Family Homelessness In America

More Families Are Homeless Family homelessness, once viewed as episodic and situational, has become chronic, with families The number of families experiencing homelessness accounting for 37% of the overall homeless population is greatest in America compared to all other and 50% of the sheltered population (HUD, 2014). Family homelessness industrialized nations (National Center on Family The 2014 U.S. Housing and Urban Development Homelessness, 2011) and has now reached historic is a growing social (HUD) Point-In-Time (PIT) count of people who are proportions (Bassuk, DeCandia, Beach, & Berman, homeless on a single night in January—using HUD’s problem affecting 2014). Family homelessness is a growing social literal definition of homelessness (e.g., families in problem affecting families in every state. More than emergency shelter, transitional or supportive housing, families in every state. 2.5 million children, many below the age of six, are and safe havens, or families living in places not homeless each year (Bassuk, DeCandia, Beach, & meant for human habitation such as cars, parks, and Berman, 2014). Despite these staggering figures, One in five families abandoned buildings)—reported that 216,261 family comprehensive strategies to end family homelessness members were homeless. Of these, 23% (135,701) is now headed by a have not been implemented, and the nature and mix were children under the age of 18 (HUD, 2014). Given of housing options coupled with services and supports woman alone. the voluntary nature of the PIT count that misses many continues to be debated. These families are communities and does not include families doubled- With the exception of the Great Depression, family up with neighbors, acquaintances, and sometimes at greatest risk of homelessness first surfaced as a significant social strangers, this is an undercount that sets a floor on the problem in the 1980s (Burt, 1992). Driven by the number rather than a ceiling. becoming homeless. lack of a national housing policy, decrease in federal Using the definition of family homelessness in the assistance to the poor, and the dramatic growth education subtitle of the McKinney-Vento Act, the in female-headed households that shifted millions U.S. Department of Education reported that more of families into poverty, the number of families than 1.2 million school-aged children were homeless experiencing homelessness has steadily increased. during the 2012-2013 school year, and 1.4 million in Now, one in five families is now headed by a woman the next school year (U.S. Department of Education, alone (U.S. Census Bureau, 2009-2013); these families 2014, 2015). Adding the number of homeless children are poorer than traditional families, elderly individuals, in the U.S. who were not yet school aged in 2013, and those who are disabled—and are at the greatest almost 2.5 million children (2,483,539) were homeless risk of becoming homeless. in America in 2013 (Bassuk, DeCandia, Beach, & Berman, 2014).

8 Services Matter A typical homeless family is comprised of a single capacity to parent and support their families. Stressed Family Homelessness mother with her two young children (Burt et al., by their circumstances, mothers experiencing 2000). Most mothers head their households alone, homelessness have much higher rates of major and have limited education and few job skills or work depressive disorders compared to the general female experience (Bassuk et al., 1996; Hayes, Zonneville, population. Approximately 12% of women from all 37% & Bassuk, 2013). Early research estimates that 26 socioeconomic groups are depressed (Grote, Zuckoff, percent of the mothers are young parents under the Swartz, Bledsoe, & Geibel, 2007; Kessler et al., 2003). age of 25 (Burt, 1999), and recent national estimates This percentage approaches 25% for those living in find 22 percent of adults in sheltered families are poverty and for ethnic/racial minorities (Grote et al., Percentage of Families between the ages of 18 and 30, compared with 2007; Kessler et al., 2003), and 40% to 60% for low- in Overall Homeless population just 15 percent of adults in U.S. families (HUD, income mothers with young children, and pregnant 2011). A family’s loss of housing primarily results and parenting teens (Knitzer, Theberge, & Johnson, from the large gap between income and rent. 2008). Among mothers who are homeless, lifetime The unavailability of housing vouchers, combined rates of depression range from 45% to 85% (Bassuk with low-paying employment, scarce educational et al., 1996, 1998; Weinreb et al., 2006; Bassuk & % opportunities, interpersonal violence, lack of Beardslee, 2014). 50 childcare and transportation, and health and mental Maternal depression and its co-occurring disorders health problems compound this problem. Last year, can interfere with obtaining and maintaining housing the federal government provided only about 17,000 Percentage of Families and services, and limit a mother’s ability to become Section 8 vouchers to meet the housing needs of in Sheltered Homeless population self-sufficient and parent effectively. A mother’s health hundreds of thousands of families experiencing or and wellbeing also significantly impact her children’s vulnerable to homelessness. growth and development (Shonkoff & Meisels, More than 90% of homeless mothers report they 2000; Shonkoff & Phillips, 2000; Bassuk & Beardslee, had been physically and/or sexually abused over their 2014). Children living with a depressed parent have lifetimes (Bassuk et al., 1996; Hayes et al., 2013). poorer medical, mental health, and educational 51% As a result of extreme poverty combined with the outcomes (Center on the Developing Child at Harvard high rates of traumatic stress, many mothers develop University, 2009; Knitzer et al., 2008; National clinical depressions that often are unacknowledged Research Council & Institute of Medicine [NRC & IOM], of Children Experiencing and untreated. Depression may compromise their 2009a). Depression adds to a mother’s difficulties Homelessness Are Age Five and Under American children parenting, and may compromise her children’s growth, Failure of the Federal Response 1 in 30 experience homelessness development, and school readiness (Knitzer et al., The federal homeless service system was created by 2008). the federal McKinney-Vento Homeless Assistance Act One in 30 American children experience homelessness of 1987 and subsequently reauthorized (Pub. L. 100- annually; 51% are under age five (Bassuk, DeCandia, 77, July 22, 1987, 101 Stat. 482, 42 U.S.C. § 11301 Beach & Berman, 2014). Children who are homeless et seq.). It provided a range of services that enhanced experience high rates of physical and mental shelter programs. In 2009, it was consolidated into health problems, and delayed development in early the Continuum of Care (CoC) Program. The CoCs childhood (Bassuk, Volk, & Olivet, 2010; Bassuk, represented all homeless service stakeholders within Richard, & Tsertsvadze, 2015; Haskett, Armstrong, designated geographic areas who were charged & Tisdale, 2015). Ten percent to 26% of homeless with overseeing system and service development. preschoolers have mental health problems requiring They were specifically responsible for system clinical evaluation. This increases to 24% to 40% design and management, and resource allocation. among homeless school-age children—two to four Homeless assistance programs were organized times higher than low-income children aged 6 to according to residential options—rather than to 11 years (Bassuk, Tsterverde, & Richard, 2015). services and supports—and included emergency of Homeless Homeless children struggle to attend school regularly. shelters, transitional housing, and permanent Mothers Many change schools during the academic year, fall supportive housing (HUD, 2015), Partially depending More than Report academically behind their peers, are subject to higher on resources, programs for homeless families vary Physical and/ rates of school discipline, and drop out of school considerably across communities. 90% or Sexual more frequently (Buckner, Bassuk, & Weinreb, 2001; Abuse In the last 15 years, federal policies focused on Fantuzzo et al., 2012; Fantuzo & Perlman, 2007; ending chronic homelessness and, more recently, Obradovic et al., 2009; Institute for Children and ending homelessness among veterans. The primary Poverty, 2008). strategy has been to rapidly re-house people using Housing First approaches; this is based on the belief that housing is a right to be extended without any other requirements such as sobriety or lack of criminal involvement. The Corporation for Supportive Housing reported that more than 80% of supportive housing residents maintained their housing for at least a its goal of ending family homelessness by 2020. A typical homeless year and tended to engage in services even though Changes to the plan most relevant to families focus on these were not mandated (Barrow et al., 2004). In expanding and adopting “evidence-based Medicaid family is comprised the federal Collaborative Initiative to End Chronic behavioral health services for children and youth,” of a single mother Homelessness, participants showed improved housing evidence-based home visitation and prevention to stability, had fewer days of homelessness, used public preserve family attachments, and tools to assess with her two housing less, and had reduced health care costs child development (USICH, 2015b). These efforts (Mares & Rosenheck, 2010). aim to keep families together and support early young child development. They may signal the beginning In 2009, “Opening Doors,” the first strategic plan children. of strategies that will reduce the gap between the to prevent and end homelessness was issued by the science of child development and policies for homeless United States Interagency Council on Homelessness children and families (American Academy of Pediatrics, [USICH] (USICH, 2010). Until “Opening Doors,” the 2006, 2007, 2010; Center on the Developing Child, needs of homeless families, youth, and children had 2010; Cronholm et al., 2015; Haskett et al., 2015; not been a federal priority, and the role of services Moodie et al, 2014; National Scientific Council on the and supports in attaining residential stability had Developing Child, 2015; Shonkoff & Phillips, 2000). been disputed. Representing 19 federal agencies, this Although the 2015 amendment takes a small step plan provided a roadmap for ending homelessness by forward, mainstream mental health services cannot promoting interagency collaboration, strengthening meet the needs of homeless families. Treatment is public and private partnerships at state and local limited by an absence of evidence-based interventions levels, and aligning mainstream resources. Progress for this subgroup (Bassuk, DeCandia, Tsertsvadze, has been made in reducing chronic and veteran & Richard, 2014), lack of availability of services and homelessness by “developing the ‘technology’ of access to care (Hayes & DeCandia, 2012; Stagman & combining permanent housing and a pipeline of Cooper, 2010; Shipman & Taussig, 2009). support services,” advocating for congressional support, and prioritizing funding for these initiatives As described by the USICH (2010), housing is essential (USICH, 2010). for ending homelessness. It is also the platform from which services can be accessed: The most recent update of “Opening Doors” (USICH, “…stable housing is the foundation upon which 2015a) delayed its original goal of ending chronic people build their lives. Absent a safe, decent, homelessness from 2015 to 2017, but maintained “Stable housing affordable place to live, it is next to impossible to effects doesn’t exist” (Herbers & Cutuli, 2014, p. achieve good health, positive educational outcomes, 203). A recent systematic review that appraised and provides an ideal or reach one’s economic potential. Indeed, for synthesized evidence on effective housing and service platform for the many persons living in poverty, the lack of stable interventions addressing family homelessness also housing leads to costly cycling through crisis-driven reported substantial limitations in our knowledge base delivery of health systems like emergency rooms, psychiatric hospitals, (Bassuk, DeCandia, Tsertsvadze, & Richard, 2014). detox centers, and jails. By the same token, stable Preliminary research from other studies along with the care and other social housing provides an ideal platform for the delivery experience of frontline providers in the field suggest of health care and other social services focused on services focused that housing is critical, but for many families housing improving life outcomes for individuals and families. alone is not sufficient for ensuring ongoing residential on improving life Researchers have focused on housing stability as an stability, self-support, and well-being of family important ingredient for the success of children and members (Bassuk & Geller, 2006; Bassuk, DeCandia, outcomes for youth in school. When children have a stable home, Tsertsvadze, & Richard, 2014). The role of services has they are more likely to succeed socially, emotionally, individuals and remained a hotly debated area with many, including and academically.” (p.7) families.” USICH, contending that homelessness should function Although there is consensus about the essential only as a “crisis response system” with services having USICS Opening Doors, 2010 role of housing and the need for selected supports little place because they have limited impact on for various subgroups of families, the nature and immediate outcomes (USICH, 2015a & b). Because of mix remains uncertain. The evidence for effective sharply differing perspectives and a dearth of research strategies to address family homelessness is extremely findings, the role of services in addressing family limited (Bassuk, DeCandia, Tsertsvadze, & Richard, homelessness requires a much closer look. 2014), with no practices recognized in the evidence- Additional information is now available with based practice registries (Herbers & Cutuli, 2014). publication of initial data from the Family Options A critical review in 2011 of programs targeted to Study: Short Term-Impacts of Housing and Service homeless families and children indicated that no Interventions for Homeless Families (HUD, 2015)—the studies had sufficient evidence to be rated as having first large scale randomized control trial investigating positive effects that met the guidelines of the What what housing and service interventions work best for Works Clearinghouse Standards for Evidence-Based families experiencing homelessness. The goal of the Practices. The authors noted: “In most cases, this is study was to investigate the types of housing and because quality evidence that evaluates the program service interventions that work best for homeless was the most expensive. Based on these findings, For many families families. The study enrolled 2,282 families in 12 the researchers concluded that “for most families, communities, randomly assigning them to three homelessness is a housing affordability problem that housing alone is not interventions—permanent housing subsidies (SUB), can be remedied with permanent housing subsidies sufficient for ensuring community-based rapid re-housing (CBRR), project- without specialized homeless-specific psychosocial based transitional housing (PBTH), and comparing services” (HUD, 2015). ongoing residential each of these to one another and to usual care (UC). While the exploration of housing options in this study Many outcomes were investigated but the researchers stability, self-support, was meticulously investigated, the findings about the focused on housing stability, family preservation, self- impact of services fell short due to the study design. and well-being of sufficiency, adult wellbeing, and child wellbeing The nature, frequency, intensity, and duration of (HUD, 2015). family members. services in the four interventions were not specifically Reporting on data from 20-month follow-up after described across the agencies in the 12 communities. enrollment, the study found that homeless families Although specific attention was focused on case who were given priority access to subsidies had the management, the services provided were inadequately largest improvement in housing stability, and that described. Given this limitation, the conclusion benefits extended to various outcomes of wellbeing that “homeless specific psychosocial services” are (e.g., decreased family separations, decreased unnecessary goes beyond the existing data. Additional domestic violence, less psychological distress, research is necessary to determine the nature and increased school attendance, fewer schools attended, mix of services, how they should be bundled with and increased food security). The only adverse finding housing, and how they should be accessed before any was that employment rates among these families definitive conclusions can be reached about the need decreased. In contrast, families randomized to CBRR for services. The overall findings of the Family Options showed no improvement in housing stability and no Study at 20 months support the general consensus other benefits except increased food security and that housing is essential for ending homelessness, but speedier exits from shelter. Those in PBTH showed the study provides far less information about the role some improvement in housing stability but not and impact of services. among those who had been doubled up, and these In a public panel discussion (September, 2015), benefits did not extend to other outcomes. Rapid re- researchers involved in the Family Options Study housing was the least costly intervention, while PBTH joined federal policymakers from HUD and USICH to Recent federal policy discuss the current implications of the study. They Coordinated assessment, also called coordinated acknowledged the importance of the findings in entry, is a federal strategy intended to identify has focused on furthering our evidence base, but were skeptical about families with the most acute needs; a primary goal is resizing the problem mobilizing the public resources necessary to obtain to identify families that need intensive housing and the large number of housing subsidies to end family services that tend to be more costly (e.g., permanent to match available homelessness. They also focused on the accuracy of supportive housing). While prioritizing chronically the findings about rapid re-housing, the least costly homeless individuals and referring them to permanent resources. option, since the study was conducted when rapid re- supportive housing has been effective, research is housing was in its infancy. Much attention was given less clear about how to match the needs of families by HUD and USICH toward working with communities with specific housing alternatives (NAEH & HUD, to learn more about its growth and successes. At 2015). Various tools have been developed to support the same time, because of high cost and limited the coordinated assessment process, including the outcomes, the place of transitional housing was Vulnerability Index-Service Prioritization Decision questioned. Assistance Tool for Families (F-SPDAT) (OrgCode, 2013), and the Alliance Coordinated Assessment Assessment of homeless families is in its infancy. Tool Set (NAEH & HUD, 2015). Many communities Gewirtz and colleagues (2008) reported that the have begun to use the Vulnerability Index-Services homelessness system “lacks infrastructure or expertise and Prioritization Decision Assessment Tool (VI- in children’s mental health” and that many programs SPDAT) (OrgCode, 2013) to drive their coordinated do not routinely screen or assess homeless children or assessment system. Originally developed for mothers (p. 1). Families’ needs across various domains chronically homeless individuals, the family version (e.g., housing, economic self-sufficiency, education, was adapted to assess the needs of homeless parents health, mental health) are not comprehensively with children. Although the Family VI-SPDAT assesses evaluated and children’s needs are infrequently level of risk for homelessness and safety issues, it does addressed (DeCandia, Bassuk, & Richard, in press). not fully address the needs of homeless mothers and Use of standardized assessment instruments is rare children and, therefore, needs to be supplemented (DeCandia, Bassuk, & Richard, in press) as tools are to include missing domains (e.g., maternal mental often lengthy and complex. Currently no evidence- health, child development) (DeCandia, 2015). based assessments or instruments have been developed specifically for homeless children (Bassuk, DeCandia, Tsterverde, & Richard, 2014). Critics of coordinated assessment argue it is a strategy Supports and Services in Family Life All families regardless to manage the “front door” of shelter—a way of All families regardless of their socioeconomic status “diverting’ families from more costly shelter programs of their socioeconomic need supports and services at various points in by restricting their eligibility and, therefore, managing the life cycle and especially during periods where status need supports scarce resources. Although some communities using inevitable life stresses, especially losses, may become coordinated assessment and rapid rehousing report overwhelming. Few people can live alone, isolated and services at various modest gains (Cunningham, 2015; Spellman, 2015), from support, compassion, and instrumental the evidence base is not sufficiently developed to points in the life assistance. Close relationships with friends and family determine how to best stabilize millions of children serve to ease the strains of daily life, and to protect cycle and especially and families (NAEH & HUD, 2015). them in times of economic and social stress. Not during periods Recent federal policy related to homelessness has only do supports ameliorate stress once crises have focused on resizing the problem to match available occurred, they also can prevent crises. where inevitable life resources (e.g., numbers, changes in eligibility), and Support networks are women’s social capital, a to determine the mix of services based on the scarcity stresses, especially resource which poor women and women in crisis of funding rather than addressing the complex needs must often draw upon very heavily. Just as poverty losses, may become of these families. Instead of advocating aggressively has been feminized so has homelessness, with the for increased resources for these families, policies are overwhelming. majority of homeless families being headed by women instead directed to the least costly housing options, alone. Although we have identified many of the risk and to relegating families to mainstream service and protective factors for family homelessness (Bassuk systems despite barriers to obtaining these services. et al., 1997), little attention has been paid to how Federal policymakers seem to view the findings of the economic and personal variables are linked, especially Family Options Study as contributing to the evidence those related to gender issues. These factors are base. At the same time, they predict that the positive bound together in a constellation of difficulties that findings about subsidies will not be implemented must be considered as a synthetic whole (Goodman et at a proper scale because sufficient federal funding al., 2009). Without understanding this interaction, the will not be made available. As a result, policymakers importance of supports in women’s lives, particularly remain focused on rapid re-housing—the least costly those with children, can easily be underestimated intervention—combined with coordinated entry (Abt (Bassuk, 1995). Associates, 2015). Women’s self-esteem is largely defined by their violence, and the housing shortage sometimes connections with family, children, friends, and combine to disrupt relationships and dislocate long- community. Their identity and sense of self is often term residents, destroying networks that have been tightly tied to their sense of responsibility for other years in the making (Bassuk & Rosenberg, 1988). people and their role as caretakers (Belenky, Clinchy, What happens if your child has asthma and you are Goldberger, & Tarule, 1986; Giligan, 1982; Peterson, living far from your extended family, and your child 2000). More recent cross-cultural research extends gets sent home from school in the middle of the day? the study of women’s identity to include how factors If a single mother is working at a service-sector job, such as racism and oppression affect the identities of she may have no flexibility and may have to leave African American women (Peterson, 2000). Homeless during the day to care for her child. If she has too women are devoted to their children as well, and to many absences, she will inevitably lose her job. Even their dual roles as partners and mothers. When this more stressful, if a family has a child with special identity is disrupted by isolation, fragmented supports, needs, the demands escalate, options become more and loss of a home, women feel bereft, despairing, limited, and the family can become overwhelmed, and hopeless. Homeless mothers are quintessentially especially with the absence of other adults to fill in stressed, raising children alone without economic and and provide respite for the parents. social buffers that prevent everyday problems from turning into catastrophes. Research and feedback from the field strongly suggest the importance of supports and services for ensuring Essential supports for women alone with children long-term housing stability for families. In a review might include pediatric and medical care, of studies investigating the role of housing and transportation, childcare, school supports (e.g., services in ending family homelessness, Bassuk and tutoring), and supportive friendships. When these Geller (2006) found “that access to housing vouchers supports are sufficiently depleted, especially in the seems to increase residential stability and that case current housing market, poor women are at increased management and other services also contribute to risk of becoming homeless. Many homeless women residential stability and other desirable outcomes, have exhausted their supports after months and including family preservation and reunification” (p. sometimes years of doubling-up in overcrowded and 1). They also document that studies investigating often substandard apartments, setting the stage the impact of housing and services on families are for entering emergency shelter. For others, poverty, limited, and that most of the existing research does not carefully define the nature, duration, and intensity researchers did not specifically investigate the nature of services necessary to support particular subgroups and role of services other than case management— of families and children. Although the HUD Family and case management was not carefully defined. Options Study supports some of these findings, the