From Safety Net to Trampoline: On-the-ground strategies for becoming a housing crisis response system

Transcription

1 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

2 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? 2

3 Outreach The Past Shelter Prev/ RRH TH PSH Other 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 3

4 Each program a separate net that catches some people 4

5 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 5

6 Stretching the nets together. 6

7 Does the current set of components fit the need? 7

8 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 of beds, persons served) Homeless point-in-time count 8

9 Population Distribution & System Capacity Community B 9

10 Population Distribution & System Capacity Community B 10

11 Engineering Success Each System Component: Leads to success exits to permanent housing (PH) Right-sized allocation of system dollars to maximize PH exits 11

12 Success: Exits to PH 100% 90% 80% 70% 60% Percent of Initial Exits to Permanent Housing Community A Persons in HH with Children, % 89% 50% 40% 30% 20% 30% 10% 0% Shelters TH RR 12

13 Success: Exits to PH 13

14 Success that Sticks Success that sticks means leaving homelessness for permanent housing & not returning to homelessness. 14

15 Returns to Homelessness 15

16 Returns to Homelessness 16

17 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. 17

18 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.

19 Maximizing Success Lowest cost of Success that Sticks Greatest Number Housed Maximum Resources 19

20 Where are resources invested now? 20

21 Where are resources invested now? 21

22 What would happen, if? Program TH LOS 300 days Shorten LOS Program LOS TH 150 days 302 new PH Exits! 22

23 What would happen, if? Program Current $ TH $6,415,004 RR $2,052,760 Swap $2 mil Program New $ TH $4,415,004 RR $4,052, net new PH exits! 23

24 Maximizing Success that Sticks Includes: Right-sizing investments by program type according to cost and outcomes, and Assessing program performance and making funding decisions accordingly 24

25 System performance is the sum of the parts 25

26 Rewarding Performance Moving toward outcomes-based contracting Make expectations clear Flexibility/Simplify reporting Offer recognition/incentives Provide training, bring players along 26

27 Making the System Work: Greasing the Wheels Coordinated entry Assessment & assignment of right resource Buy-in to common outcomes Measuring outcomes & responding to findings 27

28 Coordinated Entry Stabilize current housing Immediate re-housing Point of Entry Assess needs and barriers Refer to shelter and/or rehousing Direct to PSH in some cases Slide from National Alliance to End Homelessness: System Design Webinar October 2010

29 Coordinated Entry 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 29

30 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 30

31 Prevention Targeting: Comparative Entry Analysis 80% 70% 60% 50% 40% 74% 36% With Family and Friends Singles in Shelters Singles in HPRP 30% 20% 17% 15% 10% 9% 2% 2% 0% Already in System Unsubsidized Housing Institution 16% With Family and Friends 4% 1% 4% 0% 18% 1% 2% 0% 0% 0% Hotel/Motel Other Refused Subsidized Housing Don t Know 31

32 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. 32

33 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 33

34 Prevention Goal: Make a difference in subsequent rates of entry 34

35 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 35

36 Program Use & Implications Community B 36

37 Program Use & Implications Community B 37

38 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

39 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

40 Common Service Components Assertive Outreach Case Management / Brokerage services Crisis Intervention Medical Assessment and Care Psychiatric Assessment and Care

41 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

42 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)

43 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 43

44 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

45 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

46 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 46

47 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 47

48 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 48

49 Q & A 49