[Research]

Needs of Children Experiencing Homelessness who are Living in Shelters: A Qualitative Investigation of Perceptions of Care Workers to Inform Music Therapy Clinical Practice

By Greta Jean Yates & Michael Joseph Silverman

Abstract

On a single night in January in 2014 there were 194,000 children living with their families in shelters in the United States (National Center on Family Homelessness, 2015). A typical family experiencing homelessness consists of a single mother with two to three children. Children experiencing homelessness are more likely to face academic, social, and emotional problems compared to children in poverty. As there is currently a dearth of peer reviewed publications related to music therapy with children experiencing homelessness, the purpose of this study was to explore the perceived needs of children living in a homeless shelter through interviews with care workers and apply results to the music therapy clinical practice. Participants were seven staff members employed at a shelter for women and children experiencing homelessness in the Midwestern part of the United States. Data analysis was based upon Braun and Clarke’s (2006) six phases of thematic analysis. Emerging themes included: (a) staff need to be positive role models and provide trusting and affectionate relationships, (b) older children require programming and opportunities for communication and emotional support, (c) wellbeing must be screened and monitored, and (d) routine and expectations are needed to promote a calm living environment. Implications for music therapy clinical practice, limitations, and suggestions for future research concerning music therapy with children experiencing homelessness are provided.

Keywords: homeless children, care workers, experiences, qualitative, music therapy



Introduction

On a single night in January in 2014 there were 194,000 children living with their families in shelters in the United States (National Center on Family Homelessness, 2015). Children experiencing homelessness are exposed to more risks than low-income housed children including hunger and poor nutrition, anxiety and depression, health problems, developmental delays, psychological problems, and academic underachievement (Bassuk & Rubin, 1987). As there are only a few peer reviewed publications related to music therapy with children experiencing homelessness (Fairchild, Thompson, & McFerran, 2016; Staum, 1993; Staum & Brotons, 1995), there is need to investigate how support staff can best care for the people they serve. The purpose of this study is to explore the perceived needs of children living in a homeless shelter through interviews with care workers. The resultant themes could then be applied to music therapy practice.


Literature Review

The United States Department of Housing and Urban Development (2014) defined homelessness as living in shelters, transitional housing, and/or public places. The United States Department of Education (2004) noted a broader definition of homelessness and included families who live with other families due to economic necessity. According to the National Center on Family Homelessness (2015), more than 1.6 million children are homeless each year in the United States. There were 216,261 families experiencing homelessness on a single night in January 2014 (United States Department of Housing and Urban Development, 2014). Families experiencing homelessness represented 37.4% of the homeless population. In regards to shelter status, 33.2% were sheltered families experiencing homelessness, while 4.2% of the total homeless population was unsheltered. Forty-five percent of all families experiencing homelessness were in major cities in the United States. In January 2014, 15,143 families were chronically homeless. Families experiencing chronic homelessness are those that have been continuously without a home for at least a year or have experienced at least four episodes being without shelter in the last 3 years.

A typical family experiencing homelessness is headed by a single mother, usually in her late 20s, with two or three young children who are typically preschoolers (National Child Traumatic Stress Network, 2005; United States Department of Housing and Urban Development, 2014). In a review of published studies involving children experiencing homelessness in the United States between 1987 and 2005, Buckner (2008) explained that children experiencing homelessness are potentially exposed to three types of risk factors:

Risks that are specifically related to being homeless (e.g., stressful conditions within a shelter); risks that are shared by children from low-income families more broadly (e.g., exposure to community violence); and risks that all children, regardless of family income, have in common (e.g., biological and certain family-related factors). (p. 722–723)

Given these risk factors, it is difficult to determine where the “poverty-related sources of risk end and homelessness-specific risks begin” (p. 726). As a whole, children experiencing homelessness often go without adequate food and may have poor nutrition, severe anxiety and depression, health problems and a lack of care, developmental delays, psychological problems, and academic underachievement (Bassuk & Rubin, 1987). Only 45% of preschool aged children age three to five living in a homeless shelter attend preschool while 93% of children experiencing homelessness aged 6-17 attend school regularly (Burt et al., 1999). According to the National Child Traumatic Stress Network (2005), children within consistent shelter are sick twice as much as other children. Relatedly, in a metropolitan city in the southern United States, health care was not available on a regular basis in shelters (Hicks-Coolick, Burnside-Eaton, & Peters, 2003).

Children experiencing homelessness are more likely to have lived through stressful events, undergone a care and protection investigation, and been placed in foster care (Bassuk et al., 1997). In a survey of 169 children aged 6-12 living in a major metropolitan area homeless shelter, Zima and colleagues (1999) found that 50% were witnesses to or victims of serious violence, 27% had behavioral problems, and 45% had lived in three or more places within the last year. According to Bassuk, Rubin, and Lauriat’s (1986) survey of 151 children living in a homeless shelter in Massachusetts, half of the children interviewed required additional psychiatric and medical evaluations. In a review of the literature, Buckner (2008) found that while homelessness can have a negative impact on children, this does not occur in all instances. Buckner also emphasized that many of these studies occurred when family homelessness was a new problem and communities were not equipped or prepared for the problem. “The size of the shelter, location, crowdedness, level of privacy, extent to which rules are enforced, warmth and skill level of shelter staff, and whether families are allowed to stay at the shelter during the day” should all be taken into account when considering how living in a homeless shelter may have an effect on children (p. 731). Given the above mentioned statistics and problems families experiencing homelessness may encounter, these children face greater risks than their matched peers.

More specifically, homelessness represents an important societal problem particularly in relation to the educational and developmental impact on children experiencing homelessness. Children experiencing homelessness between the ages of two and five are more likely to have short attention spans, social withdrawal, aggression, speech delays, sleep disorders, immature peer interactions contrasted with strong sibling relationships, immature social interaction with adults, and immature motor behavior (Buckner, 2008; Molnar, 1988). Rescoria, Parker, and Stolley (1991) view vocabulary as a result of environmental experiences and exposure to cultural education. When compared to matched peers of the same age and background living in homes, preschool children experiencing homelessness were significantly more delayed in receptive vocabulary and visual-motor development. Most preschool children were not enrolled in any childhood development program, which deprived them of the important educational benefits associated with early intervention. Instead, these children spent their days in unstructured chaotic shelter environments and in the presence of adults who were experiencing high levels of stress. Rescoria and colleagues (1991) found that school aged children also scored significantly lower in receptive and expressive vocabulary compared to matched peers who were not homeless. Due to these factors, children experiencing homelessness may require intervention and assistance in order to help them be successful in various social and academic settings.


Music Therapy with Children Experiencing Homelessness

According to the American Music Therapy Association’s 2014 Workforce Analysis, no music therapist explicitly responded that she or he worked with children experiencing homelessness. However, some responders listed “domestic violence shelters” as the work setting served. Domestic violence shelters may serve women and children experiencing homelessness. This response was categorized into the “other” category that accounted for 36.5% of responses.

To date, there are minimal refereed and published studies regarding music therapy and children experiencing homelessness. Staum (1993) researched the effects of music therapy interventions on the abilities of children experiencing homelessness to problem solve. Interventions included singing, movement and dance, instrument playing, and musical drama. There was no between-group difference in the percentage of positive and logical responses. The researcher made 10 recommendations for working with children experiencing homelessness including encouraging peer friendships within the group, developing trusting relationship with music staff, establishing a quiet setting conductive to concentration, using activities that foster a sense of being competent and being in control, and offering a consistent and predictable schedule.

In a related study, Staum and Brotons (1995) attempted to determine if music therapy as a secondary reinforcer had a greater value than a primary reinforcer (i.e., food and clothing) for children experiencing homelessness. After a music therapy session including singing, dancing, playing instruments, and dancing to recorded music, children were given the opportunity to select a new piece of clothing, eat a home cooked meal, or make a music video. There was no difference in participation between reinforcers. The authors noted that attendance varied and did not improve when incentives were offered. In fact, only six children completed all measures of the study. The authors recommended the following goals for children experiencing homelessness: attending the session, staying in the session, following directions, and behaving appropriately in group settings. Although both of the music therapy studies included recommendations, there is a lack of literature and recommendations from other professionals specific to guide music therapy clinical practice.

Recently, Fairchild, Thompson, and McFerran (2016) conducted a qualitative study to explore the experiences of a supported group performance for children and their families experiencing homelessness and family violence. The researchers found three themes: 1) The children experienced intense mixed emotions; 2) the performance connected the children to family members and their peers; and 3) the members of the audience played an active role in the performance. The authors’ findings emphasized how music performances can uniquely provide opportunities for positive and supportive family engagement during crises.

Given the limited amount of research relating to children experiencing homelessness and music therapy, we chose a qualitative paradigm to obtain current, relevant, rich, and insightful information from homeless shelter staff about the needs of children experiencing homelessness. Due to this lack of music therapy literature, it seemed as though a qualitative approach would be the most appropriate as it is the intention of the researchers to generate recommendations for best practice music therapy derived from the richness and depth of information provided in the interviews. Therefore, the purpose of this study was to explore the needs of children living in a homeless shelter for women and children through interviews with care workers. The guiding research question was as follows: Based on their experiences, what are homeless shelter care workers’ recommendations for working with children and youth experiencing homelessness and how does this apply to music therapy clinical practice?


Method

Program Description

The setting was a homeless shelter in an urban area of a Midwestern city in the United States. The shelter opened in 1990 and can accommodate 16 families experiencing homelessness with an average of 35 children at one time. Approximately 90% of the families are African American (Sudduth, personal communication, April 13, 2015). Children range in age from newborn to 17 years old and over 80% of children are aged 10 and younger. Women may be as old as 65 as some care for grandchildren while in the shelter. The typical mother is aged 18-24 and has one to three children living with her in the shelter. The average length of stay at the homeless shelter is 45 days.

The shelter offers a variety of programs for families including nursing and health classes, parenting classes, job interview preparation opportunities, art programs, and music therapy for children. All children aged three to five are required to attend preschool giving the mothers an opportunity to work–or pursue work–during the day. School-aged children are bused to the school they attended prior to moving into the shelter to prevent disruptive educational change. School-aged children have opportunities to work with tutors in the evening and attend field trips on the weekends.

Music therapy sessions for children aged three to five were 45 minutes long and occurred one time a week on Saturday mornings. On average there were five children in a group, but groups could be as small as two children and as large as eight children. Goals were often based around positive peer interaction, following directions, and pre-academic skills. Music therapy sessions for children aged six and older were 60 minutes long and occurred one time a week on Saturday mornings. On average there were five children in a group but groups ranged in size from two children to 11 children. Goals focused on positive peer interaction, following directions, academic skills, and creative expression.


Research Participants

The principle investigator (PI) conducted individual semi-structured interviews with all seven staff members at the homeless shelter. Although the PI was employed by the shelter, only two participants had observed music therapy sessions previously. The PI interviewed the following staff members: (a) the house manager employed at the shelter for 6 years; (b) the child and youth activity fitness coordinator employed at the shelter for 3 months; (c) the director employed at the shelter for 1 year; (d) the kitchen manager employed at the shelter for one and a half years; (e) the program assistant employed at the shelter for 6 months; (f) the weekend advocate employed at the shelter for 10 months; and (g) the Child and Youth Program Case Manager employed at the shelter for two and a half years. Five of the seven staff members were African American.


Procedure

Questions were developed by the researchers and modified by a graduate class to ensure they were non-leading and appropriate for the research question. Questions pertained to the children’s daily routines and the case workers’ perceived needs of the children. Interviews lasted from 15 to 40-minutes. After the PI explained the study, all participants volunteered to participate and signed consent forms. Interviews were audio recorded, transcribed, and read by the PI who removed redundancies. Transcripts were then sent to participants for member checking and returned to the PI. Participants did not receive payment for their participation. This project was approved by the researchers’ Institutional Review Board and the administrators of the shelter.


Authors’ Lenses and Biases

The PI was a board certified music therapist (MT-BC) with 2 years of clinical experience at the onset of data collection and used primarily cognitive behavioral music therapy approaches. The PI was employed by the homeless shelter for 1 year to provide 2 hours of music therapy a week. The second author is a published music therapy educator, researcher, and clinician who specialized in cognitive behavioral music therapy with adult mental health populations where homelessness was frequently a concern with these clients. Thus, it would be impossible to separate these clinical experiences from the researchers’ way of knowing, interpreting, and understanding the data. The gestalt of these factors informed the researchers’ thought processes, ways of knowing, and interpretation of the data (Edwards, 2012; Stige, Malterud, & Midtgarden, 2009). The researchers are Caucasian and the current study is specific to homelessness in the United States. The authors recognize that other countries may have different circumstances and contextual parameters that influence programming and treatments.


Qualitative Analysis

The researchers utilized Braun and Clarke’s (2006) six phases of thematic analysis including: a) familiarization with the data; b) generation of initial codes; c) searching for themes; d) reviewing themes; e) defining and naming themes; and f) producing the report. The PI independently reviewed all the data, generated initial codes, organized codes into categories, created initial themes, reviewed themes, defined themes with supportive thematic statements, and provided relevant examples from the data. To ensure trustworthiness, the PI met with two graduate student colleagues and discussed data, reviewed codes, resolved discrepancies, clarified themes, and verified that quotes pulled were grounded in the themes. The data were then triangulated with the literature. The second author oversaw the entirety of the process and verified codes, themes, and supporting participant statements for inclusion.

In accordance with Buckner’s (2008) levels of risk factors encountered by children experiencing homelessness, the researchers focused only on the needs of children living in the shelter and not on the needs of all children. For example, participants in the current study noted the need for the children to have numerous activities to prevent boredom and typically housed children also require activities to prevent boredom. Participants also noted the importance of providing academic support and diagnosing health needs for children upon entry to shelter. However, these needs are already being addressed through tutoring and coordination of services with the school system and the county. Previous researchers highlighted the need for academic and psychological interventions, but as Buckner (2008) emphasized in his literature review, those studied occurred during a period when shelters for people experiencing homelessness were underfunded and not providing adequate support to those living in the shelters. Thus, this analysis focused specifically on the needs of children experiencing homelessness during the duration of stay at the shelter instead of overarching needs for children experiencing homelessness.


Results

Four themes were identified via the thematic analysis. Codes are depicted to support themes and enhance transparency. Participants’ statements are also depicted to provide contextual support for the themes and honor their unique voices and contributions.


Theme 1: Staff Need to be Positive Role Models and Provide Trusting and Affectionate Relationships

Codes included model, support, trust, comfort, working alliance, stability, affection.

Participants noted that children moving into the shelter are coming from unstable environments. These environments may be caused by financial instability, lack of support, domestic violence, changing schools, and not having a stable home. Staff at the shelter are often unaware of the full history of the families living in the shelter. Mothers living in the homeless shelter are often concerned with finding housing, financial stability, and improvement of their personal situation, which may result in children experiencing homelessness lacking affection, support, and engagement from their mother. If children require additional support and stability, staff can assist to meet those needs. Staff function as positive role models for children to show how success is different for everyone and how people of different backgrounds coexist peacefully.

The one thing we can all do is just be really positive role models for them and show them what success looks like. We used to have a policy that we had to be really closed off about our personal lives, like our history and where we come from and what we’re doing in our regular lives. That had to remain a mystery. Over the last couple of years that’s kind of evolved into us being able to let people in even kids and answer questions and not say ‘I’m not allowed to talk about that’ but really to talk about it and talk about our lives…Our staff is really diverse and we all come from really different places. But, just to let kids see that there is something for everyone and that we are all from different places and come together on one accord to work in this place and that the kids can all do the same things and do whatever they want to do. There are always other people in life who come from something totally different from you that you can connect with. (Child and Youth Program Case Manager)
I think there is a need [for affection] and you know kids like to come to me because I’m just one of the people who will talk normal to them... Once there were two sisters here, one was seven and one was six. The six-year-old liked to come and get a hug. The other one would come up but she really didn’t know how to hug so I said ‘Oh, we’ll have to teach you how to hug’ and her sister went ‘this is how you hug!’ and came up to me. After that, the oldest one would just come and hug me…I think that they think and know which ones they feel safe with. They’re not going to do that [hug] with anybody, they have to feel safe…I can see some of that them lack affection. (Weekend Advocate)
That’s very challenging, to trust. Working with this population, it’s everything, trust and consistency. It’s going to always be a challenge here because they trust no one and everybody walks in and they walk out…Some of their needs are very simple. Whether they may just need a hug at that time, or maybe they need us to tie their shoe at that time. Just taking the time out of the day to let them know that we are ever so present and that’s why we are here. (Director)
A lot of them want somebody to talk to. There are a lot of males, especially at the older ages, you know, there’s no males besides myself here. You can tell a lot of them gravitate towards me because I’m a male and they have somebody to talk about stuff with, even if it’s just sports or this or that. They need that interaction with a male because they are here with a bunch of ladies and they need that someone…Key words: rapport, listen and talk with them because it’s rough being in a crisis situation to anybody. And then you think as an adult you’ve got thicker skin for this, but for children it’s a lot rougher. To be supportive of them is the biggest thing we can do for them, and to listen to their needs and what they’re saying and trying to understand. (Kitchen Manager)


Theme 2: Older Children Require Programming and Opportunities for Communication and Emotional Support

Codes included idiosyncratic needs, support, socialization, communication, attach, accept.

Participants noted that each age group of children living in the shelter has specific needs. Older children may have insight into their situations and may require additional services. This age group is also most likely to not attend supportive programming including games, art, and music therapy, as the groups offered at the shelter are intended for younger children aged three to five and then six and older. Supportive programming intended for school-aged children aged six and older often consists of children aged six to 10 as older children are often not interested in participating in programs with younger peers. Given the teenaged children’s awareness of their situations and their needs for additional support and opportunities to express themselves, programming specifically geared towards this age group is warranted.

Some of the moms have it really tough, but it does hit the teenagers really hard. They don’t want peers to know they’re in shelter, so they’re kind of embarrassed about it. I think the teens have it the hardest…There’s a lot of talking and trying to get them involved with the programs here and then trying to see if they are interested in maybe hanging out with another teenager here, which is problem because there isn’t enough... I think the teenagers are affected most because they don’t know where to go or have anyone to hang out with other than the kids at school, and they don’t tend to be over there. They have very little social life, it’s put on hold while they’re here…The teens like to be in the tutor lab on the computer. Other than that, we do need more groups for teens, some mentors and some more teen-things just for teens.” (House Manager)
There is that attachment piece. That they don’t know how to attach. They don’t have friends because they’ve moved from place to place. So that’s that piece there. The fact that moving around and I don’t have friends or the friends that I thought I made will hear that I’m moving again and there is some anger, some resentment. So we get that piece that we have to deal with. It’s a little harder when it’s teenagers because they really don’t open up right away, so we have to deal with that portion there. (Director)
Most of the kids take a few times of participating in things to warm up to them. It’s always nice once they do, they always enjoy it and it’s fun to see their little personalities come out. That would be the main one. They’re so hesitant and timid because it’s just so new. I think even the older kids are, from what I’ve seen, kind of even held back even more than the younger ones. (Child and Youth Activity Fitness Coordinator)
With the older kids, they can be a little more resentful because they recognize what’s going on and they blame their moms and that’s upsetting to them that they have to be in a situation solely because of what choices their parents made…The older kids tend to push away a little bit more. (Child and Youth Program Case Manager)
I do a lot of one on one meetings with the school-aged kids about what’s going on in school, what’s going on with your family, what’s going on with you, how are you feeling, do you have things you want to talk about. You know, we will talk about bullying or we will go on a meeting with the school social workers and talk about what is going on at school and why things at the shelter might be affecting that. (Child and Youth Program Case Manager)
[The older kids’] needs would be someone to sit down and talk to them. They need someone besides their parents where they’re able to understand that things happen in life. Social acceptance and things like that, because a lot of the kids, because they’re in a shelter, think it’s bad or not good. They need to understand what’s going on in their life at this point. (Kitchen Manager)


Theme 3: Wellbeing must be Screened and Monitored

Codes included assessment, screen, monitor, health and wellbeing, stabilize, sleep.

Participants noted that children are in an emergency situation while living in a shelter and need to be stabilized as quickly and effectively as possible. Children may have never been to a doctor, an optometrist, or a psychologist prior their time at the homeless shelter. Most likely, the mother did not have insurance or convenient access to these services. Services may be provided onsite at the shelter to make it easier to receive these services. In addition to requiring services, children may not have healthy habits due to their financial situation and upbringing. Staff explained how they need to observe the children in order to see what each child needs for a healthy and safe lifestyle while living in the shelter.

Moms I think kind of miss out because they’re so focused on what they need to do to get out of here and focused on finding a job and getting housing that they’re not necessarily paying attention to the kids’ needs. Like a lot of kids who move in have speech issues or like I said their dieting habits are bad or their health is poor or they have something like, you know we’ve had little kids who have had PTSD who need to be diagnosed and treated...So, a lot of times we have to get them caught up on vaccines and well child checkup and we need to make sure they get a pre-k screening and we need to make sure that, you know, that they’re up to date on everything and if they have needs and referrals need to be made that those things happen because it’s not happening without the help of staff who are here in shelter or in the schools or in childcare facilities… I would just say that [the moms] come in not knowing how to navigate systems, so they need help with a lot of things for their children. Whether that be like my kids had glasses a year ago, he broke them, how do I get him new glasses, what do we do? Or, my kid has a cavity but I don’t have access to like any dental care yet because I don’t have insurance. What do we do? So that’s a lot of what I hear too is, you know, running into these situations where they need stuff, they need help, they need coordination of services…The younger kids I think what I see is sleep patterns change a lot, which totally changes their temperament throughout the day. (Child and Youth Program Case Manager)
The problem is some of the kids don’t end up eating because the parents don’t make the kid try something, or if it looks unfamiliar. The kids might eat a piece of chicken or French fries, but when you start getting into a hot dish or a vegetable they’re not used to eating, you’ll see a child sit there and not touch anything and not made to do anything which is a sad situation because doing that, the child is not eating. That’s not good because we don’t have facilities in the room. It concerns me then when are they eating if they’re not eating at this time. Of course once in a while I believe a staff member does say something and say ‘hey, why don’t you try this?’ but sometimes I see a whole plate go into the garbage and the kid eats nothing. It’s a big concern. (Kitchen Manager)


Theme 4: Routine and Expectations are Needed to Promote a Calm Living Environment

Codes included structure, healthy environment, rules, expectations, discipline.

Participants noted that the shelter may be home to as many as 16 families, with an average of 35 children at a single time. As families are often coming from unstable environments, structure and clearly defined expectations are required in order to promote stability and healing for all 16 families. If the shelter is chaotic, children are likely to feel less stable which does not promote trust among residents and towards the staff. When there are rules, structure, and expectations, 16 families can live together more easily and staff are able to work more effectively with the families.

I think management here, I think the program director [has] made a huge impact on the calmness of the building and that affects all the children and moms. There’s structure and I think kids really do like that. No more yelling and mom can’t be cursing at their kids and stuff, and I think that’s a huge step… [Rules have a good effect] on the kids too because kids see moms follow the rules and so they tend to follow them too. It’s a lot calmer than it has been in the past. I think they like that a lot. And, just being involved in cleaning, just learning that you need to keep things tidy and in order. (Weekend Advocate)
I think we’re just kind of more consistent because I believe that all, number one, children love structure. I think they need structure in order for their brains to grow and thrive. I think that now, [the shelter], is really sound because it does have some structure and some order in place…[The kids] are confused until they get used to the routine here. But the kids get used to the routine quicker than the moms, because the kids are so resilient. They’re like literally, they’ll come in, follow suit with no problem, and love it. (Director)
[With the previous director] a lot of things had gotten really lax and there was a lot of gray area. So, this whole community of people living here felt more unstable and chaotic most of the time. There was more, I guess there was more chaos, there was more instability, so the kids were feeling that. Because, when the moms are yelling at each other, or they’re disrespecting one another or they’re disrespecting staff. That you know plays a part in knowing that the kids are seeing the world work. The kids obviously need to see positive role models and they need to see people respect one another or they’re not going to do that. So, I think now there are a lot more, different policies in place. There is a lot more structure here, which can be difficulty for the adults but for the kids structure is key. So, structure and consistency you know I think for the families because we don’t just house women, we house families so that is important for the kids. I think they operate better knowing I’m going to eat dinner at the same time every day, I’m going to be home like walking into shelter at the same time every night, my bedtime is the same every night. My expectations are the same every day. There is more than just my mom holding me accountable. It’s shelter staff who are holding me accountable as well. So, I think it’s good for them to see it…As long as there is structure, but not a power struggle, [the children] do well. (Child and Youth Program Case Manager)
I really think that providing a welcoming environment for [the children] because like I said before, a lot of the kids really don’t know what’s going on. They just know that they’re moving because mom is moving or something is happening we just need to move. So, trying to provide an environment that is calming for them, not too much anxiety going on, and that’s why [the director] tries to run a calm and quiet house because a lot of the times we don’t really know the emotional stuff that’s going on [in the beginning]. If we don’t know it, we try to just keep it calm in the house so that everybody can get acclimated and feel comfortable and be able to seek the help. (Program Assistant)


Discussion

The purpose of this qualitative investigation was to explore the perceived needs of children living in a homeless shelter through interviews with care workers. Emerging themes included: (a) staff need to be positive role models and provide trusting and affectionate relationships (b) older children require programming and opportunities for communication and emotional support, (c) wellbeing must be screened and monitored, and (d) routine and expectations are needed to promote a calm living environment. Due to the lack of music therapy literature with this clinical population, emerging themes may be helpful for music therapists.


Implications for Care Workers

Children living in a homeless shelter are in an emergency situation and sometimes require medical and psychosocial stabilization. The needs that are explored within the themes and resulting suggestions are directed towards stabilization of children while they are living in the shelter. As the average length of stay is 45 days, therapies and additional services may not always be available or warranted as other needs, such as safety, may need to be prioritized. If a family has a longer length of stay, other needs may be addressed after they have been stabilized and feel secure and safe while living at the shelter. Academic, social, and emotional needs will likely be ongoing challenges for these children after they move out of the shelter, leaving them vulnerable to continued adversity and risk (Buckner, 2008). Therefore, it is most important to provide stability and support while the children are living at the shelter.

Staff who work with this population must also be highly cognizant and prepared to address any additional challenges a child may experience. Staff should be aware that their position at the homeless shelter may require them to not only do their specific job and tasks, but also require them to provide emotional support to children by being someone to talk with and to provide affection as needed. All staff should be comfortable speaking and interacting with children even if their role does not require it. Congruent with the concept of ongoing assessment, staff should always observe children for any changes and to be sure the children are safe and healthy. Staff should also promote a living environment that is calm and structured in order to provide a safe environment for the children. It should also be noted that the average length of employment for staff at the homeless shelter was less than two years. Staff turnover does not always promote a calm and stable environment for the families living in a homeless shelter as it can be difficult for staff to be efficient when they are new to their jobs or training new employees. Therefore, it is important that new staff are oriented to their jobs in efficient manners to promote more stability for those living in the shelter. Thus, it would seem that music therapy could also be provided for caregivers at homeless shelters to target self-care and help reduce burnout.

There may be additional barriers, including potential latent or overt prejudices, that might hinder the development of trust between staff and clients and impact participants’ perceptions of client needs. If staff are Caucasian, for example, issues of social, political, and cultural power and privilege might need to be explored within the context of care at the homeless shelter. However, if staff are African-American, there may be a sense of greater equality during interactions and a subsequent understanding of situations that might have led to the families being in the shelter. In the case of the current shelter, additional variance in power differentials would seem to be at play as staff were racially mixed. Additionally, as the PI is Caucasian, this may have impacted dialogue during the interviews. Thus, these results are limited by the authors’ socio-cultural contexts and experiences as well as those ensuing parameters.


Implications for Music Therapy Clinical Practice

Music therapists, when planning and structuring their groups, should be especially cognizant of the need for structure, emotional support, affection, positive role models, and open means of communication. Just as the staff working at the shelter are sometimes appropriately open about their personal lives as self-disclosure may facilitate working alliance, music therapists may need to be prepared for these types of questions as well. Perhaps incorporating blended treatment orientations could best meet the needs of these families. For example, cognitive-behavioral approaches might provide support, coping skills, structure, and emotional support while community music therapy (Stige & Aarø, 2011) and resource-oriented approaches (Rolvsjord, 2010) could help identify assets and resources where the power differentials, cultural reflexivity, and care for all in community are considered. Additionally, while music therapy groups will vary in content, they should be held at the same time, for the same duration of time, and children should have the same expectations during treatment groups every week. Music therapists can also create a calm environment through expectations but also through teaching coping skills and relaxation skills that children may use outside of music therapy. Music therapists must be flexible when planning due to the average length of stay being 45 days. Children may move in and out quickly or stay for longer periods of time. Music therapists may need to reteach skills and routines often and be prepared to incorporate different interventions depending on the academic, emotional, and social needs of the children in attendance.

According to the Child and Youth Program Case Manager, Director, and the Child and Youth Activity and Fitness Coordinator, children’s involvement in groups is not always a representation of the children’s interest, but rather it can reflect the interests of the mother. Mothers must agree to send their children to a group and have them ready to attend. Due to outside responsibilities and busy schedules, families may also not be at the shelter when groups are being held. Thus, groups can vary greatly in the age and number of children in attendance. Music therapists should consider their intended age group. Older children are not likely to attend groups for younger children, so a group directly geared towards teenaged children may be more appropriate to increase their attendance and participation. Perhaps incorporating resource-oriented models (i.e., a music studio or guitar lessons) specifically for older children may encourage engagement and participation. Music therapists should also be aware of the children’s baseline in regard to academic skills, social skills, and emotional skills and report any changes or concerns to the appropriate staff in a manner congruent with the facility’s protocol that respects the child’s confidentiality but also promotes trust and ensures safety.

Needs found in this analysis complement and supplement the needs and recommendations outlined by Staum (1993) and Staum and Broton (1995). For example, Staum (1993) encouraged music therapists to develop trusting relationships with the children, which is congruent with Theme 1. Staum (1993) also recommended the promotion of quiet settings with a consistent and predictable schedule, which is similar to Theme 4. Staum and Broton (1995) emphasized the importance of goals and expectations for children, which is congruent with Theme 4.


Limitations and Suggestions for Future Research

The authors did not interview or collect data from the mothers who lived in the shelter with their children. Future researchers might consider interviewing mothers and children for a better understanding of the unique needs of this population from their perspective. Additionally, only two staff who participated in interviews had observed music therapy sessions. If staff members were more familiar with music therapy, future researchers could also interview staff about their perceptions of music therapy within a homeless shelter. Music therapy service users could also provide unique insights into their perceptions of treatment. Moreover, embedding cultural reflexivity within qualitative data may help to further understand unique experiences and perspectives. Investigating various music therapy approaches in relation to the unique lived experience of being homeless is warranted. Finally, as it would seem that music therapy could also be provided for caregivers at homeless shelters, this topic certainly constitutes an area for future investigation.

The purpose of this qualitative investigation was to understand care workers’ perceived needs of children living in a homeless shelter. The themes depict the need for supportive and affectionate staff as the child requires, more opportunities for older children, observation of health and wellness, and structure and expectations. Future research is warranted to better understand staff and services user’s perceptions of music therapy in the homeless shelter setting. Given the academic and clinical training necessary to practice, music therapists are likely able to help meet the needs of children experiencing homelessness and additional research is warranted.


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Voices: A World Forum for Music Therapy (ISSN 1504-1611)