Targeting Interventions for Homeless
Families and Individuals:
Program & System Approaches to
Better Targeting
Tom Albanese
July 28, 2008
National Alliance to End Homelessness
Annual Conference
Program & System Change: Process Steps
• Step 1: Assess current client characteristics/needs
• Step 2: Assess current program/system model, resources
and performance
• Step 3: Investigate other approaches, best practices
• Step 4: Design future program/system and outline goals
• Step 5: Implement and evaluate a pilot to test new
approach and assumptions
• Step 6: Implement program/system change
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Step 1: Assess current client characteristics/needs
• Admitted/served
• Not admitted/served due to:
–
–
–
–
–
barriers to access
choose not to access
needs greater than program/system capacity
ineligible or denied
pending-waitlist
• Demographics, resources, service utilization, housing history, etc.
Q: How do those admitted/served differ from those not admitted/served?
Q: Who’s not being served and why?
Q: Are clients being linked to the appropriate service and/or housing resource(s)? How is
this done? Is there an assessment tool currently used to determine the best
service/housing linkage?
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Step 2: Assess current program/system model,
resources, and performance
• Current Program/System Model
–
–
–
–
–
–
–
mission/purpose
target population
referral sources
services
housing
partnerships
staffing
Q: Does the mission/purpose reflect community values and client needs?
Q: Is there a clear system mission/purpose?
Q: Is the target population efficiently identified and linked to the program/system? How do
individuals/families access and flow through the program/system?
Q: How are system resources-services and housing-organized? Are they organized in a way that most
efficiently and effectively links clients with differing needs to the appropriate intervention?
Q: How do persons without shelter access the system? Is there a single point of access, multiple
points, centralized administration/decentralized access, other means?
Q: What works well and should be retained?
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Step 2: Assess current program/system model,
resources, and performance
• Program/System Resources
– current cash/in-kind: services, operating
– potential cash/in-kind: services, operating
Q: Are program resources sufficient to achieve program objectives and outcomes?
Q: How flexible are program resources? Can program resources be used in different
ways?
Q: Do funders have an interest in better targeting/service matching?
Q: What other resources are available to support program/system objectives and
outcomes?
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Step 2: Assess current program/system model,
resources, and performance
• Program/System Performance
– Outputs: number served, nights of service, average length of stay, etc.
– Outcomes: housing, ‘graduation’ rate, income/benefits, educational
attainment, health/recovery, recidivism, etc.
Q: What’s different between those deemed successful and those not successful? Are
those who most need the service also the most likely to not be successful?
Q: Does the program/system model facilitate or hinder achievement of program
outcomes?
Q: Is housing stability a primary goal? Why or why not?
Q: How are clients who don’t progress toward housing stability (i.e. “long-stayers”,
“chronically homeless”) identified?
Q: How are outcomes monitored? What is the program/system consequence for nonachievement?
Q: Do program outcomes align with client, funder, community expectations and
requirements?
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Example: Analysis of Family Homeless Episodes…
# of Homeless Episodes Among Families
# Episodes
1
2
3
4 or more
% of Families
72%
20%
6%
1%
# of Homeless Episodes Among Individuals
# Episodes
1
2
3
4 or more
% of Persons
49%
19%
11%
21%
Source:
Montgomery Co.,
MD: HMIS data
analysis, 20052006
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Example: Analysis of Family Homeless Episodes…
# of Days per Episode of Homelessness
Families
Length of Episode
< 7 days
7-30 days
31-60 days
61-90 days
91-120 days
121-150 days
151-180 days
181-210 days
211-240 days
241-270 days
271-300 days
301-330 days
331-365 days
> 365 days
Individuals
% of Episodes
19%
21%
14%
13%
9%
7%
7%
4%
1%
2%
2%
1%
0%
1%
Length of Episode
< 7 days
7-30 days
31-60 days
61-90 days
91-120 days
121-150 days
151-180 days
181-210 days
211-240 days
241-270 days
271-300 days
301-330 days
331-365 days
> 365 days
% of Episodes
33%
23%
15%
7%
6%
5%
4%
2%
2%
< 1%
< 1%
1%
< 1%
1%
Q: What are the characteristics of families with one episode? Multiple episodes?
What’s different between these groups?
Source: Montgomery Co., MD: HMIS data analysis, 2005-2006
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Step 3: Investigate other approaches, best practices
• Benchmarking
 The American Productivity & Quality Center (www.apqc.org) defines benchmarking as
“the process of identifying, learning, and adapting outstanding practices and processes
from any organization, anywhere in the world, to help an organization improve its
performance. Benchmarking gathers the tacit knowledge--the know-how, judgments,
and enablers--that explicit knowledge often misses.”
– programs locally or in other communities that serve the target population and have
good outcomes
– direct contact (e.g. interviews) with key contacts or review of related documentation or
research
Q: Who else is serving the target population and doing it well? How do they identify and engage the
target population?
Q: What works in other programs/communities that can be replicated?
Q: How are they funded?
Q: What key partnerships support their model? How are the partnerships managed? At system or
program level or both?
Q: What tools, forms, policies, procedures support their model? Can these be shared/modified?
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Step 4: Design future program/system and outline goals
• Program/System Plan:
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–
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–
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mission/purpose
target population: prioritization/selection criteria
referral sources
client pathway: first contact to service termination
program/system services, housing
partnerships, on-site or off-site
resources needed
client outcomes
Q: How can interventions (services/housing offered) and outcomes be differentiated according to
differing client needs?
Q: Who identifies the target population? What’s the most efficient approach?
Q: Do partner expectations align with the program model?
Q: Does one or more funding sources need to approve a modified program model?
Q: Does program/system quality and performance monitoring need to be changed to better inform
management and funders?
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Step 5: Design and implement a pilot
• Pilot the proposed program/system model to test
– assumptions
– triage/assessment tools, other forms
– policies/procedures
– process efficiency
– client outcomes
– resources needed
– staff skills needed
• Develop evaluation plan before implementing: What is being evaluated? What
data needs to be collected? How/when/where/who will collect data?
• Retain expert evaluator if feasible
• Use findings to inform full program/system implementation: What was
learned? What needs to change? Is further testing needed?
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Step 6: Implement program/system change
• Take successful aspects of pilot to scale-i.e., full
program/system implementation
• Develop evaluation plan to test full implementation at
regular intervals
• Retain expert evaluator if feasible
• Use findings to inform future program/system
improvements
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Example: Columbus Rebuilding Lives Plan
• Research concluded that:
– permanent supportive housing successfully ended homelessness for chronically
homeless individuals
– Multiple and diverse PSH options
– No single, easy to navigate access point for clients and advocates: clients with
greatest needs not always admitted
– Because supportive housing is scarce and valuable resource, need to prioritize
admission for those with the greatest needs
• RL Plan Strategy: Create a unified system for supportive housing which
includes centralized eligibility determination, prioritization and placement,
periodic review of tenant needs, and “move up” incentives to encourage
tenants to be more independent.
• 2008-2010: pilot aspects of future system
– Centralized referral, assessment, matching at two new PSH projects
– Periodic tenant review/assessment and move-up assistance with existing PSH
projects
• 2011: full system implementation
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Example: Columbus Rebuilding Lives Plan
• Targeting to focus on individuals and families who:
– Meet local Rebuilding Lives criteria (long-term homeless,
disabled)
– Are identified using administrative data (e.g HMIS) as high
service utilizer and/or meet other high risk/vulnerability
criteria
• System level administrative process to screen/link
prospective clients to PSH options
• Clients not deemed eligible and priority referred to less
intensive assistance (i.e., transitional assistance such
shallow rent subsidies, etc.)
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Other key considerations…
• No “one size fits all” approach to targeting and assessment
• Keep it simple-for clients, staff, other stakeholders
– Easily administered scales to identify level of need, appropriate intervention
– Readily accessible process for clients/advocates
• Does everyone need to agree? Who needs to buy-in?
– Success may be contingent on buy-in and support from providers, funders, consumers, advocates
and other key stakeholders. Design a process that gathers and uses input from key stakeholders
from the onset.
– Intentional, thoughtful communication key – local government, stakeholders, providers, users
– How will other providers react? Other systems of care? Will changes create stress for other
providers/systems or require them to make adjustments?
• What is the cost of change and how much are you willing to spend in dollars and
political capital?
• Good quality data are essential to both program design (knowing who you’re
targeting) and implementation (knowing when you’ve successfully identified and
served intended target population)
• Is the process (current or proposed) consumer friendly (e.g., easily navigated,
client choice, due process if denied, etc.). If not, make changes.
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Tom Albanese
Abt Associates Inc.
tom_albanese@abtassoc.com
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