Homeless Families Research Articles

Perceptions of support in shelter environments for caregivers and young children experiencing family homelessness.

Young children who stay with their families in homeless shelters face chronic challenges related to extreme poverty and acute risks from stressful events surrounding the loss of housing and move to shelter. These adversities increase the likelihood of a range of poor developmental outcomes. Consistent with the risk and resilience perspective, however, many children who experience family homelessness succeed, functioning as well or better than their non-homeless peers. As such, efforts to support resilience should consider how best to enhance protective factors, such as supportive environments within shelter settings. With data from 60 caregivers of children ages birth to 5years recruited from family shelters, we assessed caregivers' perceptions of community support as well as child and family well-being in terms of recent adverse experiences, parenting stress, access to social support, and child social-emotional functioning. Many caregivers experiencing family homelessness perceived negative aspects of the shelters where they were staying with their children. Furthermore, children whose caregivers had more negative perceptions of the shelter environment displayed worse social-emotional functioning, even when accounting for differences in parenting stress, recent family adversity, and other sources of social support. Because young children rely on their caregivers as primary resources for nurturance and support, we encourage family homelessness service providers to work in partnership with caregivers to create more inclusive and empowering practices within the shelter context. Doing so is likely to improve children's developmental outcomes and the overall well-being of the families.

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.

A Nurse Practitioner service designed to address the health needs of children living in housing instability: A non-randomised, concurrent mixed methods study protocol.

The study uses a concurrent mixed- method design where both qualitative and quantitative data are collected during the same period (between January 2021 and March 2022 as per the funding timeline). The concurrent mixed-method design will collect data from: A comprehensive assessment tool used by the Nurse Practitioner to evaluate the child accessing specialist homeless services, which assess their mental, physical and social health needs. Documentation about the child's referral needs and uptake by disadvantage families. Interviews with housing insecure families, and staff/managers of the specialist homeless service. A review of Nurse Practitioner case notes. Surveys of families with children accessing the Nurse Practitioner service. Addressing the childhood impacts of family homelessness is of global importance. Structural equation modelling, from the surveys and in-depth health assessments along with the thematic analysis of the interviews with parents and staff/managers provide an understanding of the relationships between referral uptake and variables such as education, homelessness and transport accessibility. Investigating the enablers and barriers to the usual health access and our extended referral uptake impacted by family homelessness enables a better understanding of the current health gaps. Just over one fifth of Australian children live with their families in some form of housing instability including homelessness. These children, aged from birth to 18years, are often disconnected from health and similar social institutions, making them an underserviced population. Our research investigates a Nurse Practitioner services that helps reconnect children with services to help avoid poor long-term health outcomes.

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.

Reasons for non-take-up of social rights by homeless and poor families

Reasons for non-take-up of social rights by homeless and poor families

Children's early school attendance and stability as a mechanism through which homelessness is associated with academic achievement

Unfortunately, family homelessness is a crisis in the United States. The majority of families experiencing homelessness are headed by single mothers and half of children who experience homelessness are less than five years of age. In the current study, we investigated whether children's school attendance and stability mediated the association between early experiences of homelessness (in infancy and toddlerhood) with children's school performance on standardized assessments of math and English language arts administered in the spring of third grade in a sample of children of young mothers. We used a person-centered analytic technique (i.e., repeated measures latent class analysis) to identify three classes of children's patterns of school attendance and stability from kindergarten through third grade that consisted of (a) High Absenteeism, (b) Decreasing Absenteeism, and (c) Low Absenteeism classes. Early experiences of homelessness were directly and indirectly associated with math, but not English language arts scores, through the three identified classes. The results of the current study have important implications for young children who experience homelessness and suggest promoting school attendance as one avenue to support academic achievement. In addition, supporting families and children early (i.e., before they begin pre-kindergarten) will be key in ensuring that young children who experience homelessness are successful in educational environments.

Mitigating the severity of child homelessness in the UK: a global mixed-methods systematic review

BackgroundIn 2019, 585 000 children in England were homeless or at risk of becoming homeless. The pressure of the COVID-19 pandemic on the health-care delivery system has amplified the inequalities faced by marginalised children. Although the UK has had a series of successful health sector reforms, few have designed or implemented strategies that target reach, access, and use of public health services for marginalised children. This project aims to identify such strategies by exploring solutions used in low-income and middle-income countries (LMICs), through reverse-innovation. MethodsWe undertook a systematic review of the literature published in English from PubMed, MEDLINE, and SCOPUS between Jan 1, 2010, and March 31, 2021. We explored the literature focusing on policy, strategy, intervention, and services, using keywords and Medical Subject Headings corresponding to the target population, and medical, health, and nutrition services including preventive and immunisation services, and outcomes. Our target population included homeless and marginalised children. We defined marginality in terms of social distances following Braun and Gatzweiler (2013). We included in our search homelessness, temporary accommodation (eg, makeshift accommodation, emergency shelter, and feral), the conditions that put a child at risk of homelessness (eg, war, battle, conflict, refugee, displaced, and migrant), and the general conditions of social distances (eg, poverty, and financial catastrophe) that do not belong to discrimination. We used the Arksey O'Malley framework with Levene's extension in the aforementioned databases and Google Scholar to improve inclusivity. The primary outcomes included access, coverage, and utilisation of child health and nutrition services. The impact measurements included morbidity, mortality, and economic outcomes (return on investment, cost, and efficiency). We applied natural language processing for thematic analysis of qualitative evidence. The analysis was assisted by Python (v3.7.12). FindingsWe found 53 final articles (47 quantitative and six qualitative) from LMICs. Community-focused and financial interventions were successful in different settings. Financial interventions such as user-fee removal increased health care and service use between 15–309%. Cash transfers increased immunisation coverage, financial security, and nutrition. Mobile health services and the individualised tactics of community midwives and volunteers improved the coverage and use of child health and nutrition services. Community-based savings groups, user-fee removal, and cash transfer policies improved access and utilisation. mHealth applications and capacity building of health workforce increased coverage and quality of these services and improved clinic attendance. InterpretationUK policy makers could adapt and adopt targeted and conditional cash transfer policies to provide greater financial security to homeless families and make child health care more affordable and inclusive. Volunteer and mobile-clinic-based community services would increase access and use of these services in the COVID-19 recovery phase. Our review may have missed matured strategies published before 2010. We were unable to estimate a pooled effect. FundingESRC, UK Research and Innovation rapid response COVID 19.

Ending Child Poverty by Investing in Children and Families.

Ending Child Poverty by Investing in Children and Families.

Exposure to a natural environment to improve parental wellbeing in parents in a homeless shelter: a multiple baseline single case intervention study

ABSTRACT The physical environment of a shelter for homeless families may be a stressful place for parents. Exposure to natural environments might help to improve parental wellbeing. This study tested the impact of personalized exposure to a natural environment on wellbeing of parents residing in shelters. Single-case experiments with three families involved repeated and randomized exposure to the indoor environment of the shelter (baseline phases) and to a natural environment (intervention phases). During exposure, basic psychological need fulfillment in parenting as well as parents’ overall affective state and satisfaction with life were assessed. Exposure to nature significantly increased basic psychological need fulfillment of parents but did not significantly improve affective state nor satisfaction with life. To contribute to parents’ functioning and resilience, professionals may invite families for nature exposure for the support of parents’ basic psychological need fulfillment.

Committed collaboration to address homelessness in the netherlands

Context: In the Netherlands, the number of homeless people increased from 17.800 in 2009 to 39.300 in 2018. Due to the COVID-19 pandemic and its socioeconomic consequences, the needs of marginalized people have increased worldwide in terms of access to services and relevant information. In the Netherlands, along with the Red Cross, other humanitarian organizations such as the Salvation Army, the Rainbow Foundation, and the Foundation for the Homeless are already providing people in need with primary needs such as food and housing, but also with healthcare and legal support. Cooperation between services for the homeless is also gaining attention. However, collaboration between relevant stakeholders is still insufficient and urges to be expanded. Moreover, centralized monitoring is challenging as different services are provided (shelters, assisted housing) by different stakeholders and there is no central data collection system or pre-defined indicators. Recent, comprehensive data on homelessness figures are needed to understand the needs and how these may have changed, given the exacerbated consequences of COVID-19 pandemic on those in socioeconomic vulnerability, in order safeguard the health, safety and dignity of homeless people. Policy Options: To address the needs of homeless people, innovation is needed to overcome sectoral boundaries and to work collaboratively. At the level of service provision, as shown by some successful global experiences (e.g. Homeless Individuals and Families Information System (HIFIS), Housing First, Les Infirmieres de la Rue), new partnerships and collaborations are a central dimension of many effective innovative initiatives relating to homelessness. The target of collaboration is to improve health and social outcomes in the most appropriate and efficient manner. To improve case management at the local level, in Canada, the Homeless Individuals and Families Information System (HIFIS) provides a single platform for homogeneous data collection on clients among service providers that facilitates referrals between services. Recommendations: Approaches to improve cross-sectoral collaboration and communication at two levels should be identified. Firstly, establishing a coordinated and comprehensive cross-sectoral network among organizations in the field and secondly, improving data collection. Acknowledgments: The authors would like to express their sincere thanks to J. Neicun and K. Czabanowska for their support in preparing and revising the policy brief. Authors’ contributions: All authors contributed equally to this work. Conflicts of interest: None declared Funding: None declared

A critical realist methodology in empirical research: foundations, process, and payoffs

ABSTRACT This article describes and evaluates the application of an explicitly critical realist methodology to a quantitative doctoral research project on the causes of family homelessness in Australia. It is offered as an example of a critical realist approach to empirical research, in the hope that it will provide ideas and motivation to other scholars seeking a critical realist foundation to their research practice. The paper demonstrates the role of critical realism in informing and defining the analytical and theoretical approach I took. It shows how the philosophy influenced the foundations and practical development of my work. It describes the process of moving from empirical data to theoretical models by stepping through and describing each stage. Finally, I offer an assessment of how critical realism changed, enabled, improved, and liberated my project; that is, what advantage critical realism offered to explaining a complex social phenomenon and crisis in contemporary Australia.

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.

Leveraging research to inform prevention and intervention efforts: Identifying risk and protective factors for rural and urban homeless families within transitional housing programs.

This mixed method study spotlights hardships and supportive factors for unhoused families led by single mothers who have successfully graduated from two transitional housing programs, one rural and one urban. Data collection consisted of entry and exit surveys (n = 241) as well as qualitative interviews (n = 11). Binary logistic regression results indicated education and social support as significant predictors of successful program completion. Qualitative findings further illustrate narratives surrounding supportive factors and program supports (i.e., assistance securing employment, education courses, sense of community), as well as policy implications. Implications stress the need for enhancing supportive factors (i.e., education and social capital) in early prevention efforts (e.g., schools and community centers), as well as an intentional integration of addressing socio-emotional needs and resources within housing programs and services unique to rural and urban communities.

Dublin's homeless crisis – is this reflected in emergency department psychiatry referrals?

AimsThis study seeks to explore the prevalence and impact of homelessness in an adult sample of psychiatry referrals over a one-month period via the Emergency Department at St. James's Hospital.BackgroundHomelessness has now reached a crisis point in Ireland. In July 2019, there were 10,275 people documented as homeless nationwide, with the number of homeless families increasing by 178% since June 2015. The majority of individuals registered as homeless are located in Dublin. St. James's Hospital (SJH) provides psychiatric care to a population of 136,704 people across Dublin South-City within areas of significant deprivation according to the most recent social deprivation index.MethodAll Emergency Department psychiatry referrals over a one-month period were recorded. Month of study was randomly generated. Data were collected from electronic records. Socio-demographic information was analysed. Data were anonymised and recorded using Microsoft Excel. Current homelessness statistics were accessed from the Department of Housing, Planning, and Local Government and compared to the data collected.ResultDuring the month of the Study (March 2019), 4315 adults accessed emergency homeless accommodation in Dublin. Of the 109 psychiatry referrals received through the Emergency Department at SJH during this time, over a quarter (28%) of those referred reported themselves to be homeless or living in temporary accommodation. An additional 5% were documented as living in residential or sheltered care at time of assessment. All of the referred homeless patients were unemployed (n = 30). 50% of homeless patients were referred to psychiatry following expressed thoughts or acts of self-harm. Illicit drug abuse was associated with 73% of referrals. Alcohol abuse was associated with 47%. Of those who were referred, under a quarter (23%) were assessed as having a major mental illness, and in the majority of these cases, illicit drug and alcohol abuse were compounding factors in exacerbating symptomatology. Of those referred, 66% had previously been reviewed by psychiatry during prior ED presentations and 60% of homeless presenters reported that they had previously been, or were currently linked in with community mental health teams.ConclusionFrequently, vulnerable patients most in need of social and psychiatric care, such as homeless people with addiction issues, are eclipsed from accessing supports. The high proportion of patients reporting to be homeless is cause for concern and suggests the need for tailored and integrated multi-disciplinary assessments and interventions at an Emergency Department level.

Struggling in the Land of Plenty: Race, Class, and Gender in the Lives of Homeless Families

Struggling in the Land of Plenty: Race, Class, and Gender in the Lives of Homeless Families

Health and adverse childhood experiences among homeless youth

BackgroundHomelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health.MethodsUsing data from 119,254 8th–11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates.ResultsThe prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p < 0.001), such that ACE-related health risks were moderated by housing status.ConclusionsACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Experiencing homelessness, whether unaccomapnied or with family, is associated with increased health risk, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.

Demographic, socioeconomic, and sociocultural factors associated with any breastfeeding in homeless mothers.

In high‐income countries, breastfeeding has been shown to be positively associated with socioeconomic position. However, less is known about breastfeeding practices and their associated factors among extremely disadvantaged populations. We aimed to assess the associations of cultural origins and socioeconomic factors with any breastfeeding initiation and duration in homeless families. We analyzed data from 456 children aged 6 months to 5 years from the cross‐sectional ENFAMS survey, conducted in 2013 among a random sample of homeless families in shelters in the Greater Paris area. Data were collected by bilingual interviewers in 17 languages. Four nested multivariable robust Poisson regression models were run in a hierarchical framework to determine the factors associated with breastfeeding initiation and with any breastfeeding for 6 months or more. Most of the children (86.0%) had previously been or were currently being breastfed at the time of the survey; 58.9% were fed with breast milk ≥6 months. A higher maternal age and African origin were positively associated with breastfeeding ≥6 months, although the relation to the region of origin was moderated by education level. Migration to escape war, unrest or other violence and the child's birth in France were inversely associated with breastfeeding ≥6 months. Any breastfeeding by these homeless mothers seems influenced predominantly by their cultural origin and complicated by a difficult migration trajectory. The possible influence of poor material circumstances and cumulative hardship should encourage interventions targeted at homeless mothers that emphasize social/family support with a commitment to improving the family's living conditions.

A Sector Wheel Approach to Understanding the Needs and Barriers to Services among Homeless-Experienced Veteran Families.

Veteran family homelessness is a significant issue, yet little is known about the needs and barriers to services of veteran families experiencing homelessness. This qualitative study examined the experiences, needs, and barriers to services among homeless-experienced veteran families to inform providers for this important population. Twenty-five semi-structured interviews were conducted from February through September 2016 with 18 veteran parents with a recent history of homelessness (9 mothers, 9 fathers), and 7 homeless service providers throughout Los Angeles County. The "Sector Wheel for Under-Resourced Populations" data elicitation approach was used to conduct the interviews, which allowed the participant to guide the interview by discussing different sectors of a family's life affected by homelessness. The interviews were audio-recorded, transcribed, and themes were coded with Atlas.ti. Interviews revealed parenting stress and worsening family mental health during homelessness. Participants described barriers to navigating housing, social, and health services with children, including not knowing where to seek help, difficulty connecting to health and social services in the community, and a lack of family-focused services. Parents encountered discrimination by landlords and lack of access to permanent housing in safe neighborhoods. Findings demonstrate a need for delivering family-centered and comprehensive services to homeless-experienced veteran families that recognize the multifaceted needs of this population. Advocacy initiatives are needed to address discrimination against veterans experiencing family homelessness and increase access to affordable permanent housing in safe neighborhoods for families.

The right to healthy housing

Health visitors are ideally placed to advise government on the plight of homeless families and the significant, enduring impact on the health of children

A winter of despair for homeless families

A winter of despair for homeless families