[Slide 1]{.underline}

**Michigan Statewide HMIS**

Outcomes Project

[Slide 2]{.underline}

**About Michigan**

Michigan Statewide HMIS

2.5 years old

57 COC's including Detroit

370-plus agencies with 1,322 programs

3 State Departments; DHS, DCH, DOE

90,000-plus unique clients

[Slide 3]{.underline}

**Michigan Vertical Configuration**

A chart is titled MSHMIS Basic Configuration. At the top is an oval
marked MSHMIS. Lines run down from it to four ovals each marked COC, one
oval marked DCH, and one marked DOE. One of the COC ovals has lines
running down to four ovals marked A1, A2, A3, and SCH. A2 has lines
running down to two ovals marked ES and TH. A3 has lines running down to
an oval marked Path and another marked S and C. TH and Path are
connected horizontally by a blue line to indicate sharing between
agencies. SCH has a line running down to an oval marked SCH1. DCH has
lines running down to a blank oval and an oval marked A3, which, like
the other A3 oval, has lines running down to an oval marked Path and
another marked S and C. DOE has a line running down to an oval marked
Distribution, which has a line running down to an oval marked SCH1.
Three red lines connect the two Path ovals, the two S and C ovals, and
the two SCH1 ovals to indicate sharing across the tree insuring the
count.

[Slide 4]{.underline}

**Measurement: An Ongoing Collaboration**

Funding organizations

Program leadership

Staff members who collect information and enter data

[Slide 5]{.underline}

**Selecting What to Measure**

Mix of measures

Process indicators

> Time to referral or placement in housing
>
> Percentage returning for ongoing services

Short-term or intermediate objectives: measure critical processes

> Positive housing placement at discharge
>
> Improved income at discharge
>
> Linked with needed supportive services
>
> Percent readmissions

Outcomes: measures sustained change

> Stable housing
>
> Stable employment

[Slide 6]{.underline}

**Coordinating the Process of Measurement**

How do we know what success looks like

Client characteristics slash who is served

When measurement occurs

Establishing baselines

Benchmarking slash comparing performance

Improving performance

The environment slash contextual variables

Evaluate outcomes

[Slide 7]{.underline}

**Defining the Population Served**

Developing shared screening questions. Data standards plus:

Have they had a lease in their own name

Were they homeless as children

What is their housing history

What is their education history

What is their employment history

What is their health history

Are there disabilities of long duration

[Slide 8]{.underline}

**When Measurement Occurs**

Intermediate Outcomes

Measured during care or at discharge

Reflect stable and optimized program processes

Customer satisfaction

Follow-up Outcomes

Measured after discharge for some period of time

Were changes achieved in care sustained

Did we impact other long-term primary outcomes

[Slide 9]{.underline}

**Baselines and Targets**

Critical for evaluating change and optimizing performance

Realistic slash honest targets

Stabilized processes

Percentiles are consistent across time

Systematic and routine measurement

Before

During

After program change

[Slide 10]{.underline}

**Benchmarking**

Working with like programs to:

Identify realistic targets

Identify performance that is off norm

Share ideas to improve

Address measurement problems

Build transparency

[Slide 11]{.underline}

**Example Control Chart: School Attendance**

A line graph is labeled Completed School Days Slash Available Education
Days. The x-axis lists months, and the y-axis gives numbers. A line
marked Org 1 starts around 0.68 in January, drops to about 0.31 in
February, rises to about 0.8 in June, goes on hiatus until September,
and drops to about 0.73 in December. A line marked Org 2 starts at a
high of about 0.88 and shakily ends around 0.64, with a low of about
0.58 in August. A line marked Org 3 starts at a high of about 1, remains
largely steady aside from a hiatus from June to August, and ends around
0.97, with a low of about 0.92 in May. A line marked Org 4 starts around
0.99 and slowly wobbles to about 0.89, with a high of about 1 in
February and March. A straight black line runs horizontally at about
0.75.

[Slide 12]{.underline}

**Defining the Measure**

Purpose: Measure the program's ability to support the educational plan
of children in care

A client is considered to have met their individual education plan for
the day if they participated for 75 percent or more of the time they
were scheduled to be involved in education activities

Available education days reflect only days when it was possible for the
client to participate in their individual education plan

> For example, if the resident's educational plan is to attend school,
> only those days that the school was open during the reporting period
> are counted
>
> Excused absences do not count as possible days
>
> If a client was excused due to illness, a pass, or an appointment,
> these days are not considered available education days

[Slide 13]{.underline}

**Interpretation**

This measure is unique because of the difficulty of comparing
individualized plans across children who present with differing levels
of disability

> For example, a floridly psychotic adolescent may tolerate only half
> days at school; for that youth, the plan will include fewer possible
> hours, but the same number of days
>
> Members of the QM team felt that this was a critical outcome of care
> and represented a positive measure of program function
>
> In addition to compatibility across individualized plans, a special
> challenge was to deal with summer school since information is
> submitted monthly
>
> Only Orgs 3 and 4 run year-round schooling
>
> Org 2 developed summer educational enrichment programs in order to
> participate in this measure
>
> Org 1 was unable to implement a summer plan

Org 4 received a Gates Grant in late 2000 to automate the classroom:
education attendance was nearly 100 percent when the automation was new
and has sustained very high attendance levels since the implementation
stage

[Slide 14]{.underline}

**The Context of Services**

Lack of affordable housing

Vacancy rates

Unemployment rates

Lack of access to supporting services

Long waiting lists

No insurance or pay source

Barriers to success or community assets

[Slide 15]{.underline}

**What Will the Project Do**

1: Support the development of initial measures; indicators, objectives,
and outcomes; and targets through meetings with funders, program
leaders, and staff members

2: Provide a menu of measures from which program leaders may select

[Slide 16]{.underline}

**Project Activities, Continued**

3: Provide reports that may be run monthly with a click of the button on
all selected measures; the reports will aggregate data that is viewable
through the HMIS for programs, agencies, and COC's and statewide

4: Convene routine benchmarking meetings to discuss measurement issues
as well as performance ideas

[Slide 17]{.underline}

**Project Activities, Continued**

5: Maintain, with local support, a database of contextual variables

6: Share slash problem-solve measurement issues; support the evolution
of measures

7: Provide data for statewide analysis as defined in contracts

[Slide 18]{.underline}

**Data Warehouse Project**

Shadow

> Routinely refreshing deidentified dataset linking mainstream data;
> Medicaid, DCH, Support Enforcement, DOC; with HMIS data

Using the data to measure effectiveness

> From the State agency perspective, falling into homelessness is a
> negative outcome
>
> From a homeless provider perspective, accessing mainstream benefits is
> a positive outcome

Longitudinal view of the intersection between public slash private
services for clients

[Slide 19]{.underline}

**Contact Information**

Barbara Ritter

5 1 7, 2 3 0, 7 1 4 6

<britter@mihomeless.org>

MCAH Web Site: www.mihomeless.org