Measuring OutcomesMeasuring Outcomes

Telling the senior legal Telling the senior legal helpline story.helpline story.

March 26March 26thth, 2009 Webinar, 2009 Webinar

Webinar GoalsWebinar Goals

Sharing ideas for collecting and Sharing ideas for collecting and reporting client outcomesreporting client outcomes

Developing shared outcome Developing shared outcome measuresmeasures

for future reportingfor future reporting

Objectives for Objectives for Collecting OutcomesCollecting Outcomes Quality Control – statistical Quality Control – statistical

comparisoncomparison Needs Assessment and Asset Needs Assessment and Asset

AllocationAllocation Showing complianceShowing compliance Demonstrating Value to Funders –Demonstrating Value to Funders –

Using data for maximum benefit Using data for maximum benefit

Outcomes Data from Outcomes Data from Follow Up StudiesFollow Up Studies 92% of clients reported initial benefit92% of clients reported initial benefit Getting creditors to stop contact - Getting creditors to stop contact -

most successful consumer outcomemost successful consumer outcome Getting public benefit identified by Getting public benefit identified by

hotline – highly successfulhotline – highly successful Wills/estate planning issues – 70% Wills/estate planning issues – 70%

favorable outcomesfavorable outcomes Family law issues – 30% favorable Family law issues – 30% favorable

outcomesoutcomes

Follow-Up ProceduresFollow-Up ProceduresBrainstormBrainstorm

Logic Model Outcomes Logic Model Outcomes for Legal Servicesfor Legal Services

Long-termOUTCOMES

 

Clients have increased security in protecting their basic needs – food, shelter, Health care, safety, family relationships

IntermediateOUTCOMES Clients act to obtain resolution

 

InitialOUTCOMES

 Clients gain knowledge of their legal rights and responsibilities 

 

Clients gain knowledge of legal system

 

Work with advocate, help themselves through pro se, seek help thru non-legal means (social agencies) or not act at all.

Gathering Outcome Data Gathering Outcome Data Through Case Report Through Case Report CodesCodesLevel of Service and it Impact on Gathering Level of Service and it Impact on Gathering

OutcomesOutcomes

Hotlines are not the only ones with Hotlines are not the only ones with problems reporting outcomesproblems reporting outcomes

Barriers that hotline face when Barriers that hotline face when determining outcomes because of determining outcomes because of limited contact or follow up.limited contact or follow up.

Importance of hotlines outcomes Importance of hotlines outcomes reporting as part of bigger legal reporting as part of bigger legal services picture.services picture.

Hotline Outputs vs. Hotline Outputs vs. OutcomesOutcomesOutputs for HotlinesOutputs for Hotlines Are from programmatic perspective – what services were Are from programmatic perspective – what services were

produced? for whom, etc.?produced? for whom, etc.? Statistics that show contract compliance and accountability Statistics that show contract compliance and accountability

to funders, e.g.to funders, e.g.– # of cases opened and closed,,# of cases opened and closed,,– # of clients served,# of clients served,

breakdown of client characteristics to indicate if targeting is breakdown of client characteristics to indicate if targeting is being achieved; being achieved;

types of legal issue areas being addressed; types of legal issue areas being addressed; level of service providedlevel of service provided

Hotline Outputs vs. Hotline Outputs vs. OutcomesOutcomes

Outcomes for HotlinesOutcomes for Hotlines Are from perspective of recipients of Are from perspective of recipients of

hotline serviceshotline services Indicate what hotline services actually Indicate what hotline services actually

achieve for older clients, e.g.achieve for older clients, e.g. What specific value or impact did What specific value or impact did

hotline services have on the well-being hotline services have on the well-being of the older clientof the older client

How did the client’s condition/situation How did the client’s condition/situation improve as a result of hotline service?improve as a result of hotline service?

Selecting Outcomes to Selecting Outcomes to Gather for HotlinesGather for Hotlines

Select Outcomes that -- Select Outcomes that -- Are linked to hotline program goalsAre linked to hotline program goals First ask -- What is the hotline trying to accomplish for First ask -- What is the hotline trying to accomplish for

its older clients?its older clients? Then select outcomes that will indicate how well the Then select outcomes that will indicate how well the

hotline is succeeding.hotline is succeeding.– Reflect the limited nature of hotline services, e.g.Reflect the limited nature of hotline services, e.g.

Hotlines are not intended to provide in-depth legal Hotlines are not intended to provide in-depth legal services, andservices, and

Hotlines are specifically designed to be low-cost, Hotlines are specifically designed to be low-cost, meaning they provide limited services – legal meaning they provide limited services – legal information, advice, and in some cases, brief serviceinformation, advice, and in some cases, brief service

Initial Outcomes – LCE Initial Outcomes – LCE

Code list, by Major Benefit Obtained by ClientCode list, by Major Benefit Obtained by Client Information; Information; 0001 through 00090001 through 0009 00010001 Obtained verbal explanation of legal rights, Obtained verbal explanation of legal rights,

responsibilities or proceduresresponsibilities or procedures 00090009 Obtained miscellaneous information; not legal adviceObtained miscellaneous information; not legal advice Advice;Advice; 0010 through 00190010 through 0019 0010 Obtained legal advice/counsel; no further services 0010 Obtained legal advice/counsel; no further services

receivedreceived 00110011 Obtained legal opinion; no further services receivedObtained legal opinion; no further services received 00190019 Obtained other advice (including non-legal advice)Obtained other advice (including non-legal advice) Brief ServicesBrief Services;; 0200 through 0029 0200 through 0029 02000200 Obtained legal advice/counsel based upon Obtained legal advice/counsel based upon

individualized legal researchindividualized legal research 00210021 Obtained advice/counsel based upon review of a Obtained advice/counsel based upon review of a

documentdocument 00220022 Obtained assistance in writing letter with legal importObtained assistance in writing letter with legal import 00230023 Obtained assistance in filling out a formObtained assistance in filling out a form 00240024 Obtained consultation with an attorney other than LCEObtained consultation with an attorney other than LCE 00290029 Obtained other brief legal assistanceObtained other brief legal assistance

Software Data Software Data CollectionCollection Input from group – what Input from group – what

processes do you use to gather processes do you use to gather outcome data from software outcome data from software systems?systems?

Intermediate and Long Intermediate and Long Term OutcomesTerm Outcomes

Telling the Fuller Story with Data Telling the Fuller Story with Data and Descriptionand Description

In the latest reporting period we closed 2262 cases

Outcomes report Outcomes report In the reporting period we obtained prescription In the reporting period we obtained prescription

drug insurance for 381 clients improving the drug insurance for 381 clients improving the likelihood that they will buy and use essential likelihood that they will buy and use essential prescription drugs and saving the clients an prescription drugs and saving the clients an estimated $381,000 per year. estimated $381,000 per year.

We also obtained free prescription drug insurance We also obtained free prescription drug insurance for 44 clients allowing them to obtain prescriptions for 44 clients allowing them to obtain prescriptions for a co-pay of not more then $5, resulting in savings for a co-pay of not more then $5, resulting in savings for these clients of as much as $132,000 per year.for these clients of as much as $132,000 per year.

We obtained Medicaid coverage to pay for the cost We obtained Medicaid coverage to pay for the cost of nursing home care for 61 clients resulting in an of nursing home care for 61 clients resulting in an estimated $2,050,000 in annual payments for estimated $2,050,000 in annual payments for nursing home care. nursing home care.

We provided assistance to 1776 other clients on We provided assistance to 1776 other clients on issues ranging from family law to probate. issues ranging from family law to probate.

Money talks Money talks

Value builds up fastValue builds up fast Justifies the cost of providing servicesJustifies the cost of providing services Not everything has an economic value Not everything has an economic value Look for benefits obtainedLook for benefits obtained Costs avoided Costs avoided Requires different measures for Requires different measures for

different problem codes and services different problem codes and services

Example Example

Established eligibility for Medicare Established eligibility for Medicare Part D Extra HelpPart D Extra Help

Count the number of completed Count the number of completed applications - verify approval or applications - verify approval or adjust for SSA average rejection adjust for SSA average rejection raterate

Average benefit per client = total Average benefit per client = total value of services value of services

Second Example: Second Example: Medicaid long term care Medicaid long term care qualifying income trusts qualifying income trusts

Can’t be approved for Medicaid without Can’t be approved for Medicaid without oneone

Can’t establish the trust without the help Can’t establish the trust without the help of an attorney of an attorney

Average Medicaid benefit x number of Average Medicaid benefit x number of approved trusts = $big dollarsapproved trusts = $big dollars

Small number, average private attorney Small number, average private attorney rate to do the same work ($500 vs. 2 rate to do the same work ($500 vs. 2 hours of your time = about a $400 per hours of your time = about a $400 per client savings.) client savings.)

Power of Attorney Power of Attorney

Tell the story with words and Tell the story with words and numbers numbers

Not everything has an economic Not everything has an economic valuevalue

Paint the overall picture with Paint the overall picture with emphasis on details emphasis on details

BrainstormBrainstorm

How do you collect data for How do you collect data for intermediate/long term intermediate/long term outcomes?outcomes?

How do you report it?How do you report it?

Outcome for 2008-09Outcome for 2008-09

Number of Advance DirectivesNumber of Advance DirectivesNumber of cases where client was Number of cases where client was identified as eligible for benefitidentified as eligible for benefitInput from group as to possible 2009 Input from group as to possible 2009 outcomes.outcomes.

Action StepAction Step

Email us follow up surveys, Email us follow up surveys, reports, and outcomes you are reports, and outcomes you are currently collecting.currently collecting.

kmorris@ceraresource.orgkmorris@ceraresource.org

BibliographyBibliography

1. Outcome Measures for Title IIIB Legal Assistance Programs by M. Batista, Best Practice Notes, March 2000 www.tscg.org2. It’s How you Say It, Using Measurable Outcomes to Demonstrate the Value of Hotline Services by David Godfrey, Legal Hotline Quarterly Summer 2007 www.legalhotlines.org.3. The Hotlines Outcomes Conundrum by Shoshanna Ehrlich, Legal Hotline Connection Feb. 2009 4. Showing Results by J. Allen May, LHQ LHQ Winter 20005. Statewide Senior Legal Hotlines Client Outcomes Survey, 2002. www.legalhotlines.org6. Legal Hotlines Client Follow Up Report 2006, www.legalhotlines.org7. Legal Aid Outcome Measurement Project by Gary Dart and Denise Caudill , LHQ Spring 2004