Bright Spot: Lake County | Tracking Chronic Homeless Status

September 20, 2019

To identify individuals at risk of becoming chronically homeless, sort list by those who meet disability criteria but are short of the requirement for length of time; monitor this data to target early interventions and reduce chronic homelessness

Check out this bright spot if…

● Your community is working to end chronic homelessness. 

● Your community’s main barrier to ending chronic homelessness is high inflow 

● You want to try it!


Waukegan/Lake County/North Chicago CoC implemented an automated process for tracking when individuals “age in” to chronic homeless status using HMIS and their Coordinated Entry System (CES).

Key Action: Consult with the Coordinated Entry planning committee

When the CoC’s HMIS team first began trying to account for individuals aging into chronic homelessness, they wrestled with how they should be tracking information. At the time, the team comprised just one full-time staff person without much technical expertise. The staff person found the HUD specs on tracking chronic homelessness to be confusing, and struggled to determine how to tackle a complicated reporting process, given the knowledge at hand of ServicePoint and the work on the ground in the CoC. 

After spending a great deal of time searching for a tailor-made solution for both the CoC’s HMIS vendor and local context, the staff member came to a powerful conclusion: there was no specific way that all communities were approaching the problem of tracking at-risk of chronic homelessness status over time. This realization allowed the staff member to break free from searching for prescribed, pre-packaged ways to approach the problem and to pivot instead to think about what would work best locally. 

The staff member consulted with the CoC’s Coordinated Entry planning committee. The committee was also working on developing a reporting process for participating providers to enter assessment each month, so the staff member worked with the committee to include additional data points in the assessment to help identify those individuals who might be at-risk of experiencing chronic homelessness. Because the community’s knowledge of ServicePoint reporting was limited, the committee and CoC decided to hire a report writer to execute the technical aspects of the plan. 

Key Action: Breaking THrough technical barriers

Although integrating a few additional questions in the Coordinated Entry assessment did not get the staff member all the needed information for determining at-risk for chronic homeless status, the new fields provided a basis of information for the staff member to move forward on the project. The staff member could now pull a list of individuals to focus on, though it was unclear whether the clients appearing on the list were truly at-risk of chronic homelessness due to the limited nature of the data fields added to the CE assessment. 

Rather than becoming stuck on reaching a perfect list, the HMIS staff member decided to test a course of action for working with what information the community had to start reducing inflow to chronic homelessness. The staff member instructed that the community should make the assumption that individuals on the at-risk list would qualify as at-risk of chronic homelessness. As the individual neared the date at which they would enter chronic homelessness, the provider the individual could potentially match with for a housing placement would then go back through and verify status, which the provider would have to do anyway as part of project enrollment. 

At first, providers were wary of the new way of keeping track of people aging in to chronic homelessness. After implementing the process, the community’s active chronic numbers increased, which was discouraging. At the same time, though, providers found that assuming at-risk status largely held true, leading the community to conclude that it was more important to identify people than in making sure that the people they did refer to the at-risk list were verifiably at-risk. Although disheartening to see the chronically homeless number increase, community provider confidence that the numbers on the by-name list were correct increased alongside it. 

Fail forward moments

If you throw a wider net, you can expect to identify more people who may be at-risk of chronic homelessness. Broadcast to your community that you expect your chronic homeless number to increase as a result, and that the increase is a normal part of doing a better job identifying people. It’s okay to bring in technical experts! Don’t wait until you’ve been stuck for months to ask for help! 

For more information:

Contact the community’s report writer, Sarah Walsh (, for more ServicePoint technical specifications on creating an at-risk of chronic homelessness report