Homeless Response System Online Learning Clinic 2018 – Part V: Building Dallas’ Homeless Response System – 2015-2017 – Data Transparency

All homeless service providers must practice full transparency, by reporting all data into the Homeless Management Information System (HMIS), the federally-mandated community wide database, that drives improvement of homeless services programs, without exception (barring issues of safety). Reporting into HMIS is not simply an issue of bureaucratic compliance. This is the only way we know if and how much progress our community is making. More importantly, this is the only way we can improve and self-correct, where we are not[i].
 
In the last three years, Dallas made huge strides, specifically, in this area. For instance, as late as 2014, no emergency shelter beds were reported into HMIS. It is impossible to assess system performance, in the absence of data on the point of entry into homelessness. Therefore, communities that do not have that data in their HMIS are routinely penalized for it, as Dallas was. However, unlike the housing programs, funded through the Continuum of Care (CoC) Program, MDHA cannot simply require shelters to enter their data. MDHA methodically worked with each of the major shelters, and over the last three years brought most of them into the system. As of December 2017, with the Salvation Army adding all of their 700 beds into the system, 57% of shelter beds are now entered into HMIS. In 2018, we will meet and exceed the standard set by the Federal Government, 86%.
 
These simple numbers, important as they are, bely a more fundamental shift in the HMIS, here in Dallas. In early 2015, MDHA and its partners began a discovery process that led the Continuum of Care (CoC) to adopt a new HMIS system, built from the ground up, by a non-profit founded by the Parkland Health and Hospital System, PCCI[ii], and its for-profit affiliate, Pieces Tech[iii]. This system was designed to be part of a larger ecosystem tracking individuals as they move through the healthcare system and social service organizations, Pieces Iris.



Dr. Steve Miff, PCCI

Pieces Iris was born out of the recognition that limited communication between the healthcare system and social service organizations, may cause vital information to slip through the cracks. The idea was to create a seamless system that connects healthcare and community-based organizations, allowing for smart sharing of information that makes a tangible difference in the lives of the most vulnerable populations[iv]. As PCCI President and CEO, Dr. Steve Miff, told the Becker Hospital Review[v], in September 2017, “Up to 50 percent of clinical outcomes are driven by social, economic or environmental factors, and not necessarily related to the direct care the individual received. That has basically set the stage and created the need for this solution to connect communities, and through that, to drive personalized medicine."

Over the course of the last three years, MDHA, PCCI and Pieces Tech worked hand in hand to launch the new HMIS, which went live in mid-2017. As Politico Magazine[vi] wrote in December 2017, Pieces Iris is already, “having a powerful impact on overwhelmed homeless organizations in Dallas… The availability of data showed… that homeless people were 167% more likely to have emergency room visits than the non-homeless population, and that from 300 to 400 homeless were arrested in Dallas each month. Neither of these pieces of information was shocking, but they gave [MDHA President and CEO, Cindy J.] Crain data she could take to officials to try to influence policy on homelessness. If she could show that housed people needed fewer EMS transports, ER visits and less time in jail, then, she reasoned, ‘I can make a business case to say, it’s not only the moral thing to bring housing to these homeless, mentally ill people. It’s going to save you money. If you don’t serve these people they’ll die in the street or eat you alive with these public response systems.’”

Finally, one glaring fact that “jumps out” at anyone who analyzes the data on homelessness in Dallas, is the overrepresentation of African Americans in the homeless population. Since late 2016, with the support of the United Way of Metropolitan Dallas[vii] Unite Dallas Relief Fund[viii], we are partnering with six other cities, towards establishing more racial equity in homeless services, through SPARC (Supporting Partnerships for Anti-Racist Communities)[ix], a new research and action program from the Center for Social Innovation (C4)[x].

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[i] See Dennis Culhane in the European Journal of Homelessness, http://works.bepress.com/dennis_culhane/209/
[ii] http://www.pccinnovation.org/
[iii] https://piecestech.com/
[iv] This language paraphrases, as well as uses some of the very language PCCI first used to describe this effort.
[v] https://www.beckershospitalreview.com/population-health/how-a-texas-innovation-hub-is-eliminating-socioeconomic-health-disparities.html
[vi] https://www.politico.com/magazine/story/2017/12/18/parkland-dallas-frequent-flier-hospital-what-works-216108
[vii] https://unitedwaydallas.org/uwmd/
[viii] https://unitedwaydallas.org/uwmd/unite-dallas-relief-fund-july-2017/
[ix] http://center4si.com/sparc/
[x] http://endinghomelessnessmdha.blogspot.com/2017/01/the-story-of-homelessness-in-dallas.html

On the Rise of Homelessness in Urban America, and Our Next Steps to Address It Here in Dallas

During her State of the Homeless Address on March 21, 2018, Cindy J. Crain, MDHA President and CEO, shared the results of the 2018 Homeless Count in Dallas and Collin Counties. The numbers showed an increase in homelessness, in general, and unsheltered homelessness, specifically, accompanied by drops in chronic and veteran homelessness. That same week, the Collin County Homeless Coalition published its report, which showed a drop in the number of those experiencing homelessness in that county. Not surprisingly, it takes the U.S. Department of Housing and Urban Development (HUD) many more months to report on the results for the entire country.
 
In the meantime, we do have the 2017 numbers, which came out fairly recently, this last December, with HUD’s submission of Part I of its 2017 Annual Homeless Assessment Report (AHAR) to Congress on Point-in-Time Estimates of Homelessness. HUD reported that, “Homelessness increased for the first time in seven years. The number of people experiencing homelessness increased by a little less than one percent between 2016 and 2017.” Interestingly, though, this aggregate number reflects two separate phenomena: “This increase reflected a nine percent increase in the number of people experiencing homelessness in unsheltered locations, which was partially offset by a three percent decline in the number of people experiencing homelessness in sheltered locations.”
 
More importantly, HUD emphasized that this is primarily an urban problem: “Recent increases in homelessness were driven mostly by specific changes happening within cities. Increases in the numbers of unsheltered individuals in the 50 largest cities accounted for nearly all of the national increase…  The number of all people experiencing homelessness increased in major cities and decreased elsewhere between 2016 and 2017… More specifically, increases in unsheltered homelessness in major cities drove the national increase…”

One of our homeless friends at an encampment in 2017
(Photo taken by award winning photographer, B.J. Lacasse)

Why is this? What is going on in our cities?

An earlier HUD report, Worst Case Housing Needs – 2017 Report to Congress, may help us understand:

Worst case housing needs are a national problem. Such severe housing problems have expanded dramatically during the past decade and were exacerbated by the economic recession and associated collapse of the housing market, which reduced homeownership through foreclosures and tight lending and increased demand for renting. The slight improvements observed since 2011 offer cause for hope, but the failure to sustain the more promising trends observed in 2013 is sobering… The latest resumption of worsening housing problems among the nation’s very low-income renters is attributable primarily to demographic and economic factors—especially a notable shift from homeownership to renting—that grew the number of households susceptible to worst case needs. Uneven housing market responses that increased the proportion of unassisted very low-income renters with severe rent burdens played a secondary yet substantial role.

Even with rental assistance, 6 of 10 extremely low-income renters and 4 of 10 very low-income renters do not have access to affordable and available housing units. Among very low-income renters in 2015, only 25 percent of households had rental assistance and an additional 43 percent had worst case needs for assisted or other affordable housing. In other words, only a small share of very low-income renters—32 percent—avoided severe housing problems in the unassisted private rental market in 2015.  

And where is this problem most pronounced? “Central cities were home to most (9.51 million) very low-income renters, followed by suburbs (7.23 million) and nonmetropolitan areas (2.49 million).” The report emphasizes that the main culprit in this crisis is the lack of affordable rental housing in the nation’s urban centers.
 
Arguably, what we have is not a homelessness crisis, but an acute affordable housing crisis, and the epicenter of that crisis is in our cities, including Dallas and other urban communities in Texas. As we wrote, about a year ago, “Housing is the key… Local governments must act now to create affordable housing… We need more permanent supportive housing, more second chance housing, and more affordable housing in the 0-30% AMI (Area Median Income) range.” And HUD’s prescription is clear: “A broad strategy at the federal, state, and local levels is needed to continue to rebuild the economy, strengthen and realign markets, and provide assistance to those families most in need.”

Two of our formerly homeless friends
(Photo taken by award winning photographer, B.J. Lacasse)

The emphasis on the federal level is well warranted. The current level of federal funding for the Continuum of Care Program, just over $2 billion, is essentially a rounding error in a $4 trillion Federal Budget. We can’t expect to end homelessness, with this level of investment. As we wrote in December: “Especially over the last decade, we have become extremely skillful at building systems that maximize the impact of these $2 billion. However, as a nation, we have not explored the idea of significantly adding to that funding. We have accepted… that around $2 billion, in 2017 dollars, is enough to defeat a social ill that has been with us for forty years and counting.”

Ann Oliva
Former Deputy Assistant Secretary, HUD

However, we do need to do our part here in Dallas and Collin Counties, and specifically the urban core of Dallas, to address this affordable housing crisis, that is driving the increase in homelessness. This is why on March 28-29, 2018, we brought together all of the major “players”, in Dallas and Collin Counties, who can affect this type of change on the local level, for a Homeless Response System Leadership Training and Strategic Planning Retreat. This groundbreaking gathering was facilitated by OrgCode, led by pioneering world expert, Dr. Iain De Jong. With De Jong and former HUD Deputy Assistant Secretary Ann Oliva, leading a team of facilitators, this retreat, with more than 65 senior leaders in attendance, was designed to usher in a more strategic community response to homelessness.

Dr. Iain De Jong
(Courtesy of the Salt Lake Tribune)

Participating leaders spent two whole days of intense action-oriented participative and interactive hard work. They focused on the critical nature of collective impact, and how an effective system of care can bring about an end to homelessness in our community. Together, through a strategic planning journey, utilizing the Breakthrough Thinking approach, participants made the necessary decisions and vital commitments that will chart our course, as a community.

We look forward to sharing the report OrgCode will produce to help our community flesh out the next steps. Then, united in vision and purpose, we will act on those decisions, and fulfill those commitments. That is how, working together, as a community, we can and will make homelessness in Dallas and Collin Counties, rare, brief and nonrecurring.

Watch the State of the Homeless Address Now!

• Bummed out that you missed the State of the Homeless Address? Fear not, we’ve got you covered!

 

 

• Download Cindy’s PowerPoint, so you can follow along here: http://www.mdhadallas.org/wp-content/uploads/2018/03/SOHA-2018-Final.pdf

• Don’t have time to watch now? Check out this quick summary: Metro Dallas Homeless Alliance President and CEO Delivers Annual State of the Homeless Address http://endinghomelessnessmdha.blogspot.com/2018/03/metro-dallas-homeless-alliance.html

• Check out some great coverage of the Address here: Without Enough Affordable Housing, Homelessness In Dallas Is Getting Worse, by Stephanie Kuo, KERA http://keranews.org/post/without-enough-affordable-housing-homelessness-dallas-getting-worse 

 

• How Many Homeless Live on the Streets? The Number Jumped 23% This Year, by Tasha Tsiaperas, Dallas Morning News https://www.dallasnews.com/news/social-justice-1/2018/03/21/homelessness-rise-living-dallas-streets-not-shelters-really-spiked

Metro Dallas Homeless Alliance President and CEO Delivers Annual State of the Homeless Address

Dallas, Texas – On Wednesday, March 21, 2018, the Metro Dallas Homeless Alliance (MDHA) held its fourth annual State of the Homeless Address, at Goodwill Industries of Dallas. The Address was delivered by MDHA President and CEO, Cindy J. Crain. It covered the results of January’s annual homeless count, as well as the progress of Dallas’ homeless response system, in making homelessness rare, brief and nonrecurring.

Ms. Crain’s PowerPoint Presentation may be downloaded from the MDHA website. The full address, including the question and answer period that followed it, will be posted to MDHA’s YouTube channel in the next few days. A bullet point summary of the address follows:

• Homeless Count Results:

-          Overall homelessness in Dallas and Collin Counties, clocking in at 4,140 individuals, rose by 9%, when compared to 2017.

-          Unsheltered homelessness, clocking in at 1,341 individuals, rose by 23% during the same time period.

-          The number of homeless veterans dropped from 356 individuals or 9.5% of the homeless population to 331 individuals or 8% of the homeless population.

-          The number of chronically homeless individuals (those homeless for a year or more, with a documented disability) continued to drop, for a second year now, clocking in at 424 individuals, or 21% fewer than in 2017.

-          The rise in the overall numbers and specifically the unsheltered numbers is in line with national trends across urban centers in the United States. It is attributable to the lack of affordable housing.

• MDHA’s Housing Priority List, which lies at the core of the homeless response system, is making a huge difference in Dallas. In an effective homeless response system, no placements are made in any program without objectively assessing each person, prioritizing them for service, based on the level of their vulnerability and specific needs, and placing each person on a unified Housing Priority List. Placements in housing are made only from that list, based on priority status and specific needs. As of mid-March 2018, there are about 790 individuals on the Housing Priority list, ready to be housed. 209 of these individuals are chronically homeless, which means that about half of the chronically homeless population is ready to be housed. Over the course of the last 12 months, 246 individuals have been housed from the Housing Priority List.

• MDHA is now able to analyze a wealth of data regarding health outcomes of individuals experiencing homelessness, through its new Homeless Management Information System, which is part of Pieces Iris. As Politico Magazine wrote in December 2017, Pieces Iris is already, “having a powerful impact on overwhelmed homeless organizations in Dallas…” The data collected through Iris is already making it easier to make not just the moral case, but the business case for ending individuals’ homelessness quickly and permanently. 

• Whatever measure we look at, we see a marked overrepresentation of African Americans in the homeless population. The homeless count showed that 60% of the unsheltered homeless are African Americans, and analysis of data from the Homeless Management Information System in the years 2011-2016, showed an even higher number - 66.7%. Since late 2016, with the support of the United Way of Metropolitan Dallas Unite Dallas Relief Fund, MDHA has been partnering with five other cities, towards establishing more racial equity in homeless services, through SPARC (Supporting Partnerships for Anti-Racist Communities), a new research and action program from the Center for Social Innovation (C4).

• MDHA is working with its partners, on a number of simultaneous projects, from a 90-day Emergency Shelter Housing Challenge through a separate State of Homeless Youth event in April to creating a detailed “My Housing Plan” framework for as many individuals as possible, to help them make progress in ending their homelessness, and eventually become housed.

• Next week, March 26-28, 2018 MDHA is convening a Homeless Response System Leadership and Strategic Planning Retreat, with about 65 local leaders and 10 national experts in the homelessness arena. The retreat will be facilitated by pioneering world expert, Dr. Iain De Jong, and is designed to usher in a more strategic community response to homelessness. Participating leaders will commit to two days of intense action-oriented interactive hard work, focusing on the critical nature of collective impact, and how an effective system of care can bring about an end to homelessness in our community. The ultimate goal will be to produce a Homeless Response System Consolidated Strategic Plan, through which all stakeholders can make a real impact in the fight against homelessness.

Ms. Crain ended her address, by emphasizing that the primary driver of homelessness is still extreme poverty, i.e. the lack of sufficient household income to meet the cost of housing. Demand for safe, affordable and accessible housing continues to dramatically outpace supply. Metropolitan Dallas and urban centers in America, in general, must address this problem by building more safe, affordable, accessible housing, as well as build up household incomes. That is the only way to end the modern homelessness crisis, which has afflicted the United States for more than four decades.

Homeless Response System Online Learning Clinic 2018 – Part IV: Building Dallas’ Homeless Response System – 2015-2017 – All Roads Lead to Housing

The entire system is oriented towards housing as the solution for homelessness, and this approach permeates every component of the system. There is a sense of urgency in getting everyone, and first and foremost those who are high on the Housing Priority List, into housing, as soon as possible, with as few barriers as possible. In the meantime, individuals, who need it, are offered temporary shelter, with the constant ever-present expectation that they be moved into housing as soon as possible.

Dr. Iain De Jong

(Courtesy of the Salt Lake Tribune)

Since 2015, MDHA has held regular policy discussions, trainings, lunch and learns, boot camps, and roundtables for case managers, program managers, agency leaders, and the public, to reorient every part of the Dallas homeless services ecosystem towards this thinking. Notably, in March 2017, MDHA asked pioneering world expert, Dr. Iain De Jong, of OrgCode, to conduct one of his international learning clinics on Being an Awesome Shelter, in Dallas. MDHA sponsored ten spots for Dallas shelters, to further facilitate a transformation in how Dallas shelters operate, as housing-oriented programs.
 
To further assist case managers in housing their clients, in 2015, in conjunction with United Way of Metropolitan Dallas, MDHA founded the MDHA Flex Fund[i]. This fund gives case managers an important tool to pay for hundreds of minor but impactful expenses, every year, that can help individuals resolve their homelessness, quickly and permanently. 

 

 

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[i] http://www.mdhadallas.org/the-mdha-flex-fund/

Homeless Response System Online Learning Clinic 2018 – Part III: Building Dallas’ Homeless Response System – 2015-2017 – Diversion and Coordinated Access

The linked infographic, developed by the equivalent to MDHA in Kansas City[i] a few years ago, is extremely useful in understanding how over the course of the last three years we built an effective unified homeless response system, here in Dallas. (It is helpful to consult it, while reading the next parts.) This system has four main attributes.

Diversion

It seeks to divert individuals from having to enter into or engage with the system. It recognizes that homelessness is not homogeneous; it is on a continuum. Many of those who seek our help have the capacity to self-resolve, with the help of mainstream resources, or “light touch” one-time assistance[ii]. In Dallas, Family Gateway[iii] and Austin Street Center[iv] stand out, as two partners, who over the course of 2017, put in place robust diversion protocols, to help clients end their homelessness, and avoid or shorten their stay in shelter. 

Coordinated Access
 
It assesses, prioritizes, and only then places individuals into housing. This is referred to by scholars and the Federal Government as Coordinated Assessment, or Coordinated Access. In the absence of such a system, homeless service providers each operate on their own, and when approached by an individual needing help, typically ask some version of this question, “Will this person be successful in our program?” This leads to those with lesser needs and lower vulnerability being served, while those with greater needs and vulnerability are turned away.[v]

In an effective coordinated system, the system as a whole asks, “What solutions best match the needs of this person, and will end their homelessness quickly and permanently?” The system has one (virtual) entry point only. No placements are made in any program without:
 

• Assessing – We objectively and uniformly assess each person, with an evidence-based tool[vi];
• Prioritizing – We prioritize each person for service, based on the level of their vulnerability and according to their specific needs. Each person is awarded a priority status or P number. The lower the number, the higher the priority.
• Placing – All clients go on to a unified Housing Priority List, and are housed based on their priority status and specific needs.

 
MDHA’s Housing Priority List (HPL) has been operational since early 2016. It represents the demand side of the housing equation. It is managed by the Documentation and Prioritization Status (DOPS) Coordinator, who ensures that the persons on it have not only been assessed and prioritized for service, but also have all necessary documents, so they may be housed without delay. Housing providers are expected to house those with a lower P number (indicating greater need and vulnerability) first. As of February 2018, there are about 750 individuals on the Housing Priority list, ready to be housed.
 
The Housing Inventory Chart (HIC) contains all beds funded through our Continuum of Care (CoC) program. It represents the supply side of the housing equation. It is managed by the Housing Resources Team, who ensure that when a unit becomes available, it is filled as soon as possible. The motto of the Housing Resources Team is “No Empty Bed”. All CoC program resources must be fully utilized, with every bed filled and every penny of federal housing dollars spent. The team also actively grows the supply of known housing, by finding housing units outside of the CoC program.
 
The CoC’s performance in this core area is constantly monitored by the CoC Performance Analyst, who produces the Housing Priority List Tracker, which aggregates all of the individuals on the Housing Priority List by priority status. The Analyst produces the quarterly[vii] Homeless Response System Community Dashboard[viii], through which MDHA tracks the community’s performance in housing individuals experiencing homelessness along five performance indicators on the demand side and five performance indicators on the supply side.
 

 

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[i] http://www.marc.org/Community/Homelessness-Task-Force/Assets/HTF-coordinated-intake-graphic-web.aspx

[ii] This idea is referred to as Progressive Engagement. See more on this concept, and its application to homelessness in A Prevention-Centered Approach to Homelessness Assistance: A Paradigm Shift? by Dennis Culhane, Stephen Metraux, and Thomas Byrne (2011), http://works.bepress.com/cgi/viewcontent.cgi?article=1105&context=dennis_culhane

[iii] http://www.mdhadallas.org/wp-content/uploads/2017/10/CoC-Family-and-DV-Services-Committee-Update-8-2017.pdf

[iv] http://www.austinstreet.org/ending-homelessness-through-prevention/

[v] See more at http://endinghomelessnessmdha.blogspot.com/2016/03/the-how-to-of-building-effective.html and http://endinghomelessnessmdha.blogspot.com/2016/03/coordinated-access-heart-of-effective.html

[vi] Our Continuum of Care, like many across the world, uses the VI-SPDAT and SPDAT from OrgCode Consulting – www.orgcode.com. 

[vii] See http://www.mdhadallas.org/wp-content/uploads/2015/06/MDHA-Homeless-Response-System-Community-Dashboard-3Q-July-September-2017.pdf for the latest report.

[viii] http://www.mdhadallas.org/wp-content/uploads/2017/02/MDHA-HRS-Community-Dashboard.docx