In today’s guest blog Iain De Jong discusses ways communities might begin to plan coordinated assessment processes. De Jong is President & CEO of OrgCode Consulting, an international consulting firm focused on ending homelessness, driving change to promote community prosperity and challenging the status quo.
As regulations change for Continuums of Care (CoC) and Emergency Solution Grant (ESG) recipients through the HEARTH Act, communities need to focus their attention on acting like a system – not a collection of independently operating projects. In a lot of instances, this means that the way which most CoCs and service providers operate must change.
The ESG Regulations, released in December of 2011, include a requirement for communities to develop and implement a centralized assessment system. All ESG recipients are required to participate in the community’s coordinated assessment system to initially assess the needs of each household seeking prevention or homelessness assistance.
The CoC Regulations, released in July of this year, also indicate that a centralized or coordinated process must be implemented to handle program intake, assessment, and referrals. The coordinated assessment process has to cover the CoC’s geographic area; it has to be easily accessible by households seeking housing or services; it has to be well advertised; it has to use a comprehensive and standardized assessment tool; it must respond to local needs and conditions; and, it needs to cover all ESG and CoC programs.
Simply put, coordinated assessment allows for the most efficient use of resources while improving consumer access to housing and supports. Coordinated assessment leverages the strengths of individual service providers. It makes the system much easier to navigate for households experiencing homelessness. And it reinforces the core concept that homelessness programs fundamentally exist to end homelessness.
Depending on your community’s terrain of local providers, geography, and available resources, different models should be considered. For example, if you are a small to mid-sized community that has good public transit, maybe a central location would be a good fit. If your CoC covers a large area or a large city you may consider a computer-based system, or using an existing 2-1-1, or establishing regional hubs throughout the area. Some communities are also using mobile assessment teams, which are in essence a group of specialized intake workers that go to where homeless individuals and families are rather than expecting the individual or family to go to them.
Coordinated assessment is NOT business as usual for most communities. The level of coordination in the referral process and the formal steps to ensure its success removes ad hoc approaches to getting consumers to the right program. Standardized forms and assessment tools used in a community can unsettle some service providers, but at the same time ensure greater consistency in service for people experiencing homelessness. The decision to focus services on the housing needs of specific individuals (rather than the more common program-centric approach) is a sea change in some communities.
For coordinated assessment to work, service providers across the CoC need to be fully aware of the extent of the changes, the regulatory requirements, and what it will mean for them and the people they serve. If there are funding implications related to involvement, these also need to be made transparent.
There are various steps involved in the creation of a coordinated assessment process.
One of the first, fundamental steps is to shift the service mentality amongst service providers in the community. This new arrangement of services can be seen as threatening by service providers – as if their autonomy is being taken away. While a natural reaction, the conversation must be about leveraging the strength(s) of each provider in the CoC. “Embracing the Freak Out” is helpful, and service providers should be encouraged to constructively put their concerns out on the table so each one can be addressed. Some providers will be more vocal than others; others may be passive aggressive. Others still will be encouraged by what the opportunity of common assessment and coordinated access represents, but will remain concerned about how they will keep beds filled or ensure there are a set number of people in programs to make operations viable.
As a part of this first step, education about the possible models, guiding principles, and assessment tools becomes important. Service providers need to understand that no longer will there be “side doors.” Coordinated assessment means people experiencing homelessness are assigned to programs through a collaborative approach, and are not made through individual provider’s decisions. Relinquishing the manner with which people experiencing homelessness access services that end their homelessness is deliberate and demanding.
The next step is to create a complete inventory of services and eligibility criteria. While most communities have this or something in the early stages of it, what is often the case is that what service providers write down on paper and whom they actually serve can be slightly different. Or in other instances, a service provider may consider an exception to their service population in certain circumstances – but the criteria for the exception is not made public. All that services are able to provide and whom they are able to serve must be made completely transparent.
Then, analysis and in-depth consultation can begin on which model would be a good fit for your community. Once a model shows promise it is usually tested in a smaller scale, or by using a beta version of the assessment tool chosen. Given the recent emphasis on ending chronic homelessness as a national priority, the assessment tool chosen is one that should allow for continuity and provide direction to case management services after the initial assessment. The assessment tool must be grounded in evidence and proven to work rather than being an assortment of ideas put together by a group of well-intentioned social workers on the back of a napkin.
Next, the coordinated assessment process the business process is documented, the assessment tool manual is finalized, and the training for providers is conducted. The training is a documented process outlining the rationale and approach from a client, service provider, and system perspective. Film this training, as it can be helpful for ensuring consistency when there is staff turnover.
The journey towards common assessment and coordinated access is not an easy one. But if we truly want to see every community function as a homeless and housing service system rather than a collection of projects, it is absolutely critical.
One of the challenges to measuring the performance of homelessness assistance programs is comparing performance between programs that serve different populations. Risk adjusted performance measures can help. Risk adjustment means that different performance standards are set for programs depending on the population they serve. For example, a program that serves people with no income would have fewer people exiting to permanent housing than a one that serves people who are currently employed.
One of the easiest ways to do risk adjustment is to base it on the barrier screening tools your community is using. Barrier screening tools are used to identify how many barriers a household has to moving into, and stabilizing in, permanent housing. Many communities are already using barrier screening tools them as part of a centralized intake or coordinated assessment process, and the new CoC regulations brought about by the HEARTH Act require that communities use some sort of a coordinated assessment process. (For those who are interested, here is an example of a barrier screening tool.)
If your barrier assessment tool has three categories, you can then use those categories to do the risk adjustment. For example, you could compare performance serving people in each category to other programs or benchmarks for that category. You might get an extra point for being above average, 2 extra points for being more than 10 percent above average, etc. You can also combine the categories using a weighted average.
Without something like a uniform barrier assessment process, things get a little trickier. An alternative would be to look at characteristics in your HMIS data, such as income or chronic homelessness. This will likely require an analysis of your data to determine what characteristics need to be adjusted for.
If you haven’t read it, we have a good publication on performance measurement called What Gets Measured Gets Done: A Toolkit on Performance Measurement for Ending Homelessness, and there’s a section on risk adjustment that starts on page 41.
Image courtesy of S@Z.
When it comes to coordinated assessment, one of the trickiest questions advocates must consider is how best to serve survivors of domestic violence. The safety and, in some cases, the lives of survivors of domestic violence depend not just on ready access to crisis-oriented services and a safe place to sleep at night, but also on the confidentiality of sensitive information.
We at the Alliance are developing a checklist that will help you ensure that your coordinated assessment system is equipped to meet the needs of survivors of domestic violence, but in the meantime, I would like to share with you what our friend Joyce Probst MacAlpine says staff at provider agencies in her community of Dayton/Montgomery County, OH, are currently doing to integrate their domestic violence (DV) and homeless assistance systems.
In Dayton, their domestic violence shelter is one of the community’s “gateway” shelters to their coordinated assessment system, meaning it is one of the shelters where people experiencing homelessness must go before gaining access to homeless assistance services. Here staff use the same assessment tool and decision tree process for referrals as at all the other gateway shelters, but they do their assessments on paper, not in the Homeless Information Management System (HMIS), a precaution designed to protect the private information of DV clients.
Staff at the domestic violence shelter also conduct a lethality assessment to determine how much danger a DV client might be facing in order to serve them accordingly. Once the assessment process is complete, the client is assigned a number. That number, along with the intervention they scored for, and any other basic, non-identifying information needed for the referral is sent to a centralized waiting list. No identifying information about the household is shared and no information is entered into HMIS.
When an opening becomes available and the client’s number comes up, the DV shelter and the agency to which the DV shelter is referring the client each receive an email. At that point, the client must then give permission to release their assessment information to the agency they’re being referred to. If the client agrees, their paper assessment is released to that agency and the connection between the household and the provider is made.
The staff at this second agency will then engage the client in an intake process for their specific program. If the program is not a DV program and the client signs a data release, the information from that intake process can then be entered into HMIS without compromising or sharing data from the client’s initial entry into the system via the domestic violence system. The information entered into HMIS will show that the client came to the program from shelter, but will not reveal which one.
HUD doesn’t currently require that communities have one comprehensive coordinated assessment system that incorporates DV and other homeless assistance providers, though HUD is seeking comment on the interim Continuum of Care regulations on this issue. Using one assessment process instead of two certainly does seem to have its advantages in terms of coordination, and the Dayton example shows that it is possible for communities to accomplish such coordination without compromising the safety or privacy of survivors.
We’re sure there are plenty of other models out there, and we’d love to hear how other communities are working to connect and coordinate their domestic violence and homeless assistance systems. For more information on how to work with domestic violence survivors, make sure you check out our Domestic Violence page. To see the latest materials we have on coordinated assessment (including the checklist, once it’s available), read through our Coordinated Assessment Toolkit.
Over the past few months, we at the Center for Capacity Building have been releasing short modules devoted to various aspects of rapid re-housing. Here is the third in our five-part series, which covers how to structure and pay for rental subsidies. (If you’d like to learn more about the first two modules in the series, please see Kay’s blog post).
Clearly subsidies are a big part of any successful rapid re-housing program, but many providers remain skeptical. For instance, some providers are doubtful that any subsidy short of a Housing Choice Voucher will be enough to end someone’s homelessness. However, our data show that this is not the case. Temporary, short-term, or medium-term subsidies are often enough to lift households out of homelessness.
Another frustrating part for providers is the matter of figuring out how much each household should be receiving. The trick here is to be flexible. No two households are the same, and programs need to devote time to assessing each household’s needs, or at the very least be prepared to adjust the amount of financial assistance they offer, especially if a crisis arises.
A successful program is one that stabilizes the household with the minimum amount of money possible, while also standing ready to increase the amount of assistance provided if such an increase should become necessary.
I’ll save the rest of our subsidy wisdom for our module. I hope you enjoy this latest installment. Keep your eyes peeled for the remaining two on supportive, voluntary services and outcomes!
At our recent annual conference, we held a workshop on the topic of allocating resources. One of the presentations in that session included some data and suggestions that are worth sharing again, particularly as we turn to the new HEARTH CoC regulations and the next NOFA.
You can see the slides here from the presentation by Katharine Gale, one of our close partners who has assembled a lot of the data that’s been collected about cost-effectiveness and outcomes.
Pay special attention to slides 4, 5, 7, and 14, which present the aggregated data from numerous communities.
I’ve had a chance to look at a lot of data from different communities very closely. One thing that stands out is that there tends to be a lot of variation between the average cost and outcomes of different programs within communities, far more than the variation between different communities.
In other words, the difference in average cost and outcomes, for instance, between an urban area with a high cost of living, and a rural area with a lower cost of living, isn’t that dramatic. However, the difference in cost and outcomes between two programs in a particular community can be very large.
This presentation does a nice job of summarizing that data and also identifying some of the key questions that community leaders and homeless assistance providers should be asking themselves as they implement the new CoC regulations and make their homeless assistance more efficient and effective.
Last week, I had the pleasure of presenting at and moderating the Coordinated Assessment workshop at our 2012 National Conference on Ending Homelessness. We had a big audience and some fabulous presenters. Though I’d like to think everyone came to our session because of their passion for the topic (and certainly some people did!), I have a feeling the release of the new HUD Continuum of Care regulations that mandated that communities adopt the approach probably played a bigger part in the attendance.
Communities want to make sure they’re doing things right, and because of that, we’ve had a lot of questions about how communities should get started, what they should think through carefully, and who to involve in their coordinated assessment plans. We’ve been fortunate that some communities who have developed resources for use in their own coordinated assessment processes have generously agreed to share those resources with other communities who are just now getting started.
This has allowed us update our Coordinated Assessment Toolkit with even more tools from a number of communities, including Philadelphia, PA; Memphis/Shelby County, TN; Dayton/Montgomery County, OH; and Minneapolis/Hennepin County, MN.
These new tools will help communities develop:
- An assessment tool to use upon a household’s arrival to a coordinated assessment center
- A data release authorization form that ensures the protection of client confidentiality
- Ideas about how to staff a coordinated assessment process
- A better understanding of how the coordinated assessment process should flow
These are the newest tools in our collection, and you can expect more over the coming weeks. Beginning in late August, we’ll host a series of webinars on coordinated assessment, each covering a crucial aspect of the topic.
Finally, my usual refrain: we are always looking for more community submissions. So if you have something that has helped your community with the process of developing coordinated assessment, please send it to us!
Recently, while looking for examples of good emergency housing practices, we learned about how Philadelphia manages its shelter system. Their emergency housing standards are publicly available on their website. This document is a great resource for shelter providers or community planners who don’t have standards and are looking for examples, or who want to compare what they are doing to what providers and planners are doing in other communities. Here are just a few interesting pieces:
Staff to Consumer Ratios: Philadelphia sets a ratio of one direct service person per 20 individual consumers during day hours, and a ratio of one staff person per 40 individual consumers overnight.
Staff Training: Emergency housing personnel in Philadelphia are expected to receive a minimum of 10 to 20 hours of training, budget permitting. Some of the mandatory topics include domestic violence, transgender and sexual minorities, and CPR.
Intake and Assessment Guidelines for Sexual Minorities: In this appendix, staff and service providers are instructed to accept and support a client’s self-identification of his/her gender irrespective of physical appearance, surgical status, or documentation of identity.
Does your community or organization have written shelter policies or standards? Let us know!
A few weeks ago, my colleague, Kim Walker announced our new series of our Rapid Re-housing Training Modules, short, narrated presentations about different aspects of rapid re-housing. She also announced the release of the first of the modules on Housing Barriers Assessment. As Kim mentioned, the Alliance wants to provide information about best practices in a variety of ways. Since we all have different learning styles, some of us need short “snippets” of information on a particular part of a topic rather than the whole shebang at one time. And, for most of us, just doing our work keeps us so incredibly busy that is hard to find time to stay on top of what’s out there.
This week we are releasing the second short, narrated module of our rapid re-housing series, Housing Search, Location and Landlords Module, which I have the privilege of narrating. I love talking about this stuff because there are so many ideas and ways to make this work. Without landlords, we won’t have housing for our folks. I have included a lot of different tools and ideas to recruit landlords that we have learned from communities who have had a lot of success in building landlord partnerships. In addition, this module includes two activities for you to begin developing your own plan to partner with landlords and incentives to increase landlord participation. These activities are ones we use when doing our in-person rapid rehousing trainings and are good for those of you who learn by doing. If you have plenty of time on your hands and want to learn even more, a longer training module, Strategies for Working with Landlords and Finding Housing for Clients, also is available on our website.
Keep an eye out for the third topic on designing a subsidy, which will be released in the coming weeks. Again, these modules are great for people who are new to rapid re-housing and who want to begin to understand the basic concepts, as well as for those who would like to brush up on specific topics. As usual, let us know how you feel about these new modules, and if you’d like to see more on other topics!
A few months ago, we brought you a series of posts about Alameda County’s efforts to implement the HEARTH Act through performance measurement (here, here, and here). How have things gone since then? Well, they’ve just published another performance report, and the improvements are impressive. Here’s are a couple of highlights from the report:
- The system demonstrated a 30% increase in the rate of persons exiting programs with permanent housing from 33% in 2010 to 43% in 2011
- Both transitional housing and emergency shelter providers reduced the length of time between program entry and acquiring permanent housing by 8% and 6% respectively
- Finally, providers increased the numbers of persons exiting with some income who entered the system with none. Helping people to secure earned income remained a challenge for our system.
Here’s a chart that summarizes some of the permanent housing outcomes by program type, and there’s a lot more in the report. Nice work.
I’m back to talk again about one of my favorite topics, coordinated assessment. But today I wanted to share something beyond information about how to do it, who’s currently doing it well, and how to structure it, though if you want that information our Coordinated Assessment Toolkit is always available (and expanding!)!
My secret to share today is this: A great front door is nothing without a great back door.
Imagine that a new and great restaurant opens in town. Tons of people flood to get reservations, and the restaurant does a great job of managing them – no one who calls needs to be put on hold and everyone gets the reservation they want. However, once you arrive for your slot, the kitchen isn’t properly stocked and only has one or two things on the menu. After waiting hours for the kitchen to get restocked, you give up and go home hungry.
For coordinated assessment to really work in its intended manner, the focus has to be not just on getting people to the programs that fit their unique needs and housing barriers best, but matching people with programs that will help them quickly re-enter permanent housing. Having a great system that can accept lots of people but offers no connections to permanent housing is a lot like sending people home hungry in the example above: they weren’t served properly and they didn’t get what they came for. The reasons people become homeless are varied, but the reasons they remain homeless are all the same – they lack permanent housing.
To prevent this from happening within homeless assistance systems, some individual programs are going to have to make some changes for the greater good of the people they serve beyond committing to allowing the assessment centers to make referral and admissions decisions. Programs will have to take a hard look at how they run, asking themselves questions like these:
- Are we focused on the housing needs of our clients above all else?
- Do we know how to provide support services in a way that addresses our clients’ barriers to obtaining and maintaining housing?
- Do we have connections to the resources needed to help clients get into housing (subsidies, landlords, etc.)?
- Do we know how to connect households with more intensive needs to permanent supportive housing?
Providers must focus on addressing the barriers preventing a household from re-entering permanent housing and helping clients build the strengths that will allow them to maintain it. Above all, all of us – providers and everyone else involved with homeless assistance – must remember that our primary role is to help the households we serve get back into permanent housing as quickly as possible.
Programs – and systems – that focus on helping clients move into permanent housing and supporting them in that housing they’ll get the outcomes that are best for everyone. For some systems, that’s s a new focus, and a lot to handle, and it’ll take some time to get all the “kitchens” in a homeless assistance system in order. But the information we have shows us that a strong and effective front door paired with best practices like targeted prevention, rapid re-housing, and permanent supportive housing will help us end homelessness, which will be a great feat. And luckily, we also know that providers and homeless assistance systems everywhere are capable of great things.
Image courtesy of Fey Ilyas.