Gone Fishing

As you read this, with any luck there is a bass on the end of my line or a monster lake trout. I am in Northern Ontario, about an hour from my parent’s home on the north shore of Lake Huron. Call it the middle of nowhere (no cell service, lots of wildlife, loons on the lake are the loudest sound to hear).

As many of you know, I suck at self-care. I am, however, working on it. I have been actively trying to do smaller things in the hopes of finding a greater sense of calm amidst the storm that is often life on the road. This week I am going to:

1. Cloud watch. I intend to lay on my back and watch the sky.

2. Connect with my kids. I intend to laugh at dumb jokes around the campfire and take endless fish off their hooks.

3. Purposely take 10 deep breaths each day and feel my lungs feel with air. I intend be my mindful that I am here and alive.

4. Take a nap. I intend to do this once this week while I camp on an island in the middle of a lake – even if it is only 10 minutes while my kids explore a beaver dam or go fishing with their grandfather.

5. Check in with my emotions. I intend to do some, well, feeling about how I feel about stuff.

6. Figure out how to turn one dream into a goal. I intend to plot something that will challenge and fulfill me personally and professionally.

I know that when I practice this annual art of fishing off the grid it helps me for the rest of the summer. I hope and trust you are taking time for self-care this summer to. Get some Vitamin D. See you next week.

The Next Best Thing

Imagine you live in a small to medium sized city. I also want you to imagine that you have had a heart attack. You get rushed to the emergency room in an ambulance. Paramedics have been keeping you alive with really intensive assistance.

Given the nature of your situation, you are a top priority when you arrive at the ER. Oodles of resources are allocated to your condition. ER nurses, doctors and other health staff have applied their expertise to your immediate needs. It is the best your small to medium sized city has to offer.

They page for a cardiologist. One is not available. They are busy with other people with heart issues. Now what? I know, let us put you on a waiting list. If you are still alive and it can be confirmed that your heart is still unwell when a cardiologist is available, then you will be seen. In the meantime, we will have you fill out a bunch of forms and paperwork, a lot of which have nothing to do with your heart condition.

No?

There are going to be people in your community that you think will benefit from Permanent Supportive Housing. Like most communities, you will not have enough PSH, or your existing PSH is filled with many tenants that do not actually require PSH. What happens in most of these communities is that they create waiting lists for PSH.

Let us be clear: waiting lists are a game of survivor. Waiting lists favour people with lower acuity. Waiting lists are cumbersome and administratively expensive to maintain. Waiting lists do not work for households that need the resource the most. People deteriorate and even die while on waiting lists. They languish in shelters or receive survival supports on the street. Their homelessness and dependency becomes even more institutionalized and normalized.

If you had a heart attack and a cardiologist was not available, you would want the next best thing. It may be an ears, nose and throat specialist, or a gynaecologist, or a paediatrician, or an oncologist, or generalist, or any type of medical doctor. It may be that this person is keeping you alive until the cardiologist is available. But the point is: you get served and you get the next best thing.

In the delivery of housing resources to people experiencing homelessness, we have to get into the mindset of delivering the next best thing. When there is not a PSH unit available, we need to think creatively: what would a more intensive Rapid ReHousing program look like? What could a re-think of transitional housing as intensive interim housing look like? Would might master leasing of a couple of apartments as bridge housing look like? Is there a possibility of converting a shelter or part of a shelter to be more housing like?

The point is people with deepest needs require service as immediately and as intensely as is feasible, with a strong housing focus (the only known cure to homelessness). Waiting lists are not in anyone’s best interest, whether that be looked at from the service providers perspective of the end users perspective. We need to have a solution-focused, action-orientation and not a waiting list, bureaucratic orientation.

National Alliance to End Homelessness Conference: 3 Ups and 3 Downs

I just completed my 11th National Alliance to End Homelessness conference. It is a touchdown point for me every year. It is a chance to take stalk of how I am doing and how OrgCode can help; it is a barometer of where communities and America is at in its pursuit of ending homelessness. Here are my three ups and three downs of the conference:

First the Ups:

1. The National Alliance to End Homelessness does not disappoint.

Make no mistake about it, under the leadership of Nan Roman this organization knows how to organize and succeed at the conference experience. The conference tracks this year were well organized. The calibre of speakers they can recruit is extraordinary (and if you don’t know – speakers volunteer their time and get themselves to the conference and pay for their hotel room all on their own dime). The content was relevant.

2. We have weathered the storm of the Family Housing Options study.

I thought the Family Housing Options study would be the destructive factor in the conference and railroad fruitful discussion on rapid rehousing. It did not. I think speakers – including researchers, consultants, practitioners and Alliance staff – all handled the framing of it well. There are methodological flaws. There are still some good lessons to learn.

3. Networking.

This conference is a magnetic gathering point for everyone that works in the homelessness service field. There were 1,700 people this year at the conference. That is extraordinary. How far they have grown! Registration closed early. But more important than the volume of people present was the networking that you experience and see occurring. More than just “here is the great thing my program is doing” bragging that happened historically in some instances, I saw a lot more collegial sharing and interest in listening. Oh, and people had some fun too.

Now the Downs:

1. VA Secretary McDonald.

The plenary on Friday with Secretary McDonald was a colossal disappointment to me. There was no mention of the clusterfudge that is GPD programs and how this relates to ending homelessness.  It is THE issue in my opinion as communities work to zero. I wanted to see leadership in navigating how they are responding to GPD to get a successful resolution to all homelessness. Instead there was silence. The issue of the value of ending veteran’s homelessness over other homelessness has always been a sticking point for me. I will own that. But all of the messaging around veteran’s reinforced the divide between VA services and HUD funded services in my opinion. For example, when the secretary speaks of it being a patriotic duty of landlords to rent to homeless veteran’s, is there not a patriotic duty to take care of the poor and suffering and huddled masses that were not veteran’s? I also refuse to believe the rhetoric and narrative that ending veteran’s homelessness will teach everyone else how to end homelessness. Why? Because there is no policy or funding discussion about making the same volume of resources available to HUD funded programs. Yes, proving that homelessness can be ended is a good thing. Saying that the VA funded resources will show others how to do it is a fallacy because they have resources that no one else has access to. McDonald did not build a bridge. He did not show everyone a pathway forward of ending all homelessness. He promoted a self interest. That is only going to make matters worse, not better.

2. Considerable variation on what people mean when using the same terms.

Even with a shiny glossary at the back of the conference agenda, there was still no shortage of people using the same terms and meaning different things. Let me give you an example: rapid rehousing. One guy I spoke to was describing how they use rapid rehousing for people at imminent risk of eviction, not persons experiencing homelessness. Another lady was telling me about the great outcomes of their rapid rehousing that requires participants to have employment income in order to be eligible for services. Some people in sessions seemed to be referencing a “light touch” while others talked about rather intensive supports. Other terms that require more careful parsing to move forward in a common understanding: diversion, housing first, navigator, case manager.

3. Confusing programs with systems.

A program is an approach to delivering services to a particular population (or populations) within the context of other programs, funding, policies, legislation and day to day reality. Some people can only see their program or the service orientation of their program and do not see the system as a whole and the interconnectivity of its parts. Let me give you an example: a session where a provider spoke of their conversion from transitional housing to rapid rehousing, but could not put what they experienced into the context of other service providers, the impact on homelessness in the entire community, how resources get allocated in the community, or the migration of people experiencing homelessness from one program to another. Let me give you another example related to Housing First. I have great respect for Sam Tsemberis and I am a strong supporter of Recovery Oriented Housing Focused Assertive Community Treatment. It doesn’t help when he tells a room full of people that he does not believe in coordinated entry or common assessment. He has rejected/ignored all offers to meet or discuss with me the VI-SPDAT and SPDAT, as the Alliance conference was not the first place he has made such claims. It also doesn’t help when Nan has to hold him accountable for inconsistencies in statements he has made around rapid rehousing between various meetings and conferences. Housing First is a particular type of service intervention, as well as being a philosophy to how services should be delivered – and a strongly support both. But Housing First is NOT a system and it is dangerous to suggest it is (in the same way that it is dangerous to suggest that an assessment tool is a system or an assessment tool is coordinated entry). A system has many programs. How they share a service orientation is important. How they link together is important. Confusing a program for a system – whether that is rapid rehousing or Housing First or diversion or progressive engagement or whatever – puts us backwards, not forwards.

Rethinking “Imminent Risk of Eviction” Homelessness Prevention

I want you to research two statistics in your community:

1. The number of evictions in the last year.

2. The number of unique households accessing shelter in the last year.

Let me guess – the number of evictions is higher than the number of unique households accessing shelter, and it isn’t even close.

Many communities have financial assistance programs to assist households at imminent risk of evictions. The thinking is that through these efforts homelessness is prevented. It is commendable in theory. It is most often an incorrect use of resources in practice. Why?

Even most households that get evicted (not just at risk of “imminent eviction”) never become homeless. They figure it out. They transition to another place to live. It is bunk to think that all of these households end up as doubled up or hidden homeless.

This is one of the reasons why I think it is important to put “imminent risk of eviction” in quotes. The best and strongest indicator of whether a household will become homeless is previous homelessness. I think there are loads of households that face eviction. I think there are too many households that become evicted and that government benefits do not keep adequate pace with average rental costs. Nonetheless, drawing a straight cause and effect line from eviction notice to homelessness is precarious at best, and extremely naive.

Look at the data of unique households in a community that make use of eviction prevention (including rental arrears and utility arrears programs) longitudinally and you will see something interesting (which staff that operate these programs can tell you intuitively): whenever there is a time-out period for accessing the resources, the same households find their way back time and time again as soon as they are eligible to receive assistance again. What happened in the intervening period? Were they stellar tenants making all payments in between and coincidentally needed assistance as soon as they were eligible? No.

Another interesting thing you will see if you examine the data is rates of homelessness that occur when the pool of funds to assist households runs out in any given month or any given year. There is not a spike in the number of households that become homeless. There isn’t even a small blip.

Financial assistance programs like this type of eviction prevention assistance for those at “imminent risk of eviction” are a form of charity. They are NOT a form of effective program design or permanent problem solving. Most often they are a band-aid (and a lousy one) for structural issues related to poverty, and do not solve the permanent reason why the household needed the assistance in the first place.

Some cities have used Rent Banks for almost 20 years. The idea is that a household in need because they are at imminent risk of eviction for rental arrears borrows from the Rent Bank and pays back a nominal amount each month (say $20-$50) thereafter until it is all repaid. Unless the repayment is automatically deducted from some type of income benefit, the amount borrowed is very rarely repaid. Most often the money received is written off.

Furthermore, it is interesting to examine how communities structure their financial assistance programs for households at “imminent risk of eviction”. Most often the risk tolerance is very low. Screened out are very high need households with multiple, co-occurring factors. Screened in are very low need households with single risk factors. This runs contrary to how these programs should be considered. One would think that lower need households are more resourceful and perhaps have enhanced problem solving skills compared to higher need households that have more limited options, and perhaps diminished problem solving skills. Some communities even require that the household can prove employment income in order to qualify for assistance.

I would be remiss if it was not pointed out that there is another bias in the types of households that are assisted. Time after time in my travels I see “imminent risk of eviction” programs reserved exclusively for families. It is more rare to see assistance for single adults or unaccompanied youth – and when it does occur for these two groups the resource allocation is often considerably smaller.

Why do these programs exist? Hard to say with absolute certainty. I believe providers of these programs feel they are making a bigger difference than they are actually having by doling out the money. They can speak to the number of households assisted. They can speak to the amount of money allocated. They think this data shows how much homelessness has been prevented. It does not. Why? Because they do not have a control group of households that did not get assistance that they also monitored to see if they become homeless. If they had, they would find the ones that do not get assistance rarely become homeless. Again, they think there is cause and effect in the program where nonesuch exists. But it certainly is a feel good story to think homelessness is being prevented, and I believe that is the most compelling reason why organizations, faith groups, utility companies, etc. continue to do it.

So what should be done? I believe the first big step is to reallocate a whack of the money to more direct services like Rapid ReHousing and increasing vouchers and other supportive housing options. Then, with the smaller amount of money that remains, I would recommend it be used only with those households that have previously been homeless. That would be the primary eligibility criteria. While that may be sufficient enough, if you wanted to dig deeper (and maybe you do not) households with more co-occurring issues should be prioritized for assistance before others. Keeping people from returning to homelessness probably makes the most sense for “imminent risk of eviction” financial resources.

Does Rapid ReHousing Work? Well, it depends.

Seems there is no shortage of conversation and commentary about how rapid rehousing does not work, these days. NPR did a story on it. The Family Options Study findings from HUD paint a not-so-pretty picture. The Urban Institute released research that was a bit more favourable but also raised some flags too. Aside from those, people on the inside in various states have started to see certain trends related to Rapid ReHousing, calling into question what they initially touted as success.

All of this on some level is warranted. And on some level it drives me nuts. Let me explain.

From community to community to community there are different interpretations of what exactly Rapid ReHousing is, and as a result we can be calling something Rapid ReHousing when it really is not. There are no national or international standards. There is no consistent mechanism for evaluating whether one community is doing a Rapid ReHousing intervention, or another community is providing casual housing help with rental assistance.

It is my firm belief that Rapid ReHousing is a particular type of housing intervention. It is supposed to be time limited case management assistance – usually 4-6 months – with co-occurring financial assistance as it is warranted. It is intended for an individual or family with moderate acuity. That means they have a number of medium-level issues in their life or one or two big issues. When connected to community supports and mainstream services (critical to Rapid ReHousing) they stabilize in housing. Rapid ReHousing does not solve poverty. It does not take issues away. It houses and stabilizes.

Recently we released data regarding the SPDAT and various housing interventions. Collected and analyzed independent of OrgCode, it showed 92% of households where the SPDAT was used and moved into Rapid ReHousing were still housed – and this covers a five year period. Less than 69% of people that moved into Rapid ReHousing where the SPDAT was not used stay housed. Was the housing retention rate solely a result of the impact of the SPDAT? No. OrgCode also trained every single provider in each of the 12 test communities on how to deliver Rapid ReHousing in what we believe to be the proper way of doing the intervention. We provided policy and procedures to follow. We connected and did follow-up training. We shadowed staff in all 12 communities while in the field with individuals and families to coach and measure fidelity to practice. There was very limited variation in how the supports were provided. It seems that made a difference.

What do we believe to be the essential elements for Rapid ReHousing to be successful?

• Moderate acuity households for the intervention.

• Home visits and supports in vivo.

• Choice in where the household wants to live relative to the amount of money they have (no choosing an apartment that they are unlikely to afford on their own when the subsidy ends).

• Connection to mainstream and community supports from day one in housing.

• Strong focus on employment whenever practical and possible from early on in housing.

• Objective-based interactions in each engagement.

• All goal-setting is related back to housing stability.

• Structured, sequential and documented planning.

• Crisis planning and risk assessment with each household after housed.

• Honest and realistic budgeting with an eye to when the subsidy ends.

• Rigorously following the five essential and sequential elements to housing stability.

• Following the same philosophy as Housing First, for which you can watch an easy to understand video here.

We are doing ourselves no favours debating whether Rapid ReHousing works or does not work when it is not clear whether or not we are actually talking about the same thing. This is the fundamental apples to apples argument to be made if we are going to discuss whether or not it actually works – or does not. So  before we buy into the hype of Rapid ReHousing working or not working, ask yourself what exactly was the service that was being provided. (And as an aside, you might review the methods used to evaluate Rapid ReHousing – there is a reason why the Family Options Study took so long to see the light of day.)

Transphobia, Discrimination and the Delivery of Homeless Services

Look around your community and you may find there are some services that identify as being Women’s Services or Men’s Services. You may even find a co-ed shelter that has a Men’s Dorm and a Women’s Dorm. Is that based upon biological sex? Or is that based upon self-identified gender? For example, if someone that is biologically a male identifies as a female, is she (an intentional use of a pronoun here) accepted and permitted within the Women’s Services and Dorm?

I am biologically male. I identify as male. I identify as heterosexual. I am overwhelmed by the amount of transphobia and discrimination within homeless service providers. Not all, to be sure, but enough that I felt compelled to write a blog about it. Too many services have no desire to consider service delivery based upon preferred gender identity. Instead, the default is exclusion, misgendering (assigning services based upon perceived gender rather than self-identified gender) – which can be accidental or intentional, and a lack of acceptance. While great strides have been made to counter sexism and homophobia (well, comparatively anyways), there still seems to be a considerable amount of fear of people that are transgender or do not subscribe to any other type of gender norm.

Identifying as a transgender person comes with considerable risks. There are considerable rates of violence and verbal abuse experienced by transgender individuals. There is also quite a lot of discrimination experienced in employment, access to health care, and education – and of course delivery in homeless services.

I am a proponent of serving people in the gender that they identify with, and not creating mechanisms to further discriminate against people. Let me, though, take on some of the questions and comments I have heard in my travels.

If you have a Woman’s Dorm and then you have a transgender person wanting to stay there, it makes all the women in the dorm upset. They don’t want that person (My Note: “her”) there.

This is an opportunity for education and teaching acceptance, as well as normalizing services to transgender individuals if the person identifying as female stays in the Woman’s Dorm. If you accept the premise that the other women are upset and then discriminate based upon their preference, how is that any different than, say, a dorm full of white people saying it makes them upset to have an Asian, Hispanic or African American person stay with them and wanting you to make concessions based upon the preference of the white majority in the dorm? You wouldn’t. Nor should you.

We have to protect the safety of the women. We can’t have someone like that in there. And when they don’t dress like or wear their make-up like a woman or take off their wig, the ladies get really upset.

Yup – “someone like that”. So what does it mean to be a woman, then? There are no shortages of stereotypes woven into this. I doubt there is a dress code or make-up code that all women must abide to in the shelter. Asking someone to keep an exterior appearance of matching stereotypes of womanhood is not a reasonable expectation for anyone.

We can accommodate and tolerate transgender persons through a special room we have.

Is exclusion really the answer? I am all for creating safe spaces. They may be warranted in some circumstances. Key to me, though, is that having a “special room” is a choice, not something forced upon people that identify as transgender. Also, I think we should try to champion for inclusion and acceptance rather than accommodation and tolerance.

It puts everyone else at risk. There is the risk of sexual assault and other types of violence.

Risks are present in all types of congregate settings. Lots of things can cause tension. How we manage a non-violent environment is important. How we create acceptance and integration and inclusion is important. Fear, in this instance, is not a compelling reason to NOT serve someone.

A lot of people we serve and a lot of our donors are Christian. We cannot offend their beliefs by serving them.

Organizations that are entirely privately funded can do what they want and serve who they want, within the broader structure of law. I would still argue refusing to serve people that are transgender is discrimination and warrants appropriate challenges.

If any organization receives public funding, then there can be absolutely no circumstance under which discrimination should be tolerated or supported. We should work with people that identify as being transgender to ensure trans-inclusion in how we design facilities and programs to better facilitate integration and complete acceptance.