A Cincinnati area computer system created to improve the care of the homeless is proving to be a surprising success story for cooperation among social service agencies.
Hamilton County soon will be the first area in the country to be in full compliance with new federal guidelines requiring all municipalities to implement similar systems.
Across the country, the federal mandate has sent social service agencies scrambling to find suitable database technology. It has also led some domestic violence shelters to forgo federal funding out of fear for clients' safety.
Yet in Cincinnati, directors of local homeless support agencies say the system has improved the accuracy of demographic statistics, led to more efficient care of clients and met stringent security standards.
The U.S. Department of Housing and Urban Development (HUD) requires all consortiums of agencies that serve the homeless — a consortium is called a "continuum of care" in HUD parlance — to store client data in a Homeless Management Information System (HMIS). Continuums not in compliance risk losing critical federal funds.
It's up to each consortium to install an HMIS database. The federal government doesn't have access to data stored in each continuum's HMIS, except for aggregate demographic information.
The Hamilton County Continuum has embraced a database system called Vesta, created by the local HIV/AIDS housing agency Caracole Inc.
'Homeless concierge service'
On a recent rainy afternoon, residents of the Drop Inn-Center in Over-the-Rhine mulled about the drab lobby chatting and socializing.
A few dozed on worn chairs. The center is Hamilton County's only 24-hour emergency shelter for the homeless, a refuge of last resort for many. Male and female residents may stay here one night, three months or perhaps even longer.
The Vesta database has simplified operation of the shelter and allowed employees to spend more time with residents, according to Pat Clifford, the center's director. Before Vesta, the center used an antiquated database and handwritten logs to count residents. Double counts or undercounts were common.
Now each new resident meets with an intake specialist to discuss his or her needs and to provide basic identification information such as name, age, race and social security number. The information is directly entered into the Vesta database using an encrypted Web site.
Residents are issued I.D. cards — containing a bar code, but no other visible information — that allow the Drop-Inn Center to track their comings and goings. After 30 days, the cards expire and residents once again must meet with a center employee.
"Everybody has to have a face to face talk, so we can find out their needs," Clifford says. "It's almost like a homeless concierge service."
Because Vesta is a countywide database, a homeless client can move from agency to agency without having to file repetitive paperwork, although only non-confidential information is shared. This allows a client who might enter the system at an emergency shelter like the Drop-Inn Center to move onto a long-term care program without the new agency having to confirm the client's eligibility. Previously, a confirmation could take as long as two days.
John Briggs, head of Goodwill Industries' Homeless Veterans Program, says this feature has led to a 70 percent increase in efficiency.
"It cuts down the time so much ... and it gives you the information you need" he says. "I can establish (a client's) eligibility for four programs in 30 seconds."
Collaboration pays off
Vesta began a database for the Family Shelter Partnership Program in 2000. When HUD announced the HMIS mandate, the Hamilton County Continuum decided to expand upon Vesta.
The key to making the system work has been careful planning and collaboration between agencies, according to Michelle Budzek, facilitator for the Hamilton County Continuum and HMIS administrator. For two years before the system was put into place, different committees comprised of agency representatives and homeless clients met to discuss what they wanted Vesta to accomplish.
Even before Vesta, though, local agencies that serve the homeless were collaborating, says Kevin Lab, director of social services at Bethany House and an early proponent of Vesta. He credits a 20-year history of collaboration for Vesta's success.
"This history has paid off in the implementation of the system," he says. "There was already a basic level of trust and openness."
For all the benefits of the HMIS, critics worry the databases will be open to abuse. Because each local continuum creates and manages its own database, some databases might contain security loopholes.
The National Network to End Domestic Violence has taken a strong stand against the HMIS, arguing battered women might be put at risk if a stalker were to gain access to a database. Some domestic violence shelters in Colorado, Pennsylvania and Illinois have decided to forgo HUD aid in order to avoid the HMIS.
The problem, however, might lie in how each continuum implements HMIS, not in a fundamental flaw with using a database or the HUD mandate. Many continuums purchased database systems not tailored to their specific needs.
One company attempted to peddle database software designed for a hospital; it could even write prescriptions, Briggs says.
The chair of the Vesta Advisory Committee and a computer programmer, Briggs says that, while the off-the-shelf database software was initially easier to set up, continuums ran into security problems.
"I went to a conference in September and a lot of people were screaming — and I literally mean screaming — at the vendors who provided them their software," he says.
Hamilton County's Vesta is different, Budzek and Briggs say. The software contains numerous security safeguards and all users undergo multiple training sessions.
Theresa Singleton, director of the YWCA Battered Women's Shelter, says the YWCA has taken special precautions to protect residents. Only four of its 40 staff members have access to the Vesta system and only limited amounts of data are entered into it.
At all local agencies, clients can opt out of Vesta without forfeiting care.
"Activists have legitimate concerns, but technology is here," Singleton says. "We need to work with it."
"The way we have gone about this has really strengthened the trust that people have," Lab says. "They realize that we are working for once really as a community to help them. It is not just me or someone else, but all the resources being put together in order to help a person." ©