Identifying and Engaging Priority Populations
This module is an overview of how to identify and engage priority populations for Housing First programs. It is organized into three sections: (i) Key Messages, (ii) Key Questions, and (iii) Appendices and Resources. The Key Messages section gives a brief summary of how one can think about identifying and engaging the “right” people to be served by the Housing First model. The Key Questions section is organized into a serious of general questions about common challenges that communities often face. The final contains additional information on identifying and engaging populations for Housing First that includes external links to additional resources.
- While a Housing First philosophy (i.e. person-centered, consumer-driven services) can be applied in many context, the Housing First model should be used to target individuals among the homeless population that need both housing and services.
- Assertive outreach and engagement are critical. This work must be person-centered/strengths-based and recognize that past promises from providers have been broken. Often prolonged engagement will be necessary but programs must also be able to deliver on promises (e.g. immediate housing) whenever a person is ready to receive.
- Coordinated entry systems that are being implemented by communities to increase the efficiency of response to homelessness should support rather than supplant a Housing First approach.
- Given limited system capacity (e.g. lack of housing stock and/or services), an acuity-driven triaging approach may be necessary but should include input from both providers and clients rather than relying solely on standardized assessments.
- Housing First was initially designed for adults experiencing homelessness with co-occurring mental illness and substance use disorders. Today the model has been expanded to work with other homeless populations including families, youth, and adults with addiction disorders, who may be differently prioritized.
Coordinated Entry: Efficiency versus effectiveness? Having choice is a key principle of Housing First that contributes to its effectiveness. But how do you design a system that honors choice while also maximizing efficiency? Allowing for choice in where a person wants to live can impede a system’s ability to quickly assign a person on a waitlist to the next available unit. Maximizing both choice and efficiency requires a dynamic system built on flexibility that is beyond the capacity of most existing coordinated entry systems. Additional questions that coordinate entry systems based on vulnerability indexing raise include:
- How do we balance community priorities between housing the most vulnerable and those who are chronically homeless?
- What if the most vulnerable does not meet the chronic definition?
- How do we decide who goes to the top of the list?
- What are the implications of these competing priorities?
Why should the Housing First model only be used to target individuals among the homeless population that need both housing and services?
- This selection process is the key to providing effective aftercare. If the individuals selected do not have complex needs they may be reluctant to accept the home visits that follow housing.
- Housing First programs are a scarce resource that should target those who will receive the maximum benefit. There are other interventions that may be better suited and less expensive if people do not need both housing and services.
How could coordinated entry system support a Housing First approach?
- The coordinated entry process has had the advantage of coordinating a community-wide meeting of providers but we caution against the timeliness of the meeting causing delays in providing housing.
- Some coordinated entry systems have been shown to increase the time it takes for some people to access housing.
- Well managed coordinated entry systems can more readily identify housing and support services that align with consumer preference, but few currently offer the type of preference matching software that are readily available to market rate renters (e.g. Zillow.com search engine).
Should we use a triage tool to prioritize access to Housing First?
- Many communities use vulnerability and prioritization tools.
- Proponents of vulnerability-based triage tools contend that they are more efficient and result in a better match between resources and need, while critics have noted that such screening may be unnecessary and not likely to result in more housing or quicker placements.
- Some prioritization instruments are evidenced-informed but few have been found to have validity or reliability and should thus be used to inform not make decisions. The decision about who to prioritize should include input from a client and people who know the client.
How could Housing First programs be adapted to better serve families and youth?
- Families and youth experiencing homelessness typically have different housing and service needs than adults experiencing chronic homelessness, although in all cases a person-centered approach is best.
- [add more on variation for families]
- The idea of permanent supportive housing for youth may be unappealing to policy makers and may not resonate with youth who have dreams beyond belonging to a program.
Appendices and Resources
A review of all known prioritization instruments can be found at: http://homelesshub.ca/sites/default/files/ScreeningforHF-Table-Nov17.pdf
A framework for understanding how Housing First can work to support young people who experience homelessness can be found at: http://homelesshub.ca/resource/safe-and-decent-place-live-towards-housing-first-framework-youth
Research to Support the Development of a Housing First for Families Training Curriculum can be found at: http://b.3cdn.net/naeh/7ae0405148a30e6b9d_04m6b9x2d.pdf