Homelessness Is Not Neglect
One of the challenges of addressing homeless families is that there have been many definitions of what “homeless” means over the years. The National Center on Family Homelessness reports that families make up 37% of the homeless population.
Posted under: Maternal Health, Social Determinants of Health/Disparities
Last week, I came across a story from the Los Angeles Times entitled, Pregnant, Homeless, and Living in a Tent: Meet Mckenzie. I read the article with genuine interest, as our National Perinatal Information Center Perinatal Database reveals that homelessness is one of the most reported social determinants of health (SDOH).
In the story, a young woman, Mckenzie, describes her experiences as a homeless teen during her pregnancy. She worries about having to disclose her housing situation to case managers and social workers at the hospital when she goes into labor, fearful that her baby will be taken into protective custody based on her housing status.
One of the lines in the article quickly caught my attention: Homelessness is Not Neglect.
According to Mckenzie, one of her social workers did not associate homelessness with neglect, and merely the location of living.
According to the Child Welfare Information Gateway, neglect is frequently defined as “the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child's health, safety, and well-being are threatened with harm.” So, does living in a tent meet this definition if all other needs are satisfied? Should it?
Voices Across the Nation
Last week, I reposted that article on LinkedIn and received messages from across the United States regarding experiences working with homeless mothers and the often kneejerk reactions to immediately contact Protective Services about their homelessness:
“Members of our team immediately called CPS on a Black mother for being homeless. She left AMA during labor, and we do not know where she delivered. I was so distraught. Our current policy directs us to contact CPS for homeless parents. Like they have not been traumatized enough already. We must change our policies to protect these mothers, and to make every effort to keep these newborns with their mothers”—Southeast US
“We assign blame to these mothers. Homelessness ‘must have been their choice.’ They did something to lose their home, their livelihood.’ With this kind of mindset, we will never help these women. We will simply continue to blame them”—West Coast US
“We make it impossible for women to seek help when they are experiencing homelessness. And too many care providers assume that homelessness is some permanent situation. There must be better answers”—West Coast US
“We treat convicted prisoners who deliver and give birth with more compassion than we do those who are homeless. We make great efforts to keep the mother and baby together during incarceration, but do not allow the same effort for the homeless mother. What does that say about us, and the value we place on those who are experiencing homelessness?”—Mid-Atlantic US
Homeless Families
One of the challenges of addressing homeless families is that there have been many definitions of what “homeless” means over the years. However, most states now are using the US Department of Housing and Urban Development definition, which describes a person who lacks a fixed, regular, and adequate nighttime residence.
The National Center on Family Homelessness reports that families make up 37% of the homeless population. And within those homeless families, 52% are Black, and 35% are white, according to the most recent Annual Homeless Assessment Report to Congress. The mere fact that the National Center on Family Homelessness needs to exist should give everyone pause.
According to the National Partnership for Women and Families, there are significant disparities that exist within homelessness:
- Pacific Islanders are 14 times more likely to experience homelessness than white people
- Native Americans are nearly 6 times more likely
- Black people are nearly 5 times more likely
- Black and Latina renters are disproportionately threatened with eviction
Seeking Safety, Seeking Refuge
So how do women become homeless in the first place? Domestic and sexual abuse is the primary driver for women fleeing their homes, with children in tow, to escape abuse. Studies on homelessness report that nearly 90% of homeless women have experienced sexual or physical trauma. But homeless women also have many other needs that may not be addressed during an experience with homelessness, such as pregnancy, breast health, support for menses, and other issues. In fact, a Massachusetts report on homelessness reported that women are more likely to opt out of shelters for fear of their physical safety, and therefore are not counted and are underrepresented in many estimates of homeless women. Homeless mothers experience chronic and repeated traumas that can impact both the mother and the child in irreparable ways.
So, What Can You Do?
Advocacy for access to care is not a one-and-done event. Advocating for equitable, sustainable, and compassionate services to support homeless women and their families is of the utmost importance in our communities. Just as important is advocating for resources for those who are on the brink of homelessness…just one paycheck away from having nothing.
So, before you pick up the phone and call Child Protective Services to initiate a report for neglect, have you already made every effort to secure the unmet social needs of your pregnant patient? If not, why not? Do you initiate Child Protective Services reports equitably and equally? And if not, why not? Do you track the race and ethnicity of your Child Protective Services reports based on the rationale for the call? Do you share that data with your care teams?
“Members of our team immediately called CPS on a Black mother for being homeless. She left AMA during labor, and we do not know where she delivered. I was so distraught. Our policy directs us to contact CPS for homeless parents. Like they have not been traumatized enough already. We must change our policies to protect these mothers, and to make every effort to keep these newborns with their mothers."
So, I return to this statement. What could have been done differently? How could we have kept this pregnant woman in the hospital and connected her with the services she needs to take care of her newborn? How could we better engage? How can we reframe our biases and eliminate racism within our healthcare settings to provide respectful and dignified care to all patients?
Homelessness is Not Neglect…until you say it is.
In the story, a young woman, Mckenzie, describes her experiences as a homeless teen during her pregnancy. She worries about having to disclose her housing situation to case managers and social workers at the hospital when she goes into labor, fearful that her baby will be taken into protective custody based on her housing status.
One of the lines in the article quickly caught my attention: Homelessness is Not Neglect.
According to Mckenzie, one of her social workers did not associate homelessness with neglect, and merely the location of living.
According to the Child Welfare Information Gateway, neglect is frequently defined as “the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child's health, safety, and well-being are threatened with harm.” So, does living in a tent meet this definition if all other needs are satisfied? Should it?
Voices Across the Nation
Last week, I reposted that article on LinkedIn and received messages from across the United States regarding experiences working with homeless mothers and the often kneejerk reactions to immediately contact Protective Services about their homelessness:
“Members of our team immediately called CPS on a Black mother for being homeless. She left AMA during labor, and we do not know where she delivered. I was so distraught. Our current policy directs us to contact CPS for homeless parents. Like they have not been traumatized enough already. We must change our policies to protect these mothers, and to make every effort to keep these newborns with their mothers”—Southeast US
“We assign blame to these mothers. Homelessness ‘must have been their choice.’ They did something to lose their home, their livelihood.’ With this kind of mindset, we will never help these women. We will simply continue to blame them”—West Coast US
“We make it impossible for women to seek help when they are experiencing homelessness. And too many care providers assume that homelessness is some permanent situation. There must be better answers”—West Coast US
“We treat convicted prisoners who deliver and give birth with more compassion than we do those who are homeless. We make great efforts to keep the mother and baby together during incarceration, but do not allow the same effort for the homeless mother. What does that say about us, and the value we place on those who are experiencing homelessness?”—Mid-Atlantic US
Homeless Families
One of the challenges of addressing homeless families is that there have been many definitions of what “homeless” means over the years. However, most states now are using the US Department of Housing and Urban Development definition, which describes a person who lacks a fixed, regular, and adequate nighttime residence.
The National Center on Family Homelessness reports that families make up 37% of the homeless population. And within those homeless families, 52% are Black, and 35% are white, according to the most recent Annual Homeless Assessment Report to Congress. The mere fact that the National Center on Family Homelessness needs to exist should give everyone pause.
According to the National Partnership for Women and Families, there are significant disparities that exist within homelessness:
- Pacific Islanders are 14 times more likely to experience homelessness than white people
- Native Americans are nearly 6 times more likely
- Black people are nearly 5 times more likely
- Black and Latina renters are disproportionately threatened with eviction
Seeking Safety, Seeking Refuge
So how do women become homeless in the first place? Domestic and sexual abuse is the primary driver for women fleeing their homes, with children in tow, to escape abuse. Studies on homelessness report that nearly 90% of homeless women have experienced sexual or physical trauma. But homeless women also have many other needs that may not be addressed during an experience with homelessness, such as pregnancy, breast health, support for menses, and other issues. In fact, a Massachusetts report on homelessness reported that women are more likely to opt out of shelters for fear of their physical safety, and therefore are not counted and are underrepresented in many estimates of homeless women. Homeless mothers experience chronic and repeated traumas that can impact both the mother and the child in irreparable ways.
So, What Can You Do?
Advocacy for access to care is not a one-and-done event. Advocating for equitable, sustainable, and compassionate services to support homeless women and their families is of the utmost importance in our communities. Just as important is advocating for resources for those who are on the brink of homelessness…just one paycheck away from having nothing.
So, before you pick up the phone and call Child Protective Services to initiate a report for neglect, have you already made every effort to secure the unmet social needs of your pregnant patient? If not, why not? Do you initiate Child Protective Services reports equitably and equally? And if not, why not? Do you track the race and ethnicity of your Child Protective Services reports based on the rationale for the call? Do you share that data with your care teams?
“Members of our team immediately called CPS on a Black mother for being homeless. She left AMA during labor, and we do not know where she delivered. I was so distraught. Our policy directs us to contact CPS for homeless parents. Like they have not been traumatized enough already. We must change our policies to protect these mothers, and to make every effort to keep these newborns with their mothers."
So, I return to this statement. What could have been done differently? How could we have kept this pregnant woman in the hospital and connected her with the services she needs to take care of her newborn? How could we better engage? How can we reframe our biases and eliminate racism within our healthcare settings to provide respectful and dignified care to all patients?
Homelessness is Not Neglect…until you say it is.