Methods: Data collection took place at three family homeless shelters in St. Louis, MO. Key informant interviews with staff and qualitative group model building (GMB) with homeless shelter clients with children generated insights into the processes underlying patterns of service use that reinforced vulnerability to mental disorder. GMB conducted with providers and caregivers of children in family emergency shelters utilized three “scripts,” or activities, to elicit insights on facilitators and barriers to successful homeless system exit: “variable elicitation,” “graphs over time,” and “initiative and elaborating a causal loop diagram.” Data were analyzed using content analysis with emergent coding to identify key themes and articulate a causal feedback theory to explain mechanisms driving unmet need in family homeless services over time.
Results: Staff participants included 6 providers in client-facing roles in three family homeless shelters 5- 24 years’ experience. Client participants included 37 caregivers experiencing homelessness. Caregivers were overwhelmingly female (91.2%) and African American (86.5%), and had approximately two children. Three key themes – mental health, shelter conditions, and available housing and homeless services – were involved in a number of positive (reinforcing) and negative (balancing) feedback processes. Capacity constraints and pressure on staff limited the number of families in services. Simultaneously, shelter living at times actually undermined provider goals of timely exit; with emergency shelters constantly full to capacity, both staff and clients reported overcrowding increased client stress and eroded the empowerment and self-efficacy needed to make progress toward stable housing. This delayed shelter exit as families’ needs were compounded by the stress caused by shelter conditions. Furthermore, longer stays eroded empowerment and further reinforced length of stay – exacerbating crowding. A counterintuitive insight was crowding also accelerated client exit, via increased pressure on staff members in light of limited capacity. Thus, length of stay was impacted both positively and negatively by crowding.
Conclusions and Implications: Findings support prior research suggesting homelessness and entrance into homeless services pose significant barriers to the routines of positive parenting, interfering with caregiver autonomy and parent-child attachment; this puts caregivers in the difficult situation of having to manage both their own and their children’s needs. A scarcity mindset allows factors other than client need to drive decisions about cases; agency policies and staff training should be modified to avoid moving families too soon in response to strained capacity. Finally, homeless services should emphasize mental health promotion, not only due to high rates of mental disorder among consumers, but because improved emotional well-being can accelerate sustainable return to stable housing.