Coordinated Entry System Policies & Procedures WI Balance of State Continuum of Care

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1 Coordinated Entry System Policies & Procedures WI Balance of State Continuum of Care Initial Implementation: January 1 st, 2016

2 Balance of State Continuum of Care Coordinated Assessment System Policies and Procedures Contents OVERVIEW... 1 Overview of Coordinated Assessment... 1 Timeline of WI BOSCOC Coordinated Assessment Activities... 2 Geographic Area... 2 Goals of Coordinated Assessment... 3 Target Population... 3 This Document... 3 Basic Definitions... 4 GOVERNING DOCUMENTS... 6 CoC Interim Rule... 6 ESG Interim Rule... 6 HUD Coordinated Entry Policy Brief... 6 WI Balance of State Continuum of Care Bylaws... 6 State of Wisconsin ETH Program Desk Guide... 7 Coordinated Assessment System Procedures... 8 Accessing the Coordinated Assessment System... 8 Establishing a Designated Lead Agency... 8 Initial Screening... 8 Initial Screen of Domestic Violence Survivors... 9 Prioritization List Referral Process Declined Referrals Coordinated Assessment System Policies Joining the Coordinated Assessment System System Advertisement and Outreach Outreach Advertisement Data Collection Grievance Policy... 13

3 Client Grievances Provider Grievances EVALUATION TRAINING Initial Training Training Plan On-going Training Training Documents APPENDICES Coordinated Entry Policy Brief Balance of State CoC Pre-Screen Form Vulnerability Index & Service Prioritization Decision Assistance Tool (VI-SPDAT) Vulnerability Index & Family Service Prioritization Decision Assistance Tool (VI-F-SPDAT) Universal Data Element Form Prioritization List Release of Information Order of Priority in CoC Program-funded Permanent Supportive Housing Order of Priority for Transitional Housing Beds Definitions... 63

4 OVERVIEW Overview of Coordinated Assessment The CoC Interim Rule defines several responsibilities of the Continuum of Care (578.7 (a) (8)). One of these responsibilities is to establish and operate either a centralized or coordinated assessment system, in consultation with recipients of Emergency Solutions Grants program funds within the geographic area. This centralized or coordinated assessment system provides an initial, comprehensive assessment of the needs of individuals and families for housing and services. The Continuum must develop a specific policy to guide the operation of the centralized or coordinated assessment system on how its system will address the needs of individuals and families who are fleeing, or attempting to flee, domestic violence, dating violence, sexual assault, or stalking, but who are seeking shelter or services from non-victim service providers. This system must comply with any requirements established by HUD by Notice. Another responsibility of the Continuum of Care, in consultation with recipients of Emergency Solutions Grants program funds within the geographic area, is to establish and consistently follow written standards for providing Continuum of Care assistance. At a minimum, these written standards must include: (i) Policies and procedures for evaluating individuals and families eligibility for assistance under this part; (ii) Policies and procedures for determining and prioritizing which eligible individuals and families will receive transitional housing assistance; (iii) Policies and procedures for determining and prioritizing which eligible individuals and families will receive rapid re-housing assistance; (iv) Standards for determining what percentage or amount of rent each program participant must pay while receiving rapid re-housing assistance; (v) Policies and procedures for determining and prioritizing which eligible individuals and families will receive permanent supportive housing assistance; A coordinated assessment system is defined as a coordinated process designed to coordinate program participant intake, assessment, and provision of referrals. A coordinated assessment system covers the geographic area, is easily accessed by individuals and families seeking housing or services, is well advertised, and includes a comprehensive and standardized assessment tool. This definition establishes basic minimum requirements for the Continuum s coordinated assessment system (CoC Interim Rule). Coordinated assessment systems are important in ensuring the success of homeless assistance and homeless prevention programs in communities. In particular, such assessment systems help communities systematically assess the needs of program participants and effectively match each individual or family with the most appropriate resources available to address that individual or family s particular needs. 1

5 Timeline of WI BOSCOC Coordinated Assessment Activities Coordinated Assessment Activity Date Development of Standard Forms Homelessness Verification June 2013 Certification of Disabling Condition October 2013 Regional roundtable discussions at Balance of State meeting November 2013 Local CoCs complete coordinated assessment questionnaires March 2014 Development & Approval of Program Standards Transitional Housing August 2014 Permanent Supportive Housing August 2014 ESG-Funded Rapid Re-Housing November 2014 Presentation of draft Coordinated Assessment System Policies & February 2015 Procedures Feedback period from BOS membership February-May 2015 Presentation of BOSCOC Coordinated Assessment System August 2015 Comment period from BOS membership August-September 2015 BOSCOC Membership vote to approve Coordinated Assessment System November 2015 Implementation of BOSCOC Coordinated Assessment System January 1, 2016 Proposed Implementation of Coordinated Assessment System for July 1, 2016 Emergency Shelters Proposed Implementation of Prevention and Diversion Process for July 1, 2016 Coordinated Assessment System Proposed Implementation of Coordinated Assessment System for January 1, 2017 Homeless Youth Proposed Implementation of Coordinated Assessment System for TBD Mainstream Resources Geographic Area The Wisconsin Balance of State Continuum of Care covers 69 of Wisconsin s 72 counties and extends from the shores of Lake Superior in the northwest to portions of the Chicago metro area in the southeast. The population for the continuum is 3.8 million and it covers an area of 52,533 square miles. This geographic area includes urban, suburban, and rural areas. Washington Ozaukee 2

6 Goals of Coordinated Assessment Most communities lack the resources needed to meet all of the needs of people experiencing homelessness. This, combined with the lack of well-developed coordinated entry processes, has resulted in severe hardships for people experiencing homelessness. They often face long waiting times to receive assistance or are screened out of needed assistance. A Coordinated Assessment System helps communities prioritize assistance based on vulnerability and severity of service needs to ensure that people who need assistance the most can receive it in a timely manner. The Coordinated Assessment System also provides information about service needs and gaps to help communities plan their assistance and identify needed resources. The Coordinated Assessment System is intended to increase and streamline access to housing and services for households experiencing homelessness, match appropriate levels of housing and services based on their needs, and prioritize persons with severe service needs for the most intensive interventions. HUD s primary goals for coordinated entry processes are: 1. Assistance will be allocated as effectively as possible. 2. Assistance is easily accessible no matter where or how people present. The Wisconsin BOSCOC members identified the following common goals for the Coordinated Assessment System: 1. The process will be easy for the client, and provide quick and seamless entry into homelessness services. 2. Individuals and families will be referred to the most appropriate resource(s) for their individual situation. 3. The process will prevent duplication of services. 4. The process will reduce length of homelessness. 5. The process will improve communication among agencies. Target Population This process is intended to serve individuals and households experiencing homelessness and those who are at imminent risk of homelessness. Homelessness and imminent risk of homelessness will be defined in accordance with the HUD definition of homelessness. 1 This Document These policies and procedures will govern the implementation, governance, and evaluation of the WI Balance of State CoC Coordinated Assessment System. This is a living document and will be reviewed annually in accordance with the WI Balance of State CoC Governance Charter. Changes can be made based on the information gathered through the evaluation process. 1 The definition is available here: 3

7 Basic Definitions Terms used throughout this document are defined below Chronically Homeless o An individual who: (i) Is homeless and lives in a place not meant for human habitation, a safe haven, or in an emergency shelter; and (ii) Has been homeless and living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter continuously for at least one year or on at least four separate occasions in the last 3 years where those occasions also cumulatively total at least 12 months; and (iii) Can be diagnosed with one or more of the following conditions: substance use disorder, serious mental illness, developmental disability (as defined in section 102 of the Developmental Disabilities Assistance Bill of Rights Act of 2000 (42 U.S.C )), post-traumatic stress disorder, cognitive impairments resulting from brain injury, or chronic physical illness or disability; o An individual who has been residing in an institutional care facility, including a jail, substance abuse or mental health treatment facility, hospital, or other similar facility, for fewer than 90 days and met all of the criteria in paragraph (1) of this definition [as described in Section I.D.2.(a) of this Notice], before entering that facility; o A family with an adult head of household (or if there is no adult in the family, a minor head of household) who meets all of the criteria in paragraph (1) of this definition [as described in Section I.D.2.(a) of this Notice, including a family whose composition has fluctuated while the head of household has been homeless. (24 CFR 578.3) Client Individual or family who accesses the Coordinated Assessment System Designated Lead Agency (DLA) Agency chosen by the Local Coordinated Assessment System (LCAS) to manage the Non-WISP Prioritization List and serve as the point of contact for the Coordinated Assessment Committee. Literally Homeless (HUD Homeless Definition Category 1) - An individual or family who lacks a fixed, regular, and adequate nighttime residence, meaning: (i) An individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus or train station, airport, or camping ground; (ii) An individual or family living in a supervised publicly or privately operated shelter designated to provide temporary living arrangements (including congregate shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state, or local government programs for low income individuals); or (iii) An individual who is exiting an institution where he or she resided for 90 days or less and who resided in an emergency shelter or place not meant for human habitation immediately before entering that institution (24 CFR 578.3) Imminently at Risk of Homelessness (HUD Homeless Definition Category 2) - An individual or family who will imminently lose their primary nighttime residence, 4

8 provided that: (i) The primary nighttime residence will be lost within 14 days of the date of application for homeless assistance; (ii) No subsequent residence has been identified; and (iii) The individual or family lacks the resources or support networks, e.g., family, friends, faith-based or other social networks needed to obtain other permanent housing (24 CFR 578.3) Fleeing domestic abuse or violence (HUD Homeless Definition Category 4) - Any individual or family who: (i) Is fleeing, or is attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member, including a child, that has either taken place within the individual s or family s primary nighttime residence or has made the individual or family afraid to return to their primary nighttime residence; (ii) Has no other residence; and (iii) Lacks the resources or support networks, e.g., family, friends, faith-based or other social networks, to obtain other permanent housing (24 CFR 578.3) Homeless Management Information System (HMIS) - The information system designated by the Continuum of Care to comply with the HMIS requirements prescribed by HUD. The HMIS used in Wisconsin is Service Point. HMIS Lead The entity designated by the Continuum of Care to operate the Continuum s HMIS on its behalf. Institute for Community Alliances (ICA) is the HMIS Lead for the State of Wisconsin. Housing Interventions - Housing programs and subsidies; these include transitional housing, rapid re-housing, and permanent supportive housing programs, as well as permanent housing subsidy programs (e.g. Housing Choice Vouchers). Local Coordinated Assessment System (LCAS) At this time, the LCAS is the same geographic area represented by the local continuum of care. Two or more local CoCs can choose to work together as one LCAS. Program A specific set of services or a housing intervention offered by a provider. Provider Organization that provides services or housing to people experiencing or at-risk of homelessness. o Ex: St. Vincent de Paul (Provider) has House of Hope (Program) and Rapid Re- Housing (Program) VI-SPDAT and VI-F-SPDAT Vulnerability Index-Service Prioritization Decision Assistance Tool and Vulnerability Index-Service Prioritization Decision Assistance Tool for Families are the standardized assessment tools used in the Coordinated Assessment System. The VI-SPDAT and VI-F-SPDAT are pre-screening, or triage tools that are designed to be used by all providers within the Coordinated Assessment System to quickly assess the health and social needs of people experiencing homelessness and match them with the most appropriate support and housing interventions that are available. 5

9 GOVERNING DOCUMENTS CoC Interim Rule ( (a) (8) In consultation with recipients of Emergency Solutions Grants program funds within the geographic area, establish and operate either a centralized or coordinated assessment system that provides an initial, comprehensive assessment of the needs of individuals and families for housing and services. The Continuum must develop a specific policy to guide the operation of the centralized or coordinated assessment system on how its system will address the needs of individuals and families who are fleeing, or attempting to flee, domestic violence, dating violence, sexual assault, or stalking, but who are seeking shelter or services from non-victim service providers. This system must comply with any requirements established by HUD by Notice. ESG Interim Rule ( nformingamendments.pdf) (d) Centralized or coordinated assessment. Once the Continuum of Care has developed a centralized assessment system or a coordinated assessment system in accordance with requirements to be established by HUD, each ESG-funded program or project within the Continuum of Care s area must use that assessment system. The recipient and subrecipient must work with the Continuum of Care to ensure the screening, assessment and referral of program participants are consistent with the written standards required by paragraph (e) of this section. A victim service provider may choose not to use the Continuum of Care s centralized or coordinated assessment system. HUD Coordinated Entry Policy Brief Appendix A and at: Policy-Brief.pdf WI Balance of State Continuum of Care Bylaws ( Article II, Section 3 The responsibilities of the Corporation include, but are not limited to: a. Those responsibilities outlined and defined by relevant federal law; b. Coordinate, or be involved in the coordination of, all housing and services for persons experiencing homelessness within the Corporation s geographic area; c. Establish and operate the HMIS within the Corporation s geographic area; d. Establish and operate, or designate, the centralized and coordinated assessment to be used within the Corporation s geographic area. 6

10 State of Wisconsin ETH Program Desk Guide ( Each local continuum of care is required to develop and/or operate a centralized or coordinated intake or assessment system if any agencies in the continuum of care receive ETH funding. Recipients and subrecipients must participate in the centralized intake for their continuum of care. If there is not yet a centralized intake, a recipient or sub-recipient must participate in its implementation and eventually its use. Recipients and subrecipients must use the CoC s centralized or coordinated assessment system to evaluate client eligibility. ETH recipients must ensure the CoC s system is consistent with the written standards for determining ETH assistance. Note that victim service providers that receive ETH funds may opt to not use the CoC s system. 7

11 Coordinated Assessment System Procedures This section outlines and defines the key components of the Coordinated Assessment System and how the coordinated assessment process will work. Accessing the Coordinated Assessment System Because of the diversity and size of the BOSCOC, access to the Coordinated Assessment System follows a No Wrong Door approach. The principles of this approach are: A client can seek housing assistance through any of the participating housing providers and will receive integrated services. Clients should have equal access to information and advice about the housing assistance for which they are eligible in order to assist them in making informed choices about available services that best meet their needs. Participating providers have a responsibility to respond to the range of client needs pertaining to homelessness and housing, and act as the primary contact for clients who apply for assistance through their service unless or until another provider assumes that role. Participating providers will guide the client in applying for assistance or accessing services from another provider regardless of whether the original provider delivers the specific housing services required by a presenting client. Participating housing providers will work collaboratively to achieve responsive and streamlined access services and cooperate to use available resources to achieve the best possible housing outcomes for clients, particularly for those with high, complex or urgent needs. Establishing a Designated Lead Agency Each local coordinated assessment system (LCAS) will choose a designated lead agency (DLA) to manage the Non-WISP Prioritization List and to serve as the point of contact for the Coordinated Assessment Committee. The DLA will ensure that all agencies participating in the Coordinated Assessment System have the appropriate contact information in order to access the Non-WISP Prioritization List in a timely manner. The DLA is responsible for communicating any changes in contact information to the Chair of the Coordinated Assessment Committee. Initial Screening The Coordinated Assessment System utilizes a standardized assessment tool, The Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT and VI-F-SPDAT). This tool assists the provider in consistently evaluating the level of need of individuals and families accessing services. The assessment can be conducted by any provider who has been introduced to the tool through a one hour training video presented by OrgCode (available at: 8

12 Providers that use WI Service Point should complete the one hour training on how to record results within WI Service Point (available at When an individual or family contacts a service provider for housing assistance, a Pre- Screen Form is completed as an initial screen to determine basic eligibility (e.g. screening out those who are over income or non-dv from a DV provider). This form can be completed in person or over the phone. Appendix B If the individual or family meets eligibility (homeless and below income guidelines), the VI-SPDAT or VI-F-SPDAT is completed either in person or over the phone. Appendix C & Appendix D If the individual or family meets the threshold for acuity the Universal Data Element (UDE) Form is completed, the Coordinated Assessment System Release of Information is signed, and the information is entered into the Prioritization List. Appendix E & Appendix F Initial Screen of Domestic Violence Survivors The domestic violence victim service providers (DVSP) in the BOSCOC may elect to administer the VI-SPDAT for their clients who are seeking services from other housing service providers in the BOSCOC. Each LCAS will determine if it wants consistency among DVSPs in administering/not administering the VI-SPDAT, or if it will allow some DVSPs to administer the VI-SPDAT and others to opt out. If the DVSP(s) elect to do so, they will follow this procedure: When an individual or family contacts a DVSP for housing assistance, a Pre-Screen Form is completed as an initial screen to determine basic eligibility (e.g. screening out those who are over income or non-dv from a DVSP). This form can be completed in person or over the phone. If the individual or family meet eligibility (homeless and below income guidelines), the VI-SPDAT is completed either in person or over the phone. If the individual or family meets the threshold for acuity, the DVSP provides the VI- SPDAT score and a unique anonymous identifier, such as Safe Place Client-12345, to the DLA. The DVSP destroys the paper copy of the VI-SPDAT. The DLA enters the client s score and identifier into the non-wisp prioritization list. If and when the requested service becomes available for the client, the appropriate housing agency contacts the DVSP and references the client using the anonymous identifier. The DVSP contacts the client and tells him or her that the service is available and asks the client if he or she would like to receive the service. The DVSP then communicates 9

13 the client s intentions to the housing provider. The DVSP will need a signed release of information and waiver of non-disclosure in order to share the client s name with the housing provider for cases in which the client intends to use the housing provider s service. If the DVSP decides not to administer the VI-SPDAT to their clients, the DVSP will refer these clients to another agency within the local region that does administer the VI-SPDAT. Whether the VI-SPDAT is first conducted on paper or directly inputted within HMIS, all VI- SPDAT assessments must be recorded in either the HMIS Prioritization List or the LCAS Non- WISP Prioritization List within 48 business hours of when the information was first collected. If the individual/family is not prioritized for any interventions, the provider administering the VI-SPDAT should explain why and what other services will be available to them (e.g., shelter case management, connection to mainstream resources, help connecting with family or friends). The client should be referred to the appropriate emergency shelter or other housing crisis resource, where they will receive case management and other services to help them access housing. The assessment process ends for the client at this point. Prioritization List The HMIS Lead will work with participating agencies to create the Prioritization Lists for each LCAS. Agencies that use ServicePoint will be able to make referrals to ServicePoint Prioritization Lists using the Referrals feature of the software. Anyone with a ServicePoint user license can make a referral to the ServicePoint Prioritization Lists. Individuals and families being referred to the Prioritization Lists do not need to be enrolled in a program at the agency making the referral. For additional guidance on using the Prioritization Lists in ServicePoint, you can access training at Agencies making referrals to the Prioritization Lists will be responsible for following up with the individuals and families they refer in order to determine whether the individual or family is still in need of permanent or transitional housing. Follow-up contact must occur every 90 days at a minimum. If the individual or family is still in need of housing, the agency should update contact information if necessary. If the individual or family is no longer in need of housing, the agency can delete the referral to remove the individual or family from the Prioritization List. Providers that contact a referral to offer services and find out the household is no longer in need, can also close a referral in Service Point, even if that provider did not make the referral. Referral Process It is prohibited for any HUD-funded homelessness assistance programs to serve individuals and/or families experiencing homelessness or who are at imminent risk of homelessness, without the household first going through the Coordinated Assessment System and receiving a referral to the Prioritization List. 10

14 When a program has an opening, the responsible staff person must consult the Prioritization Lists in ServicePoint and contact the DLA to inquire about individuals/families listed on the Non- WISP Prioritization Lists. Using the Order of Priority established for the program (Appendix G, Appendix H, Appendix I), program-specific requirements (e.g. single, youth, specific disability, etc.), and the VI-SPDAT score, the program will offer services to the highest prioritized individual/family. For additional guidance on prioritization, please see the recorded webinar, Prioritization & Recordkeeping: PSH and TH Programs, at the following link: If a program does not take the highest prioritized individual or family from the Prioritization Lists to fill an available spot, that agency must document the reason for not accepting that referral in the ServicePoint client file. If the highest prioritized client does not have a ServicePoint client file (because the client was referred from a DVSP), the agency must provide a written explanation to the DLA. It is the responsibility of the agency not taking the highest prioritized individual or family to ensure that the individual or family has a new referral to the Prioritization List, if needed. The individual or family remains on the Prioritization List in order to access the next available program spot, as long as the individual or family is in need of permanent or transitional housing. Declined Referrals One of the guiding principles of the BOSCOC Coordinated Assessment System is client choice. Individuals and families will be given information about the programs available to them and have some degree of choice about which programs they want to participate in. If an individual or family declines a referral to a housing program, their name remains on the Prioritization List until the next housing opportunity is available. 11

15 Coordinated Assessment System Policies This section outlines and defines the policies governing the Coordinated Assessment System. Joining the Coordinated Assessment System All programs that receive Continuum of Care funding or Emergency Solutions Grant funding are required by their funders to participate in the Coordinated Assessment System. Other programs are encouraged and welcome to join the Coordinated Assessment System. Those programs that are not required by their funder to participate in the Coordinated Assessment System, but want to participate, will sign a Memorandum of Understanding agreeing to participate in the system for a minimum of six months. System Advertisement and Outreach Outreach Each LCAS is required to contact private and public agencies including those in the Continuum of Care, 2-1-1, VA, social service agencies and state and/or local government agencies to educate and provide information on available programs. Outreach activities are required to be done a minimum of once per year. These activities can be done in conjunction with the Point in Time Count or at another time as determined by the CoC. Each LCAS is required to coordinate with existing street outreach programs as well as private and public agencies, social service organizations, etc. for referrals, so that people sleeping on the streets are prioritized for assistance in the same manner as any other person assessed through the Coordinated Assessment System. Each LCAS is encouraged to provide resources/information about the Coordinated Assessment System to 24 hour establishments, restaurants, hospitals, hot meal programs, churches, schools, check cashing locations, and other places known to be frequented by the target population. In addition, each LCAS is encouraged to explore various outreach activities such as hosting a booth at local community events, resource fairs, festivals and county fairs to provide information and resources. Advertisement Advertisement is to include a minimum of flyers posted at those places stated above (as allowed). Other forms of advertisement can include newspaper ads, radio, websites, etc. to generate referrals and applications. Advertising is to focus on people experiencing literal homelessness and will clearly state eligibility requirements in an effort to reach the target population as opposed to those who do not meet the criteria. Information about the Coordinated Assessment System will also be available on the WI BOSCOC website at 12

16 Data Collection Data will be collected on everyone that is assessed through the Coordinated Assessment System. This section, in addition to instructions embedded within the assessment tool, will detail when and how data about clients going through the Coordinated Assessment System will be collected. Once the Pre-Screen Form has been completed and the client is deemed eligible to be assessed, the staff member will review the ServicePoint Release of Information form with the client. The staff member will explain what data will be requested, how and with whom it will be shared, and what the client s rights are regarding the use of their data. The staff member will be responsible for ensuring clients understand the Release of Information and their rights regarding data confidentiality. If they sign the form, the staff member will begin the assessment process either in ServicePoint or on paper, with relevant data entered into the data fields in ServicePoint within 48 business hours. Some clients should never be entered into ServicePoint. These include: Clients who want domestic violence-specific services should never have information entered into ServicePoint. The VI-SPDAT should be done on a paper form, the score recorded, and the form shredded. If the client is being served by a DVSP, that agency may enter their information into a ServicePoint-comparable database. Clients who do not consent to data sharing should also never have their data entered into ServicePoint. Access to parts of each client record or assessment form may be restricted for safety reasons or by client request. Grievance Policy Client Grievances This policy refers to client grievances regarding the Coordinated Assessment System only. If a client has a grievance regarding a particular agency, they should follow that agency s grievance procedure. The agency completing the screening should address any complaints by clients as best as they can in the moment. Complaints that should be addressed directly by the agency staff member or agency staff supervisor include complaints about how they were treated by agency staff, agency conditions, or violation of confidentiality agreements. Any other complaints should be referred to the BOSCOC Coordinator to be dealt with in a similar process to the one described below for providers. Any complaints filed by a client should note their name and contact information so the CoC Coordinator can contact him/her to discuss the issues. Provider Grievances It is the responsibility of all boards, staff, and volunteers of CoC-funded programs and ESGfunded programs to comply with the rules and regulations of the Coordinated Assessment System. Anyone filing a complaint concerning a violation or suspected violation of the policies 13

17 and procedures must be acting in good faith and have reasonable grounds for believing an agency is violating the Coordinated Assessment System policies and procedures. To file a grievance regarding the actions of an agency, contact the WI Balance of State CoC Coordinator with a written statement describing the alleged violation of the Coordinated Assessment System policies and procedures, and the steps taken to resolve the issue locally. The CoC Coordinator will contact the agency in question to request a response to the grievance. Once the CoC Coordinator has received the documentation he/she will decide if the grievance is valid and determine if further action needs to be taken. If the individual or agency filing the grievance, or the agency against whom the grievance is filed, is not satisfied with the determination they may file an appeal with the Balance of State Board of Directors President. This must be done by providing a written statement regarding the reasons for the appeal. The Board President will bring the matter to the Board of Directors for discussion and a final decision. 14

18 EVALUATION Once the Coordinated Assessment System is implemented, a community must regularly evaluate its effectiveness. Communities should use the lessons derived from these evaluations to further improve their systems. 2 The Balance of State CoC will evaluate its Coordinated Assessment System primarily by LCAS but will also consider aggregate data. This section includes potential questions to be used for evaluation purposes and the types of data that may be gathered to evaluate the functioning and success of the Coordinated Assessment System. Questions for DLAs (who will collect and aggregate data locally) How many side doors does your LCAS have (i.e. organizations that participate in Coordinated Assessment but also admit clients in some other fashion)? How many organizations in your LCAS do not participate in Coordinated Assessment and do their own intake/assessment? Have there been significant differences between what was planned, and what has been implemented in your LCAS? What have been the challenges in implementing Coordinated Assessment, and how can the BOSCOC help to address them? Have providers noted any trends or concerns as a result of Coordinated Assessment? Are there organizations in your LCAS that have additional screening measures for clients referred through Coordinated Assessment (i.e. creating additional barriers to program entry)? How is the system advertised in your LCAS? How accessible is it? Tell us about your outreach and advertising activities. Who, What, When and Where. Questions for Consumers Thinking about the most recent time you became homeless, what could have PREVENTED you from becoming homeless? Check all that apply. o Rental assistance o Other financial assistance o Help finding a job o Substance use treatment o Health care o Help finding an apartment o Mental health treatment o Help with budgeting o Case management o Other (please specify) 2 Much of this section was adopted from the Coordinated Assessment Evaluation Tool, published by the National Alliance to End Homelessness. 15

19 To which agency did you first go to get help when you became homeless? (List name of agency) How did you find out about this agency (agency listed above)? It was easy for me to find services to help me when I became homeless. o Choose from range between Strongly Agree and Strongly Disagree I felt that the services I received while homeless were focused on helping me get into permanent housing as quickly as possible. o Choose from range between Strongly Agree and Strongly Disagree (If you are currently in housing): How many homeless assistance organizations or programs did you have to work with before you got into permanent housing? If you worked with multiple agencies, did the referral process go smoothly? o Yes/No o If answered no, please explain What can we do to make it easier for people in need of services to access the help they need? Data Evaluation Every 6 months Regional and Aggregate BOS To assess the impact of the Coordinated Assessment System, these data points will be evaluated for two 6-month periods: one prior to implementation, and one after implementation. After the initial evaluation, this data will continue to be collected and analyzed every 6 months. Program Type Number of Participating Organizations in Each Program Type Number of Referrals Made to Program Type Number of Placements in Each Program Type Rate of Exits to Permanent Housing Prevention/Diversion N/A, initially N/A, initially N/A, initially N/A, initially Emergency Shelter N/A, initially N/A, initially Transitional Housing Rapid Re-housing Permanent Supportive Housing Other Types of Housing/Programs *Rate of Exits to Permanent Housing equals the number of people that exit each program type in the given six month period for permanent housing divided by the total number of people that exited each program type within that six month period. 16

20 The following measures will be evaluated overall and by program type, as appropriate. Measure(s) Related Question(s) Data Collection Process Non-DVSP Length of time on the prioritization list Recurrence Placement rates Length of stay and housing stability How long does it take for eligible individuals and families to access services? Are individuals and families matched with the correct intervention? What portion of services are used by repeat clients? Of those referred, how many actually enter the program? Are programs denying access to eligible individuals or families? Is the system helping people efficiently move into permanent housing? Review priority list. An HMIS report will be developed to determine how long a household is on the priority list before moving into housing. An HMIS report currently measures returns to emergency shelter. This will be used until a report can be developed that will measure returns to all program types. An HMIS report will be developed to measure repeat clients. Review HMIS referrals? May be harder to determine if programs deny access to eligible families. Use HMIS report to determine average length of stay for emergency shelter programs. Data Collection Process DVSP TBD TBD TBD TBD 17

21 Client demographics Bed/unit occupancy rate Unmet needs *New entries into homelessness Has the implementation of the system adversely impacted any populations? Has implementation changed the rates at which the chronically homeless and others with high barriers are served? Does the community need to reevaluate where to place its resources? Are non-participating shelters and housing providers used more as a result of implementation? What portion of people assessed to have a need for a service are not afforded it? Are prevention and diversion efforts working effectively? Use HMIS report to determine client demographics for all LCAS programs. Use Housing Inventory Chart to determine bed/unit occupancy for point in time. Use HMIS report to determine number of unmet needs. Use HMIS report to determine number of clients newly homeless. *This measure would be added to the evaluation once prevention and diversion are incorporated into the system. To determine success: The following factors might indicate success with coordinated assessment: TBD Use Housing Inventory Chart to determine bed/unit occupancy for point in time. TBD TBD The number of organizations doing individual intake and assessment decreased There are no side doors in the community Average length of stay in homelessness is decreasing Rate of exits into permanent housing for every intervention has increased New entries into homelessness have decreased due to prevention and diversion efforts There is a centralized prioritization list now (if there wasn t before) or no wait list at all The number of organizations consumers had to work with before getting into permanent housing has decreased 18

22 Things to think about when re-assessing systems 3 : What impact is the CoC trying to make? What performance indicators best reflect and convey the impact of CAS and achievement of the BOSCOC s strategic plan? What is beyond system/program control? What players can be brought to the table to further improve the effectiveness of the system? Are the right programs collecting the right data? Is data quality sufficient? 3 Source: Performance Measurement of Homeless Systems, Tom Albanese, Abt Associates 19

23 TRAINING Initial Training The Coordinated Assessment Process What is Coordinated Assessment Coordinated Assessment requirements How the WI BOSCOC Coordinated Assessment System works Screening Process Prioritization Process Referrals Trauma Informed Care in Administering Coordinated Assessment Confidentiality and Fair Housing Laws Using ServicePoint with Coordinated Assessment Evaluation Process Outreach and Advertising Training Plan The Balance of State Coordinated Assessment Committee will host a training webinar that will be attended by at least one representative from each of the LCAS. This will be a train-thetrainer type webinar, and will last approximately two hours. This training will be recorded and can be distributed to each LCAS. This training will need to take place prior to the roll-out of Coordinated Assessment. Each LCAS will be responsible for training the remaining service providers in their region. Each region will have flexibility for how this training is conducted. The training can be either inperson or via webinar. Ideally this training will take place prior to the roll-out of Coordinated Assessment, but at a minimum should occur within two months of the Coordinated Assessment start date. ICA will work with each LCAS to provide ServicePoint training that meets their regional needs. This will allow ICA to tailor the training to meet the needs of each LCAS. Ideally this training will occur at the same time as the regional Coordinated Assessment training. If it occurs at a separate time, it will happen within two months of the Coordinated Assessment start date. Each LCAS will need to report to the BOS Coordinated Assessment Committee chairperson when the regional training occurred and who attended training. On-going Training The Coordinated Assessment Committee will record a training for new staff, which can be sent to agencies as needed. If/when on-going trainings are held, training registration information will be posted on both the ICA and BOS websites. The training documents will always be available. 20

24 Training Documents WI BOS Coordinated Assessment How-to Guide This guide will provide a basic overview of topics covered during the initial training. ICA staff will work with the BOS Coordinated Assessment Committee to include instructions on how to use ServicePoint for Coordinated Assessment, including ServicePoint screenshots. 21

25 APPENDICES A. HUD s Coordinated Entry Policy Brief B. Balance of State CoC Pre-Screen Form C. VI-SPDAT D. VI-F-SPDAT E. Universal Data Element (UDE) Form (under development) F. Prioritization List Release of Information (under development) G. Permanent Supportive Housing Order of Priority H. Transitional Housing Order of Priority I. ESG-Funded Rapid Re-Housing Order of Priority J. HUD Definitions for Order of Priority 22

26 APPENDIX A: HUD s Coordinated Entry Policy Brief Released February 2015 COORDINATED ENTRY POLICY BRIEF An effective coordinated entry process is a critical component to any community s efforts to meet the goals of Opening Doors: Federal Strategic Plan to Prevent and End Homelessness. This policy brief describes HUD s views of the characteristics of an effective coordinated entry process. This brief does not establish requirements for Continuums of Care (CoCs), but rather is meant to inform local efforts to further develop CoCs coordinated entry processes. Provisions in the CoC Program interim rule at 24 CFR 578.7(a)(8) require that CoCs establish a Centralized or Coordinated Assessment System. In this document, HUD uses the terms coordinated entry and coordinated entry process instead of centralized or coordinated assessment system to help avoid the implication that CoCs must centralize the assessment process, and to emphasize that the process is easy for people to access, that it identifies and assesses their needs, and makes prioritization decisions based upon needs. However, HUD considers these terms to mean the same thing. See 24 CFR 578.7(a)(8) for information on current requirements. HUD s primary goals for coordinated entry processes are that assistance be allocated as effectively as possible and that it be easily accessible no matter where or how people present. Most communities lack the resources needed to meet all of the needs of people experiencing homelessness. This combined with the lack of well-developed coordinated entry processes can result in severe hardships for people experiencing homelessness. They often face long waiting times to receive assistance or are screened out of needed assistance. Coordinated entry processes help communities prioritize assistance based on vulnerability and severity of service needs to ensure that people who need assistance the most can receive it in a timely manner. Coordinated entry processes also provide information about service needs and gaps to help communities plan their assistance and identify needed resources. HUD has previously provided guidance regarding prioritization for permanent supportive housing (PSH) in Notice CPD Notice on Prioritizing Persons Experiencing Chronic Homelessness in Permanent Supportive Housing and Recordkeeping Requirements for Documenting Chronic Homeless Status. This brief builds upon that Notice and provides guidance for using coordinated entry to prioritize beyond permanent supportive housing (PSH). Qualities of Effective Coordinated Entry An effective coordinated entry process has the following qualities: Prioritization. HUD has determined that an effective coordinated entry process ensures that people with the greatest needs receive priority for any type of housing and homeless assistance available in the CoC, including PSH, Rapid Rehousing (RRH), and other interventions. Low Barrier. The coordinated entry process does not screen people out for assistance because of perceived barriers to housing or services, including, but not limited to, lack of employment or income, drug or alcohol use, or having a criminal record. In addition, housing and homelessness programs lower their screening barriers in partnership with the coordinated entry process. Housing First orientation. The coordinated entry process is Housing First oriented, such that people are housed quickly without preconditions or service participation requirements. Person-Centered. The coordinated entry process incorporates participant choice, which may be facilitated by questions in the assessment tool or through other methods. Choice can 24

27 APPENDIX A: HUD s Coordinated Entry Policy Brief Released February 2015 include location and type of housing, level of services, and other options about which households can participate in decisions. Fair and Equal Access. All people in the CoC s geographic area have fair and equal access to the coordinated entry process, regardless of where or how they present for services. Fair and equal access means that people can easily access the coordinated entry process, whether in person, by phone, or some other method, and that the process for accessing help is well known. Marketing strategies may include direct outreach to people on the street and other service sites, informational flyers left at service sites and public locations, announcements during CoC or other coalition meetings, and educating mainstream service providers. If the entry point includes one or more physical locations, they are accessible to people with disabilities, and easily accessible by public transportation, or there is another method, e.g., toll-free or 211 phone number, by which people can easily access them. The coordinated entry process is able to serve people who speak languages commonly spoken in the community. Emergency services. The coordinated entry process does not delay access to emergency services such as shelter. The process includes a manner for people to access emergency services at all hours independent of the operating hours of the coordinated entry intake and assessment processes. For example, people who need emergency shelter at night are able to access shelter, to the extent that shelter is available, and then receive an assessment in the days that follow, even if the shelter is the access point to the coordinated entry process. Standardized Access and Assessment. All coordinated entry locations and methods (phone, in-person, online, etc.) offer the same assessment approach and referrals using uniform decisionmaking processes. A person presenting at a particular coordinated entry location is not steered towards any particular program or provider simply because they presented at that location. Inclusive. A coordinated entry process includes all subpopulations, including people experiencing chronic homelessness, Veterans, families, youth, and survivors of domestic violence. However, CoCs may have different processes for accessing coordinated entry, including different access points and assessment tools for the following different populations: (1) adults without children, (2) adults accompanied by children, (3) unaccompanied youth, or (4) households fleeing domestic violence. These are the only groups for which different access points are used. For example, there is not a separate coordinated entry process for people with mental illness or addictions, although the systems addressing those disabilities may serve as referral sources into the process. The CoC continuously evaluates and improves the process ensuring that all subpopulations are well served. Referral to projects. The coordinated entry process makes referrals to all projects receiving Emergency Solutions Grants (ESG) and CoC Program funds, including emergency shelter, RRH, PSH, and transitional housing (TH), as well as other housing and homelessness projects. Projects in the community that are dedicated to serving people experiencing homelessness fill all vacancies through referrals, while other housing and services projects determine the extent to which they rely on referrals from the coordinated entry process. Referral protocols. Programs that participate in the CoC s coordinated entry process accept all eligible referrals unless the CoC has a documented protocol for rejecting referrals that ensures that such rejections are justified and rare and that participants are able to identify and access another suitable project. 25

28 APPENDIX A: HUD s Coordinated Entry Policy Brief Released February 2015 Outreach. The coordinated entry process is linked to street outreach efforts so that people sleeping on the streets are prioritized for assistance in the same manner as any other person assessed through the coordinated entry process. Ongoing planning and stakeholder consultation. The CoC engages in ongoing planning with all stakeholders participating in the coordinated entry process. This planning includes evaluating and updating the coordinated entry process at least annually. Feedback from individuals and families experiencing homelessness or recently connected to housing through the coordinated entry process is regularly gathered through surveys, focus groups, and other means and is used to improve the process. Informing local planning. Information gathered through the coordinated entry process is used to guide homeless assistance planning and system change efforts in the community. Leverage local attributes and capacity. The physical and political geography, including the capacity of partners in a community, and the opportunities unique to the community s context, inform local coordinated entry implementation. Safety planning. The coordinated entry process has protocols in place to ensure the safety of the individuals seeking assistance. These protocols ensure that people fleeing domestic violence have safe and confidential access to the coordinated entry process and domestic violence services, and that any data collection adheres to the Violence Against Women Act (VAWA). Using HMIS and other systems for coordinated entry. The CoC may use HMIS to collect and manage data associated with assessments and referrals or they may use another data system or process, particularly in instances where there is an existing system in place into which the coordinated entry process can be easily incorporated. For example, a coordinated entry process that serves households with children may use a system from a state or local department of family services to collect and analyze coordinated entry data. Communities may use CoC Program or ESG program funding for HMIS to pay for costs associated with coordinated entry to the extent that coordinated entry is integrated into the CoCs HMIS. A forthcoming paper on Coordinated Entry and HMIS will provide more information. Full coverage. A coordinated entry process covers the CoC s entire geographic area. In CoCs covering large geographic areas (including statewide, Balance of State, or large regional CoCs) the CoC might use several separate coordinated entry processes that each cover a portion of the CoC but in total cover the entire CoC. This might be helpful in CoCs where it is impractical for a person who is assessed in one part of the CoC to access assistance in other parts of the CoC. The remainder of this brief clarifies a few aspects of the coordinated entry process that deserve further explanation and emphasis, including how communities prioritize people in their coordinated entry process, how communities think about and address waiting lists, and considerations for the assessment tools and processes that communities implement. This document also clarifies some of the considerations to be made at the local level as communities further develop their process. Prioritizing people who are most vulnerable or have the most severe service needs One of the main purposes of coordinated entry is to ensure that people with the most severe service needs and levels of vulnerability are prioritized for housing and homeless assistance. HUD s policy is that people experiencing chronic homelessness should be prioritized for permanent supportive housing. In some cases PSH projects are required to serve people experiencing chronic homelessness 26

29 APPENDIX A: HUD s Coordinated Entry Policy Brief Released February 2015 and in other cases, HUD provides incentives for projects to do so. HUD is strongly encouraging communities to fully implement the prioritization process included in Notice CPD In addition to prioritizing people experiencing chronic homelessness, the coordinated entry process prioritizes people who are more likely to need some form of assistance to end their homelessness or who are more vulnerable to the effects of homelessness. When considering how to prioritize people for housing and homelessness assistance, communities can use the following: Significant health or behavioral health challenges or functional impairments which require a significant level of support in order to maintain permanent housing; High utilization of crisis or emergency services, including emergency rooms, jails, and psychiatric facilities, to meet basic needs The extent to which people, especially youth and children, are unsheltered Vulnerability to illness or death Risk of continued homelessness Vulnerability to victimization, including physical assault or engaging in trafficking or sex work Communities should decide what factors are most important and, to the greatest extent possible, use all available data and research to inform their prioritization decisions. The coordinated entry process is meant to orient the community to one or two central prioritizing principles by which the community can make decisions about how to utilize its resources most effectively. This prioritization ensures that across subpopulations and people with different types of disabilities, those most vulnerable or with the most severe service needs will be prioritized for assistance. The prioritization may not target a category of people with a particular disability. However, individual programs, including CoC funded projects, may restrict access to people with a particular disability or characteristic. In these cases, the coordinated entry process should ensure that people are only referred to projects for which they are eligible. At the same time, providers should ensure that eligibility criteria are limited to those required by Federal or local statute or by funding sources. Communities should take care to ensure that their prioritization process does not allow people who are more vulnerable or who have more severe service needs to languish in shelters or on the streets because more intensive types of assistance are not available. Evidence indicates that one of the most important factors to successfully ending an episode of homelessness is the speed with which the intervention is made available to the person (see discussion of assessment tools below and HUD s February 2015 report on assessment tools). This means that if a person is assessed as being highly vulnerable, that person may be prioritized for PSH, but if PSH is not available or the PSH has a long waiting list, that person should be prioritized for other types of assistance such as RRH or TH. CoCs should not assume that because a person is prioritized for one type of assistance, they could not be served well by another type of assistance. However, CoCs should be aware that placing a household in transitional housing can affect their eligibility for other programs. For example, people coming from transitional housing are not eligible for most rapid re-housing funded under the ESG and CoC Programs and placement in transitional housing can affect a person s chronic homelessness status. Addressing waiting times through coordinated entry Long wait times make homeless assistance less effective and reduce the overall performance of a community s homeless assistance system. When a community faces a scarcity of needed resources, they should use the coordinated entry process to prioritize which people will receive housing 27

30 APPENDIX A: HUD s Coordinated Entry Policy Brief Released February 2015 assistance rather than continuing to add people to a long waiting list. For example, if a community has enough permanent supportive housing to serve 10 new households per month, but 30 households are assessed as needing PSH every month, the coordinated entry process should be adjusted to prioritize approximately 10 households for PSH each month. The other 20 households should be prioritized for other resources available in the community, such as RRH, TH (taking care to consider the impact of placement in TH on an individual s chronically homeless status or future eligibility in other programs), housing subsidies, or other mainstream resources. Short waiting times of a few days or weeks might be necessary to properly manage utilization, but waiting times for homeless assistance of several months or years should be eliminated whenever possible. Although PSH is almost always the most effective resource for people with high levels of vulnerability and high service needs, including those experiencing chronic homelessness, the lack of available PSH should not result in people languishing in shelters or on the streets without further assistance. Most communities face a gap between need and availability based on limited resources. Communities should be proactively taking steps to close these gaps that are identified through the coordinated entry process. For example, if there is insufficient PSH available in the community, the CoC should be working with PHAs, other affordable housing providers, and Medicaid-funded agencies to increase the supply of PSH. To the maximum extent possible, existing PSH should be targeted to chronically homeless people based on the severity of their service needs (as described in Notice CPD ). Where there are individuals in PSH who no longer need a high level of services, the CoC should pursue move up strategies that help those individuals shift to another form of housing assistance, freeing up the PSH assistance for another prioritized household. Implementing effective assessment tools and processes HUD does not endorse any specific assessment tool or approach, but there are universal qualities that any tool or criteria used by a CoC for their coordinated entry process should include. HUD outlined some of these qualities in the Notice CPD and is building on those qualities in this brief. HUD recognizes the need for guidance as both the process and the tools continue to evolve, so some of the qualities have remained the same, while others have had changes and additions that reflect HUD s evolving understanding of the assessment process and what is most effective. Please refer to HUD s February 2015 report on assessment tools for further information. At its core, the assessment process is not a one-time event to gather as much information about a person as possible. Instead, assessments are performed only when needed and only assess for information necessary to help an individual or family at that moment. Initial assessments happen as quickly as possible regardless of where households are residing streets or in shelter, and the assessment process uses tools as a guide to start the conversation, not as a final decision-maker. Following are several principles that communities can use to ensure an effective assessment process: Phased assessment. The assessment tools are employed as a series of situational assessments that allow the assessment process to occur over time and only as necessary. For example, an assessment process may have separate tools that assess for each of the following: o Screening for diversion or prevention o Assessing shelter and other emergency needs o Identifying housing resources and barriers o Evaluating vulnerability to prioritize for assistance o Screening for program eligibility 28

31 APPENDIX A: HUD s Coordinated Entry Policy Brief Released February 2015 o Facilitating connections to mainstream resources These assessments will likely occur over a period of days or weeks, as needed, depending on the progress a homeless household is making. The different assessments build on each other so a participant does not have to repeat their story. There will also be instances where a participant should be reassessed or reprioritized, particularly if they remain homeless for a long period of time. Necessary information. The assessment process only seeks information necessary to determine the severity of need and eligibility for housing and services and is based on evidence of the risk of becoming or remaining homeless. For example, a coordinated assessment process would only assess for a particular disability to determine if that household could be referred to a program that requires a particular disability as part of its eligibility criteria. Participant autonomy. The protocol for filling out assessment tools provides the opportunity for people receiving the assessment to freely refuse to answer questions without retribution or limiting their access to assistance. Person-centered. The assessment process provides options and recommendations that guide and inform client choices, as opposed to rigid decisions about what individuals or families need. The process also incorporates participants strengths, goals, and protective factors to recommend options that best meet the needs and goals of the people being assessed. Cultural competence. Staff administering assessments use culturally competent practices, and tools contain culturally competent questions. For example, questions are worded to reflect an understanding of LGBTQ issues and needs, and staff administering assessments are trained to ask appropriately worded questions and offer options and recommendations that reflect this population s specific needs. User-friendly. Tools are brief, easily administered by non-clinical staff including outreach workers, minimize the time required to utilize, and easy for those being assessed to understand. Privacy protections. Privacy protections are in place to ensure proper consent and use of client information. Meaningful recommendations. Tools are designed to collect the information necessary to make meaningful recommendations and referrals to available housing and services. Participants being assessed should know exactly what program they are being referred, what will be expected of them, and what they should expect from the program. The coordinated entry process should avoid placing people on long waiting lists. Written standards and policies and procedures. The CoC has written standards describing who is prioritized for assistance and how much assistance they might receive, and the policies and procedures governing the coordinated assessment process are approved by the CoC and easily accessible to stakeholders in the community. Sensitive to lived experiences. Providers recognize that assessment, both the kinds of questions asked and the context in which the assessment is administered, can cause harm and risk to individuals or families, especially if they require people to relive difficult experiences. The tool s questions are worded and asked in a manner that is sensitive to the lived and sometimes traumatic experiences of people experiencing homelessness. The tool minimizes 29

32 APPENDIX A: HUD s Coordinated Entry Policy Brief Released February 2015 risk and harm, and provides individuals or families with the option to refuse to answer questions. Agencies administering the assessment have and follow protocols to address any psychological impacts caused by the assessment and administer the assessment in a private space, preferably a room with a door, or, if outside, away from others earshot. Those administering the tool are trained to recognize signs of trauma or anxiety. Integrating youth into the coordinated entry process CoCs with a network of youth serving programs should consider whether they would better serve youth by creating coordinated entry access points dedicated to underage and transition aged youth. These access points can be located in areas where homeless youth feel comfortable and safe. They can be staffed with people who specialize in working with youth. CoCs should take care to ensure that if they use separate coordinated entry points for youth, that those youth can still access assistance from other parts of the homeless assistance system and that youth who access other coordinated entry points can access assistance from youth serving programs. Regardless of whether a CoC uses youth dedicated access points, the coordinated entry process must ensure that youth are treated respectfully and with attention to their developmental needs. Serving people fleeing domestic violence CoCs must work with domestic violence programs in their communities to ensure that the coordinated entry process addresses the safety needs of people fleeing domestic violence. This includes providing a safe location or process for conducting assessments, a process for providing confidential referrals, and a data collection process consistent with the Violence Against Women Act. If the CoC s coordinated entry process uses separate access points for people fleeing domestic violence, CoCs should take care to ensure that people who use the DV coordinated entry process can access homeless assistance resources available from the non-dv portion of the coordinated entry process and vice versa. Many people experiencing homelessness have a history of domestic violence, and should be able to access appropriate DV services even if they are not accessing it through a DV coordinated entry point. Similarly, people fleeing domestic violence often have housing and homeless assistance needs that should not be limited by their decision to access a DV coordinated entry access point. Defining coordinated entry roles in the homeless assistance system Diverse stakeholders have different roles in a coordinated entry process. In some cases, these roles are clearly defined. Often, the roles are challenging to define and can change over time. Homeless assistance organizations All homeless assistance organizations should be involved in the coordinated entry process by helping people access the system and receiving referrals. Homeless assistance organizations may also provide assessments or provide space for assessments to be conducted. Emergency shelter, transitional housing, rapid re-housing, and permanent supportive housing programs should only receive referrals through the coordinated entry process. Mainstream housing and services Affordable housing and mainstream services are crucial tools for ending homelessness and should be involved in the coordinated entry process. As a CoC s coordinated entry process is developed, mainstream providers can act as a source or receiver of referrals. For instance, sources 30

33 APPENDIX A: HUD s Coordinated Entry Policy Brief Released February 2015 of referrals could include mental health service providers, substance abuse service providers, Department of Veterans Affairs (VA) Medical Centers, jails, or emergency rooms. Receiving agencies could include public housing authorities, multifamily properties (like Section 8 PBRA, 811, and 202), mental health service providers, and substance abuse providers. Organizations acting as receiving agencies will determine the extent to which they will rely on referrals from the coordinated entry process. In some instances, certain services could be co-located with a physical access point, or a virtual access point, like a telephone service such as The more mainstream programs and resources that are connected to your coordinated entry process through the coordination of referral, application, and eligibility determination processes, the more effectively your community can consistently connect homeless individuals with housing resources and the community-based supports that they need to maintain that housing. How a provider or program is integrated into the coordinated entry process will depend on a number of factors including the makeup of the local homeless population, the patterns of service use in the community, and whether the coordinated entry process has been folded into an existing mainstream service system or if it stands alone. These decisions evolve as communities build their processes, and communities might decide to incorporate certain mainstream services over time as a referral source, a receiving agency, or both. Prevention and Diversion There are many more people who qualify for homelessness prevention assistance than homeless assistance. In developing coordinated entry processes, CoCs should consider how much capacity they have to manage prevention assistance. At a minimum, ESG funded prevention assistance should be incorporated into the coordinated entry process. Communities should decide to what extent they include additional non-prevention programs and how they are incorporated. A Note on Future Guidance As more communities implement coordinated entry and more research on the topic is conducted, HUD is learning more about what makes an effective coordinated entry process, and the Department will continually modify its guidance and recommendations to communities. This is challenging for communities, who have to adjust their processes to stay up to date. Nonetheless, HUD believes it is important to act on the best available evidence known at the time, while also recognizing that communities need time and resources to keep up with new guidance. In the coming months, HUD anticipates releasing the following materials related to coordinated entry: Summer 2015: Notice on the requirements for development and implementation of a CoC s coordinated entry process. This notice will establish requirements for coordinated entry and timelines for implementation. Ongoing: Technical Assistance products o Meeting HUD expectations and requirements o Special considerations for youth o Special considerations for people fleeing domestic violence o Compliance and monitoring o Options for funding coordinated entry o Advanced approaches for coordinated entry processes and systems 31

34 APPENDIX A: HUD s Coordinated Entry Policy Brief Released February 2015 o Deciding on community-specific assessment tools o Planning and implementation o Data sharing o CoC written standards o Using progressive engagement Additionally, HUD intends to release the Emergency Solutions Grant (ESG) and CoC Program interim rules for public comment in During this time, HUD encourages CoCs, ESG recipients and subrecipients, and CoC Program recipients to submit comments on the requirements contained in the interim rules related to coordinated entry. Resources on Coordinated Assessment HUD s Office of Policy Development & Research February 2015 Summary Report: Assessment Tools for Allocating Homelessness Assistance: State of the Evidence HUD s requirements for a Centralized or Coordinated Assessment System in CoC Program Interim Rule (24 CFR 578.7(a)(8)). HUD s Office of Special Needs Assistance Programs (SNAPS) July 2013 Weekly Focus on Coordinated Assessment HUD s Overview of Coordinated Assessment Systems Prezi and Video Community Solutions recorded one hour conference call with slide deck: Overview of Coordinated Assessment and Housing Placement System. Community s Solutions CAHP System Overview - Zero: 2016 Corporation for Supportive Housing s January 2015 Report: Improving Community-wide Targeting of Supportive Housing to End Chronic Homelessness: The Promise of Coordinated Assessment National Alliance to End Homelessness Coordinated Assessment Toolkit United States Interagency Council on Homelessness Coordinated Assessment: Putting the Key Pieces in Place 32

35 APPENDIX B: WI Balance of State CoC Pre-Screen Form Updated 2/15 BALANCE OF STATE CoC PRE-SCREEN FORM Are you currently fleeing a domestic violence situation? Yes No If yes, would you like a referral to a local DV agency? Yes No Do you have a disability or need reasonable accommodations for the DVC to provide services to you? (This question is voluntary and does not affect your eligibility for services) Yes No List Accommodations needed: Do you need an interpreter? Yes No Language? Household members List everyone living in your household, related & unrelated. Head of Household (HH) / / Last First Middle Initial Gender Date of birth / / Last Name First Name M.I. Relationship to HH Gender Date of birth / / Last Name First Name M.I. Relationship to HH Gender Date of birth / / Last Name First Name M.I. Relationship to HH Gender Date of birth / / Last Name First Name M.I. Relationship to HH Gender Date of birth / / Last Name First Name M.I. Relationship to HH Gender Date of birth Current Address: Street Apt. # City State Zip Code Telephone No: Veteran Status Never in the Service Currently in the Service Veteran Veteran Benefit Status Currently receiving Currently not receiving Never received Living situation last night: Emergency shelter, including hotel or motel paid for with emergency shelter voucher Hotel or motel paid for without emergency shelter voucher Place not meant for habitation (car, storage unit, street, etc.) Staying or living in a family member s room, apartment or house Staying or living in a friend s room, apartment or house Rental by client, no housing subsidy Rental by client, with VASH housing subsidy Rental by client, with other (non-vash) housing subsidy Jail, prison, or juvenile detention facility Length of living situation in place marked above: Transitional housing for homeless persons (including homeless youth) Permanent housing for formerly homeless persons Psychiatric hospital or other psychiatric facility Owned by client, no housing subsidy Substance abuse treatment facility or detox center Owned by client, with housing subsidy Hospital (non-psychiatric) Foster care home or foster care group home Safe haven Other 33

36 APPENDIX B: WI Balance of State CoC Pre-Screen Form Updated 2/15 One week or less More than one week, but less than one month One to three months Estimate how much longer you expect to reside there: Can t go back More than a year It s a day-by-day arrangement More than three months, but less than one year One year or longer Until shelter/housing is received Less than 3 months 3 months to a year Cause of homelessness (check all that apply): Divorce/Separation Domestic Violence Eviction Loss of job Low income Mental illness Parole Ran Away Rent increase Substance abuse Thrown out Other Housing Status (STAFF USE ONLY) Literally homeless Imminently losing their housing Unstably housed and at risk of losing housing (high risk) Stably housed Income GROSS Monthly Amount Child Support Yes No $ TANF (W2 or W2T) Yes No $ Employment Wages Yes No $ SSDI Yes No $ SSI Yes No $ Unemployment Benefits Yes No $ Pension / Retirement Yes No $ Retirement Disability Yes No $ Self-employment Wages Yes No $ Workers Compensation Yes No $ Social Security Yes No $ General Assistance Yes No $ Alimony Yes No $ Vet Non-Service Connected Disability Yes No $ Vet Service Connected Disability Yes No $ Other $ Other $ TOTAL $ NO INCOME Do you certify that you do not have any income from any source at this time? Yes No VERBAL Do you give consent that this agency may share information with other agencies such as, but not limited to, your situation, household demographics, and any questions asked during this assessment in order to provide referral to other services? Yes No VERBAL I understand that the information contained on this form is provided voluntarily. The information is true and correct to the best of my knowledge. I am aware that providing false information or not reporting pertinent information is fraud. If I provide any false information, I understand that services may be denied. I understand that completion of this form does not guarantee that I will receive assistance. VERBAL Signature of Applicant Date: Signature of CoC Agency Rep Date: 34

37 APPENDIX C: VI-SPDAT v.1 Vulnerability Index & Service Prioritization Decision Assistance Tool (VI-SPDAT) Prescreen for Single Adults GENERAL INFORMATION/CONSENT Interviewer s Name Agency TEAM STAFF VOLUNTEER Date Time Location In what language do you feel best able to express yourself? First Name Nickname Last Name Social Security Number How old are you? What s your date of birth? Has Consented to Participate YES NO If 60 years or older, then score 1. Prescreen Score PRE-SCREEN GENERAL INFORMATION SUBTOTAL A. HISTORY OF HOUSING & HOMELESSNESS QUESTIONS If the person has experienced two or more cumulative years Of homelessness, and/or 4+ episodes of homelessness, then score What is the total length of time you have lived on the streets or in shelters? 2. In the past three years, how many times have you been housed and then homeless again? PRE-SCREEN HOUSING AND HOMELESSNESS SUBTOTAL RESPONSE REFUSED Prescreen Score Page 1 35

38 APPENDIX C: VI-SPDAT v.1 B. RISKS Vulnerability Index & Service Prioritization Decision Assistance Tool (VI-SPDAT) Prescreen for Single Adults SCRIPT: I am going to ask you some questions about your interactions with health and emergency services. If you need any help figuring out when six months ago was, just let me know. QUESTIONS If the total number of interactions across questions 3, 4, 5, 6 and 7 is equal to or greater than 4, then score 1. RESPONSE REFUSED Prescreen Score 3. In the past six months, how many times have you been to the emergency department/room? 4. In the past six months, how many times have you had an interaction with the police? 5. In the past six months, how many times have you been taken to the hospital in an ambulance? 6. In the past six months, how many times have you used a crisis service, including distress centers or suicide prevention hotlines? 7. In the past six months, how many times have you been hospitalized as an in-patient, including hospitalizations in a mental health hospital? If YES to questions 8 or 9, then score 1. YES NO REFUSED Prescreen Score 8. Have you been attacked or beaten up since becoming homeless? 9. Threatened to or tried to harm yourself or anyone else in the last year? If YES to question 10, then score 1. YES NO REFUSED Prescreen Score 10. Do you have any legal stuff going on right now that may result in you being locked up or having to pay fines? If YES to questions 11 or 12; OR if respondent provides any answer OTHER THAN Shelter in question 13, then score 1. YES NO REFUSED Prescreen Score 11. Does anybody force or trick you to do things that you do not want to do? 12. Ever do things that may be considered to be risky like exchange sex for money, run drugs for someone, have unprotected sex with someone you don t really know, share a needle, or anything like that? 13. I am going to read types of places people sleep. Please tell me which one that you sleep at most often. (Check only one.) PRE-SCREEN RISKS SUBTOTAL Shelter Street, Sidewalk or Doorway Car, Van or RV Bus or Subway Beach, Riverbed or Park Other (SPECIFY): Page 2 36

39 APPENDIX C: VI-SPDAT v.1 Vulnerability Index & Service Prioritization Decision Assistance Tool (VI-SPDAT) Prescreen for Single Adults C. SOCIALIZATION & DAILY FUNCTIONS QUESTIONS If YES to question 14 or NO to questions 15 or 16, score 1. YES NO REFUSED Prescreen Score 14. Is there anybody that thinks you owe them money? 15. Do you have any money coming in on a regular basis, like a job or government benefit or even working under the table, binning or bottle collecting, sex work, odd jobs, day labor, or anything like that? 16. Do you have enough money to meet all of your expenses on a monthly basis? If NO to question 17, score 1. YES NO REFUSED Prescreen Score 17. Do you have planned activities each day other than just surviving that bring you happiness and fulfillment? If YES to questions 18 or 19, score 1. YES NO REFUSED Prescreen Score 18. Do you have any friends, family or other people in your life out of convenience or necessity, but you do not like their company? 19. Do any friends, family or other people in your life ever take your money, borrow cigarettes, use your drugs, drink your alcohol, or get you to do things you really don t want to do? OBSERVE ONLY. DO NOT ASK! If YES, score 1. YES NO Prescreen Score 20. Surveyor, do you detect signs of poor hygiene or daily living skills? PRE-SCREEN RISKS SUBTOTAL Page 3 37

40 APPENDIX C: VI-SPDAT v.1 Vulnerability Index & Service Prioritization Decision Assistance Tool (VI-SPDAT) Prescreen for Single Adults D. WELLNESS QUESTIONS If Does Not Go For Care, score 1. RESPONSE Prescreen Score 21. Where do you usually go for healthcare or when you re not feeling well? For EACH YES response in questions 22 through 25 (Medical Conditions), score 1. Do you have now, have you ever had, or has a healthcare provider ever told you that you have any of the following medical conditions: Hospital Clinic VA Other (specify) Does not go for care YES NO REFUSED Medical Conditions 22. Kidney disease/end Stage Renal Disease or Dialysis 23. History of frostbite, Hypothermia, or Immersion Foot 24. Liver disease, Cirrhosis, or End-- Stage Liver Disease 25. HIV+/AIDS If YES to any of the conditions in questions 26 to 34, then mark X in Other Medical Condition column. YES NO REFUSED Other Medical Conditions 26. History of Heat Stroke/Heat Exhaustion 27. Heart disease, Arrhythmia, or Irregular Heartbeat 28. Emphysema 29. Diabetes 30. Asthma 31. Cancer 32. Hepatitis C 33. Tuberculosis OBSERVATION ONLY DO NOT ASK: 34. Surveyor, do you observe signs or symptoms of a serious health condition? If any response is YES in questions 35 through 41, score 1 in the Substance Use column. 35. Have you ever had problematic drug or alcohol use, abused drugs or alcohol, or told you do? 36. Have you consumed alcohol and/or drugs almost every day or every day for the past month? 37. Have you ever used injection drugs or shots in the last six months? 38. Have you ever been treated for drug or alcohol problems and returned to drinking or using drugs? 39. Have you used non-beverage alcohol like cough syrup, mouthwash, rubbing alcohol, cooking wine, or anything like that in the past six months? 40. Have you blacked out because of your alcohol or drug use in the past month? YES NO REFUSED Substance Use Page 4 38

41 APPENDIX C: VI-SPDAT v.1 Vulnerability Index & Service Prioritization Decision Assistance Tool (VI-SPDAT) Prescreen for Single Adults OBSERVATION ONLY DO NOT ASK: 41. Surveyor, do you observe signs or symptoms or problematic alcohol or drug abuse? If any response is YES in questions 42 through 48, score 1 in the Mental Health column. YES NO REFUSED Mental Health 42. Ever been taken to a hospital against your will for a mental health reason? 43. Gone to the emergency room because you weren t feeling 100% well emotionally or because of your nerves? 44. Spoken with a psychiatrist, psychologist or other mental health professional in the last six months because of your mental health whether that was voluntary or because someone insisted that you do so? 45. Had a serious brain injury or head trauma? 46. Ever been told you have a learning disability or developmental disability? 47. Do you have any problems concentrating and/or remembering things? OBSERVATION ONLY DO NOT ASK: 48. Surveyor, do you detect signs or symptoms of severe, persistent mental illness or severely compromised cognitive functioning? If the Substance Use score is 1 AND the Mental Health score is 1 AND the Medical Condition score is at least a 1 OR an X, then score 1 additional point for tri-- morbidity. Tri- Morbidity If YES to question 49, score 1. YES NO REFUSED Prescreen Score 49. Have you had any medicines prescribed to you by a doctor that you do not take, sell, had stolen, misplaced, or where the prescriptions were never filled? If YES to question 50, score 1. YES NO REFUSED Prescreen Score 50. Yes or No Have you experienced any emotional, physical, psychological, sexual or other type of abuse or trauma in your life which you have not sought help for, and/or which has caused your homelessness? PRE-SCREEN WELLNESS SUBTOTAL SCORING SUMMARY DOMAIN SUBTOTAL If the Pre-Screen Total is equal to or greater than 10, the individual is recommended for a Permanent Supportive Housing/Housing First Assessment. GENERAL INFORMATION A. HISTORY OF HOUSING AND HOMELESSNESS B. RISKS C. SOCIALIZATION AND DAILY FUNCTIONS D. WELLNESS PRE-SCREEN TOTAL If the Pre-- Screen Total is 5, 6, 7, 8 or 9, the individual is recommended for a Rapid Re-- Housing Assessment. If the Pre-- Screen Total is 0, 1, 2, 3 or 4, the individual is not recommended for a Housing and Support Assessment at this time. Page 5 39

42 APPENDIX C: VI-SPDAT v.1 Vulnerability Index & Service Prioritization Decision Assistance Tool (VI-SPDAT) Prescreen for Single Adults Finally I d like to ask you some questions to help us better understand homelessness and improve housing and support services. What is your gender? MaleFemaleTransgender Other Decline to State Have you ever served in the US Military? Yes No Refused Korean War (June 1950 January 1955) Vietnam Era (August 1964 April 1975) Post Vietnam (May 1975 July 1991) If yes, which war/war era did you serve in? Persian Gulf Era (August 1991 Present) Afghanistan (2001 Present) Iraq (2003 Present) Other (Specify) Refused Honorable Other than Honorable If yes, what was the character of your discharge? Bad Conduct Dishonorable Refused Citizen What is your citizenship status? Legal Resident Undocumented Refused This city Where did you live prior to becoming homeless? This region Other part of the State Somewhere else(specify) Have you ever been in foster care? Yes No Refused Have you ever been in jail? Yes No Refused Have you ever been in prison? Yes No Refused Do you have a permanent physical disability that limits your mobility? (i.e., wheelchair, amputation, unable to climb stairs) Yes No Refused Medicaid Medicare What kind of health insurance do you have, if any? (check all that apply) VA Private Insurance None Other (specify): On a regular day, where is it easiest to find you and what time of day is easiest to do so? Is there a phone number and/or where someone can get in touch with you or leave you a message? Page 6 40

43 APPENDIX D: VI-F-SPDAT v.1 Vulnerability Index & Family Service Prioritization Decision Assistance Tool (VI-F-SPDAT) Prescreen for Families GENERAL INFORMATION/CONSENT Interviewer s Name Agency TEAM STAFF VOLUNTEER Date Time Location HEAD OF HOUSEHOLD 1 In what language do you feel best able to express yourself? First Name Nickname Last Name Social Security Number How old are you? What s your date of birth? Has Consented to Participate HEAD OF HOUSEHOLD 2 (when applicable) In what language do you feel best able to express yourself? First Name Nickname YES NO Last Name Social Security Number How old are you? What s your date of birth? Has Consented to Participate YES NO If either head of household is 60 years or older, then score 1. Prescreen Score Page 1 41

44 APPENDIX D: VI-F-SPDAT v.1 Vulnerability Index & Family Service Prioritization Decision Assistance Tool (VI-F-SPDAT) Prescreen for Families CHILDREN Total number of children under the age of 18 that are currently with the head(s) of household RESPONSE REFUSED How many children under the age of 18 are not currently with your family, but you have reason to believe they will be joining you when you get housed? RESPONSE REFUSED Last Name First Name How old? Date of Birth Only ask the following question when there is at least one female head of household, and/or if there is at least one female child 13 years of age or older: Is any member of the family currently pregnant? Single Parent Family: If there are two or more children, or any child 11 years of age or younger, and/or it is a female single parent that is pregnant, score 1. YES NO Prescreen Score REFUSED Two Parent Family: If there are three or more children, or any child 6 years of age or younger, and/or there is a female head of household that is pregnant, score 1. PRE-SCREEN GENERAL & FAMILY SIZE INFORMATION SUBTOTAL A. HISTORY OF HOUSING & HOMELESSNESS QUESTIONS If at least one head of household AND at least one child has experienced two or more cumulative years of homelessness, and/or 4+ episodes of homelessness, then score What is the total length of time you and your family have lived on the streets or in shelters? 2. In the past three years, how many times have you and your family been housed and then homeless again? PRE-SCREEN HOUSING AND HOMELESSNESS SUBTOTAL RESPONSE REFUSED Prescreen Score Page 2 42

45 APPENDIX D: VI-F-SPDAT v.1 Vulnerability Index & Family Service Prioritization Decision Assistance Tool (VI-F-SPDAT) Prescreen for Families B. RISKS SCRIPT: I am going to ask you some questions about all the times you and other members of your family have had interactions with health and emergency services. If you need any help figuring out when six months ago was, just let me know. QUESTIONS If the total number of interactions across questions 3, 4, 5, 6 and 7 is equal to or greater than 4, then score In the past six months, how many times have you and/or members of your family been to the emergency department/room? 4. In the past six months, how many times have you and/or members of your family been had an interaction with the police? 5. In the past six months, how many times have you and/or members of your family been been taken to the hospital in an ambulance? 6. In the past six months, how many times have you and/or members of your family been used a crisis service, including distress centers or suicide prevention hotlines? 7. In the past six months, how many times have you and/or members of your family been been hospitalized as an in-patient, including hospitalizations in a mental health hospital? RESPONSE REFUSED Prescreen Score If YES to questions 8 or 9, then score 1. YES NO REFUSED 8. Have you or any family member been attacked or beaten up since becoming homeless? 9. Have you or any family member threatened to or tried to harm themselves or anyone else in the last year? If YES to question 10, then score 1. YES NO REFUSED 10. Do you or any member of the family have any legal stuff going on right now that may result in being locked up or having to pay fines? If YES to questions 11 or 12; OR if respondent provides any answer OTHER THAN Shelter in question 13, then score Does anybody force or trick you or any member of the family to do things that they do not want to do? 12. Do you or any family member ever do things that may be considered to be risky like exchange sex for money, run drugs for someone, have unprotected sex with someone you don t really know, share a needle, or anything like that? 13. I am going to read types of places people sleep. Please tell me which one that you and your family sleep at most often. (Check only one.) PRE-SCREEN RISKS SUBTOTAL YES NO REFUSED Shelter Street, Sidewalk or Doorway Car, Van or RV Bus or Subway Beach, Riverbed or Park Other (SPECIFY): Prescreen Score Prescreen Score Prescreen Score Page 3 43

46 APPENDIX D: VI-F-SPDAT v.1 Vulnerability Index & Family Service Prioritization Decision Assistance Tool (VI-F-SPDAT) Prescreen for Families C. SOCIALIZATION & DAILY FUNCTIONS QUESTIONS If YES to question 14 or NO to questions 15 or 16, score 1. YES NO REFUSED Prescreen Score 14. Is there anybody that thinks you or any family member owes them money? 15. Does the family have any money coming in on a regular basis, like a job or government benefit or even working under the table, binning or bottle collecting, sex work, odd jobs, day labor, or anything like that? 16. Does your family have enough money to meet all expenses on a monthly basis? If NO to question 17, score 1. YES NO REFUSED Prescreen Score 17. Do you and each member of the family have planned activities each day other than just surviving that bring happiness and fulfillment? If YES to questions 18 or 19, score 1. YES NO REFUSED Prescreen Score 18. Do you have any friends, family or other people in your life out of convenience or necessity, but you do not like their company? 19. Do any friends, family or other people in your life ever take your money, borrow cigarettes, use your drugs, drink your alcohol, or get you to do things you really don t want to do? OBSERVE ONLY. DO NOT ASK! If YES, score 1. YES NO Prescreen Score 20. Surveyor, do you detect signs of poor hygiene or daily living skills? PRE-SCREEN SOCIALIZATION & DAILY FUNCTIONS SUBTOTAL Page 4 44

47 APPENDIX D: VI-F-SPDAT v.1 Vulnerability Index & Family Service Prioritization Decision Assistance Tool (VI-F-SPDAT) Prescreen for Families D. WELLNESS QUESTIONS If Does Not Go For Care, score 1. RESPONSE Prescreen 21. Where do you and other family members usually go for healthcare or when you re not feeling well? Hospital Clinic VA Other (specify) Does not go for care Score For EACH YES response in questions 22 through 25 (Medical Conditions), score 1. Do you or any family member have now, ever had, or had a healthcare provider ever told you that you have any of the YES NO REFUSED Medical Conditions following medical conditions: 22. Kidney disease/end Stage Renal Disease or Dialysis 23. History of frostbite, Hypothermia, or Immersion Foot 24. Liver disease, Cirrhosis, or End-- Stage Liver Disease 25. HIV+/AIDS If YES to any of the conditions in questions 26 to 34, then mark X in Other Medical Condition column. YES NO REFUSED Other Medical 26. History of Heat Stroke/Heat Exhaustion 27. Heart disease, Arrhythmia, or Irregular Heartbeat 28. Emphysema 29. Diabetes 30. Asthma 31. Cancer 32. Hepatitis C 33. Tuberculosis OBSERVATION ONLY DO NOT ASK: 34. Surveyor, do you observe signs or symptoms of a serious health condition? Conditions Page 5 45

48 APPENDIX D: VI-F-SPDAT v.1 Vulnerability Index & Family Service Prioritization Decision Assistance Tool (VI-F-SPDAT) Prescreen for Families If any response is YES in questions 35 through 42, score 1 in the YES NO REFUSED Substance Use Substance Use column. 35. Have you or any member of the family ever had problematic drug or alcohol use, abused drugs or alcohol, or told you do? 36. Have you or any member of the family consumed alcohol and/or drugs almost every day or every day for the past month? 37. Have you or any member of the family ever used injection drugs or shots in the last six months? 38. Have you or any member of the family ever been treated for drug or alcohol problems and returned to drinking or using drugs? 39. Have you or any member of the family used non-beverage alcohol like cough syrup, mouthwash, rubbing alcohol, cooking wine, or anything like that in the past six months? 40. Have you or any member of the family blacked out because of your alcohol or drug use in the past month? 41. Has any family member under the legal drinking age consumed alcohol four more times in the last month or used drugs at any point in time during the last month including marijuana or prescription pills to get high? OBSERVATION ONLY DO NOT ASK: 42. Surveyor, do you observe signs or symptoms or problematic alcohol or drug abuse? If any response is YES in questions 43 through 49, score 1 in the Mental Health column. 43. Have you or any family member ever been taken to a hospital against your will for a mental health reason? 44. Have you or any family member ever gone to the emergency room because you weren t feeling 100% well emotionally or because of your nerves? 45. Have you or any family member ever spoken with a psychiatrist, psychologist or other mental health professional in the last six months because of your mental health whether that was voluntary or because someone insisted that it be done? 46. Have you or any family member had a serious brain injury or head trauma? 47. Have you or any family member ever been told they have a learning disability or developmental disability? 48. Do you or any member of your family have any problems concentrating and/or remembering things? OBSERVATION ONLY DO NOT ASK: 49. Surveyor, do you detect signs or symptoms of severe, persistent mental illness or severely compromised cognitive functioning? If the Substance Use score is 1 AND the Mental Health score is 1 AND the Medical Condition score is at least a 1 OR an X AND IT IS ALL RELATED TO THE SAME FAMILY MEMBER, then score 1 additional point for tri-morbidity. ASK THIS QUESTION ONLY WHEN THERE WAS 1 in Substance Use AND 1 in Mental Health, and at least 1 in the Medical Conditions or an X. 50. You indicated in your responses that there is a medical condition, experience with mental health services and experience with substance use. Is that the same member of the family in all of those instances? Page 6 YES NO REFUSED Mental Health Tri-Morbidity Pre-secreen Score 46

49 APPENDIX D: VI-F-SPDAT v.1 Vulnerability Index & Family Service Prioritization Decision Assistance Tool (VI-F-SPDAT) Prescreen for Families If YES to question 51, score 1. YES NO REFUSED Prescreen Score 51. Have you or any member of the family had any medicines prescribed by a doctor that were not taken, sold, stolen, misplaced, or where the prescriptions were never filled? If YES to question 52, score 1. YES NO REFUSED Prescreen 52. Yes or No Have you or any member of your family experienced any emotional, physical, psychological, sexual or other type of abuse or trauma for which you have not sought help, and/or which has caused your homelessness? PRE-SCREEN WELLNESS SUBTOTAL Score E. FAMILY UNIT QUESTIONS If YES to question 53 OR 54, score 1. YES NO REFUSED Prescreen Score 53. Do any of your children spend two or more hours per day when you don t know where they are? 54. On most days, do any children do tasks that adults would normally do like preparing meals, getting other children ready for bedtime, shopping, cleaning the apartment, or anything like that? If either 55 or 56 are 3 or more, score 1. YES NO REFUSED Prescreen Score 55. What is the total number of times adults in the family have changed in the family over the past year because of things like new relationships, or a breakdown in the relationship, prison, military deployment, or anything like that? 56. What is the total number of times that children have been separated from the family or returned to the family over the past year? If YES to questions 57 or 58, score 1. YES NO REFUSED Prescreen Score 57. Are there any school-aged children that are not enrolled in school or missing more days of school than they are attending? 58. Right now or at any point in the last six months have any of your children been separated from you to live with a family member or friend? If YES to questions 59 or 60, score 1. YES NO REFUSED Prescreen Score 59. Has there been any involvement with any member of your family and child protective services in the last six months even if it was resolved? 60. Have you had anything in family court over the past six months or anything currently being considered in family court? PRE-SCREEN FAMILY UNIT SUBTOTAL Page 7 47

50 APPENDIX D: VI-F-SPDAT v.1 Vulnerability Index & Family Service Prioritization Decision Assistance Tool (VI-F-SPDAT) Prescreen for Families SCORING SUMMARY DOMAIN SUBTOTAL If the Pre-Screen Total is equal to or greater than 12, the family is recommended for a Permanent Supportive Housing/Housing First Assessment. GENERAL INFORMATION A. HISTORY OF HOUSING AND HOMELESSNESS B. RISKS C. SOCIALIZATION AND DAILY FUNCTIONS D. WELLNESS E. FAMILY UNIT PRE-SCREEN TOTAL If the Pre-- Screen Total is 6, 7, 8, 9, 10, or 11 the family is recommended for a Rapid Re-Housing Assessment. If the Pre-Screen Total is 0, 1, 2, 3, 4, or 5, the family is not recommended for a Housing and Support Assessment at this time. Finally I d like to ask you some questions to help us better understand homelessness and improve housing and support services. Have you or any family member ever served in the US Military? Yes No Refused Korean War (June 1950 January 1955) Vietnam Era (August 1964 April 1975) Post Vietnam (May 1975 July 1991) If yes, which war/war era did you serve in? Persian Gulf Era (August 1991 Present) Afghanistan (2001 Present) Iraq (2003 Present) Other (Specify) Refused Honorable Other than Honorable If yes, what was the character of your discharge? Bad Conduct Dishonorable Refused What is your citizenship status? Citizen Legal Resident Undocumented Refused This city Where did you live prior to becoming homeless? This region Other part of the State Somewhere else(specify) Have you ever been in foster care? Yes No Refused Have you ever been in jail? Yes No Refused Have you ever been in prison? Yes No Refused Do you ohave a permanent physical disability that limits your mobility? (i.e., wheelchair, amputation, unable to climb stairs) Yes No Refused Medicaid Medicare VA What kind of health insurance d any member of the family you have, Private Insurance None if any? (check all that apply) Other (specify): On a regular day, where is it easiest to find you and what time of day is easiest to do so? Is there a phone number and/or where someone can get in touch with you or leave you a message? Page 8 48

51 APPENDIX E: Universal Data Element Form Universal Data Element Form Under Development 49

52 APPENDIX F: Prioritization List Release of Information Prioritization List Release of Information Under Development 50

53 APPENDIX G: Permanent Supportive Housing Order of Priority Approved March 2015 Order of Priority in CoC Program-funded Permanent Supportive Housing Recipients of CoC Program-funded PSH are required to follow the order of priority when selecting participants for housing in accordance with the BOSCOC s written standards while also considering the goals and any identified target populations served by the project, and in a manner consistent with their current grant agreement. Due diligence should be exercised when conducting outreach and assessment to ensure that persons are served in the order of priority as adopted by the BOSCOC. HUD and the BOSCOC recognize that some persons particularly those living on the streets or in places not meant for human habitation might require significant engagement and contacts prior to their entering housing and recipients are not required to keep units vacant where there are persons who meet a higher priority within the CoC and who have not yet accepted the PSH opportunities offered to them. Street outreach providers should continue to make attempts with those persons using a Housing First approach to place as few conditions on a person s housing as possible. Order of Priority in CoC Program-funded Permanent Supportive Housing Beds Dedicated to Persons Experiencing Chronic Homelessness and Permanent Supportive Housing Prioritized for Occupancy by Persons Experiencing Chronic Homelessness 1 st Priority: Chronically Homeless Individuals and Families with the Longest History of Homelessness and with the Most Severe Service Needs. A chronically homeless individual or head of household as defined in 24 CFR for whom both of the following are true: 1. The chronically homeless individual or head of household of a family has been homeless and living in a place not meant for human habitation, a safe haven, or in an emergency shelter for at least 12 months either continuously or on at least four separate occasions in the last 3 years, where the cumulative total length of the four occasions equals at least 12 months; and 2. The CoC Program has identified the chronically homeless individual or head of household as having severe service needs. 2 nd Priority: Chronically Homeless Individuals and Families with the Longest History of Homelessness. A chronically homeless individual or head of household, as defined in 24 CFR 578.3, for whom both of the following are true: 1. The chronically homeless individual or head of household of a family has been homeless and living in a place not meant for human habitation, a safe haven, or in an emergency shelter for at least 12 months either continuously or on at least four separate occasions in the last 3 years, where the cumulative total length of the four occasions equals at least 12 months; and 2. The CoC or CoC program recipient has not identified the chronically homeless individual or the head of household, who meets all of the criteria in paragraph (1) of the definition for chronically homeless, of the family as having severe service needs. 51

54 APPENDIX G: Permanent Supportive Housing Order of Priority Approved March rd Priority: Chronically Homeless Individuals and Families with the Most Severe Service Needs. A chronically homeless individual or head of household as defined in 24 CFR for whom both of the following are true: 1. The chronically homeless individual or head of household of a family has been homeless and living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter on at least four separate occasions in the last 3 years, where the total length of those separate occasions equals less than one year; and 2. The CoC or CoC program recipient has identified the chronically homeless individual or the head of household, who meets all of the criteria in paragraph (1) of the definition for chronically homeless, of the family as having severe service needs. 4 th Priority: All Other Chronically Homeless Individuals and Families. A chronically homeless individual or head of household as defined in 24 CFR for whom both of the following are true: 1. The chronically homeless individual or head of household of a family has been homeless and living in a place not meant for human habitation, a safe haven, or in an emergency shelter for at least 12 months either continuously or on at least four separate occasions in the last 3 years, where the cumulative total length the four occasions is less than 12 months; and 2. The CoC or CoC program recipient has not identified the chronically homeless individual or the head of household, who meets all of the criteria in paragraph (1) of the definition for chronically homeless, of the family as having severe service needs. Where a CoC or a recipient of CoC Program-funded PSH beds that are dedicated or prioritized is not able to identify chronically homeless individuals and families as defined in 24 CFR within the CoC, the order of priority in the next section may be followed. 52

55 APPENDIX G: Permanent Supportive Housing Order of Priority Approved March 2015 Order of Priority in Permanent Supportive Housing Beds Not Dedicated or Prioritized for Persons Experiencing Chronic Homelessness CoC Program-funded non-dedicated and non-prioritized PSH should offer housing to chronically homeless individuals and families first, but minimally are required to place otherwise eligible households in an order that prioritizes, in a nondiscriminatory manner, those who would benefit the most from this type of housing, beginning with those most at risk of becoming chronically homeless. 1 st Priority: Homeless Individuals and Families with a Disability with the Most Severe Service Needs. An individual or family that is eligible for CoC Program-funded PSH who has been living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter for any period of time, including persons exiting an institution where they have resided for 90 days or less but were living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter immediately prior to entering the institution and has been identified as having the most severe service needs. 2 nd Priority: Homeless Individuals and Families with a Disability with a Long Period of Continuous or Episodic Homelessness. An individual or family that is eligible for CoC Program-funded PSH who has been living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter continuously for at least 6 months or on at least three separate occasions in the last 3 years where the cumulative total is at least 6 months. This includes persons exiting an institution where they have resided for 90 days or less but were living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter immediately prior to entering the institution and had been living or residing in one of those locations for at least 6 months or on at least three separate occasions in the last 3 years where the cumulative total is at least 6 months. 3 rd Priority: Homeless Individuals and Families with Disability Coming from Places Not Meant for Human Habitation, Safe Havens, or Emergency Shelters. An individual or family that is eligible for CoC Program-funded PSH who has been living in a place not meant for human habitation, a safe haven, or an emergency shelter. This includes persons exiting an institution where they have resided for 90 days or less but were living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter immediately prior to entering the institution. 4 th Priority: Homeless Individuals and Families with a Disability Coming from Transitional Housing. An individual or family that is eligible for CoC Program-funded PSH who is coming from transitional housing, where prior to residing in the transitional housing lived on streets or in an emergency shelter, or safe haven. This priority also includes homeless individuals and homeless households with children with a qualifying disability who were fleeing or attempting to flee domestic violence, dating violence, sexual assault, or stalking and are living in transitional housing all are eligible for PSH even if they did not live on the streets, emergency shelters, or safe havens prior to entry in the transitional housing. 53

56 APPENDIX H: Transitional Housing Order of Priority Approved March 2015 Order of Priority for Transitional Housing Beds Recipients of CoC Program-funded TH are required to follow the order of priority when selecting participants for housing in accordance with the CoC s written standards while also considering the goals and any identified target populations served by the project, and in a manner consistent with their current grant agreement. Due diligence should be exercised when conducting outreach and assessment to ensure that persons are served in the order of priority adopted by the BOSCOC. HUD and the BOSCOC recognize that some persons particularly those living on the streets or in places not meant for human habitation might require significant engagement and contacts prior to their entering housing and recipients are not required to keep units vacant where there are persons who meet a higher priority within the CoC and who have not yet accepted the TH opportunities offered to them. Street outreach providers should continue to make attempts with those persons using a Housing First approach to place as few conditions on a person s housing as possible. 1 st Priority: Categories 1 & 4 Homeless Individuals and Families with a Disability with the Most Severe Service Needs. HUD Definition of Category 1 Homelessness: An individual or family that is eligible for CoC Program-funded TH who has been living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter for any period of time, including persons exiting an institution where they have resided for 90 days or less but were living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter immediately prior to entering the institution, or HUD Definition of Category 4 Homelessness: Any individual or family that is eligible for CoC Program-funded TH who is fleeing, or is attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member, including a child, that has either taken place within the individual s or family s primary nighttime residence or has made the individual or family afraid to return to their primary nighttime residence; has no other residence; and lacks the resources or support networks, e.g., family, friends, faith- based or other social networks, to obtain other permanent housing, and A household member has a disability, and The individual or family has been identified as having the most severe service needs by VI-SPDAT or VI-F- SPDAT score. If two or more households have the same VI-SPDAT or VI-F-SPDAT score, priority should be given to the household with the longest length of current homelessness. 2 nd Priority: Categories 1 & 4 Homeless Individuals and Families without a Disability with the Most Severe Service Needs. An individual or family that is eligible for CoC Program-funded TH who has been living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter for any period of time, including persons exiting an institution where they have resided for 90 days or less but were living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter immediately prior to entering the institution, or 54

57 APPENDIX H: Transitional Housing Order of Priority Approved March 2015 Any individual or family that is eligible for CoC Program-funded TH who is fleeing, or is attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member, including a child, that has either taken place within the individual s or family s primary nighttime residence or has made the individual or family afraid to return to their primary nighttime residence; has no other residence; and lacks the resources or support networks, e.g., family, friends, faith- based or other social networks, to obtain other permanent housing, and The individual or family has been identified as having the most severe service needs by VI-SPDAT or VI-F- SPDAT score. If two or more households have the same VI-SPDAT or VI-F-SPDAT score, priority should be given to the household with the longest length of current homelessness. 3 rd Priority: Category 2 Homeless Individuals and Families with a Disability and with the Most Severe Service Needs Who Are Imminently At Risk of Homelessness. HUD Definition of Category 2 Homelessness: An individual or family who will imminently lose their primary nighttime residence provided that the primary nighttime residence will be lost within 14 days of the date of application for homeless assistance; no subsequent residence has been identified; and the individual or family lacks the resources or support networks, e.g., family, friends, faith-based or other social networks needed to obtain other permanent housing, and A household member has a disability, and The individual or family has been identified as having the most severe service needs by VI-SPDAT or VI-F- SPDAT score. If two or more households have the same VI-SPDAT or VI-F-SPDAT score, priority should be given to the household whose homelessness is most imminent (i.e. needing to be out in 2 days is higher priority than needing to be out in 10 days). 4 th Priority: Category 2 Homeless Individuals and Families without a Disability Who Are Imminently At Risk of Homelessness. An individual or family who will imminently lose their primary nighttime residence provided that the primary nighttime residence will be lost within 14 days of the date of application for homeless assistance; no subsequent residence has been identified; and the individual or family lacks the resources or support networks, e.g., family, friends, faith-based or other social networks needed to obtain other permanent housing, and The individual or family has been identified as having the most severe service needs by VI-SPDAT or VI-F- SPDAT score. 55

58 APPENDIX H: Transitional Housing Order of Priority Approved March 2015 If two or more households have the same VI-SPDAT or VI-F-SPDAT score, priority should be given to the household whose homelessness is most imminent (i.e. needing to be out in 2 days is higher priority than needing to be out in 10 days). 56

59 APPENDIX I: ESG-Funded Rapid Re-Housing Order of Priority Approved November 2014 Balance of State Continuum of Care Program Standards for ESG-Funded Rapid Re-Housing Programs PRIORITIZATION STANDARD: Programs will determine and prioritize which eligible families and individuals will receive Rapid Re-Housing assistance. CRITERIA: 1. The program will screen/assess each household for barriers to obtaining housing and barriers to retaining housing. a. Barriers to obtaining housing only include problems that a prospective landlord could find out during the application and screening process AND could use as a reason to deny a rental application, whether or not the manner of determination and use is legal or illegal. b. Barriers to retaining housing are defined by the direct impact they have had on the on the household s previous housing history, and the potential for affecting future housing. 2. The program will categorize each applicant household using the VI-SPDAT Assessment Tool based on number and severity of barriers. 3. Programs will utilize the Rapid Re-Housing Triage Tool developed by the National Alliance to End Homelessness, Center for Capacity Building (see attachment) to match the household to the most appropriate housing option. a. Category 1: Short-term Rapid Re-Housing assistance is offered only as payer of last resort AND if there are no other eligible households in categories 2 through 5. b. Categories 2 & 3: Prioritized for Rapid Re-Housing. c. Category 4: Prioritized for Transitional Housing, or Rapid Re-Housing if no Transitional Housing program exists in the local CoC. d. Category 5: Prioritized for Permanent Supportive Housing, or Transitional Housing if no Permanent Supportive housing exists in the local CoC, or Rapid Re-Housing if no Transitional Housing program exists in the local CoC. Service prioritization must look at all programs and services within the local CoC, not just within a single agency. 57

60 APPENDIX I: ESG-Funded Rapid Re-Housing Order of Priority Approved November 2014 Rapid Re-Housing Triage Tool This tool may be helpful for the purposes of determining what services a rapid re-housing eligible household is in need of. Communities would ideally use this tool only after prevention or diversion had been ruled out as options for a household and before or very shortly after admitting them to a shelter program if they have no place else to stay. This tool should be used as a starting point; communities are encouraged to refine the tool to reflect local data and system outcomes. Level of Assistance Level 1 The household will need minimal assistance to obtain and retain housing. The Rapid Re-Housing (RRH) program offers the following for most Level 1 households: Financial assistance for housing start-up (e.g. first month s rent, security deposit, utility deposit) Initial consultation related to housing search (e.g. where to find rental information, how to complete housing applications, documentation needed) Time-limited rental assistance, per client Housing Plan Home visit/check-in after movein Offer of services (at tenant request) for up to 3 months. Landlord assistance will likely include only program contact information for tenancy concerns Tenant Screening Barriers (Barriers to Obtaining Housing) Household has no criminal history Rental history: an established local rental history. No evictions, landlord references are good to fair Credit history is good, with the exception of a few late utility and credit card payments Retention Barriers (Barriers to Sustaining Housing) No significant barriers except financial: very low income, insufficient emergency reserves 58

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