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Mentor Research Institute Programs For Homeless Children A Report on Mental Health: Homeless Families and Children. By Jackie L. Culver MFA, MA If I ran the government… Mental heath care for the homeless children and families would be outreach, free, and intervention oriented. The immediate intervention would be in the family trauma that affects the resiliency of hundreds of thousands of homeless children in America. The trauma in and around the conditions of homelessness and the lack of the internalization of safety effects cognition, physical growth, nutrition, and is a cause for developmental delays and kinetic activity that is more often than not, misdiagnosed as the ever popular and mythical Attention Deficit Disorder. According to the National Law Center on Homelessness and Poverty, 3.5-4.5 million people are estimated to be homeless in America. Upwards of 40% of the homeless populations are families with children below the age of 12. Unaccompanied youth between the ages of 12-18 account for 4%. Single parents account for 67%. On any given day 42% of homeless families report not having any food and for having gone more than 24 hours with out anything to eat or drink. Many parent/s are unable to care for their children’s emotional needs during this period of crisis. Precisely at the time of most need, mental health services are not available. According to the Department of Health and Human Services report from 1999 20% of homeless families have no insurance at all and 73% have only what Medicaid will cover. Most coverage does not include mental health except in extreme cases. Suffering children are not considered extreme. Families may wait up to three months for an appointment consisting of assessment. There is no protocol for mental health crisis intervention for homeless children yet in the study by the DHHS, mental health issues were one of the factors relating to homelessness. The report does not cite any intervention for adults or children. If they are not covered by insurance, there is no statistic available in the study. Mental health issues are confined to addiction problems and listed with the factors of homelessness. Therapists well trained in crisis and homeless populations would greatly enhance services if these services were quickly available. Assessment time would be confined to those issues immediately needing tending. Families in shelter can not wait for services. In most cases shelter is a 30 day maximum stay. If a family waits for mental health services, they may have to move on, go to another shelter, or somehow get to another city if they have used up their voucher time in their present location. The longer a family waits for appropriate therapeutic intervention the more hopeless and helpless they begin to feel. The more hopeless and helpless a family feels the less likely they can participate fully in case management plans and acquire the needed resources to escape from the cycle of homelessness. A net search of Colleges and University’s contained no hits of course work designed to serve homeless populations. This in itself begs the question as to how therapists and counselors could get training in homeless issues. If no specific course work or trainings are available the answer to the high turn over in case management and support services is clear. The work is difficult. The population stressed. Limited funding and low pay are not the primary causes of the burnout. Lack of training is cited as the main reason for the high level of worker fatigue and vicarious traumatization. Children in homeless conditions receive no mental health services designed to treat trauma and yet the Report on the Surgeon General’s Conference on Children’s Mental Health clearly states that for every dollar spent on intervention at least four dollars is saved in future services. Some children may receive some treatment as designated by managed care. As this service is not immediate, not trauma specific, and more often than not done by practicum students in mental health with little or no training in work with homeless children, little is accomplished. Children suffer. These children miss weeks of school and are frequently fall too far behind to complete the needed work. The drop out rate is consistently high. Their behavior is trauma reactive and misunderstood. They are easily distracted, unable to focus, emotionally impoverished from lack of consistent safety, often inadequately nurtured and physically suffering from lack of nutritious food. Because of the misdiagnosis, many of these children are labeled and ignored or worse yet, drugged. The message of drugging kids for behavior problems is unacceptable. A noted study by the Annie E. Casey Foundation entitled Children at Risk: State Trends 1990-2000 cites “high risk” family conditions. Interestingly enough, homelessness is not considered high risk. Though much data was collected, high risk families were considered on the bases of 5 key indicators. None of those five were issues on housing, mental health, or nutrition. Immediate intervention on issues of safety show noticeable results in normalizing conditions of homelessness. Children given even some appropriate intervention do better than those children who are expected to recover with no help. Services to homeless families would include immediate intervention for trauma, advocacy in case management, and consistent care for the emotional needs of the children during their homeless crisis including liaison work with the schools so that these children are not targeted as behavior problems in the class room. Therapists need trained in alternative theories that address the immediate homeless crisis, the use of the McKinney-Vento Reauthorization 2001 Act, and therapeutic interventions to ease the suffering of children. The parent/s need therapy that is directed towards the crisis event, it’s causes and remedies. Psychoanalysis and other long term therapy processes are ineffective and improbable. The new McKinney Act expands and defines homeless persons as “anyone who lacks a fixed, regular and adequate night time residence”, this enables children immediate placement in a classroom not just enrolment in a school, and enforces the rights of homeless children to free, appropriate, and public education. The act also makes clear that each school district must have a McKinney liaison to advocate for the needs of homeless children and to make sure that they are not targeted or kept from other children solely on the basis of homelessness. All homeless children are entitled to free breakfast and lunch regardless as to if school district offers these services. Whether homelessness is due to violence, addictions, poverty, or a
combination, children suffer. On minimun wage in Oregon, a family is
expected to survive on 13,500 per year. Parent/s suffer because they feel
they have failed and can do nothing to help themselves or their children.
Some children are placed in foster care because the parent/s can’t think of
any other solution out of the financial problems. One study (Piliavin, Sosin, &Westerfelt, 1993) cited in the Department of Health and Human Services report stated that in 1990 27% of family placements for children in homeless situations under 18 were: 12% in foster care, 10% in group homes, and 16% in residential homes. More recent data from DHHS stated that in 2000, 72% of children of homeless parents did not live with them. This is a national tragedy. The study cites that 19% were in foster care or group homes, 46% lived with another relative, and 10% lived in other placements. Other “placements” is not defined. In that same study, 29% of the homeless adults with families cited that they had had an adverse experience while living outside the family and in foster care themselves. An adverse experience was defined as abuse or neglect. The National Alliance to End Homelessness cites work from The Web of Failure: The Relationship Between Foster Care and Homelessness (Roman & Wolfe, 1995). This study looked at the correlation between adults who had been in foster care as children and the connection to homelessness. They concluded that: there is an over-representation of homeless adults with foster care history, homeless people with foster care history were more likely to have their own children so placed, and that multiple placements where more probable. It was also cited that foster care history was more likely to cause early homelessness and that there was a correlation between the substantial increase in the length of a person’s homeless experience. Cited as causal were that the children were failed by a system that did not deal with their mental health issues and that youth emancipated from the foster care system lack independent living skills and support networks. The study suggests that a better job needs to be done to support families in order to keep children from foster care. If children are placed in care it is necessary that they have immediate access to support and that extraordinary steps should be taken to avoid placing children in foster care solely because their parent/s lack housing. Some families are terrified to ask for mental health intervention fearing that if they do so, their children will be taken from them. Again, therapists trained in homeless issues can clearly see the difference between poverty and neglect and can give families the support they need to follow case plans with greater efficiency and effectiveness. Homeless people with mental health problems seem to have had a higher
rate of foster care placement than those with out such placement. The Web
of Failure study also supplies the reader with the data collected by the
research. The authors cite that 36.2% of homeless adults interviewed had
foster care history and that 77% had hat least one child already in the
system. In the case studies it was determined that the system fails to
provide children with any type of therapy to help address the problems that
brought them into the system. With immediate and appropriate mental health services to families the trauma of homelessness can be eased enough to help them work with case management, find safe housing, keep families together, keep children in school, and relieve the burden of agencies that are strapped for resources. Trained therapists also ease the burden on case-management. Many parents, having no one else to help, ask case workers to also supply mental health information. Homeless by definition: someone who lacks fixed, regular, and adequate night time residence. McKinney Vento needs to expand the definition to include foster children as they have no fixed residence. The Roman and Wolfe study shows a clear relationship between foster care and homelessness. By this action the estimated 300,00 children in foster care would be given protection under McKinney. Given the fact that that on any night over 1 million children are homeless by definition, if those children each have 3 children, it isn’t difficult to see where homelessness and it’s traumatic effects will lead. Without free, outreach, and intervention focused mental health support we condemn the majority of these children to repeat homelessness as adults and families. With therapists trained in homeless issues, mental health for children and families need not be long term and will save money, enhance resources, and assist family emotional stability. Looking at the statistics cited approx. one million youth are homeless by definition and on the street on any given night in America. If one million children had small pox, something would be done and done quickly. Because children’s suffering is emotional, it is falsely assumed that what ails them is not contagious nor life threatening. Those of us working with homeless children and families know and understand that not only is homelessness contagious but it is a life threatening situation. The numbers speak for themselves. More than three million homeless families and more than one million homeless youth is an epidemic. This unseen epidemic is here in our county. The only inoculation for the problem is quick intervention by those trained in the issues and treatments that enhance family resiliency, encourage case management support, child advocacy, and help to keep families and children from returning to the system. Poor children don’t belong in foster care. Families can stay together. Children can heal. We can do better.
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