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

2. 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 ( ), 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)
Building a Response to the Homeless Family Crisis

3. Homelessness
The term homelessness is often misunderstood, many people believe that the definition is restricted to those who sleep on the streets. In fact, the definition is far broader.”

4. 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. “

5. The Faces of Homelessness
The visibly homeless are people who are:
living rough, or
sleeping in designated emergency accommodation such as a hostel
The hidden homeless are people who are:
staying with relatives or friends because there is no alternative accommodation for them, or
remaining in institutional care because there is no affordable accommodation for them
People at risk of homelessness have housing but are likely to become homeless through:
economic difficulties, or
the threat of violence
People rough sleeping are:
not in contact with emergency services, and
not staying in emergency accommodation

6. 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.

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

8. Families Experiencing Homelessness in Dublin
Source: Dublin Homeless Regional Executive (DRHE) March 2107

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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.

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

19. Families who are not accommodated
PHN Response to Families in Emergency Accommodation *PHN’s must assess each family case by case and comply with local PPG’s*
The PHN maintains contact and keeps the child health records
Family are well known to PHN with a good record of attendance
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
Families who become homeless and are given emergency accommodation in a contracted unit e.g. Hotel, apartment, B&B
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
Family are known to the PHN with a history of DNA and non engagement with the service
PHN makes contact with the assigned PHN for the contracted unit
Family known to PHN and there are child protection issues
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
Families who need to self accommodate e.g. Hotels on a short term basis
PHN maintains link with the family
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 who are not accommodated
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
Coordinator Health Link Team and Public Health Nursing Service Dublin West, Dublin South West and Dublin South City 19

20. 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

21. Source: Better Outcomes, Brighter Futures 2014 - 2020
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

22. 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 McHugh 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.

23. Thank You