Archive for November 30th, 2011
Today’s guest blog comes to the Alliance from Iain DeJong.
I have the great privilege of working with communities and organizations across North America that are dedicated to ending homelessness. Being the nerd that I am, I feel passionate about using real-time information to link the right intervention to the people who need that intervention. This seems to make sense to a lot of people, but the unfortunate reality is that this is not how many organizations or communities work.
Imagine you have a heart attack. You are rushed to the hospital by paramedics. I now want to give you a choice: you can be seen by a cardiologist or an obstetrician/gynecologist (OB/GYN). Which one do you choose? The cardiologist, of course. Are cardiologists successful with heart attack victims 100 percent of the time? Nope. But that doesn’t prevent us from seeking out cardiologists when we experience a heart attack. They’re heart experts after all.
Here is another choice for you: again, you’ve had a heart attack. The cardiologist and OB/GYN choices remain, but this time I want to add a third choice: an acquaintance who watches a lot of House on TV. Oh, and he used to watch ER, dabbles in Grey’s Anatomy, and loves MASH re-runs. Who do you choose this time? My money is still on the cardiologist.
Here is your final choice: again, you’ve had a heart attack. All the cardiologists are not available. Why? Because they are too busy seeing people with common colds. Now your choice is limited to the OB/GYN or the acquaintance who watches House. I’m guessing you would choose the OB/GYN. It may not be their field of expertise – and your heart condition may have complexities that are outside their field of knowledge – but they likely still have a better chance of keeping you alive until the cardiologist is available than the acquaintance who watches House.
What are the lessons here for homelessness and housing service systems?
The first lesson: Perform common assessment to determine where (which organization) and how (which type of service) assistance should be provided.
I have seen the value of standardized assessment tools (or like this one) used across communities or a coordinated entry process, where the standardization takes much of the guess work out of determining where and how people can be served.
The second lesson: Prioritize highest need cases first.
Services should not be first come, first served. Can you imagine if people who experienced heart attacks were left to wallow in waiting areas? I suspect a lot more people would die waiting for the services they need, when the resources to help exist.
Communities that are serious about ending homelessness have methods for determining which individual/family should be served when and why. It isn’t random. It isn’t luck. It is informed decision-making that matches information gleaned from the assessment with the best available resources.
The third lesson: Capitalize on experts and their expertise.
Homelessness organizations cannot be all things to all people. We don’t want cardiologists to be inundated with people with common colds much like we wouldn’t want Assertive Community Treatment teams or Intensive Case Managers overloaded by people with lower acuity needs.
Oh…and don’t think words like “expert”, “professional” and “expertise” are accidental. Ending homelessness is professional work that draws upon a body of evidence, research, and proven methods. Simply being well-intentioned – without expertise – is code for being ill-prepared or improperly trained which can result in more harm than good. It is analogous to your acquaintance, the House fan, treating heart attacks.
The fourth lesson: Work cooperatively as a homeless assistance system.
The paramedics actually took the heart attack victim to the hospital – it wasn’t a blind referral, it was a warm transfer. In other words, once the paramedics arrived on scene they didn’t just tell the person where the hospital was and hope the person would get there while they moved onto the next heart attack victim. That’s not how paramedics work. They revive. They stabilize. They take people to the location with the expertise to meet their needs. They communicate with the hospital in advance of showing up to make sure that they know they are coming, which also gives the hospital the chance to say they are full or have no cardiologists available. At the hospital the paramedics remain until they directly pass the patient off to the next professional. They also pass every tidbit of information onto that other professional. And they document all that they did.
The fifth lesson: Ask the right questions at the right time.
We need to orient our information gathering towards matching people to the right housing intervention to meet their needs. Once they are involved in the program best designed to meet their needs, more pertinent information can always be collected. A mistake in homeless services that I have seen repeatedly is inundating people with questions to populate databases at the wrong time. Housing is the only known cure to homelessness. Shouldn’t we be orienting our questions towards a housing solution? Asking someone “How can I help you?” allows the conversation to go to any one of a number of different directions, most often related to their present survival needs. Asking someone “How can I help you get housing?” provides a very clear scope and direction and places the individual asking the question at the center of the discussion, which reinforces accountability.
My final point is that people who experience heart attacks are not kept in the hospital indefinitely. When the time is right – based upon professional opinion and further assessment – the person who had the heart attack is discharged from the hospital. The person in many instances is going to be connected to other community resources to help them get healthier and stronger while back in the community.
As we look at HEARTH indicators, we know that a system-wide approach to service delivery – rather than a collection of programs – demands that we think critically and strategically about how to get the right information that allows us to get the right individual/family to the right service. This system-based, strategic approach improves coverage of services, reduces length-of-time experiencing homelessness, and reduces recidivism. It also provides terrific opportunities for diversion.
So, let’s help people who are homeless with really complex needs access the resources best able to help them. Instead of just any organization, let’s help them get to the organization with the expertise and resources to have the greatest likelihood of success. Let’s focus on quality interventions rather than a quantity of interventions.
Let’s help people who are homeless with moderate needs access the resources best able to help them. Let us respect and value that not every individual is going to have really acute needs and let us also appreciate that some organizations do phenomenal work at effectively serving people with moderate needs.
Let’s do this across our entire systems of care and across all program areas. And let’s do our best to help people of all presenting needs and acuities access the housing they need.
Iain De Jong is one of the Managing Partners of OrgCode Consulting, Inc. and a long-time – and popular – presenter at Alliance Conferences. He has worked in the non-profit, non-governmental, private and public sectors, from policy development to direct service delivery and program design and evaluation. His work has generated a number of awards for innovation, affordable housing, impact on public policy and service quality. In addition to his work at OrgCode, Iain teaches in the Graduate Planning Programme at York University. If you are interested in learning more about his work or perspectives on ending homelessness, check out Iain’s Blog on the OrgCode website www.orgcode.com , Like OrgCode Consulting on Facebook or follow @orgcode on Twitter.