Homelessness

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Clinical Child and Family Psychology Review, Vol. 7, No. 3, September 2004 ( C© 2004)

Homelessness Among Families, Children, and Adolescents: An Ecological–Developmental Perspective1

Mason G. Haber2,3 and Paul A. Toro2

This paper reviews and evaluates the literatures on children in families that are homeless and on adolescents who are homeless on their own. After presenting several emerging theoretical approaches, we propose a broad ecological–developmental perspective that recognizes that, although persons in these groups often lack resources and experience negative events that can amplify the risk for poor outcomes, they also have resources and adaptive potential. The perspective also recognizes that homelessness may have different meanings and outcomes at different points in development and that we need to consider interactions between individ- ual development and multiple levels of social organization in order to foster new solutions to homelessness. On the basis of this perspective, we discuss directions for treatment and preventive interventions as well as social policy.

KEY WORDS: homelessness; children; families; poverty; development.

Homelessness is an enormous problem in the United States, with lifetime prevalence estimates ranging as high as 7–8% among adults (12–15 mil- lion people; Burt, Aron, Lee, & Valente, 2001; Link et al., 1994; Tompsett, Toro, Guzicki, Manrique, & Zatakia, 2004; Toro & McDonell, 1992). In addition to its enormity in absolute terms, recent multinational comparisons have suggested that the United States may surpass much of the developed world in life- time prevalence of homelessness, perhaps by a con- siderable margin (Tompsett et al., 2003; Toro et al., 2004). Homelessness in this country has persisted de- spite considerable concern expressed by the public and media regarding the problem, as well as substan- tial public funding levied to combat it on the fed- eral, state, and local levels (the well-known federal McKinney Act alone has been providing about $1.5 billion annually for services assisting homeless peo-

1Further information on homelessness, including details on var- ious studies and reports of our Research Group on Home- lessness and Poverty cited in this paper, can be found at http://sun.science.wayne.edu/∼ptoro/.

2Wayne State University, Detroit, Michigan. 3Address all correspondence to Dr Paul A. Toro, Department of Psychology, Wayne State University, 71 W. Warren Avenue, Detroit, Michigan 48202; e-mail: [email protected].

ple; Toro & Warren, 1999). Furthermore, despite good economic times during most of the 1990s, the most re- cent prevalence estimates suggest that homelessness has not been decreasing (Burt et al., 2001; Ouellette & Toro, 2002; Tompsett et al., 2004). Many of those who are homeless are mothers with young children; it has been estimated that this group comprises 14– 43% of people who are homeless and that mothers with young children represent the fastest growing seg- ment of the homeless population (Burt et al., 2001; Shinn & Weitzman, 1996; U.S. Conference of May- ors, 1989, 1993). Adolescents have also been shown to be vulnerable to homelessness. In one represen- tative survey, the annual prevalence of homelessness among this age group was estimated at 7.6% (Ring- walt, Greene, Robertson, & McPheeters, 1998). On the basis of such findings, it has been suggested that adolescents are the single age group most at risk for experiencing homelessness (Robertson & Toro, 1999).

Over the last 20 years, considerable psycholog- ical research has been generated concerning home- lessness, most of it on adults who are homeless. However, an increasing number of studies have also been conducted examining families that are home- less and adolescents who are homeless on their own.

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Together, these studies would appear to constitute an impressive base of knowledge (Baumohl, 1996; Toro, 1998). However, this research has tended to be fragmented in some important ways, and this frag- mentation has limited the usefulness of homelessness research for the development of theory, policy, and effective interventions. First, much of the psycholog- ical research on homelessness has tended to cast the problem as one of individual vulnerabilities by fo- cusing on individual characteristics of people who are homeless, leaving the examination of the social context of homelessness to other fields, such as so- ciology. The approach of examining individual dif- ferences is typical of emerging areas of psychologi- cal inquiry, and it has its advantages; however, it is an insufficient approach where homelessness is con- cerned, because homelessness is clearly a social phe- nomenon involving transactions between the individ- ual and his or her social context (Shinn, 1992; Toro, Trickett, Wall, & Salem, 1991). Second, research con- cerning homelessness has, with few exceptions, not been applied to the development of empirically based interventions. Finally, and most importantly for the purposes of the present paper, the specific literatures on adolescents who are homeless on their own and on families that are homeless have been evolving largely in isolation from one another and from the larger literature on adult homelessness. Thus, criti- cal issues such as relationships between risk factors at different developmental phases or possible inter- generational dynamics of homelessness have been neglected.

In recognition of these problems, the present re- view has several objectives. After a discussion of def- initions of the different groups of people who are homeless commonly studied in the literature, we will review the literature on homelessness as it presently stands, by first briefly touching on the literature on adult homelessness to provide a reference point, and then considering in more detail the literatures on ado- lescents who are homeless on their own and on fam- ilies that are homeless. Next, we will summarize the weaknesses of these research literatures and identify several theoretical approaches that are beginning to be applied. Next, we will evaluate these approaches and propose a broad ecological–developmental per- spective that may be useful in integrating them and guiding future research. Finally, we will suggest di- rections for intervention and policy, with a special emphasis on present efforts to apply broad develop- mental and ecological frameworks to inform program development.

Definitions

Arriving at a general definition of who is consid- ered to be homeless is not easy and raises many is- sues. This is particularly the case when homelessness is considered across the life span, as some of the issues that must be considered are developmentally circum- scribed (e.g., those related to the legal status of chil- dren embedded in families that are homeless and ado- lescents who are homeless on their own). Even plac- ing aside these issues, thorny definitional questions remain. For example, how long must one be without housing to be considered homeless? Is it enough to be without housing for just one night, or is a longer period necessary? What about squatters or persons living in substandard housing, such as shacks in ru- ral areas, or dangerous and unsanitary public housing projects, or living doubled up with family or friends? With respect to these issues, most researchers have chosen to study people who are “literally homeless” (Toro, 1998, p. 121), i.e., people who have spent at least some time in homeless shelters or living on the streets or in other unconventional settings.

The overall population of those experiencing homelessness can be divided into three identifiable subgroups: Adults who are homeless without chil- dren (mostly men), families that are homeless, mostly young women with children under age 10, and adoles- cents on their own who are homeless, that is, without the supervision of a guardian or other primary care- taker. These groups, adults who are homeless, families that are homeless, and adolescents who are homeless on their own are largely distinct. In developed na- tions, relatively few families that are homeless include children of age 12 or older (only 12–20%; Buckner, Bassuk, Weinreb, & Brooks, 1999; Burt et al., 2001), and children under age 12 are rarely found home- less on their own (Robertson & Toro, 1999). Reasons for the infrequency of older children and adolescents among families that are homeless as well as the rela- tively low numbers of children under age 12 found on their own are further discussed below, in sections sum- marizing the existing literature on these populations.

In many studies on homelessness, the term ado- lescent has been rather loosely defined, with some studies including individuals past the legal age of ma- jority, sometimes as old as 24 years or even older (e.g., Kipke, Montgomery, & MacKenzie, 1993; Mc- Carthy & Hagan, 1992). Unfortunately, the inclusion of adolescents who are 18 or older with younger ado- lescents obscures legal, policy, and intervention issues that are different in important ways for these groups,

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because of the impact of achieving the legal age of ma- jority. For example, homelessness in adolescence has traditionally been defined on the basis of the pres- ence or absence of a legal guardian or other care- giver. Because they cannot perform basic legal func- tions required to establish a residence, such as signing a lease, adolescents under the age of 18 are dependent upon adults for shelter. On the other hand, because adolescents aged 18 and older can legally establish their own residences, the presence or absence of a caregiver is not a sensible criterion for determining homelessness for this age group. In addition to prob- lems created by their different legal status, inclusion of adolescents over age 18 in research on adolescent homelessness creates a problematic overlap with the literature on homelessness in adulthood, as there is a high degree of similarity between samples of such young adults who are homeless (i.e., approximately between 18 and 25) and samples of older single adults who are homeless (McCarthy & Hagan, 1992). In a re- cent large study (N = 823), Tompsett, Toro, and Gold- stein (2003) found that “young adults” (aged 18–34) often fell midway between “adolescents” (aged 12– 17) and “older adults” (aged 35–60) on many out- comes, including physical health symptoms and sub- stance abuse problems. On the other hand, achieve- ment of one’s 18th birthday does not magically confer greater capacities for practical self-care, and in many respects, the challenges faced by those aged 18 and over who are not residing with guardians may resem- ble those faced by younger adolescents. In the present review, we will include research that identifies individ- uals over as well as under 18, taking note of the special problems associated with this research.

Another difficulty in defining homelessness among adolescents derives from the fact that, un- like adult homelessness, which is primarily defined according to setting, an important aspect of adoles- cent homelessness is the presence or absence of a caregiver, although this has not always been acknowl- edged explicitly in the literature. For example, in the Ringwalt et al. (1998) study on the prevalence of ado- lescent homelessness, homelessness was defined as spending at least one night in one of a variety of home- less settings (e.g., a youth or adult shelter, a public place such as a train or bus station, outside in a park, etc.) or “with someone they did not know because they needed a place to stay.” Acknowledging contro- versies surrounding how to define adolescent home- lessness, these authors based their operational defi- nition on federal guidelines that identify adolescents who are homeless as those who have spent the night

in a homeless shelter or in locations not intended to be dwelling places and/or where safety would be com- promised.

The designation of spending a night with a stranger used in the Ringwalt et al. (1998) study as conferring homelessness is clearly based on the rea- sonable idea that spending the night with a stranger potentially compromises safety. Ringwalt et al. (1998) conducted focus groups to determine how aspects of the operational definition of homelessness used in their study were interpreted by the adolescents they surveyed. Among other findings, they discov- ered that some adolescents had construed spending the night with a stranger to include such situations as staying with an acquaintance (e.g., “a friend of a friend”) because they could not or did not want to go home. These are important situations to consider as possible examples of adolescent homelessness. Su- perficially, these situations most clearly resemble the “doubled-up” situation typically not included by most researchers when defining literal homelessness (as dis- cussed above). However, with respect to the safety of such arrangements, an important difference between adolescents and adults is adolescents’ need for a care- giver’s supervision, and the absence of such supervi- sion in situations in which they are away from home without the regular caregiver’s knowledge and/or ap- proval.

Other studies (e.g., Cauce et al., 2000; McCaskill, Toro, & Wolfe, 1998) have usually tried to avoid deal- ing with these issues in operationalizing adolescent homelessness, because of the complexity of attempt- ing to determine when an adolescent’s supervision is sufficiently compromised to meet a criterion for homelessness (e.g., should an adolescent spending the night outside the home without approval of a guardian or regular caregiver always be categorized as home- less, even if he/she is staying with familiar adults?) and the fact that most adolescents outside the supervision of their caregivers meet other criteria for adolescent homelessness, such as staying in a shelter or on the streets. However, as further discussed below, the rela- tionship of an adolescent experiencing homelessness to their caregivers is clearly an important determi- nant of the nature of their experiences while homeless. Further, specifying explicitly that adolescents who are homeless are also “on their own” helps to distinguish them from the much smaller group of adolescents em- bedded within families, who are homeless for different reasons and who are likely to have very different is- sues from adolescents who are homeless on their own. Thus, throughout the remainder of the review, we will

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continue to refer to adolescents who are homeless as also being “on their own.”

As mentioned above, families that are homeless tend to be headed by women, and the active presence of an adult male in the family unit appears to be un- common (Perloff & Buckner, 1996; Toro, 1998). Burt et al. (2001), in their national survey of nearly 3,000 adults utilizing services for homeless people, found that only 2.3% of all adult clients involved a man with his children whereas 14.2% involved a woman with her children. Likely because of their predominance in samples of families that are homeless, the research on families that are homeless tends to focus on those families that are headed by young, single females, and this review will consequently focus on this type of family unit in its discussion of family homelessness. Nonetheless, it should also be noted that significant numbers do not fit this description. Furthermore, at least in some localities, proportions of “intact” fami- lies that are homeless may be higher than those impli- cated in the prevalence research conducted by Burt et al. (2001), and may even be higher than the propor- tions of intact families found among the housed poor (e.g., Shinn et al., 1998). Although reporting artifacts may contribute to such findings (e.g., housed mothers may fear the loss of eligibility for welfare benefits as a consequence of reporting the presence of a partner, whereas shelter requesters may need to report their involvement with a partner if they wish to stay housed together), the presence of a man in a family might also make a family less attractive as a subtenant in a friend or relative’s home. Thus, although most families that are homeless are headed by single females, it does not necessarily follow that there is a direct relationship be- tween homelessness and single parenthood, as some authors have suggested (e.g., Jencks, 1994). Rather, single parenthood is more likely to be a protective factor against homelessness amongst families already in poverty.

Families that are homeless are rarely found on the streets. We are, in fact, familiar with no study that has attempted to sample families that are homeless from the streets. Families that are homeless tend to be found in homeless shelters, often ones specifically de- signed for families. Many families can be found tem- porarily doubled up with extended family or friends, a situation that presents a definitional problem, par- ticularly because many of these families do not con- sider themselves to be homeless. Such families have sometimes been accessed by researchers through soup kitchens and other programs serving the poor, often as a way to obtain an appropriate comparison group

that is not homeless (e.g., Boyd, Toro, & McCaskill, 2004). Most researchers have chosen to exclude the precariously housed or doubled-up, which is unfortu- nate in some ways, because it is likely that such indi- viduals represent a much larger portion of the gen- eral population than those who are literally homeless (Rossi, 1989), a circumstance likely to be especially true among urban families. Because families that are homeless are rarely found on the streets and because studies of families that are homeless routinely ex- clude doubled-up families, most studies of families that are homeless have sampled exclusively from shel- ters. The fact that families that are homeless as typi- cally studied are usually found in shelters may partly explain the absence of adult males from this group, as many shelters have policies prohibiting men and/or limiting family size (Molnar, Rath, & Klein, 1990; Shinn & Weitzman, 1996). Another group typically excluded from the research is women with their chil- dren in shelters specifically designed for victims of do- mestic violence. Like those doubled up, the battered women in such settings often do not see themselves as homeless.

ADULTS WHO ARE HOMELESS: A BRIEF SUMMARY

Although a detailed review of the literature on adult homelessness is beyond the scope of this paper, a brief summary is provided as a reference point for the literatures on adolescents on their own and families who are homeless. People who are homeless, regardless of their population subgroup (i.e., single adults, adolescents on their own, or families who are homeless) appear to come disproportionately from poor, urban, and certain ethnic minority backgrounds (Ahmed & Toro, in press; Baker, 1994; Toro, 1998 ). Single adults who are homeless are predominantly male: Burt et al. (2001), in their national survey, found a rate of 80%, and Toro, Wolfe, et al. (1999), in their two-city study, found rates of 73–74%. Most single adults who are homeless fall in the age ranges comprising young and middle adulthood (roughly, 18–60 years old, with a substantial majority, 68–78%, of these under the age of 40; Toro, 1998; Toro, Wolfe, et al., 1999). Elderly single adults experiencing homelessness are relatively infrequent, for a variety of possible reasons (e.g., premature death due to poor living conditions associated with poverty in general and homelessness in particular, relatively generous social benefits for the elderly). Note, however, that

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one study has suggested that the age of the homeless population has been increasing in recent years (Ouellette & Toro, 2002).

Although homelessness clearly represents a lack of economic and housing resources, which are social phenomena, much social science research on adults who are homeless has focused on their individual characteristics or risk factors, rather than their social context or interactions between the two (Blasi, 1990; Shinn, 1992; Toro et al., 1991). Characteristics that have been associated with adult homelessness have included psychiatric disorders such as affective and psychotic disorders and substance abuse. For exam- ple, across nine samples using the Diagnostic Inter- view Schedule (DIS; Robins, Helzer, Croughan, & Ratcliff, 1981), point prevalence rates for major de- pression have typically fallen in the 14–30% range, and prevalence rates for schizophrenia have exceeded those in the general population by a factor of 2–6, typ- ically ranging from 5 to 10% (see Toro, 1998). Studies that have used comparison groups of housed adults matched for such variables as socioeconomic and eth- nic status, however, have sometimes shown that some characteristics, such as psychotic disorders, are not clearly associated with homelessness, once other ba- sic demographic variables are taken into account. Other characteristics, a history of substance abuse in particular, consistently discriminate the homeless from matched housed groups (e.g., Laurin, Fournier, Toupin, & Ostoj, 1996; Toro et al., 1995).

The degree of similarity between homeless and matched housed groups in matching studies suggests conceptualizing homelessness as an extreme form of poverty (Burt et al., 2001; Marpsat & Firdion, 2000; Toro et al., 1995). A possible intermediary group bridging the hypothetical continuum between the housed and homeless poor are the “precariously housed” persons who may not be “literally homeless,” but who may be one paycheck or another misfortune away from losing their housing. Research suggests that there are many more adults who are precari- ously housed than adults who are homeless (Rossi, 1989), and that in some cases these individuals may cy- cle between precarious housing and literal homeless- ness. The connection between homelessness and pre- carious housing suggests that macrosocial processes that threaten housing stability and increase the preva- lence of precariously housed people may increase the prevalence of homelessness as well. Factors that may contribute to or reflect such processes include gentrification in urban communities (Adams, 1986; Shinn, 1992), the lack of an effective “social safety

net” (Tompsett et al., 2003), and an uneven distribu- tion of wealth in society (Toro et al., 2004). The pro- posed continuum between secure housing, precarious housing, and homelessness can be applied to under- standing adolescent and family homelessness as well, as will be seen below.

Much of the existing intervention research in- volving homeless adults has focused on providing services to meet specific needs, such as immediate needs for food and shelter (Toro & Warren, 1999) as well to address particular disorders such as men- tal illness, substance abuse, or health problems (e.g., Argeriou & McCarty, 1990; National Institute on Al- cohol Abuse and Alcoholism [NIAAA], 1991; Ng & McQuistion, 2004). More comprehensive approaches aimed at helping people to escape homelessness are, however, becoming more common. One such ap- proach involves intensive case management in which workers assist homeless clients with the full range of their long- and short-term needs, including perma- nent housing, job training and placement, and link- ages to services in mental health, substance abuse, and health care (e.g., Morse, Calsyn, Allen, Tempelhoff, & Smith, 1992; Toro et al., 1997). Supportive housing is another comprehensive approach. In this approach, homeless persons are offered permanent housing with all necessary supportive services on site or read- ily available through a caseworker (e.g., Tsemberis, 1999). There have also been attempts to integrate services on a large scale in some communities, often through case management and similar programs (e.g., Randolph, Blasinsky, Leginski, Parker, & Goldman, 1997).

ADOLESCENTS WHO ARE HOMELESS “ON THEIR OWN”: A BRIEF REVIEW

Recent literature has relied on four basic ap- proaches to sampling youth who are or have been homeless or “on their own.” One surveys large groups of teens in the general population and identifies youth from this pool who have a history of homelessness (e.g., Ringwalt et al., 1998; Windle, 1989). The sam- pling method of choice for such surveys involves random-digit dialing or other means of randomly sam- pling households, and then selecting an adolescent for interview in each of the homes in which ado- lescents reside. Although somewhat counterintuitive in that these methods are largely incapable of sur- veying adolescents who are currently homeless, such methods have typically yielded the highest lifetime prevalence estimates for homelessness in studies with

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adults (Link et al., 1994; Tompsett et al., 2004) as well as adolescents (Ringwalt et al., 1998), suggest- ing that other methods may underestimate the extent of homelessness in the general population. Nonethe- less, because they do not include youth who are currently homeless, these approaches underrepresent youth who have longer histories of homelessness or institutional histories, who are more likely to be on their own at any given point in time than youth who have experienced infrequent and/or short episodes of homelessness. The second approach draws from ser- vice settings such as inner-city medical clinics (Kipke et al., 1993; Yates, MacKenzie, Pennbridge, & Cohen, 1988). Such studies describe youth seeking services who may be very different from those who do not seek help. The third approach draws youth from shel- ters (e.g., McCaskill et al., 1998). These facilities of- ten receive youth directly from their homes who have never spent a night on the streets, sometimes brought by their families or third parties (e.g., police). They en- courage (or require) youth to commit to staying until they find suitable lodgings elsewhere and provide a range of services, such as counseling geared toward reuniting youth with their families. Such youth are often younger and less likely to have extensive histo- ries of homelessness (Robertson & Toro, 1999). The fourth approach involves sampling from street loca- tions where adolescents who are homeless on their own are known to congregate and/or from drop-in centers designed to serve street youth by providing lodging on a drop-in basis, bathing facilities, food, clothing, and/or other services (e.g., Cauce et al., 1994; Kipke et al., 1995). This method, especially if it in- cludes youth who are 18 or older, generally yields a much more deviant profile of adolescents who are homeless on their own. Some studies have combined methods in an effort to obtain more representative samples (e.g., Heinze, Toro, & Urberg, 2004; Paradise et al., 2001; Unger et al., 1998; Whitbeck, Hoyt, & Yoder, 1999).

The Scope and Patterns of Adolescent Homelessness

The central importance of caregivers in deter- mining the nature and impact of adolescent home- lessness is shown in taxonomic labels often used with this group. These labels include runaways, who have left home without parental permission, throwaways, who have been forced to leave home by their par- ents, and street youth, who have spent at least some time living on the streets. It is important to recog-

nize that these are not mutually exclusive groups. It is not always easy to determine if an adolescent ran away from home or was thrown out by parents, and there are cases in which neither process appears to ap- ply, such as where adolescents were initially removed from their caregivers by authorities or where ado- lescents initially left their parents by mutual agree- ment for a cooling-off period. Furthermore, on most important characteristics, adolescents who are home- less resemble one another, regardless of their identi- fied pathway to homelessness (MacLean, Embry, & Cauce, 1999). Street youth are also not a fully distinct group, as research has shown that such youth often spend significant amounts of time in other settings, in- cluding their primary caregivers’ homes, shelters and other institutional settings, and temporary living ar- rangements with friends or other family (Greenblatt & Robertson, 1993). Given the fluidity of living ar- rangements among street youth, it might be more ac- curate to conceptualize presence on the street as a marker of severity, existing on a continuum (i.e., rang- ing from a single, short episode of living on the street to an episodic or chronic presence) rather than as a defining characteristic of a distinct subgroup. How- ever, as a group, adolescents who are homeless on their own and who have spent any time on the street tend to fare worse in many ways than those who have not spent time on the street, reporting more exten- sive life disruptions and personal problems. Similarly, adolescents on their own who are sampled from street settings tend to have more psychological symptoms and diagnoses of mental illness than other samples of adolescents who are homeless on their own (Robert- son & Toro, 1999).

The annual prevalence figure cited above for homelessness during adolescence (7.6%; Ringwalt et al., 1998) may actually be an underestimate because it was generated by a household survey. Thus, adoles- cents who were homeless at the time of the survey were not included, as were others at heightened risk for past homelessness (e.g., those involved in delin- quent activity, truant from school). Note that the rate found for homelessness at any point in adolescence in this study highlights even more the very high risk for homelessness in this age group (15%; Ringwalt, Greene, & Iachan, 1994). The experience of home- lessness for many of these youth is confined to time spent in shelters, rather than time spent on the street. Although adolescent street populations may be un- dersampled in some studies, such youth appear to be rare relative to the general population of adoles- cents who are homeless on their own. In the Ringwalt

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et al. (1998) survey as well as in two recent proba- bility samples of adolescents who were homeless on their own from throughout the Detroit metropolitan area (Heinze et al., 2004; McCaskill et al., 1998), the typical formerly homeless adolescent had never lived on the streets. Despite their likely smaller numbers, street youth are obviously of concern due to the se- vere consequences of street life, and much research has focused on them.

In the national survey of housed youth described above (Ringwalt et al., 1998), those with a history of recent homelessness were found throughout the na- tion and across urban, suburban, and rural areas. Nev- ertheless, adolescents who are homeless on their own appear to be most concentrated and visible in ma- jor cities (Robertson & Toro, 1999). Homelessness in rural areas has generally been understudied, and thus it is possible that the appearance of a greater concentration in urban areas may be a result of a lack of knowledge. The few studies that have docu- mented recruitment of rural adolescents who are on their own have tended to recruit them in fairly small numbers (e.g. Heinze et al., 2004; Thrane & Yoder, 2000). Little is known regarding characteristics dis- tinguishing urban, suburban, and rural adolescents who are homeless on their own. Studies that have examined this question (Cauce et al., 2000; Thrane & Yoder, 2000) have documented few differences between urban, suburban, and rural youth who are homeless.

Researchers documenting significant numbers of youth living on the streets have tended to be based in certain large metropolitan areas, mostly on the east and west coasts, such as Los Angeles, San Francisco, Seattle, and New York City, communities that also tend to have large numbers of adults who are home- less. Large numbers of adolescents alone and on the street have rarely been documented in most Midwest- ern and Southern cities, at least where definitions of youth are restricted to those who are homeless under the age of 18 (Robertson & Toro, 1999). Geographical variations in numbers or, at least, visibility of street youth may relate to differences in values and legal traditions across the cities involved: Adolescents who are homeless on the street may be more readily toler- ated in “liberal” cities on the coasts, and laws in the South and the Midwest may more rigorously require that police return adolescents who are homeless on the street to their parents.

The amount of time adolescents spend home- less and their number of homeless episodes appear to vary by whether youth are sampled from shel-

ters or from streets and drop-in centers. Adolescents who are homeless and in shelters have generally been homeless for relatively short periods of time and have not experienced prior episodes of homelessness. For example, in a probability sample of 118 adolescents (ages 12–17) from all six major youth shelters in the Detroit metropolitan area, two-thirds had never ex- perienced homelessness before, and most (86%) had been homeless for 4 weeks or less in their current episode (McCaskill et al., 1998). Studies that have sampled significant numbers of adolescents on the streets have tended to document more frequent and lengthy residential disruptions. For example, Whit- beck et al. (1999) found that adolescents reported spending an average of 123 days on the street in their lifetimes, with 278 days spent “unsupervised” (i.e., ei- ther on the street or housed but in the absence of a responsible adult). Paradise et al. (2001) reported in their sample of both street and sheltered youth that over three quarters of the sample had a history of leav- ing home prior to their present homeless episode and close to one third had cycled between home and the streets at least six times. One large-scale study sam- pling only from the streets (Greenblatt & Robertson, 1993) found that most youth demonstrated patterns of either episodic (i.e., multiple episodes adding up to less than 1 year; 44%) or chronic home- lessness (i.e., being homeless for 1 year or longer; 39%).

Time spent homeless is associated with age, of course, because older adolescents have had a longer period of time to accumulate experience with being homeless. In addition, among adolescents who have run away, the amount of time that has elapsed since their first run is associated with the likelihood of spending time on the street, a finding that suggests that patterns of increasing homelessness may acceler- ate as adolescents age into late adolescence and early adulthood (Yoder, Whitbeck, & Hoyt, 2001). Thus, studies including adolescents over the age of 18 are more likely to document more frequent homelessness and/or chronic patterns of homelessness.

Background Characteristics and Psychosocial Problems of Adolescents Who Are Homeless

A wide variety of adolescents who experience homelessness are described in the literature, suggest- ing many possible explanations for why adolescents become homeless in the first place and why they may remain so. Yet, it is difficult to determine the degree to

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which any particular factor might be a primary cause or a contributing factor to adolescent homelessness, whether it maintains homelessness once it is first es- tablished, whether it is caused by homelessness, or some combination of these. Below, we review recent findings and highlight the diversity of the adolescent population that is homeless.

Gender and Age

On the basis of recent studies, the vast majority of adolescents who are homeless and on their own ap- pear to be aged 13 or older, although several studies have identified small numbers of youth who are home- less on their own as young as 9 (Clark & Robertson, 1996; Robertson, 1991). In the Ringwalt et al. national survey, males were significantly more likely than fe- males to report recent homelessness. However, gen- der representation in other studies seems to vary de- pending on the source and age of the sample. Samples from shelters suggest either even numbers or more fe- males (e.g., Heinze et al., 2004). In contrast, samples of street youth or older youth tend to include more males (e.g., Cauce et al., 2000). The risk for home- lessness among women appears to drop as they age from adolescence into adulthood, but rise for men during the same period (Boesky, Toro, & Bukowski, 1997).

Ethnicity

Ringwalt et al. (1998) found no differences in rates of homelessness by racial or ethnic group. Al- though some local studies tend to document that youth who are homeless generally reflect the racial and ethnic makeup of their local areas, others re- port an overrepresentation of members of racial or ethnic minorities. For example, African Americans were overrepresented in a probability sample from shelters throughout metropolitan Detroit, where 46% of 118 adolescents who were homeless were African American compared to 22% of African Americans among the area’s general population (McCaskill et al., 1998). Both African Americans and Native Americans were overrepresented in a street sample from Seattle (Cauce et al., 1994) and a statewide sam- ple from Minnesota (Owen et al., 1998). Of course, as suggested for families that are homeless (Masten, 1992), relative overrepresentation of ethnic minori- ties among adolescents who are homeless may simply reflect their overrepresentation among the poor.

Poverty

Studies have suggested that disproportionate numbers of adolescents who are homeless come from low-income or working-class families and neighbor- hoods. For instance, in a broad four-state Midwestern sample of 602 adolescents who were homeless, two thirds of the youths’ parents (68%) reported family in- comes under $35,000 (Whitbeck, Hoyt, Tyler, Ackley, & Fields, 1997). In a study sampling from Detroit- area shelters, most youth (69%) came from families in which the parents held unskilled or blue-collar jobs (McCaskill et al., 1998). Most youth (80%) also came from neighborhoods where the median family income was under $40,000 (which was the approximate 1990 median family income for the total Detroit metropoli- tan area). However, the families of adolescents in this sample were less impoverished than similarly sam- pled families that were homeless and single adults who were homeless in the same area (Tompsett et al., 2003).

Residential Instability and Out-of-Home Placement

Homelessness among adolescents may be an ex- tension of a long pattern of residential instability shown by many of their families (Robertson & Toro, 1999). For example, Cauce et al. (2000) found that, among adolescents who were homeless in their sam- ple, the average number of changes in living situa- tions (most of which occurred while adolescents were with their families) over the previous 3-month pe- riod was 2.3, with about one move occurring every 45 days. In a probability sample of 251 adolescents who were homeless in Detroit and surrounding coun- ties, the average number of lifetime housing moves was nearly 5, with a matched housed group of 145 youth having fewer than half that many moves (Toro & Goldstein, 2000). Residential disruption related to institutional placement is also common. As has been found among homeless adults (e.g., Toro, Wolfe, et al., 1999), many studies report that adolescents who are homeless have histories of foster care or other institu- tional placements, with rates ranging from 21 to 53% (Cauce et al., 1998; Robertson, 1989, 1991; Toro & Goldstein, 2000). Similarly, many adolescents in such facilities have histories of homelessness or residen- tial instability (Embry, Vander-Stoep, Evens, Ryan, & Pollack, 2000; Mundy, Robertson, Greenblatt, & Robertson, 1989).

The high incidence of prior public system con- tacts among adolescents who are homeless, and

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conversely, the high incidence of prior homeless episodes among adolescents in the public system, to- gether suggest that adolescent public system place- ment and homelessness may be closely linked. Evi- dence from studies of street youth in Hollywood and San Francisco suggests that the link may be due to adolescents’ risk of becoming homeless upon sepa- ration from residential placements and institutional settings. In these samples, more than one quarter of those who had been in foster care, group homes, or juvenile detention became homeless upon their most recent separation, meaning that they had spent their first night after leaving these sites in a shelter or on the streets (Clark & Robertson, 1996; Robertson, 1989). Of particular concern are adolescents who have “aged out” of the foster-care system and who are thus ex- pected to establish independent living situations, but lack the resources to do so (e.g., financial or prac- tical support from family; Lindblom, 1996). One re- cent follow-up of such youth found that, in the 12 months after “aging out,” a full 12% of the youth had spent at least some time homeless (Courtney, Piliavin, Grogan-Kaylor, & Nesmith, 2001).

School and Learning Difficulties

Studies have consistently suggested that home- less adolescents often have interrupted or difficult school histories, and that many are currently not at- tending school. Across several studies, 25–35% re- port having been held back a year in school (Clark & Robertson, 1996; Robertson, 1989; Upshur, 1986; Young, Godfrey, Matthews, & Adams, 1983). In a Detroit sample of 251 adolescents who were home- less and on their own, 88% had been suspended, expelled, and/or dropped out of school (Toro & Goldstein, 2000). Difficulties in school behavior and poor achievement may be due in large part to high rates of specific learning difficulties. In two studies of adolescents on the street, about one quarter reported participation in special or remedial classes (Clark & Robertson, 1996; Robertson, 1989). One study found a high rate (32%) of attention deficit disorder (ADD; Cauce et al., 2000). Another study examined a popu- lation of 123 sheltered adolescents with several instru- ments widely used in the assessment of learning dis- abilities and concluded that 80% suffered from a di- agnosable disability (Barwick & Siegel, 1996). While a history of school problems is prominent in the liter- ature, its relationship with homelessness among ado- lescents is unclear. School problems are often hypoth-

esized to be a precipitant of family conflict that results in a runaway response. Others suggest that school dif- ficulties are symptoms of family conflict. Yet another possibility is that school difficulties are the indirect result of residential instability, which may result in frequent school interruptions that then compromise educational achievement.

Family Instability, Conflict, and Maltreatment

Many adolescents who are homeless on their own report disrupted family histories, which may con- tribute to the risk for homelessness. In a Hollywood street sample (ages 13–17), many adolescents had no previous contact with their biological fathers (16%), and some had no prior contact with or their mothers (9%). Among the parents who were known, almost three quarters had been divorced or were never mar- ried (Greenblatt & Robertson, 1993). In a probabil- ity sample of 122 sheltered youth who were homeless from Detroit (ages 12–17), most grew up in single- parent (34%) or “blended” (32%) families, many (22%) had been formally placed outside the home by officials, and about half (48%) had lived with rel- atives (not parents) for a substantial amount of time (Reed, 1994). Youth consistently report family con- flict as the primary reason for their homelessness. Sources of conflict vary but include conflicts with par- ents over a youth’s relationship with a stepparent, sex- ual activity and sexual orientation, pregnancy, school problems, and alcohol and drug use (Owen et al., 1998; Robertson & Toro, 1999; Whitbeck & Hoyt, 1999).

Neglect and physical or sexual abuse in the home are also common. Across studies of youth who are homeless and on their own, rates of sex- ual abuse range from 17 to 60%, and those of physical abuse from 16 to 60% (Molnar, Shade, Kral, Booth, & Watters, 1998; Powers, Eckenrode, & Jaklitsch, 1990; Robertson, 1989; Rotheram-Borus, Mahler, Koopman, & Langabeer, 1996; Rothman & David, 1985; Tyler, Hoyt, Whitbeck, & Cauce, 2001; Unger et al., 1998; Yates et al., 1988). While rates vary widely, probably because of methodological vari- ations such as broader or narrower definitions of abuse, these rates appear to be substantially higher than those found in the general adolescent popu- lation. Studies employing comparison groups show this to be the case. For example, most (75%) of 122 youth in homeless shelters (ages 12–17) in Detroit reported some form of maltreatment (Boesky, Toro, & Wright, 1995). Neglect was most common (57%),

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although many also reported physical (40%) and sex- ual (31%) abuse. Many experienced more than one of these forms of maltreatment (e.g., 16% reported all three). When compared to housed peers, youth experiencing homelessness reported more maltreat- ment and received higher scores on standardized mea- sures of family conflict (Wolfe, Toro, & McCaskill, 1999). In a larger sample (i.e., 249 youth who were homeless) adolescents experiencing homelessness re- ported more frequent occasions of parent physi- cal and verbal aggression against them relative to housed adolescents; however, these adolescents also reported more frequent verbally and physically ag- gressive acts toward their parents. Although violence from these youth may very well have been in response to the parent’s initial violence, the youth violence was found to have an additional impact in terms of pre- dicting subsequent poor outcomes (Haber & Toro, 2003).

There is evidence that abuse may precipitate separations of many youth from their homes. In a Hollywood street sample (ages 13–17), many youth reported leaving their homes in the past because of physical abuse (37%) or sexual abuse (11%). One fifth of the sample (20%) had at some earlier point been removed from their homes by the authorities because of neglect or abuse (Robertson, 1989). Simi- larly, a study of 356 street youth (ages 13–21) in Seat- tle found that 18% had been removed from their homes (MacLean, Embry, et al., 1999). Neglect and psychological violence (such as verbally threatening or demeaning behavior) are less studied than other forms of maltreatment both generally and in the liter- ature on adolescent homelessness. Further research on these phenomena is clearly warranted, because they nearly always accompany physical and sexual abuse and often occur independently as well (e.g., Claussen & Crittenden, 1991).

Victimization

Adolescents who are homeless on their own re- port victimization by perpetrators outside the fam- ily at rates far exceeding those reported in the gen- eral adolescent population. Runaway clients from an outpatient clinic in Hollywood sought treatment for trauma (4%) and rape (2%) at rates that were three times higher than nonrunaway clients (Yates et al., 1988). The majority of a Hollywood street sample had been victimized in the past 12 months, many by physi- cal assault (42%) and sexual assault (13%; Greenblatt

& Robertson, 1993). In their four-state Midwestern sample, Whitbeck, Hoyt, and Ackley (1997) docu- mented a wide range of types of victimization. While experiencing homelessness, 18% of the boys and 12% of the girls had been beaten up more than once, 11 and 7% had been robbed more than once, and 11 and 4% had been assaulted with a weapon more than once. With such high rates of victimization, it is not surpris- ing that adolescents who are homeless show higher rates of posttraumatic stress disorder (PTSD) relative to housed adolescents (see below).

Mental Disorders and Behavior Problems Among Adolescents Who Are Homeless

As with adults who are homeless, the assessment of mental health status among adolescents who are homeless poses a number of problems (Robertson, 1992; Robertson & Toro, 1999; Toro, 1998). It is diffi- cult to determine whether the emotional disturbance of an adolescent who is homeless at a given point in time is more causally associated with an underlying emotional or mental disorder, the exigencies of home- lessness, chronic stresses such as family violence or parental substance abuse, the youth’s own use of al- cohol or other drugs, or some combination of these (Robertson & Toro, 1999). Furthermore, whereas prevalence rates for some diagnoses have been largely consistent across studies (e.g., Major Depressive Dis- order [MDD]), for other diagnoses (e.g., conduct dis- order [CD]) markedly different prevalence rates have been obtained depending on the assessment method and the sample involved. More rigorous assessment methods have tended to identify lower rates than less rigorous ones, and samples obtained primarily from shelters have tended to obtain lower rates than sam- ples intercepted on the streets (Robertson & Toro, 1999).

Prevalence of Mental Disorders Among Those Who Are Homeless Vs. Housed

Regardless of the assessment method and sample used, prevalence rates identified among adolescents who are homeless have generally been higher than those found in matched, housed groups or the gen- eral population. Studies have shown adolescents who are homeless to be at elevated risk for mood disor- ders and suicide attempts (Cauce et al., 2000; Feitel, Margetson, Chamas, & Lipman, 1992; McCaskill

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et al., 1998; Powers et al., 1990; Rew, Thomas, Horner, Resnick, & Beuhring, 2001; Robertson, 1989; Rotheram-Borus, 1993; Toro & Goldstein, 2000; Yates et al., 1988) and PTSD (Cauce et al., 2000; Clark & Robertson, 1996; Feitel et al., 1992; Fronczak & Toro, 2003; Greenblatt & Robertson, 1993). As might be expected given similar findings among adults who are homeless (Toro, 1998; Toro et al., 1995), rates of psy- chotic disorders among adolescents who are homeless are low, and perhaps no higher than those found for matched, housed adolescents (McCaskill et al., 1998).

Disruptive Behavior Disorders, Illegal Behavior, and Risky Sexual Behavior

Of the mental disorders commonly found among adolescents who are homeless, the most prevalent appear to be disruptive behavior disorders and sub- stance use disorders (SUDs), including substance abuse and substance dependence disorders. Cauce et al. (2000) found that 51% of adolescents in her sam- ple qualified for a diagnosis of oppositional defiant disorder (ODD) or CD. McCaskill et al. (1998) and Toro and Goldstein (2000) both found the rate of CD in their samples of adolescents who were homeless to be approximately 40%. This rate was significantly higher than the rate of CD in the demographically matched housed samples used in these studies (ap- proximately 20%), even though running away from home was excluded as a criterion for diagnosis of CD. Specific illegal behaviors that may contribute to diag- noses of CD have also been studied. Whitbeck et al. (1997) found, in a sample of 602 youth experiencing homelessness, that 23% reported stealing, 14% re- ported forced entry into a residence, 20% had dealt drugs, and 2% had engaged in prostitution. Many of the youth reported engaging in these activities to ob- tain food or shelter.

A number of studies have reported high rates of sexual activity among adolescents who are home- less on their own, much of which is unprotected (e.g., Kipke, O’Connor, Palmer, & MacKenzie, 1995; Lombardo & Toro, 2004; Rotheram-Borus et al., 1992; Whitbeck & Hoyt, 1999). Given these factors, it is not surprising that rates of sexually transmitted dis- eases (e.g., Kipke et al., 1995; Lombardo & Toro, 2004; Rotheram-Borus, 1991; Rotheram-Borus et al., 1992) and pregnancy (e.g., Cauce et al., 1994; Whitbeck & Hoyt, 1999) among adolescents who are homeless on their own are also high. Toro and Goldstein (2000) re- ported that rates of sexual experience and pregnancy

were higher among adolescents who were homeless on their own than in a matched, housed sample of ado- lescents. High rates of unprotected sexual activity and pregnancy among adolescents who are homeless sug- gest an important area of overlap with the literature on family homelessness, a point that will be revisited below.

Substance Use Disorders

Although the onset for SUDs in the general pop- ulation is typically later than for the disruptive behav- ior disorders, with SUDs usually not appearing until late adolescence or young adulthood, such disorders may appear earlier among youth who are homeless (Boesky et al., 1997). Adolescents who are homeless also show higher rates of SUDs than matched, housed youth: McCaskill et al. (1998) and Toro and Goldstein (2000) found rates of alcohol abuse/dependence (16– 21%) and drug use/dependence (18–24%) disor- ders that significantly exceeded rates found in their matched housed samples. The frequent co-occurrence of SUDs and serious mental health problems in gen- eral, and CD in particular, among adolescents who are homeless has been well-documented (e.g., MacLean, Paradise, & Cauce, 1999; Robertson, 1989; Rotheram- Borus, 1993; Yates et al., 1988). A common envi- ronmental contributor to both disorders among ado- lescents who are homeless may be the experiences that occur during homeless episodes, especially in in- stances in which episodes include time on the street. For example, research has suggested that adolescents who are homeless have a higher likelihood of associ- ating with deviant peers, some of whom may them- selves be (or have been) homeless (Kipke et al., 1995; Robertson, 1989; Toro & Goldstein, 2000).

FAMILIES AND CHILDREN WHO ARE HOMELESS: A BRIEF REVIEW

As discussed at the beginning of the paper, un- derstanding homelessness among families is essential to understanding homelessness among children, be- cause children who are homeless are almost always embedded within a family. Homelessness among chil- dren, then, can be regarded as directly resulting from the personal, social, and economic situation of their parent(s), as young children cannot be expected to secure housing by themselves. It is conceivable that characteristics of children could function as a stres- sor increasing risk for homelessness, by increasing

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parenting demands. Certainly, behavioral problems and other deficiencies documented among children who are homeless present enormous challenges to parenting. However, the reverse is likely also often true: that is, homelessness may place stress on parents, reducing resources available for parenting, which in turn may have an adverse impact on children, parti- cularly those who have already had difficulties.

The Scope and Patterns of Homelessness Among Children and Families

On the basis of their large national survey of per- sons using shelters, food programs, and other services for people who are homeless, Burt et al. (2001) esti- mated that, over the course of a year (in 1996), there were 1.4–2.1 million adults who were homeless and an additional 0.9–1.3 million children who were home- less. On the basis of the fact that 15% of all the adults who were homeless had children with them, we could estimate the annual prevalence of persons in fami- lies that are homeless at 1.1–1.6 million (which repre- sented 0.4–0.6% of the total U.S. population in 1996). Many families experiencing homelessness are hard to access, as they drift from family to friend to shelter; so these are underestimates (as Burt et al., themselves, admit). It has been noted that many parents who are homeless do not have their children with them while in the shelter, perhaps because they wish to protect them from the harshness of being homeless and/or from missing school and, therefore, ask family or friends to care for them, at least temporarily (Burt et al., 2001; Shinn & Weitzman, 1996). Burt et al. (2001) found that a full 48% of their national sample reported hav- ing dependent children (although only 15% had their children with them while homeless). Other studies have also found that approximately half of all adults who are homeless report having dependent children (e.g., 39–43% in the two-city study of Toro, Wolfe, et al., 1999; 54% reported by Rossi, 1989). Thus, chil- dren are directly or indirectly affected in about half the cases of homelessness in America.

As is the case for the literature on adolescent homelessness, the literature regarding the geographic distribution of and geographic differences among families that are homeless across urban and rural ar- eas is virtually nonexistent. The vast majority of stud- ies concerning homelessness among families focus on urban settings, and very few studies have focused on homelessness among rural families. Difficulties in studying this problem include gaining access to fam-

ilies that are homeless, which would be expected to be even more problematic in rural and suburban ar- eas, because these areas tend to offer fewer settings in which groups of people who are homeless may be found (First, Rife, & Toomey, 1994; Lawrence, 1995). Despite these difficulties in sampling, it is apparent that homelessness is nonetheless a significant prob- lem in many rural areas, and that families that are homeless may represent a substantial percentage of those who are homeless in these areas (First et al., 1994).

Like adolescents who are homeless (at least those found in youth shelters), families that are homeless tend to experience relatively short episodes of home- lessness. In a sample of 101 families experiencing homelessness across the metropolitan Detroit area, Boyd et al. (2003) found that 44% had been homeless for less than a month, another 44% 1–5 months, and only 13% for more than 5 months. In a sample of fam- ilies experiencing a first episode of homelessness in New York City, Stojanovic, Weitzman, Shinn, Labay, and Williams (1999) found that 44% remained home- less for less than 6 months, 42% for 6–18 months, and 13% for more than 18 months. Single adults typically spend much more time homeless. For example, in two separate probability samples from Detroit, one col- lected in 1992–94 and the other in 2000–02, 40–45% of the adults had been homeless (current episode) for at least 1 year and 18–20% for at least 3 years (Ouellette & Toro, 2002).

Background Characteristics of Families That Are Homeless

Gender and Age

As noted earlier, most parents who are home- less are women. Parents who are homeless tend to be young, with many, if not most, in their 20s (Bassuk et al., 1996; Burt et al., 2001). By contrast, single adults who are homeless are often in their 30s and 40s (Ouellette & Toro, 2002). Children in families that are homeless tend to be equally divided between boys and girls (e.g., Boyd et al., 2003; Burt et al., 2001). The age distribution of children who are homeless tends to be skewed toward infants and toddlers, with chil- dren of school age (5–10) also common and teenagers still less common. Burt et al. (2001) found in their na- tional survey that 42% of the children experiencing homelessness were 5 or younger, 33% were 6–11, and only 20% were 12–17. Other studies including the full

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range of ages have found a similar breakdown (e.g., Boyd et al., 2003). This age distribution, much younger than the general population of children in the United States (Burt et al., 2001), could be due to many fac- tors, including that some shelters restrict adolescents (Shinn & Weitzman, 1996), child protective services may intervene to remove school-age children, and/or relatives may be more willing to take in older children who pose fewer care-taking hassles than infants and toddlers. Because of their underrepresentation, there has been very little research on adolescents who are homeless with their families. As a consequence, in this review we will generally be considering families with children under the age of 12 when we discuss “families that are homeless.”

Teenage mothers have been shown to have a higher risk of becoming homeless than their peers who do not have children (Greene & Ringwalt, 1998). They tend to drop out of school, decreasing per- sonal resources and increasing their chances of un- employment and dependency on social welfare ser- vices, factors that would predispose them to poverty and thus also potentially to homelessness (Ahn, 1994). Teenage mothers may also find themselves homeless if their families refuse to continue to provide hous- ing for them as a consequence of their motherhood (Robertson & Toro, 1999). As reviewed earlier, ado- lescents who are homeless report higher rates of sex- ual victimization. The contribution of teenage moth- erhood to risk of subsequent poverty and its possible contribution to the risk of homelessness, as well as possible higher risk of pregnancy among adolescents who are experiencing or have experienced homeless- ness on their own, suggest a possible area of overlap between research on adolescents who are homeless and families that are homeless. However, most studies of mothers who are homeless exclude those under age 18 and few studies of adolescents who are homeless explicitly include teenage mothers in their samples (Heinze et al., 2004, is one exception).

Ethnicity

More so than for adolescents who are homeless, and perhaps even more so than for single adults who are homeless, minority groups, particularly African Americans and Latinas, tend to be heavily overrep- resented among families that are homeless, especially in the urban settings where most family shelters are found. For example, in a Detroit metropolitan sam- ple, Boyd et al. (2003) found that 80% were non-

White (mostly African American). Furthermore, mi- nority groups may show more chronic homelessness. For example, Webb, Culhane, Metraux, Robbins, and Culhane (2003) found that, although only 50% of all women of child-bearing age in their Philadelphia cohort of shelter seekers were African American, a full 90% of all homeless episodes in a 7-year period involved African American women. Baker (1994) has suggested that the heavy overrepresentation of African Americans among women who are home- less (especially those with children) simply mirrors their heavy overrepresentation among the very poor (a similar point might be made regarding chronicity). Speaking more generally, Masten (1992) suggested that overrepresentation of members of any ethnicity among families that are homeless in a given region tends to reflect similar overrepresentation among poor families. However, there is some evidence to sug- gest that, even among poor families, certain minority groups (in particular, African Americans) might be overrepresented (e.g., Culhane & Lee, 1997; Shinn et al., 1998), although the mechanisms associated with this phenomenon are unclear. One possibility could be ongoing housing discrimination (Shinn et al., 1998).

Residential Instability and Other Disruptive Experiences of Families That Are Homeless

Homeless mothers, like adolescents who are homeless, show a range of disruptive experiences in their histories, including death or divorce of a par- ent, and foster-care placement (Shinn & Weitzman, 1996). Among families that are homeless, many prior housing moves are also common. For example, Wood, Valdez, and Hayashi (1990) found that families ex- periencing homelessness in Los Angeles averaged nearly 6 moves in the 5-year period prior to an episode of homelessness, as compared with only 2.3 moves among poor, housed families.

Domestic Violence and Poverty

Whether or not one includes families found in shelters for battered women, high rates of domes- tic and neighborhood violence are common among families that are homeless (Bassuk, Rubin, & Lauriat (1986); Boyd et al., 2003; D’Ercole & Struening, 1990; Roll, Toro, & Ortola, 1999; Shinn, Knickman, & Weitzman, 1991; Vostanis, Grattan, Cumella, & Winchester, 1997). Particularly in the urban family

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shelters where most of the research samples have been obtained, poverty is very prominent in the back- grounds of families that are homeless, probably much more so than is observed among either adolescents who are homeless or single adults who are homeless (e.g., Bassuk et al., 1997; Tompsett et al., 2003). Co- hen and Toro (1999) found that domestic violence tended to be present as a risk factor more frequently among Whites (many of whom were from suburban areas) whereas poverty was a more frequent risk fac- tor among African Americans (most from urban ar- eas). Other commentators have questioned the de- gree to which the factors of domestic violence and poverty are dissociable among families that are home- less, given the prominence of poverty among home- less families and the high level of domestic violence found among poor families in general (e.g., Browne, Salomon, & Bassuk, 1999). However, studies using such methods as matching mothers that are homeless with housed poor mothers (e.g. Boyd et al., 2003), and event history analysis (Bassuk et al., 2001; Metraux & Culhane, 1999), have suggested that domestic vio- lence may be a factor that is independently associated with the onset and chronicity of homelessness as well as outcomes among the children in these families.

Parenting and Social Support

Few studies have investigated the parenting prac- tices of mothers who are homeless and, among those that have, no consistent findings have been produced. For example, Easterbrooks and Graham (1999) showed few effects of housing status on par- enting variables, whereas Koblinsky, Morgan, and Anderson (1997) found that mothers who were home- less showed less warmth and provided their children with less cognitive and social stimulation. Similarly conflicting findings have occurred in examinations of the social support and social networks among mothers who are homeless. Some studies have documented sig- nificantly less social support available to mothers who are homeless as compared to the housed (e.g., Bassuk & Rosenberg, 1988; Wood et al., 1990), whereas oth- ers have found no differences (e.g., Clinton, Toro, & Williams, 1998; Goodman, 1991). Shinn et al. (1991) had yet a different sort of outcome in their study of mothers experiencing a first episode of homelessness in New York City. They found that, at the time of shelter request, the mothers who were homeless actu- ally reported more social support than did the housed. However, although the homeless mothers initially re-

ported more social support than housed mothers, the authors suggested this might be due to greater sup- port seeking by these mothers, a phenomenon which could ultimately deplete these resources (as exem- plified by the fact that, although three quarters of the homeless mothers had stayed with friends or relatives prior to shelter seeking, they were nonetheless even- tually compelled to use a homeless shelter). This inter- pretation of Shinn et al.’s (1991) findings is also sup- ported by Bassuk and Rosenberg (1988), who found that length of time homeless among mothers experi- encing homelessness was associated with less social support.

Mental Disorders and Behavior Problems Among Families That Are Homeless

It has often been noted that mothers who are homeless, when compared to both single men who are homeless and single women who are homeless, show lower rates of a range of disorders and other problems, including depression, substance abuse, and criminal behavior, leading some to suggest that moth- erhood could be a protective factor in the context of homelessness (Burt et al., 2001; North & Smith, 1993; Roll et al., 1999; Shinn & Weitzman, 1990; Smith & North, 1994). Recent qualitative research by Banyard (1995) supports such notions by showing that many young mothers who are homeless rely on their chil- dren as a coping strategy for enhancing their motiva- tion and their perceptions of social support. Given that Banyard’s research is observational in nature and relies on a potentially biased sample of moth- ers who are homeless (e.g., less adept mothers ex- periencing homelessness may not have been repre- sented in her study, given that mothers who are home- less may be at greater risk for loss of custody), we cannot infer from her research that motherhood is an effective strategy for all mothers who are home- less; however, the reports of those mothers who were sampled in her study suggest that, at least for some, motherhood was a source of strength, rather than a vulnerability.

Boyd et al. (2003), using the Diagnostic Inter- view Schedule ([DIS]; Eaton & Kessler, 1985; Regier et al., 1988), found relatively high rates of substance abuse (45% lifetime prevalence for alcohol and/or drug abuse/dependence) and severe mental disorders (37% lifetime prevalence for schizophrenia and/or MDD) in a sample of 51 mothers experiencing home- lessness. This study may have obtained higher rates

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than prior studies on families that are homeless due to its more rigorous assessment methods, an explana- tion supported by another study that obtained sim- ilarly high rates using a structured interview (Bas- suk & Rosenberg, 1988). Many studies have sim- ply asked mothers who are homeless whether they have ever been hospitalized for a mental disorder (Shinn & Weitzman, 1996). Self-reported hospital- ization history has many problems as a diagnostic method (Bellavia & Toro, 1999), perhaps especially among mothers who might avoid hospitalization, even in the face of great need for service, for fear of los- ing their children to child protective services. Moth- ers who are homeless may also fear reporting sub- stance abuse or mental illness due to the same sort of fear.

Despite their high rates, when Boyd et al. (2003) compared their sample of mothers who were home- less to a carefully matched sample of poor, housed mothers, they found no significant differences in the rates of the two major diagnoses assessed (39 and 27% among the housed, respectively, for substance abuse and severe mental disorders). So, although these rates are high in comparison to those observed in the general population, elevations in rates of substance abuse and mental illness may more likely be associ- ated with the circumstances of poverty generally than with homelessness specifically. Differences in preva- lence rates between mothers that are homeless and poor, housed mothers have, however, been found in a few other studies. For example, LaVesser, Smith, and Bradford (1997) showed higher rates for DIS di- agnoses of MDD and PTSD among homeless rela- tive to poor, housed women. Interestingly, researchers have also shown that most women who are homeless with diagnoses of PTSD first developed the disorder prior to their first episode of homelessness (North & Smith, 1992). Thus, in the case of some psychologi- cal disorders, etiology may either be independent of homelessness or, alternatively, some of the same fac- tors leading to the development of the disorder may also lead to the development of homelessness (e.g., poverty and/or perceptions of poverty; see Costello, Compton, Keeler, & Angold, 2003; Costello, Keeler, & Angold, 2001; Fitzgerald & Zucker, 1995; Lupien, King, Meaney, & McEwen, 2001).

Children who are homeless have been found to be at elevated risk for a variety of problems, in- cluding poor health, educational delays, poor school performance, behavior problems, and poor coor- dination (Bassuk & Gallagher, 1990; Bassuk & Rubin, 1987; Bassuk et al., 1986; Dail, 1990; Masten,

Miliotis, Graham-Bermann, Ramirez, & Neeman, 1993; Menke & Wagner, 1997; Molnar et al., 1990; Rabideau & Toro, 1997). However, despite these ap- parently common findings, some studies have failed to show differences between housed poor children and children who are homeless (e.g., Boyd et al., 2003; Garcia Coll, Buckner, Brooks, Weinreb, & Bassuk, 1998; Ziesemer, Marcoux, & Marwell, 1994). Because children experiencing homelessness were nonetheless showing poor outcomes, it has been suggested that the impact of homelessness on children needs to be un- derstood as part of a continuum of risk tied to poverty, with homelessness simply representing an extreme form (Buckner et al., 1999; Masten et al., 1993). It is possible that homelessness may have an additional, in- dependent impact on children only when prolonged. Unlike the Masten et al. study in which families that were homeless had experienced relatively short pe- riods of homelessness, the more prolonged home- lessness experienced by the families in the Buckner et al. study was shown to be positively related to in- ternalizing symptoms among the children (i.e., de- pression, anxiety, social withdrawal, and somatic symptoms).

It should be noted that when differences are ob- served between housed poor children and children in families that are homeless, they invariably favor the housed poor children, suggesting that in some cases the failure to find differences may be due to small sam- ples and consequent low power. Of the areas men- tioned above, the one in which differences between children in families that are homeless and housed chil- dren have been observed most consistently is edu- cational outcomes. This could be due to the greater school mobility rates among children in families that are homeless (Buckner, Bassuk, & Weinreb, 2001; Masten et al., 1993), which have been shown to contribute to poor academic performance and aca- demic failure (Heinlein & Shinn, 2000; United States General Accounting Office, 1994). Further evidence of a direct relationship between homelessness and poor school achievement among children in fami- lies that are homeless comes from a recent study (Rafferty, Shinn, & Weitzman, 2004), which showed that children in homeless families scored more poorly on achievement tests than children in housed poor families approximately 1 year after shelter entry, but performed equivalently with housed poor children on achievement tests several years later. These findings suggest that poorer academic performance among children in homeless families may improve if these children return to stable housing.

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LIMITATIONS OF THE EXISTING RESEARCH AND NEW METHODOLOGICAL DIRECTIONS

Aside from the general lack of studies, the avail- able literatures on both adolescents who are homeless on their own and families that are homeless have a number of major limitations, suggesting directions for future methodological development. Because most of the limitations as well as our suggestions for method- ological development apply across the family and ado- lescent homelessness literatures, we review them to- gether here.

Definitions, Sampling, and Measurement

Early studies on both adolescents on their own and families that are homeless often involved small, nonrepresentative samples selected on the basis of un- clear and/or inconsistent definitions of homelessness. Researchers have begun to use more sophisticated ap- proaches to select more representative samples (e.g., Boyd et al., 2004; McCaskill et al., 1998; Shinn et al., 1998). One such general approach, probability sam- pling, involves identifying the unique proportion of the total persons who are homeless found at many different sites (e.g., shelters, soup kitchens, streets) and sampling from each site relative to its overall estimated contribution to the population (for de- tails on probability sampling, see Burnam & Koegel, 1988; Toro, Wolfe, et al., 1999; Zlotnick, Robertson, & Lahiff, 1999).

Most existing studies on adolescents and families have also used measures without established reliabil- ity or validity. Some recent studies have paid careful attention to develop and/or adapt measures appro- priate for use with different age groups and worked to establish their psychometric properties (e.g., Boyd et al., 2004; Heinze et al., 2004; McCaskill et al., 1998). We believe that it is especially important to include sound measures of complex constructs such as mental disorders, substance abuse, violence, and social sup- port and social networks. Basing such constructs on a single item or handful of items, often developed ad hoc for the particular study, leaves much to be de- sired. The weak and inconsistent sampling and mea- surement approaches used across studies may account for some of the variability in findings.

Appropriate Comparison Groups

Many early studies on both adolescents on their own and families that are homeless portrayed both

subpopulations in a very negative light (Rafferty & Shinn, 1991; Robertson, 1991). However, it has be- come clear that housed populations corresponding with these groups show many of the same problems. A number of recent studies have selected appropri- ate comparison groups to distinguish the unique char- acteristics of persons who are homeless from those of the housed poor. As in similar studies of adults who are homeless (e.g., Toro et al., 1995), adolescents on their own do show many problems, even when compared to carefully matched housed adolescents. For example, they show more conduct and depres- sive symptoms and come from more disturbed fam- ily environments (e.g., McCaskill et al., 1998; Toro & Goldstein, 2000; Wolfe et al., 1999). As described above, a different picture has been emerging from the most recent comparison group studies among families that are homeless: When compared to care- fully matched poor housed families, both the chil- dren and the mothers in families that are homeless have not shown clear, consistent differences, espe- cially when other life circumstances are taken into account.

Strategies to Improve Understanding of the Causes and Consequences of Homelessness

If we are to improve the situation for peo- ple who are homeless or prevent homelessness from occurring in the first place, it is critical to understand the causal mechanisms that produce homelessness as well as the sequelae of home- less episodes. Unfortunately, we cannot use exper- imental methods to directly assess the causes and consequences of homelessness. However, there are other strategies that may be helpful in understanding homelessness.

Comparison Group Studies

Comparison group studies represent one methodology with the potential to identify factors that relate uniquely to homelessness among families, children, and adolescents, rather than factors that relate more generally to other characteristics such as poverty. For example, on the basis of the studies just described, it appears that family homelessness may be largely indistinguishable from extreme poverty among families, whereas homelessness among ado- lescents may have some antecedents aside from general economic disadvantage.

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Longitudinal Studies

Tracking the natural course of homelessness may also help suggest causes and consequences of home- lessness. Although there have been several longi- tudinal studies done recently with adults who are homeless (e.g., Toro, Goldstein, et al., 1999; Zlotnick, Kronstadt, & Klee, 1999), there have been only a few such studies on families that are homeless (e.g., Shinn et al., 1998) and adolescents homeless on their own (e.g., Cauce et al., 1994; Toro & Goldstein, 2000). Studies following samples of poor or other children or adolescents at risk for homelessness over long pe- riods of time would provide even better causal evi- dence. However, we are aware of only one existing study of this type (i.e., Courtney, Piliavin, Grogan- Kaylor, & Nesmith, 2001, who studied youth “aging out” of foster care).

International Comparisons

Considering homelessness and related social phenomena across nations could also help us in the search for causes of homelessness. For example, as- suming variability in the rates of homelessness across nations, economic, cultural, and other factors asso- ciated with the varying rates of homelessness among adolescents on their own and families could be identi- fied. Although there have been some studies on home- lessness within other nations (especially in the United Kingdom; e.g., Burrows, Pleace, & Quiliagars, 1998; Fitzpatrick, 2000), we are aware of only a few attempts to compare homelessness across nations (e.g., Adams, 1986; Daly, 1990; Toro & Rojansky, 1990) and only one study that has used sound empirical data for such comparison. In national telephone surveys with over 1,500 respondents, Toro et al. (2004) found that the lifetime prevalence of literal homelessness was the highest in the United States (6.2%) and the United Kingdom (7.8%), with lower rates in four other Eu- ropean nations (the lowest, 2.4%, in Germany; see also Tompsett et al., 2003).

Theoretical Development

Although the existing literature on homelessness among adults can easily be criticized on the same grounds, it is clear that the research literatures on both adolescents who are homeless on their own and fami- lies that are homeless are largely atheoretical. This is perhaps understandable given how new the system-

atic study of homelessness is, with the rate of publica- tion in professional outlets not becoming substantial until the 1990s (Buck, Toro, & Ramos, 2004). In ad- dition, as is the case with the literature on homeless- ness among adults described earlier, much of the lit- erature examining homelessness among adolescents and families continues to focus on deficits (or, alterna- tively, “vulnerability” or “risk” factors) of adolescents homeless on their own and families that are homeless, and tend to ignore their resources and strengths. Fur- ther, despite the clear impact of broader social phe- nomena on homelessness (e.g., housing and welfare policy) and the impact of media coverage and public attitudes toward homelessness, the literatures on ado- lescents who are homeless on their own and on fam- ilies who are homeless frequently fail to place these problems in their broader social context. In later sec- tions of this paper we will attempt to draw together a number of emerging developmental theories on ado- lescents who are homeless on their own and on fami- lies that are homeless with ecological perspectives on adolescent and family homelessness with the hopes of contributing to a better understanding of home- lessness across the life span, of increasing acknowl- edgement of the potential strengths and resources of adolescents on their own and families who are home- less, and of enhancing the appreciation of the broader social factors that interact with the individual and family characteristics of these groups. We hope that our ecological and developmental theoretical integra- tion will promote more theory-driven research in the future.

Intervention Research

Since the Stuart B. McKinney Homeless Assis- tance Act (Public Law 100-77) was signed into law in 1987 by Ronald Reagan, a vast array of shelters, food programs, and other emergency services have devel- oped to serve people who are homeless and psychol- ogists and other mental health professionals have be- come increasingly involved with designing and deliv- ering services to address their needs (Toro & Warren, 1999). Grant funds have become increasingly avail- able and many new interventions for people who are homeless have been implemented (Levine & Rog, 1990; NIAAA, 1991). Unfortunately, like the research literature on homelessness, interventions tend not to be grounded in theory. In addition, few have been formally evaluated and the few that have generally have not employed rigorous experimental or quasi- experimental designs. Well-designed, theoretically

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grounded experimental or quasi-experimental evalu- ation of interventions would help to guide future de- velopment of interventions, as well as potentially sug- gest possible causes of homelessness to guide future research, which, in turn, could be used to guide addi- tional intervention studies. We are aware of only one such evaluation of a program for adolescents who are homeless (Cauce et al., 1998) and one that targeted both single adults and families (Toro et al., 1997). Be- low, we will discuss suggestions for future intervention research.

Note on the Issue of Causes vs. Effects

As already discussed, homelessness among fam- ilies, children, and adolescents is often a transient and/or episodic phenomenon. In many cases, it is dif- ficult to clearly distinguish homelessness from being “precariously housed,” a state that is characteristic of so many poor people. In addition, any practical def- inition of homelessness will necessarily incorporate phenomena that range greatly, both qualitatively and quantitatively. For example, as we have noted, the sig- nificance of homelessness for any given individual or family system may vary according to the length of time spent homeless, number of homeless episodes, or setting of homelessness (e.g., street vs. shelter). Homelessness is neither an isolated, homogeneous, or clearly defined phenomenon; as a result it is diffi- cult to develop theories of homelessness that clearly specify which phenomena precipitate homelessness, which perpetuate homelessness, and which follow or are determined by homelessness.

As previously mentioned, some commentators regard homelessness as a severe form of poverty, a proposal we will explore in greater detail later in the paper. Although this conceptualization may not be equally satisfactory in every case (e.g., although adolescents who are homeless on their own are pre- dominantly poor, many originate from middle-class households), we believe that the extent to which the constructs of homelessness and poverty overlap is broadly supportive of this approach. Regarding homelessness as a severe variant of poverty may be helpful in resolving the issue of causes versus con- sequences, because the issue of poverty raises sim- ilar problems that have been explored elsewhere (McLoyd, 1990). A noteworthy example of such an approach is the Conservation of Resources (COR) model, summarized below (Hobfoll, 1989, 2002). In COR, clear distinctions between the causes and con-

sequences of poverty are not necessary, as poverty is represented as a continuous process in which ini- tial resource losses precipitate further resource losses. Thus, conceptualized as resource loss, poverty is both a cause and a consequence. This approach is con- sistent with holistic perspectives that represent phe- nomena as systems, rather than as sequential pro- cesses (e.g., Bronfenbrenner, 1979). This approach is also consistent with the growing field of develop- mental psychopathology (e.g., Cicchetti & Rogosch, 2002; Sameroff, Lewis, & Miller, 2000), in which psy- chological problems are understood in the context of continua between normality and pathology, as well as early and later development.

THEORETICAL PERSPECTIVES ON HOMELESSNESS AMONG FAMILIES, CHILDREN, AND ADOLESCENTS

The growth of the empirical literature on home- lessness at multiple stages of the life spectrum has permitted a number of viable developmental and other theories on homelessness to be proposed. Data supporting the application of these theories is still largely absent. However, each appears to have some value in integrating existing research and guiding fu- ture research on families, children, and adolescents experiencing homelessness. In this section, we ex- amine several theoretical perspectives that have al- ready been applied to either homelessness in gen- eral or homelessness among families, children, and adolescents. We also explore other means through which the literatures on family, child, and adolescent homelessness could be integrated, either through the adoption of theories from other research ar- eas, or through the application of novel perspec- tives that suggest directions for future theoretical development.

Poverty and Child Development

There is a long history of research on the impact of family income, economic hardship, poverty, and related socioeconomic factors on child development. Although there has been some conflicting data (e.g., Mayer, 1997), most research in the field confirms that there is a clear positive association between family in- come and child outcomes (Duncan & Brooks-Gunn, 1997; McLoyd, 1990). The association appears to re- main even after controlling for parenting variables

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and other key correlates of poverty and appears par- ticularly evident for younger children and when stud- ies include families with very low levels of income. It is not difficult to see how this body of research might apply in the context of homelessness, because most children within homeless families and adoles- cents who are homeless on their own also come from poor backgrounds and because homelessness can be seen as the extreme end on a continuum of poverty and residential instability (Burt et al., 2001; Toro et al., 1995). Although the general negative impact of low income and poverty seems clear, there is more con- troversy about the mechanisms that account for this impact. One view, originally drawn from economic theories (e.g., Becker & Thomes, 1986), suggests that a combination of the parent’s biological endowment and the resources they have available to promote the child’s development (including materials, expe- riences such as enriching schools, and services such as medical care) promote positive outcomes among children. Another view, following from psychologi- cal theories focused on the quality of parenting, is that poverty puts parents under stress that, in turn, affects the quality of their parenting and makes them less capable of promoting the child’s positive devel- opment (Conger & Elder, 1994). Yeung, Linver, and Brooks-Gunn (2002) recently compared these two competing viewpoints in a large study of preschool children and found support for both perspectives. In particular, the first “parental investment” perspective was supported when predicting cognitive/academic achievement outcomes, whereas the second “family stress perspective” was supported when predicting child behavior problems.

Homelessness as Trauma

Drawing on the large body of research on the harmful effects of stress and trauma (e.g., Cohen & Wills, 1985; Van der Kolk, 1987), Goodman, Saxe, and Harvey (1991) have argued that homelessness can be seen as involving a set of traumatic events that puts one at risk for a range of poor outcomes, such as PTSD and MDD. Applied to child development, their view is similar to the family stress perspective described by Yeung et al. (2002). Supporting this view are the high levels of stressful events and victimization, as well as depression and PTSD, reported among all sub- groups of persons experiencing homelessness, includ- ing both parents and children within homeless fami- lies and adolescents who are homeless on their own

(Robertson & Toro, 1999; Toro, 1998). We believe that this theoretical perspective makes sense when consid- ering homelessness within both groups. Among chil- dren within families that are homeless, who are gener- ally homeless because of the situation of their parents that they likely cannot control or even comprehend, the experience of homelessness (as well as the equally uncontrollable events that often surround the experi- ence) can be seen as very much like those producing learned helplessness. However, because poor, housed children seem to show many of the same negative behavioral outcomes as children who are homeless, it would appear that this perspective may apply to these children as well. Parents who are homeless may similarly feel helpless to control their outcomes or those of their children. Adolescents who are homeless on their own, although they may have some control over whether they leave their home, may still expe- rience unexpected negative outcomes once homeless, such as the high levels of victimization documented earlier.

A possible criticism of the homelessness as trauma approach is that some traumatic events that may distinguish the histories of people who are home- less from people who are housed, and more specifi- cally, women and/or mothers who are homeless from housed, are likely to have occurred before the onset of a first episode of homelessness. For example, Bassuk and Rosenberg (1988) and Shinn et al. (1991) have found that rates of physical and sexual abuse reported by mothers who are homeless during their own child- hoods exceeded rates reported by matched housed mothers. Moreover, as reviewed earlier, psychologi- cal disorders such as PTSD may often develop prior to the first episode of homelessness, and factors such as domestic violence may be more endemic to poverty generally rather than uniquely related to homeless- ness. Ecological perspectives, which conceptualize homelessness in the context of a broader continuum of housing instability and poverty rather than as a dis- crete event, could assist in addressing this criticism. Intergenerational perspectives, which relate episodes of homelessness early in the life cycle to homelessness later on, may also be helpful. Both perspectives are reviewed below.

Social Learning Theories

Many studies have documented the impact of family environment on a broad range of future outcomes among children and adolescents. Among

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these, as noted earlier, family environment is clearly associated with homelessness among adolescents on their own. However, research has suggested that fam- ily environment variables do not operate in a sim- ple cause-and-effect manner, but rather, through an ongoing interaction between the evolving character- istics of both the child and the family environment (for reviews, see Collins, Maccoby, Steinberg, Hether- ington, & Bornstein, 2000; Scarr & Deater-Deckard, 1997). Because of the greater capacity of parents to control the environment of their offspring at ear- lier ages, parenting would be expected to play the greatest role in the ongoing interaction between child and environment early in development, with a de- clining role in later childhood and adolescence. Such as perspective is consistent with some existing the- ories of aggression and delinquency, in which early aversive family environments result in maladaptation that is subsequently reinforced by the social environ- ments of children outside the home, in turn predis- posing them to poor outcomes later (e.g., Dishion, Patterson, Stoolmiller, & Skinner, 1991; Patterson, 1982). Notably, the sole integrative theory explain- ing adolescent homelessness, the risk amplification model (RAM) discussed below, incorporates many of the mechanisms implicated in these theories of aggression and delinquency. Because social learning models implicate family, parenting as well as other contextual “nurture” factors as being more power- ful at younger ages, individual differences are gener- ally hypothesized to be more stable later in develop- ment. These models are consistent with the approach of much of the clinical literature on adult homeless- ness, which tends to focus on relatively stable risk fac- tors and deficits of people who are homeless apart from their social contexts (Shinn, 1992). However, there are good reasons to suspect that family environ- ment continues to play a dynamic role in the develop- ment of homelessness through adolescence. For one, surveys generally indicate that adolescents who are homeless often attribute their latest homeless episode to current family conflict (Robertson & Toro, 1999). Among adolescents identified as throwaways in the MacLean, Embry, et al. (1999) study, parents were more frequently reported to have substance abuse and legal problems, suggesting that parents’ prob- lems may serve to precipitate homelessness for some youth. Furthermore, although peers acquire greater influence as children age into adolescence, a grow- ing body of research suggests that parents continue to exert considerable influence, and that parent influ- ence may serve to moderate the impact of peers (e.g.,

Marshal & Chassin, 2000; Mason, Cauce, Gonzales, & Hiraga, 1994).

The Risk Amplification Model

Creating a comprehensive theory on the devel- opment of homelessness is a daunting task. However, researchers have recently begun to present a com- prehensive developmental theory to explain the de- velopment of homelessness among adolescents, re- ferred to as RAM (Paradise et al., 2001; Whitbeck & Hoyt, 1999). This theory has largely been devel- oped and elaborated from social learning theories concerned with other phenomena indicative of so- cial dislocation, such as delinquency and antisocial behavior (see section above), and integrates research on the impact of early family environment, the im- pact of deviant peer associations among adolescents, and research concerning victimization in the high- risk settings entailed by homelessness with the find- ings of several large, prospective surveys of homeless adolescents (e.g., Cauce et al., 1994; Whitbeck, Hoyt, 1999).

An extensive literature implicates the role of early family environment and deviant peer relation- ships in the emergence of conduct problems and anti- social behavior (e.g., Dishion, Patterson, & Griesler, 1994; Sampson & Laub, 1993; Simons, Johnson, Beaman, Conger, & Whitbeck, 1996). RAM expands upon this model by incorporating the experience of homelessness as an aggravating factor in these ongo- ing processes. Results of a number of cross-sectional studies cumulatively support RAM. For example, long-standing family problems and deviant peer as- sociations appear to increase the likelihood of ex- posure to homelessness through running away, being forced to leave by parents, or institutionalization. Ex- posure to homelessness, in turn, increases exposure to deviant peer networks in settings such as home- less shelters for youth or inpatient psychiatric facili- ties, or to deviant peers and marginal and/or antisocial adults on the streets (McMorris, Tyler, Whitbeck, & Hoyt, 2002; Paradise et al., 2001). Homelessness may also contribute to antisocial behavior if adolescents are compelled to engage in illegal activities to obtain food or shelter, such as theft or prostitution (Tyler, Hoyt, & Whitbeck, 2000; Unger et al., 1998; Whitbeck et al., 1999). Associations with deviant social networks and engagement in illegal activities may also leave the adolescent increasingly vulnerable to victimiza- tion experiences such as physical and sexual assault,

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which contribute to such trauma related problems as depression and substance use (McMorris et al., 2002; Tyler et al., 2000; Whitbeck et al., 1999; Whitbeck, Hoyt, Yoder, Cauce, & Paradise, 2001). Thus, the experience of homelessness is seen as compound- ing the noxious impact of the early environment in producing conduct problems, antisocial behavior and other psychological problems (e.g., problems result- ing from trauma such as depression and PTSD) that compromise functioning and further contribute to so- cial marginalization (Tyler et al., 2000; Whitbeck et al., 1999, 2001). In addition to cross-sectional support, recent prospective research has also supported as- pects of the RAM model. For example, Lombardo and Toro (2004) found that deviant peer associations during and prior to homeless episodes among adoles- cents predicted subsequent risky sexual behavior and substance abuse over a 6-month period. More recent preliminary findings from this ongoing longitudinal study, which has now followed over 320 of the origi- nal sample of 399 over 4.5 years, indicate that those adolescents originally homeless on their own when 13–17, as compared to matched housed youth, were much more likely to experience subsequent home- lessness and/or other institutional placement or jail in later adolescence/early adulthood in the 2–3 years prior to follow-up (41% for the homeless vs. 5% for the housed; H. Janisse, personal communication, May 26, 2004).

RAM conceptualizes homelessness as the result of a developmental trajectory defined by successive environmental disruptions, each of which places in- dividuals at greater risk for homelessness and associ- ated poor outcomes on its own, and also places the individual at greater risk by moving to the next stage of environmental disruption. In addition to cumula- tive effects resulting from such a progression, risk is also believed to be multiplied at each stage because the environmental risks associated with later phases present graver challenges to development and adapta- tion. The first experience of homelessness is regarded as a critical point in this process, because it is the length of homelessness (i.e., number and length of homeless episodes, age of first homeless episode) that predicts the extent to which early risks are amplified (Paradise et al., 2001; Whitbeck & Hoyt, 1999). In its identifica- tion of homelessness as the proximal factor indicating increased risk, the RAM perspective elaborates on the ideas of Goodman et al. (1991), which emphasize how stressors associated with being homeless lead to the development of depression, PTSD, and other poor outcomes.

A challenge for RAM involves how homeless- ness is defined and measured. For example, in consid- ering adolescents who are homeless, RAM and com- mon sense both might suggest that adolescents who leave the home on one occasion for one night will dif- fer from those who are absent for substantially longer periods of time, or those with repeated episodes of homelessness. However, the greater pathology of ado- lescent street populations relative to populations in shelters suggests that considering days homeless out of context could be misleading. From this perspective, a few days on the streets for an adolescent might be a more significant predictor of pathology than many days in a shelter. Complicating this issue still further is the episodic nature of homelessness for many adoles- cents. As noted above, most adolescents experience homelessness in short episodes, following which they return home, in some cases becoming homeless again later. It would be useful to document the relative im- pact of multiple brief episodes of homelessness versus, for example, one long continuous episode.

Although this theory is primarily concerned with homelessness and its sequelae among adolescents on their own, the theory may also contribute indirectly to the explanation of homelessness among families. For example, factors contributing to the devel- opment and progression of homelessness among adolescents on their own may also contribute to the development of homelessness among families, to the extent that such adolescents may be more likely than housed adolescents to have children (as reviewed above), or to the extent that adolescent homeless episodes predispose adolescents to further episodes of homelessness during childbearing years (see Inter- generational, Perspectives below). More generally speaking, mechanisms of compounded risk such as those proposed in RAM may be useful to explore in developing models of homelessness among families that are homeless, although the specific risk factors involved may differ. For example, given the greater prominence of poverty in the backgrounds of families that are homeless, poverty may more likely be a prox- imal cause of family homelessness than of adolescent homelessness, for which family dysfunction is more likely to be an immediate precipitant. Therefore, one possible model of homelessness among families could use family poverty, rather than family dysfunction, as the critical event leading to subsequent exposure to the risks associated with homelessness. Similarly, the risks associated with exposure to homelessness among families may also differ. For example, residen- tial disruptions may lead to school moves, which may

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compromise academic achievement among children in families that are homeless (USGAO, 1994), or the rules and other aspects of the environment in homeless shelters may disrupt effective parenting (Hausman & Hammen, 1993; Thrasher & Mowbray, 1995).

Intergenerational Perspectives and the COR Model

The important role of parenting environment in the developmental literature has led some commenta- tors to discuss homelessness as an intergenerational phenomenon (Miller, 1991; Rickel & Becker, 1997; Robertson & Toro, 1999). The still largely fragmented nature of the research literature on homelessness, which has tended to examine homeless families sep- arately from adolescents and adults who are home- less on their own, generally does not permit exam- ination of such intergenerational dynamics. To our knowledge, there are no studies yet that have ac- tually tracked children who are homeless with their families prospectively to determine whether they are more likely to become homeless later in life. However, studies have provided some evidence suggesting the possible intergenerational transmission of homeless- ness. A common finding in studies on adults who are homeless is the high rate observed for foster care and other out-of-home placements during childhood (e.g., Bassuk et al., 1997; Burt et al., 2001; Koegel, Melamid, & Burnam, 1995; Marpsat & Firdion, 2000; Piliavin, Sosin, & Westerfelt, 1988; Susser, Lin, Conover, & Struening 1991; Toro, Wolfe, et al., 1999; Weitzman, Knickman, & Shinn, 1992). It is not much of log- ical stretch to consider time spent in a shelter or other homeless situation during childhood as an out- of-home placement itself. It has also been reported that both children who are homeless and adolescents who are homeless on their own are at a high risk for foster care and other out-of-home placements (e.g., Burt et al., 2001; Robertson & Toro, 1999; Shinn & Weitzman, 1996; Toro & Goldstein, 2000). Further- more, it has been observed that adults who are home- less are very likely to report having been homeless as an adolescent. Burt et al. (2001), for example, found that, among service clients under 20, a full 51% had run away and 50% had been thrown out of their homes prior to age 18 (the percentages were less extreme, but still very high, for older age groups). Taken to- gether, these findings suggest that it is quite plausi- ble that homelessness during childhood and adoles- cence (whether the youth experiences homelessness

in the context of a family or alone) increases risk for homelessness later in life, in addition to other negative outcomes.

As documented in earlier sections, children born into both families that experience homelessness and housed but poor families are subject to a host of risks from poor prenatal care to poor early parenting and physical environment, stresses associated with home- lessness and residential disruptions, all of which may then contribute to family, school, and social problems. These problems, in turn, may reduce the probability of a successful rise up the social ladder and increase the probability of behaviors—including running away— that may further amplify the risk for poverty and homelessness in adulthood. Because of the apparent large rise in homelessness during the 1980s (Jencks, 1994; O’Flaherty, 1996), we expect that intergenera- tional factors may be particularly important to study now, as children born during the 1980s are now in their childbearing years.

The substantial literature on the intergenera- tional dynamics of poverty provides a broader the- oretical perspective from which to understand the intergenerational dynamics of homelessness. This lit- erature has suggested mechanisms such as the re- source loss cycles posited in COR theory to explain the greater stability of SES in lower relative to higher social strata (Hobfoll, 1989, 2002). COR theory holds that individuals, alone, in families, or in larger social systems, strive to minimize resource loss, including both material and psychological resources (i.e., things that people value or that act to protect what is val- ued). Resource loss results in psychological stress, an adverse outcome in itself. However, perhaps more sig- nificantly, such loss leads to further resource losses, as resources are spent to offset those that have al- ready been lost. Research showing the deterioration of the social support networks among the victims of Hurricanes Andrew and Hugo, many of whom lost their homes, supports this perspective (Norris & Kaniasty, 1996). This model could easily be applied and tested to further the understanding of how home- lessness and/or poverty is passed down through fam- ilies. For example, evidence cited earlier (Koblinsky et al., 1997), indicating that mothers who are homeless provide infants with less warmth and stimulation, sug- gests that resources formerly available for child rear- ing have been diverted to cope with the loss of a home. Loss of parenting resources may over time interfere with the development of the child’s own resources, placing greater strain on parents and contributing to the family conflict and disintegration manifested

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in adolescent homelessness. In turn, family conflict and disintegration during adolescence may increase the likelihood that such resource loss cycles will con- tinue into adulthood, resulting in more adults who are homeless, some of whom will become parents with children who are homeless.

Ecological Perspectives on Homelessness

Although never dominant within psychology, ecological perspectives have a long history in psy- chological theory, research, and intervention (e.g., Bronfenbrenner, 1979; Jackson, 2003; Kelly, 1986). Toro et al. (1991) have provided a discussion of the phenomenon of homelessness from an ecological per- spective. This perspective identifies targets for change at multiple levels of social analysis, ranging from the individual to large-scale social policies and cultural norms. It encourages us to consider creative ways for recycling existing resources in order to make them available for reducing homelessness, and it encour- ages active collaboration with people who are home- less and other stakeholders in solving the problem of homelessness. From an ecological perspective, the assets and resources of people who are homeless, as well as the obstacles and assets in their environments, should be assessed, as change in either internal or ex- ternal resource domains has the capacity to improve adjustment. The perspective is, perhaps, not a theory in the traditional sense. Rather than attempting to reduce large amounts of data to a simple explanatory model, it recognizes and attempts to describe the com- plexity of social phenomena in context. Thus, rather then being a testable theory, the ecological perspec- tive is a general framework that can guide research, in- tervention, and policy. A few recent studies on adoles- cents who are homeless on their own and families that are homeless have implicitly or explicitly adopted an ecological perspective (e.g., Rabideau & Toro, 1997; Shinn et al., 1998; Toro & Goldstein, 2000; Wolfe et al., 1999).

AN ECOLOGICAL–DEVELOPMENTAL PERSPECTIVE

In this section, we will evaluate the research lit- erature and theoretical approaches presented above. We will advocate for an ecological–developmental perspective that we believe incorporates the exist- ing data and theoretical approaches and, most impor-

tantly, provides ideas for a rich array of interventions and policies to address homelessness among families and homelessness among adolescents on their own (ideas that are discussed in the last portion of the pa- per). Many of the ideas presented in this section have not been tested, but they are certainly testable. Thus, one purpose in articulating them here is to suggest the potential of ecological–developmental frameworks for generating testable hypotheses. The ecological– developmental perspective starts from ecological con- ceptualizations of homelessness, such as the idea that homelessness results from inadequate resources, or, consistent with the idea that homelessness may rep- resent an extreme form of poverty, that homelessness is a manifestation of a lack of resources, because a stable home is certainly a critical resource in itself. In addition, consistent with both ecological and devel- opmental approaches, the ecological–developmental perspective recognizes the importance of the family system in mediating the resource losses that result in or manifest as homelessness. Thus, the eventual im- pact of resource losses extrinsic to the family (e.g., income) on housing status or the negative outcomes associated with homelessness is mediated by its im- pact on resources intrinsic to the family (i.e., the rela- tionships that constitute the family system). Changes in family relationships, for example, may precipitate adolescent homelessness by increasing family conflict, which (as reviewed earlier) tends to precede adoles- cent homelessness. As suggested by Barnyard’s (1995) research, the resource loss represented by home- lessness may strengthen bonds between parents and young children, which may then serve as a resource for adjustment until a new home is established. Alter- natively, homelessness may weaken bonds between parents and children, for as children age and become independent, they may become more susceptible to forces associated with homelessness that challenge the parent and child bond (e.g., the greater likelihood or removal of custody by child protective services; see Cowal, Shinn, Weitzman, Stojanovic, & Labay, 2002), and/or restriction of adolescents by some shelters as well as other factors disruptive to parenting in the context of shelter life (Hausman & Hammen, 1993; Thrasher & Mowbray, 1995). It is also plausible that parental authority may be undermined in many home- less situations, in particular, shelters, because shelter rules may supersede those that would otherwise be imposed by parents on their children, and because children may have inordinate control over outcomes for the family, because their misbehavior may result in ejection from a shelter.

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The proposed ecological–developmental per- spective is also designed to encompass interactions involving stages of development at the level of the in- dividual (i.e., infancy or early childhood, later child- hood, and adolescence) and larger social systems, including both the family and higher levels of social organization (e.g., social support networks and service agencies). Some developmental approaches fail to at- tend to possible interactions of developmental phase and social context in determining the significance of developmental events. For example, the “trauma” as- sociated with homelessness (Goldman et al., 1991). might mean different things in different developmen- tal periods. Finkelhor and Dziuba-Leatherman (1994) have proposed a “developmental victimology” per- spective that serves as an example of how interactions between developmental phase and larger social con- text may be modeled. They note that different forms of victimization tend to occur at different ages and that victimization may, in fact, be defined differently across age groups. They further suggest that the cor- relates and consequences of victimization should be expected to be different at different developmental periods.

We can think of a number of possible applications of such suggestions to homelessness among families with young children and to homelessness among ado- lescents on their own. For example, housed–homeless differences may be more common in unaccompanied adolescent samples than in child samples because of differing circumstances that homelessness entails for these age groups. Perhaps homeless shelters for fami- lies represent an improvement on the whole, relative to the substandard living conditions frequently found among the precariously housed (conversely, it is pos- sible that conditions for adolescents in shelters do not represent an improvement relative to those found in their homes). Children who are homeless with their parent also maintain the support of this most piv- otal supportive figure while homeless. In contrast, among adolescents, homelessness generally entails disruption in preexisting family and peer support net- works, and adoption of new and possibly less adaptive ones. Adolescents may also be more acutely aware that they are different from their peers as a func- tion of being homeless. To test possible ecological– developmental explanations for more frequent and/or greater housed-homeless differences among adoles- cents relative to housed–homeless differences among children in families, studies could either compare groups that are currently housed and currently home- less across a broad range of age cohorts, ranging from

the childhood years and into adolescence, or, more optimally, follow young children who are housed and/or homeless prospectively into adolescence, dur- ing which time we would expect many of the children who had experienced homelessness with their families to begin experiencing homelessness “on their own.” Such a research program would ideally draw together researchers concerned with families that are home- less and adolescents who are homeless on their own, groups that thus far have tended to work separately.

The potential usefulness of ecological- developmental theories of homelessness is par- ticularly apparent in the case of adolescents who are homeless on their own. For example, the lack of distinctions alluded to earlier between adolescents who are identified as runaways and those identified as “throwaways” (i.e., leaving the home of their own volition as opposed to being forced to leave by parents) as well as the difficulty even identi- fying which of these categories applies to a given adolescent experiencing homelessness suggests that homelessness is neither a maladaptive behavior on the part of the adolescent (as implied by the phrase “running away,” a symptom of CD in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV]; American Psychiatric Association, 1994), or a maladaptive behavior on the part of the parent (as suggested by the pejorative tone of the word “throwaway”), but a failure in the parent–adolescent relationship, which may be further contextualized as taking place in a given resource situation for the family as a whole (e.g., financial losses, residential instability, disruption of support networks in the community). An ecological orientation is at times at least partially evident in the writings of advocates of the RAM model. For example, Paradise et al. (2001) refer to homelessness among adolescents as representing “disintegration” of the family, as opposed to a reflection of adolescent or parent psychopathology; however, the approach nonetheless limits the scope of inquiry to the family system and fails to consider the interaction between this level and the broader social contexts in which the family is placed. For example, although family conflict may be an important precipitant of ado- lescent homelessness, such family conflict may be modulated by elements of “social control” (Hirschi, 1969) outside of the family, such as the adolescents’ peer associations or services obtained. Agnew and Huguley (1989) tested the utility of a social control model in a sample of adolescents for predicting the likelihood that adolescents would physically

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assault parents, an escalation of conflict predictive of adolescent homelessness (Haber & Toro, 2003). Among other factors, Agnew and Huguley (1989) found that reported associations with peers who assaulted their parents significantly predicted the extent to which adolescents had physically assaulted their parents.

An ecological–developmental perspective could also help to inform theories that are pertinent to fam- ilies that are homeless. Of the theoretical perspec- tives previously reviewed, Hobfoll’s COR theory best integrates ecological considerations, as it provides a mechanism that describes dynamics linking phenom- ena at the level of the family system to phenomena at higher levels of social organization (e.g., social sup- port networks). Consistent with a developmental per- spective, COR describes these dynamics as evolving over time, with progressive resource losses resulting in more extreme poverty or decreased opportunities for exit from impoverished to economically advantaged classes. The hypothetical continuum described earlier between residential stability, instability (i.e., “precar- ious housing”), and homelessness may represent one aspect of these resource loss cycles for families that are homeless. For adolescents who are homeless, this continuum could be further adapted to emphasize is- sues particular to this group. For example, the contin- uum between economic well-being and stable housing could be paired with a continuum between family in- tegration and family disintegration, with shifts along the continuum described by economic and residential stability processes resulting in corresponding changes in level of family integration and/or disintegration, in turn leading to a greater or lesser propensity by the adolescent to leave and/or be forced to leave the home. Integration of economic and family processes in this way might better describe ways in which the macrosocial processes precipitate or maintain home- lessness among adolescents who are homeless on their own and families that are homeless.

A complete theory from an ecological– developmental perspective would elucidate the factors that permit improvement of housing stability as well as improvements in other domains, such as family functioning. Such protective or resiliency factors should be investigated at macrosocial as well as individual and family systems levels. For example, recent research has suggested the role played by ethnicity and culture (e.g., collectivist vs. individualist culture) in buffering the impact of economic stressors, including housing instability and/or homelessness on psychological well-being,

more specifically, symptoms of depression (Ashby & Sachs-Ericsson, 2004). In another example, over a follow-up period of roughly 5 years, Stojanovic et al. (1999) found that the vast majority of families exiting from a shelter at baseline achieved stable housing when their housing was subsidized. Thus, level of public assistance appears to be highly associated with the achievement of residential stability following homelessness.

Findings that many families that are homeless eventually achieve stable housing and studies that identify the personal and social resources permit- ting this achievement encourage us to consider the full context of homelessness, and not just the imme- diate needs and troubles of people who are home- less. As grim as conditions may seem for people who are homeless, their responses to these difficulties can be evaluated for their adaptive potential, as well as their possible maladaptive consequences. For exam- ple, adolescents who leave home for short periods may in so doing provide a valuable outlet in fami- lies in which conflict has become unbearable for all parties involved. The temporary respite may permit resolution of the conflict to some degree, improving the situation for both the adolescent and the fam- ily as a whole. Longitudinal data from a sheltered sample of adolescents showing average improvement at 18-month follow-up on several symptomatic mea- sures of psychopathology and substance abuse are consistent with this idea (Toro & Goldstein, 2000). Similarly, certain choices may indicate adaptive po- tential among families that are homeless. A parent who seeks help from a homeless shelter may be mak- ing an informed choice to locate her family in an envi- ronment in which additional services may be accessed, or similarly, may be wisely leaving an uncomfortable situation in which the family is imposing on members of their social network in an attempt to preserve re- sources for the future (e.g., living “doubled up” in cramped quarters).

In addition to providing a more comprehen- sive understanding of homelessness among adoles- cents and families, we believe that the integration of ecological considerations into developmental the- ories creates new, important targets for prevention and intervention at the community level. Although we do not wish to deny the potential benefits of pro- grams that exclusively target parenting and family relationships such as parent counseling and family therapy, we believe that interventions targeting dy- namics at higher levels of social organization such as community-wide dynamics may be more effective

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in some cases. Although we are aware of no stud- ies attempting to compare the impact of these two approaches directly, research regarding moderation of parenting effects by community-level variables is instructive. For example, in a longitudinal study of adolescents (i.e., ages 13–17) who were sampled from shelters and other agencies at baseline, Fowler, Toro, and Hobden (2004) found that protective parenting variables such as warmth were associated with psy- chological health at follow-up only when commu- nity violence was low. Leventhal and Brooks-Gunn (2000) have recently reviewed studies concerning the effects of neighborhood residence on myriad out- comes among children and adolescents, including the effects of neighborhood poverty, which may amplify the effects of family-systems level variables such as parenting or family poverty. From an ecological per- spective, we believe that all of these factors are rel- evant to interventions to ameliorate homelessness and prevent future homelessness among families and adolescents.

Ecological perspectives also suggest changes at even higher levels of social analysis, such as macroso- cial changes at the state or national levels. In sug- gesting such targets for intervention, examination of chronological relationships between macrosocial changes and fluctuations in the prevalence of home- lessness may be useful. For example, it has been sug- gested that many who are homeless currently are men- tally ill and that the surge in homelessness observed in recent decades is a consequence of the extensive de- institutionalization (Jencks, 1994). Although the inci- dence of severe mental disorders among single adults who are homeless appears to be elevated, a clear majority of single adults who are homeless are not mentally ill (Toro, 1998). As reviewed above, severe mental illness appears even less characteristic of fami- lies, children, and adolescents who are homeless. Even fewer differences are evident when families that are homeless and adolescents who are homeless on their own are compared to groups matched on key variables such as SES. Thus, other social trends contributing to homelessness need to be examined. For example, the relationship between the rapid pace of gentrifi- cation over the past several decades (Adams, 1986; Dolbeare, 1996; Wright & Lam, 1987), the effects of dwindling opportunities for low-cost housing (Mulroy & Lane, 1992; Shinn & Gillespie, 1994), and the effects of increasing income inequality (O’Flaherty, 1996; Phillips, 1990) could be examined. Given the seeming importance of low-cost housing to the is- sue of homelessness among low-income families in

particular. Given the importance of low-cost hous- ing to the issue of homelessness among low-income families in particular, the relative lack of attention to the effects of constriction in the low-cost housing market on the problem of homelessness is surprising (Shinn, 1997). International comparisons could also be of use here. For example, as noted earlier, it ap- pears that the United States and the United King- dom have higher rates of homelessness than Ger- many and some other nations in Europe. Identifying macrosocial factors that could account for this vari- ation might help us in designing interventions and policy.

In addition to widening the field of possible tar- gets for intervention, we believe the integration of ecological ideas into developmental theories of home- lessness among families and adolescents is useful, because such integration discourages interventions that implicitly treat the problems of families that are homeless and adolescents who are homeless on their own as the product of deficiencies or limitations of individuals, rather than instances of poor “person– environment fit” (Toro et al., 1991, p. 1210). Sev- eral recent investigations have found that the extent of personal, social, and/or service resources avail- able (e.g., subsidized housing), rather than the de- gree of pathology, is the best predictor of successful long-term adaptation among people who are home- less (e.g., Shinn et al., 1998; Stojanovic et al., 1999; Zlotnick et al., 1999). Despite such findings, the ma- jority of local, state, and federal governments have focused mainly on addressing the immediate, emer- gency needs of the people who are homeless by pro- viding temporary shelter, food, and short-term medi- cal care, or addressing other obvious problems shown by people who are homeless, such as mental illness and substance abuse. It has been suggested that short- term approaches geared to meeting immediate needs, despite good intentions, may actually be fostering homelessness by decreasing the resources available to support more permanent housing options (Toro & Warren, 1999). Similarly, approaches oriented toward treating problems of people who are homeless, such as substance abuse or mental health treatment pro- grams, may detract from programs oriented toward building strengths, including job training or job place- ment programs for parents who are homeless, or tu- toring and educational assistance programs for ado- lescents who are homeless. Indeed, a recent study on the reported service utilization and availability among adults who are homeless (including those in fami- lies) suggest that the greatest discrepancies between

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available and needed services occur for services that are oriented toward building competencies and strengths, like vocational training, rather than pro- grams dealing with short-term needs or deficits such as emergency shelter, substance abuse, and men- tal health programs (Israel & Toro, 2003). Re- sults were similar whether those asked were ser- vice providers or persons experiencing homeless. Similar “needs-gaps” research that incorporates the knowledge and expertise of service providers as well as the expertise of populations that are homeless would be useful in evaluating services for ameliora- tion of homelessness among families, children, and adolescents.

Two final advantages of incorporating ecologi- cal perspectives into developmental theories of fam- ily, child, and adolescent homelessness are worthy of mention. As previously suggested by advocates of the ecological perspective (Toro et al., 1991), we believe that conceptualization of the problems of those ex- periencing homeless as the result of poor “person– environment fit” is more consistent with empathic service provision than a deficit-based model. These approaches are also less stigmatizing, which is poten- tially important, as stigmatization has often been sug- gested as an iatrogenic danger associated with deficit- based treatment strategies (Levine & Perkins, 1997). Finally, we believe that the “person–environment fit” approach has the potential to be more cost-effective relative to a deficits-based approach. Because indi- vidual deficit models stress stable individual prob- lems rather than problems that vary according to con- text, the targets of deficits-based models tend to be conceptualized as relatively chronic. If a deficiency or limitation is chronic, then services must be pro- vided on a chronic basis, potentially at great cost. However, if individual problems are conceptualized as problems of person–environment fit, where the po- tential of adaptation rather than personal limitation is stressed, the potential for self-sustaining change is increased. Conceptualization of homelessness as a problem of person–environment fit suggests the need for a broader range of social niches for people who are homeless, many of whom have been unable to adapt to the limited niches available to them (Toro et al., 1991). Creating more niches need not result in a vastly in- creased expenditure of resources. For example, Shinn, Knickman, Ward, Petrovic, and Muth (1990) have suggested that different kinds of housing may be best for different kinds of people who are homeless, de- pending on their family constellation and paths that led them into homelessness. Thus, rather than sim-

ply attempting to increase housing units available, a policy that attempts to increase the diversity of hous- ing options might better serve the needs of people who are homeless. At the individual level, attention to person–environment fit suggests that there should be careful assessment of the various circumstances people who are homeless might face when design- ing interventions. Thus, interventions developed to alleviate homelessness in urban areas may not be useful in rural areas, and certain interventions might be most helpful for particular ethnic, age, or other subgroups.

IMPLICATIONS FOR TREATMENT, PREVENTION, AND POLICY

Traditionally, the provision of clinical services in psychology and related fields has been guided by the “medical model” (Levine & Perkins, 1997, pp. 41–45). This model, which shares many features with the “deficits-based approaches” described above, advo- cates short-term interventions for problems that are conceptualized as acute and that result from a sin- gular cause, or pathogen. Thus, problems tend not to be contextualized from developmental or ecolog- ical standpoints. Although it has many advantages, the medical model of service delivery has been crit- icized for failing to encompass the social aspects of many important human problems, resulting in ineffec- tive and/or needlessly costly interventions (Levine & Perkins, 1997). With respect to interventions for peo- ple who are homeless, the medical model of service delivery and the programs guided by it are insufficient, perhaps even counterproductive (Shinn, 1992; Toro & Warren, 1999). Services provided on a short-term basis can be expensive yet often do not address the long-term needs of people who are homeless, includ- ing their needs for permanent housing, job training and placement, and reliable transportation (Acosta & Toro, 2000). Short-term services also tend to address deficits (e.g., treating depression or substance abuse), rather than building competencies such as learning or vocational skills. In addition to focusing on short-term needs and personal deficits, existing services generally do not attend to the needs of the large numbers of people likely to become homeless in the future (e.g., the precariously housed). Furthermore, although ser- vices for people who are homeless have incorporated developmental considerations in some obvious ways (e.g., establishing separate facilities for adolescents, young mothers and their children, and single adults),

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implementation of such concerns in practice often remains superficial. For example, homeless shelters for adolescents tend to adapt a “one size fits all” ap- proach, in which adolescents who are homeless are treated similarly, regardless of the type and chronol- ogy of their homelessness (e.g., whether they have spent time on the streets, the number and duration of homeless episodes). Such thoughts lead us to con- sider interventions that more closely attend to the de- velopmental context of episodes of homelessness. In addition to improving services for the presently home- less, such programs could also help to prevent future episodes of homelessness.

Espousal of an ecological–developmental per- spective does not require eschewing approaches tar- geting groups or deficits entirely, as this would re- quire the creation of an entirely new program for each individual, and would encourage practitioners to ig- nore individual vulnerabilities and deficits where they occur. We do, however, strongly advocate greater sen- sitivity to variation within groups and the role of eco- logical and developmental context in problems tradi- tionally conceptualized as static and based in the in- dividual. Some of our suggestions have already been incorporated to some degree in the field. We hope in these cases that our suggestions serve as further support and reinforcement for these ongoing efforts. It is also important to recognize that in critiquing and suggesting improvements to current support sys- tems for family, child, and adolescent populations experiencing homelessness, it is in keeping with an ecological–developmental perspective to treat indi- vidual deficits where they occur. Thus, in many cases, the interventions suggested below are to some de- gree influenced by clinical and/or medical model per- spectives. In these cases, our intent is to present ways in which these clinically/medically oriented models can be made more ecologically and developmentally sensitive.

In compiling this section, we attempted to iden- tify interventions consistent with our perspective that have already been well-tested in the field. Unfortu- nately, as noted earlier, few empirical evaluations ex- ist of ecologically and developmentally sensitive pro- grams, or, for that matter, intervention programs to combat homelessness more generally. Thus, some of the recommendations suggest intervention ideas that have not been formally tested. We provide the recom- mendations nonetheless in the hopes that more efforts will be made to develop and rigorously test interven- tions on the basis of ecological and developmental principles in the future.

Treatment Interventions With Families, Children, and Adolescents Who Are Homeless

Below we describe a number of recommenda- tions for intervention with currently or recently home- less families, children, or adolescents. We note that, in compiling this section, we encountered some dif- ficulties in establishing which interventions consti- tuted “treatment” and which interventions consti- tuted “prevention.” At what point does a residential program cease to be a shelter and become a tran- sitional living facility or even permanent housing? Should programs providing shelter be designated as residential arrangements for people who are currently homeless according to objective considerations such as length or stay and privacy of living arrangements, or should such programs be classified according to the preferences of staff and/or residents (e.g., women in domestic violence shelters typically prefer not to be considered homeless)? Our difficulties of classifi- cation reflect similar difficulties in more generally es- tablishing categorical distinctions between preventive and treatment interventions. We prefer to regard def- initions of prevention and treatment interventions as representing somewhat arbitrary points along a con- tinuum ranging from interventions targeting the gen- eral population (primary prevention), to those tar- geting those at-risk (secondary prevention), and to those targeting individuals who are currently expe- riencing a problem or who have a history of that problem (more detailed discussion of definitional is- sues involving prevention and treatment can be found in Dalton, Elias, & Wandersman, 2001; Levine & Perkins, 1997).

Comprehensive and Family-Focused Treatment Programs

Robertson and Toro (1999) advocate for a com- prehensive array of services tailored to the specific needs of adolescents who are homeless, and similar arguments have been made for services for families that are homeless (Cain, 1993; Homan, Flick, Heaton, & Mayer, 1993). The need to tailor services follows from the heterogeneity of adolescents who are home- less on their own and families that are homeless with younger children, as documented in the review above. Consistent with our ecological–developmental per- spective, tailoring services also provides an opportu- nity to construct treatments collaboratively with fami- lies, children, and adolescents, and consider their own

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goals and aspirations, keeping in mind that expec- tations for goal-setting on the part of children and adolescents are appropriate for their developmental phase. For example, families should be involved in goal-setting for adolescents (and certainly children) experiencing homelessness, at least in cases in which family dysfunction is not so severe that the parents cannot be expected to play a supportive role. Tai- loring services also provides opportunities to identify and utilize the unique strengths of members of these heterogeneous populations. These strengths include positive aspects of relationships developed with fam- ily members. Among families experiencing homeless- ness, possible protective factors associated with par- enthood such as those suggested by Banyard’s (1995) research should be more fully explored and explic- itly acknowledged and utilized in clinical work. Simi- larly, among adolescents experiencing homelessness, attempts should be made to identify supportive or otherwise protective aspects of family relationships, even in cases in which such strengths are not readily apparent.

One general category of comprehensive in- terventions, consistent with an ecological–develop- mental perspective, involves intensive case manage- ment. These interventions, first used among adults who are homeless (including those with mental ill- ness; see review above), often explicitly seek to foster close, supportive relationships between caseworkers and clients. Thus, in addition to providing more tai- lored, appropriate services for particular cases, these interventions provide opportunities for the formation of close relationships that may in themselves serve as resources for families that are homeless and for ado- lescents who are homeless on their own. Interventions that can provide only one or two narrow services (e.g., mental health, substance abuse, housing, or employ- ment) may have limited effectiveness with the multi- problem cases that tend to be common among both adolescents who are homeless on their own and fam- ilies that are homeless.

Some case management interventions have been successfully adapted and evaluated among adoles- cents who are homeless (Cauce et al., 1994; Paradise et al., 2001) and families that are homeless (Homan et al., 1993; James, Smith, & Mann, 1991; Toro et al., 1997). These services are often provided in the context of existing shelter and drop-in agencies for these pop- ulations. They have often adopted ecological, trauma reduction, and/or social learning perspectives, and have targeted multiple types of problems over long periods (often 6 months or more). For example, the

intervention evaluated by Toro et al. (1997), on the ba- sis of an ecological model, targeted the full range of needs of the families and individuals who were home- less and served clients intensively over a long period of time (an average of forty-one 45-min sessions over 4– 8 months). Targeted needs included obtaining perma- nent housing, job training and placement, child care, and health, mental health, and dental services. On the basis of a randomized design, Toro et al. found that both families that were homeless and single adults who were homeless in the treatment group showed significant improvements, relative to those in a control group. Over an 18-month follow-up period, the treat- ment group was housed in significantly better qual- ity environments, reported fewer stressful events, and received lower interviewer ratings of psychopathol- ogy (both groups showed drastically less homeless- ness over the follow-up period). Also on the basis of a randomized design, Cauce et al. (1994) found that, relative to youth in a regular case management pro- gram, youth assigned to an intensive case manage- ment program showed reduced externalizing behav- iors and improved quality of life ratings over an initial 3 months.

Subsidized Housing for Families That Are Homeless

Earlier, we addressed the importance of improv- ing the availability of low-cost housing in approaching the problem of homelessness on a macrosocial level, but clearly, interventions on the case level should be designed to assist families in obtaining low-cost housing as well. These services are often incorpo- rated into the intensive case management services mentioned above, but we wish to underscore the im- portance of this aspect of a comprehensive treat- ment approach in light of its demonstrated efficacy in returning families to stable housing, even in the absence of other services. Several studies have sug- gested that access to subsidized housing alone, with or without access to other services, may be sufficient to end homelessness for many if not most families (Rog, Holupka, & McCombs-Thorton, 1995; Shinn et al., 1998; Weitzman & Berry, 1994). Despite such suggestions, we would still advocate provision of ad- ditional services to treat other problems frequently found among families that are homeless, such as those associated with family poverty generally, and/or pro- vision of services to treat the immediate psychiatric, educational, social, and other effects of homelessness episodes.

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Independent Living Programs for Adolescents Who Are Homeless

Although we have recommended family-focused programming, where possible, for adolescents on their own, there are many situations in which an adoles- cent who is homeless may be escaping a severely abu- sive or neglectful family situation. In these situations, efforts must be made to find alternative placements such as foster homes, but options for foster placement may be limited, and unfortunately, may sometimes not represent a great improvement in living conditions in comparison to the former family (e.g., Benedict, Zuravin, Brandt, & Abbey, 1994; Rosenthal, Motz, Edmonson, & Groze, 1991). Partially in response to the problems of “aging-out” foster youth, fed- eral funding opportunities have been expanded re- cently to support supervised independent living pro- grams, in which older adolescents receive assistance in establishing independent or semi-independent resi- dences, finding employment, and furthering their edu- cations assisted by such services as case management and mentoring programs (Ansell, 2001). A number of such programs have been reported (e.g., Hoge & Idalski, 2001) but data on their effectiveness is very limited. Psychologists could assist in piloting and con- ducting evaluation of future programs of this kind targeting homeless adolescents and/or all youth ag- ing out of foster care (who are known to be at risk for homelessness in early adulthood; Courtney et al., 2001).

Needs Assessment and Program Evaluation at Shelters and Other Agencies

Although tailoring interventions to individual families, children, and adolescents is highly desirable, decisions must also be made concerning the array of services offered to the larger population served at a given intervention site. In making such decisions, program development and funding priorities should stress interventions that are likely to utilize or en- hance the strengths and resources of families, chil- dren, and adolescents who are homeless. Program planners should also take into account the preferences and values of those they serve in making programming decisions. Ideally, the preferences and values of the families, children, and adolescents served in a given facility should be considered, again, in a manner tak- ing into account the developmental capacities of those involved. Representative methodologies in needs as-

sessment include surveys and focus groups. For exam- ple, one ongoing study is using both these methods si- multaneously to evaluate service provision at several agencies serving people who are homeless (Tompsett, Heinze, Josefowicz-Simbeni, & Toro, 2004). Where it is not possible to determine the needs of a target pop- ulation at a given site or within a given agency (e.g., if the site or agency is in the process of being formed), attempts could be made to canvass the target commu- nity for those likely to access the proposed service and survey this population. Less ideally, program develop- ers could consult survey results from similar popula- tions (e.g., Acosta & Toro, 2000; Israel & Toro, 2003; Jacobs, Little, & Almeida, 1993), although this prac- tice risks inappropriately generalizing between com- munities and sacrificing ecological validity if the de- velopers’ impressions concerning the compatibility of the communities are not accurate.

Alternative Communities and Families

Various alternative and/or self-help communities could also serve as models for new ways of providing supportive housing to prevent homelessness and/or provide housing for families that are homeless. For ex- ample, the Oxford House movement provides perma- nent, self-run, low-income housing to persons recov- ering from substance abuse, including many who have been homeless (about 48%; Jason, Ferrari, Groessl, & Dvorchak, 1997). Although Oxford homes have tradi- tionally served young, unmarried males with histories of substance abuse, recent research has suggested that they might be as effective for women as well, includ- ing women with children (Davis, 2003; Ferrari, Jason, Nelson, & Curtin-Davis, 1999), and commentators have observed that, in certain cases, Oxford homes may offer special advantages for women with children (e.g., linkages to gender-specific services; Dvorchak, Grams, Tate, & Jason, 1995). Others have suggested using the model to house non-substance-abusing pop- ulations of women with children, particularly popu- lations that might otherwise be homeless (e.g., pro- viding a housing option for women leaving domestic violence shelters; Olson et al., 2003). Although some might raise concerns that such an environment would potentially provide children with poor role models (e.g., many substance abusers with troubled histories), research concerning the therapeutic mechanisms as- sociated with Oxford House participation (e.g., so- cial support for abstinence and psychological sense of community; Ferrari, Jason, Olson, Davis, & Alvarez,

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2002; Jason, Davis, Ferrari, & Bishop, 2001) suggests that models in the Oxford House context are more likely to be positive. Applying the model to a more mixed sample (including parents who are not sub- stance abusers) would reduce this concern yet further.

Another interesting idea is to create “alternative families” for mothers with children that are home- less. Killion (2000) collected pilot data concerning the feasibility of house-sharing arrangements involv- ing young mothers who are homeless with children and elderly women. Observing that elderly women appear to be less at risk for homelessness, but may be vulnerable to other “resource deficits” that may contribute to poor quality of housing (e.g., lack of ca- pacity to care for a home due to limited incomes), Killion (2000) suggested that young mothers who are homeless and housed elderly women might have com- plementary strengths and vulnerabilities that would make them ideal house-sharing partners. For exam- ple, young mothers might be able to improve hous- ing quality for stably, but marginally housed elderly women by contributing to household income (partic- ularly if given vocational assistance), or by otherwise contributing to upkeep of the home (e.g., by making repairs that the elderly may be too disabled to com- plete on their own). Survey data collected by Killion (2000) suggested that members of each group were comfortable with the idea of a house-sharing arrange- ment with the other group.

Suggestions have been made in the literature re- garding building similar alternative communities or “alternative families” for adolescents that are home- less, for example, in the context of an adolescent homeless shelter, facilitating “family meetings,” in- cluding adolescents who are homeless and staff mem- bers with staff members playing the parental role and adolescents interacting as siblings (e.g., Freeman, 1993). Although such a strengths-building approach is broadly consistent with ecological principles, we would caution that such an intervention may be dif- ficult to implement successfully among adolescents, given emerging data on the possible iatrogenic effects of group treatment among deviant youth (see discus- sion below).

Special Caution About Peer-Based Approaches for Adolescents

In designing treatment programs for adolescents who are homeless on their own, it is important to consider data summarized in the review by Dishion, McCord, and Poulin (1999) that concluded that inter-

ventions offered to adolescents at risk for delinquent behavior in a peer-group format may have harmful effects through a process of “deviancy training” (i.e., reinforcement of deviant and/or antisocial behavior by peers, consistent with the social learning models and RAM reviewed above). Given that adolescents who are homeless on their own share many char- acteristics of delinquent youth (Robertson & Toro, 1999), we would recommend caution in developing peer group approaches to preventing youth homeless- ness. Dishion et al. (1999) made specific suggestions for minimizing iatrogenic hazards of peer-group for- mats for adolescents that may be helpful to consider in designing peer group approaches, including group- ing at risk or delinquent youth with more prosocial youth. The suggestion of mixing prosocial with antiso- cial youth appears to be supported by a recent meta- analysis showing that group skills training interven- tions for delinquent youth were more effective when training involved more prosocial peers and did not segregate antisocial youth into homogenous groups (Ang & Hughes, 2002).

The potential role of deviancy training in ac- celerating processes leading to homelessness as pro- posed by social learning and RAM models also has serious implications for shelters for adolescents who are homeless. Even in highly supervised settings, rein- forcement of deviancy by peer groups can undermine efforts by staff to prevent future homeless episodes and delinquent behavior (e.g., Buehler, Patterson, & Furniss, 1966). We believe these considerations argue against extended placement of adolescents in groups with similar peers. Similarly, shelters that house only a small number of adolescents with high staff-to- adolescent ratios may be more successful in foster- ing interaction between adolescents and supportive staff and reducing deviancy training. We emphasize that these recommendations have not been tested, but appear consistent with our ecological–developmental perspective.

General Clinical Issues

In working with families that are homeless and with adolescents that are homeless on their own in any type of program, there are a number of general issues that service providers may wish to consider. Although it is obviously important that the immediate needs of people who are homeless (e.g., for short-term housing and food) should be addressed, the long-term needs of people who are homeless require even more attention and may be more difficult to effectively address. These

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needs can include job training and placement, health care, suitable permanent housing, mental health ser- vices, and assistance to repair damaged family and other social relationships. The intensive case manage- ment services described above are explicitly oriented toward addressing such a multiplicity of client needs.

Note that treatment priorities are likely to be dif- ferent for adolescents who are homeless and fami- lies with children that are homeless. As noted above, based on current evaluation research, the priority in developing interventions for families that are home- less appears to be to create opportunities for sta- ble housing, most likely through financial assistance. Among adolescents who are homeless on their own, a priority in developing interventions is likely to be addressing damaged family relationships, because family conflict tends to be the proximal cause of such adolescent homelessness; however, it may be difficult to address family problems of these adolescents un- less the resource needs of the family are addressed, as argued above. For example, intergenerational consid- erations and the COR model suggest that poor par- enting may be associated with the stresses and obsta- cles associated with poverty, precarious housing, or homelessness among families of adolescents.

The presence of depressive symptoms among adolescents who are homeless on their own and fam- ilies that are homeless also needs to be considered. Because mothers who are homeless have not shown higher rates of depression when compared to SES- matched housed mothers, these symptoms should be understood as reflecting, at least in part, impoverished living circumstances generally, rather than homeless- ness in particular. On the other hand, as discussed ear- lier, some recent research has suggested that children who are homeless may suffer from more internaliz- ing problems than housed children, including depres- sion (Buckner et al., 1999), and research has generally suggested elevated rates of depression among ado- lescents who are homeless on their own relative to matched housed youth (Robertson & Toro, 1999). Whether depression among families that are home- less and adolescents who are homeless on their own reflects homelessness specifically or poverty in gen- eral, service providers must deal with the sense of hopelessness and despair that is so commonly seen among people who are homeless. Such negative af- fect can stymie well-intentioned intervention efforts by undermining the motivation of those served. Thus, it may sometimes be necessary to address depression in order to motivate people who are homeless to work on their other problems.

Although the rates of substance abuse among mothers who are homeless and adolescents who are homeless on their own are not nearly as high as those seen among single adults who are homeless, the po- tential role of substance abuse should not be forgot- ten. Although, as discussed earlier, high substance abuse prevalence among mothers in homeless fami- lies may be associated with poverty in general, rather than homelessness itself, substance abuse is of partic- ular concern in this population because of its already- heightened vulnerability (Weinreb & Bassuk, 1990). Among adolescents on their own, it is clearer that substance abuse rates are elevated relative to housed poor adolescents, and that adolescents in homeless situations are more likely to be exposed to risks as- sociated with onset and/or exacerbation of alcohol or drug use (as described in RAM). Consequently, in- terventions targeting substance abuse are even more likely to be of specific importance to this group. We would caution that, for both groups, substance abusers are clearly in the minority, and thus programs providing substance abuse treatment services with- out proper identification and assessment of the sub- populations likely to benefit from such services may not be cost-effective. Effective substance abuse pre- vention strategies among adolescents homeless and on their own might be valuable. Although there are discussions in the literature of treatment programs specifically designed for the treatment or prevention of homelessness among substance-abusing mothers (e.g., Dvorchak et al., 1995; Sacks, Sacks, Harle, & DeLeon, 1999), or programs designed to assist ado- lescents on their own with substance abuse prob- lems (e.g., Freeman, 1993), literature on intervention with substance abuse problems specifically in these populations is limited. We would welcome further research regarding the possible contributions of sub- stance abuse treatment interventions in this area, par- ticularly with adolescents who are homeless on their own.

Preventing Homelessness

Thoughts on how to prevent homelessness are relatively new in the research literature (e.g., Lindblom, 1996; Shinn & Baumohl, 1999; Toro, Lombardo, & Yapchai, 2002). Note that many of the interventions described below could easily be ap- plied to the currently homeless. In such cases, the interventions could be considered as secondary pre- vention of future episodes of homelessness or other unwanted outcomes related to homelessness.

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Identifying At-Risk Groups

As noted earlier, children and youth with histories of residential instability, foster care, and other out-of-home placements are at heightened risk for later homelessness. Such groups could be special targets for preventive intervention. Adolescents who are “aging out” of the foster-care system appear to be particularly vulnerable to homelessness. Perhaps the age of eligibility for foster care, other placements, and/or support services could be extended to age 21 or later. Such changes have already been achieved for some programs in some localities, but clearly need to be expanded to cover a broader range of services and to include those communities in which such extensions have yet to be fully implemented (Toro, Janisse, & Fowler, 2004). Foster parents could also be targeted to better assist their foster children (which might, in turn, ultimately prevent homeless- ness; see Zlotnick et al., 1999). Recent examination suggests that support services for adolescents who have aged out of the system, even where available, are insufficient, at least in the sense that few young adults take advantage of them (Lindblom, 1996). Reasons for low service utilization in this group (e.g., aversion to the foster-care system, objections to requirements that using services might entail) need to be investigated to guide future improvements.

As noted earlier, teenage mothers with children are another at-risk group. Fischer (1997) targeted pregnant teens and provided pre- and postnatal care, educational assistance, job training, parent training, intervention aimed at preventing subsequent preg- nancies, and services to strengthen support from the family of origin. Compared to a comparison group, the girls who received the intensive services showed more educational attainment, better health outcomes, less subsequent pregnancies, and more employment at an 18-month follow-up. Similarly, using a randomized design, O’Sullivan and Jacobsen (1992) found that teenage mothers receiving intensive services showed a rate of repeated pregnancy less than half that of a control group.

Identifying At-Risk Communities

Although programs targeting at-risk groups can be helpful, these programs can be criticized from an ecological perspective because they tend to focus on individual deficits and ignore the broader, community-wide contexts in which they occur. As noted earlier, these programs are potentially

stigmatizing and possibly less cost-effective, because they may target individuals who, despite having certain problems, may already have resources at their disposal that make homelessness unlikely (e.g., teenage mothers may already have considerable support from immediate and/or extended family). In addition, the extent to which a given group is “at risk” may also vary from community to community (e.g., in predominantly African American communities, teenage mothers may be less stigmatized as a result of their pregnancy; Henly, 1993). On the basis of their analysis of the prior address distribution of families admitted to shelters in New York City and Philadelphia, Culhane, Lee, and Wachter (1996) have suggested that people vulnerable to homelessness tend to be heavily concentrated in certain neighbor- hoods that cannot be predicted simply by average income. Further studies examining factors associated with homelessness in communities are warranted, using approaches such as those employed by Culhane et al. (1996).

School-Based Programs

Early childhood intervention programs, such as Head Start, have demonstrated effectiveness at reducing the harmful developmental outcomes of- ten associated with poverty (Committee on Child Psychiatry, 1999). Such programs have been applied to children who are homeless and could promote the secondary prevention of homelessness (NAE- HCY/HCH, 1999). However, we believe that to ac- complish prevention, whether secondary prevention for currently homeless children or primary preven- tion for housed children at risk for homelessness, such programs probably need to do more than sim- ply provide day care, educational stimulation, and nutritious meals, by providing additional services di- rectly targeted to parents. While the day care provided could serve a preventive function (by helping the par- ent(s) maintain employment, financial viability, and housing), other services such as case management, educational and employment assistance, and parent training could be even more important in prevent- ing future homeless episodes. In fact, one of the most widely cited studies demonstrating the long-term ben- efits of early childhood intervention programs (i.e., Schweinhart & Weikart, 1988) involved a compre- hensive intervention that included all of these compo- nents. Comprehensive and tailored interventions may be most effective if one wishes to effectively prevent homelessness. Given the close connection between

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homelessness and poverty, especially for children who are homeless, it is reasonable to consider any program that can reduce poverty and its possible harmful con- sequences as, in the long run, also having the potential to prevent homelessness.

School-based programs also have potential for preventing homelessness among older children and adolescents. Hendrickson and Omer (1995) discussed the “comprehensive service school” that takes an eco- logical perspective in examining relationships among students, families, institutions, and communities. Ser- vices in such schools include adult education and career development, child care, economic and so- cial services (e.g., helping families find housing, jobs, food assistance), family support services (e.g., par- enting classes, support groups), transportation, legal services, health services, and mental health counsel- ing. School-based programs may also help to prevent adolescent homelessness to the extent that they pro- vide prosocial niches outside the home, improving the person–environment fit. For example, an adolescent who is involved in supervised extracurricular activi- ties, which may include a high proportion of prosocial adolescents, may be less vulnerable to influences of deviant peers (e.g., Chen et al., 2004; Johanson, Duffy, & Anthony, 1996). Such activities also constitute addi- tional social bonds or attachments (Hirschi, 1969) that may in turn discourage deviant behavior that could be inciting or perpetuating family conflict.

Social Networks and Support

An ecological perspective encourages us to con- sider ways of using currently wasted resources. For example, many women who are poor and/or home- less have developed effective coping skills and excel- lent parenting abilities (e.g., Banyard, 1995). These skills could be honed and put to use in prevention programs. For example, women with effective parent- ing skills could serve as paraprofessional parent train- ers or teacher aides in preschool programs, providing the mothers with a meaningful source of employment while also meeting societal needs for more and better day-care services.

Influencing Policy

Welfare Reform

Recent welfare reforms have focused primar- ily on reducing welfare rolls by increasing employ- ment, typically in very low-wage jobs. Many authors

have criticized these reforms for not meeting the complex and long-term needs of families experienc- ing homelessness, housing instability, and poverty, involving, as they do, short-term interventions with many types of multiproblem families (e.g., Knitzer, Yoshikawa, Cauthen, & Aber, 2000; Lindsey, 1998; Salomon, Bassuk, & Brooks, 1996). A recent review of the literature on the effects of welfare reform has suggested that, despite some indications of positive ef- fects, policies central to welfare reform programs such as time limits and sanctions are likely to deepen rather than ameliorate poverty among many poor families (Duncan & Brooks-Gunn, 1999), and at least one statewide study has suggested that the negative effects of these programs as they have matured may have in- creased, rather than decreased (Ovwigho, Leavitt, & Born, 2003).

Welfare reform also may play a role in in- creasing the vulnerability of adolescents to disci- plinary and school problems, both outcomes that would be expected to increase family conflict of- ten cited as the precipitant of adolescent homeless- ness, and/or decrease adolescents’ future employa- bility and adjustment in adulthood, setting the stage for adult homelessness. For example, in another statewide study of welfare reform policy changes, Morris, Bloom, Kemple, and Hendra (2003) suggested that welfare reform may have had more pronounced negative effects on adolescents, effects that exceeded those found for younger children. These included ef- fects on the number of suspensions as well as school achievement. The researchers attributed these effects to adolescents’ increased responsibility for parent tasks following parents’ return to work and decreased parental monitoring.

Although it may be politically unpopular (Brodkin, 2003), enhancing rather than cutting pub- lic benefits for people who are poor and/or homeless, makes sense, especially given the apparent correla- tion between such benefits and homelessness across the developed nations of the world (Tompsett et al., 2003; Toro et al., 2004).

The Need for More Low-Income Housing

In most large urban areas, there is a critical short- age of quality low-income housing (Dolbeare, 1996; Shinn, 1992). Policies and interventions that promote the development of such housing and help families to remain in it make sense as preventive strategies. One specific benefit that has, in recent years, helped many

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who were homeless and/or precariously housed ob- tain affordable housing is the federally funded Sec- tion 8 voucher program, which subsidizes qualified poor people in high-quality housing of their choos- ing. In many cities there is a long wait-list to obtain such vouchers and there has been relatively flat fund- ing for these vouchers (Burt et al., 2001). In gen- eral, the United States has one of the lowest rates of support for public housing: For example, Daly (1999) notes that many European nations provide subsidies for up to 20% of the total housing (e.g., the Netherlands, Austria). Again providing more, rather than cutting, public housing could stem the tide of homelessness in the United States. The “Habitat for Humanity” program is another example of how low- income housing can be expanded. This program taps interested volunteers in the community to develop low-income housing. It also involves the poor fami- lies in the construction and/or rehabilitation of their housing.

A Call to Action for Psychologists

While it may seem that psychologists have little to offer with regard to social action, it has been ar- gued that they have many skills in this regard (Toro & Warren, 1999). For example, psychologists often are familiar with the complex problems seen among many families that are homeless and adolescents who are homeless on their own; they know how to access human service systems; and they have expertise in operating and evaluating programs. Because they are typically respected citizens in their communities, psy- chologists may have some success applying such skills to improve the state of homelessness.

REFERENCES

Acosta, O., & Toro, P. A. (2000). Let’s ask the homeless people themselves: A needs assessment based on a probability sam- ple of adults. American Journal of Community Psychology, 28, 343–366.

Adams, C. T. (1986). Homelessness in the post-industrial city: Views from London and Philadelphia. Urban Affairs Quarterly, 21, 527–549.

Agnew, R., & Huguley, S. (1989). Adolescent violence toward par- ents. Journal of Marriage and the Family, 51, 699–711.

Ahmed, S., & Toro, P. A., (in press). Homeless African Americans. In S. M. Barrow, E. L. Bassuk, J., Baumohl, M. R. Burt, D. P. Culhane, & R. E. Drake (Eds.), Encyclopedia of homelessness. Great Barrington, MA: Berkshire Publishing/Sage.

Ahn, N. (1994). Teenage childbearing and high school completion: Accounting for individual heterogeneity. Family Planning Per- spectives, 26, 17–21.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Ang, R. P., & Hughes, J. N. (2002). Differential benefits of skills training with antisocial youth based on group composition: A meta-analytic investigation. School Psychology Review, 31, 164–185.

Ansell, D. (2001). Where are we going tomorrow: Independent liv- ing practice. In K. A. Nollan & A. C. Downs (Eds.), Preparing youth for long-term success: Proceedings from the Casey Fam- ily Program National Independent Living Forum (pp. 35–44). Washington, DC: Child Welfare League of America.

Argeriou, M., & McCarty, D. (Eds.). (1990). Treating alcoholism and drug abuse among homeless men and women: Nine com- munity demonstration grants. New York: Haworth Press.

Ashby, P. E., & Sachs-Ericsson, N. (2004). Racial and ethnic differ- ences in depression: The roles of social support and meeting basic needs. Journal of Consulting and Clinical Psychology, 72, 41–52.

Baker, S. G. (1994). Gender, ethnicity, and homelessness: Account- ing for demographic diversity on the streets. American Behav- ioral Scientist, 37(4), 476–504.

Banyard, V. L. (1995). “Taking another route”: Daily survival nar- ratives from mothers who are homeless. American Journal of Community Psychology, 23, 871–891.

Barwick, M. A., & Siegel, L. S. (1996). Learning difficulties in ado- lescent clients of a shelter for runaway and homeless street youths. Journal of Research on Adolescence, 6, 649–670.

Bassuk, E. L., Buckner, J. C., Weinreb, L. F., Browne, A. Bassuk, S. S., Dawson, R., et al. (1997). Homelessness in female- headed families: Childhood and adult risk and protective fac- tors. American Journal of Public Health, 87, 241–248.

Bassuk, E., & Gallagher, E. (1990). The impact of homelessness on children. Child and Youth Services, 14, 19–33.

Bassuk, E. L., Perloff, J. N., & Dawson, R. (2001). Multiply home- less families: The insidious impact of violence. Housing Policy Debate, 12, 299–320.

Bassuk, E., & Rosenberg, L. (1988). Why does family homeless- ness occur? A case-control study. American Journal of Public Health, 78, 783–787.

Bassuk, E., & Rubin, L. (1987). Homeless children: A neglected population. American Journal of Orthopsychiatry, 57, 279–286.

Bassuk, E., Rubin, L., & Lauriat, A. (1986). Characteristics of shel- tered homeless families. American Journal of Public Health, 76, 1097–1101.

Bassuk, E. L., Weinreb, L. F., Buckner, J. C., Browne, A., Salomon, A., & Bassuk, S. S. (1996). The characteristics and needs of sheltered homeless and low-income housed mothers. JAMA, 276, 640–646.

Baumohl, J. (Ed.). (1996). Homelessness in America. Phoenix: Oryx Press.

Becker, G. S., & Thomes, N. (1986). Human capital and the rise and fall of families. Journal of Labor Economics, 4, S1–S139.

Bellavia, C., & Toro, P. A. (1999). Mental illness among homeless and poor people: A comparison of assessment methods. Com- munity Mental Health Journal, 35, 57–67.

Benedict, M. I., Zuravin, S., Brandt, D., & Abbey, H. (1994). Types and frequency of child maltreatment by family foster care providers in an urban population. Child Abuse and Neglect, 18, 577–585.

Blasi, G. L. (1990). Social policy and social science research on homelessness. Journal of Social Issues, 46, 207–219.

Boesky, L. M., Toro, P. A., & Bukowski, P. A. (1997). Differences in psychosocial factors among older and younger homeless adolescents found in youth shelters. Journal of Prevention and Intervention in the Community, 15(2), 19–36.

Boesky, L. M., Toro, P. A., & Wright, K. L. (1995, November). Mal- treatment in a probability sample of homeless adolescents: A subgroup comparison. Paper presented in the annual meeting of American Public Health Association, San Diego, CA.

P1: KEE

Clinical Child and Family Psychology Review (CCFP) pp1347-ccfp-494639 October 13, 2004 19:30 Style file version Nov. 07, 2000

158 Haber and Toro

Boyd, C. J., Toro, P. A., & McCaskill, P. A. (2004). Behavioral and cognitive functioning among homeless and housed poor children: A comparative study. Unpublished manuscript un- der editorial review, Department of Psychology, Wayne State University, Detroit, MI.

Brodkin, E. Z. (2003). Requiem for welfare. Dissent, 50, 29–38. Bronfenbrenner, U. (1979). The ecology of human development:

Experiments by nature and design. Cambridge, MA: Harvard University Press.

Browne, A., Salomon, A., & Bassuk, S. S. (1999). The impact of recent partner violence on poor women’s capacity to maintain work. Violence Against Women, 5, 393–426.

Buck, P. O., Toro, P. A., & Ramos, M. (2004). Media and profes- sional interest in homelessness over three decades (1974–2003). Unpublished manuscript under editorial review, Wayne State University, Detroit, MI.

Buckner, J., Bassuk, E., Weinreb, L., & Brooks, M. (1999). Home- lessness and its relation to the mental health and behavior of low-income school-age children. Developmental Psychology, 35, 246–257.

Buckner, J. C., Bassuk, E. L., & Weinreb, L. F. (2001). Pre- dictors of academic achievement among homeless and low- income housed children. Journal of School Psychology, 39, 45– 69.

Buehler, R. E., Patterson, G. R., & Furniss, J. M. (1966). The re- inforcement of behavior in institutional settings. Behavior Re- search and Therapy, 4, 157–167.

Burnam, A., & Koegel, P. (1988). Methodology for obtaining a representative sample of homeless persons: The Los Angeles Skid Row Study. Evaluation Review, 12, 117–152.

Burrows, R., Pleace, N., & Quiliagars, D. (1998). Homelessness and social policy. London: Routledge.

Burt, M., Aron, L. Y., Lee, E., & Valente, J. (2001). Helping America’s homeless: Emergency shelter or affordable housing? Washington, DC: Urban Institute Press.

Cain, A. (1993). Homeless families. In C. Fawcett (Ed.), Family psychiatric nursing (pp. 195–212). St. Louis, MO: C.V. Mosby.

Cauce, A. M., Morgan, C. J., Wagner, V., Moore, E., Sy, J., Wurzbacher, K., et al. (1994). Effectiveness of intensive case management for homeless adolescents: Results of a 3-month follow-up. Journal of Emotional and Behavioral Disorders, 2, 219–227.

Cauce, A. M., Paradise, M., Embry, L., Morgan, C., Theofelis, J., Heger, J., et al. (1998). Homeless youth in Seattle: Youth char- acteristics, mental health needs, and intensive case manage- ment. In M. Epstein, K. Kutash, & A. Duchnowski (Eds.), Outcomes for children and youth with emotional and behav- ioral disorders and their families: Programs and evaluation best practices (pp. 611–632). Austin, TX: PRO-ED.

Cauce, A. M., Paradise, M., Ginzler, J. A., Embry, L., Morgan, C. J., Lohr, Y., et al. (2000). The characteristics and mental health of homeless adolescents: Age and gender differences. Journal of Emotional and Behavioral Disorders, 8(4), 230– 239.

Chen, C., Dormitzer, C. M., Gutiérrez, U., Vittetoe, K., González, G. B., & Anthony, J. C. (2004). The adolescent behavioral repertoire as a context for drug exposure: Behavioral autarce- sis at play. Addiction, 99, 897–906.

Cicchetti, D., & Rogosch, F. A. (2002). A developmental psy- chopathology perspective on adolescence. Journal of Consult- ing and Clinical Psychology, 70, 6–20.

Clark, R., & Robertson, M. J. (1996). Surviving for the moment: A report on homeless youth in San Francisco. Berkeley, CA: Alcohol Research Group.

Claussen, A. H., & Crittenden, P. M. (1991). Physical and psycho- logical maltreatment: Relations among types of maltreatment. Child Abuse and Neglect, 15(1/2), 5–18.

Clinton, A. M., Toro, P. A., & Williams, E. L. (1998, August). Comparison of social characteristics of homeless and housed

mothers. Paper presented in the 106th Annual Convention of American Psychological Association, San Francisco.

Cohen, E. L., & Toro, P. A. (1999, August). Ethnic differences among homeless mothers. Paper presented in the 107th Annual Con- vention of American Psychological Association, Boston.

Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357.

Collins, W. A., Maccoby, E. E., Steinberg, L., Hetherington, E. M., & Bornstein, M. H. (2000). Contemporary research on parent- ing: The case for nature and nurture. American Psychologist, 55(2), 218–232.

Committee on Child Psychiatry. (1999). In the long run: Longitu- dinal studies of psychopathology in children. Washington, DC: American Psychiatric Association.

Conger, R. D., & Elder, G. H. (1994).Families in troubled times: Adapting to change in rural America. New York: Aldine de Gruyter.

Costello, E. J., Compton, S. N., Keeler, G., & Angold, A. (2003). Re- lationships between poverty and psychopathology: A natural experiment. JAMA, 290, 2023–2029.

Costello, E. J., Keeler, G. P., & Angold, A. (2001). Poverty, race/ethnicity, and psychiatric disorder: A study of rural chil- dren. American Journal of Public Health, 91, 1494–1498.

Courtney, M. E., Piliavin, I., Grogan-Kaylor, A., & Nesmith, A. (2001). Foster youth transitions to adulthood: A longitudinal view of youth leaving care. Child Welfare, 80(6), 685–717.

Cowal, K., Shinn, M., Weitzman, B. C., Stojanovic, D., & Labay, L. (2002). Mother–child separations among homeless and housed families receiving public assistance in New York City. American Journal of Community Psychology, 30, 711–730.

Culhane, D. P., & Lee, C. M. (1997). Where homeless families come from: Toward a prevention-oriented approach in Washington, D.C. Washington, DC: Fannie Mae Foundation.

Culhane, D. P., Lee, C. M., & Wachter, S. M. (1996). Where homeless people come from: A study of the prior address distribution of families admitted to public shelters in New York City and Philadelphia. Housing Policy Debate, 7, 327–365.

Dail, P. W. (1990). The psychosocial context of homeless mothers with young children: Program and policy implications. Child Welfare, 69(4), 291–308.

Daly, G. (1990). Programs dealing with homelessness in the United States, Canada, and Britain. In J. Momeni (Ed.), Homelessness in the United States: Data and issues (pp. 133–152). New York: Praeger.

Daly, M. (1999). Regimes of social policy in Europe and the pat- terning of homelessness. In D. Avromov (Ed.), Coping with homelessnesss: Issues to be tackled and best practices in Eu- rope, (pp. 210–235). Aldershot, UK: Ashgate.

Dalton, J. H., Elias, M. J., Wandersman, A. (2001). Community psychology: Linking individuals and communities. Belmont, CA: Wadsworth/Thomson Learning.

Davis, M. I. (2003). Sex differences in alcoholics and addicts re- covering in Oxford House: Exploring characteristics, social support, and self-efficacy. Dissertation Abstracts International, 63(12), 6089B.

D’Ercole, A., & Struening, E. (1990). Victimization among home- less women: Implications for service delivery. Journal of Com- munity Psychology, 18, 141–152.

Dishion, T. J., McCord, T. J., & Poulin, J. (1999). When interventions harm: Peer groups and problem behavior. American Psychol- ogist, 54, 755–764.

Dishion, T. J., Patterson, G. R., & Griesler, P. C. (1994). Peer adapta- tions in the development of antisocial behavior: A confluence model. In L. R. Huesmann (Ed.), Aggressive behavior: Current perspectives (pp. 61–95). New York: Plenum.

Dishion, T. J., Patterson, G. R., Stoolmiller, M., & Skinner, M. L. (1991). Family, school, and behavioral antecedents to early adolescent involvement with antisocial peers. Developmental Psychology, 27, 172–180.

P1: KEE

Clinical Child and Family Psychology Review (CCFP) pp1347-ccfp-494639 October 13, 2004 19:30 Style file version Nov. 07, 2000

Homelessness Among Families and Adolescents 159

Dolbeare, C. N. (1996). Housing policy: A general consideration. In J. Baumohl (Ed.), Homelessness in America (pp. 34–45). Phoenix: Oryx Press.

Duncan, G., & Brooks-Gunn, J. (Eds.). (1997). Consequences of growing up poor. New York: Russell Sage Foundation.

Duncan, G., & Brooks-Gunn, J. (1999). Family poverty, welfare reform, and child development. Child Development, 71, 188– 196.

Dvorchak, P. A., Grams, G., Tate, L., & Jason, L. A. (1995). Preg- nant and postpartum women in recovery: Barriers to treatment and the role of Oxford House in the continuation of care. Al- coholism Treatment Quarterly, 13(3), 97–107.

Easterbrooks, A. M., & Graham, C. A. (1999). Security of attach- ment and parenting: Homeless and low-income housed moth- ers and infants. American Journal of Orthopsychiatry, 69(3), 337–346.

Eaton, W. W., & Kessler, L. G. (1985). Epidemiologic field meth- ods in psychiatry: The NIMH Epidemiologic Catchment Area Program. Orlando, FL: Academic Press.

Embry, L. E., Vander-Stoep, A., Evens, C., Ryan, K. D., & Pollack, A. (2000). Risk factors for homelessness in adoles- cents released from psychiatric residential treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 39(10), 1293–1299.

Feitel, B., Margetson, N., Chamas, R., & Lipman, C. (1992). Psy- chosocial background and behavioral and emotional disorders of homeless and runaway youth. Hospital and Community Psy- chiatry, 43, 155–159.

Ferrari, J. R., Jason, L. A., Nelson, R., & Curtin-Davis, M. (1999). An exploratory analysis of women and men within a self-help, communal-living recovery setting: A new beginning in a new house. American Journal of Drug and Alcohol Abuse, 25, 305– 317.

Ferrari, J. R., Jason, L. A., Olson, B. D., Davis, M., & Alvarez, J. (2002). Sense of community among Oxford House residents recovering from substance abuse: Making a house a home. In A. T. Fisher & C. C. Sonn (Eds.), Psychological sense of community: Research, applications, and implications (pp. 109– 122), New York: Plenum.

Finkelhor, D., & Dziuba-Leatherman, J. (1994). Victimization of children. American Psychologist, 49, 173–183.

First, R. J., Rife, J. C., & Toomey, B. G. (1994). Homelessness in rural areas: Causes, patterns, and trends. Social Work, 39, 97–104.

Fischer, R. L. (1997). Evaluating the delivery of a teen pregnancy and parenting program across two settings. Research on Social Work Practice, 7, 350–369.

Fitzgerald, H. E., & Zucker, R. A. (1995). Socioeconomic status and alcoholism: The contextual structure of developmental pathways to addiction. In H. E. Fitzgerald & B. M. Lester (Eds.), Children of poverty: Research, health, and policy issues (pp. 125–148). New York: Garland.

Fitzpatrick, S. (2000). Young homeless people. Basingstoke, UK: MacMillan Press.

Fowler, P. J., Toro, P. A., & Hobden, K. (2004). Long-term effects of parents and families on the psychological well-being of adoles- cents exposed to community violence. Poster session presented at the annual meeting of the Midwest Psychological Associa- tion, Chicago.

Freeman, E. M. (1993). Developing alternative family structures for runaway, drug-addicted adolescents. In E. M. Freeman (Ed.), Substance abuse treatment: A family systems perspective (pp. 48–70). Thousand Oaks, CA: Sage.

Fronczak, E., & Toro, P. A. (2003). Posttraumatic stress disorder in homeless and other high-risk urban adolescents. Unpublished manuscript under editorial review, Department of Psychology, Wayne State University, Detroit, MI.

Garcia Coll, C., Buckner, J., Brooks, M., Weinreb, L., & Bassuk, E. (1998). The developmental status and adap- tive behavior of homeless and low-income housed infants

and toddlers. American Journal of Public Health, 88, 1371– 1374.

Goodman, L. (1991). The relationship between social support and family homelessness: A comparison study of housed and homeless mothers. Journal of Community Psychology, 19, 321– 332.

Goodman, L., Saxe, L., & Harvey, M. (1991). Homelessness as psy- chological trauma: Broadening perspectives. American Psy- chologist, 46, 1219–1225.

Greenblatt, M., & Robertson, M. J. (1993). Homeless adolescents: Lifestyle, survival strategies and sexual behaviors. Hospital and Community Psychiatry, 44, 1177–1180.

Greene, J. M., & Ringwalt, C. L. (1998). Pregnancy among three national samples of runaway and homeless youth. Journal of Adolescent Health, 23, 370–377.

Haber, M., & Toro, P. A. (2003). Parent–adolescent violence as a predictor of adolescent outcomes. Poster session presented at the Biennial Conference on Community Research and Action, Las Vegas, NM.

Hausman, B., & Hammen, C. (1993). Parenting in homeless fam- ilies: The double crisis. American Journal of Orthopsychiatry, 63, 358–369.

Heinlein, L. M., & Shinn, M. (2000). School mobility and student achievement in an urban setting. Psychology in the Schools, 37, 349–357.

Heinze, H., Toro, P. A., & Urberg, K. A. (2004). Delinquent behaviors and affiliation with male and female peers. Jour- nal of Clinical Child and Adolescent Psychology, 33, 336– 346.

Hendrickson, J., & Omer, D. (1995). School-based comprehen- sive services: An example of interagency collaboration. In P. Adams & K. Nelson (Eds.), Reinventing human services: Community and family centered practice. Modern applica- tions of social work (pp. 145–162). Hawthorne, NY: Aldine de Gruyter.

Henly, J. R. (1993). The significance of social context: The case of adolescent childbearing in the African American community. Journal of Black Psychology, 19, 461–477.

Hirschi, T. (1969). Causes of delinquency. Berkeley: University of California Press.

Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44, 513–524.

Hobfoll, S. E. (2002). Social and psychological resources and adap- tation. Review of General Psychology, 6(4), 307–324.

Hoge, J., & Idalski, A. (2001). How Boysville of Michigan speci- fies and evaluates its supervised independent living program. In K. A. Nollan & A. C. Downs (Eds.), Preparing youth for long-term success: Proceedings from the Casey Family Program National Independent Living Forum (pp. 83–93). Washington, D.C.: Child Welfare League of America.

Homan, S. M., Flick, L. H., Heaton, T. M., & Mayer, M. (1993). Reaching beyond crisis management: Design and implemen- tation of extended shelter based services for chemically depen- dent homeless women and their children: St. Louis. Alcoholism Treatment Quarterly, 10, 101–112.

Israel, N., & Toro, P. A. (2003, June). Perceptions of homeless clients and key informants on service needs and accessibility. Paper presented in the Biennial Conference on Community Research and Action, Las Vegas, NM.

Jackson, A. P. (2003). The effects of family and neighborhood char- acteristics on the behavioral and cognitive development of poor black children: A longitudinal study. American Journal of Community Psychology, 32, 175–186.

Jacobs, F., Little, P., & Almeida, C. (1993). Supporting family life: A survey of homeless shelters. Journal of Social Distress and the Homeless, 2, 269–288.

James, W., Smith, A., & Mann, R. (1991). Educating homeless chil- dren: Interprofessional case management. Childhood Educa- tion, 67(5), 305–308.

P1: KEE

Clinical Child and Family Psychology Review (CCFP) pp1347-ccfp-494639 October 13, 2004 19:30 Style file version Nov. 07, 2000

160 Haber and Toro

Jason, L. A., Davis, M. I., Ferrari, J. R., & Bishop, P. D. (2001). Oxford House: A review of research and implications for substance abuse recovery and community research. Journal of Drug Education, 31, 1–28.

Jason, L. A., Ferrari, J. R., Groessl, E. J., & Dvorchak, P. A. (1997). The characteristics of alcoholics in self-help residential treat- ment settings: A multi-site study of Oxford House. Alcoholism Treatment Quarterly, 15(1), 53–63.

Jencks, C. (1994). The homeless. Cambridge, MA: Harvard University Press.

Johanson, C., Duffy, F. F., & Anthony, J. C. (1996). Associations between drug use and behavioral repertoire in urban youths. Addiction, 91, 523–534.

Kelly, J. G. (1986). Context and process: An ecological view of the interdependence of practice and research. American Journal of Community Psychology, 14, 581–589.

Killion, C. M. (2000). Extending the extended family for home- less and marginally housed African American women. Public Health Nursing, 17, 346–354.

Kipke, M. D., Montgomery, S., & MacKenzie, R. G. (1993). Sub- stance use among youth seen at a community-based health clinic. Journal of Adolescent Health, 14(4), 289–294.

Kipke, M. D., O’Connor, S., Palmer, R., & MacKenzie, R. G. (1995). Street youth in Los Angeles: Profile of a group at high risk for human immunodeficiency virus infection. Archives of Pe- diatrics and Adolescent Medicine, 149(5), 513–519.

Knitzer, J., Yoshikawa, H., Cauthen, N. K., & Aber, L. J. (2000). Welfare reform, family support, and child development: Perspectives from policy analysis and developmental psy- chopathology. Development and Psychopathology, 12, 619– 632.

Koblinsky, S. A., Morgan, K. M., & Anderson E. A., (1997). African-American homeless and low-income housed mothers: Comparison of parenting practices. American Journal of Or- thopsychiatry, 67(1), 37–47.

Koegel, P., Melamid, E., & Burnam, A. (1995). Childhood risk factors for homelessness among homeless adults. American Journal of Public Health, 85, 1642–1649.

Laurin, I., Fournier, L., Toupin, J., & Ostoj, M. (1996). Home- less and housed men: A study of risk factors. Paper presented at the 104th Annual Convention of American Psychological Association, Toronto, Canada.

LaVesser, P. D., Smith, E. M., & Bradford, S. (1997). Characteris- tics of homeless women with dependent children: A controlled study. Journal of Prevention and Intervention in the Commu- nity, 15(2), 37–52.

Lawrence, M. (1995). Rural homelessness: A geography without a geography. Journal of Rural Studies, 11, 297–307.

Leventhal, T., & Brooks-Gunn, J. (2000). The neighborhoods they live in: The effects of neighborhood residence on child and adolescent outcomes. Psychological Bulletin, 126, 309–337.

Levine, I. S., & Rog, D. J. (1990). Mental health services for home- less mentally ill persons: Federal initiatives and current service trends. American Psychologist, 45, 963–968.

Levine, M., & Perkins, D. V. (1997). Principles of community psy- chology: Perspectives and applications (2nd ed.). New York: Oxford University Press.

Lindblom, E. N. (1996). Preventing homelessness. In J. Baumohl (Ed.), Homelessness in America (pp. 187–200). Phoenix: Oryx Press.

Lindsey, E. W. (1998). Service providers’ perception of factors that help or hinder homeless families. Families in Society, 79, 160– 172.

Link, B. G., Susser, E., Stueve, A., Phelan, J., Moore, R. E., & Struening, E. (1994). Lifetime and five-year prevalence of homelessness in the United States. American Journal of Public Health, 84, 1907–1912.

Lombardo, S., & Toro, P. A. (2004). Risky sexual behaviors and substance abuse among homeless and other at-risk adolescents.

Unpublished manuscript under editorial review, Department of Psychology, Wayne State University, Detroit, MI.

Lupien, S. J., King, S., Meaney, M. J., & McEwen, B. S. (2001). Can poverty get under your skin? Basal cortisol levels and cognitive function in children from low and high socioeconomic status. Development and Psychopathology, 13, 653–676.

MacLean, M. G., Embry, L. E., & Cauce, A. M. (1999). Homeless adolescents’ paths to separation from family: Comparison of family characteristics, psychological adjustment, and victim- ization. Journal of Community Psychology, 27(2), 179–187.

MacLean, M. G., Paradise, M. J., & Cauce, A. M. (1999). Substance use and psychological adjustment in homeless adolescents: A test of three models. American Journal of Community Psychol- ogy, 27(3), 405–427.

Marpsat, M., & Firdion, J. (Eds.). (2000). La rue et le foyer. Une recherche sur les sans-domicile et les mal-logés dans les années 90 [The street and the home: A study on the homeless and poorly housed during the 1990s] (Works and Documents, No. 144). Paris: National Institute for Demographic Studies.

Marshal, M. P., & Chassin, L. (2000). Peer influence on adolescent alcohol use: The moderating role of parental support and dis- cipline. Applied Developmental Science, 4(2), 80–88.

Mason, C. A., Cauce, A. M., Gonzales, N., & Hiraga, Y. (1994). Ado- lescent problem behavior: The effect of peers and the moder- ating role of father absence and the mother–child relationship. American Journal of Community Psychology, 22, 723–743.

Masten, A. (1992). Homeless children in the United States: A mark of a nation at risk. Current Directions in Psychological Science, 2, 41–44.

Masten, A., Miliotis, D., Graham-Bermann, S., Ramirez, M., & Neeman, J. (1993). Children in homeless families: Risks to mental health and development. Journal of Consulting and Clinical Psychology, 61, 335–343.

Mayer, S. E. (1997). What money can’t buy: Family income and children’s life chances. Cambridge, MA: Harvard University Press.

McCarthy, B., & Hagan, J. (1992). Surviving the street: The expe- riences of homeless youth. Journal of Adolescent Research, 7, 412–430.

McCaskill, P. A., Toro, P. A., & Wolfe, S. M. (1998). Homeless and matched housed adolescents: A comparative study of psy- chopathology. Journal of Clinical Child Psychology, 27, 306– 319.

McLoyd, V. C. (1990). The impact of economic hardship on Black families and children: Psychological distress, parenting, and so- cioemotional development. Child Development, 61, 311–346.

McMorris, B. J., Tyler, K. A., Whitbeck, L. B., & Hoyt, D. R. (2002). Familial and “on the street” risk factors associated with alco- hol use among homeless and runaway adolescents. Journal of Studies on Alcohol, 63(1), 34–43.

Menke, E. M., & Wagner, J. D. (1997). A comparative study of homeless, previously homeless, and never homeless school- aged children’s health. Issues in Comprehensive Pediatric Nurs- ing, 20(3), 153–173.

Metraux, S., & Culhane, D. P. (1999). Family dynamics, housing, and recurring homelessness among women in New York City homeless shelters. Journal of Family Issues, 20, 371–396.

Miller, H. (1991). On the fringe: The dispossessed in America. Lexington, MA: DC Heath.

Molnar, J. M., Rath, W. R., & Klein, T. P. (1990). Constantly com- promised: The impact of homelessness on children. Journal of Social Issues, 46(4), 109–124.

Molnar, B. E., Shade, S. B., Kral, A. H., Booth, R. E., & Watters, J. K. (1998). Suicidal behavior and sexual/physical abuse among street youth. Child Abuse and Neglect, 22(3), 213–222.

Morris, P., Bloom, D., Kemple, J., & Hendra, R. (2003). The effects of a time-limited welfare program on children: The moderat- ing role of parents’ risk of welfare dependency. Child Devel- opment, 74, 851–874.

P1: KEE

Clinical Child and Family Psychology Review (CCFP) pp1347-ccfp-494639 October 13, 2004 19:30 Style file version Nov. 07, 2000

Homelessness Among Families and Adolescents 161

Morse, G., Calsyn, R. J., Allen, G., Tempelhoff, B., & Smith, R. (1992). Experimental comparison of the effects of three treat- ment programs for homeless mentally ill people. Hospital and Community Psychiatry, 43, 1005–1010.

Mulroy, E. A., & Lane, T. S. (1992). Housing affordability, stress, and single mothers: Pathway to homelessness. Journal of Sociology and Social Welfare, 19(3), 51–64.

Mundy, P., Robertson, J., Greenblatt, M., & Robertson, M. (1989). Residential instability in adolescent inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 28(2), 176–181.

National Association for the Education of Homeless Children and Youth and the National Coalition for the Homeless. (1999). Making the grade: Successes and challenges in provid- ing educational opportunities to homeless children and youth. Washington, DC: Authors.

National Institute on Alcohol Abuse and Alcoholism. (1991). Syn- opses of cooperative agreements for research demonstration projects on alcohol and other drug abuse treatment for home- less persons. Rockville, MD: U.S. Department of Health and Human Services.

Ng, A. T., & McQuistion, H. L. (2004). Outreach to the homeless: Craft, science, and future implications. Journal of Psychiatric Practice, 10, 95–105.

Norris, F. H., & Kaniasty, K. (1996). Received and perceived social support in times of stress: A test of the social support dete- rioration deterrence model. Journal of Personality and Social Psychology, 71, 498–511.

North, C. S., & Smith, E. M. (1992). Posttraumatic stress disorder among homeless men and women. Hospital and Community Psychiatry, 43, 1010–1016.

North, C. S., & Smith, E. M. (1993). A comparison of homeless men and women: Different populations, different needs. Commu- nity Mental Health Journal, 29, 423–431.

O’Flaherty, B. (1996). Making room: The economics of homeless- ness. Cambridge, MA: Harvard University Press.

Olson, B. D., Curtis, C. E., Jason, L. A., Ferrari, J. R., Horin, E. V., Davis, M. A., et al. (2003). Physical and sexual trauma, psychiatric symptoms, and sense of community among women in recovery: Toward a new model of shelter aftercare. Jour- nal of Prevention and Intervention in the Community, 26, 67– 80.

O’Sullivan, A. L., & Jacobsen, B. S. (1992). A randomized trial of a health care program for first time adolescent mothers and their infants. Nursing Research, 41, 210–215.

Ouellette, N., & Toro, P. A. (2002, May). Detroit/Wayne County People and Transitions in Housing (PATH) Project: Needs as- sessment data collected over 10 years (1992–2002). Presented to the Needs Assessment Committee of the Homeless Action Network of Detroit, Detroit, MI.

Ovwigho, P. C., Leavitt, K. L., & Born, C. E. (2003). Risk factors for child abuse and neglect among former TANF families: Do later leavers experience greater risk? Children and Youth Services Review, 25, 139–163.

Owen, G., Heineman, J., Minton, C., Lloyd, B., Larsen, P., & Zierman, C. (1998). Minnesota Statewide Survey of Persons Without Permanent Shelter: Volume II, Unaccompanied Youth. St. Paul, MN: Wilder Foundation.

Paradise, M., Cauce, A. M., Ginzler, J., Wert, S., Wruck, K., & Brooker, M. (2001). The role of relationships in developmen- tal trajectories of homeless and runaway youth. In B. Sarason & S. Duck (Eds.), Personal relationships: Implications for clini- cal and community psychology (pp. 159–179). Chichester, UK: Wiley.

Patterson, G. R. (1982). Coercive family process. Eugene, OR: Castalia.

Perloff, J. N., & Buckner, J. C. (1996). Fathers of children on wel- fare: Their impact on child well-being. American Journal of Orthopsychiatry, 66, 557–571.

Phillips, K. (1990). The politics of rich and poor: Wealth and the American electorate in the Reagan aftermath. New York: Random House.

Piliavin, I., Sosin, M., & Westerfelt, A. H. (1988). The duration of homeless careers: An exploratory study. Social Service Review, 67, 576–598.

Powers, J. L., Eckenrode, J., & Jaklitsch, B. (1990). Maltreatment among runaway and homeless youth. Child Abuse and Neglect, 14(1), 87–98.

Rabideau, J. M. P., & Toro, P. A. (1997). Social and environmen- tal predictors of adjustment in homeless children. Journal of Prevention and Intervention in the Community, 15(2), 1–17.

Rafferty, Y., & Shinn, M. (1991). The impact of homelessness on children. American Psychologist, 46, 1170–1179.

Rafferty, Y., Shinn, M., & Weitzman, B. C. (2004). Academic achievement among formerly homeless adolescents and their continuously housed peers. Journal of School Psychology, 42, 179–199.

Randolph, E. L., Blasinsky, M., Leginski, W., Parker, L. B., & Goldman, H. H. (1997). Creating integrated service systems for homeless persons with mental illness: The ACCESS pro- gram: Access to community care and effective services and supports. Psychiatric Services, 48, 369–373.

Reed, N. Y. (1994, August). Family constellation and outcomes among homeless adolescents and their peers. Paper presented in the 102nd Annual Convention of American Psychological Association, Los Angeles.

Regier, D. A., Boyd, J. H., Burke, J. D., Jr., Rae, D. S., Myers, J. K., Krammer, M., et al. (1988). One-month prevalence of mental disorders in the United States: Based on five epidemiologic catchment area sites. Archives of General Psychiatry, 45, 977– 986.

Rew, L., Thomas, N., Horner, S. D., Resnick, M. D., & Beuhring, T. (2001). Correlates of recent suicide attempts in a triethnic group of adolescents. Journal of Nursing Scholarship, 33(4), 361–367.

Rickel, A. U., & Becker, E. (1997). Keeping children from harm’s way: How national policy affects psychological development. Washington, DC: American Psychological Association.

Ringwalt, C. L., Greene, J. M., & Iachan, R. (1994, November). Prevalence and characteristics of youth in households with run- away and homeless experience. Paper presented in the meeting of the American Public Health Association, Washington, DC.

Ringwalt, C. L., Greene, J. M., Robertson, M., & McPheeters, M. (1998). The prevalence of homelessness among adolescents in the United States. American Journal of Public Health, 88(9), 1325–1329.

Robertson, M. J. (1989). Homeless youth in Hollywood: Patterns of alcohol use. Report to the National Institute on Alcohol Abuse and Alcoholism (No. C51). Berkeley, CA: Alcohol Research Group.

Robertson, M. J. (1991). Homeless youth: An overview of recent literature. In J. H. Kryder-Coe, L. M. Salamon, & J. M. Molnar (Eds.), Homeless children and youth: A new American dilemma (pp. 33–68). London: Transaction.

Robertson, M. J. (1992). The prevalence of mental disorder among homeless people. In R. I. Jahiel (Ed.), Homelessness: A pre- vention oriented approach (pp. 57–86). Baltimore: The Johns Hopkins University Press.

Robertson, M. J., & Toro, P. A. (1999). Homeless youth: Research, intervention, and policy. In L. B. Fosburg & D. L. Dennis (Eds.), Practical lessons: The 1998 National Symposium on Homelessness Research (pp. 3-1:3-32). Washington, DC: U.S. Department of Housing and Urban Development and U.S. Department of Health and Human Services.

Robins, L. N., Helzer, J. E., Croughan, J., & Ratcliff, K. S. (1981). National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Archives of General Psychiatry, 38, 381–389.

P1: KEE

Clinical Child and Family Psychology Review (CCFP) pp1347-ccfp-494639 October 13, 2004 19:30 Style file version Nov. 07, 2000

162 Haber and Toro

Rog, D. J., Holupka, C. S., & McCombs-Thorton, K. L. (1995). Implementation of the homeless families program: 1. Ser- vice models and preliminary outcomes. American Journal of Orthopsychiatry, 65, 502–513.

Roll, C. N., Toro, P. A., & Ortola, G. L. (1999). Characteristics and experiences of homeless adults: A comparison of single men, single women, and women with children. Journal of Commu- nity Psychology, 27, 189–198.

Rosenthal, J. A., Motz, J. K., Edmonson, D. A., & Groze, V. (1991). A descriptive study of abuse and neglect in out-of-home place- ment. Child Abuse and Neglect, 15, 249–260

Rossi, P. H. (1989). Down and out in America: The origins of home- lessness. Chicago: University of Chicago Press.

Rotheram-Borus, M. J. (1991). Homeless youths and HIV infection. American Psychologist, 46, 1188–1197.

Rotheram-Borus, M. J. (1993). Suicidal behavior and risk fac- tors among runaway youths. American Journal of Psychiatry, 150(1), 103–107.

Rotheram-Borus, M. J., Mahler, K. A., Koopman, C., & Langabeer, K. (1996). Sexual abuse history and associated multiple risk be- havior in adolescent runaways. American Journal of Orthopsy- chiatry, 66(3), 390–400.

Rotheram-Borus, M. J., Meyer-Bahlberg, H. F. L., Koopman, C., Rosario, M., Exner, T. M., Henderson, R., et al. (1992). Life- time sexual behaviors among runaway males and females. Jour- nal of Sex Research, 29, 15–29.

Rothman, J., & David, T. (1985). Status offenders in Los Angeles County: Focus on runaway and homeless youth (Bush Pro- gram in Child and Family Policy). Los Angeles: University of California.

Sacks, J. Y., Sacks, S., Harle, M., & DeLeon, G. (1999). Home- lessness prevention therapeutic community (TC) for addicted mothers. Alcoholism Treatment Quarterly, 17(1/2), 33–51.

Salomon, A., Bassuk, S. S., & Brooks, M. G. (1996). Patterns of wel- fare use among poor and homeless women. American Journal of Orthopsychiatry, 66, 510–525.

Sameroff, A. J., Lewis, M., & Miller, S. M. (Eds.). (2000). Handbook of developmental psychopathology (2nd ed.). Dordrecht, the Netherlands: Kluwer Academic.

Sampson, R. J., & Laub, J. H. (1993). Crime in the making: Pathways and turning points through life. Cambridge, MA: U.S. Harvard University Press.

Scarr, S., & Deater-Deckard, K. (1997). Family effects on indi- vidual differences in development. In S. S. Luthar & J. A. Burack (Eds.), Developmental psychopathology: Perspectives on adjustment, risk, and disorder (pp. 115–136). New York: Cambridge University Press.

Schweinhart, L. J., & Weikart, D. P. (1988). The High/Scope Perry Preschool Program. In R. M. Price, E. L. Cowen, R. P. Lorion, & J. Ramos-McKay (Eds.), Fourteen ounces of prevention: A casebook for practitioners (pp. 53–65). Washington, DC: Amer- ican Psychological Association.

Shinn, M. (1992). Homelessness: What is a psychologist to do? American Journal of Community Psychology, 20, 1–24.

Shinn, M. (1997). Family homelessness: State or trait? American Journal of Community Psychology, 25, 755–769.

Shinn, M., & Baumohl, J. (1999). Rethinking the prevention of homelessness. In L. B. Fosburg & D. L. Dennis (Eds.), Prac- tical lessons: The 1998 national symposium on homelessness research (pp. 13:1–13:26). Washington, DC: U.S. Department of Housing and Urban Development and US Department of Health and Human Services.

Shinn, M., & Gillespie, C. (1994). The roles of housing and poverty in the origins of homelessness. The American Behavioral Sci- entist, 37, 505–521.

Shinn, M., Knickman, J. R., Ward, D., Petrovic, N. L., & Muth, B. J. (1990). Alternative models for sheltering homeless families. Journal of Social Issues, 46(4), 175–190.

Shinn, M., Knickman, J., & Weitzman, B. C. (1991). Social rela- tionships and vulnerability to becoming homeless among poor families. American Psychologist, 46, 1180–1187.

Shinn, M., & Weitzman, B. C. (1990). Research on homelessness: An introduction. Journal of Social Issues, 46, 1–11.

Shinn, M., & Weitzman, B. C. (1996). Homeless families are differ- ent. In J. Baumohl (Ed.), Homelessness in America (pp. 109– 122). Phoenix: Oryx Press.

Shinn, M., Weitzman, B. C., Stojanovic, D., Knickman, J. R., Jimenez, L., Duchon, L., et al. (1998). Predictors of homeless- ness among families in New York City: From shelter request to housing stability. American Journal of Public Health, 88, 1651–1657.

Simons, R. L., Johnson, C., Beaman, J., Conger, R. D., & Whitbeck, L. B. (1996). Parents and peer group as mediators of the effect of community structure on adolescent problem behav- ior. American Journal of Community Psychology, 24, 145– 171.

Smith, E. M., & North, C. S. (1994). Not all homeless women are alike: Effects of motherhood and the presence of children. Community Mental Health Journal, 30, 601–610.

Stojanovic, D., Weitzman, B. C., Shinn, M., Labay, L. E., & Williams, N. P. (1999). Tracing the paths out of homelessness: The hous- ing patterns of families after exiting shelter. Journal of Com- munity Psychology, 27, 199–208.

Susser, E. S., Lin, S. P., Conover, S. A., & Struening, E. L. (1991). Childhood antecedents of homelessness in psychiatric patients. American Journal of Psychiatry, 148, 1026–1030. American Journal of Public Health, 84, 1907–1912.

Thrane, L. E., & Yoder, K. A. (2000). Comparing rural and ur- ban runaway and homeless adolescents: Age at first run, de- viant subsistence strategies, and street victimization. Poster ses- sion presented at the Society for Research on Adolescence, Chicago.

Thrasher, S. P., & Mowbray, C. (1995). A strengths perspective: An ethnographic study of homeless women with children. Health and Social Work, 20(2), 93–101.

Tompsett, C. J., Heinze, H., Josefowicz-Simbeni, D., & Toro, P. A. (2004, September). Best practices in services for homeless youth and families. Presentation at the Fifth European Congress on Community Psychology, Berlin.

Tompsett, C. J., Toro, P. A., & Goldstein, M. S. (2003). A compar- ison of homeless adolescents, young adults, and older adults. Paper presented in the Biennial Conference on Community Research and Action, Las Vegas, NM.

Tompsett, C. J., Toro, P. A., Guzicki, M., Manrique, M., & Zatakia, J. (2004). Homelessness in the United States: As- sessing changes in prevalence and public opinion, 1993– 2001. Unpublished manuscript under editorial review, De- partment of Psychology, Wayne State University, Detroit, MI.

Tompsett, C. J., Toro, P. A., Guzicki, M., Schlienz, N., Blume, M., & Lombardo, S. (2003). Homelessness in the United States and Germany: A cross-national analysis. Journal of Community and Applied Social Psychology, 13, 240–257.

Toro, P. A. (1998). Homelessness. In A. S. Bellack & M. Hersen (Eds.), Comprehensive clinical psychology: Vol. 9. Appli- cations in diverse populations (pp. 119–135). New York: Pergamon.

Toro, P. A., Bellavia, C., Daeschler, C., Owens, B., Wall, D. D., Passero, J. M., et al. (1995). Distinguishing homelessness from poverty: A comparative study. Journal of Consulting and Clin- ical Psychology, 63, 280–289.

Toro, P. A., & Goldstein, M. S. (2000, August). Outcomes among homeless and matched housed adolescents: A longitudinal comparison. Paper presented in the 108th Annual Conven- tion of American Psychological Association, Washington, DC.

P1: KEE

Clinical Child and Family Psychology Review (CCFP) pp1347-ccfp-494639 October 13, 2004 19:30 Style file version Nov. 07, 2000

Homelessness Among Families and Adolescents 163

Toro, P. A., Goldstein, M. S., Rowland, L. L., Bellavia, C. W., Wolfe, S. M., Thomas, D. M., et al. (1999). Severe mental illness among homeless adults and its association with longitudinal outcomes. Behavior Therapy, 30, 431–452.

Toro, P. A., Janisse, H. C., & Fowler, P. J. (2004, February). Fos- ter care: A national problem. Institute for Social Policy and Understanding (Policy Brief No. 3). Clinton Twp., MI.

Toro, P. A., Lombardo, S., & Yapchai, C. J. (2002). Homelessness, childhood. In T. Gullotta & M. Bloom (Eds.), Encyclopedia of prevention and health promotion (pp. 561–570). New York: Kluwer/Plenum.

Toro, P. A., & McDonell, D. M. (1992). Beliefs, attitudes, and knowledge about homelessness: A survey of the general pub- lic. American Journal of Community Psychology, 20, 53– 80.

Toro, P. A., Rabideau, J. M. P., Bellavia, C. W., Daeschler, C. V., Wall, D. D., Thomas, D. M., et al. (1997). Evaluating an intervention for homeless persons: Results of a field experiment. Journal of Consulting and Clinical Psychology, 65, 476–484.

Toro, P. A., & Rojansky, A. (1990). Homelessness: Some thoughts from an international perspective. The Community Psycholo- gist, 24(1), 8–11.

Toro, P. A., Tompsett, C. J., Lombardo, S., Schlienz, N., Stammel, N., Blume, M., et al. (2004). Homelessness in Europe and North America: A comparison of prevalence and public opinion. Un- published manuscript under editorial review, Department of Psychology, Wayne State University, Detroit, MI.

Toro, P. A., Trickett, E. J., Wall, D. D., & Salem, D. A. (1991). Homelessness in the United States: An ecological perspective. American Psychologist, 46, 1208–1218.

Toro, P. A., & Warren, M. G. (1999). Homelessness in the United States: Policy considerations. Journal of Community Psychol- ogy, 27, 119–136.

Toro, P. A., Wolfe, S. M., Bellavia, C. W., Thomas, D. M., Rowland, L. L., Daeschler, C. V., et al. (1999). Obtaining representa- tive samples of homeless persons: A two-city study. Journal of Community Psychology, 27, 157–178.

Tsemberis, S. (1999). From streets to homes: An innovative ap- proach to supported housing for homeless adults with psychi- atric disabilities. Journal of Community Psychology, 27, 225– 242.

Tyler, K. A., Hoyt, D. R., & Whitbeck, L. B. (2000). The effects of early sexual abuse on later sexual victimization among female homeless and runaway adolescents. Journal of Interpersonal Violence, 15(3), 235–250.

Tyler, K. A., Hoyt, D. R., Whitbeck, L. B., & Cauce, A. M. (2001). The impact of childhood sexual abuse on later sexual victim- ization among runaway youth. Journal of Research on Adoles- cence, 11, 151–176.

Unger, J. B., Simon, T. R., Newman, T. L., Montgomery, S. B., Kipke, M. D., & Albornoz, M. (1998). Early adolescent street youth: An overlooked population with unique problems and service needs. Journal of Early Adolescence, 18, 325–348.

U.S. Conference of Mayors. (1989). A status report on hunger and homelessness in American cities, 1989: A 27 city survey. Washington, DC: Author.

U.S. Conference of Mayors. (1993). Ending homelessness in America’s cities: Implementing a plan of action. San Francisco: Homebase.

United States General Accounting Office. (1994). Elementary school children: Many change schools frequently, harming their education (GAO/HEHS-94-45). Gaithersberg, MD: Author.

Upshur, C. C. (1986). Research report: The Bridge, Inc., in- dependent living demonstration. In Amendments to the foster care and adoption assistance program. Hearing be- fore the subcommittee on public assistance and unemploy- ment compensation of the Committee on Ways and Means, House of Representatives, 99th Congress (September 19,

1985) (Serial 99-54). Washington, DC: Government Printing Office.

Van der Kolk, B. A. (1987). Psychological trauma. Washington, DC: American Psychiatric Press.

Vostanis, P., Grattan, E., Cumella, S., & Winchester, C. (1997). Psychosocial functioning of homeless children. Journal of the American Academy of Child and Adolescent Psychiatry, 36(7), 881–889.

Webb, D. A., Culhane, J., Metraux, S., Robbins, J. M., & Culhane, D. (2003). Prevalence of episodic homelessness among adult childbearing women in Philadelphia, PA. American Journal of Public Health, 93, 1895–1896.

Weinreb, L. F., & Bassuk, E. L. (1990). Substance abuse: A grow- ing problem among homeless families. Family and Community Health, 13, 55–64.

Weitzman, B., & Berry, C. (1994). Formerly homeless families and the transition to permanent housing: High-risk families and the role of intensive case management services (Final report to the Edna McConnell Clark Foundation). New York: New York University.

Weitzman, B. C., Knickman, J. R., & Shinn, M. (1992). Predictors of shelter use among low-income families: Psychiatric history, substance, abuse, and victimization. American Journal of Pub- lic Health, 82, 1547–1550.

Whitbeck, L. B., & Hoyt, D. R. (1999). Nowhere to grow: Homeless and runaway adolescents and their families. New York: Aldine de Gruyter.

Whitbeck, L. B., Hoyt, D. R., & Ackley, K. A. (1997). Abusive fam- ily backgrounds and victimization among runaway and home- less adolescents. Journal of Research on Adolescence, 7, 375– 392.

Whitbeck, L. B., Hoyt, D. R., Tyler, K. A., Ackley, K. A., & Fields, S. C. (1997). Midwest homeless and runaway adoles- cent project: Summary report to participating agencies. Un- published manuscript, Department of Sociology, Iowa State University.

Whitbeck, L. B., Hoyt, D. R., & Yoder, K. A. (1999). A risk- amplification model of victimization and depressive symptoms among runaway and homeless adolescents. American Journal of Community Psychology, 27(2), 273–296.

Whitbeck, L. B., Hoyt, D. R., Yoder, K. A., Cauce, A. M., & Par- adise, M. (2001). Deviant behavior and victimization among homeless and runaway adolescents. Journal of Interpersonal Violence, 16(11), 1175–1204.

Windle, M. (1989). Substance use and abuse among adolescent run- aways: A four-year follow-up study. Journal of Youth and Ado- lescence, 18, 331–344.

Wolfe, S. M., Toro, P. A., & McCaskill, P. A. (1999). A compari- son of homeless and matched housed adolescents on family environment variables. Journal of Research on Adolescence, 9, 53–66.

Wood, D., Valdez, R. B., & Hayashi, T. (1990). Homeless and housed families in Los Angeles: A study comparing demographic, eco- nomic, and family function characteristics. American Journal of Public Health, 80, 1049–1052.

Wright, J. D., & Lam, J. A. (1987). Homelessness and the low- income housing supply. Social Policy, 17(4), 49–53.

Yates, G. L., MacKenzie, R., Pennbridge, J., & Cohen, E. (1988). A risk profile comparison of runaway and non-runaway youth. American Journal of Public Health, 78, 820–821.

Yeung, W. J., Linver, M. R., & Brooks-Gunn, J. (2002). How money matters for young children’s development: Parental in- vestment and family processes. Child Development, 73, 1861– 1879.

Yoder, K. A., Whitbeck, L. B., & Hoyt, D. R. (2001). Event his- tory analysis of antecedents to running away from home and being on the street. American Behavioral Scientist, 45(1), 51– 65.

P1: KEE

Clinical Child and Family Psychology Review (CCFP) pp1347-ccfp-494639 October 13, 2004 19:30 Style file version Nov. 07, 2000

164 Haber and Toro

Young, R. L., Godfrey, W., Matthews, B., & Adams, G. R. (1983). Runaways: A review of negative consequences. Family Rela- tions, 32, 275–281.

Ziesemer, C., Marcoux, L., & Marwell, B. (1994). Homeless chil- dren: Are they different from other low-income children? So- cial Work, 39, 658–668.

Zlotnick, C., Kronstadt, D., & Klee, L. (1999). Essential case man- agement services for young children in foster care. Community Mental Health Journal, 35, 421–430.

Zlotnick, C., Robertson, M. J., & Lahiff, M. (1999). Getting off the streets: Economic resources and residential exits among home- less adults. Journal of Community Psychology, 27, 209–224.