ClientTalk is where our industry experts give you their best insights and best practices across the spectrum of social services. Below is part 2 a summary of the interview from episode 2, where our head of Strategic Programs walks us through the principles of coordinated entry (CE), why it matters, and where CE is likely to go in the future. Part 1 can be found here, which discusses the basics of CE and how HUD thinks about it.
The community social safety net goes beyond just combatting homelessness, as we know. Communities should be using technology and a full range of tools to meet the needs of vulnerable populations, David emphasizes. One of those tools is having a consistent access model for coordinated entry throughout the continuum of care (CoC).
“No Wrong Door” and Other Coordinated-Entry Access Models
Because of finite resources, care communities have a decision to make for handling intakes and entry: whether to implement a “No Wrong Door” approach or a centralized approach.
Usually, “No Wrong Door” (NWD) means a client will be assessed at any service location and placed on the CE by-name list (BNL), regardless of where they enter the system, the “door” in this case being the entry point. Considered the Holy Grail of CE by many communities, NWD requires a lot of coordination. Below is a summary of the US Department of Housing and Urban Development’s (HUD’s) comparison of the access models:
|Single Point of Access||Multisite Centralized Access||No Wrong Door||Assessment Hotline|
|Location||Centralized||Population centers, high-volume providers||All provider locations||Telephone or online|
|Number of Access Points||One||2–4 based on geography, possibly near homeless populations||Variable, including outreach teams||1 phone number or website|
|Services Offered||Primary: Access, assessmentSecondary: Triage, emergency, etc.||Primary: Access, assessment|
Secondary: Provider services (if co-located), or subpopulation services
|Primary: Access, assessment (albeit somewhat limited without proper training) Secondary: Whichever services the provider offers||Primary: Access, limited assessment capability|
|Staff/Organization||Permanent specialists, possibly shared||Mobile or permanent specialists, possibly shared between co-located providers||Independently operated||Hotline agency|
David favors the NWD approach because it’s usually the easiest for the client, which makes it more likely the client will actually receive services, by removing the barriers inherent to a “single point of access” approach. That said, there are advantages and trade-offs to each of these models:
|Single Point of Access||Multisite Centralized Access||No Wrong Door||Assessment Hotline|
|Advantages and Trade-Offs||Advantages: Highest control over implementation and compliance for the CoC|
Trade-offs: Harder to access for clients
|Advantages: Moderate control over implementation and compliance for the CoC, sometimes higher participation because of location|
Trade-offs: Can be harder to access for clients
|Advantages: High participation from clients because of ease of access|
Trade-offs: Lower control over implementation and compliance for the CoC
|Advantages: Cost and convenience for the CoC|
Trade-offs: Lower participation due to lack of access to technology or lack of trust
More Benefits and Trade-Offs of “No Wrong Door”
As with any clinical relationship, a common challenge to intake is establishing trust with the client. Many clients in homeless populations have been referred multiple times from agency to agency, so it’s important they can go where they feel trust toward the provider. Some populations are more likely to speak with a street-outreach team member or an emergency shelter they frequent because of that trust.
After all, what matters most is getting people into stable housing.
However, the definition of CE is often changing because of new ways of assessing vulnerability, dynamic prioritization, and the like. That means truly executing NWD to its fullest potential means training—and lots of it—because of the myriad services and processes throughout the CoC.
Why Data Sharing Doesn’t Always Happen
Coordinated entry requires, well, a lot of coordination. That means communities have to make sure that coordination is effective and well communicated, which is a challenge at any organization made up of humans. However, data sharing between providers is a challenge for a few reasons:
- Burnout: As an industry, social workers experience a lot of secondary trauma, high caseloads, long hours, and often low compensation.
- Complexity: Caseworkers have limited bandwidth to learn new methods, and some people might just never get services, based on where they are on the waitlist. You might have a team of two or three HMIS administrators supporting 300–400 end users.
- Biases: Some assessment tools, like the VI-SPDAT, are being called into question now because of its lack of scoring racial dynamics equitably.
- Misunderstanding privacy laws: This is a problem not unique to CE. During his time as an HMIS administrator, as a consultant, and as a board member in the National Human Services Data Consortium (NHSDC), David noticed a lot of misunderstanding in organizations about how they can use their data. Yes, there’s a lot of regulations about private data, but HIPAA does not prohibit communities from sharing anonymized client data for the purpose of reporting and forecasting.
A Word for Victim Service Providers
Victim service providers (VSPs) face unique challenges other social services don’t face. There are additional constraints from VAWA and VOCA, and VSPs can’t enter data directly into an HMIS; for concerns of recipient safety and privacy, VSPs have to use a comparable database. However, if they get HUD funding, they have to participate in coordinated entry.
When thinking about every vulnerable population, David reiterates, we have to consider who we’re collecting our data from and how they’re going to access services, which brings us back to the requirement for equity: victims need access based on their vulnerability.
For example, David recalls an experience in his community where there was a virtual hotline and a 211 hotline that could be accessed from anywhere, which was for the victims’ safety.
How Can Technology Facilitate Coordinated Entry?
David says, “I feel this is where the greatest growth needs to happen and where the greatest opportunity is.”
Too much of what caseworkers are expected to do is involved in manual outreach, manual data entry (often in multiple databases), and manual coordination. And the need for more data is only going to grow. We should be using data to inform planning and managing the social safety net, but we’re putting too much burden on the caseworker to do that, which is a recipe for disaster. Caseloads are only growing, as is complexity.
This inflection point is where technology can really step up. A flexible HMIS platform, for example, can automate many aspects of CE, such as
- managing referrals;
- dynamically prioritizing;
- updating data remotely via outreach teams, saving them from having to return to the office to manually input;
- manage access points more efficiently; and,
- tailor CE to the unique parts of a community.
“We need to do more with the data we’re collecting, and we’re not doing enough,” he reiterates. “The single greatest opportunity for growth in how we evolve is going to come in the investments we make in technology, because we already have amazing heroes out there every day doing the case management, providing the services, and supporting those who are in the worst possible place in their life, but we need to do more to support those heroes.”
Final Words of Advice
There’s no one-size-fits-all approach to coordinated entry, so keep that in mind. It’s important, whatever model a CoC chooses, that the CoC embrace CE with its structure: that it creates the subcommittees and processes to make adjustments as needed. One thing that’s overlooked a lot—but is becoming a more widespread practice—is including people with lived experience in the process. Often, those people will have the insights that couldn’t be provided by data alone, and they will likely have more effective strategies for emergency shelters or street-outreach teams.
David’s most important advice to service providers, for ensuring the most effective referrals in their networks:
- Ask questions of your CoC board, your HMIS lead, and each other. Remember that the CoC board works for you, not the other way around.
- If you believe you could be using your data better, speak up. What’s obvious to you might not be obvious to others.
- Establish the HMIS as the foundation for coordinated entry. When you do, you’re creating a community foundation that goes beyond just solving homelessness. There are those who are at risk of losing housing but aren’t unhoused yet, so how do you address that problem? You need your HMIS to inform that conversation, beyond just the minimum federal requirements.
- Review your technology stack regularly, and challenge your CoC board on those decisions.
If you would like further solutions to help your managed care organization implement true coordinated entry effectively, Eccovia’s experts are ready to help when you schedule a demo.