# Presentation: 522775

## What Works:  Systems ChangePolicy Academy on Chronic HomelessnessChicago, IllinoisMay 21, 2003

- Carol Wilkins
- Director of Intergovernmental Policy
- Corporation for Supportive Housing

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

*	*CSH helps communities create permanent housing with services to prevent and end homelessness
- For more information visit www.csh.org

## 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and indicators of a changed system

**Power** – people who have formal authority and responsibility for new activities
**Money** – funding is available and reliable
**Habits** – people and organizations interact with each other to carry out new activities as part of their normal ongoing routines
**Technology & Skills** – skilled practitioners at all levels can effectively deliver results
**Ideas & Values** – a new understanding of the problem to be solved and new definitions of performance or success are widely shared

## 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
- 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

## Building Blocks (continued) tested tactics of systems change

- Data and Communications to Make the Case
- Cultivating Leaders, Champions, and Advocates
- The Irresistible Force – Events that Compel Action
- An Intermediary as Neutral Catalyst

## 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 _solutions_ – something they could take credit for.  Field trips to visit model programs often help!