We are reprinting this piece this week from previous content on the OrgCode Facebook page (which you should like by the way). Questions continue to come up on how and why the VI-SPDAT suggests people should be considered for certain groups of people. This attempts to answer that question.
One of the most popular questions we have been asked – especially with the growing use of the VI-SPDAT and the 25 Cities Initiative with homeless veterans – is a repeated variation of “How can rapid re-housing be an effective intervention for…???” – and then finish the sentence with “people unattached to services” and/or “people with a serious mental illness” and/or “people living outside for many years” and/or some variation related thereto.
Before diving too deep into the answer, there are a few important things to address: the purpose and approach to Rapid Re-Housing; the purpose and intent of the VI-SPDAT; the relationship between the VI-SPDAT and SPDAT; and, how it is possible to meet the definition of chronic homelessness yet still be recommended for a Rapid Re-Housing intervention.
In the VI-SPDAT and SPDAT tools, Rapid Re-Housing is seen as a specific type of intervention. Aligned with the overall philosophy of housing first, Rapid Re-Housing focuses on identifying people with a moderate level of needs. These individuals are then provided time limited financial and/or case management assistance, along with assistance accessing housing. Rapid Re-Housing is NOT simply access to an apartment nor is it just a subsidy. Given the flexibility of case management supports within this time-limited period (usually 3-6 months with some possibility for extension), some people will need a light to medium “touch” to stabilize in housing and access other mainstream services.
That said, there is nothing that precludes a case manager in Rapid Re-Housing from providing a more intensive level of support for a shorter period of time to help the person get connected to resources that will support ongoing housing stability. An example might be the person that has serious mental health issues impacting overall wellness, but is not currently connected to mental health resources in the community. A mental health diagnosis or a psychotic episode does not mean a person will necessarily require intensive supports for the rest of her/his life regardless of how they present at time of initial engagement. Everything we know about Mental Health Recovery proves this time and again. However, if a case manager is not trained on how to appropriately provide Rapid Re-Housing supports aligned with best available evidence and current proven practice, they may very well be stymied by the seemingly complex presenting issue(s) and think a more intensive service is required.
One of the other issues we come across is that people fail to understand exactly what the VI-SPDAT and SPDAT assess for, and therefore start making assumptions that are inaccurate. These tools examine current state of vulnerability and future risk of housing instability. They are born from peer reviewed published literature, considerable data, and a large number of government documents. They have been carefully tested and examined to ensure they do what they are supposed to do. Even with that said we sometimes hear things like “But the tool doesn’t examine how engaged they are with current services – and that’s a priority for us”. That may well be a priority – and may even be an appropriate one for your program – but connecting to services and a determination of whether those connections are effective is a function of case management (it gets at the very theory and practice of case management). If/when case management is done well, people that are disconnected from resources and have profound needs are connected to the best available resources in a meaningful way, can and do attach well and get positive outcomes. I stress “outcomes” here because it is not just making a referral or a scattered shot approach to seeing what will stick (that has more to do with how one might measure outputs) – what we want to know is if those attachments make a difference.
It also bears repeating that the VI-SPDAT and SPDAT are intimately related, but are different instruments. The VI-SPDAT is a triage tool. It looks for the presence of an issue. The SPDAT is an assessment tool. It looks at the nuances of the depth and impacts of what is happening in the person or family’s life. We always encourage people that use the VI-SPDAT to also use the SPDAT whenever possible. Why? One of the main reasons is that if you are ever in doubt of the self-reported response or depth of needs reported through the VI-SPDAT, you can explore deeper using other methods in the full SPDAT instrument. The analogy we most often use is this: the VI-SPDAT is the triage station in an emergency room, determining whether or not there really is an issue, the severity of the issue in comparison to all others that have issues at the same time, and the sequence/priority of serving people; the SPDAT is what happens when the physician sees the patient after triage, exploring a complete history, context, co-occurring issues, and the most appropriate treatment pathway. Both the VI-SPDAT and SPDAT inform the work of prioritization. It is providing objective, evidence-driven advice to the assessors on who should be served next and why. If a community had more staff, time, money, housing or other resources than it knew what to do with the matter or prioritization would not be necessary. Both the VI-SPDAT and SPDAT move service providers out of a mentality of first come, first served to a thoughtful, deliberate strategy that objectively determines who needs to be served in which order.
Lastly there is the matter of how a person can meet the definition of chronic homelessness and be recom- mended for Rapid Re-Housing instead of Permanent Supportive Housing or a more intensive intervention. There are several circumstances under which this may occur:
- There is a bottleneck in service delivery, and the individual has met the time requirements of the definition for chronic homelessness because there is a lack of capacity or other deficiencies in the service delivery system, rather than because the individual is dealing with complex, co-occurring issues that impact his or her ability to maintain housing;
- The person has a small number acute issues that seriously impact his or her housing stability, rather than a larger number of complex, co-occurring issues; the cumulative impact of these issues may result in the person meeting the definition of chronic homelessness even though he or she has lower overall acuity.
- Note: Most people that live in your community who are coping with issues like extreme poverty, substance use, or compromised mental health will never experience homelessness – that is a statistical fact, and as such it is better to understand what those individuals are able to do in order to access and stay housed, rather than acting on an assumption that homeless persons with the same characteristics MUST have permanent supportive housing in order to be successful in housing.
What the Data Shows
We have been able to pull comprehensive data from three test-site communities that have used the VI- SPDAT and SPDAT where:
- each community was trained on effective Rapid Re-Housing strategies by OrgCode Consulting,
- where we have thorough demographic data, and
- where housing retention data on the households is available and complete.Two of the communities are from Michigan and one is from California. In each test community we pulled a random sample, weighted by proportionate size of homelessness in the community, as per the last PIT Count. Each is a different size community with remarkably different characteristics.
Data on Households Recommended for Rapid Re-Housing Intervention
1 This includes any return to homelessness with current homeless or unknown status since time of initial housing access. Lengths of time since housed for households included in this data analysis were a minimum of 1 month (representing less than 5% of all households included in analysis) to households housed greater than 1 years (43% of all households included in analysis).
2 There is the presence of a mental health/cognitive functioning issue, substance use issue and physical health issue within the same person.
3 The Family VI-SPDAT and Family SPDAT were used for assessing these families.
4 If a family is noted as “Known to Have” a mental health, physical health, or substance use issue – it can be any member of the family, not just head(s) of household. Tri- morbidity in these instances means it is the same family member that has all three conditions, but still does not necessarily mean it is a head(s) of household.
5 These families represent 3,011 people.
6 None of the Youth Households were families, nor were any veterans.
As is the case in almost every community where data has been shared with us, the single greatest group of people requiring Rapid Re-Housing are non-chronic households, but there are, to varying degrees, a percentage of people in each community that meet the HUD definition of chronic homelessness, yet are recommended for a Rapid Re-Housing intervention based upon acuity level. Chronic homeless house- holds have been homeless longer on average; however, they do not consistently have higher acuity than their non-chronic counterparts.
Both chronic and non-chronic households have a percentage of households that lose housing and return to homelessness. It seems inevitable that this will happen for some of the households served. While chronically homeless households are slightly more likely on a percentage basis to return to homelessness, in absolute numbers this is a rather small number of households.
Furthermore, in digging deeper into understanding the characteristics of those households that lost housing, there is no significant relationship between losing housing and any particular presenting issue, whether that be mental health/cognitive functioning, substance use, physical health, or even tri-morbidi- ty. Overwhelmingly, a household with any one or combination of these issues is more likely to stay housed than to lose their housing.
What is not known from this data is the impact the training delivered by OrgCode Consulting on effective Rapid Re-Housing strategies had on the overall outcomes. As previously noted, each of these communi- ties received the training in addition to using the tools. There is no untrained control group in any of these communities to compare the results against.
There is a regular cycle for updating the VI-SPDAT. During the update cycle, any community using the VI-SPDAT is welcome to provide input for consideration on future versions of the tool. Analysis of all the input provided will provide a course of action for future amendments.
Increasingly, communities are seeking additional training on the VI-SPDAT – how to apply it; how it relates to prioritization; the best approach for engagement; etc. We encourage communities to go this route, especially if there is any doubt on its application or effective engagement locally. At a minimum we recommend that communities effectively use the VI-SPDAT Manual to ensure the application of the tool is sound.
Furthermore, many communities forget or did not know that they can add other questions to the VI- SPDAT, so long as they are non-scoring questions. Most often this occurs at the end of the survey. If there is a specific local or program interest that you want to inquire about, by all means add the other ques- tions. If that has a direct tie into program prioritization or priorities for a particular funding initiative, it allows for data sorting to occur in a meaningful way, staying true to the VI-SPDAT and your specific needs at the same time.