Housing is a Human Right
Every individual in our society should be guaranteed a secure home as a basic human right. A lack of access to safe and stable housing is a barrier to economic independence, quality health care, and social support for those in society already facing vulnerability.
At the start of 2020, the National Alliance to End Homelessness estimated that, on any given night, more than half a million people in the United States experienced homelessness—and about 30% of those people were families with children. These numbers were gathered just prior to the COVID-19 pandemic. While the full impact of the economic consequences of the pandemic is not yet clear, a survey conducted the week following the end of the federal eviction moratorium (August 18-30, 2021) indicated that an estimated 3.7 million people report facing some form of housing insecurity.
Families experiencing homelessness are similar to other families living in poverty. These families tend to be headed by young single women with limited education. Approximately 80% have been victims of domestic violence. They have other challenges as well, including exposure to community violence and high rates of mental illness. According to the United States Interagency Council on Homelessness, they may have less access to housing subsidies and supportive services and weaker social networks.
For children, the experience of being homeless is often stressful and traumatic. Researchers in North Carolina found that these children are exposed to circumstances, including violence and chronic poverty, that place them at risk for a range of adverse outcomes, including mental health, health, and academic problems.
Housing First: A permanent housing model
The Housing First (HF) approach is a consumer-driven permanent supportive housing intervention that aims to increase housing stability and has been implemented in a number of countries across the world. Unlike traditional “treatment first” models, the HF approach offers immediate, independent housing to people experiencing homelessness with co-occurring chronic mental health conditions and substance use disorders without requiring them to receive treatment as a prerequisite.
The HF approach is based on the belief that people need access to basic human rights (e.g., food, water, shelter) before they can attend to other needs such as their behavioral health and employment challenges. The HF approach also offers supportive services such as job training, substance use treatment, and health care, but participation in these services is not required as a precondition for housing. Pathways Housing First is one particular model of the HF approach that was created in 1992 in New York City and currently has programs across the U.S., Canada, and Europe.
Position Statement on Family Homelessness
In response to the release of “America’s Youngest Outcasts” in 2009, we joined with the National Center on Family Homelessness to develop a special section on parenting and homelessness in AJO and a position statement (adopted in 2015) on family homelessness.
For newer research on family homelessness from AJO, please see our research highlights below.
What can you do?
- Advocate in your community and state for more affordable housing.
- Learn more about homeless populations in your community and state.
- Organize a network in your community to provide support to homeless children and families.
- Raise awareness in your community and state about the challenges facing homeless populations.
Research on Family Homelessness in AJO
Psychosocial risk exposure in childhood is associated with a greater probability of emotional, behavioral, and academic problems. It is not surprising that children who experience homelessness, a marker of high cumulative risk, show significant emotional and behavioral problems and lower academic achievement than other children, including impoverished children who are not homeless. Nonetheless, some children manifest positive adjustment despite the hazards associated with homelessness, and it is important to identify protective influences that might be targeted for intervention. One potential factor is mastery motivation (MM), or the drive to control and master challenges, theoretically associated with resilience and empirically linked to adaptive cognitive outcomes in low-risk children. Currently, there is little research on MM in high-risk young children overall, and data are particularly limited on the key question of whether MM is associated with better outcomes in domains crucial for school readiness, including socioemotional adjustment, self-regulation, and academic competence. This study examined observed MM in 85 young children ages 3 to 5 living with their parents in an emergency shelter. Children completed behavioral tasks to assess MM, and measures linked with school readiness were assessed directly or by parent report. Higher MM was associated with better social and emotional functioning and emotion regulation but not math achievement or executive functioning. Follow-up analyses indicated that MM was indirectly associated with prosocial behavior through better emotion-regulation abilities. Implications are discussed for further research and for interventions designed to address educational disparities and promote school success for children experiencing homelessness.
Ramakrishnan, J. L., & Masten, A. S. (2019). Mastery motivation and school readiness among young children experiencing homelessness. American Journal of Orthopsychiatry. Advance online publication. https://doi.org/10.1037/ort0000428
This article examines the feasibility of a complex intervention designed to facilitate the transition of youth out of homelessness. It is intended to contribute to efforts to build out the youth homelessness intervention literature, which is underdeveloped relative to descriptive characterizations of risk. The 6-month intervention examined here, referred to as the Housing Outreach Program—Collaboration (HOP-C), is comprised of transitional outreach-based case management, individual and group mental health supports, and peer support. The intervention was delivered through a multiagency, interdisciplinary collaboration. Feasibility was assessed using a mixed methods design that included prepost intervention metrics and the study site was a large Canadian urban center. A total of 31 youth participated in the study with 28 completing the intervention. Overall, implementation and youth engagement was successful though patterns and intensity of engagement were quite variable. While prepost, self-report metrics improved modestly, substantial gains were observed in employment, education, and mental health service connectedness. Qualitative themes focused on the benefits of a flexible, multicomponent approach, close attention to seamless delivery and common factors, and supporting youth in the balance of isolation versus independence. These findings suggested that this tertiary prevention approach is feasible and warrants further investigation.
Kidd, S. A., Vitopoulos, N., Frederick, T., Leon, S., Karabanow, J., & McKenzie, K. (2018). More than four walls and a roof needed: A complex tertiary prevention approach for recently homeless youth. American Journal of Orthopsychiatry. Advance online publication.
Research has neglected the potential role of perceived parental control as a moderator between stressful life events (SLEs) and child-internalizing symptoms. Using secondary data from the Early Risers “Skills for Success” Program (August, Realmuto, Hektner, & Bloomquist, 2001), this study examined the impact of perceived parental control on the association between SLEs and child internalizing symptoms in formerly homeless families. The sample consisted of 137 families with 223 children between 4 and 12 years of age (M = 8.1, SD = 2.3) living in supportive housing sites in Minneapolis, Minnesota. Participants completed measures assessing the number of SLEs experienced (e.g., unemployment of parent, death of loved one, serious illness, homelessness), perceived parental control, and child-internalizing symptoms. In this sample, 65% of children (n = 144) experienced at least 1 SLE with an average experience of 2 SLEs (M = 2.0, SD = 1.9, range = 0–7). A regression analysis found that experiencing more SLEs and a perceived absence of parental control over child behavior were positively associated with child-internalizing symptoms. A significant interaction between SLEs and perceived absence of parental control over child behavior in predicting child internalizing symptoms was also found. These findings suggest that children of parents who model appropriate control are more likely to experience fewer internalizing symptoms in response to SLEs.
Utržan, D. S., Piehler, T. F., Gewirtz, A. H., & August, G. J. (2017). Stressful life events and perceived parental control in formerly homeless families: Impact on child-internalizing symptoms. American Journal of Orthopsychiatry, 87(3), 317-325.
There is a dearth of empirical evidence that addresses how racial minority, sexual minority, and homeless statuses, with their accompanying experiences of stigma and discrimination, are related to mental health in adolescent and young adult populations. The current study addresses this gap by examining the associations between multiple forms of discrimination, depressive symptoms, and suicidality in a sample of 89 Black adolescents and young adults (52% female; 47% nonheterosexual, ages 16–24) experiencing homelessness. Results from a series of ordinary least squares and logistic regressions suggested that perceived homelessness stigma and racial discrimination were associated with higher levels of depressive symptoms, controlling for gender, age, and other types of discrimination, while perceived sexual identity discrimination showed no association. Having ever spent a homeless night on the street, an indicator of homelessness severity, accounted for a substantial amount of the association between homelessness stigma and depressive symptoms. In contrast, suicidality was not significantly associated with any measure of discrimination, homelessness severity, or personal characteristics. We also found no indication that the associations between perceived discrimination targeted at racial and homelessness statuses and mental health differed by sexual minority status. Our results suggest that depressive symptoms and suicidality are prevalent among Black homeless youth, and that depressive symptoms are particularly associated with racial discrimination and indicators of homelessness. The roles of discrimination and a lack of safe housing may be taken into account when designing programs and policies that address the mental health of Black adolescents and young adults experiencing homelessness.
Gattis, M. N., & Larson, A. (2016). Perceived racial, sexual identity, and homeless status-related discrimination among Black adolescents and young adults experiencing homelessness: Relations with depressive symptoms and suicidality. American Journal of Orthopsychiatry, 86(1), 79-90.
Family homelessness has become a growing public health problem over the last 3 decades. Despite this trend, few studies have explored the effectiveness of housing interventions and housing and service interventions. The purpose of this systematic review is to appraise and synthesize evidence on effective interventions addressing family homelessness. We searched 10 major electronic databases from 2007 to 2013. Empirical studies investigating effectiveness of housing interventions and housing and service interventions for American homeless families regardless of publication status were eligible for inclusion. Outcomes included housing status, employment, parental trauma and mental health and substance use, children’s behavioral and academic status, and family reunification. Study quality was appraised using the Effective Public Health Practice Project tool. Six studies were included in this review. Overall, there was some postintervention improvement in housing and employment, but ongoing residential and work stability were not achieved. Methodological limitations, poor reporting quality, and inconsistent definitions across outcomes hindered between-study comparisons. Substantial limitations in research underscore the insufficiency of our current knowledge base for ending homelessness. Although many families were no longer literally homeless, long-term residential stability and employment at a livable wage were not ensured. Developing and implementing evidence-based approaches for addressing homelessness are long overdue.
Bassuk, E. L.; DeCandia, C. J.; Tsertsvadze, A.; & Richard, M. K. (2014). The Effectiveness of Housing Interventions and Housing and Service Interventions on Ending Family Homelessness: A Systematic Review. American Journal of Orthopsychiatry, 84(5), 457-474.
A disproportionate number of lesbian, gay, bisexual, and transgender (LGBT) youth experience homelessness each year in the United States. LGBT youth who are homeless have particularly high rates of mental health and substance use problems, suicidal acts, violent victimization, and a range of HIV risk behaviors. Given the intense needs of LGBT youth experiencing homelessness, it is imperative to understand their unique experiences and develop responsive practices and policies. The range and severity of health risks vary across subgroups of all homeless LGBT youth, and because the population is nonhomogeneous, their particular needs must be identified and addressed. Thus, the purpose of this article is to review the causes of homelessness among LGBT youth, discuss the mental health and victimization risks faced by this population, address differences among homeless LGBT subgoups, and recommend effective interventions and best practices. The authors conclude by discussing promising future research and public policy directions.
Keuroghlian, A. S., Shtasel, D., & Bassuk, E. L. (2014). Out on the street: A public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless. American Journal of Orthopsychiatry, 84(1), 66-72.
The role of effective parenting in promoting child executive functioning and school success was examined among 138 children (age 4 to 6 years) staying in family emergency shelters the summer before kindergarten or 1st grade. Parent–child coregulation, which refers to relationship processes wherein parents guide and respond to the behavior of their children, was observed during structured interaction tasks and quantified as a dyadic construct using state space grid methodology. Positive coregulation was related to children’s executive functioning and IQ, which in turn were related to teacher-reported outcomes once school began. Separate models considering parenting behavior demonstrated that executive function carried indirect effects of parents’ directive control to school outcomes. Meanwhile, responsive parenting behaviors directly predicted children’s peer acceptance at school beyond effects of executive function and IQ. Findings support theory and past research in developmental science, indicating the importance of effective parenting in shaping positive adaptive skills among children who overcome adversity, in part through processes of coregulation.
Herbers, J. E., Cutuli, J. J., Supkoff, L. M., Narayan, A. J., & Masten, A. S. (2014). Parenting and coregulation: Adaptive systems for competence in children experiencing homelessness. American Journal of Orthopsychiatry, 84(4), 420-430.
The experience of homelessness can pervade multiple levels and facets of a child and family’s world. In view of the historical risks in the lives of children who are experiencing homelessness (e.g., growing up under conditions of poverty, exposure to family violence), it is clear that interventions, services, and supports need to be equally comprehensive to have a positive influence on child functioning and development. Consequently, service systems, providers, and community supports need to address the circumstances of children and families experiencing homelessness and, more specifically, better attend to their ecologies and the diverse factors that can affect their well-being and adjustment trajectories. Such an approach is needed to better understand the range of factors and influences on the development and adaptation of these youngsters at home, at school, and with their peers as well as to guide the identification and implementation of adequate family-centered services and supports.
Kilmer, R. P., Cook, J. R., Crusto, C., Strater, K. P., & Haber, M. G. (2012). Understanding the ecology and development of children and families experiencing homelessness: Implications for practice, supportive services, and policy. American Journal of Orthopsychiatry, 82(3), 389-401.
Recent national reports suggest that nearly 1,000,000 families with children experience homelessness and that this number is rising (National Center on Family Homelessness, 2009; U.S. Conference of Mayors, 2010; U.S. Department of Housing and Urban Development, 2011). Families experiencing homelessness are disproportionately more likely to have experienced economic, health, and social risk factors. These experiences can adversely influence the parent-child relationship. The purpose of this article is to (a) review the literature on the determinants and contextual issues of parenting in shelters; (b) describe specific programs that are focused on positive parenting in the context of homelessness; and (c) provide practice, research, and policy recommendations for supporting positive parenting among families living without homes.
Perlman, S., Cowan, B., Gewirtz, A., Haskett, M., & Stokes, L. (2012). Promoting positive parenting in the context of homelessness. American Journal of Orthopsychiatry, 82(3), 402-412.
Pregnancy rates among young women who are homeless are significantly higher than rates among housed young women in the United States (J. M. Greene & C. L. Ringwalt, 1998). Yet, little research has addressed mental health or risk and resilience among young mothers who are homeless. Based on a sample from the Midwest Longitudinal Study of Homeless Adolescents, this study explores pregnancy and motherhood in unaccompanied homeless young women over a period of 3 years. The data are supplemented by in-depth interviews with a subset of young women. Results show that almost half (46.4%) of sexually active young women who are homeless (n = 222, Mage = 17.2) had been pregnant at baseline. Among those who stated they had children between Waves 2 and 13 (n = 90), only half reported caring for their children consistently over time, and one fifth reported never seeing their children. Of the participants with children in their care at the last interview (Wave 13), almost one third met criteria for lifetime major depressive episode, lifetime posttraumatic stress disorder, and lifetime drug abuse, and half met criteria for lifetime antisocial personality disorder. Twelve-month diagnoses are also reported. The impacts of homelessness on maternal and child outcomes are discussed.
Crawford, D. M., Trotter, E. C., Hartshorn, K. J. S., & Whitbeck, L. B. (2011). Pregnancy and mental health of young homeless women. American Journal of Orthopsychiatry, 81(2), 173-183.
Approximately 1.5 million children experience homelessness in America each year. The current economic recession and staggering numbers of housing foreclosures have caused the numbers of homeless families to increase dramatically. The impact of homelessness on families and children is devastating. Without a place to call home, children are severely challenged by unpredictability, dislocation, and chaos. Homelessness and exposure to traumatic stresses place them at high risk for poor mental health outcomes. Despite the pressing needs of these children, federal policy during the last decade has focused primarily on chronically homeless adult individuals—to the exclusion of the families. In 2010, however, the U.S. Interagency Council on Homelessness issued a comprehensive plan to eradicate homelessness for all people through interagency collaboration and aligning mainstream services. A key goal is to prevent and end homelessness for families, youth, and children within 10 years. This policy‐focused article describes several tools that can be used to help achieve this goal, including: general principles of care for serving homeless families and children; BSAFE—a promising practice that helps families access community‐based services and supports; and the Campaign to End Child Homelessness aimed at action on behalf of homeless families and children at the national, state, and local levels.
Bassuk, E. L. (2010). Ending child homelessness in America. American Journal Of Orthopsychiatry, 80(4), 496-504.