1. Measuring Success Using Performance Measurement NAEH Conference on Ending Family Homelessness Michelle Abbenante Brooke Spellman February 8, 2008

2. 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.

3. 2008 NAEH Family Conference - Outcomes Workshop 3 Multiple Levels of Performance Measurement Local Service Provider 1. Program Level Program Funding Report, such as HUD APR CoC 2. CoC/System Level Ten-Year Plan Report Card or CoC Application 3. State Level State-wide Report or Performance Measurement Tool 4. National Level NAEH Assessment of National Progress or Federal GRPA and PART Reviews

4. 2008 NAEH Family Conference - Outcomes Workshop 4 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.

5. 2008 NAEH Family Conference - Outcomes Workshop 5 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.

6. 2008 NAEH Family Conference - Outcomes Workshop 6 Performance Measurement Process Activities Outreach Shelters Case Management Rent Subsidies & Services Outputs # Clients Served by Program Service Linkages New PSH Units/Subsidies Vacancy Statistics Outcomes 30% exited to PH 40% increased income 25% reduction in CH 25% shorter LOS < recidivism How do we document our efforts? What did our efforts achieve? Inputs $ (CoC and Other) Programs Infrastructure Staff Should we adjust how we spend our resources? Should we add or change use of resources to expand our impact?

7. 2008 NAEH Family Conference - Outcomes Workshop 7 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

8. 2008 NAEH Family Conference - Outcomes Workshop 8 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

9. 2008 NAEH Family Conference - Outcomes Workshop 9 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:

10. 2008 NAEH Family Conference - Outcomes Workshop 10 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

11. 2008 NAEH Family Conference - Outcomes Workshop 11 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?

12. 2008 NAEH Family Conference - Outcomes Workshop 12 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 housing at least 6 months

13. 2008 NAEH Family Conference - Outcomes Workshop 13 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?

14. 2008 NAEH Family Conference - Outcomes Workshop 14 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.

15. 2008 NAEH Family Conference - Outcomes Workshop 15 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

16. 2008 NAEH Family Conference - Outcomes Workshop 16 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 DateExit DateEmployment Entry Employment Exit 11/31/079/15/07UnemployedEmployed 23/15/076/28/07Unemployed 37/11/07--Unemployed-- 47/7/079/18/07EmployedSame Employment 58/2/065/12/07EmployedHigher Paying Job 611/7/068/2/07UnemployedEmployed

17. 2008 NAEH Family Conference - Outcomes Workshop 17 Define the Base Population for Each Goal Client ID Entry DateExit DateEmployment EntryEmployment Exit 11/31/079/15/07UnemployedEmployed 23/15/076/28/07Unemployed 37/11/07--Unemployed-- 47/7/079/18/07EmployedSame Employment 58/2/065/12/07EmployedHigher Paying Job 611/7/068/2/07UnemployedEmployed 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?

18. 2008 NAEH Family Conference - Outcomes Workshop 18 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

19. 2008 NAEH Family Conference - Outcomes Workshop 19 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 better employment Program Goal 2: Improved Employment at Exit

20. 2008 NAEH Family Conference - Outcomes Workshop 20 Exercise 2 and the Performance Measurement Process Inputs Money: $250,000 Staff: 4 FTEs 1 Facility Activities Job Training Classes Interview Assistance Job Placement Services Outputs 6 enrolled in weekly services 6 employment assessments Referred to av. 4 jobs each Outcomes 67% achieved empl. 50% improved empl.

21. 2008 NAEH Family Conference - Outcomes Workshop 21 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

22. 2008 NAEH Family Conference - Outcomes Workshop 22 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?

23. 2008 NAEH Family Conference - Outcomes Workshop 23 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.

24. 2008 NAEH Family Conference - Outcomes Workshop 24 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.

25. 2008 NAEH Family Conference - Outcomes Workshop 25 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.

26. 2008 NAEH Family Conference - Outcomes Workshop 26 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

27. 2008 NAEH Family Conference - Outcomes Workshop 27 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

28. 2008 NAEH Family Conference - Outcomes Workshop 28 *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, DC FY 07 DHS Performance Measures

29. 2008 NAEH Family Conference - Outcomes Workshop 29 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

30. 2008 NAEH Family Conference - Outcomes Workshop 30 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

31. 2008 NAEH Family Conference - Outcomes Workshop 31 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 67% (60 of 90 persons) Non-disabled Clients 23% (70 clients) All Clients (n=300) 12% (30 of 250 persons) Disabled Clients 80% (40 of 50 persons) Non-disabled Clients Program B 12% (31 of 260 persons) Disabled Clients 71% (100 of 140 persons) Non-disabled Clients CoC Outcome Results By Population

32. 2008 NAEH Family Conference - Outcomes Workshop 32 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)

33. 2008 NAEH Family Conference - Outcomes Workshop 33 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

34. 2008 NAEH Family Conference - Outcomes Workshop 34 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 1A 1B 2A 3C 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

35. 2008 NAEH Family Conference - Outcomes Workshop 35 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 data 1. 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

36. 2008 NAEH Family Conference - Outcomes Workshop 36 Summary of System Performance Measurement Activities Adjust type and intensity of activities based on outcomes; track if improves Outputs Document the level of effort provided Use to ensure activities delivered efficiently Outcomes Interim Outcomes signal client success; Impact outcomes track progress to goals Inputs Use program-level & system-wide results to adjust use of resources

37. Questions? Contact us for more information or assistance: Michelle Abbenante, michelle_abbenante@abtassoc.commichelle_abbenante@abtassoc.com Brooke Spellman, brooke_spellman@abtassoc.combrooke_spellman@abtassoc.com