September 18-19, 2006 – Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development Realizing Benefits of Participating in HMIS for Consumers and Case Managers Gloria J. Townsend, Baltimore Homeless Services, Inc. Michelle Budzek, The Partnership Center Dale Fitch, School of Social Work, University of Michigan Stacy Ebron, Washtenaw County Office of Community Development

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 2 Overview Learning Objectives Using an HMIS for Case Management Generating Homeless Certifications with HMIS Case Study of Using HMIS Real Time Conducting System Analysis on HMIS Implementation

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 3 Learning Objectives Promote the sharing of innovative ideas of benefit to consumers among communities and solution providers. Expand awareness of the potential benefits of HMIS to consumers and case managers. Understand strategies for how HMIS can be fully integrated into program and shelter operations.

September 18-19, 2006 – Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development Using an HMIS for Case Management Gloria J. Townsend/Baltimore, MD Homeless Services

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 5 Overview Benefits to the consumer Identifying eligible mainstream benefits at intake or assessment Identifying the documentation needed to apply for benefits Determining eligibility for various programs based on case history Producing a comprehensive referral notice document

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 6 Using an HMIS for Case Management Benefits to Case Managers A tool for case planning A tool for recording client progress in working their plan to achieve housing and self-sufficiency goals Increased data quality for accuracy in reporting (APR, monthly activity reports, state reports) Eligibility determination for mainstream benefits

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 7 HMIS Case Management Features Centralized database provides shared case management capabilities Case Managers can enter public or private case notes to protect client confidentiality A defined set of descriptive indicators called “statuses” narrate the client’s progression through case management Specific status values are tied to outcome measures for reporting purposes

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 8 The Individual Case Plan (ICP) With a case manager, clients define short, medium and long term goals for themselves in any one of 15 key areas Case Manager and client both sign agreement to work together to achieve stated goals

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 9 Individual Case Plan (ICP) One part of a complete case management tool Easily ties to reporting requirements in APR Keeps client focused on specific outcomes Creates a historic record of the client’s efforts toward specific goals Documents service delivery for audit purposes

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 10 Presumptive Eligibility Automates the eligibility tests for food, income, health care, veterans benefits and employment assistance Helps case managers identify clients potentially eligible for assistance Documents number of clients referred to mainstream resources

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 11 Presumptive Eligibility: Simplifying the client interview process Helps Case Manager and client identify family members and confirm accuracy of basic information for each member Displays if a person is already receiving mainstream benefits Simple screen design to enter additional information needed for eligibility determination Presumptive eligibility data retained for audit trail

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 12 Presumptive Eligibility: How it works First, confirm basic information such as name, relationship and birth date for each family member Next, an expanded Income Table identifies mainstream benefits currently received by any family member Then, additional data elements are collected, allowing HMIS to complete the eligibility determination for each mainstream program Finally, an “Eligibility Summary Screen” is displayed showing the results of the eligibility determination

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 13 Sample Eligibility Data from HMIS

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 14 Sample Eligibility Data from HMIS (Cont’d)

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 15 Eligibility Data from HMIS: Eligibility Summary Screen

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 16 Shelter Exit Form Summarizes Client’s stay in Housing; –Changes in income and income sources –Education level when entering and leaving housing –Support services received during stay –Destination upon leaving –Reason for leaving

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 17 Shelter Exit Form How the information benefits the Case Manager: A monitoring requirement that an exit interview is done Provides a “snapshot” of what happened to the client while in the program Shows what services the client received while in the program Helps Supervisor review case manager’s caseload

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 18 Shelter Exit Form Used for APR preparation “Comments section” used to record contact information for referral of client to next destination; and to record circumstances of client leaving the program Documentation for proof of homeless for a client referral from a Transitional Housing Program or Permanent Housing Program Serves as a reminder to document client exit on HMIS

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 19 Extending HMIS: Homeless Certifications Michelle Budzek The Partnership Center, Ltd. Cincinnati, OH

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 20 Origins of Homeless Certification Challenge: Develop a standardized method for documenting and verifying homelessness. Solution: Homeless receive paper certifications for accessing specialized services throughout the Continuum of Care.

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 21 Paper-based Homeless Certification Simplified referrals for case managers Enabled quick verification of eligibility for services and/or transitional and permanent housing programs Feedback from clients and case managers was overwhelmingly positive.

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 22 HMIS Homeless Certification Benefits of incorporating homeless certificates within HMIS: Make Continuum of Care programs accessible online Eliminate need for clients to carry documentation of homelessness Develop consistent methods to distinguish between homeless and non-homeless clients for reporting

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 23 Certificate keeps personal identifying information to a minimum Certifying program or worker withheld to protect confidentiality (e.g. HIV/AIDS status) Certificates can be verified by calling HMIS staff. Improved Confidentiality

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 24 When is a homeless certificate created? Upon intake into an emergency shelter Upon intake into a street outreach program Upon intake into a permanent or transitional housing program IF there is a previous homeless certificate in HMIS from an outreach program or emergency shelter HUD Definition of homeless is used

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 25 Additional Documentation Some clients can not be automatically certified homeless – either because they did not consent to HMIS information sharing, or because they are not yet in HMIS. Permanent and transitional housing providers have the option to enter additional information which will generate a homeless certification.

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 26 Certificates do not circumvent the rules surrounding eligibility Certificates applied consistently across the Continuum of Care Consistent Continuum-wide Standards Certificate does not eliminate need for documentation, for example, a copy of an eviction notice or a letter from institution staff regarding prior living situation.

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 27 HMIS Implementation and Homeless Certification Results Positive consumer and provider feedback. Positive HUD monitoring feedback. Expanded the participation in the system (cited as a reason non-funded agencies asked to participate) “Closed the system” to certified homeless only Rated as a significant factor in reducing the homeless count in our largest shelter.

September 18-19, 2006 – Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development Using HMIS In Real Time: A Case Study Stacy Ebron, HMIS Coordinator Washtenaw County Office of Community Development

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 29 Overview Agency Description Prior Data Collection Process Implementation Goals Inputs: Participants, Data Sources, Requirements Gathering Outputs Implementation Activities New Data Collection Process Outcomes: Benefits and Challenges

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 30 Agency Description Agency is a 50 bed emergency shelter that also operates a drop-in center, rotating shelter, and a warming center Agency is located in a newly built facility that has interview rooms for client intake equipped with computers Computers are also at front desks for staff use on each floor of the shelter

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 31 Prior Data Collection Process All client intakes performed using a variety of paper forms Some case managers used word processing software to create case notes and others used paper One person was responsible for all of the agency’s data entry and report generation in the HMIS system Other databases were used for client check-in at the front desk and for counting number of clients served in non-shelter beds

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 32 Implementation Goals Embed HMIS system into daily shelter operations Use HMIS as a communication tool in the agency Provide one database system that all agency staff can use for data collection, reporting, and case management Reduce data collection redundancy Improve data collection and timeliness of data entry

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 33 Inputs: Participants University of Michigan graduate students in two different classes participated in requirements gathering efforts One class was comprised of students in the School of Information and the other in the School of Social Work

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 34 Inputs: Data Sources Agency staff (individual and group interviews) Observation notes from staff meetings Notes from meetings with HMIS staff and agency management staff All agency paperwork and forms –At the client level, forms for intakes, assessments, and case management notes –At the management level, forms related to admission status, information reports, incident reports, and waiting lists White papers including HUD HMIS requirements and HMIS system specifications

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 35 Inputs: Requirements Gathering Students spent over 100 hours conducting interviews and observing agency staff No audio taping was conducted due to confidentiality issues Class time used for debriefing and discussion Initial impressions were shared with agency staff for validation

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 36 Inputs: Requirements Gathering (cont.) Interviews typically included the following questions: 1. What information do you need and use to perform your job? 2. What information do you use when making decisions? 3. Where does this information come from? / How do you get it? 4. Where is information about clients kept or stored? 5. Who else looks at this information in addition to you? 6. Is the information you gather information you would routinely want to share within the agency? 7. How does this information sharing currently happen? 8. Where do you record information that helps guide your decision-making processes?

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 37 Inputs: Requirements Gathering (cont.) Students demonstrated the HMIS system with case managers Students recorded case manager questions and concerns Students observed case managers using the test system to mimic a typical client interview

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 38 Outputs Student group presented their report to the agency and HMIS staff Students developed custom assessments that reflected some of the agency’s current forms HMIS staff and faculty worked with agency managers to customize case management module HMIS staff and agency point person worked with management team at shelter to develop a roll-out plan for the case managers

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 39 Implementation Activities HMIS staff created custom assessments in production site to mimic paper forms used by agency staff Agency program managers were trained prior to case managers After training, case managers began using HMIS in real-time HMIS staff and agency point person coordinated resolution of system issues after roll-out HMIS staff observe use of system in real-time to evaluate outcomes and benefits

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 40 New Data Collection Process Case managers perform client intake in real-time in HMIS Case managers using additional non-required assessments for data collection Case managers track service outcomes Case notes and client information collected in one database

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 41 Outcomes: Benefits Data entry is timely - client intake is real-time Data is more complete –Case managers using additional non-required assessments for data collection –Service outcomes are tracked Data is now easily shared between staff Data accuracy is improved - staff collecting and using the data is responsible for entering it Most report HMIS intake takes less time than paper

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 42 Outcomes: Challenges Developing, documenting and standardizing best practices Lack of internal auditing tool to find errors and gaps Lack of user-friendly reporting tool Need for system enhancements

September 18-19, 2006 – Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development Conducting a System Analysis on Your HMIS Implementation Dale Fitch, Professor School of Social Work, University of Michigan

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 44 Typical HMIS Utilization An agency has an administrative person entering batches of client information solely for the purpose of producing the HUD report Shelters have a paper-based (in real time) and a digital-based (after the fact) HMIS operation In an era of tight fiscal constraints, such duplication of effort may not be desirable

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 45 HMIS Capabilities Most HMISs are able to serve as fully functioning management information systems capable of handling data necessary to perform: –Assessments –Referrals –Client tracking –Care coordination –Program planning and management –…..and gather statistics

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 46 System Analysis Should focus on organizational functioning and view information as a source of energy for an organization and something that must be processed efficiently in order for the organization to function efficiently A system analysis reveals the information flows in an agency thereby allowing for the customization of a HMIS for daily shelter operations

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 47 Vital Organizational Processes Identify processes that lead to the loss of necessary information Identify processes that make information more readily available to people in need of such information Identify any handling of information that has to be recorded in several places, copied, etc.

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 48 HMIS Implementation Question In what ways does the HMIS need to be customized in order to facilitate the primary information flows in the agency most efficiently?

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 49 Data Sources Agency staff - individual and group interviews Observations notes from staff meetings All agency paperwork and forms (e.g. intake forms, assessments etc.) Technical reports including HUD HMIS specifications need to be analyzed.

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 50 Organizational Functional Units/Processes Operational level – line level composed of case managers or shelter staff; provide direct services Tactical level – composed of supervisors and lower level managers; responsible for agency procedures or protocols Management level – typically program directors; responsible for implementing policies and general program oversight Executive level – occupied by the executive director; responsible for all agency functions and linkages to the community Board level – composed of the board of directors who provide expertise for agency functions

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 51 Questions What advantages does HMIS have over verbal or written communication? How much time is spent trying to locate information in a chart that may be found in any number of places?

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 52 Questions con’t Are there a lot of blank areas on forms meaning that no one is obtaining this information in the first place? And, is the information used? Are staff engaged in multiple methods of communicating information due to inadequate channel capacity? If so, what can be done to reduce the need for this redundancy? What workarounds does the organization employ in being able to capture or transmit important information relative to client care?

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 53 Questions con’t If the agency has a HMIS, do operational staff enter data on a real time basis? If not, what is (are) the source(s) of information used by staff for decisions that need to be made at the Operational level? If not, how does the time lag affect decision making at the Management/Executive levels? On balance, are agency reports primarily generated for entities outside the agency or for internal staff?

September 18-19, Denver, Colorado Sponsored by the U.S. Department of Housing and Urban Development 54 Questions con’t Do the Operational and Management levels answer the following questions differently: What information do we gather? What information do we really need? If so, in what ways? Do the data elements in an organization’s systems of information allow the agency to determine whether or not it achieved its Mission? What can we deduce to be the purpose of an agency by analyzing its system(s) of information?