Family Homeless Shelters Research Articles

The Adaptation of a Postpartum Depression Prevention Evidence-Based Intervention in Family Homeless Shelters

Evidence-based interventions (EBIs) are considered the gold standard but it is unclear if they are effective across settings. Reach Out and Stay Strong, Essentials for new Mothers (ROSE) has been shown to prevent postpartum depression in clinical settings, but has not been implemented or tested in homeless populations. We used the Exploration, Preparation, Implementation and Sustainment (EPIS) model overlaid with the Dynamic Adaptation Process (DAP) to adapt ROSE for implementation in a homeless shelter system in a large U.S. city, using feedback from both the organization and community. The adapted intervention was called Strong in Shelter (SIS). In this paper, we present 4 DAPS (April, 2018- December, 2020); the EPIS stages within each DAP are described. The Exploration Stage is centered around early and ongoing engagement with shelter providers and residents. The Preparation Stage includes adaptations based on learnings from the Exploration and the Implementation Stages from previous DAPs. The Implementation Stage highlights what we learned from implementation and both quantitative and qualitative feedback from shelter staff and residents. Following the DAP cycles, we created scalable plans in the Sustainment Stage. Thematic analysis was used to identify, analyze and report patterns within qualitative data, and descriptive analyses were conducted with quantitative data. Participant engagement and satisfaction were high and facilitators reported implementing SIS with fidelity to ROSE’s core components. By engaging staff and the participants early and continually, and utilizing an iterative and flexible adaptation process, EBIs such as ROSE can be adapted and implemented with fidelity in new settings.

Family homeless shelters as contexts for early childhood development: Shelter resources and staff capacity

AbstractFamily homeless shelters are critical contexts in which many young children develop; however, little is known about the developmental appropriateness of these settings, including their resources and the capacity of their staff to effectively meet the needs of the children and families they serve. The current study involves both quantitative and qualitative components to assess aspects of developmental appropriateness of US shelter spaces for children ages birth to 5 years, with an emphasis on staff knowledge, parenting programmes, and play spaces. Participants were 64 staff working in different family homeless shelters representing all 10 Housing and Urban Development regions. Data were collected via semistructured phone interviews. Results indicated that most shelters offered some type of parenting programme (65.5%) and had some developmentally appropriate space for families with young children (87.5%); however, the nature of these spaces and programmes varied considerably, with very few respondents describing use of evidence‐based practices. Findings on knowledge of early child development among shelter staff indicated substantial need for trainings on a range of topics, including typical child development, parent–child relationships, and impacts of trauma on families with young children. Furthermore, we identified a need for better measurement tools to assess knowledge of child development.

1456. Environmental and Nasal Pathogen Surveillance in Seattle Area Homeless Shelters

Abstract Background The need for community surveillance of respiratory viruses in high-risk settings such as homeless shelters has been underscored by the COVID-19 pandemic. Here, we show that sampling high-touch surfaces is a low-cost, minimally intensive means of community respiratory virus surveillance. Methods Environmental samples were collected weekly from adult and family homeless shelters in King County, WA from November 2019 – April 2020. At times when residents were present, a 10cm2 area of selected high-touch surfaces were swabbed and bioaerosol samples were collected in high-traffic areas. Surfaces included entrance and restroom doorknobs, counters, and surfaces unique to each shelter. Study staff collected mid-turbinate swabs from shelter resident participants aged > 3 months with symptoms of acute respiratory illness (ARI). All samples were tested by RT-PCR for 27 viruses. From January 1, 2020 onward, samples were also tested for SARS-CoV-2. Results A total of 788 environmental swabs, 1509 nasal swabs, and 98 bioaerosol samples from 6 adult and 3 family shelters were tested. Adenovirus (109 positive swabs, 13.8% of tested swabs), rhinovirus (107, 13.6%) and human bocavirus (62, 7.9%) were the most frequently detected viruses in surface swabs. Rhinovirus (160, 10.6%), human coronaviruses (79, 5.24%) and influenza B (43, 2.85%) were the most detected in nasal swabs. All viruses detected in nasal swabs were found in surface swabs. Of 9 surfaces, exterior bathroom doorknobs were the physical location with the highest number of pathogens detected. SARS-CoV-2 was first detected in surface swabs on 3/20/20, and in nasal swabs on 3/10/20. Bioaerosol samples detected virus in a low percentage of samples relative to surface and nasal swabs. Table 1Count and period prevalence of environmental viral detection by shelter type, November 18, 2019 - April 10, 2020.Figure 1Number of viral pathogens detected from environmental swabs, disaggregated by shelter type.Figure 2Bar graphs comparing prevalence of respiratory pathogen detection in mid-turbinate nasal swabs and environmental swabs/bioaerosol samples by epidemiologic week, November 18, 2019 - April 30, 2020. Conclusion Respiratory viruses detected through environmental sampling in homeless shelters were similar to the viruses detected from ARI episodes in study participants. Environmental surface sampling presents a plausible, minimally invasive method of surveillance for both endemic and emerging respiratory pathogens, as evidenced by the detection of SARS-CoV-2 during the early stages of the pandemic. Further research could focus on sampling public locations for broader community surveillance and culturing viruses found on these surfaces. Disclosures Michael J. Boeckh, MD PhD, Allovir: Advisor/Consultant|Amazon: Grant/Research Support|Ansun Biopharma: Grant/Research Support|EvrysBio: Advisor/Consultant|Gates Ventures: Grant/Research Support|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|Helocyte: Advisor/Consultant|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Kyorin Pharmaceuticals: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Regeneron: Grant/Research Support|ReViral: Advisor/Consultant|Symbio: Advisor/Consultant|Takeda: Grant/Research Support|Vir Biotechnology: Advisor/Consultant|Vir Biotechnology: Grant/Research Support Janet A. Englund, MD, AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Helen Y. Chu, MD, MPH, Cepheid: Reagents|Ellume: Advisor/Consultant|Gates Ventures: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant.

‘Meeting them where they are at’: A practice note on implementation of the Child and Family Traumatic Stress Intervention in an emergency family homeless shelter

Families experiencing homelessness report higher rates of traumatic exposure than the general population, and traumatic experiences can often be precipitating factors for entrance into a homeless shelter. Emergency shelter is meant to be a brief, temporary housing intervention to support families toward more stable and permanent living arrangements. Beyond this ecological intervention, there is a frequently unmet need for trauma-specific mental health services. Further still, psychosocial interventions to support sheltered families should be sensitive to both the trauma-specific needs of this population and the constraints of the shelter setting. The Child and Family Traumatic Stress Intervention (CFTSI) is a brief, secondary prevention protocol that aims to prevent PTSD after exposure to a traumatic event, with research demonstrating its effectiveness in acute care settings such as child advocacy centres and emergency departments. This case study illustrates the implementation of CFTSI in an emergency family shelter in a large urban area, highlighting the appropriateness of the intervention for the setting, its adaptability to client needs and its generalizability to other non-traditional intervention settings.

Children's Access to Books, Libraries, and Storybook Reading: Survey of Mothers at a Family Homeless Shelter

Access to books and storybook reading contribute to children's language, literacy and academic development. Homeless children often experience delays in these areas of development; however, their access to books and storybook reading is understudied. This study of 24 children in a family homeless shelter and 27 housed children in the same urban neighborhood found homeless children had fewer books, visited libraries less often, were unlikely to have library cards, and fewer were read to daily. Identifying these disparities has implications for reducing the inequalities and developmental risks often associated with childhood homelessness and associated challenges for schools that educate them.

Point of Care Spirometry Assessment for Pediatric Asthma Prevalence in a Family Homeless Shelter in Omaha, Nebraska

Introduction: The few studies on pediatric asthma in US homeless shelters describe a 27.9 – 39.8% prevalence, and historically Omaha has had a high incidence of fatal pediatric asthma. Thereby, Clarkson Family Medicine (CFM) residency began a pediatric asthma outreach to a local family-homeless shelter to assess the prevalence of pediatric asthma and follow-up appointment attendance.

Striving for Structure and Stability in Cincinnati's Family Homeless Shelters: A Community-Based Participatory Research Approach.

Experiencing homelessness negatively impacts child health, development, and emotional-behavioral functioning, but there is limited knowledge regarding specific service priorities, as articulated by families themselves, to prevent or address these adverse sequelae. Thus, to elicit the service needs perspective of families in shelter and to translate these findings into real-world action, we undertook a community-based participatory research effort using Group-Level Assessment, a focus group methodology. An action-based participatory needs assessment called a Group-Level Assessment (GLA) was conducted in collaboration with parents currently experiencing homelessness. A total of 53 parents from 3 Cincinnati homeless shelters participated by responding to 17 to 20 open-ended prompts regarding their child's medical, developmental, learning, social, and behavioral needs. Using GLA methodology, we found that the needs expressed by families residing in shelters coalesced around the following themes: job and housing stability, education and skill development, emotional support, and improving shelter life. The GLA findings were then shared with shelter and community leaders, leading to a number of policy and practice enhancements in the shelters. This study demonstrates the power of the GLA approach to affect community action as a direct result of priorities generated by families experiencing homelessness.

Story hour at a family homeless center: contribution to graduate students’ preparation and confidence in preliteracy skills

PurposeThis study evaluated the potential benefit to graduate students’ of participating in a service-learning program conducting a storybook reading program for children in a family homeless shelter. MethodTen graduate students in the second year of a two-year master's degree program in communication science and disorders participated in the storybook reading program. The graduate students engaged in reflective writing about their experiences and completed self-ratings of confidence in preliteracy skills before and after program participation. Twenty graduate students in two comparison groups (10 students in a pre-program comparison group, and 10 in a post-program comparison group) also completed questionnaires. The mixed-methods study used quantitative analyses to analyze questionnaire ratings and qualitative methods to analyze reflective writings. ResultsTogether, the quantitative and qualitative results indicated positive outcomes from the service-learning experience with regard to graduate students’ perceived confidence in preliteracy skills and preparation for careers as speech-language pathologists. The results provide empirical data showing that service-learning experiences with at-risk populations can contribute to graduate students’ clinical education and preparation as speech-language pathologists. ConclusionThe results support the value of service-learning experiences in communication sciences and disorders. Clinical preparation in preliteracy development also supports the American Speech-Language-Hearing Association statement on the roles and responsibilities of speech-language pathologists in relation to reading and writing in children.

Understanding Mechanisms Driving Family Homeless Shelter Use and Child Mental Health

Homeless shelters throughout the U.S. are overcrowded and under-resourced. Families with children face substantial barriers to timely, successful shelter exit, and prolonged shelter stays threaten child mental health. This community-based system dynamics study explored barriers to timely, successful shelter exit and feedback mechanisms driving length of stay and child mental health risk. Group model building – a participatory systems science tool – and key informant interviews were conducted with clients (N = 37) and staff (N = 6) in three family homeless shelters in a Midwestern region. Qualitative content analysis with emergent coding identified key themes feedback loops. Findings indicated overcrowding delayed successful shelter exit; longer stays exacerbated crowding and stress in a vicious cycle. Furthermore, longer stays exacerbated child risk for mental disorder both directly and indirectly via crowding and caregiver stress. Capacity constraints limited families served, while contributing to ongoing unmet need. Future research should investigate the roles of these dynamic feedback relationships in the persistent vulnerability of homeless families. Service design should prioritize interventions that alleviate crowding and subsequent threats to mental health such as private or scattered-site shelter accommodations, affordable child care, and homelessness prevention to facilitate successful shelter exit and mitigate child mental health risk.

Characteristics of COVID-19 in Homeless Shelters : A Community-Based Surveillance Study.

Homeless shelters are a high-risk setting for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission because of crowding and shared hygiene facilities. To investigate SARS-CoV-2 case counts across several adult and family homeless shelters in a major metropolitan area. Cross-sectional, community-based surveillance study. (ClinicalTrials.gov: NCT04141917). 14 homeless shelters in King County, Washington. A total of 1434 study encounters were done in shelter residents and staff, regardless of symptoms. 2 strategies were used for SARS-CoV-2 testing: routine surveillance and contact tracing ("surge testing") events. The primary outcome measure was test positivity rate of SARS-CoV-2 infection at shelters, determined by dividing the number of positive cases by the total number of participant encounters, regardless of symptoms. Sociodemographic, clinical, and virologic variables were assessed as correlates of viral positivity. Among 1434 encounters, 29 (2% [95% CI, 1.4% to 2.9%]) cases of SARS-CoV-2 infection were detected across 5 shelters. Most (n = 21 [72.4%]) were detected during surge testing events rather than routine surveillance, and most (n = 21 [72.4% {CI, 52.8% to 87.3%}]) were asymptomatic at the time of sample collection. Persons who were positive for SARS-CoV-2 were more frequently aged 60 years or older than those without SARS-CoV-2 (44.8% vs. 15.9%). Eighty-six percent of persons with positive test results slept in a communal space rather than in a private or shared room. Selection bias due to voluntary participation and a relatively small case count. Active surveillance and surge testing were used to detect multiple cases of asymptomatic and symptomatic SARS-CoV-2 infection in homeless shelters. The findings suggest an unmet need for routine viral testing outside of clinical settings for homeless populations. Gates Ventures.

Developing a Screening Tool for Young Children Using an Ecological Framework.

Young children from impoverished backgrounds experience high levels of family and environmental stress, adversely impacting developmental functioning. Early identification provides a pathway to solutions, but many children are never assessed. In addition, the child-serving workforce lacks resources and expertise to use traditional measures. Furthermore, existing measures do not account for the substantial influence of a child's ecology. To bridge these gaps, we developed the Neurodevelopmental Ecological Screening Tool (NEST) and conducted a pilot study (n=60) to test its feasibility for use with caregivers of children ages 3-5 in low-resource settings. We developed an item pool across three domains (child, caregiver, environment), vetted it with experts, and conducted cognitive interviewing with parents (n=15) and case managers (n-10). Simultaneously, we built an online, user-friendly delivery platform. We used a one parameter Item Response Model and a Rasch-based Rating Scale Model (RSM) and fit confirmatory factor analytic (CFA) models to test for unidimensional and construct validity. The results support the feasibility of screening children from low SES populations within low-resource settings using an ecological perspective and supports the work of child-serving paraprofessionals in identifying and addressing risks in the lives of young children.

Reclaiming “good motherhood”: US mothers’ critical resistance in family homeless shelters

Unhoused mothers not only contend with housing precarity and economic hardship but also intersecting classist, racist, and sexist stereotypes that position them as unfit mothers. Classed, raced, and gendered conceptualizations of “good” and “bad” motherhood are reified in US shelter regulations (e.g. strict rules governing parent and child behavior, curfews, mandatory participation in parenting classes) that seek to “reform” homeless mothers. To gain a better understanding of perceptions of and responses to shelter regulations, we interviewed 28 formerly unhoused US mothers about their experiences in family shelters. Participants overwhelmingly rejected “bad mother” stereotypes that equated lack of material resources with inadequate parenting and engaged in a range of overt (e.g. strategic recounting of life histories) and covert (e.g. subverting paternalistic rules) strategies to reclaim “good motherhood” and negotiate daily shelter life. Instrumental, discursive, covert, and overt critical resistance strategies were used to maintain parental authority, preserve one’s self-image as a “good” mother and obtain needed resources from shelter staff. Our findings highlight the complexity of critical resistance to class, race, and gender oppression and call for greater interrogation of how seemingly well-intentioned shelter rules and policies reinforce status hierarchies.

“I run inside the buildings”: adolescents’ perceptions of physical health and nature in family homeless shelters

ABSTRACTThis article reports results from two focus groups designed to understand perceptions of health and nature among adolescents living in emergency family shelters. Following institutional rev...

Mothering in the margin: a narrative inquiry of women with children in a homeless shelter

ABSTRACTWomen living with their children in residential treatment family homeless shelters are often stigmatized on multiple fronts: for their addictions, being “homeless”, and assumptions about their mothering skills. This qualitative narrative inquiry study explored women’s experiences of living in a homeless shelter with their children as they recover from alcohol/drug addiction. Specifically, we examined the various ways in which the women conceptualized and performed mothering while residing at the New Beginnings shelter (pseudonym) in the mid-Southern U.S. Understanding the complexities of the women’s social, emotional, and health-based contexts can enable institutions to examine and shape implicit and explicit assumptions surrounding motherhood. We employed semi-structured interviews with six women and analyzed transcripts using two rounds of thematic coding. Five recurring themes emerged. The findings illustrate the way “appropriate mothering” is situated in specific institutional, political, historical, and economic contexts. We suggest hegemonic assumptions need to be interrogated to better serve families in crisis.

The experiences of adolescents and young adults residing with their families in emergency shelters in Canada

ABSTRACTEmergency homeless shelters can be stressful environments for families. They can be associated with emotional distress and feelings of restriction for parents, and with behavioural, social, and developmental challenges for children. However, little is known about the experiences of accompanied youth residing in shelter with their families, as the literature about this age group's experiences of homelessness has mainly focused on unaccompanied youth. Findings from the current study are drawn from qualitative interviews with 16 adolescents and young adults (aged 16–21) who were homeless and living with their families in family homeless shelters in Ottawa, Ontario, Canada. Youth described family homeless shelters as stressful environments but also found that the shelters provided support to them and their families. Youth discussed the various strategies they used to cope in facing the challenges of shelter life. These findings add to our understanding of youth who are homeless and highlight the ways ...

Seasonal Variation in Family Homeless Shelter Usage

Seasonal surges in family homeless shelter usage occur in numerous communities around the United States. These surges are significant because they may place demands on shelter systems, require families to use lower quality shelter facilities, or impose significant costs on the municipalities that provide shelter services. This study uses empirical data from Hennepin County, Minnesota, to provide explanations for the seasonality of family homeless shelter usage. The results suggest that multiple factors may contribute to the surge, but that families with school-age children are the primary driver of seasonal increases in the family shelter population. This study provides initial findings that may help to improve the targeting of homelessness prevention resources.

Homelessness in the elementary school classroom: social and emotional consequences

This study examined elementary school teachers’ experiences working with homeless students. Specifically, we focused on the psychosocial impacts of homelessness on students and their teachers. Qualitative, semi-structured interviews were conducted with 28 teachers who worked at designated public schools for family homeless shelters. A prominent theme that emerged from teachers’ accounts was how the instability tied to homelessness affected students’ behavioral, social, and emotional adjustment in the classroom (e.g. externalizing problems, difficulty developing peer relationships, and withdrawn behavior). Teachers’ own social and emotional competencies (e.g. fostering positive teacher–student relationships, and perspective taking) influenced the manner in which they responded to their students’ needs. Findings suggest that critical components may be lacking articulation in the McKinney-Vento Act’s Education for Homeless Children and Youth Program such as guidelines for teacher responsibilities, supports for teachers, and an emphasis not only on children’s academic but also social and emotional needs.

Improving youth mental health through family-based prevention in family homeless shelters

This exploratory study examines changes in suicidal ideation among a sample (N=28) of homeless youth, ages 11–14, residing within family shelters in a large metropolitan area. Changes in suicidal ideation from pretest to posttest are compared across two group approaches to delivering HIV prevention. Youth and their families participating in the HOPE Family Program, incorporating a family strengthening approach, are compared to those receiving a traditional health education-only approach. Multivariate analyses reveal that youth in the HOPE Family Program were 13 times more likely to report a decrease of suicidal ideation. These findings indicate that health education programs integrating a family strengthening approach hold promise for positively impacting mental health outcomes for vulnerable youth.

Cooking, Healthy Eating, Fitness and Fun (CHEFFs): Qualitative Evaluation of a Nutrition Education Program for Children Living at Urban Family Homeless Shelters

We assessed the feasibility of a 15-week nutrition education, physical activity, and media literacy program for children living in urban family homeless shelters. We developed a qualitative monitoring tool to evaluate program process and impact at 2 shelter sites in the Bronx, New York, from 2009 to 2012. Facilitators recorded indications of participants' understanding of intended messages and demonstrations of changes in attitudes and behaviors. Comments, insights, and actions were recorded as they occurred. Facilitators also documented barriers to delivery of content and activities as intended. We used content analysis to examine data for patterns and identify themes. A total of 162 children participated at the 2 shelter sites. Analysis of qualitative data yielded 3 themes: (1) children's knowledge and understanding of content, (2) children's shift in attitudes or intentions, and (3) interpretations through children's life experience. Food insecurity as well as shelter food service and policies were important influences on children's choices, hunger, and sense of well-being. Children's experiences highlighted the need to advocate for shelter policies that adequately provide for children's nutritional and physical activity requirements and foster academic development.

Putting Guidelines Into Practice

To assess improvement in documentation of asthma indicators using the Asthma Toolbox, an asthma decision-making tool developed in accord with National Asthma Education and Prevention Program guidelines. Retrospective medical record review using cross-sectional, independent, random samples. Reviews were conducted for 1-year periods before and after implementation and after revision reflecting 2007 guideline modifications. Two inner-city, federally qualified health center programs providing pediatric primary care to housed and homeless populations. A total of 1246 patients aged 6 months to 18 years with at least 1 asthma visit to a community health center using paper records (n = 600) or a mobile medical program serving family homeless shelters using an electronic health record (EHR; n = 646). Implementation of the Asthma Toolbox incorporated into paper encounter forms and embedded in the EHR to guide providers (ie, physicians and nurse practitioners) through pediatric asthma assessment and management. Documentation of a subset of asthma severity/control measures, emergency department visits, hospitalizations, and percentage of persistent asthmatic patients prescribed controller medications. Documentation of each asthma indicator increased significantly after implementation (χ(2) tests; P < .001 all comparisons) for both programs. Documentation of severity/control increased from 25.5% to 77.5% in paper records and from 11.7% to 85.1% in the EHR (P < .001). Increases were sustained after Asthma Toolbox revision for all indicators. The percentage of patients with persistent/uncontrolled asthma prescribed controller medications reached 96% to 97% in both programs. Use of the Asthma Toolbox, an asthma decision-making tool, significantly increased documentation of pediatric asthma management among providers working in high-disparity, urban primary care settings.