Supporting the health of families who are marginalised: A public health nursing perspective

The welfare of children is of paramount importance” Children First 2011

Public Health Nursing

Public Health Nursing integrates with primary care to provide a service to people in the community 

The focus of Public Health Nursing is to promote Health and Wellbeing and to provide quality clinical care.

The PHN

PHN: Caseload holder in a primary care setting

Child Health

Older Person

Disability

Clinical activity

PHN Services Specific to Child and Family

Child Health and Well Being

Children with Life Limiting Conditions

Complex Care Needs

Early Learning Support

Child Protection and Welfare

Child Health and Well Being

Parent craft/ Antenatal Classes

Postnatal Pilates and Baby Massage (Physio Team)

Birth Notification within 48-72 hours

Neonatal Screening 72hrs post delivery

Nurse led Developmental Assessments

Breast feeding support

Infant feeding/ nutrition/ weaning programme

Child Protection and Welfare (CF 2011)

Child Health Well Being continue

Child Safety Awareness Programme

Follow up Infant Immunisation Programme

Child and Family Health Needs Assessment (Development /Parenting/ Environment)

Parenting Programmes

Community Mothers Programme

Postnatal Depression Screening (PAC 2005)

Primary/ Post Primary Immunisation/ School Screening Programme

Area Profile West Tallaght

Population 47,540 ( CSO 2011)

2 of the 4 disadvantaged communities; highest areas of deprivation in the country (Kelly & Tekjeur 2013)

One of the electoral areas; highest growth in population 22% increase (CSO 2011)

Profile continued; the context

2700 Births annual ( DSW/ HSE 2014)

1200 are in West Tallaght

600 families are from African, Asian and Eastern European countries (PHN records 2014)

54 births born to Traveller mothers in DSW 38 in West Tallaght (PHN Records 2014)

400 of 652 referred to Tusla were from West Tallaght (first 4 months of 2015 Tusla DSW)

Families: an every day encounter

Families from other countries

Traveller families

Drug and Alcohol use

Domestic violence

Mental Health issues

Families; continued

Disabilities; intellectual disabilities/ autism/ behavioural issues

Physical Disabilities

Children with life limiting conditions

Poverty>> homelessness and risk of homelessness/ relocation >> >>>>>>

Isolation and Stress

Traveller Women; a snap shot

Traveller females, life expectancy 70.1 2008

General Female , life expectancy 80 2008

Infant mortality rate (12 per 1000) 4 times general population

129 Female prisoners 21 were Travellers

(Traveller women 22 times more at risk of prison)

(AITHS 2010)

Roma families

The Case of Child A removed form his family home in Athlone 2013

The Case of Child T removed from her family home in Tallaght 2013

Significance of the information recorded by the PHN in both cases

The Emily Logan Report (2014)

Adverse Childhood Experiences ACE

ACE: Largest study of its kind examines the health and social effects of adverse childhood experiences over a lifespan (The Centres for Disease Control and Prevention 2014)

Adverse childhood experiences are the most basic cause of health risk behaviours, morbidity, disease, mortality disability, and health care costs ((Fellitti & Anda 2010 )

Professor Trevor Spratt TCD Director of the Children’s Research Centre

Interagency

No one professional has all the skills, knowledge, or resources necessary to comprehensively meet all the requirements of an individual case. It is essential therefore that a coordinated response is made by all professionals involved with a child and his carer/s (Children First 2011).

Interagency ProjectsMcUlliam Project: Barnardos and PHN: A Parent Toddler & Child Health Project (Barnardos/ HSE 2014)

Set up in 2012 in response to a recent closure of a preschool facility

PHN finding it difficult to access families and young children

Mother and Toddler Group and Child Health Clinic/ (Developmental/ Parenting/ Environment)

Antenatal to Three Initiative ATTI

Government’s Area Based Childhood Programme ABC

Improve health, education and social outcomes for children who live in poverty and social exclusion

Improve the effectiveness of existing services 0 to 3

Consultation Finding: Up to 50 services working across the spectrum, Interagency tends to be reactive/ Need for a coordination approach (CDI 2015)

To Date: Speed Network/ Interagency Approach: Maternal Mental Health / Infant Mental Health (Attachment)

Report available from CDI Tallaght West (Haran 2015)