vulnerability index: prioritizing outreach & housing placement by mortality risk
TRANSCRIPT
Vulnerability Index:Prioritizing Outreach &
Housing Placement by Mortality Risk
Why?
• Homelessness is lethal• Scarce resources + lethality
compels– hard data to justify more resources– renewed sense of urgency from
policymakers – prioritization of outreach and housing
placement in the meantime
Vulnerability Index
• Based on Dr. Jim O’Connell’s research
• Presence of a risk factor indicates a 40% mortality rate over 7 years
• Most Vulnerable = individuals with the most co-occurring risk factors who have been homeless the longest
Vulnerability Index
• More than 6 months 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 hospitalizations in prior year• Tri-morbid (mentally ill+ abusing substances+ medical
problem)
Vulnerability Guides Outreach & Housing
Placement
• Every person encountered during outreach is offered survey – most agree
• Create on-going name and photo registry
• Prioritize by mortality risk and length of homelessness
• Direct outreach workers efforts on a weekly basis
• Next vacancy offered to next most vulnerable person
Basic Steps to Implement VI:
1. Convene community stakeholders2. Identify an area of focus3. Train surveyors4. Conduct baseline count5. Administer surveys 6. Analyze data7. Brief community on findings8. Develop housing action plan based on
results
Vulnerability in Action
Santa Monica: 260
Skid Row: 350
New Orleans: 150
NYC: 500
Washington, DC: 1,100
Project 50
Reframing & Rapid Transformation
• 35/50 most vulnerable from Skid Row• Realignment and new resources for
Santa Monica • Humanitarian closure of encampment in
New Orleans • NYC and Washington, DC using
techniques city-wide – will house 800 most vulnerable by September 2009
Prevalence of Risk Indicators
Risk indicator Average
Sample Size 2422
Tri-morbid 22%
3x hospital last year 12%
> 60 years old 12%
Liver Disease 9%
3x ER last 3 months 8%
Frostbite/Cold Weather 8%
Kidney Disease 4%
HIV+/AIDS 2%
% vulnerable 42%
Mental Health & Substance Abuse
69
124
164
0
20
40
60
80
100
120
140
160
180
Mental IllnessONLY
Addiction ONLY Dually-Diagnosed
400 Most Vulnerable
% Veterans
18%
21%
10%
12%
14%
16%
18%
20%
22%
% veterans
DC Total
400 Most Vulnerable
Insurance
Medical, 26%
Medicare, 12%None, 54%
VA, 2%
Private, 2%
Medical
Medicare
None
VA
Private
Health Care Services
0%
5%
10%
15%
20%
25%
30%
35%
40%
2% 0.60% 2% 25% 5% 15% 12%
50 Most Vulnerable
Hospitalizations
86%
47%
14%
53%
0%10%20%30%40%50%60%70%80%90%
100%
% population % hospitalizations
Non-Vulnerable 50 Most Vulnerable
50 Most Vulnerable Report 124 hospitalizations over past year
For more information on CG Vulnerability Index
Becky Kanis Director of InnovationsCommon [email protected](917) 957-7104