Coordinated Assessment

Federal Definition … 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. - CoC Interim Rule, Section 578.3

Components 1. Access 2. Assessment 3. Assignment 4. Evaluation

Components 1. Access: Coordinated and simplified entry point into the homeless response system.

Components 1. Access: Coordinated and simplified entry point into the homeless response system. Well-advertised, collaborative process with no side doors and no wrong doors.

Components 1. Access: Coordinated and simplified entry point into the homeless response system. Well-advertised, collaborative process with no side doors and no wrong doors. Access to initial assessment no matter where first point of contact may be.

Components 2. Assessment: Uniform, progressive assessment and documentation of clients housing needs and barriers by well-trained and clearly identified assessors.

Components 2. Assessment: Uniform, progressive assessment and documentation of clients housing needs and barriers by well-trained and clearly identified assessors. Initial Assessment : Screen to divert or prevent homelessness.

Components 2. Assessment: Uniform, progressive assessment and documentation of clients housing needs and barriers by well-trained and clearly identified assessors. Initial Assessment : Screen to divert or prevent homelessness. Full Assessment: Comprehensive assessment to identify: history of homelessness, barriers to housing, and personal goals, skills and assets of household.

Components 2. Assessment: Uniform, progressive assessment and documentation of clients housing needs and barriers by well-trained and clearly identified assessors. Initial Assessment : Screen to divert or prevent homelessness. Full Assessment: Comprehensive assessment to identify: history of homelessness, barriers to housing, and personal goals, skills and assets of household. Priority scoring based on assessment and community prioritization.

Components 3. Assignment: Linkage to appropriate services based on assessment, system mapping and written programs standards.

Components 3. Assignment: Linkage to appropriate services based on assessment, system mapping and written programs standards. Utilization of uniform system tools and process based on system mapping.

Components 3. Assignment: Linkage to appropriate services based on assessment, system mapping and written programs standards. Utilization of uniform system tools and process based on system mapping. Waitlist and prioritization based on assessment score and community priorities.

Components 3. Assignment: Linkage to appropriate services based on assessment, system mapping and written programs standards. Utilization of uniform system tools and process based on system mapping. Waitlist and prioritization based on assessment score and community priorities. Assistance with linkage to services for individuals with high barriers.

Components 4. Evaluation: Comprehensive evaluation of consumer outcome and performance (program, agency and system) to increase; effective use of resources (both staff and fiscal), quality of service to consumers, and the ability to proactively identify and plan services.

Components 4. Evaluation: Comprehensive evaluation of consumer outcome and performance (program, agency and system) to increase; effective use of resources (both staff and fiscal), quality of service to consumers, and the ability to proactively identify and plan services. Establishment, promotion and review of system-wide performance standards.

Components 4. Evaluation: Comprehensive evaluation of consumer outcome and performance (program, agency and system) to increase; effective use of resources (both staff and fiscal), quality of service to consumers, and the ability to proactively identify and plan services. Establishment, promotion and review of system-wide performance standards. Annual review of system tools and process with multi-level feedback.

Why Coordinated Assessment? 1.Opportunities for improved client outcomes. 2.Better utilize resources. 3.Opportunities for improved data: 4.Principals of effective crisis response 5.Experience with the Rapid Re-Housing Demonstration 6.CoC and ESG requirement

System ChangeCURRENT Uncoordinated Forms & Assessment are unique to system (prevention, ES, PH) Forms & Assessments are different for each provider. Referrals inconsistent and sometimes incomplete. Should we accept this client into this program?COORDINATED o Coordinated o Standardized assessment/forms. o Uniform process o Referral is comprehensive and done with understanding of entire system. o What housing and service strategy is best for this household based on the services available?

The Fargo-Moorhead Pilot Start Date: July 2, 2012 Goal: Soft Pilot of Coordinated Assessment Involved 4 Pilot Agencies Tested: - Triage tool, - timing, - access, - opening up HMIS - targeted referrals Included evaluations of: - consumers, - agencies - community partners

What we learned! o Triage Tool o simplified process for consumers & Case Managers o Training is essential. o Multi-levels assessment process is necessary for those with higher barriers to and to prioritize waiting lists and to help assure accuracy of referrals. o Took about 20 minutes longer post CA, but they felt they had a better assessment overall.

What we learned! o HMIS o Open system can provide benefits to consumers & agencies. o Need access to HMIS for non-HMIS referral agencies.

What we learned! Other o Education & training is essential! o Process in writing. o Tool not enough, Case Management is needed to help individuals prepare for housing once on the list (obtain IDs, gather rental history, etc.) Few individuals follow-up on their own.

Moving Away From… Having to call the same programs every day for weeks or months Being sent from program to program Finding out about more helpful programs too late Being asked the same questions over and over again

CARES is a collaborative initiative between North Dakota & West Central Minnesota Continuums of Care (CoC) designed to create a more effective and efficient homeless response system.

CARES Partners Churches United for the Homeless City of Fargo City of Moorhead Clay County Housing & Redevelopment Authority Creative Care For Reaching Independence Dorothy Day House of Hospitality Fargo Housing & Redevelopment Authority Fargo Public Library First Link Gladys Ray Shelter and Veterans Drop-in Center Lakes & Prairies Community Action Partnership Legal Services of NW MN Moorhead Public Housing Authority New Life Center SouthEastern North Dakota Community Action Agency The Salvation Army of Fargo, North Dakota Fargo VA Welcome House YWCA Cass-Clay

CARES Overview The joint CoC initiative is based upon; A desire to ease access to services for clients who migrate across the ND/MN border. (26.8% A long history of cross-boarder collaboration FM Coalition for the Homeless Tri-annual Wilder Study Annual Homeless Point-in-time count A desire to have improved data. Better understand duplication of client data & services Identify gaps & needs for improved system planning.

Guiding Principles 1.Reorient service provision 2.Identify which strategies are best for each household 3.Link households to the most appropriate intervention 4.Provide timely access and appropriate referrals 5.Shorten the number of days homeless 6.Provide immediate access to information 7.Create an advanced system Collaborate 8.Provide for ongoing participation

Anticipated Benefits 1.Client focused 2.Increased efficiency 3.Improved Communication 4.Planned service strategies 5.Better-quality data 6.Greater Consistency

Anticipated Benefits Client focused : Easier access. Dont have to navigate what can sometimes be a complex system. More effective outcomes for clients when linked to right intervention.

Anticipated Benefits Increased efficiency : Case managers will have quick access to online service directory and key client data. Clients do not have to repeatedly fill out intake forms and repeat their story. Progressive assessment and online directory simplify eligibility and referral process.

Anticipated Benefits Improved Communication: Easier for agencies to identify discrepancies, missing data and issues. Agencies utilizing system have reported better collaboration in helping client achieve goals.

Anticipated Benefits Planned service strategies: Communities can prioritize service specific populations/subpopulations based on current trends and needs of clients. Service delivery system is clear and intentional. Written standards for administration of programs.

Anticipated Benefits Better-quality data: Increased understanding of system gaps/duplication (unduplicated & system-wide). Easier to review performance (agency, program and system).

Anticipated Benefits Greater Consistency: Equal access to services for anyone entering the system eliminating inequality based on personality conflicts, discrimination or agency/client history. Process (access, assessment, and referral) is the same for everyone and based on assessment score not where or when a client enters the system.

Managing Expectations o Coordinated Assessment wont create more housing. o An assessment tool and open system wont deliver perfect information. o A system mapping survey and assessment tool alone wont change your system.

Planning: Next Steps 1.System Mapping 2.Continue with HUD Technical Assistance 3.Establish a Governance Structure 4.Launch an open data management system.

Planning: System Mapping 1. Understand existing system interventions: Identify stakeholders and services in each CoC system. Identify the system gaps and duplications Identify the flow of persons through the system. 2.Help to establish link between CARES assessment and intervention: Determine assessment score linkage to intervention type. Help individuals be placed in right intervention as soon as possible to assure best outcome and utilization of services. 3.Help set written standards for CARES: List eligibility criteria for intervention and programs. Identify intervention components and definitions. Help determine processes and protocols. 4.Determine system intervention improvements: Evaluate inventory for potential development. Determine if there are needed changes to the flow. Analyze inventory for potential reassignment or program specialization to better meet needs of the system.

Planning: TA 1.Coordinators participate in monthly progress calls. 2.Review TA timeline and make assignments to respective committees. 3.Review example documents provided by TA providers. 4.Host TA calls and webinars as needed to provide education, support and information to identified groups (committees, subpopulations, governance, etc.) 5.Send proposed forms, policies and protocols to TA providers for review.

Planning: Structure 1.Elect a Governance Board CoCs vote on representatives. FMCHP votes on representative. 2.Participate in a Committee Protocol Implementation Performance & Evaluation Data 3.Hire Staff Continue to fundraise for key positions Evaluate reassignment of existing resources

Planning: Data 1.Participate in State of MN HMIS Technical Assistance 2.Obtain estimate from Bowman for Data Bridge 3.Review and pilot potential assessment tools 4.Develop a fundraising plan for Data needs.

THANK YOU! Questions? Comments?