Our work on the Homeless Policy Academy Initiative, a joint effort funded by the U.S. Department of Health and Human Services and the U.S. Departments of Housing and Urban Development, Veterans Affairs, Labor, and Education illustrates a practical application of the Altarum Systems Change Model.
Working closely with our clients, Altarum utilized the Altarum Systems Change Model to define and organize the work – and to create systems change by fostering collaboration, enhancing partnerships, and building capacity.
Define the Need: An estimated 3.5 million people are classified as homeless every year. Individuals and families often experience difficulty making the transition from homelessness due to a number of factors, including persistent poverty, stigma and discrimination, disabling conditions, the lack of affordable housing, and numerous service-system barriers. The complicated system of homelessness is the result of fragmented funding; restrictive administrative procedures; insufficient services and housing resources; underutilization of mainstream resources; and a lack of programs built on person-centered, recovery-based, family/consumer guided and culturally-competent values.
As an informational and consensus-building forum, the Altarum Institute Policy Academy Initiative helped our Federal clients and participating states and territories to further define the need for a collaborative, systems-based approach that would help integrate service. They knew that the needs of people who are homeless cross administrative boundaries and systems (e.g., public and primary health, housing, employment, education, and criminal justice), yet they struggled with ways to integrate their approach. Altarum helped participating states and the federal partners define a common vision, integrate planning processes, and leverage resources toward the overall objective of reducing homelessness.
Step Back: Altarum conducted site visits in all 56 states and territories and facilitated meetings with the Federal Interagency Planning Committee to help them step back and assess the environment within each system. After identifying which systems play a part in causing/impacting/addressing homelessness (e.g. housing, substance abuse, mental health, primary health, veteran’s services, criminal justice, education, etc.), the states and federal partners were able to do the following:
- Analyze strengths, weaknesses, opportunities and threats within each system – and the turf issues, stigma, and information gaps that may hinder collaborative work
- Analyze fragmented administrative obstructions, service systems, funding sources, and policy barriers that prevent efficient delivery of much-needed services to people who are homeless
- Identify current planning activities and technical assistance resources and considered opportunities for cross-agency coordination and integration
- Develop a common vision and priorities for moving forward
Understand Relationships: To create systems change, it was critical for federal partners and state team members to have (or have direct access to) power and ability to make policy- and program-level decisions. It was also critical to revisit the team or committee structure throughout the process to figure out who’s missing, invite those missing and prepare them to participate, and structure the process in such a way as to value input.
To participate in a Policy Academy, the governor of the state or territory submitted applications outlining a team of senior state officials, including a representative from the governor’s office; representatives from the state’s “mainstream” assistance programs; and local stakeholders, such as providers, consumers, and local government representatives. States faced challenges persuading key stakeholders from the various systems to put aside issues concerning turf, scarce resources, and cultural differences to participate in effective collaboration. Altarum provided targeted assistance to ensure appropriate representation and that all team members were heard, respected, and integrated in the process.
As their understanding of the issue and the involved systems deepened, the federal partners recognized the need to expand the vision beyond housing and health and human services. Altarum helped to identify and engage new partners who contributed valuable insight, expertise, and ultimately some additional funding.
Dig Deeper: Next, Altarum worked with states and federal partners to dig deeper to uncover the root causes of these problems and to fundamentally reframe their understanding of how best to address cross-cutting issues.
As states and territories figured out what wasn’t working, they often used data to reframe the problems and to create innovative solutions. With Altarum’s help, some focused on:
- Gathering new data – by asking partners to include questions on housing status
- Creating, enhancing, and/or integrating data collection systems – by improving and expanding access to Homeless Management Information Systems
- Using data to guide planning and program design – by conducing cost-benefit analyses and identifying critical areas for collaboration and cost saving
- Using data to build political will – by creating talking points and localized fact sheets to engage key stakeholders.
Altarum also convened large meetings with the states and federal partners to increase the awareness of federal priorities and funding opportunities, national best and promising practices, and the valuable work within states. These meeting also provided an opportunity to share states’ experiences, challenges, successes, and lessons learned with their peers, their federal partners, and other interested parties. These gatherings also allowed all parties to learn about successful interventions, new approaches, and promising practices and how they may be adapted to fit various state contexts.
Move Forward: Finally, we helped our federal and states clients move forward. There is no question that the Homeless Policy Academy Initiative served to create momentum to address homelessness. Altarum helped the states and federal partners create and sustain systems change in a variety of ways.
For states, the results included:
- Developing action plans in 53 of 56 states and territories and creating tools and technical assistance products now available online (http://www.hrsa.gov/homeless) to support states in addressing homelessness.
- Institutionalizing the process, including the formal establishment of a Policy Academy Team or a State Interagency Council on Homelessness, ongoing strategic planning and review processes, support and commitment from the governor, and funding to support both the planning work of the Team and the implementation activities
- Creating representative teams featuring strong and committed leadership, staff dedicated to the planning and implementation process, and individuals with the power to change policies on the teams
- Achieving tangible outcomes related to housing, support services, discharge planning, and data infrastructure
- Progressing toward their goal of reducing or ending homelessness by utilizing technical assistance to provide critical resources, connect them to promising practices, and help maintain momentum
For our federal partners, the results included:
- Achieving a shared vision of leveraging resources across agencies to address homelessness by implementing the three interagency Policy Academy contracts, coordinating technical assistance resources to assist the Policy Academy Teams, and creating a jointly-funded Chronic Homelessness Initiative which was awarded to 11 grantees.
- Engaging new partners, by expanding the vision beyond housing and health and human services, who became equally engaged in the issue and contributed valuable insight, expertise, and some additional funding
- Creating a groundbreaking, collaborative federal effort that modeled at the federal level what can be done at the state and local level to address homelessness in a coordinated and collaborative fashion and created a continuous feedback loop between the federal agencies and the states and localities
The Altarum Systems Change Model’s effectiveness can be demonstrated in Altarum Institute’s work on the Centers for Disease Control & Prevention and the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment-funded Substance Abuse and Infectious Disease Cross-Training Initiative.
Working closely with our clients, Altarum staff used the Altarum Systems Change Model to define and organize the work.
Define the Need: In this project, we helped our federal clients and grantees define the need, which we helped them determine was the need to improve prevention and control of co-occurring substance abuse and infectious disease across administrative boundaries and systems.
Step Back: Altarum provided ongoing technical assistance to state-level coordinators within community based organizations and state and local health departments to step back and assess the environment and opportunities to control and prevent substance abuse and infectious disease at the systems, organizational, and individual levels.
Understand relationships: Multiagency training events fostered relationship-building and collaborative planning among the participants and provided the opportunity for participants to understand relationships and address gaps in information, turf issues, and the effects of stigma on their work.
Dig deeper: The training plans and curriculum developed and facilitated by Altarum, in conjunction with local experts, helped administrators and providers dig deeper and understand the capacity of the system to address the needs of individuals with co-occurring disorders and strategies for enhancing that capacity.
Move forward: The Cross-Training resulted in outcomes that allowed our clients to move forward. Altarum provided knowledge and skill enhancement, strategic planning to guide integration of services and training, cultural adaptations of services, the creation of formal service agreements and the local adaptation of the training program.