Centralized intake is upon us and communities nationwide are scurrying to establish their coordinated assessment processes and configure their Homeless Management Information Systems (HMIS) to meet HUD standards. A common question among CoCs regards which standardized assessment tool is best designed for centralized intake purposes?
A Changing Landscape in Homelessness Assistance
In several instances, HUD has pointed to the tendency of CoCs to employ a ‘first-come, first-serve’ method for service provision as a central barrier to ending homelessness. Such a strategy places the most vulnerable and incapacitated individuals in the same selection pools as individuals with less dire housing needs. And, because many CoCs also employ a tenant selection process that prioritizes services to those who are most likely to succeed, those who are most in need of housing are often placed at the end of the line.
HUD intends the implementation of centralized intake and coordinated assessment to encourage communities to restructure their processes and HMIS to resolve this very issue. However, the success of any coordinated assessment process is fully dependent upon the efficacy of its standardized assessment tool.
Co-occurring social and medical factors are the primary factors that contribute to homelessness. As such, CoCs are in dire need of a standardized assessment tool that addresses both of these aspects.
For this reason, the VI-SPDAT—which is a convergence of the Vulnerability Index (VI) and the Service Prioritization Decision Assistance Tool (SPDAT) into one ‘super tool’—has become the tool of choice for many communities. It combines the strengths of a hybrid prescreening tool that covers medical risk factors (VI) with social risk factors (SPDAT), making it the most effective standardized assessment tool available.
HUD’s 9 Criteria for Choosing a Standardized Assessment Tool
In their recently posted Notice regarding updates surrounding chronic homelessness and PSH, HUD provided recommendations for an effective Standardized Assessment Tool. The following outlines HUD’s recommendations as they are presented in the Notice, and explains how the VI-SPDAT meets these recommendations.
“Tools should be evidence-informed, criteria-driven, tested to ensure that they are appropriately matching people to the right interventions and levels of assistance, responsive to the needs presented by the individual or family being assessed, and should make meaningful recommendations for housing and services.”
Both the VI and the SPDAT are backed by years of rigorous testing. The VI is based on medical research, and before its convergence with the SPDAT, over 120 communities used it to house more than 80,000 of their most medically vulnerable homeless. The antecedent of the concept for the VI is rooted in an environmental vulnerability index developed by the South Pacific Applied Geoscience Commission (SOPAC) with the United Nations Environment Programme (UNEP).
The SPDAT is also an evidence-informed tool that stems from academic research and scholarship, with further refinement in the field. It was developed after extensive review of existing literature and assessment tools, and its development was overseen by the advisement of an outside panel of experts.
Thus the convergence of these two instruments into the VI-SPDAT represents the creation of a highly valid tool that accurately pinpoints correct interventions and assistance through correct need measurement—thus ensuring its capability to make accurate recommendations.
“The tool should produce consistent results, even when different staff members conduct the assessment or the assessment is done in different locations.”
The reliability of the VI-SPDAT was verified through testing in numerous communities, including California, Louisiana, Michigan, and Alberta in Spring 2013. These communities provided extensive and standardized feedback, which shaped further refinements to the content, language and sequence of questions, lending to its ability to provide consistent results.
“The tool should encompass the full range of housing and services interventions needed to end homelessness, and where possible, facilitate referrals to the existing inventory of housing and services.”
Causal and predispositional factors of homelessness fall within wide spectrums of social and medical risk factors. The VI-SPDAT addresses these two spectrums in their entirety, as the VI is rooted in medical research, and the SPDAT is founded upon research into the social causes of homelessness.
“Common assessment tools put people–not programs–at the center of offering the interventions that work best. Assessments should provide options and recommendations that guide and inform client choices, as opposed to rigid decisions about what individuals or families need. High value and weight should be given to clients’ goals and preferences.”
The VI-SPDAT is a street outreach assessment that fosters authentic communication between the interviewee and the caseworker. The assessment offers a recommendation instead of a rigid, calculated, and impersonal score that dictates a single particular program. The caseworker can use this evidence-based recommendation in addition to their knowledge of the interviewee’s situation to make the best possible referral.
“The tool should be brief, easily administered by non-clinical staff including outreach workers and volunteers, worded in a way that is easily understood by those being assessed, and minimize the time required to utilize.”
The electronic version and paper version of the VI-SPDAT are user-friendly and easy to deploy in the field. Once the information is collected, it is easy to implement it into the HMIS to generate a score.
“The tool should assess both barriers and strengths to permanent housing attainment, incorporating a risk and protective factors perspective into understanding the diverse needs of people.”
The VI-SPDAT is composed of four domains, each encompassing a category of contributing factors: History of Housing and Homelessness, Risks, Socialization and Daily Function, and Wellness. Each domain is designed to uncover specific risk factors in order to create a comprehensive constellation of factors that are unique to the interviewee.
7. Housing-First Orientation
“The tool should use a Housing First frame. The tool should not be used to determine “housing readiness” or screen people out for housing assistance, and therefore should not encompass an in-depth clinical assessment. A more in-depth clinical assessment can be administered once the individual or family has obtained housing to determine and offer an appropriate service package.”
The VI-SPDAT allows communities to assess clients’ various health and social needs quickly, and then match them to the most appropriate (which is not necessarily always the most intensive) housing interventions available. It also helps to uncover initial pressing issues to determine whether a full assessment is warranted.
8. Sensitive to Lived Experiences
“Providers should 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 should be worded and asked in a manner that is sensitive to the lived and sometimes traumatic experiences of people experiencing homelessness. The tool should minimize risk and harm, and allow individuals or families to refuse to answer questions. Agencies administering the assessment should have and follow protocols to address any psychological impacts caused by the assessment and should administer the assessment in a private space, preferably a room with a door, or, if outside, away from others’ earshot. Those administering the tool should be trained to recognize signs of trauma or anxiety. Additionally, the tool should link people to services that are culturally sensitive and appropriate and are accessible to them in view of their disabilities, e.g., deaf or hard of hearing, blind or low vision, mobility impairments.”
No assessment or measurement scale can take the place of the trust that comes from the interpersonal dynamic and rapport built between the caseworker and interviewee. The brevity, simplicity, and non-intrusiveness of the VI-SPDAT make it the perfect tool to use in street outreach.
“The relationship between particular assessment questions and the recommended options should be easy to discern. The tool should not be a “black box” such that it is unclear why a question is asked and how it relates to the recommendations or options provided.”
Because the VI-SPDAT is intended for street outreach, the interviewee has ample opportunity to discuss each question with the caseworker. It is a flexible assessment in the sense that it is intended to be conducted in a conversational format, thus eliminating any formalities that can lead to questions or suspicion on the part of the interviewee.
As centralized intake and coordinated assessment preparation continues, communities nationwide must look to each other to share ways to create successful coordinated assessment processes. Collaboration, not only amongst agencies and programs, but also amongst CoCs is the leading strategy to combat homelessness.
For more information on the VI, SPDAT, and the VI-SPDAT, please visit the Evidence Brief provided by 100,000 Homes.