Core Performance Indicators for Homeless-Serving Programs Administered by the U.S. Department of Health and Human Services. Suggested Core Performance Measures

09/01/2003

Despite the difficulties and constraints in developing a core set of performance measures, our review of the performance measurement systems in existence across the four programs also indicates potential for both enhancement and movement toward more outcome-oriented measures. For example, the general approach to performance measurement used within the Treatment for Homeless Persons Program  which features pre/post collection of participant-level data and outcome-oriented measures  provides a potential approach that could be applicable to the other three programs (as well as other non-homeless-serving programs operated by DHHS). In suggesting a potential set of core performance measures cutting across these four homeless-serving programs, it is important to consider where the four programs intersect with respect to program goals/objectives for the homeless individuals being served. From this commonality of goals arises the potential for a core set of measures (with the recognition, however, that each program will also likely require additional measures specific to differing objectives and service offerings). Of critical important to our efforts to suggest core measures, all four of the programs are aimed at (1) improving prospects for long-term self-sufficiency, (2) promoting housing stability, and (3) reducing the chances that individuals will become chronically homeless.(16) In addition, the four programs (some more than others) also stress addressing mental and physical health concerns, as well as potential substance abuse issues.

Based on the common objectives of these four programs, we suggest a core set of process and outcome measure that could potentially be adapted for use by the four homeless-service programs (see Exhibit 4-1). We suggest selection of the four process measures, which track numbers of homeless individuals (1) contacted/outreached, (2) enrolled, (3) comprehensively assessed, and (4) receiving one or more core services. We then suggest selection of several outcome measures from among those grouped into the following areas: (1) housing status, (2) employment and earnings status, and (3) health status. In addition, we have suggested a several additional outcome measures that could be applied to homeless youth.

Exhibit 4-1:
Potential Core Performance Measures for DHHS Homeless-Serving Programs
Type of Measure Core Performance Measure When Data Item Could Be Collected Comment
**PROCESS MEASURES**
Process # of Homeless Individuals Contacted/Outreached At first contact with target population  
Process # of Homeless Individuals Enrolled At time of intake/ enrollment or first receipt of program service  
Process Number/Percent of Homeless Individuals Enrolled That Receive Comprehensive Assessment At time of initial assessment May include assessments of life skills, self-sufficiency, education/training needs, substance abuse problems, mental health status, housing needs, and physical health
Process Number/Percent of Homeless Individuals Enrolled That Receive One or More Core Services At time of development of treatment plan, first receipt of program service(s), or referral to another service provider Core services include:
  • Housing Assistance
  • Behavioral Health Assistance (Substance Abuse/Mental Health Treatment)
  • Primary Health Assistance/Medical Treatment
**OUTCOME MEASURES  HOUSING STATUS**
Outcome  Housing Number/Percent of Homeless Individuals Enrolled Whose Housing Condition is Upgraded During the Past Month [or Quarter]
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
Possible upgrade categories:
  • Street
  • Emergency Shelter
  • Transitional Housing
  • Permanent Housing
Outcome  Housing Number/Percent of Homeless Individuals Enrolled Who Are Permanently Housed During the Past Month [or Quarter]
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
 
Outcome  Housing Number/Percent of Homeless Individuals Enrolled Whose Days of Homelessness (on Street or in Emergency Shelter) During the Past Month [or Quarter] Are Reduced
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
  • HADS systems may provide useful data on shelter use (but not street homelessness)
**OUTCOME-MEASURES  EARNING/EMPLOYMENT STATUS**
Outcome  Earnings Number/Percent of Homeless Individuals Enrolled with Earnings During the Past Month [or Quarter]
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
  • UI quarterly earnings data (matched using SSN) could be useful  though data lags, potential costs, and confidentiality issues
Outcome  Earnings Number/Percent of Homeless Individuals Enrolled with Improved Earnings During Past Month [or Quarter]
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
  • UI quarterly earnings data (matched using SSN) could be useful  though data lags, potential costs, and confidentiality issues
Outcome  Employment Number/Percent of Homeless Individuals Enrolled Employed 30 or More Hours per Week
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
  • Hours threshold could be changed (20+ hours; 35+ hours); hours worked could be for week prior to survey or avg. for prior month or quarter
  • UI quarterly wage data not helpful (hours data not available); so follow-up survey probably needed
Outcome  Employment Number/Percent of Homeless Individuals Enrolled with Increased Hours Worked During the Past Month [Quarter]
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
  • UI quarterly wage data not helpful (hours data not available); so follow-up survey probably needed
**OUTCOME MEASURES  HEALTH STATUS**
Outcome  Substance Abuse Number/Percent of Homeless Individuals Enrolled and Assessed with Substance Abuse Problem That Have No Drug Use the Past Month [or Quarter]
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
  • Drug screening could be used
Outcome  Physical Health Status Number/Percent of Homeless Individuals Enrolled Assessed with Physical Health Problem That Have Good or Improved Physical Health Status During Past Month [or Quarter]
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
  • May be difficult to objectively measure good or improved
Outcome  Mental Health Status Number/Percent of Homeless Individuals Enrolled Assessed with Mental Health Problem That Have Good or Improved Mental Health Status During Past Month [or Quarter]
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
  • May be difficult to objectively measure good or improved
**OUTCOME MEASURE  YOUTH-ONLY**
Outcome  Family Reunification Number/Percent of Homeless & Runaway Youth Enrolled That Are Reunited with Family During Past Month [or Quarter]
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
  • Reunification may not always be an appropriate outcome  and it is often hard to know when it is
Outcome    Attending School Number/Percent of Homeless Youth Enrolled That Attended School During Past Month [or Quarter]
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
 
Outcome  Completing High School/GED Number/Percent of Homeless Youth Enrolled That Complete High School/GED During Past Quarter
  • At intake/enrollment
  • 3, 6, and/or 12 months after point of enrollment
  • At termination/exit
 

With regard to housing outcomes, we have identified three potential outcome measures intended to track (1) changes in an individuals housing situation along a continuum (from living on the street and in emergency shelters to securing in permanent housing), (2) whether the homeless individual secures permanent housing, and (3) days of homelessness during the preceding quarter (or month). It should be noted with regard to housing outcomes, that although the four homeless-serving programs focus primarily on other non-housing related goals and services (e.g., improving mental or physical health status, reducing/eliminating substance abuse, reuniting runaway youth with their families), that housing outcomes for homeless individuals are of paramount importance. Housing outcomes are appropriate to consider for programs focused on homelessness even when their primary goals may be focused on improving mental health status or physical health status.

Two earnings measures are identified  one that captures actual dollar amount of earnings during the past quarter (or month) and a second measure that captures whether an individuals earnings have improved. Two employment measures are also identified  one relating to whether the individual is engaged in work 30 or more hours per week and another that measures whether hours of work have increased. Three health-related measures are offered, focusing on use of drugs, improvement in physical health status, and improvement in mental health status. Finally, three measures are offered that are targeted exclusively on youth (though the other outcome measures would for the most part also be applicable to youth): (1) whether the youth is reunited with his/her family, (2) whether the homeless youth is attending school, and (3) whether the homeless youth graduates from high school or completes a GED.

A pre/post data collection approach is suggested with respect to obtaining needed performance data  for example, collecting data on housing, health, and substance abuse status of program participants at the time of intake/enrollment into a program and then periodically tracking status at different points during and after program services are provided (i.e., at termination/exit from the program and/or at 3, 6, or 12 months after enrollment). Collection of data on homeless individuals at the point of termination can be problematic because homeless individuals may abruptly stop coming for services. The transient nature of the homeless population can also present significant challenges to collecting data through follow-up surveys/interviews after homeless individuals have stopped participating in program services (e.g., at 12 months after enrollment).

Given difficulties of tracking homeless individuals over extended periods (and particularly after individuals termination from programs), the extent to which existing administrative data can be utilized could increase the proportion of individuals for which it is possible to gather outcome data (at a relatively low cost). Probably the most useful source in this regard is quarterly unemployment insurance (UI) wage record data, which can be matched by Social Security number (though releases are required and it may also be necessary to pay for the data). UI wage withholding data provides the opportunity to track earnings on a quarterly basis (from covered employers) and, for example, examine how earnings may change from quarter to quarter and potential effects of program involvement on workforce participation and economic self-sufficiency.

A second potential source of administrative data that may have some potential utility for tracking housing outcomes are HADS system maintained by many states and/or localities. As noted in Chapter 3, HADS systems are not used principally for measuring program performance or outcomes  though have the capability to provide analyses of length of stay. The HADS principally serve as registry systems that facilitate tracking of program participant characteristics, services received, length of stay, and movement within emergency and transitional housing facilities. Such systems may provide useful data for tracking use of emergency and transitional housing, as well as chronic homelessness  though are limited for purpose of determining housing status once an individual leaves emergency or transitional housing (i.e., on the street or in permanent housing).

Finally, in terms of tracking self-sufficiency outcomes, data sharing agreements with state and local welfare agencies may provide possibilities for tracking dependence on TANF, food stamps, general assistance, emergency assistance, and other human services programs.

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