Cradle and All:
With homeless babies and toddlers at record-high levels, new ways to help them emerge.
By Kendra Hurley
The baby was only 2 weeks old, but her mother did not want to hold her. Asked why, she’d say she didn’t have the time or patience to sit with the baby. For feedings, she propped a bottle on a pillow for the infant to suck. “I was very concerned about that,” remembers Cynthia Greaves, a case manager in the Northern Manhattan Perinatal Partnership, who met the mother and child in their first home together— an East Harlem shelter for homeless families.
Greaves is not a social worker, nor does she have training in mental health issues. The program she’s part of is designed to provide practical help to reduce infant deaths. But she knows that to thrive, babies need touch, and their caretakers need to bond with them—something that may not come easily to mothers burdened by trauma and stress.
This mother, Greaves learned, had both. Disowned by her family, she had grown up in group homes and other institutions and said she had never really felt close to anyone. Several years ago, she’d given birth to her first baby, a son, but her brother now had custody of him and he didn’t let her see him. Now, bonding with her newborn felt like a luxury compared to the looming, urgent need to search for a permanent home—something the case manager at the homeless shelter was urging her to do.
Like this mother’s case manager, most shelter staff focus on practical issues, like helping parents find jobs, daycare and homes. They are not expected to help families address mental health issues, like the effects of trauma on bonding with a newborn.
Greaves knew that a referral to the Administration for Children’s Services (ACS) was the most common path to securing some mental health help for this mother, but she also worried that it would put the mom at risk of losing her baby to foster care. “If ACS preventive stepped in they wouldn’t see what I saw,” Greaves says. “She loved her baby.”
So Greaves did what she was trained to do. She set a practical goal. “My goal was to get her to hold the baby, and feed the baby, to get a connection,” she says. Greaves told the mother that the baby was still too young to feed herself. She asked her to consider breastfeeding. When Greaves’s time with the mother was up, she enrolled her in a program that would continue visiting the mother and child in the shelter, and hoped for the best. But Greaves remained concerned. “I did everything in my power to help her build a closeness with this child,” Greaves says. “And that girl would not hold the baby.”
The de Blasio Administration hopes to begin reversing the sad, historic flood of families into the city’s homeless shelters. Until that happens, however, a record number of babies and toddlers will continue spending the bulk of their early lives in city shelters. Last year, children under 6 represented more than one-third of all New Yorkers under the age of 18. They made up 34 percent of all the city’s children living below the poverty level. Yet children under 6 represented 45 percent of all children living in family shelters during city fiscal year 2014.
During that fiscal year, which ended last June, nearly 19,000 children in city shelters were 5 years old or younger. That’s about 1,000 more babies, preschoolers and kindergarteners than the Barclays Center has seats.
African-American young children are especially at risk of being homeless. Using data from the U.S. Census and DHS, Child Welfare Watch estimated that 8 percent of all African-American children age 5 and under in our city spent time in a shelter in the last fiscal year.* For African-American children 5 and under living in poverty, the incidence of homelessness rose to 22 percent.**
The stress and damage that poverty and homelessness can inflict on children is well-documented. (See “The Science of Upheaval.”) For babies and toddlers, whose brains are developing at an especially rapid clip, a family’s exposure to the kind of chronic tension and trauma common to shelter-living can be particularly debilitating. It can prevent infant-parent bonding, wreak havoc on how children’s bodies respond to stress, and ultimately derail their development.
Research has demonstrated that children who are not separated from their primary caregivers during their first two years of life are more likely to become resilient when facing stressful situations than those who are separated. But homeless children are at high risk of being separated from their parents. One study published in the American Journal of Community Psychology found that among families receiving public assistance in New York City, homelessness was the most common predictor that a mother would be separated from her child. While just 8 percent of non-homeless mothers in that study were separated from their children, an alarming 44 percent of those who had entered shelters five years earlier were. Many separations occurred after a mother and her child left the shelter system, often not because child welfare authorities or the court mandated it, but because fathers or the children themselves decided it was best. This led the study’s authors to speculate that shelter life—with its crowding, lack of privacy, and rules that can erode a parent’s authority—may weaken mother-child relationships.
Fortunately, a growing body of research suggests that a caregiver who is generally warm, nurturing and responsive to a baby’s cues can help to strengthen parent and child bonds and buffer young children from the potentially brutal impact of conditions common to homelessness and poverty. Such research has also begun to identify mental health and parenting interventions that promote such nurturing parenting, and that can be particularly effective in helping parents living in the stressful circumstances common to poverty, including overcrowding and homelessness.
Yet while babies and toddlers in homeless shelters may be most in need of these types of services, in New York City they have historically received the least.
Perversely—as Greaves and other case workers have seen again and again— one of the surest ways to get a mother help for a problem like postpartum depression is to report her to ACS for suspected abuse or neglect. By its very nature this creates more stress.
City data show that 25 percent of families living in the shelter system have cases open with ACS. About 13 percent of families receive services designed to monitor children’s safety while providing supports to their families—so that help comes hand-in-hand with stigma and fear. “There is no way to frame that as a positive,” says Geniria Armstrong, Henry Street Settlement’s deputy program officer for transitional and supportive housing. “Trust me, we’ve struggled. We tell the parents, ‘Look at the resources here,’ but they’re hearing ‘Bad mother.’”
But across the city, in what may soon become a movement, a handful of advocates, program directors, and government officials have begun to view the time young children spend in shelters as a chance to meaningfully influence the trajectory of their lives, potentially preventing more costly interventions later on. In a historic move, Mayor Bill de Blasio’s Children’s Cabinet, which is chaired by Deputy Mayor Richard Buery and is tasked with bolstering communication and collaboration among city agencies focused on children’s welfare, has identified the cognitive development of young children living in poverty, including those in the shelter system, as an issue it will soon take on. “We nailed it on pre-K and we are going to continue on that,” says Michael Nolan, a top City Hall advisor to the Children’s Cabinet. “But we also know that a lot happens to kids’ development before they even get to pre-K.”
Statistically speaking, infancy is the time when anyone in the United States is at the highest risk of being homeless, says Marybeth Shinn, chair of the Department of Human and Organizational Development at Vanderbilt University.
For women in precarious housing situations, a pregnancy or new baby often heralds the moment they’re pushed out of the homes of friends or relatives and into the shelter system.
“A lot of moms get kicked out of houses when they’re pregnant or decide whatever living situation they’re in won’t work when they have a baby because it isn’t safe or welcoming,” says Alex Shaw, a former shelter worker and author of a policy paper on aftercare services for the city’s homeless families.
The needs of young children are intense. For a working parent on the brink of poverty, the margin for error is minute; being late for work or missing a paycheck can unravel their lives.
A number of homeless mothers with babies and toddlers are young themselves, and have never had a job or lived on their own and lack very basic life skills, says Sister Mary Doris, executive director of the Bronx shelter Siena House.
Postpartum depression may also play a role in homelessness. One study published in the American Journal of Public Health found that mothers who experienced depression during the postpartum year were significantly more likely than those who did not to be homeless or at risk of homelessness by the time their children were 3 years old. This association held true even for mothers who had no previous housing problems.
In the past, the shelter system could provide families with clear paths for securing permanent housing; homeless families received priority for public housing as well as rental subsidies. But in recent years, these exits from the shelter system closed, and the time families languished in shelters skyrocketed: the average stay in family shelters jumped from 281 days in city fiscal year 2009 to 427 days in fiscal year 2014.
For a baby, 427 days is a once-in-a-lifetime opportunity for intense learning. It’s long enough to go from being a newborn with a floppy neck to learning to smile, sit up, feed oneself, walk, fall and say “Mommy” and “Daddy.” It’s also long enough to intuit whether the world is a generally benign, benevolent place, or one fraught with danger.
These early years are often described as the time when the “architecture” of our brains is created, laying the foundation for our ability to regulate emotions, interact with others and understand the world. When infants and their parents are exposed to an onslaught of stress, the effect can be toxic.
Families in the shelter system have a million-and-one reasons to be stressed. In December 2013, The New York Times documented in devastating detail the effects of living in Fort Greene’s now-shuttered Auburn Family Shelter on Desani, an 11-year old girl. In interviews with homeless families and the service providers working with them, Child Welfare Watch has heard numerous stories echoing Desani’s plight: the shame and stigma of homelessness that attaches to each family member; the frequent antagonism between shelter staff and the families they work with; the broken door locks that don’t get fixed; the bugs and vermin and pesticides in close proximity to sleeping children; the overcrowding and general stresses of parenting in public; the watchful, seemingly ever-present eye of the foster care system. (See “Trapped.”)
For homeless school-age children like Desani, school can offer security and consistency. It’s the place where they might connect to adults who have not only the desire but the resources to help. Babies have no such outlet. “If they’re 13, they run out the door. Infants are more vulnerable. And you can do a lot of damage in a short period of time,” says Philip Georgini, director of shelter services at Nazareth Housing on the Lower East Side. “Those are the ones I worry about most.”
The stresses of homelessness typically begin well before a family arrives at a shelter and linger long after they leave. “There are usually years of people going from family member to family member or resource to friend,” before they become homeless, says Christy Parque, executive director of Homeless Services United. “By the time they end up at the shelter, they are in crises, not just for a housing crisis, they are in a family crisis.”
During homelessness intake, adults without children in tow are assessed for mental health and other issues; that informs where they will live and what services they will receive. But for families, unless something is glaringly wrong, “like a person wears a lampshade and is sitting upside down,” says Josh Goldfein, senior staff attorney at the Legal Aid Society, they receive no such assessment.
Depending on what’s available, families are funneled into one of two types of general family shelters administered by DHS.*** Over half of all families now live in “cluster site shelters” or “hotels,” says Patrick Markee, deputy executive director for advocacy at the Coalition for the Homeless. These are individual apartment units that private landlords rent to social service organizations, and which have no social services on-site. Families are supposed to regularly see a case manager who helps them move toward permanent housing. But in cluster sites, with “the logistical problem of these families scattered in apartments throughout the neighborhood,” says Markee, providing services is difficult, and often doesn’t happen.
The rest of families in DHS housing live in shelters that house multiple families in separate units under one roof. These “Tier II” shelters have case managers on-site and typically provide more services than cluster sites. But the focus is on helping parents find jobs, child care and permanent housing. Advocates say that in recent years, the pressure on parents to find jobs and affordable apartments in a city short on both has fueled an atmosphere of mistrust between staff and residents, making it less likely that parents will reach out to shelter staff with concerns for their children.
DHS requires case managers to ask heads of households a series of intake questions, and some of these touch on mental health. However, there is no DHS protocol for what a case manager should do if a mother, say, suffers from post-traumatic stress disorder. “It is the shelter’s discretion” what to do with that information, says Kristen Mitchell, assistant commissioner of program planning and evaluation at DHS.
Advocates say this approach may miss a mental health issue or family dynamic which could be at the root of a family’s homelessness. “Kids react to what happens with mom and the mom reacts to what happens with the baby and child, so to rehouse families and keep them housed you have to look at the mental health of the family,” says Parque.
Ask around about which shelters are doing particularly good work with children, and chances are Henry Street Settlement will come up. Henry Street runs three family shelters. Its largest has a case manager who lives alongside residents and is available to help out at any time of the day or night. Parents and their children have access to Henry Street’s nearby rich array of community services and programs, including drop-in daycare for children 2 and older and a mental health clinic. But it has been 28 years since Henry Street has had a program designed for babies. “The group we provide the least amount of programming is 0-2,” says Geniria Armstrong, deputy program officer for transitional and supportive housing at Henry Street.
Henry Street is far from unique. In a world short on mental health resources, children too young to speak are chronically overlooked. A 2012 analysis by the Citizens’ Committee for Children estimated that New York City mental health clinics had treatment slots for only about 1 percent of all city children ages 4 and younger with behavior problems.
For children in homeless shelters, the odds of a baby receiving services that do not involve opening a case with ACS are likely even longer.
In the “Baby Steps” 2013 issue of Child Welfare Watch, we highlighted the city’s handful of mental health programs doing innovative work with parents and young children living in poverty. Many of the most effective programs co-located services in places where babies already are: pediatric clinics, daycare centers, Family Court and foster care agencies. Yet we found no infant mental health practitioner based where some of the city’s most vulnerable babies live—in a New York City family shelter.
This may, however, be about to change. In what could be a harbinger of things to come, a handful of advocates are advancing projects to support babies’ and toddlers’ development in homeless shelters. Some are small in scale, like a parent-andbaby group that Armstrong at Henry Street hopes to put in place this year to focus on interaction between parents and their babies, and “on providing an environment where parents can have enjoyable time with their infants.”
In West Harlem, Northern Manhattan Perinatal Partnership just completed a pilot parenting workshop for a handful of men with young children at a family shelter. They are hoping to soon run a similar workshop that stresses nurturing parenting for mothers.
At the social service organization CAMBA, Janee Harvey, the program director of preventive services, is preparing to bring the practical parenting program SafeCare to their Brownsville homeless family shelter. (See “Can a Time-Tested Parenting Program Succeed in a Shelter?”)
Perhaps the most ambitious plan comes from Anne Heller, who until recently was DHS deputy commissioner of the family shelter system, and is now focusing her attention on the city’s most vulnerable babies and toddlers. Heller was struck by city data showing that while most families who come into the shelter system do so only once, a smaller percentage come through repeatedly.
“Many of those families have come into contact with the child welfare system, juvenile justice and mental health systems,” says Heller. They are the families “that have more problems and maybe intergenerational poverty,” she says.
Hoping to find a meaningful way to help those families, Heller began scouring the research on the impact of toxic stress on young children. She was frustrated to find that most city programs either focused very narrowly, took a long time or were costly. Still others simply did not reach the most at-risk families.
Heller has become interested in Attachment Biobehavioral Catch-Up Method, an intervention developed by psychologists at the University of Delaware that works with babies and caregivers in their homes to increase attachment. Known as ABC, “it empowers the mom to make the difference in the child’s life,” says Heller.
Because the program is just 10 weeks long, Heller thinks it will be scalable and also appealing to parents. She hopes to make the model a part of well-baby care in New York City’s poorest neighborhoods, targeting families who need it most, including frequent users of the shelter system.
With Mayor de Blasio’s Children’s Cabinet on the lookout for innovative ways to address the mental health needs of young children, including those in shelters, the time may be ripe for such big dreams. As far as existing services to help homeless babies and toddlers, says Nolan of the Children’s Cabinet, “I don’t think there’s a lot of that happening, to be blunt.”
For Heller, focusing on babies feels like both the ultimate in homelessness prevention and the urgent continuation of work she began at DHS, when the number of children in shelters reached dizzying heights. “If I had known then what I know now, I absolutely would have worked to put earlier services in to try to make a more proactive effort to help kids,” she says, adding, “because the babies can’t wait.”
Martinez was just 19 years old the first time she landed in a shelter with her 3-month-old son and 3-year-old daughter. That was nine years ago. Since then, she and her two children have been in and out of more shelters than she cares to remember. But it wasn’t until her kids became of school-age and began to act out in class that ACS got involved and the family received help. “They got everything then,” says Martinez. “They had therapy. I had therapy. They had a psychiatrist. They got after school. They got an intensive worker who would check the house to see if you need food and bring things like free movie tickets.”
The help came too late to keep her family together. This past year, her children spent nine months in foster care. Soon after the family was reunited in a shelter, Martinez’s daughter ran away for three weeks. At the time Martinez spoke to Child Welfare Watch, her daughter was undergoing an intensive, 21- day psychiatric evaluation at the foster care agency Children’s Village. Martinez’s son, who lives with his mother in the cluster site shelter, suffers from panic attacks.
Sometimes Martinez wonders how things would have turned out if she and her children had received meaningful help when they first entered the shelter system. “My kids would have had a home and I would have been able to start looking for a job,” she says. Instead, Martinez says she is now paying a higher price than she ever imagined. “It’s stressful not being situated and scrambling everywhere and bringing them everywhere with me,” she says. “A lot of the times I think [my children] don’t like being with me because we are always in crappy places.”
* Data from DHS refers to fiscal year 2014. U.S. Census data is from the 2013 American Community Survey.
** This assumes that the number of children living in homeless shelters who do not come from families with poverty-level incomes is negligible.
*** After the deaths of two children late in 2014, DHS has recently changed shelter intake procedures to identify families who are particularly high risk and place them in Tier II shelters, which have more services onsite.