Measuring the Vulnerability of People who are Street Homeless in 4 (now 7) Australian Cities

1. Felicity Reynolds, CEO Mercy Foundation and Chair ACGA Karyn Walsh, Co-ordinator, Micah Projects Janelle Kwong, Micah Projects Stephen Nash, Former CEO Homeground Heather Holst, A/CEO Homeground Liz Thomas, Managing Director Common Ground, Tasmania Stephanie Brennan, Manager Community Services, Wentworth Community Housing Measuring the Vulnerability of People who are Street Homeless in 4 (now 7) Australian Cities

2. Introduction & acknowledgements • At the time the conference abstract was submitted, the major cities that VI project had been done were: Brisbane, inner Sydney, Melbourne and Hobart. • It had also been done in a regional centre – Townsville. • Since then, it has been done in Western Sydney (May 2012) and in Perth (August 2012). • This presentation covers results from all locations, except Perth (because it was only done recently). However, some summary results from Perth have also been included where it has been possible. • Many thanks to Janelle Kwongfrom Micah Projects for most of the analysis used in this presentation.

4. Overview • About the Vulnerability Index • Research on which it is based and the 8 vulnerability factors • Interview methodology and questions • Summary results from 6 cities/locations • Overview of health service use • What has been happening since the VI project/Registry Week? • What do you need to be safe and well (quotes from participants in Western Sydney)

6. Vulnerability Index • Key tool used by various communities across Australia and by homelessness programs internationally • Ranks an individual’s likelihood of death based on a number of risk factors • Using the VI, individuals are indentified as vulnerable or not vulnerable

7. Vulnerability Index • The VI is based on a study conducted by Hwang et al. (1998) • The study identified the demographic and clinical factors associated with an increased risk of death in homeless individuals • One of the study’s coauthors is Dr Jim O’Connell, a leading physician in providing healthcare to people experiencing homelessness

8. Vulnerability Index • Common Ground New York’s Street to Home team developed the VI tool from this research, with the support of Dr O’Connell. • Common Ground developed the campaign methodology to administer the VI • a new organisation, Community Solutions, now carries on this work with partner communities across the USA under the 100,000 Homes Campaign

10. Vulnerability Index Survey

11. Interview Questions • Housing history • Health • Usual health services accessed • ED presentations in the past three months • Hospitalisations in the past twelve months • Questions related to physical health conditions • Drug and alcohol • Mental health • History of trauma

12. Interview Questions (continued) • Institutional involvement • Demographics • Engagement with support services • Employment, benefits, citizenship • Photo is taken

13. Vulnerability Index • More than 6 months street homeless AND at least one of the following: • End Stage Renal Disease • History of Cold Weather Injuries • Liver Disease or Cirrhosis • HIV+/AIDS • Over 60 years old • Three of more emergency room visits in prior three months • Three or more ER or hospitalisations in prior year • Tri-morbid (mentally ill+ abusing substances+ medical problem) • Under 25 risk factors • Alcohol everyday in past 30 • HIV+/AIDS • Injection Drug Use

14. Vulnerability Index – practical application How do we conduct the survey? • Mapping and intelligence-gathering of rough sleeping locations • Recruitment and training of volunteers • Campaign methodology adapted for each region • People surveyed during registry week • Registry week campaigns conducted across Australia • Results shared with the community and government at the end of the week

15. Vulnerability Index – practical application Ongoing practice tool VI adopted as an ongoing practice tool in some regions to: • inform part of the assessment process for various communities • identify and match needs to appropriate housing and resources • profile people sleeping rough based on self-disclosure of health and psycho-social needs • advocate based on vulnerability risk and mortality • enables tracking of progress in housing people

16. 56 425 148 463 321 109 1522 people surveyed as at May 2012 (and since 16th August add 158 from Perth = 1680)

17. The population surveyed Gender • Sample size = 1522

18. The population surveyed Cultural identity

19. The population surveyed Age • Most of the population surveyed were between 36 and 55 years old • 458 people (30%) were between 36 and 45 • 358 people (24%) were between 46 and 55 • Sample size = 1522

21. Income sources Top three reported income sources (Australia wide) • Sample size = 1522

22. Institutional history Australia-wide • Sample size = 1522

23. Homeless history Average age and time homeless - by region 44 45 44 48 38 40 • Sample size = 1522

24. Homeless history Times homeless and housed in three years Half (773) of the population surveyed (1522) have not been housed at all in the past three years

25. Previous trauma / history of disability Australia-wide • Sample size = 1522

26. Drug and alcohol Australia-wide • Sample size = 1522

27. Mental health Australia-wide • Sample size = 1522

28. Vulnerability Australia-wide by region Perth (August 2012) Total sample size = 158 Number of Vulnerable = 93 (59%)

29. Vulnerability risk qualifiers Australia-wide by region * This means having general health and mental health problems and a history of substance abuse.

30. Vulnerability risk qualifiers Australia and USA * This means having general health and mental health problems and a history of substance abuse. A greater percentage of people identify as vulnerable in Australia compared to the USA.

31. Other health conditions Australia-wide • Sample size = 1522

32. Health care Where do people go for health care? • Sample size = 1522

33. Emergency department Users of ED in a three month period (Australia-wide) This represents a total cost of $390,000, based on an occasion of ED service being $197*. Sample size = 1522 * Productivity Commission Report (2010)

34. Hospitalisation Hospitalised as an inpatient in a one-year period (Australia-wide) This is a total cost of $9.36M, based on a cost per period of care in hospital being $4172*. Sample size = 1522 * Productivity Commission Report (2010)

35. What’s been happening……… • The VI has been designed to identify those who are most vulnerable, have significant health issues and are at a higher risk of dying • While the VI was designed in Boston, our experience in Australia shows that there are synergies with the Australian population • We know that housing is critical to addressing presenting health conditions and reducing mortality risk • In Brisbane 134 people (32%) of the 425 surveyed have been permanently. • Sydney has seen more than 80 people permanently housed from those surveyed. Most recently, 26 people who were on the VI register were prioritised for PSH in Common Ground at Camperdown (approximately 23%). • So far Hobart has housed: 35 (out of 131/93 V) 27% • Melbourne has housed: 58 - 18% The Australian government target is to reduce rough sleeping by 25% by 2013

36. Mortality rates among people supported by Micah Projects Street to Home Brisbane • However, people are still dying. The following information has been collated by Micah Projects in Brisbane. • Since the 50 Lives 50 homes campaign began and the VI survey introduced in June 2010, there have been 6 known deaths from the VI register and another 3 known deaths from among the homeless population that Micah Projects Street to home team have supported • This does not include other deaths that have occurred amongst the broader homeless population in Brisbane that we can’t report on • The most recent death was just two months ago. • Of the 9 people, 6 had completed a VI survey.

37. What do you need to be safe and well? A roof over my head Somewhere dry and warm Good food, affordable housing My own space A home Help with getting a house House and stability Feed and a roof over my head Safe and secure accommodation A place I can live so my Grandkids can visit Roof over head and food and people to trust

38. Somewhere permanent to live Housing – so that I can have my children restored Stable home Permanent accommodation and employment Stable accommodation, close to doctors and services A house with a backyard A home for me and my son A house for my baby A stable living environment that would enable my partner to look for work A warm house, 1 bedroom, close to shops and transport.

39. Not unreasonable things to want.... Further information: Contact ACGA Chair Felicity Reynolds CEO, Mercy Foundation 02 9911 7390 Felicity.reynolds@mercyfoundation.com.au