Assessing the health needs of homeless families as delivered by Sue Reid and Kirit Sembit of the Newham Transitional Team at the LNNM homeless conference April 4th 2014

1. Sue Reid – Service Lead
Jane Cook – Lead Nurse, Homeless Healthcare

2. Those who approach the problems of family
homelessness purely as a housing issue will
try to solve it purely as housing issue. This
is a simple but ineffective approach …….
Without paying equal attention to the
personal/social side of the homeless
equation, it would achieve little more than moving
families’ problems behind closed doors.
Taylor Gaubatz 2000

3. Figures
80 000 children are homeless – the highest number
for a decade – Shelter
64 000 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

4. Causes of homelessnessLack of affordable housing
Domestic violence
Relationship breakdown
Debt
Mortgage/rent arrears
Eviction
Anti-social behaviour
Harassment
Overcrowding
Under-occupancy
Empty properties
More likely to have had
histories of:
Abuse
Lived in care
Been on the at risk register

5. A quarter of all homelessness is due to
relationship breakdowns with 70% involving
domestic violence
A study in Birmingham homeless centres
found that 89% of the families using the
centres lost their homes because of violence
P Vostanis et al(1999) Homeless Children: Problems and needs.
Jessica Kingsley

6. Accommodation and conditions
Homeless at home
Squatting
Temporary
accommodation
Hostels
Transitional housing
Bed-and-breakfast
hotels
Overcrowding
Noise
Unsafe
Lack of space
Lack of privacy
Shared amenities
Isolation
Lack of planning and
control over one’s life

7. The impact of homelessness
Loss of security and
control
Overcrowding
Mobility
Isolation
Deskills
Loss of confidence and
self esteem
Institutionalises
Disruption of education
Lack of security, space,
privacy and play areas
Loss of:
Family
Friends
Community
Support
Country

8. “Frequent moves can make it difficult to
access the services they need. For those
already socially excluded moving frequently
can worsen the effects of their exclusion”

9. Impact on health of children
Respiratory problems
Infectious diseases
Skin problems
Gastro-intestinal
problems
Severe developmental
and speech delay
Behavioural problems
High rate of accidents
High rate of psychiatric
problems (estimated at
30%)
Twice as likely to be
admitted to hospital
Low rates of
immunisation

10. Impact on the health of adults
Mental health problems
Gastric problems
Respiratory problems
Musco-skeletal
problems
Antenatal and postnatal
problems
Loss of self esteem
Loss of confidence
Institutionalises
Present with multiple
needs that relate to:
Poverty/low income
Inadequate housing
Poor health
Loss of opportunities

11. Vulnerability of homeless families
Families living in social housing
Families with a young mother
or young father
Where the mother’s main
language is not English
Where the parents are not co-
resident
Where one or both parents
grew up in care
A history of abuse, mental
illness or alcoholism in the
mother’s family
Chronic health problems
Low birth weight or prematurity
Parents with few or no
qualifications
Parents not in education,
employment or training
Families living in poverty
Parents with mental health
problems
Unstable partner relationships
Intimate partner abuse
Parents with a history of anti-
social or offending behaviour
Low self esteem or low self-
reliance
Child Health Programme DofH 2008

12. Parent – vulnerability - child
Drug and alcohol misuse
Family violence (past and
present)
Homelessness, poverty
and unemployment
Non-compliance with
professionals
Physical and mental
health issues
Young and lone parents
Learning difficulties
Disabled and long term
illness
Looked after children
including unaccompanied
minors
Private fostering
Trafficked children

13. Vulnerability
(serious case reviews)
36% parents moved frequently and lived in
temporary accommodation – mobility
60% emergency department attendance
34% did not have a GP
66% issues of domestic violence
55% mental health problems
London Safeguarding Children Board (2007)
Mobile Children and Families in London Child Protection Procedures
Dfes (2006) Working Together to Safeguard Children

14. Solutions
Multidisciplinary teams
Interagency response
Integrated working - joint
strategies, referral pathways
Holistic assessments
Notification system
Robust data base
Monitoring, audits
Consultation with service users
Outreach
Accessible venues
Training
Key workers, advocates
Develop skills – life skills and
parenting
Cross sector approach in
planning - Partnership working
– multi-agency steering group
Single set of local priorities
Shared positive outcomes
Shared inequality indicators
Health equity audits
CNA
Joint commissioning – pooled
budgets
Public health approach – needs
lead
Co-ordinated information
strategy

15. “……housing is more than economics,
it is a matter of humanity and morality,
as well as economics”.
Housing is a moral issue: A statement from
the Department for Social responsibility of
the Catholic Bishops’ Conference of
England and Wales 1985