Dear and Urban Health roviders, VERVIEW - ERFRMANCE BJECTIVES FY2016-17 Measuring client improvement and successful completion of target objectives is an important part of SFDH contracting. The Transitions- Services (HUH) and the Contract Development and Technical Assistance (CDTA) sections have been working this past year to create performance objectives, standardized across most service categories. ur goal was to build from current objectives, and create meaningful, measurable, demonstrable objectives that will accurately reflect the good work that you provide to your clients, and will lead to clearly understood and interpreted review of performance in meeting objectives during the DH program monitoring process. During this process many providers participated in focus groups and helped with the review of the first drafts of these standardized objectives. The provider feedback and expertise was greatly appreciated. Contractors are responsible for compliance with all items in the erformance s and the Declaration of Compliance. This document is comprised of the following 4 tabs. Tab 1 (age 3): Lists Transitions- Services (HUH) utcome s Tab 2 (age 7): Lists Transitions- Services (HUH) rocess s Tab 3 (age 11): Lists Transitions- Services (HUH) HIV utcome s (Ryan White art A funded programs) Tab 4 (age 15): Lists Transitions- Services (HUH) HIV rocess s (Ryan White art A funded programs) Standard rogram s are listed under the "s" column and the applicable service categories and modalities for each one are indicated. For each objective, a column describes the following: a) client inclusion criteria, b) source of data to measure the objective, c) measurement period, and d) additional notes for consideration. Unique program objectives are indicated by program name and are shaded to make identification easier. Revision Date: 7/1/16 age 2 of 17
Transitions- Services (HUH) utcome s Service Adult Day Health Services (ADH), Residential Care,, roperty perating Subsidy, Rental Subsidy Adult Day Health Services, Residential Care, Support Services, Third arty Rent ayment, s (Superscripts refer to corresponding number in the notes column) 90% 1 of residents will retain their housing for more than one year. 75% 1 of residents who have an individualized service plan will accomplish one or more goals. housed for 12 months or more; ADH: All clients in Direct Access to (DAH)/ADH housed for 12 months or more ADH: in DAH/ADH for 6 months or more; Third arty Rent ayment: All clients in DAH/Third arty Rent ayment for 6 months or more; All other modalities: All residents housed for 6 months or more (Compliance / rogram eriod 1) Variable rate based on program size. Variable rates will be documented in contracts. 1) Variable rate based on program size. Variable rates will be documented in contracts. 2) A sample of 10 randomly selected charts will be reviewed during monitoring. Revision Date: 7/1/16 age 3 of 17
Transitions- Services (HUH) utcome s Service s (Superscripts refer to corresponding number in the notes column) (Compliance / rogram eriod Adult Day Health Services, Residential Care, Support Services,, Rental Subsidy, perating Subsidy, roperty Management 75% 1 of residents who exit housing will secure housing 2 appropriate to their needs (e.g., independent/unsubsidized housing, move-in with family or friends, transition to level of care appropriate for their needs, etc.). who exit housing; clients who pass away are excluded; ADH: All clients in DAH/ADH who exit housing; clients who pass away are excluded 1) Variable rate based on program size. Variable rates will be documented in contracts. 2) The discharge plan indicates what type of housing client will transition to. Residential Care, 100% of residents housed for at least six months will have maximized their income and benefits for which they are eligible, or are in the application process. housed for 6 months or more roperty, perating Subsidy, Rental Subsidy 90% of inspected units will be in compliance with health and safety standards at the time of monitoring. All inspected units roperty management Revision Date: 7/1/16 age 4 of 17
Transitions- Services (HUH) utcome s Service Residential Care, roperty perating Subsidy, Rental Subsidy s (Superscripts refer to corresponding number in the notes column) At least 90% 1 of residents will not have a hospital admission during the contract year. 85% 1 of resident lease violations will be resolved without loss of housing to tenants. All residential care clients (Compliance / rogram BHS/BIS Database or agency client files/ DAH Lease Violation Form, eriod 1) Variable rate based on program size. Variable rates will be documented in contracts. 1) Variable rate based on program size. Variable rates will be documented in contracts. Third arty Rent ayment 90% of clients who complete an intake will retain services. who complete an intake Revision Date: 7/1/16 age 5 of 17
Transitions- Services (HUH) utcome s Service s (Superscripts refer to corresponding number in the notes column) (Compliance / rogram eriod rimary Care Curry Senior Center will retain at least 90% of clients in primary care through home or clinic visits. DAH residents at Civic Center Residence and West Hotel. BHS Database, or agency client files/ This objective is applicable to Curry Senior Center (BHS) contract (HUH appendix) only. 80% of Autumn Glow residents will show decreased signs of decline as a result of participating in daily exercises and activities, as measured by the Activities of Daily Living (ADL) assessment. All residents This objective is applicable to Self-Help for the Elderly/Autumn Glow only. 70% of Autumn Glow residents will be able to maintain overall cognitive functioning, as measured by the results of the Standardized Memory Test twice per year. All residents files/; baseline at entry and follow up ADL assessments This objective is applicable to Self-Help for the Elderly/Autumn Glow only. 100% of Autumn Glow residents who are clinically assessed as required for more intensive level of care will be referred to an appropriate higher medical care program as measured by the quarterly assessment and recommendation by the primary physicians. All residents This objective is applicable to Self-Help for the Elderly/Autumn Glow only. Revision Date: 7/1/16 age 6 of 17
Transitions- Services (HUH) rocess s Service s (Superscripts refer to corresponding number in the notes column) (Compliance/rogram eriod Adult Day Health Services, Support Services, Services staff will actively outreach 1 to 95% of residents once every 30 days. All DAH clients; ADH: All DAH/ADH clients 1) Actively outreach is personto-person contact. Adult Day Health Services, Residential Care, Third arty Rent ayment, 100% of residents will have an individualized service plan in place within 90 days of service enrollment. For ADH: 100% of clients will have an individualized service plan no later than 30 days after admission. All DAH clients; ADH: All DAH/ADH clients; Support Services and : engaged in services Adult Day Health Services 50% of DAH residents who participate in adult day health services will participate in weekly groups. All DAH/ADH clients Adult Day Health Services, Residential Care, 80% of individualized service plans will be updated at least once every six (6) months. For Residential Care: 100% of clients plans will be updated every three months or more frequently as the resident's condition warrants. All DAH clients engaged in services; ADH: All DAH/ADH clients Revision Date: 7/1/16 age 7 of 17
Transitions- Services (HUH) rocess s Service s (Superscripts refer to corresponding number in the notes column) (Compliance/rogram eriod Residential Care, 100% of residents will be assessed for benefits within 30 days of move in. Agency client 100% of residents will be assessed for primary medical care needs within 90 days of move-in. 100% of residents will be assessed for mental health and substance use treatment needs within 90 days of move-in. roperty, perating Subsidy, Rental Subsidy 100% of units will be inspected annually. All units roperty management files or Residential Care, 100% of residents who have jeopardized their housing due to program rule and/or lease violations will be offered support services at least once per incident. who receive program rule and/or lease violations Revision Date: 7/1/16 age 8 of 17
Transitions- Services (HUH) rocess s Service s (Superscripts refer to corresponding number in the notes column) (Compliance/rogram eriod Third arty Rent ayment 80% of clients budget service plans All Third arty will be updated at least once annually. ayment clients Financial lan Updated report and clients budget service plans Third arty Rent ayment 95% of clients will be scheduled for intake within three business days of referral. who receive a referral Agency Third arty Rent ayment The third party rent payment provider will send monthly reports to property management that detail tenant income changes. N/A Agency roperty perating Subsidy,, Rental Subsidy roperty Management will collect at least 90% of monthly rent 1 from occupied units. Disclaimer: Rent is not collected for occupied units undergoing an eviction process. as demonstrated in random months Agency 1) The monthly rent will exclude rent owed as a result of evictions. 100% of residents with planned exit from program will have a comprehensive discharge plan 1 that includes referrals for, but not limited to, case management, housing, food, clothing, medical treatment, detox, and other services as necessary and appropriate. with planned exit and agency has at least two weeks notice from the client of their exit date. Agency 1) Discharge plan may have different names at different agencies, e.g. Case lan. Revision Date: 7/1/16 age 9 of 17
Transitions- Services (HUH) rocess s Service rimary Care rimary Care s (Superscripts refer to corresponding number in the notes column) Curry Senior Center will serve up to 50 unduplicated residents. Curry Senior Center will provide 300 rimary Care Face to Face Encounters. DAH residents at Civic Center Residence and West Hotel. DAH residents at Civic Center Residence and West Hotel. (Compliance/rogram eriod This objective is applicable to Curry Senior Center (BHS) contract (HUH appendix) only. This objective is applicable to Curry Senior Center (BHS) contract (HUH appendix) only. 100% of Autumn Glow residents will have an individualized service plan/care plan no later than 30 days after admission. All residents This objective is applicable to Self-Help for the Elderly/Autumn Glow only. 100% of Autumn Glow residents' individualized service plans/care plans will be updated every three months or more frequently as the resident's condition warrants. All residents This objective is applicable to Self-Help for the Elderly/Autumn Glow only. Revision Date: 7/1/16 age 10 of 17
Transitions- Services (HUH) HIV utcome s (Ryan White art A funded programs) Service Categories Emergency Facility Based Care Services HIV Rental Subsidy HIV HIV Transitional Residential MH & Residential SU Tx s (Superscripts refer to corresponding number in the notes column) (Compliance/ rogram eriod Facility Based Care Services 90% of residents 1 will demonstrate improved physical and psychosocial status 2 within 30 days of intake.. Contract Year 1)This objective is specific to Larkin Street Youth Services and does not apply to other programs. 2) Improved physical and psychosocial status is measured by increased participation in health care services and increased participation in mental health and/or substance abuse services (includes groups, individuals, meeting with nurse providers). Facility Based Care Services Less than 10% of residents will need to be transferred to a higher level of care in order to meet their needs. files (physical or electronic files) 1) ercentage can be variable. rograms should email their CDTA program manager to discuss variable percentage rate. Variable percentage rates will be documented in contracts. Revision Date: 7/1/16 age 11 of 17
Transitions- Services (HUH) HIV utcome s (Ryan White art A funded programs) Service Categories Emergency Facility Based Care Services HIV Rental Subsidy HIV HIV Transitional Residential MH & Residential SU Tx Emergency s (Superscripts refer to corresponding number in the notes column) 90% of clients will meet with the Stabilization rogram Coordinator (SC) at least once a week. (Compliance/ rogram. eriod Emergency 80% of service providers who respond to an anonymous client satisfaction survey will indicate that they are either satisfied or very satisfied with program services. All service providers Analysis of provider satisfaction survey HIV Support Services, Medical Case Management 90% of residents will retain their housing by the end of the contract year. housed at beginning of contract year. 1) ercentage can be variable. rograms should email their CDTA program manager to discuss variable percentage rate. Variable percentage rates will be documented in contracts. Revision Date: 7/1/16 age 12 of 17
Transitions- Services (HUH) HIV utcome s (Ryan White art A funded programs) Service Categories Emergency Facility Based Care Services HIV Rental Subsidy HIV HIV Transitional Residential MH & Residential SU Tx s (Superscripts refer to corresponding number in the notes column) (Compliance/ rogram eriod Residential 80% 1 of clients who participate Treatment, HIV in services will accomplish at Support least one goal established in Services, their individualized services Medical Case plan. Management All HIV support services & medical case management clients; all clients for Residential Treatment 1) ercentage can be variable. rograms should email their CDTA program manager to discuss variable percentage rate. Variable percentage rates will be documented in contracts. 2) A sample of randomly selected charts will be reviewed during monitoring. HIV Rental Subsidy, HIV Support Services, Medical Case Residential Treatment 75% 1 of clients who exit housing will secure housing 2 appropriate to their needs (e.g., independent/unsubsidized housing, move-in with family or friends, transition to level of care appropriate for their needs, etc.).. 1) ercentage can be variable. rograms should email their CDTA program manager to discuss variable percentage rate. Variable percentage rates will be documented in contracts. 2) The discharge plan indicates what type of housing client will transition to. Revision Date: 7/1/16 age 13 of 17
Transitions- Services (HUH) HIV utcome s (Ryan White art A funded programs) Service Categories Emergency Facility Based Care Services HIV Rental Subsidy HIV HIV Transitional Residential MH & Residential SU Tx s (Superscripts refer to corresponding number in the notes column) (Compliance/ rogram eriod HIV Support Services, Medical Case Management 75% 1&2 of all referrals for primary care, mental health and/or substance use services will be linked to those services. All HIV support services & medical case management clients referred to services, including ARIES. 1) ercentage can be variable. rograms should email their CDTA program manager to discuss variable percentage rate. Variable percentage rates will be documented in contracts. 2) ercentage rate for nonresidential programs is 50%. HIV Support Services, Medical Case Management 100% 1 of clients housed for at least six months will have maximized their income and benefits for which they are eligible, or are in the application process. housed for 6 months or more. 1) ercentage can be variable. rograms should email their CDTA program manager to discuss variable percentage rate. Variable percentage rates will be documented in contracts. Revision Date: 7/1/16 age 14 of 17
Transitions- Services (HUH) HIV rocess s (Ryan White art A funded programs) Service Categories Emergency Facility Based Care Services HIV Rental Subsidy HIV HIV Transitional Residential MH & Residential SU Treatment s (Superscripts refer to corresponding number in the notes column) (Compliance/ rogram eriod Facility Based Care Services 100% of clients will be assessed annually for dementia and other cognitive impairment by use of Mini- Cog Test. files and Activity Summary log is applicable only depending on client population. (N/A Larkin Street Youth Services programs) Facility Based Care Services Emergency 95% of new clients will be evaluated for counseling, longrange planning and/or end-of-life care needs. The SC will schedule and facilitate quarterly meetings with all referring agencies. All new clients All referring agencies. Meeting minutes or sign-in sheets N/A Larkin Street Youth Services programs Emergency rogram will maintain 90% utilization of stabilization rooms. Agency report Emergency The SC will confirm that 100% of clients have an individualized service plan in place at referral.. Revision Date: 7/1/16 age 15 of 17
Transitions- Services (HUH) HIV rocess s (Ryan White art A funded programs) Service Categories Emergency Facility Based Care Services HIV Rental Subsidy HIV HIV Transitional Residential MH & Residential SU Treatment Medical Case Management s (Superscripts refer to corresponding number in the notes column) 90% of clients will access primary care services at least once during the contract year. All medical case management clients who have been retained in services for at least 60 days. (Compliance/ rogram, including ARIES. eriod 1) ercentage can be variable. rograms should email their CDTA program manager to discuss variable percentage rate. Variable percentage rates will be documented in contracts. HIV Support Services, Medical Case Residential Treatment 100% of new clients will have a individualized service plan in place within 30 days of initial assessment. All HIV support services & medical case management clients; all clients for Residential Treatment. HIV Support Services, Medical Case Management 80% of individualized service plans will be updated at least every six (6) months. housed for 6 months or more. HIV Support Services, Medical Case Management 100% of clients will be assessed for benefits within 30 days of service enrollment. All HIV support services & medical case management clients. Revision Date: 7/1/16 age 16 of 17
Transitions- Services (HUH) HIV rocess s (Ryan White art A funded programs) Service Categories Emergency Facility Based Care Services HIV Rental Subsidy HIV HIV Transitional Residential MH & Residential SU Treatment s (Superscripts refer to corresponding number in the notes column) (Compliance/ rogram eriod HIV Support Services, Medical Case Residential Treatment 100% of clients will be assessed at least once a year for primary medical care and medical case management service needs. All HIV support services & medical case management clients; all clients for Residential Treatment. HIV Support Services, Medical Case Residential Treatment 100% of clients will be assessed for mental health and substance use treatment needs at least once per year. All HIV support services & medical case management clients; all clients for Residential Treatment. HIV Rental Subsidy 100% of subsidy recipients will have their Eligibilty recertified at least annually.. Revision Date: 7/1/16 age 17 of 17