How to Build an Effective and Equitable Assessment Tool

Assessment tools inform one of the most important decisions your community makes: Who gets to benefit from your CoC’s limited resources?

When the stakes are this high, it’s crucial to ensure that assessment tools are doing their job in the best possible way. That means connecting people with care and resources according to their level of need — and doing so in a localized, inclusive, and trauma-informed manner — to promote equity in your coordinated entry processes.

Whether you’re about to roll out a new custom assessment or you’re still weighing the pros and cons of developing one, the Bitfocus team is here to help. We’ll discuss what makes an assessment powerful, what we’ve learned from the shortcomings of the VI-SPDAT, and how you can build an assessment tool that will serve your ultimate goal: ending homelessness in your community.

The VI-SPDAT: Relic of the Past or Useful Foundation?

In 2013, OrgCode and Community Solutions co-created the VI-SPDAT.

OrgCode CEO Iain De Jong writes that the tool was designed to “support communities in engaging people experiencing homelessness, identifying what the next steps might be for each household based on their unique situation, and to assist with identifying the 'most vulnerable' to be served first.”

Crucially, the VI-SPDAT was developed as a triage tool, not an assessment tool. It’s meant to identify a client’s most urgent needs, not provide a comprehensive evaluation to inform long-term care. However, in the years since its introduction, both use cases have become common — often, to the detriment of people experiencing or on the verge of experiencing homelessness.

However, even when it has been properly used for triage, data and stories from CoCs across the nation have shed light on a handful of critical deficiencies in the tool, prompting OrgCode to announce in 2020 that “the beginning of the end” had arrived for the VI-SPDAT.

But what happens now?

What if your community is still using the VI-SPDAT and doesn’t have the resources for an assessment revamp — or just doesn’t know where to begin?

We at Bitfocus have good news: Though the VI-SPDAT is not the ideal assessment tool, it can still serve as a springboard for communities interested in developing their own assessment and prioritization processes. Better yet, by borrowing from what the VI-SPDAT does well and learning from where it missed the mark, your community can streamline the creation of an effective and equitable assessment of your own.

What the VI-SPDAT Got Right

For an assessment and prioritization tool to be effective, it must be easy to use. Otherwise, frontline staff won’t be able to administer it efficiently, and you’ll run into barriers with community-wide adoption.

Here, the VI-SPDAT hits the nail on the head. It’s simple and takes less than ten minutes to complete, which is part of the reason it’s so widely used.

More importantly, the VI-SPDAT includes various domains (e.g. History, Risks, Socialization & Daily Functioning, etc.) to help understand a person’s needs and barriers to housing. The premise behind those domains offers a strong starting point for communities designing a custom assessment tool.

Throughout this piece, you’ll see how your community can borrow from and build on the VI-SPDAT to create a highly impactful, local assessment.

What a Great Assessment Should (and Shouldn't) Do

Let’s zoom out from the VI-SPDAT and think about the entire universe of possible assessment tools. What are some surefire signs that your assessment is doing its job? What are the symptoms of a broken or inadequate assessment?

A great assessment tool should:

• Facilitate housing connections. Your assessment’s core purpose is helping your CoC identify a person’s needs, vulnerabilities, and barriers to housing so you can prioritize referrals.
• Capture only the necessary information. Per page 28 of the HUD Coordinated Entry Core Elements, you should “only gather information necessary to determine the person’s severity of need and potential match for housing and supportive services.”
• Be efficient and trauma-informed. Leveraging HMIS features like tooltip text and conditional logic is a great way to guide your assessors and minimize the resurfacing of traumatic experiences. (If you want a peek at how your HMIS can help you do this, check out our guide here!)
• Reflect local needs. An assessment in Southern Nevada might not need questions about experiencing extreme cold, but it may need additional questions about gambling or the use of a region-specific synthetic drug.
• Produce consistent, fair results. Even across different users and contexts, a strong assessment will generate reliable results that don’t show any signs of bias. 

As your team devises a new assessment, keep an eye on the checklist below to ensure you’re on the right track.

Must-Have Domains and Questions for Your Assessment

Having considered the high-level requirements of an effective assessment tool, let’s unpack the meat of the assessment: domains and individual questions.

Below, we’ll explore the domains that are the heart of an effective assessment. As we noted, the VI-SPDAT provides a useful skeleton to build on, and you’ll likely notice similarities to its structure. However, we’ll also call out specific areas where the VI-SPDAT falls short and offer guidance for improvement.

Housing and Homeless History

Description
Before progressing to more nuanced questions, your assessment needs to capture a few foundational pieces of information:

• Is this individual currently unhoused?
• How long have they been unhoused?
• How frequent are their episodes of homelessness?
• Have they tried to obtain and keep housing in the past? If so, what support did they receive and what barriers did they face?

Understanding this basic information is the first step to determining the person’s vulnerability and chronicity when it comes to finding housing. It’ll also help you quickly identify the appropriate level of support.

Special Considerations
A key criticism of the VI-SPDAT is that it doesn’t do enough to help identify victims of intimate partner violence (IPV) or sexual violence (SV). While most questions that directly address this topic would fall into the “Risks and Safety” domain below, the effects of IPV or SV can spill over into the realm of housing history.

For example, someone who is escaping a violent situation might abruptly break a lease or be forced to move multiple times in a short period — behaviors that could be screened for in this domain.

Risks and Safety

Description
Here, your assessment should dig into the key indicators of vulnerability that can greatly impact survivability. It’s crucial to determine the potential for harm from others, self-harm, exploitation, experience of domestic violence, sexual assault, or other forms of interpersonal violence.

Special Considerations
Another important lesson to take away from the VI-SPDAT? Questions don’t always translate equally across cultural groups. In fact, a 2019 study on racial equity and the VI-SPDAT found that race is a predictor of 11/16 of its subscales, and that “most subscales are tilted towards capturing vulnerabilities that Whites are more likely to endorse.”

For example, white people are more likely to seek out — and report seeking out — formal health care. If this topic isn’t communicated in a culturally inclusive way, it could contribute to higher scores and faster housing for white people, even though Black, Indigenous, and People of Color (BIPOC) are disproportionately affected by homelessness.

In that same vein, questions about illicit or risky behavior have the potential to introduce bias and should be carefully evaluated to ensure that they are locally appropriate and phrased in a sensitive way.

Health and Wellness

Description
Indicators of health and wellness (for example, substance use, disabilities, or access to behavioral health services) are also an invaluable piece of assessing a person’s level of need and connecting them with the appropriate resources. While questions about physical health are crucial, they should never be viewed in a silo. A commitment to whole person care extends beyond purely physical needs into the realm of social, emotional, and mental well-being.

Special Considerations
Many assessments do a good job of screening for behavioral health conditions and the use of crisis services. However, a critical gap in some assessment tools is evaluating the presence of chronic illnesses, disabilities, and other physical health conditions that contribute to vulnerability.

As your team develops a tool, remember that not all risk factors are immediately evident. While most people are quick to associate a life-saving medical treatment like chemotherapy with an increased level of vulnerability, we might not think the same way about lack of access to an electrical outlet — even though being able to refrigerate a medicine can have a serious impact on survival.

Daily Living and Functional Status

Description
Can this person perform basic self-care tasks like bathing, dressing, and eating? How about more complex tasks like managing medicines and cooking? Answering questions like these will highlight areas of vulnerability that influence the level of support an individual likely needs. In this domain, an assessment should also strive to identify cognitive impairments or developmental disabilities, as this information will affect a person’s housing stability and their ability to comply with social norms.

Special Considerations
In the spirit of empowering providers to offer whole-person care, it’s important to supplement questions about basic self-care with questions that address meaning and fulfillment. Though the former will help you make smart short-term decisions, the latter can inform your thinking as you seek to develop a long-term care strategy for the person being assessed.

5 Tips for Developing an Equitable Custom Assessment

It’s one thing to talk about creating an efficient, culturally sensitive assessment tool. Putting it into practice is far more challenging. When building a custom assessment, have the following tips top of mind to ensure that your tool minimizes bias and maximizes impact.

Tip 1: Give diverse perspectives a voice — early and often!

In the early stages of design and testing, bring a wide range of people with lived experience of homelessness into the process — the more perspectives, the better. After all, homelessness is an extremely complex issue, and only a nuanced tool can adequately capture the needs of unhoused people in your community.

Conduct pilot testing with diverse groups to identify any potential biases or misunderstandings in the questions, using this feedback to refine the tool. As you iterate on your assessment, you’ll progress toward questions that are sensitive and culturally relevant while filtering out questions that introduce confusion or contain assumptions that are not universally applicable.

Tip 2: Invest in excellent translation.

Designing and rolling out a custom assessment can be a multi-year process. Make the most of that hard work by translating your assessment into all of your community’s primary spoken languages. Hire professional translators who are familiar with cultural nuances to ensure that your tool serves its intended purpose.

Tip 3: Invite ongoing community input.

Nailing the first version of your assessment is a triumph. Knowing how fast the needs of your unhoused population will evolve, though, it’s not enough to release a V1 and never look back.

Instead, your community should establish advisory boards with members from various racial and cultural groups to provide continuing input on your assessment tool and practices. Conduct focus groups and surveys with diverse community members to gather feedback and reveal any issues related to cultural relevance and fairness, then use that information to optimize your tool.

Tip 4: Train your staff well.

Even if you design the most thoughtful and inclusive assessment possible, bias can still be introduced, often unintentionally, by staff who conduct assessments.

To mitigate this bias, provide cultural competency training for team members in the field. Be sure to cover cultural differences, implicit biases, and effective communication strategies to empower your staff to do their best work.

Tip 5: Dig into the data.

In addition to reviewing input from your advisory board and people with lived experience, analyze your assessment data to identify any patterns of racial disparities. Let that information guide changes you make to the assessment process. We touched on this earlier, but it bears repeating — assessment tools should evolve in dialogue with your community. Regularly review and update your tools to make sure they remain relevant and fair as demographics and cultural contexts change.

Striking the Right Balance Between Comprehensiveness and Speed

All assessments, even the most effective ones, operate in the following tension:

• Shorter assessments are easier to use BUT don’t always adequately inform long-term care strategies
• Longer assessments capture all the vital information BUT can be unwieldy and pose challenges for unhoused people

How should your community resolve this tension?

For our team at Bitfocus, it all comes down to defining purpose. Why does the tool exist?

If your tool is meant to support urgent interventions (much like the VI-SPDAT), make sure that it’s easy to implement and can be completed in less than ten minutes. Cover the most vital information, and use care-empowering features to streamline your assessment.

If, on the other hand, your tool is designed to guide long-term care strategies, it should fall on the “comprehensive” end of the spectrum. It should still be efficient — ideally, able to be completed in one meeting — but it ought to paint a fuller picture of your client’s story, needs, and goals.

Again, involving diverse perspectives and people with lived experience is imperative, especially as you create a longer assessment. That way, you can uncover as much information as possible without causing clients to relive trauma, linger too long on uncomfortable subjects, or skip questions due to the length of the assessment.

Remember: Defining the purpose of your assessment, and then sticking to that purpose in implementation, is one of the most important things you can do as you roll out a new assessment tool.

Doing so will help you care for your unhoused population in the short and long run, empowering stronger strategies for your entire CoC.

Creating a New Assessment: Southern Nevada’s Success Story

There’s no doubt that designing, testing, and implementing a new, custom assessment requires tremendous effort. However, when done strategically, it can also be tremendously rewarding.

If you’d like to dive deeper, check out our series on how Southern Nevada moved on from the VI-SPDAT to devise their own assessment tools, the SATT and the CHAT, and received a powerful, positive community response upon rolling them out.

• Developing a New Assessment: Learn more about Southern Nevada’s issues with the VI-SPDAT and how they built the right team to guide their own assessment creation.
• Rolling the Assessment Out: Explore how Southern Nevada ensured a smooth transition to the new assessment — and hear the encouraging reactions from their community.
• Using Clarity to Create a Custom Assessment: Dive into how our user-friendly HMIS, Clarity Human Services, helped Southern Nevada create an efficient and equitable assessment.

Reminder: All Great Things Start Small

If you’re on the cusp of creating a custom assessment, you’ve already done some of the hardest work: getting started. As you build momentum in your community, our team at Bitfocus is here to encourage and support you however we can.

Send us a message and let us know what you’re looking for — and if you’re interested, explore the HMIS we’ve been proudly working on for over a decade, Clarity Human Services. We’re confident that we could help you save time and energy, and we’d love to show you how.

Thank you for joining us!