The impact of childhood foster care and other out-of-home placement on homeless women and their children

Pergamon

Child Abuse & Neglect, Vol. 23, No. 11, pp. 1057–1068, 1999 Copyright © 1999 Elsevier Science Ltd Printed in the USA. All rights reserved 0145-2134/99/$–see front matter

PII S0145-2134(99)00082-4

THE IMPACT OF CHILDHOOD FOSTER CARE AND OTHER OUT-OF-HOME PLACEMENT ON HOMELESS WOMEN AND THEIR CHILDREN CHERYL ZLOTNICK Alcohol Research Group, Public Health Institute, Berkeley, CA, USA; and Center for The Vulnerable Child, Children’s Hospital Oakland, Oakland, CA, USA

MARJORIE J. ROBERTSON Alcohol Research Group, Public Health Institute, Berkeley, CA, USA

MARGUERITE A. WRIGHT Center for The Vulnerable Child, Children’s Hospital Oakland, Oakland, CA, USA

ABSTRACT Objective: This study compares homeless women who had childhood histories of foster care or other out-of-home placement to those who have not. Method: A countywide probability sample of homeless women (n ⫽ 179) received structured interviews. Results: One-third of homeless women reported being raised apart from their parents. Among women with children under age 18, most (61.5%) had children who had lived in foster care or other out-of-home placements. Variables associated with homeless mothers’ children living in foster care or other out-of-home placements were: Child was school-age, mother was age 35 or older, mother had a current alcohol or drug use disorder, mother experienced childhood sexual abuse, and mother ran away from home (when under age 18). Conclusions: Parenting is difficult for homeless mothers who may need to place their children with others to facilitate school attendance. Parent-child interaction may be problematic in family shelters where privacy is rare. Thus, programs promoting family preservation for homeless mothers should provide parenting support as well as permanent housing. © 1999 Elsevier Science Ltd Key Words—Homeless, Foster care, Family preservation, Substance use.

INTRODUCTION FAMILY PRESERVATION IS a serious problem faced by parents who are living in homeless shelters or doubled up with relatives or friends. According to testimony presented in the US House of Representatives, the living situations of parents experiencing homelessness have jeopardized

Data collection was funded by National Institute of Mental Health (NIMH) grant MH46104; analyses were funded by NIMH MH51651 and National Instute on Drug Abuse (NIDA) DA09334. Received for publication August 18, 1998; final revision received December 16, 1998; accepted January 12, 1999. Requests for reprints should be sent to Cheryl Zlotnick, RN DrPh, Alcohol Research Group, Public Health Institute, 2000 Hearst Avenue, Berkeley, CA 94706. 1057

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child safety and contributed to an increasing number of children being placed into foster care (Select Committee on Children Youth & Families, 1989; Zlotnick, Kronstadt, & Klee, 1998). Many women with children who are homeless have substance use and mental health problems, and have few positive family experiences. Consequently, these women may be emotionally and socially ill-equipped to undertake adulthood responsibilities such as parenting. Stressors such as homelessness further detract from their ability to maintain family stability, and in certain cases, some children are placed into foster care (Roman & Wolfe, 1995). This study will examine a sample of homeless women and the relationship between childhood foster care or other out-of-home placements and (1) childhood problems (e.g., sexual and physical abuse, living on welfare as a child); (2) selected adulthood problems (e.g., health and mental health status, substance abuse, social support, duration of homelessness, arrests); and (3) the prevalence of foster care or other out-ofhome placement among minor-age children of homeless mothers. LITERATURE In 1995, an estimated 483,629 US children (or 6.3 per 1000 children) had experienced out-ofhome placements into foster care, group homes, relative and nonrelative placements (Petit & Curtis, 1997). This reflects more than a 50% increase over the 280,000 children placed in foster care during 1980 (US General Accounting Office, 1995). Foster care, poverty, and parental substance abuse appear to be intertwined. Children entering foster care are often from socioeconomically poorer families (Rosner & Markowitz, 1997; Wolock & Horowitz, 1984). Persons from poorer families more frequently engage in substance use (Community Epidemiology Work Group, 1996; Flewelling, Ennett, Rachal, & Theisen, 1993; Leukefeld & Bukoski, 1991); and parental substance abuse has been identified as the primary contributor to the recent dramatic increase in numbers of children entering foster care (Select Committee on Children Youth & Families, 1989; US General Accounting Office, 1994, 1995). Homeless adults, a subgroup of individuals living in poverty, have an extremely high prevalence rate of substance use (Fischer, 1989; Lehman & Cordray, 1993; Robertson, Zlotnick, & Westerfelt, 1997), which may contribute to the increasing number of children entering the foster care system (Select Committee on Children Youth & Families, 1989; Zlotnick et al., 1998). Curiously, surveys have noted that a disproportionate number of homeless adults report histories of childhood out-of-home placements with estimates ranging from 10.2% in Los Angeles to 38.6% in Minnesota (Bassuk et al., 1997; Herman, Susser, Struening, & Link, 1997; Koegel, Melamid, & Burman, 1995; Piliavin, Sosin, Westerfelt, & Matsueda, 1993; Susser, Lin, Conover, & Struening, 1991). A nationwide survey of providers drawn from organizations serving homeless adults estimated that 36.2% of clients had histories of childhood foster care (Roman & Wolfe, 1995). When childhood neglect, physical, and sexual abuse necessitates foster care, and the trauma from these experiences is left untreated, adulthood emotional and social problems may occur (Roman & Wolfe, 1995). McDonald and colleagues (1993) support this belief with the explanation that children who grow up moving among multiple foster care placements have not had the experience of assembling and maintaining support systems or learning the necessary survival skills to sustain a stable residence or household. However, homelessness jeopardizes family preservation not only as a result of the perpetual need to relocate, but also as a result of the parenting difficulties imposed by living in homeless shelters or doubled up in other peoples’ homes, and consequently, under someone else’s scrutiny and subject to other people’s rules (Thrasher & Mowbray, 1995). These observations inspired the following two hypotheses. Among homeless women, those with any history of childhood foster care or other out-of-home placements will report more childhood adversities, more health difficulties, and more psychosocial problems than those without. Among homeless mothers with children under age 18, more mothers with childhood histories of foster care

Out-of-home placement

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or other out-of-home placements than mothers without will report that their children are living apart from them.

METHODS Sampling Design A county was selected as the geographic boundary for the study since counties are often used as geographic catchment areas for social and health services including the administration of the foster care system. Alameda County includes urban, suburban, and semi-rural areas and was estimated to include a diverse homeless population of 3000 to 6000 adults (Vernez, Burnam, McGlynn, Trude, & Mittman, 1988). The target population consisted of homeless adults, persons age 18 or older who spent the previous night: (a) in an emergency shelter; (b) “on the streets” (i.e., in sites not intended for human habitation including abandoned or public buildings, vehicles, or out-of-doors); (c) in a hotel or motel room paid with a voucher; or (d) “doubled up” in homes of friends or family members if the adult also spent at least one night of the previous 30 on the streets, in a shelter, or in a vouchered hotel room. Since sampling frames of shelters and meal programs are reported to include the great majority of homeless persons (Burnam & Koegel, 1988; Dennis, 1991; Smith, North, & Spitznagel, 1991; US National Institute on Drug Abuse, 1990), this sampling frame was comprised of Alameda County sites that regularly provided free meals, including emergency shelters, meal programs, and drop-in centers. Institutional settings (e.g., jails, hospitals, residential treatment facilities) and domestic violence shelters were excluded because they serve special populations. The sampling design was a multistage cluster sample with stratification. The first stage consisted of compiling a list of sites that served homeless or other indigent adult clients. In addition to using three directories of service providers throughout Alameda County, other contacts with staff at churches and other community organizations and homeless persons were included. The final list containing 80 sites constituted the sampling frame. Strata of type of facility (shelter or nonshelter), usual number of unduplicated clients, geographic location (Oakland or outside Oakland), and whether facilities served families with children were made. Ensuring that all strata were represented, a computer-generated sample of 29 sites was drawn from the original 80. For the second stage, a probability proportionate to size was used to select the days of the week to visit each shelter and the days and meal times to visit other sites. The third stage involved systematic random sampling of individuals within each of 29 sites to be screened and interviewed if eligible. To reduce the chance of duplicate recruitment into the study (Burnam & Koegel, 1988), an individual who had stayed in a shelter during the past 7 days was not eligible for recruitment (Piazza & Cheng, 1992). Interviewers went to the designated facilities and used systematic random sampling with a random start to select individuals for screening. Individuals were selected for screening in shelters from client lists or sleeping places and in other sites by their place in line entering or leaving the meal programs. The nature of the study was explained and all participants who agreed to participate signed a consent. The interviews averaged 1.75 hours; and each respondent was paid $20 cash as incentive. The sampling strategy, designed to be executed within a 30-day period, was implemented four times during baseline data collection between April 15 and August 15, 1991. Four independent probability samples were combined into a final baseline sample of 564 adults with an overall completion rate of 90.4%. There were no significant differences between those who agreed and those who refused interviews by gender or ethnic self-identification. Of the 564 homeless adults interviewed, 179 were women. This study only used responses from the women.

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Instrumentation Childhood out-of-home placement included three mutually exclusive categories of out-of-home care. Women were categorized into the “foster care” group if they reported formal placement in foster homes, group homes, juvenile detention, or the state youth authority or formal placement with family members (e.g., by the local department of children’s services). Among those remaining, women were categorized into “other out-of-home placement” if they reported living most of their childhood without either biological parent. The remainder were coded as having “neither” placement. Participants were also asked about other childhood experiences. History of family welfare was assessed for a woman’s family of origin (i.e., for the family with whom the respondent lived most of the time as a minor). Other dichotomous variables represented whether each woman reported a history of arrest, physical or sexual abuse, “running away from home” for seven nights or more, or being homeless alone as a minor. Demographic characteristics included age, racial or ethnic self-identification, education, marital status, and women’s parental status. Racial or ethnic selfidentification was divided into Black or other. Women’s parental status was divided into four mutually exclusive categories: Those who had no children, those who only had preschool-age children (i.e., under age 6); those who had any school-age children (ages 6 to 17); and those who only had adult children. Among women with minor-aged children, women were categorized according to whether any of their children were “staying with” their mothers at the time of the interview or if the children were staying with someone else such as their mothers’ parent(s), other relatives or friends, or in institutional care (i.e., foster care, group home, juvenile detention, or state youth authority). Current social environment included perceived social support (e.g., did the woman identify at least one relative or one friend she felt close to). Other social indicators included attendance at religious or other social events in the previous 30 days or a recent stay in a battered women’s shelter (previous 12 months). Another indicator was a history of ever having been arrested as an adult. Women also reported where they had spent the most consecutive nights in the previous 12 months. These sites were dichotomized as homeless or housed for this analysis. History of homelessness was operationalized by total time homeless as an adult and categorized into less than 1 year or 1 year or longer. A variety of dichotomous current health indicators was examined including drug and alcohol use disorders, major mental disorders, and physical disability. Alcohol and drug use disorders refer to the maladaptive behavior associated with more or less regular use of particular substances (American Psychiatric Association, 1987) and was assessed with the Diagnostic Interview Schedule, Version III-R (DIS-III-R), a standardized structured diagnostic interview designed for use by trained nonclinicians. Diagnoses are based on criteria from the Diagnostic and Statistical Manual of the American Psychiatric Association (APA), Version III-R (DSM-III-R) (American Psychiatric Association, 1987; Robins & Regier, 1991). Versions of the DIS have been used in studies of homeless adults (Fischer, 1991; Fischer & Breakey, 1991; Fischer, Shapiro, Breakey, Anthony, & Kramer, 1986; Koegel & Burnam, 1988). Respondents were categorized as having a drug-use disorder if they had a diagnosis of abuse or dependence for any of eight classes of drugs including: Cannabis, stimulants, sedatives, cocaine, opiates, PCP, other hallucinogens, or inhalants. Respondents were categorized as having an alcohol use disorder if they had a diagnosis of abuse or dependence for alcohol. Diagnoses were made using a computer algorithm provided for use with the DIS. Respondents were classified with a “current” drug or alcohol use disorder if they had a lifetime history of a specific alcohol or drug use disorder, respectively, and also reported a symptom of abuse or dependence related to use of that specific substance during the previous 12 months (Anthony & Helzer, 1991).

Out-of-home placement

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Table 1. Demographics of Homeless Women by their Childhood Placement History Other Out-ofHome Placement (n ⫽ 14)

Foster Care (n ⫽ 45)

Women’s Parental Statusa No children All children ⬍6 One or more 6–17 All children 18⫹ Age ⬍35 years ⱖ35 years Race/Ethnicity Black Other Education ⬍12th Grade ⱖ12th Grade Marital Status Never married Ever married

Neither (n ⫽ 120)

All Women (n ⫽ 179)

%

(n)

%

(n)

%

(n)

%

(n)

27.5 17.5 52.5 2.5

(9) (13) (22) (1)

23.1 15.4 53.8 7.7

(3) (3) (6) (2)

13.5 13.5 61.1 11.9

(16) (20) (68) (16)

17.3 14.5 58.7 9.5

(28) (36) (96) (19)

65.0 35.0

(30) (15)

57.1 42.9

(7) (7)

52.4 47.6

(62) (58)

55.6 44.4

(99) (80)

62.5 37.5

(27) (18)

92.9 7.1

(13) (1)

69.8 30.2

(76) (44)

70.0 30.0

(116) (63)

42.5 57.5

(21) (24)

28.6 71.4

(2) (12)

26.2 73.8

(30) (90)

30.0 70.0

(53) (126)

47.5 52.5

(24) (21)

76.9 23.1

(9) (5)

46.0 54.0

(48) (72)

48.6 51.4

(81) (98)

a

Two missing values. Percentages are weighted, sample sizes are unweighted.

Current major mental disorders were also assessed with the DIS and included current diagnosis of schizophrenia or major affective disorder (i.e., major depression or bipolar disorder). Current dual diagnoses included current diagnoses of both major mental disorder and drug or alcohol use disorder. Perceived disability was operationalized by a woman reporting that her health condition “—physical, emotional, or mental—” currently limited the amount or kind of work she could do. ANALYSIS To reduce potential bias, weights for each respondent were used to adjust for varying probabilities of being selected into the sample (Piazza & Cheng, 1992). SPSS or StatXact was used to conduct all analyses (Cytel Software Corporation, 1992; SPSS, 1996). The Chi-Square Test of Independence and Fisher’s Exact Test were employed to compare frequencies of categorical data. Logistic regression was used to identify factors associated with mothers not having their children with them; odds ratios (OR) and 95% confidence intervals (CI) are reported. Diagnostic plots were used to examine residuals and determine whether any observations exerted undue leverage on the model. Fit was judged by examination of the ⫺2 Log Likelihood (⫺2LL), the Hosmer-Lemeshow Goodness of Fit Test, and Wald statistics of beta coefficients (Hosmer & Lemeshow, 1989; Hosmer, Taber, & Lemeshow, 1991). RESULTS Homeless women (n ⫽ 179) were categorized into one of three groups based on their histories of childhood foster care or other out-of-home placement (Table 1). Women who reported any history of being in a group home, a foster care home (including relative or kinship foster care placement), juvenile hall, or in the state youth authority before they turned 18 years old were

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C. Zlotnick, M. J. Robertson, and M. A. Wright Table 2. Childhood Experiences of Homeless Women by their Childhood Placement History

Foster Care (n ⫽ 45) Childhood Experiences Childhood History of Sexual Abuse** Childhood History of Physical Abuse* Family Received Welfare During Childhood Ran Away from Home Seven Nights or More*** Arrested When ⬍18 Years*** Homeless by Self When ⬍18 Years*

Other Out-ofHome Placement (n ⫽ 14)

Neither (n ⫽ 120)

All Women (n ⫽ 179)

%

(n)

%

(n)

%

(n)

%

(n)

50.0

(21)

53.8

(4)

23.8

(25)

31.8

(50)

25.0

(10)

46.2

(3)

13.6

(14)

18.5

(27)

32.5

(14)

57.1

(7)

40.8

(43)

40.2

(64)

57.5

(27)

57.1

(5)

19.8

(22)

31.1

(54)

57.5

(26)

7.1

(1)

7.1

(10)

18.3

(37)

32.5

(15)

–

(0)

2.4

(3)

8.9

(18)

*p ⬍ 0.05; **p ⬍ 0.01; ***p ⬍ 0.001. Percentages are weighted, sample sizes are unweighted.

classified as having been in childhood foster care. Of the remaining women, those who reported growing up in the homes of relatives or friends, but were not formally placed into the foster care system, were classified as having been in other out-of-home placement. Forty-five women (25.1%) reported childhood foster care, 14 women (7.8%) reported other out-of-home placements, and the remaining two-thirds reported neither situation. There were no significant differences in demographic characteristics between groups based on history of childhood placement (Table 1). Most women had children who were ages 6 to 18 years (i.e., school-age). Another fifth reported no children. The rest had children who were either under 6 years old or older than 18 years. Most women were under age 35 years, Black, with at least a 12th grade education. Almost one-third of the women reported childhood sexual abuse and about one-fifth reported physical abuse (Table 2). More women in the childhood foster care and other out-of-home placement groups compared to women who had neither history reported childhood sexual abuse, physical abuse, and had run away from home before age 18 (p ⬍ .01, p ⬍ .05, and p ⬍ .001, respectively). Childhood arrests and homelessness were more common among women in the childhood foster care group compared to women in the other two groups (p ⬍ .001 and p ⬍ .05, respectively). Many women had drug use disorders, alcohol use disorders, major mental disorders, dual disorders, or perceived that they had disabilities that impaired their daily function. The majority of women reported relationships with relatives and friends, and had attended religious and social events; however, no group differences were found (Table 3). Negative adulthood events were also found among most women. The majority of women had been arrested as adults and many had spent at least 1 day in the past year at a battered women’s shelter. Also, more women with histories of childhood foster care and other out-of-home placement reported a year or more of homelessness compared to women with neither history (p ⬍ .05). Next, among the 151 (84.5%) homeless women who had children, we found that many (61.5%) had their children currently living elsewhere (Table 4). Compared to other groups, more women with histories of foster care placement had children who were living somewhere else (p ⬍ .10). Mothers who had childhood histories of other out-of-home placements were most likely to have

Out-of-home placement

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Table 3. Health and Psychosocial Problems of Homeless Women by their Childhood Placement History

Foster Care (n ⫽ 45) Health and Psychosocial Problems Current Health Status Drug use disordera Alcohol use Disordera Major mental disordera Dual disordera Perceived disability Social Environment Has “close” relatives Has “close” friends Attended religious event/30 days Attended social event/30 days Adulthood arrests Battered Women shelter/12 months Homeless ⱖ365 days as an adult*

Other Out-ofHome Placement (n ⫽ 14)

Neither (n ⫽ 120)

All Women (n ⫽ 179)

%

(n)

%

(n)

%

(n)

%

(n)

35.0 35.0

(14) (13)

7.7 35.7

(1) (3)

33.3 20.6

(34) (19)

31.8 25.0

(49) (35)

27.5 17.5 37.5

(12) (6) (17)

38.5 21.4 61.5

(2) (1) (6)

28.8 18.3 45.2

(30) (15) (53)

29.2 18.3 44.7

(44) (22) (76)

69.2 70.0

(28) (31)

53.8 76.9

(10) (9)

75.4 69.6

(89) (84)

72.5 70.2

(127) (124)

52.5

(26)

76.9

(10)

52.4

(55)

54.2

(91)

38.5 75.0

(18) (34)

42.9 53.8

(3) (7)

36.0 59.5

(43) (65)

37.1 62.6

(64) (106)

20.0

(8)

7.7

(2)

11.2

(17)

12.9

(27)

46.2

(15)

61.5

(2)

29.3

(28)

35.4

(48)

␶

p ⬍ 0.10; *p ⬍ 0.05. Percentages are weighted, sample sizes are unweighted. a DSM-III-R criteria, 12-month recency.

their children in foster care situations (i.e., group home, a foster care home, juvenile hall, or in the California Youth Authority) compared to mothers with histories of childhood foster care or mothers with neither history (p ⬍ .05). No differences in placement of children with relatives or friends were found by mothers’ group status. Among mothers with children under age 18 years old, we expected more mothers with childhood

Table 4. Location of Child Placement of Homeless Mothers (n ⴝ 151) by Mothers’ Childhood Placement History Other Out-ofHome Placement (n ⫽ 11)

Foster Care (n ⫽ 36) Child Placement At Least One Child is Currently Not with Respondent Current Location of Child(ren) Foster care, Group homes, or Juvenile authority* Relatives Friends ␶

Neither (n ⫽ 104)

All Women (n ⫽ 151)

%

(n)

%

(n)

%

(n)

%

(n)

70.0

(23)

60.0

(6)

59.3

(44)

61.5

(73)

10.3 50.0 6.9

(4) (17) (2)

50.0 40.0 0

(3) (4)

13.0 50.0 2.8

(7) (38) (2)

15.0 49.3 3.4

(14) (59) (4)

p ⬍ 0.10; *p ⬍ 0.05. Percentages are weighted, sample sizes are unweighted.

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C. Zlotnick, M. J. Robertson, and M. A. Wright

histories of foster care or other out-of-home placements to have their children living elsewhere. Stepwise logistic regression was used to create a model with the dichotomous dependent variable of at least one child being cared for by someone other than the parent versus not. Demographic characteristics of the mother included: Having a school-age child (6 –17 years), being age 35 or older, Black race, 12th grade education or above, and ever being married. The mothers’ childhood experiences were: Sexual abuse, physical abuse, living with a family that received welfare, running away from home for a week or more, arrested when under age 18 years, and being homeless alone as a child under age 18 years. Dichotomous health and psychosocial indicators included: Current drug or alcohol use disorder, current major mental disorder, current dual disorder, perceived disability, having “close” relationships with relatives or friends, attending religious events or social events, history of adulthood arrests, recent stay in a Battered Women’s Shelter in the past 12 months, was homeless more than a year, and had a history of childhood foster care or other out-of-home placement. Based on ⫺2LL, Wald statistics and the Hosmer-Lemeshow Goodness-of-Fit Test, we found no association between mother’s history of either childhood foster care or other out-of-home placement and not having ones’ child(ren) with them. The best model with the dependent variable of not having ones’ child(ren) with them contained the following independent variables related to the mother: Had a school-age child (OR ⫽ 4.07, CI ⫽ 1.39 –11.90, p ⬍ .05), was aged 35 or older (OR ⫽ 5.00, CI ⫽ 1.70 –14.66, p ⬍ .01), had a current alcohol or drug use disorder (OR ⫽ 3.69, CI ⫽ 1.33–10.20, p ⬍ .05), ran away from home for a week or more as a child (OR ⫽ 6.11, CI ⫽ 1.67–22.34, p ⬍ .01), and was sexually abused as a child (OR ⫽ 3.34, CI ⫽ 1.08 –10.33). This model correctly predicts whether children were with their mothers (i.e., the dependent variable) 79.6% of the time. The Hosmer-Lemeshow Goodness of Fit Test suggests that the model has a good fit (␹2(8) ⫽ 5.88, p ⫽ .66). DISCUSSION A surprising 61.5% of homeless mothers had at least one child living elsewhere supporting congressional testimony and other studies indicating that many homeless women have children living in foster care or other out-of-home placements (Roman & Wolfe, 1995; Select Committee on Children Youth & Families, 1989; Zlotnick et al., 1998). However, findings did not support the hypothesis that homeless mothers who experienced childhood foster care or other out-of-home placement themselves as children were more apt to have their children in foster care or other out-of-home placement. Homeless mothers whose children were living elsewhere were more likely to be age 35 or older; have a school-aged child; have a current alcohol or drug use disorder; have experienced childhood sexual abuse; or have run away from home in childhood. Although family homelessness and poverty alone do not support legal charges of child neglect against parents, there are some sequella associated with these conditions that do. For example, families experiencing episodes of homelessness may need to move from shelter to shelter; as a result, their children may have high rates of school absenteeism (Bassuk, 1990; Bassuk, Rubin, & Lauriat, 1986; Page, Ainsworth, & Pett, 1993; Parker et al., 1991). Homeless mothers may be compelled to place school-aged children with others since homelessness may hamper regular school attendance, and erratic school attendance may instigate charges of parental neglect. Consequently, it was not surprising to find that school-aged children (6 –17 years) were more than four times as likely as nonschool-aged children to be living apart from their mothers; and it was also not surprising to find that mothers age 35 or older (mothers old enough to have a school-age child) were more than five times as likely as younger homeless women to not have their children with them. Parental substance abuse was another factor associated with having one’s child placed into foster

Out-of-home placement

1065

care or in other out-of-home placement. As expected, homeless mothers who had a current alcohol or drug use disorder were 3.69 times more likely than other homeless mothers to have their children living elsewhere. Parental substance use has been considered the most pervasive factor associated with child entry into the foster care system (US General Accounting Office, 1994, 1997), and is a problem among children of homeless parents (Bassuk et al., 1997). Several homeless women reported adverse childhood experiences. Almost a third reported childhood sexual abuse. About one-third reported running away from home as a child, and almost a fifth reported childhood physical abuse. Two adverse childhood experiences, running away from home and sexual abuse, were independently associated with mothers not having their children with them. Several researchers have indicated that women who have adverse childhood experiences, particularly sexual abuse, were more likely to engage in riskier behaviors and experience more adulthood problems due to low self-esteem, absence of good role models, and lack of internal resources (Browne, 1993; Simons & Whitbeck, 1991; Weitzman, Knickman, & Shinn, 1992). Similarly, anecdotal accounts have suggested that homeless adults who experience childhood foster care or other out-of-home placements may have difficulties in many areas of their lives, including small social support networks, low self-esteem, and inadequate knowledge of independent living and establishing a safe household environment for children (Roman & Wolfe, 1995). Consistent with previous studies of homeless women, this study provides no evidence to support the hypothesis that homeless women with childhood foster care or other out-of-home placements have more health or psychosocial problems than other homeless women (Hausman & Hammen, 1993; Shinn, Knickman, & Weitzman, 1991; Wagner & Perriner, 1994). One explanation for this lack of difference is that children entering into the foster care system may have different experiences. Abusive or neglectful caregivers, whether they are biologically related to the child or not, may have a similar detrimental impact on the child’s development. Research suggests that children raised in nurturing and supportive long-term foster and adoptive homes grow up to be as psychologically healthy as children raised with their birth parents (Barth & Berry, 1988). The family environment may be the single most important factor determining positive outcomes among at-risk children (Poulsen, 1993; Resnick et al., 1997; Werner & Smith, 1992). The alarming high prevalence of sexual and physical abuse reported by homeless women in this study (including women who did not live in foster care or other out-of-home placement) may suggest that some women grew up in families with caregivers who did not provide for their basic safety or emotional needs. Several studies on formal kinship care (biological relative care) indicate that these homes are not as closely screened, monitored or supported as are unrelated foster homes (Berrick, Barth, & Needell, 1994; Dubowitz, Feigelman, & Zuravin, 1993; Gebel, 1996; Lewis & Fraser, 1987). The women who lived in relatives’ or friends’ homes may have experienced the disadvantage of not even having the limited services provided to foster care kinship caregivers since they were not formally in the system (i.e., not regarded as dependents of the state). As a result, they may have been more subject to undetected and untreated abuse or neglect than children who were formally placed into the foster care system. Since the results of this study are based on self-reported survey data, they are subject to recall bias or underreporting of sensitive variables such as sexual and physical abuse. Also, the survey did not contain questions on the quality of foster care and other out-of-home placements. Sample sizes of women who had at least one child not living with them were small; therefore, other studies with larger probability sample of women are needed to further investigate the relationship between mothers’ childhood foster and other out-of-home placements and the subsequent living arrangements of their children. The study sample was drawn from Alameda County in northern California, and findings may not generalizable to homeless women living elsewhere.

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CONCLUSION This study examined homeless women and the relationship between childhood foster care or other out-of-home placements and (1) childhood problems; (2) adulthood problems; and (3) the placement of homeless mothers’ children into foster care or other out-of-home placements. These findings provide additional support to other studies suggesting that homelessness threatens family integrity. Furthermore, this study indicates that many homeless mothers also have to deal with a legacy of childhood sexual abuse and other childhood problems as well as current adulthood problems of mental or substance use disorders—all of which may have deleterious effects on their adult function and ability to parent. Programs targeting homeless families must address these problems in their interventions and the challenges posed by homeless shelters where parents’ actions and conversations are continuously under the scrutiny of other parents, children and shelter personnel (Hausman & Hammen, 1993). Clearly the first and most immediate goal for homeless families is to find stable housing. However, the second goal is to help mothers with parenting and life skills that will promote family preservation and stability. REFERENCES American Psychiatric Association. (1987). DSM-III-R: Diagnostic and statistical manual of mental disorders (3rd ed. revised). Washington, DC: American Psychiatric Association. Anthony, J. C., & Helzer, J. E. (1991). Syndromes of drug abuse and dependence. In L. N. Robins & D. A. Regier (Eds.), Psychiatric disorders in America: The Epidemiologic Catchment Area Study (pp. 116 –154). New York: The Free Press. Barth, R., & Berry, M. (1988). Adoption and disruption. New York: Aldine de Gruyter. Bassuk, E. L. (1990). Who are the homeless families? Characteristics of sheltered mothers and children. Community Mental Health Journal, 26, 425– 434. Bassuk, E. L., Buckner, J. C., Weinreb, L. F., Browne, A., Bassuk, S. S., Dawson, R., & Perloff, J. N. (1997). Homelessness in female-headed families: Childhood and adult risk and protective factors. American Journal of Public Health, 87, 241–248. Bassuk, E. L., Rubin, L., & Lauriat, A. (1986). Characteristics of sheltered homeless families. American Journal of Public Health, 76, 1097–1101. Berrick, J., Barth, R., & Needell, B. (1994). A comparison of kinship foster homes and foster family homes: Implications for kinship foster care as family preservation. Children and Youth Services Review, 16, 33– 64. Browne, A. (1993). Family violence and homelessness: The relevance of trauma histories in the lives of homeless women. American Journal Orthopsychiatry, 63, 370 –384. Burnam, M. A., & Koegel, P. (1988). Methodology for obtaining a representative sample of homeless persons: The Los Angeles Skid Row study. Evaluation Review, 12, 117–152. Community Epidemiology Work Group. (1996). Epidemiologic trends in drug abuse: Proceedings (NIH Publication No. 96-4127). Rockville, MD: National Institute on Drug Abuse. Cytel Software Corporation. (1992). StatXact-Turbo: Statistical software for exact nonparametric inference (User manual). Cambridge, MA: Cytel. Dennis, M. L. (1991). Changing the conventional rules: Surveying homeless people in nonconventional locations. Housing Policy Debates, 2, 701–732. Dubowitz, H., Feigelman, S., & Zuravin, S. (1993). A profile of kinship care. Child Welfare, 72, 153–169. Fischer, P. J. (1989). Estimating the prevalence of alcohol, drug and mental health problems in the contemporary homeless population: A review of the literature. Contemporary Drug Problems, 16, 333–389. Fischer, P. J. (1991). Alcohol, drug abuse and mental health problems among homeless persons: A review of the literature (DHHS Publication [ADM] 91-1763[A]). Rockville, MD: Department of Health and Human Services. Fischer, P. J., & Breakey, W. R. (1991). The epidemiology of alcohol, drug, and mental disorders among homeless persons. American Psychologist, 46, 1115–1128. Fischer, P. J., Shapiro, S., Breakey, W. R., Anthony, J. C., & Kramer, M. (1986). Mental health and social characteristics of the homeless: A survey of mission users. American Journal of Public Health, 76, 519 –524. Flewelling, R. L., Ennett, S. T., Rachal, J. V., & Theisen, A. C. (1993). National household survey on drug abuse: Race/ethnicity, socioeconomic status, and drug abuse 1991 (DHHS Publication (SMA) 93-2062). Washington, DC: US Government Printing Office. Gebel, T. (1996). Kinship care and nonrelative family foster care: A comparison of caregiver attributes and attitudes. Child Welfare, 75, 5–18. Hausman, B., & Hammen, C. (1993). Parenting in homeless families: The double crisis. Special section: Homeless women: Economic and social issues. American Journal of Orthopsychiatry, 63, 358 –369.

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Herman, D. B., Susser, E. S., Struening, E. L., & Link, B. L. (1997). Adverse childhood experiences: Are they risk factors for adult homelessness. American Journal of Public Health, 87, 249 –255. Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. New York: John Wiley & Sons. Hosmer, D. W., Taber, S., & Lemeshow, S. (1991). The importance of assessing the fit of logistic regression models: A case study. American Journal of Public Health, 81, 1630 –1635. Koegel, P., & Burnam, M. A. (1988). Alcoholism among homeless adults in the inner city of Los Angeles. Archives of General Psychiatry, 45, 1011–1018. Koegel, P., Melamid, E., & Burman, M. A. (1995). Childhood risk factors for homelessness among homeless adults. American Journal of Public Health, 85, 1642–1649. Lehman, A. F., & Cordray, D. S. (1993). Prevalence of alcohol, drug, and mental disorders among the homeless: One more time. Contemporary Drug Problems, 20, 355–383. Leukefeld, C. G., & Bukoski, W. J. (Eds.). (1991). Drug abuse prevention intervention research: Methodological issues. Washington, DC: US Government Printing Office. Lewis, R., & Fraser, M. (1987). Blending informal and formal helping networks in foster care. Children and Youth Service Review, 9, 153–169. McDonald, T. P., Allen, R. I., Westerfelt, A., & Piliavin, I. (1993). Assessing the long-term effects of foster care: A research synthesis. Madison, WI: Institute for Research on Poverty. Page, A. J., Ainsworth, A. D., & Pett, M. A. (1993). Homeless families and their children’s health problems: A Utah urban experience. Western Journal of Medicine, 158, 30 –35. Parker, R. M., Rescorla, L. A., Finkelstein, J. A., Barnes, N., Holmes, J. H., & Stolley, P. D. (1991). A survey of the health of homeless children in Philadelphia shelters. American Journal of Disease in Children, 145, 520 –526. Petit, M., & Curtis, P. (1997). Child abuse and neglect: A look at the states. Washington, DC: CWLA Press. Piazza, T., & Cheng, Y.-T. (1992). Sample design for the study of Alameda County residents (unpublished manuscript). Berkeley, CA: Survey Research Center, University of California. Piliavin, I., Sosin, M., Westerfelt, A. H., & Matsueda, R. L. (1993). The duration of homeless careers: An exploratory study. Social Service Review, December, 577–598. Poulsen, M. (1993). Strategies for building resilience in infants and young children at risk. Infant and Young Children, 6, 29 – 40. Resnick, M., Bearman, P., Blum, R., Bauman, K., Harris, K., Jones, J., Tabor, J., Beuhring, T., Sieving, R., Shew, M., Ireland, M., Bearinger, L., & Udry, R. (1997). Protecting adolescents from harm: Findings from the national longitudinal study on adolescent health. The Journal of the American Medical Association, 278, 823– 832. Robertson, M. J., Zlotnick, C., & Westerfelt, A. (1997). Drug use disorders and treatment contact among homeless adults in Alameda County. American Journal of Public Health, 87, 221–228. Robins, L. N., & Regier, D. A. (Eds.). (1991). Psychiatric disorders in America: The epidemiologic catchment area study. New York: The Free Press. Roman, N. P., & Wolfe, P. B. (1995). Web of failure: The relationship between foster care and homelessness. Washington, DC: National Alliance to End Homelessness. Rosner, D., & Markowitz, G. (1997). Race, foster care, and the politics of abandonment in New York City. American Journal of Public Health, 87, 1844 –1849. Select Committee on Children Youth & Families. (1989). No place to call home: Disabled children in America. Washington, DC: US Government Printing Office. Shinn, M., Knickman, J. R., & Weitzman, B. C. (1991). Social relationships and vulnerability to becoming homeless among poor families. American Psychology, 46, 1180 –1187. Simons, R. L., & Whitbeck, L. B. (1991). Sexual abuse as a precursor to prostitution and victimization among adolescent and adult homeless women. Journal of Family Issues, 12, 361–379. Smith, E. M., North, C. S., & Spitznagel, E. L. (1991). Are hard-to-interview street dwellers needed in assessing psychiatric disorders in homeless men? International Journal of Methods in Psychiatric Research, 1, 69 –78. SPSS. (1996). SPSS for Windows: Base system user’s guide, release 6.0. Chicago, IL: SPSS Inc. 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. Thrasher, S. P., & Mowbray, C. T. (1995). A strengths perspective: An ethnographic study of homeless women with children. Health and Social Work, 20, 93–101. US General Accounting Office. (1994). Foster care: Parental drug abuse has alarming impact on young children (GAO/HEHS-94-89). Washington, DC: General Accounting Office. US General Accounting Office. (1995). Foster care: Health needs of many young children are unknown and unmet. 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Wagner, J. K., & Perriner, R. M. (1994). Women at risk for homelessness: Comparison between housed and homeless women. Psychological Reports, 75, 1671–1678. 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 Public Health, 82, 1547–1550. Werner, E., & Smith, S. (1992). Overcoming the odds. New York: Cornell University Press. Wolock, I., & Horowitz, B. (1984). Child maltreatment as a social problem: The neglect of neglect. American Journal of Orthopsychiatry, 54, 530 –543. Zlotnick, C., Kronstadt, D., & Klee, L. (1998). Foster care children and family homelessness. American Journal of Public Health, 88, 1368 –1370.

RE´SUME´ Objectif: Cette e´tude compare deux groupes de femmes: des femmes sans logis qui ont ve´cu en foyers d’accueil ou dans d’autres milieux hors de la famille durant leur enfance et des femmes qui ont grandi dans leur famille. Me´thode: On a mene´ des entrevues structure´es aupre`s d’un e´chantillon national de 179 femmes sans logis. Re´sultats: Un tiers des femmes sans logis ont grandi a` l’exte´rieur du milieu familial. Parmi les femmes qui avaient des enfants de moins de 18 ans, la plupart (61,5 p.c.) Avaient des enfants qui avaient e´te´ place´s en foyers d’accueil ou autre milieu hors-famille. On a releve´ les variables suivantes pr rapport a` ces enfants: ils e´taient d’aˆge scolaire, leur me`re avait 35 ans ou plus, elle souffrait de proble`mes d’alcool ou de drogue, elle avait subi des agressions sexuelles en enfance et elle avait fui le foyer avaint l’aˆge 18 ans. Conclusions: Il est difficile pour des femmes sans logis de remplir leur roˆle de parent. Elles doivent souvent plaer leur enfant en foyer d’accueil pour qu’ils puissent aller a` l’e´cole. L’interaction entre parent et enfant est rendue difficile lorsqu’ils vivent dans un abri. Ainsi, les programmes qui cherchent a` pre´server la vie familiale des me`res sans logis devraient les appuyer dans leur roˆle de parent en plus de leur fournir un logement.

RESUMEN Objetivo: Este estudio compara mujeres sin hogar quienes tenı´an historias de cuidado sustituto u otras colocaciones fuera del hogar con otras que no. Me´todo: Se realizaron entrevistas estructuradas a una muestra probabilı´stica de mujeres sin hogar (n ⫽ 9). Resultados: Un tercio de las mujeres sin hogar reportaron haber sido criadas separadas de sus padres. Entre las mujeres con hijos menores de 18 an˜os, la mayorı´a (61.5%) tenı´an hijos que habı´an vivido en hogares sustitutos u otras colocaciones fuera del hogar. Las variables asociadas con que los hijos de las madres sin hogar vivieran en hogares sustitutos u otras colocaciones fueron: el nin˜o tenı´a edad escolar, la madre tenı´a 35 an˜os o mayor, la madre tenı´a un desorden de uso de alcohol o droga, la madre habı´a sufrido abuso sexual en la nin˜ez, y la madre se habı´a fugado de su casa (cuando tenı´a menos de 18 an˜os). Conclusiones: La crianza es dificil para las madres sin hogar que pueden necesitar el poner a sus hijos con otros para facilitar su asistencia a la escuela. La interaccio´n padre-hijo puede ser problema´tica en refugios familiares donde es raro tener privacidad. De manera que los programas que promueven la preservacio´n de la familia para las madres sin hogar deben ofrecer apoyo en la crianza ası´ como casas permanentes.