Increasing numbers of homeless female-headed families are entering temporary shelters. Social workers who work with sheltered families are confronted with a complex array of health care problems. This article introduces an analytic framework that classifies the types of health problems that emerge among shelter residents and serves as a guide to social work intervention with the health problems of shelter residents. The framework covers three categories of health problems. illnesses coincident with homelessness, those exacerbated by limited health care access, and those associated with the psychosocial burdens of homelessness. The failures of the current structure of the health care reimbursement and the deficiencies of service delivery to homeless families are discussed. The analytic framework conceptualizes the interrelationship between health and poverty. It can be used as a tool for informed social work intervention, advocacy, training, and research activities.
Female-headed families are the fastest growing subgroup of the homeless population. Runaway teenagers and individuals displaced from housing because of impoverishment in old age or acquired immune deficiency syndrome (AIDS) are also among the "new homeless." The increasing diversity of the homeless population is matched by the increasing range of health problems found among them.
Female-headed families are estimated to constitute up to one-third of the estimated 2.5 million homeless people in the United States (U.S. Conference of Mayors, 1987). Comprehensive data on the health conditions of sheltered female-headed families is still sparse. Social work practitioners who work with sheltered homeless families need to know about the health problems associated with family homelessness; the shelter stay may provide the best opportunity for social workers to coordinate service needs and expedite diagnoses, treatment, and follow-up care for these families.
Social workers also need to understand that all impoverished families, including currently homeless, formerly homeless, and never-homeless families, face similar problems with access to primary health care (Sosin, Colson, & Grossman, 1988) and have similar susceptibilities to ill health. Indeed, the similarities between the health problems of homeless families and those of nonhomeless impoverished families are probably greater than the dissimilarities. This article selectively reviews research drawn from samples of sheltered populations and presents current epidemiological findings on the types of health problems prevalent among sheltered homeless women and their dependent children. Key differences between sheltered homeless and nonhomeless impoverished families are highlighted. This article also includes some predictions about the range of health problems social workers can anticipate finding in practice with sheltered families caused by the circumstances of sheltered families' lives- their often crowded and inadequate physical environments, the dearth of primary health care services, and the stresses of transitory living.
Most of the social work literature focuses on antecedents to homelessness, most particularly mental illness, alcoholism, and drug abuse (Bassuk, Rubin, & Lauriat, 1984; Moxley & Freddolino, 1991; Rife, First, Greenlee, Miller, & Feichter, 1991). This concern is not surprising given that these problems are the traditional province of social work intervention. Less attention has been directed to health problems that result from or are complicated by homelessness. Because of their adverse and transitory living arrangements, homeless people in general have a higher prevalence of illness resulting from exposure to the elements, violence, poor nutrition, parasites, and infectious disease than other impoverished persons (Bassuk et al., 1984; Brickner et al., 1986) The degree of risk for these health problems varies by where homeless people reside, for example, streets versus shelters (Gelberg & Linn, 1989); the duration of homelessness; and the individual characteristics of homeless individuals such as age and gender
To compound this enhanced risk, homeless people face more barriers to medical care than other population groups. …