1. Vulnerability Index

2. 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

3. 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

4. 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).

5. Development of VI

6. 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

7. 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

8. 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

9. 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

10. 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

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

12. Demographics Gathered 154 surveys, 150 were scorable
51 participants qualify for vulnerability ranking (>6 months homeless)
Ages ranged from

13. 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

14. 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

15. 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

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