Tucson/Pima CountyCoordinated Assessment

Planning Workshop AM SessionsApril 18, 2013

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Morning Session:• Overview of Core Concepts and Planning

Considerations• Defining Local Priorities and Approaches • Local Considerations, Questions, Issues• System Mapping• Design Considerations• Best Practice Community Examples

Workshop Overview

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Participants will…• Understand regulatory requirements and

identify benefits of implementing advanced approaches.

• Understand local priorities and design decisions.

• Review best practice approaches and consider alternatives for local implementation.

Workshop Learning Objectives:

A note about terms…

Coordinated Access vs. Centralized Intake

The CoC and ESG Interim Rules use the term “centralized or coordinated assessment”. Coordinated Assessment is intended to encompass the broader system design approach of which “centralized intake” is just one form.

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HEARTH Act and Systems Coordination

• Each project functions as a part of a community’s effort to minimize the time that people experience a housing crisis

• Homelessness interventions should move clients out of the homelessness system as quickly as possible

• Systems-level outcomes require systems-level performance and planning

• Resources are needed for projects to develop coordinated support services that use community networks of services 5

The McKinney-Vento Act, as amended by HEARTH Act provided a blueprint for how system components might come together at the local level, envisioning the following:

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• CoC Interim Program Rule• Emergency Solutions Grant (ESG) Interim

Rule

The CoC Program interim rule requires that all CoCs implement a coordinated assessment/centralized intake system and to do so in collaboration with their local ESG grantees.

Regulatory Requirement

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A coordinated assessment system is the CoC’s approach to organizing and providing services to persons experiencing a housing crisis within a specific geographic area.

Definition

Centralized or coordinated assessment system is defined to mean a centralized or coordinated process designed to coordinate program participant intake, assessment, and provision of referrals. A centralized or coordinated assessment system covers the geographic area, is easily accessed by individuals and families seeking housing or services, is well advertised, and includes a comprehensive and standardized assessment tool. CoC Program Interim Rule

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• Reorient service provision, creating a more client-focused environment.

• Identify which strategies are best for each household based on knowledge of and access to a full array of available services.

• Link households to the most appropriate intervention that will assist the household to resolve their housing crisis.

HUD’s Guiding Principles

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• Focus on Prevention and Shelter Diversion• Triage (emergency) services available 24/7• Eliminate barriers to programs’ accessibility (enrollment criteria)• Leverage existing strengths (Safe Harbors, 211, Day One Program)• Adopt “Housing First” philosophy for all programs• Close the “side doors” – all enrollments sourced from HRC• Resources prioritized based on client need• System functions with accountability and transparency• System is easily understood and navigable by clients• Client choice is supported• Support ongoing needs analysis (gaps and redundancies) and make

adjustments

TPCH Guiding Principles

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Guiding Question for System Design

Current Systems1. Should we accept this family into

our project?

• Program-centric• Unique forms and assessment

processes for each organization or small subgroup of projects

• Project-specific decision-making• Ad hoc referral process between

projects• Uneven knowledge about available

housing and service interventions in the CoC’s geographic area

Coordinated Assessment Systems1. What housing and service assistance

strategy would be best for each household?

2. What housing and service assistance strategy among all available is best for each household?

• Client-centric• Standard forms and assessment

processes used by every project for every client

• Community agreement on how to triage based on household needs

• Coordinated referral process across the CoC’s geographic area based on written standards for administering programs.

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1. Defined Access Point(s)2. Standardized Assessment3. Coordinated Referral

Core Operational Components

Access – HUD RequirementAccess – Coordinated entry point into the CoC system of care.• covers the geographic area of the CoC;• easily accessed by individuals and

families seeking homeless or homelessness prevention services; and,.

• well advertised.

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Coordinated Access Models

Access – process by which clients enter the system:• Single point of access• Multisite centralized access• Assessment hotlines• No wrong door

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Access Model Comparisons

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Single Point of Access

Multisite Centralized Access

Assessment Hotlines

No Wrong Door

Site Location Centralized One per population center or at specific high-volume provider locations

Telephone-based

All existing provider locations

Number of Access Points

One Variable, based on geography (2 to 4)

One Telephone number

Many

Services Offered

Primarily access and assessment; may include triage services, emergency services, or other mainstream services

Primarily access and assessment; may include the services of a co-located provider; may be targeted to one of several subpopulations

Access and often access to an abundance of mainstream services; limited assessment capability

Access, at least limited assessment, referrals, and the standard services of each provider

Operating Authority

Permanent independent access specialists; may be shared staff of a central shelter or other organization

Mobile or permanent independent access specialists or shared staff of co-located providers

Local 211 or other designated hotline agency

Independently operated by each provider

Access Model Comparisons

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Single Point of Access

Multisite Centralized Access

Assessment Hotlines

No Wrong Door

Hours of Operation

Hours of the central location

Hours of each access site

Typically 24-hour operation/ 7 days a week

Hours depend on and vary with each provider

Considerations Highest level of control over implementation and compliance for the CoC; also known as centralized intake

Moderate level of control over implementation and compliance for the CoC; the most adaptable model, sometimes called a hybrid system

211 is the most popular example; may be combined with any of the other models as a pre-screening tool; often must build a relationship with an outside provider

Lowest level of control over implementation and compliance for the CoC; still requires standardized forms and coordinated referrals for all; still answers the guiding question

Access – Advanced Approaches

• Specialized access points for special populations (e.g. youth, victims of domestic violence, Veterans).

• Mobile staff provide access to coordinated assessment services to clients unable or unwilling to utilize traditional access points.

• Serves as access point for non-homeless or other community-based emergency assistance services (e.g. supplemental food assistance programs for persons who may not be homeless).

• CoC uses HMIS to document clients’ use of centralized or coordinated intake services.

• CoC use of HMIS to document client movement or transfer among CoC system projects (i.e. from emergency shelter to transitional housing).

• Access point documents extent and scope of persons requesting homeless assistance services but who do not enroll in a CoC project (e.g., persons diverted from homeless system). Reasons for persons not enrolling are also tracked.

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Access – Proposed TPCH Approach

• Multiple access points for all populations (211, HRC, outreach teams/staff).

• Housing Barriers Screen to determine “low barrier” vs. “high barrier” clients.

– “Low barrier clients are offered mediation, re-unification support, relocation support, housing placement coordination, temporary (minimal) financial assistance.

– “High barrier” clients are referred to HRC for in-persons assessment.• CoC uses HMIS to document clients’ use of centralized or coordinated

intake services.

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Assessment – HUD Requirement

Assessment - document the needs of individuals and families seeking housing or services. • Must use a comprehensive tool and

standardized assessment process

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HUD does not require the coordinated assessment to determine eligibility.

Assess – Advanced Approaches

• Assessment process documents client needs, based on assessment, eligibility, based on written program standards for enrollment, referral based on available resources, and disposition, based on availability of housing and services in the CoC.

• Assessment process documents client eligibility for available services and shares eligibility documentation with referral providers as appropriate.

• CoC uses ongoing or progressive assessment as clients initially enter the crisis response system and move through the homeless system from one project or service to another.

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Assess – Advanced Approaches

• Document client’s homelessness history and housing barriers

• Identify appropriate services• Document discrepancy between client needs and

available resources to meet need• Respect client preferences• Capture “just enough” data to meet project needs• Obtain consent for sharing with providers• Draft, or at least initiate, a housing plan• Apply standardized practices at every point

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Assess – Proposed TPCH Approach

• Triage yields diversion/prevention and “low” vs. “high” barrier determination.

• Referral and linkage to other I&R resources• CoC uses ongoing or progressive assessment as

clients initially enter the crisis response system and move through the homeless system from one project or service to another.

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Referral (Assign) – HUD Requirement

Referral provided for housing and/or services for individuals and families experiencing a housing crisis.

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CoC must establish written standards for administering projects, including eligibility criteria.

Referral (Assign) – Advanced Approaches

• CoC uses HMIS to document client referrals and linkages among CoC system programs (not just the initial entry point).

• CoC adopts policies outlining the acceptable reasons a client referred to a project can be rejected/denied access by that project.

• Referrals are managed within the context of a centralized waiting list for limited service or housing slots.

• Referrals for available service and housing slots are made based on a CoC-defined prioritization process.

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Referral – Proposed TPCH Approach

• TPCH providers accept referrals only through HRC source

• Referral is managed electronically in HMIS

• TPCH providers give feedback on quality and appropriateness of referrals

• Unit/bed availability tracked in real time• Centralized waitlist managed for each

program type24

Reflections on TPCH Design Decisions

• Questions, concerns, ideas, issues?

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Break

Coordinated Assessment Workshop

System Mapping

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System Assessment & DesignSystem Mapping Questions:• How many clients currently access

emergency response services?• How do clients use existing bed/units and

services?• Are existing service strategies sufficient to

meet the client demand? Where are the gaps?

• How can Coordinated Assessment address gaps? 28

System Assessment Tool• Current System Capacity

– HIC, PIT, HMIS• System Assumptions

– LOS, Turn Over Rates, Referral Strategies• System Component Alignment

– Coordinated Assessment Design program operations program goals system goals HEARTH objectives

29Refer to Excel file of TPCH system mapping results

Design Considerations - Access

• Specialized access points for special populations (e.g. youth, victims of domestic violence, Veterans).

• Mobile staff provide access to coordinated assessment services to clients unable or unwilling to utilize traditional access points.

• Serves as access point for non-homeless or other community-based emergency assistance services (e.g. supplemental food assistance programs for persons who may not be homeless).

• CoC use of HMIS to document client movement or transfer among CoC system projects (i.e. from emergency shelter to transitional housing).

• Access point documents extent and scope of persons requesting homeless assistance services but who do not enroll in a CoC project (e.g., persons diverted from homeless system). Reasons for persons not enrolling are also tracked.

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Design Considerations – Assess

• Assessment process documents client needs, based on assessment, eligibility, based on written program standards for enrollment, referral based on available resources, and disposition, based on availability of housing and services in the CoC.

• Assessment process documents client eligibility for available services and shares eligibility documentation with referral providers as appropriate.

• CoC uses ongoing or progressive assessment as clients initially enter the crisis response system and move through the homeless system from one project or service to another

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Design Considerations – Referral

• Assessment process results in score/decision/ determination for service and housing intensity, duration, scope… housing plan.

• Each TPCH project defines a target population, service strategy, and intended outcomes… written standards for administration of programs.

• Referral scores, client placement, and outcomes are tracked to assess system results… evaluation.

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Community Examples

• Columbus, OH• Los Angeles, CA• State of Ohio• Dayton, OH

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Columbus, OH

NAV

IGAT

OR

SN

AVIG

ATO

RS

NAV

IGATO

RS

NAV

IGATO

RS

Connection to Services

Once People are Housed

Friends of the Homeless

(Southeast)

YMCA

VOA

Faith Mission(Lutheran Social

Services)

Maryhaven

Diversion &

Prevention

POINTS OF ACCESS

Coordinated Point of Access

HP = Housing Path

STABLE HOUSING

Direct admission for those returning to shelter

Exit on own terms

Front Door & Overflow Shelter

Columbus, OH

Los Angeles, CA

State of Ohio

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Homeless Persons & Families

Each Agency

Completes Standard

Assessment

Standard Criteria for Voucher &

Rapid Rehousing

$$

Salvation Army

Montgomery County/Dayton (OH)Assessment – conducted at all Front Doors (n=4)• Intake – goal is diversion, done within first 3 days• Comprehensive assessment – done within first 7-14 days

Referral decision worksheet to identify most appropriate program type to help client move to permanent housing• All eligibility criteria set by funding sources must be complied with• Programs must remove additional barriers to entry• Priority for PSH openings for long-stayers, elderly and medically fragile

Process to refer appropriate client to specific program when opening occurs• Done by CoC system staff for transitional housing, PSH and Safe Haven• Planned to be in HMIS but issues with seeing referral

Policies• Require that programs accept 1 in 4 referrals

• Eliminate all program entrance requirements except those required by funding (i.e. no drug testing)

• All program vacancies must be filled through the Front Door process – close the “side doors”

• Referral denial triggers case conferencing

• Development of program and system performance outcomes based on HEARTH

Montgomery County/Dayton (OH) Policies

Policies• Closed “side doors” into CoC programs so all homeless

system resources used for people in shelter or on the street

• All long-term stayers (>200 nights homeless) housed

• Established policies about expectations for people in shelter– Use income for housing– Expected to accept first appropriate referral

• Have client-centered data for HEARTH planning

Montgomery/Dayton Accomplishments

Special Subpopulation Considerations

Rural Areas• Standardize tools• Referrals based on available resources• Consider hybrid approaches• Leverage remote technology – 211• Consider different approaches for each

subpopulation

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Special Subpopulation Considerations

Domestic Violence• VAWA and security concerns may prevent

complete integration• DV provider as Centralized Intake operator• Consider other information coordination

processes (non HMIS)

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Special Subpopulation Considerations

Transition-Aged Youth• TAY resources and systems within the CoC

may be different than single adults and families

• Youth may have different outreach, triage, intake needs

• Youth may need specially designed assessment and referral strategies

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Special Subpopulation Considerations

Veterans• VA funds CRRC (Community Resource

and Referral Centers)• Coordinated entry point for VA housing,

mental health, physical health, referral services

• 17 CRRCs currently open. Expansion expected.

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