used the VI- SPDAT and SPDAT where:

• each community was trained on effective Rapid Re-Housing strategies by OrgCode Consulting,

• where we have thorough demographic data, and

• where housing retention data on the households is available and complete.Two of the communities are from Michigan and one is from California. In each test community we pulled a random sample, weighted by proportionate size of homelessness in the community, as per the last PIT Count. Each is a different size community with remarkably different characteristics.

Data on Households Recommended for Rapid Re-Housing Intervention

1 This includes any return to homelessness with current homeless or unknown status since time of initial housing access. Lengths of time since housed for households included in this data analysis were a minimum of 1 month (representing less than 5% of all households included in analysis) to households housed greater than 1 years (43% of all households included in analysis).

2 There is the presence of a mental health/cognitive functioning issue, substance use issue and physical health issue within the same person.

3 The Family VI-SPDAT and Family SPDAT were used for assessing these families.

4 If a family is noted as “Known to Have” a mental health, physical health, or substance use issue – it can be any member of the family, not just head(s) of household. Tri- morbidity in these instances means it is the same family member that has all three conditions, but still does not necessarily mean it is a head(s) of household.

5 These families represent 3,011 people.

6 None of the Youth Households were families, nor were any veterans.

Veterans Non- Veterans

Discussion

As is the case in almost every community where data has been shared with us, the single greatest group of people requiring Rapid Re-Housing are non-chronic households, but there are, to varying degrees, a percentage of people in each community that meet the HUD definition of chronic homelessness, yet are recommended for a Rapid Re-Housing intervention based upon acuity level. Chronic homeless house- holds have been homeless longer on average; however, they do not consistently have higher acuity than their non-chronic counterparts.

Both chronic and non-chronic households have a percentage of households that lose housing and return to homelessness. It seems inevitable that this will happen for some of the households served. While chronically homeless households are slightly more likely on a percentage basis to return to homelessness, in absolute numbers this is a rather small number of households.

Furthermore, in digging deeper into understanding the characteristics of those households that lost housing, there is no significant relationship between losing housing and any particular presenting issue, whether that be mental health/cognitive functioning, substance use, physical health, or even tri-morbidi- ty. Overwhelmingly, a household with any one or combination of these issues is more likely to stay housed than to lose their housing.

What is not known from this data is the impact the training delivered by OrgCode Consulting on effective Rapid Re-Housing strategies had on the overall outcomes. As previously noted, each of these communi- ties received the training in addition to using the tools. There is no untrained control group in any of these communities to compare the results against.

Moving Forward

There is a regular cycle for updating the VI-SPDAT. During the update cycle, any community using the VI-SPDAT is welcome to provide input for consideration on future versions of the tool. Analysis of all the input provided will provide a course of action for future amendments.

Increasingly, communities are seeking additional training on the VI-SPDAT – how to apply it; how it relates to prioritization; the best approach for engagement; etc. We encourage communities to go this route, especially if there is any doubt on its application or effective engagement locally. At a minimum we recommend that communities effectively use the VI-SPDAT Manual to ensure the application of the tool is sound.

Furthermore, many communities forget or did not know that they can add other questions to the VI- SPDAT, so long as they are non-scoring questions. Most often this occurs at the end of the survey. If there is a specific local or program interest that you want to inquire about, by all means add the other ques- tions. If that has a direct tie into program prioritization or priorities for a particular funding initiative, it allows for data sorting to occur in a meaningful way, staying true to the VI-SPDAT and your specific needs at the same time.

Defining an End to Homelessness

This blog is part of the “You asked for it” series. In December, on the OrgCode FaceBook page I asked people want blogs they wanted to see. These blogs are a direct response to the most popular suggestions. This one goes out to Angela in Waterloo. She asked for a blog about “How do you define ‘ending homelessness’. Some communities are saying they’ve ‘functionally’ ended it. Provide a clear definition of that, for example.”

When a person or family is housed, their homelessness has ended. That is rather absolute. But the question, I think, has more to do with how can we define “ending homelessness” at a city, regional or national level.

Those of you north of the border having likely heard lots about how Medicine Hat in Southeast Alberta is going to be the first city in Canada to end homelessness. They are certainly on track to do that. (As an aside, Tracy from our team used to live there and organized the infrastructure and plan to end homelessness for the city; Jeff from our team still lives there and used to do SPDAT assessments for entry into Rapid Re-Housing and Housing First; and, in the first few years of the program I visited the city at least four times a year to provide training and coaching). Does it mean all shelter beds will be closed in Medicine Hat? No. Does it mean that no one will ever experience homelessness ever again in Medicine Hat? No. What it does mean is that there is a housing focus to all service delivery; that they have adjusted investment in services to reflect solutions rather than crises; and, no person experiencing homelessness will ever have to spend 30 or more days homeless before getting housed again. The last Point in Time Count they did found less than a handful of people living outdoors. Even the Mayor of Medicine Hat has become a huge convert to Housing First.

Those of you south of the 49th Parallel likely have heard plenty about Phoenix and Salt Lake City ending chronic homelessness amongst veterans. This is a slightly different kettle of fish that required some thoughtful analysis and commentary in those communities to explain the remarks. In December 2013, Mayor Stanton of Phoenix declared on MSNBC that they had ended chronic homelessness amongst veterans. Only a couple weeks later, Mayor Becker of Salt Lake City made the same claim, also on MSNBC. For the sector as a whole, in cities far away from Salt Lake and Phoenix, this was an overall win – “proof” that it was possible to align political will and services to put an end to homelessness for this population. Within Salt Lake and Phoenix, however, you could still find veterans experiencing homelessness, which caused some to question exactly why Mayors Becker and Stanton had made such claims. Were they lying? Was it all spin? Or did the truth lie in how to define what was occurring?

The biggest problem with trying to define an end to homelessness (or defining “homelessness” itself for that matter), is that homelessness is always in a state of flux. While one person gets housing, another person may become homeless. As one chronically homeless person makes his way into housing, another person reaches (for example) the length of time threshold required to qualify as chronically homeless. Because homelessness is not static, there will always need to be a balance between real time data and population prioritization data, which likely is from a list compiled historically.

Phoenix is a good example of prioritization data historically influencing how the data was interpreted and considered. In short, it went something like this: through a Stand Down event for veterans on Veterans Day in 2011 a list of chronically homeless veterans was compiled with slightly more than 220 chronically homeless veterans identified; that data was updated and augmented through other sources; the number was down to 145 in February 2013, just over 50 in October 2013, and down to zero just before Mayor Stanton made the announcement. In real time (as of the day you read this) are there zero chronically homeless veterans in Phoenix? Unlikely. But don’t interpret that as failure. More on that in a moment.

The Salt Lake experience used a similar approach, and there are some lessons that should be learned from them as well. First of all, Salt Lake City demonstrates the importance of confirming homelessness status – including chronic homeless status or veteran status – as the number decreased from the initial list collected because of ineligibility. Salt Lake also experienced a situation encountered very commonly in other communities and with other populations: difficulty locating some people when it was time to house them, even when there were vouchers available.

Is change in eligibility status just a convenient way to decrease the size of the issue? No. The reality is that definitions matter when it comes to resource allocation, so not meeting eligibility criteria is very important. Should Salt Lake have waited until they had located and housed the last of all people they had first identified? Nope. You have to work with the population you can actually work with, and with absolute uncertainty as to where the un-locatable people went, it would be foolish to spend considerable resources waiting and tracking people down, especially when they may have left town.

What can actually be ended?

Chronic homelessness can be ended. It can be defined. There are support and service interventions, as well as resources, that allow for an end to chronic homelessness. Phoenix and Sal Lake City are examples of ending homelessness within a sub-population of the chronic homeless populations: veterans. If you look at Salt Lake City you will also see that some resources were not veteran-specific that were used, in addition to veteran-specific resources. It is entirely possible that ending chronic homelessness amongst non-veterans was influenced negatively by this decision.

Episodic homelessness can be ended. It, also, can be defined. There are support and service interventions, as well as resources like shallow or time limited subsidies, that allow for episodic homelessness to not be repeated. The case of Medicine Hat is one where both chronic homelessness and episodic homelessness, by measuring acuity and aligning system resources, allowed both groups to be addressed and not just one at the expense of the other.

In both of the above (chronic and episodic homelessness), a functional zero would be occurring when the availability of resources exceeds the size of the population needing the resources. In other words, your community would have enough things like vouchers, rent geared to income housing, and case manager resources to meet the needs of everyone in the episodic or chronic homelessness group that wanted the resources.

Would all shelters close in a community where this happens? No. There will still be people that experience homelessness for the first time. We will never be able to prevent all people from never becoming dislodged from housing – nor would it be a practical use of resources to attempt to do so.

Would there never be street (outdoor) homeless where this happens? You cannot guarantee that either. Housing is a voluntary choice. Nobody should ever be forced, tricked or coerced into accepting housing. But we should know each of those people by name and have a plan for each.

Are Phoenix, Salt Lake City and Medicine Hat examples of perfect systems? Not at all. I’d argue, for example, that Medicine Hat could still improve its diversion techniques, its use of interim housing, and expand its permanent supportive housing options. I’d also argue, for example, that Phoenix needs to wrestle its behemoth campus for singles into a unified, integrated support network across multiple organizations. I’d also argue, for example, that Salt Lake City needs an improved housing focus to things like the major day resources and street outreach. Each of these cities have accomplishments to be remarkably proud of, but none of them have yet achieved a unified, system-wide, functional end to homelessness. They have achieved it for subsets of the population – or in the case of Medicine Hat, are at the precipice of doing it as a whole.

What it all comes down to when we talk about definitions and achievements is that any end to homelessness has to look at the supply to demand relationship. Because chronic and episodic homeless populations are more easily identifiable, and arguably more stable and predictable, it is possible to better target and rationalize the use of resources for these groups. It is also possible to prioritize through an acuity tool, the order in which people that meet these groups should be housed and supported. Homelessness is ended when the availability of supply means no person or family has to experience homelessness for a prolonged period of time. To ensure the system becomes aligned in this way, it is helpful to: allocate resources specifically for chronic and episodically homeless people; prioritize within these resources (the most acute persons first); support and allocate resources differently for newer homeless persons; have a strong housing orientation to the entire service delivery system (shelters, outreach, drop-ins, day centers, food programs, etc.); eliminate any program that incentivizes homelessness, even if well intentioned (for example: access to employment or health services only if homeless); and, stop trying to heal or fix people or convert people to a particular faith, and instead focus on properly supporting imperfect people in housing, regardless of faith (or lack thereof) or perceived sins or shortcomings.

If you desire an absolute end to homelessness, it will be VERY different than what it is required to have a functional end to homelessness. Anabsolute end to homelessness would require undoing the policy and program implications from the last two generations. As I lay out what this would require, you will probably realize this to be a dream, not an attainable reality in our lifetime. To achieve absolute homelessness, the supply of truly affordable housing (ample available stock across all income cohorts and household sizes) would need to exceed demand; income assistance rates and government benefits would have to increase in just about every community and be indexed to inflation annually; minimum wages would need to adjust to living wages; access to health care would need to be free and readily available; resources to assist families and persons with inter-personal conflict would need to be readily available and free; mental health resources would need to be readily available and free; availability of employment for lower skilled persons would be necessary; reintegration would need to be improved for persons leaving incarceration and we would need to remove barriers to housing and employment for persons with a history of felony convictions; community-based care and support would need to be expanded in the health care system; free long-term and nursing care for older adults and persons with acute health issues would need to be expanded and free; transition programs for persons ageing out of care would need to be more robust and resourced differently than they are currently; integration and support programs for newcomers to the country would need to be expanded and resourced much more than they are currently; inter-generational trauma for some population groups (such as indigenous persons) would need to be better resolved; domestic and intimate partner violence would need to cease; all parents would need to become fully accepting of their gay, lesbian, bisexual, queer, questioning, transgendered, trans-sexual, and two-spirited children (and any variation of gender identity or sexual preference other than heterosexual) and never kick them out of the home; there would be more evidence on the types of substance use treatment is more effective than others in different situations and expanded upon, as well as being free; and, there would never be anyone displaced by fire or other unforeseen event or disaster.

So, it is probably best that we focus on a functional end to homelessness. We should look to places like Medicine Hat to see what that looks like in practice, and learn from places like Phoenix in Salt Lake City as they formed their approach and prioritized resources. We should scale the amount of resources we have to the size of the need, and allocate them through prioritization. We should do this through heightened coordination across service providers, and with the needs of the end user of services in mind always.

Diversion: Making it Work

This blog is part of the “You asked for it” series. In December, on the OrgCode FaceBook page I asked people want blogs they wanted to see. These blogs are a direct response to the most popular suggestions. This one goes out to Zach Brown. He asked for a blog about “the whole biz on diversion” because it is “sorely lacking out there in the informosphere.”

Some people think diversion is about rejecting service to people. Seriously. I have seen it happen. Other people think diversion is about finding short-term fixes like a motel room instead of having people come into shelter. I am not kidding.

Diversion is a service. It is not the absence or denial of service. It is the art and science of finding safe and appropriate alternatives to shelter use. It is about empowering the front end of the system to try and resolve problems through natural supports and progressive engagement of “lighter touch” solutions before providing a more intensive response through the shelter system or any other homeless service.

Diversion is highly effective when there is coordinated entry into shelter services because there is greater structure and control, and less variation in how it is applied. When diversion is used in a decentralized approach to shelter entry, there is a risk of “service shopping” emerging where someone that is seeking service does not get the immediate answer they want of shelter entry they go to another shelter (and another and another and another in larger cities) until they get admitted.

Let me give you an example of a place where diversion is kicking butt: Phoenix. There is a centralized intake for families known as the Family Housing Hub. Here is what they wrote in mid-December:

Great news! Since launching the Family Housing Hub in mid-August, our staff has formally diverted 100 families from emergency shelter. Rather than add them to community waiting list for services, our highly skilled staff spent at least an hour with each of these families to help them problem-solve and identify safe, affordable housing options to prevent them from entering the homeless system. We are having great success at providing information and tools so families are able to end their own homelessness. And it’s working! Only 2 of the 100 families have returned to the Family Housing Hub and entered the homeless service system.

How did they do it? And how are others like them doing it? They are treating diversion as a service, investing in training to learn how to do it properly (in this case from yours truly), and applying these nine steps, outlined generally here (and more in depth in training):

STEP ONE:

Explanation of the diversion conversation. You want to use a scripted conversation that outlines how you wish to avoid entry into shelter whenever there is a safe and appropriate alternative.

STEP TWO:

You want them to articulate why – exactly – they are seeking shelter today. As part of the same step you want to know what they have already tried or thought about trying but haven’t attempted yet.

STEP THREE:

You want to understand where they stayed last night, how long they have stayed there, and whether or not they can return there safely for at least another three days while trying to figure out next steps. If where they were staying is unsafe or they cannot return, you can skip to Step Six.

STEP FOUR:

Following on the previous step, you want them to name the MAIN reason they had to leave the place they stayed the night before. Then, as a follow up, you want to know if there are any other reasons they cannot stay there. (Sometimes what they saw as the main reason and what the more pressing reason really is from your perspective may be different and illuminating.)

STEP FIVE:

You then want to find out if their time there could be extended if the person knew that permanent solutions and referrals were being made, connecting them to other community resources. If they still say they have no way to extend, you want to ask what it would take to extend it.

STEP SIX:

If they cannot return to where they stayed the night before or if it was unsafe, you then want to explore other potential people they could stay with that may be safe and appropriate to connect with.

STEP SEVEN:

After determining there is no alternative for them to put into action, and before admitting to shelter, there are a series of exploratory questions to better understand why they are having difficulties finding permanent housing. This sometimes reveals nuggets of information that can inform an appropriate referral that can solve their housing instability.

STEP EIGHT:

This step explores what resources they may have at their disposal or through family members that would allow for an alternative to shelter and/or could help inform their pathway to permanent housing.

STEP NINE:

This step is the parting words for shelter access. It goes like this:

• If admitted to shelter there is still an expectation that you will be attempting to secure permanent housing for you and your family. What is your plan at this point for securing housing if you are admitted to shelter?

We want people to know, even upon shelter entry, that shelter is not the answer. Permanent housing is the answer. Even if they do not have a plan, we want them to stay focused on housing and getting out of shelter from the first day they are in shelter.

Social Service, Community Mental Health and Homeless Service Provider Collaboration for Effective Case Management

This blog is part of the “You asked for it” series. In December, on the OrgCode FaceBook page I asked people want blogs they wanted to see. These blogs are a direct response to the most popular suggestions. This one goes out to Lauren Frederick. She asked for a blog about “Promoting efficient collaboration between social service agencies, community mental health, & homeless service providers for effective housing case management”

The last time I blogged about collaboration was the summer of 2013. I stay convinced that the five steps for effective collaboration that I outlined in that blog remain true:

1. Agree on how you will communicate with each other

2. Ensure creative conflict

3. Be deliberate and thoughtful in figuring out with whom you are collaborating

4. Have a defined process

5. Make certain there is accountability

And I also remain convinced that any talk of collaboration only makes sense if we are all on the same page about what is meant by collaboration. To that end, you can read this old blog gem from March 2012. One of the quotes in that blog that rings true to me whenever I go about discussing collaboration is from Thomas Stallkamp, who has had a rather successful career in business and now leads a group calledCollaborative Management, who remarked, “The secret is to gang up on the problem, rather than each other.”

That said, many people who work in this industry talk a good game about collaboration because we think it is the answer. It isn’t always. Collaboration only works when there is a genuine commitment to labor together (which, by the way, is the origins of the word). Collaboration is not partnership. It is not mutual aid. It is working together.

How do you get groups to work together?

First of all, they have to consent to do so and commit to do so. In a number of communities the way to ensure this will actually occur is a signed charter or memoranda with signatures from the parties that agree to collaborate.

Groups really only work well together when they have mutual interest. To that end, if a group wants collaboration so that, say, a behavioral health service will assist a participant in your program, that isn’t mutual interest. That is an interest in you having someone do the job that they are mandated to do. Mutual interest would be if the behavioral health service provider had something they wanted you to labor on with them.

Sometimes that we think having shared clients on caseloads creates an environment where collaboration will definitely occur. Nope. It only works if the sum of the various parties working together exceeds the impact of any one party working alone.

Let’s us assume that a group (comprised of three agencies: social services, a homeless service provider, and community mental health) agrees to collaborate. It will not all go smoothly, and it shouldn’t. We want there to be different perspectives and opinions on what should occur, in which way, and why. And let us not forget that the participant should have an active voice as well. Sometimes the best way to promote collaboration is to let prospective parties participating in the collaboration to know that you don’t expect everyone to agree.

Identifying the objectives of having the parties collaborate with each other is necessary for it to be effective and efficient. If you want people to come together and labor together without identifying the objectives, expect it to all fall apart, quickly and with considerable frustration. Why? Because chances are different parties had different objectives to achieve through the collaboration.

You would be hard-pressed to find any of these groups (social services, homeless service providers, or community mental health providers) with more staff, money or time than they know what to do with. Because everyone is overtaxed, suggesting one more meeting or get together is probably the last thing on anyone’s mind. “Many hands making light work” only succeeds if people feel that there is equal effort in participation. You also need to let people know how you plan on communicating about the work if they do agree to collaborate – Case conferences? Phone contact? All visiting participants at the same time? Emails? Skype chats?

Before you actually begin the collaboration, I would also make sure that people know how the group will have mutual accountability. That way if someone is not carrying their load or laboring in the way that was agreed to, there is recourse. If you don’t have this, people can start skipping out and avoiding participation.

How I might go about doing collaboration for the purposes of ending homelessness

1. Signed Memorandum of Understanding between senior managers in all three sectors of service.

2. One pager writing out the objectives of the collaboration signed by the frontline staff involved in all three parties.

3. Outline the steps that will be taken if there is operational conflict.

4. Identify the first five participants to collaborate on through discussion of all three parties.

5. Weekly email communication on tactical and operational division of labor across all three parties with specific clients.

6. Meet the second Friday of the month to discuss broader shared work strategically and actively create debate on approach, technique, and strategies for specific participants.

7. Summarize results of collaboration to Senior Managers of all three parties on a quarterly basis.

8. Expand to additional participants (incrementally) after at least two consecutive quarters of effective collaboration, with improved client outcomes.