# Presentation: 109478

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

- HomeBase/Legal and Technical Services Supporting Shared Prosperity

- The Emerging New Paradigm

## Introduction

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- _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.

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## 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.  

- _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.

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-  Creating the Continuum of Care

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## Experience/Knowledge Gained from First Phase:

- Homelessness is a blend of individual and systematic causes.
- Housing, incomes, and services/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.

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## 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.

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- Mid-1970’s
- Local Communities Incremental Responses (soup kitchens, emergency shelter, blankets, etc.)

- Networks of Collaborating Agencies

- Strategic Responses to Homelessness
- (supported by local admin planning processes)

- Continuum of Care:
- 1994

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## “Continuum of Care” is used to describe three things

- Assessment/Prevention

- Emergency
- Shelter

- Transitional
- Housing

- Permanent
- Housing

- Supportive
- Housing

- “Continuum of Care” is used to describe three things
**1. CoC: Comprehensive Homeless Assistance Housing and Services System**

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- Prevention of Housing Loss

- Outreach/Intake
- Assessment

- Permanent
- Housing

- Emergency
- Shelter

- Transitional
- Housing

- Supportive
- Housing

- Mental Health	Substance Abuse
- Job Training	Family Support
- Independent Living Skills    	Education/ H.I.V.

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## 2.  CoC: Local 18-month and/or Five-year Strategic Plans

- 	Which led to....
- 			Creation of Local Homeless Point Persons
- 			Local Departments/Offices Dedicated to Homelessness
- 			Increased Local Revenue to Implement the Plan
- 			Coordinated Local Programs Targeting Youth, Veterans, Families, Etc.
**3. CoC: Annual Funding Cycle Managed by HUD**
- 	In 1994, over 68% of McKinney Act Homeless Specific Resources were concentrated in and distributed through HUD.

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## CoC: National Policy

- The CoC stands as “The Federal Plan to Break the Cycle of Homelessness.”
- It was issued by the Interagency Council on the Homeless, part of the White House Domestic Policy Council, in 1994.

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## 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 4–14 times as many people moving from streets to shelter to self-sufficiency with just twice the investment of Federal resources.

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## 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:

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- 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.

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## Table of Contents Continued...

**Table of Contents Continued...**

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## We went from:

- 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.

- 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.

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## This second phase was top down.

- _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.

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- Ten Year Plan End Goal

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## Top-down Response to Problems Perceived:

- Localities were struggling with how to sustain an ever-expanding CoC system.
- Many were labeling the hard-working local agency folk as having an “entitlement” mentality toward the national resources being disbursed.
- 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.
- There was no private-market business involvement at a significant level.
- Despite thousands of people who had been well-assisted out of homelessness, “street people” 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 “problems” 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.

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## Activities of the Second Phase

- 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.
- NAEH launched “Open the Front Door, Close the Back Door” in 2000.

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## +

- _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.

**+**

**=**

- 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 10 Year Plan implementation and to leverage increased State and Federal investments.

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## Examples of Successful Local Investment Towards Ending Homelessness

**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 “low-demand,” 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, SAMHSA, 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 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.

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

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- 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

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-   In what parts of the CoC
-   In the mainstream world
-   In business/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 10-year visions.

## 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 cocreated 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.

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- 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.

**Ten Year Plan End Goal**

**CoC System**

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## The seventh seed, the Administrative/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.

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## Supporting the New Paradigm

- _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.

**Veterans**

**Healthcare**

**Youth/Education**

**Labor**

**Department of Defense**

**Mental Health/ Substance Abuse**

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## Department of Veterans Affairs

**Veterans**

- www.va.gov/homeless

- National Coalition for Homeless Veterans
- www.nchv.org

- HUD Veterans Resource Center (HUDVET)
- www.hud.gov/offices/cpd/about/hudvet

- National Coalition for the Homeless Fact Sheet on Homeless Veterans
- www.nationalhomeless.org/veterans.html

-   Convenings
-   Funding
-   Research
-   Policy direction

-   Network convenings
-   Advocacy

-   Resources
-   Information

-   Information
-   Advocacy

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## Health Care for the Homeless Information Resource Center

- bphc.hrsa.gov/hchirc/

- HUD Veterans Resource Center (HUDVET)
- www.hud.gov/offices/cpd/about/hudvet

-   Newsletter/video library
-   Publications/bibliographies
-   Resources

-   Convenings
-   Advocacy
-   Research
-   Trainings/education
-   Resources/publications

**Health Care**

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## All six outer seeds have similar networks of support.

**Youth/**
**Education**

**Labor**

**Department of Defense**

**Mental **
**Health/**
**Substance **
**Abuse**

- 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 & Other Resources*.

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## 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.  

- 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.

- 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.

- Knowledge Application

- Resource Acquisition

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## Bringing the Response to Homelessness to Scale

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

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

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## New Business Model

- _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

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**Transformation**

**Innovation**

**Integration**

## Working within the realm of “what we do not know” 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 “manage” their businesses and customers the same way for decades. Please ponder these for your community, as you review the research, learn of ideas/strategies under way, and  reflect on other communities’ experiences.

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## 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.

**1**

**5**

**3**

**6**

**2**

**4**

**7**

**A**

**B**

**D**

**C**

**8**

**9**

**10**

**11**

**12**

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**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/Substance Abuse
- Triangles:
- A-Creating Continuum of Care
- B-Ten Year Plan End Goal
- C-Knowledge Application
- D-Resource Acquisition

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