Resetting Policies to End Family Homelessness.

Homelessness is a devastating experience for children and their families. Families, the majority of whose members are children, now comprise more than one-third of the overall US homeless population. Most of these children are less than six years old. Various assumptions have driven policy and the allocation of resources to programs serving these families. Although decades of research and field experience suggest strategies for preventing and reducing this problem, perspectives differ, hindering the development of effective solutions. In this article, we explore some of these assumptions, including (a) definitions of homelessness used to count the numbers of families and determine resource allocation, (b) the needs of children and responses to the impact of adverse childhood experiences, and (c) whether services matter and should be integrated with affordable housing. We conclude by suggesting various directions to ensure that these children are protected and have the opportunity to grow and thrive.

Organizational trauma-informed care: Associations with individual and agency factors.

In response to the growing awareness of the high rates of potentially traumatic experiences and their potential adverse impacts, health and human service providers have increasingly focused on implementing trauma-informed care (TIC). However, studies focusing on effective implementation have been limited. In this study, we explored the relationship of individual and agency characteristics to the level of organizational TIC. With data collected from a sample of 345 providers from 67 agencies, we used the TICOMETER, a brief measure of organizational TIC with strong psychometric properties, to determine these associations. We found weak relationships between individual factors and TICOMETER scores and stronger associations for agency-level factors. These included agency type, time since last trauma training, and involvement of service users. These findings highlight the importance of robust cultural changes, service user involvement at all levels of the organization, flattening power differentials, and providing ongoing experiential training. This analysis fills an important gap in our knowledge of how best to ensure agency-wide provision of TIC. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Universal Design for Underserved Populations: Person-Centered, Recovery-Oriented and Trauma Informed.

Person-centered care has yet to be widely implemented in health care settings, a circumstance that disproportionately affects individuals with behavioral health disorders and those with trauma histories. A need exists for a universal approach to care that encompasses compassionate, collaborative relationships between providers and service users. Person-centered care, enhanced by recovery-oriented care and trauma-informed care, forms the basis for a universal approach to health care. For this paper, we adopted a modified Delphi method to establish consensus on a set of basic principles and practices for developing a universal design based on these three frameworks. We used a two-stage process to arrive at guidelines for use in health and human service settings by: 1) convening an expert panel to draft guidelines; and 2) conducting an online survey of multidisciplinary experts to refine the guidelines. We conclude with recommendations for implementation.

Peer-Delivered Recovery Support Services for Addictions in the United States: A Systematic Review.

This systematic review identifies, appraises, and summarizes the evidence on the effectiveness of peer-delivered recovery support services for people in recovery from alcohol and drug addiction. Nine studies met criteria for inclusion in the review. They were assessed for quality and outcomes including substance use and recovery-related factors. Despite significant methodological limitations found in the included studies, the body of evidence suggests salutary effects on participants. Current limitations and recommendations for future research are discussed.

The prevalence of mental illness in homeless children: a systematic review and meta-analysis.

OBJECTIVE: The numbers of children experiencing homelessness have increased. To develop responsive interventions, we must understand their mental health/behavioral needs. The purpose of this systematic review was to update the evidence base by identifying, appraising, and summarizing studies on the prevalence of mental health issues among homeless children, comparing these individuals to low-income-housed children, and discussing research, practice, and policy implications. METHOD: We searched 3 electronic databases and included empirical studies investigating the prevalence of mental illness in homeless children in the United States (1990-2014). Retrieved publications were screened, data extracted, and study quality appraised by independent reviewers. Evidence synthesis was based on qualitative and quantitative analyses. Prevalence odds ratios (OR) of individual studies were pooled using an inverse-variance random effects model. RESULTS: Twelve studies were included and reviewed. Overall, 10% to 26% of homeless preschoolers had mental health problems requiring clinical evaluation. This proportion increased to 24% to 40% among homeless school-age children, a rate 2 to 4 times higher than poor children aged 6 to 11 years in the National Survey of America's Families. According to our meta-analyses, the difference in prevalence measured by Child Behavior Checklist (CBCL) Total Problems (T score ≥60-64) was not significantly different between homeless and housed preschool children (OR = 1.49; 95% CI = 0.97-2.28). School-age homeless children compared to housed children were significantly more likely to have a mental health problem as defined by the CBCL Total Problems subscale (T score ≥60; OR = 1.78; 95% CI = 1.19-2.66). CONCLUSION: Evidence-based mental health interventions for children experiencing homelessness are long overdue. Universal screening, treatment plan development, and support of adaptive systems that focus on positive parenting and children's self-regulation are essential.

The effectiveness of housing interventions and housing and service interventions on ending family homelessness: a systematic review.

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.

Out on the street: a public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless.

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.

Depression in homeless mothers: addressing an unrecognized public health issue.

Homeless mothers experience disproportionately high rates of major depressive disorder compared with the general population. Stressed by their circumstances, these women struggle to protect their families. Children living with a depressed parent have poorer medical, mental health, and educational outcomes. Despite the adverse impact on children, depression among mothers experiencing homelessness remains unacknowledged, unrecognized, and untreated. This article reviews the evidence supporting preventive and therapeutic interventions with low-income and homeless mothers and children, and finds that few services have been adapted and evaluated for use in the homelessness service system. Based on the robust evidence describing positive outcomes in programs for low-income parents with depression, the authors propose guidelines for adapting and implementing services directly by programs serving homeless families. Once families are housed and urgent issues addressed, they recommend assessing all family members, routinely providing culturally competent parenting supports, trauma-informed services, and treatment for major depressive disorders. They also emphasize the critical importance of creating child-centered spaces and developmental services for the children. To ensure quality care, training must be available for the staff. Given the increasing numbers of homeless families and high rates of maternal depression and its negative impact on children, support for these programs should become a high public health priority.

Ending child homelessness in America.

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.

Parenting and homelessness: overview and introduction to the Special Section.

This overview of parenting and homelessness includes the characteristics and needs of families who are homeless, with a focus on the unique challenges faced by mothers, fathers, and children. In addition, the authors discuss how homeless families are narrowly defined based on the family members who present at shelters and other service programs. In order to fully support parents and their children as they exit homelessness, homeless service programs should consider the broader context of the nontraditional family system and support networks. The overview also includes common challenges to parenting while homeless, a summary of the articles in the Special Section, and recommendations for research, practice, and policy.

Exposure to violence and low-income children's mental health: direct, moderated, and mediated relations.

The authors examined the association between exposure to violence and different indexes of mental health among 95 extremely poor children (age range = 8-17 years) and analyzed potential moderators and mediators. Findings indicated that 62% of youths had been exposed to at least 1 form of violence. Controlling for other explanatory factors, exposure to violence was significantly associated with internalizing symptoms (e.g., depression, anxiety) across all children, but the relation was stronger for girls compared with boys. Externalizing problem behaviors were also associated with exposure to violence, but subgroup differences were not detected. Regression analyses indicated that self-esteem and a measure of perceived chronic danger may partially mediate the link between violence exposure and mental health symptoms.

Role of kin and nonkin support in the mental health of low-income women.

Data from the Worcester Family Research Project were analyzed to determine whether social support processes are altered by poverty and whether kin and nonkin support are differentially related to mental health in low-income mothers. The authors found that conflict with family and friends predicted adverse mental health and more strongly predicted these outcomes than emotional and instrumental support. Moreover, sibling conflict was a stronger predictor of mental health than parent conflict. Finally, only instrumental support from professionals predicted mental health.