5 Perspectives from the Transatlantic Exchange Program

With today’s guest blog post, we would like to introduce you to five homeless assistance professionals who spent several weeks learning about homeless assistance practices in England. They traveled there as participants in the Transatlantic Practice Exchange program, which was coordinated jointly by the Alliance and Homeless Link and generously funded by the Oak Foundation. This post provides just a quick look at what they learned. For more detail, please check out their reports on the Alliance website.

Adrienne Breidenstine, Mayor’s Office of Human Services, Executive Director of the Journey Home

Here in the U.S., we lack a consistent model or best practice for hospital admission and discharge of people experiencing homelessness. Consequently, hospitals frequently discharge homeless patients to the streets or to shelters with care instructions that are difficult to follow in these living situations. Without a safe, medically appropriate place to recover, their health is further compromised, which often results in readmissions to the hospital. During my stay in Brighton, England, I examined hospital admission and discharge practices for homeless patients. I came across several strategies that improved how hospitals discharge of their homeless patients in Brighton. Below are a few recommendations based on what I learned:

  • Invest in long-term solutions for reducing preventable hospitalizations: Homeless persons are frequent users of emergency health services and inpatient hospitalizations. By investing in their long-term housing stability, we can reduce the frequency of their visits and their lengths of stay, and thereby reduce their high cost to the health care system. In Brighton, the hospital has seen a reduction in hospital re-admission for homeless patients who have been discharged to stable housing.
  • Identify a funding mechanism for Medical Respite: Medical respite is short-term post-hospital residential care for homeless persons who are too ill to recover on the streets, but are not ill enough to remain in a hospital. Medical respite serves as an alternative to discharging homeless patients to the streets so that they can continue hospital-recommended care and fully recover. This is a type of model in London that they are looking to expand in England.

Aubrey Patino, Avalon Housing, Director of Tenant Programs

My action packed tour of programs in the UK focused on what they call the “complex needs” population, which is defined as people experiencing homelessness who touch multiple social service systems, but aren’t being adequately served since their needs expand beyond one siloed system of care. I studied the work of the Making Every Adult Matter Coalition being piloted in Cambridgeshire. This model implemented a cross systems collaboration to target and serve the complex needs population, demonstrating significant cost savings to the public sector, particularly in crime and mental health costs, in addition to quality of life improvements.

The Transatlantic Practice Exchange served as an invaluable experience that has influenced my work tremendously. Although I interface with collaborations in my work, they rarely expand across multiple systems of care. The intervention being provided in the UK by MEAM truly cross-walked all involved systems of care into the housing and care coordination of the complex needs population.

I encountered some intriguing contrasts and similarities during my exchange. In the UK, the focus is on getting people off the streets (or ending “rough sleeping" as they refer to it) more effectively, while we have made more strides in implementing long-term solutions. I was very impressed by the police response demonstrated in their "street life officer team" who worked closely with service providers in coordination of care and were dedicated to the cause of tackling homelessness, thriving peer programs and legal mandates for service user feedback, innovative harm reduction strategies, and truly elevated collaborative efforts across all systems of care.

The experience provided a window into what’s possible. An effective and sustained collaboration with allocated time and resources across sectors is what this population requires and the programs I witnessed in the UK truly embodied that commitment.

Deanna Villanueva

I examined No Second Night Out (NSNO), which started as a pilot program in London in April 2011 as the mayor’s response to rough sleeping, or street homelessness. The program is built on the belief that rough sleeping is urgent, harmful, dangerous and unacceptable. NSNO also operates based on quick intervention and as a result, NSNO works to reach rough sleepers on their first night on the street in order to prevent long-term episodes of homelessness. NSNO coordinates with outreach teams throughout London who identify people who are out on the street and refer them to NSNO assessment hubs.

At the time of my exchange, I was a little over one year into running the City of Alexandria, Virginia’s coordinated assessment program as the Homeless Services and Resource Manager for an emergency shelter. It was the perfect time to examine best practices from an innovative rapid response program like NSNO.

During my trip, I learned how important of a component quick intervention could become to the coordinated assessment model as it is a way to prevent long-term episodes of homelessness. I also realized that incorporating a street outreach component and providing round-the-clock case management in an overnight assessment hub could provide critically needed resources to clients to help them get into housing as quickly as possible when they would otherwise be sleeping outside.

The NSNO program succeeds because it focuses on quickly addressing homelessness to prevent long-term episodes of it. That’s a challenging goal, but one that can get closer with more programs like NSNO.

Elizabeth Eastlund, Rainbow Services, Director of Programs

The Transatlantic Practice Exchange program provided me with the opportunity to explore the implementation of Psychologically Informed Environments (PIE) in homeless shelters in London. I was interested in exploring PIE as I run domestic violence shelters in the US and I have implemented trauma informed care, which shares similarities with the PIE model. PIE’s take into account the physical environment of the shelter, the psychology of the residents, and supporting staff through a process of reflective practice to understand the psychological processes of residents.

My experience exploring PIE reinforced my belief that we need to take more risks in trying out different ways of working with people rather than continuing with “business as usual.” We can benefit from recognizing what is working and how to replicate it. Overall, I walked away with the understanding that although systems change is challenging, it is necessary if we are going to properly support those who are most vulnerable. Our efforts on both sides of the pond are more effective when we understand that improving the training and support of our front line workers will ultimately lead to improved outcomes for those we are attempting to help.

Megan Gibbard, King County Committee to End Homelessness, Homeless Youth and Young Adult Project Manager

I spent two weeks in London examining two programs that utilize family reunification and shelter intervention to prevent youth and young adult homelessness. My goal was to learn how and whether these strategies could be utilized in the United States.

I was struck by the depth of community support demonstrated in the Nightstop program – individuals will open up their homes to homeless young people. With the Reconnect program, I was struck in part by a comment staff made, “Ultimately, the measure of success in the Reconnect program is that a young person and family feel that they have a stronger relationship.”

I now understand that to end youth homelessness in the US we need:

  • An absolutely deliverable plan to lobby local government. It needs to be clear on how many young people are on our streets. It needs to detail the specific solutions and their costs. “We need more of everything” will not get us to the scale and sophistication of the response needed for young people.
  • A government that will hold the nonprofit sector and themselves accountable. We need government attention down to the person. We cannot solve a problem we cannot see, and we must see each individual with a name who is struggling on our streets tonight.

For further information about the Transatlantic Practice Exchange program, read participants’ reports here. If you have questions about US participants’ experiences with the program or US host organizations, please contact Julie Klein (jklein@naeh.org). If you have questions about UK participants experiences with the program or UK host organizations, please contact Tasmin Maitland (tasmin.maitland@homelesslink.org.uk).