1. 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

2. Agenda Overview 1. Welcome & Introduction
Jennifer Hill, Executive Director, Alliance
2. Presentation by Focus Strategies
Introduction to Focus Strategies
Review of Strategic Plan
Planning Framework for
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.

3. 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

4. Purpose of Our Work in Suburban Cook County
Facilitate development of a new three-year Strategic Plan to End Homelessness
Build upon previous plan ( )
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

5. 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

6. 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.

7. 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

8. 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.

9. 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 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).

10. 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.

11. 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

12. 2018-2021: Creating a Systematic Response to Homelessness
The 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?

13. 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.

14. 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.

15. 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.

16. Homeless Crisis Response System

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

18. 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

19. 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?

20. 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].

21. Ending Homelessness Graph
Homeless Crisis Response System!

22. 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?

23. 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.

24. 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.

25. 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

26. 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.

27. 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

28. 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).

29. 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.

30. 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.

31. 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.

32. 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

33. 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.

34. 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

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

36. 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

37. 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.

38. 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

39. 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

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

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

42. 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.

43. 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?

44. Next Steps in the Planning Process

45. 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

46. 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

47. 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?