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PŪNĀWAI REST STOP PROGRAM EVALUATION JANUARY, 2020
PŪNĀWAI REST STOP PROGRAM EVALUATION
JANUARY, 2020
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PŪNĀWAI REST STOP “providing safe hygiene services for homeless
individuals to regain their dignity, and self-respect.”
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TableofContents
Executive Summary .................................................................. 2
Program Background ..................................................................... 2
Outputs .......................................................................................... 2
Findings ......................................................................................... 3
Conclusions and Recommendations ............................................... 3
The Rest Stop Model Overview .................................................. 4
Pūnāwai Rest Stop – Honolulu ....................................................... 4
Description of the Pūnāwai Service Model ...................................... 5
Logic Model .................................................................................... 7
Program Implementation ....................................................... 11
Program/Process Implementation ............................................... 11 Safety and Security ................................................................................ 13 Staffing/Human Resources ...................................................................... 15
Evaluation of Outputs ............................................................. 16
Services ....................................................................................... 16
Participant Feedback Regarding Services ..................................... 18 Pulse for Good ....................................................................................... 18 Participant Interviews ............................................................................. 20
A Unique Model of Case Management ..................................... 22
The PRS Model of Case Management ............................................ 22 Models of Case Management .................................................................... 23 How Pūnāwai is Different ......................................................................... 24
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Case Management Data ................................................................ 25 Race/Ethnicity ....................................................................................... 25 Income Status ....................................................................................... 26 Access to SNAP Benefits .......................................................................... 27 Housing Status ...................................................................................... 28 Medical Insurance Status ........................................................................ 28 Identification Document Status ................................................................ 29 Needs of Case Management Participants .................................................... 30
Evaluation of Outcomes .......................................................... 32
Pūnāwai Rest Stop as a Safety Net ............................................... 32
Early Impacts on Participants ...................................................... 33
Evaluation of Community Perspectives ................................... 34
Local Businesses .......................................................................... 34
Government Partners ................................................................... 35
Homeless Provider Partners ......................................................... 36
Recommendations .................................................................. 38
Ongoing Evaluation Plan ......................................................... 41
Outcome Measures ....................................................................... 41
Basic Evaluation Plan ................................................................... 42
Advanced Evaluation Plan ............................................................ 42
References ............................................................................... II
Appendices .............................................................................. II
Evaluation Methodology ............................................................ I
Interview Questions – Participants ............................................... II
Survey Questions – Area Businesses ............................................. II
Survey Questions - Partner Agencies ............................................ II
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TableofFigures
FIGURE1:PŪNĀWAIRESTSTOPLOGICMODEL 9FIGURE2:INCIDENTREPORTSSEPTEMBER-DECEMBER2019 14FIGURE3:2019PŪNĀWAIRESTSTOPVISITS 16FIGURE4:2019CLIENTSERVICESUSE 17FIGURE5:PULSEFORGOODSATISFACTIONRATINGSOCTOBER-DECEMBER2019 19FIGURE6:CULTUREOFRESPECTATPRS 20FIGURE7:COMPONENTSOFPŪNĀWAIMANAGEMENTMODEL 24FIGURE8:RACE/ETHNICITYOFCASEMANAGEMENTPARTICIPANTS 26FIGURE9:INCOMESOURCEOFCASEMANAGEMENTPARTICIPANTS 26FIGURE10:INCOMEAMOUNTSOFCASEMANAGEMENTPARTICIPANTS 27FIGURE11:SNAPBENEFITSTATUSOFCASEMANAGEMENTPARTICIPANTS 27FIGURE12:HOUSINGSTATUSOFCASEMANAGEMENTPARTICIPANTS 28FIGURE13:MEDICALINSURANCESTATUSOFCASEMANAGEMENTPARTICIPANTS 28FIGURE14:DOCUMENTATIONSTATUSOFCASEMANAGEMENTPARTICIPANTS 29FIGURE15:CASEMANAGEMENTNEEDSOFCASEMANAGEMENTPARTICIPANTS 30FIGURE16:PRSASSAFETYNET 32FIGURE17:REASONFORREFERRALTOPŪNĀWAIRESTSTOP 36
Mahalo
TheevaluationteamwouldliketoextendasincereThankYoutothosewhoassistedincluding:
• HPUBSWstudentswhoparticipatedintheconstructionofthedatacollectioninstrumentsanddatacollection.ThankyoutoNoelleFisher,CorinneGanacias,GloriaKempner,Edison“Lou”Loualhati,LindaMoultrie,LeonardoMourao,JohniquaSmith,BrittennyUbasa,andKasidyVergara.
• ThestaffandvolunteersatMHKandPRSwhowereto-the-person
cooperativeandforthcomingintheirassistance.Thisprojectwouldnothavehappenedwithoutyourhelp!
Pono no kākou e kūlia i kā kākou hana po‘okela.
(We must strive to do our best work.)
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ExecutiveSummary
ProgramBackground
• OpeninginJanuary,2019,thePūnāwaiRestStopsgoalistoprovideneededservicestopeopleexperiencinghomelessnesswhomightnototherwisehaveaccesstobathroomsandlaundries.Itishopedthatbypairingbasichygieneserviceswithsocialservices(interimcasemanagement),PūnāwaiRestStopwillencouragethosewhoutilizethereststoptocontinuetoaddressotherbarrierstohousingandemployment,improvetheirhealthandresolveissuesthatmayhavepreventedthemfromstablehousing.
• During2019,itisestimatedthat2,238peopleutilizedatleastoneofthegeneral
servicesavailableatPūnāwaiRestStop.
• 371participants(17%oftotalparticipants)utilizedcasemanagementservicesoverthecourseoftheyear.Only15%ofclientshadallofthelegaldocumentsthattheyneeded,andthebiggestidentifiedneed,asexpectedwashousing.
Outputs
• PūnāwaiRestStophasservedapproximately128%morepersonsexperiencinghomelessnessperdaythanwasinitiallyanticipated.ThisspeakstotheoverwhelmingneedthattheRestStopisaddressing.
• PūnāwaiRestStopprovidedthefollowingservicesoverthecourseoftheyear:
• Showers(39,373) •Lockers(31,492) •Laundry(26,572)
• Toilets(16,984) •Petspace(1,928) •USMailservice(1,393)
• Itisestimatedthatcasemanagershaveassistedapproximately92participantswith
securinghousing,35participantsgainsomelevelofemployment,and10participantsenterintosubstanceusetreatment.
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Findings
• FromthePulseforGooddataaswellasindividualclientinterviews,participantsaregenerallyverypleasedwiththestaffandservicesatPūnāwai.
• OtherHomelessserviceprovidersareawareofPūnāwaiandtheservicesprovidedandhaveactivelybeenreferringclientsthere.Theyalsoreportahighsatisfactionlevelwiththeservicesthere.
ConclusionsandRecommendations
• PūnāwaiRestStophasachieveditsgoalinprovidingamuchneededservicetopeoplewhoareexperiencinghomelessness.
• LookingmorecloselyatHumanResourcesandStaffingissuesthathaveoccurredduringthepastyear.IncorporatingmoretrainingandproceduredevelopmentspecificallyforPRS.
• PRSshouldcontinuetofocusonanddeveloptheirexistingservices,avoidingmissiondriftasmuchaspossible.
• Improvinganddevelopingaccuratedatacollectionandmanagementsystems.• WhatPRShasbeenabletodevelopinashortperiodoftimeissomethingvery
special.Therelationshipsdevelopedwithclientsandthecommunityissomethingthatwillbeimportanttomaintaingoingforward.Thisisnotsomethingthatiseasilyquantifiable,butitsomethingthatwasfeltbyclients,staffandtheevaluators.
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TheRestStopModelOverviewThereststopmodelwasinspiredbytheUrbanRestStop(URS)programinSeattle,wherethreereststopshavebeenoperatingformanyyears,providinghygieneservicestopeoplewhoarehomeless.ByprovidingaccesstoessentialhygieneservicestheURShasimprovedthequalityoflifeforhomelessindividualsandfamilies.TheRestStopistheonlyhygienefacilitywithextendedservicehourswhicharespecificallydesignedtoassisthomelesspersonswhoareworkingorneedtogettoajobinterview.Ahomelessjobapplicantcannotbesuccessfulduringajobinterviewwithouttheself-confidencethatashowerandcleanclothescanprovide.Ahomelessindividualcannotmaintainsteadyemploymentorhopeforadvancementwithoutaccesstoshowersandlaundryfacilities.Thereststopmodelisbasedonalow-barrierapproachthatprovidesbasicservices“whereaclientisat.”Thisisincontrasttomanyhomelessservicesthatrequireparticipantstomeetaseriesofrequirementsinordertoreceiveservices,suchasabstinencefromalcoholorothersubstances(Wallace,Barber,&Pauly,2017).Lowbarrierservicesrelaxmanyoftherulesthatmayexcludepersonswithaddictions,seriousmentalillness,orchronic,long-termhomelessnessthusdiminishingbarrierstosocialinclusionthatlackofaccesstobasicservicescreates.Themodelworksontheassumptionthatprovidingservicessuchasshowers,laundry,phoneandmailaccesstothoseexcludedfromsocialservicesystemswillleadtheparticipantstofurtherinclusioneffortssuchasengagementwithtraditionalproviders,alternativepathwaystorecovery,and,ultimately,stableandpermanenthousing.PūnāwaiRestStop–HonoluluIn2013,CityCouncilmanJoeyManahanproposedthatthecityadministrationexplorethefeasibilityofanUrbanRestStopModelinHonoluluasawaytoprovideaccesstoessentialhygieneservicesthatwouldimprovetheself-sufficiencyofhomelessindividualsandfamiliesandaddresscitypublichealthissues.CouncilmanManahanreachedouttopartnerssuchasMayorCaldwell,KenFarm(PresidentoftheKalihi-PalamaNeighborhoodBoard),andtheHonoluluPoliceDepartmentwhoallrecognizedthatsuchaprogramwasapotentialwinforthoseaffectedbythisissue.Theaimwastohaveahygienecenterthathadlittletonobarriersforusebypersonsexperiencinghomelessness.Variousfundingsourcesfortheprojectwereconsideredtodeterminewhichhadthefewestpotentialuserequirements.Inthe2017City&CountyBudget,2millionwasappropriatedforplanningandconstructionofahygienecenterintheIwileiarea.In2018theCity&CountyreleasedaRFPtorunareststopforpersonsexperiencinghomelessnesson431KuwiliStreet.PūnāwaiRestStopisaprogramoperatedbyMentalHealthKokua,sponsoredbytheCity&CountyofHonolulu.PūnāwaiRestStopopenedinJanuary,2019,andisahygienecenterprovidingrestrooms,showers,andlaundryfacilitiestohomelessmen,womenandchildrenwithinaclean,safeanddignifiedenvironment.Allservicesareatnocosttopatrons.
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Operatinghoursarespecificallydesignedwithextendedtimestoassisthomelesspeoplewhoareworking(7am-7pmdaily).AtPūnāwai,onecanfind8privateshowerrooms,10washerand10dryerunits,largemen's&women'srestrooms,kennelsforpets,lockersforsmalleritemsandstorageforlargeritemssuchascartsduringuseofservices.Patronsreceivefreetoiletriesincludingtoothbrushes,toothpaste,disposablerazors,shavingcream,shampooandsoap.Patronsmayalsoborrowacover-upwhiletheywashtheirclothes.FreeWiFiandcomputerstationsareavailableforusebypatrons.Inaddition,mailboxesforU.S.PostalServicestosendandreceivemailandstampsareavailableatnocost.Inadditiontothehygieneservices,PūnāwaiRestStop(PRS)providesinformationandreferralmaterialsaswellasinterimcasemanagementservicesforhomelessindividualsandfamilies.Casemanagersprovideassistancewithavarietyofneeds,includingbenefitsandmedicalinsurance,legalidentificationdocuments,referralsforemploymentandpermanenthousing.ResourcesareavailableinEnglishandotherlanguages.Finally,PRSservesasavenueforoutsideagenciestoconnectwithpersonsexperiencinghomelessness.Withthehighvolumeofparticipantsaswellaspercentageofparticipantswhoarelargelydisconnectedfromtraditionalproviders,thePRSisanidealsitetoconnectwithandprovideservicestothispopulation.OrganizationswhohavecometoPRSduring2019toassistparticipantsinclude:theStreetDogCoalition,LegalAid,thePublicDefender’soffice,theSupplementalNutritionAssistanceProgram(SNAP),andavarietyofmedicalprogramssuchasoptometryandmentalhealth.DescriptionofthePūnāwaiServiceModelPūnāwaiRestStopprovidesservicesviaalow-barriermodel.Thislow-barriermodelisembracedbyPūnāwaistaffandreflectedintheatmosphereattheRestStop,itsproceduresandservicesoffered.Itwasevidentthroughoutthisevaluationthatexhibitingrespect,compassionandanon-judgementalattitudetowardparticipantsandcolleaguesisexpectedandunderliestheplanninganddeliveryofallservices.Understandingsomeofthebarriersencounteredbyparticipantsshedslightontheneedforalow-barrierserviceagencysuchasthePūnāwaiRestStop.IninterviewswithPRSparticipantsthreecategoriesofsystemicbarrierswerespokenabout;rigidity,access,andlackofrespect.Participantsdescribeddifficultieswiththerigidityofthecurrentsocialservicesystemanditsprograms.Forparticipants,thisrigidityresultedinalackofconsiderationfortheirunique,individualneeds.
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• Oneparticipantreported“Theotheragencypersonwasmorecontrolling,shewantedmetodothingsthewayshefeltIshoulddothem.Thatwasabriefexperienceatthatagencyforme.”
• Anotherexplained,“Ioncebeforewenttothisotherplace.TheoneImetwithwasveryaggressivewhenIaskedforhelpandsaid“wedon’tdothat,wearen’tdoingthis”,Idon’tgothereanymore.”
Participantsalsospokeofbarriersaroundaccessincludinglimitedhoursofoperation,distancetoservices,andthecostofservices.
• Oneparticipantstated“Theyhaveshowersoverthere[AgencyX],buttheyareonlyopeninthemorningandsometimesthereisn’tenoughtimetogetashowerin.”
• Anotherreported“Atotherplacesyouhavemorestrictrulesaboutwhentogetyourstuff.ItmeansIcan’tgotomymeetingsbecauseIhavetoworryaboutmystuff.”
• Accesstoservicesisoftentiedtomembershipandcomplianceinaprogram.Thiscanserveasabarrierasoneparticipantstated,“Igoto[AgencyX]formealsandtheytoldmetocomeoverhere.Theydidn’tallowgueststouseshowers,justtheirownresidents.”
• Oneparticipantspokeaboutthebarrierofevensmallfeesforservices,“Theyhavefreelaundryhere,that’sawesome.IusedtodowhateverIcouldtogetabitofmoneysoIcouldjustbuynewclothes,becauseit’ssoexpensivetowash,andyourstuffisjustgoingtogetstolenanyway.”
Finally,participantsspokeaboutnotfeelingacceptedorsafeasabarriertoreceivingservices.
• Oneparticipantspokeofthefeelingofalackofrespectforherpossessions,“Atmytemporaryhousingourstuffisallleftinabigroom,wedon’tgetourownlockers.Peoplecomeinandstealstuff.”
• Thefeelingofbeingjudgedservesasabarrierforoneparticipantwhosaid“Someplaces“downyou”,thinkingtheyknowwhereI’vebeen.”
• Someparticipantsspokeaboutnotfeelingsafeatotherspaces.“Theotherplace,theirbathroomsaren’tsafe.Stuffgoesoninthere.There’slikenoscreeningsoIdon’tgothere.”
PRSisdesignedasalow-barrierserviceprogramthatcomplementsotherservices/providersinthesystemofcarethatincludessocialservices,housing,andemployment.TheStateofHawai`i,CountyofHonolulu,andlocalnon-profitshavededicatedextensiveresourcesoflatetoaddresstheissueofgrowinghomelessness(Mayor’sOfficeofHousing,2019;Hawai`iPolicy&BudgetCenter,2019).Resourcesincludeacoordinatedentrysystemthatseekstocoordinatetheprovisionofhousingandotherservicestopersonsexperiencinghomelessness.
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LogicModelThefollowinglogicmodel(Figure1)expressestheevaluators’understandingoftherelationshipbetweentheactivitiesofthePRSanditsintendedeffects.TheoverallgoalofthePūnāwaiRestStopispredicatedonprovidingparticipantsawelcomingspacethatemphasizespersonaldignity.Thecombinationofhuman,physical,andsocialresourceinputsresultintheservicesthattheRestStopprovides.Thoseservicesleadtooutputsincludingreferralstooutsideagencies,retentionofemploymentandhousing,referralstoobtainhousingandsecurementofbenefits.ItisatthisstagethatthereportingexpectationsfromtheCity&CountyofHonolulu,havebeenmet.Thecontractbetweenthetwoentitiesdetailedoutputsofservices.However,PRSisalsodirectedatseveraloutcomes:short,midandlongterm.PRSaimstoimprovethequalityoflifeoftheirparticipantsintheshort-termbyimprovingtheirhygieneandsubsequentlytheiroverallhealth.Additionally,thePRSmodelaimstoimprovetheself-respectofeachparticipant.Beinghomelessisoftenadehumanizingexperience(Weiss&Quinn,2018).Throughtheprovisionofasafespace,groundedinrespect,participantscanexperienceimprovedself-worth.Relatedly,theprovisionofaspacetocarryoutactivitiesrequiredfordailylivingsuchasshoweringandlaundrygivesparticipantsimprovedsenseofsafetyintheirlives.Peoplewhoarehomelessareoftenthevictimsofaggression(Lee&Schreck,2005),sohavingasafespaceduringthedayisasignificantoutcomeofthisprogram.Finally,engagementinPRSandthecasemanagementservicesisashort-termoutcomeofthePRSmodel.Thisengagementisanimportantsteptosocialintegration.
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Figure1:PūnāwaiRestStopLogicModelGoal:Byprovidingbasicservicestopersonswhoarehomelessinawelcomingplacethatemphasizespersonaldignity,participantswillimproveoverallwellbeingandundertakefurtherinclusioneffortssuchasengagementwithtraditionalproviders,alternativepathwaystorecovery,and,ultimately,stableandpermanenthousing.
Resources
Activities
Outputs Outcomes
• Staff
• Centerassistants
• Interimcasemanagers
• FundingC&C
• Buildingspace
• Washers/dryers
• Computers• Showers
• Lavatories
• Casemanagementoffices
• Storagespace
• Partneragencies
• Communitysupport
-Localbusiness-Government-Generalpublic
Hygieneservices
• Showers
• Lavatories
• Washer/dryer
• ToiletriesOtherservices
• Computers/Wifi• Storagelockers
• Mailaccess
• KennelsCasemanagement
• Informationandreferral
• Housing/shelter
• Employment
• Medical• Psychiatric/mental
health
• Benefits
• Supportivecounseling
• NeedsassessmentSpaceforOutsideProviders
• #servicesprovided
• #receivingshort-termcasemanagement
• #referralsmade
• #enteredsubstanceabusetreatment
• #retainedemployment
• #retainedhousing
• #registeredforFederaland
Short-term Mid-term Long-term
• Improvedhygiene
• Improved
health
• Improvedself-respect/self-worth
• Improved
safety
• EngagementinPRS
• Engagementincasemanagement
• Activeincasemanagement
• Engagementinserviceswithotherproviders
• Increased
resources
• Increasedemployment
• Increased
permanenthousing
• Increased
overallsocialreintegration
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Statebenefits
• #obtainedID
Figure 1: Pūnāwai Rest Stop Logic Model
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Theseshort-termoutcomesareintendedtoleadtothefollowingmid-leveloutcomes;activeinvolvementincasemanagementandplanningoverone’slife,increasedengagementintheoverallservicesystem,andincreasedresourcesavailabletotheparticipant,includingincomeandbenefits.ThisiswherePRSfillsanimportantgapintheservicesysteminHawai`i.TherearemanyservicesforpersonsexperiencinghomelessnessinHawai`i.Inspiteofthis,theStatecontinuestostrugglewithreversingthetrendofincreasedhomelessness.Certainlytheoveralleffortofalloftheservicesforthehomelessisaimedatattainmentofpermanentandstablehousing.PRSisaimedathelpingpersonsexperiencinghomelessnesstore-engageinthesocialfabric.Theydothisinavarietyofways;throughmakingservicesavailabletoall,atnocost;bytreatingparticipantswithrespectandcare;andbyprovidinginterimcasemanagementfocusedonbuildingquick,genuinerapportandsuccessatmeetingexpressedneeds.Atthispoint,PRShandsofftootherserviceproviderstoassistinachievingthelong-termoutcomes.CertainlytherearetimesthatinvolvementinPRSservicesleadsdirectlytoemploymentandhousing,howevertherealaimofPRSistoincreaseparticipantsactiveinvolvementwithotherserviceprovidersthroughachievementofthosemid-termoutcomes.
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ProgramImplementationProgram/ProcessImplementationTheevaluationteamwasnotinvolvedfromthebeginningoftheprogram,buthasspentalmostthreemonthstalkingtomanagement,casemanagers,andcenterstaffabouthowtheprogramanditsprocesseshavebeenimplementedalongthewayaswellasreviewingdocumentationinordertoassessprogramimplementation.AgrandopeningwasheldonJanuary,8,2019,whereCityandothergovernmentofficialscametocelebratePūnāwai’sstartofservices.Astobeexpected,numbersincreasedovertimeasindividualsandagencieslearnedaboutPūnāwaiandtheservicesavailable.AstoryprintedintheHonoluluStarAdvertiserinFebruary,2019discussedtherelativelyquickincreaseinshowerutilization,butthatcasemanagementservicesweretakingtime(Nakaso,2019).Staffmembersdiscussedtheearlypushwithbrochures,meetingwithagenciesandgeneraloutreachtoletthecommunityatlargeknowabouttheopeningofPRSandtheservicesavailable.Whileoutreachcontinuesintermsofdistributingbrochuresandcommunicationswithotherserviceproviders,thereismuchmoreawarenessofPūnāwai.PeoplearereferredtoPūnāwaithroughwordofmouth,police,hospitals,sheltersservingthehomelesspopulationandothersocialserviceagencies.Aswithanynewprogram,therewerechallengesandsuccessesthroughoutthatfirstyear.Someofthemainchallengesthatpresentedinthedatawere:
• Naturalprogressionofagency/serviceso PoliciesandProcedureso Documentationo Vision/MissionandAgencyCulture
• SafetyandSecurityforstaffandparticipants• Staffing/HumanResources
TheprimarychallengesthatPRSexperiencedcanbeattributedtothetypicalgrowingpainsexperiencedbyanewprogram.Oneexampleofthisisthedevelopmentofpoliciesandprocedures.Tobegin,PRSadopteditspoliciesandproceduresfromitsparentorganization,MentalHealthKokua(MHK).Assituationsarose,procedureswereinformallytailoredtoPRS.Someexamplesofthisaredescribedinthe‘SafetyandSecurity’discussion.TherearesignificantpointsofdeparturebetweenPRSandMHKthatnecessitateattentionbepaidtodevelopingindividualizedpoliciesandproceduresthataddressPRS’suniqueneeds.
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Anotherexampleofthechallengesthathavebeenexperiencedasanewprogramistheevolutionofdocumentation.DocumentationatPRSduringthisfirstyearfocusedoncapturingtheoutputssuchasnumbersofshowerstakenorloadsoflaundrycompleted.Challengestoevenaccuratelycapturingthatdatahavearisen.Theagencyusesasign-insheetatthefrontdesktocollecttheserviceusedata,howeverastheagencyhasevolvedfromutilizingadedicatedfrontdesksecurityguardtostaffassumingthatrole,accuratedocumentationhasbeendifficulttocapture.Staffarecalledawayfrequentlytodealwithimminentissues.Whenparticipantscomeandgofromthereststopduringtheday,shouldeachvisitbecountedseparately?Howlongareparticipantsoutsidebeforeitcountsasaseparatevisit?Currentlytheprimarypersonresponsiblefortheintegrityofthedatacollectedhasnumerousduties,manymoreimminent.Dedicatingenoughtimetoensurethedataisaccurateisdifficultgiventhecurrentstaffingpatternsanddatacollectionsystem.Inconcertwiththeefforttokeeptheagencylow-barrier,individualleveldataisnotcapturedoneachparticipant,unlesstheyareseeingacasemanager.Astheagencyfacespressuresfromoutsidefunders/publictojustifyitsmodelandcapturemoreaccuratedata,theprogramischallengedtokeepthePRSlow-barrier.Theadditionofanydocumentationstep(s)thatinvolvescollectingdatafromparticipantscanbeunderstoodasabarrierandinordertokeepfidelitywiththisemergingmodelshouldbeweighedcarefully.Athirdareathathasdevelopedoverthisyearintheprogramisthesolidificationoftheagencycultureandearlydevelopmentofmissionandvisionoftheprogram.TheevaluatorswillbringupthisthemeofagencycultureandrespectthroughoutthisreportasitseemstobethefoundationformuchofthesuccessforPūnāwai’sprogramandrelationshipwithclients.PRShasauniqueapproachthatemphasizesremovingsystemicbarriersthatareoftenoverlooked.Minimizingthesebarriersandprovidingservicesinacultureofrespectresultsinhumanizationofservices,allowingforfullerreintegrationofparticipantsandincreasedutilizationofservices.Thisagencyculturehasevolvedoverthelastyearandisseenasaprimarycomponentofthesuccessthattheagencyhasseen.
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SafetyandSecurityConsistentwiththelow-barriermodel,theRestStophasminimalhouserules,balancingeaseofaccesswithmaintenanceofasafeenvironmentforstaffandparticipants.PRShasthefollowinghouserules:
• Nostorageofclientpropertyexceptwhileclientisusingthefacilities
• Onepersonintheshoweratatime(exceptforminorchildrenandcaregiversofdisabledparticipant)
• Cleaningsuppliesandmaterialsforstaffuseonly
• Nothreats,violenceorweapons
• Noverbalabuse
• Noalcohol,illegaldrugsorparaphernalia
• Nosexualactivityorharassment
• Nobusiness(buyingorsellingofgoodsorservices)
• Novandalism,destructionofproperty,orlittering
• Noeatinginthebuilding
• Notheft
• Nocampingorloitering
• Nopanhandling
• Petsmustbekeptundercontrolatalltimes
• Noproselytizing
WhilePRShasfewerrulesandbarrierstoaccessthanothersettings,controllingtheenvironmentisasignificantprogrammaticconcern.Forexample,theRestStopisequippedwithseveralclosedcircuitsurveillancecamerasmonitoredbystaff.Staffregularlysuspendparticipantscaughtviolatingtherules.Analysisofthe41incidentreportsfiledfromSeptember-December,2019yieldedtwocategoriesofincidents;incidentsthatweremedicalinnatureandincidentsthatinvolvedinfractionofrules.Therewere17medicalincidentsresultinginanambulancecallfornineofthoseand24incidentsofrulesviolations,withthepolicebeingcalledfornineofthose.Figure2detailstheincidents.IncidentsarereviewedbytheCenterDirectorandClinicalManagerandchangesmadetoproceduresasneeded.
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Figure 2: Incident Reports September - December 2019
EmployeesofPRShaveavarietyofpersonalandprofessionalphilosophiesthatinfluencehowtheyworkwithparticipantsaroundruleinfractionandenforcementofconsequences.Thetwomaincompetingphilosophiesarearoundthethemesofprovidingconsistentenforcementandstructurefortheparticipants;theotherhasbeentotakeanindividualizedapproachwitheachsituationandtotakeintoconsiderationtheremorseshown,andforgiveness.Thesephilosophicaldifferenceshaveledtomisunderstandingandmiscommunicationamongststaffandparticipantsaroundwhattherulesare,aswellaswhattheconsequencesmaybe.Staffreportedfrustrationaboutinconsistentruleenforcementthatmakesonestaffmembera‘badguy’.Staffhavealsoexpressedconcernthatthissendsconfusingmessagestoparticipantsaswell.Aneedforacommonapproachtoruleenforcementisevident.InitiallyitwasthoughtthatanoutsideservicewouldprovidesecuritypersonnelatPRSonadailybasis.Acontractwithasecurityservicewasexecuted,andsecurityofficersweretobeonsiteduringoperatinghours,from7a.m.-7pm.Staffandmanagementfoundthisservicewasnothelpful,andonoccasion,mayhavebeenharmfultopatrons.Therewerereportsofregulartardinessandcallingoutsick,whichdelayedtheopeningofPRSonsomedays.Securityofficershaddifficultykeepingaccuratestatisticsofpeoplevisitingthecenter.TherewerealsoreportsofinappropriatecontactwithPRSpatrons,includinginappropriateuseofforce,theft,andboundaryviolations.Ininterviews,participantsreportedthatoneoftheprimaryreasonstheyattendedPRSwasbecauseitfeltsafe.Therewasasmallsub-groupofparticipantsthatreportedconcernsrelatedtosafety,includingnotwantingtobringtheirsmallchildrentherebecause“itseemsthreateningforkids”.Additionally,twofemaleparticipantsreportedfeelingunsafe.One
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participantstatedthat“therearealotoffightsgoingonoutsidewhichareveryscary.”Anotherreported“somebodystolethreepursesinonedayoutside.It’skindoffrightening.”Staffexpressedsomeconcernsregardingtheirownsafety.Specifically,astaffmembermentionedtheydiscovereddrugparaphernaliainlaundryequipmentwhenmovingaclientsclothesfromthewashertothedryer.Onaseparateoccasion,astaffmemberfoundthatapipehadburstinsideamachine.Inresponsetotheseincidents,changeshavebeenmade.Clientsmustnowbepresenttomovetheirclothesfromthewashertothedryer.However,thereisanoveralllackofformalsafetypoliciesandproceduresinplacethatarespecifictothePRS.Staffing/HumanResourcesThereareatotalof12fulltimestaffatPūnāwai.Thatnumberhasfluctuatedovertime,aspeoplehaveleftforotheropportunities,beenterminatedandprocessestofillthosepositionshavetakenplace.Atonepoint,staffingwaslowenoughthatitrequiredPRStocloseat3pminsteadoftheusual7pm.Thisonlylastedforafewweeks,butitdidimpactserviceprovisionandaccesstohygieneservices.GiventhecurrentrateofunemploymentinHawaiioverthepastyear,manynonprofitagencieshavestruggledtofillpositionsastheyareoftenonthelowerendofthepayscale.Itwasreportedthattheprogramhasexperiencednear100%turnoverofstaffonthreeseparateoccasionsinthefirstyearoftheprogram.SomeRestStopstaffareformerorcurrentclientsofMentalHealthKokua.Thishasthepotentialtocreatedifficultieswithcreatingandmaintainingboundariesbetweenstaffandclients.Incidentshaveoccurredwheredualrelationshipshavebeenproblematic.StaffhavebeenencouragedtoreflectandworkonsettingboundariesintheirexistingrelationshipswithknownclientspriortoandduringtheiremploymentattheRestStop.Thestaffpositionsallrequirespecializedtrainingincludingtrainingincrisismanagementandde-escalation,activelisteningskills,complexunderstandingofmanagingboundaries,aswellasotherareas.However,theRestStopstaffislargelycomprisedofparaprofessionals,whocannotbeexpectedtohavethesamekindoftrainingassomeonewithafour-yeardegreeinahumanservicesarea.ThisleadstoaneedforcomprehensivetrainingforallstaffatPRS.TheRestStopstaffhavereceivedtrainingsthatarepartoftheMentalHealthKokuageneraltrainingcalendarsuchasHIPAA,basicde-escalationofcrises,andCPR/first-aid.
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EvaluationofOutputs
ServicesPRSstaffhavebeendocumentingserviceprovisionsincetheprogrambegan.Asnotedabove,therehavebeensomechallengestoaccuratedocumentation.Thisdataiscollectedviaasign-insheetatthefrontdeskwhereparticipantsdesignatetheservicestheyareusingthatday.Thereisnoindividualleveldatacollectedonparticipantsatthistimeforgeneralserviceuse,onlyatthelevelofcasemanagementservices.Thissectiondetailstheservicesprovidedperthisdocumentation.Monthlyattendanceisdisplayedinthechartbelow.January2019sawapproximately3075visitsby448guestsandcontinuedtogrowtoupwardsof6500monthlyvisitsinthefollowingmonths.Eachmonthfollowingopeningsawanywherefrom115-232newusers.PRSdatacollectionstaffestimateanaveragedailyattendanceof200guests,andfurtherestimate1000+unduplicatedparticipantsover2019.
Figure 3: 2019 Pūnāwai Rest Stop Visits
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Figure4belowdisplaysmonthlyusesofeachofPRS’coreservices.ShowershaveshowntobeconsistentlypopularamongstPRSclients.Lockersandlaundryhavealsobeenwidelyused.Toiletuseislikelyreportedwithsubstantialerroras,unliketheotherservicestrackedbystaff,useisself-reportedbyguestsviasign-insheetpostedoutsidetherestroomentrance.Privatetoiletsarealsoavailablewithintheshowerroomsandthus,accordingtostaff,notreportedseparatelyfromshoweruse.USmailservicessign-upsshowsthemonthlynumberofPRSclientsregisteringtousePRS’addressasamailingaddress.
Figure 4: 2019 Client Services Use
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ParticipantFeedbackRegardingServicesParticipantfeedbackinformedthisevaluationviatwomethods,analysisofthePulseforGooddataandanalysisof261:1interviewswithparticipants.PulseforGoodThePulseforGoodSurveywasinitiatedinOctoberof2019bytheCity&CountyofHonolulutocaptureclientfeedback.AnelectronictablethasbeenmountedatPRSandparticipantsareencouragedtocompletethebriefsurveyabouttheirexperiencesattheagency.Participantsratefiveaspectsoftheirexperiencesona1-5Likertscale;overall,thisvisit,safety,facilitiesandstaff.Thereisalsospacetogivequalitativefeedback.Duringthistimeperiod(October-December)participantsrated576oftheirvisits.Giventhenatureofhowthesurveyisconducted,thereisnowayofknowinghowmanyuniqueparticipantsmadecomments.Theresultsshouldbeinterpretedcautiouslybecausethosewhotookthesurveymayhavehadapositiveornegativebiastowardthereststopatthetimeofsurveycompletion.Therefore,thisdatamaynotberepresentativeofthetotalpopulationofclientsutilizinginthereststop.Giventhatlimitation,overall,participantsratedtheprogram4.23onthe1(notgood)-5(verygood)scale.Oneweek,12/1-12/7,hadamuchlowersatisfactionthanthegenerallyconsistentresults.Inexploringthedataforthatweek,itisdifficulttoascertainwhytheratingswereloweracrossmeasures.Elevenpeoplecompletedthesurveythatweek,thelowestresponseratesincetheweekthesurveybegan.Thecommentsleftthatweekshednolightonthelowratings.Ofthecategoriesthatdataiscollected,staffhaveconsistentlybeenratedhighestandsafetythelowest.Theredoesnotseemtobeatrendinthedata.Analysisofthe158commentsthatmakeupthequalitativecontentofthesurveysresultedinfourcategories;staff,rules,facilitiesandsuggestionsforadditionalprogramming.
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Figure 5: Pulse for Good Satisfaction Ratings October - December 2019
Commentsaboutstaffmembersweregenerallyverypositive(n=64)vs.negative(n=9).Thefollowingquoteisagoodexampleofthepositivecommentsmade,“IliveonthestreetandamalwaystreatedwithnoughtbutrespectwhenIcomeinhere.”Thenegativecommentsexpressedconcernsaboutstaffyelling(n=1)andhavingdisrespectfulattitudes(n=5).Additionallytherewerefiveparticipantswhoreportedtheneedformorestaffing.Thenextcategoryhadtodowithcommentsabouttherulesoftheprogram(n=9).Fiveparticipantscomplainedabouttherulesoftheprogramasshownbythefollowingparticipant,“Stopthrowingoutitemsfromlockersattheendoftheday.It’shardenoughbeinghomeless.”Anotheraskedthatsleepingbeallowedagain.Finallytwoparticipantsexpressedconcernaboutparticipantsbreakingrulesaroundalcoholanddruguse,“Iseepeopledisrespectingtheprivilegeofferedbydrinkingalcohol,doingdrugsoutsideorinthebathroom.”Concernsaboutthefacilitieshadtodoprimarilywiththeshowers(n=11).Hereparticipantswereconcernedaboutshowersbeingbrokenandunavailable,thelimitsonhotwaterusage,andthelongwaitforshowers.Oneparticipantsummedthisupduringaninterview,“afterbeingsofreeoutfront,youhavetogoback[totheshowers].Youhavetoyelloutformorewaterhalfwaythroughyourshowerwhichseemslikeaprisonsystem”Staffnotethattheprocesstogettheshowersfixedinvolvedmultiplelayersofpermissionanddelays.RecentlyadministrationreportsthattheCity&CountyhasgivenpermissiontoMHKtocontractdirectlytorepairthefacilities.Thisshouldhelpgreatlywiththisissue.
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Anadditionalsuggestionconcerningthefacilitywasaroundoperatinghoursoftheprogram,suggestinglongerhours(n=5)andmorepredictablehours(n=2).Thereweremanysuggestionsforprogramming,themostcommonbeinghavingaTV(n=4)“tonotfeelasisolated,”havingfoodavailableeitherthroughvendingmachines,hotmealsonceamonthorallowingparticipantstoeatinthereststop(n=7),andmakinghygienematerialmoreavailable,includingfemininehygiene(n=5)andadultdiapers/pads.Oneparticipantsuggestedaddressingtheeatingissue,“it’ssupposedtobenofoodinside,onlyoutside.Itwouldbeniceifpeoplecouldeat,self-monitored.Toallowpeopletohavefoodwhiletheysitaroundandwaitforlaundryorplaygameswouldbenice.”Additionalsuggestionsweretoaddsomeclasses,addingcomputers,havingbooksormagazinesavailable,addingabarber,havingtrashbagsavailable,airconditioningonhotdays,andshowingmovies.ParticipantInterviewsParticipantswereaskedtoparticipateinbriefinterviews.Twenty-sixparticipantsagreedtobeinterviewed.TheimpactofthecultureofrespectthatisdeliberatelycultivatedbystaffatPRSwasmadeevidentduringtheseinterviews.Creatingasafespace,thecleanlinessandaestheticofthefacilities,buildingofconnections,andtherespectfulattitudeofstaffweretheprimarycontributorstothesenseofrespectparticipantsreceivedfromtheprogram.Eachofthesethemesarefurtherillustratedbyparticipantcommentsbelow.
Figure6:CultureofRespectatPRS
Figure 6: Culture of Respect at PRS
Havingasafespacewasoneofthewaysthatparticipantsfeltrespected.“Thisisareallysafeenvironment;noharassingbystaff;noharassingpolicepresenceorsecurity.”Participantsconsistentlyspokeabouthowthesafetycreatedwasoneofthereasonstheykeptreturning.Thepresentationofthefacilitieswasnotedasanotherwaytheprogramdemonstratesrespecttotheclients.“Thisplaceisclean.Itshowedmerespectthatway.I’mnotadirty-for-nothing.”Thestaffactivelycommittokeepingthefacilityandresourcesclean.Forexample,
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staffwashdowntheshowersbetweeneachparticipantsuse.Knowingthatrestroomsareclean,thatshowersarecleanedbetweenusersarebothexamplesofhowrespectisshowntoeveryonewhoaccessesPRS.Staffreportthatparticipantshavealsoshownrespectforthepropertyandfacilities,notingthattherehasbeennodamagenorgraffittioverthecourseoftheyear.PRSdemonstratesrespectbybuildingconnectionswithandbetweenparticipants.Manyparticipantshangoutabitduringtheday,multipledaysaweek.Bydoingthat,theybuildconnectionswitheachotherandthestaff.Oneparticipantsummedthisupbysaying“There’sasenseofcommunityhereand[I’m]meetingnewpeopleallthetime.It’slikegoingbacktoschoolagain.”Anotherstated“OnceIhadtousethecomputerimmediatelybuttherewasn’toneavailable.[Astaffperson]tookmetothebacktotheircomputerandsaidIcouldusethatone.It’salloftheselittlethings.Idon’tcomeherethatoften,butwhenIdotheyknowmebyname.”Finally,staffbuildrespectbydemonstratinggenuine,non-judgmentalattitudes.“Idon’tfeeljudgedhere.Thestaffaren’tcocky.”Participantsdescribethestaffaskind,havinggreatenergy,encouraging,helpful,supportive,andhardworking.RespectforeveryoneisafoundationalpartofPRS’services.Inclientinterviews,itwasconsistentlyreportedthatclientsfeltrespectedwhileaccessingthehygienecenter.Thisenvironmentofrespectcannotbeminimized-manyoftheclientshavenotbeentreatedwithbasicrespectforquitesometime.OneparticipantsummeduptheimportanceofthecultureofrespectthatPRSbuildsinthefollowingquote:
“ThisplaceisliketheVIPforthehomeless.Lookatmeinmyrobe,justshowered,waitingformylaundry.It’slikeaspa,ahighclassspaforthehomeless.”
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AUniqueModelofCaseManagementAsignificantdeparturethatPRSmadefromtheUrbanRestStopmodeloutofSeattlewastheadditionofcasemanagement.CasemanagementwasaddedbyMentalHealthKokuaintheirinitialproposalbecauseoftheperceivedneedformoreinterimcasemanagementinthelocalservicesystem.Casemanagementisacommoncomponentinsocialservices,especiallyforindividualswhohaveamentalhealthdiagnosisorwhoareidentifiedashomeless.Thereareseveraldifferentmodelsofcasemanagement,dependingonthelevelofacuity/need,populationserved,aswellasthegoalsandoutcomesthataredesired.TheresearchteaminvestigatedseveraldifferentcasemanagementmodelsthatmostresembledwhatitisthatPRShasbeendoingintheprocessofdevelopingtheirownuniquemodel.TheCriticalTimeIntervention(CTI)Modelisonethathasthreedistinctphasesandistime-limited,usuallyupto9months,withservicesdecreasinginintensityovertime(SilbermanSchoolofSocialWork,n.d.).AnexampleofhowPRSmightprovideaservicethatresemblestheCTImodelisreachingouttoaclient’sfamilyonthecontinent,withclientpermission,tostartrebuildinganinformalsupportnetwork.Theyworktoensurethatbothfamilialsupportandsocialassistancearesetupbeforeassistingaclienttorelocate.TheBrokerage/Generalistmodelsarealsotimelimited,andtheproviderhaslimitedcontactwiththeclient(sometimesasfewas1-2contacts).Thegoalistogetclientsinvolvedinotherservices/supportsystemstomeettheirneeds.(Tonigan,2017).Pūnāwaiisregularlydoing“warm”referralstootheragencies,buttherearegenerallymorethanoneortwocontactswithaclientbeforethathappens.WhilePRScertainlyutilizescomponentsfromboththeCTIandtheBrokeragemodel,theyhave,intheprocess,developedtheirownmodelofcasemanagement.ThePRSModelofCaseManagementThreecasemanagementstaffareavailabletoclientsonadailybasis.Theyaresupervisedbyalicensedclinicianwhomeetsonceaweekroutinelyandonanasneededbasis.WhenPRSinitiallyopened,staffandcasemanagerswouldspendsometimeininitialoutreachwithclientstoletthemknowabouttheservicesavailableandhowtoaccessthem.Overtime,staffandcasemanagersreportedthatpeoplefoundoutabouttheservicethroughwordofmouth-andthatwhentheycameintoPRS,theywouldasktosignuptomeetwithsomeone.TheLeadCenterAssistantactivelyreferspeopletocasemanagementwhentheyhavespecificquestionsoranissuethattheyneedhelpwith.Thisisaprocessthatisnot“paperworkheavy”orthatisdependentupondoinglongpsychosocialreports--itisfocusedonbuildingarelationshipwiththeclient.
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ModelsofCaseManagementWhiletheCriticalTimeIntervention(CTI)modelpresentsengagementandrapportbuildingassomethingthathappensbeforecasemanagementservicesbegin,itisanactivecomponentofestablishingrelationshipswithclientsforPRS-andapartofthecasemanagementprocess.ThisprocessislikelyfurtheredandmayhappenmorequicklybecauseofthecommunityatPRS.PeerswhoalsousePRSareapowerfulpartofthe“wordofmouth”referralsthatgotocasemanagers.Whenclientsfirstsignuptomeetwithcasemanagers,theyareinthe“driver’sseat.”Assistingclientswithimmediateneeds(e.g.,governmentdocumentsorhomelessverification)helpstobuildtrustwithsomeonewhomaynothavepreviouslyhadsuccesswithatraditionalserviceprovider.Havingthatinitial“win”letstheclientknowthatthecasemanagerisinapositiontohelpandfollowthroughwithrequestsforassistance.TheBrokeragemodelisaboutlinkingclientswiththeservicesthattheyneed-notrelyingasheavilyonrapportandrelationshipbuilding.Itistypicallyaverybriefmodel-theremayonlybeoneortwomeetings.Theprocessismuchlessfocusedonmonitoringandoutcomes,astheoutcomesarethoselinkages.Whentherearelargersystemsinvolved,HomelessManagementInformationSystem,forexample,itcansometimesbeeasiertotrackandfollowclientsastheymaketheirwaythroughtheentiresystem.
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Figure7:ComponentsofPūnāwaiCaseManagementModel
Figure 7: Components of Pūnāwai Management Model
HowPūnāwaiisDifferentThereareseveraldifferencesthatwerenotedininterviewingcasemanagersabouthowservicesareprovidedtoclients:
• Atitscore,itisaboutrelationshipbuildingandtrust• Clientsarenotoverburdenedwithpaperworktogetservicesortocontinueservices• Thereisnotawait-listtoaccessservices• Casemanagerstakeanactiverolesuchasprovidingtransportation,goingwith
clientstomeetingstoassistinnavigatingsystems,ormakingcallsonbehalfofclients
ThefactthatPRS’modelisuniquedoesnotmeanthatitiswithoutchallenges.Thepopulationbeingservedarepotentiallydealingwithavarietyofconcerns:lackofhousing,substanceuse,personalsafetyandsurvival,complexhealthneeds,mentalhealthneeds,etcetera.Theremayalsobedifficultyinaccessingtransportation,aswellastelephoneandcomputerservices.Allofthesecancontributetoclientshavingdifficultywithfollowingup,beinglateormissingappointments,andtracking/navigatingnewsystems.Onechallengethatthecasemanagershavefacedoverthepastyearishowtousedocumentationinthecasemanagementprocess.Consistentwiththeprogram’smissionofoutputs,casemanagerskeptdocumentationprimarilydirectedatoutputs;recordinghowmanyarebeingreferredforhousing,forSNAPbenefits,etc.Additionally,recordswerekeptintheinterestoftheparticipantssuchascopiesofidentificationdocumentsincase
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participantslostthem.DatawasalsocollectedanddocumentedintheHomelessManagementInformationSystemasneeded,suchaswhenaVulnerabilityIndex-ServicePrioritizationDecisionAssistanceToolwascompleted.Emphasiswasonprovisionofservices,withlittleemphasisondocumentingthoseservices.Consentsforservicesweretypicallycompleted,butlittleelseintheformoftraditionalclinicaldocumentationwasfound.TherewereveryfewclosuresofcasesduringtheyearthatPRShasbeenopen.Atthisjuncture,thecasemanagementteamhasrecognizedtheneedforincreaseddocumentationandstandardizationofrecordsinordertominimizerisk,improvecontinuityofservices,ensureparticipantrightsregardingconsent,andbetterdemonstrateachievementofagencygoals.Thechallengefortheteamissimilartothechallengesthe‘frontend’oftheprogramfacesregardingbalancingtheneedfordataanddocumentationwiththeneed/desiretokeeptheprogramlowbarrier.CaseManagementDataOverviewofCaseManagementParticipantsDuringthe2019year,PRScasemanagersservedapproximately371participants.Thesenumbersmaybehigherduetonotrecordingparticipantswhoreceivedarapidhand-offtoanotheragencyorwhowerecontactedviacasemanagementoutreachaimedatrapport-building.DocumentationofcasemanagementservicesevolvedthroughouttheyearthatPRShasbeenopen.Thedatasummarizedbelowisbasedondatacollectedbythevariouscasemanagersthroughouttheprogram,butismuchmoreaccuratelyreflectingthelastsixmonthsofservices.Documentationofcasemanagementserviceshasbeenevolvingthroughthedevelopmentoftheprogram.Thedatapresentedisdrawnfromthe312participantsonwhomdatawascollected.Race/EthnicityPRScasemanagersservedparticipantsofabroadvarietyofracial/ethnicgroups,presentedinFigure8.
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Figure 8: Race/Ethnicity of Case Management Participants
IncomeStatusForthe312participantsincasemanagement,40%reportednoincome.Fortheother60%,thesourcesofincomearereportedbelow.
Figure 9: Income Source of Case Management Participants
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Theamountofincomerangesfrom$0-$4880/month.Fifty-sevenpercentofparticipantsincasemanagementreportedlessthan$500/monthinincome.
Figure 10: Income Amounts of Case Management Participants
AccesstoSNAPBenefitsFoodsecurityisasignificantconcernforpersonsexperiencinghomelessness.ThegraphbelowdetailswhethercasemanagementparticipantswerereceivingSNAPbenefits.
Figure 11: SNAP Benefit Status of Case Management Participants
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HousingStatusHousingstatusforthoseparticipatingincasemanagementisreportedbelow.Thecategoryof‘Sheltered’includesparticipantswhoarecurrentlyinasocialservicehousingprogramsuchasNextStep,HaleMauliola,andIHS.Thecategoryof‘UnstableHoused’includesthoseindangerofeviction,inthehospital,orlosingbenefits.
Figure 12: Housing Status of Case Management Participants
MedicalInsuranceStatusHavingmedicalinsuranceisasignificantneedforpersonsexperiencinghomelessness.
Figure 13: Medical Insurance Status of Case Management Participants
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IdentificationDocumentStatusHavinglegaldocumentsthatconfirmidentityisanecessityinordertoescapehomelessness.Lackoflegalidentification(stateidentification,birthcertificate,driverslicense,socialsecuritycard)isabarriertoaccessingbenefitssuchasmedicalinsuranceandSNAPaswellasreceivinghousingorobtainingemployment.Keepingyourvitaldocumentsisoftenastruggleforpersonswhoarehomelessastheymovearoundalot,haveitemsstolen,orlosetheirpossessionscaughtupin“homelesssweeps”(Darrah-Okike,Soakai,Nakaoka,Dunson-Strane,&Umemoto,2018).PRSservestohelpinthisareabyassistingparticipantsingettingtheirdocumentsaswellasstoringacopyofthedocumentsintheircasefiles.Thefigurebelowillustratesthedocumentstatusforthosewhoparticipatedincasemanagementservices.
Figure 14: Documentation Status of Case Management Participants
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NeedsofCaseManagementParticipantsReviewofthecasemanagersdocumentationrevealedavarietyofneeds.Someneedsrequiredasinglevisitorreferralandothersrequiredmultiplemeetingsandfollow-up.Thechartbelowsummarizestheneedsexpressedbythecasemanagementparticipants.
Figure 15: Case Management Needs of Case Management Participants
Housingneedsincludedsupporttomaintainhousing,generalhousingreferrals,andassistancefindingspecifictypesofhousingsuchasclean&soberhousing,section8housing,andseniorhousing.Financialneedsincludedageneralneedforincome,needtohelpwithbuildingsavings,andhelpwithbudgeting.Medicalneedsincludedassistanceobtainingmedicalinsurance,andreferralsformedicationmanagement,nursingcare,andlongtermcare.Benefitneedsincludedhelpobtainingbenefitssuchasfoodstamps,SSI,SSDI,orgeneralassistanceaswellasproblemswithcurrentbenefits.Thirtyparticipantsdidnotfollowupwiththecasemanagersaftertheirinitialvisitandsodidnothaveaneedlisted.
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Finally,the‘other’categoryincludedASLsupport,helpwithgettingmorefamilysupport,andassistancewitheldercare.Ananalysisofthebarriersofgettingtheabovementionedneedsmetrevealedthatthenumberonebarrierwaslackoffollow-uponthepartof40%oftheparticipantsincasemanagement.
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EvaluationofOutcomes
Evaluationofoutcomesisnottheprimaryfocusofthisreport.Asmentioned,PRSdatacollectionisaimedatcapturingtheoutputsoftheprogram,consistentwiththeirfundingcontract.Duringthisevaluation,qualitativedatawascollectedthatreflectsontheshort-term,mid-term,andlong-termoutcomesoftheprogramover2019.Becauseoftheuniquenessofthismodel,itisstronglyrecommendedthatoutcomemeasuresaredevelopedtofullycapturehowthisprogramimprovesthelivesofitsparticipantsandthecommunityofHawai`i.PūnāwaiRestStopasaSafetyNetOneoutcomethatisevidentrelatestotheroleofPRSintheoverallsystemofcareinthestate.ThedatasuggeststhatPRSisfillingagapinthecurrentsystem,servingasasafetynetforthoseexperiencinghomelessness.Evidenceofthiscamefromthestaffandcasemanagerinterviews,participantinterviews,andcommunitypartnersurveys.Inordertounderstandhowthisoccurs,anunderstandingofthepresentsystemisimportant.Figure16:PRSSafetyNet
Figure 16: PRS as Safety Net
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PRSprovidesservicestothosewithlittleornoconnectiontotraditionalserviceproviders.Additionally,PRSsupportsotherserviceprovidersbyprovidingservicestheydonotprovide.PRSservesasacatch-allforthesystem.ThiswasmostclearlyevidencedbyaPRScasemanagerwhoreported:
“WhenIwasgoingthroughtheCESlisttoreviewtoseewheresomeofmyclientswereonthewaitinglist,Isawanameofoneofourclients.Hehadn’tbeenaroundmuchlately.Hisnamehadrisentothetopandhewaseligibleforhousing,buthewasn’tabletobelocated.Inaweekhewouldhavebeenremovedfromthelist.Iknewthatanotherofourcasemanagerswasworkingwithhim,soIlethimknow.He’snowabouttoenteranapartment.He’sbeenonthestreetsforyears.Luckywefoundhim.”
EarlyImpactsonParticipantsTheimpactofPRSonthelivesofitsparticipantswasexpressedthroughparticipantinterviews.Theinterviewshighlightedhowtheservicesimprovelives:
• “I’vehadseveraljobsfrombeingabletousetheinternet,showers,andwashers.”• “Wecanusethelockersandgetourstuffattheendoftheday.Wecanleaveand
comeback,likeifIhaveanintervieworwanttogotothegym.”Theimpactsoccurredintermsofincreasingresourcesavailable:
• “Mycasemanagerhelpedmealotwithgettingmydisabilitybenefits.Icouldn’tfindouthowtopullmymedicalrecords.SomethingthattookmemonthsoflookingintowhichIeventuallygaveupon,shewasabletofindinliketwodays.”
• “Igothelpapplyingforfoodstampsandfindinghousing.”Impactsareoccurringrelatedtochangesinbehavior,beliefs,andattitudes:
• “Itgivesasolidfoundationthatmakeslifeeasier.Itchangedeverything.”• “Notjustyourcurrentsituationcanbehelpedhere,butyourfuturesituationtoo
becauseofthecasemanagershere.”Casemanagers,throughreviewoftheircaserecords,estimatethattheyhaveassistedapproximately92participantstosecurehousing,35participantsfindsomelevelofemployment,and10participantsenterintosubstanceusetreatment.Thisdata,fromthecasemanagersandtheparticipants,suggestspotentialoutcomemeasurestopursuewhenestablishinganongoingevaluationplan.Theyhintatthenotionthatprovidingrespectasthefoundationofservices,eliminatingasmanybarriersaspossible,andfocusingonconnectioncanresultinchange.
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EvaluationofCommunityPerspectivesThereistangibleevidenceofcommunitysupportintheformofdonationsofgoods,time,andservices.Therehavebeenmultipledonationsofgoodsmadeovertheyear,fromsmalldonationsofextraclothingtolargedonationssuchascasesoftowelsdonatedbyAlscoAmericanLinen.Additionally,therehavebeenmanyorganizationswhohavedonatedtheirtimeandskillstoimprovethelivesofparticipantsofPRS.SomeoftheseprovidershavenowestablishedregularservicetimessothatparticipantscangetspecificneedsmetsuchasthePublicDefender’sofficeandtheStreetDogCoalition.Thelatterreportedthattheyheld21animalclinicsatPRSduringwhichtheycompleted229appointmentsonanimalsthatincludedflea/ticktreatment,vaccinations,spaysandneuters,dentalcleanings,and/ordistributionofpetsuppliesandfood.Thesedonationsofgoods,timeandservicesextendedthereachofPRSservices.LocalBusinessesLocalbusinessesandunrelatedagencieswerevisited,aswellascontactedviaemailandtelephonetorequesttheirparticipationinanopen-endedresponsesurvey.ThiswasperformedattherequestofMHKinordertogaugetheexperiencesofoutsidestakeholdersinordertobegoodneighbors.QuestionsfocusedonexperiencesbothbeforeandafterPRSwasintheareaaswellasthoughtsonsafety,communication,andoverallimpressions.Nineteenlocalbusinesses/agencieswerecontactedandwereceivedtenresponsesfromninebusinesses.Businesses’depthoffeedbackandleveloffamiliaritywithPRSshowedastrongcorrelationbetweentheirlocationrelativetoPRS.ThosecloserinproximityexhibitedahigherdegreeoffamiliaritywithPRS’operationsandexpressedastrongervestedinterestintheexistenceandlocationofPRS.BusinesseswhichwerelocatedfromonetoseveralblocksawayexpressedminimalfamiliaritywithPRSandfairlyneutralattitudestowardsthereststop,withseveralrespondentsadvisingtheywereunawarethatPRSexisted.Whilemostareastakeholdersexpressedconcernandahighdegreeofnegativityoverthehomelesssituationintheareaingeneral,thoselocatedonthesameblockand/oradjacenttoPRSexpressedsomedegreeofreservationwiththecurrentlocationofPRS.Severaladjacentbusinessesexpressedconcernswithrespecttocustomerexperience,areasafety,nuisance,and/orloiteringontheblock.Severaladjacentstakeholdersalsofelttherehadbeenalackofcommunication,outreach,andeducationprovidedtothembyPRS.MostareastakeholdersexpressedsupportforthecoreservicesPRSprovidesthehomelesscommunity.Someoftheconcernspresentedbytheadjacentbusinessesand/oragenciesaboutrecentincidentsrelatingtopersonsassumedtobehomelessincluded,butwerenotlimitedtothefollowing:
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• Staffandcustomersfeelingunsafeand/orbeingapproachedbypersonswhoseemhomelessastheygetinandoutoftheirvehicles
• Theftofcustomers’and/orvendors’belongings(suchastools,deliveries)fromtheirvehicles
• PRSclientsloitering,campingand/orhangingoutinfrontofthebuilding• Safetyissuessuchasfightingbetweenand/orassaultingofotherPRSclients• Break-ins,pettydamage,andneedles/trashinthevicinity• PRSparticipantstraversingthroughtheirbuildingasashortcutfromother
homelessservicesprovidersonneighboringblocks• Personsassumedtobehomelessdefecatingand/orurinatinginthehallways
and/oroutsideoftheirbuildings• Alackofconsultationandcommunicationprovidedtothe
businesses/agenciesintheareabothpriortoandafteropeningPRS• Lackofadequateeducationprovidedtotheareastakeholdersabouthowto
handleincidentsthatarisewithrespecttoPRSand/ortheirclientsGovernmentPartnersRelevantlocalandstategovernmentrepresentativeswerecontactedviaemailandtelephonetorequestthattheytakepartinashortopen-endedresponsesurvey.Questionsaskedcoveredtheofficials’opinionofandsupportforPRS,community/constituentfeedback,andanopportunitytoshareanyrelevantexperiences.Onlyone(n=1)officialprovidedresponses.TherespondentexpressedsupportforPRSandsharedthathehadnotreceivedfeedbackonthereststopfromtheconstituentsinthearea,negativeorpositive.Therespondentadvisednegativefeedbackfromareaconstituentshavebeenaboutthehomelesssituationintheareaingeneral,andnocomplaintswithrespecttoPRShadbeenreceived.The2019monthlymeetingminutesfromneighborhoodboardmeetingsintheDowntown-ChinatownandKalihi-Palamaareaswerereviewed.Theminutesfromlastthreemonthlymeetingsof2018intheDowntown-ChinatowndistrictwerealsoauditedtogaugeattitudesaboutPRSpriortoopening.ConcernssurroundinghomelessnesswerediscussedatlengthintheDowntown-Chinatownmeetings,includingissuessurroundingsafety,impacttobusinesses,publicnuisance,publicintoxication,publicdefecationandurination,loitering,andhomelessencampments,amongothers.Whilecommunityconcernswithrespecttohomelessnesswereacommonthemeinbothdistricts(andparticularlyintheDowntown-Chinatowndistrict),meetingattendeesandboardmembershadlittlecommentaryonPRSspecifically.IntheNovember2018Downtown-Chinatownmeeting,theboardrequestedtohaveotherservicesforthehomelessrelocatedtoPRS’newestablishment,suchastheRiverofLifeMissionmeals.Inmanymeetings,repeatedrequestsweremadeforservicessuchasthePauahiStreetHygieneCentertobemoved.PRS’location,slightlyfurtherawayfromthecoreofChinatown,maythenhelpsatisfyChinatownbusinessowners’andboardmembers’concerns.
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HomelessProviderPartnersAnelectronicsurveywassenttohomelessserviceprovidersthroughPartnersinCare(PIC).PICisaplanning,coordinating,andadvocacyalliancethatdevelopsrecommendationsforprogramsandservicestofillneedswithinOahu’sContinuumofCare(CoC)forhomelesspersons.Atotaloffifteenindividualsrespondedtothesurvey(n=15).RespondentshadaverygoodunderstandingoftheservicesthatPRSoffers;100%ofthemidentifiedatleasttwoofthecoreservicesavailableand12out15(80%)wereabletolistfourormore.AlloftherespondentshadreferredpeopletoPRSforservices(oneagencydoesnotprovidedirectservicessotheywerenotcountedforthiscategory).BelowisachartthatdescribeswhyclientswerereferredtoPRS.
Figure#17:ReasonforReferraltoPRS
Figure 17: Reason for Referral to Pūnāwai Rest Stop
WhenaskedwhatitisthatPRSdoesbest,respondentshadverypositivethingstosay:
• “Allofit,butespeciallythehours[of]availability.7to7,sevendaysaweekmakesiteasytoremember--andisahugeamountoftimetobeavailable.”
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• “Thestaffissuper!Iamnewtothecommunityworkerroleandtheywerewelcomingandinformative,eveniftheywerebusy.”
• “It[Pūnāwai]providespeaceofmindandcomfortwhenthey[peoplewhoarehomeless]otherwisedon'tgetany.”
ProvidersalsorespondedtoaquestionabouthowPRShaschangedthelandscapeofservicesonOahuforpeoplewhoarehomeless.Fromtheresponses,itisevidentthatPRShashadquiteanimpactduringitsfirstyearofprovidingservices:
• “It'sbeenagamechangeriswhatourclientshavestated.”• “Ithinkitfillsanextremelyimportantniche.”• “It'salow-barrierplaceforpeopletoaccessbasicservices.Thebuildingitselfisclean
andthestaffarefriendly,whichisachangefromotherhomelessproviders.”• “It'sasteady/stationaryplacethatpeoplecango,whereIknowtheycanbe
connectedtoserviceswithoutpressuringthemaboutshelter.”
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Recommendations
• AsPRShasdevelopedoverthepastyear,auniqueandexcitingprogramisemerging.Thishasleadtothepresentneedforclarificationofmissionandvisionandtheoperatingprinciplesoftheprogram.Creationofavisionstatementwouldhelpwiththechallengestoconsistencythatstaffidentified.Inaddition,thiswouldhelpwithmissiondriftastheprogrammovesintoitssecondyearandwilllikelyexperiencemultiplepressurestoexpandservices.Focusingonfurtherdevelopingthequalityofcurrentservicesisrecommendedratherthanventuringintoserviceexpansion.
• TheneedfortheservicesatPRSisevident.Theyareaveragingapproximately230
participantvisits/daywithdaysofover300visits,muchhigherthantheoriginal120visits/daythatwasanticipatedwhenthecontractwaswritten.Giventhis,issuesofcapacityneedtobekeptintheforefrontofplanningefforts.Thefacilityislimitedintermsofspaceandthenumberofshowers,washers,anddryersitcanhouse.Also,theabilityofstafftomaintainqualityandsafetyhasalimitintermsofnumberofparticipants.Monitoringincidentreports,staffmorale,andusageofservicesmayprovidedirectionintermsofneedtoincreasestaff,expandhours,orchangeprogramming.OpeningofanadditionalreststopinanotherHonoluluneighborhoodwouldalsoberecommended.
• Generalpoliciesfromtheoperatingorganization,MHK,donotadequatelyaddress
someoftheuniqueneedsofthisprogram.PRShasbeenadaptingwelltotheneedsofparticipants,buthasdonesoonaveryinformalbasis.Itisrecommendedthatpoliciesandproceduresbeformalizedandwrittendown.Thiswillhelpwithstaffconsistency,anexpressedconcernofstaff.Itisfurtherrecommendedthattheseproceduresbemadeavailabletoparticipantstohelpwiththeircooperationandunderstanding.Creatinganddistributinganorganizationalchartthatclearlydefinespositionsandrolesisrecommended.Writtenproceduresareneededinareassuchas:
o Enforcementofthehouseruleso Managementofoutsidespaceso Howvariousservicessuchasmail/shower/lockerworks
• Relatedly,specifictrainingandsupportissuggestedforstafftosupportthe
challengingworkthattheydo.PRSstafffacefrequentoutburstsanddisruptions,necessitatingamoreadvancedlevelofcrisisandde-escalationtraining.Indepthtrainingonadvancedactivelisteningskills,expressingempathy,andproblemsolvingwouldgreatlybenefitstaff.Traininginhowtoeffectivelymanageboundariesisnecessarygiventheuniquechallengestoboundariesthatthisstafffaces.Anotherareaoftrainingthatwouldbehelpfulforstaffisintraumainformedcareasthispopulationhasatypicallyhighincidenceoftrauma.Afourthareaoftrainingisrecommendedthatisconsistentwiththepopulationservedisintheareaofnaloxonetrainingandharmreductionprogramming.
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• StaffretentionhasbeenaproblematPRS,acommonrealityformanynon-profitsinHawai`i.Onepositiveresponsetothisproblemthatwasmadepartwaythroughtheyearwastheincreaseinhourlywageto$15/hourfor‘CenterAssistants’.Inordertorecruitandretainqualifiedstaff,itisrecommendedthatanewcategoryofstaffbecreated.Currentlythereare‘CenterAssistants’and‘LeadCenterAssistants.’Giventheknowledgeandskilldemandsofthejob,significantadditionaltrainingofentry-levelstaffisneeded.Creatinga‘CenterAssociate’categoryforstaffwhohavecompletedtheextensiveadditionaltrainingwithadditionalcommensuratedutiesassignedwouldrecognizethatadvancement.Thiswouldservetohelpwithretentionaswellasimproveoverallcompetenceofstaff.
• Documentationintheareaofcasemanagementservicesneedstobestandardized
andbroughtmoreinlinewithcurrentpracticesinthefield.CurrentcasemanagementpracticesatPRSleavetheorganizationvulnerabletorisk.Thereisabroadrangeofdocumentationpracticesinthefieldofcasemanagement,fromtheextensivechartingthatoccursforCARFaccreditationtominimalnote-takingcommonamongstoutreachcasemanagementwork.Itisrecommendedthatthecasemanagementteamdevelopstandardchartingprotocolsthatfitwiththeirlow-barriermodel,suchasaconsenttoengage,co-developmentofaserviceplan,andstandardsaboutwhentoclosecases.
• PRShasdoneanexcellentjobofcreatingasenseofcommunitywithinthecenteras
wellaswithpartneragencies.ThisisevidentfromthelonglistofproviderswhohavevisitedanddeliveredservicesatPRS.Althougheffortsweremadeinthebeginningtoengagelocalbusinesses,itisclearthatengagementneedstobesustained.EvaluationresultsshowthatbusinessesaresignificantlyimpactedbypersonswhoarehomelessintheareaandareinterestedintheservicesPRSprovides.Havingregularcommunicationwiththesebusinesseswouldprovideanopportunityforcollaborationandeducationforbothparties.Itisrecommendedthataflyerwithacleardescriptionofservicesandanopeninvitationtolocalbusinessestocalliftheyneedassistancewithparticularincidentsorwanttorefersomeoneforservices.
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• Bestpracticesforthesocialservicessectorsuggeststhateveryprogramshouldhaveaprogramevaluationplaninplace(Janzen,Ochocka,Turner,Cook,Franklin&Deichert,2017).SomeofthechallengesforPRSinimplementinganevaluationplanarelimitedavailabilityofstaff,needtokeepagencylowbarrierandsominimizedatacollectedincludingthenumberofformsbeingfilledoutbyparticipants,andalimitedbudget.However,inordertocapturewhatishappeningatPRSandresistthepullthatmayoccurtoerectthesamebarriersthatotheragencieshavedone,documentingthesuccessesandwhatinthismodelleadstothesesuccessesisimportant.Evaluationplansarepresentedbelow.
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OngoingEvaluationPlanTwoevaluationplansarepresentedbelow.Oneplanrequiresaminimalcommitmentofresourcesandyetwillprovidedataonoutcomes.Thesecondplanwouldrequireinvestment,possiblyofafundingpartner,andisaimedatbetterarticulatingthecasemanagementmodelatPRSanddefiningthevariouspathwaystosuccessintheprogram.Bothoptionswouldrequireachangeindatacollectionprocedurestobettercaptureaccuratedata.OutcomeMeasuresDevelopment of appropriate outcome measures and targets needs to be done. Datacollection procedures would need to be implemented to capture the data directed atinforming these targets. Below details potential measures and targets for each level ofoutcome.
1. Short-termoutcomesa. Improvedhygiene
i. #showering/laundry-whatelseherearoundhygieneb. Improvedhealth
i. Self-reportedimprovedhealthstatusc. Improvedself-worth
i. Self-reportedimprovedself-worthd. Improvedexperienceofsafety
i. Decreaseinreportedincidentsofvictimizationii. Standardizingincidentreportdocumentationandmonitoring
e. IncreasedengagementinPRSi. 60%participantsengageinmorethanoneserviceovertime
f. Engagementincasemanagementi. 30%participateincasemanagement
2. Mid-termoutcomesa. 60%casemanagementparticipantsactive
i. Havesignedplanofserviceprovisionii. Makeprogressonplanmonthly-objectivesbeingaccomplished
b. 60%casemanagementparticipantsexperiencehand-offtootherserviceprovider
i. Increasenumberofreferralsmadeii. 50%ofthosereferralsresultinactualfollow-upbyparticipants
c. 80%participantsincasemanagementhaveanincreaseinfinancialresourcesavailabletothem
3. Long-termoutcomes
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i. LongtermoutcomesarenotthefocusofserviceprovisionatPRS;itisnotrecommendedtofocusondatacollectionaroundtheseoutcomesatthistime.PRSmaywanttoaddressthisinthefuture,butitismoreimportanttolookatdataaroundtheoutputsandshorttomidtermoutcomes.
BasicEvaluationPlanAbriefqualityoflifesurveywouldbedevelopedtocapturedataontheparticipants’currenthygiene,health,senseofsafety/victimization,andself-worth.ArandomnumberofparticipantscouldbeaskedtocompletethesurveywhentheybeginservicesatPRS.Staffwouldthenreconnectwiththesameparticipantsat3monthsandagainat6monthstoreadministerthesurvey.Thiswouldprovidedatarelatedtochangeinqualityoflifewhileparticipatingintheprogram.Onthecasemanagementside,amonthlydatacollectionformcouldbecreatedtocapturethepercentageoffileswithacurrentsignedserviceplan,aratingbythecasemanagerofprogresstowardgoals,trackingofthenumberofreferralsmade,trackingofchangeinincomestatusforparticipants,andnumberofcasesclosedwithadeterminationofreasonforclosure(i.e.participantdroppedoutofservices,participantbeingservedbyanotheragency,etc.).AdvancedEvaluationPlanThisplanisaimedatbetterarticulatingthePRScasemanagementmodelanddefiningthevariouspathwaystosuccessfuloutcomes.Theevaluationwouldincludeunderstandingwhattheindividualdifferencesandtreatmentdifferencesarethatmightpredictchange.Potentialindividualdifferencesincludedemographics,substanceusehistory,severityofillness,andcomorbidityofillnesses.Treatmentdifferencesincludedifferencesinamountandtypeofservices.ItisrecommendedthatanumberofparticipantsarerandomlyrecruitedtoparticipateinmoreextensivedatacollectionthantheBasicEvaluationPlanarticulatedabove.Incentivescouldbeusedtokeepparticipantsengagedovertheevaluationperiodasthispopulationisoftenmobileanddifficulttoreach.Participantswouldbeinterviewedquarterlyovera1-yearperiodwithdatacollectedonsatisfaction,functioning,qualityoflife,andclinicalstatus.Therearemultiplewell-beingmeasuresthatcouldbeusedtoassesseachoftheseareasincludingtheBriefSymptomInventory,theSocialAdjustmentScale,andtheQualityofLifeInventory.Followingparticipantsinthiswayovera1-yearperiodwouldgivePRSabetterunderstandingoftheeffectsthattheprogramishavingonparticipantsanddocumentchange.
2
ReferencesDarrah-Okike,J.,Soakai,S.,Nakaoka,S.,Dunson-Strane,T.,&Umemoto,K.(2018).“ItwaslikeIlosteverything”:theharmfulimpactsofhomeless-targetedpolicies.JournalofHousingPolicyDebate,28(4),pp.635-651.Hawai`iPolicy&BudgetCenter(2019).HowHawai`iisspendingitsmoney,2018-19.Retrievedfrom:https://hibudget.org/2019/03/how-hawaii-spending-money-2018-19/Janzen,R.,Ochocka,J.,Turner,L.,Cook,T.,Franklin,M.,&Deichert,D.(2017).Buildingacommunity-basedcultureofevaluation.EvaluationandProgramPlanning,65,pp.163-170.Lee,B.A.,&Schreck,C.J.(2005).Dangeronthestreets:Marginalityandvictimizationamonghomelesspeople.AmericanBehavioralScientist,48(8),1055-1081.Mayor’sOfficeofHousing(2019).WhatistheCitydoingtohelp.Retrievedfrom:http://www.honolulu.gov/housing/homelessness/ohou-what.htmlNakaso,D.(2/4/19).HomelessflocktoIwileireststop,butfewusesocialservices.HonoluluStarAdvertiser.Retrievedfrom:https://www.staradvertiser.com/2019/02/04/hawaii-news/homeless-flock-to-rest-stop-but-few-use-social-services/CenterfortheAdvancementofCriticalTimeIntervention(n.d.).AbouttheCTImodel.SilbermanSchoolofSocialWork.Retrievedfrom:https://live-critical-time-intervention.pantheon.io/wp-content/uploads/2014/08/About-the-CTI-Model-82114.pdfTonigan,A.(2017).Substanceabusespecificintensivecasemanagement.Retrievedfrom:http://isr.unm.edu/centers/center-for-applied-research-and-analysis/behavioral-health-initiative-reports/summarized-literature-reviews/intensive-case-management.pdf)Weiss,C.&Quinn,D.(2018).Stigmatizedidentities,psychologicaldistress,andphysicalhealth:Intersectionsofhomelessnessandrace.Stigma&Health(3),pp.229-240.
Appendices
I
EvaluationMethodologyThisprogramevaluationreportfocusesontheimplementationofthePūnāwaiRestStopinHonolulufromJanuary2019throughDecember2019.Inparticular,theevaluationstrivesto:
• Understandaspectsofserviceprovisionandimplementation;• Detectoutputsandimpact;• Presentalogicmodelfortheprogram;• Giverecommendationsregardingprogramdevelopmentandevaluationmoving
forward.ThecontractforevaluationwascompletedinOctoberof2019,andworkbeganassoonasitwassigned.Threeresearchassistantswerehiredtoassistthetwofacultywholedtheevaluation.AnundergraduateSocialWorkresearchclasswasalsoinvolvedinthedevelopmentofinstrumentsandconductinginterviews.Theevaluationteamdevelopedamulti-prongedapproachtocollectdatafrominternalandexternalstakeholderstogivebroadperspectivesontheimpactofPRS’firstyearofservice.Allinstrumentsdevelopedbytheevaluatorsareincludedasanappendix.Amixofquantitativeandqualitativedatawascollectedandanalyzedaccordingly.SourcesofData
• Interviewswithstaff,casemanagers,casemanagersupervisor,andprogrammanager
• Notesfromweeklystaff/casemanagementmeetings• Interviewswithclients• Interviewswithparticipantswhomstaffidentifiedas‘successstories’• Interviewswithnearbybusinesses• Interviewwithgovernmentofficial• WeeklyoutputreportssenttoCityandCountyofHonolulu• PulseforGooddata• CaseManagementIntakeDataSpreadsheet• SurveytoHomelessServiceProviders• Incidentreports• NeighborhoodBoardMeetingMinutes• HMIS• OrganizationalChart(s)
II
InterviewQuestions–Participants
1. WhatmadeyoufirstcometoPRS?Howdidyouhearaboutit?2. WhatdoyoudoatPRS?3. HowhascomingtoPRSmadeadifferenceinyourlife?4. Whatarethestafflike?5. Doyouseeacasemanagerhere?Whatisthatlike?6. Anysuggestionsforimprovement?
SurveyQuestions–AreaBusinesses
1. HaveyouheardaboutPūnāwaiRestStop?a. Ifyes,canyoutellmewhatyou’veheardandwhatyouknowaboutwhatthe
agencydoes?b. Ifyes,whenyouheardthereststopwasgoingtobeestablished,whatwere
youexpecting?c. Ifyes,whatactuallyhappened?Wastheexperiencedifferentthanyouwere
expecting,oraboutthesame?d. If yes, do you feel as though your safety has been impacted? For the
better/worse?2. How has the situation in the area changed over the last year? (ex.more or fewer
encampments in the area, more or less crime [perceived or actual], increase ordecrease in litter, any break ins/loitering? Etc) What changes have you noticedoverall,whethergood,bad,orneutral?
3. Has the Pūnāwai staff or Mental Health Kokua reached out to your business atall?Haveyoumetanyofthestaff?
4. Whatareyouroverallimpressionsoftheservicethusfar(ifany)?5. WhatareyouroverallimpressionsofhowhavingaprogramlikePūnāwaiRestStopis
impactingthearea?Doyouforeseeanyfurtherchangesorimpactshappening?6. Isthereanythingyouarehopingtoseechanged?7. Are there any thoughts or suggestions youwould like to share? Do you have any
commentsonanythingthathasn’tbeencoveredinthepreviousquestions?SurveyQuestions-PartnerAgencies
1. WhatisyourunderstandingoftheservicesthatPūnāwaiRestStopprovides?2. Haveyou/youragency/yourprogramreferredclientstoPūnāwai?
a. Approximatelyhowmany?b. Whatwerethereason(s)foryourreferral?
3. Haveyou/youragency/yourprogramreceivedreferralsfromPūnāwai?
III
a. Approximatelyhowmany?b. Whyweretheyreferredtoyou/youragency?
4. HasPūnāwaihelpedyouragency/programinprovidingservicestoyourclients?How?5. How do you think Pūnāwai has changed services available for people who are
homeless?6. WhatdoyouthinkPūnāwaidoesbest?7. Doyouhaveanyrecommendations/suggestionsforPūnāwaimovingforward?8. Wouldyouliketoreceivemoreinformation/educationabouttheservicesthatPūnāwai
provides?Ifso,pleaseenteryournameandemail.
