1. Dayton-Montgomery CountyFront Door Assessment National Alliance to End Homelessness First Contact: Creating a Front Door to Your Homelessness System July 13, 2011

2. Moving from a program centered system to a client centered system

3. Front Door Assessment Overview A consistent assessment tool and scoring process to determine appropriate exit from homelessness, administered at all the ‘front doors’ to the homeless system. Policies related to program and client acceptance expectations.

4. Homeless System in Dayton-Montgomery County

5. Dayton-Montgomery County CoC Homeless Solutions Community 10 Year Plan: A Blueprint for Ending Chronic Homelessness and Reducing Overall Homelessness in Dayton and Montgomery County, OH adopted in June 2006 Received $7.2 million in 2010 CoC funding from HUD 965 homeless people in 2011 Point in Time Count

7. Development of the Front Door Assessment

8. Background System defined by program eligibility and intake decisions made by individual programs. Shelter case managers to submit applications for every possible program person could be eligible for. Lack of data on client need to make system planning decisions.

9. Goals Rapidly exit people from homelessness to stable housing. Efficient and effective use of system resources – clients receive appropriate services. Ensure that all clients, including the hardest to serve, are served. Transparency and accountability throughout the assessment and referral process.

10. FDA Development Background 10 Year Plan finding that some homeless people were never successfully engaged by the existing system and that the system was hard to navigate. 2007-2009 – Initial Front Door Committees meetings Review assessment tools from other communities Develop assessment structure (independent organization vs. existing providers) Identify provider concerns (oversight of assessors to ensure objectivity and fairness) Interim implementation of assessment in family system because of temporary closure of a shelter program Secured funding and developed RFP for Front Door consultants Requirement to participate in Front Door Assessment once it started in RFPs for local and CoC funding for last 2-3 years.

11. FDA Development Jan 1st – Aug 1st 2010 –The Front Door Committee and Consultants: Conducted client focus groups on current system and provider interviews and meetings by program type Defined each program type in system – clients served, length of stay, program & system outcomes (using HEARTH), positive exit destinations Developed assessment tool, scoring matrix, referral process and timelines Developed policies related to FDA implementation – PSH priorities Programmed FDA into HMIS

12. FDA Development (cont.) Trained assessors on FDA Trained providers on receiving FDA referrals Developed FDA reports Provider input through meetings and calls at every step of the process. Substantial changes made to every FDA component as a result of this input. Initially expected July 1st implementation but significant provider concerns in June delayed implementation for a month.

13. Provider FDA Concerns No provider refused to participate in FDA. The concerns expressed before implementation included: Developed program over long period including entry screening criteria of time to ensure serving right clients Currently receiving referrals from other sources Lack of PSH and affordable housing made outcomes hard to achieve Need more than 7 days to decide if they will take a referral Requirement to take 1 in 2 referrals too limited, may need to reject several consecutive referrals Takes operational control over who they serve from the agency, agency needs ultimate control over who is housed and evicted Proposed process is too bureaucratic Assessment tool does not adequately assess mental health or predict client behavior Requiring reviews of self-referrals will delay clients receiving services

14. Response to Provider Concerns Delayed implementation by 1 month to discuss concerns and conduct additional training. Changed rejection policy to 1 in 4 referrals instead of 1 in 2. Agreed to Six Month Review to assess FDA implementation impact.

15. Intake Assessment Initial questions – What led you to come here? What do you need right now? What is your plan for leaving shelter? HUD required data elements with additional housing questions focused on whether household can be diverted from shelter Income Clients’ support network/Independent living Questions related to leaving shelter – legal issues, pregnancy, IDs, school location for children, homeless history Rick Assessment – sex offender status, mental health, medications Diversion Plan developed if appropriate

16. Comprehensive Assessment Five year housing history Five year employment history Income - Benefits & Entitlements Debt/Expenses Legal (5 year felony history & 10 year incarceration history) Physical & Behavioral Health with disability documentation and substance use frequency; includes questions from Vulnerability Index Family/Dependent Children Independent Living Skills assessment

17. Housing Barrier Screen Elements from all eight Comprehensive Assessment domains – total of 59 questions Scored differently for different populations (youth, families, singles) Barriers scored as Low, Medium, High

18. Referral Decision Worksheet Assessment filters applied: Income, independent living skills checklist score, Housing Barriers score, disability status, recovery status, life transition issue, placement considerations (ie. sex offender, veteran, accessible unit, school district) Referred to Rapid Rehousing if client has regular income or recent work history If not Rapid Rehousing then scored for: Permanent Housing Programmatic Shelter Transitional Housing Permanent Supportive Housing Safe Haven

19. Assessment & Referral Process Assessment - conducted at all Front Doors Intake – goal is diversion, done within first 3 days (one-third of shelter clients stay 7 nights or less) Comprehensive assessment – done within first 7-14 days Referral decision worksheet to identify most appropriate program type to help client move to permanent housing. All eligibility criteria set by funding sources must be complied with Programs must remove additional barriers to entry Priority for PSH openings for long-stayers, elderly and medically fragile Process to refer appropriate client to specific program when opening occurs. Done by system staff for transitional housing, PSH and Safe Haven Planned to be in HMIS but providers can not see referrals because HMIS is closed

20. Policies Require that programs accept 1 in 4 referrals. Eliminate all program entrance requirements except those required by funding (i.e. no drug testing). All program vacancies must be filled through the Front Door process – close the ‘side doors’. Development of program and system performance outcomes based on HEARTH.

21. FRONT DOOR ACCOMPLISHMENTS AND SIX MONTH REVIEW FINDINGS

22. Accomplishments Closed ‘side doors’ into CoC programs so all homeless system resources used for people in shelter or on the street. 31 of 57 long-stayers (more than 200 nights of homelessness in 2010) housed. Established policies about expectations for people in shelter: use income for housing expected to accept first appropriate referral Have client-centered data for HEARTH planning.

23. Six Month Review Findings HMIS functionality and reporting issues limited data collection and management capacity. Assessment process implementation not always followed consistently. Additional definitions for client history needed. Front Door Assessment policies not uniformly adopted by all providers.

24. Six Month Review Findings (cont.) Improvement in tracking, management and reporting of Front Door Assessment processes needed. Front Door Assessment implementation identified gaps and deficiencies in program approaches and operations across the homeless system. Open HMIS so all providers can see all data for all clients – increase coordination.

25. Data In first 6 months 1,051 assessments conducted 32% scored for Permanent Supportive Housing 4% scored for Safe Haven 24% scored for Rapid Rehousing or Permanent Housing 39% scored for Transitional Housing or Programmatic Shelter 63% of the households scored on the Front Door Assessment are not disabled enough to need PSH or Safe Haven. Need efficient and effective way to get them employed and into affordable housing with appropriate supports.

26. FRONT DOOR IMPLEMENTATION CONSIDERATIONS

27. Resource Commitments Consultants – $200,000 over 2 years System staff HMIS programming staff Provider involvement Meetings, staff training Front Door assessment agencies spend more time on assessment, HMIS and referrals

28. Process and Products Front Door Committee Monthly meetings Provider forums Development of forms, manuals, reports Very intensive HMIS work Assessment in HMIS Programming reports Case conferences Process and referral reviews, esp. PSH referrals

29. Next Steps for Your Community Look at data How long are people in shelter? Who are your long-stayers? Where do they go? Do your housing programs take all their clients from shelter or streets? Look at program entry process and criteria Who is not being served? Start talking about who each program type in your system should be serving and how your system ensures that everyone is served

30. Joyce ProbstMacAlpine Manager of Housing & Homeless Solutions Montgomery County, Ohio 937-225-4218 macalpinej@mcohio.org