Housing interventions for homeless, pregnant/parenting women with addictions: A systematic review
Journal: Journal of Social Distress and the Homeless
Authors: Jessica Krahn, Vera Caine, Jean Chaw-Kent, and Ameeta Singh
This article reviews the literature on the issues facing homeless women and examines whether housing interventions demonstrate an impact for homeless, pregnant/parenting women with addictions.
First, here is what the Canadian Observatory on Homeless defines as being homeless:
The COH also has a homeless 101 section including a fantastic glossary on their website.
The background section of the article is full of data that can challenge the victim blaming and stigma that serve to further victimize women who are struggling. Here are some findings that stand out to me:
- In 2013 in the United States, 1 in 30 children were homeless and 37% of the homeless population was comprised of families (Bassuk, DeCandia, Beach, & Berman, 2014). [According to the COH, as of 2013, the child poverty rate in Canada was at 19%]
- Homeless women may have poorer health related to housing instability, limited access to healthcare, high levels of childhood victimization, low self-esteem, and limited resources to meet their needs (Teruya et al., 2010).
- Homeless women are significantly more likely to become pregnant than women who are housed (Crawford, Trotter, Hartshorn, & Whitbeck, 2011).
- Most pregnancies during homelessness are unintended. This is related to low reports of consistent and proper birth control use, increased rates of mental health challenges and/or substance use, high rates of sexual activity, and increased sexual behaviour (Thompson, Begun & Bender, 2016).
- The odds of experiencing depression or PTSD among mothers who had been homeless for at least two years was twice as high compared to non-mothers (Zabkiewicz, Patterson, & Wright, 2014).
- Depression among mothers who are homeless can be linked to stressful circumstances and trauma (Bassuk and Berdslee, 2014).
- Higher rates of drug and alcohol use among women who are homeless is linked to abuse by substance abusing partners, various forms of abuse in childhood and adulthood, subsequent PTSD, and social environments that portray substance use as “normal” (Saloman, Bassuk & Huntington, 2002).
- The stigma attached to substance use in motherhood and pregnancy can prevent pregnant women and mothers with substance use disorders from accessing health care out of fear of child apprehension, shame, and fear of treatment from service providers (Racine, Motz, Leslie, & Pepler, 2009).
Housing models:
- Case management: A caseworker or team is connected to the homeless person to ensure the individual gets the services and supports they need to move forward in their lives
- Continuum of Care: Generally, individuals move through multiple “steps” of addiction recovery and housing independence before living independently (e.g., start with emergency shelter and work towards independent housing).
- Housing First: Housing is provided regardless of “readiness.” It is provided and maintained without the requirement of client change in their use of substances or mental illness symptoms. It is believed that meeting the basic need for housing will lead to improvement in all areas of life.
The second half of the article uses the current (limited) research evidence to evaluate the impact of 4 programs being provided to homeless women in the United States.
- Supportive Housing for Families in Conneticut, NY
- Homelessness Prevention Therapeutic Community
- Family Critical Time Intervention
- Ecologically Based Treatment
Take Home Messages:
- Evaluating and assessing the impact of these types of services is challenging due to the complex and varied needs of the population. Establishing the “best” model is difficult because of the lack of standardized outcome measures, different study designs and quality, and differences in populations across studies. Standardizing outcome tools in future research will be important.
- Timely and tangible housing (Housing First approach) + positive, supportive, collaborative, and resourceful case management is promising:
- The key to engaging clients with case managers and programming was to provide access to tangible housing supports first and then provide access to community-based services and supports to address obstacles to keeping the housing (e.g. substance use treatment, vocational/educational counseling).
- Important caseworker characteristics: responsive, supportive, resourceful, knowledgeable, and available. Caseworker interest and care => client engagement.
- Improved outcomes extends to the mental health and behavioural functioning of children in these families.
- Access to housing can mean that women are able to have custody or parenting responsibilities, which is often the goal, but can elevate parenting stress.
- Housing will alleviate stressors related to homelessness, but the complex factors that lead to homelessness in the first place need to be addressed via supports such as:
- Linkages to child care so that mothers can work
- Housing subsidies so that mothers have the option to be home with their children or have the time to pursue treatment for substance use and other mental illnesses
- Goods or transportation vouchers
- Linkages to community groups that enhance positive support networks
- Trauma-informed services to enhance positive coping
Hello! I’m Dr. Marnie Makela and I’m one of the voices behind the CanFASD blog. I’m also a researcher with CanFASD and a Registered Psychologist in Edmonton, AB. I received my PhD in School and Clinical Child Psychology from the University of Alberta. I work with individuals with FASD and other complex disabilities, their families, and their service providers to complete assessments and develop effective intervention plans that will create meaningful and positive life experiences