Coordinated Access, Common Assessment and Rural Communities
I really enjoy working in smaller communities and towns as well as vast county areas. I appreciate the pace of life in most instances, the work ethic, and a work-life balance that sometimes seems lost when I am in larger urban centres. I also appreciate that homelessness can look and feel different in locations such as these.
One of the earliest adopters of the full SPDAT was a rural community in Michigan. It was intriguing to me, and I applaud the leadership of the organization for wanting to give it a try. She was dedicated to continuous improvement in her organization as a whole, and this seemed to be the next step in the evolution of performance excellence.
Up to that point in time, services were delivered solely based upon eligibility. The implementation of a common assessment tool meant that prioritization based upon acuity also entered the mix. The result? An incredible transformation for the organization. They became focused on who needed service the most, not just who was eligible for service. It changed how staff did their jobs.
This was affirmed when another adopter of SPDAT with a lot of rural and even remote environments took on the tool. This was the Province of Newfoundland and Labrador. There are some urban areas in the province, but look at a map and population data and you see it is a HUGE area with smaller populations in most communities. Sure enough, the SPDAT changed the conversation and worked there as well.
In many smaller communities and rural counties there aren’t a lot of services. So coordination can look different. Sometimes there is more than one organization working with homeless people. Sometimes not. Sometimes coordination is with mainstream services more than other non-profits. The introduction of the tool changed those discussions too.
There were similarities to more urban and metropolitan environments too that were being discovered in rural environments. For example, some of the people that organizations thought would have higher acuity did not and some people that the organizations thought would have lower acuity ended up with much more complex needs once the tool was put into place. Leaders of homeless services in the communities came to understand strengths of services and some gaps in services in a manner that was driven by data. And like larger urban settings, the tool resulted in much more informed case management supports and better housing stability.
Taking the lessons learned from this experience, I have found that coordinated access and common assessment has been powerful in many other rural communities as well. Some use the full SPDAT. Some use the VI-SPDAT. I am talking about places like Nebraska – outside of Lincoln and Omaha – and West Virginia and the areas of Arizona outside of Phoenix and other smaller communities in Michigan and smaller communities in North Dakota – and other places like that. Time and again, it has been successful and transformative.
But there is no doubt that implementing in some communities that are rural there is a resistance and opinion about the tool that is different than what is experienced in some other more urban environments. Here are some examples:
people think that coordination is not required because there are so few services anyway. But, clearly coordination can be improved on any scale when there is more than one entity (government, non-profit, faith groups, etc.) involved in the issues.
people think that asking questions about drugs, sex work, or other higher risk behaviour is offensive in rural areas because there can be a perception that such activity does not exist. The truth is, as the data shows from other rural environments, that it does, in fact, exist. Drug use and drug dealing, involvement in exploitative activities, etc. also exist in rural environments. It may, however, look different than how it manifests itself in other places.
people think that they should be able to serve everyone because they are a small agency in a smaller community. However, while they think they should be able to (and stressing the word should would be an ideal utopia in a community of any size) given the nature of how resources are allocated, smaller towns and rural environments often have a small amount of funding to work with. Prioritizing the use of these resources makes sense in smaller communities too.
people think that because some of the people they are assisting have been doubled up or sleeping in shifts or staying in a heated barn or garage that a tool that looks for acuity does not apply because the folks in their community are not sleeping on the streets or in a large shelter. But what they fail to appreciate is that the SPDAT considers ALL types of homelessness.
Rural environments have a lot to teach large urban centres. I find it encouraging to see innovation in data collection, services, funding decisions, training, and performance excellence that comes from smaller communities. But so long as the “we’re different…we’re unique…we’re rural” card is played, it pushes the knowledge transfer backwards, not forwards. Housing is the only known cure to homelessness whether that is a hamlet or a metropolis. Not assessing for and matching to resources based upon need is ludicrous whether that is a city of one million or a town of a thousand.