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An Open Letter to the WV Balance of State Continuum of Care on Prioritization

It’s come to my attention that despite continued training, technical assistance, and guidance on Coordinated Access, Prioritization, and Centralized Intake, we still have quite a bit of confusion as to the purpose and function of prioritization. Therefore, I want to take some time to clarify some things in a simple, straightforward way:

  1. Prioritization is for the purpose of Housing: The prioritization list that is generated from HMIS is for the purpose of your community to place persons in housing as quickly as possible, based on the individual or family’s acuity on the VI-SPDAT and their stated eligibility (stated by the funder). People should be moving into housing in less than 30 days. Preferably much, much quicker. If it’s taking any longer, then you are doing it wrong. If you’re having a prioritization meeting that involves client case management discussion, then stop. If you’ve housed everyone in the Permanent Supportive Housing and Rapid Re-Housing acuities AND are working on case management across agencies, then perhaps your community requires a separate meeting called a case conference. If not, and if you have not housed everyone on your list (no community in WV that I know about has), then your efforts are best spent on housing alone.

  2. Prioritization does not work when Housing First is not on the other end: Housing first, to reiterate, is the philosophy of providing housing with no predetermined expectations of behavior, income, or sobriety, beyond following the terms of a basic lease. Rules, edicts, the requirement of paperwork prior to housing, additional assessments, hoops, barriers, and requirements that keep people out of housing will ensure that your prioritization process will fail. Recently, I’ve heard things from agencies (funded by CoC funds, ESG funds, or both) to the effect of “we are unable to house that person who is next on the list due to the need for disability paperwork”. This is not the case. You have 45 days, per HUD regulations, to obtain disability verification. Rarely are there circumstances that preclude you from putting people into housing unless they are self-imposed in terms of willingness to personally do the work, or policies in your agency that preclude your ability to effectively put people into housing. If you are receiving any type of HUD or VA money you have already committed to housing first as a philosophy and therefore agency policies that create barriers to housing should have already been changed.

  3. Centralized Intake is Coordinated Access and Utilizes Prioritization to create Rapid Housing Placement: Centralized intake is a system by which clients use “one door” to access your housing and services systems, receive an assessment, be prioritized by acuity, and to be assigned to housing based on that acuity and availability of beds. If you have centralized intake and are using it for anything other than housing placement for persons experiencing homelessness, then you’re not really doing centralized intake, nor are you following the coordinated assessment policies of the Continuum of Care. Unless you have adequately housed all chronically homeless individuals and families, literally homeless individuals and families, and homeless youth, centralized intake (or any coordinated access apparatus) should not be used for precariously housed people, section 8 placement, or as a homelessness prevention tool other than diversion of low acuity people.

  4. The Point of Assessing for Acuity is to House by Acuity: We run into many situations, particularly when looking at acuity data, that point to an evident issue with agencies housing people with no attention to the VI-SPDAT acuity score. For instance, there are many instances of someone with a “3” or “4” on the VI-SPDAT being housed prior to someone with a “12” or “16” being housed. The point of assessing people via the VI-SPDAT is to ascertain the highest need persons among those we assess and provide them quick and effective housing. If communities aren’t housing by acuity, then you are not only ignoring the CoC’s Coordinated Access Policies and Procedures, but you are also creating an unacceptable environment where higher need people may never have the ability to access housing. This is the kind of move that at best, leads to long-term homelessness, and at worst, kills people. We must perform in such a manner and complete all due diligence to secure housing for the highest acuity, highest need people in our communities. Anything less is a misuse of the system we’ve collectively toiled to create.

  5. Having a list for the list’s sake is not enough: A couple providers have come to us with the refrain, “Hey, Agency A has bailed on our prioritization list, and that’s not cool. You should punish them”. Which seems alarming at first glance, but Agency A had already contacted us and said, “At Agency A, we are really more interested in housing people than case conferencing, and our prioritization committee is doing more talking than housing, so we’re going to prioritize our own clients and house them.” To which we reply, “Cool, good idea, Agency A”. Just having a community list and holding prioritization meetings in name doesn’t “count” as having a prioritization process. Prioritization is for housing. That’s the purpose. So, if your data is not showing movement from list to permanent housing, then we have a problem. And if the community is not willing to change that process, ask the CoC for help in refining that process (for the purpose of housing placement), then we as the CoC will move on with providers who are housing-focused. Sure, not as ideal as having an entire community process driven toward housing, but much better than people hanging out on a list, hanging out on the street, and then maybe dying.

The process of having a prioritization list is more than “checking a box to make the CoC or HUD happy”. My team has done the hard work of creating the list (Matt), refining the list (Matt, Rachael, and Amanda) and monitoring around compliance with a prioritization process (Rachael and Amanda) for the purpose of arming you, as communities, with a more effective and efficient ways of housing people quickly and with a mindfulness toward the best possible housing scenario. We’ve come a long way from the confusing, hunch-based “first come, first serve” days and we know that prioritization is working better in some communities than others.

It is, however, imperative that you, as communities in the WV Balance of State, aim for the following goals:

  1. To have a community-wide prioritization process bringing all resources to bear in your community (HUD, VA, Housing Authority, Outreach, etc.) for the purpose of housing people, if you don’t already have one.
  2. To refocus your prioritization efforts on housing people, if you do have a prioritization process.
  3. To be as “true” as possible to your community-wide process (i.e. don’t manipulate VI-SPDAT scores or take clients as an agency outside of the process).
  4. Stop discussing client issues at prioritization meetings, but aim for quick, purposeful meetings focused on housing.
  5. Remove your own agency barriers so you can house people more effectively.
  6. House people more effectively (and quicker).

Stick with these basic concepts, and I promise things will start looking awesome in your community. Stick to them not, and I promise that it will be reflected in the CoC funding profile of your community in the coming months and years.

And, as always, please use us. Ask questions. Voice your concerns. Be active in including us as part of your solutions. You may not always hear what you want to hear, but I promise you’ll hear what you need to hear. People are dying in our Continuum of Care, far too many. But, we can stop this together with fixity of purpose and a commitment to housing all of our high-acuity, high-need people first.

While our list is cool, it’s just a list. It doesn’t think, make decisions, advocate for people, or get a hole in its belly when someone dies in the woods. You do that. And only you can take the awesome tools we have and wield them with your experience, professionalism, and local knowledge to do good things. So, go do it. And know that we are with you every step of the way.

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