Scoping review of the characteristics assessed by vulnerability indices applied to people experiencing homelessness

Abstract

Background The objectives of this scoping review are to investigate the characteristics assessed by existing vulnerability indices and the health outcomes achieved by applying them to people experiencing homelessness. This review forms part of the development and implementation of a novel tool to prioritise people experiencing homelessness for healthcare based on their need and capacity to access healthcare. Methods Included papers were primary research, published in the English language, participants were experiencing homelessness and aged over 18 years at the time of the study, a vulnerability index was used in the study, sample size was greater than 30, and the study had a health focus. Databases searched were MEDLINE, Embase, CINAHL, Scopus, PubMed and Web of Science, between January-April 2020. The Joanna Briggs Appraisal criteria were used to quality appraise the included studies. Results were synthesised narratively. Results Six papers were included, a total of 27,509 participants. The reported use of the indices varied; they included screening and profiling homeless populations, comparing homeless populations, and two studies evaluated the predictive capacity, reliability and validity of the indices. One vulnerability index focused on screening for human immunodeficiency virus, one used a 50-item index and four used a nine-item index. No direct health outcomes were reported from applying the vulnerability indices. The studies identified limitations of using vulnerability indices, including the potential bias of relying on self-reported data and two studies highlighted the need for further psychometric testing to ensure validity and reliability of the indices. Discussion The sample of included studies was small. Vulnerability indices are reportedly a useful and easily accessible method of gaining valuable data on the health status and health needs of people experiencing homelessness. The variety of characteristics included in the vulnerability indices suggests the importance of tailoring vulnerability indices to the needs of the population to which it is to be applied. Conducting appropriate psychometric testing is critical so that an index can be used to accurately inform decision making and accurately prioritise people experiencing homelessness who are most at risk of mortality and morbidity. A specific tool that prioritises people experiencing homelessness for access to health care is not yet available. The review was funded by a St Vincent’s Network Inclusive Health grant.

Development of the Homeless Health Access to Care Tool to identify health-related vulnerability among people experiencing homelessness: Delphi study, Australia

“…The next phase of developing the Homeless Health Access to Care Tool will focus on Scale Development. 22 This will include pretesting the items to ensure they are meaningful and establishing the construct validity and interrater reliability of the tool. The construct validity will be tested using fictional case studies, of which clinicians are asked to first ‘instinctually’ rate the case studies as slightly/moderately/highly vulnerable, and then rate the case studies using the Homeless Health Access to Care Tool.…”

“…Once validity and reliability are established, a process of item reduction will be undertaken to ensure the tool is as short as possible. 22 Feedback received from the Delphi suggested the need to ensure the Homeless Health Access to Care Tool is as short in length as possible. The conciseness of the tool is likely to improve both clinicians and clients’ compliance in completing it, with the challenge to include all relevant items for acceptable validity and reliability of the test.…”

“…Following the literature review, 22 the tool that appeared most comprehensive in its assessment of health needs was the Vulnerability Index Service Prioritisation Decision Assistance Tool (VI-SPDAT) (Org Code). The VI-SPDAT has 50-items of yes/no questions focused on a person’s history of housing and homelessness, risks, socialisation, daily functions and wellness.…”

Integrating healthcare services for people experiencing homelessness in Australia: key issues and research principles

“…6 Better recognition of homelessness in healthcare services requires the development of screening tools and processes, as well as systems that support healthcare workers in understanding and responding to homelessness. 7 Though issues exist with the use of administrative health service data for research purposes (eg, 'no fixed address' being shown to be a poor indicator of homelessness), 6 there is potential for such data to better characterise the composition and the needs of this population. Data linkage also offers the opportunity of connecting health with other sectors.…”

Multistage Psychometric Testing of the Homeless Health Access to Care Tool

“…Ability to access health care is defined using the definition proposed by Levesque et al (2013) [ 12 ]: ability to seek, perceive, reach, pay and engage healthcare. Vulnerability indices are commonly used to assess mortality and morbidity of people experiencing homelessness [ 13 ]. Vulnerability indices populate a risk score based on the self-report responses to a series of questions on health and wellbeing.…”