Sunday, June 11, 2017

News from the Continuum

20th Century Record Keeping
When the Trump administration announced recently its plan to spend billions to overhaul the Department of Veteran Affairs' electronic medical records system, no one questioned the need for  providers to be able to "trade information seamlessly and...seamlessly execute a shared plan of care with smooth handoffs."

So, one can't help but wonder why the value of sharing information and plans of care for the homeless seems to have been such a hard sell.  Is it because homelessness is somehow a different problem?  Well, yes and no.

It's different in that, historically, homeless services have not been much of a priority -- except perhaps when the homeless were veterans.

It's the same in that, to paraphrase Secretary Shulkin, technological innovation is not a core competency of the average homeless services provider.  

It's also the same in that technology, like everything else, is a resource issue.  When resources are limited, the tendency is to want to focus on "direct services", or what some might call the human side of the equation.  This was likely the situation with the VA, and would be still, but for a new administration deciding things needed to change.  

Sometimes, what appears from the inside to be working fairly well can look pretty ridiculous to someone outside the system.  That's why pressure to change tends to come from outside, or not at all.

Here in the valley, the pressure on homeless services to change has been very low indeed.  For the most part, the emergency shelter and homeless housing programs in Marion and Polk Counties, as in surrounding counties, are of 20th century vintage, meaning they were designed for single adult men with mental and substance abuse disorders, because,  in the 1990s, only 11 percent of the adult homeless population was aged 50 and over.  Providing basic needs for this younger population included treating the aforementioned disorders, traumatic injuries and infections.  The care was mostly short-term.

Today, however, half the adult single homeless population in the US is aged 50 and over.  (Jimmy Jones says the median age single adults in in Marion and Polk Counties is 46.5.)  They have chronic diseases like diabetes and heart and lung disease.  They need to make repeated visits to health care providers and adhere to complicated medication regimens, specific diets and physical routines, which is all but impossible to do while homeless.  Add to that "high rates of cognitive impairment (problems with memory, information processing and following directions), functional impairment (the ability to manage daily tasks such as dressing, bathing, toileting), mobility impairment (the ability to walk), and deteriorating hearing and vision", and the value if not necessity of being able to track and trade information seamlessly among housing and service providers becomes obvious, but only if you're looking at the data.

The most effective homeless housing and services providers collect and share data through a homeless management information system (HMIS).  In Oregon, and in other states across the US, the HMIS application is ServicePoint. 
from the MSI ServicePoint Handbook
Without ServicePoint, providers must rely solely on whatever information their clients are able to provide, and their staff are able to collect.  They work in relative isolation with limited information, and get predictably limited results, which is acceptable, right? 

Well, don't look for any announcements from the Rose Garden, but the winds of change are blowing across Marion and Polk Counties.

We got Marion County and Keizer pivoting homeless initiatives to COG, we got MWVCAA sp'dattin' people up and down the Canyon, we got the Rotary, City Club and Rental Housing Association talkin' about homelessness, we got SHA partnering with social care agencies to create something called supportive housing, we got a City Council strategically planning for housing and  homelessness long term, we got Judge Aiken trying to create a Community Court, we got WestCare's new veterans shelter partnering with The ARCHES Project, we got Catholic Community Services helping St. Joseph Shelter to reopen, we got the Salvation Army and maybe even UGM looking at ServicePoint, and we're slowly building a client-centric service delivery system of coordinated assessment and entry.  And that's just some of what's been going on.

Over to the left is a list of area housing providers that indicates the programs and beds that are yet to be covered by ServicePoint, Oregon's HMIS system.  As you can see, until UGM's beds are "covered" in the system, we won't be able to collect enough data to give us an accurate picture of how well our programs are working, or have a true coordinated entry system.  For more on this, see here and here.

It's hard to underestimate how  significant it is to the community for providers to share access to this kind of information.  Nevertheless, up until recently, we've managed to give it almost no value whatsoever.  This error and omission is one of the many side effects of our having thrown in with the ROCC, aka the "Oregon BOS CoC", back in 2012.  When we did that, we lost much of our incentive and ability to track local data on homeless housing and services.  Now, it's only with a good deal of extra effort that we're able to pull maybe one or two annual reports.  It's nothing like it should be, or could be, if we were to reform OR-504, the Salem, Marion and Polk CoC, which would make our data readily available to anyone who was interested, through the HUD Data Exchange, which would, in turn, give greater incentive to providers to participate in the HMIS, aka ServicePoint.

Incidentally, ROCC summonsed us to a meeting last week (June 7, to be precise).   

The very next day, Jo Zimmer shows up at the "Region 7 CoC Grantees" meeting over at MWVCAA, and gets all flustered when she's asked to give an "update" on ROCC (in social service agency land, this is comparable to asking "Hi, how are you?").  She did manage to share that she was "working on the agenda" for ROCC's annual meeting (a mere three weeks away), and that the VA, HUD, and OHCS would be attending, and there would be HMIS training.  The meeting's to be at the Salem Convention Center, if anyone's interested in going.

The ARCHES Project is Moving
Other tidbits shared at the meeting included Polk County adding another Oxford House, and Polk CDC "getting involved on the shelter side."  Jimmy Jones said MWCAA had referred the first six individuals on the Centralized Wait List to the SHA, even though HRAP won't "launch" until July 10, because SHA staff wanted to have some time to develop relationships.  MWCAA is getting ready to dole out a bunch of State Homeless Assistance Program (SHAP) funds (they didn't say how much) through some obscure process no one is allowed to know about, and is looking for tenants for the 8,000 SF upper level of their new building at 615 Commercial Street NE.

We reviewed a data quality report on one of the SHAP subgrantees (grade: F), and there was  some discussion of who was responsible for data quality (MWVCAA) and what might be done (know that when the October update creates a new field, you have to enter data in that field for all pre-existing clients and a designated person could visit sub-grantees quarterly to review their reports and help them clean up their data, until they get the hang of it).  But, despite these very practical realizations, nothing.was.decided.

This is the third meeting in which we've witnessed this sort of discussion of data quality, and observed that no one takes notes, and nothing is decided.  It's like no one is in charge, so no one can decide anything.  It's quite the exercise in helplessness, and things have really got to change if we are going to have a functional and effective CoC, especially within the ROCC.  We really can't afford to have a "lead" agency that can't or won't lead.   

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