Facilitating Self-Resolution Anne Marie Edmunds, Pierce County Human Services Department Annie Pennucci, Building Changes

Diversion in Pierce County What prompted us to think about diversion? How did we respond? What did we learn? Why is it the first conversation we have with everyone? Hi Thank you for the opportunity to talk about how we are engaging families in conversations about housing solutions and diverting them from a prolonged period of homelessness. Over the next few minutes I will share a little bit of what prompted us to consider a diversion approach, how we piloted this technique, what we learned, and why it has become the cornerstone of our crisis response system. Before I dive in – I do want to offer one language caveat – I’m going to refer to “Diversion” here – but in our community, we try not to use the term “diversion” with clients. As you’ll see in a few slides, we engage in a creative conversation with families to help support their process of identifying a housing solution. The emphasis is on conversation – since it’s a dialogue – and not on it being a “program.” But – because Diversion is sort of the industry’s term of art, we use it for presentation purposes. Slide 2 of 11

What Prompted Diversion? Client calls and is screened Client is scheduled for an appointment Client is assessed Client is put on Placement Roster When a vacancy opens, one lucky eligible client gets the call Lost contact with about 1/3 of the people on the placement roster Around 20% found housing on their own Only 20% were entering our system Remainder stayed on placement roster… for a long time Quick overview of our system at the time (2014): Over-simplification Don’t judge  The Agency that ran what we then called CI would call through the Placement Roster (aka wait list) about once every quarter to update information and to remove people who couldn’t be contacted. That was important, because it gave us a glimpse into what happened to people while they were waiting for a housing referral: The agency would lose contact with about 1/3 of the people on the placement roster – cell phone disconnected, don’t return calls or come in for assessment Around 20% of people on the list found housing on their own – whether with friends, family or re-establishing a rental on their own. Only 20% entered our system through a housing referral The remainder were long-stayers on the placement roster – some of whom, frankly would never get a referral. So we decided to see, what would it look like if we helped people to self-resolve upfront? To answer that question, we started a diversion pilot with families. Slide 3 of 11

How Did We Respond? Acknowledging the Resiliency of Families Trained Staff in Mediation Objective, no pre-determined outcome Active Listening and Reflecting techniques Placed Staff at Coordinated Entry FIRST system response focused on immediate housing options Since we began our pilot on the premise that families are strong, resilient and motivated to keep their housing we partnered with our local dispute resolution center to draw on their problem-solving expertise. As a result of bringing CDR into the fold, our diversion approach is based on mediation techniques, which relies on the mediator being objective. There’s no predetermined outcome – the conversation is about handing the problem – and the solution – back to the HH, because in the end, the HH will need to do the really hard work of keeping their housing. Also relies heavily on Active Listening and Reflecting techniques to begin to help them identify their own solutions We also placed diversion staff at coordinated entry (not shelter – different than most communities). As families contacted our system, we wanted our FIRST response to be a problem-solving approach, drawing from the premise that families are strong and resilient and motivated to keep their housing. It’s that resiliency – that creativity – that we try to capitalize on through diversion. As a result, we only offered diversion to literally homeless households (also different than most communities). So, as you can see, we employed this approach BEFORE screening and we very intentionally meet people where they are. Slide 4 of 11

How Did We Respond? Creative Conversations Staff Role Safe Space Exploratory, Problem Solving Conversation Strength-Based and Client-Driven Staff Role Creativity Reality Testing So, the first step in our homeless crisis response system is what we call a “creative conversation” We create a safe place for HH to process their crisis (move from fight/flight mentality to critical thinking – can’t do without a safe space to process) Very exploratory conversation with lots of asking open-ended questions (tell me more about that…) summarizing (so the HH feels heard), and reflecting (with a focus on resiliency and HH strengths) – all with the end of the HH deciding the path they will take. Very, very client-driven conversation. I’ll also briefly note here that if HH chooses NOT to pursue a housing solution either on their own or with a small amount of support from staff at this point, then staff will continue collecting necessary data elements in a conversational manner in order to enter HH into the Priority Pool (which is our community’s name for a dynamic wait list for a referral to a permanent housing program). Staff role in this conversation is two-fold: 1. creativity – helping clients to think outside the box (sometimes people only have one, very specific solution in mind), drawing on creative solutions from other households, scrappy with resources, open to unorthodox solutions, stimulates space to brainstorm Enthusiasm, highly motivated…rubs off on clients.  2. reality-testing – also responsible to ensure solutions are achievable. Solutions first and foremost must ALWAYS be a SAFE option, but also ensure it is sustainable. Work with clients to think through next steps and future housing stability. Now Annie is going to share a little more about what we learned during the pilot. Slide 5 of 11

What Have We Learned? Many Families Obtained Housing Through Diversion BC funding pilot project in Pierce County …. about 1,000 families …. HMIS data …. Right away we saw 50% and were astounded that it didn’t waiver, it really does hover around 50%. Even when Pierce expanded this to all populations, still continues to hover around 50%. (We see this in King). Not just success of a pilot but generally, of those who opt-in, about half are successful. What happens if clients do not obtain housing through diversion? If people aren’t successful or don’t identify an option they want to pursue, then the conversation flows into doing an assessment Don’t use an off the shelf tool for assessment, developed a community-specific tool focusing on barriers to housing, reducing vulnerability to harm Can go into a priority pool to be referred for other services such as RRH As started testing diversion with families, RRH providers noticed they were getting more challenging families Found that diversion is a really organic way to prioritize. Not based on anyone’s criteria except the households’. Still have too few resources to provide assistance to all. Families can always choose to give it another try if they are waiting for referrals to other services. CAVEAT: not a comparison group study, we don’t know what would have happened to these same families without diversion, except based on what we know from before the pilot project (many stayed in the pool without referrals). That’s a next step in our evaluation research. Building Changes analysis of HMIS data from Pierce County pilot project Slide 6 of 11

What Have We Learned? Families Exited Services Relatively Quickly Make sure to define length of stay – in this context, it means how long they are receiving services and support. Diversion: exit when they move in ES: exit when they move in RRH: This is for the full length of time, so the “move-in date” happens much sooner. However support services and rental assistance continues for, typically, just over 200 days TH: longer-term by design. Still considered homeless during this time frame. Again, not a comparison group study – it may very well be that those who received longer-term services needed that, and thus would not have achieved success without diversion. But we do know that this approach can work for many, and quickly. Building Changes analysis of HMIS data from Pierce and King counties Slide 7 of 11

What Have We Learned? Families Obtained Housing at Relatively Low Cost Walk people through costs … Diversion costs reflect the actual cost of the pilot project, a combination of staff time & flex funds ($500, $1200). ES, RRH, TH costs are the median cost per housed family reported to the state by providers from the counties in which we operated the pilot projects.. TH is low because this is just for one year of cost, and as we saw on previous slide, length of stay is greater than one year These other interventions, esp. ES and TH, they are limited to specific units. A limited resource. Diversion is only limited by client creativity and opportunity. The more we can serve with diversion the more we can reserve our precious limited resources for people who need it most. Helps us prioritize and make best use of resources. The quicker we can get people back into housing the less likely they are to return (those who are likely to be homeless have already been homeless, so the more we can limit that experience, the more we can impact returns) Updated cost estimates based on Building Changes analysis of diversion grantee data from Pierce and King County pilot projects and 2016 Washington State Department of Commerce data for Pierce and King County ES, RRH, and TH. *Likely underestimate. TH enrollments typically last over one year. Slide 8 of 11

What Have We Learned? Returns to the Homeless Response System Are Low These are a little higher than what we tend to see from other interventions, but not substantially so (systemwide we tend to see between 5-7% after a year for a more limited measure of returns—returns to programs of literal homelessness such as ES and TH. This is a broader measure of returns to the overall system, which includes prevention). Slide 9 of 11

Why Is This Our First Conversation? Screening for diversion is ineffective Households will self-select Diversion is an organic prioritization Progressive Engagement for the system Creates positive urgency Maximizing opportunity Sets a problem-solving, housing-first orientation within the system So why is this our first conversation with everyone? To answer that, I’ll share what we learned from a system perspective: We found that screening for diversion, or attempting to predict who will be successful, was not useful. Began the pilot by only offering to family with either housing or employment history in the last six months Had enough staff bandwidth to offer to ALL family households Did not change outcomes, in terms of percentage of households who opt for diversion or the success rate We were surprised! Turns out, that by relying on client self-determination and resiliency, letting households self-select for diversion is the MOST effective screening mechanism Trend continued when we began serving all populations with diversion We will never be able to perfect predict success, SO DON’T We also found that by positioning diversion as essentially triage into our coordinated entry system, it functions as an organic prioritization for our system It’s a form of progressive engagement, for the system. Those who can self-resolve, do (and therefore do not utilize deeper resources). Even before our system formally implemented referral prioritization, our RRHers noticed that they were receiving higher barriered households Also, creates a positive urgency to find a solution Combination of short timeframes and limited funds Taking advantage of opportunity Maximizes procrastination phenomenon Sets the right tone in our system Even for households who pursue a solution, but don’t attain it – they are set up to continue problem-solving and attaining their own housing stability in RRH. We believe in this approach so much that we have expanded Creative Conversation training to all providers across our whole system We have added a full-day workshop as part of our Provider Academy – so that providers offering emergency shelter, rapid rehousing or permanent supportive housing have the opportunity to learn these client engagement techniques, to focus on client-driven, strength-based, PROBLEM-SOLVING Slide 10 of 11

Questions? ?