Exploring Trauma Across the Lifespan in the Context of Homelessness
Elizabeth Russo, Stevenson University
Abstract: From the prenatal period to late adulthood, homelessness is a complicated societal issue that has a significant influence on people's physical and mental health as well as their emotional and mental development. The following will look at the multitude of adversities that homeless people encounter at various ages, emphasizing the unique risks and hardships that come with being a homeless person. It emphasizes the crucial role that interdisciplinary cooperation plays in effectively approaching homelessness by drawing on research and literature. Policymakers, educators, social workers, and healthcare professionals are all crucial in putting into practice initiatives that deal with the underlying causes of homelessness and enhance the lives of individuals impacted. Through acknowledging the unique needs of homeless people throughout their lives and collaborating with professionals from other fields, communities can create plans which cover all domains to reduce homelessness and assist those who are at risk.
Homelessness is either 1) Living in a place that does not meet adequate living standards such as a car or 2) Lacking the access to adequate housing (Amore et al., 2011). Applying the implications of this definition, homelessness remains a persistent issue in the United States, worsening over time. While it is difficult to determine an exact number of individuals, according to the US census, over 300,000 Americans reside in emergency and transitional housing. However, this statistic fails to encompass those living on the streets, in vehicles, or temporarily lodging with friends. An annual homeless assessment report found that on a singular night there were 553,742 individuals who were undergoing homelessness in the United States (Sciences et al., 2018). The demographic most affected by homelessness, particularly among younger adults is comprised of individuals struggling with mental health disorders or substance abuse challenges (Quigely et al., 2001) (Kozloff et al., 2016).
With homelessness being such a distinct problem in our country it is shocking to see a lack of intervention or initiatives by many of the agencies that serve this community. Healthcare systems, hospital records, and child welfare agencies oftentimes fail to identify whether a client is homeless. To these public agencies, the condition of homelessness appears inconsequential (Culhane, 2008). In the past, one of the primary responses to confront the growing issue of homelessness was to provide emergency and transitional housing. The focus then switched to providing financial aid to help individuals “get back on their feet.” However, research has proven that this plan is not effective. The cost to reward ratio is low, and data suggests it could be more helpful to give aide to those who are in stable housing but experience poverty (Evans et al., 2016). Homelessness extends beyond mere financial or housing challenges; it infiltrates every aspect of an individual's life, affecting their physical health, mental well-being, and behaviors (Deck & Platt, 2015). The ordeal of homelessness is profoundly traumatic, with individuals at different stages of life enduring distinct traumas. Our government and public health system must act and make solutions based on the extensive research that has been provided over the past decades. The numerous unsuccessful reforms clearly demonstrate the urgent need for substantial and sustained change. It is time to view homelessness not merely as a social issue, but as a problem affecting human beings. In order to properly address how to help this issue first we must evaluate the various stages across the lifespan, and the unique traumas each group faced.
Prenatal Homelessness
In order to properly cover the entire lifespan, it is appropriate to evaluate traumas experienced from the earliest form of life. The literature has shown that the individuals who suffer from homelessness the earliest are those who experience it prenatally. This occurs for individuals who are in utero that have a birth mother experiencing homelessness. Mothers grappling with both pregnancy and homelessness encounter extreme challenges in obtaining adequate health care both for themselves and their child. The primary struggles pregnant women experience while homeless include securing affordable access to nutritious food and proper prenatal healthcare (Cutts et al., 2014).
Even when provided with free clinics, transportation and availability also prohibits women from making appointments. In addition, the natural stressors of housing instability have led many women who are pregnant to engage in unhealthy habits to cope. These habits include turning to substance abuse and alcohol, along with improperly nourishing their bodies (Little et al., 2005). The use of substances while pregnant can significantly impact the baby, most commonly leading to fetal alcohol syndrome. The combination of unhealthy habits with limited access to proper healthcare has resulted in the children born of these mothers to struggle with relatively serious health concerns including respiratory issues, cardiovascular, and physical limitations (Galvin et al., 2023). Therefore, not only are these newborns being born into housing instability and financial stress, but they must also live their lives suffering from medical conditions caused indirectly from homelessness.
The most commonly seen negative birth outcomes of those who experienced prenatal homelessness is low birth weight. Children born to mothers experiencing prenatal homelessness typically have an average birth weight 53 grams lower than children born to mothers without prenatal homelessness (Cutts et al., 2014). Low birth weight raises significant risks, as research has shown that newborns who are underweight are more likely to suffer from cognitive problems, physical health problems, and lower academic performance (Little et al., 2005). Furthermore, mothers experiencing pregnancy and homelessness are more inclined to present with higher levels of stress, depression, and anxiety. As a result, this can lead to newborns experiencing hypertension, increased cortisol, and being born premature (Sandel et al., 2018). Children who fell victim to prenatal homelessness experience these negative effects relatively long term. Low-birthweight, hypertension, and being born premature carries over into health concerns seen later in infancy and toddlerhood.
Despite extensive research and literature on the adverse health effects of prenatal homelessness, there has been a lack of significant action to address these issues. The birth of children into the world under such disadvantageous circumstances is a critical concern, in addition to the many other challenges they face across all aspects of their lives. While free clinics offer a foundation by providing essential prenatal care, further interventions are necessary to support the mental and physical health of mothers, ensure access to proper nutrition, and facilitate transportation for medical appointments. It must take a holistic approach that addresses all needs to properly address this issue.
Infant-Toddler Homelessness
Although infants and toddlers are a vulnerable community typically protected among society, they are still not immune to the adversities and trauma of homelessness. Among all of the age categories across lifespan, the most common age to live in a homeless shelter is infancy (Brown et al., 2017). A horrifying statistic from 2021 showed that a little over 10% of homeless shelter residents are under the age of one (Fanning, 2021). Among infants and toddlers experiencing homelessness, emotional dysregulation, sleep and eating challenges, and behavioral issues are some of the most frequently observed adverse effects (Landis et al., 2020). Research from 1990 to the present has consistently found that children who were infants or toddlers while experiencing homelessness experienced severe physical and developmental impairments. Compared to children who did not experience homelessness, children who did showed delayed language, gross and fine motor skills, as well as insecure attachment styles (Fanning, 2021).
The prevalent adverse effects stem from the extensive trauma experienced by these young children. It is very common for children aged 6 and under, residing in homeless shelters, to have either witnessed or been subjected to domestic and community violence (Cutuli et al., 2016). The majority of these children are born into single-mother family dynamics. In many cases the mothers struggle with their own mental and physical health challenges. The primary issue is the physical toll caused by stress. Single mothers dealing with homelessness experience stress across various aspects of their lives. They must navigate the challenge of meeting their children's basic needs—food, clothing, water, and shelter—while also addressing their own necessities. Managing all of this places an overwhelming burden on a single parent. (Daryn et al., 2012). Often, toddlers internalize the stress and trauma observed in their mothers (Herbers et al., 2014), which could explain their developmental delays and behavioral problems.
Infants and toddlers, despite societal norms of protection, are disproportionately affected by homelessness, with infancy being the most prevalent age group in shelters. The impacts include emotional dysregulation, sleep and eating difficulties, and developmental delays. Similar to prenatal homelessness, the impacts on infants are significant and could potentially be lifelong problems. Issues such as physical and developmental delays are major challenges that demand extensive effort and care to address. Implementing proper healthcare and policies are crucial not only to alleviate these issues but also to prevent future infants from enduring similar adversities caused by homelessness.
Adolescent Homelessness
Young children who are either born into homelessness or have recently become homeless also experience significant negative consequences due to their housing instability. Youth experiencing homelessness similar to other age categories are impacted in multiple facets of their lives. Studies indicate an increased probability of academic underachievement, developmental delays, and impaired intellectual abilities. Moreover, more than half of these children exhibit delayed language skills (Haskett et al., 2015). These poor side effects are a direct result of something known as turbulence. Turbulence is when an individual has two or more residence changes, parents’ employment changes, or changing of schools within the past 12 months (McCoy-Roth, et al., 2012). These constant changes cause children to be overexposed to stress leading to problems with self-regulation, and high rates of behavioral disorders (Herbers et al., 2014). Many of these problems are similar to the ones seen in infants and toddlers.
Adolescents facing homelessness endure added trauma when they witness their family units undergoing stress and turmoil, particularly those raised by single mothers. Single mothers with young children represent the fastest growing population within the homeless community. Specifically single mothers with two or more children under the age of 6 years old (Daryn et al. 2012). These mothers are enduring significant stress and challenges in their efforts to secure stable housing. The presence of their children further adds to their burden, resulting in a different level of care compared to children who are not experiencing homelessness. As a result, children who are homeless are less likely to be enrolled in early educational programs, and center-based care (Brown et al., 2017). In addition to parental stress, outside factors also contribute to low school enrollment including lack of clothing and school supplies, difficulty obtaining previous school records, and lack of transportation options (Daryn et al., 2012).
Witnessing one’s parents undergo severe stress is traumatic for any young child, especially when a child has to watch their caregiver struggle to provide them basic needs such as stable housing and food (Herbers et al., 2014). Moreover, these stressors contribute to the increased likelihood of anxiety, depression, sleep problems, and aggression (McCoy-Roth et al., 2012). Among the most striking discoveries concerning youth homelessness was the elevated likelihood of early pregnancy, substance abuse, and premature mortality. Young children, particularly those who frequent shelters, are exposed to harmful behaviors from an early age. This early exposure makes them more susceptible to engaging in such behaviors compared to children who are not homeless (Morton et al., 2018).
Children experiencing homelessness are now not only vulnerable to physical and mental illnesses but also face an increased likelihood of early death, underscoring an urgent need for action. The demanding and dangerous conditions of homelessness take a profound toll on their health. Furthermore, the heightened risk of early pregnancy perpetuates a troubling cycle, where children face prenatal homelessness while their mothers navigate their own significant challenges. Children should not be exposed to such powerful adversities at a young age. It is important to be made aware of the difficulties homeless children endure so proper change can be made to better their quality of life, and eventually prevent this issue altogether.
Emerging Adult Homelessness
Emerging adults are young individuals who are transitioning into the workforce and gaining independence, usually between the ages of 18 and 29.This is also a population that faces the widest range of adversities and traumas as a result of homelessness. There are an estimated 41,662 emerging adults living either on the streets or in shelters (Fowler et al., 2019). One of the primary findings among homelessness in emerging adults is the prevalence of moderate to severe mental illnesses. A study done across midwestern states revealed that 89% of emerging adults met the criteria for at least one type of mental illness. More than half of this demographic exhibited conduct disorder and oppositional disorder, with approximately 20% showing signs of a mood disorder (Narendorf, 2017). These kinds of mental illnesses are chronic and in many ways debilitating. They impact one’s cognition and day to day functions. Furthermore, homeless young adults are at higher risk of presenting with schizophrenia, along with health problems such as HIV/AIDS, and chronic pain (Palimaru et al., 2023).
In addition to psychological disorders, this population is more likely to engage in unhealthy coping behaviors to combat the stressors of their life. These behaviors include binge drinking, alcohol use disorder, unprotected sex, and sex with multiple partners (D’Amico et al., 2024). Moreover, to confront financial and food insecurity this age group is more likely to engage in undesirable jobs to support themselves. Males typically involve themselves in criminal activity or labor-intensive jobs while females involve themselves in sex for trade work (Ferguson et al., 2015). Emerging adults who experience homelessness not only experience the health, and developmental consequences but social as well. They are forced to live a dangerous lifestyle in order to provide for themselves.
Within this community is another demographic who experiences additional trauma to what has been discussed. This community is LGBTQ+ individuals within the homeless emerging adult community. Emergency shelters and transitional housing have proven to not be safe or functional for members of the LGBTQ+ community (Semborski et al., 2021). With the government-provided housing being unsafe these individuals have turned to “couch surfing” (Grainger & Cagle, 2016). This poses a problem as individuals who are not in transitional or emergency housing will not have proper access to the additional services provided (McDonald et al., 2024) (Semborski et al., 2021). Members of the LGBTQ+ community deserve access to safe shelters and transitional housing. Without this essential support, their challenges are worsened, leaving them without stability or a sense of belonging. Consequently, they often have to seek their own solutions due to the lack of accommodating facilities.
The accumulation of these challenges within the community heightens the situation for emerging adults, trapping them in a cycle of instability and poverty. People struggling with mental and physical illness encounter difficulties in securing and retaining stable employment. This employment instability can result in food insecurity, leading to poor nutrition, further harming an individual's overall health issues (Palimaru et al., 2023). In addition, the government does not begin to provide aid until one has reached “literal homeless” (meaning without stable housing). Therefore, individuals who are in dangerous home environments such as domestic violence cannot receive aid until they ultimately have nothing (Fowler et al., 2019). Instead of aiding emerging adults in overcoming homelessness, this system is actually driving them further into it, leading this population to develop into adult and older adult homelessness.
Adulthood Homelessness
Among the older adult homeless population almost half experienced homelessness for the first time after the age of 50 (Brown et al.,2016). Homelessness seen in older adults is commonly related to incarceration, the rates of incarceration for individuals 55 years and older have increased 366% from 1999 (Garcia-Grossman et al., 2021). These individuals leave prison and end up with nowhere to go leaving them no choice but to be homeless. This puts this demographic in a unique place, as many do not suffer with the mental, and development disabilities that those who were homeless younger in their life have experienced (Brown et al., 2016). Living on streets with instability in finances and food inevitably sends individuals back down a path of criminal activity or engaging in substances. Although crimes could be small such as shoplifting, with already having a record these individuals are more likely to face harsher punishment (Garcia-Grossman et al., 2021). Similarly, as we saw in emerging adults there is this cycle among homeless people that proves exceedingly challenging to break.
The other fold to homelessness among older adults is those who succumbed to the cost of living. As of 2016, 30% of renters and 23% of homeowners were spending more than half of their income on their housing (Brown et al., 2016). These individuals who experienced homelessness later on in their lives described the feeling of being a subhuman, and that they lost some part of their humanity the day they no longer had housing (Dys et al., 2021). Older adults who are homeless also tend to have the least number of social connections compared to both older adults with stable housing, and younger homeless people. As a result, this demographic is highly isolated and report a sense of disconnect from a community (Reynolds et al., 2016).
While psychological disorders, developmental delays, and behavioral issues primarily afflict other age demographics, older adults seem to bear the brunt of social ramifications. They frequently express a profound sense of dehumanization and endure intense feelings of isolation, potentially leading to loneliness.
Interventions and Solutions
Homelessness affects virtually every aspect of an individual's life across all age groups, spanning from prenatal stages to late adulthood. Cognition, behavior, intelligence, mental health, and physical well-being are all profoundly affected by the experience of homelessness. Numerous individuals find themselves homeless due to adverse life circumstances, such as domestic violence. The trauma and hardship associated with homelessness often adds to existing challenges, worsening their situation. Working to rectify this issue goes beyond just providing financial aid but taking a multidisciplinary approach to both 1) prevent homelessness and 2) properly help those who are homeless receive a better quality of life.
Despite the trauma and adversity faced by individuals experiencing homelessness, there remains hope for change and intervention to alter the course of their lives. The variety of statistics and research that has been done regarding the homeless community gives all the necessary tools for proper changes to be made. If this research can be properly utilized change can be made to help this vulnerable community combat the trauma that they face.
One of the first institutions which has been working towards change is the healthcare system. Research indicates that in medical environments, particularly when receiving care from nurses, pregnant women benefit from therapeutic communication. This form of communication emphasizes both the client's thoughts and feelings alongside their physical symptoms. Such an approach helps women feel more comfortable discussing their symptoms and experiences (Azarmehr et al., 2018). In addition, it is increasingly important that if this relationship has been formed that this health care provider is consistently seeing the same patients. Consistency proves to be highly significant as it allows for providers to service homeless individuals with a full range of care. For instance, if a pregnant woman was consistently receiving prenatal care from the same physician, her complete medical history becomes better known and understood. This ensures she receives optimal care compared to seeing different providers each time (Gallardo et al., 2020). Alongside therapeutic communication, the implementation of trauma-informed care is vital for ensuring the most effective care possible. Trauma-informed care involves understanding and acknowledging the marginalized experiences individuals have endured, while also recognizing the potential impact of these adverse experiences on their health (Andermann et al., 2020).
Alongside healthcare workers, social workers can play an integral role in changing the culture of homelessness, and the treatment that they are receiving. One of the main roles of social workers working with the homeless population is providing some type of shelter. The main problems seen by social workers when working on finding placement is stigma, marginalization, and discrimination among the homeless community. These beliefs held by policymakers and the public prevent the creation of new shelters or interventions in communities (Wu & Karabanow, 2020). However, social workers play an interesting role where they can act as a liaison between policymakers, sociologists, and the homeless community. With social workers unique perspective, they can provide policymakers with more helpful policies which works to advocate for the homeless rather than criminalize them. Their individual relationships with those in the homeless community provides anecdotal support to use when talking to policymakers (Aykanian & Lee, 2016).
In addition to social workers who work in direct contact with the homeless another vital group that can play a significant role in advocating for children are educators. One of the first suggestions given to teachers to help homeless students is to read the literature and be up to date on the rate of child homelessness within their community. This allows teachers to be on guard that homelessness is a real possibility in their school district. In addition, learning what the legislation looks like for the state in which they work in (Hallett & Skrla, 2021). Furthermore, educators who strive to empathize with homeless children and develop positive relationships with them have demonstrated significant effectiveness. Given the intense stress experienced by these children's parents, fostering a positive bond between children and adults can enhance their academic performance, potentially breaking the cycle of poverty (Bullis et al., 2018). Simply through staying educated on the literature about homelessness, and showing understanding toward the children impacted, educators can make a major change in improving the quality of life for homeless children (Hallet & Skrla, 2021). There stress levels can potentially lower, and their academic performance could rise allowing these children to create a better life for themselves.
While these professions play crucial roles in effecting change, policymakers hold the most significant potential for making impactful changes to decriminalize homelessness, prevent its occurrence, and enhance the quality of life for those experiencing homelessness. Policy has been put in place in the past to combat homelessness: from 1992-2000 federal administrations created the form “continuums of care,” from 2000-2008 a 10-year plan to end homelessness was established, and from 2008-2016 the program HUD-VASH was created (Nelson et al., 2021). However, even with these policies being put in place homelessness is still highly prevalent and on the rise. This is because shelter-based approaches such as providing emergency and transitional shelter is not solving the issues but instead just temporarily helping (Cunningham, 2009).
Research has revealed that homelessness goes deeper than simply lacking a place to live; if policymakers want to help the problem they must address it as a whole. The age demographic of emerging adults struggles the most in terms of mental illnesses. This group has the highest rates of mental illnesses, with the lowest rates of outpatient utilization (Narendorf, 2017). As a result, policy regarding mental health services, and easier access to such services could prove to be the most helpful in this community. Pregnant women who experience homelessness face the most struggles in receiving proper prenatal care, nutrition, and stopping substances (Cutts et al., 2014) (Little et al., 2005). Policy that is put in place regarding easier access to healthcare, and food pantry systems to provide these women with proper nutrition, have great potential to improve the quality of life for these women and ensure both the mother and baby are healthy. Older adults found themselves experiencing homelessness either after a recent incarceration, or due to inability to keep up with living expenses (Brown et al., 2016) (Garcia-Grossman et al., 2021). The best policy to put in place for this population should revolve around rehabilitation programs to aid those recently out of jail into the world again and working to lower the cost of living for low-income older adults.
Each age group presents its own set of challenges when it comes to homelessness. By collaborating closely with social sciences, policymakers can discern these distinct patterns and tailor individualized strategies to address people's unique circumstances. Homelessness manifests uniquely based on individuals' stories and experiences. Attempting to resolve homelessness with one-size-fits-all policies will always fall short because homelessness defies such simplistic solutions. Recognizing the potential influence of professions like educators, social workers, and healthcare providers on the homeless community can lead to significant shifts in the culture surrounding homelessness and improve the quality of life for these individuals. As a society, we possess all the necessary tools to tackle this issue directly; the next step is to put them in action.
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