6/29/2016 Fr From om Cr Creaming to to Coordi dinated nated Assessm ssessment: One Commun One mmunity’s Ef Efforts to to Addr Address ess Homelessn Homelessness ess Diane R. Bessel, PhD, LMSW, CNM Daemen College Despite being third poorest large city in the US today, Buffalo ‐ Erie County, NY has experienced real success in its efforts to address homelessness. 1
6/29/2016 Setting the Context Implementation of the Government Performance & Results Act of 1993 required federal agencies to improve their decision ‐ making capabilities and accountability. Homeless Continuums across the country were also compelled to develop “Ten Year Plans to End Chronic Homelessness.” 2
6/29/2016 These new, largely unfunded mandates sent shock waves to homeless service provider organizations and their local communities. Creaming describes the process where providers select cases that are easier to manage over clients who are typically identified earlier, with longer homeless histories, and/or greater needs. “From a strictly bureaucratic standpoint, it is easier to take someone who is going to be easier to work with – financially, emotionally, from a staff/resource consumption point of view, productivity, it is just – it’s the old “creaming effect”– you take the cream of the crop and you leave the rest behind…it is alive and well.” “Every month there is some kind of an issue where an agency feels that the level of support that the consumer has in the community is not adequate to provide them with a likelihood of being successful – sometimes it is a just a refusal or the classic is “six months clean and sober and you can come back and see us” – well, if the person could get six months clean and sober maybe they wouldn’t even need your help to begin with…” 3
6/29/2016 Shoring up is a process where providers work with other professionals to ensure that clients meet eligiblity criteria for homeless housing and/or services. “People get around the criteria by telling people to go spend one night in a shelter. One night at a shelter does not make you homeless in my mind especially because someone told you to spend one night in a homeless shelter…. It doesn’t happen very often within our agency but I know that it occurs and I was told by people higher up within the area that if they don’t meet criteria that is what we tell them to do. Go to a shelter and get that paper [documentation of homelessness]. I don’t think that is right – let’s be honest, if your mom will hang on to you for a month, she will hold on to you for six months. And someone who doesn’t have that support should get the funding first even if it means we’ll have to work harder.” “I was told that if the mental illness does not meet criteria to call the person who signed the paper and have them shore up the diagnosis. The person who told me to call the doctor and shore ‐ up the diagnosis said “well if that person only has depression – NOS [Not Otherwise Specified] you shouldn’t be helping them – they don’t really need the help” but in the same breath said to “call their doctor and ask them to change the diagnosis.” That doesn’t mean that they need the help any more just because the doctor is willing to change it!” 4
6/29/2016 Homeless service providers grew increasingly suspicious and distrustful of one another and collaboration declined. Num Number of of Chr Chronically lly Hom Homele less ss Pe Persons Buf Buffalo ‐ Er Erie Coun County Continuum uum of of Car Care 350 300 289 274 250 236 206 200 193 157 150 125 100 50 0 2008 2009 2010 2011 2012 2013 2014 “If we had a case load of ten to twenty SPMI [Severe and Persistently Mentally Ill] clients including schizophrenics and people who were MICA, it would make our caseloads that much more difficult and chasing people around town and asking them to participate in services would make it that much more difficult. So, if you can even it out with the “easier clients,” you do.... I really think that is the number one reason…I think people who are truly homeless, the group that HUD is trying to eradicate, are the same people who are on the street next summer because they didn’t get into these programs because they are the ones that are harder to serve.” 5
6/29/2016 Source: National Alliance to End Homelessness, 2013 In July 2012, United States Department of Housing and Urban Development (HUD) established mandatory use of coordinated assessment. Effective coordinated assessment systems prioritize persons with greatest need and are fair, inclusive, easily accessible, person ‐ centered, and well connected to needed resources. 6
6/29/2016 The Process Continuum planned a series of strategic retreats – aimed at improving trust, buy ‐ in, and ownership within the provider community. Guid Guidin ing Pr Princi cipl ples es Efforts should: • Seek to minimize wait, be easy to use and understand, and focus on positive customer experiences; • Be based on an objective and standardized assessment conducted by well ‐ trained and well ‐ qualified professionals; • Be client ‐ centered and client ‐ driven with a focus on offering services that fit specific needs; and • Ensure the availability and accessibility of holistic services for all clients. The overall goal is to develop long ‐ term solutions for people in need rather than short term fixes. 7
6/29/2016 Participants examined other coordinated assessment systems to identify best practices that might fit within the local community. Participants also mapped available resources and began to develop an initial plan for implementation. Buffalo Buf alo ‐ Erie Erie Coun County ty Coordi dinated nated Assessm ssessment Plan Plan • 2 ‐ 1 ‐ 1 (Identification) Access Access Primary Physical Location (DSS) • Possible Satellite Locations • Coordinated Assessment Team • Derived from Provider Community As Assess sess • Identify opportunities: diversion/rapid rehouse • Entry into HMIS – standardized assessment • Maintain single system ‐ wide wait list • Mechanism for appropriate placement As Assign sign • Eligibility criteria/program philosophy review • Client/Provider Determination • Coordinated Assessment Advisory Board Acc Accountabil ility ity • Homeless Alliance of Western New York • System and Outcome Monitoring 8
6/29/2016 Continuum established various committees to carry out key aspects of coordinated assessment plan. Continuum quickly began to focus on Housing First and Rapid Rehousing strategies to address homelessness 9
6/29/2016 Num Number of of Chr Chronically lly Hom Homele less ss Pe Persons Buf Buffalo ‐ Er Erie Coun County Continuum uum of of Car Care 350 300 289 274 250 236 206 200 193 157 150 134 125 100 50 25 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 Key Lessons Learned Government ‐ led change efforts can yield positive results – but, be wary of unintended consequences. 10
6/29/2016 Organizations must be part of the process and must be able to identify self ‐ interest in order to balance risk and reward. Quality data is essential to ensure transparency and accountability within collaborative efforts. Communities must identify and invest the right resources, at the right time, in order to be successful. 11
6/29/2016 “Ending homelessness does not mean that nobody will become homeless, but that effective systems will be in place to help people become housed again rapidly.” ‐ Nan Roman, NAEH Contact Information: Diane R. Bessel, PhD, LMSW, CNM Assistant Professor & MSW Program Director Department of Social Work & Sociology Daemen College Email: dbessel@daemen.edu Phone: 716 ‐ 566 ‐ 7876 12
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