Mar 102014

We continue to be overwhelmingly pleased with the expanded use of the Service Prioritization Decision Assistance Tool (SPDAT for short) and the VI-SPDAT as well. The more data that is shared with us from communities (made anonymous) the better. One of the very interesting things to observe is the small group of people in communities (has been less than 5% in the data that we’ve seen of all assessments, but in some communities making up more than a quarter of all higher acuity households) that have higher acuity, but DO NOT meet the HUD definition of chronic homelessness. Maybe it is time to re-think our targeting efforts for programs based upon acuity level, not based upon eligibility of meeting a definition of chronic homelessness (or maybe we need to rethink the definition of chronic homelessness to include some consideration of acuity). If we don’t, some of the most unwell people on our streets and in our shelters will never meet eligibility criteria for some of the support and housing programs best capable of meeting their support needs because there are many Permanent Supportive Housing programs exclusively for chronically homeless persons – and in some communities ALL of the PSH is for chronically homeless persons.  Acuity speaks to the severity of a presenting issue. In the case of an evidence-informed common assessment tool like the SPDAT, acuity is expressed as a number with a higher number representing more complex, co-occurring issues that are likely to impact overall housing stability. Chronic by [...]

Nov 252013

Let us put an end to waiting lists for housing (or – gulp – shelter for that matter). Let us replace those lists with priority lists. Waiting lists, with some exceptions, are not designed to serve those with the deepest needs. They are designed to serve those that have waited the longest. But here’s the thing – if I have really deep needs it is entirely possible that I will die before my time comes up on a waiting list. Imagine if emergency rooms took the waiting list mentality. Last night, Sally stubbed her toe. She goes to the ER and is told by triage that there is nothing they really do for a stubbed toe and that she should go home. Sally insists on waiting. This morning, around 6am, Bernie sliced his finger while making breakfast. He goes to the ER. Triage tells him they aren’t sure if he is going to need stitches or not. They bandage him up. They tell him to take a seat until a doctor becomes available. They tell him that if anything changes or gets worse, to come back to the triage window. Fred had a heart attack at 9am. Sally is still waiting. Bernie is still waiting. Who gets served next? Fred. But why? Haven’t Sally and Bernie been waiting longer? Yes they have. But Fred’s needs are more acute than Sally and Bernie. If you don’t serve Fred right away he may die. Bernie can wait a little bit. Sally, well, [...]

Aug 192013

Is your community trying to move towards common assessment as part of coordinated access? You should be. In response to inquiries from a few avid blog readers (thanks!) here are some questions you should ask when your organization/community is choosing an assessment and prioritization tool. 1. Is it grounded in evidence? There is no shortage of ideas on what may be a good thing to assess when a homeless person or family seeks services. Unfortunately, too many communities come up with their own list (sometimes LONG list) of things to assess without those ideas actually being grounded in evidence of what works, and the main currents of thought and practice in service delivery. That which we think and that which we know are often two totally different things. Your assessment tool should be grounded in knowledge and data, not unsubstantiated thoughts or feelings. 2. Has it been tested? Given the assessment tool informs which type and intensity of service an individual or family may be offered, it is important to make sure the tool actually does the things that the designers of the tool thought it should do in the first place. This requires extensive testing and feedback in trial versions of the assessment tool. It also requires testing the tool against other potential tools and the use of no tool at all. 3. Has it been independently evaluated? Researchers and developers involved with the tool do an incredible amount of leg work to get the tool off the ground. [...]

Nov 182011

PART SIX: Using Data to Drive Program Improvements Data. I know it is a four-letter word. It makes policy wonks salivate lustfully and makes many front-line practitioners run for the hills (or the bottle). Truth is, data doesn’t have to be scary or cumbersome or a nuisance. Done right, data is the ace up your sleeve to make your program transition from good to great. As a starting point, know that there are resources out there that can help you if you are unfamiliar or uncomfortable with data. The National Alliance to End Homelessness has a range of nifty resources. I especially like What Gets Measured Gets Done. Data and performance measurement is also a subject matter I get asked to speak about a lot. So, if you want to check out some of that – littered with “Iain-isms” – feel free. Plus there are a few previous blogs (not part of this current series) where I have talked about performance measurement, data and organizing information in the context of functioning like a system instead of a collection of projects. This one in particular is short and the feedback we’ve received suggests it is my most entertaining blog entry (fire alarms, vibrating bed, strobe lights, knocks on the door in the middle of the night – how can you go wrong?). A couple of other articles may be a useful read if you are unfamiliar with some of the core concepts of data and performance management, or want to better [...]

Sep 142011

So you have a client that has engaged in case management supports with your organization, but they never seem to be around or seem completely unengaged when you do meet. They have high acuity. They likely have several complex issues and have experienced long-term homelessness. Is the fact that they are rarely around or seem completely unengaged sufficient to “cut them loose”? Should your organization move on to another person who is more eager to actively participate in what you have to offer? No. In this blog I talk about how to use assertive engagement appropriately to first engage with people who have accepted case management services and then become unengaged, as well as how to effectively engage with people who are homeless and do not seem interested in having a conversation about housing and case management. In a perfect world – heck, even in a lot of “normal” therapeutic environments – people seeking service come to a safe support environment. Appointments are booked. People are focused on the support and not distracted. People are sober and have taken medications. People have absolutely embraced that they want support and are going to work their butts off to get better. This is not the reality I work in. When working with a population with long-term street engagement, this is not the norm. Sometimes the best environment you get is an encampment in the woods or a dry spot under a bridge. In my career I’ve had to engage with people from [...]

Apr 292011
Prioritizing Who Gets Served Next Matters – The Service Prioritization Decision Assistance Tool (SPDAT)

When I led the largest Housing First program in North America, one of the things that bothered me was that we had no defensible way to prioritize who we served next. We dabbled with different instruments and had some stellar research thanks to folks like Toby Druce – but couldn’t quite put our finger on exactly how to prioritize who got served next and why. At least not in a defensible, reliable, consistent and valid way. Sure, there are some awesome instruments out there like the Vulnerability Index used by Common Ground and now the 100k Homes Campaign (and we are big fans of both); the Camberwell Assessment of Needs; the Outcome Star; the Denver Acuity Scale. But none of these were a perfect fit for the type of Housing First program that I was leading or other Housing First programs that I was familiar with. One of the first things I started working on when I made the move to OrgCode was to develop the right tool for determining who should get served by what type of housing intervention and why. Being the nerd that I am, I took an inventory of all existing tools that I could get my hands on – hoping that I had just missed something in my previous work. No point re-inventing the wheel. Truth is, not much with credible overlap other than the ones previously mentioned – and even then, too many limitations or shortcomings. I found a small number of communities and [...]