Meaghan Bell University of Calgary

Housing First&

Screening ToolsFor Communities

Stephen Gaetz Canadian Observatory on Homelessness, Professor, York University

Paula Goering Centre for Addiction and Mental Health, University of Toronto

PART 1What is an assessment?

• 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.

The Screening Process can Serve Several Purposes

Assessment Roadmap

1. Screening

2. Service/Support planning

3. Service/Support provision

CAMH User

Can we use assessment roadmap to give larger picture?

CAMH User

Can we use assessment roadmap to give larger picture?

CAMH User

Can we use assessment roadmap to give larger picture?

Assessment is but one part of a broader community strategy in

working with people who are homeless.

Where does ASSESSMENT fit in?

Clinical Assessments

Community Priorities

Intake

Assessment Tool

Interventions

Case Management

Data Management Systems (HMIS, HIFIS)

PART 2Assessment 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: Is the person homeless? Chronically? Episodically?

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?

SERVICE USE: Is the individual a high service user?

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 3What 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:

Assessment tools are one source of information to guide decision making.

Avoid SCIENTISM!

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 4Review of Existing Tools

• Inadequacy of certain tools to match community priorities

• Cumbersome nature of existing tools

• Confusion about what is the ‘right’ tool

Responding to Concerns From Communities About:

We decided to review tools to provide guidance

to communities

• Pressure to identify people who are appropriate for HF

• Increasing cost of tools and/or training

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

• Who developed it?

• Who is using it?

• Strengths?

• Weaknesses?

• Ease of use

Areas for Assessment

• Appropriateness for assessment

• Cost

• EVIDENCE: Supporting literature / Validity / Reliability

HUD Rating Criteria

• Tools should be valid, reliable, inclusive, person-centered

• User-friendly, strengths-based, have a Housing First orientation,

• Sensitive to lived experience and transparent.

• 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

Tools Assessed

• DESC – Vulnerability Assessment Tool

• Homelessness Asset and Risk Screening Tool (HART)

• LondonCAReS • Hennepin County Rapid Exit

Screening • Rural Arizona Self-Sufficiency

Matrix • Homelessness Outcomes Star• City of Toronto

Vulnerability Assessment Tool

(VAT)

Recommended Tool

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 5Coming Soon!

• 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

Last Comments

Questions or comments?

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