Homeless Services, Healthcare, and Criminal Alicia Lehmer, HomeBase Joni Canada, HomeBase Brooke Page, Clark County Social Services Tauri Royce, BitFocus, Inc.
Learning Objectives HomeBase Attendees will leave this session with an understanding of : Strategies for overcoming barriers and leveraging opportunities for cross-systems data sharing The ways in which CoCs have taken innovative yet practical steps to facilitate data sharing across homeless, health, and criminal justice systems serving individuals experiencing homelessness Southern Nevada s multi-faceted approach to cross-systems data sharing through local projects including Clark County FUSE, Healthy Living Program, and Hospital to Home.
Plan for the Session HomeBase Why Pursue Cross System Data Sharing? Barriers to Sharing Privacy Concerns Legal Restrictions Technology and/or Capacity Limitations Making it Work: Southern Nevada s multi-faceted approach to crosssystems data sharing through local projects Clark County FUSE Healthy Living Program Hospital to Home.
HomeBase Why Pursue Cross-System Data Sharing? Matched/shared data can help: Identify people who frequently use multiple services/systems and target appropriate housing and social service interventions; Improve collaboration and coordination of housing, health care, and supportive services for individuals with health conditions or criminal justice involvement who are experiencing homelessness; Facilitate better understanding of system-level operations, effectiveness, and efficiency of current resources in addressing the comprehensive needs of individuals experiencing homelessness; and Engage in data-driven decision-making around service provision at both the provider- and system-level.
Privacy Concerns HomeBase Addressing misconceptions: Generally, privacy laws......prevent the sharing of data across systems of care Privacy laws establish a framework for the sharing and integration of data across systems of care....only apply to healthcare data Privacy law is about more than just HIPAA. HMIS and other system administrators should be mindful of privacy laws and regulations even if they only store basic client data.
Other Barriers to Data Sharing HomeBase Incompatible data systems: Hospitals, behavioral health providers, health centers, jails, and criminal justice systems often cannot easily share data due to technological and/or legal concerns, which is one of the basic necessities to partnership. No tracking of housing status: Housing status is not often tracked in the criminal justice system, and few hospitals and health care systems use ICD codes to track housing status, making it difficult to easily identify individuals experiencing homelessness within the system. Lack of capacity or resources: Too few staff with capacity or training to participate in data-sharing; lack of technology or data system needs; financial concerns or constraints. Difficulty getting started: Even those interested in cross-system data sharing are unsure how to begin the conversation.
Overcoming Barriers to Data Sharing HomeBase
Obtain Notice and Consent HomeBase Notice: Description of how personal information is collected, stored, used, and disclosed Consent: Client s agreement to the use and disclosure of their personally identifying information (PII) not already described in the privacy notice Also referred to as Release of Information ( ROI ) An ROI is needed to allow agencies to share the information that they have collected. It helps overcome barriers created by other data privacy rules by granting permission to share data with other agencies.
HomeBase Notice and Consent Drafting Tips Plain English: Client ROIs should minimize jargon and clearly explain both how and why personal information is collected, stored, used, and shared. It will require a signature and must allow the client the option to decline. Establish Consistency: The data sharing language in an ROI should be consistent across all providers involved in collaboration. Demonstrate Value: Outline the benefits of participation, as well as the consequences of non-participation. Lay the Foundation for Collaboration: Collaborate with other systems of care to develop a common framework for sharing and collaboration.
Data Mapping HomeBase Invest in data mapping: Investments in data mapping (i.e., diagramming out data sources, types, flows, and conditions) during early stages will save both time and resources, and help clarify data needs and sharing parameters. Example: The Louisiana Public Health Institute Using health information technology to improve care coordination and access to services across sectors for those with severe and persistent mental illness. Worked with partners in their community to map out current data sources, types, and current flow, and then layered in the changes desired for their program. Identification of what is necessary at systems level expedited the data sharing agreement process.
Generating Buy-In HomeBase Start early to generate buy-in for data sharing agreements. Developing legal agreements is a complicated process that can take months or years. Project leadership should ensure broad conceptual support from key community leaders, stakeholders and lawyers early in the process, then work diligently to negotiate the specifics. Example: Baltimore City Health Department Creating a real-time data surveillance system to track fall-related emergency department visits and hospitalizations. Worked closely with executive leadership, including the City Solicitor, attorneys, and the Health Commissioner, to obtain their buy-in. Collaboratively mapped a tiered legal framework for data sharing that outlines different legal strategies based on specific applications of data from public health surveillance activities to sharing protected health information.
Build Organizational and Collaborative Data Knowledge HomeBase Building data knowledge consists of ongoing training and education within the organization or collaborative, at all levels. Executive Level: This may be training on setting strategic goals or determining what data are needed to support a particular project. Administrative Level: Training may include understanding what data should be input into the system and how it needs to be entered. Develop a Common Language: Among people (as well as technology) to avoid miscommunication, poor data collection techniques, and invalid or erroneous data entries, leading to better data analysis and higher quality data.
HomeBase Memorandums of Understanding (MOUs) Data-sharing agreements such as memorandums of understanding (MOUs), combined with solid relationships, minimize the risks and fears associated with data-sharing. An MOU is: A renewable agreement that is entered into for a set period of time and formalizes and supports the partnership by outlining the key responsibilities and expectations of all partners. An operating document that explicitly sets the expectation for all of the partners related to training, screening, patient, clinic, and population health interventions. These agreements protect the agency providing data by helping to reduce potential misuse or misunderstanding between data sharing partners. ***Consider hiring an outside attorney who specializes in these types of contracts to help finalize data-sharing agreements.****
HomeBase Memorandums of Understanding (MOUs) A data-sharing agreements or MOUs should address the following concerns: Period of agreement: When the provider will give the data to the receiver and how long the receiver will be able to use the data. Intended use of the data: How the receiver will use the data. Constraints on the use of the data: Any restrictions on how the data or data findings can be used. Data confidentiality: The required processes the receiver must use to ensure the data remain confidential. Data security: The methods the receiver must use to maintain data security. Methods of data-sharing: The way in which data will be transferred from the provider to the receiver. Financial costs of data-sharing: Clarify who will cover the monetary costs of sharing data.
Data-Sharing Assistance & Resources: Health HomeBase All in: Data for Community Health is a national network dedicated to building the capacity of local collaborations to capture, integrate and use data to address social determinants of health. Data Across Sectors for Health (DASH) aims to identify barriers, opportunities, promising practices and indicators of progress for multi-sector collaborations to connect information systems and share data for community health improvement. The Network for Public Health Law has developed information resources on health information data sharing and offers technical assistance
Cross-Systems Data Sharing in Southern Nevada
Homeless Services, Healthcare, and Criminal Tauri Royce Southern Nevada s Healthy Living About: 2012 Bonus Continuum of Care 61 Bed Permanent Supportive Housing Program Chronically Homeless and Medically Fragile: A chronic physical or behavioral health condition which results in a prolonged dependency on medical care for which Home Health/ Physician visit interventions or behavioral health care treatment is medically necessary. Services: Intensive case management Permanent supportive housing Recuperative Care Case Management Educational Services Job Training Transportation SOAR Process Outreach Child Care Employment Readiness Access to counseling and treatment Mainstream Benefits Access to Health Benefits
Case Management Activities: 1. Outreach 2. Transporting Clients 3. Frequent Contact 4. Appointment Management 5. Supportive Services Medical Care Case Management Behavior Management Behavior Management Activities: 1. Substance Abuse Treatment 2. Life Skills Training 3. Mental Health Counseling Medical Care Activities: 1. Primary Care ID 2. Follow-Up Appointments 3. Medication Monitoring 4. Skilled Nursing Care 5. Wraparound outpatient Medical services. Employment Service Activities: 1. Job Training 2. Job Searches 3. Resume Building Employment Services Housing Data Management LONG-TERM OUTCOMES Serve 30 chronically homeless/ medically fragile families to include 41 individuals 95% from the street 5% from emergency shelter. 25 individuals will maintain or increase income levels 11 individuals will ensure mental health treatment 7 individuals will ensure substance abuse treatment compliance Data Management Activities: 1. Reporting 2. Tracking 3. Invoicing Housing Activities: 1. Moving Assistance 2. Furnishings 3. Utility Assistance 4. Life Skills Training MISSION STATEMENT Serve chronically homeless medically fragile individuals, from local area hospitals, using a Housing First Harm Reduction philosophy, with permanent supportive housing and medical care management in order to transition them to self-sufficiency.
Tauri Royce Southern Nevada Healthy Living Humble Beginnings: 2013 Initial discussions and demonstrations took place between our local University Medical Center (UMC), CoC Leadership, and HMIS Administrator, Bitfocus. Main topics of concern included: HIPAA compliance Staff capacity What are the benefits? These dialogues led to invitations within the medical community for Bitfocus to speak about the benefits of collaboration for case management, care coordination, and discharge planning.
Tauri Royce Southern Nevada s Healthy Living Expansion: 2014-2016 2014 Partnership Development, MOUs/DUAs Signed, Contract Services 2015 Training, Onboarding, Initial Client enrollment; UMCs integration into HMIS 2016 Partnership Expansion to MCOs United Health Care and Anthem 2017 Healthy Living Reaches Capacity and Hospital to Home Partnership Evolves 2014 2015 2016 2017 2018
Southern Nevada Healthy Living The Process Today - Assessment Tauri Royce Southern Nevada currently has 6 participating organizations (hospital or MCO) who are completing the preliminary assessment within HMIS to determine client eligibility and capture pertinent information about the unique situation. The assessment contains 15-20 questions, depending on the client circumstances. Location and contact information (room #, phone, etc..) Length of stay in hospital and projected discharge date Social worker name and contact information Current function, ambulation, and transfer status (alert, wheelchair bound, transfers with equipment, etc ) Primary language Medicaid details Initial confirmation of chronically homeless AND medically fragile status
Southern Nevada Healthy Living The Process Today - Referral Tauri Royce If the assessment determines that the client appears to be chronically homeless and medically fragile, an electronic referral is made to either the Healthy Living or the Hospital to Home project.
Southern Nevada Healthy Living The Process Today Referral cont.. Tauri Royce Referral notification is provided within HMIS and also delivered via email to assigned staff. Immediately upon receipt of the referral, project staff are deployed to the hospital (within 24 hours) to meet with the client, perform a full coordinated entry assessment, and confirm project eligibility.
Southern Nevada Healthy Living The Process Today - Discharge At discharge, the client is transported directly into permanent housing with continued medical care. WIN! Tauri Royce
Homeless Services, Healthcare, and Criminal Brooke Page Southern Nevada s ClarkCountyFUSE The Grant About: 2014 Bonus Continuum of Care Permanent Supportive Housing Program 104 beds Chronically Homeless and Frequent User of Crisis Services: are individuals who frequent high cost systems such as emergency rooms, jails, shelters, clinics, and other costly crisis service systems as defined by the partnering agency. Services: Intensive case management Permanent supportive housing Recuperative Care Case Management Educational Services Job Training Transportation SOAR Process Outreach Child Care Employment Readiness Access to counseling and treatment Mainstream Benefits Access to Health Benefits
Case Management Activities: 1. Outreach 2. Transporting Clients 3. Frequent Contact 4. Appointment Management 5. Supportive Services Medical Care Case Management Behavior Management Behavior Management Activities: 1. Substance Abuse Treatment 2. Life Skills Training 3. Mental Health Counseling Medical Care Activities: 1. Primary Care ID 2. Follow-Up Appointments 3. Medication Monitoring 4. Skilled Nursing Care 5. Wraparound outpatient Medical services. Employment Service Activities: 1. Job Training 2. Job Searches 3. Resume Building Employment Services Housing Data Management LONG-TERM OUTCOMES Serve 93 chronically homeless/ frequent user households or 104 individuals. Referrals crisis systems such as jails, emergency rooms. 37 individuals will maintain or increase income levels 16 individuals will ensure mental health treatment 10 individuals will ensure substance abuse treatment compliance Data Management Activities: 1. Reporting 2. Tracking 3. Invoicing Housing Activities: 1. Moving Assistance 2. Furnishings 3. Utility Assistance 4. Life Skills Training MISSION STATEMENT Serve chronically homeless frequent users of crisis services using a Housing First Harm Reduction philosophy, with permanent supportive housing and intensive supportive services in order to transition them to self-sufficiency.
Homeless Services, Healthcare, and Criminal Brooke Page Southern Nevada s ClarkCountyFUSE The Reason for Data Integration
Identified an Issue Brooke Page Southern Nevada s ClarkCountyFUSE The Process Developed a Program Design Defined Frequent User Researched Solutions Applied for Technical Assistance Designed a Tracking Mechanism Conducted a Needs Assessment Secured a Base of Stakeholders Developed Agreements
Southern Nevada s ClarkCountyFUSE The Matching Process Brooke Page
Southern Nevada s ClarkCountyFUSE The Matching Process Brooke Page
Southern Nevada s ClarkCountyFUSE The Matching Process Brooke Page
Southern Nevada s ClarkCountyFUSE The Partners Brooke Page Criminal Homeless Medical MediCaid Fire & Rescue
Next Steps & Lessons Learned Expand the base of Stakeholders Elected Officials Budget/ Finance Dept. Heads Court System Other Jurisdictions Continue to Educate Jail has had a constant change in leadership Execute Agreements Pay for Success Feasibility Analysis Brooke Page Engage General Counsel as Early as Possible Obtain an Elected Official Champion to Lead the Charge Ensure Regular Communication Throughout the Process Identify Subject Matter Expert Committees Dedicated Staff