# Presentation: 008569

## Forging New Relationships to Promote Employment for People Who Are Homeless

**Strategies for Change That **
**Cross System Cultures**
*David M. Wertheimer, M.S.W., M.Div.*
*Kelly Point Partners*

## 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## So What Is Systems Integration?  

- Housing, health, and human services systems are integrated when there is sharing of:
*Information*
*Planning*
*Clients*
*Resources*
*Responsibility*

- Kelly Point Partners 2006

## Wrapping Our Heads Around Systems Integration

- Kelly Point Partners 2006

## Systems Integration: The Mechanic’s Perspective

- Kelly Point Partners 2006

## 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 nonmechanics among us need it to be easy

- Kelly Point Partners 2006

## Systems Transformation:  Making Integration Invisible to the “End User”

- Kelly Point Partners 2006

## In the World of Homelessness, Housing, and Employment,YOU Are the Mechanics! 

- So how do we promote systems change to empower systems integration?

## A Perspective on Systems Change

- The Corporation for Supportive Housing Perspective

## 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

- Kelly Point Partners 2006

**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 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

**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 that it can be done and is worth replicating

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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!

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## Use Old Money in New Ways

- Change eligibility rules, e.g.:
- 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, etc.
- Address policy or technical problems that create or sustain gaps and barriers

- Kelly Point Partners 2006

## 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 (e.g., Medicaid, Section 8, Shelter Plus Care, TANF, WIA/WDC, block grants)
- Utilize dedicated funding streams not subject to annual appropriations
- Use new financing models – stretch!

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## 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/brokering role on behalf of clients

- Kelly Point Partners 2006

## Service and Systems Change: Four Key Levels

- Consumers & Line Staff

- Supervisors & Program Mgrs.

***Service Integration***

***Systems Integration***

- Agency CEOs

- Funders & Policymakers

***Functional Supportive Housing, Treatment, and Employment Linkages***

***Vision, Policy, and Funding Alignment Across Systems***

- Kelly Point Partners 2006

## 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

- Kelly Point Partners 2006

## The THCH Employment Initiative

- 2005: Launched THCH Employment Initiative
- Convened cross-systems “Leadership Team”
- Convened cross-systems “Research Group”
- Conducted research
- Authorized next steps

- Kelly Point Partners 2006

## 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”

- Kelly Point Partners 2006

## 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?

- Kelly Point Partners 2006

## And Don’t Forget About Joseph:

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

- Kelly Point Partners 2006

## Questions and Discussion