An unstable start ALL BABIES COUNT: SPOTLIGHT ON HOMELESSNESS - Sally Hogg, Alice Haynes, Tessa Baradon and Chris Cuthbert

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An unstable start ALL BABIES COUNT: SPOTLIGHT ON HOMELESSNESS - Sally Hogg, Alice Haynes, Tessa Baradon and Chris Cuthbert
An unstable start
        ALL BABIES COUNT:
   SPOTLIGHT ON HOMELESSNESS

Sally Hogg, Alice Haynes, Tessa Baradon and Chris Cuthbert
Contents

Executive summary                                        5

1. Introduction                                          8

2. Families’ stories                                    11

3. Background: What do we know about homeless families
and their needs?                                        13

4. How can homelessness affect
babies’ safety and wellbeing?                           19

5. Recommendations                                      29

6. A Gold Standard for babies                           32

Appendix A: Examples of promising practice              34

Bibliography35

                                                              Contents 3
Acknowledgements

This report was written by the NSPCC in partnership
with the Anna Freud Centre.
Written and researched by:
Sally Hogg
Alice Haynes
Tessa Baradon
Chris Cuthbert
We would like to thank the following people for
their support in writing this report:
The families who shared with us their experiences of
homelessness.
Jessica James
Sonja Jutte
Ann Rowe
Diane Astin
Francine Bates
Geraldine Joyce
Kate Billingham
Lorraine Ibison
Melanie Mallinson
Merle Davies
Zoe Hallett
Maria Hafizi
Deborah Garvie
And all the professionals who spoke to us on the
telephone or attended our workshops.
Published in February 2015

This report is one of a series of Spotlight reports
published as part of the NSPCC’s All Babies Count
campaign. All Babies Count aims to raise awareness
of the importance of pregnancy and the first year of
life to a child’s development. The NSPCC is calling
for better early support for parents during this
period to ensure that all babies are safe, nurtured
and able to thrive. Our Spotlight reports focus on
particularly important issues that affect families
during this time. Other reports in this series explore
the impact on babies of parental drug and alcohol
misuse, perinatal mental illnesses and parental
involvement in the criminal justice system.

4 An unstable start - All Babies Count: Spotlight on homelessness
Executive summary

•       Babies living in homeless families can be            •    Homelessness can affect parents’ ability to meet
        extremely vulnerable. This is because babies’             these needs. It can impact on the physical and
        development is reliant on the quality of the care         mental wellbeing of pregnant women because of
        their parents are able to provide and for some            the stresses associated with housing instability
        parents who are homeless, providing this care             and because it is harder to adopt a healthy
        can be difficult.                                         lifestyle in such circumstances. The capacity of
                                                                  parents to provide their babies with sensitive,
•       Homelessness means lacking a supportive,
                                                                  responsive and consistent emotional care can
        affordable, decent and secure place to live. This
                                                                  also be affected by homelessness because of
        includes individuals and families who are judged
                                                                  the association between adverse mental health
        statutorily homeless (and are housed by their
                                                                  and parenting.
        local authority in the private rented sector or in
        temporary accommodation such as hostels and          •    A baby’s physical development can be affected,
        B&Bs), and those who are not eligible for support         with many types of homeless accommodation
        or who do not seek support (who may be staying            lacking the important safety, cleanliness and
        with family or friends).                                  facilities babies need in order to thrive.
•       Parents who are homeless are often themselves        •    Homelessness often means that families do
        amongst the most vulnerable in society, bringing          not receive the formal and informal support
        with them histories of trauma and loss. The               they need. Local services may not be geared to
        state of homelessness in and of itself creates            respond quickly to new homeless families in their
        a potential physical and mental assault on                area, and families might not know where services
        parenting due to the stresses and deprivations            are or how to access them. Families might also be
        inherent within it, such as insecurity, loss of           placed in accommodation away from their family
        social support, stigma and isolation.                     and friends.
•       Pregnancy and the first years of a child’s life
        are periods of rapid development which lay the
        foundation for later physical, social, cognitive
                                                                 Recommendations
        and emotional development. This is a time                A healthy society starts with healthy babies. Yet,
        of both vulnerability and opportunity, when              while we know that babies living in homeless
        experiences – positive or negative – can have a          families are some of the most vulnerable in our
        significant impact. For a healthy and safe start         society, often families who are homeless do not
        in life, evidence tells us that babies need the          receive even the basic support they need. How do
        following key ingredients:                               we ensure that the developmental pathways of
                                                                 babies are not compromised by homelessness?
    •    A healthy pregnancy: Maternal mental and
         physical health in pregnancy are crucially              Prioritisation
         important for babies’ later wellbeing and               Too often, the needs of babies and their parents
         development.                                            are poorly considered in both national and local
    •    Healthy early relationships: Babies need their          planning, and service provision for homeless
         caregivers to provide sensitive, responsive and         families. In order to ensure that babies in
         consistent care.                                        homeless families get a healthy and safe start in
                                                                 life, these needs, in particular the need for safety,
    •    Effective care and support for the caregivers:          stability and social support, must be prioritised
         Parents need social support and respectful              at national and local levels of government.
         care and help from professionals so that                The Government’s commitment to applying
         they have the emotional resources to care for           a ‘Family Test’ to the policy making process
         their baby.                                             provides an opportunity to ensure this occurs.
    •    A safe and stimulating environment:                     Our recommendations include that data on the
         Babies need to be in a safe and stimulating             total number of babies affected by homelessness
         environment where they are able to grow, learn          should routinely be captured through Joint
         and explore.                                            Strategic Needs Assessments and that Health

                                                                                                    Executive summary 5
and Wellbeing Boards should take responsibility                        Stability for families
 for ensuring their needs are met. Local
                                                                        Every family should be supported to live in a
 Safeguarding Children’s Boards (LSCBs) should
                                                                        stable, safe and suitable home to raise their
 review the role that housing problems have
                                                                        children. Unstable housing and frequent or
 played in Serious Case Reviews and take action to
                                                                        poorly managed transitions between housing can
 improve local policy and practice.
                                                                        cause stress and anxiety in parents, impacting
                                                                        both on the mental and physical wellbeing of
 Service and policy integration                                         mothers during pregnancy and on parents’
 Homelessness requires a joined up response                             ability to provide their babies with sensitive and
 from public services in order to meet the                              attuned care. We recommend an urgent review
 multiple and complex needs that families                               of out of area placements and their impact on
 present. A more co-ordinated response has the                          families, babies and children, and that before
 potential to prevent a range of poor health and                        pregnant women or families with babies are
 social outcomes, at the same time generating                           moved between accommodation, there needs
 savings for the public purse. However, rather                          to be an assessment of the suitability of the new
 than homelessness triggering this co-ordinated                         accommodation, the family’s readiness to move
 response, currently many families are faced                            and the support they will receive. The Government
 with further challenges and adversity due both                         should also create a ‘Gold Standard’ that sets
 to the way the system operates and the way it                          out expectations of what homelessness services
 impacts on them. These families are often called                       should achieve for pregnant women and families
 ‘hard to reach’, and yet many are desperately                          with babies
 seeking co-ordinated support from services. Our
 recommendations include integrated pathways                        .
 and processes of information sharing between
 housing, health, children’s and adult services,
 and that those working directly with families and
 babies in housing services should have the skills,
 competencies and supervision to support parent
 and infant mental health, and family functioning.

6 An unstable start - All Babies Count: Spotlight on homelessness
ssness on babies                                   Homelessness means lacking
The scale and impact of homele                                                                                                      a place to live that
                                                                                                    is supportive, affordable, dec
                                                                                                                                   ent and secure

            Numbers of homeless babies

                                                      We estimate that in England:

      around                                                    around                                           around

      15,700 0-2 year olds                                      710 0-2 year olds                                170 0-2 year olds                                       45%
      live in families who are classed as                       live in   B&Bs                                   have been living in   B&Bs
      statutorily homeless                                                                                       for longer than 6 weeks

                                                                                                                                               = 100          A study of 40 serious case reviews in
                                                                                                                                                              England found that 45% of families were
                                                                                                  = 100
                                                                                                                                                           highly mobile and living in poor conditions
            = 1,000

                                                              ortunity and risk                                   The impact of homelessness on babies
              Babies’ development: a time of opp

                                                                                                              Parents’ capacity to care

                                                                                                                             Homeless parents often have a history of adversity
                                                                                                                74%                        report experiencing at least one difficulty such as mental
                                                                                                                                           health problems or domestic violence as an adult
       In the first two years of life,                     Healthy brain development                                         74%
            new neural                                   requires sensitive and responsive
       700 connections                                     interactions with caregivers –                                                                            Homelessness can mean reduced
                                                            called ‘serve and return’                                  Homelessness can increase
      form in the brain every second                                                                                                                                 support networks for parents because
                                                                                                                       the risk of adult adversities or
                                                                                                                       compound existing difficulties                they may be housed away from friends,
                                                                                                                                                                     family and their local services

                      The care a baby receives from conception to age 2                                       Poor living conditions
                      shapes the way the connections in the brain form, providing
                      a foundation for all future learning, health and behaviour
                                                                                                                            Temporary accommodation can be small, dirty, unsafe, noisy or lacking
                                                                                                                            equipment babies need
  The estimates are based on available data from the government and ONS population data.
  There remains a significant gap in the official data on these vulnerable babies. For further details,
  please see the full report, An unstable start – All Babies Count: Spotlight on homelessness.
1. Introduction

The public image of homelessness is of adults                       challenging for new parents, but also increase the
sleeping rough. Very few people ever think that a                   risk of mental health problems. During this lifestage
baby could be homeless. Yet sadly, many babies                      parents can be engaged and motivated to make
live in homeless families and these babies are often                positive changes in their life, but they can also
particularly vulnerable. This report brings those                   be very vulnerable, as their roles in the family and
babies and their needs into the spotlight.                          couple change.4
To be homeless is to “lack a place to live that                     A woman’s risk of mental illness is higher in the
is supportive, affordable, decent and secure”.1                     weeks following childbirth than at any other time
Homelessness during pregnancy and infancy is a                      in her life.5 Fathers are also at risk of experiencing
significant, and increasing, problem in the UK that                 depression in the postnatal period, in part as a result
is not yet getting the response it deserves. Whilst                 of changes to sleep patterns, changes to social
housing problems more generally are rising up the                   support networks and changes to their relationship
political agenda, scant attention is given to the                   with their partner.6 Research suggests that around
damaging impact that homelessness can have                          5 to 10% of fathers experience depression in the
during particularly critical lifestages and transitions,            postnatal period.7
such as the birth of a baby.
                                                                    There are moral, social and economic arguments for
The NSPCC and the Anna Freud Centre both deliver                    investing in pregnancy and infancy:
services to families during pregnancy and infancy.
                                                                    •   All children have the right to have their basic
Our experiences working with families across the
                                                                        needs met, to be safe, and to have opportunities
country (but especially in London) have led us to
                                                                        to reach their full potential.
be particularly concerned about babies in families
who do not have a secure and stable home. We have                   •   Healthy infant development leads to better social
seen that homelessness has a direct impact on                           and emotional outcomes, so babies are more
babies because it makes it much harder for families                     likely to grow up to be happy, healthy and fully
to give their babies the care they need.                                contributing members of society.
                                                                    •   Prevention is both better, and cheaper, than cure.
The case for action                                                     Babies who have a good start in life are likely to
                                                                        cost less and contribute more to the economy
Why focus on babies?                                                    over their lifecourse.8
During pregnancy, a woman’s mental and physical
health, behaviour, relationships and environment                    Why focus on homelessness and babies?
all influence the intrauterine environment and                      Homelessness in England is a growing problem: the
the developing foetus, and can have a significant                   number of families who are homeless has increased
impact on the baby’s wellbeing and long term                        in recent years, and is likely to continue to increase
outcomes. After birth, babies’ brains and bodies                    due to a number of factors, including the economic
continue to develop rapidly. In the first two years of              climate and changes to the benefit system.9 The
life, 700 new neural connections form in the brain                  increase in homeless families, paired with pressures
every second.2 Because of this, any early experience                on local government finances, create a ‘perfect
- positive or negative - can potentially have long                  storm’ which means that councils are becoming
term and far reaching impacts. Whilst a baby’s                      less able to provide homeless families with suitable
future is not completely determined by their early                  housing and support.10
life, without firm foundations, success later in life
can be more difficult.3                                             The limited research on the specific impact of
                                                                    homelessness on babies shows that homeless
The perinatal period is a time of both opportunity                  infants experience a significant decline in general
and vulnerability for new families. For both mothers                developmental function between 4 and 30
and fathers, pregnancy and the birth of a baby                      months.11,12 Most of the research and policy work
is a significant transition - a time when their                     focuses on older children, for whom homelessness
roles, responsibilities and relationships change.                   is linked to an increased risk of a broad range of
Pregnancy and childbirth are not only physically                    problems, including poor health, developmental

8 An unstable start - All Babies Count: Spotlight on homelessness
delays, poor school performance, behaviour                However, as this report describes, changes to the
problems, psychological problems, increased               welfare system and decisions about housing are
risk of accidents and injuries, and poor co-              proceeding seemingly without full consideration
ordination.13,14,15,16                                    of their potential impacts on babies and children,
                                                          and the lifelong legacy this might cause. Instead,
Evidence also shows that homelessness and
                                                          housing policy is increasing the stress, insecurity
temporary accommodation during pregnancy are
                                                          and instability experienced by many families
associated with an increased risk of preterm birth,
                                                          during the critical first 1001 days, the important
low birth weight, poor mental health in infants and
                                                          period between conception and their child’s
children, and developmental delay.17,18 All of these
                                                          second birthday.
factors are, in turn, associated with the risk of poor
outcomes in later life.                                   The Prime Minister recently announced that from
                                                          autumn 2014, the Government will conduct a
Babies seem to be overlooked in housing policy and
                                                          ‘Family Test’ on all policies, meaning that “policies
the research in this field, perhaps because people
                                                          that fail to support family life will not be allowed to
do not appreciate how much homelessness affects
                                                          proceed”.20 The test specifically challenges policy
babies, and because babies cannot speak out about
                                                          makers to consider the impact of their decisions
their experience. In fact, babies are likely to be more
                                                          on families going through key transitions, such as
vulnerable to homelessness than older children for
                                                          becoming parents.
a number of reasons: babyhood is a particularly
critical lifestage, babies are more vulnerable and
susceptible to the effects of stress and adversity on      The new ‘Family Test’ requires policy makers to
their parents, and they are also likely to spend more      ask 5 questions:21
time at home than older children.                          1. What kinds of impact might the policy have on
                                                              family formation?
The policy context
                                                           2. What kind of impact will the policy have on
The Government has made a number of welcome                   families going through key transitions such as
commitments to improve outcomes for children in               becoming parents, getting married, fostering
early life and to promote the emotional wellbeing             or adopting, bereavement, redundancy, new
of parents so that they can provide their children            caring responsibilities or the onset of a long-
with the best quality care. In particular, we have            term health condition?
been pleased to see the growing consensus in
parts of Westminster about the importance of early         3. What impacts will the policy have on all family
intervention and the first years of life.                     members’ ability to play a full role in family life,
                                                              including with respect to parenting and other
                                                              caring responsibilities?
“… this Government is determined that early                4. How does the policy impact families before,
intervention should be a defining principle in                during and after couple separation?
how we tackle social problems, central to our              5. How does the policy impact those families
strategy for delivering social justice, breaking              most at risk of deterioration or relationship
the cycle of disadvantage … we are starting with              quality and breakdown?
the family, taking action in the earliest stages of
a child’s development, and helping parents in             It is clear that if policy makers want to create strong
order to give their infants a better start in life.”      and healthy families and communities in the
                                                          future, they should be taking decisive action now
(Rt Hon Iain Duncan Smith MP, Speech to the
                                                          to support new parents and create the conditions
Wave Trust, 2013)19                                       in which all babies can be safe, nurtured and able
                                                          to thrive. We hope that ‘Family Test’ will be robustly
                                                          applied to housing policy and this will bring about

                                                                                                      Introduction 9
crucial changes to ensure the needs of pregnant
women and families with babies are fully met.
                                                                     “There can be no keener revelation of a
The Government has recognised the huge                               society’s soul than the way in which it treats
variability in council homelessness services, and                    its children.”
has introduced a ‘Gold Standard’ for the highest
performing services. In this report we set out our                   (Nelson Mandela, Speech at the launch of the
own standards for the housing and support that                       Nelson Mandela Children’s Fund, 1995)
should be provided for homeless families during
pregnancy or with a baby. We do not believe that
any service should think of itself as ‘gold standard’
                                                                     The report structure and methodology
unless it is catering to the needs of the youngest,
and often most vulnerable members of society.                        This report focuses on homelessness in England.
                                                                     We start by describing the impact of homelessness
 We recommend that:                                                  on babies by setting out the types of homelessness
                                                                     that families face, the number of homeless families
 •   The Government develop and implement a                          and the reasons families become homeless. We
     clear strategy to ensure that every family can                  then examine how homelessness affects the extent
     afford to live in a suitable home to raise their                to which babies receive the key ingredients they
     children. This should include:                                  need for a healthy and safe start in life. We end by
     -- The funding of enough affordable housing                     making recommendations for the Government, local
        to meet local need;                                          authorities and others who can make a difference.

     -- A social security system that allows families                To inform the research, we conducted a desk based
        on low incomes to afford suitable private                    review of the existing research literature and policy
        rented accommodation;                                        context, conducted telephone interviews with
                                                                     professionals from a range of relevant disciplines,
     -- Adequate discretionary housing payments                      spoke with families who had experienced
        to prevent people losing their homes; and                    homelessness during pregnancy and the first
     -- Measures to improve housing conditions,                      years of life, and held workshops both with thought
        particularly in the private rented sector.                   leaders within the sector, and health, housing and
                                                                     children’s services professionals.
 For a full list of our recommendations, please see
 section 5.

10 An unstable start - All Babies Count: Spotlight on homelessness
2. Families’ stories

As part of this research, we gathered case studies
with families who had experienced homelessness
during pregnancy and the first years of their child’s
life. Throughout this report, we draw upon the
following two stories to bring to life the impact of
homelessness and housing policies on real families.

 Cathy’s story
 Cathy was living with her partner Jack in a house       When their baby, Sam, was five days old, the
 share when she became pregnant. At this time,           couple received an eviction notice. Fearing that
 Jack lost his job and Cathy had to stop work            they would be forced to sleep on the streets with
 without pay due to back pain. When the couple           their baby, the couple barricaded themselves into
 told their landlord that Cathy was pregnant, he         their flat for three months. During this time the
 told them they could not stay because the house         family were helped to access legal aid by Shelter.
 was not suitable for a baby. Cathy and Jack left the    Eventually they were supported by social services
 property and sought housing support, but were           in the area where they were living, who moved them
 told that they were not eligible because they had       to a family hostel.
 become intentionally homeless. They were advised
                                                         The family have a small room in the hostel, with
 that they should have remained in the property
                                                         very basic kitchen facilities and little space for Sam
 against the landlord’s wishes until legal action
                                                         to play or crawl. There are no laundry facilities, so
 was threatened.
                                                         Cathy takes her washing to her mother-in-law’s
 When Cathy was 28 weeks pregnant, the couple            house. Sam has eczema, which Cathy is anxious
 were placed in a hostel for three weeks and then        about and attributes to living in the hostel.
 were temporarily housed in a studio flat in a
                                                         Cathy said she had an excellent midwife
 different local authority. The flat was infested with
                                                         throughout her pregnancy, although when she
 mice and damp, and the couple were afraid to
                                                         was moved out of the area she had to travel for
 leave their home because of the prevalence of drug
                                                         appointments. She also said she got a lot of
 use, violence and burglaries in the local area. Cathy
                                                         support from her health visitor. Cathy and Sam
 was very scared and became depressed.
                                                         attend a Baby Group in the hostel and go out to the
 Cathy went into pre-term labour with Sam, which         local children’s centre. Cathy explained that she
 she attributes to the stress caused by her housing      tries to get out of the hostel as much as possible.
 problems. Luckily the labour was stopped, and
                                                         Cathy continues to be treated for depression. She
 Sam was born at full-term.
                                                         and Jack are both keen to move out of the hostel
 When Cathy was 8 months pregnant, the couple            as soon as possible in order to improve Sam’s
 received a letter telling them to visit the housing     quality of life. The couple have been told that they
 office to renew the lease on the flat. However          cannot get help to move until their rent arrears
 when they arrived, they were told this wasn’t           have been paid. They are both eager to work, but
 necessary. Shortly after this, their housing benefit    had been told that working would mean paying
 was terminated, which then led to a build-up of         more to stay in the hostel, therefore preventing
 rent arrears.                                           them paying off their rent arrears.

                                                                                               Families’ stories 11
Beth’s story
 Beth had already been homeless for 15 years                         After three months, and following a positive
 when she became pregnant. During this time, she                     outcome, the family were moved to a family hostel
 had experienced severe mental health problems,                      where they stayed for 16 months.
 including being sectioned, and was using illicit
                                                                     In the hostel, they had one small room which
 drugs. She met her partner Aaron whilst staying in
                                                                     included a small hob for cooking on. The room was
 a hostel for single people and became pregnant.
                                                                     too small for the baby to play in and the hostel did
 Beth did not realise she was pregnant until 4                       not have working laundry facilities. Beth became
 months gestation. She was then referred to the                      depressed and was prescribed anti-depressants by
 Family Drugs and Alcohol Court by her social                        her GP. During this time Aaron also spent a short
 worker. With their encouragement, Beth stopped                      period in prison for breach of an ASBO.
 using drugs by the sixth month of her pregnancy.
                                                                     Beth and her family have been supported by three
 Beth and Aaron continued to be housed in a hostel                   different social workers in the two years between
 for single adults until she was 8 months pregnant.                  Beth getting pregnant and our visit to the family.
 This was a frightening and difficult time for Beth,                 Beth felt that the skills and approach of these
 as she was surrounded by people who misused                         social workers varied a lot, but she got on well with
 drugs and alcohol, and fights often broke out. Beth                 the social worker who supported her when she first
 told us that she had a good relationship with a key                 moved to the hostel. Beth was also very happy with
 worker in her hostel, although she felt he didn’t do                the support she had received from her midwives
 enough to help her move out of the hostel when                      and health visitor.
 she became pregnant.
                                                                     There was a baby group at the hostel, which Beth
 Just three weeks before Beth gave birth, she and                    felt was a lifeline for her.
 Aaron were moved to a family hostel. When their
                                                                     Following 9 months of searching for private rented
 baby, Jess, was born, they were kept in hospital
                                                                     sector accommodation with their housing support
 for five days because the doctors were concerned
                                                                     worker, the family was moved to a large private
 that Beth’s drug use might have affected her baby.
                                                                     rented flat with a small garden, where they hold a
 Luckily Jess was healthy. The family were then sent
                                                                     year-long tenancy. The flat is in a different local
 to a family assessment centre. There, they were well
                                                                     authority from the hostel, and when we met Beth
 supported by a social worker and the centre, and
                                                                     she was trying to find out about the local services –
 felt supported to develop routines for caring for
                                                                     such as children’s centres- in the area.
 their baby.

12 An unstable start - All Babies Count: Spotlight on homelessness
3. Background: What do we know about
homeless families and their needs?

Types of homelessness                                            professionals, we were told about families who were
                                                                 treated as intentionally homeless because they did
‘Homelessness’ is a term that encapsulates a range               not understand the homelessness rules.
of situations in which families lack an affordable
and decent home. The impact of homelessness on
families’ and babies’ lives and wellbeing will depend
                                                                 Cathy explained to us how she was categorised
on the nature of the accommodation they live in and
                                                                 as intentionally homeless when pregnant
the amount of time that they spend there. Figure 1
shows the different types of homelessness.                       because she did not understand what qualified
                                                                 as being evicted by her landlord.
Councils only have duties to rehouse people who
are homeless or threatened by homelessness if they                “… I found out I was pregnant and we were
have a reason to believe the applicant:                           living in a house share with like four different
•   Is eligible for public funds (which depends on
                                                                  rooms and it was all men. And my landlord
    immigration status)                                           had said when I was pregnant, “You need to
                                                                  move out. You can’t live here with a baby, it’s
•   Has a local connection to the local authority                 not practical.
    area*
                                                                  … When [the council] spoke to the landlord,
•   Is unintentionally homeless (this means that
    they did not become homeless as a result of
                                                                  the landlord told them, “Well they had to get
    deliberate action or inaction, and there is no                out.” So he’s pretty much saying to them, “I
    accommodation available that they could                       told her she had to get out.” So I didn’t make
    reasonably be expected to occupy), and                        myself intentionally homeless.
•   Is in ‘priority need’ (which includes pregnant                … Someone [at the council] said to us, “Well
    women and families with dependent children).                  you should have known that we can’t help you.
Assessing whether a family is ‘unintentionally’                   And obviously if you leave a property without
homeless is complex and can lead to errors. For                   going through the right procedures … you’re
example, while the Government has stated that                     at fault. So therefore you’ve left without going
those families who are homeless due to a reduction                through the courts and what not, so you’ve
in benefits should not be considered as becoming                  made yourself intentionally homeless.”
intentionally homeless, some research has indicated
that following the recent cap on benefits, this is                They literally told us we should have left it
occurring.22, 23 Government guidance on intentional               until the point where our landlord would have
homelessness also clearly states that “Acts or                    taken us to court before we could have got
omissions made in good faith where someone was                    housing.”
genuinely unaware of a relevant fact must not be
regarded as deliberate … This could apply where
someone leaves rented accommodation in the                       Families who qualify as statutorily homeless
private sector … and the former tenant was genuinely             are usually accommodated for a brief period
unaware that he or she had a right to remain until the           in voluntary agency, local authority or housing
court granted an order and warrant for possession.”24            association hostels, or in some cases a bed and
However in our discussions with parents and                      breakfast. The majority (89%) of the 45,620

* Under the Localism Act 2011, local authorities are given the power to set their own eligibility criteria for those eligible
to receive housing support, including what constitutes a ‘local connection’, although recent government guidance
strongly recommends that local authorities consider introducing a minimum 2 year residency criterion.

                                                     Background: What do we know about homeless families and their needs? 13
Figure 1

  Types of homelessness

                                                                  Families who are rehoused immediately
                                                     (this is around 21% of statutorily homeless families in England,
                                                                     but only 6% of those in London).

                Families who are
             statutorily homeless                            Families placed in temporary accommodation
            (or awaiting a statutorily                   (a self-contained unit, bed and breakfast or a hostel).
              homeless decision).

                                                   Families classed as statutorily homeless but living in unsuitable
                                                    accommodation while waiting for housing (the ‘homeless at
                                                                               home’).

                                                   If families are not eligible support (for example if they are judged
                                                     to be intentionally homeless or do not have recourse to public
                                                     funds), the local authority can provide families with temporary
                                                    accommodation for a limited period to give them a reasonable
                                                      opportunity to find accommodation. Children’s services may
                                                        end up paying for a families’ housing, if they judge this is
                                                     required to safeguard and promote the welfare of the children.
              Families who are not
               eligible for support.
                                                   The Border Agency must provide housing for asylum seekers who
                                                   are destitute and homeless, but this housing will only be provided
                                                     in dispersal areas outside London and the South East. Failed
                                                   asylum seekers may be entitled to accommodation if they cannot
                                                        return home or are seeking to reopen their application.

                                                          Families helped to find private rented accommodation.
           Families who are supported
               by ‘homelessness
             prevention and relief’.
                                                     Families persuaded to stay in their current accommodations.

           Families who do not come                Families who never come into contact with homelessness services,
           into contact with services.             but without a stable home eg. moving between friends and relatives
                                                   (sofa surfing), or unable to sustain private rented accommodation.

            Traveller families who may be homeless because they have nowhere legal to park their caravan or
           mobile home, or can no longer live in their current home. The council has a duty to treat such families
            as any other homeless families, however councils have duties to consider the particular needs of a
             family when dealing with their homelessness situation, which may include a travelling lifestyle.

 14 An unstable start - All Babies Count: Spotlight on homelessness
households with children living in temporary              kitchen and bathroom facilities, and rooms can be
accommodation on 30 September 2014                        quite small. Thus, for example, a single mother will
were described as living in self-contained                have to leave her baby alone in the room or take the
accommodation.25                                          infant to a crowded kitchen. There are often limits in
                                                          what furniture and belongings families can take into
Self-contained accommodation may be flats or
                                                          hostels, and who can visit them there.
bedsits that are owned by the council, housing
association or private providers. The benefits of
self-contained units are that they offer families
some privacy and have kitchen and bathroom                Beth described the room in the family hostel
facilities. However they are often unfurnished and        where she and her family lived for 16 months.
can be isolated. The quality of these homes can
                                                           “… And then we just moved to this one room
sometimes be very poor, particularly if they are in
                                                           where everything was just in one room and – I
the private sector.26
                                                           mean it was all right at first, for about the first
                                                           six months and then I started to get quite
Cathy told us about the flat that she and her              depressed in there … it is the nicest hostel that
family were first placed in when they became               I’ve ever stayed in but I don’t think it’s ideal
homeless.                                                  with children. Maybe when they are babies it’s
                                                           not so bad but when they can start walking
 “That was going to be the first house we took             they haven’t really got any room to stretch
 our son to … I was scared, I didn’t want to               their leg … I had about this much worktop to
 go out, I had all my stuff for the baby. I was            make a dinner to try and make dinner because
 scared someone was going to come and rob                  our steriliser was on there and a kettle and
 out my house and take all of our stuff and                toaster and then it was just impossible. And
 leave us with nothing … I had police knocking             then you sort of feel like you are eating right
 on our door like three, four o’clock in the               where you are sleeping. You are sleeping in
 morning waking me up, arguments, music                    the kitchen.”
 blaring … When I think back to it and I think I
 don’t know how we coped with it, but we had
 to. There was mould, mushrooms growing                   In extreme cases, families are placed in bed and
 in the bathroom, mice running around the                 breakfast (B&B) accommodation. In September
 house, eating up my food, running all over the           2014, 5% of households with children living in
 baby’s stuff.”                                           temporary accommodation (2,080 households
                                                          in total) were living in B&Bs. 28 Based on the most
                                                          recent ONS population data available, we estimate
In June 2014, 7% of households with children              that on 30 September 2014, around 710 0-2 year
living in temporary accommodation (3,110                  olds lived in B&Bs with their parent(s).29
households in total) were living in hostels.27 Hostel     Living in a B&B tends to mean that families have
accommodation for families can vary greatly. There        a very small room, a shared bathroom, no kitchen
are hostels specifically for families, but sometimes      facilities, and they may not be allowed to stay
families can be placed in mixed hostels, and              in during the day. Families with children are not
pregnant women can be placed in hostels for single        supposed to be put into B&Bs for more than six
people which may also accommodate difficult and           weeks, but in September 2014, there were 500
potentially dangerous people. Some hostels provide        families in England with children in bed and
very little support, but in the best cases, they          breakfast accommodation who had been there for
can offer families a range of high quality support        more than six weeks.30 Again using ONS data, we
services including dedicated key-workers, advice          estimate that on 30 September 2014, around 170
services and baby groups. Most hostels have shared        0-2 year olds had been living with their parent(s)

                                               Background: What do we know about homeless families and their needs? 15
in B&Bs for longer than six weeks. The period that
                                                                      We recommend that:
families spend in temporary accommodation can
vary from a few days to several months, or even                       •   Local authorities provide tenancy training for
years in some cases.31                                                    families to help them to manage their tenancy
                                                                          (including budgeting, understanding their
Since the Localism Act 2011, local authorities
                                                                          entitlements to benefits and knowing their
have also been able to discharge their
                                                                          rights as tenants), so that they are better
homelessness duties by placing families in
                                                                          equipped to meet their baby’s needs. It is
private rented accommodation, provided that
                                                                          particularly important that families moving
the accommodation is suitable and has a
                                                                          out of temporary accommodation and social
minimum tenancy of 12 months. This initiative
                                                                          housing are supported to develop these skills
is too new to really understand its impact, but
                                                                          when moving into Private Rented Sector
charities have raised concerns that private rented
                                                                          accommodation.
accommodation is both less secure and less stable
than social housing.32 Private rented sector (PRS)                    •   Local private rented sector access schemes
accommodation can be particularly unstable for                            extend support beyond six months so
families because:                                                         that people are able to seek help again if
                                                                          something goes wrong in the tenancy or if
•   Families can be unclear about their rights;
                                                                          they need support to find another property.
•   Families have more responsibility for managing
                                                                      •   Local authorities provide information to
    their own housing benefit and rent payments,
                                                                          ensure that landlords understand housing
    which can be challenging for those with chaotic
                                                                          and benefit legislation and tenants’ rights so
    lives, poor numeracy skills and/or who have never
                                                                          that pregnant women and families with babies
    managed a tenancy before;
                                                                          are protected.
•   Families are often only accommodated in fixed
    term tenancies of 12 months, which can lead to
                                                                     As figure 1 shows, families who are counted
    anxiety around eviction33 and the potential for a
                                                                     amongst the ‘statutory homeless’ are only part
    repeated cycle of homelessness;
                                                                     of the population. There are also those who will
•   Private Rented Sector accommodation can be                       receive support to try and avoid them becoming
    cold, damp, overcrowded, and landlords can be                    homeless. The ‘Homelessness Prevention and
    unresponsive and aggressive.34                                   Relief’ scheme aims to prevent families becoming
                                                                     homeless by either helping them to stay in their
Accommodation in the private sector is not always
                                                                     current accommodation or finding alternative
in single occupancy units, it can also be shared
                                                                     accommodation for them (usually in the private
accommodation, known as a ‘house in multiple
                                                                     rented sector).
occupancy’ or HMOs. HMOs are homes with at
least 2 separate households who are sharing basic                    There are also many families who will not be
amenities such as a kitchen or bathroom. Private                     judged eligible for housing services and those who
HMOs are not always inspected before a license is                    do not seek formal support, who move between
issued by the local authority,35 and there is no duty                family, friends (‘sofa surfing’) and/or short term
on local authority HMOs to be inspected; therefore,                  accommodation. These families are of particular
the quality of these homes can be variable and                       concern, since they may have additional needs
sometimes very poor.                                                 but are not ‘on the radar’ of local services to
                                                                     receive support.

16 An unstable start - All Babies Count: Spotlight on homelessness
Numbers of homeless families                              Why are families homeless?
Shelter estimates that every eleven minutes a family      Not all homeless families with a baby are newly
in Britain loses their home.36 The Government             homeless. Some families will have been homeless
collects data on the number of decisions made             before babies were conceived. There is a high
by local authorities on applications for statutory        incidence of unplanned pregnancy amongst
homelessness assistance, as well as the number of         homeless women, many of whom go on to have
homeless households accepted as being owed the            their babies. In a survey of 31 London hostels in
full statutory rehousing duty and living in temporary     2000, 24% of women had been pregnant in the
accommodation. The ‘acceptance’ and temporary             previous year.39
accommodation data include the number of
                                                          Many adults in homeless families will have
households with children. However, these statistics
                                                          experienced multiple adversities such as domestic
do not contain details of children within these
                                                          abuse or mental illness, and losing their home is
households, such as the number of pregnant
                                                          just one of a number of problems in their lives. A
women and ages of children, so we have no official
                                                          significant number of adults in homeless families
figures on how many babies are homeless. In
                                                          are likely to have experienced childhood adversities.
addition, many more homeless households are
now assisted outside the homelessness legislation         Families become homeless for different reasons.
via homelessness prevention and relief. The               The most common causes of homelessness in
prevention and relief statistics do not record the        families with children are relationship breakdown
number of households with children or any further         (with a partner, friends or family) which may have
household details.                                        involved domestic violence, or housing pressures
                                                          such as eviction or overcrowding.40 The birth of a
Using the best data we have on statutory
                                                          baby can also be a trigger for housing problems as
homelessness, we do know that the majority
                                                          existing accommodation may become unsuitable.41
of households currently living in temporary
                                                          During this research, we spoke to a number of family
accommodation include children or expected
                                                          nurses who told us how relationships between
children. On 30 September 2014 (the latest statistic
                                                          new young parents and their families may break
that is available), there were 60,940 households in
                                                          down when a child was born. Teenage mothers are
temporary accommodation in England, 6 per cent
                                                          sometimes evicted because their parents do not like
higher than at the same date in 2013. Around 75%
                                                          the father of their child, or do not want the baby at
of these households included children and/or a
                                                          home. The pregnancy could be the ‘last straw’ if the
pregnant woman (consisting of 87,420 children).37
                                                          young woman already has a difficult relationship
Using the most recent ONS data available, we
                                                          with her family.
estimate that around 15,700 of these children are
aged 0-2.38                                               There are families who have not previously
                                                          experienced adversity but lose their house a result
 We recommend that:                                       of a number of negative life events, such as the loss
                                                          of a job, illness, or family breakdown. However, this is
 •   The Department for Communities and Local             not usually the case. In a study for the Department
     Government regularly collects data on the            for Communities and Local Government in 2008,
     number of children and pregnant women in             74% of adults in homeless families with children
     all homeless families, the ages of children,         reported that they had experienced at least one
     and their needs. This will assist national and       form of adult adversity, such as mental health
     local planning in meeting the needs of these         problems, violence or prolonged unemployment. 42
     parents, babies and children.                        This means that many homeless families are already
 •   Local Health and Wellbeing Boards ensure             at risk of poor outcomes which may be exacerbated
     that the number, make-up, and needs of               by their housing situation.
     homeless families are represented in their
     Joint Strategic Needs Assessments.

                                               Background: What do we know about homeless families and their needs? 17
The relationships between adverse experiences                        Whilst this report focuses on homeless families
and homelessness are complex. As noted, many                         with babies, it is important that services do not wait
of the serious personal and family problems                          until people become parents before offering them
homeless people face will exist before the person                    support. In one of our case studies, Beth had been
becomes homeless, but they are likely to “aggravate,                 homeless for 15 years, and struggling with drug
precipitate or prolong” homelessness.43,44 The                       and mental health problems before she became
data do suggest that homelessness in infancy is                      pregnant. However it was only when she became
associated with worse maternal and infant health                     pregnant that she received intensive support to
than would be expected using adjusted data to                        tackle her drug habit. Better support for single
control for the other risk factors in affected families,             homeless people could reduce the number of
demonstrating that either being or becoming                          vulnerable homeless parents in the future.
homeless leads to babies having worse outcomes
than they otherwise would.45, 46

“Homelessness is rarely a one-off event. Most
families have histories of previous chronic
adversities that constitute risk factors for both
children and parents.”
(Vostanis, 2002)47
“Women often described their lives as a
remarkably consistent stream of distressing
and spirit- breaking encounters, beginning in
early childhood … including lifelong poverty,
parental neglect, exposure to domestic
violence, childhood abuse … and unhappy and
painful personal relationships.”
(David, Gelberg, & Suchman, 2012)48

18 An unstable start - All Babies Count: Spotlight on homelessness
4. How can homelessness affect
babies’ safety and wellbeing?

Babies need their parents to be mentally and           recognise the critical importance to parents and
physically healthy, and able to provide them with      babies of safety and security in pregnancy and the
sensitive, consistent and nurturing care and a safe    first months of a child’s life. While pregnant women
environment in which to grow. Research suggests        are recognised as a category of ‘priority need’ in
that that there are four ‘ingredients’ which are       terms of receiving accommodation, the housing
critically important for babies to be safe, nurtured   system does not take into account the particular
and able to thrive.                                    needs of pregnant women and their babies in
                                                       respect to where they are placed or how they
 •   A healthy pregnancy: Development before           are treated.
     birth is the basis for what happens next,
     so maternal mental and physical health in         Maternal mental health
     pregnancy are crucially important for babies’     Becoming and being homeless impacts on people’s
     later wellbeing and development.                  mental health in a number of ways, through:
 •   Healthy early relationships: Babies need their    stress and worry about their housing situation and
     caregivers to provide sensitive, responsive and   financial issues; loss of social support; stigma;
     consistent care.                                  isolation; and fear because of their neighbours
                                                       or environment. In turn, mental health problems
 •   Effective care and support for the caregivers:    can have consequences for a healthy pregnancy
     Parents themselves need social support and        because they can make it harder for a woman to
     respectful care and help from professionals       look after her physical health. To reduce the risk to
     in overcoming some of the problems they           maternal mental health, it is important to improve
     may face, so that they have the emotional         parents’ pathways through the housing system and
     resources to care for their baby.                 the quality of accommodation available to them.
 •   A safe and stimulating environment:               This is to ensure they have high quality care from
     Babies need to be in a safe and stimulating       universal services, such as midwifery and health
     environment where they are able to grow, learn    visiting, who monitor and promote maternal mental
     and explore.                                      health and make referrals to specialist services
                                                       where necessary.
In this section, we explain how homelessness can
threaten each of these aspects of a baby’s life.
                                                       Beth and Cathy both told us about the impact
                                                       that homelessness had on their mental health.
A healthy pregnancy
A mother’s mental and physical health, behaviour,       “I can’t understand how some people have
diet, relationships and environment all influence       stayed [in the hostel] six or seven years. I’d
the intrauterine environment and the developing         just go potty. I think I’d go mad because
foetus, and can have significant impacts on a           already in that room, I was only there sixteen
baby’s wellbeing, brain development and long            months and the doctor said to me, I think you
term outcomes.49 We know that a woman’s mental          need to be on anti-depressants. I’d just wake
health in pregnancy affects foetal development,         up in the morning in the bed and just want to
with lasting results. Studies have shown that           go back to sleep – have a look around and just
foetal development can also be influenced by a
                                                        want to go back to sleep.” Beth
wide range of factors that go beyond the mother’s
immediate health and wellbeing, and which               “I’ve been suffering quite bad with depression
include environmental factors such as exposure to       since I’ve had him because of the whole
pathogens, smoke, sunshine and air pollution.           situation … I’m still a little bit depressed and
Both national policies and local practice can lead      thinking, “When are things going to get
to turbulence for women and their families during       better? When’s it going to be our time?” Cathy
this important time in their lives. The timescales
and priorities within the housing system do not

                                                       How can homelessness affect babies’ safety and wellbeing? 19
Double jeopardy:
  How homelessness can affect babies

                                            Problems ac                                 lth
                                                        cessing               Mental hea        Trauma
                                  tabilit
                                          y      services                       problems
                              Ins
                                                                                       Past history
                     Poor qualit
                                   y     Homelessness
                                                                                       of adversity
                       ho u si n g
                                           Moving away from                   Domestic
                                           family and friends                  violence       Substance misuse

                                                                              Poor physical health and
                                       Anxiety and stress
                                                                                 health behaviours

                                                                                        Reduced
           Unhealthy                                                                                               Strain on
                                           Unsafe                 Increased            capacity to
           gestation                                                 risks                                       parent-child
                                         environment                                provide sensitive
            and birth                                              for baby                                      relationship
                                                                                          care

Maternal physical health                                               Cathy also told us how the accommodation she
Homelessness can have direct and indirect effects                      lived in when pregnant affected her physical
on women’s physical health. For example, living in                     and mental health.
a noisy hostel may make it more difficult to sleep,                     “I went into pre-term labour with Sam from
and they may find it harder to adopt a healthy                          stresses and I literally had to go in hospital
lifestyle and resist behaviours such as smoking,
                                                                        every week and go and have a test to make
drug and alcohol use. Smoking rates are much
higher amongst homeless people and those living                         sure they didn’t think I was going to have him
in hostels than in the wider population.50 Homeless                     early and they put that down to stress … I do
women can lack both the resources to buy nutritious                     blame [the local authority] for that because it
food and the means to store and prepare it.                             doesn’t take more than half an hour to go and
                                                                        check a flat and make sure it’s stable enough
                                                                        to put a person in there that’s pregnant. There
Beth described her time in the single person’s                          was mould all over the place. Like I was sick
hostel where she lived until she was eight                              a lot when I was pregnant from the mould …
months pregnant. Beth was trying to stop                                It was getting to the point where I thought I
using drugs during this time, but the hostel                            was going to go mad. I was stuck in these four
environment made this more difficult.                                   walls …”
 “… fights would break out or you know
 someone would be drunk and the drugs was
 just all around me and I was really trying not                        Antenatal care
 to. It was just - it wasn’t ideal.”                                   Homelessness can also make it harder for women
                                                                       to engage with maternity services, particularly if
                                                                       they are moved between areas (see section ‘Care

20 An unstable start - All Babies Count: Spotlight on homelessness
for caregivers’ for further information), and with      Payments to ‘top up’ housing benefit for pregnant
specialist services, particularly therapeutic and       women to enable them to move to a larger house
support services in which longer-term practitioner-     earlier in pregnancy. However this is not standard
client relationships are part of the support system.    practice in other areas.

Instability and the impact on pregnancy
                                                        Beth also told us how difficult it was to move
Women can be moved around different                     when she was heavily pregnant or had a new
accommodation because their needs and eligibility       baby. Here she describes moving to supported
for services change as they become pregnant and
                                                        accommodation with a five day old baby, and
have their baby. There is also a lack of clarity and
consistency about when pregnant women should
                                                        then moving from the hostel to her new home.
be moved from hostels for single people to family        “… when we first went we couldn’t all get in the
accommodation. Services can be slow to react to a        cab with the suitcases and everything and the
pregnancy and resistant to place women in family         social worker was like, well Aaron can follow
hostels until they are sure that the pregnancy is
                                                         up tomorrow. And I was like, no, I said, we’re all
viable. This can mean that pregnant women are left
                                                         going to go together and he went on the tube
in unsuitable housing and then have the upheaval
of moving late in their pregnancy. In Blackpool, we      and got there before me.”
were told that a new standard had been introduced        “I asked the social worker if she would help
to move women before they were six months                move us because apparently the Council
pregnant. This helps to ensure that they have            don’t move if it’s into permanent so I did ask
both safer accommodation during the end of their
                                                         them to help about that. After I asked her she
pregnancy, and stability around the time of their
child’s birth.                                           just didn’t answer the phone for a week and by
                                                         then we’d had to think of something else and
                                                         move anyway.”
Beth told us about how she had to move home
twice within weeks of her daughter’s birth.
 “They just thought it wasn’t safe for me to stay        We recommend that:
 [in the single person’s hostel] but I was actually      •   The Government, as part of their ‘Family
 there until I was eight months pregnant. I                  Test’, review and revise housing and social
 moved in [to the family hostel] about the end               security legislation and regulations, as
 of November and she was born on Boxing day                  well as statutory and practice guidance, to
 so only a couple of weeks I moved before I had              ensure that the system prioritises pregnant
                                                             women’s need for safety, stability and social
 her. Then I moved there, I was there for a month
                                                             support, and enables pregnant women and
 only because when Jess was born, although                   their families to be housed in suitable stable
 she wasn’t born addicted they wanted to get us              accommodation early in pregnancy with room
 into … a family unit.”                                      for the new baby. This should include paying
                                                             the spare room subsidy to families receiving
                                                             housing benefit when a woman is in the final
Under the housing benefit rules families are
                                                             trimester of pregnancy.
not eligible for a home with a bedroom for their
new baby until that baby is born. This can leave         •   Local authorities ensure that pregnant
them unable to plan and move in advance of the               women in temporary accommodation
birth. It can also result in families receiving time-        are routinely supported, encouraged and
limited offers of accommodation whilst they are              enabled to move to accommodation that
heavily pregnant, or around the time of birth,               meets the expectations set out in our ‘Gold
requiring them to move (sometimes to unfurnished             Standard’ for babies, as soon as possible
accommodation) just after the baby is born.                  after housing workers are alerted to the
Moving between accommodation can be costly and               pregnancy. This should help ensure that
difficult for them. In Blackpool, we heard how the           pregnant women are housed in safer, family-
local housing services used Discretionary Housing            friendly accommodation.

                                                        How can homelessness affect babies’ safety and wellbeing? 21
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