PŪNĀWAI REST STOP PROGRAM EVALUATION

JANUARY, 2020

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PŪNĀWAI REST STOP “providing safe hygiene services for homeless

individuals to regain their dignity, and self-respect.”

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TableofContents

Executive Summary .................................................................. 2

Program Background ..................................................................... 2

Outputs .......................................................................................... 2

Findings ......................................................................................... 3

Conclusions and Recommendations ............................................... 3

The Rest Stop Model Overview .................................................. 4

Pūnāwai Rest Stop – Honolulu ....................................................... 4

Description of the Pūnāwai Service Model ...................................... 5

Logic Model .................................................................................... 7

Program Implementation ....................................................... 11

Program/Process Implementation ............................................... 11 Safety and Security ................................................................................ 13 Staffing/Human Resources ...................................................................... 15

Evaluation of Outputs ............................................................. 16

Services ....................................................................................... 16

Participant Feedback Regarding Services ..................................... 18 Pulse for Good ....................................................................................... 18 Participant Interviews ............................................................................. 20

A Unique Model of Case Management ..................................... 22

The PRS Model of Case Management ............................................ 22 Models of Case Management .................................................................... 23 How Pūnāwai is Different ......................................................................... 24

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Case Management Data ................................................................ 25 Race/Ethnicity ....................................................................................... 25 Income Status ....................................................................................... 26 Access to SNAP Benefits .......................................................................... 27 Housing Status ...................................................................................... 28 Medical Insurance Status ........................................................................ 28 Identification Document Status ................................................................ 29 Needs of Case Management Participants .................................................... 30

Evaluation of Outcomes .......................................................... 32

Pūnāwai Rest Stop as a Safety Net ............................................... 32

Early Impacts on Participants ...................................................... 33

Evaluation of Community Perspectives ................................... 34

Local Businesses .......................................................................... 34

Government Partners ................................................................... 35

Homeless Provider Partners ......................................................... 36

Recommendations .................................................................. 38

Ongoing Evaluation Plan ......................................................... 41

Outcome Measures ....................................................................... 41

Basic Evaluation Plan ................................................................... 42

Advanced Evaluation Plan ............................................................ 42

References ............................................................................... II

Appendices .............................................................................. II

Evaluation Methodology ............................................................ I

Interview Questions – Participants ............................................... II

Survey Questions – Area Businesses ............................................. II

Survey Questions - Partner Agencies ............................................ II

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TableofFigures

FIGURE1:PŪNĀWAIRESTSTOPLOGICMODEL 9FIGURE2:INCIDENTREPORTSSEPTEMBER-DECEMBER2019 14FIGURE3:2019PŪNĀWAIRESTSTOPVISITS 16FIGURE4:2019CLIENTSERVICESUSE 17FIGURE5:PULSEFORGOODSATISFACTIONRATINGSOCTOBER-DECEMBER2019 19FIGURE6:CULTUREOFRESPECTATPRS 20FIGURE7:COMPONENTSOFPŪNĀWAIMANAGEMENTMODEL 24FIGURE8:RACE/ETHNICITYOFCASEMANAGEMENTPARTICIPANTS 26FIGURE9:INCOMESOURCEOFCASEMANAGEMENTPARTICIPANTS 26FIGURE10:INCOMEAMOUNTSOFCASEMANAGEMENTPARTICIPANTS 27FIGURE11:SNAPBENEFITSTATUSOFCASEMANAGEMENTPARTICIPANTS 27FIGURE12:HOUSINGSTATUSOFCASEMANAGEMENTPARTICIPANTS 28FIGURE13:MEDICALINSURANCESTATUSOFCASEMANAGEMENTPARTICIPANTS 28FIGURE14:DOCUMENTATIONSTATUSOFCASEMANAGEMENTPARTICIPANTS 29FIGURE15:CASEMANAGEMENTNEEDSOFCASEMANAGEMENTPARTICIPANTS 30FIGURE16:PRSASSAFETYNET 32FIGURE17:REASONFORREFERRALTOPŪNĀWAIRESTSTOP 36

Mahalo

TheevaluationteamwouldliketoextendasincereThankYoutothosewhoassistedincluding:

• HPUBSWstudentswhoparticipatedintheconstructionofthedatacollectioninstrumentsanddatacollection.ThankyoutoNoelleFisher,CorinneGanacias,GloriaKempner,Edison“Lou”Loualhati,LindaMoultrie,LeonardoMourao,JohniquaSmith,BrittennyUbasa,andKasidyVergara.

• ThestaffandvolunteersatMHKandPRSwhowereto-the-person

cooperativeandforthcomingintheirassistance.Thisprojectwouldnothavehappenedwithoutyourhelp!

Pono no kākou e kūlia i kā kākou hana po‘okela.

(We must strive to do our best work.)

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ExecutiveSummary

ProgramBackground

• OpeninginJanuary,2019,thePūnāwaiRestStopsgoalistoprovideneededservicestopeopleexperiencinghomelessnesswhomightnototherwisehaveaccesstobathroomsandlaundries.Itishopedthatbypairingbasichygieneserviceswithsocialservices(interimcasemanagement),PūnāwaiRestStopwillencouragethosewhoutilizethereststoptocontinuetoaddressotherbarrierstohousingandemployment,improvetheirhealthandresolveissuesthatmayhavepreventedthemfromstablehousing.

• During2019,itisestimatedthat2,238peopleutilizedatleastoneofthegeneral

servicesavailableatPūnāwaiRestStop.

• 371participants(17%oftotalparticipants)utilizedcasemanagementservicesoverthecourseoftheyear.Only15%ofclientshadallofthelegaldocumentsthattheyneeded,andthebiggestidentifiedneed,asexpectedwashousing.

Outputs

• PūnāwaiRestStophasservedapproximately128%morepersonsexperiencinghomelessnessperdaythanwasinitiallyanticipated.ThisspeakstotheoverwhelmingneedthattheRestStopisaddressing.

• PūnāwaiRestStopprovidedthefollowingservicesoverthecourseoftheyear:

• Showers(39,373) •Lockers(31,492) •Laundry(26,572)

• Toilets(16,984) •Petspace(1,928) •USMailservice(1,393)

• Itisestimatedthatcasemanagershaveassistedapproximately92participantswith

securinghousing,35participantsgainsomelevelofemployment,and10participantsenterintosubstanceusetreatment.

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Findings

• FromthePulseforGooddataaswellasindividualclientinterviews,participantsaregenerallyverypleasedwiththestaffandservicesatPūnāwai.

• OtherHomelessserviceprovidersareawareofPūnāwaiandtheservicesprovidedandhaveactivelybeenreferringclientsthere.Theyalsoreportahighsatisfactionlevelwiththeservicesthere.

ConclusionsandRecommendations

• PūnāwaiRestStophasachieveditsgoalinprovidingamuchneededservicetopeoplewhoareexperiencinghomelessness.

• LookingmorecloselyatHumanResourcesandStaffingissuesthathaveoccurredduringthepastyear.IncorporatingmoretrainingandproceduredevelopmentspecificallyforPRS.

• PRSshouldcontinuetofocusonanddeveloptheirexistingservices,avoidingmissiondriftasmuchaspossible.

• Improvinganddevelopingaccuratedatacollectionandmanagementsystems.• WhatPRShasbeenabletodevelopinashortperiodoftimeissomethingvery

special.Therelationshipsdevelopedwithclientsandthecommunityissomethingthatwillbeimportanttomaintaingoingforward.Thisisnotsomethingthatiseasilyquantifiable,butitsomethingthatwasfeltbyclients,staffandtheevaluators.

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TheRestStopModelOverviewThereststopmodelwasinspiredbytheUrbanRestStop(URS)programinSeattle,wherethreereststopshavebeenoperatingformanyyears,providinghygieneservicestopeoplewhoarehomeless.ByprovidingaccesstoessentialhygieneservicestheURShasimprovedthequalityoflifeforhomelessindividualsandfamilies.TheRestStopistheonlyhygienefacilitywithextendedservicehourswhicharespecificallydesignedtoassisthomelesspersonswhoareworkingorneedtogettoajobinterview.Ahomelessjobapplicantcannotbesuccessfulduringajobinterviewwithouttheself-confidencethatashowerandcleanclothescanprovide.Ahomelessindividualcannotmaintainsteadyemploymentorhopeforadvancementwithoutaccesstoshowersandlaundryfacilities.Thereststopmodelisbasedonalow-barrierapproachthatprovidesbasicservices“whereaclientisat.”Thisisincontrasttomanyhomelessservicesthatrequireparticipantstomeetaseriesofrequirementsinordertoreceiveservices,suchasabstinencefromalcoholorothersubstances(Wallace,Barber,&Pauly,2017).Lowbarrierservicesrelaxmanyoftherulesthatmayexcludepersonswithaddictions,seriousmentalillness,orchronic,long-termhomelessnessthusdiminishingbarrierstosocialinclusionthatlackofaccesstobasicservicescreates.Themodelworksontheassumptionthatprovidingservicessuchasshowers,laundry,phoneandmailaccesstothoseexcludedfromsocialservicesystemswillleadtheparticipantstofurtherinclusioneffortssuchasengagementwithtraditionalproviders,alternativepathwaystorecovery,and,ultimately,stableandpermanenthousing.PūnāwaiRestStop–HonoluluIn2013,CityCouncilmanJoeyManahanproposedthatthecityadministrationexplorethefeasibilityofanUrbanRestStopModelinHonoluluasawaytoprovideaccesstoessentialhygieneservicesthatwouldimprovetheself-sufficiencyofhomelessindividualsandfamiliesandaddresscitypublichealthissues.CouncilmanManahanreachedouttopartnerssuchasMayorCaldwell,KenFarm(PresidentoftheKalihi-PalamaNeighborhoodBoard),andtheHonoluluPoliceDepartmentwhoallrecognizedthatsuchaprogramwasapotentialwinforthoseaffectedbythisissue.Theaimwastohaveahygienecenterthathadlittletonobarriersforusebypersonsexperiencinghomelessness.Variousfundingsourcesfortheprojectwereconsideredtodeterminewhichhadthefewestpotentialuserequirements.Inthe2017City&CountyBudget,2millionwasappropriatedforplanningandconstructionofahygienecenterintheIwileiarea.In2018theCity&CountyreleasedaRFPtorunareststopforpersonsexperiencinghomelessnesson431KuwiliStreet.PūnāwaiRestStopisaprogramoperatedbyMentalHealthKokua,sponsoredbytheCity&CountyofHonolulu.PūnāwaiRestStopopenedinJanuary,2019,andisahygienecenterprovidingrestrooms,showers,andlaundryfacilitiestohomelessmen,womenandchildrenwithinaclean,safeanddignifiedenvironment.Allservicesareatnocosttopatrons.

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Operatinghoursarespecificallydesignedwithextendedtimestoassisthomelesspeoplewhoareworking(7am-7pmdaily).AtPūnāwai,onecanfind8privateshowerrooms,10washerand10dryerunits,largemen's&women'srestrooms,kennelsforpets,lockersforsmalleritemsandstorageforlargeritemssuchascartsduringuseofservices.Patronsreceivefreetoiletriesincludingtoothbrushes,toothpaste,disposablerazors,shavingcream,shampooandsoap.Patronsmayalsoborrowacover-upwhiletheywashtheirclothes.FreeWiFiandcomputerstationsareavailableforusebypatrons.Inaddition,mailboxesforU.S.PostalServicestosendandreceivemailandstampsareavailableatnocost.Inadditiontothehygieneservices,PūnāwaiRestStop(PRS)providesinformationandreferralmaterialsaswellasinterimcasemanagementservicesforhomelessindividualsandfamilies.Casemanagersprovideassistancewithavarietyofneeds,includingbenefitsandmedicalinsurance,legalidentificationdocuments,referralsforemploymentandpermanenthousing.ResourcesareavailableinEnglishandotherlanguages.Finally,PRSservesasavenueforoutsideagenciestoconnectwithpersonsexperiencinghomelessness.Withthehighvolumeofparticipantsaswellaspercentageofparticipantswhoarelargelydisconnectedfromtraditionalproviders,thePRSisanidealsitetoconnectwithandprovideservicestothispopulation.OrganizationswhohavecometoPRSduring2019toassistparticipantsinclude:theStreetDogCoalition,LegalAid,thePublicDefender’soffice,theSupplementalNutritionAssistanceProgram(SNAP),andavarietyofmedicalprogramssuchasoptometryandmentalhealth.DescriptionofthePūnāwaiServiceModelPūnāwaiRestStopprovidesservicesviaalow-barriermodel.Thislow-barriermodelisembracedbyPūnāwaistaffandreflectedintheatmosphereattheRestStop,itsproceduresandservicesoffered.Itwasevidentthroughoutthisevaluationthatexhibitingrespect,compassionandanon-judgementalattitudetowardparticipantsandcolleaguesisexpectedandunderliestheplanninganddeliveryofallservices.Understandingsomeofthebarriersencounteredbyparticipantsshedslightontheneedforalow-barrierserviceagencysuchasthePūnāwaiRestStop.IninterviewswithPRSparticipantsthreecategoriesofsystemicbarrierswerespokenabout;rigidity,access,andlackofrespect.Participantsdescribeddifficultieswiththerigidityofthecurrentsocialservicesystemanditsprograms.Forparticipants,thisrigidityresultedinalackofconsiderationfortheirunique,individualneeds.

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• Oneparticipantreported“Theotheragencypersonwasmorecontrolling,shewantedmetodothingsthewayshefeltIshoulddothem.Thatwasabriefexperienceatthatagencyforme.”

• Anotherexplained,“Ioncebeforewenttothisotherplace.TheoneImetwithwasveryaggressivewhenIaskedforhelpandsaid“wedon’tdothat,wearen’tdoingthis”,Idon’tgothereanymore.”

Participantsalsospokeofbarriersaroundaccessincludinglimitedhoursofoperation,distancetoservices,andthecostofservices.

• Oneparticipantstated“Theyhaveshowersoverthere[AgencyX],buttheyareonlyopeninthemorningandsometimesthereisn’tenoughtimetogetashowerin.”

• Anotherreported“Atotherplacesyouhavemorestrictrulesaboutwhentogetyourstuff.ItmeansIcan’tgotomymeetingsbecauseIhavetoworryaboutmystuff.”

• Accesstoservicesisoftentiedtomembershipandcomplianceinaprogram.Thiscanserveasabarrierasoneparticipantstated,“Igoto[AgencyX]formealsandtheytoldmetocomeoverhere.Theydidn’tallowgueststouseshowers,justtheirownresidents.”

• Oneparticipantspokeaboutthebarrierofevensmallfeesforservices,“Theyhavefreelaundryhere,that’sawesome.IusedtodowhateverIcouldtogetabitofmoneysoIcouldjustbuynewclothes,becauseit’ssoexpensivetowash,andyourstuffisjustgoingtogetstolenanyway.”

Finally,participantsspokeaboutnotfeelingacceptedorsafeasabarriertoreceivingservices.

• Oneparticipantspokeofthefeelingofalackofrespectforherpossessions,“Atmytemporaryhousingourstuffisallleftinabigroom,wedon’tgetourownlockers.Peoplecomeinandstealstuff.”

• Thefeelingofbeingjudgedservesasabarrierforoneparticipantwhosaid“Someplaces“downyou”,thinkingtheyknowwhereI’vebeen.”

• Someparticipantsspokeaboutnotfeelingsafeatotherspaces.“Theotherplace,theirbathroomsaren’tsafe.Stuffgoesoninthere.There’slikenoscreeningsoIdon’tgothere.”

PRSisdesignedasalow-barrierserviceprogramthatcomplementsotherservices/providersinthesystemofcarethatincludessocialservices,housing,andemployment.TheStateofHawai`i,CountyofHonolulu,andlocalnon-profitshavededicatedextensiveresourcesoflatetoaddresstheissueofgrowinghomelessness(Mayor’sOfficeofHousing,2019;Hawai`iPolicy&BudgetCenter,2019).Resourcesincludeacoordinatedentrysystemthatseekstocoordinatetheprovisionofhousingandotherservicestopersonsexperiencinghomelessness.

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LogicModelThefollowinglogicmodel(Figure1)expressestheevaluators’understandingoftherelationshipbetweentheactivitiesofthePRSanditsintendedeffects.TheoverallgoalofthePūnāwaiRestStopispredicatedonprovidingparticipantsawelcomingspacethatemphasizespersonaldignity.Thecombinationofhuman,physical,andsocialresourceinputsresultintheservicesthattheRestStopprovides.Thoseservicesleadtooutputsincludingreferralstooutsideagencies,retentionofemploymentandhousing,referralstoobtainhousingandsecurementofbenefits.ItisatthisstagethatthereportingexpectationsfromtheCity&CountyofHonolulu,havebeenmet.Thecontractbetweenthetwoentitiesdetailedoutputsofservices.However,PRSisalsodirectedatseveraloutcomes:short,midandlongterm.PRSaimstoimprovethequalityoflifeoftheirparticipantsintheshort-termbyimprovingtheirhygieneandsubsequentlytheiroverallhealth.Additionally,thePRSmodelaimstoimprovetheself-respectofeachparticipant.Beinghomelessisoftenadehumanizingexperience(Weiss&Quinn,2018).Throughtheprovisionofasafespace,groundedinrespect,participantscanexperienceimprovedself-worth.Relatedly,theprovisionofaspacetocarryoutactivitiesrequiredfordailylivingsuchasshoweringandlaundrygivesparticipantsimprovedsenseofsafetyintheirlives.Peoplewhoarehomelessareoftenthevictimsofaggression(Lee&Schreck,2005),sohavingasafespaceduringthedayisasignificantoutcomeofthisprogram.Finally,engagementinPRSandthecasemanagementservicesisashort-termoutcomeofthePRSmodel.Thisengagementisanimportantsteptosocialintegration.

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Figure1:PūnāwaiRestStopLogicModelGoal:Byprovidingbasicservicestopersonswhoarehomelessinawelcomingplacethatemphasizespersonaldignity,participantswillimproveoverallwellbeingandundertakefurtherinclusioneffortssuchasengagementwithtraditionalproviders,alternativepathwaystorecovery,and,ultimately,stableandpermanenthousing.

Resources

Activities

Outputs Outcomes

• Staff

• Centerassistants

• Interimcasemanagers

• FundingC&C

• Buildingspace

• Washers/dryers

• Computers• Showers

• Lavatories

• Casemanagementoffices

• Storagespace

• Partneragencies

• Communitysupport

-Localbusiness-Government-Generalpublic

Hygieneservices

• Showers

• Lavatories

• Washer/dryer

• ToiletriesOtherservices

• Computers/Wifi• Storagelockers

• Mailaccess

• KennelsCasemanagement

• Informationandreferral

• Housing/shelter

• Employment

• Medical• Psychiatric/mental

health

• Benefits

• Supportivecounseling

• NeedsassessmentSpaceforOutsideProviders

• #servicesprovided

• #receivingshort-termcasemanagement

• #referralsmade

• #enteredsubstanceabusetreatment

• #retainedemployment

• #retainedhousing

• #registeredforFederaland

Short-term Mid-term Long-term

• Improvedhygiene

• Improved

health

• Improvedself-respect/self-worth

• Improved

safety

• EngagementinPRS

• Engagementincasemanagement

• Activeincasemanagement

• Engagementinserviceswithotherproviders

• Increased

resources

• Increasedemployment

• Increased

permanenthousing

• Increased

overallsocialreintegration

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Statebenefits

• #obtainedID

Figure 1: Pūnāwai Rest Stop Logic Model

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Theseshort-termoutcomesareintendedtoleadtothefollowingmid-leveloutcomes;activeinvolvementincasemanagementandplanningoverone’slife,increasedengagementintheoverallservicesystem,andincreasedresourcesavailabletotheparticipant,includingincomeandbenefits.ThisiswherePRSfillsanimportantgapintheservicesysteminHawai`i.TherearemanyservicesforpersonsexperiencinghomelessnessinHawai`i.Inspiteofthis,theStatecontinuestostrugglewithreversingthetrendofincreasedhomelessness.Certainlytheoveralleffortofalloftheservicesforthehomelessisaimedatattainmentofpermanentandstablehousing.PRSisaimedathelpingpersonsexperiencinghomelessnesstore-engageinthesocialfabric.Theydothisinavarietyofways;throughmakingservicesavailabletoall,atnocost;bytreatingparticipantswithrespectandcare;andbyprovidinginterimcasemanagementfocusedonbuildingquick,genuinerapportandsuccessatmeetingexpressedneeds.Atthispoint,PRShandsofftootherserviceproviderstoassistinachievingthelong-termoutcomes.CertainlytherearetimesthatinvolvementinPRSservicesleadsdirectlytoemploymentandhousing,howevertherealaimofPRSistoincreaseparticipantsactiveinvolvementwithotherserviceprovidersthroughachievementofthosemid-termoutcomes.

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ProgramImplementationProgram/ProcessImplementationTheevaluationteamwasnotinvolvedfromthebeginningoftheprogram,buthasspentalmostthreemonthstalkingtomanagement,casemanagers,andcenterstaffabouthowtheprogramanditsprocesseshavebeenimplementedalongthewayaswellasreviewingdocumentationinordertoassessprogramimplementation.AgrandopeningwasheldonJanuary,8,2019,whereCityandothergovernmentofficialscametocelebratePūnāwai’sstartofservices.Astobeexpected,numbersincreasedovertimeasindividualsandagencieslearnedaboutPūnāwaiandtheservicesavailable.AstoryprintedintheHonoluluStarAdvertiserinFebruary,2019discussedtherelativelyquickincreaseinshowerutilization,butthatcasemanagementservicesweretakingtime(Nakaso,2019).Staffmembersdiscussedtheearlypushwithbrochures,meetingwithagenciesandgeneraloutreachtoletthecommunityatlargeknowabouttheopeningofPRSandtheservicesavailable.Whileoutreachcontinuesintermsofdistributingbrochuresandcommunicationswithotherserviceproviders,thereismuchmoreawarenessofPūnāwai.PeoplearereferredtoPūnāwaithroughwordofmouth,police,hospitals,sheltersservingthehomelesspopulationandothersocialserviceagencies.Aswithanynewprogram,therewerechallengesandsuccessesthroughoutthatfirstyear.Someofthemainchallengesthatpresentedinthedatawere:

• Naturalprogressionofagency/serviceso PoliciesandProcedureso Documentationo Vision/MissionandAgencyCulture

• SafetyandSecurityforstaffandparticipants• Staffing/HumanResources

TheprimarychallengesthatPRSexperiencedcanbeattributedtothetypicalgrowingpainsexperiencedbyanewprogram.Oneexampleofthisisthedevelopmentofpoliciesandprocedures.Tobegin,PRSadopteditspoliciesandproceduresfromitsparentorganization,MentalHealthKokua(MHK).Assituationsarose,procedureswereinformallytailoredtoPRS.Someexamplesofthisaredescribedinthe‘SafetyandSecurity’discussion.TherearesignificantpointsofdeparturebetweenPRSandMHKthatnecessitateattentionbepaidtodevelopingindividualizedpoliciesandproceduresthataddressPRS’suniqueneeds.

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Anotherexampleofthechallengesthathavebeenexperiencedasanewprogramistheevolutionofdocumentation.DocumentationatPRSduringthisfirstyearfocusedoncapturingtheoutputssuchasnumbersofshowerstakenorloadsoflaundrycompleted.Challengestoevenaccuratelycapturingthatdatahavearisen.Theagencyusesasign-insheetatthefrontdesktocollecttheserviceusedata,howeverastheagencyhasevolvedfromutilizingadedicatedfrontdesksecurityguardtostaffassumingthatrole,accuratedocumentationhasbeendifficulttocapture.Staffarecalledawayfrequentlytodealwithimminentissues.Whenparticipantscomeandgofromthereststopduringtheday,shouldeachvisitbecountedseparately?Howlongareparticipantsoutsidebeforeitcountsasaseparatevisit?Currentlytheprimarypersonresponsiblefortheintegrityofthedatacollectedhasnumerousduties,manymoreimminent.Dedicatingenoughtimetoensurethedataisaccurateisdifficultgiventhecurrentstaffingpatternsanddatacollectionsystem.Inconcertwiththeefforttokeeptheagencylow-barrier,individualleveldataisnotcapturedoneachparticipant,unlesstheyareseeingacasemanager.Astheagencyfacespressuresfromoutsidefunders/publictojustifyitsmodelandcapturemoreaccuratedata,theprogramischallengedtokeepthePRSlow-barrier.Theadditionofanydocumentationstep(s)thatinvolvescollectingdatafromparticipantscanbeunderstoodasabarrierandinordertokeepfidelitywiththisemergingmodelshouldbeweighedcarefully.Athirdareathathasdevelopedoverthisyearintheprogramisthesolidificationoftheagencycultureandearlydevelopmentofmissionandvisionoftheprogram.TheevaluatorswillbringupthisthemeofagencycultureandrespectthroughoutthisreportasitseemstobethefoundationformuchofthesuccessforPūnāwai’sprogramandrelationshipwithclients.PRShasauniqueapproachthatemphasizesremovingsystemicbarriersthatareoftenoverlooked.Minimizingthesebarriersandprovidingservicesinacultureofrespectresultsinhumanizationofservices,allowingforfullerreintegrationofparticipantsandincreasedutilizationofservices.Thisagencyculturehasevolvedoverthelastyearandisseenasaprimarycomponentofthesuccessthattheagencyhasseen.

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SafetyandSecurityConsistentwiththelow-barriermodel,theRestStophasminimalhouserules,balancingeaseofaccesswithmaintenanceofasafeenvironmentforstaffandparticipants.PRShasthefollowinghouserules:

• Nostorageofclientpropertyexceptwhileclientisusingthefacilities

• Onepersonintheshoweratatime(exceptforminorchildrenandcaregiversofdisabledparticipant)

• Cleaningsuppliesandmaterialsforstaffuseonly

• Nothreats,violenceorweapons

• Noverbalabuse

• Noalcohol,illegaldrugsorparaphernalia

• Nosexualactivityorharassment

• Nobusiness(buyingorsellingofgoodsorservices)

• Novandalism,destructionofproperty,orlittering

• Noeatinginthebuilding

• Notheft

• Nocampingorloitering

• Nopanhandling

• Petsmustbekeptundercontrolatalltimes

• Noproselytizing

WhilePRShasfewerrulesandbarrierstoaccessthanothersettings,controllingtheenvironmentisasignificantprogrammaticconcern.Forexample,theRestStopisequippedwithseveralclosedcircuitsurveillancecamerasmonitoredbystaff.Staffregularlysuspendparticipantscaughtviolatingtherules.Analysisofthe41incidentreportsfiledfromSeptember-December,2019yieldedtwocategoriesofincidents;incidentsthatweremedicalinnatureandincidentsthatinvolvedinfractionofrules.Therewere17medicalincidentsresultinginanambulancecallfornineofthoseand24incidentsofrulesviolations,withthepolicebeingcalledfornineofthose.Figure2detailstheincidents.IncidentsarereviewedbytheCenterDirectorandClinicalManagerandchangesmadetoproceduresasneeded.

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Figure 2: Incident Reports September - December 2019

EmployeesofPRShaveavarietyofpersonalandprofessionalphilosophiesthatinfluencehowtheyworkwithparticipantsaroundruleinfractionandenforcementofconsequences.Thetwomaincompetingphilosophiesarearoundthethemesofprovidingconsistentenforcementandstructurefortheparticipants;theotherhasbeentotakeanindividualizedapproachwitheachsituationandtotakeintoconsiderationtheremorseshown,andforgiveness.Thesephilosophicaldifferenceshaveledtomisunderstandingandmiscommunicationamongststaffandparticipantsaroundwhattherulesare,aswellaswhattheconsequencesmaybe.Staffreportedfrustrationaboutinconsistentruleenforcementthatmakesonestaffmembera‘badguy’.Staffhavealsoexpressedconcernthatthissendsconfusingmessagestoparticipantsaswell.Aneedforacommonapproachtoruleenforcementisevident.InitiallyitwasthoughtthatanoutsideservicewouldprovidesecuritypersonnelatPRSonadailybasis.Acontractwithasecurityservicewasexecuted,andsecurityofficersweretobeonsiteduringoperatinghours,from7a.m.-7pm.Staffandmanagementfoundthisservicewasnothelpful,andonoccasion,mayhavebeenharmfultopatrons.Therewerereportsofregulartardinessandcallingoutsick,whichdelayedtheopeningofPRSonsomedays.Securityofficershaddifficultykeepingaccuratestatisticsofpeoplevisitingthecenter.TherewerealsoreportsofinappropriatecontactwithPRSpatrons,includinginappropriateuseofforce,theft,andboundaryviolations.Ininterviews,participantsreportedthatoneoftheprimaryreasonstheyattendedPRSwasbecauseitfeltsafe.Therewasasmallsub-groupofparticipantsthatreportedconcernsrelatedtosafety,includingnotwantingtobringtheirsmallchildrentherebecause“itseemsthreateningforkids”.Additionally,twofemaleparticipantsreportedfeelingunsafe.One

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participantstatedthat“therearealotoffightsgoingonoutsidewhichareveryscary.”Anotherreported“somebodystolethreepursesinonedayoutside.It’skindoffrightening.”Staffexpressedsomeconcernsregardingtheirownsafety.Specifically,astaffmembermentionedtheydiscovereddrugparaphernaliainlaundryequipmentwhenmovingaclientsclothesfromthewashertothedryer.Onaseparateoccasion,astaffmemberfoundthatapipehadburstinsideamachine.Inresponsetotheseincidents,changeshavebeenmade.Clientsmustnowbepresenttomovetheirclothesfromthewashertothedryer.However,thereisanoveralllackofformalsafetypoliciesandproceduresinplacethatarespecifictothePRS.Staffing/HumanResourcesThereareatotalof12fulltimestaffatPūnāwai.Thatnumberhasfluctuatedovertime,aspeoplehaveleftforotheropportunities,beenterminatedandprocessestofillthosepositionshavetakenplace.Atonepoint,staffingwaslowenoughthatitrequiredPRStocloseat3pminsteadoftheusual7pm.Thisonlylastedforafewweeks,butitdidimpactserviceprovisionandaccesstohygieneservices.GiventhecurrentrateofunemploymentinHawaiioverthepastyear,manynonprofitagencieshavestruggledtofillpositionsastheyareoftenonthelowerendofthepayscale.Itwasreportedthattheprogramhasexperiencednear100%turnoverofstaffonthreeseparateoccasionsinthefirstyearoftheprogram.SomeRestStopstaffareformerorcurrentclientsofMentalHealthKokua.Thishasthepotentialtocreatedifficultieswithcreatingandmaintainingboundariesbetweenstaffandclients.Incidentshaveoccurredwheredualrelationshipshavebeenproblematic.StaffhavebeenencouragedtoreflectandworkonsettingboundariesintheirexistingrelationshipswithknownclientspriortoandduringtheiremploymentattheRestStop.Thestaffpositionsallrequirespecializedtrainingincludingtrainingincrisismanagementandde-escalation,activelisteningskills,complexunderstandingofmanagingboundaries,aswellasotherareas.However,theRestStopstaffislargelycomprisedofparaprofessionals,whocannotbeexpectedtohavethesamekindoftrainingassomeonewithafour-yeardegreeinahumanservicesarea.ThisleadstoaneedforcomprehensivetrainingforallstaffatPRS.TheRestStopstaffhavereceivedtrainingsthatarepartoftheMentalHealthKokuageneraltrainingcalendarsuchasHIPAA,basicde-escalationofcrises,andCPR/first-aid.

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EvaluationofOutputs

ServicesPRSstaffhavebeendocumentingserviceprovisionsincetheprogrambegan.Asnotedabove,therehavebeensomechallengestoaccuratedocumentation.Thisdataiscollectedviaasign-insheetatthefrontdeskwhereparticipantsdesignatetheservicestheyareusingthatday.Thereisnoindividualleveldatacollectedonparticipantsatthistimeforgeneralserviceuse,onlyatthelevelofcasemanagementservices.Thissectiondetailstheservicesprovidedperthisdocumentation.Monthlyattendanceisdisplayedinthechartbelow.January2019sawapproximately3075visitsby448guestsandcontinuedtogrowtoupwardsof6500monthlyvisitsinthefollowingmonths.Eachmonthfollowingopeningsawanywherefrom115-232newusers.PRSdatacollectionstaffestimateanaveragedailyattendanceof200guests,andfurtherestimate1000+unduplicatedparticipantsover2019.

Figure 3: 2019 Pūnāwai Rest Stop Visits

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Figure4belowdisplaysmonthlyusesofeachofPRS’coreservices.ShowershaveshowntobeconsistentlypopularamongstPRSclients.Lockersandlaundryhavealsobeenwidelyused.Toiletuseislikelyreportedwithsubstantialerroras,unliketheotherservicestrackedbystaff,useisself-reportedbyguestsviasign-insheetpostedoutsidetherestroomentrance.Privatetoiletsarealsoavailablewithintheshowerroomsandthus,accordingtostaff,notreportedseparatelyfromshoweruse.USmailservicessign-upsshowsthemonthlynumberofPRSclientsregisteringtousePRS’addressasamailingaddress.

Figure 4: 2019 Client Services Use

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ParticipantFeedbackRegardingServicesParticipantfeedbackinformedthisevaluationviatwomethods,analysisofthePulseforGooddataandanalysisof261:1interviewswithparticipants.PulseforGoodThePulseforGoodSurveywasinitiatedinOctoberof2019bytheCity&CountyofHonolulutocaptureclientfeedback.AnelectronictablethasbeenmountedatPRSandparticipantsareencouragedtocompletethebriefsurveyabouttheirexperiencesattheagency.Participantsratefiveaspectsoftheirexperiencesona1-5Likertscale;overall,thisvisit,safety,facilitiesandstaff.Thereisalsospacetogivequalitativefeedback.Duringthistimeperiod(October-December)participantsrated576oftheirvisits.Giventhenatureofhowthesurveyisconducted,thereisnowayofknowinghowmanyuniqueparticipantsmadecomments.Theresultsshouldbeinterpretedcautiouslybecausethosewhotookthesurveymayhavehadapositiveornegativebiastowardthereststopatthetimeofsurveycompletion.Therefore,thisdatamaynotberepresentativeofthetotalpopulationofclientsutilizinginthereststop.Giventhatlimitation,overall,participantsratedtheprogram4.23onthe1(notgood)-5(verygood)scale.Oneweek,12/1-12/7,hadamuchlowersatisfactionthanthegenerallyconsistentresults.Inexploringthedataforthatweek,itisdifficulttoascertainwhytheratingswereloweracrossmeasures.Elevenpeoplecompletedthesurveythatweek,thelowestresponseratesincetheweekthesurveybegan.Thecommentsleftthatweekshednolightonthelowratings.Ofthecategoriesthatdataiscollected,staffhaveconsistentlybeenratedhighestandsafetythelowest.Theredoesnotseemtobeatrendinthedata.Analysisofthe158commentsthatmakeupthequalitativecontentofthesurveysresultedinfourcategories;staff,rules,facilitiesandsuggestionsforadditionalprogramming.

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Figure 5: Pulse for Good Satisfaction Ratings October - December 2019

Commentsaboutstaffmembersweregenerallyverypositive(n=64)vs.negative(n=9).Thefollowingquoteisagoodexampleofthepositivecommentsmade,“IliveonthestreetandamalwaystreatedwithnoughtbutrespectwhenIcomeinhere.”Thenegativecommentsexpressedconcernsaboutstaffyelling(n=1)andhavingdisrespectfulattitudes(n=5).Additionallytherewerefiveparticipantswhoreportedtheneedformorestaffing.Thenextcategoryhadtodowithcommentsabouttherulesoftheprogram(n=9).Fiveparticipantscomplainedabouttherulesoftheprogramasshownbythefollowingparticipant,“Stopthrowingoutitemsfromlockersattheendoftheday.It’shardenoughbeinghomeless.”Anotheraskedthatsleepingbeallowedagain.Finallytwoparticipantsexpressedconcernaboutparticipantsbreakingrulesaroundalcoholanddruguse,“Iseepeopledisrespectingtheprivilegeofferedbydrinkingalcohol,doingdrugsoutsideorinthebathroom.”Concernsaboutthefacilitieshadtodoprimarilywiththeshowers(n=11).Hereparticipantswereconcernedaboutshowersbeingbrokenandunavailable,thelimitsonhotwaterusage,andthelongwaitforshowers.Oneparticipantsummedthisupduringaninterview,“afterbeingsofreeoutfront,youhavetogoback[totheshowers].Youhavetoyelloutformorewaterhalfwaythroughyourshowerwhichseemslikeaprisonsystem”Staffnotethattheprocesstogettheshowersfixedinvolvedmultiplelayersofpermissionanddelays.RecentlyadministrationreportsthattheCity&CountyhasgivenpermissiontoMHKtocontractdirectlytorepairthefacilities.Thisshouldhelpgreatlywiththisissue.

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Anadditionalsuggestionconcerningthefacilitywasaroundoperatinghoursoftheprogram,suggestinglongerhours(n=5)andmorepredictablehours(n=2).Thereweremanysuggestionsforprogramming,themostcommonbeinghavingaTV(n=4)“tonotfeelasisolated,”havingfoodavailableeitherthroughvendingmachines,hotmealsonceamonthorallowingparticipantstoeatinthereststop(n=7),andmakinghygienematerialmoreavailable,includingfemininehygiene(n=5)andadultdiapers/pads.Oneparticipantsuggestedaddressingtheeatingissue,“it’ssupposedtobenofoodinside,onlyoutside.Itwouldbeniceifpeoplecouldeat,self-monitored.Toallowpeopletohavefoodwhiletheysitaroundandwaitforlaundryorplaygameswouldbenice.”Additionalsuggestionsweretoaddsomeclasses,addingcomputers,havingbooksormagazinesavailable,addingabarber,havingtrashbagsavailable,airconditioningonhotdays,andshowingmovies.ParticipantInterviewsParticipantswereaskedtoparticipateinbriefinterviews.Twenty-sixparticipantsagreedtobeinterviewed.TheimpactofthecultureofrespectthatisdeliberatelycultivatedbystaffatPRSwasmadeevidentduringtheseinterviews.Creatingasafespace,thecleanlinessandaestheticofthefacilities,buildingofconnections,andtherespectfulattitudeofstaffweretheprimarycontributorstothesenseofrespectparticipantsreceivedfromtheprogram.Eachofthesethemesarefurtherillustratedbyparticipantcommentsbelow.

Figure6:CultureofRespectatPRS

Figure 6: Culture of Respect at PRS

Havingasafespacewasoneofthewaysthatparticipantsfeltrespected.“Thisisareallysafeenvironment;noharassingbystaff;noharassingpolicepresenceorsecurity.”Participantsconsistentlyspokeabouthowthesafetycreatedwasoneofthereasonstheykeptreturning.Thepresentationofthefacilitieswasnotedasanotherwaytheprogramdemonstratesrespecttotheclients.“Thisplaceisclean.Itshowedmerespectthatway.I’mnotadirty-for-nothing.”Thestaffactivelycommittokeepingthefacilityandresourcesclean.Forexample,

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staffwashdowntheshowersbetweeneachparticipantsuse.Knowingthatrestroomsareclean,thatshowersarecleanedbetweenusersarebothexamplesofhowrespectisshowntoeveryonewhoaccessesPRS.Staffreportthatparticipantshavealsoshownrespectforthepropertyandfacilities,notingthattherehasbeennodamagenorgraffittioverthecourseoftheyear.PRSdemonstratesrespectbybuildingconnectionswithandbetweenparticipants.Manyparticipantshangoutabitduringtheday,multipledaysaweek.Bydoingthat,theybuildconnectionswitheachotherandthestaff.Oneparticipantsummedthisupbysaying“There’sasenseofcommunityhereand[I’m]meetingnewpeopleallthetime.It’slikegoingbacktoschoolagain.”Anotherstated“OnceIhadtousethecomputerimmediatelybuttherewasn’toneavailable.[Astaffperson]tookmetothebacktotheircomputerandsaidIcouldusethatone.It’salloftheselittlethings.Idon’tcomeherethatoften,butwhenIdotheyknowmebyname.”Finally,staffbuildrespectbydemonstratinggenuine,non-judgmentalattitudes.“Idon’tfeeljudgedhere.Thestaffaren’tcocky.”Participantsdescribethestaffaskind,havinggreatenergy,encouraging,helpful,supportive,andhardworking.RespectforeveryoneisafoundationalpartofPRS’services.Inclientinterviews,itwasconsistentlyreportedthatclientsfeltrespectedwhileaccessingthehygienecenter.Thisenvironmentofrespectcannotbeminimized-manyoftheclientshavenotbeentreatedwithbasicrespectforquitesometime.OneparticipantsummeduptheimportanceofthecultureofrespectthatPRSbuildsinthefollowingquote:

“ThisplaceisliketheVIPforthehomeless.Lookatmeinmyrobe,justshowered,waitingformylaundry.It’slikeaspa,ahighclassspaforthehomeless.”

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AUniqueModelofCaseManagementAsignificantdeparturethatPRSmadefromtheUrbanRestStopmodeloutofSeattlewastheadditionofcasemanagement.CasemanagementwasaddedbyMentalHealthKokuaintheirinitialproposalbecauseoftheperceivedneedformoreinterimcasemanagementinthelocalservicesystem.Casemanagementisacommoncomponentinsocialservices,especiallyforindividualswhohaveamentalhealthdiagnosisorwhoareidentifiedashomeless.Thereareseveraldifferentmodelsofcasemanagement,dependingonthelevelofacuity/need,populationserved,aswellasthegoalsandoutcomesthataredesired.TheresearchteaminvestigatedseveraldifferentcasemanagementmodelsthatmostresembledwhatitisthatPRShasbeendoingintheprocessofdevelopingtheirownuniquemodel.TheCriticalTimeIntervention(CTI)Modelisonethathasthreedistinctphasesandistime-limited,usuallyupto9months,withservicesdecreasinginintensityovertime(SilbermanSchoolofSocialWork,n.d.).AnexampleofhowPRSmightprovideaservicethatresemblestheCTImodelisreachingouttoaclient’sfamilyonthecontinent,withclientpermission,tostartrebuildinganinformalsupportnetwork.Theyworktoensurethatbothfamilialsupportandsocialassistancearesetupbeforeassistingaclienttorelocate.TheBrokerage/Generalistmodelsarealsotimelimited,andtheproviderhaslimitedcontactwiththeclient(sometimesasfewas1-2contacts).Thegoalistogetclientsinvolvedinotherservices/supportsystemstomeettheirneeds.(Tonigan,2017).Pūnāwaiisregularlydoing“warm”referralstootheragencies,buttherearegenerallymorethanoneortwocontactswithaclientbeforethathappens.WhilePRScertainlyutilizescomponentsfromboththeCTIandtheBrokeragemodel,theyhave,intheprocess,developedtheirownmodelofcasemanagement.ThePRSModelofCaseManagementThreecasemanagementstaffareavailabletoclientsonadailybasis.Theyaresupervisedbyalicensedclinicianwhomeetsonceaweekroutinelyandonanasneededbasis.WhenPRSinitiallyopened,staffandcasemanagerswouldspendsometimeininitialoutreachwithclientstoletthemknowabouttheservicesavailableandhowtoaccessthem.Overtime,staffandcasemanagersreportedthatpeoplefoundoutabouttheservicethroughwordofmouth-andthatwhentheycameintoPRS,theywouldasktosignuptomeetwithsomeone.TheLeadCenterAssistantactivelyreferspeopletocasemanagementwhentheyhavespecificquestionsoranissuethattheyneedhelpwith.Thisisaprocessthatisnot“paperworkheavy”orthatisdependentupondoinglongpsychosocialreports--itisfocusedonbuildingarelationshipwiththeclient.

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ModelsofCaseManagementWhiletheCriticalTimeIntervention(CTI)modelpresentsengagementandrapportbuildingassomethingthathappensbeforecasemanagementservicesbegin,itisanactivecomponentofestablishingrelationshipswithclientsforPRS-andapartofthecasemanagementprocess.ThisprocessislikelyfurtheredandmayhappenmorequicklybecauseofthecommunityatPRS.PeerswhoalsousePRSareapowerfulpartofthe“wordofmouth”referralsthatgotocasemanagers.Whenclientsfirstsignuptomeetwithcasemanagers,theyareinthe“driver’sseat.”Assistingclientswithimmediateneeds(e.g.,governmentdocumentsorhomelessverification)helpstobuildtrustwithsomeonewhomaynothavepreviouslyhadsuccesswithatraditionalserviceprovider.Havingthatinitial“win”letstheclientknowthatthecasemanagerisinapositiontohelpandfollowthroughwithrequestsforassistance.TheBrokeragemodelisaboutlinkingclientswiththeservicesthattheyneed-notrelyingasheavilyonrapportandrelationshipbuilding.Itistypicallyaverybriefmodel-theremayonlybeoneortwomeetings.Theprocessismuchlessfocusedonmonitoringandoutcomes,astheoutcomesarethoselinkages.Whentherearelargersystemsinvolved,HomelessManagementInformationSystem,forexample,itcansometimesbeeasiertotrackandfollowclientsastheymaketheirwaythroughtheentiresystem.

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Figure7:ComponentsofPūnāwaiCaseManagementModel

Figure 7: Components of Pūnāwai Management Model

HowPūnāwaiisDifferentThereareseveraldifferencesthatwerenotedininterviewingcasemanagersabouthowservicesareprovidedtoclients:

• Atitscore,itisaboutrelationshipbuildingandtrust• Clientsarenotoverburdenedwithpaperworktogetservicesortocontinueservices• Thereisnotawait-listtoaccessservices• Casemanagerstakeanactiverolesuchasprovidingtransportation,goingwith

clientstomeetingstoassistinnavigatingsystems,ormakingcallsonbehalfofclients

ThefactthatPRS’modelisuniquedoesnotmeanthatitiswithoutchallenges.Thepopulationbeingservedarepotentiallydealingwithavarietyofconcerns:lackofhousing,substanceuse,personalsafetyandsurvival,complexhealthneeds,mentalhealthneeds,etcetera.Theremayalsobedifficultyinaccessingtransportation,aswellastelephoneandcomputerservices.Allofthesecancontributetoclientshavingdifficultywithfollowingup,beinglateormissingappointments,andtracking/navigatingnewsystems.Onechallengethatthecasemanagershavefacedoverthepastyearishowtousedocumentationinthecasemanagementprocess.Consistentwiththeprogram’smissionofoutputs,casemanagerskeptdocumentationprimarilydirectedatoutputs;recordinghowmanyarebeingreferredforhousing,forSNAPbenefits,etc.Additionally,recordswerekeptintheinterestoftheparticipantssuchascopiesofidentificationdocumentsincase

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participantslostthem.DatawasalsocollectedanddocumentedintheHomelessManagementInformationSystemasneeded,suchaswhenaVulnerabilityIndex-ServicePrioritizationDecisionAssistanceToolwascompleted.Emphasiswasonprovisionofservices,withlittleemphasisondocumentingthoseservices.Consentsforservicesweretypicallycompleted,butlittleelseintheformoftraditionalclinicaldocumentationwasfound.TherewereveryfewclosuresofcasesduringtheyearthatPRShasbeenopen.Atthisjuncture,thecasemanagementteamhasrecognizedtheneedforincreaseddocumentationandstandardizationofrecordsinordertominimizerisk,improvecontinuityofservices,ensureparticipantrightsregardingconsent,andbetterdemonstrateachievementofagencygoals.Thechallengefortheteamissimilartothechallengesthe‘frontend’oftheprogramfacesregardingbalancingtheneedfordataanddocumentationwiththeneed/desiretokeeptheprogramlowbarrier.CaseManagementDataOverviewofCaseManagementParticipantsDuringthe2019year,PRScasemanagersservedapproximately371participants.Thesenumbersmaybehigherduetonotrecordingparticipantswhoreceivedarapidhand-offtoanotheragencyorwhowerecontactedviacasemanagementoutreachaimedatrapport-building.DocumentationofcasemanagementservicesevolvedthroughouttheyearthatPRShasbeenopen.Thedatasummarizedbelowisbasedondatacollectedbythevariouscasemanagersthroughouttheprogram,butismuchmoreaccuratelyreflectingthelastsixmonthsofservices.Documentationofcasemanagementserviceshasbeenevolvingthroughthedevelopmentoftheprogram.Thedatapresentedisdrawnfromthe312participantsonwhomdatawascollected.Race/EthnicityPRScasemanagersservedparticipantsofabroadvarietyofracial/ethnicgroups,presentedinFigure8.

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Figure 8: Race/Ethnicity of Case Management Participants

IncomeStatusForthe312participantsincasemanagement,40%reportednoincome.Fortheother60%,thesourcesofincomearereportedbelow.

Figure 9: Income Source of Case Management Participants

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Theamountofincomerangesfrom$0-$4880/month.Fifty-sevenpercentofparticipantsincasemanagementreportedlessthan$500/monthinincome.

Figure 10: Income Amounts of Case Management Participants

AccesstoSNAPBenefitsFoodsecurityisasignificantconcernforpersonsexperiencinghomelessness.ThegraphbelowdetailswhethercasemanagementparticipantswerereceivingSNAPbenefits.

Figure 11: SNAP Benefit Status of Case Management Participants

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HousingStatusHousingstatusforthoseparticipatingincasemanagementisreportedbelow.Thecategoryof‘Sheltered’includesparticipantswhoarecurrentlyinasocialservicehousingprogramsuchasNextStep,HaleMauliola,andIHS.Thecategoryof‘UnstableHoused’includesthoseindangerofeviction,inthehospital,orlosingbenefits.

Figure 12: Housing Status of Case Management Participants

MedicalInsuranceStatusHavingmedicalinsuranceisasignificantneedforpersonsexperiencinghomelessness.

Figure 13: Medical Insurance Status of Case Management Participants

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IdentificationDocumentStatusHavinglegaldocumentsthatconfirmidentityisanecessityinordertoescapehomelessness.Lackoflegalidentification(stateidentification,birthcertificate,driverslicense,socialsecuritycard)isabarriertoaccessingbenefitssuchasmedicalinsuranceandSNAPaswellasreceivinghousingorobtainingemployment.Keepingyourvitaldocumentsisoftenastruggleforpersonswhoarehomelessastheymovearoundalot,haveitemsstolen,orlosetheirpossessionscaughtupin“homelesssweeps”(Darrah-Okike,Soakai,Nakaoka,Dunson-Strane,&Umemoto,2018).PRSservestohelpinthisareabyassistingparticipantsingettingtheirdocumentsaswellasstoringacopyofthedocumentsintheircasefiles.Thefigurebelowillustratesthedocumentstatusforthosewhoparticipatedincasemanagementservices.

Figure 14: Documentation Status of Case Management Participants

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NeedsofCaseManagementParticipantsReviewofthecasemanagersdocumentationrevealedavarietyofneeds.Someneedsrequiredasinglevisitorreferralandothersrequiredmultiplemeetingsandfollow-up.Thechartbelowsummarizestheneedsexpressedbythecasemanagementparticipants.

Figure 15: Case Management Needs of Case Management Participants

Housingneedsincludedsupporttomaintainhousing,generalhousingreferrals,andassistancefindingspecifictypesofhousingsuchasclean&soberhousing,section8housing,andseniorhousing.Financialneedsincludedageneralneedforincome,needtohelpwithbuildingsavings,andhelpwithbudgeting.Medicalneedsincludedassistanceobtainingmedicalinsurance,andreferralsformedicationmanagement,nursingcare,andlongtermcare.Benefitneedsincludedhelpobtainingbenefitssuchasfoodstamps,SSI,SSDI,orgeneralassistanceaswellasproblemswithcurrentbenefits.Thirtyparticipantsdidnotfollowupwiththecasemanagersaftertheirinitialvisitandsodidnothaveaneedlisted.

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Finally,the‘other’categoryincludedASLsupport,helpwithgettingmorefamilysupport,andassistancewitheldercare.Ananalysisofthebarriersofgettingtheabovementionedneedsmetrevealedthatthenumberonebarrierwaslackoffollow-uponthepartof40%oftheparticipantsincasemanagement.

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EvaluationofOutcomes

Evaluationofoutcomesisnottheprimaryfocusofthisreport.Asmentioned,PRSdatacollectionisaimedatcapturingtheoutputsoftheprogram,consistentwiththeirfundingcontract.Duringthisevaluation,qualitativedatawascollectedthatreflectsontheshort-term,mid-term,andlong-termoutcomesoftheprogramover2019.Becauseoftheuniquenessofthismodel,itisstronglyrecommendedthatoutcomemeasuresaredevelopedtofullycapturehowthisprogramimprovesthelivesofitsparticipantsandthecommunityofHawai`i.PūnāwaiRestStopasaSafetyNetOneoutcomethatisevidentrelatestotheroleofPRSintheoverallsystemofcareinthestate.ThedatasuggeststhatPRSisfillingagapinthecurrentsystem,servingasasafetynetforthoseexperiencinghomelessness.Evidenceofthiscamefromthestaffandcasemanagerinterviews,participantinterviews,andcommunitypartnersurveys.Inordertounderstandhowthisoccurs,anunderstandingofthepresentsystemisimportant.Figure16:PRSSafetyNet

Figure 16: PRS as Safety Net

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PRSprovidesservicestothosewithlittleornoconnectiontotraditionalserviceproviders.Additionally,PRSsupportsotherserviceprovidersbyprovidingservicestheydonotprovide.PRSservesasacatch-allforthesystem.ThiswasmostclearlyevidencedbyaPRScasemanagerwhoreported:

“WhenIwasgoingthroughtheCESlisttoreviewtoseewheresomeofmyclientswereonthewaitinglist,Isawanameofoneofourclients.Hehadn’tbeenaroundmuchlately.Hisnamehadrisentothetopandhewaseligibleforhousing,buthewasn’tabletobelocated.Inaweekhewouldhavebeenremovedfromthelist.Iknewthatanotherofourcasemanagerswasworkingwithhim,soIlethimknow.He’snowabouttoenteranapartment.He’sbeenonthestreetsforyears.Luckywefoundhim.”

EarlyImpactsonParticipantsTheimpactofPRSonthelivesofitsparticipantswasexpressedthroughparticipantinterviews.Theinterviewshighlightedhowtheservicesimprovelives:

• “I’vehadseveraljobsfrombeingabletousetheinternet,showers,andwashers.”• “Wecanusethelockersandgetourstuffattheendoftheday.Wecanleaveand

comeback,likeifIhaveanintervieworwanttogotothegym.”Theimpactsoccurredintermsofincreasingresourcesavailable:

• “Mycasemanagerhelpedmealotwithgettingmydisabilitybenefits.Icouldn’tfindouthowtopullmymedicalrecords.SomethingthattookmemonthsoflookingintowhichIeventuallygaveupon,shewasabletofindinliketwodays.”

• “Igothelpapplyingforfoodstampsandfindinghousing.”Impactsareoccurringrelatedtochangesinbehavior,beliefs,andattitudes:

• “Itgivesasolidfoundationthatmakeslifeeasier.Itchangedeverything.”• “Notjustyourcurrentsituationcanbehelpedhere,butyourfuturesituationtoo

becauseofthecasemanagershere.”Casemanagers,throughreviewoftheircaserecords,estimatethattheyhaveassistedapproximately92participantstosecurehousing,35participantsfindsomelevelofemployment,and10participantsenterintosubstanceusetreatment.Thisdata,fromthecasemanagersandtheparticipants,suggestspotentialoutcomemeasurestopursuewhenestablishinganongoingevaluationplan.Theyhintatthenotionthatprovidingrespectasthefoundationofservices,eliminatingasmanybarriersaspossible,andfocusingonconnectioncanresultinchange.

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EvaluationofCommunityPerspectivesThereistangibleevidenceofcommunitysupportintheformofdonationsofgoods,time,andservices.Therehavebeenmultipledonationsofgoodsmadeovertheyear,fromsmalldonationsofextraclothingtolargedonationssuchascasesoftowelsdonatedbyAlscoAmericanLinen.Additionally,therehavebeenmanyorganizationswhohavedonatedtheirtimeandskillstoimprovethelivesofparticipantsofPRS.SomeoftheseprovidershavenowestablishedregularservicetimessothatparticipantscangetspecificneedsmetsuchasthePublicDefender’sofficeandtheStreetDogCoalition.Thelatterreportedthattheyheld21animalclinicsatPRSduringwhichtheycompleted229appointmentsonanimalsthatincludedflea/ticktreatment,vaccinations,spaysandneuters,dentalcleanings,and/ordistributionofpetsuppliesandfood.Thesedonationsofgoods,timeandservicesextendedthereachofPRSservices.LocalBusinessesLocalbusinessesandunrelatedagencieswerevisited,aswellascontactedviaemailandtelephonetorequesttheirparticipationinanopen-endedresponsesurvey.ThiswasperformedattherequestofMHKinordertogaugetheexperiencesofoutsidestakeholdersinordertobegoodneighbors.QuestionsfocusedonexperiencesbothbeforeandafterPRSwasintheareaaswellasthoughtsonsafety,communication,andoverallimpressions.Nineteenlocalbusinesses/agencieswerecontactedandwereceivedtenresponsesfromninebusinesses.Businesses’depthoffeedbackandleveloffamiliaritywithPRSshowedastrongcorrelationbetweentheirlocationrelativetoPRS.ThosecloserinproximityexhibitedahigherdegreeoffamiliaritywithPRS’operationsandexpressedastrongervestedinterestintheexistenceandlocationofPRS.BusinesseswhichwerelocatedfromonetoseveralblocksawayexpressedminimalfamiliaritywithPRSandfairlyneutralattitudestowardsthereststop,withseveralrespondentsadvisingtheywereunawarethatPRSexisted.Whilemostareastakeholdersexpressedconcernandahighdegreeofnegativityoverthehomelesssituationintheareaingeneral,thoselocatedonthesameblockand/oradjacenttoPRSexpressedsomedegreeofreservationwiththecurrentlocationofPRS.Severaladjacentbusinessesexpressedconcernswithrespecttocustomerexperience,areasafety,nuisance,and/orloiteringontheblock.Severaladjacentstakeholdersalsofelttherehadbeenalackofcommunication,outreach,andeducationprovidedtothembyPRS.MostareastakeholdersexpressedsupportforthecoreservicesPRSprovidesthehomelesscommunity.Someoftheconcernspresentedbytheadjacentbusinessesand/oragenciesaboutrecentincidentsrelatingtopersonsassumedtobehomelessincluded,butwerenotlimitedtothefollowing:

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• Staffandcustomersfeelingunsafeand/orbeingapproachedbypersonswhoseemhomelessastheygetinandoutoftheirvehicles

• Theftofcustomers’and/orvendors’belongings(suchastools,deliveries)fromtheirvehicles

• PRSclientsloitering,campingand/orhangingoutinfrontofthebuilding• Safetyissuessuchasfightingbetweenand/orassaultingofotherPRSclients• Break-ins,pettydamage,andneedles/trashinthevicinity• PRSparticipantstraversingthroughtheirbuildingasashortcutfromother

homelessservicesprovidersonneighboringblocks• Personsassumedtobehomelessdefecatingand/orurinatinginthehallways

and/oroutsideoftheirbuildings• Alackofconsultationandcommunicationprovidedtothe

businesses/agenciesintheareabothpriortoandafteropeningPRS• Lackofadequateeducationprovidedtotheareastakeholdersabouthowto

handleincidentsthatarisewithrespecttoPRSand/ortheirclientsGovernmentPartnersRelevantlocalandstategovernmentrepresentativeswerecontactedviaemailandtelephonetorequestthattheytakepartinashortopen-endedresponsesurvey.Questionsaskedcoveredtheofficials’opinionofandsupportforPRS,community/constituentfeedback,andanopportunitytoshareanyrelevantexperiences.Onlyone(n=1)officialprovidedresponses.TherespondentexpressedsupportforPRSandsharedthathehadnotreceivedfeedbackonthereststopfromtheconstituentsinthearea,negativeorpositive.Therespondentadvisednegativefeedbackfromareaconstituentshavebeenaboutthehomelesssituationintheareaingeneral,andnocomplaintswithrespecttoPRShadbeenreceived.The2019monthlymeetingminutesfromneighborhoodboardmeetingsintheDowntown-ChinatownandKalihi-Palamaareaswerereviewed.Theminutesfromlastthreemonthlymeetingsof2018intheDowntown-ChinatowndistrictwerealsoauditedtogaugeattitudesaboutPRSpriortoopening.ConcernssurroundinghomelessnesswerediscussedatlengthintheDowntown-Chinatownmeetings,includingissuessurroundingsafety,impacttobusinesses,publicnuisance,publicintoxication,publicdefecationandurination,loitering,andhomelessencampments,amongothers.Whilecommunityconcernswithrespecttohomelessnesswereacommonthemeinbothdistricts(andparticularlyintheDowntown-Chinatowndistrict),meetingattendeesandboardmembershadlittlecommentaryonPRSspecifically.IntheNovember2018Downtown-Chinatownmeeting,theboardrequestedtohaveotherservicesforthehomelessrelocatedtoPRS’newestablishment,suchastheRiverofLifeMissionmeals.Inmanymeetings,repeatedrequestsweremadeforservicessuchasthePauahiStreetHygieneCentertobemoved.PRS’location,slightlyfurtherawayfromthecoreofChinatown,maythenhelpsatisfyChinatownbusinessowners’andboardmembers’concerns.

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HomelessProviderPartnersAnelectronicsurveywassenttohomelessserviceprovidersthroughPartnersinCare(PIC).PICisaplanning,coordinating,andadvocacyalliancethatdevelopsrecommendationsforprogramsandservicestofillneedswithinOahu’sContinuumofCare(CoC)forhomelesspersons.Atotaloffifteenindividualsrespondedtothesurvey(n=15).RespondentshadaverygoodunderstandingoftheservicesthatPRSoffers;100%ofthemidentifiedatleasttwoofthecoreservicesavailableand12out15(80%)wereabletolistfourormore.AlloftherespondentshadreferredpeopletoPRSforservices(oneagencydoesnotprovidedirectservicessotheywerenotcountedforthiscategory).BelowisachartthatdescribeswhyclientswerereferredtoPRS.

Figure#17:ReasonforReferraltoPRS

Figure 17: Reason for Referral to Pūnāwai Rest Stop

WhenaskedwhatitisthatPRSdoesbest,respondentshadverypositivethingstosay:

• “Allofit,butespeciallythehours[of]availability.7to7,sevendaysaweekmakesiteasytoremember--andisahugeamountoftimetobeavailable.”

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• “Thestaffissuper!Iamnewtothecommunityworkerroleandtheywerewelcomingandinformative,eveniftheywerebusy.”

• “It[Pūnāwai]providespeaceofmindandcomfortwhenthey[peoplewhoarehomeless]otherwisedon'tgetany.”

ProvidersalsorespondedtoaquestionabouthowPRShaschangedthelandscapeofservicesonOahuforpeoplewhoarehomeless.Fromtheresponses,itisevidentthatPRShashadquiteanimpactduringitsfirstyearofprovidingservices:

• “It'sbeenagamechangeriswhatourclientshavestated.”• “Ithinkitfillsanextremelyimportantniche.”• “It'salow-barrierplaceforpeopletoaccessbasicservices.Thebuildingitselfisclean

andthestaffarefriendly,whichisachangefromotherhomelessproviders.”• “It'sasteady/stationaryplacethatpeoplecango,whereIknowtheycanbe

connectedtoserviceswithoutpressuringthemaboutshelter.”

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Recommendations

• AsPRShasdevelopedoverthepastyear,auniqueandexcitingprogramisemerging.Thishasleadtothepresentneedforclarificationofmissionandvisionandtheoperatingprinciplesoftheprogram.Creationofavisionstatementwouldhelpwiththechallengestoconsistencythatstaffidentified.Inaddition,thiswouldhelpwithmissiondriftastheprogrammovesintoitssecondyearandwilllikelyexperiencemultiplepressurestoexpandservices.Focusingonfurtherdevelopingthequalityofcurrentservicesisrecommendedratherthanventuringintoserviceexpansion.

• TheneedfortheservicesatPRSisevident.Theyareaveragingapproximately230

participantvisits/daywithdaysofover300visits,muchhigherthantheoriginal120visits/daythatwasanticipatedwhenthecontractwaswritten.Giventhis,issuesofcapacityneedtobekeptintheforefrontofplanningefforts.Thefacilityislimitedintermsofspaceandthenumberofshowers,washers,anddryersitcanhouse.Also,theabilityofstafftomaintainqualityandsafetyhasalimitintermsofnumberofparticipants.Monitoringincidentreports,staffmorale,andusageofservicesmayprovidedirectionintermsofneedtoincreasestaff,expandhours,orchangeprogramming.OpeningofanadditionalreststopinanotherHonoluluneighborhoodwouldalsoberecommended.

• Generalpoliciesfromtheoperatingorganization,MHK,donotadequatelyaddress

someoftheuniqueneedsofthisprogram.PRShasbeenadaptingwelltotheneedsofparticipants,buthasdonesoonaveryinformalbasis.Itisrecommendedthatpoliciesandproceduresbeformalizedandwrittendown.Thiswillhelpwithstaffconsistency,anexpressedconcernofstaff.Itisfurtherrecommendedthattheseproceduresbemadeavailabletoparticipantstohelpwiththeircooperationandunderstanding.Creatinganddistributinganorganizationalchartthatclearlydefinespositionsandrolesisrecommended.Writtenproceduresareneededinareassuchas:

o Enforcementofthehouseruleso Managementofoutsidespaceso Howvariousservicessuchasmail/shower/lockerworks

• Relatedly,specifictrainingandsupportissuggestedforstafftosupportthe

challengingworkthattheydo.PRSstafffacefrequentoutburstsanddisruptions,necessitatingamoreadvancedlevelofcrisisandde-escalationtraining.Indepthtrainingonadvancedactivelisteningskills,expressingempathy,andproblemsolvingwouldgreatlybenefitstaff.Traininginhowtoeffectivelymanageboundariesisnecessarygiventheuniquechallengestoboundariesthatthisstafffaces.Anotherareaoftrainingthatwouldbehelpfulforstaffisintraumainformedcareasthispopulationhasatypicallyhighincidenceoftrauma.Afourthareaoftrainingisrecommendedthatisconsistentwiththepopulationservedisintheareaofnaloxonetrainingandharmreductionprogramming.

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• StaffretentionhasbeenaproblematPRS,acommonrealityformanynon-profitsinHawai`i.Onepositiveresponsetothisproblemthatwasmadepartwaythroughtheyearwastheincreaseinhourlywageto$15/hourfor‘CenterAssistants’.Inordertorecruitandretainqualifiedstaff,itisrecommendedthatanewcategoryofstaffbecreated.Currentlythereare‘CenterAssistants’and‘LeadCenterAssistants.’Giventheknowledgeandskilldemandsofthejob,significantadditionaltrainingofentry-levelstaffisneeded.Creatinga‘CenterAssociate’categoryforstaffwhohavecompletedtheextensiveadditionaltrainingwithadditionalcommensuratedutiesassignedwouldrecognizethatadvancement.Thiswouldservetohelpwithretentionaswellasimproveoverallcompetenceofstaff.

• Documentationintheareaofcasemanagementservicesneedstobestandardized

andbroughtmoreinlinewithcurrentpracticesinthefield.CurrentcasemanagementpracticesatPRSleavetheorganizationvulnerabletorisk.Thereisabroadrangeofdocumentationpracticesinthefieldofcasemanagement,fromtheextensivechartingthatoccursforCARFaccreditationtominimalnote-takingcommonamongstoutreachcasemanagementwork.Itisrecommendedthatthecasemanagementteamdevelopstandardchartingprotocolsthatfitwiththeirlow-barriermodel,suchasaconsenttoengage,co-developmentofaserviceplan,andstandardsaboutwhentoclosecases.

• PRShasdoneanexcellentjobofcreatingasenseofcommunitywithinthecenteras

wellaswithpartneragencies.ThisisevidentfromthelonglistofproviderswhohavevisitedanddeliveredservicesatPRS.Althougheffortsweremadeinthebeginningtoengagelocalbusinesses,itisclearthatengagementneedstobesustained.EvaluationresultsshowthatbusinessesaresignificantlyimpactedbypersonswhoarehomelessintheareaandareinterestedintheservicesPRSprovides.Havingregularcommunicationwiththesebusinesseswouldprovideanopportunityforcollaborationandeducationforbothparties.Itisrecommendedthataflyerwithacleardescriptionofservicesandanopeninvitationtolocalbusinessestocalliftheyneedassistancewithparticularincidentsorwanttorefersomeoneforservices.

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• Bestpracticesforthesocialservicessectorsuggeststhateveryprogramshouldhaveaprogramevaluationplaninplace(Janzen,Ochocka,Turner,Cook,Franklin&Deichert,2017).SomeofthechallengesforPRSinimplementinganevaluationplanarelimitedavailabilityofstaff,needtokeepagencylowbarrierandsominimizedatacollectedincludingthenumberofformsbeingfilledoutbyparticipants,andalimitedbudget.However,inordertocapturewhatishappeningatPRSandresistthepullthatmayoccurtoerectthesamebarriersthatotheragencieshavedone,documentingthesuccessesandwhatinthismodelleadstothesesuccessesisimportant.Evaluationplansarepresentedbelow.

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OngoingEvaluationPlanTwoevaluationplansarepresentedbelow.Oneplanrequiresaminimalcommitmentofresourcesandyetwillprovidedataonoutcomes.Thesecondplanwouldrequireinvestment,possiblyofafundingpartner,andisaimedatbetterarticulatingthecasemanagementmodelatPRSanddefiningthevariouspathwaystosuccessintheprogram.Bothoptionswouldrequireachangeindatacollectionprocedurestobettercaptureaccuratedata.OutcomeMeasuresDevelopment of appropriate outcome measures and targets needs to be done. Datacollection procedures would need to be implemented to capture the data directed atinforming these targets. Below details potential measures and targets for each level ofoutcome.

1. Short-termoutcomesa. Improvedhygiene

i. #showering/laundry-whatelseherearoundhygieneb. Improvedhealth

i. Self-reportedimprovedhealthstatusc. Improvedself-worth

i. Self-reportedimprovedself-worthd. Improvedexperienceofsafety

i. Decreaseinreportedincidentsofvictimizationii. Standardizingincidentreportdocumentationandmonitoring

e. IncreasedengagementinPRSi. 60%participantsengageinmorethanoneserviceovertime

f. Engagementincasemanagementi. 30%participateincasemanagement

2. Mid-termoutcomesa. 60%casemanagementparticipantsactive

i. Havesignedplanofserviceprovisionii. Makeprogressonplanmonthly-objectivesbeingaccomplished

b. 60%casemanagementparticipantsexperiencehand-offtootherserviceprovider

i. Increasenumberofreferralsmadeii. 50%ofthosereferralsresultinactualfollow-upbyparticipants

c. 80%participantsincasemanagementhaveanincreaseinfinancialresourcesavailabletothem

3. Long-termoutcomes

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i. LongtermoutcomesarenotthefocusofserviceprovisionatPRS;itisnotrecommendedtofocusondatacollectionaroundtheseoutcomesatthistime.PRSmaywanttoaddressthisinthefuture,butitismoreimportanttolookatdataaroundtheoutputsandshorttomidtermoutcomes.

BasicEvaluationPlanAbriefqualityoflifesurveywouldbedevelopedtocapturedataontheparticipants’currenthygiene,health,senseofsafety/victimization,andself-worth.ArandomnumberofparticipantscouldbeaskedtocompletethesurveywhentheybeginservicesatPRS.Staffwouldthenreconnectwiththesameparticipantsat3monthsandagainat6monthstoreadministerthesurvey.Thiswouldprovidedatarelatedtochangeinqualityoflifewhileparticipatingintheprogram.Onthecasemanagementside,amonthlydatacollectionformcouldbecreatedtocapturethepercentageoffileswithacurrentsignedserviceplan,aratingbythecasemanagerofprogresstowardgoals,trackingofthenumberofreferralsmade,trackingofchangeinincomestatusforparticipants,andnumberofcasesclosedwithadeterminationofreasonforclosure(i.e.participantdroppedoutofservices,participantbeingservedbyanotheragency,etc.).AdvancedEvaluationPlanThisplanisaimedatbetterarticulatingthePRScasemanagementmodelanddefiningthevariouspathwaystosuccessfuloutcomes.Theevaluationwouldincludeunderstandingwhattheindividualdifferencesandtreatmentdifferencesarethatmightpredictchange.Potentialindividualdifferencesincludedemographics,substanceusehistory,severityofillness,andcomorbidityofillnesses.Treatmentdifferencesincludedifferencesinamountandtypeofservices.ItisrecommendedthatanumberofparticipantsarerandomlyrecruitedtoparticipateinmoreextensivedatacollectionthantheBasicEvaluationPlanarticulatedabove.Incentivescouldbeusedtokeepparticipantsengagedovertheevaluationperiodasthispopulationisoftenmobileanddifficulttoreach.Participantswouldbeinterviewedquarterlyovera1-yearperiodwithdatacollectedonsatisfaction,functioning,qualityoflife,andclinicalstatus.Therearemultiplewell-beingmeasuresthatcouldbeusedtoassesseachoftheseareasincludingtheBriefSymptomInventory,theSocialAdjustmentScale,andtheQualityofLifeInventory.Followingparticipantsinthiswayovera1-yearperiodwouldgivePRSabetterunderstandingoftheeffectsthattheprogramishavingonparticipantsanddocumentchange.

2

ReferencesDarrah-Okike,J.,Soakai,S.,Nakaoka,S.,Dunson-Strane,T.,&Umemoto,K.(2018).“ItwaslikeIlosteverything”:theharmfulimpactsofhomeless-targetedpolicies.JournalofHousingPolicyDebate,28(4),pp.635-651.Hawai`iPolicy&BudgetCenter(2019).HowHawai`iisspendingitsmoney,2018-19.Retrievedfrom:https://hibudget.org/2019/03/how-hawaii-spending-money-2018-19/Janzen,R.,Ochocka,J.,Turner,L.,Cook,T.,Franklin,M.,&Deichert,D.(2017).Buildingacommunity-basedcultureofevaluation.EvaluationandProgramPlanning,65,pp.163-170.Lee,B.A.,&Schreck,C.J.(2005).Dangeronthestreets:Marginalityandvictimizationamonghomelesspeople.AmericanBehavioralScientist,48(8),1055-1081.Mayor’sOfficeofHousing(2019).WhatistheCitydoingtohelp.Retrievedfrom:http://www.honolulu.gov/housing/homelessness/ohou-what.htmlNakaso,D.(2/4/19).HomelessflocktoIwileireststop,butfewusesocialservices.HonoluluStarAdvertiser.Retrievedfrom:https://www.staradvertiser.com/2019/02/04/hawaii-news/homeless-flock-to-rest-stop-but-few-use-social-services/CenterfortheAdvancementofCriticalTimeIntervention(n.d.).AbouttheCTImodel.SilbermanSchoolofSocialWork.Retrievedfrom:https://live-critical-time-intervention.pantheon.io/wp-content/uploads/2014/08/About-the-CTI-Model-82114.pdfTonigan,A.(2017).Substanceabusespecificintensivecasemanagement.Retrievedfrom:http://isr.unm.edu/centers/center-for-applied-research-and-analysis/behavioral-health-initiative-reports/summarized-literature-reviews/intensive-case-management.pdf)Weiss,C.&Quinn,D.(2018).Stigmatizedidentities,psychologicaldistress,andphysicalhealth:Intersectionsofhomelessnessandrace.Stigma&Health(3),pp.229-240.

Appendices

I

EvaluationMethodologyThisprogramevaluationreportfocusesontheimplementationofthePūnāwaiRestStopinHonolulufromJanuary2019throughDecember2019.Inparticular,theevaluationstrivesto:

• Understandaspectsofserviceprovisionandimplementation;• Detectoutputsandimpact;• Presentalogicmodelfortheprogram;• Giverecommendationsregardingprogramdevelopmentandevaluationmoving

forward.ThecontractforevaluationwascompletedinOctoberof2019,andworkbeganassoonasitwassigned.Threeresearchassistantswerehiredtoassistthetwofacultywholedtheevaluation.AnundergraduateSocialWorkresearchclasswasalsoinvolvedinthedevelopmentofinstrumentsandconductinginterviews.Theevaluationteamdevelopedamulti-prongedapproachtocollectdatafrominternalandexternalstakeholderstogivebroadperspectivesontheimpactofPRS’firstyearofservice.Allinstrumentsdevelopedbytheevaluatorsareincludedasanappendix.Amixofquantitativeandqualitativedatawascollectedandanalyzedaccordingly.SourcesofData

• Interviewswithstaff,casemanagers,casemanagersupervisor,andprogrammanager

• Notesfromweeklystaff/casemanagementmeetings• Interviewswithclients• Interviewswithparticipantswhomstaffidentifiedas‘successstories’• Interviewswithnearbybusinesses• Interviewwithgovernmentofficial• WeeklyoutputreportssenttoCityandCountyofHonolulu• PulseforGooddata• CaseManagementIntakeDataSpreadsheet• SurveytoHomelessServiceProviders• Incidentreports• NeighborhoodBoardMeetingMinutes• HMIS• OrganizationalChart(s)

II

InterviewQuestions–Participants

1. WhatmadeyoufirstcometoPRS?Howdidyouhearaboutit?2. WhatdoyoudoatPRS?3. HowhascomingtoPRSmadeadifferenceinyourlife?4. Whatarethestafflike?5. Doyouseeacasemanagerhere?Whatisthatlike?6. Anysuggestionsforimprovement?

SurveyQuestions–AreaBusinesses

1. HaveyouheardaboutPūnāwaiRestStop?a. Ifyes,canyoutellmewhatyou’veheardandwhatyouknowaboutwhatthe

agencydoes?b. Ifyes,whenyouheardthereststopwasgoingtobeestablished,whatwere

youexpecting?c. Ifyes,whatactuallyhappened?Wastheexperiencedifferentthanyouwere

expecting,oraboutthesame?d. If yes, do you feel as though your safety has been impacted? For the

better/worse?2. How has the situation in the area changed over the last year? (ex.more or fewer

encampments in the area, more or less crime [perceived or actual], increase ordecrease in litter, any break ins/loitering? Etc) What changes have you noticedoverall,whethergood,bad,orneutral?

3. Has the Pūnāwai staff or Mental Health Kokua reached out to your business atall?Haveyoumetanyofthestaff?

4. Whatareyouroverallimpressionsoftheservicethusfar(ifany)?5. WhatareyouroverallimpressionsofhowhavingaprogramlikePūnāwaiRestStopis

impactingthearea?Doyouforeseeanyfurtherchangesorimpactshappening?6. Isthereanythingyouarehopingtoseechanged?7. Are there any thoughts or suggestions youwould like to share? Do you have any

commentsonanythingthathasn’tbeencoveredinthepreviousquestions?SurveyQuestions-PartnerAgencies

1. WhatisyourunderstandingoftheservicesthatPūnāwaiRestStopprovides?2. Haveyou/youragency/yourprogramreferredclientstoPūnāwai?

a. Approximatelyhowmany?b. Whatwerethereason(s)foryourreferral?

3. Haveyou/youragency/yourprogramreceivedreferralsfromPūnāwai?

III

a. Approximatelyhowmany?b. Whyweretheyreferredtoyou/youragency?

4. HasPūnāwaihelpedyouragency/programinprovidingservicestoyourclients?How?5. How do you think Pūnāwai has changed services available for people who are

homeless?6. WhatdoyouthinkPūnāwaidoesbest?7. Doyouhaveanyrecommendations/suggestionsforPūnāwaimovingforward?8. Wouldyouliketoreceivemoreinformation/educationabouttheservicesthatPūnāwai

provides?Ifso,pleaseenteryournameandemail.