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Systems-Level Performance Measurement Setting the Bar High, Setting It Properly, and Clearing It San Systems-Level Performance Measurement Setting the Bar High, Setting It Properly, and Clearing It San Diego, CA Friday, February 13, 2009 Matthew D. Simmonds, President, Simtech Solutions Inc. National Alliance to End Homelessness Conference

Overview of the Approach o o o o o Identify the Need Create the Overview of the Approach o o o o o Identify the Need Create the Design Plans Gather the Tools Set the Foundation Build the Framework Measure Twice, Cut Once Monitor the Process Share the Outcomes Repeat National Alliance to End Homelessness Conference February 13, 2009 2

Identify the Need o o o Talk with Case Managers Look at Service Demands Identify the Need o o o Talk with Case Managers Look at Service Demands Follow the Money Do Your Homework Perform Client Surveys Check for Data Anomalies National Alliance to End Homelessness Conference February 13, 2009 3

Create the Design Plans o Provide Background on the Need o Identify Stakeholders and Create the Design Plans o Provide Background on the Need o Identify Stakeholders and Resource Needs o Set Performance Measures o Give it a Timeline o Announce the Plan o Get to Work National Alliance to End Homelessness Conference February 13, 2009 4

Gather the Tools o HMIS Software o Intake Sheets o Staff trained on HMIS Gather the Tools o HMIS Software o Intake Sheets o Staff trained on HMIS and “on board” o PC & Server Network(s) o Data Warehouse o Reporting Engine o Collaboration Utilities o Consumer Surveys National Alliance to End Homelessness Conference February 13, 2009 5

Set the Foundation o Define the Reporting Universe o Cleanse Existing Data o Define Set the Foundation o Define the Reporting Universe o Cleanse Existing Data o Define and Establish Business Rules o Define Security Requirements o Set a Performance Baseline from Current Findings National Alliance to End Homelessness Conference February 13, 2009 6

Build the Framework o Use a Proper Database Structure o Open or Closed? o Build the Framework o Use a Proper Database Structure o Open or Closed? o Define Regions and Other Relations o Build Custom Assessments and Reports o Role Based Security o Keep it Scalable o Allow for Data Exchange National Alliance to End Homelessness Conference February 13, 2009 7

Measure Twice, Cut Once o Create Protected and Self. Healing Systems o Manage the Measure Twice, Cut Once o Create Protected and Self. Healing Systems o Manage the Data Quality Identify Duplicates 2. Ensure Timely Data Entry 3. Check Completion Rates 4. Compare Occupancy with Capacity 1. National Alliance to End Homelessness Conference February 13, 2009 8

Monitor the Process o Dashboard Reporting o Define Reporting Levels and Stakeholders o Aggregate Monitor the Process o Dashboard Reporting o Define Reporting Levels and Stakeholders o Aggregate and Detail Reports o Ad hoc and Canned Reports o Implement Auditing and Accountability Measures o Provide Supporting Tools o Manage the Data Quality National Alliance to End Homelessness Conference February 13, 2009 9

Share the Outcomes o Peer Review and Benchmarking o Conferences and Meetings o The Share the Outcomes o Peer Review and Benchmarking o Conferences and Meetings o The Press o White Papers o Update the Plan National Alliance to End Homelessness Conference February 13, 2009 10

The Community Quincy-Weymouth Co. C General Population Count - 142, 013* The Need To The Community Quincy-Weymouth Co. C General Population Count - 142, 013* The Need To Reduce Individual Shelter Occupancy Business Rules Using HUD’s Chronic Definition Performance Baseline 275 homeless individuals on 3/18/04 *Source: 2000 US Census Figures National Alliance to End Homelessness Conference February 13, 2009

An Identifiable Need We compared the service utilization rates of the chronically homeless individuals An Identifiable Need We compared the service utilization rates of the chronically homeless individuals with the utilization rates of the non-chronic. This is what we found: o Chronic clients served FY 04 = 397 o Total clients served in FY 04 = 1285 o % clients that were chronic = 397/1285 or 30. 8% o Chronic clients served on 2/1/04* = 72 o Total clients served on 2/1/04 = 146 o % clients served that were chronic = 72/146 or 49. 3% Less than one third of the total clients were utilizing roughly half of the bed stays! * One of several randomly selected dates all of which showed similar results. Source: HMIS Data and Custom AS/400 Data Warehouse National Alliance to End Homelessness Conference February 13, 2009 12

The Design Plans Measurable Outcomes from Quincy’s 10 Year Plan to End Chronic Homelessness: The Design Plans Measurable Outcomes from Quincy’s 10 Year Plan to End Chronic Homelessness: o Reduce Inappropriate Discharges o Decrease Cost of Emergency Services o Increase Housing o Improve Regional Collaboration and Support Source: Quincy 10 Year Plan to End Chronic Homelessness National Alliance to End Homelessness Conference February 13, 2009 13

The Tools National Alliance to End Homelessness Conference February 13, 2009 14 The Tools National Alliance to End Homelessness Conference February 13, 2009 14

Measure Twice, Cut Once Sample Audit of Case Manager Assessments of Chronicity If the Measure Twice, Cut Once Sample Audit of Case Manager Assessments of Chronicity If the client has a disability (Fx=Yes), and they either had 4 or more homeless episodes (Gx=Y) OR were homeless for greater than 1 year (Jx>365), and are 18 years old or older (Kx>=18), and are an individual (household ID = blanks) then count them as chronically homeless. National Alliance to End Homelessness Conference February 13, 2009

Monitor the Process National Alliance to End Homelessness Conference February 13, 2009 16 Monitor the Process National Alliance to End Homelessness Conference February 13, 2009 16

Performance Goal 1: Reduce Inappropriate Discharges This data was shared with the Mass. Interagency Performance Goal 1: Reduce Inappropriate Discharges This data was shared with the Mass. Interagency Council on Homelessness as well as statewide advocacy groups such as Mass Housing and Shelter Alliance. This research resulted in: o A change in discharge policies from statewide systems of care. o A new Housing First pilot program assisting 20 young adults aging out of state systems. National Alliance to End Homelessness Conference February 13, 2009 17

Performance Goal 2: Decrease Cost of Emergency Services Cost Benefit Analysis – Shelter Vs. Performance Goal 2: Decrease Cost of Emergency Services Cost Benefit Analysis – Shelter Vs. Housing Hard costs per client at the shelter per year = $14, 600. Hard costs per client at Claremont House per year = $11, 195. Total savings per client = $3, 405. Cost Benefit Analysis – Medical Costs The Claremont House study showed out of 12 women placed emergency room visits dropped from 22 visits prior to housing to 11 after housing and inpatient stays dropped from 44 to 4. Dr. Barber from Quincy Medical stated cost savings to the community were roughly $60, 000 or $5000 per client for the first year of the study alone. National Alliance to End Homelessness Conference February 13, 2009 18

Performance Goal 3: Increase Housing Closed an emergency shelter due to lack of need Performance Goal 3: Increase Housing Closed an emergency shelter due to lack of need and took 35 total beds offline. 2+ years ahead of pace on the 10 year plan goal to build up 100 -120 housing units for the chronically homeless with 52 new units National Alliance to End Homelessness Conference Source: Quincy’s Annual Point in Time Count February 13, 2009 19

Performance Goal 4: Improve Regional Collaboration Application Inventory ss ele m Ho ot N Performance Goal 4: Improve Regional Collaboration Application Inventory ss ele m Ho ot N Prevention Initial Assessment Ho m ele ss Triage XM L ML X Our Community XM ML L X Shelter Program XML Re-housing & Stabilization o Initial Assessment* o HUD HMIS Data Collection & Reporting** o Bed Register** o Non-Homeless Data Collection* o HUD XML and CSV Data Exchange*** o Custom Assessments*** o GIS Mapping* o Agency Directory* o Referral Passing Tools* o Services Tracking*** o Housing Inventory Chart Mgmt Tools* o Point In Time Counting Tools* o Advanced Reporting* o PATH Data Collection & Reporting* o Data Quality Monitoring Tools & Reports*** * = Agency. Dash. com (non-HMIS) ** = SHORE (HMIS) Supportive Services SHORE *** = Both (HMIS) Agency. Dash. com (Non-HMIS) National Alliance to End Homelessness Conference February 13, 2009 20

Share the Outcomes National Alliance to End Homelessness Conference February 13, 2009 21 Share the Outcomes National Alliance to End Homelessness Conference February 13, 2009 21

Forecasting NAEH Conference February 13, 2009 22 Forecasting NAEH Conference February 13, 2009 22

Peer Benchmarking Source: Agency. Dash. com – Daily Bed and Meal Census July 1 Peer Benchmarking Source: Agency. Dash. com – Daily Bed and Meal Census July 1 2 -008 to Jan 31 2009 National Alliance to End Homelessness Conference February 13, 2009 23

Peer Benchmarking Source: Agency. Dash. com, November 15 2008 – Jan 31 2009 National Peer Benchmarking Source: Agency. Dash. com, November 15 2008 – Jan 31 2009 National Alliance to End Homelessness Conference February 13, 2009 24

Trend Analysis Source: Microsoft Excel and Agency. Dash. com Jan 2006 - Jan 2009 Trend Analysis Source: Microsoft Excel and Agency. Dash. com Jan 2006 - Jan 2009 National Alliance to End Homelessness Conference February 13, 2009 25

Trend Analysis Source: Microsoft Excel and Agency. Dash. com Jan 2006 - Jan 2009 Trend Analysis Source: Microsoft Excel and Agency. Dash. com Jan 2006 - Jan 2009 National Alliance to End Homelessness Conference February 13, 2009 26

Histograms Source: SHORE HMIS and Microsoft Excel Jan 2007 - Dec 2007 Histograms Source: SHORE HMIS and Microsoft Excel Jan 2007 - Dec 2007

Histograms Source: SHORE HMIS and Microsoft Excel Jan 2008 - Dec 2008 Histograms Source: SHORE HMIS and Microsoft Excel Jan 2008 - Dec 2008

Community Information Co. C Description - Brockton-Plymouth Point in Time Count – As of Community Information Co. C Description - Brockton-Plymouth Point in Time Count – As of January 30 th 2008, 645 persons were homeless Median Income - $71, 113* General Population Count – 494, 000* Co. C Description - Quincy-Weymouth Point in Time Count – As of January 30 th 2008, 256 persons were homeless Quincy Median Income - $55, 113* General Population Count - 142, 013** Source: * US Census ACS Survey, 2007 ** US Census 2000 National Alliance to End Homelessness Conference February 13, 2009 29

An Identifiable Issue NAEH Conference February 13, 2009 SOURCE: BEACON, Colleen Collins 1 -24 An Identifiable Issue NAEH Conference February 13, 2009 SOURCE: BEACON, Colleen Collins 1 -24 -09 30

Trend Analysis using PIT Data NAEH Conference February 13, 2009 Source: Microsoft Excel and Trend Analysis using PIT Data NAEH Conference February 13, 2009 Source: Microsoft Excel and Agency. Dash. com Brockton/Plymouth Co. C Jan 2006 - Jan 2009 31

Household Composition Plymouth County Source: SHORE HMIS Jan 1 2007 - Dec 31, 2007 Household Composition Plymouth County Source: SHORE HMIS Jan 1 2007 - Dec 31, 2007 National Alliance to End Homelessness Conference February 13, 2009 Quincy-Weymouth 32

Poverty Comparison National Alliance to End Homelessness Conference February 13, 2009 33 Poverty Comparison National Alliance to End Homelessness Conference February 13, 2009 33

Housing Stock Comparison Community - Brockton-Plymouth Total Housing Units – 191, 333 Occupied Units Housing Stock Comparison Community - Brockton-Plymouth Total Housing Units – 191, 333 Occupied Units – 172, 721 Vacant Units – 19, 916 (10. 3%) NAEHConference February 13, 2009 Community - Quincy Total Housing Units – 40, 637 Occupied Units – 37, 537 Vacant Units – 3, 100 (7. 6%) Source: US Census Bureau American Community Survey, 2007 34

Gender Comparisons Plymouth County Quincy Source: SHORE HMIS Jan 1 2007 - Dec 31, Gender Comparisons Plymouth County Quincy Source: SHORE HMIS Jan 1 2007 - Dec 31, 2007 National Alliance to End Homelessness Conference February 13, 2009 35

Disabilities and Housing Plymouth County Quincy Source: US Census Bureau American Community Survey, 2007 Disabilities and Housing Plymouth County Quincy Source: US Census Bureau American Community Survey, 2007 Source: SHORE HMIS Jan 1 2007 - Dec 31, 2007 National Alliance to End Homelessness Conference February 13, 2009 36

Housing Burden Comparison National Alliance to End Homelessness Conference February 13, 2009 37 Housing Burden Comparison National Alliance to End Homelessness Conference February 13, 2009 37

Rent as % of Household Income National Alliance to End Homelessness Conference February 13, Rent as % of Household Income National Alliance to End Homelessness Conference February 13, 2009 38

Foreclosure Rates by Town Foreclosure Rate = # of Foreclosed Homes # of Residential Foreclosure Rates by Town Foreclosure Rate = # of Foreclosed Homes # of Residential Properties National Alliance to End Homelessness Conference SOURCE: The Warren Group, 2006—Sep 2008 February 13, 2009 39

NAEH Conference February 13, 2009 SOURCE: BEACON - Sep 2007 & 2008 40 NAEH Conference February 13, 2009 SOURCE: BEACON - Sep 2007 & 2008 40

The Design Plans Stakeholders: South Shore regional network Systems: Family Providers Resources: ICHH Funding The Design Plans Stakeholders: South Shore regional network Systems: Family Providers Resources: ICHH Funding Measurable Outcomes: o Increased Stabilization Rates o Increase Local Placement Rates o Reduce Average LOS (Shelter to Triage) o Increase Housing First Units o Increase Self-Sufficiency Rates National Alliance to End Homelessness Conference February 13, 2009 41

The Tools National Alliance to End Homelessness Conference February 13, 2009 42 The Tools National Alliance to End Homelessness Conference February 13, 2009 42

Questions? National Alliance to End Homelessness Conference February 13, 2009 43 Questions? National Alliance to End Homelessness Conference February 13, 2009 43