A scoping study: children, policy and cultural shifts in homelessness services in South Australia: are children still falling through the gaps?

Abstract

What is known about this topic• Homeless children are at higher risk of disengagement from health, education and welfare services.• Disengagement has long-term deleterious health, interpersonal and educational outcomes for homeless children as they grow.• Policy changes have addressed disengagement by directing homelessness services staff to provide an improved level of assessment and referral processes for children. What this paper adds• Policy changes have failed to address the specific training and educational requirements of frontline staff.• Child aware approaches are integral to improving service access for children. AbstractHomeless families are the fastest growing segment of the homelessness population. Homelessness services are often the first to know when children are at risk of disengagement with health, welfare and education services. Changes to Australian policy to explicitly attend to the needs of children are attempts to address the complexity of, and provide better outcomes for, homeless children. There are mounting levels of evidence describing some of the needs of children who are homeless. Using the scoping study methodological framework, this review of academic and grey literature identified the extent to which service providers provide for the needs of homeless children. The literature search was conducted from September 2012 to April 2013 using ProQuest, Science Direct, Sage and OVID databases. Therefore, the objectives of this scoping study were to: (i) identify the specific needs of children in homelessness; (ii) describe recent changes in policy relating to care for children in homelessness services; (iii) explore the evidence on how service providers can enact care for children in homelessness services; (iv) identify the types of practice changes that are needed to optimise outcomes for children; and (v) identify the gaps in service delivery. This article describes the Australian policy changes and explores the potential impact of subsequent sector reforms on the internal practices in front-line homelessness services, in order to overcome structural and systemic barriers, and promote opportunities for children in homeless families. This scoping study literature review contributes to the understanding of the impact of policy change on front-line staff and suggests possible practice changes and future research options.

A Nurse Practitioner service designed to address the health needs of children living in housing instability: A non‐randomised, concurrent mixed methods study protocol

“…Issue about referral uptake in the literature mostly concern inequities such as homelessness, direct costs such as the medical gap fees, indirect cost such as transport and parking, and education levels which affects health literacy and/or ability to navigate health services (Creswell & Plano Clark, 2011; Field, 2018; Greenhalgh & Papoutsi, 2018; Harvey & Kitson, 2015; Johnson, 2017; Lambert et al, 2014; Mueller & Hancock, 2010; Parry, 2012; Parry, Grant, & Burke, 2016; Polit, 2017; Sekhon et al, 2017). This concurrent mixed‐methods evaluation, using triangulated data methods, will enable the research team to explore, in depth, the barriers involved in referral uptake as well as the enablers that support housing insecure children and their families to adhere to referrals and improve health referral outcomes.…”

“…This is partly due to models of health service delivery not meeting the needs of children and families facing adversity, such as those living in homelessness and housing instability (AAP, 2013; AIFS, 2012; AIHW, 2012, 2017; Hurley et al, 2018; Parry, Grant, & Burke, 2016). Without access to health care and other social supports, developmental milestones may be missed, or children may suffer longer term physical and mental health impacts from disadvantage (Department of Health, 2019; Parry, Grant, & Burke, 2016; Smith Family, 2019).…”

“…The most vulnerable included approximately 7300 children aged 0–14 years, who were documented as homeless in 2016 Australian census (Department of Health, 2019). The exposure of children to homelessness and disadvantage can have lifelong negative impacts (American Academy of Paediatrics [AAP], 2013; Australian Institute of Family Studies [AIFS], 2012; Australian Institute of Health and Welfare [AIHW], 2017; Bedford et al, 2013; Davidson et al, 2018; Department of Health, 2019; Ding et al, 2014; Duncan et al, 2010; Goldfeld et al, 2017; Hurley et al, 2018; Leventhal & Newman, 2010; Parry, Grant, & Burke, 2016; Pungello et al, 2010; Sandstrom & Heurta, 2013; Strong Foundation Collaboration, 2019). For example, disadvantaged and vulnerable children have poorer access to health services, lower medical appointment compliance, increased emergency department (ED) utilization and overall poorer health outcomes (AIHW, 2018; Bedford et al, 2013; Duncan et al, 2010; Hudson et al, 2014; Kubicek et al, 2012; Long et al, 2018; Neuman et al, 2014; Parry et al, 2009; Parry, Ullah, et al, 2016; Pungello et al, 2010; Sandstrom & Heurta, 2013; Strong Foundation Collaboration, 2019).…”

“…For example, disadvantaged and vulnerable children have poorer access to health services, lower medical appointment compliance, increased emergency department (ED) utilization and overall poorer health outcomes (AIHW, 2018; Bedford et al, 2013; Duncan et al, 2010; Hudson et al, 2014; Kubicek et al, 2012; Long et al, 2018; Neuman et al, 2014; Parry et al, 2009; Parry, Ullah, et al, 2016; Pungello et al, 2010; Sandstrom & Heurta, 2013; Strong Foundation Collaboration, 2019). This is partly due to models of health service delivery not meeting the needs of children and families facing adversity, such as those living in homelessness and housing instability (AAP, 2013; AIFS, 2012; AIHW, 2012, 2017; Hurley et al, 2018; Parry, Grant, & Burke, 2016). Without access to health care and other social supports, developmental milestones may be missed, or children may suffer longer term physical and mental health impacts from disadvantage (Department of Health, 2019; Parry, Grant, & Burke, 2016; Smith Family, 2019).…”

Where is community during COVID‐19? The experiences of families living in housing insecurity

“…Women and their children experiencing housing insecurity remain the invisible face of homelessness and housing instability; moreover, they are the largest and most recent expanding subgroup within the homelessness population (Parry, 2020 ; Parry & Sivertsen, 2021 ). They also lack proper access to social, educational, health and economic supports, which further compounds their social isolation (Parry et al, 2016b ; Parry et al., 2020 ). Children from non‐Caucasian background are three times more likely to be homeless or live‐in inadequate housing, while housing instability and homelessness place children, especially First Nations children, at a much higher risk of adverse psychological, developmental and physical outcomes (Butler et al., 2019 ; Coughlin et al., 2020 ).…”