An Evaluation of an Initiative to Improve Coordination and Service Delivery of Homeless Services Networks:

Tables

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Table 1:
Site Overviews

Site

Description
Broward County, Florida ~ HHOPE Program The HHOPE program, a collaboration of the Broward County Human Services Department, Homeless Initiative Partnership Administration, provides scattered site housing and supportive services to severely and persistently mentally ill and chronically homeless individuals through Shelter Plus Care. The project is implementing a Housing First approach and using a modified ACT team.  Their goal is to serve 80 individuals over the life of the project.
Chattanooga, Tennessee ~ The Collaborative Initiative Chattanooga’s Collaborative Initiative, coordinated by the Fortwood Center, serves chronically homeless individuals in scattered site housing.  The Initiative is implementing the Housing First approach and an ACT team to provide wrap-around services for clients in housing.  The goal of the Initiative is to serve 50 individuals over three years, in housing subsidized through Shelter Plus Care.
Chicago, Illinois ~ ACT Resources for Chronically Homeless (ARCH) Led by the Chicago Department of Human Services, ARCH targets chronically homeless individuals with mental health, substance abuse, and/or co-occurring disorders.  They are using Shelter Plus Care vouchers to secure 59 tenant-based permanent housing units. The units are both scattered site and clustered.  ARCH uses a Housing First approach and an ACT team. Their goal is to bring about significant expansion of permanent supportive housing, coordination and maximization of mainstream resources, and expansion of evidence-based service strategies to meet the complex needs of chronically homeless people.
Columbus, Ohio ~ Rebuilding Lives PACT Team Initiative (RLPTI) RLPTI is led by Southeast, which contracts project management to the Community Shelter Board.  The project serves chronically homeless individuals with severe mental disabilities or co-occurring substance abuse and mental illness.  For this initiative, they have five clustered site housing units through a Supportive Housing Program grant and use a Housing First approach. They use a PACT model and have incorporated several evidence-based practices.  One of RLPTI’s main goals is to increase the behavioral healthcare system in Franklin County, particularly by increasing Southeast’s capacity and treatment slots. In addition, they plan to increase income supports and entitlements for the chronically homeless. The goal of the RLPTI is to house and serve 108 individuals.
Contra Costa, California ~ Project Coming Home (PCH) Led by the Contra Costa Office of Homeless Programs, PCH serves chronically homeless individuals using a Health, Housing, and Integrated Services Network (HHISN).  Through Shelter Plus Care, PCH uses a housing first, scattered site model facilitated through partnerships with the housing authority and Shelter Inc.  The goals of PCH include: increasing the effectiveness of integrated systems of care by providing comprehensive services and treatment, linked to housing; increasing the use of mainstream resources that pay for services and treatment; and supporting the development of infrastructures that sustain housing, services treatment, and inter-organizational partnerships beyond the federal initiative.  Over a five-year period, they expect to contact 5,250 chronically homeless individuals and house 155 individuals.
Denver, Colorado ~ Denver Housing First Collaborative (DHFC) DHFC, a Shelter Plus Care grant is a collaboration of agencies led by Colorado Coalition for the Homeless.  It seeks to provide coordinated housing and treatment to chronically homeless individuals with disabilities, substance abuse, severe and persistent mental illness, co-occurring disorders, and/or chronic physical illness.  DHFC uses a Housing First approach and an ACT team.  Housing is both scattered site and clustered.  DHFC aims to serve 100 clients in year one.
Los Angeles, California ~ Skid Row Collaborative The Collaborative, which has a Shelter Plus Care Grant, is coordinated by the Skid Row Housing Trust, and seeks to serve chronically homeless and disabled persons.  It uses the Health, Housing, and Integrated Services Network (HHISN) model.  To reach their goal of assisting clients into permanent housing, the Collaborative is expanding mental health and co-occurring treatment services by adding a team of case manager specialists in mental health and substance abuse and peer advocates to provide outreach, engagement, support and recovery services/ treatment, and case management.  They have a goal of housing and serving 62 individuals. The project has already had contact with 140 homeless individuals in its first year.
New York, New York ~ In Homes Now (IN)/Project Renewal IN, a Supportive Housing grant, is coordinated by Project Renewal serves chronically homeless individuals who are active substance abusers in New York City.  IN uses a Housing First approach and an Intensive Integrated Service Team to supplement existing programs (Continuum of Care and Pathways to Housing) for which active substance users are not eligible.  The project’s goal is to house and provide comprehensive services for 40 individuals from the target population in scattered-site SRO apartments located in Manhattan and the Bronx.
Philadelphia, Pennsylvania ~ Home First With the City of Philadelphia as the lead agency, Home First serves homeless individuals who have serious mental illness and/or co-occurring disorders and who have among the highest number of documented days in the city’s emergency shelter and residential behavioral health system. They use a Housing First approach and an ACT team.  The project intends to serve approximately 85 chronically homeless individuals over the life of the Supportive Housing Program project.
Portland, Oregon ~ The Community Engagement Program (CEP III)/ Central City Concern CEP III, which has a Shelter Plus Care grant, is coordinated by Central City Concern.  The project focuses on the “hardest to serve” of Portland’s chronically homeless population – those with a significant disability (i.e., physical health, mental health, and/or substance abuse issues) and/or co-occurring disorders.  Based on ACT and the Housing First approach, clients are housed in scattered site, clustered, or Shelter Plus Care units.  The project’s main goal is to demonstrate an effective model in reducing chronic homelessness for people with co-occurring disorders. CEP III seeks to serve 100 clients in the first year and 150 over the life of the project.
San Francisco, California ~ Direct Access to Housing (DAH) The San Francisco Department of Public Health is the lead agency for the Direct Access to Housing initiative, which has a Supportive Housing Program grant.  They are creating 70 units of permanent supportive housing through an expansion of their DAH program at the Empress Hotel.  DAH serves chronically homeless individuals with disabilities, using a supportive housing model.

Table 2:
Four-Factor Solution to a Factor Analysis of 15 Dyadic Integration/Coordination
Items from the Network Participation Survey
Burden Item Factor Loading
Factor 1: Joint Planning and Cooperation  

   Send clients to or receive homeless clients from this agency

.831

   Co-locate staff and/or services in the same location with this agency 

.594

   Cooperate in serving clients 

.912

   Communicate clearly with this agency in serving clients 

.894

   Agree on goals with this agency for  serving clients

.780

   Cooperate with this agency in planning

.526

   Communicate clearly with this agency in planning 

.558

   Send information to or receive information from this agency for coordination, control, planning, or evaluation 

.539

   Have written documents (e.g., MOUs) or flow charts specifying working relationship with this agency 

.452

Factor 2: Trust and Respect

  

   Trust this agency 

.903

   Respect this agency 

.905

Factor 3: Send Funds to or Influence Flow of Funds to Other Agency

  

   Send funds to this agency 

.920

   Influence flow of funds to agency

.889

Factor 4: Receive Funds From or Influences Flow of Funds to Your Agency

 

   Receive funds from this agency 

.910

   To what extent does this agency influence the flow of funds to you

.906

Table 3:
Two-Factor Solution to a Factor Analysis of 8 Housing Emphasis Items
from the Network Participation Survey
Burden Item Factor Loading

Factor 1: Current Housing Emphasis by CICH network

  

    Emergency Shelter

.749

    Transitional Housing

.829

    Affordable Housing

.645

 

 

Factor 2:  Change in Housing Emphasis by CICH Network

 

    Emergency Shelter

-.659

    Transitional Housing

-.728

    Permanent Supported Housing

.578

 

Table 4:
Descriptive Characteristics: System-Level Measures Across All Time Points
Variable Groups Variables N Mean Scores SD Range

System Connectedness And Integration

Integrative Practices

215

2.08

.52

0-3

Coalition Involvement

187

2.25

.72

0-3

Working Together

210

2.66

.51

0-3

Involvement of Local Organizations: Number

211

7.65

2.42

0-12

Dyadic Joint Service Planning and Coordination

1,366

1.82

.87

0-3

Dyadic Trust and Respect

1,369

2.64

.60

0-3

Emphasis On Providing Housing Services And On The Associated Goal Of Ending Homelessness

Emphasis on Transitional, Emergency, and Affordable Housing as Contrasted with Permanent Supported Housing

206

2.23

.72

0-3

Change in Emphasis from Emergency Shelter and Transitional Housing to Permanent Supported and Non-supported Housing

208

2.12

.52

1-3

Development Of Homeless Services Management Information System

Client and Services Information Available

208

.84

.29

0-1

CICH Management Information System Exists

199

1.51

1.01

0-4

Use of Evidence-Based mental health Practices

Use of  Evidence Based Practices

208

2.30

.44

.11-3

Funds Transfer and Influence

Fiscal Relationship Exists

1,355

.31

.46

0-1

Table 5:
Correlations of All Measures at Agency Level
Variables 1 2 3 4 5 6 7 8 9 10 11 12

1=Integrative Practices (N=215)

1.00

 

 

 

 

 

 

 

 

 

 

 

2=Coalition Involvement (N=187)

.39 (.0001)

1.00

 

 

 

 

 

 

 

 

 

 

3=Working Together (N=210)

.53 (.0001)

.25 (.001)

1.00

 

 

 

 

 

 

 

 

 

4=Involvement of Local Organizations: Number (N=211)

.35 (.0001)

.28 (.0001)

.33

(.0001)

1.00

 

 

 

 

 

 

 

 

5= Dyadic Joint Service Planning and Coordination (By Rating Agency) (N=217)

.47 (.0001)

.07

 (.35)

.23 (.001)

.23 (.0009)

1.00

 

 

 

 

 

 

 

6=Dyadic Trust and Respect (By Rating Agency) (N=221)

.45 (.0001)

.11

 (.13)

.26 (.0001)

.30 (.0001)

.52 (.0001)

1.00

 

 

 

 

 

 

7= Emphasis on Transitional, Emergency, and Affordable Housing as Contrasted with Permanent Supported Housing (N=206)

.27 (.0001)

.008 (.91)

.23 (.0012)

.29 (.0001)

.20 (.0035)

.29 (.0001)

 

 

 

 

 

 

8= Change in Emphasis from Emergency Shelter and Transitional Housing to Permanent Supported Housing (N=208)

-.084 (.23)

-.14 (.059)

-.216 (.0019)

-.036 (.61)

-.014 (.84)

0.12 (.083)

 

 

 

 

 

 

9=Client and Services Information Available (N=208)

.32 (.0001)

.21 (.004)

.26 (.0002)

.22 (.0014)

.27 (.0001)

.05

 (.47)

.105 (.14)

-.053 (.45)

1.00

 

 

 

10=CICH Management Information System Exists (N=199)

.25 (.0005)

.13 (.085)

.20 (.0052)

.20 (.0053)

.24 (.0009)

.15 (.038)

-.004 (.96)

.13 (.071)

.28

(.0001)

1.00

 

 

11= Average Degree Evidence Based Practices Used (N=208)

.66 (.0001)

.23 (.002)

.56 (.0001)

.33 (.0001)

.38 (.0001)

.46 (.0001)

.24

(.001)

-.031 (.66)

.22 (.0002)

.20 (.004)

1.00

 

12=Funds Transfer and Influence (N=215)

.20

(.0029)

-.008

(.91)

.11

(.12)

.16

(.023)

.49

(.0001)

.28

(.0001)

.13 (.07)

.14 (.043)

.12 (.09)

.20

(.004)

.16 (.02)

1.00

Table 6:
System Integration Over Time
Measures of System Connectedness and Integration N Mean Scores Time Comparison

Wave 1

Wave 2

Wave 3

Percent Change (Wave 1 to Wave 3)

P*

Pairwise Comparison**

Integrative Practices

204

1.94

2.06

2.23

14.9%

.003

W3>W1

Coalition Involvement

187

2.36

2.09

2.29

-3.0%

.049

W1>W2

Working Together

210

2.59

2.70

2.69

3.9%

.30

None

Involvement of Local Organizations: Number

203

7.34

7.73

8.21

11.9%

.12

W3>W1

Dyadic Joint Service Planning and Coordination

1,366

1.63

1.85

2.04

25.2%

.0001

W3>W2>W1

Dyadic Trust and Respect

1,369

2.58

2.68

2.67

3.5%

.005

W3>W1, W2>W1

*Proc mixed used in which autocorrelation controlled for with respect to site for those measures based on key informant observations (site and ID for those based on relationship characteristics)

 **Only those comparisons with significance in which p<.05 reported

Table 7:
Comparisons Over Time of Other System Characteristics
Variable Groups Variables N Mean Scores Time Comparison
Wave 1 Wave 2 Wave 3 Percent Change (Wave 1 to Wave 3) P* Pairwise Comparison**

Emphasis On Providing Housing Services And On The Associated Goal Of Ending Homelessness

Emphasis on Transitional, Emergency, and Affordable Housing as Contrasted with Permanent Supported Housing (Factor Score)

206

2.33

2.21

2.15

-7.7%

.32

None

Change in Emphasis from Emergency Shelter and Transitional Housing to Permanent Supported Housing (Factor Score)

208

2.12

2.07

2.18

2.8%

.47

None

Development Of Homeless Services Management Information System

Client and Services Information Available

208

.75

.86

.90

20.0%

.0009

W3>W1, W2>W1

CICH Management Information System Exists  

199

1.23

1.47

1.90

54.5%

.0006

W3>W1, W3>W2

Use of Evidence-Based mental health Practices

Use of  Evidence Based Practices (Mean Rating)

204

2.12

2.35

2.41

13.7%

.0002

W3>W1, W2>W1