Nursing service for homeless children exposes lack of access to health care

A nurse practitioner service delivered in Adelaide’s south in collaboration with Flinders University has found that only 11% of homeless children are fully immunised and more than half have health conditions requiring immediate intervention.

The United Care Wesley Bowden’s (UCWB) Inner Southern Homelessness Service is led by a paediatric ED nurse practitioner who provides a free full paediatric health assessment to children and their families already linked to UWCB’s homelessness services.

The service was launched at Marion in December 2019 in collaboration with Flinders Caring Futures Institute researcher and child and adolescent nursing expert Dr Yvonne Parry.

The nurse has seen 60 children over the past six months, all of which are aged between 0-18 and living in housing instability. However, most of them are aged between four and eight, and almost half are Indigenous.

According to the 2016 Census, 22% of children were living in housing instability.

Dr Parry says early results show that most of the children who had engaged with the service over the past six months were disconnected from health, welfare and education services.

Nearly 70% of the children have health conditions requiring immediate interventions and referrals ranging from chronic dental caries to craniosynostosis, a birth defect in which the plates in the baby’s skull close before they are supposed to, impacting on the brain’s development and size, she says.

“Without this intervention these children would remain disconnected from health and wellbeing services including education, exacerbating their care needs and delaying vital interventions,” Dr Parry says.

“Further to this, 11% of the children are not fully immunised leaving them at greater risk to preventable diseases such as measles and whooping cough.

“With increased unemployment, the need to access free immunisation is imperative if we are to maintain community immunity.”

Dr Yvonne Parry

The nurse practitioner also supports families with referrals onto medical, allied health and mental health services to improve the health and wellbeing outcomes for the child.

Dr Parry says while the increase in client referrals to health services has been positive, the children who presented with conditions that needed immediate intervention faced a roadblock.

“Our results also show that children are presenting with conditions that need immediate intervention but may need to wait up to three months before the referral is triaged to a waiting list,” she says.

“The barriers to appropriate and timely health care for children can be beyond the control of the parents and this leaves children already in disadvantaged and vulnerable situations facing even greater health and wellbeing risks.”

Dr Parry says all children living in housing instability need an immediate triage pathway allowing for an instantaneous appointment with acute health care services.

“If we act early in the life of the child and early in the life of the problems, we save time, money and potential lifelong ill-health,” she says.

UCWB Chief Executive Fiona Kelly says the nurse practitioner service has delivered contemporary health assessments that are trauma informed and holistic, in addressing the health needs of children and their families who are experiencing homelessness.

“Our families often present with complex trauma, mental health and are other presenting issues that can inhibit the capacity to navigate the health system.” she adds.

For the past six months, the nurse practitioner has provided health assessments to homeless children and families in-centre at Marion, through outreach at home visits across the Marion, Holdfast Bay and Mitcham council areas, and through Emergency Accommodation.

Dr Parry is seeking further funding to allow the service to continue into 2021.

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