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    Homeless kids face mental health risks

    The tensions facing their families can create a wide range of behaviors in children, some of which can be misinterpreted.

    Ben Danielson, M.D., is medical director of the Odessa Brown Children’s Clinic of Seattle Children’s Hospital.

    Ben Danielson, M.D., is medical director of the Odessa Brown Children’s Clinic of Seattle Children’s Hospital. Courtesy of Odessa Brown Children's Clinic

    The truest victims of homelessness are young children, who have no control over the decisions that put them there, and no power to change their circumstances.

    The typical homeless families in the country are headed by young women in their 20s, typically with two children. Nearly half those kids are under age five.

    The consequences of homelessness can be devastating and long-lasting for young children. By age 8, one in three homeless children has a mental health problem that affects their functioning, said Karen Hudson, social worker with Children’s Hospital of Philadelphia and a national expert on homeless children.

    More than three-quarters of homeless children under age 5 have developmental delays. And nearly 40 percent exhibit emotional and behavioral problems, she said.  These early problems can set the stage for problems, including homelessness, later in life. Surveys have noted that more than one-quarter of homeless adults experienced homelessness when they were young.

    Children who lack stable housing face a host of challenges that stress their developing systems, including lack of sleep, hunger, fear, and increased levels of stress hormones such as cortisol, which can wreak havoc on young brains.

    Sleep deprivation or disruption can make a child look and behave as though they have severe behavioral problems such as oppositional defiant disorder, said Dr. Ben Danielson, medical director of the Odessa Brown Children’s Clinic of Seattle Children’s Hospital.

    The symptoms that result from the stress of homelessness, can include anxiety, depression, extreme withdrawal, poor concentration or various forms of “acting out,” such as tantrums.

    “We see attachment disorders, big time,” said Danielson.

    Serious mental problems can go untreated because they are difficult to diagnose.

    “Depression can look a lot different in kids,” said Danielson. “A child might not say, ‘I’m depressed,’ but might have real problems sustaining relationships with friend and performing in school.”

    Children go through specific developmental stages between birth and 5. Those stages prepare their minds for learning, said Jill Klenota, who supervises parent child services for Wellspring Family Services, a Seattle-based nonprofit that works with homeless families.

    “We have mothers living in motels by themselves, suffering PTSD,” she said. “They’re terrified. The question becomes how does the mother attend to a baby under those circumstances?”

    Most homeless families have experienced trauma. The majority of homeless women are victims of violence, and one-third of mothers have Post Traumatic Stress Disorder, three-times rate of general female population, she said. More than 50 percent experience major depressive episode while homeless.

    Under these circumstances, the brains of babies flood with the stress hormone, cortisol.

    If the crisis is happening when a child is a toddler, they may act out more in the form of more frequent or extreme tantrums or defiant, challenging behavior.

    Older children may become highly introverted. “They may be shy, reserved, quiet, making no trouble,” said Burr-Chellin. “Essentially they are trying to be invisible.”

    Often the first sign of trouble is when the family’s life seems to be improving.

    Klenota recently worked with a family where the child started shoplifting after the mom had gotten into housing. Now that the child feels safer, she’s acting out. “She’s showing she’s still a troubled 8-year-old.”

    Therapists at Wellspring and elsewhere emphasized working with the whole family as a way to help children get back on track. Helping parents see what’s keeping them from meeting their children’s needs, and how to change their own behavior is one step. They often need help understanding normal child behavior and development and practice with parenting skills.

    Building confidence is critical.

    Parents who are homeless are often demoralized and depressed, said said Judy Burr-Chellin, director of Parent/Child Services for Wellspring. “But no matter what, they are still the most important person in their child’s life.”

    Carol Smith is senior writer for InvestigateWest. Her 2008 story on Washington state’s broken mental health system won a 2009 Casey Medal for Meritorious Journalism. She can be reached at csmith@invw.org.

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    Posted Tue, Oct 26, 10:55 p.m. Inappropriate

    I'm really pleased to see the insight demonstrated in this piece affecting the lives of homeless families. As stated in the article, in many cases homelessness is instigated by violence (particularly domestic violence), and creates a domino effect on the family's stability and wellbeing.

    It's also important to point out, however, the specifics of the causes of violence and demoralization. While the initial source of trauma in a violent home or partnership may have pushed a family out into living on the streets, it does not account for everything else that takes place while living there. Homeless women and children are at particularly high risk for victimization, and while there are more resources available for housing women and children, particularly survivors of domestic violence, there are still scant resources to meet a growing population.

    It is perhaps of even greater import to note that many social service agencies and providers are not educated in the long-lasting impacts of trauma and victimization, and are largely not able to be flexible to the complex and nuanced needs of these families. Some agencies strive to offer wraparound services, but resources are few and burnout is high.

    While the work being done to support homeless families and especially the parents in these families, it is also significant to address the systematic issues at play, shifting responsibility from solely parents to folks working in and running the mental health and social service system for being accountable to these women and children.


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