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 7390Felicity.reynolds@mercyfoundation.com.au