Public Health Nurses Views and Experiences of Homeless families and
Children
and whether there is an impact on Children’s Development
Demonstration Practice Project (DPP) Module SS7135 Submitted for Part
Fulfilment of the Postgraduate Diploma in Child Protection and Welfare
Author Amy Fallon
Tutor Rosemary McKean
Date Submitted 13th May 2016
Word Count: 8780
Abstract
Homelessness is becoming more prevalent and more families are presenting to
homeless services due to issues like poverty, family breakdown, lack of affordable
accommodation, drug and alcohol misuse. They are placed in emergency
accommodation such as hotels, bed and breakfasts (B&Bs), and hostels. This has a
hugely negative impact on the health and wellbeing of these families. Public Health
Nurses (PHNs) are engaging with these families more frequently due to the
increased number of homeless families being placed in emergency accommodation
within the catchment area of the PHN. The aim of the study is to explore PHN views
and experiences of homeless children and families, and to identify whether
homelessness impacts negatively on children’s development. A review of relevant
literature was undertaken and interviews were carried out with four PHNs who work
with homeless families.
The findings of the study highlighted that PHNs observed a negative impact on
infants and children who presented as homeless and who are currently living in
emergency accommodation. Gross motor delay, speech delay, infections and
behavioural problems were evident but it was difficult to establish the full effects of
homelessness on children due to the constant movement of families. A number of
risk factors are linked to child protection involvement, such as the number of times a
family will move, therefore homeless families and children are vulnerable and need
continuity of care and routine. These children deserve nothing more than to have
happy and healthy lives.
Acknowledgements
I would very much like to thank the following people for their input, encouragement
and support:

The Public Health Nurses who gave up valuable time to participate in the
study

My tutor Rosemary McKean who gave constant support and encouragement

Dr Helen Buckley for her kindness and support throughout the year

Mary Sayers, Acting Assistant of Public Health Nursing

Angela Kennedy, Director of Public Health Nursing, who supported the study
through funding from the NMPDU and approved study leave throughout the
year

My work colleagues who were extremely supportive and gave great insight
throughout the year

My family for being patient kind and supportive throughout the year
Table of Contents
Chapter 1 .............................................................................................................................................. 1
1.1 Introduction: Current policies ................................................................................................... 1
1.2 Back ground to the Study ......................................................................................................... 3
1.3 Area Profile ................................................................................................................................. 4
1.4 Role of the Public Health Nurse .............................................................................................. 5
Chapter 2 Literature Review ............................................................................................................ 6
2.1 Introduction ................................................................................................................................. 6
2.2 Issues facing Public Health Nurses ........................................................................................ 6
2.3 Children at risk ........................................................................................................................... 7
2.4 Impact of Homelessness .......................................................................................................... 7
2.5 Homelessness and Children .................................................................................................... 8
2.6 Conclusion .................................................................................................................................. 9
Chapter 3 Methodology .................................................................................................................. 10
3.1 Introduction .................................................................................. Error! Bookmark not defined.
3.2 Study Design ............................................................................................................................ 11
3.3 Ethical Consent ........................................................................................................................ 11
3.4 Sample Selection ..................................................................................................................... 12
3.5 Data collection.......................................................................................................................... 13
3.6 Data Analysis ........................................................................................................................... 13
3.7 Limitations ................................................................................................................................. 13
3.8 Conclusion ................................................................................................................................ 14
Chapter 4 Findings and Discussion ............................................................................................ 14
4.1 Introduction ............................................................................................................................... 14
4.2 Lack of Space........................................................................................................................... 15
4.3 Stress and the impact on infants and children .................................................................... 17
4.4 Lack of Facilities ...................................................................................................................... 18
4.5 Poor Health and Nutrition ....................................................................................................... 19
4.6 Creating routine ....................................................................................................................... 20
4.7 Conclusion ................................................................................................................................ 21
Chapter 5 Recommendations ....................................................................................................... 22
Chapter 6 Conclusion ..................................................................................................................... 25
Chapter 1
1.1 Introduction:
More increasingly than ever Public Health Nurses (PHNs) are engaging with families
who present as homeless and placed in temporary accommodation within the
catchment area of that PHN. Temporary or emergency accommodation can include
hotels, B&B and hostel accommodation. Government policies and strategies
however have petitioned for the elimination of this type of accommodation. The Way
Home; A Strategy to Address Adult Homelessness in Ireland (Department of the
Environment, Heritage and Local Government, 2008) acknowledges this and makes
recommendations to address the issue by allocating funding into long term housing
projects. More recently Sustaining Dublin’s Pathway to Home. The homeless action
plan framework 2014-2016 (Dublin City Council, 2014) mentions the current priority
and objective is to eradicate the long term use of emergency accommodation by
2016 or minimize the length of time in emergency accommodation. However certain
barriers have prevented this from occurring. A soaring demand for property
correlating with increased rents have forced families out of private rented
accommodation and into homelessness for the first time. Austerity measures taken
by the Government in the economic downturn such as budget cuts to the provision of
social housing had a rippling effect (Dublin City Council, 2014). Families can remain
in emergency accommodation for up to a year and a half with deleterious effects on
health and wellbeing. Long term homelessness is defined as residing in
accommodation longer than six months.
Recent statistics and data on homelessness across Ireland stem from the
Department of Environment, Community and Local Government. Recent data for
Dublin homeless population stems from the Dublin Region Homeless Executive
1
(DRHE 2016). The DRHE set up the Pathway Accommodation and Support System
2
(PASS) in 2011 and replaced the link system. It gives invaluable insight into the
nature and prevalence of the homeless population across Dublin. From the PASS
system it is apparent that the majority of homeless families are being placed in hotels
1
The Dublin Region Homeless Executive operates under the Dublin City Council as the lead statutory local
authority in response to homelessness in Dublin. It formally replaced the homeless agency in 2011.
2
The pathway and accommodation and support system is an online system that gives vital information into
1
with recent figures for April of this year indicating 670 families with 1539 dependants
in hotels, and 218 families with 427 dependants in other accommodation (DRHE,
2016). Looking at statistics for Ireland with regards to homeless families, there were
790 families in Dublin compared to the northwest, which documents just 2 families in
February of this year (Department of Environment, Community and Local
Government 2016). It was also noted that out of the 790 families 496 were a single
parent family (see Figure 1 for breakdown of percentages of Irish families
documented as homeless). The statistics highlighted here do not take into
consideration other homeless groups such as families and individuals sleeping rough
couch surfing or sleeping in cars. Maycock et. al., (2015) refers to these as the
invisible homeless.
While considerable strides continue to be made with regards to ending
homelessness as (O’Sullivan, 2012) notes, families continue to present to homeless
services due in part to the lack of housing with families struggling to afford rising
rents. The process of becoming homeless and entering into emergency
accommodation seems to present huge challenges for parents, infants and children
(Halpenny et. al., 2002, (Walsh and Harvey ,2015). This will be discussed further in
this study as the author looks to explore PHNs views and experiences of homeless
children and families, and whether this has an impact on children’s development. It is
important to note that when researching the area of homelessness through the lens
of a PHN, understanding what homelessness means is crucial. Different triggers and
risk factors are associated with homelessness, which practitioners should be aware
of, to identify needs and in order to provide seamless and efficient services. In order
to know how to prevent homelessness there has to be an understanding of the
potential reason for families and children becoming homeless but also to establish
the types of families who are at risk of becoming homeless. A child can be greatly
affected by homelessness due to the process alone of becoming homeless (Walsh
and Harvey, 2015).
Irish legislation makes reference to homelessness and under part two of the Child
Care Act 1991 (Government of Ireland, 1991) there is a statutory obligation to
promote the welfare of children and in section five of the Act it states ‘Where it
appears to a health board that a child in its area is homeless, the board shall enquire
into the child's circumstances, and if the board is satisfied that there is no
accommodation available to him which he can reasonably occupy, then, unless the
2
child is received into the care of the board under the provisions of this Act, the board
shall take such steps as are reasonable to make available suitable accommodation
for him’.
Homeless families are extremely vulnerable and often feel like nobody cares about
them. Stigmatization around homelessness has not yet been ameliorated as
qualitative studies have shown (Halpenny et al, 2002), (Maycock et. al., 2015) and
(Walsh and Harvey, 2015). Feelings of shame worthlessness and embarrassment
can be attributed to the term homeless. There can be far reaching consequences for
families and children experiencing homelessness (Harvey 2006). This will be looked
at in depth from a PHN perspective as the author researches the topic further.
Breakdown of Homeless Families in February
2016
900
800
700
600
500
400
breakdown of families in Ireland
homeless feb 2016
790
breakdown of families in Ireland
homeless feb 2017
300
dublin
200
100
87
21
13
16
11
2
12
13
17
0
DUBLIN
MIDEAST
MIDLANDS MIDWEST NORTHEASTNORTHWEST SOUTHEAST SOUTHWEST
WEST
Figure 1: Graph showing statistics from The Department of the Environment showing a breakdown in
no and percentage of families in Ireland who were registered homeless Feb 2016
1.2 Back ground to the Study:
The author works in a Primary Care Team (PCT) in a health centre in Drumcondra.
There are four full time PHNs covering four caseloads and two part time PHNs.
There are also other members of the PCT based in the health centre, which include
two physiotherapists, an occupational therapist, a psychologist, a speech therapist
3
and a dietician. The community welfare officer and the home help service operate
from a different building and are a great resource, particularly with vulnerable
families. Working as part of a PCT facilitates effective collaboration between
disciplines, which is extremely important. Interagency collaboration is illustrated in
Children First: National Guidelines for the Protection and Welfare of Children (DCYA,
2011). In the document it is acknowledged that not every professional involved in
child protection and welfare is completely current in skill set and knowledge. If
interagency collaboration does not occur, Buckley (2012) notes the potential
increase of children can be missed in the system. Collaborating with other
professionals ensures responses are thorough and timely, gaps are reduced and
professionals are not dealing with cases in isolation without support (DCYA, 2011).
1.3 Area Profile:
Community Health Office 9 (CHO 9) was previously Dublin North City and has been
renamed under the policy strategy Future Health (DoH, 2012). This incorporates ten
health centres with forty one PHNs, three Assistant Directors of Public Health
Nursing and one Director of Public Health Nursing. Drumcondra is classified as
Botanic C and has a SAHRU score of seven, which indicates pockets of deprivation.
The 3SAHRU score is a score that is given to each electoral division to determine the
level of deprivation. This is true to the authors caseload. Due to this, the author has
encountered and continues to encounter transient families, which include asylum
seekers and homeless families. The author has a number of bedsits within her area
and two B&Bs, where a number of homeless families have been and continue to be
placed. During the author’s ten years of working in the geographical area with these
vulnerable and complex families, an interest developed with regards to the effects of
homelessness on families. The author decided to explore whether homelessness
has any effect on families, and in particular children, so as to gain more insight and
understanding, and highlight other PHNs views and experiences.
3
SAHRU (Small Area Health Research Unit) A deprivation index for health from 1-10 calculated according to
the level of unemployment, social class, proportion of rented accommodation in the area and car ownership.
4
1.4 Role of the Public Health Nurse:
The PHN in Ireland has a large remit and is responsible for providing a primary,
secondary and tertiary service to individual’s families and communities (Hanafin
1998, Hanafin et al, 2002). Part of this role involves delivering a health care service
to mothers and infants, with a focus on population health (O’Dwyer, 2012), (Pye,
2015). The PHN is required to visit all babies within forty eight to seventy two hours
of birth (HSE, 2015). The PHN is governed by the Nursing and Midwifery Board of
Ireland (NMBI), which was previously known as An Bord Altranais, and is guided by
the framework Scope of Nursing and Midwifery Practice (An Bord Altranais, 2000).
The role of the PHN is described in circular 27/66 and most recently the revised
41/2000. Child protection and welfare practices in relation to PHNs, which if
identified, are underpinned by policy documents and legislation such as Children
First: National Guidelines for the Protection and Welfare of Children, (DCYA, 2011)
The Child Care Act 1991 (Government of Ireland 1991), and Best Health for Children
(Denyer 2005). As PHNs provide a service to families at home, they can identify
child protection concerns and children who are vulnerable (Phelan and Davis, 2015).
Child protection and welfare guidelines were introduced to CHO 9 to assist PHNs in
identifying and assessing families at risk (O’Dwyer 2012). The Child and Family
Health Needs Assessment Framework (O’Dwyer 2012) however is not officially in
use in all areas.
The author as part of her caseload has a number of vulnerable families, which
include families who are homeless and have been placed in temporary
accommodation. The author will explore the impact of homelessness on the family,
and children in particular, and will look at what the issues and challenges faced by
homeless families are and what the implications and recommendations might be.
5
Chapter 2 Literature Review:
2.1 Introduction:
Whilst researching the impact of homelessness in Ireland, particularly focusing on
the impact of homelessness on infants and preschool children from a PHNs
perspective, it was evident that the literature is scant. Some studies carried out in
Ireland, such as Halpenny et al (2001), Halpenny et. al., (2002), were published
more than ten years ago and do not specifically focus on the impact on preschool
children. However, they do give a very comprehensive view of homelessness from
the perspectives of parent’s older children and from professionals working in
homeless services. More recent studies, such as (Maycock et. al., 2015),
(O’Sullivan, 2012) and (Walsh and Harvey 2015), are relevant and current and
contain in depth analysis, discussion and findings. Parents, children and
professionals were interviewed in two of the studies, which gives great insight into
the daily lives of homeless families in emergency accommodation. The author also
looked at literature published in the UK and Canada due to the similar roles and
responsibilities between PHNs and Health Visitors in these countries.
2.2 Issues facing Public Health Nurses:
PHNs in Ireland are generalist practitioners with a wide range of roles that address
the needs of clients in the community across their lifespan (Hanafin, 1998; O’Dwyer,
2012). Kent et. al., (2011) explains that the remit of the PHN incorporates child
protection and welfare. The PHN role has not changed in Ireland since 1966
(Hanafin, 1998) however this can be disputed due to an increase in workload, more
accountability, an increase in paperwork, early discharges from hospital and more
complex cases, as Giltenane et al (2009) and Pye (2015) point out. Due to increased
demands faced by PHNs there is some discussion around creating specialist roles in
the community to specifically work with vulnerable families (Denyer, 2005; Pye,
2015).
Kent et. al., (2011) makes reference to the future of Public Health Nursing with
regard to specialist roles and advanced nurse practitioner roles. Hanafin and O’Reilly
(2015) suggest that if PHNs were willing to engage in a specialist role rather than a
6
generalist role in relation to child health, they would find it a positive experience. The
development of these roles within Public Health Nursing in certain areas in Ireland
has recently been trialed with positive results. Health visitors in the UK solely provide
a service to children and families. Cowley et. al., (2014) highlights that health visitors
are professionals who encourage and help foster early child development, by
delivering a universal service designated to promote the healthy development of preschool children, along with improving public health and limiting health inequalities.
2.3 Children at risk:
Homelessness has a huge effect on infants and children due to the complexities
associated with it (Sleed et. al., 2009). Social, emotional and attachment issues can
be some of the many effects noted. The PHN is obliged to carry out core
developmental checks on infants and preschool children and can therefore identify,
assess and refer children at risk (Denyer, 2005) (O’Dwyer, 2012 and (Hanafin,
2013). The most critical time in a child’s life are the first five years, as huge growth
and development takes place (Harker, 2006; Davies, 2011; Walsh and Harvey,
2015). Core developmental checks are carried out by the PHN at 3 months, 7
months, 18 months and 3 years old (Denyer, 2005). Therefore, any developmental
delay or abnormities are identified and the relevant referral is made by the PHN. As
noted earlier the recent introduction of the Child and Family Health Needs
Assessment (CAFHNA) is used by PHNs to identify children at risk as early as
possible. The importance of screening infants and children is to treat any anomaly as
early as possible so as to ensure positive outcomes.
2.4 Impact of Homelessness:
A home is where one can relax and be themselves (Fordham, 2015). It is a safe and
secure place that satisfies a myriad of needs, which include social, emotional
psychological and to some extent material needs (Ridge, 2002). When one finds
themselves homeless the impact can be devastating (Walsh and Harvey, 2015). As
illustrated in The Housing Act (Government of Ireland, 1988) a person will be
rendered homeless when ‘(a) there is no accommodation available which, in the
opinion of the authority, he, together with any other person who normally resides with
7
him or who might reasonably be expected to reside with him, can reasonably occupy
or remain in occupation of, or (b) he is living in a hospital county home, night shelter
or other such institution and is so living because he has no other accommodation of
the kind referred to in paragraph a and he is in the opinion of the authority unable to
provide accommodation from his own resources.’
Homelessness with regard to families, as illustrated by Harvey and Walsh (2015) in
their research study Family Experiences of Pathways into Homelessness is one of
the most devastating experiences to happen to a family. Homelessness is linked to
high mortality rates, morbidity, poor mental health and alcohol and drug problems,
which makes them a particularly vulnerable group (Keogh et al, 2015). Coinciding
with the above is the economic downturn and the financial crisis that occurred in
Ireland, which led to budget cuts and tax increases. Harker (2006) illustrates that life
trajectories for children will be affected by the quality of their surroundings’ negative
effects of emergency accommodation on the daily lives of parents and children
included stress and worry lack of support routine and space (Halpenny et al 2002).
Homeless families residing in emergency accommodation are as O’Sullivan (2012)
notes, transitional. The author will focus on transitional homeless people, which
O’Sullivan (2012) notes mostly include families that enter into emergency
accommodation due to poverty and housing issues for a short period of time.
Poverty has an adverse effect on parents and children and is cited in international
research as one of the main reasons for becoming homeless (Halpenny et. al., 2002;
Martins, 2008 Harker 2006 Walsh and Harvey,2015). However, Halpenny et. al.,
(2002) highlight that becoming homeless is not just associated with one particular
factor, as there is a myriad of complexities involved.
2.5 Homelessness and Children:
PHN case loads are diversifying, with homeless families becoming more prevalent
and requiring a PHN service. Children in homeless families are among the most
vulnerable in our society as the experience of being isolated from family and friends
alone can be traumatic (Walsh and Harvey, 2015). The experience of becoming
homeless and entering into emergency accommodation for children can have an
effect on their development and the level of support required is heightened.
8
Research suggests that this group are a high risk group and can be difficult to trace
(Swick, 2010). The frequent movement of families means that children don’t get an
opportunity to maintain friendships. It is well documented that early identification and
intervention is key for children where health issues become apparent (Denier, 2005).
Infants and children can have emotional and attachment issues and being homeless
can exacerbate these issues. PHNs can help to empower these marginalised groups
by linking them into services, for example mother and toddler groups, parenting
groups and crèches for children. Evidenced based support groups include
community mothers and the triple parenting programme.
The impact that homelessness has on a child’s wellbeing can be enormous.
Research illustrates that outcomes for children remain poor due to the fact that
parents can have alcohol, drug and mental health problems (Moore et. al., 2009).
This in turn affects parenting. These issues can potentially be a factor in families
remaining homeless. Children can be exposed to different types of abuse and their
most basic needs may not be met. Swick (2010) illustrates that homeless children
and families face barriers to their health like, chronic poverty, persistent stress and
lack of basic resources. There is also the issue of privacy, security and a space to
play as these children are confined to one room (Halpenny et. al., 2002). Children
who are homeless may not just suffer emotional trauma but physical, social,
cognitive and psychological trauma also.
2.6 Conclusion:
It is now apparent from researching the topic of homelessness that children are affected and
this can result in an array of issues. One of the main themes to emerge from the literature
was that issues, such as poverty, can cause serious traumatic and long lasting effects on
children. A lack of space was associated with developmental delay in infants and children.
For parents, a lack of access to support and community resources, interrupted education,
and mental and physical health issues were noted, which in turn have adverse effects on
infants and children. This can be seen with regards to behaviour. The enormity of the task of
parenting in emergency accommodation has consequences for infants and children.
Homelessness can affect generation after generation and therefore it is important that the
cycle of intergenerational homelessness is stopped. In order to do this Government and local
authorities need to be proactive in their approach to ending homelessness. The Ombudsman
9
for Children recently published a document Homeless Truths due to complaints received
from children who are homeless. The document reveals what children are experiencing on a
daily basis. This is invaluable for service provision and policy reform.
Finally, it is important to note the key themes and issues that have been presented from
research carried out around homelessness and its effect on families, infants and children.
The key themes noted on why people enter into homelessness in the first place include; lack
of affordable housing, poverty, mental health and substance misuse. The effect that
homelessness can have on infants and children include; interrupted sleep, maternal-infant
dyad and attachment developmental delay due to lack of space, which can include speech
and gross motor delay. Other behavioural effects have also been demonstrated. It is
important to be cognisant of the fact that the United Nations Convention on the Rights of the
Child (UNCRC, 1989) emphasises, ‘the right of every child to a standard of living that is
adequate for his or her physical, mental, spiritual, moral and social development’.
10
Chapter 3 Methodology:
3.1 Introduction:
This study aims to explore the impact of homelessness on children’s development as
observed by PHNs. The author’s rationale for using a qualitative approach rather
than a quantitative one will be discussed in this chapter along with ethical consent
and the sample size.
3.2 Study Design:
The study incorporated a qualitative research method in order to highlight the impact
of homelessness on children and their development. Polit and Beck (2006) illustrate
that the aim of qualitative research involves understanding an aspect of human
experience by studying it in great depth. Qualitative research first and foremost
focuses on a holistic element and according to Munhall (2012, p.5) gives authenticity
and meaning. It also aims to give an understanding from the participant’s perspective
and from their own experiences. The research is carried out by collecting information
and subsequently analysing that information. The author carried out a series of
interviews on participants, in this case PHNs involved with homeless families. In
order for this to take place the author asked and received permission from the
Director of Public Health Nursing to collect information by interviewing PHNs
involved with homeless families. Information was then sent to all PHNs in the area.
PHNs who wished to take part in the study were invited to contact the author directly.
3.3 Ethical Consent:
Certain ethical principles need to be adhered to when undertaking any research. An
Bord Altranais (2007) highlights six principles, which include confidentiality, fidelity,
veracity, justice, beneficence and respect for autonomy. With regards to the research
proposal and ethical consent, the author did not need to obtain consent from an
ethics committee. Consent however was given by the Director of Public Health
11
Nursing to interview PHNs in the area. In relation to the research question,
information was sent to every PHN in the area along with a consent form. The aim
and objectives of the study were outlined. The information also stated that partaking
in the study was voluntary and at any stage the participant could withdraw. With
regards to the consent form, each participant signed the consent form attached.
Mulhall (2012:496) acknowledges that informed consent is an agreement between
participant and researcher. For the participant the process involves knowing what the
research entails.
3.4 Sample Selection:
The sample group in this research consisted of PHNs who look after homeless
families and homeless children. There are currently eight PHNs looking after
homeless
families
that
have
been
placed
in
emergency
or
temporary
accommodation. Of these eight, four PHNs were interviewed. At the time the author
was conducting the interviews, two of the PHNs were out on sick leave and two
PHNs were out on annual leave. The PHNs that participated in the study worked
predominantly in vulnerable areas with an extensive amount of child protection cases
identified with PHN involvement, and levels of experience differed, ranging from two
to
eight
years
(as
depicted
in
Figure
2
below).
12
Length of Time Qualified as a Public Health
Nurse
9
8
7
6
5
4
3
2
1
0
participant 1
participant 2
participant 3
participant4
Figure 2: The number of years qualified of each Public Health Nurse interviewed in CHO 9 .
3.5 Data collection
Semi-structured interviews were used to interview participants. Whiting (2008) notes
that taped interviews are beneficial as the interviewer can then focus more on the
participant, which can create a relaxed setting. The interviews lasted from between
twenty to forty minutes. All the interviews were audio-taped, listened to and
transcribed. The author acknowledges some flaws in the data collection process as a
pilot test was not carried beforehand, which could have identified weaknesses.
3.6 Data Analysis:
The author listened to and transcribed all interviews verbatim. The author then read
and reread the transcripts in order to become entrenched in the literature. The author
began to extract similarities within different areas, which developed into themes.
3.7 Limitations:
One of the limitations was the fact that the author did not do a test outside the area
to check for validity. Another limitation was the sample size. There are four other
PHNs that look after homeless families as part of their case load however due to the
fact that they were on leave at the time the interviews were being scheduled, as
mentioned, this resulted in a smaller than intended sample size. Unfortunately, due
to the limited amount of PHNs involved with homeless families the author could only
interview those PHNs who provide a service to homeless families in the area. While
the author acknowledges the small sample, the data received was still quite
insightful.
3.8 Conclusion:
This chapter explains the methodological approach used and discusses the method
used for collecting research data. The author will now discuss the findings in the next
chapter and will outline and discuss the key themes that emerged from the data.
Chapter 4 Findings and Discussion:
4.1 Introduction:
In this chapter the author will present the findings which came to light following
collation and analysis of the research. The author analysed the findings and
categorised them by the major and minor themes that arose. Nine themes in total
emerged from the analysis, of which there were five major and four minor. The major
themes were those that were common to almost all participants’ responses and
appeared to relate to a significant impact on child development as a result of
homelessness. The minor these were those that were not common to all participants’
responses but still appeared to relate to a significant impact on child development as
a result of homelessness and were therefore deemed worth including. Using a
thematic framework, as Bryman and Burgess (1994:179) explains, assists in
highlighting important themes after familiarisation with transcripts. Major and minor
themes became evident after analysis of all the collected data. As depicted in figure
three below, the major themes to emerge included; lack of space, parental stress
and the emotional impact on infants and children, lack of facilities, poor health and
nutrition and lack of routine. The minor themes to emerge included; noise levels, lack
of supports, transport issues and constant movement. The rationale for division of
themes into major and minor themes were due to the number of participants referring
to the themes however they all have an impact on health and well being.
Major Themes
Minor Themes
Lack of Space
Noise Levels
Parental Stress
Lack of
Supports
Lack of Facilities
Constant
Movement
Poor Health and
Nutrition
Transport Issues
Lack of Routine
Figure 3: A diagram representing the major and minor themes.
4.2 Lack of Space:
A prominent theme to emerge throughout the process of analysing the data was the
lack of space for families living in emergency accommodation. With regards to lack
of space, one of the participants stated:
‘There isn’t a different room for eating or sleeping, they are all in the one room’.
(Participant 1)
This is indicative of similar studies, for example Riley et al (2001) and Halpenny et al
(2002), which illustrate that homeless families spoke of not having space and a safe
play area for children. Difficulties like overcrowding due to lack of space can arise.
Living in one room can have huge negative effects on the health and wellbeing of
children and families. Keogh et. al., (2006) highlights that the negative effects of
overcrowding on child health and wellbeing can include bedwetting, chest infections,
colds, flu, asthma, disrupted sleep and behavioural issues.
Overcrowding can have huge health implications for families in emergency
accommodation. One participant spoke of this and stated that;
‘It is like being back in the tenements for these families, it is terrible’.
(Participant 4)
Infant’s growth and development may become stunted because of the lack of space
in certain accommodation. There is little room for floor play and stimulation and
Leitschuh et. al., (2014) illustrates that movement and early brain growth and
development are interconnected and important. With regard to floor play, one
participant noted;
‘Looking after families in emergency accommodation I would see huge impacts on
children’s developmental needs. From a physical point of view, it would be lack of
floor space to play on, so maybe their head control is poor because they don’t have
space for tummy time’.
(Participant 2)
Another participant noted:
‘The difficulties are huge regarding their safety and actual place to develop and
grow, like putting a baby on the floor, and with toys, and clothes drying in spaces
where they are not supposed to be drying, and takeaway cups and things, infants
haven’t enough space to move around freely and I would always have to refer these
infants for physiotherapy and then either a group or crèche where the baby could be
stimulated.’
(Participant 3)
Gross motor development, as Williams et al (2013) explains, is crucial for
exploration, creating independence and for running and playing. PHNs are trained to
identify and refer onwards as appropriate, as one participant stated:
‘I observe children’s development and if there are any anomalies I refer on to PCT or
outside, maybe the GP or 4AMO’.
(Participant 1)
4.3 Stress and the impact on infants and children:
The second theme to emerge from the study is the impact that the stress and trauma
of homelessness can have on parents. This in some instances was known to transfer
onto infants and children. One of the participants stated, when asked about the
impact of homelessness on families:
‘I think it has to do with the mom and the dad, how they feel about the homeless
accommodation, and I know it’s not ideal for any family but I do feel that the impact
that it’s having on the parent, it’s a domino effect, because the baby is picking up on
that impact’.
(Participant 2)
When a person ends up in a situation where they become homeless, William and
Law (2011) note that the continual stress can be linked to mental and physical
health. Finfgelt (2010) illustrates that the turbulent nature of homelessness on
women and children is huge. This is also mentioned by Walsh and Harvey (2015),
who noted that the effects of homelessness were shown to have an impact on
parents’ physical and mental health, with a similar effect noticed on some children.
Stress, anxiety and depression can be a first time diagnosis brought about by
homelessness as O’Sullivan (2012) and William and Law (2011) highlight. However
in other studies it has been noted that mental health problems were diagnosed prior
to becoming homeless (Haber and Toro, 2004). Parenting as a single mother is
particularly difficult as one participant highlighted;
‘As a single mam living in a hotel room, that may not have any other supports, she is
with the children all the time and she feels like she does not get a break’.
(Participant 2)
4
AMO: Area Medical Officer
The role of the PHN in supporting vulnerable parents is significant. Cohen and
Reutter (2007) acknowledge that part of the role of a PHN is working with mothers
and children and advocating on their behalf. This was also mentioned by a
participant when asked about the role of the PHN with this vulnerable group;
‘I would contact the local authorities for my area which is Dublin City Council and I
would make representation highlighting the needs of the children and the family as a
unit so that they would be ofay with the deleterious effects it was having on the
children and the family’.
(Participant 3)
4.4 Lack of Facilities:
It was very apparent that a lack of facilities was another prominent theme, which was
mentioned by all the participants. One of the participants stated:
‘A lot of the families have bought microwaves so therefore they are buying meals
that can be microwaved or they are buying takeaways’.
(Participant 2)
Another participant noted:
‘Simple things even like sterilizing bottles. They might not have a fridge to put these
bottles in if they have a room. They have to go to a communal kitchen and the risk of
contamination and things like that is huge’.
(Participant 3)
When comparing previous studies, such as Halpenny et. al., (2001), Halpenny et al
(2002) and Walsh and Harvey (2015), the issues faced on a daily basis by homeless
families are quite similar. Both reported a lack of facilities as a huge barrier when
parenting in emergency accommodation. In a UK study where 20 families were
interviewed, not having anywhere to wash clothes was a hugely negative drawback
(Harker, 2006). One family recalled that carrying bags of laundry to a facility is time
consuming and expensive. General hygiene can be difficult to maintain when there is
only one bathroom for a family. Multifaceted issues arise for parents due to lack of
facilities and this was emphasized by one participant who stated:
‘What would be a treat for these families, maybe in the summer for one or two days,
has now become a nightmare.’
(Participant 4)
4.5 Poor Health and Nutrition:
The biggest limitation for families appears to be not having a kitchen to prepare
healthy meals and snacks in. As previously mentioned, families are having to rely on
fast food and takeaways as a substitute for a healthy home-cooked meal. The
nutrient value of such meals is minimal and over time this type of diet can lead to
micronutrient deficiencies, malnutrition or obesity. It is also instilling bad eating habits
in children as children observe this as normal. There are short and long term
consequences of poor nutrition on families and children. A participant noted that one
family stated:
‘If I never saw a takeaway again it would be too soon’
(Participant 2)
Williams et. al., (2013) illustrate that one in four children aged three are overweight
and there is a correlation between weight and deprivation. For parents with infants
and toddlers of a certain age, there can be difficulties around introducing and
sustaining a complementary diet. One participant stated:
‘When you are living in emergency homeless accommodation it is very difficult to try
and give a complimentary diet, which would be vegetables and protein, such as
cooked lentils, beans, red meat, eggs and fish’
(Participant 1)
Halpenny et. al., (2002), when interviewing professionals involved with homeless
families, noted that bottles might not be sterilized properly or milk could be out of
date, which can then lead to gastroenteritis in infants and children.
4.6 Creating routine:
One of the participants stated:
‘They are saying that there is children out in the hall way, or they are hearing noises
from the other rooms, cause the rooms are so close together, and they can hear
other children crying in another room, and that’s waking their child, or that there is
people out in the corridor coming in and they may have been on a night out, or
maybe older children playing outside at say half seven, and their child goes to bed at
seven, so it’s very difficult to create a routine within the room.’
(Participant 2)
This correlates with Halpenny et. al., (2002) who noted that parents acknowledged
the limitations imposed on them in creating a routine and the frustration and conflict
this brings. Similar problems with routine were discussed by another participant, who
noted:
‘It’s very difficult for parents to create a routine within the room because the parents
have to go to sleep when the child goes to sleep and therefore they can’t turn on the
television because that’s impacting the child’.
(Participant 3)
When infants and children have established regular routines, a sense of trust and
security develops. Another participant noted:
‘Maladaptive behaviour is what I would see in infants and children who are in
emergency accommodation where it’s hard for parents to instigate any kind of
pattern or routine’.
(Participant 1)
Behavioural issues observed in children can be linked to the significant demands of
parents (Haber and Toro, 2004).
4.7 Conclusion:
From the author’s findings it is clear that better strategies should be developed to
help families who, by no fault of their own, become homeless. As one participant
stated:
‘Homelessness is a big issue, so I don’t actually know why it hasn’t been
addressed already, but I think it is a scrappy service as is’.
(Participant 4)
All of the participants highlighted the need for a specialist team to deal with the
homeless in CHO 9 due to the complexity of their needs and the amount of families
who are being placed in emergency accommodation, and require help and support.
The data on the themes that emerged from this study are similar to that of Halpenny
et. al., (2002), from their qualitative study on 20 families with 78 children, however
differences in sample size and participants’ ages were taken into consideration.
Chapter 5 Recommendations:
In light of the author’s findings, and the associated research carried out with PHN
participants, it is apparent that being made homeless and living in temporary
accommodation is negatively impacting families and in particular children’s
development. The literature also highlights the extreme difficulties and hardship
homelessness brings, and how the negative effect of this on parents permeates their
children also. However the author acknowledges that due to the limited number of
participants and the time constraints involved in her research, there is scope to
undertake further research in this area. The data that emerged from the study is still
important however, and the issues identified in this study pose implications for
practice, therefore further exploration of this topic should be undertaken. A lengthy
study similar to Growing Up in Ireland (Williams et al 2009) could emphasize the
implications of homelessness on children by measuring their physical, social,
psychological and emotional development. The problem of homelessness has been
around for a long time and it is clear that homelessness is continuing to increase,
with more families becoming homeless for the first time. Statistics in Ireland currently
show that there are approximately 5000 people homeless at any one time according
to Department of Environment Heritage and Local Government (2016). In one study
it is noted that, five families were placed in emergency accommodation, (Halpenny
et. al., 2002) which is a stark contrast to the current situation. The author believes
there are a number of recommendations from a Public Health Nursing point of view
that could be implemented to support and advocate for this disenfranchised group.
The first, which all of the participants acknowledged, is to set up a specialised team
with the sole remit of providing a PHN service to homeless families. The team could
consist of two to three PHNs, along with a Social Worker, a Community Welfare
Officer and an Area Medical Officer. A PCT designated specifically for the homeless
would potentially have more time to carry out comprehensive assessments on
families and children and better address any health problems they observe. The aim
of primary care, as the World Health Organisation (2008) illustrates, is to offer
enhanced quality care to a population in an appropriate and timely manner. Within
the area two teams currently provide a service to schools. Within the last year in
CHO 9 the Director of Public Health Nursing trialled a schools team and a
vaccination team. The PHNs involved carry out vision and hearing screening and
vaccinations to primary and secondary schools. The aim is to give an enhanced and
quality service to individualised groups where there is a specific public health need.
Both teams have been very successful and the vaccination team has been rolled out,
while a permanent schools team is currently being configured.
In this study, the difficulty in allocating time to homeless families on top of a heavy
mixed caseload was also highlighted by PHNs. Due to the complexity of their needs
and the follow up involved, by the PHN, it is crucial that these families receive a
comprehensive and integrated service. With the current system of constant
transience in place, families and in particular infants and children could slip through
the net. It is also very timely that the Children’s Rights Alliance are asking for a child
protection review of every child resident in emergency accommodation.
Another recommendation arising from the findings of this study is for PHNs to set up
a database containing all information regarding homeless families, which should be
regularly updated, and should a family be moved they can then be traced very
quickly. All PHNs nationwide would have access to the database. Flaws in the
notification system emerged from the study due to staffing shortages within the
homeless section of Dublin City Council. Lack of communication and collaboration
was also highlighted. This role needs to be managed by those who are directly
engaging with the homeless families, so that they are known to the appropriate
services.
Movement of homeless families was another issue highlighted by PHN’s and in
many cases, by the time an appointment is made to see a family they have been
moved. This is often due to demand for rooms at premium cost around bank
holidays. Therefore another recommendation would be that homeless families living
in emergency accommodation should be able to remain in the same place, unless
they request a transfer due to being placed lengthy distances from family and
schools.
Another recommendation could be that PHNs would be facilitated to undertake
training in the area of homelessness. It was acknowledged in one study, where PCT
Nurses were involved in looking after the homeless, that they did not have any
training or experience with this client group (Tansey, 2008).
Homelessness is linked to a myriad of complexities and the advocacy role of the
PHN is extremely relevant. Cohen and Reutter (2007) identify the positive impact this
role can have with vulnerable families such as the homeless. Another
recommendation, which could be implemented at a national level, would be for
effective interdepartmental collaboration to work together to target homelessness. A
commitment and drive is required from the Government which Davies (2011) notes
that homelessness should not be dealt with in isolation. The strategy documents The
Way Home (Department of Environment Heritage and Local Government 2008)
makes reference to all government departments agencies statutory and nonstatutory services working together but note that it will be difficult. One final
recommendation which is already documented in
5
FEANTSA could be for the
Government to look to countries where legislation and policy changes have already
made positive contributions towards ending homelessness, such as Scotland and
Finland (Busch-Gerstema, 2010). An international database where information
pertaining to homeless populations could be shared which could inform policy
direction.
5
FEANTSA stands for the European Federation of National Organisations.
It was established in 1989 as a European Non Governmental Organisation to prevent and alleviate poverty
and social exclusion of people threatened by or living with homelessness.
Chapter 6 Conclusion:
The author initially presented an overview of homelessness, including its definition
and characteristics. The author then presented the research, the focus of which was
to explore the views and experiences of homeless families and children, and identify
whether homelessness has an impact on children’s development. The author now
concludes that there is evidence to suggest that infants and children are affected by
homelessness. However, the author acknowledges that the research carried out as
part of this study was limited and in addition the associated time constraint did not
allow for a full review of all child health records, which could have provided further
empirical data on the numbers of infants and children being referred for treatment
following placement in emergency accommodation. This could potentially highlight
the level of need and where service delivery could be more effectively targeted.
Therefore the author concludes that due to the limited research on this specific
issue, which was evident by the literature reviewed as part of this study as well as
the author’s own limited research, further research is required in this area to better
understand and identify those families at risk, as well as ways of implementing a
more proactive and pre-emptive solution to this issue.
It was clear from undertaking the study and interviewing the participants that the role
of the PHN is as vital as ever if the challenges facing homeless families, and
specifically the effects that homelessness is having on child development, is to be
better addressed. The amount of time PHNs spend with these families, as evidenced
by the study’s participants, illustrates the complexities of their needs. The feedback
received from the participants, in relation to working with this group, shows that
families are willing to engage with the service and therefore the PHN role is essential
to the continued engagement with and support to these families. Support and advice
is of huge value to these families, therefore it is critical that they be effectively linked
in with PHN services, as depicted in Figure 4.
Health and
wellbeing
Developmental
checks on
infants and
preschool
children
Advocating for
the whole
family
Figure 4: Diagram of Elements of PHN role & its engagement with Homeless families.
Homeless families might not know the area they have been allocated to and thus
require information. One participant spoke of this as something she carried out in her
role as PHN:
‘I have a list I give the family, and my contact details, with local supports and where
Focus Ireland is situated.’
(Participant 2)
Another strength of the PHN role in particular is that, PHNs are the only
professionals that have a mandate to visit all infants and children (Hanafin, 1998)
and carry out developmental checks at birth, 3 months, 7 months, 2 and 3 years, as
per Best Health for Children (Denyer,2005). Unfortunately due to the transient
movement of this group it can be difficult to offer a consistent service to them. One
participant stated:
‘If I have been down in the hotel and the manager lets me know about a new family, I
will meet them, give them information, ask about the children’s development and
immunisations, then go back to the office and request the child health charts. The
problem is by the time I get the charts for the children, the families could have
moved, as it can take a really long time to get the charts, sometimes twelve weeks.’
(Participant 3)
The HSE has rolled out parental child health records in some areas and is due to roll
this out nationally, which will document all information regarding a child’s weight
height and development. This while excellent in theory ultimately depends on the
responsibility of parents to bring it with them to appointments.
As noted from research studies carried out on homelessness, the myriad of ways in
which people become entrenched in the cycle of homelessness is evident. Triggers
can include poverty, family breakdown, substance misuse, domestic violence, lack of
finances and a lack of housing (O’Sullivan, 2012; Walsh and Harvey, 2015;
Halpenny et. al., 2001; Halpenny et. al., 2002; Haber and Toro, 2004). From Irish,
UK, American and Canadian studies, it is apparent that homelessness is prevalent
and increasing. In this study it was highlighted by all the participants that this group
can be classed as hugely vulnerable and that homelessness is obviously far from
ideal. The stigma, trauma and isolation homelessness brings cannot be
underestimated. Homelessness is a result of how elements of our society are
malfunctioning, therefore a greater understanding of its causes is required, in order
for legislators and policy makers to implement more effective changes and enhance
service delivery, in order to end homelessness (FEANTSA, 2010; Halpenny et. al.,
2002). Homelessness is not the sole responsibility of one Government Department
and if the end goal is to eradicate homelessness, an interdepartmental strategy is
required to address the issue, which can provide an integrated solution. This solution
needs to be targeted at individuals and families who are currently homeless, but also
those on the cusp of homelessness as Halpenny et. al., (2002) states ‘those at risk
of losing their homes’. Important risk factors for families who become homeless have
been identified and recommendations made in order to ameliorate these.
It must be noted however that the Government have set aside a budget of 2.2 billion
over the next three years which will be invested in social housing units. Modular
housing units are underway with twenty two homes nearing completion in Ballymun.
More however are needed due to the issues of supply and demand and the number
of new first time families presenting to homeless services. One wonders why families
are becoming homeless in the first instance. Evictions from private rented
accommodation should be reviewed by the Government to prevent this from
occurring.
From undertaking this study the author now has a much better understanding of
what homelessness is and the specific issues and challenges that homeless families,
and particularly children, face on a daily basis. Navigating the system is complex
when one has never before encountered homelessness and it is important that
practitioners have empathy and understanding for this group. The author will present
the findings in this piece of research to her colleagues and PCT members in order
for shared learning and discussion to take place, and with the hopes of implementing
positive changes wherever possible to try to improve the service being offered to this
vulnerable group in society. The Constitution of Ireland (1937) states in article 42.1.1
‘The state shall cherish all the children of the State equally’. and 42.1.2 states ‘The
state recognises and acknowledges the natural and imprescriptible rights of all
children including their right to have their welfare regarded as their primary
consideration and shall as far as practicable, protect and vindicate those rights’. Our
children should be cherished
References and Bibliography
An Bord Altranais (2007) Guidance to Nurses and Midwives regarding Ethical
Conduct of Nursing and Midwifery Research, Dublin: An Bord Altranais.
An Bord Altranais (2000) Scope of Nursing and Midwifery Practice Framework,
Dublin: An Bord Altranais.
Appleton, J.V. (1994) The role of the health visitor in identifying and working with
vulnerable families in relation to child protection: a review of the literature, Journal of
Advanced Nursing, vol. 20, no.1, pp.167-175.
Buckley, H. (2012) ‘Using Intelligence to Shape Reforms in Child Protection’. Irish
Journal of Applied Social Studies, vol. 12, no. 1, pp. 63-73.
Busch- Geerstema, V. (2010) Defining and measuring homelessness, in E. O’
Sullivan, V Busch -Geerstema, D., Quilgars, N., Pleace., (EDS) Homeless Research
in Europe, pp.19-39 Brussels: FEANTSA.
Butler, S. (1996) Child protection or professional self-preservation by the baby
nurses? Public health nurses and child protection in Ireland. Social Science &
Medicine, vol. 43, no. 3, pp 303-314.
Bryman, A., Burgess, S. (1994) Analysing Qualitative Data, London: Routledge.
Cohen, B. E., Reutter, L. (2007) Development of the role of public health nurse in
addressing child and family poverty: a framework for action, Journal of Advanced
Nursing, vol. 60, no.1, pp. 96-107.
Cowley, S., Whittaker, Karen., Malone, Mary., Doneto, Sara., Grigulis, Astrida.
(2015) Why Health Visiting? Examining the potential public health benefits from
health visiting practice within a universal service: A narrative review of the literature,
International Journal of Nursing Studies, vol. 52, no. 1, pp.465-480.
Davies, C. (2011) Experiences of homelessness: An interpretative
phenomenological analysis. Brunel University, pp.1-35.
David, H. D., Gelberg, L., Suchman, E, N. (2012) Implications of homelessness for
parenting young children. A preliminary review from a developmental attachment
perspective, Infant Mental Health, vol.33, no. 1, pp.1-9.
Denyer, S., Thornton, L. Pelly, H. (2005) Best Health for Children Revisited: Report
from the National Core Child Health Programme Review Group to the Health Service
Executive October 2005. Health Services Executive, Programme of Action for
Children, Dublin: Health Service Executive.
Department of Children and Youth Affairs (2011) Children First: National Guidelines
for the Protection and Welfare of Children, 2011, Dublin: Stationery Office.
Department of Children and Youth Affairs (2013) Right From The Start. Report of the
expert advisory group on the early years strategy, Dublin: Government Publications.
Department of Health (2012) Future Health: A Strategic Framework for Reform of the
Health Service 2012-2015, Dublin:Government Publications.
Department of Health (2000) Job description of the Public Health Nurse: Circular
41/2000, Dublin: Department of Health.
Department of Health (1966) Ministerial Circular 27/66 District Nursing Service:
Dublin: Department of Health.
Department of Health (2001) Primary Care: A New Direction, Dublin: Stationery
Office.
Department of the Environment, Heritage and Local Government (2008) The Way
Home: A Strategy to Address Adult Homelessness in Ireland 2008-2013, Dublin:
Stationery Office.
Downey, D. (2008) Perspectives on Irish Homelessness, past present and future,
Dublin: Housing Agency
Dublin Region Homeless Executive (2014) Sustaining Dublin’s Pathway to Home:
The homeless action plan framework, 2014-2016, Dublin City Council.
Finfgeld -Connett, D.( 2010) Becoming Homeless, Being Homeless, Resolving
Homeless in Women. Issues in Mental Health Nursing, vol. 31, no. 7, pp. 461-469.
Fordham, M. (2015) The lived experience of homeless women: Insights gained as a
specialist practitioner, Community Practitioner, vol. 88, no. 4, pp. 32-37.
Giltenane, M., Kelly, M. Dowling, M. (2015) Public health nurses' experiences of
their role as part of a primary care team in Ireland, Australian Journal of Advanced
Nursing, vol. 32 no.3, pp.6-15.
Government of Ireland (1991) Child Care Act, 1991, Dublin: Stationery Office.
Government of Ireland (1970) Health Act 1970, Dublin: Stationery Office.
Government of Ireland (1988) The Housing Act, 1988, Dublin: Stationery Office.
Government of Ireland (1937) The Irish Constitution, Dublin: Stationery Office.
Grineski, S. (2014) 'The Multi-Dimensional Lives of Children who are Homeless',
Critical Questions in Education. 5, no. 3, 203-217.
Haber, M.G. Toro, P.A. (2004) Homelessness among families, children, and
adolescents: An ecological–developmental perspective, Clinical Child and Family
Psychology Review, vol.7 no 3, pp.123-164.
Halpenny, A.M., Greene, S., Hogan, D., Smith, M., Magee, H. (2001). Children of
homeless mothers: The daily life experiences and well being of children. Dublin: The
Children’s Research Centre, Trinity College Dublin: The Royal College of Surgeons
in Ireland.
Halpenny, A.M., Keogh, A.F., Gilligan, R. (2002) A place for children? Children in
families living in emergency accommodation: The perspectives of children, parents
and professionals in homeless families. The Children’s Research Centre, Trinity
College Dublin.
Hanafin, S. (1998) Deconstructing the role of the public health nurse in child
protection, Journal of Advanced Nursing, vol.28, no.1, pp.178-184.
Hanafin, S., Houston, A.M. Cowley, S. (2002) Vertical equity in service provision: a
model for the Irish public health nursing service, Journal of Advanced Nursing, vol.
39, no. 1, pp. 68-76.
Hanafin, S. (2013) Child Protection reports: key issues arising for public health
nurses, Community Practitioner, vol. 86, no.10, pp.24-27.
Hanafin, S., O’Reilly, D. (2015) Multiple stakeholders’ views on changes in delivery
of public health nursing, British Journal of Community Nursing, vol. 20, no. 8, pp.389393.
Harker, L. (2006) Chance of a lifetime: the impact of bad housing on children's lives.
Shelter UK.
Harvey, B. (2014) The Case for Prevention and Early Intervention. Promoting
positive outcomes for children, families and communities, Prevention and Early
Intervention Network.
Health Service Executive (2015) National Service Plan.
Haber, M.G. Toro, P.A. (2004) Homelessness among families, children, and
adolescents: An ecological–developmental perspective, Clinical Child and Family
Psychology Review, vol.7 no 3, pp.123-164.
Kent, S., Dowling. M., Byrne, G. (2011) Community nurses’ child protection role:
views of public health nurses in Ireland, Community Practitioner, vol.84 no. 11,
pp.33-36.
Keogh, C., O’Brien, K.K., Hoban, A., O ‘Carroll, A., Fahy, T. (2015) Health and use of
health services of people who are homeless and at risk of homeless who receive
free primary health care in dublin, BMC Health Services Research, vol. 15, no. 1,
pp.1-8.
Keogh, F., Halpenny, A., Gilligan, R. (2006) Educational Issues for Children and
Young People in Families living in Emergency Accommodation- An Irish Perspective,
Children and Society, vol.20, no. 5, pp.360-375.
Leitschuh, A. C., Harring, R. J., Dunn, W. (2014) A monitoring tool of infant and
toddler moving skills, Journal of Early Intervention, vol.36 no. 1 pp.18-36.
Martins, D.C. (2008) Experiences of homeless people in the health care delivery
system: a descriptive phenomenological study, Public Health Nursing, vol. 25, no. 5,
pp.420-430.
Maycock, P., Sheridan, S., Parker, S. (2015) The Dynamics Of Longterm
Homelessness Among Women In Ireland. The Children’s Research Centre, Trinity
College Dublin.
Moore, T., McArthur, M., Noble-Carr, D. (2011) 'Lessons learned from children who
have experienced homelessness: what services need to know', Children and
Society, vol.25, no.2, pp.115-126.
O’Dwyer, P. (2012) A Report on the Child and Family Health Needs Assessment
Framework Project in the HSE Dublin Mid Leinster Public Health Nursing Service
Areas of Laois, Offaly, Longford and Westmeath. Mullingar, Ireland. Dublin: Health
Service Executive.
Office of the Nursing and Midwifery Service Director (2012) Report on Current Public
Health Nursing Services, Dublin. Health Service Executive.
O ‘Sullivan, E. (2012) Ending Homelessness- A Housing Led Approach. Dublin:
Department of Environment, Community and Local Government.
Phelan, A., Davis, M. (2015) Lessons Learned: Public Health Nurses Practice in
Safeguarding Children in the Republic of Ireland, Global Paediatric Health, vol.1, no.
2, pp.1-9.
Polit, D., Beck, C. (2006) Essentials of Nursing Research: Methods, Appraisal and
Utilization, USA -Lippincott Wiliams and Wilkins.
Pye, V. (2015) Reshaping Public Health Nursing in the Republic of Ireland, British
Journal of Community Nursing, vol.20 no.7, pp.348-353.
Rae, B.E., Rees, S. (2015) The perceptions of homeless people regarding their
healthcare needs and experiences of receiving healthcare, Journal of Advanced
Nursing, vol.71, no.9, pp.2096–2107.
Ridge, T. (2002) Childhood Poverty and Social Exclusion, Bristol: Policy Press,
Journal of Social Policy, vol.32, no.3, pp.478-480.
Riley, R., Johnson, T., Pearson., l. (2001) An Audit into homeless families in
temporary accommodation, British Journal of Community Nursing, vol. 6, no.1,
pp.1462-4753.
Swick, K. (2010) 'Responding to the Voices of Homeless Preschool Children and
Their Families'. Early Childhood Education Journal, vol. 38, no.4, pp.299-304.
Tansey, K. (2008) Homelessness: A way forward for nurses, Primary Health Care,
vol.18, no.1, pp.16-18.
Walsh, K., Harvey, B. (2015) Family experiences of pathways into homelessness,
the families perspective, Dublin: Housing Agency.
Watts, B. (2014). Homelessness, empowerment and self-reliance in Scotland and
Ireland: The impact of legal rights to housing for homeless people, Journal of Social
Policy, vol.43, no.4, pp.793-810.
Whiting, L.S. (2008) Semi structured interviews: guidance for novice researchers,
Nursing Standard, vol. 22, no. 23, pp.35-40.
Williams, J., Murray, A. McCrory, C., McNally., S. (2009). Growing up in Ireland:
National Longitudinal Study of Children. Development from Birth to Three Years.
Report no 5 from the infant cohort. Dublin: Stationery Office.
William, J., Law, K. (2011) Addressing the health needs of the homeless, British
Journal of Community Nursing, vol. 16, no. 3, pp.134-139.
Appendix 1
Guide Questions for Semi- structured interviews
1. Could you tell me how many homeless families you are currently
involved with?
2. Could you tell me about the role that the Public Health Nurse plays with
homeless children and families?
3. Could you elaborate on the type of impact that homelessness has on
the families and the challenges it brings.
4. With regards to referring a child who is in temporary accommodation
and has a developmental delay is there a direct pathway?
5. Could you tell me about the impact that homeless families have on
your caseload and the challenges you face as a Public Health Nurse?
6. In your opinion is there anything that might make a difference to help
these families?
7. Is there anything else you would like to add?
Appendix 2
Demonstration Practice Project
An Exploratory Study of the Views and Experiences of PHN’s
engaging with homeless families and whether there is an Impact
on Children’s Development
I ___________________________ have read the attached letter
outlining the aim of the interview. I agree to be interviewed for the
purpose of the above Demonstration Practice Project.
Signed: ______________________
Date________________________
Appendix 3
Re: Demonstration Practice Project
Purpose: To Undertake an Exploratory Study of Public Health Nurse’s
Views and Experiences of engaging with Homeless families and whether
there is an Impact on Children’s Development
Dear Colleagues,
As you may be aware, I am undertaking the Postgraduate Higher Diploma in
Child Protection and Welfare at Trinity College, Dublin. To fulfil the
requirement for this course, I am carrying out a piece of research called a
Demonstration Practice Project to explore, “Public Health Nurses Views and
Experiences of engaging with Homeless Families and whether there is an
Impact on Children’s Development.
I am writing to you to ask for your assistance with exploring your thoughts on
the above subject. It more so pertains to PHN’s working with homeless families
and children. I would be grateful if you could contact me and we can arrange to
meet at a time that suits you.
The interview will be tape recorded and will take approximately 30-40 minutes.
In the interview I will ask you a number of questions about your views of the
Impact of Homelessness on Children. Your participation is voluntary. All
answers will be anonymous and strictly confidential. If you are available to
share your thoughts, please let me know by returning the signed consent
attached.
I am aware of the many demands that are placed on your workload and
consequently I would be very grateful for any assistance you can give.
Kind regards,
Amy Fallon
Public Health Nurse
Tel No 01 8040037
Appendix 4
Amy Fallon
Public Health Nurse
Millmount Avenue Health Centre
Drumcondra
Dublin 9
Date: 01/03/16
Mrs Angela Kennedy
Director of Public Health Nursing
Dublin North City
Ballymun Civic Centre
Ballymun Civic Offices
Ballymun
Dublin 9
Re: Demonstration Practice Project
Purpose: To Undertake an Exploratory Study of Public Health Nurse’s Views and
Experiences of Engaging with Homeless Families and whether there is an Impact on
Children’s Development
Dear Mrs Angela Kennedy,
I am currently undertaking in the Postgraduate Higher Diploma in Child Protection
and Welfare at Trinity College, Dublin. In order to fulfil the requirement for this course
I am undertaking a Demonstration Practice Project to explore Public Health Nurse’s
Views and Experiences of engaging with Homeless Families and whether there is an
Impact on Children’s Development.
Following discussion with my course supervisor, the most appropriate form of
methodology will be for me to carry out individual interviews with Public Health
Nurses in Dublin North City who are currently providing a service to families and
children in emergency accommodation. I am writing to you to request permission to
interview the Public Health Nurses involved with this client group. I shall notify you in
advance of the dates of when I will begin commencement of the interviews. The
interviews will last approximately 20-40 minutes.
Participation of public health
nurses in the study is voluntary and each participant is free to withdraw at any time.
The interviews will be recorded and each participant’s anonymity and confidentiality
will be assured. Each participant will be assigned a number to maximise privacy. All
material that is recorded and transcribed will be destroyed on completion of the
Demonstration Practice Project.
If you have any questions about the research or would like to discuss this in more
detail, please don’t hesitate to contact me on 0871206823.
Thanking you,
Amy Fallon
Public Health Nurse