Tucson’s homelessness outreach workers spent a decade using a national questionnaire to decide who gets housing resources. This summer they’re using a homegrown one instead that is centered around a new question: who is most likely to die outside?
That shift to identifying people most at risk of losing their lives while living outside, and prioritizing them for scarce housing resources, is the latest example of the ways that local providers are shifting a broad range of services to address the stakes of extreme heat.
“One of the main issues that we saw in the community is that people were literally dying on the streets while experiencing homelessness and that’s something we really, really wanted to address,” Zach Simmons, a resource navigator at the University of Arizona’s Southwest Institute for Research on Women, told Arizona Luminaria when interviewed for the project in 2025.
The survey was created by the Tucson Pima Collaboration to End Homelessness in collaboration with local nonprofits like Primavera that work extensively in the homelessness support space, and launched midway through last summer, making this year the first time it will be used through the entire hot season.
It replaces the VI-SPDAT questionnaire, a widely used framework developed over a decade ago and used in localities across the country to help governments understand need when deciding who gets access to scarce housing resources. In recent years, it’s increasingly been criticized for the ways in which the framing of some questions exacerbates racial inequalities in access to housing.
“It’s really hard when someone is in crisis and trying to figure out what their next step is to ask them questions that you would see in the VI-SPDAT which are deeply personal,” the National Alliance to End Homelessness’ Chief Equity Officer Mary Frances Kenion told Arizona Luminaria.
The VI-SPDAT, for example, contained questions such as: “Do you ever do things that may be considered to be risky like exchange sex for money, run drugs for someone, have unprotected sex with someone you don’t know, share a needle, or anything like that?”
Tucson’s new survey asks about exchanging resources for sex, but phrases it in a way that focuses less on a person making risky choices and instead on whether there has been pressure leading to that dynamic. The question asks: “While experiencing homelessness has anyone stalked, Cyber-stalked or threatened you or anyone else in your household with violence OR pressured you to exchange sexual acts for money, drugs, food, a place to stay, clothing or protection?”
Still, says Kenion, the reality remains that with the speed of people becoming homeless, there are not enough resources to give everyone permanent housing, which is why some sort of tool to prioritize services is needed.
“We know that [on average] 17,500 people per week throughout the United States are becoming homeless for the first time,” Kenion said. “Our systems — or resources — were never designed to meet that level of demand.”
Deadly heat
In Tucson, extreme heat meets housing insecurity to create a potentially deadly combination.
In 2024, Tucson had 112 days of 100 degree-plus heat, more than any year on record so far, according to the National Weather Service. In 2025, Tucson hit 100 degrees April 11, more than a week earlier than the previous record of April 19 in 1895. That record was broken in 2026, when Tucson had its first 100-degree day in March.
Of the deaths investigated by the Pima County medical examiner’s office in 2024, 195 — or 10% — were people experiencing homelessness.
That rate was similar in 2025: of the 2,103 deaths investigated by the Pima County medical examiner’s office, 201 or 10% were experiencing homelessness when they died.
The data collected by the medical examiner’s office was key to developing Tucson’s new questionnaire, said Simmons of the Southwest Institute. “We were able to determine the leading causes of death,” he said.
From there, they work to identify people most vulnerable to dying and prioritize getting them into services.
Being unsheltered exposes an individual to 200-300 times the risk of heat-related death, according to a University of Arizona study of the surge in Pima County and Maricopa heat deaths over the past two decades.
For people who already have risk factors, like the use of drugs like methamphetamine or heart disease, exposure to the increase in urban temperatures as well as being unsheltered are key factors in the chances of death.
Whether a person can get to a cooler place can be key to survival, said Slade Smith, one of the researchers on the project and now an attorney in private practice. “You simply have to have places for people who are now outside to be inside and air conditioned,” he said.
That gets more complicated when a person is suffering from serious addiction or serious mental illness, he said.
A Tucson-specific survey
To test the survey, community assessors spoke to the lived experience counsel at the Tucson Pima Collaboration to End Homelessness. They also ran a pilot with 10 assessors who interviewed over 270 people between Nov. 2023 and May 2024. Compared to the VI-SPDAT, the results better prioritized the target group they believed were most vulnerable to dying outside.
The survey includes a small number of tiebreakers that might make one person eligible for housing above another, said Simmons, such as how likely they are to have experienced domestic violence and other historical factors that have been shown to increase vulnerability.
“The beautiful thing about having a survey developed in-house is if it doesn’t work how it’s intended, we’re able to change it. We know how all the levers work. We know what is and isn’t working in our community,” Simmons said.
Still, Tucson must use federal definitions in its new survey as a significant part of the city’s homeless response was traditionally federally funded, even as a part of that funding is now at risk. (Since President Donald Trump took office, he has promised to cut homeless housing programs and has tried to shift money away from permanent housing, a move Tucson is challenging in court).
The questionnaire adds people who are unhoused to a list called the “By Name List” — a database that stores answers from the survey. The people on that list are then prioritized for housing access based on their vulnerabilities.
The new questionnaire, like the old one, is working with scarce housing resources.
“The changing of the coordinated entry assessment tool isn’t going to all of a sudden create more housing or create more availability,” Simmons said. “It is like a zero sum game.”
And if someone does make their way to a priority position for housing, they could lose that spot if they are unable to be contacted or found by an outreach worker on three separate occasions using three separate outreach methods when the spot opens up.
That spot is then given to another person on the batch list, and they must re-do the questionnaire to be considered for future openings.
It’s imperfect, Simmons admits, but with the new list he hopes to keep more people alive while they work their way through the housing system. “The main goal of developing it was trying to prevent and limit mortality while experiencing homelessness.”
Read a version of the survey shared in 2025 here:
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