usingdatatospursystemschange heading home hennepin minnesota

Presenters: Presenters: Cathy ten BroekeCathy ten BroekeMatthew AyresMatthew AyresLisa ThornquistLisa Thornquist

Heading Home Hennepin• A community plan to end versus manage

homelessness• Specific plan with measurable benchmarks• City Council and County Board Approval –

December 2006• Implementation began January 1, 2007

6 Goals of the Plan

• Prevention• Outreach• Housing• Service Delivery• Capacity for Self Support• Systems Improvement

The Need for Evaluation

• One of the pieces of the plan is to evaluate the plan and report annually.

• The plan has dozens of initiatives, each designed to either prevent or end homelessness.

Forging a relationship to produce evaluation

• Hennepin County is data rich.• U of M is student/faculty rich.• Hennepin offers U students and faculty

experience with administrative data, difficult analytical questions and real world issues.

• The U offers an independent analysis.

The Hennepin University Partnership

• Hennepin County and the U of M have a standing agreement to provide academic expertise to issues facing the county

• The OEH work with faculty throughout the University to find common issues for evaluation.

Major Projects in Collaboration with U of M

• Housing First evaluation• Single Adults in Shelter – Definition of LTH• Families in Shelter and Rapid Exit• Frequent Users Service Enhancement (FUSE)• Refugees• Collaboration capstones

Other Research/Evaluation Projects

• Prevention Targeting• Highest Users of Single Shelter• Downtown 100• Group Residential Housing stability• Project Homeless Connect

Capstone on Housing First (p. 23)

• Masters Level Public Policy students looked at participants in single adult Housing First compared to a match set of shelter users.

• We matched in health insurance coverage and criminal justice data.

• Students analyzed data as well as conducted interviews with program participants

Capstone on Housing First: Finding

• HF participants’ shelter use dramatically declined compared to other shelter users.

• HF participants increased the number of days and continuity of health care coverage.

• HF participants had a reduction in CJ involvement, both as victims and perpetrators of crime, pre versus post and compared to other shelter users.

Capstone on Housing First: Finding

• Interviews showed that housing had a positive impact on safety and well-being.

• Transition to housing posed challenges related to daily activities and social needs.

• Transportation was a significant barrier in housing and some participants changed housing after initial placement.

Impact of the Research on Housing First

• Helped provide support for further funding – Currie Avenue Partnership.

• Told policy makers that this model works in OUR community.

• We greatly expanded our scattered site Housing First program.

Capstone on Single Shelter Use and Definition of LTH (p. 5)

• Wanted to know when to intervene for single adults in shelter

• Stories of people being “stuck” in shelter for years.

• People staying in shelter waiting to meet the definition of long-term homeless to be eligible for programs.

Capstone on Single Shelter Use

• Provided data from county data systems and HMIS for single adults in shelter from 2007-2009.

• First time we looked at whole single shelter system at once.

Capstone on Single Shelter Use

• Evaluate dynamics of shelter use of single individuals in public and private shelters in Hennepin County

• Mixed Method Analysis using focus group interviews and analysis of administrative data

Capstone on Single Shelter Use: Focus Group

Capstone on Single Shelter Use• Fixed Window Method:

Count days of shelter for 12 mo. following shelter entry, for those who first entered shelter between 7/1/07 and 12/31/08• Cox Proportional Hazard Models

Estimate probability of ending a shelter spell in each month, given that you are still in shelter, for spells that start in the period 7/1/07-12/31/09

Definition - homelessness spell

• Define beginning of spell as date first recorded shelter use

• Define end of spell as date in which individual leaves shelter and remains out of shelter for two weeks or longer

Fixed Window Analysis

Fixed Window Analysis

Hazard Model Analysis

Capstone on Single Shelter Use: Findings

• A large number of people stay in shelters for very short periods of time.

• Targeting people with long spells would reduce days in shelter more than targeting people with multiple spells

Capstone on Single Shelter Use: Findings• Probability of exiting shelter declines rapidly from

months 6 to 12 and then levels off. This may reflect either:

--staying in shelters discourages exits

--less disadvantaged group leaves first

Single Shelter Use: Policy Implications• Targeting people at 5 months for assessment into

housing programs• Ongoing discussions of efficacy of targeting at 5 months

versus 1 year – how are limited resources best spent.

Frequent User Service Enhancement (FUSE) (p. 26)

• In 2007, Hennepin County found that 266 individuals used 70,000 nights of shelter, jail and detox over 5 years, costing taxpayers $4.2 million.

• The FUSE project began, targeting the highest users of both shelter AND jail.

• The intervention was housing, case management, and probation services.

FUSE

• An examination of the first 6 program participants found that they used, on average, $95,000 in services prior to housing. After housing, they used $16,000 in services on average.

• This included jail bookings, jail days, detox, shelter, and Emergency Department use at Hennepin County Medical Center (HCMC)

FUSE

• Sociology graduate students from the U of M conducted a more in-depth study of the first year of the program.

• The researchers compared FUSE participants to a similar cohort of high users of both jail and shelter.

FUSE

• The program participants had a significantly larger decline in shelter use versus the comparison group.

• They found that both participants and the comparison group reduced their use of the criminal justice system.

FUSE and other interventions

• The findings from the FUSE study lead to some interesting questions.

• We have so many interventions in downtown Minneapolis: FUSE, Downtown 100, Street Outreach, Currie Avenue Partnership.

• We also know there is a significant decline in downtown arrests. Who gets the credit?

Implications of FUSE

• Shows targeting of specific populations can interrupt overuse of systems.

• This study, and others, let us know that targeting high users can greatly impact the overall system.

Top 50 Users of Single Shelter

• Looked at highest users from Jan 2008 – April 2011

• Range from 737 days to 1413 days• Data in county go back to 1997 – 12 of

these top 50 were in shelter in 1997• Very little is known about these top users –

they are not high users in other systems

Top 50 Users of Single Shelter

• Small group of county employees with access to all data systems.

• Included direct service staff from county and contracted shelters.

• Overall goal – to create a crack free system.

Top 50 Users of Single Shelter

• 20 had social service activity in the county• 10 on General Assistance, 10 on RSDI/SSI• 12 had been to jail, 7 to detox• 11 engaged with the mental health system,

but twice as many were reported by staff to have mental health barriers

Top 50 Users of Single Shelter

• Medical services were more prevalent– 29 received Healthcare for the Homeless

services– 38 got health care through Hennepin County

Medical Center (HCMC)

Top 50 Users of Single Shelter Policy Implications

• No wrong door.• Rules and policies need to be flexible.• Onus on county workers to reach out to

people in shelter, to ensure they get services they are eligible for.

Prevention Targeting

Rapid Exit has been a program in Hennepin County since 1993.

It focuses on early intervention in financial assistance where:-non-preventable, verifiable financial crisis

Prevention Targeting

• Rapid Exit program started in 1993• Focus was on preventing homelessness for

families to reduce number of families entering shelter

Prevention Targeting

• Eligibility:– Non-preventable, verifiable financial crisis– No other resources available– Prevention assistance will preserve housing– Goal was to reduce shelter admissions by 10%

and reduce length of stay by 10%

Prevention Targeting

• Results:– 96% did not enter shelter within 1 year– 43% reduction in family shelter admissions

Prevention Targeting

• After 17 years, time to re-examine the program.

• Used HMIS data and barrier assessments to compare characteristics of families who received prevention versus those who did not and ended up in shelter.

• If targeting well, families should look similar.

Prevention TargetingPrevention Shelter

Incomes < $1000/mo 40% 94%

> 65% of income for

housing 45% 94%

homeless before 36% 63%

Head of hh < age 22 1% 33%

Prevention Targeting

New criteria:• Families < 30% Area median income• Event is expected to result in housing loss

within 30 days• No resources or viable plan to resolve crisis• Reasonable expectation for sustained

resolution

Prevention Targeting

Six month evaluation:• Data from May – Dec 2010• 436 households served• 7.4% returned to shelter within 6 months

(same as before)

Prevention Targeting Policy Implications

• Change definition of success.• While a smaller percent of people who

receive prevention may avoid shelter, we may actually be preventing more homelessness.

Refugees (p. 25)

• We partnered with the Center for Advanced Studies in Child Welfare for research on refugee experiences with homelessness.

• This led to findings to be incorporated into SSW learning modules.

• It also led to a dissertation currently being completed on refugee homelessness.

Refugees• A graduate student conducted in-depth

interviews with 15 refugee families experiencing homelessness.

• We conducted a survey of 237 refugees in the Twin Cities asking about housing stability, ethnic identify and assimilation.

• A doctoral student is completing more in-depth interviews with refugee families in shelter.

Refugees: Findings• Culture matters. While the barriers to

housing are similar to American-born families, specific cultural beliefs and values impact how families respond.

• Refugees who moved in with relatives first had less stability than those placed in their own apartment upon arrival.

Refugees: Findings• Those whose current housing is unstable

have more mental health issues, less social capital or social networks, and use less public assistance.

• Larger families have more housing instability.

• Language continues to be a barrier.

Refugees: Findings• A housing crisis pushes refugees to seek

more formal help both within their ethnic group and also with government agencies.

• Those with housing instability turned to public assistance and that assistance did stabilize housing for them.

Refugees: A pilot• Hennepin County and the McKnight

Foundation funded a pilot to work with refugees at risk of homelessness.

• The intervention provided intensive case management and housing subsidies for a limited time.

• The focus was on housing stability, increased income and school engagement.

Refugees: A pilot• Findings: 70 families were served. 98%

remained in housing during the program.• 83% increased their incomes due to an

increase in number of family members working.

• The families needed a rental subsidy for 6.3 months, on average.

• 97% reported positive engagement with their children’s school.

Refugees: Policy Implications

Another example of targeting a population with special needs

The need for culturally specific services and service providers

Development of refugee-specific housing with cultural competency of landlords

Project Homeless ConnectOngoing Evaluation

• Use HMIS data to track long-term trends, service needs, demographics.

• Allows us to craft each event to the needs of the guests, and fundraise for additional services

• Allows up to accurately report to funders, policy makers, and volunteers.

Project Homeless Connect• Homeless status of guests served at event, comparison to previous events

Project Homeless Connect

• Proportion of “doubled-up” clients, comparison to previous events

Project Homeless Connect• Where PHC guests come from.

Project Homeless Connect

• Main types of service sought by household

What are the Implications of a Robust Evaluation Program?

• U of M more engaged in homelessness than ever before

• Hennepin County more committed to supporting research to better understand programs and outcomes

• Evaluation program builds on itself – it brings in money

• It builds community will

For more information

• Cathy.ten.broeke@co.hennepin.mn.us

• Matthew.ayres@co.hennepin.mn.us

• Lisa.thornquist@co.hennepin.mn.us

• www.headinghomehennepin.org