Implementing a Community-Wide Supportive Housing Registry: UNITY of Greater New Orleans

After Hurricane Katrina, the City of New Orleans began to experience a large increase in the number of individuals living unsheltered. During that time, Martha Kegel, Executive Director of UNITY of Greater New Orleans was interested in the most effective practices in ending homelessness following this crisis. She was introduced to the Vulnerability Index (VI) and Supportive Housing Registry promoted by the 100,000 Homes Campaign and Community Solutions. These tools help a community determine who is experiencing chronic homelessness in their community, gathering information about each individual’s physical and mental health to help prioritize who needs permanent supportive housing most quickly. This process of assessment and housing placement is one of the most effective ways communities can target supportive housing interventions to those experiencing chronic homelessness who are most at-risk of dying on the streets.

Kathleen North of UNITY of Greater New Orleans is the Director of the Supportive Housing Registry at UNITY, the only community-wide supportive housing registry in the country. She has directed the Registry for four years and shared with USICH how the use of the Vulnerability Index has changed over the years into a dynamic tool that has changed the paradigm of targeting in New Orleans.

Registry Process

Outreach and the Vulnerability Index

The population of individuals experiencing chronic homelessness differs in many ways from other subpopulations– they are sicker, live unsheltered, and often do not walk into shelters seeking help like other populations, notes Ms. North. Outreach is the first step in the process, enabling UNITY to do an initial screening with the Vulnerability Index. The VI process includes assessing the individual using the Index as well as asking further questions or observations that may point to items not on the VI. There are eight “markers” (physical, behavioral, or substance abuse issues) on the Index that assess individuals who have been homeless at least six months and are at a high risk of mortality: each one of these markers an individual is experiencing gives them a “point” on the VI. The higher the point value, the higher an individual should be placed on the Registry for a more rapid placement into housing. In order to find and then engage the most vulnerable in your community, she notes, the key is outreach at all times of the day or night. “When housing providers do not have outreach who are going out during both the day and night they aren’t really targeting the most vulnerable– if you’re not going under bridges or in abandoned buildings you aren’t reaching them.”  CoC housing providers receive referrals from the Registry and this means the person’s homelessness is documented and that they are of the most in need of housing.  

More information on the Vulnerability Index

Assessing the Data

The second step in the process is assessing this data. All the information outreach workers gather from a VI is entered into a centralized data system. This enables the Registry Director to keep track of every individual that outreach has come into contact with. An important step taken when entering data into the registry is working to enter information from other sources such as medical records. “Relationships with hospital medical records staff helps us access records quickly when trying to gain more information about mental and physical health, “said Ms. North. “An individual on the street knows what illnesses they have, but they may not know detailed information like their blood sugar levels or even if they are HIV-positive. The information that we get from a fuller medical record helps us to see if an individual should be moved to the top of the Registry so we can prioritize their housing placement.”

The Registry Director’s role, as Ms. North describes it,

is to work with outreach workers and community social service providers to prioritize individuals for housing using the VI , medical records when available, and assessment of functioning. This includes managing the database and providing on-going individual and group training on assessment and documentation of disability. During Registry meetings we discuss issues that may increase the vulnerability of a client and leapfrog them to the top of the Registry such as poor social skills that result in banning from local shelters. If there is more information needed that affects their functioning on the street such as stroke, developmental disability, persistent victimization or abuse, or an untreated severe seizure disorder, we can get that information and give them a score on the VI for these factors.  

UNITY leadership and outreach workers have adapted the assessment tool over the years so that some issues such as severe mental illness or significant developmental disability can get a person a point on the VI. 

Weekly Meetings and the Top Ten

Every week, outreach workers from UNITY and social service providers from various agencies, including  VA, meet to discuss the Registry in detail– who they engaged this week, the status of other individuals on the Registry, and who they believe needs to be put in housing next. “It’s not as simple as taking the person with the next highest score on the list. There are over 1500 disabled homeless individuals on the registry and not enough housing slots. It is a much more dynamic process of looking at the bigger picture of an individual’s situation to see factors that would make it the most difficult to stay on the streets,” North says. It is at these weekly meetings where  the decisions about housing are made and the group discusses where best to focus attention that week– going back always to UNITY’s “Top 10.” “These are some of those we have difficulty engaging (but we believe they can and should be housed) and/or the most vulnerable folks we come into contact with and who we are most worried about,” North says. We discuss these 10 every week, as well as new developments with other individuals, and work together to figure out how we’re going to work to get them into housing.”  Another good outcome of registry and outreach meetings is the informal and formal training and collaboration that takes place on identifying and documenting disability and homelessness.  Working as a team, pooling the knowledge and skill of all the staff, and assisting one another in working to get the most vulnerable in to housing is crucial.

These meetings are where the theory of targeting resources to the most vulnerable is put into practice: “We debate, we fight, and then at the end of the meeting we walk away friends because we all understand why the Registry is done this way– it really is the best way to make decisions about who should fill a slot in permanent housing. It is much more than a waiting list.”

Community Engagement

To involve the CoC in the process, Ms. North talks about the Registry to all Continuum of Care providers and leadership at monthly CoC meetings and invites their continued participation in getting the most vulnerable in to housing. She discusses the concept of the Registry overall– that of serving the sickest and most vulnerable based on the VI score and assessment of functioning. UNITY staff and CoC PSH providers successful at Housing First support this process as well in other CoC meetings and trainings. This has resulted in the increased support of the Registry process and Housing First by Coc providers.  “Service providers and the community want to know that there is a reasonable and fair process for determining who receives the resources.  Supporting Housing First principals is also one of the criteria for being funded for new PSH projects, and this helps increase support asas well.  In order for a community to be on board you need to be repetitive and inclusive and they need to understand why it is in the best interest of the community to house the most vulnerable.”