The Role of the Homeless Service System

"The Modern Homelessness Crisis" is fundamentally two problems: 

1. It is the portfolio of socioeconomic policies that, since the early 1980s, has been making it more likely for individual crises to result in a loss of housing. (what happened)
2. It is then the way we have hyper-localized our response to homelessness, creating a patchwork of different city and county responses of varying degrees of effectiveness. (our response to what happened)

These insights raise an incredibly important question about the role, purpose, and scope of the homeless service sector itself. 

Are we - the civic leaders tasked with responding to this challenge - responsible for the broader systems creating housing instability? OR, are we simply responsible for creating the best possible "rehousing system" after these crises occur?

The "Disaster Recovery" Mindset

According to systems theorist Daniel Kim: 

Mental Models are the beliefs and assumptions we hold about how the world works. We can view these assumptions as “systemic structure generators” 

By and large, over the last 40 years, the prevailing mental model for addressing homelessness has been "disaster recovery." This approach is essentially adopted from how we respond to crises like hurricanes, floods, and other natural emergencies. 

When emergencies like this happen, we create what are supposed to be temporary resources to help people get back on their feet - night-to-night shelter, food programs, light touch engagement from social workers or volunteers, etc. As the proverbial storm passes, people rebuild, they move on with their lives, and then this emergency infrastructure goes away. 

While it might make intuitive sense to structure our response to homelessness like this, after 40 years, this framework is clearly not delivering results. There are two primary reasons for this:

1. The temporary, natural conditions that might give rise to a powerful hurricane or tornado are not at all like the ongoing, entrenched socioeconomic policies that are making it harder for people to maintain housing. Unlike natural disasters, which are inherently unpredictable and require a reactive response, there is sadly a predictable and quantifiable number of people who face housing insecurity in every community. This requires predictable and proactive resource planning.
2. The "disaster recovery" mindset fundamentally misunderstands the needs of people experiencing long-term chronic homelessness, who by definition need ongoing support for disabling health conditions. In a cruel twist, when these folks fail to quickly "figure it out," rather than seeing the underlying vulnerabilities that are making it harder for people to resolve their homelessness, many communities instead frame these individuals as the least deserving of support.  

Using the Right Analogy

With systems thinking, words - and by extension, the underlying mental models they represent - matter. 

When it comes to homelessness, a growing number of leaders have started using a new analogy for conceptualizing the role of the homeless service system. As a top leader in Houston, TX, one of the only major metropolitan areas in the country measurably reducing homelessness, put it:

“We are not here to solve poverty. We aren’t here to fix the affordable housing problem. Think of the homeless system in America as an emergency room for a triaged slice of poverty.”

This is exactly right. 

We are poverty's emergency room. 

We are not its public health department. We are not its primary care physicians or specialists. 

We are on the frontline, triaging emergencies, with the number one goal of rehousing people as quickly as possible, so they can then get the ongoing help they need, should they even need it.  

A More Proactive Response

Over many decades, hospitals across the world have developed a fairly consistent process for determining and addressing patient needs: 

• If we get really sick, we go to a central location within the hospital called the emergency room.
• Within the emergency room, a nurse or doctor triages our symptoms and needs with a standardized assessment.
• Based on the results of that assessment, hospital staff route us to the medical intervention we need, while also indicating how urgently that intervention needs to be applied.

This probably sounds so obvious it’s hard to imagine an alternative, but consider a different process. 

What if we had to go to the hospital, but there was no central check-in location and no emergency room? Instead, what if we had to go department by department, wasting valuable time completing different forms and surveys to see if we’re in the right place.

As a patient this would be extremely frustrating, but it would also be a headache for the hospital. Unless all of those different departments were regularly coordinating and sharing data, they would have no idea who was seeking services and what types of assistance those people needed.

Customer Journey Mapping

Many private sector companies, from hospitals to tech, use what are called "customer journey maps" to help design effective and consistent product and service experiences for their clients.

A customer journey map [is] a visual story of your customers’ interactions with your brand. This exercise helps businesses step into their customer’s shoes and see their business from the customer’s perspective. It allows you to gain insights into common customer pain points and how to improve those. 

One of the biggest problems with the way we have localized the response to homelessness in this country is that as a sector / industry / movement, we have failed to create a common understanding of how the parts of a homeless system of care typically fit together. 

Worse, we often rebrand or use inconsistent terminology for different programmatic interventions, thus making it even harder for both policymakers AND people experiencing homelessness to understand how the system works. 

STEPS

There are a limited number of building blocks that go into a homeless system of care. They include:

• Societal Issues - The policies and conditions that are making it more likely for individual crises to result in episodes of homelessness
• Prevention - Trying to stop homelessness before it happens (typically involves legal or financial assistance)
• Diversion - Trying to find rapid housing solutions outside of the traditional homeless service system, such as reconnecting a person with family or friends (sometimes called "problem solving")
• Administration & Coordination - The data sharing, case conferencing, and other service navigation processes that coordinate efforts across providers
• Outreach - Social workers or case managers who engage people in unsheltered settings
• Basic Needs - Services to help people with basic survival (e.g., drop-in centers, food, hygiene, laundry) 
• Shelter - Short-term housing to help people avoid sleeping on the street (can take many forms, including: congregate, non-congregate, safe parking, tiny homes, motel vouchers, etc.)
• Permanent Supportive Housing (PSH) - Ongoing subsidized housing that includes wraparound support services (this is the data driven solution to chronic homelessness)
• Rapid Rehousing (RRH) - Timebound case management and housing assistance for people with lower levels of acuity who have a path back to self-sufficiency
• Other Housing - The broader ecosystem of programs, interventions, and supports to support housing placements (e.g., treatment options, landlord recruitment, homesharing)

STEPS is intended to show how these building blocks tend to fit together. Importantly, they are undergirded by a second S - Systems. This refers to the principles and policies that tie all of these pieces together:

• Vision / Strategy - A clear community goal and approach tying all local efforts together 
• Leadership - Proactive leadership coordinating stakeholders throughout the system (e.g., city, county, providers)
• Structure - The meetings, policy and procedures, and other mechanisms for implementing the vision / strategy
• Funding - Resource allocation to support the vision / strategy
• Equity & Lived Experience - Ensuring the system is producing equitable outcomes and is informed by the people who are utilizing it
• Data - The metrics and outcomes providing overall accountability and feedback

Orientation

STEPS in its own right is an extremely powerful tool for helping for helping local communities better organize their local response. For example, it can help:

• Quantify current and/or future spending
• Create a basis for strategic planning
• Help providers determine their service niche(s)
• Provide community engagement and understanding

However, there is an even deeper and more important insight here.

If the building blocks for a homeless system of care are generally the same in every community, then it stands to reason that if you compared all of the various approaches to a given building block, "optimal" approaches would emerge (i.e., best practices).

Thus, STEPS can not only help to coordinate better locally, it also serves as a framework to orient local communities to "north stars" for what is working elsewhere. 

AHEAD

If STEPS is the what, AHEAD is the how. 

The secret ingredient spurring the communities that are making the most progress reducing homelessness is simple - it's sparking and sustaining momentum. 

Momentum looks like having clear, baseline data on the current system, identifying programmatic benchmarks that are more effective than the status quo, rapidly piloting new approaches, measuring the impact, and then repeating the process.

 AHEAD is simply a way of visualizing this feedback loop.

• A - Assess: Gather baseline data, solicit feedback from key stakeholders, and use STEPS to evaluate the current system.
• H - Hypothesize: Identify workstreams that would most improve challenges surfaced during the initial analysis.
• E - Execute: Implement the changes identified in the previous step, ideally using quarterly “action cycles.”
• A - Analyze: Collect data and feedback to compare to the initial baseline and also to measure quarterly improvements.
• D - Decide: Continually revisit the original hypothesizes and do more of what is working and less of what isn’t.