Working with the young and homeless - an unconventional role
Louise Abela works at Centrepoint, a national homeless charity supporting young people and is a great example of how dietitians can branch out and specialise in variety of alternative or non-conventional work environments
As the importance of nutrition and healthy eating has gained prominence within society so has the amount of areas dietitians can work in. The majority of dietitians are employed in the NHS, but they can also work in media, public health, the food industry, research, freelance, or in charities.
I work at Centrepoint, a national homeless charity supporting young people aged 16 to 25 who live in homeless hostels. As a Healthy Living Adviser I support young residents in habit and lifestyle changes; achieving outcomes in optimum nutrition, and improving their physical and sexual health. The latter role is beyond the scope of a dietitian but I can provide this support due to having received sexual health training and having also volunteered for a HIV charity for six years. Based in London, I work in a multidisciplinary team, comprising of psychotherapists, dual diagnosis practitioners, healthy relationships worker, and a substance misuse worker.
Housing and health
At Centrepoint I have a caseload of clients with nutrition-related problems and so the aim of my sessions with them is to give them practical experience in a kitchen. I also deliver two classes per week, giving young people a chance to cook together and share their experiences. Centrepoint aims to reduce health inequalities through outreach work and by offering direct access to health support.
Research has shown a direct link between poor housing and poor health1 and poverty has deleterious affects on health and wellbeing2 so creating opportunities to bridge these gaps are vital if homeless young people are to improve their health. Moreover, a holistic approach is essential, as social aspects will impact on a successful outcome; for example, access and sustaining benefits, facing isolation or abusive relationships, immigration status, and self harm or suicidal ideation.
Recent research from Centrepoint’s ‘Toxic Mix’3 report show that 50% of homeless young people use illegal substances and 42% have a diagnosed mental health problem and that these are additional concerns that we as health practitioners need to support young people with. Offering support from a multidisciplinary team allows direct access to other health professionals, and also ensures better outcomes.
(Homeless?) young people encounter a variety of nutrition-related health conditions; the most common I have seen are vitamin deficiencies, including vitamin D and anaemia, overweight and underweight, disordered eating, diabetes, and pregnancy. I also work with young (homeless?) parents supporting them and their children with eating difficulties. Young parents I have worked with in the past reported that they “really enjoy the sessions and it is helping me with my money”; also “this food is good for me and my baby”.
Structure of the sessions
Clients are offered blocks of six sessions for one hour every week. During the assessment we discuss the client’s referral, current lifestyle and take a food diary alongside exploring their relationship, motivation and cultural understanding of food and fluids. In addition, we explore the outcomes they want to achieve and goals are set and a programme agreed. At the end of the six sessions we review and evaluate the intervention.
I employ motivational interviewing techniques to engage my clients and ensure the goals they want to achieve are SMART (please spell out acronym); dietetics skills such as empathy and active listening are essential in this context. Furthermore, I am also proactive with my own continued professional development and have monthly training, reflections and supervision, all of which ensure best practice. With many homeless young people experiencing sensitive issues alongside receiving nutritional advice; it is inevitable that they will disclose issues not directly related to nutrition, highlighting the need for adequate counselling skills.
Due to language barriers some clients have required the use of interpreters or the development of relevant resources in their first language. Reducing language barriers is another way to ensure access to health support. Clients always appreciate it when an interpreter or resources are provided in their own language, increasing their engagement and better client outcomes.
Everyone encounters barriers to change at some stage in their lives; however imagine doing so with no fixed address, feeling unsafe or isolated, experiencing abuse, or high levels of stress and anxiety. For this reason the MDT team at Centrepoint proactively tackles cancellations and DNAs (Did Not Attend) by adopting a client-centred approach that is both realistic and manageable. Our approach helps to build rapport with the client, gives them a safe space to learn while also accepting a nutritional intervention. One young person put this nicely, “Thank you so much, I really appreciate what you have taught me.”
Working with food
When working with homeless young people the sessions are based on the practicality of food. Using a pragmatic approach with food ensures that it does not become an abstract concept, theory or just a check list. The emphasis is on food as something real that we must touch, prepare, eat and enjoy together. Furthermore, cooking together ensures that clients learn food preparation and hygiene that skills essential for independent living.
Most of our clients have had no one to learn from or be creative with in relation to food. My cooking sessions with the client help to reduce their fear and develop their confidence so they can make gradual food and lifestyle changes or take steps to challenge or break a habit. I had one client tell me, “In my country, men are not supposed to be in the kitchen, but now I understand it is important for me to learn how to cook for myself”. Money is also a popular topic and I emphasise the price per portion compared to buying a take-away meal, one client remarked when they found out the price for a whole chicken; “That’s so cheap! I could be saving loads of money”. Focusing on cost comparison encourages clients to have a better awareness of the cost of food allowing them to budget better.
Working in homeless hostels is a unique and rewarding experience and has allowed me to develop and enhance my dietetics skills. It is a rewarding role and I love the fact that I am helping to reduce health inequalities within a group of people who would not normally have access to dietetic support. This job is an example of dietitians working in less conventional areas but in where they can develop and put into practice their skills and also learn from others too.
1) Hood E. Dwelling Disparities: How Poor Housing Leads to Poor Health. Environ Health Perspect. 2005; 113(5): A310–A317.
2) Cattell V. 2001. Poor people, poor places, and poor health: the mediating role of social networks and social capital. 52(10):1501-16.
3) Centrepoint. 2015. Toxic Mix: The health needs of homeless young people. Executive summary.