Appendix D (continued)
Shelters
Shelter Typologies and Definitions
Homeless shelters (assistance providers) are organized at
the State and county level into Continuums of Care (CoCs). CoCs are
essentially local networks that provide services appropriate to the range of
homeless needs in individual communities, and coordinate the delivery of care
across various provider types. These can include: Prevention and
Outreach/Assessment Services, Emergency Shelters, Transitional Housing
Programs, Permanent Supported Housing and other, population-specific homeless
assistance programs. CoCs typically rely on Federal Department of Housing and Urban Development (HUD) Supportive Housing Program
(SHP) grant funding for a significant portion of their budgets, and report data
to HUD. Individual shelters depend on a mix of public and private (foundation
and faith-based) funds to maintain operations. CoC lead agencies can be either
nonprofit or governmental organizations.
Emergency Shelters are typically the points of
entry into the homeless service system. Emergency shelters provide up to sixty
days of temporary housing. Many are congregate facilities, but emergency
housing can also include hotel or motel vouchers and short-stay apartments.
CoCs typically dedicate separate facilities to single men, single women, and
families.67
In addition, more specialized shelters cater to specific subpopulations such as
homeless veterans, victims of domestic abuse, mental health and HIV/AIDS
patients, homeless or runaway youth, and teen parents. Nationally, the size of
emergency shelters and the number and types of clients served vary by
geographic location.68
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Transitional Housing Programs provide homeless persons or
families with housing and case management for up to 9 months (6 months in some
jurisdictions). Transitional housing programs typically offer on-site
case-management services, which range from alcohol and drug abuse treatment to
financial counseling and job training.
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Permanent Supported Housing is affordable rental housing
with support services for limited-income people or homeless persons (and their
families) with disabilities, severe mental illness, chronic substance abuse
problems, or HIV/AIDS and related diseases.
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Disaster Shelters are activated in schools, town halls,
stadiums and other open-spaces and often are run by nonprofit organizations
such as the Red Cross, the Salvation Army and United Way working with State and
local officials after an emergency. Some disaster shelters are designated as
"special needs" shelters, for persons who have medical needs but who do not
require hospitalization. Recent efforts to improve communication among the
various local and national aid organizations have resulted in the formation of
the Coordinated Assistance Network (CAN)69
and the affiliated National Shelter System. CAN contains person-level records
for each person sheltered by any of the participating voluntary organizations
(American Red Cross, National Voluntary Organizations Active in Disasters, Safe
Horizon, Salvation Army, 9-11 United Services Group, and United Way of America). The National Shelter System contains information about tens of thousands of
disaster shelters, including their capacity (number of evacuees who can be
sheltered) and facilities such as food preparation, back-up generators, etc.
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Homeless Shelter Intake and Discharge Processes
Homeless Shelter Intake. Shelter intake
processes, although varied, generally consist of assigning clients to a bed and
performing some sort of needs assessment, tasks which are usually assigned to
trained shelter staff or social workers. Intake staff will collect basic
identifying and demographic information on persons making use of shelter
services and are responsible for assigning client IDs to all new users.70 In some cases, the
attempt to determine a person's prior use of the shelter's services is verbal
and self-reported. In others, staff may query an electronic database to search
for existing client files as a means of preventing duplication. According to
shelter administrators, the attempt to re-use unique identifiers and verify
prior admission is a key component of the log-in procedure given clients'
frequent reluctance to provide personal identifying data such as name, social
security number or date-of birth. Unlike at the larger urban shelters, where
admission or login most often occurs via a Web-based information management
system, staff at many of the smaller, less well-funded shelters continue to
rely on paper-based systems to collect data on the people they house. Under
these circumstances, persons seeking shelter are assigned to a bed and given a
questionnaire or data sheet to fill out, which, once completed, is entered into
the shelter's database for tracking and reporting purposes by either full-time
staff or shelter volunteers. Desk staff and caseworkers typically spend time
with program participants to either help them complete the login procedure or
answer any questions they may have. Data-entry at these smaller organizations
typically occurs within 72 hours but may vary depending on staff size and
resource availability. Use of census information technology (IT) systems and reporting requirements for
the various shelter types are discussed in greater detail below.
Although most smaller shelters do not distribute physical
devices to program entrants that allow them facility access, large shelters
servicing a sizeable portion of a local homeless population or those providing
both emergency and transitional housing services will sometimes generate badges
or tags to facilitate admission. For clients staying at a shelter longer than
one night, a photo ID or badge with a bar code is used to re-enter the program
and allows easy access to meals and other social services.71 While there is a
recognized need among administrators and intake personnel for a simpler intake
process, a majority of shelters do not have the resources or funding to
purchase ID generating technology. Loss of IDs and badges—which can link to
an individual's personal data—is also of great concern to shelter staff and
managers alike and, as one participant stated, "Issuing badges in the midst of
a crisis would most probably not be ideal".
Discussions with shelter administrators indicated that
while medical personnel are typically not part of the intake process, shelter
staff do receive training to help them determine whether clients require
emergency medical attention or specific assistive devices. In some cases, CoCs
have adopted information-sharing policies that allow intake staff to view a
client's file and history of service use within the local continuum; under
these circumstances, shelter staff are capable of assessing a person's health
and referral needs upon program entry. Interviewees indicated however that a
majority of shelters have not adopted this approach, noting that comprehensive
needs assessment is typically separate from intake and that caseworkers—as
opposed to intake staff—are most often involved in this process. The extent
to which shelters collect health status information varies according to the
type of services a shelter provides: homeless assistance programs serving
persons with HIV/AIDS will, for instance, collect more detailed and complete
information on a clients' health status than on an emergency housing program.
As one participant noted, intake workers at most shelters will simply ask
clients if they have special needs. When trained medical professional are
available, intake will ask program entrants if they would like to make an
appointment to speak with whoever is on premises. Although most shelter
programs do not collect information on whether a person is ambulatory, intake
staff are more likely than not to make that determination due to the nature of
the beds available (ie: bunk beds vs. cots or mats).
Although emergency shelters and temporary housing programs
are not required to maintain open-door policies, many of these organizations
will provide individuals with housing regardless of bed availability, either in
the form of hotel vouchers or floor-space when demand is high or when receiving
clients from sister shelters in need of extra beds. When helping other
facilities with overflow, shelters may not necessarily log all arrivals into
their own system because no actual services are being provided beyond helping
to fill another program's gap for a night or two. People in transition from one
shelter to another can therefore easily slip through the cracks should there be
high demand for housing or other homeless assistance services.
Homeless Shelter Discharge. While shelters
are generally good at collecting data upon a person's entry into a program,
exit data can be more difficult to collect. Formalized departure processes are
implemented only in transitional or permanent housing programs. Emergency
shelters in particular, which clear out on a nightly basis, have trouble
gathering information from clients before they leave as many simply abandon
their beds without checking out. If a bed is unoccupied, it is assumed to be no
longer in use. As one participant stated, "Nothing about the shelter
environment encourages people to check out or inform intake personnel of their
plans". Transitional and permanent housing programs do however make a more
concerted effort to document a person's health and housing status at the end of
that person's stay. Clients are typically asked to provide information on their
next destination, and workers will check to see if a person's economic,
employment, or health status has changed. The frequency with which entry and
exit data is documented depends on the type of services provided: Whereas
emergency shelters make use of bed-lists and document the number of people on
location daily, transitional and permanent housing programs collect data at the
beginning and end of a person or household's stay. Files are updated
periodically during caseworker follow-up sessions, but there are no Federal
requirements or protocols for the frequency of these visits. Clients in
permanent or supported housing programs are not required to login or out
intermittently and program staff have no way of tracking or monitoring their
whereabouts.
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Shelter Information Technology Systems
Homeless Shelters. CoCs receiving State and
Federal Supported Housing Program (SHP) funds are required to collect
client-level data on assistance use and the characteristics of homeless persons
within their community via Homeless Management Information Systems (HMIS). An
HMIS is a Web-based software application that can encompass information from
disparate providers in geographic areas ranging from a single county to an
entire State. Although intake and discharge processes vary by shelter type, all
participating homeless assistance providers must collect a standard set of data
elements. These include: name, date of birth, Social Security number, unique
ID, and program entry/exit date. Programs with annual progress reporting
requirements and providers funded through Housing Opportunities for Persons
with AIDS must also supply detailed information on the health and
socio-economic status of clients and the types of services received during
their stay. The table below provides more detailed information on the
client-level information captured by HMIS.
Although response categories for both universal and
program-specific data elements are HUD mandated, providers have flexibility in
terms of how the data is collected and when it is entered into an HMIS. For
shelters with Internet connectivity and available workstations, data may be
entered real-time at intake; however, a majority of participating shelters at
present are simply documenting user data through existing paper-based or legacy
systems and entering it into the HMIS later. More specifically, providers are
allowed to collect universal and program-specific elements via client
interviews or questionnaires and can submit data to their local HMIS soon
thereafter (Although CoCs can establish their own data entry protocols;
discussants noted that most providers transfer data with 2-to-3 business days
of intake). HMIS administrators at the CoC level receive information from all
participating providers for de-duplication on a quarterly basis; aggregate
(de-identified) data is then reported to HUD annually.
HMIS prevalence and market concentration: Of the
469 CoCs that applied for Federal SHP funding in 2005, nearly three-quarters
(72%) reported that they were collecting client-level information. According to
HUD, there are currently 351 HMIS implementations in the country. 72 Of these, 32%
reported having achieved at least seventy-five percent bed coverage for each of
the three main shelter types (emergency, transitional and permanent housing).
An additional 34 % of communities anticipated achieving this goal by the end of
2005.73
While HUD expects HMIS participation to become a normative practice for
homeless-service providers across the country, information gathered in
discussions with HMIS vendors and administrators indicates that users currently
represent approximately sixty percent of shelters nationwide and are more
likely to be found in urban than rural locales. Nonusers typically are private
or faith-based organizations that rely on either homegrown or paper-based
systems to meet homeless assistance needs of the populations they serve. While
providers within a single continuum all use the same HMIS product or
application to capture client-level information, a CoC can choose from many
HMIS solution providers. HUD maintains a Web page of vendors with registered
HMIS products to help communities identify potential partners; presently, 48
vendors advertise on HUD's site. Despite the proliferation of software vendors,
the market for HMIS systems seems to be relatively concentrated in that the
largest vendor covers nearly 70% of all participating providers.
HMIS data quality and reporting issues: Because
HMIS implementation is a relatively new Federal requirement; homeless
assistance providers are facing a variety of issues relating to data quality
and de-duplication. Some of the issues raised by participants during
discussions include: how to deal with missing or incomplete client records, the
provision of false information (i.e., when a client is unwilling to provide
shelter staff with accurate data), delayed data entry or record transfer,
transcription errors, and lack of specified and timely data-entry protocols for
specific data elements that are subject to change. When asked whether it would
be possible for providers to generate daily status reports using HMIS in the
event of a natural disaster or mass casualty incident, most discussants
responded that although technically possible, participating HMIS shelters are
not yet able to produce timely or accurate person-level data on a moment's
notice for the reasons noted above. Lack of resources, training, and the time
involved to produce accurate, de-duplicated counts are barriers to conducting a
daily census. In addition, should daily reporting by providers become a
requirement during such an event, there would be no way to track clients or
evacuees in transition from one CoC to another or from one region to the next since
identifiers are unique to individual communities.
Universal Data Elements
Data Element |
Use & Disclosure |
Frequency |
Name |
Current and
previous names |
Intake |
Social Security
Number |
Required for
unduplication and to access previous records |
Intake |
Date of Birth |
Age at program
entry and for unduplication |
Intake |
Ethnicity and Race |
Ethnicity and race
recorded separately (two ethnicity categories and five race categories) |
Intake |
Gender |
To determine
number of homeless men and women |
Intake |
Veteran Status |
Service in the U.S. Armed Forces |
Intake/as needed |
Disabling
Condition |
Disabling
conditions determined from client interview, self-administered form,
observation or formal assessment (conducted separately from intake unless
information required to determine program eligibility) |
Intake/as needed |
Residence Prior to
Program Entry |
Where the person
slept the night before program entry. There are separate fields for type of
residence and length of stay in that residence |
Intake/as needed |
Zip Code of Last
Permanent Address |
Five-digit zip
code of the apartment, room, or house where the client last lived for 90+
days |
Intake/ as needed |
Program Entry Date
and Exit Date |
Month, day, and
year of first day of service. Used to calculate length of stay and homeless
episodes |
At each entry/exit |
Personal
Identification Number |
Permanent and
unique number generated by the HMIS software for every client in the system |
Computer generated
upon client's first contact with local HMIS |
Program
Identification Number |
Assigned by HMIS
for every program event for every client. Includes FIPS code for geographic
location of provider; locally determined facility code; HUD-assigned CoC
code; and program type code. |
Computer generated
at each entry |
Household
Identification Number |
Defined as a group
of persons who apply together for homeless assistance services. Used to
differentiate between persons receiving services as individuals and persons
in households. |
Computer generated
at each entry |
Disaster Shelters. CAN and the National
Shelter System, jointly developed by the American Red Cross Association and
the Federal
Emergency Management Administration (FEMA), is a nationwide, Web-based, registry of disaster-related shelters,
services, and agency resources, as well as a records system for persons
sheltered during an evacuation. It also supports referrals from shelters to
numerous social service agencies. The National Shelter System currently
contains information about some 40,000 disaster shelters, as well as the roads
and transportation networks leading to them. The National Shelter System is
supported by software that allows participating communities and agencies with
pre-existing, formalized agreements with the Red Cross to upload facility and
resource specifications both prior to and during a natural disaster or
incident. A 3-year pilot program is currently being implemented in six cities
to test usability and develop an emergency preparedness model applicable for
the rest of the nation. Shelter location, capacity, utilities, accessibility,
food prep, and Americans with Disabilities Act (ADA) compliance are all documented; additional data and files can
also be loaded manually into the system or over the phone during a disaster as
facilities open their doors to the public. Hospitals and nursing homes are not
currently included in the system even though these may occasionally become
shelters in the event of a natural or man-made disaster. A mapping tool allows
those operating the system to identify best possible routes to and from
designated facilities.
The CAN client service management software application
allows shelters to match evacuee needs with available resources. It tracks
disaster shelter residents' individual and household information while
identifying evacuee health, housing and social service needs. Plans for this
component of the system include collecting person-level data such as name, date
of birth, age, gender, room or cot number, arrival and departure date and
relocation address or phone. Additional information on health needs, housing
needs and legal assistance will also be collected. This application can be used
on a daily basis as new evacuees enter the system and will remain activated
during a community's recovery phase.
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Shelter Privacy and Confidentiality Issues
Data sharing among participating providers at the CoC is
limited to HMIS baseline privacy standards as stated in HUD's Final Notice on
HMIS Privacy and Technical Standards. Organizations wishing to adopt open
systems or share client-level information for referral purposes within their
CoC must also comply with more stringent State and local confidentiality laws.
Baseline standards require providers to 1) inform clients of the reasons for
collecting information in the form of a privacy posting at intake and 2)
develop a privacy notice that is available to all those who wish to see it.
Privacy notices describe the uses and disclosures of personal identifying
information, protocol for client access to and correction of personal
identifying information, provider efforts to ensure client accountability and
data quality, certification of staff confidentiality training and a statement
noting the possibility of amendment. According to HUD's Final Privacy notice,
providers may not use or disclose personal identifying information for purposes
not listed in their own notices without first obtaining individual client
consent. Should a shelter choose to adopt more stringent privacy protections
regarding use and disclosure of protected information such as seeking written
or oral consent or limiting disclosure to the minimum necessary, these
protections become mandatory as opposed to merely suggestive. Although most
homeless assistance providers are not subject to Health Insurance Portability and Accountability Act (HIPAA) regulations, this may be
a concern for particular programs providing targeted health services to
homeless persons in the community. The recently re-authorized Violence Against
Women Act may also limit domestic violence providers' ability to disclose
person-level information, let alone participate in an HMIS. As stated in HUD's
Final Notice, access to person-level data is restricted to local CoCs and is
not intended for distribution at the national level.
Despite these restrictions, discussants noted the need for
more open information-sharing and referral policies, especially in the face of
a natural disaster or Katrina-like incident. Although providers "walk a fine
line between trying to both honor the people [they] serve and maintaining a
good working relationship with different agencies and providers", many seemed
to think that if HIPAA-like provisions were relaxed and measures were taken to
safe-guard the identity of specific homeless sub-populations that information
sharing would be possible in the event of national emergency. Because HMIS
applications can be customized to meet the needs of a specific program or
shelter, safeguards to limit access to personal identifying information to
specific providers and ensure confidentiality already exist.
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Shelter Perceptions: Benefits of Evacuation Tracking
Perceived benefits of implementing a national system among
shelter administrators are mainly related to improved evacuation procedures and
coordination of disaster relief resources transportation in the event of a mass
casualty incident. Shelters located on the Gulf coast, and those having previously
been on the receiving end of evacuations, were particularly interested in the
possibility of better-coordinated transportation and referral services. Nearly
every participant we spoke to indicated that they would consider this as an
incentive to participate in a national system. According to the information
gathered during these conversations, most shelters do not have enough resources
to provide clients with safe and easily accessible transportation to another
location—large shelters may have vans at their disposal but most would rely
on their local 211 or cab companies for aid. Despite their limited resources,
homeless assistance providers consider themselves responsible (or are
considered responsible by the county) for arranging for clients' transportation
needs. Moreover, while individual agencies may have pre-established agreements
with other facilities in a nearby locales should evacuation be required,
continuum-wide disaster planning appears to be in its infancy as there is
limited information sharing regarding bed or other resource availability among
providers today. There is however a recognized need for this type of
communication—local 211 agencies, emergency-responders and county
representatives in many States are in the process of holding discussions
regarding this particular issue. HUD itself is currently providing technical
assistance to regions directly affected by Hurricane Katrina to establish a
case management and tracking system for shelter residents and is working with
HMIS vendors to provide region-wide resource directories for use by local
providers.
67. U.S. Department of Housing and Urban Development (HUD), Office of Policy Development and Research; "Evaluation of Continuums of Care for Homeless People Final Report." May 2002.
68. HUD's 2002 CoC Evaluation discusses the variation in both style and intensity of emergency services provided by communities across the country.
69. CAN is a formal partnership among seven leading disaster relief nonprofit organizations: Alliance for Information and Referral Systems (AIRS), American Red Cross, National Voluntary Organizations Active in Disaster (NVOAD), Safe Horizon, Salvation Army, 9-11 United Services Group, and United Way of America. The CAN IT vendor is responsible for maintaining the National Shelter System and its related applications during an evacuation.
70. Family programs will collect information by household and maintain one file per family as opposed to collecting data on individual family members.
71. The Salvation Army Emergency Shelter in Sarasota, FL and the Shreveport-Bossier Rescue Mission in Louisiana both generated badges for their clients during recent mass evacuations. Both indicated that badges only work at their individual shelters and cannot be used to log in at other locations.
72. CoCs can choose to implement HMIS on their own or in conjunction with other CoCs. Of the 351 HMIS currently implemented, 314 represent a single CoC, 31 implementations include between 2 and 4 CoCs, and 6 include 5 or more CoCs.
73. U.S Department of Housing and Urban Development, Office of Community Planning and Development: "Report to Congress: Fifth Progress Report on HUD's Strategy for Improving Homeless Data Collection, Reporting and Analysis." March 2006.
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