The Promise of Information -- Using HMIS Data to Address Homelessness

National Conference Center, Lansdowne, VA

July 15, 2003

[Remarks by Philip Mangano]{.underline}

Thank you, Dennis for your kind introduction.

Twenty-three years ago when I first began serving homeless people with
other volunteers on the first breadline in downtown Boston since the
Great Depression, we didn't think for one moment about date or research
or counts or statistical or data standards. The only numbers we were
interested in were the number of sandwiches and cups of coffee we should
make for that day. In the early days we made 100 sandwiches and prepared
to serve 75 cups of coffee. We averaged about 50 people in those first
days back in 1980. Eventually, as the line increased, we increased the
slicing of cold cuts, the unpacking of bread, the fashioning of
sandwiches, and the brewing of coffee.

After a year the line increased to over 100 and after a year and a half
we were up to 150 and by year two, 250. We just kept making the
sandwiches and brewing the coffee. We had a simple formula. For every
person expected we prepared two sandwiches and made one and a half cups
of coffee. And we volunteers would each chip in a go off to the local
Woolworth's and buy enough cookies so that everyone had a couple.

Little did we know that we were gathering data based on our past
"research" to meet projected need. And even for a breadline that size
and the limited resources to support it, those computations helped us
stay on target.

I long, now, after 15 months in Washington for the simplicity of that
breadline and our uncomplicated system. If we ran short, we just went
back to the kitchen, and made more sandwiches or coffee.

Even in my work advocating for homeless people in a small city, then
Greater Boston, then Massachusetts with each geographical expansion the
work was more complex, and seemingly the resources more limited. No more
was it possible to just go to the kitchen to catch up and supplement.
Often there was no supplementing.

I learned that each resource for homeless people was finite. Limited. A
trip to the "kitchen," now in reality the legislature or administration
did not always result in the needed supplement. If even there was a time
that we needed a breaking of the five loaves and two fishes into
overflowing bounty, it was for now for this population. But no one I
know of has that miraculous capacity. But less mysterious means, we
discovered, could sometimes do the trick.

What we did learn was that if we collected information, compiled data,
supported research, we would strengthen our capacity to generate new
resources. While less miraculous and mysterious, it worked.

When we brought the data we had collected at the front door of homeless
programs to the policy makers, we could conduct our own alchemy. We
traded numbers for resources. The very essence of advocacy.

When our numbers were challenged, we weren't defensive. "Show us yours,"
we said, "and if they be credible, we'll withdraw ours."

The sad reality was that none of these other systems had numbers -- not
foster care, not substance abuse, not mental health, not corrections.
Not with regard to discharge dispositions.

Our numbers stood and in standing won resources much needed to
ameliorate difficult circumstances of those at risk of homelessness and
those already fallen.

Had we tried to accomplish our alchemy another way -- say trading
anecdote and hear say for resources, we'd have been turned away at the
door.

We learned and I learned that data and research could drive policy and
increase resources. A lesson I've never forgotten.

That's why now in Washington the Interagency Council's work is premised
on a management agenda whose foundation rests on data and research. A
management agenda that is data driven, performance based and results
oriented.

It's an old fashioned approach that has re-captured the minds and
intents of the past several administrations and only now is being
applied to investment in homelessness. Research and data come first.
Then policy. Followed by resource investment and implementation. Then
more research to ensure our trajectory is true.

You've undoubtedly heard of our initiative to end chronic homelessness
in this country in the next ten years. An initiative borne out of
research that constellated policy and now modest investment. As research
tell us that we're making visible, measurable, quantifiable change for
that population, moving people off the streets and out of shelters into
housing and stability, the investment will increase. The way we'll know
is through the data and research.

You've all heard in one way or another about the Tipping Point, most
recently in Malcolm Gladwell's best selling book of that name. His
premise is not complicated. For any big social problem there is only a
small amount of new resources to be invested. (When has it been
otherwise?) Gladwell tells us that the investment of those resources
through "intelligent action" in the most visible expression of the
problem is a way not only to resolve the visible, but the means by which
to "tip" the whole problem. Innovation is key, as is the remoralization
that comes with accomplishment. The belief that change is possible, even
on the seemingly intractable issue.

Just recently on England we've seen this strategy carried out. Four
years ago the Blair Government decided to recommit to homelessness. They
were tired of resultless efforts and a lack of outcomes on investment.
Sound familiar?

They decided to target what they call "rough sleeping." We call these
folk "street people;" they say "rough sleepers." They created a
management based strategy that called for results. They made a modest
investment, implemented the strategy, and collected the data.

A month ago we had the architects of the plan come to the White House,
to the Council meeting. They reported that "rough sleeping" in England
had decreased by 60%. That 6 in every 10 people on the street were now
in.

Part of their strategy was repetitive street counts against data and
research-based baseline. When they invested they could demonstrate
whether or not the strategy was having the intended result. If
necessary, the strategy was tweaked to provide the outcomes sought. Not
punitive response; but planful.

They invested in "intelligent action" in the most visible expression of
the public issue and made visible, quantifiable, measurable change. The
result -- they have created a new sense of hope and determination about
the issue as a whole, and new investment in family homelessness among
others is now being made.

They've succeeded in "tipping" the issue toward a tipping point. Through
research and data collection they could demonstrate progress and that
encouraged a renewed sense of commitment and resources.

I'll conclude with my favorite recent story on data and research
influencing policy around seemingly intractable problem. This past week
the President was in Africa. He made a substantial commitment on behalf
of our government in combating AIDS.

While the President received the headlines this weekend the origin of
the commitment is in an unlikely elected official. None other than
former Secretary Jesse Helms. And even more confounding is that the
genesis of our government's activities is in conversations between the
most conservative Mr. Helms and a practitioner of politically active
rock and roll, U2's Bono.

Schmoozing between this odd couple seems unlikely, and that it would
result in policy change, unthinkable.

Who'd have guessed those two would get together in the first place? And
who'd guess that the topic would be AIDS -- Africa!

If I told you a few years ago that this would happen, you'd have ordered
a cat scan of my brain. "No way," Bono's fans would have told you. "No
way he'd meet with Jesse Helms. He's too smart and humanitarian to do
that." "No way," Jesse Helms' constituents would have told you. "No way
he'd meet with some left leaning rock and roll impresario. What would
they talk about?"

But there they were. Talking. Enjoying themselves. Sharing ideas.
Comparing spiritual journeys.

It's a strange world. Who'd have guessed that just a few weeks after
their meeting one of them would write a column for the Washington Post
and say: "There is no reason why we cannot eliminate, or nearly
eliminate, mother to child transmission of HIV-AIDS - - just as polio
was virtually eliminated 40 years ago. Drugs and therapies are already
provided to many in Africa and other afflicted areas. Only more
resources are needed to expand this most humanitarian of projects," he
wrote.

Bono? You'd expect it from him. He's made a career of using his musical
celebrity to tackle political and social issues. No surprise that he
would author such sentiments.

Jesse Helms? Wouldn't expect it from him. He's not known for his
sympathy to the AIDS issue or to issues related to Africa. Nor is he
known as someone who champions government interventions. He's for
limited government. Doesn't add up to Senator Jesse Helms.

Well, it [was]{.underline} written by the Senator. And he did indicate
that he was ashamed he hadn't done more concerning the world's AIDS
pandemic. He did speak about the crisis in sub-Saharan Africa. And, most
importantly, he did offer an amendment to add \$500 million to fight the
pandemic. In fact he says of the funding: "The goal of this new money
will be to make treatment available for every HIV-positive pregnant
woman." He went on to write: "As President Bush would say, we will leave
no child behind."

Eliminating mother to child transmission of HIV-AIDS. What a notion.
There was a growing collective sense that such a goal was unattainable.
Some knew the politics weren't right. Some knew the distribution of the
needed medicine wouldn't happen. Most knew that public opinion couldn't
be mustered.

In his article Senator Helms noted that "more than half a million babies
in the developing world would contract from their mothers the virus that
causes AIDS" in his very first sentence. He went on to note that
"experts believe that more than 2 million pregnant women in sub-Saharan
Africa have HIV. Of these nearly one-third will pass the virus along to
their babies."

He goes on to say that "mother-to-child transmission of AIDS \[is\] the
number one killer of children under 10 in the world." He further points
out that the "United Nations has already set an ambitious goal of
reducing the portion of infants infected with HIV by 20 percent by 2005
and 50 percent by 2010." Quick enough? Not for Senator Helms. He goes on
to say: "We can accelerate these efforts, saving hundreds of thousands
of lives, with larger investment of public and private funds now."

[Somebody did their homework. Someone advanced the research and gathered
the data.]{.underline} And that informed advocacy made Senator Helms an
unlikely, but powerful advocate.

Now let's get [our]{.underline} numbers right. As long as the crisis in
Africa was anecdotal, not much was happening in response. When research
yielded data, the result was informed advocacy.

The time has come for us to advance the research, to gather the data and
win allies locally, in our states, and in the Congress. Allies who will
be informed by irrefutable data gathered from programs in neighborhoods,
communities, and states all over our country.

HUD is equipping you to do it -- with resources, with technical
assistance, with a vision. They're giving you the means to improve the
advocacy. They're arming you to make the case. Do it.

The equation is irresistible. Better data + improved advocacy =
Increased resources.

That's what data and research can lead to -- the investment that will
result in the outcome we desire, the abolition of homelessness beginning
with the elimination of chronic homelessness in the next ten years.

Which is more likely -- that Senator Helms would meet with rock star
Bono and subsequently call for increased funding for the AIDS pandemic
in sub-Saharan Africa -- three unlikely occurrences -- the aggregate
odds of all three happening would make the odds makers quiver in Las
Vegas. Or, that given our collective commitment, expertise, and resolve,
the end of chronic homelessness is just years away?

A month ago, if I were a betting man, the former would have been too
unthinkable and the latter more likely. Now that the former has
happened, the latter is not only doable, but you'd best set your
watches, mark your calendars. This social tragedy is coming to an end.