Reporting Plan for Navigation Team November 7, 2017 I Q's Seattle Of?ce of City Auditor Reporting Plan for Navigation Team Report Highlights Background Seattle City Councilmember Lisa Herbold asked the Office of City Auditor to review the Theory of Change for the City’s Navigation Team and to identify additional information that the City Council may want to gather. The Navigation Team is an approach developed by former Mayor Murray’s administration for addressing the issue of people living unsheltered in Seattle. It is important for the City to ensure that the Navigation Team is an approach that is appropriate and humane as well as efficient and effective. Recommendations This report includes a reporting plan with 14 requests for information (i.e., “reporting checkpoints”) that can help inform the City Council’s understanding of the Navigation Team approach. The Executive has agreed to this reporting plan; their response is included in Appendix C of this report. Checkpoint # 1.1 1.2 1.3 1.4 2.1 2.2 2.3 2.4 3.1 3.2 3.3 3.4 3.5 3.6 Request Analysis of Navigation Team engagement rate Organizational staffing assessment Trauma-Informed Care self-assessment Evaluation of Navigation Team training Assessment of opportunities for early-outreach intervention Assessment of opportunities for prioritizing hygiene Assessment of strategies to prevent trash accumulation Assessment of opportunities for greater coordination with King County Report on 2017 baseline data – “Results and Outcomes” Report on 2017 expenditures Report on 2017 measures of system performance Report on 2017 racial equity impacts Evaluation plan Plan for unsheltered individuals to be meaningfully involved in Navigation Team evaluation Due Date Q1 2018 Q 2 or Q3 2018 Q1 2018 Q1 2018 Q1 or Q2 2018 Q2 or Q3 2018 Q2 2018 Q1 or Q2 2018 Q1 2018 Q1 2018 Q2 2018 Q1 2018 Q2 2018 Q2 2018 Seattle Office of City Auditor David G. Jones, City Auditor www.seattle.gov/cityauditor Reporting Plan for Navigation Team TABLE OF CONTENTS INTRODUCTION 1 REPORTING AREA 1: NAVIGATION TEAM COMPOSITION 3 REPORTING AREA 2: STRATEGIC APPROACH 11 REPORTING AREA 3: DATA AND EVALUATION 18 APPENDIX A References and Hyperlinks 24 APPENDIX B Navigation Team Theory of Change 30 APPENDIX C Response from the Department of Finance and Administrative Services 65 APPENDIX D Seattle Office of City Auditor Mission, Background, and Quality Assurance 67 Reporting Plan for Navigation Team INTRODUCTION On August 29, 2017, Seattle City Councilmember Lisa Herbold asked the Office of City Auditor to review the Theory of Change for the City’s Navigation Team and to identify additional information that the City Council may want to gather. The Navigation Team is an approach developed by former Mayor Murray’s administration for addressing the issue of people living unsheltered in Seattle. It is important for the City to ensure that the Navigation Team is an approach that is appropriate and humane as well as efficient and effective. This report includes a reporting plan with 14 requests for information (i.e., “reporting checkpoints”) that can help inform the City Council’s understanding of the Navigation Team approach. The Navigation Team became operational in February 2017. The 22person team is “comprised of specially-trained Seattle Police Department (SPD) officers, a supervising police sergeant, an outreach coordinator, an encampment response manager, field coordinators, and contracted outreach providers.” The goal of the Navigation Team is “to provide outreach to people living unsheltered that is efficient and effective at moving people out of hazardous conditions and onto a path toward health, stability, and permanent housing.” The Navigation Team Theory of Change specifies that, “the City has made the strategic operational decision to deploy the Navigation Team in conjunction with the ongoing encampment cleanup work conducted by the Finance and Administrative Services (FAS) Department.” (See Appendix B – Navigation Team Theory of Change.) Following a request from City Councilmember Lisa Herbold, the City of Seattle Mayor’s Office developed a Theory of Change for the Navigation Team on August 11, 2017 (see Appendix B). In its simplest form, a Theory of Change is a discussion of what change is expected to happen as a result of a specific intervention. 1 It should describe how the intervention will bring about the intended results and should identify the outcome measures that will help determine if the intervention is on track for success. A valid Theory of Change is one that is grounded in research evidence or in well-developed theory on what works. 2 1 For example, United Way of King County’s Parent-Child Home Program is designed to improve school readiness and academic success of children from low-income families by providing twice-weekly home visits from trained parent coaches who model educational play. This theory of change clearly identifies the change that is expected (improvement in school readiness and academic success) and the mechanism by which that change will be affected (twice-weekly home visits). See website https://www.uwkc.org/giving-kids-equal-chance/pchp/. 2 There are many online resources for developing a Theory of Change including a guide from the Annie E. Casey Foundation at http://www.aecf.org/resources/theory-of-change/ and a website from the U.S. Agency for international Development at https://usaidlearninglab.org/lab-notes/what-thing-called-theory-change. Page 1 Reporting Plan for Navigation Team The Navigation Team Theory of Change developed by the Mayor’s Office provides helpful descriptions of the context for the development of the Navigation Team, its organizational structure, and a description of the logic and assumptions underlying the approach. The document (Appendix B) is a good starting point for helping the City understand more about the Navigation Team approach and for thinking about what information will be needed to determine its success. Our questions about the Navigation Team Theory of Change fall into three broad categories: 1. Is the composition of the Navigation Team appropriate for Seattle’s needs? 2. Are there opportunities for the City to increase effectiveness by incorporating a more strategic approach? 3. How might the City better use data and evaluation to ensure that the Navigation Team achieves its intended outcomes? The sections that follow comprise a “Reporting Plan for Navigation Team” that addresses these three questions by creating reporting checkpoints for the Executive to provide additional information to the City Council. Each section begins with a description of the research evidence, leading practices, and emerging issues that support the requests for this additional information. Limitations: Due to the short timeframe, this project was limited to assessing the Navigation Team Theory of Change. We did not conduct any direct observations of the Navigation Team’s work in the field. Also, we did not verify the accuracy and completeness of the information provided by the Executive. This reporting plan was developed by Claudia Gross Shader and David G. Jones of the Office of City Auditor. We would like to thank the following individuals for providing comments on an earlier draft of the report: Alan Lee, Seattle City Council Central Staff; Lee Thornhill and Dr. Nadine Chan, Seattle King County Public Health; Justin Anderson and Kayvon Zadeh, King County Auditor’s Office; and Shannon Harper, University of Washington West Coast Poverty Center. The Executive has agreed to this reporting plan; their response is included in Appendix C of this report. Page 2 Reporting Plan for Navigation Team REPORTING AREA 1: NAVIGATION TEAM COMPOSITION The Navigation Team is comprised of 22 full-time staff: • 9 sworn Seattle Police Department(SPD) staff (a sergeant and 8 officers), • 5 civilian City staff (a team lead, a manager, and 3 field coordinators), and • 8 contracted outreach staff through REACH (a supervisor and 7 outreach workers). The 2017 budget for Navigation Team staff and related expenses is nearly $2.7 million, and the 2018 proposed budget is nearly $3.1 million. 3 See Exhibit 1 below. Our review of the Navigation Team Theory of Change raised questions about the composition of the Navigation Team. Specifically: • Is this composition the right size and mix of skill sets? Might there be alternative team compositions that the City could consider, including paramedics and behavioral health specialists? • Might unsheltered individuals be reluctant to engage with a police-led team? • What steps can the City take to ensure that interactions with police do not unintentionally re-trigger trauma in unsheltered individuals? • How can the City ensure that the training for SPD Navigation Team officers is appropriate and effective? 3 These budget amounts do not reflect other costs associated with encampment removal and cleanup, such as trash removal, compliance monitoring by the Seattle Office of Civil Rights, and SPD overtime for traffic. Page 3 Reporting Plan for Navigation Team Exhibit1: Navigation Team Budget 2017 - 2018 Department Description 2017 Budget FAS 1.0 FTE Director of Office of Homeless Emergency Response $ FAS 1.0 FTE Encampment Response Manager 2 1.0 FTE Strategic Advisor 2 - Policy and Operations Support $ FAS 2.0 FTE Strategic Advisor 1 $ FAS 1.0 FTE Outreach Coordinator (SA2) FAS 0.5 FTE Admin Spec 2 FAS 1.0 FTE Admin Spec 2 FAS One-time expenses (support, tech, new location, showers, etc.) $ FAS Training and referral documentation Human Services Department (HSD) SPD FAS 2018 Budget (proposed) $ 192,372 $ 126,617 $ 149,380 252,460 $ 252,460 $ 144,203 $ 149,380 $ 47,995 $ $ 126,617 - - $ 88,026 150,000 $ 264,000 $ 70,000 $ Contracted outreach $ 600,000 $ 585,000 8.0 FTE Police Officer (estimate) $ 940,448 $ 940,448 SPD 1.0 FTE Sergeant $ 141,861 $ 141,861 SPD SPD Overtime (estimate) $ 200,000 $ 182,400 $ 2,673,584 $ 3,071,944 TOTAL - Source: Seattle City Council Central Staff analysis Team Composition The Navigation Team Theory of Change indicates that the Navigation Team was created based on discussions with police departments of Anaheim, Salt Lake City, Colorado Springs, New York City, Cambridge (MA), San Diego, and Los Angeles and the Mayor’s Office of Los Angeles. These jurisdictions “have a version of a police department homeless outreach team,” and in some jurisdictions this approach also includes other disciplines. 4 Our review of the research was unable to identify any police outreach models that have been rigorously evaluated to determine their impact or effectiveness. Therefore, it is very difficult to determine whether it is a good idea for Seattle to replicate the police outreach approach. One rigorous research study suggests that specially-trained paramedics may be well-suited for homeless outreach. A 2016 research study examined San Francisco’s Homeless Outreach and Medical Emergency 4 For example, San Diego’s Homeless Outreach Team is comprised of police officers, County psychiatric clinicians, and County mental health eligibility technicians. Page 4 Reporting Plan for Navigation Team (HOME) Team, an Emergency Medical Services (EMS)-based outreach effort using specially-trained paramedics to redirect frequent users of EMS to other types of services. The study found that homeless individuals who were frequent users of emergency services responded well to the HOME team as measured by a decline in their EMS usage (Tangherlini, et al., 2016). At least one jurisdiction, Austin, Texas, has integrated EMS into the composition of its homeless outreach team. Austin’s Homeless Outreach Street Team (HOST) is currently comprised of two police officers, two paramedics, three behavioral health case managers, and one court case manager. From June 2016 through June 2017, “HOST intervened with 947 individuals (nonduplicated), made 1,528 contacts with these individuals, met over 889 needs, and created 89 diversions from the revolving door of emergency services to more appropriate resources” (Arellana, 2017). From its inception, Austin’s HOST has collaborated with the Austin-Travis County Community Health Paramedic Program which is designed to provide effective solutions for frequent users of the EMS system. A September 8, 2017 memo to Austin’s Mayor and City Council noted that, “over the next fiscal year, agencies will firm up the team foundation by moving HOST’s programmatic home from APD (Austin Police Department) to EMS.” Staff from EMS in collaboration with Austin’s Bloomberg Innovation Team will over the next year be working to clarify roles and optimize the team’s configuration. Role of SPD Following the example of Austin, the City might take steps to clarify the role of the Navigation Team members, including the SPD officers. Such a staffing assessment would provide the City with an opportunity to further consider its use of police as an expedient means of expanding outreach capacity. City officials indicated to us that before the development of the Navigation Team in 2017, contracted outreach workers often asked for SPD to accompany them in their work because they felt unsafe to enter unsanctioned encampments. City officials indicated that before 2017, untrained SPD officers who accompanied outreach workers stood to the side and did not interact directly with homeless individuals. The thinking about the development of the Navigation Team was, “If SPD needs to be present, why not use them as active, engaging, constructive team members?” Page 5 Reporting Plan for Navigation Team The City officials indicated that the Navigation Team approach represents an improvement over the prior practice because the Navigation Team officers have received special training and all have a desire to do this work. Further, City officials have indicated that the formal addition of police as outreach team members was an expedient way to increase the size of the City’s outreach team in a resourceconstrained environment. Moreover, the City officials indicated that the police presence has been helpful for conveying “an end date for moving” out of hazardous conditions. In the following sections, we present some things that the City might consider regarding the composition of the Navigation Team, including the role of the police. A fundamental question that the City may want to address in a staffing assessment of the Navigation Team (See Reporting Checkpoint 1.2 below) is whether the police should be used to increase the City’s capacity for outreach, or whether the police should be reserved solely for public safety purposes? Engagement Rate Another reason that Seattle should be thoughtful about the composition of the Navigation Team is that negative perceptions of the police might potentially be a barrier that prevents homeless individuals from engaging with the Navigation Team. A 2016 study commissioned by the City of San Diego included Interviews with 108 individuals living unsheltered in San Diego’s East Village neighborhood that gauged their perceptions of encounters with the police and their experiences with the Homeless Outreach Team (HOT). 34% of respondents had experienced five or more interactions with the police in the past year; 53% had felt “a little” to “very much” harassed by the police; and 39% felt that police did not ensure their safety. The authors concluded that, “given that homeless individuals are more likely to interact with police officers, it is not surprising that these individuals are wary of the police.” Consequently, although 94% of those interviewed knew what HOT was, only 20% reported receiving assistance from HOT (Sage Project, San Diego State University, 2016). In addition, there may be cultural reasons why certain homeless individuals, especially immigrants and refugees, might be reluctant to speak with the police. Research has found that immigrants are less likely to report crimes to the police for reasons including: negative experience with law enforcement in their countries of origin, fear of the police due to immigration status, and cultural and language barriers. These issues might also present barriers for immigrants and refugees who are homeless from engaging with SPD Navigation Team officers. Page 6 Reporting Plan for Navigation Team At this point, the City of Seattle does not have enough information to know whether wariness about the police affects the performance of the Navigation Team. However, data collected by the Navigation Team from February 20 to May 5, 2017 indicate that 69% of the unsheltered individuals approached by the Navigation Team accepted services (e.g., ID acquisition assistance, vehicle repairs), referrals (e.g., case management, medical support), or basic needs (e.g., bottled water, socks). 5 31% of those contacted by the Navigation Team accepted nothing. Exhibit 2 below illustrates how this rate of reluctance to receive even a basic need (e.g., bottled water, socks) from the Navigation Team sharply limits the number of individuals that receive services and ultimately move to alternative living situations. Exhibit 2: Navigation Team Data, February 20, 2017 to May 5, 2017 Source: Navigation Team responses to 2017 MDAR Informational Questions 5 Navigation Contacts between February and October 6, 2017 reflect a similar trend: • • • 5,127 total contacts to a total of 1,340 individuals. Of those 1,340 individuals, 528 (39%) accepted relocation to safer spaces, including shelter, authorized encampments, and reconnecting with family or other support system. Of the 1,340 individuals, 864 (64%) accepted some sort of service, including case management support/referral; mental health support/referral; substance use disorder treatment referral; state ID acquisition assistance; medical support/referral; coordinated entry housing assessment (VISPDAT); King County Housing Authority lottery registration; employment support; benefits activation support; vehicle repairs; and basic needs. Page 7 Reporting Plan for Navigation Team City officials indicate that a 69% acceptance of services, referrals, and basic needs is an improvement over previous outreach efforts. In keeping with continuous improvement, it may also be helpful for the City to seek information from homeless outreach teams that have a higher rate of engagement than that of the Navigation Team to determine whether team composition or other factors may affect this rate. For example, Santa Rosa California’s Homeless Outreach Services Team (HOST) is comprised of outreach workers from Catholic Charities. They receive referrals from police and other social service agencies, but the outreach team members (four outreach workers and one supervisor) work for Catholic Charities. From inception in August 2015 through June 2016, their rate of engagement, including completion of a federally-required coordinated entry assessment, was 89%. 6 By December 2016, Santa Rosa’s HOST had increased their rate of engagement to 100%. 7 Santa Rosa HOST has explored some innovative strategies for engaging homeless individuals. For example, Santa Rosa HOST credits some of their success with outreach efforts to their operation of a 16-foot mobile trailer with two bathroom/shower units. “In addition to providing access to clean showers and bathrooms, (the mobile shower) serves as an outreach tool to further HOST’s efforts to engage homeless persons in our community into services.” Trauma-Informed Care Especially since the composition of Seattle’s Navigation Team includes police, the City might consider steps that might be taken to ensure that interactions with police do not unintentionally re-trigger trauma in unsheltered individuals. In 2017, the Navigation Team received a 4hour training on trauma-informed care from Seattle King County Public Health. Building on this, the Navigation Team might also consider using a selfassessment tool that identifies steps the program can take to become more trauma-informed. For example, the Trauma-Informed Toolkit for Homeless Services was commissioned by the U.S. Substance Abuse and Mental Health Services Administration in recognition that homeless individuals often have significant histories of trauma that impact their current functioning and needs. It is designed to be used by homeless-serving programs to evaluate how well they incorporate 6 See City of Santa Rosa’s August 2016 report on HOST performance measures at https://casantarosa.civicplus.com/DocumentCenter/Home/View/14048. 7 See City of Santa Rosa’s March 2017 report on HOST performance measures at https://casantarosa.civicplus.com/DocumentCenter/Home/View/14046. Page 8 Reporting Plan for Navigation Team trauma-informed practices, identify areas for organizational growth, and make practical changes using their self-assessment as a guide. Navigation Team Training Appendix 4 in the Navigation Team Theory of Change (Appendix B to this report) lists the classes that the Navigation Team Officers have taken over the past five years. It indicates that the supervising sergeant works with the officers to ensure that these skills are applied in the field, “specifically regarding crisis intervention, de-escalation and racial bias.” However, the Theory of Change does not mention whether or how the efficacy of the officer training will be evaluated. Evaluating Navigation Team officer training can be helpful in uncovering areas of strength as well as misunderstandings or gaps in learning. The evaluation of officer training does not have to be overly time-consuming or difficult. In a recent letter to Chief Kathleen O’Toole, Dr. Jack McDevitt from Northeastern University’s Institute on Race and Justice suggested developing short case studies from the field as a way to reinforce SPD hate crime training. Similar case studies could potentially be created for the Navigation Team to evaluate the effectiveness of the training and reinforce key principles. The evaluation of officer training could also identify any process improvements or additional trainings that might be helpful. For example, if the Navigation Team is not already doing this, the team might develop a checklist for ensuring that Navigation Team clients have all their necessary medical supplies (e.g., medications, inhalers, eye glasses, dentures) as they relocate to a safer living situation. If a medical checklist is developed, additional training necessary for officers to begin to utilize it could then be identified and evaluated. The Theory of Change for the Navigation Team did not include information regarding training for the non-police members of the team. This information can be provided under Reporting Checkpoint 1.4 below. Page 9 Reporting Plan for Navigation Team Reporting Checkpoints Checkpoint # 1.1 Request The following additional information will be helpful to the City Council to understand more about the composition of the Navigation Team. Description Due Date Analysis of Navigation Team engagement rate This should include an analysis of the engagement rates through December 2017. Has the Navigation Team seen an increase or decrease in the 31% rate of refusal to accept services, referrals, or basic needs? To what extent is this affected by perceptions of the police by the homeless? The City might consider partnering with a local university to study this issue (e.g., San Diego study). The analysis might also identify potential strategies for improving the engagement rate, such as the mobile shower used by Santa Rosa HOST. Q1 2018 1.2 Organizational staffing assessment This staffing assessment for the Navigation Team should address questions including: What is the right size and right mix of police, outreach, other (e.g., paramedics, behavioral health specialists)? What are the costs of various options? The City of Seattle might consider learning more from the City of Austin’s Bloomberg Innovation Team about their efforts to assess the staffing size and composition of their homeless outreach team. Q 2 or Q3 2018 1.3 Trauma-Informed Care self-assessment Complete and report on findings from a Trauma-Informed Care self-assessment. An example of a self-assessment tool that the City may wish to consider was developed by the U.S. Substance Abuse and Mental Health Services Administration, Homelessness Resource Center. See http://www.air.org/sites/default/files/downloads/report/ Trauma-Informed_Organizational_Toolkit_0.pdf. Q1 2018 1.4 Evaluation of Navigation Team training Develop a plan for evaluating the effectiveness of Navigation Officer Training. The City might consider the creation of short case studies as suggested by Northeastern University’s Institute on Race and Justice. Provide information on the training received by the nonpolice members of the Navigation Team. Q1 2018 Page 10 Reporting Plan for Navigation Team REPORTING AREA 2: STRATEGIC APPROACH Our review of the Navigation Team Theory of Change raised questions about whether there might be potential opportunities for increasing effectiveness by incorporating a more strategic approach. Specifically: Early-Outreach Interventions • What opportunities exist for early-outreach interventions? • What opportunities exist to prioritize hygiene? • What opportunities exist for measures to prevent trash accumulation? • Could gains be made by improving coordination with King County? The goal of the Navigation Team is “to provide outreach to people living unsheltered that is efficient and effective at moving people out of hazardous conditions and onto a path toward health, stability, and permanent housing.” However, the Navigation Team Theory of Change specifies that, “the City has made the strategic operational decision to deploy the Navigation Team in conjunction with the ongoing encampment cleanup work 8 conducted by the Finance and Administrative Services (FAS) Department.” Therefore, the scope of Navigation Team outreach is limited to unsheltered people at those sites selected for encampment removal and cleanup work. In its operational decision linking the scope of the Navigation Team outreach exclusively with encampment removal and cleanup work, 8 City Officials indicated that the Navigation Team prioritizes the encampments it engages based on rule FAS 17-01 and MDAR 17-01. These rules apply to the removal of encampments on public property by any City employee. FAS 17-01 identifies priorities for removal of encampments, essentially based on hazard: “5.1.3 The following criteria, which have no relative priority, shall be considered when prioritizing encampments for removal: (1) objective hazards such as moving vehicles and steep slopes; (2) criminal activity beyond illegal substance abuse; (3) quantities of garbage, debris, or waste; (4) other active health hazards to occupants or the surrounding neighborhood; (5) difficulty in extending emergency services to the site; (6) imminent work scheduled at the site for which the encampment will pose an obstruction; (7) damage to the natural environment of environmentally critical areas; and (8) the proximity of homeless individuals to uses of special concern including schools or facilities for the elderly.” City officials indicated that the criteria “have no relative priority”, because one or many of them could apply to a particular situation to a greater or lesser extent, and prioritization is based on the totality of the circumstances. Finally, FAS 17-01 defines the characteristics of sites so dangerous that they may be removed immediately: “3.3 “Immediate hazard” means an encampment where people camping outdoors are at risk of serious injury or death beyond that caused by increased exposure to the elements or their presence creates a risk of serious injury or death to others; including but not limited to encampments at highway shoulders and off-ramps, areas exposed to moving vehicles, areas that can only be accessed by crossing driving lanes outside of a legal crosswalk, and landslide-prone areas.” Page 11 Reporting Plan for Navigation Team might the City be missing opportunities for earlier outreach interventions? Below we present three potential strategies for early-outreach interventions to limit the amount of time individuals spend on the streets. 1. HOME-STAT New York City’s HOME-STAT program was informed by state data that indicate that street-homeless individuals need an average of five months of intensive contact by outreach workers to move into transitional housing and more than a year for permanent housing. Therefore, the HOME-STAT program combines time-intensive, trust-building work with those who are already street homeless with proactive canvassing to identify individuals who are new to the streets. Teams of contracted street outreach providers conduct weekly proactive canvassing of hot-spots of street homelessness in Manhattan and the boroughs. This includes partnerships with 35 public libraries and nine hospitals. Also, one contracted outreach team conducts 24x7 canvassing in the subways. The proactive canvassing provides a consistent weekly look at daytime conditions of street and homelessness and supplements the City’s efforts to encourage public requests for homeless outreach assistance via the City’s 311 phone line and mobile app. HOME-STAT also instituted a new citywide overnight quarterly count (in addition to the City’s annual count) that enables outreach staff to confirm the locations of clients with whom they are already working and find new people who could benefit from the City’s enhanced outreach services. In addition, New York City’s HOME-STAT provides a variety of online public reports including: a daily public dashboard that maps 311 service requests from the public, a weekly dashboard that maps data from HOME-STAT canvassing, and a monthly dashboard reports on aggregate outcomes, conditions and performance. 2. “No Second Night Out” Another strategy for quick identification and system-intake of unsheltered individuals is the UK’s No Second Night Out. This program exclusively targets individuals who find themselves sleeping on the streets for the first time. It includes a 24-hour coordinated entry and assessment hub and rapid offers of housing or family reunification. A study of a six month pilot indicated that Page 12 Reporting Plan for Navigation Team outreach teams worked with over 2500 individuals, and over 1700 (67%) left the streets for a safer situation after just one night. 78% of this group did not return to the streets once helped. 3. “Pop-Up Services” Austin’s homeless outreach team, HOST, recently began experimenting with strategies for earlier outreach. In July 2017, Austin HOST began offering “pop-up services” to handle the needs of individuals experiencing homelessness with combined offerings at a single location, including street medicine, 9 pharmacists, and case management. Attendance has increased at each pop-up so far, and HOST reports that these events are building trust among Austin’s unsheltered population. Prioritize Hygiene City officials indicated that the Navigation Team works only at places “where conditions are the worst.” As San Diego experienced this year with a Hepatitis A outbreak among the homeless, conditions for people living unsheltered can easily go from bad to worse because of lack of access to proper hygiene facilities including restrooms, handwashing, and showers. The City might want to consider options for prioritizing access to hygiene to reduce the risk of sites experiencing environmental hazards and communicable disease outbreak. An example of the unintended consequences of inaction in addressing hygiene occurred recently in San Diego. Sixteen people have died and hundreds have been hospitalized between November 2016 and September 2017 from an outbreak of Hepatitis A among the homeless in San Diego. The disease has spread because of lack of access to hygiene and sanitation facilities. Emergency response from health officials included vaccinations and portable handwashing stations. On September 13, 2017, San Diego’s Mayor issued a press release stating, “Offering more clean and safe spaces that transition the homeless from living on the streets to living in a permanent home is exactly what San Diego needs right now.” He announced the creation of three new “bridge to housing” 24X7 shelters that will serve over 100 people each and are consistent with best practices. The large tent-like structures 10 can be constructed rapidly, and at least one will be open by December. 9 For an example of street medicine in Seattle, see the University District Street Medicine program run by student volunteers from the University of Washington. 10 See an example of a large tensioned-membrane structure used as a homeless shelter in San Diego at http://www.sprung.com/casestudy/father-joes/. Page 13 Reporting Plan for Navigation Team Ethical Framework Researchers from the Institute for Social Policy, Housing, Equalities Research in Edinburgh, Scotland recently developed an ethical framework for considering the legitimacy of homeless interventions. The framework describes four criteria used for judging the legitimacy of a homeless intervention: 1. 2. 3. 4. Whether it serves a legitimate purpose, Whether it allows for a voluntary response, By its effects on the character of the parties involved, and Whether it is an effective, proportionate, and balanced means to pursue the(legitimate) purpose(s) for which it is deployed. (Watts, Fitzpatrick, & Johnsen, 2017) Not surprisingly, the framework sets a high ethical bar for justifying the use of “hard interventions” such as civil or criminal sanctions. Less intuitively, however, the framework also “allows for ethical judgements about the costs of inaction.” Consequently, the framework calls for consideration of the unintended consequences of inaction (Watts, Fitzpatrick, & Johnsen, 2017). Prioritization of hygiene might include exploring providing even greater access to facilities with restrooms and showers (e.g., Parks Community Centers), or providing more access to portable/mobile units (e.g., mobile showers). Moreover, as is the case in San Diego, addressing an acute hygiene problem might involve rapidly creating more safe places for people to go that offer proper sanitation and hygiene. There are several jurisdictions, including San Diego, Los Angeles, Honolulu, and Oakland, that are currently exploring ways to rapidly create more safe, inclusive, low-barrier places for people to go that also offer proper sanitation and hygiene. Seattle’s sanctioned encampments have been a model for a number of jurisdictions. Seattle was the first in the country to establish sanctioned encampments, and as of 2017, the City supports six permitted encampments. A June 2017 report from the City of Seattle Human Services Department (HSD) indicates that people living in Seattle’s sanctioned encampments have had a higher rate of placement in permanent housing (26%) than those living in shelters (18%). These early findings also suggest that the permitted encampments with tiny houses 11 and on-site case management appeared to have higher rates of exits to permanent and transitional housing than other permitted encampments. In September 2017, the City of Oakland announced plans to use three City parcels to house up to 40 people each in pre-fabricated Tuff Sheds. The lots would be fenced with toilets and a daytime manager. As previously mentioned, in September 2017, the City of San Diego announced plans to construct three 24x7 tensioned-membrane structures (including showers, laundry, etc.) for a total of approximately 300 people using a Housing First approach. Also, in July 2017, King County issued a Request for Information for modular units (including showers, laundry, etc.) that could serve as 24x7 shelters using a Housing First approach. In September 2017, the King County Executive released a shelter expenditure plan that includes the development of two modular shelters in South Seattle serving approximately 135 people. In considering its options for prioritizing hygiene, the City may want to consider the tradeoffs between diverting funds away from creating more permanent housing and whether these options might contribute to lowering our standards about what constitutes affordable housing. 11 Each tiny house is 8x12 feet; it is insulated, has electricity, and costs approximately $2,200 to build. Page 14 Reporting Plan for Navigation Team Three recent papers by the California Law Review, a PhD student at the University of California Berkeley, and Seattle University School of Law caution that thinking of sanctioned encampments as a type of ‘transitional micro-housing’ can be a slippery slope to a general lowering of the standard of affordable housing (Loftus-Farren, 2011) (Herring, 2015) (Junejo, Skinner, & and Rankin, 2016). There is a “growing concern that the new forms of legal encampment constitute a quick-fix, low-cost solution to the immediate problem of relieving homelessness that largely ignores the more fundamental problem of ensuring decent housing for all citizens“ (Herring, 2015). Trash Accumulation In 2017, through July 31, the City has spent about $4.3 million 12 on encampment clean-up. A recent audit report on homeless encampments by the Los Angeles Controller estimated that the City of Los Angeles is spending as much as $1,000 per hour on encampment cleanups. Accumulated trash is costly to deal with, and, left unaddressed, can increase the severity of hazard in Seattle’s unauthorized encampments. This can affect the frequency of encampment removals and deployments of the Navigation Team. There may be some opportunities for the City to take additional proactive measures to prevent large accumulations of trash that pose public health risks and are costly to clean up. In July 2017, Seattle Public Utilities (SPU) began an Encampment Trash Pilot project that provides to unsanctioned homeless encampments garbage bag distribution, scheduled solid waste pickup services, and on-call trash pick-up service, as needed. Large items (e.g., couches) may be picked up with these services. This service is separate from collection of trash following a scheduled encampment cleanup. SPU is currently providing or has provided weekly trash collection at 10 locations. SPU also provides on-call collection at sites near unsanctioned homeless encampments as requested by the public ,FAS, orHSD. SPU has partnered with the Union Gospel Mission (UGM) Search and Rescue Team to distribute designated purple bags and educate unsanctioned encampment residents on the garbage collection days. UGM has distributed over 4,000 bags, and SPU has collected over 76,000 pounds of trash since tracking began July 2017. The City may want to assess this service to determine whether it might be improved, expanded, or altered. Some homeless encampment areas in Seattle may have been the sites of opportunistic illegal dumping by people who do not live in those 12 Source: City of Seattle City Council Central staff memo, October 17, 2017. Page 15 Reporting Plan for Navigation Team encampments. A preventative strategy the City might consider is conducting a geographic analysis13 to determine which encampment areas have experienced the most illegal dumping, followed by site assessments at those areas to identify potential physical changes (e.g., concrete highway barriers to prevent access for dumping) that might reduce opportunities for illegal dumping at those sites. Some cities have found that garbage can also accumulate around encampments due to street-side donations that are not well coordinated to prevent food spoilage. Several cities, including Las Vegas, Phoenix, and San Jose, have recently been working with local nonprofit organizations and community groups to better coordinate street-side donations (especially food) for the homeless. King County Public Health has developed a planning and management checklist for sanctioned encampments that requires sanctioned encampments to have a plan for food donation management. Some of the elements from this tool might help guide the City’s approach to more coordinated street-side donations. Coordination with King County The Navigation Team Theory of Change indicates that the Navigation Team will use King County’s Homeless Management Information System (HMIS) and participate in the County’s Coordinated Entry system. Further, City officials indicated that the County provided training for the Navigation Team in Trauma Informed Care and commitment services, and Navigation Team members can make referrals to several County programs. 14 An example of city-county cooperation on the issue of homeless encampments is Austin’s HOST, which is an explicit collaboration between the City of Austin and Austin-Travis County EMS. In fact, Austin will be moving the functional home of its outreach team to the County EMS in the next fiscal year. More explicit coordination of Seattle and King County outreach might create opportunities and efficiencies. A September 22, 2017 HSD report on the first year of Pathways Home noted, “While there are many outreach providers who individually are doing good work, Seattle and King County do not have a coordinated system of outreach to ensure adequate coverage, outreach, and placement.” In 2016, HSD, King County All Home, and REACH convened a workgroup and established a 13 Seattle Public Utilities maintains an online map of illegal dumping sites, so this data could potentially be used to help identify the encampment areas that have experiences the most opportunistic illegal dumping. 14 City officials indicated that Navigation Team members can make referrals to a number of County programs including: Crisis and Commitment, Kid’s Plus/Mom’s Plus, the Needle Exchange, Familiar Faces, the Mobile Medical Van, the Program for Assertive Community Treatment, and Behavioral Health and Recovery. Beyond that, however, there may be opportunities for the Navigation Team to forge a deeper collaboration with King County. Page 16 Reporting Plan for Navigation Team standard of practice for all outreach providers (See Navigation Team Theory of Change Appendix 2). It might be helpful for the City assess the degree to which the Navigation Team is following the standard of practice and to learn more about the Navigation Team’s role in any other efforts to align outreach countywide. There may be additional potential opportunities for collaboration with King County. For example, should the Navigation Team decide to operate a mobile shower to improve outreach performance, like Santa Rosa, California, could it be a resource that is shared with King County? Reporting Checkpoints Checkpoint # 2.1 The following additional information will be helpful to the City Council to understand more about opportunities for the City to increase effectiveness by incorporating a more strategic approach. Request Description Due Date Assessment of opportunities for earlyoutreach intervention Assess the feasibility of the City pursuing early-outreach intervention. Consider examples from other jurisdictions (e.g., HOME-STAT, Pop-ups, No Second Night Out.) Q1 or Q2 2018 2.2 Assessment of opportunities for prioritizing hygiene Assess opportunities for improved access to hygiene to reduce the risk of environmental hazards or communicable diseases. Q2 or Q3 2018 2.3 Assessment of strategies to prevent trash accumulation Provide an assessment of new and revised strategies to prevent trash accumulation (e.g., SPU encampment trash pilot, street-side donations coordination, opportunistic illegal dumping prevention, etc.) Q2 2018 2.4 Assessment of opportunities for greater coordination with King County Assess the degree to which the Navigation Team is following the standard of practice for outreach; describe the Navigation Team’s role in any other efforts to align outreach countywide; report on any other potential areas of collaboration with King County. Q1 2018 Page 17 Reporting Plan for Navigation Team REPORTING AREA 3: DATA AND EVALUATION Our review of the Navigation Team Theory of Change raised questions about how the City might better use data and evaluation to ensure that it achieves its intended outcomes. Specifically: 2017 Baseline Measures • What baseline measures need to be collected for 2017? • How might the City strengthen its evaluation of the Navigation Team? • How might unsheltered individuals be meaningfully involved in ongoing evaluation of the Navigation Team? Without strong data collection in place, the City will not be able to assess how well the Navigation Team is achieving its goals, whether the program is having unintended consequences, and what are the costs versus benefits of the work. In addition, without sufficient datagathering and analysis, the Navigation Team itself will not be able to adequately monitor its operations in real time and make course corrections and improvements. Therefore, it will be important for the Navigation Team to begin to explore and demonstrate their capacity for data collection and analysis with the compilation of data from 2017. A complete set of 2017 baseline data for the Navigation Team would include: • Measures for the 2017 “Activities, Results and Outcomes” identified in the Navigation Team logic model • 2017 expenditures • 2017 measures of system performance • 2017 racial equity analysis The Navigation Team Theory of Change - Appendix 5 presents a logic model with sets of Activities, Results, and Outcomes, each which could be tracked or measured. And the report indicates that the team is currently capturing the following information: individual level data on demographics, interactions, offers made, and offers accepted. While some of the long-term outcomes cannot be measured at this point, collecting data on most of the other measures included in the logic model should be straightforward. Using the demographic data collected by the Navigation Team, the City should be able to construct a racial analysis that might point out disparities that need to be addressed. King Page 18 Reporting Plan for Navigation Team County All Home, for example, presents some online quarterly data that can be viewed by race. In addition, the Executive has been tracking costs associated with the Navigation Team. So, it should be reasonable for the Navigation Team to compile the 2017expenditure information by early 2018. In addition, there are important data that are not collected by the Navigation Team itself that reflect how well the Navigation Team and the overall system is functioning. A key example of a measure of overall system functioning is the rate of individuals returning to the street. The Navigation Centers in San Francisco have served and exited 1,192 individuals since they opened in 2015; however new data show that 27% (323) have returned to homelessness. This is a troubling trend, but this data point allows program managers and policy makers to examine the system to better understand why this is happening. King County All Home has established several System Wide Performance Targets. 15 In addition, it may be helpful for the City to determine if there are additional measures of overall system functioning that would be helpful for its review of the Navigation Team. Some important measures of system performance were captured by HSD’s 2016 Homeless Needs Assessment including percentage of unsheltered who have not been approached by an outreach worker (47.2%) and percentage of respondents living outdoors who have completed a coordinated entry (27%). It might be helpful to gauge how comprehensive outreach coverage is by recapturing some measures from the 2016 assessment. Additional measures of system functioning might include: reasons for which the Navigation Team was unable to place individuals in an alternative living situation (e.g., no capacity, not a good fit, etc.), rate of City compliance with the Multi-Department Administrative Rule, rate of individuals reaching their alternative living situation with all of their medical supplies (glasses, medicines, inhalers), and so on. The Navigation Team might also consider including comparable measures from other jurisdictions in the 2017 baseline. The Navigation Team Theory of Change indicates that the Navigation Team was created based on discussions with police departments of Anaheim, Salt Lake City, Colorado Springs, New York City, Cambridge (MA), San 15 King County All Home has established several System Wide Performance Targets, specifically: • Reduction in length of time homeless and increased rates of exits to permanent housing evidenced by: Navigating people living unsheltered into shelter or housing by completing or confirming the completion of a Coordinated Entry for All assessment • Reduction in returns to homelessness evidenced by: linking people living unsheltered to outpatient physical, mental health, substance abuse treatment, e.g., confirmed attendance at a clinical visit • Reduction in the number of unsheltered as evidenced by: documentation of homeless status for all clients served. Page 19 Reporting Plan for Navigation Team Diego, and Los Angeles and the Mayor’s Office of Los Angeles. Unfortunately, the Navigation Team Theory of Change does not describe what types of data these jurisdictions are tracking and how they are measuring the success of their efforts. Further, there appears to be very little publicly-available data generated from these teams. For example, Salt Lake City, Utah published a report on its Homeless Outreach Survey Team (HOST) that contained metrics from only four months of operation. 16 Austin, Texas published a report from a pilot of its Homeless Outreach Street Team (HOST) conducted from June 1 – August 15, 2016. 17 Although not among the cities with whom Seattle officials spoke, Santa Rosa’s HOST publishes detailed quarterly data. Exhibit 3 below provides a very limited comparison of these teams with Seattle’s Navigation Team based on available data. However, it might be possible for the Navigation Team to establish relationships with peer jurisdictions to share data on certain baseline measures that might be useful benchmarks, such as staffing levels and engagement rates. Exhibit 3: Limited Comparison of Data from Homeless Outreach Teams Team Composition Reporting Period # of Unique Individuals Engaged Salt Lake City, Utah 3 total (2 police officers, 1 sergeant) 4 months (November 2014-March 2015) 291 (~73/month) Austin, Texas 8 total (2 police officers, 2 paramedics, 4 case managers) 2 ½ months (June 1-August 15, 2016) 300 (~120/month) Santa Rosa, California 5 total (4 outreach workers – contract, 1 supervisor – contract) 16.5 months (August 15, 2015-December 31, 2016) 848 (~51/month) Seattle, Washington 22 total (8 police officers, 1 sergeant, 1 team lead, 1 manager, 3 field coordinators, 7 outreach workers-contract, 1 outreach supervisor-contract) 2.5 months (February 20-May 5, 2017) 344 (~138/month) 16 Between November 2014 and March 2015, Salt Lake City HOST, consisting of two police officers and one sergeant, made 291 contacts with results that included 25 job placements and 51 people reunited with family members. 17 Between June 1 and August 15, 2017, Austin HOST, consisting of two police officers, two paramedics, and four case managers, served 300 unique clients. Page 20 Reporting Plan for Navigation Team Evaluation Plan There are several possibilities that the City might consider to strengthen its capacity to evaluate the Navigation Team ranging from technical assistance from other government agencies, to low-cost graduate student studies, to partnerships with university research partners. First, some federal agencies offer technical assistance grants to help with evaluation of local programs. In addition, the evaluation unit at Seattle King County Public Health can potentially be a good source of technical assistance for developing an evaluation approach, connecting with researchers, and applying for research grants. Because homeless individuals of color are overrepresented in the homeless system county-wide, any evaluation of the Navigation Team should include a racial equity analysis. Seattle’s Office for Civil Rights might be able to provide technical assistance for this aspect of the evaluation. In addition, local universities, including the University of Washington (UW) and Seattle University might be interested in exploring low-cost evaluation possibilities, including field research conducted by graduate students, such as the study conducted by San Diego State University. The City might also consider engaging a university research partner(s) to conduct a rigorous evaluation of the Navigation Team. Findings from such an evaluation could help the City better judge the effectiveness of the program, shape program improvements, and ensure the sustainability of a proven program through changes in leadership. An example of a Seattle area program that has incorporated rigorous evaluation is the Downtown Emergency Services Center’s (DESC) 1811 Eastlake Housing First program. Working with research partners from the University of Washington, 1811 Eastlake Housing First has been evaluated through a rigorous multi-pronged approach that compared outcomes for program participants against a control group. The study reported an average cost-savings of 53 percent, nearly $2,500 per month per person in health and social services (Larimer, et al., 2009). The City might consider reaching out to the UW researchers who conducted the 1811 Eastlake Housing First evaluation to understand more about that evaluation process and to determine whether something similar might be possible for the Navigation Team. Finally, as part of its evaluation plan, the City might consider conducting a formal benefit-cost analysis of the Navigation Team that captures the savings to the overall public system (e.g., savings from reduced emergency responses). The Washington State Institute for Page 21 Reporting Plan for Navigation Team Public Policy has a well-established methodology for benefit-cost calculations and could provide technical assistance to the City. The City might consult with other jurisdictions who are currently conducting benefit-cost analysis of their homeless outreach programs. 18 Unsheltered Community Participation in Evaluation The Navigation Team Theory of Change does not currently mention how unsheltered individuals might be engaged in planning and evaluation efforts, and it is not clear to what extent unsheltered individuals had been involved in developing the Theory of Change itself. There are many potential ways to meaningfully engage the people served by the Navigation Team in its evaluation, including surveys or interviews to gauge their satisfaction, consumer seats on a steering committee, etc. For example, this year the City of Austin’s Bloomberg Innovation Team will “partner with HOST during their popups to capture oral narratives and journey maps 19” from HOST clients. The City may want to consider using an empowerment evaluation framework for the evaluation of its Navigation Team. Empowerment evaluation is a professional and systematic approach to self-evaluation that has been used in over 16 countries and a diverse array of organizations including Hewlett-Packard, the Centers for Disease Control, the Arkansas Department of Education, and women-artisan’s cooperatives in Peru. Empowerment evaluation is conducted by the organization itself, with coaching and technical assistance from an evaluator(s), who ensures the rigor of the evaluation but does not control the evaluation. Organization staff and stakeholders (including program consumers/clients) are provided with evaluation concepts, techniques, and tools that are used for self-evaluation of the organization. The focus of the evaluation is on continuous improvement. The ten principles of empowerment evaluation include: improvement, community ownership, inclusion, democratic participation, social justice, community knowledge, evidence-based strategies, capacity building, organizational learning, and accountability. (Fetterman, Kafterian, & Wandersman, 2015) WATCH: One of the developers of empowerment evaluation, Dr. David Fetterman, former director of the Division of Evaluation in the School of Medicine at Stanford University, offers a six-minute Ignite presentation describing the theory and practice of empowerment evaluation. https://www.youtube.com/watch?feature=player_embedded&v=fjUvV4HHH38 18 The City of Austin gathered preliminary benefit-cost data for its pilot implementation of HOST, and, according to a September 26, 2017 audit, the City of Honolulu is currently working with the University of Hawai’i on a benefit cost analysis of homeless services, including outreach. 19 For example, in 2017, to help guide an expansion in homeless outreach services, New York City created an 11-step journey map that details the most likely routes for street homeless individuals to more stable and permanent housing. See http://www1.nyc.gov/assets/dhs/downloads/pdf/turning-the-tide-on-homelessness.pdf. Page 22 Reporting Plan for Navigation Team Reporting Checkpoints Checkpoint # 3.1 Request The following additional information will be helpful to the City Council to understand how to better use data and evaluation to ensure that the Navigation Team achieves its intended outcomes. Description Due Date Report on 2017 baseline data – “Results and Outcomes” Per the Navigation Team Logic Model, provide a report of the 2017 baseline “results and outcomes” measures, including offers of services made, voluntary relocations to safer conditions, etc. Consider whether there might be baseline measures that could be compared among jurisdictions comparable to Seattle (e.g., engagement rate). Q1 2018 3.2 Report on 2017 expenditures Report on total 2017 expenditures for the Navigation Team including staffing and related costs. Report on total 2017 expenditures related to encampment removals and cleanups (trash removal, SPD overtime for traffic, etc.) Q1 2018 3.3 Report on 2017 measures of system performance Identify and report on additional measures not currently defined in the Theory of Change that reflect overall system performance for the Navigation Team, including: percent of unsheltered individuals not approached by outreach, reasons for lack of placement in alternative living situations, rate of compliance with MDARs. Q2 2018 3.4 Report on 2017 racial equity impacts Evaluation plan Provide an assessment of 2017 racial equity impacts. Q1 2018 Develop a plan for strengthening the evaluation of the Navigation Team. Q2 2018 Plan for unsheltered individuals to be meaningfully involved in Navigation Team evaluation Develop a plan for unsheltered individuals to be meaningfully involved in Navigation Team evaluation. Consider applying the principles of empowerment evaluation. Q2 2018 3.5 3.6 Page 23 Reporting Plan for Navigation Team APPENDIX A References Arellana, R. (2017, September 8). Assistant City Manager, City of Austin. Homelessness Outreach Street Team (HOST) Pilot Results and Recommendations. Austin, Texas. Fetterman, D. M., Kafterian, S. J., & Wandersman, A. (2015). Empowerment Evaluation: Knowledge and Tools for Self- Assessment, Evaluation Capacity-Building, and Accountability. Los Angeles, CA: Sage. Herring, C. (2015). Tent City America. Places Journal, placesjournal.org. Junejo, S., Skinner, S., & and Rankin, S. (2016). No Rest for the Weary: Why Cities Should Embrace Homeless Encampments . Homeless Rights Advocacy Project, http://digitalcommons.law.seattleu.edu/hrap/4 . Larimer, M., Malone, D., Garner, M., Atkins, D., Burlingham, B., Lonczak, H., . . . Marlatt, G. (2009). Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems. JAMA, 301(13):1349–1357. Loftus-Farren, Z. (2011). Tent Cities: An Interim Solution to Homelessness and Affordable Housing Shortages in the United States. California Law Review, 1037-1081. Sage Project, San Diego State University. (2016). An Assessment of Homeless Individuals’ Perceptions of Service Accessibility in Downtown San Diego. San Diego, CA: San Diego State University School of Public Affairs. Tangherlini, N., Villar, J., Brown, J., Rodriguez, R., Y. C., F. B., & Wada, P. (2016). The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS. . Prehospital and Disaster Medicine, 31(6):603–607. Watts, B., Fitzpatrick, S., & Johnsen, S. (2017). Controlling Homeless People? Power, Interventionism, and Legitimacy. Journal of Social Policy, 1-18. Hyperlinks Page # 1 1 1 Website Name / Description United Way of King County’s Parent-Child Home Program Theory of Change guide from the Annie E. Casey Foundation Theory of Change guide from the United States Agency for Website Address https://www.uwkc.org/giving-kids-equal-chance/pchp/ http://www.aecf.org/resources/theory-of-change/ https://usaidlearninglab.org/lab-notes/what-thing-called-theorychange Page 24 Reporting Plan for Navigation Team Page # 3 4 4 5 5 5 6 6 8 8 8 8 Website Name / Description International Development (USAID) REACH, King County program of Evergreen Treatment Services Research Study: The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS San Francisco’s Homeless Outreach and Medical Emergency (HOME) Team Austin’s Homeless Outreach Street Team Austin-Travis County Community Health Paramedic Program September 8, 2017 memo to Austin’s Mayor and City Council San Diego’s Homeless Outreach Team 2016 study commissioned by the City of San Diego: An Assessment of Homeless Individuals’ Perceptions of Service Accessibility in Downtown San Diego Santa Rosa California’s Homeless Outreach Services Team Federally-required coordinated entry: Coordinated Entry Policy Brief City of Santa Rosa operation of a 16-foot mobile trailer with two bathroom/shower units: Homeless Outreach Services Team (HOST) Clean Start Mobile BathroomShower Schedule The National Center on Family Homelessness: TraumaInformed Organizational Toolkit for homeless services Website Address http://www.etsreach.org/ https://www.cambridge.org/core/journals/prehospital-and-disastermedicine/article/home-team-evaluating-the-effect-of-an-emsbasedoutreach-team-to-decrease-the-frequency-of-911-use-among-highutilizers-of-ems/DDDDD6366FAD9F771F9CD4C9ED0F56FA http://sf-fire.org/homeless-outreach-medical-emergency-home-team https://www.austintexas.gov/department/homelessness-outreachteam http://www.austintexas.gov/edims/document.cfm?id=154794 https://endinghomelessness.bloomfire.com/posts/1453882homelessness-outreach-street-team-results-and-recommendationsmemo-to-austin-ma https://www.sandiego.gov/homeless-services/programs/hot https://sdsudspace.calstate.edu/bitstream/handle/10211.3/183014/SD001%20PA4 97_CJ540_Sp16%20An%20Assessment%20of%20Homeless%20Indiv iduals'%20Perceptions%20of%20Service%20Accessibility%20in%20D owntown%20SD.pdf?sequence=1 https://srcity.org/764/Homeless-Outreach-Services-Team-HOST https://www.hudexchange.info/resources/documents/CoordinatedEntry-Policy-Brief.pdf https://srcity.org/documentcenter/view/6328 http://www.air.org/sites/default/files/downloads/report/TraumaInformed_Organizational_Toolkit_0.pdf Page 25 Reporting Plan for Navigation Team Page # 8 8 9 9 10 10 10 10 10 11 Website Name / Description City of Santa Rosa Memorandum: Fourth Quarter Report – Homeless Outreach Services Team (HOST) Program City of Santa Rosa Memorandum: Second Quarter Report – Homeless Outreach Services Team (HOST) Program Letter to Chief Kathleen O’Toole from Jack McDevitt: Review of City Auditor’s Report, Review of Hate Crime Prevention, Response and Reporting in Seattle: Phase I Northeastern University’s Institute on Race and Justice An Assessment of Homeless Individuals’ Perceptions of Service Accessibility in Downtown San Diego City of Santa Rosa Homeless Outreach Services Team (HOST) Clean Start Mobile BathroomShower Schedule City of Austin’s Bloomberg Innovation Team The National Center on Family Homelessness: TraumaInformed Organizational Toolkit for homeless services Short case studies suggested by Northeastern University’s Institute on Race and Justice: Letter to Chief Kathleen O’Toole from Jack McDevitt: Review of City Auditor’s Report, Review of Hate Crime Prevention, Response and Reporting in Seattle: Phase I Turning the Tide on Homelessness in New York City, City of New York Website Address https://casantarosa.civicplus.com/DocumentCenter/Home/View/14048 https://casantarosa.civicplus.com/DocumentCenter/Home/View/14046 http://spdblotter.seattle.gov/wp-content/uploads/2017/09/McDevittCity-Auditors-Report.pdf http://www.northeastern.edu/irj/ https://sdsudspace.calstate.edu/bitstream/handle/10211.3/183014/SD001%20PA4 97_CJ540_Sp16%20An%20Assessment%20of%20Homeless%20Indiv iduals'%20Perceptions%20of%20Service%20Accessibility%20in%20D owntown%20SD.pdf?sequence=1 https://srcity.org/documentcenter/view/6328 http://www.austintexas.gov/news/city-austin-receive-grantbloomberg-philanthropies-innovation-team-program-0 http://www.air.org/sites/default/files/downloads/report/TraumaInformed_Organizational_Toolkit_0.pdf http://spdblotter.seattle.gov/wp-content/uploads/2017/09/McDevittCity-Auditors-Report.pdf http://www1.nyc.gov/assets/dhs/downloads/pdf/turning-the-tideon-homelessness.pdf Page 26 Reporting Plan for Navigation Team Page # 11 11 11 11 13 13 13 13 13 13 14 14 14 14 14 14 Website Name / Description Street Outreach, Department of Homeless Services, City of New York HOME-STAT Mayor’s Office of Operations, City of New York The UK’s No Second Night Out Study of a six-month pilot: No Second Night Out Across England Austin HOST “pop-ups” Outbreak of Hepatitis A in San Diego Lack of access to sanitation and washing in San Diego San Diego Mayor press release: City to Open Temporary ‘Bridge’ Shelters to Help the Homeless University District Street Medicine Father Joe’s, national provider specializing in the needs of the homeless Ethical framework for considering the legitimacy of homeless interventions, Cambridge University June 2017 City of Seattle Human Services Department – Evaluation of sanctioned encampments San Diego Mayor press release: City to Open Temporary ‘Bridge’ Shelters to Help the Homeless Father Joe’s tensionedmembrane structures HUD Exchange: Housing First in Permanent Supportive Housing Brief King County Request for Information: Modular Shelter Facility Development, Management and Services Website Address http://www1.nyc.gov/site/dhs/outreach/street-outreach.page http://www1.nyc.gov/site/operations/projects/HomeStat.page http://www.nosecondnightout.org.uk/about-nsno/ http://www.homeless.org.uk/sites/default/files/siteattachments/20140211%20NSNO%20England%20Wide%20Report%2 0FINAL.pdf https://endinghomelessness.bloomfire.com/posts/1453882homelessness-outreach-street-team-results-and-recommendationsmemo-to-austin-ma http://www.cnn.com/2017/09/14/health/hepatitis-a-outbreak-sandiego-county/ http://www.huffingtonpost.com/entry/san-diego-homeless-hepatitisoutbreak_us_59c02b9fe4b0f22c4a8be47c https://www.sandiego.gov/mayor/news/releases/mayor-faulconercity-open-temporary-%E2%80%98bridge%E2%80%99-shelters-helphomeless https://sites.google.com/uw.edu/udstreetmed/home http://www.sprung.com/case-study/father-joes/ https://www.cambridge.org/core/journals/journal-of-socialpolicy/article/controlling-homeless-people-power-interventionismand-legitimacy/0794C172577CAA13DFEF97421A01858E http://www.seattle.gov/documents/departments/humanservices/abo utus/final%202017%20permitted%20encampment%20evaluation(0).p df https://www.sandiego.gov/mayor/news/releases/mayor-faulconercity-open-temporary-%E2%80%98bridge%E2%80%99-shelters-helphomeless http://www.sprung.com/case-study/father-joes/ https://www.hudexchange.info/resource/3892/housing-first-inpermanent-supportive-housing-brief/ http://kingcounty.gov/~/media/depts/community-humanservices/housing/documents/rfps-nofas-awards/2017/2017Modular-Shelter-RFI.ashx?la=en Page 27 Reporting Plan for Navigation Team Page # 14 14 14 14 15 15 15 16 16 16 17 19 19 19 19 Website Name / Description King County shelter expenditure plan City of Oakland: Oakland homeless plan: ‘outdoor Navigation Centers’ in Tuff Sheds California Law Review: Tent Cities: An Interim Solution to Homelessness and Affordable Housing Shortages in the United States Tent City America -Chris Herring PhD Student University of California Berkeley Seattle University School of Law: No Rest for the Weary: Why Cities Should Embrace Homeless Encampments September 2017 Los Angeles Controller report on homeless encampments October 17, 2017 City of Seattle City Council Central Staff memo Sanctioned Homeless Encampments Initial Planning and Management Checklists Austin Police Department Homeless Outreach Street Team (HOST) September 22. 2017 HSD report on first year of Pathways Home Seattle Public Utilities online map of illegal dumping sites King County All Home online quarterly data San Francisco new data: More Homeless Returning to Streets from Navigation Centers City of Seattle 2016 HSD Homeless Needs Assessment City of Seattle MultiDepartment Administrative Website Address http://kingcounty.legistar.com/LegislationDetail.aspx?ID=3156176&G UID=694E35A3-8FDC-4A6D-8BFB-B063FB820C6D http://www.sfchronicle.com/bayarea/matier-ross/article/Mayorwants-Oakland-to-install-its-own-navigation-12230688.php http://scholarship.law.berkeley.edu/cgi/viewcontent.cgi?article=1033 &context=californialawreview https://placesjournal.org/article/tent-city-america/ http://digitalcommons.law.seattleu.edu/hrap/4/ http://www.lacontroller.org/encampments http://seattle.legistar.com/View.ashx?M=F&ID=5507173&GUID=BAB CF5D2-66C8-4931-BD6C-CAFBD5187A29 http://www.kingcounty.gov/depts/health/locations/~/media/depts/h ealth/homeless-health/sanctioned-homeless-encampmentschecklists.ashx https://www.austintexas.gov/department/homelessness-outreachteam https://www.seattle.gov/Documents/Departments/HumanServices/R eports/Final_PH_1_Year.pdf http://www.seattle.gov/util/environmentconservation/ourcity/reportil legaldumping/ http://allhomekc.org/quarterly-data/ http://sfpublicpress.org/news/homelessness/navigation/201706/navigation-center-exits http://coshumaninterests.wpengine.netdna-cdn.com/wpcontent/uploads/2017/04/City-of-Seattle-Report-FINAL-with-4.11.17additions.pdf https://www.seattle.gov/homelessness/unauthorized-encampments Page 28 Reporting Plan for Navigation Team Page # 20 20 20 21 21 21 22 22 22 22 Website Name / Description Rule: Unauthorized Encampments Salt Lake City Police Department Homeless Outreach Service Team (HOST) Program Overview City of Austin Homeless Outreach Street Team City of Santa Rosa HOST detailed quarterly data Evaluation of Downtown Emergency Services Center’s (DESC) 1811 Eastlake Housing First program Study conducted by San Diego State University: An Assessment of Homeless Individuals’ Perceptions of Service Accessibility in Downtown San Diego Washington State Institute for Public Policy Benefit-cost calculations City of Austin preliminary benefit-cost data for its pilot implementation of HOST City of Honolulu September 26, 2017 audit: Audit of Housing First, Community Assistance Program, and Hale Mauliola Homeless Programs David Fetterman – AEA Ignite Website Address https://ric-zai-inc.com/Publications/cops-w0816-pub.pdf https://endinghomelessness.bloomfire.com/posts/1257052-austin-shomelessness-outreach-street-team-s-aug-30-briefing-to-citycouncil https://srcity.org/764/Homeless-Outreach-Services-Team-HOST https://jamanetwork.com/journals/jama/fullarticle/183666 https://sdsudspace.calstate.edu/bitstream/handle/10211.3/183014/SD001%20PA4 97_CJ540_Sp16%20An%20Assessment%20of%20Homeless%20Indiv iduals'%20Perceptions%20of%20Service%20Accessibility%20in%20D owntown%20SD.pdf?sequence=1 http://www.wsipp.wa.gov/BenefitCost http://www.wsipp.wa.gov/BenefitCost http://www.austintexas.gov/edims/document.cfm?id=262144 https://www.honolulu.gov/rep/site/oca/oca_docs/Homeless_Audit__Final_Report.pdf https://www.youtube.com/watch?feature=player_embedded&v=fjUv V4HHH38 Page 29 Reporting Plan for Navigation Team APPENDIX Navigation Team Theory of Change Navigation Team Theory of Change August 11, 201 7 Homelessness in Seattle A Growing Problem The 2017 Point?in-Time Count, locally referred to as Count Us In, conducted in King County found that there were at least 5,485 individuals living unsheltered in King County, with 70% or 3,857 people living unsheltered in the City of Seattle.1 The current crisis is the result of complex social and economic factors including income inequality, rapidly rising rents, the opioid epidemic, mass incarceration and a significantly underfunded mental health system. It is estimated that more than 45% of people experiencing homelessness report having a mental health condition and 36% report substance use disorder. The structural and institutional racism in the juvenile and criminal justice, education, child welfare, health care, and housing systems has created a stark disparity when it comes to who experiences homelessness. The Count Us in survey found that 55% of people experiencing homelessness identify as people of color (compared with 32% of the general population), with the greatest disparities observed among those who identify as Black or African American, Hispanic or Latino, and Native American. Public Health and Safety Challenges The reality of nearly 4,000 people living unsheltered in Seattle impacts not only the health and safety of the individuals but also of the community at large. Encampments often show signs of rodent infestation due to unsecured food and an abundance of nesting material (trash, abandoned bedding, etc.). Lack of sanitation facilities leads to accumulation of human waste and potential spread of disease. The City of Seattle has also seen a recent increase in complaints about trash, needles and illegal dumping on public property. This increase is attributable not only to encampment residents who have limited means to remove garbage, but also to people who are housed and who may ?nd it acceptable to illegally dump unwanted items near encampments or the public right-of?way. While many people living in unauthorized encampments are not involved in criminal activity, large encampments can attract criminal behavior which both impacts the already vulnerable homeless individuals and the surrounding community. Over the past 6 months, Seattle has seen many ?res and violent crimes reported related to unauthorized encampments, including the rape and sex trafficking of at least 3 teenage girls, a Woman who reported being held hostage in her tent while being assaulted; reports of shots ?red and subsequent victims arriving at Harborview Medical Center with gunshot wounds; multiple RV fires and propane tank explosions under critical roadways. The Need for a New Approach Connecting with people living unsheltered with services while addressing critical public health and safety issues is an essential component of the City?s homelessness response. Beginning in 2014, the City began to increase resources to add to the capacity for outreach throughout the City and in specific geographic 1 nsive-Report?df Page 30 Reporting Plan for Navigation Team Navigation Team Theory of Change areas. With the growing numbers of unsheltered individuals over the last three years, the need to act with urgency, increase coordination, and geographically disperse teams has become apparent. 2 Page Page 31 Reporting Plan for Navigation Team Navigation Team Theory of Change Seattle?s Traditional Homeless Outreach Model Scope and Nature of Outreach Contracted outreach: Outreach has been a tool used by providers to develop a trusting relationship with people living outside in Seattle for decades. The relationship development component of outreach is critical to supporting clients to gain access to housing, medical support, mental health support, and basic needs. In 2017, the City is investing in outreach services from seven agencies, a 41% increase over 2015. ORGANIZATION TARGET POPULATION GEOGRAPHIC AREA REACH Adults in encampm ents Citywide DESC-HOST Adults with mental illness Primarily Downtown YouthCare Youth/Young Adults Downtown/U-district/Capitol Hill Metropolitan Improvement District Adults Downtown/Capitol Hill Road to Housing Adults in vehicles Citywide Mobile Medical Van Adults w/ medical needs Citywide Kids Plus Families Citywide Despite the increased investment in outreach services, several challenges have emerged in trying to effectively address the needs of people living unsheltered. Outreach providers have historically focused primarily on addressing basic needs and providing harm reduction support. They were neither expected nor resourced to provide people living unsheltered with direct housing or shelter placement. In addition, expected outcomes for outreach had not been de?ned in a systematic manner across funde rs. Outreach providers were also not required to participate in the Homeless Management Information System (HMIS) prior to 2017, so the City?s ca pacity to track outcomes has been limited. When shelter options were available for outreach providers to offer, the options have typically had barriers to entry that made them unsuitable or undesirable options for people living outdoors overnight only, do not allow couples or pets). Seattle Police Response: Seattle Police Department (SPD) has traditionally provided outreach and support services to unsheltered individuals through the routine work of patrol officers, Community Policing Tea ms, the Crisis Response Tea m, and the West Precinct?s Neighborhood Response Team. These efforts are typically coordinated at the individual precinct level, with SPD Of?cers making connections with known service providers in their areas. SPD officers also provide precinct-speci?c resource guides to unsheltered individuals with whom they interact. Seattle Police Departm ent?s Crisis Intervention policy states that the department: the need to bring community resources together for the purpose of safety and to assist and resolve behavioral crisis issues. The Department further recognizes that many people suffer crises, and that only a small percentage has committed crimes or quali?es for an involuntary evaluation. Persons su?ering crises will be treated with dignity and will be given 3 I a :31? Page 32 Reporting Plan for Navigation Team Navigation Team Theory of Change access to the same law enforcement, government and community service provided to all members of the public. Providing support to vulnerable and unsheltered populations has long been part of the scope and mandate of Seattle Police Of?cers, and SPO has invested time and resources in ensuring that officers are equipped to fulfill this part of their mission. In practice, however, of?cers do not typically have long stretches of time available to build the trusting, individual relationships that are the primary ingredient of a successful outreach engagement. Officers frequently work with a long backlog of calls that require attention, and are regularly called away to respond to more urgent public safety issues. Addressing Unauthorized Encampments: The 2008 Multi-Departmental Administrative Rules (MDAR) 08?01 established protocols for clean-up of encampments which involves staff from multiple departments including Finance and Administrative Services the relevant property owning department (Seattle Department ofTra nsportation (5 Seattle Department of Parks and Recreation (DPR), Seattle City Light (SCL), Seattle Public Utilities (SPU) or Seattle Center}; and SP0 acting primarily in a security role. The MDAR protocols required outreach to engage with people in the encampments before clean-up. The Human Services Department contracted with Evergreen Treatment Services? REACH team to provide these services. In addition, a team from YouthCare was dispatched in the event people under the age of 25 were known to be at a specific location. Challenges with Interdepartmental Coordination With multiple city departments responsible for organizing pieCes of the City?s response to increasing camping complaints, the orchestration of responses was inconsistent. In monitoring SO encampment responses between September and December of 2016, the Office of Civil Rights took action in 7 situations when communication issues or lack of interdepartmental/interagency coordination created issues with complying with the 2008 MDARs. Furthermore, the increased need for encampment responSe activity has also reduced the ability ofoutreach to engage with people living unsheltered separate from encampment response, leading to a critical need for expanded resources and improved coordination of our response to meet the growing needs of the unsheltered population. Low Rates of Acceptance of Shelter The outreach effort dispatched previously as pa rt of the encampment removal process resulted in few people accepting referrals to shelter. REACH made 4,548 contacts with adults (this includes multiple contacts with same individual) between February and December 2016 which resulted in 214 adults verbally accepting a referral to relocate to a safer location. The most commonly stated reason adults declined was a preference to stay in the neighborhood, anecdotally stemming from a desire to stay with the community the person had built in/around the encampment.Z 2 %20Re 4 Page 33 Reporting Plan for Navigation Team Navigation Team Theory of Change The shelter options presented were generally not the most desirable or suitable for the people being engaged according responses in the Seattle Needs Assessment.3 The shelter options often had limited hours, no right of return, no place to store belongings, may not have allowed couples to stay together, may not have allowed pets, and/or had sobriety requirements. Outreach was also unable to provide transportation to the shelter, or to confirm that the person referred actually used the bed that night. In light of the growing homelessness crisis, it became apparent by mid-2016 that the City's traditional street outreach model has been largely ineffective in moving unsheltered individuals out of hazardous conditions and onto a path toward housing. In response, the City undertook a concerted effort to redesign our outreach to unsheltered individuals from the ground up. 3 Sll'agt? Page 34 Reporting Plan for Navigation Team Navigation Team Theory of Change Research Evidence for What Works in Outreach In Fall 2016, the City of Seattle commissioned a needs assessment to gain insight into the needs and experiences of people living unsheltered to help inform the homeless response effort. In this report, focus group participants shared their challenges in "navigating the system,? including physical, mental and behavioral health, and housing support services. Among several reported barriers, focus group respondents highlighted insufficient outreach as a significant challenge for navigating the system and accessing services? Research from academic institutions and the United States Interagency Council on Homelessness (USICH) find that targeted homeless outreach teams, such as Seattle?s Navigation Team, increase access to and participation in physical, mental and behavioral health, and housing support servuces. Academic research finds that assertive outreach to individuals experiencing homelessness increases participation in services for unsheltered individuals. Several studies researching the efficacy of the federal Access to Community Care and Effective Services and Supports (ACCESS) project in New Haven, CT find that individuals experiencing homelessness with substance abuse and/or mental health disorders are less likely to avail themselves to services and treatment. These studies further find that proactive outreach to individuals experiencing homelessness ?speci?cally those suffering from substance abuse disorder and/or mental illness is effective in connecting people living unsheltered to treatment and services.5 Additional research on the Greater Bridgeport Community Mental Health Center?s Homeless Outreach Team (HOT) further highlights the early success of assertive outreach to individuals experiencing homelessness and substance use/mental health disorders.6 Although not all persons experiencing homelessness suffer from substance use and/or mental health challenges, a majority of respondents in the City of Seattle Homeless Needs Assessment did report drug use and/or mental health issues. These studies suggest that the City's implementation of the Navigation Team would increase access to services for individuals experiencing homelessness, especially those struggling with substance use disorder and/or mental health illness. Reports from the United States Interagency Council on Homelessness (USICH) further support these academic findings. USICH has developed an emerging practices brief that makes recommendations for ending homelessness for people living in encampments. A core tenet of the emerging practices is the need to perform ?intensive and persistent outreach" as the critical front door to the homeless response system. USICH recommends outreach should include the following strategies to address the needs of people living in encampments: 0 Identification of members of an encampment by name and tailoring interventions to their individual needs; 0 A consistent presence so that relationships can be formed over time; and 4 5 2990600754006," Rowe6/publication/11338249 Engaging Persons with Substanc Use Disorders Lessons from Homeless 5 6 Page Page 35 Reporting Plan for Navigation Team Navigation Team Theory of Change 0 Ability to refer individuals directly into interim options that can be immediately available and that provide a clear path toward permanent housing using Housing First principles. USICH also emphasizes the importance of maintaining honest and transparent communication by all involved in an encampment response and the value of cross-training among the various partners to both increase coordination and enhance the sensitivity of staff working directly with people experiencing homelessness.7 USICH provides further guidance on connecting people living in encampments to services in its report "Sea rching Out Solutions, Constructive Alternatives to the Criminalization of Homelessness.? USICH has found that many cities have seen a reduction in the number of people living unsheltered when there is close coordination between police and behavioral health and social service providers.8 Emerging Best Practice Models Several cities across the country are following guidance and implementing homeless outreach teams. For example, San Francisco? 5 homeless outreach team is a collaboration between the Department of Public Health, Human Services, the Public Library and the non?profit Public Health Foundation Enterprises and is compriSed of paraprofessionals, clinicians, social workers, and peers who provide outreach and case management to unsheltered individuals. In other locations like Houston, Oklahoma City, Salt Lake City, Wichita, Colorado Springs, and Lubbock, TX, community policing models inform homeless outreach teams and are comprised exclusively of law enforcement of?cers. Still other cities, including San Diego, Austin, and St. Petersburg, FL, include a mix of law enforcement and social workers, mental health professionals, and case managers. In order to inform the development of the Navigation Team, Seattle Police Department staff held discussions with seven police departments?3 who are regarded as making substantial progress in the national effort to produce positive outcomes in the areas of homelessness, supportive ho using, behavioral health, and low-level, persistent offending. All seven jurisdictions have a version of a police department homeless outreach team. In most jurisdictions, the team is multidisciplinary. Teams that are seeing the most success have special training in working with people experiencing homelessness, have deep knowledge of the homeless service system and ca access the availability of shelter or interim housing options in real time. Each jurisdiction stressed that any version ofa homeless outreach team should be voluntary and staffed by officers committed to this sort of work and training. Stakeholder Engagement A variety of stakeholder efforts have taken place over the past year to more deeply understand the needs of persons living unsheltered and to improve the efficacy of outreach efforts. Each of the efforts below, in addition to the experiences and expertise of the Navigation Team members themselves, have Homelessness for People Living in Encampments AugZOl 8 9 Police Departments of Anaheim, Salt Lake City, Colorado Springs, New York City, Cambridge (MA), San Diego, and Los Angeles; Mayor's Office of Los Angeles. 7 Page Page 36 Reporting Plan for Navigation Team Navigation Team Theory of Change informed the development and practices of the Navigation Team. The applicable learnings from the efforts below are more fully described in Appendix 1. All Home Outreach Continuum Workgroup (Winter 2016) 2016 Seattle Homeless Needs Assessment (Fall 2016) 0 Taskforce on unsanctioned Encampment Clean-up Protocols (October 2016) Convening of Behavioral Health Providers (February 2017) Pathways Home Pathways Home, release in September 2016, is the City of Seattle?s road map to transform its homeless effort and investments into a person-centered, systemic response to homelessness that invests in models with demonstrated success and addresses racial disparities.lD Pathways Home also puts ending a person?s experience of homelessness with permanent housing as the ultimate goal of the homeless response system. For people living unsheltered and disconnected from services, the most critical entry point into our homeless response system is outreach. Pathways Home commits to improving the City?s existing outreach effort to ensure that outreach is truly a gateway to housing placement and that people living outside have access to outreach regardless of where in the city they are located. ?1 Page 37 Reporting Plan for Navigation Team Navigation Team Theory of Change A New Outreach Model: The Navigation Tea Emerging from the City?s research, and in conjunction with the implementation of Pathways Home, the Mayor?s Office, HSD and FAS devised a plan to completely reimagine the City?s outreach to unsheltered individuals from the composition of the team to the way success is defined and measured. The result of this plan is the Navigation Team, a multidisciplinary team designed to bring together the ingredients of a successful outreach engagement together under a single, unified organizational structure. In pulling together these traditionally independent bodies of work, the City hopes that increased collaboration and coordination will lead to an expanded capacity to provide outreach that meets the needs of people living unsheltered. Navigation Team Goal The goal of the Navigation Team is to provide outreach to people living unsheltered that is ef?cient and effective at moving people out of hazardous conditions and onto a path toward health, stability, and permanent housing. Navigation Team Composition The team is comprised of specially-trained SPD officers, a supervising police sargent, an outreach coordinator, an encampment response manager, field coordinators, and contracted outreach providers. These groups work together in the field as a single team to offer individualized services and alternative living spaces to individuals experiencing homelessness. An organizational chart illustrating the Navigation Team's current structure can be found in Appendix 3 of this document. Scottie Poiice O?icers: As indicated above, SPD has long been engaging with and responding to the needs of people living unsheltered as part of their regular duties. Despite this work, SPD was not considered a formal part of the City?s outreach to people experiencing homelessness until the creation of the Navigation team. The incorporation of dedicated police officers into the Navigation Team has formalized the role of our police department in outreach, and has signi?cantly increased the number of people directly working to connect people living unsheltered with services they need. The nine police of?cers currently on the Navigation Team volunteered to work in an outreach capacity with people living unsheltered. They are all certi?ed in Crisis Intervention, and have received training in de-escalation techniques, implicit bias, and harm reduction. A full list of the SPD Navigation Team training is available in Appendix 4. Outreach Coordinator: The Navigation Team includes a new Outreach Coordinator position charged with fulfilling the Pathways Home mandate to build the Outreach Continuum. The coordinator is responsible for assembling the package of shelter and services from other social service providers that the Navigation Team can offer to people living unsheltered. When appropriate, the Outreach Coordinator also requests assistance from partner agencies, including: YouthCare Metropolitan Improvement District (MID) Outreach, Case Management 84. Mental Health Staff 9 a :31? Page 38 Reporting Plan for Navigation Team Navigation Team Theory of Change 0 Union Gospel Mission (UGM) Outreach team I Community Mental Health Program and Hope Place 0 Harborview Mental Health a Law Enforcement Assisted Diversion Mary?s Place 0 Downtown Emergency Services Center HOST Program The Outreach Coordinator is also a Licensed Mental Health Counselor, bringing valuable mental health expertise to the team. In cases where the team contacts someone who is dealing with mental health challenges, the Outreach Coordinator assumes the lead with that individual, making an assessment, engaging and ma king the appropriate referral to support the individual?s needs. The Outreach Coordinator is also responsible for the collection and analysis of data and reporting on Navigation Team outcomes. In addition, the Outreach Coordinator oversees a live "by?name" list that tracks the progress of individuals that the Navigation Team has referred to authorized encampments. In addition, the Outreach Coordinator seNes as the City?s primary connection point to the broader social service community by chairing the Providers Resource Exchange and Planning (PREP) meeting each month. This venue is designed to facilitate the sharing of resources, coordination for care, and problem- solving of issues related to the unsheltered population in Seattle. Contracted outreach providers: The City currently contracts with Evergreen Treatment Service?s REACH program to provide seven outreach workers and a supervisor as part of the Navigation Team. These eight outreach providers bring expertise in assessing the needs of people living unsheltered including shelter/housing, mental health, substance use, and physical health needs. Contracted outreach is then able to establish connections to community services that meet the needs of their clients, including providing ongoing support to navigate processes and systems that are often complex. Encampment Response Manager and Fieid Coordinators: The Encampment Response Manager is responsible for managing Navigation Team scheduling, prioritization, logistics, and for providing oversight of encampment clean-ups. The Encampment Response Manager receives and assesses information from the City?s Customer Service Bureau (CSB) about locations that may warrant the services of the Navigation Team, and then dispatches ?eld coordinators to inspect reported encampment sites. Field coordinator assessments are then used to determine the schedule and prioritization of outreach and clean-up work across the city. The Encampment Response Manager oversees the Field Coordinators? work with individuals during clean- ups to store personal belongings and later return those items upon request. The Encampment Response Manager is also responsible for developing safety protocols and training for the Navigation Team. They also provide training for contracted clean-up crews, and work to ensure compliance 2017 MDAR 17-01.11 ments/ Dega ulesj ca moment-ruIe-N-ULpdf 10 a :31? Page 39 Reporting Plan for Navigation Team Navigation Team Theory of Change Coordination of Navigation Team The Navigation Team model brings an unprecedented level of interdepartmental and interdisciplinary coordination to the City?s homelessness outreach and encampment mitigation efforts. This coordination brings with it an increased clarity on roles, responsibilities, and how each piece of the City?s response fits together within the context of the broader work. The Navigation team meets each morning to assess operational priorities and logistical issues for the coming day. This meeting provides space to problem-solve for individuals encountered in the course of the previous day?s or week's outreach work. Importa ntly, the Navigation team also receives daily vacancy information from the low-barrier Navigation Center, traditional shelters, and authorized encampments. Having this information at the beginning of the day allows the Navigation team to approach individuals experiencing homelessness with meaningful offers for relocation in-hand. 11 Page Page 40 Reporting Plan for Navigation Team Navigation Team Theory of Change Program Logic intensive and Persistent Engagement The foundation of the Navigation Tea m?s approach is relationship-building through persistent engagement with individuals living unsheltered in Seattle. Not only is the experience of living outdoors highly stigmatized, many people also identify as members of other marginalized communities (communities of color, LG BTQ, undocumented immigrants, people experiencing mental illness, and those with substance use disorder) and have diverse and multicultural needs. Many people living unsheltered have also had negative interactions with the social service system. As a result, many are anxious about reengaging with this system and its services. Establishing (or re-establishing) trust is an essential first step toward moving people onto a pathway toward permanent housing. An offer ofshelter or social services is not usually accepted on the first outreach contact with an individual. The National HealthCare for the Homeless Network (HCH N) has reported that engaging homeless individuals with serious mental illness often requires a sustained effort, and can take up to nine months to move them into the larger service system.12 On average, the Navigation Team contacts an individual roughly 3 times before an offer for shelter or services is accepted. The Navigation tea m?s outreach model is focused on building trust with people living unsheltered, with the understanding that a personal relationship can mean the difference between whether an offer is accepted or rejected. improved offers of shelter The City is moving toward more shelter options that better meet the needs of people living outdoors. As an example, the recently opened Navigation Center is a 24 hour, low-barrier program that accommodates couples, pets and people?s possessions. In addition, the Navigation center does not require sobriety or an ID for admission and residence. These traditional barriers have signi?cantly impacted the success of past outreach efforts. The Navigation Team is intentionally the sole referral point for people into the Navigation Center, allowing the Team to have a high quality interim housing options in hand when they are working with people in the ?eld. In addition, the Navigation Team has access to daily vacancy information for several shelters and 3 authorized encampments (Georgetown, Myers Way and Licton Springs). While the authorized encampments are not an ideal shelter solution, the 24-hour access and the ability for people to have the privacy and security ofa "tiny house" is often a more attractive option than a limited hour shelter. Further, the Navigation Team offers transportation to the shelter/authorized encampment that helps to facilitate the acceptance of relocating. Contracted outreach providers also have access to flexible funding that allows them to immediately problem-solve with clients, including helping people reconnect with their personal support networks by paying for their transportation home; covering upfront costs to get individuals housed if they have income and can manage rent on their own; and assistance in getting a Washington State ID. 15 98.pdf 12 I l: Page 4i Reporting Plan for Navigation Team Navigation Team Theory of Change Alignment to Pathways Home The Navigation Team has been designed centered on the principles embodied in the Pathways Home policy framework. Person-Centered: The Navigation Tea takes a person-centered approach that puts the diverse and multi-cultural needs of the individuals first. The Team honors the autonomy of an individual and empowers that person to be the expert on their own life while coming along side to support them in accomplishing their goals. Utilizing a harm reduction framework, the Navigation team sees change as happening along a continuum and are supportive of those at different stages in the change process. The Navigation Team actively problem solves with clients when they are in the field and tailors service packages that best fits someone?s needs. Further, the Navigation team helps their clients navigate the complex social service system by providing warm handoffs. Low-Barrier: The Navigation Team does not have any screening criteria or eligibility requirements that would prevent them from engaging with any person who is living unsheltered. This is consistent with the evolving models of service delivery such as the Navigation Center and the Licton Springs Authorized Encampment which do not require sobriety, ID or background checks. The Navigation team believes that traditional barriers perpetuate chronic homelessness. Housing First: The Navigation Team focuses on helping people living unsheltered move out of hazardous conditions and onto a pathway to housing. There are no pre?conditions for offers of shelter. The Navigation Team also helps connect people with the countywide coordinated entry system for housing. By Name List: The Navigation Team maintains a live "by name list" of the people they engage with in encampments that serves as a strategic resource to maintain continuity of care and that helps the team develop individualized services for the people over time, with the goal of moving people onto a path to housing. Performance-based: Under their contract with HSD, the contracted outreach provider is required to enter information about clients into the Homeless Management Information System (HMIS) and is tracking outcomes of clients in accordance with the Pathways Home performance metrics. Adding Law Enforcement to the Outreach Effort While police officers have long been a point of ?rst contact for individual experiencing homelessness in our community, they have until recently on only had two options: arrest or simply provide a list of resources on where services and shelter might be found. True connections to services is beyond the capacity of typical officers. Pairing social workers with police officers has the advantage of adding more robust human services skills and resources to the frequent interactions police are having with the homeless population. This partnership allows police to continue to function in their public safety role, while providing added capacity to connect people with the resources they need. It also allows the officers the focused time to build the trusting relationships so vital to helping someone move toward stability. The Navigation Team has found that some individuals are more responsive to police officers than professional outreach 13 a :31? Page 42 Reporting Plan for Navigation Team Navigation Team Theory of Change workers, and the training of police officers makes them comfortable offering certain services, like transporting unsheltered individuals, that are problematic for outreach staff to provide. Finally, of?cers have information from police resources that provides a more complete picture of the challenges facing an individual. Deployment in conjunction with the City?s encampment clean-up efforts The City has made the strategic operational decision to deploy the Navigation team in conjunction with the ongoing encampment cleanup work conducted by the Finance and Administrative Services (FAS) Department under MDAR 17?01. Encampment cleanups are prioritized by public health and safety hazards they pose to both encampment residents and the broader community. As a result, the City typically encounters the most vulnerable unsheltered individuals, living in the direst of conditions, through this body of work. Given that these vulnerable individuals also represent the Navigation team?s highest priority for engagement, the operational decision has been made to join these bodies of work into a uni?ed effort that brings together public health and safety concerns with individualized solutions for unsheltered people in need. Program Logic Model The Navigation Team program logic model was built to clearly articulate the connection between the people and resources being devoted to this new approach to outreach, their activities on the ground, and the impact the program hopes to achieve. The program logic model sees relationship-building and meaningful offers of shelter and services as the foundational pieces of the Navigation Team's work. This foundation builds toward acceptance of the Navigation Team's offers, toward the end goal of efficiently and effectively moving people out of hazardous conditions and onto a path toward health, stability, and permanent housing. The logic model can be found in Appendix 5. Program Assumptions The Navigation Team program logic contains a number of assumptions that should be explicitly stated. These assumptions are divided into two groups, as follows: 1. Assumptions about how the Navigation Team?s activities produce its desired results a. Building relationships with unsheltered individuals fosters a level of trust that makes the acceptance of an offer for shelter and/or services more likely b. A meaningful offer for shelter and/or services is one that substa ntially meets an individual's primary areas of need. c. Offers of shelter and/or services will be accepted at a higher rate when these offers are tailored to meet a individual?s set of needs. d. The human service delivery system can be difficult to navigate, particularly for individuals living outdoors. A "wa rm ha ndoff? to shelter and services on offer can facilitate a smoother transition to accessing these services. e. Some encampments are so hazardous that the harm done by uprooting individuals living in those spaces is less significant than the risks posed by allowing them to stay in extremely unsafe living conditions. 14 a :31? Page 43 2. Reporting Plan for Navigation Team Navigation Team Theory of Change Assumptions about how the results of the Navigation Team's results build toward near-term, medium-term, and long-term outcomes a. Near-term assumptions - i. Connection to a personal support network can facilitate progress toward a path to permanent housing. (Connections to personal support networks like family and friends may not represent a positive step in all cases.) ii. Barriers to coming inside can be reduced with a tailored offer of services and shelter. Living unsheltered in hazardous encampments presents a range of problems that can be immediately mitigated by simply bringing people to safer physical locations. b. Medium?term assumptions: i. There is capacity in our system to accept the number of people willing to accept meaningful offers to come inside. ii. Living in safer physical locations contributes to the stabilization of individuals previously in crisis. When immediate survival needs are met, individuals gain capacity to enter and sustain participation in programs designed to facilitate progress toward health, stability, and permanent housing. c. Long-term assumptions: i. Bringing people indoors and out of unauthorized encampments will result in an improvement in the public health and safety issues associated with those encampm ents. ii. Moving people to safer locations creates space for them to successfully participate in programs and services designed to move them toward permanent housing. The Navigation Team meets the needs of individuals who would have otherwise relied on emergency services for assistance. 15 Page 44 Reporting Plan for Navigation Team Navigation Team Theory of Change Navigation Team De?nition of Success The mission of the Navigation Team is to ef?ciently and effectively move people living unsheltered out of hazardous conditions and onto a path toward health, stability, and permanent housing. The Navigation Team measures its success by the number of offers for relocation and services that are accepted and utilized by individuals living unsheltered in Seattle. An accepted offer is typically the product of intensive time and energy spent building relationships, understanding each individual?s set of needs, and identifying available resources to help meet those needs. In order for an offer of relocation and services to be accepted by an unsheltered individual, it must be seen as a viable opportunity to im prove their circumstances. The tremendous amount of work that goes into building relationships and identifying resources that meet the needs of unsheltered individuals is of central importance to fulfilling the Navigation Team?s mission. However, this work alone does not constitute success. For the Navigation Team to be considered successful, an offer of relocation and services must be both accepted and utilized by an unsheltered individual. To ensure that its offers are both accepted and utilized, the Navigation Team will often provide a ?warm handoff? to a service provider, including transportation, to facilitate a successful transition. Data Collection and Analysis Robust data collection and analysis is a major component of the Navigation Tea m?s work. In collaboration with the Human Services Department and Office for Civil Rights, the navigation team is collecting individual level data on demographics, interactions, offers made, and offers accepted. Collection of this data will allow the Navigation Team to: - Understand emergent patterns and trends in the population the Team seeks to serve and tailor its program model accordingly; - Report on the Team?s effectiveness in making offers for relocation and services that are both accepted and utilized; and - Assess the race and social justice impacts of their work to ensure that equitable service is provided to unsheltered individuals regardless of race, ethnicity, gender, sexual orientation, language, or other factors. Program Evaluation Plan The Navigation Team is committed to evaluating the efficiency and effectiveness with which it moves people onto a pathway toward health, stability, and permanent housing. This evaluation work can only be made possible through a robust data collection and analysis effort. The highest priority questions for this work will include: 0 Are those who accept offers from the Navigation Team ending up on a path toward permanent housing? 0 Which offers are being accepted, and why? 0 Which offers are being rejected, and why? 16 a :31? Page 45 Reporting Plan for Navigation Team Navigation Team Theory of Change Are the Navigation Team?s offers for shelter and services, and associated outcomes, racially equitable? In addition, the City is actively looking at opportunities to further improve the way data is collected and used by the Navigation team, including enhanced integration of outreach work with the County-wide Homeless Management Information System. There is currently a plan to add additional capacity to the Navigation Team in the form of a data and evaluation specialist. This position will be tasked with overseeing the Navigation Team?s data collection effort, and will be responsible for providing ongoing evaluation of the Team's performance to outcomes. This ongoing evaluation work will be accountable to both the Human Services data team and the Citywide Performance Team in the City Budget Office. Early Evidence of Success The Navigation Team is seeing more success than previous efforts in terms of people accepting offers for services and shelter/authorized encampments. Between February and July 2017, the Team had tallied 3,473 contacts with 1,067 unique individuals. These contacts resulted in 338 referrals to safer living alternatives including 50 people who have moved to the Navigation Center. In comparison, between February and December 2016, previous encampment related outreach made more contacts (4,548) but had less acceptances (214) over a longer period of time. Under the Pathways Home Framework, the City is committed to ensuring that outreach is the front door for shelter services and that shelter is responsive to the needs of people living unsheltered. This is being operationalized in encampment operations, the Navigation Center and new shelter beds coming online in 2017, and will be further enhanced by the Homeless Investments RFP as described below. 17 3:31? Page 46 Reporting Plan for Navigation Team Navigation Team Theory of Change Future 0 pportunities There are several opportunities to further enhance the City?s outreach effort in 2018 and beyond. Homeless Investment RFP HSD is currently accepting applications for its Homeless Investments Request for Proposals (RFP) where outreach is one of the targeted program areas; applications are due on September 5, 2017. The RFP is envisioned as the first opportunity to look at all outreach investments within the framework of Pathways Home to build a true continuum across geographies, needs and populations. The RFP requests proposals that are grounded in the Pathways Horne principles of housingfirst, low barrier services, progressive engagement, and providing participant choice and tailored services in service provision; and that meet the intentions of the outreach program model as described in the Appendix of the RFP materials.13 In addition, the RFP also included funding for Emergency Services and will prioritize those proposals that enhance and coordinate day/night services to provide 24/7 services and support exits to housing. Technology Technology, in the form of HMIS scan card technology and mobile data entry, is another outreach enhancement that has seen success in other jurisdictions in increasing data quality. HSD is working with King County to implementa pilot the use of scan cards with a homeless services provider for day center and shelter services. Scan card technology will allow for real time vacancy information to be available to outreach teams. A pilot is currently underway with a homeless services provider for day center and shelter services. Mobile technology for data entry will increase data completeness and ease the burden on outreach providers who are currently entering similar data in multiple systems. Seattle IT has anticipated that mobile technology will be available in the 4th quarter of 2017. Partnerships Finally, increasing the Navigation Tea m?s formal partnerships will enhance the level of services the team can offer to people living unsheltered. The Navigation Team sees opportunity in more closely pairing with additional mental health and substance use disorder specialists with their outreach efforts. To truly address the mental and behavioral health needs of people living unsheltered, the barrier of appointment-based treatment needs to be addressed. Harborview, Sound Mental Health and Evergreen Treatment have all expressed interest in exploring how to deepen efforts with the Navigation Team. 13 pa rtments/Homel essi nvestme nd page 4-6 18 I l; 3 Page 47 Reporting Plan for Navigation Team Navigation Team Theory of Change Append ix 1: Sta ke holder In put A variety of stakeholder efforts have been launched over the past year to more deeply understand the needs of persons living unsheltered. Each of the efforts below have informed the development and practices of the Navigation Team. All Home Outreach Continuum Work Group All Home convened a group of stakeholders in 2016 to develop a set of outreach continuum recommendations. This group was co?facilitated by a REACH co-director and an HSD strategic advisor and included countywide representation of outreach providers. The result of this work was a set of competencies that outreach providers should be able to access or provide directly and include: 0 Assessment and service provision that establishes a trusting relationship capable of addressing the complex and varied needs of individuals living unsheltered. 0 Ca pa city to navigate the homeless housing system and create appropriate referrals/placements. 0 Capacity to navigate the behavioral and physical health needs of individuals with a focus on harm reduction strategies. 0 Skilled in harm reduction, trauma care, skill based assessments and provider coordination. - Culturally competent and knowledgeable of unique population needs. 0 Data management, documentation and performance/program evaluation. These standards have been used to inform the development of the Navigation Team, 2017 Request for Proposals and contractual requirements for outreach providers. The recommendations of the workgroup are included in Appendix 2. 2016 Seattle Homeless Needs Assessment In addition to service provider engagement, the City conducted a needs assessment of persons living unsheltered to further explore opportunities to improve services.? The results of the needs assessment clearly demonstrate areas for improvement. The need for outreach and service providers to recognize the needs for individualized solutions was a dominant theme; participants felt they were seen as 'refusing service' when the service or shelter offer made to them was not one that they felt would be the most effective in addressing their needs. It also critical to ensure that we have adequate numbers of outreach providers to connect with the vast number of people living unsheltered; only 46% of those living in an unauthorized outdoor location had been contacted at some point by an outreach provider. This is especially important in a landscape where many focus group participants pointed out the challenges of trying to access fragmented and geographically dispersed services with convoluted eligibility processes. Finally, focus group participants identi?ed a desire to have consistent relationships with outreach and case management providers and the need for more people with lived experience of homelessness to be part of the homeless response system. 3? http://h urna ninterests.seatt 16-homeless-needs?assessment/ Appendix 1 Page 48 Reporting Plan for Navigation Team Navigation Team Theory of Change Tasquorce on Unsanctioned Encampment Clean up Protocols In August 2016, the Mayor convened a community task force to review and make recommendations to improve the City's management of unsanctioned encampments. At about the same time the ACLU and several other organizations proposed legislation that would have provided homeless persons new rights to camp on public property and that would have imposed severe restrictions on the City?s efforts to manage and clean-up unsanctioned encampments. In October 2016, when attempts to negotiate a more balanced approach failed and public opinion became highly contentious, the Mayor proposed a comprehensive set of reforms to our management of encampments based on the recommendations of the task force, including: 0 Providing better outreach to homeless persons in encampments and on the streets 0 Opening new sanctioned encampments and adding new 24/7 indoor shelter capacity 0 Creating more compassionate, transparent protocols for cleaning unsanctioned encampments Emergency Operations Center Convening of Behavioral Health Providers On February 21, 2017, Mayor Murray activated the Emergency Operations Center (EOC) to accelerate and coordinate the City?s response to the homelessness crisis in Seattle. The work at the EOC has been centered around accelerating the work of Pathways Home and implementing the actions outlined in the Bridging the Gap plan to help get individualized services to people living outside, including the launching of the Navigation Team. As such, early in the EOC activation, a group of healthcare providers including substance use disorder services, inpatient and outpatient mental health, mobile medical and clinical outreach met to discuss increased service coordination as a means to increase the impact and efficacy of the Navigation Team. The Navigation team proposed reducing barriers to services in a few critical areas to increase their success with clients in the field: 0 Access to a mental health specialist was requested via support for the HOST team. I Access to Narcan was identified as a critical resource when working in the ?eld. 0 Access to same day appointments with med prescribers was requested from Harborview and Sound Mental Health. 0 Increased health care services via mobile medical was identified as a possible alternative to in- clinic visits. 0 Increased availability or better coordination for access to detox beds on demand for clients who choose in the field to accept. Appendix 1 Page 49 Reporting Plan for Navigation Team Navigation Team Theory of Change Appendix 2: All Home Outreach Continuum Recommendations Appendix 2 Page 50 Reporting Plan for Navigation Team OUTREACH CONTINUUIVI RECOMMENDATIONS City of Seattle Edwa Murray Ma aory Hum nSe eicrv esDe Hp artm ent Page 51 Reporting Plan for Navigation Team BACKGROUND The City of Seattle Human Services Department (HSD), All Home and REACH co?facilitated a workgroup during 2016 to review current outreach practices and develop recommendations to create a more defined approach to outreach and case management to people living unsheltered. Outreach has played a significant and important role in relationship development and survival services to those in need for many yea rs in the City of Seattle and throughout King County. However, historically outreach providers struggle to create the necessary linkages needed to connect those they serve to the housing and other supportive services they need in an immediate fashion. This struggle is part of a systemic challenge resulting in barriers to housing services access as a result of distrust, mistrust and inability to navigate a complex system on the part of people living unsheltered. As well as, lack of resources allocated to outreach providers who are working to connect people living unsheltered with viable and immediate safe alternatives. The role of outreach providers in ending the crisis of homelessness is significant, USICH has published some lessons learned that highlight much of what is discussed in this report. It became evident through the development of the Pathway?s Home work with Barb Poppe and Focus Strategies that persons living unsheltered did not have direct access to the housing and services needed to end their homelessness. Data showed that a range of 23% to 53% of programs are accepting individuals from housed situations. With Coordinated Entry For All and specifically for single adults on the horizon it was critical to begin planning for deeper connections between outreach and housing. The Outreach Continuum Planning workgroup has met since July 2016 with the objective of 1) assessing and defining what outreach is, 2) development of a standard of practice for all outreach providers, and 3] developing tools for coordination of care particularly to Coordinated Entry for All. What follows in this report are clear recommendations provided by members of the workgroup that provide a clear working definition of the purpose of outreach as well as a common standard of care that Providers must adhere to ensure the greatest efficacy in moving those living outside into safer alternatives. However, there is still work to be done by this group in conjunction with All Home and King County to further refine how a By Name List process can support housing navigation services provided by outreach teams and the launch ofcoordinated entry for single adults anticipated to begin in early 2017. DEFINITION OF OUTREACH The Workgroup has developed the following definition: Coordinated, person centered, and persistent engagement bringing services directly to the peopie experiencing homelessness who might not seek out services and connect them to permanent housing and necessary supports. INVENTORY OF OUTREACH PROGRAMS King County Department of Community and Human Services (DCHS) conducted a survey of Outreach programs in 2016 and found that 15 programs operate throughout King County. Of those, 7 outreach programs are specifically funded by the City to conduct outreach work. Each of these programs has a target population that they support including individuals with mental illness, individuals living in encampments, young adults living unsheltered, and individuals with significant street presence in the downtown and Capitol ill areas. Overall, HSD funds roughly 22 outreach positions to operate throughout the City. Considering the vast area these staff must cover and the volume of people they must attempt to engage demand continues to outpace Page 52 Reporting Plan for Navigation Team capacity- At this rate, each outreach provider would have to engage regularly with over 130 people (using the One Night Count numbers of unsheltered} to coordinate access to services. ORGANIZATION TARGET POFUMTION GEDGRAPHIC AREA REACH 3 Adults in encampments Throughout the City 2 Adults with mental illness Primarily Downtown YouthCare 4 Youthfl?oung Adults DowntownfUdistrictf?apitol Hill Kids Plus 2 Families Throughout the City Metropolitan improvement District 3 Adults DowntownfCapitol Hill Road to Housing 3 Adults in vehicles Throughout the City PROPOSED OUTREACH STANDARDS The role of outreach should primarily be directed towards ending a person?s homelessness- its All Home, the City of Seattle HSD, and King County DCHS worl: towards systems transformation efforts It is important to identify opportunities for improved service delivery and enhanced systems coordination. While outreach providers operating now within King County utilize many of the following practices, increasing skills and standardizing tools will further enhance the ability of outreach providers to move people living unsheltered with more efficacy. Assessment and Service Provision Competency An outreach provider should be able to establish a trusting relationship with the individual experiencing homelessness. An outreach prowder should be qualified to conduct and document a reliable assessrnent of needs of individuals experiencing homelessness which includes, but is not limited to; needs related to: behavloral health, including mental illness or other mental or emotional limitations; substance use and treatment status; and harm reduction measures; physical health. including need for assessment and care by medical professionals: disability; housing; employment; household composition considerations; and geographic considerations. An agency deploying outreach providers should have the capacity to train and deploy outreach-based staff such that it can engage clients with intensive and ongoing support; when needed; in order to ensure successful linkages to community services that address the needs that the provider has assessed. Thus a provider's operating model must afford its staff the flexibility to accommodate a broad spectrum of client capability for self-advocacy and navigating the complex processes that often present barriers to sustainable linkages to services; Agencies should devote staff time and other resources to ascertaining when a simple referral to services has been insufficient to effectuate a successful linkage to an agency that provides shelter andfor housing: outpatient mental health; substance use, or physical health care services; andfor more intensive inpatient health services such as a hospital or respite care facility. Further, it must also devote staff time and other resources to following up in an intensive fashion to walk With the client through the linkage process; as required. An outreach provider should be prepared to attempt to secure shelterfhouslng services based on what the Clientdetermines they Want or need. Page 53 Reporting Plan for Navigation Team Housing System Competency Several comprehensive systems exist that address the critical needs oiindividuals experiencing homelessness in Seattle. Providers should suoport people experiencing homelessnesa to access housing, and to provide effective means to support people to resolve their homeless crisis. A Provider should go beyond simply referring clients to other agencies and should have extensive knowledge and internal processes for assisting clients to access resources. Understanding of Coordinated Entry for All a federally-mandated King County?wide system that establishes a coordinated, transparent, and equitable system for connecting individuals and familiES experiencing homelessness to housing interventions such as emergency shelter, rapid rehousing, and permanent housing. Outreach providers participate in CEA by providing housing assessor and navigation services. -2 All Housing Assessors are required to complete CEA Housing Assessor Training and once trained, will complete intake and CEA housing assessment with individuals in need of housing. When possible, the Housing Assessor will connect the individual with a Houaing Navigator. Housing Assesaors? responsibilities Include, but are not limited to the following: I Operating as the initial contact for the CEA and communicating eligibility For CEA I Exploring resources other than homeless housing programs, such as diversion or employmentg?education Conducting Houaing Assosarnents Communication with assessed households about next steps and types oi resources the hOUSehold may be referred to I Participation in By Name List processes as needed I Notifying households about other servicesfresources, programs they may be eligible for outside of CEA, including hoLJsing through Section 8, emergency housing, and other community-based resources {employment services, behavioral health, domestic violence Services, etc.) All Housing Assessors are required to complete CEA Housing Assessor Training and once trained, will complete intake and CEA housing assessment with individuals in need of housing. When possible, the Housing Assessor will connect the individual with a Housing Navigator. Housing Assessors? responsibilities include, but are not limited to the following: I Operating as the initial contact for the CEA and communicating eligibility for [Eh I Exploring resources other than homeless housing programs, such as diversion or employment/education, I CondUcting HoUsing Asse55ments Communication with assessed households about next steps and types of resources the house hold may be referred to I Participation in By Name List processes as needed I Notifying households about other servicesfresources, programs they may be eligible for outside of CEA, including housing through BHRD, Section 3, emergency housing, and other community-based resources {employment services, behavioral health, domestic violence services, etc.) Page 54 Reporting Plan for Navigation Team Knowledge ofemergency shelter programs and housing resources that are not part ofCEA?section vouchers, affordable housing resources, motel vouchers. Behavioral and Physical Health Competency in When an outreach provider assesses an individual experiencing homelessness as needing access to behavioral andfor physical health services, they should be able to directly refer the person to a licensed behavioral health andfor physical health care services. I An outreach provider should be able to verify such services are provided to the individual experiencing homelessness either where the individual resides or at the behavioral health provider's location. When Individuals have an existing provider, outreach teams should be able to coordinate care. ?1 An outreach provider should be trained in harm reduction practices including: safe needle exchange and disposal; carrying and using Narcan and training other individuals to carry and use Narcan: informing individuals of their rights related to drug overdose leg. Good Samaritan Law]; drug treatment options, including Medication Assisted Treatment (Buprenorphine and Methodone}; and focusing on minimizing physical, social and legal harms. An outreach provider should execute harm reduction practices where needed and In accordance with the standards set forth by the National Health Care of the Homeless Council. Training and Safety Competency a An outreach provider should be trained in best practices of outreach and engagement, Including: Engaging in Person Centehed Approach, Trauma Informed Care, Motivational Interviewing, Skill Based assessments, and Sta ges of cha ngefenga ge ment. on An outreach provider should practice adequate safety and backuo for outreach workers in the field always by perform duties in pairs. s: An outreach provider sh0uid coordinate With Law Enforcement, First Responders, Designated Mental Health Professional and as needed to ensure safety of persons experiencing homelessness as Well as outreach providers. '1 An outreach provider should be trained in self?care practices related to secondary trauma and burn out which are very real risks associated with this practice. Cultural Competency A provider should hava a policy for how they will work with the following grouos and any other protected class in compliance with City non?discrimination laws and racial equity principles: I Those affected by Domestic Violence People living with physical or intellectual disabilities Page 55 Reporting Plan for Navigation Team I Community I Distinct racial and ethnic communities, including Immigrants and Refugees I Youth who have been sexually exploited I Veterans Data Management and Documentation Competency Data management is a critical component of this work, particularly as it relates to documentation of homeless status required by housing providers and federal funding requirements for targeted housing programs. Regular and consistent documentation of outreach efforts decreases the likelihood of overlooking individuals experiencing homelessness who are most in need, as well as the duplication of services. A systematic approach also allows greater participation from other partners and systems in the community and fas ter access to a wider variety of targeted and mainstream programs - USiCl-l. Confidentiality is required when providing direct services to individuals particularly as information pertaining to health status and personally identifying information (PPI). Compliance with federal and state regulations is required in the management of PPI is required for outreach providers. 0 An outreach provider shall protect the confidentiality of individuals experiencing homelessness and comply with all relevant laws to such confidentiality. This includes Mandated Reporting, Domestic Violence laws, Run Away laws and any other contracted requirements. 0 An outreach provider must collect and enter information in Homeless Management Information System (HMIS) to satisfy contractual reporting requirements in adherence to HMIS performance standards. Performance Measures Outreach is a critical component of the network of services designed to support persons experiencing homelessness. It is important to ensure that outreach efforts are measured to ensure that people living unsheltered have access to the housing and services that they need to end their crisis of homelessness. Providers must measure and report rates of success in the System Wide Performance Targets established by All Home: I Reduction in length of time homeless and increase rates of exits to permanent housing evidenced by: Navigating people living unsheltered into shelter or housing by completing or confirming the completion of a Coordinated Entry for All assessment. I Reduction in returns to homelessness evidenced by: linking people living unsheltered to outpatient physical, mental health, substance use treatment, confirmed attendance at a clinical visit I Reduction the number of unsheltered as evidenced by: documentation of homeless status for all clients served. Providers may also be required, depending on specific outreach program objectives, to measure specific instances of: I Syringe distribution I Na rcan training and distribution I Referrals to medically assisted treatment (MAT) and other substance use treatment I Placement in employment I Obtaining IDs Page 56 Reporting Plan for Navigation Team 0 Securing financial assistance, such as public benefits . Clientrcenrered goal setting related to phvsicai or behavioral health. TOOLS FOR COORDINATION OF CARE IOngoing work is needed to develop and maintain coordination between other svstems of care and outreach providers. HMIS and CEA are the first two primarv tools available for the coordination of services With the homeless housing and services arena. The outreach Workgroup will continue to explore opportunities and tools. to increasa coordination with non-homeless specific providers as Phase II of this Work during 201?. To support providers to develop outreach programs that meet the competencies outlined above and achieve the performance measures additional work is required by the Outreach Continuum to ensure seamless connections to and coordination with various systems including: Law enforcement Healthca re for the Homeless Needle Exchange First Responders HMIS BEA Housing Navigation Park Ra ngers DMHP's Business Districts Neighborhood councils fails Hospitals Courts NEXT STEPS Systems transformation planning is ur?rderwavr with All Home, King Countv DCHS, United Wav of liing County and the {it}:I of Seattle Human Services Department to align investments and performance commitments towards the goal of moving people rapidly into housing. The recommendations from the Butt each Continuum planning group as well as other engagement efforts will help to inform and shape future funding opportunities. HSD is planning now for the release ofa competitive funding process during 2017 which will include funding for outreach programs. The awards made In 201? will be contracted In 2018. While P'hase i of this effort focused on competencies required for outreach providers, Phase II will focus on coordination of resources and services that further support ending the crisis of homelessness for people in our oommunltv. Phase ll components I Mobile access to Hiv'llS and CEA 0 Communication tools that work across various systems not linked to Refinement of svstem wide performance targets OUTREACH CONTINUUM PLANNING WORKS ROUP MEMBERS Thank you to the-followmg people for vour invaluable insight and commitment to this effort. Page 57 Reporting Plan for Navigation Team Navigation Team Theory of Change Appendix 3: Navigation Team Organizational Structure Appendix 3 Page 58 Reporting Plan for Navigation Team Navigation Team Organizational Structure FAS Director of Operations Navigation Team Lead August 8, 2017 Public Safety Navigation Team SPD Sergeant Navigation Team SPD Of?cer Navigation Team SPD Of?cer Navigation Team SPD Of?cer Navigation Team SPD Of?cer Navigation Team SPO Of?cer Navigation Team SPD Of?cer Navigation Team SPD Of?cer Navigation Team SPD Of?cer Hazardous Site Cleanup Encampment Response Manager Field Coord ina to Field Coordinator Field Coordinator Outreach Outreach Coordinator I Outreach Supervisor ?1l Outreach Provider l_ Outrea ch Provider Page 1 Page 59 Reporting Plan for Navigation Team Navigation Team Theory of Change Appendix 4: Navigation Team Officer Training All Seattle Police Officers are required to attend 80 hours of mandatory training each year which incorporates de-escalation, crisis intervention, and ha rm reduction as standards. Navigation Team Officers have all completed the state certification for Crisis Intervention Training (40 hours]. In addition, Sargent Erik Zerr, the lead Navigation Team Officer, is an instructor for several courses relevant to the Navigation Team work, specifically regarding crisis intervention, de-escalation and racial bias. Part of Sargent Zerr?s role is to work with the officers to ensure these skills are applied in the field. The list below includes the training that the Navigation Team Officers have accrued over the past five years: I 4Ghour Crisis Intervention Training -- State Certification I Advanced Crisis Intervention Training - Sargent Zerr, instructor I Crisis Intervention Training Sargent Zerr, instructor 0 De?escalation and Contact St Cover -- Sargent Zerr, instructor 0 Race: The Power of an Illusion -- Sargent Zerr, instructor 0 Interacting with Transgender Individuals I Post?Traumatic Stress Disorder Anti-Harassment and Anti-Discrimina tion I Mental Health Contact Report I Tactical De-Escalation/Firearms Individual Skills I Perspectives on Pro?ling I Family Intervention Restorative Services 0 Threat Assessment and Prisoner Control Rece rtification I Less Lethal certification I Bias-Based Complaint I Bias Free Policing I Biased Free Policing and Voluntary Contacts and Terry Stops I Authorized Force I Use of Force Core Principles I Trauma Informed Care I South Seattle Community College Life Skills to Work Appendix 4 Page 60 Reporting Plan for Navigation Team Navigation Team Theory of Change Appendix 5: Navigation Team Logic Model Appendix 5 Page 61 Reporting Plan for Navigation Team TEAMS Human services carts-?ed Special'y italPEC SPD Navigation unit Etl'ltl Administrative Se?: s?ol?i RESOURCES Navigation Social Service id at a Behavioral Health Pro-riders Medical Set.- lr-chh. etc Shelter and Authorized Encampment Frontiers Cit'; Ersal?ncmon: Cleanup Start 8: Contractors Flexible Funds I'lIElyo?tI'eur'ierlidl Relationships Community Partners FiJsiItess. Ct?lmn'tl'littl; etc 1 NAVIGATION TEAM LOGIC MODEL Our Goal: The City?s outreach to unsheltered individuals is efficient and effective in moving people out of hazardous conditions and onto a path toward health, stability, and permanent housing. ACTIVITIES UNDERSTANDTHE NEED . Ergoao aria build relalionships with inalviclua luring Ouileact data so Iectiol' and analysis OFFER HELP 0 Make meaningiul oliere at ar'lJ sen-Hoes Problem?solve for ndividuaio facira barriers to sheila all: Seik'iCGS PROVIDE SUPPORT Honduct ASEESSMENS Facilitate registration fl'l' Seattle. and King Cour-[tr 'lousi?l-g Authority otter}- Ersure rights are protected tl?rcugn corrupt d?l'le Harm-reduction Interventions put-sides at current uneanctionoa oncampmorts IMPROVE SAFETY 0 Assist encalnpt'lert hazard assessment Assess encampnlents particularly 'il'l unstable 'rdnriduals Pol-tide sncar?rprrent cleanup Taci itate emergency medical response Diane l'1dl'c'ldliEll9 in crisis on 72 mental health hold to rt n: a: :3 RESULTS Otters GI relocation It: lJ?t?r tailored it! the nee-as of Incl-t dJa-Is a'e accents: . Otters 01? services and support that are. tai cod 1: rc-::s of an: accepted . Irdav'irluals convoluted or lecmltecred wit": case workers . Ird-t-iduals reconnected with personal eupporl theme, . Ensure racial-v oquitablc outcomes . Belarlgir'gs 11' [loss .lr's'lelime-I saterI stored . Transportation pro-lI doc to alternate II'u'lr?g 'clilaii'g?iijlile'ltti . Irdividuals l'rto county 'rr'dc llama-less support system . i'ldUB 'l'ilul Child Protective Services . Referrals lTac?c to Crisis Clinics . Health and safety risks pose-rt by unaLtllor zed eroamol?lents are mitigated WI (H NEAR-TERM 1. Earriereto exitvng unsate Il?rng conditions are reduced . Mitigation of Immediate Issues facing unsaelteled duals It: clisis . Hecannectlon to personal support network facilitates exit at unsafe tilt ng situation as QUTGOMEE :l EDI . ll'lai-liduals succesaiuny enter appropriate supporl program {mortal health. behavioral nealth. assistance. are] People living unsheltere: voluntarily relocate to sol-2r Ii't-ng Sliuamns Cull . Wizh immediate.- surviu'al needs met. Individuals begin to stabilize p. . Iniiulduals begin developing a plan DT action [or improving circu metancee .h WI KS LONG-TERM . Previously unsheiteled indilriauals Succession}; embark upon a path to permanent housing 0 2. Reduction In tho bu Helen posed by the unshellered population on the City?s Emergency Response resources (It) . improvement in public sale-ti; . Mitigation or public health inwards posed by llrauthcrizec encampments Ind sustain participation in appropriate services to rr'ee'. non-steter needs in are Intended estimates at the storage outreach engagement. Actual length or engagement varies by indiridual needs and circumstances. Cityr of Seattle - Budget Oilice I w? Page 62 Reporting Plan for Navigation Team Navigation Team Theory of Change References Applied Survey Research (2016). City of Seattle 2016 Homeless Needs Assessment. Bassett, Ellen Tremoulet, Andree; and Moe, Allison, "Homeless Encampments on Public Right-of? Way: A Planning and Best Practices Guide" (2012). Urban Studies and Planning Faculty Publications and Presentations. Pa per 29. fee/29 City of Austin. Homeless Outreach Team. ustintexas.gov/depa rtment/homelessness? outreach-team City of Lubbock Police Department. Homeless Outreach Team. depa City of San Diego. Homeless Outreach Team. services ro rams hot City of St. Petersburg. Street Outreach Team. outreach teamphp Colorado Springs Police Department. Homeless Outreach Team. Fisk, D., Rakfeldt, J., 8: McCormack, E. (2006). Assertive outreach: An effective strategy for engaging homeless persons with substance use disorders into treatment. The American journal of drug and alcohol abuse, 32(3), 479-486. HCHN Clinician?s Network. (1998). ?Operation Safety Net: Outreach to Unsheltered Homeless People." HEALING HANDS 02.07 (November 1998). National Healthca re for the Homeless Network. Retrieved From: 98.pdf Houston Police Department (2015}. Houston Police Department Mental Health Division 2015 Annual Report. reducedpdf Lam, J. A., Rosenheck, R. (1999). Street Outreach for Homeless Persons with Serious Mental Illness Is It Effective?. Medical care, 894-907. Nasper, E., Curry, M., Omara-Otunnu, E. (1992). Aggressive Outreach to Homeless Mentally Ill People. New England Journal of Public Policy, 65. References Page 63 Reporting Plan for Navigation Team Navigation Team Theory of Change Oklahoma City Police Department. Homeless Outreach Team. mu nitv-progra Rowe, M., Fisk, D., Frey, J., Davidson, L. (2002). Engaging persons with substance use disorders: Lessons from homeless outreach. Administration and Policy in Mental Health and Mental Health Services Research, 29(3), 263?273. RoweB/publica?an/11338249 Engaging Person 5 with Substance Use Disorders Lessons from Homeless d823606f.gdf Salt Lake City Police Department. (2016). Homeless Outreach Service Team (HOST) Program Overview. San Francisco Budget and Legislative Analyst. (2016). "Perfo rmance Audit of Homeless Services in San Francisco." Board of Supervisors of the City and County of San Francisco. Bud%26LegAnalvst.pdf United States lnteragency Council on Homelessness (USICH). (2015). "Ending Homelessness for People Living in Encampments: Advancing the Dialogue.?I library/Ending Homelessness for People Livi ng in Encampments Aug2015.pdf United States Interagency Council on Homelessness (USICH). (2015). Opening Doors Federal Strategic Plan to Prevent and End Homelessness. content/uploads/2016/06/USICH OpeningDoors AmendmentZOlS United States Interagency Council on Homelessness (USICH). (2016). 10 Strategies to End Chronic Homelessness. librarv?O Strategies to End Chronic Homel United States Interagency Council on Homelessness (USICH). (2017). Crisis Response. Wichita Police Department. Homeless Outreach Team. .aspx References Page 64 Reporting Plan for Navigation Team APPENDIX (is Seattle Finance 8: Administrative Services Date: October 31, 2017 To: David Jones, City Auditor From: Fred Podesta, Director Subject: Reporting Plan for Navigation Team Thank you for the work of your office to consider ways to evaluate and improve the effectiveness of the Navigation Team. The purpose of the Navigation Team is two?fold. The team offers outreach and safe alternatives to the occupants ofthe most hazardous unauthorized encampments in the City, requires occupants to move and abates the hazardous conditions. After careful review, we are very concerned that the reporting plan focuses only on outreach elements ofthe Navigation Team, without the context of eliminating hazards and the opportunity for individual change created by closing an encampment to abate these hazards. None the less, we are committed to improving the Navigation Team, and will provide the reports identi?ed in this plan. The targeted approach of the Navigation Team has improved the City?s ability to connect people living unsheltered in hazardous conditions with services and relocation to safer locations like shelter or managed encampments. Between February and October 5, 2017, the Navigation team made 5,127 contacts with a total of 1,340 individuals. 0f the 1,340 individuals, 864 accepted some sort of service, including case management support/referral; mental health support/referral; substance use disorder treatment referral; state ID acquisition assistance; medical support/referral; coordinated entry housing assessment King County Housing Authority lottery registration,- employment support; benefits activation support; vehicle repairs; and basic needs. A 64% acceptance rate for Services is a significant improvement over previous outreach efforts. For example, prior to the implementation of the Navigation Team, outreach to residents of the East Duwamish Greenbelt had a successful engagement rate of 19% for any services and 18% for alternative living arrangements. Most importantly, the work of the Navigation Team has shown signi?cant improvement in the number of people willing to relocate to a safer alternative, in part because it has desirable, low-barrier options to offer. Between February and October 2017, 528 individuals accepted relocation to safer spaces, including shelter, authorized encampments and reconnecting with family or another support system. For comparison, during the entire year of 2016, outreach related to encampment response resulted in only 214 people accepting referrals to an alternate living arrangement (an estimated acceptance rate of 17%)1. As we move into 2013 with requirements for outreach providers to use HMIS, the City will be able to better evaluate the eventual housing outcomes of the people the Navigation Team helps connect with shelter. We share the desire to improve outcomes and are already engaged in continual process improvement to maximize the positive outcomes of the Navigation Team effort. We appreciate the reporting plan's emphasis on evaluation, but also must recognize that the Reporting Plan adds a significant body of work to the Navigation Team and Human Services Department that may have significant impact on the continued progress and improved outcomes achieved to date. We expect full compliance with the entire reporting 1 4,780 duplicated contacts to an unknown number of individuals at a ratio of 3.8 contacts per person is approximately 1,258 individuals, 214 of which accepted a shelter referral. Fred Podesta, Director -'f_lfll Ant I l? Hui-i gill-'13? I Eda-lull], QSIJJ flit-185i ?Ki illil'l ??41 I ?lm/lit. Page 65 Reporting Plan for Navigation Team plan on the established time-line will, at the very least, slow down the work on application of the Racial Equity Toolkit that is under way now and will continue in 2018. Page 66 Reporting Plan for Navigation Team APPENDIX D Seattle Office of City Auditor Mission, Background, and Quality Assurance Our Mission: To help the City of Seattle achieve honest, efficient management and full accountability throughout City government. We serve the public interest by providing the City Council, Mayor and City department heads with accurate information, unbiased analysis, and objective recommendations on how best to use public resources in support of the well-being of Seattle residents. Background: Seattle voters established our office by a 1991 amendment to the City Charter. The office is an independent department within the legislative branch of City government. The City Auditor reports to the City Council, and has a four-year term to ensure her/his independence in deciding what work the office should perform and reporting the results of this work. The Office of City Auditor conducts performance audits and nonaudit projects covering City of Seattle programs, departments, grantees, and contracts. The City Auditor’s goal is to ensure that the City of Seattle is run as effectively, efficiently, and equitably as possible in compliance with applicable laws and regulations. How We Ensure Quality: The office’s work is performed in accordance with the Government Auditing Standards issued by the Comptroller General of the United States. These standards provide guidelines for audit planning, fieldwork, quality control systems, staff training, and reporting of results. In addition, the standards require that external auditors periodically review our office’s policies, procedures, and activities to ensure that we adhere to these professional standards. Seattle Office of City Auditor 700 Fifth Avenue, Suite 2410 Seattle WA 98124-4729 Ph: 206-233-3801 www.seattle.gov/cityauditor Page 67