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HERE
Dr. Centrone elucidates a common situation those experiencing homelessness know all too well in just about every city in the country. It is certainly true that in some towns providers have more effectively collaborated to accomplish far more together than they ever could have individually, but the truth is that even in most of those places, increased collaboration among agencies, services and resource allocators continues to be elusive and below the level that is actually available.
Homeless services have never been at the top of the priorities list for funding opportunities from their local, state and federal purse-holders. They've always had to fight for very scarce resources and for a very long time, because so little was known about both the numbers of homeless in a given community and how best to serve them, oversight was....tepid; how does one provide oversight if one doesn't know the scope of - or the remedy(ies) needed to - correct the problem?
As a result, agencies have learned to be protective of their funding streams while at the same time figuring out for themselves how best to address the niche they carved out as a result of the funding stream.
Let me explain:
WARNING: BRAIN GLAZING FUNDING INFORMATION COMING!
grants are narrowly targeted. It's not like an agency can send in a "proposal" with a vague and overly broad request to "help people who are homeless" to someone like Housing and Urban Development (HUD) or the Substance Abuse and Mental Health Services Administration (SAMHSA) That proposal must be pretty specific to the announcement of funding opportunity (a Request For Proposal/RFP. or Request for Application/RFA). As a result, organizations often find themselves building their approach around a specific RFP, which then also essentially ties their hands to remain within the parameters of the requirements laid out in the RFP.
Because these funds originate at the Federal level (usually), it's challenging, to say the least, for Federal policy makers seeking to provide some help to local entities for their problems or issues to know exactly what this might entail. They work around this in a couple of ways; first, by providing "block grants" to states so that the state itself can decide what priorities it will set and then release RFPs for the available funds. Second, the feds put out federal RFPs (duh) targeting specific approaches known as Evidence Based Practices (EBPs) or Promising Practices.
Understand I'm being overly broad and vague myself on this as I don't want to put you to sleep, nor am I in any way, shape or form a Subject Matter Expert (SME) on grants and funding procurement. But I do know probably just enough about them to be dangerous to myself and others with it, and part of this danger I think many of us share when we apply for funding at the local level.
This is because as I mentioned earlier, we find ourselves tied to the requirements - and the restrictions - within the grant itself. And if the grant is disbursed over a period of years, as many of them can be, whole departments; hell, whole organizations may be built upon them.
This is a key point, because what then becomes an issue - sometimes the overarching issue - is keeping that funding in order to keep the staff employed in order to keep bringing the service(s) to the population being served; the “no money, no mission” paradigm.
There's little incentive to collaborate or to share resources because a. the requirements of the grant narrow the scope of what the agency is able to do, and b.the agency is already running on a shoestring and the last thing they want to do is to give a competitor for those scarce resources any of the goodies - or the inside info around the grant requirements - they worked their tails off to get for themselves. There's also little incentive to change funding streams, since winning a grant is always "iffy" and it used to be much easier to write a continuation application rather than a new RFP.
Let be LOUD and clear here; agencies DO want to collaborate, and they often DO SO even when they know it can be potentially harmful to the funding they receive for the job they're doing. It's just that for a very long time, there wasn't really a directive to find ways to to collaborate, nor was there a paradigm shift from - and this is a critically important point -
managing homelessness to
ending homelessness.
Over the last 5-7 years, the Federal government has ramped up their investigative efforts around homelessness and have begun to understand much more clearly the scope of the problem. This in turn has helped to identify the remedies needed to accomplish this shift.
What they've discovered is what most folks on the ground providing services have known for quite some time; the precursors leading to - as well as the issues chaining people to - homelessness are varied, complex, and there is no "one size fits all" answer.
And, s it is so often, when we figure out one thing, new challenges and barriers suddenly materialize or come more sharply into view as a result.
Now one of the bigger problems we're all facing is getting people to understand the need for the paradigm shift from management of homelessness to the idea of ending homelessness, and this is no easy task. People have some very deeply held beliefs around the causes and conditions of homelessness, and there are widely held stereotypical beliefs that, while often erroneous, continue to be pervasive and hard to eliminate.
All of this "discovery" and tactical shifting takes time, especially when it must come from something like the Federal government, who is as far removed from the realities of the daily life on the ground in Murfreesboro, TN or Round Rock, TX or Davenport, IA., as is a citizen of Zimbabwe.
The key here of course is to raise awareness, but it is also to ensure that as money flows from federal to state to local programs, those programs are evaluated based on outcomes tied tightly to ending - not managing - homelessness. If, as your program has contact with individuals experiencing homelessness, you are releasing them back onto the streets when your "treatment" is complete rather than being able to release them into housing, we need to rethink continuing funding to this organization
under a homeless services grant.
Let me be crystal clear here; services to address the immediate needs of those experiencing homelessness
are essential and must be continued. HOWEVER, these services should NOT be stand alone services, and we
must begin to hold agencies accountable for helping to end homelessness with every individual they engage with who is currently experiencing homelessness. If your service is not directly connected in some way, shape or form in the measurable reduction of people experiencing homelessness in your community, funding for your program should come from some other source to allow the scarce dollars allocated to homelessness to be used solely to assist with ending it.
I know this sounds a little extreme, but if we want to reduce the costs associated with homelessness and bring an end to the scourge itself, there is only one real answer:
we must put people into houses.
Slaying the Ego in Homeless Services Delivery by Wayne Centrone
Posted on
September 11, 2012 by C4 Thought
At the end of our talk today at the San Diego, California Region IX Health Care for the Homeless Conference, I had an opportunity to speak with a service provider. He told me about his efforts to get organizations to build a coalition in his community. He told me about the six months it took him to schedule the first meeting of the homeless services agencies in his area.
He told me that he had not given up hope that the coalition will pay off with great dividends. I complimented him on his efforts and reassured him that his efforts would indeed pay off. I told him that he may never know the impact of his efforts, but, I told him, if his efforts led to ending the experience of chronic homelessness for one person, then it was worthwhile.
I enjoy speaking at these conferences. They are full of amazing people working in homeless services. I love to reconnect with old friends, inspiring thought leaders, and change agents. The people who work in homeless health clinics, supportive housing programs, mental health and substance use treatment programs around the country are gifted and courageous people.
I spoke at this conference with my colleague Steven Samra. We talked about our work on a new model of outreach we are calling “Housing-Focused Outreach” (HFO). Steven and I, along with the leadership and thoughtful intellect of Ken Kraybill, have been incubating the ideas of HFO for a few years. Our ideas are not unique. They are born from the work of Dr. Sam Tsemberis at Pathways to Housing, and the visionary work of the 100,000 Homes Project. Our ideas are also born from our years of experience in serving people experiencing homelessness and the work we have all been doing over recent years in visiting supportive housing programs around the United States.
The talk was about shifting the paradigm of service delivery. We are considering how to develop and operationalize a new model to impact agency level activities. A summary of our conversation, a work in progress, looks like this:
(1) In order to truly end chronic homelessness, we [homeless service providers, peers, and advocates] need to lead with housing and build effective bridges to supportive services.
(2) The only way to ensure adequate access to housing and supportive services is to build bridges of collaboration with a number of organizations and resources.
We talk about the fact that most communities around the country have the pieces to put together a really effective model to end chronic homelessness. The issue, however, is that these pieces are fractured and disjointed from one another. Our main predicate for the Housing Focused Outreach model is training service providers to be experts in building partnerships.
When we give this talk, we hear repeatedly how little collaboration actually occurs on the ground. I hear over and over again at talks like this: “Oh, that [collaborating with partner agencies] won’t work . . . we are all fighting for the same pot of money, and we can’t really collaborate or we will lose our agency level effectiveness.”
Don’t get me wrong, I totally understand the “no money, no mission” paradigm. I also know that without collaboration and resource sharing, true, lasting change is not possible. I am not sure how we can get more people invested in the idea that collaboration is one of greatest and most underutilized tools. One thing I do know: it will take some serious ego slaying and a strong commitment to service.
Now lets keep in mind that State and Federal Governments have already been putting restrictions on these types of medicines, some of which need to be accounted for pill-by-pill. But since drug addicts are still finding ways to obtain these drugs, the Mayor's next plan to fight this kind of drug abuse is to take the drugs away from those who will legitimately benefit from them. This is not really a surprise given that this is the same solution he has for combating gun crime, basically targeting those who legally own and would like to legally own weapons.
So because people are dying from prescription medicine abuse, abuse that I have no control over, the Mayor's logic is that I must have less or even no pain killers because people who don't need it, are consuming too much. 
John McCain is a Republican Senator from Arizona. He ran for President against Barack Obama and lost. I voted for John McCain because he would have been a better President than Barack Obama. That does not mean that Senator McCain is not an idiot. Being an idiot is not what cost him the election, especially given that he lost the election to an even worse Senator. That said, if this is what Senator McCain thinks counts as serving his country, then I say that Senator McCain has served our Country long enough.
Almost 6 years later, not much has changed and in fact, this spreadsheet is woefully outdated today because a number of new cities need to be added, including Nashville and now, Philly (and Nashville initiated theirs so long ago that it's barely worth mentioning and is only listed here because I happen to live here).