# Presentation: 043332

## Creating Viable Strategies for Systems ChangePolicy Academy on Chronic HomelessnessMiami, FloridaDecember, 2003

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

## 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

## 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

## 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

**Notes:**
The “system” is the set of relationships that link these 5 elements with each other and with the goals that they are meant to serve.

## 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

## 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

## 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

## 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

## 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

## What is Systems Integration?(Kelly Point Partners)

- Human services systems are integrated when there is sharing of:
*Information*
*Planning*
*Clients*
*Resources*
*Responsibility*

## 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

**Notes:**
These are “the five signs” or key elements / indicators of systems change.
Achieving real and lasting systems change is different from (more than) making the system do something innovative – it’s about new patterns of doing things in a new way on a consistent basis so they become habit –an accepted part of the way people and organizations do their jobs 
People and systems regularly do the new thing – not just in response to a special initiative, or because particularly skilled or committed individuals happen to care about it – and others can rely on the system to operate in a changed way

## 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

## 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

## 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!”

## 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

## 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

## 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

## 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

## Cultivate Heroes & Heroines

- The most effective champions aren’t necessarily the most powerful individuals (although they can help!)
- Business people, 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

## 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

## 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

## 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

## 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

## 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