Do you know how many alleys there are in the average city? Well, ok, neither do I…but after last night, I have a much better idea. Last night, instead of just bustling by these dark passages as I usually do, I traipsed up and down every alley I came across here in downtown DC.
As you’ve probably guessed, I was exploring these alleys, and every other nook and cranny of the Golden Triangle (which also happens to be, more or less, the Alliance’s neighborhood) as a volunteer with DC’s annual PIT Count. Still relatively new to the field and working on federal policy here at the Alliance, I don’t often venture over to the practice side of the field. I do, however, rely heavily on data and experiences gathered by practitioners every day to make the argument for increased funding for key federal homelessness programs. Last night was my opportunity to match each number with a face.
After more than three hours and more than 30 people counted (yes, that’s unfortunately more than one person for every square block I covered in a neighborhood a stone’s throw from the White House), I was beginning to sympathize with the challenges that every homeless person faces, but particularly those living on the streets. There were common themes: bureaucratic delays within departments like Veterans Affairs, long waits (years and years) for Section 8 or Public Housing, and a distinct lack of housing, affordable of otherwise, into which one might be placed. As Leroy, a man who made his home for the night in front of a Subway, noted to me, “I don’t need food kitchens or a place to shower, I need housing.”
It was frustrating for me, having these conversations with veterans, the elderly, parents disconnected from their children, and everyone else to know that the solutions are out there and the programs are, for the most part, in place. We just need the right resources and investments to take them to scale to assist people like those I met last night.
Before we departed for the Count, Scott Gould, the Deputy Secretary of Veterans Affairs, spoke briefly about the importance of conducting these count. Deputy Secretary Gould hit upon the crux of the issue by saying, “good data leads to good policy.” We couldn’t agree more! We think the staggering numbers of people experiencing homelessness in America speak for themselves. We know what needs to be done. Now, more than ever, is the time to make the right federal investments so that next year, or the year after that, I have a very boring, quiet night counting.
To everyone that has helped or will help conduct counts in your community this January: thank you. Our work here at the Alliance wouldn’t be possible without your efforts. But as we know, data collection is just the first step to addressing the problem. Now is our opportunity to take what we’ve seen and learned to Congress to make a national impact. Here in DC last night, we had it easy – walking around a beautiful city in unseasonably warm temperatures, ending the night at home in our beds. But people like Henry, Lana, and Leroy don’t have it so easy. Simply put: sequestration and balanced budgets shouldn’t keep them, or anyone else I met last night, on the streets any longer.
Join us in 2012 as we work with Congress and the Administration to improve the lives of these and others across the nation. Together, we can make the need for PIT Counts a thing of the past.
- Homeless tally ‘not an accurate account’ of population in Delaware County (Star Press, DE)
- Point in Time homeless count offers opportunity to help (News Leader, MO)
- Camden County begins 24-hour count of its homeless (Philadelphia Inquirer, PA)
- Harford, Balto. counties survey homeless for annual census (Baltimore Sun, MD)
- Connecticut social service providers set for annual count of homeless (Associated Press, CT)
Our new Capacity Building Associate, Kay Moshier McDivitt, joins the Alliance’s Center for Capacity Building with a strong background in community planning and programming to prevent and end homelessness. Throughout her career, she has worked to develop systems change and implement best practices specific to vulnerable populations. Kay was an early advocate for the Housing First approach, pioneering the “Shelter to Independent Living Program,” a best practices model of rapid re-housing.
Building on her community experience with the Lancaster County Coalition to End Homelessness developing systems change and shifting the local community direction to a system of prevention, diversion, and rapid re-housing, Kay has provided consultation and technical assistance to a number of communities in ten year plan development and systems change. Kay passionately believes that ending homelessness is possible and has committed her professional career to helping communities find the tools and strategies to accomplish this goal.
The Lancaster, PA resident enjoys travel (including her commute to the Alliance office), spending time with her family, and Saturday morning breakfast with friends.
As we move forward in ending homelessness, we have seen an increasing focus on measuring positive outcomes for clients. Programs and systems are evaluated on their ability to produce these outcomes. For some, this has caused a fear that programs will “cream”.
When we talk about “creaming” in the homelessness system, we talk about intentionally selecting families and individuals that we expect will have the best outcomes to participate in our programs. The term is particularly used when we talk about programs that are rich in services and provide longer term financial assistance. While this may seem selfish or calculating, it isn’t always. Sometimes we fear “setting up a client for failure” or providing an intervention and, at the end of it, “being right back where we started”.
The assumption of some people who “cream” in their programs is that community resources could be wasted and as such, these people offer their resources to families or individuals who could take better advantage of limited capital. Unfortunately, this is the wrong assumption on both accounts and, often, the cost to communities is both human and economic.
To start with, we know from research on rapid re-housing that the majority of families are able to exit homelessness to permanent housing with very little help. Unfortunately, the families and individuals who are often the most in need of assistance (and frequently the deepest assistance) are also the families and individuals who look like they will “fail”. They end up being left with little or no assistance, spending long stays in emergency shelters or worse, on the street or in another unsafe environment. The impact these long stays have on individuals, families, and children are sometimes not measurably negative, but they are known to disrupt to family dynamics, increase the incidence of depression, and compromise children’s education.
In addition to the human toll that long stays in homelessness take on families and individuals who are the most in need of assistance and the least likely to exit homelessness independently, these families and individuals tend to cost systems – not just the homelessness system, but mainstream systems as well – a lot of money. By not directly targeting these families and individuals and instead choosing households who may not have been able to exit homelessness with very little assistance or no assistance, programs are actually costing the community additional resources in shelter expenditures, jails and police costs, child protective services interventions, and health care.
While “creaming”—either intentional or unintentional—may help improve a single program’s outcomes, in the long run it diminishes a community’s likelihood of ending homelessness and places additional burden on the families and individuals most in need within a community.
What makes a housing program good? What is the difference between good housing programs and great housing programs? Which types of housing approaches work best for which populations? Throughout my career I have been investigating these questions, putting them in practice and sharing with others what I have learned – and can prove. I am an evidence-informed practitioner with a penchant for being a skeptical empiricist and I do not embrace hunches and anecdotes. I have come to understand that there are 10 essential elements for a successful rapid re-housing or Housing First program
I love seeing the profound change in people when they make the transition from being homeless to having sustainable housing and life stability. For the past couple of years I have been working with communities around the world to help them establish, evaluate, and tweak their housing programs to achieve better long-term success, use their resources effectively, and never lose sight of their mission (which is to end homelessness, in case you are wondering). Prior to that I spent five years starting and growing a highly successful and very large housing program – and we evaluated and researched what we were doing, learning why certain practices seemed to work and others did not. (I should also point out that I am a nerd to the nth degree and hold a faculty position in the Graduate Planning Programme at York University.) Without further adieu, here are the first 5 of the 10 essential elements for a successful rapid re-housing or Housing First program.
1. Know the population you aim to serve
Housing programs should never attempt to be all things to all people. From explaining your program’s intent to prospective clients, to hiring the best people to provide housing access and support services, it is necessary for you to know who you are intending to serve and why. It is important to make the right program available to the right person at the right time if you want to see your homeless service system optimized (which you can read more about here). Some advice:
- Do NOT have a first come, first served approach to housing services.
- Have a centralized intake process or standardized process across your community (great examples can be found in Columbus and Dayton, Ohio).
- Measure acuity of presenting issues (the Vulnerability Assessment Tool, Vulnerability Index and Service Prioritization Decision Assistance Tool are all good options) and facilitate access to the right housing program to meet their needs.
- Remember that homelessness for most people is a once-in-a-lifetime event for a very short period of time. Most of those folks will end their own homelessness and aren’t going to need intensive services from your organization. Do not do anything that will prolong their homelessness (for example, employment programs that require people to be homeless in order to participate).
- Rapid re-housing is a specific type of housing intervention. It isn’t just about getting people into housing quickly. It is about supporting individuals or families with a few complex issues in accessing housing and providing the supports necessary for them to integrate into the community and, ultimately, no longer need your supports.
- Housing First is also a specific type of housing intervention. While it is housing first, it is not housing only. This type of housing intervention is for persons who have experienced chronic homelessness and have multiple complex issues. Both Intensive Case Management and Assertive Community Treatment approaches have proven to be effective in support delivery, and require fidelity to the intervention to be successful longer term.
2. Have the right service orientation
The key to having the right service orientation is to meet people where they are at – rather than expecting our clients to conform to our programs. To truly be client-centered we need to check, double-check, and even triple check that we aren’t system-centered or client-directed. If you want to make sure you have the right service orientation:
- Allow clients to make choices – from the type of housing they move into, to the type, frequency, duration and intensity of services;
- Provide supports in vivo – in the client’s natural settings and their home rather than expecting them to come to an office or trying to deliver supports through text messages, phone calls, or email;
- Ensure the service plan is individualized as opposed to “cookie cutter”;
- Remember to avoid coercion and judgment;
- De-link the housing support functions from the tenancy (if they lose their housing they don’t lose their supports);
- Appreciate that neither sobriety nor treatment participation nor medication compliance are preconditions for housing success;
- Exercise harm reduction;
- Help people integrate into their community;
- Teach, model, and support people instead of creating unrealistic expectations or being punitive;
- Appreciate your role is to support housing stability, not to “fix” people;
- Remember that your goal is to be professional, not charitable.
3. There are five sequential and essential components
Delivering your housing program in the right order with the right focus of attention is critically important. The order for maximum success is as follows:
1. Focus on Housing Before Anything Else
2. Create an Individualized Service Plan – After the Person has been Housed
3. Increase Self Awareness
4. Support Achievements in Self Management
5. Allow the Client to Reframe/Rebuild One’s Life and Future
4. Structure and staff the housing team properly
Successful housing programs have comparable team structures and roles:
Team Leader – supervise housing case managers and is dedicated to ensuring fidelity to the program, measuring output and outcomes, and coaching for success
Housing Case Managers – can support clients in various phases of housing stability, and use proactive, objective-based discussions with clients to facilitate change and better housing and life stability.
Housing Locator – specializes in working with landlords and gaining access to housing stock. The best ones understand how rental markets and the business of being a landlord works.
5. Work well with landlords & understand their business
If you are working with landlords in the private market, you first need to appreciate that renting housing is a business. Engage with landlords from a business perspective and demonstrate how your approach can help them make more money. If you go into the discussion looking for landlords with big hearts you may find a few, but you likely won’t get as many units long term or be as successful than if you go into it from a business perspective.
Stay tuned for Part Two of the 10 Essential Elements of Successful Housing First and Rapid Re-Housing programs, which looks at items 6-10 in the list.
Iain De Jong is the President & CEO of OrgCode Consulting, Inc. He has been working with many communities to help them improve their housing programs in advance of HEARTH. He is a frequent and popular speaker at Alliance Conferences. You can see him at the Conference in February in Los Angeles. Iain is also the chief blogger, tweeter and FaceBook persona for OrgCode. Take a look at www.orgcode.com or @orgcode or www.facebook.com/orgcode
It’s the top ten time of year.
And today, instead of the usual Friday News Roundup, we wanted to share with you the top ten blogposts and top ten website publications for the year.
Let us know what you think of these posts or if we missed any of your favorites.
What the debt deal means for homelessness
What does the federal budget mean for HEARTH Act implementation
Chronic homelessness and cost studies
Why are people homeless
Posts about youth homelessness
Poverty Increases lead to fear of increased homelessness
The budget is out!
HUD releases 2010 PIT counts
Homeless children on 60 Minutes: Filling in the Solutions Gap
State of Homelessness in America 2011
Changes in Homelessness 2005 – 2007 Map
Increases in Homelessness on the Horizon
Total Homelessness by State – State of Homelessness 2011
National Conference on Ending Homelessness 2011
Data Point: Veteran Homelessness in the United States
Summary of the HEARTH Act
The Heterogeneity of Homeless Youth in America: Examining Typologies
Multi-Year Homeless Counts Map
Homelessness Looms as Potential Outcome of Recession
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.
Dream of a Nation is an anthology of essays about the most pressing issues facing the country today: bolstering the economy, improving health care, ending poverty, fostering community, creating constructive media, among others. The essays are penned by the national experts, including the Alliance’s own Nan Roman, who contributed an essay – co-written by Alliance board member Irene Mabry Moses – about ending homelessness in America.
Moving forward, we’ll tell you more about the Dream of a Nation campaign, how to get involved, where to buy the book, and what you can do to learn more about fulfilling the dream of our United States. For now, please check out the website, learn about the publisher, and read a few reviews.
Today’s guest post comes to us from the Alliance’s new federal policy fellow Sam Strike.
Hi everyone! This is Sam Strike, the new Federal Policy Fellow at the National Alliance to End Homelessness. I will be here for the fall helping the policy team find the best evidence-based policies and using them to end homelessness.
Issues of housing and homelessness first became personal for me when I taught at a middle school summer program in New York City. A couple of the kids I taught were in and out of homes and shelters. It was eye-opening to interact with these smart, fun kids and their great, supportive parents. There was no reason why they should be out on the street.
Then I worked for the housing unit at Legal Services of Eastern Missouri. I worked with people who were getting kicked out of their homes and it became clear to me that something was wrong with the system- and that some people were being unfairly treated.
At Legal Services, I was helping people avoid homelessness through HPRP grants and I got to see first-hand how much good a federal policy can do in real people’s lives. Much of the recent national narrative has been focused on reducing the role of the federal government in citizen’s lives – but I was privileged to see how much good government can actually do. If we’re able to turn great ideas into effective, efficient federal programs, we can make a tangible and significant impact on the lives of people most in need of our help. And that’s what I came to the Alliance to learn to do.
Homelessness is a concrete problem that we can study, address, and solve. I want to learn as much as I can while I’m here and contribute to the great work that the people here at the Alliance are doing. If we put together a coherent and well-funded homeless system, we can make sure that everybody has the dignity of a home to call their own. This is a goal that the Alliance is working to achieve with their revolutionary Ten Year Plan to End Homelessness, which focuses on prevention, rapid re-housing, and other housing-based solutions.
When I’m not at the Alliance, you’ll find me settling into my own new home in the District! I just graduated from law school at Washington University in St. Louis and moved into the city. I’m originally from Cincinnati (go Reds) and you can find me exploring DC, trying new restaurants, or looking for a good hiking trail.
Last week, Alliance president and CEO Nan Roman attended the first National Poverty Summit in Fort Worth, Texas hosted by Catholic Charities USA. The conference hosted leaders from 10 leading national human service organizations, including Save the Children, the Alliance, and Bread for the World, who engaged in a discussion about pragmatic, strategic, and compassionate ways to reduce poverty.
Since the Census released their report last week, there have been a number of news stories about the increasing number of people struggling to keep themselves clothed, fed, and housed. Only this morning, the New York Times reported that one in five New York City residents live in poverty; the Baltimore Sun said the number is one in four in their city. The Associated Press singled out the young adult population – who face a stagnant job market and the burden of school debt – as a group with a higher risk of poverty.
It goes without saying that there exists a relationship between homelessness and poverty (specifically deep poverty). Most people who experience homelessness were very, very poor before they were lost their housing. As such, programs that alleviate poverty also keep people and families from falling into homelessness.
But such programs are being threatened. With deficit reduction fervor racing through Washington (and much of the country), even effective, efficient government programs that help people move out of poverty and homelessness are at risk of being axed. And there is a flurry of other news articles – from Missouri to Arizona to Illinois – that have documented the potential human cost of denying these critical services to people who need them most.
While austerity is an important virtue, it cannot be achieved by punishing those who are already going without. As Nan Roman remarked at the National Poverty Summit, “We do have a deficit, but we can’t reduce the budget on the backs of vulnerable people. It’s a false savings when we allow so many more people to become homeless and stay poor.”