Transcript Slide 1

11-16 May 2014 and beyond...
THE GOAL

To identify the must vulnerable people in inner city
Perth

To prioritise them for housing, health and other support
services based on their assessed vulnerability

To assess which level of housing support best matches
each individual’s needs
THE PROCESS
85 surveyors in teams interviewed:
 Individuals sleeping rough on Perth inner-city streets
between 4am and 6 am on 13th-15th May 2014

People accessing homelessness services during days and
evenings of 13th-15th May
(Day Centres, Women’s Refuges, Soup Runs, Nyoongar
Patrol, Youth, Mobile GP & Street Dr)
THE SURVEY TOOL : VI-SPDAT (PRE-SCREEN TOOL)
Recently-released (2013) amalgamation of VI and SPDAT
 Both original instruments and the amalgamation are
evidence-based, extensively tested, valid and reliable
 Vulnerability Index (VI)
Measures chronicity and medical vulnerability
 Shows level of risk of dying if not housed
 Was used at 2012 Perth Registry Week


Service Prioritisation Decision Assistance Tool (SPDAT)

Identifies best type of support and housing intervention
LOCATIONS OF INTERVIEWS
Locations
Number
Perth CBD
Forrest Chase, William St, Murray St, Hay
St, Anglicare, Train Station, Langley Park,
Supreme Court Gardens, Tranby, State
Library
62
East Perth
Anglicare, Royal St, Wellington Square,
Victoria Gardens
22
Northbridge
Anawim, ALS, Beaufort St, Ruah Centre,
Ruah Refuge, Weld Square, Parker St
71
Maylands
Shopfront
13
THE RESPONDENTS
 204
people identified as experiencing primary
homelessness
 168 agreed to be surveyed
 127 agreed to photos for identifying them later
for housing and support assistance
 79 assessed as needing Permanent Supportive
Housing - the most intensive of the
intervention options identified by the VI-SPDAT
DEMOGRAPHICS
41 respondents (24.4%) were under 25 years old
 The youngest was 15 years old
 6 (3.6%) respondents were older than 60 years
 The oldest was 77 years old

AGE AND GENDER
Age




41 respondents
(24.4%) were under
25 years old
The youngest was
15 years old
6 (3.6%)
respondents were
older than 60 years
The oldest was 77
years old
Gender
<24
>25 Total
Male
26
92 118
Female
15
33
48
Transgender
0
2
2
Total
41 127 168
CULTURAL IDENTITY
Aboriginality
11 (26.8% of Youth and
54 (42.5%) of Adults
identified as Aboriginal or
Torres Strait Islander
 Total of 65 Aboriginal
respondents – 38.7% of
homeless people
surveyed
 2011 Census: Aboriginal
people 3.1% of total WA
population
Cultural Identity

Cultural Identity
80
70
60
50
40
Youth
30
Adult
20
10
0
ATSI
Australian
UK
NZ (incl
Maori)
Other
AT-RISK INDICATORS
Youth
(24 and under)
Adults
(25 and over)
Total
Total homeless 6 months or more
29
110
139
Trimorbidity of co-occurring psychiatric,
medical and substance use problems
11
62
73
3+ A&E visits or hospital admissions in last 6
months
3
43
46
3+ A&E visits in last 6 months
4
31
35
>60 years old
0
6
6
HIV/AIDS
0
3
3
Liver Disease
2
16
18
Renal disease
0
8
8
Wet/cold weather injuries
2
11
13
Alcohol daily for past 30 days
9
53
62
Injecting drug use
3
38
41
DETERMINING ACUITY OF NEED
Pre-Screen total score based on domains of
 History of Housing and Homelessness
 Risks
 Socialisation and Daily Functions
 Wellness
Score
Acuity
Youth
Adult
Total
10+
Ongoing Support
16
63
79
5-9
Short Term Support
18
56
74
0-4
No Support
7
8
15
Acuity by Gender
60
50
40
Female
30
Male
20
Transgender
10
0
Ongoing Support
10+
Short Term
Support 5-9
No Support 0-4
Acuity by Age Range
25
20
0-25
15
26-35
36-45
10
46-55
5
56+
0
Ongoing Support 10+ Short Term Support 5-9
No Support 0-4
COMPARING ACUITY
Acuity: ATSI
Acuity: Non-ATSI
8%
9%
Ongoing Support
10+
41%
51%
43%
Short Term
Support 5-9
No Support 0-4
48%
Ongoing Support
10+
Short Term
Support 5-9
No Support 0-4
WHERE THEY USUALLY SLEEP
Sleeping rough
Family and
friends
Ongoing Support
9 (56%)
6 (38%)
Other
temp
accom
1 (6%)
Short Term Support
10 (56%)
5 (28%)
3 (17%)
18
No Support
2 (29%)
3 (43%)
2 (29%)
7
20
12
8
41
YOUTH
Acuity
ADULTS
Total surveyed
Total
surveyed
16
Sleeping rough
Family and
friends
Other temp
accom
Total
surveyed
Ongoing Support
53 (84%)
3 (5%)
7 (11%)
63
Short Term Support
35 (62%)
9 (16%)
12 (21%)
56
No Support
4 (50%)
3 (37%)
1 (12%)
8
92
15
20
127
Acuity
Total surveyed
Locations for Rough Sleepers
3%
Question: Where do you
sleep most frequently?
1%
2%
4%
Bushland
12%
Car
Park
14%
Squat/cave
Streets
64%
Tent
Train/bus station
Where People are Sleeping Most
Frequently
100
80
60
Youth
40
Adults
20
0
Sleeping rough
Friends/family
Hostels/shelters
Duration of Homelessness
18
16
14
12
10
8
Number
6
4
2
0
0
5
10
15
20
25
30
Years Homeless
35
40
45
50
Income Sources
60
50
40
30
20
Odd jobs,
savings, stealing,
hustling, loans,
rely on friends
Youth
Adult
10
0
VIOLENCE: COERCION AND FEELING UNSAFE
Youth
Adult
Someone who forces me or stands over me to do
things I do not want to do
7 (17.5%)
39 (30.7%)
People who take my money, borrow cigarettes, use
my drugs, drink my alcohol
21 (52.5%)
57 (44.9%)
I engage in risky behaviours like unprotected sex
with strangers, exchanging sex for money, running
drugs, sharing a needle
9 (22.5%)
25 (19.7%)
I have threatened or tried to harm myself or
someone else in the past year
21 (52.5%)
44 (34.6%)
VIOLENCE, BRAIN INJURY AND TRAUMA




21 of the 60 Adults who had
been attacked or beaten
since being homeless also
said they had a brain injury
No Youth attack victims
reported brain injury
55 Adults said trauma they
had not reported had led to
homelessness – 17 of these
had serious brain injury
19 Youth had experienced
trauma – 3 of these had
serious brain injury
Violence, Brain Injury and Trauma
50
45
Youth%
40
Adult%
35
30
25
20
15
10
5
0
Attack victim
Brain injury
Trauma
JUSTICE SYSTEM




Multiple recent
contacts with police
80% Youth and 72%
Adults had some
contact with police
over past 6 months
Pending legal issues
(“Legal Stuff”) that
may lead to fines or
incarceration
Previous detention
(Watch House, youth
detention, prison)
Police, Courts and Incarceration
100
90
80
70
60
50
40
30
20
10
0
Youth
Adult
UNEQUAL REPRESENTATION
13% of ATSI respondents
had 20 or more contacts
with police in past 6
months
 76% have been to prison
 76% in the watch house
 54% in youth detention
 48% awaiting outcome of
“Legal Stuff”

ATSI Police, Courts and Incarceration
60
50
40
30
20
10
0
Youth
Adult
UNEQUAL REPRESENTATION
Foster Care and the Justice System
40
35
30
25
Youth
20
Adult
15
10
5
0
Foster Care
Police "yes"
LegalStuff
WatchHouse
YouthDetention
Prison
Physical Ill Health
45
40
35
30
25
20
15
10
5
0
Youth
Adult
Mental Ill Health
80
70
60
50
40
30
20
10
0
Youth
Adult
Alcohol and Other Drug Use
100
90
80
70
60
50
40
30
20
10
0
Youth
Adult
Other Health Conditions
70
60
50
40
Youth
30
Adult
20
10
0
Cellulitis
Foot/skin
infection
Scabies
Dehydration Convulsions
Epilepsy
Pregnancy
Dental
problems
Other Health Conditions by Acuity
60
50
40
30
Ongoing Support 10+
20
10
0
Short Term Support 5-9
No Support 0-4
Health Services Accessed
50
45
40
35
30
25
20
15
10
5
0
Youth
Adult
People Using Acute Health
Services
100
80
60
Youth
40
Adult
20
0
A&E
Ambulance
Inpatient
Number of Uses of Acute Health
Services
800
600
Youth
400
Adult
200
0
A&E
Ambulance
Inpatient
FREQUENT USERS OF ACUTE SERVICES

Mandelberg et all (2000): a small number of vulnerable
people account for a large percentage of Accident and
Emergency visits
# People
# Occasions
Average
A&E
48
704
15 visits
Ambulance
27
238
9 trips
Inpatient
22
151
7 stays
AN EXPENSIVE WAY TO RECEIVE TREATMENT
# People # Occasions
Average
A&E
48
704
15 visits
Ambulance
27
238
9 trips
Inpatient
22
151
7 stays





Average cost per A & E attendance is
$642.00
Those 48 users would have cost
$451,968.00
Average cost of inpatient stays
$6245 per day
Average cost of stay in authorised
mental health unit $1320 per day
Ambulance fees $468 per nonurgent use or $872 per urgent use:
238 trips could range from
$111,384.00 - $207,536.00
USE OF HEALTH SERVICES
Health Services Accessed by Acuity
35
30
25
20
15
10
5
0
Ongoing Support 10+
Short Term Support 5-9
No Support 0-4
TOP 5
Ongoing Support 10+
Short Term Support 5-9
No Support 0-4
RPH
Mobile GP
Street Doc
None
GP
RPH
Street Doc
GP
None
Aboriginal Service/ Mobile GP
Mobile GP
RPH
Street Doctor
None
Health Insurance and Concessions
120
100
80
Youth
60
Adult
40
20
0
Medicare
HCC
Private
Other
None
WHAT DO YOU NEED TO BE SAFE AND WELL?
Perth Registry Week 2014
WHAT HAS BEEN ACHIEVED?
Using the VI-SPDAT across Perth Registry Week 2014 we
have been able to
 Collect a consistent set of information about individuals
sleeping rough in Perth inner city
 For most, have photographic identification
 Understand the acuity of their need
 Prioritise and match support to each person’s presenting
needs
IMMEDIATE FOLLOW UP

Ruah Street to Home in partnership with other agencies are
searching for and where possible working with those in greatest
need (transient, hard to find):
High VI-SPDAT scores
 Pregnant
 No income
 Over 60 years

OUTCOMES SO FAR






1 woman housed with Department of Housing and linked with
support (Street to Home)
2 young men accommodated through Passages transitional
accommodation and linked with support (Street to Home)
1 young man accommodated in private rental with support
(Medicare Local)
1 young man is linked with Street to Home while awaiting return
to family and support in NZ
MCOT are tracking people with highest mental health needs
Mobile GP following up people who are physically vulnerable
NEXT STEPS

Discuss ongoing possibilities for use of VI-SPDAT
database to inform effective service delivery

Collective impact approach –involving various Govt
Depts, WA Police, local Councils, NFP service providers
and the wider community

Develop an ongoing campaign (Registry Week is only a
week, homelessness is an ongoing problem)