Transcript Part 11 CoC Plan

Coalition on Homelessness and
Housing in Ohio
COHHIO
Rural Convening:
Systems Change
Sponsored by:
COHHIO
Rural Convening
Purpose & Outline

To provide homeless assistance
providers in rural Ohio with strategies
for changing homeless systems:
– What is “systems change” and why should we
consider it?
– Program approaches that support systems
change
– Client targeting and assessment
– HUD’s policy initiatives



HMIS
HPRP
Hearth Act
– Measuring systems change
Systems Change… what is it?
Coordinate and manage homeless
services and system resources to help
people resolve their housing crisis
and remain stably housed.
Re-orients homeless planning efforts
Housing stability-oriented approach
Change the way communities solve
homelessness
Systems Change… how to?



Services integration + systems integration must be
pursued simultaneously
Commitment to change without adequate resources
is not enough
3 strategies are key:
– Designate a leader
– Get key decision-makers to the table
– Use formal strategic planning process


Incremental change is how most systems evolve
Seek advice from others
Why consider “systems change”?
Current Approach:
 Multiple entry points
 Multiple assessments
 Service referral
 One-stop shop


Shelter-based
Homeless-specific
inventory
Systems Change Approach:
 Centralized intake
 Coordinated assessment
 Service linkage
 Specialized programs and
services
 Prevention-based
 Flexible, responsive
housing
Goals for Systems Change:






Reduce the length of stay in shelter or in
homelessness
Reduce the number of people experiencing
homelessness for the first time
Increase the number of people who are diverted
from shelter to stable housing
Reduce repeat episodes of homelessness
Reduce the number of people overall who are
homeless.
Others?
What are the major barriers or
challenges?





Resources/funding
Lack of safe, decent, affordable
housing
Distribution of programs and services
across a broad geographic area
Rural issues aren’t addressed by
today’s program models
Others?...
Future system vision…





Planning
Program Models
Infrastructure
Management & Coordination
Technology
What are your goals?
Program Approaches that
Support Systems Change





Centralized intake (virtual)
Coordinated assessment
Service linkage
Homeless Prevention
Rapid Re-housing, Transition-in-Place
Targeting & Assessment

Who gets homeless assistance?
– “But for this assistance…”

Who serves them?
– Homeless systems vs. mainstream services
– First point of contact vs. coordinated referral and
service linkage

How do they get served?
– Holistic approach vs. housing-first model
Break?
HUD’s Policy Implications for
Systems Change



HMIS
HPRP
Hearth Act
HUD Policy Implications:
HMIS

What is HMIS?
–
a locally administered, electronic
data collection system that
stores person-level information
about clients who access the
homeless service system.
Why is HMIS Important?



Each Continuum of Care (CoC)
must implement an HMIS; HUD
assesses and scores progress in
CoC application
Local HMIS data is critical for the
Annual Homeless Assessment
Report (AHAR)
Implementation of HMIS at the
local level can support coordinated
Why is HMIS Important?
(cont’d)

HMIS enables:
–
–
–
–
–
Collecting common set of data elements
Identifying who is literally homeless or at
risk of homelessness
Tracking homeless assistance provided
Reporting client progress and program
performance
Monitoring on-going data quality
HMIS Video
Every Story Makes a Difference
http://www.hmis.info/Resources/300/Every-Story-Makes-a-Difference-Video.aspx
What are the HMIS Data and
Technical Standards?

Federal Register Notice that defines
baseline requirements for:
–
Data collection (data elements and response
categories)


–
–

Universal data elements (required for all programs)
Program-specific data elements (required for
programs required to generate annual reports )
Privacy
Security
Under Revision to include HPRP data
elements
HMIS Data Standards Terminology

Continuum of Care (CoC) Lead

CoC Program
–
Homeless Assistance Program
–
Homelessness Prevention Program

Contributory HMIS Organization (CHO)

Contributory CoC Program

Non-Contributory CoC Program
HMIS Data StandardsTerminology (cont’d)

Unduplicated Accounting of Homelessness
– Note- for HPRP reporting, unduplicated
accounting is only required at the subgrantee
level

HMIS Lead Agency (HMIS Lead)

Annual Performance Report (APR)
HMIS System Level Graphic
CoC
NonContributory CoC
Program
PPI
HMIS
Lead Agency
Contributory
CoC Program
Contributory
Agency
Unduplicated
Accounting
Contributory
Non-CoC
Program
21
Components of the HMIS
Data Standards

Three components:
– Program Descriptor Data Elements

New for 2009 Draft Notice
– Universal Data Elements

Revised for HPRP
– Program-Specific Data Elements

Revised for HPRP
Program Descriptors
The Program Descriptor Data Elements are:
2.1
2.2
2.3
2.4
2.5
2.6
2.7
Organization Identifier
Organization Name
Program Identifier
Program Name
Direct Service Code
Site Information
Continuum of Care Number
Program Descriptors (cont’d)
2.8 Program Type Code
2.9 Bed and Unit Inventory Information
2.10 Target Population A
2.11 Target Population B
2.12 Method for Tracking Residential Program
Occupancy
2.13 Grantee Identifier**
** = NEW Element
Universal Data Elements
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9
Name
Social Security Number
Date of Birth
Race
Ethnicity
Gender
Veteran Status
Disabling Condition
Residence Prior to Program Entry
Universal Data Elements
(Cont’d)
3.10
3.11
3.12
3.13
3.14
3.15
Zip Code of Last Permanent Address
Housing Status**
Program Entry Date
Program Exit Date
Personal Identification Number
Household Identification Number
** = NEW Element
Program-Specific Data
Elements
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
Income and Sources
Non-Cash Benefits
Physical Disability
Developmental Disability
Chronic Health Condition
HIV/AIDS
Mental Health
Substance Abuse
Program-Specific Data
Elements (cont’d)
4.9 Domestic Violence
4.10 Destination
4.11 Date of Contact
4.12 Date of Engagement
4.13 Financial Assistance Provided**
4.14 Housing Relocation & Stabilization Services
Provided**
4.15 Client Outcome Measures
** = NEW Element
HUD Policy Initiative:
Homeless Prevention & Rapid
Re-housing (HPRP)
Program Intent
 Focus of HPRP is housing stabilization


Provides temporary financial
assistance and/or services to help
persons gain housing stability
Temporary assistance as a bridge to
long-term stability
Program Intent

Intent is to serve persons who:
– Are homeless or would be homeless but
for this assistance
– Can remain stably housed after this
temporary assistance ends
HPRP is NOT….

A mortgage assistance program
Intended to serve persons who need
long-term and/or intensive supports

ESG Program

–
Different eligibility requirements & activities
Rapid Re-housing (RRH) Demonstration

–
Different requirements and activities
State of Ohio’s HPRP RFP
Process



State funds ($26+ million) allocated to
“Service Areas”, with 70% directed to nonentitlement areas
Subgrantees can be single counties or multicounty collaborations
Applications due 7/14 with grant execution
expected by 9/1
HPRP Requirements



HPRP funds must be issued to a third
party (e.g., landlord or utility company),
NOT directly to program participants
An assisted property may not be owned
by the grantee, subgrantee or the parent,
subsidiary or affiliated organization of the
subgrantee
Funds used for ineligible activities be
repaid to HUD
Timeline

July 2: HUD completes review
– Once grant agreements are signed by HUD – this
starts the clock for expenditure deadlines


Sept 30: Grant Agreements with sub-grantees must
be signed
Two years from date HUD signed grant agreement:
– 60% funds drawfunds must be issued to a third
party (e.g., landlord or utility company), NOT
directly to program participants

Three years: 100% drawn
Eligible Participants

Program participants must be homeless or
about to become homeless AND:
– Initial consultation to determine appropriate
assistance
– Income of 50% or less Area Median Income
(AMI): see www.huduser.org/DATASETS/il.html
– No other housing options
– No financial resources or support networks to
obtain or remain in housing
Eligible Activities –
Four Categories

Financial Assistance
– Short and medium term rental assistance,
security/utility deposits, utility payments,
moving assistance, motel/hotel vouchers

Housing Relocation & Stabilization Serv.
– Outreach/engagement, case management,
legal services, housing search, credit repair
Eligible Activities –
Four Categories

Data Collection and Evaluation
– Costs related to data collection on HPRP
clients in HMIS or comparable database, as
appropriate
– Costs associated with participating in HUD’s
evaluation of HPRP

Administrative costs
– Costs related to accounting of funds, audit,
preparation of HUD reports, grant
administration, staff training on HPRP
Unprecedented Opportunity

Level of Funding

Missing Link

Transformative Change

Systemic Change
Level of Funding



HPRP equals HUD’s entire annual
homeless assistance budget
Infusion of targeted and essential
resources
Provides new opportunities to
Continuums of Care (CoCs)
Missing Link:
NEW CoC Interventions
Outreach, Intake,
Assessment
Emergency
Shelter
Transitional
Housing
Support
Services
Permanent
Supportive
Housing
Rapid
Re-housing
Prevention
Transformative Change

Re-orients homeless planning efforts

Housing stability-oriented approach

Change the way communities solve
homelessness
Systemic Change
Prevention &
Homeless
Service System
Housing
Stability
Mainstream
Services
Innovation



Encourage grantees to think outside
the box in program implementation
Adopt key components of best practice
models with jurisdictional variation
Maximize use of other ARRA funds and
existing mainstream resources
Key Prevention Provisions


Form partnerships
Prioritize people most likely to become
homeless
– Analyze HMIS/other data for predictors

Continuous performance improvement
– Reviewing shelter admission data to see who
was served but still became homeless and
who was not served and became homeless
Coordination of HPRP and Other
Efforts



HPRP is a one-time influx of funds to
implement and learn from innovative
approaches
HPRP funds must be administered in
coordination with the Continuum and other
local efforts
Grantees are required to coordinate HPRP
funds with other ARRA funds in the
community
Thinking Ahead – What are you
trying to achieve with HPRP?

Outcomes of HPRP can include:
– Reducing the length of stay in shelter or in
homelessness;
– Reducing the number of people experiencing
homelessness for the first time;
– Increasing the number of people who are
diverted from shelter to stable housing;
– Reducing repeat episodes of homelessness;
– Reducing the number of people overall who are
homeless.
Resources

Available at www.HUDHRE.info
– Notice and programmatic guidance
– Virtual help desk, Q & A document, searchable
FAQ database
– Sample community documents
– Program guidance documents, tools, and
templates (under development)
– Webcast materials
– Regional Training materials
HUD Policy Initiative:
HEARTH Act


On May 20, 2009 Obama signed into
law the Hearth Act – reauthorizes
McKiney-Vento homeless assistance
programs and significantly changes
the CoC process and structure
Is this an opportunity or a threat?
HEARTH Changes to the CoC





Homeless Prevention significantly expanded
More emphasis on rapid re-housing, especially for
families
Chronic definition expanded to include families
Match requirement = 25%, applied community
wide not project by project
Rural communities have the option of applying
under a different set of guidelines that offer more
flexibility and more assistance with capacity
building
ESG =
Emergency Services Grant




Eligible activities include traditional shelter,
outreach, rent assistance, housing
relocation assistance, mediation, housing
stabilization services
Can serve homeless and those “at risk”
ESG funding increases by 20%
40% of ESG funds must be used for
prevention and re-housing
Definition of “Homeless”

Current definition expanded to include:
– Persons at imminent risk of homelessness
– Doubled-up who must leave within 14 days
– Includes Dept of Ed. Definition



Persons who have lived a long period without
independent or stable (permanent) housing
Persons who have moved frequently
Persons experiencing housing instability as a result of a
disability, history of abuse or violence, multiple barriers
to employment
New Program Type



SHP, S+C, SRO consolidated into a
single “CoC Program”
Same eligible activities as all of the
programs combined
Prevention and Re-housing explicitly
added as a new eligible activities
(modeled after HPRP)
Rural Programs under HEARTH



Continuums that are entirely rural can
apply under a simplified set of criteria
Rural applicants are scored only in
comparison to other rural applicants
Up to 20% of CoC funding can be
used for “capacity building”
Break?
Measuring Systems Change
System Performance Cycle
Activities
Job Training Classes
Interview Assistance
Job Placement
Services
Outputs
Inputs
6 enrolled in
weekly services
6 employment
assessments
Referred to av. 4
jobs each
Money: $250,000
Staff: 4 FTEs
1 Facility
Outcomes
67% achieved empl.
50% improved empl.
3 System Performance
Measurement Methods
1.
Measure Outcomes by Applying
Program Measures System-wide
2.
Use Program Performance Results to
Change or Manage the System
3.
Measure System Results with HMISBased Impact Outcomes
1st System Performance
Measurement Method…
Measure Outcomes by
Applying Program Measures
System-wide
Measure Outcomes by Applying
Program Measures System-wide

What: Examine how the system (across all programs
or across part of a system) performs on a specific
measure.
– What percentage of all homeless persons have greater
incomes when they leave the homeless system?

When to use outcome measures:
– To assess and communicate the overall system’s success in
helping clients achieve intended outcomes
– To indicate interim success towards overall impact goal
– To reinforce or adjust current expenditures and support
new funding requests
Example: Does the System
Increase Client Incomes?
Participation In System
TH
Increased Income
Services
Ability to Pay Rent
End Household
Homelessness

Need to calculate the % of clients who
increased their income while enrolled in (as
a result of) the homeless system
How Do You Define a Query?
You have to specify all parts of your
query/calculation:

Programs
– Across a program type (e.g., all shelter, all TH programs)
– All programs
– Programs that serve a specific subpopulation (e.g. DV)

Clients (de-duplicated across programs)
–
–
–
–

All exiters
All participants
All currently enrolled
Those who stayed > 6 mo
Data Elements
– Same HMIS elements as program measures
– Need rules to reconcile data across programs if client was enrolled in
more than one program

Timeframe
– Define date range
– Specify date field (entry date, exit date, placement date, assessment
date, etc.)
Defining Increased Income
Query

Programs
– All programs in system

Clients (de-duplicated across programs)
– Adults with a homeless episode that began after January 1, 2008, have
exited the system, and have not returned for at least 6 months since exit

Data Elements
–
–
–
–
Client ID or identifiers to de-duplicate
DOB to filter for adults
Program Entry/Exit dates
Client income & date of income assessment to tie $ to program entry/exit
dates
– Source of income (Are you interested in all income; only income gained
through employment; cash benefits?)

Timeframe (Reporting Period: 1/1/08 thru 6/30/09 – 18 mos.)
– 1st Program Entry Date in Episode is after January 1, 2008
– Has Exit Date for most recent Program Entry Date in last Episode
Steps to Calculate Increased
Income Query
Step 1
De-duplicate clients
across programs
Step 4
Consolidate sequential stays into single
episode (gaps < 30 days = same episode)
Step 2
Filter for adults only
(DOB > 18 yrs ago)
Step 3
Calculate program
stays per client
Step 5
Income at Exit from Last Program in Episode
─
Income at Entry to First Program in Episode
For multiple episodes, calculate income gain (loss) for each
episode separately and sum results for time person spent in
homeless system.
Steps to Calculate Increased
Income Query
Step 1
5 client records →
4 unduplicated clients
Client
ID
Prog.
ID
DOB
Entry
Date
Exit
Date
LOS
1
A
6/2/70
1/8/08
5/1/08
1
B
6/2/07
6/1/08
9/1/08
206
2
A
2/9/65
3/1/09
6/30/09
121
3
C
3/4/57
9/1/08
3/7/09
187
4
B
9/1/41
4/3/08
2/1/09
309
Step 2
All 4 clients are adults
(> 18 yrs old)
Step 3
Calculate program
stays per client
Step 4
Combine stays for
Client 1 in A & B
Steps to Calculate Increased
Income Query (cont.)
Step 5a
Results
Examine Entry/Exit
Income by Client
Rate of Increased Income: 67%
Av: $162 ↑; Low: $500 ↓; High: $635 ↑
Step 5b
Client
ID
Prog.
ID
Entry
Income
Exit
Income
Calculate Client-level
Change in Income
1
A
$100
$350
1
B
$350
3
C
4
B
Exit Entry
Income
Change
$450
$450 $100
$350
$500
$0
$0 $500
($500)
$0
$635
$635 $0
$635
Step 5c
Calculate Results
Across
Clients/Programs
System Results (all Clients/Programs)
$162
Caveats of System Analysis

System analysis may require a lag in time
even beyond the client’s completion of
program involvement
– Measuring recidivism requires a certain period of
time (12 months?) after program exit in which
return to the system might occur

If the HMIS only includes data from a
subset of programs, the system analysis will
provide an incomplete picture
– Perceived decline in recidivism may only reflect
absence from participating providers as opposed
to not being homeless anymore
2nd System Performance
Measurement Method
Use Program Performance
Results
to Change or Manage the
System
2nd System PM Method: Use
Program Performance Results to
Change or Manage the System

What: Compare performance results on selected
program measures from one program to another.
(Risk adjust for client differences.)
– Our system is not as effective as we want in increasing
client incomes… which programs are working best or
least well?

Use: Mid-term
– To help understand whether individual programs are
working
– To help decide how to allocate dollars or rank programs
for funding
– To identify best practices or agencies that need TA
– To determine how performance expectations should differ
for different populations, and how to refer clients most
appropriately
Apples to Apples: Risk
Adjustment


Problem: Comparing program results can
encourage programs to “cream” to ensure
strong results
Solution: Risk adjustment allows you to
account for differences in client populations
when comparing results across programs
Results can be adjusted on the basis of…



Client characteristics, such as demographics, family size,
disability
Client history, such as past eviction, criminal background,
Client functionality or level of engagement/commitment
to change
Risk Adjustment Requires
Expertise

To adjust for client differences, programs need to
collect consistent data on clients to use during
analysis of program results
– Agree on these standards beforehand

Develop an analysis plan for how you intend to
adjust for client differences
– Engage a researcher to help develop the plan

Even if you don’t formally adjust results,
acknowledge that different programs may have
different outcome expectations based on
differences in clients targeted and/or served
Simplified Illustration of
Dissecting Client Outcomes on
Increased Earned Income
Program A
Program B
All Clients (n=100)
All Clients (n=300)
61% (61 clients)
23% (70 clients)
CoC Outcome
Results By
Population
Disabled Clients
Disabled Clients
Disabled Clients
10%
(1 of 10 persons)
Non-disabled Clients
12%
(30 of 250 persons)
Non-disabled Clients
12%
(31 of 260 persons)
Non-disabled Clients
67%
(60 of 90 persons)
80%
(40 of 50 persons)
71%
(100 of 140 persons)
By establishing targets, programs can be compared against CoC
expectations in the future to determine if program performance is
higher or lower than expected.
3rd System Performance
Measurement Method
Measure System Results
with HMIS-based Impact
Outcomes
3rd System PM Method:
Measure Impact Results (Does the
System Work?)

What: Define a process to track the impact of the system’s
efforts on the need/problem.
– Is the system reducing the time that people stay homeless, and
therefore reducing the point-in-time prevalence?

When to use long-term impact results:
– To determine if you need to continue actions, expand current
efforts (add resources to the current system), tweak current
efforts, or fundamentally change the structure and approach of
your homeless system
– To evaluate whether past actions (expanding the system or
adding money) helped address the issue
– To communicate the overall system’s success (such as, when
justifying funding requests)

Theory: In the long-term, you need to demonstrate that the
collective actions of the system solve the problem.
Sample Impact Measures




Incidence of homelessness - Is homelessness
declining?
Incidence of chronic homeless - Is street or chronic
homelessness declining?
Length of stay in system, across all homeless
programs - Do people stay homeless for shorter
periods of time?
Rates of Recidivism – Are repeat occurrences of
homelessness avoided or declining?
Cross-tabulate results by core characteristics to
understand if/how results vary for different
subpopulations
Steps to Calculate System
Length of Stay
De-duplicate clients
across programs
Step 4
Consolidate sequential
stays into single
episode (gaps < 30
days = same episode)
Step 5
Calculate mean (168
days), low (81 days),
high (309 days)
Step 3
Step 2
Step 1
Create table with all
Entry/Exit Dates by
Client
Calculate LOS for
each Stay
Client
ID
Prog
ID
Entry Date
Exit Date
LOS
1
A
5/8/06
5/30/07
22
1
B
6/1/07
9/1/07
2
A
3/1/07
5/21/07
81
3
C
2/1/06
12/7/06
309
114
92
Some notes of caution…

There is more to performance measurement than
conducting the analysis
– Educate, train, obtain buy-in

Be careful about how you interpret and use the
data
1. Jump in, but don’t be careless in how you use the results
2. Look at the results within the context of all the outputs,
interim measures and impact measures to validate the
interpretation that’s being made
3. Vet the results before publicly releasing anything
4. Appropriately caveat the limitations of the data and
analysis
Summary of System
Performance Measurement
Activities
Adjust type and
intensity of
activities based on
outcomes; track if
improves
Outputs
Inputs
Document the level of
effort provided
Use to ensure activities
delivered efficiently
Use program-level &
system-wide results
to adjust use of
resources
Outcomes
Interim Outcomes
signal client success;
Impact outcomes
track progress to
goals