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