The Ten-Year Plan to End Chronic Homelessness

Sunday, May 19th, 2013

Overview

The TYP held its third Public Conversation tonight, Wednesday, June 23, 2010 at the Deane Hill Recreation Center about the origins of our own Knoxville and Knox County Ten-Year Plan to End Chronic Homelessness (TYP). Dr. Bill Lyons, the City of Knoxville’s Senior Director of Policy & Communication, acted as moderator. Dr. Roger Noose, Professor (Emeritus) UT College of Social Work; Linda Rust, Knox County Community Development; and Mike Dunthorn, TYP Project Manager, delivered a presentation about the process by which the TYP was developed in our community, the forces that drove its development, and its rationale. The meeting was quite well attended (probably just over fifty folks came out), and the conversation, once again, was respectful and quite informative.

I’ve transcribed my notes from the conversation below, edited only for clarity.

Notes

[These are my notes. I tried to capture as much of what was said as I could. If I've misrepresented anything here, or left out something you believe to be significant, please mention that in the comments below this post.]

Attendees included several City Councilpersons: Vice Mayor Bob Becker, Marilyn Roddy, Brenda Palmer, Nick Della Volpe and former Councilman Barbara Pelot. County Commissioners Amy Broyles, Finbarr Saunders and Ed Shouse were in attendance. Also in attendance were several members of the staff of the City’s and the County’s Community Development department–Madeline Rogero (Director City of Knoxville Community Development)  and Grant Rosenberg (Director Knox County Neighborhoods and Community Development). My apologies if I’ve missed anyone.The format of this meeting was one hour. The first half hour was used for presentation, the second half hour was for conversation with attendees. The meeting ran longer than one hour; I think it ended at about 7:15 or 7:20pm, but I’m not sure.

Dr. Lyons, in his role as moderator, focused this meeting’s topic on the formation of the TYP, the thinking behind it, the process of developing it, and its logic and goals. He also mentioned that this meeting is the third in a series to fully explain and dialog about the components and strategies connected with our community’s efforts to end chronic homelessness. Dr. Lyons mentioned that the presentation half of the conversation would focus on the long process we went through to develop the Knoxville/Knox County response to homelessness.

Dr. Nooe led off with background. To understand our TYP, you have to look back to the 1980s. There was at that time a growing awareness that homelessness was increasing across the country. In Knoxville at that time there were six shelters, and lots of groups who were providing food and other resources to homeless people. The causes of homelessness were beginning to be better understood, and included a national trend towards significant reductions in low-income housing that was partly brought about by urban renewal; deinstitutionalization, a movement to close or greatly reduce mental institutions in favor of residence and treatment in the community; increasing substance abuse; a job market whose competitiveness was increasingly growing; rising domestic violence, and other factors.

In 1986, Mayor Kyle Testerman and County Executive Dwight Kessel appointed a task force to study homelessness. The first biennial study happened that year, and showed 1000 homeless persons in any given month. By 2006, that number had jumped to 1900 homeless persons in any given month. This trend made it ever more clear that we were losing ground. Several issues during this period became much more obvious. (1) Service delivery was extremely fragmented. Agencies did not communicate with each other, nor did they coordinate service delivery. This made our “system” extremely inefficient. (2) Most services were were geared towards increasing the comfort of people who were still living in the streets. Well-intentioned groups offering these kinds of palliative services were mostly concerned with things like delivering blankets, soup, clean socks, restroom facilities.

In 1996, a group came together with the intention of developing a plan to address these issues, but it never generated much momentum and fell through. But in 2003, the United States Interagency Council on Homelessness (USICH) came onto the scene nationally, and in 2004 Knoxville Mayor Bill Haslam and Knox County Mayor Mike Ragsdale appointed a homelessness task force with 17 members and four staff members. This Task Force kicked off our TYP. The Task Force developed four working groups: (1) Housing, (2) Mental Health/Social Services, (3) Employment, and (4) Community Concerns.

Mike Dunthorn discussed the reformation of the mission of USICH under the leadership of Philip Mangano. Dunthorn emphasized the “interagency” component of USICH, which really did focus on bringing together different agencies to tackle the issues around homelessness using research and best practices. It began to become clear it was especially important to begin doing things differently regarding chronic homelessness, and Mangano embarked with USICH upon a mission to promote ten-year plans nationwide. More than 200 communities joined this movement.

Research was starting to suggest that the continuum of care model did not work very well for the chronically homeless population because it essentially asked them to attain sufficient stability to succeed in housing while still living on the streets. [Note: people who are chronically homeless are defined by HUD as unaccompanied disabled adults who have been homeless for at least a year or who have experienced four episodes of homelessness in the past three years. Research demonstrates that although they may make up only 10-15% of the homeless population, they consume about 50% of all the resources communities expend on all homeless persons.] Research was also beginning to demonstrate that housing first works very well with the chronically homeless population, and people were beginning to see housing alone was giving people who had been homeless for long periods of time the kind of stability that leads to positive life change and success. We were seeing good things happening in New York City, Seattle, and other cities, and people here started saying, “Let’s focus on the chronically homeless population, and do something different, because what we’ve done up to now isn’t working.”

Dr. Nooe mentioned at this point that housing is very important, but it’s not all there is to the TYP. He said that he gets very passionate about discharge of homeless people from jail, hospitals, or mental institutions to the streets. There should at least be some kind of coordination between a shelter and a discharging institution. And our TYP also recognized the importance of coordinating services. A homeless person doesn’t need five different case managers—there should just be one. And let’s use technology more effectively. We should also seek permanent solutions to homelessness instead of doing all of this recycling of people through the jails and emergency service providers. And get our churches involved in this solution, and work hard to prevent homelessness from occurring in the first place. Those things are all reflected in our TYP, which is not just about housing.

Linda Rust spoke to the process of developing the TYP. It started in September 2004 with the two mayors doing the Walk the Walk/Talk the Talk event, in which they got to interact with people in shelters and camps. This event had a profound impact on Mayors Haslam and Ragsdale, and the Homeless Coalition, which was forwarding the development of the TYP, wanted to take advantage of this “bigger leadership” represented by the City’s and County’s executives.

Working Groups started later that fall, and Ms. Rust was in the Community Concerns Working Group, which included representatives from the Council of Involved Neighborhoods (COIN), Center for Neighborhood Development (CND), 4^th & Gill Neighborhood Association, Fort Sanders, Knox Area Transit, Knoxville Police Department, and several other organizations. The group discussed  gaps, problem areas, and grappled with the question, “Why are we failing in re: homelessness?”

The Community Concerns working group recognized that, in the past, we had measured success by the number of beds in shelters, the number of meals served, but that we were not helping in a permanent way. They examined and discussed: the impact of homelessness on Knoxville’s downtown; methods for assessing the true cost of homelessness (taking into account more than just the cost of shelter beds, feeding programs, and other services operated specifically for the homeless population); better tracking of numbers of homeless people via improved utilization of the Homeless Management Information System database; the perception that the neighborhoods closest to downtown carry more of the burden associated with the issue of homelessness than they should; the issue of integration into the community; the fact that homelessness is really a community problem that crosses geographic barriers (noting the large number of camps distributed throughout Knox County). The Community Concerns working group also recognized that housing first and permanent supportive housing needed to be a priority in the emerging TYP.

This group also discussed ways to engage neighborhoods, and the Center for Neighborhood Development appeared poised to take the lead on that issue when it went out of existence in 2006.

The Community Concerns working group looked at several different communities, including Louisville KY, Chattanooga, and Maricopa County AZ, and how they were developing their own approaches to homelessness.

Members of all of the working groups recommended that both mayors (City and County) would take responsibility for and ownership of the TYP. An Advisory Board would meet quarterly, and the TYP would need a director, someone who would wake up every day thinking about the implementation of the plan. The Plan itself was always discussed as a living document that would evolve during the course of implementation.

Mike Dunthorn mentioned that there was a great deal of discussion about ownership of the plan. It was super-important to everyone involved in developing the plan that it not just gather dust on a shelf somewhere.

Dunthorn spoke to the TYP’s emphasis on prevention of homelessness. Knox County Community Action Committee (CAC) operates a prevention program in four KCDC properties. They provide case managers there who have reduced evictions into homelessness from an average of 67 per year to zero evictions into homelessness during the first 18 months of the CAC program’s operation. Prevention works, and we know it. Properly-resourced case management works, and we know it.

Coordination is also hugely important. Prior to implementation of the TYP, coordination between agencies was not very good. Now, it’s quite good and getting better all the time, and the change we see in our effectiveness as a community is profound. Coordination was something we developed in our plan and that is one of its main pillars.

Bill Lyons mentioned that some have said that there wasn’t much knowledge of, or community engagement in, the formation of the TYP. He pointed to copies of news stories from the time the TYP’s development process was getting underway, and acknowledged that now that the TYP’s implementation is touching neighborhoods and becoming more visible, people are learning more about it and getting more involved with it. Some of that involvement is critical of the TYP, of course, but even that is good. We need the hard questions. But notwithstanding all that, this plan was not developed in a vacuum.

Dr. Lyons opened the meeting up for questions and comments, asking that participants stick to the broad topic being discussed tonight.

An attendee asked how many homeless people have been housed? Mike Dunthorn responded that 287 people who used to be chronically homeless have been placed in permanent supportive housing in existing apartment units.

Someone then asked for the total number of homeless people in Knox County. Dr. Nooe responded. That’s a hard question to answer because the homeless population is very changeable. The number you’re asking about is never a static number because the people you’re counting don’t have addresses and they move around from place to place a lot. In the past we relied on statistical analysis of estimates based on data collection methods that were at the time the best we had. For example, in February 1986 it was estimated that the number of homeless in Knox County that month was around a thousand. Now, we estimate that between 7000 and 8000 people will experience homelessness in Knox County in one year. Most of those people will be homeless for less than six months, and that’s a good thing. People who are chronically homeless face a very different reality because the issues that have led to their homelessness are so profoundly difficult to address while they’re still living on the streets. It’s very hard to count homeless people and communities always struggle to do it, but our biennial study is really very good compared to other communities’ studies of the same issue. Dr. Nooe also related that back in 1992, a group of people connected with Whittle Communications had asked Dr. Nooe to locate some folks in the community who had escaped longterm homelessness. At that time, Dr. Nooe could only located five people in Knox who fit that description. He pointed out that now we’re placing people in housing in huge numbers [the average rate in Knox County is over 8 per month with one-year retention rates of better than 90%, which is better than the national average].

Jessica Bocángel asked the presenters to discuss what it means to not discharge people to the streets and into homelessness. She also asked how churches used to be engaged, and how they’re being engaged now. Mike Dunthorn responded that discharge to the streets is tough. Funding for hospitals, mental healthcare facilities, jails, etc., is beyond our immediate control, and those organizations serve other people besides just the homeless. They’re not equipped to get people into housing. We are working with them to develop better protocols. You start with simple solutions, like making sure there’s interaction between the discharging organization and the local shelter, so the shelter folks at least know that someone’s coming their way and can anticipate their needs. But it will require changes at the state and federal levels to really improve this problem significantly. The faith community has always been engaged with the issue of homelessness, largely focused on providing for the needs of people who are still homeless. The Compassion Coalition’s Circles of Support, which is a mentoring program specifically for people who live in permanent supportive housing, is a groundbreaking program that seeks to engage the faith based community in a different way, one that leverages the ability and mission of that community to provide healthy friendships so that people who’ve left the streets can more easily rebuild their lives where they live.

Joe Minichiello asked why there is no “cap” on the number of chronically homeless people served in our community. He said that according to Dr. Nooe’s research, 45% of the homeless in Knox County aren’t from here. Why wasn’t that addressed in the plan? Mike Dunthorn asked attendees to raise their hands if they were born here. He said “That’s the issue.” He went on to say that Dr. Nooe’s survey asks “Where were you born?” whereas the Homeless Management Information System database asks “What is the zip code of your last permanent residence?” In our community, over 60% of respondents list a 379 zip, with just under 80% coming from the counties that surround Knox. Dunthorn said that every one of his colleagues around the country gets asked the same question: “Why does our community attract all these homeless people? We’re the destination of choice for them from all over the country.” and that the situation is probably very similar everywhere else. If we’re all creating plans to effectively address the issue of homelessness, we’re all going to be attracting people to our communities about equally.

Brandon, a resident of the neighborhood surrounding the Cox Street permanent supportive housing development built and operated by Helen Ross McNabb Center, raised the issue of security, asking “What do you do with repeat offenders?” He said that he and his neighbors have been dealing with this at Cox Street since October 2009. He went on to say that he realizes that these kinds of facilities are going to be owned and operated by private entities, but who enforces accountability? Mike Dunthorn responded that it is important to recognize that people who are homeless are in the community already. We’re aware of this issue, and are taking steps to see that it’s resolved. In fact, you contacted the TYP to seek resolution and we got on it right away. That wouldn’t have been an available option before the TYP existed. The issue is very important to us, and we are working hard to resolve it. Brandon asked “What is being done about illegal drug use in the neighborhood?” Dunthorn responded that first of all the lease is enforced. That’s the side of the equation controlled by providers of permanent supportive housing. If a person is using illegal drugs on the property, they’re subject to immediate eviction, not to mention arrest. Engaging in violent or threatening behavior will also result in rapid eviction. However, it is important to note that the whole purpose of the TYP is to end homelessness, and that means working very hard with people who need a lot of help. You don’t just want to be kicking them out of their housing the first time they mess up–that would defeat the purpose. Case managers and other staff will be onsite, and they will work with residents to prevent eviction if possible.  If they get evicted, will they just get dumped out in the neighborhood, evicted to the street? No. The case manager would work very hard to place that client in a more appropriate housing setting, perhaps one with more supervision if that’s appropriate.

[Note: TYP director Jon Lawler engaged this situation as soon as he heard about it and offers this account.]

At the South Knoxville Meeting on Monday (6/21/10) and at the Deane Hill Community Center Meeting on Wednesday (6/23/10) a gentleman named Brandon made repeated references to Helen Ross McNabb’s mismanagement of its Cox Street Development.  This issue came to my attention on Monday afternoon when Brandon called my office.  I agreed with Brandon that his concerns were very valid, and I encouraged him to speak with Jana Morgan at Helen Ross McNabb.  I also asked him to call me back on Tuesday (6/22/10) by 2:00 p.m. to give me an update on his conversation with Helen Ross McNabb.

I did not hear from Brandon on Tuesday.  On Wednesday morning I called Andy Black (CEO of Helen Ross McNabb) to inquire about this issue and to determine what action had been taken.  He was unaware of the problem but told me that he would follow up and call me back.

Andy Black immediately called me back to let me know that Brandon had spoken with Jana Morgan on Tuesday afternoon.  Jana had been on vacation on Monday, so she was unable to return Brandon’s call until Tuesday.  Andy communicated to me that while Jana was on vacation the resident manager quit.  This left no nighttime presence at the facility.  Jana communicated to Brandon that Helen Ross McNabb was giving this issue its immediate attention, and Jana also communicated to Brandon that Helen Ross McNabb would schedule a neighborhood meeting to address its current and future methodology for responding to the neighborhood’s concerns.

Brandon knew all of this before he attended the meeting on Wednesday.  In fact, when I spoke to him after the meeting, he expressed his satisfaction at Helen Ross McNabb’s response and their plan for moving forward.  I am not sure why he chose to speak on Wednesday night as if Helen Ross McNabb had been unresponsive.

It should be noted that Helen Ross McNabb has been operating permanent supportive housing in Knoxville as long or longer than anyone else (Child and Family has also been operating PSH for a long time).  Helen Ross McNabb’s model is different than the model that has been proposed at Minvilla and Flenniken.  The Cox Street (15 units plus a resident manager unit) development has a case manager that visits during the day, and a resident manager that is on call during the night.  Cox Street is two buildings, and the main entrance is not monitored by a full-time staff person.  This model has worked well for McNabb in the past, and I am certain that it will work well at Cox Street.

Ron Peabody asked for the total number of homeless persons in the USA in the year 2000. Dr. Nooe responded that he could look that up, but didn’t know it off the top of his head. Suffice it to say that the numbers today are better than they were in 2000. Mr. Peabody said that our “best numbers” were between 1,200,000 and 1,500,000 in 2000, and that President Obama’s new homelessness plan which has just been released stated that there had been a 10% reduction in chronic homelessness in the last ten year, and that that doesn’t sound like success. Dr. Nooe responded that the results vary quite a bit from city to city, and that a 10% reduction would seem like a very good start. Mike Dunthorn held up a copy of the new homelessness plan Mr. Peabody had referenced, Opening Doors Federal Strategic Plan to Prevent and End Homelessness, and corrected Mr. Peabody’s figures by citing this from page 17: “After declining 30% between 2005 and 2007, the number of persons who experienced chronic homelessness remained essentially the same in 2008, but dropped 11% in 2009.” Dunthorn added, “I’d call that successful.”

Scott Smith said that he now understands permanent supportive housing and how it’s necessary to solve this problem, but wondered why sobriety is not a condition of the lease. Linda Rust responded that based on her experience working at Helen Ross McNabb Center, when a case manager encounters a client, the case manager has to meet that client on the level of the client, and clients are not homogenous–they are in all different kinds of places. It’s the case manager’s responsibility to determine needs and find resources to help the client address those needs. To make sobriety a condition of the lease would be very counterproductive for a lot of people, because they would perceive that condition as coercive. Research demonstrates that clients are more likely to get services if they make a choice to do it, and don’t feel coerced. The stability provided by housing is therapeutic in and of itself. It provides a level of peace that helps residents be in a better place to get the services they need to help them confront their issues. Scott Smith replied that at Cox Street, the case manager quit, so surely it would be better to have addressed sobriety in the lease. Bill Lyons said that we have to make sure case managers are present. We must ensure that people living in permanent supportive housing don’t do harm to residents of the surrounding neighborhoods. We need to strengthen all of the functional relationships so that communication between all the constituents is really good. A woman who lives near the Cox Street property said that the neighbors do not have anyone that they can call. Bill Lyons responded that we are aware of this situation, and that we are taking steps to ensure that proper relationships are established and maintained. Dr. Nooe suggested that neighbors contact Andy Black at Helen Ross McNabb Center.

Dave Gartner asked for the name of the Council of Involved Neighborhoods rep in the Community Concerns working group. Linda Rust said that they were Whitney Stanley and Polly Doka.

Brandon said that a Helen Ross McNabb staff person had told him that there is no requirement that they have 24/7 awake staff on site at Cox Street. He said there should be such staff anyway. Linda Rust said that that’s why she was on the phone to Helen Ross McNabb the moment she heard Brandon’s story. Nobody’s happy about the kind of situation he described and everyone involved wants to find out what’s going on get it resolved as soon as possible.

Dave Gartner said that there is no enforcement mechanism in place to ensure that operators of permanent supportive housing do things to an agreed-upon standard. Mike Dunthorn pointed out that while there’s no specific enforcement mechanism, any operator who does poor work puts his or her organization at risk of loss of funds. It’s not like we’re completely without leverage in a situation like what’s being described here. Whatever’s going on, we’ll find out about it and make sure it gets addressed.

A gentleman asked who bears the cost burden of permanent supportive housing residents. Linda Rust replied that many qualify for Social Security disability, which is a federal program, and that people in permanent supportive housing have to pay some portion of their housing expenses. She gave the examples of group homes, permanent supportive housing–you qualify for those kinds of housing because of your disability. Dr. Lyons mentioned that some expense is borne locally, too. Dr. Nooe said that we’ve got to solve this problem, and that we can. He discussed a group that meets every other Tuesday to address the most challenging of our community’s chronically homeless individuals. This meeting is about assigning responsibility, and it’s one of the best things we’re doing to coordinate our efforts and take responsibility for individuals who are out on the streets. He pointed out that not everyone is capable of living in the community, and that we will always need to screen people carefully and help them gain access to appropriate housing.

Next meeting

The next public conversation will be held at the Cansler YMCA from 6-7pm on Wednesday, July 21. The topic will be mental healthcare delivery in the context of the TYP. We’ll publish more information here about that as we get closer to the date of the meeting. We’ll follow the same basic format. First half hour presentation, second half conversation about the subject.