Coordinating Your Way Home in Houston

USICH's Robert Pulster, Lindsay Knotts, and Brittani Manzo,
with Scot More (center) and Ana Rausch (second from right) 
from Houston's Coalition for the Homeless, after a
site visit of Coordinated Access in February.

You know that “butterflies in your stomach” feeling when you speak in front of a large group of people? That’s how I felt for most of 2013-14 as we implemented coordinated entry (or as we call it in Houston, “Coordinated Access”) for the TX-700 Continuum of Care (CoC).

But let me back up: The work to build Coordinated Access in Houston began in 2012 as part of a community-wide system redesign process. At that time, we redesigned our governance structure, built models of accountability and full transparency, and conducted an analysis of our resources and housing inventory.

Then HUD issued a notice for coordinated entry deadlines and requirements, so the Coalition for the Homeless (lead agency to the CoC known here as “The Way Home”) brought together a Coordinated Access workgroup to develop the system in Houston and the rest of The Way Home’s vast geography, which at the time covered more than 2,600 square miles and three counties - Harris, Fort Bend, and Montgomery.

The Coordinated Access workgroup developed a standardized housing assessment tool to determine the best housing for an individual or household. We focused first on Permanent Supportive Housing (PSH), since new PSH units would be coming online during the roll-out of Coordinated Access. Emergency shelter and transitional housing were not incorporated into Coordinated Access because we don’t have a large shelter bed inventory, most shelter beds are privately funded, and our system was in the process of reallocating transitional housing funds to permanent housing.

Once we agreed on an assessment tool, we worked with our HMIS software provider to incorporate the assessment into HMIS and develop a system that would integrate a housing match and wait list. That way, after an assessment was completed, the Housing Assessor would be able to see in HMIS if a client was eligible for a PSH intervention and what programs and units they matched. The system would also show which programs had real-time availability. In cases where there was not availability, the client would be placed on one community-wide waitlist for PSH.

At the same time, a PSH workgroup convened to standardize the intake documents for all PSH providers within The Way Home, and to determine how to prioritize within the waitlist. All PSH units in The Way Home are dedicated to individuals or households that are experiencing chronic homelessness. The Vulnerability Index ™ (VI) assessment was used to further prioritize the most vulnerable clients on the PSH waitlist. The VI scores range from 0-8 (8 is the highest vulnerability) and the HMIS automatically sorts the waitlist by VI score, with the most vulnerable client being referred first.

The next issue to tackle was staffing. I was the only paid staff assigned to Coordinated Access implementation, and there was no other funding available to hire new staff. With some creative thinking, we asked our partner agencies if they would be willing to repurpose some of their existing staff to work on behalf of the system. A CoC-funded Supportive Services Only grant was repurposed to pay for our first two Coordinated Access Navigators. Additionally, other intake staff funded by state, city, and county Emergency Solutions Grants and other private funds were repurposed to pay for our first Coordinated Access Assessors.

It was a challenge to convince our partners to essentially pay for their staff to do the same job, but for the whole system, but we pointed out that the outcomes for their grants would still be met. To this day, our Coordinated Access staffing mechanism remains one of the greatest homelessness system transformations that our community has ever seen.

With these pieces in place, and existing PSH waitlists in the system, we rolled out Coordinated Access in January 2014. Due to the vastness of The Way Home’s geography, we opted for a coordinated system versus a centralized system. This included multiple access points at emergency and day shelters, and Coordinated Access-staffed outreach teams. Our physical Coordinated Access Hubs were set up where clients were already accessing services--at the VA Drop-in Center, all family and single shelters in downtown Houston, and the day program. Other hubs are located outside the city in social service agencies. We’ve integrated Medicaid providers, hospital emergency departments, and programs that serve those exiting jails or prisons. Houston has also recently implemented a telephonic intake assessment that is available to providers to call with the client present.

Coordinated Access is managed entirely within HMIS, and no matter which hub a person goes to, the process is the same. People in need of a housing assessment meet with an Assessor who uses the assessment tool to determine the best housing intervention. This is followed by the VI Assessment to determine the client’s vulnerability score.     

Based on the assessment, HMIS automatically matches clients with programs for which they are eligible, and they can always choose among programs that they want. The Assessor and client review the list. Although we have one community-wide waitlist for PSH, clients can always indicate a preference for a particular program or programs and/or a particular agency. If no units are available, the client is placed on the one waitlist with a noted preference for a specific program. The vulnerability score determines when the client will be referred. If units are available and the client is next on the waitlist, a referral is made to a program in real time. Previous experience had shown us that people experiencing chronic homelessness often get lost from referral to move-in, so they are partnered with a Navigator who supports them through the move-in process. Once moved in, the client and Navigator meet with the PSH case manager for a warm hand-off.

Our CA system is a living, breathing system that focuses on continuous improvement. Since the roll out, we have added programs like rapid re-housing, and we have developed new, local prioritization tools for youth, families, and non-chronically homeless singles. We have added 10 hubs, and we updated our assessment to include an income intervention to go along with a client’s housing intervention, when the assessment indicates a need. We are also looking at our assessment and prioritization tools as our population demographics change.

There have been some bumps in the road, but Coordinated Access has proven to be more effective and efficient than the old way of doing things—we are all united behind a common goal. The unprecedented collaboration of The Way Home partners has helped change the path toward ending homelessness for our community, and it is something that we are all incredibly proud of.