Targeting Interventions for Homeless Families and Individuals: Program & System Approaches to Better Targeting National Alliance to End Homelessness Annual Conference Tom Albanese July 28, 2008

2 Program & System Change: Process Steps Step 1: Assess current client characteristics/needs Step 2: Assess current program/system model, resources and performance Step 3: Investigate other approaches, best practices Step 4: Design future program/system and outline goals Step 5: Implement and evaluate a pilot to test new approach and assumptions Step 6: Implement program/system change

3 Step 1: Assess current client characteristics/needs Admitted/served Not admitted/served due to: – barriers to access – choose not to access – needs greater than program/system capacity – ineligible or denied – pending-waitlist Demographics, resources, service utilization, housing history, etc. Q: How do those admitted/served differ from those not admitted/served? Q: Who’s not being served and why? Q: Are clients being linked to the appropriate service and/or housing resource(s)? How is this done? Is there an assessment tool currently used to determine the best service/housing linkage?

4 Step 2: Assess current program/system model, resources, and performance Current Program/System Model – mission/purpose – target population – referral sources – services – housing – partnerships – staffing Q: Does the mission/purpose reflect community values and client needs? Q: Is there a clear system mission/purpose? Q: Is the target population efficiently identified and linked to the program/system? How do individuals/families access and flow through the program/system? Q: How are system resources-services and housing-organized? Are they organized in a way that most efficiently and effectively links clients with differing needs to the appropriate intervention? Q: How do persons without shelter access the system? Is there a single point of access, multiple points, centralized administration/decentralized access, other means? Q: What works well and should be retained?

5 Step 2: Assess current program/system model, resources, and performance Program/System Resources – current cash/in-kind: services, operating – potential cash/in-kind: services, operating Q: Are program resources sufficient to achieve program objectives and outcomes? Q: How flexible are program resources? Can program resources be used in different ways? Q: Do funders have an interest in better targeting/service matching? Q: What other resources are available to support program/system objectives and outcomes?

6 Step 2: Assess current program/system model, resources, and performance Program/System Performance – Outputs: number served, nights of service, average length of stay, etc. – Outcomes: housing, ‘graduation’ rate, income/benefits, educational attainment, health/recovery, recidivism, etc. Q: What’s different between those deemed successful and those not successful? Are those who most need the service also the most likely to not be successful? Q: Does the program/system model facilitate or hinder achievement of program outcomes? Q: Is housing stability a primary goal? Why or why not? Q: How are clients who don’t progress toward housing stability (i.e. “long-stayers”, “chronically homeless”) identified? Q: How are outcomes monitored? What is the program/system consequence for non- achievement? Q: Do program outcomes align with client, funder, community expectations and requirements?

7 Example: Analysis of Family Homeless Episodes… # of Homeless Episodes Among Families Source: Montgomery Co., MD: HMIS data analysis, # of Homeless Episodes Among Individuals

8 Example: Analysis of Family Homeless Episodes… # of Days per Episode of Homelessness Families Individuals Source: Montgomery Co., MD: HMIS data analysis, Q: What are the characteristics of families with one episode? Multiple episodes? What’s different between these groups?

9 Step 3: Investigate other approaches, best practices Benchmarking  The American Productivity & Quality Center ( defines benchmarking as “the process of identifying, learning, and adapting outstanding practices and processes from any organization, anywhere in the world, to help an organization improve its performance. Benchmarking gathers the tacit knowledge--the know-how, judgments, and enablers--that explicit knowledge often misses.” – programs locally or in other communities that serve the target population and have good outcomes – direct contact (e.g. interviews) with key contacts or review of related documentation or research Q: Who else is serving the target population and doing it well? How do they identify and engage the target population? Q: What works in other programs/communities that can be replicated? Q: How are they funded? Q: What key partnerships support their model? How are the partnerships managed? At system or program level or both? Q: What tools, forms, policies, procedures support their model? Can these be shared/modified?

10 Step 4: Design future program/system and outline goals Program/System Plan: – mission/purpose – target population: prioritization/selection criteria – referral sources – client pathway: first contact to service termination – program/system services, housing – partnerships, on-site or off-site – resources needed – client outcomes Q: How can interventions (services/housing offered) and outcomes be differentiated according to differing client needs? Q: Who identifies the target population? What’s the most efficient approach? Q: Do partner expectations align with the program model? Q: Does one or more funding sources need to approve a modified program model? Q: Does program/system quality and performance monitoring need to be changed to better inform management and funders?

11 Step 5: Design and implement a pilot Pilot the proposed program/system model to test – assumptions – triage/assessment tools, other forms – policies/procedures – process efficiency – client outcomes – resources needed – staff skills needed Develop evaluation plan before implementing: What is being evaluated? What data needs to be collected? How/when/where/who will collect data? Retain expert evaluator if feasible Use findings to inform full program/system implementation: What was learned? What needs to change? Is further testing needed?

12 Step 6: Implement program/system change Take successful aspects of pilot to scale-i.e., full program/system implementation Develop evaluation plan to test full implementation at regular intervals Retain expert evaluator if feasible Use findings to inform future program/system improvements

13 Example: Columbus Rebuilding Lives Plan Research concluded that: – permanent supportive housing successfully ended homelessness for chronically homeless individuals – Multiple and diverse PSH options – No single, easy to navigate access point for clients and advocates: clients with greatest needs not always admitted – Because supportive housing is scarce and valuable resource, need to prioritize admission for those with the greatest needs RL Plan Strategy: Create a unified system for supportive housing which includes centralized eligibility determination, prioritization and placement, periodic review of tenant needs, and “move up” incentives to encourage tenants to be more independent : pilot aspects of future system – Centralized referral, assessment, matching at two new PSH projects – Periodic tenant review/assessment and move-up assistance with existing PSH projects 2011: full system implementation

14 Example: Columbus Rebuilding Lives Plan Targeting to focus on individuals and families who: – Meet local Rebuilding Lives criteria (long-term homeless, disabled) – Are identified using administrative data (e.g HMIS) as high service utilizer and/or meet other high risk/vulnerability criteria System level administrative process to screen/link prospective clients to PSH options Clients not deemed eligible and priority referred to less intensive assistance (i.e., transitional assistance such shallow rent subsidies, etc.)

15 Other key considerations… No “one size fits all” approach to targeting and assessment Keep it simple-for clients, staff, other stakeholders – Easily administered scales to identify level of need, appropriate intervention – Readily accessible process for clients/advocates Does everyone need to agree? Who needs to buy-in? – Success may be contingent on buy-in and support from providers, funders, consumers, advocates and other key stakeholders. Design a process that gathers and uses input from key stakeholders from the onset. – Intentional, thoughtful communication key – local government, stakeholders, providers, users – How will other providers react? Other systems of care? Will changes create stress for other providers/systems or require them to make adjustments? What is the cost of change and how much are you willing to spend in dollars and political capital? Good quality data are essential to both program design (knowing who you’re targeting) and implementation (knowing when you’ve successfully identified and served intended target population) Is the process (current or proposed) consumer friendly (e.g., easily navigated, client choice, due process if denied, etc.). If not, make changes.

16 Tom Albanese Abt Associates Inc.