Homeless Campuses: What Does the Future Hold?

There was a time when homeless campuses were seen as the best possible approach to working with people experiencing homelessness. Some consultants (experts?) continue to talk about a Housing Fourth approach (read this) as they try to get government officials to choose the campus approach. No doubt, though, there is loads to be learned from existing campuses – and from this learning we can posit what the future may hold.

I have been to MANY homeless campuses. I have been to the big ones like Haven for Hope in San Antonio and what they do for single adults in Phoenix. I have been to smaller and medium sized ones like what they do in Lafayette. I would say that some have made valiant attempts to offer excellent services co-located on one plot of land, and that campuses with a single central service provider would appear to perform better than campuses with multiple, co-located service providers. I do not hesitate to say, however, that I have seen considerably more terrible campuses than decent ones. Whenever asked for my professional opinion, it is a no brainer to me: don’t ever do a campus unless you absolutely have to…and if you have to, you likely need a visionary Chief Programs Officer (or comparable position) to hold it altogether and get results.

First the pains that I have seen from visiting plenty of campuses…

Co-location does not, it seems, result in collaboration in most instances. When more than one service provider is in the same geographic area on the same plot of land it seems to result in competition and suspicion instead of unified, cooperative services. You may think people will want to work with each other to end homelessness. That is not really the case. There is, most often in these instances, a lack of governance or empowerment of a leader to take charge across the campus when there is more than one service provider. What occurs is lots of talk about wanting to work with each other, followed by talk of what another service provider is doing to get in the way of that, followed by inertia. If you go back to the planning phases, and in some instances early stages of operation, there was energy amongst different service providers to be working in lock step. Over time that seems to fade. Senior leaders, then, start spending more time managing relationships across service providers, than doing program improvements to get people out of homelessness.

Funders sometimes think they can whip things into shape by setting expectations of cooperation when there are multiple service providers on the same campus. But what happens is a lot of finger pointing. Organizations want to put their best foot forward, even if it means throwing others under the bus. There is loads of energy expended protecting each organization’s slice of the campus pie that they have no common interest in what funders are trying to achieve.

Prioritization is difficult on a campus. Organizations on a campus can have different mandates, missions or interests. Heck, even when there is just one service provider on the entire campus you can see differences between program areas in how they respond to prioritization. Without central authority, getting to a place where there is agreement on whom to serve in which order is tough – if not impossible. Then you spend all of your time assessing and none of your time housing. Because campuses are magnets for people experiencing homelessness the volume of people seeking assistance can exceed the capacity of intake and assessment.

When there are other homeless services in a community in addition to a campus, communities often struggle with how to put the pieces of the puzzle together. By sheer size and multitude of programs, the campus can see itself AS the system. When there are multiple service locations, the campus is PART of the system, not THE system.

It has also been my experience that on many, many campuses antiquated ideas die a slow death. Employment readiness? Still see it in spades. Focus on transitional housing as a way to prove readiness or worthiness for housing? Tons of it. Reforming the behaviour of people to make them ready for housing? Alive and well. This isn’t necessarily because of poor-intentioned staff. Antiquated programs can come as a result of the built form that exists on the campus. For example, if the original campus built a lot of classrooms and vocational teaching spaces, they can get stuck on employment readiness. If the campus built reams of transitional housing, then they seem to hold tight. If the campus created a “step up” or continuum model between physical spaces on the campus, then amending even one part of the campus creates havoc on the whole model – and, well, keeping things as they were seems easier.

Assets inhibit innovation. Because the campus revolves around the built form, making change is difficult or financially cumbersome. Urban planners would have a field day figuring out what should have happened and why. So much about the campus experience misses the client-centered approach to design and instead focuses on greater ease of service delivery for the service provider. While the scale of the campus plays a role in this, it doesn’t make smaller campuses exempt from the challenges of reforming and changing parts of the built form. To that end, I think of places like Lafayette and the sheer energy and determination it takes to even amend small parts of the campus.

If you track the planning and development cycle of a campus, there is excitement that so much money that has been invested in the campus. There are generally no shortages of celebrations of what has been fundraised and built. But wait a couple years because that elation is often followed by heartache that it does not seem to be panning out. Then there is wonder and consideration if there was just a small thing that was done wrong. Then systemic and systematic review. Many times I have seen this followed by a desire to blow up and start some parts of it (or the whole thing) all over again.

The social impacts of campuses must also be considered. First, let us look at the relationship of the campus to the rest of the community. Often (though not always) the campus is stuck away from other services. In Phoenix, for example, the campus for single adults is on the edge of downtown not far from a somewhat run-down and forgotten cemetery. In San Antonio it is literally on the other side of the tracks. It is isolating. “Out of sight, out of mind” comes to mind. And then after the campus is built there is no shortage of businesses and elected officials that wonder why they see people that are homeless anywhere in the downtown or near businesses or residential neighbourhoods. I have encountered people who think you can legislate and confine people that are homeless to a campus – as if it is a prison of some sort.

The social issues located near the campus when there is such a concentration of people is also an issue. What can be manageable behaviours and expectations of being neighbourly when homeless services are integrated into community goes out the window when the scale gets too large and all concentrated in one place. I have yet to see a campus for single adults that has not seemingly blown its brains out on security costs and measures and/or had ongoing difficulties working with local law enforcement because of social issues near the campus.

Another social impact is what the concentration of people with co-occurring issues sharing the same space on that scale does to people. Spend enough time homeless and the experience of homelessness becomes normal, not abnormal. Spend day in and day out with a social group that reinforces the normalcy, and an exit from homelessness can be much more problematic. Amplify this by 100 and you can see how people get entrenched or even lost on the campus.

Not long ago I had the chance to learn about the early stages of planning, development and operations of a large and somewhat infamous campus. A psychosocial-rehabilitation model seems pervasive in many campuses, and this one was no exception. It became clear to me in the discussion that there were probably more ideas that didn’t work than did work. Problems that they were assured would be solved in the community through the campus were not solved, just relocated (and with that came some new issues) There has been a huge evolution in programming there, and I have been so proud to play a small part in it, helping them move more towards support and housing people quicker through assessment.

To be clear, not every campus has the issues noted above. Some seem to work, though I would argue, not because of the campus, but despite the campus. And I think there are some opportunities to improve existing campuses further to make them more amenable to ending homelessness.

When there are multiple service providers on one campus, I think a campus has the opportunity to do better work if there is a single pot of funding that goes to the campus rather than providers on the campus. There should be mutual performance metrics associated to what the campus achieves with this funding as a whole. For this to be successful, more centralized oversight is critical related to funding and performance.

Overcoming the overwhelming concentration on a campus can be improved through better diversion to keep as many people out of the campus as possible when there is a safe and appropriate alternative. A robust front door that does problem solving prior to entry into programs is critical (whether in person or over the phone). This must be resourced properly for this to be successful because of the sheer volume of people that can arrive at a campus in any given day. Satellite intake points may be worthy of consideration.

Again when there is more than one service provider on the campus, if each campus has a czar to make decisions and provider leadership, there is a greater likelihood of success. However, leadership only comes with followers. This only works if there is agreement to follow a centralized leader. Nonetheless, it seems critical to me that a highly accountable governance structure is put in place, with an administrator empowered to make decisions on behalf of the entire campus and to provide direction to providers on the campus that must be followed.

Consolidating housing resources becomes possible in a campus environment to truly prioritize and leverage the strengths of different programs on campus. There is the ability to get people housed quicker when there is rapid assessment and assignment to a housing resource. This should ensure that the most chronic people get out of homelessness and into housing – without a return to homelessness – as quickly as possible. I would argue for a more centralized approach to assessment and prioritization on the campus.

Campuses could be an excellent example of co-located services if they were designed to be person-centered. The campus as a whole has to share this vision and approach, and not be a case where individual programs or service providers on the campus consider people to be “my clients”. This likely requires a shared vision of what each campus is attempting to achieve.

And for campuses to ever succeed there has to be loads of education to elected officials, business and community leaders prior to embarking on the process. People that are homeless may end up in places other than the campus…including the downtown, public parks, open space, and civic areas. A campus is not automatically less costly. And if there is one final take-away for those parties, an important reminder that a campus does not end homeless – housing does!

Drop Ins and Day Shelters in the Era of Coordinated Entry

Much discussion in communities has been focused on shelters, street outreach, and the match to support and housing options as communities have focused on implementing coordinated entry. Where drop-ins, day shelters, and other types of programming during daytime hours fits in is worthy of exploration.

One of the challenges to figuring out the role for the likes of drop-ins and feeding programs is that they often serve both homeless and precariously housed households. This is a challenge because with the former group we should be able to figure out intentional engagement and assessment strategies, whereas with the latter group the focus is going to be on maintaining housing stability through various strategies. One way (though rarely feasible or preferred by service providers) is to separate population groups: some drop-ins and feeding programs only serve people experiencing homelessness, while others only serve people that are precariously housed. Another way is to try and deliberately determine through staff/volunteer engagement within the environment which guests are experiencing homelessness and which ones are not. In this situation, there should then be follow-up with people experiencing homelessness to assess and determine how best to support and house them.

Day shelters have different challenges. For example, while homelessness is almost always a given in these environments, patrons of day shelters have often engaged with other homeless service facilities like a nighttime shelter or street outreach service. Therefore, one of the biggest challenges is avoiding duplication of engagement and assessment.

Drop-ins, day shelters and other daytime programs present opportunities as well when it comes to coordinated entry. Let us explore those:

1. They are terrific locations to find and engage with people that have already been assessed as a follow-through to housing.

Given the mobility of persons experiencing homelessness on a day to day basis from one service to another, the more communities integrate the sharing of knowledge across service providers (with participant consent) the better. It makes it easier to locate people when there is space available in a housing program.

2. They are another engagement and assessment site for people not previously assessed.

There is always a risk that people will “fall through the cracks” as they move from one location to another in a community while experiencing homelessness. In other words, they are using various services, but at no particular service have they been engaged and assessed for housing. When this has not occurred through a night shelter or outreach or other type of program, any daytime service can provide another vehicle for making sure people are assessed.

3. Maintaining momentum in the housing process can be active rather than passive.

While sometimes day shelters, drop-ins and other daytime services like feeding programs can be passive locations with minimal staff/volunteer engagement, I would argue that they provide an incredible opportunity to maintain momentum in the housing process in a very active manner. This can range from support in getting identification, information on securing government benefits, assistance in getting diagnosis or accessing other health supports, and the like (all of which are dependent on resources being available) to purposeful engagement by staff to reassure a program participant of their choice to move towards achieving housing.

4. Social contact and support.

Day shelters and drop-ins can be the living rooms of people experiencing homelessness. They can be a place of positive fellowship and connectivity to others. When framed towards social contact and support in the process of being housed (and not just contact and support in homelessness), then there is excellent alignment towards the intention of ending homelessness in a community.

5. Continued support in meeting basic needs. 

Until such time as each person has housing and can meet their needs with greater independence, there will be a need to meet basic needs in community. Daytime programs are often critical to meeting these needs. But this is not the only purpose they should serve. They are programs that support people achieve housing while meeting basic needs programs; not just basic need programs.

The Difference Between Commitment & Interest

If you are committed to achieving something:

• you have steadfast fixity of purpose (nothing gets in your way or detracts you from getting results)

• you have a solution-focus to barriers/problems (there is not a culture of excuse making)

• the good results are fuel to keep working and poor results are welcome as data on what needs to be improved (data drives refinement and improvement)

• you invest in gaining the knowledge to know how to be successful (you don’t assume you know how to be successful or do all of the practices that will be required, you learn how to be successful and implement various practices)

• you innovate as necessary (in the absence of a known solution you experiment to create approaches that may work until you find one that does)

• you have informed, meaningful performance targets that reasonably challenge and stretch people engaged with the work (“some” is not a number and “soon” is not a time – there is analysis that goes into goal setting, not wish lists or dreams)

• you spend time fixing problems instead of wishing others would (you don’t have a laundry list of hollow advocacy wishing some other organization, program or government did something differently)

If you are interested (but not committed) to achieving something:

• you will achieve success if the stars align properly (luck plays a role)

• you are quick to point out all that could/will go wrong or that there are a bunch of things outside your control that will influence your ability to success (you do not accept full responsibility)

• you may report out data, but will be quick to frame it as you want it interpreted not how it is (and are likely to make excuses for why certain results are not favourable)

• you will engage as a passing moment in your career (this task is something you do as a job, not something that you are called to achieve)

• you may make assumptions that you know things you do not know or that certain knowledge does not apply to you or will not work where you live (and sometimes this results in “Made In [insert name of city]” approaches that have no merit of fact)

• you will spend a lot of time advocating for others to make change (a lot of “If they did ‘x’ then we could achieve ‘y’ statements are made)

Another way of looking at this is bacon an eggs. Bacon is a lifetime commitment for a pig. Eggs are a passing interest for a chicken. Ask yourself: are you a pig or a chicken?

Gone Fishing

As you read this, with any luck there is a bass on the end of my line or a monster lake trout. I am in Northern Ontario, about an hour from my parent’s home on the north shore of Lake Huron. Call it the middle of nowhere (no cell service, lots of wildlife, loons on the lake are the loudest sound to hear).

As many of you know, I suck at self-care. I am, however, working on it. I have been actively trying to do smaller things in the hopes of finding a greater sense of calm amidst the storm that is often life on the road. This week I am going to:

1. Cloud watch. I intend to lay on my back and watch the sky.

2. Connect with my kids. I intend to laugh at dumb jokes around the campfire and take endless fish off their hooks.

3. Purposely take 10 deep breaths each day and feel my lungs feel with air. I intend be my mindful that I am here and alive.

4. Take a nap. I intend to do this once this week while I camp on an island in the middle of a lake – even if it is only 10 minutes while my kids explore a beaver dam or go fishing with their grandfather.

5. Check in with my emotions. I intend to do some, well, feeling about how I feel about stuff.

6. Figure out how to turn one dream into a goal. I intend to plot something that will challenge and fulfill me personally and professionally.

I know that when I practice this annual art of fishing off the grid it helps me for the rest of the summer. I hope and trust you are taking time for self-care this summer to. Get some Vitamin D. See you next week.

The Next Best Thing

Imagine you live in a small to medium sized city. I also want you to imagine that you have had a heart attack. You get rushed to the emergency room in an ambulance. Paramedics have been keeping you alive with really intensive assistance.

Given the nature of your situation, you are a top priority when you arrive at the ER. Oodles of resources are allocated to your condition. ER nurses, doctors and other health staff have applied their expertise to your immediate needs. It is the best your small to medium sized city has to offer.

They page for a cardiologist. One is not available. They are busy with other people with heart issues. Now what? I know, let us put you on a waiting list. If you are still alive and it can be confirmed that your heart is still unwell when a cardiologist is available, then you will be seen. In the meantime, we will have you fill out a bunch of forms and paperwork, a lot of which have nothing to do with your heart condition.

No?

There are going to be people in your community that you think will benefit from Permanent Supportive Housing. Like most communities, you will not have enough PSH, or your existing PSH is filled with many tenants that do not actually require PSH. What happens in most of these communities is that they create waiting lists for PSH.

Let us be clear: waiting lists are a game of survivor. Waiting lists favour people with lower acuity. Waiting lists are cumbersome and administratively expensive to maintain. Waiting lists do not work for households that need the resource the most. People deteriorate and even die while on waiting lists. They languish in shelters or receive survival supports on the street. Their homelessness and dependency becomes even more institutionalized and normalized.

If you had a heart attack and a cardiologist was not available, you would want the next best thing. It may be an ears, nose and throat specialist, or a gynaecologist, or a paediatrician, or an oncologist, or generalist, or any type of medical doctor. It may be that this person is keeping you alive until the cardiologist is available. But the point is: you get served and you get the next best thing.

In the delivery of housing resources to people experiencing homelessness, we have to get into the mindset of delivering the next best thing. When there is not a PSH unit available, we need to think creatively: what would a more intensive Rapid ReHousing program look like? What could a re-think of transitional housing as intensive interim housing look like? Would might master leasing of a couple of apartments as bridge housing look like? Is there a possibility of converting a shelter or part of a shelter to be more housing like?

The point is people with deepest needs require service as immediately and as intensely as is feasible, with a strong housing focus (the only known cure to homelessness). Waiting lists are not in anyone’s best interest, whether that be looked at from the service providers perspective of the end users perspective. We need to have a solution-focused, action-orientation and not a waiting list, bureaucratic orientation.

National Alliance to End Homelessness Conference: 3 Ups and 3 Downs

I just completed my 11th National Alliance to End Homelessness conference. It is a touchdown point for me every year. It is a chance to take stalk of how I am doing and how OrgCode can help; it is a barometer of where communities and America is at in its pursuit of ending homelessness. Here are my three ups and three downs of the conference:

First the Ups:

1. The National Alliance to End Homelessness does not disappoint.

Make no mistake about it, under the leadership of Nan Roman this organization knows how to organize and succeed at the conference experience. The conference tracks this year were well organized. The calibre of speakers they can recruit is extraordinary (and if you don’t know – speakers volunteer their time and get themselves to the conference and pay for their hotel room all on their own dime). The content was relevant.

2. We have weathered the storm of the Family Housing Options study.

I thought the Family Housing Options study would be the destructive factor in the conference and railroad fruitful discussion on rapid rehousing. It did not. I think speakers – including researchers, consultants, practitioners and Alliance staff – all handled the framing of it well. There are methodological flaws. There are still some good lessons to learn.

3. Networking.

This conference is a magnetic gathering point for everyone that works in the homelessness service field. There were 1,700 people this year at the conference. That is extraordinary. How far they have grown! Registration closed early. But more important than the volume of people present was the networking that you experience and see occurring. More than just “here is the great thing my program is doing” bragging that happened historically in some instances, I saw a lot more collegial sharing and interest in listening. Oh, and people had some fun too.

Now the Downs:

1. VA Secretary McDonald.

The plenary on Friday with Secretary McDonald was a colossal disappointment to me. There was no mention of the clusterfudge that is GPD programs and how this relates to ending homelessness.  It is THE issue in my opinion as communities work to zero. I wanted to see leadership in navigating how they are responding to GPD to get a successful resolution to all homelessness. Instead there was silence. The issue of the value of ending veteran’s homelessness over other homelessness has always been a sticking point for me. I will own that. But all of the messaging around veteran’s reinforced the divide between VA services and HUD funded services in my opinion. For example, when the secretary speaks of it being a patriotic duty of landlords to rent to homeless veteran’s, is there not a patriotic duty to take care of the poor and suffering and huddled masses that were not veteran’s? I also refuse to believe the rhetoric and narrative that ending veteran’s homelessness will teach everyone else how to end homelessness. Why? Because there is no policy or funding discussion about making the same volume of resources available to HUD funded programs. Yes, proving that homelessness can be ended is a good thing. Saying that the VA funded resources will show others how to do it is a fallacy because they have resources that no one else has access to. McDonald did not build a bridge. He did not show everyone a pathway forward of ending all homelessness. He promoted a self interest. That is only going to make matters worse, not better.

2. Considerable variation on what people mean when using the same terms.

Even with a shiny glossary at the back of the conference agenda, there was still no shortage of people using the same terms and meaning different things. Let me give you an example: rapid rehousing. One guy I spoke to was describing how they use rapid rehousing for people at imminent risk of eviction, not persons experiencing homelessness. Another lady was telling me about the great outcomes of their rapid rehousing that requires participants to have employment income in order to be eligible for services. Some people in sessions seemed to be referencing a “light touch” while others talked about rather intensive supports. Other terms that require more careful parsing to move forward in a common understanding: diversion, housing first, navigator, case manager.

3. Confusing programs with systems.

A program is an approach to delivering services to a particular population (or populations) within the context of other programs, funding, policies, legislation and day to day reality. Some people can only see their program or the service orientation of their program and do not see the system as a whole and the interconnectivity of its parts. Let me give you an example: a session where a provider spoke of their conversion from transitional housing to rapid rehousing, but could not put what they experienced into the context of other service providers, the impact on homelessness in the entire community, how resources get allocated in the community, or the migration of people experiencing homelessness from one program to another. Let me give you another example related to Housing First. I have great respect for Sam Tsemberis and I am a strong supporter of Recovery Oriented Housing Focused Assertive Community Treatment. It doesn’t help when he tells a room full of people that he does not believe in coordinated entry or common assessment. He has rejected/ignored all offers to meet or discuss with me the VI-SPDAT and SPDAT, as the Alliance conference was not the first place he has made such claims. It also doesn’t help when Nan has to hold him accountable for inconsistencies in statements he has made around rapid rehousing between various meetings and conferences. Housing First is a particular type of service intervention, as well as being a philosophy to how services should be delivered – and a strongly support both. But Housing First is NOT a system and it is dangerous to suggest it is (in the same way that it is dangerous to suggest that an assessment tool is a system or an assessment tool is coordinated entry). A system has many programs. How they share a service orientation is important. How they link together is important. Confusing a program for a system – whether that is rapid rehousing or Housing First or diversion or progressive engagement or whatever – puts us backwards, not forwards.