This is a follow-up to our previous blog post: Who's on our BNL? If you haven’t read it, it’s probably a good place to start.
Some communities are still struggling with the idea of the By-Name List, or BNL for short. Is it even useful anymore? Do you really need to keep a list? If you’re using HIFIS, how do those concepts relate to each other? Is the idea of the BNL now outdated?
To answer these questions and more, we need a history lesson. Buckle up!
The Dark Ages
In the not-to-distant past (we’re talking about, like, early 2010s here, so like 15 years ago?) the common practice was for each service provider in the homelessness sector to go it alone. Shelters would often get funding directly from the provincial or federal government, and it was typically a heads-in-beds payment model. That is, you had 25 beds full on Tuesday, you’d receive funding for 25 beds. Housing First didn’t really exist yet, and supportive housing - where it existed - was either operated by an organization that also had a shelter, and was therefore available to people staying in that shelter, or was part of the health sector and available through the healthcare system. Affordable housing was generally accessed via a chronological waiting list. And no one had ever heard of a By-Name List.
In terms of data, a lot of service providers were doing things the old-fashioned way: paper case files. Some shelters were using HIFIS 3, but each shelter would have their own instance, they didn’t talk to each other, and it was pretty much only used to track shelter occupancy.
Holy moly, now that I’m writing this all out, that sounds terrible. I can’t believe it was so recent. Did you know that Ontario, for example, did away with the heads-in-beds funding model for shelters in 2013? That’s only 13 years ago!
The Middle Ages
Of course, I’m not the only one to say that that old system sounded not great. Slowly, we started to see pioneers doing things differently. Here are some milestones on the road to change:
The Government of Alberta required each of their 7 cities to implement coordinated homelessness plans as early as 2007
The At Home/Chez Soi project began in 2009
The Canadian Alliance to End Homelessness (CAEH) was founded in 2012
The Government of Ontario required communities to develop municipal plans to address homelessness from 2013
Community Solutions launched the 100,000 Homes Campaign in 2014
The federal government started to fund Housing First programs in 2014 under the Homelessness Partnering Strategy (HPS)
The first communities started using HIFIS 4 in 2015, allowing data sharing for the first time
The CAEH launched the 20,000 Homes Campaign in 2015
During this period, there was a growing movement away from silos and laissez-faire, and towards the realization that people fall through the cracks. That’s it. That’s the big learning. If you haven’t read Malcolm Gladwell’s 2006 “Million-Dollar Murray,” (a) you should, do it right now, I’ll wait, and (b) the key takeaway is that letting people fall through the cracks is more expensive than doing something about it.
People started to figure out that in order to prevent people from falling through the cracks, you had to know who they were, and so terms like the “By-Name List” and “Registry Week” were born.
In the absence of a common database, communities turned to the tools they had available, which in many cases was Microsoft Excel. Somone working for the municipality (usually) would maintain an Excel spreadsheet with a list of clients on it. This would require processes to be developed related to adding people to the BNL and ensuring that the BNL is up-to-date, including policies for removing people after a period of no contact.
Just keeping a list of people isn’t enough to solve the problem, so once you have a list, you need to figure out what to do with it. In this era, you started to see communities implementing systems in which access to housing resources (including things like supportive housing and rent supplements) was coordinated - the team of service providers would decide to offer an apartment to whoever was the highest priority, not just who had the best caseworker to advocate for them or who was willing to jump through the most hoops. You started to see the adoption of things like common assessment tools, scoring criteria, and prioritization frameworks.
Some communities embraced this approach and figured out how to do it really well. Among these were members of the 20,000 Homes Campaign, which later became Built for Zero Canada. Best practices started to emerge, and the CAEH worked with communities across Canada to adopt them.
A Turning Point
Although best practices were clearly established by 2019, for many communities across Canada, participation was optional (one exception was Alberta, which had been doing coordinated access for over a decade). This changed with the launch of the federal Reaching Home program in 2019, requiring all (designated) Canadian communities to implement coordinated access. A few years later, these same communities were also now required to use HIFIS or an equivalent HMIS system that also supported coordinated access.
Although it took time to get everyone implementing coordinated access and implementing HIFIS, it’s fair to say that most of Canada is now well past the point of figuring out what a BNL is and implementing it. There are some outliers, sure, but for the most part, communities in HIFIS have had BNLs and coordinated access and HIFIS for 5+ years at this point.
So What Comes Next?
Finally, we can return to our original question that we started looking at today.
Let’s imagine you’re explaining the current lay of the land to a new hire:
“So everybody that we fund is required to use this common database where all the clients are shared and we can look up in real-time the last time anyone had contact with them, what their needs are, their contact information, where they’ve been staying this week, and who their caseworker is.”
“Right, got it.”
“And we are also required to maintain a By-Name List that has real-time data including the last time anyone had contact with them, what their needs are, their contact information, where they’ve been staying this week, and who their caseworker is.”
“Sounds like you’ve got that covered, then?”
“No, see, with the By-Name List we need to track how many people are on the list, and how many people get added to it every month, and how many people are getting removed from it every month, and we need to make sure that the math works out that the total number of people on the list at the end of the month is the same as the previous month minus the outflow plus the inflow.”
“Couldn’t you, you know, pull that information from this common database that everyone is required to use?”
“Well yeah, but we’re required to keep a By-Name List, that’s totally different from a database. We have to record things like the date they were added to the BNL, make sure it doesn’t contain duplicates, and implement an inactivity policy, among other things. HIFIS has a date the client file was created, a date they were first recorded as homeless, a date they signed consent, and a date they completed an assessment, but there isn’t a field specifically called ‘date added to BNL’. There could be duplicates in HIFIS! And even though clients automatically go inactive after it’s been 90 days without services, we can’t flag people who will go inactive soon unless we run a report that does exactly that, and we can’t manually mark people as inactive according to our policy. A BNL is totally different from a database.”
“Okay, so what do you do?”
“That’s the problem, we are stumped. Got any ideas?”
The whole principle behind creating By-Name Lists was to have client-level data about each person experiencing homelessness to ensure that people didn’t fall through the cracks, and HIFIS (or an equivalent HMIS) accomplishes this goal way better than any spreadsheet ever could. A real-time database in which all shelter staff, case managers, residential support workers, outreach teams, and drop-in centre staff are recording their day-to-day activities is not just way more useful than keeping a spreadsheet, it’s also way more efficient. No need for front line staff and coordinated access leads to email back and forth asking for updates. The principle should be, instead: keep HIFIS up-to-date and accurate, and then query your database to answer any question you need.
So, do we even need a By-Name List anymore? I’m not saying that we don’t need to know clients by name. I’m not saying we don’t need to assess our clients using a common assessment tool. I’m not saying we don’t need to prioritize our top clients.
But.
Recently, I’ve heard a few communities get bogged down by being told they have to “implement HIFIS” and also “maintain a BNL” as if they were two separate things. It’s confusing! For example:
The Reaching Home program does not require communities to have a “BNL”, but they are required to implement HIFIS and also “use their HIFIS/HMIS to generate data for their Unique Identifier List in order to meet Coordinated Access requirements, and to generate data for outcome reporting in order to meet the Outcomes-Based Approach requirements.”
The Government of Ontario currently requires its 47 service managers to implement a By-Name List and have things like policies “for keeping the By-Name List accurate and up to date on a monthly basis.”
If you fit into both categories - a Reaching Home funded community in Ontario - you have to do both. And it sounds like those are different requirements (“Unique Identifier List” versus “By-Name List”). Some communities currently have policies about “adding someone to the BNL” even though they’re using HIFIS community-wide (like “A client is added to the BNL after they’ve been homeless for at least 14 days and completed a VI-SPDAT assessment. Email the Coordinated Access Lead with a copy of their VI-SPDAT and identity documents to add them.”). So what’s the difference between adding a client to HIFIS and adding them to the BNL? Is there some magical step that needs to be taken, once a client is in HIFIS, to signal that they’ve been added to the BNL? And if so, why? What’s the value in having that extra step?
As discussed in our previous blog post, having a database gives you flexibility to apply a variety of filters to answer different questions. The question of: “how many clients are homeless that we know about?” is different from “how many clients have consented to data sharing?” which is again different from “how many clients have we assisted in the last three months?” and again different from “who should we offer this apartment to?”
Instead of thinking about your client in a binary sense: are they on the BNL or not on the BNL, it’s way more beneficial to go back to the original principle: just keep real-time, client-level data about everyone experiencing homelessness.
What if we took the original policy — “A client is added to the BNL after they’ve been homeless for at least 14 days and completed a VI-SPDAT assessment. Email the Coordinated Access Lead with a copy of their VI-SPDAT and identity documents to add them.” — and translated that into HIFIS language? We could say something like “Record a client’s history of homelessness and VI-SPDAT assessment in HIFIS and upload identity documents by the time they’ve been homeless for at least 14 days.” And then we could have a report that pulls a list of clients that have been homeless at least 14 days, have a VI-SPDAT assessment and identity documents in HIFIS. We could even flag the clients that have recently met all these conditions by highlighting them or something similar, so Coordinated Access Leads can easily know which clients are new.
With that in mind, I think it’s time to stop talking about By-Name Lists at all. HIFIS contains your BNL and also so much more. HIFIS isn’t a BNL, it’s a BNL+.
The Canadian Alliance to End Homelessness has recently shifted their language to talk about By-Name Data (BND) instead of By-Name Lists, and that’s a change I wholeheartedly support.
Instead of creating and maintaining a BNL (as you’re specifically directed to by funders), here’s what you should be focusing on instead:
Onboarding all of your service providers to HIFIS and getting to 100% coverage for your service area
Improving your data quality to the point that your data in HIFIS is reliable — you can believe it if it tells you you have 17 chronically homeless veterans
Obtaining the reports you need to answer all your coordinated access questions — prioritization lists, inflow/outflow reports, consent and activity audits, missing fields reports
If you focus on those three things, you will have a BNL and be meeting all the funding requirements that are out there, even though you’re not technically creating something that you’re calling a BNL.
So join me in saying farewell to BNLs! You served us well for a time, but your era has passed, like the pager and the floppy disk and the telegram. Thank you for your service!
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