New York Continuum of Care Report (Long)

Graeme Bacque (gbacque@arcos.org)
Sun, 19 Apr 1998 21:38:44 -0400


Keep in mind this report was authored by two senior City of Toronto
bureaucrats... even so it paints a pretty scary picture.
Graeme
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OBSERVATIONS OF NEW YORK CITY'S
CONTINUUM OF CARE PROGRAM FOR THE HOMELESS

Robert Yamashita and Alice Gorman

January 1998

GENERAL OBSERVATIONS:

1) There is little recognition of the dignity, will, inherent skills and
diversity of the individual persons experiencing homelessness.

2) There is no recognition of the strength and potential of the
community of homeless people (there is no Community Development
component).

3) There is no systemic analysis about the root
societal/economic/globalization causes to homelessness.

4) Community development, or any  non-judgemental approach that starts
with where people are at (eg. harm reduction, self help, CED) are
antithesis to the Continuum of Care ( C of C)approach.

5) The program definition of "Continuum" means a linked system that the
individual must move through in designated timeframes as opposed to our
interpretation of a "Continuum" as a set of options to be used when and
if the person chooses.

6) The program is based in the belief that homelessness is essentially
the result of individual mental illness, addictions and unemployment.
The personal responsibility tenets of the program are imbued with
judgements of laziness, weakness of character, lack of accountability,
criminality and sickness. The clients are almost
exclusively African and Hispanic - Americans.

7) The solution to homelessness is a coordinated treatment program
complemented with a time limited private sector based housing subsidy
program. The assessment aspects of the program are limited in their
diagnoses by the narrow levels of C of C responses.

8) The program is very expensive, time limited and based in zero
tolerance.

9) The program was a precursor but is presently the implementing program
to the national Personal Responsibility Legislation.

10) Public and private sector support is garnered through immediate and
tangible results eg. no visible homeless population, perceptions of
crime reduction, increased business and tourism.

11) The program supports a new layer of unqualified private sector
service providers.

12) The existing community based agencies have changed their
localized/client centred approach in order to be part of city/state wide
program.

13) The clients, patients or customers are expected to assimilate into
mainstream jobs, housing and society  and be independent of any
program/subsidy support within a 2 year time frame.

14) The localized nature of homeless persons existence has been
dislocated in the transportation of individuals out of their
neighbourhoods and in some cases out of the city.

15) Visible homelessness has been criminalized and the police form the
frontline to the points of entry into the Continuum. This is empowered
by law in Mayor Guiliani's "Quality of Life" act.

16) By state legislation all homeless services must have full security
measures including metal detectors and personal searches. This has
effectively eliminated anyone who might exhibit anti- social behaviors.

17) The people who are newly homeless and have had mainstream experience
can move through the system easier. It is this group that derives the
greatest benefit from the C of C and supports their success data.

18) This is a relief system and in concert with personal responsibility
legislation eliminates any concept of entitlement.

20) All agencies that were visited used psycho tropic medication as
basic support for all their clients.

21) After the assessment all clients enter into "performance contracts"
which commits them to the treatment plan and time frames.

22) Overnight in 1994 this system was imposed on the existing homeless
support network.

23) There is no long term commitment to the C of C program.

24) The Department of Homeless Service actively destroyed Community
Economic Development projects.

25) If clients pay for their stay in the hostels they do not have to
participate in the performance contracts.

26) This is a top down system, the homeless and frontline staff have no
input into policy, administration or review .

27) The program overtly discriminates between those who are deemed
deserving and those who are not.

CONCLUSIONS:) Heightened awareness of value of the dignified and
sensitive approaches that are continuously evolving in the City of
Toronto.

2) Our programs and projects are sucessful, long lasting and sustainable
because they recognize the role of homeless persons, the need for local
solutions and the critical role of skilled frontline staff.

3) We already have a highly developed and sophisicated systems of a
Continuum of Support and a Community Development Continuum. However we
are by nature reluctant to recognize and celebrate our made at home
solutions.

5) We recognize the patience and time required to resolve complex human
issues.

6) We recognize the diversity of the homeless population and need for a
rainbow of supports and alternative approaches.

7) We recognize the need for innovations and social experimentation.

8) Our open ended systems of services have evolved overtime as opposed
to imposition of a closed system. As such our services can adapt and
remain relevant to local and personal needs as they change.

9) Our services and the homeless have in large measure described clients
needs.

10) We also provide services under the component labels (outreach
assessment, transition and long term housing), however; the underlying
principles and style of delivery are dramatically different.

BACKGROUND:

In late November of 1997 Robert Yamashita of the Housing Division and
Alice Gorman of the Public Health Division of the City of Toronto had
the opportunity to examine New York City's Continuum of Care Program for
the homeless. The visit was setup through the office of Mayor Hall to
the Deputy Commissioner's office of Lisa Diaz at the Department of
Homeless Services.

New York State is the only state that is constitutionally (Article 17)
obligated to "take care of the needy". Social advocacy organizations
forced the state through the courts to enforce the constitution. In the
1970's the vast number of armouries were  used to house persons
experiencing homelessness. Mayor Koch during his tenure
as the Mayor of New York city enacted a "consent decree" which
guaranteed shelter for all persons that needed it. He also created the
"Homesteading" program to help rebuild abandoned buildings where the
homeless squatted. This program was squashed by the introduction of the
C of C program.

At the same time the state created a law known as the "winter alarm"
with a 90 day annual limit. Part of this legislation allowed the police
to establish general patrols to pick up homeless persons who were
demeaned to be " a danger to themselves".

In 1992 Andrew Cuomo Chaired the Commission on homeless, known as the
"Way Home". It recommended the establishment of the "Continuum of Care"
( C of C) program.  Subsequently as the Director of the national Housing
the Urban Development Agency (HUD) Cuomo established a housing subsidy
program to assist cities in procuring private housing rental stock for
persons participating in the C of
C.

The other important player in the development and evaluation of the C of
C both locally and nationally is Dennis Culhane. He is the academic
resource and policy developer that has been instrumental in the
promotion of the concept of the Continuum of Care.

In May of 1994 Mayor Guiliani created the Department of Homeless
Services (DHS) to work in co-ordination with an array of clean up
initiatives. The department was to experiment with the C of C approach
and be reviewed biannually. Guiliani was re-elected in 1997 on his
dramatic record of cleaning up the city.

THE CONTINUUM OF CARE

PROGRAM TENETS
     "It recognizes that government has the responsibility to care for
the needy ..."

     "...but it also expects homeless people to take personal
responsibility for their      lives."

     " New Yorkers expect drastic reform of New York's program for
assisting      homeless people ... and that a system replaces temporary
solutions with permanent ones".

     " a system that provides emergency assistance to those who  truly
need it,             assesses their needs within a limited time frame,
and refers them, where            appropriate, to services to meet those
needs and end their homelessness. "

PROGRAM OBJECTIVES

1. Implement a comprehensive eligibility determination process and
ensure that scarce resources will be available to those most in need.

2. Implement a full continuum of care including outreach, prevention,
shelter diversion, eligibility determination, assessment, emergency
shelter, access to needed services, and access to permanent and
supportive housing.

3. Make available flexible client-based services.

4. Ensure short stays in emergency shelters.

5. Develop small, community based programs.

6. Mutual responsibility.

7. Better management.

8. Changes in Shelter Capacity.

9. Improved government colloboration.

10.Strengthen the Chief Executive's (Mayor) responsibility.

PROGRAM COMPONENTS

1. "The city will undertake a more aggressive outreach effort to
homeless people ...and provide direct placements into treatment
programs".

2. " The primary means of access to the adult shelter system will be
through new emergency assessment shelters. The goal will be to assess
the individual's needs and move him or her through the emergency system
within 90 days. Those who refuse a housing placement, or who have
sufficient funds to make their own living arrangements, but refuse to do
so, will be ineligible for continued temporary housing assistance.

3."Eligible applicants who are mentally ill, alcohol or substance
abusers, unemployed ... will be referred from assessments centers to
providers of rehabilitative treatment. The provider will develop a
treatment plan with which the individual is expected to comply as a
condition of continued eligibility. "

4."Adults who refuse placements in programs offering rehabilitative
treatment will be referred to a municipal residence facility. These
facilities will have staff to reconnect residents to treatment or other
rehabilitative programs".

5. Access to housing is critical to ensure that stays in costly
emergency shelters and residential treatment programs are as brief as
possible.

(A important component of the outreach function and the major tool to
criminalize homelessness is Mayor Guiliani's "Quality of Life " by-law.
It is an enforcement plan that gives the police unprecedented power to
remove the homeless from all public spaces.)

PROGRAM COSTS

For the adult C of C program the annual budget of 369 million dollars (
half a billion CDN dollars) serves approximately 15,000 people. In the
absence of any public health care these funds are used for basic health
services. Generally the homeless have very
little access to any services and this program attempts to provide
these.

The city staff were reluctant to provide any data or cost figures for
the program.

PROGRAM OUTCOMES.

There are no more visible homeless persons on the streets of New York
city. Even in semi public spaces in subway tunnels or makeshift shanties
the homeless are no longer visible. The very few that are seen from time
to time shuffle along a manageable pace, because they are no longer
allowed to stop.

Private companies have their own agents to keep their strips clean and
free of "vagrants". The public supports the program because there is a
perception of a safer city. However the coersive and often violent
nature of the police and community outreach initiatives ( mean sweep )
is now experiencing a public backlash.

CONTINUUM OF CARE IN PHILADElPHIA, PENNSYLVANIA AND SOUTH BEND, INDIANA

We examined the Philadelphia Continuum of Care in 1995 and had a
thorough presentation of the same program in South Bend Indiana at a
Homeless workshop in October 1997. It is apparent that C of C is a
national program in the United States. Although the National McKinney
Act of 1985 provided the enabling legislation for
community development, state sponsored homeless initiatives it is no
longer funded and is superseded by the Personal Responsibilities act of
1997. As in Canada the national government has devolved responsibilities
for the administration of social programs to the state but the
controlling  legislation remains a national one.

RECOMMENDATION:

City of Toronto's existing  made at home  CONTINUUM OF SUPPORT and
Community Development Continuum need to be recognized, supported, and
enhanced.

The City of Toronto, its community agencies, volunteers, institutions
and programs have worked very hard over the past 25 years to create both
a system of support and the framework for community development
initiatives. These programs and projects
recognize the need for supports as they are required and the dignity of
homeless persons to develop self help alternatives. It is imperative to
begin identifying both the existing services and their linkages in order
to formalize a Continuum of Support and
a Community Development Continuum. Although these systems are
essentially different in nature, style of delivery and temporal
qualities they nonetheless cover the spectrum of approaches that provide
short and long term solutions for people experiencing homelessness.

 APPENDIX A
SAMPLE PROJECTS DESCRIPTIONS
JOHN HEUSS HOUSE

This is a day shelter program in the heart of the financial district. It
is managed by the Trinity Church and serves 106 designated/referred
clients. There are approximately 30% white clients, the rest are black.
The church has their own outreach services and additional church
shelters. All clients are medicated
as an essential part of their program. Most of the clients have trusteed
their incomes to the church.

THE CAMBER ARMOURY

This is a Brooklyn based project in a former armoury. It is managed by a
local merchants association and serves 70 women with long term
pyschiatric problems. Like many of private sector providers they are in
a tall learning curve. Only now after 2 years is there a sense of a
stable service with appropriate staff. The clients are
referred to this service from city wide assessment centres and come from
the region at large. Most the recreation programs are volunteer
delivered. High airport style security for everyone entering and leaving
facility.

 FORMER BELLEVUE PSYCHIATRIC CENTRE

This former psychiatric institution has been converted for several large
Continuum of Care projects. All services are contracted.

1. General shelter
This a general shelter for 850 adults over 32 years of age with no
outstanding warrants. There are no young addicts permitted. Shelter
clients must be used to camping. Most (1000 people) are directed to Camp
La Guardia, a former prison 50 miles northwest of the city. Clients
choose this option to get away from the city and the required activity
of many shelters. Camp occupants are bused from the rural shelter and
processed through this centre for all services.

2. The Assessment Centre
This is one of 3 city wide assessment centres. Private transport
companies move people to vacancies in other shelters. After 4pm public
transit tokens are provided.

3. Volunteers of America
This is the largest agency in New York state. This projects provides 46
clients with long term mental illness, a 6 month program to prepare them
for housing. These are people who are "hostel resistant" and require
high levels of psychiatric support.
Low demand facility with no medications forced on clients. They receive
3 meals a day and have full time access to 5 case managers.

 SALVATION ARMY, BORDER AVE. VETS CENTRE

This is the largest Vets centre in the US. It serves 410 short homeless
vets. Contract with Veterans Affairs and the city Department for
Homeless services. Successful in finding 300 full time mainstream jobs
for clients. Forty percent return to centre
over time. It has a staff of 10 full time social workers and one family
counsellor. The DHS identifies this as an Employment Program Shelter.

  The KINGSBRIDGE ASSESSMENT CENTRE

This is in one of the largest armouries in the USA ( approximately six
football fields in dimension). Until 1994 it the largest family hostel
in New York City. Presently it is managed by a organization as a primary
assessment centre and a transition hostel for 40 women (all
African-American). They are all medicated and have a 90 day limited on
their residency before moving on to permanent housing.

          THE PALACE - BRC HUMAN SERVICES CORPORATION

This is a satelite project of BRC. It is a former Bowery flophouse that
housed 650 men in very small (4x7) cubicles. Presently it is a 60 bed
shelter and support single men for up to 6 month whilst they reconnected
to housing and jobs. They have an Aids support program, employment
search program, and a day drop-in. The Executive Director is a
disenchanted former Commissioner of the Department of Human Services who
understood the inherent flaws in the Continuum of Care system. This
project is member of the System however it is trying to bridge the gap
between the System and street realities. The project and its staff
recognize that the people who benefit the most from this approach are
the newly homeless who have the least difficulty in regaining a
mainstream existence. The longer term homeless with more complex issues
reap the least benefit and in most cases cannot participate.

                   E-Quality of Life Campaign

State legislation provides funding and support for advocacy and watch
dog organizations to scrutinize the C of C. This organization was
started by homeless people and is staffed largely with volunteers. This
organization educates the homeless about human rights violations,
structures legal responses, monitors sweeps, and
tracks hidden shelters. They are also affordable housing advocates.
Provide support to the very small group of community agencies willing to
question city policies and C of C.

In their observations many of the community outreach agency have been
pushed to perform and act more violently than the police. The
"Eligibility Verification Review" system has been useful in redefining
homelessness to fit the C of C program and produces successes. The state
Govenor Burtaci has enacted a bill relieving all shelters of their need
to conform to Fire, Building and Health Codes.

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APA - No Way!! Toronto, June 3, 1998
<http://web.arcos.org/gbacque/antiAPA.htm>
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!