Research indicates that homeless children have high rates of both acute and chronic health problems. They are more likely than their poor housed counterparts to be hospitalized, to have delayed immunizations, and to have elevated blood lead levels (Alperstein, Rappaport, and Flanigan, 1988; Parker et al., 1991; Rafferty and Shinn, 1991; Weinreb et al., 1998; the Better Homes Fund, 1999). They also have high rates of developmental delays (Bassuk and Rosenberg, 1990; Molnar and Rath, 1990) and emotional and behavioral difficulties (Bassuk and Rosenberg, 1990; Buckner and Bassuk, 1997; Molnar and Rath, 1990; Zima, Wells, and Freeman, 1994).
Masten and her colleagues found that homeless children experienced nearly twice as many stressors as a comparison group of children in poor families (Masten et al., 1993). Higher levels of stress, in turn, are associated with mental health and behavior problems. Twenty-one percent of homeless preschoolers and almost 32 percent of older homeless children (ages 9-17) in the Worcester Family Research Project, for example, had serious emotional problems with functional impairment. More specifically, the results from this study indicate that children who are homeless have more problems with internalizing behaviors (e.g., anxiety, depression, withdrawn behavior, or somatic complaints) than children in poor families (Buckner et al., 1999).
Interestingly, the relationship between length of time homeless and internalizing behaviors (as measured with the Child Behavior Checklist [CBCL]) in this study was curvilinear, which suggests that children might be adjusting to their surroundings (or scores could perhaps be a function of services being provided by shelters). It also should be noted that, while the overall CBCL scores of homeless children were higher than those in the housed group, these differences were generally minimal, and nearly equal numbers of children in both the homeless and poor but housed groups scored in the clinical range on this measure (Bassuk et al., 1997; Buckner et al., 1999).
In addition to being homeless, trauma and violence are endemic in the lives of both homeless and housed poor families, with the majority of children either witnessing violence or being directly victimized. The most powerful independent predictor of emotional and/or behavioral problems in both homeless and housed poor children in the Worcester Family Research Project was their mother's level of emotional distress, often due to trauma experienced (Buckner and Bassuk, 1997).
Homelessness appears to have negative effects on school performance. Rafferty and associates (Rafferty, Shinn, and Weitzman, 2004) used Board of Education records to trace children's performance on achievement tests before, during, and after homelessness. Prior to becoming homeless, children in families who would later become homeless had similar scores to other poor children who would remain housed. Homeless children's scores dropped significantly during homelessness and partially rebounded afterward. However, by this time, 50 percent of formerly homeless children had repeated a grade (compared to 40% of housed poor children and 25% of school children in New York City). Further, 22 percent of the homeless children had repeated two grades (compared to 8% of the housed poor children). Within the general population, grade retention is a strong predictor of failure to complete high school (e.g., Hess, 1987; Rumberger and Larson, 1998).
As noted earlier, large numbers of homeless children become separated from their families during homelessness. Research suggests that children who are separated from their families face a number of problems later in life. A study of individuals who were in the New York child welfare system as children, for example, found that children who experienced out-of-home placement were twice as likely to eventually enter the New York City homeless system as adults than those who received nonplacement preventive services (Park, Metraux, Brodbar, and Culhane, 2004b). Similarly, a study of dually-diagnosed homeless adults in three Philadelphia programs found that those who experienced out-of-home placement as children progressed worse than others in the program (Blankertz, Cnaan, and Freedman, 1993). Because most research on homeless children concerns only those who remain with their parents in shelter (e.g., SAMHSA, 2004), and because those who are separated are likely to be worse off than those who remain with families, the needs of homeless children are likely to be underestimated in the literature.