Interview with Anne Giordano: Pregnancy, Birth, and Homelessness

Various studies have found that pre-natal and post-natal homelessness result in long-term negative health impacts on children, families and communities, and that the combination of pre-natal and post-natal homelessness has a “dose-response” effect that compounds the health risks linked to both pre-natal and post-natal homelessness. Further, compared with consistently housed mothers, mothers with a history of homelessness have a greater chance of experiencing fair or poor health and depressive symptoms. Additionally, pregnant homeless women are typically younger than nonpregnant homeless women, and frequently have a history of family disruption. Finally, very young children who experience homelessness are more likely to experience health problems and developmental delays; longer periods of homelessness have been found to be associated with worse health outcomes.

We interview Anne Giordano, MA, DSP, IMH-E®, who is an Early Childhood Specialist at EdAdvance in Litchfield, CT. She has coordinated a McKinney-Vento subgrant for the school district, provides training for the CT Association in Infant Mental Health, and frequently develops and provides training at the state and national levels on the impact of homelessness on expectant parents, young children and their families.

Hello, Anne. Can you tell us a little about yourself?

I’ve been working in the field of child and family homelessness for a number of years on the local level coordinating a McKinney Vento sub-grant with a local public school system. Through this project, we’ve endeavored to enhance systems of identification, student stability and success within the school district. We directly support families with very young children who may not yet be enrolled in any programming through outreach and by connecting personally with families who are residing in our local shelters, as well as those who are doubled up, sharing the housing of others. Through this work, I regularly meet both expectant families and those who are newly parenting.

What are the unique needs and challenges you see facing women experiencing homelessness during pregnancy, delivery, and their first few months with their newborn?

Unlike families with school-aged children who are experiencing homelessness and tend to be more readily identified, pregnant women and those with very young children are more often under the radar. They are less likely to be enrolled in any formal programming that addresses homelessness and therefore they are often missed. They may even be invisible. Pregnancy and parenting while homeless can be an even greater challenge for youth. A recent study by Chapin Hall found that unmarried parenting youth have a 200% higher risk of becoming homeless, and with that comes an increased risk for maternal and perinatal depression, and a host of other pervasive concerns. HUD data indicate that over 27% of families in HUD shelters are headed by someone under the age of 25.

These young women face daunting challenges because they are young, highly stressed, isolated and are experiencing their own physical and mental health issues. Additionally, they often lack access to the appropriate medical care and nutrition required to support healthy pregnancy and birth outcomes. Finally, many themselves have experienced abuse in their own lives, resulting in long histories of personal relationship challenges, and even abandonment.

The instability of homelessness interferes with the natural process of creating a space in their lives and homes for their newborn. It severely limits their ability to experience a positive prenatal period of anticipation needed to promote optimal health and development for both the mother and the baby, such as obtaining adequate prenatal care and “nesting,” or mentally and physically preparing for parenthood, the birth experience, and caring for their newborn child. All of these factors provide the foundation for the building of a secure and healthy attachment relationship between the parent and infant; and it is from this positive relationship and sense of security that the infant is able to grow, learn and build relationships with others.

“I remember distinctly one young mom that I met at our local shelter, who had arrived there just days before her due date. She delivered a tiny, but healthy baby girl, and returned to the shelter when her daughter was two days old. The staff rallied around the young mother, and provided as much emotional support as they could, even though they were essentially strangers to her. I couldn’t help but wonder what the shuffling among so many different adults throughout the day meant for this precious infant. What did this arrangement mean for the attachment relationship for Mom and baby? What was it like for this infant to see so many different faces? What did it mean for Mom to “parent” her first child in front of so many people?”

– Anne Giordano

What are the unique needs and challenges for the newborn babies of parents experiencing homelessness?

The experience of homelessness creates toxic stress. The instability and ongoing lack of routine and predictability, in addition to the extreme lack of basic needs and resources, have a profound impact on the infant. Infants and toddlers are particularly vulnerable to the negative impacts of trauma because of the developing structure of their young, growing brains. The primary task of infancy is to develop a sense of security and trust in the world, which is accomplished by experiencing warm, consistent, and nurturing care provided by those we rely on most. Parents are hard pressed to provide this environment for their infant if their own basic needs are not met. The unpredictable, inadequate physical environments, overcrowding or overstimulating conditions, exposure to extreme temperatures or unsafe conditions – these experiences of homelessness work against infants’ developing a sense of safety, which is the foundation for all future learning. Homelessness also can render parents emotionally unavailable, and often physically unable to respond and to meet the caregiving needs of a newborn in consistent, nurturing ways. These situations have profound and lasting negative impacts in early childhood and into adulthood.

I remember distinctly one young mom that I met at our local shelter, who had arrived there just days before her due date. The shelter staff were very welcoming of her, and gathered as many needed baby items they could prior to the delivery. She delivered a tiny, but healthy baby girl, and returned to the shelter when her daughter was two days old. The staff rallied around the young mother, and provided as much emotional support as they could, even though they were essentially strangers to her. Residents and staff alike doted on the baby. While this support was very appreciated by Mom, I couldn’t help but wonder what the shuffling among so many different adults throughout the day meant for this precious infant. What did this arrangement mean for the attachment relationship for Mom and baby? What was it like for this infant to see so many different faces? What did it mean for Mom to “parent” her first child in front of so many people?

Can you suggest ways we might bring more attention to the needs of expectant and new parents and their babies who are experiencing homelessness, perhaps ways we might change our practice to be more sensitive to their unique needs during this period of family life?

We need to do a much better job of educating the public, the medical community, housing providers, policymakers and others of the gravity and enormity of this crisis in our country. I imagine that most are quite unaware of the impact of homelessness on this population and the long-term impact that family homelessness in early childhood has on everyone – families, communities, and our nation’s future. Homeless babies are growing up now! Additionally, while we need to address the many complex root causes of homelessness, in the interim we need to establish and support more family-friendly, supportive shelter and transitional homes for young, parenting families. These shelters and homes should have appropriate environments for bonding and breastfeeding, access to ongoing physical and mental health services, training on recognizing the signs of and routinely screening for perinatal mood disorders, and creating opportunities for fathers to be part of their babies’ lives. Identifying and addressing homelessness during this vulnerable period for parents and babies is critical. Making home visiting available could help to ensure ongoing support for families.

What special sensitivity does the infant mental health perspective bring to this work?

Infant mental health concerns the attachment relationships that infants and young children develop with their primary attachment figures, which may be the child’s parents or other primary caregivers. It has been described as the developing capacity of the child from birth through age five to experience, regulate, and express emotions, to form close, secure interpersonal relationships, and to explore his/her environment and learn – all within the context of family, community, and cultural expectations (Zero to Three Infant Mental Health Task Force, 2001). A famous quote in the infant mental health world is “what about the baby?” This is an all-encompassing statement which reflects the idea of the parallel process. It serves as a reminder to us all that the biggest impact we can have is to support parents so they can support their babies! We have a lot of work to do!

Can you think of suggestions or challenges unique to dads? Can you say a few words about dads in particular and how homelessness impacts their role as an expectant and new parent?

Dads are so often left out of the equation. We must improve policies to ensure they are not separated from their family by the housing community, and that we support their ability to bond with and nurture their babies. This will have lasting and positive impacts for our babies. A colleague from Minnesota, Dr. Glen Palm, who works tirelessly to support fathers often says, “When a baby is born, a father is born.” We mustn’t forget this! It is well said, and this thinking should drive our advocacy, too.