VI-SPDAT: 14 Things That Irk Me

Here are the 14 things that people do with the VI-SPDAT, say about the VI-SPDAT, or don’t know about the VI-SPDAT that irk me:

1. Confuse it with an assessment tool.

The VI-SPDAT is a triage tool. The SPDAT is an assessment tool. In almost all instances when a person says something to the effect of, “But the VI-SPDAT doesn’t give us enough detail about x, y or z.” I agree with them. Because the VI-SPDAT as a triage tool is not designed to give all the details about x, y or z. If you want to know more about x, y or z, learn how to administer the assessment tool because the level of detail you are yearning for is stuff that should be gleaned through an assessment.

2. Have an inconsistent introductory script. 

If you want reliability in using the VI-SPDAT, make sure that every person that administers the tool in your community introduces it and explains it in EXACTLY the same way. No variation.

3. Think that you cannot explore for more information.

 In Version 1 of the VI-SPDAT, this was the case – you could only ask the questions as written. In Version 2 of the VI-SPDAT we made it possible to further explore through observation, documentation and, with consent, what other professionals know about certain parts of the household’s history.

4. Use it too far up stream.

Diversion first at shelter entry. When that does not work, give people a chance to self resolve. Only when that does not work should a community dig into the VI-SPDAT. If you do the VI-SPDAT right away, you may inadvertently give up on people that may otherwise self resolve.

5. Use it judgmentally. 

The VI-SPDAT gives you a number. If a community starts referring to people as a number then the tool has failed. People are not a number. People are people.

6. Lack knowledge of the full suite of SPDAT tools.

There are full SPDAT instruments for youth, families and single adults. There are VI-SPDAT instruments for youth, families, single adults and people leaving incarceration. There is also a diversion and prevention VI-SPDAT. Use the wrong tool in the wrong situation and you will get the wrong results.

7. Think the score of the VI-SPDAT is the only piece of information that should be used when establishing community priorities for coordinated entry.

Let me be really clear on this – we do NOT suggest that any community prioritize households based upon the VI-SPDAT score alone. Only your community can establish the priorities for your community. That usually is some combination of VI-SPDAT along WITH things like chronic homelessness, where they are homeless (like the street), trimorbidity.

8. Fail to examine what the data tells them about their system or program performance.

Every now and then a community will say things like, “The VI-SPDAT does not work for Rapid Re-Housing. It keeps saying people should need RRH, then they lose their housing. They really needed Permanent Supportive Housing.”

Part of that may be true. But let us consider something else as well – that your RRH sucks. The issue may not be the tool. The issue may be that service providers in your community do not know how to do RRH properly. Or even PSH properly. That isn’t an issue with the tool.

9. Add multipliers.

You can establish community priorities based upon priorities like trying to house medically vulnerable people first. No problem. What you can’t do is take things like the Wellness section and decide to multiply that by 2 or 3. Filter your data. Do not multiply your data.

10. Do not understand how the questions were actually created.

Most of the questions within the tool were actually created by people experiencing homelessness. We would take the research to them in shelters, drop-ins, hygiene facilities, in the woods, etc. and we would say, “We need to ask a question about x, y or z. How would you ask yourself that question?” Then we tested it and refined it. Over and over and over and over again.

11. Say that the tool is not culturally appropriate, or make claims that it is not trauma-informed, or not appropriate for programs that serve people that have experienced domestic or intimate partner violence.

To make this claim ignores that we have spent hundreds of thousands of dollars getting experts in trauma, domestic violence and culturally appropriate services to vet the tool, make suggestions on improvements, and testing it with the targeted audiences.

12. Claim it does not work for (insert type of program or population group).

The more that we hear these sorts of things, the more that we investigate and find dead ends. So far the only group that MAY have some legitimacy is young head of household families. And even then, we don’t know for sure yet.

13.  Doing the VI-SPDAT over and over and over again.

Unless the household has been housed and become homeless again, or has had a major change in their life circumstances, you only need to do the VI-SPDAT once. Period. 

14. Think it is perfect.

The tool provides data. It does not make decisions, it informs decisions. The tool is not perfect. It will continue to evolve and improve. It is the best available tool based upon the best available evidence and testing. Continue to have an active voice in making it better.

Depression Sucks

It has been a few weeks since I have blogged. I have wanted to. I have not been able to. Not because I have been busy. Not because I did not have access to a computer. Not because I didn't have some ideas of what to blog about. I just couldn't.

Depression sucks.

My schedule is booked out months in advance. Communities and organizations expect me on certain dates to deliver on certain things...training, meetings, motivation, shadowing, a speech, strategy, coaching, etc. What is not booked out in advance is when depression will rear itself at a level that I am not expecting or prepared to deal with appropriately. Recently I have gone through one of the worst spells in a long time. I am working my way out of it. And I promise you there will be more blogs on more important subjects in the not so distant future.

But in the meantime, know that I am concentrating on my wellness. I am trying to take care of myself so that I can be present for others and deliver in the ways that people expect at home and on the road.

I am acknowledging my irritability and fatigue.  I am acknowledging and working through my difficulties in concentrating and remembering smaller details. I am working through my feelings of emptiness and worthlessness. I am dealing with my anxiety and loneliness. I am working on taking care of my overwhelming feelings of being tired all the time. 

I know I owe many of you emails or data or phone calls. I know that these keep adding up. And I know that when I don't respond people think it is because I am aloof, or preoccupied, or busy, or forgetful. To the outsider, I can only imagine what depression looks like when you are counting on someone who lives with it, but you don't know they are going through a spell. I feel horrible that I fail at taking care of things like communication at times like this. I want to so bad be able to manage that while working through the depression. But I can't. 

As I said, I am on the upswing again. Over the coming weeks I will catch up. Promise.

Insensitive & Desensitized

How do we get people to care about homelessness?

That question comes up a lot. Sometimes "people" means the general public. Other times it is elected officials. Sometimes it is the business community or the police. It also refers to homeless service providers in some instances.

I wish there was a magic answer. 

The truth is, homelessness - as we see it on the streets, queuing outside of homeless services, presented on the news and in media - has been with us for so long in its present form that the general result is being insensitive or even desensitized.

When the response is one of insensitivity, those that feel sensitive about homelessness feel enraged or sad. They ask - how could someone suggest that being without a home be criminalized? Or, why do some people just want those that are homeless to move along? Or, do they not see that we are talking about human beings with parents and even siblings or children?

Perceptions and actions based upon insensitivity are not solely expressions of those outside of homeless services. When there is mounting evidence of interventions that work better than others, it can be seen as insensitive when a homeless service provider or Continuum of Care or Service Manager makes or supports decisions that are not aligned to evidence. Those that have heightened sensitivities ponder how someone cannot follow the evidence and do what is right.

A parallel phenomenon is dealing with people that have become desensitized to homelessness and the realities of day to day life when homeless. People encounter homelessness every single day. Once upon a time they cared about it. They were shocked by it. They were bothered by it. They questioned how their society allowed it to happen. They wanted to see somebody do something to help those that were impacted by homelessness. A combination of emotions from pity and sympathy through to anger and frustration by it were common. 

But then, with each passing day, encountering homelessness became normalized. The feelings subsided. Rather than seeing homelessness as a tragedy or catastrophe or failing of policy or a reflection of society, they stopped seeing it at all. Or, they expected to see people in parks, on sidewalks, panhandling at off ramps; they expected to see tents and structures on their way to work. 

With both insensitivity and becoming desensitized, those that experience homelessness are seen as the "other". The language is quite telling. Phrases like "those people" and "the homeless" become commonplace. People that are homeless are not seen as equals. People that are homeless are seen as less than. And in that hierarchy of human worth, people are quick to blame people for their homelessness or see it through the lens of labels and stereotypes that are likely ill-informed...alcoholic, lazy, crazy, violent, ungrateful, dependent, scourge, troublemaker, criminal. The same feelings they label and attribute to the condition of homelessness become the same feelings that drive their NIMBYism lest housing and supports be suggested near where people live, work or recreate. Trying to penetrate these feelings with fact or an alternate way of seeing homelessness can be met with further entrenchment or statements of having given money through their place of worship or to the United Way or some other charity that is meant to prove that they have cared and that should not be held accountable to actions that still demonstrate an insensitivity or that they have actually become desensitized.

So, what to do?

Insensitivity and becoming desensitized to homelessness are emotional reactions to the condition of not having a home. Presenting facts and logic to those that respond and view things emotionally will have limited benefits unless you find a way to connect emotionally on the issue first. Gathering an emotional connection rarely happens well through an education campaign or slathering bus stops and billboards with poverty porn. Building emotional connection is an iterative process that takes time and considerable effort. It requires finding places and times to communicate about the issues of homelessness. It (at times painfully) means listening, acknowledging and appreciating that the insensitivity or the process by which they became desensitized came as a result of experiences or feelings of inaction. It could be argued that most people that find themselves engaged in insensitive acts towards those that are homeless or that have become desensitized to homelessness did not just one day wake up and decide to be that way. Something happened (or did not happen) that led them to feeling that way. Those that are sensitive to the issues need to create space and time to hear and acknowledge that, while legitimizing their feelings and correcting assumptions without anger or negative assumptions regarding their motivations. Resolving conflict means getting to maybe before getting to yes. Resolving conflict means finding common ground.

And finally, there is the question of what you would want people to do if they did become sensitive to the issues of homelessness again? Is your motivation that they will stop engaging in actions that work against what you are trying to achieve to end homelessness? Is your motivation that they will be more humane? Is it your motivation that they will give your organization more money or resources? Is your motivation that you will have champions for your next housing project rather than more naysayers? If you cannot name the benefits of having people that have become insensitive or desensitized turning their feelings around, it kind of begs the question of what difference it would make to expend all of that effort to connect and educate them. Name your purpose for engagement and chances are your engagement becomes driven by mission and values which can be lived in action.

Hawaii Progress: Views From an Outsider

Recently, Hawaii released data in their progress towards ending homelessness. Hawaii (the Big Island), Maui and Kauai all posted decreases. Oahu more or less stayed the same, but perhaps because of improved counting methods in their Point in Time Count. As an outsider, I want to focus a bit on what they were able to achieve on the Big Island. Having visited Hilo and Kona several times over the past couple years, I want to share some observations of what I think the difference makers have been to see a greater than 30% reduction there. And if you are unfamiliar with the Hawaii landscape by way of geography and policies, this reduction is truly extraordinary.

Leadership

The Hawaii Community Foundation has made it possible for several leaders from across all of the islands to enhance their leadership, making a multi-year investment in capacity building in that regard. On the Big Island, people from Hope Services went a step beyond this, also availing themselves to leadership training opportunities specifically within the homelessness sector (they came to the Leadership Academy and Master Class offered by OrgCode). The leadership of Hope, along with willing County and community partners, made the brave decision to take risks and do things differently in services rather than waiting for direction or permission from others. It has changed the culture of service delivery in the community, and has provided very clear messaging on the intention of homeless services to end homelessness through housing.

Professional Development

Do what you have always done and get as you have always gotten. To change direction, there has been the promotion and infusion of a learning culture. Throughout the entire organization there has been an unrelenting commitment to learn and implement new practices to yield the outcomes that would be necessary to end homelessness. 

Working the Problem

The transition of programs and services to focus on ending homelessness has not been without its challenges. Rather than reverting to old practices or giving up, there has been a desire to figure things out. The people at Hope Services especially seem to embrace that imperfect action trumps perfect planning. They are doers. And when issues have emerged they reach out to other people and resources to gain perspective and figure out a pathway forward, staying true to what they are trying to accomplish.

Lower Barrier Shelter

Gone are the days of many pages of shelter rules. Here are the days of less than ten expectations for a shelter stay. Gone are the days of barriers to shelter that would screen many people out. Here are the days where shelter has a strong housing focus and deliberately tries to engage people with higher needs. Gone are the days of loads of in-house programming. Here are the days when programming stays focused on getting people out of homelessness as fast as possible. Gone are the days of being focused on drug testing. Here are the days of focus on behaviour not exclusion for use.

More Targeted Outreach

Another shift has been from a "contact" based approach to street outreach to a housing-focused approach to street outreach. Across the island the focus is on assisting those with higher acuity in resolving their homelessness. The measure of their success is not how many people that see or connect with, and into measuring success by how much homelessness is resolved.

Reworking the Organization

Within Hope Services - the beacon of homeless and housing supports in my eye on the Big Island - the commitment to end homelessness meant they also had to change the way the organization worked. Policies and procedures changed. Rules for services changed to expectations. Job descriptions changed. Orientation and on-boarding for staff changed. The outward relationship of the organization changed.

Unapologetic and Unrelenting Housing Focus

The purpose of providing a homeless service is to end homelessness. This is lived in practice every single day. There has been a strong movement away from short-term charity to long-term results in ending homelessness through housing. Hope Services in particular is proof positive that you can meet immediate, basic needs while never losing sight of the importance of housing.

I am very proud of my friends and colleagues in Hawaii on turning the corner with homelessness, especially on the Big Island. I will see many of them this week and look forward to giving them the high five they deserve for their homelessness. I am also excited to see the early gains in Maui and Kauai translate into deeper gains over time. And I remain hopeful that Oahu can continue to steer the large homelessness and housing infrastructure there towards the success that is being realized on the neighbour islands.

If You Were Your Successor

What if you were the person that replaced you in your current job? 

What would you do differently? Is there something that is occupying your time that you would eliminate from your day to day? Is there something that you should be making a priority that you are not making a priority? Is there a relationship you need to build or fix that you are not attending to - or other relationships that you need to let go of? Is there a new idea or project that you really want to get off the ground but have not been able to operationalize? Is there something that is definitely not working in what you are doing now but you have not been attending to?

All of this begs the question - if you know things that need to change and you ARE in the job currently, why aren't you taking action NOW?

If you had a successor, I suspect you would want that to be a different (better?) version of you. But you don't have to wait for a successor to be different (or better). You have the power to steer a course towards change now, and take the action needed to get there. Perhaps if you take some time to reflect on what your successor should or would do, you can start to steer that course sooner, and take action faster.

3 Main Approaches to Coordinated Entry

As communities work toward establishing a high functioning coordinated entry system for housing, there appears to be some confusion and lack of knowledge on effective models to achieve this aim. Here is a high level overview of the three main approaches.

1. Descending Acuity

This is probably the most common one used. Your community has a list of every person and family that an assessment has been completed with across the community. Using HMIS or some other database, these people and families are ordered from the highest score to the lowest score. Rules have likely been established to deal with tie-breaking scenarios. At set times (weekly is common) a group of providers get together to discuss people on the list and who is next to be housed in a vacancy.

There are a few things that can negatively influence the effectiveness of this approach. One is that it introduces subjectivity into the process when people get together to case conference, which can quickly render the use of an assessment tool moot if the community is not careful. Another potential problem is the time lag of agreeing on a particular person or family and the time it takes to locate them and house them, which can result in vacancy loss. And a final potential problem worth noting is that a community can struggle with how to work through descending acuity while also accounting for other community priorities like addressing chronic homelessness, trying to ensure those that are the sickest are served first, or other potential priorities like addressing longer term stayers or outdoor homelessness.

2. Frequent Service Users

This can be a terrific approach for a community that has decided they would like to first address those individuals and families that use the most services first. Now, this has to be coupled with policy that outlines which services are in scope (just health services, or health and justice services, or health and justice and homeless services, etc.), as well as an understanding of how the frequent service use will be measured (linking databases versus self report is the most dominant debate). In most instances, addressing frequent service users has the greatest potential to demonstrate cost savings in ending homelessness through housing.

But frequent service use also has some potential problems that need to be addressed for it to be effective. For one, some of the most frequent service users by their very nature are currently in facilities that do not render them imminently house-able. For example, the most frequent user may currently be in hospital or in jail. That will beg the question of whether you hold a unit for them or if you go to the next most frequent user on the list. Another potential issue arises if there is a desire to get consent from people to link databases in order to identify frequent service users rather than using self report. This is not always as straight forward as it may seem.

3. Universal System Management

This is the best approach for addressing multiple priorities at once, making the housing process more efficient, and taking as much subjectivity out of the process as possible while leveraging HMIS. In this approach, a community establishes their priorities for different types of housing interventions. Who do we want to offer PSH to first? Who do we want to offer RRH to first? And so on. Then, the community collects an inventory of all of the eligibility requirements for each of those PSH and RRH programs. The community can then be clear, for example, that their top priority for offering a PSH unit is a person who meets the definition of chronic homelessness, who is tri-morbid, who has been homeless for three or more years, and who has a VI-SPDAT score of 13 or higher. This will then generate a list of just those people that meet that group for the top priority. Assuming all of the documentation is in order for each of those people, the list can provided to PSH providers that serve that group that have a vacancy, and they can pick anyone from that list. In this approach, the emergency side of the system (shelters, outreach, drop-ins) are responsible for getting people document ready and putting them on a list, and housing providers are responsible for taking people off the list. There can also be fail safes of assigning people if they are not picked within a certain period of time. And it can generate specific lists for every type of PSH, RRH, TH or any other type of housing intervention that exists in your community. Gone are the days of case conferences and trying to chase people down. 

This approach also comes with some problems that need to be resolved. It can be difficult for a community to establish and agree upon priority groups. It can be cumbersome to learn every single eligibility detail for every single housing program, in large part because many providers have unwritten rules. It can be difficult for well intentioned service providers to let go of advocating for specific people to the point where it actually circumvents why coordinated entry is so necessary. 

There is no right or wrong approach per se in choosing a model for coordinated entry. What is necessary, however, is that your community has thought through which model is going to be best for you based upon geography, available resources, priorities, and the assessment tool you are using. Each model has pros and cons that need to be thought through carefully. No matter which approach you go, you will need to write out policies and procedures to make it transparent. And, you should think about how you can most easily leverage your existing data in HMIS to achieve this as seamlessly as possible, rather than creating parallel data collection systems.

We are ready to help your community craft and implement any of these models if you need assistance. An investment in our services to help you create the infrastructure can lay the groundwork for a much more effective approach to ending homelessness going forward. And given we have implemented these models in dozens of communities, there is no point in you reinventing the wheel.