Coordinated Assessment: Putting the Key Pieces in Place
Remarks by Eric Grumdahl at a gathering of community stakeholders focused on ending Veteran and chronic homelessness
Thursday, March 27, 2014
Today, I would like to share what we at USICH see as key components of an effective coordinated assessment system. I will talk about some questions you might be wrestling with, some tactics you can use to make progress, and then review key components of coordinated assessment.
Before coming to Washington, I was responsible for housing and homelessness programs for a metropolitan county, where we were pushing in fits and starts toward a no-wrong-door coordinated assessment system linked to our mainstream systems. I understand that coordinated assessment sounds straightforward, but in practice it can be really challenging.
We suspect that your community is wrestling with some of these critical questions:
- Is your response effectively reducing how many people experience homelessness?
- Does it ensure that resources are used well?
- Does it contain the right mix of interventions?
We know that communities are facing challenges to ensure that the success rate of your response to homelessness is as high as it can be, and that permanent housing is obtained as quickly as possible by everybody served by it. We know that in a resource-constrained environment a central challenge is to make sure that the resources that are available are designed and delivered strategically.
We also know that homelessness-specific resources are not the only game in town, and that indeed we won't end homelessness through targeted programs alone. Communities must engage mainstream resources as much as possible.
So how do we make progress? The key tactics that we've identified among communities making progress include the following:
- Communities need to use data to focus efforts and drive performance.
- Mainstream systems and resources need to be engaged completely.
- Communities have to make hard choices about where interventions and resources are focused and do that in a systemic way, not just a program-specific way.
- Communities have to be using proven practices. There's a large and growing body of proven practices to end homelessness, like adopting a Housing First approach to reduce barriers to accessing services and focus on interventions on achieving housing outcomes.
- Finally, we know that the challenge of using the limited resources available is to be wise and strategic about how they should be invested, especially as new opportunities present themselves.
So, how do we create a coordinated assessment system that helps us do these things?
We view coordinated assessment as being about people. Coordinated assessment sounds fancy and clinical, but fundamentally it is about shifting the orientation of our response to homelessness toward identifying the best options for each individual and family experiencing homelessness. It is about structuring the way we use our resources, with shared, explicit criteria, and a common process and a common purpose for how decisions get made.
It is not about simply following the output of a tool, but it does require yielding program-specific decision-making. It's about buying into the benefits of a shared response – for the people served, for the system as a whole, and even for programs themselves – rather than preserving business as usual.
Coordinated assessment puts people – not programs and not tools – at the center of offering the interventions that work best. Offering interventions: we need a system that enables people to choose what intervention best responds to their needs and goals, to have those options informed by helpful assessment and on-the-ground insight and understanding, and to have our entire system oriented to ensure that the smartest choices for people are the choices people make.
Rather than a mysterious black box that spits out matches between people and interventions, consumer choice and practitioner wisdom both have a central place in an effective coordinated assessment system. Policies and practices that screen out the people most in need of an intervention do not.
Here are some of the key components of coordinated assessment:
First, we know that the path from homelessness to housing varies significantly from person to person, from family to family. We would ideally have a system that whatever front door somebody entered, they could quickly be connected to the right resources. That means making sure that there's meaningful coordination between the homeless response system and the intake processes for mainstream systems. Creating those linkages can be challenging, but ultimately mainstream systems have as much to benefit from having an option for the people experiencing or at risk of homelessness that they encounter as people experiencing homelessness and the homeless response system have to benefit from a connection to those mainstream resources.
Next, we know that if we're not connected with the people in need of interventions, it's impossible for coordinated assessment system to make smart connections between people and resources. That means that outreach is essential for a coordinated assessment system to function well.
We also know that these systems have to leverage the local capacities and resources including data systems like your local Homelessness Management Information System and take into account the specific and unique factors in every community, including the physical and political geography, the capacity of partners in your community, and the opportunities unique to your context.
The purpose of coordinated assessment is to make sure that the right access to services is established. This can happen in a variety of ways: access to services can be centralized, a one-stop shop approach; access can be coordinated, leveraging outreach capacity and linking or integrating with mainstream systems. There isn't a single path or option for how best to increase access to services -- how you do that depends a lot on the details of your community. The point here is simply that increased access is central to the purpose.
We also want to be sure we have access to the right stuff. We know that at a systems level, that means making sure that the various types of interventions that are available are all aligned and used strategically where they're most helpful. Again, we have to yield on making decisions about access to resources in isolation in order to get the benefits of a true systems approach and the best use of our limited resources.
Slide 10 provides a schematic view of how some of these pieces fit together. Coordinated assessment is linked with outreach, with a strong assertive outreach linkage to the discharge processes for a variety of mainstream systems. That "in-reach," as it is sometimes called, can be in addition to the other connections to the intake processes for other mainstream resources. These connections, informed by an assessment process with clear criteria to guide the prioritization of access to some services over others, leads to rapid connection to the housing and services that each person served needs and wants.
The push to establish for coordinated assessment systems is enshrined in the HEARTH Act and HUD's regulations for it. Those regulations stipulate the following criteria for a coordinated assessment system:
- It must cover the entire continuum of care.
- It must be easily accessible and well-advertised.
- It must use an assessment tool that is standardized across the whole system.
- It must be attuned to the local needs and conditions.
- It must include at least the Continuum of Care and Emergency Solutions Grant programs.
The last point here is really important, because even though the HEARTH Act regulations require that the Continuum of Care and Emergency Solutions Grant programs are in the coordinated assessment system, that is really just a starting point. Many communities are exploring how mainstream systems can also play a part, either as feeders into coordinated assessment, or as additional resources that a coordinated assessment process can access.
VA's vision for a coordinated assessment system reinforces the HEARTH Act requirements: a coordinated assessment system needs to be centralized or coordinated, easily accessible, and use a tool that puts people at the center and is based on established criteria. The purpose, or benefit, is to have a better process for connecting people to services, including better referrals and better coordination between programs, which produces better results for people.
I want to emphasize that coordinated assessment is a process, not a tool. The process serves your community's efforts to end homelessness by bringing into the open, in a more explicit way, how resources are deployed – and should be deployed – to serve the members of your community experiencing homelessness. Tools are an important part of assessment systems, but the tool alone is not sufficient.
So the shift that we are calling for is from thinking about access to programs in isolation, to thinking about options for individuals and families, shifting from "should my program accept this person," to thinking about "which programs offer the best options for this person or family." Another way to think about this is it's having good social work at a systemic level, while maximizing the impact of the resources you have by targeting them intentionally.
We acknowledge that yes, there are challenges with putting a system like this in place. Yes, there are thorny issues about control, discretion, history, and inertia. The point of departure on every community's journey to establish a coordinated assessment system is recognizing the benefits that come from having a system in place, committing to moving toward a systemic response, and to confronting these challenges.
So, what can communities do? Here are some suggestions.
First, you can begin to coordinate the efforts across your community to identify people experiencing homelessness and engage them in services. This coordination provides you with the platform for shared decision-making about access to resources. Often, parallel outreach efforts are not aware of each other’s efforts to engage the same individual, which makes coordinated anything tough.
Outreach also needs to be oriented to achieve housing outcomes. We understand that the purpose of outreach is engagement, and yes, engagement can take time. But the purpose of engagement is housing, and so we must make sure that every engagement attempt has housing as the goal.
Of course, you also need to assess the variety and capacity of programs in your community, to identify and fill critical gaps, and to ensure that there's a range of those options needed for a coordinated assessment system to work well. We can't have a response to homelessness that recognizes that one size does not fit all if we only have one size to offer.
Next, you can begin to engage the programs and interventions in your community about adopting a common way to make decisions. Yes, this can be hard. The Federal government has your back in this work. HUD's regulations and VA's vision require communities to move in this direction. I know many communities have already begun this work, and a few have their systems in place. Learn from each other.
There are also some "must-haves" for your local system. Every community must adopt a Housing First approach, but we also have to make sure that local adoption of Housing First is meaningful —commit to remove preconditions from each person's access to housing, focus on housing outcomes, and delink service expectations from housing --. It's easy to say your community adopts Housing First. Make sure you're doing it in a meaningful way. VA, HUD, and USICH all have tools to help you.
Similarly, we need supportive services that don't screen out or alienate the very people who would most benefit from them.
Every community must commit to making careful decisions about how we target the most intensive interventions like permanent supportive housing. In fact, how we should prioritize access for permanent supportive housing can be a case study of how coordinated assessment can work more generally. What we need is to shift from reacting and having a passive role in identifying supportive housing tenants to a more deliberate and intentional engagement of those most in need of that resource and intentionally prioritizing who gets access based on clear and objective measures of need.
In terms of mainstream resources, communities are not alone in trying to identify ways to link mainstream services to your local efforts to end homelessness. HUD has provided some really helpful guidance for public housing authorities and for multifamily housing developments. USICH has released a guidebook focused on partnerships between public housing authorities and other parts of the homeless response system, which can help you in thinking about how to maximize the impact of those partnerships.
In addition to public housing authorities, make sure that you are making connections in your community to your healthcare system, with the workforce development system, and with mainstream income and benefits. These resources are not only critical for each person experiencing homelessness, but also serve as an important front door for people to access care.
Finally, just as coordinated assessment itself is a process, the process of building a coordinated assessment system can yield a lot of benefits. These include creating new partnerships and collaborations, increasing your understanding of how homelessness manifests locally, and most importantly making sure you're using resources wisely to achieve our intended outcomes. As your community moves toward coordinated assessment, you will undoubtedly identify gaps in your system, and the collaboration you create can help you identify options for filling those gaps.
On behalf of USICH and the Obama Administration, thank you for the work that you do and for your commitment to establishing the systems we need in place to achieve our shared goal of ending homelessness.