Archive for March, 2012
Today’s blog is a re-run of a guest blog from Iain DeJong. This post was among the top 10 most popular in 2011.
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.
It’s the Atlantic that makes the case that we might have made as well – one good outcome of this situation is that it brings attention to the very real and disturbing problem of homelessness in the country. From the Atlantic: “An estimated 600,000 Americans are currently homeless, including nearly 70,000 veterans, according to the recently released The State of Homelessness in America from the National Alliance to End Homelessness. That’s a small drop-off from 2009, but U.S. rates are alarmingly high: 21 homeless per 10,000 people across the country.”
BBH, the advertising firm that came up with the “homeless hotspots” concept wrote their own defense on their blog yesterday.
In other news:
- The Associated Press wrote about a report that raises concerns for homeless female veterans and their families;
- Reuters covered homeless single mothers and their struggles to provide for their families; and
- The Detroit Free Press wrote about a White House Conference in their city covering LGBT homelessness and youth homelessness.
Yesterday, the Senate Committee on Veterans Affairs held a hearing called, “Ending Homelessness Among Veterans: VA’s Progress on its 5 Year Plan.” The hearing examined the progress the Department of Veterans Affairs (VA) has made on its plan to end homelessness among veterans by 2015. Chairman Patty Murray (D-WA) took the opportunity to highlight the challenges facing female veterans in particular, who are a growing subpopulation among homeless veterans.
The hearing included testimony from veterans on their own experiences transitioning into civilian life, as well as testimony from VA officials discussing the various challenges and opportunities that are likely to arise as we move forward to end veteran homelessness.
In recent years, veteran homelessness has become a focal point for policymakers in the broader fight to prevent and end homelessness in America. In response, we’ve seen increased resources for homeless veteran programs, increased interagency collaboration and involvement from regional VA offices and VA medical centers, and widespread implementation of proven practices, such as permanent supportive housing supported by the joint Department of Housing and Urban Development –VA Supportive Housing (HUD-VASH) vouchers.
As a result, we’ve seen real progress in reducing veteran homelessness!
In February, the President included $1.35 billion in funding for homeless veteran programs in his Budget Proposal for fiscal year 2013 –a remarkable 33 percent increase! While his proposal is just a suggestion (Congress will need to make a final decision), there’s been significant movement around providing increased funding for veterans programs in Congress, particularly HUD-VASH vouchers.
Just this week, there are two Dear Colleague letters being circulated, one in the House and one in the Senate, in support of providing robust funding for HUD-VASH vouchers. The House letter closes today, but it’s already received approximately 45 signatures – an impressive feat in this difficult funding environment.
There’s been significant progress, but we still need your help! We need to make sure that as many senators as possible sign on to the Dear Colleague letter being circulated by Senators Jack Reed (D – RI), Olympia Snowe (R – ME), and Charles Schumer (D – NY) in support of robust funding for HUD-VASH and for HUD’s McKinney-Vento Homeless Assistance Grants, which served more than 12,000 homeless veterans in 2010.
Reach out to your senators’ offices by March 20 and encourage them to sign on! On March 20, the letter will be sent to the leaders of the Appropriations Committee, who are making the ultimate decisions on funding levels for programs like HUD-VASH vouchers. The more support from they see for funding for homeless veteran programs from their colleagues, the more likely they are to provide increased resources.
The HEARTH Act will significantly change the way the U.S. Department of Housing and Urban Development (HUD) funds homelessness assistance. Communities will be expected to work towards the federal goal that no one remains homeless for longer than 30 days. Additionally, performance on new outcomes will be measured, including reducing lengths of homeless episodes, and reducing new and returning entries into homelessness.
How can your community encourage homelessness programs to perform better on these outcomes? I recently spoke with Elaine de Coligny, Executive Director of EveryOne Home in Alameda, on the unique incentive they have devised – a prize.
EveryOne Home, a community-based nonprofit that coordinates Alameda County, California’s plan to end homelessness, has recently announced the 2012 Outcomes Achievement Awards. Programs that make the most progress on key community-wide outcomes will now be rewarded with one of two prizes.
The idea for the awards came to Elaine during a Performance Improvement Clinic (formerly called the HEARTH Academy) the Alliance held with Alameda County stakeholders in June of last year. She then approached a funder EveryOne Home had a previous relationship with, the Y&H Soda Foundation, about the idea. Elaine says the Y&H Soda Foundation was excited to support the initiative, and generously funded two achievement awards. The first award for $10,000 will be given to the highest achieving program, and the second for $5,000 will be given to the most improved program. Awards will be made to programs that have the highest rate of exits out of homelessness to permanent housing in the shortest time from program entry.
One of the most exciting aspects of the award is that programs do not need to fill out a single application form. The outcome data used to determine the achievement of programs will come directly from the information they enter into HMIS. This way, programs can concentrate on moving people to permanent housing rather than filling out paperwork. This is possible because of the work Alameda County has done to make their HMIS system generate reports and data that they can use strategically to measure success on key outcomes.
Elaine hopes that these awards, which will be given out in early 2013, will energize the approximately 50 programs in Alameda County eligible for the awards to improve their outcomes. If so, she says, there may be more awards available in the future.
If you spend your day helping people who have experienced chronic homelessness, you know a lot about “person-centered” care. It means organizing services and supports around the specific needs of an individual – a place to live first and foremost, then recovery supports, medical treatment, supported employment, and so on. In a world of service silos and payment mazes, it also often means a headache of coordination – you braid together programs and accounts, keep an eye on staff resources, manage partner relationships, and try to catch whatever falls off the table before it lands on your client. (You’re welcome). Fortunately, the health care system just might be catching up to you.
There is one area of health care reform that doesn’t draw much partisan controversy. It’s the drive to make the system work smarter with the resources dedicated to people who use the most services. We are all aware of the problem. In health care, the highest share of spending is associated with a small percentage of people who have very complicated health and functional profiles. How much of the costs can be managed better by paying more attention to care management and service coordination? Medicaid policymakers think the answer is “a lot,” and they have gotten behind new strategies to prove it. This is welcome news for homeless advocates.
The medical home (or health home) is one of the most promising ways to integrate health care with supportive housing interventions. The concept came to the fore first as a health-care-quality initiative, and later as a possible cost-saver. A medical home is a single provider responsible for organizing a person’s care – especially needed if the care involves many disciplines and practitioners. A qualified medical home provider – like a health center or a doctor’s office — can be paid a certain monthly fee for this service.
Starting this year, Medicaid is paying extra federal funds to states that designate health homes for certain high-need, high-cost populations – including people with mental illness. The Centers for Medicaid and Medicare Services (CMS) has approved health homes in at least three states so far – Missouri, New York and Rhode Island. More health home approvals are in the pipeline. The federal guidelines are clear that Medicaid health homes can be broad in the scope of service – using interdisciplinary teams, emphasizing behavioral health, and providing links for covered enrollees to “community and social support services.”
New York state has clearly made the connection between Medicaid health homes and addressing chronic homelessness. Its application for federal approval explicitly mentions “lack of permanent housing” as an issue to be addressed in its health home population. Housing specialists are considered possible members of interdisciplinary teams in New York and in a number of other Medicaid health home models. All three of the early states have responded to the call for integrating behavioral health with Medicaid health homes. Missouri and Rhode Island are building on their existing infrastructures; community mental health centers will serve as health homes for their Medicaid enrollees with severe mental illness.
This could be good news, and something to watch, for advocates working to end chronic homelessness. However, better service coordination does not have to depend on a Medicaid health home designation. In many communities and service networks, leaders in housing and health care are taking stock and creating betters ways of working together to make supportive housing a sustainable solution. Often, the process begins by getting everyone on the same page about recent changes in policies and programs. Have you had a conversation with your community partners about what’s new in your state? There may be ways to leverage new resources together, to improve how vulnerable homeless people experience their systems of care.
The Alliance is on the lookout for best practices in integrating housing solutions with changes in the health care system. Let us know what’s happening in your community. We are also keeping track of new and improved policy approaches, as the Affordable Care Act is implemented. If you want more information on health homes and related Medicaid strategies, check out the Integrated Care Resource Center and the Safety Net Medical Home Initiative. Take another step: Advocate! Make sure your leaders in state health policy are using this important information as well.
Keep your eyes out for news about the National Conference on Ending Homelessness in July 2013. Our annual conference is slated to take place from Monday, July 16 to Wednesday, July 18 in Washington, D.C. The website for the conference – including online registration – is still under construction but we’re hoping to launch it at the end of this month.
Now – the news of the week:
- The Oregonian highlighted a group of faith-based organizations that are helping individuals and families with rapid re-housing.
- Reuters wrote about a New Jersey legislator who went undercover to see if he could access shelter and services as a homeless person.
- Earlier this week, there was a White House conference on housing for LGBT people during which Secretary Donovan announced a rule that mandates equal access to housing services for LGBT individuals and families. In a related story, the Associated Press discussed if the next big LGBT issues was over housing for LGBTQ homeless youth.
- In Alliance blog news, we’re happy to announce a few ongoing series for the month of March:
- On Tuesdays, senior policy analyst Lisa Stand will discuss the relationship between the Affordable Care Act and ending chronic homelessness,
- On Wednesdays, capacity building associate Anna Blasco will write about the Alliance’s efforts to help communities transform their homeless systems,
- And on Thursdays, the advocacy team will continue their series on federal legislation and how you can make a difference.
Don’t miss it!
If the District’s 70+ degree weather today is any indication, it’s spring time here in our nation’s capital, and that means two things: the Cherry Blossoms are about to bloom and appropriations season is in full swing!
In addition to writing letters to your senators and representatives urging them to submit their funding priorities to the Appropriations Committees, there are currently two Dear Colleague letters circulating in the House supporting increased HUD McKinney-Vento and HUD-VASH funding.
Dear Colleague letters, also known as “sign-on letters,” are usually sponsored by one to three Members of Congress and contain a message for specific people in Congress – in this case, the sign-on letter is addressed to the Chair and Ranking Member of the Appropriations Committee or an Appropriations Subcommittee. The letters asks to increase or maintain funding levels for specific programs for the upcoming fiscal year. The sponsors circulate the letter among their colleagues in either the House or Senate (in this case, both letters are in the House) to gather signatures.
The first letter is being circulated by Rep. Gwen Moore’s office in support of providing the $2.321 billion requested by the President for the Department of Housing and Urban Development’s McKinney-Vento Homeless Assistance Grants for fiscal year (FY) 2013.
The second letter is being circulated by Reps. Al Green, Mike Michaud, and Michael Grimm in support of providing $75 million for new HUD – Veterans Affairs Supportive Housing (HUD-VASH) vouchers in FY 2013. The President also requested $75 million for the vouchers, which will provide approximately 10,000 new vouchers for homeless veterans.
Dear Colleague letters are an easy way for a Member to show support and convey that support to their colleagues and constituents. The sign-on letters are also a great opportunity to connect with your Members’ offices!
If you would like to see your representative’s name on either of these letters supporting increased funding for homeless veterans and the nation’s most vulnerable people, reach out to them! Let the offices know that the letters are being circulated and that you, as their constituent, would like to see them sign on! View the HUD-VASH or McKinney letters on our website for more talking points, sample letters, and instructions on how your representative can show their support! Then be sure to let us know who you contacted!
Last week I discussed how Whatcom County, Washington, is preparing for the HEARTH Act by launching a coordinated entry system. The HEARTH Act aims to streamline and modernize the McKinney-Vento Homeless Assistance Grants and help communities create more efficient, more effective homeless assistance systems.
Whatcom County is one community taking a few steps to move in that direction. (Go Whatcom County!)
In addition to implementing a coordinated entry system, the county is also working on a prevention targeting and diversion initiative. They’re modeling theirs after one currently in existence in Hennepin County, MN (a model the Alliance has highlighted) and the goal is of the initiative is to better target their homeless prevention resources to people most likely to become homeless.
Not only that, Whatcom County hosted one of the Alliance’s Performance Improvement Clinics (formerly called the HEARTH Academy) last year and based on what they learned, the county has added diversion assistance to their menu of homeless interventions. Diversion is a strategy that redirects people seeking shelter and helps them identify immediate, alternate housing arrangements. If necessary, diversion assistance also connects these people and families with services and financial assistance to help them return to permanent housing. Case management staff had already been providing diversion assistance informally for some time in Whatcom County, but the new diversion process has become formal and deliberate. Case managers are now trained to see friends and family members of a household as “informal landlords.”
I asked Greg Winter of the Whatcom Homeless Service Center to discuss his experience with the Alliance’s Performance Improvement Clinic and specifically, I asked him a question we receive often from communities interesting holding their own Performance Improvement Clinic: who should we invite?
Greg encouraged communities to seek a representative sample of the types of homelessness programs in their communities. Additionally, he felt that having the local housing authority, local governmental officials, or whoever is in charge of funding housing programs in the community. Whatcom also has a history of strong collaboration between housing providers and domestic violence providers, and he felt that their participation in the Performance Improvement Clinic was very important.
This makes sense. In order for interventions like coordinated entry, diversion, and prevention to be effective and efficient, the whole homeless assistance system has to be on board. The best way to have a significant, positive impact on people experiencing or at risk of experiencing homelessness is to provide deliberate, concerted service as one cooperative community.
The Alliance is working with communities like Whatcom County across the country. Learn more about homeless assistance strategies and holding a Performance Improvement Clinics of your own on our website.
At the end of March 2012, the Supreme Court will hear oral arguments in the challenge against the Patient Protection and Affordable Care Act. Every Tuesday in the month of March, the Alliance will blog about the impact the ACA has had and can have on preventing and ending chronic homelessness.
March marks the second anniversary of passage of the Affordable Care Act. This national legislation is changing the way communities take care of their most vulnerable residents. For people working to end chronic homelessness, it’s a good time to take note of some important milestones.
At the end of this month, the ACA is going before the Supreme Court. The nine Justices will hear oral arguments for three days about a host of issues raised by ACA opponents. After oral arguments, it could be some time – several months at least – before we know how the highest court in the land decides about upholding this historic piece of health care legislation.
Whatever happens, there is no denying that the Affordable Care Act has been helping people. In its first two years, the ACA has made the most progress in the private sector – making insurance more accessible for people with pre-existing conditions, and young people who age out of family policies.
For low-income populations, there is some good news but still a long way to go. The Affordable Care Act channeled millions more dollars to community health centers, which directly serve 20 million people who otherwise cannot access health care services. There are more than 1,100 such sites across the country today, including 208 projects that specifically serve one million homeless people every year. The ACA gives CHCs a critical role to play in rebuilding a health care system that puts people first. With expanded funding, the safety net has greater reach, with new centers and training programs for community health workers.
For chronically homeless people, the ACA’s biggest promises are still unfolding. Millions of poor and low-income adults still lack access to essential health care services, and many are denied Medicaid even though they have serious and disabling illnesses. The health care safety net remains fragmented and difficult to navigate. From Washington, it’s sometimes easy to think these problems are solved; that’s because we are only seeing federal agencies and states prepare for changes that are yet to come in a meaningful way for people who desperately need them.
But, help is on the way. Medicaid programs in states like Missouri, New York, and Rhode Island are moving ahead with new “health homes.” Health homes dedicate more Medicaid funding to the task of coordinating services and helping people achieve their highest potential for health and independence. (We’ll look more closely at health homes in a blog later in the month.) Other pilot programs are under way to find the best practices, tried-and-true approaches to integrating primary and behavioral health care services. More and more, health care experts are recognizing that housing can be part of the solution. Just last week, the Corporation for Supportive Housing announced $2.8 million in awards to 4 communities that are building out integrated models, capturing cost efficiencies while improving health outcomes.
Finally, Medicaid is getting ready to expand eligibility for basic health benefits, covering as many as 16 million more low-income people – who are uninsured and have not been eligible in the past. This part of the ACA is set to take effect in 2014. It is one of several key aspects that ACA opponents are challenging in the Supreme Court. Meanwhile, advocates are influencing implementation at the federal and state levels. The main task is to see that essential health benefits truly deliver on the promise of access to needed health services for all.
The Alliance will be blogging on the ACA throughout the month of March and paying close attention to the impending Supreme Court case challenges provisions of the health care reform law. For more information about homelessness and health, visit our website. We’ll be featuring these and related resources in later blogs.
What can be done now to improve the experiences of unaccompanied runaway and homeless youth? The question is an important one given the lack of new resources dedicated to federal appropriations of the Runaway and Homeless Youth Act. In fact funding decreased from $116 million to $115 million dollars while unaccompanied runaway and homeless youth continue to be in need of more shelter, housing, and services.
But there are still ways to help. Among them:
Increase family intervention efforts. Research shows that most youth who runaway return home and youth who maintain contact with their family fare better than those who do not. By implementing family intervention strategies we can tap into built-in support network and housing resources and avoid sending youth into the system. While doing this, providers should continue to assess the appropriateness and safety of a youth returning home to his or her family.
Decrease barriers. Youth who are most in need may present with the most challenging behaviors. Targeting those most in need and ensuring that they have the ability to access services can lead to a decrease in the number of youth experiencing homelessness.
Decrease involuntary exits. Decreasing involuntary exits will increase youth’s access to an array of supportive services. These youth might otherwise be at greater risk of becoming disconnected when told to leave a program. To prevent involuntary exits, service providers can provide youth support during their lowest and most vulnerable moments.
Improve data on youth. To effectively solve youth homelessness, we first need to understand the scope of the problem. We need to know the number of homeless youth, how long they have been away from home, services they’ve accessed while on their own, their age, gender, race, sexual orientation and gender identity.
Communities can improve their counts of homeless youth during point-in-time counts or by conducting youth-specific counts and /or surveys. Also, programmatic data can be improved by de-duplicating the tally of youth served in drop-in centers and transitional housing programs.