Change in the Homeless System

For the last five years, my work at Steadytown has primarily been dedicated to a complex societal issue—homelessness.

I’m in it for a few different reasons. First, homelessness is the result of failures with a number of social support systems—which is what makes it complex, and the art in making sense of complexity interests me.

A mentor of mine once told me, “Don’t ever just go up to someone on the street and ask them how they became homeless”. Because it’s traumatic and complicated.

Second, homelessness services is one of those fields that’s not very mature. It’s not like airlines or banking. It’s newer, it’s small, it’s still trying to figure out what it needs to be (and understanding what it can’t possibly be, as it needs systems further upstream to do their job, too). As a result, change has the potential to happen faster than it might in other fields.

Third, because it is a kind of Wild West, you see all kinds of ideas offered up by an array of players in it for different reasons (from feel good charity to public health). The result is a lot of variance and inefficiency. As an analyst I find this interesting—it presents opportunities to study all the ways the problem is defined and move the needle.

So homelessness is complex—hard to predict and hard to solve, despite the paradox of what seems like a simple solution: housing. But that’s what makes it an engaging field to be in. You get freedom to work on the design of effective homelessness services, and you get to influence change in the upstream systems that contribute to homelessness.

This article will explore the major trends happening in the homeless system today. Change is happening, and the communities that are embracing it are generally making greater progress. To provide some context, let’s first explore what the status quo looks like and some of the pressures that are driving change.

The Status Quo—the Wild West #

I’ll use the term “Wild West” again not only to describe the nascent aspect of the field, but how the homeless system has traditionally felt to clients: every “homeless” person for him or herself (I put homeless in quotes because what is homeless often varies by who you talk to).

I’ll get into this, but to sum it up: traditionally, if you are resourceful enough to navigate the book of all the various “homeless” service providers in your community and their programs, understand what it means to be a “fit”, and make it to the offices of the right ones to fill out an application completely, you’ll likely get some help with the rent or a cheaper place to live eventually—at least temporarily. The squeaky wheel usually gets the grease. Whether or not homelessness is decreasing in your community, especially the unsheltered or street variety, is another question. In most communities, it’s not, it’s increasing. And traditionally, service providers don’t reach the people actually living on the street.

Other characteristics associated with the status quo include: a system that is loosely collaborative and highly fragmented, arbitrary, and imbalanced. That casts a wide net and is generally first-come-first-serve. That can be very political and mandates special programming in exchange for service. That’s office or facility-based and program centric, measuring success mainly by the utilization of its programs.

Let’s take a look at an example.

Example of a Traditional System #

A traditional system works something like this. Citizens with housing problems are provided a community resource book and directed to call a hotline (in Florida and in Brevard County, that is 211.) All kinds of calls will come in—because there are many different types of housing problems. Many are seeking help with the rent or a cheaper place to live, some are saying they have nowhere to go.

Because the hotline casts such a wide net (anyone with a housing problem), it’s hard to tell who is truly homeless. The majority of callers are not and most people living on the street don’t call at all.

Yet traditionally, this becomes the primary referral channel for the homeless service providers. What happens is everyone ends up calling everyone in the book—they are even encouraged to shop around to see who has available “funds” or “beds”.

Remember, in this system the resourceful squeaky wheel gets the grease. And the system is resource or program centric, so there is “no wrong door”.

This results in several consequences. First, service providers each have to staff their own intake personnel. This means clients must tell their story over and over again, which can induce trauma and foster a culture of sharing only what clients think providers want to hear.

Second, the referral volume is immense, because people with all sorts of housing problems are referred. So there is a lot of noise to sort through resulting in frequent rejections of service—or alternatively, and this happens a lot, providers induce homelessness to make those they are sympathetic to service eligible (an example would be paying for one night in a hotel for someone living with family in order to satisfy program eligibility requirements).

Third, as I mentioned previously, most people living on the street don’t call. They may go to the local meal center, but they don’t make it to the housing providers, and the housing providers don’t come to them. So they don’t get referred.

Of those that are deemed service eligible, most end up on a waiting list. The more resourceful will typically get on multiple waiting lists to see which one hits first. They may or may not still be homeless when their name is called—often they are not, because most aren’t going to stay homeless for long.

Key Drivers of Change #

One of the big drivers of change with a system like this is simple math. The size of the population with general housing problems vastly outweighs the capacity of the homeless system (and remember, the intent of the homeless system is to be small by design—to serve a special needs population).

Consider some numbers. Here in Brevard County, around 10,000 people called the 211 hotline last year seeking housing help. Only $900,000 flows into Brevard County annually for direct homeless services. That’s like $90 per household. Casting a wide net with such a small pie doesn’t add up.

Then you have concern over the efficiency of that money. Traditionally, the money is spread across a number of service providers that loosely collaborate. Everyone that receives an allocation takes an admin cut and employs separate intake staff. And they all face pressure to market themselves independently—competing against one another for limited local dollars, which creates silos and political divisions.

Next you have concern over how success is measured. In a system like this, it’s all about program utilization: keeping the beds full, spending down the rent money. Everyone is so worried about hitting their utilization targets—that’s why casting a wide net seems to make sense—it seems easier to hit your numbers so you stay funded. But is success being defined in the right way?

In summary, the status quo is keeping the service providers busy and their beds filled, but homelessness in communities across the country (including Florida and Brevard) is increasing. While other systems do contribute to the problem, the homeless system is not doing its part—because it’s not serving those that are living on the street—a special population. Furthermore, the homeless system isn’t big enough — by design — to cast a wide net and serve the general population (and it can’t be asked to compensate for problems created by other, much larger systems).

The Shift to Targeted and Highly Coordinated Service #

So change is happening to relieve these pressures, and for the most part it’s being driven top-down by the largest funders versus bottom-up. Communities that don’t adapt will receive less funding over time, while those that do will see more matched to the need (so long as the need is accurately defined within the accepted scope of the maturing homeless system).

One of the biggest shifts is from program silos to coordinated service that is highly targeted in nature. This shift has been ongoing for several years, but is now accelerating to the point where communities will lose funding if they don’t adapt. Some service providers won’t care enough to change—perhaps they are satisfied with the charitable giving they already receive—but they are likely to decline over time.

A modern system is coordinated. Key to coordination is having a common “brain” — or lead — that provides the structure by which a diverse set of service providers in the community can work together. With the lead facilitating, providers work out what programs they will offer for what target populations and plug in.

Providers then get out of the intake business and rely on the system for all referrals. They now focus squarely on delivering high-performing programs that serve a targeted need and the system handles all the matching.

Generally, the system has a designated fundraising arm that raises most of the core service money from federal, state, and local stakeholders. Providers receive allocations based on the roles they play and their performance to standard.

This is a system-centric design instead of a program-centric one. Now, citizens claiming to be homeless can’t show up at a provider’s door and angle their way into a particular program—they go through centralized intake first. Intake will focus on empowering self-resolution whenever possible, and only those with special needs verified to be stuck on the street without self-resolution options will be referred.

Success is measured differently, too. Before, it was all about program utilization. Now it’s about system health measured by three key metrics: 1. length of homelessness, 2. flow out of homelessness, and 3. returns to homelessness. A healthy system is one where the time people spend homeless in the community is decreasing, people are positively exiting homelessness at an efficient rate, and most people aren’t coming back.

Other characteristics of a modern system include: it’s standardized, voluntary, person-centered, and community-based—all characteristics of the “Housing First” service philosophy.

Let’s look at an example of such a highly coordinated system in motion.

An Example of a Modern Homeless System #

It starts with establishing a baseline. The lead organizes a population survey to baseline the size, demographics, and needs of the community’s homeless population. The survey is conducted strategically, by establishing survey centers at places where homeless persons frequent (for example, the local meal center).

Surveys are then conducted over a week long period. The centers also integrate street outreach services so those that are not service connected aren’t missed.

The survey results provide insight such as:

  1. How many single adults, families, and youth are homeless in the community
  2. How long they’ve been homeless
  3. What % are sheltered vs. unsheltered
  4. What % are homeless with a disability or have serious health problems

For example, in the Melbourne Florida area the results look like this:

Of the 150 single adults:

Of the 40 families:

Of the 10 youth:

The results provide a baseline that inform program allocations. How does that work?

With the lead facilitating, the participating service providers first inventory their “projects”. A project is an implementation of a program standard that serves a target homeless population. For example, the South Brevard Sharing Center has a project called “Street to Home” that is a scattered-site implementation of the Permanent Supportive Housing (“PSH”) program standard targeting households with disabilities and high service needs experiencing chronic patterns of unsheltered homelessness.

For each project, providers register the capacity they have. A unit of capacity is called a “spot”. An available spot is a program opening. For example, Street to Home has 60 total spots, and of those, 10 might be available while 50 are taken.

To ensure appropriate matching and service, the community defines baseline targeting, prioritization, and delivery criteria for each program standard. For example, the PSH standard (and by extension, all PSH projects) may adopt the following:

Baseline Targeting Criteria:

  1. Households that are homeless with a disability and have high service needs.

Prioritization Criteria:

Delivery Criteria:

  1. Move-in completed within 30 days following project enrollment.
  2. Permanent housing unit with a standard rental lease and permanent rent affordability subsidy.
  3. Voluntary community-based supportive services that adhere to Housing First standards.
  4. Long-term housing stability benchmark of 80%.

Let’s summarize the example criteria above:

In terms of overall targeting, PSH would be reserved for households in the community that have been formally documented as homeless with a disability having high service needs. Able-bodied households or those having low service needs would not be prioritized for the PSH program.

To determine relative priority, households targeted for PSH would be matched to one of six groups. The groups are ordered by their community priority–group 1 is higher priority than group 2 and so on.

Individual PSH projects elect to serve one or more of the groups. Street to Home serves groups 1, 2, and 3, for example. So when someone is prioritized in group 1, Street to Home would offer that person a spot before someone in group 2 or 3.

In this example, highest priority is reserved for households with disabilities having the longest histories of homelessness and most severe service needs, consistent with federal guidance on PSH prioritization. An example of “severe service needs” would be frequent emergency room utilization due to chronic health problems such as untreated disease, mental illness and/or substance use dependency.

The community may design specialized projects to further target specific subgroups. Consider a “Behavioral Health” PSH project targeting single adults under the age of 62 with serious mental illnesses. Such a project might offer spots to individuals meeting the criteria from groups 1 and 4.

Another example of targeting would be a PSH project serving homeless families with minor children that have disabilities and high service needs where family unification is supported by the child welfare system. CSH outlines a standard for such a program called One Roof. In this example, such a project might serve groups 4, 5, and 6.

Providers may specialize or implement more than one program standard to serve different target populations. For example, Carrfour Inc. is a leading provider of supportive housing in a congregate setting (50% of the apartments in their communities are typically set-aside for formerly homeless households). By registering spots in different programs, Carrfour may serve multiple targeted needs and design for community diversity (mixing lesser-need transitionally homeless with greater-need chronically homeless in the same community, for example).

No project in any program may screen out prioritized applicants in a discriminatory manner or introduce arbitrary barriers to enrollment.

The need baseline helps the community set capacity targets for the different programs and their priority groups. This is important, as the need often exceeds capacity. For example, if an overweight number of chronically homeless individuals reside in the community, more PSH spots may need to be dedicated to groups 1, 2, and 3 to balance that out. If the current mix of providers can’t accommodate that, then reallocation and/or opportunities for expanding PSH capacity may need to be evaluated.

In general, a greater number of chronically homeless in conjunction with a lesser number of PSH spots may suggest that the lower priority groups may be better served by PSH program alternatives such as Rapid Re-Housing (“RRH”), Diversion/Prevention, or mainstream resources. Creative innovations such as RRH projects that facilitate co-living among two households on fixed disability incomes may be an important alternative for making the most of limited PSH resources, for example.

Households should not be prioritized when there is no capacity to serve, and households that do end up on a priority list past 60 days without being offered a spot should be flagged for problem-solving (Basically, each household should have the right to know what group they’re in and what happens if they don’t get matched after a period of time).

To assess progress, the community has access to system performance dashboards and gets together every quarter to six months to evaluate system health trends and reallocation opportunities. Population survey baselines are also updated at that time.

In summary, with the lead facilitating, the community decides which programs it needs and the targeting, prioritization, and delivery criteria for each. Providers then create program implementations called projects. They register their capacity and prepare for referrals. Finally, they deliver service and evaluate performance together.

All of this work is informed by the population baseline—it is true coordination informed by data. Instead of the “Wild West”, everyone is now rowing together in the same direction.

Summing Up #

The homeless system is small by design—it exists to serve a special needs population that has fallen through the cracks. But traditional systems cast a wide net, so their impact is diluted. Modern systems are coordinated, so their impact is targeted. A targeted impact is more likely to lead to a decrease in homelessness. Other social support systems do contribute to the problem, but those systems should be reformed—the homeless system should not be asked to do more than it is designed.

Put yourself in the shoes of a homeless system administrator—you oversee one million dollars in program funding annually to address the problem. Will you allocate $100 to 10,000 people with housing problems, or will you allocate $10,000 to 100 people that have been living on the street for years, while at the same time, influencing broader change in affordable housing, health and human services, finance, labor, and criminal justice? Which will have the greater impact?
—KD

 
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