Performance Improvement: Program and system-focused strategies

to improve outcomes

National Conference on Ending HomelessnessWashington DC

July 14, 2011

Katharine GaleKatharine Gale Consulting

& Focus StrategiesBerkeley, CA

(510) 710-9176, kgaleconsulting@sbcglobal.net www.focusstrategies.net

Key to Community-Wide Performance Improvement

Thinking like a community/system:•We are working to end homelessness for all the people in our system vs. my agency is working to help our specific clients•We need to know how we are doing and target our scarce resources to the best solutions•To do this well, we must hold ourselves and each other accountable

2

Mutual AccountabilityTwo examples of communities increasing mutual accountability

1) Alameda County – Performance measurement and contracting

2) Metro Area CoC (Omaha- Council Bluffs)Housing Crisis Resolution through Coordinated Access system

3

Performance Measurement: Alameda County

• EveryOne Home (County’s 10- Year Plan) called for “Measuring Success and Reporting Outcomes”

• Began outcomes development process in Fall 2009

• Initial Outcomes and Benchmarks adopted in May 2010, and revised in Sept. 2010 with most recent data

• First year report will be given July 25, 2011

4

Process• Drafting Committee appointed: 6 providers,

3 jurisdictions and 1 private funder, plus EveryOne Home Director– Committee studied best practices around

outcomes in other communities– Reviewed current metrics and recommended

measures and benchmarks– Made process recommendations for time-frame

for adoption and technical assistance

5

Outcomes Selected

•Obtain (or retain) permanent housing

•Reduce exits to homelessness (negative exits)

•Obtain permanent or interim housing

•Exit with earned income

•Those with no income exit with an income

•Rate of return to system (“recidivism”)

6

Efficiency/Process Measures Selected

•Occupancy

•Exit to “Known Destination”

•Time from entry to Permanent Housing

•Time to employment

7

Establishing Benchmarks

•To establish benchmarks Committee looked at - current performance in the system where measures were available (i.e. exits to PH, exits with employment income, lengths of stay within programs)

- Other communities' goals where no local data available (example: returns to homelessness)

8

Establishing Benchmarks

• Where there was reasonably good data, basic benchmark established at 75th percentile of current performance (rounded down to nearest 0 or 5 number.)

• 25% of providers already exceeding goal, and another 25% close to goal.

• Where no data, committee made a values-based decision

• An improvement of 10% is considered having met the benchmark

9

9

Benchmarking Example: Transitional Housing Programs Exits to Perm.

Housing

Alameda County Matrix of Outcomes for Whole System (Excerpt)

12

Implementation Process

•Principles and benchmarks adopted May 2010•Base line report produced and reviewed September

2010, some adjustments made for better data•Funders (several cities, County Social Services and

Housing and FEMA board) putting three year phase-in approach into contracts

•EveryOne Home leading the way to resources for technical assistance and training

12

Using HMIS for system and provider reports

• System and component level reports generated from Countywide HMIS

• Providers can generate their own program reports and compare their progress to the system and the goals

• Iterative process – ongoing data cleaning, trouble shooting and adjustments being made

• Performance Management Committee oversight

13

Sample Alameda County Report: Emergency Shelters

EMERGENCY SHELTERS Jan 1, 2010 -

Dec 31, 2010 Dec 2010 Nov 2010Jan 1, 2009 - Dec 31, 2009 GOAL

People obtaining permanent housing 24.2% 26.2% 21.5% 21.3% {30%}

Exiting to streets or shelter 15.3% 18.5% 23.4% --- {<30%}

Exit with employment income 16.1% 17.9% 21.7% 15.6% {20%}

Of adults entering with no income, an increase in those

who exit with an income 4.4% 3.7% 3.6% 5.7% {15%}

Return to homelessness in 12 months --- --- --- --- {N/A}

Efficiency/Process Measures

Exit to Known Destination 67.7% 74.7% 71.8%        57.8% {85%}

Obtain permanent housing within 60 days 58.1% 17.4% 0.00% 46.8%

{50% <60 days}

14

Source: Alameda County HCD InHOUSE HMIS, 2/8/11

Next step: system-assessment in process• HEARTH Academy held June 2011

• Using NAEH Homeless System Evaluator Tool can see where system is bottle-necked or not cost effective. Includes:

• Charts with exits rates/types by component

• Cost per exit and cost per outcome

• Returns to homelessness by component

Able to complete Evaluator because data now pretty good!

15

Next step: system-assessment in process

• Using system outcome and cost data to make system-improvement decisions including:

• Expand coordinated intake approach beyond HPRP

• Expand resources for rapid rehousing

• Repurpose some transitional housing

16

Commitment to System Coordination: Omaha and Council Bluffs Metro Area

Continuum of Care (MACCH)

17

Commitment to System Coordination: MACCH

•10- year plan called for the implementation of systemic strategies that prevent the flow of individuals and families into homelessness.

•In 2010 did assessment of prevention & rehousing system

•Report “Meeting the Effectiveness Challenge” found resources not well targeted and not well-coordinated

18

Recommendations from Report

1) Develop a system of centralized access to the homeless prevention system and shelter resources with efficient referral to an agency/agencies who take responsibility for assisting clients through their crisis

2) Modify current funding streams or develop new financial assistance resources that are more flexible to address the crisis with an outcome of housing stability 

3) Improve program targeting and remove barriers to serving those with greatest need

19

Result: Commitment to Develop a Coordinated Access System

•Become a Housing-Crisis Resolution Focused System

•Ensure clients get to the right place, get served appropriately, and exit the system without falling out

•Be able to answer the question:

“Who’s Got the Ball?”

20

Vision

• One Call and/or One Tool• Assessment and referral to an agency that

can assist with the presenting housing crisis• Agency follows individual/household until

crisis resolved OR “hands off” the client to someone else appropriate

• MOU that holds agencies mutually accountable and data system that tracks this

21

Steps to Implement

• Identify assessment and referral point(s)• Develop common assessment tool and

agency/program criteria• Assess technology needs and ensure data

can be both collected and assessed to evaluate progress (including changes in outcomes!)

• Develop MOU between parties to ensure mutual accountability for client outcomes

22

More Information

• National Alliance to End Homelessnesswww.endhomelessness.org • Alameda County EveryOne Home www.everyonehome.org • Metro Area Continuum of Care (MACCH) http://macchomeless.org • Me email: kgaleconsulting@sbcglobal.net www.focusstrategies.net

23