Slide 1:
What Works: Systems Change
Carol Wilkins
Director of Intergovernmental Policy
Corporation for Supportive Housing
www.csh.org
Slide 2:
The Corporation for Supportive Housing
a national non-profit intermediary
organization
CSH supports the expansion of permanent housing opportunities linked
to comprehensive services for persons who face persistent mental health,
substance use, and other chronic challenges, and are at risk of homelessness,
so that they are able to live with stability, autonomy, and dignity,
and reach for their full potential. We work through collaborations
with private, nonprofit, and government partners, and strive to address
the needs of, and hold ourselves accountable to, the tenants of supportive
housing.
Slide 3:
The Problem in Brief
- Integrated services & supportive housing are products with proven
effectiveness ending chronic homelessness – but
without a system to produce them
- Homeless people must hunt
for and combine discrete services for their needs
- Every project
is a patchwork of authorizations and funding
- Often, success means
using money for purposes that weren’t
officially intended
Slide 4:
One Goal, Many Systems
- Homeless Services
- Mental Health
- Substance Abuse
- Hospitals, clinics, public health
- Social Services
- Employment
- Housing Development Finance
- Rent Subsidy
Slide 5:
What’s In a Changed System?
- “
Any door” leads to effective bundle of housing and services
for chronically homeless people
- Service and housing resources allocated
in a single or coordinated process, timed as needed for development
and operation of supportive
housing and programs that work for chronically homeless people
- Rules
and funding not improvised project-by-project, or on exceptional
basis, but established in routine practice.
Slide 6:
The Key Components of Systems
- Power
- Money
- Habits
- Technology & Skills
- Ideas & Values
Slide 7:
Triggers or Levers of Change
- Change takes decades, not months.
- It usually starts with new activity, forums, and products, not
a new system.
- Any of the 5 components can start the process, but it’s
not done until all are changed.
- First comes credibility for a new product or idea, then a system
may build around it.
Slide 8:
Old Systems are Built to Last
- The tools of System Change are meant both to unsettle old systems
and build new ones.
- Old systems will resist – they exist because
they have survived pressures and onslaughts before.
- Services & Housing are not just separate systems, but separate
cultures, disciplines, and sets of values.
Slide 9:
Behavior Modification
Besides their framework of rules and incentives, systems deal with
behavior – habits, ideas, relationships.
Change thus becomes a behavior-mod recipe:
- Persuasion,
- Incentives,
- Trust, and
- Practice
Slide 10:
Coercion and its Limits
- People can be forced to change, but only by superiors who will
last long enough – and enforce the change long enough – to
make it stick.
- Usually, that doesn’t happen. Politicians leave office,
top executives have other priorities, and constant coercion is
exhausting.
Slide 11:
Building to a ‘Tipping Point’
The spread of new ideas, habits, values, and know-how often comes
from three forces:
(courtesy of Malcolm Gladwell)
- Gifted ‘sellers’
- A receptive audience (aware of a need,
or caught in a moment of crisis)
- A message that ‘sticks’ when
delivered
Slide 12:
Building Blocks
tested tactics of systems change
- Collaborative Planning
- Investment and Leveraging Resources
- Integration, Coordination, and Streamlining Funding
- Building Provider Capacity
- Industry Standards, Quality Assurance, and Monitoring
- Data and Communications to Make the Case
- Cultivating Leaders, Champions, and Advocates
- The Irresistible Force – Events that Compel Action
- An Intermediary as Neutral Catalyst
Slide 13:
Collaborative Planning
- Consensus-building
- Clarifying need & opportunity
- Establishing numeric goals
- Estimating costs/identifying resources
- Planning together/sharing ownership
- Accomplishing something together
- Becoming used to working together – through MOUs, task forces,
projects, etc.
- Beginning to advance a wider change
Slide 14:
Who Should Collaborate?
- Programs that target homelessness and mainstream programs
- Housing: development & finance, rent subsidy
- Services: mental health, addiction treatment, health care, social
services, employment
- Trusted bridge-builders
Slide 15:
How Big a Group?
- Large enough to include the people you need to get started – planners,
funders, and builders who will actually be involved
- Not so big that people feel marginal, bored, or unable to contribute
Slide 16:
Who Should Participate
- Usually not the top executives – they won’t stick
with it.
- Usually not the front-line staff – they don’t have
enough influence over the wider system.
- People who are trusted, influential, able to pull levers.
Slide 17:
Altering the Use of Resources
- New money is powerful, but scarce and hard to sustain
- Most change is old money used in new ways
- First task is to assemble a funding package that does more, solves
more problems, serves more goals, for equal or less money
- Even one pilot or demo starts the process
Slide 18:
Using old money in new ways
- Changing eligibility rules
- Target populations
- Providers
- Services
- Targeting
- Priorities or preferences
- Set aside
- Solving technical problems
Slide 19:
How Resources Change
- New money (often discretionary or 1-time funds) gets things started
and leverages commitments from existing funding streams
- Private fund-raising from philanthropy and business also may ‘jolt’ the
system
- Targeting of ‘mainstream’ federal funds (e.g. TANF,
block grants, HOME, Section 8)
- Dedicated funding streams not subject to annual appropriations – the
start of lasting change
- New financing models, e.g. managed care
Slide 20:
Integrating/Streamlining Funds
Even when using money for the same purposes as before, a key goal
is to make applications and the administration of funding consistent
with the process and needs of supportive housing and other integrated
responses to chronic homelessness.
Slide 21:
Interagency Coordination
planning bodies, task forces and MOU’s
establish:
- Consistent standards for eligibility and shared set of priorities
- Single or coordinated application process
- Benefits for individuals
- Funding and approvals for projects
- Calendar for applications and decisions that matches program development
and start-up
- Shared decision-making for multiple sources of funding
- Consistent and efficient reporting and oversight
Slide 22:
Building Provider Capacity
- Develop and sustain new skills and systems
- Engagement and multi-disciplinary service strategies
- Housing finance, development & management
- Effectively serving and housing people with substance use
problems or other barriers to stability
- Financial and administrative systems to access new sources
of revenue
- Partnerships, organizational and board development
- Momentum depends on the ability to do more and more –moving from
a ‘boutique’ product to widespread, mainstream production.
Slide 23:
Standards & Quality Assurance
- A changed system will depend partly on proof that new methods
will achieve more than old ones, with superior quality, while maintaining
important consumer protections and safeguards.
- Choose standards and outcomes that matter and assess them consistently.
- Quality – of both housing and services – is the ‘sticky’ element
of the systems change message.
- People won’t take this initially on faith. It has to be enforced & demonstrated
place-by-place.
Slide 24:
Data, Research, Communication
- Identify the costs of chronic homelessness if we do nothing to
change systems – and the savings from reduced crises when
effective services and housing are provided
- Really complete data are rare
- Data don’t have to be perfect – circulate what you
know
- Keep working at getting more data – it usually takes years
to get, and then even longer to make usable
- But the pay-off of good evidence is huge
Slide 25:
Making the Case
- Communicating effectively to policymakers
- Focus on the results instead of the problem
- Keep it simple
- Personal stories matter
- Use the media
- Use site visits and tours to provide a context for data : put
a ‘face’ on
the findings
Slide 26:
Grooming Champions & Leaders
- The most effective champions aren’t always the most powerful
individuals
- Businesspeople, budget officials, staff aides and advisers, all
may be better than professional advocates or top elected officials
- Needs to be passionate, untiring, a gifted ‘salesperson,’ with
a huge Rolodex and a convincing command of the subject
Slide 27:
Catalysts for systems change
Often the most effective broker for changing systems is a person
or organization that is…
- Independent of the old system. A new or outside force without
longstanding alliances to factions that old systems failed to integrate.
- With a clear point of view, and a way out of the woods.
- Drawing from experience, not just ideas.
Slide 28:
Their Problem, Your Opportunity
- Mainly, system reformers look for places in the old system where
players are unhappy, frustrated, losing the race.
- Whoever feels the pain the worst may be your first ally.
- Most of all, show them something they could take credit for – field
trips to visit model programs often help.
Slide 29:
What Works: Systems Change
Carol Wilkins
Director of Intergovernmental Policy
Corporation for Supportive Housing
www.csh.org
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