Friday, November 11, 2016

HMIS and Coordinated Entry

The is the second of two posts about data collection.  You can find the first one here.

Coordinated entry is the "no wrong door" idea that recognizes it's just too not realistic to expect most clients to access to services on their own.  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 ACA, 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/our ability to deliver homeless assistance as effectively as we might.           
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.  You can see we have a long way to go.  One might argue that the challenge of building a system inclusive of 28 counties (not all of them rural) is just too big.  We are, however, working on it.   

The good news is that MWVCAA recently hired Jimmy Jones, who has expertise in coordinated entry systems.  Below is Jimmy's  description of what he's been working on (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.* * *

Since Jimmy arrived at MWVCAA, the ARCHES Project has 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.  To do that, the assessments will be entered 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 the other day, 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 OSH and area corrections facilities. He guesses, based on what he's been told about how we conduct our PIT counts 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.

Of course, we have no way of knowing whether Jimmy's estimates are accurate, but we can agree that more good data is needed, and the work he's doing is definitely the direction we need to be taking to get good data.  For that reason, his work and presence are very encouraging.

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