Mental Health Needs of Children Experiencing Homelessness

Mental Health Needs of Children Experiencing Homelessness

By Mary E. Haskett, PhD & Heather Finster, MS
North Carolina State University

We appreciate this opportunity to introduce members of SCCAP to an area of research, practice, and advocacy in which few psychologists are engaged—family and young child homelessness. This is an area in which the research, intervention, and advocacy expertise of members is desperately needed.

Why should we be engaged?

Homelessness among infants, toddlers, and preschool-aged children occurs at alarming rates. According to the most recent US Department of Education report, Early Childhood Homelessness State Profiles (2021), nearly 1.3 million children under age 6 experienced homelessness during the 2018-19 school year; that is 6% of all young children. National point-in-time data indicate that homelessness among families increased 16% between 2020 and 2023. Nearly three of every 10 people experiencing homelessness (28% or roughly 186,100 people) did so as part of a family with children (U.S. Department of Housing and Urban Development, 2023).

Experts in public health view homelessness as an adverse childhood experience (Mersky, Janczewsko, & Topitzes, 2017; Radcliff, Crouch, & Strompolis, 2019). The developmental risk factors that these children commonly experience include inadequate prenatal care, crowded and unsafe living circumstances, transience and disrupted family routines, food insecurity, poor nutrition, and lack of access to preventive healthcare (Nilan, Rapp, & Haskett, 2023). In addition, homelessness is associated with traumatic experiences such as exposure to family and neighborhood violence (Cowan, 2014). Parent history of adverse childhood experiences and mental health challenges also contributes to children’s difficulties (Herbers, et al., 2020).  Systemic oppression and long-standing racial inequities and disparities are also at the root of homelessness and related experiences, and these structures exacerbate the long-term impact of homelessness (Benson-Goldsmith et al., 2024; Carter, 2011; Olivet, et al, 2021).

Given the adversity faced by children who experience homelessness, it follows that homelessness in early childhood is associated with developmental delays (Haskett, Armstrong, & Tisdale, 2015), mental health challenges and emotion dysregulation (Herbers et al., 2014), and poor physical health (Cutts et al., 2011). Despite elevated risk for these outcomes, there is strong evidence of resilience among young children who experience homelessness (Cutuli et al., 2013; Herbers, Cutuli, Keane, & Leonard, 2020). Therefore, factors known to be associated with resilient functioning—including warm & nurturing caregiving and high-quality early childhood services—must be promoted.

How can we be engaged?

Early childhood services can change the trajectory of young children’s lives, especially when those programs use a two-generation approach. Indeed, caregivers are the key to their children’s resilience. The most well-supported protective factor known to mitigate the potential negative impact of homelessness is responsive parenting (Cutuli & Herbers, 2014). One of the mechanisms through which responsive parenting impacts children’s resilience is coregulation that occurs when parents are sensitive and warm. That is, responsive parenting sets up coregulation opportunities for children to acquire self-regulatory skills that are foundational for their social-emotional competence (DePasquale, 2020; Herbers et al., 2011, 2014).

Many parents with unstable housing maintain bonds with their children and engage in sensitive parenting practices (Gewirtz et al., 2009; Holtrop et al., 2015). In fact, using the Five-Minute Speech Sample method, we found positive features of parents’ approach to child rearing that should be respected and used to strengthen their parenting challenges (Owens, Stokes, & Haskett, 2022). Parenting challenges stem from life circumstances that increase stress, erode parenting quality, and negatively impact the parent–child relationship and, ultimately, children’s well-being. Using evidence-based parenting programs would be a reasonable approach to support these parents but there is sparse research in this area (Haskett, Loehman, & Burkhart, 2016). We have seen positive impacts of Triple P-Positive Parenting Program seminars (Haskett, Armstrong, Neal, & Aldianto, 2018) and discussion groups (Armstrong, Owens, & Haskett, 2021) for families residing in shelters. Although parents appreciated Triple P seminars, they also recommended adaptations of the material and presentation mode to accommodate life in shelters. Given their unique living situation, we must listen closely to parents to understand what they need and want in terms of parenting support (Holtrop, et al., 2015). My Baby’s First Teacher, a program designed specifically to meet the needs of families with young children in shelters has been developed and tested (Herbers, et al 2020). This area of research is ripe for investigations and is increasingly important given high rates of homelessness and clear evidence of the protective nature of parental warmth.

As noted above, high-quality early childhood services can change the developmental trajectory of young children who have experienced adversity. Because homelessness creates barriers to accessing and participating in home visiting/parent education programs and high-quality early childhood programs, very few unhoused children benefit from these services (Dworsky, Carreon, Griffin, & McDaniel, 2022). In fact, a recent report by School House Connection (2022) shows that only about 7% of infants and toddlers experiencing homelessness are served by early childhood programs. Understanding the barriers that homeless families face in accessing early childhood programs can help us be stronger advocates and more effective in delivery of services (Finster, Buccelli, Hobbs, & Haskett, 2023). One of the most common barriers is lack of awareness among service providers that families that are doubled up (i.e., shared living arrangements) meet the definition of homeless; outreach is often restricted to families in shelters and other formal housing programs. High mobility of families in homeless situations is another service barrier; if these families are not given priority, they tend to be “lost” by the time they reach the top of waitlists. Finally, families experiencing homelessness often do not have vehicles or funds to pay for public transportation. Home-based services might be best for these families; of course, their living circumstances can make home-based services challenging. This is where psychologists and early childhood providers apply creativity and flexibility in serving families “on their terms and on their turf” is needed.

The majority of studies conducted to gain understanding of families and young children experiencing homelessness are carried out in shelters or supportive/transitional housing, but most children experiencing homelessness are not living in those settings. Many communities across the country do not even have those resources available. Instead, approximately 75% of children who experience homelessness live temporarily in doubled-up situations with other families. These are crowded, tenuous, highly stressful situations, with the constant threat of being asked to leave on a moment’s notice without other options for shelter. Families in doubled-up circumstances are rarely included in research studies because they are difficult to identify and tend to be invisible in our communities. This leaves a huge gap in understanding the experience of homelessness. Because Head Start and Early Head Start programs are required to prioritize enrollment for families that qualify based on homelessness, data sets including children in Head Start can be excellent sources of data on children living doubled-up. One such data set is the Head Start CARES data. Housing status is available for the children in this rich data set, and it has been productive for our research team (Haskett, Neal, & Norwalk, 2020).

The pandemic exacerbated risks to homeless children and their parents. The pandemic also exposed pre-existing problems in access, equity, and quality of both housing and early childhood services systems. We must accelerate efforts to support families and young children experiencing homelessness because the cost of inaction is much too high to tolerate. We hope SCCAP members might be motivated to serve this population, conduct research to contribute to positive outcomes for the children, and advocate for decreased barriers and increased services for families struggling with unstable and unsafe housing. Psychologists interested in advocacy for young children experiencing homelessness can view a recent Action Plan for an Early Childhood Homelessness Support System we developed with our colleagues for the state of North Carolina. Most of the recommendations in that plan are relevant across the U.S.

References

Benson-Goldsmith, M. E., Gildea, B., Richards, T. N., Roley-Roberts, M. E., Greenberg, P., & Hobbs, A. (2024). An Exploratory Analysis of Domestic and Intimate Partner Violence Victimization Among Persons Experiencing Eviction. Violence Against Women, 0(0). https://doi.org/10.1177/10778012231225231

Carter, G. R. (2011). From exclusion to destitution: Race, affordable housing, and homelessness. Cityscape: A Journal of Policy Development and Research,13(1), 33–70. https://www.jstor.org/stable/20868768

Cowan, B. A. (2014). Trauma exposures and mental health outcomes among sheltered children and youth. In M. E. Haskett, S. Perlman, & B. A. Cowan (Eds.) Supporting families experiencing homelessness: Current practices and future directions. NY: Springer Science + Business Media pp. 37-55.

Cutts, D. B., Meyers, A. F., Black, M. M., Casey, P. H., Chilton, M., & Cook, J. T. (2011). US housing insecurity and the health of very young children. American Journal of Public Health, 101, 8, 1508-1514. https://doi/org/10.2105/AJPH.2011.300139

Cutuli, J. J., Desjardins, C. D., Herbers, J. E., Long, J. D., Heistad, D., Chan, C. K., … Masten, A. S. (2013). Academic achievement trajectories of homeless and highly mobile students: Resilience in the context of chronic and acute risk. Child Development, 84, 841 – 857. doi:10.1111/cdev.12013

Cutuli, J. J., & Herbers, J. E. (2014). Promoting resilience for children who experience family homelessness: Opportunities to encourage developmental competence. Cityscape: A Journal of Policy Development and Research, 16, 113 – 140.

Dworsky, A., Carreon, E., Griffin, A. M., & McDaniel, B. (2022). Home visiting with families experiencing homelessness. Chapin Hall at the University of Chicago.   https://www.chapinhall.org/wp-content/uploads/HVHF-Evaluation-Final-Report.pdf 

Finster, H., Buccelli, A., Hobbs, E., & Haskett, M. E. (2023). In parents’ words: Reflections on the social-emotional health system for young children experiencing homelessness. Social and Emotional Learning: Research, Practice, and Policy, 3, 10023 https://doi.org/10.1016/j.sel.2023.100023

Haskett, M. E., Armstrong, J. M., Neal, S. C., & Aldianto, K. (2018). Perceptions of Triple P—Positive parenting program seminars among parents experiencing homelessness. Journal of Child and Family Studies, 27, 1957–1967. https://doi.org/10.1007/s10826-018-1016-5

Haskett, M. E., Armstrong, J., & Tisdale, J. (2015). Developmental status and social-emotional functioning of young children experiencing homelessness. Early Childhood Education Journal, 44, 119-125. https://doi.org/10.1007/s10643-015-0691-8

Haskett, M. E., Loehman, J., & Burkhart, K. (2016). Parenting interventions in shelter settings: A qualitative systematic review of the literature. Child and Family Social Work, 21, 272-282. https://doi.org/10.1111/cfs.12147

Haskett, M. E., Neal, S. C., & Norwalk, K. (2020). Variability in social and behavioral adjustment among children in Head Start who are unstably housed. Journal of Education for Students Placed at Risk. http://dx.doi.org/10.1080/10824669.2020.1869554

Herbers, J. E., Cutuli, J. J., Keane, J. A., & Leonard, J. A. (2020).  Childhood homelessness, resilience, and adolescent mental health: A prospective, person‐centered approach. Psychology in the Schools, 57,1830-1844. doi:10.1002/pits.22331

Herbers, J. E., Cutuli, J. J., Lafavor, T. L., Vrieze, D., Leibel, C., Obradovic, J., & Masten, A. S. (2011). Direct and indirect effects of parenting on academic functioning of young homeless children. Early Education and Development, 22, 77–104. https://doi.org/10.1080/10409280903507261

Herbers, J. E., Cutuli, J. J., Monn, A. R., Narayan, A. J., & Masten, A. S. (2014). Trauma, adversity, and parent-child relationships among young children experiencing homelessness. Journal of Abnormal Child Psychology, 42, 1167–1174. https://doi.org/10.1007/s10802-014-9868-7

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, 420–430. https://doi.org/10.1037/h0099843

Herbers, J. E., Cutuli, J. J., Fugo, P. B., Nordeen, E. R., & Hartman, M. J. (2020). Promoting parent–infant responsiveness in families experiencing homelessness. Infant Mental Health Journal, 41(6), 811-820. doi: 10.1002/imhj.21868

Herbers, J. E., & Henderson, I. (2019). My Baby’s First Teacher: Supporting parent-infant relationships in family shelters. ZERO TO THREE, 39 (4), 35-41.

Holtrop, K., Chaviano, C. L., Scott, J. C., & Smith, S. M. (2015). Identifying relevant components to include in a parenting intervention for homeless families in transitional housing: Using parent input to inform adaptation efforts. American Journal of Orthopsychiatry, 85, 600–611. https://doi.org/10.1037/ort0000111

Mersky, J. P., Janczewsko, C. E., & Topitzes, J. (2017). Rethinking the measurement of adversity: Moving toward second-generation research on adverse childhood experiences. Child Maltreatment, 22; 58-68. https://doi.org/10.1177/1077559516679513

Nilan, D., Rapp, N. G., & Haskett, M. E. (2023). Family homelessness: The dilemma of invisible families. In R. Denby-Brinson & C. Ingram (Eds), Compendium of policy and practice: Approaches to child and family protection. Washington DC: CWLA Press.

 Olivet, J., Wilkey, C., Richard, M., Dones, M., Tripp, J., Beit-Arie, M., Yampolskaya, S., & Cannon, R. (2021). Racial Inequity and Homelessness: Findings from the SPARC Study. The ANNALS of the American Academy of Political and Social Science, 693(1), 82-100. https://doi.org/10.1177/0002716221991040

Owens, C. R., Stokes, M. K. N., & Haskett, M. E. (2022). ‘I just want my parenting to be able to be better than what it is’: A qualitative exploration of parenting strengths and needs of mothers experiencing homelessness. Child & Family Social Work, 1–12. https://doi.org/10.1111/cfs.12924

Radcliff, E., Crouch, E., Strompolis, M., & Srivastav, A. (2019). Homelessness in childhood and adverse childhood experiences (ACEs). Maternal and Child Health Journal 23, 811–820. https://doi.org/10.1007/s10995-018-02698-w

SchoolHouse Connection (2022). Infants and Toddlers Experiencing Homelessness: Prevalence & Access to Early Learning in Twenty States. https://schoolhouseconnection.org/wp-content/uploads/2022/11/SHC_Infant-and-Toddler-Homelessness_2022.pdf

U.S. Department of Housing and Urban Development (2023). The 2023 Annual Homelessness Assessment Report (AHAR) to Congress: Part 1: Point-in-Time Estimates of Homelessness. https://www.huduser.gov/portal/sites/default/files/pdf/2023-AHAR-Part-1.pdf