1. 1 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Mary Schwartz Washington State Department of Commerce Melissa Ford Shah Washington Department of Social and Health Services Conference on Ending Homelessness Yakima, Washington MAY 22, 2014 Ending Homelessness In Washington State: What The Data Tells Us Getty Images, iStock

2. 2 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Roadmap 1.Two Efforts to End Homelessness in Washington State 2.DSHS-Commerce Research and Data Partnership 3.Informing the Chronic Homelessness Policy Academy 4.Data on the Ending Family Homelessness Pilot Project Getty Images, iStock

3. 3 DSHS | Research and Data Analysis Division ● MAY 22, 2014 PART 1 Overview of Two Efforts to End Homelessness in Washington State Getty Images, iStock

4. 4 DSHS | Research and Data Analysis Division ● MAY 22, 2014 MISSION STATEMENT Promote sustainable housing as part of recovery for chronically homeless people VISION Ending chronic homelessness for most vulnerable high cost system users FOCUS Develop and implement a model for ending the experience of chronic homelessness for 3,000 people identified in 2013, and replicate the model to a system-wide level by 2016 Chronic Homelessness Policy Academy: Housing 3,000 Subcommittee

5. 5 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Chronic Homelessness Policy Academy: Housing 3,000 Subcommittee STEPS 1.End Chronic Homelessness in the State of Washington through targeted, solution-oriented approaches that can be scaled for efficacy around the State 2.Permanently house 3,000 people experiencing chronic homelessness in the State of Washington 3.Build a collaborative, integrated approach to identify and connect individuals who experience chronic homelessness with comprehensive services to support permanent housing

6. 6 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Washington State Policy Academy Process WORKGROUPFOCUSNEXT STEPS Expanding Housing Meet with key stakeholders to identify housing needs and opportunities Bring together Federal, State and County level agencies and stakeholders Data Integrate data to improve our understanding of the needs of homeless veterans Analyze medical and behavioral health costs for homeless Medicaid clients If awarded, a SAMHSA supplemental grant will fund an analysis of homeless veterans CSH and WLIHA finalizing a White Paper that includes a medical cost analysis for chronically homeless individuals System Design Configure the “pieces” of the overall Policy Academy activity to build a long term (and sustainable) solution to ending chronic homelessness in the State of Washington Working to add supportive services to Medicaid benefit Implementing BRIDGES grant, which provides behavioral health supportive housing services Key Activities:

7. 7 DSHS | Research and Data Analysis Division ● MAY 22, 2014 In April 2013, five counties (Cowlitz, Mason, Snohomish, Spokane and Whatcom) implemented a pilot program involving: – Active coordination with local CSOs, WorkSource, and housing providers – Goal of moving homeless TANF families into permanent housing immediately while connecting them to services so income could support that housing in 6 months January 2014: Pilot program was expanded under the consolidated homeless grant (CHG); continued partnership between Commerce, DSHS and ESD Statewide technical assistance being provided to EFH providers in partnership with Building Changes and the Gates Foundation Research being conducted by RDA on outcomes of 80+ households served in the pilot Ending Family Homelessness (EFH): Rapid Re-housing for Homeless Families on TANF

8. 8 DSHS | Research and Data Analysis Division ● MAY 22, 2014 PART 2 DSHS and Commerce Research and Data Partnership Getty Images, iStock

9. 9 DSHS | Research and Data Analysis Division ● MAY 22, 2014 School Outcomes Preschool – College Washington State DSHS Integrated Client Database Internal Arrests Births Deaths Charges Convictions Incarcerations Community Supervision Dental Services Medical Eligibility Medicaid, State Only Hospital Inpatient/ Outpatient Managed Care Physician Services Prescription Drugs Hours Wages Housing Assistance Emergency Shelter Transitional Housing Homeless Prevention and Rapid Re-housing Permanent Supportive Housing Public Housing Housing Choice Vouchers Multi-Family Project-Based Vouchers External Administrative Office of the Courts Employment Security Department Department of Health Department of Corrections Washington State Patrol Department of Commerce Health Care Authority Housing and Urban Development Public Housing Authority WASHINGTON STATE Department of Social and Health Services INTEGRATED CLIENT DATABASE WASHINGTON STATE Department of Social and Health Services INTEGRATED CLIENT DATABASE Nursing Facilities In-home Services Community Residential Functional Assessments Case Management Community Residential Services Personal Care Support Residential Habilitation Centers and Nursing Facilities Medical and Psychological Services Training, Education, Supplies Case Management Vocational Assessments Job Skills Child Protective Services Child Welfare Services Adoption Adoption Support Child Care Out of Home Placement Voluntary Services Family Reconciliation Services Institutions Dispositional Alternative Community Placement Parole Food Stamps TANF and State Family Assistance General Assistance Child Support Services Working Connections Child Care DSHS Juvenile Rehabilitation DSHS Economic Services DSHS Aging and Long- Term Support DSHS Developmental Disabilities DSHS Vocational Rehabilitation DSHS Children’s Services Child Study Treatment Center Children’s Long- term Inpatient Program Community Inpatient Evaluation/ Treatment Community Services State Hospitals State Institutions Assessments Detoxification Opiate Substitution Treatment Outpatient Treatment Residential Treatment DSHS Behavioral Health and Service Integration Mental Health and Substance Abuse Services Education Research Data Center De-identified

10. 10 DSHS | Research and Data Analysis Division ● MAY 22, 2014 The vast majority of housing clients in HMIS have been DSHS clients In State Fiscal Year (SFY) 2013, 78 percent of HMIS housing recipients gave consent and had sufficient information for linkage to DSHS records (71,652 of 91,524) 91 percent of those who could possibly be linked were found in the DSHS Integrated Client Database (64,974 of 71,652) HMIS ALL Housing Assistance Recipients n = 91,524 Gave consent and had sufficient information for linking n = 71,652 DSHS-HMIS HMIS Linked to DSHS Integrated Client Database n = 64,974 HMIS Housing Program Clients with DSHS Service History SFY 2013

11. 11 DSHS | Research and Data Analysis Division ● MAY 22, 2014 PART 3 Identifying Chronically Homeless Individuals in Washington State Getty Images, iStock

12. 12 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Data on chronic homelessness is missing for four counties in Washington because it is not part of the HMIS data standards THURSTON GRAYS HARBOR MASON JEFFERSON CLALLAM WHATCOM SAN JUAN ISLAND KITSAP SKAGIT SNOHOMISH KING PIERCE LEWISPACIFIC WAHKIAKUM COWITZ CLARK SKAMANIA YAKIMA KLICKITAT KITTITAS CHELAN DOUGLAS OKANOGANFERRYSTEVENS PEND OREILLE GRANT BENTON FRANKLIN WALLA ADAMS LINCOLN SPOKANE WHITMAN GARFIELD COLUMBIA ASOTIN  Everett  Tacoma  Spokane

13. 13 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Proportion of homeless population meeting criteria for chronic homelessness *NOTE: This data represents all HMIS entries in the state in CY 2012, with the exception of Clark, Pierce, Snohomish, and Spokane counties. These records are not unduplicated at the client level. Chronically Homeless, January 2013 Point in Time Count TOTAL HOMELESS IN STATE = 17,775 Chronically Homeless, CY 2012 HMIS Entries * TOTAL CY 2012 ENTRIES IN HMIS = 22,158 Chronically Homeless 12% n = 2,219 Chronically Homeless * 20% n = 4,345 Homeless not chronically 88% n = 15,556 Homeless not chronically 80% n = 17,813

14. 14 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Characteristics of Washington’s Chronically Homeless Population DEMOGRAPHICS TOTAL = 4,345* n = 1,573n = 699n = 359n = 1,462n = 2,760 *NOTE: This data represents all HMIS entries in the state in CY 2012, with the exception of Clark, Pierce, Snohomish, and Spokane counties. These records are not unduplicated at the client level.

15. 15 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Characteristics of Washington’s Chronically Homeless Population HOMELESS EPISODES TOTAL = 4,345* Continuously Homeless 83% n = 3,627 Frequently Homeless 48% n = 2,076 Both Continuously and Frequently Homeless 31% n = 1,358 *NOTE: This data represents all HMIS entries in the state in CY 2012, with the exception of Clark, Pierce, Snohomish, and Spokane counties. These records are not unduplicated at the client level.

16. 16 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Characteristics of Washington’s Chronically Homeless Population HEALTH AND BEHAVIORAL HEALTH CONDITIONS TOTAL ENTRIES = 4,345* n = 612n = 2,089n = 1,702n = 1,968n = 3,037 *NOTE: This data represents all HMIS entries in the state in CY 2012, with the exception of Clark, Pierce, Snohomish, and Spokane counties. These records are not unduplicated at the client level.

17. 17 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Identifying Chronically Homeless Population with the ICDB: Medical assistance clients meeting HUD definition Homeless in June 2012 n = 10,532 52% Yes. Got Assistance 12% n = 2,445 No. Did not receive HMIS-Recorded Housing Assistance n = 8,087 40% Total Medical Assistance Population SFY 2012 = 1.5 million Met HUD definition of Chronically Homeless in SFY 2012 n = 20,174 1.3% Homeless in SFY 2012 but not in June 2012 n = 9,642 48%

18. 18 DSHS | Research and Data Analysis Division ● MAY 22, 2014 PART 4 Data on the Ending Family Homelessness Pilot Getty Images, iStock

19. 19 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Monthly EFH Enrollment Trends by Pilot County APRIL – SEPTEMBER 2013 Whatcom n = 30 Mason n = 20 Cowlitz n = 37 Snohomish n = 64 Spokane n = 94 35 128 167 235 249 TOTAL = 277 245 SOURCE: The Ending Family Homelessness Pilot: Rapid Re-Housing for TANF Families, Ford Shah, et.al., DSHS Research and Data Analysis Division, January 2014. http://publications.rda.dshs.wa.gov/1498/

20. 20 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Average Monthly EFH Costs per Household APRIL – SEPTEMBER 2013 Average cost per month of program participation for all heads of household with reported EFH costs... Average cost per service user per service month... RENT n = 71 SECURITY DEPOSIT n = 71 UTILITY DEPOSIT n = 71 MOTEL/HOTEL COST n = 71 ALL COSTS n = 71 $ 636 $ 180 $ 37 $ 36 $ 889 RENT n = 70 SECURITY DEPOSIT n = 60 UTILITY DEPOSIT n = 16 MOTEL/HOTEL COST n = 8 ALL COSTS $ 688 $ 592 $ 207 $ 800n/a SOURCE: The Ending Family Homelessness Pilot: Rapid Re-Housing for TANF Families, Ford Shah, et.al., DSHS Research and Data Analysis Division, January 2014. http://publications.rda.dshs.wa.gov/1498/

21. 21 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Prior Living Situation Recorded in HMIS for EFH Recipients Emergency Shelter 67% n = 75 57% n = 158 19% n = 13 65% n = 24 64% n = 23 96% n = 23 Place not meant for human habitation All others 22% n = 25 38% n = 105 78% n = 53 35% n = 13 36% n = 13 4% n = 1 11% n = 12 5% n = 14 3% n = 2 TOTAL = 277 TOTAL = 112 TOTAL = 68 TOTAL = 37 TOTAL = 36 TOTAL = 24 SOURCE: The Ending Family Homelessness Pilot: Rapid Re-Housing for TANF Families, Ford Shah, et.al., DSHS Research and Data Analysis Division, January 2014. http://publications.rda.dshs.wa.gov/1498/

22. 22 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Three-Year Shelter Use History for EFH Participants: Chronic, Temporary, and Episodic Homelessness 10% n = 29 14% n = 38 No Prior Shelter 42% n = 115 Episodic Homelessness 2% n = 6 TOTAL CASES = 277 Chronic Homelessness Temporary Homelessness Prior Shelter Not Recorded in HMIS* 32% n = 89 74% n = 204 *Program staff in the five pilot counties confirmed that these 89 individuals with prior shelter not recorded in HMIS were either 1) entering EFH from shelters not required to report into HMIS or 2) fleeing domestic violence when served in shelter. Three-Year History: EFH Clients with Prior Shelter Use in HMIS Temporary (n = 38) Episodic (n = 6) Chronic (n = 29) TOTAL (n = 73) Average number of shelter episodes12.31.1 Average number of days in shelter9.86.389.141.0 Average number of days per episode9.8386.639.8

23. 23 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Issues Identified in the Comprehensive Evaluation: EFH Parents Compared to Other TANF Parents EFH TANF Other TANF Other TANF Other TANF Other TANF Other 0 n = 24 of 105 8,725 of 55,505 n = 23 of 105 4,578 of 55,505 n = 38 of 105 8,217 of 55,505 n = 22 of 105 5,962 of 55,505 n = 45 of 105 20,542 of 55,505 SOURCE: The Ending Family Homelessness Pilot: Rapid Re-Housing for TANF Families, Ford Shah, et.al., DSHS Research and Data Analysis Division, January 2014. http://publications.rda.dshs.wa.gov/1498/

24. 24 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Pregnancy and Ages of Children in the Household: EFH Parents Compared to Other TANF Parents EFH TANF Other TANF Other TANF Other TANF Other TANF Other 0 n = 8 of 105 5,719 of 55,505 n = 55 of 105 25,491 of 55,505 n = 32 of 105 17,737 of 55,505 n = 25 of 105 11,974 of 55,505 n = 0 of 105 973 of 55,505 SOURCE: The Ending Family Homelessness Pilot: Rapid Re-Housing for TANF Families, Ford Shah, et.al., DSHS Research and Data Analysis Division, January 2014. http://publications.rda.dshs.wa.gov/1498/

25. 25 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Percent Homeless or Unstably Housed: April 2011-March 2012 20112012 EFH Parents Other TANF Parents SOURCE: The Ending Family Homelessness Pilot: Rapid Re-Housing for TANF Families, Ford Shah, et.al., DSHS Research and Data Analysis Division, January 2014. http://publications.rda.dshs.wa.gov/1498/

26. 26 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Behavioral Health and Medical Risk Indicators AMONG THOSE WITH MEDICAL COVERAGE EFH TANF Other TANF Other TANF Other TANF Other 0 n = 26 of 105 8,575 of 55,505 n = 20 of 105 4,436 of 55,505 n = 52 of 105 20,579 of 55,505 n = 52 of 105 19,374 of 55,505 n = 16 of 105 4,958 of 55,505 EFH TANF Other n = 29 of 105 11,525 of 55,505 n = 24 of 105 6,853 of 55,505 Alcohol and/or Other Drug (AOD) Use 24-month baseline period Mental Health 24-month baseline period Medical Indicators 12-month baseline period SOURCE: The Ending Family Homelessness Pilot: Rapid Re-Housing for TANF Families, Ford Shah, et.al., DSHS Research and Data Analysis Division, January 2014. http://publications.rda.dshs.wa.gov/1498/

27. 27 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Foster Care Placement In 12-Month Baseline Period EFH children were less likely to have had a foster care placement and more than twice as likely to experience poor health conditions IN BASELINE YEAR Proportion with Poor Health Status Among those with Medical Coverage EFH TANF Other n = 4 of 1454,156 of 104,899 EFH TANF Other n = 6 of 1452,164 of 104,899 00 SOURCE: The Ending Family Homelessness Pilot: Rapid Re-Housing for TANF Families, Ford Shah, et.al., DSHS Research and Data Analysis Division, January 2014. http://publications.rda.dshs.wa.gov/1498/

28. 28 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Coming Attractions... Youth at Risk of Homelessness (YARH) Planning Grant  Predicting homelessness among youth exiting foster care Vulnerable Families Partnership and TANF PRISM  Predicting homelessness among TANF households and providing information to caseworkers on key risk factors Ending Family Homelessness (EFH)  Evaluating the impact of the program on key outcomes for EFH participants compared to a statistically matched comparison group of their peers Housing and Essential Needs (HEN)  Evaluating the impact of HEN on key outcomes for recipients compared to a statistically matched comparison group of their peers

29. 29 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Identifying Homeless and Unstably Housed DSHS Clients in Multiple Service Systems APRIL 2012 Shah, Black, Felver http://publications.rda.dshs.wa.gov/1457/ The Housing Status of Individuals Discharged from Behavioral Health Treatment Facilities JULY 2012 Shah, Black, Felver http://publications.rda.dshs.wa.gov/1460/ Impact of Housing Assistance on Short-Term Homelessness Among TANF, Disability Lifeline, and Basic Food recipients with recently recorded spells of homelessness SEPTEMBER 2011 Shah, Estee, Mancuso, Black, Felver http://publications.rda.dshs.wa.gov/1443/ A Profile of Housing Assistance Recipients in Washington State: History of Arrests, Employment, and Social and Health Service Use MARCH 2011 Shah, Estee, Albrecht, Yette, Felver http://publications.rda.dshs.wa.gov/1438/

30. 30 DSHS | Research and Data Analysis Division ● MAY 22, 2014 Permanent Options for Recovery-Centered Housing: Year 1 Annual Report JUNE 2012 Galvez, Lucenko, Black, Felver http://publications.rda.dshs.wa.gov/1462/ Intensive Case Management within a Supportive Housing Facility OCTOBER 2008 Shah, Mancuso, Nordlund, Felver http://publications.rda.dshs.wa.gov/1367/ Behavioral Health Risk among TANF Parents: Links to Homelessness, Child Abuse and Arrests DECEMBER 2010 Shah, Mancuso, He, Estee, Felver, Beall, Fiedler http://publications.rda.dshs.wa.gov/1429/ Washington State’s Housing and Essential Needs Program Impacts on Housing Status, Use of Food Assistance, Arrests, Incarcerations, and Health Outcomes JANUARY 2013 Mancuso, Ford Shah, Black, Felver http://publications.rda.dshs.wa.gov/1476/

31. 31 DSHS | Research and Data Analysis Division ● MAY 22, 2014 For more Information.... Mary Schwartz mary.schwartz@commerce.wa.gov Melissa Ford Shah shahmf@dshs.wa.gov Getty Images, iStock