Running Head: THE EFFECTS OF HOMELESSNESS ON CHILDREN 1

THE EFFECTS OF HOMELESSNESS ON CHILDREN20

The Effects of Homelessness on Children in the United States and FinlandDalton LuskElizabeth RuckQuade Vickers Megan Wallace Samantha WilsonMissouri State University

Concerns for Health Promotion and Prevention of DiseaseHomeless children are at extreme risk for disease and lack of access to health care. Because they are children, they often rely on adults for basic care needs. If these are not being provided, they are at an increased risk for the development of disease. Because they are homeless, this likely means that they do not have adequate funds for basic health care needs. A nurse must first recognize the child who is homeless. Then, he or she can plan interventions for health promotion and prevention of disease that relate to the specific risk factors of this population. Once the nurse has established that a child is homeless, he or she must then identify areas of concern that address health promotion and disease prevention for the population. When considering the population of homeless children specifically, areas of concern for a nurse in the US and Finland would be lack of access to quality health care, hazardous living conditions, and poor nutrition (Karr, n.d.). Although all homeless families are different, many who are homeless also do not have health insurance or qualify for Medicaid. Because children rely on their guardians for health insurance, if their guardians do not have health insurance, neither will the children. Homeless children who do not have a guardian will also lack health insurance because they are too young to obtain employment benefits or to apply for health insurance. While many communities offer free health care services through health fairs and clinics, many do not meet a childs specific health care needs. In turn, many homeless children lack access to quality health care.When a child is homeless, he or she is not protected by the comfort and safety of a home. By living on the streets, bouncing between couches in different homes, or temporarily living in a shelter, homeless children can be exposed to many threats to their health. Exposure to disease is increased when living in dirty environmental conditions or shelters with hundreds of people who carry various illnesses. A child may also be exposed to dangerous conditions, such as abuse, drugs and alcohol, unsanitary water, and increased toxins and air pollutants. While all of these hazards could also be in a home, a homeless child may be at greater risk because of his or her environmental surroundings. Lastly, an area of concern for homeless children is poor nutrition. As the price of groceries continues to rise, many families cannot afford to feed their children. In addition, a homeless family does not have a refrigerator or freezer and would have to purchase only non-perishable food items. While many communities offer free meals for the homeless population, most are high in carbohydrates and lack essential nutrients from fruits and vegetables because the organizations need to keep the meals cheap. A child is in desperate need of adequate nutrients, vitamins, and minerals to support healthy growth and development. Most homeless children come from low-income families. Often this low-income is not enough to provide a sufficient amount of food for dietary needs, and a homeless child suffers from poor nutrition. Health ServicesAlthough lack of access to health care, hazardous living conditions, and poor nutrition are all areas of concern for homeless children in the US and Finland, there are available health services in both countries that can promote health and prevent disease in this population. I chose to identify health services in Missouri because I will most likely be working in Missouri and would like to know where to refer my clients. Many of these services are family-based. The city of St. Louis, MO offers a homeless hotline that homeless individuals are encouraged to call so they can be referred for emergency shelter and support services. There are also prevention services, transitional housing, and emergency shelter. Supportive services offered that could benefit a homeless child include nutrition services, support groups, health care services, parenting assistance, and mental health services (City of St. Louis, 2011). Springfield, MO offers many services for the homeless. The Ozarks Family Resource Center offers emergency shelter services to children who need to be removed from crises (Great Circle, 2014). Jordan Valley Community Health Center provides health care services to low-income families, and the MSU clinic will be opening to provide health services to people without health insurance. The Springfield-Greene County WIC program is used to improve the nutrition of women and children and provides services such as supplemental food and education about nutrition. WIC is one health service that accepts mothers on Medicaid. There are also national programs that create policies to reduce homelessness among children and provide services to promote health and prevent disease. In the US, one of these organizations is the National Health Care for the Homeless Council. When visiting the organizations website, one can find sections about research on homelessness and public policy and advocacy to reduce the number of homeless children in the US. Another website is the Health Care for the Homeless Information Resource Center. This site is supported by the US Department of Health and Human Services, and it includes a state-based directory of projects that promote health care resources for the homeless. It also provides hotlines for crisis situations. In Finland, services such as the Federation of Mother and Child Homes and Shelters are available. The purpose of this federation is to offer homes and shelters as well as aid families in obtaining resources to find a permanent, safe living situation. The main health services offered in Finland are shelters that have programs such as counseling, education, safety classes, legal assistance, social services, and healthcare services for families and children (Expat Finland, 2015).When comparing the US and Finland, it is clear that they are very similar when it comes to health promotion and disease prevention for homeless children. Both countries use shelters for emergency housing from crisis situations and for temporary housing for protection from hazardous environments. Health promotion most often comes in the form of education. Both countries provide numerous educational opportunities for the prevention of disease and enhanced quality of life. Disease is also prevented through programs such as WIC, which provides nutritional counseling and supplements, immunizations, and other health care services. In addition, both countries also implement policies to improve the quality of life of homeless children. For example, the US implemented the McKinney-Vento Homeless Assistance Act as part of the No Child Left Behind Act, which was put in place to ensure that homeless children received equal access to the same public education as all other children. This policy ensures that whether or not they have a home or the required paperwork for enrollment, homeless children will still receive educational services that will help them meet the states student academic achievement standards (United States Department of Education, 2004). Homeless children are a vulnerable population with areas of concern, such as lack of access to quality health care, hazardous living conditions, and poor nutrition. Unfortunately, homeless children have many risk factors for poor health, but when children and families who are homeless utilize health services in the US and Finland, health can be promoted and disease prevented through education, nutrition, immunizations, and a safe environment.RehabilitationThe Merriam-Webster Dictionary defines rehabilitation as the act of bringing someone back to a good condition. When talking generically about a vulnerable group of people, rehabilitation may refer to programs or organizations such as social services, psychiatric treatment, or even homeless shelters. In regards to homeless children, types of rehabilitation that would be necessary may include youth homeless shelters and reaching out to various programs that cater to at-risk youth or youth currently experiencing homelessness. Examples of these programs in the United States include the Family and Youth Services Bureau (FYSB), the National Association for the Education of Homeless Children and Youth (NAEHCY), or the National Center on Family Homelessness. The Family and Youth Services Bureau works by supporting and advocating for other organizations that deals with homeless youths. They often provide financial support in the form of grants (FYSB, 2015). NAEHCY is an organization in the United States that aims to allow children dealing with homelessness to still achieve academic excellence (NAEHCY, 2015). NAEHCY provides training support and a variety of resources to help children achieve excellence in an academic setting (NAEHCY, 2015). Lastly, the Family and Youth Services Bureau collaborate with programs and homeless shelters that aim to assist children in need of housing. In Finland, some of the main Finnish organizations include the Federation of Mother and Child Homes and Shelters and the Helsinki Deaconess Institute (Expat, 2015). The Federation of Mother and Child Homes and Shelters aims to keep mothers and their children together while providing them with the necessary housing or shelters (Expat, 2015). The goal of the Helsinki Deaconess Institute is to provide children with educational programs, social services, and healthcare services who otherwise may not have access to some of these options (Expat, 2015). In regards to nursing, when dealing with children who have been subjected to long periods of homelessness, one challenge may include the educational/language barrier. Children who are homeless may not be cognitively functioning at the same level of children the same age due to a lack of education. Because of this, it could be difficult when trying to communicate plans of care to the young client. In summary, there are organizations in both countries that aim to cater to children in need of housing. These organizations generally help by providing financial assistance to the youth homeless shelters. Rehabilitation Programs in FinlandThe Finnish and English systems for rehabilitation of homeless families are both very different, with some similarities with different conclusive effects. Crites (2015) believes that the Finnish Government organizations and the non-profit (charitable) organizations work together to achieve their goals and targets, however the review of the English system for combating homelessness was not as positive and seemed quite highly flawed in detecting the definition of homeless and leaving people without a home, but did not fall under legislative law as the definition of homeless. Finland, as a country, has a national comprehensive policy on homelessness; which allows them to define national goals and strategies, which is why Crites (2015) believes Finland, as a country is so successful on combating homelessness. With in the UK, one of the positives that is highlighted through a negative statement by Crites (2015) exemplifies that people were not being identified as vulnerable, which as whole for the homeless population is negative, however children are categorized as a vulnerable group, therefore help would be provided. Therefore even though Finland seems to have an overall bigger and more positive impact of homeless children and families, the UK is trying to provide help for the most vulnerable. Within the UK there are many different provisions that are given to children who are homeless to support their care and health needs. Shelter (2010) has given a guideline on supporting homeless children for health visitors, who support the child from the ages of birth to 5 years of age. Shelters (2010) guidance is molded by the Every Child Matters (2003). The program allowed services and individuals to protect and safe guard children more thoroughly a vulnerability group. The most important goals for every child were made clear through the 2003 paper, with first and for most be healthy and be safe, which homelessness impinges on both. Shelter, (2015) state in detail that poor living conditions impinges on health, safety, achieving, positive contribution and economic well-being gravely. Therefore using health visitors as a positive rehabilitation enforcement to instigate using CAF (common assessment framework) forms to assess the child and whether their needs are being met, which allows them to refer to an array of multi-disciplinary groups. The use of many different services such as baby clinics with in homeless shelters, free prescriptions for children (NHS, 2014), and many other applicable offered help for children contributes to the rehabilitation of homeless childrens health. Although the focus on childrens rehabilitation from homelessness and health support throughout homelessness is extremely well governed and provided in England the overall rehabilitation system does not seem to be working as well as in Finland, this is seen due to the statistics involving homelessness and the Finnish having a stronger national comprehensive policy on homelessness that the UK do not have (Crites, 2015). The English system may arguably impact considerably on a childs wellbeing due to them more likely to be in temporary accommodation, which normally the conditions are not well supported in regards to health, in comparison with a very low rate of temporary housing for homelessness in Finland, giving them long term accommodation which just not inhibit their health, is also reflected in the decrease of homeless health care services needed. Finland also provide children and expecting mothers with the Finnish Maternity and child health clinic system, ranging right back to the 1920s and by 1944 most of the country was covered (Finland Care, 2014). The maternity package is also another free system for every expecting mother to provide the child with the best start, no matter what the living circumstances are. Overall, Finland seems to have the stronger rehabilitation guidance as a whole, however England also has very strong guidelines when it comes to protecting a childs welfare and position whilst homeless with the rehabilitation and support needed once finding permanent housing. The Finnish also have stable programs in place to protect childrens welfare, whether there are homeless or not, of which the programs have been established for longer periods of time, arguably making them more permanent; however England have much newer reinforcements to protect children as a vulnerability group, making them more up to date and approaching the problems that have occurred more recently such as a rise in the homeless population. Similarities and Differences with Rehabilitation in the US and FinlandRehabilitation with in Finland is very strategized and molded by an organization of goals to combat homelessness being present with in the Finnish community. In 2008-2011 and then in 2012-2015, the main goals for reducing long-term homelessness were set, and the introduction of the housing first model. The Ministry of The Environment report (2015) suggests that the model was actually collaborated after analyzing the systems with in the UK, the US of A, and Sweden; therefore Finland was trying to exuberate the best of each country with in a model that would prove to be the most successful statistically and a reflection with in the countries financial gain. Overall it has been recognized that the goal to reduce long-term homelessness on a national level has been successful, with the help of a far-reaching cooperation strategy that meant the program to reach the goals could strive and be beneficial to the Finnish people. The status of homelessness is a constantly changing singularity on events inclusive of the support given to prevent homelessness and the demand for housing and when it is supplied; it is also affected by immigration. The overall report (Ministry of Environment, 2015) was inclusive of a summary of three sections, property market, prevention and housing and support. Prevention is normally seen as more cost effective and socially beneficial than a cure to problem, therefore prevention is a highly used tactic in both the USA and within Finland. The prevention of evictions is a scope for dealing with homelessness as quickly and as effectively as possible with in the USA. Within Finland the housing guidance has proven to be a successful method in preventing adults and children being evicted from homes; which includes the management of finances and psychosocial case control assistance. Finland focuses on targeting vulnerable groups, such as children/young people with substance abuse that are at risk of long term homelessness or people are risk of social exclusion (Environment report, 2015). This highlights the importance of being prepared with long-term housing provisions to minimize the risk of vulnerable people being in a homelessness state of conditions. Housing and support Is another crucial factor when considering rehabilitation with in Finland and the USA. The Finnish model differs from the original USA model of housing and support, however it does achieve its goals through remaining constant to the principles of the Housing first philosophy, to provide long-term housing for homeless vulnerable people. In both the USA and Finland peer support proved to be successful in integrating people back into society, and as a preventative rehabilitation. Communal housing options and following the Housing First principle in Finland will be continued to ensure positive results are still unveiling from the project. The housing will only be available when the property market conditions are allowing housing to be found for long term and permanent reliant vulnerable people. The conversion of shelters into housing units has been significant for the advancement in helping the homeless in Finland. Within the USA, it has been noted that it has been made achievable that they could house many homeless people in rental accommodation through the private sector, once setting up support systems to guarantee it as a long term solution (The Environment Report, 2015). Governmental and Nongovernmental AgenciesWhen discussing the health concerns of both Finland and the United States, it is important to first examine how each of these health care systems work. Finlands health care system is set up at three levels: municipal health care, private health care, and occupational health care (Vuorenkoski, 2008). All three of these levels receive public funding, with municipal health care receiving the most. Using municipal health care allows more freedom for each city to design and implement a plan that works best for their region. While many people support the decentralization of their health care system, others believe that the disadvantages may outweigh the advantages (Vuorenkoski, 2008). Some of these complaints include the waiting times, waiting lists, and access to care (Vuorenkoski, 2008). This health care system in Finland differs in many ways from the United States health care system. In the United States, health care is run at the state and federal levels. The federal government implements universal laws on health care that must be followed by each state; however, states still have influence over how these laws are enacted. While health care has always been available to everyone, not everyone has always had insurance coverage. With the Affordable Care Act (Obamacare) passed into law, all citizens are now required to obtain insurance coverage. Providing coverage to all has some advantages, but it also has many disadvantages. These disadvantages include problems with waiting times, waiting lists, and access to preferred health care, which are comparable to problems faced in Finland. There are many organizations in Finland and the United States that offer services to homeless children. In the United States, most agencies that deal directly with children are nongovernmental agencies that receive their funding through donations. Two well-known nongovernmental agencies that are helping with this issue are the Covenant House and StandUp for Kids organizations. Covenant House is the largest privately-funded agency in the United States that is taking strides to counteract homelessness in children (Covenant House, 2015). This organization helps children aged 14-20 with developing and obtaining the skills needed to become active members of society (Covenant House, 2015). Covenant House currently has locations across the country that are easily accessible. StandUp for Kids is a not-for-profit organization that originated in San Diego, CA (StandUp for Kids, 2015). This organization offers children a wide variety of services, including anger management sessions, tutoring services, financial aid, study skills, and goal-setting skills. StandUp for Kids has locations in cities all across the country including Washington, D.C. Unlike Covenant House, StandUp for Kids is almost entirely volunteer-run, which helps reduce their overhead and further drives the company (StandUp for Kids, 2015). Two large governmental agencies that are fighting homelessness in the United States are the United States Department of Health and Human Services (HHS) and United States Department of Housing and Urban Development (HUD). The Department of HHS is taking steps to improve the health and well-being of all Americans. HHS has a department devoted to runaway and homeless youth, which focuses on providing programs and outreach services that will offer assistance to homeless children (USDHHS, 2015). HUD is another governmental agency that reaches over 1 million homeless people every year (HUD, 2015). This organization focuses on providing housing for those in need, which can have a positive impact on homelessness in children. By providing housing to families, they are reducing the number of children who are being forced to live on the street. Both the HUD and HHS provide a plethora of services that can aid homeless children in the United States. Like the United States, Finland also faces many problems with homelessness in children. Two organizations that are fighting this ever-growing problem are Expat and Youth Advocate Program International (YAPI). Expat is a Finland-based not-for-profit company that assists in emergency and crisis situations (Expat, 2015). Their website offers resources for the homeless and provides 24 hour violent situation support (Expat, 2015). YAPI is an organization based out of Washington, D.C. that is trying to implement services across the world that will end child labor, violence, and homelessness among children (YAPI, 2015). They are currently providing support around the world, including Finland. Finland and the United States are both facing major issues with homeless children in their countries. Both countries have very similar organizations that are working to counteract the effects of homelessness. These organizations provide very similar services, as stated above. Both nations recognize there is a problem within their borders and something needs to be done to fix it. However, despite the numerous organizations in place and the corresponding efforts, there is still a growing number of homelessness in each country. This indicates that there is a gap somewhere in these systems between implementation and effectiveness. The source of the problem may not lie with the organizations, but with the people. With all of the available resources, it is hard to see how the number of homeless men, women, and children continue to grow. Part of this may be due to the mindset of the people in this situation. If the homeless population is not willing to make efforts to help better their situations, the problem will always remain. Once we can develop a system that motivates people to help themselves, then, as a nation, we can begin to have profound effects against homelessness.Community Health ConcernsThe community health concerns with in Finland in comparison to England and the United States are very minimal when analyzing the statistics, especially when concerning homelessness regarding children, however a comparison of statistics may deem unfair upon the United States due to the considerably larger population there, compared to England and Finland. A comparison between Finland and England may also be reasoned also incompatible due to the distance in size of population and distribution of living circumstances. Therefore the most serviceable comparison would be the concerns with in the community of homelessness and the health concerns surrounding them and who is addressing the concerns, both governmental and non-governmental based. The Finnish system when regarding homelessness first presents with staircase models (Housing First, 2015), which promotes rehabilitation through giving vulnerable people the chance to gain leverage through social rehabilitation to promote them reaching earning their own housing. Unlike the United States and England, The Housing First Finnish organization encourages the idea that gaining housing is only the first step in the ladder to social rehabilitation with in the community after being homeless. The Networking for Development (2014) scheme supports the national governmental target of eradicating long-term homelessness by the end of 2015. This target would never be made by governmental and non-governmental organizations with in the United States, as the problem is too vast and to wide spread with in those countries. As the statistics for children subjected to homelessness in England from a BBC (2014) report stated that 84,390 children under 18 were reported homeless. Therefore underlining that even though we cannot compare statistics, we can use them to highlight that because of the size of the problem, the difference in goal expectations will be addressed in different ways and methods to create realistic expectations. Within 2011, there were 7,572 people, including adults and children detected homeless, and Global Homelessness (2015) statistics suggests that there has also been a considerable drop in the amount of homeless people since the 1980s due to the National Homeless Strategy (2012). The national homeless strategy has developed but the initial scope was to reduce long-term homelessness between 2008-2011, and then remove long-term homelessness completely by 2015. Due to governmental funding of 200 million euros, this insured adequate funding to provide the country with results. Although the breakdown of the funding did not specify whether this included health concerns, it is clear that the first stage of the strategy work considerably well, therefore eliminating the needs for excessive health care funding for the homeless. The Finnish National Programme (2010) for reducing long-term homelessness report did indicate about the financial gains from the decrease in homeless people in using healthcare provisions. The use of social and health services decreased as homelessness decreased, due to being fewer substance abusers using health services. Finland has shown a successful streak in improving the homelessness situations amongst families, showing that there is almost no need for temporary housing (Busch-Geertsema and Sahlin, 2007). It has been identified that Finland moved towards approaching homelessness to provide long-term suitable accommodation initially, supported with appropriate health care services, derived from the Housing First approach. Finlands primary health care system has been available since 1972 and is funded by the local public authorities (Kokko, 2009). Kokko (2009) stated that the health care model during the time of research was being changed so that it would also split the age groups of the service users, which would be beneficial for children and adolescents, however it is exclaimed with in this research that models have been drawn up to promote health in sectors of vulnerability groups such as homelessness to provide extra health care needs. Primary health care with in the public services in Finland provides all permanent Finnish residents with health care, inclusive of; vaccinations, school and student healthcare, emergency treatment, consultations with a doctor, health counseling and mental health services. Primary health care in Finland is not completely free, however is reasonable according to some, as to see a doctor it normally will cost 16.10 euros. Municipalities must determine health care fees on whether the client is able to pay, and will it be detrimental to the client or familys needs (EXPAT, 2015). This is a crucial point for the homeless people who need healthcare, as some will be unable to pay the medication fees and the consultation fees, which is where the strategies do help. The school and student healthcare especially is beneficial for the small community of homeless children with in Finland. Primary, Secondary and Tertiary PreventionA nursing theory that incorporates primary, secondary and tertiary prevention that can be applied to the vulnerability group of homeless children is Betty Neumans Systems Model. This theory goes in depth to discuss the individuals relationship and reaction to stressors that occur throughout the lifespan. The model displays energy resources representing the person as the open system, central core, surrounded by three lines of defense representing internal factors that help protect the individual from these stressors. The normal line of defense surround the internal lines of defense in this model and represent the individuals state of equilibrium, or the balance that they are currently experiencing or not experiencing. Outside of these lines lies the flexible lines of defense that illustrate what is dynamic in nature and constantly changing over time. The nurse must work to maintain the stability of this system and can do so through primary, secondary and tertiary prevention efforts (Reyes, Ricana, Rico, Rimas, & Rosales, 2008). Regardless of the housing status of children, all citizens need health promotion at the primary, secondary and tertiary levels in order to be well and stay well. Many homeless children around the country find stability in their lives through the public school system. A means of primary prevention that is often used for children experiencing homelessness is the healthcare that is made available to them through public school. Although these children do not have health insurance, public school have nurses that can provide treatment for basic ailments and illnesses. Schools often have access to community resources such as mobile health clinics that provide flu shots, physicals, and dental care, which can make a huge impact on primary prevention in this group as well. Free and reduced lunches, clothing banks, and backpack meal programs through public school programs also help meet basic food and clothing needs so that these children can move on to having more advanced hierarchies of needs met. Primary prevention according to Neumans Systems Model protects the normal line of defense. For example, strengthening the individuals normal state of equilibrium by providing education about hygiene community resources. Primary prevention also strengthens the flexible lines of defense, which make it more unlikely that the patient will be affected by stressors and more likely to overcome the ones that they are faced with (Reyes, Ricana, Rico, Rimas, & Rosales, 2008).Secondary prevention in homeless children is often a challenge because these children are not usually being seen regularly in a clinic, making it difficult to know about the existence of a disease. Often times, the public school system provides a means for secondary prevention for these children as well. Hearing and vision screenings are provided by nurses in public schools across the country. If abnormalities are detected, referrals to appropriate community resources can be made through school nurses and guidance counselors. Often times, there are programs that work to serve underprivileged children in communities that provide funding and transportation for children and families who would otherwise not have access to appropriate services. Secondary prevention is very important in this particular vulnerability group because without proper treatment, conditions that go unmanaged can rapidly progress into chronic conditions that lead to lifelong health problems.According to Neumans Systems Model, secondary prevention helps to strengthen the individuals internal lines of resistance and reduce the reaction to stressors. This could include things like screenings and early treatments for conditions such as poor vision, poor hearing, or asthma. If an individual is able to maintain control over the onset of a condition, they are more likely to prevent it from progressing and therefore help strengthen their internal lines of resistance (Reyes, Ricana, Rico, Rimas, & Rosales, 2008). Regarding tertiary prevention in the vulnerable group of homeless children, extra care must be available for them to help manage their chronic conditions. Children with asthma or diabetes require medications and testing supplies to help keep the disease from exacerbating. It is often difficult for homeless families to access these supplies due to lack of health insurance and access to resources. Nurses, volunteers, social workers, and people who advocate for community programs can help broadcast the availability of free healthcare resources to the homeless by hanging flyers in homeless shelters, soup kitchens and other places that work to serve the homeless population. Controlling chronic disease from a young age can help a child manage his or her condition more tightly and provide better outcomes in the future as they grow into adulthood. Tertiary prevention in the Systems Model helps to stabilize the individuals state of equilibrium and help them return as closely to their normal state as health as possible (Reyes, Ricana, Rico, Rimas, & Rosales, 2008). Management of chronic conditions such as diabetes and epilepsy can protect the individual from further deterioration of body systems and help them prevent episodes that otherwise have a negative impact on the individual.Conclusion Homelessness affects millions of men, women, and children across the world. Finland and the United States are no exceptions to this ever growing problem. While people are aware of homelessness, it is easy to forget that this is a major problem for children. Most people view homelessness as a self-appointed position by those who are suffering from it, however, it is important to remember that children are placed into this position not by choice. Many children lack, or are unable to possess, the resources necessary to combat their situation. Both the United States and Finland are aware of these issues and are making great efforts to aide in preventing homelessness in children. These efforts are offering more resources, but there are still a growing number of children becoming homeless. Both nations need to fight this using a holistic method that approaches homelessness from many different angles.

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