Efforts by the King County Committee to End Homelessness succeeded in housing more than 4,700 homeless individuals in 2009 and helping more than 5,000 residents in need of emergency funds stay in their homes instead of being evicted. These are impressive numbers, especially when added to committee totals for 2008: 4,600 individuals housed and nearly 5,000 saved from losing their homes.
But King County’s January 2010 One Night Count showed just a 5 percent decline since 2009 in the number of people sleeping outside or in emergency shelters, while Pierce County's point-in-time (PIT) figures showed a decrease of 13 per cent, and Spokane County's a decline of 15 per cent.
The slower progress in King County raises questions deserving exploration, about whether local strategies for ending homelessness, and the levels of coordination in carrying out those strategies, measure up to approaches around the state and nationally.
PIT counts are rough snapshots, not always comparable because factors such as housing availability differ in each area. And as James D. Wright says in Address Unknown: The Homeless in America, given “a poor economy and continuing deterioration of the low income housing supply,...no matter how rapidly we can get people to exit the homeless condition, there are legions waiting in the wings of economic uncertainty to take their place.”
For example, in Washington in 2009, 30 percent of residents were unemployed or underemployed, according to the state Budget and Policy Center. The 2009 Affordable Housing Report from the Washington Low Income Housing Alliance shows that around the state, many veterans, disabled individuals, and retired workers (among others) could not afford market-level rents. Reports this month from United Way of King County indicate that rising numbers of citizens need help with basics like housing and food.
Yet as needs surge and public dollars dwindle, is King County responding well to new federal calls for system change, meant to ensure that proven best practices are used around the country in addressing homelessness?
Last month's ten-year-plan forum in Yakima featured discussions of new demands from the U.S. Interagency Council on Homelessness (USICH). One is to gather more robust, comparable information about the needs of individuals in each area into a database shared by all programs, and another is to coordinate the delivery of services. The goal is to use diminishing public resources more efficiently.
As Mary Forbes of the Veterans Administration told forum attendees, “There’s lots of motivation but not a lot of coordination" with regard to housing homeless people. "The question," Forbes said, "is how to get the money where it’s most needed?”
In a telephone interview, Nan Roman, president of the National Alliance to End Homelessness (NAEH) in Washington, D.C., said, “One of the real keys to a good homelessness system is targeting services properly. This is not very good around the country.” Often people with fewer or less severe problems receive more services or more expensive ones, she said.
“Misallocation of resources doesn’t work to end homelessness. An absolutely fundamental shift has to be made if the numbers are to go down,” said Roman. It’s critical to have “a common way of assessing people’s needs, and proper intervention for that level of need.”
Roman conceded that homelessness everywhere is “fundamentally a housing issue, and expensive housing is what’s driving it.” However, she said, the U.S. cities and counties that have reduced homeless numbers the most have developed central intake systems linked to a database shared by area programs. Full information on each person seeking help is promptly entered so that eviction can be prevented or housing secured, and fast. People who need case management and services receive them rapidly and at the level needed, no more and no less. The database reveals what services are missing, duplication of services is avoided, and resources are accurately deployed.
“Look at it from the perspective of a homeless person," said Roman. If someone needs a bed and there's no centralized system connecting shelters in the area, "you’ve got to call every night, find out the rules, when to arrive, what you can bring — it’s hard on people.” It’s unfair, too. “Clients who are attached to one place have access that other applicants don’t have,” who may be needier. Most important from a budget standpoint, staff in different shelters with a central intake system can manage bed space more efficiently and economically.
Roman is most concerned about wasting permanent housing that has support services installed on the premises. “Lots of people living across the country in permanent supportive housing don’t need it, and lots of disabled, chronically homeless people living on the streets can’t get into that housing because others who don’t need it to begin with are there.”
What also happens is that “after people have been in supportive housing a long time and get stabilized and don’t need it any more, it becomes a very expensive intervention,” with superfluous services. "It's a front-end problem," she said. (For instance, one agency may have access to information that a unit is available and move in a family with lesser needs, while another agency with needier clients isn’t aware of the vacancy.)
How well do programs in King County coordinate? Is there a central intake system with a centralized database for efficiency and effectiveness?
According to Roman, our area is “making progress,” but more needs to be done. And while some city and county leaders say that federal demands are steering local systems in the right direction, others see them as bureaucratic interference.
The database is one system that has needed steering. For several years, federal funding has been tied to developing a Homeless Management Information System (HMIS) that separate providers will use to see that clients receive the services they need. Without a shared database containing full, accurate information, said Roman, “you don’t know whether they’re getting served elsewhere.”
She said that database development “seems really lagging in the Seattle area. I thought it was odd, with Microsoft there," and with King County “ahead of the curve” in some other respects.
Al Poole, division director of homelessness intervention for Seattle human services, recalled that King County’s Web-based HMIS program, now called Safe Harbors, was started about 10 years ago at the initiative of Peter Steinbrueck, a Seattle city councilmember at the time. “There was no software to capture the data they needed back then," Poole said, "so the first four years were a disaster. They came out with clunky software, changed managers several times, and there was resistance from some of the nonprofits about submitting data.”
Bill Hobson, executive director of the Downtown Emergency Services Center (DESC), said, “Given that this region is one of the most advanced technological nexuses on the face of the earth, we are way behind. Without empirical information, provider services are more a product of politics than they should be. One agency puts pressure on one group in the city, a million dollars are disgorged, and we have no clue whether that money was addressing the most pressing need.” He credited each agency with having good information, but added that the problem of occasionally duplicating services to the same individuals has not been overcome. Yet attitudes toward centralizing aren't always positive within some agencies. “There’s still resistance," Hobson said, "and it’s unfortunate.”
Much of the resistance to pouring information about clients into a data bank comes from service providers who fear that the locations of individuals who are victims of domestic violence might accidentally be given to their abusers. Other organizations are reluctant to press people suffering from mental illnesses to identify themselves, because they may be incapable of giving informed consent in accordance with state law. Thus many clients seeking services are allowed to opt out of answering data survey questions. As a result, the 2009 Safe Harbors report has large gaps, with 50 percent and more of potentially useful information about applicants in some categories marked “unknown.”
According to Roman at NAEH, “in a lot of places DV (domestic violence) programs do participate” in data sharing, and in others it’s “a hotly contested issue whether they should or shouldn’t.” But without full identifying data on clients, she said, it’s impossible to tell whether a client is receiving duplicate services.
Hobson concurs. “The only way you can unduplicate is through data identifiers,” he said, adding that improper use of information is unlikely. "The AIDS system has had a robust data system with King County Public Health for years, and not once since inception has there been misuse, according to the ombudsman. In the mental health system you are identified, and your services are identified, and there are safeguards around disclosure.”
Poole said that some clients have told him, “Put my name in the system so I don’t have to answer the same questions over and over." For Hobson also, failure to record identifying information serves clients badly. “Eighty per cent of our DESC clients live with a psychiatric disorder. The symptoms are in no small part suspicion and paranoia. When you ask for their personal information and then ask permission, you get rejections. We try to help people see the need for their information in order to design better programs."
HMIS technology is starting to catch up, said Poole. Data on a city application for funding in 2008 was weak, lessening the size of the award received, “but in 2010 we … scored extremely high, above the national median, so we are getting there." Poole wants more robust data sets throughout the region so that elected officials will get the information they need for making decisions. “They’ll have a better understanding of the size of the problem.”
On the other hand, said Poole, “I don’t think a data point of view shows the face of homelessness." Much planning and programming has to be based on professional judgments made through personal contact with clients.
How good is coordination among services providing that personal contact and making the professional judgments?
Vince Matulionis, United Way director of ending homelessness, said that fragmentation in provider systems is partly caused by the way funders operate. "Providers are out there performing miracles, doing remarkable work in trying, very difficult situations, including the challenge of working with multiple funders with different priorities and applications.” He said that an important achievement (made under project director Bill Block's leadership of the Ten-Year-Plan) has been aligning funders around specific goals and benchmarks in order to “agree on what the priorities are, what the strategies are, and who can do the work.” With a coordinated Funders Group, said Matulionis, some orchestration of provider services develops naturally, and “better coordination has led to more housing being built.”
Indeed, with a Committee to End Homelessness Funders Group now experienced in collaboration, LIHI quickly secured financing this year for a sudden opportunity to build top-quality low-income housing for homeless veterans and others. (The story appeared in Crosscut in July.)
According to other voices in King County, the new federal demands for coordination are a bureaucratic distraction. Alison Eisinger, who directs the Seattle/King County Coalition on Homelessness (SKCCH), said, "It's vital to keep our collective energy focused on the economic and political realities of addressing homelessness and not get too mired in the bureaucratic dramas of addressing homelessness. I don’t mean to say that it’s not significant to make sure you aren’t over-serving people, but I don’t think that’s our problem right here in King County.
"We don’t have enough resources, so worrying about whether we’re deploying them in the right way — we should be so lucky!"
Nonetheless, service providers are having to work differently now in order to qualify for funding from local and national sources. Besides questioning King County's progress on some aspects of coordination, Roman praised its innovative work on other aspects. She cited the partnerships between private philanthropy and the state in the Bill and Melinda Gates Foundation's Washington Families Fund, aimed at breaking the cycle of family homelessness. According to Block at CEH, the whole region's “extraordinary level of collaboration between the private, public, and nonprofit sectors has been identified nationally as a best practice.”
Roman also noted the significant economies of the county's transition-in-place model of permanent supportive housing, in which “support services are transitional, but the housing is permanent, so that people don’t have to move” after they no longer require the services. “It saves money not to have tenant turnover. New leases are an expensive process,” she said.
Pierce County has made rapid progress in coordinating intake and services, perhaps in part because the county has 30 providers with multiple programs to align instead of 100-plus, as in King County. Troy Christensen, Pierce County manager for initiatives to end homelessness, described a new provider-developed system for homeless families. “It starts with centralized intake," he said, "a central place where people can call to find out what’s available and where we can get enough information from them to match the need with the program.”
In the past, families were calling 20 to 30 places a day until they found room, said Christensen. “Now, if we don’t have an immediate match, someone is assigned to them until a place is found. They are never told ‘nothing is available.’ Meanwhile, they get hooked up with WorkSource and medical care. We’re better prepared to coordinate than we have ever been.” The provider-developed system will be launched on Jan. 31.
Asked about the King County ten-year plan's level of success in light of achievements elsewhere, project director Block replied that many variables affect the numbers reported in different areas. When making comparisons "you want to make sure it's apples and apples," he said, and to include the fact that many CEH practices have become national models of success for other programs.
In this sixth year of the plan to end homelessness, said Block, "What I look at is the faces of all the people we’ve housed who would otherwise still be on the street.”
