HOME TEAM PROJECT EVALUTION

24 months of operation

July 2010 through June 2012

By

Thomas Chalmers McLaughlin, PhD

University of New England

January 2013

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Overview

The HOME project in Portland is an ambitious collaborative venture between the City of

Portland, Preble Street, the Milestone Foundation, the University of New England, School of

Social Work and Opportunity Alliance to provide outreach and community supports to those

living on the streets who have chronic health and substance abuse problems. The project is based

on successful projects in Cambridge, Massachusetts and in Burlington Vermont which aim to

divert frequent users of hospital emergency rooms and other health care systems away from these

systems in into more appropriate treatment and support environments, and to provide active

regular outreach in the downtown areas of each city. In most cases, these high end users present

at the emergency rooms with non-emergency, non-medical issues.

This report continues the evaluation of the HOME team deployments, high

frequency user diversion strategies and inquiry into the number, frequency

and costs associated with high frequency user interactions with the Portland

Police department, MedCU services, Mercy Hospital Emergency room

services and Maine Medical Center Emergency room services.

This overview covers HOME team program operations during 24 months of team

implementation from July 1, 2010 through June 30, 2012.

Focus on High Frequency User of Home Team Services

As part of our ongoing analysis, we have selected 30 users of HOME Team services who

comprise 35 percent of all team encounters. This analysis of the high frequency users includes

an analysis of use of Medcu ambulance runs and encounters, police and emergency room

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services 12 months prior to HOME team deployments and comparing those contacts with current

police, Medcu and emergency room data.

Demographics

The HOME Team as had 9194 contacts during the first twelve months of operation. During the

second 12 months the team had 10395 contacts or 13 percent increase over the first 12 months of

operation. 12 months of operation. The team averages about 28 client contacts each day.

Figure 1-Who initiated contact

100.00% 92.30%93%
90.00%
80.00%
70.00%
60.00%
50.00% 2011
40.00% 2012

30.00%
20.00%
10.00% 4.10% 5%
1.00% 1% 0.70% 2%
0.00%
Initiated by HOME team members Concerned citizens

As with previous analysis the HOME team plays a proactive role in connecting with clients on

the street, 93 percent were initiated by HOME team members in 2012. This represents the

majority of the teams work. Slight increases were also observed in dispatch referrals. Business

and property owner referrals accounted for 2 percent of all encounters in 2012, or a total number

of 214 referrals in 2012. Referral sources and types have remained consistent during the

reporting period.

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Of note is the number of businesses who report being aware of the HOME team activities in the

target area. In a survey of business owners in the target area, 54 percent reported being aware of

the HOME team. Of those who reported being aware of the TEAM, 62 percent reported calling

the HOME team with a referral during the 2012 reporting period.

Encounters by month

Figure 2-Frequency of encounters by month

1200

990 1012 1023 1024 992

993
1000 952
922 894 891
855 841
800
800 770 768 771
685 691
655
620 625
595
600 552 548
2011
400 2012

200

As the data suggests, the number of encounters by the HOME team have increased since

implementation in of the project in July 2010. With the exception of April 2012, HOME Team

encounters were averaging 10 percent higher than during the first 12 months of deployment. Not

surprisingly, HOME team encounters are higher during the summer months-May-September. Of

note from the period of July and August 2012, the City of Portland experienced a record number

of people seeking shelter at Oxford Street Shelter, these numbers are also reflected in the number
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of encountered by the HOME team. In July 2012, HOME team encounters increased 30 percent

from the same period in 2011. The date of encounter data also matches with the data on the

number of transports and location of encounters.

Figure 3 Reason for the encounter

80.00%
68.50%
70.00%
60.00% 54.20%
50.00%
40.00%
29.80%
30.00% 24.80%
17.60% 2011
20.00% 11.60% 2012
10.00% 2.00% 2.00%
0.00%

As team deployments evolved over the course of the year there was a corresponding change in

the type of work which team members were doing. As the figure shows, team members are

working more with people who are disruptive and disoriented in 2012. As the data suggests,

there has been a significant increase in these two areas. Additionally, team members have also

worked with clients who have significant health issues. Data from July-June 2012 suggests

HOME team encounters for health related issues were 352 or about 3 percent of the encounters

for the 2012 reporting period. This seems to suggest that clients whom the HOME team is

working with have health related issues which are the main reason for the encounter.

Location

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The following is a breakdown of where HOME team members are encountering a majority of

their clients:

Figure 4: Encounter location

Location of encounter 2011 2012

Monument square 28.2% 15.3%

Waterfront-(State Pier) 14.4% 21.%

Longfellow Square 10.5% 1.7%

Congress square 26.1% 19.7%

Bayside 18.4% 42.4%

The data suggests a significant decrease in the number of encounters in the Longfellow square

area and an increase in the Waterfront area for the encounters by HOME team staff.

Additionally, the number of encounters in Monument square has decreased by nearly 50 percent

in 2012.

Transports

The data suggests that the HOME team transported 2366 clients, or about 99 percent of the

encounters, to the Milestone shelter. In contrast, MEDCU transported 15 cases, or less than .06

percent and the police transported 7 cases or less than .002. This represents a significant

decrease in MEDCU and Police transports during the 2012 reporting period. Prior to the HOME

Team, MEDCU was transporting 157 clients to the emergency room in 2010 and the police

reported 104 transports to emergency rooms in 2010. As suggested here, MEDCU transports for

2012 was 15 and police transports accounted for a total of 7 cases. This represents a 91 percent

decrease in MEDCU and Police transports for clients whom the HOME team has been working
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with. Instead of emergency room transports, a majority of these cases, 99 percent in the current

reporting period, were transported to Milestone by HOME team staff. This suggests a significant

cost savings to MEDCU and the Police in the time associated with the encounters and transports

to emergency room by HOME team clients.

Busiest time frame for HOME Team deployments

HOME Team deployments have fluctuated between the hours of 1000-2000 over the course of

the past two years. Figure 5 provides an overview of deployments.

Figure 5: Contacts by time of day

Average # contacts
30 28
26
25

20 18

15
11
10

5 4

0
1000-1200 hrs 1200-1400 hrs 1400-1600 hrs 1600-1800 hrs 1800-2000 hrs

As the table suggests, the most active time for HOME team contacts is between the hours of

1400 and 1600 and 1800-2000 hours. Contacts also cycle between summer and winter months.

During the summer months, HOME team contacts average 34 between May and September

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between the hours of 1800-2000. During the winter months, HOME team contacts between the

hours of 1400-1600 hours are higher between November and February, averaging nearly 30

contacts.

High frequency users

The data suggests that of the original 30 high frequency users of this service, whom accounted

for nearly 37 percent of all MEDCU, Police and HOME team encounters during 2010 and early

2011, the HOME team has engaged with them only 2131 times during the 2012 reporting period.

This is a 49 percent decrease in encounters with these high frequency users inception of the

program. Of the 30 high frequency users whom the HOME team has worked with, 4 have died

in the past 12 months, 4 are in recovery and 3 have moved out of the Portland area. Additionally,

4 have been housed in Portland and have not been part of the HOME Team deployments. Of the

11 clients who are in recovery, moved away or are currently housed, these cases accounted for

1103 encounters by HOME team members and 16 times by MEDCU and police in 2011. In

2012, the data suggests they were encountered only 88 times by HOME team members and 6

encounters by police. This is a significant reduction in team and police encounters. On balance,

as suggested above, HOME team encounters have increased which suggests team members are

working with a wider variety of clients during the 2012 reporting period.

Police contact with high frequency users

Portland Police Department provided data on the 30 individuals who were

identified as the high frequency users. This is part of an ongoing data

collection process on these high frequency users. Data is analyzed based on

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12 months of baseline data as compared with the first and second year team

deployments.

Figure 6: Criminal Incidents by HOME Team High Frequency users

140
129
120 120

100

80

60
55
40

20

0
Ciminal Incidents of HOME team high frequency users between July 2009 and Dec 2009

The data suggests a decrease of 9 criminal incidents during the most recent reporting period,

however criminal incidents by the high frequency users is more than double from baseline.

Figure 7: CFS contacts with high frequency users

120
114
100

80
75
66
60

40

20

0
CFS of HOME Team high frequency users between July 2009 - June 2010

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The data suggests CFS contacts of the 30 high frequency users suggests cases are nearly double

from baseline measurements.

As noted earlier, 11 of the high frequency users have either been housed, moved away or are

deceased. As such, this last reporting period is data based on 19 remaining high frequency

users. Of the remaining 19 clients, 2 account for nearly 50 percent of police contacts during the

2011-2012 reporting period.

Cost savings

Based on the analysis of the reduction in the number of visits to the emergency rooms by the 30

highest users, as well as the reduction in MEDCU costs, it is estimated a cost savings to the

emergency medical system of $57,560 over the first 12 month period of deployments-(2010-

2011). Cost savings for 2012 as still being analyzed.

Of note is the cost savings associated with the 11 clients who have moved out of Portland, are

currently in housing or are in recovery. Based on the transport data, it appears all 11 of these

clients were homeless which suggests a savings to the emergency shelter system. Based on the

average number of bednights from these clients an average of 240 nights each, the cost savings

from housing or receiving assistance and services elsewhere is estimated at $145,200 in

emergency shelter bednights.

Summary

The data suggests HOME team deployments have not had the desired effect at decreasing police

calls for service or police interactions with high frequency users. While an initial reduction in

police encounters was observed in early 2010, the data suggests the frequency of contact with

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clients has increased in 2011 and 2012. On balance, based on two years of data on HOME Team

activities, police, Medcu and emergency room contacts, the HOME deployments provide an

important resource in addressing the changing nature of homelessness in Portland. With the

Portland Emergency Shelter system operating nearly 40 percent over capacity nearly every night,

the HOME teams work on placements, referrals and outreach is notable.

With the increases in number of encounters which are not primarily for intoxication, the HOME

team has become part of the emergency service delivery system for businesses and community

members. It appears that, as a matter of course, the HOME team is called to work with clients

who may be presenting with other issues other than intoxication, e.g. disorientation, disruption.

All of this suggests the HOME team is playing an important role in outreach and engagement.

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