[Slide 1]{.underline}

**Aligning the Continuum of Care with the Ten Year Plan**

The Emerging New Paradigm

At the bottom of each page are these words: Home Base Slash Legal and
Technical Services Supporting Shared Prosperity

[Slide 2]{.underline}

**Introduction**

There have been three phases of action toward ending homelessness.

We are now in the third of these three phases. This third phase is an
emerging New Paradigm based on the outcomes of the first two phases.

The second of the three phases was a shift from the successful
management of meeting human needs in a homeless targeted response, to a
cross-system mainstream integrated effort.

And the first of these three phases, the immediate response to meeting
human need, was the basis for the later two.

[Slide 3]{.underline}

**First Phase**

The first phase toward ending homelessness involved isolated emergency
responses; research into alcohol, substance abuse, and public health
consequences of homelessness; and an urgent sense of need to help people
out of chaotic conditions. Some early planning efforts occurred, as well
as analysis of housing needs. This phase stretched from the mid 1970s to
the late 1980s and evolved into comprehensive community-based systems of
care.

This movement was bottoms up.

A triangle, pointing upward, has the words Creating the Continuum of
Care just above the bottom side.

[Slide 4]{.underline}

**Experience slash Knowledge Gained from First Phase**

Homelessness is a blend of individual and systematic causes.

Housing, incomes, and services slash treatment need to be provided in
tandem at the level needed by each person.

Meeting individual need requires attention to underlying causes, such as
the need to expand housing subsidies, increasing levels of income
support, and treatment on demand.

No single agency should handle the needs of a community's burgeoning
homeless population. Comprehensive, collaborative approaches are needed.

Private investment could create models that public resources could
expand to the scale needed to handle the problem.

Research into individual experiences of homelessness may expand our
understanding and help tailor programmatic responses.

This experience was supported by resources from the 1987 McKinney Act.

[Slide 5]{.underline}

The first phase toward ending homelessness resulted in the Continuum of
Care, COC: an evidence-based, award-winning practice underway in close
to 500 communities.

At the bottom of a triangle pointing upward are the words Mid 1970's,
Local Communities Incremental Responses: soup kitchens, emergency
shelter, blankets, et cetera. From there, an arrow points up to the
words Networks of Collaborating Agencies. From there, an arrow points up
to the words Strategic Responses to Homelessness, supported by local
admin planning processes. From there, an arrow points up to the words
Continuum of Care: 1994.

[Slide 6]{.underline}

Quote, Continuum of Care, unquote, is used to describe three things

**1: COC: Comprehensive Homeless Assistance Housing and Services
System**

At the top of one diagram is a box labeled Outreach slash Intake
Assessment slash Prevention. It connects with a non-arrow line to a
lower box marked Emergency Shelter, which has arrows pointing rightward
to boxes marked Transitional Housing, Permanent Housing, and Supportive
Housing. The Transitional Housing box also has rightward arrows pointing
to the Permanent Housing and Supportive Housing boxes, the former being
above the latter.

The same diagram is repeated below, but with new additions. Now a box
labeled Prevention of Housing Loss is at the top and connected with
non-arrow lines to the Outreach slash Intake Assessment box, which no
longer includes Prevention, and the Permanent Housing box. At the
bottom, connected with non-arrow lines to the Transitional Housing and
Supportive Housing boxes, is a box with a long label: Mental Health,
Substance Abuse, Job Training, Family Support, Independent Living
Skills, Education slash HIV.

[Slide 7]{.underline}

**2: COC: Local 18 Month and-or Five Year Strategic Plans**

Which led to:

Creation of Local Homeless Point Persons

Local Departments slash Offices Dedicated to Homelessness

Increased Local Revenue to Implement the Plan

Coordinated Local Programs Targeting Youth, Veterans, Families, et
cetera

**3: COC: Annual Funding Cycle Managed by HUD**

In 1994, over 68 percent of McKinney Act Homeless Specific Resources
were concentrated in and distributed through HUD.

[Slide 8]{.underline}

**COC: National Policy**

The COC stands as, quote, The Federal Plan to Break the Cycle of
Homelessness, unquote.

It was issued by the Interagency Council on the Homeless, part of the
White House Domestic Policy Council, in 1994.

This slide shows the cover of Priority, Home: The Federal Plan to Break
the Cycle of Homelessness. At the right is its table of contents.

[Slide 9]{.underline}

**COC: Evidence-based Practice**

The COC was found to be extremely effective at:

> Assisting homeless people
>
> Creating a response
>
> Enhancing collaboration
>
> Engendering local autonomy
>
> Inspiring significant additional investments
>
> Providing policy guidance
>
> Adapting to new policy guidelines

Thus:

> Having a very positive impact on all communities across the United
> States.

**COC: Award-winning**

The Ford Foundation and Harvard University Kennedy School awarded the
COC a rare Innovations in Government Award as an exemplary and
innovative example of a government program improving the quality of life
of its citizens. They found it extremely effective, resulting in 4 to 14
times as many people moving from streets to shelter to self-sufficiency
with just twice the investment of Federal resources.

This slide shows the cover of The Continuum of Care: A Report on the New
Federal Policy to Address Homelessness. At the right is its table of
contents.

[Slide 10]{.underline}

**COC: Successful Outcomes**

Finally, the Urban Institute conducted an Evaluation of all aspects of
the Continua of Care for Homeless People in 2002, finding again that:

> This systematic approach works
>
> More people receive better assistance than they would without it
>
> It is a more effective funnel for channeling resources to the local
> level
>
> It provides opportunity to integrate nonhomeless resources, such as
> mainstream resources, to the homeless population as a means to end
> homelessness.

This slide shows the cover of Evaluation of Continuums of Care for
Homeless People. At the right is its table of contents.

[Slide 11]{.underline}

**Table of Contents Continued**

This slide continues the table of contents from Evaluation of Continuums
of Care for Homeless People.

[Slide 12]{.underline}

The first phase to end homelessness thus brought us from chaos to
community:

> Through use of a demonstrated, effective practice now adopted and
> replicated by almost 500 communities in the United States.

We went from:

> Isolated local responses to a national strategy
>
> Small one-time grants to national legislation providing annual funding
>
> Intuitive responses with anecdotal evidence to research-based
> practices producing consistent outcomes
>
> Singular agencies acting alone to coordinated local responses
> mirroring a national paradigm.

The slide shows five identical images: a circle with rainbow-colored
arrows curving out of it counterclockwise.

[Slide 13]{.underline}

**Second Phase**

The second phase toward ending homelessness was the progression from our
success in managing the issue: a thorough understanding that is both
research and practice based, having a common definition and set of
strategies; core funding; and getting people off the streets, back into
housing. Those were the successful outcomes that allowed a refocus on
ending the problem.

This second phase was top down.

A triangle, pointing downward, has the words Ten Year Plan End Goal at
the top.

[Slide 14]{.underline}

**Top-down Response to Problems Perceived:**

1: Localities were struggling with how to sustain an ever-expanding COC
system.

2: Many were labeling the hard-working local agency folk as having an
entitlement mentality toward the national resources being disbursed.

3: The early private funding was shrinking, especially that which
supported advocacy such as the 1989 Housing Now March on Washington, the
hunger strikes of Mitch Snyder, and the presence of Stevie Wonder
singing on the Capitol steps to end homelessness.

4: There was no private-market business involvement at a significant
level.

5: Despite thousands of people who had been well-assisted out of
homelessness, quote street people unquote were still pervasive in many
downtown areas, creating a sense of discomfort and disorder and the
impression of intractability. This led to new focus on chronic
homelessness.

These quote problems unquote created a perceived need for change,
building upon the fledgling COC response to human need helping
individual homeless persons, toward a more dramatic forceful effort to
end homelessness fully.

[Slide 15]{.underline}

**Activities of the Second Phase**

1: Federal department staff members charged with mainstream safety net
programs began meeting across agencies creating possibilities for
aligning efforts, collaborating, and cross-learning from the emerging
research.

2: NAEH launched Open the Front Door, Close the Back Door in 2000.

This slide shows the cover of a publication from the National Alliance
to End Homelessness. It is titled, A Plan, Not a Dream: How to End
Homelessness in Ten Years.

[Slide 16]{.underline}

**Results**

The second phase toward ending homelessness thus resulted in the
cross-system, homeless and mainstream, integrated vision of the Ten Year
Plan to end homelessness, widely supported by elected officials and
staff in all levels of government.

The Ten Year Plan effort has led to the third phase to end homelessness,
just now becoming visible from the merging of phases one and two.

In the middle of the slide is a formula with geometric images: an upward
triangle plus a downward triangle equals the two overlapping to form an
internal diamond.

This is a paradigm shift of large magnitude encompassing all three
meanings of the COC effort with the restructuring of mainstream systems
of meeting human needs so that the needs of all are accommodated.
Strategies include expanding mainstream programs, increasing the
investment in mainstream programs that serve people who are homeless,
and expanding access for people who are homeless throughout mainstream
systems.

Local mainstream revenue sources must be dedicated to support Ten Year
Plan implementation and to leverage increased State and Federal
investments.

[Slide 17]{.underline}

**Examples of Successful Local Investment Towards Ending Homelessness**

Direct Access to Housing, DAH, Department of Public Health, San
Francisco

> The Department of Public Health has invested heavily in housing as a
> health intervention for homeless individuals with complex medical
> problems. The DAH program provides quote low-demand unquote, permanent
> supportive housing to single adults from the streets, shelter, and
> acute hospital or long-term care facilities. Residents are accepted
> into the program with active substances abuse disorders, serious
> health conditions, and-or complex medical problems. Funding for the
> DAH program comes predominantly from the city general fund. Other
> revenue sources for the project include State money targeted toward
> homeless mentally ill persons, Ryan White Care Funds, Samsa, and
> reimbursement through the Federally Qualified Health Center system for
> a portion of the medical and mental health related expenses.

Pathways to Housing-DC, Department of Mental Health, Washington, DC

> The Department of Mental Health has committed over 15 million dollars
> in capital funds to develop permanent supportive housing for people
> who are homeless. Through a partnership among the Department of Mental
> Health, Pathways-DC, and the Community Partnership for the Prevention
> of Homelessness, new permanent supportive housing has been developed
> and targeted to serving homeless people with co-occurring disorders.

[Slide 18]{.underline}

The third phase toward ending homelessness is coming forth from the
outcomes of the first and second into a New Paradigm.

This shift requires that we:

> Imagine what a new paradigm world looks like in 2020
>
> Ask who needs to make what changes for this to happen
>
> In what parts of the COC
>
> In the mainstream world
>
> In business slash civic society.

We need to work carefully to integrate the COC homeless services system
with mainstream systems of care, building upon COC Plans to implement
ten-year visions.

[Slide 19]{.underline}

**Description of the New Paradigm**

The COC component is homeless-targeted work crafted in the context of
reorganizing the safety net.

The Emerging Paradigm is homeless-specific activity being consciously
co-created with mainstream safety net and community service program
participation.

The New Paradigm encompasses seven seeds of our future, which have
emerged from early Continuum of Care components.

In the middle of the slide, a diagram shows two overlapping triangles.
The higher one, pointing downward, is labeled Ten Year Plan End Goal.
The lower triangle, pointing upward, is labeled COC System. The
diamond-shaped overlapping portion contains seven randomly placed
circles.

Within the third phase are these seven seeds. The following chart shows
the New Paradigm components of the response to homelessness, which have
emerged from the COC.

[Slide 20]{.underline}

+----------------+-------------------------+--------------------------+
| **The Seven    | **Continuum of Care     | **Emerging Paradigm**    |
| Seeds**        | Component**             |                          |
+----------------+-------------------------+--------------------------+
| Prevention     | Rent slash mortgage     | Discharge planning:      |
|                | assistance              | re-entry, community      |
|                |                         | re-integration           |
+----------------+-------------------------+--------------------------+
| Outreach slash | Multiservice centers,   | Basic housing assistance |
| Engagement     | safe havens             | centers, with basic      |
| slash          |                         | needs services           |
| Assessment     |                         |                          |
+----------------+-------------------------+--------------------------+
| Support        | Multiple intake,        | Assertive community      |
| Services       | multiple case managers  | treatment slash          |
|                |                         | integrated service       |
|                |                         | teams, using critical    |
|                |                         | time interventions; and  |
|                |                         | continuous community     |
|                |                         | treatment slash          |
|                |                         | integrated service       |
|                |                         | teams, using critical    |
|                |                         | time interventions; and  |
|                |                         | Continuous Community     |
|                |                         | Treatment: Every Door    |
|                |                         | the Right Door;          |
|                |                         | treatment: mental        |
|                |                         | health, alcohol, and     |
|                |                         | other drug treatment on  |
|                |                         | demand; co-occur         |
|                |                         | disorder treatment;      |
|                |                         | centralized case         |
|                |                         | management; target       |
|                |                         | Federal entitlement      |
|                |                         | programs for 100 percent |
|                |                         | enrollment               |
+----------------+-------------------------+--------------------------+
| Emergency      | Congregate open space,  | Safe haven as permanent  |
| Shelter        | dorms, motel vouchers   | supportive housing,      |
|                |                         | emergency shelter,       |
|                |                         | interim housing, service |
|                |                         | enriched, time fits the  |
|                |                         | person, rapid housing    |
|                |                         | focus                    |
+----------------+-------------------------+--------------------------+
| Transitional   | 2 years to stabilize    | Transitional housing as  |
| Housing        |                         | needed: families, DV,    |
|                |                         | youth, vets, ex-prison;  |
|                |                         | rapid housing focus;     |
|                |                         | transition lease from    |
|                |                         | agency to person         |
+----------------+-------------------------+--------------------------+
| Permanent      | Housing when deemed     | Permanent housing        |
| housing        | ready and rule abiding, | supports as and when     |
|                | permanent supportive    | needed, rapid housing    |
|                | housing                 |                          |
+----------------+-------------------------+--------------------------+
| Administrative | Monitor slash site      | Leadership succession;   |
| slash          | visit                   | legacy planning,         |
|                |                         | evaluate data with MIS   |
| Coordinating   |                         | and annual analysis      |
| Structure      |                         |                          |
+----------------+-------------------------+--------------------------+

[Slide 21]{.underline}

The seventh seed, the Administrative slash Coordinating Structure,
requires that communities create an implementation tool to be updated
annually. This tool will include tracking progress from the prior year
and outline the goals and action steps for the coming 18 months. Below
is an example from Contra Costa County, California that demonstrates the
importance of local coordination across local strategies to end
homelessness. This example highlights the first seed of Prevention.

+-----------------------------+----------------------------------------+
| **18 Month Plan**           | **10 Year Plan**                       |
+-----------------------------+----------------------------------------+
| Prevent further             | Prevent homelessness from occurring in |
| homelessness through        | the first place.                       |
| changed systems and         |                                        |
| community-based             | > Expand homelessness prevention       |
| partnerships for in-reach.  | > services.                            |
|                             | >                                      |
| > Plan discharge to housing | > Create quote housing support centers |
| > by requiring the          | > unquote at each of the county's      |
| > corrections system,       | > multiservice centers and target      |
| > foster care, hospitals,   | > additional funding to other          |
| > mental health programs    | > community-based prevention programs  |
| > and drug and alcohol      | > in neighborhoods identified as being |
| > treatment programs to     | > significant sources of homelessness. |
| > develop residential       | >                                      |
| > stabilization programs to | > Create an Eviction Prevention Team   |
| > connect clients to        | > with linkages to Landlord-Tenant     |
| > community housing and     | > Court to identify people at risk of  |
| > services prior to         | > losing their housing and to agencies |
| > discharge. 8 months       | > providing prevention services,       |
| >                           | > including the Department of          |
| > Establish a special       | > Employment and Human Services, the   |
| > respite care unit in      | > Housing Support Centers, and the     |
| > interim housing for       | > County Office of Homeless Programs.  |
| > homeless patients         | >                                      |
| > discharged from the       | > Start a new bridge subsidy program,  |
| > hospital who are          | > to fill the gap for those at risk of |
| > medically frail and still | > homelessness between losing housing, |
| > need some degree of       | > including institutional discharge,   |
| > specialized assistance.   | > and entering a Section 8 or other    |
| > 18 months                 | > permanently affordable unit.         |
| >                           | >                                      |
| > Designate the             | > Improve early identification and     |
| > multiservice centers as   | > intervention.                        |
| > basic housing assistance  | >                                      |
| > centers, BHAC's to        | > Require that all public, nonprofit,  |
| > provide housing support;  | > and faith-based health and social    |
| > define BHAC service       | > service providers assess clients for |
| > package and allow all COC | > risk of homelessness as part of      |
| > agencies to adapt. 9 to   | > client intake interviews. Staff will |
| > 14 months                 | > be trained to identify homelessness  |
| >                           | > risk factors and conduct appropriate |
| > Create an Eviction        | > referrals, including linking clients |
| > Prevention Team with      | > to the Housing Support Centers, the  |
| > linkages to               | > Eviction Defense Prevention Team,    |
| > Landlord-Tenant Court to  | > and Legal Aid slash Fair Housing     |
| > identify people at-risk   | > services.                            |
| > of losing their housing   | >                                      |
| > and connect them to       | > Adopt a countywide just-cause        |
| > agencies providing        | > eviction ordinance to reinforce      |
| > prevention services. 6 to | > tenant's rights to security of       |
| > 8 months: identify        | > tenancy and habitable living         |
| > revenue stream; 17        | > conditions.                          |
| > months: operational       | >                                      |
| >                           | > Enhance discharge planning efforts.  |
| > Improve early             | >                                      |
| > identification and        | > Require the corrections system,      |
| > intervention efforts by   | > foster care, hospitals, mental       |
| > mainstream health and     | > health programs, and drug and        |
| > social service agencies   | > alcohol treatment programs to        |
| > who are often in touch    | > develop residential stabilization    |
| > with households at risk.  | > programs to connect clients to       |
| > Train staff to identify   | > community housing and services prior |
| > homelessness risk factors | > to discharge. Core outcome measures  |
| > and conduct appropriate   | > for these programs will be revised   |
| > referrals. 14 months      | > to include client post-placement     |
|                             | > residential stability and service    |
|                             | > linkages.                            |
|                             | >                                      |
|                             | > Establish a special respite care     |
|                             | > unit at a shelter for homeless       |
|                             | > patients discharged from the         |
|                             | > hospital who still need some         |
|                             | > specialized assistance.              |
+-----------------------------+----------------------------------------+

[Slide 22]{.underline}

**Supporting the New Paradigm**

Our seven seeds will thrive with the elements needed to support their
growth, including collaboration of other networks necessary to take them
to scale.

At the center of the diagram are two triangles overlapping to form a
six-pointed star. This star overlaps a set of 13 circles in the
formation of a six-armed asterisk. Each end circle has a label:
Veterans, Health Care, Youth slash Education, Labor, Department of
Defense, and Mental Health slash Substance Abuse.

[Slide 23]{.underline}

At the upper left is a circle labeled Veterans. It has four arrows, each
pointing to information about a different organization:

> 1: Department of Veterans Affairs, www.va.gov/homeless
>
> Convenings
>
> Funding
>
> Research
>
> Policy direction
>
> 2: National Coalition for Homeless Veterans, www.nchv.org
>
> Network convenings
>
> Advocacy
>
> 3: HUD Veterans Resource Center, Hudvet,
> www.hud.gov/offices/cpd/about/hudvet
>
> Resources
>
> Information
>
> 4: National Coalition for the Homeless Fact Sheet on Homeless
> Veterans, www.nationalhomeless.org/veterans.html
>
> Information
>
> Advocacy

[Slide 24]{.underline}

At the upper left is a circle labeled Health care. It has two arrows,
each pointing to information about a different organization:

> 1: Health Care for the Homeless Information Resource Center,
> bphc.hrsa.gov/hchirc/
>
> Newsletter slash video library
>
> Publications slash bibliographies
>
> Resources
>
> 2: HUD Veterans Resource Center, Hudvet,
> www.hud.gov/offices/cpd/about/hudvet
>
> Convenings
>
> Advocacy
>
> Research
>
> Trainings slash education
>
> Resources slash publications

[Slide 25]{.underline}

At the top of the slide are circles, lined up from left to right,
labeled Youth slash Education, Labor, Department of Defense, and Mental
Health slash Substance Abuse.

All six outer seeds have similar networks of support.

For information on the above four and on additional relevant issue
areas, please see the enclosed hand-out entitled National Level
Homelessness-related Research, Networks, Publication, and Other
Resources.

[Slide 26]{.underline}

The Ten Year Plan is a process mechanism for engagement, within the
context of knowledge application and resource acquisition. Your tax
dollars have been invested in developing a knowledge base that needs to
be applied.

A triangle pointing upward is labeled Knowledge Application.

Implementation of a Ten Year Plan is necessary given the existence of
the COC but also incorporates the hallmarks of the first 30 years of our
national response to homelessness, which are that, 1, locally designed
solutions will work best; 2, innovation must be constantly fostered; 3,
flexibility is continuously desired; and 4, responsiveness to changing
client need and community conditions always must be possible.

A triangle pointing downward is labeled Resource Acquisition.

[Slide 27]{.underline}

**Bringing the Response to Homelessness to Scale**

A major lesson of these 30 years is that this work never has been taken
to the scale needed to resolve the problem.

Image: A series of upward arrows, each taller than and overlapping the
one to its left

We need resources at a sufficient scale to make an impact.

We need leadership slash shared responsibility for change at the Federal
level.

We need comprehensive policies adopted at the State, Federal, and local
levels.

We need recognition that the local level and local action is the center
of gravity for transformation.

[Slide 28]{.underline}

**New Business Model**

Efforts to end homelessness cannot succeed fully until we integrate the
knowledge of our history with our vision for the future.

The Ten Year Planning effort cannot succeed unless we learn what there
is to know, integrate that knowledge into our activity, and then shift
to a new business model.

New Business Model: Transformation

Deep, profound, continuous process of innovation

Arises from the unpredictable and impossible

A downward triangle has Transformation written on its top side,
Innovation on its left, and Integration on its right.

[Slide 29]{.underline}

Working within the realm of quote, what we do not know, unquote,
implement your plans, not at the margins but at the core of the system,
by asking:

> What can we eliminate from our efforts?
>
> What can we reduce?
>
> What can we increase?
>
> What can we create?

This four-point conversion and refocusing business process is used by
industry leaders who know they cannot, quote, manage, unquote, their
businesses and customers the same way for decades. Please ponder these
for your community, as you review the research, learn of ideas slash
strategies under way, and reflect on other communities' experiences.

[Slide 30]{.underline}

And as we all move forward, please contribute to the national knowledge
base -- so that you help form the circle of completion:
local-State-national coordinated action implementing every strategy that
alleviates human suffering.

At the right is a circle containing a set of 13 circles in the formation
of a six-armed asterisk. A small upward triangle marked A reaches into
circles numbered 1, 2, 3 and 7. A small downward triangle marked B
reaches into circles 1, 4, 5, and 6. A large upward triangle marked C
reaches into circles 1, 2, 3, 4, 5, 6, 7, 8, 10, and 12. A large
downward triangle marked D reaches into circles 1, 2, 3, 4, 5, 6, 7, 9,
11, and 13.

**Circle of Completion**

Seeds:

> 1: Prevention
>
> 2: Outreach, Engagement, Assessment
>
> 3: Support Services
>
> 4: Emergency Shelter
>
> 5: Transitional Housing
>
> 6: Permanent Housing
>
> 7: Administrative Coordinating Structure
>
> 8: Veterans
>
> 9: Health Care
>
> 10: Youth Education
>
> 11: Labor
>
> 12: Department of Defense
>
> 13: Mental Health slash Substance Abuse

Triangles:

> A: Creating Continuum of Care
>
> B: Ten Year Plan End Goal
>
> C: Knowledge Application
>
> D: Resource Acquisition