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Use Data to Improve Efforts: Strategy 3 of the HUD SNAPS Initiative

If you’re just joining us, this is the fourth article of a four-part series covering the new HUD SNAPS initiative strategies. We’re discussing what it looks like for communities to achieve an advanced level of implementation of said strategies.

Strategy 3: Continuums and stakeholders use data to improve efforts to end homelessness

Strategy Three really delineates the three specific ways that HUD wants CoCs to utilize their HMIS Data:

  1. System planning
  2. Coordination of care
  3. Prioritization of resources

CoCs uses data for system planning

Criteria for Advanced CoCs in 3–5 Years: Use all data sources (including data from non-homeless systems of care) to prevent and end homelessness


HUD emphasizes that CoCs must be equipped to accommodate the “unique needs of different populations, including […] [those] disproportionately represented among people experiencing homelessness.” Therefore, many Bitfocus HMIS communities are paying careful attention to how local conditions perpetuate racial inequities in program and service coverage — even during the Coordinated Entry (CES) process.

Bitfocus is investing aggressively in tools that promote the use of data to facilitate real-time decision support, and help communities better understand and act on their data. In addition to the dozens of pre-built reports in our report library, Clarity Human Services includes robust business intelligence and data analysis tools that allow users to explore and interact with their client data. Our data analysis tab removes the complexity that often stands in the way of accessing and understanding the data contained in case management software, empowering users to answer questions themselves and to leverage the best available data to inform and support decision-making.


Reliable information and smart data analysis can help you identify
and tackle structural barriers in your CES.


Bitfocus System Administrator Team, Example 2

HUD stresses that CoCs must be equipped to accommodate the “unique needs of different populations, including […] [those] disproportionately represented among people experiencing homelessness.” Therefore, many Bitfocus HMIS communities are paying careful attention to how local conditions perpetuate racial inequities in program and service coverage — even in their Coordinated Entry (CES) process.

Last year, for example, Bitfocus system administrators in one CoC began an ambitious project to analyze their CES data. Using Clarity’s numerous data quality analysis tools and custom reporting features, the team had no problem identifying messy content.

To tidy-up the system, they merged duplicate client accounts using Clarity’s merge tool. Next, they refreshed the pool of clients on the Community Queue — Clarity’s community waitlist — by removing everyone and then re-adding folks from a list of high-priority clients.

After analyzing the newly organized data, the team noticed that people of color were disproportionately represented among those who are deemed highly vulnerable and in need of housing — particularly African Americans and Native Americans.

In response, the CoC assembled several work groups involving service providers and people who formerly experienced homelessness from these communities. To identify areas where racial disparities appear frequently and why they might be occurring, Bitfocus system administrators collaborated with these workgroups by analyzing data using Clarity’s data analysis tools and making dashboards and custom reports.

They also used Clarity’s canned reports to assess how race-based disparities were affecting CES and referrals outcomes, including:

  • VI-SPDAT Referral Detail (This can be customized for any standardized assessment tool
  • Coordinated Entry Community Assessment
  • VI-SPDAT Details
  • Community Queue Report
  • Referral Statistics
  • Referral Outcomes Statistics
  • Community Queue Detail
  • Coordinated Entry Compliance Report
  • Community Queue Program Eligibility Report

Clarity’s referral system allows the community to track essential information regarding how long it takes to evaluate a client’s needs, send them to the Community Queue, and make a successful program or housing placement.

“By combining the coordinated entry workflow with what was previously viewed as a mere data repository, we’re able to see how somebody is moving through the homeless services and coordinated entry system. And then, with all this data, we can see that certain groups are staying homeless longer, and are not being served or housed at the same rate as other groups,” says one Clarity HMIS system administrator.

Equipped with HMIS and CES data, CoC leaders have been introducing policy reforms to fix inefficiencies and structural barriers in the referral process. For example, previously, after a client completed an assessment, they would go automatically to the Community Queue. But because the CoC faces a deficit in housing and a glut in homelessness, the waitlist would develop numerous bottlenecks.

To ease the client flow to the Queue, the community modified its referrals process to emphasize diversion practices, which look first to opportunities outside of the homeless services system to help clients obtain temporary or permanent housing. These options may involve conflict mediation, financial assistance, or other “light touch” services.

As a reinforcement of the diversion process, CoC leaders changed the referral policy so that the Community Queue is used only for the highest-priority clients. Additionally, the CoC is collaborating with Bitfocus system administrators to develop a new housing triage assessment survey. This tool will make it easier to identify high-priority folks and capture data that are essential to improving the community’s understanding of race-based disparities.

According to the system administrator team, “Clarity allows for the easy creation of custom assessments and custom scoring processors, so technical barriers to improving the CoC’s evaluation tools are swept away. Political obstacles still exist, of course, but once these are resolved, the community can benefit quickly from its new instruments.”

CoC leaders have also created a “matchmaker” HMIS access role, which they’ve assigned to specific users. Matchmakers can view all available programs within the Community Queue, and direct the flow of traffic on the Queue by re-assigning or denying referrals, or signaling when they are pending or in process. To help matchmakers track referrals in real-time and identify patterns of racial bias as they emerge, system administrators built custom dashboards and embedded them in Clarity’s referrals tab.

As the example above shows, using Clarity HMIS data is an integral tactic to recognize race-based inequities, identify where efforts should be directed, and monitor progress toward goals. Bitfocus system administrators demonstrate the power of these tools daily as they partner with CoCs to end homelessness for all people.


CoC uses data for coordination of care

Criteria for Advanced CoCs in 3–5 Years: Homeless providers and non-homeless systems of care coordinating to remove systemic barriers to housing and services

Communication is key to removing the systemic barriers to housing and services, particularly communication amongst and between service providers — homeless and non-homeless service providers alike. Clarity Human Services is configured to facilitate intersystem communication in very simple and nimble ways. Clarity also allows the end user to see the client’s entire situation at-a-glance, which significantly improves their ability to provide care. And finally, and perhaps most importantly, the Clarity Human Services HMIS plays well with other systems — the apps and integrations we’ve built into the software remove the types of technological barriers that can prevent persons from receiving the housing and services they need. Each of these elements are described below.

Intersystem Communication

Clarity Human Services is equipped with an intersystem messaging system that allows staff members to securely communicate with other staff members. Systemwide emails are accessed here as well. End users can also create Public Alerts to alert other users to any pertinent information regarding the client (e.g., they have mail, or they’re up for housing). Clarity Human Services also includes customizable referral notification alerts that can be delivered either via in-app message and/or external email (without client PII). The system administrator can also post user alerts on the login screen of the Clarity Human Services application. Clarity Human Services also offers an integrated Calendar, which may be subscribed to through an external email client such as Gmail or Outlook. The Calendar feed also contains links directly to client programs and services. For example, a staff member can set a due date for reassessment for a particular program. The link will automatically appear on the calendar when the re-assessment is due. When the link is selected, it will automatically direct the user to the requested location.

A Central Hub for Each Client Record

is the Client History Tab, which is considered to be the ‘Central Hub’ of the client record. Here the end user can view and conduct advanced, filtered searches on all client activities (service transactions, assessments, referrals, reservations, etc.), which are listed in a color-coded fashion. Note that the items included in a client’s history tab will directly coincide with the sharing permissions of the client, agency, program, as well as with the end user’s access role. So, in short, they can only view what they are authorized to view.

Apps & Integrations

To be successful today, even the most full-featured HMIS solutions need to be able to play well with others. Coordinated Entry, Frequent User Initiatives, and other efforts require ever closer cooperation and coordination between various systems of care and their respective data systems. At the same time, the human services space itself is quickly expanding to encompass the full spectrum of service providers. Clarity Human Services includes a RESTful API to securely connect authorized applications with HMIS. The API offers a well-documented, standards-based means of building upon the Clarity Human Services platform without the need for Bitfocus professional services or support. For more casual integrations, Clarity Human Services recently introduced a powerful drag-drop data import tool that allows users to manually import both HUD XML/CSV and custom data fields with minimal technical complexity.

CoC uses data to prioritize existing resources for neediest clients

Criteria for Advanced CoCs in 3–5 Years: Data from non-homeless systems of care is used to prioritize highly vulnerable persons, plus highly targeted prevention (based on local evidence)

As aforementioned, good data quality relies on several factors — timeliness, comprehensiveness, and accuracy. These, in turn, depend on a well-trained team equipped with a robust and easy-to-use system. When these factors align, your HMIS is much more than a mere place to house data; it’s a sophisticated tool, enabling you to understand your data, make informed decisions about policy, and connect your clients with valuable resources.

Bitfocus believes that nowhere is this truer than with Coordinated Entry Systems (CES). That’s why we wholly integrated Coordinated Entry into the Clarity Human Services HMIS workflow to create an end-to-end solution: everything you need from outreach to move-in.

Clarity Human Services includes a robust suite of Coordinated Entry tools and features that support each of the core elements of Coordinated Entry:

  • Access
  • Assessment
  • Prioritization
  • Referral

From initial outreach through engagement, Clarity Human Services helps communities maximize access to the coordinated entry system and ensure full coverage throughout each continuum’s complete geographic area.

  • Support for Variety of Access Models: Coordinated Entry functionality in Clarity Human Services supports a variety of access models and configurations that adapt to the needs, policies, and resources available to each community.
  • Mobile-Ready: Full support for mobile devices empowers outreach workers with full access to HMIS functionality. Authorized users can securely track outreach efforts, complete Coordinated Entry assessments, and — where appropriate — reserve housing and service resources from the field.
  • Location-Aware: Add geographic context to homeless data by using GPS coordinates (e.g., using a mobile device) and automatic geocoding of manually entered addresses. Location information can be combined with other data points to create geographic visualizations using our built-in Data Analysis tool or third-party reporting tools (e.g., Tableau or ArcGIS), via our Customer Data Model.

Whether using a standard assessment tool or something more custom, Clarity Human Services allows communities to efficiently and effectively assess the housing needs, preferences, and vulnerability of homeless families and individuals.

  • Standard Assessments: Support for popular assessments, including the VI-SPDAT and OrgCode assessments, comes built-in — including automatic scoring.
  • Custom Assessments and Score Processors: System Administrators can customize any assessment or create custom scored assessments to match the unique needs and priorities of their communities.

The Community Queue features in Clarity Human Services help CoCs manage the inventory of community housing resources and services available, and ensure that those persons with the greatest need and vulnerability receive the resources needed to resolve their housing crisis.

  • Waitlist Management: Maintaining an accurate and timely waitlist of eligible persons seeking housing can be challenging — particularly for large continuums. Clarity Human Services offers a variety of tools to aid communities in managing their waitlist. Features include the ability to distinguish active vs. inactive clients based on system activity; “snooze” clients to remove them temporarily from the waitlist; and interactive reporting to gain insight into system info, wait times, and placements.
  • Case Conferencing: Referral-specific case notes, a full referral history, and automated eligibility screening facilitate secure collaboration between housing navigators and provide an ideal platform for case conferencing.
  • Customizable Waitlists and Dashboards: Communities can customize Coordinated Entry waitlists and create custom dashboards that combine assessment scores with other data elements (including support for custom fields).
  • Real-Time Inventory Management and Reservations: Understand current and anticipated availability with real-time bed and unit inventory management — including support for reservations to prevent duplicate referrals to the same resource.

Finally, our referral features facilitate a smooth handoff to available housing resources and services, while helping to ensure compliance with local Coordinated Entry Policies and Procedures.

Eligibility Engine: A robust eligibility engine automates program eligibility screening and aids housing navigators in quickly screening for eligible clients.

  • Document Management: Digital copies of files and documents can be uploaded directly to the client’s record, allowing the full housing navigation and application process to happen within HMIS. Additionally, Clarity Human Services compares the type of documents uploaded against program requirements to determine if a client is “doc-ready” for a particular program.
  • Outcome Tracking: Each referral is tracked in the system to evaluate its outcome and help ensure each program’s compliance with community Coordinated Entry policies and procedures.


The new SNAPs strategy is a call by HUD for CoCs to fully participate in the data revolution that’s changing how we provide services and solve vexing social problems. At the heart of all these efforts is your HMIS.

Of course, most communities are at different stages in our shared purpose of using data to end homelessness. But what’s important is that we’re all moving forward. Bitfocus helps in this endeavor by removing any of the technical obstacles on your path. We believe that, ultimately, helping the homeless and those at risk of becoming homeless is not a competition; it is a collaborative effort that is strengthened by the exchange of ideas. This article contributes to this effort by highlighting how communities use their Clarity Human Services HMIS to plot their course and charge ahead in pursuit of their mission.

Hopefully, the ideas we’ve shared will encourage a frank dialogue in your CoC about where you currently are in light of HUD’s goals and what it will take to progress. Most importantly, we hope the examples provided here will inspire you to discover new frontiers for leveraging technology to end homelessness. Just remember, if you ever need more crew members to help you explore, Bitfocus is ready to sign up.


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