Slide 1:
What Works: Systems Change
Carol Wilkins
Director of Intergovernmental Policy
Corporation for Supportive Housing
Slide 2:
The Corporation for Supportive Housing a national non-profit intermediary organization
CSH supports the expansion of permanent housing
opportunities linked to comprehensive services for persons
who face persistent mental health, substance use, and other
chronic challenges, and are at risk of homelessness, so that
they are able to live with stability, autonomy, and dignity, and
reach for their full potential. We work through collaborations
with private, nonprofit, and government partners, and strive to
address the needs of, and hold ourselves accountable to, the
tenants of supportive housing.www.csh.org
Slide 3:
Why An Integrated Service System?
- People who are chronically homeless have multiple needs – for health care, treatment, housing, income supports, skills training, and jobs – that can not be addressed by a single service system
- People who are chronically homeless experience many obstacles to accessing housing and services
- Long term homelessness imposes substantial costs in multiple systems – there are opportunities to achieve and re-invest savings
Slide 4:
Goal of a Comprehensive and Integrated Service System
- People who are chronically homeless can enter any service “door”, be assessed, and obtain access to the full complement of services and supports that they want and need
- Services and supports can adjust to meet changing needs while people achieve and maintain housing stability
Slide 5:
What is a System?
- The way in which . . .
- Power
- Money
- Ideas and values
- Technology or know-how (methods & skills)
- Day-to-day routine (habits)
- . . . are linked to achieve a mission or goal
Slide 6:
How Systems Change Occurs
Someone recognizes a better way of doing things, leading to changes in:
- Power: duties and authority are re-arranged and designated positions are responsible for new activities
- Money is routinely or reliably allocated in new ways
- Ideas and values: “success” is defined differently, using different data, standards, and values that are widely shared
- Methods: Skilled practitioners at most levels have experience using new approaches
- Habits: participants in the system interact with each other differently as part of their jobs
Slide 7:
Getting to a Changed System
Usually a system hasn’t truly changed until:
- Most or all of the five signs are visible, and
- The difference has endured for years, not months
Slide 8:
Effective Systems Change
- Requires persistent pressure on most or all of the key elements over a sustained period of time
- To get there, often begins with:
- Persuasive short-term accomplishments
- Producing a new product or service by extraordinary means, just to show it can be done and is worth replicating
Slide 9:
Impetus for Systems Change
- When a Governor orders a major policy change
- When the Federal government allocates money in a new way
- When public philosophy or ideology shifts fundamentally
- When a court mandates a new government obligation
- When technology or know-how changes
- The surrounding system may then change if the difference is profound and long-lasting
Slide 10:
Key Requirements for Progress Toward a Comprehensive and Integrated System to Deliver Housing and Services
- Develop infrastructure and leadership
- Have full-time staff person(s) dedicated to integration
- Conduct ongoing coordinated planning and support for implementation
- Provide flexible funding and coordinate the allocation of categorical resources
- Regularly update strategies and action steps
Slide 11:
Anticipate and Overcome Obstacles to Systems Change
- Vested interests of entrenched and organized stakeholders who benefit from the status quo
- Inertia of long-standing practice and habits – and pride about current expertise
- Poor understanding of new system and its advantages
- Distrust and uneasiness between people who need to collaborate
- Stigma about the people we seek to serve
Slide 12:
Obstacles to Anticipate and Overcome (more)
- Evidence-based programs may be politically difficult to establish – especially when they challenge approaches based on values and moral judgments
- Existing programs lack adequate resources to meet current mandates / demands, making it hard to change in response to demands perceived as “new” or additional
- Complementary programs and services are uncoordinated
Slide 13:
Systems may lack capacity or infrastructure to act in new ways
- Data is not integrated
- Staff in different systems don’t share common language, skills, and training
- Few ongoing cross-systems planning and goal-setting structures are in place
Slide 14:
Overcoming the Obstacles
- Persuade by helping people recognize the costs of status quo – and see how they will benefit from changed system
- Overcome with power and/or compromise
- Cultivate champions credible with skeptics and opponents
- Change attitudes with first hand encounters with the solution – show the effects of a changed system
- Coordinated planning, linked with ongoing support for implementation and accountability structures
Slide 15:
Elements of a Comprehensive and Integrated System to End and Prevent Long-term Homelessness
- Effective continuum of care
- Collaborative planning & oversight
- Investment & leveraging resources
- Public: mainstream & targeted assistance
- Private: philanthropy & business
- Integrated, coordinated & streamlined funding
- Integrated data / evaluation system
- Provider capacity
- Quality assurance and monitoring
- Leaders / champions for changed system in strategic places of power
Slide 16:
Effective Continuum of Care
- Substantial system-wide planning for homelessness, including all homeless-specific programs and services
- Significant involvement of mainstream agencies responsible for services to people at risk of homelessness
- A full Continuum with well established pathways for people to get what they need when they need it
Slide 17:
Effective Service Delivery Systems to End Long-term Homelessness
- Outreach to effectively engage people who often do not enter or successfully complete treatment
- Integrated treatment for co-occurring mental illness, substance abuse, and other health problems
- Culturally relevant services
- Consumer-centered services
- New service strategies require workforce and organizational development to build new skills and infrastructure to support new programs
Slide 18:
Collaborative Planning: Process
- Build relationships and common language across systems
- Get commitments including resources to carry out the plan
- Approval by elected officials
- Develop a working structure to carry out the plan
Slide 19:
Collaborative Planning: Content
- Identify the need (types of households, geography, service needs, etc)
- Establish numeric goals to meet identified needs within specified time period
- Develop a strategy for community participation and education
- Develop a cost analysis for the goals and strategies
- Develop MOU that documents roles, responsibilities, and commitments to implement the plan
Slide 20:
Investment and Leveraging Resources: Process
- Identify funding needs and existing and potential funding sources
- Identify how existing funds could be used differently (integrating, targeting, allocation)
- Identify potential for new funds
- Develop solutions to technical problems
Slide 21:
Investment and Leveraging Resources: Content
- Allocation of discretionary funds (state or local General Fund tax revenues)
- Target “mainstream” Federal funds (e.g. TANF, block grants, HOME, Section 8)
- Dedicated funding streams not subject to annual appropriations (Trust Fund, statutory set-aside)
- New financing models (Medicaid, managed care)
- Fund-raising (philanthropy, business)
Slide 22:
Integration, Coordination and Streamlining Funding
- Inter-agency partnerships
- documented in written agreements
- top-level commitments and broad-based recognition and support
- Inter-agency council or formal on-going structure to provide centralized authority
- Coordinated articulation of funding priorities
- Coordinated or pooled funding applications and decisions
- Commit matching funds to leverage new resources for identified priorities
Slide 23:
Creating Housing Opportunities to End Long-Term Homelessness
- Coordinate funding decisions for housing and services based on shared priorities and established goals
- Multi-year funding commitments
- Support for siting and community acceptance
- Manage projects as they move through the pipeline (planning, development, occupancy)
- Targeted outreach and ongoing communication to ensure that people in priority target population get and keep housing (reasonable accommodations)
Slide 24:
Quality Assurance and Monitoring
- Establish consistent data collection, performance standards, reporting requirements
- Create single point of accountability for integrated services and housing outcomes
- Tie funding to quality assurance with participation by state or local government
- Cross-training
Slide 25:
Recognizing Opportunities for Systems Change
- Those in power are dissatisfied or frustrated with the current system
- Current system is in financial trouble or headed for trouble
- New / better methods for doing things are beginning to appear in the field
- Convincing evidence emerges, showing that new methods work
- People in the system show interest in new methods
Slide 26:
Looking Ahead: Systems Often Don’t Change at Only One Level
- It’s hard to change systems working only at the state or local level
- Federal programs, agencies, rules and incentives are part of state and local systems
- State government is part of most local systems
- Profound lasting change usually develops best at multiple levels
Slide 27:
Never doubt that a small group of thoughtful committed citizens can change the world. Indeed it’s the only thing that ever has.
Margaret Mead