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 CuthbertContents
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 3Acknowledgements 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 5and 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 homelessnessssness 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 homelessnessdelays, 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 9crucial 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 homelessness2. 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 11Beth’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 homelessness3. 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? 13Figure 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 homelessnesshouseholds 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? 15in 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 homelessnessNumbers 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? 17The 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? 19Double 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 homelessnessfor 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? 21You can also read
