Planned Disengagement
In time-limited housing support programs, when and how we end the housing support process requires careful thought.
Disengagement has a slew of other names in our sector. Graduation. Program exit. Program end. Service delivery conclusion. etc. I am going to go with disengagement, and in this blog, I am talking about planned, voluntary termination of time in a program because the program participant has been successful in the program. I am not talking about involuntary, unplanned ends of program involvement.
Because we are looking at disengagement in the context of time-limited programs, the time factor is a variable that should, whenever possible, exist as a goal post rather than fixed absolute. For example, having a six month program that expels people from a program because six months is up rather than because goals were reached, will have the unintended consequence of having people return to homelessness. The time factor should have us reverse engineering the milestones that need to be reached to allow for the self-sufficiency after disengagement to occur.
Disengagement is best implemented by having a transition process when goals are reached and self-sufficiency seems to be intact. To be clear, I don't know if there is any absolute way of accurately measuring self-sufficiency, so this is more of an informed opinion on the part of the housing support worker and the program participant than having a finite checklist of criteria to be met. (For example, I am not advocating communities dust off the Self-Sufficiency Matrix and start using it as the measure for ending supports.) What we can measure, though, is whether goals are being reached and whether a variety of life skills have been learned. It can be helpful use tools like the Effective Exit Worksheet that you can get from the Products section of our website.
Disengagement is worth acknowledging as a milestone in the journey of being in a program and exiting homelessness, but I am not sure it is worth celebrating with cake and whatnot the way some programs do. By the time we get to disengagement I would expect that supports would have gradually been withdrawn to the point where the supports end with a whimper rather than a bang. And besides, disengagement is really about the program participant growing, changing and adapting to the point where they can integrate all of the knowledge and skills development received through the case management support; it isn't about taking a victory lap of some sort.
Speaking of the program participant interests, I think disengagement is more likely to be successful if we keep them front and centre in the planning of the disengagement. At the start of the program the participant should know that disengagement is the goal in the time-limited program. The program participant should know, transparently and from the beginning, what the criteria are for disengagement.
Disengagement may mean the end of case management support from a housing worker, but that does not mean that all supports from other community providers must also come to an end. For disengagement to work well there can be a whole process of linking the program participant to alternative community resources, and where necessary and with consent, to have information about the disengagement shared with other community service providers.
It is not uncommon for program participants to have concerns before or during the disengagement process. It is best that there is open dialogue to name these and address each one. It can be helpful to start this process months before the actual disengagement.
Being Authentic in Ending Homelessness
This week I am channeling my inner Brene Brown and focusing on what it takes to be authentic. This has been top of mind for me lately. I went fishing Saturday, which is one of the activities I do that lends itself to being self-reflective. My grandfather once had a sign up in his house that said, "Fishing: a jerk on one end of the line waiting for a jerk on the other." Fishing is time to focus on whether or not I am being a jerk.
To be authentic, one must:
Cultivate courage to be imperfect, set boundaries, and be vulnerable;
Exercise compassion that comes from realizing and accepting we all are made from strengths and struggles;
Nurture connection and sense of belonging that can only happen when we believe we are good enough;
Invite grace, joy and gratitude into life.
The courage to be imperfect is really hard. I live this a lot, but it is scary. The VI-SPDAT is a good example of having the courage to be imperfect because the tool is not perfect, people often use it wrong, and I spend every day (well, part of each day) thinking about what to improve upon it and the other SPDAT products next. The SPDAT products are the best and worst part of my contributions towards ending homelessness. It has changed how communities go about addressing homelessness, but it also has its haters. Having the courage to be imperfect often means inviting haters into your life whether you want them there or not. I would love to Taylor Swift them all and "shake it off" but that is easier said than done. Why? Because the hatred of the tools often becomes personal and is about the creator not the tool itself. That makes me feel lonely and self-conscious and inadequate.
Exercising compassion is also really hard. I am a work in progress in this regard. As a younger man I would pounce on the weakness of others to make a point or exert influence. On my weak days, I still see the ugly side of myself. I can talk a good game of being strength-based - and I try hard to be - but I am also weakness-influenced. Thankfully this has never been the case for me with people who are homeless. But it happens sometimes where I struggle to exercise compassion with service providers that, say, argue against the merits of Housing First. I wish I knew how to enter into relationship with them in such a way that would make them more open to another point of view, but alas, staying focused exclusively on the merits of the debate gets muddled by my inner-voice trying to silence their opposition.
Nurturing connection is something I struggle with because a) I am on the road all the time; b) I struggle to trust people; c) I live with low self-esteem; and, d) I am, at heart, an introvert masquerading as an extrovert much of the time (which is exhausting). Maybe it is a history of getting burned. Maybe it is because I have met many awful people with alternative motives. But nonetheless, nurturing connection is something that is worthwhile because I have also seen the benefits of doing so. I have learned that being vulnerable enough to let people into my life that want to be my friend, talk about things other than work, support me in my low points and share with me in my highs, is gratifying. Some of the finest people I have ever met on this planet work in the field of ending homelessness.
Inviting grace, joy and gratitude into life is something I am continually learning to lean into. There are many moments of grace that can be glossed over or missed. There is joy that is waiting to be fully celebrated. And when I go fishing, in addition to reflecting on being a jerk, it also allows me the chance to reflect on things for which I am grateful. Not lost on me is that I get to work on ending homelessness as my life's work - even with haters. I get to see amazing things organizations and entire communities are doing to work towards ending homelessness. I get to share successes with others. I get to lead an incredible team of talented people. I get to keep learning and keep being challenged to be better and better and better. My eldest son even made his 7th Grade Oral Speech about me this year, which makes me well with pride.
I know of no one that is perfect in the pursuit of ending homelessness. But I know there are people I aim to be more like in my pursuit. I know there are people I can continue to learn from and grow from in this pursuit. And I know that when I am open to grace, those moments come to me. It makes me pause, most of the time, take a satisfied breath, and realize there is a real gift to living the most authentic life I can.
A Move Towards Ohana Zones?
As communities struggle with outdoor homelessness, more and more are looking to Ohana Zones as they are called in Hawaii, sanctioned tent cities as they may be called elsewhere. In some communities these are strictly for single adults, while other communities consider these for families with children. Some have premade structures and tents, while other communities require people to bring their own tent or create their own structure. Some are service rich environments with professional staff onsite, while others allow the campers to self-govern. Some have running water and other amenities onsite, while others rely on bottled water and portable toilets. The truth is, there is so much variation it is difficult to provide a comprehensive outline of exactly what constitutes a sanctioned place such as these, other than to say government allowed, encouraged or created it.
Let us look at this critically. I have six questions:
1. Does a sanctioned tent city solve street homelessness?
A sanctioned tent city does not take care of street homelessness in the way that many proponents would like. These are not jails or prisons. You cannot force people to stay in a tent city - sanctioned or otherwise. Yes, you may have some people who were living on the street make use of them. You will still have unsheltered homelessness outside of the sanctioned tent city. The response to this from communities is often along the lines of, “We will enforce existing laws making it very difficult for anyone to stay anywhere other than the sanctioned site.” So, you increase police and court costs and still have very vulnerable people who will refuse to use the sanctioned tent city. And then you have a public relations nightmare on your hands because you spent so much on the sanctioned tent city and expended political capital to put it in place and the general public still sees people staying outside.
You may also have the unintended consequence of having other people who had been precariously housed gravitate to them, or have people exit bricks and mortar shelter to live in the tent city.
2. Isn’t it a cheap fix?
In most instances sanctioned tent cities are expensive to operate. If it is professionally run and operated there are the infrastructure costs and staffing costs. This quickly gets into the millions in community after community and doesn’t actually solve the problem of inadequate supply of bricks and mortar shelter or affordable housing. If it is not professionally run and operated there are still the possibilities of infrastructure costs, but also the increased likelihood of policing costs to address unfortunate instances on the site. People living in congregate settings tend to have conflict.
3. What’s the end game?
There is no end game in sight once sanctioned sites start because communities are not concurrently investing in and/or creating the housing supply that would get the community to the place where the sanctioned sites are not needed. If a community envisions people transitioning through the sanctioned site then there needs to be a concurrent strategy and action plan in place to get people housed out of the sanctioned site. Most sanctioned sites have a fixed size. What is the plan when the current Ohana Zone fills up? Create another one?
4. Who is served?
The population aimed to be served is remarkably acute and complex. If the intention is to serve those that would otherwise be unsheltered, a sanctioned camp likely needs a staffing compliment that surpasses that which is found in a typical shelter. Why? Because study after study shows that unsheltered persons are generally sicker, less connected to services, and have a shortened life expectancy. Go ahead and check out Montgomery et al. Homelessness, Unsheltered Status, and Risk Factors for Mortality Public Health Rep. 2016 Nov-Dec; 131(6): 765–772 or Cheung AM, Hwang SW. Risk of death among homeless women: a cohort study and review of the literature. CMAJ. 2004;170(8):1243–1247 or Cousineau MR. Health status of and access to health services by residents of urban encampments in Los Angeles. J Health Care Poor Underserved. 1997;8(1):70–82 or Hwang SW, Lebow JM, Bierer MF, O’Connell JJ, Orav EJ, Brennan TA. Risk factors for death in homeless adults in Boston. Arch Intern Med. 1998;158(13):1454–1460 or Stergiopoulos V, Dewa CS, Tanner G, Chau N, Pett M, Connelly JL. Addressing the needs of the street homeless. Int J Ment Health. 2010;39(1):3–15 or Levitt AJ, Culhane DP, DeGenova J, O’Quinn P, Bainbridge J. Health and social characteristics of homeless adults in Manhattan who were chronically or not chronically unsheltered. Psych Serv. 2009;60(7):978–981 or Nyamathi AM, Leake B, Gelberg L. Sheltered versus nonsheltered homeless women: differences in health, behavior, victimization, and utilization of care. J Gen Intern Med. 2000;15(8):565–572
Better to invest in professional street outreach services with connections to permanent housing and integrated with health care.
5. We spent a long time making mistakes that led to wanting a sanctioned tent city. Shouldn’t we double-down?
The need for expanded shelter services did not happen overnight. It would appear as though someone was asleep at the switch in long-term homeless system planning, or there was a lack of appetite to invest strategically along the way to prevent the need for a quick fix. Let finger pointing begin on whose fault that was.
6. What should we do instead?
I get it. You have acute needs. The community is bursting at the seams with homelessness. You need housing, appropriate permanent shelter, professional staffing, and a plan. Most sanctioned tent cities are an idea in search of a comprehensive strategy. Yes, the thought of doing the right things comes with a hefty price tag, but compare that to the hollow outcomes and expense of providing sanctioned campsites, and it is a no-brainer.
Mountains
The size of the mountain you have to climb is secondary to the fact that there is a mountain in front of you at all.
I was asking around for blog ideas recently, and it turned into a venting session for many. Anecdotally, I know of many who are feeling overwhelmed these days, and know of three people that have quit or resigned in the last month.
In life, and this work, the heaviest thing you will ever have to lift is your own spirits.
So you - yes you - person reading this blog, I want you to know that you matter and I want to say thanks.
You matter because you reach out to find more information on how to be better at ending homelessness. You are not resting on your laurels. You read the blog probably as part of that journey towards making yourself better (or because you think I am an idiot and it is validating to position your moral superiority against my lame ideas every week).
And I want to say thanks because people like you who read the blog make the blog worth writing. If this thing didn't have an audience there would really be no point in doing it.
No rah-rah speech here, but let me say a few things that may help you prepare to conquer that mountain and to lift your own spirits.
1. Our sector has some of the brightest, smartest people you will ever meet. These are individuals that could likely work in a range of other industries, excel at it, and make way more money. But they chose this industry. We should be grateful that we get to work with really, really smart people. I know it rubs off on guys like me. Maybe you too.
2. If compassion was quantifiable, we would need a lot of numbers to represent it in this sector. I am not talking about sympathy or charitable do-goodery. I am talking about people that work in this sector who are truly present from a place of empathy in this work not because they see themselves as greater than those we have the privilege of serving, but because they are seen as equals to those we serve.
3. When you look at the big picture, we are doing way better than we used to be doing. Even with chronic numbers creeping up slightly, the big picture is a positive one. When faced with a crappy economy, tight rental markets, terrible access to mental health services and homeless-creation-factories like prisons and the foster care system doing their best to give us a steady supply of new people to support, you have been up to the challenge.
4. You stare down a challenge and say, "bring it". Not enough money for resources? Landlord resources getting more scarce? Turnover in staff? Scant affordable housing resources? Folks like you get out of bed in the morning and are not defeated by it. You say, "bring it" because while you are not ready with an answer, you are ready for a challenge. We are a scrappy, rag-tag bunch that does this work well because we dig in to find answers rather than bellyache about problems.
5. You know what you are brilliant at. Why? Because you have endured discovering all of the things you are average or even lousy at. You have discovered much about yourself as you have done this work. Some of that learning about yourself was difficult, unforgiving and painful. But you learned and got better, and stuck around. There is no 'teachers copy' with all of the answers to how to end homelessness, so you invest what is necessary to learn a lit bit more and a lit bit more to get better and better. You compare notes with others and realize you aren't that bad at this work. So you stick around for another day.
Hey you - you are awesome. Don't forget it.
Radical Acceptance
The practice of radical acceptance is not easy. It demands that regardless of background or circumstance we find strengths and live our empathy. It demands that we see people and their potential, not their past. It challenges us to examine our own potential biases because of our own values and beliefs and rise beyond those to enter into relationship with others who live their lives differently than how we live ours.
Radical acceptance means we acknowledge that life is what it is. We cannot force change in others. We are limited in how much influence we can have in particular circumstances. We cannot change the past. We have to grow from it, and at times, grow with it.
Suffering is what you do with that pain and the interpretation you put on the pain. Suffering is optional; pain is not. The people we serve have pain, and their pain can be difficult to accept without judgment. It’s difficult to accept what you don’t want to be true. And it’s more difficult to not accept. Not accepting pain brings suffering to those we serve and to ourselves. People we serve have a history and often current realities of pain. That doesn’t mean they should suffer. We serve those that have been rejected by other systems, other services, themselves and their families. We serve those that have rejected offers of assistance. We serve those where the easy thing to do is see deficits.
When we truly live and practice from a place of radical acceptance, it is freeing for us as the support provider. We enter into a relationship based upon an understanding of equality, not a relationship between healer and wounded. We see and live our own humanity in being present in the humanity of others, believing and embracing that everyone should have a future that is not dictated by their past.
Every now and then I fool myself into thinking we don’t need to talk about radical acceptance anymore. And I am wrong. Last week, for example, I struggled (and became internally frustrated) at the inability for people to see housing prioritization based upon people with deeper needs first. At issue in this situation was a strong reluctance on the part of some to house people with substance use disorders if there was a “motivated” person without a substance use disorder that could be served first; to serve people with criminal backgrounds – including involvement in things like pedophilia – when they thought a “motivated” person without a criminal background should be served first.
What becomes most difficult to me in situations such as what I described above is that the barrier is one of feelings, not logic. I can lay out facts related to serving people with higher needs, and point to policy direction that reinforces doing just that. But what I cannot breakthrough using logic is the intractability that comes with a deserving and undeserving poor.
Where do we go from here? What is the solution to this? It is my belief that we need to not only practice radical acceptance, we need to talk about it too. We make assumptions that others that do this work are on the same page as us when it comes to morals and beliefs. Are they? There is only one way to find out. And where there is distance between us, it behooves us to find out why and whether our collective interests in ending homelessness are, in fact, compatible.
3 Things I Look For When Monitoring
“When you go into a community or organization,” one of the people I mentor asked me the other day, “what are the first things you look for to know if people have bought into ending homelessness?”
Great question.
There are three things:
Leadership
Data
Morale
It all starts with leadership for me. I am not just talking about position power that comes from titles and reinforced through hierarchy. No, what I am looking for is a leader-full organization that has leaders in all sorts of positions who have a shared vision of what it takes to end homelessness. In these types of communities and organizations, they explicitly talk about their shared guiding principles and standards of service. They seek accountability and marry that with realistic optimism. They are collective problem-solvers who steadfastly stay engaged in the mission without being distracted by so many other things that could take them off course.
The importance of leadership (and the frequent absence of it) is one of the main reasons why we started the Leadership Academy on Ending Homelessness a few years ago. Leaders succeed when they are engaged in self-knowledge (the kind you don’t necessarily find on bookshelves), have awareness of others and how others impact them, and when they are systems thinkers. Of all of the conferences and such that a person can go to in any given year, at least some time and attention should be paid to investing in leadership development. If you are interested in the Leadership Academy, you can find more information and register for it here.
The second thing I know needs to be in place for proof that people have bought into ending homelessness is data. And I mean an unrelenting almost obsessed fixation on data. Not just any data – the right data. What do I mean?
Well, it is easy to go to the three performance metrics that matter most: i) Length of homelessness; ii) Positive destinations out of homelessness; iii) Returns to homelessness.
But I think we can go beyond this and still not end up too cute or in the weeds too far. I like data to have context. Show me how you are faring compared to previous time intervals or in comparison to other organizations or communities of comparable size and volume of funding. That is a big part of it.
The next important thing related to data for me are other elements of quality. For example, show me what the data looks like from different acuity bands, or conduct a gender or race analysis of performance using the data - as examples.
Finally, related to data, I look for a community or organization to demonstrate that they are making adjustments and improvements to performance based upon the data that they have acquired – and that they are using THEIR data on a REGULAR basis. THEIR as in they have accepted ownership of the data and what it says and are not waiting for someone else to interpret their data. REGULAR as in there are preset intervals for a data analysis plan to be activated.
Then there is morale which seems more intangible than the other three, though to me there are clear indicators that provide evidence of morale being high or low or somewhere in between. The first thing I inquire about is staff retention and staff acquisition, which is really getting at whether the staff tend to stay in their jobs and whether the organization or the work within the community attracts top tier talent to available positions. The next thing I look at is burnout, compassion fatigue and vicarious trauma. I want to know how the work is impacting those that are doing the work.
By way of morale, I am sensitive to the language that people use when talking about the work and the people that they serve. Are they trying to impose their values and beliefs on others? Are they frustrated, angry or resentful of program participants? Do they legitimately engage in solving problems, or are they more interested in naming problems without solving them or looking to others to always be the answer?
Also, with morale, I look to see if people feel positively challenged by the work itself. This helps say something about commitment and professional development and growth. There is ample proof that when people feel challenged by the work they are more inclined to stay involved and engaged in the work.
Finally, for morale, I look to whether there is a collective, collaborative approach to the work. Does ending homelessness translate to every position on the front line? Or is that something the mucky-mucks on the 6th floor talk about in the admin building but seems foolish to those that are engaged with people who are homeless daily? If it isn’t translating to the frontline, there is a problem with morale.