Fitting the “Service Box”: Unintended Consequences of Funding and Service Dynamics

 

The social support sector in our community – and in countless others – is faced with a daily challenge of stretching a finite and limited amount of essential resources to help as many community members as possible. This emergency response to a sustained crisis requires difficult decisions to prioritize access for those in need. Recent research conducted with individuals experiencing homelessness identified that those seeking assistance can feel pressure to act and present themselves in a certain way to meet expectations associated with services. This phenomenon of “reproducing aspects of homeless identities” carries with it challenges and unintended consequences for the overall system, the individual organisations and service providers, as well as the individuals seeking support themselves.

But how can we best address this challenge?

We connected with Dr. Shelley Cook for her perspectives on this topic, based on her expertise in the field as well as the specific findings and implications of the study she co-authored, published in the Journal of Human Behavior in the Social Environment last year: “Appropriately homeless and needy”: Examining street homeless survival through the lens of Bourdieusian social capital theory.

Dr. Cook offered a range of reflections on the opportunities and challenges facing frontline workers, service organizations, system planners, and other academics as we strive to understand and improve the outcomes and experiences of vulnerable community members in accessing essential services.

 

VIDEO: Global News Interview (January 21, 2021)

 

[Interviewer: Kyler Woodmass – Associate Research Coordinator, KHRC]

Dr. Cook, thank you so much for taking the time to discuss your research and the broader challenge of pressures to “perform representations of homeless identity” to align with implied or explicit criteria associated with the essential services that those experiencing homelessness depend on. I think there were many aspects of your project that drew interest within the local community, including individuals with Lived Experience and service providers who might have seen news summaries (Castanet, Global, etc.), as well as fellow academics with access to the academic article itself. We can discuss either (or both) angles, as I imagine some readers might also be interested in your theoretical frame as well as Lived Experience participation in research as knowledge holders in addition to roles on an Advisory Committee. 

And then I’ll also note that the summaries tended to focus more on your findings than the range of implications that I know you touch on in your discussion within the article, so we can expand on the latter as well.

[Dr. Shelley Cook]

Right. He had such a quite a precise view of social capital and the components of power, so that’s why I used Bourdieu. I know it can be like “what does that mean?”, but in the article it was important to specify.

In terms of the news coverage, I think everyone sort of added their own spin to it, but I think Global took out an important piece of the implications, though it might have been a little bit abstract for people. I find it to be one of the most important findings, but I know it might be a little muddy and hard for people to wrap their heads around it.

So this important piece that you saw them trying to highlight, how would you characterize that?

Well I think the implications for practice, that’s the most important part. And that’s why this conversation is important. And I think the questions you provided get at the things that I find particularly important, and what I find problematic.

I think to start, it should be noted that a variety of terms were used to summarize the phenomenon that you address in your research: “forced to play up”, “learn to play up”, “tendency to play up”, etc. What would your one-sentence summary of this “social pressure” be in this context? Pressures on providers and on service users, acknowledging that your research focused on service users but includes a call for the provider perspective as well.

As you noted, my focus was on the service users and their social capital and what sources of social capital were most important. So I think just to highlight the fact of their absolute and utter dependency on the system of homelessness and the critical services provided. And I’ll get back to this, and used different versions of what you read out, but I think it’s really important to first highlight that point on social capital. Lots of previous research has found that those experiencing homelessness have very diverse social networks, relying on a mix of family, peers, and formal social services of key sources of support, including emotional support. My research clearly indicated a direct reliance on social services for basic material survival. So that sets up a problematic dynamic, coupled with the fact that services are massively over capacity. These represent bookend pressures impacting individuals. So I think that’s an important piece for service providers to recognize.

From my perspective, it’s bigger than any one organization and comes down to how our services are structured, and how we directly, indirectly, subtly, or overtly communicate messages on the categories of individuals or health and social issues prioritized for care. While it’s important to look at what organizations can do to mitigate potential pressures, they are a part of a larger system. And that’s why we really have to think about it from a systems perspective to really have an impact.

I would say people take their cues from the environment and also learn through their relationships with others of the street as well as with service providers to reproduce – and this is what I kept using – different aspects of homeless identity that aligned with the homeless context. I’m not sure about “forced”, but they “learn” to play up different aspects, fundamentally to received services that they’re dependent upon. When I think of power and when I think of agency in that context, their only form of resistance would be to refuse services, and so that leaves them in a precarious situation. By reproducing these representations of homelessness they actualize their power in that situation and to get material support.

And to what extent do you see any reliance on social support from providers? Because I think one topic that has been front of mind is this 10% (or whatever the figure was) of participants in the At Home / Chez Soi Housing First study that were unable to secure housing through the intervention. And that this group, among other things, had stronger sense of belonging to their street social networks (p.19). I think there’s an interest in better understanding that group and their perspective.

Well they’re asking people to give up their social connection. And it’s not even social connection, this is why I framed it in terms of social capital. There’s real stuff that comes out of these relationships, and again in terms of their basic material survival.

And to just expand a bit, I think I wonder when people ask about “social support on the streets” whether it’s interpreted as related to peers, if not otherwise specified. And I think for some people, interactions with service providers might represent a large portion of their daily interactions. I was wondering how that might factor into that dependency, for a variety of needs. 

Well, material survival. Not all individuals were necessarily getting their emotional needs met. To some extent, that requires the trust attached to feeling safe enough to authentically present yourself as you are in terms of your needs. For me, there’s usually that separation of street peers for that emotional component and formal service providers for that material survival. And again, some of that other support. I’m not suggesting there aren’t other forms of support, but that’s usually how it tends to break down. And in this situation – and again I think because of the level of crisis and need on the street and the level of competition around resources, people bumping up against each other spatially… I think there are lots of reasons why there aren’t street connections in the way that people might anticipate. And it might be a bit of romanticizing, that there are always these street families taking care of each other. And that’s not really what seems to be happening.

And the population contacted during your study would fall under that category of “Absolute Homelessness”?

Yes, chronic or episodic.

So at a variety of levels – municipal, provincial, and federal – there seems to be support for placing those experiencing homelessness into congregate supportive housing, as one support / solution. Do you feel that there might be less of a pressure or inventive to “perform” as a service user once they have that basic material need of shelter in place?

I think we need to not forget the importance of relationships, and how that – irrespective of whether that person is housed – is still incredibly important.

So just going back to your earlier point, there can be pressure to make choices between social connections and their housing. There’s a lot of capital that’s generated through different contexts that we might not be aware of. Just the ability to go to a gas station inside of a “red” [restricted] zone could mean that they get a meal that day.

I ask because in our series of focus groups on vulnerabilities leading to homelessness and potential solutions, vulnerabilities were identified for both those actively homeless as well as those that were housed and / or accessing services. They wanted additional supports, but the right supports, and opportunities to learn, mentor, volunteer, work, etc. So to bring that back to your research and today’s discussion, it sounds like connection with housing and / or other services can continue to perpetuate some of these pressures.

They can reinforce a homeless identity. There are still expectations around performing in particular ways even when housed, it doesn’t necessarily stop. And in fact, it might become further entrenched.

I think that we need to be mindful of people’s relationships and their connection to certain locations in the urban environment, and that is certainly another part of it for sure. In terms of knowing where people are going, why they are going, and what they’re getting out of that.

In the current system, would programs criteria with a greater focus on strengths and abilities help mitigate the observed impacts? Is playing up strengths an equal / lesser risk?

The argument that I try to make at the end of the paper is that existing service criteria are primarily focused on deficits. Assessments that focus exclusively on challenges and deficits aren’t designed to capture the strengths and abilities, so in that orientation there’s no mechanism for including positive, individual factors to influence service decision. And overlooking those strengths poses a critical risk to authentic representation as well as authentic relationships.

So in a system where housing might be related to strengths – or maybe “motivations” – such as going to school or work, would the pressure to perform exist in the same way?

Well where this works would be if contact is made with a vulnerable individual and they say “I want to go to school, can you find me some housing that would help facilitate that?” As opposed to “I need housing” followed by trying to get them into a given available option. It’s about matching services to individual need as opposed to trying to fit people into a service box based on what’s available. So that could be a wonderful fit if it were a reflection of individual need and interest.

To what extent does that influence aspects of centralized intake and coordinated access in relation to a Housing First focus and ending chronic homelessness (i.e. those that are most vulnerable)?

It’s about meeting people where they’re at, having authentic dialogue of understanding of what their needs are, and then doing your best to provide services that meet those needs. And again, in a way that builds on existing strengths, abilities, and capacities, including existing social capital.

Around the centralized intake, and I mention this is my dissertation, but these people who I was interviewing discussed trying to figure out how best to present themselves. You’ve got people going into these situations and understanding what the outcome is and what’s available. It’s not accurate to say that people aren’t interpreting – they’re talking to each other, they’re interpreting, and they understand the scarcity of resources. So they have an understanding of what might be needed to get into the line and to get to the front of the line.

So at the system level, as you conclude, a lot of it has to do with resources. If there are limited resources there’s going to be competition. But leaving aside investing in the supply of resources to meet the demand  – which I think is a topic worthy of discussing on its own – at an organisational level, how would you suggest management examine their programs and associated policies within the context of the current resource levels and structures? And I recognize that’s somewhat touched on in your future research, and that you talk about “recognizing underlying discourse”. How does one go about doing that?

Well I’d have an honest conversation, potentially with your clients, in a way that facilitates safe communication. Because they’ll let you know. But as I say in the article, I think it’s important for people to take a look at the narrative around homelessness underlying their services. So why might people not want to access your services? Is there a downside? How are you building upon the strengths and capacities of individuals? How are you building authenticity?

We talk about trauma-informed practice, and I think it’s reasonable to assume that everyone in this category has potentially experienced trauma. Therapeutic benefit is not possible without authenticity in relationships. So verifying and fostering authenticity is a necessary condition for any individualized, strengths-based, trauma-informed, etc. care. How might your criteria portray that there are only specific types of homelessness or need? Who is included and who is excluded? All of these things.

So the study I cite from Winnipeg had similar findings, where those experiencing homelessness produced this notion of “good neoliberal citizens”. That was connected to messages from service providers that in turn were linked to messages from funders about a business-orientation. So these messages can carry and be reproduced across levels of the system. Organizations exist in a context. So grounding everything in Housing First might similarly impact how individuals present themselves.

Discourse can be a tricky concept, are there things we can draw on from that theoretical / academic lens to further inform this topic? Is that somewhere that further research can play a role in informing practice?

That might overcomplicate something that is really straightforward and that people already pick up. Again, stepping away from that word “discourse”, how does what you do in your practice suggest that you serve a particular type of person? Or even how is your environment structured, and associated messages? How are your interactions, your interviews, your criteria influencing things? “Detectable expressions of homelessness”. And again this is a growing body of research.

It’s everything about how services are structured. Ultimately what people know is what’s coming out, what the outcomes are. And that includes the level of discussions between organisations that contribute to systemic narratives. It’s about “what is the mantra, what are you producing, what are the outcomes, and how do people get there”.

And from the perspective of an organisation seeking to establish a “niche”, do you have a sense of how that factors into differentiating / specialization in a sector with multiple organizations?

I think it’s important that different organisations do different things, so I’m certainly not suggesting otherwise. But I think that it’s important to evaluate why services directed at those experiencing chronic homelessness might fail to sustainably house a subset of that population. Same with centralized intake, if that process involves meeting a person and identifying their individual need and to then find the best fit, that’s a different intent than slotting individuals into a set of existing supply of resources.

And I imagine the challenge from a planning and funding perspective is that if people perform to meet the existing supply, you lose the ability to capture the diversity and level of services that would best support the group (even if those needs might not be able to currently be met and require additional investment).

Yes, in a broader sense, and you’re also not able to best support their needs, both at an individual and at a group level. But it’s how your system is structured. So how you shift it is just trying to do your best in meeting the full range of needs and accommodations.

So what would you tell individual providers or individual organizations on how they can advance system-level changes? Do authentic interactions lead to system change, or are broader changes needed?

It’s very difficult for an organization to deviate from the conditions of a funder.

But I want to set some context a little bit. What I fear is depleting people of resiliencies, capacities, and strengths. John McKnight is someone who has done some research in this area. The desire to professionalize functions – and in his example he does a comparison between the advent of the modern plough and a bereavement counselor coming to town. And in the same way that this plough was very effective and efficient in churning, it depleted the earth of its minerals. And this bereavement counsellor through an over professionalization of things depleted people of their ability to actually take care of themselves.

This is my concern. We’re overcapacity and overloaded with need, and there are more and more coming. And more and more need. And we need to meet it in the right way, in a way that doesn’t reproduce dependency on the system. And instead maximizing their strengths and abilities, anything beyond their weaknesses and challenges.

So in the context of what we’ve discussed, on an organizational level action includes advocating for changes to the system. And again, I think we can have an impact and we can also acknowledge. You can work within the parameters and have a positive impact, even if you can’t fundamentally change what’s going on.

So at an individual service user level it’s about survival, at an individual provider level it’s about ensuring strengths-based relationships, and organizations can actively review policies to foster positive environments and advocate for associated system changes.

You can create the context where people feel safe to share, you can create an environment that encourages it.

And to explicitly state this, strength-based does not necessarily mean not capturing weaknesses, but rather to start with strengths to orient the appropriate service paths and to mitigate identified challenges and risks.

Yes, but again I think there are lots of ways to keep it focused on resiliencies and capacities, and to work to better understand those. People have incredible capacities and resiliencies that we don’t even realize if people aren’t sharing that. And that goes back to taking a critical lens on how practices, environments, and policies reinforce or inhibit that.

And so that in turn applies to stakeholders involved in funding, in terms of critical evaluations on the implications of limits and restrictions. What does that looks like in terms of designated streams, no streams, set continuums, etc.?

You know what, I’ve been looking a lot at that, in terms of how we establish contracts and relationships in ways that are different. When you think about things from a systems perspective, rigid oversight and control does not work, nor do many efforts to build in social accountability such as tick boxes, etc. What that does is create unintended consequences – this is an unintended consequence. So what I want to emphasize is taking a systems perspective and systems thinking about the interconnections between all these things, the link between policy and practice. Where policy tries to control whereas practice is trying to be innovative and flexible.

So for individual organizations that critical self-evaluation can include asking “to what extent is that based on our internal policies and to what extent is that based on external policies?”

Sure. How is this reinforced? Or even mandated? And again, you can meet different needs, but as soon as we start focusing to heavily on verify specific, limited bits of information about individuals, that starts to get problematic. So what I would want to see is a focus on the individual. And coming up with some type of service, and while it might not meet everything, expressing that it will be the best possible planning for that individual.

And as noted previously, the existence of external policies or mandates that inhibit that goal can be responded to by advocacy to shift that upper level of policy. And with that rationale given, “this is what it’s limiting, this is what it’s reinforcing, this is what it needs to be”, etc. And part of that might be associated with more discretionary funding?

And again, it’s about moving from housing types of homelessness and thinking more about a continuum and individual need. The focus on episodic and chronic homelessness was reflective of those populations not being adequately served, so they were prioritized. But that carries unintended impacts. Systems are complex and interconnected, and knowing that presents an opportunity to do things differently to break that cycle.

And at a funding level, I imagine even while working with a finite level of resources (and that level being lower than the demand), you can have mandates to reinforce a strengths-based approach.

The other thing is looking at those different types of contracting arrangements. That would include alliance contracting (see, e.g., Sanderson et al., 2017), relational contracting (see, e.g., Davidson 2006). So these are less defined and are built around a sense of trust and strong relationships with an organization, so that they are able to pivot – in any way that they need to – with the funds in order to get the outcomes that they see possible. And that can be better for accountability as well. We need to be watching for impacts that result from how things are structured.

And once an undesirable impact is identified, you can try to follow the path within the system and try to identify what can be done at various levels (e.g. implications for policymakers, funders, individual organizations, individual providers, etc.).

Yes, moving beyond service integration into system integration is a critical element. A focus on system integration would be working with funders and policy-makers to change how they deliver funding and provide oversight (versus trying to coordinate local services).

A prevailing error in health and social services is defining systems as complicated when they are complex. Another pervasive problem is thinking about integration of services just at an organisational level as opposed to a systems level. I want to emphasize that we need a systems perspective, to see things as interconnected, and that everything has outcomes that we can’t predict. We need to be looking for those outcomes and adjusting as needed, and looking for opportunities for feedback to change a system.

That can be very daunting at an organisational level, but again that study by Kuhn and Culhane on chronic homelessness in shelters was once just a research study. But that got actualized into homeless policy in a very real way, and fundamentally changed the shape of service delivery. As did trying to target certain populations by looking at services linearly.

And in the homelessness context with municipal, provincial, and federal policies, programs, and funding, does that influence how to shift the discussion?

Well again, to take Housing First as an example, I’m not against Housing First but I think it’s one of many approaches needed to address the situation. We need to focus less on coming up with one perfect model and instead find ways to support individuals. Policy shifts can serve agendas that are not helpful and shifts in language also carry impacts. Shifts to focus on specific groupings such as chronic homelessness can minimize other forms of homelessness.

There is no one program that will address the complexity of everyone’s overlapping needs.

And not to get too far off topic, but in terms of establishing key performance indicators on outputs in lieu of policies or contracts guiding the process, that would be associated with what the community wants from those programs. For example, that we want most people to be able to move to self-sufficiency, but also that some will require long-standing or permanent support, etc. And that the projects that demonstrate impact are renewed at the end of the term, and so on. Because I also recognize the vulnerabilities that can be caused by changing policy and programs for service users and providers.

The thing from my perspective is an accountability model that believes those concerned with accountability aren’t just at the top; everybody wants to do what’s right and what’s best. And where creativity and innovation come from is practice, not policy. So this is about allowing more flexibility within the scope of people’s contracts.

So, for example, within disability services there can be individuals’ hours, but then they shift to global hours so that if Tom needs less hours you can shift them over to Mary. Even that level of flexibility. And a realization that organisations very capable and very motivated. So I think we need to look at both vertical and horizontal accountability and how we’re promoting accountability in communities and in society. Especially over any alternative models of rigid oversight and control (see Never & de Leon, 2017, on the cost of accountability). We need to be sharpening our skills. It’s about doing good work, and hoping to perpetuate services in communities that will actually make a difference.

And this also needs to be imbedded within a regional strategy. It’s a complex situation that needs a regional lens.

And we also need to be talking about cross-system collaboration and integration of services. As opposed to individual organisations needed to fill each need in-house with limited funding. This is where we need to be able to work in the spaces between the cracks in the system. And that’s consistent with that systems perspective. We need courage, courage to change the system.

And of course your perspective here is that this can be done. It’s both complex, and in terms of the solution, might also be a complicated in getting to consensus answers and actions. But it’s not “this is a resource problem and therefore it can’t be fixed”. It’s “this is a resource problem occurring at multiple levels of a system and therefore has to be critically evaluated and discussed at each of these levels, and how they interact, and how they mutually reinforce each other”. But that a lot of this has to do with resources, so part of that discussion should include the full process of how we direct them.

Because the information that gets used in planning and delivery can only benefit from being as representative of the felt realities as we can get it.

Again, from a systems perspective we really have to think about local context. Good responses are about understanding context. There can be a tension between efforts to reproduce approaches across communities and the organic nature of what we know works in community. So it’s a interesting thing, if Kelowna as a community just gets a pocket of money, how do we as a community decide what the priorities are.

Thank you again so much for taking the time to overview this piece of local research. I think your findings and reflections will be valuable context for other topics and can help shape possible avenues for inquiry and action moving forward.