Santa Clara’s “Triage Tool” Pinpoints the Most Vulnerable on the Streets

Providing proper supportive housing to homeless individuals can be the difference between life and death. But when the number of homeless people overwhelms the current housing supply, how can officials prioritize the neediest to receive shelter? The answer may come in the form of the Silicon Valley Triage Tool.

Revealed in February 2016, the Triage Tool comes on the heels of the nonprofit policy group Economic Roundtable’s report Home Not Found: The Cost of Homelessness in Silicon Valley. The report analyzed the records of the 104,206 individuals who experienced homelessness in California’s Santa Clara County at any point between 2007 and 2012. The data received included the medical and justice system history of each person, as well as the cost of any and all services they received.

These records were linked across all justice system, social service, health care, and housing agencies to form one of the largest and most comprehensive bodies of information on the financial cost of homelessness in the United States.

“Poor folks and homeless people in particular tend to be invisible in a lot of data… If you don’t have a home, you’re not in the sampling frame for a lot of surveys. Record linkage projects like this are very valuable because they connect the dots… You see those windows of reality and can use them for targeting people for extra help or intervention,” said Daniel Flaming, President of Economic Roundtable.

It was this record linkage that facilitated the use of the Triage Tool in Santa Clara, a county that stretches from Palo Alto to Gilroy and is home to nearly 1.9 million people, including 6,500 homeless residents.

Using the database of linked Santa Clara County records, the Economic Roundtable developed a sophisticated algorithm that predicts which chronically homeless individuals will be most likely to utilize public services like medical services or prisons at high rates without intervention. Providing permanent supportive housing to these high-risk individuals may reduce the need to utilize such services, decreasing the costs associated with their use.

“Generally, when people are overusing our systems… it’s because they’re in the greatest amount of suffering. They’re having a lot of challenges and they need a lot of help. [The Triage Tool] gave us a way to find those people who are most vulnerable in our community and prioritize them for housing,” said Jennifer Loving, Director of Destination: Home, a public-private organization that co-sponsored the development of the Triage Tool. “Until there’s enough housing for everybody, we have to find a way to be able to create a coordinated assessment and way to prioritize people for accessing the housing that’s available.”

Preliminary research for the tool in Los Angeles revealed that once connected with housing and supportive sources, the expenses of high-cost, high-risk homeless persons decreased by about 68%, says Flaming. The ability to receive preventive care, visit doctors, and receive mental health care on an outpatient basis stabilizes lives and drives costs down.

In fact, according to Flaming, if Santa Clara County provided housing to the top 1,000 homeless residents predicted to have the highest costs, the average savings could amount to about $19,000 per person housed.

“We’ve been doing this for about five years, so we’ve seen homelessness reduced by about 14% across our county… When we first started looking at prioritizing homeless based on this sort of methodology was a change from a first-come-first-serve or a shelter-based model, so there was work to be done around educating and getting a consensus about why this sort of change is necessary,” said Loving.

The algorithm was designed as an open source document, and any jurisdiction interested in using the Silicon Valley Triage Tool to streamline housing in their own city or county is welcome to for free, as long as they have the data linkage across sectors to allow the tool to operate.

In the future, such an algorithm could even be used statewide to prioritize housing from linked databases. With more detailed records collected over longer periods of time, the Triage Tool has even more predictive potential.

“Most people are saying yes, we want government to make that possible, to use their resources efficiently and effectively, to prioritize individuals. As the county, we operate and administer the safety net program, so it makes sense that we are focused on reducing costs, avoiding unnecessary expenses, and being efficient with those safety net programs,” said Ky Le, Director of Supportive Housing in Santa Clara.

An earlier version of the tool is being used to streamline patient care in about 15 Los Angeles hospitals, and other California districts like San Francisco and Los Angeles are currently in talks to use their Triage Tool in their own systems. Work is still underway to prepare the tool for its official launch in Santa Clara County, although Le is confident that the first report will be run by the fall.

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