Strategies for Including Youth Data in HMIS September 13-14, 2005 St. Louis, Missouri Sponsored by...

Strategies for Including Youth Data in HMIS

September 13-14, 2005St. Louis, Missouri

Sponsored by the U.S. Department of Housing and Urban Development

Julie Hovden, The U.S. Department of Housing & Urban Development (Moderator)

Bryan Tosi, Nevada Partnership for Homeless Youth (NPHY)

Kat Freeman, Maine State Housing Authority

Clark County/ Las Vegas, NV



Bryan Tosi – Miner (HMIS) Project ManagerNevada Partnership for Homeless Youth (NPHY)

September 13-14, 2005 St. Louis, MissouriSponsored by the U.S. Department of Housing and Urban Development

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Clark County/Las Vegas HMIS

• Background

• How does a homeless youth provider become the HMIS lead agency?

• No HUD Funding

• Our choice of software

• Help us collect data, and there’s no charge to use HMIS


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• Collecting data

• Phase 1• We had providers ask the question: “Were you homeless

before you reached the age of 18?”– Did not provide very good results

• Phase 2• We changed the question to: “At what age did you first

become homeless?”– Better, but most clients were simply saying they did not

remember


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• Collecting Data (cont.)

• Phase 3 – Couch Surfing• We decided to add a question: “Did you ever have to sleep

at a friend or relative’s house because you did not have a place to stay for the evening?”

• If they answered “Yes”, we asked a follow-up question: “Do you recall how old you were when that first happened?”

– More probing, better responses from the clients

• Phase 4 (only 1 month in use as of July 2005)• We decided to ask the questions from both Phase 2 & 3


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• Results (after 1 month)

• 10% - 12% of the adult homeless population experienced some form of homelessness before they reached adulthood


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• Using HMIS

• Since NPHY was the lead agency on the HMIS project, we felt it was important to actually be a user of the system

• We began using HMIS in January 2005 to manage our “Step-Up” program which provides assistance to former Foster Care kids in the State of Nevada

• Other youth providers using HMIS• Center for Independent Living began using HMIS in June

2005


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• Using HMIS (cont.)

• Youth providers interesting in using HMIS• The following providers have expressed an interest in

coming on to the HMIS:– Westcare– St. Judes– Girls & Boys Town

• All youth providers have expressed an interest in sharing data amongst themselves


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• Challenges

• Funding• NPHY contributed approximately $50,000 of it’s own funds

for the project in the first year• Raising money for the project has been very difficult

• Sharing data• Initially, most providers were against sharing data• In order to move forward, we decided to implement the

system with no data sharing• Providers are now beginning to warm up to the idea of

sharing


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• Challenges (Cont.)

• System usage• Providers have been very slow to begin using the system

after being trained

• Platform change• After less than one-year of operation we had to switch from

hosting our own servers to Vendor-Hosting– After eight weeks of intensive work, the transition to Vendor-

Hosting was completed with no issues


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• Looking ahead

• Interest in HMIS is increasing• Especially from privately funded agencies that are not

required to be on HMIS

• HMIS training levels are increasing• Providers are beginning to use the software for more than

just collecting data for HMIS


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• Looking ahead (Cont.)

• Interest in sharing data is increasing• 5 Providers are in the process of executing sharing

agreements

• Interest in data from the HMIS is increasing• Providers, government officials, and funders have been

asking about when data in the HMIS will be published• We decided to publish a report based on the data entered

during our first 8 months of operation

Engaging Youth Providers in HMIS:Maine State Housing Authority



Kat Freeman, Maine State Housing Authority


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Maine

The State of Maine’s HMIS is a dedicated, collaborative, statewide implementation encompassing 3 Continua of Care. The system is overseen by Maine State Housing Authority. Technical decisions for system development are made by HMIS Project staff with input from the various working groups.

We have a system that can accept data from any external data source and does not rely on a product like ServicePoint to achieve our HMIS goals. We went live on March 17, 2004 and have a participation rate of 69% (which does not include Youth or DV).

Our youth agencies are moving towards participation, but we still have obstacles to overcome in regards to Unaccompanied Youth without a release of information.


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Major Challenges (HMIS Implementation Staff)

• DHHS Youth Shelter Licensing language prohibits release of information to unauthorized persons

• Establishing communication between • HMIS Project staff and Agency Directors• HMIS Project staff and Agency Intake and Case workers• HMIS Project staff and DHHS Licensing Staff• HMIS Project staff and the State Attorney General’s office• Agencies and their clients• HMIS Project staff and youth clients

• Educating agencies and clients on concepts of data security and client confidentiality

• Agency Staff Burden/ Lack of Resources


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Major Challenges (Youth Shelters)

• The youth themselves do not have the ability to give consent• Additionally, youth, because of the things that have happened in their

lives, are younger emotionally than their actual age, which prohibits their understanding of the concepts of consent and privacy

• Youth are rarely the ones in control – their lives are controlled by adults (caseworkers, guardians, parents…)

• Youth are not homeless because of lack of housing and the goal is rarely the attainment of housing or employment, but rather the resolution of conflict or fulfillment of a wait period before moving to a different place (juvenile detention, foster home, etc) so HUD measures and goals of housing and/or employment attainment to do not fit the youth population

• The goal of youth shelters is to engage the youth enough to provide safety – because youth do not want their guardians to know where they are (because of abuse issues), asking for permission to pursue a release of information from the potential abuser becomes an impediment and in conflict with the shelter’s goal


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• Fundamental inconsistency – don’t need consent for them to stay the night, but need consent to collect information for a funding source

• Licensing and Grant Contract restrictions on authorization of data contribution and/or sharing

• Professional Licensing/ Code of Ethics: must have a “clear and compelling reason for the safety and well being” of the child in order to breach confidentiality• Because kids can’t give consent, the reason for release of

information to external partners must meet the “clear and compelling” reasoning articulated in the Code of Ethics

• Licensed Professionals can lose their licenses if they breach confidentiality without “clear and compelling” reason


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• Client Safety• There needs to be a hierarchy of policy enforcement at

all levels to avoid a child being injured because a user released information

• Assurances– Against political influences

• Clear ramifications for breaches (articulated at the federal level)

– End User (Data Entry, Intake, Case workers)– Agency Management (including Directors)– System Admins/ System Developers– Companies hosting and/or developing applications which

house or have access to client identifiable information

• Misrepresentation of information because full data set cannot be given to the HMIS system


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Possible Solutions – Money Talks

• Involve your Continuum – • If waivers are being asked for, your Continuum must

approve and provide written approval since they will be the ones financially impacted by lack of participation

• Work with CoC on application scoring techniques that include HMIS participation in scoring criteria

• Federal and State Funding Sources (ESG, etc)• Address grantee compliancy issues – HMIS participation

as a requirement• Assist in drafting policies and rule language for setting

realistic participation goals


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What’s Really Wrong?

• Agencies are not comfortable within their own knowledge base that client information will be protected and not misused

So What Do You Do?• Provide regular trainings to clients, advocates,

agency staff and state entities on system security and data confidentiality

• Stay up with the technology• Create options – what meets the HUD mandate

and still gets the job done?• Allow delayed entry


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What’s Really Wrong?

• Involve other resources serving youth• Change the language you are using – Data

Contribution vs. Data Sharing – which are you really doing?

• Get Youth and Youth Agencies involved in writing policies and procedures on security and confidentiality

• Challenge Youth Shelters to find advantages and work out outcomes and goals they want HMIS to collect information for


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Who Is Going to Do This Work – and With What?

• Provide Solutions for hardware and software issues whenever possible• Discount software• Agencies who donate quality used hardware• Find ways to help with online connectivity

• Integrate reporting requirements into one Single Point of Entry system

• Integrate the Point In Time Survey• Develop Assessments specific to Youth Shelter

Needs• Pick up development and integration costs

wherever you can


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Possible Solutions

• Educate, Educate, Educate!• Not just clients and provider agencies, but also funding/

contracting/ licensing entities who would fine the providers for perceived breaches of confidentiality by participation in HMIS

• If clients are educated, they can influence the provider and licensing agencies to make policy changes to share and contribute information to the benefit of the clients

• Regardless of Resistance – bring the shelters to the table!• If they don’t talk, you can’t listen!

• Listen to them – regardless of what you believe, their concerns are very viable and important to them!• You will never get cooperation if you cannot identify and

address their concerns.• Challenge them – to find the positive aspects of participation and

benefits to their clients; • What are the benefits? - Clients - Funders- Agency - Policy Makers


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Lessons Learned

• Clients and agencies need to be involved from the moment of idea conception to realization

• If you allow a process to explore and identify their concerns, and encourage them to propose solutions and options, you will have better buy in and a more suitable system for meeting client and agency needs

• If you are a System Administrator/ Project Manager - Don’t confuse your job!! When your attempts at a common ground solution fail, go back to the Continuum for support; It’s their job to insure participation; You provide technical solutions

• You must discuss the realistic financial repercussions to both the agency and the Continuum – no matter how hard


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Back to the Future

• Maine is embarking on an assertive campaign to educate clients, advocates, agency staff and state agency stakeholders

• We believe that 4 things will occur from this education campaign• Informed clients will ultimately begin to influence agency

policies on how their information is handled• Greater understanding of the technologies and policies used to

protect data will bring greater confidence by the agencies• Better reporting will show its usefulness and bring better value

to agencies and clients for influencing system and policy change

• This may lead to changes in policies that prohibit or restrict participation

• We are hosting a series of meetings with youth shelters to begin the process of identifying application outcomes and goals, including integration of reporting requirements into a Single Point of Entry system


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Remember…

• It’s okay to be different:• Regardless of the suggestions and solutions put

forth, the ending combination of solutions that bring your shelters into your HMIS implementation will look completely different from that of the person sitting next to you

• You have a choice:• The greatest advantage you can give yourself is to

have an open your mind so you can know and accept what your shelters have for issues – and you will never know what these are until you can bring the agencies to the table and listen to their concerns


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Remember…

• Be Proactive:• Don’t push this down their throats – they must

have time to explore their unique situations to find the advantages and benefits of participation; They need an opportunity to weigh the pros and cons to make an educated decision and they need to find out what their clients want

• You can’t please everyone:• No matter what you do, you may not be able to

convince everyone; Validate their continued concerns, but move forward with those who want to


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Engaging Youth Provider Data in HMIS

• Questions and Comments ?

Strategies for Including Youth Data in HMIS September 13-14, 2005 St. Louis, Missouri Sponsored by...

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