Tucson/Pima County Coordinated Assessment Planning Workshop

1. Tucson/Pima CountyCoordinated Assessment Planning Workshop AM Sessions April 18, 2013

2. 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

3. 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.

4. 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.

5. 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

6. 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.

7. 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 acentralized or coordinated processdesigned to coordinate programparticipant intake, assessment, andprovision of referrals. A centralized orcoordinated assessment system coversthe geographic area, is easily accessedby individuals and families seekinghousing or services, is well advertised,and includes a comprehensive andstandardized assessment tool. CoC Program Interim Rule

8. 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.

9. 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

10. Guiding Question for System Design Current Systems • 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 • What housing and service assistance strategy would be best for each household? • 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.

11. Core Operational Components • Defined Access Point(s) • Standardized Assessment • Coordinated Referral

12. 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.

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

14. Access Model Comparisons

15. Access Model Comparisons

16. 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.

17. 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.

18. 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.

19. 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.

20. 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

21. 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.

22. 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.

23. 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.

24. 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

25. Reflections on TPCH Design Decisions • Questions, concerns, ideas, issues?

26. Break

27. Coordinated Assessment Workshop System Mapping

28. 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?

29. 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

30. 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.

31. 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

32. 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.

33. Community Examples • Columbus, OH • Los Angeles, CA • State of Ohio • Dayton, OH

34. Columbus, OH

35. Columbus, OH Direct admission for those returning to shelter NAVIGATORS Friends of the Homeless (Southeast) NAVIGATORS POINTS OF ACCESS Faith Mission (Lutheran Social Services) STABLE HOUSING Connection to Services Once People are Housed VOA Front Door & Overflow Shelter Coordinated Point of Access YMCA Diversion & Prevention NAVIGATORS NAVIGATORS Maryhaven Exit on own terms HP = Housing Path

36. Los Angeles, CA

37. State of Ohio Standard Criteria for Voucher & Rapid Rehousing $$ Homeless Persons & Families Each Agency Completes Standard Assessment Salvation Army

38. 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

39. 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

40. 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

41. 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

42. 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)

43. 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

44. 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.