Coordinated Assessment and Entry

Revised: January 2019

 

By Sarah Owens and Michael Livingston

The is the second of two posts about the tools needed to support a systematic approach to improving homeless services delivery.

The first post (here), introduced ServicePoint, a Homeless Management Information System (HMIS) application in use in Oregon, and showed how it can be used to monitor Bed Usage Rates (BURs).

This post covers coordinated assessjment and entry system (CES) basics. 

Coordinated assessment and entry (or, "coordinated entry", for short) is the "no wrong door" idea that recognizes it's just too not realistic to expect most clients to navigate all the available services on their own, trying to find the one that is appropriate to their situation.  No one disputes that services are too spread out, there are too many restrictions, forms, rules, and regulations, and the programs are too siloed.  

A lot's been written about "no wrong door" in the context of the Affordable Care Act, where privacy requirements continue to be a challenge to full implementation.  If you want to read about coordinated entry in the homeless assistance context, the best place to start might be with HUD's Coordinated Entry Policy Brief, which identifies the qualities of an effective coordinated entry system:

1. Prioritization
2. Low barrier
3. Housing First orientation
4. Person-centered
5. Fair and equal access
6. Emergency services
7. Standardized access and assessment
8. Inclusive
9. Referral to projects
10. Referral protocols
11. Outreach
12. Ongoing planning and stakeholder consultation
13. Informing local planning
14. Leverage local attributes and capacity
15. Safety planning
16. Using HMIS and other systems for coordinated entry
17. Full coverage

As noted elsewhere, ROCC does not have an effective coordinated entry system, and this has hurt its  ability to deliver homeless assistance, and to compete for HUD funding.  
       

ROCC's 2016 Consolidated Application

At left is ROCC's description to HUD of the coordinated entry elements ROCC does have or is working on.   Without question, the challenge of building a system inclusive of 28 counties (not all of them rural) continues in 2019 to be beyond ROCC's capabilities, despite all the hard work by Jimmy Jones, now Executive Director of the Mid Willamette Community Action Agency (MWVCAA), and his assessment teams, over the past two years.    

In 2016, Jimmy was just getting started.  He described his efforts as follows (edited somewhat for brevity and links added):

Basically we are moving toward a Coordinated Entry program that embraces (as close to best practices as resources allow) the principles embodied in the Coordinated Entry Policy Brief.  The first principle on that list is...prioritization of access, based on vulnerability.  We are determining vulnerability by means of the [Vulnerability Index - Service Prioritization Decision Assistance Tool] VI-SPDAT. For clients that are chronic[ally homeless] and score into PSH, we also have been using the VAT, as a tool for better case management and potentially, one day, opening or partnering with a PSH-Housing First facility, which would serve the highest scoring clients in our area.

The SPDAT is a fairly simple tool. Easy to teach, train and use.  It gives a score that has demonstrated very high correlation, when it’s been tested against other decision assistance tools.  It is widely used across the United States. I have attached a map of current usage. This map is a little older and doesn’t include many places that use the SPDAT...My previous employer has been using the VI-SPDAT for two years, in a county that has a very well developed coordinated entry and assessment program.  I have personally given more than 200 VI-SPDATS in the last year and I believe in it.  It’s not only descriptive of someone’s current situation, but it is also highly predictive of the kinds of case management and the nature of placement (PSH/TH-RRH/Diversion) that they’ll need.  Essentially it operates on a triage approach.  The original SPDAT was developed for use in hospitals, and the VI-SPDAT follows the same model—trying to direct resources to the people who need it the most. 

So while the SPDAT is a breadth tool, the VAT is a depth tool.  It was developed by DESC up in Seattle, who use it even for shelter (in a slightly different method).  This tool is basically designed to get a good measure of the most vulnerable clients.  It’s sometimes hard to differentiate between different PSH clients, trying to figure out (in essence) who has the highest risk of dying outside, without intervention.  The VAT requires specialized training. And each written assessment is then reviewed by another qualified and trained VAT reviewer.  I have completed 50 VATS in the last year, which is a pretty large number.  In one comparison of similar assessment instruments, the VAT had the highest validity ratio of any tool in the country.* * *

When Jimmy arrived at MWVCAA, The ARCHES Project stopped accepting electronic applications, and changed its intake policy of "first come, first served."  Instead, they use the VI-SPDAT at intake, which takes about 15 minutes for experienced staff.  If the client scores very high on the VI-SPDAT, they also use the VAT, which takes about 45 minutes to do, and another hour to write up.  Using these tools allows The ARCHES Project to prioritize those most in need of services, determine whether the services provided were effective, and, over time, establish a truer picture of homelessness in the community than exists now.  This involves entering the assessment data into Servicepoint, Oregon' HMIS application.

Thanks to the good work of Rena [Croucher at OHCS] and Hunter [Belgard, Portland Housing Bureau(up in Portland), we’ll...have a new coordinated entry entry-exit assessment in HMIS that we will use here in Mid-Willamette [Community Action Agency].  This will allow us to generate our base assessment and SPDATs inside HMIS.  Our Process here will be:

1)    Client comes into contact with our agency.

2)    We open and complete our entry-exit for coordinated assessment.

3)    We place our clients on a master wait list, priority determined by SPDAT score.

4)    Once a housing program selects the client for placement, our coordinated entry-exit is then closed, with an exit destination set to the new housing program.

In casual conversation (back in 2016), Jimmy told us he thought the picture of homelessness here in Salem would not be as bad as it was in Clark Co., WA, where he last worked, but after several months doing assessments at The ARCHES Project and elsewhere in the area, he's concluded it's probably worse, owing in large part to the presence of the Oregon State Hospital and area corrections facilities. He guesses, based on what he's been told about how MWVCAA conducts the annual Point-in-Time Homeless Count and the assessments he's done, that Marion and Polk Counties have something like 5,000 people experiencing some type of homelessness, half of whom are extremely vulnerable (lots of issues), half of whom are homeless more due to misfortune combined with tight economic circumstances.  He said this community just doesn't have the resources to deal with that more vulnerable population, and hasn't had the data required to demonstrate the need in order to get the resources.

Asked in January 2019 what he thought of his 2016 estimates, Jimmy said they were "pretty dead on", based on what he and his team had learned over the past couple of years.  "One thing that shocks me still is the larger number of unsheltered homeless women living in camps.  Closer to half female.", he said.  "The other thing is the physical health conditions for the nearly 300 [highest needs] HRAP-VAT clients turned out a bit worse than expected: not just the normal stuff like diabetes and heart conditions, but head traumas and weird stuff like mobility issues."  And, he now refers to area resources -- financial and organizational -- as "grossly inadequate."