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
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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.
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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
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•
•
•
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Institutional involvement
Demographics
Engagement with support services
Employment, benefits, citizenship
Photo is taken
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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)
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Under 25 risk factors
 Alcohol everyday in past 30
 HIV+/AIDS
 Injection Drug Use
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
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
1522 people surveyed as at May 2012
(and since 16th August add 158 from Perth = 1680)
56
425
148
463
321
109
The population surveyed
Gender
Sample size = 1522
The population surveyed
Cultural identity
Cultural identity
Australian
Aboriginal
New Zealander
Torres Strait Islander
Other
Total
1074
318
77
28
272
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
Income sources
Top three reported income sources
(Australia wide)
Top 3 income sources
Hobart
Total
%
Brisbane
Sydney
Disability Support Pension
199
99
144
37
59
34
572
38%
Newstart Allowance
153
166
112
15
37
60
543
36%
8
64
38
0
3
1
114
7%
Begging
Sample size = 1522
Melbourne Townsville
Western
Sydney
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
60
50
40
6
10
15
9
7
6
30
44
45
44
48
Brisbane
Sydney
Melbourne
Townsville
38
40
20
10
0
Average age
Sample size = 1522
Hobart
Average years homeless
Western Sydney
Homeless history
Times homeless and housed in three years
All
Not housed in
respondents 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
Total
Percentage
Victims of violent attack
779
51%
Limited mobility
363
24%
Brain injury or head trauma
439
29%
Sample size = 1522
Drug and alcohol
Australia-wide
Drug or alcohol history
Total
Percentage
Injection drugs or shots
665
44%
Drug/alcohol abuse
Consumed alcohol every day for the past 30
days
1114
73%
372
24%
Chromed paint/petrol/other substances
211
14%
Received treatment for drug or alcohol abuse
696
46%
Sample size = 1522
Mental health
Australia-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
Vulnerability
Australia-wide by region
Western
Sydney
Brisbane
Townsville
Sydney
Sample size
425
56
463
148
Number of
vulnerable
295
36
294
67
Melbourne
Hobart
Total
Percentage
321
109
1522
100%
204
70
966
63%
Perth (August 2012) Total sample size = 158
Number of Vulnerable = 93 (59%)
Vulnerability risk qualifiers
Australia-wide by region
Western
Sydney
Brisbane
Townsville
Sydney
Cold/wet Weather Injury
24
<5
38
7
HIV+/AIDS
12
<5
12
Kidney disease
35
12
Liver disease
94
3x ER last 3 months
Melbourne
Hobart
Total
36
13
118
<5
5
<5
29
27
7
28
5
114
11
86
19
66
30
306
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
* This means having general health and mental health problems and a history of substance abuse.
Vulnerability risk qualifiers
Australia and 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%
* 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.
Other health conditions
Australia-wide
Health Condition
Heart disease
Asthma
Diabetes
Hepatitis C
Emphysema
Cancer
Any serious medical condition
Mental health
Substance abuse
Dually diagnosed
Sample size = 1522
Total
276
424
114
393
197
124
1044
923
1223
788
Percentage
18%
28%
7%
26%
13%
8%
69%
61%
80%
52%
Health care
Where do people go for health care?
70%
Hospital
60%
GP
50%
Primary Health Care
Facility/Community Health Centre
40%
Drug and Alcohol Service
30%
Specialist Mental Health Service
20%
Other
10%
0%
Brisbane Townsville
Sample size = 1522
Sydney
Melbourne
Hobart
Western
Sydney
Emergency department
Users of ED in a three month period (Australia-wide)
Use of ED
ED visits in a three month period
Total occasions of
care
Total number of
people
1972
604 (40%)
This represents a total cost of $390,000, based on an occasion of
ED service being $197*.
Sample size = 1522
* Productivity Commission Report (2010)
Hospitalisation
Hospitalised as an inpatient in a one-year period
(Australia-wide)
Use of hospitals
Hospital admissions in a 1 year period
Total occasions of
care
Total number of
people
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 Reynolds
CEO, Mercy Foundation
02 9911 7390
Felicity.reynolds@mercyfoundation.com.au