5.6 Katharine Gale


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5.6 Katharine Gale

  1. 1. Performance Improvement : Program and system-focused strategies to improve outcomes <ul><li>National Conference on Ending Homelessness </li></ul><ul><li>Washington DC </li></ul><ul><li>July 14, 2011 </li></ul><ul><li>Katharine Gale </li></ul><ul><li>Katharine Gale Consulting </li></ul><ul><li>& Focus Strategies </li></ul><ul><li>Berkeley, CA </li></ul><ul><li>(510) 710-9176, [email_address] </li></ul><ul><li>www.focusstrategies.net </li></ul>
  2. 2. Key to Community-Wide Performance Improvement <ul><li>Thinking like a community/system: </li></ul><ul><li>We are working to end homelessness for all the people in our system vs. my agency is working to help our specific clients </li></ul><ul><li>We need to know how we are doing and target our scarce resources to the best solutions </li></ul><ul><li>To do this well, we must hold ourselves and each other accountable </li></ul>2
  3. 3. Mutual Accountability <ul><li>Two examples of communities increasing mutual accountability </li></ul><ul><li>Alameda County – Performance measurement and contracting </li></ul><ul><li>Metro Area CoC (Omaha- Council Bluffs) </li></ul><ul><li>Housing Crisis Resolution through Coordinated Access system </li></ul>3
  4. 4. Performance Measurement: Alameda County <ul><li>EveryOne Home (County’s 10- Year Plan) called for “Measuring Success and Reporting Outcomes” </li></ul><ul><li>Began outcomes development process in Fall 2009 </li></ul><ul><li>Initial Outcomes and Benchmarks adopted in May 2010, and revised in Sept. 2010 with most recent data </li></ul><ul><li>First year report will be given July 25, 2011 </li></ul>4
  5. 5. Process <ul><li>Drafting Committee appointed: 6 providers, 3 jurisdictions and 1 private funder, plus EveryOne Home Director </li></ul><ul><ul><li>Committee studied best practices around outcomes in other communities </li></ul></ul><ul><ul><li>Reviewed current metrics and recommended measures and benchmarks </li></ul></ul><ul><ul><li>Made process recommendations for time-frame for adoption and technical assistance </li></ul></ul>5
  6. 6. Outcomes Selected <ul><li>Obtain (or retain) permanent housing </li></ul><ul><li>Reduce exits to homelessness (negative exits) </li></ul><ul><li>Obtain permanent or interim housing </li></ul><ul><li>Exit with earned income </li></ul><ul><li>Those with no income exit with an income </li></ul><ul><li>Rate of return to system (“recidivism”) </li></ul>6
  7. 7. Efficiency/Process Measures Selected <ul><li>Occupancy </li></ul><ul><li>Exit to “Known Destination” </li></ul><ul><li>Time from entry to Permanent Housing </li></ul><ul><li>Time to employment </li></ul>7
  8. 8. Establishing Benchmarks <ul><li>To establish benchmarks Committee looked at </li></ul><ul><li>- current performance in the system where measures were available (i.e. exits to PH, exits with employment income, lengths of stay within programs) </li></ul><ul><li>- Other communities' goals where no local data available (example: returns to homelessness) </li></ul>8
  9. 9. Establishing Benchmarks <ul><li>Where there was reasonably good data, basic benchmark established at 75 th percentile of current performance (rounded down to nearest 0 or 5 number.) </li></ul><ul><li>25% of providers already exceeding goal, and another 25% close to goal. </li></ul><ul><li>Where no data, committee made a values-based decision </li></ul><ul><li>An improvement of 10% is considered having met the benchmark </li></ul>9
  10. 10. 9 Benchmarking Example: Transitional Housing Programs Exits to Perm. Housing
  11. 11. Alameda County Matrix of Outcomes for Whole System (Excerpt) 12
  12. 12. Implementation Process <ul><li>Principles and benchmarks adopted May 2010 </li></ul><ul><li>Base line report produced and reviewed September 2010, some adjustments made for better data </li></ul><ul><li>Funders (several cities, County Social Services and Housing and FEMA board) putting three year phase-in approach into contracts </li></ul><ul><li>EveryOne Home leading the way to resources for technical assistance and training </li></ul>12
  13. 13. Using HMIS for system and provider reports <ul><li>System and component level reports generated from Countywide HMIS </li></ul><ul><li>Providers can generate their own program reports and compare their progress to the system and the goals </li></ul><ul><li>Iterative process – ongoing data cleaning, trouble shooting and adjustments being made </li></ul><ul><li>Performance Management Committee oversight </li></ul>13
  14. 14. Sample Alameda County Report: Emergency Shelters 14 Source: Alameda County HCD InHOUSE HMIS, 2/8/11 EMERGENCY SHELTERS Jan 1, 2010 - Dec 31, 2010 Dec 2010 Nov 2010 Jan 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}
  15. 15. Next step: system-assessment in process <ul><li>HEARTH Academy held June 2011 </li></ul><ul><li>Using NAEH Homeless System Evaluator Tool can see where system is bottle-necked or not cost effective. Includes: </li></ul><ul><ul><li>Charts with exits rates/types by component </li></ul></ul><ul><ul><li>Cost per exit and cost per outcome </li></ul></ul><ul><ul><li>Returns to homelessness by component </li></ul></ul><ul><li>Able to complete Evaluator because data now pretty good! </li></ul>15
  16. 16. Next step: system-assessment in process <ul><li>Using system outcome and cost data to make system-improvement decisions including: </li></ul><ul><ul><li>Expand coordinated intake approach beyond HPRP </li></ul></ul><ul><ul><li>Expand resources for rapid rehousing </li></ul></ul><ul><ul><li>Repurpose some transitional housing </li></ul></ul>16
  17. 17. Commitment to System Coordination: Omaha and Council Bluffs Metro Area Continuum of Care (MACCH) 17
  18. 18. Commitment to System Coordination: MACCH <ul><li>10- year plan called for the implementation of systemic strategies that prevent the flow of individuals and families into homelessness. </li></ul><ul><li>In 2010 did assessment of prevention & rehousing system </li></ul><ul><li>Report “ Meeting the Effectiveness Challenge ” </li></ul><ul><li>found resources not well targeted and not well-coordinated </li></ul>18
  19. 19. Recommendations from Report <ul><li>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 </li></ul><ul><li>Modify current funding streams or develop new financial assistance resources that are more flexible to address the crisis with an outcome of housing stability  </li></ul><ul><li>Improve program targeting and remove barriers to serving those with greatest need </li></ul>19
  20. 20. Result: Commitment to Develop a Coordinated Access System <ul><li>Become a Housing-Crisis Resolution Focused System </li></ul><ul><li>Ensure clients get to the right place, get served appropriately, and exit the system without falling out </li></ul><ul><li>Be able to answer the question: </li></ul><ul><li>“ Who’s Got the Ball?” </li></ul>20
  21. 21. Vision <ul><li>One Call and/or One Tool </li></ul><ul><li>Assessment and referral to an agency that can assist with the presenting housing crisis </li></ul><ul><li>Agency follows individual/household until crisis resolved OR “hands off” the client to someone else appropriate </li></ul><ul><li>MOU that holds agencies mutually accountable and data system that tracks this </li></ul>21
  22. 22. Steps to Implement <ul><li>Identify assessment and referral point(s) </li></ul><ul><li>Develop common assessment tool and agency/program criteria </li></ul><ul><li>Assess technology needs and ensure data can be both collected and assessed to evaluate progress (including changes in outcomes!) </li></ul><ul><li>Develop MOU between parties to ensure mutual accountability for client outcomes </li></ul>22
  23. 23. More Information <ul><li>National Alliance to End Homelessness </li></ul><ul><li>www.endhomelessness.org </li></ul><ul><li>Alameda County EveryOne Home www.everyonehome.org </li></ul><ul><li>Metro Area Continuum of Care (MACCH) </li></ul><ul><li>http://macchomeless.org </li></ul><ul><li>Me  email: [email_address] </li></ul><ul><li>www.focusstrategies.net </li></ul>23