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Vulnerability Index: Assessing the Mortality Risk Among the Street Homeless Population in Santa Ana, CA

J. Alarcón, M. Marini, O. Florsheim, N. Birnbaum, S. Pipkin & C. Florio

ABSTRACTThe purpose of this research is to identify mortality risk among homeless individuals in Santa Ana, CA by implementing the Vulnerability Index. The Vulnerability Index is an anonymous survey that has been validated to identify mortality risk among homeless individuals. During the Fall of 2016 the survey was implemented at the Civic Center, the largest encampment of people experiencing homelessness in Santa Ana, CA.

•People experiencing homelessness suffer from disproportionally high rates of chronic and acute health conditions.

•Their life expectancy is almost 15 years lower than their house counterparts.

•There was a 208% increase in rates of homeless deaths from 2005-2007 in Orange County.

•Deaths due to overdose, as seen across the nation, significantly contributed to this increase.

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25.

50.

75.

100.

125.

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10

%

Response distribution

YES NO DON'T KNOW

BACKGROUND

OBJECTIVES

•Utilize the Vulnerability Index to assess the mortality risk among individuals residing in the Civic Center encampment.

•Include 2 additional questions in the survey to identify the prevalence of prescription and non-prescription drug use among participants.

•Increase awareness of the risk of mortality faced by individuals experiencing homelessness, including risk of overdose.

METHODS

•Cross-sectional sample with 20 surveyors.

•The survey was implemented during the day for 3 hours at the Civic Center in Santa Ana, CA.

•Survey was conducted in English & Spanish.

•For individuals that have been homeless for more than 6 months, each of the conditions identified in the first 8 questions have been used as “markers” that place the participants at higher risk for mortality.

1) Have you been hospitalized or visited the emergency room more than 3 times in the past year?

2) Have you visited the emergency room more than 3 times in the previous three months?

3) Are you 60 years old or older?

4) Do you suffer from cirrhosis of the liver?

5) Do you suffer from end-stage renal disease?

SURVEY

RESULTS

•157 participants completed the survey.

•28% (45) reported visiting the hospital or emergency room >3x in the past year.

•The majority of participants (66%, 104) reported suffering from a psychiatric, substance abuse, or chronic medical condition.

•26% (41) reported the use of a prescription drug for non-medical reasons while 41% (91) endorsed having used illegal substances.

CONCLUSION

• The majority of individuals experiencing homelessness that participated in the survey suffer from a chronic medical condition that places them at higher risk of dying.

•Proven initiatives such as Housing First should be implemented across the county to prevent unnecessary suffering and mortality.

•An important next step will be to link responses to individuals and use this information to allocate resources.

6) Have you had frostbite, infections/injuries in your feet, or hypothermia?

7) Do you have HIV+/AIDS?

8) Do you suffer from a psychiatric issue, substance abuse, or chronic medical condition?

9) Do you or have you used prescription drugs for non-medical reasons?

10) Do you our have you used illegal drugs?