Improve the quality of homelessness response services, based on the concerns and priorities of people experiencing homelessness.
Eleanor Bradford from the Detroit Advisors Group speaks about the need to improve service access and quality across Detroit and the impact it would have on people experiencing homelessness.
People experience harmful, abusive treatment within homeless service settings every day, compounding the trauma of the experiences of housing instability and homelessness.
Despite this and like many cities, previous local service improvement initiatives focused primarily on procedures and policy alignment and not on quality of experience for the person using the services. Providers and administrators also expressed technical assistance fatigue from different efforts that have started and stopped over the years.
Frontline staff and people who have experienced homelessness, as well as administrators and funders, recognize the need to systematize and broaden person-centered, continuous quality improvement in all homeless service settings. The Homeless Action Network of Detroit and the City’s Housing and Revitalization Department have undertaken a systematic and pragmatic process to improve service provision in permanent supportive housing across the city as an attempt to improve the quality of experience for people in those programs.
Other common insights and themes that emerged from interviews and the community workshop include:
- Service agencies are given broad jurisdiction to manage homeless services with little operational oversight or accountability;
- Client to staff ratios are not capped and case managers have very large caseloads;
- Budget cuts have significant impacts on frontline staff who are expected to provide an increasing number of services with less time to do so;
- System changes and improvement efforts have fallen on frontline workers such as case managers to improve outcomes; and
- Service connections for people experiencing homelessness are disjointed due to limited connections between providers and staff across service points.
If we ever needed to file a complaint. It would be this really big intimidating book that they would like position and be like, Oh, you got to do this and do all that, and nine times out of 10 at the time and myself included, I wasn’t about to read all that and I was not about to go through all those processes, because just imagine how hard it was to get housing and fill it out and always follow up with on that, then you gotta give it to the person who you naturally probably complaining about anyway.
TGNC Community Member in Detroit
Implement contractual clauses to prescribe services within each type of service setting and limit the size of case managers’ caseloads.
State and local, public and private funders should implement contractual agreements that outline what case management services, connections to systems, and system navigation supports must be provided by contracted service providers across each type of service setting (outreach, diversion, coordinated entry, shelter, rapid re-housing, permanent supportive housing, and eviction prevention). These agreements should be structured based on the stated needs of people experiencing homelessness and developed in close consultation with members of the community who have accessed homeless services in Detroit.
Strategy in Action
The Government Performance Lab at Harvard University suite of Active Contract Management tools can help community members and administrators design processes and structures to improve service delivery through active funder-contractor collaboration. While technical assistance may be helpful in this transition, members of the community are also well-equipped with the expertise, if not the resources and leadership, to lead this process.
Identify gaps and develop services and supports for survivors of domestic violence.
Detroit has a dearth of housing services tailored to the needs of survivors of domestic violence and those fleeing domestic violence. Leaders should create a process for survivors and advocates to define what service needs exist and co-design the necessary service models and programs alongside homeless service providers and administrators. Homeless service providers and administrators should also streamline their
partnerships with domestic violence service
providers nearby but outside the city to ensure that all Detroiters who have those needs in the short term can be easily and seamlessly connected to the services and supports they require.
Strategy in Action
The Domestic Violence and Housing Technical Assistance Consortium offers a wide-reaching set of tools and guidance for homeless service providers and domestic violence service providers to build and strengthen their connections in order to better serve survivors.
Improve coordination between outreach providers, MDHHS, and the homelessness response system.
Funders and providers should build and streamline relationships and connections between outreach providers and other homeless services and supports to offer person-centered care and to sustain and strengthen relationships between people experiencing homelessness and those providing services.
[There’s a] large gap in care when someone gets into housing. As street outreach providers we lose touch with them, folks get moved in and don’t have phones to let us know. Their needs don’t seem as urgent once they’re in housing, but it’s one of the most important times to ensure people still have social support. Our patients struggle emotionally so much because people turn a blind eye, it’s so degrading and so hard for people.
Outreach Worker
Strategy in Action
The U. S. Interagency Council on Homelessness published lessons learned from a panel of experts convened by the Substance Abuse and Mental Health Services Administration (SAMHSA) as well as guidance on the core elements of effective outreach.
Utilize performance-based contracting to resume quality improvement efforts.
Local partners should resume the work that began before the pandemic to improve service delivery within shelters and focus on ensuring that shelter services are:
- Safe and affirming,
- Connected to housing navigation services and the CAM process, and
- More quickly connect people to supportive resources that can be utilized while in shelter and after exiting to housing.
Performance-based contracting for publicly funded shelters should include clear service quality standards and people with lived experiences of shelters should be included in designing the standards used in performance-based contracts. Efforts to improve service quality in permanent supportive housing can be leveraged to define quality standards and organize technical assistance to help shelter providers improve service quality.
Strategy in Action
Federal technical assistance is available through HUD to support communities in strengthening service delivery models. Given that service providers and administrators expressed “technical assistance fatigue,” leaders should create space for these initiatives to be community-led and community-driven in order for them to be holistically developed and useful to all stakeholders involved. Technical assistance should be defined by the community and local experts, including and especially people who have experienced homelessness themselves, who should be positioned as leaders and subject matter experts in this work.