Access: The TAC Blog
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.
TAC staff members Jenna Espinosa, Ellen Fitzpatrick, Ayana Gonzalez, Lauren 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.
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
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.
Improving Homelessness Response Systems in California’s Counties
Under a new contract with California’s Department of Housing and Community Development, TAC is providing capacity-building technical assistance (TA) to help California’s communities enhance their homeless crisis response systems. First, TAC staff traveled with state officials and TA peers to meet with homeless system representatives from around the state, learning about their needs and introducing potential TA resources. Since then, TAC has been engaged by several communities, including Butte County where we are helping with disaster recovery after the devastating 2018 Camp Fire.
In Vermont, a Focus on Ending Youth Homelessness
Through the U.S. Department of Housing and Urban Development, the Vermont Balance of State Continuum of Care became an official Youth Homelessness Demonstration Program site in the summer of 2018. This award provides support to the CoC and its Youth Action Board (YAB) as they develop a plan to prevent and end youth homelessness in 13 of Vermont's 14 counties. TAC Associates Lauren Knott and Ellen Fitzpatrick are helping CoC leaders to develop and drive the planning process - focusing especially on strengthening youth voice, analyzing local data, and defining the CoC's vision for the initiative. With the CoC's written plan to HUD submitted and now approved, TAC is now helping with project selection and the implementation process. TAC staff members were also fortunate to participate in a two-day Youth Collaboration training facilitated on-site by True Colors United and including both YAB members and CoC leaders. TAC has supported the Vermont Balance of State CoC as it incorporate takeaways from this training and creates a system in which authentic youth collaboration is at the forefront of all planning to prevent and end youth homelessness in Vermont.
TAC Staff in Action
More than 700 leaders and managers from Supportive Services for Veteran Families (SSVF) grantee organizations attended five regional meetings in January, focused on rapid resolution — with TACsters Phil Allen, Ellen Fitzpatrick, Marie Herb, Ashley Mann-McLellan, Naomi Sweitzer, Douglas Tetrault, and Jim Yates providing coordination and giving presentations; Associate Ashley Mann-McLellan presented on “Designing Coordinated Entry Systems and Prioritization to Better Serve Individual Adults” at the Solutions for Individual Homeless Adults conference sponsored by the National Alliance to End Homelessness (BONUS: Check out Ashley’s blog post on what’s working in coordinated entry!); and Senior Associate Rachel Post led two sessions on Assertive Community Treatment and intensive case management at the Fairbanks (AK) Symposium on Homelessness.
A Nevada Community Mobilizes to End Youth Homelessness
In 2017, Southern Nevada tallied the third highest rate of unaccompanied youth homelessness in the nation. Recognizing the urgent need for a dedicated response to this crisis, the community, which includes the city of Las Vegas, issued a national request for technical assistance proposals. Through this competitive process, TAC was selected to facilitate a robust and inclusive planning effort, and ultimately to draft the first-ever Southern Nevada Plan to End Youth Homelessness.
From April to October 2018, TAC consultants Lauren Knott, Ellen Fitzpatrick, and Ashley Mann-McLellan worked with the community to create decision-making groups, analyze data to identify areas of need, articulate goals and strategies, and strengthen the active involvement of "Young Adults in Charge" (the Southern Nevada Homeless Continuum of Care's official Youth Action Board) in guiding the development of the Plan.
This engagement culminated in a Summit to End Youth Homelessness, a packed and lively event at which the Plan was officially launched. Rounding out presentations by members of the planning group, TAC consultants facilitated brainstorming sessions for Summit participants on implementation of the Plan, focusing on next steps with identified strategies. Service providers, educators, law enforcement, policymakers, funders, faith groups, and business leaders were all in attendance, demonstrating this community's broad commitment to the shared goal of ending youth homelessness in Southern Nevada.
Meeting the Challenge of Expanding Access to Integrated Physical Health and Addiction Care
With support from the Melville Charitable Trust, TAC Senior Consultant John O'Brien assembled teams of experts to produce two new papers exploring the ways care integration is being practiced - and paid for - in a rapidly changing U.S. health care environment.
Rather than searching for a uniform set of requisite elements in the integration of substance use disorder (SUD) treatment and mainstream medical care, the authors of "Integrating Substance Use Disorder Treatment & Mainstream Medical Care: Four Ground-Level Experiences" decided to showcase a few very different groups of providers that have each moved in this direction. In each case, they asked the same key questions, including "What is the context in which your integrated care effort occurred?" "Why and how did the shift to integrated care come about?" and "What more should we know about integrated care?" A condensed version of this paper was published on the AcademyHealth Blog.
From 2000 to 2014, the rate of deaths in the U.S. from drug overdoses increased by 137 percent, yet access to treatment services for people with SUDs continues to lag. Expanding the capacity of primary care providers to assess and treat addiction is critical to filling this gap, especially given the stigma associated with seeking treatment in specialty settings. "Exploring Value-Based Payment to Encourage Substance Use Disorder Treatment in Primary Care," a joint publication project with the Center for Health Care Strategies, describes how several states and health plans are exploring value-based payment to promote SUD treatment in primary care, and offers considerations for others who might want to implement these models.
TAC Staff in Action
Executive Director Kevin Martone moderated a plenary panel on "The Health of Housing: State and Community-Based Approaches" at the National Association of Medicaid Directors' fall conference (to see the panel, start at about 31:00), delivered the keynote address at the 20th anniversary gathering of the Supportive Housing Association of New Jersey, and led a workshop on Mainstream Housing Choice Vouchers at the National Association of Housing and Redevelopment Officials (NAHRO) conference; Senior Consultant John O'Brien has been named a distinguished adviser at the Pew Charitable Trusts and was recently interviewed by Pew on "How Health Care Payers Can Help Stem the Opioid Crisis"; Subcontractor Naomi Sweitzer led a well-attended event to promote the homeless preference in multifamily housing, held at Austin (TX) City Hall and hosted by Mayor Steve Adler; Associate Ashley Mann-McLellan facilitated workshops and leadership conversations with the Suburban Cook County (IL) CoC on maximizing the impact of rapid re-housing to end homelessness; Ashley also volunteered at Boston's annual Surge to End Chronic Homelessness event; Senior Consultant Jim Yates, Associate Phil Allen, and other partners from the Rural Supportive Housing Initiative traveled to Fairbanks, AK to help the community establish new permanent supportive housing units and house more families and individuals through a robust rapid re-housing program.
A Community Focuses on Solutions to Rising Homelessness
IN LANE COUNTY, OREGON AND ITS LARGEST CITY, EUGENE, service providers, community stakeholders, and elected officials are coming together to improve the community's response to a growing population of people experiencing homelessness. To help understand the problem better, and to identify potential solutions and best practices, the Lane County Department of Health and Human Services engaged TAC in March to conduct a public shelter feasibility study. With the study, the community sought to learn how people enter into homelessness in Lane County, which housing and services they are able to access, and what factors might be contributing to any system bottlenecks.
Over the past seven months, TAC consultants Gina Schaak, Liz Stewart, and Douglas Tetrault have worked to assess Lane County's homeless crisis response and service systems, focusing on both resource capacity and gaps in coordinated entry, diversion, outreach, day shelter, emergency shelter, transitional housing, rapid-rehousing, and permanent supportive housing. To get a comprehensive picture of the existing system, TAC met with Lane County and City of Eugene staff, conducted interviews and focus groups with service providers and other key community stakeholders, and - with the help of the Human Services Research Institute - analyzed data from numerous sources.
On October 10, Liz, Gina, and Douglas presented TAC's preliminary findings to a joint session of Lane County Commissioners and the Eugene City Council, and later that day to community members at a well-attended public forum. TAC explained that Lane County can significantly reduce homelessness best by strengthening all system components. By improving the alignment of policy and training, and consistently implementing best practices throughout both Lane County and Eugene, the community can ensure that its resources are applied effectively. In December, TAC will deliver a final report authored by Liz, Gina, Douglas, and TAC Senior Consultant Lisa Sloane, with specific recommendations on system and policy changes as well as results of system modeling.
Second Annual Rapid Re-Housing Institutes Energize Providers from Across the Country
In partnership with the Department of Veterans Affairs (VA), the Department of Housing and Urban Development (HUD), and the U.S. Interagency Council on Homelessness, TAC designed and delivered the second annual Rapid Re-Housing Institutes last month. Held in Miami, FL and San Diego, CA, these intensive two-day trainings brought together over 800 rapid re-housing practitioners, Continuum of Care leads, government officials, philanthropic groups, and federal partners. Sponsored primarily by the VA's Supportive Services for Veteran Families (SSVF) program, the Institutes focused on rapid re-housing practice and planning, homelessness diversion and rapid exit strategies, and coordinated entry practices. Emerging topics such as shared housing solutions, data-informed system design, and sustainable homeless crisis response systems were also highlighted. TAC, along with our partner Abt Associates, is the primary technical assistance (TA) provider for SSVF, working closely with national partners and other TA firms to deliver high-quality planning and training development for grantees of the program. The Institutes are the only event of their kind to deliberately target both SSVF nonprofit providers and homeless service providers funded by HUD and local groups.
TAC Staff in Action
TAC Executive Director Kevin Martone co-led a workshop on mainstream vouchers at the annual conference of the National Association of Housing & Redevelopment Officials; Kevin also joined Senior Associate Rachel Post and frequent TAC collaborator Jacob Mihalak to moderate and present in several panels at last month's Supportive Housing and Supported Employment post-conference institute after the Washington State Co-Occurring Disorders and Treatment conference; Rachel also presented at the Washington Council on Behavioral Health's Peer Pathways 2018 conference on supported employment and supportive housing for justice-involved populations, and at the Oregon Housing Conference on the role of supported employment in promoting recovery for people in supported housing.
We are delighted to welcome two new Senior Associates to TAC! Tyler Sadwith joins TAC's Human Services practice, after over seven years at the Center for Medicare and Medicaid Services advancing strategies to help states introduce behavioral health system reforms and address complex policy, operational, and strategic challenges. Nicole Sweazy will work with our Housing practice, bringing nearly two decades of expertise in affordable housing and federal programs; as Executive Director of the Louisiana Housing Authority, she oversaw the state's permanent supportive housing and homeless programs and was responsible for developing Louisiana's plan to end homelessness.
FAIRBANKS IS THE REGIONAL HUB for interior Alaska, an area larger than the state of Texas. The city’s need for supportive housing is amplified by its remote rural and frontier location and extreme arctic conditions. Although the number of people experiencing homelessness in Fairbanks — approximately 250 people at any given time — seems small compared to what other major U.S. cities report, the impact of homelessness in this community is an important factor: Even during bouts of -50° Fahrenheit temperatures, Fairbanks routinely has more than 50 people trying to survive in local encampments. There have been times when dramatic temperature changes caught encampment residents off guard, resulting in numerous cold weather injuries and even some deaths.
Since 2014, TAC has worked with state and local partners on strategies to create permanent supportive housing and rapid re-housing opportunities for Alaskans. Last December, TAC was invited to facilitate the Fairbanks Symposium on Homelessness, with the goal of generating momentum toward a community planning strategy for tackling homelessness in some of the most diverse geography and climate in the United States. As in other cities and towns across the country, both the cost of housing and a lack of available units present significant challenges. But the "must do" attitude of the local Fairbanks community has already resulted in remarkable progress, and can serve as a beacon for those working in other rural communities to prevent and end homelessness.
The Fairbanks Housing and Homeless Coalition is leading the charge, representing more than 20 local organizations that provide shelter, support, and opportunities for community members struggling with housing barriers. Since the Symposium, the city’s housing and homelessness coordinator has brought local agencies together for more planning. Collectively, the group has contributed an estimated $58,360 worth of in-kind donations to initiate a program that can quickly connect families and individuals experiencing homelessness to permanent, private market housing through intensive case management, applicable employment services, and tapering financial support. Just this month, the Alaska Mental Health Trust announced that it will fully fund this local rapid re-housing program!
The Fairbanks Rescue Mission, which is already implementing rapid re-housing for Veterans through a federal Supportive Services for Veteran Families grant, has been designated as the lead agency for the award. The funding provided by the Trust will allow the new program to hire two full-time staff members and assist approximately forty families a year with housing, case management, and landlord support. The Trust has given a further boost to efforts in the region by providing funding for the Alaska Coalition on Housing and Homelessness to hire a rural housing planner who can help build local coalitions in rural Alaska and improve the region’s readiness to apply for funding to meet its needs.
Fairbanks’ challenging environmental conditions and extremely rural setting make providing effective and targeted services to the community’s most vulnerable individuals a high priority. Fortunately, the community’s determination to make life better for its least advantaged members is just what is needed.
VA Awards TAC a New Supportive Services for Veteran Families Contract
THROUGH THE SUPPORTIVE SERVICES FOR VETERAN FAMILIES PROGRAM, the U.S. Department of Veterans Affairs (VA) helps service providers across the country to strengthen the housing stability and independent living skills of very low-income veteran families occupying or transitioning to permanent housing. TAC is honored to have been awarded a new five-year grant from the VA to continue and deepen the technical assistance we have provided to SSVF grantees since the program was launched in 2011. Joining us on the TA team are our longtime partners Abt Associates, the National Alliance to End Homelessness' Center for Capacity Building, the National Coalition for Homeless Veterans, Policy Research Associates, Inc., and Atlas Research.
Nearly 400 SSVF grants fund nonprofit organizations and consumer cooperatives across the country. TAC coordinates and provides specialized TA to all these grantees through in-person trainings, regional gatherings, program site visits, carefully designed products and tools, one-on-one consultation, webinars, and online group learning. By focusing on crisis intervention and housing stability, targeting practices to ensure effective delivery of resources, and using permanent supportive housing to improve both housing stability and behavioral health outcomes, we help communities develop system-level capacity to meet the unique needs of veterans and their families.
TAC Staff in Action
Ashley Mann-McLellan, TAC Associate, led community-wide rapid re-housing (RRH) trainings in Maricopa County, AZ and Orange County, CA (where she also led an accompanying executive-level training), kicking off efforts to use RRH as a system-wide strategy; Ashley also presented on decision-making and accountability frameworks at a Seattle CoC summit on governance, strategic planning, and racial equity, and gave a workshop on landlord engagement at this month's Housing First Partners conference in Boulder, CO; Executive Director Kevin Martone wrote about the importance of new affordable housing resources in the National Association of County Behavioral Health and Developmental Disability Directors newsletter, drawing on a widely read Access blog post by Senior Associate Gina Schaak and Senior Policy Advisor Lisa Sloane; Lisa was also invited to present on "Housing First and Permanent Supportive Housing 101" to the Oregon Housing and Community Services Department; at a March event, Associate Douglas Tetrault co-presented with the New Hampshire Interagency Council on Homelessness at a discussion on the state's efforts - supported by TAC since 2016 - to end veteran homelessness.
Significant Affordable Housing Opportunities for People with Disabilities in the FY 2018 Omnibus Spending Bill
THE OMNIBUS BUDGET BILL for Fiscal Year 2018, passed by Congress and enacted by the president last week, includes a ten percent ($4.6 billion), one-year increase to the U.S. Housing and Urban Development (HUD) budget overall and gives especially strong support to housing programs serving people with disabilities.
Affordable Housing for People with Disabilities — Highlights
$400 million (est.) will go to new Section 811 mainstream vouchers for non-elderly people with disabilities. TAC estimates these funds will provide nearly 50,000 new vouchers for people with disabilities!
$82.6 million for new Section 811 Project Rental Assistance (PRA) capital advances and Project Rental Assistance. This increase may provide an opportunity for states that have not yet received PRA funds to benefit from this program!
Other Good News
$130 million increase for Homeless Assistance grants. The National Alliance to End Homelessness estimates that this increase will be enough to move 20,000 to 25,000 more people from homelessness to permanent housing.
$40 million for new supportive housing for homeless veterans with disabilities, through the HUD-Veterans Affairs Supportive Housing (VASH) program.
$20 million for new Family Unification Program vouchers that target two populations: (1) families unifying with children who were placed or are at imminent risk of placement out of the home due to lack of adequate housing for family, and (2) youth (18 to 24 years old) who are aging out of the foster care system.
A 12.5% increase in the Low Income Housing Tax Credit allocation and a 30% increase in the HOME Investment Partnerships Program (HOME), both of which will help states and localities to increase affordable housing production.
Thanks are due to all of the disability, homelessness, and affordable housing proponents across the country whose hard work and advocacy have ensured that thousands more people with disabilities will have the chance to live in safe, affordable apartments — rather than in institutions, in shelter, or on the streets. Thanks especially to Rep. Rodney Frelinghuysen, outgoing chair of the House Appropriations Committee, who has been a steadfast supporter of housing for non-elderly people with disabilities.
Long-Range Planning for Supportive Housing in New Mexico
Beginning with the successful launch of the New Mexico Behavioral Health Purchasing Collaborative Long Range Supportive Housing Plan in December of 2007, TAC has supported the state's sustained effort to create and maintain independent, decent, safe, and affordable housing options linked to flexible community-based supports - a model commonly referred to as permanent supportive housing (PSH). Now, with the release of the new Strategic Plan for Supportive Housing in New Mexico: 2018-2023, co-authored by Cynthia Melugin of the New Mexico Human Services Department and TAC Senior Consultants Jim Yates and Sherry Lerch, the state is excited and empowered to continue creating new PSH opportunities - while also advancing efforts to realign New Mexico's behavioral health services system. New Mexico aspires to lead by example, adopting innovative strategies to address the challenges of operating PSH across a rural frontier state with a diverse population.
TAC Staff in Action
Associate Phil Allen, TA & Training Coordinator Kyia Watkins, and Senior Consultant Jim Yates, in partnership with the Department of Veterans Affairs, led a first-ever two-day Program Manager Academy for 75 Supportive Services for Veteran Families (SSVF) program managers from across the country; Associate Amy Horton conducted a site visit in New York, NY as part of SAMHSA's national evaluation of the Cooperative Agreements to Benefit Homeless Individuals (CABHI) grant program; Associate Ashley Mann-McLellan and two young adult TA providers from the National Youth Forum on Homelessness attended a two-day workshop together in King County, WA on incorporating youth voices into ending youth homelessness; Ashley also attended this month’s National Alliance to End Homelessness Conference on Youth and Family Homelessness, where she presented on infusing behavioral health partnerships into housing models; Kevin Martone, TAC’s Executive Director, was at the conference too, facilitating a panel discussion he organized on Medicaid and homelessness — and in February, Kevin spoke at the Families USA Health Action Conference on “Reconstructing a Fragmented Behavioral Health System through Wellness and Whole Person Care”; Senior Associate Gina Schaak and Senior Policy Advisor Lisa Sloane headed to Washington, DC for the National Low income Housing Coalition’s annual legislative forum; and Associate Douglas Tetrault, in partnership with the VA SSVF Program Office, led a day-long planning meeting in San Juan, PR focused on efforts to end homelessness among veterans following the devastation of hurricanes Irma and Maria.
Congratulations to Associate Lauren Knott and her family on the birth of Eliza Everett Knott — glad to have you on the team, Eliza!
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!
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.