Bridget Deschenes Bridget Deschenes

Street Outreach and Coordinated Access

Recently in a community I had a well-established street outreach provider ask me how they can help explain their importance now that coordinated access was taking shape in the city. It seems that with the infrastructure of coordinated access taking root, the street outreach provider was facing questions from its primary funder of whether it should continue to exist.

The short answer is that yes, I think that street outreach should exist in a city that has coordinated access.

Now a longer answer…

Street outreach has merit as a service when it is connecting people to long-term solutions to her/his homelessness. Street outreach, in my opinion, has little merit if it just about providing food or socks or clothing or sleeping bags or prayer. Yes, those things can meet immediate needs, but it doesn’t solve the problem of having someone sleep outdoors, in whatever location they may be in. So, I think street outreach should continue to be funded in communities with coordinated access if there is a housing-focus to the street outreach.

To use an analogy that seemed to work well in a training I recently did with an outreach provider, street outreach is to coordinated access as fluffers are to the adult film industry. Yes, the (ahem) “money shot” (housing in the case of coordinated access) is the conclusion that is remembered, but it was only made possible because of everything that occurred behind the scenes up to that point that no one ever sees. The things street outreach workers see and experience day in and day out as they work with a person in getting them a step closer to being housed is beyond the imagination of many people.

Street outreach provides an important access point into the homeless service delivery system for those people that do not use shelters or cannot use shelters because they are barred/trespassed or have legal restrictions that prevent them from using the shelters. In some communities street outreach is the only access point to housing for people that use substances but there are no shelters that allow people to enter if they have been using substances.

When street outreach has a positive connection with police and paramedics and can respond to issues that are deemed to be a “social disorder” there is also considerable benefit in having them in the community. Skilled street outreach workers can deal with complex social situations that are not really an emergency warranting police or ambulance, thereby freeing up first responders to attend to other emergencies, while concurrently helping that individual start to get connected to the long-term solution to their homelessness and even connect into shelter if the person is willing to go (which can be made easier if the community is coordinated shelter access as well as coordinated access to housing).

Finally, let me leave you with this thought – because visible homelessness is most often what the general public sees and therefore how it judges a community’s response to homelessness (rightly or wrongly), I think it would be foolish to remove funding from a street outreach provider that is doing high-quality work because there is coordinated access. The general public cannot see nor can it easily understand coordinated access. What the general public can see is street outreach workers engaged with its most vulnerable people laying on street corners and camped out in parks.

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Bridget Deschenes Bridget Deschenes

Waiting Lists to Nowhere for the “Un-houseable”: How Not to Do Coordinated Access

Assessing for the sake of assessing sucks. That isn’t coordinated access. That is a bureaucratic response (and not just government) to the issue that solves nothing.

Recently I was in a community that has been putting coordinated access into place over the last few months. In an effort to get community buy-in, their weekly meeting of housing providers allows for over-ride of assessment if the person is deemed to be too complex. Want to guess what is happening? They have a list of dozens of names of people with higher acuity that no housing provider is stepping up to house.

Creating waiting lists of people with complex issues instead of solving their homelessness is not about ending homelessness. It is a waiting list to nowhere.

Who are these people on the waiting list? Yes, they all have higher acuity. To a person they have co-occurring, complex issues across quite a spectrum – substance use, mental health issues, physical health issues, involvement in high risk and exploitive situations, numerous interactions with emergency services, and more. But in addition to that, they are almost exclusively people that have been housed several times before. They are the waiting list of people waiting to be re-housed…people that previous attempts at housing have broken down because of partying, guests, drug use, noise complaints, loneliness, paranoia, etc.

If we want to truly end homelessness this is the exact population we need to figure out not only how to house, but how to keep housed. If we want coordinated access to work we can’t allow there to be an over-ride to not accept the “unhouseable” and instead we need to put our collective wisdom together to figure it out.

Study after study, community after community, shows that 80% or more of people with complex issues in a Housing First program will remain housed. That means that at least 20% in each community are not. I suspect that is the group on the waiting list to nowhere. It is when we figure out how to meaningfully house and support this group that coordinated access will really make a difference and we will truly end homelessness.

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Bridget Deschenes Bridget Deschenes

The Big Picture: A Statewide Approach to Common Assessment

I am writing this about halfway through the first leg of the statewide SPDAT tour of Michigan. Michigan, in all her VAST glory, has joined a number of states and provinces that have decided that they want the same common assessment tool used across the entire State. Not just a community-by-community decision – a full, statewide implementation. Every Continuum of Care…all programs that get funding through the Michigan State Housing Development Authority, Department of Human Services or Department of Community Health…all regions…all types of communities (urban, rural, remote) – all using the exact same tool.

This was the State’s idea. OrgCode didn’t push it or sell them on the idea. And while they were not the first to go this route (hello forward thinking Newfoundland & Labrador), we applaud the State and the handful of other states and provinces that have gone this direction. We also hope that other States and Provinces considering going this route pay close attention.

It is a great idea to see the Big Picture and go statewide (or province wide) with implementation of the same common assessment tool. Here’s 10 reasons why:

  1. Different funding sources doing work with the same population all work using the same language and approach to assessing needs, decreasing conflict across departments or funding sources.

  2. State funding sources are aligned with federal funding sources in the use of the same tool.

  3. The State doesn’t have to try and make sense of whether different tools are showing different acuity levels or really showing the same thing – or how to even translate it all – because they are all using the same tool throughout the entire state.

  4. There is one State sponsored approach to training and creating an infrastructure of sustainability rather than Continuums trying to figure it out on their own.

  5. There is a strong data infrastructure to make sense of how people’s lives are impacted statewide. How someone’s life is changed in Northern Michigan can be measured and understood exactly the same way as how we talk about someone’s life changing in Detroit.

  6. There is a long-term view and commitment to common assessment. Because the state is implementing it across multiple Departments and making it statewide, this isn’t a “flash in the pan” decision to do something just to meet a HUD requirement. This is a thoughtful, long-term approach with requisite processes in place to ensure effectiveness.

  7. It doesn’t matter if a person or family moves from one CoC to the next to get services. Their acuity score can follow them and/or the approach to measuring acuity will be the same. Service shopping across CoC borders is neutered.

  8. It increases consistency in how coordinated access occurs. While there is still tweaking of processes at the local level, how and when the assessment fits into the mix is normalized.

  9. It is fair and transparent to all people that experience homelessness in the State. A person who is homeless is not advantaged or disadvantaged by what tool may be in place and/or the training that goes into it based upon where in the state they try to access services.

  10. It allows us (OrgCode) to more strategically provide longer-term support and work closely at the local and state level to ensure alignment with training objectives and approach with policy, funding and program expectations.

 

It is a great privilege to be part of this initiative in Michigan and to help better assess and support individuals and families experiencing homelessness statewide. We see the benefits from a policy, program and funding perspective. And we look forward to seeing the great volume of data that is likely to demonstrate how programs can also be improved on a statewide basis to ensure the state is moving even closer towards ending homelessness.

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Bridget Deschenes Bridget Deschenes

Ultracrepidarianism and Fauxpinions

The first is a real word. The second one is made up. They are both related.

The first is to have opinions outside of one’s area of expertise or knowledge.

The second is to present opinions as facts when the opinion is not based upon fact.

In the world of social change, both hamper and thwart efforts to be effective.

Consider that most public policy is crafted and approved by legislators that do not have subject matter expertise regarding the matter that they are enshrining into law, funding, rights, etc. But they do have opinions. Regardless of what the public service may have put before them by way of data, research, experience of other jurisdictions, framing of pros and cons, financial impacts, etc., it is always the prerogative in a democracy for elected officials to deviate from the advice they are given and craft an approach based upon opinions alone.

This is the wretched, recurring uhtceare moment for the skeptical empiricist that would rather see evidence drive us to discussion and deliberation rather than opinion. Examples: mandatory minimums do not deter crime, but we seem to have an opinion that they do so and legislators create more reasons and longer sentences; sobriety is not a precondition for success in housing, but we seem to still fund and support a litany of recovery services that masquerade as homeless services and reinforce a false notion that people can only remain housed if they are sober; countries that have a long history of same-sex marriages and unions have not seen a deterioration of their moral fabric or destruction of opposite-sex marriages and unions, yet there remain some circles that fear-monger and suggest that such a thing will occur.

While we can see the snollygoster making such opinions possible in the realm of policy – and the populace is mumbudget – perhaps it is worse when fauxpinion takes fervent root. Another way of looking at the fauxpinion – the repeat of a lie enough times that people come to accept it as truth.

The master of the fauxpinion exists in just about every community. I find they are often long-term disciples within the service they work. They are held with reverence or placated rather than challenged. They hold power because they have woven their fauxpinions into some semblance of truth that has actually formed the foundation of the approach to addressing the social issue. Examples: the provision of survival supports like sleeping bags and food as a necessary ingredient to get people off the streets; addressing economic poverty is the only true way to combat housing instability; chronically homeless people (or a large subset thereof) prefers to be homeless than housed.

We need to shine a light on data in meaningful ways to get it into the discussion of public policy and social change. We need to present it with certainty and in terms that lay people can understand and use immediately. And we need to be assured because we can prove it that decisions based upon sound data and research is better than approaches founded solely on opinions that are beyond the subject matter expertise of the decision-maker, or based solely upon false facts that have tried to translate opinions into sounding like facts.

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Bridget Deschenes Bridget Deschenes

Peddlers of Hope

(My thanks to Johnny Mac in Rhode Island for introducing me to the phrase “Peddlers of Hope”, which I have gone on to use quite extensively in my training on effective housing-based case management.)

We are peddlers of hope. Hope for those who feel no ability to hope. Providers of hope who need a bit more to get to the next stage of recovery. Champions of tomorrows, not yesterdays.

Our hope is not blind. It is not unrealistic. It is not a panacea for pain. Hope does not erase history, it merely provides the opportunity to recover and grow from it.

Hope is not a promise, but it is less than delusional dream. It is the fuel that makes life turn out more positively than it currently is, anchored in who we are and the capabilities as a person. We can speak a language of hope because we have seen so many take brave steps out of catastrophe or excruciating illness to tackle the empty feelings in their heart.

We can’t touch hope. But we know it exists.

We can’t create one roadmap of how to turn hope into a journey towards better days. We know that hope lends itself to a person journey.

We know that hope is more than just one thing. Hope is many things…a plan, a feeling, an attitude, motivation, belief in self, protection from more misery.

What makes us a peddler is our desire to spread hope widely and universally.  We are persistent in our approach to being hopeful about hope.

Too often we keep people looking backwards, not forwards. “Tell me your story…”; “Tell me what happened…”;”And then what…”  The past creates a picture of the present, but as peddlers of hope we need to then focus the discussion into the future. “What will your story be…”

Ours is not a false hope. Ours is not another promise to be broken. Our is not a guarantee that everything will be alright.

Crippled by remorse and shame, we can exude positivity in appropriate doses to help others see the power of hope. Devastated by broken promises and shattered relationships, we can exude positivity in appropriate doses to help others see the power of hope. Hurting from self-inflicted harm to person or spirit, we can exude positivity in appropriate doses to help others see the power of hope.

As a peddler of hope, we know that hope is intentional. As a peddler of hope, we embrace the possibilities that can realistically occur. As a peddler of hope, share the desire for better things to happen – and provide the fuel to make that possible when the individual/family has no hope of her/his own.

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Bridget Deschenes Bridget Deschenes

The Difference Between Having Higher Acuity and Being Chronic

We continue to be overwhelmingly pleased with the expanded use of the Service Prioritization Decision Assistance Tool (SPDAT for short) and the VI-SPDAT as well. The more data that is shared with us from communities (made anonymous) the better. One of the very interesting things to observe is the small group of people in communities (has been less than 5% in the data that we’ve seen of all assessments, but in some communities making up more than a quarter of all higher acuity households) that have higher acuity, but DO NOT meet the HUD definition of chronic homelessness.

Maybe it is time to re-think our targeting efforts for programs based upon acuity level, not based upon eligibility of meeting a definition of chronic homelessness (or maybe we need to rethink the definition of chronic homelessness to include some consideration of acuity). If we don’t, some of the most unwell people on our streets and in our shelters will never meet eligibility criteria for some of the support and housing programs best capable of meeting their support needs because there are many Permanent Supportive Housing programs exclusively for chronically homeless persons – and in some communities ALL of the PSH is for chronically homeless persons.

 Acuity speaks to the severity of a presenting issue. In the case of an evidence-informed common assessment tool like the SPDAT, acuity is expressed as a number with a higher number representing more complex, co-occurring issues that are likely to impact overall housing stability.

Chronic by definition is something that has persisted for a long time. Furthermore, chronic is, by definition, something showing little change or extremely slow progression over time. In the disease literature, chronic refers to something lasting greater than three months in duration. In the parlance of HUD (though to HUD’s credit an evolving definition), chronic homelessness means one year of continuous homelessness or four episodes of homelessness in the last four years AND a disabling condition.

From purely a language perspective, I would argue there is greater utility in focusing on acuity as it lends itself to monitoring and measuring changes, whereas chronic is more stationary focused more on history and less on future. Chronic is backwards looking. Acuity is forward looking when changes in acuity are measured and monitored. Given the very nature of support programs that do the best work in supporting people with complex, co-occurring needs are hopeful in nature, acuity is better aligned to being peddlers of hope.

While most assessments are showing that people that meet the chronic definition of homelessness have more severe presenting issues (higher acuity), we need to start the discussion of how best to serve those that may be high service users, have a plethora of issues, be quite unwell, and would seem to benefit from the likes of Permanent Supportive Housing, but do not meet the federal definition. Some communities are doing more and more on this – but it likely warrants a more thorough policy and program discussion. If we don’t, three things will happen:

  1. prioritization through coordinated access will be limited/flawed because some of the people with the deepest needs won’t be eligible for existing programs;

  2. we will misinterpret our progress in ending chronic homelessness as a sign that the people with the deepest needs have the support and housing they need and deserve; and,

  3. we won’t ever truly end homelessness amongst some of the people with the most severe issues.

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