Coordinated Entry

Best Practices

Equitable Program Entry

Coordinated entry is a streamlined, harmonized effort by a community to ensure equitable access to services that at-risk populations need. As a requirement from the US Department of Housing and Urban Development (HUD), coordinated entry is a way that a Continuum of Care (CoC) can become more person centered by changing the question from, Can we help this person?, to, How do we help this person?A coordinated entry program includes four steps: access, assessment, prioritization, and referral.The best coordinated-entry programs are more than a network of providers that speak to each other and send individuals to get the care they need—they’re a fully integrated crisis response system. Through a standardized reporting infrastructure, CoCs use coordinated entry to plan system and project requirements and to allocate resources most effectively.Also through coordinated entry, a CoC can prioritize housing and supportive services that are needed first, so nobody is left without necessary help.
Coordinated Entry Help

The Process

As outlined, coordinated entry includes four key steps:

  1. access points,
  2. standardized assessment,
  3. household prioritization, and
  4. referral for services.

Step 1—Access

Access refers to the initial entry point and any subsequent entry points a person might pass through when services are given. Access models might vary but must be inclusive so anyone needing services can find them. Inclusive access points might look like the following:
  • Full coverage of access is available within the geographic boundaries of the CoC;
  • Outreach is treated as a form of access, and incoming participants are prioritized equally;
  • Emergency services remain accessible even when coordinated entry processes are not operating;
  • Standardized assessment is documented for each access point, including those affecting subpopulations;
  • Non-discriminatory access is provided to all subpopulations, and aids are provided when necessary for communication;
  • Safe and confidential access is given to those fleeing domestic violence and all related standards are met; and
  • Consent is necessary for data storage, and abstinence of disclosure does not equate to a denial of service.

Coordinated Entry Access Models

The most common access models that a community may employ are:
  1. A single point of access,
  2. Multisite centralized access,
  3. A “no wrong door” approach, and
  4. An assessment hotline.
Coordinated EntryCoordinated Entry Access Models
Access Models

Single Point

Multisite
Centralized

No Wrong Door

Assessment Hotline

LocationCentralizedPopulation centers,
high-volume
providers, or
subpopulation-focused
All existing providersTelephone or internet-based
Number of Access Points1Depends on
geography
(2–4)
Many1 phone number or website
Services Offered• Access
• Assessment
• Triage
• Emergency
• Mainstream
• Access
• Assessment
• Co-located
• Subpopulation
• Access
• Limited Assessment
• Referrals
• Standard
• Access
• Mainstream
• Limited Assessment
Operating Entity, StaffingIndependent access
specialists, single
organization
Independent
access specialists,
co-located
providers
Operated
by each
provider
Local 211 or other hotline agency
Hours of OperationHours of the central
location
Hours of each
access site
Hours vary
by provider
24/7
ControlHigh control with central intakeModerate
control, a
‘hybrid’
approach
Lowest control and most referralsInitial triage tool
Source: HUDExchange
This information can help your community decide what access model is the best fit. More than one approach might be needed. When selecting the right model or models to meet your needs, consider the following questions:
  • What kinds of access points are there? How accessible are they? Should they be retained?
  • What are the most common entry points in to the crisis response system? How do prevention resources coordinate with these access points?
  • How are shelter diversion and prevention activities employed within the CoC?
  • Who will operate the access points, and what training and qualifications will they require?
  • How will coordinate entry integrate the most frequent users of services?
  • What does homelessness look like in your community? What are the demographics and needs of those experiencing homelessness, and what is the easiest way for them to reach access points?
  • What access points uniquely serve specific groups, like domestic violence victims, ESL participants, and the like?

Common Challenge in Coordinated Access—Rural and Suburban Communities

If your CoC is more rural or is a balance of state, not every model will fit your needs. Less urban environments often have challenges: fewer providers and resources, limited visibility of the population and the issue, limited public transportation, lack of provider connectedness, or greater distance between providers. Consider all factors when selecting access points for your region, and build a program that will be the most beneficial for your community.

Step 2—Assessment

Assessment is the process of gathering and documenting information about a person or family upon access to the coordinated entry network. A standardized assessment must be used at all access points across a CoC, and sufficient information must be collected for prioritization to remain consistent. Requirements of a coordinated entry assessment include:
  • Standardized criteria used for uniform decision-making across access points and staff;
  • Process outlined for when a participant refuses to answer one or more assessment questions; and,
  • Annual training provided to staff after initial training on the CoC’s assessment protocols
coordinated entry next step assessment

Types of Coordinated Entry Assessments

While there are many types of assessments that a community could employ, it should be noted that the following list is a guide that can be used to identify what types of assessments a given community might find appropriate. A combined assessment may work better for a singular access point or for simplification. Types of assessments may include:
 
  1. Initial Triage, which would define the nature of the crisis and ensure an individual’s immediate safety;
  2. Diversion, which would examine an individual’s resources and options outside of the homeless system;
  3. Intake, which would gather information from an individual after they accept crisis assistance or shelter;
  4. Initial Assessment, which would identify the level of risk, vulnerability, barriers, goals, preferences, and needs of an individual;
  5. Potential Eligibility Screening, which would assess an individual’s likelihood of admittance into a program based on the CoC’s eligibility requirements for the program and the prioritization standards being met;
  6. Comprehensive Assessment, which would clarify and verify an individual’s history, barriers, goals, and preferences. A plan is developed between the staff and individual that would meet the needs of the individual and allow them to exit the homeless system; and,
  7. Next-Step Assessment, which would re-evaluate individuals who have been stably housed for some time and are ready for less intensive services and possibly self-sufficiency, or when further direction and a new strategy is needed.
While a homeless management information system (HMIS) is not necessary to use for coordinated entry assessment, an HMIS should be involved in the process so that information gathered during this stage of coordinated entry may be documented and reported on according to HUD requirements. Qualities of an effective assessment tool, evidenced as an HMIS, can be found in the table below.
Assessment


Quality Explanation


ValidTools should be evidence informed, criteria driven, tested to ensure they appropriately match 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.
ReliableThe tool should produce consistent results, even when different staff members conduct the assessment or the assessment is done in different locations.
InclusiveThe tool should encompass all housing and service interventions needed to end homelessness, and where possible, facilitate referrals to the existing inventory of housing and services.
Person centricCommon 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.
User friendlyThe tool should be brief, easily administered by non-clinical staff (including outreach workers and volunteers), easily understood by those being assessed, and minimize the time required to utilize.
Strengths basedThe tool should assess both barriers and strengths to permanent housing attainment, incorporating a perspective on risk and protective factors in to understanding the diverse needs of people.
Housing First orientationThe tool should use a Housing First framework. 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.
Sensitive to lived experiencesProviders 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 should 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).
TransparentThe 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.
Source: HUDExchange
Coordinated assessments will vary from community to community; however, there are best practices any community can use to quantify the efficacy of their assessments. Consider the following:
  • How many assessment phases will the CoC need?
  • What is the purpose of each phase, and does each phase contribute to engagement and data accuracy?
  • Does some data require confirmation by being requested several times?
  • What will be the process for reconciling inconsistent data?
  • Will there be any changes necessary to comply with HMIS or data collection/sharing requirements?

Common Challenges in Coordinated Assessment

  1. Standardizing the assessment for each provider and addressing concerns from individual providers about the standard assessment;
  2. Including the right amount of information so that important information is captured but the assessment is not exhausting; and,
  3. Prejudice within the assessment (see HUD’s CoC Analysis Tool: Race and Ethnicity).

Step 3—Prioritization

coordinated entry prioritization lists
Prioritization is the act of analyzing the information provided by an individual at the assessment stage and identifying their needs relative to others who have also been assessed for services. When a CoC defines its prioritization criteria, it must comply with existing CoC and ESG program standards as HUD has defined them. Priority criteria may vary from project to project (e.g., RRH, PSH) but must be standard with the guidelines provided by HUD. Consider the following for coordinated entry prioritization criteria:
  • Medical or behavioral health challenges requiring support to maintain permanent housing;
  • Relying on emergency services to meet basic needs;
  • The degree to which minors are unsheltered within the community;
  • Underlying medical conditions that render individuals more vulnerable to illness or death; and,
  • Vulnerability to being victimized (e.g., trafficking)
Prioritization lists (also known as “master” or “by-name” lists) help CoCs prioritize housing according to the most urgent needs of the most vulnerable candidates. Answer these questions when planning a prioritization list:
  • What existing prioritization criteria exist? What factors contribute to these criteria?
  • What regional factors might impact service availability and accessibility, and how might this impact prioritization?
  • How can prioritization be quantified to create consistent, non-arbitrary criteria?
  • What is the process for reviewing and updating priority lists or criteria? How will an individual’s priority level change if their situation changes?
  • How will the CoC manage multiple waiting lists as it consolidates them into a single, central list?
  • What funder-required prioritization criteria need to be accommodated during the referral process?

Common Challenge in Coordinated Prioritization—List Conversion

Transitioning from individual provider prioritization lists to a centralized prioritization list comes with challenges (e.g., comparison of needs, fair process, reassessment of individuals for some programs) but can be managed with the help of case conferencing and transparent, frequent collaboration between involved agencies.

Step 4—Referral

Referrals for housing or services are given to the individuals with highest priority. HUD requires that barriers to referral, such as income, historical information, disability, or an existing criminal record be removed when referring services. Discrimination should also be avoided.
There are four distinct components to an effective referral process:
  1. Eligibility Screening: The collection of required eligibility documentation for referral
  2. Participating Project List: A list of available service providers for referral
  3. Referral Rejection Protocols: Documentation about when a referral would be rejected
  4. Referral Data Management and Efficiency Tracking: The data collected alongside a referral
    1. Referral date and time
    2. Contact information for the agency currently serving the individual
    3. Contact information for the agency receiving the individual
    4. Individual’s name
    5. List of services being referred
    6. The individual’s prioritization score, if applicable
    7. Eligibility or entry requirements
    8. The individual’s preferences
    9. Special considerations, such as location, unit size, and restrictions
    10. Verification documentation, as appropriate
    11. Expectations for follow-up
Best practice is to perform a “warm hand-off” when handing off a client between different agencies inside the CoC. This simply means that the referring agency follows up with the referred agency to ensure the client accepts and receives services. This helps prevent clients from falling through the cracks and getting trapped in the mechanisms of coordinated entry. Consider the following as you plan your referral process:
  • Who will manage the process? What do they need to have consistency in all referral decisions?
  • How might the CoC’s culture impact the coordinated entry referral system?
  • Will service providers be moving from paper records? What will transition look like?
  • How will delays be resolved (e.g., a receiving agency taking too long to make an eligibility determination)? Will there be a process in place to accommodate delays?
  • How will you handle situations where another service would better help a client than an accepted referral?
  • How will referrals be made to providers outside the CoC?
  • How will data issues (e.g., bad data, data received later) be handled?

Common Challenges in Coordinated Referral

  1. Service provider concerns about referral control relinquishment
  2. Differing and conflicting strategies that exist within a CoC
  3. Lack of appropriate housing or services
  4. Preference and circumstance incompatibilities

Benefits of Optimized Coordinated Entry Processes

Many stakeholders benefit from a successful coordinated entry process.
Homeless or at-risk persons

Housing or service projects

Public and private funders

CoC or homeless system planners

• Locate housing or services faster• Avoid ineligible referrals• Know that projects are supporting the right people• Identify areas of improvement for better outcomes
• Are supplied only the services they’re eligible for• Better prioritize participants• Observe that compliance requirements are met• Improve fair and ease of access to resources
• Access services upon referral• Comply with CoC and ESG requirements• Have better data for planning• Improve data for resource allocation
• Can appeal rejections transparently• Identify areas of improvement for localized activities• Experience improved reporting
• Better understanding of who’s being served
Source: HUDExchange

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