Denver Shelter Assessment_2012

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Denver Shelter Assessment

BACKGROUND

The National Alliance to End Homelessness (the Alliance) was contracted by the City of Denver

to assess the quality and capacity of Denver's homelessness shelter system, to review shelter

practices in other communities, and to make recommendations for improving Denver's shelter

programs.

In conducting our assessment, we reviewed the following practices:

How people access emergency shelter, including screening processes and what happenswhen there is not enough space;

Shelter waiting lists and list management; Standards for safety, security, cleanliness, and health among shelter residents and staff; Shelter capacity, including overflow capacity; The interaction between overnight shelters, 24-hour programs, and day programs; Geographic location of shelters, zoning issues, and transportation; Special populations, including LGBTQ, unaccompanied youth, people with chemical

addictions, families with children, and childless couples;

Data and performance standards; Shelter based services, including strategies for helping households exit homelessness; Staff training and cultural competence; Alternatives to shelter; Street outreach; and Interactions between the shelter system and detoxification programs.


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Site visits were conducted by Alliance staff on June 6 to 8. Sites visited included:

St. Francis Center; Urban Peak; Salvation Army Crossroads; Volunteers of Americas Brandon Center; Family Motel; Denvers Road Home Respite Program; Delores Project; The Gathering Place; Samaritan House; and Denver Rescue Mission Lawrence Street Shelter.The Alliance interviewed many other stakeholders in Denver, including staff from Denvers

Road Home, Denver Health, and the Colorado Coalition for the Homeless. We also reviewed

documents obtained during site visits, surveys of shelter residents, homelessness data from the

Metropolitan Denver Homelessness Initiative, and several other resources.

Alliance staff interviewed city leaders and shelter and substance abuse detoxification providers

from numerous communities, including:

Portland, Oregon (Janus, a youth shelter provider; Central City Concern, which runs asobering center and detoxification program; and Transition Projects, which operates adult

shelters);

Philadelphia, Pennsylvania (City of Philadelphias Office of Supportive Housing, whichoversees a large shelter system);

Worcester, Massachusetts (Community Healthlink, a nonprofit organization that partners inshelter, clinical services, and re-housing initiatives); and

Hennepin County, Minnesota (The county government, which oversees many of the sheltersin Minneapolis and Hennepin County).


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In addition to those interviews, the Alliance spoke with numerous experts and reviewed

relevant evidence on best practices related to emergency shelter systems.

AUTHORS

Norm Suchar, Director of Capacity Building, National Alliance to End Homelessness

Norm directs the Alliances Center for Capacity Building, which helps communities implement

system-wide strategies that prevent and end homelessness.

Anna Blasco, Capacity Building Assistant, National Alliance to End Homelessness

Anna provides planning, coordination, and logistical support to the Alliances Center for

Capacity Building.

On any given night 636,017 people are

homeless in the United States.

The National Alliance to End Homelessness is a leading voice on the issue of

homelessness. By working collaboratively with the public, private, and nonprofit sectors

to build state and local capacity, leading to stronger programs and policies that help

communities achieve their goal of ending homelessness. We provide data and research

to policymakers and elected officials in order to inform policy debates and educate the

public and opinion leader nationwide.


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TABLE OF CONTENTS

Overall Assessment ......................................................................................................................... 5

Framework for Recommendations ................................................................................................. 6

Overview of Recommendations ..................................................................................................... 7

Assessment Findings ....................................................................................................................... 9

Detailed Recommendations ......................................................................................................... 16

Back Door Recommendations........................................................................................... 16

Improve Oversight, Coordination, and Accountability across the Shelter System .......... 18

Improve Front Door Strategies ......................................................................................... 22

Improve the Shelter System ............................................................................................. 25

Conclusion ..................................................................................................................................... 32

Appendix ....................................................................................................................................... 34


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OVERALL ASSESSMENT

Overall, we found that Denver's shelter providers, day center providers, and other service

partners perform well considering the constraints, particularly the budget constraints, which

they operate under. The shelter system in Denver has less public investment and less overall

investment than in many other communities, resulting in lower quality than in some other

cities, although not significantly so. For example, Philadelphias Office of Supportive Housing

invests $28 million annually in its emergency shelter system, compared to approximately $2

million invested by the City and County of Denver. Philadelphia shelters approximately twice as

many people at a given time as are in emergency shelter in Denver. The lack of shelter

investment on the part of the City and County of Denver is partly a function of the prioritization

of permanent supportive housing and reducing chronic homelessness. 1 Evidence indicates that

prioritizing permanent supportive housing is a good strategy.

Improvements to a shelter system can help improve conditions for people experiencing

homelessness. However, investments that more directly help people move from homelessness

to housing, including permanent supportive housing and rapid re-housing, can have a greater

impact. Permanent supportive housing has likely had a more positive impact on people

experiencing chronic homelessness in Denver than if more resources had been invested in

shelters.

The most important deficiency in the city's shelter system is the lack of an exit strategy for its

residents. There is very little re-housing assistance for people experiencing homelessness in

Denver. As a result, people are in the shelter system for longer than is necessary, which puts

additional strain on the shelter system. Addressing this need should be the city's first priority.

Access to the shelter system is uncoordinated and generally does not prioritize people who are

most vulnerable. People who need to access the shelter system spend more time and energy

gaining that access than is necessary. This is a stressful process and the time could be better

utilized on efforts to find employment and housing.

1Chronic homelessness refers to homelessness among people with disabilities who have been homeless

continuously for at least one year or who have been homeless at least four times in the past three years.


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The shelter system is greatly inhibited by the lack of system-wide data and measured

outcomes. The Metropolitan Denver Homeless Initiative (MDHI) is shifting to a new data

system, which will help remedy this situation. This shift provides an opportunity to create a set

of shared outcomes and measures for assessing the performance of different components of

the shelter system. Currently, there appears to be little work on creating those outcomes.

Each shelter has developed standards, training protocols, and policies. However, there is an

overall lack of community-wide standards and outcomes in the shelter system. One problem

with the lack of community-wide standards is that it places a greater burden on shelter

providers to create their own standards. It also results in some discontinuity of policies across

providers.

The most obvious solution to the lack of investment in shelters would seem to be to invest

more public resources into the shelter system. However, we do not recommend making this a

high priority. Investing in helping people exit shelter quickly will have a greater impact, followed

by the need to create a more coordinated process for accessing shelter. When a more robust

infrastructure for re-housing people experiencing homelessness and a more coordinated

process for accessing shelter are in place, less emergency shelter capacity will be needed, and

public investment can focus on improving the quality of the shelter system, but at a smaller

overall capacity.

FRAMEWORK FOR RECOMMENDATIONS

There are several inter-related factors that affect the functioning of a shelter system. These

factors can be divided into the following categories:

Oversightincluding performance management and coordination; Front doorincluding prevention and diversion efforts and access to the shelter system; Shelter systemincluding the quality of shelter, outreach, and day centers, and the ease with

which people can navigate those programs; and

Back doorincluding re-housing, permanent supportive housing, and other assistance thathelps people exit homelessness.


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As a result of the interaction of all of these factors, there are numerous trade-offs that will be

faced by any city seeking to improve its shelter system. These trade-offs include:

Cost vs. Quality; Investment in Shelter vs. Investment in Re-Housing vs. Investment in Prevention; Coordination vs. Provider Autonomy; and Burden on People Experiencing Homelessness vs. Burden on Providers.In making these recommendations we have been mindful of these tradeoffs.

OVERVIEW OF RECOMMENDATIONS

The Alliance has numerous recommendations, some of which can be implemented

immediately, and some that will take time. We attempted to be realistic about the ability of the

city government, providers, and funding community to invest vast new resources in the shelter

system. However, we also include some recommendations that would require larger

investment. We have included symbols to indicate cost, ranging from no or low cost ($) to high

cost ($$$$). More detail about the recommendations can be found in the section Detailed

Recommendations. In this section we have prioritized the recommendations, with Back Door

recommendationsthose that increase re-housing assistancebeing most important, followedby improvements to the oversight of shelters, improving front door strategies such as

prevention and coordinated access to shelters, and finally, direct improvements to shelter

programs.

Back Door Recommendations:

1. Develop a robust rapid re-housing capacity focused on housing search assistance, familyreunification, and providing small amounts of financial assistance. ($$$$)

Oversight Recommendations:

2. Assign responsibility for the citys overall shelter policy and design to a staff person atDenvers Road Home. ($$)

3. Develop system-wide performance measures to track the overall effectiveness ofDenver's shelter system. ($)


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4. Transition to an open HMIS to allow data sharing between providers. ($)5. Consolidate the planning for the Continuum of Care (CoC) with the planning and

oversight of emergency shelter and other emergency services. ($)

6.

Create a mechanism to get regular feedback from people experiencing homelessnessabout the shelter system, including surveys and focus groups. ($)

Front Door Recommendations:

7. Develop a coordinated intake system so that people experiencing homelessness cancontact one entity to be assigned to a shelter bed or other assistance. ($$)

8. Develop a shelter diversion program that is coordinated with the intake system. ($$$)Shelter System Recommendations:

9. Begin planning a redesign of the emergency shelter system, with an eye toward usingsome of the existing transitional housing capacity as a 24-hour shelter system, and using

existing emergency shelter beds, if they continue to be needed, as overflow shelter.

($$$)

10.Develop system-wide standards for safety, cleanliness, resident rights, data, outcomes,and staff training. ($)

11.Conduct regular inspections. ($$)12.Encourage shelters to specialize. ($$)13.Improve coordination between detoxification services, shelter, and outreach, and create

a two-level substance abuse detoxification system with sobering center and sub-acute

detoxification facility. ($$)

14.Delay investing in new employment programs, day centers, outreach, and life skills orcase management activities and seek opportunities to shift current capacity to rapid re-

housing activities. ($)

15.Partner with the Regional Transportation District. ($$)16.Create a streamlined method of conducting tuberculosis tests. ($)17.Create shelter capacity for intoxicated youth. ($$)


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ASSESSMENT FINDINGS

This section summarizes our assessment of Denvers shelter system and related programs.

Access to emergency shelter, screening processes, and what happens when there is not

enough space

There is no universal shelter entry process in Denver. For the most part, shelters develop their

own screening and entry processes. For example, the Delores Project allows potential

consumers to call in Mondays and Thursdays, and will accept people on a first come, first

served basis. Denvers Rescue Mission conducts a nightly lottery. Crossroads conducts twice

weekly lotteries.

People who need shelter typically find the shelters through word of mouth or by getting

information from other service providers and outreach workers. When there is not enough

space at a shelter, people are typically provided with information about other shelter

possibilities. People experiencing homelessness who completed surveys administered by

Denvers Road Home occasionally mentioned the amount of time wasted lining up for shelter

beds. When shelters are full, people often line up at another shelter.

Many shelter providers are willing to shelter people who are intoxicated or who have

behavioral health issues. Shelter providers generally do not screen out potential guests

unnecessarily. Screening criteria are developed by shelter providers.

In other cities we examined, an uncoordinated system was typical for single adult shelters.

However, cities have started shifting to a more coordinated shelter entry process. Family

shelters have tended to be better coordinated, and many cities have policies that ensure that

no family is unsheltered. Several of our recommendations focus on strategies for making

shelter entry simpler, better coordinated, and more efficient.

Shelter waiting lists and list management

None of the shelters we visited maintain waiting lists for shelter entry, although some do

maintain lists for people who are moving from overflow to regular shelter beds. Especially for


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nightly shelters, there is little value in maintaining waiting lists for emergency shelter, so this is

a prudent policy.

Standards for safety, security, cleanliness, and health among shelter residents and staff

The process for inspecting shelters for safety and health is inconsistent. Programs that have

beds funded by the Department of Veterans Affairs get regular and thorough inspections.

Others receive inspections if they serve food or by the fire marshal, or in the case of Urban

Peak, because they are licensed as a child care facility. One of the major health concerns with

shelter programs in Denver and in most other cities is bedbugs. Much effort is made to prevent

the spread of bedbugs and to quickly eliminate them.

Following are examples of the inspection processes for several programs:

St. Francis does not receive inspections from the city. If there is a safety issue, they callthe police.

Urban Peak receives many inspections because they are a licensed child care facility. In the Crossroads shelter, Denver Health regularly comes to give tuberculosis tests, and

the shelter contracts with a pest control company to spray monthly for bed bugs.

Brandon Center receives inspections from the health department, and food is inspectedby the city and county.

The Gathering Place is only inspected by the fire department. At Samaritan House, inspections are done by the Department of Veterans Affairs and

the fire department, and the meals and kitchens are inspected by the USDAs Child and

Adult Care Food Program.

Denver Rescue Mission sprays for pests monthly. They are inspected by the fire marshaland by sthe health department when there is a complaint, and they follow Association

of Gospel Rescue Missions guidelines for health and safety.

Shelter capacity, including overflow capacity

Overall shelter demand and capacity are influenced by many factors, including weather, private

housing markets, the quality of the shelter system, and the presence of other programs that

prevent homelessness or help people exit homelessness. In conversations with shelter


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providers, it was clear that emergency shelter facilities generally operate near capacity, and

that under certain circumstances, as when weather is bad, they have to open up space for

people to sleep that would not normally be used as shelter.

The interaction between overnight shelters, 24-hour programs, and day programs

Most people who use Denvers emergency shelter system use one of the large shelters (e.g.

Crossroads, Samaritan House, Rescue Mission, Delores Project), and many of them also use one

of the large day programs (e.g. The Gathering Place, St. Francis Center). Few people have access

to 24-hour emergency shelter, although respite clients are a notable exception.

Geographic location of shelters, zoning issues, and transportation

The vast majority of shelter beds are located very near each other and near day centers and

other services [See Figure 1: Location of Mens Emergency Shelters and Day Centers]. Those

that are not tend to be located near bus lines. However, transportation is an issue for youth and

women. The youth shelter, Urban Peak, is quite far from day services and downtown. The

Gathering Place is located a considerable distance from shelters and other services, and from

downtown.

Following are examples of transportation and access for major homeless assistance programs.

St. Francis is located near a bus line, though most people walk from nearby shelters. Urban Peak is located a good distance from downtown, but is near a bus stop. Most people walk to Crossroads, but some are escorted by the police. Most people walk or take the bus to Brandon Center, but must be dropped off two

blocks away for confidentiality reasons.

The Gathering Place is located a considerable distance from downtown. Most peoplewalk.

Samaritan House and Denver Rescue Mission are both located near bus lines and closeto downtown and other services.


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Figure 1: Location of Mens Emergency Shelters and Day Centers

Special populations, including LGBTQ, unaccompanied youth, people with chemical

addictions, families with children, and childless couples

Like the general population, people who experience homelessness are diverse and have

differing needs. In recent years, more attention has been placed on LGBTQ populations and

their access to homeless services. For the most part, emergency shelters allow individuals to

self-identify their sex, which is a good policy for serving transgendered people. One exception

to this policy is Samaritan House, which uses the sex indicated on a persons identification.

Another challenge for emergency shelters is addressing specific subpopulations, including

people with pets, people with service animals, people who are intoxicated, childless couples,

and fathers with their children.


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We were not able to identify any emergency shelter that take pets, although some, like the

Rescue Mission, take service animals. Many of the shelters serve people who are intoxicated,

although there appear to be no good options for youth who are intoxicated. Those youth are

sent to either one of the adult shelters or to a detoxification program. There also appears to be

no place for childless couples, although they can stay in separate shelters, or in the case of

Samaritan House, in separate rooms of the shelter.

Data and performance standards

Almost every shelter provider and day center is collecting data and entering it into the

Homeless Management Information System (HMIS). However, data is not utilized, and several

providers are frustrated by their inability to get useful performance information from the

existing HMIS. Several providers are using two or in some cases more data systems

simultaneously, an inefficient process. Few providers are able to identify the outcomes of their

assistance, for example the exit destinations. Urban Peak is a notable exception as they are

quickly able to provide information about exit destinations, a critical performance measure.

HMIS data is not regularly analyzed, and this is to the detriment of shelter providers, people

experiencing homelessness, and the city at large. Shelter policies are made based on

assumptions about how they would affect behavior without any test to see if they have the

desired impact. For example, shelters have various policies for the length of time people are

allowed to stay, under the assumption that the stay limit will encourage people to work harder

to move out. This may be true or it may not, but it is a testable question and should be

evaluated using HMIS data.

HMIS is closed, which means that providers cannot share data with other providers, even when

a consumer wants them to share data. As a result, a person who goes from one program to

another has to provide the same information to both providers. Many cities use an open HMIS,

where providers can share data with consumers consent. Those that have experience with

both open and closed systems prefer an open system. A new HMIS is currently being

implemented.

Shelter based services, including strategies for helping households exit homelessness

There are basically three types of exits from the Denver shelter system:


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People exit with little or no help in finding or paying for housing; People exit to another homeless assistance program, either transitional or permanent

supportive housing; or

People have negative exits such as being arrested, or hospitalized.Missing is a focus on rapid re-housing. Many of the caseworkers and service providers focus

their work on identifying housing for people, but they have few of the tools needed to actually

get people into housing. There appears to be almost no rapid re-housing being provided

currently (although we assume that the city and county of Denver will utilize some of its

Emergency Solutions Grant for rapid re-housing). Other cities we evaluated are increasing their

use of rapid re-housing, particularly for families with children.

To the degree that services exist, they tend to be located in the day centers rather than the

shelters, because most of the shelters only serve people overnight. Many of the services focus

on housing issues or employment, although the Gathering Place offers a very rich array of

services to women.

Some providers offer case management and other services for people residing in their

emergency shelter program (e.g. Samaritan Housing, Brandon Center). Services in these

programs tend to target people with fewer housing and service barriers. For example, some

services are targeted to people who are employed, others to people who are successfully

making progress on their case plan. In essence, additional services were being provided as a

reward for good behavior and progress. Unfortunately, this tends to leave people who most

need services (those without jobs or who have trouble achieving the goals of a case plan)

without those very services. An exception to this process is the Fresh Start program, which

tends to serve people who were having more difficulty exiting the motel program or finding

other services.

It is impossible to assess the mix of services and whether the right services are being provided

without better data about how people are exiting homelessness, and especially how often they

return to homelessness.


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Staff training and cultural competence

For the most part, emergency shelters and day centers take the initiative to train their staff on

necessary skills. Given the potential for conflict in a shelter or day center program, training on

conflict resolution and de-escalation is important. For example, at Crossroads and Delores

Project, employees take de-escalation classes.

Although people who utilize shelter have diverse backgrounds, including many who primarily

speak a language other than English, language and cultural issues are largely left up to shelter

providers to deal with. Few shelter and day center staff have formal training in cultural

competence. Many shelters try to hire Spanish speaking staff, but sometimes they rely on other

shelter residents to translate. If shelter residents primarily speak a language other than English

or Spanish, they are likely to have a difficult time.

Alternatives to shelter

When shelter policies prevent people from being able to access the shelter (for example, no

shelters take a person with pets) there are no alternatives.

When people attempt to access shelter, there is rarely much effort to prevent their homeless

episode by reaching out to their previous landlord or other friends or family members to

negotiate a continued stay.

Street outreach

Street outreach efforts are hampered by the lack of resources to link people to. Outreach

efforts are effective when workers are able to identify housing options or services that are

available and beneficial to the people they are working with. For example, outreach workers

were utilized for implementation of the Homelessness Prevention and Rapid Re-Housing

Program (HPRP), which appears to have been quite successful, even with an unusual program

design (few other cities used outreach workers to provide housing location). With these kinds

of resources, outreach workers are effective. Without them they are less effective.

We also received numerous positive comments about the police officers dedicated to working

with people experiencing homelessness. A few cities have similar initiatives, and they all appear

to work well.


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Interactions between the shelter system and detoxification programs

Although it was not part of our initial assessment, the interaction between substance abuse

detoxification and shelter programs came up repeatedly. Many of the shelter providers in

Denver will tolerate substance use to a point (including the Rescue Mission and Crossroads),

and at that point, people are transported to the detoxification program operated by Denver

Cares. One of the problems with this process is that people are brought to the detoxifications

program even when it is not an appropriate placement. This largely occurs when a person has

more intensive medical needs or requires more intensive assistance than is available at Denver

Cares.

DETAILED RECOMMENDATIONS

Back Door Recommendations

1. Develop a robust rapid re-housing capacity focused on housing search assistance, family

reunification, and providing small amounts of financial assistance.

Expanding rapid re-housing capacity is our highest priority recommendation. Even a mildly

effective re-housing program will improve the functioning of nearly every other part of the

shelter system. Currently, people experiencing homelessness in Denver face a dauntingchallenge because Denver has a relatively low rental vacancy ratethe 11

thlowest out of the

75 largest cities in the country.2

However, many other cities with similarly low vacancy rates

have experienced great success with rapid rehousing strategies. Several of those cities are

included in Figure 2: Vacancy Rate Comparison.

2Source: Current Population Survey/Housing Vacancy Survey, Bureau of the Census, Washington, DC 20233


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Figure 2: Vacancy Rate Comparison

An increasing amount of federal resources, particularly for homeless veterans, is being directed

to rapid re-housing programs. Denvers allocation of HPRP was very successful, re-housing

hundreds of homeless people. Based on our experience analyzing rapid re-housing programs

across the country, we recommend expanding rapid re-housing in the following ways:

The city and county of Denver and MDHIs should begin working with the Department ofVeterans Affairs to plan for the expansion of the Supportive Services for Veterans and

their Families (SSVF) program.

MDHI should begin identifying transitional housing providers who are good candidatesfor retooling their programs into rapid re-housing using the CoC reallocation process.

Existing job descriptions for case managers should be reviewed to identify opportunitiesto shift their focus to housing location and housing stabilization, including family

reunification (many providers have already begun doing this).

Private funders should be encouraged to shift their funding to rapid re-housing. To the maximum extent possible, rapid re-housing should be directed to respite clients

and people who have long or repeated shelter stays.

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

5.0%


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The benefits of providing more rapid re-housing are many, and they outweigh the benefits of

other investments that could be made to improve the shelter system. [See Appendix E: Data on

the Impact of Rapid Re-Housing]

Improve Oversight, Coordination, and Accountability across the Shelter System

As in most cities, Denvers shelter system operates as a collection of programs more than a

system. In a system, there would be established criteria for determining who can access

shelters, who is prioritized for shelter, how people are referred to other programs, and the

expected outcomes of each program. Cities that shift from a program to system approach are

generally successful at reducing homelessness because they can more efficiently match people

with the programs that can best serve them. Furthermore, the people who experience

homelessness in communities with a system approach find it easier to access services.

2. Assign responsibility for Shelter Policy and Design to a staff person at Denvers RoadHome.

One of the underlying challenges we discovered is the lack of an overarching system of

policymaking, data collection, resource allocation, and accountability. For example, shelters

each have their own intake process and have different policies for how long people can stay at

the shelter and what is expected of them. Although shelter providers are entering data into

HMIS, there is not a consistent set of outcomes that they are reporting on or working toward.

Shelter providers are coordinating through regular meetings and by maintaining good

relationships with each other, however, the lack of uniform policies creates additional burden

for shelter staff. Moreover, many of the recommendations we have included in this report will

require a high level of coordination across the shelter system.

There are few cities that currently have this kind of structure in place, but those that do find

that they can quickly and efficiently address gaps and problems in the shelter system. For

example, in our interviews with Philadelphias Office of Supportive Housing (which is

responsible for the citys shelter system among other things), it became clear that the citys

shelters had clear and uniform standards, a uniform access process for residents, clear

outcomes, and a consistent policy for termination and discharge. These are all important


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contributors to their successes at reducing the number of homeless people who are

unsheltered. Though Philadelphia has roughly double the population of Denver, and twice as

many people experiencing homelessness, they had roughly the same number of people

unsheltered in their 2011 Point in Time Count as did Denver.

The task of coordinating shelter activities would not require an entire full time employee

initially; approximately one half full time employee is likely to be sufficient. The duties of this

individual would include the following, which encompass implementation of this reports

recommendations:

Shelter system planning; Coordinating policies across emergency programs; Evaluating data to identify gaps in services; Evaluating cost effectiveness of programs; Working with funders to promote consistent policies; and Evaluating utilization of homeless assistance programs.

3. Develop system-wide performance measures to track the overall effectiveness of Denver's

shelter system.

A robust performance measurement structure helps homeless assistance programs operate

more effectively. A simple and clear set of outcome measures, regular assessment of progress

on those measures, and some accountability to achieve outcomes all help align the activities

and incentives of providers and other stakeholders. Only a few simple measures are needed,

but they should be applied as broadly as possible. Performance measures would also help

identify system inadequacies, such as the lack of housing assistance.

Shelter programs in Columbus, Ohio and Philadelphia, Pennsylvania have fairly robust

performance measurement systems. In Philadelphia, performance benchmarks are in place

regarding the number of placements into subsidized and unsubsidized housing and connecting

people with benefits and other resources. Columbus has measures in place for successful

housing outcomes, security, and efficient use of resources. [See Appendix B: Community Shelter

Board (Columbus, Ohio) Performance Measures for Emergency Shelter Programs]


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Most programs in Denvers shelter system have developed internal measures. These measures

are largely used to demonstrate to funders and the broader community that the programs are

effective. The measures do not, however, help drive larger policy or resource decisions and

they are not consistent across programs. For example, a measure of housing placements could

help identify which activities are most efficiently housing people, and a measure of shelter

stability (people who exit a shelter and are not going to a different shelter) would identify cases

where people are cycling between programs and may need more targeted assistance.

Development of performance measures is an iterative process and requires engagement of

funders, providers, local officials, and other stakeholders.

4. Transition to an open HMIS to allow data sharing between providers.

Providers in Denver do not currently share HMIS data. Additionally, the largest shelters in

Denver prescribe short lengths of stay, resulting in people frequently moving between

programs. Each of these programs requires new intake forms, slowing down how quickly people

are able to access services and resulting in a larger administrative burden for each program.

In many cities HMIS operates as an open system, allowing consumer information to follow them

if they move between programs, reducing the number of times that consumers have to provide

their information, and making it easier to track outcomes. Health Insurance Portability and

Accountability (HIPAA) protected health information and domestic violence related information

cannot be viewed.

To increase the efficiency of the system and improve the data available about how and in what

ways people experiencing homelessness move throughout the system, the HMIS used in Denver

should transition to become an open system. HMIS is currently the responsibility of MDHI, the

lead agency for Denvers regional CoC, and they would have to take the lead in making the

change. Transitioning to an open HMIS will require a data sharing agreements between

programs, and a client release of information consent form. [See Appendix C: Whatcom

Housing Group Inter-Agency Data Sharing Memorandum of Agreement and Appendix D:

Dayton-Montgomery County HMIS Client Notice and Consent for Release]


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5. Consolidate the planning for the Continuum of Care with the planning and oversight of

emergency shelter and other emergency services.

Although transitional housing is often viewed as a separate part of the homelessness system, it

is best to view it along with the network of shelters, day centers, and outreach programs, as

part of a system of emergency housing and services. Providers and planners of these types of

assistance should meet more regularly to coordinate their efforts.

The city and county of Denver has a complicated relationship with the CoC jurisdiction in which

it is located, which includes numerous suburban communities. As a result, planning and

coordination for shelters and emergency services are carried out separately from planning for

transitional and permanent housing funded through the CoC process. This is a problem because

each system has a profound effect on the other. CoC funded programs are a significant

destination source for people exiting emergency shelters. When CoC funded programs have

long stays, it reduces the number of openings and thus creates back-ups in the emergency

shelter system.

The impact can be dramatic. If Denvers shelter and transitional housing programs are typical of

those in the nation (Denver does not have sufficient data yet to make the calculation using local

data), then reducing the length of transitional housing stays by 20 percent would result in

approximately 150 fewer people needing emergency shelter each night.3 Better coordination

could also help ensure that people with longer potential shelter stays are prioritized for

transitional housing and permanent supportive housing openings. This would further reduce

the burden on the existing emergency shelter system.

6. Create a mechanism to get regular feedback from people experiencing homelessness about

the shelter system, including surveys and focus groups.

Many shelter providers have regular forums that enable people experiencing homelessness to

provide feedback. However, these forums do not adequately address the need for consumer

feedback. Denvers Road Home recently conducted a round of surveys, which we reviewed as

3Calculation: 2,366 (people in transitional housing PIT 2011) X 0.8 (representing 20 percent reduction) X 2.1/6.5

(factor to account for the fact that people stay in transitional housing over 3 times as long as they stay in shelter) =

153 fewer people needing emergency shelter on a given night.


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part of this assessment. Denvers Road Home should hold periodic focus groups and surveys to

get consumer feedback. Twice annual or quarterly focus groups and surveys would be a good

start. The focus groups especially should seek to identify specific concerns about the shelter

system, particularly around safety, cleanliness, health hazards, and treatment by staff.

Improve Front Door Strategies

Front door strategies refer to those interventions that either prevent the need for a person to

enter the homeless system or facilitate their entry into the homeless system, including

strategies such as homelessness prevention and centralized intake.

7. Develop a coordinated intake system so that people experiencing homelessness can

contact one entity to be assigned to a shelter bed or other assistance.

Accessing homeless assistance can be extremely challenging, compounded by the fact that

people accessing homeless assistance tend to be in a state of crisis. Several cities have

developed centralized or coordinated intake systems to make it easier for people to access

assistance, and also to ensure that they access the assistance that is most appropriate for their

needs. Furthermore, the U.S. Department of Housing and Urban Development (HUD) is

requiring that CoCs develop a coordinated assessment process, which can take several forms

such as:

Centralized intake, Multi-point or regional intake centers, Virtual intake centers using 2-1-1 or similar systems, or Common assessment tools and procedures that are used in various social service

locations.

Given that most homeless services in Denver are located in a relatively small geographic area,

creating centralized intake locationsone for youth and adults and one for families with

childrenis a sensible approach. An initial assessment would be conducted at the intake

locations that would identify whether the household needs shelter and the most appropriate

shelter placement.


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Currently, shelters in Denver each have their own intake process. Several shelters conduct

lotteries to assign beds. This results in a process where people line up for one shelter lottery,

and if they do not get a bed, they go to another shelter to try to gain admission. This takes up

the time of shelter staff and people experiencing homelessness. Under a centralized intake

system, people would go to the centralized intake center when they first become homeless.

The intake center would assign a bed at a shelter location and input the data on the household

into HMIS. The bed would be assigned for a period of time (we recommend 15 days as a

starting point).4

If there is not enough shelter capacity to meet the need on a given night, the

intake center would use a risk assessment to set priorities.

After the 15-day period, consumers would visit the intake center again for another bed

assignment and referral to other programs if appropriate. This process could also take place

over the phone. [See Figure 5: Coordinated Assessment Example Process]

Figure 5: Coordinated Assessment Example Process

4The appropriate length of time will vary depending on circumstances. A shelter provider in Portland, Oregon that

we interviewed assigned beds for 15 days at a time, which seems like a good place to start. Over the long term, the

assignment process could be evaluated based on data and the experiences of intake staff, shelter providers, and

homeless people.

INTAKE

HMIS


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The benefits to the centralized intake process are:

It removes some of the burden for intake and triage from the shelter providers; It streamlines access to shelter assistance for people experiencing homelessness; It provides a better match between shelter beds and peoples needs (for example

people with mobility problems could be directed to a shelter that is more accessible or

people needing respite can be prioritized for transitional housing units more efficiently);

and

It streamlines data entry, which can be done mostly at the centralized intake location.One of the immediate issues that a centralized intake process would address is the use of

shelter beds as respite. In general, people with medical illnesses who are being discharged from

a hospital are not well served by going to emergency shelters. There are currently beds in a

motel program reserved for respite, but respite clients are going to other shelters, even when

the motel beds are not full. A centralized intake process, where hospitals discharging clients

would contact the intake center, would enable clients to be placed in the best bed available.

Furthermore, respite clients should be prioritized for transitional housing assistance. [See

Appendix A: Additional Resources Coordinated Assessment Toolkit]

8. Develop a shelter diversion program that is coordinated with the intake system.

One of the most successful homelessness prevention programs is homelessness diversion. A

diversion program would identify people who are seeking emergency shelter but whose current

housing situation, with a little assistance, could be salvaged. Diversion programs typically

require case managers who are skilled at problem solving and negotiating with landlords and

family members, and flexible financial assistance for things like overdue rent or utility

payments. Shelter diversion programs can reduce the number of people who need shelters, but

they do have a cost. We recommend that diversion programs be developed and that the

centralized intake be the place where people are screened for and provided with diversion

assistance.

Diversion programs are relatively simple to structure, and numerous examples of programs,

forms and screening tools are available. [See Appendix A: Additional Resources]


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Improve the Shelter System

9. Begin planning a redesign of the emergency shelter system, with an eye toward using some

of the existing transitional housing capacity as a 24-hour shelter system, and using existing

emergency shelter beds, if they continue to be needed, as overflow shelter.

Denver currently has many homeless people, ranking 30th

in the per-capita rate of

homelessness among the top 100 metro areas.5

There are many reasons for this, but one factor

is that there is very little assistance for re-housing people experiencing homelessness. Instead

of investing in new shelter capacity, the city should invest in re-housing (more about this

recommendation is included under the heading Back Door Strategies), which will reduce

demand for shelter.

As re-housing capacity is implemented, the relevant stakeholders should begin planning a

redesign of the citys shelter and transitional housing system. The redesign should focus on

shifting some existing transitional housing programs to do more of the work of the emergency

shelter system. For example, placements could be made directly into transitional housing

whenever possible, especially for families with children and people with special needs such as

medical illnesses. Transitional housing programs would shift their programming to focus on

helping people exit to permanent housing situations more quickly, allowing the transitional

housing to serve more people over time and reducing the need for existing emergency shelters.

Initially, transitional housing stays could be limited to nine months, with providers encouraged

to help people exit in no less than four months. Services that are typically provided in the

transitional housing, including case management and employment services, could be provided

in some cases after a person has moved into his/her own housing.

This would be a more efficient way to alleviate some of the shortcomings of the existing

emergency shelter system than creating new emergency shelters. In general, the transitional

housing units have case management attached to them, usually operate 24 hours, and have

better facilities. Furthermore, the programs are not all located at the center of the city, so there

5See: State of Homelessness in America 2012: Appendix One

http://www.endhomelessness.org/files/4361_file_Appendix_One.pdf


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would be more options for people with connections to communities outside of central Denver

who need shelter.

One of the guiding principles of the redesign should be that people with more barriers to

exiting homelessness and special needs should receive more intensive assistance. We identified

several examples where providers with richer resources (more case management, allowed

longer stays, etc.) would only accept people who had employment or had better compliance

with case plans. We also saw examples of the opposite, where more intensive resources were

correctly targeting people with greater needs. As a general rule, richer programs should target

people with longer shelter stays, more severe disabilities, and more hurdles to exiting

homelessness. Non-compliance with case plans or lack of employment are frequently indicators

of more need, not less.

The redesign of the emergency assistance system should better match resources with

outcomes and need. Currently, the amount of funding a provider receives does not seem to

have any connection with its outcomes or the value of its programs. Oftentimes, this is merely a

function of differing fundraising capabilities. With an overall shelter and emergency services

plan, funders could be educated about where the need lies and which strategies are most

important for moving forward, which would help better align resources and priorities.

There are some models of redesigned shelter systems in other cities that Denver could draw

lessons from. For example, Columbus, Ohio has transformed their family shelter system and

Chicago, Illinois had remade their transitional housing into emergency housing.6

More

important than the details of the transition is that it will take a long-term effort to develop

enough consensus among funders, providers, and other stakeholders to move forward. This

planning process should begin soon with the goal of executing the redesign over a several year

period.

6In Chicago, these emergency housing programs are called Interim Housing, and they have a goal of re-housing

individuals and families within 120 days.


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10. Develop system-wide standards for safety, cleanliness, resident rights, data, outcomes,

and staff training.

Most shelters in Denver currently have standards for safety, cleanliness, resident rights, data,

outcomes, and staff training, but they are developed in isolation. Standards that are not

uniform and are not developed publicly and independently could be challenged by advocates

and the public as being inadequate.

In our visits to Denver shelters, it was clear that shelter providers created high standards for the

quality, safety, and security of their facilities. All staff at the Salvation Armys Crossroad shelter,

for example, are required to take verbal de-escalation classes. Given the resource constraints

they operate under, this is no small feat. Because the city funds few of the shelters, it does not

have an easy method for ensuring adherence to standards. However, most shelters would likely

participate in a voluntary system.

The City of Philadelphia has adopted many system wide standards, including standards for

consumer rights, HMIS, medication and health, food preparation and distribution, and sexual

minorities. For example, Philadelphia requires emergency housing staff to receive a minimum

of 10 to 20 hours of training per year, including mandatory and elective topics [See Appendix A:

Additional Resources - Philadelphia Emergency Shelter Standards]. Having these universal

standards communicates to the broader community and to people experiencing homelessness

a consistent message about the quality of homeless assistance and relieves providers of the

burden of developing their own standards.

Denver should develop system-wide standards for safety, cleanliness, resident rights, data,

outcomes, and staff training. Providers should participate in the development of these

standards and volunteer to adopt the standards. Eventually, funders could require participation

in the standards. Importantly, standards should include a policy of self-identification for

transgendered people.

In addition, some homeless assistance providers across the country are shifting to voluntary

service models. The reasons for this are twofold. First, people experiencing homelessness are

much more likely to participate in services in a more meaningful way when they believe they


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are in control of their service plans. Second, when services are voluntary, service providers do

more to make their services interesting and engaging so that clients will participate. Both lead

to better service outcomes.

Many shelters in Denver, including Samaritan House, The Gathering Place, and Brandon Center,

among others, have realized the importance of hiring bilingual staff members, and have begun

to prioritize bilingual job applicants. However, it is not always possible to hire bilingual staff, or

have bilingual staff available at all times. For this reason, all shelters in Denver should have

access to translation services.

11. Conduct Regular Inspections.

No comprehensive inspections of shelter facilities are currently conducted in Denver.

Inspections are done by the fire department to ensure adherence to fire safety standards and

the Department of Veterans Affairs inspects shelters it funds. Inspections of all facilities serving

people experiencing homelessness should be conducted regularly and systematically by an

outside agency.

12. Encourage Shelters to Specialize

Like many communities, the homeless assistance system in Denver evolved organically. In some

ways a natural differentiation among shelters has appeared to serve different populations. For

example, some shelters allow very short lengths of stays and few services, and others allow

longer stays and offer many services.

The city and county of Denver should assess what services are currently available and what

services are lacking. During this process, they should encourage shelters to specialize. Currently,

there are populations that do not fit into the shelter structure. Serving these populations

should be prioritized for specialization:

Childless couples; Elderly; People under 18;


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People whose primary language is not English; People with disabilities that affect their mobility; People with pets; People with serious mental illness; People with service animals; Sex offenders; and People who smoke.

The Family Motel is very well positioned to serve populations that do not easily fit into Denvers

current shelter programs. Vouchers can be issued late at night when other shelters may be full

or closed, and the individual rooms can be configured to house people that may not be safe or

comfortable in open rooms with a large number of beds. Therefore, these beds should be used

for populations that are hard to accommodate in other shelters and for late night access.

13. Improve coordination between detoxification services, shelter, and outreach, and create a

two-level substance abuse detoxification system with sobering center and sub-acute

detoxification facility.

Substance use detoxification programs are an important adjunct to the shelter system.

Although several of the shelter providers in Denver will shelter people who are intoxicated,

they rely on the detoxification program operated by Denver Cares for people who are so

intoxicated that they might be a danger to themselves, or who cannot function well enough to

stay at their shelters. We identified a few problems with how people are referred to these

detoxification programs, particularly that people with special needs or significant medical

problems that Denver Cares was unequipped to handle were coming to the detoxification

program.

We examined detoxification strategies in several other cities, and the most promising approach

was one used in Portland, Oregon, which essentially has two components, a sobering center,

where no medical services are provided, and a sub-acute detoxification facility, where some

medical services are provided. The approach makes it easier to differentiate assistance to

people who just need a safe place for the night to sober up, and those who need longer or for

whom detoxification services could be a pathway to treatment.


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Better coordination between the homeless assistance providers and the Denver Cares program

is also needed. A basic screening tool that helps shelter and outreach providers to identify who

should be referred to Denver Cares and who needs hospitalization should be developed.

14. Delay investing in new employment programs, day centers, outreach, and life skills or

case management activities and seek opportunities to shift current capacity to rapid re-

housing activities.

Employment, outreach, case management, and other similar services are beneficial to people

experiencing homelessness. However, they are less efficient than they could be because there

is very little housing assistance provided to help people exit homelessness. The most important

place to invest resources currently is for expanding re-housing assistance.

Outreach assistance in particular is hampered by the lack of assistance to link people to. One of

the primary goals of outreach programs is to connect people sleeping on the streets to services,

such as housing or health care, that will help them exit homelessness or improve their well-

being. When assistance is available, as was the case when HPRP funds were available, outreach

workers were able to effectively assist people sleeping on the streets. Without such assistance,

outreach is not as effective.

Additionally, much of the existing case management exists to help people navigate the

homeless system as they move from shelter to transitional housing and permanent supportive

housing. Creating a coordinated intake function, and improving coordination between the

shelter system and CoC programs will eliminate much of the need for this type of case

management, freeing those staff to help people access public benefits, mainstream services

(mental health services for example), and housing.

As the grants for any employment, outreach, and case management activities come up for

renewal, or as staff funded under these grants turn over, providers and homeless assistance

funders should take these opportunities to shift either the position or the funding to rapid sre-

housing assistance. Programs that offer employment, outreach, and case management services

should also have to meet outcome goals for moving people into permanent housing.


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15. Partner with the Regional Transportation District.

Many shelters interviewed for this assessment noted that despite being located near public

transportation, most households walk between shelters and day centers. This may be a result

of the limited availability of bus passes and the relatively high cost of public transportation in

Denver. Some womens shelters and day centers in particular are located far away from each

other. The short lengths of time women and families are able to stay in the various shelters

means that these households must often move all of their possessions from program to

program. Women and families may struggle with the burden of commuting to the only

womens day shelter, which is located approximately 17 blocks from downtown.

To help improve transportation options for people experiencing homelessness in Denver,

partnerships should be sought with the Regional Transportation District (RTD). Denver should

seek ways to collaborate with RTD, and encourage RTDs leadership to participate in relevant

homelessness committees and advisory groups. RTD should be approached about providing

free or dramatically reduced fares to people experiencing homelessness.

16. Create a streamlined method of conducting tuberculosis tests.

To access shelter in Denver, people are required to present proof of recent tuberculosis (TB)

tests, or to obtain a screening within the first few days of accessing shelter. Access to TB tests

varies throughout Denvers shelter system. Some shelters, including the Salvation Armys

Crossroads Shelter, have arranged for nurses associated with clinics or the hospital to come to

the shelter and conduct regular screenings. A number of shelters do not provide clients with

this option; instead clients seeking shelter are responsible for the two trips to a clinic or

hospital required to receive the test. This presents a barrier to accessing shelter and may also

result in a greater incidence of clients not accessing shelter and being involuntarily exited from

shelter because of an inability or reluctance to obtain a TB test.

The city and county of Denver should develop strategies to increase access to the tests to

smooth shelter entry and avoid involuntarily exits from shelter. Instead of requiring

households to transport themselves to health centers or local hospitals, the health department


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should be approached about a system whereby people can receive TB tests at day centers and

other sites that currently require those tests for entry.

17. Create shelter capacity for intoxicated youth.

There is currently not an appropriate place in the shelter system for intoxicated youth. It is

unclear what happens to youth who need shelter and are under the influence of drugs or

alcohol, although studies of youth in other cities indicate that there are many potential dangers

for this group.

First Place for Youth is located in Oakland, California and employs a low-barrier, harm reduction

program model. The program does not screen out or evict youth because of drug or alcohol use

or behavioral issues. It instead works to retain all youth in the program and help them improve

their capacity to live independently. First Place identifies the harms associated with the

behaviors and works with the youth to develop a plan to mitigate those risks. For example, if a

young adults substance use is preventing them from showing up at work, staff will work with

the youth to develop a plan to curb use so it doesnt affect their work life.

Denvers Road Home should work with Urban Peak or another provider to help design a locally

acceptable approach to serving youth who are under the influence of drugs or alcohol.

CONCLUSION

Homelessness is one ofour nations most difficult problems. People experiencing homelessness

in Denver, as in most other cities, must navigate a variety of shelter and service programs.

Sleeping conditions are poor, and services are generally unable to keep up with demand.

Homeless assistance providers cannot by themselves, meet all the needs of people

experiencing homelessness, nor can they repair the problems that lead to homelessness, such

as lack of incomes, a frayed safety net, and the lack of affordable housing.

Making progress in such an environment requires a balance between strategies that meet

immediate needs and those focused on long-term solutions. Evidence from communities that

have made progress reducing homelessness indicates that for a large share of the homeless


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population, rapid re-housing approaches are an effective strategy for reducing the duration and

trauma of homelessness. In our assessment, expanding rapid re-housing assistance in Denver

will have the largest impact on the citys homeless population. Additionally, several other

improvements, such as creating a centralized intake process and developing consistent

standards across the shelter system, can improve conditions.

Implementing these recommendations will require a shift in how homeless assistance in Denver

is managed. While there is a significant amount of coordination that is currently taking place,

Denvers Road Home will have to facilitate the creation of clear and consistent policies that

utilize best practices. The data infrastructure will need to be enhanced to support a more

robust performance measurement system that will enable resource and policy decisions to be

based on performance across the entire system.


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APPENDIX

Appendix A: Additional Resources

Closing the Front Door: Creating a Successful Diversion Program for Homeless Families

National Alliance to End Homelessness

August 16, 2011

City of Philadelphia Emergency Housing Standards(PDF)

City of Philadelphia Office of Supportive Housing

Revised 2010

Coordinated Assessment Toolkit

National Alliance to End Homelessness

March 22, 2012
http://www.endhomelessness.org/library/entry/closing-the-front-door-creating-a-successful-diversion-program-for-homelesshttp://www.endhomelessness.org/library/entry/closing-the-front-door-creating-a-successful-diversion-program-for-homelesshttp://www.phila.gov/osh/PDFs/EH_Standards_Revised_2010.pdfhttp://www.phila.gov/osh/PDFs/EH_Standards_Revised_2010.pdfhttp://www.endhomelessness.org/library/entry/coordinated-assessment-toolkithttp://www.endhomelessness.org/library/entry/coordinated-assessment-toolkithttp://www.endhomelessness.org/library/entry/coordinated-assessment-toolkithttp://www.phila.gov/osh/PDFs/EH_Standards_Revised_2010.pdfhttp://www.endhomelessness.org/library/entry/closing-the-front-door-creating-a-successful-diversion-program-for-homeless


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Appendix B: Community Shelter Board (Columbus, Ohio) Performance Measures for

Emergency Shelter Programs

Emergency Shelter Tier I

Ends Measurement Annual Metrics

Efficient number of

households served

Households served (#) Set based on prior year(s)

attainment, fair share of system

demand, facility capacity, and funds

available to program.

Access to resources to

address immediate

housing need

Successful outcomes (%) Obtain housing at standard belowor

greater if prior year(s) achievement

was greater:

At least 25% for adult shelters At least 70% for family shelter At least 15% for inebriate shelter.

Successful outcomes (#) Calculated based on the successful

outcomes % measurement.

Successful housing

outcomes (%) (YWCA

Family Centeronly)

Set based on prior year(s)

attainment. Excludes exits to Tier II

shelters.

Successful housing

outcomes (#) (YWCA

Family Centeronly)

Calculated based on the successful

housing outcomes %

measurement.

Usage of CSB Direct ClientAssistance (%)

% ofhouseholds that receive CSBDCA will be consistent with prior

performance and /or program

design.

Usage of CSB Direct Client

Assistance

(#) (YWCA Family Center only)

# ofhouseholds that receive CSB DCA

will be consistent with prior

performance and /or program

design.

Pass program certification Provide access to and coordination

with community resources and

services toprevent homelessness.Successful diversion

outcome (%) (YWCA

Family Center only)

At least 39% will be diverted to

other community resources.

Basic needs met in

secure, decent

environment

Pass program certification Provide secure, decent shelter.


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Temporary, short-term stay Average length ofstay Not to exceed standard below or

average for prior year(s) ifless than

standard below:

30 days for adult shelters 20 days for family shelter 12 days for inebriate shelter.

Average FHC transition

time (YWCA Family Center

Only)

Not to exceed standard based on

the FHC policies and procedures (less

or equal to 7 days)

Not re-enter the

emergency shelter

system

Recidivism


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Appendix C: Whatcom Housing Group Inter-Agency Data Sharing Memorandum of Agreement

The Whatcom Housing Group agrees to share client data among participating agencies via the

HMIS (Homeless Management Information System) for the purpose outlined below. Each

participating agency must complete and comply with the Agency Partner Agreement. Each

individual HMIS user must complete and comply with the User Code of Ethics, Policy, and

Responsibility Statements. Both documents are available on the WA State Department of

Commerce website http://www.commerce.wa.gov/site/936/default.aspx.

Uses of HMIS Data:

Coordinate housing services for families and individuals experiencing homelessness orfacing a housing crisis in Whatcom County,

Understand the extent and the nature of homelessness in Whatcom County, Evaluate performance and progress toward community benchmarks, Improve the programs and services available to Whatcom County residents experiencing

homelessness or a housing crisis,

Improve access to services for all Whatcom County homeless and at-risk populations, Reduce inefficiencies and duplication of services within our community, Ensure that services are targeted to those most in need, including hard to serve

populations,

Ensure that clients receive the amount and type of services that best fits their needsand preferences,

Pursue additional resources for ending homelessness, and Advocate for policies and legislation that will support efforts to end homelessness in

Whatcom County.

Client Protections:

Informed consent must be given by clients in order for their identifying information tobe entered into HMIS and shared among agencies in the Whatcom Housing Group (see

Whatcom Housing Group Participating Agencies). Non-identifying client information

may be entered in the system for all clients regardless of whether they give their

informed consent and regardless of their domestic violence status.

Only non-identifying information will be entered for clients currently fleeing or indanger from a domestic violence, dating violence, sexual assault or stalking situation.


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Identifying client information will only be shared among agencies that have signed thisagreement. At the time of informed consent, and at any point after, the client has the

right to see a current list of the Whatcom Housing Group participating agencies.

Additional agencies may join the Whatcom Housing Group with notification and consentof current data sharing agencies. As part of the informed consent process, clients must

be informed that additional agencies may join the Whatcom Housing Group at any time

and will have access to their information.

HMIS Users will maintain Whatcom HMIS data in such a way as to protect againstrevealing the identity of clients to unauthorized agencies, individuals, or entities.

Clients may not be denied services based on their choice to withhold their consent.Each party to this memorandum of agreement shall defend, indemnify, and hold all other

parties harmless from any and all claims arising out of that partys negligent performance of

this agreement. Any loss or liability to third parties resulting from negligent acts, errors, or

omissions of a Whatcom Housing Group HMIS user while acting within the scope of their

authority under this Agreement shall be borne by that user exclusively.

Agreed to and signed by the following agency representative:

Signature Name Agency Date


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Appendix D: Dayton-Montgomery County HMIS Client Notice and Consent for Release

Participation in data collection is a critical component of the communitys ability to provide the

most effective services and housing possible.

This client notice and consent form is for the Dayton-Montgomery County HomelessManagement Information System (HMIS) and describes how information about you may be

used and disclosed and how you can get access to this information. Please review it carefully.

I, ________________________ (insert clients name), understand and acknowledge that

__________________________ (Agency) is affiliated with the HMIS, and I consent to and

authorize the collection of information and preparation of records pertaining to the services

provided to me by the Agency. The information gathered and prepared by the Agency will be

included in a Homeless Management Information System (HMIS) database and shall be used

by the Agency and Montgomery County to:

(a) provide individual case management to me;

(b) promote collaborative case management;

(c) produce group reports regarding use of services by all clients;

(d) track individual program-level outcomes;

(e) identify unfilled service needs and plan for the provision of new services;

(f) allocate resources among agencies engaged in the provision of services.

______ (please initial) I understand and acknowledge the following collection of information:

(Initial the kind of information that can be included)

_______ Identifying information (name, birth date, gender, race, social security number,

residential information, education level, household information)

_______ Medical records (except HIV/AIDS and alcohol and drug treatment), psychological

records and evaluations, vocational assessments, care coordinators recommendations and

direct observations, employment status, etc.

_______ Financial information (income verification, public assistance payments and allowances,

food stamp allotments, disability payments, etc.).

_______ HIV/AIDS diagnosis

_______ Substance abuse diagnoses, treatment plan, progress in treatment, discharge, etc.


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______(please initial) I understand that I have the right to inspect, copy, and request all records

maintained by the Agency relating to the provision of services to me and to receive a paper

copy of this form.

______ (please initial) I understand that this release can be revoked by me at any time and that

the revocation must be signed and dated by me. I further understand that this consent issubject to revocation at any time except to the extent that the Agency has already taken action

in reliance on it. If not previously revoked, this consent terminates automatically 180 days after

my last treatment or discharge from Agency.

______ (please initial) I understand that my records are protected by federal, state, and local

regulations governing confidentiality of client records and cannot be disclosed without my

written consent unless otherwise provided for in the regulations.

Additionally, I understand that participation in data collection is optional, and I am able to

access shelter and housing services if I choose not to participate in data collection.

I agree that, by initialing the yes below, information in the HMIS may be shared with other

agencies. Attached is a description of the information shared and the partner agencies in the

HMIS. The agencies that participate in the sharing may change from time to time. However, a

copy of the list of agencies is available upon request at any given time. I understand that

sharing information between agencies can reduce the number of times I am asked the same

questions and can help other agencies do a better job assisting me and/or my family.

Yes: ________ No: _______

Date: _____________________________

Signature: _________________________

DESCRIPTION OF INFORMATION THAT IS SHARED

The Dayton-Montgomery County HMIS Client Release Form authorizes the following

information to be routinely shared using the Dayton-Montgomery County HMIS to better helpme and/or my family.

Evaluation/Assessment Information Related to:

Profile Information (Name, Social Security Number, Age)

Additional Profile Information, including:

Family/Household Information


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Income and Benefits Information Education and Employment History Housing History Veteran Information Program and Service Involvement

LIST OF COVERED HOMELESS ORGANIZATIONS

AIDS Resource Center Ohio PLACES

Daybreak Miami Valley Housing Opportunities

Goodwill Easter Seals Miami Valley Red Cross Dayton Chapter

Greater Dayton Premier Management Samaritan Homeless Clinic

Holt Street Miracle Center St. Vincent de Paul Social Services

Homefull VA Medical Center

Homeless Solutions (Montgomery County) Volunteers of AmericaLinda Vista YWCA Dayton

Mercy Manor

Line through and initial any agencies in the above list with whom you do not want to share

information.

In addition to the above list of agencies, I agree that, by initialing below, information in the

HMIS can also be shared with the following agencies:

Initial Agency Name


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Appendix E: Data on the Impact of Rapid Re-Housing

The Alliance has collected data from numerous communities about the outcomes and efficiency

of emergency shelter, transitional housing, and rapid re-housing strategies. Data from 14

communities was compiled by Focus Strategies and is presented in the charts below. They show

that rapid re-housing strategies tend to be more cost effective and have better outcomes thanshelter or transitional housing programs.


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Date post:	04-Apr-2018
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Denver Shelter Assessment_2012

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