Health Visiting for Homeless Families – the UK and Australian Experience

In October 2019, the QNI’s Homeless Health Programme hosted a visit from Dr Yvonne Parry, visiting Paediatric Nurse, researcher and senior lecturer from Australia. Dr Parry met with a group of UK Health Visitors specialising in homeless families and this blog records some of the issues that were discussed.

The QNI has made contact with charity Shelter and the Ministry of Housing, Communities and Local Government about some of the issues raised in the meeting, and another Health Visitors’ networking meeting is planned for 2020. If you are a Health Visitor working with homeless and vulnerable migrant families and you would like to find out more, please get in touch.

Homeless Families in the UK

Six Health Visitors working with homeless and vulnerable migrant families in the UK (Debbie Fawcett, Nicola Ford, Catherine Gladstone, Sandra Oritsesan, Louise Roberts and Dianne Vigilance), shared their experiences in the meeting. In the UK, 84,740 households were in temporary accommodation at the end of March 2019, and this represents a 77% increase since December 2010 (House of Common Library, 2019). Although not as extreme as the Australian situation, concerns about the capacity to respond, and the impact of adverse childhood experiences were mirrored. Individual HV caseloads were up to 150 families.

The role of nurses in improving the health and wellbeing for vulnerable populations, especially children, was discussed along with similarities in the issues of meeting the core health care and developmental needs of children. The discussion revealed highly complex, sensitive work taking place, with high levels of responsibility.

Current issues described included:

• There being no consistent policy on the provision of specialist homeless health visiting for homeless and vulnerable migrant families. Whether specialist provision exists is seeming to depend on local advocacy and strong practitioner voices;
• Notifications of families moving into and out of areas being at times inadequate, and there being no consistency as to how this is managed. Health Visitors in some areas receive routine Local Authority notifications, but in other areas this not happening;
• Long stays in so called ‘emergency’ and ‘temporary’ accommodation – one family was said to have been in emergency accommodation for 6 years;
• Accommodation being frequently too small and sub-standard. ‘Bleak Houses (2019)’ a report from the Children’s Commissioner also outlined this recently;
• Out of borough placements being very common against current guidance (see NHAS guidance from 2018), and very challenging for parents regarding appointments, benefits payments, schooling, travel etc.;
• Parents lacking life skills, and this being a gap in the support available. Specialist programmes like the Family Nurse Partnership are not consistently provided.

Homeless Families in Australia

In Australia there are around 180,000 homeless families, and 1 in 28 children are homeless. Many families are living in cars or are sofa surfing, largely from the indigenous aboriginal populations. Lots of children from this group are not in school, and there are low levels of immunisation – in some cases only 80% (e.g. measles, whooping cough). Health visiting as an outreach intervention doesn’t really exist, although ‘orange vans’ that outreach to street homeless individuals also work with families. Only 6 weeks accommodation is provided before families need to find private rental accommodation, although deposits are generally given. In parallel with the UK, much of the social housing stock was sold off, and many families are consequently in a revolving door scenario.

Children and babies miss out on important services, including basic health care, if they are affected by homelessness. Free health care will be offered to homeless families in Adelaide’s south under a bold new initiative led by UnitingCare Wesley Bowden and Flinders University.

In a first for the South Australian homelessness sector, a nurse practitioner – Flinders graduate Alicia Bell – will be available at Marion where children and their families who are engaged with UCWB’s homelessness services will have access to professional and free health services. The new initiative will also be available as an outreach service across the Marion, Holdfast Bay and Mitcham council areas.

The project recognises the detrimental impacts crisis and homelessness can have on children and their families and fills the gap for them to access services to support their physical and mental health. The new service builds on the successful partnerships that saw student nurses from Flinders University work alongside UCWB’s homelessness team and win an award from the National Association for the Prevention of Child Abuse.

During her time in the UK, Dr Parry also gave a workshop to researchers and PhD candidates at the University of Derby. The workshop was titled ‘Not about me without me’ and covered how to work/research in partnership with marginalised and vulnerable populations. It included her work with homeless families and the intervention evaluation research she has led with the national Communities for Children programs. The examples provided in the workshop also included Yvonne’s work with Aboriginal and refugee families.

Contact Samantha Dorney-Smith for more information.