Searching For Nashville's Most Vulnerable, One Person At A Time....

Another busy weekend on the streets of Nashville, we spent Saturday evening from about 330am until around 630am scouring the city in three teams, trying to get an accurate count for our upcoming Vulnerability Index Survey  (PDF available here) that begins Tuesday morning at 4amish.

Becky Kanis arrives today and we'll be establishing the surveying strategy today at an afternoon meeting.  From there we hit the streets in earnest, as we hope to canvass and survey every single person experiencing homelessness in the Nashville downtown area over the next three consecutive days.

The goal of course is to establish a restricted and private database of the city's most vulnerable so that we can more narrowly focus our dollars and manpower on actually helping those who need it the most, rather than simply "shotgunning" our resources across the community and providing piecemeal assistance whenever it is needed.

I should point out that while we have dramatically changed the way we will be providing street outreach, it doesn't mean we won't help those who need our help.  However, as an outreach worker, I will now have what might be considered an actual caseload that I will be responsible for contacting and sheperding through the often ridiculously difficult process of trying to obtain services and housing in our fair city.

Those on my caseload will be individuals we've identified that are at extreme risk of serious injury, illness and/or death if some form of intervention is not initiated quickly.

Surveying some 8,000+ people will not be easy.  We've got a lot of volunteers and every agency we've contacted so far that is charged with providing services to those experiencing homelessness have indicated their willingness to assist us.    Still, it is a daunting task to get it all done in such a short period of time, so as I understand it, we will also be providing the survey to anyone who shows up and requests it after we've completed the initial sweep.

We also want to make sure we keep the list "fresh" and updated, so we are encouraging those we meet with to report changes in conditions whenever appropriate.  The more information we have, the better we can serve our population.  YOU can help as well by referring people to us, by reporting locations of those experiencing homelessness and by letting anyone who is interested know about us.

Ultimately, we hope to begin a new phase in the care and assistance of Nashville's homeless population.  By targeting those who most need the scarce resources, we believe we can save lives, minimize suffering, reduce costs to the city and the community, lower emergency responses for homelessness-related problems, and  provide a return of dignity and self-worth to those who have been incorrectly labeled as lazy or malingering by ignorant critics.

Let the surveying begin.......

Vulnerability Index: Prioritizing the Street Homeless Population by Mortality Risk

The Vulnerability Index is a tool for identifying and prioritizing the street homeless population
for housing according to the fragility of their health. It is a practical application of research into
the causes of death of homeless individuals living on the street conducted by Boston’s
Healthcare for the Homeless organization, led by Dr. Jim O’Connell. The Boston research
identified the specific health conditions that cause homeless individuals to be most at risk for
dying on the street. For individuals who have been homeless for at least six months, one or more
of the following markers place them at heightened risk of mortality:

1) more than three hospitalizations or emergency room visits in a year
2) more than three emergency room visits in the previous three months
3) aged 60 or older
4) cirrhosis of the liver
5) end-stage renal disease
6) history of frostbite, immersion foot, or hypothermia
7) HIV+/AIDS
8) tri-morbidity: co-occurring psychiatric, substance abuse, and chronic medical condition
In Boston, 40% of those with these conditions died prematurely, underscoring the need for
housing and appropriate support for this group.

The Vulnerability Index is administered in a form of a survey, which captures a homeless
individual’s health and social status. It identifies the most vulnerable through a ranking system
which take into account risk factors and the duration of homelessness. This ranking allows those
with the most severe health risks to be identified and prioritized for housing and other support.

Dr. Jim O’Connell said it best:

“The painfully obvious lesson for me has been the futility of solving this complex
social problem solely with new approaches to medical or mental health care…I
dream of writing a prescription for an apartment, a studio, an SRO, or any safe
housing program, good for one month, with 12 refills.”

From the early successes of its Street to Home program, Common Ground has consistently
observed that putting names and faces – and now medical conditions – to formerly anonymous
street homeless individuals inspires action. The commitment of housing resources and the
expedited housing placement of the medically-fragile, have been the direct, concrete results of
the use of the Vulnerability Index. The Vulnerability Index has been used in New York City,
Los Angeles County’s infamous Skid Row, Santa Monica, and New Orleans as a powerful force
for change.

This simple and replicable tool, rooted in solid scientific research, helps mobilize communities to
act decisively, organize around individuals’ housing needs, and solve a seemingly intractable
problem.

How to Use the Vulnerability Index in Your Community
Common Ground uses these techniques to strip away the anonymity of street homelessness and
reframe homelessness as a public health issue:

1. Assemble community stakeholders (service providers, housing providers, police, business
improvement districts, political leadership) to educate on the use of the Vulnerability
Index, gain support for the concept, and identify an area of focus

2. Conduct a count of those sleeping outside between the hours of midnight and 6:00 am.
The purpose of the count is to create a baseline understanding of the numbers of
homeless individuals in an area, and to determine the number of surveys that the project
should expect to complete. The average response rate is 83% of those counted.

3. Train volunteers on how to administer the survey (attached) and how to take a good
digital photograph.

4. Administer the survey between 3:00 am and 6:00 am for at least three consecutive
mornings.

5. Enter the data into a spreadsheet or database.

6. Analyze the surveys to calculate risk factors and establish housing priority list

7. Brief community on the findings.

8. Develop and implement a housing action plan based on results.