Many state and federal programs in the past five years have focused on building connections between service sectors to better support vulnerable people in our communities. In California, one of these programs funded by the State’s 1115 waiver (Medi-Cal 2020) is Whole Person Care (WPC) and our firm has worked closely with many WPC programs. These county-level initiatives often focus on improving programmatic and data sharing linkages between health, behavioral health, homelessness and other social determinants programs. Given the homelessness crisis in many California municipalities, WPC programs have generally taken-on the effort of linking housing services with other sectors more directly than many comparable 1115 waiver programs in other States.  As a part of this work, many WPC programs have worked hand in hand with their Housing and Urban Development (HUD) funded service networks (called Continuums of Care) to implement coordinated entry policies that define a unified process for prioritizing services and matching people experiencing homelessness to the program that best fits their needs. 

Whole Person Care counties have been working to create relationships, data sharing agreements, and new partnerships between clinics, hospitals, emergency response, and community-based organizations that provide myriad services. These efforts have laid a foundation for better collaboration in times of crisis. The WPC Evaluation team at the UCLA Fielding School of Public Health published an article in the April 2020 issue of Health Affairs on the integration of health and human services in WPC programs. Their related blog post, “How California Counties’ COVID-19 response benefited from the ‘Whole Person Care’ Program” discusses which aspects of WPC innovation and collaboration are being refocused on COVID-19 response.[1] They summarize,

Challenges to emergency response include the need for centralized leadership and rapid and effective information sharing; this is necessary to raise awareness of priorities and implement a coordinated response across all sectors that provide essential health and human services. WPC pilots can address these challenges, as they are typically led by county health or public health agencies and include an explicit focus on development of cross sector partnerships, forming multidisciplinary care teams, and building data sharing infrastructure to support care for vulnerable residents. 

One of the most important cross-sector collaborations for effective COVID-19 response that we have witnessed is between health and housing. In order for counties to implement more effective and safe shelter in place protocols for all people experiencing homelessness, and quarantine for people who test positive for COVID-19 or have symptoms, they have had to quickly and creatively expand access to shelter and emergency housing. Many are keeping watch on how the state is ramping up access to motel rooms and less dense shelter options through Federal Emergency Management Agency (FEMA) funding and partnerships with local motels (see the recent California Health Care Foundation blog post on COVID-19 and Homelessness[2]). Governor Newsom announced Project Roomkey, with 75% FEMA matching funding for up to 15,000 hotel/motel rooms only two weeks after issuing the state stay at home order.[3] 

While generating supply is one critically important piece of the solution, having a system for assigning people to resources is another piece. The work that counties have done over the past 4 years to design and organize county-wide coordinated entry housing service triage systems have also contributed to effective response in a time of crisis. HUD’s “Coordinated entry policy brief” defines the qualities of effective coordinated entry processes, which, “…help communities prioritize assistance based on vulnerability and severity of service needs to ensure that people who need assistance the most can receive it in a timely manner.” [4] Many counties are using the coordinated entry processes established between networks of service providers to funnel housing and shelter requests for COVID-19 response and make sure that they are handled in a consistent, fair, transparent, and rapid manner. Counties have built strong and structured relationships with service partners through WPC and coordinated entry collaboration and are putting those relationships and processes to work quickly for identifying the community’s most vulnerable, prioritizing outreach, housing vulnerable people quickly, and supporting them once they are housed by connecting to additional services and supports.

In Marin County, WPC had already brought together a multi-disciplinary team to provide wrap around services to clients with complex needs before the current emergency. Their WPC and coordinated entry teams worked closely together to focus on their goal of ending chronic homelessness in the County. These same teams are now providing leadership in the COVID-19 emergency response and all emergency housing efforts are functioning through the established Coordinated Entry List processes.[5]  Similarly, in Alameda County, the coordinated entry processes had already created a shared managed list of people experiencing homelessness and their assessed relative vulnerability, called the “By Name List.” This list is currently helping providers target outreach and efforts to find temporary housing for those most at risk of serious outcomes from COVID-19 exposure. Contra Costa County created a new division to bring together housing and health initiatives called Health, Housing and Homelessness. This division manages their coordinated entry list, and during the COVID-19 emergency has worked to develop and implement rapid and creative solutions to support people experiencing homelessness during this crisis, from reducing density in shelters, securing hotel rooms, distributing tents and handwashing stations, and outreach and education. Their efforts are described in a recent publication called “COVID-19, 90 Days in Review; Contra Costa’s Pandemic Response.”[6]

One leader of a local social service organization recently reiterated that housing is often the most important social determinant of health. Coordinated entry processes are working to make sure we are matching the housing resources we have to the most vulnerable residents in our communities and can be an important model in other California counties, but also in other States where cross-sector collaboration is happening under the auspices of different programs, or in the form of local community initiatives.    

 

[1] Pourat, Nadereh, Emmeline Chuang, Leigh Ann Haley. “How California Counties’ COVID-19 response benefited from the ‘Whole Person Care’ Program” Health Affairs Blog. April 28, 2020. https://www.healthaffairs.org/do/10.1377/hblog20200427.341123/full/

[2] Bion, Xenia Shih. “Homelessness and COVID-19 collide in California.” California Health Care Foundation Blog.  April 6, 2020. https://www.chcf.org/blog/homelessness-covid-19-collide-california/

[3]The Office of Governor Gavin Newsom. “At Newly Converted Motel, Governor Newsom Launches Project Roomkey: a First-in-the-Nation Initiative to Secure Hotel & Motel Rooms to Protect Homeless Individuals from COVID-19:  April 3, 2020: https://www.gov.ca.gov/2020/04/03/at-newly-converted-motel-governor-newsom-launches-project-roomkey-a-first-in-the-nation-initiative-to-secure-hotel-motel-rooms-to-protect-homeless-individuals-from-covid-19/

[4] Housing and Urban Development. “Coordinated Entry Policy Brief.” 2015: https://files.hudexchange.info/resources/documents/Coordinated-Entry-Policy-Brief.pdf

[5] Marin County Whole Person Care Website: https://www.marinhhs.org/whole-person-care

[6] Contra Costa Health Services. “COVID-19; 90 Days in Review; Contra Costa County’s Pandemic Response, May 2020.”  https://813dcad3-2b07-4f3f-a25e-23c48c566922.filesusr.com/ugd/ee8930_fae73bfbf7a04ca793c824803cd552a4.pdf

 

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