By Erica C. Barnett
In October 2020, a little more than six months into the pandemic, the King County Regional Homelessness Authority quietly changed the criteria it uses to place people in the so-called “priority pool” for housing—sometimes known as the “top 40 list.”
Instead of relying on an interviewing tool that has been widely criticized for producing racially biased outcomes, the KCRHA will use a simpler list of criteria developed in response to COVID-19 that prioritizes older people, people of color, and people with specific physical conditions, such as diabetes or a weakened immune system, that make them susceptible to COVID. The new system relies on data from local medical providers and information people self-report through the Homeless Management Information System used by most homeless service providers. Unlike other tools, it does not include factors such as mental illness or substance use disorders, which are common barriers to housing and part of the standard definition of “chronic homelessness.”
The need for a quasi-objective tool to decide who gets housing is a product of scarcity: For decades, the number of people experiencing homelessness in Seattle has far outpaced the amount of available housing for people with little or no income or who need extra support to stay housed. Today, the King County Regional Homelessness Authority estimates there are as many as 45,000 homeless people in the region. Because there isn’t enough affordable housing for all those people, the homeless system has to triage—picking and choosing who gets access to housing based on their level of “vulnerability,” a term with a shifting definition. The calculus is brutal: Without enough housing, most people will always be left out in the cold; the only question is who makes the cut.
“Only a very small slice of people who are homeless are getting help,” said Nan Roman, president and CEO of the National Alliance to End Homelessness. “Not many people qualify and there’s not a lot of funding in the system for people experiencing homelessness.”
“When we do have enough housing, prioritization as we’ve known it is something that that will no longer be necessary,” KCRHA program performance manager Alex Ebrahimi said.
“But as long as there’s that scarcity, then we have to be able to identify a group of folks” to prioritize.
King County has used a number of different tools over the years to assess people’s vulnerability and prioritize them for housing—most recently (between 2016 and 2019) an interview-based assessment called the Vulnerability Index—Service Prioritization Decision Assistance Tool, or VI-SPDAT for (sort of) short. For years, critics argued that the VI-SPDAT led to racially biased outcomes—Black people, in particular, were underrepresented compared to white people—and King County adopted new criteria that de-prioritized the VI-SPDAT, but didn’t discard it, in early 2019.
Later that same year, a study from a group called C4 Innovations confirmed that the VI-SPDAT gave white people a better shot at housing and services than Black people and other people of color, and suggested some possible reasons why: The tool asks a number of extremely personal questions about things like domestic violence, drug and alcohol abuse, and sex work, that white people may feel more comfortable answering in the affirmative, especially if the interviewer is also white. The study also found that the VI-SPDAT asked questions about vulnerabilities that white people were more likely to have than people of color.
The new criteria do away with that by only looking at race, age, and physical health (including pregnancy)—and by foregoing in-person interviews altogether. “What is fundamentally different [with the COVID-19 criteria] is that instead of asking folks a lot of invasive, retraumatizing questions,” KCRHA program performance manager Alex Ebrahimi said, is that “the tool is based on data… so that litany of really invasive, not trauma-informed questions doesn’t have to happen.” The KCRHA gets its information from both “administrative data” taken from the Health Care for the Homeless Network and Medicaid, and from the Homeless Management Information System, a giant database used by most homeless providers that is based on self-reporting.
In the year and a half the new system has been in place, the percentage of Black heads of household prioritized for housing increased from 27 percent to 49 percent, while the percentage of white households declined from 32 to 11 percent. (The percentage of Latinx and American Indian/Alaska Native households that were prioritized for housing also increased slightly, while the number of Asian and multiracial households declined). The change was also striking among families with children, where the percentage of Black households increased from 33 percent to 52 percent, while the percentage of white households declined from 27 to 6 percent.
But the biggest change since the KCRHA started prioritizing people for housing based on COVID vulnerability has been in the age of single adults who receive priority for housing placement. Because the COVID criteria put a premium on age—seven of eight “tiers” count age as one of a small handful of potential qualifiers, with a lower cutoff of 65—the average age of single adults who were prioritized for housing skyrocketed, from 41 to 61 years old. For a typical middle-aged person without any physical ailments that make them specifically vulnerable to COVID, the odds of getting bumped up the queue for housing are slimmer than ever.
Looked at one way, this makes perfect sense: By the time a homeless adult is 60, they are usually much “older,” biologically, because living outdoors is terrible for a person’s health. “The population of older adults who are homeless is expected to double by 2025 and triple by 2030,” Roman said, and “few are going to make it past 60. [By the time] they’re 55, they present as older and they have the problems of older people, but they’re not eligible for federal assistance to older people because they’re not old enough.”
Still, the exclusion of behavioral health conditions from the criteria is a significant shift—one that could mean some people with substance use disorders or disabling mental health conditions have to wait longer for housing. Ebrahimi, from KCRHA, says the authority may take behavioral health into consideration in the future, but notes that this information isn’t readily available through data; people have to disclose it voluntarily through the kind of interview process that the VI-SPDAT, with its biased outcomes, was based on.
Marc Dones, the KCRHA’s director, acknowledged during a recent city council meeting that while the agency has “seen much more equitable results” with the new criteria, “we also want to recognize … that [the new system] is not perfect, and we look forward to continuing the conversation with community and researchers and evaluators to understand what might be better and to create iterative improvements.”
Alison Eisinger, the director of the King County Coalition on Homelessness, said, “Nobody is sad to see VISPDAT go—[it was] long overdue. It wasn’t serving this community well nor was it designed for the purpose.” But, she added, she hopes the authority will engage in an “an iterative and transparent process in real time that involves the people who have to use” the new tool, including people experiencing homelessness.