Exploring Access and Utilization of Early Intervention Services Among Families Experiencing Homelessness: A Qualitative Study

Background: In 2018, nearly half of children living in federally-funded emergency and transitional housing programs were age five or younger.[1] Experiencing homelessness in early childhood has been associated with an increased likelihood of chronic illnesses, developmental delays, and readiness for school.[2] Several early childhood interventions have been shown to help mitigate the adverse effects of early experiences.[3] Children facing homelessness, however, have unique barriers to accessing early intervention (EI). Though the McKinney-Vento Homeless Assistance Act includes the right of homeless families to access “appropriate early childhood education programs,” most eligible children experiencing homelessness do not receive these programs.[4]

Methods: We recruited nineteen caregivers of children ages 3 or younger who had recently experienced or were contemporaneously experiencing homelessness from three sites in Boston. Each interview was 45-60 minutes in length, audio-recorded, and fully transcribed with accompanying field notes. Analysis was conducted through immersion and crystallization, an iterative process in which the original data was organized and interpreted to articulate patterns and themes. The research team regularly compared and discussed emerging themes in order to strengthen the analysis. Interviews were conducted until thematic saturation was reached. All notes, reports, codes, and documents were gathered to form an audit trail of the data.

Results: Participants often cited shelters as the first point of contact for EI services, and caregivers attributed entering shelter as a facilitator for initial access to EI. While facilitating access, the shelter environment also created barriers to effective service engagement. These included limited available physical space, loss of care continuity amidst frequent relocations, and challenges with trust due to feelings of stigma and loss of autonomy. EI providers were a crucial bridge to mitigate these challenges, but were often insufficient to overcome structural barriers important to care. Effective EI strategies included flexibility in accommodating shifting schedules, provisions of socioemotional support in times of stress, and providing warm handoffs to additional upstream resources.

Conclusion: While EI services are an important source of support for families experiencing homelessness, caregivers experiencing homelessness describe several barriers to engaging in optimal care. Efforts to mitigate shelter-related challenges will require interdisciplinary collaboration between early interventionists and shelter staff at both local and state levels. Further efforts should focus on providing increased engagement and continuity of care for children in a manner that acknowledges the structural barriers of homelessness and supports caregiver autonomy.