Screening and Assessment of Homeless and At Risk Families: The community feedback period for this idea began on 8/8/2018 and ended on 10/6/2018. *STATUS UPDATE*

What is the problem that needs to be addressed? Please describe how it is related to mental health.

Housing needs among families who become homeless or at-risk of homelessness are affected by social and economic factors but most housing programs are not typically well-linked to programs that address these underlying conditions. This can affect the stability of housing placements over time and thus impact their effectiveness and costs. If housing programs had richer data on these social and economic conditions affecting housing stability, it would be possible to provide services that are better-matched to the needs of families which represent 35% of the population who are homeless and newly housed. Providing access to services before the situation becomes irreversible allows for a less costly and tailored approach supporting families in a successful transition.

Why is this a concern for Orange County? What can Orange County and other counties learn from this project?

Adding richer, more extensive information about the housing stability histories of families would enable housing and services agencies to better target their resources and increase retention of families with risk factors in subsidized housing. This would include:

  • Summarizing the costs of services received and subsidies required to support housing retention.
  • Assessing the data bases used to track clients’ services in response to their needs and reviewing the analysis needed to determine the relationship between those services and longer-term housing stability.
  • Compiling the actual services that are intended to respond to these characteristics and those received by housing client families.
  • Compiling the current and potential use screening and assessment tools to determine clients’ characteristics that may affect housing stability.

What is currently being done to resolve this problem in our county and throughout the United States? If applicable: Is it working; why or why not?

The nature and intensity of efforts needed to engage clients in relationships with service providers, a critical component of service use, has only recently been explicitly addressed in housing research. Housing programs typically are not required to follow families long enough to establish whether they can maintain residential stability for several years and what, if any, services and subsidies help them do so.  “Despite housing stability being a key concept in housing and homelessness policy, research, and service provision, it remains poorly defined and conceptualized, and to date there are no standard measures.”[Frederick and Chwalek, 2014] Studies need to examine the fit between assessed risk factors and responsive services addressing those risks, such as employment and improved mental health for parents, and improved developmental outcomes, emotional stability, and health for children. Putting a roof over a family’s head does not ensure that the family will become self-sufficient or that parents and children will recover from the risk factors or events and trauma that led to homelessness Additional cost-effectiveness studies can examine where resources are going, what potential offsets can be achieved, and what specific outcomes and supportive services might help policy makers make more informed clinical, budgetary, and policy choices.

What is new or different about this project idea? Please describe how this differs from what is already being done (Question 6). Please list any research that was done on this topic.

The Project will track and report the services needed to keep clients engaged and remaining in stable housing for 24 to 48 months. Assessment of the families from intake to 48 months will develop knowledge of client characteristics—both risk and protective factors–,services utilized and outcomes achieved that go beyond short-term residential stability. Such outcomes will include but not limited to improved employment training and education, income enhancement, support system connections, developmental outcomes, emotional stability, and physical and mental health for children. The project will identify the underlying factors that led to homelessness or at-risk homelessness to determine how well services responded to those factors and how well protective factors were engaged to impact housing stability outcomes. A cost-analysis will be included that reviews the services, supports and subsidies that were utilized, and on possible cost offsets. This analysis will inform Orange County public and private agencies, as well as providers in other locales about on the most effective therapeutic services, supports and resources that reinforce positively impact long term housing stability.

While housing models have demonstrated great success in getting homeless family’s off the street, they don’t address the systemic issues that put them there. Short-term efforts to improve the symptoms of a societal problem often go awry without a coordinated and long-term approach—a systemic approach to change and a better understanding of the specific services needed to provide long term housing stability so that the families do not reneter the housing dilemma again (Senge, Hamilton, and Kania, 2014). The systems driving the causes of homelessness must be addressed through a measured and service array model, supported by policy and key community partners and stakeholders able to engage the source of the problem and be included in the data review for project changes and course corrections. Policies that do not incorporate a high-level understanding of these factors drive duplication, incoordination and waste vital resources.

What is the project idea? Please describe how this project will operate.

The focus of the project is to measure the long term success of a new Prevention and Diversion program rather than only those families that met the HUD definition of homeless. The homeless population is only considered homeless when they meet the HUD definition of homeless. If a family is at risk such as being close to eviction, staying with friends and family, at a motel, etc, they do not qualify for the services they need to remain housed because of the lack of funding for prevention.

The project will review current screening and assessments of Orange County families who are at risk of homelessness to determine how well these programs can link three sets of data: the characteristics of families who at-risk of homelessness, the services they need and receive, and the outcomes and duration of outcomes once stability housed. Such family assessments will foster ongoing relationships, building trust between a family and the housing service agency, and provide opportunities for families to access programs and resources as their circumstances and needs change.

The project will treat prevention not just as an option for short term shelter but instead investigating what services can divert the family from being homeless, prevent the family from future homelessness, and measure the success of which service accomplish the goals of long term outcomes of housing stability, family safety and

A project that takes some families who are about to become homeless, gives them services and assistance with their immediate problems, and successfully diverts them from becoming homeless while finding out what specific characteristics of the families and the services provided reached the outcome goals of the project.

Nationally, homelessness prevention programs don’t make expensive investments in their participants, and so in that sense, probably cannot eliminate severe mental health, substance use, or domestic violence. Providing services to these families and A financial investment in prevention and diversion with measured follow up on the success of services provided and 6- 12- 24 month follow up on current housing stability of families that were provided Prevention and Diversion services

Ideally, a P&D family information system collects three types of information linked to specific clients:

  1. Client characteristics (adult and child), both demographic, service needs and conditions
  2. Are clients screened effectively for risk factors that may affect their outcomes, such as mental illness, substance use disorders, unstable income or job history?
  3. Which clients are succeeding in achieving positive outcomes and which are not—are the risk factors and protective factors associated with outcome success identifiable?
  4. What other key factors are tracked over time to determine which clients stay in programs and which do not enroll or drop out?
  5. Services provided to specific clients
  6. Which services are associated with positive outcomes?
  7. Which services are used most frequently?
  8. What services from other external agencies are being received concurrently?
  9. Which services are used in combination or in sequence?
  10. Referrals made to other agencies should be tracked and monitored for success or unsuccessful linkage
  11. Short and long term outcomes achieved by specific clients
  12. How long do we need to track clients’ outcomes to determine that they have achieved stability? What is the needed duration of client monitoring, given changes over time in family stability?

If this data is tracked and evaluated, it becomes possible to answer the question of which clients, receiving which services, achieved desired outcomes or made progress in that direction.

Additional Information

P&D targeted efforts can lead to a significant reduction in the number of families sheltered in hotels and motels, and housing providers and use the data to build an evidence-based model for family housing stabilization.

The story of “what works” emerges from three sources. First, there exists a remarkable consistency in the national data on population characteristics and risk profiles of homeless families. Second is the ever growing convergence of research from such varied disciplines as economics, child Prevention and diversion assistance may include a combination of financial assistance, mediation, housing location, or other supports. When the intervention is aimed at helping families stay in their current housing, safety should be a primary consideration. USICH, 2014

The story of “what works” emerges from three sources. First, there exists a remarkable consistency in the national data on population characteristics and risk profiles of homeless families. Second is the ever growing convergence of research from such varied disciplines as economics, child development, and neuroscience identifying best practices to support vulnerable children and families. Third, anecdotal reports are increasingly being supported with qualitative and quantitative data capturing the voices of providers and families.

Homeless Services. Approximately 39 percent of people who are homeless have a mental disorder, and an estimated 50 percent of adults with serious mental illnesses who are homeless have a co-occurring substance abuse disorder (U.S. DHHS, 1999b; Lehman and Cordray, 1993; Ridgely & Dixon, 1993; Fisher and Breakey, 1991). Because individuals who are homeless are far less likely to use the traditional systems for receiving care (Burt et al., 1999), a broad range of community programs has emerged to address their substance abuse, mental health, housing and social support needs. SAMHSA, 2014

June 7, 2018


How is this idea different from the San Diego Prevention and Diversion model?

The San Diego Prevention and Diversion program is a program added to help at-risk individuals and families in the city of San Diego avoid becoming homeless and prevent long-term, repeated shelter stays. The program proposed here would not only provide those services but also collect data on the actual services that are intended to respond to characteristics of those received by housing and prevention and diversion (P&D) client families in addition to compiling the current and potential use screening and assessment tools to determine clients’ characteristics that may affect housing stability and be most effective for P&D families. Nationally, the measurement has been focused on the calculation of housing units, shelter beds and number of services accessed. This INN project would take this to the next level of a deeper analysis of the assessed risk factors and responsive services that are most effectively addressing those risks based on the characteristics of the risk factors (DV, employment, MH, SUD, single parents, persons with cognitive disabilities, etc).

How are the measuring tools different from other housing stability programs?

Currently, housing stability is calculated by housing programs as to whether or not they re-entered the same system, same agency, and same county within a short time period. This is not accurate data on housing stability. Defining housing stability with standardized measures is not occurring throughout the nation.
Standardized methodology that included OC HMIS/Clarity and numerous housing and shelter agencies’ internal databases/data systems does not focus on family outcomes insufficient depth to be able to improve those outcomes. Most evaluation of supportive housing programs does not focus on family outcomes, or on the effects of supportive services of the children and youth in such families. Single individuals tend to be the population most often emphasized, and when families are involved, outcome measures typically do not track improvements in family functioning. Projects linked formally to child welfare caseloads, such as the demonstration programs funded by the Administration on Children and Families which are just concluding, have not yet produced findings that address family-specific issues.

Sounds like the idea is proposing a tracking system as well as a prevention & diversion program. It is difficult to understand how the program will run, what the innovative component is and what are the learning objectives?

The INN proposal would include several P&D agencies, housing agencies and shelter agencies working together with funding for services and evaluation of all of these agencies, the services they provide, the standardized follow up of the clients after program completion or drop out., The innovative components are longer-term follow-up of housing stability, an emphasis on family outcomes, the duration of housing subsidies and their costs, and deeper analysis of the relationships among client characteristics, services received, and outcomes.

Innovations Team

Thank you for your idea submission. Upon review and discussion, it was discovered that a similar project is being done within San Diego’s Prevention and Diversion program and it is unclear what new learning this project could contribute to the field of mental health. The Innovation team is unable to continue exploring this idea under the MHSA Innovation component as currently proposed.

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