Reports and Briefs
A Tangled Web: Homeless Family Subpopulations and Their Overlapping Needs
HIV/AIDS affects roughly six percent of adults in families and individuals living in permanent supportive housing (5.8% and 6.6%, respectively [figure 1]). The rate of infection for homeless families is nearly twelve times higher than for persons nationwide (0.5%).[x] Homeless mothers, with their limited access to screenings and preventative care, have a higher risk of infection than their housed peers.[xi] The effects of the disease (exorbitant health care costs and job loss from discrimination or extended absence) can increase the risk of homelessness for low-income families; up to 70% of persons living with HIV/AIDS report one or more episodes of housing instability.[xii] Conversely, homelessness is associated with HIV-risk behaviors, including substance abuse; a Florida study reported that almost one-third (30.5%) of HIV-positive homeless clinic clients were injection drug users, nearly three times the national rate (11.7%).[xiii]
Over nine in ten (91.6%) homeless mothers experience severe physical and/or sexual abuse during their lifetimes, nearly four times the rate of women in the general population (25.5%).[xiv] A Minnesota study revealed that one in three (31.0%) women listed domestic violence as a primary reason for their homelessness.[xv] Despite federal laws prohibiting discrimination, women are often evicted for violent activity in their unit or landlords refuse to rent to persons with histories of abuse. Poor credit history and lack of financial resources stemming from their abuse also prevent women from obtaining housing. Faced with a lack of economic resources, many mothers remain with their abusers, leaving themselves and their children at risk of further violence. Between 3.3 million and 10 million children in the country witness violence in their homes each year, which can lead to developmental delays.[xvi] Domestic violence is often a multigenerational problem for homeless families; the odds that women who are abused as children will experience adult victimization are three times those of women without histories of childhood abuse.[xvii] Women facing domestic violence often suffer from high rates of depression (47.6%) and posttraumatic stress disorder (PTSD; 63.8%) and are 15 times more likely to abuse alcohol.[xviii]
Although the majority of homeless veterans are single adults (13.6% of total sheltered individuals), 3.1% (4,425) are members of a family (representing 1.9% of sheltered families nationwide).[xix] Homeless veteran families are undercounted since many veterans live and request shelter separately from their children. Female veterans have two to four times the risk of becoming homeless as the general female population and are most at risk when they are heading families with young children.[xx] Compared to their nonveteran counterparts, homeless veteran families are more than twice as likely to have a male adult present (21.6% and 53.5%, respectively).[xxi] Although the federal government targets many services towards homeless single veterans, the needs of families—particularly those headed by single women—have been largely neglected.
Over half (53%) of homeless female veterans have at least one major mental disorder, which certain studies blame on their high rate (20%– 48%) of military sexual trauma.[xxii] Almost three-quarters (74.2%) of homeless female veterans suffer from PTSD, which has been linked to social and behavioral problems in their children.[xxiii] Domestic violence rates are also high (19%) among all female veterans and close to two-thirds (62.1%) of Health Care for Homeless Veterans clients have a substance use disorder.[xxiv]
Data are classified using quintiles.
Source: U.S. Department of Housing and Urban Development, HUD's 2010 CoC Homeless Assistance Programs—Homeless Populations and Subpopulations.
One in ten (10.7%) sheltered adults is chronically homeless (figure 2) with no separate data for adults in families.[xv] The federal Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009 expanded the definition of “chronically homeless” to include families with children.[xvi] Because this family subpopulation has only recently been singled out for observation, little research exists on its characteristics and needs. What is apparent is families’ extreme vulnerability due to co-occurring disabilities (serious mental illness, substance abuse, or developmental or physical impairment) and long-term homelessness conditions. Studies on family supportive housing programs—whose clients share characteristics with chronically homeless individuals—reveal mothers who are typically older and better educated (but with similarly poor employment patterns), with longer histories of homelessness and more disabilities than those served by the emergency shelter system.[xvii]
Conclusion: Need for Better Data
As the number of homeless families increases, recognizing family variability and the overlap between subgroups (figure 3) becomes even more important. Current lack of data on unique and co-occurring service needs poses a challenge for the planning and evaluation of programs serving families, as well as for the development of broad-scale, collaborative service networks. Homeless families headed by a single mother dealing with domestic violence and severe depression differ from those with HIV-positive fathers.
Families with one substance abusing parent have different needs than those where both parents abuse drugs and alcohol. The importance of homeless households with co-occurring disorders, such as a veteran mother with military sexual trauma and her physically disabled child, should also be regarded. Assessing subpopulation rates for families in permanent supportive housing (figure 1) versus emergency shelter and transitional housing (figure 2) would also be useful in order to target services to the highest needs. However, due to conflicting definitions of mental illness and substance abuse between these sources, the data are impossible to compare. Without comprehensive and consistent data, the longterm effectiveness of any housing program and its applicability for all homeless families cannot be determined.
[x] U.S. Department of Housing and Urban Development, The 2010 Annual Homeless Assessment Report to Congress; U.S. Census Bureau, 2010 American Community Survey 1-year Estimates; U.S. Centers for Disease Control and Prevention, “HIV Surveillance—United States, 1981–2008,” Morbidity and Mortality Weekly Report 60, no. 21 (2011): 689 – 693.
[xi] National Health Care for the Homeless Council, HIV/AIDS & Homelessness: Recommendations for Clinical Practice and Public Policy, February 2000.
[xii] Angela Aidala, et al., “Housing Need, Housing Assistance, and Connection to HIV Medical Care,” AIDS Behavior 11 (2007): 101–115.
[xiii] James Shultz, et al., “HIV Seroprevalence and Risk Behaviors Among Clients Attending a Clinic for the Homeless in Miami/Dade County, Florida, 1990 –1996,” Population Research and Policy Review 18 (1999): 357–372; Irene Hall, et alv., “Estimation of HIV Incidence in the United States,” Journal of the American Medical Association 300, no. 5 (2008): 520 –529.
[xiv] Ellen Bassuk, et al., “The Characteristics and Needs of Sheltered Homeless and Low-income Housed Mothers,” The Journal of the American Medical Association 276, no. 8 (1996): 640 – 646; U.S. Department of Justice, Full Report of the Prevalence, Incidence, and Consequences of Violence Against Women: Findings From the National Violence Against Women Survey, November 2000.
[xv] Wilder Research, 2009 Homeless Adults and Children in Minnesota Statewide Survey: Physical and Sexual Abuse, June 2010.
[xvi] Massachusetts Advocates for Children, Helping Traumatized Children Learn: A Report and Policy Agenda, 2005.
[xvii] Susan Wenzel, et al., “Risk Factors for Major Violence Among Homeless Women,” Journal of Interpersonal Violence 16, no. 8 (2001): 739 –752.
[xviii] Jacqueline Golding, “Intimate Partner Violence as a Risk Factor for Mental Disorders: A Meta-analysis,” Journal of Family Violence 14, no. 2 (1999): 99 –132; National Coalition Against Domestic Violence, Domestic Violence and Substance Abuse.
[xiv] U.S. Department of Housing and Urban Development and U.S. Department of Veterans Affairs, Veteran Homelessness: A Supplemental Report to the 2010 Annual Homeless Assessment Report to Congress.
[xx] Gail Gamache, et al., “Overrepresentation of Women Veterans Among Homeless Women,” American Journal of Public Health 93, no. 7 (2003): 1,132–1,136; National Center on Homelessness Among Veterans, Prevalence and Risk of Homelessness among U.S. Veterans: A Multisite Investigation, August 2011.
[xxi] U.S. Department of Housing and Urban Development and U.S. Department of Veterans Affairs, Veteran Homelessness: A Supplemental Report to the 2010 Annual Homeless Assessment Report to Congress.
[xxii] John C. Buckner, et al., “Mental Health Issues Affecting Homeless Women: Implications for Intervention,” American Journal of Orthopsychiatry 63, no. 3 (1993): 385–399; U.S. Department of Labor, Women’s Bureau, Trauma-informed Care for Women Veterans Experiencing Homelessness: A Guide for Service Providers, 2011.
[xxiii] Donna Washington, et al., “Risk Factors for Homelessness Among Women Veterans,” Journal of Health Care for the Poor and Underserved 21, (2010): 81–91.
[xxiv] U.S. Department of Labor, Women’s Bureau, Trauma-informed Care for Women Veterans Experiencing Homelessness: A Guide for Service Providers, 2011; Congressional Research Service, Veterans and Homelessness, July 2011.
[xxv] U.S. Department of Housing and Urban Development, HUD’s 2010 CoC Homeless Assistance Programs—Homeless Populations and Subpopulations.
[xxvi] Chronically homeless families are those with at least one adult member who have a disabling condition and have been continuously homeless for at least a year or have had at least four episodes of homelessness in the past three years; Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009, S 896, 111th Cong., 1st sess.
[xxvii] Corporation for Supportive Housing, Family Permanent Supportive Housing: Preliminary Research of Family Characteristics, Program Models, and Outcomes, February 2006.