Denver Shelter Assessment

BACKGROUND
The National Alliance to End Homelessness (the Alliance) was contracted by the City of Denver to assess the quality and capacity of Denver's homelessness shelter system, to review shelter practices in other communities, and to make recommendations for improving Denver's shelter programs. In conducting our assessment, we reviewed the following practices: How people access emergency shelter, including screening processes and what happens when there is not enough space; Shelter waiting lists and list management; Standards for safety, security, cleanliness, and health among shelter residents and staff; Shelter capacity, including overflow capacity; The interaction between overnight shelters, 24-hour programs, and day programs; Geographic location of shelters, zoning issues, and transportation; Special populations, including LGBTQ, unaccompanied youth, people with chemical addictions, families with children, and childless couples; Data and performance standards; Shelter based services, including strategies for helping households exit homelessness; Staff training and cultural competence; Alternatives to shelter; Street outreach; and Interactions between the shelter system and detoxification programs.

Site visits were conducted by Alliance staff on June 6 to 8. Sites visited included: St. Francis Center; Urban Peak; Salvation Army Crossroads; Volunteers of Americas Brandon Center; Family Motel; Denvers Road Home Respite Program; Delores Project; The Gathering Place; Samaritan House; and Denver Rescue Mission Lawrence Street Shelter.

The Alliance interviewed many other stakeholders in Denver, including staff from Denvers Road Home, Denver Health, and the Colorado Coalition for the Homeless. We also reviewed documents obtained during site visits, surveys of shelter residents, homelessness data from the Metropolitan Denver Homelessness Initiative, and several other resources. Alliance staff interviewed city leaders and shelter and substance abuse detoxification providers from numerous communities, including: Portland, Oregon (Janus, a youth shelter provider; Central City Concern, which runs a sobering center and detoxification program; and Transition Projects, which operates adult shelters); Philadelphia, Pennsylvania (City of Philadelphias Office of Supportive Housing, which oversees a large shelter system); Worcester, Massachusetts (Community Healthlink, a nonprofit organization that partners in shelter, clinical services, and re-housing initiatives); and Hennepin County, Minnesota (The county government, which oversees many of the shelters in Minneapolis and Hennepin County).

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In addition to those interviews, the Alliance spoke with numerous experts and reviewed relevant evidence on best practices related to emergency shelter systems.

AUTHORS
Norm Suchar, Director of Capacity Building, National Alliance to End Homelessness Norm directs the Alliances Center for Capacity Building, which helps communities implement system-wide strategies that prevent and end homelessness. Anna Blasco, Capacity Building Assistant, National Alliance to End Homelessness Anna provides planning, coordination, and logistical support to the Alliances Center for Capacity Building.

On any given night 636,017 people are homeless in the United States.

The National Alliance to End Homelessness is a leading voice on the issue of homelessness. By working collaboratively with the public, private, and nonprofit sectors to build state and local capacity, leading to stronger programs and policies that help communities achieve their goal of ending homelessness. We provide data and research to policymakers and elected officials in order to inform policy debates and educate the public and opinion leader nationwide.

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TABLE OF CONTENTS
Overall Assessment ......................................................................................................................... 5 Framework for Recommendations ................................................................................................. 6 Overview of Recommendations ..................................................................................................... 7 Assessment Findings ....................................................................................................................... 9 Detailed Recommendations ......................................................................................................... 16 Back Door Recommendations........................................................................................... 16 Improve Oversight, Coordination, and Accountability across the Shelter System .......... 18 Improve Front Door Strategies ......................................................................................... 22 Improve the Shelter System ............................................................................................. 25 Conclusion ..................................................................................................................................... 32 Appendix ....................................................................................................................................... 34

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OVERALL ASSESSMENT
Overall, we found that Denver's shelter providers, day center providers, and other service partners perform well considering the constraints, particularly the budget constraints, which they operate under. The shelter system in Denver has less public investment and less overall investment than in many other communities, resulting in lower quality than in some other cities, although not significantly so. For example, Philadelphias Office of Supportive Housing invests $28 million annually in its emergency shelter system, compared to approximately $2 million invested by the City and County of Denver. Philadelphia shelters approximately twice as many people at a given time as are in emergency shelter in Denver. The lack of shelter investment on the part of the City and County of Denver is partly a function of the prioritization of permanent supportive housing and reducing chronic homelessness. 1 Evidence indicates that prioritizing permanent supportive housing is a good strategy. Improvements to a shelter system can help improve conditions for people experiencing homelessness. However, investments that more directly help people move from homelessness to housing, including permanent supportive housing and rapid re-housing, can have a greater impact. Permanent supportive housing has likely had a more positive impact on people experiencing chronic homelessness in Denver than if more resources had been invested in shelters. The most important deficiency in the city's shelter system is the lack of an exit strategy for its residents. There is very little re-housing assistance for people experiencing homelessness in Denver. As a result, people are in the shelter system for longer than is necessary, which puts additional strain on the shelter system. Addressing this need should be the city's first priority. Access to the shelter system is uncoordinated and generally does not prioritize people who are most vulnerable. People who need to access the shelter system spend more time and energy gaining that access than is necessary. This is a stressful process and the time could be better utilized on efforts to find employment and housing.

Chronic homelessness refers to homelessness among people with disabilities who have been homeless continuously for at least one year or who have been homeless at least four times in the past three years.

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The shelter system is greatly inhibited by the lack of system-wide data and measured outcomes. The Metropolitan Denver Homeless Initiative (MDHI) is shifting to a new data system, which will help remedy this situation. This shift provides an opportunity to create a set of shared outcomes and measures for assessing the performance of different components of the shelter system. Currently, there appears to be little work on creating those outcomes. Each shelter has developed standards, training protocols, and policies. However, there is an overall lack of community-wide standards and outcomes in the shelter system. One problem with the lack of community-wide standards is that it places a greater burden on shelter providers to create their own standards. It also results in some discontinuity of policies across providers. The most obvious solution to the lack of investment in shelters would seem to be to invest more public resources into the shelter system. However, we do not recommend making this a high priority. Investing in helping people exit shelter quickly will have a greater impact, followed by the need to create a more coordinated process for accessing shelter. When a more robust infrastructure for re-housing people experiencing homelessness and a more coordinated process for accessing shelter are in place, less emergency shelter capacity will be needed, and public investment can focus on improving the quality of the shelter system, but at a smaller overall capacity.

FRAMEWORK FOR RECOMMENDATIONS

There are several inter-related factors that affect the functioning of a shelter system. These factors can be divided into the following categories: Oversightincluding performance management and coordination; Front doorincluding prevention and diversion efforts and access to the shelter system; Shelter systemincluding the quality of shelter, outreach, and day centers, and the ease with which people can navigate those programs; and Back doorincluding re-housing, permanent supportive housing, and other assistance that helps people exit homelessness.

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As a result of the interaction of all of these factors, there are numerous trade-offs that will be faced by any city seeking to improve its shelter system. These trade-offs include: Cost vs. Quality; Investment in Shelter vs. Investment in Re-Housing vs. Investment in Prevention; Coordination vs. Provider Autonomy; and Burden on People Experiencing Homelessness vs. Burden on Providers.

In making these recommendations we have been mindful of these tradeoffs.

OVERVIEW OF RECOMMENDATIONS
The Alliance has numerous recommendations, some of which can be implemented immediately, and some that will take time. We attempted to be realistic about the ability of the city government, providers, and funding community to invest vast new resources in the shelter system. However, we also include some recommendations that would require larger investment. We have included symbols to indicate cost, ranging from no or low cost ($) to high cost ($$$$). More detail about the recommendations can be found in the section Detailed Recommendations. In this section we have prioritized the recommendations, with Back Door recommendationsthose that increase re-housing assistancebeing most important, followed by improvements to the oversight of shelters, improving front door strategies such as prevention and coordinated access to shelters, and finally, direct improvements to shelter programs.

Back Door Recommendations:

1. Develop a robust rapid re-housing capacity focused on housing search assistance, family reunification, and providing small amounts of financial assistance. ($$$$)

Oversight Recommendations:
2. Assign responsibility for the citys overall shelter policy and design to a staff person at Denvers Road Home. ($$) 3. Develop system-wide performance measures to track the overall effectiveness of Denver's shelter system. ($)

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4. Transition to an open HMIS to allow data sharing between providers. ($) 5. Consolidate the planning for the Continuum of Care (CoC) with the planning and oversight of emergency shelter and other emergency services. ($) 6. Create a mechanism to get regular feedback from people experiencing homelessness about the shelter system, including surveys and focus groups. ($)

Front Door Recommendations:

7. Develop a coordinated intake system so that people experiencing homelessness can contact one entity to be assigned to a shelter bed or other assistance. ($$) 8. Develop a shelter diversion program that is coordinated with the intake system. ($$$)

Shelter System Recommendations:

9. Begin planning a redesign of the emergency shelter system, with an eye toward using some of the existing transitional housing capacity as a 24-hour shelter system, and using existing emergency shelter beds, if they continue to be needed, as overflow shelter. ($$$) 10. Develop system-wide standards for safety, cleanliness, resident rights, data, outcomes, and staff training. ($) 11. Conduct regular inspections. ($$) 12. Encourage shelters to specialize. ($$) 13. Improve coordination between detoxification services, shelter, and outreach, and create a two-level substance abuse detoxification system with sobering center and sub-acute detoxification facility. ($$) 14. Delay investing in new employment programs, day centers, outreach, and life skills or case management activities and seek opportunities to shift current capacity to rapid rehousing activities. ($) 15. Partner with the Regional Transportation District. ($$) 16. Create a streamlined method of conducting tuberculosis tests. ($) 17. Create shelter capacity for intoxicated youth. ($$)

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ASSESSMENT FINDINGS
This section summarizes our assessment of Denvers shelter system and related programs. Access to emergency shelter, screening processes, and what happens when there is not enough space There is no universal shelter entry process in Denver. For the most part, shelters develop their own screening and entry processes. For example, the Delores Project allows potential consumers to call in Mondays and Thursdays, and will accept people on a first come, first served basis. Denvers Rescue Mission conducts a nightly lottery. Crossroads conducts twice weekly lotteries. People who need shelter typically find the shelters through word of mouth or by getting information from other service providers and outreach workers. When there is not enough space at a shelter, people are typically provided with information about other shelter possibilities. People experiencing homelessness who completed surveys administered by Denvers Road Home occasionally mentioned the amount of time wasted lining up for shelter beds. When shelters are full, people often line up at another shelter. Many shelter providers are willing to shelter people who are intoxicated or who have behavioral health issues. Shelter providers generally do not screen out potential guests unnecessarily. Screening criteria are developed by shelter providers. In other cities we examined, an uncoordinated system was typical for single adult shelters. However, cities have started shifting to a more coordinated shelter entry process. Family shelters have tended to be better coordinated, and many cities have policies that ensure that no family is unsheltered. Several of our recommendations focus on strategies for making shelter entry simpler, better coordinated, and more efficient. Shelter waiting lists and list management None of the shelters we visited maintain waiting lists for shelter entry, although some do maintain lists for people who are moving from overflow to regular shelter beds. Especially for

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nightly shelters, there is little value in maintaining waiting lists for emergency shelter, so this is a prudent policy. Standards for safety, security, cleanliness, and health among shelter residents and staff The process for inspecting shelters for safety and health is inconsistent. Programs that have beds funded by the Department of Veterans Affairs get regular and thorough inspections. Others receive inspections if they serve food or by the fire marshal, or in the case of Urban Peak, because they are licensed as a child care facility. One of the major health concerns with shelter programs in Denver and in most other cities is bedbugs. Much effort is made to prevent the spread of bedbugs and to quickly eliminate them. Following are examples of the inspection processes for several programs: St. Francis does not receive inspections from the city. If there is a safety issue, they call the police. Urban Peak receives many inspections because they are a licensed child care facility. In the Crossroads shelter, Denver Health regularly comes to give tuberculosis tests, and the shelter contracts with a pest control company to spray monthly for bed bugs. Brandon Center receives inspections from the health department, and food is inspected by the city and county. The Gathering Place is only inspected by the fire department. At Samaritan House, inspections are done by the Department of Veterans Affairs and the fire department, and the meals and kitchens are inspected by the USDAs Child and Adult Care Food Program. Denver Rescue Mission sprays for pests monthly. They are inspected by the fire marshal and by sthe health department when there is a complaint, and they follow Association of Gospel Rescue Missions guidelines for health and safety. Shelter capacity, including overflow capacity Overall shelter demand and capacity are influenced by many factors, including weather, private housing markets, the quality of the shelter system, and the presence of other programs that prevent homelessness or help people exit homelessness. In conversations with shelter

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providers, it was clear that emergency shelter facilities generally operate near capacity, and that under certain circumstances, as when weather is bad, they have to open up space for people to sleep that would not normally be used as shelter. The interaction between overnight shelters, 24-hour programs, and day programs Most people who use Denvers emergency shelter system use one of the large shelters (e.g. Crossroads, Samaritan House, Rescue Mission, Delores Project), and many of them also use one of the large day programs (e.g. The Gathering Place, St. Francis Center). Few people have access to 24-hour emergency shelter, although respite clients are a notable exception. Geographic location of shelters, zoning issues, and transportation The vast majority of shelter beds are located very near each other and near day centers and other services [See Figure 1: Location of Mens Emergency Shelters and Day Centers]. Those that are not tend to be located near bus lines. However, transportation is an issue for youth and women. The youth shelter, Urban Peak, is quite far from day services and downtown. The Gathering Place is located a considerable distance from shelters and other services, and from downtown. Following are examples of transportation and access for major homeless assistance programs. St. Francis is located near a bus line, though most people walk from nearby shelters. Urban Peak is located a good distance from downtown, but is near a bus stop. Most people walk to Crossroads, but some are escorted by the police. Most people walk or take the bus to Brandon Center, but must be dropped off two blocks away for confidentiality reasons. The Gathering Place is located a considerable distance from downtown. Most people walk. Samaritan House and Denver Rescue Mission are both located near bus lines and close to downtown and other services.

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Figure 1: Location of Mens Emergency Shelters and Day Centers

Special populations, including LGBTQ, unaccompanied youth, people with chemical addictions, families with children, and childless couples Like the general population, people who experience homelessness are diverse and have differing needs. In recent years, more attention has been placed on LGBTQ populations and their access to homeless services. For the most part, emergency shelters allow individuals to self-identify their sex, which is a good policy for serving transgendered people. One exception to this policy is Samaritan House, which uses the sex indicated on a persons identification. Another challenge for emergency shelters is addressing specific subpopulations, including people with pets, people with service animals, people who are intoxicated, childless couples, and fathers with their children.

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We were not able to identify any emergency shelter that take pets, although some, like the Rescue Mission, take service animals. Many of the shelters serve people who are intoxicated, although there appear to be no good options for youth who are intoxicated. Those youth are sent to either one of the adult shelters or to a detoxification program. There also appears to be no place for childless couples, although they can stay in separate shelters, or in the case of Samaritan House, in separate rooms of the shelter. Data and performance standards Almost every shelter provider and day center is collecting data and entering it into the Homeless Management Information System (HMIS). However, data is not utilized, and several providers are frustrated by their inability to get useful performance information from the existing HMIS. Several providers are using two or in some cases more data systems simultaneously, an inefficient process. Few providers are able to identify the outcomes of their assistance, for example the exit destinations. Urban Peak is a notable exception as they are quickly able to provide information about exit destinations, a critical performance measure. HMIS data is not regularly analyzed, and this is to the detriment of shelter providers, people experiencing homelessness, and the city at large. Shelter policies are made based on assumptions about how they would affect behavior without any test to see if they have the desired impact. For example, shelters have various policies for the length of time people are allowed to stay, under the assumption that the stay limit will encourage people to work harder to move out. This may be true or it may not, but it is a testable question and should be evaluated using HMIS data. HMIS is closed, which means that providers cannot share data with other providers, even when a consumer wants them to share data. As a result, a person who goes from one program to another has to provide the same information to both providers. Many cities use an open HMIS, where providers can share data with consumers consent. Those that have experience with both open and closed systems prefer an open system. A new HMIS is currently being implemented. Shelter based services, including strategies for helping households exit homelessness There are basically three types of exits from the Denver shelter system:

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People exit with little or no help in finding or paying for housing; People exit to another homeless assistance program, either transitional or permanent supportive housing; or People have negative exits such as being arrested, or hospitalized.

Missing is a focus on rapid re-housing. Many of the caseworkers and service providers focus their work on identifying housing for people, but they have few of the tools needed to actually get people into housing. There appears to be almost no rapid re-housing being provided currently (although we assume that the city and county of Denver will utilize some of its Emergency Solutions Grant for rapid re-housing). Other cities we evaluated are increasing their use of rapid re-housing, particularly for families with children. To the degree that services exist, they tend to be located in the day centers rather than the shelters, because most of the shelters only serve people overnight. Many of the services focus on housing issues or employment, although the Gathering Place offers a very rich array of services to women. Some providers offer case management and other services for people residing in their emergency shelter program (e.g. Samaritan Housing, Brandon Center). Services in these programs tend to target people with fewer housing and service barriers. For example, some services are targeted to people who are employed, others to people who are successfully making progress on their case plan. In essence, additional services were being provided as a reward for good behavior and progress. Unfortunately, this tends to leave people who most need services (those without jobs or who have trouble achieving the goals of a case plan) without those very services. An exception to this process is the Fresh Start program, which tends to serve people who were having more difficulty exiting the motel program or finding other services. It is impossible to assess the mix of services and whether the right services are being provided without better data about how people are exiting homelessness, and especially how often they return to homelessness.

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Staff training and cultural competence For the most part, emergency shelters and day centers take the initiative to train their staff on necessary skills. Given the potential for conflict in a shelter or day center program, training on conflict resolution and de-escalation is important. For example, at Crossroads and Delores Project, employees take de-escalation classes. Although people who utilize shelter have diverse backgrounds, including many who primarily speak a language other than English, language and cultural issues are largely left up to shelter providers to deal with. Few shelter and day center staff have formal training in cultural competence. Many shelters try to hire Spanish speaking staff, but sometimes they rely on other shelter residents to translate. If shelter residents primarily speak a language other than English or Spanish, they are likely to have a difficult time. Alternatives to shelter When shelter policies prevent people from being able to access the shelter (for example, no shelters take a person with pets) there are no alternatives. When people attempt to access shelter, there is rarely much effort to prevent their homeless episode by reaching out to their previous landlord or other friends or family members to negotiate a continued stay. Street outreach Street outreach efforts are hampered by the lack of resources to link people to. Outreach efforts are effective when workers are able to identify housing options or services that are available and beneficial to the people they are working with. For example, outreach workers were utilized for implementation of the Homelessness Prevention and Rapid Re-Housing Program (HPRP), which appears to have been quite successful, even with an unusual program design (few other cities used outreach workers to provide housing location). With these kinds of resources, outreach workers are effective. Without them they are less effective. We also received numerous positive comments about the police officers dedicated to working with people experiencing homelessness. A few cities have similar initiatives, and they all appear to work well.

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Interactions between the shelter system and detoxification programs Although it was not part of our initial assessment, the interaction between substance abuse detoxification and shelter programs came up repeatedly. Many of the shelter providers in Denver will tolerate substance use to a point (including the Rescue Mission and Crossroads), and at that point, people are transported to the detoxification program operated by Denver Cares. One of the problems with this process is that people are brought to the detoxifications program even when it is not an appropriate placement. This largely occurs when a person has more intensive medical needs or requires more intensive assistance than is available at Denver Cares.

DETAILED RECOMMENDATIONS
Back Door Recommendations
1. Develop a robust rapid re-housing capacity focused on housing search assistance, family reunification, and providing small amounts of financial assistance. Expanding rapid re-housing capacity is our highest priority recommendation. Even a mildly effective re-housing program will improve the functioning of nearly every other part of the shelter system. Currently, people experiencing homelessness in Denver face a daunting challenge because Denver has a relatively low rental vacancy ratethe 11th lowest out of the 75 largest cities in the country.2 However, many other cities with similarly low vacancy rates have experienced great success with rapid rehousing strategies. Several of those cities are included in Figure 2: Vacancy Rate Comparison.

Source: Current Population Survey/Housing Vacancy Survey, Bureau of the Census, Washington, DC 20233

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Figure 2: Vacancy Rate Comparison

5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0%

An increasing amount of federal resources, particularly for homeless veterans, is being directed to rapid re-housing programs. Denvers allocation of HPRP was very successful, re-housing hundreds of homeless people. Based on our experience analyzing rapid re-housing programs across the country, we recommend expanding rapid re-housing in the following ways: The city and county of Denver and MDHIs should begin working with the Department of Veterans Affairs to plan for the expansion of the Supportive Services for Veterans and their Families (SSVF) program. MDHI should begin identifying transitional housing providers who are good candidates for retooling their programs into rapid re-housing using the CoC reallocation process. Existing job descriptions for case managers should be reviewed to identify opportunities to shift their focus to housing location and housing stabilization, including family reunification (many providers have already begun doing this). Private funders should be encouraged to shift their funding to rapid re-housing. To the maximum extent possible, rapid re-housing should be directed to respite clients and people who have long or repeated shelter stays.

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The benefits of providing more rapid re-housing are many, and they outweigh the benefits of other investments that could be made to improve the shelter system. [See Appendix E: Data on the Impact of Rapid Re-Housing]

Improve Oversight, Coordination, and Accountability across the Shelter System

As in most cities, Denvers shelter system operates as a collection of programs more than a system. In a system, there would be established criteria for determining who can access shelters, who is prioritized for shelter, how people are referred to other programs, and the expected outcomes of each program. Cities that shift from a program to system approach are generally successful at reducing homelessness because they can more efficiently match people with the programs that can best serve them. Furthermore, the people who experience homelessness in communities with a system approach find it easier to access services. 2. Assign responsibility for Shelter Policy and Design to a staff person at Denvers Road Home. One of the underlying challenges we discovered is the lack of an overarching system of policymaking, data collection, resource allocation, and accountability. For example, shelters each have their own intake process and have different policies for how long people can stay at the shelter and what is expected of them. Although shelter providers are entering data into HMIS, there is not a consistent set of outcomes that they are reporting on or working toward. Shelter providers are coordinating through regular meetings and by maintaining good relationships with each other, however, the lack of uniform policies creates additional burden for shelter staff. Moreover, many of the recommendations we have included in this report will require a high level of coordination across the shelter system. There are few cities that currently have this kind of structure in place, but those that do find that they can quickly and efficiently address gaps and problems in the shelter system. For example, in our interviews with Philadelphias Office of Supportive Housing (which is responsible for the citys shelter system among other things), it became clear that the citys shelters had clear and uniform standards, a uniform access process for residents, clear outcomes, and a consistent policy for termination and discharge. These are all important

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contributors to their successes at reducing the number of homeless people who are unsheltered. Though Philadelphia has roughly double the population of Denver, and twice as many people experiencing homelessness, they had roughly the same number of people unsheltered in their 2011 Point in Time Count as did Denver. The task of coordinating shelter activities would not require an entire full time employee initially; approximately one half full time employee is likely to be sufficient. The duties of this individual would include the following, which encompass implementation of this reports recommendations: Shelter system planning; Coordinating policies across emergency programs; Evaluating data to identify gaps in services; Evaluating cost effectiveness of programs; Working with funders to promote consistent policies; and Evaluating utilization of homeless assistance programs.

3. Develop system-wide performance measures to track the overall effectiveness of Denver's shelter system. A robust performance measurement structure helps homeless assistance programs operate more effectively. A simple and clear set of outcome measures, regular assessment of progress on those measures, and some accountability to achieve outcomes all help align the activities and incentives of providers and other stakeholders. Only a few simple measures are needed, but they should be applied as broadly as possible. Performance measures would also help identify system inadequacies, such as the lack of housing assistance. Shelter programs in Columbus, Ohio and Philadelphia, Pennsylvania have fairly robust performance measurement systems. In Philadelphia, performance benchmarks are in place regarding the number of placements into subsidized and unsubsidized housing and connecting people with benefits and other resources. Columbus has measures in place for successful housing outcomes, security, and efficient use of resources. [See Appendix B: Community Shelter Board (Columbus, Ohio) Performance Measures for Emergency Shelter Programs]

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Most programs in Denvers shelter system have developed internal measures. These measures are largely used to demonstrate to funders and the broader community that the programs are effective. The measures do not, however, help drive larger policy or resource decisions and they are not consistent across programs. For example, a measure of housing placements could help identify which activities are most efficiently housing people, and a measure of shelter stability (people who exit a shelter and are not going to a different shelter) would identify cases where people are cycling between programs and may need more targeted assistance. Development of performance measures is an iterative process and requires engagement of funders, providers, local officials, and other stakeholders. 4. Transition to an open HMIS to allow data sharing between providers. Providers in Denver do not currently share HMIS data. Additionally, the largest shelters in Denver prescribe short lengths of stay, resulting in people frequently moving between programs. Each of these programs requires new intake forms, slowing down how quickly people are able to access services and resulting in a larger administrative burden for each program. In many cities HMIS operates as an open system, allowing consumer information to follow them if they move between programs, reducing the number of times that consumers have to provide their information, and making it easier to track outcomes. Health Insurance Portability and Accountability (HIPAA) protected health information and domestic violence related information cannot be viewed. To increase the efficiency of the system and improve the data available about how and in what ways people experiencing homelessness move throughout the system, the HMIS used in Denver should transition to become an open system. HMIS is currently the responsibility of MDHI, the lead agency for Denvers regional CoC, and they would have to take the lead in making the change. Transitioning to an open HMIS will require a data sharing agreements between programs, and a client release of information consent form. [See Appendix C: Whatcom Housing Group Inter-Agency Data Sharing Memorandum of Agreement and Appendix D: Dayton-Montgomery County HMIS Client Notice and Consent for Release]

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5. Consolidate the planning for the Continuum of Care with the planning and oversight of emergency shelter and other emergency services. Although transitional housing is often viewed as a separate part of the homelessness system, it is best to view it along with the network of shelters, day centers, and outreach programs, as part of a system of emergency housing and services. Providers and planners of these types of assistance should meet more regularly to coordinate their efforts. The city and county of Denver has a complicated relationship with the CoC jurisdiction in which it is located, which includes numerous suburban communities. As a result, planning and coordination for shelters and emergency services are carried out separately from planning for transitional and permanent housing funded through the CoC process. This is a problem because each system has a profound effect on the other. CoC funded programs are a significant destination source for people exiting emergency shelters. When CoC funded programs have long stays, it reduces the number of openings and thus creates back-ups in the emergency shelter system. The impact can be dramatic. If Denvers shelter and transitional housing programs are typical of those in the nation (Denver does not have sufficient data yet to make the calculation using local data), then reducing the length of transitional housing stays by 20 percent would result in approximately 150 fewer people needing emergency shelter each night.3 Better coordination could also help ensure that people with longer potential shelter stays are prioritized for transitional housing and permanent supportive housing openings. This would further reduce the burden on the existing emergency shelter system. 6. Create a mechanism to get regular feedback from people experiencing homelessness about the shelter system, including surveys and focus groups. Many shelter providers have regular forums that enable people experiencing homelessness to provide feedback. However, these forums do not adequately address the need for consumer feedback. Denvers Road Home recently conducted a round of surveys, which we reviewed as
3

Calculation: 2,366 (people in transitional housing PIT 2011) X 0.8 (representing 20 percent reduction) X 2.1/6.5 (factor to account for the fact that people stay in transitional housing over 3 times as long as they stay in shelter) = 153 fewer people needing emergency shelter on a given night.

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part of this assessment. Denvers Road Home should hold periodic focus groups and surveys to get consumer feedback. Twice annual or quarterly focus groups and surveys would be a good start. The focus groups especially should seek to identify specific concerns about the shelter system, particularly around safety, cleanliness, health hazards, and treatment by staff.

Improve Front Door Strategies

Front door strategies refer to those interventions that either prevent the need for a person to enter the homeless system or facilitate their entry into the homeless system, including strategies such as homelessness prevention and centralized intake. 7. Develop a coordinated intake system so that people experiencing homelessness can contact one entity to be assigned to a shelter bed or other assistance. Accessing homeless assistance can be extremely challenging, compounded by the fact that people accessing homeless assistance tend to be in a state of crisis. Several cities have developed centralized or coordinated intake systems to make it easier for people to access assistance, and also to ensure that they access the assistance that is most appropriate for their needs. Furthermore, the U.S. Department of Housing and Urban Development (HUD) is requiring that CoCs develop a coordinated assessment process, which can take several forms such as: Centralized intake, Multi-point or regional intake centers, Virtual intake centers using 2-1-1 or similar systems, or Common assessment tools and procedures that are used in various social service locations. Given that most homeless services in Denver are located in a relatively small geographic area, creating centralized intake locationsone for youth and adults and one for families with childrenis a sensible approach. An initial assessment would be conducted at the intake locations that would identify whether the household needs shelter and the most appropriate shelter placement.

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Currently, shelters in Denver each have their own intake process. Several shelters conduct lotteries to assign beds. This results in a process where people line up for one shelter lottery, and if they do not get a bed, they go to another shelter to try to gain admission. This takes up the time of shelter staff and people experiencing homelessness. Under a centralized intake system, people would go to the centralized intake center when they first become homeless. The intake center would assign a bed at a shelter location and input the data on the household into HMIS. The bed would be assigned for a period of time (we recommend 15 days as a starting point).4 If there is not enough shelter capacity to meet the need on a given night, the intake center would use a risk assessment to set priorities. After the 15-day period, consumers would visit the intake center again for another bed assignment and referral to other programs if appropriate. This process could also take place over the phone. [See Figure 5: Coordinated Assessment Example Process] Figure 5: Coordinated Assessment Example Process

INTAKE

HMIS

The appropriate length of time will vary depending on circumstances. A shelter provider in Portland, Oregon that we interviewed assigned beds for 15 days at a time, which seems like a good place to start. Over the long term, the assignment process could be evaluated based on data and the experiences of intake staff, shelter providers, and homeless people.

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The benefits to the centralized intake process are: It removes some of the burden for intake and triage from the shelter providers; It streamlines access to shelter assistance for people experiencing homelessness; It provides a better match between shelter beds and peoples needs (for example people with mobility problems could be directed to a shelter that is more accessible or people needing respite can be prioritized for transitional housing units more efficiently); and It streamlines data entry, which can be done mostly at the centralized intake location.

One of the immediate issues that a centralized intake process would address is the use of shelter beds as respite. In general, people with medical illnesses who are being discharged from a hospital are not well served by going to emergency shelters. There are currently beds in a motel program reserved for respite, but respite clients are going to other shelters, even when the motel beds are not full. A centralized intake process, where hospitals discharging clients would contact the intake center, would enable clients to be placed in the best bed available. Furthermore, respite clients should be prioritized for transitional housing assistance. [See Appendix A: Additional Resources Coordinated Assessment Toolkit] 8. Develop a shelter diversion program that is coordinated with the intake system. One of the most successful homelessness prevention programs is homelessness diversion. A diversion program would identify people who are seeking emergency shelter but whose current housing situation, with a little assistance, could be salvaged. Diversion programs typically require case managers who are skilled at problem solving and negotiating with landlords and family members, and flexible financial assistance for things like overdue rent or utility payments. Shelter diversion programs can reduce the number of people who need shelters, but they do have a cost. We recommend that diversion programs be developed and that the centralized intake be the place where people are screened for and provided with diversion assistance. Diversion programs are relatively simple to structure, and numerous examples of programs, forms and screening tools are available. [See Appendix A: Additional Resources]

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Improve the Shelter System

9. Begin planning a redesign of the emergency shelter system, with an eye toward using some of the existing transitional housing capacity as a 24-hour shelter system, and using existing emergency shelter beds, if they continue to be needed, as overflow shelter. Denver currently has many homeless people, ranking 30th in the per-capita rate of homelessness among the top 100 metro areas.5 There are many reasons for this, but one factor is that there is very little assistance for re-housing people experiencing homelessness. Instead of investing in new shelter capacity, the city should invest in re-housing (more about this recommendation is included under the heading Back Door Strategies), which will reduce demand for shelter. As re-housing capacity is implemented, the relevant stakeholders should begin planning a redesign of the citys shelter and transitional housing system. The redesign should focus on shifting some existing transitional housing programs to do more of the work of the emergency shelter system. For example, placements could be made directly into transitional housing whenever possible, especially for families with children and people with special needs such as medical illnesses. Transitional housing programs would shift their programming to focus on helping people exit to permanent housing situations more quickly, allowing the transitional housing to serve more people over time and reducing the need for existing emergency shelters. Initially, transitional housing stays could be limited to nine months, with providers encouraged to help people exit in no less than four months. Services that are typically provided in the transitional housing, including case management and employment services, could be provided in some cases after a person has moved into his/her own housing. This would be a more efficient way to alleviate some of the shortcomings of the existing emergency shelter system than creating new emergency shelters. In general, the transitional housing units have case management attached to them, usually operate 24 hours, and have better facilities. Furthermore, the programs are not all located at the center of the city, so there

See: State of Homelessness in America 2012: Appendix One http://www.endhomelessness.org/files/4361_file_Appendix_One.pdf

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would be more options for people with connections to communities outside of central Denver who need shelter. One of the guiding principles of the redesign should be that people with more barriers to exiting homelessness and special needs should receive more intensive assistance. We identified several examples where providers with richer resources (more case management, allowed longer stays, etc.) would only accept people who had employment or had better compliance with case plans. We also saw examples of the opposite, where more intensive resources were correctly targeting people with greater needs. As a general rule, richer programs should target people with longer shelter stays, more severe disabilities, and more hurdles to exiting homelessness. Non-compliance with case plans or lack of employment are frequently indicators of more need, not less. The redesign of the emergency assistance system should better match resources with outcomes and need. Currently, the amount of funding a provider receives does not seem to have any connection with its outcomes or the value of its programs. Oftentimes, this is merely a function of differing fundraising capabilities. With an overall shelter and emergency services plan, funders could be educated about where the need lies and which strategies are most important for moving forward, which would help better align resources and priorities. There are some models of redesigned shelter systems in other cities that Denver could draw lessons from. For example, Columbus, Ohio has transformed their family shelter system and Chicago, Illinois had remade their transitional housing into emergency housing.6 More important than the details of the transition is that it will take a long-term effort to develop enough consensus among funders, providers, and other stakeholders to move forward. This planning process should begin soon with the goal of executing the redesign over a several year period.

In Chicago, these emergency housing programs are called Interim Housing, and they have a goal of re-housing individuals and families within 120 days.

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10. Develop system-wide standards for safety, cleanliness, resident rights, data, outcomes, and staff training. Most shelters in Denver currently have standards for safety, cleanliness, resident rights, data, outcomes, and staff training, but they are developed in isolation. Standards that are not uniform and are not developed publicly and independently could be challenged by advocates and the public as being inadequate. In our visits to Denver shelters, it was clear that shelter providers created high standards for the quality, safety, and security of their facilities. All staff at the Salvation Armys Crossroad shelter, for example, are required to take verbal de-escalation classes. Given the resource constraints they operate under, this is no small feat. Because the city funds few of the shelters, it does not have an easy method for ensuring adherence to standards. However, most shelters would likely participate in a voluntary system. The City of Philadelphia has adopted many system wide standards, including standards for consumer rights, HMIS, medication and health, food preparation and distribution, and sexual minorities. For example, Philadelphia requires emergency housing staff to receive a minimum of 10 to 20 hours of training per year, including mandatory and elective topics [See Appendix A: Additional Resources - Philadelphia Emergency Shelter Standards]. Having these universal standards communicates to the broader community and to people experiencing homelessness a consistent message about the quality of homeless assistance and relieves providers of the burden of developing their own standards. Denver should develop system-wide standards for safety, cleanliness, resident rights, data, outcomes, and staff training. Providers should participate in the development of these standards and volunteer to adopt the standards. Eventually, funders could require participation in the standards. Importantly, standards should include a policy of self-identification for transgendered people. In addition, some homeless assistance providers across the country are shifting to voluntary service models. The reasons for this are twofold. First, people experiencing homelessness are much more likely to participate in services in a more meaningful way when they believe they

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are in control of their service plans. Second, when services are voluntary, service providers do more to make their services interesting and engaging so that clients will participate. Both lead to better service outcomes. Many shelters in Denver, including Samaritan House, The Gathering Place, and Brandon Center, among others, have realized the importance of hiring bilingual staff members, and have begun to prioritize bilingual job applicants. However, it is not always possible to hire bilingual staff, or have bilingual staff available at all times. For this reason, all shelters in Denver should have access to translation services. 11. Conduct Regular Inspections. No comprehensive inspections of shelter facilities are currently conducted in Denver. Inspections are done by the fire department to ensure adherence to fire safety standards and the Department of Veterans Affairs inspects shelters it funds. Inspections of all facilities serving people experiencing homelessness should be conducted regularly and systematically by an outside agency. 12. Encourage Shelters to Specialize Like many communities, the homeless assistance system in Denver evolved organically. In some ways a natural differentiation among shelters has appeared to serve different populations. For example, some shelters allow very short lengths of stays and few services, and others allow longer stays and offer many services. The city and county of Denver should assess what services are currently available and what services are lacking. During this process, they should encourage shelters to specialize. Currently, there are populations that do not fit into the shelter structure. Serving these populations should be prioritized for specialization: Childless couples; Elderly; People under 18;

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People whose primary language is not English; People with disabilities that affect their mobility; People with pets; People with serious mental illness; People with service animals; Sex offenders; and People who smoke.

The Family Motel is very well positioned to serve populations that do not easily fit into Denvers current shelter programs. Vouchers can be issued late at night when other shelters may be full or closed, and the individual rooms can be configured to house people that may not be safe or comfortable in open rooms with a large number of beds. Therefore, these beds should be used for populations that are hard to accommodate in other shelters and for late night access. 13. Improve coordination between detoxification services, shelter, and outreach, and create a two-level substance abuse detoxification system with sobering center and sub-acute detoxification facility. Substance use detoxification programs are an important adjunct to the shelter system. Although several of the shelter providers in Denver will shelter people who are intoxicated, they rely on the detoxification program operated by Denver Cares for people who are so intoxicated that they might be a danger to themselves, or who cannot function well enough to stay at their shelters. We identified a few problems with how people are referred to these detoxification programs, particularly that people with special needs or significant medical problems that Denver Cares was unequipped to handle were coming to the detoxification program. We examined detoxification strategies in several other cities, and the most promising approach was one used in Portland, Oregon, which essentially has two components, a sobering center, where no medical services are provided, and a sub-acute detoxification facility, where some medical services are provided. The approach makes it easier to differentiate assistance to people who just need a safe place for the night to sober up, and those who need longer or for whom detoxification services could be a pathway to treatment.

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Better coordination between the homeless assistance providers and the Denver Cares program is also needed. A basic screening tool that helps shelter and outreach providers to identify who should be referred to Denver Cares and who needs hospitalization should be developed. 14. Delay investing in new employment programs, day centers, outreach, and life skills or case management activities and seek opportunities to shift current capacity to rapid rehousing activities. Employment, outreach, case management, and other similar services are beneficial to people experiencing homelessness. However, they are less efficient than they could be because there is very little housing assistance provided to help people exit homelessness. The most important place to invest resources currently is for expanding re-housing assistance. Outreach assistance in particular is hampered by the lack of assistance to link people to. One of the primary goals of outreach programs is to connect people sleeping on the streets to services, such as housing or health care, that will help them exit homelessness or improve their wellbeing. When assistance is available, as was the case when HPRP funds were available, outreach workers were able to effectively assist people sleeping on the streets. Without such assistance, outreach is not as effective. Additionally, much of the existing case management exists to help people navigate the homeless system as they move from shelter to transitional housing and permanent supportive housing. Creating a coordinated intake function, and improving coordination between the shelter system and CoC programs will eliminate much of the need for this type of case management, freeing those staff to help people access public benefits, mainstream services (mental health services for example), and housing. As the grants for any employment, outreach, and case management activities come up for renewal, or as staff funded under these grants turn over, providers and homeless assistance funders should take these opportunities to shift either the position or the funding to rapid srehousing assistance. Programs that offer employment, outreach, and case management services should also have to meet outcome goals for moving people into permanent housing.

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15. Partner with the Regional Transportation District. Many shelters interviewed for this assessment noted that despite being located near public transportation, most households walk between shelters and day centers. This may be a result of the limited availability of bus passes and the relatively high cost of public transportation in Denver. Some womens shelters and day centers in particular are located far away from each other. The short lengths of time women and families are able to stay in the various shelters means that these households must often move all of their possessions from program to program. Women and families may struggle with the burden of commuting to the only womens day shelter, which is located approximately 17 blocks from downtown. To help improve transportation options for people experiencing homelessness in Denver, partnerships should be sought with the Regional Transportation District (RTD). Denver should seek ways to collaborate with RTD, and encourage RTDs leadership to participate in relevant homelessness committees and advisory groups. RTD should be approached about providing free or dramatically reduced fares to people experiencing homelessness. 16. Create a streamlined method of conducting tuberculosis tests. To access shelter in Denver, people are required to present proof of recent tuberculosis (TB) tests, or to obtain a screening within the first few days of accessing shelter. Access to TB tests varies throughout Denvers shelter system. Some shelters, including the Salvation Armys Crossroads Shelter, have arranged for nurses associated with clinics or the hospital to come to the shelter and conduct regular screenings. A number of shelters do not provide clients with this option; instead clients seeking shelter are responsible for the two trips to a clinic or hospital required to receive the test. This presents a barrier to accessing shelter and may also result in a greater incidence of clients not accessing shelter and being involuntarily exited from shelter because of an inability or reluctance to obtain a TB test. The city and county of Denver should develop strategies to increase access to the tests to smooth shelter entry and avoid involuntarily exits from shelter. Instead of requiring households to transport themselves to health centers or local hospitals, the health department

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should be approached about a system whereby people can receive TB tests at day centers and other sites that currently require those tests for entry. 17. Create shelter capacity for intoxicated youth. There is currently not an appropriate place in the shelter system for intoxicated youth. It is unclear what happens to youth who need shelter and are under the influence of drugs or alcohol, although studies of youth in other cities indicate that there are many potential dangers for this group. First Place for Youth is located in Oakland, California and employs a low-barrier, harm reduction program model. The program does not screen out or evict youth because of drug or alcohol use or behavioral issues. It instead works to retain all youth in the program and help them improve their capacity to live independently. First Place identifies the harms associated with the behaviors and works with the youth to develop a plan to mitigate those risks. For example, if a young adults substance use is preventing them from showing up at work, staff will work with the youth to develop a plan to curb use so it doesnt affect their work life. Denvers Road Home should work with Urban Peak or another provider to help design a locally acceptable approach to serving youth who are under the influence of drugs or alcohol.

CONCLUSION
Homelessness is one of our nations most difficult problems. People experiencing homelessness in Denver, as in most other cities, must navigate a variety of shelter and service programs. Sleeping conditions are poor, and services are generally unable to keep up with demand. Homeless assistance providers cannot by themselves, meet all the needs of people experiencing homelessness, nor can they repair the problems that lead to homelessness, such as lack of incomes, a frayed safety net, and the lack of affordable housing. Making progress in such an environment requires a balance between strategies that meet immediate needs and those focused on long-term solutions. Evidence from communities that have made progress reducing homelessness indicates that for a large share of the homeless

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population, rapid re-housing approaches are an effective strategy for reducing the duration and trauma of homelessness. In our assessment, expanding rapid re-housing assistance in Denver will have the largest impact on the citys homeless population. Additionally, several other improvements, such as creating a centralized intake process and developing consistent standards across the shelter system, can improve conditions. Implementing these recommendations will require a shift in how homeless assistance in Denver is managed. While there is a significant amount of coordination that is currently taking place, Denvers Road Home will have to facilitate the creation of clear and consistent policies that utilize best practices. The data infrastructure will need to be enhanced to support a more robust performance measurement system that will enable resource and policy decisions to be based on performance across the entire system.

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APPENDIX
Appendix A: Additional Resources Closing the Front Door: Creating a Successful Diversion Program for Homeless Families National Alliance to End Homelessness August 16, 2011 City of Philadelphia Emergency Housing Standards (PDF) City of Philadelphia Office of Supportive Housing Revised 2010 Coordinated Assessment Toolkit National Alliance to End Homelessness March 22, 2012

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Appendix B: Community Shelter Board (Columbus, Ohio) Performance Measures for Emergency Shelter Programs Emergency Shelter Tier I Ends Efficient number of households served Measurement Households served (#) Annual Metrics Set based on prior year(s) attainment, fair share of system demand, facility capacity, and funds available to program. Successful outcomes (%) Obtain housing at standard below or greater if prior year(s) achievement was greater: At least 25% for adult shelters At least 70% for family shelter At least 15% for inebriate shelter. Successful outcomes (#) Calculated based on the successful outcomes % measurement. Successful housing Set based on prior year(s) outcomes (%) (YWCA attainment. Excludes exits to Tier II Family Center only) shelters. Successful housing Calculated based on the successful outcomes (#) (YWCA housing outcomes % Family Center only) measurement. Usage of CSB Direct Client % of households that receive CSB Assistance (%) DCA will be consistent with prior performance and /or program design. Usage of CSB Direct Client # of households that receive CSB DCA Assistance will be consistent with prior (#) (YWCA Family Center only) performance and /or program design. Pass program certification Provide access to and coordination with community resources and services to prevent homelessness. Successful diversion At least 39% will be diverted to outcome (%) (YWCA other community resources. Family Center only) Pass program certification Provide secure, decent shelter.

Access to resources to address immediate housing need

Basic needs met in secure, decent environment

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Temporary, short-term stay

Average length of stay

Not re-enter the emergency shelter system

Efficient and effective use of a pool of community resources

Not to exceed standard below or average for prior year(s) if less than standard below: 30 days for adult shelters 20 days for family shelter 12 days for inebriate shelter. Average FHC transition Not to exceed standard based on time (YWCA Family Center the FHC policies and procedures (less Only) or equal to 7 days) Recidivism <5% of those who obtain housing will return to shelter. 4 (%) (Single Movement <15% of those who exit the Adult emergency shelter will immediately Shelters only) re-enter another shelter. Detox exits (Inebriate shelter At least 10% of inebriate shelter only) exits will enter a detoxification program. 3 Diversion Recidivism <5% of those diverted will enter (%) (YWCA Family Center shelter. only) Cost per household Cost per household will be consistent with budget. Cost per successful Cost per successful housing outcome housing outcome will be consistent with budget. Pass program certification Provide access to resources and services to end homelessness.

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Appendix C: Whatcom Housing Group Inter-Agency Data Sharing Memorandum of Agreement The Whatcom Housing Group agrees to share client data among participating agencies via the HMIS (Homeless Management Information System) for the purpose outlined below. Each participating agency must complete and comply with the Agency Partner Agreement. Each individual HMIS user must complete and comply with the User Code of Ethics, Policy, and Responsibility Statements. Both documents are available on the WA State Department of Commerce website http://www.commerce.wa.gov/site/936/default.aspx. Uses of HMIS Data: Coordinate housing services for families and individuals experiencing homelessness or facing a housing crisis in Whatcom County, Understand the extent and the nature of homelessness in Whatcom County, Evaluate performance and progress toward community benchmarks, Improve the programs and services available to Whatcom County residents experiencing homelessness or a housing crisis, Improve access to services for all Whatcom County homeless and at-risk populations, Reduce inefficiencies and duplication of services within our community, Ensure that services are targeted to those most in need, including hard to serve populations, Ensure that clients receive the amount and type of services that best fits their needs and preferences, Pursue additional resources for ending homelessness, and Advocate for policies and legislation that will support efforts to end homelessness in Whatcom County. Client Protections: Informed consent must be given by clients in order for their identifying information to be entered into HMIS and shared among agencies in the Whatcom Housing Group (see Whatcom Housing Group Participating Agencies). Non-identifying client information may be entered in the system for all clients regardless of whether they give their informed consent and regardless of their domestic violence status. Only non-identifying information will be entered for clients currently fleeing or in danger from a domestic violence, dating violence, sexual assault or stalking situation.

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Identifying client information will only be shared among agencies that have signed this agreement. At the time of informed consent, and at any point after, the client has the right to see a current list of the Whatcom Housing Group participating agencies.

Additional agencies may join the Whatcom Housing Group with notification and consent of current data sharing agencies. As part of the informed consent process, clients must be informed that additional agencies may join the Whatcom Housing Group at any time and will have access to their information.

HMIS Users will maintain Whatcom HMIS data in such a way as to protect against revealing the identity of clients to unauthorized agencies, individuals, or entities. Clients may not be denied services based on their choice to withhold their consent.

Each party to this memorandum of agreement shall defend, indemnify, and hold all other parties harmless from any and all claims arising out of that partys negligent performance of this agreement. Any loss or liability to third parties resulting from negligent acts, errors, or omissions of a Whatcom Housing Group HMIS user while acting within the scope of their authority under this Agreement shall be borne by that user exclusively. Agreed to and signed by the following agency representative: Signature Name Agency Date

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Appendix D: Dayton-Montgomery County HMIS Client Notice and Consent for Release Participation in data collection is a critical component of the communitys ability to provide the most effective services and housing possible. This client notice and consent form is for the Dayton-Montgomery County Homeless Management Information System (HMIS) and describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

I, ________________________ (insert clients name), understand and acknowledge that __________________________ (Agency) is affiliated with the HMIS, and I consent to and authorize the collection of information and preparation of records pertaining to the services provided to me by the Agency. The information gathered and prepared by the Agency will be included in a Homeless Management Information System (HMIS) database and shall be used by the Agency and Montgomery County to: (a) provide individual case management to me; (b) promote collaborative case management; (c) produce group reports regarding use of services by all clients; (d) track individual program-level outcomes; (e) identify unfilled service needs and plan for the provision of new services; (f) allocate resources among agencies engaged in the provision of services. ______ (please initial) I understand and acknowledge the following collection of information: (Initial the kind of information that can be included) _______ Identifying information (name, birth date, gender, race, social security number, residential information, education level, household information) _______ Medical records (except HIV/AIDS and alcohol and drug treatment), psychological records and evaluations, vocational assessments, care coordinators recommendations and direct observations, employment status, etc. _______ Financial information (income verification, public assistance payments and allowances, food stamp allotments, disability payments, etc.). _______ HIV/AIDS diagnosis _______ Substance abuse diagnoses, treatment plan, progress in treatment, discharge, etc.

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______(please initial) I understand that I have the right to inspect, copy, and request all records maintained by the Agency relating to the provision of services to me and to receive a paper copy of this form. ______ (please initial) I understand that this release can be revoked by me at any time and that the revocation must be signed and dated by me. I further understand that this consent is subject to revocation at any time except to the extent that the Agency has already taken action in reliance on it. If not previously revoked, this consent terminates automatically 180 days after my last treatment or discharge from Agency. ______ (please initial) I understand that my records are protected by federal, state, and local regulations governing confidentiality of client records and cannot be disclosed without my written consent unless otherwise provided for in the regulations. Additionally, I understand that participation in data collection is optional, and I am able to access shelter and housing services if I choose not to participate in data collection.

I agree that, by initialing the yes below, information in the HMIS may be shared with other agencies. Attached is a description of the information shared and the partner agencies in the HMIS. The agencies that participate in the sharing may change from time to time. However, a copy of the list of agencies is available upon request at any given time. I understand that sharing information between agencies can reduce the number of times I am asked the same questions and can help other agencies do a better job assisting me and/or my family. Yes: ________ No: _______

Date: _____________________________ Signature: _________________________

DESCRIPTION OF INFORMATION THAT IS SHARED The Dayton-Montgomery County HMIS Client Release Form authorizes the following information to be routinely shared using the Dayton-Montgomery County HMIS to better help me and/or my family. Evaluation/Assessment Information Related to: Profile Information (Name, Social Security Number, Age) Additional Profile Information, including: Family/Household Information

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Income and Benefits Information Education and Employment History Housing History Veteran Information Program and Service Involvement

LIST OF COVERED HOMELESS ORGANIZATIONS AIDS Resource Center Ohio Daybreak Goodwill Easter Seals Miami Valley Greater Dayton Premier Management Holt Street Miracle Center Homefull Homeless Solutions (Montgomery County) Linda Vista Mercy Manor PLACES Miami Valley Housing Opportunities Red Cross Dayton Chapter Samaritan Homeless Clinic St. Vincent de Paul Social Services VA Medical Center Volunteers of America YWCA Dayton

Line through and initial any agencies in the above list with whom you do not want to share information. In addition to the above list of agencies, I agree that, by initialing below, information in the HMIS can also be shared with the following agencies: Initial Agency Name

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Appendix E: Data on the Impact of Rapid Re-Housing The Alliance has collected data from numerous communities about the outcomes and efficiency of emergency shelter, transitional housing, and rapid re-housing strategies. Data from 14 communities was compiled by Focus Strategies and is presented in the charts below. They show that rapid re-housing strategies tend to be more cost effective and have better outcomes than shelter or transitional housing programs.

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