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Strategic)Planning)to)Enhance)a)Person1 Centered)Approach)to)Ending) Homelessness) Tracy'Flaherty#Willmo6'' Senior'Associate' OrgCode'Consul@ng,'Inc.'
Today’s'Purpose' • Leverage'local)knowledge)and'exper@se' • Create'a'forum'for'meaningful)discussion) • Gather'a'broad)range)of)input)from'mul@ple' perspec@ves' • Focus'discussion'on'poten@al'ways'of' opera=onalizing'the'journey'forward'to'end' homelessness' • Iden@fy'opportuni@es'to'provide'input'into'an' implementa=on)strategy'tailored'to'the'local' needs'and'reali@es.'
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Why You Were Chosen •
You'have'posi@on#power' and'influence'
•
You'have'subject'ma6er' exper@se'
•
You'have'the'ability'to' see'interconnec@vity'in' complicated'systems'
•
You'are'solu@on# oriented'
The)miracle'of'your' mind'isn't'that'you'can' see'the'world'as'it'is.' It's'that'you'can'see' the'world'as'it'isn't.' ' ''''''''#'Kathryn'Schulz'
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What'We'Need'from'You' •
Solu@on#focused'par@cipa@on.'
•
Focus'on'solu@ons,'not'barriers.'
•
Stretch'your'thinking'and'perspec@ves.'
•
A'focus'on'facts'and'evidence.'
•
Accelerated'decision#making.'
•
The'ability'to'champion'the'proposed' enhancements'aWer'today.'
Sectors'of'Service'to'End' Homelessness' •
Sector'1:'Preven@on'&'Coordinated'Access'
•
Sector'2:'Connec@on'to'Permanent'Solu@ons'
•
Sector'3:'Re#Housing'Services'
•
Sector'4:'Ancillary'Services'
•
Opera@on'As'a'System'–'Leadership!!'
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Outreach & In-reach
Shelter: DV & Homeless
Coordinated Access
Drop-ins & Day Centers
Substance Treatment, Health & Mental Health Transportation
Diversion Conflict with the Law Congregat e PSH
Ending Homelessness
Employment & Education
Scattered Site ICM Furniture Scattered Site ACT Bridge/ Interim Housing?
Transitional
Rapid ReHousing
Housing Locator
Spiritual Support
Beyond the Data…The Current Landscape • 5 Topics for Small Group Discussions:! ! – Leadership & Governance! – The Front Door ! • Coordinated Access to Homelessness & Housing Services! • Prevention & Diversion!
– The Foyer – What happens to encourage a return to housing! • Shelters, Outreach, Drop-Ins, Meal Programs – Destination OR part of the Re-housing process!
– The Staircase – Connection to Re-Housing Options! • Matching Needs to Re-Housing Service & Case Management Supports! • Fidelity to Practice! • Transparency & Accountability!
– Along the Hallway – Access to Ancillary Services & Supports!
! IDENTIFY YOUR SMALL GROUP…
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Length of Time Homeless & Acuity How do we identify who needs what intervention?
The'Truth'about' Homelessness' Transi@onally'homeless'
Episodically'homeless' Chronically'homeless' 10'
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Values'&'Beliefs' • Our'own'values'and'beliefs'influence'our' prac@ce.'' • We'are'wired'to'have'an'emo=onal)response'to' informa@on'before'a'logical'response.' • Values'and'beliefs'can'impact'data'driven' decision'making.'
Cogni@ve'Dissonance' • Evidence'is'when'there'are'facts'that'make'an'approach'or' belief'true.'Opinion'may'or'may'not'be'aligned'to' evidence.'' • Cogni@ve'dissonance'occurs'when'opinions'override' evidence'and'sees'an'alternate'approach'as'being'true' when'there'is'not'evidence'to'support'it.'' • Common'cogni@ve'dissonance'examples'in'ending' homelessness:'' – A'belief'that'all'types'of'homelessness'can'be'ended'or' prevented;'' – A'belief'that'local'condi@ons'are'so'unique'that'proven' prac@ces'from'elsewhere'will'not'apply'locally;'' – A'belief'that'anything'other'than'housing'will'end' homelessness;' – Moral'beliefs'about'behavior'override'what'studies'show.'
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Myths'Impede'Our'Success' • Substance'users'need'to'achieve'sobriety'to'be'successful' in'housing.' • People'with'mental'health'issues'need'to'take'their'meds' and'be'connected'to'a'psychiatrist'to'be'successful'in' housing.' • People'need'to'be'“housing'ready”.' • People'need'to'have'an'income'prior'to'being'housed.' • Chronically'homeless'people'choose'to'be'homeless.' • People'need'to'hit'“rock'bo6om”'before'they'are'ready'to' make'important'life'changes.' • Shelters'need'a'lot'of'programming'to'prepare'people'for' success'in'housing.'
Why do housing & homelessness programs exist? • Divert people away from the homeless service delivery system! • Provide a rapid response to those that require an intervention through progressive engagement! • Put an end to chronic and episodic homelessness! • Ensure emergency/crisis responses function relative to their original intent (short-term, infrequent)! • Focus on the only known solution to homelessness – housing!! • Shorten the pathway from homeless to housed and stable!
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FOOD)FOR)THOUGHT…) Successful'Elements'In'Strategies'To' End'Homelessness' Learning'from'the'experiences'(and' mistakes)'of'others…'
These individuals are all homeless but they are not a homogeneous group
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They need to all be assessed using a common tool, which will determine their acuity and the best intervention for them
These folks have lower acuity. They should receive the lightest touch possible
Lower Acuity
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These folks have moderate acuity. They should usually receive time-limited financial and/or case management supports
Moderate Acuity
Lower Acuity
These folk(s) have higher acuity. They usually need a Housing First intervention and/or Permanent Supportive Housing
Higher Acuity
Moderate Acuity
Lower Acuity
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Pathway to Housing Presents for Shelter
Prioritization Determined
Client Notified of Priority Status
Monitor Results
Diversion Attempted
1. Housing First/PSH 2. Rapid Re-Housing 3. No Housing Assistance
Assigned Case Manager
Goal Setting Linked to Higher Acuity Areas
Minimal Service (encouragement) for 14 days
Shelter Admission if Diversion Unsuccessful
Prep for Housing
Acuity Determined
Housing Triage
Housing Search
Case Management Begins in Earnest
Lease Signing
Move in!
Pathway to Housing
WAIT!!! What about people that return to shelter?
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Pathway to Housing Returns to Shelter
Prioritization Determined
Client Notified of Priority Status
Monitor Results
Diversion Attempted
1. Housing First/PSH 2. Rapid Re-Housing 3. No Housing Assistance
Assigned Case Manager
Goal Setting Linked to Higher Acuity Areas
Minimal Service (encouragement) for 7 days
Shelter Admission if Diversion Unsuccessful
Prep for Housing
Acuity Determined
Housing Triage
Housing Search
Case Management Begins in Earnest
Lease Signing
Move in!
Pathway to Housing
WAIT!!!))) What'about'long%term* shelter*stayers*or'people' living'outdoors?'
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Pathway to Housing Start Here Prioritization Determined
Client Notified of Priority Status
Monitor Results
1. Housing First/PSH 2. Rapid Re-Housing 3. No Housing Assistance
Assigned Case Manager
Goal Setting Linked to Higher Acuity Areas
Prep for Housing
Acuity Determined
Housing Search
Case Management Begins in Earnest
Housing Triage
Lease Signing
Move in!
Food'for'Thought…'
Unified'Housing'&'Homelessness'System' • ShiW'from'funding'driven,'independent'programs'to'an' integrated'service'model'that'is'outcome#based'and' dedicated'to'maintaining'housing'stability' • Op@mize'service'pathways'to'effec@vely'and'efficiently' end'homelessness' • Formalized'collabora@on'and'alignment'among'the' sectors'that'impact'homelessness'and'community' based'agencies' • Resul@ng'in'reduced'system'costs,'improved'demand' management'and'higher'quality'service'provision'
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Enhancing'Leadership'to'Create'a' Unified'Housing'&'Homelessness' System' Moving'from'What'&'How…' To'WHY' '
Vision' Vision is a futurebased, current reality. In other words, the decisions you make today must support where you want to be. It is not about where you were or where you are now.
Commitment = steadfast fixity of purpose '
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Commitment'to'Vision' •
There'is'a'difference'between'commitment'and'interest.' •
Commitment'means'you'conquer'all'obstacles'to'achieve'what'you' want'to'achieve.'It'is'hard'work.'It'requires'steadfast*fixity*of* purpose.'
•
Interest'means'that'if'things'pan'out'and'chips'fall'in'the'right' order,'you’d'be'happy'in'that'future'reality.'However,'interests' change'and'fade.'
•
Are'we'commi6ed'to'ending'homelessness?'
Tension'in'the'Vision' The'best'vision'is'one'that'challenges' organiza@ons,'departments,'sectors'#'and'the' people'within'them'#'to'move'to'what'they'want.'' ' This'means'leaving'behind,'changing,'leveraging,'or' adding'on'to'what'they'already'have.'' ' Vision*is*change."
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Principles that Inform Our System •
The"fundamental"beliefs"of"our"system."
•
Serve"as"the"founda6on"for"the"behavior"of" our"service"delivery"and"chain"of"reasoning."
•
Inform"our"ethics"and"standards"of"service."
•
Allows"us"to"formulate"opinions"on"“rights”" and"“wrongs”"in"how"we"deliver"services" when"made"transparent."
EXAMPLE…"
Principles
1. Diverse individuals and families require diverse solutions for their homelessness based upon assessed needs. 2. We believe in evidence-based housing solutions that are provided through informed choice and assessed needs. 3. We are committed to using local data to drive an evidence-informed housing response system. 4. A respectful and supportive conflict resolution and grievance process will be applied to better serve the client. It is credible, transparent and universal. It applies to both agencies and service recipients. 5. Coordinated assessment linked to information on availability and referral across the whole community in a clear and transparent manner, leveraging the strengths of each service provider; while concurrently informing gaps in the system and opportunities for future strategic investment. 6. We believe in data driven assessment to direct our resources to those people with the greatest vulnerability or most acute needs.
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Food for Thought… ! Use of Evidence & Data to Guide and Monitor! • Across the world, communities with reductions in homelessness have insisted on using data to guide and inform decisions. ! • Many times, what we think and what we know are different things. ! • Corrective action comes from monitoring. Improved data is necessary to enhance functioning at program and system levels!
Data Points to Dig Deeper On! • How many individuals and families presented for shelter services but were diverted as a direct result of your system’s efforts?! • What is the average length of time it takes individuals/families to get out of shelter and not return to homelessness?! • Using a consistent assessment tool, what percentage of these individuals/families that did not get out of homeless may be classified as high acuity, moderate acuity, low acuity?! • What is the average number of times an individual/family re-enters a shelter within a six month period?! • Using a consistent assessment tool, what percentage of these individuals/families that return three or more times may be classified as high acuity, moderate acuity, low acuity? ! • How many individuals/families are living outdoors or any place not fit for human habitation?! • Using a consistent measurement, what percentage of these individuals/families may be classified as high acuity, moderate acuity, low acuity?!
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Food'for'Thought:' Sectors'of'Service'to'End' Homelessness' •
Sector'1:'Preven@on'&'Coordinated'Access'
•
Sector'2:'Connec@on'to'Permanent'Solu@ons'
•
Sector'3:'Re#Housing'Services'
•
Sector'4:'Ancillary'Services'
Coordinated Access
Outreach & In-reach
Shelter: DV & Homeless
Drop-ins & Day Centers
Substance Treatment, Health & Mental Health Transportation
Diversion Conflict with the Law Congregat e PSH
Ending Homelessness
Employment & Education
Scattered Site ICM Furniture Scattered Site ACT Bridge/ Interim Housing?
Transitional
Rapid ReHousing
Housing Locator
Spiritual Support
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Food for Thought: ! Prevention & Diversion! •
Prevention must be targeted. !
•
Diversion occurs at the “front door” of homeless services before people are admitted to “shelter”!
•
The goal of diversion is to find a housing solution – even if temporary - that stabilizes their housing without shelter access. Concurrently, long term housing stability is promoted.!
•
Majority of shelter guests exit within a very short period of time, suggesting that they may not have needed shelter at all!
•
Evidence from diversion programs in North America and the U.K. suggest that between 30-50% of people seeking emergency shelter can be diverted.!
•
Recent research in Phoenix (87% diverted with only 2% return rate) and Waterloo (67% diverted, less than 5% return rate) show amazing results.!
Food for Thought:! Homelessness Prevention & Diversion! • • • • •
Prevention efforts must be targeted! Diversion occurs at the “front door” of homeless services before people are admitted to shelter! The goal of diversion is to find a housing solution – even if temporary - that stabilizes their housing without shelter access. Concurrently, long term housing stability is promoted.! Majority of shelter guests exit within a very short period of time, suggesting that they may not have needed shelter at all! Evidence from diversion programs in North America and the U.K. suggest that between 30-50% of people seeking emergency shelter can be diverted.!
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Food for Thought: ! Coordinated Access & Common Assessment! •
Most efficient use of finite resources!
•
What service providers say they !
•
Improves consumer access to housing and supports!
•
Improves system navigation & function!
•
Leverages the strengths of individual service providers!
•
Proven to shorten pathway from homeless to housed with supports!
•
An important element in creating an effective system!
SAMPLE…Coordinated)Assessment)Priori=za=on)Guidelines))* Documentation)of)Priority)Status)
Pri orit y)
Dedicated)CH)PSH) Beds)
CommiUed)CH)PSH) Beds)Created)by) Turnover' (85%)program)goal))
Homeless)Category)
Length)of)Stay)in)Homelessness)
1)
Chronic'#'Individual'or'HHLD'with' Children'
>'12'Months'Continuous''OR**Total'of'at'least'4'Episodes'Total'>'12'months'in'3' years'
2)
Chronic'#'Individual'or'HHLD'with' Children'
>'12'Months'Continuous'OR**Total'of'at'least'4'Episodes'Total'>'12'months'in'3' years'
3)
Chronic'#'Individual'or'HHLD'with' Children'
4)
Chronic'#'Individual'or'HHLD'with' Children'
5)
Category'1'#'Individual'or'HHLD'with' Children'
6)
Category'1'#'Individual'or'HHLD'with' Children'
7)
Category'1'#'Individual'or'HHLD'with' Children'
8)
Category'1'#'Individual'or'HHLD'with' Children'
9)
Category'1'or'4'HHLD'with'Children'
Where)Experience)Homelessness)
Severity)of)Service) Needs)
Documented)Disability)
UN,'ES,'SH'
High'='VI#SPDAT'Score'of'10'or' greater'
Yes'
UN,'ES,'SH'
Low=VI#SPDAT'Score'less'than'10'
Yes'
Total'of'at'least'4'Episodes'Total'<'12'months'in'3'years'
UN,'ES,'SH'
High'='VI#SPDAT'Score'of'10'or' greater'
Yes'
Total'of'at'least'4'Episodes'Total'<'12'months'in'3'years'
UN,'ES,'SH'
Low=VI#SPDAT'Score'less'than'10'
Yes'
UN,'ES,'SH'OR**Institution'if'UN'ES'SH'Prior'to'entry'
High'='VI#SPDAT'Score'of'10'or' greater'
Yes'
UN,'ES,'SH'OR**Institution'if'UN'ES'SH'Prior'to'entry'
Low=VI#SPDAT'Score'less'than'10'
Yes'
UN,'ES,'SH'OR**Institution'if'UN'ES'SH'Prior'to'entry'
Low=VI#SPDAT'Score'less'than'10'
Yes'
TH'IF'previous'UN,'ES,'or'SH''''''(dependent"on"funding"source"CoC"or" ESG")'
Low=VI#SPDAT'Score'less'than'10'
UN,'ES,'SH'
Low=VI#SPDAT'Score'less'than'10'
Not'required.'Collect'documenation'if' available'
UN'ES'SH'
Low=VI#SPDAT'Score'less'than'10'
Not'required.'Collect'documenation'if' available'
UN'ES'SH'
Very'Low=VI#SPDAT'Score'less' than'5'
Not'required.'Collect'documenation'if' available'
UN'ES'SH'
Very'Low=VI#SPDAT'Score'less' than'5'
Not'required.'Collect'documenation'if' available'
No'Subsequent'residence'identified'and'no'social'networks'to'obtain' permanent'housing'OR'ES'
Very'Low=VI#SPDAT'Score'less' than'5'
Not'required.'Collect'documenation'if' available'
Very'Low=VI#SPDAT'Score'less' than'5'
Not'required.'Collect'documenation'if' available'
Any'Length'of'Stay'OR'='<'90'Days'Institution'
>'or''='6'Months'Continuous'OR**at'least'3'episodes'in'3'years'>''='6'Months'OR**=' <'90'Days'in'Institution'
Any'time'>'30'days'OR**='<'90'Days'Institution'
Any"Length"of"Stay">"14"days"
Any"Length"of"Stay"
Yes'
TH' 10) 11)
Category'1'or'4'Individual'
Category'1'or'4'HHLD'with'Children'
Length"of"Stay">"14"days"
Any"Length"of"Stay"
RRH) 12)
Preven=on)and) Diversion)
Category'1'or'4'Individual'
N Homeless'Category'2'Individual'or'HHLD' P1) with'Children''OR'Category'1'Homeless' N P2)
At#Risk'of'Homelessness'Category'1,'2' or'3'Individual'or'HHLD'with'Children'
Length"of"Stay">"14"days"
Primary'nigh6ime'residence'lost'within'14'days'OR'Category'1'Homeless'with' Length'of'Stay'<'14'days'
Primary'nigh6ime'residence'will'be'lost'wihtin'21'days'
Meet'any'At'Risk'of'Homelessness'Criteria'
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Ending homelessness in the most straight-forward ! manner possible....! !
What service providers say they do on paper is what they do in practice. No exceptions.!
!
!
Access to shelter and re-housing opportunities is coordinated. No secondary assessments.!
!
As many rules/barriers/compliance requirements that can be eliminated are eliminated.!
!
!
Assessments and interventions should be grounded in evidence and best practice. Not hunches or anecdotes.!
!
! Coordination and assessment inform choices that people can make, not make choices for people. !
! Operates with transparent decision-making process. Not dependent on case manager or leader knowing how to skirt around the system.! !
! Professionalize your services - If you want me to do things differently, train me!!!
Food for Thought:! Housing Solutions & Supports! •
Housing is the only known solution to homelessness.!
•
People do better in housing and stay housed longer when they have choice, not placement.!
•
There is more than one housing solution…one size does not fit all.!
•
Use acuity data to drive program matching as well as intensity, frequency and duration of support.!
•
THP, RRH & PSH must maintain fidelity to practice. Is this maintained in VA Beach? Can we measure fidelity?!
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Ending Homelessness with Housing Solutions
What it Takes
Can You Say Yes? 1. Consumers have an active voice in deciding where they live 2. Consumers do NOT have to have an income before they are housed 3. Staff to consumer ratios do NOT exceed evidence informed threshold (1:20 for ICM/PSH and 1:25 for RRH) 4. Consumers have an active voice in the type, duration, frequency, and intensity of services 5. Consumers do NOT have to be sober or attend treatment to be housed 6. Consumers do NOT need to take medication 7. Consumers sign a standard tenancy agreement 8. Consumers do NOT lose support if they lose their housing 9. There are NO limits on the number of times a person can be re-housed 10. The persons with the MOST acute needs are served first 44'
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Can You Say Yes?
You prepare crisis plans with each consumer? You conduct risk assessments AFTER housing and then use people, processes or technology to minimize risks? You reduce harm in the areas of substance use, involvement in sex work, and disconnected mental health? 45'
To make it work as a system and within organizations:
Changing staffing or re-staffing - greater expectations and education and higher compensation!
Flexibility of work hours!
Restructuring intake and link to housing programs!
Using acuity data to drive services and supports!
Flexible dollars to solve unforeseen events!
Ongoing professional development/coaching with smaller teams for 2-5 years!
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The Team
•
Highly trained professionals that do not believe in steady 9-5 work days.
•
Maximum of five case managers to each Team Leader - hopefully with access to a housing broker.
•
Unwavering mutual accountability and transparency.
•
Entirely solution-focused and persistently engaging staff.
Opportunities for Enhancements?! • 5 Topics for Small Group Discussions:! ! – Enhanced Leadership & Governance! • Vision & Principles! • Data for Decision Making & System Performance!
– The Front Door ! • Coordinated Access to Homelessness & Housing Services! • Prevention & Diversion!
– The Foyer – What happens to encourage a return to housing! • Shelters, Outreach, Drop-Ins, Meal Programs – Destination OR part of the Re-housing process!
– The Staircase – Connection to Re-Housing Options! • Matching Needs to Re-Housing Service & Case Management Supports! • Fidelity to Practice! • Transparency & Accountability!
– Along the Hallway – Access to Ancillary Services & Supports!
!
IDENTIFY YOUR SMALL GROUP…
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Your'Task' Considering'your'own'experience,'exper@se'and'the'informa@on' presented'today,'let’s'discuss'the'following'for'your'topic…'
– What'is'currently'working'well?' – What'enhancements'are'required?' – Iden=fy)the)top)3)strategic)priori=es)to)enhance)the)person1centered) approach)of)ending)homelessness)in)Virginia)Beach)within)your) Topic.' ' '
Respond'to'the'following'statements…'
– Enhancements'are'most'likely'to'be'successful'if'we'do'the'following…' – In)order)for)these)enhancements)to)be)successful,)we)must)stop) doing…) – These'enhancements'are'most'likely'to'fail'if'the'following'happens…'
Next'Steps' • What'can'be'accomplished'in'the'next'6' months?' – Leadership'Group'to'revisit'the'findings/insights' from'today' – Next'steps'to'be'iden@fied'
• A'commitment'to'ac@on'the'approved' enhancements.'
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Celebrate'the'Awesomeness'of'Service'Providers' If'you'enhance'person#centred'approaches:' • Shorten'pathway'from'homeless'to' successfully'housed' • Make'the'most'of'finite'resources'
Some@mes'we'' forget'that'we'were' made'to'be'' AWESOME'
• Help'services'be'great'doing'the'thing' they'say'they'do' • Don’t'expect'each'service'provider'to' be'all'things'to'all'people' • Let'the'system'coordinate'&'navigate' service'access,'not'individual'providers'
Imperfect action beats perfect planning.!
Perfectly'imperfect'people'can'be' successfully'housed.'
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@orgcode
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416-698-9700
[email protected]
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