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Improving the health of a vulnerable community

Improving the health of a vulnerable community

A vulnerable community in West Auckland

In West Auckland, one caravan park has around 300 residents, including up to 50 children. Situated on ten acres, the park offers 60 caravans and another 60 units (including cabins, small units, trailer homes and powered sites). The accommodation at the caravan park is basic with limited facilities, and can be cold and damp in winter.

Residents of the caravan park are comprised of:

  • families with young children, single people of all ages
  • people with a range of health issues (eg general health issues, mental health, addictions)
  • people who have experienced a range of social situations (eg incarceration, family violence, discrimination, homelessness)

West Auckland caravan parkIt is estimated that 90% of residents are unemployed, or are receiving a sickness or domestic purposes benefit. Residents pay rent for the caravans and units ranging from $195 for a small unit to $480 per week for a 3 bedroom unit, and additional charges for other utilities. Given that most of the residents are on benefits there is very little money left over after they have paid for rent and many live a day-to-day existence. As a consequence many residents struggle to live a healthy lifestyle and to pay for basic health services, such as visiting a doctor or getting a prescription.


What are we trying to achieve?

Public health nurses provide an important advocacy and navigation service for many of the residents of the park. Residents are often marginalised by their past experiences and current circumstances, and are often overwhelmed into inactivity. Supporting this vulnerable population to achieve success in just one health or social issue that they face can lead to them gaining the confidence to attempt to address other issues in their lives.

Our aims were to:

  • establish a rapport with all residents and improve their health outcomes
  • identify the types of services that residents wanted and needed to access, and what services were available on site or within the local community
  • support residents to prepare for their transition out of the caravan park
  • develop relationships with relevant agencies to provide a supportive network for the caravan park

What did we find?

  • The caravan park residents were:
    • not accessing primary health care, even though there was a medical centre located directly across from the caravan park
    • missing hospital appointments
    • not addressing their basic health needs because of lack of transport, cost and previous experiences with health providers
  • There was a gap in residents’ knowledge about how to access support for mental health issues
  • There was a lack of trust and residents were suspicious of health workers going into the park

Data collected over six months showed that residents have presented with a wide range of health concerns. However, the predominant concerns relate to skin infections, hearing and ear health and sexual health (including gynecological concerns).

Health concerns of residents at first presentation to public health nursing service (Oct14-Apr15)


What have we done?

Our public health nurses (PHN) have been visiting the caravan park in their mobile Health Bus, and since October 2014 they have had contact with 232 residents. New residents seen per month are detailed in the graph below (please note the graph only details new residents seen, follow-ups are not included).

Public health nurse contacts with residents from Oct 2014 to Apr 2015 

The public health nurses have supported residents by:

  • undertaking health assessments to identify health issues and develop shared care plans
  • providing health screening and preventative care
  • providing more timely and affordable access to general practices and for medications
  • proactively referring and helping them to access a range of other health and social service providers, including mental health services, housing, dental services and Child, Youth and Family
  • providing health education and promotion activities so that they can better manage their own health and wellbeing

Public health nurse visiting residentsThe public health nurses have developed relationships with other agencies to create a support network by:

  • using a community development framework to identify health needs and developing a multiagency action plan
  • participating in interagency meetings and working in partnership with the HUB coordinator
  • maintaining a working relationship with the caravan park owners and keeping them, and the DHB, informed of current issues and trends
  • working with local schools and Early Education Centres to promote attendance and engagement of the resident children in education

‘Welcome packs’

We have developed and provided 55 ‘welcome packs’ to new residents as a way of introducing the public health nursing service within the park. Packs include basic hygiene items (such as soap, toothpaste and a hand towel) and information about health and social services in the local area.

They have been very much appreciated and feedback received is that they are very useful, as some of the new residents arrive in the park with just the clothes they are wearing.


Did we make a difference?

The increased allocation of public health nursing hours has enabled the improvement in the overall health of residents through:

  • better relationship with park managers who are now referring individuals and families to the public health nursing service when they believe that there are health issues impacting on the resident’s wellbeing
  • improved engagement and trust of residents with the public health nurses and local health service providers
  • more timely access to services based on residents’ specific health needs, eg increased presence of mental health services in the park through a liaison nurse from the Adult Mental Health Services

Feedback

Feedback received to-date indicates that:

  • the quality of services provided are excellent and have met residents’ needs
  • the residents would like the public health nurses to have an increased presence in the park
  • the residents are recommending the service to other people residing in the park

Where to from here?

Ensuring continuity of these proactive and preventative services into the future is essential to enable this vulnerable population. Funding has been confirmed for the next twelve months for our project to continue.

The Well Foundation is also raising funds for a new mobile health clinic for the public health nursing service to increase their support in the community [view more about our Well Foundation fundraising initiatives].

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