Homeless Response System Online Learning Clinic 2018 – Part V: Building Dallas’ Homeless Response System – 2015-2017 – Data Transparency

All homeless service providers must practice full transparency, by reporting all data into the Homeless Management Information System (HMIS), the federally-mandated community wide database, that drives improvement of homeless services programs, without exception (barring issues of safety). Reporting into HMIS is not simply an issue of bureaucratic compliance. This is the only way we know if and how much progress our community is making. More importantly, this is the only way we can improve and self-correct, where we are not[i].
 
In the last three years, Dallas made huge strides, specifically, in this area. For instance, as late as 2014, no emergency shelter beds were reported into HMIS. It is impossible to assess system performance, in the absence of data on the point of entry into homelessness. Therefore, communities that do not have that data in their HMIS are routinely penalized for it, as Dallas was. However, unlike the housing programs, funded through the Continuum of Care (CoC) Program, MDHA cannot simply require shelters to enter their data. MDHA methodically worked with each of the major shelters, and over the last three years brought most of them into the system. As of December 2017, with the Salvation Army adding all of their 700 beds into the system, 57% of shelter beds are now entered into HMIS. In 2018, we will meet and exceed the standard set by the Federal Government, 86%.
 
These simple numbers, important as they are, bely a more fundamental shift in the HMIS, here in Dallas. In early 2015, MDHA and its partners began a discovery process that led the Continuum of Care (CoC) to adopt a new HMIS system, built from the ground up, by a non-profit founded by the Parkland Health and Hospital System, PCCI[ii], and its for-profit affiliate, Pieces Tech[iii]. This system was designed to be part of a larger ecosystem tracking individuals as they move through the healthcare system and social service organizations, Pieces Iris.



Dr. Steve Miff, PCCI

Pieces Iris was born out of the recognition that limited communication between the healthcare system and social service organizations, may cause vital information to slip through the cracks. The idea was to create a seamless system that connects healthcare and community-based organizations, allowing for smart sharing of information that makes a tangible difference in the lives of the most vulnerable populations[iv]. As PCCI President and CEO, Dr. Steve Miff, told the Becker Hospital Review[v], in September 2017, “Up to 50 percent of clinical outcomes are driven by social, economic or environmental factors, and not necessarily related to the direct care the individual received. That has basically set the stage and created the need for this solution to connect communities, and through that, to drive personalized medicine."

Over the course of the last three years, MDHA, PCCI and Pieces Tech worked hand in hand to launch the new HMIS, which went live in mid-2017. As Politico Magazine[vi] wrote in December 2017, Pieces Iris is already, “having a powerful impact on overwhelmed homeless organizations in Dallas… The availability of data showed… that homeless people were 167% more likely to have emergency room visits than the non-homeless population, and that from 300 to 400 homeless were arrested in Dallas each month. Neither of these pieces of information was shocking, but they gave [MDHA President and CEO, Cindy J.] Crain data she could take to officials to try to influence policy on homelessness. If she could show that housed people needed fewer EMS transports, ER visits and less time in jail, then, she reasoned, ‘I can make a business case to say, it’s not only the moral thing to bring housing to these homeless, mentally ill people. It’s going to save you money. If you don’t serve these people they’ll die in the street or eat you alive with these public response systems.’”

Finally, one glaring fact that “jumps out” at anyone who analyzes the data on homelessness in Dallas, is the overrepresentation of African Americans in the homeless population. Since late 2016, with the support of the United Way of Metropolitan Dallas[vii] Unite Dallas Relief Fund[viii], we are partnering with six other cities, towards establishing more racial equity in homeless services, through SPARC (Supporting Partnerships for Anti-Racist Communities)[ix], a new research and action program from the Center for Social Innovation (C4)[x].

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[i] See Dennis Culhane in the European Journal of Homelessness, http://works.bepress.com/dennis_culhane/209/
[ii] http://www.pccinnovation.org/
[iii] https://piecestech.com/
[iv] This language paraphrases, as well as uses some of the very language PCCI first used to describe this effort.
[v] https://www.beckershospitalreview.com/population-health/how-a-texas-innovation-hub-is-eliminating-socioeconomic-health-disparities.html
[vi] https://www.politico.com/magazine/story/2017/12/18/parkland-dallas-frequent-flier-hospital-what-works-216108
[vii] https://unitedwaydallas.org/uwmd/
[viii] https://unitedwaydallas.org/uwmd/unite-dallas-relief-fund-july-2017/
[ix] http://center4si.com/sparc/
[x] http://endinghomelessnessmdha.blogspot.com/2017/01/the-story-of-homelessness-in-dallas.html

How Do We Know What We Know? - The Final Installment of the CoC Strategic Work Plan Online Learning Clinic

In this final installment of our Continuum of Care Strategic Work Plan, we touch on Goal V: Drive Decision-making with HMIS Data, zeroing in on Objective VIIII: Increase Homeless Management Information System (HMIS) participation rates to no less than 86% of all beds and housing types.
 
In a recent blog post we talked about the idea of ending veteran homelessness, and how more than fifty communities have achieved just that. Now, you might ask: Are you trying to say that there are no homeless veterans in any of those communities? Well, no, that is not what we are trying to say. Indeed, the quote from the U.S. Interagency Council on Homelessness (USICH) in that blog post talks about those communities bringing down the number of veterans experiencing homelessness not to zero, but as close as possible to zero. So, what is it? What do we mean by ending veteran homelessness?
 
USICH helpfully defines this for us in a document that is worth reading in full. Basically, it means that all veterans experiencing homelessness are and continue to be identified, that shelter is provided immediately to all who request it, that traditional transitional housing is rarely used, and instead all are offered and provided with permanent housing, as swiftly as possible. Most importantly, that community must not have done all of this on an ad hoc basis, but show that it, “has resources, plans, partnerships, and system capacity in place should any Veteran become homeless or be at risk of homelessness in the future.”


Governor Dan Malloy, of Connecticut,

discussing his state being the second to end veteran homelessness

(Courtesy of WNPR)

The importance of knowing that more than fifty communities have done this is, as we pointed out in that previous blog post, that this is doable. We often assume that what is, always was, and will always continue to be. Perhaps this is a result of our evolution, which before modern times granted us extremely short life spans. Indeed, the forty years of the modern homelessness crisis is longer than the life expectancy of our prehistorical ancestors roaming the African savannah. That is just it, though, this crisis is a new phenomenon in American Life.

What we aim to return to, through the development of effective homeless response systems across the country, is not full housing, with no one ever becoming homeless. What we aim to return to is a reality that existed in our country prior to the mid-seventies of the last century, when homelessness was rare, brief and nonrecurring. And so, when we speak of ending homelessness, what we really mean is bringing about an end to the modern homelessness crisis.

(Parenthetically, this is not to say that full housing is not a desirable outcome. As Dr. Barbara DiPietro pointed out in her visit mid-October, it is extremely desirable, and it too is very doable. However, this would require a realignment of resources, across our society on a much broader level. At the minimum, it would likely require that housing vouchers be made available to all who qualify for them, and that refusing to accept them as payment be outlawed across the land.)

But, how will we know when we get there? This might seem like a simple question. If only. In fact, one might ask a broader philosophical question, “How do we know what we know?” The study of how we know what we know, epistemology, has become extremely important, as our society further fractures and sources of information multiply. We are forced to ask ourselves, “What are the necessary and sufficient conditions of knowledge? What are its sources? What is its structure, and what are its limits?”

This is especially true regarding homelessness, where, “our failures are the most visible and our successes the most hidden." In this type of environment, it becomes difficult not to fall into the trap of assuming that data is just the plural of anecdote, and that the latest sensational headline negates evidence based practices.

The only hope for truly knowing what we know is the painstaking continuous and relentless collection and analysis of data in one shared open system, which everyone reports into. That word everyone is the crux of this proposition. As we mentioned in a previous post on this blog, “In early 2015, only 3%(!) of the shelter beds available to Dallas’ homeless population were reported into the (homeless management information) system… It was… analogous to Schrödinger’s Cat… the cat was 97% sealed within the box.”

 

We have come a long way since that 3% mark in 2015, partnering with PCCI and now Pieces Tech to develop and over the last few months implement, that single open state-of-the-art HMIS for Dallas, gradually and continuously increasing the number of beds in the system. We are determined under this plan to break that 86% mark, the minimum acceptable to the Federal Government, and keep on pushing until we get as close as possible to 100%. That alone is bringing us that much closer to achieving an end to not only veteran homelessness, but all types of homelessness, making this societal ill, once again, rare, brief and nonrecurring, and keeping it that way.

Building Dallas’ Homeless Response System - Where We Are and Where We Are Going

Where We Are:

Systems:

• Established a community strategic work plan, to build an effective homeless response system for Dallas, aligned with Opening Doors, the national strategic plan to end homelessness.
• Laid the groundwork for a Coordinated Access (or Assessment) System - CAS, a system where all persons are assessed, using a common, uniform, objective and evidence based assessment tool, so they may be prioritized for service and matched with the services that will best help end their homelessness as quickly as possible.  
• As Dallas awaits federal funding necessary to fully deploy its CAS, it has already deployed the core of the system, the housing priority list, actively managed by a dedicated expert. Once a person is assessed and has all documentation needed to be housed, they go on to this dynamic list. Housing programs populate their housing units exclusively from that list, as quickly as possible, in order of priority.

Data:

• Developed a partnership with PCCI for an HMIS customized to Dallas, rolling out in the second half of 2016, to get much higher quality and quantity of data necessary to better track performance and drive improvement in programs serving more than 8,800 clients annually.
• Brought Austin Street Center into HMIS, growing shelter coverage from 3% to 25%.
• Marshaled 600-700 volunteers for Dallas’ most comprehensive Homeless Count to date.

Capacity:

• Instituted new learning, training and development opportunities for homeless providers.
• Founded the MDHA Flex Fund, to pay for minor but impactful expenses that can help individuals resolve their homelessness.
• Led the peaceful and housing-oriented clearing of Tent City, housing as many residents as possible, facilitating the sheltering of many who could not yet be housed, and creating a name by name list to follow up with everyone to ensure they are eventually housed.

Where We Are Going:

Systems:

• The Dallas Commission on Homelessness is marshalling the support of the community for building out an effective homeless response system.
• Build an updated 2016-2017 strategic work plan, building on the lessons of the last 15 months, and the existing strategic work plan.
• Fully build out and deploy Dallas’ Coordinated Access (or Assessment) System - CAS

Data:

• Roll out the new PCCI HMIS, to achieve higher quality and quantity of data necessary to better track performance and drive improvement in programs serving the homeless.
• Bring all shelters and other service providers into HMIS, growing shelter coverage, as close as possible to 100%.
• Marshal 1,000 volunteers for Dallas’ most comprehensive Homeless Count to date in January 2017.

Capacity:

• Continue to enhance knowledge and performance of homeless providers through learning, training and development opportunities.
• Grow MDHA Flex Fund, to pay for minor but impactful expenses that can help individuals resolve their homelessness.
• Build robust street outreach, to proactively engage, shelter and house unsheltered individuals through MDHA’s CAS.
• Facilitate action by the City of Dallas and other related entities creating more permanent supportive housing and affordable housing.

Ending Homelessness, Homeless Response Systems and MDHA – a Link “Primer”

Would you like to learn more about ending homelessness, homeless response systems and MDHA? We recently compiled this handy link “primer” to help you out with just that. Happy learning!

Opening Doors – the National Strategic Plan to End Homelessness:

http://usich.gov/resources/uploads/asset_library/USICH_OpeningDoors_Amendment2015_FINAL.pdf

About MDHA:

http://www.mdhadallas.org/what-is-mdha/

MDHA in Depth:

http://www.mdhadallas.org/mdha-in-depth-2/

Homelessness in Dallas:

http://www.mdhadallas.org/state-of-the-homeless-address-2016/

http://www.mdhadallas.org/2016-homeless-count/

http://www.mdhadallas.org/wp-content/uploads/2014/08/HDX-PIT-All-Summary-2016.pdf

2015-2016 Continuum of Care Strategic Work Plan – Building an Effective Homeless Response System:

http://www.mdhadallas.org/wp-content/uploads/2014/08/CoCSWP-2015-2016-FINAL1.pdf

http://www.mdhadallas.org/wp-content/uploads/2015/06/CoCSWP-2015-2016-3-Q-Report.pdf

Housing First Efficacy:

http://endinghomelessnessmdha.blogspot.com/2016/04/it-works-sample-of-research-on-efficacy_1.html

https://www.amazon.com/Housing-First-Homelessness-Transforming-Changing/dp/019998980X/ref=sr_1_1?ie=UTF8&qid=1466107055&sr=8-1&keywords=housing+first

MDHA Flex Fund:

http://www.mdhadallas.org/the-mdha-flex-fund/

http://endinghomelessnessmdha.blogspot.com/2016/05/solomons-ticket-out-of-homelessness.html

Building an Effective Homeless Response System:

http://endinghomelessnessmdha.blogspot.com/2016/03/the-how-to-of-building-effective.html

http://endinghomelessnessmdha.blogspot.com/2016/03/dallas-commits-to-building-effective_14.html

http://www.marc.org/Community/Homelessness-Task-Force/Assets/HTF-coordinated-intake-graphic-web.aspx

Coordinated Access Blog Post Series:

http://endinghomelessnessmdha.blogspot.com/2016/03/coordinated-access-blog-post-series.html

http://endinghomelessnessmdha.blogspot.com/2016/03/coordinated-access-heart-of-effective.html

http://endinghomelessnessmdha.blogspot.com/2016/03/coordinated-access-in-action-in-tarrant.html

http://endinghomelessnessmdha.blogspot.com/2016/05/coordinated-access-in-action-in-tarrant.html

http://endinghomelessnessmdha.blogspot.com/2016/05/coordinated-access-in-action-in-tarrant_11.html

http://endinghomelessnessmdha.blogspot.com/2016/05/coordinated-access-in-action-in-dallas.html

Tent City Closure:

http://www.mdhadallas.org/wp-content/uploads/2015/06/I45-Encampment-Closure-Report.pdf

http://endinghomelessnessmdha.blogspot.com/2016/05/tent-city.html

http://thescoopblog.dallasnews.com/2016/05/tent-city-closed-so-where-do-dallas-homeless-go-from-here.html/

MDHA Partnership with PCCI:

http://endinghomelessnessmdha.blogspot.com/2016/01/a-data-driven-alliance-to-end_12.html

Cindy J. Crain, MDHA President and CEO Delivers State of the Homeless Address 2016

Yesterday, Tuesday, March 22, 2016 Cindy J. Crain, President and CEO of the Metro Dallas Homeless Alliance (MDHA) delivered her second annual State of the Homeless Address, with more than 300 people in attendance, at Goodwill Industries of Dallas. MDHA leads the development of the homeless response system that, in accordance with Opening Doors, the national strategic plan to end homelessness, will make homelessness in Dallas and Collin Counties rare, brief and nonrecurring.

Crain was introduced by Dallas Mayor Mike Rawlings, the city’s former “homeless czar”, who shared remarks and pledged his support in word and deed to support MDHA’s efforts to end homelessness. Crain called on MDHA Board Member and homeless advocate, Ricky Redd to share some of his knowledge gained through lived experience as a person experiencing homelessness. Redd elicited tears as well as laughter, as he movingly spoke of what he learned and what are the most pressing needs of those experiencing homelessness. Crain’s address was followed by public comments and questions.

Ricky Redd

Crain opened with the purpose of the address: To review what we know, and how this will influence our decisions, to be honest about the challenges we deal with, and to welcome insights from the community on how we can make homelessness rare, brief and non-recurring.  The numbers she shared were sobering. The 2016 Point–in-Time Homeless Count conducted in late January, indicated an increase of 24% in the homeless population in Dallas and Collin Counties over the 2015 Count, going from 3,141 to 3,904 individuals. The number of chronically homeless individuals, i.e. those that have been homeless for 12 months and have a disability did not see significant change, dropping from 615 to 597. She presented elaborate graphs and charts, drilling down into this data by age, gender, race, ethnicity, sheltered vs. unsheltered and more.

Some of the most interesting data collected during the Count was from surveys, which the more than 700 volunteers in both counties administered to those they counted. One of the more sobering statistics was that of 358 unsheltered persons who were willing to share if they had experience in the criminal justice system, 75% had answered yes. This enforces the idea that with mass incarceration, we are creating a “prison to poverty and homelessness pipeline”. Of the 387 responses regarding health, 48% reported significant health conditions.

Cindy Crain

Crain discussed the lessons MDHA has accumulated from working with the residents of the Tent City under the I-45 Bridge, specifically highlighting the importance of increased professional street outreach and interagency collaboration, to help house as many people as possible.

Crain highlighted the tension between short term needs and long term housing solutions. She emphasized that the question, “What is your housing plan?” must become a mantra that pushes everyone towards housing, with services that support smooth transition and permanence in housing. She also reminded the assembled that true solutions lie in systemic and systematic changes, like Coordinated Assessment, a system through which all persons are assessed, using a common, uniform, objective and evidence based assessment tool, so they may be prioritized for service and matched with the services that will best help end their homelessness as quickly as possible. (MDHA is currently running a blog post series that explains how this federally required system will help end homelessness.)

In this context, Crain referenced MDHA’s partnership with PCCI, a nationally recognized leader in creating information systems that connect community based organizations with healthcare organizations to create an integrated community wide system of care. Together, MDHA and PCCI are creating a new Homeless Management Information System, customized to the needs of the Dallas community. With this new system, the community will have a far clearer picture of the nature and extent of homelessness and have the data necessary to optimize housing and services to make the experience of homelessness rare, brief, and non-recurring.

Crain ended her address emphasizing the need for all members of the community to work together. Without collaboration, cooperation and coordination of information and services, she stressed, we will keep more people homeless longer. By working together we, as a community, and each of us individually, can and must do better.

Crain’s PowerPoint presentation is available on the State of the Homeless Address 2016 page on MDHA website, and a full video recording of the proceedings will be available there later this week.