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

In 2019–2020 we conducted a pilot study of a Nurse Practitioner clinic working with housing insecure children (0–18 years) that found high levels of developmental delay, missed immunizations and dental caries. This present non-randomized, concurrent mixed-methods study protocol explains the next phase of the research designed proving proof of concept for a Nurse Practitioner model of care for these vulnerable children. Focusing on identifying and understanding clinic admission processes, tracking referral pathways and uptake, and how many vulnerable children miss potential care and why. This will help us to understand and address gaps in health service delivery for this cohort.

Design: The study uses a concurrent mixed- method design where both qualitative and quantitative data are collected during the same period (between January 2021 and March 2022 as per the funding timeline).

Methods: The concurrent mixed-method design will collect data from:

- A comprehensive assessment tool used by the Nurse Practitioner to evaluate the child accessing specialist homeless services, which assess their mental, physical and social health needs.

- Documentation about the child's referral needs and uptake by disadvantage families.

- Interviews with housing insecure families, and staff/managers of the specialist homeless service.

- A review of Nurse Practitioner case notes.

- Surveys of families with children accessing the Nurse Practitioner service.

Discussion: Addressing the childhood impacts of family homelessness is of global importance. Structural equation modelling, from the surveys and in-depth health assessments along with the thematic analysis of the interviews with parents and staff/managers provide an understanding of the relationships between referral uptake and variables such as education, homelessness and transport accessibility. Investigating the enablers and barriers to the usual health access and our extended referral uptake impacted by family homelessness enables a better understanding of the current health gaps.

Impact: Just over one fifth of Australian children live with their families in some form of housing instability including homelessness. These children, aged from birth to 18 years, are often disconnected from health and similar social institutions, making them an underserviced population. Our research investigates a Nurse Practitioner services that helps reconnect children with services to help avoid poor long-term health outcomes