Monday, March 21, 2016

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:

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