Children and babies miss out on important services, including basic health care, if they are affected by homelessness. Photo: Getty Images.
Nurse practitioners working with social service agencies is one way to help the estimated 22% of Australian children living in temporary or precarious living conditions, with families hit hard by unemployment and other problems created by the pandemic.
These children – some skipping health checks, vaccinations and even nutritional meals – may not have regular doctor appointments, and poorer access to health services, leading to more physical and mental health issues and emergency department presentations.
A pilot part-time nurse practitioner program, led by Flinders University child health experts in partnership with UnitingCare Wesley Bowden (UCWB), will expand to two other Adelaide metropolitan sites with support from the latest Channel 7 Children’s Research Foundation grant round.
The Channel 7 Children’s Research Foundation 2021 Grant Round will provide assistance to 18 projects in total that will channel $1.5 million in funding into SA-led research into children’s health, education and welfare. This latest round focused on priority areas of children’s mental health, protection, obesity and the effects of social determinants.
Project leader, Flinders University senior lecturer Dr Yvonne Parry, says the grant will provide more early intervention and health support for marginalised families in a setting on the ‘coalface’ where nurses can “operate in their full scope of practice”.
The program, currently available at UCWB’s Marion office, will extend to two other sites, and give Flinders researchers insights into areas of demand and health needs in other metropolitan areas.
“In the past year, 74 children have been seen by a specialist paediatric nurse at Marion, where children and their families who engage with UCWB’s homelessness services have access to professional and free health services,” Dr Parry says.
UCWB’s homelessness services support about 700 people each year of which around 150 are children aged under nine.
UCWB chief executive Fiona Kelly, left, Dr Parry, UCWB’s Mark Parry and Alison Kimber with Flinders University graduate and now academic Alicia Bell, who was the inaugural UCWB Nurse Practitioner at Marion. Photo: Ben Searcy
UCWB chief executive Ms Fiona Kelly says extending the nurse practitioner service to additional locations will make it easier for families to access free healthcare while going through extremely difficult times.
“Having a nurse practitioner working along side our social workers will enable us to intervene early to disrupt patterns of ill health for these families,” says Ms Kelly.
“These structured, community embedded interventions by a nurse practitioner with the skills to provide advanced paediatric full health assessments of children aged 0-18 living in housing instability, provides important health pathways to ensure their development and long-term wellbeing,” says Dr Parry, from Flinders’ College of Nursing and Health Sciences Caring Futures Institute which provided funding for the pilot.
Details of the seven grants awarded to Flinders University projects running from 2021-22 are:
LINKING homeless children and their families to community health and wellbeing services: Using a Nurse Practitioner model of care to improve child health outcomes (led by Dr Yvonne Parry – College of Nursing and Health Sciences).
DEFINING endotypes in infant bronchiolitis: the first step toward personalised treatment (led by Associate Professor Dani Dixon – College of Medicine and Public Health)
Bronchiolitis is the most common severe respiratory tract illness in infants and remains the dominant cause of infant hospitalisation. There is no specific treatment apart from respiratory support as disease mechanisms are unknown. Bronchiolitis is predominantly caused by viral infections that induce an immune response which varies between patients. We, and others, have found measurable biomarkers associated variably with severity, length and chronic morbidity of bronchiolitis. By modelling clinical characteristics with combinations of these biomarkers we aim to be able to identify representative cohorts (endotypes) of bronchiolitis as a first step toward personalised treatment regimens, enhancing individual care and recovery.
CREATING positive educational futures for young people who are at risk of, or are already in, out-of-home care (Dr Priscilla Dunk-West – College of Education, Psychology and Social Work)
The link between child abuse and related trauma on young people’s educational engagement is clear. Statutory removal into out-of-home care can lead to behavioural issues that result in school exclusion or disengagement. This project applies an educational intervention to work with young people aged 14-17 at risk of, or who are already in, out-of-home care. Using a tailored, trauma-informed approach to education will improve future employment prospects and wellbeing for this cohort by helping them to feel hopeful about their futures and competent heading into independent living.
DOES maternal obesity drive childhood obesity through interactions between the gut microbiome and gut endocrine cells? (Professor Damien Keating – College of Medicine and Public Health)
There is clear evidence that children born to obese mothers have increased obesity and cardiac problems in childhood and beyond. However, little is understood about how this occurs. This project will undertake proof of concept experiments that will test whether interactions between the gut microbiome and neighbouring endocrine cells lining the gut wall drive these effects. We will combine molecular genetics, pharmacology, diet perturbations and faecal matter transfer in mice to determine whether interventions targeting the gut microbiome and gut-derived hormones can prevent childhood obesity in progeny derived from obese mothers.
A RANDOMISED controlled trial of cognitive behavioural therapy for insomnia in children on the autism spectrum (Dr Michelle Short – College of Education, Psychology and Social Work)
Children with autism experience a markedly higher prevalence of sleep problems than their peers (78% versus 26%), predominantly, insomnia (Couturier et al., 2005). Thus, research into sleep problems is a core recommendation in NICE autism guidelines for children. This research will be a world-first clinical randomized controlled trial testing the efficacy of the gold standard insomnia treatment, Cognitive Behaviour Therapy for insomnia (CBTi) including sleep restriction in children with autism. Autistic children with co-occurring insomnia have significantly worse outcomes than those without. Untreated, insomnia frequently has a chronic course, impacting school, family, social, mental health and vocational outcomes.
OPTIMISING the early detection of ear disease and hearing impairment among Aboriginal and Torres Strait Islander children aged under 8 years (led by Dr Jacqueline Stephens – College of Medicine and Public Health)
All children should be able to hear well. However, Aboriginal and Torres Strait Islander children experience some of the highest levels of ear disease and hearing impairment in the world which can lead to lifelong consequences. In South Australia, children under 8 years undergo hearing assessments coordinated by a state-wide program lead by Aboriginal Health Council of South Australia. We propose a modification to current assessment protocols by replacing time consuming and technical audiometry with simpler and quicker otoacoustic emission testing in a bid to increase testing rates and increase the early detection and expedited care for these children.
SUPPORTING mental health and wellbeing for children from migrant and refugee backgrounds with disability (Associate Professor Anna Ziersch – Southgate Institute for Health, Society and Equity, College of Medicine and Public Health)
Refugee children experience higher rates of disability, including mental health and developmental disorders, than non-refugee children. In addition, migrant and refugee children with disability can experience negative mental health impacts as a result of their disability. They also face multiple potential service access barriers including issues with diagnosis, language and service navigation, a lack of culturally responsive services, and varying service eligibility – however, there is limited research examining this. This project will examine mental health support needs and engagement with services, and provide recommendations for promoting mental health and wellbeing for migrant and refugee children and their carers.