1. Best Practices in Effective Crisis Housing, Bridge Housing, and Emergency Shelter
2017 Florida Institute on Homelessness and Supportive Housing
Kay Moshier McDivitt

2. Cynthia
A little about us...
The National Alliance to End Homelessness works in three primary areas: research, policy, and capacity building.
The Center for Capacity Building works directly in communities to identify and evaluate policy and program strategies, promising and best practices, to help communities replicate and customize the best of those strategies than can effectively reduce homelessness.

3. Who’s Here?

4. Key Elements of an Effective Crisis Response System that Ends Homelessness
Access and Prioritization
Coordinated entry
Crisis Housing
Bridge/Interim/Shelter
Assistance to Return to Housing
Rapid Re-Housing, Permanent Supportive Housing, Market Rate Housing
kay

5. An effective crisis response system provides immediate and low-barrier access to safe and decent shelter to anyone that needs it and aims to house people as quickly as possible
Cynthia
In other words, An effective crisis response system should provide immediate and low-barrier access to safe and decent shelter to anyone that needs it and aims to house people as quickly as possible otherwise people can get stuck outside of shelter and be living on the street or in other places not meant for human habitation or they can get stuck in shelter with no assistance to exit.

6. Why Is Crisis Housing So Important?
Shelter/Crisis Housing is a community’s immediate response to a housing crisis
People in a housing crisis will always need a safe and decent place to go that is immediately available while they work on permanent housing
Cynthia
Shelters and other types of crisis beds are critical to the functioning of an effective crisis response system. Why? Because People will continue to have housing crises and need a safe and decent place to go when having a housing crisis, even when the system has achieved a system that makes homelessness rare, brief, and non-recurring.

7. Are immediately accessible to those who need it most
Goal of Crisis Housing is to provide shelter and crisis response services that:
Are immediately accessible to those who need it most
Are low-barrier without pre-requisites for entry
Increase exits to permanent housing
Reduce the length of time people are homeless
Cynthia
If you haven’t set goals yet or are looking for goals to set over the next 3-6 months, here are goals that other shelters set and achieved in that time period.
Look at metrics. Develop specific benchmarks of where you want to be by August 2017 for each of these areas like:
Increase exits to PH by 25% over the next 3 months
Decrease all average LOS to 60 days
Eliminate D&A testing by …
Eliminate _____ barrier for immediate access
Add housing locator activities to job descriptions by……
Train all staff and board on best practices by ……
Talk to the other teams at your table and share your benchmarks. What do you have in common? How can you support each other?

8. The Role of Shelter in the Crisis Response System
Cynthia
This is a very simple depiction of a crisis response system.
People enter the system in different ways and ideally, access assistance through an established coordinated entry system that prioritizes the people experiencing homelessness who are most in need of help for shelter, housing, and housing support services based on their individual needs and strengths.
As permanent housing is usually not immediately available, people need access to shelter while they are trying to access a more permanent housing solution.
People should flow through shelter as quickly as possible to a permanent housing solution. In other words, as shelter should be a process, not a destination –something I am borrowing from OrgCode.
However, this is often not how shelter works in a community. People often get stuck either trying to access shelter, and are unable to because of lack of shelter capacity, high barriers to get into shelter, or other reasons. OR they get stuck in shelter because they are unable to access a permanent housing solution that would help them exit shelter and end their homelessness.

9. People have to be able to get in…
Crisis Housing/Shelter should be part of a process of getting someone housed, not a destination
People have to be able to get in…
...and be able to get out (to housing).
Basically, a good rule for how to think about the role of shelters is
People have to be able to get in to shelter...

10. The Role of Shelter in the Crisis Response System
Identifies all people experiencing or at risk of experiencing homelessness across the community
Prevents homelessness whenever possible
Provides immediate access through coordinated entry to shelter and crisis services without barriers to entry, as stable housing and supports are being secured
Quickly connects people who experience homelessness to housing assistance and/or services tailored to the unique strengths and needs of households
U.S. Interagency Council on Homelessness
The US Interagency Council on Homelessness describes the elements of an effective crisis response system in the following way –
An effective crisis response system
Identifies all people experiencing or at risk of experiencing homelessness across the community
Prevents homelessness whenever possible
Provides immediate access through coordinated entry to shelter and crisis services without barriers to entry, as stable housing and supports are being secured
Quickly connects people who experience homelessness to housing assistance and/or services tailored to the unique strengths and needs of households

11. What Do We Know About Crisis Housing Stays?
The majority of individuals and families who become homeless have relatively short stays in the homeless system and rarely come back to it
Families with long stays are no more likely than families with short stays to have intensive behavioral health treatment histories, to be disabled, or to be unemployed
The results suggest that system decisions rather than family characteristics are responsible for long homeless stays
Cynthia
In other words, shelter programs rules were keeping people there longer, not necessarily people’s inability to get housing. For example, if you were allowed to stay in shelter for a year, and you didn’t have any help to get out, you would probably stay there the whole time if you could follow the rules. IF you had help as soon as you entered, you wouldn’t want to stay in shelter for that long.
Dennis Culhane, Testing a Typology of Family Homelessness Based on Patterns of Public Shelter Utilization in Four U.S. Jurisdictions: Implications for Policy and Program Planning, 2007

12. What Do We Know About Crisis Housing Stays?
Significant portion of people self-resolve or seek help from another system
Most people can exit homelessness with a light touch of services and assistance to exit homelessness for good (RRH)
Minority of people need more intensive services and long-term housing supports (TH, PSH)
So we should design our system accordingly. Shelters should help facilitate the self-resolvers ability to get housed quickly on their own, assume that most people can exit shelter to housing with some assistance, and that only a minority of people will need to access a very intensive intervention like PSH.

13. What does a good shelter look like
What does a good shelter look like? After talking with providers across the country, we heard 5 common themes from the highest performing shelters (Read all)
Each of these could be a session in itself: today we will focus primarily on utilizing a Housing First Approach and Immediate and Low-Barrier Access

14. Shifting Shelter/Crisis Housing PHILOSOPHICAL SHIFT
Philosophical Shift Practice Shift Operations Shift
Cynthia
There are three areas of shift that will need to happen to transition to a shelter that incorporates these key elements. Your shelter will likely have to make a philosophical shift, a practice shift, and shift in the actual way you operate the shelter, including hours of operation, staffing, and the way you utilize space. We won’t spend much time today on operational shift, but will dive deeper into those shifts in upcoming webinars.

15. Housing First Approach
Homelessness is a housing problem
Everyone is ready for housing now
People should be returned to or stabilized in permanent housing as quickly as possible and connected to resources necessary to stay there
Issues that contributed to a household’s homelessness can best be addressed once they are permanently housed
You may be wondering how a shelter, which provides temporary crisis housing, can use a Housing First approach when itself is not a permanent housing intervention.
However, Housing First is a philosophical approach to program design and service delivery.
Housing First promotes that:
Homelessness is a housing problem
Everyone is ready for housing now
People should be returned to or stabilized in permanent housing as quickly as possible and connected to resources necessary to stay there
Issues that contributed to a household’s homelessness can best be addressed once they are permanently housed
So, Using a Housing First may require a significant philosophical shift in your current shelter design and how you deliver services. Everyone on staff, from the Executive Director, to the intake coordinator, should make this shift to operate an effective low- barrier shelter with positive housing outcomes.
National Alliance to End Homelessness

16. Housing First in Practice
Few to no programmatic pre-requisites to permanent housing entry
Low-barrier admission policies
A focus on helping individuals and families access and sustain permanent rental housing as quickly as possible
Supportive services are voluntary
National Alliance to End Homelessness

17. Safe and Appropriate Diversion
A strategy that prevents homelessness by helping people experiencing a housing crisis and seeking shelter to preserve their current housing situation or make immediate alternative arrangements without having to enter shelter
Diversion is A strategy that prevents homelessness by helping people experiencing a housing crisis and seeking shelter to preserve their current housing situation or make immediate alternative arrangements without having to enter shelter
Why is diversion so important to implement for shelter?
Many shelters do not have capacity to accommodate everyone who needs shelter and have long-waiting lists. Are there ways to help people seeking shelter that provide them better options?
Done well, diversion can:
Cut down on shelter wait lists
Conserve and target precious shelter resources – people use shelter beds used only when needed
Improve quality of life by helping people avoid the stress of shelter stays

18. Safe and Appropriate Diversion in Practice
Help people identify immediate alternate housing arrangements or helps them stay where they are if safe and appropriate
Problem-solving and solutions-focused
NOT a separate “program” but rather part of the entire crisis response system
Diversion should feel like a service, not like being turned away with no assistance
Diversion happens through coordinated entry process and/or at shelter front door
So what do we mean by diversion? While we could spend a whole webinar just talking about diversion, and staff should receive training on diversion to do it well, we just wanted to provide a brief overview of what diversion is:
Diversion prevents homelessness for people seeking shelter by helping them identify immediate alternate housing arrangements or helps them stay where they are if safe and appropriate
Diversion is problem-solving and solutions-focused
Diversion is NOT a separate “program” but rather part of the entire crisis response system
Diversion should always be safe and appropriate for the person or household seeking help
Diversion should feel like a service, not like being turned away with no assistance
Diversion happens through coordinated entry process and/or at shelter front door
Remember, even if your coordinated entry is conducting the first level of diversion, shelters play a key role in that second level of problem solving. If a safe alternative, including connecting with family and friends, can be identified, it is always better that shelter.
Cuts down on shelter wait lists
Conserves and targets resources – shelter beds used only when needed
Improves quality of life by helping people avoid the stress of shelter stays

19. Immediate and Low-barrier Access
The most acute, highest need people are prioritized for shelter such as unsheltered individuals and families who are at greatest risk for severe health and safety consequences if not sheltered.
Fill your shelter with those that need it the most, not those that got there first or can “comply” with the rules
Do not require service participation to stay in shelter
Cynthia
Providing immediate and low-barrier access also means:
That the most acute, highest need people are prioritized for shelter such as unsheltered individuals and families who are at greatest risk for severe health and safety consequences if not sheltered.
Fill your shelter with those that need it the most, not those that got there first or can “comply” with the rules
Do not require service participation to stay in shelter – this does not align with a Housing first approach. That doesn’t mean people shouldn’t be doingg anything to work towards getting housed. Staff should be as proactive as possible in engaging every person to have a housing plan and achieve that housing plan so they can leave shelter to get to housing. Staff need to figure out how to make their services helpful and engaging so people want to use them, but this shouldn’t be a requirement. We will talk more in a bit about how to encourage people to want to get housed.

20. Immediate and Low-barrier Access in Practice
Screening people in, not out
Faculty is open 24/7.
People do not have to leave in the morning
No drug and alcohol testing to get in
No criminal background checks to get in
Not requiring income to get in
Not requiring “housing-readiness” to get in
Allowing people, pets and possessions
Cynthia
People have a lot of different ideas about what low-barrier means. We will try to define it here and also talk about what it DOESN’T mean.
Providing low-barrier access means simplifying eligibility criteria for entry to allow for immediate and easy access to shelter.
Remember the reasons that people do not want to enter shelter that we just mentioned. We want to create shelters that are accommodating to the people who need them, not make people accommodate the shelter program and its rules. We don’t want our shelter rules to be the reason that someone has to stay out on the street. We don’t want to be the barrier between them and an exit out of homelessness. In other words:
We want to screen people in, not out.
So, when possible, shelters should remain open 24/7 so that people don’t have to leave early or enter at a certain time and have to carry their things with them
As much as staffing and resources allow, try to Get rid of nightly check ins so people do not have to line up for a bed each night or leave early in the morning, as this can be really tough for people, especially if they have to take their possessions with them every day or have jobs that don’t let them adhere to the shelter’s schedule.
Low barrier access means No drug and alcohol testing to get in – Focus on behaviors instead. (We will address this more in a later webinar on the “rules” in shelter)
No criminal background checks to get in
Not requiring income to get in
Not requiring “housing-readiness” or”motivation” , or “Exhibiting a “desire” to change or Having a “good” attitude
And very importantly, Allowing people, pets and possessions whenever possible so people don’t have to part with the things and people that are very important to them, sometimes all they have

21. Low-Barrier No Rules
Low barrier does NOT mean that your shelter is a free-for-all and that you cannot have rules. BUT…it should be hard to get kicked out of your shelter, and the rules you have should be related to health and safety!

22. Retooling the Rules Rules Expectations
It might be helpful to reframe the whole notion of rules and re-frame them as community expectations. This has a whole different ring to it, feels less about compliance or about being punitive, and more about the expectation of a safe and comfortable community environment.

23. Cynthia
So, take a look at all your rules, guidelines, client handbooks, written materials, and ALL signage in your shelter and ask yourself:
Review incidents resulting in clients being barred
Recognize similar issues that could be handled in other ways
Meet with staff and clients to discuss changing the rules and gather input
Review each rule for whether it helps people get out of shelter into housing - or whether it inhibits this from occurring quickly?
Eliminate rules that make it more difficult for people to get into housing
Drop rules that don’t make sense, especially those created in reaction to a one time incident that is unlikely to happen again
Rules that remained should be directly related to safety
Post new rules and let them take effect in 30 days
Hold frequent meetings with staff and clients to assess how the new rules are working and revise as needed
Track if the number of people barred decreases
One program got 18-page manual down to 1 page! But…need to include staff in the process (buy-in!) Re-think EVERYTHING: Just because you’ve done something one way for a long time doesn’t mean you need to keep doing it

24. Housing-Focused, Rapid Exit Services
All services should be focused on exiting people to permanent housing as rapidly as possible
Create a “housing focused” environment
Shift the case management approach from: “What can I do to help you?” to
“How can I help you to obtain housing?”
Anna
Shelters have all kinds of different services – from employment, to budgeting, parenting, life skills, computer classes, etc.
The question shelters should ask is: how are these services helping people get housed? And what services can be delivered after someone is houses?
What services do we need to help people get housesd?
All services should be focused on exiting people to permanent housing as rapidly as possible
It is important to note that exiting people arbitrarily at 30 or 60 days or whatever length of time to homelessness is not a positive exit. So we are not recommending to exit people quickly based on arbitrary exit dates. Instead focus on exiting people TO HOUSING and doing everything you can in shelter to get people connected to housing resources.

25. Housing-focused Rapid Exit Services Practice
Create a “housing focused” environment
At entry, start to focus on a “housing plan”
Identify barriers to tenancy that will be worked through in the housing plan
Connect to housing resources
Focus every in-person meeting on a quick move to permanent housing
Review and discuss the housing plan weekly at a minimum
Anna

26. “I tell my staff, ‘if you’re not talking about housing, you’re having the wrong conversation.’”
Anna
Deronda Metz, Salvation Army, Charlotte, NC

27. Data to Measure Performance
DECREASE Length of Stay/Time Spent Homeless
INCREASE Exits to Permanent Housing
DECREASE Returns to Shelter
Anna How many of you collect data? How many of you use data to measure performance?
To truly know if you are effectively performing and truly trying to make an impact in ending homelessness, you can’t just reporting the number of beds filled, the number of nights of shelter, the number of meals served, the number of case management contacts, or the number of meetings held – an we know this is often the stuff that shelters are asked to report – and this shows how much work shelters are doing - but these are shelter OUTPUTS. What are your shelters OUTCOMES?
When you start focus on results that end homelessness, they get better. Everything you do should focus on whether you are ending homelessness.
READ SLIDE.
You want to know:
Are you DECREASing Length of Stay/Time Spent Homeless
INCREASING Exits to Permanent Housing
DECREASING Returns to Shelter

28. Data to Measure Performance In Practice
These outcomes must be evaluated together
For example:
If the length of stay in shelter is 30 days because the shelter only allows people to stay for 30 days, that is not a good outcome UNLESS a high percentage of people are exiting to permanent housing
Do not arbitrarily shorten the length of stay in shelter without considering exits to housing!
Kay
THIS IS VERY IMPORTANT : Do not arbitrarily shorten the length of stay in shelter without considering exits to housing!
These outcomes must be evaluated together!
For example:
If the length of stay in shelter is 30 days because the shelter only allows people to stay for 30 days, that is not a good outcome UNLESS a high percentage of people are exiting to permanent housing
Do not arbitrarily shorten the length of stay in shelter without considering exits to housing!

29. Emergency Shelter Outcome Metrics#
Measure
May 1
Total number of beds
Total beds for unaccompanied individuals
Total beds for families 2
Total unique households served 3
Total households entering shelter 4
Total households exiting 5
Total households exiting to a permanent housing destination 6
Average length of shelter stay in days for all households exiting the shelter to any destination 7
Average length of shelter stay in days for all households exiting to a permanent housing destination 8
Total household stayers (those households who entered in previous months and did not exit this month) 9
Average length of shelter stay in days for all stayer households
Anna
Here is a sample monthly metrics report. You can download it from this webinar or our website after this webinar. Every month, you should be tracking the shifts happening in the outcomes. The interesting thing we have been observing is that as shelters adopt the key elements see these metrics improve in a relatively short amount of time.

30. CREATE AN ACTION PLAN! Review each key element
Create action steps and goals for each key element that you want to accomplish in the next 3-6 months
Cynthia

31. Planning the Shift Set Core Values
Switch from a “housing readiness” approach to “rapid exit” approach (focus on housing rapidly rather than program completion)
Shift from “what you need to do to stay here successfully” to “what you need to leave here quickly and successfully”
Redefining of “who we are” and “how we do business”-a paradigm shift
Train existing staff or hire new staff
Paradigm shift has to be embraced by staff

32. Planning the Shift
How can we use our current staffing more effectively to help people obtain or sustain housing?
What will our culture shift look like? (Focus on “moving folks to housing more quickly”)
Do our consumers have a sense of urgency about being rehoused from day one?
What changes do we need to make to our job descriptions?
What training will be needed?
Are all of our outcomes rapid exit to housing focused?

33. https://endhomelessness.org/resource/
More Resources
Emergency Shelter Webinar Series
Shelter Self-Assessment and Action Plans
Shelter Outcome Metrics Form
Infographics
emergency-shelter/
BRING PRINTED COPIES OF THESE FOR DISTRIBUTION!!!!

34. Questions? Some common questions and concerns:
What if our clients aren’t ready for housing?
What if we are “setting people up to fail” by putting them in housing too quickly?
What if there is no housing available?
What if we don’t have extra resources for these changes?
What if staff quit?
What if we need more training?
What if we are de-stabilizing people who are trying to stay clean and sober in a shelter with people who are using?
Before we launch into the main topic of this webinar, we want to acknowledge that you may have a lot of concerns or questions. These are common concerns you may be having about transitioning to a new model of emergency shelters. We will try to address all of these concerns today but it is normal for you to have these questions. Over time and through experience, you will find that some of the concerns will change or disappear as you start to experience more success in helping clients find housing.

35. Thanks! Kay Moshier McDivitt kmoshiermcdivitt@naeh.org Twitter @60_kay
National Alliance to End Homelessness