By: Punreet K. Bhatti, MD
Evictions Lead to Homelessness
I often reminisce on the life I once lived when everything in that 10×20 storage unit used to be under a two-story home in Pembroke Pines, FL. Nostalgia, anger, then pure sadness come over me as I remember the events leading to the eviction. My childhood home was taken away from my family and I this year after my dad was diagnosed with Vascular Dementia. If you have ever been evicted from your own home, then you understand that words can’t even describe how dehumanizing and heart breaking of an experience it is or the shame and guilt you feel afterwards. However, failing to be on time with rent due to a medical ailment is not uncommon. I was fortunate enough to be able to take care of my family and come out with only a scratch of emotional trauma. But what happens when the same event happens for a child over and over again, eventually leading to homelessness?
How Did We Get Here?
Risk Factors, Outcomes & Challenges That Kids Face
Although ~10% of homeless families in the United States are living unsheltered in cars, on the street, and in other areas not meant for human habitation, 90% are sheltered. This population is invisible in plain sight because they’re living in places like hotels or doubling up in a family member or friends’ home. These families go undocumented especially when it comes time to make decisions for funding. Parents of these kids don’t speak out because of the fear that their children will be taken away from them and children remain silent due to fear of being bullied at school.
There are many risk factors that contribute to family homelessness with lack of a high school degree or GED being the top. This stems from the fact that many high school students experiencing family homelessness will drop out of school to help support their family – making homelessness an intergenerational issue. Other scenarios are the mother that flees in the middle of the night with her children from a domestic violence relationship or the father that has just been laid off from his job or the LGBTQ+ teen who has been outcasted by his/her/they parents. Organizations such as Project HOPEAlliance, serve families with children and provide a level of support as generational disruptors of homelessness.
High rates of asthma and obesity as well as psychiatric, behavioral, or developmental problems are just a few of the major issues that have been documented as a result of homelessness. Unstable living conditions make it more difficult to make healthy food choices or engage in physical activity. Often, areas where families are living offer little green space and drug and human trafficking may be present. Therefore, children are unable to play or interact with their environment, contributing to the growing epidemic of childhood obesity. Additionally, youth who experience homelessness engage in a wide variety of health risk behaviors at significantly higher rates than their housed peers.
In studies from shelters in NYC, immunization delays, iron deficiency anemia, and poor growth have been documented. Another study in an NYC shelter hotel showed three-quarters of the preschool-aged children had language delays and emotional problems. Children who are living in confined places are more prone to developmental delays. For example, families living on the street might keep their child in a car seat, stunting the child’s growth and consequently delaying them from walking and putting them at risk for other motor delays.
Most often, schools will experience the behavioral problems of a child first-hand. Research show that 80% of our brain develops in the first five years of life and children thrive best in environments that promote consistency and structure, and the devotion of caretakers. However, toxic levels of stress during homelessness can alter the structure of the brain, making simple tasks and thought processes difficult. Research shows that children learn and grow more when they have proper play space. At Horizons for Homeless Children, play spaces meet this need for different developmental stages – from the literacy area where parents can read to their baby to the blocks and puzzles room where they can work on developing gross and fine motor skills to the dramatic play room where kids can dress up, put on a show and feel more in control.
Policy & Advocacy
Ending the Battle of Family Homelessness
Current policy and funding for ending homelessness is focused on single men and single women. The McKinney-Vento Act, has important provisions for children and families, especially concerning child nutrition and education. Although, more advocacy is needed to ensure states are following the regulations, including the right for children who are homeless to attend preschool and school. The Homelessness Prevention and Rapid Re-Housing Program, funded by the American Recovery and Reinvestment Act of 2009, provided resources for families including help with rent payments, housing and credit counseling. However, the program ended in 2012, and funds are no longer available.
Low-income families can’t afford housing without help. In Chicago, there is a severe housing cost burden of about 31%, making it difficult for families to supply the funds for other basic necessities such as food, clothes and healthcare. The federal housing programs, which offer a fixed number of housing vouchers, public housing units, and low-income housing tax credit-built units, often have waiting lists that are completely full. Approximately one-quarter of families who are eligible actually receive these housing options. Advocacy related efforts need to be a larger focus to help revive programs like the Homelessness Prevention and Rapid Re-Housing Program as well as increasing the access and eligibility to housing choice vouchers for families with children.
Another way communities can combat homelessness is revamping houses and subsidizing them for low-income families then tracking their success on a yearly basis. Organizations and companies like Stage2Properities have added more value to the Southside of Chicago by offering more employment opportunities, listening to the needs of the community and partnering with nonprofits like Northwest Side Housing Center to bring everything full circle to those most in need.
Pediatricians, Schools, Early Child Care Centers & Community Organizations Working Together
Pediatricians have an opportunity to help families with children dealing with homelessness by collaborating with schools, early child care centers, and community organizations. Schools and early care centers are a community hub that can bring together health, employment, housing, and even extended school days. At organizations like SchoolHouse Connection, members work to overcome homelessness through education.
Children’s hospitals like Children’s Hospital of Philadelphia (CHOP) have already made it an initiative to close the gap in access to healthcare for families dealing with homelessness. Research shows these families can’t afford to pay for healthcare and thus use the emergency room (ER) more often. Shelters sometimes encourage these families to go to the ER so it is documented. From this, the Homeless Health Initiative at CHOP was formed in order to connect families to shelters and other resources and to help pediatricians become more trauma-informed. Lurie Children’s Healthy Communities is working on addressing family homelessness amongst our patient population. Other hospitals that are looking to collaborate with community leaders working on this issue should read the US Interagency Council on Homelessness’ strategic plan, called Home Together. The Council is a federal agency created by Congress to lead the national effort to end homelessness.
Pediatricians should also make it part of well child visits to screen for family homelessness by asking questions like:
- Are you worried or concerned that in the next two months you may not have stable housing that you own, rent, or stay in as a part of a household?
- How often have you moved in the last year?
- Do you have problems with bug infestation, mold, lead paint or pipes, inadequate heat, water leaks, broken appliances or smoke detectors?
They may find what no lab test or imaging modality will be able to detect…a child with no place to call home.