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A'Unified'Housing'&''Homelessness'System'

A"Person)Centered"Approach"to"End"Homelessness"–""

Making"it"Work"

'OrgCode(Consul-ng,(Inc.(

Tracy(Flaherty8Willmo<(

Senior(Associate(

(

1.  The&opportunity&

2.  What&is&in&and&out&of&scope&

3.  Who&we&aim&to&serve,&why&&&how&

4.  Examples&of&models&

&

5.  Designing&Your&System&

6.  Service&Delivery&Targets&

7.  Adjourn&

What'We'Need'from'You'•  SoluBon#focused'parBcipaBon.'

•  Focus'on'soluBons,'not'barriers.'

•  Stretch'your'thinking'and'perspecBves.'

•  A'focus'on'facts'and'evidence.'

•  Accelerated'decision#making.'

•  The'ability'to'champion'the'proposed'soluBon'aLer'today.'

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In'Scope'•  Your'experience.'

•  Your'ideas'on'soluBons.'

•  Persons'and'families'that'are'homeless'and'have'the'greatest'needs'are'served'first.'

•  System'focuses'on'the'shortest'path'from'homelessness'to'housed'and'increased'stability.'

Out'of'Scope'•  Overhaul'of'external'systems.'

•  Advocacy'for'policy'or'funding'changes.'

•  Excuses'for'what'cannot'be'done.'

•  Opinions'not'grounded'in'fact'or'evidence.'

•  Persons'that'do'not'meet'the'parameters'of'the'populaBon'targeted'for'the'intervenBon.'

Why'Implement'A'Unified'System?'

•  Most'efficient'use'of'finite'resources'

•  Improves'consumer'access'to'housing'and'supports'

•  Improves'system'navigaBon'&'funcBon'

•  Leverages'the'strengths'of'individual'service'providers'

•  Proven'to'shorten'pathway'from'homeless'to'housed'with'supports'

•  An'important'element'in'ending'homelessness'

Person#Centered'vs.'System#Centered'

• A'person#centered'approach:'•  Tries'to'figure'out'the'best'way'to'care'for'the'person’s'needs,'

holisBcally,'and'without'judgment;'

•  A\empts'to'modify'behaviour'through'reasoning'and'access'to'most'appropriate'programs.'

• A'system#centered'approach:'

•  Tries'to'figure'out'how'to'determine'individual'system'responsibility'or'co#responsibility'across'silos;'

•  Works'to'reduce'costs'and'duplicaBon;'

•  A\empts'to'modify'behaviour'through'retribuBon'or'reciprocity.'

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Keep

the

people youserve

at

the

centerof

performance

Comprehensive'Coordinated'System'

•  System'Principles'

•  Coordinated'Access'&'Diversion'

•  Comprehensive'Assessment'

•  Service'PrioriBzaBon'

•  Formalized'Service'Pathways'

•  Accountability'&'Transparency'

Our Focus•  The point is not prettier, the point is better

•  A system that matches the needs of consumers, not the needs of providers

•  Providers that can work together toward a well-defined, common goal

•  A process that makes it easier to get shelter, ancillary services & reach housing

Principles'•  The$fundamental$beliefs$of$our$system.$

•  Serve$as$the$founda6on$for$the$behavior$of$our$service$delivery$and$chain$of$reasoning.$

•  Inform$our$ethics$and$standards$of$service.$

•  Allows$us$to$formulate$opinions$on$“rights”$and$“wrongs”$in$how$we$deliver$services$when$made$transparent.$

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Food'For'Thought:'Homeless'PopulaBons'

•  Diversity:'

•  Age'

•  Gender'

•  Length'of'Bme'homeless'

•  Number'of'Bmes'homeless'

•  Acuity'of'needs'

•  Household'composiBon'

•  Where'staying'(sheltered,'unsheltered,'etc.)'

Food'for'Thought:'Housing'SoluBons'

•  Housing'is'the'only'known'soluBon'to'homelessness.'

•  People'do'be\er'in'housing'and'stay'housed'longer'when'they'have'choice,'not'placement.'

•  There'is'more'than'one'housing'soluBon.'

Food'for'Thought:'Use'of'Evidence'&'Data'to''

Guide'and'Monitor'

•  Across'the'world,'communiBes'with'reducBons'in'homelessness'have'insisted'on'using'data'to'guide'and'inform'decisions.'

•  Many'Bmes,'what'we'think'and'what'we'know'are'different'things.'

•  CorrecBve'acBon'comes'from'monitoring.'

Food'for'Thought:'Conflicts'&'Grievances'•  Even with thoughtful planning, human

behavior and circumstance are such that things don’t always go as planned.

•  Formal processes for addressing and redressing issues results in better commitment to process and better results.

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Food'for'Thought:'OrganizaBon'of'Service,'Service'Access,'and'Different'Approaches'to'Services'

•  Even'when'driving'services'through'evidence,'there'is'not'a'“one'size'fits'all”'approach.'

•  Transparency'in'how'to'access'services'and'eligibility'improves'results.'

•  Different'approaches'to'services'is'not'acceptance'of'poor'services'or'ineffecBve'service.'

Our'First'Goal'

•  To'have'agreed'upon,'defensible'principles'to'inform'the'homeless'service'delivery'system'in'your'community.'

Example:'Kansas'City,'Missouri'

1.  Diverse'individuals'and'families'require'diverse'soluBons'for'their'homelessness,'based'upon'assessed'needs.'

2.  We'believe'in'evidence#based'housing'soluBons'that'are'provided'through'informed'choice'and'assessed'needs.'

3.  We'are'commi\ed'to'using'local'data'to'drive'an'evidence#informed'housing'response'system.'

4.  A'respecjul'and'supporBve'conflict#resoluBon'and'grievance'process'will'be'applied.'It'is'credible,'transparent'and'universal.'It'applies'to'both'agencies'and'service'recipients.''

5.  Coordinated'assessment'will'occur,'linked'to'informaBon'on'availability'and'referral'across'the'whole'community'in'a'clear'and'transparent'manner,'leveraging'the'strengths'of'each'service'provider,'while'concurrently'informing'gaps'in'the'system'and'opportuniBes'for'future'strategic'investment.'

6.  We'believe'in'data'driven'assessment'and'decisions'to'direct'our'resources'to'those'people'with'the'greatest'vulnerability'or'most'complex'needs.'

Service in the person centered system

Step'2:''

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• Centralized'versus'Decentralized'• PrevenBon'&'Diversion'• Shelter'Referral,'If'Necessary'

• Evidence'Informed,'Validated'Tools'• Triage'versus'Assessment'

• Transparency'of'Program'Criteria,'Target'PopulaBons,'Outputs'

• Service'PrioriBzaBon'Process'• Client'NoBficaBon'&'Consent'

• Real'Time'Data'• Monitor'Governance,'Processes,'Outcomes,'Priority'Lists,'CommunicaBon'

Models'of'Coordinated'Access'

!  Centralized(!  Physically/Geographically'!  “211”'type'System'!  Centralized'Mobile'Team'!  Lead'service'prioriBzaBon'process'!  OLen'easier'for'smaller'

communiBes'or'ciBes'with'good'transportaBon'

!  Consistency'&'efficiency'easily'gained'

!  Decentralized(!  MulBple'LocaBons/Regional'

Hubs'!  “No'Wrong'Door”'Approach'!  Supervision'is'normally'locaBon#

specific'!  CollaboraBve'approach'needed'

for'monitoring'standards'of'care'and'service'prioriBzaBon'

!  OLen'idenBfied'as'opBmal'in'larger'geographical'areas'with'insufficient'transportaBon'

Think in Terms of Sectors of Service and the Roles and Functions of Each Sector in Ending

Homelessness

Sector 1: Diversion

Sector 2: Connecting to Permanent Solutions

Sector 3: Ancillary Services

Sector 4: Housing & Supports

Ending Homelessness

Diversion

Coordinated Access Shelter: DV

& Homeless

Outreach & In-reach

Drop-ins & Day

Centers

Employment & Education

Furniture

Housing Locator

Congregate PSH

Scattered Site ICM

Scattered Site ACT

Rapid Re-Housing

Transitional

Substance Treatment,

Health & Mental Health

Transportation

Conflict with the

Law

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Non-Negotiable Elements of a System Approach to Ending

Homelessness

•  'What'service'providers'say'they'do'on'paper'is'what'they'do'in'pracBce.'No'excepBons.'

'•  'Access'to'PSH'is'centralized.'No'secondary'assessments.'

•  'As'many'rules/barriers/compliance'requirements'that'can'be'eliminated'are'eliminated.'

'•  'People'are'people.'Not'a'number.'Not'a'conclusion'of'an'assessment.''

•  'CoordinaBon'and'assessment'inform'choices'that'people'can'make,'not'make'choices'for'people.''

•  Operates'with'transparent'decision#making'process.'Not'dependent'on'case'manager'knowing'how'to'skirt'around'the'system.'

Ensure'the'FoundaBon'is'Strong'with'Solid'

ImplementaBon'of'the'Basics'

• 'Consistent'tools'and'referral'procedures'''• 'Wri\en'procedures'explaining'how'and'why'people'are'referred/prioriBzed'''• 'No'side'doors'''• 'Provider,'funder,'and'consumer'understanding'of'the'point'of'the'process'''• 'Consistent'HMIS'or'data'tool'usage…how'to'share'data'

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Examples of models.

Kansas City 2014

Medicine Hat, Alberta

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System'Design'•  Discussion'Groups'

•  Select'a'Facilitator'&'Recorder'

•  Topics:'

•  Coordinated'Access'

•  Assessment'

•  Service'PrioriBzaBon'&'Matching'

•  ConnecBvity'to'Other'Systems'

•  Accountability'#'Data,'Indicators,'Outputs'&'Outcomes'

Assignment'#1'#'Access'

•  Considering'your'own'experience'and'experBse,'and'the'informaBon'and'models'presented'today,'in'five'sentences'or'less,'describe'how'the'current'approach'can'be'improved.'

•  Is'diversion'pracBced'uniformly?'By'whom?'How'can'it'be'coordinated'effecBvely?'

•  You'may'want'to'think'about:'phone'versus'in#person'opBons;'target'versus'catch#all;'centralized'versus'decentralized;'integraBon'or'non#integraBon'with'other'systems;'mobile'versus'place#based;'etc.'

Assignment'#2'#'Assessment'

•  In'three'sentences'or'less,'describe'how'the'current'approach'to'assessment'can'be'improved.'

•  Who'should'complete'Triage?'

•  Who'should'complete'Assessment?'

•  How'are'assessment'results'shared,'with'whom'and'why?'

Assignment'#3'–'Service'PrioriBzaBon'&'Matching'

•  In'three'sentences'or'less,'describe'how'individuals/families'connect'with'the'best'program'to'end'their'homelessness'quickly'and'permanently.'

•  How'do'programs'engage'with'service'prioriBzaBon?'

•  How'is'availability'of'openings'and'units'maintained'and'reported?'

•  What'informaBon'would'be'needed'from'programs/agencies'to'do'Service'PrioriBzaBon'&'Matching'properly?'

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Assignment'#4'–'Service'Referrals'

•  In'3'sentences'or'less,'describe'how'service'referrals'could'be'made.'

•  Would'these'happen'electronically?'

•  What'should'the'process'and'guidelines'be'for'agencies'to'decline'referrals?'

Step'3:'Map'Out'the'System'

•  How'to'make'what'you'have'work;'not'a'dream.'

•  SoluBon#focused,'not'excuses.'

•  Create'from'the'experience'of'the'end'user.'

•  Turn'it'into'a'graphic'and'socialize'this'in'the'community.'

'

Service'Delivery'Targets'•  ExpectaBons'are'based'on'service'being'

delivered'

•  Main'currents'of'thoughts'and'pracBce'inform'the'expectaBons'

•  Not'a'dream,'nor'an'aspiraBon'

•  Funding'should'be'linked'to'expectaBons'and'achieving'outcomes'associated.'

Diversion(

Problem'Statement'

Individuals/families'that'have'safe'and'appropriate'alternaBves'to'homeless'services,'including'shelters,'should'be'supported'in'achieving'those'alternaBves.'

Service'Delivery'Model'

#  Safety'determinaBon'# Understanding'of'previous'night’s'locaBon'of'stay'# Return'if'safe'and'appropriate'to'do'so'# AlternaBve'locaBons'that'may'be'safer'or'more'appropriate'# Underlying'presenBng'issues'# Housing'plan'upon'entry'to'services'if'no'alternaBves'

Indicators'

#'of'households'presenBng'for'services'#'of'households'where'diversion'is'implemented'#'and'%'of'households'iniBally'diverted'that'subsequently'return'for'future'diversion'#'and'%'of'households'iniBally'diverted'that'subsequently'return'and'enter'into'homeless'services'system'

Intended'Outcomes'

#'30%'of'households'seeking'homeless'services'can'have'their'needs'safely'and'appropriately'met'through'other'means'

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Coordinated(Access(

Problem'Statement'

Without'coordinaBon'across'programs'and'organizaBons'at'a'system'level,'the'individual/family'gevng'to'the'right'service'to'address'his/her'needs'is'difficult'and'inefficient,'enhances'trauma'and'may'inadvertently'prolong'homelessness.''

Service'Delivery'Model'

#  Common'assessment'tool'across'all'types'of'services'#  Decentralized'or'centralized'approach'to'being'assessed'#'walk#in'and'phone'based'

#  Typologies'and'prioriBes'established'based'upon'acuity,'not'first'come,'first'served'

#  Safety'screening'put'in'place'#  Assessment'follows'the'person'without'unnecessary'secondary'assessments'

Indicators'#'of'households'idenBfied'as'higher'acuity,'moderate'acuity,'and'lower'acuity'#'of'households'assigned'to'programs'by'program'type'and'acuity'level'

Intended'Outcomes'

#  PrioriBzed'access'for'services'based'upon'acuity'level'#  Service'planning'based'upon'gaps'and'opportuniBes'in'system'emerging'from'assessment'data'

#  “Side'doors”'and'access'to'services'based'upon'feelings'of'readiness'are'eliminated'

Outreach(&(In8Reach(

Problem'Statement'

Some'individuals/families'are'not'connected'to'services'or'are'not'connected'in'such'a'manner'that'it'is'ending'her/his'homelessness.''

Service'Delivery'Model'

# Geographically'based'with'set'hours'of'services'# By'name'registry'of'people'being'sought'for'engagement'# Housing'soluBon'is'primary'purpose'of'engagement'# No'coercion'or'threats'# Acuity'determined'“in'the'field”'

Indicators'

#'of'households'idenBfied'as'higher'acuity'#'of'higher'acute'households'accessing'shelter'#'of'higher'acute'households'accessing'housing'#'and'%'of'higher'acute'households'that'return'to'homelessness'

Intended'Outcomes'

# Decreased'acuity'#  80%'remain'housed'and'do'not'return'to'homelessness'

Shelter(

Problem'Statement'

Individuals/families'experiencing'homelessness'require'safe'and'appropriate'overnight'shelter.'''

Service'Delivery'Model'

#  Safety'assessment'#  Provision'of'basic'material'needs'(bedding,'hygiene,'food)'# AddiBonal'services'may'be'provided'so'long'as'they'do'not'incenBvize'homelessness''

Indicators'

#'of'households'accessing'shelter'Average'length'of'stay'by'type'of'household'#'and'%'of'households'experiencing'recidivism'Acuity'range'of'those'staying'longer'than'14'days'Average'number'of'homelessness'episodes'per'person'within'last'three'years'Average'cumulaBve'duraBon'of'homelessness'

Intended'Outcomes'

#  Year'over'year'decreased'length'of'stay'#  Year'over'year'improved'rates'of'recidivism'(less'returns'to'homelessness)'#  Year'over'year'decrease'in'cumulaBve'duraBon'of'homelessness'

Rapid(Re8Housing(

Problem'Statement'

Individuals/families'with'moderately'acute'needs'require'case'management'supports'to'assist'with'housing'and'life'stability,'otherwise'will'cycle'in'and'out'of'homelessness.''

Service'Delivery'Model'

#'No'mandatory'program'prerequisites'#'ParBcipaBon'based'upon'consent'and'acuity'#'Home'based'case'management'#'Each'case'manager'has'their'own'case'load'#'Moderate'level'acuity'results'in'focused'a\enBon'on'2#3'primary'issues'#'Case'management'supports'usually'for'3#6'months'

Indicators'

#'of'people'housed'#'of'families'housed'%'that'remain'housed'at'6'months'#'and'%'of'unknown'and'unsuccessful'exits'

Intended'Outcomes'

#'Decreased'acuity'#'Improved'quality'of'life'#'85%'remain'housed'throughout'duraBon'of'support'

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Sca<ered(Site(Intensive(Case(Management(

Problem'Statement'

Individuals/families'with'higher'acute'may'benefit'from'intensive'case'management'supports'to'assist'with'housing'and'life'stability'while'integraBng'into'community,'otherwise'will'cycle'in'and'out'of'homelessness.''

Service'Delivery'Model'

#'ParBcipaBon'based'upon'higher'acuity'and'more'complex,'co#occurring,'intensive'issues'#'Home'based'case'management'#'Brokering'and'advocacy'to'community'resources'#'Case'management'supports'are'permanent'

Indicators'#'of'people'housed'%'that'remain'housed'at'6'months'and'12'months'#'and'%'of'unknown'and'unsuccessful'exits'

Intended'Outcomes'

#'Decreased'acuity'#'Improved'quality'of'life'#'80%'remain'housed'

Permanent(Suppor-ve(Housing(Congregate(

Problem'Statement'

Individuals/families'with'higher'acute'may'benefit'from'intensive'case'management'supports'available'on#site'24/7'to'assist'with'housing'and'life'stability,'otherwise'will'cycle'in'and'out'of'homelessness.''

Service'Delivery'Model'

#'24/7'on#site'supports'#'ParBcipaBon'based'upon'higher'acuity'and'more'complex,'co#occurring,'intensive'issues'#'Home'based'case'management'#'Advanced,'specialized'access'to'supports'such'as'mental'wellness,'physical'wellness'#'Case'management'supports'are'permanent'

Indicators'#'of'people'housed'%'that'remain'housed'at'6'months'#'and'%'of'unknown'and'unsuccessful'exits'

Intended'Outcomes'

#'Decreased'acuity'#'Improved'quality'of'life'#'80%'remain'housed'

Avoid'Common'Mistakes'

•  CreaBng'an'approach'that'simply'reinforces'the'system'you'already'have'to'make'it'easier'for'providers.'

•  Using'amount'of'income'as'an'assessment'element.'

•  Using'presence'of'mental'illness,'substance'use'or'physical'illness'as'a'decision'element'in'diversion'a\empts.'

•  Using'“gut'feelings”'instead'of'assessment'or'as'an'over#ride'to'assessment.'

•  A\empBng'to'assess'for'housing'readiness.'

•  Assessing'for'the'sake'of'assessing.'

•  Assessment'quesBons'with'no'relevance'to'housing'stability.'

•  Lack'of'rapid'through#put'to'housing.'

•  AddiBonal'assessments'(oLen'mulBple'addiBonal'assessments)'to'be'enrolled'in'programs/'get'supports'once'housed'or'while'in'shelter.)'

“Embrace'the'Freak'Out”'#'Myths'to'Debunk'

•  “Who'do'they'think'they'are?”''I'will'lose'control'of'who'enters'my'program'

•  I'can'just'take'referrals'from'the'central'intake'process'when'I'am'unable'to'self#select'candidates'

•  My'staff'members'know'what'to'look'for'–'those'staff'won’t'screen'like'we'do'

•  I'won’t'conBnue'to'receive'referrals'and'funding'will'be'jeopardized'

•  I'will'get'all'the'clients'that'are'unsuccessful'or'rejected'by'others'

•  I'need'to'collect'data'regarding'the'number'of'people'requesBng'services'to'demonstrate'need'

•  The'community'knows'what'we'do'and'it'would'cause'too'much'confusion'if'we'stopped'taking'calls'and'referrals'directly'

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CreaBng'Awesomeness'into'the'Future'

If'you'do'this'right:'

•  Service'ParBcipants'will'be'at'the'center'of'ALL'your'deliberaBons'

•  What'will'your'system'look'like'in'6'months;'18'months;'36'months'from'now?'

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