System Level Performance Measurement: Using HMIS to Drive Change Darlene Mathews, The Community Partnership Lianna Barbu, Community Shelter Board September 23, 2008

Learning Objectives Learn the fundamentals of performance measurement. Learn how to develop and use HMIS-based performance measures to support local system planning and policymaking on homelessness. Identify strategies to use HMIS-based performance measures to improve program and system performance. 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Why HUD is Interested in Performance Measurement Accountable to Congress, OMB, the White House, and taxpayers HUD’s overall objective: to “end chronic homelessness and to move homeless families and individuals to permanent housing” At least 71.5% of formerly homeless individuals will remain housed in HUD permanent housing projects for at least 6 months At least 63.5% of homeless persons will move from HUD transitional housing into permanent housing At least 19% of persons exiting HUD homeless assistance projects will be employed CoC’s accountable for achieving & documenting results Performance Measurement 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Performance Measurement Fundamentals 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

What is Performance Measurement? Performance measurement is a process that systematically evaluates whether your Continuum of Care’s efforts are making an impact on the clients you are serving. 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Multiple Levels of Performance Measurement Local Service Provider 1. Program Level APR or Other Performance Measurement Tool CoC 2. CoC/System Level CoC Application or Other Performance Measurement Tool 3. State Level State-Specific Performance Measurement Tool 4. National Level GRPA and PART Reviews 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Purpose of System Measurement Are actions achieving intended goals? What is the purpose of the system? Goals? Does the system work? If yes, what makes it work? If no, what part doesn’t work, and how do you fix it to make it work? Note that you may have system goals that only relate to certain types of clients or parts of the system (e.g., different goals for severely disabled persons) 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Performance Measurement Building Blocks Inputs include resources dedicated to, or consumed by, the system—e.g., money, programs, facilities. Activities are what the system does with the inputs to fulfill its mission, such as providing shelter, feeding the homeless, or providing job training. Outputs are the direct products of system activities. They usually are presented in terms of the volume of work accomplished—e.g., number of participants served, number of service engagements, number of shelter nights. Outcomes are benefits or changes among clients during or after participating in system activities. Outcomes may relate to change in client knowledge, attitudes, values, skills, behaviors, conditions, or other attributes. 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Example: Single Adult Shelter System’s Impact Over Time Outputs Outcomes Short-term 400 single adults will receive shelter and access to services. 350 clients will receive individualized housing information and referral assistance. 75% of clients will have a plan to obtain and maintain stable housing. 50% of clients who exit will obtain stable housing. 180 clients will receive weekly check-up calls and problem solving assistance, as needed, after exiting to stable housing. 85% of clients who obtain stable housing will not return to shelter within 12 months (43% of all exits). Long-term 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Framework for Converting System Goals into Outcomes Who is the base for measuring results? Step 1 What do you hope to achieve with this population? Step 2 Within the base, how many persons achieved it? Step 3 Who is the base population for measuring results? Within the base, how many persons achieved it? Step 4 Outcome (%) 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Converting System Goals into Outcomes: Example Program Goal: Exiting single adult shelter clients into “stable” housing Step 1 Step 2 Step 3 Persons who exited during the past year (N= 400) Obtain stable housing 200 persons obtained stable housing 400 200 Step 4 50% obtained stable housing 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Look Out for Ambiguous Concepts Developing and measuring performance outcomes often invites ambiguous concepts into the process. For example, what do we mean by… …obtaining stable housing? …obtaining employment? …increasing income? …accessing services? …becoming more self-sufficient? Which data elements and responses will count? 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Key Underlying Assumptions Outcomes can be calculated consistently for all clients if, and only if: Staff are collecting the required information at entry and exit for each client. Staff are recording this information into the HMIS in a timely fashion (e.g., 4th business day of every month for prior month). The target population is clearly defined. The program goals are clearly defined for the target population. 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Developing Performance Measures: Key Elements For each measure (output or outcome): Purpose: identifies the reason for the measure Application: identifies the programs and/or system for which a measure applies Definition: definition for the measure Goal-Setting Methodology: used by program or system to set goals around the measure Reporting Methodology: detailed description of how measure is calculated Use HMIS data elements Develop and test before implementation 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Example: Successful Housing Outcome a) Purpose: Indicates program’s success in ending homelessness by linking households to appropriate next step housing which includes transitional and permanent housing. A higher number and rate are considered positive. b) Programs: All c) Definition: the number of distinct households that exit (i.e., latest exit for households with multiple stays during report period) to successful housing as defined in Table X and the percentage this represents of total distinct households exited during the report period. d) Goal-setting methodology: Meet or exceed CoC goal or prior performance. Multiply the percentage goal by the projected number of exited households (i.e., latest exit for households with multiple stays during the report period). e) Reporting methodology: Calculate the total number of distinct household exits and the total number of destinations that are considered successful housing outcomes. Divide the number of successful housing outcomes by the number of total exits during the report period. 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Considerations When Developing Measurement Methodology Specify all parts of query/calculation: Programs Across a program type (e.g., all outreach, all PSH programs) All programs Programs that serve a specific subpopulation Clients (de-duplicated across programs) All Exiters All participants All currently enrolled Those who stayed > 6 months Data Elements Same HMIS elements as program measures Need rules to reconcile data across programs if client was enrolled in more than one program Timeframe Define date range Specify date field (entry date, exit date, placement date, assessment date, etc.) You have to define all parts of your query 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Wherever Possible Use HMIS to Define Your Concepts Based on the Destination HMIS data element, we can define stable housing (narrowly) using the following response categories: Emergency shelter Apartment or house that you own Transitional housing Staying/living with family Permanent housing Staying/living with friends Substance abuse facility or detox center Hotel or motel voucher paid for without ES voucher Hospital (non-psychiatric) Foster care home or group home Jail, prison, or juvenile detention center Place not meant for human habitation Room, apartment, or house that you rent Other Don’t Know Refused 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Performance Measurement Methods 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Performance Measurement Methods Measure Interim Outcomes by Applying Program Measures System-wide Use Program Performance Results to Change or Manage the System Measure System Results with HMIS-Based Impact Outcomes 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

1st System Performance Measurement Method Measure Interim Outcomes by Applying Program Measures System-wide What: Examine how the system (across all programs or across part of a system) performs on a specific measure Example: What percentage of all homeless persons have greater incomes when they leave the homeless system? Example: What percentage of all homeless single men leave the shelter system for transitional or permanent housing? Use: Mid-term (e.g., annually) To assess and communicate the overall system’s success in helping clients achieve intended outcomes To indicate interim success towards overall impact goal To reinforce or adjust current expenditures and support new funding requests 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Establishing System Performance Measures Adopt system goals Past performance data Account for state and federal goals Account for local goals related to achievement of long-term impact Establish program performance expectations based on system goals Negotiate with agencies Incorporate into CoC/funding agreements Include quarterly, semi-annual, annual goals Response to low performance Performance reports Set frequency Determine audience/distribution Use data that meets quality standards System and program level performance 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Case Study: Columbus, Ohio Performance Measures Prevention Outreach Emergency Shelter Resource Specialists Rapid Re-Housing Permanent Supportive Housing Number Served  Successful Housing Outcomes Average Length of Stay Average Length of Participation Recidivism Successful Income Outcomes (Tier II shelter) Direct Client Assistance Utilization Occupancy Housing Stability Housing Retention 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Case Study: Columbus, OH Performance Reporting Annual Evaluation System & program measures compared to period goal Used to help determination annual funding Data mostly derived from HMIS Programs scored as: High: no less than one not achieved Medium: half or more achieved Low: less than half achieved Quarterly System & Program Indicator Reports System & program performance measures compared to period goal Used to identify system(s) and program(s) “of concern”, need for intervention Annual Community Report on Homelessness Annual and trend data Point-in-time count data Reports issued to CSB Board of Trustees, CoC Steering Committee, funders, www.csb.org 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Case Study: Washington, DC Performance Measures   Clients Served (all) Clients Served (chronic) Facility Occupancy Rate Clients Engaged in Case Mgmt Exits (Positive & Negative) Clients w/ Income Upon Exit Length of Stay Self Sufficiency Low Barrier & Severe Weather  Temporary Shelters Transitional Housing Permanent Supportive Housing Low Barrier and Severe Weather Shelters are not required to set measures for the baseline Performance Indicators listed above because they are not indications on the quality of services offered. However, like all other programs, they are responsible for ensuring that their data is accurate so that we may calculate Occupancy, Clients Served and Chronically Homeless numbers per site. Self Sufficiency Temporary, Transitional and Permanent Supportive Housing Programs required to submit a Self Sufficiency Indicator will have to choose from Substance Abuse, Education, Mental Illness Assistance or Employment. 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Case Study: Washington, DC Performance Measures (con’t) Outputs/Efficiency Measures Clients Served Chronically Homeless Served Occupancy: the rate at which program was used Interim Outcome Measures Permanent Housing Positive client destinations at exit (TH programs) Retain clients for 6+ months (PSH programs) Income: the amount of income or sources obtained Self-Sufficiency: change in substance use, education, mental illness or employment Measures apply differently to each program type and are supplemented with qualitative data for ranking purposes 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

2nd System Performance Measurement Method Use Program Performance Results to Change or Manage the System What: Compare performance results on selected program measures from one program to another. (Risk adjust for client differences.) Our system is not as effective as we want in increasing client incomes… which programs are working best or least well? Use: Mid-term (e.g., annual) To help understand whether individual programs are working To help decide how to allocate dollars or rank programs for funding To identify best practices or agencies that need TA To determine how performance expectations should differ for different populations, and how to refer clients most appropriately Theory: Programs with the same goals can be compared to understand and improve performance of each program individually and the system as a whole 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Caveats of System Performance Measurement & Analysis May require a lag in time even beyond the client’s completion of program involvement Measuring recidivism requires a certain period of time (12 months?) after program exit in which return to the system might occur If the HMIS only includes data from a subset of programs, the system analysis will provide an incomplete picture Perceived decline in recidivism may only reflect absence from participating providers as opposed to not being homeless anymore 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Apples to Apples: Risk Adjustment Problem: Comparing program results can encourage programs to “cream” to ensure strong results Solution: Risk adjustment allows differences to be accounted for in client populations when comparing results across programs Results can be adjusted on the basis of… Client characteristics, such as demographics, family size, disability Client history, such as past eviction, criminal background Client functionality or level of engagement/commitment to change To adjust for client differences, programs need to collect consistent data on clients to use during analysis of program results Agree on these standards beforehand Develop an analysis plan for how to adjust for client differences Engage a researcher to help develop the plan Even if results not formally adjusted, acknowledge that different programs may have different outcome expectations based on differences in clients targeted and/or served 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

3rd System Performance Measurement Method Measure System Results with HMIS-based Impact Outcomes What: Define a process to track the impact of the system’s efforts on the need/problem. Is the system reducing the time that people stay homeless, and therefore reducing the point-in-time prevalence? Use: Long-term (e.g., three years) To determine if you need to continue actions, expand current efforts (add resources to the current system), tweak current efforts, or fundamentally change the structure and approach of your homeless system To evaluate whether past actions (expanding the system or adding money) helped address the issue To communicate the overall system’s success (such as, when justifying funding requests) Theory: In the long-term, important to demonstrate that the collective actions of the system solve the problem. 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Sample Impact Measures Incidence of homelessness - Is homelessness declining? Incidence of street or CH - Is street or chronic homelessness declining? Length of stay in system, across all homeless programs - Do people stay homeless for shorter periods of time? Rates of Recidivism – Are repeat occurrences of homelessness avoided or declining? Cross-tabulate results by core characteristics to understand if/how results vary for different subpopulations Provide a one-pager on data/steps to calculate each of these for a CoC. 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Some notes of caution… There is more to performance measurement than conducting the analysis Educate, train, obtain buy-in Be careful about how data is interpreted and used Jump in, but don’t be careless in how results are used Look at the results within the context of all the outputs, interim measures and impact measures to validate the interpretation that’s being made Vet the results before publicly releasing anything Appropriately caveat the limitations of the data and analysis 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Look before you leap…. It appears that the rate of family homelessness is going down. 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

…Lesson Learned Reality: Programs couldn’t accept new families as beds were still occupied by existing clients who had dramatically longer LOS. 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Value of Performance Measurement Communicates more accurate description of population (vs. individual, anecdotal needs) Creates higher level of understanding of community problem (builds community support) Informs resource allocation (annual funding) Informs program development/improvement (CQI) Informs policy options (more shelter vs. housing) 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Additional Resources What Gets Measured Gets Done: A Toolkit on Performance Measurement for Ending Homelessness, National Alliance to End Homelessness, www.endhomelessness.org The Community Partnership for the Prevention of Homelessness (Washington, DC) www.community-partnership.org Community Shelter Board (Columbus, OH) www.csb.org 2008 HMIS Training: Setting the Standard - U.S. Department of Housing and Urban Development

Questions & Discussion