• AIRS – Alliance of Information and Referral Systems
  • AHAR – Annual Homeless Assessment Report
  • APR – Annual Performance Report
  • ATA – Agency Technical Administrator
  • CAPER – Consolidated Annual Performance and Evaluation Report
  • CES – Coordinated Entry System
  • CDBG – Community Development Block Grant CoC - Continuum of Care
  • CH – Chronically Homeless
  • CoC – Continuum of Care
  • DOB – Date of Birth
  • DQSC – Data Quality Sub-Committee
  • DV – Domestic Violence
  • ES – Emergency Shelter
  • ESG – Emergency Solutions Grant
  • EVHI – Ending Veteran Homelessness Initiative
  • Homeless Emergency Assistance and Rapid Transition to Housing HIPAA - Health Insurance Portability and Accountability Act of 1996
  • HMIS – Homeless Management Information System
  • HoH – Head of Household
  • HOPWA – Housing Opportunities for Persons with AIDS
  • HPCC – Homeless Prevention Call Center
  • HUD – Housing and Urban Development
  • NOFA – Notice of Funding Availability PIT - Point in Time
  • NP - Non-Participating (Agency is listed as not using ServicePoint or no longer in operation)
  • PATH - Projects for Assistance in Transition from Homelessness
  • PPI – Personal Protected Information
  • PSH – Permanent Supportive Housing
  • RHY – Runaway and Homeless Youth
  • ROI – Release of Information
  • RRH – Rapid Re-Housing
  • SH – Safe Haven
  • SHP – Supportive Housing Program
  • SRO – Single Room Occupancy
  • SSI – Supplemental Security Income
  • SSN – Social Security Numbe
  • SSO – Supportive Services Only
  • SSVF – Supportive Services for Veteran Families
  • UDE – Universal Data Element
  • TANF – Temporary Assistance for Needy Families
  • TFA – Temporary Financial Assistance
  • VASH – Veteran Affairs Supportive Housing

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    Unsheltered Homelessness Initiative (UHI): Augmented Case Management (ACM) - Service Transaction Requirements

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    Rischelle Fajardo
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    The purpose of this article is to communicate the service transactions that Unsheltered Homelessness Initiative (UHI) - Augmented Case Management (ACM) programs are required to record in HMIS.

    • Stabilization services are an integral part of the ACM program model. Therefore, ACM projects are required to track services provided to participants after enrollment. Please refer to the table below, which outlines the services you need to track. You are not required to track any services beyond those listed.
    • Providers should enter a new service transaction each time they provide that service to the participant. Common services such as case management, counseling, and transportation should be recorded as frequently as they are provided.
    • If the same service is provided twice on the same day, it should be recorded only once. Since services capture the interactions between providers and participants over time, recording the same service twice on the same day is unnecessary.

     

    Table of Contents:

     

    Data Entry Timeliness

    Please ensure that each service listed below is entered into the HMIS system within two business days of being provided to a participant.

    All Chicago will monitor the timeliness of Referral Need Status updates, per the following Contact Protocols.

    Event Description Timeliness Standard: How many days are projects expected to make the update from the original referral date? Referral Need Status
    The participant is initially referred to the Augmented Case Management project N/A CES: CES Team Only: System Navigation Matched/Assigned.
    Augmented Case Management project receives referral and have begun attempting to contact the participant 2 Business Days CES: Attempted/Attempting Contact.
    Participant has been contacted and in progress to be fully enrolled. 15 days CES: Client Engaged, In Progress to Enrollment
    Participant has not yet been enrolled in the ACM project and a Rematch is needed 15 days
    • CES: Rematch Needed: Client Declined to participate (specify in notes)
    • CES: Rematch Needed: Client located but not engaged in housing process 
    • CES: Rematch Needed: Ineligible: Household Composition
    • CES: Rematch Needed: Ineligible: Age
    • CES: Rematch Needed: Ineligible: Not Experiencing Homelessness
    • CES: Rematch Needed: Not able to contact client
    • CES: Rematch Needed: Not living in Chicago
    • CES: Rematch Needed: Other (specify in notes)
    Participant has been engaged and enrolled in the ACM project. If the participant is ineligible or declines the housing project match, they may elect to remain enrolled in the Augmented Case Management project until they can be rematched and housed with a new housing project. In this case, the Referral Need Status can remain as CES: Enrolled until the participant is housed with a new housing project. In this case, the Referral Need Status can remain as CES: Enrolled. 15 days CES: Enrolled
    The participant is housed with their referred housing project and has completed the ACM project.  Augmented Case Managers should exit the ACM project enrollment and keep the RNS set to CES: Enrolled as CES: Enrolled is a terminal Referral Need Status. CES: Enrolled
    If the participant has been enrolled in the project and either goes out of contact or needs to be exited from the ACM project. Augmented Case Managers should keep the RNS set to CES: Enrolled and exit the participant’s ACM project enrollment within  30 days of non communication or any other reason. CES: Enrolled

     

    How to Enter Services in HMIS

    Services are entered in the Service Transaction tab of the client record > Add Service

    For more information on how to enter services, please see this article. 

     

    Services and Definitions

    The Chicago CoC's HMIS uses AIRS codes to keep service transaction records consistent. To help match the services provided by each program, the table below explains each service and shows the corresponding Service Type to choose.

    Each service is designated as required or individualized. Participants should receive all required services. However, individualized services may or may not be applicable depending on the needs of each individual participant.

     

    Service Provided

    HMIS

    Service Type

    		 Definition Required or individualized
    Case/Care Management Case/Care Management, PH-1000 Case management activities which assess a client's basic needs and goals, including in-person assessment to determine how a client's needs can be met by the program.  This may include creating a client centered plan with use of motivational interviewing, trauma-informed conversations, goal setting, etc. Required
    Counseling - Life Skills
    Life Skills Education, PH-6200.4600    		 Supportive conversations or referral to services that will aid the client to live independently and/ or care for personal needs. Individualized
    Health / Dental Service Health Care, L Referral to health care providers, transportation to doctor’s appointments, supporting client goals related to their health.   Individualized
    Substance Abuse Services Substance Use Disorder Services, RX Referral to harm reduction and substance use services and/ or providing education surrounding harm reduction and providing harm reduction materials and supplies such as Naloxone, clean needles, etc. Individualized
    Community Connection & Supports  Basic Needs, B Referred to local food pantries, community centers, public benefits office, libraries, laundry services, public transportation, medical clinics/centers, pharmacy, grocery stores, schools, park districts, in home health aides and/or care giving.  Required
    Mental Health Services Mental Health Support Services, RR Referral to mental health services. Individualized
    Counseling - All Other Counseling Services, RP-1400 Motivational interviewing and/or trauma-informed conversations to support the client’s overall well-being. Referral to counseling or therapy. Individualized
    Identification and Other Documentation Support Identification Application/Replacement Clinics, FT-3400 Assistance to attain necessary identification or other documentation that supports access to benefits and housing Individualized

     

    Example Scenarios of Service Provision

    Interaction Between Provider and Participant Services Provided
    The provider meets with the participant. They create goals that include registering with the neighborhood food pantry and regularly visiting a doctor. The provider gives the participant a referral to a local doctor, and they plan to visit together. The provider and participant discuss how to get to the food pantry using public transit.

     
    • Case Management
    • Community Connections and Support
    • Health / Dental Service
    This interaction is not Counseling – Life Skills as the conversations include specific referrals to local resources and details about the client’s unique community.
    The provider calls the participant to confirm the participant’s first doctor’s appointment the next day. They review the logistics of when and where they will meet.

         		 Case management
    This interaction is not Health/Dental service because a new referral was not made; instead, they engaged in case management by ensuring that the participant meets their goals.
    At the participant’s request, the provider refers the participant to another healthcare provider. During the same interaction, they also refer the participant to a dental provider. 
     
    • Health / dental service
    Since both referrals are provided on the same day, Health/Dental service should only be entered once. 
    The provider and participant discuss the participant’s well-being, and the provider relies on motivational interviewing. The participant is interested in a therapy group, and the provider makes that referral.   

     
    • Counseling – all other
    While this could be considered "Case Management" since the service provided is "Counseling – All Other", there is no need also to record it as case management.

     

    Proactive Engagement

    As part of the Coordinated Entry System's (CES) Priority List Implementation, Proactive Engagement include households who are currently being pre-engaged for upcoming housing opportunities (60 households).

    These households are assigned a Housing Resource Specialist (HRS), which may be a may be an Augmented Case Manager to complete the Priority List Assessment. They are then expected to:

    1. maintain a communication plan with the household

    2. collect vital documentation, and 

    3. keep their HMIS data updated

     

     

    For these participants, navigators will need to Create a new Interim Review with the Interim Review Type: CES Priority List Update and complete the Coordinated Entry Priority List Assessment.

     
     
     
     
    See the following article for a more detailed walkthrough of the workflow: Proactive Engagement Workflow
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