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Homelessness Among Families: A Review of Health Care Issues

This review explores the challenges faced by homeless families, including barriers to accessing health care and the impact on children's health, development, and education. It discusses innovative approaches and interventions to address these issues.

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Homelessness Among Families: A Review of Health Care Issues

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  1. S U S Homelessness by Kim Wilson reviewed by William Bithoney Jean Ciborowski Irwin Redlener

  2. How big is the problem? • Estimates vary considerably • 250,000 to 3 million homeless persons • 1/ 3 to 1/2 are homeless families with children • Increasing yearly

  3. Why the increase in numbers of homeless families? • Increasing numbers of children living in poverty • Shortage of affordable housing • Decline in rent subsidies

  4. Who are the homeless families? • In Boston study: • Most were single parent, female headed • Multiple children, over 1/2 less than age 5 • Over 1/2 of mothers had a history of • Domestic violence • Significant physical or mental illness • Substance abuse

  5. Where do homeless families live? • "Rootless" before Homeless • Average of 6 - 8 moves in year prior to entering shelter • Live " doubled up" with family or friends • Live on the street

  6. Once in the shelter system • Group Shelters • Welfare "motels" • Temporary transitional apartments • Many far from original neighborhood • Average length of stay 9 -15 months

  7. Barriers to Accessing Health Care for Homeless families • Geographic and social isolation • Frequent moves • Difficulty in meeting basic needs (food, money, permanent housing) • Lack of transportation

  8. Health Problems in Homeless Children - Overview • Delayed Primary and Preventative Care • Increased rates of common pediatric illnesses • Nutrition - FTT and Obesity • Developmental Delays • Behavior Problems

  9. Delayed Primary and Preventative Care • Seattle study: 59 % of homeless children with no primary care MD • Homeless families use Emergency Departments 2 - 3 times more than housed poor children • Immunization Delay in homeless 2 year olds in NYC - 70 %

  10. Acute Pediatric Illness • Increased illnesses in homeless children similar to those in housed poor children • Otitis Media, URI's, Asthma, Anemia, gastroenteritis • In homeless children, these illnesses more likely to be untreated or only episodically treated

  11. Nutritional Problems in Homeless Children • Barriers to good nutrition • Lack of local shopping facilities • Lack of cooking facilities/refrigeration in some shelters • Lack of money • Use local fast food restaurants or convenience stores --> high fat diet

  12. Nutritional Findings in homeless children • Obesity most common - 12 - 35 % in NYC • Fe Deficiency - 19 % in NYC • Failure to Thrive

  13. Developmental, Behavioral and School Problems • Homeless Vs. Housed Poor • On entry into shelter system, similar rates of developmental problems • After months of homelessness, homeless children show higher rates of: • Developmental delay • School Failure • Behavioral problems

  14. Challenges to healthy development • Family stresses • Sub optimal environment for living, playing, studying • Higher rates of illness

  15. Developmental Findings in studies of homeless children • Over 1/2 have 1 or > areas of delay on DDST • Rates of developmental delay 2 - 3 x > than housed poor children • Score higher on scales of anxiety, depression, and aggression

  16. School Problems in studies of homeless families • Absenteeism - 17 % reported missing 1 week/month • School Failure - 1/3 of homeless children reported needing to repeat a grade

  17. Interventions for clinicians • Careful screening for development, behavior, school problems in ALL homeless or rootless children • Early referral for services • Early intervention • Head start • Special educational services

  18. Innovative Approaches to Providing Health Care to Homeless Families

  19. Helping Families get to health care • Transportation Vouchers to primary care sites • Case manager to coordinate services and appointments • Using acute care visits (in ED or office) to screen for primary care needs

  20. Improving Coordination of Health Care Information • Use of medical "passport" (summary of all health information and preventative care) that family keeps • City, county or state wide computerized immunization tracking systems

  21. Bringing Health Care to Homeless Families • Mobile medical vans in NYC • Establish clinic sites at shelters

  22. Advocacy • Pediatricians can be powerful advocates • for individual families with housing authorities • with legislators for improvements in housing, shelters, and services

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