Assessing the health needs of homeless families
Post on 19-Jun-2015
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Sue Reid – Service Lead Jane Cook – Lead Nurse, Homeless
Healthcare
Those who approach the problems of familyhomelessness purely as a housing issue willtry to solve it purely as housing issue. Thisis a simple but ineffective approach …….Without paying equal attention to thepersonal/social side of the homelessequation, it would achieve little more than
movingfamilies’ problems behind closed doors.Taylor Gaubatz 2000
Figures80 000 children are homeless – the highest
number for a decade – Shelter64 000 homeless households were living in
temporary accommodation at the end of March 2009 – over 49 000 had dependent children
£630 million spent by L.A.s on emergency accommodation since the election
The number of homeless families in London rose by 32% in one year - 2013
Causes of homelessnessLack of affordable housing
Domestic violenceRelationship
breakdownDebtMortgage/rent arrearsEvictionAnti-social behaviourHarassmentOvercrowdingUnder-occupancyEmpty properties
More likely to have had histories of:
AbuseLived in careBeen on the at risk
register
A quarter of all homelessness is due torelationship breakdowns with 70% involvingdomestic violence
A study in Birmingham homeless centresfound that 89% of the families using thecentres lost their homes because of violence
P Vostanis et al(1999) Homeless Children: Problems and needs.Jessica Kingsley
Accommodation and conditionsHomeless at homeSquattingTemporary
accommodationHostelsTransitional housingBed-and-breakfast
hotels
OvercrowdingNoiseUnsafeLack of spaceLack of privacyShared amenitiesIsolationLack of planning and
control over one’s life
The impact of homelessnessLoss of security and
controlOvercrowdingMobilityIsolationDeskillsLoss of confidence
and self esteemInstitutionalises
Disruption of educationLack of security, space,
privacy and play areas
Loss of:FamilyFriendsCommunitySupportCountry
“Frequent moves can make it difficult toaccess the services they need. For thosealready socially excluded moving frequentlycan worsen the effects of their exclusion”
Impact on health of childrenRespiratory problemsInfectious diseasesSkin problemsGastro-intestinal
problemsSevere developmental
and speech delayBehavioural problemsHigh rate of accidents
High rate of psychiatric problems (estimated at 30%)
Twice as likely to be admitted to hospital
Low rates of immunisation
Impact on the health of adultsMental health
problemsGastric problemsRespiratory
problemsMusco-skeletal
problemsAntenatal and
postnatal problems
Loss of self esteemLoss of confidenceInstitutionalisesPresent with multipleneeds that relate to:Poverty/low incomeInadequate housingPoor healthLoss of opportunities
Vulnerability of homeless familiesFamilies living in social
housingFamilies with a young
mother or young fatherWhere the mother’s main
language is not EnglishWhere the parents are not
co-residentWhere one or both parents
grew up in careA history of abuse, mental
illness or alcoholism in the mother’s family
Chronic health problemsLow birth weight or
prematurity
Parents with few or no qualifications
Parents not in education, employment or training
Families living in povertyParents with mental health
problemsUnstable partner
relationships Intimate partner abuseParents with a history of anti-
social or offending behaviourLow self esteem or low self-
reliance
Child Health Programme DofH 2008
Parent – vulnerability - childDrug and alcohol
misuseFamily violence (past
and present)Homelessness, poverty
and unemploymentNon-compliance with
professionalsPhysical and mental
health issuesYoung and lone parentsLearning difficulties
Disabled and long term illness
Looked after children including unaccompanied minors
Private fosteringTrafficked children
Vulnerability(serious case reviews)36% parents moved frequently and lived
in temporary accommodation – mobility60% emergency department attendance34% did not have a GP66% issues of domestic violence55% mental health problems
London Safeguarding Children Board (2007) Mobile Children and Families in London Child Protection
Procedures Dfes (2006) Working Together to Safeguard Children
SolutionsMultidisciplinary teams Interagency response Integrated working - joint
strategies, referral pathways
Holistic assessmentsNotification systemRobust data baseMonitoring, auditsConsultation with service
usersOutreachAccessible venuesTrainingKey workers, advocatesDevelop skills – life skills
and parenting
Cross sector approach in planning - Partnership working – multi-agency steering group
Single set of local prioritiesShared positive outcomesShared inequality
indicatorsHealth equity auditsCNA Joint commissioning –
pooled budgetsPublic health approach –
needs leadCo-ordinated information
strategy
“……housing is more than economics,it is a matter of humanity and morality,as well as economics”.
Housing is a moral issue: A statement fromthe Department for Social responsibility ofthe Catholic Bishops’ Conference ofEngland and Wales 1985
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