A Theory of Mental Health and Optimal Service Delivery for Homeless Children
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A Theory of Mental Health and Optimal Service Delivery for Homeless Children Katherine E. Marcal1
Published online: 18 October 2016 Springer Science+Business Media New York 2016
Abstract Homeless children are a vulnerable group with high risk for developing mental health disorders. The pathways to disorders among homeless children have not been fully elucidated, with significant logistical and measurement issues challenging accurate and thorough assessment of need. The environments of homeless children are uniquely chaotic, marked by frequent moves, family structure changes, household and neighborhood disorder, parenting distress, and lack of continuous services. Despite high rates of service use, mental health outcomes remain poor. This paper reviews the literature on homeless children’s mental health, as well as prior theoretical explorations. Finally, the paper proposes a theoretical model that explains elevated rates of mental health problems among homeless children as consequences of harmful stress reactions triggered by chronic household instability along with repeated service disruptions. This model draws upon existing conceptual frameworks of child development, family poverty, health services utilization, and the biology of stress to clarify the role of environmental chaos in the development of child emotional and behavioral problems. Potential strategies to mitigate the risk for mental health disorders among homeless children and future research directions are discussed.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. & Katherine E. Marcal [email protected] 1
George Warren Brown School of Social Work, Washington University in Saint Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
Keywords Family homelessness Mental health Child development Service delivery Theory Homeless children comprise one of the most vulnerable groups in the US. They experience greater exposure to extreme poverty, household chaos, family instability, and violence than their stably housed peers, with significant consequences for psychological well-being. Up to two in five children who have experienced a homeless episode suffer from a clinically diagnosable mental health disorder—more than twice the rate seen among comparable non-homeless children (Bassuk, Richard, & Tsertsvadze, 2015). Despite high rates of service use across multiple systems, mental health outcomes among these children remain poor. The pathways to mental health disorders among homeless children are not fully understood, with significant financial and human capital costs. This paper contends that mental health problems among homeless children must be considered in light of chronic instability beyond a single homeless episode, and current service delivery practices exacerbate rather than mitigate the underlying chaos that characterizes homeless children’s lives. A theoretical model is proposed t
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