Service Manager By-Name List 2022 guidelines

Overview

These guidelines provide details on the requirements and standards for service managers to maintain a comprehensive By-Name List of people experiencing homelessness to connect them to the services and supports they need.

In Ontario, service managers plan and deliver housing and homelessness services for their local service area. Service managers are either:

• regional governments
• counties or separated cities
• district social services administration boards, which are boards established in each of the ten districts in Northern Ontario

As part of the new Homelessness Prevention Program, service managers must continue maintaining their By-Name List in accordance with the Province’s requirements, and implement the new requirements outlined in these guidelines. 

Introduction

Ensuring all Ontarians have a place to call home, especially our most vulnerable, is a priority for our government. In March 2021, the Province released the Service Manager Guidelines: By-Name List implementation and homeless enumeration and directed all service managers to implement a By-Name List. A By-Name List is a real-time list of people experiencing homelessness across the service manager area that can connect people to services and supports they need and can create a foundation for better service coordination. The list provides a more standardized approach for assessment and referral protocols to support people experiencing homelessness by matching them to the services and supports they need. All service managers now have a By-Name List in place to understand homelessness, track changes in service needs, and coordinate and prioritize service delivery in their communities. The Ontario Service Manager By-Name List 2022 (BNL 2022) Guidelines introduce new requirements for service managers that build on the previous requirements and supports the goal of addressing and reducing homelessness. The BNL 2022 must be implemented by April 1, 2023.

In March 2022, the government announced the new Homelessness Prevention Program (HPP), which consolidates three Ministry of Municipal Affairs and Housing (MMAH) programs – the Community Homelessness Prevention Initiative (CHPI), Home for Good (HFG), and the Strong Communities Rent Supplement Program (SCRSP).  Having these new programs under a single policy and accountability framework will help to prevent and reduce homelessness, including chronic homelessness.

In December 2021, the Office of the Auditor General of Ontario (OAGO) conducted a Value for Money Audit of Homelessness Programs. The report made a number of recommendations including:

• collecting better data to measure homelessness and track the impact of initiatives and progress in reducing homelessness
• establishing and requiring service managers to report common performance indicators to monitor progress in addressing homelessness and the root causes of homelessness

• requiring service managers to have a consistent, fair, and documented process to prioritize people in need of housing and supports, based on assessed need

The government is introducing new By-Name List requirements that build on the previous requirements and respond to the OAGO Value for Money Audit of Homelessness Programs recommendations. As a condition of HPP funding, service managers must continue maintaining their By-Name List in accordance with provincial requirements and implement the new requirements outlined in this guideline by April 1, 2023.

The BNL 2022 approach includes a more extensive set of data points, and broader coverage and comprehensiveness that will help communities better understand the needs of people experiencing homelessness to effectively prioritize and connect people to services and supports they need. 

Comprehensive and up-to-date information of people experiencing homelessness over the long-term provides valuable insight into factors and root causes that contribute to homelessness in each community and will help track the impact of programs and services.

What’s New: Summary of By-Name List 2022 Requirements

The By-Name List 2022 requirements supersede previous requirements. The summary below highlights key changes that service managers will need to implement by April 1, 2023 as part of HPP. Service managers will also be required to submit an Implementation Plan to MMAH by July 29, 2022 to indicate that they are meeting the BNL 2022 requirements or how they plan to meet them by April 1, 2023.

Scope of the Guidelines

These guidelines detail the new BNL 2022 approach that must be implemented by all service managers by April 1, 2023.

The ministry recognizes that many service managers are already going beyond the previous provincial requirements by collecting monthly updates and real-time data on populations beyond chronic and youth homelessness. The BNL 2022 approach builds on work underway in many communities and provide flexibility for service managers to develop a By-Name List that meets both provincial requirements and local needs.

To ensure communities are on track to meet the requirements by April 1, 2023, service managers must submit an Implementation Plan to MMAH by July 29, 2022. This Implementation Plan should outline how the service manager has achieved or plans to achieve the BNL 2022 requirements.  

As part of HPP, a set of performance indicators related to By-Name Lists have been developed to monitor and track progress on HPP outcomes. Service managers will be required to report to MMAH on performance indicators pertaining to the By-Name List annually in the HPP year-end report. These By-Name List performance indicators are outlined in a separate HPP Performance Indicators Technical reporting guide.

Note: approaches for collecting the information to better understand and respond to homelessness may evolve over time because of research, consultations, and service manager feedback. As such, the ministry may update these guidelines on an as-needed basis and will communicate any updates to service managers.

Implementing BNL 2022 Approach

Objectives

A By-Name List is a real-time list of people experiencing homelessness across the service manager area. Implementing the new BNL 2022 approach will build on the work service managers undertook in 2021 to have an operational By-Name List in place.

The objectives of the BNL 2022 approach are to:

1. Better understand the characteristics of people experiencing homelessness and pathways into and out of homelessness to identify trends and improve service delivery and effectiveness.
2. Connect people experiencing homelessness to services and supports they need
3. Improve access to services and supports, including where possible identifying and addressing barriers experienced by Indigenous communities and populations that are at higher risk of experiencing homelessness (due to discrimination and marginalization)^{footnote 1[1]}.
4. Monitor progress related to HPP outcomes of addressing and reducing homelessness, including chronic homelessness.

Principles

The Province’s approach for BNL 2022 is guided by the following principles:

1. Outcomes-focused:

The BNL 2022 approach is an effective way to help service managers achieve the HPP outcomes of:

• addressing overall homelessness (people who are homeless and chronically homeless obtain and retain housing and support services)
• reducing chronic homelessness (reduction in chronic homelessness)

By collecting real-time and comprehensive data, service managers will have a better understanding of root causes of homelessness to better connect people to services and supports they need to find housing and to remain stably housed.    

For further information on the HPP outcomes and performance indicators, refer to the HPP Program Guidelines and the HPP Performance Indicators Technical reporting guide.

2. People-centred:

People, and their experiences and stories, are vital to developing a By-Name List.  A people-centred approach to By-Name List processes will consider individual needs and promote safety, including culturally appropriate responses and practices. This may include engaging with people with lived experience and population specific organizations to understand barriers that may deter people from consenting to be on a By-Name List.  

Service managers should also use the By-Name List information to assess how services and supports are being accessed by people experiencing homelessness, including whether diverse populations have equitable opportunities to achieve positive outcomes. By-Name List information may be useful in identifying and addressing barriers experienced by Indigenous people and communities or populations that are at higher risk of experiencing homelessness (due to discrimination and marginalization).

3. Partnership and relationship building:

Addressing homelessness requires collaboration and a strong partnership with: 

• all levels of government
• indigenous organizations and communities
• homelessness response providers and people with lived experience
• other service providers (health, corrections, child welfare, social services, and community and developmental services)
• community organizations (for example, Social Planning Councils, Chambers of Commerce and Business Improvement Areas)

Building on the work that took place in 2021 to implement a By-Name List, service managers should continue working with existing partners and build new relationships across sectors to ensure a comprehensive and effective By-Name List.  

4. More responsive systems:

Better understanding the needs and experiences of people experiencing homelessness can help to build a service system that is responsive to the current and changing needs of the people it serves. Information collected through a By-Name List can help to better understand immediate needs for shelter and safety and longer-term housing and support needs of people experiencing homelessness.

5. Balance:

The BNL 2022 approach aims to balance consistency in By-Name List approach provincially with the flexibility to meet local needs.  

The new requirements will support local needs by providing service managers with flexibility in several aspects of implementation to ensure local needs are addressed. For example, service managers have the flexibility to collect various information on the By-Name List based on local needs and prioritize populations beyond provincial priorities for services and supports.

6. Building on success:

The Province recognizes that service managers have made significant strides to implement a By-Name List and work with local community partners to maintain a list that connects people to services and supports. A number of service managers have also gone beyond the previous provincial requirements aligning with key elements of the BNL 2022 approach. Knowing this, the BNL 2022 approach aims to build on the experiences and successes achieved to date to have a robust and comprehensive By-Name List.

Roles and Responsibilities

Defining Homelessness for By-Name Lists

• unsheltered or staying in a makeshift shelter (including an encampment) or a structure not meant for habitation (for example, garage or van)
• staying in an emergency shelter that may include emergency shelters that target specific sub-populations, including women, families, youth or Indigenous persons
• staying in provisional accommodation that is temporary or lacks security of tenure such as with friends/acquaintances or family (for example, hidden homelessness or couch surfing)
• exiting from a provincial institution, including correctional facilities, in-patient healthcare (including mental health and addictions) facilities or accommodations provided under the child welfare system, and immediately into unsheltered, emergency sheltered, or provisional accommodation

Homelessness response providers are referenced throughout these Guidelines and refers to providers whose primary purpose is to serve the homeless population and receives funding for this purpose. This includes emergency shelters and homeless outreach services in receipt of homelessness funding, likeMMAH-funded homelessness response providers, municipally and federally funded homelessness response providers, and non-profits, and charities who primarily serve people experiencing homelessness^{footnote 2[2]}.

By-Name List 2022 Requirements

1. Timelines for implementation

Service managers are expected to implement the BNL 2022 approach by April 1, 2023.

Service managers are required to complete and submit an Implementation Plan to MMAH on or before July 29, 2022 that outlines the plan to work towards achieving the BNL 2022 requirements.

A BNL 2022 is considered implemented when it meets the requirements listed below that include monthly updates for all populations, increased participation, and comprehensiveness, and tracking of key populations and homelessness movements.

2. Adding to and updating the list

Keeping information on the By-Name List up to date can help service managers to quickly match people according to their needs to services and supports that become available. 

Service managers are expected to work with homelessness response providers to keep By-Name List information current and real-time by adding and updating information each month, at a minimum for all people experiencing homelessness. This level of frequency goes beyond the prior requirements to update chronic and youth homelessness information every three months.

Monthly updates should also reflect changes in housing status. People on the By-Name List who find housing, for example, accommodation in market housing, community housing, supportive and transitional housing, should have their status changed to “housed”.

To support this requirement, service managers must also develop and implement a policy/protocol with participating providers for keeping the By-Name List accurate and up to date on a monthly basis.

3. Provider participation

Under the BNL 2022 approach, service managers are to increase homelessness response provider participation on the By-Name List to ensure broad and full coverage across the entire service manager area. Recognizing that people experiencing homelessness tend to come into contact with multiple service systems, cross-sector participation on the By-Name List will provide more opportunities to identify people who may be in need of assistance.

Service managers must aim to have as many homelessness response providers as possible adding to and updating the By-Name List with the intention of having the participation from all homelessness response providers in the service manager area. This will entail going beyond the MMAH-funded homelessness response providers to engage with municipally and federally funded homelessness response providers, non-profits, and charities. 

Other service providers may include mental health and addictions providers, health centres, justice services, and social services who offer services to the homeless population. Connections with other service providers is encouraged by MMAH as this can lead to early interventions and reductions in homelessness.

4. Comprehensiveness

In addition to increasing provider participation, service managers must implement a By-Name List that is comprehensive whereby the majority of people in the service manager area who are experiencing homelessness are included on the By-Name List (following consent).

Under the BNL 2022 approach, service managers must link to key homelessness pathways in order to maintain a list that includes all people experiencing homelessness who provide consent. The following pathways and locations should be included to achieve a comprehensive list:  

• unsheltered
• emergency sheltered
• provisionally accommodated

Refer to Appendix A for definitions for each location.

Please note that, people experiencing homelessness who enter provincial institutions should remain on the list until such time as they are deemed to exceed the inactivity threshold (more than 90 days). Refer to Inactivity Policy for further details.

In particular, homelessness is often less visible and/or spread out over a large geographic area in smaller and more rural communities. The ministry encourages service managers to work with partners and community service agencies such as food banks, drop-in centres and clothing banks, to identify people experiencing homelessness, and to connect them to the By-Name List. Service managers can also leverage existing services or service events (for example, completing housing applications, ID clinics, outreach events to canvass the community for people who are underrepresented on the By-Name List like Indigenous people and youth. 

The By-Name List should also include people who have provided consent to be on the list but have not yet completed a full intake or assessment.  Service managers have the flexibility to determine the minimum amount of information necessary to add someone who has consented to the By-Name List (for example, name and consent) but has not yet completed a full intake or assessment.

5. Unsheltered coverage and outreach

Up-to-date information about where unsheltered people stay and congregate helps to ensure the By-Name List is not missing sub-populations of people experiencing homelessness. Under the BNL 2022 approach, service managers must identify all hotspots for unsheltered homelessness and regularly update this information in order to coordinate services and access to the By-Name List. To help support this requirement, service managers can refer to their 2021 homelessness enumeration where new and existing public spaces for unsheltered homeless were identified.  This may also involve working with local homelessness response providers and stakeholders to identify locations or map out where unsheltered people may be staying.    

Similarly, outreach services for unsheltered people must be identified and regularly updated to ensure adequate coverage of unsheltered hotspots. Coordination of these hotspots and outreach services should be undertaken to improve access and ensure people experiencing homelessness are adequately supported and connected to services and supports they need.

6. Collect consistent information

It is important for service managers to collect consistent information on the By-Name List to house people appropriately, understand local system functions, and track progress in addressing homelessness at the local level. 

Similar to the previous guidelines, service managers should continue using a common set of questions (for example, through a common assessment / intake / screening tool) to collect information from clients. Service managers are responsible for selecting the tool or tools that work best for their communities, based on local needs and priorities. Approaches for collecting information from clients can be adjusted, as appropriate, for specific populations and groups.

Building on the previous requirements of collecting names, contact details, and information related to needs, service managers must also collect the following population and demographic information as part of the BNL 2022 approach, including provincial priority groups highlighted below.

• length of time homeless – ​to determine chronic homelessness (provincial priority)
• age – to determine youth homelessness (provincial priority)
• Indigenous identity (provincial priority)
• people transitioning from provincial institutions, including corrections, health facilities, and child welfare (provincial priority)
• gender identity
• households: singles (person living alone) and families (family group which includes couples and adults with dependent children)

The By-Name List must be able to link people who are part of the same household where there are partners or dependents and sort/filter the list by multiple populations and data elements at one time (for example, age, chronic homelessness and Indigenous identity).

Refer to Appendix A for key definitions.

While the information listed above are required under the BNL 2022 approach, not all data points will need to be reported to MMAH as part of HPP.  For details on reporting requirements under HPP, please refer to the HPP Performance Indicators Technical reporting guide.

Please note: service managers have the flexibility to collect additional information (such as, data elements) on the By-Name List to support local priorities and needs.

The ministry recognizes that service managers may need to adjust their data collection procedures to be able to adhere to the new requirements. In particular, the priority population group for ‘People transitioning from provincial institutions’ may not be currently tracked by some service managers and may result in less reliable data in the first year of HPP (2022/23).

7. Tracking movement and progress

The BNL 2022 approach must also track the movement of people on the By-Name List to monitor the progress towards the goals of addressing and reducing homelessness. Movement of homelessness includes tracking, on a monthly basis (at a minimum), the number of people actively homeless, inflows, and outflows, and length of time on the By-Name List.

Image

Inflows into homelessness

• Number of new people added to the By-Name List.
• Number of people returned to homelessness on By-Name List from housing.
• Number of people returned to homelessness on By-Name List from inactive status.

Actively Homeless

• Number of people on the By-Name List whose status is active.
• Number of households overall on the By-Name List whose status is active.

Outflows from homelessness

• Number of people on the By-Name List moved to housing (for example, market housing, community housing, supportive housing, transitional housing, or other long-term housing assistance such as rent supplements or housing allowances).
• Number of households overall on the By-Name List moved to housing (for example, market housing, community housing, supportive housing, transitional housing, or other long-term housing assistance such as rent supplements or housing allowances).
• Number of people on By-Name List turned to inactive status.

Time on By-Name List

Time on the By-Name List must also be tracked on the By-Name List. The following movement of people should be time stamped:

• date first added
• date moved to outflow (move-in to housing or moved to inactive)
• date reactivated on the list from housing or from inactive status

Receiving Long-Term Housing Assistance under HPP

Service managers must also track the number of households on the By-Name List who have obtained housing assistance for long-term housing (rent supplements or housing allowances), or Supportive Housing provided by HPP. This data is to be reported to MMAH annually through the HPP year-end report.

While the information listed above are required under the BNL 2022 approach, not all data points will need to be reported to MMAH as part of HPP. For details on reporting requirements under HPP, please refer to the HPP Performance Indicators Technical reporting guide.

8. Inactivity policy

Circumstances and needs can change over time, affecting an individual’s status on the By-Name List. 

Those who are not housed and are not active in the system for longer than 90 days should be changed to inactive status on the By-Name List. Reasons for inactive status could include:

• left community
• deceased,
• lost contact
• staying at institutions like hospitals or correctional facilities (longer than 90 days)

Service managers should maintain an inactive policy that includes a standard of 90 days maximum without contact before changing someone's active status to inactive. The policy should also include processes to be taken before moving people to inactive status (for example, after 60 days without contact, flagging a person on the list and taking steps to try to find them) and protocols to change status from active to inactive.  Similarly, there should be processes in place when a person who was turned to inactive reappears in the homelessness system and can be turned to active status on the By-Name List.

9. One consolidated list

Consistent with previous By-Name List requirements, service managers should be adding people experiencing homelessness onto one consolidated list. Service managers should also strive to have a de-duplicated list (that is, people are not listed more than once) to ensure better coordination and prioritization of services and supports.

10. Consent

Consistent with the previous By-Name List requirements, informed consent is needed to add someone to the By-Name List. Informed consent will allow service managers to share information with identified service providers to support access to services and supports. Consent must be documented, which could include recording the date consent was attained and by whom in the By-Name List database.

The ministry encourages service managers to continue working with homelessness response providers, including emergency shelters, outreach services, and youth services, Indigenous communities, and people with lived experience to develop strategies to build trust and remove barriers that may deter people experiencing homelessness from consenting to be on the By-Name List. This will also help service managers maintain a comprehensive list that aims to include everyone experiencing homelessness in a community.

11. Privacy is protected 

Consistent with the previous requirements, the ministry expects service managers to continue maintaining policies and procedures to protect privacy and confidentiality of information contained in the By-Name List.  

Protecting privacy includes maintaining protocols and practices to limit access to information and ensuring that information is stored on devices that have appropriate security protections.

By-Name List 2022 Standards

The ministry has identified three standards to help service managers maintain a By-Name List, meet the new requirements, and achieve HPP outcomes.

1. Consistency and analysis

Circumstances and needs can change over time. By-Name List information should be collected and updated in a consistent manner to effectively match people with the right services and supports, based on assessed need, as they become available. Policies and procedures should be maintained to ensure providers and staff are following the process consistently. 

By-Name List data should be regularly analyzed and reviewed to ensure there are no errors or gaps in the information and to better understand root causes of homelessness to inform prioritization and improved service delivery.

2. Cross-sector collaboration

People who lose their housing may find a variety of temporary housing solutions and come into contact with a number of service systems in health, justice, social services, community and developmental services, and services that support victims of domestic violence, before they use services for people experiencing homelessness. Service managers should continue leveraging cross-sector collaborations and tables (situation tables or case conferencing) to help maintain a list that is comprehensive and supports a more coordinated service system, especially for people with complex needs. 

Some populations face barriers to accessing supports and services that address their unique needs. Service managers are encouraged to work with organizations and sectors serving marginalized communities to ensure populations that are at higher risk of experiencing homelessness are appropriately reflected on the By-Name List and have equal access to services and supports to achieve positive outcomes.

In maintaining the By-Name List, it is also important for service managers to engage and collaborate with Indigenous organizations and communities – including First Nations, Métis, and Inuit organizations and communities to ensure approaches to add and update information are culturally appropriate. This may include establishing Indigenous data governance principles or a data sovereignty agreement with Indigenous partners to clarify how Indigenous data will be collected, analyzed, and shared.

Insufficient discharge planning from provincial institutions like corrections, health and child welfare can result in people becoming homeless. Collaboration with the justice, healthcare, and child welfare sectors to support transitions and reintegration into the community can lead to positive outcomes and reduction in homelessness. 

3. Clear prioritization criteria and processes

Service managers should have formalized and documented criteria and procedures for making decisions about who should be prioritized for housing / services first when a dedicated housing or support resource becomes available. Criteria and processes for prioritizing offers for services and supports will vary by service manager based on local needs; however, prioritization and matching processes from the By-Name List should be clear, transparent and consistently applied.

By-Name List 2022 Performance Indicators and Reporting

A set of performance indicators related to By-Name Lists have been developed to monitor and track progress on achieving HPP outcomes. Service managers will be required to report to MMAH on By-Name List performance indicators annually in the HPP year-end report. These performance indicators are outlined in a separate HPP Performance Indicators Technical reporting guide.  As well, service managers will also be required to report to MMAH on compliance in meeting the new By-Name List 2022 requirements through the HPP year-end report.

HPP Funding for By-Name Lists

Under HPP, By-Name List costs are eligible expenses under the Community Outreach and Support Services category. Eligible costs include engaging clients from the By-Name List through assessments, monthly updates, case management, referrals, and activities related to maintaining a By-Name List (for example, staffing, data management, and training).

Service managers that receive funding from other sources for By-Name List implementation and associated activities are required to allocate those funds first before using their HPP funding. Refer to the HPP Program Guidelines for further details on eligible expenses related to By-Name Lists.

Supports from Canadian Alliance to End Homelessness

The ministry is continuing to partner with Canadian Alliance to End Homelessness (CAEH) in 2022 to 2023 to support service managers to implement the BNL 2022 requirements by April 1, 2023.

Services and supports from CAEH will include:

• delivering training and workshops
• offering comprehensive coaching
• providing online tools and resources

The ministry encourages service managers to take advantage of the supports, coaching, and training provided by CAEH. As part of these services and supports, CAEH can provide valuable feedback to service managers by reviewing aggregate (anonymized) data from the By-Name List to help track progress and ensure the list is accurate.

Service manager participation in services and supports provided by CAEH as well as sharing data with CAEH is voluntary.

By-Name List Resources

Ontario By-Name List Best Practice Guide (contact the ministry to obtain a copy)

The information and resources on the sites below may answer questions and support communities to develop and maintain a By-Name List:

• CAEH guide to By-Names List
• Homelessness Hub
• Homelessness Learning Hub

Appendix A: Key Definitions

Appendix B: MMAH Staff Contacts

For questions and inquiries regarding the BNL 2022 Guidelines, please contact Vicky Rajput (Vicky.Rajput@ontario.ca) and Kirti Gandhi (Kirti.Gandhi@ontario.ca). You may also contact your respective MMAH Municipal Services Office (MSO) regional contacts, or Housing Programs Branch staff contact for further information as noted below