Reflections on #NAEH15: Ensuring Forward Momentum

David Wertheimer is a Deputy Director with Bill & Melinda Gates Foundation.

As someone well into my second decade of NAEH conferences, I always come to the gathering with the hope and expectation of learning about new solutions to homelessness, engaging with interesting people, and honing my own skills in the field. This year, I was (once again) not disappointed.

The level of knowledge – and sophistication – that our field has achieved is impressive. We can, with increasing confidence, say that we know what it takes to make homelessness rare, brief and non-recurring, and how to apply our shared wisdom in urban, suburban and rural settings to minimize, or even prevent, the crisis of homelessness for unaccompanied youth, adults or families.

Although everyone’s experience of an NAEH conference will vary depending on which sessions they attend, here are a few of my thoughts about the themes and priorities from this year’s gathering:

1. The homeless numbers really are starting to go down in many communities. The data that is emerging – as cautious as we must be about our various counting methodologies – are extremely promising. Community after community is following in the footsteps of places like Phoenix and Salt Lake City, where chronic homelessness among veterans is becoming a thing of the past through the use of the Housing First approach. If we can do this for veterans, we can do it for everyone. Although there are those who say that we can only win more resources to combat homelessness by showing numbers that continually go up, I actually think the opposite is true: The more we can show we know what needs to be done to end homelessness – and demonstrate that we can do it – the better the case we can make for more resources to actually get the job done.

2. We are more consistently understanding the limited role of the homeless system. Those of us involved in responding to people who are homeless are increasingly aware that we are, first and foremost, a crisis response system. Our role is to prevent or end the specific trauma of being without a home, and to provide housing and supports that can then serve as a platform for ongoing stability. The resources that our systems have at our disposal cannot – by themselves – end poverty. That can only happen when we work in concert with other critical components of people’s lives – family systems, community supports as well as government-funded services – that can build resilience, social capital and economic stability.

This was most clearly reflected in Nan Roman’s opening comments and the ongoing discussions throughout the conference, about the Family Options Study recently released by HUD. It should surprise none of us that the families who did the best in this particular study along a number of key measures were those who received a permanent housing voucher. But the political and economic realities of our nation right now are such that the possibility of providing a permanent voucher to every individual and family who could benefit from it is something of a pipe dream. Given this context, we need to be looking for the most effective interventions that are time-limited in duration and cost efficient. Although the Family Options Study examined a very early iteration of rapid re-housing – a model that has evolved significantly even since the study was launched – it is clear that this intervention holds enormous promise, and must remain a focus of our efforts as we continue to refine the modality.

3. We are learning more and more about the importance of cross-system partnerships. Every homeless provider, advocate and funder knows well the importance of working across multiple systems to help stabilize and support people who are homeless in their own journeys of recovery. What’s clear, however, is that we’re getting better and better at these partnerships. New opportunities – especially related to health care reform – offer some of the most powerful and promising partnerships to date. The implementation of the Affordable Care Act, presents what is likely among the most significant new partnership opportunities we will have for decades to come. Increases in Medicaid eligibility, combined with the potential to fund services in supportive housing, mean the possibility of greater health and well-being for the people that we serve.

Caution is warranted, however, as we develop this new partnership. We must learn the language and understand the priorities of our healthcare system allies, rather than jumping into assumptions about what we can and cannot achieve with their funds. In particular, leading with the opportunity to shift the cost burden of supportive services from HUD Continuum of Care funding to Medicaid resources is a sure fire way to alienate our new health system friends. Rather, we need to articulate the ways in which the housing and services that can be made available to individuals and families who are homeless can produce significant short and long-term savings to the healthcare system, as well as the positive health outcomes we seek for our clients.

4. Owning the role that racism plays in creating and prolonging homelessness. For the first time in my memory, NAEH hosted a specific, focused conversation about how the structural forces of racism that are embedded within our culture reinforce the realities of homelessness in communities of color. For example, one New York City and Philadelphia study of family homelessness, determined that a Black child under five years old is 29 times more likely to end up in a shelter than a white child. That is an absolutely stunning statistic.

In a nearly filled room, the mini-session that tackled this issue proved to be one of the most electrifying and engaging workshops I have ever attended at an NAEH conference. It was both deeply disturbing and powerfully encouraging. Those in the room were ready for a difficult, challenging discussion about a very uncomfortable topic. Confronting the unattractive realities of our society – and the consequences for people who are homeless – is not an easy exercise. But it is a critically important one, and essential to the success of our efforts over time to end homelessness. This is a conversation I hope we continue and deepen at future NAEH gatherings.

In short, a hearty “thank you!” to the NAEH team for another conference that, for me, hit it out of the ballpark. I was wondering how NAEH could ever top the appearance by the First Lady at last year’s gathering. Congratulations on meeting that challenge.