Author: Deirdre Jacob Primary Healthcare Social Worker 2013 Tallaght Roma Integration Project...

Author: Deirdre Jacob Primary Author: Deirdre Jacob Primary Healthcare Social Worker 2013Healthcare Social Worker 2013

Tallaght Roma Integration Project Tallaght Roma Integration Project

(T.R.I.P)(T.R.I.P)

http://www.google.ie/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=Xka4imc_1uhWGM&tbnid=CPcymIz90JlnCM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.donegaldaily.com%2F2013%2F02%2F04%2Fdonegal-taxi-drivers-anger-at-new-hse-call-out-system%2F&ei=0WozUYL4IMm2hQfYlICQCA&bvm=bv.43148975,d.ZG4&psig=AFQjCNHE-BpNkRx_3vOA7zxI9z6UQr81yg&ust=1362410267288798

http://www.google.ie/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=mYTC5ZYgQGuMKM&tbnid=eUuo-PQW8FrU_M:&ved=0CAUQjRw&url=http%3A%2F%2Fasthmasociety.ie%2Fnews-events%2Fasthma-society-attends-fettercairn-health-open-day&ei=dmwzUeiaM5OXhQfQroDIBQ&bvm=bv.43148975,d.ZG4&psig=AFQjCNHFaGwqlG1BZfhQnmXuNwEbV1PHfg&ust=1362410828593220

http://www.google.ie/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=eETxwjVHEyKu4M&tbnid=HPVhV5hDv8lbKM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.corkcoco.ie%2Fco%2Fweb%2FCork%2520County%2520Council%2FCounty%2520Development%2520Board%2FProgrammes%2FRAPID&ei=D20zUaPjH4XRhAejkoCQAw&bvm=bv.43148975,d.ZG4&psig=AFQjCNEIofbENvl6Lp0BqKQHdGA8zXEtog&ust=1362411134198568

http://www.google.ie/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=eETxwjVHEyKu4M&tbnid=HPVhV5hDv8lbKM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.corkcoco.ie%2Fco%2Fweb%2FCork%2520County%2520Council%2FCounty%2520Development%2520Board%2FProgrammes%2FRAPID&ei=OW4zUfC2LMGmhAeh3YCwCQ&bvm=bv.43148975,d.ZG4&psig=AFQjCNELLMluk260o_xsQPTnApjwYZWxeg&ust=1362411311645606

http://www.google.ie/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=eETxwjVHEyKu4M&tbnid=HPVhV5hDv8lbKM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.corkcoco.ie%2Fco%2Fweb%2FCork%2520County%2520Council%2FCounty%2520Development%2520Board%2FProgrammes%2FRAPID&ei=OW4zUfC2LMGmhAeh3YCwCQ&bvm=bv.43148975,d.ZG4&psig=AFQjCNELLMluk260o_xsQPTnApjwYZWxeg&ust=1362411311645606


The Roma in IrelandThe Roma in Ireland• Like other European countries Ireland Like other European countries Ireland

experienced an increase in migration levels with experienced an increase in migration levels with 10 new countries joining the EU in 2004 10 new countries joining the EU in 2004 followed by two (Romania and Bulgaria) in followed by two (Romania and Bulgaria) in 2007. 2007.

• Most of the EU's original members placed an Most of the EU's original members placed an exclusion order of 7 years preventing citizens exclusion order of 7 years preventing citizens from the accession countries working, hoping t0 from the accession countries working, hoping t0 prevent welfare tourism. prevent welfare tourism.

• Ireland, the UK and Sweden were exceptions to Ireland, the UK and Sweden were exceptions to this rule for a while allowing citizens of the first this rule for a while allowing citizens of the first ten (excluding Bulgaria and Romania) countries ten (excluding Bulgaria and Romania) countries access to their labour markets, but later limiting access to their labour markets, but later limiting this access with the introduction of the this access with the introduction of the Habitual Habitual Residency ConditionResidency Condition in Ireland the UK. in Ireland the UK.


The Roma in IrelandThe Roma in Ireland

• As with other European countries, there are As with other European countries, there are no official statistics (in Ireland) relating to the no official statistics (in Ireland) relating to the Roma population (demography, Roma population (demography, accommodation, age, gender, and familial accommodation, age, gender, and familial

profiles).profiles). • It is estimated that there are approximately It is estimated that there are approximately

5,000 members of the Roma Community living 5,000 members of the Roma Community living in Ireland (Pavee Point, 2012).in Ireland (Pavee Point, 2012).

• The majority live in or near the major cities, The majority live in or near the major cities, the majority are from Romania and it is the majority are from Romania and it is understood that they came to Ireland in search understood that they came to Ireland in search of a better life or to join family already here.of a better life or to join family already here.


Healthcare Statistics of the Healthcare Statistics of the RomaRoma• Infant mortality is 1.4 times higher than the national Infant mortality is 1.4 times higher than the national

averageaverage• Life expectancy 10 years below the average Life expectancy 10 years below the average • Higher incidence of infectious disease, mainly hepatitis B Higher incidence of infectious disease, mainly hepatitis B

and C. and C. • Higher incidence of HIV Higher incidence of HIV • Deficient child vaccinationDeficient child vaccination• Inadequate follow-up on “Healthy child” programmes Inadequate follow-up on “Healthy child” programmes • Deficient eating habits and nutrition, especially in the case Deficient eating habits and nutrition, especially in the case

of children (also affecting dental health)of children (also affecting dental health)• Adult diets are characterised by excessive consumption of Adult diets are characterised by excessive consumption of

coffee and fats.coffee and fats.• Improper use of medicines: this tendency is directly Improper use of medicines: this tendency is directly

related to the Roma population’s use of the “scientific related to the Roma population’s use of the “scientific treatment model” and a desire to “solve the problem right treatment model” and a desire to “solve the problem right here and now.”here and now.”

• Higher incidence of accidents and involuntary injury such Higher incidence of accidents and involuntary injury such as: burns, falls, pedestrian traffic accidents, bone as: burns, falls, pedestrian traffic accidents, bone fractures, cuts, intoxications, etc.fractures, cuts, intoxications, etc.

• High-risk group for congenital malformations.High-risk group for congenital malformations.


The Roma in TallaghtThe Roma in Tallaght•2009 Interagency Meeting Chaired by: HSE Social 2009 Interagency Meeting Chaired by: HSE Social Inclusion Manager as a response to rising Child Inclusion Manager as a response to rising Child Protection and Welfare concerns within the HSEProtection and Welfare concerns within the HSE

Children and Families Agencies:Children and Families Agencies:•HSE Children & Families, National Education HSE Children & Families, National Education

Welfare Board (NEWB), ISPCC, Public Health Welfare Board (NEWB), ISPCC, Public Health Nurse Service.Nurse Service.

Community Agencies:Community Agencies:•Dodder Valley Partnership, Probation and Welfare Dodder Valley Partnership, Probation and Welfare

Service, Community Work and Primary Care Social Service, Community Work and Primary Care Social Work and Access Ireland. Work and Access Ireland.


The Roma in TallaghtThe Roma in Tallaght• Pool experiences and expertise to generate focussed Pool experiences and expertise to generate focussed approach to engaging the Roma communityapproach to engaging the Roma community

•Utilising the knowledge and expertise of Roma Utilising the knowledge and expertise of Roma cultural mediators to assist in developing this cultural mediators to assist in developing this approach.approach.

•Two-pronged multi-agency approach:Two-pronged multi-agency approach:

1.1. Case Management Approach (Child Welfare)Case Management Approach (Child Welfare)

2.2. Community Development Approach (Social Community Development Approach (Social Determinants of Health)Determinants of Health)


Roma Families Working Roma Families Working GroupGroup

•Sub-group of original Interagency groupSub-group of original Interagency group

•HSE Community Work, Primary Healthcare HSE Community Work, Primary Healthcare Social Work, Dodder Valley & Roma Cultural Social Work, Dodder Valley & Roma Cultural Mediators Access IrelandMediators Access Ireland

•Established Relationships with Roma in Established Relationships with Roma in SpringfieldSpringfield

•Aim: Conduct Participative Needs Analysis of Aim: Conduct Participative Needs Analysis of the Roma Community in Springfieldthe Roma Community in Springfield


Roma Families Working Roma Families Working GroupGroup

•2nd November 2009 12nd November 2009 1stst meeting with 5 Roma meeting with 5 Roma families living in the Springfield area (Approx. families living in the Springfield area (Approx. 40 Participants)40 Participants)

•Supported by Cultural mediators, Gabi, Rodica Supported by Cultural mediators, Gabi, Rodica & Lydia members of the Roma Community& Lydia members of the Roma Community

•Aim: Develop a clear picture of the issues that Aim: Develop a clear picture of the issues that most affected Roma families in Tallaghtmost affected Roma families in Tallaght


Recurring ThemesRecurring Themes• Health & Health CareHealth & Health Care: (Access to medical cards and GP : (Access to medical cards and GP visit cards are inexplicably linked with social welfare visit cards are inexplicably linked with social welfare entitlement)entitlement)

– No access to a Medical Card and therefore no access to a GP. No access to a Medical Card and therefore no access to a GP. – Participants reported regular attendance at Tallaght Hospital Participants reported regular attendance at Tallaght Hospital

for themselves and their children.for themselves and their children.– Participants reported on occasion using another person’s Participants reported on occasion using another person’s

medical card to attend A & E.medical card to attend A & E.– Participants reported not being able to pay €100 A & E charge Participants reported not being able to pay €100 A & E charge

and therefore not returning for outpatient follow-up and therefore not returning for outpatient follow-up appointments.appointments.

• Social/Community WelfareSocial/Community Welfare: : – Interpretations of Interpretations of HRCHRC between the departments of Social between the departments of Social

Protection and the HSE vary Protection and the HSE vary – Difficulties in accessing payments including Child Benefit. Difficulties in accessing payments including Child Benefit. – Pre & Post 2007 groupsPre & Post 2007 groups


Recurring ThemesRecurring Themes•Housing:Housing: •No entitlement to apply for rent allowance No entitlement to apply for rent allowance

– No Access the Local Authority Housing No Access the Local Authority Housing – Due to the HRC and other difficulties in engaging with Due to the HRC and other difficulties in engaging with

Social WelfareSocial Welfare

•Education:Education: – General lack of education among this group hampered General lack of education among this group hampered

their engagement with most services due to difficulties their engagement with most services due to difficulties understanding correspondence and filling out HRC forms.understanding correspondence and filling out HRC forms.

– The paucity of English language assistants in schools is The paucity of English language assistants in schools is hampering their progress in the school systemhampering their progress in the school system


ResponsesResponses• Invited Agencies to come and speak to the Invited Agencies to come and speak to the

families about their issuesfamilies about their issues

•Cross care/ Pavee Point/Citizens Information Cross care/ Pavee Point/Citizens Information Centre/Housing Advice Unit/ Immigrant Centre/Housing Advice Unit/ Immigrant Council of Ireland & CairdeCouncil of Ireland & Cairde

•Agencies who work on the ground on a daily Agencies who work on the ground on a daily basis with the issues affecting the Romabasis with the issues affecting the Roma


Policies Impact on Service Policies Impact on Service ProvisionProvision

•HRC: Social Welfare/ Community Welfare/ HRC: Social Welfare/ Community Welfare/ Housing/ Medical Cards & Access to FAS & Housing/ Medical Cards & Access to FAS & YouthreachYouthreach

– “The Habitual Residence Condition was intended to ensure that only individuals who had been living in Ireland for a certain period of time could qualify for social welfare payments. The legislation states that a person is not habitually resident until he or she has been present in Ireland or the Common Travel Area for a continuous period of two years” (FLAC, 2012).

•European Accession restrictions for European Accession restrictions for Romanians & Bulgarians 2007Romanians & Bulgarians 2007

– Work Permits onlyWork Permits only

• Irish Integration StrategyIrish Integration Strategy

•Economic RecessionEconomic Recession


Focussing on SolutionsFocussing on Solutions

• Engaging Safetynet Mobile Health Unit Engaging Safetynet Mobile Health Unit • Acknowledging lack of accessible Primary Care Acknowledging lack of accessible Primary Care

services for Roma due to impact of Habitual services for Roma due to impact of Habitual Residence ConditionsResidence Conditions

• Frequent/ Regular attendance in Accident and Frequent/ Regular attendance in Accident and Emergency in Tallaght Hospital (Paediatric Emergency in Tallaght Hospital (Paediatric A&E)A&E)

• Rise in uptake of Safetynet Primary Care Rise in uptake of Safetynet Primary Care Services by Roma women and children in Services by Roma women and children in Capuchin Centre in DublinCapuchin Centre in Dublin

• Recognising the need for culturally competent Recognising the need for culturally competent primary care and support services for Romaprimary care and support services for Roma


Safetynet Roma GP Service Safetynet Roma GP Service • Pilot Phase September to December Pilot Phase September to December

2012 accommodated by Tallaght 2012 accommodated by Tallaght HospitalHospital

• Welcomed 91 members of Roma Welcomed 91 members of Roma Community for GP Services and support Community for GP Services and support and advice over a 12 week period.and advice over a 12 week period.

• 58 Adult contacts: 20 Male & 38 Female.58 Adult contacts: 20 Male & 38 Female.

• 33 Child Contacts: 73% Children under 33 Child Contacts: 73% Children under five years of age & 25% children five years of age & 25% children between 5 and 18 years of age.between 5 and 18 years of age.


BenefitsBenefits• Roma and their children without medical Roma and their children without medical

cards for the first time now have access to a cards for the first time now have access to a GP and Interpreter serviceGP and Interpreter service

• Roma have access to other supports that help Roma have access to other supports that help to maintain their health and general well-to maintain their health and general well-being provided by the support volunteersbeing provided by the support volunteers

• Developed a system for the administration of Developed a system for the administration of childhood vaccination with a GP in Aylesbury childhood vaccination with a GP in Aylesbury Medical Centre in Tallaght.Medical Centre in Tallaght.

• Established links with local pharmacist Mark Established links with local pharmacist Mark Ellis Pharmacy in Springfield for Ellis Pharmacy in Springfield for prescriptions.prescriptions.


The FutureThe Future•Safetynet Roma GP Bus is the first step in Safetynet Roma GP Bus is the first step in

responding to the health needs of the Roma responding to the health needs of the Roma Community Community

• Inter-Agency Approach which combines Inter-Agency Approach which combines community development approaches, primary community development approaches, primary healthcare approaches and rights based healthcare approaches and rights based approaches, where members of the Roma approaches, where members of the Roma Community are involved in discussions about Community are involved in discussions about their own health needs, has been most their own health needs, has been most successful in helping to address some of the successful in helping to address some of the social and health needs of this community.social and health needs of this community.


The FutureThe Future• Acknowledge the impact of systemic policy Acknowledge the impact of systemic policy

restrictions (Habitual Residence Conditions)restrictions (Habitual Residence Conditions)

• TRIP alongside Safetynet and Pavee Point TRIP alongside Safetynet and Pavee Point building sustainable relationships with the building sustainable relationships with the Roma Community build capacity to engage Roma Community build capacity to engage appropriately with health servicesappropriately with health services

• To work alongside Safetynet to address To work alongside Safetynet to address healthcare issues within the Roma Community healthcare issues within the Roma Community e.g. Ante-Natal Care & Women’s Health Issues.e.g. Ante-Natal Care & Women’s Health Issues.


• There is a growing body of evidence about There is a growing body of evidence about what makes people healthy. In particular, what makes people healthy. In particular, there is mounting evidence that the there is mounting evidence that the contribution of medicine and health care in contribution of medicine and health care in isolation are quite limited and there are isolation are quite limited and there are strong and growing indications that other strong and growing indications that other interrelated factors such as living and interrelated factors such as living and working conditions are crucially important working conditions are crucially important for a healthy population (Lolande Report, for a healthy population (Lolande Report, 1974)1974)


Thank YouThank You

Author: Deirdre Jacob Primary Healthcare Social Worker 2013 Tallaght Roma Integration Project...

Documents

Transcript of Author: Deirdre Jacob Primary Healthcare Social Worker 2013 Tallaght Roma Integration Project...