I was in Denver this week, working with SAMHSA's Homelessness Resource Center training team, and one of our keynote speakers was Paul Carlson. Paul is a regional director and is responsible for promoting the mission of the Council in AK, AR, AZ, CO, ID, MT, ND, NM, OK OR, SD, UT, WA, WY.
He's got a lot on his plate, but you'd never know it; the man is intensely personable, gregarious, energetic and in a sense, prophetic as well. He's the second high-ranking Council member I've had the pleasure of not just hearing speak, but also having an opportunity to actually spend some time chatting with about various issues related to homelessness and veteran homelessness.
The other person was Anthony Love, an incredibly bright and personable man who promotes the goals and the mission of the Council with a zeal that infects and motivates you. I only wish all our federal personnel approached their duties with the drive and energy Paul and Anthony bring to the table.
I know both these men would be horribly embarrassed to hear me gushing about their personalities, as they both seem to be really humble servants of a cause that anyone reading this blog can understand; not just managing homelessness, but ending this damned scourge permanently.
During Paul's Keynote address at the Denver conference, he said something that really hit home, and it concerned something I've seen happening in Nashville for some time now, but reports coming to me from a number of sources have indicated that it seems to be worsening recently.
Paul was talking about the master plan from the Council,
Opening Doors, The Federal Strategic Plan to Prevent and End Homelessness (full plan can be downloaded as pdf here). One of the things he mentioned during his conversation was this goal to get agencies and organizations that work with the Homeless population to stop "creaming" the easiest cases while leaving the most difficult languishing on the streets yet again.
When I heard that statement, I instantly recalled policies and procedures I'd run across in the area over the past several years that established and perpetuated the "creaming" mentality, and for the most part, this was an unintentional consequence of the lack of available services needed to assist some of our more challenging population members. Unfortunately, allowing direct service providers to cream is a slippery slope; initially, they may be forced into picking the easiest cases because the lack of said services makes it fruitless to try and assist those (beyond the basics of backpack survival items) in any meaningful way.
There is an important secondary issue here as well; as an advocate or an outreach worker, the last thing you want to do is to ruin an engagement and relationship with a client(s) by running them through a bunch of hoops that won't pan out, for whatever the reason. It's better to support the folks, remain committed to serving them and vigilant to new programs coming that can provide some help, and keep them informed of those new opportunities as soon as they arise. Folks on the street will be far more appreciative if you're not blowing smoke up their butts. It's the old "underpromise and overdeliver" mantra anyone with more than a few days of outreach under their belts will immediately understand.
The lube on the slope unfortunately, seems to be that once we set in motion creaming for reasons related to non-existent resources, it seems to send a message to the staff that we seek the easy ones because the challenging cases are "uninterested in help," or are "non-compliant anyway" and therefore don't deserve our help. It becomes very easy to justify denying services to difficult clients by blaming it on the workload, on previous efforts to assist the individual that failed, that there are more "deserving" cases out there (one of the main issues I have with the Vulnerability Index), and just plain laziness, too.
Before I go further, I want to point out clearly that there is a huge difference between creaming and suffering from the same frustration those on the street are enduring as a direct result of the lack of resources available to all of us. If you feel the finger is pointing at you, well then perhaps you ought to examine your motives and your caseload. There are a great many conscientious and dedicated providers who suffer dearly from the lack of resources and unintentionally forced creaming that occurs as a result. My desire is not to impugn your extraordinary efforts in service delivery and I apologize in advance if this post rubs some the wrong way. I would reiterate however, that if you feel a tinge of defensiveness rising somewhere within you, it may pay to re-examine your practices.
As Paul mentions when he talks passionately about Housing First, "we don't give up on the person when a housing unit is lost by the client." It's a philosophical approach, really, in that when we commit to ending homelessness, we don't commit only for those who are "easy," who may be able to sail through a SOAR application while making every appointment on time and kissing the butts of those filling out the application throughout the entire process.
We don't give up on someone who, after spending decades on the street, is coerced into a housing unit through fear of their camp being closed down, then evict that individual when we find they are unable to live with the new rules of an apartment complex.
We don't abandon the alcoholic or addict when they fail a stint in rehab, and we don't ditch the person when another rehab ejects them back onto the same tormenting streets when their time is up after "successful" completion of the program.
I get that we have huge caseloads, that resources are so scarce every single penny must be carefully weighed under the "benefit of the greater good" scale. I understand that we have some damned challenging folks who need our help, and they aren't always acting the way
we think they should. I know these people well, because I am one of them, and you can bet your last dollar
you are too.
ALL of us would rather have real choices, not the slick methods of denial cloaked under the banner of providing "choices" some agency personnel like to trot out when rationalizing to the rest of us why it is they aren't providing services to a potential client, or now refusing to serve a client they once had on their caseload. This kind of discriminatory behavior towards people experiencing homelessness should be called out at every opportunity, and we as a community - and as taxpayers - ought to seriously consider revoking funding from agencies receiving federal grant money.
It took me seven years from the time I dimly recognized I was suffering from a serious disease and illness to the point at which I finally entered what I would consider real recovery. During that period, countless assholes wrote me off, labeled everything me from "non compliant" to "malinger" (I actually
saw this as a diagnosis from a quack physician, no less, who continues practicing his dangerous, biased, discriminatory ignorance upon our community members to this day), deemed me "unworthy" of services, labeled me "DNS," and generally stomped just about every last ounce of self respect and dignity out of me in the process.
I've since come to understand, thank the Gods, that it wasn't my inability to recover, it was
their inability to put the correct options in front of me to assist me in my recovery, and when they couldn't do their own jobs, they found a way to blame the failure upon me.
Because I was "non compliant" under the terms of their "resource requisites and prerequisites," I was often either summarily dismissed or quickly weeded out from services, kicked to the curb, and left to fend for myself.
Over that period of time, I surely cost local and state taxpayers thousands of dollars as a result of my addictions, my incarcerations, my inability to work and the resultant food stamps and medical, vision and dental services I received on the state's dime. Who knows what kind of productivity I may have been capable of with the right employer, so how much money in tax revenue, in providing goods and services to others, did we as a community lose?
Factor in the boost in self esteem and general well-being I could have had, had I been treated appropriately the first, second, third, even fourth time around, and if my current recovery trajectory is indicative of my abilities, I'd say you all lost bigtime as a result of the improper handling of my illness and disease. All because I'd been "creamed" out by people who weren't willing to spend the time needed to work with this "challenging" case.

If you're providing services and you're finding ways to deny potential clients services, regardless of whether you want to pretty up the act by arguing that you're "providing choices" to the individual as you send them packing, you're as much of the barrier to ending chronic homelessness as is lack of affordable housing and poverty.
When you signed on to this line of work, you made a commitment to serve.
Everyone.
If you aren't doing that, I hope you are either working to change the policies of your agency or are looking for another job in an unrelated field.
Too many people are suffering while you skim the cream....