Reaching Home: Including the right clients

For Reaching Home Designated Communities, a major task is to utilize HIFIS to manage client-level data and use it for Coordinated Access.

One of the components of this is to have a By-Name List / Prioritization List / Unique Identifier List that takes your data in HIFIS and converts that into a list of people that you can use to make prioritization decisions about housing resources.

Anther component of this is to be able to determine how many people are becoming homeless and how many are exiting homelessness. This is part of the Reaching Home reporting requirements (on the Outcomes Report), and the CAEH monthly reporting requirements, and is also a requirement under HPP if you happen to be in Ontario too.

Although your output for these two components is different (see Why you need TWO reports for Coordinated Access), both of these tasks share a fundamental, underlying dataset: you need to know which clients are actively homeless on any given day. If you look at just one day (today), that gets you a list of clients you can prioritize. If you look at a period of time, you get your inflow and outflow data.

In order to identify which clients are actively homeless, a few things need to be true.

Housing Status

You always need to know the housing status for your current clients.

For some programs, like shelters, this is very easy. They spent last night in an emergency shelter bed, so we know for certain that they’re homeless. In fact, the service that we’ve provided them with proves that they’re homeless, so simply knowing that they received the service (of a shelter bed) tells us what their housing status is.

For other programs, like drop-in centres, meal programs, housing resource centres, food banks, and other day programs, this is much more challenging. If someone is accessing a meal program, that doesn’t tell you anything about their current housing status, just that they’re hungry. You need to specifically ask each client about where they’re sleeping tonight (or where they slept last night), which could very well be a data point that not all day programs actually collect.

It’s not at all uncommon for food programs to express their impact in the context of the number of people who experience food insecurity, not homelessness. So if you have Reaching Home funded programs that deliver food, you may need to introduce a new expectation that they need to obtain housing status information for all clients.

Once you’re sure that all your service providers that receive Reaching Home funding know about the housing status for all of their clients, it’s time to record that in HIFIS.

A client’s housing status is derived from a combination of their Housing History and the Admissions module. Any time there is an Admission (Stay), then the client gains a housing status of Homeless for the dates with an Admission. If, however, they aren’t staying in a shelter, HIFIS will look to see if there is a Housing History record. If there is, HIFIS checks to see whether the Housing Type matches the definition of Homeless, Housed, Transitional, or Public Institution (this is in the Reaching Home Housing Continuum). Then the client will gain the matching Housing Status.

Note that if a client accumulates enough time with the Housing Status of Homeless, HIFIS will determine at what point they meet the federal definition of chronic homelessness, and that will also be indicated in HIFIS.

In summary, for all of your current clients, you need to make sure that they always have either a current Admission or a current Housing History record at all times.

Activity

You also need to know who is currently active at any given time.

A note about definitions here: there is some debate about whether it’s more important to keep track of who is currently homeless (“actively homeless”) versus who is actively participating in your system (“actively receiving services”).

For example, if you want to keep track of who is actively homeless, then you’d be including the non-consenting clients who live in an encampment and anytime a staff approaches them they are told to go away and leave them alone. It’s important to know that these people exist, but hard to keep track of them. Since they’re not consenting to participate in your Coordinated Access system, you don’t have their permission to collect any data about them. You certainly shouldn’t be adding files to HIFIS about these clients, and you might not even know their names. So it would be very challenging to maintain client-level data about folks like these.

HIFIS treats activity somewhat closer to the latter approach: actively receiving services (see Activity and Inactivity). There are a list of actions in HIFIS that constitute activity, and overall they tend to reflect an interaction between a client and a service provider. So an interaction with a client counts as activity in HIFIS.

There are vaguely-worded expectations about HIFIS use in the Reaching Home directives (“Reaching Home-funded service providers must actively use their HIFIS”). “Active” use of HIFIS is not defined, and so there is often some confusion about to what extent staff need to be putting data in. In the context of client activity, we can infer that a minimum requirement is that enough data is getting put into HIFIS that active (real-world) clients are not becoming inactive in HIFIS due to a lack of data in their client files.

Generally speaking, the list of what constitutes activity in HIFIS matches the actions staff are expected to take when they provide assistance to a client. (Provided them with a shelter bed? Add a HIFIS Admissions record. Began case management? Open a HIFIS Case file.) As a general rule, it’s good to tell staff to simply record what they did with their clients in HIFIS. If staff do that, HIFIS can determine which clients are active and which are inactive as of any date.

(As a side note, recording what staff do with clients also includes closing services when they’re no longer working with clients. I’ve seen far too many service providers that simply don’t even realize that they need to close Cases or Housing Placements or Housing Loss Prevention records or Housing Subsidies. Lots of reports look at who had open services during a reporting period, and so services with no end date would be considered active/open/ongoing services.)

Consent

The last thing that should be relevantly discussed is consent. In HIFIS there are 4 types of consent:

• Explicit consent means the client has agreed to data sharing

• Declined - Anonymous consent means the client has not agreed to data sharing

• Inherited consent means a parent or guardian has provided consent on their behalf

• Coordinated Access consent means the client has agreed to participate in the Coordinated Access system

When trying to implement Coordinated Access as a system, it’s important that informed consent about data sharing is collected for as many clients as possible. There will always be some clients that decline to consent, but when that’s a higher number than just a handful, it becomes increasingly difficult to deduplicate our clients. If one Declined - Anonymous client stayed at a shelter, and a Declined - Anonymous client went to a second shelter, and a Declined - Anonymous client visited a drop-in centre, it’s impossible to say whether that’s a single client accessing three different providers or three different clients. The more frequently this happens, the wider your margin for error is.

Let’s pretend you had exactly that situation: 1 Declined - Anonymous consent at Shelter A, 1 Declined - Anonymous consent at Shelter B, and 1 Declined - Anonymous consent at Drop-In Centre C. If you also had 99 consenting clients, then you know that your total number of clients is between 100 and 102, which is a small and tolerable margin.

If instead you had 50 Declined - Anonymous consents at Shelter A, 50 Declined - Anonymous consents at Shelter B, and 50 Declined - Anonymous consents at Drop-In Centre C, along with 50 consenting clients, then your total number of clients is somewhere between 100 and 200 - a huge margin of error!

It’s important to reduce the frequency of clients with Declined - Anonymous consent to as close to 0 as possible.

Coordinated Access

Putting it all together, a requirement of Reaching Home is to ensure that all of your current clients have:

1. An accurate Housing Status

2. An accurate Activity Status

3. Informed Consent

If you ensure that your system is constantly keeping this information up-to-date, then, for any given date or date range, you should be able to determine how many clients were actively homeless during that time, how many were housed, how many were new to homelessness, how many became chronically homeless, how many lost contact due to inactivity, and more. And you can further use this information to identify trends over time, such as whether there is more homelessness in the summer or the winter, and how many homeless individuals you’re able to house per month on average.

Struggling with these measures? Check out the HIFIS Health Check! It measures, among other things:

• The percentage of your clients with Unknown housing status

• The percentage of clients who are Inactive but who are actively receiving services

• The percentage of your clients agreeing to data sharing (consent)

HIFIS Health Check 2.0