Characteristics and Dynamics of Homeless Families with Children. Appendix A: Impact of Homelessness on Children: An Analytic Review of the Literature

This paper reviews published research conducted in the United States pertaining to the effects of homelessness on the mental health, behavior, health, and academic performance of children who are homeless with their families. This has been the central aim of most of the studies involving homeless children that have been conducted to date. A primary intent of the chapter is to describe what has been learned as well as to discuss some of the issues that may have led to inconsistent study findings over the years. In addition, the paper identifies gaps in the understanding of homeless children, one of which is the lack of information on different subgroups of homeless children based on varying constellations of problems or needs.

• Part I: Literature Review

  • Using data from the National Survey of Homelessness Assistance Providers conducted in 1996, The Urban Institute (2000) estimated that families with children account for about 39 percent of the homeless population in this country on any given night.¹ Based on this survey, researchers at The Urban Institute estimated that somewhere between 874,000 and 1,360,000 children experienced a homeless episode² at some point in 1996. This implies that about 9 percent of poor children in the United States had a spell of homelessness that year. In most cases, a homeless family is comprised of a single mother with one or two young children in tow. This is particularly true in the Northeast, where, for instance, in Massachusetts about 95 percent of homeless families are single parent female headed (Bassuk et al., 1996). In some parts of the country it is more common to also encounter two-parent (or couple) families or families headed by a single father (U.S. Conference of Mayors, 2001).

    The research literature on homeless children now spans about 18 years, with the earliest studies having been published around 1987. One approach to reviewing empirical studies of homeless children is to summarize findings according to topical domain (e.g., mental health, health, education). To some extent, this chapter adopts this approach as well as it facilitates meaningful comparisons and inferences across studies. However, in an effort to make better sense of incongruities in various investigations of homeless children that have made their way to the published literature, it is also helpful to organize them in chronological order. Toward this end, it is useful to distinguish between a set of “first generation” studies and a second stage of research investigations on homeless children. Not all studies in the literature can be grouped so neatly, but such a distinction is reasonable in most cases. This review is not an exhaustive attempt to describe every study that has been published but covers many of the empirical investigations, particularly those that have included a housed comparison group children as it is very difficult to gauge the impact of homelessness, per se, on children by only involving homeless children in a study.

    The first studies that were conducted on homeless children sounded an alarm (cf. Alperstein, Rappaport, and Flanigan, 1987; Bassuk and Rubin, 1987; Miller and Lin, 1988; Rescorla, Parker, and Stolley, 1991; Wood, Valdez, Hayashi, and Shen, 1990). Their findings indicated that homeless children had a range of health and mental health problems that called for immediate attention. Data for these investigations were collected in the mid-1980s, not long after the issue of homelessness for families became apparent. Families who required emergency shelter during this period in time encountered a shelter system in the United States that was only beginning to determine how to handle the needs of parents with young children and it is conceivable that shelter conditions were at their worst during the period in which these studies were conducted.

    A second generation of studies on homeless children followed in the early 1990s spearheaded by these earlier findings. Some of these studies were funded by the National Institute of Mental Health (NIMH), while others were supported by foundations and local grants. Investigators who included homeless children in their studies attempted to advance an understanding of the impact of homelessness on children by involving larger study populations, a greater breadth and quality of assessment instruments, and more advanced statistical techniques with which to analyze the data (cf. Bassuk, Weinreb, Dawson, Perloff, and Buckner, 1997; Buckner and Bassuk, 1997; Buckner, Bassuk, Weinreb, and Brooks, 1999; Buckner, Bassuk, and Weinreb, 2001; Garcia Coll, Buckner, Brooks, Weinreb, and Bassuk, 1998;; Masten, Miliotis, Graham-Bermann, Ramirez, and Neemann, 1993; Masten, Sesma, Si-Asar, Lawrence, Miliotis, and Dionne, 1997; Rafferty, Shinn, and Weitzman, 2004; Rubin, Erickson, San Agustin, Cleary, Allen, and Cohen, 1996; Schteingart, Molnar, Klein, Lowe, and Hartmann, 1995; Weinreb, Goldberg, Bassuk, and Perloff, 1998).

• Part II: Why Studies of Homeless Children Have Produced Inconsistent Findings

  • The previous section reviewed many of the published empirical articles that address the potential impact of homelessness on children. The continuum-of-risk figure (Figure 1-1) is helpful in summarizing various study findings. A rather consistent result across studies is noting elevated problems among homeless and low-income housed children compared to children in the general population. In essence, most studies have documented an apparent negative effect caused by exposure to a common set of “poverty-related” risks. What is less consistent across studies is whether an additional elevation in problems among homeless children as compared to low-income housed children is also found. Moreover, when differences are detected, limitations in methodology (such as not adequately measuring additional risk factors and/or not using multivariate analyses to control for them) call into question whether homelessness, per se, is behind the heightened severity of problems. In other words, it is hard to demarcate where poverty-related sources of risk end and homelessness-specific risks begin.

    While the overall pattern of findings across studies does suggest that, more often than not, children’s exposure to homelessness increases their risk of adverse outcomes, it is difficult to make strong and definitive assertions about the impact of homelessness on children due to inconsistent study results. Rather, the effect that homelessness appears to have on children would seem to be dependent on a range of contextual factors and “effect modifiers.” Put simply, whether homelessness has an impact on children may depend. On the other hand, studies are much more consistent in discerning a negative impact of poverty on children (i.e., both low-income housed and homeless) across outcome domains and among different age groups within domains.

    The remainder of this section offers some explanations as to why various studies involving homeless children have not been able to reliably produce findings suggestive of a negative impact of homelessness above and beyond the effects of broader poverty-related risks.

• Part III: Future Directions for Research

  • Research conducted to date on homeless children has illuminated the knowledge on current needs and the impact of homelessness. Additional studies of homeless and housed children along the lines of previous investigations may do little to clarify the inconsistencies in findings. If future research is conducted that specifically addresses the question of how and to what degree homelessness impacts children, it should address some of the issues brought up earlier. However, this is no small task because it would be impossible to control on historical factors that may have affected past results and it would be very difficult to account for contextual factors, such as the extent of a housing shortage in a community or shelter conditions, without conducting a large multisite study. Clearly there are variables that moderate the relationships between housing status and important indices of children’s well-being, but many of these variables may be at levels of analysis higher than the individual (e.g., shelter, community, etc.) and are difficult to investigate. Nonetheless, to advance this area of research to be more practical for policymakers and service providers, it would be helpful to understand some of the contextual, moderating influences raised here.

• References

  • Achenbach, T.A. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.

    Achenbach, T.A., and Rescorla, LA. (2001). Manual for the ASEBA Preschool-age Forms and Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.

    Achenbach, T.A., and Rescorla, LA. (2001). Manual for the ASEBA School-age Forms and Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.

    Alperstein, G., Rappaport, C., and Flanigan, J.M. (1988). Health problems of homeless children in New York City. American Journal of Public Health, 78, 1232-1233.

    Anderson, L.M., Janger, M.I., and Panton, K.L.M. (1995). An evaluation of state and local efforts to serve the educational needs of homeless children and youth. Washington, DC: U.S. Department of Education, Office of Educational Research and Improvement.

    Bassuk, E.L., and Rubin, L. (1987). Homeless children: A neglected population. American Journal of Orthopsychiatry, 57, 279-286.

    Bassuk, E.L., and Rosenberg, L. (1988). Why does family homelessness occur? A case-control study. American Journal of Public Health, 78, 783-788.

    Bassuk, E.L., and Rosenberg, L. (1990). Psychosocial characteristics of homeless children and children with homes. Pediatrics, 85, 257-261.

    Bassuk, E.L., Weinreb, L.F., Buckner, J.C., Browne. A., Salomon, A., and Bassuk, S.S. (1996). The characteristics and needs of sheltered homeless and low-income housed mothers. Journal of the American Medical Association, 276, 640-646.

    Bassuk, E.L., Buckner, J.C., Weinreb, L.F., Browne, A., Bassuk, S.S., Dawson, R., and Perloff, J. (1997). Homelessness in female-headed families: Childhood and adult risk and protective factors. American Journal of Public Health, 87, 241-248.

    Bassuk, E.L., Buckner, J.C., Perloff, J., and Bassuk, S.S. (1998). Prevalence of mental health and substance use disorders among homeless and low-income housed mothers. American Journal of Psychiatry, 155, 1561-1564.

    Bassuk, E.L., Weinreb, L.F., Dawson, R., Perloff, J.N., and Buckner, J.C. (1997). Determinants of behavior in homeless and low-income housed preschool children. Pediatrics, 100, 92-100.

    Buckner, J.C. (1991). Pathways into homelessness: An epidemiologic analysis. In D. Rog (Ed.), Evaluating programs for the homeless (Vol. 52, New Directions in Program Evaluation). San Francisco: Jossey-Bass.

    Buckner, J.C. (1998). Displaced children: Meeting the health, mental health, and educational needs of immigrant, migrant, and homeless youth. In S.B. Friedman and D.R. Demaso (Eds.), Adolescent psychiatric and behavioral disorders. Adolescent medicine: State of the art review, 9(2) (pp. 323-334). Philadelphia: Hanley and Belfus, Inc.

    Buckner, J.C. (2004). Impact of homelessness on children. In D. Levinson (Ed.), Encyclopedia of Homelessness, Volume 1 (pp. 74-76). Thousand Oaks, CA: Sage.

    Buckner, J.C., Bassuk, E.L., and Zima, B. (1993). Mental health issues affecting homeless women: Implications for intervention. American Journal of Orthopsychiatry, 63, 385-399.

    Buckner, J.C., and Bassuk, E.L. (1997). Mental disorders and service utilization among youths from homeless and low-income housed families. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 890-900.

    Buckner, JC., Bassuk, E.L., Weinreb, L., and Brooks, M. (1999). Homelessness and its relation to the mental health and behavior of low-income school aged children. Developmental Psychology, 35, 246-257.

    Buckner, J.C., and Bassuk, E.L. (1999). Family homelessness in America. In Vostanis, P. and Cumella, S. (Eds.), Homeless children: Problems and needs. London: Jessica Kingsley Publishers.

    Buckner, J.C., Bassuk, E.L., and Weinreb, L.F. (2001). Predictors of academic achievement among homeless and low-income housed children. Journal of School Psychology, 39, 45-69.

    Buckner, J.C., Mezzacappa, E., and Beardslee, W. (2003). Characteristics of resilient children living in poverty: The role of self-regulatory processes. Development and Psychopathology, 15, 139-162.

    Buckner, J.C., Beardslee, W.R., and Bassuk, E.L. (2004). Exposure to violence and low income children’s mental health: Direct, moderated, and mediated relations. American Journal of Orthopsychiatry, 74, 413-423.

    Buckner, J.C., Mezzacappa, E., and Beardslee, W. Self-regulation and its relations to adaptive functioning in low-income youths. Manuscript under peer review.

    Cowal, K., Shinn, M., Weitzman, B.C., Stojanovic, D., and Labay, L. (2002). Mother-child separations among homeless and housed families receiving public assistance in New York City. American Journal of Community Psychology, 30, 711-730.

    Garcia Coll, C., Buckner, J.C., Brooks, M.G., Weinreb, L.F., and Bassuk, E.L. (1998). The developmental status and adaptive behavior of homeless and low-income housed infants and toddlers. American Journal of Public Health, 88, 1371-1374.

    Kupersmidt, J.B., and Martin, S.J. (1997). Mental health problems of children of migrant and seasonal farm workers: A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 224-232.

    Larson, O.W., Doris, J., and Alvarez, W.F. (1987). Child maltreatment among U.S. east coast migrant farm workers. Child Abuse and Neglect, 11, 281-291.

    Masten, A.S., Miliotis, D., Graham-Bermann, S.A., Ramirez, M., and Neemann, J. (1993). Children in homeless families: Risks to mental health and development. Journal of Consulting and Clinical Psychology, 61, 335-343.

    Masten, A.S., Sesma, A., Jr., Si-Asar, R., Lawrence, C., Miliotis, D., and Dionne, J.A. (1997). Educational risks for children experiencing homelessness. Journal of School Psychology, 35, 27-46.

    Miller, D.S., and Lin, E.H.B. (1988). Children in sheltered homeless families: Reported health status and use of health services. Pediatrics, 81, 668-673.

    National Commission on Migrant Education. (1992). Invisible children: A portrait of migrant education in the United States. Washington, DC: U.S. Government Printing Office.

    Park, J.M., Metraux, S., Brodbar, G., and Culhane, D.P. (2004). Child welfare involvement among children in homeless families. Child Welfare, 83, 423-436.

    Rafferty, Y. (1995). The legal rights and educational problems of homeless children and youth. Educational Evaluation and Policy Analysis, 17, 39-61.

    Rafferty, Y., and Shinn, M. (1991). The impact of homelessness on children. American Psychologist, 46, 1170-1179.

    Rafferty, Y., Shinn, M., and Weitzman, B.C. (2004). Academic achievement among formerly homeless adolescents and their continuously housed peers. Journal of School Psychology, 42, 179-199.

    Research Triangle Institute (1992). Descriptive study of the Chapter 1 Migrant Education Program. Research Triangle Park, NC: Author.

    Rescorla, L., Parker, R., and Stolley, P. (1991). Ability, achievement, and adjustment in homeless children. American Journal of Orthopsychiatry, 61, 210-220.

    Rubin, D.H., Erickson, C.J., San Agustin, M., Cleary, S.D. Allen, J.K., and Cohen, P. (1996). Cognitive and academic functioning of homeless children compared with housed children. Pediatrics, 93, 289-294.

    Schteingart, J.S., Molnar, J., Klein, T.P., Lowe, C.B., and Hartmann, A.H. (1995). Homelessness and child functioning in the context of risk and protective factors moderating child outcomes. Journal of Clinical Child Psychology, 24, 320-331.

    Shaffer, D., Fisher, P., and Dulcan, M.K. et al. (1996). The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): Description, acceptability, prevalence rates and performance in the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 865-877.

    Shinn, M. (1992). Homelessness: What is a psychologist to do? American Journal of Community Psychology, 20, 1-24.

    Shinn, M. (1997). Family homelessness: State or trait? American Journal of Community Psychology, 25, 755-769.

    Slesinger, D.P., Christenson, B.A., and Cautley, E. (1986). Health and mortality of migrant farm children. Social Science and Medicine, 23, 63-74.

    Stronge, J.H. (1992). The background: History and problems of schooling for the homeless. In J.H. Stronge (Ed.), Educating homeless children and adolescents: Evaluating policy and practice (pp. 3-25). Newbury Park, CA: Sage.

    Urban Institute. (2000). A New Look at Homelessness in America. Washington, DC: Author. http://www.urban.org/url.cfm?ID=900302

    U.S. Conference of Mayors. (2001). A status report on hunger and homelessness in America’s cities 2001: A 27-city survey December 2001. Washington, DC: Author.

    U.S. Department of Education. (1995). Report to Congress: A compilation and analysis of reports submitted by states in accordance with Section 722(d)(3) of the Education for Homeless Children and Youth Program. Washington, DC: U.S. Department of Education, Office of Elementary and Secondary Education.

    Weinreb, L., Goldberg, R., Bassuk, E., and Perloff, J. (1998). Determinants of health and service use patterns in homeless and low-income housed children. Pediatrics, 102, 554-562.

    Weinreb, L.F., and Buckner, J.C. (1993). Homeless families: Program responses and public policies. American Journal of Orthopsychiatry, 63, 400-409.

    Weinreb, L.F., and Rossi, P.H. (1995). The American homeless family shelter “system.” Social Services Review, 86-107.

    Wood, D.L., Valdez, R.B., Hayashi, T., and Shen, A. (1990). Health of homeless children and housed, poor children. Pediatrics, 86, 858-866.

    Ziesemer, C., Marcoux, L., and Marwell, B.E. (1994). Homeless children: Are they different from other low-income children. Social Work, 39, 658-668.

    Zima, B.T., Bussing, R., Forness, S.R., and Benjamin, B. (1997). Sheltered homeless children: Their eligibility and unmet need for special education evaluations. American Journal of Public Health, 87, 236-240.

    Zima, B.T., Wells, K.B., and Freeman, H.E. (1994). Emotional and behavioral problems and severe academic delays among sheltered homeless children in Los Angeles County. American Journal of Public Health, 84, 260-264.

    Zlotnick, C., Robertson, M.J., and Wright, M.A. (1999). The impact of childhood foster care and other out-of-home placement on homeless women and their children. Child Abuse and Neglect, 23, 1057-1999.

     

• Endnotes

  • ¹ This estimate is children who are part of families and does not include unaccompanied adolescents.

    ² This is a period (e.g., 12-month) prevalence estimate for a homelessness episode of any duration. A point prevalence estimate (e.g., the number of children homeless on any given night) would be a substantially smaller number.

    ³ There is some minor variation in syndrome scales for the two age groups, but the composite internalizing and externalizing global scores can be calculated for each version thereby providing a useful means for aggregating data across the two age ranges.

    4 Children are considered in the clinical range of the instrument, suggesting the need for further assessment and possibly treatment by a mental health care provider, with T-scores of 64 or greater. T-scores from 60 to 63 are considered to be in the “borderline-clinical” range.

    ⁵ The association between mothers’ psychological distress and CBCL ratings of their children’s problem behavior is a consistent finding in the literature. However, the nature of the link is unclear. One possibility is that a mother’s mental health influences her child’s behavior but the reverse could also be true. Furthermore, a mother who views the world in negativistic terms may report herself as having more distress as well rate her child’s behavior as more problematic.

    ⁶ This is consistent with anecdotal reports and conjecture that older children experience more distress as a result of being homeless as compared to younger children. Possible reasons include older children’s increased awareness of their external surroundings and the greater likelihood of encountering stigmatization from peers.

    ⁷ These CDI scores are nearly identical to those found by Bassuk and Rosenberg (1990) about 8 years earlier in Boston.

    ⁸ Children ages 6 to 8 years who were included in the Buckner et al. (1999) report were not part of this paper because they were too young to be directly administered the DISC.

    ⁹ A possible explanation is that the CBCL is better at picking up the effects of recent events than is the DISC, although both assessments use the same 6-month retrospective time frame. Also, diagnostic criteria for mental disorders versus behavior problem checklists do not correspond exactly, so the instruments may be assessing somewhat different things. The discrepancy could also be due to the source of the information (the CBCL is based on parent report, whereas the information taken to arrive at diagnoses for children regarding internalizing disorders came from the youth him or herself).

    ¹⁰ The DDST was not administered to housed children in this study.

    ¹¹ In contrast, one could speculate that the results of Rubin et al. (1996) and that of Rafferty et al. (2004) (both which were conducted in New York city at about the same time), which each found higher school absences and lower academic achievement among homeless children, suggest that the EHCY program in this city was not as successfully implemented as compared to in Worcester 5 years later.

    ¹² As shown in Table 1-1, the “Ho > Hou > GP” abbreviation can be interpreted to mean that the “homeless group had more problems on the outcome measure(s) than the low-income housed comparison group, which in turn had more problems than children in the general population/normative data.”

    ¹³ However, only some studies collected assessments of a range of adversities that children living in poverty experience, so it is not always possible to document how much risk children in the homeless and housed groups were exposed to.

    ¹⁴ In Massachusetts, the Department of Transitional Assistance (DTA), which is in charge of the emergency shelter system (as well as other assistance programs for persons with low-income), refers to this as “rendering oneself homeless.” This term is an acknowledgement of the reality that some families decide a temporary stay in a family shelter may be worth it if it speeds up the process of securing permanent housing; especially if the alternative is to continue living in crowded, “doubled-up” quarters with relatives or friends. In general, DTA disapproves of rendering oneself or family homeless.

    ¹⁵ As illustration of this, in the Worcester study when families in both groups were re-interviewed a year after the initial baseline interview, 92 percent of the initially homeless families were now in permanent housing and 8 percent were still homeless. By the same token, 92 percent of the housed families were still in permanent housing but 8 percent were now homeless. In other words, one year after enrollment, exactly the same proportion of “homeless” and “housed” families in our longitudinal study were living in permanent housing.

    ¹⁶ Chronic strains include such things as feeling hungry, being cold in the winter, worrying about the safety of one’s relatives, feeling a lack of privacy. These are circumstances that can be experienced on a regular basis, and children were asked if they had experienced a strain, how frequently, and how much they were worried or bothered by it. Life events are more acute in nature and tend to have an onset and endpoint. They can include extreme events, such as witnessing violence, having a relative die, having a parent be arrested, and more normative events, such as changing schools or having a new sibling born into one’s family.

    ¹⁷ A primary goal of cluster analysis is to take a group of variables (e.g., indices of mental health and other outcome measures) and try to identify subgroups where members are similar to one another but different from other subgroups. A goal is to minimize within-group variation on the values of variables used in the clustering, but maximize differences between groups. This yields an empirical typology.

View full report

Download

"report.pdf" (pdf, 4.18Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®