A lack of system coordination has long been a critique of the social service sector. Systems have been created without the end-user in mind, resulting in complicated pathways to care. To reduce these system barriers, coordinated systems, named “Coordinated Access” in Canada and “Coordinated Entry” in the United States, have been developed to streamline access to housing and support options among people experiencing homelessness. Coordinated systems are federally required components of Continuums of Care (United States) and Designated Communities (Canada).
In the same way that Housing First was adopted as a leading policy driver due to an extensive amount of evidence on its effectiveness, one would imagine that the widespread implementation of coordinated systems was also driven by evidence. However, it appears that evidence on coordinated systems is limited at best. This prompted our team of authors to conduct a critical commentary on the state of the evidence on coordinated systems, the results of which we present below.
What are the components of a coordinated system?
There are four main components of a coordinated system: (1) community access points to engage people experiencing homelessness; (2) the use of standardized assessment tools; (3) prioritization of individuals and families for housing; and (4) matching and referral of people experiencing homelessness to housing and support interventions.
Is there evidence on the effectiveness of coordinated systems?
We did not find many examples of studies that examined coordinated systems as a whole. For this reason, we critiqued the four individual components of coordinated systems.
Based on our review, communities should take a “no wrong door” approach that includes active outreach to promote awareness of the coordinated system and population-specific access points. It is also important to take a “decentralized” or “hybrid” approach, where multiple access points are used. Prioritizing the hiring of individuals with lived experience as peer outreach and intake workers will help to develop trust in coordinated systems and encourage people experiencing homelessness to access the system.
Use of Assessment Tools
The use of assessment tools greatly impacts prioritization, matching/referral and ultimately the ability to attain housing. The most widely used tool is the VI-SPDAT. Research on the tool has shown poor reliability and validity and evidence of gender and racial bias. Our commentary suggests that assessment tools should be just one part of the assessment process and that communities need to hire skilled assessment workers that are able to develop rapport and build trust with the people being assessed. As well, any assessment tool that is used should be culturally valid and meet the needs of local communities.
The need for prioritization strategies is justified as a method to address the limited supply of affordable housing and supports that exist in communities. However, prioritization strategies have shown little evidence of being effective. Enforcing prioritization strategies may also impact the delivery of prevention services, as receipt of services through coordinated systems is often contingent upon a person’s length of stay in homelessness. It is clear that prioritization strategies need to be examined in much greater detail.
Matching & Referral
The matching and referral process also requires further investigation. Evidence has demonstrated that coordinated systems:
• May not be increasing access to housing and supports
• May hinder eligibility for housing
• May not lead to improved housing outcomes
Matching and referral processes may be facilitated by using case conferences, where providers come together to identify housing and support options for people on the priority list. However, it is important that these tables are client-centered and are informed by people with lived experience of homelessness. Like the other components of coordinated systems, matching and referrals processes need to be examined in greater detail.
Where do we go from here?
There is clear and helpful guidance from the US Department of Housing and Urban Development (United States) and Reaching Home (Canada) on how communities can implement coordinated systems in their community. What’s missing is an evidence base on the efficiency and effectiveness of these systems. Communities need to incorporate feedback mechanisms within their coordinated systems and develop evaluation strategies to examine how their systems are working and if they are contributing to helping people find housing and supports that meet their needs. Communities should use this information to adjust their systems accordingly. Given the significant resources invested in coordinated systems, it is imperative that research and evaluation be used to inform the development of fair and effective approaches.