Housing First Screening Tools For Communities Meaghan Bell

Housing First & Screening Tools For Communities Meaghan Bell Stephen Gaetz Paula Goering University of Calgary Canadian Observatory on Homelessness, Professor, York University Centre for Addiction and Mental Health, University of Toronto

PART 1 What is an assessment?

The Screening Process can Serve Several Purposes • Allows for initial engagement • Determines if individuals meet program eligibility requirements. • A system of prioritization can be developed in order to place individuals with the highest needs into Housing First services quickly.

Assessment Roadmap 1. Screening 2. Service/Support planning 3. Service/Support provision

Assessment is but one part of a broader community strategy in working with people who are homeless.

Where does ASSESSMENT fit in? Community Priorities Intake Assessment Tool Interventions Clinical Assessments Case Management Data Management Systems (HMIS, HIFIS)

PART 2 Assessment in the Community Context

What is your community context? • Community priorities? (Chronic? High acuity mental health and addictions? Youth? ) • Community assets? (Can you assemble an ACT team? Do you have permanent supportive housing? ) • Data management and alignment with other data being collected

Certain Domains Should be Assessed HOUSING STATUS: SERVICE USE: Is the person homeless? Chronically? Episodically? Is the individual a high service user? VULNERABILITY STATUS: What is their level of vulnerability (physical health, mental health, substance use)? Is the person at risk of harm to him/herself or others? SEVERITY OF NEED: What is the individual’s severity of need (low, moderate, high)? FURTHER ASSESSMENT: Does the individual require further assessment or assistance?

Critical Steps to Implementing a Screening and Prioritization Tool 1. Understanding ecology of homelessness in your community 2. Consensus on priority population(s) – i. e. chronic shelter users? High system users?

4. System Mapping – what resources does your community have and how may this impact the screening and prioritization? 5. Be open to adaption in order to meet your local needs! 6. Use the tool as a mechanism to facilitate collaboration and shared planning across the homeless serving sector (e. g. placement committees) 7. Engage in ongoing consultation and feedback with those using the tool

PART 3 What makes for a good screening assessment tool?

Characteristics of a Good Tool: • • Responsive to community needs Evidence based and effective Ease of use (for providers and clients) Assists in service planning Complements other tools Community capacity building (including training) USEFUL!

Brevity and Usability An assessment tool should include a question only if the answer to that question is needed right then to determine what kind of assistance a person will receive.

No Single Tool Can or Should do Everything • • • Priority setting Screening Intake Triage Acuity assessment Case management

Evidence Based Rely on tools that are tested evidence based and there is clarity about what is being measured.

A word of caution: Avoid SCIENTISM! Assessment tools are one source of information to guide decision making. They are not magic, and they cannot make decisions for you. Trust your own knowledge as well.

Training and Technical Support that is SIMPLE and builds community capacity

PART 4 Review of Existing Tools

Responding to Concerns From Communities About: • Inadequacy of certain tools to match community priorities • Pressure to identify people who are appropriate for HF • Cumbersome nature of existing tools • Increasing cost of tools and/or training • Confusion about what is the ‘right’ tool We decided to review tools to provide guidance to communities

Task Force • Composed of researchers, service providers and person with lived experience • Scan of practices and tools in homeless sector • Rated using HUD criteria • Key informant interviews conducted • Identified most promising tools and selected one

Areas for Assessment • Who developed it? • Who is using it? • Strengths? • Weaknesses? • Ease of use • Appropriateness for assessment • Cost • EVIDENCE: Supporting literature / Validity / Reliability

HUD Rating Criteria • Tools should be valid, reliable, inclusive, personcentered • User-friendly, strengthsbased, have a Housing First orientation, • Sensitive to lived experience and transparent.

Tools Assessed Vulnerability Index Calgary Acuity Scale Denver Acuity Scale Rehousing, Triage and Assessment Survey • SPDAT • Memphis/Shelby County Intake/Assessment Packet • Alliance Coordinated Assessment Tool Set • • • DESC – Vulnerability Assessment Tool • Homelessness Asset and Risk Screening Tool (HART) • London. CARe. S • Hennepin County Rapid Exit Screening • Rural Arizona Self-Sufficiency Matrix • Homelessness Outcomes Star • City of Toronto

Recommended Tool Vulnerability Assessment Tool (VAT)

Developer: Evaluation?

Domains of VAT • • • Survival Skills Basic Needs Mortality risks Medical risks Organization/Orientation Mental Health Substance Abuse Communication Social Behavior Homelessness

Strengths of VAT • Easy to use and covers all necessary domains • Relatively short • Evaluated by external researchers • Good reliability and validity • Structured interview with behavioral anchors • Person-centered • Includes strengths

Survival Skills

Caveats regarding VAT Use • Just one phase of assessment process • May need to be complemented with other data sources and communication vehicles (referral sources, case conferences, individual preferences) • Developed for single adult population, will require adaptation or other tools for families, youth, victims of violence, etc.

PART 5 Coming Soon!

Last Comments • Screening tool will be free • VAT to be added to HIFIS • Manual available from COH • Training and technical support will be low cost with goal of building community capacity to support training on an ongoing basis

www. homelesshub. ca Questions or comments?