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Homelessness

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

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Homelessness

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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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