Linda Weinreb

Homelessness in female-headed families : Childhood and adult risk and protective factors

OBJECTIVES To identify risk and protective factors for family homelessness, a case-control study of homeless and low-income, never-homeless families, all female-headed, was conducted. METHODS Homeless mothers (n = 220) were enrolled from family shelters in Worcester, Mass. Low-income housed mothers receiving welfare (n = 216) formed the comparison group. The women completed an interview covering socioeconomic, social support, victimization, mental health, substance use, and health domains. RESULTS Childhood predictors of family homelessness included foster care placement and respondents mothers use of drugs. Independent risk factors in adulthood included minority status, recent move to Worcester, recent eviction, interpersonal conflict, frequent alcohol or heroin use, and recent hospitalization for a mental health problem. Protective factors included being a primary tenant, receiving cash assistance or a housing subsidy, graduating from high school, and having a larger social network. CONCLUSIONS Factors that compromise an individuals economic and social resources are associated with greater risk of losing ones home.

Homelessness and Its Relation to the Mental Health and Behavior of Low-Income School-Age Children.

This study examined the relationship between housing status and depression, anxiety, and problem behaviors among children age 6 and older who were members of low-income, single-parent, female-headed families. Participants were 80 homeless and 148 never homeless children living in Worcester, Massachusetts. Children in both groups had recently been exposed to various severe stressors. Mother-reported problem behaviors were above normative levels for both homeless and poor housed youths but self-reported depression and anxiety were not. Controlling for other explanatory variables, housing status was associated with internalizing problem behaviors but not with externalizing behaviors. Among homeless youths, internalizing behavior problems showed a positive but curvilinear relationship with number of weeks having lived in a shelter. Housing status was not associated with self-reported depression and anxiety. Findings are discussed in terms of their implications for programmatic interventions and in light of recent welfare reform.

Health Characteristics and Medical Service Use Patterns of Sheltered Homeless and Low-Income Housed Mothers

OBJECTIVE: To compare the health characteristics and service utilization patterns of homeless women and low-income housed women who are heads of household.DESIGN: Case-control study.SETTING: Community of Worcester, Massachusetts.PARTICIPANTS: A sample of 220 homeless mothers and 216 low-income housed mothers receiving welfare.MEASUREMENTS AND MAIN RESULTS: Outcome measures included health status, chronic conditions, adverse lifestyle practices, outpatient and emergency department use and hospitalization rates, and use of preventive screening measures. Both homeless mothers and housed mothers demonstrated low levels of physical and role functioning and high levels of bodily pain. Prevalence rates of asthma, anemia, and ulcer disease were high in both groups. More than half of both groups were current smokers. Compared with the housed mothers, homeless mothers reported more HIV risk behaviors. Although 90% of the homeless mothers had been screened for cervical cancer, almost one third had not been screened for tuberculosis. After controlling for potential confounding factors, the homeless mothers, compared with the housed mothers, had more frequent emergency department visits in the past year (adjusted mean, homeless vs housed, 1.41 vs .95, p=.10) and were significantly more likely to be hospitalized in the past year (adjusted odds ratio 2.22; 95% confidence interval 1.13, 4.38).CONCLUSIONS: Both homeless mothers and low-income housed mothers had lower health status, more chronic health problems, and higher smoking rates than the general population. High rates of hospitalization, emergency department visits, and more risk behaviors among homeless mothers suggest that they are at even greater risk of adverse health outcomes. Efforts to address gaps in access to primary care and to integrate psychosocial supports with health care delivery may improve health outcomes for homeless mothers and reduce use of costly medical care services.

Predictors of Academic Achievement among Homeless and Low-Income Housed Children.

Abstract Based on a study of sheltered homeless and low-income housed families, predictors of academic achievement among 174 English-speaking children age 6 and older were examined, focusing on housing status, mobility, and race/ethnicity. Days absent from school was hypothesized as the mediating link between homelessness and academic achievement. In multivariate analyses, a composite measure of academic achievement was independently predicted by childs gender (girls scoring higher than boys), race/ethnic status (non-Latino Whites scoring higher than children of color), age, and school mobility. Housing status was not associated with academic achievement. Results indicated that homeless and housed children had comparable rates of absenteeism and other school-related problems, which may explain why homeless and housed children were similar in terms of achievement. Although children of color were equivalent to non-Latino White children in terms of nonverbal intellectual ability, their lower academic achievement scores suggest that they are not reaching their academic potential.

A Comparison of the Health and Mental Health Status of Homeless Mothers in Worcester, Mass: 1993 and 2003

OBJECTIVES We assessed background characteristics, health status, and prevalence rates of mental health disorders in 2 studies of homeless mothers conducted in Worcester, Mass, one in 1993 and the other in 2003. METHODS We compared the women taking part in the 2 studies, which involved similar methodologies, on the key variables of interest over time. RESULTS Homeless families taking part in the 2003 study were poorer than those taking part in the 1993 study, and female heads of household in that study reported more physical health limitations, major depressive illness, and posttraumatic stress disorder. CONCLUSION Data from 2003 suggest that the characteristics of homeless mothers changed over the 10-year period assessed. Service providers and shelter staff may need to refine services so that they are responsive to these changing needs.

Homelessness and food insecurity

Abstract Numerous assistance programs are designed to alleviate homelessness and food insecurity in the US, two of the more severe possible consequences of poverty. While we expect families with a higher probability of homelessness to also be at higher risk of food insecurity, after controlling for observed factors the relationship is not immediately apparent. To analyze this relationship, we use a unique data set with food insecurity information on both housed and homeless families. After instrumenting for the probability of homelessness, we find that families more prone to homelessness have higher levels of food insecurity. When we use dichotomous measures of food insecurity, however, the effects of homelessness are smaller.

The developmental status and adaptive behavior of homeless and low-income housed infants and toddlers.

OBJECTIVES This study describes the development status of 127 homeless and 91 low-income housed infants and toddlers. METHODS The Bayley Scales of Infant Development and the Vineland Screener were used to gather data. RESULTS There were no differences between homeless and low-income housed children. However, younger children in both groups performed better than the older children on most summary scores. CONCLUSIONS Homeless and low-income housed children did not differ in their cognitive and motor skills. However, older children scored lower than younger children on most measures of development status, suggesting that the cumulative effects of poverty may increase with time.

Implementation of Guideline-Based Care for Depression in Primary Care

Evidence-based clinical practice guidelines for treating depression in primary care settings were developed, in part, to ensure that health services are provided in a consistent, high-quality, and cost-effective manner. Yet for a variety of reasons, guideline-based primary care for depression remains the exception rather than the rule. This work provides a brief review of effective strategies used to customize and then deliver evidence-based treatment for depression in primary care settings; describes two representative case studies that illustrate locally customized collaborative care strategies for treatment delivery; and concludes with principles and implications for policy and practice based on our practical experiences.

Screening for Childhood Trauma in Adult Primary Care Patients: A Cross-Sectional Survey

OBJECTIVE Compared to screening for partner violence, screening for childhood physical and sexual abuse among adult patients has received little attention, despite associated adverse health consequences. The objective of this exploratory study was to describe the practices, skills, attitudes, and perceived barriers of a large sample of family physicians in screening adult patients for childhood sexual or physical abuse. METHOD Surveys were mailed to the 833 members of the Massachusetts Academy of Family Physicians in 2007 eliciting information about screening practices. Factors associated with routine or targeted screening among adult primary care patients were evaluated. RESULTS Less than one-third of providers reported usually or always screening for childhood trauma and correctly estimated childhood abuse prevalence rates; 25% of providers reported that they rarely or never screen patients. Confidence in screening, perceived role, and knowledge of trauma prevalence were associated with routine and targeted screening. Women and physicians reporting fewer barriers were more likely to routinely screen adult patients. CONCLUSIONS Despite the 20%-50% prevalence of child abuse exposure among adult primary care patients, screening for childhood abuse is not routine practice for most physicians surveyed; a large subgroup of physicians never screen patients. Study findings draw attention to a largely unexplored experience associated with considerable health care costs and morbidity. Results highlight the need to develop training programs about when to suspect trauma histories and how to approach adult patients.

Health Care for the Whole Person: Research Update

NADINE J. KASLOW, PhD, ABPP, earned her PhD in clinical psychology from the University of Houston. She is professor and chief psychologist at Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences. Her research and clinical work are focused on women’s mental health, family violence, depression and suicide, and family systems medicine. She is active in predoctoral internship and postdoctoral fellowship education and training. ANNIE M. BOLLINI received her PhD in clinical psychology from Emory University, completed her postdoctoral training at Emory School of Medicine, and is a licensed clinical psychologist in Georgia. Her main research areas have included schizophrenia and spectrum disorders, cognitive functioning, and stress. Currently, she is a behavioral scientist at the Centers for Disease Control and Prevention in Atlanta. She conducts research and develops and evaluates programs on HIV/AIDS prevention on international projects, mainly in African countries. BENJAMIN DRUSS received his MD degree from New York University in 1989. He is the Rosalynn Carter Chair in Mental Health at the Rollins School of Public Health at Emory University. His work focuses on improving care on the interface between mental health and primary care. ROBERT L. GLUECKAUF, MD, is a professor in the Department of Medical Humanities and Social Sciences, College of Medicine, Florida State University. He received his PhD in clinical psychology from Florida State University in 1981. His current research interests lie in the areas of telehealth, program evaluation, and family intervention for persons with chronic illnesses. LEWIS R. GOLDFRANK received his medical degrees from the University of Brussels Medical School in 1970. He is chair and professor of the Department of Emergency Medicine at New York University and Medical Director of New York City Health Department’s Poison Center. His work focuses on preparedness and medical toxicology. KELLY J. KELLEHER received his MD degree from Ohio State University College of Medicine and his MPH from Johns Hopkins University School of Hygiene and Public Health. He currently is a professor of pediatrics and psychiatry, The Ohio State University Colleges of Medicine and Public Health. His research interests focus on accessibility, effectiveness, and quality of health care services for children and their families, especially those affected by mental disorders, substance abuse, or violence. ANNETTE MARIE LA GRECA received her PhD in clinical psychology from Purdue University. A professor of psychology and pediatrics, she is director of clinical training at the University of Miami. Her research addresses peer influences in the physical health and emotional adjustment of children and adolescents, risk and resilience factors in children’s reactions to natural disasters and other traumatic events, and family and peer support in the management of childhood chronic disease. R. ENRIQUE VARELA, PhD, received his doctorate from the University of Kansas. He is an assistant professor of psychology at Tulane University. His main research interests are in the areas of cross-cultural manifestations of childhood anxiety and parenting practices in Latin American families. He is also interested in adherence issues in chronically ill children. SAMUEL S.-H. WANG received his PhD in neuroscience from Stanford University. He currently is in the Department of Molecular Biology and Program in Neuroscience at Princeton University. His areas of research are neuroscience, synaptic plasticity, and in vivo and in vitro physiology. LINDA WEINREB received her MD in 1982 from Pennsylvania State University Medical School. She is vice chair and professor, Department of Family Medicine and Community Health, University of Massachusetts Medical School. She has expertise in developing innovative models of integrated behavioral health care and mental health care for vulnerable populations, including homeless populations. LONNIE ZELTZER received her MD from the University of Cincinnati College of Medicine. She is a professor of pediatrics, anesthesiology, psychiatry, and biobehavioral sciences at the David Geffen School of Medicine at UCLA and director of the Pediatric Pain Program at UCLA Mattel Children’s Hospital. Her interests lie in gender differences in pain and pathways to pain and pediatric pain. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Nadine J. Kaslow, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Grady Health System, 80 Jesse Hill Jr. Drive, Atlanta, GA 30303. E-mail: nkaslow@emory.edu Professional Psychology: Research and Practice Copyright 2007 by the American Psychological Association 2007, Vol. 38, No. 3, 278–289 0735-7028/07/