Slide 1:

What Works: Systems Change

Policy Academy on Chronic Homelessness
Chicago, Illinois
May 21,2003

Carol Wilkins
Director of Intergovernmental Policy
Corporation for Supportive Housing

Slide 2:

The Corporation for Supportive Housing
a national non-profit intermediary organization

CSH helps communities create permanent housind with services to prevent and end homelessness

For more information visit www.csh.org

Slide 3:

The Problem in Brief

• Integrated services & supportive housing are products with proven effectiveness ending chronic homelessness – but without a system to produce them
• Homeless people must hunt for and combine discrete services for their needs
• Every project is a patchwork of authorizations and funding
• Often, success means using money for purposes that weren’t officially intended

Slide 4:

One Goal, Many Systems

• Homeless Services
• Mental Health
• Substance Abuse
• Hospitals, Clinics, Public Health
• Social Services
• Employment
• Housing Development Finance
• Rent Subsidy

Slide 5:

What’s In a Changed System?

• “Any door” leads to effective bundle of housing and services for chronically homeless people
• Service and housing resources allocated in a single or coordinated process, timed as needed for development and operation of supportive housing and programs that work for chronically homeless people
• Rules and funding not improvised project-by-project, or on exceptional basis, but established in routine practice.

Slide 6:

The Key Components of Systems

• Power - people who have formal authority and responsibility for new activities
• Money - finding is available and reliable
• Habits - people and organizations interact with each other to carry new activities as part of their normal ongoing service
• Technology & Skills - skilled practioners at all levbels can effectively deliver results
• Ideas & Values - a new understanding of the problem to be solved and new definitions of performance or success are widely shared

Slide 7:

Triggers or Levers of Change

• Change takes decades, not months.
• It usually starts with new activity, forums, and products, not a new system.
• Any of the 5 components can start the process, but it’s not done until all are changed.
• First comes credibility for a new product or idea, then a system may build around it.

Slide 8:

Old Systems are Built to Last

• The tools of System Change are meant both to unsettle old systems and build new ones.
• Old systems will resist – they exist because they have survived pressures and onslaughts before.
• Services & Housing are not just separate systems, but separate cultures, disciplines, and sets of values.

Slide 9:

Behavior Modification

Besides their framework of rules and incentives, systems deal with behavior – habits, ideas, relationships.

Change thus becomes a behavior-mod recipe:

• Persuasion
• Incentives
• Trust
• Practice

Slide 10:

Coercion and its Limits

• People can be forced to change, but only by superiors who will last long enough – and enforce the change long enough – to make it stick.
• Usually, that doesn’t happen. Politicians leave office, top executives have other priorities, and constant coercion is exhausting.

Slide 11:

Building to a ‘Tipping Point’

The spread of new ideas, habits, values, and know-how often comes from three forces:
(courtesy of Malcolm Gladwell)

• Gifted ‘sellers’
• A receptive audience (aware of a need, or caught in a moment of crisis)
• A message that ‘sticks’ when delivered

Slide 12:

Building Blocks
tested tactics of systems change

• Collaborative Planning
• Investment and Leveraging Resources
• Integration, Coordination, and Streamlining Funding
• Building Provider Capacity

Slide 13:

Building Blocks (continued)
tested tactics of systems change

• Industry Standards, Quality Assurance, and Monitoring
• Data and Communications to Make the Case
• Cultivating Leaders, Champions, and Advocates
• The Irresistible Force – Events that Compel Action
• An Intermediary as Neutral Catalyst

Slide 14:

Collaborative Planning

• Consensus-building
• Clarifying need & opportunity
• Establishing numeric goals
• Estimating costs/identifying resources
• Planning together/sharing ownership
• Accomplishing something together
• Becoming used to working together – through MOUs, task forces, projects, etc.
• Beginning to advance a wider change

Slide 15:

Who Should Collaborate?

• Programs that target homelessness and mainstream programs
• Housing: development & finance, rent subsidy
• Services: mental health, addiction treatment, health care, social services, employment
• Trusted bridge-builders

Slide 16:

How Big a Group?

• Large enough to include the people you need to get started – planners, funders, and builders who will actually be involved
• Not so big that people feel marginal, bored, or unable to contribute

Slide 17:

Who Should Participate

• Usually not the top executives – they won’t stick with it.
• Usually not the front-line staff – they don’t have enough influence over the wider system.
• People who are trusted, influential, able to pull levers.

Slide 18:

Altering the Use of Resources

• New money is powerful, but scarce and hard to sustain
• Most change is old money used in new ways
• First task is to assemble a funding package that does more, solves more problems, serves more goals, for equal or less money
• Even one pilot or demo starts the process

Slide 19:

Using old money in new ways

• Changing eligibility rules
  • Target populations
  • Providers
  • Services
• Targeting
  • Priorities or preferences
  • Set aside
• Solving technical problems

Slide 20:

How Resources Change

• New money (often discretionary or 1-time funds) gets things started and leverages commitments from existing funding streams
• Private fund-raising from philanthropy and business also may ‘jolt’ the system
• Targeting of ‘mainstream’ federal funds (e.g. TANF, block grants, HOME, Section 8)
• Dedicated funding streams not subject to annual appropriations – the start of lasting change
• New financing models, e.g. managed care

Slide 21:

Integrating/Streamlining Funds

Even when using money for the same purposes as before, a key goal is to make applications and the administration of funding consistent with the process and needs of supportive housing and other integrated responses to chronic homelessness.

Slide 22:

Interagency Coordination 
planning bodies, task forces and MOU’s establish:

• Consistent standards for eligibility and shared set of priorities
• Single or coordinated application process
  • Benefits for individuals
  • Funding and approvals for projects
• Calendar for applications and decisions that matches program development and start-up
• Shared decision-making for multiple sources of funding
• Consistent and efficient reporting and oversight

Slide 23:

Building Provider Capacity

• Develop and sustain new skills and systems
  • Engagement and multi-disciplinary service strategies
  • Housing finance, development & management
  • Effectively serving and housing people with substance use problems or other barriers to stability
  • Financial and administrative systems to access new sources of revenue
  • Partnerships, organizational and board development
• Momentum depends on the ability to do more and more –moving from a ‘boutique’ product to widespread, mainstream production.

Slide 24:

Standards & Quality Assurance

• A changed system will depend partly on proof that new methods will achieve more than old ones, with superior quality, while maintaining important consumer protections and safeguards.
• Choose standards and outcomes that matter and assess them consistently.
• Quality – of both housing and services – is the ‘sticky’ element of the systems change message.
• People won’t take this initially on faith. It has to be enforced & demonstrated place-by-place.

Slide 25:

Data, Research, Communication

• Identify the costs of chronic homelessness if we do nothing to change systems – and the savings from reduced crises when effective services and housing are provided
• Really complete data are rare
• Data don’t have to be perfect – circulate what you know
• Keep working at getting more data – it usually takes years to get, and then even longer to make usable
• But the pay-off of good evidence is huge

Slide 26:

Making the Case

• Communicating effectively to policymakers
  • Focus on the results instead of the problem
  • Keep it simple
  • Personal stories matter
  • Use the media
• Use site visits and tours to provide a context for data : put a ‘face’ on the findings

Slide 27:

Grooming Champions & Leaders

• The most effective champions aren’t always the most powerful individuals
• Businesspeople, budget officials, staff aides and advisers, all may be better than professional advocates or top elected officials
• Needs to be passionate, untiring, a gifted ‘salesperson,’ with a huge Rolodex and a convincing command of the subject

Slide 28:

Catalysts for systems change

Often the most effective broker for changing systems is a person or organization that is…

• Independent of the old system. A new or outside force without longstanding alliances to factions that old systems failed to integrate.
• With a clear point of view, and a way out of the woods.
• Drawing from experience, not just ideas.

Slide 29:

Their Problem, Your Opportunity

• Mainly, system reformers look for places in the old system where players are unhappy, frustrated, losing the race.
• Whoever feels the pain the worst may be your first ally.
• Most of all, show them something they could take credit for – field trips to visit model programs often help.