Characteristics and Dynamics of Homeless Families with Children. Service Needs, Access, and Utilization Patterns of Homeless Mothers: Health, Mental Health, Trauma, and Substance Use


Homeless mothers and their families face a number of challenges and problems, some that may stem from being homeless and others that may have contributed to becoming homeless. Homeless mothers, for instance, have more acute and chronic health problems than the general population of females under 45 years of age. Bassuk and her colleagues (1996), for example, found that 22 percent of the homeless mothers in their study reported having chronic asthma (more than four times the general population rate), 20 percent reported chronic anemia (10 times the general population rate), and 4 percent reported chronic ulcers (four times the general rate).

In the Robert Wood Johnson/Housing and Urban Development (RWJ/HUD) Homeless Families Program (Rog et al., 1995b), 26 percent of the mothers reported having two or more health problems in the past year and 31 percent characterized their health as poor or fair. Likewise, in the more recent SAMHSA Homeless Families study, 44 percent of the women in the study reported their health as being only fair, poor, or very poor when they entered the study, and 43 percent indicated that they had needed some sort of medical services in the prior 3-month period (SAMHSA Homeless Families Project, 2004). Despite the reported poor health, however, in both of these studies most women reported having had some access to health services while homeless: 75 percent in the RWJ Homeless Families Program, typically through Medicaid (Rog et al., 1995b), and 81 percent in the SAMHSA Homeless Families Project (SAMHSA Homeless Families Project, 2004).

A greater unmet health need among homeless families is dental services. The RWJ/HUD Homeless Families program found that 62 percent of the families needed dental services at baseline, while only 30 percent reported receiving services prior to entering the program (Rog and Gutman, 1997). Similarly, in the more recent SAMHSA Homeless Families project, 44 percent of the families reported needing dental services at baseline, and only 28 percent of these families reported receiving dental services in the 3 months before entering the program (SAMHSA Homeless Families Project, 2004).

Studies differ on overall prevalence of mental health and substance abuse problems among homeless mothers, largely because of how they are defined and measured (including both the actual measure and the time period being assessed) (Shinn and Bassuk, 2004). Regardless of the measurement employed, however, it is clear that the nature of the problems is far different than for single homeless adults. Depression is relatively common, as it is for poor women generally, while psychotic disorders are rare (Bassuk et al., 1998; Shinn and Bassuk, 2004). Given the high levels of stress and the pervasiveness of violence, it is not surprising that homeless mothers have high lifetime rates of posttraumatic stress disorder (PTSD) (three times more than the general female population), major depressive disorder (2.5 times more than the general female population), and substance use disorders (2.5 times more than the general female population) (Bassuk et al., 1998).

Bassuk and colleagues (1996) found, however, few differences between homeless and poor mothers. Thirty-six percent of homeless mothers had a lifetime prevalence of PTSD, with 18 percent currently reporting PTSD, while 34 percent of poor housed women experienced lifetime prevalence of PTSD, with 16 percent of poor housed women reporting current PTSD.

Similar findings have been reported by a variety of other researchers (Fischer and Breakey, 1991; Smith, North and Spitznagel, 1993; Zima et al., 1996). The most common current co-occurring disorders were major depression, substance use disorders, anxiety disorder, and PTSD (Bassuk, et al., 1998; Shinn and Bassuk, 2004). In addition, between one-quarter and one-third of homeless mothers report attempting suicide at least once in their lifetime (Bassuk et al., 1996; Rog et al., 1995). In fact, Rog reported that a majority of the mental health hospitalizations reported by women were related to suicide attempts (Rog and Gutman, 1997).

Homeless families are more likely than other poor families, but less likely than homeless individuals, to report abusing substances (Bassuk et al., 1997; Burt et al., 1999). Rates of reported lifetime use of substances range from 41 percent (Bassuk et al., 1996) to 50 percent (Rog et al., 1995b), with much lower rates reported for current use (12 percent in Rog et al., [1995b] report illicit drug use in the past year; 5 percent in Bassuk et al., [1996] report use of drugs in the past month).

Smith and North (1994) found that single homeless women have more personal vulnerabilities than homeless mothers, such as higher rates of psychiatric (e.g., schizophrenia, bipolar disorder) and substance use disorders (i.e., alcoholism); in fact, some may have lost their children as a result. In contrast, they describe homeless mothers as more socially vulnerable because of their lack of employment and the stress of caring for dependent children. The findings among homeless mothers support Belle’s (1982) argument that psychiatric disorders are more common among poorer women, largely because of the multiple stressors associated with poverty. Pervasive violence, in the context of poverty, may account for many of the emotional disorders in homeless mothers, particularly the high rates of PTSD.

Although poverty is associated with elevated risk of psychiatric and substance use disorders (Robertson and Winkleby, 1996), little empirical data exist on the prevalence, patterns, and correlates of mental health and substance abuse service use among homeless women with children. Studies that gathered data on both psychiatric status and mental health service use suggest a high proportion of homeless women have unmet treatment needs (e.g., Rog et al., 1995b; SAMHSA, 2004).

Finally, it is important to recognize that many homeless women face multiple problems and issues. Rog and her colleagues (Rog et al., 1995b), for example, noted that 80 percent of the homeless women enrolled in their study had current needs in at least two of three areas examined: human capital (poor education or lack of a job), health, and mental health (including substance abuse and trauma-related issues). One-quarter of the women had issues in all three areas.

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