Slide 1:

Creating Viable Strategies for Systems Change

Policy Academy on Chronic Homelessness
Denver, Colorado
October, 2003

David M. Wertheimer, M.S.W., M.Div.
Principal, Kelly Point Partners

Slide 2:

Why Systems Change?

Most services for persons who are chronically homeless are highly fragmented:

• Access to services is haphazard at best
• Homeless persons must seek out and combine the services they need to recover
• Programs and resources are cobbled together without an overall strategy

Slide 3:

Systems Change Works!

• Integration of services and supportive housing are a proven strategy for success
• Integration doesn’t just happen -- it must be planned, pursued with vigor and sustained with efforts over time
• Success requires innovation, stretching and creative use of existing and new resources

Slide 4:

So, What is a System?(Corporation for Supportive Housing)

Try a new approach to defining systems: A system is the ways that…

• 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 5:

Changes in Power

Changes in power require that:

• Duties and authority are re-arranged
• Designated positions are given responsibility for new activities
• Stakeholders that have not been heard or present may assume new and different roles

Slide 6:

Changes in Money

Changes in money require:

• Analysis of how funds are currently or traditionally identified, allocated, spent and monitored
• Development of new resource procedures
• Testing of new procedures for reliability, manageability and effectiveness

Slide 7:

Changes in Ideas and Values

Changes in ideas and values require:

• Re-examination of traditional definitions of “success”
• New definitions of “success” are rooted in different data, standards, and values that are widely shared
• Discussion of and education about “success” occurs across multiple systems

Slide 8:

Changes in Methods

Changes in methods require:

• Identification of new promising practice approaches
• Development of skill bases among practitioners required to implement promising practices
• Implementation, monitoring and evaluation of changes/new models

Slide 9:

Changes in Habits

Changes in habits require:

• Understanding the demands of an integrated, “multi-cultural” environment
• Providing training and rationale for changing habits
• Developing capacity among participants to interact with each other differently as part of their core work activity

Slide 10:

What is Systems Integration?(Kelly Point Partners)

Human services systems are integrated when there is sharing of:

Information
Planning
Clients
Resources
Responsibility

Slide 11:

How Systems Change Occurs 

• A better way of doing things is recognized
• A new vision guides the change process, e.g. “No Wrong Door”
• Resources are made to work together: Allocation of housing and service resources are coordinated
• Administrative and program structures are linked: There are shared policies, procedures and funding mechanisms

Slide 12:

Effective Systems Change

• Requires persistent pressure on most or all of the key elements over a sustained period of time (years, not months)

To get there, begin with:

• Persuasive short-term accomplishments
• Production of a new product or service by extraordinary means, just to show it can be done and is worth replicating

Slide 13:

Systems Change Building Blocks

• Collaborative planning
• Building consensus and setting goals
• Investment and leveraging resources
• Coordination and streamlining of funding
• Building provider capacity
• Developing industry standards, quality assurance and monitoring
• Cultivating leaders and champions
• Data and communications to make the case

Slide 14:

Expect Resistance!

• Systems change unsettles old systems as it builds new ones: This is to be expected!
• Old systems exist because they have survived pressures and onslaughts before: You are the next concept of the day and hopefully will disappear!
• Services & housing are not just separate systems, but separate and distinct cultures with unique histories, institutions, beliefs, values and stereotypes: Build “multicultural competence!”

Slide 15:

Head for the Dysfunction

• Look for places in the old systems where players are most unhappy and frustrated
• Utilize media incidents and disasters
• Those who feel the pain the most may become your first and strongest allies
• Show potential allies real solutions – e.g., field trips to visit model programs
• Create shared ownership to promote shared accountability and commitment

Slide 16:

Agree on Where You’re Going

• Change relies in part on proof that new methods will achieve more than old ones, with better quality, while maintaining consumer-centered protections and safeguards
• Assess progress consistently
• Insist on quality, in housing and services alike
• Demonstrate and enforce mutually shared standards

Slide 17:

Data is Your Best Friend

• Identify the costs of chronic homelessness
• Project savings from reduced crises when effective services and housing are provided
• Data don’t have to be perfect – circulate what you know and do have available
• Work at getting more data – it may take years to get, and then even longer to make usable

Slide 18:

Make the Case!

• Communicate what you know to key policymakers
  • Focus on the results instead of the problem
  • Keep language and concepts simple
  • Gather and use personal stories
  • Promote media interest
• Put a ‘face’ on the findings: Consumers and human stories (anecdotes) are the essential companion to data

Slide 19:

Cultivate Heroes & Heroines

• The most effective champions aren’t necessarily the most powerful individuals (although they can help!)
• Businesspeople, budget officials, staff aides and advisers all may be better than professional advocates or top elected officials
• Leadership must be passionate and untiring. Find a gifted ‘salesperson’ with a huge Rolodex and a convincing command of the subject

Slide 20:

Use “Boundary Spanners”

• Find individuals and organizations that can span the gaps and penetrate the barriers
• Working across systems requires balancing trust in the change agent with suspicion about the change process
• Boundary spanners are open to input from all systems and able to articulate a clear point of view that offers a way out of the woods
• Change agents draw from experience and ideas

Slide 21:

Be Creative About Money

• New money is powerful, but scarce and hard to sustain over time
• Most change comes from old money used in new ways
• Work to assemble a funding package that does more, solves more problems, serves more goals, and uses equal or less money
• One effective pilot or demo can start the process

Slide 22:

Use Old Money in New Ways

• Change eligibility rules, e.g.:
  • Target populations
  • Providers
  • Services
• Establish clear target populations for resources
  • Priorities or preferences
  • Set aside
• Solve policy or technical problems that create or sustain gaps and barriers

Slide 23:

Use Multiple Funding Strategies

• New money (often discretionary or one-time funds) gets things started and leverages commitments from existing funding streams
• Private fund-raising from philanthropy and businesses also may ‘jolt’ the system
• Target mainstream funds (e.g. Medicaid, TANF, block grants, HOME, Section 8)
• Utilize dedicated funding streams not subject to annual appropriations
• Use new financing models, e.g. managed care

Slide 24:

Create Systems that Make Sense to Clients

• Even when using money for the same purposes as before, make applications and the administration of funding consistent with the experiences and needs of individuals experiencing chronic homelessness
• Put the client first in terms of how we define, conceptualize and move towards integrated systems solutions that promote true change