Keeping Families linked to Public Health Nursing Service

Keeping Families linked to Public Health Nursing Service A Public Health Nursing Response to the Homeless Family Crisis ICHN Conference 17 th May 2017 Jackie Austin, Sharon Boyle, Liz Pigott-Glynn

Building a Response to the Homeless Family Crisis ❖ ❖ ❖ Growing concerns from PHNs regarding homelessness and the difficulty in tracking the whereabouts of vulnerable families and children. Joint strategic planning initiated between PHNs, Health-Link Team and the S. D. C. C Homeless Unit, . This project was built on a pillar of effective communication already in existence Guiding documentation: Better Outcomes Brighter Futures (2014 -2020), Nurture Programme (2016) , Children First Documentation and Legislation Irish Enquiries and Reports; particularly recommendations from the Monageer Report in relation to public health nursing: “ An evaluation of the tracking, the movement of families and the management of records (Buckley and O’ Nolan 2013)“ Extensive International and UK literature and guidance documentation, for example, Shelter Homeless Organisation (2016, 2015, 2014) and NSPCC (2016)

Homelessness

Definition of Homelessness Section 2 of the Housing Act, 1988 states that a person should be considered to be homeless if: (a) there is no accommodation available which, in the opinion of the authority, he, together with any other person who normally resides with him or who might reasonably be expected to reside with him, can reasonably occupy or remain in occupation of, or (b) he is living a hospital, county home, night shelter or other such institution, and is so living because he has no accommodation of the kind referred to in paragraph (a), and (c) he cannot provide accommodation from his own resources.

The Faces of Homelessness

Statistics ❖ Currently 7472 people experiencing homeless in Ireland. (Government Homeless Report March 2017) ❖ Nationally: 1256 families with 2, 563 dependents ❖ 66% of these are lone parent families (2% male lone parents) ❖ 38% of the children are aged 0 -4 years ❖ Dublin Regional Homeless Executive (DRHE) shows almost 50% increase in the Dublin region between Dec 2015 and Dec 2016 ❖ Not included in the statistics are rough sleepers and the ‘hidden homeless’ i. e. those who are living in squats or ‘sofa surfing’ with friends or people who are living in domestic violence refuges.

Families Experiencing Homelessness Nationally Area Families Dublin Adults Single Parent Total Families Dependants 1069 1426 712 2134 Mid East 24 36 12 69 Midlands 24 34 14 48 Mid West 42 57 23 79 North East 7 10 4 13 North West 2 2 2 7 South East 8 8 8 13 South West 61 81 41 145 West 21 28 14 55 1256 1682 830 2563 Total Source: Department of Housing, Planning, Community & Local Government Homelessness Report March 2017

Families Experiencing Homelessness in Dublin 2500 2000 Dec 15 1500 Jan 16 1000 Mar 17 500 0 Families Hotels Contracted Units Source: Dublin Homeless Regional Executive (DRHE) March 2107 Dependants

Governments Plan to Tackle Homelessness ❖ Aim : To tackle homelessness in a comprehensive manner. ❖ Accelerate the provision of social housing ❖ Deliver more housing ❖ Utilise vacant homes ❖ Improve the rental sector ❖ Address the needs of homeless people and families.

The Faces of Homelessness National and international research shows time and again that what happens to a child during pregnancy and the first three years of life will influence the child’s health and wellbeing for their lifetime. ” Nurture Programme, 2016

Impact of Homelessness on Families ❖ Harder to maintain contact with services – developmental delay, speech delay/regress ❖ Embarrassment regarding their situation – no place to call home ❖ Having to change services - SLT, AON, other agencies ❖ Schools not always local ❖ Change in routines for the families ❖ Overcrowding – causes sleep problems ❖ Financial Strain ❖ Unable to make plans

Impact of Homelessness on Families ❖ Higher risk of Mental health problems such as depression, PTSD and isolation ❖ Child and infant mental health ❖ Longer term issues; smoking and substance misuse, addictions ❖ ❖ Adverse impact on nutrition – problems for diabetics, obesity, malnutrition, weaning Antenatal and postnatal problems with premature births, small for dates and PND

Impact of Homelessness on Children ❖ Respiratory problems particularly asthma ❖ Infectious diseases; such as ear infections, lice and wound infections ❖ Gastro-intestinal problems – diarrhoea ❖ Higher risk of accidents – homeless accommodation not suitable for “home” ❖ No out door space to play ❖ Developmental delay – no room to crawl, develop and grow ❖ Toilet training issues

Impact of Homelessness on the Service Provider ❖ Increase in homelessness in the last three years – continues to rise ❖ Transient nature of families – Which service to refer to (challenge for PHNs) ❖ Stretched Caseloads for PHNs – Traceability of families adds to workload ❖ Often complex cases with multiple problems ❖ Difficulty providing holistic care to the family ❖ Support networks often in different areas ❖ KPIs not accurate

Working Group “Early intervention and prevention create the best possible outcomes for children. It helps children meet their developmental goals and offers them the best chance of living a happy and fulfilled life. ” Source: The Nurture Programme, 2016

Working Group ❖ ❖ February 2016, following a meeting facilitated by SDCC a working group was set up to address issues that were raised by PHNs and the Health -Link Team for Homeless. The group consisted of members from the PHN Service in Dublin South West, Dublin West and Dublin South City, and the Coordinator of the Health-Link Team for Homeless. A literature review was completed and the findings helped guide the group. A PHN consultation identified the challenges that the PHNs faced with tracking and maintaining contact with families and the management of the Child Health Records.

Outcome of Working Group ❖ ❖ ❖ The group identified the complexities of homelessness A single point of contact was established in each CHO 7 area (ADPHN) to link with the Coordinator of the Health-Link Team for Homeless A flow chart was designed to guide the PHN in maintaining contact with homeless families and with the management of the Child Health Records.

The Link from Local Authority to PHN Service Notify designated ADPHN in the area of origin Fingal County Council Contracted Unit Notify designated ADPHN and PHN in the area of accommodation Dun Laoghaire Rathdown Health-Link Team Self Accommodate Notify designated ADPHN in area of origin No offer of accommodation Notify designated ADPHN in area of origin Dublin City Council South Dublin County Council

PHN Response to Families in Emergency Accommodation *PHN’s must assess each family comply with local PPG’s* Family are well known to PHN with a good record of attendance Families who become homeless and are given emergency accommodation in a contracted unit e. g. Hotel, apartment, B&B Family are known to the PHN with a history of DNA and non engagement with the service Family known to PHN and there are child protection issues Families who need to self accommodate e. g. Hotels on a short term basis Families who are not accommodated PHN maintains link with the family case by case and The PHN makes contact with the assigned PHN in the area of the contracted unit to inform her/him that the family are temporarily in their area but that the child health records will stay with the current PHN The PHN maintains contact and keeps the child health records PHN makes contact with the assigned PHN for the contracted unit A) If there are no child protection concerns or risks to the family, the PHN will keep the child health records. Developmental appointments must be offered by either PHN as agreed when initial contact is made B) If there are concerns or risks, with agreement between the PHNs, records are transferred by registered post and the CHIS system is updated PHN contacts the assigned PHN for the contracted unit and the child health records are transferred via registered post CHIS system and Tusla are updated A) If there are no risks or concerns no action is required until a more permanent placement is found for the family B) If there are child protection concerns or risks the child health record remains with the PHN. A PCCC referral form, a copy of the CFHNA, and if required a risk assessment must be sent to the assigned PHN for the hotel etc via your ADPHN. Tusla must be updated. Families present themselves to the council as homeless and are not accommodated PHN is made aware that the family presented as homeless PHN keeps the family in her case load Coordinator Health Link Team and Public Health Nursing Service Dublin South West, Dublin West and Dublin South City

Special Note Homelessness is a complex multi system process The Flow chart is only a guide Each family must be assessed individually Communication is vital Always adhere to ❖ Children First Guidelines 2011 ❖ Local Policies and Procedures

Final Note Working Together to Make Ireland “one of the best small countries in the world in which to grow up and raise a family, and where the rights of all children and young people are respected, protected and fulfilled. ” Source: Better Outcomes, Brighter Futures 2014 - 2020

Implementation Team ❖ Jackie Austin ADPHN Dublin South West ❖ Liz Pigott Glynn Coordinator Health-Link Team for Homeless ❖ Barbara Goldsmith ADPHN Dublin South West ❖ Sharon Boyle PHN Dublin South West ❖ Frances Mc. Hugh ADPHN Dublin West ❖ Tara Creighton ADPHN Dublin South City ❖ Supported by DPHN Ger Mc Goldrick Dublin South West and Niamh Milliken Social Work Department S. D. C. C.

Thank You