Coordinated Access and Assessment

Coordinated Access and Assessment improves coordination among agencies while reducing redundancies in services as information and data becomes centralized and standardized. CAA works to improve the client experience within the System of Care through improved access and support for system navigation. Furthermore, a more robust triage process allows for more effective and accurate program placements. It ensures the most vulnerable people in our community are referred to housing programs equipped to meet their needs. Coordinated Access and Assessment operates based on a triage model, targeting and prioritizing individuals based on chronicity, individual needs, and vulnerability factors.

Calgary Homeless Foundation and Coordinated Access and Assessment

There is only one common characteristic of people experiencing homelessness – they do not have a home. There are many reasons why people do not have a home; this is often called “root causes” of homelessness. Calgary Homeless Foundation (CHF) recognizes that there are three main ‘society’ causes to homelessness, and is empathetic to the personal issues and situations that can contribute to an individual becoming homeless. We work with government, stakeholders and the Homeless Serving System of Care (HSSC) to address societal contributors such as macroeconomics, public policy and availability of local resources. On an individual basis, our primary focus is to quickly connect that person to supports to end their homelessness permanently. This is the fundamental principle of Housing First.

In recognition of the diverse and unique needs of the people we serve through the HSSC, CHF aims to fund a variety of Housing First programs to meet the needs of all people experiencing homelessness. Unfortunately, the demand for housing programs exceeds the spaces available in housing programs. As such, CHF works to coordinate the programs to assess the needs of the clients and match programs and services to their needs to end their homelessness permanently. This is done through a program called Coordinated Access and Assessment (CAA). CAA acts as the entry point into all CHF funded housing programs.

Due to the lack of available program spaces, CAA is designed to meet the needs of the most vulnerable first by triaging. It creates a more efficient homeless serving system by:

  • helping people move through the system faster, thereby reducing the amount of time people spend moving from program to program before finding the right match
  • reducing new entries into homelessness by consistently offering prevention and diversion
  • Resources up-front
  • improving data collection and quality to provide accurate information on what kind of assistance consumers need

The CAA team of Housing Strategists provides standardized service delivery for homeless individuals or families seeking housing services. The CAA Team at SORCe is operated by the Distress Centre, and is primarily delivered from the fixed location of SORCe, with capacity for mobile outreach services.

Diverting people from the homeless-serving system is an important part of CAA and is achieved using the Needs and Services Questionnaire (NSQ) and Housing Plan. Housing Strategists are trained to help clients develop plans to end their homelessness independently, reserving valuable program spaces to those in greatest need. Calgary’s System of Care has several ‘door agencies’ with Housing Strategists on staff offering prevention and diversion resources and will complete NSQs creating additional access points into CAA.

When an individual access the CAA Team at SORCe or a Door Agency, a Housing Strategist utilize the NSQ and a Housing Plan based on individual choice. The NSQ helps determine the level of service a client requires and type of program needed to end their homelessness. These tools may not suggest the intervention necessary is through a CAA Placement Committee, but instead suggest some resources to aid in Prevention and Diversion. NSQs are reviewed at weekly Placement Committee meetings for triaging into Housing First programs. Membership is comprised of CHF-funded agencies and System Partners to create a Collaborative Service Delivery Group. Clients are matched to programs based on availability, length of homelessness, best fit, and client choice.


Placement Committee

The purpose of each committee is to review completed NSQs, and match clients to programs best suited to meet their needs based on the capacity in those programs. Three Placement Committees occur each week; Families, Youth, Adults.

Please refer to the Terms of Reference (ToR) under the ‘Resources’ section at the bottom of this page for each committee for specific details. These are currently being restructured and will be posted with updates in Summer 2018.


The Issue

Issue

Coordinated Access and Assessment (CAA) was implemented in September 2013 to “build coordinated intake into the homeless-serving system”.[1] It represents a single, standardized process for people at risk of or experiencing homelessness to access housing and support services. With coordination and efficient intake processes, clients can access appropriate housing services with better accuracy, minimizing stress and respecting client dignity.

CAA improves coordination among agencies while reducing redundancies in services as information and data becomes centralized and standardized. CAA works to improve the client experience within the System of Care through improved access and support for system navigation. Furthermore, a standardized assessment process allows for more effective and accurate program placements. It ensures the most vulnerable people in our community are referred to housing programs equipped to meet their needs. CAA operates based on a triage model, targeting and prioritizing individuals with the highest needs and chronicity of homelessness.

[1] Calgary Homeless Foundation, Annual Report 2013, p.5


The Information

Why Coordinated Access and Assessment?

Homeless individuals are not a uniform population. Various interventions and programs within a Collaborative Service Delivery Group are necessary to successfully meet the needs of the individuals within this demographic. Coordinated Access and Assessment provides a single entry point into the HSSC that helps identify the needs and interventions most appropriate for individuals within each target group through the use of standardized assessment tools. For more information please see the Program Type Resource Guides for each sector listed under the Resources section, or click here for a list of our funded programs accessed through CAA.

CAA has four primary activities to guide the System of Care:

  • Prevention services aimed at “closing the front door to homelessness”
  • Diversion services to re-direct individuals and families to community-based services rather than to emergency response/homelessness services
  • Assessments for individuals and families who face barriers to exiting homelessness on their own
  • Adaptive Case Management, Supportive Housing and Permanent Supportive Housing referrals

CAA creates a more efficient homeless serving system by:

  • Helping people move through the system faster by reducing the amount of time people spend moving from program to program before finding the right match
  • Reducing new entries into homelessness by consistently offering prevention and diversion resources upfront
  • Ensuring people are referred to appropriate programs designed to meet their needs, effectively reducing recidivism into homelessness and improving client outcomes
  • Improving data collection and quality and providing accurate information on what kind of assistance individuals and families using homeless sector services need

CAA is designed to direct specific target populations towards interventions that best meet their needs. In this way, not only will people experience more success when matched to the correct program, they will also be provided the level of service that meets their needs while promoting housing stability and independence as appropriate to their unique situation.

Ensuring resources are targeted to first address those with the highest level of need provides greater efficiencies in the System of Care while streamlining its operations and facilitating best use of finite resources. In addition, for those with lower needs, utilizing only those resources necessary to address their needs, promotes a sense of self-empowerment and achievement which are vital to limiting dependency on the HSSC and to individual well-being.

As CAA triages people with complex needs and lengthy chronicity, it is necessary to provide multiple access points to the homeless-serving system that are accessible and low-barrier – this may include outreach to encampments, corrections and hospital wards.

How does Coordinated Access and Assessment work?

Calgary’s CAA Program utilizes the Needs and Services Questionnaire (NSQ) and the Housing Plan as tools when an individual contacts for assistance. For more information on the NSQ please see the HMIS section, these can be found under Forms & Assessments and are listed as three unique VI SPDATs by sector for CAA.

The foundation for a successful Coordinated Access and Assessment program is a consistent questionnaire that can be applied in the system of care in a standardized and methodical way. The questionnaire must identify the needs of the client in order to assign the most appropriate intervention.

The system of care relies heavily on the reliability and accuracy of questionnaire tools. The questionnaire must be able to determine the needs of the client in a defensible, consistent and valid way. Moreover, the tool must be easily implemented in the system of care with a broad scope and defining language.

Prevention and diversion strategies are designed to “close the front door to homelessness” by helping people identify immediate alternate housing arrangements and, if necessary, connecting them with services and financial assistance to help in their return to permanent housing. Diversion programs can reduce the number of individuals or families becoming homeless, the demand for shelter beds, and the size of program wait lists. This can be captured in a Housing Plan so that all door agencies can see an individual’s plan and any referrals that may already be in progress.

The Needs and Services Questionnaire (NSQ) is an evidence-informed tool designed to determine the needs and key issues related to a client’s housing needs. The questionnaire produces a score (based on 4 dimensions related to client’s History of Homelessness, Risks, Socialization and Daily Functioning and Wellness) which is used in conjunction with community knowledge shared via collaboration among CHF funded Housing First program and System Partners to prioritize client need for program referral. The process is to ensure fairness in placements with the focus on serving those with the longest history of homelessness (chronicity), as well as other factors like mental health, physical health and/or addiction issues to accurately match the client to resources; the success of this model is dependent on a Collaborative Service Delivery Group which has been created through CAA implementation.

CAA Placement Committees meet weekly to review the System of Care for available program spaces and match clients to appropriate program placements. This is not a typical chronologically based “wait list” but a triage list based on chronicity and vulnerability. The goal of these committees is to ensure programs within the HSSC maintain appropriate occupancy levels, to facilitate timely and efficient service delivery, and to document learnings. The committees are designed to seek consensus on all placement decisions. Because each population corresponds to a segment of the System of Care (i.e. family programming, permanent supportive housing etc.), the Placement Committees focus on their population and program area of expertise.

The placement process in CAA requires the staff of the program in which the client is placed to contact the client within two days to notify them of their placement and coordinate the intake process. Notification of placement into a program does not necessarily equate to immediate housing. For some programs, intake into a program may involve the client beginning the process to find housing utilizing case management and housing location services in a program.

Access to CAA services is voluntary and the client can terminate involvement at any point in the continuum.

Who provides CAA and how do clients access it?

The CAA is a partnership between the Calgary Homeless Foundation (CHF) and the Distress Centre Calgary with the participation of CHF funded agencies and System Partners creating a Collaborative Service Delivery Group.

The CAA team of Housing Strategists primarily provides services from the fixed location of the SORCe to those presenting without referral or via referrals from participating agencies, including the Distress Centre 211 line. The CAA team has capacity to provide mobile outreach services for those who have barriers to accessing services at the SORCe, or in increasing accessibility for harder to engage individuals within the homeless sector. If you are a System Partner seeking to refer an individual to CAA services please see the CAA Referral Form which can be found under the Resources tab. For more information please also see the CAA Info Guide – Agency and System Partners under the Resources tab.

CAA can also be accessed through door agencies, these are agencies within the System of Care who have one or more Housing Strategists trained in providing both prevention and diversion strategies and the NSQ. These staff are part of the broader CAA team within the context of their agency and function as a ‘door’ for their clients into the HSSC throughout Calgary.

What is the benefit of Coordinated Access and Assessment?

Without a coordinated entry and assessment to determine client needs, individual agencies have historically independently determined which clients they accepted into their programs through agency-specific eligibility requirements and program entry. This led to multiple system access issues and obstructions. The CAA program allows agencies to work together with a common language, questionnaire tool, processes and policies. This provides greater ease of access for clients and more consistent, harmonized processes across the sector, regardless of where or how an individual enters the System of Care.

CAA also eliminates a common outcome of agency-centric systems of care where by clients could apply for entry into multiple programs at the same time to increase their likelihood of acceptance. This resulted in a system with multiple wait-lists and no way of knowing if the same client waits on numerous lists.

When defining structure in the system of care, it is important to have a thorough understanding of the needs of the population and the programs required to meet those needs. False data related to program wait-lists can skew funding decisions and lead to a HSSC not representative of client needs.

Successful CAA programs identify the needs of the target population, guiding interventions and funding towards the program types in most demand.


The Implications

Implications

The program was designed to coordinate single-point entry into the system of care and refer clients to the best program to meet their needs. While CAA has improved our knowledge regarding system gaps and program waitlists, it has not impacted the environmental factors that contribute to homelessness in Calgary, such as high rates of migration to the city, limited affordable housing options and lack of employment opportunities. Additionally, while we aim to coordinate the system of care through CAA, the need continues to outweigh the resources and therefore bottlenecks occur and individuals remain not receiving services until more program spaces are funded.

Consistent and repetitive communication is critical to the success of the program. Moreover, the collection and use of client and user feedback must be respected and valued. Through recent CAA Enhancements based on community feedback and data, a standardized tool (The Housing Plan) is now available to Housing Strategists to enhance the work being done with individuals on achieving housing independently. The program will continue to be modified and improved to achieve the desired outcomes and to support continued advocacy for increased resources and partnerships.

For a system long marked by navigational challenges, CAA demonstrates a concrete move toward centralization and coordination of services. A Collaborative Service Delivery Group can ensure resources are optimally deployed so that the right intervention for the right client at the right time is available for everyone seeking help.


Other

FAQ’s

What is SORCe?

The Safe Communities Opportunity and Resource Centre, or SORCe, is a location where people can access programs and services that address their current situation. SORCe offers information; provides an initial assessment to determine a person’s need; will offer counseling as required; facilitates referrals for individuals to a range of programs and services that respond to their unique circumstances; and transports people to agencies when appropriate.

What is CAA?

Coordinated Access and Assessment is a single program for people experiencing homelessness to access housing services and other system referrals. It is a system-wide program designed to meet the needs of the most vulnerable first by triaging. It creates a more efficient homeless serving system by:

Helping people move through the system faster by reducing the amount of time people spend moving from program to program before finding the right match
Reducing new entries into homelessness by consistently offering prevention and diversion resources up front.

Improving data collection and quality providing accurate information on what kind of assistance consumers need.

What is the Needs and Services Questionnaire?

The NSQ (Needs and Services Questionnaire) is a tool used to determine the client’s needs and can be applied in the System of Care in a standardized and methodical way. This questionnaire helps prioritize client need to determine the program best suited to the specific needs of each client. The process is to ensure fairness in placements with the focus on serving those with the longest history of homelessness and other vulnerability factors first and to accurately match the client to resources. For more information on the NSQ please see the HMIS section, these can be found under Forms & Assessments, listed as unique VI SPDATs by sector for CAA.

What are Placement Committees?

The purpose of Placement Committees is to review the completed NSQs for triaging. Placement Committees are comprised of CHF-funded agencies and System Partners to create a Collaborative Service Delivery Group. Committees for Youth, Families, and Adults meet each week to match clients based on availability, chronicity and vulnerability factors, best fit, and client choice.

How long will it take to get housing after completing an NSQ and Housing Plan?

Completing the NSQ with the CAA Team at SORCe or a CAA door agency will guarantee the client is entered into placement consideration. It does not guarantee housing or placement in a program. This is not a typical “wait list”, but rather about best possible match based on client needs and availability of services. Additionally, clients are applying to be accepted into a housing and case management program – not just housing. They will need to participate in case management, meaning they will be assigned a worker that will visit them in their home on a weekly basis to work on client identified goals.

What is a door agency?

Some agencies act as a door into CAA and have staff working as Housing Strategists. These Housing Strategists act as members of the larger CAA team and are coordinated by CHF. They are trained on the NSQ, Housing Plan, and Prevention and Diversion resources and strategies serving the HSSC as a whole.

How is client information protected?

The protection of client information is governed by FOIP. The CAA program adheres to these principles and policies both in verbal sharing of information and the securing of hardcopy and electronic storage of information. Client information will not be released to any person, agency, organization or institution except by a legal subpoena or by the expressed consent of the client by way of a Release of Information.

Resources

CAA Referral Form

Needs & Services Questionnaire Info Booklet for Clients

CAA Info Guide – Agency and System Partners

Resource Guide: Adult Sector Housing Programs (July 2018)

Resource Guide: Family Sector Housing Programs (July 2018)

Resource Guide: Youth Sector Housing Programs (July 2018)

Adult Placement Committee Terms of Reference

Family Placement Committee Terms of Reference

Youth Placement Committee Terms of Reference