measuring success using performance measurement naeh conference on ending family homelessness...

Measuring Success Using Performance Measurement

NAEH Conference on Ending Family Homelessness

Michelle Abbenante

Brooke Spellman

February 8, 2008

2008 NAEH Family Conference - Outcomes Workshop 2

What is Performance Measurement?

Performance measurement is a process that systematically evaluates whether your efforts are making an impact on the clients

you are serving or the problem you are targeting.


Multiple Levels of Performance Measurement

Local Service Provider

1. Program Level Program Funding Report, such as HUD APR

CoC

2. CoC/System LevelTen-Year Plan Report Card

or CoC Application

3. State Level State-wide Report or Performance Measurement

Tool

4. National LevelNAEH Assessment of National Progress or

Federal GRPA and PART Reviews


Why Should Programs be Interested in Performance Measurement?

We are all in the business of helping people, which means we need to…

…understand whether current activities are working to achieve intended results.

…drive program improvement and share information on effective practices with others.

…acknowledge that high-performing programs are more likely to receive funding through competitive funding processes.


Building Blocks of Performance Measurement

Inputs include resources dedicated to, or consumed by, the program—e.g., money, staff and staff time, volunteers and volunteer time, facilities, equipment and supplies.

Activities are what the program does with the inputs to fulfill its mission, such as providing shelter, feeding the homeless, or providing job training.

Outputs are the direct products of program activities. They usually are presented in terms of the volume of work accomplished—e.g., number of participants served and the number of service engagements.

Outcomes are benefits or changes among clients during or after participating in program activities. Outcomes may relate to change in client knowledge, attitudes, values, skills, behaviors, conditions, or other attributes.


Performance Measurement Process

ActivitiesOutreachShelters

Case ManagementRent Subsidies &

Services

Outputs# Clients Served by Program

Service LinkagesNew PSH Units/Subsidies

Vacancy Statistics

Outcomes30% exited to PH

40% increased income

25% reduction in CH25% shorter LOS

< recidivism

How do we

document our

efforts?

What did our efforts achieve?

Inputs

$ (CoC and Other)Programs

InfrastructureStaff

Should we adjust how

we spend our resources?

Should we add or change

use of resources to expand our

impact?


Outputs vs. Outcomes

Whereas, an outcome is: An output is: Focused on what the participant

will gain from the program. Focused on what the program

will do to achieve the outcome.

A way to measure the client-level impact with clear targets and methods for measuring change.

A way to quantify the frequency and intensity of the activity.

Attributable (a result of) to that program.

Specific to the activity described for the program.

Meaningful and attainable. Feasible and attainable.

Be mindful to distinguish between outputs and outcomes.

If outcomes show the program works… outputs are needed to understand how to replicate results


Group Exercise:Outcome, Output, or Neither?

150 clients received prevention counseling and one-time financial assistance.

90% of persons will obtain employment by completion of program.

75% of program staff will be trained in crisis management techniques.

Met 40% (50) of Permanent Supportive Housing goal.

65% of clients with chronic medical condition will improve physical health

Examples Answers

Output

Outcome

Activity

Output

Outcome


Achieving Your Outcomes

Short-term outcomes: What change will the client experience within a month of his/her involvement in the program? How will you measure this?

Intermediate outcomes: What change will the client experience within a year of being involved in the program? How will you measure this?

Long-term outcomes: What is the long-term (e.g., 3-year) impact of the program on clients? Has it been sustained? How will it be measured?

Achieving your outcomes can be a progression. Monitoring this progression requires data that are

collected at different intervals:


Example: Employment Program’s Impact Over Time

93% of participants (97% of people who completed the job training class) will show improved job skills

52% of participants (55% of those who complete the job training class) will obtain full-time employment

39% of participants (75% of those who get a job) will retain their jobs for > 12 months.

~95 participants will complete job training classes.

All of those who complete the training classes (~95 clients) will be referred to jobs and receive job placement counseling.

All of those who get a job (~52 clients) will receive weekly check-up calls and job counseling, as needed.

100 people expected to participate in the program annually

Short-term

Long-term


Framework for Converting Program Goals into Outcomes

Who is the base for measuring

results?

Step 1

What do you hope to achieve

with this population?

Step 2

Within the base, how many persons achieved it?

Step 3

Who is the base population for measuring results?

Within the base, how many persons achieved it?

Step 4

Outcome (%)

1. How do I convert program goals into measurable outcomes?

2. What do I need to calculate the outcomes?


Converting Program Goals into Outcomes: Example

Program Goal: Supporting participants in stable housing at least 6 months

Base= Persons who have been enrolled > 6 mo or have exited

(n=40 people)

Step 1

Goal: remain housed > 6 mo

Step 2

20 people are still in stable housing (6+mo) or exited after being in housing for 6+ mo

Step 3

40

20

Step 4

50% remain in stable housingat least 6 months


Look Out for Ambiguous Concepts

For example, what do we mean by…

Developing and measuring performance outcomes often invites ambiguous concepts into the process.

• …obtaining stable housing?

• …obtaining employment?

• …increasing income?

• …accessing services?

• …becoming more self-sufficient?

Which data elements and responses will count?


HMIS Data Elements Are the Building Blocks of Performance Measurement

Universal Data Elements: Program-Specific Data Elements:

Name Income & Sources *

Social Security Number Non-Cash Benefits *

Date of Birth Physical Disability

Ethnicity & Race Developmental Disability

Gender HIV/AIDS

Veteran Status Mental Health

Disabling Condition Substance Abuse

Residency Prior to Entry Domestic Violence

Zip Code of Last Permanent Add Services Received

Entry Date Destination

Exit Date Reasons for Leaving

Person, Program, & HH ID

* These data elements are collected at entry and exit.


Wherever Possible Use HMIS to Define Your Concepts

• Emergency shelter • Apartment or house that you own

Based on the Destination HMIS data element, we can define stable housing (narrowly) using the following response categories:

• Transitional housing

• Permanent housing

• Substance abuse facility or detox center

• Hospital (non-psychiatric)

• Jail, prison or juvenile detention center

• Room, apartment, or house that you rent

• Don’t Know

• Staying/living with family

• Staying/living with friends

• Hotel or motel voucher paid for without ES voucher

• Place not meant for human habitation

• Other

• Foster care home or group home

• Refused


Group Exercise

Employment Program

The goals of the program are to help unemployed clients obtain employment and help employed clients get “better” jobs. During the past year, the program served 6 (unduplicated) persons:

Client ID

Entry Date Exit Date Employment Entry

Employment Exit

1 1/31/07 9/15/07 Unemployed Employed

2 3/15/07 6/28/07 Unemployed Unemployed

3 7/11/07 -- Unemployed --

4 7/7/07 9/18/07 Employed Same Employment

5 8/2/06 5/12/07 Employed Higher Paying Job



Define the Base Population for Each Goal

Client ID

Entry Date Exit Date Employment Entry Employment Exit


2 3/15/07 6/28/07 Unemployed Unemployed

3 7/11/07 -- Unemployed --

4 7/7/07 9/18/07 Employed Same Employment

5 8/2/06 5/12/07 Employed Higher Paying Job


Goal 1: Achieve employment at exit

Goal 2: Obtain “better” employment at exit

Is everyone part of the target population?E.g., Do you expect to calculate an outcome for everyone?


Calculate the Outcome for Goal 1

All unemployed persons at entry who

exited (N= 3)

Step 1

Achieve employment

Step 2

2 persons achieved employment

Step 3

3

2

Step 4

67% achieved employment

Program Goal 1: Obtain Employment at Exit


Calculate the Outcome for Goal 2

Persons who were employed at entry and exited (N= 2)

Step 1

Improve employment

Step 2

1 person increased earnings

Step 3

2

1

Step 4

50% gained betteremployment

Program Goal 2: Improved Employment at Exit


Exercise 2 and the Performance Measurement Process

Inputs

Money: $250,000Staff: 4 FTEs

1 Facility

ActivitiesJob Training ClassesInterview Assistance

Job Placement Services

Outputs6 enrolled in

weekly services6 employment

assessmentsReferred to av. 4

jobs each

Outcomes67% achieved empl.50% improved empl.


Using Outcomes to Inform Future Program Operations

Step 1

Review outcomes

with program managers

Develop action steps

and timelines

Step 2

Implement action steps

Step 3

Regular monitoring

Step 4


Step 1: Reviewing Outcomes with Managers

Program director and managers should review outcomes collaboratively to understand what the outcomes are suggesting.

Break down the outcomes to understand the underlying forces:

What’s Going On?

• What are we doing right? What activities contributed to our ability to meet/exceed our benchmarks?

• Where do we need to improve? What activities fell short of producing the desired outcomes?

• What else might be contributing to our outcomes? How can we influence or mitigate these external forces to further our positive outcomes?


Step 2: Developing Action Steps and Timelines

Reinforcing the Good and Adjusting the Bad

Outcomes that were achieved/exceeded: Continue to support the activities that led to our positive performance.

Outcomes that were not achieved: Allocate our inputs differently to support different types/levels of activities.

Set target dates for reviewing all outcomes—e.g., 3-month intervals.

Collaborate with other service providers to “control” the external impacts on the program.


Step 3: Implementing the Action Steps

Getting Buy-In Through Information Sharing

• You can’t implement what you don’t understand: program directors, managers and front-line staff must understand the reasons for making changes in program operations.

• Information sharing promotes the idea that “we are all in this together.”

• Information sharing is fluid: program directors, managers and front-line staff can learn from one another; it’s not a one-way (top-down) process.


Step 4: Regular Monitoring

It’s Easier to Adjust Program Operations Incrementally than Wholesale

• Monitor your progress by generating your performance outcomes at different periods of time—e.g., 3-month intervals.

• Adjust your approach as needed, but usually incrementally.

• Important to acknowledge that clients’ needs may shift, and thus program goals and approach may also need to shift.


Comparing Program Results

• You can compare results from one program to another to see which programs are working best and which are working least well

– With limited dollars, you want to fund the programs that are most effective.

– You can use program results to identify best practice programs and those that need TA

– You can use results from multiple programs to help set a community expectation or standard of performance


Case Study: How Washington, D.C. Uses Program Results

• Outputs/Efficiency Measures

– Clients Served

– Chronically Homeless Served

– Occupancy: the rate at which program was used

• Interim Outcome Measures

– Permanent Housing

• Positive client destinations at exit (TH programs)

• Retain clients for 6+ months (PSH programs)

– Income: the amount of income or sources obtained

– Self-Sufficiency: change in substance use, education, mental illness or employment

• Measures apply differently to each program type and are supplemented with qualitative data for ranking purposes


Provider Performance Measures Clients

Served Chronically Homeless

Occupancy Rate

Housing Destinations

Income Length of Stay

Self Sufficiency*

Outreach Programs

Severe Weather & Low Barrier Shelters

Temporary Shelter

Transitional Programs

Permanent Supportive Housing

Supportive Service Programs

*Self Sufficiency Temporary, Transitional and Permanent Supportive Housing Programs required to submit a Self Sufficiency Indicator will have to choose from Substance Abuse, Education, Mental Illness Assistance or Employment.

Washington, DCFY 07 DHS Performance Measures


Apples to Apples: Risk Adjustment

• Problem: Comparing program results can encourage programs to “cream” to ensure strong results

• Solution: Risk adjustment allows you to account for differences in client populations when comparing results across programs

Results can be adjusted on the basis of…

• Client characteristics, such as demographics, family size, disability

• Client history, such as past eviction, criminal background,

• Client functionality or level of engagement/commitment to change


Risk Adjustment Requires Expertise

• To adjust for client differences, programs need to collect consistent data on clients to use during analysis of program results

– Agree on these standards beforehand

• Develop an analysis plan for how you intend to adjust for client differences

– Engage a researcher to help develop the plan

• Even if you don’t formally adjust results, acknowledge that different programs may have different outcome expectations based on differences in clients targeted and/or served


Simplified Illustration of Dissecting Client Outcomes on Increased Earned Income

By establishing targets, programs can be compared against CoC expectations in the future to determine if program performance is higher or lower than expected.

Program A

61% (61 clients)

All Clients (n=100)

10% (1 of 10 persons)

Disabled Clients


Non-disabled Clients

23% (70 clients)

All Clients (n=300)

12% (30 of 250 persons)

Disabled Clients



Program B

12%(31 of 260 persons)

Disabled Clients

71%(100 of 140 persons)


CoC OutcomeResults By Population


System Performance Measurement

• Are your actions achieving your intended goals at the system level?

– Does the system work?

– If yes, what makes it work?

– If no, what part doesn’t work, and how do you fix it to make it work?

• Note that you may have system goals that only relate to certain types of clients or parts of the system (e.g., different goals for severely disabled persons)


Sample Impact Measures

• Incidence of homelessness - Is homelessness declining?

• Incidence of street or CH - Is street or chronic homelessness declining?

• Length of stay in system, across all homeless programs - Do people stay homeless for shorter periods of time?

• Prevention – Are fewer people experiencing homelessness for the first-time?

• Rates of Recidivism – Are repeat occurrences of homelessness avoided or declining?

Cross-tabulate results by core characteristics to understand if/how results vary for different subpopulations


Steps to Calculate System Length of Stay

De-duplicate clients across programs

Step 1

Consolidate sequential stays into single

episode (gaps < 30 days = same episode)

Step 4

Create table with all Entry/Exit Dates by

Client

Step 2

Calculate LOS for each Stay

Step 3

Calculate mean (168 days), low (81 days),

high (309 days)

Step 5

Client ID

Prog ID

1 A

1 B

2 A

3 C

Entry Exit Date Date

5/8/06 5/30/07

6/1/07 9/01/07

3/1/07 5/21/07

2/1/06 12/7/06

LOS

22

92

81

309

114


Some notes of caution…

• There is more to performance measurement than conducting the analysis

– Educate, train, obtain buy-in

• Be careful about how you interpret and use the data1. Jump in, but don’t be careless in how you use the results

2. Look at the results within the context of all the outputs, interim measures and impact measures to validate the interpretation that’s being made

3. Vet the results before publicly releasing anything

4. Appropriately caveat the limitations of the data and analysis


Summary of System Performance Measurement

ActivitiesAdjust type and

intensity of activities based on outcomes; track if

improves

OutputsDocument the level of

effort providedUse to ensure activities

delivered efficiently

OutcomesInterim Outcomes

signal client success;Impact outcomes track progress to

goals

Inputs

Use program-level &system-wide results

to adjust use of resources

Questions?

Contact us for more information or assistance:

Michelle Abbenante, [email protected] Spellman, [email protected]

mailto:[email protected]

mailto:[email protected]

measuring success using performance measurement naeh conference on ending family homelessness...

Documents

program staff

completion of program

performance measurement

drive program improvement

staff time

current activities

clientlevel impact

use of resources