“Family and child homelessness is a crisis and it is not getting the attention it deserves,” said Ellen Bassuk, M.D., primary author of America’s Youngest Outcasts: A Report Card on Child Homelessness. The report was released in November 2014 by the National Center on Family Homelessness at American Institutes for Research. Between 2012 and 2013, the rate of homelessness among children rose by 8% nationally. “That means that 1 in 30 American children—2.5 million—were homeless in 2013,” Dr. Bassuk, founder and former president of The National Center on Family Homelessness, said. “These are historically high rates. In 1988, families accounted for about 1% of people experiencing homelessness; now, it’s about 36%.” The report rates each state and the District of Columbia on four dimensions: extent of child homelessness, child well-being, risk for child homelessness, and state policy and planning efforts. As the report shows, the number of children who experience homelessness continues to climb sharply, yet most states’ efforts are not sufficient to address the crisis. The typical family experiencing homelessness in 2013, according to the report, consists of an African-American mother under the age of 27 with two small children; 51% of children who experience homelessness are under the age of six. Domestic violence, sexual abuse, and other types of interpersonal violence are widespread among this group of women; 90% have experienced severe trauma. “This young mother is likely to be relatively uneducated and has little opportunity to earn a living wage that could support her family,” said Dr. Bassuk. “And because she is low-income and has young children, she needs but can’t afford childcare to hold a job. Add to this picture alarming rates of domestic violence, and this woman is behind the eight ball—and so are her kids.” Child Homelessness Often Is Under-estimated While progress has been made in recent years in reducing chronic homelessness among veterans and other single adults, Dr. Bassuk said the opposite is true for families. Policymakers tend to under-count families experiencing homelessness because the Department of Housing and Urban Development (HUD) does not count precariously housed or doubled-up families, only those living on the street or in shelters. In addition, programs designed for families experiencing homelessness tend to focus on the needs of the mother and pay less attention to the critical needs of the children. While becoming homeless is potentially traumatizing for people of any age, it is important to recognize that, when young children experience trauma, there is a relatively short window in their developmental process to address the trauma before it becomes a serious problem that affects them as adults. “We know from the Adverse Childhood Experiences study that childhood trauma has lifelong negative effects on physical and mental health,” said Dr. Bassuk. “These children are typically facing multiple adverse events before they even enter school. Two-thirds of homeless mothers have a history of domestic violence; one-third of them are actively fleeing domestic violence when they become homeless.” The type of shelters available to families contributes to the destabilizing trauma experienced by children, according to Dr. Bassuk. Family shelters are often large, older houses where the entire family stays in one room. There is no privacy or safe place for children to play, and boys over the age of 12 are often not permitted. If families do not quickly find permanent housing and are forced to remain in the shelter system, 40 to 50% of them will break up within 5 years, with children being sent to live with relatives or placed in foster care, Dr. Bassuk noted. These children face almost insurmountable obstacles as they become adults and are often trapped in a cycle of poverty, ill health, and significant social disadvantages. To compound the barriers these families face, it is very difficult—if not impossible—for them to become stably housed without access to subsidized housing, according to Dr. Bassuk. Yet the amount of subsidized housing available has actually gone down at the same time that the need has skyrocketed. “Family homelessness is exploding because the demographics of the family have changed,” Dr. Bassuk said. “There’s a rise in female-headed households and poverty, an expansion of the low-wage economy, lack of affordable housing, increased levels of violence against women, and cuts in human service programs. Family homelessness consolidates all of our society’s gender issues in one place.” Solutions to Help Address the Crisis So what can and should be done to deal with this expanding national crisis? “One thing we know is that housing is essential, but not sufficient to make a difference for these families,” Dr. Bassuk said. “We not only need housing, but we also need services for these kids and moms, and we need services for them in the shelters and afterwards.” While some advocates believe that children who experience homelessness should use mainstream mental health and support services, Dr. Bassuk said that does not work. It is unrealistic, she believes, to expect stressed-out homeless families to navigate the fragmented human service system to try to get help for their traumatized children at the same time they are trying to find stable housing and employment. “Six months to a year in a shelter without supportive services is a very long time in the life of a toddler,” Dr. Bassuk said. “These kids need services now!” This article was originally published as a Voices from the Field Blog to highlight the theme of Housing. Find the latest SAMHSA Blog posts about behavioral health and homelessness. Access more behavioral health and homelessness resources.