The 5 Essential and Sequential Elements
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In the fourth part of the series we look at the sequence of events that needs to occur for housing programs to be successful.
PART FOUR: The 5 Essential and Sequential Elements
Regardless of the presenting needs and complexity of issues, housing programs always function best when housing is the first task to focus on. Throughout my travels I have seen far too great an emphasis on trying to get a case plan in place prior to getting someone housed…or getting the client into treatment first…or getting the client compliant with medication first – and I could go on. It doesn’t matter if you are a fan of Housing First or not – what is critically clear through the evaluations we have performed and my years of professional practice is that housing has to be the first thing worked on or else the rest of the tasks are not going to be successful in helping people achieve housing stability.
So, here are the 5 Essential and Sequential Elements of Successful housing programs.
Focus on Housing Before Anything Else
Create an Individualized Service Plan
Increase Self Awareness
Support Achievements in Self Management
Allow the Client to Reframe/Rebuild One’s Life and Future
Now let’s look at the critical components of each one:
1. Focus on Housing Before Anything Else
We need to have a range of housing choices for people to consider. This will cover things like permanent supportive housing, scattered site market housing with supports, and perhaps things like well managed boarding homes or rooming houses or even secondary suites like basement apartments. After we have presented a range of choices and the client has selected a place and the lease is in place, the critical components for the housing to be successful (as a first step in a process) are:
Relationships – creating an environment of awareness about the relationships that the client has with others in their life and how those relationships may support or create conflict in keeping their housing. They may have family and friends that are supportive and healthy relationships that will make the reintegration process easier. On the other hand, they may have some pals from the street or shelter that they want to invite back to their place – maybe even offer them their floor or couch to sleep on. This may have deleterious consequences depending on how many of these folks we are talking about, behaviors and their relationship to the person we are supporting. We need to create the opportunity for meaningful conversation about relationships relative to maintaining housing.
Basic Needs – we never want someone to move into a place where the basic needs aren’t in place. On the day of the move in (and I stress “the day of” not “soon after”) the apartment should be furnished (preferably with furniture of the client’s choosing), there should be food in the cupboards and fridge and basic cleaning supplies should be in place. Meet these basic needs in the apartment and the client is going to be more inclined to stay in their place.
Supports – we should ensure that the client is aware of the supports available to them. In a lot of instances this is going to be a case manager of follow-up support worker of some kind. Regardless of the type of support, the client should know when and how to contact the person(s) who are providing support and what they can expect when they seek support. Given superintendents/landlords also play a support role to all tenants in their building, it is important than the client understand what the superintendent/landlord role is as well. We also need to distinguish crisis supports that may be available from case management and other types of less intensive supports that may be available.
Safety – all prospective places that people move into should be in habitable condition and be safe. Clients should have doors that they can lock to keep the world out if they so choose. They should also have windows that close so as to avoid intrusions that way as well. We want our clients to feel that their place is their home; that they can decide who they let into their home and who they keep out.
2. Create an Individualized Service Plan
AFTER the person is in housing is when the individualized service plan should be created (not before). My preference is to call it an individualized service plan rather than a case plan – but that’s just me. This is the document where the client outlines what they want to work on in partnership with their supports so that their housing remains stable. I don’t believe there is anything cookie cutter about these documents. I certainly don’t support a checklist type approach to pulling them together or putting in place predetermined/required goals that the client has never agreed to (SOAP BOX MOMENT – I may blow a gasket if I see another one of these documents where the agency has put sobriety, treatment or meeting with a psychiatrist in as a goal for the client when they have never agreed to wanting to achieve these things….but I digress).
Individualized service plans tend to work best when these have these components:
Life Stability – I like to see the goals and activities related to life stability to be situated in a context of housing stability rather than stand-alones. The reason for this is that I want to see people reflecting on how to sustainably stay in housing while they work on whatever other areas of their life they think are important to work on.
Meaningful Daily Activities – everybody should have things that they do to occupy their time that isn’t used by other service plan activities like meeting with doctors or income supports or those sorts of things. Worst thing is people who sit around with nothing to do and are completely socially isolated. We need to make a strong effort to increase awareness and opportunities for the clients that we serve that gets them into an environment ripe for community integration. Most often this will be most days of the week, ideally, and will provide good satisfaction and fulfillment – whether that fulfillment be emotional, spiritual, social, recreational, intellectual, etc.
Education and/or Employment – indeed education and employment may be types of meaningful daily activities that a client engages with. However, I keep these separate because of all that has been learned from the likes of supported employment and from different research that has occurred on recovery services that show these as two positive stand-alone components.
Connections with Other Systems – in many cases the people that we serve will also have connections with the likes of doctors, psychiatrists, parole officers, therapists and others. Given we don’t have control over these other systems, we need to focus our attention on connecting to these other systems in a way that works to the benefit of the people that we serve. This can take a range of approaches, but the advice I always provide is to have formalized brokered access to services rather than the system connections being a series of one-offs. Connecting at a policy and senior management level in addition to the operational level is preferred.
Social Awareness – to assist the people we serve in moving beyond their identity as a “formerly homeless person” we need to help create environments where they connect with people across a broad range of income strata and life experiences. We also want to create opportunities for people to potentially become more comfortable and confident in meeting with other professionals – like, say, biding time in a waiting room while waiting to be seen by a dentist.
3. Increase Self Awareness
Self-awareness calls for use of introspection skills and the ability to become attuned to one’s knowledge, values, opinions and beliefs. Self-awareness allows for “ownership” of these feelings and the ability to put into context what one beliefs relative to what others may think, the influences used by others and the environment within which one lives. I would argue that for many of the people we serve – especially those that have experienced long-term homelessness or long-term institutional living – that self awareness becomes compromised because they are socialized (or even forced) to think and behave in certain ways as a requirement for receiving services. Further, I would argue that some of the behaviors exhibited by the people we serve that seem to have negative consequences on their life in the past are directly related to imposed reduced self awareness.
Helping the people we work with increase their self-awareness requires focused attention on three components:
Self-Assessment – this is intuitive to many people, as a function of how we interpret a broad range of stimuli, the situation we are in and information we are presented with – and then determine the most appropriate behavior relative to the circumstances. Self-assessment is really an identity aspect of our personality. People who have been subjected to being told what to do for long periods of time rather than independent analysis of a situation can have their self-assessment skills compromised. Some of the people we work with will need help re-establishing the skills of reflection on circumstance and environment and thinking critically through the most appropriate responses to the various stimuli and emotions felt in the situation. Open ended questions related to specific circumstances are best for helping to build this skill set.
Triggers – this relates to understanding how certain responses or behaviors directly relate to various stimuli, emotions, situations or circumstances. A deeper understanding of the triggers that related to how and why they became homeless in the past can help with planning for greater housing stability on an ongoing basis. Reflecting on specific situations can be helpful for assisting our clients identify their triggers.
Confidence – reinforcing positive growth in self-assessment increased confidence. Confidence becomes important in calculated risk-taking in growth and personal change related to the individualized case plan. It can also help with emotional strength and resiliency, as well as problem-solving that still keeps housing stability at the center of deliberations of how to respond to various situations.
4. Support Achievements in Self Management
Self Management in this context refers to working collaboratively with a range of supports and information for more holistic and informed decision-making. This is linked to how one cares for oneself along various dimensions: emotionally, physically, spiritually, socially, intellectually, etc. Our role can be to provide support and education to the people that we work with to help them establish the means through which they can exercise self management. Of importance here is that we do not enter into a dependent relationship where we are somehow at the center of the decision-making structure. We want to encourage the individuals to seek out other resources and information to make decisions so that they can do so independently of us in the future.
There are three components to supporting achievements in self management:
Control – we want people to experiment with and exercise greater control in their own life. This relates to where and how they get information that relates to their decision-making, how they respond to the decisions they have made, which individuals they invite into their life to be part of the information collection process, etc. What we are trying to reinforce is that the client is in control of their service plan, their decisions, their own future.
Accountability – as an extension of exercising control, individuals should be in a position to accept greater accountability for the information they are using and the decisions that they are making. Because our service orientation is focused on the individual and we are not using any type of cookie-cutter approach, it becomes important for the individual to exercise self-accountability. Ultimately we want the people we work with to feel accountable for their successes, as well as when things did not go as planned. The accountability in the latter is how we can facilitate a discussion about what they can learn from the experience.
Optimism – exercising self management should lead to feelings of optimism. We want the people we serve to feel control over their lives and accountable for the decisions they are making, all with a feeling that the future (whether that is tomorrow, next week, next month or years from now) are worth looking forward to and working hard to make better. Optimism is fueled by meaningful reflection on what has been achieved. It is for this reason that we need to take time to also work with our clients to reflect on all that they have achieved, not just what still needs to be done.
5.Allow the Client to Reframe/Rebuild One’s Life and Future
As our work focuses on helping the people we work with achieve greater independence in their lives, this final Essential and Sequential Element is a tell-tale sign that all of the hard work put into change on the part of the client, and all of the case manager’s hard work put into support have created a place and time for transition.
There are four components to the Reframe/Rebuild phase:
Infrastructure – in this stage, the client will have a solid social and physical infrastructure. The social infrastructure refers to “natural” supports like family and friends that can help provide a safety net in the event that something goes awry in the future. The physical infrastructure refers to having security of tenure in their apartment. Further to this last point, they will have a standard lease, the ability to pay their rent on time and in full, and there are no significant concerns about their tenancy becoming compromised in the near future.
Relationship Management – in this stage, the client will feel a greater sense of control within their social networks – which people they let into their life and for what purpose. They will also have acquired the skills to manage the relationship with neighbors and their superintendent/landlord. We would expect them to appropriately manage relationships with professional supports as well, knowing which supports they are connecting to and for what purpose. Finally, they are exercising more independence and exhibiting greater direction in the relationship with their case manager that has supported them in housing. Tell-tale signs of this occurring are things like independent goal setting, action identification and task completion; personal advocacy for needs and services outside of the support workers assistance; decreased time and frequency of home visits without any negative consequences on housing stability.
Purpose & Identity – this is the magical moment where the client begins to see their identity as a housed person with future goals and aspirations, rather than as a previously homeless person. How they speak of themselves is more often in the present and future tense, rather than dwelling on the past. Moreover, they are most likely connected with opportunities and activities that they feel gives their life greater purpose.
Greater Independence – at this point, the client has become integrated with a range of supports and opportunities outside of the case management relationship. They have considerable life stability. They can seem to independently manage their tenancy – taking care of their apartment and paying rent. They have built a formal and informal support network. They focus on the present and the future. They have thought about what may possibly go wrong in the future and have developed a plan on how they will respond to possible scenarios while keeping their housing intact.
Following these 5 Essential and Sequential Elements to Success is a recipe for program excellence and will help more clients achieve fuller integration with the broader community, improved quality of life, enhanced wellness and a sense that the future is brighter. The length of time it takes to progress through these steps is informed by a range of factors relative to the complexity of the client’s needs and interests, to the availability of time and intensity of supports.
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Iain De Jong has developed the 5 Essential and Sequential Elements based upon years of practice, research, program evaluation and working with a range of successful housing programs. It has taken him more than 10 years to distill the elements and sequence to these points, but feels it was well worth the effort and journey to finally get to a place that makes sense to practitioners, policy makers, funders and clients. OrgCode has used this framework to successfully make amendments to funding and program requirements in other jurisdictions, and can demonstrate improved outputs and outcomes as a result. If you’d like more info on these elements, feel free to contact him at idejong@orgcode.com
The Structure of the Housing Team and Its Functions
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PART THREE: The Structure of the Housing Team and Its Functions
Successful housing programs have three different types of positions:
Team Leader – supervises the work, coaches team members and creates opportunities for professional development, assigns households to different case managers, sets priorities and ensures fidelity to the approach. (Read more about Team Leaders, their importance and why they need specialized training.)
Housing Case Manager – provides direct support to households (individuals or families) that have been housed and works with them to create an individualized service plan that will help them achieve housing and life stability.
Housing Locator – works directly with landlords, property management firms, etc. to secure available units for the housing program. (There is an entire future blog dedicated to how to make this work.)
My experience suggests that in most cases social workers tend to make crappy landlords and landlords tend to make crappy social workers. While there will always be exceptions, I would argue that keeping them separate functions helps. The best Housing Locators I have ever met, for example, are not schooled in social work or other helping professions. They know how to speak “landlord” and how to make the business transaction part of the housing program work. But I digress…and again getting ahead of myself and a future blog.
Each housing case manager can serve a MAXIMUM of 20 households at any one time. Any more than that and you have a list of people that you aim to serve, but truly serve none. Even then, the 20 have to be at different stages of the program and housing stability. About 5 of the households will be more newly housed – approximately 3 months or less. About 10 households will be housed 4-9 months or thereabouts. The remainder will be 10 months or more. This isn’t perfect or absolute in terms of time in the program, but seems to be a good rule of thumb across the dozens of teams I have created, coached or evaluated.
In exceptional circumstances a housing case manager may serve less than the 20 households at one time. The types of exceptions that would go into that decision-making might include: several of the households have a large number of family members; the housing case manager is new to the field; some of the clients have remarkably high acuity and several complex co-occurring issues (for example, let’s say they have Fetal Alcohol Spectrum Disorder and are using crack cocaine and have diabetes and have had a recent foot amputation and have criminal charges pending for assault).
Each Team Leader can supervise up to 5 case managers at a time. If you get beyond that number a Team Leader will struggle to prioritize and balance across the team and will not be able to keep abreast of more than 100 households being supported at any point in time. One of the Team Leaders core functions in supervision is to create balance across the team. This balance pertains to the number of households being supported by each case manager as well as the complexity of household needs within those caseloads.
Borrowing heavily from Patrick Lencioni’s fantastic book “Death by Meeting” I have come to instill a very specific approach to meetings in all of the housing teams I have provided leadership to, created, coached or evaluated because I can demonstrate better housing outcomes as a result of the meeting structure. The structure goes like this:
Getting organizations oriented to this type of meeting structure can take some arm-twisting, cajoling and reassurance that it is worth people’s time. However, I have yet to meet a successful housing program that instilled this approach that didn’t see the dividends of it once they got it into place.
All of the meeting types are important, but if I had to put all my eggs in one basket it would be the weekly tactical meeting. This is the meeting where I want each case manager to briefly (90 seconds or less) review each household that they are working with, the client’s current acuity measurement compared to past acuity measurement (read more about one approach to establishing acuity), the case plan priorities for the client, the three objectives for the next home visit with the client and when the visit will be occurring. Each case manager is allowed two holds per meeting for a more extensive discussion with their peers and joint problem solving on particular cases. It is the Team Leader’s job to chair the meeting and keep the meeting moving. I also suggest starting at either end of the alphabet in alternate weeks.
With someone to record all that is discussed on a white board, shared file or the like, it is possible to see at a glance who all is being served by the program, the general state of stability of the case load and the movement towards greater independence with each client. It creates a structure of increased accountability. What case managers tend to love about it is that it gets them out of a crisis mode with their clients and into a deliberate and planned framework…they know how they will spend their day, who they will see and what will be happening during those interactions. This is really important because these types of housing programs are not crisis services, they are case management services.
An example recording of a few client names (names are fictitious) may look like this in the weekly tactical meeting:
The last piece I’ll cover in the Team Structure and Functions is the type of person who is a good candidate to deliver excellent service given this is professional work (as opposed to charity or volunteer driven work). What I have always wanted on the teams I have created or coached are people who can successfully answer these five questions for themselves and to my satisfaction:
Why am I here? (I want to hear that people share the belief in the mission at hand.)
Where am I going? (I want to hear that people are committed and share a vision of ending homelessness – even if it is just one person, one family at a time.)
How am I doing? (I want to hear that people reflect on their practice and strive to get better; that they want feedback and coaching.)
What’s in it for me? (I want to know what their motivation is for doing the work and how it enriches them. In most instances it isn’t going to be money. What I am really hoping it is NOT is filling time until the next opportunity comes along.)
Where do I go for help? (I want people who will trust their team members and team leader to assist them in case planning, who are dedicated to the team unit as a whole. People who are passionate about learning and challenging themselves are also quite welcome so long as it relates to the mission.)
There is no doubt that the structure of the team is one of the key elements of housing program success. In smaller communities I have seen a shared Team Leader across agencies and/or housing case managers from different organizations collaborating together to form one cohesive team. In larger agencies and communities I have seen multiple housing teams within the same agency with multiple Team Leaders and discrete teams. The key to success is to stay true to the structure to best meet the needs of the people you want to serve from a quality perspective.
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Iain De Jong has been involved in the development of his own housing teams and has helped organizations throughout the world establish their own successful housing teams. The structure presented here is no accident. It comes from years of practical experience, evaluation and peer review to land on the right structure for successful housing programs. If you have any questions or want help setting up your housing team to maximize success, drop him a line at idejong@orgcode.com
Service Orientation
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In this multi-part blog series we are examining the essential elements of successful housing programs that focus on ending homelessness. We pick up here in Part 2 looking at the Service Orientation that is necessary.
PART TWO: Service Orientation
The secret to a successful housing program? Meet people where they are at in their life journey. Don’t set up barriers or unattainable expectations. Accept the decisions that people have made in their life and how they became homeless at face value, help them achieve housing, and then provide the supports necessary to help them achieve long-term residential stability.
In case you missed the subtlety – house people, then support them. If you put together an elaborate service plan or case plan prior to helping someone get housing you are doing it “bass ackwards”.
House people then support them. The evidence is clear that people achieve better long-term housing outcomes and achieve a more positive quality of life when this is the sequence of evidence. While it remains popular for there to be life skills training, budgeting classes, skills upgrading, addiction treatment, etc prior to helping people achieve housing, the evidence would suggest that this is unwarranted and actually results in poorer housing outcomes long term.
We shouldn’t have different standards of behavior for people who access human services compared to others in society generally. For example, sobriety is not a precondition for successful long-term housing. Statistically, most people who are alcoholics or who use other substances are housed, not homeless. Any housing program that requires people demonstrate sobriety for any length of time prior to gaining access to housing is lengthening a person’s homeless experience for a reason not supported by fact. Furthermore, any program that drops support services because someone has started using again is, in my opinion, doing a better job of creating homelessness than ending it.
We need to wrap our heads around what harm reduction is and why it is important for the population that we are working with. We are trying to focus on ways of reducing harm to the individual and community/society at large. We are looking at things like substance use and sex work from a community health and public health perspective. Harm Reduction is not an approach that demands the client achieve sobriety over time. While it can be effectively blended with approaches that decrease involvement in harmful activities, first and foremost a harm reduction approach tries to decreases risks associated with use. For example, using with friends instead of alone or with strangers; use of condoms; use of clean needles and safer crack use kits; drinking palatable alcohol instead of non-palatable alcohol. Some clients may have a goal of abstinence, but this is not a requirement. A harm reduction approach is pragmatic. Not only does it increase the health and stability of the client, it also has public health benefits, decreases policing costs, and also decreases emergency room, ambulance and hospital costs.
As someone who lives with a mental illness (depression) I know I can have strong opinions about how many organizations view and support persons with compromised mental wellness. In the context of creating and maintaining successful housing programs I would urge you to understand, embrace, support and practice recovery-oriented practices with individuals that have experienced compromised mental wellness. I would suggest that everyone learn about the practices and work of the likes of Mary Ellen Copeland and Patricia Deegan. I want people to know how to support individuals who have experienced mental illness in having a hopeful orientation towards the future, with an increased understanding of symptoms and triggers, with thoughtful crisis planning and awareness of resources and approaches that can be used. I want people to know how much survivors of psychiatric services have come to emphatically embrace these practices and experience better housing and quality of life outcomes as a result. I want people who have experience mental illness to feel empowered to have a voice in their care and supports.
For housing programs to be successful, punitive approaches when people relapse – whether that is in their substance use, medication management, housing stability, etc. – should be replaced with approaches that try to focus on what lessons can be learned and how to achieve stability and housing success in the future. People will relapse and it is natural. Sure, we would love to prevent it as much as possible and support people as necessary to try and mitigate it from occurring. But relapse will happen.
Related to this is a relapse into homelessness. Not everyone supported by a program is going to remain housed despite all of the efforts a housing team puts into it. But let’s not rip away their supports or refer to them as a failure or make them go to the bottom of the waiting list if they lose their housing. NO! Let’s re-house them, learn what we can do better and focus on how greater sustainability can be achieved the next go around.
We also need to move away from program models that are coercive if we want to have a successful housing program. Clients should never be tricked or forced to do anything that they don’t want to do. I urge people to be fully transparent on what the housing program and supports are that we are offering and let people choose if that is right for them.
A critical component for a successful housing program is client choice. This starts with empowering the people we work with to choose where they want to live. Some people may want permanent supportive housing while others may want scattered site housing with supports. Some people may want an efficiency or bachelor unit while others will want a one-bedroom. Some people may want housing close to the downtown while others want to be as far away from downtown as possible. Housing programs need to stop thinking that they place people into housing and start thinking that they provide meaningful housing choices for people. We don’t know what is best for people. What we should know is which options we can present that are affordable, actionable (reason to believe the landlord will rent to us) and appropriate (e.g., there are no legal restrictions on where they can live; it isn’t a four storey walk up and the person uses a mobility assistance device). Then we need to respect the housing choice that the client makes and support them in that housing.
We also need program participants to choose the type, duration, frequency and intensity of the service supports that they receive. If we do this in the right way we can remain truly client-centered and support people through the stages of change. This doesn’t mean we are client-directed. It also doesn’t mean that we are system-centered. It means that we are going to take the necessary steps to ensure that our service delivery and organization remain centered on opportunity for growth and positive change.
We need to know under what circumstances it is prudent to create intentional conversations, practice respectful persistence and engage assertively with the people we work with. We are agents of change; navigators of resources. We don’t heal people. We don’t fix people. We aren’t directly responsible for the decisions that people make in their lives. But we should do the best we can to provide access to information and opportunities that will allow people to engage in activities that will provide the greatest likelihood of quality of life improvements.
We need to think of our work as professional work. Damien Cox, a writer for the Toronto Star, said of my beloved Maple Leafs (and I am paraphrasing) “Stupid and nice is no way to run a hockey team.” I know and appreciate that people get involved in delivering services to homeless people for a wide range of reasons. But they need to know the limits of what they can do versus what experts need to do. I think of, for example, the Sisters of St. Joseph and their involvement in health care and development and administration of hospitals. The Sisters knew the difference between their role and the role of trained medical professionals. They didn’t try to do things that they were neither qualified nor trained to do. They knew that doing so would hurt or even kill more people than it helped.
Given the populations that we are serving, it is necessary to orient program delivery such that it happens in the community. Supports cannot meaningfully be delivered by text message or email or phone call. We need to go meet them in their housing. We need to see the condition of their housing. We need to see their adjustment and skill implementation first hand. We need to respect and support people’s natural settings. We can’t do this in an office. We need to go to the people.
As support functions go, I find it is best when organizations embrace their role as teacher, model and resource specialist. I strongly suggest staff make themselves available to accompany people to appointments. We need to be willing to do a load of dishes or load of laundry with people to teach them the skills. We should demonstrate the likes of budgeting by taking people grocery shopping. We need to be prepared to roll up our sleeves and clean toilets and showers and the like until people have the skills to do it themselves. We need to know whom else within the community we may recommend that the client connect to and for what purpose.
Deficit-based approaches to working with people are not as successful as strength-based approaches. I appreciate that sometimes finding the strengths beneath a rough exterior and years of hard living can present some challenges. Truth is, a lot of the people that we work with may not have traditional strengths. We need to be creative in how we work with and look at the life experience of people. The will to survive after years of living under a bridge may be seen as a strength. Considerable stubbornness may actually be viewed as a strength. Managing one’s basic needs while dealing with active psychosis may be seen as a strength. And I could go on.
Our job when we work with people to support them in housing is to orient our approach such that we enhance dignity and empowerment by making the people we serve the center of all planning activities and goal setting. I suggest transparency and a small wins approach, with the patience to accept that people will change their minds. I want the people we serve to think about the obstacles that may come up and how they will tackle those challenges before they ever happen.
For many years some of the people with the most complex needs have been subject to compliance based programs. This means that they have to do things like demonstrate sobriety for a fixed length of time, take medications, agree to see a psychiatrist, agree to take anger management courses, etc. in exchange for having a roof over their head. Anytime compliance faltered, the individual was subject to a “three strikes and you’re out” or “contracting” process or else asked to leave immediately. Too often this meant a return to homelessness. Evidence suggests that compliance-based service delivery does not achieve impressive housing outcomes, especially in the longer-term.
We need to help the clients we serve understand what our role is and the length of time we are available in their life for. I want clients to achieve greater independence over time. This helps inform the approach used to case planning and supports. It also makes me critically aware at all times that establishing a dependent relationship is not going to be helpful or sustainable longer term. I suggest as many connections as possible to mainstream services with a strong focus on community integration.
There are only six types of homeless people: Someone’s mother. Someone’s father. Someone’s sister. Someone’s brother. Someone’s daughter. Someone’s son. I really love when I see compassionate service providers who never lose sight of the humanity of our work. It is these organizations that exemplify the non-judgmental attitude that I think we need…the same sort of acceptance without criticism that I would love to receive should I ever find myself homeless.
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Iain provides extensive workshop training and keynote addresses on changing ideological approaches to truly focus on ending homelessness in a way that accepts people where they are at. Comfortable with his many own imperfections, Iain has found that the focus on the right service orientation not only improves housing outcomes, it also shakes up some of the underpinnings of homeless service delivery systems by encouraging critical analysis of why some programs operate the way that they do.
Ensuring People Who Are Homeless Get the Right Housing Intervention and Supports to End Their Homelessness
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In this multi-part blog series we are examining the essential elements of successful housing programs that focus on ending homelessness. We pick up here in Part 2 looking at the Service Orientation that is necessary.
PART ONE: Ensuring People Who Are Homeless Get the Right Housing Intervention and Supports to End Their Homelessness
“The homeless”. Ugh. What a bland, homogenizing and completely inaccurate phrase. There are homeless people. There are homeless individuals and families. But “the homeless” is downright demeaning in my opinion. There is considerable diversity within the homeless population. While there may be some striking similarities when it comes to indicators of why/how a person becomes homeless, rarely are two paths into homelessness the same. Understanding the heterogeneity within homeless populations allows us to provide the opportunity of the right supports and right housing to the right person at the right time for the right reason.
To be clear, the focus is on ending homelessness. Housing is the only known cure to homelessness.
Homeless service systems need to have meaningful intake and assessment processes where acuity is determined. They cannot be “first come, first served” if they truly want to end homelessness. Truth is, some individuals will have rather complex needs and a higher acuity warranting one type of intervention, while other individuals will have needs nowhere near as complex and with lesser acuity. In the same way that these two individuals are not the same, the services that are offered and the expectations of those services will also be different.
I am frequently frustrated by intake processes. Too often they have evolved to become, “Come in. Let me take your information. I’m not sure why I am asking the questions that I am asking. Oh, and I am not sure what I am supposed to be doing with the information either. I might make a referral somewhere else. No guarantees though.”
Sigh.
In Malcolm Gladwell’s book Outliers, he says: “To build a better world, we need to replace the patchwork of lucky breaks and arbitrary advantages that today determine success with a society that provides opportunities to all.”
So true.
When people seek access to homeless and housing services – whether through a central intake or through a more standardized process used across organizations in the same community – we need to have an intake process that will permit us to make informed decisions about what service choices we may present to the individuals. To be clear, we never want to PLACE people into a program. We want to offer it as a choice.
In our extensive research of homeless populations, we have come to realize that there are three dominant categories that provide general descriptors of the intensity of service to be offered based upon information gleaned through intake. Within each of these the autonomy of the individual, their unique needs and individual circumstances are still respected and worked with. What these categories intend to do is help create a service typology so that the right services are offered to the right people at the right time to do the right thing about their homelessness.
The first group is those with lower acuity. Let us keep in mind that most people that ever experience homelessness in their life experience it for a short period of time and are never homeless again. In many communities this can be upwards of 60% of all people who experience homelessness in a given year. Do these people need case management? No. Do they need service offerings that are going to keep them homeless longer – like life skills training within a shelter? No. Truth is, many of these households can be diverted from the shelter in the first place. If they do get in, they tend to use shelters for the purpose they were originally designed – short term and infrequent use. These households may need some instruction on how to apply for benefits. They may need access to a computer. They may need a list of landlords with available rentals. They aren’t going to need much more. Don’t give them anything more. Please. Don’t.
The second group is those with a mid-range acuity. These folks need support with Rapid Re-Housing. Some people erroneously think that Rapid Re-Housing just means getting people who experience homelessness back into housing quickly. Not quite true. Rapid Re-Housing is a specific type of intervention, which our research suggests is between 15-35% of homeless populations. These individuals and families tend to have a few areas in their life with more complex presenting issues, but there are generally two or three areas of higher need in their life. They benefit from having support locating housing and supports once housed maybe for a few months; rarely for more than a year. Most often this will be scattered site housing within the community, most often in the private market, with or without a subsidy or voucher of some kind (depends on the local housing market and local income assistance rates). They benefit from an individualized service planning process and case management supports. They have the ability to reintegrate into mainstream resources more readily than other individuals and families with higher acuity.
The third group is those with higher acuity. These folks benefit from support through Housing First – either Intensive Case Management or Assertive Community Treatment. Housing First is far from housing only. The number of individuals and families requiring a Housing First intervention in a community will be small – between 15-25% of most homeless populations. They will, however, most likely be voracious consumers of services, and the costs of serving this population while homeless tend to be disproportionately higher than other types of individuals and families. They are much more likely to experience chronic homelessness and have more areas in their life where they have complex and/or intensive needs. Given the broader number of issues where it may be reasonably expected that the individual or family have complex issues, it is likely that these people benefit from case management supports over a longer period of time – usually 12 months or more. Research suggests that both permanent supportive housing (like what DESC offers in Seattle) as well as scattered site apartment units with intensive supports (like what Pathways to Housing offers in New York City in the ACT model or what Streets to Homes in the ICM model offers in Toronto) can work for this population. It can take longer to help these individuals and families integrate with other community supports. Given that most will have experienced chronic homelessness just the emotional and psychological adaptation to the reality of housing can take time, patience and intensive support. The service plan for this group definitely needs to be individualized. There is nothing cookie cutter about serving this population.
This latter group – the Housing First folks – have also dealt with considerable stigma within the housing and homeless service sector. They are frequently labeled “service resistant” or “hard to house” or “not housing ready”. The truth is they are none of these things. We cannot blame them for their complexity. Two research studies that I have spearheaded also overwhelmingly support that this population absolutely does want housing, despite this myth that a large group of people choose to be homeless or like the lifestyle. What we need is the right services that are individualized, supportive, non-punitive, non-coercive and oriented towards harm reduction. What we need is access to different types of housing models that people can access rather quickly without arduous bureaucratic processes, with supports that wrap around them in a way that makes sense and is centred on their needs.
There are a couple of other important considerations for the Rapid Re-Housing and Housing First crowd. The first is that they have to make an informed choice about their participation in the program and supports. We cannot force or coerce people to accept a support intervention and expect it to work. The second is that we want people to know in advance that there will be home visits where case management supports will be provided, and we want them to know that they will receive supports to create an individualized service plan that will focus on helping them achieve housing and greater life stability. They need to know that they guide the case management process and get to determine the type, frequency, intensity and duration of services. The third is that we will be supporting them – not forcing them, tricking them or using any other type of punitive measure in the process of delivering supports. It is their supports, not ours, and there is nothing “cookie cutter” about our approach to individualizing services.
Focusing attention on an intake and assessment process that will help service providers and help people seeking service access the right type of service intensity, supports and housing is an important component of having a successful housing program in your community.
Iain De Jong has helped many communities throughout North America retool their homeless service system based upon an understanding of the heterogeneity of homeless populations. Through his work communities see reduced lengths of homelessness and increased accountability in service delivery. Stay tuned for the second installment in the blog series, which looks at the Service Orientation for effective service delivery.
Organizing Information as a System Instead of a Collection of Projects in an Effort to End Homelessness
In working with housing and homeless information throughout my career it has always been my mission to get people to think and act like a system instead of a collection of projects. Truth is, funders like to attach the word “Program” to a lot of the work that they do, and this orientation has led many communities to organize their services by funding source rather than by what the outcomes are that the funding is trying to achieve. Across various funding programs there can be comparable, complimentary outcomes that are intended. So let’s take a closer look at how to organize information as a system instead of a collection of projects – which ultimately means organizing our projects like a system too.
It is my ardent belief that housing and homeless programs and services exist to end homelessness. A system-based approach places this belief at the center of the organization of information and wraps program areas around the central belief of ending homelessness. This means that all of the programs that are funded must be seamlessly linked to ending homelessness. Outreach services? Exist to end homelessness. Prevention services? Exist to end homelessness. Rapid Re-housing services? Exist to end homelessness. Emergency shelters? Exist to end homelessness. And I could go on with other program areas.
If we truly belief in ending homelessness – and we know that housing is the only known cure to homelessness – then each of these program areas needs to have a housing orientation as well. This can be a challenging way of thinking for some program areas that traditionally have not always kept this top of mind. Take for example a program area like street outreach. What is the link between street outreach and ending homelessness? What difference are we hoping street outreach makes? Some might think that street outreach exists to keep people alive through the provision of soup, sandwiches, sleeping bags and those sorts of things. Others might suggest that street outreach exists to connect or befriend people and create a trusting rapport. Yes, I believe that keeping people alive is a good thing. And yes, I believe that there has to be a professional connection. However, I do not believe that providing survival supports or building a trusting relationship is a sufficient output nor outcome in a service system design that supports ending homelessness. Street outreach services, therefore, should focus on getting people directly into housing or providing direct warm referrals to organizations that have a housing specialization.
Another good example is emergency shelter. What purpose do we really want emergency shelter to serve as we work to end homelessness? As it stands now – as I have seen countless times in my travels throughout North America – shelters have become a location that tend to gravitate (though not always) from one end of the continuum or the other without finding a balance. On the one end is the type of shelter that only opens at night – most often long after all other services and mainstream benefits offices have closed – and close up around breakfast time in the morning. On the other end are those shelters that have become so service rich that they have become de facto housing. These are the types of shelters that have the likes of employment programs, life skills classes, parenting classes, counseling services, clothing rooms, etc all on site. Access to these programs is most often predicated on being a resident at the shelter. The unintended consequence of this is that it keeps people homeless longer. And, evidence would suggest that helping people get out of the shelter and into the community and then providing supports to them in their housing would be better. So, with an orientation towards ending homelessness, we really need to view shelters as centers of opportunity. The opportunity we should be creating is the opportunity to get out of shelter rapidly, housed in the community and connected with services that are best equipped to meet their needs. Ending homelessness does not have to be anti-shelter. As I often say in my keynotes and training speeches, just because we have gotten better at fire prevention doesn’t mean you want to get rid of all of the fire halls in your city. The same is true of shelters. The key difference is that we want shelters to return to their original purpose – short term, infrequent use where people have their needs met quickly and move on. If we don’t have this orientation, demand for shelters will just increase more and more, and many a community will erroneously move towards an expansion of their shelter system rather than the original intended use of shelters.
Purpose drives metrics. Information organizes systems. In our world the system is intended to end homelessness. We need to have the right information to know if that is happening.
The first question I ask folks when they are working to address this is: what problem exists that this program should work to solve?
The second question I ask is: what difference will this program make?
These two questions are important because they frame the way in which I suggest projects and information become organized.
Let’s go back to outreach as an example. Broadly, outreach exists to solve the problem of homeless individuals not be connected to the services and resources that will end their homelessness. Within the program area called “Outreach” we can have a series of outreach projects. For example, maybe there is a specific project providing outreach to homeless youth. Maybe another tries to work with veterans. Another still might be for individuals with serious and persistent mental illness. Three different projects (and a lot of communities would have more than three) likely with three different sources of funding. But the common element of all three – and the way we need to look at them relative to a system approach – is that they are all types of outreach. The difference we hope they make may be that people are connected with relative to the intended populations served and geographic area, that services are offered and accepted that end their homelessness, and that their quality of life improves as a result of the outreach experience.
Project logic models are common, but my experience suggests that Program logic models are infrequent. Project logic models are almost exclusively related to a single source of funding. Program logic models transcend funding source and, in fact, are a single place where all investment into a program sector can be tracked regardless of what the source of the funds are.
I think it is important that our work be seen as a quality business, not a quantity business. While the metrics for any program sector are definitely going to be quantified, the biggest mistake we see is that many an organization (often as a result of many a funder) focus on outputs instead of outcomes and seek a large volume of people connected with. If we want to have a quality business we must be thinking about standardized assessments across all program areas, revamped intake processes that provide us the information necessary for knowing which individuals will be best served by which programs (and projects within those programs) and ensuring that investment in the time and resources, say, to house and support 100 people with more intensive service needs is likely going to be more costly than having 300 people with moderate needs housed but having two-thirds or more become homeless again.
If we want to drive this sort of change in organizing by program sectors and perhaps even drive change in service approaches in each of these program sectors, what is necessary next is to have a clear strategic objective for the program sector and the right program indicators and right program targets.
The strategic objective sets out what exactly it is we want the program sector to strategically accomplish. It needs to be SMART: Specific; Measurable; Attainable; Realistic; Timed. Missing any of those ingredients and the strategic objective won’t hold the program sector together and it will also invite ambiguity in mission across the various projects.
Allow me to again use street outreach as an example to demonstrate a SMART strategic objective for the entire program sector:
Decrease street homelessness by 50% or more by the next Point in Time Count, providing direct assistance to street homeless individuals and families by helping them locate and maintain housing, assisting them in moving off the street by reuniting with family/friends, and through the use of emergency shelters.
In this type of example, the Performance Indicators for the Outreach Program Sector (which, as a reminder, is likely comprised of a range of different outreach projects) may include the likes of:
# of unique individuals served
# of single person households, two person households without children and adult head(s) of household with children served, unaccompanied children served
# of successful housing outputs (unique individuals & by type of household)
# of successful reunifications with family/friends that result in moving off the street (unique individuals & by type of household)
# of successful emergency shelter referrals
# and % of households that experience recidivism and return to the street
And we can drive change and provide clarity for the Outreach Program Sector example by providing some very specific Performance Targets such as:
each outreach team to work with no more than 25 unique households per month
4 successful housing outputs per outreach team per month, 3 of which must have higher acuity
6 successful shelter outputs per outreach team per month, 4 of which must have higher acuity
1 successful family/friend reunification per outreach team per month
As you can see, the emphasis is having the right Strategic Objective, Indicators and Targets for the Program Sector. This provides clarifying unity of purpose across all projects within the sector. Does it prevent some projects of having some unique elements? No. Does it take away individual organizational autonomy? No.
For funders and policy makers, this type of approach can allow them to better understand and leverage resources across different areas. It can also streamline meetings, communications and interactions with communities when, for example, all funders that invest in outreach come together at the same time with their service provider community.
For service providers, this type of approach provides many benefits as well. For one, they can increase their community accountability and accountability with the people that they serve. They can better describe their project activities within broader program objectives. And it should provide the opportunity to decrease duplication in services within any program area.
For the community as a whole, this orientation allows everyone to track whether the mission of ending homelessness is making progress. Ending homelessness doesn’t happen as a result of any single funding source. It happens across funding sources. The approach to organizing information and the system as a whole has to reflect that.
The Importance of Mentoring
Yogi Berra once famously said of Bill Dickey, “Bill is learning me his experience.”
I have the great privilege of being a mentor to about a half dozen people throughout the US and Canada. Of all the many things I do, this is one of the most rewarding.
Mentors have had a phenomenal impact on my life. They have helped shape my career track, instilled confidence, taught me different communication and problem-solving styles, given me a safe outlet to share, learn and grow. I will forever be grateful to people like Gerry Lalonde, Barbara Rahder, Noreen Dunphy and John Whitesell. (Prior to John and I becoming business partners, he mentored me for the better part of 10 years.)
We need more mentors – and not just because it helps those who receive the mentoring. Many studies show that it improves retention (see Ragins, Gibb, Lewis). Other studies demonstrate that it increases diversity and gender equity in work environments (see Henford, Tennent). The evidence is also clear that it helps create both leaders and managers.
Consider some of these facts:
A meta-study by Blanchard et al found over 90% of organizations that encourage mentorship have more positive outcomes
A 2006 study by Gartner showed people who received mentoring were 5 times more likely to improve their salary.
The same Gartner study also showed that Mentors were 6 times more likely to advance in their careers and Mentees were 5 times more likely to advance in their careers compared to people not involved in being a mentor or receiving mentoring.
A survey of 60 Fortune 500 companies showed that those who did not receiving mentoring were twice as likely to quit as those that receiving mentoring.
A separate study of Fortune 500 CEOs showed that 75% of the CEOs listed mentoring as one of the three top critical factors for their career success.
A 1999 study called Emerging Workforce demonstrated that organizations with mentoring programs had much better performance.
From a gender perspective, another study showed that 91% of female executives had a mentor at some point in their life, with four out of five indicating the mentorship was instrumental in their success.
Amongst young people, a study called “Mentoring: A Promising Strategy for Development” showed that people who were mentored were better communicators and had more positive societal attitudes.
A Ford Foundation study showed that people who are mentored are much more likely to be involved in voluntary community service.
I separate mentorship from coaching because I don’t see it as necessarily directly related to projects or tasks that I am working on, nor do I think it has to be deficiency-based, and I definitely don’t think the mentor is laying out a game plan. Coaching can be important, but it is a different type of relationship than mentoring in my opinion.
And I separate mentoring from counseling or therapy, because I don’t think it has the same qualities as a therapeutic relationship (though a mentoring session can be revealing).
I also separate it from supervision. While some of the supervisors I have had in my life have had a positive influence, I wouldn’t consider any of them mentors because there was always a power-dynamic that could potentially be at play. Mentorship has been effective for me when it is a safe place to explore ideas and feelings without wondering if it would negatively impact another person’s perception of my job performance.
So what is mentorship to me?
First off, I see it as a developmental partnership. “Developmental” as in growth process. “Partnership” as in joint interest and commitment. When mentorship has been successful in my life there has been a willingness to grow on my part and there has been another person who has made the commitment to engage with me for that growth. The mentee and the mentor both get something out of it.
Secondly, I don’t see mentors as having all of the answers to everything. Sure there can be technical knowledge shared in some mentoring relationships. However, the great value of mentorship I see is in imparting different ways of thinking, knowing, processing, reacting, researching, analyzing, synthesizing, feeling… And this comes from their experience and ability to empathize.
Thirdly, as previously mentioned, I see mentorship relationships as a safe place. In mentorship you get the insights and thoughts of another trusted person while exploring ideas, feelings, perspectives, problems and situations. Mentorship only works if it is confidential.
Lastly, mentorship is how I think people learn leadership…or at least is how I learned leadership. I think management can be taught in many different settings, but leadership for me has always been learned and explored in a mentorship setting. This doesn’t mean that everyone who has mentorship is going to be a leader, but they can learn leadership which increases their knowledge of how influence occurs.
When I think about impactful mentors in my life there are several characteristics that they share that I try to also embody in my role as a mentor:
honesty
carving out specific times for mentoring sessions
sharing insights
never solving problems for the other person
providing encouragement
offering reading or other resources to look at
warm appreciation that mistakes are part of life
teaching things like managing ambiguity, unwritten rules of conduct, organizational culture
cultivating self-confidence and self-esteem
respectfully challenging perceptions or pre-conceived notions
not interfering with the direction provided by a supervisor
actively listening
While there can be informal or formal mentorship, I favour formal mentorship. I think in formal mentorship arrangements it shows that an organization values mentorship (happens during work time) rather than it being something people have to do in addition to their other work. I think it gives supervisors a sense of comfort that they know there is a mentorship relationship going on (even though they don’t know the content) rather than feeling that someone else is giving their staff direction. I also think a formal mentorship allows for better accountability and tracking of the impact of the mentorship over time.
Different people need different types of mentors. I always valued people outside the organization than within it. Larger organizations may have the value of internal mentors. Smaller organizations can have difficulty finding time to commit to mentorship while also creating the right atmosphere.
Mentorship can take different forms as well. As was the case with John, he mentored me on an ongoing basis for a long period of time. This was a huge investment on his part (for which I will eternally be grateful). Obviously we covered a lot of material over that decade. But it doesn’t always have to be this way.
One of the emerging forms of mentorship that is really taking hold is short-term, goal-oriented mentoring. In this type of mentoring the task is to match up a mentor and mentee for a shorter period of time (usually 1-3 months) to work on specific goals in the mentoring relationship. Whereas a longer term mentorship can be much more organic and free-flowing, in this short-term and goal-oriented approach there is an in-depth understanding on the part of the mentee of what exactly they are looking to explore and then they find the right fit.
E-mentorship – surprise, surprise in the day of quick communication – is also becoming quite popular. This allows the communication flow to occur at a time that is convenient when the mentor and/or mentee have already busy schedules. It can also allow for more thinking and thoughtful response to the material being discussed in the mentoring relationship. E-mentorship can also increase the pool of potential mentors when face to face meetings are not critical. Maintaining confidentiality in the communication chain becomes important though.
So, does your organization value mentorship? Do you encourage your senior staff to become mentors? Do you create an environment where your junior staff are encouraged and supported in finding and having a mentor?
Think about it.
Then do it.
If you want to know more about how your organization can become involved in encouraging mentorship, drop us a line at info@orgcode.com