Access: The TAC Blog
January 2018: We Need All of Us: Tips for Continuums of Care Working to Include People with Lived Experience of Homelessness
IT IS NOW WIDELY ACCEPTED that planning and implementing successful programs to prevent and end homelessness requires direct involvement by people who have themselves been homeless. Individuals with this lived experience, often referred to as “consumers” because of their direct interactions with homeless services, bring a well-informed awareness of the supports that are most needed and desired. Many valued innovations, such as the Housing First approach, are based on consumer preferences shared through interactions and studies.
Continuums of Care (CoCs) — collaborative planning bodies funded by the U.S. Department of Housing and Urban Development to improve homeless service coordination in specific geographic areas or communities — are required to include on their decision-making boards people who are or have been homeless, along with key stakeholders from nonprofit provider organizations, local government agencies, philanthropic organizations, and local businesses. Furthermore, any agency that receives funding through the CoC program must include a person who is homeless or formerly homeless on its own board or other policymaking entity.
However, many CoCs and agencies receiving CoC funds lack well-developed consumer involvement strategies. In response to a 2015 survey, 47 percent of CoCs said consumers influence some decisions, while only about 15 percent indicated that consumers influence all major decisions. Some CoC respondents reported that they want to involve consumers to a greater extent, but are challenged to find people who have enough “interest and stability” to be actively and consistently involved.
In 2016, the United States Interagency Council on Homelessness reported on a gathering of consumer advocates convened to discuss how decision-making bodies can create a welcoming environment for people with lived experience of homelessness. Based on these findings, together with insights from research on mental health consumer involvement, we’ve put together some tips to help you first build interest and excitement among homeless and formerly homeless people to become actively involved, and then to make sure this involvement is a positive experience for all.
Clearly “advertise” what the role is and why it is important. For a CoC board, what is the time commitment? What does the board do? For a CoC-funded agency, what input is the agency seeking?
Develop and maintain strong connections to trusted community organizations that provide housing and services to people who are homeless. These partners can identify potential candidates and encourage participation.
Financially compensate board members with lived experience of homelessness for time and travel in a similar fashion to others serving in the same capacity.
Explain responsibilities, reimbursement policies, the time commitment expected, and options for participating in different ways, such as attending meetings or reviewing draft materials. It may be helpful to use the term “like a job” to clarify the level of expectation.
Language matters! Use “people first” language in all your materials and communications, such as “people who are experiencing homelessness” rather than “the homeless.” Consider your language choices when talking about subpopulations as well, for instance saying “young adults” rather than “kids” when talking about young people experiencing homelessness.
Identify and resolve any barriers to participation, like scheduling conflicts with employment, lack of access to transportation, or the need for child care. Devote part of each meeting to addressing these barriers, and meet with people individually as needed to problem-solve. Consider non-traditional meeting times to accommodate these needs, such as in the evenings or on the weekends. Meet in locations that are accessible by public transportation, and offer child care or child-friendly meeting spaces.
Designate a point person for questions and concerns. This person should check in regularly with the consumer to make sure they understand the board or committee’s processes (meeting agendas, voting procedures) and the content to be discussed during each meeting. It’s also important to bring people up to date on what happened at any meetings they missed. Offer opportunities to provide input in ways besides speaking publicly at a meeting, such as in writing or via email before or after meetings. Individualized connections like this may be especially important when working with board/committee members who have a serious mental illness.
Make every effort to accommodate consumers’ needs, particularly in relation to health difficulties. For people with disabilities, accommodations should include a physically accessible room, materials in appropriate formats (e.g., large print, Braille), and access to Communication Access Realtime Translator (CART) and American Sign Language (ASL) interpreters. The meeting’s facilitator may need to be deliberate in making the space for members with disabilities to be heard – especially those with mental health conditions. As noted earlier, making meetings child-friendly or offering child care can enable participation by people with young children.
Eliminate tokenism by recruiting more than one person with lived experience, and offer other opportunities for inclusion as well. Invite people to suggest ways in which they would like to contribute, and work to create an environment that actively engages and solicits the input of all members of the group, including those with differing communication capacities.
Value consumers and their perspectives regardless of what led to their experience of homelessness.
Include a cross-training component, in which each advisory board member takes five to ten minutes to explain to the group the expertise they have to offer, which for some members will include their lived experience of homelessness. Ensure that this time does not turn into a “job interview” format where members are merely listing qualifications.
Create opportunities for informal interactions between consumers and other committee members, such as sponsoring and paying for group lunches and social outings.
Consider ways to bring people with lived experience of homelessness into leadership roles within your CoC, through the board and committee membership, or by spearheading specific CoC initiatives. Establish a clear process for those who may be interested and invest time in actively recruiting members.
Make sure everyone is up to speed before shifting gears or making decisions. This includes educating consumer members on the basics of the CoC, and defining common terms and acronyms. Try to use plain, non-specialized language in meetings. Consider making decisions by consensus through group discussion, rather than by majority vote.
It can be challenging for any group to work together across significant differences in background and experience. But it’s worth it! To make their programs as effective as possible, CoCs need the insights and ideas of people with current or recent experiences of homelessness. In turn, the organizational leaders and policymakers who serve on a CoC or agency board offer connections, knowledge, and authority — valuable resources to which consumers on their own often lack access. Continuums of Care that rise to the challenge of fully incorporating people with lived experience of homelessness will be all the stronger for it.
A Quick Guide on Consumer Engagement in Governance of Health Care for the Homeless Projects (2016, National Health Care for the Homeless Council).
Guidance for Consumer Advisory Board Staff Support [on Homlessness Projects] (2017, National Health Care for the Homeless Council).
Nothing About Us Without Us: Seven Principles for Leadership and Inclusion of People with Lived Experience of Homelessness (2016, Lived Experience Advisory Council of the Canadian Obervatory on Homelessness).
Recommendations for Effective Implementation of the HEARTH Act Continuum of Care Regulations (2012, National Alliance to End Homelessness)
Youth Collaboration Toolkit (2017, True Colors Fund)
Thanks to TAC Associate Lauren Knott for her assistance with this post!
The tenth edition of the Priced Out: The Housing Crisis for People with Disabilities report, released today by TAC and our partners at the Consortium for Citizens with Disabilities Housing Task Force, once again demonstrates that non-elderly adults with disabilities who rely on Supplemental Security Income (SSI) are among the groups most severely affected by the extreme shortage of affordable rental housing across our nation.
Over the last decade, increased rental demand combined with development primarily at the high end of the market has led to record-low vacancy rates, higher rents, and increased competition for affordable and subsidized housing. This overall market trend is reflected in the ever-worsening affordability gap for extremely low-income renters with disabilities.
Supplemental Security Income is the federal income maintenance program that assists people with significant and long-term disabilities who have virtually no assets and — in most instances — no other source of income. The national average rent for a studio/efficiency unit in 2016 was $752, equal to 99% of a monthly SSI payment. In thirteen states and the District of Columbia, areas with the highest housing costs in the nation, the average studio/efficiency rent exceeded 100% of the income of an SSI recipient.
This housing affordability crisis deprives hundreds of thousands of people with disabilities of a basic human need: a place of their own to call home. Because of the disparity between SSI income and rental housing costs, non-elderly adults with significant disabilities in our nation are often forced into homelessness or segregated, restrictive, and costly institutional settings such as psychiatric hospitals, adult care homes, nursing homes, or jails.
Ideally, there would be enough job opportunities that match the skills of people with disabilities and pay a livable wage so that all could afford housing in their communities. However, as the National Low Income Housing Coalition documents in its 2017 Out of Reach report, it would require more than two full-time jobs at the federal minimum wage to pay for a one-bedroom apartment at fair market rent.
Federal rental assistance — meaning a subsidy that helps renters pay no more than 30% of their income for housing — is the key to solving the housing crisis that has been documented in Priced Out reports over the past 19 years. Unfortunately, because of funding limitations that have grown worse in recent years, federal rental subsidy programs currently reach only 35 of every 100 extremely low-income households; with incomes equal to only 20% of area median income, one-person households receiving SSI fall within this category. This shortfall translates into long waiting lists at Public Housing Agencies and affordable housing developments, and a critical shortage of permanent supportive housing opportunities for people with significant disabilities who have SSI-level incomes.
A unified advocacy effort by the disability community is needed to support and potentially expand permanent supportive housing programs along with other rental assistance strategies. Providing housing assistance to people with the most significant and long-term disabilities is not only the right thing to do, but is also more cost-effective than perpetuating the alternatives: costly institutional care, uncontrolled expenses to the health care system, and homelessness.
FOR SEVERAL YEARS, TAC consultants have been on a journey with communities to create effective, sound Coordinated Entry (CE) systems and processes that contribute to their larger goal of ending homelessness. As the U.S. Department of Housing and Urban Development’s (HUD) January 23, 2018 deadline for Coordinated Entry compliance nears, we want to share some planning tips that we have seen contribute to creative and efficient systems.
Align Your Local Goals to End Homelessness WITH HUD’s Goals for Coordinated Entry
We often see communities concerned about the compliance aspect of Coordinated Entry, which leads them to direct planning efforts toward the goal of “checking off the boxes” of Coordinated Entry requirements. We challenge communities instead to consider Coordinated Entry a powerful tool in their efforts to end homelessness. HUD promotes some key strategies that really are essential in reducing and ending homelessness, such as ensuring that all processes are as low-barrier as possible, implementing uniform assessment to ensure uniform decision-making across systems, and prioritizing assistance to the most vulnerable. Some planning activities to align your own local goals with the goals of Coordinated Entry might be helpful:
Create a crosswalk between key goals in your local strategic plan to end homelessness and those in HUD’s Coordinated Entry Notice.
Spend some time with your stakeholders envisioning your ideal system for any consumer. Draw on this process to create a list of values that will guide decision-making throughout the CE planning process.
Engage local funders to be part of planning efforts by finding alignment between their goals and your CE goals.
Integrate Change Management Strategies into Planning
Implementing Coordinated Entry is a significant systems change, and will continue to have effects long past a community’s first iteration of CE. It is important to acknowledge the shift that stakeholders will undergo, and to use change management strategies that can strengthen the planning process:
Continually acknowledge the change that is happening. This will start to normalize the process, making the reality of systems change familiar to your stakeholders.
Engage your stakeholders in creating the system, or in problem-solving any challenges that arise. People often respond better to change if they are part of the thought process, rather than having change forced upon them.
Work to create a culture of innovation and “failing forward.” It’s good to make use of reference materials to guide Coordinated Entry planning processes, but the bottom line is that there is no pre-packaged Coordinated Entry system with assembly instructions. Each community must figure out what works given its own local stakeholders, populations, and conditions. A learning culture that celebrates innovation can help to promote new ideas and reduce negative backlash toward methods that were tried but did not succeed. We are seeing this type of culture work well particularly in the development of diversion techniques within Coordinated Entry.
Promote Fidelity to Housing First
The guiding principles of the Housing First philosophy are critical to creating flow through your Coordinated Entry system. Practices such as lowering barriers to housing admission, creating housing pathways and processes with a commitment to referral success, fostering participant choice, prioritizing assistance to the most vulnerable, and terminating participants from housing programs only in the most egregious cases not only create system flow, but also poise communities to improve their success in several of HUD’s system performance measures. To maintain fidelity to Housing First, there are several actions your community can take:
Incorporate consumers into your planning process. Communities have found many ways to infuse consumer voices into planning in a meaningful way. Often the key is to employ several strategies at once: hold multiple seats for consumers on your planning committees and Continuum of Care board; create a consumer advisory body to receive an even more diverse set of viewpoints; hold focus groups with consumers who may not be able to commit to an ongoing committee, but who would like to give input; and compensate consumers for their time.
Continually assess programs’ fidelity to Housing First. Programs may incorporate self-assessments, such as the Housing First Assessment recently released by HUD, to gauge current fidelity and identify areas for improvement. Many communities have also found success in setting up learning collaboratives for both frontline and manager-level program staff to share strategies in implementing a Housing First philosophy.
Get funders trained and engaged in Housing First. At TAC, we have done substantial work with communities’ funders to assist them in aligning their contracts, performance targets, and monitoring processes with the Housing First philosophy. Getting funders on board helps with the promotion of Housing First not only at a program level, but at a systems level.
We are continually impressed by the perseverance we have seen in communities to create Coordinated Entry systems and processes that can drive progress towards ending homelessness. We look forward to continuing to learn alongside you!
Even though “Bill” showed up right on time for Boston’s Third Surge to End Chronic Homelessness, he told me that he "thought it was going to be stunt, a lot of talking but nothing to show for it.” But when Bill left the building — some seven hours after I greeted him as his assigned ambassador for the day — he had plenty to show for his efforts: a doctor and an appointment, an insurance provider, and best of all his own apartment. It was clear that this was no stunt but an incredible collaboration between the Commonwealth of Massachusetts, the City of Boston, and lots and lots of providers and volunteers.
Behind the Scenes
In many ways, an event like this is just plain old common sense: Bring together all the players — MassHealth/Medicaid, Social Security, the Boston Housing Authority, the Metropolitan Boston Housing Partnership, accountable care organizations, homeless service providers, housing navigators, and the people who need what all of them have to offer — to resolve the barriers that have kept Boston's chronically homeless individuals from finding and keeping housing. But that view is just like looking at the face of the watch and not seeing all the intricacies that hide behind it.
Led by the Massachusetts Department of Elder Affairs and Boston's Department of Neighborhood Development, the Boston Surge was the product of months of detailed planning and collaboration. Data was shared between MassHealth and homeless shelter and outreach providers, and matched to identify individuals over age 50 who had been living on the streets or in homeless shelters for a year or more or who had experienced homelessness several times over the past few years. Some of these individuals were currently on Medicaid while others had previously been, but were no longer active. For the Third Surge, 124 individuals were invited and encouraged and supported to participate. Meanwhile, the Boston Housing Authority and the Metropolitan Boston Housing Partnership looked through their portfolios of housing units and subsidies to identify available housing resources. An individualized "passport" with potential options of health care and support services was created for each person before the event.
The Big Day
Finally, on the day of the Surge, the teams arrived. Representing Social Security, MassHealth, the Housing Authority, service providers, and accountable care organizations, they brought computers, printers, and a determination to get the job done. Ambassadors (all volunteers like myself) were each connected to one "guest" and walked them through the process. The day was busy, chaotic at times, but filled with an energy and a collective sense of will to get people housed. There were no photo ops, no speeches — there was too much work to do.
More than half of the people experiencing chronic homelessness who had been invited — a strong turnout — came to the event. Bill and I got to know one another over breakfast. A Boston native, he fell on hard times two years ago, lost his housing, and had been living in a shelter ever since. On the spot, we got Bill's social security documentation printed out. We met with several providers from senior care organizations, and he signed up for health services, supportive services, and a primary care physician.
Next, we filled out the Boston Housing Authority application and waited while staff reviewed Bill's criminal background records and other eligibility requirements. We sat outside the room and smiled each time we heard clapping indicating that someone had received a housing unit. Then it was Bill's turn. He was told he was eligible, and then got to pick a housing development that met his needs. The applause was for him this time. He sat there just saying over and over, "I thought this was going to be a stunt, I can't believe it!"
Boston’s Third Surge to End Chronic Homelessness produced impressive results. Forty-two elders left this one-day event with offers of apartments, while another seventeen have strong linkages to housing after a few more steps. MassHealth was able to re-enroll or upgrade coverage for 12 participants. And 62 elders are now engaged with supportive services to help them stabilize their health and housing for the long term.
The best news is that Boston's model can easily be replicated. No big hero is required — or even stunt doubles. All it took to make it happen was the commitment of key individuals and agencies, along with plenty of hard work. I’m proud of Boston for coming together to end chronic homelessness, and I know your community can do it too.
Propelling Innovation to End Youth Homelessness
TAC consultants have been criss-crossing the U.S. this spring to help strengthen local youth homelessness prevention efforts. In Washington's Seattle/King County, our TA is an integral part of the Youth Homelessness Demonstration Program, a HUD initiative awarded to ten communities. So far, we've worked with Seattle/King County on flexible system design, engaging a Youth Advisory Board, compiling promising practices from across the country, analyzing data to measure the need for housing and services, creating landscape scans of current housing and service inventories, and developing continuous improvement strategies the community can use to evaluate and learn from implementation. Once the planning process wraps up in July, our focus will shift to creating an implementation "road map" for community stakeholders and providing training and capacity-building to Seattle/King County agencies working to end youth homelessness in their community. Learn more about TAC's TA with programs serving children and youth.
Sharing Strategies for Successful Community Integration
From May 1-2, HUD Section 811 Project Rental Assistance grantees from 25 states — including both housing and service providers — joined TAC staff members and officials from the Department of Housing and Urban Development (HUD) and the Centers for Medicare and Medicaid Services (CMS) in Washington, DC. Participants in this TAC-organized initiative shared successes and insights from their experiences implementing PRA to expand integrated supportive housing opportunities for extremely low-income people with disabilities.
TAC Staff in Action
Policy Advisor Francine Arienti and TAC consultant Naomi Sweitzer were invited by the Vermont Youth Homelessness Prevention Plan Committee to present on federal/state resources and models of state plans around the country; Senior Associate Jonathan Delman gave the keynote address at Employment Matters! (annual conference of the Massachusetts Association of People Supporting Employment First); Jon's article on "Employer-based Strategies to Increase Employment Rates for People Living with Serious Mental Illness," co-authored with Senior Consultant Lynn Kovich and Executive Director Kevin Martone, has been published in Psychiatric Rehabilitation Journal; Associate Ashley Mann-McLellan hosted a community planning meeting in Denver to help advance the city's strategy on ending veteran homelessness; Ashley also met with HUD Youth Homelessness Demonstration Project grantees and TA providers at the CSH Supportive Housing Summit in May; and Associate Douglas Tetrault presented on "Community-wide System Assessment and Improvement" at the National Coalition for Homeless Veterans conference, while Senior Consultant Jim Yates presented on "Using Federal Fair Housing Guidance to Reduce Access Barriers to Housing" at NCHV's pre-conference Housing Summit.
TAC is seeking a Senior Associate/Consultant with expertise in behavioral health and Medicaid. Read the full description and application information.
Appealing to Affordable Housing Developers in Boston
When affordable housing developers and service providers collaborate, new possibilities open up for people who have been homeless to make the transition to being long-term, successful tenants. TAC, together with the Boston Department of Neighborhood Development and Mayor Marty Walsh, led a convening at City Hall on April 13 to foster such partnerships — and specifically to encourage the implementation of homeless veteran and “move on” preferences in affordable housing properties. Speakers described the key role that prioritizing vacant units for populations such as homeless veterans and supported housing residents plays in Boston’s efforts to end homelessness. TAC Associate Ashley Mann-McLellan, who helps communities across the U.S. build public-private partnerships to implement homeless preferences in HUD-assisted housing, explained how developers can adopt homeless preferences with the support of service providers to ensure successful results for everyone: new tenants, their neighbors, and property staff.
TAC Staff in Action
Senior Associate Jon Delman has joined the board of the Association for People Supporting Employment First – MA chapter; Senior Consultant Sherry Lerch presented to the leadership of AbbeHealth in Cedar Rapids, IA on ways to maximize the effectiveness of permanent supportive housing; Associate Ashley Mann-McLellan led a two-day, customized workshop on Housing First for providers in Long Island, NY, and a training on property owner engagement for organizations serving homeless veterans in Denver, CO; Executive Director Kevin Martone taught a class this semester to 3rd and 4th year medical students at Tufts University Medical School, on “Mental Health Systems and Public Health”; at the National Council for Behavioral Health Conference in Seattle, WA, Senior Consultant John O’Brien presented on Medicaid strategies for supportive housing and co-led a recovery housing workshop; Senior Policy Advisor Lisa Sloane and Associate Ellen Fitzpatrick — plus a film crew — headed to Maryland, Minnesota, and Louisiana to work on our forthcoming videos about the HUD 811 Project Rental Assistance program; Senior Consultant Jim Yates presented on “National Trends in Supportive Housing” at the Housing Leadership Group Summit in Albuquerque, NM, and on the National Housing Trust Fund at the National Low Income Housing Coalition’s Legislative Forum in Washington, DC; Jim has also been conducting strategic planning sessions in communities that are part of HUD’s Vets@Home initiative; the TAC Supportive Services for Veteran Families team was instrumental in planning and delivering eight regional meetings for SSVF grantees and their community partners, as well as — together with key partners at Abt Associates — eight locally driven community meetings around the country to help Continuums of Care in their efforts to end veteran homelessness.