[Slide 1]{.underline}

**Forging New Relationships to Promote Employment for People Who Are
Homeless: Strategies for Change That Cross System Cultures**

David M Wertheimer, MSW, M Div

Kelly Point Partners

[Slide 2]{.underline}

**Listening to What Our Customers Tell Us**

I am not incompetent; I just need help moving the obstacles out of the
way.

> Joseph, a homeless man with co-occurring mental illness and substance
> use disorders living in a shelter in Seattle

[Slide 3]{.underline}

**We Are Actually Some of the Obstacles**

We have designed systems that make sense to bureaucrats, funders, and
agency administrators

We have not created systems that make sense from the perspective of
people with multiple problems who need or are seeking our help

[Slide 4]{.underline}

**This Includes Treatment, Housing, and Employment Programs**

Treatment agencies too often assume that a person with significant
disabilities and a history of homelessness is incapable of employment

Housing providers chasing reliable subsidies fail to make the connection
between meaningful work and sustained tenancy

Employment programs consider work for people who are homeless a
"specialty" service outside the mainstream of employment services

[Slide 5]{.underline}

**Further Complications: Systems-level Cultural Barriers**

Treatment, housing, and employment systems are separate and distinct
cultures

Creating a single, homogenous "melting pot" environment will not succeed

Promoting understanding and competency reaching across cultures is a
critical task

Systems integration is a critical goal

[Slide 6]{.underline}

**How We Get There from Here**

Acknowledging the current levels of systems fragmentation

Recognizing that most of our clients are struggling with multiple
problems that make providing treatment, housing, and employment all
significant challenges

Changing the basic ways we do business

Promoting systems integration as an alternative to fragmentation

[Slide 7]{.underline}

**Systems Integration: Why Bother**

The issues that we are here to address are beyond the capacity of any
single system to solve on its own

No one system has the resources

No one system has the expertise

No one system has the person power

No one system has the complete solution

[Slide 8]{.underline}

**So What Is Systems Integration**

Housing, health, and human services systems are integrated when there is
sharing of:

Information

Planning

Clients

Resources

Responsibility

[Slide 9]{.underline}

**Wrapping Our Heads Around Systems Integration**

A photo shows a Ford Model T.

[Slide 10]{.underline}

**Systems Integration: The Mechanic's Perspective**

A photo shows the interior of a car's hood.

[Slide 11]{.underline}

**The Mechanic's View**

The engine is a complex piece of machinery

The mechanic needs to know how it works, how the pieces fit together,
how to diagnose a problem, and how to repair what broken

To the rest of us, looking under the hood is a daunting and confusing
task

If we're going to use a car, the non-mechanics among us need it to be
easy

[Slide 12]{.underline}

**Systems Transformation: Making Integration Invisible to the End User**

A photo shows a steering wheel and other controls as viewed from inside
a car.

[Slide 13]{.underline}

**In the World of Homelessness, Housing, and Employment, You Are the
Mechanics**

So how do we promote systems change to empower systems integration

[Slide 14]{.underline}

**A Perspective on Systems Change**

The Corporation for Supportive Housing Perspective

[Slide 15]{.underline}

**What a System Is**

A system is the ways that:

Power

Money

Ideas and values

Technology or knowhow: methods and skills

Day-to-day routine: habits

Are linked to achieve a mission or goal

[Slide 16]{.underline}

**Changes in Power**

Changes in power require that:

Duties and authority are rearranged

Designated positions are given responsibility for new activities

> Stakeholders who have not been heard or present may assume new and
> different roles
>
> Housing, treatment, and employment systems promote cross-system
> alignment

[Slide 17]{.underline}

**Changes in Money**

Changes in money require:

> Identification of funds in play from all systems: housing, supportive
> services, treatment, and employment
>
> 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 18]{.underline}

**Changes in Ideas and Values**

Changes in ideas and values require:

Reexamination of traditional definitions of success

> New definitions of "success" rooted in different data, standards, and
> values that are widely shared
>
> Discussion of and education about success occurs across multiple
> systems

[Slide 19]{.underline}

**Changes in Methods**

Changes in methods require:

> Identification of new promising practice approaches for employment
> linked to housing and supportive services
>
> Development of skill bases among housing, treatment, and employment
> services that providers require to implement promising practices
>
> Implementation, monitoring, and evaluation of changes/new models

[Slide 20]{.underline}

**Changes in Habits**

Changes in habits require:

> Understanding the demands of an integrated, multicultural environment
>
> Providing training and rationale for changing habits and practices
>
> Developing capacity among participants to interact with each other
> differently as part of their core work activity to support employment
> goals

[Slide 21]{.underline}

**How Systems Change Occurs\
**New goals are identified

A better way of doing things is recognized

A new vision guides the change process

Resources in all relevant systems are made to work together

Administrative and program structures are linked

[Slide 22]{.underline}

**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 that it can be done and is worth replicating

[Slide 23]{.underline}

**Building Blocks of Systems Change**

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 24]{.underline}

**Expect Resistance**

Systems transformation 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.

[Slide 25]{.underline}

**Be Creative About Money**

New money is powerful but scarce and hard to sustain over time

Most transformation comes from old money used in new ways

Work to assemble packages of existing funding that reach across systems:
housing, treatment, and employment

One effective pilot or demo can start the process

[Slide 26]{.underline}

**Use Old Money in New Ways**

Change eligibility rules; EG:

> Target populations: Are people who are homeless screened in or out of
> programs

Providers: Are employment goals prioritized in treatment plans?

> Services: Are employment services accessible and accepting of people
> who have been or are homeless

Establish priorities, set-aside funds, et cetera

Address policy or technical problems that create or sustain gaps and
barriers

[Slide 27]{.underline}

**Use Multiple Funding Strategies**

New money, often discretionary or one-time funds, gets things started
and leverages commitments from existing funding streams

Private fundraising from philanthropy and businesses also may jolt the
system

Target mainstream funds; EG, Medicaid, Section 8, Shelter Plus Care,
Tanf, WIA slash WDC, block grants

Utilize dedicated funding streams not subject to annual appropriations

Use new financing models: stretch

[Slide 28]{.underline}

**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

Braid funding as far upstream as possible

[Slide 29]{.underline}

**The Systems Change Mechanic: Boundary Spanning**

Individuals and organizations that can span the gaps and penetrate the
barriers that exist across systems: housing, treatment, employment, etc.

Boundary spanners operate at both the service and systems levels

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

Boundary spanning across systems requires balancing trust in the change
agent with suspicion about the change process

[Slide 30]{.underline}

**Boundary Spanners as the Essential Glue**

Boundary spanning can occur at both the service and system levels

> Systems-level Boundary Spanners: Reach across multiple systems to
> promote collaborative approaches to problem solving and removal of
> barriers
>
> Service-level Boundary Spanners: Reach across multiple direct service
> disciplines to promote holistic treatment of persons with co-occurring
> disorders

[Slide 31]{.underline}

**Systems-level Boundary Spanners**

Identify statutory, regulatory, and policy-level gaps and barriers to
employment linkages for people who are or have been homeless in all
relevant systems

Stimulate cross-system dialogue and activities at senior levels of
relevant systems

Develop formal cross-system working agreements that articulate a clear
employment vision and measurable goals

[Slide 32]{.underline}

**Service-level Boundary Spanners**

Function with ease in multiple agency and system environments

Demonstrate multisystem competencies: housing, services, and employment

Ensure continuity of care from system to system and from location to
location

Can provide both direct services and a liaison slash brokering role on
behalf of clients

[Slide 33]{.underline}

**Service and Systems Change: Four Key Levels**

An inverted pyramid has four levels. In descending order, they are
labeled Consumers and Line Staff, Supervisors and Program Managers,
Agency CEO's, and Funders and Policy Makers. A dotted line separates the
top two and bottom two levels. The top levels are labeled Service
Integration at left, with a box marked Functional Supportive Housing,
Treatment, and Employment linkages at the right. The bottom levels are
labeled Systems Integration at left, with a box marked Vision, Policy,
and Funding Alignment Across Systems at the right.

[Slide 34]{.underline}

**Case Study: Taking Health Care Home's King County Program**

Taking Health Care Home: Addressing systems alignment for populations
experiencing long-term homelessness

Began with mobilizing a permanent supportive housing pipeline

Turned next to employment: The region was far behind where it needed to
be in this area

[Slide 35]{.underline}

**The THCH Employment Initiative**

2005: Launched THCH Employment Initiative

Convened cross-systems Leadership Team

Convened cross-systems Research Group

Conducted research

Authorized next steps

[Slide 36]{.underline}

**The THCH Employment Initiative: Surprising Results**

A massive report detailing the current environment, the challenges to be
addressed, and the opportunities ahead

Report included early quick victories where the systems could begin

Extensive material about this work will be presented in the topical
sessions on Strategies for Linking Systems

[Slide 37]{.underline}

**Consider the Implications**

What would bringing the homelessness, housing, treatment, and employment
systems together in your community look like

What would it take to get these systems to the same table

What would it take to keep them there and working on the core issues

[Slide 38]{.underline}

**And Don't Forget About Joseph:**

I am not incompetent; I just need help moving the obstacles out of the
way

[Slide 39]{.underline}

**Questions and Discussion**