1. Meaghan Bell University of Calgary Housing First & Screening Tools For Communities Stephen Gaetz Canadian Observatory on Homelessness, Professor, York University Paula Goering Centre for Addiction and Mental Health, University of Toronto

2. PART 1 What is an assessment?

3. Allows for initial engagement Determines if individuals meet program eligibility requirements. A system of prioritization can be developed in order to place individuals with the highest needs into Housing First services quickly. The Screening Process can Serve Several Purposes

4. Assessment Roadmap 1. Screening 2. Service/Support planning 3. Service/Support provision

8. Assessment is but one part of a broader community strategy in working with people who are homeless.

9. Where does ASSESSMENT fit in? Clinical Assessments Community Priorities Intake Assessment Tool Interventions Case Management Data Management Systems (HMIS, HIFIS)

10. PART 2 Assessment in the Community Context

11. What is your community context? Community priorities? (Chronic? High acuity mental health and addictions? Youth?) Community assets? (Can you assemble an ACT team? Do you have permanent supportive housing?) Data management and alignment with other data being collected

12. Certain Domains Should be Assessed HOUSING STATUS: Is the person homeless? Chronically? Episodically? VULNERABILITY STATUS: What is their level of vulnerability (physical health, mental health, substance use)? Is the person at risk of harm to him/herself or others? SERVICE USE: Is the individual a high service user? SEVERITY OF NEED: What is the individual’s severity of need (low, moderate, high)? FURTHER ASSESSMENT: Does the individual require further assessment or assistance?

13. Critical Steps to Implementing a Screening and Prioritization Tool 1.Understanding ecology of homelessness in your community 2.Consensus on priority population(s) – i.e. chronic shelter users? High system users?

14. 4.System Mapping – what resources does your community have and how may this impact the screening and prioritization? 5.Be open to adaption in order to meet your local needs! 6.Use the tool as a mechanism to facilitate collaboration and shared planning across the homeless serving sector (e.g. placement committees) 7.Engage in ongoing consultation and feedback with those using the tool

15. PART 3 What makes for a good screening assessment tool?

16. Characteristics of a Good Tool: Responsive to community needs Evidence based and effective Ease of use (for providers and clients) Assists in service planning Complements other tools Community capacity building (including training) USEFUL!

17. Brevity and Usability An assessment tool should include a question only if the answer to that question is needed right then to determine what kind of assistance a person will receive.

18. No Single Tool Can or Should do Everything Priority setting Screening Intake Triage Acuity assessment Case management

19. Evidence Based Rely on tools that are tested evidence based and there is clarity about what is being measured.

20. A word of caution: Assessment tools are one source of information to guide decision making. Avoid SCIENTISM! They are not magic, and they cannot make decisions for you. Trust your own knowledge as well.

21. Training and Technical Support that is SIMPLE and builds community capacity

22. PART 4 Review of Existing Tools

23. Inadequacy of certain tools to match community priorities Cumbersome nature of existing tools Confusion about what is the ‘right’ tool Responding to Concerns From Communities About: We decided to review tools to provide guidance to communities Pressure to identify people who are appropriate for HF Increasing cost of tools and/or training

24. Task Force Composed of researchers, service providers and person with lived experience Scan of practices and tools in homeless sector Rated using HUD criteria Key informant interviews conducted Identified most promising tools and selected one

25. Who developed it? Who is using it? Strengths? Weaknesses? Ease of use Areas for Assessment Appropriateness for assessment Cost EVIDENCE: Supporting literature / Validity / Reliability

26. HUD Rating Criteria Tools should be valid, reliable, inclusive, person- centered User-friendly, strengths- based, have a Housing First orientation, Sensitive to lived experience and transparent.

27. Vulnerability Index Calgary Acuity Scale Denver Acuity Scale Rehousing, Triage and Assessment Survey SPDAT Memphis/Shelby County Intake/Assessment Packet Alliance Coordinated Assessment Tool Set Tools Assessed DESC – Vulnerability Assessment Tool Homelessness Asset and Risk Screening Tool (HART) LondonCAReS Hennepin County Rapid Exit Screening Rural Arizona Self-Sufficiency Matrix Homelessness Outcomes Star City of Toronto

28. Vulnerability Assessment Tool (VAT) Recommended Tool

29. Developer: Evaluation?

30. Domains of VAT Survival Skills Basic Needs Mortality risks Medical risks Organization/Orientation Mental Health Substance Abuse Communication Social Behavior Homelessness

31. Strengths of VAT Easy to use and covers all necessary domains Relatively short Evaluated by external researchers Good reliability and validity Structured interview with behavioral anchors Person-centered Includes strengths

32. Survival Skills

33. Caveats regarding VAT Use Just one phase of assessment process May need to be complemented with other data sources and communication vehicles (referral sources, case conferences, individual preferences) Developed for single adult population, will require adaptation or other tools for families, youth, victims of violence, etc.

34. PART 5 Coming Soon!

35. Screening tool will be free VAT to be added to HIFIS Manual available from COH Training and technical support will be low cost with goal of building community capacity to support training on an ongoing basis Last Comments

36. Questions or comments? www.homelesshub.ca