The Canadian Observatory on Homelessness (COH) continues to evaluate the design and use of assessment tools within the homelessness sector, to ensure that communities have access to the best, most evidence-based resources. This blog shares our recent reflections on assessment tools and processes. It also highlights key findings from a national survey on assessment tools launched by the COH in the fall of 2021.
The COH’s mission is to create and mobilize research that informs policies, programs and practices that support efforts to prevent and end homelessness in Canada. Our work is driven by the desires and needs of stakeholders across Canada who strive to find practical and evidence-informed solutions that prevent and end homelessness in their communities. When assessment tools became more common, we developed resources to support communities and increase their capacity to make informed decisions. For example, in 2015, the COH convened an expert task force to review screening tools for Housing First providers.
Over time, assessment tools remained a focus of our work, mainly as questions and concerns about their design and use emerged in communities. In 2019, communities that received funding from the Government of Canada’s Reaching Home program were required to use a common assessment tool within their local homeless-serving system. Assessment tools became a central feature within the operations of the homelessness sector in communities across Canada.
A key challenge is that tools were being used as a “one-size fits all” approach to triage and assess people’s service needs, and prioritize access to the limited housing supports and resources. However, research showed that the use of existing common assessment tools for prioritizing people’s access to housing had significant limitations. For example, studies reported that the tools lack an intersectional approach and inadequately measure and define “vulnerability”.
Additionally, research conducted with communities in Canada and the United States reported that commonly used assessment tools lead to inequitable outcomes, particularly among Black, Indigenous Peoples and People of Colour, which are noted by Cronley, Tsemberis et al and Wilkey et al. With the growing implementation of tools in communities across Canada, we began to hear a desire for evidence-based, easy-to-use, non-intrusive tools that reliably help understand clients' needs.
The evolving developments related to assessment tools led us to reach out for perspectives from communities across Canada. Late last fall, we launched a national online survey to gather insight from service providers in the homelessness sector on their current use, needs, and interests regarding assessment tools and processes.
- Almost one-third of respondents (27%) are not satisfied with the assessment tool that they use
- Over one quarter of respondents (26%) do not feel confident in the effectiveness of the assessment tool that they use
- Over half of respondents (54%) are not confident that the tool they use provides equitable outcomes, particularly among groups that have been marginalized (e.g., First Nations, Métis, Inuit, Black, and 2SLGBTQ+ communities)
- An overwhelming majority of respondents (94% ) indicate an interest in learning about alternative assessment tools or processes
Survey respondents also reported concerns with the assessment tools they use including:
- being embedded with race and gender bias and discrimination
- lacking accuracy in assessment results often due to the client’s mistrust, and/or inconsistent use
- lacking integration of a trauma-informed or strengths-based approach; being deficits focused
- being inherently colonial and culturally unsafe
Highlighting these key themes, a survey respondent shared that assessment tools are,
“colonizers’ tools, and continue to colonize”. Another respondent stated that assessment tools have, “no consideration of social identity. [Are] based on one idea of homelessness and negates others. [And] doesn’t consider safety factors for 2SLGBTQIA+, Indigenous, Black or people of colour.”
Given the emerging research on race and gender bias within assessment tools, our survey asked how equity could be embedded within assessment tools and processes. The results varied and include comments such as:
“That we have to prioritize some over others feels wildly unethical when the root issue is a dearth of appropriate, accessible, safe, healthy, affordable (RGI rental) housing.” “I don’t believe they can be equitable.”
“Ensure that pre- and post-assessment tools are culturally sensitive and that they capture race and other characteristics accurately so research can be done to see if these populations are being served appropriately.”
“Co-created, and validated in collaboration with PWLE (People with Lived Experience), equity-seeking groups, and community. Assessment tool needs to be both informed by Indigenous peoples and approved by local Indigenous communities.”
The key findings from our survey indicate a significant need for ongoing work to improve the design and use of assessment tools and processes.
At the COH, the embedded systemic discrimination within assessment tools is why we paused our work on assessment tools. With new knowledge about assessment tools contributing to inequitable outcomes, we felt we needed to refrain from further promoting assessment tools until they satisfy obligations to cultural competency and equitable outcomes. We are learning that part of this work will require understanding where and how human bias plays a role in tool design and implementation.
We also heard the need to integrate opportunities to analyze data and outcomes, particularly among Black, Indigenous Peoples and People of Colour, on an ongoing basis, so we can monitor whether or how people are gaining access to the support they truly need to end their experience of homelessness.
Finally, we recognize the concern that assessment tools do not respond to structural barriers, particularly the lack of adequate housing in Canada. These barriers disproportionately impact Black, Indigenous, and People of Colour. Without a sharp growth in housing stock, supports, and resources, and deeper investment in homelessness prevention, we recognize that we must shift the provision of resources to be more equitable.
Now that we know better, we must do better.
Moving forward, the development of equitable assessment tools and processes should follow a human-centred design process, and position people with lived experience and expertise of homelessness as leaders in designing, implementing and evaluating assessment tools. In the design of tools, we must draw on evidence based in the homelessness sector and allied professions, and tools must be validated by experts in the field of assessment so that communities can confidently rely on their efficacy.
As noted in a study by Brown et al, “Because coordinated assessment instruments are utilized in large homeless service systems, the development of measures producing accurate and reliable responses in settings faced with barriers to controlled implementation should be a key priority.” Clarity on the purpose of assessment must be at the forefront when making decisions about tool design and implementation.
It is also important to remember that tools should only be one part of the assessment process, and should be used in conjunction with other means of determination. As noted in the survey responses, assessment tools can be needlessly triggering, traumatizing, and intrusive, leading to inaccuracies. Kim Kakakaway, Indigenous Training and Relations Coordinator with A Way Home Canada asked, "who gets asked about their trauma history when they apply for a mortgage?" Deciding if someone qualifies for access to a type of housing support or resource should be an uncomplicated and harmless process; it must also be fair.
Further, when someone receives case management services, we may gather more information to determine support needs. However, the assessment process must allow time to build trusting and respectful relationships between the worker and the client. The centring of relationships is particularly essential among Indigenous communities. As a key informant noted in the report, Revisioning Coordinated Access: Fostering Indigenous Best Practices Towards a Wholistic Systems Approach to Homelessness, “it’s not about taking people and putting them into this machine and coming out with a number. Or your little ingredients of what the needs are. It’s about interpersonal relationships. Building that trust. Because it always comes down to building the relationship” (p. 59).
The COH is interested in learning more about the design, use, and evaluation of assessment tools within the homelessness sector in Canada. We are committed to supporting those who are developing tools and approaches that are steeped in equity work and validated from a research perspective. If your work involves developing assessment tools and processes that are centred on equity and cultural competency, we would love to hear about it. You can reach us at firstname.lastname@example.org.