A Roadmap for Sharing Data to Enable More Effective Collaboration —
CompTIA’s latest report Homelessness and Opioids: A Roadmap for Sharing Data to Enable More Effective Collaboration, examines how access to better information and harvesting of existing data on homelessness and opioid abuse across multiple systems may help inform and evolve service delivery to those suffering from the growing epidemic. This article is adapted from the white paper.
More than one-half a million people in the United States were reported homeless in 2018 by the U.S. Department of Housing and Urban Development (HUD). For this same time frame, opioid deaths in this country exceeded rates of 115 per day.*
Given the staggering rates for both homelessness and opioid deaths, and the intersection between these 2 populations, it follows that finding effective solutions to address homelessness will have a positive effect on opioid abuse and death rates.
While arguments can be made on either side of the debate as to whether substance abuse is the cause or the effect of these individuals becoming homeless, it is nevertheless a societal challenge that must be addressed.
It is also noteworthy to mention that in 2019, homelessness in the US increased for the second consecutive year. This stresses both our medical and first responder community, as homeless people suffer from the same illnesses as other individuals but at rates 3 to 6 times higher.
Also, on average, people without homes are 3 to 4 times more likely to die, and on average die 30 years sooner.
According to the most recent annual survey by the U.S. Conference of Mayors, the top causes of homelessness are:
• Lack of affordable housing
• Mental illness and the lack of needed services
• Substance abuse and the lack of needed services
While no clear solution to homelessness exists, there are 2 prominent models that have emerged in response to the need for housing for persons with co-occurring substance abuse and unstable housing.
1. The Linear model emphasizes abstinence from substances as an explicit goal. In this model, substance use treatment is an integral first step to obtaining permanent, stable housing.
2. The Housing First model takes the view that the provision of subsidized, and in some cases free housing, should occur first. In this model, case management services are sometimes offered to residents, and it emphasizes a "low threshold" with personal choice about whether to address substance abuse and mental health problems.
We are advocating for widespread data sharing across the various agencies that bear responsibility for providing support and services to those impacted by homelessness and opioid abuse. Because of the sensitive nature of the issue, there are some real and/or perceived constraints on the ability to share information that would provide better insight on the severity of the problem and perhaps suggest which of the 2 models — Linear or Housing First — represents the most effective path towards ameliorating the homelessness issue while influencing the opioid abuse and death rate.
Program administrators and data stewards have a critical role to play in addressing the homelessness and opioid epidemics. While not thought of as front-line workers in these issues, these individuals are uniquely poised to shape strategy to bridge critical data that is currently dispersed across a myriad of agencies. Information that could inform a case worker of the likelihood that their client will suffer from homelessness or opioid use is buried across numerous agencies’ servers, siloed and unharnessed to be used for broader insights.
Homelessness and opioid abuse affect people in a wide variety of individual ways, increasing the complexity of any appropriate response. The inherent difficulty in tackling these intertwined epidemics is due to countless individualized circumstances and unique reasons that lead to an individual becoming homeless or addicted. Data stewards alone often lack the necessary information and governance authority to comprehensively identify challenges, to assess needs, and to apply appropriate services to meet individualized demands most effectively.
Critical information is dispersed among a variety of stakeholders at varying levels across multiple jurisdictions. The ability for stakeholders to cooperatively share siloed data, while applying advanced analytics to this aggregated information, can drastically improve the ability to address needs on an individualized level, shape policy and practice, and allow for targeted interventions which more effectively utilize scarce resources.
Data Sharing Constraints
Privacy concerns are a legitimate consideration that limits the sharing of data around opioids and homelessness. For instance, the legal guidance around the Health Insurance Portability and Accountability Act12 (HIPPA) ensures that entities "protect the privacy of individuals’ health information while allowing covered entities to adopt new technologies to improve the quality and efficiency of patient care."
While HIPAA allows the creation of data aggregation systems, there must simultaneously be an extremely rigorous patient data protection scheme alongside.
Another consideration for this type of information is 42 CFR (Code of Federal Regulations) Part 2 which protects the privacy of substance use disorder (SUD) patient records by prohibiting unauthorized disclosures of patient records except in limited circumstances.* The confidentiality protections of Part 2 are vital for SUD patients to avoid discrimination and negative consequences.
For certain types of sensitive and personal data, consent and disclosure procedures must be considered if they are not already required by law. Regardless of how local groups decide to begin coordinating data for analytics, constituents will still expect reasonable disclosure about how that work is getting done. Implementing proactive user consent for cookie tracking on digital platforms, creating open comment periods for proposed integration work, hiring third party risk assessors, and more, are all ways to ensure constituents stay well-informed. Government must also consider the potential risks for misuse or abuse of data.
Further complicating things in this area is that since many opioids users are homeless or involved in the criminal justice system, consent over the use of the data is even more challenging.
In addition to legal and policy considerations, the technical mechanics of how patient data is siloed within each agency or stakeholder presents significant barriers. Data systems are often not interoperable. There is a lack of standard data collection, accessibility, and integration practices, for various types of data, including electronic medical records, social determinants of health data, behavioral data, and toxicology data. Real-time data collection also presents additional technological and accessibility challenges.
Whatever the reason, siloed data limits the ability of social services to have a holistic view of their patients and clients. With limitations in the availability and completeness of data coupled with the challenges of integrating multiple data sources across multiple stakeholders and jurisdictions, governments are inefficiently directing resources and, in many cases, ineffectively serving its citizens.
Conclusions and Recommendations
The rates of homelessness and opioid abuse in the country are staggering, and the resulting societal impact is enormous. With the incident rate so pervasive, the underlying causes so deep-seated, and effective solutions still quite elusive, continued and enhanced federal funding is undoubtedly a critical ingredient in solving these individual and intertwined public crises.
However, funding for programs to support the homeless or those battling opioid abuse will always face the same challenges as other social programs: there will never be enough.
As such, the critical path forward is not only identifying solutions that support those already impacted, but more importantly, it is identifying effective solutions to prevent homelessness and opioid abuse.
By stemming the tide of those becoming homeless or abusing opioids, this approach will offer the best opportunity to begin to eradicate these conditions. A key element of such a solution is using shared data to not only understand these conditions and contributing factors but how to predict and implement effective intervention to avoid homelessness and/or opioid abuse.
We must find a way to adequately mitigate this epidemic in order to prevent further deterioration within our communities. The impact on our communities is multi-faceted from the impact on child health and welfare to the burden placed on our country’s medical and public first responder services.
The epidemic and intersection of both homelessness and opioid abuse is so incredibly detrimental to the overall well-being of our nation. While advocates, administrators, and policy makers alike are working hard to solve this issue, we implore those involved in seeking solutions to recognize and embrace the use of shared data as a key component to stabilization and prevention.
Sharing data and then analyzing the aggregated information available across the spectrum of involved agencies offers an opportunity to increase the toolkit availability for tackling the drivers for homelessness and opioid abuse, and to improve the detection of the relationship between them. Moreover, this additional insight could lead to identifying additional solutions and or funding that might be leveraged or redirected to more effective, long-lasting outcomes for treatment and stabilization, as well as early prevention and intervention.
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Many thanks to the Human Services Information Technology Advisory Group (HSITAG). The HSITAG Homelessness and Opioid Workgroup members contributed to the effort that produced the white paper "Homelessness and Opioids: A Roadmap for Sharing Data to Enable More Effective Collaboration". HSITAG Homelessness and Opioid Workgroup members include Megan Atchley, Adobe; Galen Bock, CGI; Nicole Geller, Grant Thornton; Paula Hildebrand, IBM Watson Health; Bob Nevins, Oracle; Ruthie Seale, Microsoft; Kim Shaver, Chair, Kim Shaver Consulting; and Rob Tai, Google.
*See the complete white paper, with its references, resources, and notes, at https://comptiacdn.azureedge.net/webcontent/docs/default-source/advocacy-documents/comptia_homelessness-and-opioids_white_paper_web.pdf?sfvrsn=b8dd9e51_2.
The Computing Technology Industry Association (CompTIA) is a leading voice and advocate for the $5 trillion global information technology ecosystem; and the more than 50 million industry and tech professionals who design, implement, manage, and safeguard the technology that powers the world’s economy. Through education, training, certifications, advocacy, philanthropy, and market research, CompTIA is the hub for advancing the tech industry and its workforce. Visit www.comptia.org to learn more.