Tucson/Pima County
Coordinated Assessment
Planning Workshop
AM Sessions
April 18, 2013
Workshop Overview
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
2
Workshop Learning Objectives:
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.
3
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
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:
• 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
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Regulatory Requirement
• 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.
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Definition
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.
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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HUD’s Guiding Principles
• 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.
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TPCH Guiding Principles
•
•
•
•
•
•
•
•
•
•
•
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
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Guiding Question for System Design
Current Systems
1. 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 Systems
1. 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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Core Operational Components
1. Defined Access Point(s)
2. Standardized Assessment
3. Coordinated Referral
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Access – HUD Requirement
Access – 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.
12
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
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
Telephonebased
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
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Access Model Comparisons
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 prescreening tool;
often must
build a
relationship
with an outside
provider
Lowest level of
control over
implementatio
n and
compliance for
the CoC; still
requires
standardized
forms and
coordinated
referrals for all;
still answers
the guiding
question
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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
HUD does not require the coordinated
assessment to determine eligibility.
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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.
CoC must establish written
standards for administering
projects, including eligibility criteria.
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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 type
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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 & Design
System 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?
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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
Refer to Excel file of TPCH system mapping results
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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
Coordinated
Point of Access
Exit on own terms
HP = Housing Path
Faith Mission
(Lutheran Social
Services)
VOA
YMCA
Maryhaven
STABLE
HOUSING
Connection
to Services
Once People
are Housed
NAVIGATORS
Diversion
&
Prevention
Front Door &
Overflow Shelter
NAVIGATORS
POINTS OF
ACCESS
Friends of the
Homeless
(Southeast)
NAVIGATORS
Direct
admission
for those
returning to
shelter
NAVIGATORS
Columbus, OH
Los Angeles, CA
State of Ohio
Homeless
Persons &
Families
Standard
Criteria for
Voucher &
Rapid
Rehousing
$$
Each
Agency
Completes
Standard
Assessment
Salvation Army
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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
Montgomery County/Dayton (OH) Policies
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/Dayton Accomplishments
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
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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