2010 Florida HMIS Conference

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Using HMIS to Inform Performance Measurement Outcomes

• Objective:– Enhance awareness and understanding

on using HMIS to impact local policy, service delivery, and practice: • Assumptions • Levels of measurement• Importance of measuring performance

outcomes• Terminology• Role of HMIS

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Assumptions

• Use of HMIS that collects:– Program Descriptors– Universal Data Elements– Program-specific Data Elements– Services Provided

• Use of HMIS that can de-duplicate

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Levels of Performance Measurement

• Five levels of performance measurement:1. Client2. Program3. Continuum of Care4. State5. National

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Importance of Measuring Performance Outcomes

• Five reasons to measure performance:1. To understand if current activities are working

to achieve intended results2. Drive program improvement and disseminate

best practices3. Ensure all partners, staff, and consumers

understand the end goal and the plan to achieve it

4. To support advocacy5. Added incentive to accomplish goals

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Performance Measurement Terminology

• Inputs: Resources• Activities: Services• Outputs: Units of Service Provided• Outcomes: Results

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Performance Measurement Terminology

• Outputs: – What the client or program will do to

achieve the outcome– Frequency and intensity of activity from

client perspective

• Outcomes:– What the client will gain from the program– Client-level impact

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Performance Measurement Terminology

“Think of the outputs as the recipe and the outcomes as the cake. How much of each ingredient do you need for the cake to taste good? How many case management meetings or service engagements did it take to achieve your goal with clients.”

What Gets Measured, Gets Done: A Toolkit on Performance Measurement forEnding Homelessness (July 2008)

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Performance Measurement Terminology

• Logic models can articulate and be a tool to monitor performance outcomes

• Five components of a logic model:1. Problem, need, situation2. Service or activity3. Outputs and outcomes4. Measurement reporting tools 5. Evaluation process

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Performance Measurement Terminology

• Getting Started: Building an Outcome:– Identify the target population– Determine what you want to achieve – Pull HMIS data from last year on select

outcome– Identify services and programs associated

with higher achievement of select outcome– Determine if last year outcomes are

acceptable

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Using HMIS to Inform Performance Measurement

• The ability to use HMIS for performance measurement is dictated by:– Unique client identifiers for de-duplication – Collection of required information at entry

and exit for each client– Timely data entry– HMIS compliance with HUD Data Standards

for Program Descriptor, Universal, and Program-specific data elements

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Using HMIS to Inform Performance Measurement

• The ability to use HMIS for performance measurement is dictated by:– HMIS coverage, participation, and entry

and exit data quality– Client enrollment in programs that make

sense for data aggregation

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Using HMIS to Inform Performance Measurement

Many HMIS can perform the following functions, which can provide data to identify if performance measures are being met:

1. Generate Point-In-Time, average day, and longitudinal counts

2. Identify clients with multiple program uses during a defined timeframe

3. Count persons by household type

4. Generate frequencies for basic demographic characteristics

5. Cross-tabulate the length of stay within each program household type by gender and age

6. Total the number of households with children by program type

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Using HMIS to Inform Performance Measurement

• Policy considerations:– Establishing the framework– Resource allocation and best practices– Risk adjustment– Setting targets– Validating, reviewing, and disseminating

results

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Using HMIS to Inform Performance Measurement

• Use HMIS to monitor progression toward outcomes throughout the year and make changes when necessary– Short-term outcomes– Intermediate outcomes– Long-term outcomes

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HMIS Example: UDE

• 3.1 Name• 3.2 SSN • 3.3 DOB • 3.4 Race• 3.5 Ethnicity• 3.6 Gender• 3.7 Veteran Status• 3.8 Disabling Condition• 3.9 Residence Prior to

Program Entry

• 3.10 Zip Code of Last Permanent Address

• 3.11 Housing Status• 3.12 Program Entry

Date• 3.13 Program Exit

Date• 3.14 Personal

Identification Number• 3.15 Household

Identification Number

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HMIS Example: Program Specific*

• 4.1 Income and Sources

• 4.2 Non-Cash Benefits• 4.3 Physical Disability• 4.4 Developmental

Disability• 4.5 Chronic Health

Condition• 4.6 HIV/AIDS• 4.7 Mental Health• 4.8 Substance Abuse

• 4.9 Domestic Violence• 4.10 Destination• 4.11 Date of Contact• 4.12 Date of

Engagement• 4.13 Financial

Assistance Provided • 4.14 Housing

Relocation & Stabilization Services Provided

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HMIS Example: Optional Data Elements*

• 4.15A Employment• 4.15B Education• 4.15C General Health Status• 4.15D Pregnancy Status• 4.15E Veteran’s Information• 4.15F Children’s Education• 4.15G Reason for Leaving• 4.15H Services Provided

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HMIS Example: PH Outcome

Permanent Housing Outcome: – % of individuals staying in Emergency Shelter A will exit to

PH within 30 days– % of these individuals will remain in same or comparable

PH for 6 months– % of these individuals will remain in same or comparable

PH for > 6 months

Relevant HMIS data elements: Program Descriptors, UDE, Program Entry Date, Program Exit Date, and Destination

Other HMIS data elements of possible interest: Reason for leaving, Services Provided, Income and Sources, Non-cash Benefits, Employment

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HMIS Example: Destination

• 4.10 Destination• Rationale: Destination is an important

outcome measure needed to complete APRs and QPRs for all HUD-funded CoC Programs, including HPRP programs.

• Data Source: Client interview or self-administered form.

• When Data Are Collected: At program exit.• Subjects: All clients served.

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HMIS Example: Destination

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HMIS Example: Employment

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• 4.15A Employment• Rationale: To assess client’s employment status and

need for employment services.• Data Source: Client interview or self-administered

form.• When Data Are Collected: In the course of client

assessment nearest to program entry, at program exit and at least once annually during program enrollment, if the period between program entry and exit exceeds one year.

• Subjects: All clients served or all adults and unaccompanied youth.

HMIS Example: Employment

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HMIS Example: Education

• 4.15B Education• Rationale: To assess client’s readiness for

employment and need for education services.• Data Source: Client interview or self-administered

form.• When Data are Collected: In the course of client

assessment nearest to program entry, at program exit and at least once annually during program enrollment, if the period between program entry and exit exceeds one year.

• Subjects: All clients served or all adults and unaccompanied youth.

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HMIS Example: Education

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HMIS Example: Services Provided

• 4.15H Services Provided• Rationale: To determine the services provided to

clients during program participation. This data element can be used to track referrals from street outreach programs. It may also be useful in identifying service gaps in a community and for meeting monitoring and reporting requirements for non-HUD funded programs.

• Data Source: Case manager records.• When Data are Collected: When services are provided

during the course of program participation.• Subjects: All clients served.

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HMIS Example: Services Provided

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HMIS Example: Reason for Leaving

• 4.15G Reason for Leaving• Rationale: Reason for leaving is used, in part, to

identify the barriers and issues clients face in completing a program or staying in a residential facility, which may affect their ability to achieve economic self-sufficiency.

• Data Source: Client interview, self-administered form or staff observation.

• When Data Are Collected: At program exit.• Subjects: All clients served.

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HMIS Example: Reason for Leaving

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Performance Measurement in FL

• Causes of Homelessness:– Employment/financial reasons (50.4%)– Medical/disability (15.6%)– Housing issues (12.4%)– Family problems (12%)– Forced to relocate from home (7.3%)– Recent immigration (1.4%)– Natural or other disasters (.9%)

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Performance Measurement in FL

• Rapid re-housing:– Length of homelessness episode

• Less than 3 months (38.5%)• 3-12 months (22.2%)• Over one year (39.3%)

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Performance Measurement in FL

• What are some outcomes FL CoCs are currently using HMIS to monitor?

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Wrap-up

• HMIS is an existing resource that can provide data to inform local homelessness and housing policy, program design, and practice

• Questions/Discussion

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Resources

• Presentation informed primarily by: – Florida Department of Children and Families, Homeless

Conditions in Florida: Annual Report, Fiscal Year 2008-2009 (June 2009).

– National Alliance to End Homelessness, What Gets Measured, Gets Done: A Toolkit on Performance Measurement for Ending Homelessness (July 2008).

– U.S. Department of Housing and Urban Development, Office of Community Planning and Development, Homeless Management Information System (HMIS) Data Standards Revised Notice (June 2009).

– Detailed Information on the Homeless Assistance Grants (Competitive) Assessment found at ExpectMore.gov: http://www.whitehouse.gov/omb/expectmore/detail/10001234.2005.html

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