Up to our Eyeballs in
VI-SPDATS: How our CAA is
transforming our
community by ending
homelessness
Angie Walker, CCAP, Housing Advocate &
Chris Greenwood, CCAP, Community Health Manager
City of Rockford Community Action Agency
Rockford, IL
Who are we?
We are a municipal Community Action Agency (CAA) serving a two county area in
Northern Illinois (Boone & Winnebago) about 90 miles Northwest of Chicago.
Rockford is the largest city in that area with just over 153,000 people. Total
population of the two counties is approximately 345,000 with a combination of
urban and rural areas.
Some of our services include: LIHEAP, Weatherization, Emergency Services, Head
Start, Employment Programs, Summer Food, DCFS Housing Advocacy,
Scholarships, ESG Rapid Rehousing, and Single Point of Entry (SPOE) for the
homeless.
How can a CAA be involved
in the fight to end
homelessness?

For years CAAs have been known for community resources and referrals.
Taking on more responsibility with the homeless population has been a natural
transition.

CAAs already serve many of the poorest families in our communities. Through
relationships we have built and current outreach, CAAS are well known in the
community.

Our CAA is currently the lead agency for both the Zero:2016 and Mayors
Challenge to End Veteran Homelessness Initiatives and we:
 Act as the grantee/Collaborative Applicant for CoC funding
 Serve on the board of our local Continuum of Care as well as
several other committees.
 Coordinate the yearly Point-in-Time count of the homeless.
 CAA staff acts as the Chair of the Coordinated Intake Committee
for the CoC.
What is the scope of our
homeless problem?

According to our January 2015 Point-in-Time (PIT) Count, there were a total of
327 homeless persons counted. Of these, 146 were in Emergency Shelters, 152
were in Transitional Housing, and 29 were unsheltered.

We do feel that many homeless are being missed during the count because they
are living in vacant or condemned buildings or cars. Many of the homeless went
uncounted prior to the Single Point of Entry.

Although the PIT number was relatively low, a total of 515 persons were seen in
the first 6 months of the SPOE.

There is also a list of homeless “Super-Utilizers” who frequent the emergency
rooms and have many interactions with police and fire departments, which
causes a significant financial burden to our community. Most of the individuals
on this list are chronically homeless but never appear on our PIT count or
shelter logs. We also participate with a group addressing this problem
specifically.
HUD CHANGE
In 2009, HUD implemented the HEARTH Act, which changed many of the definitions and
Regulations about homelessness. The bigger changes include:
 A requirement to serve the “hardest to house” first,
 Clear definitions about homelessness and what programs can serve what categories of
homeless,
 The addition of Rapid Rehousing which provides funding to rapidly rehouse persons
in private housing for up to 24 months. It also allows people to keep their homeless
status for the purpose of publically funded units in case public housing or a
supportive housing project is a better fit but has a waiting period,
 Started defining “Housing First” as the model CoCs should follow, and
 Eliminated the ability of transitional or permanent supportive projects to remove
someone from a program for breaking program rules, only lease violations can be
used for dismissal.
 HUD also added new funding streams for outreach and planning to support these
changes.
ALL OF THESE CHANGES BENEFIT COMMUNITY ACTION PARTICIPANTS WHO ARE OFTEN THE
“HARDEST TO SERVE”.
What is Coordinated
Assessment?

Coordinated assessment is ideally a system-wide process and can serve
any and all homeless populations.

Systems may accomplish coordinated assessment through the use of a
centralized phone hotline (e.g. a 2-1-1), a single physical point of
assessment (through an emergency shelter or a dedicated assessment
center, for example) or a decentralized coordinated system (with
multiple assessment points all employing the same assessment and
referral process).

Each assessment point in a coordinated system handles assessment or
screening of consumer need, data entry, referrals, and, potentially,
program admissions. Ideally, these centers are the main access points
for prevention and diversion services as well.

Assessment center staff, after an initial assessment, should either
provide the necessary prevention or diversion services or admit or refer
a family to the program that is best equipped to get them into
permanent housing as quickly as possible.
http://www.endhomelessness.org/library/entry/coordinated-assessment-toolkit
Why do we have a Single Point of Entry?
 HUD’s HEARTH (Homeless Emergency Assistance and Rapid Transition to Housing)
Act mandates that any Continuum of Care receiving federal funding use a
Coordinated Entry System (aka: coordinated intake, assessment, or entry).
• Our community initially considered multiple sites for intake but reconsidered
and established a SPOE.
• SPOE offers more consistent knowledge of programs, housing availability,
and client interactions
• Most agencies did not have the resources to act as an intake site.
 A SPOE reduces barriers to homeless clients by using only one place for intakes
and referrals. The SPOE determines what services they are eligible for and gets
them to the agency with openings.
 Our CoC, in conjunction with Coordinated Entry, has established common intake,
assessment, termination, and discharge policies.
 As a CAA, it is our mission to serve those living in poverty by identifying and
addressing community needs. We felt serving as the SPOE was a good fit for us
and our goals.
What are the benefits of Coordinated Assessment?
Old system vs New system

Our old system asks, "should we
allow this family into our program?"

Program-centric

Unique forms and assessments for
each organizations

Does not ensure match between
need and service received

Uneven knowledge about available
housing & service interventions in
the CoC

New system asks, "What housing or
assistance is best and quickly ends
their housing crisis permanently?"

Client-centric & system driven

Standard forms & assessment
processes used by every agency for
every program

Coordinated referral process across
the CoC

Accessible information about
available programs & services
Culture change & barriers

In our CoC, clients historically had to go through the various stages of programs—emergency
shelter, transitional housing, and then to permanent housing once they have “earned” it.
Many did not earn it and remained unhoused.

Finally we have implemented a housing first approach.
As defined by the National Alliance to End Homelessness it is “an approach to ending homelessness
that centers on providing people experiencing homelessness with housing as quickly as possible – and
then providing services as needed. This approach has the benefit of being consistent with what most
people experiencing homelessness want and seek help to achieve.”

Agencies are no longer able to admit their own homeless clients. All new clients must first
come through the SPOE. There are no SIDE DOORS allowed. The hope is to cut down on the
“creaming” that agencies may do to ensure better outcomes.

Working with our local shelter, a Rescue Mission, to reduce barriers to staying there and
reasons to discharge people back into homelessness.

When conducting our annual Housing Inventory Count, we have seen what appears to be
discrimination in housing programs, with a higher percentage of white homeless people
getting into transitional and permanent housing while African American and Latino
homeless are kept in the shelters. Through use of the VI-SPDAT which measures the
vulnerability of each individual, we are hoping to end any inequalities.
What is the process?

Each homeless client completes an intake and assessment.

Use the VI-SPDAT (Vulnerability Index & Service Prioritization Decision
Assistance Tool) to get a priority score for each homeless client. We are
looking at a possible locally made tool that can meet our needs.

Also look at special populations such as veterans, chronically homeless, and
youth.

Placements to permanent housing are made based on the “score” and the
date and time people apply.

While waiting for housing, we work with people on an individual basis to try
to ensure they have temporary placements.

Everyone is encouraged to apply for subsidized housing and work with our
local Township office, if they qualify. We work with clients to get verification
of their homeless status, which is a local PHA preference, and to appeal
denials when appropriate.

For after-hours and weekends, staff is on call 24-7 in case of emergency
placements usually coming from hospitals, police, and paramedics.
How is this benefitting the
community?
Homelessness is extremely costly to communities and to tax payers.

People who are homeless spend more time in jail or prison, which is tremendously costly
to the state and locality. Often, time served is a result of laws specifically targeting the
homeless population, including regulations against loitering, sleeping in cars, and
begging.

The cost of homelessness can be quite high. Hospitalization, medical treatment,
incarceration, police intervention, and emergency shelter expenses can add up quickly,
making homelessness surprisingly expensive for municipalities and taxpayers.

In Rockford, 20 of the top 30 “super utilizers” of ambulance and ER services are
chronically homeless.
•
Rarely are they having emergent medical issues that would mean using these
services. Generally they just want a warm place, bed, and meal. Not only is this a
very expensive way to “house” them, but it also takes resources that could be used
for those with true medical needs. For example, an ambulance that is transporting
a homeless person is no longer available for the person who is having a heart attack.
Changing lives-Jose
From the Rockford Journal Standard (December 24, 2014)
Jose R. will celebrate Christmas Day in his own apartment for the first time in years, not bunked at
the house of family willing to take him in for a night or in a tent on the streets. Struggling with
alcohol, medical problems and a divorce, Jose spent nearly six years homeless in Rockford. Then in
October, Community Action Housing Advocate Angie Walker got a tip that Jose was living behind a
garage and went looking for him with a Rockford Fire Department firefighter.
Jose was still injured from a brutal mugging in March. Jose said that it was like a prayer was
answered when Walker found him. Although a hospital patched Jose up after he was assaulted by
three men March 21 outside a shopping center laundromat, his injuries never healed. His middle
finger is still broken and juts out at an unnatural angle from his hand. His nose was broken and still
bleeds occasionally. Two teeth were knocked out. Jose thinks he was targeted because he was
homeless and alone.
What’s it like being homeless?
“Rough. Like sandpaper. You don’t know if you are going to get cold or if water is going to leak
through your tent, you don’t know if someone is going to come back there and mess with you. They
stole a lot of stuff while I was gone,” Jose said. “You never know where your next meal is going to
come from. You don’t know if you are going to get one either.”
Once a machinist and a mechanic, Reyes views the assistance from the city and the Rock River
Homeless Coalition as a second chance and plans to look for a job soon.
http://www.rrstar.com/article/20141224/NEWS/141229600/?Start=3
Cost Savings: Jose
The following table is an example of how much one homeless individual cost our
community in just ambulance and hospital costs alone.
Year
Ambulance
Emergency
Inpatient
Totals
Costs
Room Costs
Hospital Costs
$38,949.79
$62,701.56
2012
$114,456.55
$12,805.20
2013
Jan 2014-Oct.
2014
Nov. 2014June 2015
$23,120.20
$26,908.40
$0
$69,184.86
$138,602.61
$230,907.67
$69,458.85
$61,935.39
$158,302.64
1 ER visit in
May, no bill
$0
yet but client
now has
Medicaid.
$0
This individual has been housed since October 22, 2014 and has only had one emergency
room visit which did not involve an ambulance or inpatient stay. Our agency spent $1900
to house him for 3 months with Rapid Rehousing and now he is receiving subsidized
housing.
What have we learned?

Community Action, due to its flexible nature and broad community resource knowledge can
be the leader in ending homelessness in communities.

Change is hard, even when you believe in what you are doing! It is even harder to get others
to buy into what you are doing.

In laying out a new project, you may not always solve with every problem at the outset.
You must implement the program and make alterations as you go; otherwise, you will never
start it!

A SPOE can’t do the work by itself, it is a community effort

Despite the misconception that many street homeless do not want a place to live, many have
been very grateful and receptive of our program. Just because some may have difficulty
following specific program rules, does not mean they don’t want a place to live.
What does the future hold?

From outreach and media attention, we have gotten new partners on board.

Super-Utilizers Committee will be seeking funding for a true Housing First
program for those homeless who are unable to get into other programs due to
their addictions and refusal to follow rules. We do not have any true HF
programs currently for singles.

Housing partners have agreed to begin coordinated case management to
ensure that those who are hardest to house, get housed as soon as possible.

The Coordinated Assessment Committee (CAC) is planning to work with local
PHA’s to update their Admissions & Continued Occupancy Plan (ACOP) to have
better or different homeless preferences and looking into “Flow” Vouchers as
a way to get people out of Permanent Supportive Housing who no longer need
it.

The CAC is also planning to begin outreach with local area churches and
veterans groups to try to implement some type of an “adopt-a-family”
strategy to ensure that the formerly homeless families with no support
systems stay housed and stable.
Zero 2016: Ending veteran & chronic
homelessness
• Started in January 2015 with the goal to end veteran homeless by the end of
2015.
• We were given a target of 42 veterans that we needed to house to complete the
task.
• Through July, we have housed 32 of the targeted 42.
• By working with partner agencies including the Veteran’s Administration, County
Veterans Assistance Commission, and other vet providers a by-name list of
veterans who need housing assistance was developed
• We have identified more than the initial 42 that need help. On top of the 32
already housed, we have identified 24 additional homeless veterans.
**Our community goal is to have all of the remaining vets housed this
year by Veteran’s Day!!
“Most wars are declared by old men and
fought by the young. But our war on
poverty asks everyone to get involved in
the fight.”
-Sargent Shriver (1966)
“Peace will happen not through the
absence of war but through the presence
of love. The kind of love that will see to
it that men have enough food to eat,
enough clothes to wear, enough houses to
live in.”
-Sargent Shriver (1966)
Questions???
Thank you for coming!
Please contact us with any questions:
Angie Walker, CCAP
[email protected]
or
Christopher Greenwood, CCAP
[email protected]