Urban Homelessness: Psychological Outcomes for Mothers and Children
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This article offers a historical perspective on homelessness in urban America, focusing particularly on homeless mothers and their children. The article reports the results of two studies of homeless and domiciled families in Detroit, Michigan, and offers suggestions for therapeutic interventions with homeless families.
Key words: homeless, urban, women, children, psychopathology, depression
Terrie A. Harshaw, Ph.D., and Renee M. Brockington Bouey, Ph.D., are practicing school psychologists with the Detroit Public Schools, Psychological Clinic, Longfellow Annex, Room 248, 13141 Rosa Parks Blvd, Detroit, Michigan, 48238.
Homelessness is a phenomenon that has been a part of the American lifestyle since colonial times. The meaning of homelessness has changed many times since the early years of the colonial settlements with different definitions emerging in response to national and regional situations. Since the mid-eighteenth century, homelessness has increased in times of economic difficulty and declined during periods of prosperity or with the outbreak of war. In previous centuries, the homeless poor were supported by family members. This system of relief usually remedied breaks in the family structure. Since poverty was virtually uncommon, the community regarded these people as their wards and assumed responsibility for those in distress. Little stigma was attached to homelessness because it was generally felt to be due to circumstances beyond one's control.
CURRENT STATUS OF THE HOMELESS
Over the last century, an increase in homelessness has been largely attributed to an increase in unemployment, underemployment, and poverty in general. Currently, the nature and scale of homelessness differs depending on the definition used. While the U. S. Bureau of the Census does not define homelessness, it has adopted the definition of the U. S. Department of Housing and Urban Development (HUD). A person is considered homeless if his or her nighttime residence is in either (a) public or private emergency shelters (schools, church basements, governmental buildings, former firehouses) or where temporary vouchers are provided by private or public agencies (hotels, apartments, or boarding homes); or (b) streets, parks, subways, bus terminals, railroad stations, airports, abandoned buildings without utilities, cars, trucks, under bridges or aqueducts, or in any other public or private space that is not designed as shelter (HUD, 1984). HUD's definition excludes residents of halfway houses and long-term detoxification centers. However, it does include those individuals temporarily detained in a local jail who would normally be on the street or in emergency shelters. Also included as homeless are battered women housed in temporary shelters.
National estimates of homelessness continue to fluctuate greatly. The 1990 Census found that approximately 400,000 Americans were homeless, while advocacy groups have put the figure between 700,000 and 3 million. More current data suggest that there may be as many as over a million actual homeless individuals at any given time in the continental United States—with as many as three million people experiencing homelessness at some time each year. According to recent estimates, some 13.5 million Americans have been homeless for at least a few days sometime during their lives; and an additional 12.5 million have stayed off the street only by moving in with friends at some point in their lives, for periods that ranged from a few days to a year (Link, 1994). These data minimize current beliefs that homelessness is an aberration affecting Americans who have distinct personal histories or who are situated on the fringes of society.
HOMELESSNESS IN DETROIT
The Detroit area, with a population of approximately 2.2 million residents, represents approximately 25% of Michigan's 9.1 million residents. The Detroit area ranks sixth in population size among major urban areas in the United States. Generally, the rate of homelessness is higher in larger cities than in smaller cities (Hopper & Hamberg, 1990). However, until recently there has been very little formal data on Detroit's homeless population.
Unlike other cities in the U. S. where many of the homeless sleep on streets or in parks, the homeless of Detroit most often sleep in abandoned buildings. It has been estimated that over 27,000 people are homeless each year in the Detroit metropolitan area alone, with an average of 500 in need of shelter daily (Mobray, Solarz, Johnson, Phillips & Combs, 1986; Solarz, 1988). In 1989, there were over 1,500 emergency shelter beds in the city of Detroit. While these numbers suggest that Detroit has adequate shelter space, in reality the shelter hotline received over 2,500 calls a month requesting assistance.
The new homeless, unlike the old transient poor, appear not to have the same support systems. According to the 1987 Comprehensive Homeless Assistance Plan (CHAP) the population in the city of Detroit at risk of being homeless is 460,000 to 500,000 individuals. These projections included individuals who are elderly, receive public assistance, are unemployed, are in adult foster care homes or halfway houses as well as the working poor. The new homeless include (a) single parent households; (b) former working families; (c) racial and ethnic minorities; (d) single women; (e) victims of domestic violence; (f) psychiatrically disturbed individuals; (g) ex-offenders; (h) youth; (i) the elderly; and (j) legal and undocumented immigrants (Hopper & Hamberg, 1990).
Detroit, like other cities across the country, is home to three diverse groups of homeless people (Detroit Urban League, 1989). The first group is the traditional street people who have been around for a long time. The second group is the deinstitutionalized mentally ill. This group has grown significantly in the last 5 to 10 years as the revisions to the Michigan Mental Health Code have reduced the population of patients in state facilities for the mentally ill. A third group is Detroit's newly "dishoused." Whether victims of spouse abuse or of the high rates of unemployment in Detroit's inner city and a lack of decent, low cost housing, this group contains an increasing number of homeless children. According to the Urban League study (1989), 25% of the homeless population in Detroit (or approximately 125,000) were women with children. The median age of the women was 30.5 years.
HOMELESS WOMEN AND CHILDREN
Historically, there has been little public interest in homeless women, either on skid row or elsewhere in the urban area. Homeless women, living on the streets, were considered a rare phenomenon. Ecological concentrations of homeless women were not perceived as threatening to the social order or as neighborhood problems. However, research over the past two decades in this country indicates that 30% of the homeless families include homeless women who are mothers, under the age of 35, members of a minority group, have often not completed high school, have usually experienced more than one episode of homelessness in their lifetime, and are of single marital status with two to three children (Milburn & Booth, 1990; Bassuk, Rubin, & Lauriat, 1986; Bassuk & Rubin, 1987; McChesney, 1986; Robertson & Cousineau, 1986; U. S. Conference of Mayors, 1987; Bassuk & Rosenberg, 1988; Mills & Ota, 1989; Redmond & Brackmann, 1990; Milburn & D'Ercole, 1991; Rafferty & Shinn, 1991).
According to a recent report of the Michigan League for Human Services (Homeless in Michigan: Voices of the Children, 1996), the typical homeless family in Michigan's shelters consisted of a mother and one or two children. Although no one knows precisely how many of Michigan's children are homeless, the Michigan Department of Education estimated that roughly 140,000 of the state's school-aged children were homeless at some time during the 1994-95 academic year.
Research on Homeless Mothers and their Children
Only a few researchers have focused on the mental health of homeless children, although among Detroit's homeless, mental health problems such as depression are relatively common. A study by the Michigan Department of Mental Health found that 25% of adult participants had been hospitalized for psychiatric problems (Solarz, 1988). However, it is unclear whether the relationship between parental psychopathology and perceived child pathology is in fact a function of learned factors, environmental factors, effects of the parent's disorder, the views of the parent regarding the child, or the result of a genetic factor that involves the parent and the child (Wender et al., 1986).
Research focusing on both homeless women and children has been mostly descriptive in nature. Research findings suggest that homeless children display problems implicating poverty as well as specific conditions of homelessness. Psychological problems identified most often in research on homeless children include depression, anxiety, and behavioral difficulties (Bassuk & Rubin, 1987; Bassuk & Gallagher, 1990; Rescoris, Parker & Stolley, 1991; Fox, Barrnett & Davies, 1990; Wagner & Menke, 1991; Zima, Wells & Freeman, 1994). Researchers only now are attempting to adopt a comprehensive model to organize and interpret recent empirical findings concerning homeless women and children.
We conducted two studies in Detroit to investigate the mental health of women and their children. Data were collected from 80 adult mothers and their children from ages 8 to 12 years. Forty pairs were homeless family members and 40 pairs were poor domiciled family members. Homeless families were defined as those children and families who were in emergency shelter facilities. The homeless subjects resided in various homeless shelters in the Wayne County area, were homeless for 30 days or more, and had been homeless on at least one previous occasion. The homeless subjects did not include individuals who were substance abusers or those homeless due to domestic violence.
The adult subjects were administered three instruments assessing psychopathology, family environment, and communication deficits: the Brief Symptom Inventory (Derogatis & Spencer, 1982); the Family Environment Scale (Moos & Moos, 1986); and the Toronto Alexithymia Scale (Taylor, Bagby, & Parker, 1992). The children were administered four scales to determine their mental health status and language abilities: the Children's Depression Inventory (Kovacs, 1985); the Revised Children's Manifest Anxiety Scale (Reynolds & Richmond, 1985); the Coopersmith Self Esteem Inventory (Coopersmith, 1981); and the Comprehensive Receptive and Expressive Vocabulary Test (Wallace & Hammill, 1994).
The first study was designed to explore the mental health and family environments of homeless and poor domiciled (housed) children. Previous research had disclosed that homeless families lose control over their environment and that homeless parents are at extreme risk of depression. Most often children of depressed or mentally ill parents have an increased rate of psychiatric disorders, and the severity of the parental psychopathology is related to the number of symptoms reported for the children (Kashani, Beck, & Burk, 1987; Jensen, Lewis, & Xanakis, 1986; Ovaschel, Weisman, Padium, & Lowe, 1981). In evaluating the children of depressed parents, studies have shown that behavioral disturbances, anxiety symptoms, and bulemia are associated with parental psychopathology (Curran, 1991). Such psychopathology in the parents, as well as homelessness itself, was hypothesized to place homeless children at risk of depression, anxiety, and low self esteem. The first study was designed to explore the effects of homelessness, parental psychopathology, and family environment on depression, anxiety, and self esteem in children.
Results of Study 1 (Harshaw, 1996) revealed that homeless mothers and their children were clinically more depressed and anxious than poor domiciled mothers and their children. Sixteen of the homeless children (40%) versus two of the domiciled children (5%) scored in the clinically significant range for depression. Twenty-three of the homeless children (58%) and five of the domiciled children (13%) scored in the above average range. The homeless children displayed significantly more depressive symptomology than the poor domiciled children on all of the depression subscales (anhedonia, ineffectiveness, interpersonal problems, negative mood, and negative self esteem).
The homeless children also were significantly more anxious than poor domiciled children; however, none of the children obtained total scores in the clinical range. The individual subscale scores showed that the homeless children had significantly higher levels of worry, anxiety, and social concerns than the domiciled children. This finding suggests that homeless children may be experiencing "subclinical" levels of anxiety not shared by the majority of domiciled children.
Below normal self-esteem scores were obtained by both the poor domiciled and homeless children, although surprisingly the domiciled group was significantly lower in general self esteem than the homeless group. The correlation between self esteem and brief symptom scores indicated a moderate and positive relationship for both groups.
Both the homeless and the poor domiciled families were categorized as having disorganized family environments. Twenty-seven homeless mothers (68%) and thirty-four domiciled mothers (85%) scored in the significant range on this subscale. None of the families met the criteria of support-oriented families, although about equal percentages of domiciled (43%) and homeless (45%) mothers classified their families as conflict-oriented. However, a significant negative relationship was found between children's depression and the family environment subscales of conflict and expressive orientations, suggesting that as depression in the children increases conflict and expressiveness in the family processes decreases.
The second study (Brockington Bouey, 1996) examined the relationship between alexithymia and depression in homeless and domiciled parent populations. Alexithymia as in Greek means "without words for emotions" (Sifneos, 1972). Alexithymia is characterized by a noticeably pragmatic, as well as an affectless, manner of relating to oneself and to others (Marty & de M'Uzan, 1963; Marty, de M'Uzan, & David, 1963). Specifically, this study explored the presence of alexithymia and depression in mothers, and the relationships of maternal alexithymia and depression to children's depression, anxiety, and language development. The impact of homelessness versus domiciled living status on all variables was also investigated. Sample and methods were the same as in the first study described above.
Study 2 found a highly significant positive relationship between alexithymia and depression for the poor domicilied and the homeless mothers, supporting the use of the Toronto Alexithymia Scale-20 (Taylor, Bagby, & Parker, 1992) with these populations. Although the current study had few individuals with severe depression (two standard deviations above the mean), the hypothesized relationship between those individuals who were 'alexithymic' and also 'high' in depression was evident. Similar relationships were found between maternal alexithymia in mothers and children's depression and between maternal alexithymia and children's anxiety. While family environment scores did not significantly predict alexithymia, family expressiveness was lower for individuals who were found to be alexithymic.
Homeless living status also proved to be a significant factor in all analyses of mothers. Homeless mothers had a significantly greater incidence of both alexithymia and depression than their domiciled counterparts. However, living status was not a significant factor in children's expressive language skills, even though homeless children had mothers with the greatest incidence of both alexithymia and depression. Homeless children's expressive language skills were comparable to their domiciled peers. Homeless living status, however, significantly affected receptive language skills. Homeless children's receptive skills were significantly greater than the skills of domiciled children. These findings with respect to language raise the following questions, which will be addressed in future research:
- If homeless children are more depressed and anxious than their domiciled peers, why are they doing as well expressively and better receptively than those same peers?
- If they have mothers who are more apt to be alexithymic and depressed, by what mechanism are the children gaining or maintaining their language development?
- Is their performance a reflection of a type or degree of compensation or coping with homelessness, or with mothers who may be depressed and/or alexithymic?
Implications for Intervention
Clinically, mothers with children (particularly those who are homeless, depressed and/or alexithymic) might benefit from mental health services that can provide:
- Family therapy for the mother and the child to explore coping mechanisms that might alleviate the stress of being homeless. The understanding of homelessness and of the effects that it may have on the family is important. Educating the family about these effects may allow family members to find methods of identifying and mediating feelings of hopelessness, depression, and anxiety. Techniques that might be employed are brief psychotherapy, behavioral therapy (particularly modeling), play therapy (particularly role playing), counseling, and education.
- Individual therapy for both the mother and child to decrease depression and anxiety as it relates to homelessness. Individual therapy that focuses on enhancing affective well being while learning how to communicate feelings in a supportive environment might be helpful. For the children this might include play therapy which would focus on the feelings the child is having because of the homeless situation or other problems the child is experiencing. Individual therapy for the parent might include strategies to help alleviate some of their depression and anxiety due to the homeless situation.
- Self-help programs to promote positive self esteem for both the homeless and the domiciled child. A climate of warmth and acceptance would foster improvement in the child's self image. Self esteem would also be strengthened by the child's achieving greater mastery in daily activities and in the improvement of interpersonal relationships.
- Community support systems such as Big Sisters and Big Brothers to provide support to the family and to enhance self sufficiency. The goal of the Big Sisters and Big Brothers program is to provide mentoring and modeling for children. Under this program the children would be allowed to have social relationships with different children of varying backgrounds. The homeless children and the poor domiciled children would be involved in activities that are not available in a sheltered environment.
- Parents/Children Workshop series that include topics specific for parents that focus on community concerns, organizational skills, parenting skills, and empowerment issues (e.g., dealing effectively with agencies/individuals, how and where to find information). Children's workshops might include topics/activities centered around self esteem, motivation, problem solving, and conflict resolution. These workshops might utilize plays/skits with puppets, games, flash cards, art work, and story time to address the identification and resolution/acquisition of emotional, conflict, and empowerment issues—especially those precipitated by homelessness, eviction, joblessness, and other losses emanating from abandonment (including separation, divorce, and death).
- Finally, the development of on-site socially supportive shelter programs for mothers and their children that provide families with an understanding of how to become actively involved in specific programs. Many of the shelter programs have social work staff that are available to oversee clients on issues involving entitlements and permanent housing. Usually the clients must travel to a community mental health center to receive therapeutic services. Appointments are not readily available and many times the client has moved to another shelter or found permanent housing by the time an appointment is given. This system does not allow for the immediate treatment of the situation. An in-house social work system would aid the family in the learning about services that are available for both parents and children.
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