Vulnerability Index

About IGHSL UAB Interprofessional Global Health Service Learning (IGHSL) undergraduate class Focused on service learning and project development in conjunction with community partners Students: William Carter Agam Dhawan Stephen Voss Basic Explanation of career paths of all of us

What is a Vulnerability Index (VI)? An assessment tool to rate the vulnerability to death of an individual ongoing homelessness death on the streets Used in many cities to prioritize housing of homeless individuals into supportive housing settings time is of the essence housing is limited

Why does One Roof want to test a VI? Measure vulnerability in the community Establish a baseline Explore the possibility of using an existing VI in the One Roof Continuum of Care Begin discussion about how/if this information can help people experiencing homelessness in central Alabama Incorporate in forms that already exist: PIT, PromisAL, standard shelter intake forms (that will then be input into PromisAL).

Development of VI

Developing and testing VI Reviewed research and currently existing VI in other locales Participated in Homelessness 101 workshop Met with local emergency shelter case managers and social workers Created our version of the VI and supplemental list Planned administration logistics Recruited and trained volunteers Administered VI Analyzed the results Assessed surveyors’ experiences This is the overview of what steps we took for the development of the VI

Developing VI to Meet our Needs Research of existing models brought two candidates: The DESC VI: administered by a social worker or case manager more subjective focused on vulnerability to ongoing homelessness The Common Ground VI: administered by a volunteer more objective focused on vulnerability to death Due to the resources available we decided to use the Common Ground model Article, explaining why 1 is better? In presentation, give brief overview of two DESC-Downtown emergency service shelter, Seattle WA

Create VI and Supplemental list Used the Common Ground scale, but developed our own survey layout Removed all non-scoring elements and identifiers Created supplemental disease list to help volunteers understand and explain some of the conditions included on the VI Weather related, more imp. in boston than here Removed the non-scoring elements so there would be no identifiers so clients would not be uncomfortable sharing some info supplemental list to explain to the clients what the condition was, if needed

Determined Scoring Assigned a score between 0-8 Respondent must be homeless 6 mo+ to rank on scale Other factors add to respondent’s overall score: Tri-morbidity (physical illness, mental health condition, & drug abuse) (+1) More than 3 hospitalizations or ER visits over a year (+1) More than 3 Emergency Room visits in the past three months (+1) 60 years or more of age (+1) HIV+/AIDS (+1) Kidney Disease / ESRD or Dialysis (+1) Liver Disease / HEP C / Cirrhosis / End stage liver disease (+1) Cold Weather Injuries (frostbite, immersion foot, hypothermia) (+1) Why are some illnesses ranked (ex. Liver) but not others (ex. heart disease, tuberculosis etc.) Read article explaining it, common ground. conditions associated with liver? ex. alcohol Why only one check needed for any mental health check? That’s what Common Ground did all of these are based on what common gound did and will probibaly be hanged in the future

Administration Details Administered in three member emergency shelters: First Light, Firehouse, and Salvation Army Administered by trained volunteers: IGHSL students, nursing students, AmeriCorps members, and One Roof staff Privacy, fliers. Encouraging without coercion Why done in shelter? Organization easier. More resources than we had. Just pilot. Wanted baseline Would take an extensive amount of planning, survey

Data and Results total 154 only 150 were usable Intro demographic data. How our VI data compared to others

Demographics Gathered 154 surveys, 150 were scorable 51 participants qualify for vulnerability ranking (>6 months homeless) Ages ranged from 18-65+

Interesting findings All VI scores fell at 5 or below Both heart disease and asthma were much higher here than in other environments Hot weather may be of more of a threat than cold weather (may also be due to the time of the survey) Chronically homeless population experience higher rates of most conditions compared to overall population At Shelter 3, the HIV % was abnormally high, and the participants below age 25 were very low in comparison to the other shelters

Limitations Administered by different volunteers so inconsistencies in data collection Self-reported data relied on participants’ honesty Only shelter participants, no street outreach, so scores potentially lower than actual numbers

Conclusions Scoring parameters need to be adjusted for Birmingham’s population Set up of survey is user friendly Vast majority of population have mental health or substance abuse condition Participation was dependent on shelter staff involvement

Next Steps Assess and revise the index and the scale Incorporate questions into Point in Time What choices could we make from this?