Front Door Assessment


Dayton-Montgomery County’s Front Door Assessment process is a coordinated entry system designed to rapidly assess people entering shelter and refer them to housing assistance programs geared to their level of need. Designated “front door” providers conduct the assessments and rapid re-housing referrals, while referrals to permanent supportive housing, transitional housing, and safe havens are centralized through the County. The program is a good example of a community that successfully achieved the challenging shift from a program-centered to a coordinated, client-centered assessment and referral system.

Problem or Challenge Practice Addresses:

The Dayton-Montgomery County Front Door Assessment process was created as a means to more effectively serve priority populations among people in shelters or on the streets by matching them to the resources they most need. Previously, homeless assistance programs each decided who they would serve, had their own waiting lists, and made individual intake decisions. As a result, some people were not being served by any programs and were languishing in shelters. Stakeholders didn’t know if resources within the homeless service system (shelter, transitional housing, rapid re-housing, permanent supportive housing, safe haven) were being allocated in proportion to the needs of the individuals and families experiencing homelessness.

In 2007, the Homeless Solutions Policy Board, which was created to implement the community’s Homeless Solutions Community 10-Year Plan to End Chronic Homelessness and Reduce Overall Homelessness, formed a Front Door Committee to gather data and input from a wide range of stakeholders to design a new approach. Through this process, they found that some homeless assistance programs had very high barriers to entry – so while some people could have benefitted from the services offered by the programs, they were never able to gain entry. In some cases, programs were full even though they rarely took people from shelter. They also found that shelter case managers, in an effort to help people leave shelter, helped their clients apply for every possible program the person could qualify for. As a result, some people entered programs where they were over-served because they did not need the level of intervention that the program provided; some were under-served, which made achieving successful outcomes difficult. Decisions on applying for new Continuum of Care bonus dollars were based more on anecdotal information and less on data about what was needed and by whom.

Working with a consultant, the Front Door Committee crafted a coordinated, system-wide process to screen and refer people at the front door of a shelter. The new Front Door Assessment process was launched in August 2010.

Description of Solution:

The Front Door Assessment (“FDA”) is a consistent assessment tool and scoring process to determine the individual household’s barriers to getting and keeping housing and the best means to help them exit homelessness and be stably housed. The FDA is conductedafter people enter an emergency shelter so that it does not present a barrier to their safety. FDA is administered at all the “front doors” of the homeless system. Four of these are “gateway” shelters (one for men, one for women and children, one for youth, and one for victims of domestic violence). The other is the PATH outreach program.

Making the shift

For the local homeless assistance system, FDA has meant a conceptual change from a program-centered to a client-centered system. As a foundation for this change, the Front Door Committee developed a set of goals to serve as the foundation for the process:

  •  Rapidly exit people from homelessness to stable housing
  •  Make efficient and effective use of system resources, ensuring that people receive services appropriate to their level of need
  •  Ensure that all people, including the hardest to serve, are served
  •  Ensure transparency and accountability throughout the assessment and referral process.

The Policy Board began preparing for the shift several years before it actually was made. Discussion about a system-wide assessment process began in 2007. Starting in 2009, all RFPs and contracts for local and HUD funding for homeless services required projects to participate in the Front Door Assessment process once in place. Montgomery County provided funding for consultants to conduct numerous provider interviews and consumer focus groups, develop and deliver provider trainings, help develop the assessment tools and scoring matrix, and set up data processes within the Homeless Management Information System (HMIS). As the FDA program was rolled out, its program manual and program policies were further adjusted based on provider feedback gained through meetings and calls.

Implementation Steps/Tips:

Assessment

FDA uses a two-part assessment process based in HMIS:

  • The intake assessment is conducted within the first three days of entering shelter. This intake is brief and is focused on diverting people who have alternatives to staying longer in shelter.
  • A comprehensive assessment is conducted within 7-14 days of shelter entry. The Policy Board has found that about one third of people who enter shelter stay for less than seven nights, so waiting a week or two to conduct the assessment has proven to be a better use of resources.

The comprehensive assessment focuses on the household’s housing barriers, including housing history, income, and legal and health issues. It also includes an independent living skills assessment. Based on these screens, the household’s barriers are scored as low, medium, or high. A referral decision worksheet then uses additional filters to determine the type of referral to be made. A household is referred to rapid re-housing if they have a regular income or recent work history. Otherwise, the assessment scores are used to guide decisions about referrals for permanent housing, permanent supportive housing, transitional housing, safe haven, or a programmatic shelter. Programmatic shelters offer an assigned bed for 60 to 90 days, with required participation in case management services.

Referrals

Once people are scored and matched to an appropriate program type, referrals are made to individual programs. Persons referred must meet any funder-mandated eligibility criteria of the programs (for example, an individual must have a disability for a Shelter Plus Care unit).

 All referrals for the most expensive programs - transitional housing, safe havens, and permanent supportive housing - go to the County, which maintains the waiting lists for these programs. Because many of the local providers operate several tiers of programs (shelter, transitional housing, permanent supportive housing, etc.) this system eliminates any concern that provider preference might come into play if providers referred people to their own programs. It also ensures that households determined to need a type of program at the different Front Door locations have equal access to programs. When there is an opening in a program, the provider informs the County, which refers the next eligible household on the list. When a referral is made, the provider can view the assessment screen for the referred household in HMIS.

The Policy Board established a set of ground rules for its referral process:

  1. The provider must accept 1 in 4 referrals from the Policy Board.
  2. Priority for openings in permanent supportive housing are people who are long-stayers in shelter (200 nights or more per year),   elderly, medically fragile, on the streets, or youth.
  3. Programs are not allowed to impose non-funder-required criteria that impose high barriers to entry, such as sobriety requirements.
  4. Vacancies in programs funded through the homeless system must be filled through the Front Door process. Units are no longer filled through direct referrals from community agencies. During the transition to FDA, the Policy Board honored programs’ existing waiting lists but programs could not add people to these lists through the traditional “side doors.”

Outcomes/Results:

The Policy Board conducted a six month review after launching FDA. The review included focus groups with consumers and provider staff and leadership. Over 95 percent of those participating said that the FDA process was an improvement, particularly the priority for long stayers in shelter.

The review also revealed some areas in need of improvement, including the need for improvements in tracking, management and reporting of FDA services through HMIS. FDA implementation also surfaced uneven adoption of FDA policies among providers and some weaknesses in program models or approaches across the homeless system. The next step for the Policy Board is to address some of these gaps, as well as boost provider trainings and improve the speed of referrals and management of the waiting list.

A Front Door Process final report was completed by the Policy Board’s consultants in December 2011. Most of the report reviewed the improvements in the implementation of the Front Door Assessment following the training and process changes made in response to the six month review. The final report provides baseline length of stay and recidivism information for every program to help the system prepare for HEARTH Act implementation. Recommendations for shifts in system inventory were made based on the program needs identified by the Front Door Assessment.

Overall homelessness in Dayton-Montgomery County fell by 9 percent between 2010 and 2011, including 12 percent for families and 9 percent for single adults. The January 2012 Point-in-Time Count was 5 percent below the 2011 PIT. While the FDA is primarily a decision tool for how to serve households once they are homeless, the fall 2011 expansion into shelter diversion has impacted the number of families that enter shelter. Reducing chronic homelessness is a Homeless Solutions Plan priority. Since 2006 chronic homelessness has fallen 61 percent, including a 20 percent reduction from 2011 to 2012. The FDA, with its focus on housing long-stayers, has had an impact on the number of people who are chronically homeless.

Lessons learned:

Resource commitments are integral to the transition process. The process of changing to a Front Door Assessment requires an investment of time and resources. The County funded the costs of the consultants and dedicated staff time for HMIS programming, convening provider meetings, and conducting trainings. The agencies delivering the front door assessments found they needed to spend more time than previously on assessment, HMIS, and referrals.

Ensure regular stakeholder involvement as the program is developed. Dayton-Montgomery County invested considerable time in ensuring stakeholder input and involvement through its Front Door Committee; in developing forms, manuals, and reports for FDA; and in integrating the process in HMIS. They also structured in regular case conferences and referral reviews.

Contact Info for Follow-up:

Montgomery County Homeless Solutions Leadership Team

http://www.mcohio.org/services/fcfc/homeless_solutions.html

Related Profiles:

Evidence-Based Practice: Permanent Supportive Housing

Promising Practice: Coordinated Entry

Promising Practice: Rapid Re-Housing

Model Program: Whatcom Homeless Service Center (Whatcom Co., WA)

Model Program: Columbus Coordinated Entry

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