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BEST PRACTICES FOR

UTILIZING HMIS DATA

Presenters & Examples

Rita Flegel, Facilitator

Rusty Bennett & Chris Pitcher – Housing & Health Connection

CARES, Inc.

Cascade AIDS Project

River Region Human Services

Harris County, TX

Chris Pitcher – Coordinated Assessment

West Virginia

Mike Lindsey – Funding Solutions for HMIS

Allegheny County, PA

Overview

Housing and Health Connection

Housing is Health Care

Researchers have shown that housing is an effective

structural intervention.

Researchers have also found a positive relationship

between stable housing and access to care and

maintenance of care.

Unmet housing needs are a significant barrier to

accessing and maintaining appropriate medical care.

Homelessness and housing instability are often associated

with higher health care costs.

Housing is Health Care cont.

Homelessness both causes and

results from serious health care

issues, including

Addiction,

Psychological disorders,

HIV/AIDS, &

Various other ailments that require

long-term, consistent care.

Housing Is Health Care cont.

The HIV/AIDS Care

Continuum illustrates

housing’s effect along

the care continuum.

Housing increases

access, retention in

care, and health

outcomes.

82%

66%

37% 33%

25%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Diagnosed Linked to Care Retained to Care Prescribed ART ViruallySuppressed

Perc

enta

ge o

f all P

eople

with H

IV

95% 87%

62%

99%

NYC

HOPWA

Program,

2011

HIV Care Continuum cont.

To optimize overall health, HIV/AIDS housing and services

providers must focus on “filling” each gap in the HIV/AIDS

Care Continuum.

Existing research linking housing status to HIV health outcomes

supports new strategic collaborations between housing and

health providers to better integrate care for PLWHAs that

experience homelessness and/or unstable housing.

Measuring health outcome and reducing costs are

increasingly important to health care providers.

CARES, Inc., Albany, NY

Housing & Health Connection

CARES, Inc. 9

Strategy: Customize HMIS

Community Context: CARES, Inc. is a county-wide HOPWA

provider, CoC lead for Albany City and County, and HMIS

Administrator

Scope: IHHP pilot, scaling up to CoC

Strategy: Built all housing and health data points required for

HOPWA into HMIS

CARES, Inc. 10


Barriers: Time management, software limitations (e.g. HMIS is

not a relational database), need to use Access to analyze

data and hire additional staff for analysis

Successes: Measure impact of housing and employment on

health using HMIS

CARES, Inc. 11


Impact Measurement

Improved availability of data

on employment and health

indicators

Integrated health indicators. For example, track

income, viral load, and CD4 count.

Improved availability to

measure employment and

health outcomes

Ability to track changes in income and health

outcomes (viral load, CD-4 count, adherence to

treatment) over time.

Increased coordination of

housing and health systems

Ability to track housing and health outcomes of

PLWHA at client, agency, and community-level. For

example, CARES, Inc. is examining the relationship

between increased income, housing status, and

health. The intent is to lead to stronger connections

between housing and health providers and use

data to advocate for resources.

Cascade AIDS Project, Portland, OR


Cascade AIDS Project 13

Strategy: Build a Data Bridge

Community Context: CAP is a large HOPWA and RW

provider that uses HMIS for all housing and CAREWare for all

health data points required for HOPWA

Scope: Community-wide data bridge (EMSA/TGA); data

bridge utilizes housing specific info from entire agency

(HOPWA, CoC Supportive Housing, S+C, RW, privately funded

programs)

Strategy: Closer collaboration with community partners to

prevent double data entry, ensure more efficient client case

management services, and improve engagement in care.



Barriers: Staff turnover, technical issues such as challenges with

confidentiality and “opt-out” option, and designating

responsible party to solve problems

Successes: Better coordination with medical providers, medical

case managers, and other RW funded agencies; ability to flag

clients who are disconnected from care; potential for improved

health outcomes; more efficient internal and external program

delivery



Impact Measurement

Increased engagement of

care for PLWHA

Number of individuals re-engaged in care through

analysis of joint client data.

Increased coordination of

housing and health systems

Ability to track housing and health outcomes of

PLWHA at client, agency, and community-level

without double data entry. The expectation is that

when complete, data integration will improve care

coordination and as a result, improve outcomes.

Increase in health outcomes

of PLWHA (In Progress)

Working towards measuring changes in health

outcomes compared to housing status at client,

agency, and community-level.

River Region Human Services, Jacksonville, FL


River Region Human Services, Inc. 17


Community Context: RRHS uses HMIS for all housing and

health data points required for HOPWA

Scope: IHHP Pilot, later expansion to 5-county RW Provider

Network and 3-county CoC

Strategy: Coordination between CAREWare and HMIS

administrators to engage in data sharing



Barriers: Initial hesitation and reluctance on the part of the RW

Part A Program Manager and HMIS Database Manager;

coordination of schedules, resistance to change

Successes: Getting buy-in from relevant parties, coordinating

efforts, and laying the technical groundwork to complete data

bridge; addition of 50+ health-related fields from CAREWare

into HMIS; facilitation of re-engagement in care.



Impact Measurement

Increased engagement of

care for PLWHA

Number of individuals re-engaged in care through

analysis of joint client data.

Improved access of data

on housing and health

indicators

Ability to track client progress and provide

integrated care

Increased staff buy-in to

reporting

Staff are engaged in identifying data needs

Harris County, TX

Housing and Health Connection

Harris County, TX

Population

Harris County: 4.1 million

City of Houston: 2.2 million

2014 Point-in-Time

Total – 5,351

Sheltered – 3,060

Unsheltered – 2,291

Houston, TX

There was a Public Health Concern for all residents

of Harris County

The instances of Eastern Equine Encephalitis (EEE

commonly called Triple-E or West Nile Virus) were

increasing

The EEE risk to those sleeping outdoors and places

not meant for human habitation were much higher

Harris County, TX

Utilized Geographic Information System (GIS) and

health data to map the areas where EEE cases were

occurring

Added geographic homeless outreach data to the

health data to identify areas where persons

experiencing homelessness would be at the highest

risk of EEE

Harris County, TX

Using the GIS data map outreach teams targeted

the areas at highest risk and distributed EEE

prevention kits

These targeted efforts lead directly to fewer

instances of EEE among homeless persons

West Virginia

Coordinated Assessment

West Virginia Coordinated Assessment

26

Beyond federal reporting requirements, no process is sacred.

The process is geared toward housing.

Particular importance is placed on high-acuity/high need/chronically homeless.

Everyone is assessed, whether they are a contact or an engagement.

All outreach follows our coordinated access and prioritization procedures.

The Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT) is used.

VI-SPDAT

27

Wellness: Chronic health issues and substance use

Socialization and Daily Functioning: Meaningful daily activities, social supports, and income

History of Housing and Homelessness: Length of time experiencing homelessness and cumulative incidences of homelessness

Risks: Crisis, medical, and law enforcement interdictions Coercion, trauma, and most frequent place individual has slept

Family Unit (Family VI-SPDAT Only): School enrollment and attendance, familial interaction, family makeup, and childcare

Acuity Scoring with VI-SPDAT

28

Intervention

Recommendation VI-SPDAT Pre-Screen Score

Diversion 0-4

Rapid Re-Housing 5-9

Permanent Supportive

Housing/Housing First 10-16

Core Mindset

29

WV Balance of State Coordinated Access Process in HMIS (ServicePoint)

VI-SPDAT to Full SPDAT to Prioritization List for PATH Outreach

1 Encountered on the street

during outreach. 2 Contact, Engagement, and

VI-SPDAT performed.

Diversion if possible (VI-

SPDAT Score of 0-4). If

Diversion is not possible,

PATH entry and triage.

Score feeds to community

prioritization list.

3

5

Client moves in and

case management,

services, and housing

stability begin in

earnest, with full

SPDAT.

Community Accesses next

person on the list, by acuity. 7

6

Back to

Step 3

4

Communities then pull a

local Prioritization List, by

Acuity, from HMIS to

determine rapid placement

into housing.

Based on client choice, client is then

placed into housing based on acuity

score and program eligibility with the

following recommendations by score:

1. Permanent Supportive

Housing/Housing First: VI-

SPDAT Score of 10 or above.

2. Rapid Re-Housing: VI-SPDAT

Score of 5-9.

3. No Housing Support

Recommendation (Diversion):

VI-SPDAT Score of 0-4.

Referral is made to

appropriate housing

intervention in

HMIS.

Client Demographics and VI-SPDAT

30

VI-SPDAT Prescreen

31

Acuity Score and Additional Info

32

VI-SPDAT Prioritization List

33

Acuity Data

6.72

8.78

10.36

5.78

7

5.25

0

2

4

6

8

10

12

ES PATH PSH RRH SSVF TH

Average VI-SPDAT Acuity by Program

34

Acuity Data

33.8

47.5

35.84

24.02

50

27.25

0

10

20

30

40

50

60

ES PATH PSH RRH SSVF TH

Average Days from VI-SPDAT Assessment to Housing by Program

35

Lessons Learned

Simplify the HMIS workflow whenever possible.

Train communities on prioritization with outreach at

the table, like any other program.

Have periodic re-training sessions for outreach

personnel across CoCs.

Ensure workflow is easy to use in the field, then data

quality and reporting will come.

Learn as you go, and modify as needed. The goal is

not prettier, but better.

36


Funding Strategies for HMIS


Population

Allegheny County approx. 1.2 million

City of Pittsburgh approx. 300,000

2012 Point-in-Time

Total – 1,376

Sheltered – 1,320

Unsheltered - 56

Allegheny County DHS

Department of Human Services

$800 million annual budget Children, Youth and Family

Area Agency on Aging

Office of Behavioral Health

Office of Community Services

Office of Information Management

Office of Administration

Office of Data Analysis and Research

Executive Office

Multi-System Consumers

40

Under 18 years 18 years and older

Served by one program office 60% 41%

Served by two program offices 23% 23%

Served by three program offices 11% 15%

Served by four or more program offices 6% 21%

Persons served by DHS in 2010,

approximately 202,000 (unduplicated)

Data Warehouse: Data Sources 41

External Sources

Allegheny County Housing Authority

Allegheny County Jail

Allegheny County Medical Examiner’s Office

Department of Public Welfare

Housing Authority City of Pittsburgh

Juvenile Probation

Pittsburgh Public Schools

10+ other school districts and counting

Potential Data Sources

“Place-based Data”

County Probation

Health Department

Employment & Training

Internal Sources

Aging

Children, Youth and Families

Community Service Block Grant

Drug & Alcohol

Early Intervention

Family Support Centers

HeadStart

Human Services Development Fund

Homeless/Housing

Low Income House Energy Assistance Program

Maximum Participation Project

Medical Assistance Transportation Program

Mental Health

Mental Retardation

System of Care Initiative

The Funding Dilemma

2007 CoC Application received a 70% reduction in funding

$7 million in housing/services were lost

Housing emphasis was below threshold – 20%

Leveraging was below threshold

Solution

Data Warehouse analysis

System Analysis

Analyze Funding Structure

System Change

Cross System Match of PH Clients

Have clients currently enrolled in Permanent Supportive

Housing ever receive any level of MH services?

61.37% have

Are clients currently enrolled in Permanent Supportive

Housing CURRENTLY receiving any level of MH services?

40.68% are

Continuum of Care Priority…establish new Shelter Plus

Care Permanent Housing Units for Allegheny County’s

homeless

Results

2008 Continuum of Care Priority…establish new

Shelter Plus Care Permanent Housing Units for

Allegheny County

Matched Data

• Results:

60% of homeless clients have also received MH

services

40% of homeless clients have also received D&A

services

Impact

• $4.4 million commitment of MH service dollars

• Leveraged 51 single S+C units & 50 family S+C units

• 15% direct increase in homeless units available in Allegheny County

Increase in S+C Units

Shelter + Care Capacity

0

100

200

300

400

2000 2004 2007 2010 2011

Housing vs. Services Over Time

Housing vs. Services

$-

$5,000,000

$10,000,000

$15,000,000

2000 2004 2007 2010 2011

Year

Sp

en

din

g b

y

Pro

vid

ers

Housing Services

2008 – 2012 The Results

$8 million commitment of MH service dollars

Approximately $1.5 million commitment of leverage services multiple CYF sources

$18 million in NEW SHP program funds

282 MH dedicated homeless single/family units

59 Formerly incarcerated

19 PH for veteran’s

65 Former foster care

73 Permanent Supportive Housing

System Involvement

68%

60%

45%

38%

36%

23% 23% 23% 22%

10%

100%

85% 85%84%

63%

75%

23%

19%

32%

16%

0%

20%

40%

60%

80%

100%

120%

MH DPW (FS) DA MATP ACJ DPW (SSI) DPW (OM) DPW (GA) CYF

(parents)

CYF

System

Perc

en

t o

f P

op

ula

tio

n

Homeless Population (N=2033)

5% High-end (N=88)

3%

10%

10%

2%

13%

29%

3%

5%

8%

8%

34%

1%

4%

7%

23%

28%

1%

7%

30%

31%

1%

6%

6%

9%

24%

1%

3%

3%

2%

27%

1%

14%

15%

2%

9%

10%

Juvenile Probation Placement

Juvenile Probation

JUVENILE JUSTICE

INTELLECTUAL DISABILITY

Public Welfare: TANF

Public Welfare: Food Stamps

Homelessness/Housing Support

Public Housing Assistance

Family Support Centers

Medical Transportation (MATP)

System of Care Initiative

Drug & Alcohol

Early Intervention

Mental Health

BEHAVIORAL HEALTH

CYF as Parent

CYF Placement

CYF

CHILD WELFARE

Involved Within Last Year Prior Involvement

CHILD WELFARE

BEHAVIORAL HEALTH

SUPPORT SERVICES

INTELLECTUAL DISABILITY

JUVENILE JUSTICE

Overlap of Children Served

53 percent (14,450) of PPS Students have prior Human Service involvement 36 percent (9,750) were involved with a Human Service within the last year

Questions?

Remember to sign up for one-one-one assistance

during the HMIS TA clinics!

If you have additional questions, or would like to

talk about strategies for your organization related

to HMIS....

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