When a community is sufficiently advanced in creating appropriate housing and service models to end homelessness, it may encounter the problem of assuring that clients with multiple barriers or disabilities, who are most likely to fall through the cracks, get into the available new slots. Some communities hire staff to place clients into programs efficiently and appropriately; others use cross-agency communication protocols or direct service staffing meetings to identify and place clients; others have developed technology to support client referrals and manage waitlists; still others employ a single point of entry to triage clients. Research has not been conducted to assess whether one model is more or less effective than another. In the meantime, we present several examples that appear to be effective to illustrate how communities working on system change have addressed this issue and changed their habitual ways of doing things into new and more effective habits. In a broader sense, this section also illustrates how system change efforts cannot be limited to big picture policymaking, but must also consider and resolve even the smallest details if they are to realize positive benefits for clients.
We start with Portland, because staff there were especially articulate about the work still needing to be done even after everyone officially accepted the goal of serving the longest-term homeless people. We follow this discussion with descriptions of targeting mechanisms in several other communities as well as discharge planning efforts that are working to prevent homelessness.
Portlands Housing-Client Match Facilitator
In 2005, Portland/Multnomah County was sufficiently far along in creating PSH to have come up against a level of system change that does not become obvious until PSH units become available. The housing units are available, with operating and service supports in place, and there are people who need this housing. But the agencies with the people are not the agencies with the housing, so there is still the issue of getting the people with the most complex and challenging conditions into the available units. The issue was recognized and well defined, which local informants perceived to be a good part of the battle. A position was created within the Department of Community Health Services (DCHS) to coordinate this client-level matchmaking and smooth the way with providers a position that would not have been needed, possible, or realized without the explicit system change work that had been going on in Portland for the previous two years. The time was right for this development. THCH staff had done the matchmaking at the provider level, getting development, operations, and services providers together to create PSH units. But the last steps had yet to be taken. The agencies that know the clients often are not on pick up the phone when you need to and just call terms with the agencies that have the housing. That is where the new DCHS coordinator forges the necessary linkages. As further support for providers, Portland has changed recruitment and referral patterns, found new sources of support for landlords, and generated the trust of landlords by delivering on promised tenant supports. These strategies all work to ensure the hardest-to-serve people get the housing they need.
Philadelphias Placement Approach for Supportive Housing
Some years ago, Philadelphia faced a situation in which permanent housing providers were reluctant to take some of the hardest-to-serve homeless people who needed housing, and there was no central or coordinated way to match people with housing. One result was that long-term homeless people did not get housed as quickly as possible, and providers also had relatively high vacancy rates, approaching about 10 percent of existing beds. The citys Office of Adult Services, which has responsibility for homeless programs, responded by taking over placements. It began sending specific people to a provider and asking the provider to take them. The result has been more of the hardest-to-serve homeless people receiving housing and services, and more efficient use of available resources (vacancy rates are now around 1 or 2 percent, just enough to leave some placement opportunities when new clients need housing).
Approaches for Reducing Family Homelessness
The emergency shelter system for homeless families in Washington, D.C., has been revamped over the past couple of years to reflect a triage or targeted approach to matching families with appropriate housing and services. In the past, all families were treated similarly regardless of their needs. As a result the system was overcrowded and even the crisis shelter frequently had a waiting list. Today, all families experiencing a housing crisis are directed to the central intake facility, where they undergo an assessment. Based primarily on the nature of each familys housing crisis, intake workers have three primary ways to assist the family. If the family needs a place to stay immediately, it is referred to a central crisis shelter until space opens in a more service-intensive apartment-style emergency shelter program that can help the family find permanent housing and link it with appropriate services. If the family is able to remain in its current housing for a few days and is fairly high functioning, the family is referred to the Community Care Grant program, which provides flexible housing assistance and case management to quickly rehouse families or support them in their current housing. If the family can remain in its housing for up to 30 days, workers attempt to avert homelessness by providing ongoing mediation to resolve family disputes and housing search assistance. Homeless prevention funds are also available through a community-based program in each ward of the city. Changes in D.C.s homeless system are evident, reflecting a change in ideas (adopting the notion that family homelessness can be prevented), habits (old ways have been revamped through structured service delivery improvements), skills (staff are newly equipped to respond to families in different ways), and in the way money is spent (resources were reallocated to support a rapid rehousing approach).
Columbus, Ohio, uses a single point of entry coupled with careful screening and consideration of available prevention/diversion resources to determine which families can be helped to avoid homelessness and which need to enter a shelter. The system succeeds in helping about half the families who call to avoid shelter entry. Hennepin County, Minnesota, has a similar screening mechanism for controlling shelter entry and diverting families with relatively simple housing problems to a network of prevention agencies.
Other efforts currently being planned are even broader. For example, Massachusettss Department of Transitional Assistance (the state TANF agency), sponsored pilot projects several years ago to see whether a shallow rent subsidy offered to families facing housing crises would keep them from becoming homeless. The results (Friedman, 2006) were encouraging enough that the department strategized a statewide implementation; its future, however, depends on a new gubernatorial administration, epitomizing the fragility of even the most well-justified change efforts.
New York/New York III and Client Targeting
In the first two rounds of the New York/New York Initiative, which provides housing and supportive services to people with serious and persistent mental illness, providers had a lot of flexibility in choosing the people they would serve. New York/New York III, which began in 2006, sets specific population targets, including several groups of homeless people that providers have been somewhat reluctant to serve in the past. For the first time, New York Citys Department of Homeless Services is expecting to take control of the placement process, including developing lists of the neediest homeless people in each target group and offering only these people to service providers. It remains to be seen how successful this new approach will be. But as the legislation governing New York/New York III is very explicit about who must be served, and as the Department of Homeless Services will be the entity paying providers to serve the targeted clients, some accommodation that meets the needs of all parties is likely to be reached.
A California state program to alleviate or prevent homelessness among people with serious mental illness, known as AB 2034 after the Assembly Bill that sponsored it, is being used in Los Angeles to assure that people with mental illness leaving the county jail do not end up homeless (Burt et al., 2004; Burt and Anderson, 2005). Eighteen nonprofit community mental health agencies receive the funding and work with the county jail to identify at-risk prisoners shortly before their release. The AB 2034 money allows providers to do what it takes to keep clients from being homeless; the resources have mostly been used for supportive services, with the programs becoming skilled at finding housing resources through partnerships with other providers in the community and Shelter Plus Care vouchers designated for Department of Mental Health clients.
In Massachusetts, the Department of Mental Health has spent years promoting the attitude that housing is a clinical issue a significant change in ideas from previous ways of thinking. It has developed a way to identify clients who were homeless when they entered institutional care and who are at risk of homelessness at exit, which it couples with an elaborate discharge planning mechanism. Recognizing that discharge planning will only succeed in averting homelessness if housing is available, the department established housing coordinators in each service area and in its central office to help develop suitable independent and semi-independent housing in the community (Burt, Pearson, & Montgomery, 2005).