CHAPTER 5 How Will You Unite the Right People?

In 1997, a photograph was taken in downtown Reykjavík, Iceland, that would later become emblematic of a major national problem. It shows a city block jammed thick with people—the heads are mostly blond, with a few brunettes sprinkled in. It’s summertime in Iceland, when the sun doesn’t really set so much as take a breather for a few hours. So even though the photo was shot at 3:00 a.m., all those faces are pretty easy to see, and almost every last person in the picture is a drunk teenager.

The teens have taken over the city.

In 1998, 42% of Icelandic 15- and 16-year-olds reported having been drunk in the previous 30 days. Almost a quarter smoked cigarettes daily, and 17% had already tried cannabis. “I remember having helped a friend of mine to puke in an alley,” said Dagur Eggertsson, a physician who became mayor of Reykjavík in 2014. “And another friend actually fell into the sea—he was trying to balance on an oil pipe in the harbor area.… These were normal stories. This was part of growing up. This was part of getting your first paycheck, when you were working during the summer, when you were 14.”

This behavior went beyond normal teenage hijinks. Among 22 European countries, Icelandic tenth-graders had the second-highest rate of accidents or injuries related to alcohol use. They were near the top, too, in other disturbing categories: the percentage who’d been drunk at the age of 13 or younger and the percentage who’d been drunk 10 or more times during the previous year. To the Icelandic teenagers, this was all normal—it was the world they knew. But as the rate of substance abuse crept up almost every year during the 1990s, a group of leaders grew concerned.

The leaders had awoken from problem blindness—they were no longer willing to write off this teenage behavior as natural or inevitable. They resolved to move upstream. So, now what?

To succeed, leaders of upstream interventions need to address seven key questions, and in this section of the book, we’ll devote a chapter to each one. We’ll explore both the reasons why each question can be difficult to answer and the strategies smart leaders have used to overcome those obstacles. The first of those seven questions is: How will you unite the right people?

Recall that many upstream efforts are a kind of volunteer work. Chosen, not obligated. That was true in Iceland: Many people and government agencies had to cope with the consequences of teenage substance abuse, but it was no one person’s or agency’s job to prevent it (at least at the beginning). But many people cared enough to try. So the first step, as in many upstream efforts, was to surround the problem—to recruit a multifaceted group of people and organizations united by a common aim.

In 1997, a handful of those people—primarily academic researchers and politicians—launched an anti-substance-abuse movement called Drug-free Iceland. The campaign team eagerly courted help from anyone who was willing to assist: researchers, policymakers, schools, police, parents, teenagers, singers/musicians, NGOs, government agencies, municipalities around Iceland, private companies, churches, health care centers, sports clubs, athletes, media members, and the State Alcohol and Tobacco monopoly. This may sound like a sprawling set of collaborators, but keep in mind that most Icelanders live in or around the capital city of Reykjavík, which has a population of less than 250,000. In land area, the whole nation is about the size of Kentucky (the key distinguishing features from Kentucky being its active volcanoes, massive glaciers, and Björk). The point being, in Iceland a few hundred leaders from different domains could be connected together relatively quickly.

What attracted these parties was a brand-new vision for combatting drugs and alcohol. Traditionally, the work had focused on individual behavior change: getting teenagers to abstain from alcohol or drugs. But the campaign leaders in Iceland believed that the historical focus on “saying no” missed the big picture: What if the drugs were never offered at all? Or what if the teens enjoyed some other activity—soccer or theater or hiking—so much that they didn’t feel like getting drunk? In short, what if drug and alcohol use came to feel abnormal in their world rather than normal? “We wanted to change communities in order to change behavior among the kids,” said Inga Dóra Sigfúsdóttir, a social scientist and one of the campaign’s key leaders.

Academic research has identified a number of risk factors for teenage substance abuse: Having friends who drink or smoke is an obvious risk. Another is having lots of unstructured time available to hang out with those friends—at parties or, say, in downtown streets at 3:00 a.m. There are also protective factors that reduce the risk of substance abuse. Most of them boil down to having better ways for teens to spend their time: by participating in sports and extracurricular activities, or simply by hanging out more with their parents. (Interestingly, research suggests the quantity of time spent matters more than quality—which was not altogether welcome news for many Icelandic parents, Sigfúsdóttir reported.) In short, a teenager’s discretionary hours are finite, so a well-behaved hour can crowd out a badly behaved one.

The campaign’s guiding philosophy, then, was simple: Change the culture surrounding teenagers by reducing the risk factors for substance use and boosting the protective ones. The people involved—from parents to politicians to sports club leaders—had different resources at their disposal, but what they shared was an ability to influence one or more of those factors.

Communities and parents worked to change the culture around popular festivals, where many teens had hung out unsupervised, to encourage families to attend together. Teenagers were recruited to script and shoot anti-drinking television commercials.

Most of the efforts relied on cooperation by multiple players. One example: Iceland had long prescribed certain hours when kids could be outside, depending on their age. This “outside hours” policy was basically a friendlier version of a curfew, with no legal penalties for kids caught in violation. And the policy was frequently ignored. All those kids jamming the streets of Reykjavík in that memorable photograph, for instance—they were all breaking the rules.

To combat this nonchalance, the campaign sent a letter from Reykjavík’s mayor and police chief to all parents of young people, encouraging them to honor the outside hours. The letter also included a refrigerator magnet, which showed the specific times when young people were allowed outside. Previously, said Sigfúsdóttir, enforcement of the outside-hours laws was largely left to parents, which made a villain of the lonely parents trying to stick to the policy. Teens would predictably protest, “Nobody else’s parents care about the curfew!” The magnets made the curfews seem more “official” somehow, and compliance increased significantly. (Parents in some communities also took organized walks at night, nudging any teens found outside to go home.)

One of the most creative aspects of the campaign arose from the research of Harvey Milkman, an American clinical psychologist who specializes in addiction. “I had the realization that people were not getting addicted to drugs so much as changing the chemistry of their brains,” said Milkman. “So the corollary to that was natural highs.” In other words, we shouldn’t fight teenagers’ instinct to “get high.” Instead, we should give them safer ways to get high. The campaign leaders had already known that kids needed better ways to spend their time—that was a classic protective factor—but Milkman’s insight added some nuance. Teens don’t just need more activities of any kind, they need activities with natural highs: games, performances, workouts, exhibitions. Activities that compel them to take physical or emotional risks.

After the school day ends, Icelandic kids often go to “sports clubs”: facilities where students can play a variety of different sports, ranging from soccer to golf to gymnastics. Many communities invested in better coaching in the clubs, so that the soccer coach was no longer a volunteer parent but a paid, experienced veteran. This “professionalization” of the sports was critical: The Iceland team’s work on substance abuse draws a distinction between informal and formal sports participation, and it’s the latter that counts. If you play pickup basketball down the block with your friends, you’re likely to drink just as much (or more) than another teenager who doesn’t. But if you play in a basketball league, it’s different. You’ve made a commitment. You’re on a team. Your social network orbits a healthy activity. To support participation in sports clubs and other recreational activities, the City of Reykjavík—and later other cities—gave every family what amounted to a gift card, worth hundreds of dollars, to spend on membership fees or lessons.

All these efforts made a difference. An annual survey, “Youth in Iceland,” was conducted to measure the alcohol and drug habits of the country’s teenagers—and it also tracked the risk and protective factors the campaign had identified (e.g., time spent with parents). The survey served as a kind of scoreboard for the campaign. To review these results, and to plan each successive wave of action, there were meetings. Always meetings. Doctors prescribe, miners dig, teachers teach, and upstreamers meet. The steering committee alone met 101 times during the first five years of the campaign. But these meetings are not the same glazed-eye snooze fests that you suffer through at work. When they’re done right, upstream meetings can be energizing: creative and honest and improvisational, with the kind of camaraderie that emerges from the shared struggle to achieve something meaningful.

Even in the first few years, the movement saw progress: Participation in formal sports was up. Time spent with parents was up. Compliance with outside hours was up. And that feeling of success—that’s the emotional payoff that keeps people engaged in the work and attracts new collaborators to the mission. In 2018, twenty years after the campaign began, teenage culture had been transformed. To make the results tangible, imagine a high school class with 40 students. In 1998, 17 of those students would have been drunk in the last 30 days; in 2018, only 3 had been. Before, 9 students would have smoked every day; after, only 2. Before, 7 would have tried cannabis; after, only 1. The plummeting lines in the graph below tell the story:

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Perhaps the most astonishing part of the story in Iceland is that its success has been so complete as to be invisible. Most teenagers today aren’t really aware of it. They’ve simply grown up in a world where substance abuse is largely absent.

Iceland’s campaign became the envy of the world, and teams from cities in other countries—including Spain, Chile, Estonia, and Romania—have been quick to adopt the approach. “There’s this one element of this model that is the most important, and it’s empowerment,” said Sigfúsdóttir. “It’s giving communities, giving parents, giving kids a voice. For all of the players in the system, each one of them gets a role. I think that’s the driving force behind it.”

How will you unite the right people? Start with Sigfúsdóttir’s insight: Each one of them gets a role. Given that your progress may hinge on people’s voluntary effort, it’s smart to maintain a big tent.

But a philosophy of “the more, the merrier” is not sufficient. The core team should be selected more strategically. Preventive interventions often require a new kind of integration among splintered components. To succeed in upstream efforts, you need to surround the problem. Meaning you need to attract people who can address all the key dimensions of the issue. In Iceland, the campaign leaders engaged the teenagers and almost all the major influences on them: parents, teachers, coaches, and others. Each one had something critical to contribute. By contrast, downstream action is often much narrower. Think of the Expedia example that opened the book: To react to a customer’s call required the effort of just one call-center representative. But to prevent that customer from calling at all required integration among multiple teams of people.

Once you’ve surrounded the problem, then you need to organize all those people’s efforts. And you need an aim that’s compelling and important—a shared goal that keeps them contributing even in stressful situations where, as in the next story, people’s lives may depend on your work.

In 1997, Kelly Dunne, a recent college graduate, had just arrived in the quaint town of Newburyport, Massachusetts, about an hour’s drive north of Boston. Shortly after arriving, she responded to a flyer requesting volunteers to help victims in court who had filed restraining orders. After completing some training, she showed up one Monday at the local district court for her first official volunteer shift. She brought a book to read, figuring that not much would have happened over the weekend.

But there were three women already waiting to talk with her. One had spent the weekend locked in her basement. Another had a bruise on her arm, where her child had gripped her frantically while the woman’s husband was beating her.

“I was just horrified,” said Dunne. She thought, Holy shit, I can’t believe what’s going on in this sleepy little New England town over the weekend. She grew more and more devoted to the work—helping the victims of domestic abuse—and soon she was working full-time for the organization where she’d volunteered, now called the Jeanne Geiger Crisis Center.

Five years later, one of the women she was assisting—Dorothy Giunta-Cotter, a longtime victim of abuse who had tried to exit her marriage while keeping her daughters safe—was murdered by her estranged husband, as reported in the New Yorker. He had pushed past one of their daughters at the front door, broken down the door to Dorothy’s bedroom, and dragged her out. When the police arrived, he shot Dorothy and then himself. Their two daughters were orphaned.

The murder caused a crisis of faith for Dunne. “I either had to leave the work or really think about what are we doing: How have we set up these systems? And are they really set up in a way that helps people?” Dunne said about her reaction to Dorothy’s murder. “Her case showed us where all the gaps in the system were.”

The system was splintered into specialized functions: police officers to respond to 911 calls; health care providers to mend wounds; advocates to help victims; district attorneys to prosecute cases; and parole officers to monitor abusers after they served sentences. Women like Dorothy were essentially falling in the cracks between these roles. None of the groups that performed these functions had both the mission and the wherewithal to prevent homicide. Dunne saw that the only way to prevent murder was to unite these groups and to direct their focus toward the women at greatest risk.I

But how can you know, in advance, which women are at the greatest risk of becoming victims of homicide? The question led Dunne to the work of Jacquelyn Campbell, a nurse and a leading domestic violence researcher at Johns Hopkins University. Earlier in her career, Campbell had had her own awakening to the epidemic of domestic violence. While seeking a master’s in nursing, she worked with the local police department in Dayton, Ohio, to review all the cases in which a woman had been murdered by a husband, boyfriend, or ex. (If a woman is murdered, there’s a nearly 50% chance that the perpetrator fits one of those descriptions.)

Many of the files she reviewed contained crime-scene photographs, and one of those scenes is chiseled into her memory. It showed a woman handcuffed to a chair, dead from a gunshot wound. Her husband had shot her in the temple. It was a gruesome scene, but there was another detail that drew Campbell’s attention. The woman had a cast on her arm. The file showed that she’d broken her ulna—one of two parallel bones in the forearm—along with the radius.When people have accidents, they typically break both bones or just the radius. To break the ulna only is unusual and suggests a defensive injury. The woman had been holding up her arm to protect herself when she was hit with something hard enough to break her bone.

But it wasn’t the injury that surprised Campbell—every file she reviewed included physical brutality. It was the cast. Because the cast meant that the woman had sought help in the health care system, and no one had been willing or able to protect her against further harm. “That’s why I became convinced that I needed to work with abused women,” said Campbell.

Campbell began to study the patterns in cases where domestic abuse escalated to homicide. Some risk factors were foreseeable, such as the abuser having access to guns or being an alcoholic. Others were less obvious: If an abusive partner became unemployed, that put the victim at greater risk. Based on the patterns in the data, Campbell developed a “Danger Assessment” tool, which has been validated multiple times as an accurate predictor of intimate partner homicide. The current version of the tool asks female victims of abuse to mark on a calendar the approximate dates, over the previous year, when they were abused. Then they are asked to answer 20 yes/no questions about the abuser, including:

Years later, Kelly Dunne, who had become one of the top leaders at the Geiger Center, realized Campbell’s Danger Assessment tool represented an early-warning system that might have prevented Dorothy’s homicide. Had Dorothy filled out the questionnaire, she would have scored an 18 out of 20: Extreme danger. Campbell’s tool offered advocates something new: the time to intervene before the worst happened. Now Dunne had to figure out how to use that time.

In 2005, she organized the Domestic Violence High Risk Team, composed of all the people who had regular interaction with abuse cases: police officers, parole and probation officers, staff from a local hospital, advocates for victims, someone from the DA’s office, and even a group that offered an intervention for batterers. She was surrounding the problem. The high-risk team of 13 to 15 people met once a month to review the cases of women who had scored the highest on Campbell’s Danger Assessment.

It’s hard to overstate how uncommon—and unlikely—this collaboration was. In many communities there was outright hostility between victims’ advocates and police officers, for instance. What all these people had done up to that point, primarily, was pass the baton to each other in the course of their work: The hospital would refer a victim to the advocates; the advocates would tell the police about a violent abuser; the police would refer a case to the DA; and so on. But they’d never sat at the same table to work together—and certainly not with an eye toward prevention rather than reaction.

In their meetings, the high-risk team would review cases, one by one. Often the first step was to create an emergency plan for a woman: Where would she go if she needed to escape? Who would pay for a hotel or taxi? Who would be notified? Another frequent conversation concerned the need for “drive-bys”: Police officers would start driving by a victim’s house during their rounds, in order to send a signal to the abuser: We’re watching.

The drive-bys sent a signal to the victims, too. Bobby Wile, a now-retired detective in nearby Amesbury, mentioned an officer who was doing a drive-by of one woman’s house and noticed something that made him stop. “So he parked and knocks on the door and he asks the lady, ‘Is everything okay?’ And she said, ‘Yeah, why? What’s up?’ And he goes: ‘Well, that light is on in the attic and that light hasn’t been on. I just want to make sure everything is okay.’ She was ecstatic.” Ecstatic because a police officer was paying close enough attention to notice that a new light was on. She invited the officer in and gave him cookies.

As the team worked together, they began to identify flaws in the system that could be exploited by abusers. When offenders were required to wear GPS bracelets as a condition of release, for instance, there was often a gap of a few days between their release and their first parole appointment, at which point they’d receive the bracelet. “Well, for two days, where are they?” said Detective Wile. “Now it’s protocol: You get released. We bring you up to probation, and the bracelet is put on immediately. That way, [the offender] is not going to get those two days.”

“Twenty years ago, if you told me police officers would be sitting in the same room with domestic violence advocates, sharing coffee and a laugh and socializing together, I would have told you that you were delusional,” said Doug Gaudette, an advocate from another organization that’s part of the high-risk team. “But now that’s happening.”

Since 2005, the team has accepted over 172 high-risk cases. Ninety percent of those victims reported no subsequent re-assault. In the 10 years prior to the formation of the high-risk team, there were 8 domestic violence–related deaths in the area, according to Dunne. And in the 14 years since the high-risk team began to serve those communities, with a mission to protect the women at greatest risk of violence, not one woman has been killed in a domestic violence–related homicide. Not one.

The lesson of the high-risk team’s success seems to be: Surround the problem with the right people; give them early notice of that problem; and align their efforts toward preventing specific instances of that problem. To clarify that last point, this was not a group that was organized to discuss “policy issues around domestic violence.” This was a group assembled to stop particular women from being killed.

Note the similarity to the Chicago Public Schools story earlier in the book. Remember this quote from Paige Ponder, who led the district’s Freshman On-Track efforts: “The beautiful thing about teachers—you can have whatever philosophy you want, but if you’re engaged in a conversation about Michael, you care about Michael. It all boils down to something real that people actually care about.… ‘What are we going to do about Michael next week?’ ”

That same motivation led the work in Newburyport. The cops and DAs and advocates and health workers all had different institutional priorities. But what they shared was a desire not to see one of their neighbors murdered by her abusive husband. And that shared aim became the fuel for their coordination.

The other point of connection between the two stories is the primacy of data, which was a theme I observed repeatedly in my research, and one that surprised me. I knew data would be important for generating insights and measuring progress, but I didn’t anticipate that it would be the centerpiece of many upstream efforts. I mean this even in a literal sense—what the teachers and counselors in Chicago were doing, and what the high-risk team members in Newburyport were doing, was sitting around a table together and looking at data. Discussing how the fresh data in front of them would inform the next week’s work.

In Chicago, the data was: Has Michael been coming to school since we last met? How are his grades in all of his courses? How can we help him this week? In Newburyport, the data was: Where was Nicole’s abuser? What has he been doing? How can we help her this week?

This kind of system is what Joe McCannon calls “data for the purpose of learning.” McCannon is an expert in scaling up efforts in the social sector—a former nonprofit and government leader, he has advised movements in many countries. McCannon distinguishes “data for the purpose of learning” from “data for the purpose of inspection.” When data is used for inspection, it sounds like this: Smith, you didn’t meet your sales targets last quarter—what happened? Williams, your customer satisfaction numbers are going down—that’s unacceptable.

Using data for inspection is so common that leaders are sometimes oblivious to any other model. McCannon said that when he consults with social sector leaders, he’ll ask them, What are your priorities when it comes to data and measurement? “And I never hear back ‘It’s important to set up data systems that are useful for people on the front lines.’ Never,” he said. “But that’s the first principle! When you design the system, you should be thinking: How will this data be used by teachers to improve their classrooms? How will this data be used by doctors and nurses to improve patient care? How can the local community use the information? But that’s rarely how the systems are designed.”

McCannon believes that groups do their best work when they are given a clear, compelling aim and a useful, real-time stream of data to measure their progress, and then… left alone. The situation at Expedia, with its millions of unnecessary calls, provides a model. A cross-functional group is presented with a goal: Help millions of our customers avoid the nuisance of calling us. That’s a valuable and challenging target. And then the group is basically locked in a room together, armed with regularly updated data to see if the number of calls is going up or down. The team members come up with theories and then they test them. They watch what works. That’s the “data for learning” part. They don’t need a boss standing over them, hollering out specific targets: “We need to cut four percent call volume by tomorrow!”

The team members hold each other accountable, and the data keeps them honest and keeps them pushing. Making data useful for the front lines can be a daunting task. But sometimes grounding an effort in concrete data is the only way to unlock the solution to a major problem.

In 2014, Larry Morrissey, the then-mayor of Rockford, Illinois, was challenged by a colleague to take the Mayor’s Challenge, a campaign promoted by the federal government with the goal of ending veteran homelessness in communities around the nation. Morrissey was approaching the midpoint of his third term as mayor, and he’d been working on the issue of homelessness since he first took office, nine years prior.

Homelessness was partly a by-product of the hard times Rockford was enduring. In 2013, an article in the Wall Street Journal painted a bleak picture about the city, which is about 90 miles northwest of Chicago: “Once a prosperous manufacturing hub that created the airbrush and electric garage-door opener, Rockford is now the nation’s underwater capital. In about 32% of the metro area’s mortgages, the homes are worth less than the money owed.” Morrissey felt the pain; his mortgage was underwater, too.

Rockford’s population (about 150,000 in 2018) had been shrinking since the great recession as people fled for better opportunities. “The entire town had a form of codependency,” said Morrissey. “We were addicted to mediocrity. We were accustomed to failure. We resembled as a community a lot of the characters you would see in a family bound by addiction. A lot of finger pointing, a lot of blame.” To Morrissey, homelessness was a symbol of this defeatism: It was “ground zero for encompassing so much of what was wrong.”

Even though Morrissey knew homelessness was important, when he was challenged to take the pledge, he was skeptical. “For a decade, I’d been working on homelessness,” he said. “In my first term, we developed this ten-year plan to end homelessness, and we hadn’t done it. If anything, maybe things had gotten worse.… What’s gonna change?”

He reluctantly took the pledge and agreed to attend a training session in Chicago along with some social services colleagues in early 2015. The training was led by the federal Department of Housing and Urban Development (HUD). He was the only mayor in a room filled with housing people.

Morrissey and his colleagues weren’t expecting a transformational experience—it was a workshop run by a federal agency, after all. Yet the session became a turning point in Rockford’s work on homelessness, for the simple reason that Morrissey finally understood why they’d failed. “The lightbulb went off,” he said. “I realized what the missing ingredients were.”

Less than a year later—on December 15, 2015—Rockford became the first city in the United States to have effectively ended homelessness among local veterans. How could the city spin its wheels on homelessness for nine years and then achieve dramatic success in less than one?

The first change was mental. Jennifer Jaeger, Rockford’s community services director, and one of the key leaders in the work on homelessness, called it her “ ‘I believe in fairies’ moment.” “The very first step is to believe you can actually do it,” said Jaeger. “It’s hard. It’s a big mind shift. It’s no longer just taking care of the problem, which is what we were doing historically, but ending the problem.”

I met with Jaeger in the fall of 2018 in the city’s human services department building in Rockford. Her drab, windowless office was large and peculiarly shaped, like a jigsaw puzzle piece, and in the tab of that puzzle piece was a towering stack of small white boxes—hundreds of low-flow showerheads. They were to be part of some energy-efficiency kits being distributed to low-income people; there was apparently nowhere else to store them. If there were a recruitment poster for upstream work, it would feature Jaeger’s office, with its mountain of showerheads, along with the slogan: IF IT’S GLAMOUR YOU’RE AFTER, GET BACK DOWNSTREAM.

In the aftermath of the HUD training, the team in Rockford made three critical shifts en route to ending veteran homelessness: a shift in strategy, a shift in collaboration, and a shift in data. The strategic shift was to embrace what’s called “housing first.” In the past, the opportunity to receive housing was like a carrot dangled in front of homeless people to encourage them to fix themselves: to receive substance abuse treatment, or treatment for mental illness, or job training. The idea was that homeless people needed to earn their way into housing.

“Housing first” flips that sequence. It says that the first step in helping the homeless—not the last—is to get them into housing as soon as possible. “I stopped thinking of people as ‘homeless’ and started thinking of them as people without houses,” said Jaeger. “All a homeless person is, is somebody without a house. The same issues homeless people have, people who are housed have.… People who are housed can start working on those other issues.”

Along with the “housing first” strategy came a shift in collaboration, involving what’s known as “coordinated entry.” Cities have many different housing options for homeless people—supportive housing, transitional housing, shelters, and more—and there are many different agencies that interact with the homeless. Imagine a hotel with seven different front desks, each with its own set of policies for who can book a room and how long they can stay, and so on. It was a “willy-nilly” system, said Angie Walker, a colleague of Jaeger’s. “Everybody just took whomever they wanted, whenever they wanted,” she said.

Now, Walker said, “Our office here, we’re the single point of entry. If you’re homeless and you need a place to live, you need to come in here.” The advantage of coordinated entry is that you can be thoughtful about who receives housing. You can prioritize. In the willy-nilly system, the people who received housing were often the people who asked for it first—or worse, the people who were easiest to house. Since organizations were often rewarded for how many people they had housed, they had an incentive to cherry-pick the ones who could be housed with the fewest headaches.

The new mandate was: House the most vulnerable people, the people who most desperately need housing. And that’s where the final shift—the shift in data—fits in. Previously, Rockford’s housing team conducted an annual “point in time” census of the homeless population. It was required by HUD. And its method was to visit all the homeless shelters in the area during a particular day and count the number of people there. “Nobody even went out to the streets to actually count unsheltered people,” said Walker. When she took over the count, she fixed that. The census evolved from a “point in time” count, conducted once a year, to something that’s called a “by-name list.”

The by-name list is a real-time census of all the homeless people in Rockford, listed by name in a Google Doc. It includes notes on their history and their health and their last-seen location. And the use of the by-name list is uncannily similar to the high-risk team’s work in Newburyport. Once or twice per month, a group of collaborators in Rockford—representatives of the VA, the fire department, the health and mental health systems, and social service agencies—meet to discuss homelessness. And when they meet, they talk about the specific people on the by-name list.

Angie Walker described how she might kick off a typical meeting: “I would say, ‘John Smith, he is thirty-two. He stated he was fleeing domestic violence. He last said he’s with friends. Who here has seen John Smith?’ ” And the fire department might say, Oh, we took him to the hospital last week—he might still be there. Then someone from the mental health team might say, No, I was under the bridge two days ago and I saw John. A worker at the local homeless shelter, the Carpenter’s Place, might add, John has come for lunch quite a bit recently. And then the group would make a plan. Okay, Carpenter’s Place, it seems like you see him the most. Could you check with him and find out where he’s staying and what he needs? And let him know that when he’s ready, we have housing available for him.

These meetings had happened in the past, but the use of the by-name list transformed them. Mayor Morrissey said that, previously, the meetings had been “bitch sessions.” “We’d sit around and we’d talk about what’s broken,” he said. Jennifer Jaeger said the meetings “feel alive now. The data itself feels like it’s sort of a living creature. Because it talks. It talks to us.… It tells us, ‘You need to look at this, you need to think about this.’ ”

Beth Sandor, the head of Built for Zero, a national effort to help communities end homelessness, said that when communities begin to use data in this way, it’s transformational. “Data takes you away from philosophical insights. You move away from anecdotal fights about what people think is happening to what is happening,” she said. “You can’t solve a dynamic problem with static data.” (Rockford is one of more than 60 communities that have joined the Built for Zero movement.)

Using the process outlined above, Rockford housed 156 veterans in 2015 before they achieved what’s called “functional zero.”II In 2017, they achieved functional zero on the chronic (long-term) homeless population, and they hoped to reach that milestone with youth homelessness by the end of 2019. It’s remarkable, really, how much changed in Rockford—given how little had changed. What hadn’t changed: the people involved with homelessness, the resources they had at their disposal, and the city’s macro conditions. Simply by changing the way they collaborated, and the goals that guided their collaboration, their efforts became dramatically more effective.

“Every day is hard,” said Walker. “Getting people housed is hard. Dealing with landlords is hard. I fight with my clients. I fight with agencies. It’s an uphill battle, it really is—you know the picture they always show of the guy pushing the rock up the hill? I mean, it’s like that every day. But if the outcome is to end homelessness, it seems to be worth it.”

Walker and Jaeger have begun to work on the problem of “inflow”—reducing the number of new people who become homeless. It’s a thorny problem, for all the reasons you’d expect, but they’ve already identified one leverage point: evictions. In some neighborhoods in Rockford, the eviction rates are as high as 24%. In early 2019, the city conducted a pilot program in which it acted as an intermediary between tenants and landlords in situations where eviction was imminent. In some cases, the city negotiated a new payment plan for the landlord and tenant; sometimes, the city also contributed money on behalf of the tenant. A month or two of rent payments was far more cost-effective than re-housing people if they became homeless. Jaeger reported that the pilot had decreased the number of people who became homeless due to eviction by 30%.

They’re moving further upstream: Rather than acting quickly to serve people who are homeless, they’re trying to keep people in their homes to begin with. That’s an example of systems change, which is the topic we’ll explore next. Can we learn to reengineer the machinery that creates problems? And, in the process, can we improve the odds that the problems will not arise in the first place?

I. Rachel Louise Snyder in the New Yorker tells the story of Dorothy Giunta-Cotter—and the Jeanne Geiger Crisis Center—at greater length. Snyder’s moving and insightful article is how I learned about the center’s work.

II. Functional zero means that the number of homeless people on the street is lower than the city’s monthly housing placement rate. E.g., say that the city has proven that it can move five people per month from the street into housing. If there are only four homeless people in the community, then the city still maintains its “functional zero” status. This is not some kind of loophole—it’s just an acknowledgment that “real zero” is impossible, for the time being, because new people will unfortunately become homeless. The point is that even if new people become homeless, they can quickly be housed because the system is working.