Implementing the VI in Hospitals/Clinics/Medical Outreach

Greetings from Nashville,

I hope you are well.

I am looking for guidance on the best way to implement the VI in health care settings - hospitals, clinics, medical outreach teams, etc. Health care settings seem to be a natural environment for the VI, as the VI is a tool to capture someone's known health status. If more physicians used this tool, we would have a better idea if folks are under-reporting or over-reporting their illnesses.

In Nashville, there are a number of medical providers who are interested in implementing the VI. However, I am reluctant to train them on using the VI because the current VI survey is a self-reporting survey. It is not a tool that lends well to objective medical information that a physician could provide. In other words, I would fear that a patient experiencing homelessness would be handed a VI survey while sitting in the waiting room for an appointment...there is nothing on the survey that would require a physician to be there, to give input, etc.

So, we all know that the VI rocks the house!! But, can it or should it be tweaked before we implement it in health care settings? Should we use the current version of the VI for "survey blitzes" with volunteers and develop another "medical" version of the VI for physicians?

Thanks a bunch for your help with this. Robb Nash - a nurse practitioner in Nashville who staffs a respite clinic for the homeless - wants to help think through this with us. Here are some of his initial questions that could help get this discussion going:

"What experience do people have with the VI in terms of clinically ranking a person's acuity of illness? For example, one person's hypertension is not anothers, nor is one person's CD4 count and viral load equal to anothers. Given that, how are people using the VI to accurately rank folks for services/housing based on their health? Is anyone out there using the VI along with some more clinically objective addendum?" - Robb Nash, Clinical Instructor, Vanderbilt School of Nursing

So, is there room for objective medical evidence in the VI? If so, how do we incorporate it? If we want physicians to be involved in the reporting of health conditions, how do we structure the survey so that a physician can use it best?

Thanks again. Take it easy. Peace.

Hope in the Mundane

Small groups of socially conscious, inspired people engaged on the fringes of society can do amazing things. Problems that seem intractable, impersonal and distant become glaringly hideous and embarrassing and, most importantly, solvable when ordinary individuals join hands and complete very mundane tasks. We meet at early hours of the morning, make coffee, collect pens, print copies, adjust cameras, pocket food vouchers, smile at our neighbors and go out into the cold with a higher purpose. What we have done locally has grown into something much larger. Thank you Becky Kanis and Common Ground Community for inspiring me and my native city.

In Nashville, here is what has happened in just a couple of months since our initial “survey blitz”:
**Nashville’s only “housing-first” program scrapped its usual referral process and is now only taking individuals off of the Vulnerability Index ™.
**Nashville’s housing authority promised 32 housing subsidies for the most vulnerable.
**$100,000 of city funds will match any private donations to create a local rental subsidy for the most vulnerable.
**The Vulnerability Index ™ is being used to address homeless encampments sprouting up around Nashville.
**In March, health care providers will begin completing surveys with their homeless patients. One such provider manages over 15 community health clinics in Nashville.
**The VA is considering a “pilot” that would help the most vulnerable veterans access VASH subsidies in a more timely manner.

As I list the successes above, I must confess that I am doing my own version of a Vulnerability Index ™ dance. Fortunately, none of my staff are around to see. Let’s just say it incorporates some moves from Slumdog Millionaire.

Less-than-graceful dance moves and goosebumps are occurring because I know the successes above are just scratching the surface. The future looks so promising; solving homelessness in Nashville doesn’t seem overly idealistic anymore.

The Vulnerability Index ™ galvanizes and inspires action because it tells a story, our human story. It reminds us of what happens when health fails and our systems of care disappoint. It inspires action despite geography, climate and culture.

I can’t wait to hear your stories of how you and your community have met death with hope in the form of a 5-minute survey. Thanks again Becky and Common Ground Community for what you do and this venue. Peace.

Welcome to the Vulnerability Index Blog

Hi -

Welcome! This blog is for everyone working to end street homelessness. Author invitations were just sent out to change agents across the US and Canada who have adapted the Vulnerability Index to their community. In 2008, over 4,300 surveys were administered in NYC, LA County's Skid Row, Santa Monica, New Orleans, Washington, DC, Portland, Nashville, Calgary, and Fort Worth. Not counting the housing placements in NYC -- there were many - this should be posted by those who did the heavy lifting on that! - more than 680 individuals identified as being homeless the longest with the highest mortality risk were placed into housing by the cities mentioned above last year. This is absolutely amazing.

I wanted to find a way to connect all of you with one another, a forum for the exchange of great ideas, best practices, success stories, lessons learned, and good questions. Please use this as a space to brag about your housing placements, the transformation of your outreach practices, and to share your opinions, knowing that you are among friends.

We will be adding content to this blog over the next several weeks so that it can become a "go-to" place to download relevant studies, reports, and useful tools. Please see this as shared space for anyone working to end street homelessness - I look forward to the community that this will build and to seeing each of you on my next trip to your town!

If you have an idea about how to use the Vulnerability Index --> post it!

If you have a question about the Vulnerability Index --> post it!

If you have a story about how the Vulnerability Index is being used in your city --> post it!

If you're one of the 680+ people who were identified by the Vulnerability Index and are now in housing --> post it!

If you're not sure how to post to the blog, or have suggestions for how to make this blog better, please contact me at bkanis@commonground.org.