Audit Findings

Preventing and Ending Homelessness Regionally

NIS was contracted to first complete a systems audit to map the current regional response to preventing and ending homelessness. This audit centered on the needs of people experiencing homelessness as defined by individuals and groups engaged in the process. The scope of the audit included understanding movement across systems and jurisdiction borders, was informed by the current social justice movements and the response to the COVID pandemic, and mapped efforts to promote equitable access to quality and affordable housing.

The findings presented below meet principles below that collectively reflect our organizational values, informed by HHMFC’s guiding questions and—most importantly—what was expected by the Regional Advisory Group. These guiding principles will continue to evolve and expand as the coalition of stakeholders engaged in the Blueprint continues to grow, the proposed actions are finalized, and the community moves to Phase II – co-designing and implementing solutions. Our shared principles at this time are:

Do the findings identify systematic barriers to housing justice, including equitable access, experience, and outcomes across the region?
Are the findings consistent with what we heard from the community?
Were the findings and this report centered on the experiences of individuals who have had to navigate these systems and have been impacted by them?
Do the findings drive toward solutions that are incremental, structural, and transformative?
Did the process of conducting the systems audit and drafting the findings also identity ongoing opportunities to:
1. Achieving role clarity, authority, and leadership for a regional vision, priority setting, and investments in solutions
2. Understanding where power lies to advance the solutions needed
3. Surfacing clear opportunities to build on existing structures and mechanisms to scale person-centered policies and practices
4. Identifying the level of investment needed in prevention and affordable housing regionally

The system audit methodology used for the Blueprint differs from the typical homeless response system audit. This system audit starts with centering the experiences of those who have gone through the system, worked at the frontline, and system planners. Quantitative data is then used to further articulate the barriers identified by the interviews, focus groups, and workshops with stakeholders.

In conversations with local stakeholders and members of the community who have experienced homelessness, it was consistently expressed that there is a need for a strategic vision and community-driven goals to prevent and end homelessness across the Twin Cities 7 County Metro Region. While ending homelessness and building housing justice in the region will be a multi-step process, the first step is to get on the same page about what the region is attempting to accomplish, and rooting those goals in the values of the community.

There was widespread agreement amongst local leaders that, in order to begin operating collaboratively, the first step would be to come together as a regional coalition and begin to create a vision for housing justice that is rooted in racial equity and that addresses prevention, crisis response, and safe and affordable housing. It was made clear that city, county, and state-level leaders need to come together around affordable housing production across the metro region and establish broader goals around prevention and the affordable housing resources that are needed.

Articulated goals and investments in tenant rights and protections, housing preservation, and production to meet the need for deeply affordable housing options for individuals and families with extremely low incomes and/or experiencing homelessness are all critical to pursuing this shared vision.

Prevention and diversion solutions have been built onto the homeless response system for quite some time now. For example, investments like the Federal Homelessness Prevention and Rapid Re-Housing Program (HPRP) from 2009-2012 and in community-led initiatives to prevent unnecessary interactions with the crisis response system. These efforts have helped to evolve the local collective understanding of the benefits of preventative solutions. The call for housing justice requires the field to think more broadly and “upstream” than the experiences and prevalence known to the front end of the homeless response system. It is necessary to increase and target investments in community-based solutions that eliminate the need and inflow of individuals and families who are struggling against poverty, exploitative housing markets, and a reliance on short-term and shallow supports.

There is no regional vision that explicitly calls out the impact of housing discrimination, continued displacement, no-fault and/or inappropriate evictions, and the lack of renter protections, which drives the region’s current strategy of building out the existing crisis response systems per county and continuum of care, instead of a call to action that addresses these inflow levers at a regional level. Equity in Place’s 2020 Policy agenda has clearly outlined a missed opportunity at a regional level to address these inequitable practices through local and state policy.

The 2021 State of the State’s Housing 2021 Report by the Minnesota Housing Partnership reported that the Twin Cities Metro Region contains 61 percent of the state’s population of extremely low-income renters (ELI), or renter households that earn less than 30 percent of area median income (AMI). Additionally, while there are 103,140 ELI renter households in the region, there are only 35,105 units that are affordable and available to ELI renter households.

Furthermore, a vision for housing justice must include investments to achieve higher levels of homeownership in Black, Indigenous, and other people of color (BIPOC) communities, but there is a significant gap to be closed. According to the Minnesota Housing Partnership, the Twin Cities Metro Region has the largest homeownership gap in the state and the largest population of BIPOC households in the region. While the region accounts for 76 percent of BIPOC households in the state, only 40 percent of BIPOC households are homeowners, compared to 75 percent of White households — a 35 percent gap.

Heather describes why a lack of a regional vision is crucial.

Collaboration and collective goal-setting led by BIPOC community leaders and individuals who have been impacted by policy and practice decisions is disincentivized by encouraging competition, particularly across counties through state and county funding processes.

A consistent theme found throughout the audit was the systemic tendency to not collaborate across jurisdictions. This is largely attributed to the ways in which current funding structures operate, creating a barrier for meaningful collaboration amongst the region. The competition encouraged by this structure drives siloed approaches to the issue of housing and homelessness, and this shows up in everything from coordinated entry to the design and evaluation of policy and programs. For a coalition to be built across counties, communities must be incentivized to work together to center the needs of people experiencing homelessness and housing instability.

To end homelessness, first we have to address it and prevent it. we need to discuss the problems in order to end it.
Community Member

In conversations with community leaders and people with lived experience of homelessness and housing instability, it was often stated that the way funding moves through local and national government institutions is a driving factor in sustaining poverty and homelessness. This is attributed to overhead costs and decision-making that is not driven by individuals impacted by those policies and practices. While this issue is not unique to the Twin Cities Metro Region, it is clear that the way current funding structures operate ensures that not enough resources are reaching the communities they are intended to support.

There’s a power dynamic and tension across jurisdictions in determining what to do and when to do it.
Community Member

This gap in impact can be bridged through establishing equitable decision-making processes with BIPIOC community leaders and individuals most impacted by policies and practices. Investing in the decision-making power of these communities will be essential in reversing a long legacy of harm by collaboratively establishing a plan to invest in intensive and deliberate resources.

This summer, we would go to the city, they would say the responsibility lies in the county, the county would say the responsibility lies in the city and the state, and then the state wouldn’t return our calls. It’s a cascade of failures.
Community Member

The dual current crises of unsheltered homelessness and the pandemic only allowing for the capacity to deal with the immediate crisis response.

While the current number of people experiencing homelessness in the Twin Cities Metro Region is unknown, the visibility of unsheltered people has risen dramatically over the course of the COVID-19 pandemic. The state’s emergency response to the pandemic shut down many public spaces, such as libraries and the pandemic has restricted space in shelters and prompted many to pitch tents outdoors rather than risk illness in indoor spaces.

In July of 2020, the largest outdoor encampment in the metro area’s history, at Powderhorn Park, had 560 tents, where an estimated 800 people lived. The number of people living on the streets or in cars, parks, or skyways was 980 at last count, almost five times higher than in 2015, driven largely by a lack of affordable housing. While the homelessness crisis has long existed in the Twin Cities Metro Region, the visibility of encampments like the one at Powderhorn Park increases public urgency and raises pressures from housed neighbors.

We tackle emergencies, we tackle problems but are not guided by a particular vision beyond “let’s end homelessness.” We are in a reactionary mode and hard to step out of and be planful.
Community Member

As we have seen across the country and in the Twin Cities Metro Region, the COVID-19 pandemic has only furthered these dynamics, compounding the long-standing unsheltered crisis, a legacy of structural racism, and a global pandemic. According to state health officials, Black and Indigenous Minnesotans have died from the coronavirus at disproportionately high rates. While there is widespread agreement that the present urgency of the unsheltered homelessness crisis is a legitimate concern, the scale of the crisis has largely only allowed for the response system to attend to the present crisis and decrease capacity for long-term visioning for the future.

The outcomes of my job are measured by the community statistics on reductions and exits. My number one goal is to bring in resources, so I have to compete, even though we all have the same goal, but want the most resources.
Community Member

A legacy of structural racism within the history of housing service provision, locally and nationally.

To illustrate structural racism in housing within the Twin Cities Metro Region, one can point to the way public service provision is spread out across counties: housing programs are more prevalent in some areas and far less prevalent in others. This type of disparate programming structure is often pointed to as a way to maintain race and class segregation. It is essential to consider this structural segregation when attempting to understand the region’s struggles to come together and devise a collective vision.

It is impossible to talk about dynamics between suburban and urban counties without acknowledging that Black people in the U.S. were prohibited from buying homes in the suburbs from the 1940s-1960s by the Federal Housing Administration (FHA) and gained none of the equity appreciation that their White counterparts gained. Additionally, the FHA subsidized mass-production builders to create area subdivisions that were “White-only” and they subsidized the White families who were living in the central city to move into white-only suburbs. The effects of this continuing legacy of racism persists today: Black and Indigenous people make up less than 15% of the Twin Cities’ population but account for 65% of all people experiencing homelessness.

Any vision has to be built on and connected to racist histories of access to education and housing. We need to acknowledge that history and pivot from it intentionally. We need to be explicit about covenants, gentrification, and limited access to education.
Community Member

Counties aren’t just counties and communities aren’t just communities; they’re made up of people. Regional power dynamics and relationships between areas need to be explicitly stated and understood. When creating a plan for regional goal-setting, it’s important to not only be clear that different counties are composed of different racial groups and socioeconomic classes, but also to recognize why that is the case in the first place. Being explicit about the foundational racism that led to regional population differences will be essential to building coalitions across county and community lines.

How do we get to a system where the county government doesn’t have to lead everything? I want to envision a future in which the community can set the priorities.
Community Member

Human services—including public assistance programs, behavioral and substance abuse services, and health care—are critical to the housing stability and health of individuals and families experiencing housing insecurity and homelessness. Although Minnesota has significant investments in human services at both the state and county level, access to and navigation of these services by people experiencing homelessness continues to be a major barrier to addressing homelessness and housing instability throughout the Twin Cities Metro Region.

The majority of public benefits programs including general assistance, housing supports, SNAP benefits, and MFIP (TANF) are funded through federal and state dollars but processed and managed by individual county human services departments. When a person moves across county lines the case must be transferred to the new county of residence after 60 days or residing in the new county. The processing of the transfers, including disputes between counties on residency, can lead to access barriers for people experiencing homelessness as they try to navigate which county office is managing their case; it can even lead to a disruption of benefits due to confusion on who they must work with to meet the requirements of the different public benefit programs.

Behavioral health and substance abuse services are also managed by individual counties and also require counties to match investments from the state and federal government. Counties cover these match requirements through county and city taxes, local government aid, and grants by Minnesota Department of Human Services (DHS). There are different levels of investment in human services across the seven counties in the funds they receive from the state, grants, and the county tax dollars invested in human services.

There is also a set of complex state legislation (chapter 256G of the Minnesota State statute), referred to as County of Financial Responsibility (CFR), that governs the financial responsibility for counties to cover part of the costs of the behavioral and substance abuse services, and how county responsibility for those costs transfers as a person moves.

For those experiencing homelessness, this has led to a complex web of rules and regulations to navigate in accessing critical public benefits and human services in both the counties they are experiencing homelessness in and the counties in which they are attempting to access homelessness services and/or housing.

The law has also created perverse incentives for counties to withhold investments in crisis shelter, homeless services, specialized housing, including permanent supportive housing, and in-patient behavioral health and substance abuse treatment because of the cost of providing human services to those who may utilize the resources within the county. The result is a lack of robust homeless and human services in some of the Twin Cities Metro Region, and a mismatch between where the services are accessible to where affordable and safe housing may be available.

Although county workers bear some of the burdens helping to verify eligibility and transfer assistance as a person moves across the region, the overwhelming burden lies on the person experiencing homelessness. They are often faced with difficult decisions around where they should go to access housing and services and what effects taking a job or housing placement across the seven counties may have on their ability to obtain or remain stably housed.

Structural racism is also deeply embedded in the distribution of human services within the Twin Cities and across the metro region and the access and navigation of those services by people experiencing homelessness and housing instability. The majority of people experiencing homelessness in Hennepin and Ramsey counties are Black and Indigenous and a disproportionate number of Black and Indigenous people are experiencing homelessness across the Twin Cities Metro Region, linking homelessness and race across the region.

Within the Twin Cities, the structural racism is evident even in the location of public human services remaining concentrated in certain areas of the cities as a way to keep people in certain neighborhoods and hidden from others. In the region, structural racism is embedded in the culture of not investing county tax dollars in human services in parts of the region as a way of keeping the region segregated between the Twin Cities and the suburbs. Although this linkage may not be explicitly stated, it is embedded into the system of funding and has real effects on the ways in which Black and Indigenous people experiencing homelessness can move across the region while accessing the housing and services needed.

Heather describes why not being able to access services across county lines is a barrier.

Access to human services for people experiencing homelessness is negatively affected by State law that governs county of financial responsibility and by the culture it has created to safeguard county investment in and access to human services.

The relationship between behavioral and substance abuse services and a county’s fiscal responsibility for sharing the cost of the services has led to a culture of safeguarding the types of services developed throughout the region and access to those services. It also contributes to a lack of investment in homelessness housing and services that may be perceived as bringing in people who will need behavioral and substance abuse services.

The effects of the CFR law go beyond the text of the law. It has created a culture in the region of safeguarding human services for those that are considered to be the county’s residents and putting in administrative barriers to access in order to ensure the safeguards.

It also drives counties to decline to build crisis shelters, specialized housing for people with substance abuse and mental health issues, permanent supportive housing, and other homeless services because most of these shelter and housing types are not considered excluded time under the law; meaning that if a person where to move into the county to utilize the shelter and/or housing they county of financial responsibility for administering public benefits and cost sharing any behavioral health and substance abuse services shifts to the county after 60 days. This results in people experiencing homelessness having to move across county lines to access crisis resources, losing the connection to their home community while shifting the financial responsibility to another county.

Structural racism is built into these barriers to access: the majority of people who experience homelessness in the Twin Cities Metro Region are Black and Indigenous and the barriers to accessing human services as they move across county lines contributes to keeping Black and Indigenous people experiencing homelessness and housing insecurity in the Twin Cities and out of the suburban counties. It also contributes to Black and Indigenous people experiencing homelessness in the suburban counties needing to move to the Twin Cities to access critical services such as shelter. These decisions to severely limit resources in some counties and to push people experiencing homelessness and housing insecurity toward the central core of the Twin Cities contributes to the racial segregation of the region.

The culture of safeguarding access to public human services has been described in the following ways:

Disinvestment in homelessness services (shelter, outreach, and other critical supports) because of the cost to the county to provide the potential human services needed by people experiencing homelessness.

Divestment from critical types of human services such as specialized behavioral health and substance abuse treatment programs because of the financial cost to the county to provide the human services for those accessing the service, and the belief that those accessing will not be from the county where the services are being offered.

The requirements and procedures around transferring the administration of public benefits as people move across county lines is negatively impacting people experiencing homelessness.

The law requires the administration of public benefit programs including, General Assistance (GA), the Minnesota Family Investment Program (MFIP), and Housing Support program, to be transferred when a person is residing in a different county for two calendar months of non-excluded time. Emergency shelters for people experiencing homelessness are considered non-excluded time, meaning that if a person accesses an emergency shelter in a different county and resides in that shelter for two calendar months the administration of their public benefits case must be transferred to the county where they are seeking shelter. Similarly, if they leave
the county to access a housing placement in another county they must transfer their case to the new county.

With limited emergency housing across the region, people often move across county
lines in order to access emergency shelter or other options to try and stay safe. The limited affordable housing options across the region means people experiencing homelessness often may be placed by the homeless response system in another county or choose housing that is affordable with the assistance offered in another county. The result of both cases is that people experiencing homelessness are often highly mobile and experience more frequent moves across county lines, making the administration of their public benefits more complicated and highly inefficient for the counties and more importantly, for people experiencing homelessness. These complications can lead to a disruption in critical benefits and delays in the ability to be quickly re-housed or stay stably housed.

The administration of public benefits across counties is further complicated by an outdated transfer process that relies on mailing files across transferring counties as opposed to electronic file shares and by a lack of county financial workers to process the applications and transfers. This leads to delays in transfers; unfunded administrative costs to the county to process the transfers; and the need for people experiencing homelessness to have multiple engagements across counties with multiple agencies while trying to navigate their benefits.

The requirements to transfer cases to new counties have been described in the following ways:

A barrier to continuing public benefits without delays or gaps in services due to the time and outdated process of transferring cases.

A barrier to being able to quickly move people out of a shelter or unsheltered homelessness due to the inability to quickly align benefits when their county of residence is in a neighboring county.

A large unfunded administrative cost to counties due to the staff time needed to transfer cases and process applications.

County of Financial Responsibility (CFR) and the culture of protecting financial liability for human services has a negative effect on accessing and navigating residential behavioral health and substance abuse services.

The law gives individuals eligibility to the housing support program funded by the Minnesota Department of Human Services (DHS) for up to three months after being discharged from residential behavioral health treatment if the person has no fixed and adequate housing upon discharge, with the responsibility being on the county of last residence before entering a facility.

The CFR State legislation also outlines a county’s financial responsibility to pay for costs related to the use of civil commitment and the aftercare services upon discharge, ensuring the county pays for the residential services/state hospital stays if the person is ready to leave but the county has not found adequate housing and services for discharge.

This complex set of state law is an administrative burden to county social workers trying to assist individuals in accessing critical services while ensuring secured housing upon exiting the residential center or a civil commitment and it is a large fiscal burden to counties that are trying to place people with high barriers into communities with limited resources.

The resources spent on paying for state hospital costs are resources that could be used to invest in behavioral health and housing in the community of origin to more quickly exit people from these services but instead, the funds are paid by the county to the state and put back into state general funds not necessarily used for human services.

This current setup is also a burden to the individual seeking services and having to navigate the county responsible for paying for the service while in the crisis of trying to secure a safe, affordable place to live near any outpatient services and support they may need, including for those trying to relocate to another community across county lines in order to access residential substance abuse or mental health services. When moving across county lines the county of origin must continue to pay for services in the new county, as it is considered excluded time under CFR, and it must be coordinated through the county of residence human services agency. This often leads to people becoming lost between multiple county human services agencies, resulting in disruption or complete loss of services and support.

The requirements around CFR and accessing residential behavioral health and substance abuse services have been described in the following ways:

A deterrent to funding inpatient and residential services due to the potential financial burden of providing human services for those accessing and leaving the programs.

A reason to avoid the structural racism embedded in the decision to not invest in behavioral health and substance abuse services across counties.

A large financial burden to counties who struggle to find housing for people coming out of civil commitment with high barriers, particularly in counties who have not invested in the services in their county needed to safely house the individuals.

It feels like another form of segregation and it is particularly triggering as POC!
Community Member

More willing to share financial resources and capacity- especially if funding better follows people where they go. County of Financial Responsibility – we need to rethink how that works and counties can feel like they aren’t taking on an unfunded burden we would be willing to take down more barriers.
System Leader

Differing state and county investments across the region on human services has created unequal access to services and mismatches between where services are located and where affordable housing is accessible for people experiencing homelessness.

The region lacks the necessary human services to ensure equitable access in communities of people’s choice.

As described above, there are disproportionate investments in human services across the county from local government assistance, county tax funds, and state grants. CFR, particularly the county cost match for behavioral health and substance abuse services, is one contributing factor to the differing human services across counties, but is not the sole factor. The culture built around county human services and the decisions to not invest in services believed to encourage people from other counties to relocate or to encourage people in the county to access human services has also greatly contributed to the inequitable distribution and access of human services.

This all has led to a mismatch between where services are located and where a person may choose to live based on housing availability, employment, and social ties. People experiencing homelessness must often make complex choices on where to live based on where they can access needed services and affordable housing, many times making sacrifices in one area of need to meet the other area of need. Those accessing housing assistance from one of the three Continuum of Care (CoC) bodies in the region also must make decisions on taking the housing option available to them, even when it is not near accessible services, or prolonging their homelessness.

The lack of equitable public human services across the region has been described in the following ways:

A form of modern-day redlining that contributes to more Black and Indigenous people being essentially locked out of certain areas of the region due to the disproportionate amount of Black and Indigenous people experiencing homelessness and attempting to navigate services.
A shifting of financial responsibility between counties where more services are available, and therefore more residents of the region may move to access services.

The administrative burden of applying for and receiving state grants contributes to less state investment and less available human services in the outer counties.

Counties, particularly smaller counties, with less human service agency infrastructure struggle with the administrative burden of applying for and administering state-funded human services grants. The staff time and resources to respond to funding requests, along with reporting requirements and unfunded administrative work connected to the grants result in some counties being unable to apply for certain funding streams from the state further contributing to the inequitable distribution and access of human services across the region. The grants also require a deep level of coordination across the Twin Cities Metro Region, and there is often little to no dedicated funding towards the staff time required to effectively plan and coordinate across counties.

The administrative burden of applying for and administering state grants for human services has been described in the following ways:

An unfunded financial burden connected to applying for and administering the grants that takes away from staff capacity that could be used to serve individuals and families.

A large staffing drain to plan and coordinate the grants with little to no dedicated funding to support the system planning and coordination across the region.

A Continuum of Care (CoC) is a regional or local planning body that coordinates housing and services funding for homeless families, youth, and individuals. HUD requires each CoC to establish and operate a “centralized or coordinated assessment system” (referred to as “coordinated entry” or “coordinated entry process or CES ”) to increase the efficiency of local crisis response systems and improving fairness and ease of access to resources, including mainstream resources.

Coordinated entry processes are intended to help communities prioritize people who are most in need of assistance and are determined by using an assessment, vulnerability scoring, prioritization policies, and eligibility that connects people to potential housing and services.

Additionally, coordinated entry incorporates project-specific requirements to inform matches and referrals of individuals prioritized for available housing options available in the community. A limitation to the current inventory across the region is the capacity to both move individuals seamlessly from shelter to housing, but also from housing programs like rapid rehousing to more permanent and affordable housing.

Housing options (available emergency shelter, permanent supportive housing, and rapid rehousing beds and units) are tracked as a point-in-time count in what’s called the Housing Inventory Count (HIC). This annual count is intended to track all beds and units available to meet the needs of people experiencing homelessness and informs who is prioritized through a coordinated entry process. More broadly, the housing inventory count allows for communities to compare rates of housing instability and homelessness (based on data available through a data management system) and the capacity of the “system” to meet the need. Data points available through the count include the types of housing options (ES, PSH, RRH) available in a specific CoC geographic area, as well as the rates of utilization of available options.

The Twin Cities Metro Region is home to three CoCs (Hennepin, St.Paul,Ramsey and Suburban Metro Area Counties (SMAC)) that manage separate coordinated entry systems which cover 100% of the region.

Over the past decade, Hennepin, Ramsey, and Suburban Metro Area Counties (SMAC) Continuum of Care have worked to be in communication and in collaboration with each other, as well as with additional Continuum of Cares statewide. A few examples from 2020:

SMAC celebrated the end of veteran homelessness per USICH benchmarks (achieving functional zero) by implementing a system that can identify and quickly rehouse Veterans experiencing homelessness. This regional initiative demonstrated the ability and capacity to focus cross-jurisdictional strategies, resources, and data to achieve a shared goal.

The statewide Homeless Management Information System (HMIS) governing board, inclusive of the three CoCs, provided strategic direction and decision-making support to Minnesota’s HMIS system. In the past year, the work of this board included improving data standards to support CoC’s understanding of disparities in experience and outcomes, raising awareness of ways in which HMIS perpetuates racism for BIPOC individuals and households, and developing ongoing strategies to center anti-racism and racial equity in the system.

Marla describes the effects of operating in silos.

Under-resourced service and housing inventory will require the CoCs to continue to perpetuate the need to prioritize based on individual vulnerability and a scarcity model.

Coordinated entry strategies are intended to connect households at risk of or experiencing homelessness to housing and support available in the continuum of care geographic area. The ability to meet the needs of households known to the CoC is limited to the availability of prevention assistance, emergency beds, rental assistance, housing programs, and affordable housing units in a community. The 2020 community needs assessments identified the following gaps and barriers from within the current capacity and ability for the system to respond to the needs of individuals and families experiencing homelessness.

In recent community need assessments and coordinated entry evaluations across the three continuums of cares, the following examples were identified as barriers to decreasing wait times for housing placement and slow movement of prioritization lists.

Inadequate supply of crisis housing options (emergency shelter beds, hotel rooms, etc) making it difficult to stay connected to and in communication with individuals and households waiting for housing placement.
A lack of frequent vacancies in housing programs that meet the needs of those on the priority list (housing with support services packaging) and/or the availability of rental assistance without a service package to support housing stability.
Low inventory and vacancy rates in the private market making it difficult to shop with a voucher in the required timeframe provided to an individual or family.

Coordinated Entry prioritization is often driven by front-end responses to housing instability and homelessness; and investments in and eligibility criteria for services like outreach, emergency assistance, crisis housing, emergency shelter, and diversion. For those who achieve getting on a prioritization list; housing placement is not guaranteed and dependent on additional factors that include communication between the list manager or assessor and a contact representing the housing option and the ability to remain in contact while remaining homeless so as to not lose your “place in line.”

In response to the increasing unsheltered population, the Twin Cities Metro Region has increased emergency shelters which led to adjustments within coordinated entry systems meant to facilitate movement through and towards housing placement. However, when the system makes adjustments to respond to inflow into coordinated entry, it must also be able to adjust on the back end to support exits to housing opportunities.

Targeted investments in subpopulations (for example families or veterans) and based on definitions of homelessness (for example chronic homelessness or long-term homeless) dictates who is then prioritized by coordinated entry policies to ensure households meeting these subpopulations and homelessness definitions access the available resources.

A particular barrier in increasing exits to longer-term housing opportunities is the limited permanent supportive housing (PSH) units available to the three metro area continuums of care. Permanent supportive housing has been a critical housing solution for many individuals and households experiencing homelessness with support service needs. The three metro area CoC’s have prioritized investments in permanent supportive housing based on needs assessments over several years and what is available continuously to not meet the need compounded with the continued lack of deeply affordable housing units for folks to move on to. With the low vacancy rates of PSH units, all three CoCs experience very low turnover rates resulting in longer wait times for households seeking PSH.

Philosophically, coordinated entry systems are meant to connect people in need (inflow) to permanent housing opportunities (outflow) in a world where the available housing opportunities reflect housing options that meet the needs of the household, promote choice and self-determination.

In reality, coordinated entry systems are rooted in a scarcity framework requiring the tools, the policies, and the people implementing the system to normalize the following common beliefs:

The resources available are finite and therefore we cannot meet the needs of everyone
Decisions have to be made about who is worthy of getting their needs met
The system “is what it is” and it took a lot to get here. Why risk what we have achieved.

These beliefs, although not explicitly named or acknowledged, inform the culture of coordinated entry policies and procedures. They create boundaries on what is considered possible, and what and who is centered in designing and advancing improvements.

Individuals and families currently carry an undue burden in navigating access to the three coordinated entry systems to identify available housing and supports to meet their individual needs.

Although the 3 CoC have each implemented coordinated entry systems to serve their geographic regions, individuals and families continue to access all three systems as they navigate what their individual needs are and available options restricted to each CoC. Through this process, several examples were provided to help illustrate the burden placed on individuals and families because of the natural movement across the county and continuum of care boundaries. For example:

A family (a single parent with two children) originally had residency in Ramsey county, had one child in daycare and one in school but was able to access emergency shelter in Hennepin County. As a result, this family accessed Hennepin County’s coordinated entry system and has been provided housing opportunities in Hennepin County although they have prioritized continuing their child’s education and meeting their child care needs in Ramsey County.

A single adult assessed through SMAC’s coordinated entry system may have access to an inventory that represents a broader geographic area but, in reality, is now being offered housing in Carver County although they identify with a community in Washington County.

To navigate this barrier multiple community stakeholders shared strategies to support individuals and families navigating the three systems noting that a critical part of access was first working through varying homeless definition eligibility, residency requirements guiding eligibility, and potential housing and supports available in each continuum of care and county. Of note were the following strategies:

Outreach workers talked about carrying around assessments for the three coordinated entry systems to provide an opportunity to walk through and discuss the differences and to support clients making an informed choice of which system to navigate first.
Assessors shared experiences of families and individuals asking about vulnerability scoring and prioritization policies before completing the assessment based on what they had learned and/or heard about who was having success navigating a specific coordinated entry system.

Lastly, for those who received an assessment: due to the long wait times and or perceptions about who’s experience resulted in a housing placement, there was a common reflection that access to coordinated entry demonstrated by a completed assessment in no way meant an individual or family would receive housing. What individuals shared was linked to both understanding existing prioritization lists used to move individuals and families along with referrals to housing opportunities, as well as the limited availability of diverse housing options to meet the needs of people waiting.

Coordinated entry systems perpetuate racial inequities in experiences and outcomes for BIPOC communities.

Multiple studies across the Twin Cities Metro Region and statewide have documented the racial disproportionality of low-income residents experiencing housing insecurity and homelessness. More locally, communities can track and monitor system performance based on race, ethnicity, gender, and disability, through their individual coordinated entry data dashboards hosted by ICA, the state’s HMIS administrator. These dashboards have served to inform coordinated entry policies and procedures in the pursuit of equitable and transparent access to housing and support resources available in a community.

In the last year, ICA identified ways in which the HMIS system could be used to address racial disparities and acknowledged ways in which the system continued to create barriers for Black, Indigenous, and people of color interacting with coordinated entry. Key points identified include:

A lack of cultural responsiveness in the homeless response system

The impact of an assessor’s racial and experiential background

A lack of data regarding on who is unable to access the system

Beyond the experience of accessing coordinated entry, however, are the continued barriers residents face in accessing housing and supports they need, based on additional individual vulnerabilities and in the face of navigating additional systemic racism based on system involvements. Identified through interviews, community workshops, and with the Regional Advisory Group, the following subpopulations of individuals and families continue to experience significant barriers in accessing housing and supports and reporting negative outcomes related to their criminal background/history, need for treatment and recovery services, parenting as a transitional aged youth (16-24) and as newly homeless with fewer vulnerabilities than those on established priority lists.

Limited ability to provide a person-centered and trauma-informed experience that results in connections to the housing and supports needed in a community of their choice.

A disheartening theme throughout the stakeholder interviews, community workshops, and in conversation with the advisory group was the common experience of individuals and households describing experiences with the coordinated entry systems as difficult to navigate, disrespectful, dehumanizing, and not transparent. Although the scope of this work does not assess every experience of an individual or household served by all three of the coordinated entry system, these common experiences point to the limitations of the existing systems that are in theory intended to provide a person-centered approach, in a time of crisis with the intent of gathering very personal information for the sake of connecting them to a housing solution.

As the most tangible and public-facing component to what communities call the “homeless response system,” coordinated entry acts as the first step and/or connection to finding help. Reflected through community workshop discussions, participants talked about the disconnect between the community’s perception of what coordinated entry is, what is available through coordinated entry and who can receive help through coordinated entry.

The commitment to providing a trauma-informed, person-centered experience is dependent on the capacity of coordinate entry systems to 1)connect people to housing and supports that they need, 2)in their community of choice, 3) in the shortest amount of time possible, and 4) without putting those people at any more risk or in harm’s way as a condition to be served.

You are telling people to go back to a system that didn’t treat them with respect and mistreated- they have to make a choice to go back to that system or choose homelessness. I had something lined up but had to go to shelter to get the key.
Community Member