St. Louis City, MO

Spotlight on Process to Track those who have declined services

Saint Louis City achieved the BFZ quality data milestone for all single adults in September 2023 as a result of two years of collaboration. Reliable, accurate, and comprehensive monthly data is a top priority for the St. Louis City Continuum of Care (CoC). This data is essential for building a community-wide understanding of the extent of homelessness and for uniting efforts to develop effective solutions. With over 1200 single adults experiencing literal homelessness, St. Louis City recognized the importance of ensuring that individuals are counted as soon as they are identified, even when they may not yet have consented to services, completed an assessment, or signed a release of information. St. Louis City has diligently developed and implemented processes and resources that: (1) are person-centered and housing-focused, (2) respect and protect people’s privacy, (3) recognize the need for progressive engagement, and (4) increase accountability to accurately count and engage people experiencing literal homelessness. 

Long-standing Commitment to People-Centered Quality Data  

Located at the confluence of the Mississippi and Missouri Rivers, St. Louis covers 62 square miles and has a population of approximately 300,000. The city has a dedicated BFZ improvement team that meets weekly, including representatives from the CoC lead, Coordinated Entry, HMIS admin, VA, Youth, the City, and leaders from Outreach, Service, and Housing providers.

The St. Louis City Department of Human Services serves as the Collaborative Applicant and partners with the Institute for Community Alliances (ICA) Missouri as the CoC’s HMIS Lead Agency. Through this partnership, ICA provides a full-time CoC Data Analyst who develops and delivers both customized monthly and ad-hoc Wellsky reports.

St. Patrick’s Center acts as the BFZ Improvement team lead as well as the Coordinated Entry and Outreach lead agency. The community’s commitment to quality data reflects a core value: ensuring that the system effectively acknowledges and counts everyone who is experiencing literal homelessness is a critical step toward helping and housing individuals.

During the BFZ quality data process, the St. Louis City BFZ team focused on building a shared understanding around the importance of Street Outreach workers entering appropriate information into HMIS and supporting implementation with user-friendly HMIS protocols, resources, and training developed and delivered by ICA. This thoughtful approach to developing and documenting clear and accessible materials and procedures helped St. Louis City to achieve the BFZ standard on the All Singles Scorecard, including question #5, which requires communities to have a way to track actively homeless individuals who have not consented to services and/or assessment by:

• Establishing a method to include individuals in the by-name dataset if they have not consented to assessment or services
• Adhering to the data-sharing and confidentiality requirements of any applicable community policies
• Documenting community-wide policies and procedures that describe the process of how the system is tracking and minimizing duplication of those who are experiencing literal homelessness but do not consent to services or assessment 

Developing Standards, Protocols, and Coordination for Effective Street Outreach 

In St. Louis City, tracking individuals actively experiencing homelessness who have not consented to services or assessments is inextricably linked to how Street Outreach teams function. During the summer of 2023, Saint Patrick’s Center, ICA, and VA collaborated to update the policy. 

Street Outreach is committed to ensuring that individuals who do not have a signed Release of Information (ROI) or have not yet completed an assessment are still counted in the by-name dataset. To achieve this, outreach workers are expected to input data into the HMIS regardless of whether the assessment has been finalized. In practice, this is reflected in both living policy documents and ongoing training. When an ROI has not been signed, outreach workers create a de-identified profile for the individual, using a pseudonym (such as “Redhat Tenthstreetbridge”) and an estimated date of birth to indicate the person’s age category — child, youth, or adult. This approach helps with system coordination while avoiding any inclusion of personally identifiable information (PII). As outreach efforts progress and additional information and permissions are obtained, the records are updated accordingly. A key component of this implementation was the establishment of a standing outreach coordination meeting, which has been instrumental in reinforcing these practices.

The collaborative efforts of Saint Patrick’s Center, ICA, and VA have significantly enhanced how Street Outreach teams in St. Louis City track and manage data for individuals experiencing literal homelessness who have not consented to services or assessments. This well-rounded approach not only improves system coordination but also demonstrates a commitment to inclusivity and data integrity to reduce homelessness.

View St. Louis City Coordinated Street Outreach Working Copy

Building a Shared Understanding of HMIS ROI requirements

ICA has published resources to help clarify HUD requirements, when an HMIS ROI is required, as well as what information can be entered into HMIS without an ROI. ROI forms address what information can be shared across different providers and during case conferencing. 

What sets St. Louis City apart is the way implementation of these requirements are coordinated and how they support provider agencies and front-line staff to develop consistent practices. Kaitlyn Poepsel, ICA HMIS Manager, emphasized the importance of the work done across the CoC to help staff understand the benefits to the client of entering information into HMIS. These resources include: 

• The HMIS Release of Information Guide & FAQs include many essential explanations, which cover:
  • Guidance from the State of Missouri that posting the Consumer Notice in an area where clients will see it during or prior to intake allows the data to be entered into HMIS without a written consent. This applies to all HUD-funded projects (with the exception of protected providers) as well as emergency shelters and transitional housing programs. 
  • Steps for when a client refuses to sign an HMIS ROI, including the required documentation and how to request a locked record for the client. 
• The HMIS ROI Need-to-Know for Street Outreach provides important and concise guidance that:
  • Includes HUD’s acknowledgement of the challenges to gathering information for HMIS with clients living on the streets and a process allowing for data to be collected over multiple interactions  
  • Outlines the minimum data collection for record creation
  • A summary and tables defining what constitutes identifying information and an explanation of the requirement to lock a record that has any identifying information without an HMIS ROI

• ICA also provides examples of HMIS Releases of Information, including “Signed HMIS ROI” and “Refused HMIS ROI” as well as a website help desk feature which generally provides responses to questions within a few hours. 

As outlined above, ICA offers substantial guidance on the use of HMIS Release of Information, clarifying when and why an ROI is needed, and detailing procedures for recording data both with and without ROI. This includes critical information on HUD’s accommodations for street outreach, minimum data requirements, and protocols for handling client refusals. By providing clear instructions, examples, and responsive support, ICA ensures that service providers can effectively manage client information and comply with regulations while addressing practical challenges. While the resources developed by ICA are important, the leadership from the St. Louis City CoC to ensure coordination and alignment across providers has been paramount to successful implementation in St. Louis. 

Developing Comprehensive Custom Reports that Leverage HMIS

St. Louis City has successfully leveraged their core belief in counting everyone to build a culture where entering client information into HMIS is highly valued. This has been supported by training on when and for what an HMIS release is required, clear guidelines on how to enter records with limited information, and an ongoing expectation that entering clients into HMIS matters. Because the data is entered into HMIS, St. Louis City has confidence that they have established a successful method to track individuals who have not consented to services and assessments. 

In addition to ensuring strong practices for data input, St. Louis City prioritized time and resources to ensure comprehensive user-friendly data output. This approach depended on a dedicated data analyst who played a key role in iteratively designing reports. The analyst collaborated with a programmatic group that met weekly to align on goals and review data accuracy. The data analyst also worked closely with a skilled and well-staffed HMIS team to troubleshoot issues. In working toward consistent data input and utilizing custom-designed HMIS reports, St. Louis City can more effectively account for individuals who do not consent to services or complete assessments, and consistently track their status in the monthly metrics for active homelessness, inflow, and outflow.

Prioritizing Funding to Build Data Capacity and Culture

St. Louis City is a data-driven community that recognized the need for additional data capacity and advocated to identify additional resources. Working with the St. Louis City Department of Human Services, the community used ARPA (American Rescue Plan Act) funding to pilot a dedicated data analyst position. St. Louis City has demonstrated that employing a CoC-embedded data analyst through ICA, their HMIS lead agency, has enabled the community to build the data infrastructure necessary to achieve and maintain the BFZ quality data standard. This role has also enhanced the use of data for advocacy and improvement. The presence of a full-time, community-dedicated data analyst has increased data literacy and strengthened the “data culture,” as CoC committees use the data to identify and address system-level issues in the homeless response system. Funding for this position has been renewed over the past 2.5 years. Building on St. Louis City’s success, ICA is now collaborating with another Missouri community to develop a dedicated data analyst position focused on youth and young adult populations through a YHDP grant. This analyst will provide reports and dashboards featuring comprehensive, system-wide monthly metrics, gap analyses, and identification of key areas for growth, fostering new collaborative planning efforts for systemic change.

Conclusion

St. Louis City CoC and HMIS leaders offered a number of strategic insights, including challenges and suggestions, for other communities working to reach the standard for tracking individuals who have not yet signed a release of information,

or consented to services or assessment. 

During the work to implement and sustain these new processes, St. Louis City encountered several challenges. One major issue has been the need to customize the HUD data quality scorecard for Street Outreach programs to prevent penalties for incomplete information, which can unintentionally create disincentives. Work is currently underway to address this concern. As the community actively engages with their data, St. Louis City recognizes the importance of continuous improvement in street outreach coordination and data collection. Jonathan Belcher, Senior Director of Programs, Long-Term Transformation at St. Patrick Center, emphasized the ongoing challenge of maintaining consistent outreach coordination due to staff turnover. In response, the CoC is prioritizing the re-establishment of regular outreach coordination meetings to address these issues.

Belcher further emphasized the importance of accurately counting individuals who are experiencing literal homelessness, even if they have not yet consented to services, completed assessments, or signed an HMIS Release of Information. This approach is crucial for providing elected officials and the public with a more accurate count of homelessness in St. Louis City. A recent gaps analysis revealed discrepancies between the unsheltered Point-in-Time (PIT) count and the number of individuals enrolled in Street Outreach or Coordinated Entry within HMIS. The monthly by-name dataset, which reports 800 more unsheltered individuals compared to the PIT count, has been essential for building a shared understanding of the issue and for the CoC to set clear goals and priorities.

Observable Results and Future Plans

Initially, there was significant pushback from outreach teams regarding the new approach. Many team members did not see the importance of collecting comprehensive data, as they were concerned about the lack of sufficient shelter and housing options and were focused on achieving immediate positive outcomes for clients. They also did not perceive how the data would directly benefit their clients. However, progress has been made in addressing these concerns. By highlighting that accurate data is essential for advocating for more services, expanding affordable housing, securing additional funding, and improving community planning, the teams have begun to appreciate the value of thorough data collection.

St. Louis City plans to include a review of the percentage of individuals who have not yet been assessed, consented to services, or have an anonymized profile within the street outreach program due to not signing an HMIS Release of Information in the upcoming evaluation of Coordinated Entry. Additionally, the development of a performance dashboard that includes racial and ethnic disparities is underway. 

Learning-in-progress

Expanding Outreach

The new approach has led to an expanded outreach. Efforts to include a broader audience have been successful, enabling better engagement with individuals who were previously underrepresented. This expansion has been instrumental in improving the overall understanding of homelessness in the community.

Culturally Responsive Outreach

With an improved understanding of those who have not been assessed, the outreach methods can become more culturally responsive. Tailoring engagement strategies to fit the cultural contexts and specific needs of different groups will enhance the effectiveness of outreach efforts.

Progressive Engagement

Understanding how many people have not yet been assessed and/or are de-identified can lead to improvements in how outreach can continue to build relationships with individuals to gradually engage with services. Examining the data will help St. Louis City to test more effective and incremental connections with services, helping individuals progress through the system more smoothly.

By examining what works best, the community hopes to continue to refine its approaches and focus on the most impactful methods for engaging with individuals experiencing homelessness.

Advice for Other Communities

For other communities looking to implement similar strategies, building relationships and gaining buy-in from all outreach providers, regardless of CoC or HUD funding, is crucial. It is advisable to take a patient approach, addressing the concerns of long-term practitioners who may not initially see the value in these changes. Allocating funds to support data analysis with a well-staffed HMIS lead agency is an essential part of St. Louis City’s success. Having a dedicated data analyst and a strong, skilled HMIS team can significantly enhance the effectiveness of data utilization and advocacy efforts. St Louis City also recommends using the resources and opportunities available through the BFZ network to gain additional insights and strategies from communities overcoming similar obstacles. To facilitate this, BFZ offers group calls to foster peer connections and new materials in the Quality Data Toolkit.