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Improving homeless access to emergency shelters through technology
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Improving homeless access to emergency shelters through technology
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SOCIAL WORK 722
IMPLEMENTING YOUR CAPSTONE AND RE-ENVISIONING YOUR CAREER
Ron Manderscheid, Ph.D (advisor)
Assignment #3: CAPSTONE PAPER
by Michael Grant Rocco
Doctor of Social Work
December 2019
1
EXECUTIVE SUMMARY
This Capstone project addresses the wicked social problem of homelessness as it is
defined by the Twelve Social Work Grand Challenges (Padget & Henwood, 2018).
Specifically, this author focuses on a bureaucratic issue that prevents homeless people
from accessing emergency shelters in a particular city and in varying degrees in
different cities across the United States: required documentation that prevents them
from gaining entry to an emergency homeless shelter.
This author offers a proposed innovative solution: use technology to store the required
documents to help those who wish to gain entry to an emergency shelter. While each
city might have different requirements for a homeless person to gain admission to a
shelter, the vast majority of shelters nationwide do have some type of documentation
requirement.
The market for this particular innovation may initially be small, especially in the pilot
study phase, but the growth opportunity is quite large. The initial focus would be
Sacramento, California, but if proven successful, the innovation/intervention could be
expanded to any municipality or jurisdiction in the United States, a sizeable growth
opportunity indeed.
The potential competitive advantage is good. There are a couple entities across the
country doing similar things, addressing similar issues, but no one is doing the exact
same thing: using a database to store photo identification cards and health clearance
2
information. The closest “competitor” is storing identification cards in a device that
resembles a Fitbit.
The planned business model will be based on a customer service model as hospital
emergency department(s), emergency homeless shelter(s), and homeless people as
actual customers. The actual “price” at this juncture will be for the technology (if not
already possessed by the two potential community partners listed above) for a database
that can contain all the required documentation noted above, or potentially additional
information that a community partner, or customer can request be added to their
(database) profile. The cost of acquiring the technology varies, but for the purposes of a
potential pilot study, it is negligible, especially for a large acute care hospital. For a
smaller non-profit, like an emergency homeless shelter, the cost for the technology
could prove prohibitive. There is no precise sales or marketing strategy to obtain a
community partner like Dignity Health or the Union Gospel Mission, but anyone wishing
to implement this plan could easily propose the idea to a potential community partner
like the two listed above. For example, this writer created a website and social media
accounts to promote the ideas put forth by this suggested intervention/innovation.
The staff to implement this innovation would likely be existing staff at potential
community partners, like the examples noted above, with the writer acting as a
consultant. One potential alternative would be the formation of a 501c3 (non-profit
organization) in which the author would create an organization that would provide this
service to various (homeless) service providers. If implemented, that scenario could
also be extrapolated on a much broader scale eventually, but for which no current
infrastructure exists. As a consultant, or as the leader of a non-profit, this writer has
3
almost thirty years’ experience, including the personal experience of having a brother
become homeless, and a cousin recently (October 2019) commit suicide due to chronic
homelessness. This is a topic that is both familiar, and dear, to this author.
Finally, in this Executive Summary, the area of financial projections and potential
funding must be addressed (Zwilling, 2011). Outlined much more detailed fashion in the
following pages, the biggest initial outlay of monies will be for the acquisition of
technology. As already noted above, if absorbed by existing and potential community
partners like Dignity Health (national hospital and outpatient clinics chain) and/or Union
Gospel Mission (local Sacramento emergency homeless shelter) the costs will be
minimal due to existing infrastructure and potentially existing technology. Also, the writer
is currently a Dignity Health employee.
Overall, this business plan for the innovation of “Creating a Database to Help End
Homelessness” was created and developed out of the necessity of everyday social work
services with homeless people in a hospital Emergency Department and over thirty
years’ personal and professional experiences with homelessness in San Francisco,
Sacramento, and Los Angeles, California. The focus is on the practical, partialization,
expediency, and common sense. This specific innovation could be implemented and
could make a difference.
4
CONCEPTUAL FRAMEWORK
GRAND CHALLENGE & SOCIAL SIGNIFICANCE
Ending Homelessness is the Grand Challenge focus for this writer’s Capstone
Project. In Sacramento, California, the number of homeless people continues to
increase, while the number of emergency shelter beds continues to remain static or to
decrease (CSUS,2017). To access an emergency shelter bed in the Sacramento area,
an individual must have a photo identification card and documentation that s/he is free
of Tuberculosis infection. Many homeless people have great difficulty obtaining this
required documentation and keeping it in their possession. While the number of
homeless people in Sacramento has increased 30% since 2015 (CSUS,2017), and they
face many challenges, this writer will focus on one specific, seemingly small aspect of
the problem of the chronically homeless who have never utilized the local emergency
shelters that blocks them from entry: the bureaucratic barrier noted above, lack of
required documentation. At the time of writing for this paper, the number of homeless in
Sacramento County has increased 19% (beyond the figure noted above) since the last
PIT Count, and there has been no increase in local emergency shelter beds (Yoon &
Clift, 2019).
CAPSTONE PROBLEM STATEMENT
Due to the reality described above, many homeless people seek shelter
wherever they find it. This writer works on the night shift at Methodist Hospital in South
Sacramento as a Licensed Clinical Social Worker doing mental health evaluations in the
5
Emergency Department. This is an area where most people are in a lower
socioeconomic class, and there are many homeless people, many care homes, many
who are diagnosed with a chronic mental illness, and/or struggling with addiction related
issues.
As with many Emergency Departments nationwide, there are many homeless
people seeking shelter, but have nowhere else to go other than one of their local
hospital Emergency Departments (AHA, 2013). These people most often do not have
the required documentation noted above to access local emergency homeless shelters.
These people are seeking temporary respite from the elements, and hospital
Emergency Department staff want to help, but have few tools at their disposal to do so.
The precise problem these people face is not the lack of emergency shelter beds,
theoretically there are beds available, However, most agree that there is an insufficient
number overall. The precise problem is that the homeless people who need emergency
shelter face all kinds of barriers: pets not being allowed, physical barriers for
wheelchairs, not enough room for belongings, gender specific issues, children, etc.
There are many more, but the “great equalizer” is the one already noted: lack of a photo
identification card and proof of an individual being “TB free.” This may seem small, or
insignificant, but in this writer’s fifteen-year experience, it is the most common reason
people cannot get into a homeless shelter: no ID, no proof of being TB free. Even if they
once had it, they may have lost it, and there is no record kept of it by anyone.
As noted above, the number of homeless people in Sacramento has increased
30% since 2015 to 2018, then what most still perceived as an undercount: 4,000
people. The next PIT count (“point-in-time” count done nationally on the same night
6
each year) was in 2019, and it was expected that the numbers would again rise. They
did, but much more than expected: an additional 19% (to 5,600), and in just one year!
California continues to buck the national trend: our numbers of homeless continues to
increase while nationally this is not the trend (Hosseini,2017). As noted above, the
numbers have increased another 19% in one year, since the last local PIT Count (Yoon
& Clift, 2019).
CAPSTONE PROJECT AND PROPOSED INNOVATION
This writer’s proposed Capstone project is the development of a database that
will contain the documentation that is required to enter Sacramento area emergency
homeless shelters. Local shelters are somewhat open on the requirement for photo ID,
but for proof that an individual is “TB free,” it must be the result(s) of a recent TB Tine
test, or a clear chest x-ray. The database will retain the documentation if the client
desires and assigned staff will share the documentation with local providers as the
patient requests it.
The policy that would possibly need to change would be the local emergency
shelter’s desire and ability to accept this documentation from a third party. The program
would be this new proposed service/practice in assisting homeless patients in Methodist
Hospital’s Emergency Department as a proposed pilot, or in Dignity Health’s Emergency
Departments regionally, as Dignity Health is the parent company that owns Methodist
Hospital. A recent merger with another hospital chain (Catholic Health Initiative) has
created an even larger private, non-profit hospital chain that stretches coast to coast.
7
The proposed name is “Common Spirit.” This proposed practice/intervention could also
be applied to any locality and keep the homeless patient’s required documents for
accessing local emergency shelter beds. With this recent merger, the potential to reach
even more homeless people is far greater. This proposal addresses a widespread
(almost universal) barrier that keeps homeless people out of emergency shelters: lack
of required documentation.
SOCIAL SIGNIFICANCE
My Capstone proposal is innovative because no one else has attempted to
implement this idea yet. The main features of this proposal are not being attempted
anywhere else that this writer discovered after several internet searches and after
talking to patients, workers, and providers in this field of serving the homeless. There
are several municipalities that are attempting to increase access to emergency shelters,
decrease barriers, also trying different innovations, but this writer was not able to locate
one that was using a database in the proposed manner. This writer could not find any
homeless service providers that are utilizing a database, or more precisely a database
that retains their personal information to help with any type of housing. In past few
weeks before submission of this paper, this writer had two additional conversations with
a State (CA) leader of services to the homeless (Nor Cal and SoCal), as well as a
leader of a national organization that is involved in providing health care services to
homeless people. There is still no known provider, or entity using a database to store
required documentation for entrance requirements (to emergency shelters). In fact, the
8
State leader suggested that the stored information be expanded to include the
individual’s primary health care concerns (HIPAA protected).
My Capstone proposal will disrupt the social norm of accepting widespread
homelessness as a reality for our nation, that we cannot “do better.” If successful, this
innovation will decrease homelessness in Sacramento, and circumvent the extreme
NIMBYism (another norm) that prevented two new large, multipurpose emergency
shelters that the City of Sacramento attempted to build after they received several
million dollars from the State of California’s demonstration grant of “Whole Person Care
(Garrison & Lillis, 2017).
The hopeful expectation emanating from this proposal would be fewer homeless
people on the streets of Sacramento City and County, and more people able to access
emergency shelter beds locally. The result of removing this barrier to access would be
more access and more utilization of local emergency shelter beds by homeless people.
9
LITERATURE REVIEW
Grand Challenge of Ending Homelessness by American Academy of Social Work
and Social Welfare (2018) Oxford University Press Authors: Deborah K. Padget, PhD;
Benjamin F. Henwood, PhD; Dennis P. Culhane, PhD
The “go to” text for understanding the current “wicked social problem” of homelessness
in the United States. A comprehensive look at how we got here, the unfortunate “norm”
that homelessness is now an accepted part of the American urban landscape, what is
working to reduce homelessness, some new trends, commentary on the current state of
affairs for homeless people, implications for social work, and some good, concrete
suggestions on how we can move forward, thus “Ending Homelessness.”
Congressional Budget Office (2015). Federal housing assistance for low income
households (Publication No.50782). Retrieved from
https://www.cbo.gov/publication/50782
This report by the Congressional Budget Office offers a plethora of facts, figures, and
history of services and programs to homeless population of the United States. The
report was prepared at the request of US Senate’s Chairman of the Budget Committee
and offers details on the cost of programs, the progress toward stated goals, and an
impartial analysis of programs like Housing Choice Vouchers (HCV), PRBA (rental
assistance), public housing, tax credits, etc. The focus appears to be on numbers and
demographics. A good source of factual details and the scope of the problem.
Culhane, D.P., Metraux, S., Byrne, T., Stino, M. & Bainbridge, J. (2013) The age
structure of contemporary homelessness: Evidence and implications for public policy.
Analyses of Social Issues in Public Policy. 13, 228-224. doi:10.1111/asap.12004
This author is one of the main leads for the Grand Challenge of Ending Homelessness
and “ASAP” is an acronym for Analysis of Social Issues & Public Policy is an electronic,
scholarly journal sponsored by Wiley-Blackwell on behalf of the Society for the
Psychological Study of Social Issues. The focus of this article is the aging homeless
population, especially those in New York City, and those at the tail end of the “baby
boom” The author points out that this population is at higher risk of homelessness than
others before, or after it, chronologically. The author points out the necessity to plan
accordingly, with emphasis on unique needs of the elderly and/or newly homeless in
this age group.
10
Delaware, C.N., & Crowley, S. (2002). Changing priorities: The federal budget and
housing assistance 1976-2007. Retrieved from National Low-Income Housing Coalition
website:
http//nilc.org/site/default/files/changingpriorities.pdf
NLIHC is a public policy and advocacy organization that works toward the goal of
achieving “affordable and decent homes for all.” This article details the trends and
policy changes of the federal government in low income housing assistance and
homelessness over the course of three decades. For example, the shift of the federal
government toward vouchers and away from construction of housing, and the
subsequent results.
Herman, D.B., Conover, S., Gorrochurn, P., Hinterland, K., Hoepner, L., & Susser,
E.S. (2011). Randomized trial of critical time intervention to prevent homelessness after
institutional discharge. Psychiatric Services 62(7), 713-719.
doi:10.1176/ps62.7pss6207_0713
This article discussed a study that addressed the effectiveness of interventions targeting
the chronically mentally ill as they were discharged from an acute hospitalization. The
study of the interventions showed that they were effective in reducing the incidence of
homelessness following an involuntary psychiatric hospitalization.
Montgomery, A.E., Hill, L.L., Kane, V. & Culhane, D.P. (2013) Housing chronically
homeless veterans: Evaluating the efficacy of a Housing First approach to HUD-VASH.
Journal of Community Psychology, 41(4), 505-514. doi:10.1002/jcop.21554
This article documents the first study to document positive outcomes for utilization of a
“Housing First” approach. Model has been successfully extrapolated for use with other
homeless populations with similar results.
National Alliance to End Homelessness. (2012) An emerging framework for ending
unaccompanied youth homelessness (Report) Retrieved from
http://www.endhomelessness.org/library/entry/an-emerging-framework-for-ending-
unaccompied-youth-homelessness
This is a policy brief that discusses the need to develop an overall framework for work
with this specific population, and how to measure success or progress in that work.
Also, how to deploy resources to better address the needs of this population and the
process provides some good statistics on homeless youth.
11
National Alliance to End Homelessness. (2014, April). Rapid re-housing: A history
and core components (Solutions Brief). Retrieved from
http:endhomeless.org/library/entry/rapid-rehousing-a-history-and-corecomponents.
This is an additional policy brief that discusses the three core components of rapid-
rehousing: Housing Identification, Rent & Move-in assistance (usually not permanent)
programs, & case management (detailed) services. A good overall guide on the
implementation of this approach.
HUD Annual Homeless (AHAR) Assessment to Congress (October 2014): Office of
Community Planning and Development. Retrieved from
https://www.hudexchange.info/resources/documents/2014-AHAR-Part1.pdf
The Principal Investigator for this assessment was Dennis Culhane, a lead in the Social
Work Grand Challenge to End Homelessness. At first glance, this document looks as if
it is entirely made up of charts and graphs. It does give very precise information about
the homeless population across the country, specific demographics, and trends in
individual states/localities.
Journal of Substance Abuse Treatment (2012) A Qualitative Analysis of Case
Manager use of harm reduction in practice. Henwood, D.B. Published online 4-23-2012
This is a study that discusses how the HF (Housing First) model focuses on consumer-
provider relationships and also explains how harm reduction works well with ACT
(Assertive Community Treatment). The results were very positive, and the model has
been adopted by over forty U.S. cities nationwide.
Journal of Social Service Research (2015) Promising Programs for LGBTQ Runaway
& Homeless Youth Ferguson,K.M. & Maccio,E. Volume 41, Issue 5; Pages 659-683
Published 8-17-2015
This is a qualitative study of 19 not-for-profit organizations serving this population.
Twenty-four staff members were interviewed about new programming, perceived
service gaps, and recommendations for policy, practice, and research.
12
PROGRAM THEORY AND LOGIC MODEL
The main theory behind my proposed solution to the bureaucratic barrier(s) of
getting homeless people into emergency shelter beds is the “Housing First” theory
(MHSA, 2008), which is the philosophy that homeless people may have many concerns
but getting them into ideally permanent housing should be the highest priority
regardless of any other circumstances. This approach has shown results locally, in
Sutter Hospital’s T3 program, which was noted earlier in this paper (AHA,2013). This
approach has been so successfully across the United States (Cunningham & Batko,
2018) that it was adopted as national policy when President Obama signed HPRP
(Homelessness Prevention and Re-Housing Program) legislation in 2009 (HUD,2010).
PROBLEMS OF PRACTICE AND INNOVATION SOLUTIONS
If successful, this innovation will take homeless people off the streets of
Sacramento and put them into emergency shelter beds by removing a key barrier: lack
of documentation to access an open bed in one of the local emergency shelters.
Ending homelessness, or at least greatly reducing it is the goal of many local services
agencies.
Providing various services (like counseling or hot meals) to homeless people
encompasses many more agencies. There are many stakeholders in this area,
including homeless people themselves. In my initial survey of approximately forty
homeless people using the Emergency Department at Methodist Hospital, I found
results that verified my initial perceptions: lack of photo ID and health clearance were a
13
barrier. Also, in my many informal conversations, or formal interviews with all these local
stakeholders since 2004, there is one thing all can agree upon: there are not enough
local emergency shelter beds, or permanent housing for those that need it. What is
available is not accessible, for many reasons.
Initially, this writer was not aware of any other attempts to address this specific
problem of bureaucratic barriers (like this documentation), at least locally. In preparing
for the submission of this paper, the writer has confirmed with a State leader, with thirty-
five years’ experience in providing services to the homeless, that there is not a
homeless services provider in California using a database to store required
documentation. As noted above, the executive director of a national organization that
provides health care services to homeless people also confirmed that he had not heard
of any provider using a database to store any documentation for homeless patients. As
much as these two realities bolster this writer’s appeal, and proposal, it should be noted
there are efforts elsewhere in the United States to address similar barriers, like
expediting the acquisition of photo identification, but after several discussions and
internet searches, this writer has uncovered no initiatives utilizing a database, especially
one that links required documentation to actual entry or attainment of a shelter bed.
The effort by MiniCity in Atlanta seems to be the closest development.
There is no perceptible initial cost to beginning this innovation, especially if the
main/host partner is Dignity Health, writer’s current employer. This innovation could
rather easily be adapted to other localities across the United States, also using other (if
needed) documentation specific to that specific locality. This model could also be used
14
for a similar target using the Housing First theory: permanent housing (much like T3
mentioned earlier).
While technically “not ready for prime time,” the startup for this innovation could
begin rather quickly once partners were secured and M.O.U. (memoranda of
understanding) signed. The logic model in Appendix 1 provides the details that illustrate
this last statement.
The Lean Canvas is Appendix 2 gives additional illustration about progress
toward the immediate goal of a pilot, with a specific mention of a need for blockchain.
The Logic Model has also been amended with a nod to the need for blockchain.
At time of this writing, it should be noted that writer is in the process of securing
letters of support from potential community partners, and current, local (homeless
related) service providers in the field.
PROJECT STRUCTURE, FINANCIAL PLANS, AND STAGING
This innovation could very likely be completely developed and absorbed by
Dignity Health, which is this writer’s current employer. This writer has received
preliminary approval to proceed with development, but there is no current technical or
practical support to proceed to a formal prototype of the blockchain/database.
If this writer were to find another community partner, or partners (hospital
Emergency Departments are the most natural partners for reasons described earlier in
this paper), that might facilitate the emergence of new, or hidden costs, especially
regarding the development of infrastructure robust enough to partner with an entity as
15
large as a large acute care hospital. The main, anticipated expense would be the
acquisition of blockchain technology (“wallet app” is most compatible it seems) which
seems to range from $5000 to $20,000. This database component would need to be
resolved before advancing to an implementation of the pilot/prototype stage. The only
alternative would be if the prototype were to be significantly “scaled down,” thus
rendering the acquisition of blockchain initially unnecessary. The only potential revenue
sources on the horizon would be from potential community partners (paying for the
service), or if the innovation were to be picked up by Dignity Health.
BUDGET FORMAT AND CYCLE
As noted above, like other parts of this proposal, the budget cycle will depend on
which direction is taken by this writer: absorption by Dignity Health or another provider,
creating a 501(c)(3), or attempting to create a new private enterprise, selling the
technology/service to governments and agencies engaged in serving the homeless
population. Writer will be working with “zero-based” budgeting initially, due to familiarity,
but also due to the reality of the situation if this proposal is individually driven, and a
“start-up.” The budget cycle would be determined by potential funders: governmental
funding will require adherence to the federal/state/local fiscal years, foundation grants
would warrant their own budget cycle dates, and so on.
The United States Federal Fiscal Year (FFY) runs from October to September.
The California State Fiscal Year (FY) runs from July to the end of June each year.
Private foundations seem to vary, by locality, size, projects, etc. In this writer’s limited
16
experience, there does not seem to be a standardized date, as writer also checked
several foundation websites to verify that statement.
REVENUE PROJECTIONS
Initial revenue will be required immediately if the proposal is not adapted by a
sponsoring entity like Dignity Health. If the route is via 501(c)(3), or a private endeavor,
it will require immediate funding for acquisition of block chain infrastructure, or
sponsorship on the “other end” of service provision: homeless services providers. Writer
has estimated the cost acquiring block chain technology as approximately $20,000. If
block chain technology is not required, and writer’s existing, private resources can be
utilized, the initial requirement for revenue would be significantly minimized. This then
would only require willing individual participants, and two willing partners, on “either
end” of the service spectrum, i.e. hospital Emergency Department, or similar referral
source, or an emergency homeless shelter.
PHASES/STEPS FOR INTERVENTION
As noted above in the previous sections of Part B, the potential sources of
revenue would be a payor source (because subjects/clients would have to be patients) ,
to a sponsoring organization like Dignity Health, or a contractual partner like DMH, The
State of California (via a State grant program like Whole Person Care), or a foundation.
Depending on individual various details (related to auspices mostly), and the
most likely scenario, very generally speaking, the first year’s budget would be under
17
$500,000 with the biggest expense being labor (and based on premise that writer would
remain a Dignity employee, with Dignity salary/benefits in own cost center) and cost of
acquiring Blockchain technology (approximately $20,000). This is very general and
broad but does address the assignment requirements. Other than patient’s payor
sources (for care in the Emergency Department of local Dignity hospitals), there could
be funds available via the State of California’s Whole Person Care demonstration grant
(which is in phase II locally), or through “subcontractor” status on that same grant with
the City of Sacramento, for example.
UNITS OF SERVICE FOR PROPOSED INNOVATION/INTERVENTION
At this juncture, units of service will be employee time spent with clients after
infrastructure is in place to begin operations, and successful placements of clients into
emergency homeless shelters. Until such time that operations begin, units of service
would be calculated as activities completed to set up operations.
STAFFING PLANS AND COSTS
This depends on sponsorship (by Dignity or Saint Anne’s) of the proposal versus
an independent effort, or the creation of a 501(c)(3). Existing infrastructure in large,
sponsoring organizations such as Dignity Health, or Saint Anne’s, would significantly
lower startup costs. This seems to less likely if sponsorship is obtained “on the other
end” of services, or client access like emergency homeless shelters. The technology
needs will also help determine costs. As noted above, if the costs of acquiring
18
Blockchain can be delayed, and this writer is only person initially involved/dedicated to
the “startup” phase, then costs will be minimal and help facilitate viability of this
proposal/project.
OTHER SPENDING PLANS AND COSTS
Again, these calculations depend on potential sponsorship, on which “service
end” intervention occurs, or the successful fundraising efforts of a new 501c3, or
individual entrepreneur. Obviously, if there is a sponsoring organization, it will absorb
these costs to get the project implemented. If this proposed innovation is involved in a
newly created 501(c)(3), or the result of private entrepreneurship, this will greatly affect
the related costs, especially if the proposal is implemented, participants/partners
secured, and a new entity created. Once the entity is established, things like
employees, benefits, office supplies, etc. will become a reality.
LINE ITEM BUDGET
As noted often above, the initial outlay will be for block chain technology, and that
is based on the premise of the innovation not being incorporated into a larger
organization like Dignity Health. If this proposal is not adopted by a larger organization,
then the initial budget will not be large, or very detailed. A budget for the project that is
still within the overall organization of a Dignity Health, or a similar organization, will look
very different from a startup 501c3, especially in terms of a dedicated FTE, computer,
office, benefits, office supplies, etc. than if it just this writer trying to create something
19
from scratch in his spare time. The budget process for an existing business is different
from a startup budget. An existing business will have a history of transactions and
numbers (budgeted and actual) from which to draw and it isn’t difficult to look back to
some of the average costs and sales for months and years at a time, to see important
trends and patterns. The startup budget, on the other hand, has no historical data, so
assumptions must be made and prorated into the future (Murray, 2018). The following
pages illustrate the preliminary budget steps for a startup 501(c)(3), or where the project
(& subsequent budget) process is at time of this writing.
20
21
KEY SUCCESS METRICS/BENCHMARKS
Perhaps the most obvious benchmarks will be actual clients who “sign up” for the
service. The plan will also be to “track” actual clients who use the service to see if they
are able to sustain use of a given shelter, and can continue to utilize the database to
access a shelter bed in the future, even if it is in a different homeless shelter.
Theoretically, the data could be exported to providers in different geographical areas.
Other, more basic benchmarks are the acquisition of a suitable and compatible
community partner, and the resolution of the database technology issue. The
“acquisition” of participants does not seem to present a problem, especially if
“incentives” like gift cards, or small cash grants are utilized, as evidenced by this writer’s
relative ease of obtaining over forty participants in the “pre-pilot” survey. Perhaps those
results could also be a part of the actual “pre-test.”
The process going forward needs to consider the following entities and
dynamics, regardless of the final sponsoring organization(s), or individuals:
FACILITATORS:
*Potential Sponsoring Organizations (like Dignity Health, Saint Anne’s Home,
emergency homeless shelters)
*Community Partners (like law enforcement, homeless coalitions, miscellaneous
service organizations)
*Hospital patients (who are also potential utilizers and clients)
22
*Personal and Community Supporters (via financial or in-kind, moral support,
volunteering, guidance, etc.)
*Professional Contacts (client referrals, shared information, and resource
information)
*Consultants (help with training, fundraising, grant writing, etc.)
BARRIERS:
*Bureaucratic (like HIPAA, or like “built-in” inertia like a hospital environment)
*Non-Cooperation (like staff resistance to pilot, resistance to “outsiders,” or generic
opposition to any change at all)
*Indifference (from the community in general, homeless people, or providers)
*Politics (between agencies, among staff, any type, in any environment)
*Funding (mostly regarding issues if the route taken is the creation of a 501(c)(3) or a
private enterprise endeavor)
*No interest, or participation from homeless people, or potential sponsors
23
IMPLEMENTATION STRATEGY AND PROCEDURES
My proposed strategy is contingent upon the route taken: 501(c)(3), Within
Dignity Health, or a venture of private enterprise. My preference and comfortability are
multifaceted, as it seems the most comprehensive, and the type that might allow for the
most control. It important to recall and emphasize here that writer is not discussing
Evidence Based Practices (EBP) per se, but they could be used as a model, or as a
means of analysis.
This writer has included a Gantt Chart as an appendix (number 3) and it
illustrates the procedure(s) and timeline for implementation. There are nine overall
categories/stages and the graphic depicts the coming year (2019) month by month
within each category/stage, and the precise activities therein.
For example: writer’s current contacts with MiniCity (an Atlanta based Tech firm)
about their current phase II of a pilot study focused on a bracelet given to Atlanta
homeless people that resembles a Fitbit and retains their photo identification and
enables them to access important social services in Fulton County, Georgia, and/or the
City of Atlanta. The Gantt Chart indicates that writer will be in close contact with them
(mostly the PI it seems) from time of this writing until at least July 1
st
. Other
stages/categories are ongoing, such as “Funding Pursuits,” or “Community Consulting
Regarding a potential Start Up.”
24
PROCESS AND OUTCOME MEASURES AND EVALUATION
To obtain more information and viewpoints, writer has developed a series of
questions posed to homeless with whom writer has daily contact, as well as various
service providers like local Emergency Department staff, local law enforcement,
Emergency Shelter staff, and random members of the general public who have no
known attachments to this Grand Challenge, the wicked social problem, writer, etc.
Writer has held informal focus groups and tabletop discussions, both within Dignity
Health, and in the community, with homeless people, providers, professional peers,
(homeless) family members, etc. As a result, writer would propose some changes to a
formal pre-test, posttest, if this project is able to proceed to implementation.
NEW SURVEY QUESTIONS
This writer has begun data collection via a simple survey using some basic
questions:
*Have you ever used an Emergency Shelter bed in Sacramento?
*What do you think is the biggest obstacle to using emergency shelter beds in
Sacramento County?
*Would you use an emergency shelter bed in Sacramento County if someone were to
help you with the required documentation?
*What percentage of homeless people in Sacramento County do you think have never
used an emergency shelter bed?
25
*Name one Sacramento organization that does a good job serving the homeless?
This simple survey format would seem to be high on content validity, as the
questions posed have to do with closely related subjects to writer’s concrete, narrow,
and specific innovation and proposed remedy. It also seems to this writer that this
survey is high on internal validity, as the questions posed seem to be able to establish
a relationship between the independent and dependent variables. The level of external
validity seems to be acceptable as the results thus far can be generalized to “other
homeless people” who are not necessarily the focus of this survey and the target of the
intervention/innovation. The reliability seems to be at least an acceptable level as the
consistency of the responses to the survey thus far are offering the same type
information over, and over again.
The plan for monitoring the implementation and outcomes is more theoretical at
this juncture.
POTENTIAL CHALLENGES AND ALTERNATIVE STRATEGIES
Other than the benchmark issues of the database technology and community
partners noted above, the biggest perceived challenge appears to be the resolution of
any potential HIPAA (Federal Confidentiality law) related concerns. As the MiniCity pilot
study (Mazzoni, 2018) discovered, HIPAA occasionally presents its own obstacles
(usually reticence of people to have their personal information gathered and shared).
This is a potential challenge at this juncture, as a prototype has not been formally
26
presented, or approved, by USC, Dignity Health, or a potential alternative community
partner.
OVERVIEW OF SUSTAINABILITY/PLANS MOVING FORWARD
This innovation appears very sustainable if it is integrated into Dignity Health’s
existing hospitals, departments, infrastructure, etc. If not, then there could be the option
of forming a business, or a 5013c, and proceeding with an alternative community
partner. The database will be a more prominent challenge though if that is the route
taken, because funding for the database will likely emerge as an obstacle.
There are many current sources for funding available for homeless related
services. In fact, some have noted that current available funds are not being spent
(Dillon, 2018). Potential available sources of funding (other than Dignity Health and
Foundation funds) are a State of California demonstration grant: Whole Person Care,
MHSA (Mental Health Services Act/Prop 63) funding administered by California
Counties for new programming, and the recently (11-6-18) passed Proposition 2
funding, which specifically targets housing for the homeless mentally ill.
The next step will be to pursue the Dignity Health option, to see if the Dignity
Health Development Department will commit to the process of developing this proposal
to completion. If not, then the alternatives noted above would need to be attempted.
27
PROTOTYPE
The “deliverable” prototype is a replication of the informal survey done of forty
randomly selected homeless people in the Sacramento, CA. area. The survey
questions were minimal and basic. Here are the three questions used by writer with
over forty homeless people over the past two years:
1) Have you used Sacramento area emergency homeless shelters?
2) If no, why not?
3) If you lack ID, or health clearance documentation, and someone were to store the
required documents for you, would you participate in that process?
As noted earlier, the survey participants were homeless people who were either
patients in the Emergency Department at Methodist Hospital in Sacramento, California,
who also stated they needed assistance with their homeless situation, or they were
literally homeless people on the streets of Sacramento, California who approached this
writer for a donation.
Those participants remained anonymous, with no identifying information, save for
gender, approximate age, and race. As with the hospital group, these participants self-
identified as homeless, agreed to willingly participate, and were a diverse group, very
representative of Sacramento (and its homeless population) and its diversity.
This survey could be used as a sort of pre-test for homeless people who agreed
to participate in a pilot once the blockchain technology has been acquired by a
28
participating community partner. This is like the pilot that MiniCity is undergoing in their
second year of their “ID bracelet” technology for homeless people in Atlanta (Mazzoni,
2018). The survey could be completed in an inexpensive manner using traditional
materials like paper and pencil, or perhaps using software already in use by potential
community partners. It does not appear that any current software in use by either
community partner approached by writer is used by both entities, so it appears at time
of this writing that the traditional means of collecting data in a pre-test manner would not
be completed via any common technology (at least currently, and per current level of
knowledge of both providers).
Although it seems unlikely, and quite dramatic, writer has discovered on the day
of this assignment’s submission, that there is an exploratory effort among Dignity
Health, and all local emergency, homeless shelter care providers to develop software
that tracks vacancies in local homeless shelters. This is similar to Los Angeles County’s
HIMS system, which does the same thing. There is no implementation date, but it does
seem to be a certainty, and on the near horizon.
As already noted, potential pilot study participants could perhaps be the exact
ones that have already participated in writer’s initial, informal survey. If not possible or
desirable, alternative participants could be recruited in the same manner as the initial
participants, in the same locations: Methodist Hospital Emergency Department patients
who are homeless (randomly referred/selected), and homeless people on the street,
who were willing to speak with writer about these concerns.
The most important aspects of using this (same) survey are: readily available
data, existing results, quick launch of a potential pilot, easy access to most participants
29
if so desired, simple and easy to understand results, easy capture of needed data, and
“matches up” easily with blockchain/database concept.
As noted earlier, this all works the best and quickest, if Dignity Health chooses to
be a part of the pilot, and an initial community partner, as their infrastructure would
facilitate a seamless transition to the first year of a potential pilot. This could also bridge
any tech or financial gaps/issues if the other (emergency homeless shelter) is not able
to technologically and financially match Dignity’s contribution(s).
Both proposed/potential community partners (Dignity Health and the Union
Gospel Mission) are already private, non-profits with the requisite paperwork for private,
religious based, non-profits.
As noted, many times above, by writer already completing an informal survey,
this proposed prototype has been partially utilized already, with some success (at least
numerically). The results reinforced writer’s perceptions that this phenomenon is a
barrier. It is not a barrier to many homeless people, nor is it the number one barrier
faced by people trying to access emergency shelter beds, but it is a problem that could
be eased by implementing this innovation. There are potential secondary gains to
utilized if this information is captured (or expanded upon), as noted by a community
expert, and a similar pilot already underway in another major American city (Mazzoni,
2018).
In terms of ethical considerations, there do not seem to be any major
considerations detected. At this stage, certainly, there is no need for a monitoring body
to evaluate the project, or its components. A pilot study has not been done. The
30
proposed idea has not implemented: no photo identification cards have been collected
or stored, no chest x-rays have been performed. There are no known ethical
considerations e.g. no one will be getting goods and services that other participants will
not receive. There is no potential need for human subjects (IRB) to become involved, or
for a professional organization like NASW (National Association of Social Workers) to
be consulted.
CONCLUSIONS, ACTIONS AND IMPLICATIONS
SUMMARY OF PROJECT PLANS
The current state of the project is in a state of stasis, as there is no current
funder, or community partner. Dignity Health (at least at the Methodist campus) has not
agreed to a formal pilot study, thus making a formal pilot study difficult, unless another
hospital Emergency Department is secured. This is potentially possible, but not likely.
There are other hospital Emergency Departments in town that might be interested, but
there is no infrastructure in place as writer would not be an employee, or does not
possess any infrastructure, a consulting business, or the means to bring anything
tangible to the table to begin “the process.” As mentioned earlier, there is would always
be the option of beginning a 501(c)(3).
31
CURRENT PRACTICE CONTEXT FOR PROJECT CONCLUSIONS
For social workers already working with homeless people in these practice
settings (hospital Emergency Departments and emergency homeless shelters), there is
little impact: it is “business as usual.”
There are many innovations in discussion, and some innovations are still in early
stages of implementation. Housing First as a policy offers us a recent and promising
example. Housing First is still somewhat new (not as a concept) as an implemented
policy. Under President Obama’s administration, it was the policy in terms of preferred
interventions in addressing homelessness. It has not been implemented on a
widespread basis, but where it has been implemented, it has shown improvement in
decreasing the amount of homelessness in the localities where it has been
implemented. The writer uses Housing First’s implementation as a potential example of
how implementation of this innovation: using a database to store the required
documentation for access to an emergency homeless shelter.
PROJECT IMPLICATIONS FOR PRACTICE AND FURTHER ACTION
The potential for impact on this work by social work, with homeless people
remains great. There are similar projects, using similar ideas, technology, and
interventions across the country. While no one is implementing this specific idea, it is
likely of no great significance, but that social work as a profession is attempting to use
innovation to implement of the Twelve Social Work Grand Challenges (Ending
Homelessness) is the larger, more important development. The rise of a pilot study like
32
MiniCity’s in Atlanta demonstrates that change is possible, and that small, specific
change using technology and innovation within social work to help poor and homeless
people is possible. It is this type of thinking and intervention that will lead to the actual
end of large-scale homelessness in the United States and finally subvert the norm that
we, as a culture must accept it.
PROJECT LIMITATIONS
There are certainly limitations in this idea, this specific proposal, and the focus
and scope of this specific project, but the overall intervention, using a database as an
intervention to combat homelessness, albeit a very thin aspect of homelessness, is
quite limitless, as already pointed out by the local expert who encouraged this writer to
widen the focus e.g. to include medical information in the database of homeless (pilot
study participants) patients in hospital Emergency Departments. This is not the
movement changing innovation, like the reality changing implementation of Housing
First as a policy, and how it has changed the numbers of homeless people for the
better. This does have the potential to make things better though, if properly managed
and implemented. It still would not likely make mention in any follow up literature of how
the Grand Challenge of ending homelessness was met.
33
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05/29/2018; retrieved from www.thebalance.com
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36
Appendix #1
LOGIC MODEL TEMPLATE
Resources/Inputs
(Human, financial,
Organizational,
community
resources
available/needed to
accomplish
program activities)
Activities
(Processes,
events, tools,
technology,
actions
involved in
program
implementatio
n)
Outputs
(Direct
products of
program
activities:
evidence of
service
delivery)
Short Term
Outcomes
(Outcomes you
expect to see re
participants’
behaviors,
knowledge, skills,
functioning)
Long Term
Outcomes
(Outcomes/impact
s expected longer
term)
HIPPA issues
resolved.
I can start
implementation
once agreements
and approvals are
in place.
Agreement from
local shelters to
participate.
Permission from
Dignity Health to
begin (if they are
actual partner).
If not Dignity
Health, then an
optional partner
would be needed.
If Dignity Health is
partner, no initial
financial outlay is
needed
Resolve questions
about blockchain
capacity
Negotiate
M.O.U.
(make sure to
include
transport by
hospital
partner for
example)
Potential
Clients
identified by
E.D. staff.
Forms
finalized like
special
assessment
form,
Informed
Consent, &
HIPAA/ROI
I begin to
interview/ass
ess
Documents
scanned in
MOU
secured
Forms/forma
t finalized
Clients sign
up for
service
First forms
for first
clients
successfully
sent to
providers (of
emergency
shelter)
Critical mass of
clients sign up for
service
First clients are
actually/physicall
y placed in local
shelters.
A smoother
process of
placing clients in
homeless
shelters has now
been initiated.
The numbers of
homeless people
participating in
program increase
Numbers of people
who have been
chronically
homeless and
whom have never
used emergency
shelter increase.
Ultimately the
number of
homeless people
decreases in
Sacramento
decreases (or in
any other locality
using this
innovation. Per
annual PIT.
37
Appendix #2
38
Appendix #3
Abstract (if available)
Abstract
The author focuses on a bureaucratic issue that prevents homeless people from accessing emergency shelters in a particular city and in varying degrees in different cities across the United States: required documentation that prevents them from gaining entry to an emergency homeless shelter. While each city might have different requirements for a homeless person to gain admission to a shelter, the vast majority of shelters nationwide do have some type of documentation requirement. An innovative solution is proposed - use technology to store the required documents to help those who wish to gain entry to an emergency shelter.
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Asset Metadata
Creator
Rocco, Michael Grant
(author)
Core Title
Improving homeless access to emergency shelters through technology
School
Suzanne Dworak-Peck School of Social Work
Degree
Doctor of Social Work
Degree Program
Social Work
Publication Date
12/12/2019
Defense Date
11/21/2019
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
access,California,Documentation,entry,homeless,OAI-PMH Harvest,requirement,Sacramento,Shelter,TB,Technology
Language
English
Contributor
Electronically uploaded by the author
(provenance)
Advisor
Manderscheid, Ron (
committee member
)
Creator Email
gdinlb@yahoo.com,mvrocco@yahoo.com
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-c89-252721
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UC11673824
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Rocco, Michael Grant
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texts
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University of Southern California Dissertations and Theses
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