i need connection' city life research paper 2010

‘I NEED CONNECTION’

CITY LIFE HEALTH & WELLBEING

NEEDS ANALYSIS AND SERVICE PLAN

Authors: Crystal McDonald & Janet Reid

Chisholm TAFE Dec 2010

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Executive Summary

Research background

This project was undertaken by two Community Development students of Chisholm TAFE Frankston,

under the auspice of the City Life, a Christian charity that works with the homeless and

disadvantaged who describe themselves as having a mandate to ‘support the dislocated people of

Frankston through empowerment, connection and mercy’. The research supported current projects

by the Frankston Homeless Support Service (FHSS) and the Monash Health and Wellbeing

partnership, both committed to finding solutions to the problems faced by the homeless and

disadvantaged people of Frankston. These projects followed research by the Royal District Nursing

service (RDNS) whom identified through the research paper “I Require Medical Assistance” (Everard,

2008) that a Homeless persons program (HPP) was needed in Frankston.

This research followed observations by the above bodies that many of the people who attended City

Life were of poor health or hygiene and the hypothesis that they may have needed better access to

Health Care.

Objectives

The objectives of this report were:

1. To discover what Health and Wellbeing meant to City Lifes clients and identify what they

needed to acheive this.

2. To discuss the barriers to Health and Wellbeing that clients face.

3. To discover what service could help support clients Health and Wellbeing.

Methodology

Research was undertaken using the method of Participatory Action Research (PAR), a process of

social research that looks to improve a particular situation by working closely with all who have a

stake in the outcome, particularly the Critical Reference Group (CRG) who contribute to defining the

issue and identifying possible solutions through discussion of their experiences. This method was

used because it is particularly suited to projects wanting to understand the experiences of the

participants.

The research activities were conducted over a period of 9 weeks (total project taking 4 months

including preparation and reporting stages) with 35 participants during meal times at City Life’s Cafe.

Survey’s were completed with participants to identify the demographic of the people who access

City Life’s services, and indicate any service needs they may have. Secondly, a focus group was run

over four weeks with 2-5 participants where the above objectives were posed as questions to

participants who discussed their experiences and thoughts with the group. Lastly, a forum was held

with 10 self-selected participants to again discuss the above objectives and crosscheck information

obtained through previous stages.

Participants

The CRG in this research were the clients of City Life which consist of a varied demographic, most of

which are single parents, middle aged and elderly people, and people on disability pensions. A total

of 50 people participated in the research activities.

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Frankston

City Life is located in the heart of the city of Frankston which has been identified as the 8th most

disadvantaged Local Government area in Melbourne and was recorded as having 775 homeless

people during the 2006 Census (ABS, 2006).

Results

The findings of this research are summarised below:

Of the CRG 100% of clients reported having either a physical and/or mental illness.

94% reported their main source of income as a government pension

57% fell into the status of insecure housing defined by the federal governments definition of

homeless

74% came to City Life between 1-3 times a week

80% reported having a regular Doctor

Wellbeing means having support spiritually, mentally and physically

The CRG require health services to be more Holistic.

66% of participants expressed that they would access dental services

60% wanted a counselling service at City Life

Peer support is important during difficult times

Social connection greatly improves the Health and Wellbeing of CRG.

Family relationships have a great affect on the CRG’s Wellbeing.

CRG desire greater social connection but don’t know how, or lack the confidence to connect.

City Life is the main provider for social opportunities for the CRG.

Doctors appointment s were rushed and did not always treat the clients varied needs

Although research was born out of observations around the Health of City Life’s clients, research

indicated that participants had good access to health care and in most cases regularly visited a

doctor. The emphasis was in fact not on Health but Wellbeing and on the importance of healthy

relationships and social connections to improve health and wellbeing. Participants expressed that

they needed support in connecting better to their families and the community.

Recommendations

The information obtained throughout research suggests that City Life participants need better social

connections - and support to make these connections- to improve their Health and Wellbeing. Due

to the existing connection City Life has with homeless and disadvantaged demographic, and their

geographical location, it is recommended that City Life provide the following:

1. Support groups- to foster peer support and provide an environment to share information

and experiences

2. Social Groups- to improve confidence and social skills and offer an alternative lifestyle

3. Workshops- To educate participants on topics of need

4. Outreach services- To increase access to services and provide appropriate care.

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Acknowledgments

We would like to acknowledge the support and guidance of the following people and organisations:

City Life Health & Wellbeing Partnership. This partnership exemplifies true intragrated practice and

the commitment and passion to help those most vulnerable in our city is inspiring.

We would also especially like to mention Kate Sommerville from Frankston City Council, who has helped guide and educate us in forming the survey and approach to health and wellbeing. Mark & Sue Whitby, founders of City Life, who have opened their doors to us as researchers and allowed us to develop what we felt was a hunch. Mark and Sue are community development personified and make an incredible difference in many people’s lives. Finally, Chisholm Institute for their teaching and support as we endeavour to develop ourselves as workers in the field.

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Glossary

Acronyms used in this report

CCC Community Care Centre

CD Community Development

CRG Critical Reference Group

CUPSE Community Understanding of Social Exclusion LGA Local Government Area

PAR Participatory Action Research

RDNS Royal District Nursing Service

RDHS HPP Royal District (Nursing Service Homeless Persons Program

SMR Southern Metropolitan Region

Defining Key Concepts

Community Development (CD)

The process of helping a community (or parts of a community) strengthen itself and develop towards

its full potential. Employing techniques and principles such as empowerment, participation &

negotiation.

Royal District Nursing Service (RDNS)

A community nursing service that outreaches to clients in their lived environment. The RDNS

Homeless Persons Program (RDNDHPP) is a specialist unit of this service that seeks to empower

those reciving their care whilst also supporting mainstream healthcare providers to become more

accessible to Homeless people. (2008, p36)

Disadvantaged

People identified as being socially or economically less advantaged than the majority of others in

their community.

Marginalised

People identified as existing on the margins (Outskirts) of mainstream society possibly because they

are possibly disadvantaged in some way or do not follow social norms.

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Saturation

The point during research at which you feel you are hearing the same responses or themes often

and therefore can assume this is the most accurate representation of participant’s experiences and

hence may choose to conclude research.

Holistic Care

Acknowledging that there are many elements that influence a persons health and wellbeing and

hence providing care that supports a persons mental, physical and spiritual needs.

Social Inclusion

Social Inclusion is the answer to a problem: Social Exclusion. Exclusion occurs when an individual or

group is “not part of the networks that support most people in ordinary life” (2008).

Homelessness

The Australian Bureau of Statistics define Homelessness in three categories which are summarized

below:

Primary Homeless: People without conventional accommodation i.e.: sleeping on streets (also

known as rough sleeping) or squatting etc.

Secondary Homeless: People who move from one temporary accommodation to another. This

can encompass those staying with friends or family or those in emergency accommodation etc.

Tertiary Homeless: People who live in a boarding or rooming house where they do not have their

own facilities (kitchen or bathroom) and do not have the security of tenure provided by a lease.

All three refer to housing that is insecure and so this report refers to any of these three when using

the term ‘Homeless’.

Need/s

It is the purpose of this research to ascertain participant’s self-defined health and wellbeing needs

and to then identify the services that would best respond to those needs.

The idea of need looks at the kinds of problems that people experience; the requirements for a

particular kind of response; and the relationship between the problems and the responses available

(Everard, 2008 p.8)

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Table of Contents

Executive Summary ................................................................................................................................. 1

Acknowledgments ................................................................................................................................... 3

Glossary ................................................................................................................................................... 4

Table of Contents .................................................................................................................................... 6

Introduction ............................................................................................................................................ 8

City Life .................................................................................................................................................... 8

Project Background and History ............................................................................................................. 8

Critical Reference Group ......................................................................................................................... 9

CRG- City Life clients ....................................................................................................................... 9

Frankston City ..................................................................................................................................... 9

Previous Health & Being Research ........................................................................................................ 10

Methodology ......................................................................................................................................... 12

Participatory Action Research (PAR) ................................................................................................. 12

Participation .......................................................................................................................................... 12

Timeline................................................................................................................................................. 13

Stage One: Research Preparation & Collaboration ..................................................................... 13

Preliminary Survey ........................................................................................................................ 13

Stage Two: Research Development (Surveys) and Reflection ..................................................... 13

Stage Three: Research Development (Focus Groups) and Reflection ....................................... 14

Stage Four: Research Development (Forum) and Reflection ....................................................... 15

Stage Five: Analysis and Reporting .............................................................................................. 15

Limitations ............................................................................................................................................ 15

Findings ................................................................................................................................................. 16

General .............................................................................................................................................. 16

Health ................................................................................................................................................ 17

Wellbeing .......................................................................................................................................... 18

Barriers to Health & Wellbeing ......................................................................................................... 18

Solutions for Change ......................................................................................................................... 19

Analysis of Findings ............................................................................................................................... 20

Recommendations ................................................................................................................................ 21

1. Support groups.......................................................................................................................... 21

2. Social groups ............................................................................................................................. 21

3. Workshops ................................................................................................................................ 21

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4. Services ..................................................................................................................................... 21

Conclusion ............................................................................................................................................. 22

Bibliography .......................................................................................................................................... 23

References ............................................................................................................................................ 24

Appendicies

One: Survey Results ................................................................................................................. Attached

Two: Focus Group Summaries ................................................................................................. Attached

Three: Evaluation Form ........................................................................................................... Attached

Four: Outdoor Inc .................................................................................................................... Attached

Five: Consent Form .................................................................................................................. Attached

Six: Focus Group Invite ............................................................................................................ Attached

Seven: Blank Survey................................................................................................................. Attached

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Introduction

The World Health Organisation (WHO) defines Health as:

‘...a state of complete physical, mental and social well-being, and not merely the absence of disease

or infirmity (World Health Organization, 1948).

What can be gained from this definition is the recognition of the holistic nature of health, which is certainly a positive thing. But if Health is the state of complete achievement of these elements as the World Health Organisation states, most people are a long way off. Unfortunately those living in poverty or with a mental or physical illness are even further removed from this definition of Health. Many ask the question: Which comes first, poverty or sickness? Do people get sick because of poverty or does illness cause them to live in poverty? It is a complex question and regardless of which came first, the fact remains that poverty and illness go hand in hand. City Life, a charity that works with homeless and the disadvantaged, has long considered this dilema and has requested research be done into the Health and Wellbeing of their clientele. This research project has been a partnership between Chisholm Institute under the auspice of the City Life Health and Wellbeing partnership. This report is intended to support the development of concurrent projects of the partnership by providing current information on the Health and Wellbeing needs of City Life’s clients and to explore what services would assist them.

City Life

City Life is a registered Christian charity located in the heart of Frankston which provides support for

the disadvantaged and marginalised. They are not government funded and relies on the income

from their Op Shop, grants and donations to provide their many services. One of the main areas of

support is providing free hot meals four times a week to around 100 people each meal in their Cafe.

City Life also offers support with referral through their Community Care workers as well as

emergency relief, mainly through food parcels. Free internet access and the opportunity for training

is also provided. City Life have a self imposed ‘mandate to support the dislocated people of

Frankston through empowerment, connection and mercy’ and their ethos is to ‘Help People Dream

Again’ (Whitby, 2010)

Project Background and History

A number of agencies and individuals reported concurring observations on the health needs of both

the homeless and those on very low income in Frankston. The first of these agencies to contact City

Life was the Royal District Nursing Service (RDNS) whom identified through research paper ‘I Require

Medical Assistance’ (Everard, 2008) that a Homeless Persons Program was needed in Frankston. At

around the same time, The Frankston Homeless Support Service (FHSS) were planning to provide a

shower for the homeless. These groups both approached City Life as a possible hub for their projects

and an obvious solution was to create a space both could use. The Community Care Centre (CCC)

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was created using a shop front at the City Life Centre consisting of a shower, two consulting rooms

and a reception area.

As the discussion developed between City Life, FHSS & the RDNS regarding a joint project, a number

of volunteers who are nurses and work for Monash University observed a need for health care

among the City Life clients. They, like other organisations, noticed clients had issues of basic care

such as hygiene, medication maintanance, as well as diabetes. These volunteers also approached

the leadership of City Life and Monash University with the idea of linking the resources of Monash, -

specifically their Medicine & Science Faculty- to the CCC to contribute to the vision of supporting the

health and wellbeing of City Life clients.

As all these groups came together to form the City Life Health & Wellbeing Partnership, they

developed two main questions to identify the specific needs of the clients and tailor appropriate

referral and services to these needs:

What do the clients at City Life identify as a need to improve their health and

wellbeing?

What services at City Life could help support clients health and wellbeing?

These question form the basis of this report.

Critical Reference Group

CRG- City Life clients

The Critical reference group for this research consisted entirely of City Life clientele, most of which

reside in Frankston City. City Life’s clientele cover a wide demographic including single parents,

families, middle aged men, elderly women, people on disability pensions. According to our survey

results, almost all of them are on Centrelink support and almost all of them would be on the poverty

line. Note: See on ‘Participation’ for information on the selection of the CRG.

Frankston City

The City of Frankston is made up of the suburbs of Carrum Downs, Frankston, Frankston North,

Frankston South, Langwarrin, Langwarrin South, Sandhurst, Seaford and Skye. (Figure 1, 2) It

stretches across 131 square kilometres, and nestles beside Port Phillip Bay, where the suburbs

interface with the Mornington Peninsula. At the time of the 2006 census, Frankston City was home

to 117,801 people and the population is estimated to be growing at 1.69% per year. (ABS 2006,

2007)

Figure 2: Frankston in Greater Melbourne

Figure 1: City Of Frankston Suburbs

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Frankston City has been identified as being the eighth most disadvantaged Local Government Area

(LGA) in Melbourne, and Second highest in the Southern Metropolitan Region (SMR). By

comparison, the City of Greater Dandenong has the highest level of relative social disadvantage of all

Melbourne LGAs, the City of Casey is ranked 11th, while Mornington Peninsula Shire is ranked 15th

and the City of Kingston 17th. (Commonwealth of Australia, 2006)

Frankston City also includes some of the most disadvantaged individual suburbs in Victoria.

‘Frankston has the dubious distinction of being one of Melbourne's three most disadvantaged

suburbs while Frankston North, along with twenty-two other suburbs, experiences the highest level

of relative social disadvantage in all of Victoria.’ (Everard, 2008, p. 17)

Analysis of household income levels in Frankston City in 2006 compared to the Melbourne Statistical

Division shows that there was a smaller proportion of high income households (those earning $1,700

per week or more) but a larger proportion of low income households (those earning less than $500

per week). (Frankston City Council, 2010)

As the data indicates, Frankston has a high level of relative social disadvantage which impacts on the

community and the services available within that community.

Previous Health & Wellbeing Research

As we began the process of exploring the Health and Well Being of the clients who attend City Life,

we realised that we were not alone in wanting answers. Finding out what the barriers to achieving

health and wellbeing were and what services could help them overcome those barriers reflected a

question numerous professionals were asking for both their individual regions as well as on a

national and international level.

Measuring the basic needs of an individual to determine if they are disadvantaged does not

necessarily reflect the general wellbeing of a person. As previously stated, the World Health

Organisation defines health as ‘a state of complete physical, mental and social wellbeing and not

merely the absence of disease or infirmity’ (World Health Organization, 1948). This suggests that to

indicate whether a person has health and wellbeing, other factors outside of their physical health

need to be considered.

Peter Saunders former Director of the Social Policy Research Centre (SPRC) at the University of New

South Wales, has spent years researching poverty, income distribution, household needs and living

standards among the most vulnerable of our society. His paper ‘Experiencing Poverty: The Voices of

Low-Income Australians: Towards New Indicators of Disadvantage’(2006) clearly defines new

parameters for assessing basic wellbeing for people. Using a questionnaire tool titled ‘Community

Understanding of Poverty and Social Exclusion’ (CUPSE), Saunders identifies a process to determine

essentials of a person’s life and if they feel they are deprived of those essentials. (see Figure 3)

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In the CUPSE survey people were given a list of items and asked if each of them was essential, this

being defined as ‘things that no-one in Australia should have to go without today’ (Saunders, 2008).

The results were then classified into the following categories:

Accommodation and housing

Location and transport

Health and health care

Social and community participation

Care and support

Employment, education and skills

Close to half the clients surveyed that were currently receiving welfare were deprived of many of the

aspects of the essentials established, adversely affecting their health and wellbeing. CUPSE is

following an international trend to classify disadvantage with more than just financial indicators.

The UK and European Union have each developed similar approaches and indicators to ‘improve the

circumstances of disadvantaged groups (Scutella, Wilkins, & Horn, 2009, p. 3).’ Emphasising it is

important to develop services that support and resource all areas of an individual’s life in order for

them to pathway to health.

When assessing health and wellbeing and services needed, especially for those on a low income or

with issues of homelessness, it is important to note that in Australia over 75% of homeless people

has a mental illness. It is well known that the state of being homeless can exasperate mental illness

and the fact that a person has a mental illness makes them more suseptible to being homeless.

(Mental Health Council of Australia, 2009 In Home Truths, a publication from the Mental Health

Council of Australia (2009, p11), it states ‘It is important that definitions of homelessness

acknowledge that many homeless people experience poverty and social exlusion, face the likelihood

of multiple disadvantage, experience a lack of belonging an connection to community’ reiterating

that poverty, illness and social exlusion are usually hand in hand.

Based on statistical information and research from Frankston Narelle Evans’ report, ‘I Require

Medical Assistance’ (2008) also makes a link between support for the homeless through social

inclusion and appropriate health care initiatives. Evans states ‘The process of social exclusion all too

often operates to keep homeless people from receiving healthcare and other services, acting as a

positive feedback loop, and locking the individual into their socially excluded existence (2008, p. 10).’

Figure 3 (Saunders, 2006)

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Methodology

This research was conducted following the methodology of Participatory Action Research (PAR), and incorporates elements of Action Research. This method was chosen because of its client-centred focus which was most appropriate to answer the research questions and supports a strengh based approach that considers ‘participant’s as experts in their own situations’ (McCashen, 2005, p. 5)

Participatory Action Research (PAR)

PAR is a process of social research that looks to improve a particular situation by working closely

with all who have a stake in the outcome, particularly the CRG who contribute to defining the issue

and identifying possible solutions through discussion of their experiences. It is the participants who

control the research.

The process of PAR begins with small cycles of planning, acting, observing and reflecting

(Wadsworth, 1991 p79) and continues until the research question has been satisfied. However, it is

common for PAR to be perpetual, constantly evaluating and improving practices.

Through reflection on a current situation, an issue is identified ‘as a hunch’ by Researchers who

begin looking at why it exists and how the situation could be better- it is here that they identify the

research question/s.

Researchers then begin to find out what others think about the issue by identifying 4 conceptual

parties or Stakeholders:

Conceptual Parties Project specific Stakeholders

1) Who or what is to be “researched”? Current City Life ‘clients’ and their Health & Wellbeing needs

2) Who is to be the researcher/s? Students/Employees of City Life, Monash Partnership

3) Who is to benefit? (Referred to as the Critical Reference Group (CRG))

City Life clients

4) Who needs to know? City Life, Monash University, RDNS, Funding bodies

By working collaboratively with other parties involved in the issue, PAR attempts to minimise

‘resistance to change and to also understand where resistance may be rooted in conflicting views

and competing kinds of practice(Wadsworth, 1991 p79.)’. Through this collaboration, researchers

identify a common ground around the interests of the CRG.

Active participation (by the group who’s “issue” is being addressed) is the key to this research and

the input of participants constantly reshapes research direction and outcomes.

Participation

PAR starts with a small group of collaborators, but widens the community of participants so that the

research gradually includes more and more of those affected by the practices (or issue) in question

(Wadsworth, 1991 p79.).

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This project has attempted to involved participants incrementally, starting with one group and

widening the scope of participation through various research activities.

Researchers for this project sourced participants by making announcements during meal service at

City Life’s café –at each stage of implementation- requesting to speak with interested people. Their

participation was voluntary and could be withdrawn at any time. See ‘Timeline’ below for more

information on participation at each stage.

Yoland Wadsworth (1991, pg. 81) offers this explanation of PAR, which highlights the focus on active

participation,

‘In order to find out what people think and value, what things mean, to them, we need to

engage fully in a process of immersion of their /our worlds. We observe, read, listen,

interact, participate, question, and listen again, exploring meanings of feedback until we

reach effective understanding. We can ask very open questions at first, gradually refining

them as our hunches get challenged or confirmed.’

Timeline

This research was conducted over a period of 4 months and was implemented over five stages:

Stage One: Research Preparation & Collaboration

Approximately 3 weeks

Stage one of this project focused on planning and collaboration. Researchers from City Life met with

Monash partnership and discussed the aims of the Community Care Centre and the areas in which

further research would benefit the project. Previous observations surrounding clients Health and

Wellbeing were discussed and ‘hunches’ about the cause of the identified issues were explored,

which led to the development of the research question.

To gather further insight into the current situation, a survey was produced that would identify the

demographic of the people who access City Life’s services, and indicate any needs they may have for

further services.

Preliminary Survey

These surveys were trialled in the Café with interested participants, and then small adjustments

were made to improve the relevance and workability of questions.

Stage Two: Research Development (Surveys) and Reflection

Approximately 4 weeks

The final survey was also implemented in the Café during meal times with interested participants to

gain information in the following areas:

Age, Gender & Suburb

Main source of income o If this income was sufficient o In what areas could they benefit from assistance

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Employment status

Accommodation situation

Family situation

How often they attend City Life

What City Life services do they use

Health o Frequency of Doctor visits o If they had a regular doctor o Last time they visited Emergency

Where they go to for help/support

Would they use the Shower at City Life

What services they would like City Life to offer Overall, 35 participants completed the surveys with the researcher over several meal times in the

Café. Although a quantitative method, the surveys became a catalyst for conversation around

Health and Wellbeing where qualitative information was also recorded. These ‘interviews’ lasted

between 15-40minutes each.

Surveys were then collated and a Survey Results document (Appendix One) was produced. This data,

along with Qualitative information, was discussed with the Monash Partnership and the appropriate

questions for stage three were designed.

Stage Three: Research Development (Focus Groups) and Reflection

Approx 4 weeks

An announcement was made during meal service and individuals were approached similarly to Stage

Two. After a brief introduction, interested clients were invited to join the Focus group. 5 clients were

listed, however only four arrived for session 1 and only two for sessions 2,3 & 4.

These groups were conducted over 4 weeks and the following questions were used to provoke

discussion about the participant’s experiences:

Phase One: What is Health & Wellbeing?

Focus: Establish the client’s perception of Health & Wellbeing, and what they identify as

needs. Additional to obtaining specific health information of individuals it was important to

allow participants to define what Health & Wellbeing was for them.

Phase Two: What are the Barriers to achieving Health & Wellbeing?

Focus: Discuss what stops clients from fulfilling their identified needs,

Phase Three: What services could be provided (or improved) to overcome these barriers?

Focus: List ideas for new services or service improvements that would help clients achieve

their identified needs.

Evaluation forms (Appendix Three) were also completed during phase three and the participants

were offered a Certificate of Appreciation for their time and effort.

Notes were taken at each of the Focus Groups and were checked by participants for their accuracy.

These session summaries are included in this report (Appendix Two).

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Stage Four: Research Development (Forum) and Reflection

Approx 1 week

Clients of City Life were asked to stay behind after their meal to participate in a forum on Health &

Wellbeing. Approximately 10 people of varying age and gender participated.

The purpose of this one-off session was to extend the research questions to a wider audience by

providing an alternative platform in which clients might feel more comfortable participating. Being

the third research activity of the project, this stage provided the opportunity for researchers to

‘crosscheck’ the information previously provided by clients to find areas of similarity or difference.

After reflecting on the outcome of stage two, questions were simplified and presented to the Forum

as follows:

1. What is Health & Wellbeing? 2. What stops us? (from achieving it) 3. What services could help? (to achieve this)

For the purpose of keeping to time constraints, examples from previous stages were offered with

each question to get conversation going. All responses were brainstormed on the whiteboard.

The information gained at every stage was recorded and reviewed before the commencement of the

following stage, with alterations made where necessary. In this way, researchers ensured the

research was driven by the participant’s experiences and not by the preconceived ideas of the

facilitators.

Stage Five: Analysis and Reporting

Approx 4 weeks

At the completion of each Research activity, findings were reviewed and discussed by project

workers to ascertain the level of saturation achieved and to set the goals for further activities. These

incremental findings were also provided to committee members at committee meetings where

possible.

All information obtained over the course of this research was collated and analysed over a period of

two weeks and a final findings summary was provided to all stakeholders.

Limitations

This research project was undertaken by two project workers over a four month time frame. These

workers were also employed and volunteering at City Life respectively. It is possible that this

involvement with City Life created some personal bias for the workers.

This also effected the time available to the workers to undertake research activities within working

hours. Further research would benefit from a full time project worker who was employed solely for

the purpose of undertaking the research thereby allowing them ample time to dedicate to research

activities and more opportunity to carry them out with a wider clientele base.

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Additionally, this project was undertaken to support current projects by two existing committees,

surrounding the Health & Wellbeing of City Life’s clientele and the homeless people of Frankston

respectively. These two committees each consist of representatives from several organisations,

including City Life. For the research project to be a useful tool in the implementation of their

projects, the research had to satisfy the needs of their many stakeholders, thus creating some

limitation to the project workers’ freedom and the PAR process.

Random sampling was not a feature of this study. Participants in this research were invited to

participate and then they self selected into each activity. Due to the varied nature of client’s health

issues, a more private approach to gaining information may have been more beneficial.

Furthermore, it became increasingly difficult to gain interested participants for research activities

during the course of this project contributing to a relatively small sample size which limits the ability

of the results to be generalised to a larger community.

Literacy skills varied between participants but more often than not, participants were unable to

either read the survey or write their answers. This increased the time necessary to complete each

survey and this consequently affected the amount of surveys researchers were able to complete in

the allowed time frame which also contributed to a smaller sample size than hoped.

Finally, throughout the focus groups it became apparent that participants were not attending to

simply participate in research; they were attending for the value of being a group and connecting as

individuals. The research activities were for them, an exercise in social inclusion which gave them

great satisfaction. In reflection this aspect was not sufficiently taken into account by facilitators and

may have influenced the outcome.

Note: This observation was confirmed during the evaluation session when participants disclosed the

value of group participation for them and the process they went through personally to achieve this

level of connection with others.

Findings

Note: Please see Appendices One and Two for a full record of Findings

General Clients of City Life consist of a varied demographic. Those who participated in research were equally

represented by each gender and almost all of them had children. Income was mostly from

government pension and in most cases was not sufficient to meet their needs.

Average age of 46

68% lived in Frankston Council

86% of those with children did not live with them

43% were on a disability pension

94% reported their main source of income as a government pension

57% fell into the status of insecure housing defined by the federal governments definition of homeless

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When participants were asked if they were in a situation of stress or harm (where they needed some

support or going through a rough time) where would they go for help, the most common response

was they would not speak to anyone but try and deal with the crisis themselves. As a last resort they

would go to family followed by their Doctor. When discussing why they would not seek assistance

they gave the following responses:

“I don’t trust anyone”

“It’s a pride thing, you just don’t go to others for help, you sort it out yourself”

Although most felt their issues were private, it was observed and often directly stated that

participants came to City life for the social connection and peer support it provided more

than any other reason.

74% came to City Life between 1-3 times a week

89% came for the café

63% accessed emergency relief food parcels

Health

Of the CRG 100% of clients reported having either a physical and/or mental illness. The below chart

displays the health issues reported by the CRG:

80% reported having a regular Doctor

77% had visited a Doctor in the last 3 months

23% had been to the Hospital Emergency in the last 3 months

Though many clients regularly visit their medical professional, it was stated that visits were short and

not necessarily holistic in their approach especially when dealing special or varied needs.

The most significant health service request was dental care with 66% of participants expressed that

they would access dental services if provided at City Life.

Health Issues

Depression

Dental

Arthritis

Asthma

Blood pressure

Diabetes

Heart Disease

Other

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Other health services participants would like to access at City Life were:

60% wanted a counselling service

40% wanted nutritional support/education

31% wanted a podiatry service

31% wanted a physiotherapy service

Wellbeing

Participants were very open to discussing their experiences and needs and described health and

wellbeing as follows:

‘To have a healthy life, to be happy and well and be good to others’

‘To be able to ask for help, not to dwell on the past but look to the future’

‘Happy and be able to help other people. Hope for the future. Have a good life and then

contribute to others people’s good life.’

It was identified that positive family relationships was the most significant contributor to their

health and wellbeing. It was also stated that to experience wellbeing meant having support

spiritually, mentally and physically.

Participants stated the following places they seek support from:

City Life

Church

Frankston Information and Community Support

Medical Professionals

Life-partner

Centrelink

Barriers to Health & Wellbeing

In defining the barriers participants experienced, four key areas were identified:

Physical Health:

Finances- effects nutrition and food choices

Unhealthy Habits

Lack of Motivation

Exercise- inability to exercise due to mental and physical illness

Mental Health:

Stress

Injury

“Medication prescribed for one condition can cause issues in another area”

Motivation

Losing hope – due to lack of control

Family disconnection/breakdown

Inappropriate diagnosis/care

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Social Health:

Isolation- “thinking you’re the only one in that situation.”

Lack of knowledge about services

Inability to articulate

“When you’re paranoid from past experiences” General Barriers affecting all Health and Wellbeing:

Family disconnection

Shyness/”A phobia of asking for help”

Communication – “can’t explain what’s wrong with you”.

Negative/unhealthy communication

Lack of control over personal situations

Feeling your powerless to change situation

Complicated forms

Solutions for Change

Participants provided the following suggestions for the improvement or provision of services to

improve Health and Wellbeing:

Physical Health:

Education on healthy food on a budget

Doctor can only do so much, need specialist access

More bulk-billing doctors needed locally – can’t afford transport to existing doctors.

Happy with own (full fee) Doctor but need financial assistance to pay for it.

Need ongoing self care advice

Meals on wheels

Somebody to steer in right direction to get right services

Dietician- (participant has used before and found really helpful but ran out of money)

Having someone to exercise with, get you up. –Personal trainer/motivator

Having a dog to walk (companionship, responsibility)

Discussed walking group/ daunting in a group. Different ability levels

Mental Health:

Psychologist /Counsellors-It was stressed by participants that the worker need to be the right person for the job and needed to understand clients perspective and provide a safe, private, comfortable environment

Referral service to appropriate care

Education on alternative health options

Education about your condition/s

Drug education /discussion group.

Social Health:

More small groups

6- 8 people is comfortable

Mix of Sexes

Supply food Ideas for groups

Divorce/Separation support group

‘People with similar problems’

Walking

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Craft

Community Kitchens

Participants discussed the importance of peer support during difficult times and as a catalyst for

better social connection.

“You look for comfort, attention and understanding.”

“Group sessions to discuss personal hardships with other people with similar problems and

situations in a controlled environment.”

Analysis of Findings

Participant’s responses to the survey were limited to the questions asked, however the qualitative

information obtained from this process proved consistence with the themes that arose during later

stages:

Social connection greatly improves the Health and Wellbeing of CRG.

Family relationships have a great affect on the CRG’s Wellbeing.

CRG desire greater social connection but don’t know how, or lack the confidence to connect.

City Life is the main provider for social opportunities for the CRG.

‘Mental and Dental’ are the greatest health care needs of CRG.

The CRG require health services to be more Holistic.

Due to this research being born out of an observation that the clients of City Life were in poor

health, there was expectation that research would uncover gaps in health care. It is important to

note that this assumption was not validated due to clients reporting good health care access. This

instead suggests that the issue is the standard of the health care being provided.

A common response from participants is that appointments were ‘rushed’ and that the doctors don’t

ask the appropriate questions or only treat them for the obvious issue and don’t look at the larger

picture such as the cause of the issues. This identifies a need for Holistic care.

There was a strong emphasis on the importance of healthy relationships and social connections to

improve health and wellbeing. Participants expressed that they need support in developing skills

and pathways to help them connect better to their families and the community.

The enjoyment and benefit participants reported from participating in focus groups, was a good

indication that groups improve people’s social connection skills.

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Recommendations

The suggestions offered by participants, and the information obtained throughout this research have

been combined to make the following recommendations:

1. Support groups

Run by/at City Life- To foster peer-support and provide an environment to share information and experiences.

Parents with part time or no access to their children

Parenting groups

Divorced/separated people

Living with a mental illness

2. Social groups

Run by/at City Life in partnership with other community groups- To improve confidence and social skills and offer an alternative lifestyle

Craft

Day outings

Outdoor recreation

Walking

Arts Programs

3. Workshops Run at City Life in partnership with other service providers.- To educate participants on particular topics of need

What to do when things get tough: Housing options and process

Building healthier/stronger relationships

Being assertive and in control

Increasing motivation and confidence

Healthy food on a budget

4. Services

Run as an outreach service by Monash University and other service providers from the CCC.- To increase access to services and provide appropriate care

Financial counsellor

RDNS Nurse

Community Dentist

Mental Health worker

Referrals (Including connection to other services above) Due to the frequency of CRG’s attendance at City Life, the Community Care Centre would be an ideal

location for the provision of services. City Life also have ample space within premises to house

Workshops and support groups. Depending on the level of expertise required, these groups could be

run by volunteers or by linking in with other service providers to share facilitation.

Social groups should ideally be provided firstly from City Life, and then branch out further as

participants confidence improves. Utilising other service providers for outings such as Outdoor Inc.

(Appendix Four) would provide a specialist service to participants whilst not requiring too many

resources from City Life.

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Conclusion

If Health is the state of ‘complete physical, mental and social well-being...’ (WHO), we must pay

equal consideration to our mental state and level of wellbeing as we do to our physical. This

research has indicated that not only is a holistic appraoch to health crucial, but that the other

elements of this holistic approach (mental health and wellbeing) rely heavily on the individuals level

of social connection. It is therefore imperitive that social inclusion is a key consideration to all health

providers, and that the mental and social aspects of a persons situation are acknowledged with the

physical.

Although this report acknowledges the links between poverty and illness, the findings reflect that it

is social inclusion that can mitigate the effects caused by these conditions and therefore greatly

increase a person’s wellbeing.

City Life, with its strong existing connections to the homeless and disadvantaged people of

Frankston, and partnerships with leading community organisations, is the most suitable location at

which to implement socially inclusive programs and services. Being located in the second most

disadvantaged community in the Southern Metropolitan Region, suggests that there is a great

opportunity to connect with some of the region’s most disadvantaged, thus improving the Health

and Wellbeing of the community. A continued partnership with the FHSS, Monash university, and

RDNS would greatly benifit the outcomes of such programs.

The people of City Life have shared thier needs and voiced thier wishes. They want services that give

them appropriate care, and connection to the community around them. In other words:

‘The I in Illness is isolation and the crucial letters in wellness are we.’ (Guarneri, 2007)

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i need connection' city life research paper 2010

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