Table 4

Qualitative responses round one Delphi survey

Theme and frequencyExample
The number of questions included in the adapted VI-SPDAT is appropriate. Somewhat agree=5, Strongly agree=5
Time (n=4) Comprehensive (n=9) Privacy (n=1) Number of questions (n=4) Client connection (n=3)‘in ED…staff will be less hesitant to use it if they have less to do.’ (Time)
‘It is short yet comprehensive enough to be able to illicit information from a person within a short space of time.’ (Comprehensive)
The questions included in the adapted VI-SPDAT will facilitate the objective assessment of people experiencing homelessness in relation to their ability and need to access healthcare? Strongly agree=1, Agree=8, Disagree=1
Evidence base (n=1) Access to care (n=2) Validity (n=2) Self-report (n=2) Scoring (n=3)‘This couldn’t be used as a 1 short assessment where you can be 100% confident in the results.’ (Access to care)
‘In total these aspects and questions are a good indication of their ability to access.’ (Validity)
In what language do you express yourself? English ☐ Other: Interpreter required? Y ☐ N ☐ Highly relevant=5, Quite relevant=3, Somewhat relevant=1, Not relevant=1
Communicating (n=4) Understanding (n=2) Interpreter (n=3)Way of asking (n=2)‘Very relevant question in terms of communication/miscommunication’ (Communication)
‘if an interpreter is required then you would get one prior to commencing the questions’ (Interpreter)
Medicare? Y ☐ N ☐ Number: Highly relevant=5, Quite relevant=4, Somewhat relevant=0, Not relevant=1
Relevance of question (n=6)
Lost cards (n=1) Context (n=1)
‘frequent problem and impedes many services/access to care if lost’ (Relevance of question)
‘‘ED viewpoint—This should happen at admin [Reception desk].’ (Context)
Do you identify as Aboriginal or Torres Strait Islander: Y N Are you or were any members of your community part of the stolen generation? Y N Highly relevant=10
Culturally appropriate care (n=5) Morbidity /mortality (n=3) Trauma (n=3) Access (n=1)‘Can provide context as to how a clinician might approach assessment in a culturally appropriate way/make allowances for communication issues related to mistrust of the system, etc. May inform more appropriate treatment planning that is, referral to Indigenous workers/services.’ (Culturally appropriate care)
Where do you sleep most frequently? Highly relevant=6, Quite relevant=2, Somewhat relevant=2, Not relevant=0
Timeframe (n=1) Sleeping location (n=1) Contacting a client (n=4) Context to client’s well-being (n=1) Rapport (n=3)‘Not always a question some homeless people want to answer, especially if there may be fears around a system being enacted on them. Often a question of trust and individual rapport between clinician/person.’ (Rapport)
What is the total time you have ever lived on the streets or in emergency accommodation? Highly relevant=5, Quite relevant=2, Somewhat relevant=3, Not relevant=0
Other reasons for vulnerability (n=2) Correlate to ill health (n=3) Context to well-being (n=5) Subjective (n=1)‘Relevant in there being a statistical correlation between length of time homeless and morbidity/early mortality.‘ (Ill health)
‘The longer someone has been in the named situation is a good indication of their level of trauma and of the level of support they will need post housing.‘(Context of well-being)
Do you avoid healthcare or are you unable to go for healthcare when you are not feeling well? Avoids care Y N Why? Unable to go for care? Y N Why? Highly relevant=8, Quite relevant=2, Somewhat relevant=0, Not relevant=0
Indicates barriers (n=1) Capacity to access (n=3) Indicate chronic illness (n=1) Self-report (n=1) Provide support (n=2) Posing question (n=2)‘Relevant in terms of assessing capacity/insight/need for treatment/issues around treatment history’ (Capacity to access)
‘Yes, allows us to be able to provide support to the person to feel more comfortable to access healthcare if we know the reasons why they may avoid it or are unable to attend.’ (Provide support)
‘For some reason I feel that asking this question may come across as accusatory, however maybe if rephrased.’ (Posing question)
In the past 6 months, how many times have you: Received healthcare at an emergency department? Taken an ambulance to hospital? Have you had an admission to hospital for your mental health? Have you had an admission to hospital for your physical health? Highly relevant=4, Quite relevant=3, Somewhat relevant=2, Not relevant=1
Posing question (n=1) perception of healthcare received (n=1) Access to care (n=4) Self-report (n=1) Frustrate client (n=1)‘Highly relevant in terms of identifying/triaging/ access to services/treatment planning/treatment history.’ (Access to care)
‘Relevant but also can be subjective based on memory capabilities’ (Self-report)
Is there someone we can contact for you in an emergency? Y N Friend Relative Other: Highly relevant=6, Quite relevant=3, Somewhat relevant=0, Not relevant=1
Safe place/relationship (n=5) Indicate trauma (n=2) Not relevant (n=1)‘May indicate a safe place and relationship to enlist for support.’ (Safe place/relationship)
Are you currently able to take care of your daily needs like bathing, changing clothes, using a toilet, getting food and clean water and other things like that? Observation: Does the client appear able to take care of daily needs? Highly relevant=9, Quite relevant=1
Inclusion of observation (n=1) Indicates disorganisation (n=5) Links to services (n=2) Posing question (n=1)‘one of the few observed measures, marker of general disorganisation’ (Indicates disorganisation)
‘We need to know what access they have, if they choose to use or not is a different story.’ (Links to services)
Is there anyone that you feel unsafe with/threatened by or that causes you harm in any way? Highly relevant=9, Quite relevant=1
Access to care (n=1) Identifying domestic violence (n=3) Posing question (n=4)
Indicate need for referral (n=2)
‘Identifying someone’s safety concerns/issues is an essential component to emergency care’ (Identifying domestic violence)
‘Probably a question I would ask towards the end of an interview when hopefully some rapport has been established.’ (Posing questions)
Do you have any medical conditions? A serious brain injury/head trauma Kidney disease/ dialysis Gastric disorders Liver disease/cirrhosis Heart disease High or low blood pressure Emphysema/Chronic Obstructive Pulmonary Disease/asthma Diabetes Cancer Hepatitis C Epilepsy/seizures HIV/AIDS Heat stroke/exhaustion TB Cellulitis Other: Highly relevant=7, Quite relevant=3
Add other issues (n=1) Symptoms Indicates well-being (n=2) Access to care (n=2) Posing the question (n=2)‘Allows us to provide specific care and treatment to the person if they are aware of their medical conditions. Also, by asking the question it avoids us missing out on important health information.’ (Access to care)
‘Just need to reduce the conditions if possible.’ (Posing the question)
Are you currently or could you be pregnant? Y N Highly relevant=10
Trauma (n=2) Referrals to obstetric care (n=4) Increases vulnerability risk (n=2)‘May avoid healthcare interaction if traumatic interaction re loss of previous children’ (Trauma)
‘Needs link into antenatal care if pregnant.’ (Referral to obstetric care)
Have you ever been diagnosed with a mental health condition? Anxiety Depression PTSD Bipolar disorder Schizophrenia Psychosis Personality Disorder Do you ever have thoughts of self- harm? Y N Do you ever have thoughts of suicide? Y N Other: Highly relevant=8, Quite relevant=1, Somewhat relevant=1, Not relevant=0
Posing the question (n=2)
Ability to access (n=2) Common issue (n=2) Shame (n=1) Referral (n=2)
I would tend to adjust the questions about existing diagnoses for example, schizophrenia—I find those who have been diagnosed usually disagree but do admit to experience of positive symptoms.’ (Posing the question)
‘In total these aspects and questions are a good indication of their ability to access.‘ (Ability to access)
Have you ever been told you have a learning disability or developmental/intellectual disability? Y N Highly relevant=6, Quite relevant=3, Somewhat relevant=1, Not relevant=0
Ability to interpret experience (n=2) Assessment of baseline (n=2) Associated trauma (n=1) Providing appropriate care (n=3)‘Relevant in identifying baseline functioning/capacity/appropriate treatment planning’ (Assessment of baseline)
‘Allows us to provide appropriate care to the person and also allows us to provide information to the person appropriate to their level of understanding.’ (Providing appropriate care)
Are there any medications that you have been told to take each day? Y N Are you taking these as advised? Y N What are they? Highly relevant=8, Quite relevant=2
Reason why (n=1) Compliance (n=3) Assessment (n=4) Health literacy (n=1)‘Need to be able to know what a person is taking to identify current management of/differentiate potential withdrawal/at risk/medical emergency states. ‘May provide information about medical and other conditions.’ (Assessment)
On a typical day what is the best way to contact you? Highly relevant=9, Quite relevant=1
Support structure (n=1) Continuity (n=1)‘Might be good to ask about informal supports such as other incredible organisations we collaborate with basic probe for ability to connect to care’ (Support structure)
  • ED, emergency department; PTSD, post-traumatic stress disorder; VI-SPDAT, Vulnerability Index Service Prioritisation Decision Assistance Tool.