From Safety Net to Trampoline: On-the-ground strategies for becoming - - PowerPoint PPT Presentation

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From Safety Net to Trampoline: On-the-ground strategies for becoming - - PowerPoint PPT Presentation

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From Safety Net to Trampoline: On-the-ground strategies for becoming a housing crisis response system Katharine Gale Using the Right Tools to End Homelessness Hartford, CT March 20, 2012 kgaleconsulting@sbcglobal.net 1 Overview Moving

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From Safety Net to Trampoline:

On-the-ground strategies for becoming a housing crisis response system

Katharine Gale

Using the Right Tools to End Homelessness

Hartford, CT March 20, 2012 kgaleconsulting@sbcglobal.net

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Overview

  • Moving toward a system of crisis resolution: shifting the

paradigm

  • How should we invest our resources?
  • How do we review program performance?
  • What makes us work as a system?

– Coordinating our efforts from first touch to exit – Targeting our resources

  • Prevention
  • Higher Cost Interventions

–What does this mean for our work?

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The Past

Objectives:

  • Maximize and keep funding in Continuum
  • Keep programs open and operating
  • Collaborate to increase resources
  • Maintain high standards for serving people
  • Focus on a variety of individual client results

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Out- reach Shelter TH PSH Prev/ RRH

Other

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Each program a separate net that catches some people

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Housing Crisis Resolution System

Objectives:

  • Permanent housing fast and make sure housing sticks
  • Least expensive resource to each household to resolve their

homelessness

  • Measure what is working, do right amount of that
  • Measure what is not working, do better and/or less of that

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Stretching the nets together….

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Does the current set of components fit the need?

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Local data sources

  • Information from Homeless Management

Information System (HMIS) (destinations, lengths of stay)

  • Information from local HUD-mandated reports

(APR, AHAR, HIC)

  • Program-level information (budgets, number
  • f beds, persons served)
  • Homeless point-in-time count

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Population Distribution & System Capacity – Community B

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Population Distribution & System Capacity – Community B

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Engineering Success

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Each System Component:

  • Leads to success – exits to permanent housing (PH)
  • Right-sized allocation of system dollars to maximize PH exits
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Success: Exits to PH

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30% 71% 89%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Shelters TH RR

Percent of Initial Exits to Permanent Housing – Community A Persons in HH with Children, 2010

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Success: Exits to PH

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Success that Sticks

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Success that sticks means leaving homelessness for permanent housing & not returning to homelessness.

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Returns to Homelessness

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Returns to Homelessness

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Sources: HMIS & HPRP data collection tool, 2010 program stays, 2011 returns data. Budget data from provider agencies, in a few cases estimates created from publicly available information.

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Sources: HMIS & HPRP data collection tool, 2010 program stays, 2011 returns data. Budget data from provider agencies, in a few cases estimates created from publicly available information.

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Maximizing Success

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Lowest cost of Success that Sticks Maximum Resources

Greatest Number Housed

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Where are resources invested now?

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Where are resources invested now?

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What would happen, if…?

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Program LOS TH 300 days Program LOS TH 150 days

302 new PH Exits!

Shorten LOS

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What would happen, if…?

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Program Current $ TH $6,415,004 RR $2,052,760 Program New $ TH $4,415,004 RR $4,052,760 Swap $2 mil

592 net new PH exits!

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Maximizing Success that Sticks

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Includes:

  • Right-sizing investments by

program type according to cost and outcomes, and

  • Assessing program

performance and making funding decisions accordingly

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System performance is the sum of the parts

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Rewarding Performance

  • Moving toward outcomes-based

contracting

  • Make expectations clear
  • Flexibility/Simplify reporting
  • Offer recognition/incentives
  • Provide training, bring players along

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Making the System Work: Greasing the Wheels

  • Coordinated entry
  • Assessment &

assignment of right resource

  • Buy-in to common
  • utcomes
  • Measuring outcomes &

responding to findings

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Coordinated Entry

Point of Entry

Stabilize current housing Immediate re-housing Assess needs and barriers Refer to shelter and/or re- housing Direct to PSH in some cases

Slide from National Alliance to End Homelessness: System Design Webinar October 2010

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Coordinated Entry

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Why is it important?

  • Fairness to clients
  • Better use of resources
  • Improves targeting
  • Accountability: Means someone “has the ball”
  • Supports a system paradigm and helps

providers do their job …Not a panacea - will show gaps in system

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Targeting

  • Applying resources where they are most

needed based on our best understanding of the data

– Ask: can we keep them from coming in? – If they come in, how fast can we get them out? – Save our highest cost interventions for those who really need them as demonstrated by past utilization in our system or other systems

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Prevention Targeting: Comparative Entry Analysis

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17% 15% 9% 36% 4% 0% 18% 2% 0% 2% 2% 74% 16% 1% 4% 1% 0% 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% Already in System Unsubsidized Housing Hotel/Motel Other Refused

Singles in Shelters Singles in HPRP Institution With Family and Friends Subsidized Housing Don’t Know With Family and Friends

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Other data on sheltered households in HMIS

  • Income amounts
  • Typical Income Sources
  • Prior Shelter stays
  • Age of Head of Household
  • Pregnancy/Age of Children
  • Education Level

Hennepin County did this and redid their prevention screening tool.

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From 2012 Homebase Study (Shinn

and Greer… publishing soon)

High Risk of Shelter Entry (Risk Factor):

  • Female Head of Household
  • Pregnancy
  • Child younger than two
  • History of public assistance
  • Eviction threat
  • High mobility in last year
  • History of protective services
  • High conflict in household
  • Disruptions as a child (e.g. foster care, shelter history as youth)
  • Shelter history as an adult
  • Recent shelter application
  • Seeking to reintegrate into community from an institution
  • High number of shelter applications

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Prevention Goal: Make a difference in subsequent rates of entry

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Targeting Higher Cost Interventions

  • Even programs for most high need can be

developed and run with the idea of the trampoline… (a slow trampoline)

– CTI model – Frequent User Programs

  • Finding the users of ours or other systems

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Program Use & Implications –

Community B

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Program Use & Implications –

Community B

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Projects Serving Frequent Users of Emergency Services

  • New Directions – Santa Clara County, Hospital

Council of Northern and Central California

  • SF Emergency Department Case Management –

San Francisco General Hospital

  • Project RESPECT – Berkeley/Oakland, LifeLong

Medical Care

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Populations Served

Similarities Across Programs

  • Adults ages 18 and older
  • 75 - 85% males
  • Homeless
  • Uninsured
  • High prevalence of mental health/substance use

issues

  • Hospital data identifies frequent and avoidable ED

visits

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Common Service Components

  • Assertive Outreach
  • Case Management / Brokerage services
  • Crisis Intervention
  • Medical Assessment and Care
  • Psychiatric Assessment and Care
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LifeLong Medical Care Project RESPECT

  • FQHC in Berkeley, Oakland and Richmond (9

primary care clinics, 1 dental clinic, large supportive housing program)

  • Frequent User program since 2005
  • Contracts to serve 3 hospitals (Highland, Alta Bates,

Summit)

  • Served 250 frequent users
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Project RESPECT Model

  • Core service team – case managers and LCSW

provide outreach and services

  • Based in a primary care setting; also does benefits

advocacy

  • 10 or more visits per year to the ED or 4 visits/yr. for

2 consecutive years

  • Contracted to serve total of 80 clients at any point in

time, case load 1:20.

  • Connected to housing resources (Shelter Plus Care)
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Impacts and Outcomes

  • Program costs average $5,000 to $5,500 a year (not

including housing)

  • Average program stay is under one year
  • 88% of clients without an income approved for SSI
  • Clients decrease ED visits by 63%
  • Increase in inpatient visits in first year (chronic

illnesses, deferred care) which decreases in year two

  • Hospitals supporting because reduces ED stress and

increases ability to bill once client has Medicaid

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Key element: Hospital Coordination

  • Identifying key staff who have buy in
  • Flags in hospital systems to identify project clients
  • Patient coordination, reinforcement of messages
  • Access to real time ED and inpatient data
  • Pain management support/coordination
  • Strengthen referrals back to the primary care source
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Information Exchange

  • Identify target population
  • Provide feedback to staff on what has happened to

referred patients

  • Track outcomes
  • Track cost
  • Provide positive reinforcement for referrals (case

studies and data)

  • HIPAA issues
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Things we have to stop saying/believing…

  • “There is no housing…”
  • “There are no services…”
  • “We are setting them up for failure…”
  • “We need a lot more resources to improve

performance…”

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Things we have to start/keep doing

  • Commit to meeting the broader need as a

system; use our data to invest our resources.

  • Provide the lightest touch we can whenever

possible, leaving the door open as needed

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Things we have to start/keep doing

  • Connect people to the real-world resources

that should be their ongoing source of support rather than trying to be their support

  • Help ourselves and our staff understand the

new paradigm and reward improvement

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Q & A

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