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 INTERVIEWSLocations 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

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 Gender

<24 >25 Total

Male 26 92 118Female 15 33 48

Transgender 0 2 2

Total 41 127 168

CULTURAL IDENTITY

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

Aboriginality Cultural Identity

ATSI Australian UK NZ (incl Maori)

Other0

10

20

30

40

50

60

70

80

Cultural Identity

YouthAdult

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 3Liver Disease 2 16 18

Renal disease 0 8 8Wet/cold weather injuries 2 11 13

Alcohol daily for past 30 days 9 53 62Injecting 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

Ongoing Support 10+

Short Term Support 5-9

No Support 0-40

10

20

30

40

50

60

Acuity by Gender

FemaleMaleTransgender

Ongoing Support 10+ Short Term Support 5-9 No Support 0-40

5

10

15

20

25

Acuity by Age Range

0-2526-3536-4546-5556+

COMPARING ACUITY

51%41%

8%

Acuity: ATSI

Ongoing Support 10+Short Term Support 5-9No Support 0-4 43%

48%

9%

Acuity: Non-ATSI

Ongoing Support 10+Short Term Support 5-9No Support 0-4

YOUTH

Acuity Sleeping rough Family and friends

Other temp

accomTotal

surveyed

Ongoing Support 9 (56%) 6 (38%) 1 (6%) 16

Short Term Support 10 (56%) 5 (28%) 3 (17%) 18

No Support 2 (29%) 3 (43%) 2 (29%) 7

Total surveyed 20 12 8 41

ADULTS

Acuity 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

Total surveyed 92 15 20 127

WHERE THEY USUALLY SLEEP

2%4%

12%

14%

64%

3%1%

Locations for Rough Sleepers

BushlandCarParkSquat/caveStreetsTentTrain/bus station

Sleeping rough Friends/family Hostels/shelters0

102030405060708090

100

Where People are Sleeping Most Frequently

YouthAdults

Question: Where do you sleep most frequently?

0 5 10 15 20 25 30 35 40 45 500

2

4

6

8

10

12

14

16

18

Duration of Homelessness

Number

Years Homeless

AgedPen

sion

Beggin

g

Disabilit

ySupport

Family

TaxB

enefi

t

HomeAway

Allowan

ce

NoIncome

Other

OtherPen

sion

ParentingP

aymen

t

RentA

ssista

nce

Unemploym

entBen

efit

WorkE

mployee

WorkS

elfEm

ployed

YouthAllo

wance

0

10

20

30

40

50

60

Income Sources

YouthAdult

Odd jobs, sav-ings, stealing, hustling, loans, rely on friends

VIOLENCE: COERCION AND FEELING UNSAFE

Youth AdultSomeone 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 Attack victim Brain injury Trauma

0

5

10

15

20

25

30

35

40

45

50

Violence, Brain Injury and Trauma

Youth% Adult%

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 >19 LegalStuff WatchHouse YouthDetention Prison

0

10

20

30

40

50

60

70

80

90

100

Police, Courts and Incarceration

YouthAdult

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”ATS

I

Police >1

9

LegalS

tuff

Watc

hHouse

YouthDete

ntionPris

on0

10

20

30

40

50

60

ATSI Police, Courts and Incarceration

YouthAdult

UNEQUAL REPRESENTATION

Foster Care Police "yes" LegalStuff WatchHouse YouthDetention Prison0

5

10

15

20

25

30

35

40

Foster Care and the Justice System

YouthAdult

Cancer

Kidney

Frostb

iteLiv

er

HeatEx

haustS

troke

Heart

HIV-AIDS

Emphyse

ma

Diabete

s

Asthma

Hepati

tisC

Tuberc

ulosis

Observe

SerH

ealth

Conds0

5

10

15

20

25

30

35

40

45

Physical Ill Health

Youth

Adult

MHTAga

instWill

HospEm

otionsNerv

es

MHProfes

sionalA

ppt

TraumaN

otSough

tHelp

Problem

sConcen

trating

BrainInjury

Learn

ingDev

tDisa

bility

Observe

MHProb

0

10

20

30

40

50

60

70

80

Mental Ill Health

Youth

Adult

DrugA

lcoholAbuse

InjectionUse

DrugA

lcoholTr

eatm

ent

NonBevera

geAlco

hol

Blacke

dOut

AlcoholDail

yLastM

onth

Observe

DrugA

lcoholAbuse

0102030405060708090

100

Alcohol and Other Drug Use

Youth

Adult

CellulitisFoot/skin infection Scabies Dehydration Convulsions Epilepsy Pregnancy Dental problems0

10

20

30

40

50

60

70

Other Health Conditions

YouthAdult

Celluliti

s

Foot/s

kin in

fection

Scabies

Dehyd

ration

Convulsio

ns

Epile

psy

Pregnan

cy

Dental

problem

s0

10

20

30

40

50

60

Other Health Conditions by Acuity

Ongoing Support 10+Short Term Support 5-9No Support 0-4

RPH SCGH Bentley Fremantle GP Mobile GP Street Dr MHS AHS CHC Other None0

5

10

15

20

25

30

35

40

45

50

Health Services Accessed

Youth Adult

A&E Ambulance Inpatient0

102030405060708090

People Using Acute Health Services

YouthAdult

A&E Ambulance Inpatient0

100200300400500600700800

Number of Uses of Acute Health Services

YouthAdult

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 non-urgent use or $872 per urgent use: 238 trips could range from $111,384.00 - $207,536.00

USE OF HEALTH SERVICES

AborHea

lthSe

rvice GP

HospCharl

esGard

iner

HospOther

HospRoya

lPerth

MobileGP

Stree

tDoc

None05

101520253035

Health Services Accessed by Acuity

Ongoing Support 10+Short Term Support 5-9No Support 0-4

Ongoing Support 10+ Short Term Support 5-9 No Support 0-4RPH RPH Mobile GPMobile GP Street Doc RPHStreet Doc GP Street DoctorNone None NoneGP Aboriginal Service/ Mobile GP

TOP 5

Medicare HCC Private Other None0

20

40

60

80

100

120

Health Insurance and Concessions

YouthAdult

Perth Registry Week 2014

WHAT DO YOU NEED TO BE SAFE AND WELL?

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)