Caring for the Health and Wellness of Children Experiencing Homelessness

Every year, 1.2 million children under 6 years old experience homelessness in the United States. Many of these children are in early childhood education programs. Explore this tip sheet to learn how homelessness impacts various areas of health and wellness. Discover ways to identify and assess the needs of families experiencing homelessness and connect them to medical and dental homes. Also, find resources and supports to connect families to health and wellness providers.

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When working with families experiencing homelessness, it is important to remember that children's health and housing security are closely intertwined. Children experiencing homelessness are more likely to experience chronic diseases, behavioral health concerns, developmental delays, hunger, and malnutrition than those who have homes.

Definition of Homelessness Based on McKinney-Vento

Homelessness refers to a state in which individuals lack a fixed, regular, and adequate nighttime residence, including children who are sharing housing of other persons owing to loss of housing, economic hardship, or similar reason (living in motels, hotels, trailer parks, or camping grounds owing to lack of alternative adequate accommodations; living in emergency or transitional shelters or abandoned in hospitals, cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations). Homelessness may apply to migrant children under certain circumstances. This document provides information about determining eligibility of McKinney-Vento rights and services.

NOTE: This is a definition used by federal, state, and local educational institutions (e.g., Head Start/Child Care, PART C and Part B).

For more information about McKinney-Vento as it relates to the Child Care Development Fund (CCDF) or Head Start, visit Supporting Children and Families Experiencing Homelessness.

Causes of Homelessness

Natural disasters (e.g., storms, hurricanes, mudslides, fires) have caused many families to experience homelessness. Domestic violence can also be a reason that families experience homelessness. According to the National Law Center on Homelessness & Poverty, for women, domestic violence is a leading cause of homelessness. The top causes of homelessness among families are lack of affordable housing, unemployment, poverty, and low wages.

Identifying and Assessing Need

1.2 million children under 6 years old in the United States experience homelessness every year. As an early care and education program provider, you may already be serving families with young children who are experiencing homelessness or who are at risk for homelessness. You play an important role in identifying, supporting, and connecting these families to resources that can help keep them healthy. There are many resources to help your program in this process.

Self-assessment tools such as this one developed by the Administration on Children and Families (ACF) can assist your program in identifying families who are at risk for homelessness, to help support them and connect them with the resources they may need.

A young girl eating at the tableEffects of Homelessness on Children's Health and Wellness

Children experiencing homelessness may be affected by a variety of health challenges because of difficulty accessing regular health care or not having a medical home, inadequate nutrition and access to food, education interruptions, trauma, and disruption in family dynamics. Children experiencing homelessness are sick at twice the rate of children who have homes. They also go hungry twice as often as children who have homes. Children experiencing homelessness have twice the rate of learning disabilities and three times the rate of emotional and behavioral problems of children who have homes.

Medical and Dental Homes

A medical home plays an important role in supporting children's mental wellness. Encourage families to share updates with a trusted provider in their medical home or help connect them to a medical home if they do not have one. A medical or dental home is not a building or a place. It is an approach to providing comprehensive and high-quality primary care that facilitates partnerships between patients, clinicians, medical or dental staff, and families. A medical or dental home extends beyond the four walls of a clinical practice. It includes specialty care, educational services, family support, and more. A key strategy to improving the health and wellness of families experiencing homelessness is to connect them to medical and dental homes. Early care and education programs can play an important role in connecting families experiencing homelessness to medical and dental homes that provide comprehensive and coordinated services that can help address their ongoing health concerns and special health care needs and provide stability and consistency in care that is often missing for these families.

Mental Health and Families Experiencing Homelessness

Recent studies on adverse childhood experiences have shown that multiple stressors that begin in childhood can have long-term adverse effects on a child's neurobiological make-up, cognitive ability, and mental health, as well as on their ability to manage stressors as an adult. Studies also show that these effects can lead to chronic physical health problems. Adults experiencing homelessness have higher levels of stress and depression than those who have homes, which can make parenting young children difficult. Therefore, it is very important to address mental wellness and identify mental health resources and services for families experiencing homelessness. Your program may have access to mental health consultants who can help you develop strategies to support resilience in families experiencing homelessness. Visit this link for more information on mental health consultants. To learn more about resilience in children and trauma informed care visit Understanding Stress and Resilience in Young Children.

Oral Health and Homelessness

Children experiencing homelessness are less likely to visit a dentist than children from families with low incomes who have homes. Families experiencing homelessness may find it difficult to carry belongings, including a toothbrush and toothpaste. They may have limited access to facilities where they can brush their teeth. Most children experiencing homelessness are eligible for oral health services paid for by Medicaid. However, outreach efforts are not adequate to reach many of these families. The key to supporting the oral health of families experiencing homelessness is to assist them with accessing services to help maintain healthy habits like toothbrushing with fluoride toothpaste and drinking water. Your program may also want to partner with local homeless shelters and health and wellness partners to provide services in-house to families. To learn more about how to support families who are homeless, visit Oral Health Resources for Families.

When working with children who are homeless it is important to keep in mind the following:

Regulations/Funding

  • Become familiar with regulations that provide flexibility or grace periods related to completing paperwork and meeting health requirement deadlines for families experiencing homelessness.

Social Services

  • Identify and connect with social service programs that can assist with obtaining stable housing or safe temporary housing and emergency funds for rent, utilities, and support services.

Cultural Perspectives

  • When working with families experiencing homelessness, use strengths-based approaches that include perspectives of different cultures.

Partnerships

  • Connect with community health and wellness partners to maintain and promote healthy environments for children (e.g., park districts, museums, boy's and girl's clubs).

Physical Health

  • Determine eligibility and help families enroll in Medicaid or other health insurance.
  • Work with families to identify or maintain connections to medical and dental homes where they feel supported.
  • Help families access high quality mental health, oral health, and physical health services.
  • Promote ongoing well child care visits, including health and developmental screenings and preventive care with the same providers at medical and dental homes.
  • Promote continuous, ongoing physical health and oral health visits for sick child care at a consistent location where medical and dental history is easy to access (medical or dental home).

Nutrition/Healthy Active Living

  • Homeless shelters often provide foods that lack adequate nutrients for infants, toddlers, and preschool children and instead provide foods high in fat and low in fiber.
  • Connect with food and nutrition assistance programs such as WIC to secure access to healthy foods for families experiencing homelessness.
  • Work with families on simple strategies to keep children active (e.g., 5-2-1-0 Growing Healthy) [PDF, 198KB].

Mental Health

  • Support the social-emotional health of infants, toddlers, and preschool children by utilizing mental health consultants.
  • Explore training opportunities on trauma-informed practices to support children and families experiencing homelessness.
  • Connect with mental health centers or medical homes with behavioral health specialists to assess children's and families' mental health needs during transitions into homelessness.

Parent and Family Supports

  • Work with parenting supports or home visiting programs to help identify strategies to create healthy activities for parents experiencing homelessness.
  • Become familiar with resources available to help prevent families from experiencing homelessness.
  • Work collaboratively with families experiencing homelessness to help them access resources.
  • Become familiar with resources available to families with young children experiencing homelessness.
  • Develop strong relationships with families experiencing homelessness to help build resilience and trust.

Administration for Children and Families (ACF) Resources:

Early Childhood and Family Homelessness Resource List

Early Childhood Homelessness in the United States: 50 State Profile June – 2017

Resources to meet the Child Care CCDF requirements

Expanding Early Care and Education for Children Experiencing Homelessness

Additional Resources:

ACES/Trauma Building Resilience

Find a Health Center

Health and Human Services Programs

Community Action Partnership

Health Care for Homeless Projects

National Center for Homeless Education

National Center on Health Care for Homeless

National Association for the Education Care of Homeless Children and Youth

Last Updated: July 16, 2018