How Can Schools Help Children from Homeless Families?

ABSTRACT: Families represent the fastest growing subgroup among the homeless in America. Most homeless families are headed by women who lack high school diplomas, have poor work skills, little job training, and are long-term users of Aid to Families with Dependent Children (AFDC). The average homeless family is comprised of two to three children, most of whom are younger than age five. These children suffer from a number of acute and chronic health problems. Once in school, these children often experience developmental and academic delays which increase the potential for school dropout. School districts must address the health and academic challenges these children bring to school. Measures include forming a community-based task force, working with homeless shelters in addressing needs of these families, increasing awareness of faculty and staff, and developing specific classroom/school environment strategies to encourage these children to succeed. Opportunities for involvement by teachers, counselors, and school nurses are noted, and seven strategies to help the homeless child in school are offered.     

The montefiore community children's project: A controlled study of cognitive and emotional problems of homeless mothers and children

Objectives This study compares the prevalence of emotional, academic, and cognitive impairment in children and mothers living in the community with those living in shelters for the homeless. Method In New York City, 82 homeless mothers and their 102 children, aged 6 to 11, recruited from family shelters were compared to 115 nonhomeless mothers with 176 children recruited from classmates of the homeless children. Assessments included standardized tests and interviews. Results Mothers in shelters for the homeless showed higher rates of depression and anxiety than did nonhomeless mothers. Boys in homeless shelters showed higher rates of serious emotional and behavioral problems. Both boys and girls in homeless shelters showed more academic problems than did nonhomeless children. Conclusion Study findings suggest a need among homeless children for special attention to academic problems that are not attributable to intellectual deficits in either children or their mothers. Although high rates of emotional and behavioral problems characterized poor children living in both settings, boys in shelters for the homeless may be particularly in need of professional attention.     

Homeless and housed families in Los Angeles: a study comparing demographic, economic, and family function characteristics.

We studied 196 homeless and 194 housed poor families in Los Angeles, California to gain an understanding of events that precipitate family homelessness. Both homeless and housed poor mothers averaged 29 years old and were accompanied by two or three children. Three-fourths of both the homeless and housed families had income below the poverty level, and both groups expended almost two-thirds of their income on housing. Mothers in homeless families more commonly reported spousal abuse (35 vs 16 percent), child abuse (28 vs 10 percent), drug use (43 vs. 30 percent), or mental health problems (14 vs 6 percent) and weaker support networks. Homeless mothers more commonly came from homes where their parents abused drugs or alcohol (49 vs 34 percent) or more commonly lived outside the home or in foster care (35 vs 25 percent). Homelessness was reported as due primarily to economic pressures of housing costs, but personal and family problems frequently played a contributing role, especially for single parent families. Burdens of increasing housing costs and family dysfunction among housed poor families place many at risk for homelessness.     

Homeless Children: Needs and Services

This study explored needs of homeless children and shelter services available to them. The first phase of this mixed-method study consisted of open-ended interviews of key personnel in six diverse homeless shelters in metropolitan Atlanta, Georgia. This qualitative data gave direction to the creation of a questionnaire used in a larger follow-up survey of shelters in the state of Georgia. Roughly two-thirds of the 102 reporting shelters that served children provided food, clothing, and school supplies with 40% offering some form of transportation. More than 75% of the shelters were full and did not have space currently available for children, with an additional 10% having only one or two available beds. Most of the shelters lacked important services in the areas of medical and developmental assessments, access to education, childcare, and parent training. Forty-seven percent lacked onsite worker training in the characteristics and needs of homeless children. In addition, while the McKinney Act legally mandates ways to serve homeless children, findings indicate that over half of key informants in homeless shelters were unfamiliar with the law.     

Why does family homelessness occur? A case-control study.

We compared 49 homeless female-headed families with 81 housed female-headed families in Boston. Most housed families were living in public or private subsidized housing. In both groups the mothers were poor, currently single, had little work experience, and had been on welfare for long periods. Many of their children had serious developmental and emotional problems. Homeless mothers had more frequently been abused as children and battered as adults and their support networks were fragmented; the housed mothers had female relatives and extended family living nearby whom they saw often. The frequency of drug, alcohol, and serious psychiatric problems was greater among the homeless mothers. The homeless mothers may have been more vulnerable to the current housing shortage because they lacked support in time of need. This, in turn, may have been due to their history of family violence. Psychiatric disabilities may have been another contributing factor in the minority of homeless women. The notion that a "culture of poverty" accounts for homelessness was not supported by the data since the homeless were less likely to have grown up in families on welfare. The data suggest that solutions to family homelessness in the current housing market require an increase in the supply of decent affordable housing, income maintenance, and assistance from social welfare agencies focused on rebuilding supportive relationships.     

Fertility Limitation and Child Schooling in Ouagadougou: Selective Fertility or Resource Dilution?

Using original data collected in Ouagadougou, Burkina Faso, this study investigates evidence for the competing theories that fertility reductions increase children's education through either the quantity–quality tradeoff (intentionally choosing smaller families to make greater investments in education and other indicators of child quality) or resource dilution (having more children reduces resources available per child, regardless of intentionality of family size). The results provide evidence for both hypotheses: children having four or fewer siblings were significantly more likely to be enrolled in school if their mothers had intentionally stopped childbearing relative to those whose mothers wanted more children but whose childbearing was limited by subfecundity. The difference between intentional and unintentional family limitation was not significant for parities greater than five. In addition, the relationship between number of siblings and their schooling is negative, regardless of the intentionality of family‐size limitation, but the strength of this negative relationship is approximately twice as high among children whose mothers intentionally limited fertility (reflecting both selection and dilution effects) than among children whose mothers were subfecund (reflecting the pure dilution effect).     

Transmission of hepatitis B virus from adopted Asian children to their American families.

In 1985, 6,991 Asian children were adopted by Americans. To estimate the risk that such children may transmit hepatitis B virus to their adoptive families, we conducted a cumulative-incidence follow-up study in the State of Washington. We examined the association between having adopted a hepatitis B surface antigen (HBsAg)-seropositive Asian child and serologic evidence of past or present hepatitis B virus infection in adoptive family members. Seven (9 per cent) of 77 family members exposed to an HBsAg-seropositive child had evidence of past or present infection compared with four (2 per cent) of 232 nonexposed (relative risk = 5.3; 90% confidence limits [CL] = 2.0-13.9). The risk was higher for those with prolonged exposure and was entirely restricted to parents.     

Government advice on peanut avoidance during pregnancy – is it followed correctly and what is the impact on sensitization?

BACKGROUND: In 1998, the UK government issued precautionary advice that pregnant or breast-feeding women with a family history of atopy, may wish to avoid eating peanuts during pregnancy and lactation. This study aimed to assess the compliance with this recommendation and investigate its impact upon peanut sensitization. METHODS: A total of 858 children born immediately after the advice were followed for 2 years and assessed for peanut sensitization. A standardized questionnaire was used to ascertain history of atopy and maternal exposure to peanuts during pregnancy. Following parental consent children were skin prick tested to assess sensitization to peanuts. RESULTS: Sixty-five per cent of mothers had avoided peanuts during pregnancy. Forty-two per cent of the mothers had heard about the government advice, and half modified their diet as a consequence. Neither maternal nor family history of atopy had any significant effect on peanut consumption. Parity did play a role, and mothers having their first child were twice as likely to change their diet (P<0.001). Mothers of 77% of the children sensitized to peanuts had avoided peanuts during pregnancy. In this cohort study maternal consumption of peanut during pregnancy was not associated with peanut sensitization in the infant. CONCLUSIONS: The majority of mothers in this cohort avoided peanut consumption during pregnancy. It is likely that either the government advice is misunderstood by mothers, or that those who communicate the advice have not fully explained who it is targeted at.     

Emotional and behavioral problems and severe academic delays among sheltered homeless children in Los Angeles County.

OBJECTIVES. Few studies have estimated the extent of specific emotional, behavioral, and academic problems among sheltered homeless children. The objectives of this study were to describe such problems, identify those children with the problems, and evaluate the relationship between child problems and use of physical and mental health services. METHODS. From February through May 1991, 169 school-age children and their parents living in 18 emergency homeless family shelters in Los Angeles County were interviewed. To evaluate the answers, interviewers used standardized measures of depression, behavioral problems, receptive vocabulary, and reading. RESULTS. The vast majority (78%) of homeless children suffered from either depression, a behavioral problem, or severe academic delay. Among children having a problem, only one third of the parents were aware of any problem, and few of those children (15%) had ever received mental health care or special education. CONCLUSIONS. Almost all school-age sheltered homeless children in Los Angeles County have symptoms of depression, a behavioral problem, or academic delay severe enough to merit a clinical evaluation, yet few receive specific care. Programs targeted at sheltered homeless school-age children are needed to close this gap.     

Risk and protective factors for adult and child hunger among low-income housed and homeless female-headed families

OBJECTIVES: We sought to identify factors associated with adult or child hunger. METHODS: Low-income housed and homeless mothers were interviewed about socioeconomic, psychosocial, health, and food sufficiency information. Multinomial logistic regression produced models predicting adult or child hunger. RESULTS: Predictors of adult hunger included mothers' childhood sexual molestation and current parenting difficulties, or "hassles." Risk factors for child hunger included mothers' childhood sexual molestation, housing subsidies, brief local residence, having more or older children, and substandard housing. CONCLUSIONS: This study found that the odds of hunger, although affected by resource constraints in low-income female-headed families, were also worsened by mothers' poor physical and mental health. Eliminating hunger thus may require broader interventions than food programs.     

Young children experiencing homelessness: the overlooked medium of play

The number of mothers with young children experiencing homelessness and seeking shelter has increased in the USA over the past decade. Shelters are often characterized as environments offering few opportunities for appropriate play experiences. This article delineates the important role of play for young children experiencing homelessness and argues for research of the contextual nature of play in shelters. Situated in the social constructivist paradigm, the article draws from the premise that rich stimulating play experiences mediate optimal early learning. A review of literature revealed scant research of children's play in homeless shelters; as a result, the study of a primary medium for learning and ameliorating adversity for children most at risk of negative life outcomes is omitted. Findings from research of play in homeless shelters can inform fields of education, human development, and health and human services, facilitating improved services for families experiencing homelessness.     

Child adjustment in high conflict families

Children exposed to spousal violence are at risk for social-emotional problems. This research investigated a number of family and child factors which might influence the effects of witnessing spousal violence on young children. Fifty-four mothers who had at least one child in the age range of 3 to 6 years participated in the study. These women had left a violent relationship 12 to 24 months prior to their participation in the study and were not in a new relationship. Information was collected through a structured interview which included the administration of a standardized family violence measure (conflict tactics scale) and child adjustment profile (child behaviour checklist). Forty-two per cent of the children exhibited a level of behavioural problems which would warrant clinical intervention. The amount of violence that the children witnessed, the children's responses when the violence occurred and whether the child copied the violent partner's behaviour, were associated with the children's behavioural adjustment scores. Maternal parenting style was not found to have a significant effect on behavioural adjustment. The study provided important quantitative and qualitative data on the nature of parent-child relationships and children's adjustment in families where there is spousal violence.     

The mental health of children in homeless families and their contact with health, education and social services

Previous research indicates that children in homeless families have a high risk of physical and mental illness. This study reports the initial stage of a longitudinal research programme to measure the prevalence of psychiatric disorders among parents and children in homeless families. A sample of parents in 113 homeless families were interviewed within 2 weeks of admission to seven homeless centres in the City of Birmingham, and compared with a sample of 29 low-income families who were not homeless. Both sets of interviews used the Child Behaviour Checklist (CBCL), the Communication Domain of the Vineland Adaptive Behaviour Scales (VABS), the General Health Questionnaire (GHQ), the Interview Schedule for Social Interaction (ISSI), and height and weight percentiles. A sub-sample of children was also interviewed. The results indicate that 85% of families became homeless because of domestic or neighbourhood violence, that in 54% of families in homelessness coincided with the separation of the partners, and that 49% of mothers had current psychiatric morbidity. Children in homeless families had delayed communication and higher mean scores for mental health problems than the comparison sample. Homeless children were also more likely to have had histories of abuse, and less likely to have attended school or nursery school since becoming homeless. Homeless families had high rates of contact with primary healthcare and social services, but few had been in contact with specialist child and adolescent mental health services. These results indicate a need for a co-ordinated action by housing, social services, education, health services, and the police to prevent families from becoming homeless by protecting victims of domestic and neighbourhood violence from further violence and intimidation. Hence the need to rapidly re-house into permanent accommodation those who do become homeless, to maintain education for their children, and to ensure that such families have access to effective social support and healthcare.     

Maternal parenting stress and its correlates in families with a young child with cerebral palsy

Objective   To investigate factors predicting parenting stress in mothers of pre-school children with cerebral palsy.
Method   Eighty mothers and children participated. Mothers completed the Parenting Stress Index (PSI) and the following measures of family functioning: family support, family cohesion and adaptability, coping strategies, family needs and locus of control. Children were assessed using the Griffiths Scales and the Gross Motor Function measure. The child's home environment was assessed using Home Observation for Measuring the Environment.
Results   Mothers had higher mean total PSI scores than the means for the typical sample; 43% had total PSI scores above the threshold for clinical assessment. Cluster analysis demonstrated five distinct clusters of families, more than half of whom were coping well. High stress items were role restriction, isolation and poor spouse support, and having a child who was perceived as less adaptable and more demanding. Lower stress items indicated that this sample of mothers found their children emotionally reinforcing and had close emotional bonds. Regression analysis showed that the factors most strongly related to parenting stress levels were high family needs, low family adaptability and cognitive impairment in the child.
Conclusions   The results confirmed the individuality of families, and that individual characteristics of coping and feeling in control, together with family support and cohesion, are associated with variation in amount of stress experienced in parenting a child with cerebral palsy.     

A population-based assessment of the health of homeless families in New York City, 2001-2003

Objectives. We compared estimated population-based health outcomes for New York City (NYC) homeless families with NYC residents overall and in low-income neighborhoods.Methods. We matched a NYC family shelter user registry to mortality, tuberculosis, HIV/AIDS, and blood lead test registries maintained by the NYC Department of Health and Mental Hygiene (2001–2003).Results. Overall adult age-adjusted death rates were similar among the 3 populations. HIV/AIDS and substance-use deaths were 3 and 5 times higher for homeless adults than for the general population; only substance-use deaths were higher than for low-income adults. Children who experienced homelessness appeared to be at an elevated risk of mortality (41.3 vs 22.5 per 100 000; P < .05). Seven in 10 adult and child deaths occurred outside shelter. Adult HIV/AIDS diagnosis rates were more than twice citywide rates but comparable with low-income rates, whereas tuberculosis rates were 3 times higher than in both populations. Homeless children had lower blood lead testing rates and a higher proportion of lead levels over 10 micrograms per deciliter than did both comparison populations.Conclusions. Morbidity and mortality levels were comparable between homeless and low-income adults; homeless children''s slightly higher risk on some measures possibly reflects the impact of poverty and poor-quality, unstable housing.Most studies examining the health of homeless populations have involved single adults and have identified higher rates of death, tuberculosis (TB), HIV/AIDS, mental health disorders, substance use, poor birth outcomes, and cardiovascular disease than in the general population.^1–7 Whether these findings can be generalized to homeless families is not known, as the 2 populations differ greatly. Nationally, homeless families overwhelmingly consist of a young female head of household with children, whereas single homeless adults are mostly men aged 31 to 50 years.⁸ Homeless families are also distinct in their reasons for becoming homeless, citing poverty more often and substance use and mental illness less often than is the case for their single adult counterparts.⁹ Based on their demographic and socioeconomic profiles, the health of homeless families may be more like that of other low-income families than that of homeless single adults.Recent economic conditions have led to a rise in the number of homeless families nationwide. Although overall US homelessness held fairly constant from 2007 to 2008, the number of homeless families increased by 9%. According to the latest available national data, an estimated 516 700 adults and children were sheltered as families over a 1-year period in 2008, constituting roughly a third of the overall sheltered homeless population during that time.⁸ More recent data from a sampling of localities found that, as of September 2009, the count of sheltered families had increased 10% from the previous quarter, as foreclosure and unemployment rates continued to rise.¹⁰In New York City (NYC), the Department of Homeless Services (DHS) supplies apartment-style shelters and support services such as childcare, housing assistance, and health care referral to homeless families. Because the city provides emergency shelter to eligible families, virtually all homeless families use shelter facilities. In 7 years of an annual count of street homeless, a family has never been found on the street.¹¹ A small share of homeless families is sheltered by city agencies other than DHS. However, analyses based on DHS shelter registry likely include the vast majority of the NYC homeless family population.Our objective was to systematically characterize the health of adults and children who used the NYC family shelter system. We matched the DHS family shelter registry with 4 health registries managed by the NYC Department of Health and Mental Hygiene, and we compared estimates of morbidity and mortality in the homeless family population with those of the NYC general and lowest-income neighborhood populations.     

ANEMIA AND INFECTION IN SCHOOL-AGED EGYPTIAN CHILDREN

Iron-deficiency anemia and infection are deterrents to optimal child health in many developing countries. We investigated the prevalence of anemia and elevated erythrocyte sedimentation rate (ESR), which reflects chronic background infection, recent illness, and diet for 190 children aged 10 to 13 years in 1995 in a Nile Delta village. The children exhibited a high prevalence of anemia (61.6%) and elevated ESR (54.9%). One-third of the children reported a minor illness within the past week, and more than 75 per cent had one or more parasites evident in stool or urine samples. There was no relationship of socioeconomic or dietary indicators to anemia or elevated ESR. Mothers’ evaluation of the child’s health status had no relationship to anemia or elevated ESR, with 43.6 per cent of mothers reporting their child’s health status as excellent or good. Maternal report of the child’s health as poor was related to recent illness. We speculate that where anemia and chronic infection are hyperendemic, both children and mothers may become habituated to the associated symptoms and consider them normal.     

Preschoolers with autism spectrum disorders: the impact on families and the supports available to them

As more children are diagnosed at a younger age with Autism Spectrum Disorders (ASD), a new population of families is growing requiring services. Little is known about their characteristics and need for support. Instead, past research has tended to focus on specialist assessments and interventions. Over 100 parents with a child aged under five years of age were interviewed individually at home using a semi‐structured questionnaire and standard rating scales. Although all children had been given a confirmed diagnosis of ASD at specialist community clinics, wide variations existed in the children’s developmental difficulties and in the characteristics of their families. A majority of families reported marked impacts on family life with increased levels of parental stress. However, the amount and type of professional support available to families were not related to child or family characteristics. Family‐centred intervention and support services are required and they should be available to parents irrespective of their child having a confirmed diagnosis.     

Perception and practice of child labour among parents of school‐aged children in Ibadan,southwest Nigeria

Background The problem of child labour has lingered on in many countries because of the complex combination of social, cultural and economic factors involved. Parents play a critical role in child labour as it provides much needed extra income for the family. This study was carried out among parents of school‐aged children in an urban, low‐income community to determine the factors associated with child labour and attitudes to child labour in the community. Methods A cross‐sectional study was carried out in an urban community in Ibadan, southwest Nigeria. Questionnaires were administered to parents of school‐aged children. Results A total of 473 parents were interviewed. They were aged between 23 and 56 years, mean 37.9 years. Thirty‐nine per cent of parents indicated that they thought their school‐aged children should work. More women than men, those from polygamous homes and those with lower educational status held this view. Reasons given for wanting their children to work were to supplement family income, 45%, to gain experience, 35% and to help in family business, 10%. In all, 236 (50%) respondents reported that their school‐aged children were working. Parental factors associated with practice of child labour were polygamous marriage, low educational status, unskilled or partly skilled occupation and large family size. Seventeen per cent of parents with working children were not satisfied with their children's work conditions and complained of low earnings, long working hours, work on school days and unsafe work environment. Measures suggested to control child labour include addressing the issue of household poverty, public enlightenment about the ills of child labour and free education up to junior secondary level. Enforcement of child labour laws was the least mentioned. Conclusion We conclude that control of child labour should be a multifaceted approach involving poverty alleviation, family planning to reduce family size and free, compulsory education up to junior secondary level. Public enlightenment especially for mothers will be of additional benefit.     

The impact of a clinical training unit on integrated child health care in Mexico.

This study had two aims: to describe the activities of a clinical training unit set up for the integrated management of sick children, and to evaluate the impact of the unit after its first four years of operation. The training unit was set up in the outpatient ward of a government hospital and was staffed by a paediatrician, a family medicine physician, two nurses and a nutritionist. The staff kept a computerized database for all patients seen and they were supervised once a month. During the first three years, the demand for first-time medical consultation increased by 477% for acute respiratory infections (ARI) and 134% for acute diarrhoea (AD), with an average annual increase of demand for medical care of 125%. Eighty-nine per cent of mothers who took their child for consultation and 85% of mothers who lived in the catchment area and had a deceased child received training on how to recognize alarming signs in a sick child. Fifty-eight per cent of these mothers were evaluated as being properly trained. Eighty-five per cent of primary care physicians who worked for government institutions (n = 350) and 45% of private physicians (n = 90) were also trained in the recognition and proper management of AD and ARI. ARI mortality in children under 1 year of age in the catchment area (which included about 25,000 children under 5 years of age) decreased by 43.2% in three years, while mortality in children under 5 years of age decreased by 38.8%. The corresponding figures for AD mortality reduction were 36.3% and 33.6%. In this same period, 11 clinical research protocols were written. In summary, we learned that a clinical training unit for integrated child care management was an excellent way to offer in-service training for primary health care physicians.