1 Evaluating Effectiveness of Georgia’s PATH Services Charley Bliss PATH Grantee Meeting December 8 & 10, 2010

2 Why Evaluate PATH Services for Effectiveness? In Order To: In Order To: –Identify Overall State Effectiveness of PATH Services –Monitor Individual PATH Providers –Implement Quality Improvement

3 Which PATH Services Were Evaluated for Effectiveness? Primary PATH Services Primary PATH Services –Outreach –Case Management

4 What Steps Were Taken To Develop Effectiveness Measures? Defined the ServicesDefined the Services Identified the Goal(s) of the ServicesIdentified the Goal(s) of the Services Listed Strategies or Interventions Identified as EffectiveListed Strategies or Interventions Identified as Effective Developed Effectiveness MeasuresDeveloped Effectiveness Measures

5 Georgia’s Definition of OUTREACH Service Identifying individuals who do not access traditional services on their own, meeting their basic needs while engaging them in a relationship that motivates them to change, and moving them from engagement to enrollment. Identifying individuals who do not access traditional services on their own, meeting their basic needs while engaging them in a relationship that motivates them to change, and moving them from engagement to enrollment.

6 Georgia’s Identified Goals for OUTREACH Service 1. To identify individuals who are PATH eligible and who are unable or unwilling to seek services on their own; and 2. To engage them with a personal connection, meet basic needs, and motivate them to consider change; and 3. To enroll them in Case Management.

7 Recommended Outreach Strategies To Identify Consumers  Use multiple outreach models including mobile, scheduled, fixed, and referral;  Collaborate with Street Ambassadors;  Focus on those locations where the chronically homeless gather.

8 Recommended Outreach Strategies To Engage Consumers  Go to them  Meet with them frequently and often (within 24 hours);  Offer something of immediate value, such as food, clothing, transportation, restrooms, sleep cover; Convey hope by telling your individual story of recovery; Convey hope by telling your individual story of recovery; Focus on their stated priority of needs; Focus on their stated priority of needs; Provide information on immediate housing options; Provide information on immediate housing options; Offer the use of a cell phone to make a call. Offer the use of a cell phone to make a call.

9 Recommended Outreach Strategies To Enroll Consumers in CM  Stimulate readiness to change by identifying the risks and problems related to current condition; Schedule next meeting within 24 hrs; Schedule next meeting within 24 hrs; Obtain their emergency contact information. Obtain their emergency contact information.

10 Georgia’s Effectiveness Measure for OUTREACH Impact Measure: Percentage of Outreach Contacts that enroll in ongoing PATH Case Management. Numerator Number who enroll in ongoing PATH service Denominator Total number of Outreach Contacts Assumption: Effective Outreach enrolls “change ready” clients in ongoing Case Management.

11 Georgia’s Definition of CASE MANAGEMENT To Assist PATH consumers with ending their homeless cycle by:  accessing immediate housing (emergency, transitional, permanent); and  linking to mainstream services needed to remain housed: -mental health treatment -mental health treatment -substance abuse treatment -substance abuse treatment -medical treatment -medical treatment -benefits (Medicaid, SSI/SSDI, Food Stamps) -benefits (Medicaid, SSI/SSDI, Food Stamps)

12 Georgia’s Identified Goals for CASE MANAGEMENT 1. Partner with the consumer in ending their homelessness; and 2. Access immediate housing (emergency, transitional, permanent); and 3. Link to mainstream support services needed to remain housed.

13 Recommended CM Strategies To Partner/Engage with Consumers Identify what is important to consumer; Identify what is important to consumer; Only promise what you can deliver; Only promise what you can deliver; Be reliable and always follow-through; Be reliable and always follow-through; Make sure consumer understands the process, answer their questions; Make sure consumer understands the process, answer their questions; Use Peer Specialists to teach and model recovery behaviors. Use Peer Specialists to teach and model recovery behaviors.

14 Recommended CM Strategies To Access Housing Initiate Family Reunification to re-connect to personal support system; Initiate Family Reunification to re-connect to personal support system; Identify Housing Options in Advance: Identify Housing Options in Advance: Dedicate Housing Coordination Funds;Dedicate Housing Coordination Funds; Identify local Continuum of Care Housing Programs- Supportive Housing Programs (SHP) and Shelter Plus Care (SPC);Identify local Continuum of Care Housing Programs- Supportive Housing Programs (SHP) and Shelter Plus Care (SPC); Go to to identify affordable housing;Go to to identify affordable housing; Recruit landlords.Recruit landlords. Dial 211 to access emergency shelters and homeless resources statewide. Dial 211 to access emergency shelters and homeless resources statewide.

15 Recommended CM Strategies To Link to Mainstream Services Access MH/SA services by dialing ; Access MH/SA services by dialing ; Accompany client to their first appointments; Accompany client to their first appointments; Actively assist with applying for SSI/SSDI (SOAR); Actively assist with applying for SSI/SSDI (SOAR); Develop “fast track” processes to link w/providers (ACT); Develop “fast track” processes to link w/providers (ACT); Co-case manage until firmly linked to mainstream services. Co-case manage until firmly linked to mainstream services.

16 Georgia’s Effectiveness Measure for CASE MANAGEMENT Impact Measure: Percentage of Consumers discharged from Case Management that access BOTH housing and mental health services. Numerator Number discharged consumers that accessed both housed and mental health services. Denominator Total number discharged consumers from PATH Case Management. Assumption: Effective Case Management accesses both housing and mainstream services for consumer prior to discharge.

17 What Are Georgia’s Effectiveness Measures for PATH Services?  Outreach Effectiveness Measure  Enrollment: Percentage of Outreach Contacts that enroll in ongoing PATH Case Management.  Case Management Effectiveness Measures  High Impact DC: Percentage of Discharges that accessed BOTH housing and mental health services.  Medium Impact DC: Percentage of Discharges that remained homeless but accessed mental health services.  Low Impact DC: Percentage of Discharges due to lack of contact or refused services.  Discharge Rate: Percentage of Enrollments that are Discharged within State Fiscal Year.

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Case Management Effectiveness Data Identified Need for Increased Access to Housing In 2009, only 23% of Consumers Discharged from CM Accessed Both Housing and Mental Health Services. In 2009, only 23% of Consumers Discharged from CM Accessed Both Housing and Mental Health Services. Set 2010 Goal: 50% of Consumers Discharged from CM would Access Both Housing and Mental Health Services. Set 2010 Goal: 50% of Consumers Discharged from CM would Access Both Housing and Mental Health Services. Actual 2010 Outcome: 54% of Consumers Discharged from CM Accessed Both Housing and Mental Health Services. Actual 2010 Outcome: 54% of Consumers Discharged from CM Accessed Both Housing and Mental Health Services.

Statewide Plan To Increase Access to Housing SPC changed Requirements to become a PATH Provider to include proof of housing resources. SPC changed Requirements to become a PATH Provider to include proof of housing resources. SPC provided additional resources to increase consumer access to housing: SPC provided additional resources to increase consumer access to housing: –Applied to PATH TA Center for Web-Based Housing Training. –Allocated additional Housing Coordination Funds to each PATH Provider. –Funded SOAR Benefit Specialists to file claims for PATH consumers.

25 Using 2010 Effectiveness Data To Monitor Individual Providers Established Minimum Performance Standards (Overall Annual Averages): Established Minimum Performance Standards (Overall Annual Averages): –49% or more Outreach Contacts Enroll in CM; –30% or less Drop-Out of CM; –73% or more Enrollments are Discharged within SFY; –50% or more Discharges Access Housing and Services. Identified Areas of Accomplishment Identified Areas of Accomplishment Identified Areas That Need Improvement Identified Areas That Need Improvement Established Future Performance Goals Established Future Performance Goals

26 Comparing PATH Service Effectiveness Between 2009 and 2010 In 2010, PATH Services: In 2010, PATH Services: –Increased Outreach Enrollments : 9% more Outreached Consumers enrolled in Case Management compared to –Decreased Drop-Outs : 11% fewer Consumers Dropped-Out of Case Management compared to –Increased Discharge Rate : 10% more enrolled Consumers were Discharged from Case Management within the State Fiscal Year compared to –Increased Access to Housing : 31% more Consumers Accessed BOTH Housing and Mental Health Services upon Discharge compared to 2009.

27 Next Steps  Examine Low Impact Discharges in hopes of identifying common variables and contributing factors in hopes of effecting change. Identify Individual Providers Falling Below Overall State Annual Average To Receive Technical Assistance and Training. Identify Individual Providers Falling Below Overall State Annual Average To Receive Technical Assistance and Training. Identify Individual Providers Falling Above Overall State Annual Average To Provide Technical Assistance and Training. Identify Individual Providers Falling Above Overall State Annual Average To Provide Technical Assistance and Training.