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Building a Unified Homeless and Housing System in Kansas City (w/ text)

The Homelessness Task Force (HTF) of Greater Kansas City is working toward a better system

Jason Bohn

on 5 February 2015

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Transcript of Building a Unified Homeless and Housing System in Kansas City (w/ text)

Coordinated Access System

A Coordinated Access System needs to be easily understood and well advertised. This provides a
single or coordinated
method by which homeless people, those at risk or service providers find and access shelter, housing and/or services. Achieving this requires the service pathway is understood across multiple access points (jails, hospitals, government offices, etc.) and that the process is also practiced by outreach staff.


"For Kansas City a common diversion approach through a decentralized approach is recommended to start, with movement towards a virtual and place-based common center for diversion within three years’ time.

To achieve this objective in the shorter term:
An inventory of all locations where people seek shelter assistance is required, knowing which locations may have limitations or restrictions on which people or population groups cannot be present at certain locations;
A common script and logic model applied in all locations where people seek assistance;
Access to shorter-term assistance such as grocery store vouchers, food hampers, etc.;
Training to all staff on the essential elements and expectations of the diversion approach;
Creation of Diversion as a Program in HMIS that people can be enrolled in so that it is possible to track the number of people and families diverted from homelessness and whether or not they return in the future for either Diversion or Shelter Entry;
Streamlined and coordinated shelter access.

To achieve this objective three years hence:
Single virtual portal for access and availability to all shelters (phone and web-based), with eligibility criteria;
Centralized Diversion Center that can serve as a consolidated in-person place where people can be assessed and diverted as appropriate?
Sheltering is a process, not a destination.

Shelters can have a range of approaches, missions, mandates, all should have a shared understanding that getting people out of shelter and into housing is the cure for homelessness. Shelters are critical for ending homelessness, but accessing shelter should not be required in order to access a housing program. In addition to meeting basic needs, shelters can play a critical role in getting people a step closer to housing: helping with identification; access to computers and phones for searching for available rentals; and personal and spiritual assistance.

In an integrated housing and homelessness system, sheltering is a multi-stage process that includes pre-screening and diversion, acuity assessment, case management, and eventually, permanent housing:
1) An individual or family presents for shelter, and diversion is attempted as shown above.
2) If diversion is not successful, the individual or family is admitted to shelter.
3) Minimal supports are provided to the client at this time, but shelter staff act to encourage the individual or family to resolve their housing situation.
4) If the client has not resolved their housing after 14 days, the shelter performs an acuity measure to determine the level of need.
5) The acuity measure indicates if the client is a good fit for Housing First/PSH, Rapid Re-Housing, or limited housing supports. The client is informed of their acuity results and their prioritization.
6) For the highest priority clients, a case manager is assigned and the housing search begins.
7) Once a unit has been found that is acceptable to the client, the lease is signed and the client moves in.
8) At this point case management begins with earnest, and includes the creation of a housing stability plan.

Housing Triage

Individual and families will fall into categories of low, medium, and high acuity, and these categories will define the housing intervention best suited to their needs. High acuity clients will receive the highest priority, and are best suited for Housing First/PSH interventions. Mid-acuity clients are the second priority, and will benefit from a Rapid Re-Housing intervention. Finally, low acuity clients are the lowest priority, and will receive minimal supports necessary to find their way into housing. A valid triage tool will provide a numeric score that will allow for the quick prioritization of clients. It is important at this point for every service provider across Kansas City to understand the eligibility criteria for other programs, so that the best fit can be found for every client.

For Kansas City to be successful in moving forward:
• there will need to be agreement on which assessment tool to use;
• the tool selected will need to be grounded in evidence and have the ability to be used with individuals and families;
• should have an existing track-record of use, not be in beta test;
• can be built into HMIS to allow for the assessment information to be easily seen and used across multiple service providers and entry points into the system.

Transitional housing remains a contentious issue in housing policy debates. All indications seem to be pointing to a retreat of the federal government from investing in Transitional Housing within a handful of years. However, for the time being, Transitional Housing – along with permanent housing options – needs to be on the table in Kansas City.

For Kansas City to be successful in this regard:
• an inventory of Transitional Housing will be required, along with the eligibility criteria of each;
• availability within Transitional Housing will be needed, in as close to real time as possible;
• access to Transitional Housing will need to be centralized, as will be the case with other housing options;
• the community will need to decide:
If Transitional Housing will follow its existing service pattern and population served; OR
If Transitional Housing is going to be used as Interim Housing for those individuals and families that would be candidates for PSH, but there is not availability within PSH.
In leveraging the benefits of Permanent Supportive Housing in the community, especially that which is located in congregate facilities, it will be necessary to have only those individuals and families that meet a certain acuity threshold in achieving access to this housing. The housing, therefore, will become restricted, at entry, only for those households that most need the housing.

For Kansas City to be successful in maximizing its Permanent Supportive Housing, it will be necessary to:

• have an inventory of all Permanent Supportive Housing and its eligibility criteria;
• centralized intake into the PSH based upon acuity;
• use the assessment tool to determine the threshold of acuity for access to the PSH;
• remove all secondary assessment criteria of individual PSH providers;
• ensure there is no ability to trump the assessment recommendation of an individual or family to the PSH.
Using Data to Monitor

A critical component in ending homelessness is collecting data through valid and consistent methodologies, and in using data to inform decisions that are made on a system-wide basis. Without concrete evidence, it is impossible to determine the success of even the most basic programs or services.

In addition, ensuring that all agencies involved in ending homelessness are able to “speak the same language” by using common tools to collect information about their clients is another vital component of a systems approach. Service providers in a housing and homelessness system should be able to reliably answer three core questions:
Who are we serving?
How are we helping them?
What happens to them?

The data collected does not need to be extensive. In fact, there is a growing movement towards collecting only the most essential data about clients. There is no value in collecting more data than is useful; in fact, such an exercise is frequently seen as a waste of time for staff (and clients) at the point of collection as well as for those people conducting subsequent analyses. A best practice in data collection is to assemble all stakeholders – including funders and service providers – and identify the most important client information and adopt an intake and tracking tool that allows all agencies in the system to assess acuity and capture information consistently and accurately.

Individuals who are homeless are not homogenous. They come with varying degrees of issues and needs. The level of acuity, essentially the level of need, can be broken down into three categories.
Lower acuity individuals are not having to cope with complex issues like chronic health or behavioral issues, and do not require a substantial investment of resources. They may require assistance in finding housing, or securing income supports, but do not require supports. (60% of the homeless population)
Mid-acuity individuals may have a few areas of their life where they are coping with complex issues. They may require assistance in finding housing and income, but will also require some supports for a few months. The individuals will benefit from case management services and an individualized planning process that links them to community resources. (25-35% of the homeless population)
Finally, high acuity individuals have multiple areas of complex needs and are likely to make up the chronically homeless population. These individuals will need ongoing case management support for at least 12 months, and often longer. The highest acuity clients will be the smallest in number, at around 16 percent of homeless individuals.
The vast majority of individuals and families experiencing homelessness do so only once and for a short period of time.
The implications of varying levels of need and that the majority of those experiencing homelessness do so once and for a very short time are substantial for the delivery of a housing and homelessness system. To appreciate how, think of a housing and homelessness system as a bucket, and the water within the bucket as the available services that the system has on offer. Clients enter the system needing a certain amount of water. Give every client a spoon, and you may satisfy the needs of some while leaving others in need. Those latter clients will return multiple times to the bucket, getting a spoonful of help each time. On the other hand, give every client a ladle and many clients are being over served. Very quickly, the amount of water in the bucket is gone.

What if we could know how much water a client needed before they drew from the bucket? Then we could prioritize those with the highest needs first to ensure they got served, and draw only as much water as needed. Even better, we could tell who could be helped without taking from the bucket at all, by diverting clients. All of this would require one way to access the bucket, with no one-offs and side-doors. Consistency and rigorous fidelity to practice would ensure that the bucket’s water was used for its highest impact. Luck would have nothing to do with it.
Link to the full written report: http://www.marc.org/Community/Homelessness-Task-Force/Assets/KC-System-Map-Draft-1-(April-2014).aspx

Many of components of this system map are occurring or have been piloted over the last 2 years, such as Housing Triage with the chronic population through the 100,000 Homes Campaign using the VI/SPDAT (also used during the Jan 2014 PIT in Jackson and Wyandotte Counties) and coordinated access through the Client-driven Coordinated Assessment (CDCA) pilot with United Way 211. We’ve been testing processes and assessing strategies and believe we are closer to Building a Unified Homeless and Housing System for KC.

We want your input and feedback. Below is a link to a survey. After you read the report, go back and click on the link. It will walk you through structured feedback questions. Your feedback is invaluable for helping us reach conclusion on the report in a timely fashion.

Survey Link: https://www.research.net/s/KansasCityReportFeedback

Client Centered vs. Program Centered

An effective and integrated system breaks down barriers between providers and allows them to specialize in certain types of services. This is essentially the meaning of a ‘client centered’ systems approach, as opposed to a ‘program centered’ approach. In a program-centered system, the onus is on the client to find providers and apply for services. If they are not eligible for all or some of the provider’s services, they must then begin the search again. There is considerable duplication in this type of system, as the client is repeatedly assessed with each new application. Moreover, the client invests considerable time in searching for the right provider, and always stands the chance of missing the service he or she needs.

In contrast, a client centered system attempts to bring the services to the client. Using one assessment, the client’s needs are identified and he or she is connected to the right services. The result is a faster application of housing or related services to the client. In a client-centered system, there is transparency around what services are available and how they are accessed. Building a client-centered system requires alignment of access, diversion, shelters, measurement, prioritization, and data.
KCMetroHousing.org is a free online housing tool in the Kansas City region. Those seeking housing can filter search results by price and necessary criteria.

Property owners and managers can post apartments or homes for rent any time.

For Kansas City to be successful in its pursuit of coordinated access and common assessment in ending homelessness:
the same tools have to be used across the system so that providers can speak the same language;
the tool must be integrated into HMIS;
it must be easy to run reports through HMIS at the provider level, in as close to real time as possible;
the assessment tool used at intake should be the same tool applied at regular intervals to track the changes in acuity of the household, which is the ultimate outcome measure.
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