Coordinated Access in Action in Tarrant County – Documentation and Prioritization

MDHA is building a CAS for Dallas and Collin Counties, based on the successful model implemented in Tarrant County.  The Tarrant County Homeless Coalition (TCHC), led by Cindy J. Crain, was an early adopter in the world of effective homeless response systems and CAS. One of the early discoveries that Crain and her team made was that they needed a well-oiled system not only for a prioritization of services, based on a person’s needs, as stated above, but also for determination and documentation of each person’s status.

Why is this? Every housing program operates under very specific rules and regulations. The most basic of these define who is homeless, who is chronically homeless, and which housing solutions such status makes them eligible for. Other rules and regulations further segment these populations. Some programs are specific to veterans, but only veterans with specific types of discharges. Other programs are specific to persons with HIV/AIDS. Some programs are for only for single men and women, and others are only for families. These bureaucratic “hoops”, if not kept in mind and managed, may cause the best of systems to grind to a halt.

The TCHC team realized that if the housing priority list was to remain true to its name, rather than become another in a series of meaningless waiting lists, they needed to place a premium on documentation. Each client needed to have a documentation and priority status or DOPS. They needed a DOPS Coordinator to work on this task and this task only, so providers could easily “pull” persons off of the housing priority list without any bureaucratic holdups. At the above mentioned “front door” i.e. the point of assessment, all documents regarding a person’s history and status were to be collected. These would include birth certificates, driver’s licenses, marriage certificates, social security cards, military discharge papers, documents proving a person has a disability or HIV/AIDS, and documents attesting to one’s homelessness. Frequently, not all of these are readily available, and so the DOPS Coordinator would work with the service provider helping the client in obtaining these documents. Once all necessary documents were obtained, housing programs could then pull persons that match their programs, in order of priority off of the list and house them. This flow chart that MDHA uses today clarifies this in a visual way:

 

 

The TCHC team also realized they needed to create a set of Coordinated Assessment Prioritization Guidelines (the DOPS Matrix), that cross referencing each person’s DOPS status with a person’s level of vulnerability and need would guide housing providers, in deciding who needed to be housed first. This is the DOPS Matrix. It helpfully awards a priority ranking to each person, based on multiple factors, and simplifies the job of housing providers in a systematic way. By clicking here, you can see the DOPS Matrix in use by MDHA today.

Couldn't Make It to the State of the Homeless Address? Watch it now!

Did you miss the State of the Homeless Address this last Tuesday, due to other pressing obligations? Don't fret! Our good friend, Corey Cleary-Stoner of f8studio, produced a video of the whole thing. Shout out to our longtime board member and supporter, Dr. Ken Altshuler, for suggesting we do this.

Now, grab a cup of coffee, sit back and watch the whole thing on YouTube. Here is the link: https://youtu.be/ZP2RB7NYyOM

 

Cindy J. Crain, MDHA President and CEO Delivers State of the Homeless Address 2016

Yesterday, Tuesday, March 22, 2016 Cindy J. Crain, President and CEO of the Metro Dallas Homeless Alliance (MDHA) delivered her second annual State of the Homeless Address, with more than 300 people in attendance, at Goodwill Industries of Dallas. MDHA leads the development of the homeless response system that, in accordance with Opening Doors, the national strategic plan to end homelessness, will make homelessness in Dallas and Collin Counties rare, brief and nonrecurring.

Crain was introduced by Dallas Mayor Mike Rawlings, the city’s former “homeless czar”, who shared remarks and pledged his support in word and deed to support MDHA’s efforts to end homelessness. Crain called on MDHA Board Member and homeless advocate, Ricky Redd to share some of his knowledge gained through lived experience as a person experiencing homelessness. Redd elicited tears as well as laughter, as he movingly spoke of what he learned and what are the most pressing needs of those experiencing homelessness. Crain’s address was followed by public comments and questions.

Ricky Redd

Crain opened with the purpose of the address: To review what we know, and how this will influence our decisions, to be honest about the challenges we deal with, and to welcome insights from the community on how we can make homelessness rare, brief and non-recurring.  The numbers she shared were sobering. The 2016 Point–in-Time Homeless Count conducted in late January, indicated an increase of 24% in the homeless population in Dallas and Collin Counties over the 2015 Count, going from 3,141 to 3,904 individuals. The number of chronically homeless individuals, i.e. those that have been homeless for 12 months and have a disability did not see significant change, dropping from 615 to 597. She presented elaborate graphs and charts, drilling down into this data by age, gender, race, ethnicity, sheltered vs. unsheltered and more.

Some of the most interesting data collected during the Count was from surveys, which the more than 700 volunteers in both counties administered to those they counted. One of the more sobering statistics was that of 358 unsheltered persons who were willing to share if they had experience in the criminal justice system, 75% had answered yes. This enforces the idea that with mass incarceration, we are creating a “prison to poverty and homelessness pipeline”. Of the 387 responses regarding health, 48% reported significant health conditions.

Cindy Crain

Crain discussed the lessons MDHA has accumulated from working with the residents of the Tent City under the I-45 Bridge, specifically highlighting the importance of increased professional street outreach and interagency collaboration, to help house as many people as possible.

Crain highlighted the tension between short term needs and long term housing solutions. She emphasized that the question, “What is your housing plan?” must become a mantra that pushes everyone towards housing, with services that support smooth transition and permanence in housing. She also reminded the assembled that true solutions lie in systemic and systematic changes, like Coordinated Assessment, a system through which all persons are assessed, using a common, uniform, objective and evidence based assessment tool, so they may be prioritized for service and matched with the services that will best help end their homelessness as quickly as possible. (MDHA is currently running a blog post series that explains how this federally required system will help end homelessness.)

In this context, Crain referenced MDHA’s partnership with PCCI, a nationally recognized leader in creating information systems that connect community based organizations with healthcare organizations to create an integrated community wide system of care. Together, MDHA and PCCI are creating a new Homeless Management Information System, customized to the needs of the Dallas community. With this new system, the community will have a far clearer picture of the nature and extent of homelessness and have the data necessary to optimize housing and services to make the experience of homelessness rare, brief, and non-recurring.

Crain ended her address emphasizing the need for all members of the community to work together. Without collaboration, cooperation and coordination of information and services, she stressed, we will keep more people homeless longer. By working together we, as a community, and each of us individually, can and must do better.

Crain’s PowerPoint presentation is available on the State of the Homeless Address 2016 page on MDHA website, and a full video recording of the proceedings will be available there later this week.

Coordinated Access – the Heart of an Effective Homeless Response System

Coordinated Access goes by different names, Coordinated or Centralized Access, Coordinated or Centralized Assessment, Coordinated or Centralized Entry. HUD defines and requires an effective Coordinated Access System to be the heart of every homeless response system, and tasks CoCs with setting up:

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… The Continuum of Care must… establish and operate either a centralized or coordinated assessment system… 

Why does HUD require this? Because, the converse, an uncoordinated environment, that expects “people to navigate multiple programs in an effort to get their needs met,” does not work:

Uncoordinated intake systems cause problems for providers and consumers. Families with housing crises may end up going to multiple agencies that cannot serve them before they get to the one most appropriate for their needs. Each agency may have separate and duplicative intake forms or requirements, slowing down families’ receipt of assistance, and each interaction with an agency opens up a need for data entry into a Homeless Management Information System (HMIS) or a similar system. Extra staff, time, and money are spent doing intake and assessment, taking time away from other, more housing-focused tasks, such as case management, housing location, and landlord negotiation. Research suggests that, in many systems, resources are being conferred on a small subset of families whose needs may primarily be economic, while those with more significant challenges (co-occurring disorders, complete lack of a social support system, etc.) are falling through the cracks. Centralized intake makes it easier for communities to match families to the services they need, no matter how difficult their barriers are to address.

How does the above translate into action? Regardless of where a person presents, they come in through the same “front door”, i.e. are assessed, using a common, uniform, objective and evidence based assessment tool. Many communities, across North America, Western Europe and Oceania use Dr. Iain De Jong’s Vulnerability Index – Service Prioritization Decision Assistance Prescreen Tool (VI-SPDAT). This tool establishes the level of need and risk of the person, so the person may be prioritized for service and matched with the services that will best help that person end his or her homelessness as quickly as possible.

A fully up and running Coordinated Access System seeks to help persons, first by helping them identify any means to self-resolve and stabilize their situation, and/or find alternative housing. Where necessary it connects persons to other services and assistance (including financial) outside of the homeless response system. These work for most people, and allow the system to focus its limited resources on the minority for whom this will not suffice. Persons in that minority, go on to a housing priority list, and are then matched with the programs that best fit their level of need and risk. Housing programs populate their housing units only from that list. All other methods of entry or “side doors” are shut.

In accordance with evidence-based practices and the preference HUD gives to permanent housing options, a majority will most likely be rapidly rehoused, with services offered in an a-la-carte fashion. A minority of persons, with the most acute needs, will be housed in permanent supportive housing, which in accordance with Housing First policies will make a comprehensive and intense set of services available, not required. Some persons, mainly domestic violence survivors and youth, for whom this is most appropriate, will be offered more traditional transitional housing. It is important also to note that when a community “flips the switch” on such a system, it typically will find itself dealing first and foremost with the “backlog” of chronic and unsheltered homelessness, first and foremost.

This 2014 infographic clarifies CAS in an arrestingly visual way. This is not meant to represent Dallas or Fort Worth’s CAS. Every community needs to establish and operate a CAS that fits its needs. However, most of what the infographic describes will be true in every system, not only in Kansas City:

 

Coordinated Access Blog Post Series

As we mentioned in the two previous blog posts, MDHA is building a Coordinated Access System (CAS). In CAS, all persons are assessed, using a common, uniform, objective and evidence based assessment tool, so they may be prioritized for service and matched with the services that will best help end their homelessness as quickly as possible. Wherever possible, persons are diverted from the system, by identifying means through which they can self-resolve, and where necessary connect to services outside of the homeless response system. Persons for whom this does not suffice, are placed on a housing priority list, and then matched with the programs that best fit their level of vulnerability and need. Housing programs populate their housing units exclusively from that list.

MDHA is building a CAS based on the successful model implemented in Tarrant County, which brought about a significant drop in the chronically homeless population. In this model, one professional manages the documentation and prioritization status (DOPS) of persons experiencing homelessness, so they may go on the housing priority list, and be ready for housing as soon as a unit becomes available. Another professional manages the supply of housing, primarily on the Housing Inventory Chart (HIC) of all HUD funded programs, so conversely, when a person needs housing, a unit is available, as soon as possible. These two professionals are guided by a manager, who pulls the whole process together in a systematic manner, aligns CAS with HMIS reporting, and integrates shelters, service providers working with the unsheltered, and housing service providers into one system of care. Dallas applied for and will receive a HUD grant to fund its CAS.

Stay tuned for our next blog posts, which tell the full story of our CAS:

• Coordinated Access – the Heart of an Effective Homeless Response System
• Coordinated Access in Action in Tarrant County – Documentation and Prioritization
• Coordinated Access in Action in Tarrant County – Housing Inventory
• Coordinated Access in Action in Tarrant County – Pulling It All Together
• Coordinated Access in Action in Dallas and Collin Counties

Dallas Commits to Building an Effective Homeless Response System

Edd Eason, CoC Chair

In 2015, the MDHA team, led by President and CEO, Cindy J. Crain, made great progress in laying the foundation for an effective homeless response system. They built a close alliance with the CoC Assembly Chair, Edd Eason, and Vice Chair, Dustin Perkins, so the CoC Assembly leadership and MDHA could work in concert and speak in one voice. Together, they introduced the annual State of the Homeless Address, as part of an effort to publicly dialogue with all communal stakeholders about the state of homelessness and the gaps and needs in Dallas' homeless response. As part of this process, they facilitated building a strategic work plan, through which the community is transforming homeless services into a unified effective crisis response system.

The most recent HUD CoC grant cycle proved to be a challenge for many communities around the country, as it came with a new set of funding guidelines and corresponding scoring system. The MDHA team responded by carefully educating its grantees, and creating a highly transparent and responsive local grant competition process, to maximize the scoring of each program, and the CoC as a whole. With the help of a reinvigorated Independent Review Committee, the CoC Assembly leadership and the MDHA Board of Directors, Crain and her team were able to submit a strong CoC grant application, which will hopefully lead to over $18 million for high performing programs in the local CoC.

They developed an innovative partnership with PCCI, a nationally recognized leader in creating information systems that connect community based organizations with healthcare organizations to create an integrated community wide system of care. Together, MDHA and PCCI are creating a new HMIS, customized to the needs of the Dallas community. This represents the first known instance that an HMIS is being built, from the ground up, tailored to the needs of a community.

The MDHA team developed another critical partnership, with United Way of Metropolitan Dallas (UWMD), and succeeded in receiving MDHA’s first ever United Way funding. With this funding they launched the MDHA Flex Fund. This fund pays for minor but impactful expenses that can help individuals resolve their homelessness. This program has been up and running since August 2015, and has already been of great assistance to clients. As these client needs cannot be paid for with federal funding, MDHA will continue to meet this ongoing need through United Way and other non-government funding sources.

Daniel Roby at Austin Street Center

(Courtesy of Austin Street Center)

In a move that has set the stage to revolutionize the way shelters will fit into Dallas’ homeless response system, they brought Austin Street Center (ASC), headed by Daniel Roby, one of the largest shelters in Dallas into the HMIS system. This led to a dramatic increase in HMIS coverage of the Dallas shelter population from 3% to 25%, and created a pathway for prioritization for housing and services for persons sheltered at ASC. Indirectly, this will encourage the other shelters in Dallas to join the HMIS system too, so their clients may benefit from services too.

For the annual Point-In-Time Homeless Count, an annual federal requirement, they marshaled a veritable army of roughly 600 volunteers in Dallas alone, armed with GIS mapping software generated routes to count and survey the unsheltered homeless. Volunteers were able to conduct Dallas’ most comprehensive census of these individuals to date.

Crain and her team instituted new learning, training and development opportunities to enhance the knowledge and performance of homeless provider professionals, including a monthly case worker round table, and a series of “Hard Conversations” on critical issues in the homelessness arena. Crucially, the team engaged internationally renowned expert on ending homelessness, Dr. Iain De Jong, to come to Dallas for three separate visits and train numerous practitioners, program managers, agency executives and policy makers on best practices in building all of the components necessary for an effective homeless response system.

As this is being written in March 2016, the work of the backbone organization has anything but let up. MDHA’s leadership in continuing to build Dallas’ homeless response system is being sought at every level, from front line case workers to the Mayor’s office, from program managers to state level officials, from local service provider CEOs to HUD personnel in the nation’s capital.

In the next few blog posts, we will elaborate specifically on what is at the heart of every effective homeless response system, a Coordinated Access System, or CAS, and how our iteration of CAS is shaping up, as we speak. It is going to be a true game changer.

The “How To” of Building an Effective Homeless Response System

Over the course of the next two blog posts, we will review the rationale for building a homeless response system, and how MDHA has made progress in this area in the last twelve months. In a series of blog posts to follow these two, we will elaborate specifically on what is at the heart of every effective homeless response system, a Coordinated Access System, or CAS, and how our iteration of CAS is shaping up, as we speak.

As you know, the Metro Dallas Homeless Alliance (MDHA) is a non-profit organization leading the development of an effective homeless response system that will make the experience of homelessness in Dallas and Collin Counties rare, brief, and non-recurring. It serves as the local Continuum of Care (CoC) lead agency, through which Department of Housing and Urban Development (HUD) funded service providers are funded, and it administrates the local Homeless Management Information System (HMIS), that tracks performance and drives improvement of service providers. Under the national strategic plan to end homelessness, Opening Doors, it is charged with transforming homeless services into a crisis response system that prevents homelessness and rapidly returns people who experience homelessness to stable housing.

Laura Zeilinger

(Courtesy of the Washington City Paper)

Former Executive Director of USICH, Laura Zeilinger argues that the essence of transforming homeless services into an effective unified homeless response system may be summed up in the right entity asking the right question: An effective homeless response system is one where individual programs no longer ask, "Will this person be successful in our program?" Rather, the system as a whole asks, “What solutions best match the needs of this person or household, and will end their homelessness quickly and permanently?"  

In this capacity, HUD has tasked each CoC with building a Coordinated Access System (CAS), at the heart of their homeless response systems. In CAS, all persons are assessed, using a common, uniform, objective and evidence based assessment tool, so they may be prioritized for service and matched with the services that will best help end their homelessness as quickly as possible. Wherever possible, persons are diverted from the system, by identifying means through which they can self-resolve, and where necessary connect to services outside of the homeless response system. Persons for whom this does not suffice, are placed on a housing priority list, and then matched with the programs that best fit their level of vulnerability and need. Housing programs populate their housing units exclusively from that list.

The results of asking this very different question, which follow a philosophy called progressive engagement, lead to more humane, more efficient, less disruptive and less costly solutions. Leading sociologist of homelessness, Dennis Culhane, states, “The majority of homeless households are able to resolve their housing emergencies in a relatively brief time. Given this, providing such households time limited assistance either avoids or limits the private trauma and public expense of a homeless episode.” This also allows the system to concentrate most of its costlier investments in time and money, in descending order, permanent supportive housing, rapid rehousing, emergency shelter, etc., on those individuals and families who really need them.

Dennis Culhane
(Courtesy of the University of Pennsylvania)

For such a transformation to occur, much less to succeed, requires in Culhane’s words, “a new multi-agency commitment.” CoCs and their lead agencies on the local level and USICH on the national level do not have the power to force individual programs to take the necessary steps, and make the requisite changes to align themselves to a homeless response system. Even if they did, no meaningful change on this scale occurs by fiat. If this is true regarding programs funded through the CoC process and/or required to report into the HMIS system, where there are “levers” that can be “pulled” in the areas of funding and regulatory compliance, this is even truer regarding programs such as shelters that are not funded through this process, particularly those that do not receive any government funding. Such programs can only be brought on board through the recognition that it is in the best interest of their clients that they become part of a unified, effective homeless response system. CoCs and their lead agencies must guide them through that journey, and help them reach that destination.

Collin County Homeless Coalition Releases Homeless Count Report

One of the pet peeves of those of us in Collin County, who work in the social services, is that some folks actually think that there is no need for this work in this county. Unfortunately, the fact that the median income of Collin County is higher than in many other counties, does not mean there is no need. There are families that can’t make ends meet. There are individuals living paycheck to paycheck. And yes, there are persons experiencing homelessness. Not for nothing does is our mission, at MDHA, to lead the development of a homeless response system that will make homelessness, in Dallas and Collin Counties, rare, brief and nonrecurring. 

This is why our partner, the Collin County Homeless Coalition, chaired by MDHA Board Member, Stacy Brown, is so important. This group meets every first Thursday of the month at 9am at the Plano Municipal Center, and they encourage anyone interested in ending homelessness to attend. One of the most important annual tasks of the Coalition is to conduct the Collin County portion of the federally mandated Point-in-Time Homeless Count, which our Continuum of Care is responsible for every year.

Stacy Brown, Chair, presents the report

This last Thursday, Stacy presented a written report of the results of the Collin County Count, accompanied by a detailed beautiful PowerPoint presentation. Click on the links to read both, and if you live and/or work in Collin County, make sure you attend this meeting regularly. We’ll see you there!