Ellen L Bassuk

Harvard Medical School | HMS · Department of Psychiatry

In response to the growing awareness of the high rates of potentially traumatic experiences and their potential adverse impacts, health and human service providers have increasingly focused on implementing trauma-informed care (TIC). However, studies focusing on effective implementation have been limited. In this study, we explored the relationship...

Although research indicates that families experiencing homelessness struggle with both structural needs (e.g., housing and income) and psychosocial issues, the assessment process varies considerably among programs serving these families. Historically, the assessment of homeless families has focused narrowly on structural needs; parental functioning...

Person-centered care has yet to be widely implemented in health care settings, a circumstance that disproportionately affects individuals with behavioral health disorders and those with trauma histories. A need exists for a universal approach to care that encompasses compassionate, collaborative relationships between providers and service users. Pe...

This systematic review identifies, appraises, and summarizes the evidence on the effectiveness of peer-delivered recovery support services for people in recovery from alcohol and drug addiction. Nine studies met criteria for inclusion in the review. They were assessed for quality and outcomes including substance use and recovery-related factors. De...

Objective: To describe the development of a new measure, the TICOMETER, a brief assessment tool that can measure trauma-informed care (TIC) in health and human service organizations at a single point in time or repeatedly as well as determine training needs. Methods: With the input of an expert panel we selected relevant items and domains. Initiall...

The numbers of children experiencing homelessness have increased. To develop responsive interventions, we must understand their mental health/behavioral needs. The purpose of this systematic review was to update the evidence base by identifying, appraising, and summarizing studies on the prevalence of mental health issues among homeless children, c...

A disproportionate number of lesbian, gay, bisexual, and transgender (LGBT) youth experience homelessness each year in the United States. LGBT youth who are homeless have particularly high rates of mental health and substance use problems, suicidal acts, violent victimization, and a range of HIV risk behaviors. Given the intense needs of LGBT youth...

Homeless mothers experience disproportionately high rates of major depressive disorder compared with the general population. Stressed by their circumstances, these women struggle to protect their families. Children living with a depressed parent have poorer medical, mental health, and educational outcomes. Despite the adverse impact on children, de...

When Hurricanes Katrina and Rita hit the Gulf Coast, their punch lasted far longer than the initial event. Biloxi and Gulfport witnessed a storm surge of 20 to 30 feet. Most of New Orleans and the surrounding parishes were plunged underwater, destroying entire communities. Neighborhoods that were home to generations of families were left in rubble....

In the past several years, families with children have joined the ranks of the homeless in significant numbers. These families now constitute a third of the homeless population and are rapidly growing. This article describes the effects of growing up in shelters and welfare hotels, and discusses various coping strategies that children have develope...

Approximately 1.5 million children experience homelessness in America each year. The current economic recession and staggering numbers of housing foreclosures have caused the numbers of homeless families to increase dramatically. The impact of homelessness on families and children is devastating. Without a place to call home, children are severely...

The purpose of this paper is to discuss the need for supports and services for families who are experiencing homelessness and to propose a framework for developing them based on families' needs over time. The authors propose a three-tier framework for understanding the needs of homeless families. Tier 1 includes short-term basic needs such as affor...

It is reasonable to assume that individuals and families who are homeless have been exposed to trauma. Research has shown that individuals who are homeless are likely to have experienced some form of previous trauma; homelessness itself can be viewed as a traumatic experience; and being homeless increases the risk of further victimization and retra...

Current knowledge about the services and supports needed to help individuals and families exit homelessness and maintain housing is incomplete. To date, there is limited research documenting which services are most effective, the best models of delivery, and recommended intensity and duration. The special issue of the Open Health Services and Polic...

Hiring and retaining appropriate staff is essential for programs serving those who have experienced chronic homelessness. This paper describes specific staffing challenges and strategies from the Collaborative Initiative to Help End Chronic Homelessness (CICH), an 11-site, multi-agency Federal program designed to serve people experiencing chronic h...

The authors recognize those who supported the development of the special section on parenting and homelessness appearing in the current issue of American Journal of Orthopsychiatry., including the Substance Abuse and Mental Health Services Administration; the Journal's staff; and the Homeless Programs Branch, Division of Service and Systems Improve...

This overview of parenting and homelessness includes the characteristics and needs of families who are homeless, with a focus on the unique challenges faced by mothers, fathers, and children. In addition, the authors discuss how homeless families are narrowly defined based on the family members who present at shelters and other service programs. In...

Using a person-centered analytical approach, this article examines data from the Worcester Family Research Project to determine whether homeless children (53 preschoolers and 69 school-age children) can be classified into subgroups based on measures of behavior problems, adaptive functioning, and achievement. Cluster analyses revealed two clusters:...

Homelessness is a tragic social problem affecting more than 2.1 million adults and1.3 million children each year (Burt et al. 2001). Almost 10% of people living inpoverty experience homelessness annually (Burt et al. 2001) and more than 25% ofall people with severe mental illness will experience the devastation of losing theirhomes at some point in...

Despite high revalence rates of intimate partner violence in the lives of extremely poor women with dependent children, few studies have investigated the patterns of violence that occur over time, and the characteristics of women that serve as risk markers for partner violence. This paper describes patterns of domestic violence longitudinally and u...

Without Abstract

This article reviews what is known about the role of housing and services in reducing family homelessness. People in families comprise 33 percent of the homeless population, but few resources are available to fully meet their needs. Some researchers have suggested that the vast majority of these families do not need services and that housing vouche...

The authors examined the association between exposure to violence and different indexes of mental health among 95 extremely poor children (age range = 8-17 years) and analyzed potential moderators and mediators. Findings indicated that 62% of youths had been exposed to at least 1 form of violence. Controlling for other explanatory factors, exposure...

More than half the global population is extremely poor. Many live in substandard housing, can’t read, earn barely enough to feed themselves and their families, and have few opportunities to better their circumstances. Their struggle to survive is often compounded by feelings of helplessness, terror, and despair. Although most of these people are re...

Data from the Worcester Family Research Project were analyzed to determine whether social support processes are altered by poverty and whether kin and nonkin support are differentially related to mental health in low-income mothers. The authors found that conflict with family and friends predicted adverse mental health and more strongly predicted t...

Based on a study of sheltered homeless and low-income housed families, predictors of academic achievement among 174 English-speaking children age 6 and older were examined, focusing on housing status, mobility, and race/ethnicity. Days absent from school was hypothesized as the mediating link between homelessness and academic achievement. In multiv...

To identify childhood antecedents for lifetime post-traumatic stress disorder (PTSD) and to determine how this diagnosis relates to health and service use among extremely poor women. We conducted a secondary data analysis of 425 women in the Worcester Family Research Project, a case-control longitudinal study of 220 sheltered homeless and 216 extre...

Little is known about the dynamics of homelessness among families that have been homeless more than once. Using longitudinal data from the Worcester Family Research Project, this article describes the duration of family homelessness, compares the characteristics of mothers who had been homeless only once with those who had been homeless multiple ti...

Knowledge of human immunodeficiency virus (HIV) and its risk behaviors have not been systematically studied in homeless mothers. The identification of the factors associated with HIV-risk practices will guide interventions for low-income housed and homeless women. We interviewed 220 homeless and 216 low-income housed mothers living in Worcester, Ma...

This study examined the relationship between housing status and depression, anxiety, and problem behaviors among children age 6 and older who were members of low-income, single-parent, female-headed families. Participants were 80 homeless and 148 never homeless children living in Worcester, Massachusetts. Children in both groups had recently been e...

This study compared the prevalence of DSM-III-R disorders among homeless and low-income housed mothers with the prevalence of these disorders among all women in the National Comorbidity Survey. The authors used an unmatched case-control design for assessing 220 homeless and 216 housed mothers receiving public assistance. Homeless and housed mothers...

Previous studies of homeless children have described more health problems and service use than in housed children, but failed to control for potential confounding factors that may differ between these children. This observational study examines the relationship of homelessness and other determinants to health status and service use patterns in 627...

This study describes the development status of 127 homeless and 91 low-income housed infants and toddlers. The Bayley Scales of Infant Development and the Vineland Screener were used to gather data. There were no differences between homeless and low-income housed children. However, younger children in both groups performed better than the older chi...

Using data from a case-control study of family homelessness in Worcester, Massachusetts, this analysis compares the economic, psychosocial and health characteristics of 159 Puerto Rican and 170 Non-Hispanic White poor, single mothers. When compared to Non-Hispanic Whites, the Puerto Rican mothers had more children, less education, fewer work experi...

Americans have started to recognize interpersonal violence as a major health care issue. Increasingly, clinicians are beginning to recognize both the high rate of victimization among extremely poor women and its health consequences. However, most clinical responses focus on the immediate effects of child abuse, partner abuse, and rape. The long-ter...

Americans have started to recognize interpersonal violence as a major health care issue. Increasingly, clinicians are beginning to recognize both the high rate of victimization among extremely poor women and its health consequences. However, most clinical responses focus on the immediate effects of child abuse, partner abuse, and rape. The long-ter...

To assess the mental health of homeless and poor housed youths, using the National Institute of Mental Health (NIMH) Diagnostic Interview Schedule for Children (DISC) Version 2.3, and to examine mental health service use. As part of a comprehensive study of homeless and housed families Worcester, MA, data were collected on 41 homeless and 53 poor h...

To describe the characteristics of homeless and low-income preschool-aged children, and to identify family and environmental determinants of their behavior. An unmatched case-control design was used to recruit a sample of sheltered homeless families and a comparison group of low-income housed families who were never homeless in Worcester, Massachus...

To identify risk and protective factors for family homelessness, a case-control study of homeless and low-income, never-homeless families, all female-headed, was conducted. Homeless mothers (n = 220) were enrolled from family shelters in Worcester, Mass. Low-income housed mothers receiving welfare (n = 216) formed the comparison group. The women co...

In Reply. —Based on our clinical and research experiences, we agree with the hypothesis of Ms Plummer and colleagues that posttraumatic stress disorder and depression may inhibit high-risk women from participating in long-term services and programs. While we have data to examine these issues, we have not yet conducted the analyses to support this...

The factors that push families into homelessness in the United States are analyzed using data on some 450 single women and their children in Massachusetts. This group has been studied since 1992. Particular attention is given to the role that welfare in the form of Aid to Families with Dependent Children (AFDC) has played in the survival of these f...

To compare characteristics of homeless and low-income housed mothers across economic, psychosocial, and physical health domains. Case-control study. Community of Worcester, Mass. A cross-sectional sample of 220 sheltered homeless mothers and 216 low-income housed (never homeless) mothers receiving welfare. Income, housing, life events, social suppo...

Introduces the articles in this issue of the American Journal of Orthopsychiatry (1993[July], Vol. 63[3]). This special section explores the experience of homeless women--a neglected population in urgent need of housing, supports, and services. The idea for a special section of the Journal addressing the unique problems faced by women initially aro...

The impact of pregnancy on the course of homelessness and the adverse effects of homelessness on pregnant women and their babies are explored. Recommendations for policy to address the urgent needs of this population are offered, and components of an innovative three-site demonstration program are described.

Examines the relationship, especially for women, between homelessness and mental health. Various mental health issues and gender-related concerns that have implications for the design of interventions for homeless women are explored. Homeless women attempt to cope with multiple psychosocial stressors often complicated by untreated medical and menta...

This article discusses the report, Federal Task Force on Homelessness and Severe Mental Illness, 1992 by the Interagency Council on the Homeless. The report discusses the complex needs of severely mentally ill homeless persons and offers 50 "action steps" for implementation by various federal departments and agencies to improve the housing, income,...

A comparison was made of 86 children from 49 homeless Boston families headed by women and 134 children from 81 housed Boston families headed by women. In both groups, the mothers were poor, currently single, and had been receiving welfare payments for long periods. Data were collected from the mothers by personal interview; standardized tests were...

We compared 49 homeless female-headed families with 81 housed female-headed families in Boston. Most housed families were living in public or private subsidized housing. In both groups the mothers were poor, currently single, had little work experience, and had been on welfare for long periods. Many of their children had serious developmental and e...

Characteristics of homeless children were assessed in interviews with 82 homeless families, including 156 children, living in 14 Massachusetts family shelters. Developmental delays, severe depression and anxiety, and learning difficulties were common among the children. Based on the use of research screening instruments, about half the children wer...

To describe the characteristics of homeless families, we interviewed 80 homeless mothers and 151 children living in 14 family shelters in Massachusetts (two-thirds of the shelters in the state). Ninety-four per cent of the families were headed by women, 91 per cent were on AFDC (aid to families with dependent children), with twice as many as the st...

As the entire system of mental health care changes, psychiatric emergency services find themselves redefining who they treat and how.

Increasing numbers of patients formerly hospitalized in state facilities are using private general hospital psychiatric emergency services. To define their clinical needs, the authors compared the characteristics of patients hospitalized in state institutions to those hospitalized privately and to those never hospitalized. They found that two discr...

Seventy-eight homeless men, women, and children staying at an emergency shelter were interviewed. The vast majority were found to have severe psychological illnesses that largely remained untreated. Approximately 91% were given primary psychiatric diagnoses: About 40% had psychoses, 29% were chronic alcoholics, and 21% had personality disorders. Ap...

Increasing numbers of chronic patients are using the general hospital emergency room for psychiatric care. The characteristics of these patients and management issues in an acute-care setting are described, and the need for continued program development and training, particularly in the area of psychosocial rehabilitation, is discussed. It is predi...