DAYTON-MONTGOMERY COUNTYFRONT DOOR ASSESSMENT

National Alliance to End Homelessness

First Contact: Creating a Front Door to Your Homelessness System

July 13, 2011

MOVING FROM A PROGRAM CENTERED SYSTEM TO A CLIENT CENTERED SYSTEM

FRONT DOOR ASSESSMENT OVERVIEW

A consistent assessment tool and scoring process to determine appropriate exit from homelessness, administered at all the ‘front doors’ to the homeless system.

Policies related to program and client acceptance expectations.

HOMELESS SYSTEM IN DAYTON-MONTGOMERY COUNTY

DAYTON-MONTGOMERY COUNTY COC

Homeless Solutions Community 10 Year Plan: A Blueprint for Ending Chronic Homelessness and Reducing Overall Homelessness in Dayton and Montgomery County, OH adopted in June 2006

Received $7.2 million in 2010 CoC funding from HUD

965 homeless people in 2011 Point in Time Count

DEVELOPMENT OF THE FRONT DOOR ASSESSMENT

BACKGROUND

System defined by program eligibility and intake decisions made by individual programs.

Shelter case managers to submit applications for every possible program person could be eligible for.

Lack of data on client need to make system planning decisions.

GOALS

Rapidly exit people from homelessness to stable housing.

Efficient and effective use of system resources – clients receive appropriate services.

Ensure that all clients, including the hardest to serve, are served.

Transparency and accountability throughout the assessment and referral process.

FDA DEVELOPMENT BACKGROUND 10 Year Plan finding that some homeless people were

never successfully engaged by the existing system and that the system was hard to navigate.

2007-2009 – Initial Front Door Committees meetings Review assessment tools from other communities Develop assessment structure (independent organization vs.

existing providers) Identify provider concerns (oversight of assessors to ensure

objectivity and fairness) Interim implementation of assessment in family system

because of temporary closure of a shelter program Secured funding and developed RFP for Front Door

consultants Requirement to participate in Front Door Assessment

once it started in RFPs for local and CoC funding for last 2-3 years.

FDA DEVELOPMENT

Jan 1st – Aug 1st 2010 –The Front Door Committee and Consultants: Conducted client focus groups on current system

and provider interviews and meetings by program type

Defined each program type in system – clients served, length of stay, program & system outcomes (using HEARTH), positive exit destinations

Developed assessment tool, scoring matrix, referral process and timelines

Developed policies related to FDA implementation – PSH priorities

Programmed FDA into HMIS

FDA DEVELOPMENT (CONT.)

Trained assessors on FDA Trained providers on receiving FDA referrals Developed FDA reports

Provider input through meetings and calls at every step of the process. Substantial changes made to every FDA component as a result of this input.

Initially expected July 1st implementation but significant provider concerns in June delayed implementation for a month.

PROVIDER FDA CONCERNS

No provider refused to participate in FDA. The concerns expressed before implementation included: Developed program over long period including entry screening

criteria of time to ensure serving right clients Currently receiving referrals from other sources Lack of PSH and affordable housing made outcomes hard to

achieve Need more than 7 days to decide if they will take a referral Requirement to take 1 in 2 referrals too limited, may need to

reject several consecutive referrals Takes operational control over who they serve from the agency,

agency needs ultimate control over who is housed and evicted Proposed process is too bureaucratic Assessment tool does not adequately assess mental health or

predict client behavior Requiring reviews of self-referrals will delay clients receiving

services

RESPONSE TO PROVIDER CONCERNS

Delayed implementation by 1 month to discuss concerns and conduct additional training.

Changed rejection policy to 1 in 4 referrals instead of 1 in 2.

Agreed to Six Month Review to assess FDA implementation impact.

INTAKE ASSESSMENT

Initial questions – What led you to come here? What do you need right now? What is your plan for leaving shelter?

HUD required data elements with additional housing questions focused on whether household can be diverted from shelter

Income Clients’ support network/Independent living Questions related to leaving shelter – legal issues,

pregnancy, IDs, school location for children, homeless history

Rick Assessment – sex offender status, mental health, medications

Diversion Plan developed if appropriate

COMPREHENSIVE ASSESSMENT

Five year housing history Five year employment history Income - Benefits & Entitlements Debt/Expenses Legal (5 year felony history & 10 year

incarceration history) Physical & Behavioral Health with disability

documentation and substance use frequency; includes questions from Vulnerability Index

Family/Dependent Children Independent Living Skills assessment

HOUSING BARRIER SCREEN

Elements from all eight Comprehensive Assessment domains – total of 59 questions

Scored differently for different populations (youth, families, singles)

Barriers scored as Low, Medium, High

REFERRAL DECISION WORKSHEET

Assessment filters applied: Income, independent living skills checklist score,

Housing Barriers score, disability status, recovery status, life transition issue, placement considerations (ie. sex offender, veteran, accessible unit, school district)

Referred to Rapid Rehousing if client has regular income or recent work history

If not Rapid Rehousing then scored for: Permanent Housing Programmatic Shelter Transitional Housing Permanent Supportive Housing Safe Haven

ASSESSMENT & REFERRAL PROCESS Assessment - conducted at all Front Doors

Intake – goal is diversion, done within first 3 days (one-third of shelter clients stay 7 nights or less)

Comprehensive assessment – done within first 7-14 days

Referral decision worksheet to identify most appropriate program type to help client move to permanent housing. All eligibility criteria set by funding sources must be complied with Programs must remove additional barriers to entry Priority for PSH openings for long-stayers, elderly and medically fragile

Process to refer appropriate client to specific program when opening occurs. Done by system staff for transitional housing, PSH and Safe Haven Planned to be in HMIS but providers can not see referrals because HMIS

is closed

POLICIES Require that programs accept 1 in 4 referrals.

Eliminate all program entrance requirements except those required by funding (i.e. no drug testing).

All program vacancies must be filled through the Front Door process – close the ‘side doors’.

Development of program and system performance outcomes based on HEARTH.

FRONT DOOR ACCOMPLISHMENTS AND SIX MONTH REVIEW FINDINGS

ACCOMPLISHMENTS Closed ‘side doors’ into CoC programs so all

homeless system resources used for people in shelter or on the street.

31 of 57 long-stayers (more than 200 nights of homelessness in 2010) housed.

Established policies about expectations for people in shelter: use income for housing expected to accept first appropriate referral

Have client-centered data for HEARTH planning.

SIX MONTH REVIEW FINDINGS HMIS functionality and reporting issues limited

data collection and management capacity.

Assessment process implementation not always followed consistently. Additional definitions for client history needed.

Front Door Assessment policies not uniformly adopted by all providers.

SIX MONTH REVIEW FINDINGS (CONT.)

Improvement in tracking, management and reporting of Front Door Assessment processes needed.

Front Door Assessment implementation identified gaps and deficiencies in program approaches and operations across the homeless system.

Open HMIS so all providers can see all data for all clients – increase coordination.

DATA

In first 6 months 1,051 assessments conducted

32% scored for Permanent Supportive Housing 4% scored for Safe Haven 24% scored for Rapid Rehousing or Permanent Housing 39% scored for Transitional Housing or Programmatic

Shelter

63% of the households scored on the Front Door Assessment are not disabled enough to need PSH or Safe Haven. Need efficient and effective way to get them employed and into affordable housing with appropriate supports.

FRONT DOOR IMPLEMENTATION CONSIDERATIONS

RESOURCE COMMITMENTS Consultants – $200,000 over 2 years

System staff

HMIS programming staff

Provider involvement Meetings, staff training Front Door assessment agencies spend more

time on assessment, HMIS and referrals

PROCESS AND PRODUCTS Front Door Committee

Monthly meetings Provider forums

Development of forms, manuals, reports Very intensive HMIS work

Assessment in HMIS Programming reports

Case conferences Process and referral reviews, esp. PSH referrals

NEXT STEPS FOR YOUR COMMUNITY

Look at data How long are people in shelter? Who are your

long-stayers? Where do they go? Do your housing programs take all their clients

from shelter or streets? Look at program entry process and criteria

Who is not being served? Start talking about who each program type in

your system should be serving and how your system ensures that everyone is served

Joyce Probst MacAlpineManager of Housing & Homeless Solutions

Montgomery County, Ohio937-225-4218

macalpinej@mcohio.org