Download - Measuring the Vulnerability of People who are Street Homeless in 4 (now 7) Australian Cities
Felicity Reynolds, CEO Mercy Foundation and Chair ACGAKaryn Walsh, Co-ordinator, Micah Projects
Janelle Kwong, Micah ProjectsStephen Nash, Former CEO Homeground
Heather Holst, A/CEO HomegroundLiz Thomas, Managing Director Common Ground, Tasmania
Stephanie Brennan, Manager Community Services, Wentworth Community Housing
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 Kwong from Micah Projects for most of the analysis used in this presentation.
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)
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
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
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
• 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
• Institutional involvement • Demographics• Engagement with support services• Employment, benefits, citizenship• Photo is taken
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
Vulnerability Index – practical application
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
How do we conduct the survey?
Vulnerability Index – practical application
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
Ongoing practice tool
425
56
148
463321
109
1522 people surveyed as at May 2012(and since 16th August add 158 from Perth = 1680)
The population surveyed
Gender
Sample size = 1522
The population surveyed
Cultural identity
Cultural identity TotalAustralian 1074 Aboriginal 318New Zealander 77 Torres Strait Islander 28Other 272
The population surveyed
Sample size = 1522
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
Income sources
Top three reported income sources (Australia wide)
Top 3 income sources Brisbane Sydney Melbourne Townsville HobartWestern Sydney Total %
Disability Support Pension 199 99 144 37 59 34 572 38%
Newstart Allowance 153 166 112 15 37 60 543 36%
Begging 8 64 38 0 3 1 114 7%
Sample size = 1522
Institutional history
Australia-wide
Institutional history Total Percentage
Foster care 431 28%
Watchhouse / Cells 1139 75%
Prison 804 53%
Sample size = 1522
Homeless history
Average age and time homeless - by region
6 10 9 15
76
0
10
20
30
40
50
60
Brisbane Sydney Melbourne Townsville Hobart Western Sydney
Average age Average years homeless
44 45 44 48 38 40
Sample size = 1522
Homeless history
Times homeless and housed in three years
All respondents
Not housed in past 3 years
3 or more times
10 or more times
No of people 1522 773 395 77
No of times 3251 0 2612 1365
Half (773) of the population surveyed (1522) have not been housed at all in the past three years
Previous trauma / history of disability
Australia-wide
Sample size = 1522
Total Percentage
Victims of violent attack 779 51%
Limited mobility 363 24%
Brain injury or head trauma 439 29%
Drug and alcoholAustralia-wide
Drug or alcohol history Total Percentage
Injection drugs or shots 665 44%
Drug/alcohol abuse 1114 73%Consumed alcohol every day for the past 30 days 372 24%
Chromed paint/petrol/other substances 211 14%
Received treatment for drug or alcohol abuse 696 46%
Sample size = 1522
Mental healthAustralia-wide
Mental health history Total Percentage
Mental health condition 923 61%
Received treatment for mental health 769 51%
Taken to hospital against will for mental health 431 28%
Sample size = 1522
VulnerabilityAustralia-wide by region
Brisbane Townsville SydneyWestern Sydney Melbourne Hobart Total Percentage
Sample size 425 56 463 148 321 109 1522 100%
Number of vulnerable 295 36 294 67 204 70 966 63%
Perth (August 2012) Total sample size = 158
Number of Vulnerable = 93 (59%)
Vulnerability risk qualifiersAustralia-wide by region
* This means having general health and mental health problems and a history of substance abuse.
Brisbane Townsville SydneyWestern Sydney Melbourne Hobart Total
Cold/wet Weather Injury 24 <5 38 7 36 13 118
HIV+/AIDS 12 <5 12 <5 5 <5 29
Kidney disease 35 12 27 7 28 5 114
Liver disease 94 11 86 19 66 30 306
3x ER last 3 months 86 11 54 17 46 16 230
3x ER or hospital last year 141 21 116 23 79 31 411
*Tri-morbid 176 15 181 53 123 59 607
> 60 years old 46 <5 35 11 27 5 124
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.
Australia USA
Sample size total 1522 30128
% vulnerable 63% 47%
Cold/wet Weather Injury 8% 7%
HIV+/AIDS 2% 3%
Kidney disease 7% 4%
Liver disease 20% 7%
3x ER last 3 months 15% 13%
3x ER or hospital last year 27% 20%
*Tri-morbid 40% 24%
> 60 years old 8% 12%
Other health conditionsAustralia-wide
Sample size = 1522
Health Condition Total PercentageHeart disease 276 18%Asthma 424 28%Diabetes 114 7%Hepatitis C 393 26%Emphysema 197 13%Cancer 124 8%
Any serious medical condition 1044 69%Mental health 923 61%Substance abuse 1223 80%Dually diagnosed 788 52%
Health care
Where do people go for health care?
Sample size = 1522
0%
10%
20%
30%
40%
50%
60%
70%
Brisbane Townsville Sydney Melbourne Hobart WesternSydney
Hospital
GP
Primary Health CareFacility/Community Health Centre
Drug and Alcohol Service
Specialist Mental Health Service
Other
Emergency departmentUsers of ED in a three month period (Australia-wide)
Use of EDTotal occasions of
careTotal number of
people
ED visits in a three month period 1972 604 (40%)
Sample size = 1522* Productivity Commission Report (2010)
This represents a total cost of $390,000, based on an occasion of ED service being $197*.
Hospitalisation
Hospitalised as an inpatient in a one-year period (Australia-wide)
Use of hospitalsTotal occasions of
careTotal number of
people
Hospital admissions in a 1 year period 2245 739 (49%)
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)
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
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.
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
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.
Further information: Contact ACGA Chair
Felicity ReynoldsCEO, Mercy Foundation02 9911 [email protected]