We Need to Tackle Grant Per Diem Funded Programs – NOW

If there is one pressing issue to be tackled from a policy and funding perspective in the pursuit of ending homelessness, it is grant per diem funding in any homeless services. While much of the spotlight has been on Veterans Affairs and its massive inventory of GPD funded beds, they are not alone. Other jurisdictions have wrestled with the concept of GPD funding in shelters for quite some time – and with little success. I say now is the time for tough change to get GPD aligned to the pursuit of ending homelessness.

If you don’t know what a GPD program is, in a nutshell it goes like this: as a service operator, you get a set fee for a head on a bed each night. Used in a sheltering context (which varies by jurisdiction, but can include things like transitional shelter, something resembling transitional housing, or emergency shelter…or in some antiquated models in the northeast something resembling a nursing home), the service provider most often provides some support services to the participants in this program.

In my experience and travels, these services are all over the map in terms of intensity, professionalism of delivery, and purpose. For example, in some instances I have seen highly qualified addiction counsellors provide a form of residential support and counselling to those striving for sobriety. But I have also seen too many poorly constructed life skills and budgeting classes, as well as terrible employment readiness programs. Some GPD programs offer around the clock access and supports. Others have periods of time where residents are expected to be out during the day. Some GPD programs require sobriety or meeting with a case manager within a certain number of days of entry or an employment plan. Others are much more low barrier. I guess my point is, people say “GPD” and make assumptions that they are all the same thing, when there is overwhelming diversity and a lack of quality assurance from city to city (or even within the same city). Country to country it is even more diverse.

What should bother us more than the diversity of programming though – and what I don’t get – is how any community or leader on the one hand can say they are all for housing first and then in the next breath support a GPD program. GPD, as it is most often delivered, is the epitome of housing readiness, which is the antithesis of housing first. The programs do not facilitate rapid access to permanent housing with supports wrapped around in the community.

GPD incentivizes homelessness. No service operator, from a financial perspective, wants to have people vacate their program until whatever imposed stay limit is exhausted. Why? They would have to find another head for the bed to ensure financial sustainability. Maybe this is not a concern in communities where there is considerable demand that outstrips supply, but the demand should not be what drives the program or its funding model in this instance. Should people stay homeless longer because it is in the financial best interest of the operator?

Those in the know will say GPD programs cannot and will not change until there is a legislative change, which steers the ship for providers. So what are we waiting for? If we know the answer, why is there little movement in most jurisdictions to rectify the matter? Is there a GPD lobby group so strong that it should overwhelm evidence and dare I say common sense? This is a classic example of a leadership void for a solution waiting to happen; an instance where popularity of a program and the fear of backlash trumps what is necessary.

Let me layout a funding transition plan that would get the ball rolling.

Offer each GPD provider guaranteed income of $25 per bed in their facility. Multiple that by 365 days. That should be enough to keep the place with a bare-bone staff and pay essential operating bills. In a 25 bed facility, that would equal $228,125.

Ensure GPD providers take people with the highest acuity first. So, the deeper the need on the part of the person that is homeless, the more likely they are to get access to the bed.

Then, offer an incentive of $500 for each person housed out of the GPD funded program. If the person does not return to homeless for three months, provide an additional $100. Do the same at 6 and 9 months. At the 12 months mark, if the person has not returned to homelessness, $1,500 bonus. If 100 people were housed through the program each year, this would actually result in the GPD funded program operator having a slightly greater annual budget (from GPD resources) than operating in the traditional manner – and it would move us all closer to ending homelessness. That would more than take care of all other staffing and building costs.

At the same time, ensure there is a financial disincentive for anyone that has a prolonged stay in a GPD program (perhaps with some exceptions for people that are palliative). So, for example, if someone has not had a positive housing destination within 6 months, the GPD provider only gets $15 for that person each night. If that reaches a year it is $10 for that person. If the person is still in GPD at 18 months, the provider only gets $5 in funding for that person.

That would work for the “traditional” GPD programs.

Then, if there is an appetite for service enriched programs like the professionally staffed addiction counselling and substance use recovery programming that I referenced earlier, call it something other than a GPD program. Give it block funding. Because really, a substance use recovery program is great (and needed for many people) but do NOT confuse a substance use recovery program with a homeless program. Homeless programs end homelessness through housing. Substance use recovery programs end the use of substances. They are NOT the same thing.

At the same time we need analysis on what the right size of GPD needs to be in each community. Some of this work has started, I know. If there has been such a HUGE investment in things like SSVF programs for veterans, and rapid rehousing in other jurisdictions where GPD is not limited to veterans, we should be seeing a reduction in GPD demand. As such, we should start decreasing the overall volume of GPD beds. With proper (and simple) analysis, this should be something that could be implemented over the next 12-18 months.

Now onto something I am going to say that will certainly be unpopular in some circles: until you have wrestled your GPD programs to the ground, do not make a claim that you have ended homelessness for veterans or any other population group for that matter. When, for example, any group doesn’t want to include GPD beds as people being homeless it is a misrepresentation of the true state of homelessness. When, for example, a community gets “cute” with how they name or classify their GPD beds in order to claim some sort of victory in getting an entire population housed, they are kidding no one and creating an overwhelmingly dangerous interpretation of what is actually happening on the ground. Out of sight does not mean out of mind. In fact, I will go so far as to say take any claim of ending homelessness with a grain of salt until there is a transparent answer on what is happening with its GPD beds. New Orleans did a good job of being transparent in this manner; but even then I would argue they should be called something other than a GPD bed.

As more and more communities start claiming “functional zero” in ending homelessness for veterans across the United States while having full GPD programs, it is a powder keg waiting to explode in the media and a public relations disaster waiting to happen. It doesn’t matter what any “takedown list” was, so long as people that are homeless continue to be served by GPD programs that are actually any variation of a shelter or transitional housing program, then let us have the courage to say: “They are still homeless and we are not done ending homelessness yet.”

Let me tackle the other argument that I hear a lot regarding any sheltering program that is funded through GPD. It goes something like this: “But, (insert name of population group like veterans, survivors of domestic or intimate partner violence, youth, people in recovery, people with concurrent disorders, recently hospitalized, etc.) NEED this GPD program in order to be successful in permanent housing.” What I think people are confusing is a mechanism for funding from a specific type of program. There are loads of great programs for different population groups. We know some work. We are still learning more about others. We know that other types of programs quite plainly fail. It is an injustice to suggest that a program that incentivizes a longer length of stay because of its funding source is a BETTER program.  I can think of no population group that has a better housed experience through a prolonged homeless experience.

So now is the time to take action. Now is the time to challenge what is occurring and demand that we do better. If we are serious about ending homelessness in any community (and I really hope we are), we have to get serious about changing the nature of GPD programs to get more people housed. In the meantime, we need to be counting people in GPD funded programs as homeless. Calling it anything else is not an honest representation of what is really happening.

Tough Love Ain't Love

"Sometimes you gotta show clients tough love so that they'll get their act together."

That is a direct quote in a community I was just in, and the third time in just over a week I had heard a similar sentiment. 

Tough love ain't love. It's being a coercive, power-hungry jerk and convincing yourself that it is love. Tough love is so far from love that it is like saying your socks are a portable napkin stuck in your shoe.

It is appropriate to set and socialize expectations with people. But denying people access to service unless they conform to a certain way of responding is akin to telling people to change who they are so that you can give them what they need. I don't subscribe to any belief of service delivery that uses housing as a reward instead of a right.

I get it - it can be frustrating to try and help people change that are resistant to the idea or actions of changing. This is why we have tools like Motivational Interviewing and Assertive Engagement. This is why we try to find strengths and assets to create a truly person-centred approach to service delivery. This is why effort (on the part of the service provider) is the siamese twin of success.

If we truly work from a place of compassion, then we embrace that it is a relationship between equals; not a relationship between healer and wounded. Tough love has a horrible power differential where the service provider deals in absolutes. I say it is like the person that wants to race home even though it is rush hour. Our work is more about moving slowly forward...but still moving. It is not about creating expectations that cannot or will not be met and then see it as a failure of the person on the journey for not getting to the destination quick enough.

A tough love approach is antithetical to understanding and practicing a recovery orientation in our work. Adding more pain is not going to stimulate more growth. Tough love increases feelings of shame, especially if the person does not measure up to the expectations that are laid out to them. Tough love does not appreciate that recovery is non-linear, and instead often circular and incremental. Tough love tries to force a one-size-fits-all approach rather than working through individual nuances.

While tough love continues to be very present in the substance use recovery industry - and that many practitioners in homeless services try to borrow the "logic" and apply it so homeless services - we must also remember that the substance use recovery industry is largely unregulated and many treatment programs institute programs and approaches that are not supported by solid, or any, evidence. Harsh rules and brutal confrontation rarely produce the desired outcome of the person enforcing the rules or engaging in the confrontation. And what is the message we are giving people with this? If you break the rules or do not respond the way that I want you to when I confront you then you are a failure. 

Those who want to practice tough love give us insight into their view of homelessness as well. Essentially, if you want to practice a tough love approach you are suggesting that homelessness is a choice, that the person is lazy, or that their homelessness is immoral. In other words, your approach is to try and break them of this bad habit. So no wonder tough love rarely works, especially over the long term, because homelessness is not a choice, a sign of laziness, or immoral. 

Let us instead radically practice kind love, not tough love. Let us begin by embracing where people are truly at, and that whatever place people are at when we engage with them is the right place for them at that moment. Let us avoid punishment or shaming if people do not change on a timeline we establish for them. Let us challenge ourselves to be more creative in our problem solving. Let us truly see and accept the dignity and worthiness of each person rather than seeing them as less than worthy of what we have to offer - and demanding that they change in order to get it.

NAEH17

The annual conference of the National Alliance to End Homelessness is happening this week. For more than a decade I have been here presenting. I have seen the conference grow through several hotels that could accommodate the increased demand for the conference and what it has to offer. I have seen superstars within the sector stay with it as long as I have, and seen others come and go.

For years, this conference has been the re-energizer that I need to keep going in this work. There is something infectious about the passion of others, and really uplifting when you see and hear the results that are being reached.

At the opening plenary this year, I was really struck by the fact that homelessness has gone down in all population groups across the country, while at the same time rents have gone up 21% and wages amongst the poorest have gone down. In other words, there is no reason why homelessness should be decreasing, yet it is.

How is this possible? What does it mean?

To me, it means that the overall perspective of homelessness as something that can be ended has taken hold.

To me, it means that knowledge and skills within service providers has improved.

To me, it means that there is a steadfast resolve to tackle problems and fix them rather than coming up with excuses of what cannot be done.

To me, it means that we have seen a shift in leadership that promotes ending homelessness rather than perpetuating therapeutic incarceration. 

I am so grateful to be here again, share what I know, and learn from others. I hope and some point in my lifetime this conference is no longer necessary. But until that time, there is no place I would rather be when the conference is happening.

Retrospective

This week marks another birthday for me. It isn't one of those milestone birthdays, and yet I have found myself more retrospective than usual for some reason. This blog is an attempt to share some of the lessons I have learned up to this point in my life.

1. People are not the problem. The problem is the problem.

Everywhere I go it is likely that a sentiment of some sort will be shared about people that do not want to change or are resisting services or are sabotaging what is being made available to them. In other locales it is that the business community or a neighbourhood group is flabbergasted that homelessness is seen as disrupting their way of life or livelihood. People are not the problem. The problem is the problem. Problems are solvable. People will just keep being people. If you focus on solving problems rather than trying to treat people as the problem, you find more success.

2. You don't need permission to be awesome.

Inspiring awe in others is a by-product of living your passion while being effective. Over and over again I meet people who know exactly what needs to be done, and often know how to do it. So why don't they? Because they live in fear of the view of others. Because they exert more effort trying to be liked than on being effective. Awesomeness is a force multiplier. Be brave enough to be awesome when it is the right thing to do and support for your impact will follow.

3. Sweat holds more value than tears.

If you work on a complex social issue it will be the hardest work you may ever do. Every day you choose to run into the fire while others are running out. And you do so for little pay or glory in almost all instances. Yet there are those whose motivation is to open a can of worms to go fishing for sympathy rather than silently working their butts off to compassionately live empathy. News flash - it is a privilege to serve others, not the other way around. Work hard in an effective manner and you will have more impact than trying to get people to feel sorry for you or the people you serve.

4. A big heart and a big brain are not the same thing.

Homelessness continues to be the only industry I know of where we think concern about the issue equates to knowledge of how to solve the issue. Caring does not equal qualified. Of those people and organizations I have met that have the biggest, long-term impact, they have figured out that marrying your heart with your head is the only way to go. We need smart compassion.

5. Therapeutic incarceration must be ended.

People do not need to be healed or fixed to be successful in housing. If you keep adding programs into a homeless service to try and heal or fix people, you are working against the objective of ending homelessness. Sure some people will need a lot of supports to be successful in housing. But put those supports where they belong - into your housing program - rather than prolonging the experience of homelessness.

6. The mistakes of our youth is what makes up the beauty of our age.

The more mistakes we make, and the faster we make them, the more we learn and the faster we perfect our craft. A musician considered to be a virtuoso did not become so over night. They practice. A lot. They make mistakes. A lot. Then they can continue to challenge themselves to get better and better and better. If you learn from your mistakes, you are doing it right. If you are risk adverse, you will become stagnant.

7. Being an innovator is unpopular.

If you are a disruptor - even a positive disruptor - by coming up with new ways of thinking and doing the work or being creating new tools and strategies, you will be hated - at least by some. The sooner you embrace that your job is not to be liked, but to serve, the easier it gets. Hatred is a problem of the hater, not a problem of the innovator.

8. Complex issues are solved by doing, not by planning.

Homelessness has never been ended in a committee. It has never been ended through a 10 year plan. It gets ended by doing. This is not to say that planning and meetings are not important. They most certainly can be. But committees and planning without dedication to doing is meaningless.

9. Figure out what you CAN do rather than lamenting what you CANNOT do.

Naming and discussing the barriers that exist becomes old fast if all you do is name and discuss and never get into the business of either: 1) what you can do regardless of the limitations and circumstances within which you work; 2) actually providing solutions to the barriers. 

10. Live an authentic and vulnerable life.

The worst, flawed real me will always be better than the best, fake me. As a recovering asshole, I can find myself relapsing back to lashing out rather than seeking understanding; I can find myself protecting my pain rather than opening myself up to sharing. Maintaining an open ear has always been harder than attacking with a sharp tongue. But the more I learn to let my guard down and invite others in, the more I find myself engaged in real relationship, real dialogue, and real change.

11. Don't waste time trying to convince others you are right when they cling to cognitive dissonance.

I have yet to see a public education campaign have a long-lasting impact on homelessness. I have seen small victories in challenges to NIMBYism but never seen it disappear. I have not seen a public deputation to elected officials result in a permanent shift in ideology. But what I have seen, time and again, is that action speaks louder than words. Show people what works rather than trying to convince people what works.

12. Time does not heal all wounds, and not everything happens for a reason.

I get while people cling to these notions, but they are trite and hollow and fake. The more I have learned to live, practice and teach others what it means to be trauma-informed, the more I struggle with how we live in a perpetual state of wanting everything to be okay rather than accepting that everything is not okay. This doesn't mean we cannot focus on healing and recovery and finding balance and supporting people to be well. We can and we should do those things. But some pains never go away and some of the shit that happens in life defies all logic. Once I realized that in my own life, I started to forgive myself for having feelings based upon past events that were completely outside my control.

13. If you don't define you, others will define you.

If I do not form the narrative of why I do what I do, what I do, and how I do it, then I am at the mercy of how others interpret and view my motivation and practice. Be who you are with your own inspiration. Otherwise you will spend a lot of time and be unsuccessful defending yourself to others.

14. Ask for and grant forgiveness.

It took me many decades to both realize and practice that requests for and providing forgiveness is a sign of strength, not a sign of weakness. The only cost of not doing so is my pride, and that is a small price to pay for the satisfaction of forgiveness. This is not to say all things are forgivable. Nor is it naive to say that all offences and wrongs are equal. My life, however, has been so much more peaceful once I realized the important function that forgiveness plays in moving forward rather than being stuck in the past. And this includes forgiving myself for many thoughts and actions in my past.

VI-SPDAT: 14 Things That Irk Me

Here are the 14 things that people do with the VI-SPDAT, say about the VI-SPDAT, or don’t know about the VI-SPDAT that irk me:

1. Confuse it with an assessment tool.

The VI-SPDAT is a triage tool. The SPDAT is an assessment tool. In almost all instances when a person says something to the effect of, “But the VI-SPDAT doesn’t give us enough detail about x, y or z.” I agree with them. Because the VI-SPDAT as a triage tool is not designed to give all the details about x, y or z. If you want to know more about x, y or z, learn how to administer the assessment tool because the level of detail you are yearning for is stuff that should be gleaned through an assessment.

2. Have an inconsistent introductory script. 

If you want reliability in using the VI-SPDAT, make sure that every person that administers the tool in your community introduces it and explains it in EXACTLY the same way. No variation.

3. Think that you cannot explore for more information.

 In Version 1 of the VI-SPDAT, this was the case – you could only ask the questions as written. In Version 2 of the VI-SPDAT we made it possible to further explore through observation, documentation and, with consent, what other professionals know about certain parts of the household’s history.

4. Use it too far up stream.

Diversion first at shelter entry. When that does not work, give people a chance to self resolve. Only when that does not work should a community dig into the VI-SPDAT. If you do the VI-SPDAT right away, you may inadvertently give up on people that may otherwise self resolve.

5. Use it judgmentally. 

The VI-SPDAT gives you a number. If a community starts referring to people as a number then the tool has failed. People are not a number. People are people.

6. Lack knowledge of the full suite of SPDAT tools.

There are full SPDAT instruments for youth, families and single adults. There are VI-SPDAT instruments for youth, families, single adults and people leaving incarceration. There is also a diversion and prevention VI-SPDAT. Use the wrong tool in the wrong situation and you will get the wrong results.

7. Think the score of the VI-SPDAT is the only piece of information that should be used when establishing community priorities for coordinated entry.

Let me be really clear on this – we do NOT suggest that any community prioritize households based upon the VI-SPDAT score alone. Only your community can establish the priorities for your community. That usually is some combination of VI-SPDAT along WITH things like chronic homelessness, where they are homeless (like the street), trimorbidity.

8. Fail to examine what the data tells them about their system or program performance.

Every now and then a community will say things like, “The VI-SPDAT does not work for Rapid Re-Housing. It keeps saying people should need RRH, then they lose their housing. They really needed Permanent Supportive Housing.”

Part of that may be true. But let us consider something else as well – that your RRH sucks. The issue may not be the tool. The issue may be that service providers in your community do not know how to do RRH properly. Or even PSH properly. That isn’t an issue with the tool.

9. Add multipliers.

You can establish community priorities based upon priorities like trying to house medically vulnerable people first. No problem. What you can’t do is take things like the Wellness section and decide to multiply that by 2 or 3. Filter your data. Do not multiply your data.

10. Do not understand how the questions were actually created.

Most of the questions within the tool were actually created by people experiencing homelessness. We would take the research to them in shelters, drop-ins, hygiene facilities, in the woods, etc. and we would say, “We need to ask a question about x, y or z. How would you ask yourself that question?” Then we tested it and refined it. Over and over and over and over again.

11. Say that the tool is not culturally appropriate, or make claims that it is not trauma-informed, or not appropriate for programs that serve people that have experienced domestic or intimate partner violence.

To make this claim ignores that we have spent hundreds of thousands of dollars getting experts in trauma, domestic violence and culturally appropriate services to vet the tool, make suggestions on improvements, and testing it with the targeted audiences.

12. Claim it does not work for (insert type of program or population group).

The more that we hear these sorts of things, the more that we investigate and find dead ends. So far the only group that MAY have some legitimacy is young head of household families. And even then, we don’t know for sure yet.

13.  Doing the VI-SPDAT over and over and over again.

Unless the household has been housed and become homeless again, or has had a major change in their life circumstances, you only need to do the VI-SPDAT once. Period. 

14. Think it is perfect.

The tool provides data. It does not make decisions, it informs decisions. The tool is not perfect. It will continue to evolve and improve. It is the best available tool based upon the best available evidence and testing. Continue to have an active voice in making it better.

Depression Sucks

It has been a few weeks since I have blogged. I have wanted to. I have not been able to. Not because I have been busy. Not because I did not have access to a computer. Not because I didn't have some ideas of what to blog about. I just couldn't.

Depression sucks.

My schedule is booked out months in advance. Communities and organizations expect me on certain dates to deliver on certain things...training, meetings, motivation, shadowing, a speech, strategy, coaching, etc. What is not booked out in advance is when depression will rear itself at a level that I am not expecting or prepared to deal with appropriately. Recently I have gone through one of the worst spells in a long time. I am working my way out of it. And I promise you there will be more blogs on more important subjects in the not so distant future.

But in the meantime, know that I am concentrating on my wellness. I am trying to take care of myself so that I can be present for others and deliver in the ways that people expect at home and on the road.

I am acknowledging my irritability and fatigue.  I am acknowledging and working through my difficulties in concentrating and remembering smaller details. I am working through my feelings of emptiness and worthlessness. I am dealing with my anxiety and loneliness. I am working on taking care of my overwhelming feelings of being tired all the time. 

I know I owe many of you emails or data or phone calls. I know that these keep adding up. And I know that when I don't respond people think it is because I am aloof, or preoccupied, or busy, or forgetful. To the outsider, I can only imagine what depression looks like when you are counting on someone who lives with it, but you don't know they are going through a spell. I feel horrible that I fail at taking care of things like communication at times like this. I want to so bad be able to manage that while working through the depression. But I can't. 

As I said, I am on the upswing again. Over the coming weeks I will catch up. Promise.