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.

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.

When Crises Converge: Hospital Visits Before And After Shelter Use Among Homeless New Yorkers.

People who are homeless use more hospital-based care than average, yet little is known about how hospital and shelter use are interrelated. We examined the timing of emergency department (ED) visits and hospitalizations relative to entry into and exit from New York City homeless shelters, using an analysis of linked health care and shelter administrative databases. In the year before shelter entry and the year following shelter exit, 39.3 percent and 43.3 percent, respectively, of first-time adult shelter users had an ED visit or hospitalization. Hospital visits-particularly ED visits-began to increase several months before shelter entry and declined over several months after shelter exit, with spikes in ED visits and hospitalizations in the days immediately before shelter entry and following shelter exit. We recommend cross-system collaborations to better understand and address the co-occurring health and housing needs of vulnerable populations.

Depression in Female Veterans Returning from Deployment: The Role of Social Factors.

Objective: Women are serving in the armed forces and deployed to areas of conflict in increasing numbers. Problems such as depressive symptoms and risks related to combat exposure can have negative effects on adjustment following service; understanding the relationship between these problems may contribute to strategies providers can use to facilitate healthy adjustment after deployment. The purpose of this study is to examine social factors as they relate to mental health adjustment, namely depressive symptoms among female veterans who served in Iraq and Afghanistan as part of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OND). We hypothesized that combat exposure would predict higher levels of depressive symptoms and that social support would moderate the relationship between combat exposure and depression. Methods: In a cross-sectional design, 128 female Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans completed an online survey about combat experience, social support, depression, demographic characteristics, and behavioral health symptom history. We conducted multiple regression analyses to examine linear and moderating relationships. Results: There was no significant relationship between combat exposure and depression; social support did not significantly moderate the relationship between combat exposure and depression. However, higher levels of social support and financial comfort were significantly related to lower levels of depression. Conclusion: This study highlights the role of social factors, specifically social support and perceived financial status, as potential barriers to healthy emotional readjustment following deployment. These findings suggest that it may be beneficial for mental health providers to screen female veterans and refer them to appropriate services to reduce financial stressors and strengthen their use of social support. More research should continue to examine more fully the impact of combat exposure on female service members' mental health and work to isolate the factors most strongly related to depression.

Reentry Program and Social Work Education: Training the Next Generation of Criminal Justice Social Workers.

PURPOSE: Social work plays a marginal role in opposing the trend of mass incarceration and high rates of recidivism, and social work education offers limited opportunities for students to specialize in working with people who are currently or were previously incarcerated. How to train students of social work to work against mass-incarceration is still challenging. METHODS: The authors devised and implemented an in-school social service agency devoted to working with people pre and post release from a prison system. The agency is a field practicum setting where interested students study and practice reentry work. In this article, the authors describe and assess the educational merit of this in-school agency. RESULTS: Findings from surveys of students and alumni suggest that the program attained its educational goals of connecting classroom education to practice experience and training students for careers in the criminal justice system. The authors also discuss pending challenges. DISCUSSION: The experience of the Goldring Reentry Initiative suggests that by developing their own social work agencies, the authors may be able to heighten their students educational experience and expand their contribution to social work practice broadly.

Migration by Veterans Who Received Homeless Services From the Department of Veterans Affairs.

We examined migration patterns among 113,400 homeless veterans, focusing on the prevalence and the basic geographic patterns of this migration. Data were for all veterans who initiated use of Veterans Affairs homeless services in 2011 or 2012; and we followed them using Veterans Affairs administrative records for up to 2 years following this initial contact. Results showed that 15.3% of the veterans migrated across regions while homeless. Those who were homeless for longer periods were more likely to migrate, and migration, were it to occur, was most likely earlier on in veterans' homelessness episodes. There were no clear geographic correlates that explained the dynamics of this migration as, overall, in-migration tended to roughly balance out-migration in a region. These findings suggest that concerns about the extent of migration and its impact on localities are exaggerated, but also sets forth an agenda for more in-depth study of these data to gain a deeper and more expansive understanding of this phenomenon.

Posthumously Assessing a Homeless Population: Services Use and Characteristics.

OBJECTIVE: Data on services use, characteristics, and geographic distribution of homeless individuals who died in Philadelphia from 2009 to 2011 provided perspective on assessments of the homeless population that rely on conventional counts and surveys. METHODS: Data from the City of Philadelphia Medical Examiner's Office were used to parse homeless decedents into three groups on the basis of use of homelessness services (known users, occasional users, and nonusers), and differences among the groups were assessed by using descriptive and multivariate methods. RESULTS: Of 141 adult decedents, 49% made substantial use of the homelessness services system (known users), 27% made occasional use of these services (occasional users), and 24% had no record of use of homelessness services (nonusers). Compared with known users, nonusers and occasional users were less likely to have had a severe mental illness diagnosis or to have received either disability benefits or Medicaid coverage and were more likely to be white. Nonusers and occasional users were also more likely than known users to have died in outlying parts of the city. CONCLUSIONS: More conventional homeless surveys and enumerations miss a substantial portion of the homeless population. Including these "hidden homeless" persons would alter perceptions about the composition of Philadelphia's homeless population, lowering estimates of the incidence of psychiatric disability and increasing estimates of racial diversity.

Relationship among adverse childhood experiences, history of active military service, and adult outcomes: homelessness, mental health, and physical health.

OBJECTIVES: We determined whether a report of adverse childhood experiences predicts adult outcomes related to homelessness, mental health, and physical health and whether participation in active military service influences the relationship between childhood and adult adversity. METHODS: Using data from the 2010 Washington State Behavioral Risk Factor Surveillance System, we tested by means of logistic regression the relationship between adverse childhood experiences and 3 adult outcomes--homelessness, mental health, and physical health--as well as differences among those with a history of active military service. RESULTS: Adverse childhood experiences separately predicted increased odds of experiencing homelessness as an adult and mental health and physical health problems. Childhood adversity increased the likelihood of adult homelessness and poor physical health among individuals with no history of active military service and the likelihood of mental health problems among individuals with a history of active military service. CONCLUSIONS: The relationship between childhood adversity and adult adversity changes in degree when history of active military service is controlled, which has implications for Armed Forces recruitment strategies and postmilitary service risk assessment.