Families with young children in homeless shelters: Developmental contexts of multisystem risks and resources.

We apply a multisystem perspective to three aims relevant to resilience for young children in emergency and transitional homeless shelters. We consider profiles of risks and resources before shelter, early childhood program enrollment during shelter, and the likelihood of returning to shelter or having a subsequent child welfare placement. We used longitudinal, city-wide data from multiple sources integrated at the individual level across the lifespan for 8 birth cohorts. Young children (N = 1,281) stayed in family shelters during an 18-month period during a multisystem intervention. Risk factor rates were high as were rates of early childhood program enrollment (66.1% in any program; 42.3% in a high-quality program), which may suggest positive effects of the multisystem intervention. Multilevel latent class analysis revealed four profiles, considering prior shelter stays, prior child welfare placements, prior elevated lead levels, perinatal factors (teenage mother, prenatal care, low maternal education, and poor birth outcomes), demographics, and early childhood program enrollment and quality. One profile with higher rates of child welfare placement before the shelter stay and considerable enrollment in high-quality early childhood programs corresponded to lower rates of subsequent child welfare placement. Profiles did not differ on the likelihood of returning to shelter.

Evaluating Approaches to Linking Evictions Records:: Assessing the Feasibility of Research with Integrated Data.

Objectives: This study investigates different approaches to integrating evictions data with Medicaid and homeless shelter utilization records at the individual level for the state of Delaware. We especially focus on evaluating the feasibility of creating an integrated dataset focused on children and adolescents through different approaches to matching. Methods: We attempt to link existing statewide records on evictions, Medicaid, and shelter from 2017-2019. We first compare direct match and probabilistic match approaches to linking evictions and Medicaid records, and then incorporate shelter records. Finally, we consider a limited set of characteristics relevant to potential future public health research among children who experienced eviction, had a shelter stay, and were enrolled in Medicaid. Results: Direct matching resulted in a lower match (14%) rate than probabilistic matching (22%) of eviction records to Medicaid data. Homeless shelter records had a high match rate to Medicaid records, even when using a direct match (75%). A sizeable subset of children (n=216) were linked across the three data sources, though this was from a small percentage of cases in the evictions data. Among this subset of children, most (71%) were enrolled in Medicaid in all three years considered by this study and Black children were greatly overrepresented (75%). Conclusions: Integrating evictions records with other health and human service data involves a number of challenges. Probabilistic matching yielded a considerably higher number of matches after manual review, resulting in a possible study sample of children who have experienced eviction, a homeless shelter stay, and were enrolled in Medicaid. Strategies to increase the match rate for eviction records through using records from other, more universal services may be necessary for investigations that require more comprehensive coverage of the population.

Associations of COVID-19 Stressors and Postpartum Depression and Anxiety Symptoms in New Mothers.

BACKGROUND AND OBJECTIVES: Early reports during the COVID-19 pandemic showed pregnant and postpartum women have increased rates of anxiety and depression. We hypothesized that exposure to more COVID-19-related events (e.g., stay-at-home orders, school closures, work layoffs, family members ill with COVID-19; Event Exposure), greater perceived impact of COVID-19 events on the family (Family Impact), and less social support would be associated with more anxiety and depression symptoms among first-time mothers. METHODS: We interviewed 125 first-time mothers of infants under 3 months of age from four pediatric primary care offices (June 2020 - February 2021) to assess COVID-19 experiences, anxiety and depression symptoms, and social support. Hierarchical linear regression evaluated relations between COVID-19 Event Exposure, COVID-19 Family Impact, and social support on maternal anxiety and depression symptoms. RESULTS: COVID-19 Event Exposure was not associated with depression or anxiety symptom scores. However, greater COVID-19 Family Impact was related to increased maternal depression and anxiety symptoms when controlling for COVID-19 Event Exposure. Reduced social support predicted higher depression symptom scores, but not anxiety symptom scores, when accounting for other variables. CONCLUSION: The number of COVID-19-related events experienced by first-time mothers did not predict anxiety or depression symptoms. However, greater perceived impact of COVID-19 on their family was associated with higher symptoms of anxiety and depression in these mothers. Pediatricians can promote resilience strategies to help new mothers adapt during the COVID-19 pandemic to help decrease anxiety and depression symptoms.

Social support as a resilience factor for parent-infant dyads experiencing homelessness.

Despite the considerable prevalence of homelessness among very young children in the United States, there is a notable lack of research on risk, resilience, and developmental well-being of infants who experience family homelessness. In the present study, we considered social support as a resilience factor for quality of parent-infant relationships and parent depression among a sample of 106 parents and their infants (ages birth to 12 months) residing in emergency shelters for families experiencing homelessness. We assessed social support, parent histories of adverse experiences during childhood and adulthood, and parent current depression symptoms via structured interview measures, and we assessed quality of the parent-infant relationship with an observational approach. Results showed different patterns for the roles of adversity the parents had experienced during childhood compared to adversity experienced more recently, as adults. Childhood adversity predicted parent-infant responsiveness, with a positive association that was moderated by level of perceived social support. Parents with more childhood adversity showed more responsiveness with their infants only when they had access to high levels of social support. Adulthood adversity predicted higher scores for parent depression, while social support predicted lower parent depression scores. This work contributes to the very limited literature on the functioning of families with infants in shelters. Our discussion includes implications for research, policy, and prevention and intervention efforts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Parental and Other Caregiver Loss Due to COVID-19 in the United States: Prevalence by Race, State, Relationship, and Child Age.

The more than one million COVID-19 deaths in the United States include parents, grandparents, and other caregivers for children. These losses can disrupt the social, emotional, and economic well-being of children, their families, and their communities, and understanding the number and characteristics of affected children is a critical step in responding. We estimate the number of children who lost a parent or other co-residing caregiver to COVID-19 in the U.S. and identify racial, ethnic, and geographic disparities by aligning COVID-19 death counts through mid-May 2022 with household information from a representative sample of individuals. We estimate that 216,617 children lost a co-residing caregiver to COVID-19; 77,283 lost a parent and more than 17,000 children lost the only caregiver with whom they lived. Non-White children were more than twice as likely as White children to experience caregiver loss, and children under 14 years old experienced 70% of caregiver loss. These losses are a salient threat to the functioning of families and the communities in which COVID-19 deaths are concentrated, compounding additional challenges to physical and mental health and economic stability disproportionately imposed by the pandemic on historically disadvantaged populations. Policymakers and systems should take steps to ensure access to appropriate supports.

Adolescent homelessness: Evaluating victimization risk based on LGBT identity and sleeping location.

BACKGROUND: Teen homelessness confers risk for victimization experiences, and teens that identify as lesbian, gay, bisexual, or transgender (LGBT) are at an even greater risk of experiencing victimization and homelessness. METHODS: Using the 2019 Youth Risk Behavior Surveillance System, we evaluated the association of experiencing homelessness with physical and sexual victimization and we examined whether LGBT identification moderated this relationship. We also evaluated if the odds of experiencing sexual and physical victimization differed depending on the reported sleeping location. RESULTS: Students who reported homelessness had increased odds of having experienced physical and sexual victimization. LGBT identity was related to increased risk for physical and sexual victimization; however, LGBT identity did not moderate the relationship between homelessness and victimization. Considering nighttime sleeping arrangement, students who reported having no usual place to stay had the highest odds of experiencing sexual or physical victimization, followed by car, park, campground, hotels/motels, emergency housing, and doubled-up with family or friends. Notably, all homeless sleeping locations were associated with increased odds of experiencing victimization relative to sleeping at a parent or guardian's home. CONCLUSIONS: Our findings confirm links between teen homelessness and sexual and physical victimization, as well as increased risk for victimization experienced by LGBT youth. Special considerations should be made when developing and implementing interventions for teens experiencing homelessness and teens who identify as LGBT.

School-based health centers as a context to engage and serve communities.

PURPOSE OF REVIEW: School-based health centers (SBHCs) primarily serve underserved students and families through removing barriers to care. The number of SBHCs have increased dramatically with investments from state-funding and federal-funding programs, including expanded funding from the American Rescue Plan. This article reviews findings on the perceived importance of school and community partnership. It also provides a critical review of the evidence base on impact on health, mental health, and education indicators. RECENT FINDINGS: Recent findings underscore the importance of SBHCs engaging the school and community to build trust while identifying and responding to needs. Engagement supports planning, implementing, and sustaining SBHCs. Studies of impact find that SBHCs increase participation in preventive and routine health and decrease emergency department utilization and hospitalization. However, additional research needs to rigorously test for effects of SBHCs on symptoms and indicators of wellbeing, especially with respect to mental health and education. SUMMARY: SBHCs increase participation of students from marginalized groups in preventive and routine care. School and community engagement are vital aspects of SBHCs, likely removing barriers related to trust. Additional rigorous evidence is needed testing efficacy of SBHCs when it comes to improving health, mental health, and education.

Adaptive systems for student resilience in the context of COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic is a disaster, defined as an event that suspends normal activities and threatens or causes severe, community-wide damage (Masten & Motti-Stefanidi, 2020). While all school children and their families have been impacted by COVID-19 to some degree, the burdens are disproportionately being borne by children experiencing poverty and children from minority racial and ethnic groups. In this article, we consider resilience and risk in the context of the COVID-19 pandemic by focusing on children's developing adaptive systems. When adaptive systems are functioning well, most children will demonstrate resilience to disaster. The capacity of children's adaptive systems to function well depends upon their developmental histories and the social and community resources available to them. We discuss how these factors contribute to children's adaptation and close with recommendations for communities looking to support resilience to the varied adversities of COVID-19. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Promoting parent-infant responsiveness in families experiencing homelessness.

My Baby's First Teacher is an intervention designed specifically for parents with infants staying in emergency homeless shelters. Infants are overrepresented in shelter populations and face considerable risk to their development, including mental health. We utilized a randomized controlled design across three family shelters to evaluate the program's effectiveness with 24 dyads assigned to the intervention compared to 21 dyads in care-as-usual. Dyads were randomized by round at each site to account for shelter effects. We used path analysis to illustrate change over time and in relation to intervention assignment.

El Primer Maestro de mi Bebé es una intervención diseñada específicamente para progenitores con infantes que se alojan en refugios de emergencia para personas sin casa. En la población de los refugios, los infantes están sobrerrepresentados y enfrentan un considerable riesgo en cuanto a su desarrollo, incluyendo la salud mental. Utilizamos un diseño de control al azar a través de tres refugios de familias para evaluar la eficacia del programa con 24 díadas asignadas al grupo de intervención que fueron comparadas con 21 díadas bajo el cuidado usual. A las díadas se les colocó al azar por etapas en cada lugar para tener en cuenta los efectos del refugio. Usamos un análisis de trayectoria para ilustrar el cambio a través del tiempo y en relación con la asignación de intervención. Resultados claves: los resultados indicaron mejoras en la observada sensibilidad de progenitor-infante relacionada con la intervención en el lugar, con un control en cuanto a los niveles iniciales de sensibilidad. Los resultados fueron consistentes entre un modelo de intención de tratar y un modelo para probar la participación cierta en la intervención. No encontramos ningún efecto significativo para el estrés de crianza o la ansiedad del progenitor, aunque las tendencias sugirieron más altos puntajes para las familias de la intervención. Implicaciones para la práctica y las políticas: presentamos los resultados considerando retos específicos en contextos de casos sin casa para la salud mental infantil. Este trabajo puede servir de base para los esfuerzos de quienes proveen servicios y encuentran familias que experimentan el estar sin casa, así como también las políticas sobre los recursos para programaciones en albergues de emergencia.

Le Premier Enseignant de Mon Bébé est une intervention conçue spécialement pour les parents dont les bébés restent dans des foyers d'urgence pour sans-abris. Les bébés sont sur-représentés dans les populations de ces foyers et ils font face à un risque considérable pour leur développement, y compris pour ce qui concerne leur santé mentale. Nous avons utilisé un schéma expérimental contrôlé pour 3 trois foyers familiaux afin d'évaluer l'efficacité du programme avec 24 dyades désignées pour l'intervention comparé à 21 dyades dans le groupe de soins habituels. Les dyades ont été randomisées par ronde sur chaque site afin de contrôler les effets du foyer. Nous avons utilisé une analyse causale pour illustrer le changement au fil du temps et en relation au groupe d'intervention. Constatations Clés: Résultats a indiqué des améliorations dans la réaction observée parent-bébé liée à l'intervention en fin d'étude, contrôlant les niveaux initiaux de réaction. Les résultats sont cohérents entre un modèle intention-de-traiter et un modèle testant la véritable participation à l'intervention. Nous n'avons trouvé aucun effet important pour le stress de parentage ou la détresse du parent, bien que des tendances suggèrent des scores plus élevés pour les familles d'intervention. Nous présentons des résultats en considérant les défis uniques aux contextes de la vie des sans-abris pour la santé mentale du nourrisson. Ce travail peut orienter les efforts des prestataires de services qui rencontrent des familles faisant l'expérience d'une vie sans abri ainsi que les lois et pratiques concernant les ressources pour des programmes dans des foyers d'accueil d'urgence.

Adolescent Homelessness and Associated Features: Prevalence and Risk Across Eight States.

This study utilizes data from the Youth Risk Behavior Survey to estimate the prevalence of adolescent homelessness and relations to five indicators of poor functioning among students attending public high school in eight states. About 3.27% of students experienced homelessness, and nearly 7% of teens who identified as lesbian, gay, or bisexual (LGB) experienced homelessness. Homelessness was related to higher rates of sexual/dating violence as well as having been bullied and feeling unsafe at school. Homelessness and LGB identification predicted higher rates of more-severe problems with alcohol, hard drug use, poor grades, suicidality, and risky sexual behavior, controlling for other factors. There was no interaction effect between homelessness and LGB status, suggesting that these risks are additive.

Childhood homelessness, resilience, and adolescent mental health: A prospective, person-centered approach.

School districts and other service providers are increasingly aware of the substantial mental health needs of students experiencing family homelessness. Past findings are mixed regarding whether homelessness conveys unique risk beyond the risks associated with extreme poverty. With prospective longitudinal data on homelessness experiences across childhood, we utilized latent profile analysis as a person-centered approach to conceptualizing mental health outcomes in adolescence for 3,778 youth. We considered literal family homelessness as well as families living doubled-up, and we employed propensity score matching to identify a comparison group of non-homeless students balanced across a range of covariates to address systematic bias. Results indicated that students who experienced literal homelessness during childhood were significantly less likely to demonstrate profiles of resilience in mental health functioning. We considered our approach and findings in light of challenges and opportunities particularly relevant to the school context.

Medical and Psychosocial Risk Profiles for Low Birthweight and Preterm Birth.

OBJECTIVES: Low birthweight and preterm birth are risk factors for infant mortality and persistent problems. This study uses representative data to assess whether distinct latent profiles of co-occurring medical and psychosocial factors have implications for preterm birth and low birthweight. METHODS: Data are from the Pregnancy Risk Assessment Monitoring System, a cross-sectional survey constituting representative data on pregnancies from 2012 to 2013. Latent class analysis derived classes of pregnant women potentially at risk for low birthweight and/or preterm birth. RESULTS: Latent class analysis identified five homogenous profiles of interrelated psychosocial and medical factors. Risk was greatest for the profile marked by high rates of medical factors, followed by a high risk for a profile marked by a combination of very low income and psychosocial factors. Two profiles involving low income and very low income also indicated greater risk for adverse birth outcomes related to socioeconomic status. CONCLUSIONS: More attention should be paid to screening for and addressing psychosocial risk in concert with prenatal care. Women who show high-risk profiles can be monitored and supported by an interdisciplinary care team, when warranted.

Introduction to the special issue: Trauma-informed care for children and families.

This special issue of Psychological Services includes 18 articles describing efforts to promote and provide trauma-informed care for children and families. Trauma-informed care is an approach to providing services that is sensitive to the possibility that children and families have experienced past or ongoing traumatic situations with implications for their current functioning and response to interventions. Installing and maintaining a trauma-informed approach in organized care settings requires effective planning, initial assessment, implementation, reassessment, and support that reflects an ongoing commitment to recognizing the impact of trauma on those being served. The articles contained in this special issue span a range of efforts in each of these areas, including the development and refinement of models of care and specific interventions, establishing quality assessment tools, and providing illustrations of lessons learned from attempts to implement and sustain trauma-informed initiatives. This introduction to the special issue provides a brief overview of these articles. The purpose of this special issue is to share current data and models of trauma-informed care and to encourage further development of collaborative models, interventions, measurement tools, and implementation efforts that lead to better services and outcomes for children and families who experience trauma. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Housing Interventions and the Chronic and Acute Risks of Family Homelessness: Experimental Evidence for Education.

This study considers risk associated with family homelessness for school functioning and experimental evidence on the effects of different housing interventions over time. Students in homeless families (N = 172; Mage  = 7.31; SD = 4.15) were randomized to housing interventions that focus on acute risks (community-based rapid rehousing), chronic risks (permanent subsidy), or usual care (UC). A matched group of low-income, housed students served as an additional reference for effects on attendance, school mobility, and reading and math achievement across 4 years. Findings partially support the chronic-risk hypothesis that family homelessness interferes with achievement through its relation to deep poverty. Children randomly assigned to UC perform as well or better than children assigned to housing interventions in this municipality.

Health and Self-Regulation among School-Age Children Experiencing Family Homelessness.

Children in homeless families have high levels of adversity and are at risk for behavior problems and chronic health conditions, however little is known about the relationship between cognitive-emotional self-regulation and health among school-aged homeless children. Children (n = 86; mean age 10.5) living in shelters were assessed for health, family stress/adversity, emotional-behavioral regulation, nonverbal intellectual abilities, and executive function. Vision problems were the most prevalent health condition, followed by chronic respiratory conditions. Cumulative risk, child executive function, and self-regulation problems in children were uniquely related to child physical health. Homeless children experience problems with cognitive, emotional, and behavioral regulation as well as physical health, occurring in a context of high psychosocial risk. Several aspects of children's self-regulation predict physical health in 9- to 11-year-old homeless children. Health promotion efforts in homeless families should address individual differences in children's self-regulation as a resilience factor.

Adversity and children experiencing family homelessness: Implications for health.

This study tests links between adversity and health problems among children in family emergency housing. Children who experience family homelessness are at risk to also experience high levels of stress, health problems, and need for pediatric care. Understanding the connection between stress and health holds the potential to reduce persistent health disparities. Analyses tested whether experiencing a greater number of stressful life events during the early years of life was related to worse health conditions, emergency health care utilization, and hospitalizations. Parents noted children's experience of negative stressful life events, health problems, emergency room (ER) use, and hospitalization. Two cohorts of kindergarten-aged children staying in emergency family housing participated in the study in 2006-07 (n = 104) and in 2008-09 (n = 138), with the results examined separately. In both cohorts, more health problems were acknowledged for children exposed to more negative stressful life events. Stressful life events were not related to ER use but did relate to hospitalization for the 2006-07 cohort. Results affirm links between stress in early childhood and health problems among children living in emergency housing. Findings are consistent with the hypothesis that adversity in early childhood contributes to income and racial disparities in health.

Youth Homelessness: Prevalence and Associations with Weight in Three Regions.

This study investigated the utility of the Youth Risk Behavior Survey (YRBS) to document associations between homeless status and weight while estimating the prevalence of youth homelessness in three regions. A school-based survey, the YRBS includes youths who have been difficult to involve in past research. Analysis of 2011 YRBS data produced population-weighted estimates of youth homelessness prevalence separately for Connecticut, Delaware, and Philadelphia. Public high school students anonymously reported their housing status, height, and weight on the YRBS. Height and weight were converted to body mass index (BMI) percentile-for-age scores. Homelessness was associated with higher BMI percentile scores for youths compared with nonhomeless peers. Associations between BMI percentile and different forms of homelessness (homeless with family, unaccompanied homeless without family) were explored at each site. Estimates of one-month homelessness prevalence ranged from 3.9 percent to 5.9 percent at each site. Homelessness, especially family homelessness, is associated with risk for higher BMI. The YRBS is an informative tool for estimating the prevalence of youth homelessness, expanding on what is known through other, more commonly used methods.

Parenting and coregulation: Adaptive systems for competence in children experiencing homelessness.

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.

Asthma and adaptive functioning among homeless kindergarten-aged children in emergency housing.

BACKGROUND: Children who experience homelessness have elevated rates of asthma, a risk factor for other problems. Purpose. Examine rates of asthma and its relation to health care use and adaptive functioning among young children staying in family emergency shelters. METHODS: Children and caregivers (N = 138) completed assessments in shelters, including measurement of child cognitive functioning, parent report of child health care service utilization and asthma diagnosis, and teacher report of child school functioning. RESULTS: Asthma diagnosis was reported for 21% of 4-to-6-year-old children, about twice the national and state prevalences. Children with asthma used more health care services and had worse peer relationships. Asthma did not relate to cognitive test performance or subsequent academic performance, or to other behavior problems in school. CONCLUSIONS: High rates of asthma remain an important issue for children in emergency family housing, a context with high levels of child risk for toxic stress exposure and developmental problems.