Toward Understanding Homelessness: The 2007 National Symposium on Homelessness Research. Homeless Families and Children. Other Needs and Problems Facing Homeless Families

09/01/2007

Family separations and influence on family composition. In recent years, the extent to which families experience the temporary or permanent separation from a child when homeless or at various stages in their residential history has become more apparent (Cowal et al., 2002; Hoffman & Rosencheck, 2001). Parent-child separation among homeless families is part of a much broader issue. Because residents of family shelters must include at least one parent and at least one child, parents who are separated from their only child or all of their children are not welcome at family shelters and instead must find shelter in facilities meant for single adults. The NSHAPC reported that 60 percent of all homeless women in 1996 had children younger than 18 years, but only 65 percent of those women lived with any of their children (and often not all of their children); similarly, 41 percent of all homeless men had minor children, yet only 7 percent lived with any of them (Burt et al., 1999). Other studies yield similar findings (Cowal et al., 2002; Maza & Hall,1988; North & Smith, 1993; Rossi, 1989; Zima et al., 1996). The residents of shelters intended for single adults include some individuals who would be in a family shelter if they were presently caring for their child(ren). This is borne out in a study conducted in Alameda County, California by Zlotnick, Robertson, and Wright (1999), who interviewed 171 homeless women drawn from a county wide probability sample. Of these women, 84 percent were mothers and 62 percent of these homeless mothers had a child under the age of 18 living either in foster care or some other out-of-home placement.

Among families with children, parent-child separation is sometimes the choice made by a parent, usually the mother, in deciding the best interests of a child; at other times, it can be a decision forced upon her by the child welfare system, shelter staff, or relatives (Cowal et al., 2002; Park et al., 2004). Cowal et al. (2002) conducted the most comprehensive investigation to date on this issue. Their study, conducted in New York City during the early 1990s, involved 543 low-income families, 251 of which had experienced homelessness at some point in the five prior years. They found that 44 percent of the homeless families had experienced a child separation, compared to only 8 percent of low-income never homeless families. Even when accounting for histories of mental health and substance abuse problems as well as domestic violence (directed at the mother), homelessness was strongly associated with a family experiencing such a separation (Cowal et al., 2002). The reasons why the risk of parent-child separation increases when a family becomes homeless is not entirely clear, but it is likely due to multiple factors. The fishbowl hypothesis posits that parenting practices are under closer scrutiny when a family is in a shelter than when housed, posing a risk for child welfare placement (Park et al., 2004). Alternatively, in some cases, a soon-to-be-homeless mother will ask that a relative care for her child so that the child can continue attending the same school. In other instances, shelters may not allow adolescents, especially males, to stay in their shelter, thereby forcing a family-child separation.

Homelessness is not only a major factor in family separations; it also makes the reunification of separated families more difficult. Cowal and colleagues (2002) found that only a subset (23 percent) of the separated children were living with their mothers at the five-year follow-up (Cowal et al., 2002). In most studies, the majority of separated children lived with relatives, but a substantial minority were in foster care or had Child Protective Service (CPS) involvement (26 percent, Cowal et al., 2002; 6 percent, DiBlasio & Belcher, 1992; 15 percent, Zlotnick, Robertson, & Wright, 1999). In a five-year follow-up of a birth cohort of children in Philadelphia, being in a family that requested shelter was strongly related to CPS involvement and to foster care placement (Culhane et al., 2003). The risk for CPS involvement increased as the number of children in a family increased. Similarly, in another Philadelphia study there was a greater risk for child welfare involvement for those families with longer shelter stays, repeated homelessness, and with fewer adults in the family (Park et al., 2004).

The link between child homelessness and foster care is even more disturbing in light of the preponderance of research that has found childhood separation  and especially foster care involvement  to be a predictor of homelessness in adults (Bassuk, Buckner et al., 1997; Bassuk, Rubin, & Lauriat, 1986; Knickman & Weitzman, 1989; Susser, Lin, & Conover,1991; Susser, Conover, & Struening, 1987) as well as future separation from ones own children (Nunez, 1993).

Human capital: Education, employment, and income. Adults in both homeless and other poor families generally have low levels of educational attainment and minimal work histories. Compared to the national average of 75 percent of adults having a high school diploma or GED, for example, high school graduation or GED rates for mothers in homeless families range from 35 percent to 61 percent across a number of studies (Bassuk et al., 1996; Burt et al., 1999; Lowin et al., 2001; Roget al., 1995b; Rog, Rickards et al., in press; Shinn & Weitzman, 1996). Overall, the rates of educational attainment for homeless families are lower than for homeless single adults (47 percent versus 63 percent in the NSHAPC) (Burt et al., 1999) but similar to other low-income families.

Not surprisingly, most homeless mothers (8499 percent) upon entry into shelter are not working (Bassuk et al.,1996; Lowin et al., 2001; Rog et al., 1995b; Rog, Rickards et al., in press.) The majority of homeless mothers have had some work experience, however, ranging from 67 percent in the Worcester study (Brooks & Buckner, 1996) to over 90 percent in the RWJF/HUD Homeless Families Program and the recent CMHS/CSAT Homeless Families Program (Rog et al., 1995b; Rog, Rickards et al., in press). Among homeless and housed low-income mothers in the Worcester study, becoming pregnant before the age of 18 significantly lowered a womans chances of having been employed (Brooks & Buckner, 1996).

Partner violence and childhood abuse. Homeless mothers, like poor women in general, have experienced high rates of both domestic and community violence (Bassuk et al., 1996; Bassuk, Perloff, & Dawson, 2001; Browne & Bassuk, 1997). Many women report having been both victims and witnesses of violence over their lifetimes. In the WFRP, almost two-thirds of the homeless mothers had been severely physically assaulted by an intimate partner and one-third had a current or recent abusive partner (Browne &Bassuk, 1997). More than one-fourth of the mothers reported having needed or received medical treatment because of these attacks (Bassuk et al., 1996). Supporting these findings, Rog and her colleagues (1995b) reported that almost two-thirds of their nine-city sample of homeless women described one or more severe acts of violence by a current or former intimate partner. Not surprisingly, many of these women reportedly lost or left their last homes because of domestic violence.

In addition to adult violent victimization, many homeless mothers experienced severe abuse and assault in childhood. The WFRP documented that more than 40 percent of homeless mothers had been sexually molested by the age of 12(Bassuk et al., 1996). Women participating in the CMHS/CSAT study reported similar findings, with 44 percent reporting sexual molestation by a family member or someone they knew before the age of 18 (Sacks et al., in press). Sixty-six percent of the women in the WFRP experienced severe physical abuse, mainly at the hand of an adult caretaker. Other studies have found similar results (e.g., Rog, Rickards et al., 1995b; Sacks et al., in press; Rog et al., in press).

Health and dental needs. Homeless mothers and their families face a number of health challenges and problems, some that may stem from homelessness and others that may have contributed to becoming homeless. Mothers who are homeless, for instance, have more acute and chronic health problems than the general population of females under 45 years of age. Bassuk et al. (1996), for example, found that 22 percent of the mothers reported having chronic asthma (more than four times the general population rate), 20 percent chronic anemia (ten times the general population rate), and 4 percent chronic ulcers (four times the general rate). These rates among homeless mothers in Worcester were comparable to those found in a comparison group of low-income housed, never homeless mothers (Bassuk et al., 1996).

In the RWJF/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 CMHS/CSAT Homeless Families study, 44 percent of the women 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 three-month period (Rog, Rickards et al., in press; Rog, 2004). Despite the reported poor health, in both of these studies most women report having had some access to health services while homeless: 75 percent in the RWJ Homeless FamiliesProgram, typically through Medicaid (Rog et al., 1995b), and 81 percent in the CMHS/CSAT Homeless Families Project (Rog, 2004).

A significant unmet health need among homeless families is dental services. The RWJF/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 & Gutman, 1997). Similarly, in the more recent CMHS/CSAT 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 three months before entering the program (Rog, 2004).

Substance abuse and mental health. Studies differ on overall prevalence of substance abuse and mental health problems among mothers who are homeless and the extent to which these problems may function as risk factors, largely due to how they are defined and measured (including both the actual measure and the time period being assessed) (Shinn & Bassuk,2004). Whatever the measurement, it is clear that the nature of the problems is far different than for single adults who are homeless.

Data from the WFRP indicates that homeless families are more likely than other low-income families, but less likely than individuals who are homeless, to report abusing substances (Bassuk, Buckner 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 (Roget al., 1995b). Rates are much lower for current use as exemplified by a reported illicit drug use of 5 percent in the WFRP (Bassuk et al., 1996)and a 12 percent rate of illicit drug use in the past year in the Rog et al. 1995b study. Heavy use of alcohol or heroin over the prior two years was found to be a risk factor for homelessness in the WFRP (Bassuk, Buckner et al., 1997). Similarly, recent reanalyses from the Fragile Families dataset (involving low-income mothers who have recently given birth) suggest that substance abuse is a risk factor for homelessness, with families who report experiencing recent homelessness having higher rates of substance use than families who remain stably housed(Rog & Holupka, unpublished).

Depression among mothers who are homeless is relatively common, as it is for low-income women generally, while psychotic disorders are rare (Bassuk et al., 1998; Shinn and Bassuk, 2004). In the reanalysis of the Fragile Families data, reports of mental health issues were related to becoming homeless and their absence related to stability (Rog et al., 2007). Forty-six percent of families experiencing homelessness in Year 1 of the study reported feeling sad or depressed two or more weeks in a row, compared to 12 percent of the families who remained stably housed during that time. Comparable percentages were found at the Year 3 follow-up.

Given the high levels of stress and the pervasiveness of violence, it is not surprising that mothers who are homeless have high lifetime rates of posttraumatic stress disorder (PTSD) (3 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, 1998) found, however, few differences between homeless and low-income housed mothers. Thirty-six percent of homeless mothers and 34 percent of low-income housed mothers had lifetime prevalence of PTSD and 18 percent of homeless mothers compared to 16 percent of low-income housed mothers reported current PTSD.

In addition, between one-quarter and one-third of mothers who are homeless report at least one lifetime suicide attempt (Bassuk et al., 1996; Rog et al., 1995b). In fact, Rog andGutman (1997) reported that a majority of the mental health hospitalizations reported by women in the RWJF/HUD nine-city evaluation were related to suicide attempts.

Finally, it is important to recognize that many women who are homeless face multiple problems and issues. In the WFRP, the most common current co-occurring disorders found were major depression, substance use disorders, anxiety disorder, and PTSD (Bassuk et al., 1998; Shinn & Bassuk, 2004). In addition, Rog and her colleagues (1995b) noted that 80 percent of the homeless women 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.

Residential instability. Family homelessness is perhaps most aptly described as a pattern of residential instability. Homeless episodes are typically part of a longer period of residential instability marked by frequent moves, short stays in ones own housing, and doubling up with relatives and friends. As an illustration, in the 18 months prior to entering a housing program for homeless families in nine cities, families moved an average of five times, spending 7 months in their own place, 5 months literally homeless or in transitional housing, 5 months doubled up, and 1 month in other arrangements. Overall, one-half (53 percent) had been homeless in the past. It is important to note, however, that this sample of families was not random, but consisted of families selected for a variety of service needs, with prior homelessness a selection criterion at some of the study sites (Rog & Gutman,1997).

Other studies document the lack of stability that the families experience both before and after experiencing homelessness. For instance, Shinn and colleagues (1988) documented that many families on the precipice of homelessness for the first time had never established themselves in stable permanent housing. Before entering shelter, doubling up with other families was common as were moves from one overcrowded living arrangement to another. At-risk families who had been able to obtain a housing subsidy were much more residentially stable and less likely to enter shelter. In a more recent study of newly homeless families in eight sites across the country who were screened as having mental health and/or substance abuse problems, the families spent less than one-half of the prior six months in their own homes (Rog, 2004). Staying with relatives or friends is often found to be the most common living situation prior to entering shelter (Lowin et al., 2001; Rog, 2004). The length of time families stay homeless is a function, in part, of shelter limits on stay and the availability of affordable housing. Families with limited incomes have few housing choices. As discussed later in this paper, there is substantial evidence that subsidized housing plays a major role in reducing homeless stays and in ending homelessness for a majority of families.

To date, there have not been any conceptual models developed, or research conducted, that help to explain the manner in which risk and protective factors for homelessness among families interrelate. Presumably, there is a class of distal as well as a class of proximal mediating variables that can be delineated in efforts to explain pathways into homelessness. Distal variables for a homeless mother could include history of childhood abuse, foster care placement, and other disruptive experiences early in life. These distal factors could affect mediating variables such as recent substance abuse, mental health issues, and conflict within the social network, which in turn play roles in affecting a persons vulnerability to becoming homeless. In addition, recent research (Rog & Holupka, unpublished) suggests that the absence of protective factors (e.g., having housing assistance, having another adult living in a household) combined with having mental health and substance abuse concerns makes it difficult for vulnerable families to stay residentially stable and heightens their risk of homelessness.

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