Design intake processes that are connected, customer-centric and radically accessible.
These actions are informed by four months of primary and secondary research conducted by our team. Our team analyzed national best practices and global innovations as well as the policies, organizational structures, regulatory authorities, and performance reports of local stakeholder agencies to understand the systems-level structures that drive performance. We consulted with more than 100 local and national public officials, system administrators, and technical experts to understand the challenges and opportunities at hand.
Our ability to develop these actions also required an understanding of the current state of services derived from the experiences of frontline staff and people experiencing homelessness. Our research team leveraged a mix of design workshops, interviews, and site visits across King County. Our lines of inquiry identified the most pressing challenges for accessing and delivering services and the dynamics between service providers, customers, and the system.
Customers
consistently characterized intake procedures as a deeply negative experiences, describing them as dehumanizing. In workshops and interviews, customers communicated significant dissatisfaction with invasive, superfluous assessment processes; endless waitlists and mismanaged expectations; complex, unnavigable systems; and geographically disconnected service points.Not only are intake processes frustrating, they can also be re-traumatizing for customers. Assessments often include questions about deeply personal information that are functionally unnecessary for the services available. This generates inefficiency in programs and systems, as well as amplifies the customers’ negative experience. In addition, it can worsen their living situation by increasing levels of toxic stress, clouding normal decision-making processes
and destabilizing their physiological well-being.Therefore, the sixth action is to design and implement intake processes that are connected, customer-centric, and radically accessible.
In a comprehensive evaluation of national standards of best practice, we identified three key opportunities to strengthen coordinated entry in the region. The first is to structure outreach efforts as a bridge to housing and supportive services through coordinated entry. The second is to structure coordinated entry as a touchpoint from which customers are offered hand-offs and referrals to all relevant resources available both within and outside of the homeless service system.
The third opportunity is to design and implement phased assessments that only collect data relevant to the resources accessible from any given support point. Below, there are several strategies that accelerate the development of intake processes that connect to all available supports in the community for permanent housing and economic mobility.Hear providers discuss discontinuities in the current intake system.
An analysis of the local coordinated entry system and system-wide referral processes found limited connections to and from other resources available in the community, indicating weak inter-system collaboration that would, in part, be addressed by consolidating authority. This, in turn, would relieve customers of the burden to develop expertise in navigating a fragmented system. In interviews and workshops, customers shared that current intake processes inhibit trust-building and create uncomfortable dynamics between providers and customers. Similarly, providers recognized the tension between their organizational values and available resources, which often leads to false promises and a lack of transparency.
King County Department of Community and Human Services, Performance Measurement and Evaluation Unit, City of Seattle Human Services Department, Data, Performance, and Evaluation Unit (2018). CEA Interim Single Adult Prioritization Formula Proposal: Results from Workgroup. Seattle, WA: CEA Policy Advisory Committee.
The review of recent Coordinated Entry for All reports delineates significant racial disparities produced by the assessment and prioritization process. Though black single adults make up 30% of those assessed within the coordinated entry system, they only make up 21% of those prioritized for housing. In contrast, single adults who identify as white makeup 51% of those prioritized for housing, despite only accounting for 47% of those assessed.
Nearly two thirds of people experiencing homelessness in the region are people of color: Native Americans and Alaskan Natives experience homelessness at seven times the rate of white people, while black people experience homelessness at five times the rate of white people, and Native Hawaiians and Pacific Islanders experience homelessness at three times the rate of white people.This degree of disproportionality requires that the system reorient itself based explicitly on the needs of customers, particularly historically marginalized populations, in order to be effective. Redesigning intake processes, implementing comprehensive coordinated entry structures, and consolidating oversight would allow for those needs to be understood at the systems level and for solutions to be scaled accordingly.
Programs often use battery-style assessment tools that map every potential aspect of customers’ needs. However, customers expressed that most of the time these assessments don’t lead to any new material support, behavioral health care connections, or resources to support economic mobility, and are therefore simply invasive. In response, a set of strategies below assure that customer experience is the primary driver for process design.
Develop intake processes that connect to all available supports in the community for permanent housing and economic mobility
1. Design and implement a low-barrier, comprehensive coordinated entry process that connects to all services and supports available in the region.
Homeless service system intake processes should be widely accessible and designed to connect customers to resources both within and outside the system, representing the community-wide effort required to end homelessness.
Coordinated entry processes and procedures should be established at every entry point into the system and should prioritize timeliness, accessibility, and customer experience.
Coordinated entry staff at each access point should be able to facilitate direct access or referrals to the partners and supportive services outlined in the illustration, including services provided by faith-based organizations as well as those not specifically targeted to people experiencing homelessness. Coordinated entry staff should be co-located within the child welfare and juvenile justice systems (a process called ‘in-reach’ where people are identified and offered supports while either already service-connected in another context or while being detained by another system) in order to ensure that young people exiting those systems are assessed for housing stability and immediately connected to available resources whenever needed.
The coordinated entry framework should reflect the systems’ customer-centered, Housing First orientation and the diversity of partners engaged should reflect the opportunity for customers to have a meaningful choice in the service and housing approaches that are accessible through coordinated entry.
Cross-system collaboration should be built on a shared understanding of the drivers of homelessness and the community-wide responsibility to support customers. This collaboration should be mandated where possible and otherwise incentivized through collaborative applicant funding pools and other opportunities to ensure comprehensive connections and efficiency in meeting customers’ needs.
Effective coordinated entry will leverage on the digital transformation strategies outlined to facilitate data sharing across programs and systems as well as the use of a de-duplicated master index to improve connections and customer experience.
In order to be meaningfully customer-oriented, the coordinated entry system should be transparent: expectations and level-setting should be openly discussed with customers.
To ensure that customer experience is the primary factor around which the process is designed and questions are connected to imminently available services and the housing waitlist:
2. Design and implement a phased assessment process.
Phased assessment would enable providers to screen only for the services, supports, and resources available directly at or from the access point in question.
This is supported by the digital transformation process outlined to facilitate data sharing across providers. This type of process would create significant efficiencies for system administrators and providers and directly addresses customers’ frustration with duplicative and impersonal assessment processes. This type of functional transformation will also play a part in mitigating the tremendous burden of homeless system navigation on customers.Hear customers address difficulties navigating the homelessness response system.
Phasing assessment relies on dynamic tools that axiomatically unlock or move past questions based on a customer’s responses in real time, rather than the current intake instruments (which are primarily battery-style evaluation tools which ask every question regardless of response). Phased assessment allows providers to identify customers’ immediate service needs as well as necessary referrals and connections. These referrals and hand-offs to other providers and partners in the community should be backed by well-established processes and procedures as outlined above. Peer supports should be employed in these outreach, intake, and in-reach roles and receive specialized training to do so.
3. Connect all in-reach and outreach to coordinated entry.
All outreach to people experiencing homelessness should be positioned as the first step in phased assessment, data collection, and relationship building. Outreach providers should be positioned to facilitate warm handoffs to coordinated entry providers and other service providers in the community. Discharge planning processes and procedures also should be modified to identify people at risk of experiencing homelessness
who are currently residing in jails, prisons, hospitals, and behavioral health treatment programs in order to begin the process of identifying resources available to prevent that experience. These in-reach efforts should be led by the system that currently has the primary point of contact with the person (e.g. criminal justice), but well-informed by and structurally connected to the homelessness authority through data sharing agreements and programmatic memoranda of understanding. Outreach and in-reach providers should be trained in trauma-informed care, motivational interviewing, and critical time intervention strategies to improve and streamline approaches to engagement with customers. To the maximum extent possible, people with lived experience of homelessness and existing peer support staff should always be considered for roles like these which require a deep understanding of a person’s current circumstances and what will seem reasonable to them in that situation.Hear customers speak to the need and value of staff with lived experience.
4. Streamline 2-1-1 information to align with coordinated entry and available resources.
The 2-1-1 information hotline should be leveraged as a key point for disseminating information about service availability within the system. Operators should be given regularly-updated information on prevention and diversion resources, shelter availability, locations for basic needs and services, human trafficking and emergency response protocols, domestic and sexual violence providers, and coordinated entry access points. When a data sharing infrastructure is established, operators should have a dynamic screening tool that offers a preliminary eligibility assessment for available prevention and diversion resources and the ability to connect people directly to them.