Characteristics and Dynamics of Homeless Families with Children. Conceptual Issues

A number of important terms and concepts have been introduced in the introductory sections of this chapter that should now be more formally defined. 

What is a typology? A typology is a classification system and a set of decision rules used to differentiate relatively homogeneous groups called subtypes.  A subtype is an abstract category organized according to some conceptual, theoretical, and clinical principle.  According to one student of clinical subtyping (Millon, 1991), subtypes of complex clinical phenomena are “splendid fictions” because nature was not made to suit the conceptual need for a well-ordered universe. As noted above with typologies of alcoholism, different concepts and categories can be formulated and labeled in a variety of ways, but bear in mind that these labels are not necessarily “realities.”  This realization should not discourage one from attempting to make sense of complex clinical phenomena and heterogeneous groups if the primary purpose is kept in mind to benefit people in need and make the most efficient use of resources.

What is a “homeless family”?  Although this term appears to be self-evident, it is important to note that “homeless” should include both literal homelessness and families who are doubling up with others by necessity, and “family” should include couples without children, couples with children, and the large category of single parent with children.

The concept of treatment or service matching refers to decision rules designed to facilitate matching to optimal treatment modality, service intensity, and ancillary services.  An important consideration in the development of a typology of homeless families is the kinds of services that the typology might relate to in terms of treatment, prevention, and other needs.  Obviously, the typology should be relevant to the types of services that are appropriate, feasible, and available to homeless families.  These services include the following:

• Shelter facilities to deal with immediate and short-term housing needs
• Child care, preschool, and school placement to deal with children’s needs
• Housing subsidies to deal with economic barriers to housing
• Supported housing and other housing programs to deal with long-term housing needs
• Services to keep families intact and to improve family dynamics
• Employment counseling
• Welfare programs to provide for basic needs
• Medical care, including sexually transmitted diseases and pregnancy care
• Clinical preventive services, including family planning, HIV prevention, and childhood immunizations
• Mental health counseling, especially for PTSD, depression, and domestic violence
• Treatment for substance abuse
• Case management to integrate and coordinate individual services

Services to help with stable housing or to rectify personal problems have to face unusually high obstacles. No matter how much help is given to finding housing, low income housing is often so limited (McChesney, 1992a) that only a small number can be rehoused unless the supply is increased.

Services to help with stable housing or to rectify problems have to be appropriately gauged to avoid a mix of insufficient and wasteful services. There is now ample evidence that the majority of homeless families can achieve stable housing based only on housing subsidies (Shinn et al., 1998; Stretch and Krueger, 1992; Wong et al., 1997).  In other studies when subsidies and a variable set of support services or case management were given, the strongest predictor of housing stability was subsidized housing regardless of the intensity of services (Weitzman and Berry, 1994; Rog, Gilbert-Mongelli and Lundy, 1998). Thus in the majority of instances, housing subsidies should be sufficient to achieve stable housing, and there is no need to provide additional case management for those families.  However, a small proportion of families return to homelessness during a 5-year follow-up period (Stojanovic, Weitzman Shinn et al., 1999). Thus an important role of a typology of homeless families would be to help in the identification of those families that need supportive services in addition to housing subsidies, and what kind of services are needed (e.g., case management, intensive case management, specialized services).

Given the nature of typological formulations and their history in clinical decision-making, an important conceptual issue is the possible functions of a typology for the management of homeless families.  The major uses of clinical typologies that have been proposed in these various literatures are the following:

• Summarize important diagnostic, prognostic and descriptive information in a simple, understandable classification scheme.
• Provide an empirical basis for client-service matching, such as programs to help with stable housing, psychological problems, medical care, social services, child care, or substance abuse.
• Minimize or remediate effects on children.
• Improve specificity of prediction of short-term as well as long-term outcomes in relation to services received.
• Help to prevent family homelessness.

Based on the experience of typological research in psychiatry and substance abuse (Babor and Dolinsky, 1988), a set of taxonomic standards can be suggested as the characteristics of a good typology.  Optimally, a typology of homeless families should:

• Be simple in its structure;
• Have practical utility (e.g., mediate judgments about clinical evidence);
• Allow matching to clinical and preventive services;
• Be easy to derive from available data;
• Permit inferences to underlying causes;
• Predict future behavior;
• Facilitate communication;
• Demonstrate empirical validity and reliability; and
• Identify subtypes that are homogeneous within categories, remain stable over time, and are comprehensive in their coverage of the homeless population.

A typology of homeless families with children is relevant to at least three public health issues: (1) how to  help such families gain stable housing; (2) how to help them with personal problems, including but not limited to those affecting housing; and (3) how to protect homeless children in situations  that may interfere with  their healthy development. The same typology may not be optimal for these three challenges. Therefore, it is possible that more than one typology of homeless families may be indicated.