HomeMy WebLinkAboutstrategic-plan-2019-21STRATEGIC PLAN
2019-2021
Alameda County
Health Care for
the Homeless
~~Alameda County
\~11 Health ure servites Aeen.:y
www.achch.org
Table of Contents
1. Who We Are and What We Do 03
2. Executive Summary 04
3. Strategic Planning Process 07
4. Themes from Our Research 08
5. Development of Strategic Priorities and Goals 10
6. ACHCH Strategic Priorities 2019-2021 11
a. Strategic Priority 1: Health Center Compliance 12
b. Strategic Priority 2: Health Center Needs and Resources Coordination 13
c. Strategic Priority 3: Community Awareness and Marketing 14
d. Strategic Priority 4: Clinical Care 15
e. Strategic Priority 5: Data and Integrated Technology 18
f. Strategic Priority 6: Leadership and Advocacy 19
7. Acknowledgments 20
8. Appendices
1. Strategic Planning Timeline 21
2. Program Activities Visual 22
3. Scope Decision Rubric 23
4. Comparative Analysis Results 24
5. Stakeholder Input and Survey Results 25
02
WHO WEARE WHAT WE DO
Alameda County Health Care for the Homeless is a
federally funded network of providers working to
improve the health of people experiencing
homelessness throughout Alameda County. The ACHCH
network includes a variety of medical practitioners,
social workers, outreach workers, and support staff who
provide no-cost, patient-centered care across nine
organizations at eighteen different locations, as well as in
encampments and on the streets. ACHCH is a program
of the Alameda County Health Care Services Agency and
is an active member of the National Health Care for the
Homeless Council. Operations are overseen by the
ACHCH Commission, the County of Alameda, and the
ACHCH Community Consumer Advisory Board.
-----.::
1 ACHCH operates under the U.S. Health Resources and Services Administration's definition of homelessness.
Please visit the following link for more information: https://www.nhchc.org/faq/official-definition-homelessness/
2 Alameda County Health Care for the Homeless Health Care Needs Assessment of Persons Experiencing
Homelessness in Alameda County. (2015). Retrieved
from https:/ /www .achch.org/u ploads/7 /2/5/4/7254 7769/achch p_homeless_health_ ca re_needs_assessment_201
4-2015.pdf
03
ACHCH provides a network of whole-person health care
services to meet the medical needs of the roughly
23,000 residents experiencing homelessness in Alameda
County annuallyY We provide access to primary care
homes, field-based health care, mental health
treatment, substance use treatment, dental care,
optometry, specialty care, and medical case
management throughout Alameda County. The ACHCH
network provided 41,280 health care visits serving 7,450
people experiencing homelessness in 2017.
EXECUTIVE SUMMARY
Alameda County Health Care for the Homeless has been a federally funded and county health
department-based network of providers since 1988. ACHCH is nationally recognized for providing
patient-centered mobile and clinic-based homeless health care services. In 30 years, the ACHCH
network has served 138,000 persons experiencing homelessness with the goal of increasing access
to health services and improving health outcomes. Our network provides a range of urgent,
primary, specialty, and enabling care services, as well as linkage to critical supports in other safety
net sectors.
In November 2017, ACHCH began a year-long strategic planning process to clarify the
organization's mission, role, and scope in the context of a rapidly changing landscape of
homelessness in Alameda County. An affordable housing crisis with an associated increase in the
number of people experiencing homelessness has significant implications for the health service
delivery model. Our strategic planning process focused on strengthening our ability to respond
most effectively to these challenges through community input, best practice research, and internal
evaluation. Affirming the program's future direction ensures that ACHCH continues to achieve its
core mission of ensuring access to health services and improving the health outcomes of Alameda
County's homeless population.
Our approach included three phases beginning with a comparative analysis of five similarly
structured Health Care for the Homeless programs. The goal of this analysis was to determine the
roles and functions of exemplary HCH programs in their communities, as well as to gather best
practices in the use of HCH resources. The second phase was comprised of a survey of key
stakeholders within Alameda County. Patients, staff, community provider organizations, and
county leaders across safety net sectors were interviewed and surveyed as a forum to evaluate the
community's perception of ACHCH's strengths and weaknesses, as well as to identify opportunities
for improvement and development. Finally, we developed strategic priorities and goals informed
by common themes identified in our research.
04
EXECUTIVE SUMMARY
The resulting six strategic priorities encompass both community input and consideration of
ACHCH's mission, capacity, and operational environment.
Health Center Compliance
~l e Improve statutory compliance, contracting, sub-recipient management, and effectiveness of ACHCH's \.:!:.,) quality improvement program
~ Result-High quality, culturally aware services across the ACHCH network sites
Health Center Needs and Resources Coordination
e Strengthen the functioning of governing and consumer advisory boards
~ Result -Increased ability of the boards to inform program strategies and planning, as well as to
articulate community needs
e Increase non-HRSA grant funding for health network services
~ Result-Decreased service gaps that exist for more vulnerable homeless sub-populations in the
county
Community Awareness and Marketing
®
e Clearly communicate health center service offerings and referral/request pathways
~ Result -Increased community awareness of the program and its service offerings
e Distribute timely, homeless-specific health information and resources
~ Result -Increased community awareness of emerging issues in the homeless community and
resources
Clinical Care
e Develop and implement consistent best practices for the coordination of outreach, portable services,
and primary care
~ Result -Increased low-barrier access to health care services for individuals experiencing
homelessness
e Develop a shelter health function and partner to increase medical respite capacity, dental care, and
optometry for individuals experiencing homelessness
~ Result -Increased access to primary care, specialty care, and medical respite for individuals
experiencing homelessness
Data and Integrated Technology
e Develop ACHCH's internal data warehouse and analysis capacity
® ~ Result -Increased program ability to inform the larger system on emergent issues in the
homeless community and services system
e Implement a modern EMR for ACHCH's directly operated services
05
~ Result -Increased integration with county-wide data sharing efforts and increased capacity to
bill for direct services
EXECUTIVE SUMMARY
Leadership and Advocacy
®
e Increase ACHCH representation and subject matter expertise in county decision making processes
~ Result -Increased program ability to inform and influence planning and policy decisions around
services for homeless individuals, families, children, and other sub-populations
e Establish a training and education function
~ Result-ACHCH can share best practices and improve the use of evidence-based practices in the
county's homeless services system
ACHCH's strategic priorities focus on administration, operations, ACHCH network services, and
system-wide leadership. Our goals include increasing the effectiveness and reach of the program's
services, as well as sharing best practices learned over years of operation. Additionally, we aim to
improve the county's homeless services system through leadership, training, and education. Our
strategic plan positions ACHCH to respond to growing challenges in the community and continue
our legacy of improving access to care and the health outcomes of our friends, family, and
neighbors experiencing homelessness.
'I . . . ._ __ .. -:
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ALAMEDA
Our Strategic Planning Process
Comparative Analysis
Our process began with an analysis of similarly structured and
exemplary Health Care for the Homeless programs in
California and Washington State. Representatives from each
organization were interviewed with questions focused on
determining the role and functions the most effective HCH
programs play in their communities and to gather best
practices in the use of HCH resources. We sought programs
that were similar in context using four criteria: programs that
are county-operated, serve large urban areas, manage
partnerships with either county health departments or grant
sub-recipients to provide clinical services, and are viewed as
exceptional programs in the homeless services community.
Contra Costa, San Mateo, Santa Clara, Santa Barbara counties
in California, and King County in Washington were the
programs selected.
Stakeholder Input
The second phase of our process was comprised of interviews
and a survey of key stakeholders within Alameda County. This
phase functioned both as a needs, gaps, and strengths
assessment, as well as an evaluation of the community's
awareness and perception of the program.
Department leads across safety net sectors, community-based
organizations, staff, and patients provided stakeholder input.
The directors of the county's Health Care Services Agency,
Public Health Department, Housing and Community
Development, Behavioral Health Care Services Housing
Services Office, and the director of the City of Oakland's
Health and Human Services Department represented
leadership. Participating community-based organizations
included Bay Area Community Services and Tri-City Health.
Additionally, 114 patients completed a survey to determine
the services which are most important to them.
07
HARD WHEAT
Flour
Themes from Our Research
Comparative Analysis
Analysis of other HCH programs provided an understanding of
the functions they prioritize in their communities. Although a
wide range of activities were mentioned, the programs
interviewed all identified the same four functions as the most
important in their roles as health care providers in their
respective counties (in ranked order):
1. Providing portable and site-based health care services
2. Facilitating access to and engagement in primary care
3. Funding for needed services and augmentations to
clinics to increase the effectiveness of engagement and
treatment for homeless patients
4. Training and education for the county's larger health
system
Additionally, our colleagues provided valuable information
about the integration of their governing boards, how priorities
are determined, and their specific relationship to housing
efforts in their counties. 4
Stakeholder Input
Themes most commonly identified by Alameda County
leadership and providers included both program strengths
and challenges. 5
The three most commonly perceived program strengths were
(in ranked order):
1. Portable Health Services-ACHCH mobile medical clinic
and street medicine and psychiatry programs were seen
as distinct and needed services utilizing effective
approaches to outreach and engagement
2. Convening and Coordinating Function -ACHCH's
positioning, power, and skill in convening different
system sectors and provider agencies towards better
coordination and collaboration were identified as a
significant program strength
4 Please see Appendix #4 for a full report of comparative analysis results
5 Please see Appendix #5 for a full report of stakeholder input
08
3. Program Leadership ACHCH's current
leadership's skill in implementing innovations and
facilitating collaboration between providers was
recognized as a substantial program strength
The three most commonly identified opportunities for
program improvement were (in ranked order):
1. Program Identity and Community Awareness-A
majority of participants highlighted the
community's lack of knowledge and awareness of
ACHCH including the program's identity, primary
focus, services, and access points. Stakeholders
indicated that improvement in these areas would
increase ACHCH's impact and influence in the
county
2. Contracting and Sub-Recipient Strategies -
Stakeholders felt that an improvement in
contracting and MOU relationships could reduce
geographical and target population gaps, as well
as increase ACHCH's influence on partner
agency's practices and performance
3. Outreach Function Utilization-Participants also
suggested that a more cohesive, efficient model
could improve ACHCH's medical outreach and
portable care activities and that the program
could increase its reach and visibility at important
homeless touchpoints
114 patients participated in our patient survey. We asked patients what services or supports were
most important to them for accessing needed health services.6
The following were our patients' four highest priorities (in ranked order):
1. Dental and eye care
2. Better information and resources
3. More portable health care and outreach services in encampments and on the streets
4. Transportation to care
6 Please see Appendix #5 for a full report of patient survey results
09
Development
of Strategic Priorities and Goals
Program leadership developed strategic priorities and goals during regular meetings taking place
over a period of three months. Data gathered from our comparative analysis, along with themes
identified in stakeholder and patient feedback helped to identify areas where the program could
capitalize on its strengths and pursue opportunities for improvement. Current county initiatives,
program capacity, gaps identified by stakeholders, and relevant homeless data were also
considered to align our goals with the community's needs and to ensure relevance to the current
landscape of homeless services in the county. Goals and strategies developed were specific and
measurable to ensure our ability to evaluate progress and achieve success.
The result is a comprehensive and ambitious strategic plan relevant to both ACHCH's internal
operations and to the needs of our community. Our plan guides quality improvement, program
operations, and program development over the next three years.
10
VISION
We envision a just society where all persons
have access to quality health care and
housing. We believe the problems of
homelessness and health inequities can be
solved
MISSION
The mission of Alameda County Health Care
for the Homeless is to improve the health of
Alameda County residents experiencing
homelessness by ensuring access to
culturally informed, whole-person health
care and housing services
11
Short-Term Goals
(1 Year)
Improve contract
management and
procurement
Increase effectiveness
and reach of the
ACHCH quality
improvement program
across the ACHCH
network
2019-2021 Strategic Priorities
Mid-Term Goals
(3 Years)
Develop a structure for
tracking health network
and other statuatory
compliance
Achieve effective and
joint ACHCH/HCSA
sub-recipient oversight
Health Center Compliance
Results
ACHCH remains in compliance
with HRSA requirements, the
enabling program to
concentrate on services and
strategies rather than
correcting deficiencies
HRSA grant sub-recipient will
be more responsive to ACHCH
and county initiatives for
serving the homeless and
more accountable in
providing homeless specific
services
High quality services are
being provided in all ACHCH
network sites under the
direction of ACHCH
Robust quality improvement
program with shared goals
and metrics that promotes
best practices at ACHCH
network locations
Strategies
• Develop and maintain
program-wide compliance
protocols and system
• Track health network
compliance through participation
in NHCHC and coordination with
regional health
department-based HCH
programs
• Develop roles for staff to
coordinate with ACHCH
Commission in tracking health
center compliance
• Establish regular convenings
between county, ACHCH, and
AHS leadership to discuss
initiatives and accountability
• Align sub-recipient MOU with
HCSA initiatives
• On site monitoring of AHS
health center compliance
• Develop consistent approach
to contract management and
oversight
• Devise an efficient strategy for
supporting organizations across
the ACHCH network to
implement RBA
• Implement RBA measures
across ACHCH network sites
• Annual identification of quality
metrics and quality improvement
plan
• Identify administrative staff
FTE to administer Ql program
• Establish regular quality review
meetings with providers across
ACHCH network
• Implement annual homeless
services audits conducted by the
CCAB
Measurable
Indicators
• Establish compliance
indicators and system
presented in successful 2019
HRSA Service Area
Competition renewal
• Successful 2021 HRSA
Operatational Site Visit
• ACHCH Commission
carrying out
oversight/compliance roles
• HCSA Hospital
Management Analyst is
overseeing alignment of
AHS/HCSA contract
deliverables
• Coordination between AHS,
BOT, and ACHCH Commission
• AHS demonstrates
improvement in homeless
data screening
• Conducting consistent,
data-driven contract
management meetings
• Consistent contract
monitoring and audits
• Timely procurement
processes that are
responsive to community
needs
• Ql data is being submitted
and evaluated consistently
• Quality committee has
shared narrative,
investment, and enthusiasm
towards Ql goals and
activities
• Individual program Ql
activities are driven by
shared RBA metrics
12
Short-Term Goals
(1 Year)
2019-2021 Strategic Priorities
Health Center Needs and Resources Coordination
Mid-Term Goals
(3 Years)
Strengthen Community
Consumer Advisory Board
and governing board's
ability to articulate
community needs to
inform health network
planning
Increase non-HRSA grant
funding for health
network services
Results
The ACHCH Commission and
the CCAB are functioning
effectively, able to articulate
relevant community needs,
and inform health network
planning
Achieve adequate ACHCH
network resource and
capacity to meet the specific
needs of the underserved
homeless population and
sub-populations
Strategies
• Increase ACHCH Commission
membership with homeless
services and health systems
expertise
• Determine role of ACHCH in
supporting the functioning of the
Commission and CCAB
• Support the ACHCH
Commission and CCAB to
develop effective operational
and communication processes
• Expand General Fund funding
for ACHCH to meet emerging
needs
• Consolidate a plan and
narrative for continued use,
maintenance, and expansion of
MHSA funds
• Assessment of scalable funding
streams, such as specialty mental
health, victims of violent crimes
and others.
• Increase collaboration with
HCSA Funding Development
Office
Measurable
Indicators
• Both the ACHCH
Commission and CCAB have
increased and stable
membership
• The ACHCH Commission
and CCAB have a refined
agenda and operational
dashboard
• Consultant-based support is
in place to strengthen each
entity
• Increased percentage of
non-grant funds secured for
ACHCH
Short-Term Goals
(1 Year)
Increase patient and
provider awareness of
ACHCH as a health
network
Clearly communicate
ACHCH health
network service
offerings and
referral/request
pathways
Distribute timely,
homeless-specific
health information
and resources
2019-2021 Strategic Priorities
Community Awareness and Marketing
Mid-Term Goals
(3 Years) Results
Patients and providers are
aware that the clinics and
services they are participating
in have functions specifically
designed to meet the needs of
people experiencing
homelessness and are part of
ACHCH health network
services
County residents have
increased awareness of
ACHCH services and access
pathways
Community members
receive accurate and timely
homeless-specific
information and resources
Strategies
• Update marketing and
education media with new HCH
logo and post at all network
locations
• Actively engage with a
strategic set of community
groups, organizations, and local
government
• Participate in community
events to provide program
information
• Create clear, accurate
educational materials for
consumers, providers, and
community members
• Streamline consumer
education materials and vet with
CCAB
• Improve ACHCH website
functionality, versatility, and
usefulness for the community
• Formalize ACHCH's strategy
and plan for distributing accurate
and timely homeless-specific
information
• Explore increasing presence on
social media platforms, including
Next Door
• Clarify ACHCH's role in
county-wide responses to
emergencies affecting the
homeless
Measurable
Indicators
• Signage is visible on every
ACHCH asset and health
network location
• ACHCH CCAB is carrying out
at least 3 community events
annually
• ACHCH staff is participating
in 3 community events
annually
• ACHCH is publishing 2
newsletters annually that are
linked to the website
• Fully implemented CCAB
process
• Staff has unified knowledge
and is able to articulate
service offerings and referral
pathways
• Functioning and accurate
ACHCH website
• ACHCH has a plan for
distribution of
homeless-specific
information, including
emergency scenarios
• ACHCH has an active
database of more than 1000
email addresses
• ACHCH has a strategy for
an increased presence on
social media platforms
14
Short-Term Goals
(1 Year)
Implement
best-practices
consistently across
ACHCH network
primary care clinics
Increase
transportation
supports for health
care access
15
2019-2021 Strategic Priorities
Mid-Term Goals
(3 Years)
Develop best practices in
Alameda County for
portable care and
outreach services
Clinical Care
Results
Homeless patients have
increased and expedited
access to primary care clinics
in the county
Transportation is no longer a
barrier to accessing health
care for ACHCH network
patients
Efficient integration of
outreach and portable care
Strategies
• Pilot regional partnerships
with outreach providers and
community-based primary care
clinics to improve access
• Clarify and summarize best
practices for homeless access
and services in primary care
• Provide technical assistance to
community primary care clinics
on best practices for engaging,
linking, and serving patients
experiencing homelessness
• Leverage relationships within
HCSA to implement best
practices across AHS and CHCN
primary care clinics
• Implement housing
coordination services at every
ACHCH network clinic
• Disseminate best practices for
engagement and linkage to
primary care clinics across
ACHCH network sites
• Develop and model best
practices for existing health
network transportation services
• Provide education about
available transportation
benefits/services through health
plans
• Conduct
geographically-specific,
data-driven pilots
• Develop effective collaboration
between outreach partners and
ACHCH portable care
• Develop and implement
consistent RBA measures for
ACHCH portable care contracts
and services
• Evaluate whether ACHCH
should directly provide or
contract for portable care and
outreach services
Measurable
Indicators
• Double the number of
homeless patients served at
Hayward Wellness Center
• Increased number of South
and East County homeless
residents accessing primary
care medical homes
• Summary document for
primary care best-practices in
serving persons experiencing
homelessness is created
• Increased availability of
housing coordination services
at ACHCH network primary
care clinics
• Survey respondents report
increased options for
transportation to medical
appointments
• ACHCH will offer increased
options for transportation
supports
• Completion of pilots and
investment in clear service
delivery model for outreach
and portable services in
Alameda County
• ACHCH funded contracts
will have consistent service
delivery models and contract
deliverables
2019-2021 Strategic Priorities
Short-Term Goals
(1 Year)
Determine ACHCH's
role in the county's
outreach strategy
Mid-Term Goals
(3 Years)
Expand ACHCH's
portable integrated
health services
Develop a shelter health
function
Increase medical respite capacity in the homeless
health system
Clinical Care
Results
A clear understanding of
county's outreach strategy
and scope of ACHCH's
participation
Effective, data-driven
allocation of portable
services to increase
coordination and outcomes
There are accessible health
services at all homeless
shelters
Increased medical respite
capacity for homeless
individuals transitioning from
institutional care
Strategies
• Determine what entity is best
positioned to hold county-wide
outreach strategy
• Participate in piloting homeless
resources coordination and
implementation of practices
aligned with Indianapolis
Ordinance in unincorporated
areas
• Pursue HRSA funding
opportunities for portable health
medicine
• Upon securing HRSA funding
for expanded services, continue
to develop and formalize model
• Implement RBA for all network
portable services
• Develop a management plan
for ACHCH operated portable
services
• Improve oversight and
management of portable
services
• Develop ACHCH capacity to
understand and track
county-wide efforts towards
field-based homeless services in
order to improve coordination
and efficiency
• Define ACHCH's role and scope
in the development and
operation of shelter health
services
• Complete a comparative analysis
of best practices and scope of
other HCH programs in
ne~hboringcountiesand
nationally in the provision of
medical respite services
• Assess feasibility of various
ACHCH roles in the
implementation of medical respite
in terms of funding and staff
resource
• Determine ACHCH's role in the
development of medical respite
capacity in the county
Measurable
Indicators
• There is a county-wide,
coordinated outreach
strategy in place with clear
roles
• A pilot initiative is in place
for unincorporated areas of
the county with clear
measures of success
• Number of times ACHCH
has successfully applied for
new funding opportunities
• Number of associated new
FTE staff resource
• ACHCH is consistently
reviewing outcome data as
indicated on UDS reporting
• ACHCH will complete a
needs assessment regarding
shelter health in the county
• Initiation of ACHCH's role
in county shelter health
• Number of respite beds in
the county
• ACHCH has clearly defined
role in medical respite
services
16
Short-Term Goals
(1 Year)
Increase access to
dental care and
optometry
2019-2021 Strategic Priorities
Mid-Term Goals
(3 Years)
Clinical Care
Results
Increased access to improved
dental care and optometry for
individuals experiencing
homelessness using ACHCH
network health services
Strategies
• Increase AHS capacity for
referral and provision of
homeless-focused dental care
• Leverage relationships with
health plans to increase coverage
and availability of dental and
optometry services
• Increase ACHCH capacity for
providing dental care
management for high-needs
homeless individuals
• Assessment and
implementation of best practices
in providing dental care to
people experiencing
homelessness
• Explore dental outreach
provision with AHS Dental
• Expand optometry contracting
to meet regional and overall
need
Measurable
Indicators
• Highland Dental Clinic
added to scope of services
• Additional optometry
provider contracted for
ACHCH health network
2019-2021 Strategic Priorities
Short-Term
Goals
(1 Year)
Mid-Term
Goals
(3 Years)
long-Term
Goals
(5-6 Years)
Develop internal functional data
warehouse and analysis
Implement modern EMR for
ACHCH's directly operated
services
Data and Integrated Technology
Results
ACHCH has relevant data and
effective analysis which is
shared with the larger
homeless services system
Strategies
• Improve and stabilize current
ACHCH data system
• Collaborate with BHCS on
planning and implementation of
ACHCH data system
• Continue strategy of exploring
HMIS implementation at ACHCH
• Assign management/staff
resource to development of a
plan for implementation of an
EMR
Measurable
Indicators
• Regular use of dashboards
that include UDS and HMIS
data
• Overlap of UDS and MHIS
systems
• Modern EMR
implemented for ACHCH
direct services
2019-2021 Strategic Priorities
Mid-Term Goals
(3 Years)
long-Term Goals
(5-6 Years)
Increase ACHCH representation and subject
matter expertise in county decision-making
processes
Increase awareness
of need for services
for children, families,
and other
sub-populations in
the homeless
community
Establish a training
and education
function for sharing
ACHCH best practices
and increasing the
use and effectiveness
of evidence-based
practices in the
homeless services
system
Leadership and Advocacy
Results
Increased county political
leadership's awareness of
ACHCH reach and scope of
work
Improved health care access
for children, families, and
other sub-populations within
the homeless community
ACHCH will provide training
and education on best and
emerging practices in
homeless health care and
services
Strategies
• Develop clear strategy for
ACHCH Director's role
• Identify decision-making
forums regarding homelessness
• Decide how to use relevant
sub-population data to support
expansion and awareness of
services
• Conduct initial conversations
with stakeholders regarding
assessing and meeting the needs
of homeless sub populations
• Conduct assessment of training
and education needs in our
community
• Research best practices in
other communities
• Assess capacity of the system
to provide training and education
• Identify homeless services
subject matter expertise existing
in the community and develop a
strategic role for ACHCH
participation in meeting training
and education needs
Measurable
Indicators
• Increased ACHCH
representation in
county-wide homeless
decision-making forums
• Completed data analysis for
2 homeless subpopulations
• Plan developed and
partners identified
• Complete review of
best-practices
• County-wide training plan
developed
I
We would like to thank the following individuals for their participation and support:
Daniel Cohen, Daniel Matthieu Cohen, LCSW, Inc., Strategic Planning Consultant
Jeffrey Seal, MD, Interim Director and Medical Director, Health Care for the Homeless, Alameda County
David Modersbach, Management Analyst, Health Care for the Homeless, Alameda County
Lucy Kasdin, LCSW, Deputy Director, Health Care for the Homeless, Alameda County
Rachael Birch, Health Services Administrator, Contra Costa County
Frank Trinh, MD, Medial Director, Health Care for the Homeless/Farm Health Program, San Mateo County
Ralph Barbosa, Program Coordinator, Health Care for the Homeless, Santa Barbara County
John Glivar, Manager, Health Care for the Homeless, Public Health Department, Seattle and King County
Selene Ho, Ambulatory Services Manager, Santa Clara Valley Medical Center
Colleen Chawla, MPA, Director, Health Care Services Agency, Alameda County
Kathleen Clanon, MD, Medical Director, Health Care Services Agency, Alameda County
Elaine De Coligny, MA, Director, Everyone Home, Alameda County
Sarah Bedford, Director, City of Oakland Health and Human Services
Muntu Davis, MD, MPH, former Director, Public Health Department, Alameda County
Erica Pan, MD, MPH, Director, Division of Communicable Disease Control & Prevention, Public Health Department,
Alameda County
Christina {Kiko) Malin, MSW, MPH, Division Director, Family Health Services, Public Health Department, Alameda
County
Kimi Watkins-Tartt, BA, Interim Director, Public Health Department, Alameda County
Robert Ratner, MD, MPH, Director, Housing Services Office, Behavioral Health Care Services, Alameda County
David Moskowitz, MD, Medical Director, HOPE Program, Alameda Health Services
Tam Nguyen, Ph.D, MS, Director of Behavioral Health, Tri-City Health Center
Jovan Iglesias, LCSW, Director of Mental Health and Housing Services, Bay Area Community Services
Daniel Cooperman, Director of Programs, Bay Area Community Services
Lora Ashworth, ASW, Senior Program Specialist, Home Stretch, Alameda County
20
APPENDIX: 1
Strategic Planning Timeline and Action Plan
Objective Outcome
Develop ACHCH strategic planning structure Project work plan approved
and process
Conduct needs, gaps, and strengths
assessment
Evaluate and align ACHCH
vision, mission, and scope
Develop strategic goals and priorities
Finalize ACHCH Strategic Plan
Develop implementation action plan
Create structures and processes
to improve effectiveness
and efficiency of ACHCH
Evaluate and improve staffing model
Establish ACHCH role in the homeless
services system
Established understanding of ACHCH's current structure and operations
Complete comparative analysis of similar ACHCH programs throughout the state
Structure and content for stakeholder input developed
Conduct stakeholder input surveys, interviews, and events
Analysis and report of stakeholder data
Common themes and priorities present in needs, gaps, and strengths assessment
compiled
Achieve agency alignment on program vision and mission
Program vision statement updated
Program mission statement updated
Analysis of stakeholder themes and priorities completed
ACHCH areas of expertise identified
Strategic goals developed and prioritized
Draft strategic plan completed
Strategic plan submitted, approved, and finalized
Core areas of work identified
Assessment of program resources and capacity complete
Implementation action plan developed
Quality improvement structure and program dashboards developed
Continued assessment of meeting schedule aligned with mission/priorities
Finalize quality improvement structure and membership
Current staffing model evaluated
Growth opportunity internally and externally identified
Internal organizational chart and reporting structure developed and honed
ACHCH areas of expertise identified
Strategy and marketing materials to communicate ACHCH functions, role, available
resources, and scope developed
Continue to strengthen and build collaborative relationships among agencies serving
persons experiencing homelessness
Implementation of ACHCH strategic plan and Cohesive, coordinated, and consistent agency functions honed and operational
establish mechanisms for sustainability
21
Timeline
10/1/2017
11/1/2017-11/13/17
11/13/17-12/4/2017
12/4/2017 -12/18/17
12/18/18 -3/30/18
3/30/18-4/6/18
4/6/18-4/27/18
4/27/18-7/16/18
7/16/18-9/28/18
9/28/18-10/29/18
10/29/18-12/17/18
12/2018-8/2021
APPENDIX: 2
Program Activities Visual
Health Care for the Homeless
Program Activities in 2021
A Strong
Health Network
Driving
System-Wide
Best Practices
Health Network
Compliance
Health Network
Needs and
Resources
Coordination
Community
Awareness and
Marketing
Clinical Care
Leadership and
Advocacy
Health Network Grant Management
Contract Management
Quality Improvement Program
Ongoing Community Needs
Assessment
Consumer and Governing Boards
Funds Development
Program Management
Public Relations
Program Information Dissemination
Primary Care Clinics
Mobile Medical Clinic
Shelter Health
Medical Respite
Dental and Optometry
Community Relations and Education
Bold: No Associated Strategic Goals
22
APPENDIX: 3
ACHCH Scope Decision Rubric
CONSIDER DECLINING
Consider conducting the initiative or activity
APPENDIX: 4
Comparative Analysis Results
Role in larger Health System
-> FQHC status holder (5/5 Programs-100%)
-> Training and education for larger health System (5/5-100%)
-> Facilitating acces to health care (5/5-100%)
-> Funding to expand range/capacity of homeless programming (3/5-60%)
How Priorities are determined
-> Governing board input (5/5-100%)
-> Director vision (2/5-40%)
-> Pressure from cities and power players (2/5-40%)
-> "Organic", "Make it up every day!" (2/5-40%)
-> Govering board directives (1/5-20%)
-> Directives from PH director (1/5-20%)
-> Input from collaborators in health system (1/5-20%)
Relationship to Housing
-> Referral to county housing system (Coord Entry, CoC) (5/5-100%)
-> Coordinate/collaborate with Coord Entry or housing dept on policy and decision making (2/5-40%)
-> Provides health services at supportive housing site, (1/5-20%)
Most Important Functions
-> Medical outreach (5/5-100%)
-> Facilitating homeless access to medical care (5/5-100%)
-> Funding of augmentations of clinics/services to increase effectiveness of engagement and treatment (5/5-100%)
-> Training and education in larger health system (5/5-100%)
-> Raising awareness of homeless issues and best practices (5/5-100%)
-> Linkage, navigation, coordination of services (4/5-80%)
-> Spearheading county initiatives to benefit the homeless (2/5-40%)
Role of Governing Board
-> Board active and directive (3/5-60%)
-> Board semi-active, provides input (2/5-40%)
Direct vs Contracted Services
-> Range of ratios from all direct to all contracted services
-> Most programs had a combination of contracted and direct service
Types of Service Operated
-> Medical outreach (5/5-100%)
-> Mobile van clinics (3/5-60%)
-> Dental clinics (3/5-60%)
-> PCP clinics in collab with PH (3/5-60%)
-> Respite housing (1/5-20%)
-> Backpack medicine (1/5-20%)
-> Medical transportation program (1/5-20%)
24
APPENDIX: 5
HEALTH CARE SYSTEM GAPS
Medical Outreach
13 Respondents
Health and Housing
Integration
9 Respondents
Resource Info and
Referral
7 Respondents
THE THREE MOST COMMON THEMES
• Street-based medical and specialty care with the ultimate
goal of linkage to brick-and-mortar primary care clinics
• Integration of housing services and support in health care
locations, health services in housing, health-related housing
continuum, and coordination of planning between housing
and health entities
• Facilitation of access to resources and health services
through dissemination of accurate, clear, and user-friendly
information and through referral services
PROGRAM STRENGTHS
Medical Outreach
8 Respondents
THE 3 MOST COMMON THEMES
• Mobile medical clinic, street medicine, and street psychiatry
are distinct and needed functions that ACHCH provides
utilizing effective approaches to outreach and engagement
Convening and
Coordinating Function
• ACHCH's positioning, power, and skill in convening different
system sectors and providers towards better coordination
and collaboration was identified as a significant program
strength
25
8 Respondents
Program Leadership
6 Respondents
• ACHCH's current leadership and the leadership's skill in
implementing innovations and facilitating collaboration was
identified as a significant program strength
APPENDIX: 5
PROGRAM CHALLENGES
THE THREE MOST COMMON THEMES
Lack of Program Identity and
Community Awareness
20 Respondents
Contracting and Sub
Recipient Strategies
10 Respondents
Outreach Function
Utilization
4 Respondents
• Stakeholders highlighted a significant lack of community
awareness of ACHCH including the program's identity,
primary focus, services, and access points resulting in
decreased impact and influence in the county
• Strategies for contracting and MOU relationships have
resulted in some geographical and target population gaps,
as well as challenges in influencing partner agencies'
practices and performance
• ACHCH's medical outreach function lacks a cohesive,
efficient model and has limited reach and visibility at
important homeless touch points
POTENTIAL ACTIVITIES NOT INCLUDED HCH'S OPERATIONS
THE TREE MOST COMMON THEMES
Training and Education of
the Larger System
10 Respondents
Resource Info and Referral
5 Respondents
Model Programming
3 Respondents
• Stakeholders emphasized the need for a robust training,
education, and technical assistance function across sectors
serving the homeless and felt that ACHCH has the capacity,
knowledge, and positioning to provide it
• Clear, up-to-date information on services, resources, and
referral pathways is a significant system gap that ACHCH
could lead or participate in addressing
• ACHCH could use its knowledge and skill to operate
programming, such as primary care clinics or homeless
drop-in centers, that serve as needed models of care in the
county
26
27
APPENDIX: 5
WAYS THAT ACHCH CAN SUPPORT SYSTEM COLLABORATION
THE THREE MOST COMMON THEMES
Take on Role of Convener
13 Respondents
Provide Training and
Education
4 Respondents
Leadership in Policy
Making
4 Respondents
• Stakeholders encouraged ACHCH to provide leadership and
mechanisms for convening different jurisdictions and parts
of the system towards shared learning of best practices,
collaboration, and coordination among entities serving
people experiencing homelessness
• ACHCH could provide training, education, and technical
assistance to increase use of best practices and to increase
knowledge of resources and services in the community
across sectors, as well as with leadership and elected
officials
• ACHCH could have more presence and an informing role in
policy making arenas that effect homeless services and the
distribution of needed resources
WAYS THAT ACHCH CAN SUPPORT SYSTEM COORDINATION
THE THREE MOST COMMON THEMES
Information and Referral
6 Respondents
Acting as a Coordination
Hub
3 Respondents
Training and Education
2 Respondents
• Stakeholders felt that ACHCH could support coordination of
homeless services by acting as a source of information on
resources and referral pathways, as well as supporting the
implementation of a community health record
• ACHCH could operate as a "coordination hub" and be a
resource for cross-sector case conferencing, coordination,
and trouble-shooting for specific coordination challenges
• ACHCH could provide information, training, and education
on best practices in homeless service provision and where
to most effectively apply those practices to increase impact
APPENDIX: 5
45
40
35
30
25
20
10
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STAKEHOLDER PRIORITY RANKING
CURRENT ACHCH ACTIVITIES: LEVEL OF IMPORTANCE TO
STAKEHOLDERS
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• Overall • Leadership • Providers • Staff
STAKEHOLDER PRIORITY RANKING
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SUPPORTS FOR ACCESSING HEALTH CARE: DEGREE OF IMPORTANCE TO PATIENTS
(N: 114)
More medical clinics
Help getting Medi-Cal and benefits
Same-day appointments at a clinic
More mental health/substance use services
More mobile health clinics (vans)
Better information and resources
Transportation to care
More medical and outreach services for encampments and streets
Dental and/or eye care
More housing case management services
0 so 100 200
28