Prioritizing Who Gets Served Next Matters – The Service Prioritization Decision Assistance Tool (SPDAT)

When I led the largest Housing First program in North America, one of the things that bothered me was that we had no defensible way to prioritize who we served next. We dabbled with different instruments and had some stellar research thanks to folks like Toby Druce – but couldn’t quite put our finger on exactly how to prioritize who got served next and why. At least not in a defensible, reliable, consistent and valid way.

Sure, there are some awesome instruments out there like the Vulnerability Index used by Common Ground and now the 100k Homes Campaign (and we are big fans of both); the Camberwell Assessment of Needs; the Outcome Star; the Denver Acuity Scale. But none of these were a perfect fit for the type of Housing First program that I was leading or other Housing First programs that I was familiar with.

One of the first things I started working on when I made the move to OrgCode was to develop the right tool for determining who should get served by what type of housing intervention and why. Being the nerd that I am, I took an inventory of all existing tools that I could get my hands on – hoping that I had just missed something in my previous work. No point re-inventing the wheel. Truth is, not much with credible overlap other than the ones previously mentioned – and even then, too many limitations or shortcomings.

I found a small number of communities and individual practitioners willing to work with us in developing a proper assessment tool for Housing First. Dedicated professionals were found who would implement our drafts, provide detailed feedback, tell us about the associated client interactions and the like. The process was amazing. Repeatedly in the draft stage we heard over and over again how the SPDAT was making them look at their practice differently – from intake through to case planning through to discharge.

In the end, the final version of the SPDAT examines 15 main components for each client. Those 15 components provide a baseline at intake and are tracked throughout the case planning process. The 15 components are:

Self Care & Daily Living Skills

Meaningful Daily Activity

Social Relationships and Networks

Mental Health & Wellness

Physical Health & Wellness

Substance Use

Medication

Personal Administration & Money Management

Personal Responsibility & Motivation

Risk of Personal Harm/Harm to Others

Interaction with Emergency Services

Involvement in High Risk and/or Exploitive Situations

Legal

History of Housing & Homelessness

Managing Tenancy

By using the SPDAT throughout the case planning process, it helps case managers in focusing their attention on those areas where clients are in pre-contemplation or contemplation, and to some degree preparation. It also ensures an ongoing client-centred and strength-based approach to service delivery. Finally, for those clients that are visual learners or have limited literacy and numeracy, the SPDAT provided the opportunity to visually demonstrate their movement – and momentum – in various dimensions of their case plan.

Version 1 of the SPDAT was implemented with thousands of clients across North America. After a year, we asked all practitioners to provide input on how to make the tool better through a detailed survey. After analysis of their comments we tested Version 2 extensively and finally launched the Version 2 in March 2011. Whereas Version 1 was focused exclusively on Housing First, Version 2 now takes into account Rapid Re-housing and more general Housing Help services as well.

There have been several interesting findings relayed to us from people and entire communities using the SPDAT:

Practitioners have been able to make significant transitions from jumping from one crisis to another to planned, logical service delivery through the SPDAT;

Many frontline workers resist the SPDAT for the first few weeks before they finally realize that it improves their job and interactions with clients;

Improved housing choices are put on the table for clients – from independent living through to permanent supportive housing;

Some of the people that previously staff may have thought were really high acuity turn out not to be – and the reverse is also true;

Local service managers and researchers really love how the SPDAT data allows them to meaningfully engage in advocacy, brokering and research and explore other areas for program improvements which are based upon evidence, not hunches or anecdotes;

Team Leaders indicate that they are better able to match the client to the staff person with the right skills to meet their needs; and,

Client outcomes (not just outputs) have significantly improved.

So far in addition to the thousands of clients and dozens of communities & organizations using the SPDAT we have had one Province seek permission to use it and integrate it with their data system, and two States that are in initial discussions with us to make it a standard in service delivery (tres cool!). The tool has also been shared at National Alliance to End Homelessness Conferences in the US and distributed to Service Managers throughout Canada.

The tool has been tested and used with a wide range of populations: youth; substance users; persons with serious and persistent mental illness; Aboriginal people; older adults & seniors; newcomers; families; childless couples; ex-offenders; and people leaving institutionalization. We are confident that given the huge implementation and reliability that the SPDAT represents considerable potential in helping to end homelessness.

The SPDAT is free. No gimmick. No bull. Free. It is our way of giving back. Any organization that chooses to use the SPDAT will get free updates in perpetuity. The only thing we ask is that practitioners are trained on how to successfully use the SPDAT the way it was intended. And even then, training is provided at a very reasonable cost to make the tool as accessible as possible, including webinars and in person workshops.

If you would like to talk more about the SPDAT, get a FREE copy of it or chat about how it can be implemented in your organization or community, please let me know idejong@orgcode.com or 416-698-9700 ext. 2