PATH - Street Outreach and Supportive Services

PATH Street Outreach & Supportive Services

This document outlines additional workflow steps needed for PATH Street Outreach and PATH Supportive Services programs & can be used in conjunction with the HelpScout articles ‘ESG Street Outreach Workflow’, ‘Program Enrollments – Assessments - Program Exits’, and ‘Documenting Services in HMIS’.

Terms

PATH – Projects for Assistance in Transition from Homelessness

PATH Street Outreach - provides outreach and engagement to clients living in places not meant for human habitation. These PATH activities are designed to meet the immediate needs of unsheltered homeless persons by connecting them with emergency shelter, housing, and/or critical health services

PATH Supportive Services - provides outreach and engagement to clients who are residing in emergency shelter or are doubled-up in housing and are at-risk of homelessness

SAMHSA – The Substance Abuse and Mental Health Services Administration (SAMHSA) is the part of the Federal Department of Health and Human Services (HHS)

SOAR – SSI/SSDI Outreach, Access, and Recovery, SOAR is a program designed to increase access to Social Security disability benefits for people experiencing or at risk of homelessness

Contact - This is an interaction between a worker and a client. These can be verbal conversations between the worker and client, or a referral to a service. Contacts are recorded using the Current Living Situation Assessment every time a client has an interaction with an outreach worker

Current Living Situation (CLS) – The Current Living Situation Assessment is used to document every contact in HMIS. The CLS Assessment must be completed every time contact is made with a client

Date of Engagement (DoE) - The date on which an interactive client relationship results in a deliberate client assessment or beginning of a case plan, etc. It is expected that all data elements, i.e. Income, Disability, etc. have been collected on or before the Date of Engagement and that deduplication efforts are complete

Eligibility Determination Status – The date a client’s SAMHSA PATH eligibility is formally determined. This must happen on or after the date of engagement.

Attained / Not Attained / Unknown – Outcome options for PATH Funded Referrals

Background

The PATH workflow starts at the first contact, or interaction, that an outreach worker has with a potential client. This will likely be before the Date of Engagement and prior to officially determining their PATH eligibility. Clarity provides the following fields to track these events:

Current Living Situation (CLS)
- This Assessment is used to record every contact with the client
- Users enter the Date of the contact, the client’s Living Situation, and Location Details
- The date of the first contact is the same as the Program Enrollment start date
Date of Engagement (DoE)
- The date a client formally agrees to participate in a PATH program
- There should be only one Date of Engagement per Enrollment
- By this date all data elements on the Profile and Enrollment screen are required to be entered into HMIS
  - Efforts to identify duplicate client files in Clarity are complete
  - And clients are not already/still enrolled in a different Street Outreach or other housing programs
- The DoE must occur on or before the ‘Date of Status Determination’
- If the client does not ‘engage’ prior to Program Exit, then no date is recorded
PATH Eligibility Status Determination
- This is the HUD defined ‘PATH Enrollment Date’
  - While the language is similar, and therefore potentially confusing, it is different than the HMIS ‘Enrollment’ of a client into a PATH Program.
- A date is entered into this field if the client meets both of the below criteria
  1. Client has been officially “engaged” (has a DoE recorded); and
  2. Has been formally determined to be eligible for ongoing PATH services (because they are both experiencing literal homelessness and are diagnosed with a severe mental illness)
- If a client is determined to be ineligible, or exits prior to determination, the date and reason for exit are documented on the Exit Assessment

Following the recommended workflow will ensure that data are entered properly into HMIS for reporting purposes, and that users are compliant with the requirements outlined in HUD’s PATH Program HMIS Manual.

Program Enrollment - Initial Client Meeting

This is the initial Contact with the client. PATH outreach workers are required to create an Enrollment in HMIS for all persons contacted. It is important to gather and include as much information as possible/appropriate. That said, it is understood that in some instances a person may not be willing to provide even basic information such as a name. These clients still require a HMIS Profile and Program Enrollment. Their initial file will include only the rudimentary information available at the time of the initial contact.

It is understood that PATH outreach workers will update the file over time.

Searching Existing Client Records

The first step to entering data into HMIS after an initial contact is to check if the client has as existing file. Follow the steps outlined in the HelpScout article ‘Searching For & Creating New Client Records’ to search existing clients
If an existing client file has been identified, please ensure all unique identifying elements match before proceeding

Adding a New Client Record

Sometimes outreach workers encounter a client who has no existing record in the HMIS database or for whom there is too little identifying information to conclusively match an existing record. In this case a new client profile should be added following the detailed procedure outlined in the HelpScout article ‘Searching For& Creating New Client Records’
When creating a file for a client whose full name is unknown, follow HUD’s HMIS Data Standards for creating an appropriate nickname or pseudonym “Street Outreach may record a project entry with limited information about the client and improve on the accuracy and completeness of client data overtime by editing data in an HMIS as they engage the client. The initial entry may be as basic as the ‘Project Start Date’ and a “code name” (e.g.,“Redhat Tenthstreetbridge”) response in the name field that would be identifiable for retrieval by the worker in the system. Over time, the data must be edited for accuracy (e.g., replacing “Redhat” with “Robert”) as the worker learns more details, more information about the client is obtained.”
- Select ‘Partial, street name, or code name reported’

As more information is obtained - i.e. full name, DOB, SSN etc. - it is important to add this information to the Client Profile
In addition, is also important to continue to cross check the new information with existing HMIS files
- If it is discovered a client has multiple files, please contact your System Administrator to have the files merged

PATH Program Enrollment

Enroll client in the appropriate Program
- Please refer to the HelpScout article ‘Program Enrollments – Assessments - Program Exits’ for additional guidance on creating an Enrollment and completing the Enrollment Assessment
- PATH Enrollments parallel other program types and the Universal Data Element (UDE) questions are all present, and should be answered to the extent possible
Program Start Date should be the same date of the first contact

Connection with SOAR must be answered when creating the initial entry record with the understanding that the response may change as more information is gathered or if the client becomes connected during their enrollment. As soon as the initial history of connection to SOAR is determined this should be entered into the Enrollment Assessment

Date of Engagement is the date the client agrees to receive services from the PATH program. Often this will not occur during the initial contact. This field may be left blank when creating the Enrollment and updated as appropriate. See below for additional details on the Date of Engagement

Date of Status Determination is the date a client’s SAMHSA eligibility for ongoing PATH services was determined. Often this will not occur during the initial contact.
- This field may also be left blank when creating the Enrollment and updated on the Status Update Assessment or Exit Assessment as appropriate

This field has conditional logic. Only when a date is entered will the End User be able to answer ‘Client Became Enrolled in PATH’
- If the answer is ‘NO’, an additional field will populate to select the appropriate ‘Reason Not Enrolled’

Client Data Unknown/Refused - If the responses to fields are unknown by the client, or client refuses to provide the information, they must be marked as ‘Client Doesn’t Know’ or ‘Client Prefers Not to Answer’, and cannot be left blank. ‘Data Not Collected’ should only be used when the outreach worker did not ask the question to a client
- New Information vs Changed Information:
  - New: As additional client information is obtained, return to the Enrollment, and fill in missing fields until all UDEs are entered
  - Changed: If the information is not newly obtained, but rather the Status itself has changed over time (i.e., a change in income), this should be entered in HMIS using a Status Update Assessment rather than editing the Enrollment Assessment

Document the First Contact

Since every interaction with a client requires entering a contact, it is necessary to record a Current Living Situation Assessment coinciding with the program Enrollment date

Documenting Updates

Current Living Situation - Documenting Contacts

Every contact with a client must be documented using the Current Living Situation Assessment.

Navigate to the Assessments tab within the Program Enrollment and click the Start button

This opens the Current Living Situation Assessment with three fields to complete
- Date of Contact (required)
- Current Living Situation (required)
- Location Details (optional)

There is conditional logic built into the Current Living Situation field meaning that some responses to this question may cause additional fields to appear. All fields must be answered
A text box is available to add any additional details about the client’s location
Click Save & Close

Connection with SOAR

As mentioned above, this field must be answered when completing the Enrollment Assessment at the initial contact
- f the initial response is uncertain or unknown, it can be answered as such on the Enrollment Assessment and updated when further information is gathered
If the client was not connected to SOAR at the time of initial contact becomes connected during their PATH enrollment, this change should be recorded using a Status Update Assessment

Date of Engagement

The Date of Engagement reflects the date a client consents to a formal case management type relationship including receiving ongoing services such as developing a case plan and working toward established goals, etc. While this could occur during the initial contact, it often occurs following a period of rapport building.

This date must occur on or before the Status Determination date.

Once the client is “Engaged” this should be reflected by updating the Enrollment record to include the Date of Engagement. This can only be updated on the Enrollment Assessment

Scroll down to the relevant question and enter the relevant date into the field

In addition, it is expected that coinciding with the Date of Engagement, any remaining unknown data elements have now been collected and the Enrollment screen is complete
With all information now known, please check for any duplicate client records or overlapping program enrollments
Make sure to enter a Client Living Situation coinciding with the Engagement date
Click Save & Close

Date of Status Determination

The Date of Status Determination reflects the date a client’s SAMHSA eligibility for PATH programing was determined. NOTE: This is considered the SAMHSA enrollment date, which is different than the HMIS enrollment date. Remember that a program Enrollment must be created in HMIS following the initial contact.

Status Determination after client has been enrolled into a PATH program
- Determination is YES, the End User will complete the ‘Date of Status Determination’ using the Status Update Assessment
- Determination is NO, the End User will exit the client and complete the ‘Date of Status Determination’ on the Exit Assessment. See below for steps on Exiting a client

Updating Changes to PSDE’s (Disabilities, Income, Non-Cash, Health Insurance, etc.)

When a client’s Status around particular data elements such as income, non-cash Benefits, disability, insurance, etc. change during an Enrollment, these changes should be documented using a Status Update Assessment.

Please refer to the HelpScout articles ‘ESG Street Outreach Workflow’ or ‘Program Enrollments – Assessments - Program Exits’ for additional guidance.

PATH Services & PATH Referrals

Documenting PATH Services

Please refer to the HelpScout article ‘Documenting Services’ for additional guidance on how to add services to a client record.

PATH specific Services can only be provided if the ‘Date of Status Determination’ has a YES response
Every time a PATH specific Service is provided it must be documented on HMIS

Documenting PATH Referrals

PATH funded Referrals are documented as a Service, and;
Can only be provided if the ‘Date of Status Determination ’has a YES response
Following the steps found in the HelpScout article ‘Documenting Services’, select the ‘Referral’ service
- PATH Referrals include the following categories:
  - Community Mental Health
  - Educational Services
  - Employment Assistance
  - Housing Services
  - Income Assistance
  - Job Training
  - Medical Insurance
  - Permanent Housing
  - Primary Health/Dental Care
  - Substance Abuse Treatment
  - Temporary Housing
- Each category includes 3 Outcome options:
  - Attained - the client was connected and received the service
  - Not Attained - the client was referred to, but may not have ever been connected with the service, or did not actually receive the service
  - Unknown- the status of the client’s connection or receipt of service is unknown to the provider entering the data
If a Referral Outcome changes overtime (i.e. Was ‘Unknown’ but then becomes ‘Attained’), do not edit or delete the original Referral
- A new Referral should be documented with the new Outcome

Exiting a Client

When Exiting a client from a PATH program, in addition to the regular Exit workflow, End Users should make sure the following PATH specific data elements are completed:

Connection with SOAR
Date of Status Determination
Current Living Situation Assessment