Measuring a Functional End to Homelessness

It is no easy task to measure an end to something as fluid and dynamic as homelessness. I am not writing this blog to critique approaches that have been suggested by others. Instead my focus is to add my voice on considerations and approaches that communities may want to contemplate to truly declare “Functional Zero”.

Focus on outcomes, not outputs. 

An output measures the volume of an activity. An outcome is the measurement of what difference any of it makes. If you are focused on outcomes, the system changes WHILE the program participants are getting housed. With veterans I would expect, for example, different outcomes related to transitional housing and GPD programs than what they currently are because of the focus on permanent housing. With chronic homelessness, for example, I would expect a change in community policing and engagement with people living outdoors. These are just a couple of examples amongst many that are possible.

The difference of any program focused on housing should be not just that people get housed (really important) but also that people stay housed (though maybe not in the same place they were first housed). Housing retention rates (preferably by acuity) are a good measure, especially if we can track changes in acuity post-housing.

Don’t blame the service participant; examine the service provider.

Noting an offer of service is good insofar as it tells us something about whether people are engaged by outreach or other service providers. What it does not tell us is if the proper service is being offered. I would suggest that we need to know HOW service providers are adjusting their services and service offers to best meet the needs of people that are in need of services. Think of it this way:

The manager of the restaurant asks his server, “Did you go to their table?”

And the server replies, “Many times.”

The manager asks, “Did they get what they came here for?”

And the server replies, “I offered them drinks each time and they kept saying ‘no’.”

So the manager inquires, “Did you offer to make them the drink of their choice? Did you offer them the dinner menu with water? Did you see if they were here just for dessert.”

And the server replies, “You just said we needed to check in on our tables. You didn’t say we had to cater what we offer to give them what they need.”

Measure fidelity to a specific type of evidence-informed support model.

If your community has an ACT program to assist with service provision, then you can measure fidelity to the ACT model. If your community is using an ICM program to assist with service provision, the you can measure fidelity to an ICM model. These are well established and will tell you if service providers are doing what is necessary to provide supports necessary to keep people housed in alignment with the main currents of thought and practice, as evaluated and published.

The assumption here is that an evidence-informed model of support is being used in your community to end homelessness. If it is not, then that probably raises bigger flags – especially if you are trying to measure an end to homelessness.

Focus on what you know you know, while respecting there are some things that you don’t know you don’t know.

A presumption and preference of knowing each person or family experiencing homelessness by name is a very good thing. But there is a huge (flawed) assumption in that, which is there is a mechanism to be all-knowing in real time.

There are things we know we know. There are things we know we do not know. There are things we do not know that we do not know.

To the best that your resources allow and to which people engage with you, you may have a voluntary list of persons that want services from you. That is a great thing. Do not assume, however, that it is 100% representational of what is happening in your community.

Measure the things you control, and not the things you do not.

Outcome measurement should be limited to the impact of resources that are directly within your control to influence. For example, considered a VA funded program that requires the person to be anything other than dishonorably discharged to be eligible. Measuring an end to veteran homelessness, therefore, may want to include people that were, say, dishonorably discharged, but the VA does not control those resources. Therefore, it is impossible and inappropriate for the VA to prefer or compel a non-VA resource to help out a veteran that was dishonorably discharged. Consider my restaurant example again:

“I sent the couple to Murphy’s next door because they did not meet our dress code” says the maitre’d to the manager.

“Very well,” says the manager, “but please go next door and make sure Murphy’s served them well.”

“But we do not own or manage Murphy’s,” says the maitre’d.

“Yes,” says the manager, “but they should serve them because we cannot.”

And what would we expect? That Murphy’s served the couple? That they would give up a table that could have served other patrons because the restaurant next door – that does not own or manage them – sent the couple over? Is that in the other restaurant’s best interest?

Decrease variation. Always.

If we are going to measure an end to homelessness there will be local circumstances that influence efforts (for example: vacancy rates, fair market rent, etc.). However, the more we suggest there can be variation rather than standardizing based upon certain characteristics, the more flawed the measurement. If we are going to benchmark, what prevents stating something like, “In markets where the vacancy rate is 2.5% or below and the fair market rent for a one-bedroom unit is $800 or above, the average length of homelessness should not exceed x.”

If it is politically driven in picking the date of when homelessness has been ended or declaring functional zero for veterans happens on or near Veterans Day, call bullshit. 

The great thing about measurement driven by data is that it is independent of political interference. There is absolutely no need to figure out when an end to homelessness fits into a Mayor’s “messaging cycle”. Functional zero happens when functional zero happens. Not when it is convenient.

Which leads me to Veterans Day proclamations. Mark my words: this will be the year when dozens of communities declare an end to homelessness amongst veterans on or near November 11. Just too big of a convenience. It is hogging the spotlight on a day when the media spotlight is conveniently focused on the issues of veterans.

Measure the right things. In the right way. Do it at the right time. Measure it with integrity. If the lives of people experiencing homelessness were important enough to you to house and support them in the first place, surely they are important enough to measure the progress of that goal in a way that respects them.

Are Tiny Homes the Answer?

Every day I get a Google News Feed about homelessness. There seems to be a disproportionate number of articles the past few months about tiny homes. They are sometimes called micro homes or city cottage homes or some variation. In some stories you read about an individual citizen creating the tiny home for a person that is homeless that they know. Sometimes it is a completely new development…like a “tiny home suburb”.

I do NOT think there is one housing solution for every person’s homelessness. I think we need a range of housing OPTIONS for people to choose from. I do NOT believe in housing placement. Could tiny homes be an option for people to choose from? Sure.

But let us dive deeper, and look at these questions:

1.Why do you want tiny homes? Do you want them because they are the nouveau thing to do? Have you asked people that are homeless in your community what they want? What do you expect to achieve through this built form that is not being achieved through other built forms?

2. Are the homes built to standards that apply to other dwellings?

Yes, in some jurisdictions this type of dwelling was not conceived in the building code and special consideration may be necessary. It isn’t that, really, that I am concerned about. What I am more concerned with: are we creating two standards of dwelling? Are we saying that there is one type of dwelling that is appropriate for “normal” folks and a lesser standard for people that were once homeless? Is health and safety and things like means of egress appropriately considered in the design of the tiny home?

3. What is your approach to supports and safety?

If you have ever visited a mature tent city, you know the potential perils of safety and how difficult it can be to penetrate the hierarchy of the community to deliver supports. A tent city will not be safe and sustainable if it becomes a den of debauchery. Do you have a central entry point? How and when can people have visitors in her/his home? What if the household has children – can they still live in the home? Would they still feel safe? Can a person invite their girl/boyfriend to live with them in their tiny home? Is there sufficient separation to avoid spread of fire if one breaks out? Who is responsible for upkeep and maintenance of the dwelling and the common areas?

4. Are you creating a community or a ghetto?

A built form is just a built form. Under what conditions would a person feel that the tiny home – surrounded by other tiny homes – creates an environment that promotes community? Is it community based upon geography or a community based upon common interest? How will residents have a voice in selecting neigbors? Or will they? How does the presence of a service provider (if there is the presence) promote and support – or stifle – community? What steps have you taken to ensure this does not just become another hodgepodge and half-assed effort to take a group of economically poor people, put them together, and request that they are grateful that they even have a roof over their head?

5. Is it the best use of land?

Yes, tiny homes provide a better yield than a duplex, townhouse or single family home. But do tiny homes provide a good yield per acre compared to multi-unit residential buildings? No. Not at all. Not even close. In larger urban areas and suburban areas where land is at a premium, land can represent a significant cost in the development process. If affordable housing development is so hard to come by, under which conditions do tiny homes make more economic sense than an apartment building? Have you thought through the cost per square foot in a tiny home compared to a multi-unit complex where you could still do stick build with stairs?

6. How will residents be selected?

So far I have not understood – in any community – the deliberate process used to select who gets the tiny home. I do not understand how resident choice is reflected in the system context. I do not understand how the service provider (when one is involved) is thinking about acuity, mix, need, compatibility, etc. Have you thought through for whom a tiny home is best designed and delivered? Have you thought about what is required to have a healthy and vibrant community?

I am not against tiny homes. They could be part of the mix. But I am not for them either. It seems to me too many communities are jumping on the bandwagon without a really thoughtful process of what they are going to accomplish, for whom, and how it fits into a broader strategy of ending homelessness.

Say What? Volume 3 – The Crazy Sh*t I Have Heard/Encountered This Quarter

Here we go with my third instalment of the year on the weird and unbelievable things I have heard or encountered on the road. This time it covers July, August and September.

1. “They are breeding like bunnies here because the only way the County cares about you is if you are a homeless family. This city has become one big homeless orgy.”

The nice lady in Minnesota was serious when she was saying this, as it was her contention that her organization gets stuck with all the people the County doesn’t want to help. To her this meant all single people.

2. “They can’t take any woman in her third trimester because they deem her to be unemployable, which means they don’t think they can house her.”

Oh Tennessee and some of your organizations that help (some?) families.

3. “If you are going to help someone get another apartment after they lost their first apartment, isn’t that just enabling behaviour that just gives people a free ride?!”

That is one way of looking at it. I call it an opportunity to reflect, learn and come up with a housing plan that is different and hopefully more successful than the last attempt.

4. “You’ve got to hug ’em…all of ’em…all of the time. Every time you see them. That is the only way they know you really care.”

And not a bad way to cross professional boundaries and maybe even get yourself killed. How about showing people how much you care by getting them housed and helping them rebuild appropriate social networks?

5. “I read your email to our CoC coordinator. I am now convinced that so-called “experts” are the reason why [name removed] is a nut-bar. He drank your kool-aid. Now the rest of us have to suffer through this coordinated access crap.”

Some people are really happy, aren’t they? Especially with change and doing things that, I don’t know, are a federal requirement for funding.

6. “Are you more of a RUSH or Nickelback sort of guy? You could be more Barenaked Ladies though…hey, didn’t they do the Big Bang song?”

And now is the time when all Canadians face palm and wait for remarks about igloos, hockey, maple syrup, and the question about whether or not we know Larry in Calgary or Suzie in Montreal…or if we have ever been to “that lake” not far from “that city” that was in the “Province of Toronto” that they went to on a camping trip when they were a kid. They caught a fish there and met nice people, but the water was cold.

7. “I get what you are saying about safer crack use kits, but wouldn’t it be safer to just take the crack away from them or call the police?”

This is proof that some days even when I am at my best delivering my favourite training on Recovery and Wellness, I am clearly not getting through.

8. “How can we possibly need to house more than 192 chronically homeless people to reach zero if we only counted 192 in our last count?”

This one sounds innocent enough, but trying to explain that: a) Any PiT Count will always be an underestimate; and, b) Some people that do not currently meet the definition of chronic homeless will meet those requirements over the next two years – well that just about made the poor man’s head explode.

9. Street Outreach Worker: At least 90% of the people I work with do not want to be housed.

Me: That seems way, way way too high to me. How do you know they do not want to be housed?

SOW: I just know. I have been going this 20 years. You can just tell by looking at a person.

Me: Have you actually asked all of them if you can help them get housing?

SOW: No. That would be a waste of time.

Me: So, of the 100% of people you work with that you have never asked if they want housing, at least 90% you know will say no.

SOW: Yes.

Me: Have you considered maybe a different profession than Street Outreach?

SOW: Why would I? I love this job. My people love me too. We’re like a big family.

Maybe this one is more sad than funny, weird or just plain crazy shit.

10. “We don’t just need small homes for the homeless. We need super-micro homes and tree houses. If we could take people out of the city and to the woods, they would survive and thrive in these homes on small spaces in the forest. And it would be easy to teach them to hunt and know what bushes they could eat and what not. This would help all of them that do drugs get clean. It would give them a sense of responsibility. They could eat the meat and sell the furs and stuff, just like that show on TV.”

This was from an email from a guy in central Michigan asking for a letter of support from us in his application for a reality TV show. In case you are wondering, I declined to provide the letter.

11. “What are your thoughts on sterilization of the homeless?”

Bad idea. And illegal. But thanks for asking. Though speaking of sterilization, have you considered it – oh nice person from a certain elected official’s office in Kentucky looking for content to help you with your speaking notes? I get there are things in Kentucky in the national media you want to take the attention off of, but seriously? Sterilization?

12. “We are doing research on how much experts, academics, researchers and consultants get paid to deal with the homeless issue. Please indicate which of the following is most true: you make less than $600 per hour; you make $600 or more per hour.”

Is there seriously someone that works in this industry making $600 or more per hour? If so, our pricing (and strong desire to only break even and make no money) is way off.

13. “Do you know Dave Morris? He was my favorite college professor. He is funny like you.”

Dave sounds nice. Really, really nice. And no, I don’t know him. I don’t know all college professors. Nor do I know all funny people. And given you live in California and I live in Ontario, and given you did not even indicate which college you went to, I have zero idea who Dave Morris is. If you see him, though, please tell him Iain says hi. Iain from OrgCode…in Canada…you know Iain De Jong?

It Ain’t Housing Only (For F Sake)

As you read this blog instalment this week, it is important you remember there is almost always a lag between when I write the blog and when it is posted. I especially do not want people to think I am pointing fingers at specific communities I have been to in the past three weeks given I make my schedule publicly available on FaceBook. Let us focus on the message – not a specific place – because you may see yourself in this instalment.

As I often do when I am in a new community, I go out and speak with people experiencing homelessness. I do this often in the evenings when I don’t have other engagements. I don’t talk about it much. And I won’t go into too much detail about why, but in a nutshell, I do it to get the pulse of people that are homeless in the community and how they see issues. It is difficult to sincerely work with local service providers and other officials if I have not spoken with people that are currently homeless. This blog is for Ferdinand. Ferdinand has been housed three times in the last year, mainly through VA programs. All three times he has returned to homelessness because he did not get supports while in housing. And lest you think I just take Ferdinand’s word for it, training in the community confirmed this to be true. And this is why I say this blog is for “F Sake”. I meant Ferdinand. You can use a different word starting with “F” if you like.

See, the Ferdinand experience confirms what keeps happening in my travels – another week and another community that is all about ending homelessness. They speak a good game. They tell me about programs. They tell me about how ready they are to make changes. They tell me about their fancy landlord recruitment strategies. They tell me their Mayor is right behind them. They tell me about their takedown targets. And yet it is the third week in a row that I want to find a blunt object to drive my head against. Why? Because no one is adequately supporting people in housing nor can they tell me the method and approach they are using to do so. And they are not resourcing after-care or housing stability supports in a meaningful way.

If you want to end homelessness you cannot just put people into housing and expect them to succeed without supports. Period.

You should be ashamed to call yourself a Permanent Supportive Housing provider if you forget the “supportive” part. Period.

If you are all about getting people into housing but not about supporting people in housing you are going to fail abysmally. Period.

If you work with people that have moderate or higher acuity you need a structured, evidence-informed, proven approach to provide support in housing. You CANNOT take a passive approach and think people will come to you if they have a problem. You CANNOT think that checking to ensure the rent is paid or making sure there are no damages to the apartment is the same thing as stabilizing people, rebuilding community connectivity, and maximizing access to mainstream resources. You CANNOT think text messages or the occasional phone call is the same as visiting someone in their home.

The proof is out there: to succeed you should help people achieve housing first. This means it is the FIRST thing you do. It does NOT mean it is the ONLY thing you do. It is the start. It is the alpha. It is not the end. It is not the omega.

If you do not figure out the supports part, train on it and invest in it, all of that money spent helping people with first and last month rent? Wasted. All of that political capital expended? Wasted. All of that hard work recruiting landlords? Wasted. All of that public support to end homelessness – whether veterans or chronically homeless persons, or families, or youth, or whatever? Wasted.

Worst of all, all of that trust people experiencing homelessness put into you to end their homelessness? Wasted.

Ask yourself even these simple questions as a start:

1. Is each person that is housed assigned a specific person or team of persons whose sole responsibility it is to keep that person housed?

2. Is the staff to client ratio possible to provide the intensity of services required? (No more than 20 clients per support person)

3. Has that specific person or team been trained on how to deliver an effective housing support intervention?

4. If the person loses their housing, does this same group of people see it as their responsibility to keep supporting the program participant while concurrently trying to get them re-housed as expediently as possible?

5. Does the support person or team connect with the person in their home to deliver supports?

6. Is the support provided in the program participant’s home happening at least once per week during the first six months they are housed?

7. Is the support person or team actively and effectively brokering and advocating for connections to other mainstream and non-profit services to assist with things like physical health, mental health, etc. – and is that brokering and advocacy based upon the program participant’s choice?

8. Are we providing all of our services through a lens of reducing harm rather than treatment compliance?

9. Did each program participant have an active and meaningful voice in what type of housing and neighbourhood they want to live in?

10. Does the program participant have an active voice in the type, duration and intensity of services – deciding what they want to work on in their life related to their housing stability in which order?

11. Does the orientation of the supports encourage and empower recovery and wellness?

12. Is the service delivery planned, structured, strategic and sequential?

If you don’t know or you aren’t do us all a favour – and a particular favour to anyone you are housing in your programs – learn how to or get out of the business and less someone that does know how do it. I don’t want to meet any more Ferdinand’s – for F Sake.

More Care Required than Home-Based Case Management Can Provide: What to Do

Not every community can afford to have (or wants to have) a Recovery-Oriented Housing-Focused Assertive Community Treatment team. Even if they did, not every program participant situation can be fully served through the ACT team alone. And while Intensive Case Management teams are more plentiful, they can be confronted with health, wellness and care needs that surpass the knowledge, expertise, or time availability of the ICM team. Many times I have had ICM staff approach me in training asking what to do with those program participants that have really complex health needs, struggle to maintain their apartment because of their health, or have even been working on a palliative care plan with a health provider.

Housing based case managers are brokers and advocates to other services, rather than the direct provider of health care services, counselling services, etc. As such, the limitation of housing supports is dictated, at times, by the overall wellness of the person. If there is not home-based health supports that cannot supplement the work of the Housing based case manager in an ICM program, the Housing Based Case Manager cannot be held responsible for the health and wellness of the participant. It is outside their expertise or job responsibilities.

The truth is, not everyone can manage independent living with certain health issues. Sometimes care homes, long-term rehabilitation housing, nursing homes, hospice care, and the like are more equipped to handle the health needs of certain program participants than a scattered site unit with supports that come to the home. Is that a failure of the ICM team or the program? No. It is the reality of how care is provided, to whom and how (which can be very different community to community) when it comes to people with compromised health.

This is not always easy to accomplish in a meaningful way in any community.

Needing more advanced health supports and having access to those supports is not the same thing. Many care facilities have long waiting lists. Some require private payment. Others have really stringent eligibility criteria and a health record verification process that almost requires an army of health professionals to navigate – and uses terminology foreign to a housing worker.

Then there is the matter of fit and expectations of people that use care facilities. Many communities do not have care facilities that tolerate the sorts of behaviours that the participants in a housing program may exhibit. You would be hard pressed, for example, to find a nursing home that is supportive of residents using crack cocaine or a long-term care facility that understands some residents are going to participate in sex work. These are communities that benefit from a core review of health services to be inclusive rather than expecting housing works to provide health care services.

Another concern is that housing workers start to disengage with any program participant with a health concern thinking it is automatically the job of care workers to pick up the slack and take the lead because of the health concern. Butting heads across system is NOT service. And it does not serve the best interests of the program participants either.

We cannot house our way out of appropriate health care, when a more medical treatment residential option is the more prudent course of action. We need to work with the health community to figure out the best support and residence models to meet the needs of our clients rather than laying blame or pointing fingers. And at the same time we cannot blame a housing case manager for not having enough health resources or knowledge when it is beyond the expectation of the position – and some program participants will need more health supports than they could ever broker or advocate to access.

Considerations in Using Competition and Comparison as a Motivation Strategy

A common approach to motivation of an organization, community or person is to use competition and comparison. There is no doubt that for those that are driven by potential accolades of being first or seen as best this is an approach that kickstarts movement at an accelerated pace. There is also no doubt that some people, organizations and community are not motivated by this quest to be first – or become demotivated when they realize that they are not going to succeed in a way that others are. I say this is akin to watching a track race where the slower competitors decrease their pace even further before they get to the finish line because it doesn’t really matter to them what their time ends up being.

Comparison leadership is not transformational leadership. There is not a defined sustainable element to comparison leadership in the way that transformative leaders intentionally embark upon while shifting people, organizations or communities in a new direction. At the core of the comparison approach is one of “us versus them” as a rallying cry. Yes, the “us” tends to perform really well. However, it almost never alters the “them” and so a narrative of friction continues.

Comparison leadership is very difficult at the personal level to perform. In essence people are asked to fit in while standing out. They are asked to be like everyone else but be better. It has a tension of assimilation (are you doing the right things that we want everyone to do) out of balance with performance improvement (and when you do those right things like everyone else do them faster or with better results or with improved efficiency compared to everyone else doing the right thing). Brene Brown is right: Comparison is the thief of happiness and success.

As a stimulating strategy for new action and direction, comparison leadership can get the ball rolling. This is surely a benefit. It can get people to gel around a strategy quickly, without a doubt. It can get people to dig in and want to prove to themselves and others that something new is possible. We should consider comparison and competition as a leadership strategy when it is warranted. However, once the new direction is on firm footing, we need to careful transition to a different approach to leadership that is more inclusive and transformative. If you don’t, people, organizations and communities are at a loss when they are surpassed; or they focus their energy on the “game of process improvement” and lose sight of the end user of their services.

Content such as this is going to be covered at the Leadership Academy on Ending Homelessness this fall. While we are sold out, you can get your name on the waiting list. You can also let us know if you would be interested in attending if we were to host another Leadership Academy next year.