Access: The TAC Blog

Leading experts report from the intersection of affordable housing, health care, and human services policy.

February 2020: News, Resources, & Happenings at TAC:

Posted Monday, February 3, 2020
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Rapid homelessness resolution for Veterans — a toolkit to help state Medicaid and housing agencies forge effective partnerships — and insights from communities where youth and young adults are helping to lead the local effort to end youth homelessness. Read More

Beyond Pizza How Communities Handle Compensation and other Practical Issues with Young Adult Partners

Communities working to end youth homelessness are increasingly bringing youth and young adults with lived experience of homelessness to the forefront of their planning and implementation efforts, often with the support of a HUD Youth Homelessness Demonstration Program award. Of course, the young people who contribute their energy and insights should be compensated for their time - but how, and how much? TAC Senior Associate Lauren Knott, together with consultant Lauren Leonardis, surveyed a range of Youth Action Boards (YABs) to find out how they handle this and other challenges. The results are available as The Gab on YABs, a collection of community fact sheets and topic spotlights full of useful information for any community committed to fully incorporating youth and young adult leadership.

Tools for Successful State Partnerships between Medicaid and Housing Agencies

From 2016 to 2018, sixteen states participated in a Centers for Medicare and Medicaid Services (CMS) Innovation Accelerator Program (IAP) State Medicaid-Housing Agency Partnerships track. The tools developed and used to provide technical assistance to these states, incorporating the work and expertise of many TAC colleagues, form the basis of a new State Medicaid-Housing Agency Partnerships Toolkit published recently to the LTSS website. The toolkit is designed to assist states as they consider systems-level changes that further community integration, including the intersection between health care and housing. It is available for states to download, use, and adapt.

Trainings for Trainers in a Unique Rapid Resolution Pilot Program for Veterans

TAC has recently hosted several three-day events focused on homelessness diversion and rapid exit strategies for Veterans. These "train the trainers" sessions, conducted in partnership with the Cleveland Mediation Center and Abt Associates, are part of our support for the Department of Veterans Affairs' Supportive Services for Veteran Families (SSVF) program. Over the past two years, TAC and our partners have provided a wide range of onsite, remote, and training technical assistance in the development and rollout of SSVF's "Rapid Resolution" initiative, the first nationwide federal effort of its kind - a pilot program that supports diversion strategies for Veterans who are entering homelessness or have only recently become homeless. The recent trainings teach critical diversion and rapid exit skills in the context of SSVF's program design and implementation, with an emphasis on giving practitioners the tools they need to transfer that knowledge to their home communities. The training effort is led by TAC Senior Associate Douglas Tetrault, with strong support from other TAC staff members and TAC partners, and project direction from TAC Senior Consultant Jim Yates.

STAFF ACTIVITIES

TAC staff members Jenna EspinosaEllen FitzpatrickAyana GonzalezLauren Knott, & Ashley Mann-McLellan have been facilitating convenings and providing TA for Youth Homelessness Demonstration Program communities in Iowa, New York, Massachusetts, and Maine; Associate Ellen Fitzpatrick and Senior Associate Ashley Mann-McLellan conducted a 3-part training for Boston agency directors to strengthen the role of housing navigators in their organizations, and is helping the Boston Public Health Commission with a strategic plan to make its 800-bed shelter more housing-focused; Ashley was also one of 350 volunteers in Boston's 40th annual homeless census - thanks, Ashley! Senior Associate Melany Mondello led a training for the Vermont Balance of State Continuum of Care on the definition and documentation standards of chronic homelessness; Senior Consultant John O'Brien spoke about the future of policy and payment at a Substance Use Disorder Action Forum hosted by the Medicaid Transformation Project; Senior Associate Rachel Post facilitated the first cohort of Housing and Healthy Communities Learning Network, with plans for a second round in the works; Senior Associate Tyler Sadwith launched a provider-to-provider pilot program to test an approach for delivering TA on medication-assisted treatment to California's Tribal health programs; and Tyler also joined Senior Consultant John O'Brien to share strategic planning advice at a roundtable for Pew Charitable Trust's Substance Use Prevention and Treatment initiative.

STAFF TRANSITIONS

TAC is growing! A warm welcome to Project Support Specialists Laura Harris and Ari Rogers; Communications Designer Jeff Nguyen; Associates Eric Gammons and Jenna Espinosa in our housing group; and Dayana Simons and David de Voursney, two new Senior Consultants in our human services group. Learn more about our new colleagues on the TAC staff page.


The Gab on YABs: Youth Action Boards Report on How They Are Partnering with Communities to End Youth Homelessness

Posted Tuesday, January 7, 2020 by Lauren Knott, M.S.W., and Lauren Leonardis
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What happens when young people who have directly experienced the challenges of homelessness or unsafe/unstable housing bring their expertise, passion, and creativity to the project of transforming systems and ending youth homelessness? We surveyed seven Youth Action Boards to find out how they are "making it work" in urban, suburban, and rural communities. Read More

WHAT HAPPENS WHEN YOUNG PEOPLE who have directly experienced the challenges of homelessness or unsafe/unstable housing bring their expertise, passion, and creativity to the goal of transforming systems and ending youth homelessness?

  • They bring reality-based understanding to existing homelessness efforts about the unique needs of youth in a given community.
  • They model a core commitment to inclusion and equity that can be a struggle for older adults and more traditional systems of decision-making.
  • They form an accepting, empowering community that strengthens the youth who participate.
  • All this and more!

Across the U.S., rural, suburban, and urban communities that have made a commitment to end homelessness are learning how to understand and address the specific needs of youth and young adults. Just as with other populations in need of services and resources, the insights of those most directly affected — in this case, young people with lived experience of homelessness — are essential to finding solutions. This is why one of the key first steps is for a community to form a Youth Action Board that brings youth and young adults to the forefront of planning and implementation efforts.

Over the past few years, TAC has worked closely with many communities on their plans to end youth homelessness. At the center of each engagement has been the YAB, a decision-making entity made up of youth and young adults who have experienced or are experiencing homelessness. YABs provide leadership and guidance in partnership with other key stakeholders in the process of developing and implementing a plan to end to youth homelessness in the communities where they operate.

Every community is different, but there has been a great deal of interest in “what works” for others, and communities often have questions about best practices nationally for YABs. TAC has encountered YABs at all different stages — some well-established, some that have met formally for a short time, and others that have two or three core members identified, but haven’t yet taken the next step. So TAC decided to gather a sampling of YAB expertise as a guide for communities at all stages of YAB development.

Working with Lauren Leonardis, an independent consultant specializing in youth homelessness issues and a founding director of the large and active Boston YAB, we surveyed seven YABs, seeking to capture a snapshot of each one. The communities were asked about the big picture — their strengths and challenges — as well as the small details that push them forward like facilitation practices, budget, and recruitment efforts.

The results are fascinating and inspiring as they show diverse strategies, challenges, and opportunities in each unique community at the specific moment when the survey was answered. To share them, TAC has created The Gab on YABs: a series of fact sheets with an overview of each community, to be followed soon by a “topic spotlight” series looking at patterns and trends in areas of interest like compensation, structure, recruitment, and more.

We hope these resources will answer some of the questions communities have about how other YABs are making it work. No matter what stage your community has reached, The Gab on YABs can help you bring the voices and power of youth and young adults with lived experience of homelessness directly into all planning and implementation decisions.


We Need All of Us: Tips for Continuums of Care Working to Include People with Lived Experience of Homelessness

Posted Tuesday, January 23, 2018 by Jonathan Delman, Ph.D., and Marie Herb, M.A.,
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People with lived experience of homelessness have important perspectives to share for the planning and implementation of homeless services — yet most Continuums of Care and provider organizations lack the well-developed strategies necessary to foster this inclusion and fully benefit from it. Read More

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.

Generate Interest

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.

Establish Stability

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.

Learn Together

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.

Helpful Resources:

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!


January 2018: News, Resources, & Happenings at TAC

Posted Thursday, January 18, 2018
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Addiction treatment programs are proliferating, but what about accountability? Consumer report cards could be part of the answer. Read More

Improving Addiction Treatment with Consumer Report Cards

"Consumer report cards are a well-established approach to improving the accountability and quality of health care providers." And, as a team of expert authors including TAC Senior Consultant John O'Brien further observe in a recently published Health Affairs blog post, such accountability is sorely needed in the burgeoning field of addiction treatment. People facing a decision about how best to tackle an opioid use disorder should have some way to determine whether a given treatment option will successfully reduce their key symptoms, improve their health and functioning, and prepare them to manage the risk of future relapses. Drawing on several new reports and tools, the authors recommend specific metrics to identify providers using evidence-based principles in their substance use disorder treatment programs.

TAC Staff in Action

Staff Activities

Senior Policy Advisor Francine Arienti and Associate Amy Horton conducted site visits in Pawtucket, RI, Northampton, MA, and Albany, NY as part of SAMHSA's national evaluation of the Cooperative Agreements to Benefit Homeless Individuals (CABHI) grant program; Managing Director Marie Herb and Senior Associate Gina Schaak met with Fall River (MA)'s Mayor's Task Force to End Homelessness to help produce a strategic plan; Associate Jennifer Ingle led a training for housing support and management staff in Malden, MA on de-escalation and crisis prevention; Associate Lauren Knott presented on "Unstably Housed Youth: Different Needs, Different Services" at the Homes Within Reach conference in December; Associate Ashley Mann-McLellan is serving as the subject matter expert for a monthly webinar series on developing non-time-limited supportive housing for youth experiencing homelessness, produced in partnership with Collaborative Solutions; Ashley also facilitated a recent session with Long Island, NY's Veteran Leadership Team to plan for sustaining its successful work to end veteran homelessness; Executive Director Kevin Martone and Associate Phillip Allen traveled to Alaska for the Fairbanks Symposium on Homelessness, where Kevin gave the plenary address and led a workshop on "Permanent Supportive Housing and Rapid Re-Housing Services," and Phil gave a workshop on "Rapid Re-Housing: A Systematic Approach to Ending Homelessness"; Kevin also traveled to Phoenix, AZ to work with several states on behavioral health care integration at an event sponsored by the National Governors Association.

Staff Transitions

Congratulations to Associate Amanda Tobey and her family on the birth of Parker Collins-Tobey — and welcome to the world, Parker!


June 2017: News, Resources, and Happenings at TAC

Posted Tuesday, June 13, 2017
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TAC helps communities to develop their own flexible systems to end youth homelessness, and hosts an event on community integration for extremely low-income people with disabilities. Read More

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

STAFF ACTIVITIES

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.

POSITION AVAILABLE

TAC is seeking a Senior Associate/Consultant with expertise in behavioral health and Medicaid. Read the full description and application information.