Current Research & Evaluations

In 2019, St Vincent’s Homeless Health Service launched a dedicated research program to evaluate the impact of its services on improving access to care for people experiencing homelessness.

CURRENT PROJECTS:

Project: Co-design of a Cooling Hub for People Experiencing Homelessness.

Team: Matthew Larkin, Alejandro Vasquez-Hernandez, Jon Swain, Danielle Austin, Lisa Wood, Cath Haswell and Timothy English.

Lived Experience Members: Nuala Fogarty, Glenn Miller, Charles Cosgrove, and Paul Rosenthal.

Summary: Heatwaves pose a significant public health risk, and people experiencing homelessness are particularly vulnerable to extreme heat and other climate change impacts while sleeping on the street, in vehicles, tents, or substandard housing. In a collaboration between St Vincent’s Hospital Sydney, the City of Sydney, the University of Sydney, University of Technology Sydney and the University of Notre Dame Australia, we are co-designing and co-evaluating a mobile Cooling Hub to provide respite from extreme heat to those experiencing homelessness in the Sydney LGA. As part of the co-design team, we have included members with lived experience of homelessness to ensure the service is grounded in real-world needs and perspectives. The Cooling Hub was piloted during the summers of 2023/24 and 2024/25, and evaluated using consumer satisfaction and comfort measures, incidence of heat-related illness, and its impact on heat-related illness presentations to St Vincent’s Hospital Sydney.

For further info, contact Timothy English: tim.english@sydney.edu.au

Website: Pop-up mobile cooling hubs - Faculty of Medicine and Health

Related publications:

• English, T., Vasquez-Hernandez, A., Miller, G., Fogarty, N., Cosgrove, C., Rosenthal, P., Larkin, M., Swain, J., Austin, D., & River, J. (2025). Dousing the burning inequity of global warming for people experiencing homelessness. Medical Journal of Australia. Wiley. (Accepted)
• English, T., Larkin, M., River, J., Vasquez-Hernandez, A., Austin, D., Swain, J., & Currie, J. (2023). Partnering with people experiencing homelessness to develop a pop-up mobile cooling hub. Parity, 36(10), 19–21. https://search.informit.org/doi/10.3316/informit.T2024081800000591359788087
• Wu, W. J., Hutton, J., Zordan, R., Ranse, J., Crilly, J., Tutticci, N., English, T., & Currie, J. (2023). Review article: Scoping review of the characteristics and outcomes of adults presenting to the emergency department during heatwaves. Emergency medicine Australasia: EMA, 35(6), 903–920. https://doi.org/10.1111/1742-6723.14317
• English, T., Larkin, M., Vasquez Hernandez, A., Hutton, J., & Currie, J. (2022). Heat Illness Requiring Emergency Care for People Experiencing Homelessness: A Case Study Series. International Journal of Environmental Research and Public Health, 19(24), 16565. https://doi.org/10.3390/ijerph192416565

Media Links:

• Sydney weather: City’s first pop-up cooling hub draws a crowd as the mercury soars
• As Sydney swelters a pop-up cooling hub offers refuge for the city's disadvantaged - ABC listen
• https://theconversation.com/australias-first-mobile-cooling-hub-is-ready-for-searing-heat-this-summer-and-people-who-are-homeless-helped-design-it-218829?utm_source=linkedin&utm_medium=bylinelinkedinbutton
• How researchers designed Australia’s first mobile cooling hub - The University of Sydney
• Australia: People who are homeless designed a mobile cooling system | PreventionWeb
• Sydney free cooling hubs (timeout.com)

Project: Evaluating the Community Re-entry Support Service (CRESS)

Team: Lisa Wood, Shannen Vallesi, Alejandro Vasquez-Hernandez and Mathew Larkin.

Summary: The Community Re-entry Support Service (CRESS) is a pilot program led by St Vincent’s Hospital Sydney Correctional Health that aims to support men with complex health and social needs who are cycling between the justice system and homelessness. The program provides intensive case management and care coordination before and after release from Parklea Correctional Centre, helping participants connect with health, housing, and community services. This evaluation project explores how the program has been implemented, its outcomes, and how it can be improved or expanded. It involves analysing non-identifiable program data and conducting interviews with participants, staff, and stakeholders to inform future service delivery and policy. Findings will inform future service design, policy development, and potential expansion of the model across other settings.

For further info, contact Professor Lisa Wood: lisa.wood@nd.edu.au

Project: Evaluating rehabilitation needs, access and service provision among people experiencing homelessness who have sustained a Traumatic Brain Injury (TBI)

Team: Christine Shiner, Simon Mosalski, Matthew Larkin, Valerie Bramah, Jane Currie, Karon McDonell, Steven Faux, Alejandro Vasquez-Hernandez and Fiona Haigh.

Summary: People who experience homelessness are particularly vulnerable to problems with their physical and psychological health, and international research has identified that approximately half suffer a brain injury at some point in their life. In the broader population, rehabilitation is known to improve health outcomes and promote recovery following brain injury. However, it is not known whether routine rehabilitation services are accessible and adequately used by people who experience homelessness. This project aims to formally evaluate the accessibility and provision of rehabilitation for people experiencing homelessness who have sustained a TBI. We will explore how often those experiencing homelessness would benefit from rehabilitation; what they need from rehabilitation; whether they can access what they need, and/or whether there are specific barriers that prevent them from accessing current rehabilitation services.

For further info, contact Dr Christine Shiner: christine.shiner@svha.org.au

Project: Access to Oral Health Services and Oral Health-Related Quality of Life in People Experiencing Homelessness

Team: Alejandro Vasquez-Hernandez, Matthew Larkin, Christine Shiner, and Andres Alonso Agudelo Suarez.

Summary: People experiencing homelessness (PEH) often suffer from poorer oral health, with higher rates of untreated oral disease and more missing teeth than the general population, affecting their quality of life, daily activities, and mental health. This study aims to identify barriers and enablers to accessing oral health services for PEH in Sydney through focus groups with individuals with lived experience and healthcare professionals from St Vincent’s Homeless Health Service. A questionnaire will explore PEH's self-perception of oral health, habits, and service use, while the OHIP-14 will assess oral health-related quality of life (OHRQOL). Lastly, hospital data will be analysed to determine the prevalence and financial impact of oral health-related Emergency Department presentations over the past five years (2019–2023).

For further info, contact Alejandro Vasquez-Hernandez: alejandro.vasquez@svha.org.au

Project: Enhancing patient voice across healthcare services for people experiencing homelessness.

Team: Claire Doherty, Matthew Larkin, Alejandro Vasquez-Hernandez, Matthew Scott, Naimisha Talluri, Ana Dillen, Shannen Vallesi, and Lisa Wood.

Summary: Compared to the general population, people experiencing homelessness (PEH) have poorer health outcomes and a lower life expectancy. Given the important association between patient experience and health outcomes, the need for the voice of PEH in patient experience data is crucial and, at present, is significantly under-represented. Quality improvement efforts will continue to be based on data that is not widely representative of those who experience the most significant disadvantage when attempting to access healthcare if this gap is not addressed. The aim of this research is to co-design a patient experience survey, including principles to guide implementation, specifically for PEH, which can be implemented across the continuum of healthcare services (acute, primary, telehealth).

For further info, contact Claire Doherty: claire.doherty@svha.org.au

Related publications:

• Miller, J. P., Hutton, J., Doherty, C., Vallesi, S., Currie, J., Rushworth, K., Larkin, M., Scott, M., Morrow, J., & Wood, L. (2024). A scoping review examining patient experience and what matters to people experiencing homelessness when seeking healthcare. BMC Health Services Research, 24(1), 492. https://doi.org/10.1186/s12913-024-10971-8

  Project: Taking Foot Care to the Streets: Assessing Barriers and Inequalities of Vulnerable Patients Accessing Foot Care

  Team: Ailbhe Murray, Dr Joel Lasschuit, Dr Lauren Christie, Sonia Robinson, Peta Daley. Lousie Hamilton, Michelle Blakeney, Tom Faulker.

  Summary: The "A Step Ahead" initiative, funded by the SVHA Health Equity Program, aims to make preventative and early foot care accessible to all, particularly vulnerable individuals. This project acknowledges that bringing foot care directly "to the streets" is crucial for reducing foot complications in the community and alleviating the burden on emergency departments. This qualitative research project will involve one-on-one interviews with consumers and stakeholders to understand their perceptions of foot care and the barriers they face when accessing traditional "mainstream" care models. There's currently limited qualitative research in this area, especially regarding the views of people experiencing homelessness and support workers. The insights gained from these interviews will be used to inform revisions to the "A Step Ahead" service model and address issues specific to our healthcare setting, ultimately ensuring equitable, readily accessible, and culturally appropriate care.

  For further info, contact Ailbhe Murray: ailbhe.murray@svha.org.au

  Project: Optimising the Scope of Practice of Nurses Providing Healthcare to People Experiencing Homelessness: Community Consultation.

  Team: Olivia Hollingdrake, Jo River, Alejandro Vasquez-Hernandez, Elizabeth Grech and Jane Currie.

  Summary: This project was built on a national survey of nurses caring for people experiencing homelessness, complemented by follow-up interviews with survey participants and a workforce capacity analysis. The primary aim of the community consultation was to explore the perspectives of people with lived experience to identify the optimal scope of nursing practice in homeless health care. Once gathered, these insights were shared with nurses in homeless health services to gather their reflections on the proposed scope of practice. Data collection through interviews and focus groups concluded in June 2024, and the results were published in the Journal of Advanced Nursing.

  For further info, contact Olivia Hollingdrake: O.Hollingdrake@latrobe.edu.au

  Related publications:

• Hollingdrake, O., River, J., Vasquez-Hernandez, A., Grech, E., & Currie, J. (2025). A Qualitative Study Exploring Nursing Scope of Practice for the Care of People Experiencing Homelessness. Journal of Advanced Nursing, 10.1111/jan.70039. Advance online publication. https://doi.org/10.1111/jan.70039
• Thompson, C., Morris, D., Larkin, M., McWilliams, L., Vasquez-Hernandez, A., & Currie, J. (2025). Optimising the Nursing Scope of Practice in a Homeless Health Service: A Qualitative Descriptive Study. Journal of Advanced Nursing, 81(7), 4187–4197. https://doi.org/10.1111/jan.16633
• Morris, D., Thompson, C., Vasquez-Hernandez, A., Larkin, M., McWilliams, L., & Currie, J. (2024). Staff perceptions of the potential for nurses to address service gaps within a homeless health service in Sydney, Australia: Results of a cross-sectional survey. Collegian. 31. 356-363. https://doi.org/10.1016/j.colegn.2024.08.001
• Currie, J., McWilliams, L., Paisi, M., Shawe, J., Thornton, A., Larkin, M., Taylor, J., & Middleton, S. (2023). Nurses’ perceptions of the skills, knowledge and attributes required to optimise scope of practice and improve access to care for people experiencing homelessness in Australia: A cross-sectional study. Collegian, 30(4), 586–594. https://doi.org/10.1016/j.colegn.2023.02.002
• Currie, J., McWilliams, L., Venkataraman, V., Paisi, M., Shawe, J., Thornton, A., Larkin, M., Taylor, J., & Middleton, S. (2023). Nurses’ perceptions on the skills, knowledge, and attributes required to provide healthcare to people experiencing homelessness in Australia: A qualitative study. Collegian, 30(4), 539–547. https://doi.org/10.1016/j.colegn.2023.03.006
• McWilliams, L., Paisi, M., Middleton, S., Shawe, J., Thornton, A., Larkin, M., Taylor, J., & Currie, J. (2022). Scoping review: Scope of practice of nurse-led services and access to care for people experiencing homelessness. Journal of Advanced Nursing, 78(11), 3587–3606. https://doi.org/10.1111/jan.15387

  Project: Exploring health-related vulnerability among people attending the St Vincent’s Hospital Sydney Emergency Department.

  Team: Jane Currie, Alejandro Vasquez-Hernandez and Lee Jones.

  Summary: This study aimed to explore the relationship between health-related vulnerability and the likelihood of re-attending an emergency department within 28 days. Health-related vulnerability was measured using the Homeless Health Access to Care Tool (HHACT), a 24-item scale developed by the Homeless Health Research Team. The HHACT was administered to 300 participants, including individuals in both stable and unstable housing, who attended the Emergency Department at St Vincent’s Hospital Sydney, during regular business hours over a 14-day period. Data collection concluded in October 2023, and the manuscript is currently under revision. We anticipate publishing the findings in the second half of 2025.

  For further info, contact Alejandro Vasquez-Hernandez: alejandro.vasquez@svha.org.au

  Project: Pilot Implementation of the Homeless Health Response Bundle: A phase II hybrid randomised controlled trial.

  Team: Jane Currie, Jennie Hutton, Claire Doherty, Andrew Chan, Lee Jones, Alejandro Vasquez-Hernandez, Hayley Pepper, Paisley Suggett and Jed Duff.

  Summary: To enhance healthcare access for people experiencing homelessness, we developed the Homeless Health Response Bundle—now called the Healthy & HomED model of care—for use in Emergency Departments and Specialist Homeless Services. This model includes the Homeless Health Access to Care Tool, which assesses health vulnerability (high, moderate, or low), and a Decision Assistance Guide to support shared decision-making in treatment planning. We tested the model in a phase II hybrid randomised controlled trial to evaluate its impact on 28-day reattendance rates at St Vincent’s Hospital Melbourne Emergency Department. The manuscript is under review. We anticipate publishing the results in the second half of 2025.

  For further info, contact Claire Doherty: claire.doherty@svha.org.au

  Related publications:

• Currie, J., Grech, E., Longbottom, E., Yee, J., Hastings, R., Aitkenhead, A., Larkin, M., Jones, L., Cason, A., & Obrecht, K. (2022). Development of the Homeless Health Access to Care Tool to identify health-related vulnerability among people experiencing homelessness: Delphi study, Australia. BMJ open, 12(3), e058893. https://doi.org/10.1136/bmjopen-2021-058893
• Currie, J., Grech, E., Yee, J., Aitkenhead, A., & Jones, L. (2022). Multistage Psychometric Testing of the Homeless Health Access to Care Tool. International journal of environmental research and public health, 19(23), 15928. https://doi.org/10.3390/ijerph192315928
• Grech, E., E. Longbottom, J. Yee, et al. 2022. Scoping Review of the Application of the Behavioural Model for Vulnerable Populations to People Experiencing Homelessness. Journal of Social Distress and Homeless, 3, no. 1: 50–64. https://doi.org/10.1080/10530789.2022.2130590
• Currie, J., Grech, E., Longbottom, E., Yee, J., Hastings, R., Aitkenhead, A., Cason, A., & Obrecht, K. (2021). Scoping review of the characteristics assessed by vulnerability indices applied to people experiencing homelessness. PloS one, 16(7), e0254100. https://doi.org/10.1371/journal.pone.0254100

Homeless Health Service – Other Publications:

• Macfarlane, S., Haigh, F., Woodland, L., Goodger, B., Larkin, M., Miller, E., Parcsi, L., Read, P., & Wood, L. (2024). Critical Success Factors for Intersectoral Collaboration: Homelessness and COVID-19 - Case Studies and Learnings from an Australian City. International journal of integrated care, 24(2), 19. https://doi.org/10.5334/ijic.7653

  This paper reports on an intersectoral response to the COVID-19 pandemic in the geographical area and surrounding suburbs of Inner Sydney, NSW, Australia, in which homelessness is highly concentrated, accounting for a third of people sleeping rough in NSW.

• Currie, J., Hollingdrake, O., Grech, E., McEnroe, G., McWilliams, L., & Le Lievre, D. (2022). Optimising Access to the COVID-19 Vaccination for People Experiencing Homelessness. International journal of environmental research and public health, 19(23), 15686. https://doi.org/10.3390/ijerph192315686

  This study assessed the Inner City COVID-19 Vaccine Hub in Sydney, which provided 4,305 vaccinations and improved access for people experiencing homelessness. Findings informed a blueprint to guide similar efforts for vulnerable populations.  

• Blueprint model of care to support vaccine hubs for people experiencing homelessness (2021): The purpose of this document is to offer guidance to other agencies in the development and delivery of vaccine hubs for people experiencing or at risk of homelessness. The model of care described here is also relevant to vaccination efforts targeting other hard to reach or marginalised people and communities. https://apo.org.au/node/314543

For additional information, please contact Alejandro Vasquez-Hernandez at: alejandro.vasquez@svha.org.au