Strategies for Integrating Homeless& Mainstream Systems

Presenters

• Danielle Wildkress, HomeBase• Piper Ehlen, HomeBase• Wendy Vaulton, Family Homelessnesss• Cindy Ward, Department of Human Services• Sherrie Downing, Montana

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Learning Objectives

Participants will learn about and understand…A. Core Concepts of Mainstreaming and Systems

ChangeB. Steps to Changing a SystemC. Levels of Coordination

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A. Core Concepts of Mainstreamingand Systems Change

• Improve coordination of resources– move awayfrom silos and towards maximizing resources

• Improve access to mainstream resources– helpmore people receive benefits

• Access and utilize “non-homeless-targeted”resources to support our work• E.g. Medicaid, TANF block grants, CDBG

• Integrated systems of care– funding and servicesare delivered seamlessly

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Improved Access for ClientsSOAR: SSI/SSDI Outreach Access Recovery

A classic example of improving mainstream access• Helps homeless clients w/ MH, AOD or COD access

disability benefits• Improves coordination between Social Security

Administration (SSA), Disability DeterminationServices (DDS), hospitals, mental health clinics, andhomeless service providers

• Improves quality of case management work• Provides a new framework for compiling a disability

claim• Brings “non-homeless targeted” resources to clients

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Improved Access to FundingMedicaid

A classic example of accessing mainstream system tofund homeless services

• Many supportive services (health, case management,and others) provided to supportive housing tenantscan qualify for Medicaid reimbursement• Warning: Medicaid varies widely between states

• Certification requirements are jurisdiction specific• Some are easier, others more complicated

• Once certified, a homeless service provider has areliable mainstream source of funding to support itswork with eligible clients

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Systems Change

“The key to successfully addressing and eliminatinghomelessness lies in substantive system change atthe community level, which is only possible to theextent that all entities involved work in concert toeliminate access barriers and create seamless localservice systems.”

* Strategies for Improving Homeless People’s Access to MainstreamBenefits and Services, March 2010

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Barriers to Mainstreaming• Access Barriers– obstacles that prevent an eligible

person from getting available benefits• E.g. where programs are located, how they are

organized, what they require of applicants• Resource Shortages– inadequacy of available

resources; funding may be finite or capped• Eligibility Block– program’s criteria for who may

receive benefit as well as time limits on receipt• Many eligibility restrictions are federal policy and

hard to influence at the local level

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Tools to Reduce Barriers

• Address problems at the street level– E.g. provide transportation; conduct outreach to streets;

co-locate mainstream eligibility workers in homelessassistance programs; provide multilingual services;improve communications among homeless assistanceworkers and mainstream agency eligibility workers

• Alter policies/practices regarding eligibility for benefits– E.g. establish a priority for homeless households

• Increase overall capacity thru additional resources• Raise funds from state or local sources• Allocate other federal funding

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Applying Lessons Learned:Alameda Pre-Release Agreement

• Alameda County Social Services Agency found thatmany people on General Assistance (GA) were recentlyreleased from the local jail (Santa Rita) withoutconnection to benefits

• Social Services suspected many were eligible forSSI/SSDI

• SSI/SSDI would decrease County’s GA costs andincrease income for citizens upon release

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Alameda Pre-Release Agreementcontinued…• Alameda County implemented a Pre-Release Agreement

between Santa Rita County jail and SSA• Upon discharge, approved applicants can receive SSI/SSDI

immediately• Effort complimented the larger SSI/SSDI redesign process

happening in the County

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Why use the Alameda example?

• Combines two types of “mainstreaming”• Uses all 3 strategies to overcome structural barriers

• Reduce structural barriers– developed a method toscreen inmates and collect records to support asuccessful SSI/SSDI application prior to dischargefrom jail

• Alter policies– SSA implemented a new policy (at thelocal level) of accepting applications while a person isincarcerated

• Increase capacity– expanded county SSI/SSDIadvocacy dollars to pay for an advocate at the jail

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B. Steps to Changing a System

1. Form a Workgroup2. Identify Barriers and Solutions3. Engage Stakeholders4. Develop a Plan5. Data Tracking

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For Today

• Choose a system that you want to “transform”• It should be a real system or agency that you work with

(or around) back home• You will use your chosen system in all of the exercises

this afternoon

My Example: Alameda

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1. Form a Workgroup

• Who is already at your table and willing to strategize?– Providers– Government administrators– Agency representatives (i.e. the local SSA office)Task• List the specific people in your workgroup (i.e.

people whose participation you can count on)• Identify anyone whose contact information you

need

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The Alameda Workgroup

When I started, the Alameda workgroup list was small. Itincluded…

• Alameda County Social Service Agency– Agency responsible for administering GA

• Alameda County SSI/SSDI advocates– Group of providers including the Homeless Action

Center (HAC)

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2. Identify Barriers and Solutions

• Start with what you know• Design a system map• List gaps and barriers• Brainstorm some solutions to the barriers• Develop a list of stakeholders needed to implement your

solutions

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What do you know about your system?

TASK: Make a list of the players, issues, and researchthat might be relevant– Who already works on the issue either directly or

indirectly?– What resources are already being used, even if

being used inefficiently?– What has worked in other similar systems?

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What We Knew in Alameda

• Suspected many GA recipients were recentlyincarcerated at Santa Rita jail

• Due to budget shortfalls, County was redesigningSSI/SSDI advocacy to transition people from GA toSSI/SSDI

• State had entered into a Pre-Release Agreement• People with co-occurring disorders tend to cost

systems more• Workgroup did not know current jail system, but did

know how an improved system would look

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What are the barriers in your system?

TASK:• List one key barrier in the current system• What is a potential solution to this issue?

As you start to develop a list of barriers and solutions,create a system map– either the current system, anideal system, or both

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Common Barriers to Mainstream Resources

• Complex/ arduous application procedures• Obtaining full medical records and disability documentation• Documentation requirements• Denials of claims for incomplete applications• Frequent client relocation, and difficulty finding clients• Criminal history• Eligibility workers lack knowledge/training due to high

turnover rates• Eligibility workers lack homeless cultural competency• Lack of transportation to and from benefits offices

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Common Solutions

• Facilitate communication with mainstream agency• Help gather required documentation and information• Complete applications with clients• Provide a place to store documents during application

process• Make appointment for client at benefit office• Provide transportation to/from benefit office• Coordinate monthly enrollment nights at shelters,

drop-in centers, or other service agencies• Form a workgroup of policymakers, providers and CoC

members to resolve system-wide barriers

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Alameda Barriers and SolutionsBarrier: Inmates are not screened for benefit eligibilitySolution: Work with jail staff to screen inmates for SSDI-related disabilities,

including a better system for collecting medical and MH records* Reduce structural barriers

Barrier: Inmates cannot file for SSI/SSDI while incarceratedSolution: Enter into a Pre-Release Agreement with the local SSA office

* Alter policies

Barrier: No one available to help inmates complete SSI/SSDI applicationSolution: County dollars for case managers to complete applications at jail

* Increase capacity

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The Alameda System Map

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3. Engage Stakeholders• Build on existing relationships

• Create talking points that emphasize benefits to eachstakeholder’s agency and cross-educate people

• Be prepared to jump through hoops. You may not findthe “right” person immediately

• Anticipate different agency cultures; creating acommon understanding and language takes time

• Follow up and be consistent. Show that you are agood partner

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What stakeholders do you need to invite tothe table?TASK: Create a list of stakeholders to implement draft planA few ideas:• Local office of a federal agency– SSA, VA, DOE, DOL, etc.• State, County, or City government social service agencies• Political officials or their aides• Mental health departments• Hospitals– primary care as well as psychiatric• Criminal justice including jails, prisons, courts• GA and other local aid offices• Homeless service providers• Formerly or currently homeless representatives

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Alameda Stakeholders

• SSA representative• DDS representative• Leadership of the jail• Mental health services at the jail• Physical health services at the jail• Inmate services at the jail• Chaplaincy

(This was in addition to the County Social ServicesAgency and the HAC– the original workgroup.)

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Good Talking Points

• Focus on the expense of the services (e.g., ER visits)and how better access to a benefit (e.g., Medicaid)could save the agency (e.g., a hospital) money

• Acknowledge that their staff is overworked• By coordinating you can make the system better for

everyone• Offer to provide case managers to assist with

applications and/or act as liaisons• Offer cultural competency training to staff• Use case studies

• Some from this workshop!

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What’s in it for me?

TASK: Develop a list of potential talking points

Talking points should…• Emphasize cost-savings and outcomes, not

“heartstrings”• Be framed as an opportunity to partner, not a blame

game• Illustrate that you are bringing resources to the table,

not demanding that an agency do new or more work• Include best practice examples to show that the work

can be done

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Alameda Talking Points

• A Pre-Release Agreement could reduce recidivism• SSI/SSDI benefits provide income for housing• Housing is key to ending cycle of homelessness and incarceration

• Reducing recidivism will save money (and it is the right thing to do!)

• There is overlap between people on GA and those in jail• If we work together to connect people to benefits, both systems win

• Our case managers are trained in SOAR and we are willing todevote staff to assisting jail inmates

• California Dept of Corrections entered into an agreement with SSA• This is the “best practice,” and we can do it, too

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4. Develop a Plan

• The plan is likely to be a work in progress• As you develop a strategy, “new” barriers will be identified

• Don’t worry, new solutions will be identified, too• Include a timeline• Set specific goals

• Some short term and some long term• Name individuals, not just agencies, as responsible for

tasks• Include data tracking that is comprehensive and realistic• Meet regularly

• Monitor progress and keep the momentum going

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Keys to Successful Partnerships

• Create clear outlines of each party’s roles/responsibilities• Outline/timeline should be detailed and specific, but not

excessive in content• Establish specific points of contact within organizations• Keep written notes during meetings• Review action steps as a group at the end of each meeting

• Ensures each person knows what s/he should do andwhen that task should be completed

• Make all contact information current and readily available• Create a follow-up system to ensure established goal is

sufficient• Be patient but persistent!

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The Alameda Plan

• Probation Dept (received basic SSI/SSDI training)refers 4 people/month

• Probation Dept refers inmates likely to be released in3 months and who have symptoms of a disability

• HAC and the Chaplaincy social worker (both SOARtrained) work to collect info about inmate’s medicaland MH history• Includes gathering records inside and outside the

jail, interviewing the inmate, and working with MHand medical professionals inside the jail

• HAC files SSI/SSDI application

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The Alameda Plan (cont.)

• Local SSA office prioritizes the jail applicants andtracks their outcomes

• Upon approval, SSA notifies inmate and HAC• Upon discharge, inmate presents discharge letter

(received from the jail) to SSA as proof that he/she isno longer incarcerated (and therefore eligible toreceive benefits)

• SSI/SSDI benefits become effective immediately

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5. Data Tracking

• Even though this is listed as the final step, you need tothink about data from the beginning

• Data entry points should be integrated into your planand system map

• Effectively measuring outcomes will be crucial toongoing support

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Steps to Creating a Tracking System

• Start with asking yourself what you will want to know• How will we know we are reaching our goals?

• Determine what data you will need to measure success• If possible, collect baseline data• Determine the best people and places in the system to

collect your data– be realistic!• Legacy and system-specific databases can be a barrier but

cannot be an excuse• At a minimum, databases can produce aggregate data• Use aggregate data to show system-level improvements

where client-level tracking in unavailable

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C. Levels of CoordinationKnow the 4 Cs

Mainstreaming requires systems change; systems changerequires partnering.

Four levels of interaction• Communication– people in different agencies talk to each

other and share information in a friendly, helpful way.• Coordination—staff from different agencies work together

on a case-by-case basis and may do cross-training• Collaboration– adds joint analysis, planning, and

accommodation to the base of communication andcoordination

• Coordinated community response– encompasses all ofthe essential agencies in communitywide collaboration withthe long-range goal of ending homelessness

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Integrated Homeless andMainstream Systems• Moving from silos to true integration takes time!• The 4 Cs are a continuum, you may move forward and

backwards• Alameda went from silos to coordination quickly, and

set an example for other systems in the community• For your project, think about where you are today and

where you want to be– not all projects require totalsystem integration

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Questions?

If you have any additional questions please contactDanielle Wildkress at danielle@homebaseccc.org