Eligibility Does NOT Equal Entitlement
Eligibility means the state of having the right to do or obtain something through satisfaction of the appropriate conditions (my emphasis added).
Entitlement means the fact of having a right to something; the belief that one is inherently deserving of privileges or special treatment (again my emphasis added).
There are subtle differences between the two. Just because you can have something when the conditions are appropriate doesn’t mean you have the fact of having a right or are deserving of privileges or special treatment. Put another way, lots of people are eligible for shelter, but that doesn’t mean they have the right to shelter (unless you live in a right to shelter jurisdiction). Or consider this: lots of veterans are eligible for SSVF, but that doesn’t mean it is their absolute right to get SSVF.
Why does any or all of this matter?
In the era of Coordinated Entry systems of support are being completely transformed. Prioritization challenges us to think through which people will be served in which order based upon two factors: 1) who is eligible for what; and, 2) who is entitled to what. When those two things get confused or treated interchangeably, the entire approach to prioritization gets messier than it need be. Furthermore, the order with which people get served changes as entitlement can trump eligibility.
It also matters because the experience of the end user is often framed by their own beliefs. Does a person who is homeless feel they are entitled to receive certain services in a certain order? Or does a person who is homeless feel they are eligible to receive services and the order will be influenced by other factors?
When there is confusion between eligibility and entitlement it can lead to frustration, anger and what seems like picking winners and losers in the service delivery matrix. For a system of care to work properly, though, we need service providers and end users to understand that discretion is inherently woven into how a community has prioritized service attainment. Discretion does not mean side doors or jumping the queue. What it means is that there has been a transparent manner by which the community has decided the order with which all people who are eligible will be served, which may take into account how entitlement fits when it is warranted to do so.
Taken too far, this can all sound exceptionally harsh – just because you can have something doesn’t mean you will get something. Nonetheless, it is this very transparency that makes it possible to defend why, say, a person who is chronically homeless will be served ahead of a person who is not chronically homeless even though they both may be eligible for the same housing program.
Do yourself a favor in your community and have discussions about eligibility versus entitlement as you tweak your coordinated entry systems, as you design your housing and support programs, and as you discuss service options with program participants. This won’t result in everyone being happy. But it will (hopefully) get people to a common understanding of how decisions are made regarding program access.
So, You Think You're a Low Barrier Shelter...Let's Check
Hey all - sorry I have been stingy on the blog lately. I am back and will be here regularly for your reading pleasure.
The conversation goes something like this:
Them: "We operate a low-barrier shelter."
Me: "What makes it low-barrier?"
Them: "We believe in Housing First."
Me: "But what does that look like in practice?"
And then they share with me. And I end up mortified. So here is a list of 10 things that really have no place in low-barrier shelters, though I have encountered them quite a bit lately in our shelter transformation work.
1. Criminal Background Checks - start doing criminal background checks or making people go to the police department for clearance prior to coming to the shelter and you are not low barrier. In some limited circumstances depending on the shelter location and/or all of the populations served within the shelter it may be prudent to know if people who are sex offenders are staying there, but that doesn't require criminal background checks or police station visits first.
2. Credit Checks - true story, a shelter that claimed to be low barrier did a check on the credit score of each household looking to enter the shelter and if too low were turned away from shelter. Then a week later I encountered another shelter that did the same thing. Let's be clear, high credit score does not equal low barrier.
3. Limiting Shelter to Those with Income - included in this category are shelters that charge program fees that claim to be low-barrier. As soon as you start charging people to be able to stay at your shelter they need income. As soon as you start requiring people to have income (which sometimes means jobs) you are not low barrier.
4. Making People Pledge their Motivation to Change - "I hereby solemnly swear that I am ready to change and will take any and all necessary actions to prove to staff and the community that my desire to change is real. I hereby further acknowledge that if I do not put my motivation into action I will be asked to leave the shelter." True story. Verbatim. Twice in the same community even though they were different, unaffiliated shelters. I think pledging that you will change is a barrier.
5. Ensuring People Show up at a Designated Location and Then are Bussed to the Facility - I want to get this straight...you are low barrier but you expect people to be organized enough to get to the one place in the community that you are going to send a bus that will pick people up and whisk them away to your secret shelter location and that any walk-ups will not be accepted or considered under any circumstance. Uh-huh.
6. Sobriety Checks - if you haul out the dipstick or the breathalyzer and call yourself low barrier I think you really are confused as to what low barrier means.
7. Having People Produce ID - NEWSFLASH People that are homeless frequently lose their identification. If you require people to produce an identification in order to be considered for shelter you have created a huge barrier.
8. Residency Requirements - anecdotally this one seems to be growing: we will only shelter our own (or our preference is for those that can prove residency here first). All people have the freedom of mobility across the country. Oh wait, unless you are homeless in some instances.
9. Mandatory (Life Skills/Budgeting,etc) Classes - you are not a low barrier shelter if you mandate that all shelter residents participate in predetermined classes, especially those that last weeks at a time. Offer some voluntary classes if you want. Maybe even make them housing-focused. But having mandatory classes is not low barrier.
10. Forced Labor Participation - when you require people have a job or require them to participate in your profit-generating industries as a condition of stay, you are not low barrier.
I fear that the term "low barrier" is/will be thrown around so much that it will lose meaning or require constant clarification. Kind of reminds me of the term "housing first" and how that has been bastardized over the years. So, let us stand up to programs that are not low barrier and call them out when they are not so we can have some fidelity to what low barrier actually means.
Motivating Teams When the Results Aren't What You Wanted
Ann Oliva takes over the blog again this week and shares her thoughts on motivating your team when the results being achieved are not what you wanted.
This last year has been one that brought a lot of changes into my life – new work, new priorities, new partners. But maybe most importantly I have had the privilege of having new types of conversations with people working on homelessness in communities around the country – and I have been overwhelmed by the acceptance and willingness of people to have me involved in their work.
As part of these interactions, I get asked questions about leadership and motivation that drive some introspection about the kind of leader I am. Thinking about these kinds of questions, I hope, will make me a better one in the future. Walking through them with Iain, and coming up with some collective thoughts about how to answer them, will definitely make me a better leader.
One of the toughest ones I have been asked recently was about how leaders can continue to motivate their teams even when the results of their work are not what they want. In other words, what does a good leader say to a team of people who, despite their best and brightest work, see the results of the PIT count go up or experience system failure?
I have to admit that I was disturbed by the question at first. I think that may be because my vantage point at the federal level gave me the opportunity to see positive change across the country in so many ways that it skewed my understanding. But I now clearly see that this is an issue that local leaders are struggling with every day. So I talked to Iain about it, and here are some of our thoughts on this important topic:
Homelessness can only be ended nationally when it is ended for every person who is experiencing it. Every time someone is placed into housing, or into a job, or into a service they want or need – you are indelibly impacting their life in a positive way. As a community, we need to remember this and raise it up when we need motivation to continue our work.
As a nation – and in most communities – the system that serves people experiencing homelessness is vastly different today than it was 10, 15, 20 years ago. I would argue that the shift from making people prove they deserve housing, to orienting our system towards the idea that all people deserve housing is fundamental and has made our nation and communities better. I would also argue that by working to remove barriers, valuing choice and equal access, acknowledging and addressing racial inequity and starting to work across systems we are making a difference. That difference, in these examples, is that we treat people with dignity and respect rather than trying to "fix" them. To me that is fundamental. It is important.
Motivation can be driven by how we react to both the wins and the losses. If we own our wins and celebrate them, then we need to own our losses and use them to make ourselves and our programs better. Losses can represent a lot of things – but in most cases we hope that losses represent a willingness to try new things and improve what we are doing. That is a good thing even if it doesn't always work out the way we want it to. So, we have to look at the totality of our work and find motivation in the journey and effort itself.
Motivation is personal – while a leader can be inspirational and use tools to motivate a team, they can't know or address the feelings of every team member. So it is up to each person working in our systems from the front line to the federal government to remember their "why." Why did you start in this work? Why do you keep getting up every morning and doing it? Sometimes your "why" changes, and that is ok. If it changes so much that you no longer want to keep doing it, is a change needed?
I am sure there are more answers to that tough question than these, but these are a start. In fact, I hope to hear more from you. In my travels I continue to be amazed by the people working in this field, and by the people who are served by our programs. I hope you all keep the hard questions – and the answers – coming.
A Big Step Forward Ending Homelessness in Canada
Reaching Home: Canada’s Homelessness Strategy was released today. It is the biggest overhaul of homelessness funding in Canada in the almost two decades that federal funding has been available for homelessness in the country. There is plenty to be excited about – a doubling of homelessness funding and an extension of the program to 10 years to name a couple.
I am most excited about three things that all needed to be inter-related if success is to be achieved: that communities must be accountable to achieve a 50% reduction in chronic homelessness, that there is a data-driven performance-based approach, and the requirement to use coordinated access.
For my readers outside Canada, some elements of this will be familiar to how your funding works. But I know of no place that requires a 50% reduction in chronic homelessness, even though many jurisdictions place an emphasis on reducing chronic homelessness. A big high five to Canada's leaders for having a target in this regard.
A community cannot reach a 50% reduction in chronic homelessness without a benchmark to compare it against. Whether we look at PIT count data, period-prevalence counts, or even service users throughout a year, a 50% reduction is nothing to sneeze at. The only way to achieve the target is to have an unrelenting focus on housing and an unprecedented use of data to measure progress against the aim, as well as target and prioritize who will get assistance. By putting requirements in place to reduce chronic homelessness by 50%, the days of first come, first served and "lucky to have a case manager who knows their way around the system" days are over. Furthermore, communities need to know a lot about the inflow into chronic homelessness to manage and target outflow out of chronic homelessness. Chronic homelessness isn't an accident – it is manufactured by the policies, programs and approaches that a community has in place. In many instances the only way to get out of the current state of chronic homelessness is to redesign the entire system of care. That may be long overdue in some communities.
A data-driven, performance-based approach makes loads of sense. There are no "feel good" and "let's just try our best" approaches to ending homelessness. The data-driven approach may be a stretch-goal for some communities to start because any data-driven approach has to go from collecting data (which happens in various degrees now) to using data to refine program approaches. I think it also forces some communities to look more critically at the big picture. System performance measures become, in some ways, more critical than any specific project's performance. If you have one or two great programs, but eight or nine underperforming programs, the overall community performance will suffer. Data-driven, performance-based approaches make all investments accountable to outcomes.
Finally, I am excited to see the movement to Coordinated Access. While many US communities have felt the pain of moving towards this manner of doing business, there are tremendous lessons to be learned of how to leverage community resources to the maximum gain based upon presenting issues and circumstances of the individual program participant. Canadians experiencing homelessness can come to expect that they will be triaged and served based upon needs, not luck. Homeless service providers will be forced to help people get housing and supports through a system of care rather than around a system. Transparency will reign supreme in how priorities are set and matching occurs. Data moves to real(ish)-time when Coordinated Access is brought to scale. As I have blogged about before there are different approaches to putting this in action, each with relative pros and cons.
Kudos to the Government of Canada for reimagining what an end to homelessness can look like, for making significant investment to make it happen, and by making bold statements and targets to achieve the aim.
What Is An Acceptable Rate of Death?
For the last month I have been working on a data set to better understand unsheltered homelessness. Yes, I have been working on that when I should have been blogging. And returning emails. And other functions necessary for running a business (which I am reminded of from time to time that OrgCode is).
Since early 2015, over 5% of the population included in the data set has died.
To be clear, three types of people died: someone's parent, someone's sibling, someone's child.
They were old and young. They were of different races and ethnicities. They had different lengths of homelessness.
As you might suspect and expect, the rate of death is higher than the general population, where just under 1% of the population dies every year.
Death is something I have come to embrace in my work on homelessness. It doesn't get any easier, nor do I get immune to it. I have given up thinking that it results in urgency for people to act. My newsfeed had this story in it today: www.cbc.ca/news/canada/british-columbia/homeless-man-spends-dying-hours-at-vancouver-tim-hortons-1.4689842 where a person who is homeless spends their dying hours in a coffee shop. At least it makes the news.
Across all age cohorts, people who are homeless are three times at greater risk of death. The literature shows that the average age of death of a person who is homeless is about 50. In 1900 that was the life expectancy. People who are homeless get the same illnesses that housed people get, just at rates 6 times higher. They also experience advanced chronological ageing.
Rates of death in individual cities seems to be on the rise too. Maybe it is opioids. Maybe it is weather phenomenon. Maybe it is known causes of death amongst people who are homeless like higher rates of cardiovascular disease. The Washington Post did an interesting article on the matter back in April.
What I do know is that we need to act with urgency if we are going to reverse what seems to be the new normal. We need to prioritize people for housing, knowing that some of those we house will also die, but with greater dignity. We need to focus our attention on cures to homelessness, not bandaids. Housing is good health care.
5 Core Principles
In ending homelessness, we need to work with urgency but not with haste. We need to focus on that which we know, not that which we think. And regardless of whether we are operating a shelter, outreach program, day service, Rapid Re-Housing or Permanent Supportive Housing program – or any other program for that matter – we need to ensure we are aligned to the same 5 core principles of the work.
Principle 1: No requirements for housing readiness
Two criteria need to be met for someone to be housing ready. 1. They are homeless. 2. They are breathing. That’s it. There are no programs that people need to graduate through or transitional or provisional housing stays where people demonstrate acquisition of skills. The hard work comes once we get the person or family housed to provide them the supports necessary for them to stay housed. We need to progressively engage and build upon their strengths to make this possible.
Principle 2: Client choice and supported self determination
We need to fiercely support choice within realistic parameters of what is possible. Choice is not carte blanche. But choice must be meaningful and centred on the needs and wishes of the individual or family. Do you present service and housing options to program participants or do you create a service pathway that they must follow? Is the person you are supporting at the centre of the decision-making or are they a bystander to decisions that are made for them?
Principle 3: Supporting a recovery orientation
It is our duty to promote mental health recovery. It is our duty to practice from a harm reducing lens. It is our duty to understand the supports necessary to help people recover from the experience of homelessness. For many – especially those that have been homeless for many years of their lives – they actually need to grieve the loss of their routines and habits they once participated in while homeless in order to forge ahead with a healthy, new reality of being housed.
Principle 4: Individualized support plan and client-centred supports
No two support plans should ever look the same because no two people are ever the same. We must push back against designing programs with people to work their way through and instead focus on customizing the supports to the needs of each individual or family. We must reject linear, milestone, one-size fits all approaches to services and appreciate that each journey that progresses to life stability will be unique, often non-linear and person specific.
Principle 5: Promoting social and community integration and meaningful activities
The people we engage need to integrate with the community and neighbourhood fabric within which they find themselves in a post-homelessness reality. If the support worker is the only support they have or if the person is socially isolated, we are doing the support part wrong. People need activities to look forward to, participate in and provide fulfillment.