Should All Ideas be Explored, or Just Those that Work?

In the discussions around homelessness in the last few months, we have heard the statement, “All ideas need to be explored,” more than once. Is it true?

I believe that in his satirical essay, New Proposal for Taking Care of Homeless Problem: a Catapult, Jim Schutze, in true Swiftian fashion, highlighted the fact that actually we all agree that some ideas do not merit exploration, or in other words, not all ideas need to be explored. Now, I could go down the Schutzian road, and say that the catapult would not work, because of its, ahem, impracticalities, but we all realize that it is really the immorality of the solution that precludes us from putting it into practice.



Cindy J. Crain, MDHA President and CEO, with a friend at Tent City, earlier this year

(Courtesy of WBAP)

So, now that we have established that not all ideas need to be explored, the question is, beyond the outright immoral solutions, how do we know which ideas are worth exploring, and which are not?

Here, unfortunately, morality will not help in decisively deciding this issue. There are those that say, that the homeless must prove themselves worthy of the help they are offered, and once they do, and only if they continue to prove themselves so worthy, should they be helped. Others contend that in a developed country, all have the right to a home, and that if, as a byproduct of our economic systems, some find themselves without a home, society is obligated to provide such a home. Both of these sides have a moral argument on their side. You, the reader, probably agree with one side and disagree with the other, and that is OK.

So, what we need to turn to in this case is not morality and philosophy, but social science. Through social science, we can analyze and decide what ideas work and what ideas do not. Social scientists can study these issues, reach conclusions, and tell us exactly what ideas work and what ideas do not. Then, in the words of our good friend, Randy Mayuex, we can do what works, rather than what we think might work, or what we wish might work.

Fortunately, or unfortunately, the modern homelessness crisis has been with us long enough, that social scientists have amassed a significant amount of evidence regarding what works and what does not. As Randy explained, though the word science makes some people (me included) sweat, the idea of following the science is really quite simple, according to Thomas Kuhn. With any new idea, the first step is to try it, the second step is to measure it, and the third step, if the measuring shows it actually works, is to replicate it. Though many outside the field of empirical peer-reviewed homelessness research may not be familiar with the research on what works and what does not, we are at that third stage. We know what works, because we have been measuring it, and we also know what does not work, because we have been measuring it. 

We know (not think) that the newer Housing First  model, housing the chronically homeless, on the condition that they abide by the terms of their lease and meet with a case manager, combined with wrap around services made available (not obligatory) to them, works for 85% of clients, on average. We know (not think) that the older Housing Readiness, housing the chronically homeless, only once they have hit certain treatment benchmarks, and conditioning their housing on their continuing to hit certain treatment benchmarks, works for 30% of clients, on average. 

Now and then we hear, that that is all fine and good, but that so and so, from her familiarity with homelessness knows that Housing First does not work. Not so. Once again, the evidence proves this person is wrong.

Now and then we hear, that that is all fine and good, but so and so simply cannot remain housed, and that proves that Housing First does not work. Not so. There is a small minority of people for whom Housing First does not work. However, often “does not work” just means that it did not work that time for that person, in that setting, with that array of services. So, we assess and try again to find an alternative setting, or a different array of services, that will help that person achieve permanent housing stability. This, by no means, proves that Housing First does not work. That is not how social science (i.e. reality) works.  

Now and then we hear that that is all fine and good, but Housing First will not work in Dallas. Now, if Housing First had not been tried in Dallas, that would still be wrong, because the numbers are consistent, everywhere it has been tried. However, Housing First has been the policy for permanent housing programs funded by the Federal Government, for a number of years, so we actually can answer that question. In Dallas, these programs, over the course of the last 12 months, have shown a 96% success rate! This is why, our good friend and board member, Ikenna Mogbo, said a few months ago, on KERA’s Think, that arguing about Housing First, is like arguing if the world is round or flat. What we need to do is stop arguing and just continue implementing.

One final criticism we hear is that Housing First might work in the long term, but we need some short term solutions too, today, tomorrow, or if possible yesterday. This criticism misses the mark too. The idea of Housing First is that the homeless can and should be housed from the street, if need be. In How Dallas is starting to solve its homeless problem MDHA President and CEO, Cindy J. Crain, shared with the readers of the Dallas Morning News, results of how we have been housing the unsheltered in the encampments in Dallas, in accordance with the precepts of Housing First, from mid-February through today. As we speak, we continue to do so, right now. These results further elucidate what can, should and will continue to be implemented in our community, in the short, medium and long term, as we follow the evidence of what works.

On the Road Again – with the Help of Austin Street Center and the MDHA Flex Fund

An effective homeless response system is one where we always ask, “What solutions best match the needs of this person or household, and will end their homelessness quickly and permanently?" In asking this open-ended question, we acknowledge that a one-size-fits-all approach to homelessness is never the right one. Solutions must match the needs of the person, more than one solution might be needed, and a progressively “lighter touch” should be preferred.

Sometimes, the answer to that question is simpler than you might think.  Take Leonard (name changed to protect his privacy), for instance, an Austin Street Center guest. Though experiencing homelessness, Leonard is a healthy 58 year old, who has made his living driving a truck. Unemployed, homelessness for this road warrior was just a bump in the road. With the help of Austin Street Center’s job program, E2, Leonard was ready to get back on the road, figuratively and literally!

An “inside look” at Austin Street Center

(Courtesy of Austin Street Center)

As you may know, they don’t just let every Tom, Dick and Harry drive a truck, or as it is technically referred to a Commercial Motor Vehicle or CMV.  The Federal Government requires that one have “a higher level of knowledge, experience, skills, and physical abilities than that (sic) required to drive a non-commercial vehicle.” Every truck driver must obtain and maintain a Commercial Driver's License or CDL. Now, though the Federal Government makes the rules, it does not issue the licenses. That is left to the states, and one must obtain one’s license from one’s state of residence. As Leonard’s CDL was from Florida, he could not use it, and so could not begin looking for a job, that could then help him resolve his homelessness. 

Fortunately, Leonard could transfer his CDL from Florida to Texas. However, because of the higher standards involved in maintaining a CDL, he would have to undergo a full Department of Transportation (DOT) physical examination by a physician. The cost of the examination is $60, which Leonard did not have. If you think about it, this is the classic example of a Catch 22. If Leonard had a job, he could probably afford the $60 examination. But, of course, he couldn’t even begin looking for a job, if he didn’t have the Texas CDL. He was stuck!

Leonard explained his situation to Dulari, an Austin Street Center program manager. She told him that though Austin Street Center could not pay for the DOT examination, she did have another tool in her tool box, that could help her quickly resolve this predicament – the MDHA Flex Fund. The MDHA Flex Fund was designed by the Metro Dallas Homeless Alliance (MDHA) and United Way of Metropolitan Dallas to address minor but impactful expenditures, just like this one, that can help clients resolve their homelessness.

Dulari helped Leonard find a physician who could perform the examination, and issue the necessary documents. The physician’s office manager made Leonard an appointment, and sent over a confirmation email, including the $60 cost. Dulari then pulled up a simple one page form, available in the guidebook on MDHA’s website. On the form she explained how this expenditure would help Leonard, and she certified that there was no existing resource, that could pay for it. She ran all of this by her supervisor, Laura, they both signed the form, and submitted it to Shavon, at MDHA, for approval. Shavon reviewed all of the details of Leonard’s case, approved the request, and asked Wayne, at MDHA, to issue a check written out to the specific physician, who would perform the examination. Dulari was then able to pick up the check, and give it to Leonard, to take to his appointment. (The MDHA Flex Fund never hands over cash to a client or a case manager.) Leonard was able to transfer his CDL, and embark on his job search. He was now one step closer, much closer, in fact, to resolving his homelessness and becoming once again self-sufficient.

Laura, one of Austin Street Center’s “Superheroes”

(Courtesy of Austin Street Center)

And, in getting Leonard the help he needs, Dulari and Laura not only helped Leonard. Once Leonard has a steady paycheck, he will be able to move into an apartment, leaving Austin Street Center behind. This will enable Austin Street Center, who is forced to turn folks away every night, due to lack of space, to take in and help one more person. And all of that, for just $60. Not a bad return on investment… 

Missed Hard Conversations: Housing First? Watch It Now!

This last Monday, September 19, 2016, MDHA, CitySquare, and the Dallas Public Library presented a book synopsis of Housing First: Ending Homelessness, Transforming Systems, and Changing Lives.  Randy Mayeux, renowned scholar and longtime book reviewer at CitySquare’s Urban Engagement Book Club spoke at the J. Erik Johnson Public Library, to a packed house, and you could hear a pin drop. Thanks, Randy! You hit it out of the park.

Cindy J. Crain, MDHA President and CEO, introduced Charles, one of many bona fide Dallas Housing First success stories to the crowd, and shared the numbers on client success in Housing First programs in Dallas. If you have read this blog before, you know those numbers already – 96%! Larry James, CEO of CitySquare spoke about how The Cottages at Hickory Crossing and other CitySquare programs utilize the Housing First philosophy, and both he and Cindy took questions.     

Our good friends from Two Hats Publishing taped the whole thing, so click here to download Randy’s handout and PowerPoint presentation, and then click here to watch the whole session:

We posted the above video, handout, and PowerPoint on the Key Documents and Hard Conversations pages on our website too, along with an audio recording (does not include Cindy and Larry’s parts). Enjoy learning, and spread the word!

This North Texas Giving Day, Give to What Works

Research shows that the only way to make real social progress is through collective impact – many organizations working together to achieve common goals. Research further shows that you need a strong backbone organization to lead the collective impact, in order for it to work. 

MDHA is a backbone organization. We partner with many organizations to work on a specific goal: Making homelessness rare, brief and non-recurring. That means that we never ask, "What's another cool program we can create?" We always ask, "What proven solutions will help us achieve our goal?"

In the last 18 months alone, we have made tremendous progress in implementing proven solutions that will help us achieve that goal. So, this September 22, 2016, North Texas Giving Day, please give to what works. Bookmark our North Texas Giving Day page - http://northtexasgivingday.org/npo/metro-dallas-homeless-alliance now, and mark that day on your calendar.

We count on, and appreciate your support. Happy giving!

Will Housing First Work in Dallas? It Already Does!

The idea of Housing First is simple: A person experiencing homelessness is housed with two conditions only: That they abide by their lease, and meet periodically with their case worker. Wrap around services and supports are made available to them. They are encouraged, to avail themselves of these services and supports, but the choice to do so or not do so, is entirely up to them.

We talk about Housing First quite a bit, because it really matters. As we have mentioned, in general, across the country and the world, Housing First has become the consensus of researchers and practitioners in the field, and the official policy of not only our Federal Government, but other governments too.

While some may disagree with Housing First philosophically, it is hard to deny its success. In general, it is successful for around 85% of clients. This means, that 85% of clients in a Housing First program remain housed, in a permanent housing setting. Here is a question we have received recently, though, “Will Housing First Work in Dallas?”

 

Housing First, the recently published book by the

“father” of the movement, Dr. Sam Tsemberis

Well, the answer might just surprise you. We recently analyzed the aggregate Annual Performance Report on 25 Permanent Supportive Housing and Rapid Rehousing programs, funded by the U.S. Department of Housing and Urban Development through our Continuum of Care. The total number of clients in these Housing First programs was 1,629, during the 12 months of July 1, 2015 – June 30, 2016. About 2/3 had a history of mental disability, about 2/5 had a history of drug and/or alcohol abuse, and more than half had two or three concurrent disabling or other health conditions. Here is what we found:

1,293 – Remained housed in their program

271 – Exited their program for another permanent housing setting

43 – Exited their program to temporary housing settings or homelessness

22 – Died

Total number that remained housed in a permanent setting – 1293+271= 1,564

Percentage of those who remained housed in a permanent setting – 1,564/1,629=96%

So, what is the answer to the question, “Will Housing First Work in Dallas?” It already does. Dallas has a 96% success rate in housing programs that utilize a Housing First approach. QED.

Supportive Services and Assessments Increased at Haskell Homeless Encampment – Racial Inequities Must be Addressed

On Tuesday, September 6, 2016, beginning at 9:30 am, the Metro Dallas Homeless Alliance and representatives from several homeless service providers will increase supportive services and client needs assessments for residents of the homeless encampment located at I-30 and Haskell in Dallas, Texas. 

Street outreach workers primarily from City Square, Austin Street Center, The Stewpot and Turtle Creek Recovery Center will embark on a “blitz” to methodically assess each person, and document their homelessness, in preparation for moving them into housing, as soon as feasible.

Effective evidence-based street outreach assumes that all persons have strengths and assets, enters into dialogue, figuratively and literally where clients are, and starts the conversation immediately, with a specific question, “What is your housing plan?” Persons are assessed using evidence-based tools, with an eye to facing the practical housing barriers the person faces. The attitude brought to such outreach is key: We are aware, that nearly all persons living unsheltered come from a position of trauma, and are coping with antisocial, destructive and avoidant behaviors. Therefore, we do not judge.

It is important to identify each person’s collateral and most immediate and achievable need, in order to build trust. Case workers must be mindful of the fact that change comes in stages: Some people can move quickly, while others require thoughtful motivational interviews and conversations. Persistence and consistency are key: Follow up, follow up, follow up, with that same question, “What is your housing plan?” Deadlines can be helpful, serving as antagonists to create bias for action, however, the best results depend on the resources available, including time.

To be effective, a ratio of one case manager to ten households is a must, since there is much to do for each person. Case managers must initiate contact, assess and prioritize for service, connect persons with services, staff each case with other relevant agencies, facilitate the development of a housing plan, follow up on said plan, directly assist with barriers to the plan, advocate for the person with other agencies, and document all of this in the Homeless Management Information System.   

It is this type of methodical work that was able to lower the estimated number of individuals experiencing homelessness in the largest encampments in Dallas’ urban core from about 300 to 200 individuals, since the May 2016 closure of the Tent City under the I-45 Bridge. Specifically, 57 persons were housed by CitySquare, 4 moved out of Dallas, 4 others were housed by other entities, 13 entered emergency shelter, and 18 have been fully assessed and prioritized, and are ready to be housed immediately, once housing units open. 

Doing this work, Dallas must come to terms with one more important fact: The persistence of racial inequality stands out in the area of homelessness. African Americans make up 13% of the population, both in the US and Dallas. Across the country, on average, African Americans make up 40% of the homeless population, and 28% of the unsheltered homeless population, which is troubling, in and of itself. However, in Dallas, African Americans make up 67% of the homeless population, and 70% of the unsheltered homeless population! And, unfortunately, true to Chief David Brown’s words on July 8, 2016, this too is one more “societal failure we put… off on the cops to solve.”

As we continue the ongoing work with the unsheltered homeless population, MDHA and its partners will seek to tackle this overrepresentation of African Americans in the homeless population. While no single initiative can end structural racism across all systems, we believe that it is possible to create positive change in attitudes and behaviors that will begin to close the racial gap that has led to the disproportionate prevalence of homelessness among African Americans. We will work to make that happen.

History of Encampment Tent Population Estimates in 2016:  

2016	Jan (PIT)	Feb	March	Apr	May	June	July	Aug	Sept
I45	181	237	221	204	77	0	0	0	0
Haskell	21	22	34	56	62	73	86	92	82
Coombs	24	28	26	41	84	82	73	14	14
Total Tents	226	287	281	301	223	155	159	106	96

Why Do I Give to United Way?

As Development and Communications Director of the Metro Dallas Homeless Alliance (MDHA), you might wonder why I would take the time to ask you to give to another organization. Well, allow me to explain.  

United Way of Metropolitan Dallas (UWMD) invests in Income, Education and Health, and is making measurable progress in these three areas. My organization, MDHA, leads the development of the homeless response system that will make homelessness in Dallas and Collin Counties, rare, brief and non-recurring. How does that connect to what UWMD is doing?

Research shows that the only way to make real social progress is through collective impact – many organizations working together to achieve common goals. Research further shows that you need a strong backbone organization to lead the collective impact, in order for it to work.

Both of our organizations are backbone organizations. UWMD partners with many organizations to work on a number of really big overarching community goals: improving the Income, Education and Health of those in need. We, at MDHA, partner with many organizations to work on a specific narrower goal: making homelessness rare, brief and non-recurring. That means that both of our organizations never ask, "What's another cool program we can fund?" We always ask, "What proven solutions will help us achieve our goals?"

Picture this: It is August 2015. There are tents and other temporary structures that have formed a Tent City under I-45. MDHA and its partners have been working with the folks living there for two or three months, getting to know them, building rapport, and connecting them to housing solutions. They know they are making progress, but it is a process.

Then, our VP, Rebecca, sees something she has never seen in any of her previous visits – a one year old baby. She immediately calls our CEO, Cindy, and they, being moms themselves, decide then and there, that this baby is not sleeping outside of a home that night. Rebecca asks the mom a few simple questions, and discovers that the baby's mom has a housing voucher and an apartment waiting for her. So, why on earth is she in a tent? Well, she can't afford the $45 application fee for the apartment. And the program that got her the voucher is funded by a grant that does not fund application fees. So, she is stuck!

Fortunately, MDHA, with the help of UWMD, had just created the MDHA Flex Fund. This fund is designed to pay for minor, but impactful expenses that can and do make a huge difference, in helping folks resolve their homelessness. So, Cindy had a $45 check immediately cut for the application fee. Rebecca ran back to the office to pick up the check and deliver it. The problem was solved. Mom and baby were housed. Since that day, with the help of the MDHA Flex Fund, we have helped more than 250 individuals and families, just like that mom and her baby. 

Now, think about the ripple effects of just those original $45. In the business world we would call it the ROI, the return on investment. Better still, think about what happens without those $45. Without those $45, that baby does not have a home. Without a home, how do you escape poverty? Without a home, how do you raise a healthy child? Without a home, how can you and your child concentrate on a kid's number one job, learning? Those $45 get you the package deal. They not only end that family's homelessness; they also give them a solid foundation for improving their Income, Education and Health.

That is why I run a United Way campaign at our office. That is why I give to UWMD. That is why I call on you to give to UWMD. So, do what I do. Figure out how much you can give, and then give that much, plus 10%. On behalf of UWMD, on behalf of MDHA and on behalf of that baby and her mom, thank you for giving.