Vulnerability Index:Prioritizing Outreach &

Housing Placement by Mortality Risk

Why?

• Homelessness is lethal• Scarce resources + lethality

compels– hard data to justify more resources– renewed sense of urgency from

policymakers – prioritization of outreach and housing

placement in the meantime

Vulnerability Index

• Based on Dr. Jim O’Connell’s research

• Presence of a risk factor indicates a 40% mortality rate over 7 years

• Most Vulnerable = individuals with the most co-occurring risk factors who have been homeless the longest

Vulnerability Index

• More than 6 months homeless AND at least one of the following:

• End Stage Renal Disease • History of Cold Weather Injuries• Liver Disease or Cirrhosis• HIV+/AIDS• Over 60 years old • Three of more emergency room visits in prior three

months• Three or more ER or hospitalizations in prior year• Tri-morbid (mentally ill+ abusing substances+ medical

problem)

Vulnerability Guides Outreach & Housing

Placement

• Every person encountered during outreach is offered survey – most agree

• Create on-going name and photo registry

• Prioritize by mortality risk and length of homelessness

• Direct outreach workers efforts on a weekly basis

• Next vacancy offered to next most vulnerable person

Basic Steps to Implement VI:

1. Convene community stakeholders2. Identify an area of focus3. Train surveyors4. Conduct baseline count5. Administer surveys 6. Analyze data7. Brief community on findings8. Develop housing action plan based on

results

Vulnerability in Action

Santa Monica: 260

Skid Row: 350

New Orleans: 150

NYC: 500

Washington, DC: 1,100

Project 50

Reframing & Rapid Transformation

• 35/50 most vulnerable from Skid Row• Realignment and new resources for

Santa Monica • Humanitarian closure of encampment in

New Orleans • NYC and Washington, DC using

techniques city-wide – will house 800 most vulnerable by September 2009

Prevalence of Risk Indicators

Risk indicator Average

Sample Size 2422

Tri-morbid 22%

3x hospital last year 12%

> 60 years old 12%

Liver Disease 9%

3x ER last 3 months 8%

Frostbite/Cold Weather 8%

Kidney Disease 4%

HIV+/AIDS 2%

% vulnerable 42%

Mental Health & Substance Abuse

69

124

164

0

20

40

60

80

100

120

140

160

180

Mental IllnessONLY

Addiction ONLY Dually-Diagnosed

400 Most Vulnerable

% Veterans

18%

21%

10%

12%

14%

16%

18%

20%

22%

% veterans

DC Total

400 Most Vulnerable

Insurance

Medical, 26%

Medicare, 12%None, 54%

VA, 2%

Private, 2%

Medical

Medicare

None

VA

Private

Health Care Services

0%

5%

10%

15%

20%

25%

30%

35%

40%

2% 0.60% 2% 25% 5% 15% 12%

50 Most Vulnerable

Hospitalizations

86%

47%

14%

53%

0%10%20%30%40%50%60%70%80%90%

100%

% population % hospitalizations

Non-Vulnerable 50 Most Vulnerable

50 Most Vulnerable Report 124 hospitalizations over past year

For more information on CG Vulnerability Index

Becky Kanis Director of InnovationsCommon Groundbkanis@commonground.org(917) 957-7104