Beacon's FACT Program
Beacon's FACT Program
- The National Center on Family Homelessness, Newton Centre, MA
- Heartland Alliance for Human Needs & Human Rights, Chicago, IL
Please note that all data below was derived from the collaboration's nomination for the Collaboration Prize. None of the submitted data were independently verified for accuracy.
Beacon’s Family Assertive Community Treatment (FACT) is an innovative Chicago-based initiative wherein co-located, evidence-based services are provided to young homeless mothers (who have a co-occurring mental health and/or substance abuse diagnosis), and children (who are five years of age and under). It is a part of a national project funded through Conrad N. Hilton Foundation and coordinated through the National Center on Family Homelessness, Zero to Three, and National Alliance to End Homelessness. Additionally, FACT reflects a broad-based cross-sector partnership of some of the oldest and most respected social service organizations and health care system advocates in Chicago.
The collaboration was created when Beacon responded to the Request for Proposals issued by the Conrad N. Hilton Foundation. The focus of the Hilton initiative was “Strengthening At Risk and Homeless Young Mothers and Children,” and the challenge was to have nonprofit agencies in varying sectors collaborate and integrate systemic approaches in service delivery to improve the housing, health, and development of the mothers and children.
In preparing the response, Beacon’s President and CEO, reached out to her vast network of colleagues to identify and develop locally-based partnerships. The result was a melding of organizations whose purpose encompassed housing for the homeless and child development agencies, as well as those that address family preservation, domestic violence, mental health, substance use and other support services for the target population.
Beacon was one of four national recipients of the Conrad N. Hilton Foundation grant award and received funding in June 2008.
The FACT model is comprised of: PROGRAM PARTNERS (direct service providers); SYSTEMS LEVEL PARTNERS (for example, the Illinois Department of Child and Family Services, Chicago Department of Children and Youth Services, Chicago Public Schools, and Voices for Illinois Children); a PLANNING COMMITTEE (city, state, funding, and private agency representatives); an ACADEMIC PARTNER (University of Illinois at Chicago which conducts the project evaluation (LOCAL FUNDING PARTNERS); the NATIONAL FUNDING PARTNER (Conrad N. Hilton Foundation); and, PROGRAM COORDINATORS (The National Center on Family Homelessness, Zero to Three, and National Alliance to End Homelessness).
The management structure was worked out during a series of planning meetings that took place when the response to the Hilton Foundation’s RFP was being formulated.
Beacon, as FACT’s lead agency, has fiduciary and coordinating responsibilities for all aspects of the project, and ensures there is compliance with the terms of all grants. A system of shared governance, by way of a Steering Committee, makes responsible and equitable oversight possible, as well as standardization of practices and program evaluation across the spectrum of organizations. The Steering Committee, co-chaired by Beacon and Heartland, has oversight of the entire FACT initiative, with representatives from all Partner agencies participating. The Steering Committee: monitors the work of the FACT team; ensures compliance with project goals and objectives; addresses strategic project decisions; and, promotes coordination among agencies. Members also communicate with the Planning Coalition (the group of that work to implement system change) with regard to project findings, systemic issues, barriers, and broad-based issues relevant to delivery of services.
A final component of the collaborative management structure is the utilization of a “boundary spanner,” a manager who works to promote co-location of services; coalition-building; cross-training; comprehensive, integrated assessment; and coordination of systems-level initiatives – strategies that are essential to successful systems integration. The Manager is also charged with ensuring that the Planning Coalition remains focused and on target with established goals and objectives as identified from the needs assessment.
The above described structure provides a mechanism for accountability and communication regarding issues and best practices. In addition, the team’s internal capacity is strengthened through continuous cross-training and joint supervision by partner agencies.
Through a layered organizational structure, commitment to the people we serve, strong leadership, and face-to-face, regularly scheduled meetings, and a willingness to compromise, FACT members deal with the challenges that present. Additionally, our colleagues have significant networks that they tap when in search of needed resolutions to any client-centered issues. Similar to how FACT teams work with young mothers who are homeless and help them deal with their challenges through direct dialog, FACT members must do the same.
Family-level, service-level, and systems-level outcomes are measured. All evaluations completed thus far have yielded positive outcomes.
The Hilton Foundation issued an Evaluation Site Report in September 2009; they surveyed 50 clients six months into their enrollment. The most significant findings were decreases in mental health symptoms and decreases in parental stress. Internal evaluation findings further show, for example, that: (1) in the 6 months prior to working with FACT only 3 families (6%) had their own apartment and 22 families (44%) lived in shelters - after working with FACT 18 months, 17 families (85%) live in their own apartments and only 1 family (5%) lives in a shelter; and, (2) before receiving services from FACT, 38 (76%) mothers reported child protective services have been involved with their family or children and 22 (44%) mothers reported cases of abuse or neglect filed against them – after receiving services from FACT, for any period of time, no reports of abuse or neglect were filed against FACT mothers.
FACT is based on a model that provides intensive and comprehensive treatment for clients with severe mental illness who do not readily benefit from clinic-based services. Monitoring the implementation of such programs is critical, because well implemented programs have been found to be effective in improving client outcomes.
FACT is innovative and holds promise for replication. Most programs serving homeless young parents and children offer a multi-disciplinary service and/or make referrals to other organizations to supplant their own offerings. FACT, in comparison, provides all of these services in a cohesive, coordinated, and seamless intervention through multi-level partnerships –this is critical because the people served receive intensive and comprehensive treatment and do not readily benefit from clinic-based services. Additionally, FACT brings to the table representatives of City and community-based organizations to plan and resolve the challenges that confront our families. This model is proving to be effective in serving this special needs population and facilitating system change.
[BACKGROUND] As mentioned in our initial response to the Collaboration Prize application, FACT is one of four initiatives funded through Conrad N. Hilton Foundation and coordinated by the National Center on Family Homelessness (NCFH), Zero to Three, and National Alliance to End Homelessness (NAEH); the last three entities are referred to as The Coordinating Center. Each brings a specific area of expertise to the initiative – NCFH’s focus is on families who are homeless; Zero to Three’s strength is in their work with young families; and, NAEH is involved with advocacy building and policy change.
Multiple operating efficiencies and program outcomes are measured within the FACT initiative. Evaluations occur at both the local and national levels and address four operational themes: (1) the family (that is, the overall health and wellbeing of both the parent and the child); (2) service delivery and system integration; (3) cost efficiencies; and, (4) adaptation of ACT as an effective model for working with homeless families.
(1) MEASURING PARENT & CHILD OUTCOMES - NCFH, on behalf of the Coordinating Center, conducts research to measure parent and child outcomes at the local level, and provides a comparative evaluation of the four projects funded by the Foundation. This evaluation utilizes multiple quantitative and qualitative data collection methods to develop a complete picture of the combined programs, successes, and challenges, and to better understand the families served. Specifically, the evaluation consists of an outcome study (to examine client well-being), a process study (to document implementation of the project), and a (system) cost study. Each aims to provide different yet complementary types of information, and takes into consideration income, education, and employment; housing and homelessness; health and well-being; and, family functioning.
To gather data, Dr. Susan Pickett at the University of Illinois interviews program participants four times. These interviews are conducted at enrollment, at six months, at one year, and at two years. Standardized interview protocol is utilized. Additionally, to collect the qualitative data, research teams conduct interviews and groups twice annually.
(2) MEASURING SERVICE DELIVERY & SYSTEM INTEGRATION - Initial determination of FACT priorities stemmed from a city-wide needs assessment completed in 2008. Over 100 consumers, funders, and provider systems whose work touched homeless families responded. The top five priorities identified in the needs assessment became the top five goals or “solutions” that FACT now seeks to resolve.
Two additional steps were implemented at that juncture. First, the Planning Coalition (service and system level partners) developed a System Integration Outcome Plan. (The Planning Coalition drives change assessment and establishes FACT’s goals and outcomes.) Second, they created five workgroups, each one charged with driving system change to address one of the priority/solution areas. Each group developed their own Work Plan and, in essence, the Work Plans operationalize the System Integration Outcome Plan.
Progress reports regarding implementation of the Work Plans are presented to the Planning Coalition quarterly. The findings spur modifications to the Systems Integration Outcome Plan, This, in turn, positions FACT to better our families and to simultaneously produce change within Chicago’s homeless system.
(3) MEASURING COST EFFECTIVENESS - FACT’s goal is to create a cost-effective means to reduce homelessness among young single mothers with severe and persistent mental illnesses, and to mitigate the impact of homelessness and abuse on the development of impacted children. For example, the quicker a family is in stable housing, the less is spent on supporting the family in a shelter. If there are fewer inpatient days and ER visits for mental health treatment, another significant cost savings is again achieved. These parameters are evaluated by the NCFH as part of their outcome study.
With regard to agency cost-effectiveness, for Beacon an annual $57,000 saving is realized. This takes into account portions of administrative salaries, rent, and other miscellaneous operating costs. If similar numbers from all Program Partners were to be ascertained, the savings would grow exponentially.
Our national partners’ involvement tremendously boosts FACT’s cost effectiveness, too. The Coordinating Center ensures that FACT and the three other programs funded by the Foundation have access to the skills, knowledge, and support needed to achieve project outcomes. They provide training; technical assistance to build FACT’s capacity to develop local collaborations, and an expansive project evaluation (as previously noted).
(4) MEASURING FACT EFFECTIVENESS - FACT (that is, Family-ACT), was adapted from the evidence-based ACT (Assertive Community Treatment) model. ACT is a team treatment approach designed to provide comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness who do not readily benefit from clinic-based services. An evidence-based practice, ACT has been extensively researched, evaluated, and proven to be clinically effective and cost efficient, inclusive of reducing homelessness among persons with severe and persistent mental illnesses. FACT attempts to go beyond ACT’s achievements in its targeting of homeless families – adults and children together – as the beneficiary of service.
Two methodologies are employed to measure the effectiveness of this approach. First, to assure adherence to implementation of ACT practices and protocols, the Dartmouth Assertive Community Treatment Scale was adapted for internal use. FACT’s Project Director and Systems Integration Manager, along with Heartland’s chief clinical officer, review and modify the model semi-annually and distribute an analysis and recommended changes to FACT’s Steering Committee for final approval. All approved changes are then implemented.
The second measure of FACT effectiveness is via study of NCFH documentation. In their annual reports, NCFH compares FACT’s outcomes to those achieved within the other three programs. What staff looks to uncover is greater progress within FACT than within the other programs; from this it would be surmised that any success is partially attributable to our approach.
[QUANTITATIVE BENEFITS RELATING TO SOCIAL GOOD] Benefits realized in addition to those thus far noted include:
* FACT continues to use the harm reduction approach and has reduced overall usage of substances by 50% in the project;
* Prior to entering FACT 28 (56%) mothers reported experiencing at least one psychiatric hospitalization and on average, 4 hospitalizations…. After working with FACT for 6 months, only two mothers were psychiatrically hospitalized…. After working with FACT for 12 months, only one mother was psychiatrically hospitalized.
* Before receiving services from FACT, 24 (48%) mothers reported attempting suicide at least
once and on average 3 times; After receiving services from FACT, irrespective of time frame, no
suicide attempts were been made.
* A few relevant system changes (please note, there is not space to list all of them), include: Chicago’s homeless family shelters are now linked to crisis nursery services; by infusing FACT onto Chicago’s Housing Options Survey Tool, housing options for homeless families in the city can now be searched for through a web-based tool; FACT’s seat in the Special Populations Committee of the Illinois Early Learning Council helped to shape recommendations for serving homeless families in early learning programs in Illinois; and, FACT families are now prioritized for Family Unification Program vouchers through DCFS (Department of Children and Family Services) – previously they were not accessing the Family Unification Program vouchers.
[THE DECISION] FACT’s genesis stemmed from Beacon’s decision to respond to the Request for Proposals issued by the Conrad N. Hilton Foundation. The focus of the Foundation’s initiative was “Strengthening At-Risk and Homeless Young Mothers and Children;” the challenge was to have nonprofit agencies in varying sectors collaborate and integrate systemic approaches in service delivery to improve the housing, health, and development of the mothers and children.
In its desire to be Lead Agency of the collaborative, Beacon’s President and CEO identified several agencies as potential senior partners. After conducting due diligence and engaging in a thoughtful vetting process, Beacon made a decision to bring Heartland into the folds of the project.
Both agencies had long histories were highly regarded within their respective service spheres. With specialty areas and expertise that complemented one another, they came together to develop this landmark initiative.
[MANAGEMENT STRUCTURE] Once Beacon and Heartland agreed to collaborate, their first undertaking was to design the organizational structure. The resultant schema was a multi-level management structure that embraced multiple established providers (referred to as Program Partners) from Chicago’s continuum of homeless services. During the first year of the project, executive level staff and managers from Beacon, Heartland, and the Program Partners met monthly as a steering committee to oversee the operations of the project.
One of FACT’s first hires was the Systems Integration Manager. This individual was charged with overseeing and developing linkages among the many systems affecting the lives of homeless women and their children. Toward that end, the Systems Integration Manager convened the Planning Coalition which is now comprised of leaders from 39 different organizations, agencies, and systems; these are the agencies and individuals who can directly influence the transformation of services for homeless families. It includes members of the foundation community and representatives from child welfare, child development, child care, housing, education, mental health, substance use, and vocational systems.
The Systems Integration Manager serves as a conduit of information between the Coalition the Steering Committee, and the clinical team. This process helps to shape the focus the direction of clinical services while advancing change at the systems level on behalf of homeless families.
[STRUCTURE:SUCCESS] Inherent to FACT’s success is the unobstructed flow of feedback, collegial relationships, and accountability paradigm between the Planning Coalition and Program Partners. The involvement of the Planning Coalition (i.e. system representatives) allows for the findings, trends, and needs that the Program Partners (i.e., direct service providers) identify to be broadcast through Chicago’s care network. This interplay enables and facilitates the epic system changes and collaborations that are in progress.
[BENEFITS] Until FACT came into being, Chicago service providers focused individually on solving pieces of the problem, but not with an array of services to embrace the total needs of FACT’s targeted vulnerable families. An equally significant benefit is currently being realized at the system level. For the first time ever, Chicago has:
(1) A “learning lab” committed to identifying the best direct service-based approaches to working with and supporting young homeless families in an urban environment; and,
(2) A comprehensive modus operandi aimed at identifying and strengthening the gaps, barriers, and weak links within the City’s human service system so that young, homeless families can remain intact, stable, and permanently housed.
As a concluding remark regarding benefits, the Coordinating Center of the national initiative will use the final evaluation results to inform systems and to influence policy and practice nationwide.
[ACHIEVING MORE] At the agency level, FACT enables Beacon to venture deeper into service provision for the homeless and for clinical staff to become even more skilled in strength-based programming, motivational interviewing and stages of change strategies, trauma-informed services, and harm reduction practices. Heartland, while highly regarded in the provision of care to (more adult) homeless individuals, is able to benefit from Beacon’s proficiencies regarding child development and in their techniques and therapies surrounding young, single, homeless parents. This reciprocity is, in fact, true for all of the Program Partners. A number of agencies are serving a population segment – young, homeless and at-risk families – they might not otherwise have reached. These agencies, whether specializing in child development, substance use, job training, or other specialties, are generally well-known in their local area for providing quality services, but homeless, young women and children had not sought out their services.
Service level changes can be translated into benefits for FACT’s participant families, as well. Through co-location of services, young mothers now interface with several providers to meet their own specific needs and those of their children, whereas previously they may have involved with only one. Of particular note is that the mothers, when asked from whom they receive services, either provide the program name or the name of a single agency rather than an individual team member.
In closing, please know that while the purpose of the Collaboration Prize is to “celebrate nonprofits that come together for greater impact,” those involved in FACT are continuously delighted with the success our collaborative efforts produced, and consequently the gains made by the people we serve. Recognition by a Collaboration Prize award will enable us to amplify these achievements and will ultimately benefit our nation’s young homeless families.