Prioritizing Homeless Support in Perth: Vulnerability Assessment and Housing Solutions

1. 11-16 May 2014 and beyond...

2. 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

3. 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)

4. 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

5. Locations of Interviews

6. 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

7. 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

8. AGE AND GENDER Age 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

9. Cultural identity Aboriginality 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

10. At-Risk Indicators

11. Determining Acuity of Need Pre-Screen total score based on domains of • History of Housing and Homelessness • Risks • Socialisation and Daily Functions • Wellness

13. Comparing Acuity

14. Where They Usually Sleep

15. Question: Where do you sleep most frequently?

18. VIOLENCE: Coercion and Feeling Unsafe

19. 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

20. 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)

21. 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”

22. Unequal Representation

30. 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

31. An Expensive Way to Receive Treatment • 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

32. Use of Health Services TOP 5

34. What do you need to be safe and well? Perth Registry Week 2014

35. 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

36. 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

37. 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

38. 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)