# Presentation: 281713

## What Works:  Systems Change

- Carol Wilkins
- Director of Intergovernmental Policy
- Corporation for Supportive Housing
- www.csh.org

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

*CSH supports the expansion of permanent housing opportunities linked to comprehensive services for persons who face persistent  mental health, substance use, and other chronic challenges, and are at risk of homelessness, so that they are able to live with stability, autonomy, and dignity, and reach for their full potential.  We work through collaborations with private, nonprofit, and government partners, and strive to address the needs of, and hold ourselves accountable to, the tenants of supportive housing*.

**Notes:**
Introduce myself & CSH:  
first became involved in efforts to end homelessness in late 1980’s when SF Mayor Agnos introduced Beyond Shelter plan
as Finance Director for city & county I saw impacts of the “crisis” of homelessness, untreated mental illness and substance abuse (especially crack epidemic) – impact not only streets and demand for shelter but also jail overcrowding, rising foster care caseloads.  Board Finance Committee director would not approve plans for building a new jail until we examined “client overlap” 
For past 8 years at CSH, working full time on systems change to integrate services needed by people who would otherwise experience long term homelessness and/or impose significant costs for inappropriate use of health services, and integrate the systems that deliver and finance housing, health care and other services.  Learned from folks like you that it takes more than funding and changing the rules – also changing people, habits, and systems.  Requires time, creativity, passion and persistence, as well as some patience and understanding.

## 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

## One Goal, Many Systems

- Homeless Services
- Mental Health
- Substance Abuse
- Hospitals, clinics, public health
- Social Services
- Employment
- Housing Development Finance
- Rent Subsidy

## 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.

## The Key Components of Systems

- Power
- Money
- Habits
- Technology & Skills
- Ideas & Values

## 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.

## 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.

## 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, and
- Practice

## 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.

## 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

## Building Blocks tested tactics of systems change

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

**Notes:**
Note: will not have time to cover all of these in today’s presentation – but all will be included in a CSH publication coming soon!

## 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

## 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

## 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

## 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.

## 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

## Using old money in new ways

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

## 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

## 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.

## 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

## 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.

## 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.

## 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

## 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

## 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

## 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.

## 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.

## What Works:  Systems Change

- Carol Wilkins
- Director of Intergovernmental Policy
- Corporation for Supportive Housing
- www.csh.org