Current Research & Evaluations

Homeless Health Service Evaluations

COMET and Tierney House Evaluation

Way2Home Evaluation

Current Research

In 2019, St Vincent’s Homeless Health Service established a program of research focused on the impact of the homeless health service on access to care. Current projects include:

• Adaptation and implementation of a homeless health vulnerability index
• Optimising scope of practice of the nursing workforce to increase access to care for people experiencing or at high risk of vulnerability
• Evaluating rehabilitation needs, access and service provision among people experiencing homelessness who have sustained a Traumatic Brain Injury

Article Title: Heat Illness Requiring Emergency Care for People Experiencing Homelessness: A Case Study Series

Team: Matthew Larkin, Jane Currie, Timothy English, Jennie Hutton, Alejandro Vasquez Hernandez

Abstract
Extreme heat and hot weather has a negative impact on human health and society. Global warming has resulted in an increase in the frequency and duration of heatwaves. Heat-related illnesses are a significant negative consequence of high temperatures and can be life-threatening medical emergencies. The severity of the symptoms can depend on the pre-existing medical conditions and vary from mild headaches to severe cases that can lead to coma and death. The risk of heat-related illness may be higher for people experiencing homelessness due to a lack of access to cool places and water, and the complex interactions between mental illness, medications and substance use disorder. This paper presents two cases of people experiencing homelessness who were admitted to the emergency department of a hospital in Sydney, Australia during a heatwave in November 2020. Both cases were adult males with known risk factors for heat-related illness including hypertension and schizophrenia (Case One) and hepatitis C, cirrhosis, and alcohol use disorder (Case Two). These cases show that severe weather can not only be detrimental to homeless people’s health but can also cause a significant economic toll, evident by the $70,184 AUD expenditure on the care for these two cases. This case report highlights the requirement to determine the risk of heat-related illness to people experiencing homelessness and need to protect this vulnerable population from weather-related illness and death.

Link: IJERPH | Free Full-Text | Heat Illness Requiring Emergency Care for People Experiencing Homelessness: A Case Study Series (mdpi.com)

Article Title:  Optimising Access to the COVID-19 Vaccination for People Experiencing Homelessness

Team: Jane Currie, Olivia Hollingdrake, Elizabeth Grech, Georgia McEnroe, Lucy McWilliams and Dominic Le Lievre

Abstract
People experiencing homelessness face challenges accessing vaccinations. The urgency of the Australian COVID-19 national vaccination program requires an ongoing, integrated, and collaborative approach to ensure that people experiencing homelessness are supported to access COVID-19 vaccination in a culturally appropriate way that fosters a sense of safety by acknowledging people’s sense of cultural identity. As of 30 July 2022, 20,160,781 (78.3%) people aged 16 years and over in Australia have received at least one COVID vaccine dose, and 19,817,623 (77.0%) have received two doses, and 14,095,910 (54.85) have received three [1]. Once vaccination became available, the Australian Government developed a three-phase national roll-out strategy [2]. In Phase 1a the strategy focused on frontline health workers, aged care and disability staff and residents, and quarantine and border workers. Thereafter, elderly adults, other health workers, Aboriginal and Torres Strait Islander people (The Torres Strait Islands stretch between the coast of Northern Australia and Papua New Guinea, with Indigenous populations that are distinct from those of Australia’s mainland) and then reaching adults aged 60–69 and the balance of the population. The final phase focused on those under the age of 18 years old. In response to the national rollout, leaders in the provision of homeless health services became concerned that those experiencing homelessness may be at greater risk of exposure to COVID-19 due to their inability to self-isolate in a dwelling. Plans were made to establish a vaccine hub specifically focused to people experiencing homelessness. In this paper we report the findings of a study that explored the model of care underpinning the homeless health Inner City COVID-19 Vaccine Hub in Sydney Australia. These findings can be used as a template to assist other services to optimize access to vaccinations for people experiencing homelessness.

Link: IJERPH | Free Full-Text | Optimizing Access to the COVID-19 Vaccination for People Experiencing Homelessness (mdpi.com)

Project Title: Scoping review of the application of the Behavioural Model for Vulnerable Populations to people experiencing homelessness

Fifteen papers met the eligibility criteria and were included. The total participant sample size was 42,152. Provision of professional support and case management were significant factors in increasing access to care for people experiencing homelessness. Findings suggest that the Behavioural Model for Vulnerable Populations is a valuable tool in identifying health needs and predicting health service use. Included studies indicate that using the Behavioural Model for Vulnerable Populations can facilitate provision of targeted health services to people experiencing homelessness by identifying unmet needs. The findings of this review are valuable to health service design and policy, to increase access to care for people experiencing homelessness.

Project Title: Optimising scope of practice of the nursing workforce to increase access to care for people experiencing or at high risk of vulnerability.

Team: Dr Jane Currie, Lucy McWilliams, Anna Thornton, Joanne Taylor, Matt Larkin, Kathryn Riddell, Sandy Middleton

Duration: November 2020 – November 2021

Project Aim: To identify how the nursing workforce can increase access to care for people experiencing or at high risk of vulnerability that St Vincent’s Hospital Sydney serves. 

Background
There are untapped opportunities within the nursing workforce at St Vincent’s Hospital Sydney to increase access to care for people experiencing or at high risk of vulnerability. The nursing scope of practice is often underutilised due to a lack of confidence or knowledge, lack of clarity of identified referral pathways and policies supporting nurse led care. This project will optimise nursing scope of practice by identifying the required skills, knowledge and attributes required by nurses (registered nurses and nurse practitioners) to provide preventative and curative care for St Vincent’s Hospital Sydney priority groups, including people experiencing homelessness, people experiencing a mental illness, Aboriginal people and people who use substances.

For further information contact Dr Jane Currie: jane.currie@qut.edu.au

Project Title: Adaptation and implementation of a homeless health vulnerability index

Team: Dr Jane Currie, Elizabeth Grech, Erin Longbottom, Amy Cason, Ruth Hastings, Jasmine Yee, Amy Aitkenhead, Matt Larkin, Karin Obrecht

Duration: January 2020 – January 2021

Project Aim: To adapt and develop a vulnerability index to be used to assess ability to access care and the need to access care, of people experiencing homelessness.

Background
The focus of this project is the adaptation, further development and implementation of a vulnerability index to the Homeless Health Service, St Vincent’s Hospital Sydney. The purpose of the index is to assess ability to access care and the need to access care of people experiencing homelessness, in order to enable more focussed prioritisation of available health resources.

For further information contact Dr Jane Currie: jane.currie@qut.edu.au

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

Team: Dr Christine Shiner, Dr Simon Mosalski, Matthew Larkin, Valerie Bramah, Dr Jane Currie, Karon McDonell, Prof Steven Faux, A/Prof Fiona Haigh 

Project Duration: Jan 2021- Jan 2022

Funding: Inclusive Health Innovation Fund, St Vincent’s Centre for Applied Medical Research 

Background
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 certain barriers which prevent them from accessing current rehabilitation services. 

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