In the homeless crisis, is Seattle finally shifting into gear?

It’s been an interesting two days if you are tracking Seattle’s response to its homeless crisis (and you should be).

Yesterday, noted expert on homeless response Barb Poppe, who is a consultant to the city, delivered a lecture  (video here) to the Human Services and Public Health Committee on general principles and best practices for a homeless crisis response. While not a “lecture” in the pejorative sense, some of her “what not to do” points hit close to home when looking at Seattle’s current muddled (and expensive) response. The talk could also be seen as a warm-up to her more detailed report, expected in August, when she will give specific recommendations on actions for the city to take to “up its game.”

She began by defining the two primary objectives of a homeless crisis response effort:

1. Reduce unsheltered homelessness;
2. Increase the throughput from homelessness to stable housing.

It’s not about just getting people off the streets and into emergency shelters; it’s about having a system in place that assesses and addresses needs and gets people connected into services that will result in them emerging out of the homelessness system and back in stable, permanent housing, making homelessness rare, brief and non-recurring. She doubled down on this point by referring to the federal government’s definition of ending homelessness: ensuring that those who become homeless return to permanent housing within 30 days. Poppe also pointed out that a homeless crisis response is distinct from an effort to alleviate poverty and an effort to improve housing affordability; there are some overlaps to be sure, but a crisis intervention can’t solve all of a city’s societal woes and over-scoping the problem that way inevitably draws resources away from dealing with homelessness into programs to address the other two issues.

The heart of her presentation is this diagram of the components that represent a “systems approach” to the problem:

In Poppe’s view an effective solution must have all of these components to be successful. Some are general principles and some represent specific actions taken at critical moments in a homeless person’s journey through homelessness, so indulge me as I re-arrange the pieces a bit to help make it more understandable.

It begins at the beginning: how people enter into the system when they are on the brink of becoming homeless. Lots of research shows that this is a critical moment: if the problems that are causing them to lose their housing can be addressed immediately, they can be prevented from entering the system at all. Conversely, the longer they spend in the system, the more difficult their exit becomes, both because of the damage it does to their appearance of housing-worthiness as well as the risk of accumulating other problems such as addiction or mental health issues. So an effective crisis response includes “coordinated entry,”  a person-centered approach that individually assesses a person’s (or family’s, or group’s) needs and refers them to the services needed at the intensity required. Coordinated entry isn’t simply about checking a set of boxes next to available services; it’s about tailoring a complete and coordinated set of services that’s right for the individual that will fully address their needs and prevent them from getting stuck in the system because of an unmet need. Coordinated entry also enters the person into a Homeless Management Information System (HMIS) which allows providers to see essential data about that person to improve service delivery (we’ll revisit the importance of HMIS systems later). And an effective coordinated entry system works to remove barriers to entry, the individual variations in a person’s story that might otherwise prevent that person from getting matched to the right services.

An effective homeless response has “housing first” as a key principle. The first priority is to get people stabilized into housing as quickly as possible; research shows that efforts to address other issues that a homeless person might have (such as opiate addiction) are far more effective once a person is stably housed. To this end, diversion is a key priority: catching people early and getting them into some form of stable housing.

The corollary also holds: emergency housing is a last resort option, for those who can’t be diverted for whatever reason. When people are brought into emergency shelters, they must also be person-centered and assist in connecting people to services (not just giving them a roof, a cot and some food). In particular, they must be focused on housing placement as the most important service to deliver, and they must prioritize those people who have been in the system the longest and who are consuming the most resources — doing so creates more capacity in the system.

All parts of the system, at every stage and in every service, must be focused on throughput. Success isn’t the number of people in shelters, or receiving addiction treatment; it’s the number of people who emerge successfully at the other end with their needs met and stably re-established in the community.

To make this work requires “progressive engagement.” This means re-assessing people as they move through the system to understand how their needs are changing — type and intensity — or where those needs aren’t being met so adjustments can be made.

Effective systems are funder-directed: the funders are making decisions and are part of a governance structure built to act, not just to “seek input.” (this was one of the points that hit close to home when one looks at Seattle’s response to-date) They are also data-driven, where data and analytics are used to identify the programs and practices that are working, and the providers that are producing results — as well as the programs, practices and providers that aren’t. Funders use the data to hold people and organizations accountable to results and outcomes, and strategically allocate resources to those that do the best to maximize the impact.

This of course requires an effective and efficient HMIS system, without which it’s much more difficult to track people’s progress through the homeless system and it’s impossible to know how to improve the effectiveness and throughput of the system. There are valid privacy concerns about collecting information about homeless people (and many homeless people don’t trust such systems) but HMIS is necessary for an effective response and Poppe has seen “robust privacy protections” put in place in other cities.

Finally, an effective  homeless response is “relentlessly focused on housing placement,” looking to leverage every available resource and opportunity toward that goal. This includes “mainstream” resources, such as the residential housing business community: developers, landlord association, real estate agent networks, and all other avenues for finding housing options and connecting people to them.

Poppe walked through some data on “benchmark cities” that have seen some recent success in dealing with their own homeless crisis or have been cited as examples to emulate (like Salt Lake City).

The news for Seattle is not great: rent prices correlate heavily with lowering the homeless rate, as does higher vacancy rate (not surprisingly). Federal funding isn’t correlated, which is sort of good news in that Seattle’s ability to address homelessness won’t be strongly tied with how much money it can find for programs and services: the city is well funded compared to its peers. The problem lies elsewhere.

Poppe’s last point was a key one: acting now. She claims that the successful cities are very focused on action, not on planning. As Bagshaw said in the hearing, “a good plan today is better than a perfect plan tomorrow.” Ironically, we won’t get Poppe’s specific recommendations for two more months.

But that leads to Thursday’s big news: Mayor Ed Murray announced that the city will open up a new “navigation center,” a 24-hour shelter modeled after San Francisco’s Navigation Center. It will accept people with any of the “3 P’s” that are the most frequent barriers to entry into shelter: pets, possessions, and partners. And it will be focused on providing the kind of coordinated entry described by Poppe in the Council committee hearing.  Committee chair Sally Bagshaw has been advocating for moving shelters in this direction for several weeks now (and extolling the virtues of the SF Navigation Center), and it’s a bit curious that she was left out of the Mayor’s announcement. Hopefully it isn’t a continuation of the spat between Murray and the Council over the plan for addressing the Jungle.

But here’s the catch: Murray’s plan calls for establishing

… a public-private partnership workgroup convened by Department of Human Services Director Catherine Lester to develop a proposal for and help implement a replication of the San Francisco model in Seattle. This workgroup will include representatives from All Home, philanthropy and nonprofit partners with expertise in delivering effective housing and services to individuals who are homeless. This workgroup will also coordinate closely with King County and other regional partners to provide technical assistance or coordination should other jurisdictions be interested in replicating San Francisco’s model in their respective jurisdictions to address the regional problem of homelessness. The workgroup will deliver its proposal to the Mayor within 60 days and the Human Services Department will then issue a request for proposal 30 days later, with a goal of successfully launching the service center by December 31, 2016.

There will be a work group. In two months, there will be a proposal. A month after that, there will be an RFP. Four months after that, if everything goes swimmingly, there might be a Navigation Center, run by an outside provider. Welcome to the “Seattle Process.”

Here’s a different option: commit the city (through the Human Services Division) to build and run it itself, as the pilot for re-inventing homeless response in the city. Outsourcing it not only takes longer to get it going, but it makes it much harder for the city to try out new ideas since it won’t be actively involved in running the center. Let this be the one and only center that the City runs itself: a test bed for new and innovative ideas, and a shining example so other providers in the city can learn and emulate its successes.

And let’s do it fast. Use the emergency authority the City Council granted the Mayor to bypass paperwork and just get it done. You don’t need to invent the starting place out of whole cloth; you’ve already put the stake in the ground that the new Navigation Center should emulate San Francisco’s. Start there, get it going as fast as possible, start bringing in homeless people and helping them, and make adjustments on the fly. Road-test the city’s HMIS program, and work out the right privacy protections. Implement a coordinated entry system that works. Get analytics in place, and start informing real data-driven decision making about what works and doesn’t. Prioritize housing placement first and foremost. Make this the textbook example of doing homeless crisis response right.

There are no providers in Seattle that are currently doing what the Mayor is calling for, and if the city tries to outsource it to one, that organization will need to build not only capacity but also skills and expertise that it doesn’t have.  So, City of Seattle, don’t go down that route. Skip the middle man, and just do it yourself. It will build the city’s own muscles, and be an ongoing resource for learning, for decision-making, and for providing prescriptive direction to other providers as Seattle scales up an effective response. HSD already has experience in providing services directly to the aging and disabled communities, and there is no better way for it to build the expertise necessary to be an active, engaged funder driving the homeless response than to build and run the Navigation Center itself. It would be in line with what Poppe has highlighted in an effective response. And it would be much faster than taking the tried-and-true “Seattle process” approach. We can still get advice from advocates and experts, but we don’t have to let them run the show (so far their results and outcomes are pretty unimpressive).

Seattle’s current homeless crisis response is expensive and ineffective. It’s time to be bold, embrace the best advice, and act now.

UPDATE: Council member Bagshaw posted a message to her blog this morning talking about the San Francisco Navigation Center and commenting on the Mayor’s announcement:

I am excited that Mayor Murray announced he will take steps to prioritize a 24/7 Navigation Center here in Seattle.  Earlier this year, our Washington State legislature approved $600,000 for a Navigation Center; and Seattle is matching this investment with a private donation of $600,000 earmarked for homelessness services, and will establish a designated fund to collect additional private donations to support the center.

This is our first step to make a significant difference for people who are experiencing homelessness, and to improve the health and safety for all of us in the City of Seattle.