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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

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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

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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

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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

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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

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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

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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

Slide 8

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

Slide 9

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

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What is Systems Integration?\
(Kelly Point Partners)

Human services systems are integrated when there is sharing of:

· Information

· Planning

· Clients

· Resources

· Responsibility

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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

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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

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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

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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!"

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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