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HomeMy WebLinkAboutAPRIL 16, 2013 WORKSHOP MINUTES 1 11 CITY OF VIRGINIA BEACH "COMMUNITY FOR A LIFETIME" o�NiA�B� c CITY COUNCIL ;"mi�... '�' MAYOR WILLIAM D.SESSOMS,JR.,At-Large U 16. 4 > VICE MAYOR LOUIS R.JONES,Bayside-District 4 GLENN R.DAVIS,Rose Hall-District 3 sq WILLIAM R.DeSTEPH,At-Large *rwoes ROBERT M.DYER,Centerville-District 1 ouc "�t BARBARA M.HENLEY,Princess Anne-District 7 JOHN D.MOSS,At-Large AMELIA N.ROSS-HAMMOND,Kempsville-District 2 JOHN E.UHRIN,Beach-District 6 ROSEMARY WILSON,At-Large JAMES L. WOOD,Lynnhaven-District 5 CITY HALL BUILDING 2401 COURTHOUSE DRIVE CITY COUNCIL APPOINTEES VIRGINIA BEACH, VIRGINIA 23456-8005 PHONE:(757)385-4303 CITY MANAGER-JAMES K.SPORE FAX(757)385-5669 CITY ATTORNEY- MARK D.STILES CITY ASSESSOR-JERALD D.BANAGAN E-MAIL:ctycncl@vbgov.com CITY AUDITOR- LYNDON S.REMIAS CITY CLERK- RUTH HODGES FRASER,MMC CITY COUNCIL WORKSHOP AGENDA 16 APRIL 2013 I. CITY COUNCIL'S BRIEFING - Conference Room- 2:00 PM A. VIRGINIA BEACH HOUSING CRISIS RESPONSE SYSTEM STUDY Dr. Debra DiCroce, President and CEO— Hampton Roads Community Foundation II. CITY MANAGER'S BRIEFINGS A. UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL James Spore, City Manager Steve Herbert, Deputy City Manager Mark Stiles, City Attorney B. PENDING PLANNING ITEMS Jack Whitney, Director- Planning Department C. FY 2013-14 RESOURCE MANAGEMENT PLAN (Budget) 3:00 PM 1. Quality Physical Environment - Public Works and Capital Improvement Program(Roadways, Buildings, Storm Water and Coastal) - Public Utilities and Capital Improvement Program(Water Utility and Sewer Utility) 2. Cultural and Recreational Opportunities - Cultural Affairs - Museums and Capital Improvement Program - Parks and Recreation and Capital Improvement Program 3. Family and Youth Opportunities - Health - Human Services -1- 4't` 7 I.4,.: G4.q.NAT:N.# VIRGINIA BEACH CITY COUNCIL Virginia Beach, Virginia April 16 2013 Mayor William D. Sessoms, Jr., called to order the City Council's Briefing regarding VIRGINIA BEACH HOUSING CRISIS RESPONSE SYSTEM STUDY, in the City Council Conference Room, Tuesday, April 16, 2013, at 2:00 P.M. Council Members Present: Glenn R. Davis, William R. "Bill"DeSteph, Robert M. Dyer, Barbara M. Henley, Vice Mayor Louis R. Jones, John D. Moss, Amelia N. Ross- Hammond, Mayor William D. Sessoms, Jr., John E. Uhrin and James L. Wood Council Members Absent: Rosemary Wilson (husband ill) April 16, 2013 -2- CITY COUNCIL'S BRIEFING VIRGINIA BEACH HOUSING CRISIS RESPONSE SYSTEM STUDY 2:00 P.M. Mayor Sessoms welcomed Dr. Debra DiCroce, President and CEO — Hampton Roads Community Foundation. Dr. DiCroce expressed her appreciation to the City Council for their continued support. Dr. DiCroce provided the attached Report which is made a part of this record. The report offers useful guidance to the City with a number of insights and best practices and it is hopeful each will be considered. Dr. DiCroce advised the Hampton Roads Community Foundation reflects the merger of the Norfolk and Virginia Beach Foundations. The Foundation services approximately 150 non-profit groups and provides scholarships for 350 students. She is looking forward to continuing the partnership with the City. This collaborative venture stands as a model for community engagement and she hopes this is just the first of many more opportunities to work together. Mayor Sessoms thanked Dr. DiCroce and the Foundation for their hard work on this project. April 16, 2013 1 1 Housing Crisisr Response System A report prepared by OrgCode for the City of Virginia Beach and funded by the Hampton Roads Community Foundation April 16, 2013 "A , __-------7:"..- Hampton Roads -..-.....- Community Foundation - Inspiring Philanthropi.Changing LI\ci,, ORG CODE < - HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Contents Executive Summary 1 Acknowledgments 7 Authorship 8 Introduction 9 Homelessness in Virginia Beach 10 The HEARTH Act and Its Impact on Homeless Service Delivery 17 The Homeless Service Delivery System and What it Means for Virginia Beach 19 Community Strengths 21 Crisis Response System I Current Reality 2013 23 The Emphasis on Housing with Supports in Community 25 Strategic Priorities to Improve the Housing Crisis Response System 29 What These Strategic Priorities Mean for Service Delivery in Virginia Beach 31 Amendment to Shelter Access and Services 31 Solution-Focused Outreach and Day Services 31 Making the Most out of Prevention and Diversion Opportunities 32 Enhancing Access to Professional Resources and Professional Development 33 Setting Benchmarks to Monitor Improvements in the Crisis Response System 34 Conclusion 37 Appendices 38 Appendix A: Approach to Engagement 39 Appendix B: Glossary of Terms 41 Appendix C: Population Characteristics of Homeless Persons Surveyed 44 Appendix D: Extensive Service Use by Homeless Respondents 45 Appendix E: The Opportunities Presented by Having a Centralized Facility Like the Housing Resource Center 46 Appendix F: Using the "4 A's" to Create a Clear Service Delivery Pathway 49 Appendix G: Possible Service Pathway from Point of Access through to Success Service Intervention 51 Appendix H: Rapid Re-Housing Triage Tool 52 Appendix I: Detailed Actions for Strategic Priorities 53 Appendix J: Professional Development Agenda 59 Appendix K: Service Prioritization Decision Assistance Tool—SPDAT v3 62 Endnotes 63 Works Cited 65 PAGE I I HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Executive Summary Over the course of a year, almost 1,000 different people make use of homeless services in Virginia Beach'. At any single point in time, over 450 people experience homelessness'. One in five is chronically homeless'. In recent years, even with the downturn in the economy, the community has seen slight decreases in the homeless population,but more work remains to be done. Virginia Beach has a long-standing history of the faith-community, non-profit service providers, government, and funders working together to address homelessness. Improving the Housing Crisis Response System in Virginia Beach will require these groups to continue to work collaboratively, while also collectively embracing some different approaches to service delivery. Federal requirements are shifting because of compelling, applied research combined with demonstrated results in ending homelessness. This will cause a significant change in practices within local communities like Virginia Beach from those used in the past. The Homeless Emergency Assistance and Rapid Transition to Housing Act (frequently known as the HEARTHAc/) was signed by President Obama in 2009. Moving forward, communities need to demonstrate: • That they are functioning as a homeless delivery system, not as a collection of funded projects. There is an expectation of interconnectivity across homeless services. This expectation is to be realized through coordinated access and common assessment tools across service providers. • That funding is allocated competitively with a strong emphasis on funding those service providers with a proven record in working towards ending homelessness. Funding is not"business as usual"; nor is it intended to ensure those service providers that have always received funding continue to receive funding. Preference is to fund those service providers most likely to decrease the length of time that people experience homelessness, reduce recidivism (returns to homelessness), as well as meet a range of other prescribed performance indicators. • That they have embraced"performance excellence" not just for specific service providers, but for all service providers within the system of service delivery. Data are expected to inform real-time decision-making about the availability of spaces in programs, as well as to help inform strategic changes in the system. Because of HEARTH, some changes in Virginia Beach are required. Homeless service delivery has developed organically in the community over time. There are multiple ways in which an individual or family that is homeless may try to access services, and no comprehensive way of managing or monitoring this work. As a result, the organization of services may be best described as well intentioned, but fragmented and inefficient. PAGE 1 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Finally, the performance expectations that HEARTH places on communities exceed the current data analysis and program-monitoring infrastructure within Virginia Beach. One of the changes that HEARTH requires is increased personnel and expertise to capture, analyze and report out on homeless service delivery data. Not doing so may place almost $1.4 Million in funding for local homelessness programs at risk. It would be inaccurate to think all of the changes necessary in Virginia Beach are solely a result of the HEARTH Act. Improving the Housing Crisis Response System in the community also means embracing proven practices to service delivery that are not readily practiced throughout homeless services in the community.As outlined in detail in this report, there is a compelling volume of research that proves getting people into housing as the first step in a service intervention and then supporting them in that housing gets better long-term housing outcomes and costs much less than a "treatment first" or compliance- based approach to service delivery. The proven practices, supported by compelling academic literature, turns on end quite a bit of traditional thinking when it comes to homeless service delivery. What this means for Virginia Beach is: • As the first step in re-orienting the system, service delivery must be focused on people who are experiencing the most acute, complex needs.Their needs will be determined through evidence-informed assessment rather than a "first come, first served" approach or "gut instinct" feelings about who might be successful in any particular program. Across all of the services in Virginia Beach,there must be coordinated access and common assessment protocols to enable meaningful triage based on needs. • Shelters should be oriented toward short-term emergency use where people are supported to get out of shelters as quickly as possible, into housing. Currently, there is significant programming offered within shelters. The offer of programming to people experiencing homelessness has to change because it has the unintended consequence of keeping people homeless longer—research shows that having quick access to housing with supports produces better long-term outcomes and is less costly. • Neither sobriety nor active engagement with mental health services are compulsory conditions for people to gain access to housing with supports. Research supports that problematic substance use and mental health are likely to improve once in housing, and that people who are housed first will stay housed longer than those expected to get treatment or access mental health assistance as a pre-condition to being housed. • Street outreach and day services can focus increasingly on directly housing people rather than having homeless people work through a continuum of services first. People do not need to move from the street or day center to a shelter, from a shelter to transitional housing, and from transitional housing into permanent housing. People can move directly into permanent housing when provided the right supports relative to their needs. • Supplementing the current network of service delivery agents with additional professional development opportunities, as well as making more professionals available to assist with behavioral health and intensive case management. PAGE 12 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 • Carefully and respectfully considering the barriers that are in place that make it difficult for often very vulnerable and marginalized persons from accessing services because of the likes of behavior, substance use, criminal record, or propensity for violence. From the increased awareness of barriers, service delivery needs to focus more on reducing risks and providing emotional and physical safety to everyone instead of barring services to some people. Realizing the opportunities to improve the lives of people who are homeless, decrease costs associated with homelessness, leverage strengths of service providers, and provide a more efficient and effective Housing Crisis Response System,means working hard to implement actions across four strategic priorities. These strategic priorities and associated goals are: I. Build a Systems Approach to Ending Homelessness With Clear Leadership &Accountability Goal: Create a "systems of care" approach to ending homelessness with public and private systems working collaboratively,with clear leadership and accountability. II. Enhance the Crisis Response System Goal: Create an effective crisis response system that works to divert people from homelessness when appropriate, and rapidly returns people experiencing a housing crisis back into housing. III. Increase Access to Appropriate Housing Options Goal: Increase access to market and permanent supportive housing sufficient to rapidly re-house homeless individuals, families, and youth, as well as meet the housing and support needs of individuals and families with higher acuity. IV. Ensure That Needs of Special Populations Are Met Goal: Create a comprehensive array of services and housing for the needs of special populations,including the subpopulations of unaccompanied youth,veterans,rough-sleeping chronically homeless people, and families. Getting to the desired future state of a highly effective homeless service delivery system where these strategic priorities are met will come with appropriate professional development and training for those that labor in the homeless delivery sector. These professional development opportunities need to be made available to volunteers and paid staff within service organizations. Furthermore, additional professionals to assist frontline volunteers and workers in the field will be of great assistance in seeing results with the strategic priorities. Virginia Beach has considerable strengths that can be leveraged to make the changes necessary to improve the Housing Crisis Response System. The improvements recommended in this report do not constitute "throwing the baby out with the bath water". Instead, the process of making improvements to the Housing Crisis Response System builds upon decades of hard work and lessons learned, existing partnerships, a strong record of developing housing, and an understanding of the needs of subpopulations like youth, single parent, female-led families and veterans. PAGE I3 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 This report is not a list of "nice to haves" for the Virginia Beach homeless services continuum. Through thoughtful analysis,the report attempts to maximize existing resources by using them in new ways or redirecting their focus. There is no expectation that millions of dollars in new funds will suddenly appear to realize the improvements in the Housing Crisis Response System. The dominant approach to service delivery in Virginia Beach is not currently geared towards helping all homeless people gain quick access to housing. For example, over time,programs in shelters have been developed that provide sober-living arrangements, access to employment training and education and life-skills classes. This programming has created two unintended consequences: 1) vulnerable people who use alcohol or other drugs are left disconnected from shelter services and predominately live outdoors; and, 2) people who gain access to a shelter with this intensive amount of programming stay homeless for a longer period of time. No homeless and housing service delivery can change overnight. Attempts to do so would be far too disruptive to the homeless people that the services aim to assist and to the many organizations, staff and volunteers that provide the assistance.As a compendium to this document, there is an Implementation Plan which outlines the sequence of activities necessary to realize the changes outlined for the Housing Crisis Response System. Improvements to the Housing Crisis Response System come with considerable accountability. A series of metrics are outlined in this report that will help track the intended changes to the service delivery system. The metrics also provide a blueprint for what the community can expect to achieve related to the HEARTH Act performance indicators. Overall,by following the recommended improvements to the Housing Crisis Response System,Virginia Beach can expect to see: • Reductions in the number of homeless people sleeping outside • More chronically homeless people accessing housing with the supports they need to stay housed • A reduction in the number of unique individuals accessing shelter each year • More permanent supportive housing for those individuals and families that have more complex needs and require a higher level of support to stay housed • More homeless veterans accessing the resources • Fewer people becoming homeless and fewer people experiencing repeated episodes of homelessness in the future • Homeless and disconnected youth better connected to services that can resolve their housing crisis • Decreased length of time a household spends in a homeless shelter • More people diverted from shelter services back to friends and family in their natural support network Achieving these results requires shared accountability across the community. Achieving these results is not something a Continuum of Care, funder, City Government, faith-group or service provider can do on their own. The collective will of the community will be required to make the improvements to the Housing Crisis Response System a reality. PAGE I 4 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 In summary, there are nine (9) overriding recommendations that have resulted from the Housing Crisis Response System Study. These are outlined in the table below and cross-referenced to the requirements of the HEARTH Act as well as to best practices in other communities. Virginia Beach Housing Crisis Response System (CRSS) Summary of Recommendations Recommendation_ ! `,�a REARei i' +,5, , �"� mr "^ x+5 a1x4 dx,�' ;m(4Addlional wrr'Wn y �. :z.. ` �a�. 7� 1. Create a system of care, • Communities are required to See Endnote 7. with clear leadership and organize services and offer services accountability. as a system rather than a collection of programs. 2. Divert people from • Communities are expected to See Endnotes 27,28. homelessness when decrease first-time homelessness. appropriate and possible to do so. 3. Orient shelters to short-term • A reduction in length of time Cost benefit and service outcomes use that focus on getting homeless is expected. of housing orientation— people out of shelter and into Endnotes 17,22,23,24,25,26. housing. 4. Implement coordinated access • Coordinated access and common See Endnotes 14,15. and common assessment assessment is a requirement of the across the service delivery HEARTH Act. system,using evidence,and focusing on those with the most acute needs first. 5. Focus on housing access in • A reduction in length of time See Endnotes 17,22,23,24,25, all program areas,including homeless and reductions in returns 26. street outreach,rather than to homelessness,are both expected. a continuum approach.In addition,implement Housing First and Rapid Re-housing services 6. Enhance professional Without professional development development opportunities opportunities,service providers are and increase the number of unlikely to successfully implement professional resources available key HEARTH requirements like to help service providers. coordinated assessment,nor will the practice of Housing First and Rapid Re-Housing be as successful as the evidence suggests it can be. PAGE 15 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Best� �m� - x�' �aE an HEARTH Act Require-Vent Practice Reference/ - � � 7. Reduce barriers to service See Endnotes 17,21,22,23,24, access especially as it relates to 25,26. substance use,criminal record, propensity for violence,and/ or,behavior,as these are not proven,pre-determinants for success in housing. 8. Address the service Throughout the project the needs gaps experienced by of some sub-populations emerged subpopulations. as more acute than others in the current service delivery framework. These included veterans,youth, families,and chronically homeless persons living outside. See Endnotes 1,2,3,4 5. 9. Consider taking advantage of Many of the Works Cited in this the opportunity to develop CRSS report invokes the need for a a Housing Resource Center comprehensive"system"approach (HRC) as part of the"system" as a proven methodology to end approach to a complete homelessness in communities. housing solution that serves the needs of clients with the highest acuity through to See Endnotes 15,16,29. prevention:those individuals and families at risk of losing their housing or precariously housed. PAGE ( 6 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 ACKNOWLEDGMENTS This report was made possible because of the financial contribution of the Hampton Roads Community Foundation. The authors wish to thank City of Virginia Beach staff for providing access to data and information on homeless service delivery,both current and historic. The authors further wish to thank the non- profit service providers, faith-based groups,government officials, school employees, and others that provided input and perspectives related to this project. There were five meetings of the Guidance Committee during this project. The Guidance Committee is composed of the following people: • Andrew M. Friedman, Director of Housing and Neighborhood Preservation, City of Virginia Beach • Tim McCarthy, Chair BEACH Community Partnership • Katrina Miller-Stevens,Assistant Professor, ODU • Sarah Paige Fuller, Former Director, Norfolk Office to End Homelessness,Director, Community Services Board • Bill Reid, COO, United Way of SHR • Shernita Bethea,Housing/Human Services Administrator, Hampton Roads Planning District Commission • Terry Jenkins, Community Leader • Suzanne Puryear, President,The Planning Council • Leigh Davis, Director, Hampton Roads Community Foundation The authors also presented an overview of the study to the Steering Committee members: • Louis Jones,Vice Mayor, City of Virginia Beach • Dr. Deborah DiCroce, President& CEO, Hampton Roads Community Foundation • John Malbon, Board Member, Hampton Roads Community Foundation We appreciate the guidance and feedback provided by both the Guidance Committee and the Steering Committee. In a very special and heartfelt way, the authors also wish to express tremendous gratitude to the 81 people experiencing homelessness that were interviewed for this study. The voice of these individuals,unfiltered through others,is exceptionally valuable input into how best to improve the Housing Crisis Response System in Virginia Beach. PAGE 17 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 AUTHORSIIIP This report was authored by OrgCode Consulting, Inc. Research, analysis,writing,interviewing, fact- checking, editing and community engagement was undertaken by: • Iain De Jong, President& CEO • John Whitesell, COO & Founding Partner • Ali Ryder, Planning Associate Lead • Gwen Potter-King, Planning Associate • Kieran Williams, Planning Associate • Pawel Nurzynski,Planning Associate An outline of the approach to engagement with community members used by the authors in the preparation of this report is outlined in Appendix A: Approach to Engagement. PAGE, 18 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Introduction It is possible to end chronic homelessness and episodic homelessness in Virginia Beach. Doing so will require the active participation of the faith community,government, funders, and service providers. It will also require shared vision of a time when homelessness in Virginia Beach will be of a short duration, and occur infrequently. Getting to this state will require changes in: • Which services are delivered to homeless individuals and families in Virginia Beach; • How the services are organized; and, • Setting and striving towards service delivery targets. There has to be an approach to service delivery that is easy for individuals and families to get out of homelessness efficiently and effectively. Services must focus on getting people into housing and providing the supports necessary to keep people housed—including the most marginalized and vulnerable amongst the homeless population. Building upon the strengths within the community, there is the opportunity to better draw upon a wealth of proven practices from other jurisdictions and apply it within the Virginia Beach context. The wheel does not need to be re-invented. This report contains suggestions about how to better work with people with complex, co-occurring physical and mental health needs, many of whom also use alcohol and other drugs. Compelling evidence from academic literature and results in other jurisdictions strongly suggest that housing people with supports achieves better housing outcomes, and it is significantly cheaper. This evidence demonstrates how services can be coordinated in a more straight-forward manner by matching homeless households to the program that is most appropriate to help them get housed as quickly as possible and sustain their housing. Tough choices will need to be made to help the existing Virginia Beach service providers make the necessary changes. Some of what is recommended in the transformation of service delivery will, undoubtedly, collide with how homelessness has been addressed for decades in Virginia Beach. The new pathways forward will require openness,growth, and willingness to change coupled with extensive professional development and training. Envisioned is a system of service delivery that is also highly accountable. Benchmarks have been established to track progress in transforming the service delivery system. Meeting these benchmarks is the responsibility of everyone involved in homeless service delivery in Virginia Beach—from frontline service workers to policy makers and from funders to data administrators. To assist the reader who may not be familiar with terminology used in the delivery of homeless programs and services, see Appendix B: Glossary of Terms. PAGE9 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 HOMELESSNESS IN VIRGINIA BEACH How many people experience homelessness in Virginia Beach?What are the characteristics of the population?What are their service needs? These seemingly simple questions do not have simple, accurate answers. A Homeless Management Information System (HMIS) is a Housing and Urban Development requirement for all organizations that are in receipt of federal funding to deliver homeless programs. It is an electronic database that captures identifiable information amongst those seeking services and records the types of services that were provided. However,not every place or organization that homeless people engage with is federally funded to deliver homeless services and, therefore,use of the HMIS is optional. Nationally, there is considerable engagement between homeless people and services that is not captured into an HMIS. Examples of the types of places that homeless people encounter where there may not be HMIS include voluntary street outreach workers providing food or sleeping gear,police, or faith-based groups. Graph 1: Where I-Iomeless Persons Sleep t�IGam'� 'lent "a .,,�tt* ',v"'fi7, ..°" \\'c t clti sir ' fit a w Car d� '==earl,i �`�; � `� Beach �r a, s r Winter Shelter Squatun Park With(Arent ()tiler Another reason why it is difficult to answer these questions currently in Virginia Beach is because there is no comprehensive point of entry to receive homeless services. The current decentralized approach means there is no common method for capturing information on those individuals that are seeking service. As such,homeless persons and/or people at risk of homelessness,may not be represented in the HMIS. Some may access services only at locations that do not have an HMIS, such as churches. Others might remain disconnected from homeless services by living in locations not designed for human habitation (such as in the woods); some of these people intentionally reject all offers of service,including outreach and are not captured in the HMIS. Finally, there are some people who are homeless but bounce around between temporary accommodation options, such as a friend's couch or a motel room. Sometimes called"couch surfers" or"hidden homeless", these PAGE 10 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 people may never connect with the formal system of homeless service delivery. See Graph 1: Where Homeless Persons Sleep, for a sample of where over 80 homeless persons interviewed for this study, reported sleeping on a particular night. So what is known about homelessness in Virginia Beach, despite these limitations? Graph 2: Sheltered Status, 2007-2013 Sheltered Status, 2007-2013 ;u,, n , 20r� tut, Ili J / I 11111 • 1111 11111 2(1I121102u09 ?tiro 101 i 1012 21113 SIi -ird 4 i) 411G 394 4 333 349 349 l nslxltcrcd 46 -8 39 S2 94 91 6- The most recent Point in Time Homeless (PIT) Count'data, from 2013, show that on a given night there are 456 people experiencing homelessness in Virginia Beach. This is a 4% decrease since 2007. The vast majority of homeless persons (85%in 2013) are sheltered, although both the proportion and quantity of unsheltered persons is rising slightly. Individuals are more likely to be unsheltered— less than two thirds were found in shelters during the 2012 PIT, though all families were sheltered. Virginia Beach has a higher rate of family homelessness than average for Virginia, the United States, and neighbouring Continuum of Cares, as illustrated in Graph 3. In 2012, 45% of all homeless individuals were part of a family, comprising a total of 66 households. These data suggest that in Virginia Beach, family homelessness is a major concern. However,while this rate is currently still higher than average, this proportion has decreased significantly since 2007,when 63% of homeless persons were identified as being in families. PAGE ( i1 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Graph 3: Family Homelessness as a Proportion of All Homeless Persons Virginia Beach Virginia USA 3'45%es '�, ' " f'"T. The rate of homelessness in the City is 10 homeless people per 10,000 in the general population, which is on par with the rest of Virginia,but lower than Newport News, Hampton, and Virginia Peninsula and much lower than average for the USA (see Graph 4). This rate has been fairly constant since 2007. Graph 4: Rate of I Iotnelessness, 2007-2012 ,o O °- •.-4 5 rru •? OS' 2u1i9 ?t12(1 1111 21112 y 4mma Virginia Beach CoC Norfolk'Chesape ake,Suttolk,'Isle of Wright`Southampton Counties CoC Nu.,Npott News,IIaniptonPkn.nsula Cay(; Virginia PAGE 12 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Twelve percent (12%) of all homeless persons in Virginia Beach were considered chronically homeless,which is lower than the national rate of 16%. Of the chronically homeless persons in Virginia Beach, approximately 60% are sheltered. Virginia Beach also has a total of 65 veterans who are homeless. While there is not enough data to make longer-term comparisons regarding homeless veterans, the topic is emerging as a priority area, as is homeless youth.' The most recent Annual Homeless Assessment Report There are 663 year-round beds made (AHAR) data show that over the course of a 12-month period, up of 125 emergency shelter beds, 225 approximately 992 people in Virginia Beach used homeless transitional housing beds, and 283 assistance services (emergency shelter, transitional housing, permanent supportive housing beds. and permanent supportive housing (PSH)). People enter the homeless assistance programs from a variety of prior living arrangements. Most families (67 percent) in emergency shelter were staying with family or friends prior to accessing shelter. Most individuals accessing homeless assistance programs were more likely to come from places not meant for human habitation and institutional settings like psychiatric facilities or prison. The majority of individuals and families accessing homeless assistance programs were from Virginia Beach. Graph 5: Length of Stay of Individuals in Emergency Shelter 4;)", __ _ ___ i ®.y wee- 3t) .._. _ 9 1 week 1 month �a - 1 l._.. � -11.:J';':- —' J h-- mm1 month 3 months ,O. Vo 2 3 months -6 months ,„,,, 4, 6nionths 9months ,3": „,...., ,,__ , a i 9 months 12 months /I)118 20(19 '010 2011 2012 The data that are available on length of stay in emergency shelter and transitional housing show that large majorities of people in families and individuals stay in emergency shelter for fewer than 3 months (76 percent of people in families and 65 percent of individuals) and almost all stay for fewer than 6 months (93 percent of people in families and 95 percent of individuals). However, trends show that average length of stay in shelters is increasing, particularly among individuals (see Graph 5`). Since 2009, there have been decreasing proportions of persons staying less than one month, and substantial increases in persons staying in shelters for 3 to 6 months. As demonstrated in Graph 6,Virginia Beach has been making a concerted effort to increase the supply of Permanent Supportive Housing as an overall percentage of all beds available in the community. Decreased reliance on a plethora of shelter beds demonstrates a community commitment to move more towards a housing-focused solution. PAGE 113 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Graph 6: Housing Inventory by Unit Type, 2008-2012 IiansitionalII using Permanent Supportive 1ni rgency Shelter Beds 20HIh FIcft ing Invent(1v M.2012 I lousing Inventory To supplement the available information from the PIT Count and AHAR, this study included in- depth interviews with 81 persons currently experiencing homelessness —51 males, 29 females, and 1 participant that self-identified as transsexual. Self-identified reasons for not being housed tended to divide along gender lines.Although both males and females identified a lack of funds as being the number one reason for their homelessness,female respondents were far more vulnerable to the effects of losing a partner's income (either through death or relationship breakdown) than their male counterparts. Further, for the female population,the lack of funds was a more frequent cause for homelessness than either addiction or mental health issues. Men were more likely to identify addiction as a cause for not being housed, and only male respondents cited having a criminal record as a reason for not being housed. The single transsexual respondent indicated that finding a trans-supportive environment in Virginia Beach was a challenge. Graph ?: Health Concerns by Gender lon., Mental health Pht sica]health `ubsrince use .111 Female AIale Female respondents were more likely to first access the homelessness support system through institutional points of entry, such as social services and schools. Males were more likely to access the system through outreach. The distinction between genders may be attributable to where they are PAGE14 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 located. Males were much more likely to live outside than women,potentially making them more visible to outreach teams. Female respondents,who predominantly lived in motels or squats,were required to access services by physically going to the service outlet. A majority of all respondents reported mental health and substance use concerns,but these issues were more concentrated in men (See Graph 7). Males were also heavier system users. Across all five measures of emergency system use (1) interactions with police, 2) emergency rooms, 3) ambulance, 4) hospitalization, and 5) incarceration), nearly half of all interviewees could be described as extensive users of these resources. But, single males were more likely than others to be extensive system users and they had more interactions with police and the emergency medical system (See Graph 8). Amongst women, the trend divides somewhat along family status;women who are extensive users of the criminal justice system are all single,while females with families make up one-quarter to one-third of the female medical system users. For more detailed information about system usage by homeless persons surveyed, see Appendix D: Extensive Service Use by Homeless Respondents. The vast majority of extensive system users disclosed mental health or substance use concerns. Moreover, those respondents whose cumulative homelessness was between 3-10 years had the highest system use. Graph 8: Extensive System Use by Gender and Type of Use Incarcerated ;—dati s in last year 1 Iospiralized i dans in List 'car Maic 4+anihulanee in last tear < y �r ri"? ,`m I ernale All 4+ISR interacnon,List e. — t`' 4+interactions with police in last tr It iii' .IIS`i. 54l`',<., or It is clear from examining the characteristics of the population and their service use patterns, that people who were homeless longer tended to have considerably more interaction with all five points of the emergency service system—ambulance, emergency rooms, hospitals,police and periods of incarceration. Based on this population interview sample,people experiencing substance use issues and/or mental health issues were most likely to have the most interactions with these services. PAGE 115 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 The current design of service delivery in Virginia Beach does not intentionally target nor prioritize service access based upon length of homelessness or presenting issues. In fact,with only a few exceptions, homeless individuals with the highest needs cannot access services in Virginia Beach unless they first achieve sobriety. Creating a barrier to service access is contrary to the evidence about how best to serve this population. Interviewees were asked to respond to a question about what needs to improve in the housing and homelessness system. The single most common complaint was related to the barriers to service entry,including a lack of services for those who are currently using drugs or alcohol. Other respondents expressed frustration at the difficulty of finding housing with a criminal record. Interviewees also frequently expressed a need to centralize services and simplify the application process for accessing help. They cited the difficulty in understanding the system as well as the requirement to travel to multiple places. Finally, many individuals identified a lack of family housing and difficulty accessing family shelter as their primary concern. PAGE 1 16 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 THE HEARTH ACT AND ITS IMPACT ON HOMELESS SERVICE DELIVERY The Homeless Emergency Assistance and Rapid Transition to Housing Act (frequently known as the HEARTH Act) was signed by President Obama in 2009. The HEARTH Act amended and re- authorized the McKinney-Vento Homelessness Assistance Act with substantial changes'. Three important and substantial changes that impact Virginia Beach resulting from the HEARTH Act and its associated requirements are paraphrased as follows: 1. a requirement that the organization of services within a Continuum of Care function as a homeless service system,rather than as a collection of funded projects, such that there is coordinated access and common assessment used throughout the system; 2. increased competition for available funding,not an annual"re-funding" or"business as usual"; 3. strong emphasis on performance not just of individually funded homeless projects,but the system as a whole. Virginia Beach received $1.39M in funding this year as a result of HEARTH. With this funding comes a requirement for coordinated,community-based homeless assistance system.Virginia Beach must be able to demonstrate that there is coordination from the point an individual or family comes in contact with a homeless service provider,right through to the point that they no longer need assistance. Part of the increased competition for funding is a desire to see solution-focused approaches to addressing homelessness established in each community. HEARTH expects that systems-based responses focus on ending homelessness. People accessing homeless services should be re-engaged with housing as quickly as possible and supported in housing. For many communities like Virginia Beach,this means re-thinking how best to operate both shelters and transitional housing as part of their crisis response systems. The strong emphasis on performance of the system as a whole also greatly impacts Virginia Beach. A system relies on data collection and data sharing across the entire system to be able to make strategic decisions related to how services are performing as a whole. This requires a significantly enhanced level of data collection, data analysis,reporting and accountability—all of which exceed the current capacity for data within Virginia Beach. From the data, there are system-wide performance indicators that HEARTH expects of every community: (4) the length of time individuals and families experience homelessness; (5) the extent to which individuals and families who leave homelessness subsequently return to homelessness (recidivism); (6) the capacity of Virginia Beach systems and services to create a comprehensive and reasonably accurate picture of the homeless population and their needs; (7) the reduction in the overall number of individuals and families experiencing homelessness; (8) the growth of jobs and income for people experiencing homelessness; and, (9) the reduction in the number of people who experience homelessness for the first time. PAGE 0 17 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 The United States Interagency Council on Homelessness' has described HEARTH as a "game changer."'This is not an understatement on the impact that HEARTH has on Virginia Beach. Not only will meeting HEARTH requirements result in changes to homeless service operations,it will also require an improved data infrastructure and additional dedicated personnel to support the data requirements. The sum)! ofserviceprovider•s asked people to rank their knowledge of HEARTH from 1 (know none of the details) to 5 (know all of the details): -2.78 average,for organizations as a whole -2.88 average of f ontline staff hut most frequent response was 2 -.3.08 was the average of Executive Directors - Volunteers, by.far, had the lowest level of knowledge PAGE I 18 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 THE HOMELESS SERVICE DELIVERY SYSTEM AND WHAT IT MEANS FOR VIRGINIA BEACH Homelessness is a rare event in almost all communities in North America. Research done by Culhane, et al.," as well as Springer,Mars' and others such as Byrne'',have consistently demonstrated that most people who experience homelessness do so only once in their life, for a short period of time, and are not ever homeless again. One of the things a homeless service delivery system attempts to do is ensure that homelessness remains a short-term,infrequent event—if it occurs at all. Whenever homelessness can be prevented, especially through "natural supports" such as a friend or family member, there is one less homeless household to re-house. The experience of other jurisdictions with high-performing system-based approaches14 all demonstrate that the more similarity and commonality in how people are first engaged with the homeless service delivery system, the better. For those individuals and families where diversion from service Currently in Virginia Beach there delivery is impossible, a homeless service delivery system next is 110 comprehensive common determines the presenting needs of the individual or family entry process into the homeless and the priority order in which they should be served. A good service delivery system. analogy to this process is the role of a triage nurse in a hospital emergency department. This process can be thought of along three fundamental questions: (1) Why is the person/family here? (2) How serious is the situation being presented? (3) Compared to all others seeking service,where does this situation rank in priority sequence? From there, the person undertaking the triage assessment15 can connect the individual or family to the service best equipped to end their homelessness as quickly Via° inia Beach needs to add<x valid as possible. This is not a "blind referral"where the individual or common assessment tool that is based family is sent to another service provider and there is hope for upon evidence, directs individuals/ the best. This is a "warm transfer" process where the individual families to the service that ends their or family is introduced to the expert most equipped to address homelessness and prioritizes who is their issues and get them out of homelessness as quickly as served next and wt:ry. Those with thepossible. One of the best ways to achieve this type of access most acute neeflr must be served first' and common assessment is through a centralized facility where people can physically present themselves for service or call to inquire about service. The proposed Housing Resource Center (HRC)for Virginia Beach—or a centralized facility like it - may be of great assistance in this regard. Once an individual or family is assigned to a service provider, the intent is to get the person out of a state of homelessness as quickly as possible. The service delivery system must be aligned to getting people into housing and providing them support to remain in housing. This represents a dramatic change to how some service providers, especially many shelter providers operate, not just in Virginia Beach but across the nation. There is no need to operate therapeutic programs within a shelter that assist with substance use,job readiness,life skills because the delivery of this type of assistance is increasingly proven to be better provided to an individual in their home, as is discussed and proven in greater detail later in this report. PAGE I19 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 There is currently no clearly defined service delivery Following the " A's"tf pathway in the City of Virginia Beach. An organic Homeless Service Delivery Systems: approach to serving people's housing needs has a-. �t 6 clearly defined Access—there has to be��lear % e.ned adver-- developed among the service providers over time. As tsed places inhere individuals andfamilies call a result, there are multiple potential access points to a and/or physically go to get help. variety of resources throughout the community, such as shelters,places of worship, outreach services, and even r4G3� using a valid assessment tool, the needs of the household are understood—both the pres- police. Although immediate needs—food or clothing (We of an issue and the severity(acuity)of the or temporary shelter - at a drop-in may be satisfied, issue these disparate access points do not provide needed assistance in ending an individual or family's experience of Assign—based upon the it formation gathered in the assessment, the household is connected to the homelessness. Instead, several things happen: program best equipped to egad their homelessness • Information that is relayed to people seeking as quickly as possible service is not always consistent; Accountability—service providers must perform • Many clients are not captured in the HMIS, the fi,nctions that they advertise that they do. resulting in difficulty in tracking the extent to which Data is used to track the outputs and outcomes services are being requested and accessed, thereby of the process in order to make refinements as necessary. resulting in an incomplete understanding of all the gaps and strengths that may be present in services; The "4 Ad'are outlined in greater detail in Ppen • There is inconsistent understanding across all rl'x 1 t shag the "f A� to Create a Clear Service Delivery Pathway A potential service points of access about exactly what is available, pathway for Virginia Beach is outlined in Ap- when it will be available and how to access it; pendia:C:Possible Service Anima from Point • Service providers become reliant on a blind referral of Access through to Success Service Intervention. rather than assessing and directly addressing the presenting issue(s) of the individuals or families; • Information about the individual or family's circumstance has to be repeated and assessed many times in the process as people attempt entry to the "system" through different access points —assuming the individual or family was able to connect to the intended resources and services along the way; • There is an absence of standardization in case management service delivery expectations, and also an absence of standardization in the delivery of sheltering services; and, • It is impossible to map the current service delivery system from point of entry to point of exit. This may appear to the reader like a particularly harsh assessment,but Virginia Beach is not alone. The organic development of service delivery in many communities has resulted in systems that may best be described as fragmented and nearly impossible to navigate for people under stress of dealing with their homelessness. It is clear that service providers in the community believe that there is greater emphasis on managing homelessness within the community rather than orienting services towards ending homelessness, as illustrated in Graph 9. PAGE I 20 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 However, service providers also demonstrate willingness to re-orient the system towards ending homelessness in the following ways and focusing on the Community Strengths. Graph 9: Service Provider Perspectives on Orientation Towards Managing vs. Ending Homelessness (_omplerelt otienred tow irds 7' ; an tna,in hcnnclessncss , li 1 �, '1QtEr 1,1Cl;arll Lan Oil iS ,� - - 5(ttnl-�t'haC l,t'tented t(AY.irdi I 1 A minaTing homcici.snci,s Equal]1 win-king tovt:trds managing and anding lintndcssness iTii,i 4 5r mct..Ft it cticnred n iGards end ng hotnelc.mess I.ht communtty as t V ilf le is.., ,o, t I (:onip(crcic onentcd tow irds cndinrglitnniit. sness 0",, 3U 40r t 611 Su 10u',, COMMUNITY STRENGTHS There is the opportunity in Virginia Beach to build upon strengths within the community to re- orient the services towards a quicker resolution of homelessness with supports: Compassionate-focused partnerships exist and are flourishing. Government, non-profits, and faith-based groups have been working diligently together for many years to manage homelessness. A shared vision towards ending homelessness' rather than simply managing homelessness will make this partnership even more effective while being consistent with HEARTH Act expectations and best practices in other jurisdictions. Faith-based groups living out their values on a community-wide scale. In Virginia Beach, many diverse, faith-based practices have come together to share ideas and discuss how best to move forward, and they represent the largest base of volunteers. This commitment to service will be integral to moving forward. Outreach. It is clear from discussions with people currently experiencing homelessness, outreach has played a critical role in helping many stay alive. Outreach services should focus on housing solutions directly from living outside. Perseverance in creating more housing stock. Very rare is the community that will partner in a regional context to stack and leverage resources to create more single resident occupany (SRO) stock. This housing stock will be integral to focusing on ending homelessness. PAGE 1 21 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Dedication to find a location for a centralized physical hub. Finding a location for a centralized services hub is no easy task from a community-relations, cost effectiveness,land use, or resource allocation perspective. A centralized hub will be critical to improve access and assessment for service. Involvement and commitment of local government staff. Not only is local government at the table, they are facilitating discussions on service improvements,leveraging the knowledge and expertise of service providers, and working diligently to expand housing and service options. Interest of local Foundation in being part of the solution. The Hampton Roads Community Foundation (HRCF) is working in partnership with local government and service providers to make improvements in ending homelessness in the best way possible. Welcoming day center environment. Places like The Lighthouse provide a safe place for homeless persons to go during the day, and address basic needs such as clothing and laundry. This becomes an excellent engagement point to help street-involved persons access to permanent housing with supports. Access to wholesome food. Food security is addressed in the community primarily through volunteers preparing wholesome foods. Going "above and beyond" to work with disconnected and homeless youth. Within the public schools, there is considerable effort made by social workers to identify the shelter,housing and support needs of families experiencing or at risk of homelessness. There are also other community programs reaching out directly to homeless youth. Desire to do what is best— strategically, not reactively. Virginia Beach is dedicated to moving forward in a way that will have the best possible results for persons that are experiencing homelessness. PAGE 0 22 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 CRISIS RESPONSE SYSTEM I CURRENT REALITY 2013 The current crisis response system (CRS) is not actually a "system"but,rather, a collection of service components that are incomplete and not fully integrated. These components have evolved over the years to address specific needs of people experiencing homelessness but they are far from a holistic approach of "wraparound" supports that have proven to help people attain and sustain their housing. The lack of integration and coordinated efforts that align behind community-wide articulated principles, strategies and goals have resulted in limited success in housing individuals and families in Virginia Beach. The current CRS is not capable of addressing the broad spectrum of housing needs as outlined in this report. The authors of this report have detailed the strengths of the current system and stand by the conclusion that there are many proven functions and capabilities of some of the service components that need to be retained and enhanced in preparation for inclusion in the future Crisis Response System. One of the key components of the current system—and the first major attempt at a centralized referral and intake process—is Connection Point. Connection Secondary Continuum of 4 Systems of Care Point Assistance Care Programs Connectivity Points Responsible for Centralized Access faith n maintaining I No consistent data information and groups for referral center assistance waitlist,program sharing access points High volume of Emergency g shelter not I Disparate intake calls,low r Pockets of funding available to forms assistance rate everyone Prevention funds Different Some PSH depleted — definitions of centralized but Irr HMIS is closed eligibility others detached Connection Point of Virginia Beach is a centralized information and referral center developed by the Department of Housing and Neighborhood Preservation to assist individuals and families that are homeless, at imminent risk of being homeless or are confronted with a housing crisis. When an agency, non-profit or faith group has contact with individuals or family members of a household who state that they have a "housing" issue and the agency, non-profit or faith group cannot adequately or directly assist, the household is referred to Connection Point. Connection Point receives a high volume of calls but only has capacity to provide a housing intervention for very few of the households. The data does not reveal the level of need because the calls are a duplicated aggregate of many callers who seek shelter and they typically make repeated calls in an attempt to access beds that become available in real time and,unfortunately for the callers,on an unpredictable basis. Many people calling for prevention assistance qualify for funds but they do not receive any because,at the PAGE23 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 time of the call,the funds have either been depleted or the funds have not been replenished.Diversion from assistance or shelter to other potential sources of help from family or networks is standard protocol when first interacting with callers but when funds are not available,diversion becomes a default strategy for everyone even if they don't have other options.This current reality regarding the functional effectiveness of Connection Point translates into another unfortunate fact of life that individuals or families must consider as they deal with their housing crisis.The outcome for many people is diversion to the streets of Virginia Beach or to a vehicle if one is available. The City does not know how many people become homeless as a direct result of the lack of assistance or provision of shelter because the system is not designed to capture this data in a reliable manner. Individuals and families who are homeless or on the verge of losing their housing do not give up seeking assistance when they are not helped through Connection Point. This typically results in many people accessing a variety of organizations from the faith community for help. The assistance provided by the faith community is generally focused on addressing basic human needs such as food and clothing. The faith community's ability to provide people with emergency shelter is limited in Virginia Beach and connecting people to options for permanent housing is non-existent and,in most cases,not a consideration in their service offering. Continuum of Care (CoC) programs maintain the practice of establishing waiting lists or other program access requirements and are not aligned with the Central Intake process as delineated through the HEARTH Act. An Emergency Shelter is not available to everyone who needs it and people are not rapidly placed in permanent housing once they have accessed a shelter. An abundance of Transitional Housing Programs allow people to remain in non-permanent housing situations for even longer periods and exacerbates the lack of movement out of shelter and the inability of the system to respond to true housing emergencies. Permanent Supportive Housing for single adults through the Single Resident Occupancy (SRO) housing model has moved closer to a centralized process but it is a regional initiative and has no direct attachment to the Virginia Beach process at this point in time. This connection needs to occur to be compliant with HEARTH requirements. Other permanent housing will also need to become part of a systems approach rather than detached, separate programs operating without direct relationship to the overall needs of the community. In fact, some agencies seek out people from other cities in the region to occupy their beds while many vulnerable people sleep on our streets.As stated earlier, these programs need to be aligned behind articulated principles, strategies and goals that will provide a singularity of purpose for their existence as part of the future Housing Crisis Response System. Finally, Human Services, Schools, Continuum of Care (CoC) agencies and the faith community do not share data across systems in a systematic and mutually beneficial way. Intake forms are not uniform but,in many cases, they collect exact data points across agencies. Even the CoC Homelessness Management Information System (HMIS) system remains closed across partner agencies. Data consistency and sharing are not difficult problems to remedy but just like the other "system" flaws detailed above, the solutions to any of the problems with the current system must be fully tested within the context of a clearly defined, future Housing Crisis Response System prior to the construction of the Housing Resource Center (HRC). PAGE 124 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 THE EMPHASIS ON HOUSING WITH SUPPORTS IN COMMUNITY Service providers in this field want to affect positive change in the lives of the people they serve. Over the past decade, an increasing body of academic research and service provider evidence from around the world has proven that outcomes of homeless individuals and families are more likely to improve if people move into housing as the first step of the assistance intervention and are provided supports in their home - rather than providing support services to assist people and then moving them into housing.'These outcomes include better longer-term housing stability outcomes, higher quality of life, fewer interactions with emergency services,improved mental and physical health and wellness, and reduction in use of alcohol and other drugs. To be clear, this isn't just the provision of housing,it is the provision of supports in people's natural settings (their own home) where they can continue to live after they no longer are receiving supports, that makes the difference. This approach to housing people is person-centered and non-judgmental. Based upon the acuity of presenting issues, either Housing First or Rapid Re-Housing,is the appropriate approach to supporting and housing people. Both of these terms (Housing First and Rapid Re-Housing) are frequently misused and misunderstood. Some people may erroneously think that this is a laissez-faire approach to service delivery. However, like other tenants, people in Housing First and Rapid Re- Housing must pay their rent on time and in full and must follow the terms and conditions of their lease. They also must not disrupt the reasonable enjoyment of the tenancy. Housing First is a specific type of service intervention, delivered through Intensive Case Management (ICM) or Assertive Community Treatment (ACT). Its critical elements include: • A focus on helping persons experiencing homelessness find permanent housing as quickly as possible. Transitional or interim housing is not a component of a Housing First approach. In fact, the delivery of transitional housing costs approximately 10 times more than direct access to housing with supports, and has no discernibly improved outcomes compared to direct housing access". • Services are provided to clients after they are housed, to promote housing stability and general wellbeing. These services vary greatly from client to client depending on individual needs, and may be time-limited or long-term. Not everyone needs the same type or level of supports. • A focus on seeking out those chronically homeless individuals and families with the highest level of needs. Housing First is not a"first come, first served" approach. • No "housing readiness" requirement. There is no expectation that clients demonstrate their readiness by being sober or seeking treatment prior to entering the program. • A harm reduction approach. Clients are not required to abstain from substance use;instead there is a focus on minimizing the risks and harmful effects associated with substance use. • The client's housing is not dependent on compliance with service—services and housing are PAGE 125 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 "de-linked". Instead, they sign a standard lease and are only expected to pay their rent on time while being provided services and supports that help them do so successfully. Clients may lose their housing,but this does not cause them to lose their supports. Instead, supports are already in place to assist the client in regaining housing as quickly as possible. • Clients have a choice in their housing, such as what part of the city they want to live in, whether they would like roommates,whether they would like to live in a congregate setting or a scattered-site setting, etc. • A client's participation in a Housing First program is completely voluntary. Rapid Re-Housing is a similar intervention to Housing First with a few key differences. First,Rapid Re-Housing is targeted towards individuals and families who have been episodically homeless for a long time and who have mid-range acuity. Typically, these clients have two or three life areas where providing supports would improve their housing stability. Second, Rapid Re-Housing is almost always time-limited. While clients move into housing that is permanent (i.e. they can live there as long as they continue to pay rent), supports are only provided for a finite amount of time,usually 3-6 months. Supports may be extended (usually in 3-month increments) a number of times,but if there are persistent barriers to housing stability that require long-term support, the client may be better served through a Housing First program. There are different levels of intensity that can be provided as part of a Rapid Re-Housing program's and these are outlined in detail in Appendix H: Rapid Re-Housing Triage Tool. Like Housing First, Rapid Re-Housing focuses on helping clients find housing as quickly as possible. There is no requirement that the client be clean or sober, or in a treatment program in either Rapid Re-Housing or Housing First. Across Virginia, there is in excess of 400,000 people that have an alcohol addiction or alcohol abuse problem,'"and only a fraction of these people will ever experience homelessness. Most people with drug or alcohol abuse will never experience homelessness. People can function with an addiction and remain housed with the right supports. Increasingly research on harm reduction demonstrates that addiction treatment is successful for some people and not for others2". Where abstinence is not a possibility,it is best to focus on reduced harm. A harm reduction approach allows people to be functional and maintain their housing. It is also much less costly than repeated failed attempts at treatment, and increased use of emergency services and correctional services while being homeless and excessively using alcohol or other drugs. There is compelling evidence indicating that people's use of substances goes down considerably once they are housed. In one study21, 49%reported a decrease in alcohol use once in housing,including 17%who said they had quit drinking, and 73% reported a decrease in drug use once in housing,including 31%who said they had quit using drugs. These approaches do not see accessing psychiatric care as a.precondition of being housed. According to the Substance Abuse and Mental Health Services Administration 2009 National Surveys on Drug Use and Health, 18.5% of people in Virginia aged 18 or older have a mental illness. Only a small fraction of these people will ever experience homelessness. The remainder will be PAGE 126 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 successfully housed and maintain their housing, and have a mental illness. People who are provided access to housing with supports without requirements to participate in psychiatric treatment as a condition of housing are also likely to report improvements in their overall mental health and wellness. One study'indicates that 57% of individuals reported that their mental health had improved since they moved into housing. Housing First and Rapid Re-Housing approaches are both promoted by HUD and they have been adopted as best practices in many jurisdictions throughout the US, Canada,Western Europe, and Australia. The National Affiance to End Homelessness, the United States Interagency Council on Homelessness, and the Corporation for Supportive Housing also embrace Housing First and Rapid Re-Housing as best practices. While credible endorsements abound,it is also acknowledged by these organizations that making a move towards these approaches can require a shift in thinking— sometimes a radical shift in thinking—as the scientific rationale for performing the work in this way can collide with people's personal perceptions and values. This is especially true as it relates to the use of alcohol and other drugs,involvement in psychiatric care, medication management, and the use of transitional housing. Academic and service level data from communities provides proof about the effectiveness of this combined approach compared to other approaches. It is also more cost effective23,with the most comprehensive,longitudinal, multi-city research demonstrating average annual savings to government of $9,390 per person because of reduced shelter, health care, and justice involvement'. Interactions with emergency services such as ambulances, and emergency departments and police decrease considerably once people are housed. Costs associated with longer-term shelter stays are avoided. Interaction with the criminal justice system decreases considerably. Stays within psychiatric facilities —which can be very expensive—overwhelmingly decrease. In addition to costs, the long-term outcomes of this type of approach to service delivery is also superior to other approaches. Three recent,independent studies have found that people will stay housed longer through this type of approach to service delivery compared to treatment protocols from the past. The studies found that over time,between 79% and 88% of Housing First participants maintained housing for two or more years. During the same periods, only 27% to 47% of individuals receiving"service as usual"maintained housing stability25 The vast majority of people in Virginia Beach currently experiencing homelessness who were interviewed as part of this study stated that they wanted housing. Only one individual out of the 81 people interviewed did not want housing because he was not sure if he would be staying in Virginia Beach. The desire to be housed that was expressed by the other 80 people was accompanied by considerable input about the type of housing that would serve them best. They wanted restrictions lifted and program models changed so that the programs would better support them in their housing, particularly amongst those that identified addiction as the primary reason why they were homeless. They wanted housing even though they may not have been ready to address their addiction. However, programs across Virginia Beach overwhelmingly require sobriety as a condition amongst service participants. Interviewees wanted their housing to be permanent and affordable, not transitional. Most said that they wanted case management supports with their housing. Many PAGE I 27 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 also wanted a place that would be small for easier maintenance. Increased effort to get people housed and support them in housing is also a strong desire of service providers in the community. Based on the survey of community service providers in Virginia Beach that was conducted for this study, there is overwhelming acknowledgement that not enough is being done within the service delivery mix to help people permanently end their homelessness. Resolving a housing crisis in Virginia Beach—with the understanding that the purpose of this study is to improve the Housing Crisis Response System—clearly means that it is critical to keep the provision of housing to the homeless front and center. PAGE ' 28 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Strategic Priorities to Improve the Housing Crisis Response System Establishing Strategic Priorities takes into account: • the strengths that exist within the community; • the gaps in service delivery; • the current design of service delivery relative to a preferred homeless service design; • the needs of homeless people; • the professed desires of service providers and other community leaders articulated through the survey, key informant interview,virtual town hall, and breakthrough thinking sessions; • requirements of the HEARTH Act, and, • proven practices from other jurisdictions and academic research that can be applied within the community to achieve even better program outcomes There are four strategic priorities: I. BUILD A SYSTEMS APPROACH TO ENDING HOMELESSNESS WITH CLEAR LEADERSHIP &ACCOUNTABILITY II. ENI IANCE THE CRISIS RESPONSE SYSTEM III. INCREASE ACCESS TO APPROPRIATE HOUSING OPTIONS IV. ENSURE THAT NEEDS OF SPECIAL POPULATIONS ARE MET The goals and key objectives related to each of the four strategic priorities are outlined below. The necessary actions to accomplish the objectives are provided in detail in Appendix I: Detailed Actions for Strategic Priorities. I. B1 11,1) ,v SYSTL'.y-IS APPRc)vCII '1'0 ENDING Ii0v1111 I.;SPNIP,SS WIJ II OMR LI'-vDI?RSIII) & ACCOLNTvBEATY " C,rc ate a -5'.stems o f care" approach to ending homelessness with public and pm tic s.stems working collaboratively,with clew leadership and accot.mttbilliv , • Strengthen the role and function of the Continuum of Care to be aligned with the , jer4':',"' requirements of the HEARTH Act; tr��a i,' , • Name a single individual as having direct responsibility for implementation of service improvements,having the autonomy and authority to direct changes as warranted in practice• ofunding; � ah tY r�E • Foster sustained and high-level coordination of all government agencies on the issue of hp '4a,s ending homelessness across the City of Virginia Beach,and across the state;and, til.-t • Ensure duplication and inefficiency are removed from the homeless assistance system. PAGE I 29 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 II. I \IIAN(;F 'FITE CRISIS RESPONSE SYSTI,:Nt Create an effective crisis response system that work:, to divert people from homelessness st a ^ eir ,,,'i When aIropr13te,and ra hv returns people experiencing i housing C151s back into housing - • Create a coordinated entry system with a valid and reliable assessment tool for homeless assistance services intake that appropriately targets housing and services that is central tot u , • Increase diversion resources to reduce the number of new households experiencing ' homelessness, fla.. z 1 • Reposition shelters to provide short-term accommodation,with reduced barriers to access, '. ' '.r n^ ^_ that will assist people in getting access to housing as quickly as possible,and • Focus outreach activities on helping people end their homelessness as quickly as possible. III. INC' v.I: i\c:CI..S ro.\PPRoPRI1v v ouSING OPTIONS � � Increase tccc;;s to market and permanent supportive housing sufficient to rapt Ii. re.house I. ...:: homeless Individuals, famines,and Loath,as well as meet the housing and support needs of A�' ,'I ��ti�u1 individuals and families with hi her:.acuity. f:t t • Support and invest in Housing First and Rapid Re-Housing models that serve homeless tives individuals and families, t���,, • Progressively engage individuals and families experiencing homelessness related to ; ..y assessed needs and present housing options accordingly, ry l 5t, i , -- t f' dt • Increase toolkit of financial options to ensure program viability and access to housing, , including Emergency Solutions Grants (ESG),Temporary Assistance for Needy Families ::.' arm (TANF)and Tenant Based Rental Assistance(TBRA), t . • Revise referral criteria to available Permanent Supportive Housing and SRO housing options based upon acuity,not"first come,first served". • Increase scattered-site housing options in market rate units with supports provided in :a a community,at the individual or family's home;builds upon success of similar initiatives e-ta tt �� by Virginia Beach Community Development Corporation(VBCDC) and Community � I 1 Alternatives Management Group (CAMG),and t,' f �n�nF a,^ x .. ° • Provide opportunities when feasible to allow individuals in PSH to transition to ' Vii" , community based affordable housing when feasible. IV. I--:.,\ t Itt{ "I:I I VI NiI II- OF S1'I.t111,Ptrt>t 1,n1IONS AM'NIF,I' vpilito Create a comprehensive, serti lees and housing for the needs of special populations, 7r0i��' u�r r ; mehldi.ng the subpopulsaticm of unaccompanied youth,v e terans,chronically homeless I, people e.pecrallc those sleeping outdoors and places not fit for human llrlxtatiori,,and ' families. It should be rioted that veterans who hav e been dishonourabh.discharged do not ani" -tff t' currently quality for mane sc:ry-lees. Irw :. t r • Increase the capacity of the housing system so that there are adequate services and crisis x .-.1.. response system beds for all special populations,and • Ensure that across the system there are competent service models in effect that promote ``: services that are appropriately geared to each special needs population. PAGE 130 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 What These Strategic Priorities Mean for Service Delivery in Virginia Beach The time is right to improve service delivery that will result in significant declines in both chronic and episodic homelessness. The underpinning to the service re-orientation is access to housing with supports as expediently and appropriately as possible. The safety, dignity, stability and security of being housed are proven to be important ingredients for long-term success in addressing other life issues that,if not addressed, can contribute to recurring episodes of homelessness or chronic homelessness. AMENDMENT TO SHELTER ACCESS AND SERVICES A waiting list fir shelter access, as is Re-orienting shelter services is the first step necessary corsrnaon in l'irginia Beach, is telltale to addressing one of the primary public pressure points sign that shelters are not designed fOr in the community—the prevalence of people living short term, infrequent use. outdoors, especially in the oceanfront area. The current shelter delivery approach has the unintended consequence of promoting outdoor homelessness because it has a strong compliance, abstinence-based,program orientation. Persons who use substances have no choice but to remain outdoors. Shelters in Virginia Beach are not oriented to persons who just want a roof over his/her head for a night; existing shelters seek to enroll people in programs for long periods of time. Restrictions on shelter access should ' Shelters need to be centers of opportunity. The greatest opportunity be based upon demonstrated that shelters need to provide is access to housing with the negative behavior, not simply supports necessary to help people remain in the community.All the presence of substance use or a long-term programming must be removed from shelters. Any history of criminal offence. assistance such as employment,life skills, addiction treatment and similar programs should be provided in the community once people are housed. No programming should result in people remaining homeless until they "graduate". Shelters must function as originally intended—short term stays for people having a life event that is infrequent and rare but results in a temporary state of homelessness. If shelters continue to be program-focused environments that require sobriety, the outdoor homeless population will continue to grow over time. SOLUTION-FOCUSED OUTREACH AND DAY SERVICES At present, outreach services are a combination of professional and volunteer services. Along the professional vein, outreach has proven to be an effective, targeted,respectable approach to engagement. In contrast, dedicated volunteer services tend to focus on survival supports: providing tents,blankets, and food on a fairly regular basis. For many of the persons currently experiencing homelessness who were interviewed as part of this study, outreach was their entry point to understanding other local services. Current day services are very busy and demanding. The physical building size of The Lighthouse, for example,is too small for current demand,but does provide an opportunity to engage with homeless people. PAGE31 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 With an assessment tool and more staff,both outreach and day services present an opportunity for improved engagement with homeless people to help them access housing, especially those individuals and families not connected to other services like shelters. MAKING THE MOST OUT OF PREVENTION AND DIVERSION OPPORTUNITIES As Virginia Beach moves towards a comprehensive system-based approach to service delivery,the interconnectivity across programs becomes even more essential. Historically, service providers have indicated that they work well in partnership. Interconnectivity takes the notion of "partnership" to the next level. It is an understanding that what happens in one organization, such as a shelter, has a ripple effect on all other shelters. Interconnectivity works to get service providers, regardless of where they are in the community, "on the same page". One of the most important areas for interconnectivity is related to diversion. Diversion is a concept to service delivery that attempts to ensure that an individual or family seeking assistance has exhausted all of their"natural" supports such as friends or family prior to getting services in the system. For example, prior to giving out financial assistance at a utilities or rent bank, there should be assurance that an applicant family has tried to get other friends or other family members to help them out with the payment first. At a shelter, diversion suggests that there should be assurance that there are no friends or family members that any guest can stay with, nor financial means to address any guest's needs in temporary lodging, prior to admitting them to shelter. Diversion is important because any service delivery system has a finite amount of resources. It cannot possibly be all things to all people. It should serve only those that cannot be served through any other means. Furthermore,unlike the image of a charitable comfortable "safety net" that will catch people, perhaps a better image is to think of services delivered as a "safety trampoline" that attempts to propel people out of needing services as quickly as possible. Central to homelessness prevention programs is the idea that giving families at risk of homelessness access to emergency funds can prevent homelessness. However,researchers in Alameda County, California concluded that: "...there is little evidence that programs that provide limited, one- time assistance have a significant impact on rates of entry into homelessness."2° For many of the individuals and families seeking assistance, their income is so low that the requirement for assistance is unlikely to be a once in a lifetime event. They are more likely to benefit from a longer- term housing subsidy, or help transitioning to a more affordable unit than what they are currently occupying. For those individuals and families that have complex needs, one-time assistance is also unlikely to be helpful in the longer-term. These are households where assistance further upstream and longer-term case management is more likely to be helpful. It is also difficult in many communities to compare those individuals and families that received short-term financial assistance with those households that later became homeless. This is because financial assistance databases, outreach databases, shelter databases, and school homeless liaison staff are not interconnected, nor are they designed to "talk" to one another. Also,many forms of temporary assistance exist outside of government programs where reporting through HUD would be mandatory, such as through Places of Worship or independent fundraising by non-profits. It is PAGE 132 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 entirely possible that these households are accessing assistance from more than one location and/or entering homeless services at a later date. Emerging research is also causing many communities to rethink how they deliver prevention resources and to whom the prevention resources are made available and under which conditions. Prevention dollars are difficult to effectively target because proving cause and effect with the distribution of the resources is difficult. In New York City, a longitudinal study was conducted on prevention resources through the HomeBase program,which determined that prevention is most effective when it is targeted to those that most clearly resemble longer-term shelter stayers. Other attempts at prevention may not be money well spent.27 ENHANCING ACCESS TO PROFESSIONAL RESOURCES AND PROFESSIONAL DEVELOPMENT One of the hallmarks of the Virginia Beach approach to addressing homelessness has been the combination of volunteer-driven services working collaboratively with non-profit (paid) service providers, and other professionals including government departments, school social workers, and specialized practitioners such as health care workers. As previously noted, this type of arrangement is one of the community's strengths. The service providers survey that was conducted for this study collected information about training needs. The top training need identified was case management practices, including techniques such as motivational interviewing and best practices. These training needs are closely aligned to the movement of the improved I-Iousing Crisis Response System which will require case management expertise to help people achieve success in housing. The second most pressing training need identified was supporting people with mental health needs,which is also a nice fit to helping ensure success in Housing First and Rapid Re-Housing. Service providers themselves acknowledged in the survey that their staff/volunteers are not trained in current approaches that are proven to end homelessness. Service providers also felt that funders and policy makers should be better trained about the day-to-day reality of service delivery,increasing their knowledge of services and how people are served. To achieve the Housing Crisis Response System outlined in this document, the community will most likely benefit from enhanced case management resources, training in how to undertake assessment and determine acuity, and improved access to other professional resources such as medical professionals and mental health professionals. A professional development agenda for all others is outlined in Appendix J: Professional Development Agenda. PAGE ( 33 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 SETTING BENCHMARKS TO MONITOR IMPROVEMENTS IN THE CRISIS RESPONSE SYSTEM What gets measured gets done. The review of local services and data, along with an understanding of promising practices in other jurisdictions, has resulted in the benchmarks outlined below Progress related to these benchmarks will inform decision-makers, funders, service providers, homeless people, and the general public whether the improvements in the housing crisis response system are being met. , (16) chronically homeless • chronic homelessness is a solvable issue if there are targeted solutions, individuals each year will achieve and the absence of intentionally serving this community is likely to housing with supports,and result in more community conflict a minimum of 80%of these • it will help prioritize access to housing for persons with chronically individuals will maintain their homeless persons,with appropriate supports housing over the next five years, with the most vulnerable(highest • chronically homeless persons have been proven to be the most acuity)individuals prioritized for voracious consumers of services and have the highest cost utilization Housing First of services(homeless services as well as police,ambulance/EMS, police,corrections,etc.),and thereby housing and supporting each of these individuals has a potential cost-savings impact on the system as a whole Emergency shelter usage will be • moves shelters away from prolonging homelessness through extensive consistently less than 250 unique programming individuals each year,and lengths • reorients the shelter system towards diversion of stay will not exceed three months • increase in housing opportunities should alleviate some strain from the shelter system,especially for longer-term stays Permanent Supportive Housing • Permanent Supportive Housing(PSH)is a critical housing option to will increase to a minimum of be offered to persons with complex,co-occurring conditions that may 340 units through acquisition, want to live in an environment with more intensive supports new builds,transformation of • opportunity to transform some of the existing investments transitional housing units,and/or (transitional housing)into more suitable long-term housing choice portable rent supplements by the without increased capital outlay—and is in line with the main currents end of 2018 of thought and practice in transitional housing throughout the nation • portable rent supplements,attached to people instead of a unit, improves mobility for households throughout changes in their life circumstances during the five years • new builds of permanent supportive housing are a strong signal to the broader community of the commitment to providing housing solutions to individuals and families that have complex,co-occurring issues PAGE ( 34 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 'ir �-r a r ar _,�' w, t :g z " e � : �� Street outreach services will help • through targeted outreach it should be possible to more effectively 32 people per year access housing reach those individuals dwelling outdoors that are historically more and supports directly from the vulnerable than others—even though they may not meet the HUD street definition of chronically homeless,but still have higher acuity • outreach services become oriented toward ending homelessness,in addition to keeping people alive (18) homeless(unaccompanied) • progress is being made in the region to better understand youth and/or disconnected youth will homelessness and the needs of disconnected youth,but more work access housing and/or family can still be done reunification,as appropriate,per • emerging research on youth homelessness suggests serving both year homeless&disconnected youth can be advantageous or else the lifetime costs through human and justice service interaction can be staggering • brain and psycho-social development of youth requires an approach that is distinct from the service delivery strategies used with adults,and should include a definition of youth that extends to the age of 25 • family reunification can be appropriate when there are the resources to support the family unit as a whole in the process (25)homeless veterans each year • strong connections between VA services and other homeless programs will access VA benefits that they and services is critical,and increasing the connectivity between these are entitled to,with 80%of these two systems is an important piece of work that requires dedicated time individuals accessing housing with and planning supports • Armed Forces are an important part of the area economy Unsheltered homeless will decrease • targeted street outreach will be able to help some people move directly by a minimum of 50%within 5 into housing,while also assisting others in accessing shelter through years the coordinated efforts of a centralized facility • the increased flow-through in the shelter system as a result of housing focused initiatives should increase available occupancy across shelter beds and make shelters a more desirable location for some individuals resistant to perceptions of crowded environments • the visibility of homelessness is one of the barometers used by the general public to gauge a community's efforts in ending homelessness First time homelessness,as • strong emphasis on doing whatever can be done to prevent entry into determined by street outreach the homeless service delivery system and shelter data,will decrease by • the homeless service delivery system is only accessed as a resource a minimum of 30%over the five when all other options have been exhausted year period • improved intake and assessment tools will provide the homeless service providers more resources to help determine who they are best equipped to serve • PAGE 135 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 :Ben WhVat is ..,, R a 'sk Important rk Recidivism rates (repeated • homeless services cannot be a revolving door on an ongoing basis for episodes of homelessness)will be most people,while appreciating that some individuals and families no greater than 30%within any 12 may need multiple attempts at housing with supports before they are month period successful at sustaining their housing and integrating into community • it emphasizes an investment in supports to keep people housed rather than just getting people housed,and the assessment tool to be introduced to service providers can be critical at helping service providers determine which individuals and families need different levels of support • places emphasis on rebuilding natural community supports A minimum of 200 individuals • diversion and prevention become interwoven throughout the entire or families will be diverted from homeless service delivery system and anchored through coordinated/ homelessness directly through centralized intake into the system targeted diversion and prevention • diversion is critical to reaching several of the other benchmarks over the five years,with less than 20%of these individuals or families ever experiencing another episode of homelessness after the diversion and prevention efforts. These are individuals and families that would reasonably become homeless if not for the direct diversion and targeted efforts Fulfilling these benchmarks will need to be part of annual funding contracts with service providers where HUD or City funding is used. Philanthropic sources of funding, as well as other government funding sources should also support these benchmarks to the best of their ability, and leadership within the City of Virginia Beach will need to play a role in building an understanding of these benchmarks. Data must be used to report on the progress and public accountability to these benchmarks. To be clear, these benchmarks are commitments.While many of the causes of homelessness are outside of the control of Virginia Beach, the community can control the focus of investments and the objectives of the investments. The community must be committed to the investments —including investments in training and professional development—to help the service provider community upgrade their skills and systems to achieve these benchmarks. Service providers must embrace the direction and urgency of achieving these benchmarks over the next five-year period. Funders must hold service providers accountable to achieving these benchmarks in funding contracts and in monitoring. Annual renewals of funding must be directly related to progress in meeting these targets. Where a service provider is incapable in helping to achieve the benchmarks relevant to their area of service delivery for two or more consecutive years, the community must commit to investing in other service providers that have proven capability to achieve the benchmarks. PAGE 136 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Conclusion The Housing Crisis Response System Study is based upon a comprehensive and inclusive process that resulted in the examination of multiple perspectives across the community. It also considered perspectives across the Hampton Roads region while being informed by policy and funding realities at both the State and National levels. Perhaps the most enlightening information came from the 81 people most impacted by the current crisis response system, since they are the ones with lived experience and the end users or clients of the system. Their stories varied in the length of time that they were homeless and the circumstances that resulted in not having safe, affordable, accessible and adequate housing. However, the people with lived experience who were interviewed for this study were also living proof of the fact that the only solution for homelessness is housing. The design of the future crisis response system must embrace proven practices that are significantly different from the approaches found in the current service delivery system. Increased emphasis needs to be placed on helping households access housing much faster while providing supports to them once in housing based upon assessed needs. A coordinated access and common assessment approach to service delivery will be in the best interest of those seeking housing services. It will also position the community to meet the requirements of the HEARTH Act, so long as there are additional data resources for the community. The change that is required to make the move to an improved housing crisis response system will be expedited by focusing on the four strategic priorities outlined in this study and by developing a variety of housing options. The current crisis response system must be adjusted to take into consideration specific subpopulations. And, overall a systems approach must be used with clear leadership and accountability. These changes will position Virginia Beach to achieve the benchmarks for performance laid out in this report. The people, service agencies and faith-based organizations that are serving homeless individuals and families in Virginia Beach were impressive with respect to their commitment; the study details their current strengths. The design of the housing crisis response system will require many people and organizations in Virginia Beach to think differently about the work that they are doing, and they will need to determine how best to align their efforts with this renewed initiative to end homelessness in Virginia Beach. This will require more than personal or organizational change. It will require community-wide coordination, communication and the commitment to adopt evidence- based practices across the entire housing crisis response system. An effective,integrated and inter- dependent crisis response system can help house all of the people who are experiencing (or will experience) homelessness in Virginia Beach. PAGE 1 37 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 APPENDICES PAGE ( 38 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Appendix A: Approach to Engagement OrgCode Consulting, Inc. (OrgCode) was retained to consult with community stakeholders and facilitate the process of creating this report—the Housing Crisis Response System Study. The development of this document was inclusive of as many stakeholders and perspectives as possible during the three-month study period from December 2012 to March 2013. Weekly project updates were conducted with the co-chairs of the Guidance Committee. The community participation process included the following input opportunities: (1) Guidance Committee Meetings • There were five meetings of the Guidance Committee during the project. The Guidance Committee is composed of the following people: - Andrew M. Friedman, Director of Housing and Neighborhood Preservation, City of Virginia Beach - Tim McCarthy, Chair BEACH Community Partnership - Katrina Miller-Stevens,Assistant Professor, ODU - Sarah Paige Fuller, Former Director,Norfolk Office to End Homelessness, Director, Community Services Board - Bill Reid, COO,United Way of SHR - Shernita Bethea,Housing/Human Services Administrator,Hampton Roads Planning District Commission - Terry Jenkins, Community Leader - Suzanne Puryear, President,The Planning Council - Leigh Davis, Director, I-Iampton Roads Community Foundation (2) Steering Committee Meetings • OrgCode presented at a Steering Committee meeting that included the following people: - Louis Jones,Vice Mayor, City of Virginia Beach - Dr. Deborah DiCroce, President& CEO, Hampton Roads Community Foundation - John Malbon,Board Member, Hampton Roads Community Foundation (3) Community Meetings • OrgCode observed and participated in several existing community meetings. These included the likes of the BEACH Planning Committee, Family&Youth Opportunities Team,VBHARP and the Virginia Coalition to End Homelessness (Rapid Re-Housing Pilot). PAGE 139 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 (4) Breakthrough Thinking Sessions • Two "Breakthrough Thinking" sessions were conducted on March 4 and March 6, 2013. The goal of these sessions was to ask participants to collectively prioritize their ideas to develop an effective and efficient Housing Crisis Response System. • Sessions were attended by a total of 38 stakeholders,with public, private, and nonprofit sectors represented. Participants included City Council Members,Executive Directors from frontline service provider agencies, people with lived experience, frontline workers, concerned citizens, police officers and health professionals. • More than 150 ideas were categorized by the participants in the Breakthrough Thinking sessions and voted on to determine the priorities for the Housing Crisis Response System. (5) Key Informant Interviews • Key informant interviews were conducted with opinion-leaders and persons with influence on the housing and homelessness service system throughout the City and Region. The purpose of these meetings was to collect feedback from key stakeholders and to identify the key issues that impact homelessness in Virginia Beach, as well as opinions about the progress that is being made in the community to address homelessness. The meetings followed a semi-structured interview guide. • There were 46 key informant interviews conducted with leaders from public,private, and non-profit sectors. (6) Interviews with Single Persons and Families Experiencing Homelessness • Eighty-One (81) people currently experiencing homelessness were interviewed throughout Virginia Beach to gather their opinions and input about how to improve the crisis response system. This included families and individuals. • Interviews occurred at all times of day and in a diverse range of locations –in the woods at encampments, meal lines, on the beach,beside people's cars, at motels,beside dumpsters, outside a 7-11,in an IHOP, etc. –to maximize opportunities for input and decrease bias that can result from conducting interviews solely within homeless serving agencies. (7) Service Providers Survey • All service providers were invited to participate in an online survey. Invitation to participate was coordinated by the City of Virginia Beach. • Thirty-six (36) service providers responded to the survey from 43 invitations — 83.7% response. (8) Virtual Town Hall • 16 members of the general public provided input through the Virginia Beach Virtual Town hall software system PAGE 40 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Appendix B: Glossary of Terms Acceptable Housing—Housing that is not in need of major repairs, as reported by the residents. Adequate Housing—Housing that is acceptable (see Acceptable Housing), affordable (see Affordable Housing), and suitable (see Suitable Housing). Housing that is not adequate is Below Housing Standards. Affordable Housing—Housing that costs less than 30% of total before-tax household income for all monthly payments inclusive of rent and utilities. Annual Housing Assessment Report (AHAR) —Perhaps the most accurate and current data on homelessness in the United States is reported annually by the Department of Housing and Urban Development (HUD) in the Annual Homeless Assessment Report to Congress (AHAR). The AHAR report relies on data from two sources: single-night,point-in-time counts of both sheltered and unsheltered homeless populations reported on the Continuum of Care applications to HUD; and counts of the sheltered homeless population over a full year provided by a sample of communities based on data in their local Homeless Management Information Systems (HMIS). Core Housing Need—Households whose housing is below standards (see Housing Below Standards) and who would have to pay 30% or more of its total before-tax income to pay the median rent of alternative local accommodation that is Adequate Housing. Department of Housing and Urban Development (HUD) —The United States federal department responsible for programs concerned with housing needs, fair housing opportunities, and improving and developing U.S. communities. Homeless Emergency Assistance and Rapid Transition to Housing Act (HEARTH Act) —This 2009 act amends and reauthorizes the McKinney-Vento Homeless Assistance Act with substantial changes,including: • A consolidation of HUD's competitive grant programs; • The creation of a Rural Housing Stability Assistance Program; • A change in HUD's definition of homelessness and chronic homelessness; • A simplified match requirement; • An increase in prevention resources; and, • An increase in emphasis on performance. Homelessness —when an individual/family lacks a safe, fixed, regular and adequate place to sleep, or who regularly spends the night in an emergency shelter, similar institution, or a place not intended for human habitation. Homelessness can be further broken down into the following categories: Absolute Homelessness -When an individual/family is without a residence and sleeps in indoor, or outdoor public places not intended for habitation (e.g. streets, parks, abandoned buildings, stairwells, doorways, cars, or under bridges). PAGE 41 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Sheltered Homelessness —When an individual/family is without a residence and spends the night in an emergency shelter or similar institution,including having no fixed address and staying overnight in a hospital, jail or prison. At-risk of Homelessness —When an individual/family is spending 50% or more of its gross monthly income on housing, or when the condition of the housing either because of state of repair or number of occupants is inadequate for ongoing habitation. Chronic homelessness —When an individual/family experiences continuous homelessness for a period of one year or greater; or, four or more episodes of homelessness within a three-year period. Most often chronically homeless persons also have complex, co-occurring and frequently disabling conditions. Episodic homelessness—When an individual/family experiences homelessness for less than a year and no more than three instances of homelessness within a three-year period. Cyclical homelessness —When an individual/family moves in and out of various states of homelessness and housing such as moving from a motel to a low-cost rental to a point of incarceration to a shelter to a hospital stay, and so on. The cycle suggests that this is a pattern of housing status that indicates consistency in the movement between a homeless and housed state, even though the exact types of housing or homelessness may change. Invisible Homelessness (Hidden Homelessness) -When an individual/family does not access emergency shelters or sleep in visible public areas,usually because they are temporarily staying with friends or family. Homeless Family—A unit comprising one or more adults accompanying at least one minor, usually but not always a blood relative,who are Homeless. Homeless Management Information System -A software application designed to record and store client-level information on the characteristics and service needs of Homeless persons. An HMIS is typically a web-based software application that homeless assistance providers use to coordinate care, manage their operations, and better serve their clients. Homeless Youth—A youth who is between the ages of 16-24,without adult supervision, and is Homeless. Housing Below Standards—Housing that does not meet all three standards of affordability (see Affordable Housing), adequacy (see Adequate Housing), and suitability (see Suitable Housing). Housing that is not below standards is Acceptable Housing. Interim Housing—Temporary housing that is available immediately to households who are Homeless, available on a short-term basis while the household searches for a more permanent solution. See also Transitional Housing. PAGE 142 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Permanent Housing—Any housing arrangement where the tenant can continue to live at the same address indefinitely, as long as the tenant pays the rent on time, follows the lease, and doesn't disrupt the reasonable enjoyment of others. Point-In-Time Homeless Count (PIT) —Sometimes referred to as a Point-In-Time Count, PIT Count, or simply a PIT,it is a one-day, statistically reliable, unduplicated count of sheltered and unsheltered homeless individuals and families in a geographic region. Suitable Housing—Suitable housing has enough bedrooms for the size and make-up of resident households,which means one bedroom for each: • cohabiting adult couple; • unattached household member 18 years of age and over; • same-sex pair of children under age 18; • additional boy or girl in the family, unless there are two opposite sex children under 5 years of age,in which case they are expected to share a bedroom. A household of one individual can occupy a bachelor unit (i.e. a unit with no bedroom). Supportive Housing—Can be either Interim Housing or Permanent Supportive Housing. Transitional Housing—Similar to Interim Housing, but most often with a specified time limit for how long tenants can stay, and often with requirements of complying with additional rules such as sobriety and/or curfews. PAGE43 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Appendix C: Population Characteristics of Homeless Persons Surveyed To supplement the available information from the PIT Count and AHAR, this study included in- depth interviews with 81 persons currently experiencing homelessness—51 males, 29 females, and 1 participant that identified as transsexual. These interviews occurred in a wide range of settings and all times of day and night over a three- day period. This information is important because it is the voice directly from people experiencing homelessness on their current state, their needs, and what they think needs to change to improve the homeless service delivery system. The average age of respondents was 39 years old, although 51 percent of respondents were 35 years old or younger. Male respondents were more numerous in the older cohorts, accounting for 78 percent of the individuals over the age of 35. The survey population was overwhelmingly unemployed,with males making up most of the employed group. For a plurality of interviewees, homelessness is a relatively new experience,but escaping homelessness after two cumulative years appeared to be a challenge;more than half of respondents can be divided between those whose cumulative length of homelessness was less than one year, and those who have been homeless for more than three years but less than five. Cumulative years drop quickly after ten years,with only five percent indicating a cumulative period of 20 years or more. Table 1: Cumulative 1'en th of ':Lime homelessness %; are esu a7�€�m^ w Under 1 year 28 35% 1-2 years 5 6% 3-5 years 18 22% 6-10 years 14 17% 11-15 years 7 9% 16-20 years 5 6% 20+years 4 5% PAGE I 44 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Appendix D: Extensive Service Use by Homeless Respondents Table 2: Extensive System Use 1\m ng I I.otneless Respondents 4+interactions with police in last year 52° 4+ER interactions last year 46% 4+ ambulance in last year 46% Hospitalized 3+ days in last year 46% Incarcerated 3+ days in last year 46% Table 3: Extensive System Use, by Gender and Wellness or gystiiii e it z �sv�, II - I' + E 4+interactions with police in last year 42 71% 55% 93% 4+ER interactions last year 37 84% 68% 70% 4+ ambulance in last year 24 83% 67% 71% Hospitalized 3+ days in last year 39 87% 62% 64% Incarcerated 3+days in last year 22 77% 50° 100% 3a �X�,�i� ��t 9 J� &.. n k'�N�P�' ' f ;..... ¢ �: .,--.:=, .,-,,.,...:,_ Vis.° 'ii� >� �' v�s ���mi,w r: �Iwma�� , 4+interactions with police in last year 7 71% 29% 86% 4+ER interactions last year 11 55% 45% 27% 4+ ambulance in last year 8 63% 50% 38% Hospitalized 3+ days in last year 11 64% 45% 27% Incarcerated 3+days in last year 3 67°A 0% 100° qM hGr ' i..... � . .. ...... ,� `ir '. .. .'t_.., $ :., � _., a s m....p w ..,.. craw_ =- :i .. ° . 4+interactions with police in last year 34 74% 59% 94% 4+ ER interactions last year 26 96% 77% 88% 4+ambulance in last year 16 94% 75% 88% Hospitalized 3+ days in last year 28 96% 68% 79% Table 4: I',xtensive System Use, by I,eng;th of Time I lomele.ss z > r' �'......s wm.. ... m...»_., .s_ :' �iG"� 1-2 3-. v4-10 'ii '''-11 i1 a— 'a,� 4+interactions with police in last year 6 3 11 8 6 4 4 4+ER interactions last year 2 3 10 10 4 4 4 4+ ambulance in last year 1 3 7 6 3 1 3 Hospitalized 3+days in last year 3 3 11 10 4 4 4 Incarcerated 3+days in last year 0 3 7 4 3 3 2 PAGE 1 45 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Appendix E: The Opportunities Presented by Having a Centralized Facility Like the Housing Resource Center Form follows function. One of the great advantages of producing this report at this time is that the Housing Resource Center has not been built yet, nor has programming on this scale been designed and developed. Unlike other communities that are challenged to fit a service delivery model within an existing physical building,Virginia Beach has the distinct advantage of designing a building to meet the requirements of a service delivery model. There are 10 ways to make the Housing Resource Center—or a centralized facility like it—supportive of the strategic priorities and goals to improve the housing crisis response system: 1) Dedicated professional outreach Professional outreach for Virginia Beach should be coordinated through one location. This ensures that all outreach activities are focused on helping people end their homelessness as quickly as possible, and avoids duplication of services either through the geography of service delivery of the type of services being provided. 2) Coordinated access infrastructure The infrastructure to support coordinated access to service has to be housed somewhere in the community, and it makes the most sense to have this function performed at the hub of service delivery and service activity within the City. The coordinated access infrastructure should be able to perform the following functions: • provide place-based assessments such as people walking in or transported to the location who are interested in housing and other services such as shelter; • provide remote assistance over the phone (though not as a call center); and, • conduct mobile assessments where staff go to hospitals, shelters, jails, etc. The coordinated access infrastructure should be an extension of the reception infrastructure. 3) Emphasis on diversion when that is appropriate When there is a central hub of service coordination,it is possible to better practice consistent diversion. Diversion is an activity that attempts to ensure that any individual or family has exhausted all other natural supports such as friends or family prior to accessing services within a shelter or other homeless serving organization. 4) On-site, low-barrier, housing-focused shelter for singles While other shelters within the community should be making the transition away from compliance- based, longer-term therapeutic environments, available data from the PIT Count,AHAR and interviews with homeless persons suggests that a low-barrier shelter for singles is warranted. Having a 40-bed shelter at the centralized facility will provide the occupants with the best access to supports that can help them access housing and other supports. The design and service model should PAGE I 46 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 intentionally support people that would be barred or have difficulties meeting program entry criteria at other shelters. For example,persons with a history of mental illness and not taking medications, persons that are medically frail, and/or persons with a criminal history. This should be a co-ed facility and the physical layout should lend itself to different configurations depending on populations being sheltered. For example,in some instances single women may request limited exposure to the general population; or,in other instances, a transgendered youth may want privacy. 5) Permanent Supportive Housing A potential Housing Resource Center or comparable facility should perform two functions related to Permanent Supportive Housing: The Center should have its own Permanent Supportive Housing for single individuals and childless couples. It is estimated, based upon available data, that 34 units of Permanent Supportive Housing would be available onsite. This housing should be reserved as a housing option for those chronically homeless individuals with the most acute needs, as a prospective housing choice for them to consider. This would supplement existing Permanent Supportive Housing elsewhere in the community. The Center can perform the coordinated intake and assessment site for all site-based permanent supportive housing and scattered site permanent supportive housing throughout the City. 6) Coordinated community-based housing supports Virginia Beach needs a single point of coordination of all people housed with supports regardless of type of housing (scattered site,permanent supportive housing, SROs, etc.). This single point of coordination is necessary for several reasons: • Tracking of locations where people are housed to avoid community saturation; • Measure,maintain and ensure fidelity to proven practices in housing supports,both Rapid Re-Housing and Housing First; • Maximize strengths of service providers that are able to support people in community; • Balance caseload size and complexity across service providers; • Efficiently link coordinated access and common assessment instrumentation in the community; • Heighten accountability through a service management function and strengthen performance per HEARTH indicators. Based upon available data, 10 housing support workers will be required to be coordinated through the Housing Resource Center. Four of these will be dedicated to delivering Intensive Case Management (ICM) following a Housing First service delivery model, and six will be dedicated to delivering Rapid Re-Housing services to people who cannot be diverted from the support system. PAGE 147 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 7) Connecting to mainstream services like income supports A centralized facility has the opportunity to be an integrated facility where the co-location of appropriate government staff should make it possible for homeless and recently housed individuals and families to apply for and access the benefits and income supports that they are eligible to receive. 8) Basic needs facilities for street involved persons A centralized facility, like a Housing Resource Center,has the opportunity to create a low-barrier, welcoming environment for street involved persons to make use of available resources within the facility, and in the process connect with staff that can help them end their homelessness. Showers, washers, dryers, and a clothing depot are all recommended. If a meal program is offered on-site, having staff available to engage with people having the meal to help determine housing needs and supports would be beneficial. 9) Identification application and safe storage Applying for identification and government documents like a birth certificate, Social Security Number, or driver's license occur more frequently for the homeless population than the general population. Safe storage of identification is an issue for people who spend large parts of the day in transit, may wear clothing until it is threadbare, and/or vacate an encampment for hours at a time during the day trusting that belongings will still be intact upon their return. A centralized facility is an opportunity to help people apply to have identification and government documents replaced, as well as provide safe storage of identification. 10) Short-term child-care Homeless families with pre-school children can find it difficult to look for housing and/or employment while concurrently caring for their young children. Short-term child-care should be provided for those households that are looking for housing and/or employment. PACE 148 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Appendix F: Using the "4 A's" to Create a Clear Service Delivery Pathway Coordinated access and common assessment is a HEARTH requirement and necessary for there to be a clear service delivery pathway for households facing homelessness. There are four considerations that Virginia Beach must address in its approach: 1) Access Access to housing services across Virginia Beach is currently fragmented and uncoordinated. People seeking service can call Connection Point for assistance. Others show up at Human Services. Some surf the City's website. Others go directly to service providers. Some have outreach as their first point of access, completely unaware that there was a system. The vision for an appropriate centralized facility/system should allow for the infrastructure necessary to support meaningful access points through agencies, outreach, through the phone or via web portal. This will need to be advertised and communicated effectively so that only those in direct need of the service provided are seeking assistance. This must not be a general housing help assistance location. It makes complete sense for the utility of Connection Point to be expanded within the centralized facility, so long as there is a concurrent retraction of other access points throughout the community. 2)Assessment There is no common assessment tool used among service providers in Virginia Beach. While the Vulnerability Index (VI) is applied to the inventory of Single Resident Occupancy (SRO) housing, this is not used in the lead up to the application from across the entire universe of service providers (for example, none of the shelter staff encountered in this report used the VI), and there are mixed opinions on how the VI is being used to inform supports once a person is housed. The assessment tool selected for the community has to be applied consistently from point of program intake right through to the end of engagement with the program. Furthermore, the assessment tool selected has to be grounded in empirical data. To that end, there are three tools that warrant further exploration by the community: The Vulnerability Index—based upon the research of Drs. Hwang and O'Connell, the Vulnerability Index is primarily designed to assess morbidity risk amongst a rough sleeping homeless population. It has been used extensively in the 100k Homes Campaign for single persons (there is no equivalent of the VI for families). The Vulnerability Assessment—pioneered and tested by DESC in Seattle, the Vulnerability Assessment is used to determine risk and support factors for permanent supportive housing. The ServicePrioritization Decision Assistance Tool (SPDAT) —based upon multi-disciplinary research, this tool is intended to be used from point of intake through to graduation,informing areas of attention for service participants and service providers throughout the relationship that will PAGE ( 49 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 result in improved housing stability. Research demonstrates higher rates of housing stability amongst singles and families using SPDAT. The SPDAT v3 is included as Appendix K. 3) Assignment The current service delivery environment does not assign people to the resources best able to meet his/her needs. Instead,where there is advice given,it most frequently results in blind referrals to other organizations that may be able to assist. With this approach, there is greater likelihood that there will be a breakdown in accessing services and that individuals and families will not achieve intended outcomes. Moreover, there are inefficiencies when each service provider invests resources to manage their own waiting lists rather than implementing a more coordinated approach that maximizes and leverages the assets across the entire service delivery system. 4) Accountability Those communities that have an organization responsible for coordinated access and assessment see improved accountability in service delivery. There has to be dedicated staff to oversee the process and ensure that intended results are occurring,while also addressing the systemic and systematic barriers to helping individuals and families that are homeless get the resources necessary to end their homelessness. In Appendix G: Possible Service Pathway from Point of Access through to Success Service Intervention there is an outline of one approach to undertaking the step-by-step decision making required in a coordinated access and assessment approach. PAGE I50 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Appendix G: Possible Service Pathway from Point ©f Access through to Success Service Intervention Setro � a � � � � � � � ��i , PSN , �� �y 9 � 9 X i� $ # •a. �s� - �.., a �sada�aaaa.,:«wd..r_..�.auu#� �5 �...r. .'+. 1 Individual or family calls or attends a centralized facility. Connection Point is used as the coordinating software tool that is integrated with the Homelessness Management Information System. 2 Professional staff associated with coordinated access conduct an assessment and try to divert the household from needing services by accessing any"natural" supports in the community such as friends or family that they can stay with.Process ends if successful in diversion.Process continues to Step 3 if unsuccessful in diversion. 3 Professional assessment staff conduct a prescreen assessment to determine the initial indication of presenting acuity and needs. 4 The household is determined to require one of the following scenarios:referred to a complete assessment for a Housing First support intervention through Assertive Community Treatment or Intensive Case Management;referred to a complete assessment for Rapid Re-Housing;no further assessment required based upon presenting issues and encouraged to resolve housing need independent of support system. 5 Household is directed to appropriate short-term shelter option,as necessary,while waiting for complete assessment.Households not requiring a further assessment may also be provided a short- term shelter option.Available shelter options are known in real time through the HMIS. 6 Complete assessment conducted.All assessments over the preceding week are reviewed collectively. Housing First and Rapid Re-Housing applicants with the highest acuity are prioritized first for service. 7 The household is assigned to a case manager by the assessment staff that will help them access housing and provide supports,either through Rapid Re-Housing or Housing First.Those households where a complete assessment was not required are assertively engaged over the following weeks to consider and choose housing as a solution to their homelessness. 8 Household assessed for Rapid Re-Housing or Housing First is assisted in accessing appropriate income supports,benefits,and/or other forms of financial or rental assistance. 9 Household assessed for Rapid Re-Housing or Housing First are provided housing options to consider relative to what is affordable,appropriate and actionable for the household.The household chooses the apartment or house to rent that best meets their circumstances. 10 Household completes all necessary paperwork and secures the apartment or house for rent,with the direct assistance of the Rapid Re-Housing or Housing First case manager. 11 Households are assessed again on or about the day of move-in on the most pressing issues where support will be required to maintain housing stability.Initial housing stability case plan is developed. 12 Household is supported in creating a crisis plan and risk assessment to increase the likelihood of not experiencing homelessness again. 13 At the end of one month in the new housed environment,households are assessed on progress again, with the information used to create a more robust service plan which will include a focus on connecting to other mainstream resources,employment/education,engaging in meaningful daily activities,etc. 14 Rapid Re-Housing clients begin exit planning at`6-8 week mark,focusing on"homeless proofing", with a desire to see program exit from case management occur between 3-6 months.Housing First clients begin exit planning at approximately 6 month mark,focusing on"homeless proofing",with a desire to see program exit from case management occur between months 12-18 for those in scattered site units,and longer for those in permanent supportive housing. PAGE I51 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Appendix H: Rapid Re-Housing Triage Tool t6- artietOo Re—tiining .ent Assistance Landlord Assistance da `ii far t G y aha --, Provided - ',ted . Level 1 A few late utility and Low income,insufficient Start-up financial assistance, Program contact credit card payments. savings. home visit after move-in. information. Level 2 Minor offense history, Inconsistent employment, Above,plus ongoing Periodic check-ins, few or no housing poor budgeting assistance with housing availability for 6 references,pattern of skills,minor mental search,weekly home visits, months,assistance if late payments. illness,possible past services available for up to 6 eviction a possibility. homelessness. months. Level 3 Some criminal history, As above,plus problems Above,plus time- 9-month availability, up to 3 evictions, with mental illness or limited rental assistance, assistance after noise complaints substance use,possible unannounced drop-in visits, program has ended, and/or property family conflict,multiple services available up to 9 possible payment of damage,closed past episodes of months. court fees,relocation accounts due to debt. homelessness. if eviction pursued. Level 4 Up to 5 evictions, As above,plus very low As above,plus staff As above,plus criminal history income,no bank account. accompanies client to meet 12-month availability, including drug with landlord,up to 12 payment or repair of offense or crimes months of service. damages,possible against person or up-front payment property. of damage deposit or other costs in addition to normal start-up costs. PAGE 152 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Appendix I: Detailed Actions for Strategic Priorities Strategic Priority t t ' 1 , ;e, 5 :,�w ue-., fP a 7� a, a �, �. Ny • A "4 Goal(s) Create a"systems of care" approach to ending homelessness with public and private systems working collaboratively,with clear leadership and accountability. Key Objectives • strengthen the role and function of the Continuum of Care to be aligned with the requirements of the HEARTH Act; • name a single individual as having direct responsibility for implementation of service improvements,having the autonomy and authority to direct changes as warranted in practice o funding; • foster sustained and high-level coordination of all government agencies on the issue of ending homelessness across the City of Virginia Beach,and across the state;and, • ensure duplication and inefficiency are removed from the homeless assistance system. Necessary (a) secure commitments from key Cite of Virginia Beach and State of Virginia stakeholder Actions agencies to actively participate in collaboration across the system.This will require: - Assigned staff resource or champion to navigate the identification and engagement of key stakeholders; - Determining the most appropriate and accountable approach to commitments from the agencies (for example:Letter of Understanding;Memorandum of Agreement;Co- signed Collaboration Framework); - Accountability measures to be placed within the collaboration structure to enhance shared responsibility and monitor results. (b)increase collaboration with the L.S.Department of Veterans Affairs to increase access for veterans to veteran specific homeless programs.This will.require: Assigned staff resource to navigate service options; - Accountability measures to be placed within the collaboration structure to enhance shared responsibility and monitor results. (c)increase access to and sufficiency of public assistance programs (including temporary \ssistance to Needy IBmilics,Supplemental Nutrition Assistance Program,and others) for families who arc experiencing homelessness by providing direction and application assistance at intake.This will require: - Improvements to intake functions; - Monitoring the number of applications completed at intake; - Investigating the rate of success in applications. (d)(examine all opportunities under implementation of the.lifordable Care Act to provide comprehensive physical and behavioral health care to people experiencing homelessness, and coordinate housing with care services. This will require: - Leveraging expertise of community providers already experienced with health care access and delivery to persons experiencing homelessness; - Review of promising and best practices in the likes of PSH for medically frail populations; - Accessing Medicaid Program opportunities,if expanded in Virginia,and applying for funding opportunities associated with improved health care service delivery for homeless individuals and families. PAGE 153 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 „e, Strate is Priori ,c M '� °. a a 4,a u . ,$ Goal(s) Create an effective crisis response system that works to divert people from homelessness, when appropriate,and rapidly returns people experiencing a housing crisis back into housing. Key Objectives • create a coordinated entry system with a valid and reliable assessment tool for homeless assistance services intake that appropriately targets housing and services that is centrally, • increase diversion resources to reduce the number of new households experiencing homelessness, • reposition shelters to provide short-term accommodation,with reduced barriers to access, that will assist people in getting access to housing as quickly as possible • focus outreach activities on helping people end their homelessness as quickly as possible Necessary Actions (a)create lcapacity so that data can be used to monitor system in real nine to provide a seamless continuum of care,and look to regional partners to develop feasible relationships that will strengthen this capacity beyond the City.This will require: - Increased awareness and training amongst service providers to enter data in a timely fashion; - Work with the private,faith-based service providers that do not use HMIS to have them update their capacity appropriately and in real-time; - Dedicated staff within coordinated access that will monitor real-time capacity and disseminate information to providers. b)expand outreach and engagement resources to increase coverage in the Citi;especially to unaccompanied youth and chronically homeless people who arc living outdoors..fhis titian require: - Orienting all funded street outreach on resolution of homelessness; - Improving data on the population living outdoors beyond the PIT Count information, using information gleaned from the outreach process; - Additional training to service providers on effective,proven models of intervention; - Introduction of assessment tools in non-traditional environments; - Building further capacity within the youth-serving sector. (c)work to ensure housing programs support family preservation for children of all ages and genders,partners,and families without children.This will require: - Ensuring orientation of some service delivery to the needs of families as a whole; - Improved service delivery to families sheltered in motels; - Improved connections between school social workers and homeless service delivery system. d)anah ze diversion methods used to better understand effectiveness of temporary, alternative-to-shelter housing options,and the effectiveness of successful doubling up.This will require: - Greater emphasis on diversion and linking to other community supports at time of assessment; - Analysis of the effectiveness of temporary,alternative to shelter housing options. (c)helping shelter providers alter their services.This will require: - Development of new business models for the shelters,articulating programming, staffing,and use of funding; - Providing additional professional development opportunities to volunteer and paid frontline staff in various shelter environments to better understand and practice a housing-orientation to their services. - Access to more professionals to provide assistance in shelters,working alongside volunteers and other paid frontline staff,as appropriate; - Creating unified shelter standards that all shelter providers can agree to,which will inform practice and service orientation. PAGE I 54 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 y Strategic Priority .c s b `J m�' , v. �rd t, ;.,.w,:c_ Goal(s) Increase access to market and permanent supportive housing sufficient to rapidly re-house homeless individuals,families,and youth,as well as meet the housing and support needs of individuals and families with higher acuity. Key Objectives • support and invest in Housing First and Rapid Re-Housing models that serve homeless individuals and families, • progressively engage individuals and families experiencing homelessness related to assessed needs and present housing options accordingly, • increase toolkit of financial options to ensure program viability and access to housing, including Emergency Solutions Grants (ESG),Temporary Assistance for Needy Families (TANF)and Tenant Based Rental Assistance(TBRA), • Revise referral criteria to available Permanent Supportive Housing and SRO housing options based upon acuity,"not first come,first served". • increase scattered-site housing options in market rate units with supports provided in community,at the individual or family's home(builds upon success of similar initiatives by VBCD and CAMG), • Provide opportunities when feasible to allow individuals in PSH to transition to community based affordable housing when feasible. PAGE ( 55 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Necessary Actions (a)increase Rapid Re Housing assistance to the maximum number of households eligible through resources provided in all sources of funding.This will require: - Repositioning some investments currently being made to programs that are managing homelessness rather than having a clear focus on ending homelessness,i.e.,programs where clients have comparatively high lengths of stay,programs with comparatively high rates of recidivism—returns to homelessness,and programs which have outcomes that are not aligned with the other HEARTH performance measures; - Strategically making various financial instruments available,such as—but not limited to— ESG,TANF,and TBRA for the purpose of Rapid Re-Housing; - Training on proven effective approaches for screening eligible candidates for a Rapid Re- Housing service intervention and providing appropriate support for longer-term success and reduces recidivism; - Working with the landlord community to identify units in good condition that would be an appropriate match for the approach. (b)implement a referral system for permanent supportive housing that prioritizes beds/units Ia vulnerability/acuity and length of homelessness.This vi].l require: - Creating an inventory of existing intake processes for PSH and actively removing barriers in the current intake so that those with deepest needs can be served; Closing the"side door" so that referrals to PSH come through a coordinated entry point,not through internal decisions of PSH providers; - Introduction and training on the use of the Vulnerability Index,Vulnerability Assessment Tool,or the Service Prioritization Decision Assistance Tool(SPDAT); - Upgrades in training to PSH staff to assist them with better serving increased volumes of people with complex and co-occurring needs. Working within HUD regulations to determine the extent to which this is feasible when HUD voucher funding is utilized (c)help people in PSI1 beds/units transition to community-based affordable housing when appropriate=' for those individuals.This will require: - Resources and dedicated staff to assist with locating and moving into community-based affordable housing; - Advertising to existing PSH residents of the opportunity to move; - Assessment of vulnerability/acuity of those interested in the opportunity to determine if support needs can be met in the community. (d)develop new supportive housing stock 1w combining city-, federal,and private sources that will create a pipeline of new units,with special attention paid to opportunities for development at the proposed 1-lousing Resource Center site.This will require: - A strategic investment and development approach across the community instead of one- off projects,mirroring some of the same Regional approaches that have been used in the development of SROs; - Determining appropriate supportive housing needs for specific populations based upon available data from PIT Count and HMIS; - Competitive process for determining appropriate provider of the housing. (e review existing transitional housing with a view to convert up to 33`n,of units into "transition in place"and/or Permanent Supportive blousing by 2018.This will require: - An in-depth review of recidivism rates of transitional housing tenants; - Inventory of programming in transitional housing; - Technical assistance to transitional housing operators to assist with the change. • PAGE 56 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Strategic Priority special `� .a „ Goal(s) Create a comprehensive array of services and housing for the needs of special populations, including the subpopulations of unaccompanied youth,veterans,chronically homeless people (especially those sleeping outdoors and places not fit for human habitation),and families. Key Objectives • increase the capacity of the housing system so that there are adequate services and crisis response system beds for all special populations,and • ensure that across the system there are competent service models in effect that promote services that are appropriately geared to each special needs population. PAGE 57 • HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Necessary Actions (a) ensure accurate data collection during the PIT count for subpopulations.This will require: - Enhancements to PIT Count methodology,building upon promising practices from other jurisdictions in reaching these populations,with such enhancements to consider: - Youth specific count strategies (for example:Los Angeles,CA;Metro Vancouver,British Columbia,Canada where youth specific counters and youth service providers have been used to engage youth in a range of settings where others may not be able to find them or have sufficient rapport to interview them) - Capture-recapture methods in street count to adjust for uncounted homeless individuals in statistically valid manner(for example:New York City,NY;Toronto,Ontario,Canada; Red Deer,AB,Canada) - Implementation of housing and service needs survey during the PIT Count(for example: Seattle,WA;Red Deer,Alberta,Canada) (b)form`‘Icor- Gmop(s) of the{:o( to investigate,report, m d advise leadership on special population needs,and to ensure that there are appropriate interventions,policies,and investments for each subpopulation in place."1"his will require: Selecting subject matter experts for the task force; - Establishing a framework and methods for investigating the subpopulations needs, including the use of available HMIS and PIT Count data; - Research on promising and/or best practices implemented in other jurisdictions proven to get better results in housing access and stability for the subpopulations (for example: The Link,Minneapolis,MN or Eva's Initiatives,Toronto,Ontario,Canada—for serving youth;Pathways to Housing,New York,NY or McMan Housing First program, Medicine Hat,AB,Canada—for serving chronically homeless people including those with compromised mental wellness;TCH and Community of Hope,Washington,DC— for serving homeless families with complex needs;etc.) - Knowledge transfer and training of practices to be implemented in Virginia Beach relative to subpopulation needs. (c)develop housing options for each subpopulation that arc appropriate (i.e.,especially developmentally appropriate transitional .tufa permanent housing situations where necessary for unaccompanied youth,supportive housing options that meet the needs of veterans and their families,and community reentry'transitional housing options for people discharged from prisons and mental health care facilities).This will require: - The appropriate transfer of knowledge and practices that are relevant to the Virginia Beach context; - Building upon existing strengths within the community in addressing the needs of these sub-populations; - Re-profiling existing resources or fundraising/applying for new resources specifically for the housing needs of the subpopulations. (d)increase resources to reflect current and fixture projected need for each subpop:dation.This will require: - Re-profiling existing resources or fundraising/applying for new resources specifically to meet the service needs of the subpopulations; - Implementation of the valid and reliable assessment tool to determine vulnerability/ acuity within each subpopulation in order to prioritize service delivery; - Capturing more in-depth information on service delivery outputs and outcomes of the approaches used with the subpopulations to help determine future needs; - Improving data capture and/or analysis of subpopulations information through the PIT Count and HMIS. PAGE 158 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Appendix J: Professional Development Agenda It is reasonable to assume that professional development will be a necessary and fruitful endeavor to align service delivery to the intended form and function of the housing crisis response system. Local leaders will need to determine the required professional development to achieve service excellence in the immediate or near future. Based upon the research conducted for this report, the review of available data, and the interviews conducted with key informants and persons currently experiencing homelessness, the following is recommended for consideration: Common Assessments: Implementation and System-wide Implications The community must make a decision about which evidence-informed common assessment tool they wish to make the standard assessment tool across all service delivery. After this decision has been made, training will be required to senior managers on the implications of a common assessment tool, and then training will need to be provided to frontline staff on how to assess and use the results of the assessment. Training will also need to be delivered on how to operationalize the assessment tool on a system-wide basis.This means that the work of assessment staff in a reception environment needs to be related to the work of shelter workers, case managers and other systems like health care and income supports. Core concepts that need to be covered in the training include: • The theory of prioritization and triaging client needs • Foundations of stages of change supported through common assessment • Strength-based service delivery based upon client profile • Aligning housing interventions to presenting issues • Assessment strategies through observation, conversation, documentation and engagement with other professionals (with consent) • Reviewing and updating assessment through client progress in service delivery • How to analyze and use assessment data in system planning Excellence in Housing-Based Case Management Moving to a housing-based case management model that blends service delivery at dedicated, congregate living buildings with scattered site community based supports will benefit from training on the main currents of thought and practice in housing-based case management. It may be beneficial to have supervisors/senior managers as well as those on the frontline that will be doing the work to attend the training to best understand how the most effective ways of delivering housing-based case management can require changes in organizational practices. Core concepts that need to be covered in the training include: • Service orientation and expectations of housing-based case management • Receiving referrals from assessors • Tailoring support services based upon acuity PAGE 159 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 • Documentation and case note requirements • Professional boundaries • Privacy, confidentiality and documentation control • Risk assessment and safety • Planning for crises • Case review structure and expectations of service progress • Establishing objective-based interactions • Exit planning • Re-housing • Working with landlords • Budgeting • Focusing on wellness Solution-Focused Street Outreach Strategies Outreach is a critical function to the success of service delivery in Virginia Beach—both currently and as the Housing Resource Center unfolds. How outreach is delivered can make the critical difference between managing homelessness and a strong focus on ending homelessness. The paradigm shift in outreach in most communities is from"How can I help you?"which addresses short-term,immediate needs to "How can I help you get housed?"which addresses the long-term solution in comparison to the experience of homelessness. Strategies on effective, solution-focused outreach strategies are important to affirm and transfer with local outreach providers in any community that is focused on ending homelessness. Core concepts that need to be covered in this training include: • Creating a by name registry • Determining location and primary focus of various outreach providers • Direct access interim housing and short-term shelter options • Balancing survival supports with solutions • Increasing awareness of patterns of survival behavior • Focusing on the housing solution options with street involved populations • Service orientation and expectations of solution-focused street outreach Professional Development Agenda for the Future to Supplement this Base In formalizing an ongoing professional development agenda,it is our recommendation that over the next 12-18 months, the following syllabus should be made available to those staff in organizations involved in direct service delivery supplement any internal training offered by the organization: • Database input and administration • Relevant legislation informing and governing practice • Personal and agency liability • Community worker safety training PAGE 160 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 • Exercising active listening • Motivational Interviewing • Valid First Aid and CPR • Navigating income supports,benefits and entitlements • Trauma informed service delivery • Assertive Engagement • Cultural awareness, anti-racism and anti-oppression • Recovery,Wellness Recovery Action Plans and DREEM • Substance use and harm reduction • Mental Health First Aid • Meeting the needs of all sub-populations as well as people within the sub-populations based on sexual orientation,i.e.,Transgendered,Transsexual,Two-Spirited and supporting community integration for gay,lesbian,bisexual, queer, questioning or inter-sexed persons • Self care • Working with victims of violence • Children's services and family reunification • Working with persons living with a brain injury • Providing a gender perspective to practice • Establishing effective case conferences • Creating and promoting meaningful daily activities • Working effectively with law enforcement • Empowering choice and personal responsibility • Integrated Dual Disorder Treatment • Illness Management Recovery • Supporting treatment protocols • Working effectively with people that hoard or collect • Supported employment PAGE 161 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Appendix K: Service Prioritization Decision Assistance Tool— SPDAT v3 PAGE I 62 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL (SPDAT v3) MARCH 2013 Disclaimer The management and staff of OrgCode Consulting,Inc.(OrgCode)do not control the way in which the Service Prioritization Decision Assistance Tool(SPDAT)will be used,applied or integrated into related client processes by ORG .CODE communities,agency management or frontline workers.OrgCode assumes no legal responsibility or liability for the misuse of the SPDAT,decisions that are made or services that are received in conjunction with the assessment tool. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 Contents Foreword 5 SPDAT Design 5 Family SPDAT 6 SPDAT Client Disclosure 6 Timing of SPDAT Implementation 7 Graphing Changes 9 Client Assessment 9 15 SPDAT Components 9 Client Assessment—Total Component Score 10 Approaches to Completing the SPDAT 10 Using the SPDAT in Providing and Helping to Guide Supports 11 Noting Discrepancies 11 Components of the SPDAT 11 A.Self Care and Daily Living Skills 12 B.Social Relationships and Networks 12 C.Meaningful Daily Activity 13 D.Personal Administration and Money Management 14 E.Managing Tenancy 16 F.Physical Health and Wellness 17 G.Mental Health and Wellness&Cognitive Functioning 18 H.Medication 20 I.Interaction with Emergency Services 21 J.Involvement in High Risk and/or Exploitive Situations 21 K.Substance Use 22 L.Abuse and/or Trauma 23 M.Risk of Personal Harm/Harm to Others 24 N.Legal 25 O.History of Homelessness and Housing 26 Summarizing Scores 27 SPDAT SUMMARY 28 Prioritizing Service Based Upon Score&Guiding Supports 30 System Navigation and Support for Clients Can Be Informed Using SPDAT Results 31 Local Variations in SPDAT Use 31 Guide to Assist SPDAT Conversation 31 Building Consistency Using SPDAT 38 OrgCode Consulting Inc. v3.0 Page 3 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 Foreword OrgCode Consulting Inc.is pleased to announce the release of Version 3 of the Service Pri- oritization Decision Assistance Tool(SPDAT).Since its release in 2010,the SPDAT has been used with over 10,000 unique individuals in over 100 communities across North America and in select locations around the world. Originally designed as a tool to help prioritize housing services for homeless individuals based upon their acuity,the SPDAT has been successfully adapted to other fields of prac- tice,including:discharge planning from hospitals,work with youth,survivors of domestic violence,health research,planning supports for consumer survivors of psychiatric care sys- tems,and in work supporting people with fetal alcohol spectrum disorders.We are encour- aged that so many service providers and communities are expanding the use of this tool, and OrgCode will continue to support the innovative use of the SPDAT to meet local needs. In preparing SPDAT v3,we have adopted a comprehensive and collaborative approach to changing and improving the SPDAT.Communities that have used the tool for three months or more have provided us with their feedback.OrgCode staff has observed the tool in operation to better understand its implementation in the field.An independent commit- tee composed of service practitioners and academics reviews enhancements to the SPDAT. Furthermore,we continue to test the validity of SPDAT results through the use of control groups.Overall,we consistently see that groups assessed with the SPDAT have better long- term housing and life stability outcomes than those assessed with other tools,or no tools at all. OrgCode intends to continue working with communities and persons with lived experi- ence to make future versions of the SPDAT even better.We hope all those communities and agencies that choose to use this tool will remain committed to collaborating with us to make those improvements over time. SPDAT Design The SPDAT is designed to: • Help prioritize which clients should receive what type of housing assistance inter- vention, and assist in determining the intensity of case management services • Prioritize the sequence of clients receiving those services • Help prioritize the time and resources of Frontline Workers • Allow Team Leaders and program supervisors to better match client needs to the strengths of specific Frontline Workers on their team • Assist Team Leaders and program supervisors to support Frontline Workers and establish service priorities across their team • Provide assistance with case planning and encourage reflection on the prioritiza- tion of different elements within a case plan • Track the depth of need and service responses to clients over time OrgCode Consulting Inc. v3.0 Page 5 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 The SPDAT is NOT designed to: • Provide a diagnosis • Assess current risk or be a predictive index for future risk • Take the place of other valid and reliable instruments used in clinical research and care The SPDAT is only used with those clients who meet program eligibility criteria.For ex- ample,if there is an eligibility criterion that requires prospective clients to be homeless at time of intake to be eligible for Housing First,then the pre-condition must be met before pursuing the application of the SPDAT.For that reason,SPDAT v3 includes an initial screen- ing tool to assess eligibility. The SPDAT has been influenced by the experience of practitioners in its use,persons with lived experience that have had the SPDAT implemented with them,as well as a number of other excellent tools such as(but not limited to)the Outcome Star,Health of the Nation Outcome Scale,Denver Acuity Scale and the Camberwell Assessment of Needs. The SPDAT is not intended to replace clinical expertise or clinical assessment tools.The tool complements existing clinical approaches by incorporating a wide array of components that provide both a global and detailed picture of a client's acuity.Certain components of the SPDAT relate to clinical concerns,and it is expected that intake professionals and clini- cians will work together to ensure the accurate assessment of these issues.In fact,many organizations and communities have found the SPDAT to be a useful method for bridging the gap between housing,social services and clinical services.This matter is discussed in further detail at the end of this guide. Family SPDAT The Family SPDAT(F-SPDAT)was released in Spring 2012 and is designed specifically for working with families.If your organization would like a copy of that tool you can send your request to F-SPDATporgcode.com. SPDAT Client Disclosure Clients should be informed that you are using the SPDAT.It is best to explain SPDAT as a tool to help guide them to the right services,as well as assist with the case planning pro- cess and track changes over time for those clients that are referred to a case management team as a result of their SPDAT score.At intake or first assessment,it is also prudent to explain to the prospective client that the SPDAT helps to determine the priority with which they will get services and housing.It is important to let the client know that the final deter- mination of a score for any component is a combination of conversation,documentation reviewed,observation and information from other sources.In other words,the outcome is not influenced solely by what they say. Page 6 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 Similar to transparency in case planning,the client should be offered a copy of the Sum- mary Sheet of the SPDAT after it is completed.Whether they may accept or decline,a copy of each SPDAT should be kept in the client's file. An evaluated best practice from versions one and two of the SPDAT was the use of the SPDAT in the"warm transfer"between intake and the case manager for clients with higher acuity.In the warm transfer,the intake worker,client and case manager(meeting the client for the first time)met together and reviewed each of the 15 components of the SPDAT in detail.Through this process,OrgCode learned: • clients appreciated understanding the intake worker's assessment and transpar- ency of their reasoning; • clients appreciated the opportunity to provide commentary on the intake worker's assessment(even though the commentary did not have any further impact on the initial score); • the receiving case managers appreciated the opportunity to learn more about the clients and ask questions of clarification from the intake worker with the client present; • the receiving case managers were able to engage in the goal setting process of case planning quicker; • there was greater continuity between intake and case management.As a result, fewer clients went"missing" between their initial intake and the beginning of the case management services; • trust between the intake workers and case managers within the community was said to have improved; and, • clients served through this approach achieved greater housing stability than those who did not. Timing of SPDAT Implementation It is recommended that the SPDAT begin at intake after the client has been screened for program eligibility.This can be accomplished at a central intake point for the entire com- munity,at various intake points across community agencies and shelters,or upon specific program intake.Although any single organization will benefit from using the SPDAT,the value of the tool and the results it provides are improved as more organizations align in its use across any given service community. The SPDAT assessment-especially the first assessment done with the client-does not need to be completed in just one client visit.Testing of the tool has demonstrated that there are no discernible differences in assessments conducted over several visits versus those completed in one visit.In the event that a client wishes to take additional time to consider their participation in a program,or in the event that the person conducting an as- sessment with the individual thinks that it would be advantageous to take a break,they are encouraged to do so.Should the accuracy of the information seem suspect to the person OrgCode Consulting Inc. v3.0 Page 7 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 conducting the interview based upon the client's self-report,keep in mind that the client's consent information can be corroborated from other sources.This type of cross-referencing may be critical for ensuring the best possible assessment that reflects the highest degree of accuracy. The early application of the tool is a baseline for subsequent SPDAT measurement.The sug- gested intervals following the baseline SPDAT assessment are as follows: 1. Intake/Early in engagement, i.e., early stages of involvement of Housing Worker and client showing interest in being housed 2. In the "warm transfer" between intake and case managers for those clients that are being recommended for supports based upon their SPDAT acuity 3. At or very shortly after(within 2 days of) move in for those clients that are receiv- ing supports For those clients that are receiving supports,the SPDAT should also be used: • On or about 30 days • On or about 90 days • On or about 180 days • On or about 270 days • On or about 365 days In addition,the SPDAT should be completed any time a client is re-housed or experiences a significant shift in their case plan,either positive or negative.As discussed later,it is not recommended that the SPDAT be completed when a client is in crisis as the episode may misrepresent the overall acuity score.If a client is in crisis,the SPDAT should be completed after the episode has subsided.This may occur in between regularly scheduled applica- tions of the SPDAT. Page 8 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 Graphing Changes Visuals are an important adult learning strategy.Therefore,it is best practice to visually graph the client's transitions relative to the time intervals noted above.The two examples below illustrate graphing by component or by overall score.The graphs illustrate how the client was assessed during their 5th of 7 applications of the SPDAT-180 days: Client Assessment [HIGH] 0 1 2 3 4 [LOW] 15 SPDAT Components Self Care&Daily Living Skills Meaningful Daily Activity Social Relationships&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/Explosive Situations Legal History of Homelessness&Housing Managing Tenancy —Early Engagement At Move —30 Days —90 Days —180 Days OrgCode Consulting Inc. v3.0 Page 9 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL (SPDAT) MARCH 2013 Client Assessment—Total Component Score LOW 60 50 50 40 iF4------- i41 30 X34 - 30 - i 20 10 0 HIGH 1 2 3 4 5 ...Early Engagement At Move 30 Days —90 Days —180 Days Approaches to Completing the SPDAT The SPDAT can be completed through observation,conversation,other documentation shared in the intake or case planning process and a client's self-report.Information can also come from the client's case plan,information gleaned from home visits and community accompaniment,or existing knowledge from the client's engagement with your organi- zation.While a conversational approach can be helpful when using the SPDAT,it is not mandatory. The SPDAT can be completed as part of one conversation in the intake process,or through a series of visits in the early stages of the relationship.For some clients with complex needs,it may be necessary to have several conversations(sometimes in the form of mul- tiple brief conversations)to gather enough accurate information to complete the tool.If you are uncertain of the accuracy of information received from the client,it is encouraged that you repeat the conversation to get clarity. A guide is included at the end of this document to assist with communication when a con- versational approach is used to gain information for completing the SPDAT.The conversa- tion guide comes from practitioners with direct experience in administering the tool. Page 10 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 Using the SPDAT in Providing and Helping to Guide Supports For those clients who are provided case management or other supports as a result of their SPDAT score,the SPDAT has proven to have great value in helping to guide case planning and support conversations. Focusing attention on those areas of the SPDAT where the client has higher acuity has been successful in helping clients work through the Stages of Change(Prochaska&DiCle- mente).It has also proven to be helpful to case managers and other supports in guiding the conversation in client follow up,as well as in establishing objectives for each follow-up visit.Throughout its use,the SPDAT remains a tool that is client-centered and allows for strength-based approaches to service delivery. Noting Discrepancies With many clients you will gather information or observe behavior that may be contradic- tory to their self-assessment.This can be a positive aspect of case management process when working towards change.Do not shy away from being transparent in your assess- ment,noting the discrepancies whenever they appear. Components of the SPDAT The SPDAT is divided into 15 components(A to 0 below).Each component has a descrip- tion that categorizes the scoring relative to each component. The scoring begins with"0"that indicates higher functioning/non-issue.Level"4"indicates a more serious issue/situation.While a description is provided for each component com- plete with definitions,it is useful to include specific client examples in conjunction with each score.Certain scenarios require careful consideration about which score to use when the scenario does not precisely match the descriptions.In these instances,it is important for staff to provide their rationale for the score indicated. For each component,there is an opportunity to record what you observed or the com- ments that the client disclosed that resulted in the score. OrgCode Consulting Inc. v3.0 Page 11 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPAT) MARCH 2013 COMPONENTA A.Self Care and Daily Living Skills ;elf-Care and Daily Living Skills This component is concerned with the functions of taking care of oneself,meeting daily needs independently,and living autonomously.Behaviours of interest here include such things as taking care of one's own personal hygiene,as well as being able to cook,clean, and do laundry. This component also gives consideration to those individuals who are collectors or hoard- ers.Crucial to this assessment is the degree to which they are aware that such behaviours are an issue that is negatively impacting their life. Under the scoring scheme below,"lives independently"refers to the ability to live without per- manent on-site supports.It does not include individuals living in couples or with roommates. If the individual is homeless at the time of assessment the most that they can receive is a 2. 0= Takes care of self and meets all daily living needs independently&lives indepen- dently. 1 = Takes care of self and meets all daily living needs by infrequently accessing other community resources as needed. 2= Attempts to take care of self and meet all daily living needs,but has a few areas where assistance is sometimes required;may not be living independently(stay- ing in a shelter). 3= Not always taking care of self and/or not always aware of what needs to be done to take care of self or daily needs;can require prompts;requires frequent as- sistance;may excessively acquire belongings(hoard or collect)but is aware that it is an issue. 4= Not taking care of self or meeting daily needs;often unaware and almost always needs prompts;requires intensive,frequent assistance;may excessively acquire belongings(hoard or collect)but is not fully aware or is not at all aware that it is an issue. COMPONENT B B.Social Relationships and Networks Social Relationships This component is concerned with social relationships and networks.Covered in this & component is the client's engagement with friends and family,and to some degree their Networks interaction and relationships with professionals. There is no quantifiable measure of how many friends or family members a client should have,or the level of interaction that determines a relationship.More than one relationship involving fairly frequent interaction over several months is encouraged. In some instances,the capacity of an individual to trust or make an informed decision Page 12 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL (SPDAT) MARCH 2013 about social interaction can be a cause for concern.This is especially true of those clients who have a history of victimization,engagement in dependent relationships,and who are exploited for goods or services. It is possible for a client to be satisfied with a relationship that is in fact detrimental to their own wellness.These types of situations are captured as a 4 on the scoring scale. 0= Has friends and/or family supports as they would like them,and has maintained those relationships for greater than 6 months. 1 = Has some friends and/or family supports,and/or working on relationships,and/ or the relationship is how they would like,but for less than 6 months. 2= Engaged in relationships with friends and/or family,occasionally with some dif- ficulties and/or still at the very early stages of relationship development. 3= Discussing or is in the early stages of establishing relationships with friends and/ or family,but having difficulty maintaining contact or advancing the relation- ship;or client has relationship with friends or family but it is have some negative consequences on the client's wellness.May be talking to new people,but not at a stage of trusting or liking them yet.Meanwhile,the individual may maintain good relationships with professionals. 4= While may have acquaintances or relationships with people out of convenience or necessity—including co-dependent relationships or feelings of need for the relationship based upon past victimization or abuse,no meaningful social rela- tionships and networks with people of their choosing that they like;or client has relationship with friends or family but it is having serious consequences on the client's wellness.While the individual may have relationships with professionals, they are not consistently good. C.Meaningful Daily Activity COMPONENT C This component is concerned with the ways in which clients spend their days.The activities Meaningful Daily Activity that a client engages in are informed by their own choices.These activities should extend beyond those pursuits that are informed solely by the requirements of the case plan.Mean- ingful daily activities should provide engagement for most,if not all,days of the week. Examples of activities that are not considered to be meaningful daily activities include using substances for large portions of the day and/or spending large portions of the day finding/getting money to pay for substances and/or sleeping or being otherwise incapaci- tated as a result of their substance use and/or acquiring substances;survival activities(e.g., binning;bottle collecting;sex work);therapy;doctor's appointments and medical treat- ments;seeking employment;court mandated or ordered activities;and,criminal activities. One's choice of meaningful daily activity is informed by personal and cultural preferences, as well as financial capacities.Of importance is not only that the client is engaged in OrgCode Consulting Inc. v3.0 Page 13 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 meaningful daily activities,but that they also have a sense of fulfillment on some level from the participation in that activity.This usually is equated with intellectual,emotional,social, physical or spiritual fulfillment. In addition,the activities and the sense of fulfillment should provide a sense of personal satisfaction.There is no specific metric for this satisfaction other than a personal feeling of self-esteem,contentment,confidence,recovery,etc. While it is reasonable for an individual to enjoy solitary meaningful daily activities,there is an expectation that some activities will involve interacting with the community outside of their immediate housing situation. 0= Has activities related to employment,volunteering,socio-recreation,etc.that provide fulfillment intellectually,socially,physically,emotionally,spiritually,etc., occupying most times of day and most days of the week,and which provide a high degree of personal satisfaction. 1 = Has some activities related to employment,volunteering,socio-recreation,etc. that provide some fulfillment intellectually,socially,physically,emotionally, spiritually,etc.,occupying some times of the day and/or some days of the week, which provide a good degree of personal satisfaction. 2= Attempting activities that may provide fulfillment intellectually,socially,physi- cally,emotionally,spiritually,etc.but not occupying most days or most parts of any given day,and not yet providing a good degree of personal satisfaction. 3= Discussing or in early stages of attempting activities that may provide fulfillment intellectually,socially,physically,emotionally,spiritually,etc.but not fully com- mitted.At times disengaged from activities,and activities are not yet occupying most days,nor providing personal satisfaction. 4= Not engaged in any meaningful daily activities that provide fulfillment intellec- tually,socially,physically,emotionally,spiritually,etc.Very little to no personal satisfaction. COMPONENTD D.Personal Administration and Money Management Persona/Administration This component is concerned with a client's ability to manage their money and the associ- &Money Management ated administrative tasks such as paying bills,filling out forms,completing a budget,and submitting necessary paperwork or documentation. Income sources should be considered formal (for example,employment income;income support through welfare,etc.)as well as informal(for example,proceeds from sex work; "working under the table";drug sales,etc.). It is understood that some individuals may only have a small amount of income.It may be Page 14 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL (SPDAT) MARCH 2013 that they manage that small amount of income quite well,but still run out of money to- wards the end of the month in most,if not all,months.This shortfall of funds is not an issue with their ability.It is an issue with the amount of money they receive relative to their other expenses such as housing.These individuals are classified as a 2. 0= Has an income source and manages all personal finances and benefits indepen- dently.Can pay bills and fill out all appropriate paperwork and forms without assistance from others.Has been doing so for 6 months or more. 1 = Has an income source and manages all personal finances and benefits inde- pendently,and can pay bills,and fill out all appropriate paperwork and forms without assistance from others.Has been doing so for less than 6 months. 2= Has an income source and manages most personal finances and benefits with a little help from time to time,which may include help paying bills,filling out paperwork and forms or using a voluntary trusteeship program.Also includes those individuals that manage their money well with what they receive but require assistance from the likes of a food bank at the end of the month to make ends meet,as well as those that are on and off income support more than 2 times in any 12 month period. 3= Has an income source,but requires frequent assistance to manage personal finance and benefits,which may include the use of a guardian or trustee(which may be voluntary).Likely requires intensive supports to take care of paperwork and forms.Likely requires prompts,reminders and/or assistance paying bills and may not always budget appropriately for all bills.Likely requires intensive assistance budgeting.If a substance user,is likely not involved in accounting for substance use in budgeting.May have significant debt load,including"street debts"and/or gambling debts. 4= May or may not have an income.Requires intensive assistance with personal finances and benefits,which may include the use of a guardian or trustee(which may be voluntary).Almost always fails to appropriately fill out forms or complete paperwork.Cannot create or follow a monthly budget.Almost always needs prompts,reminders and/or assistance paying bills and almost always does not have enough income to cover all bills from the previous month(and may not comprehend this,thinking bills are consistently higher than they should be). Most likely not budgeting for substance use,if a substance user.Likely to have significant debt,including"street debts"and/or gambling debts. OrgCode Consulting Inc. v3.0 Page 15 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 COMPONENT E E.Managing Tenancy Managing Tenancy This component is concerned with an individual's management of their apartment.The primary foci are payment of rent,not disrupting the enjoyment of other tenants,positive relations with the landlord/superintendent and avoiding unit damage. Any person who is homeless at the time the SPDAT is completed shall be considered a 4. This component is specifically concerned with the retention and implementation of skills necessary to care for one's apartment and manage their tenancy. Third party payment of rent is not considered to be assistance in the payment of rent.That is an administrative function of how rent gets paid(not unlike a direct transfer for a mort- gage payment),and not necessarily an indication of need for assistance. 0= Has taken care of apartment unit for 6 months or more without any external sup- port including such things as payment of rent,following lease agreement and physically maintaining unit in good shape. 1 = Has taken care of apartment unit for less than 6 months without any external support including such things as payment of rent,following lease agreement and physically maintaining unit in good shape. 2= Needs assistance in taking care of the apartment unit up to three times in any three month period or a maximum of once per month,which may include as- sistance paying rent,managing situations that the landlord has taken exception to,or in physically maintaining the unit in good shape.Has not needed to be re-housed within the past three months. 3= Needs assistance in taking care of the unit four to nine times in any three month period or two or more times per month,which may include assistance paying rent,conflict resolution and problem solving and mediation with the landlord,or in physically maintaining the unit in good shape.Has been re-housed as a result of these or similar issues within the past three months or will likely need to be re-housed within the next two months. 4= Needs assistance taking care of the unit ten or more times in any three month period or three or more times in any given month,which may include assistance paying rent,conflict resolution and problem solving and mediation with the landlord,or in physically maintaining the unit in good shape.Will need to be re- housed imminently or the re-housing process may be underway.This category also includes all clients that are not yet housed at time of baseline evaluation. Page 16 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 F.Physical Health and Wellness COMPONENT F This component covers physical health and wellness. Physical Health There are four considerations related to the client in this component:whether they have a Wellness physical health issue;the severity of the health issue;whether they are accessing care for that physical health issue(including those who may wish to access care but are unable to based upon insufficient health resources in the community);and,how the individual views wellness. In this component,minor physical health issues are those that can be treated without overly intensive care or through non-obtrusive,accessible interventions.For example, an individual who breaks their arm and requires a cast,but does not require surgery or extensive physiotherapy may be considered to have a minor physical health issue.Another example might include an individual with an arthritic knee who routinely uses a mobility- assistance device. Chronic health issues include,but are not limited to,conditions such as heart disease,can- cer,diabetes,and immunological disorders. Intensive health supports includes the provision of professional wound care,assistance with a colostomy bag,injection medications and similar interventions. 0= No physical health issues.Completely well. 1 = Physical health issues are relatively minor,or in the event of a chronic condition, the individual has considerable knowledge of their health needs and closely fol- lows the treatment protocol.The individual is connected to appropriate profes- sional resources. 2= Physical health issues present and while the individual is following treatment protocols,day to day functioning is still impacted. 3= Physical health issues present,which may be chronic in nature and/or requires intensive health supports,but the individual is not connected to appropriate professional resources either by choice or because of insufficient community resources.In some limited situations an individual may be connected to sup- ports and following treatment protocols,but the treatment is having very little to no impact on improving day to day living and/or the individual cannot follow all parts of the treatment protocol(e.g.,required to rest,but no place to rest 24/7 because of being homeless).The individual may not see the total value of wellness and getting better. 4= Serious health issues which are most frequently co-occurring,chronic and complex.In most instances the individual is not connected to appropriate pro- fessional resources,or the individual is involved in treatment that is having no impact on the condition and/or the individual cannot implement the treatment protocol;and/or,the individual is palliative. OrgCode Consulting Inc. v3.0 Page 17 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 COMPONENT G G.Mental Health and Wellness&Cognitive Functioning Mental Health This component covers mental health and wellness,as well as cognitive functioning.The & intent is not to provide a diagnosis.While there may be many reasons for an individual Wellness to have a compromised ability to communicate clearly or engage in socially appropriate & behaviour,these may be clues,along with the likes of delusions,hallucinations,incompre- Cognitive Functioning hensible dialogue,or apparent disconnect from reality.A suspected or untrained observa- tion of mental illness or compromised cognitive functioning can be a prompt for further dialogue to have an appropriate professional engage. There are a range of mental health conditions.Consideration should be given to any indi- vidual who would fall under Axis I,II or III disorders according to the DSM-IV(Diagnostic and Statistical Manual). An Axis I disorder covers clinical disorders including major mental disorders and learning disorders.An Axis II disorder covers retardation of mental capacity and personality disor- ders.An Axis III disorder covers acute medical conditions or physical disabilities such as brain injuries that aggravate existing symptoms or can present symptoms similar to other disorders. Caution should be exercised in considering whether an individual qualities as having a serious and persistent mental illness.Some considerations in making this determination would include such things as:whether they have been hospitalized for psychiatric care two or more times in the last two years;whether they have an Axis I or Axis II disorder;and, whether it is reasonable to believe they would likely be hospitalized for psychiatric care according to a mental health professional. Included in consideration of compromised cognitive functioning are barriers to daily functioning that result from the likes of head injuries,learning disabilities(as validated by neuropsychological or psycho-educational testing),and/or developmental disorders.In most instances barriers to daily functioning as a result of compromised cognitive function- ing will include one or more of the following:diminished aptitude;issues with memory especially related to visual or verbal acquisition,retrieval,retention and/or recognition; attention issues such as decreased visual or auditory spans of attention;compromised executive functioning such as the ability to plan,prioritize,organize or sequence activities. Page 18 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 0= No mental health or cognitive functioning issues disclosed,suspected or ob- served. 1 = The individual has disclosed that they have a mental health issue or diminished cognitive functioning,and are effectively engaged with professional assistance to manage the issue;or an individual is in a heightened state of recovery,fully aware of their symptoms and wellness and manages their mental health and wellness independently. 2= The individual has a disclosed,suspected or possibility of mental health issues and/or cognitive functioning issues based upon that which is observed or heard, but any impact on communication,daily living,social relationships,etc is mini- mal.Possibly without formal diagnosis.If diagnosed,may not require anything more than infrequent assistance. 3= The individual has a significant mental health issue disclosed,suspected or ob- served,or the individual has significantly diminished cognitive functions,most likely having an impact on communication,daily living,social relationships,etc. The individual may have supports but the mental health and/or cognitive func- tioning issues still have considerable impact on day-to-day living.Assistance is required,but the client has no consistent,ongoing assistance. 4= The individual has a serious and persistent mental health issue disclosed,sus- pected or observed and/or the individual has major barriers to daily functioning as a result of compromised cognitive functioning;most likely greatly impacting communication,daily living,social relationships,etc.,While most often without ongoing assistance,it is possible that the individual does have supports,but their serious and persistent mental health issues or major cognitive functioning issues are still greatly impacting day to day living. OrgCode Consulting Inc. v3.0 Page 19 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 COMPONENT H H.Medication Medication This component addresses medications that have been prescribed by a professional and that are being used in an amount and for a purpose that is consistent with the prescription. Over the counter medications are not included here.If a client is using an over the counter medication fora purpose other than intended,it may be considered as part of the compo- nent on substance use. Those who take medications that are not prescribed by a medical professional,even if it is for a mental health or physical ailment,should be considered substance use. 0= Does not take any medications,or has demonstrated consistent self-manage- ment of medications for greater than 6 months. 1 = Takes medications and has been self-managing the use of medications for less than 6 months. 2= Takes medications but requires some assistance from time to time,including prompts to take the medication,understanding what the medication is for and/ or instruction on proper storage or use of the medication. 3= The individual takes medications,but may forget to take them regularly or may use them improperly from time to time. If the individual is selling their prescrip- tion drugs to others,they keep the majority of the prescription for themselves. Likely requires significant assistance to manage,including regular reminders, schedules or prompts,understanding what the medication is for and/or instruc- tion on proper storage or use of the medication.May also include individuals who have had their prescription changed within the past month and the effects and routine of the new regime are not yet fully worked out,but are not having a debilitating impact on the person's health or daily activities. 4= The individual does not use medications as prescribed,which may include fre- quently failing to take the medication.This includes individuals with a prescrip- tion that is never filled(including those who did not fill the prescription because of financial restraints).If the individual is selling their prescription drugs,most or all of the prescription is sold.The individual may also demonstrate a lack of interest or understanding in how and when to take the medication,what it is for, or how it should be stored or used.May also include individuals who have had their prescription changed within the past month and the effects and routine of the new medication are significantly impacting day-to-day living,their health or daily activities. Page 20 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 I.Interaction with Emergency Services COMPONENT! This component is concerned with interactions with emergency services. Interaction with Emergency Services An interaction is not a casual encounter such as striking up a conversation with a police officer on the street,passing by a firefighter battling a blaze,seeing ambulance workers provide care on the street,or taking a friend to the emergency room.The interactions this component is interested in are deliberate and direct interactions between the client and staff from emergency rooms in hospitals,police officers,ambulance attendants and/or fire- fighters(including in the capacity of providing First Aid/CPR—not solely in their function of fighting fire). Also relevant to this component is the client's interaction with crisis services,and their time spent in hospitals for overnight or long term care. 0= No interaction with emergency rooms,hospital,crisis service,police,ambulance or fire for more than 6 months. 1 = No interaction with emergency rooms,hospital,crisis service,police,ambulance or fire for less than 6 months. 2= One to three interactions with emergency rooms,hospital,crisis service,police, ambulance and/or fire in the last 6 months. 3= Four to nine interactions with emergency rooms,hospital,crisis service,police, ambulance and/or fire in the last 6 months. 4= Ten or more interactions with emergency rooms,hospital,crisis service,police, ambulance and/or fire in the last 6 months. COMPONENT l J.Involvement in High Risk and/or Exploitive Situations Involvement in High Risk This component is concerned with a client's involvement in high risk and/or exploitive situations. and/or Exploitive Situations Involvement on the part of the client may have been voluntary or involuntary.It is both what they have done as well as what has been done unto them. While not an exhaustive list,examples of high risk and exploitive situations include:sex work;injection substance use;slavery;drug mule;unprotected sexual engagement(out- side of a monogamous relationship);binge drinking;sleeping outside as a result of black- ing out;being directly or indirectly forced to work;being used for any activity against one's will,consent or knowledge;being short-changed for work undertaken;being in environ- ments prone to violence;engaging in activity solely for the benefit of others without any personal gain or benefit. OrgCode Consulting Inc. v3.0 Page 21 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 This component also includes those individuals leaving an abusive situation given the high risk the abuser presents.As the mental or physical abuse experienced by the victims is a daily occurrence,these victims are considered a 4. People who have been sleeping rough may also be considered to be in a high-risk situa- tion.Without protective clothing and appropriate sleeping gear they run the risk of expo- sure and temperature related ailments.Depending on where they are sleeping rough,they may be exposed to higher incidents of violence,sexual assault,and theft. 0= Has not been involved in a high risk or exploitive situation for more than 6 months. 1 = Has not been involved in a high risk or exploitive situation for less than 6 months. 2= Has been involved in one to three high risk or exploitive situations in the last 6 months. 3= Has been involved in four to nine high risk or exploitive situations in the last 6 months. 4= Has been involved in ten or more high risk or exploitive situations in the last 6 months. COMPONENT K K.Substance Use Substance Use This component covers substance use,which is the use of alcohol(including non-palatable alcohol)and/or other drugs. Prescription drugs,including methadone treatment,are not considered in this component unless they are used for a purpose other than for how they were prescribed.Otherwise, they are considered in the component on medication. Information on usage thresholds has been drawn from leading addiction scholars and researchers.It is acknowledged that there can be differences in opinion amongst learned professionals in this field concerning the distinction between substance use and abuse, and in the amounts that can be safely consumed on a daily or weekly basis."Acceptable consumption thresholds"for alcohol are:2 drinks per day or 14 total drinks in any one week period for men;2 drinks per day or 9 total drinks in any one week period for women. Non-palatable alcohol includes any substance with an alcohol content that is not intended for sipping or regular consumption.This would include substances such as Listerine,cook- ing wine and alcohol based hand-sanitizers. Binge drinking is classified as any instance where a male consumes 5 or more drinks or a fe- male consumes 4 or more drinks in a single hour;or when 10 or more drinks are consumed in a single drinking episode(for example,an evening of drinking). Page 22 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 0= Has not used drugs or alcohol for 12 months or more. 1 = Does not use drugs.Alcohol consumption does not exceed acceptable con- sumption thresholds.Substance use has no impact on daily functioning.If practicing abstinence,has achieved at least 14 days of sobriety. 2= Up to four incidents of using drugs and/or alcohol in a one month period, that may occasionally include non-palatable alcohol,and/or may occasionally include binge drinking.Any impact that the substance use has on daily func- tioning is infrequent.If there are health impacts as a result of substance use,the impacts are relatively minor. 3= More than four incidents of using drugs and/or alcohol in a one month period, that may include non-palatable alcohol,may include binge drinking,and is likely to exceed daily maximum acceptable consumption thresholds on a regu- lar basis.Impacts of the substance use on daily functioning are frequent,even if the individual does not acknowledge these consequences.Health is likely compromised as a result of alcohol or drugs. 4= Use of drugs and/or alcohol is likely daily,frequently including non-palatable alcohol,most often including binge drinking,most often using to the point of complete inebriation (may include passing out).Impacts of the substance use on daily functioning are severe and may be life threatening. COMPONENT L L.Abuse and/or Trauma Abuse and/or Trauma This component is concerned with the impact of abuse or trauma experienced by the individual,including inter-generational impacts.Included in this component are individu- als who are survivors of abuse or trauma as children.Additionally,traumatic events may be very recent or ongoing,and may be the cause of the current period of homelessness.Note that the experience is not automatically considered to be a traumatic event for all people. For the purpose of this component institutional abuse is considered a history of abuse or trauma. This component uses self-reports to assess the impact of abusive and traumatic experienc- es on day-to-day life,and to assess the state of recovery,if any.The purpose of this compo- nent is not to uncover what the traumatic events were/are,and care must be exercised to avoid exploring the traumatization through questioning. In recognition that not all have access to professional counseling services,therapeutic re- covery should considered broadly.This is particularly pertinent when considering culturally significant healing practices. OrgCode Consulting Inc. v3.0 Page 23 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 0= The individual does not report a past or present experience of abuse and/or trauma. 1 = The individual has a history of abuse and/or traumatic events,but reports no serious consequences on present functioning and/or ability,or indicates resolu- tion of past abuse through therapeutic means. 2= The individual has a history of abuse and/or traumatic events that are impacting present functioning and/or ability.The individual may currently be engaged in therapeutic attempts at recovery,but does not consider self to be recovered. 3= The individual has a history of abuse and/or traumatic events that are severely impacting present functioning and/or ability.The individual has not attempted therapeutic recovery. 4= The individual is currently experiencing abuse or a traumatic event that is caus- ing the current period of homelessness.No attempt at therapeutic recovery has been made. M.Risk of Personal Harm/Harm to Others COMPONENT M This component is concerned with risk of personal harm and/or risk to others. Risk of Personal Harm/ Hatrm to Others Included in this component are both actions and written or verbal statements.That is,the undertaking of harm as well as the threatening of harm. There are no guaranteed ways in which someone can predict if another person will act in ways harmful to themselves or others. The assessment for this component takes into consideration the likelihood of risk which considers a number of indicators,the history of harming oneself or others,the time since the last action or threats,and,the individuals ability to de-escalate. The indicators that help inform the likelihood or risk include such things as: • Severe depression • Giving away personal possessions • Expressing plans for a suicide attempt • Sense of hopelessness • Access to lethal means such as a weapon or toxic substance • Previous suicide attempts • Excessive substance use • Social withdrawal and isolation • History of incarceration for violent acts • Specific threats of violence against specific people • Strong feelings of being wronged by a specific person or group of people • Expressing plans for a violent act against another person or group of people Page 24 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 0= No perceived risk to self or others.No known history of harming self or others. No known threats or making of harmful statements. 1 = Limited risk to self or others.No history of harming self or others within the past 12 months,though may have limited exposure from the past.No threats or mak- ing of harmful statements within the past 6 months. 2= Possible risk to self or others.No history of harming self or others within past 12 months,though may have exposure from the past.May have very infrequently made statements concerning potential harm to self or others within the past 6 months,but no action taken.Individual de-escalated after making statements. 3= Probable risk to self or others.Episode of attempting or actually harming self or others within past 12 months and likely verbal or written statements threaten- ing harm to self or others within the past 6 months. 4= Imminent risk to self or others.Clear,strong threats of harming self or others, without de-escalation.Recent frequent episodes of attempting or actually harming self or others. N.Legal COMPONENT N This component is concerned with legal issues. Legal Legal issues pertain to any offences by any order of government or any area of law enforce- ment to which the person is subject to such things as paying a fine,undertaking commu- nity service,or being incarcerated. Unless it is a single individual involved in such matters,it does not include any involvement in family court or child custody apprehension,as these are dealt with in a separate component. The time frames references below pertain to the length of time since the most recent court ap- pearance(not the time since the charge which may have occurred quite a bit of time before). 0= No legal issues for 12 months or more. 1 = At least one legal issue in the past 12 months,but it was discharged or resolved with- out community service,payment of fine or incarceration.No current legal issues. 2= At least one legal issue in the past 12 months and it was resolved through pay- ment of fine or community service.It may also include current legal issues that are unlikely to result in loss of housing or incarceration. 3= At least one legal issue in the past 12 months that may result in fines that may put housing at risk and/or periods of incarceration of three months or less that may place housing at risk. 4= At least one legal issue in the past 12 months that resulted in fines that place hous- ing at imminent risk and/or periods of incarceration greater than three months. OrgCode Consulting Inc. v3.0 Page 25 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 COMPONENT 0 0.History of Homelessness and Housing History of Homelessness This component is concerned with the client's history of homelessness and housing. Housing The cumulative duration of homelessness is concerned with the total number of days that a person was homeless within the specified time period.It acknowledges that a person may have been homeless for one or two days,housed,then homeless again.The number of days spent homeless is added up to produce the cumulative total. The types of homelessness captured in this section include absolute homelessness(sleep- ing rough;staying in shelters;living in a car;squatting)as well as relative homelessness (couch surfing;overcrowding).What is most important is the client's own determination of what constituted their homelessness.Prompts may be necessary to assist clients in making a determination of when they considered themselves to be housed or homeless. This component will not change in later assessments of the SPDAT unless the client reveals new information. 0= Cumulative duration of homelessness was less than 7 days over the past four years,which may include being recently re-housed. 1 = Cumulative duration of homelessness was between 8 and 30 days over the past four years,which may include being recently re-housed. 2= Cumulative duration of homelessness was between 30 days and 2 years over the past four years. 3= Cumulative duration of homelessness was between 2 years and 5 years over the past decade. 4= Cumulative duration of homelessness was greater than 5 years over the past decade. Page 26 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 Summarizing Scores It is recommended that Frontline Workers,Team Leaders and Program Supervisors build familiarity with the descriptions of all of the components above.The objective is to achieve competence in applying the SPDAT without having to reference the complete SPDAT Manual.The most important tool is the Summary Sheet on the next page.The Summary Sheet should be the only documentation visible to the client when using a conversational approach to gaining input for the SPDAT.As previously noted in the section about disclo- sure,the client should be offered a copy of the Summary Sheet after the application of each SPDAT. In the event of uncertainty between two possible scores for a component,i.e.,if you are uncertain if the client is a"2"or a"3",the higher score should be used. The Comments section should be used throughout the Summary Sheet for five fundamen- tal reasons: 1. The Comments section should reveal the source of the information that led to the assessment: Self-Report, Observation, Case Notes, Conversation, Other Docu- mentation. 2. The Comments section should be used to note if there was uncertainty and a higher score for the component was used—as noted above. 3. The Comments section can be used to note if any particular circumstances seem to be impacting the assessment score for an individual component. 4. The Comments section can be used to make note of any relevant trends in the component for the client. 5. The Comments section can be used to make any notes that will be helpful for subsequent SPDAT evaluations. Practitioners should write comments factually.Comments should only be relevant to the context of the SPDAT and mindful of the fact that clients will be offered a copy of the SP- DAT Summary Sheet. When summarizing the scores,it is important that a score is noted for every component. For example,noting a"0"is appropriate,leaving the component blank with an implied"0" is not appropriate.After there is a value for each component,a total score can be tallied for the client.This final score represents the client's level of acuity out of a total possible rating of 60. OrgCode Consulting Inc. v3.0 Page 27 M N U K ki\ \ \ 0 < e 71 2«r . Q401 r44 O -40 a Q.'. ill 0 0 14 c zU 0 § E \ -o / 744 / \ / / z 2 E \ / % o . S \ \ § >, & < t 2 -0 L s \ - \ _ R >- < 0 = • n 3 2 Cr $ 0 0 { ) 0 \ g E \ / 4 E = I N \ ± DI c ƒ \ ' \ I § ° 2 (0 2 % \ c c § k - § < / \ Cl.) ƒ / / i / 2 O a a, \ / q ' 4 e Q e u i.i d co Q ¢ 0 » ar § cn _ CC2 , M csi U cc& 2 k cnj / /» 0 , . . , ?2 < \/ g 1111r."4 N Q O 111 -0 O. ^ ° Vi0 le ^veer 10 o 14 a i- / a) / \ , • vi ° @ 0 0 til / A / / U $ $ Ln iii -0E E (tsE \ 2 § cs vl g \ m a) o 3 m I 5 & ` § \ a) » \ E rsi AO / ® / 2 2 $ E © = c o }: g / \ ) / % irc \\\� .+7. \ % \ 2 e % ¥ ` La » a a / m ± & / U } / \ / 3 7 $ Fc 3 I ILI ± _ cc • 2 / 2 d / . SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL (SPDAT) MARCH 2013 Prioritizing Service Based Upon Score&Guiding Supports The recommended intervention and approach to supports is linked to the level of acuity. Scofing ° Iq r @a 7 a ( Intervention - Comments 0-19 Housing Help Supports Generally high functioning individuals with shorter periods of homelessness.Needs are not as complex in most of the SPDAT categories.Are most likely to solve their own homelessness,perhaps with very brief financial assistance,shallow subsidy,access to apartment listings and the like. 20-39 Rapid Re-housing With some supports,though not as intensive as Housing First,the individuals can access and maintain housing.The focus of the supports will more likely be on a smaller number of SPDAT com- ponents.Support services do not last as long as Housing First supports. 40-60 Housing First These are individuals with more complex needs who are likely to benefit from case management supports either through Intensive Case Manage- ment or Assertive Community Treatment.Scores in the SPDAT are likely to be higher(3s and 4s)in many of the components. Within each category,those clients scoring closer to the top of the threshold are the first priority.For example,if two clients have undergone an intake and one scores a 53 and the other a 49,and there is only one opening on a caseload,the individual with the highest score is served first. For those clients who receive a Rapid Re-housing or Housing First service,it is expected that the overall SPDAT score is likely to decline over time during the period when a client is receiving supports even though there may be fluctuations in any of the 15 elements from one review to the next. Consistently lower scores(which reflects overall life improvements and increased stability) can be used to focus on"graduation"from program supports,leading to decreased and then terminated service supports. If a client is in crisis at the time of an SPDAT measurement,it may misrepresent overall acuity.To provide greater accuracy in the overall measurement,it is recommended that an additional SPDAT evaluation be taken once the crisis is resolved. Page 30 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 Regardless of the scoring and priority sequencing system outlined above,circumstances may that require additional information be considered in establishing the priority of clients to be served.This decision rests with the Team Leader and/or Senior Managers/Central Administrators within the community.It is incumbent upon these decision makers to justify exceptions in service delivery,acknowledging that there can be many reasons for an exception based upon local circumstances at any point in time.Known as the"notwith- standing"clause of SPDAT use,it is important that this approach is used infrequently,in limited circumstances and with sufficient justification. System Navigation and Support for Clients Can Be Informed Using SPDAT Results Individual communities as well as cross-agency partnerships can create specific processes to better assist clients relative to their SPDAT score. For example,a SPDAT score of 52+that includes higher scores related to mental health and wellness and/or physical health and/or substance use may trigger a referral or secondary assessment by a specialized health,mental health or addiction resource such as an ACT Team or another specialized service team. Within individual teams,Team Leaders can use the SPDAT scores in each component to help inform which Follow-up Support Worker may have a skill set or expertise to best assist with a specific circumstance.The assigning of a Follow-up Support Worker to a particular client can be rationalized using SPDAT information. There may also be instances where SPDAT scores are employed to enhance inter-agency partnership or overall caseload balance throughout the service system.For example,Team Leader and/or Senior Management meetings across agencies may result in client transfers among Housing First teams to ensure more balance across teams of clients with higher SPDAT scores. Local Variations in SPDAT Use Locally,system administrators can develop their own rules pertaining to priorities from scoring,system navigation,integration with a Homeless Management Information System and the use of the notwithstanding clause. Individual organizations and communities may not adjust the scoring,ranking or descrip- tions of any of the 15 components. Guide to Assist SPDAT Conversation As noted previously,much of the information for completing the SPDAT can be attained through methods other than a specific conversation about the components.For example,a home visit with a client may self-reveal that they are not managing their medications.This information is used for the SPDAT rather than seeking the information again—unless there OrgCode Consulting Inc. v3.0 Page 31 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 was confusion about the client's intent.Another example might be a client who shares some legal documentation that provides information relative to understanding how to complete the Legal category of the SPDAT.Information may also be obtained for the SPDAT through observation.Home visits are opportunities to assess the components Self Care and Daily Living Skills and/or Managing Tenancy. The SPDAT is also integrated with information from the support and case planning process. Conversations with clients relative to their goals and activities often provide sufficient information for the assessment of many of the other components.Information obtained through the support and case planning process does not need to be repeated during the SPDAT assessment unless clarification is required. When a specific conversation about the SPDAT is needed,the following questions can be helpful in guiding and assisting with that conversation.These questions have worked well during implementation of versions one and two of the SPDAT.To improve implementation, we encourage organizations within each community to share the questions that they are using to gain information from clients. The following table outlines questions that will guide and assist the conversation.These questions are suggestions,and are not mandatory to achieve responses for the SPDAT.The questions are organized by SPDAT components: I'•IZli3cme - W3� a `'w*< ffiF.r'eL" p I A.Self Care and Daily • Do you have any worries about taking care of yourself? Living Skills • Do you have any concerns about looking after cooking, cleaning, laundry or anything like that? • Do you ever need reminders to do things like shower or clean up? • If I were to come over to your last apartment, what would it look? • Do you know how to shop for nutritious food on a budget? • Do you know how to make low cost meals that can result in leftovers to freeze or save for another day? • Do you tend to keep all of your clothes clean? • Have you ever had a problem with mice or other bugs like cockroaches as a result of a dirty apartment? • When you have had a place where you have made a meal, do you tend to clean up dishes and the like before they get crusty? Page 32 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 ..a 74 G, GEa.�itaP° a ,.u.r t..7ur ... `! "._.:a',3v.. B.Meaningful Daily • How do you spend your day? Activity • How do your spend your free time? • Does that make you feel happy/fulfilled? • How many days a week would you say you have things to do that make you feel happy/fulfilled? • How much time in a week would you say that you are totally bored? • When you wake up in the morning do you tend to have an idea of what you plan to do that day? • How much time in a week would you say you spend doing stuff to fill up the time rather than doing things that you love? • Are there any things that get in the way of you doing the sorts of activities you would like to be doing? C.Social Relationships • Tell me about your friends, family and the other people and Networks in your life. • How often do you get together or chat with these people? • When you go to doctors appointments or meet with other professionals like that, what is that like for you? • Are there any people in your life that you feel are just using you? • Have you ever been threatened with an eviction or lost a place because of something that friends or family did in your apartment? • Are there any of your closer friends that you feel or always asking you for money, smokes, drugs, food or anything like that? • Have you ever had people crash at your place that you did not want staying there? • Have you ever been concerned about not following your lease agreement because of your friends or fam- i ly? OrgCode Consulting Inc. v3.0 Page 33 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 . ,.. ,a ' —Pro_+ :: wwa.u...V.. .,._,. D.Mental Health and • Have you ever received any help with your mental Wellness&Cognitive wellness? Functioning • Have you ever had a conversation with a psychiatrist or psychologist?When was that? • Do you feel you are getting all the help you might need with whatever mental health stress you might have in your life? • Have you ever hurt your brain/head? • When you were in school, did you ever have trouble learning or paying attention? Was any reason given to you for that? • Was there ever any special testing done on you when you were in school or as a kid? • Has any doctor ever prescribed you pills for your nerves, anxiety, feeling down or anything like that? • To the best of your knowledge, when your mother was pregnant with you did she do anything that we now know can have lasting effects on the baby? • Have you ever gone to an emergency room or stayed in a hospital because you weren't feeling 100% emo- tionally? E.Physical Health and • How is your health? Wellness • Are you getting any help with your health? How often? • Do you feel you are getting all the care you need for your health? • Anything like diabetes, HIV, Hep C or anything like that going on? • Ever had a doctor tell you that you have problems with your blood pressure or heart or lungs or anything like that? • When was the last time you saw a doctor?What was that for? • Do you have a clinic or doctor that you usually go to? • Anything going on right now with your health that you think would prevent you from living a full, healthy, happy life? Page 34 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 F.Substance Use • Be straight up-when was the last time you had a drink or used drugs? • Is there anything we should keep in mind related to drugs or alcohol? • [If they disclose use of drugs and/or alcohol] How frequently would you say you use [specific substance] in a week? • In the last little while have you ever drank so much you passed out? • Ever get into fights when you drink? • Ever have a doctor tell you that your health may be at risk in any way when you drink or use drugs? • Ever fall down and bang your head when drinking or using other drugs? • Have you ever used alcohol or other drugs in a way that may be considered less safe? • Do you ever end up doing things you later regret after you have tied one on? • Do you ever drink the likes of mouthwash or cooking wine or hand sanitizer or anything like that? • When you use drugs, in the last year have you ever had bad stuff that made you feel off? G.Medication • Do you take any medicines? • [If they do] Were these prescribed by a doctor?To you? • Have you ever sold some or all of your prescription? • Have you ever had a doctor prescribe you a medicine that you didn't have filled at a pharmacy or didn't take? • Were any of your medicines changed in the last month? How did that make you feel? • Do other people ever steal your medicine? • Tell me about how you store your medicine and make sure you take the right medication at the right time each day. OrgCode Consulting Inc. v3.0 Page 35 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 H.Personal A • How are you with taking care of money? dministration and • How are you with paying bills on time and taking care Money Management of other financial stuff? • Do you have any street debts? • Do you have any drug or gambling debts? • Is there anybody that thinks you owe them money? • Do you budget every single month for every single thing you need? Including cigarettes? Booze? Drugs? • Do you try to pay your rent before paying for anything else? • Are you behind in any payments like child support or student loans or anything like that? I.Abuse and/or Trauma • I don't need you to go into any details that you are not comfortable with, but has there been any point in your life where you experience emotional, physical, sexual or psychological abuse? • Are you currently or have you ever receiving profes- sional assistance to address that abuse? • Does the experience of abuse or trauma impact your day to day living in any way? • Does the experience of abuse or trauma impact your ability to hold down a job, maintain housing or engage in meaningful relationships with friends or family? • Have you ever found yourself feeling or acting in a cer- tain way that you think is caused by a history of abuse or trauma? • Is your most recent or any past episodes of homeless- ness a direct result of experiencing abuse or trauma? J.Risk of Personal Harm/ • Do you have thoughts about hurting yourself or anyone Harm to Others else? • Have you ever acted on these thoughts? • When was the last time? • What was occurring when you had these feelings or took these actions? • Have you ever received professional help—including maybe a stay at hospital—as a result of feeling or at- tempting to hurt yourself or others? Page 36 v3.0 OrgCode Consulting Inc. SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 � n..,...,..� . K.Interaction with • How often do you go to emergency rooms? Emergency Services • How many times have you had the police speak to you over the past six months? • Have you used an ambulance or needed the fire de- partment at any time in the past 6 months? • How many times have you called or visited a crises team or a crisis counsellor in the last 6 months? • How many times have you been admitted to hospital in the last 6 months? How long did you stay? L.Involvement in • Does anybody force or trick you to do something that High Risk and/or you don't want to do? Exploitive Situations • Do you ever do stuff that could be considered danger- ous like drinking until you pass out outside or deliver- ing drugs for someone or having sex without a condom with a casual partner? • Do you ever find yourself in situations that may be considered at a high risk for violence? • Do you ever sleep outside?Tell me about how you dress and prepare for that?Where do you tend to sleep? • Do you have any illnesses that may be passed on to others? M.Legal • Got any legal stuff going on? • Have you had a lawyer assigned to you by a court? • [If they do] Got any upcoming court dates? Do you think there's a chance you will do time? • Any involvement with family court or child custody mat- ters? • Any outstanding fines? • Have you paid any fines in the last 12 months for any- thing? • Have you done any community service in the last 12 months? • Is anybody expecting you to do community service for anything right now? • Did you have any legal stuff in the last year that got dismissed? • Is your housing at risk in any way right now because of legal things? OrgCode Consulting Inc. v3.0 Page 37 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 . -�. k" a ...G6 ,�S, .. 'Ya.2A #t'4 � � cczi N.History of Homeless- How long have you been homeless? ness and Housing How many times have been homeless in your life other than this most recent time? Have you spent any time sleeping on a friend's couch or floor? And if so,during those times did you consider that to be your permanent address? Have you ever spent time sleeping in a car or alley way or garage or barn or bus shelter or anything like that? Have you ever spent time sleeping in an abandoned building? Were you ever in hospital or jail for a period of time when you didn't have a permanent address to go to when you got out? 0.Managing Tenancy [For individuals who are housed] Do you think that your hous- ing is at risk? How is your relationship with your neighbours? How have you been doing with taking care of your place? Building Consistency Using SPDAT The key to effectively and consistently using the SPDAT within a team and throughout a community is training,practice and sharing successes and mistakes. Throughout a community of Housing Help,Rapid Re-housing and Housing First profession- als,there should be a common understanding about each component of the SPDAT.It is common to most assessment tools for practitioners to have different perspectives about the score of a particular component.The sign of successful,consistent application of the SPDAT is when two people who have experience working with the same client in the same situation have SPDAT scores that vary by only a single point. Staff members and organizations should not deviate from the current definitions or operational instructions for the SPDAT or create their own system.To ensure valid and reliable evaluation of outcomes,definitions and interpretations of information must be consistent within and across all organizations delivering Housing Help,Rapid Re-housing and Housing First within a community.Doing otherwise results in an inconsistent approach to prioritizing services and meeting the needs of clients."Creaming"is unacceptable and counter-productive. Infusing SPDAT into a standard practice will require the tool to be a part of the initial orien- tation or on-boarding new staff.Shadowing and coaching can be effective approaches for ensuring that new staff members apply the SPDAT consistently with other members of the team. Page 38 v3.0 OrgCode Consulting Inc. 1 11 SERVICE PRIORITIZATION DECISION ASSISTANCE TOOL(SPDAT) MARCH 2013 ORG CODE Cc > OrgCode Consulting Inc. One Tecumseth Avenue Port Credit Canada L5G I K5 T 416 698.9700 F 416 352.1498 E info©orgcode.com y . rikttor• ovolorgc.ode ,U 1 I I OrgCode Consulting Inc. v3.0 Page 39 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Endnotes 1 According to the most recent Annual Homeless Assessment Report,992 different people accessed homeless services in Virginia Beach over a 12-month period. 2 In the most recent Point in Time Count conducted in January 2013,456 different people were counted as homeless— both outdoors and using indoor homeless serving facilities—during a 24-hour period. 3 "Chronically homeless"means the individual has a disabling condition and either:a)has been homeless for a consecutive year or more;or,b)has three or more episodes of homelessness in the last four years.The determination of 1 in five homeless persons in Virginia Beach meeting this definition comes from information collected during the 2013 Point in Time Homeless Count. 4 As a condition of receiving funding from the US Department of Housing and Urban Development,communities must conduct a Point in Time count of its homeless population. 5 Tracking numbers on homelessness among veterans is now being coordinated better and data show there are 931 homeless veterans in Virginia;the rate of veteran homelessness is 13 homeless veterans per 10,000 veterans in the general population. In Virginia Beach,there are 78 homeless veterans,a 28 percent increase over 2011.Tracking numbers on unaccompanied homeless youth is also being coordinated better and data on this subpopulation should be incorporated into planning in the future;in 2013,only 1 homeless unaccompanied youth was identified in the PIT count. This is important data to have for two reasons: 1)there has been greater emphasis within Veteran's Affairs to work towards ending homelessness amongst veterans;2) there is emerging policy and research interest in better addressing youth homelessness. 6 Note that data for 2008 and 2010 did not meet the minimum participation criteria for reporting to HUD's Annual Homeless Assessment Report. 7 The McKinney-Vento Homeless Assistance Act as amended by S. 896 The Homeless Emergency Assistance and Rapid Transition to Housing(HEARTH)Act of 2009 https://www.onecpd.info/resources/documents/Homeless AssistanceActAmendedbyHEARTH.pdf 8 United States Department of Housing and Urban Development,Office of Community Development and Planning. HEARTH ACT:Performance Indicator Selection Criteria.Prepared by ABT Associates,2010. 9 The United States Interagency Council on Homelessness is an independent agency within the federal executive branch and is composed of the heads of 19 departments and agencies.The USICH is responsible for the implementation of the federal strategic plan on ending homelessness,Opening Doors. 10(USICH Communications,2012) 11 (Culhane,et al.,2007a) 12(Springer&Mars,1999) 13 (Culhane&Byrne,2010) 14 Such as Dayton,OH,Cleveland,OH,and Columbus,OH. 15 There are three main assessment tools that are evidence-informed and where validity has been proven:the Vulnerability Index;the Vulnerability Assessment Tool;and,the Service Prioritization Decision Assistance Tool. 16 (Collins,Malone,&Larimer,2012a;Collins,et al.,2012b;Culhane,Parker,Poppe,Gross,&Sykes,2007b;Gulcur, Stefancic,Shinn,Tsemberis,&Fischer,2003;Goering,et al.,2012;Larimer,et al.,2009;Pearson,Locke,Montgomery,& Buron,2007;Raine&Marcellin,2007;Tsemberis,Gulcur,&Nakae,2004) 17 (Roman,2012) 18(National Alliance to End Homelessness,2011) 19 Survey-weighted hierarchical Bayes estimation using National Survey on Drug Use and Health data. PAGE I 63 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 20 (Marlatt&Witkiewitz,2002;Westermeyer,n.d.;Svoboda,2006;Walitzer&Connors,1999) 21 (Raine&Marcellin,2007) 22(Raine&Marcellin,2007) 23 (Poulin,Maguire,Metraux,&Culhane,2010;Ku,Scott,Kertesz,&Pitts,2010;Laird,2007;Gaetz,2012;RSM Richter&Associates Inc.,2008;Palermo,Dera,&Clyne,2006;Culhane,Metraux,&Hadley,2002;Rosenheck,Kasprow, Frisman,&Liu-Mares,2003;Dunford,Castillo,Chan,Wilke,Jenson,&Lindsay,2006) 24(Goering,et al.,2012) 25 (Tsemberis&Eisenberg,2000;Tsemberis,Moran,Shinn,Asmussen,&Shern,2003;Goering,et al.,2012) 26 (Gale&Raucher,2008) 27 To learn more about which people were in support of the controlled study of HomeBase and the NYC officials' testimony,please see http://wwwnyc.gov/html/dhs/downloads/pdf/testimony_12910.pdf 28 "Appropriateness"in these circumstances is usually determined by the desire of the household to move out, coupled with:demonstrated decreased acuity;a prolonged period(usually 6+months)of paying rent on time and in-full; no outstanding issues with the landlord;demonstrated money management;stability of the household unit(for families, neither adult members nor child members have changed in the last six months). PAGE ( 64 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 Works Cited Collins,S.E.,Malone,D.K.,&Larimer,M.E. (2012a).Motivation to change and treatment attendance as predictors of alcohol-use outcomes among project-based Housing First residents.Addictive Behavior,37(8). Collins,S.E.,Malone,D.K.,Clifasefi,S.L.,Ginzler,J.A.,Garner,M.D.,Burlingham,B.,et al. (2012b). Project-based Housing First for chronically homeless individuals with alcohol problems:within-subjects analyses of 2-year alcohol trajectories.American Journal of Public Health, 102(3). Culhane,D.P.,&Byrne,T. (2010).Ending Family Homelessness in Massachusetts:A New Approach for the Emergency Assistance Program.From The Selected Works of Dennis P. Culhane:http://works.bepress.com/dennis_culhane/92 Culhane,D.P.,Metraux,S.,&Hadley,T. (2002).Public service reductions associated with placement of homeless persons with severe mental illness in supportive housing.Housing Policy Debate, 13(1),107-163. Culhane,D.P.,Metraux,S.,Park,J.M.,Schretzman,M.,&Valente,J. (2007a).Testing a Typology of Family Homelessness Based on Patterns of Public Shelter Utilization in Four U.S.Jurisdictions:Implications for Policy and Program Planning.Departmental Papers,School of Policy and Practice. Culhane,D.P.,Parker,W.D.,Poppe,B.,Gross,K.S.,&Sykes,E. (2007b).Accountability, Cost-Effectiveness,and Program Peformance:Progress Since 1998.Washington,DC:US Dept of Health and Human Services,US Dept of Housing and Urban Development. Dunford,J.V.,Castillo,E.M.,Chan,T.C.,Vilke,G.M.,Jenson,P.,&Lindsay,S.P. (2006).Impact of the San Diego Serial Inebriate Program on use of emergency medical resources.Annals of Emergency Medicine,47(4),328-336. Gaetz,S. (2012). The Real Cost of Homelessness:Can We Save Money by Doing the Right Thing?The Homeless Hub. Gale,K.,&Raucher,D. (2008).Homeless Prevention in Alameda County:Phase One Report.Hayward,CA:EveryOne Home. Goering,P.,Veldhuizen,S.,Watson,A.,Adair,C.,Kopp,B.,Latimer,E.,et al. (2012).At Home/Chea Soi Interim Report.Mental Health Commission of Canada. Gulcur,L.,Stefancic,A.,Shinn,M.,Tsemberis,S.,&Fischer,S. (2003).Housing,Hospitalization,and Cost Outcomes for Homeless Individuals with Psychiatric Disabilities Participating in Continuum of Care and Housing First Programmes.Journal of Community&Applied Social Psychology, 13,171-186. Ku,B.S.,Scott,K.C.,Kertesz,S. G.,&Pitts,S.R. (2010).Factors Associated with Use of Urban Emergency Departments by the U.S.Homeless Population.Public Health Reports> 125(3). Laird,G. (2007).Shelter:Homelessness in a Growth economy:Canadair 21 Century Paradox. Calgary,AB:Sheldon Chumir Foundation for Ethics in Leadership. Larimer,M.E.,Malone,D.K.,D.,G.M.,Atkins,D. C.,Burlingham,B.,Lonczak,H. S.,et al. (2009).Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems.Journal of the American Medical Association,301 (13). Marlatt,G.,&Witkiewitz,K. (2002).Harm reduction approaches to alcohol use:health promotion,prevention, and treatment.Addictive Behavior,27(6),867-886. National Alliance to End Homelessness. (2011,October 3). Rapid Re-Housing Triage Tool. From http://www endhomelessness.org/library/entry/rapid-re-housing-triage-tooll Palermo,F.,Dera,b.,&Clyne,D. (2006). The cost of homelessness and the value of investment in housing support services in Halifax Regional Municipals y Dalhousie University,Cities and Environment Unit.Halifax,NS:Dalhousie University. Pearson,C.L.,Locke,G.,Montgomery,A.E.,&Buron,L. (2007). The Applicability of Housing First Models to Homeless Persons With Serious Mental Illness:Final Report. US Dept of Housing and Urban Development,Office of Policy Development and Research.Washington,DC:US Dept of Housing and Urban Development. Poulin,S.,Maguire,M.,Metraux,S.,&Culhane,D. (2010).Service use and costs for persons experiencing PAGE 165 HOUSING CRISIS RESPONSE SYSTEM STUDY APRIL 16, 2013 chronic homelessness in Philadelphia:a population-based study.Pychiatric Services,61 (11). Raine,L.,&Marcellin,T. (2007). What Housing First Means for People.Toronto:City of Toronto. Roman,N. (2012,July 16).Keynote Address.National Conference on Ending Family Homelessness. Rosenheck,R.,Kasprow,W,Frisman,L.,&Liu-Mares,W. (2003).Cost-effectiveness of supported housing for homeless persons with mental illness.Archives of General Pychiatry,60(9),940-951. RSM Richter&Associates Inc. (2008). Report on the Cost of Homelessness in Calgary. Calgary,AB:Calgary Homeless Foundation. Springer,J.,&Mars,J. (1999).Profile of The Homeless Population:Mayors Homelessness Action Task Force.Toronto: City of Toronto. Svoboda,T. (2006).Measuring the `Reduction"in a Harm Reduction Program for Homeless Men Experiencing Harms Related to Alcohol Abuse and Problem Behaviors.Toronto:University of Toronto. Tsemberis,S.,&Eisenberg,R. (2000).Pathways to Housing: Supported Housing for Street-Dwelling Homeless Individuals With Psychiatric Disabilities.Psychiatric Services,51,487-493. Tsemberis,S.,Gulcur,L.,&Nakae,M. (2004).Housing First,consumer choice,and harm reduction for homeless individuals with a dual diagnosis.American Journal of Public Health,94(4),651-656. Tsemberis,S.,Moran,L.,Shinn,M.,Asmussen,S.,&Shern,D. (2003). Consumer Preference Programs for Individuals Who Are Homeless and Have Psychiatric Disabilities:A Drop-In Center and a Supported Housing Program. American Journal of Community Pychology.,32(3-4),305-317. USICH Communications. (2012,December 5).All About HEARTH:A Webinar from USICH December 10 and more resources.From USICH Blog:http://wwwusich.gov/media_center/blog/HEARTH_webinar/ Walitzer,K.S.,&Connors,G.J. (1999).Treating Problem Drinking.Alcohol Research&Health,23(2),138. Westermeyer,R. (n.d.).Harm Reduction and Moderation as an Alternative to Heavy Drinking. HabitSmart.com. PAGE 66 -3- CITY MANAGER'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL 2:10 P.M. Mayor Sessoms welcomed Steve Herbert, Deputy City Manager. Mr. Herbert expressed his appreciation to City Council for their continued support: Unsolicited PPEA Proposal to Extend Light Rail Into a Virginia Beach � Introduction:Jim Spore • p 6n Tuesday,Nov 6, the Virginia Beach City Council LRT System Extension Requests Your Vote on the Following Referendum Question: Facilities Description:Steve • Herbert are a.. PPEA Unsolicited Proposal � For more in or =OOn• Process: Mark Stiles µw Next Steps: Jim Spore City Council April 16,2013 The City received the Unsolicited PPEA on April 2, 2013. Below are the Team Members that submitted the Unsolicited PPEA: Introduction • Newtown to Rosemont Unsolicited PPEA: Newtown to Received April 2, 2013 Rosemont • Team Members: —Skanska —AECOM —The Phillip A. Shucet Company 4/16/13 April 16, 2013 -4- CITY MANAGER'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL (Continued) Below is the proposed Project Scope, including the Park and Ride at Witchduck and Rosemont Station: Proposed Project Scope I NORFOLK ' VIRGINIA BEACH •�,,, I EVMC to Newtown track I"-' t Newtown to Rosemont track extension 0 Light Rail Station Light Rail Station 4/16/13 Below provides a better understanding for the Organization for when, and if they move into the Design/Build Phase: 'I.1C" 1 riI11 .11111 Cunt actuat Structure Ciort . vraw poaos x.11nnsr. �*• % ".• SKANSKA AECOM SKANSKA ASQM a^^•^. "uiba�, JACOBS -rnt-n—as.ames PhnIPA.Swret SKANSKA JACOBS TRCIL A MY AaCOM '}• 4/16/13 April 16, 2013 -5- CITY MANAGER'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL (Continued) The Construction does include Park and Ride at Witchduck and Rosemont Roads: Proposed Project Scope Construction • Dual track of approximately 5.2 miles from existing Newtown Station to proposed Rosemont Station • 3 stations • Park and Ride at Witchduck and Rosemont • Elevated crossings at Witchduck and Independence 4/16/13 Below are the construction differences between VBTES and PPEA: Proposed Project Scope Construction Virginia Beach Transit Extension Study(VBTES) and PPEA Differences Item VBTES Proposed PPM Witchduck Station At Grade Elevated New Train Cars 3 4 Park and Ride 3 2(Witchduck and Rosemont Only,none at Independence) Feeder Bus Service Includes Does not Include 4/16/13 April 16, 2013 -6- CITY MANAGER'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL (Continued) PPEA Partners propose to provide the maintenance for the extension and the existing Norfolk line, while the system operation would be by HRT: Proposed Project Scope Maintenance and Operation • PPEA Partners propose to provide maintenance for VB extension and existing Norfolk line • System Operation by HRT 4/16/13 Below is the current cost proposal: Proposed Project Scope Cost Proposal • Proposed PPEA Project cost estimate: $235M ($45M/mile) • VBTES Preliminary Draft to Independence: $254M ($79M/mile) • VBTES Preliminary Draft to Lynnhaven: $451M (65M/mile) • VBTES Preliminary Draft to Oceanfront: $807 ($67M/mile) NOTE:VBTES Preliminary Draft cost estimates use 2018 dollars. 4/16/13 April 16, 2013 i -7- CITY MANAGER'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL (Continued) Strategic Growth Areas Plans & HRT VBTES Previous Public Outreach tight Rail PPEA Area i-� Newtown,Pembroke and - ;, ® Rosemont SGAs f+„r G F !%1 ' a 4' 1 Y —r i \k � fi ' ri T Kv\ 4/16/13 .. The public outreach over the past few years has been tremendous: Hampton Roads Transit VBTES Public Outreach Process • Sept 2009-Kick off and Stakeholder Interviews • Dec 2009-Station Area Workshops • June 2010-Project Update • Feb 2013-Hilltop Alignment Workshops • April 18, 22, 25-2013-Station Area Workshops • Ongoing-Civic League and other organization presentations upon request. At least 12 to date 4/16/13 April 16, 2013 li i -8- CITY MANAGE R'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL (Continued) Newtown SGA Plan fi ~ (7 . Pia �4� i friiii: i4.d r m ., aR,i e ( r.'o- a, f AP'a>K + dl .t r iN it 01:, .. ,.."4-* , gyp + 4 Public Meetings,Steering Committee Meetings,Civic League Meetings and Property Owner Meetings 4/16/13 Pembroke SGA Plan 'F My Y" . , f �� h iiPPww 7,15 0, . I-I )aljr . 4 3 Public Meetings,Steering t 1 Committee Meetings and Property Owner Meetings 4/16/13 April 16, 2013 Ii -9- CITY MANAGER'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL (Continued) Rosemont SGA Plan '.' ': y o tw -" \ f,,,,,- . -... `, ,r. _ 3 Public Meetings,Steering Committee Meetings and Property Owner Meetings 4/16/13 Public Outreach for SGA Plans • Extensive Public Outreach a� . , for all SGA Plans ks '� 1 ` '...." :„..4,0r, • Steering Committees, .4`� ,� ik ��F� property owners lists and Olt' meeting attendee database exists for Newtown, Pembroke and �,, Rosemont SGAs " • Staff will include all .:_ contacts and committees . :,. related to these SGAs in :-torvrt- public outreach . + „ a• • .tom .', i ;, 4/16/13 April 16, 2013 i -10- CITY MANAGER'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL (Continued) City Attorney Stiles advised the PPEA process is governed by State Code: PPEA Process References; City Guidelines (Re- adopted July 7, 2009); and Virginia Code ) 56-575,1,_..1, et sect, 4/16/13 Below is the definition of a PPEA: What is the PPEA? • The PPEA is a procurement delivery vehicle. It is an alternative method for the City to purchase, develop, maintain, or operate a qualifying project. • As with other procurement methods (such as an invitation to bid or a request for proposal),the desire is to have competition. • At the conclusion of the competitive process,the City may select a preferred partner with which to negotiate either an Interim or Comprehensive agreement. 4/16/13 April 16, 2013 l -11- CITY MANAGER'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL (Continued) Application of FOIA • Public Records: — The General Assembly inserted language into the PPEA(56-575.4(G)),using the mandatory"shall," that requires the City to take appropriate action to protect confidential and proprietary information provided by the private entity. — Three types of confidential information must be protected upon request • Proprietary trade secrets • Confidential financial information not otherwise publically available • Information that if revealed prior to negotiation of an Interim or Comprehensive Agreement would compromise the party or City's financial or negotiating position — The first two categories(trade secrets and otherwise undisclosed financial records)remain protected throughout and after the process.The third category must be made public prior to the execution of an interim or comprehensive agreement.All of the records granted confidentiality in the present proposal are in the third category and shall be disclosed upon execution of an Interim or Comprehensive Agreement. • Meetings: — City Council may meet in closed session to discuss confidential PPEA records prepared by a proposer or the City.City Council may also meet in closed session to discuss contract negotiations or consider the acquisition or disposition of public property,if discussion in open session would harm the City's negotiating strategy. 4/16/13 • Process Commencement • When the City receives an unsolicited proposal,the first decision is whether to"accept"the proposal: — If the City does not accept the proposal,state law requires the proposal be returned(56-575.31C)) — If the City accepts the proposal for conceptual consideration,it must: • i.Post the proposal within 10 business days(posting may be on the City's website or publication in the newspaper);and • ii.Solicit other proposals • State law does not require specific findings to be made at this time. The decision to accept the proposal for further consideration is discretionary. • The City will bear its own costs associated with receiving,reviewing and evaluating the proposals and negotiating and drafting any Interim or Comprehensive Agreement. • The City does not pay any private entity for that entity's costs of developing proposals or pursuing the qualifying project prior to execution of an Interim or Comprehensive agreement. 4/16/13 April 16, 2013 -12- CITY MANAGER'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL (Continued) First, the City must determine whether to initiate a process to consider the unsolicited proposal and any other competing proposals that might be submitted. It is important to note, there is no commitment to enter into any binding agreement until later in the process: Conceptual Phase • The solicitation that follows the acceptance of an unsolicited proposal seeks other proposals that provide conceptual level detail including: — The private entity's qualifications and experience — The project's characteristics — The project's financing — Project benefit and compatibility • If the City desired to solicit proposals in the absence of an unsolicited proposal,the PPEA process would begin with the above solicitation. • Additionally,the City could take the concept from an unsolicited proposal and modify the scope of the proposed project to suit its needs.This would result in requiring the firm that submitted the initial unsolicited proposal to submit an updated proposal. 4/16/13 Staff suggests the formal time period of approximately ninety (90) days in this case for receipt of any competing bids to develop a Conceptual Proposal: Conceptual Phase Review • The City's procedures mandate a period of not less than 60 days(minimum period under state law is 45 days)for the submission and receipt of competing proposals. A longer period of time may be allowed where the qualifying project requires more intensive work by the proposer. • City reviews the submitted conceptual proposals and determines: — Request additional information for any proposer; — Proceed to the Detailed Phase with one or more proposal; or — End the process. 4/16/13 April 16, 2013 -13- CITY MANAGER'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL (Continued) The purpose of the detailed phase is to evaluate the Proposals received, to gather additional, more detailed information as necessary and to arrive at a decision as to the `preferred partner"with whom to move forward toward an Interim and or Comprehensive Agreement. The current Proposal contains a suggested timeline that would involve execution of an Interim Agreement by year end. Whether the detailed phase can be completed in the time frame will depend on a number of factors, including the number of Conceptual Proposals received: Detailed Phase • Review at this stage requires an additional level of detail about the project,the private entity,the proposed financing, life-cycle costs, and other factors that would allow the City to evaluate the proposal. • Much like the Conceptual Phase review,the City may end the process, request additional information from any of the proposers, or continue to the negotiation stage with the best proposal. 4/16/13 Below is a list of Agreements: Agreement Types Interim Agreement Comprehensive Agreement • Design and Engineering • The definitive agreement • Environmental analysis and for a qualifying project mitigation including contract duration, • Survey cost,land disposition, financing requirements, • Project planning and user fees,etc. development • Ascertaining the availability of financing and firming financial commitments 4/16/13 April 16, 2013 -14- CITY MANAGER'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL (Continued) There is no requirement for Public Notice or Public Hearing regarding receipt or acceptance of an unsolicited proposal. In many cases, the first public notice would be the posting of the unsolicited proposal after acceptance. However, because of the significance of this project, the City is holding this Briefing and suggests having a Public Hearing prior to the vote on whether to accept the Proposal. Additional opportunities for public information and input can be provided as necessary: Public Input & Council Action • There are two required public input steps prior to the execution of any agreement: — Public hearing at least 30 days prior to execution — Posting the proposed agreement for public comment for 30 days. • Council approval, usually by resolution, is required prior to the execution of either an interim or a comprehensive agreement. • Additional opportunities for public input may be provided but are not required. 4/16/13 Below are the next steps: Next Steps Staff Review&Discussion with On going appropriate agencies Public Comment: April 23,2013 Consider Acceptance of Proposal: May 14,2013 Establish Timeline for Other Interested Responses: May 15—August 15,2013 Report on Results of Solicitation August 20,2013 4/16/13 April 16, 2013 Ili -15- CITY MANAGER'S BRIEFING UNSOLICITED PROPOSAL TO EXTEND LIGHT RAIL (Continued) Current Questions 1. If the City were to pursue a P3 for the light rail project,would it require the City or Hampton Roads Transit(HRT)to refund federal funds made available for the Environmental Impact Statement(EIS)? 2. If the City were to pursue the P3 process for the light rail project,would it cause the termination of the ongoing EIS? 3. If the EIS is stopped,would the city,HRT,or the TPO be responsible to reimburse the RSTP/CMAQ funds that were used to fund the study up to this point? 4. If the City were to pursue a P3 and the process would not terminate the ongoing EIS,would the City still be eligible for federal funds for future extension of the system past Rosemont Road? 5. If the City embarked on the P3 for the extension to Rosemont Road,would the City be able to count local funds expended on this segment as match for future extensions of the system? • 6. What is FTA's experience with the use of P3's in connection with light rail development in other cities such as Denver? 7. Is FTA aware of any other P3s for light rail systems elsewhere in the nation? 8. Does HRT and CVB need to complete the alternative analysis and select a locally preferred alternative before considering a P3 proposal to build a new light rail segment?Is there anything that prevents the AA/DEIS and P3 processes from running concurrently? 9. What are the actions required in order for our project to be considered for the MAP-21 Pilot Program for expedited project delivery?How would seeking entry in to the Pilot Program affect the AA/DEIS process currently underway? 10. Can the TIFIA program support debt issued to a non-governmental entity in a P3 model? Mayor Sessoms thanked everyone for their work on this project. April 16, 2013 -16- CITY MANAGER'S BRIEFING PENDING PLANNING ITEMS 3:23 P.M. Mayor Sessoms welcomed Jack Whitney, Director—Planning. Mr. Whitney expressed his appreciation to City Council for their continued support: Mr. Whitney advised nine (9) items will be considered on May 14th: Scott Roberts—Nonconforming Use Armada Hoffler—Conditional Rezoning Charlice Christian-Conditional Use Permit Dona Cox—Conditional Use Permit Miller Investment -Modification of Proffers Holloman-Brown—Conditional Rezonig City—Amendment to Zoning Ordinance Marilyn Davis—Conditional Use Permit City—Amend Code Sections re application fees Eight(8) items will be considered on May 18`'': Pontiac Arms—Modification of Conditional Use Permit Princess Anne Partners—Conditional Rezoning Silver Hill—Conditional Rezoning Theo's Plaza—Conditional Use Permit Bishop Sullivan High—Modification of Conditions Jason Gentry—Subdivision Variance Galleon Investors—Subdivision Variance Verdad Real Estate—Conditional Use Permit Mayor Sessoms expressed his appreciation to Mr. Whitney and the entire Planning Department for their hard work. 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E o 4•+ E c 0cci0 N CL CL 0- Iii 0\i sE. 4 • ', NE 3 cs es m +. >, u o .c p: 11 ;fl; ( jj _: . It O CI) I. V '� O � .Q ��iIt (6 �� �- 44- 4 f� O .. D O �+ O ® li _ O O� v d O to _ 1" O N O N 0 d d) N d / ' . a y w elilqf t AW U 7 c (U cuL3 as d N O —•- s Q an c E O i, 3 M- $ O C +r ,= O i = t0 Cg u3 > to u o +' O. t h'31 d c4 c d Lel " O O O O ® z I e II �I -17- CITY MANAGER'S BRIEFING FY2013-14 RESOURCE MANAGEMENT PLAN(Budget) PUBLIC WORKS AND CAPITAL IMPROVEMENT PROGRAM 3:50 P.M. Mayor Sessoms welcomed Phillip A. Davenport, Director—Public Works. Mr. Davenport expressed his appreciation to City Council for their continued support. Mr. Davenport provided the attached Briefing regarding the Department's Budget, which is made a part of this record. Mayor Sessoms expressed his appreciation to Mr. Davenport and the entire Public Works Department for all of the hard work. April 16, 2013 z:, M '--I 0 N k O ;014 •..... 4:::1( > 4miii0 O.. CU ct SP a Om z,t 4, ••, fo, o 4atit. 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(1) C6 Ca Co 2> •— +-+ Q V CO N 00 Q J J J ' {4'"'--) = O CU r1 N COl0 N E E- Q o '� U '_ E o0 Q I I I � I I I V) Q Q N • • _ > al al 4 N r-, CA O Ct a vo o o 4U 0 0 Ln o '--- Lri lD N al o L4 o `� M Il 1 C C\ o O = po 0 0 (V Ln � � ul LnCi O ca _ a al 0 N CO o >- >- >- >- >- N LL LL LL LLLL II ..............7., 1 .,, o� cu N 00 N0 b1A Lf') r-I 00 111 � II! 'a l0 N LC) 3 111 Cr) CO.' N m Li-) r 0l Cr) Ol cnM O m - �/) "' N 00 IA- iii 0 CI3 0 O Li, N N •U 4A C9 N i U 4--) z CO V) V a) = O O O O O O O O O I 0 O O O O O O O 0 0 O W ,. 0 0 0 O o O 0 0 0 O cuu o 0 0 0 0 0 0 0 o O 0- .c O 0O L/1 O 0O 0 O 0 N U 0 V CO in N N c-I 1-1 Lf) 1_ w 'VI VI. i./1. V? V} V? VT tr N i/? V? CO 75 � W V 0 N i--1 C O tidi n3 -IO C N LI ti (0 C3 C 0 { 0 O 2 � ' o O i N �A 1� } O WJ T LL „, O i f0 N o0 i O Ln •= o 3 N h CO >mil N Y Ol O III ooo O O N >- u_LL U o .Q A 0 O. N H LL i+ f0 3 0 O O O O O O O O O O O O O O O O O O O O O O O O O O'' O O O O O O O Y O O O O O O O O O O O 76 O O O Coco co O O O .+ O O O Coco Coco 0 N O CO l0 N O CO l0 N I- I, N ll) LU lD l0 LU 0 L11 0 0 i 0 O a--+ a) _ N N -o •N _C Q) = Q) Q) O i a) a a) l CU � CU }' L O 4- o -0 a) a) 4J CU uLE N `F Q) 4U •— a) = a) E E Li__0 0N o 0 '�) (1) CU a) = a) a) > — (f)) _ U co RS 4= Q 2N Q) ..0 L .C > a- ) a--' Q) N 4-0 Q) E ] L •� CU N p �O 0 a U - O N a Cu O a Q) +-+ N &_ 0 •— N C O - N = 11 Lti >` C N — 4-- .C U O N _ 73 Q) c\i') C C C N 4- V N e- ID a) a) — aJ a) O co C U E c F v LL U O `~ > _C Q a) Q E 0 bp oC U) a) a) _ a) ca F U CDCD CU Q N Q VfroLCao U = N •W CU U c r) Q) O U N U U L a--+ '0 I- = m r-1 > _0 > 0 a. _ ._ a) • I— W • • • • • N e--i L 0 4.I to 0 U co Wo o v -a m mu_ 4-04-.) C , { = v' tr) N 4U vo >- u_ E 0N cr } CU, N LL �/ m V c IV LL _� NlIl N Y LL co -- < 1 -I (1) 0 = 110 IL.) •_ N .4-a C ( o; • o •IWco LL W a U > LL o V) +v } 11– Q1 L 0 L LL N •(o -a 00 o —*4°4 a)) tt/)- Q N V) N Q) cL v).--lc: o co CU )1o _ a--+ r W i L.L. !C a--+ } CU o; i0 bA LL piiii -▪0 c > 0 0 0 0 0 0 v} 10 U 0 r mm LA N dN c�-1 O y%} i•o tin 1:1 — (I) .�- -0 •� 0 8 C 0 o suoill!W 0 � 4U W N N O -0 t C3{�1 CO < CC > 0 • • • +-J U a) ._, N O a) ■— •- N .� 0- 4-+ N a) c Q a) N0 U i N CU N i (0 0 N U N QJ E 115 V) crzi_ N a) O -0 U U) =. til L_ (13 }' N N W _4 UV) = a) a) c0- +., 0 cu – -0 _c Pt, •P—% u L_ w cu - ' = ° -0 a) E 4-:-- ((I', Ct imi ,.. co CO COC aA _ C(0 a, 4C C Cr) a a v wx o bp .4-) Q wo Nv) c N C6 O O 0 -� � +-I S- O O N }' U '� a L C- -o ro CU c E 73 co '4A � �tap .O Cr) c . CL . w Q. N M (/) -0 Q CC . . . . vs cL 13 0 IDD �_ s_ .1111 0 -0 - il FitZ a) C a) •— O s_ co>. C (1)cD -0 4— c +J 0 0 +� a.., 1_ ' ) O (D 03 _ C }' 0 +J a) U ;...4 0a) O O U co ti E a1 c 0 1_ (/) N 1 4-' Z CD t_ U O = C0 CZ 0 (CO _ C ; -1L_ 0 O 0 O U O ca >' (.� ca co F N U v) Cu - ' '— •i _CCUU u1—e •> Cu •� a c i _ 2 r: '0D— O O Q +, N v 0 N aii +-+ z3 _o U c aii s_ s= TD a) CU (1.) co > C ca 2 cu W Fi tip (D by .- N O C f= c > .— Q LU c •- N 0 }, c' S? D . • 4 • • ^U ■. O d' •— r-1 b.() 0 L ---i co A c w -c o � - o 0 .V) P4 1- 4--; CO v co O oZi) co aA C - > bJ) o O Q_a � • 0 +j tiO N 0 O N Z p '> c O U -o tDA O -0 C Q c O _ U O }, O N O .c . tx0 •0 O O O E c� � �N > to O ;..1 Cl)a, . O ON OQ., _c U O 0 O O ap7:3 N- • _ „:, , , , a, _. 2 CCU a" w C C V) LO 1 ^ ^ ^ O O �\ o m 0000 N iCVIN CU M r-I O Ln M MN. tai)n >,., `� r-I Lis0 `- } O W %-I LL ^ ^ CO c-i al LD 0 Ln N 00 (20 Cfr. -a o Ln 0, OCII1rl «L.ri> ao LI a, o rn 1O Cr '� to irk ell N N� ,41 LU O O ;-..4CZ M F- Ln Ln e-I LL cO N OI e-i LL T.4 CO 1-4O 6,- Cr) O 00 lO 00 Ln l0 "ir N N co ,--1 r-I e-I kO 4:t• �3 Ln u1 O DO �I N 'n 00 O l0 Ln rl cr'i Lry• ' N Ln O Ol 00 N 00 ri O rl of NLf O ID rl v r-i %-1.' Cr" 01 LL CL t/1 rl c-I c!1 / M mi ill- -cil- V). CU N Fu O 0 r-ILL Ln r--i E N Ln IN OI Lri >_ en '71H tip r-i m Ln Cr 00 CO N(t M 7y m .7t- o ', N �I +1 13C O NLn Ln NI ill I� O (t ,-i-1 ID 0 m cn ,.D �. 1* %-1r-I N r-I '4 FI L < t/1 N %-1tr) - )- i* V1 •V). W c 06 Cz5 D •L 06 0 120 O a CO o i .U N C •ia.+ N _ s_ O L., a v) > 0 > 0 >- I iY cc 1- F► v a lL 0O O O 00 M o c n •Q n Co o C- Co • t.0 %-1F- lD 1 00 M Q ,"I0 a. in imcsii >tgalipI O 0rti 4. V 0 N N CU W x W o 73 in V � O CL W 7 L► / ra ,..1 ... L Tu o6 v in tintS 4! C 13 M o = 00 0 .vf 01 C G1 m O coIA 2 0 3 co m I N of �' e� f9 L.L. Co N 0/ Q1 j N ri o 1- O 00 d N C13L i/? 0 i Ln 2 OO IA wile i � E c t0 O CD C `A co VI' CO CTS a) ea Q G CO' C w M 1Z I"A41.11 1'1w CO I 0) O C kip W LL > 0 c ruml cu v, v co .1 Oa.M a c ^' '� ++ tD N _ ' a O N c 3 C L,f1 o °' E — o m Q oo LTmil a, o E oc " ° 3 M a a, , ^ o cp tA .0 J — • N 0 m O O y U (Y) LI) c—i E O (1) N 0 O 13 O'1 N ca x—i 1 .- .4--, S: ca a) i- L_ L aA R3 ,Q ca G: _C a: .� CA co a) = N sC) _. ca V = CD L— Zf N 4—) a) C5 a) M .ry v CL �O V co Ll') LC fY) m 4-0 y--4 ,° 9 E W = a) 2 en 4— 73 tap a) N a) XE }; CD .IIIco �' = C - En a; 0 _ a' a) N i N LL! 1HI M O di � (1) C � C L, ca i cN 0 a) CI . a , E � E 7:3� _� CDUco � M 'Q V7 I c-1 U c-1 +v .": >- a) > • • • L, � L el-1 N cuU ›_, LE cu `.../ tA LP) NN E ..i.--, 4_, %-i . 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I _ C 0 a) a) a •E ..-7:,:-• C 0 2 U C cn Q co C cc U >. cn U H cu 0 CD 00 O CO f LO c- CD tapCV n x- d- LO C) M J 0 N CO '11 •- CA Cfl N H p 71- 00 N � � ti ■11 0 CO CO N.- 7t' CO N ti r� ~ N- O N N V ch 69 69 69 63 ER EA ER ER U CD ° Co N Z J 0O cc o C) 0>- co CO ce 69 E9 E - d- 0 C) O p d. C) O O ,- CV Ln W O CD LU CO O ="� < co Q C00 cc Op Co h. O ❑ I- 69 .- CO ■p■.i to to Eft E9 ER N W Ln p O (C) Co Co ` ❑ N cj O cc co M 4 ,.y Q L() in — m co co co co O � m }re 0 `� V V 69- 69 Eft ER EA (3) ■.lemi Z rn o O C) o C) J p o o N r � lf') N r ^`` U V N ,- Ln CG ct W d J CO M CO C) CA � ON V to- E/9 Ef3 69 ER CA- I O 'd- Lf) Ln r` co ❑ o Lo CO — co ct O W c- 00 , N - r I- N O N 00 ■ < • N d" CO CO O I-0 .- co- , Q e- O 69 69 69 try ft E V CR o c 0ii o 0CR c 2 U C) CA 0 E p O _ V °' O .. U oco O Cl) O fx >, o r 0 0 0 c fo = �T •O EU _. L F+1 N o >` ❑- m <` �, _ a T, w w cr D : ) 0 U o CC W o ._ U a) U co -o a) a) U L c ON 4-1 .L ^� a) W Q X a) CZ 4- .- •� �1 ate--+ Q (I, U L 0 L a '—' a)a� — CU L � CD �/ c v) Q E m `� k—i CU liD � ago m E 4U C Oa) N E 4-1 U CU 0a) E O hA +' (Z no E m 0 C Q C 0 = tri- it- (1) = +� a� U (TSO IA. 03 • 0 co O +, O CU ti) U = -- "� E C13 C13 CU 4- a) cop&It% •- > S- = To (13 c tip a) N a) co }' N N C NO 2 C N ri U- W C _ `- 4-JO0 C a) o o •E - • • • • . . . C ^a o , = -o ,0 M CU CUc •- CO cO ID 0 -> O �- E O 0 o +� m (i) V s_ NI N 4) i= LO O O Cs LT"' =3 LO Cr) Ln o d- Z u L6 (Yi r< r< cxi 0 N mc--1 1 r1 4� -u)- -cry- -cn- -v)- -v)- -cn- a) tan RI ct1 N cu e(1a = z CU 0 00 i 0 (a 0 0 —O az-- 4—) az O � s= 0 0 = co a) C.) Z 0_ v, = Z . . . . . . CJ N a) N 4- F L L = -o a) U Ca }' = tan s- = a) N c = O co CU > a) 0 C Li— > a"r (> CZ a) s_ a) ate+ E4--) C, E 4-1 D CU N a) 0- E v, _. N a) %_, > ate--+ a) . . -0 > OD C .0 ate-+ Cl) O M = ,_a) ca L— +-+ 0 -C ?- `}' ro a) 0 U CU> C� cu IA O v) 0_ N o > n3 a O) a) �O U = > C `n ca .c 0 a) co (.) a) E Ca a) .c co c I w PI + = O U pin a) a_+ = > -0 Ca Cl.) C '> U a a) .0 C Q O 0 — U a) N C C C a) u) CD ate, Q O O O .0 -C O O >• U +-) lO N — = C '> '> O to N -(1)- tn. if). U 'Ca Q Q o n3 O lD• >' a✓ CU CU 00 U f) -v- U ci 0 n > • • • • • • 0 Cr) 0 ■- Cin V Q Lt NO OLLn a o +w) CU .2 E c a a, O � cuO �E = U = % LE 0 pC - CL ca — .1NJI CO•p-4 (/) 4 J '- co 0.4) U i5E 1/1 c6 — c6 O M O CC o0 cn U cv m -18- ADJOURNMENT Mayor William D. Sessoms, Jr. DECLARED the City Council Meeting ADJOURNED at 6:22 P.M. / —5 A anda Finley-Barne., CMC Chief Deputy City Clerk th Hodges Fraser, MMC City Clerk City of Virginia Beach Virginia April 16, 2013