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Executive Director Poppe: Keynote at Coalicion de Coaliciones 5th Summit on Homelessness

9/23/11 Aquadilla, Puerto Rico

Buenos dias, good morning. It is wonderful to be here and I want to thank Francisco Rodriguez for the invitation to join you all today. First, I would like to recognize the leadership and efforts the Coalicion de Coaliciones have made over the last number of years. Aguadilla is the last stop on my trip to Puerto Rico. I have met with federal government officials from the Departments of Housing and Urban Development and Veterans Affairs, I had a productive dialogue with Secretary Irizarry at the Department of Family, I’ve met with mayors, and have seen some of your homeless service providers. I am very thankful for how gracious and welcoming all of you have been.   In Washington, we are aware of the struggles you face, but we also recognize the progress that has been made here over the last ten years, especially the work you have done to decrease the overall population since 2006. I am here today as your partner to discuss what we are doing on the federal level and to lend a hand as you make progress in your communities. 

Since 1983, I have been involved in the movement to end homelessness – it is my work and my passion.  It is a movement that seeks to ensure that all people have a right to safe and affordable housing.  Too often, this basic human need – the need for a place to call home – is not met.  

I have met thousands of persons – men, women, and children -- who have directly experienced homelessness.  For many, it’s a simple economic situation – they don’t earn enough to pay the rent. For others they have also experienced racism, sexism, classism, and prejudices related to their diseases of AIDS/HIV, domestic violence, mental illness, alcoholism and addiction.  For some they have the further burden of a past criminal record.  Each of them deserves a home.

It is their faces, their courage, and their struggles that inspire me to continue as their advocate. And that was what brought me to my current role as executive director of the United States Interagency Council on Homelessness. The mission of the Council is to coordinate the Federal response to homelessness and to create a national partnership at every level of government and with the private sector to reduce and end homelessness in the nation while maximizing the effectiveness of the Federal Government in contributing to the end of homelessness.  Department of Labor Secretary Hilda Solis is the current chair of the Council, which also includes 18 other Federal agencies.  Over the last 22 months, I have had the opportunity to work with communities across America and I’m delighted to be in Puerto Rico to extend our efforts to open doors across America here on the island.

Before starting my position in Washington, DC, I worked in Columbus, Ohio as executive director of the Community Shelter Board, a public-private nonprofit committed to ending homelessness. Learning from our peers across the country we developed local practices to divert families from shelter to community services thus avoiding homelessness altogether as well as creating alternatives to shelter through quick placement in their own apartments and providing transitional services to stabilize them in their new homes.  We also pioneered development of permanent supportive housing as a solution to long term homelessness. Using Housing First practices we were able to take men and women directly from the streets into their own apartments without requiring periods of sustained treatment as a pre requisite to housing. We were able to document what was working because we used community wide data to track progress and modify our approaches as needed. The foundation of our work was the creation of a community strategic plan – Rebuilding Lives that was launched in 1997.  We collaborated across all sectors – nonprofit, business, government, faith, advocates and community around what we call the “moral foundation”.  We believed that “homelessness was unacceptable in our community, even for one night”.

Although your assets and challenges may be different from Columbus, I am here today because I believe that Puerto Rico can also make even greater progress by using data, adapting best practices, and collaborating across all sectors to achieve your common goal of ending homelessness.

Today, I will provide an overview of Opening Doors, the first ever federal comprehensive plan to prevent and end homelessness and discuss how Puerto Rico can become more engaged and align its efforts to build upon best practices. I will also discuss using performance measures to drive success, and our new exciting initiative that we are launching this week with states and local communities called Opening Doors Across America.

With the help of stakeholders from across the United States, on June 22, 2010 we launched Opening Doors at a White House event headlined by four cabinet secretaries – HUD Secretary Shaun Donovan, Labor Secretary Solis, HHS Secretary Kathleen Sebelius, and VA Secretary Eric Shinseki, as well the head of the Domestic Policy Council Melody Barnes.  Could I see a show of hands of those who have had a chance to read this Plan? -- Thank you! You join over 300,000 others who have downloaded the plan on our website.

Opening Doors is based on the vision that no one should experience homelessness. No one should be without a safe, stable place to call home. This vision was articulated by President Obama when he stated that “it is simply unacceptable for individuals, children, families and our nation’s Veterans to be faced with homelessness in this country.”

Opening Doors represents a dramatic shift in our approach.  Opening Doors is based on the idea that solving homelessness requires that people access MAINSTREAM resources effectively and sufficiently to meet their needs and avoid homelessness. Mainstream programs are designed for people regardless of their housing status, programs like Medicaid, Social Security, Food Assistance Programs and Education.

Historically, the Federal Government’s approach to addressing homelessness was defined by using those programs specifically TARGETED to serving people who alreadyhomeless Opening Doors places PREVENTION at the center and brings ALL human services resources to bear. In our shift to mainstream resources, we are moving to where the dollars are.As important as resources that are specific to homelessness have been to our cause, we need to access these mainstream resources if we are truly going to make progress.

Opening Doors has four bold goals:

First, we will finish the job of ending chronic homelessness by 2015. By greatly increasing the number of permanent supportive housing units, we’ve reduced the number of people experiencing chronic homelessness nationally by one-third in the last five years. Permanent supportive housing rebuilds people’s lives, and is a far wiser investment of scarce public resources than having people continuously go in and out of  emergency rooms, jails, and detox facilities. Here in Puerto Rico, less than one in every six beds in your inventory of homeless programs are permanent supportive housing.

Second, as Department of Veterans Affairs Secretary Eric Shinseki has championed, we will prevent and end homelessness for America’s Veterans and their families by 2015.

Third, we will prevent and end homelessness for families, youth, and children by 2020.

Fourth and finally, Opening Doors sets a path of ending all types of homelessness.

Opening Doors outlines 10 objectives and 52 strategies. As I learned in Ohio and have seen in everywhere I’ve visited, there is not a “one-size-fits all” plan. We are considering regional opportunities and challenges when acting with our community partners at local and state levels.

Four goals. Five areas of focus.

  1. Federal leadership and collaboration
  2. Housing, housing and housing
  3. Increasing income and employment
  4. Improving health and stability
  5. Re-tooling the homeless crisis response system

Let’s start with leadership and collaboration. Now more than ever, leadership is needed to set out clear goals, timeframes, and strategies.  A fiscally prudent and collaborative response is imperative—local, state, and federal governments cannot afford to invest in anything but the most evidence-based, cost-effective strategies. 

Collaboration, as you well know, is hard work. Sometimes it is easier just to say, “I’ll do it myself.” But collaboration is critical for ending homelessness. Here’s why.

People experiencing or most at risk of homelessness are first and foremost people. They are people in a heightened state of need and the situations that threaten them with homelessness are varied and complex. Their challenges are not neatly divided into discreet problems. Getting a Veteran into a decent paying job is tied to transportation is tied to housing situation, is tied to health.

Here are a few examples of how we have been collaborating back in Washington:

To reduce chronic homelessness, HUD, VA, HHS, and the Social Security Administration are working together to get more permanent supportive housing under development through better use of mainstream resources for health care, services, and benefits.

For Veterans,  HUD and VA have turned VASH around and nearly 30,000 veterans have been housed.

We’re tackling youth homelessness by listening to youth and providers who are in the trenches in the battle to help youth escape homelessness. We have been connecting our federal partners at Departments of Education, Labor, HHS, HUD, Justice, and the Social Security Administration to develop a more unified and strategic approach to federal policy that will enable us to achieve an end to youth homelessness by 2020.

We’re also not losing sight of the needs of families with children. HHS, HUD, and Education have developed an innovative demonstration project that is awaiting Congressional approval. It includes 6,000 supportive housing vouchers through HUD, mainstream services like TANF through HHS, and homeless student identification and service coordination by Education’s homeless liaisons in school systems.
This federal interagency collaboration is only one piece of the puzzle. We are asking communities across the country to be active partners -- with one another and with us as we implement Opening Doors. 
This involves interagency collaboration at the federal regional level, state level, and in your local communities. I can’t stress it enough, collaborating at the local level is absolutely vital. This involves bringing all of the key players to the table – Ten Year Plan leaders and State Interagency councils, VA staff, public housing authorities, state and local officials, service providers, the faith based community, philanthropy and housing developers and property managers.

We have a lot of work to do in Puerto Rico and it needs to be an all hands on deck approach so that we can make significant progress towards ending homelessness. For the two Continuums of Care here in Puerto Rico, it is very important for the respective local governments to support them and remain engaged.

So the first theme of the plan is leadership and collaboration. The second is housing, housing, housing.

People who are homeless need homes. Affordable housing. For many persons living in poverty, the lack of stable housing leads to expensive and repeated visits to crisis and institutional care facilities.

Stable housing provides an ideal foundation for the delivery of health care and other social services focused on improving outcomes for individuals and families.

HUD Secretary Shaun Donovan is a tremendous leader on this issue and has been doing all he can to get the federal government back in the business of affordable housing.

Included in this area is the call for more permanent supportive housing for people who need that intensive combination of housing and services to stabilize and succeed. Committing to Housing First practices is important to our success in ending chronic homelessness.

Let me spend a few minutes on the importance of permanent supportive housing and Housing First. It is a proven solution that leads to improvements in health and well-being. AND is cost-effective when it is targeted to people with the most extensive needs.

For people experiencing chronic homelessness, the research is clear that permanent supportive housing using a Housing First approach is the most effective solution.

Housing First supportive housing minimizes barriers to housing access or pre-conditions of housing readiness, sobriety, or engagement in treatment. Participants move directly from the streets and shelters into permanent housing.  Individualized supportive services help residents maintain housing stability and improvements in the quality of their life. These low barrier practices seek to “screen people in” rather than “screen them out” and end homelessness for people with the greatest barriers to housing success.

Evaluations of Housing First permanent supportive housing have demonstrated significant improvements in housing stability and reductions in days of homelessness. And when it comes to cost-effectiveness there is no better strategy for the ever tightening state and local social services budget. The reductions in the utilization and costs of public services from emergency shelter, hospital emergency room and inpatient care, sobering centers, and jails are substantial.

For instance:

In Seattle, Housing First supportive housing was shown to reduce Medicaid costs by 41 percent and reduce sobering center admissions by 87 percent. Average total costs reduced more than 75 percent after one year.

In the federal Collaborative Initiative to Help End Chronic Homelessness – a demonstration program at 11 sites across the country -95 percent of  participants were in independent housing after one year. Average costs for health care and treatment were reduced by about half. The largest decline was associated with costs for inpatient hospital care.

You may be skeptical that this model works.  I know I certainly was after having been a provider of abstinence-based transitional housing using a therapeutic community model.  I was however convinced when I saw the successes that were occurring across the country. 

One of those who convinced me was Sam Tsemberis, the founder of Pathways to Housing. Their model provides housing in apartments scattered throughout a community. This model fosters a sense of home and self-determination, and it helps speed the reintegration of Pathways’ clients into the community. 

Sam challenges skeptics by noting: "Some people think when you give housing away that you’re actually enabling people as opposed to helping them get better. Our experience has been that the offer of housing first, and then treatment, actually has more effective results in reducing addiction and mental health symptoms, than trying to do it the other way. The other way works for some people, but it hasn’t worked for the people who are chronically homeless."

The third area is employment and income.

The best defense against homelessness is a job that pays a good wage. We know that here in Puerto Rico that you have very high unemployment. There is strong competition for available positions, which makes it very difficult for homeless persons to compete for the few jobs available against other low and middle income persons.

Earlier this month, President Obama President Obama unveiled the "American Jobs Act." The President’s plan would help out-of-work Americans and their families by extending unemployment insurance to prevent 6 million Americans looking for work from losing their benefits, while at the same time reforming the system to help support programs that build real skills, connect to real jobs, and help the long-term unemployed.

Specific to our work, the proposed legislation would create a new Pathways Back to Work Fund that would, among other things, build on the success of the Temporary Assistance for Needy Families (TANF) Emergency Contingency Fund (ECF) by supporting subsidized employment opportunities for unemployed low-income individuals.

The fourth theme is health and stability.

Health reform generally, Medicaid expansion in particular, is the secret weapon in the fight against homelessness. Health reform offers new economic security - individuals and families are significantly less likely to be made bankrupt, or enter into a downward economic spiral, when they have affordable health insurance. 

For the first time ever, all poor single adults will become eligible for Medicaid. People with mental illness and substance use disorders, who are disproportionately represented among the chronically homeless, will especially benefit by the improvements that will come with the implementation of parity. No longer can insurance companies exclude treatment of these disorders from the coverage offerings.
The Affordable Care Act will triple Medicaid funding for Puerto Rico in the next decade. The additional Medicaid funding received from the Affordable Care Act will expand the government sponsored health insurance plan coverage to 200,000 more residents in Puerto Rico. This will increase the number of Government Health Insurance Plan beneficiaries to over 1.5 million of a total population of 3.7 million. 
Many of the services for people living in supportive housing are Medicaid eligible, yet only a very small number of supportive housing service providers bill Medicaid for these services.

Successfully using Medicaid to help end chronic homelessness requires adjustment at multiple levels: the federal and state government where they manage Medicaid; managed care organizations; mainstream health and behavioral health providers; and supportive housing providers.

Within this area, is the need to integrate primary and behavioral health care services with homeless assistance programs and housing to reduce people’s vulnerability to and the impacts of homelessness. People with serious mental illness are disproportionately poor and cannot afford even modestly priced rental housing without government housing assistance. Like other communities across the United States, access and availability to mental and physical health services is important in serving the homeless population. We face the issue of a lack of access to mental health services, including detox, prior to or during housing create revolving door back to the streets. No one player can provide all services needed. I urge you to integrate government, non-profit and private sector efforts  to make services not only available, but accessible.

The fifth area is re-tooling or reorganizaing the homeless crisis response system.

Local crisis response systems of care must focus on housing stabilization (not just providing emergency shelter and outreach). These community based systems must offer alternatives to shelter admission whenever possible, make shelter available to all who need it, and result in quick housing placement and housing retention.

Emergency shelters and transitional housing programs are expensive, so it’s critical to be sure that investment in these programs is aligned with community strategies that prevent and end homelessness. Communities need to consider whether the transitional housing program should be evolved to serve households with greater needs through conversion to transition in place and/or supportive housing. I also understand that there are serious concerns about the lack of services and shelter for victims of domestic violence. There are innovative new practices being developed with support from the Bill and Melinda Gates Foundation that may be useful to you as you develop a better crisis response system for women and children fleeing abuse. I urge all of you here today to return to your communities and work together to develop and provide these critical crisis response systems.

So that’s the federal plan in five easy pieces: collaborative leadership, housing, income, health and re-tooling/reorganizing the homeless crisis response system.

Like most things in life, it is important for you to know where you have been and where are you are going. What gets measured gets done!  A serious effort to end homelessness must have a strong focus on data driven solutions.  The results of well collected data tell a story – poor results point to the need for a course correction; positive results point toward opportunities to align resources to be used more effectively.  The good news is that implementing performance management is possible using federally mandated systems known as HMIS.

In 2004, Congress directed HUD, and HUD directed jurisdictions to implement a Homeless Management Information System (HMIS) to collect real time data on, who is homeless, why they became homeless, and what services/interventions are effective in ending their homelessness.  By collecting this data communities can then make informed decisions, and develop appropriate action steps that will reveal availability and improve access to critical services like housing, mental and physical health services and employment that are essential to reduce and eventually eliminate homelessness in their community. 
Puerto Rico needs to get more serious about implementing HMIS as a performance management tool - to become best in class. Performance management can ensure the wisest use of increasingly scarce resources. If your efforts do not have system and program reporting from HMIS, you can’t understand which programs and set of services are making a difference. If you aren’t using data, you can't prioritize admissions for vulnerable populations, and you can't understand how system functions as well as how programs function within the system. HMIS can help you understand which programs actually solve homelessness rather than just providing services that support people staying homeless.

Elected officials can help make this happen by supporting the Continuum in its effort to broadly implement HMIS and ensure that all homeless programs contribute data to HMIS. It’s also important to require that data be entered in timely, accurate, and comprehensive manner.  If your communities can do a better job, then your data can be contributed to the AHAR – an annual report on homelessness.  You can also then use the data to better understand the extent of homelessness and to create your own local reports. With the implementation of the new HUD Emergency Solutions Grant (which is a block grant to many local jurisdictions) cities are required to track programs through HMIS.  Increasingly HUD is expecting communities to achieve results with HUD funding both through the Continuum of Care program and the ESG program that demonstrate successful permanent housing placement. Now is the time to work closely with Coalicion to take full advantage of the opportunity to use HMIS as your performance management platform.

Across the United States, we are calling on states and communities to join us in implementing Opening Doors.  Earlier this week, USICH announced Opening Doors Across America. I’m excited that Puerto Rico is the first place I’ve been to roll out this new initiative.

We are asking respective states and communities to adopt the four goals of Opening Doors.  I’m here to urge the government of Puerto Rico, mayors, and Coalition members that we need you to lead on homelessness as well. Your leadership is vital for Puerto Rico to build on the progress over the last decade. I urge the elected officials to adopt the Federal Strategic Plan and implement its goals and strategies.

Second, commit to incremental targets, measure your progress toward the goals, and implement strategies that will enable you to achieve these goals. As I said earlier, “What gets measured gets done.”  

Third, we need a sense of urgency.  In this tight budget environment, community-wide and cross-government strategic planning is a pivotal step in ending homelessness.  When the plans are well-crafted and implemented there are better results -- decreases in homelessness and cost savings.  Now is the time to collaborate, invest, and act on strategies that are proven to make an impact.  And here are the key strategies that I recommend you to focus on:

  • Collaboration! The Continuum’s leadership, elected officials, and heads of local and state offices and departments need to work collaboratively and build relationships.
  • Strategic planning. It is critical for Puerto Rico to implement the new  long-term statewide housing plan. We urge you to consider implementing Housing First and Rapid Re-Housing practices as you move forward.
  • Use data as a management tool. As I mentioned earlier, improve HMIS by committing to using data as a management tool to identify system and program strengths, weaknesses, and opportunities for improvement.
  • Coordinate with your VA Medical Center and the satellite clinics, as they implement the VA’s 5 Year Plan to End Veterans Homelessness. The Continuum of Care, , and the State Interagency Council should be working hand-in-glove with the VA and their partners.
  • Seize the opportunity created by health reform, both through expansion of Medicaid and expansion of community health centers by making sure eligible individuals and families are enrolled in Medicaid.
  • Adopt Best Practices – implement only what has worked and adapt approaches to be sure you get the best results for the greatest number of people. 

And the last part of this call to action is that while you implement strategic plans, keep lines of communication open with public officials at all levels to share what you are doing and learning.   Participate in USICH-sponsored discussions with us. Share solutions and let us know when federal policies are working and when these policies can be improved.

It comes down to commitment – not just by the President, the Administration, Congress, Governors, local elected officials – it is up to you. With HUD’s engagement led by Assistant Secretary Mercedes Marquez and my visit and commitment here, the federal government is your partner and we look forward to opening doors in Puerto Rico.

Your actions matter, your perseverance matters, your quest to be as efficient and effective with the available resources matters. Strong leadership.  Effective collaboration across sectors and disciplines. A bold vision and clear goals.  Focus on what works, Solid, transparent data to tell the honest story. Nimbleness to respond to changing needs and opportunities. These keys will serve you well in the months ahead.

On behalf of the Obama Administration, thank you for the work you do every day to help people get and stay off the streets. And thank you in advance for the hard work that you will do in the coming years to forge new partnerships and collaborations, to move towards mainstream programs, to prevent and end homelessness here in Puerto Rico.