Bronx Excitement to be part of the National IV Community and Progress

Hello All,
My name is Doug Becht and I am the clinical coordinator for Citizens Advice Bureau, who is contracted by NYC DHS to provide services to the street homeless in the Bronx. We started conducting the Vulnerability Survey at the beginning of June 2008 with Becky and have conducted just over 200 surveys during that period of time. We find the survey very useful, but continue to grow in our understanding of how to best utilize it. Like all of you, we view the survey as a leading tool in measuring the immediacy of services needed for an individual.
It is extremely exciting to be part of a larger community that is embracing this population and the survey. Often in our busy day-to-day grind we develop tunnel vision, only seeing the work that is happening in our neck of the woods. It is not only encouraging, but validating to see and hear about the great work and placements going on in the rest of the country in places such as New Orleans, Nashville and Skid Row to name just a few places.
Although I am not currently posting any questions or advice, Becky asked that I post some of our statistics that I have previously prepared for other meetings. Being the numbers person that I am, I was more than enthusiastic to post them. I hope these numbers are of some interest:

Out of the 203 surveys conducted since June 1st, 106 surveys scored at least a score of 1.
-46 of those individuals have been placed into housing, with 23 of them in permanent housing and 23 of them into transitional housing for individuals homeless over 1 year.

Bronx Most Vulnerable 47- Clients scoring a 2 or higher on the Vulnerability Scale

Current Dispositions:
-Clients who are in permanent placements: 13
-Clients who are in temporary housing: 11
-Clients who are in the Living Room (Drop-In Center): 3
-Clients that have passed away: 3
-Clients in other placements (i.e. HASA and Rehab): 2
-Clients on the street: 6
-Clients off of our radar: 11

Interesting Facts:
-33 out of the 47 clients are or have been on the caseload of the outreach team or the drop in center.
-27 of the 44 clients still alive, are known to be placed inside at the current time

30% Reduction in Street Homelessness in NYC

Hi everybody,

I wanted to share the exciting news that NYC reduced homelessness by 30% over the last year, and nearly 50% since 2005 when we first began doing a point in time count citywide.  I am particularly thrilled to report that 3 of the 5 boroughs of NYC -- the Bronx, Brooklyn & Queens -- achieved over a 2/3rds reduction in street homelessness since 2005.  Street homelessness is down 72% in the Bronx -- WOW!  To get all the details, click here.

I wanted to congratulate the AMAZING outreach providers in NYC - Citizen's Advice Bureau, Common Ground, Goddard Riverside and Project Hospitality -- along with the street homelessness solutions team at DHS, and all of our other partners throughout the City.   This was an incredible effort that involved a lot of teamwork and collaboration.   

If anybody would like to hear more about our street census reductions, please feel free to give me a ring at 212-361-0615 or jrudin@dhs.nyc.gov.  I'm very excited to be part of the Vulnerability Index blog community and look forward to sharing best practices and learning with all of you.

Cheers,

Jody Rudin (NYC Department of Homeless Services) 

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.

Santa Monica realizes 8% reduction in homelessness

Last week I was lucky enough to attend Santa Monica's briefing on their annual point-in-time count results.  They were able to demonstrate an 8% reduction in homelessness.  Congratulations, Santa Monica!  They've already housed 54 out of the 130 individuals identified as being at a high risk of dying with the Vulnerability Index.  That's amazing!  

To read more on Santa Monica's progress, click here.  

Does anyone else have any point-in-time results they'd like to share?  What are people seeing out there?  

Data Entry Competition in West Hollywood

Greetings from sunny Los Angeles!

This week Beth Sandor and I are delighted to be working with PATH Partners as they create the registry and apply the Vulnerability Index to the street homeless population in West Hollywood.  

Tomorrow morning is our last 4 am wake-up.   The sleep deprivation that is an unavoidable part of this work tends to really kick in on the last day and further warp our sense of humor.  Tomorrow should be fun!  

As you can see from the photo to the right, Beth and I are really suffering here in West Hollywood.  We're competing to see who can enter the Vulnerability Index survey results into the quickbase database the fastest.  As usual, Beth won.  

Monday night, we atteneded Santa Monica's briefing on the results of their annual point in time homeless count.  Congratulations for achieving an 8% reduction in homelessness! 

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.