Strategic Plan to End Homelessness in Suburban Cook County 2018-2021 Kick Off Webinar April 24, 2018 Hosted by the Alliance to End Homelessness in Suburban Cook County Presentation by Focus Strategies

Agenda Overview 1. Welcome & Introduction Jennifer Hill, Executive Director, Alliance 2. Presentation by Focus Strategies Introduction to Focus Strategies Review of 2014-2017 Strategic Plan Planning Framework for 2018-2021 Systems Approach Performance Measurement Introduction to Performance Data Next Steps 3. Discussion - Questions and Answers Note that there will be opportunities to have discussions throughout the presentation; not just at the end.

About Focus Strategies We believe the HEARTH Act and Opening Doors lead the way to finally ending homelessness.   About Focus Strategies Focus Strategies works with communities to: Assess and improve the quality of local homeless data for informing change Analyze system outcomes and costs Synthesize data from multiple systems of care (homeless, mental health, human services, etc.) to identify client overlap and service utilization patterns Identify how system resources are currently invested & recommend how they can be repurposed to be more effective

Purpose of Our Work in Suburban Cook County Facilitate development of a new three-year Strategic Plan to End Homelessness Build upon previous plan (2014-2017) Gather information to understand current system performance Learn from stakeholders about homeless system strengths and challenges Work with stakeholders to formulate strategies to reduce homelessness

Project Overview Timeline Activity Begin End Phase One: Initial Information Gathering Review plans and reports Key stakeholder interviews Collect system data March 1 April 30 Phase Two: Community Input Kick-off webinar April 24 Community input meetings May 30 May 31 Follow-up interviews June 1 June 30 Work with Alliance to develop performance data April 15 Phase Three: Board Retreat One day retreat to develop Strategic Plan strategies July 18 Phase Four: Strategic Plan Development Draft and finalize Strategic Plan August 1 August 31

2014-2017 Strategic Plan: Goals and Accomplishments To begin our work, we have read the previous plan and interviewed the Plan Committee and some key stakeholders to learn more about how to build upon it.

Planning Principles Create housing and services for hardest-to-house Promote use of best practices Prevent homelessness whenever possible Promote collaboration; look for regional solutions Use all resources to highest capacity Use data to drive decision-making

Goal Areas Housing Supportive Services System Operations Emergency Shelter Street Outreach Coordinated Assessment Transitional Housing Homelessness Prevention Alliance Capacity Rapid Re-Housing Employment Governance Permanent Supportive Housing Health Care Data Systems Affordable Housing Mainstream Resources The plan lays out goals in 14 different areas, under 3 main categories: housing, services, system operations.

Targets and Results 1,307 PSH beds by January 2018 (increase of 82 per year) Fewer than 30 chronically homeless people in 2016, 2017, and 2018 counts 700 homeless people in Jan. 2018 count (40% decline) Average placement of 18 people per month through Built for Zero 275 Households served in RRH by Jan. 2018 The plan also sets out some numerical targets. This summarizes the targets and which ones have been met (the ones in green).

Highlights of Accomplishments Increases in RRH and PSH inventory Flow vouchers Design and launch of prevention pilot Collaboration with health system; Medicaid enrollment Launch of Coordinated Assessment Data quality improvements Revisions to data dashboards These are some of the main things that have been accomplished. This is not intended to be comprehensive, but rather just an overview of what seem to be the primary results to date.

DISCUSSION Before we move on; let’s stop here and see what questions or comments people have. Do people feel like this is a good overview of the previous plan? Does anyone want to add anything or ask a question about the last plan? Also this is a time to ask questions about the project plan and timeline for the new plan that we summarized at the beginning

2018-2021: Creating a Systematic Response to Homelessness The 2014-2017 plan identifies a lot of important elements of an effective response to homelessness, but in our assessment, and also based on what we have heard from stakeholders, it suffers a bit from having a very long list of goals and activities and is not sufficiently focused. There are too many buckets of work to effectively tackle them all or track progress on them all. We recommend that the new plan be more streamlined, more focused and hone in on a small number of strategies that will achieve maximum impact. We also advise that the framework for the plan should be moving towards having a systemic response; or creating a homeless response system. You already have a lot of the pieces in place, but now the next step is to more intentionally connect them all into one system in which all the parts are working together toward a shared set of objectives. What does it mean to have a homeless crisis response system?

Ending Homelessness The HEARTH Act establishes: “…a Federal goal of ensuring that individuals and families who become homeless return to permanent housing within 30 days.” Opening Doors, As Amended in 2015: “systematic response …that ensures homelessness is …a rare, brief, and non-recurring experience.” A homeless crisis response system is also a system that ends homelessness. What does it mean for homelessness to be ended? The HEARTH Act gives a good definition, which is that everyone who becomes homeless returns to homelessness in 30 days. The HEARTH Act as recently amended provides an operational definition of the end of homelessness as being when a community has a systematic response in place to ensure homelessness is rare, brief and non-recurring. To end homelessness we need effective Housing Crisis Response Systems that quickly return people to housing. For the purpose of designing an HCRS, communities can use the goal of having no one homeless longer than 30 days as a measurable objective that ensures homelessness is rare, brief and non-recurring…the HEARTH language and Opening Doors language each are different ways of saying the same thing.

Principles of a Homeless Crisis Response System Housing-focused Person-centered Data-informed Effective use of resources Housing Focused: An HCRS is built upon the understanding that homelessness is a crisis – the loss of housing – and the solution is to quickly return people to housing. Homelessness is not an intrinsic characteristic of a person and people do not need to be “fixed” before they can be housed. The purpose of an HCRS is to identify an appropriate housing solution for each homeless household, and along the way to connect them to other services they might need. Person-centered: An HCRS is focused on meeting people’s needs for housing, not on meeting provider needs to fill their programs. It respects client choice and preferences about where and how they will be housed. They system is also easily understood and navigated by homeless people, with minimal barriers to access. Data-informed: Data is collected and analyzed to understand whether the HCRS is meeting its objectives and to improve effectiveness. Decisions about what approaches to invest in are informed by data, not by assumptions about what works. Effective Use of Resources. The HCRS is designed to achieve the best possible results using the resources that exist (and realistic expectations about what additional resources can be garnered). While ideally we would provide a permanently affordable housing unit or subsidy to each homeless household, the HCRS recognizes that we can make a huge impact on reducing homelessness with the resources we have at our disposal if we make data informed decisions about how to spend them.

A System to End Homelessness Ending homelessness means building systems that: Divert people from entering homelessness Quickly engage and provide a suitable intervention for every household’s homelessness Have short lengths of stay in programs Have high rates of permanent housing exits Use data to achieve continuous improvement What are the features of an HCRS? Based on available evidence and experience from communities that have made great strides towards ending homelessness, we had identified the following as the key features of a system to end homelessness or Homeless Crisis Response System.

Homeless Crisis Response System

Data and Performance Measurement To create a system that ends homelessness, you have to take a data-informed approach, particularly focusing on performance.

Performance Data Analysis of performance data tells us: Extent to which homelessness is rare, brief, and non-recurring Where to target efforts to become more effective How to prioritize system and program resources How to achieve continuous improvement

Performance Analysis Answers these questions: Is the local homeless system sized to house the homeless population you have? Does the speed of your system change match the urgency of the issue? Are dollars achieving highest and best impact? How is each project type performing? How is each project performing?

Suggested Performance Measures HMIS Data Quality Bed/Unit Utilization Entries from Homelessness Length of Stay Exits to Permanent Housing (PH) Cost per Permanent Housing Exit Returns to Homelessness Focus Strategies often works with communities to do a type of performance analysis that we have developed the focuses on some specific measures that are the most critical for understanding how to get to an effective systemic response. If you are familiar with the HUD system performance measures, some of these will look familiar. But they are not exactly identical. These measures can be looked at for an individual program, a program type, or the whole system. [Briefly review each measure and what they can tell us about the system].

Ending Homelessness Graph Homeless Crisis Response System!

DISCUSSION Let’s stop here and see what questions or comments people have. Do you have questions about the idea of a system to end homelessness or a homeless crisis response system? What concerns do you have about applying this framework in Suburban Cook County? What questions do people have about performance measurement?

Examples of Suburban Cook County Performance Data So, to get everyone started thinking about project and system performance, we have prepared a few slides summarizing some initial data we have collected, working with the Alliance staff. These are examples of the types of data you should be thinking about as you develop the strategic plan. We are working on a more extensive data analysis/summary that we will have ready in time for the community input sessions in late May.

Households Served (October 2016 to September 2017) Households served – shows the relative size of the different interventions in terms of how many people are accessing them. This is a fairly typical distribution. For the planning meetings we will also pull together PIT data and data about different subpopulations.

Bed/Unit Utilization Measures whether existing bed capacity is being maximized Maximizing available bed capacity is essential to ensuring that system resources are being put to their best use and that as many homeless people are being housed through the existing inventory as possible

Utilization Rate This shows unit utilization over the past five years; Alliance dashboard data. PSH has a very high utilization rate TH has been trending down – seems underutilized ES is variable – related to the PADS model – much of the inventory is not fixed.

Entries from Homelessness Measures how many people enter programs who are unsheltered or living in shelter (literally homeless) Indicator of how well system is targeting highest need households High rate of entry from housed situations could suggest need for changes to Coordinated Entry and/or focus on targeted prevention and diversion

Program Entry (October 2015 – September 2016) Almost half of people entering ES are from housed situations. Likely that prevention/diversion could be effective. Another way to measure this is to look at entries of people experiencing homelessness for the first time (HUD measure).

Length of Stay (LOS) Measures how quickly programs are helping households end their homelessness Helps identify program and system design and operation inefficiencies Long LOS suggests programs may not be adopting a Housing First approach Many programs “hold” people longer than needed because of fear the housing won’t “stick.” This assumption is usually not supported by data, important to evaluate locally. A long LOS can mean the programs are not adopting a Housing First approach and instead are requiring participation in services are a precondition to program exit. It can also mean that there are not strong connections between ES/TH and RRH or other housing programs to help people in shelter move quickly to permanent housing.

Length of Stay - ES (October 2015 – September 2016) These LOS are relatively long for all intervention types – particularly RRH. Suggests there could be some focused attention to strategies to speed up movement through programs.

Length of Stay – TH & RRH (October 2015 – September 2016) These LOS are relatively long for all intervention types – particularly RRH. Suggests there could be some focused attention to strategies to speed up movement through programs.

Exit to Permanent Housing Measures rate of exits to permanent housing Helps identify program and system design and operation inefficiencies Low rate of exit to PH can indicate system needs more capacity to provide landlord recruitment, housing navigation, housing-focused case management

Exit to Permanent Housing (October 2015 – September 2016) TH is strong on this measure; RRH not as high as recommended (plus coupled with long LOS suggests not aligned with best practices); ES is very low.

Returns to Homelessness Measures whether people who exited to permanent housing returned to a homeless program within 12 months Identifies whether programs are helping people into housing placements that “stick” Can help alleviate concerns about serving higher need clients and helping them exit more quickly

Returns to Homelessness (October 2015 – September 2016) Rate of Returns to Homelessness

Cost Effectiveness: Cost Per PH Exit Typically, communities consider cost per unit or cost per household To be performance-oriented, need to measure cost per permanent housing exit Illustrates whether system resources are being invested in interventions that are effective in ending homelessness Helps identify system components or individual programs that are not cost effective

Cost Per PH Exit: Seattle/King County Cost Per Exit to PH We don’t have this data for Suburban Cook and not sure if we will have it; but wanted to show this example to illustrate why this can be a powerful measure. In Seattle/King County, our analysis showed that the cost to exit households from ES was quite low; however, this was also due to the fact that very few were exiting at all. In comparing TH to RRH, the cost per TH exist is much higher (3x) when considering family programs. (This community did not have any single adult RRH in the analysis). This analysis helped the stakeholders understand in a concrete way the benefits of investing in RRH.

Cost Per PH Exit: Anytown USA ES Cost per PH exit is also helpful in considering the performance of individual projects. This is sample data from a fictitious community (though based on a real community). Each bar is one emergency shelter. This program level analysis provides data to understand which programs are being the most cost effective in helping clients exit to PH. It can provide helpful information to inform program improvement strategies and investment decisions

HMIS Participation & Data Quality Essential to maximize participation in HMIS to understand how the overall system is performing Accuracy and completeness of HMIS data is also critical Particularly important to know where people go when they exit programs

HMIS Participation Rate From HIC (January 2018) In Suburban Cook County it appears that participation is very high

Data Quality (October 2016 – September 2017) Relatively low rates of missing and unknown data, which is also good.

Data Quality Impact: Palm Beach, FL % We don’t have any reason to think there are data quality issues, but we wanted to share this example to illustrate how critical data quality is to understanding system performance. In Palm Beach, FL, we found that there was a high rate of exit to unknown destinations in the HMIS data system. This slide shows that for RRH programs for families, 27% exited to unknown destinations. This community worked on a data clean up and data quality improvement effort. Once this was done, they were able to determine that 68% actually exited to PH and there was only a 4% unknown exit rate.

Discussion Let’s stop here and see what comments and questions people have about the data we showed. What other types of data do you think would be helpful for us to present as part of the community input sessions, to help you think about strategies to reduce homelessness? What other questions do you think it is important to answer?

Next Steps in the Planning Process

Input Sessions In-person sessions: May 30 and 31 Broad stakeholder participation Geographic coverage Possibly some “theme” sessions Stakeholders invited to provide input on: Current system strengths & gaps Opportunities for system improvement Priorities: where to focus efforts in next three years

Board Retreat All day retreat: July 18, 2018 Board members will: Review system data Review input from stakeholders Develop strategies to create a more systematic response to homelessness

Discussion and Closing So, this is the final opportunity for people to weigh in with their questions. We also would like to hear in particular if you have any suggestions or requests for the input sessions in May. We are thinking of having two general sessions, organized by region (one for the south and one for the north/west). Then we will probably have a few that are on specialized themes that are of particular importance to the community (e.g. families and youth; prevention/diversion; chronic homelessness). What would people like to see in terms of how these sessions are organized?