Assessment & Prioritization Tools: What to Look For

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 inevidence 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. After implementation, having a credible independent evaluation completed is a good idea. An independent point of view can examine the data that comes from the tool from a fresh perspective, explore the processes involved with the tool, and also look at the outcomes that arise from using the tools.

4. If two different people are using the tool, will they get reliable results?

The only way to know this for sure is to have an independent examination of inter-rater reliability in the use of the tool. What this really gets at is whether independent bias or other related factors unduly (and even unintentionally) sways the results of the assessment.

5. Is feedback from end users of services, frontline staff and others incorporated?

Any assessment tool worth it’s salt will take the time to robustly gather feedback from a broad cross-section of individuals and families with whom the tool has been used to better understand what they think of it and how the tool could be improved. Getting the input from frontline staff that either undertake assessments using the tool and/or use the data from the tool to inform support services should also be given an opportunity to provide feedback and input into the tool improvements.

6. Does it help inform decision-making?

Assessment tools don’t make decisions – they inform decisions. It is a mistake to anthropomorphize a tool and think that it has a brain or speaks. It doesn’t. The information gleaned from the assessment feeds into a prioritization process. If there isn’t a defined process for how to use the information from the assessment to inform prioritization, then the assessment information is misaligned with how it needs to be used.

7. Is there any utility to the tool after the initial assessment?

Having a score or conclusion on depth of need or type of support from an assessment begs the question – so what? The assessment information should help guide service delivery for particular populations with specific types of needs. It is even possible to use the same tool that was implemented at initial assessment at predetermined intervals to actually see if acuity of the individual or family is going down over time.

8. Will it improve housing outcomes over the longer-term?

Longitudinal information helps inform whether the support programs that the individual or family gets connected to as a result of the assessment actually improves housing stability. If the assessment tool highlights the areas that benefit from the most intensive types of supports so that housing does not become destabilized, then the tool is also important for promoting and even supporting longer term housing stability.

OrgCode Consulting developed the Service Prioritization Decision Assistance Tool (SPDAT) that meets all of the requirements of what is asked above. You can learn more about the SPDAT here and here. You may also be interested in the integrated Vulnerability Index (VI) and SPDAT Prescreen “Supertool” which you can learn more about here.

Gone Fishing – And That’s a Good Thing

As you read this I have literally gone fishing. I am in the middle of nowhere in Northern Ontario less than two hours from where I grew up. In fact I am on a small island in the middle of a lake that is only accessible by boat. There is no cell coverage where I am. My phone is off. My computer has to wait until Friday. All I am concentrating on until Friday is making sure my eldest son is having a good time, and his uncle, grandfather and cousin aren’t spinning him tales around the campfire that will keep him up for days.

I wasn’t always this way. The thought of taking time off work used to create huge anxiety for me. When I used to lead a rather large street outreach and housing program I feared that there would be a huge client crisis or a big issue with one of my staff while I was away, or that the Mayor would need me and I would be unavailable and let him down.

Not only would I fear taking vacation, I would keep my phone on all day, every day of the week. No matter what time someone tried to get a hold of me, I was on it. Every vibration of an email elicited the same response of grabbing to scan whom it was from and whether it demanded my attention. In my Blackberry days, I would even feel phantom vibrations on my hip when it wasn’t attached to me.

I also used to work until about 11 or midnight every day and then get up early enough to get to the office for 6am so that I could have a couple hours of quiet time before the noise and demands of the day consumed me. And I worked at least Saturday or Sunday pretty much every week. When I was traveling to help other communities understand what we were doing, I would spend all evening into the wee hours staying current on everything that I couldn’t do because I wasn’t in the office that day.

Why on earth did I do all that?

I was afraid that others measured the value of my contributions by how hard I worked. I was afraid that if I didn’t work that hard I wouldn’t be a credible leader when I asked my staff to do half as much. I was afraid that people would only think I was smart if I churned out a huge volume of high quality work in a short period of time. I was afraid of failure. I was afraid that if I took my foot off the pedal that we would lose momentum in the massive change initiative that we were working through to alter homeless services. I was afraid that my boss would find a replacement for me. I was afraid of not using my talents to their fullest potential. I was afraid of being lonely – even when I felt alone while surrounded by other people. I was afraid that if I took time out for me I would be scared to confront who I had become and all of my shortcomings…my remarkable imperfections.

You may say it all sounds insecure. And it is. You may think it all sounds unhealthy and unreasonable. And it is. You may believe this is exactly the wrong type of behavior to exhibit to a staff time. And it is.

You may be that person or have been that person. Or maybe you have worked with someone that demonstrated similar behavior.

I didn’t know it or appreciate it at the time, but there is a link between these tendencies and depression in some people. I am one of the “some people”. I thought all of this behavior would make me feel whole. It didn’t. I still have the scars of these efforts that damn near killed me – or to be more honest, made me want to kill myself sometimes or at least muse about what the world would be like without me in it. (If you are a new reader and don’t know about my depression you can read this or watch this video I made after the Sandy Hook shootings last year.) No amount of being busy ever actually compensated for the emptiness I felt inside most days.

I am still learning how to relax and truly practice self-care. Make no mistake, I am a work in progress on that front. But over the last three years as I have started to make a conscious effort to practice wellness, I have come to realize that one of the best things I can do every summer is to make sure there is a week that I am gone fishing and completely unwired from the inter-web. It is part of my Wellness Plan, which I have integrated into my life to help me ensure that I am aware of what I need to do to increase the likelihood of remaining well.

Maybe I will hear the loon’s calling each other repeatedly. Maybe I will see a moose or bear or other great Canadian creature. Maybe I’ll catch a bass or 12. Maybe I’ll hear my dad’s fishing stories again. Maybe my brother and I will relive another one of our adventures from our childhood. All that stuff doesn’t matter as much as taking the time to not focus on work and just focus on decompressing…taking time to be well and appreciate wellness.

The outcome of practicing self-care is that I tend to be more relaxed, which in turn makes me more focused. When I am more focused, I am more productive and more attentive to the needs of all the people I support and work with in the pursuit of ending homelessness, increasing affordable housing, and putting social policy into practice. I will never be all things to all people; but with the right break, I can be a better person to many people, starting with myself.

Values I Can Get Behind

Since late in 2012 I have been doing some work with Crossroads Rhode Island. They are a large multi-service organization in Providence offering a wide range of services to meet a plethora of needs within one organization. From showers for people living rough through to housing, they have it covered.

However, I am writing this blog not to outline Crossroads’ services, or to talk about the work I have had the privilege of doing with the organization. (Though I do like the organization quite a bit and could easily brag about them.) Nope – what I want to talk about are the three values that they use to drive their organization. There is something radically awesome about the power and simplicity of the three values they have:

Safety – promoting an environment free from physical and emotional harm and ensuring a feeling of security and comfort to all.

Respect – acknowledging the intrinsic worth of every person.

Effectiveness – delivering services and managing the organization with efficiency, professionalism, innovation, and accountability.

(To be clear, the organization developed these values completely independent of OrgCode.)

I am especially enamored with Effectiveness as a value for an organization. To me, if an organization values Effectiveness it means they believe in doing things that are proven to work rather than relying on what “feels right”. When the value of Effectiveness is put into practice, it means that trying hard or meaning well is insufficient.

As an employer, when Effectiveness is a value I think it says to the staff team that there is a willingness to help ensure they are successful at their jobs. If this means exposure to new ideas or more training, then this has to happen. You can’t say you want to be effective and then figure everyone will figure out on her/his own how to be effective. I love how professionalism is explicitly stated as part of Effectiveness.

I appreciate that Effectiveness, as it is valued within Crossroads Rhode Island, encompasses both service delivery and management. I can think of too many examples where this type of value was out of whack between service staff on the frontlines and those a step removed from service users. What this says to me is that Effectiveness is the responsibility of the entire organization.

The last thing that I love about Effectiveness as a value is that putting this into practice increases accountability. I don’t see how one can claim to be effective without there being measures of efforts in delivering services, and preferably a measurement against a standard or expectation. Measures open up the opportunity for accountability. And for which people does this accountability matter? End users of services are the most important in my books. But peers on the staff team, the organization as a whole, peer organizations in your community, and funders also come to mind.

Does your organization or community take Effectiveness serious enough to make it one of your core values? Worth considering, ain’t it?

2013 National Alliance to End Homelessness Conference: The Top 3 Things I Took Away from This Summer’s Conference

Every summer, for almost a decade now, the Conference on Ending Homelessness put together by the National Alliance to End Homelessness in Washington, DC has been a highlight for me. It has become a tradition. It reinvigorates me. It teaches me. It reminds me why we do this work – day in and day out.

There is no way to fully capture in this blog everything that was discussed at the conference. If you search the hash tag #naeh13 you can see the thread of some of the most dominant themes by some rather prolific tweeters.

In this blog, I wanted to reflect on the top three things that I took away from the conference this year – which may also be of interest to those unable to attend:

1. Success is possible.

It is inspiring to see the success of communities like New Orleans on track to end chronic homelessness. It is invigorating to see the results of the 100K Homes campaign, especially the 43 communities in the 2.5% club. It is refreshing to hear how communities like Grand Rapids and Cleveland made the necessary, but difficult, decisions to properly coordinate access into their homeless service delivery system. It is awesome to hear how organizations like UMOM in Phoenix transformed their resources to focus on serving people with higher acuity and many barriers to housing stability.

And I could go on. For anyone who feels that the job of working to end homelessness is an impossible task, take the time to look at those that are seeing success. But I should point out that each of these communities had to make tough choices to not provide business as usual. Success came from doing things differently – not doing the same things but expecting different results.

2. There is still confusion of some key concepts and terms

It is unfortunate – but an opportunity for improvement – to help people get greater clarity on several key concepts and terms: Housing First; Rapid Re-Housing; Prevention; Diversion; Acuity; Assessment; Collaboration; Case Management; Permanent Supportive Housing. For each of these, I encountered it used incorrectly on more than one occasion. If we are going to move forward collectively in the pursuit of ending homelessness, I think it will be important to all get on the same page when it comes to the concepts and terms used quite frequently. If we aren’t all on the same page, chances are we will think we are talking about the same things when we are not, or drawing upon a body of evidence and data in an incomplete or incorrect manner.

While I have addressed many of these in blogs and videos on our website, I think a consolidated glossary would probably be helpful too. I should really get on that.

3. Good data results in good decisions

The conference reinforced the importance of data many, many times. Data will only continue to become more important for decision-making as funding remains stagnant or decreases. And it is becoming more and more important for philanthropic investments.

It was encouraging to see communities like Tulsa use data so effectively for increasing the housing stock while also demonstrating social return on investment. It was excellent to see the likes of San Francisco demonstrate, through data, the relationship between the child welfare system and homelessness – and when the support intervention may work best. It was helpful to see how USICH and HUD both shared data to demonstrate where there has been effectiveness, and where improvements still need to be made.

It is a real delight to attend the Alliance conferences and learn. The next conference focuses on homeless youth and families and is being held in New Orleans in February. Stay tuned to endhomelessness.org to get more information – it is time and scarce money well invested!

5 Considerations for Making Collaboration Work

I have previously written about collaboration and its importance in another post. I want to take it a step further in this blog, providing you five considerations for making collaboration work in your community or organization – whether that collaboration be for the purposes of planning or implementation.

1. Agree on How You Will Communicate With Each Other

Your collaboration should be about participants focusing on ideas, not chasing each other down, having “offline” conversations, contributing to the rumor mill, or engaging in the politics of difference through talk in order to gain power. Determine in advance who will talk to whom, when and the frequency for doing so. Make sure people know the process for how this will occur, and that communication outside of this process will be seen as a violation of the collaboration.

I know this may sound rigid. But the truth is, many great ideas, plans, and programs go completely sideways solely because of communication errors.

2. Ensure Creative Conflict

Creative conflict is both powerful and productive. Many successful collaborations have also found this to be necessary. Having creative conflict doesn’t mean collaborators badger each other or act disrespectfully. All it really means is that there will be stimulating, fun and innovative ways to ensure people move beyond quiet politeness or other forms of holding back from contributing. When people are “all in” there is a better change that the collaboration will reap better rewards because each person had to put their best ideas forward…being both vulnerable and potentially rewarded for doing so.

3. Be Deliberate and Thoughtful in Figuring Out With Whom You are Collaborating

People collaborating should have a purpose for doing so. It isn’t about having a passing interest or simply volunteering. Some planning and implementation fails because great efforts went into getting “inclusive” participation rather than focusing on who has a vested interest as well as the skills, experience, motivation and compatibility with others that they will be collaborating with. Collaboration isn’t for everyone. Not all people/organizations are willing or able to blend their perspectives with others or share success/failure from what comes out of the collaboration. Furthermore, people that feel they have to be there rather than wanting to be there will not be as fully invested as it may be hoped. Finally, position power (an Executive) may have been the traditional “go to” person for the collaboration, but ultimately the level of experience or type of thinking you really need is not at the most senior level of the organization you are hoping to collaborate with. Look at the qualities of the collaborator, not just the job title.

4. Have a Defined Process

Collaboration requires structure. Random brainstorms don’t work long term. Without attention to participation methods there is a greater likelihood of a smaller number of the group dominating the conversation or idea generation – or both. A range of facilitation techniques are necessary to be effective when working with diverse collaborators as they rarely get fully involved or invested in just one approach. For your collaboration to succeed you need to ensure that the people (and whether or not delegates are allowed), processes and resources are well-defined in advance so that people can focus on actually collaborating, not managing or responding to logistics.

5. Make Certain There is Accountability

Collaborations should try to focus on equitable, reliable participation from the collaborators. Deadlines are a must – and deadlines only really work if there is some type of consequence to meeting the deadline. Working respectfully means there has to be an onus to complete tasks or activities that each collaborator (or group of collaborators) agrees to accomplish. Trust and morale goes out the window if accountability is violated. Double standards, delegating by omission (not completing tasks and watching others swoop in before deadlines to ensure it gets done), ungrounded postponements, etc. all kill effective collaborations.

The Three R’s of Mindset in Human Services and How Each One Impacts our Perspective and Approach

Whether it is direct service, working with community partners to improve the service system, government policy, or funding – you have to consider the three R’s of your mindset. Each one impacts your perspective and approach. One of the R’s is proven to get better results than the others – though it should be acknowledged that none of them are perfect.

Retribution

We need to get out of the mindset of retribution. Coercion, threats, intimidation, and/or undue pressure do not result in everlasting change, positive results, “buy-in”, trust or sustainable relationships. It also neutralizes the possibility of creating an opportunity for dialogue when there are divergent points of view.

Reciprocity

We need to get out of the mindset of reciprocity. Bargaining, paybacks, obligation through ingratiation, “scratch my back and I’ll scratch yours”, and/or trade-offs do not result in transparent decision-making. It also fails to take into account that agents involved in the deal making change, as do the circumstances and stakes of what is being reciprocated. An approach that uses reciprocity also runs the risk of someone or organization being asked to bend their rules, amend their values, or turn a blind eye when what they are being asked to reciprocate collides with who or what they truly are – but there is a feeling of owing.

Reasoning

Reasoning is the preferred approach that results in better, longer-lasting, sustainable, transparent and defensible approaches to engagement. With a reasoning mindset there is a presentation of facts (not opinions), an appeal to values, an appreciation of the goals of others (and when and when there is not the possibility of alignment between them), and, an intentional approach to have the mindset fit neatly with the assessed/understood needs of the other party.

As you engage with others, think about your tactics that ground your mindset. Yes, reasoning takes longer. Yes, there are unreasonable people/organizations that fail to agree with facts. But I would be happy to have anybody else know my reasons whereas with reciprocity and retribution I’m not so sure. I would also be happy to know that I prepared and presented facts that were considered and perhaps dismissed, rather than just expecting another person or organization to do something because they were told to or felt indebted to me.