Useful strategies but no easy answers in ending homelessness

A new study from the U.S. Housing and Urban Development Department (HUD) examines the costs of serving homeless individuals and families and explores cost-saving possibilities in differentiating services according to individual characteristics.

HUD finds that different types of first-time homeless individuals and families use system resources differently, so some opportunities exist to improve outcomes by developing tailored strategies to meet the needs of each type of individual and family. For example, the report describes how African American families are often homeless primarily due to poverty rather than mental illness or substance abuse, and therefore need permanent housing but not substantial supportive services. Similarly, childless single women have different needs than families.

Despite HUD’s support for tailored services, its cost analysis revealed that there are no loopholes or easy answers when it comes to cost savings. The study found that significant cost reductions are only achievable when targeting the few individuals and families with high levels of involvement in mainstream systems prior to homelessness. Accordingly, while narrowly targeted initiatives aimed at this group will yield the greatest savings-per-person, such initiatives would only be appropriate for a small number of people.

HUD's study was released as Milwaukee is considering its new ten-year plan to end homelessness. The County Board has already endorsed the plan, and so has a Common Council committee. If fully adopted, Milwaukee will join more than 800 cities and counties that have partnered in implementing at least 355 ten-year plans to end homelessness.

Milwaukee’s plan was developed by the Continuum of Care (a conglomeration of social service agencies that address issues facing the homeless) as well as other local participants. Among other things, it calls for both earmarked state funds and reapportioned federal and local expenditures to fund services for the homeless. It targets a number of key issues raised in the HUD study, including prevention, employment, behavioral health, and permanent housing. The plan also calls for revamping methods of discharge planning for those transitioning out of foster care, hospitals, mental health care and jails.

Milwaukee’s plan appears to meet the National Alliance to End Homelessness recommendations for successful planning by possessing four elements: identifying a person or body responsible for implementation; setting numeric outcomes; identifying a funding source; and setting a clear implementation timeline.

According to the U.S. Interagency Council on Homelessness, taking a 10-year plan from “good to great” requires extensive engagement of public officials and community champions, as well as the ability to sustain momentum for implementation through changes in political leadership and priorities. With changes in political leadership likely on the horizon here in Milwaukee, it would appear that momentum-building will need to be a top priority for plan supporters.

Fiscal estimates suggest quality early childhood education is costly yet beneficial

The annual cost of operating a high-quality child care or early education center in southeast Wisconsin is an estimated $11,000 per child, more than double the cost of a typical program in the region today, according to the Public Policy Forum’s latest report from its three-year research initiative on early childhood care and education.

The report, “The Price of Quality: Estimating the Cost of a Higher-Quality Early Childhood Care and Education System for Southeast Wisconsin" stresses that only high-quality programs reap the long-term benefits our region needs most, such as better student achievement and improved graduation rates.

Noting that many other states have invested in child care quality improvement policies in order to capture those long-term benefits, the report intends to help policymakers cost out their options for improving child care quality in Wisconsin. The report provides fiscal estimates on a status quo scenario, a mid-level option and a high quality scenario for state policymakers to consider. While the report’s estimates include only the seven-county southeast Wisconsin region, the policy decisions likely will be made at the state level.

Main findings include:

· The direct costs of operating the region’s current system of early childhood care and education is an estimated $370.5 million annually to serve over 66,700 children. To operate the same sized system at a high-quality level would cost an estimated $671 million annually;

· Policies aimed at maximizing quality would be the most expensive, while a more modest improvement in quality in the region would result in total direct costs of $506.2 million;

· While taxpayers pay for direct costs only to the extent that they subsidize costs for low-income families, certain indirect costs are paid for by taxpayers, including regulation and monitoring of child care providers. These indirect costs would increase if policies were put in place to improve quality in the region and are estimated to total almost $7.5 million during the initial phases of any quality improvement initiative;

· The long-term economic and social benefits that can result from improved quality care and education are maximized when the care is of the highest quality. In addition, the benefits for at-risk and low-income children are larger than for other children.

The report presents several policy options for policymakers, ranging from low-cost and low-return on investment to high-cost and high-return. The least costly option is to maintain the current regulatory system and the focus on fraud prevention. The most costly option is to reform the system as a whole, requiring smaller caregiver-child ratios and requiring caregivers to have four-year degrees, for example. Other options include incremental improvements in quality over a period of time, focusing on improving quality for the neediest children, or a Quality Rating and Improvement System that gives parents information about the relative quality of programs. The report also analyzes five different models for financing quality improvement initiatives.

The Governor and the Legislature have child care on their radar screens right now in light of the serious fraud problems that have arisen in the Wisconsin Shares program. For the sake of children and our regional economy, stamping out fraud in Wisconsin Shares must also involve consideration of how to improve quality. This report’s overview of costs and policy options aim to provide context for upcoming legislative deliberations.

Some call for investment in people, not bricks and bridges

A recent Milwaukee Talkie blog post asked, “Can’t we all get along when it comes to spending stimulus funds?” That post tackled state-vs.-local issues with regard to infrastructure spending, but not everyone is even at the point of agreeing that President-Elect Obama’s forthcoming New Deal-like plan to stimulate the economy by funding infrastructure has the right target.

In articles like “First, Repair the Human Infrastructure,” the head of a community health initiative claims that stimulus funding used to prevent chronic illness would save billions down the line in medical care and disability costs. Similarly, another blog makes a bid for human capital: “Lots of infrastructure is decaying in this country, and that includes the people and systems that comprise our social, educational, health and other kinds of human infrastructure. It isn’t just a matter of bricks and bridges.”

In the article “Don’t Forget the Human Infrastructure,” the Brookings Institute’s Isabel Sawhill presents some pragmatic arguments for making strategic investments in the nonprofit sector, which employs 10 percent of the workforce while providing a safety net for many, but is suffering in the bad economy. She notes that if such "human infrastructure" investments were made, the nonprofit sector would:

· Spend the money quickly and fully
· Employ people with a broad range of skills
· Be able to rely on a network of preexisting institutions
· Have the capacity to spread the dollars widely
· Avoid shrinkage, thus not adding to the ranks of the unemployed.

In Milwaukee, nonprofits are feeling the crunch. A Journal Sentinel article advised the sector: "Now is a time to be wary." The Nonprofit Portal of Milwaukee's most recent online newsletter links to five articles on weathering the economic crisis.

A commenter on a Seattle blog disagrees with Sawhill and others' human infrastructure arguments, cautioning against investing too heavily in recurring costs, “When you finance a building [or a road, bridge or rail line], you’re expecting to be able to use that building for maybe 50 years. You don’t need to build it again next year. . . . When we hire a teacher, however, the cost of their salary will recur each year.”

Others agree that we should be building things, but stress that short-term projects should be emphasized to stimulate the economy more quickly. An L.A. Times article describes how complex infrastructure projects like subways have a long lead time devoted to preparing engineering studies and environmental surveys, which can delay their stimulative effect. Lawrence E. Harris, a USC professor of finance counters, “But lots of tradesmen who know how to build houses can build community buildings, senior citizen centers and early childhood centers, which don’t take a long time.” Despite its emphasis on large infrastructure projects, Obama’s stimulus package is likely to highlight modernizing schools.

At least one women’s group is also concerned about Obama’s plan. Feminist Majority Foundation President Eleanor Smeal expressed alarm that the recovery package will emphasize construction jobs “which notoriously under-represent women workers.” She cautioned, “Although we support a physical infrastructure stimulus package, we believe it must be accompanied with a human infrastructure component that will employ a majority of women workers.”

Evidence abounds that many aspects of physical infrastructure have been neglected for too long in this country, as well as locally in Milwaukee. The number of voices pointing out that other aspects of the country’s “infrastructure” – from education to the nonprofit sector to hurricane protection – also are in disrepair speaks to the myriad challenges facing the new Obama administration. But perhaps no challenge is greater than this: while consensus seems to have emerged that we must stimulate the economy somehow, and while the battle therefore will continue over what sector or project gets the money, in the end we are still spending money we don't really have.

Could last resorts spur action on Milwaukee's mental health complex problem?

High on the list of "fiddling while Rome burns" situations is the plight of Milwaukee County's mental health complex.

For years, the county's Behavioral Health Division (BHD) has been trying to provide emergency, acute inpatient, and long-term mental health care services to indigent county residents in a sprawling complex that is falling apart and no longer meets its needs. In the meantime, it's hemorrhaging dollars it doesn't have (a $3.9 million projected deficit for 2008 after several previous years of budget holes), and its efforts to pursue a new home that might produce overhead savings and better quality of care have been bogged down by infighting between the county executive and county board.

For insight into what types of options might get tossed around if things get really bad, county policymakers and special interests who have been brawling over this issue may wish to consider what's going on in Georgia. There, the state is seeking to embark on what the Atlanta Journal Constitution calls an "uncharted course": full privatization of the state's psychiatric hospitals.

Understandably, this proposal has attracted considerable concern, primarily based on fears that the only way the private sector could profit from providing mental health inpatient services for largely uninsured individuals would be to significantly cut staffing and services. Given Georgia's already poor history of service delivery, that is a troublesome possibility. State officials, however, are touting this as the only option for attempting to provide better care within existing budget constraints due to the private sector's alleged ability to provide higher levels of service at lower cost.

Could such an approach be attempted in Milwaukee County? Interestingly, some county mental health officials looked long and hard at "getting out of the inpatient business" several years ago, as it became clear to them that the dollars needed for community-based care and supports would not be available as long as they were forced to pour increasing amounts of property tax dollars into inpatient and long-term care operations. The biggest obstacle at that time, however, was the perceived impossibility of securing a private sector entity to step in given the large uninsured population served at the mental health complex.

Might those circumstances be different today, in light of new Badger Care coverage for childless adults and a push for mental health "parity" at the federal level, both of which could lead to broader coverage for mental health services? That's hard to say, but it's not hard to imagine a scenario in which the county again would have to contemplate the privatization option - at least for some of its inpatient or long-term care operations - despite concerns about impacts on service capacity and quality.

The sad reality is that the county has few options left. While it has not moved forward on the proposed move to a renovated St. Michael hospital, and is now entertaining the thought of building a new mental health complex, the fiscal situation at BHD - as demonstrated by the size of the 2009 deficit - has grown worse. The structural problems that have created budget deficits for several years are no secret to policymakers, yet they have not been addressed (with the exception of an initiative to outsource dietary services) and are likely to cause another sizeable budget hole in 2009. In the meantime, it is now logical to ask whether either a move to a renovated St. Mike's or building a new complex is practical in light of the county's deteriorating fiscal condition, which is worsening by the moment as its pension fund assets shrink and its infrastructure and service needs grow.

None of this is to suggest that privatization of inpatient mental health services should be viewed as anything but a last resort or is even viable. However, unless county policymakers do something soon to reduce overhead costs at BHD to make the cost of care more affordable, last resorts may be the only resorts left on the table. That should be reason enough for them to start working together to identify and implement a realistic solution to their mental health complex problem.

Clarke Street School program targets achievement gap

A new program at Milwaukee’s Clarke Street School, announced last week, will provide 80 first- and second-graders with extra help through elementary, middle and high school and a guarantee that they will be able to afford college. The I Have a Dream Foundation effort builds on a quarter-century of the foundation’s experience in similar programming in 29 cities. Early intervention tuition assistance programs are unique among education interventions for their combination of early, long-term support and the promise of eventual tuition funding. In some cases, programs similar to the I Have a Dream model have not been successful, revealing some lessons learned along the way. For example:

1. Start early, stay invested

After Minneapolis/St. Paul's Destination 2010 program's disappointing evaluation results, St. Paul’s then-superintendant commented, “You can’t ever start too early. Third grade – what if we had started even earlier?” (2/19/07 Pioneer Press article via LexisNexis).

Starting interventions early makes sense if the goal is to close or prevent the achievement gap; however, maintaining such an investment over the long-term is costly and can be difficult given changing politics and funding. For instance, in 1988 the New York Scholarship and Partnership Program experienced severe cuts and the program's students who had enrolled with promises of tuition help were suddenly out of luck (Coons and Petrick, 1992).

2. Emphasize the right incentive for success

The Twin Cities’ Destination 2010 program shows that it takes much more than some afterschool tutoring and a promise of tuition assistance to bolster struggling students. Five years into the program, tests scores showed that long-term monetary incentives were doing little to change students’ lives in the short-term, with program students performing worse in some testing areas than the comparison group.

The I Have a Dream model to be used by Milwaukee’s Clarke Street School program emphasizes relationships over tuition funding. The program will place a family outreach coordinator in the school to address poverty-related problems and family stability issues, ensuring that students and families receive extensive support. The intent is to make the program more than just a promise of eventual funding at the finish line.

3. Understand student barriers to success

The Twin Cities’ Destination 2010 program’s administrators thought they had a handle on the roots of the achievement gap, until their program enrollment was decimated by high student mobility.

Of the original 450 students who could have joined Destination 2010, 368 signed up. Five years later, only 215 students remained – fewer than half of the initial group. According to the program manager, 80% of those who left the program went "off the radar" (6/3/06 Pioneer Press article via LexisNexis). In addition, students who were initially from seven schools in 2000-01 had fanned out to 71 schools by 2002-03. It was common for many students to attend up to three schools in a single year, an obvious problem when trying to keep up with homework and learning. The program concluded, “We believe that lack of safe and affordable housing is at the heart of the mobility issue.”

The I Have a Dream Foundation model considers the impacts of mobility. The foundation’s website explains that often, students who are sponsored together at the same elementary school will attend different middle and high schools but will gather together for I Have a Dream programming at a local organization. This is important, as Milwaukee is no different from any other low-income, urban district with regard to mobility.

In 2006-07, Clarke Street School had a 13% mobility rate within the school year, with a 61% stability rate. This predicts that, of the 80 first- and second-graders in the new I Have a Dream program, 13% will be at a different school before the year’s end, and 39% will switch schools at the year’s end.

4. Protect program sustainability

As much as possible, it is important to insulate early intervention tuition assistance programs from the ebb and flow of budget politics. The worst case scenario would be to promise tuition to young students who later find no money available. A more common danger is that tight budgets serve to undercut program effectiveness. For instance, in the Twin Cities, school budget cuts resulted in higher teacher turnover, effecting continuity of teachers fluent in the program philosophy. State budgets cuts then reduced the availability of area after-school and tutoring programs – programs that were a key Destination 2010 intervention element to help kids stay on track (9/27/04 Pioneer Press article via LexisNexis). For long-term intervention programs, it is especially important to design a program that can make accomodations when faced with inevitable cuts in other areas.

Conclusion

Among early intervention tuition assistance programs, the I Had a Dream Foundation model has significant merit. However, when examining all types of interventions that target the achievement gap, many studies have suggested that investments in high-quality early childhood education interventions for children under age 5 have the highest long-term payoffs.

For the 80 first and second-grade children at Clarke Street School, this privately-funded program may have a huge impact if the lessons above are heeded. For the rest of the children in the district, and the infants and toddlers who will eventually be MPS students, large scale early intervention will need to take other forms.

Early Childhood Education as an Anti-Poverty Priority

When it comes to antipoverty strategies, efforts related to early childhood education and child care rise to the top for many researchers.

In the inaugural issue of Pathways magazine, poverty researcher Rebecca Blank features her priority list of top anti-poverty strategies. Out of her six recommendations, two relate directly to early childhood education and child care; two others address children in some way. According to Blank, many potential solutions for eliminating poverty should be implemented early in life when the chances for making a difference are greatest.

To combat poverty, Blank recommends two hallmarks of early childhood education success: a guaranteed pre-kindergarten program for all four-year-olds from low-income families, and expanded child care subsidies for low-income families.

Blank stresses broadening the EITC (Earned Income Tax Credit) subsidy for individuals not living with children, particularly for fathers of poor children. She writes, “[I]f their lives are more economically stable they will be better able to help raise their children and this will help stabilize the communities in which they live.”

In her most unconventional antipoverty recommendation, Blank encourages the government to work to provide every low-income family with low-cost Internet access so that “children are ready to live and work in an interconnected world.”

Two additional recommendations are encouraging candidates to be spokespeople for the poor, and using demonstration projects instead of new program models.

Blank’s priority list underscores how early childhood education is not just a schooling or a parenting issue; rather, it could be key to antipoverty efforts. The Public Policy Forum is continuing its multi-year research project focusing on early childhood education policy in the southeast Wisconsin region.

Wedding Bells are Tolling Less in Milwaukee: Considering the Implications and Misconceptions Related to Poverty

Milwaukee has marriage on the mind – or, the lack thereof, that is. Two February articles in the Journal Sentinel – a column by Patrick McIlheran and, most recently, a news story, have highlighted declining rates of marriage. The news story describes how, in 1980, there were 8.7 marriages for every 1,000 people state-wide. Today Milwaukee County shows 5.2 marriages per 1,000 people, and Waukesha County is only slightly higher at 5.5 marriages per 1,000 people. McIlheran notes that 58% of Milwaukee’s children live in single parent homes.

Since marriage is associated with a variety of positive outcomes, proponents believe that policy makers should promote marriage as a solution to problems facing low-income children. Programs funded by Bush administration marriage promotion grants aim to increase and support marriage in a way that builds relationship skills, at times with added strategies to increase income. While proponents see a clear link between marriage and poverty, others find little research-based evidence that an absence of marriage is the factor causing child poverty. When it comes to marriage as a policy issue, the “association is not causation” chant from your statistics 101 class has never been more relevant. In considering marriage’s potential association with poverty, it is helpful to consider the following:

• Is it about lack of a ring, or family disruption? Do we want our public policies to encourage children to grow up in households with married people, which may mean step-parents, or do we prefer policies geared toward encouraging situations in which children grow up in households with both of their birth parents, which may mean unmarried cohabitation? Neither scenario necessarily spells success or disaster, but research by Sara McLanahan in The American Prospect in 2002 identified growing up with birth parents as more vital to positive child outcomes. Her research suggests that it is more prudent to consider family disruption rather than the low rates of marriage, and concludes, “What matters for children is not whether their parents are married when they are born, but whether their parents live together while the children are growing up.”

• What about quality? If we are to promote marriage, can we do that in a way that also dissuades people from staying in abusive marriages, and offers strategies to guard against making a bad match in the first place (i.e., programs that might end up advising “Don’t marry this one”)? Researchers Karen Edin and Joanna Reed published a study in The Future of Children in 2005 that found the quality of many (but obviously not all) romantic relationships of low-income people to be of low quality. In their study, low-income people cited domestic abuse, infidelity, and substance abuse as common reasons for break-ups. (The federal Healthy Marriage Initiative stresses that it only promotes healthy, nonabusive marriages.)

• Where’s the economic payoff? Are we fully facing the economic and social barriers to marriage for low-income people that make it more complicated than wanting to get married or valuing the institution of marriage? Edin and Reed agree that it’s not about needing to value marriage. Their research concludes that “disadvantaged men and women highly value marriage but believe they are currently unable to meet the high standards of relationship quality and financial stability they believe are necessary to sustain a marriage and avoid divorce.” Some couples must overcome unemployment or underemployment, criminal records, and complicated blended family structures.

• Association is not causation . . . but it could drain a budget. It may be a good idea to keep marriage promotion programs as one component in a multi-front assault on poverty that also contains more traditional efforts. However, we must do so with our eyes open to the limitations: there is a lack of convincing evidence that growing up in a single-parent home or with unmarried parents causes poverty. On the other hand, there is much evidence proving that other things do cause poverty. Dialogue on this issue should include the question: should our tax money go to promoting something that, when absent, is only associated with, but not necessarily causing, the poverty problem?

While marriage deserves to be on the radar screen when discussing poverty in Milwaukee and surrounding areas, the complex task of marriage promotion is easier said than done. The recent news stories on low marriage rates and the high numbers of single parent homes in Milwaukee underscore the continuing need for a host of community efforts to support healthy and stable families for children.