Lost in Limbo

Lost in Limbo: An Exploratory Study of Homeless Mothers’ Experiences and Needs at Emergency Assistance Hotels Kristie A. Thomas & Marvin So Increases in family homelessness have led several states to use hotels and motels as shelters. Except for investigations into “welfare hotels” of the 1980s, research on this practice is largely nonexistent. This study explored the experience of living in an emergency assistance hotel through in-depth interviews with 10 homeless mothers, triangulated with proximity analyses of the walking distance and public transit time between emergency assistance hotels in Massachusetts (n = 49) and 6 basic need types. Four themes emerged from interviews: living in limbo, profound isolation, role conflict, and immense difficulty meeting basic needs—which proximity analyses further illustrated. Findings suggest the need for systems to consider homeless families’ mobility barriers and assess the built environment around hotels used to shelter families.

IMPLICATIONS FOR PRACTICE •

This research demonstrates an immediate need for social workers to engage in a multipronged approach to improve the lives of homeless families placed in emergency assistance (EA) hotels and motels.

•

A multipronged approach includes outreach to families currently living in EA hotels to tend to their physical, mental, and social health needs; educating service providers on the ways in which living in an EA hotel can affect homeless families’ well-being; and advocating for the creation of sustainable housing alternatives to eliminate the need for EA hotels.

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oint-in-time estimates from 2014 indicate that more than 200,000 people were homeless as a family in the United States, and that women head the majority of these families (Henry, Cortes, Shivji, & Buck, 2014; Solari, Cortes, Henry, Matthews, & Morris, 2014). Family homelessness is due largely to a lack of affordable housing (Grant, Gracy, Goldsmith, Shapiro, & Redlener, 2013); however, other contributing factors include institutional poverty, insufficient social support, childhood trauma (Bassuk et al., 1997; Shinn et al., 1998), and domestic violence (Bassuk, Perloff, & Dawson, 2001; Lyon, Lane, & Menard, 2008; Pavao, Alvarez, Baumrind, Induni, & Kimerling, 2007).

Although family homelessness has decreased nationally, trends differ across states (Henry et al., 2014). In Massachusetts, family homelessness rose 111% from 2007 to 2014 (Henry et al., 2014). These increases have strained the already overburdened emergency shelter system (The U.S. Conference of Mayors, 2009, 2014), resulting in the placement of families in hotel and motel rooms (hereinafter “emergency assistance [EA] hotels”).

In December 2014, approximately 1,700 families were Families in Society: The Journal of Contemporary Social Services ©2016 Alliance for Strong Families and Communities 120 ISSN: Print 1044-3894; Electronic 1945-1350

sheltered in 50 EA hotels across the state, at an estimated cost of $40 million (Bump, 2015).

The practice of using hotels and motels as overflow shelters has received attention from a range of constituents, including housing advocates (e.g., On Solid Ground Coalition, 2015), the media (e.g., Contrada, 2013; Rosenberg, 2014; Shenoy, 2014), and politicians (e.g., Massachusetts Office of the Governor, 2015). However, other than exposés about the “welfare hotels” of the 1980s (e.g., Kozol, 1988; Robbins, 1986), these sources provide the majority of knowledge about the topic.

The current study begins to address these gaps by using in-depth interviews and spatial analysis to explore the experience of living in an EA hotel in Massachusetts.

Such knowledge is vital, as Massachusetts is one of at least a dozen states using hotels as shelters (U.S. Conference of Mayors, 2014).

Literature Review A typical sheltered family is composed of a single mother with several young children (Solari et al., 2014). These mothers often lack a high school diploma (Bassuk et al., 1997) and social support (Bassuk et al., 1997; Fertig & Reingold, 2008), and they are dealing with an array of medical, mental health, and substance use problems (Bassuk & Beardslee, 2014; Weinreb, Buckner, Williams, & Nicholson, 2006). Many are domestic violence (DV) survivors (Bassuk et al., 1997; The U.S. Conference of Mayors, 2014), which can include physical, psychological, sexual, and economic abuse (Breiding, Chen, & Black, 2014). Together, DV and homelessness can be especially detrimental for the well-being of survivors and their children (Bassuk et al., 2001; Bassuk, DeCandia, Beach, & Berman, 2014; Rollins et al., 2012) Experiencing homelessness is deeply destabilizing. It disrupts familial routines, which can be 2016, 97(2), 120–131 DOI: 10.1606/1044-3894.2016.97.15

Thomas & So | Lost in Limbo: An Exploratory Study of Homeless Mothers’ Experiences and Needs at Emergency Assistance Hotels

protective against stressors that are common in the lives of low-income families (Zima, Wells, & Freeman, 1994).

Homeless families have little control over their schedules, must abide by the rules of others, lack personal space and privacy, and spend their time navigating systems—all of which affect consistent routines (Cosgrove & Flynn, 2005; Mayberry, Shinn, Benton, & Wise, 2014).

Homelessness can affect a mother’s ability to provide for her children (Mayberry et al., 2014; Perlman, Cowan, Gewirtz, Haskett, & Stokes, 2012) and discipline practices (Warren & Font, 2015), putting her at increased risk for system involvement (Park, Metraux, & Culhane, 2004). Not surprisingly, exiting homelessness can be difficult (Weinreb, Rog, & Henderson, 2010).

When families are unable to sustain independent housing, regardless of the reason, they typically turn first to informal support, moving in with relatives or friends (Solari et al., 2014). These situations are often untenable, however, leading families to seek help from emergency shelters. However, because shelters are often filled to capacity, providers have had to develop other arrangements, one of which is sheltering families in hotels and motels.

The practice of using hotels as shelters—known then as “welfare hotels”—began in the 1980s. A U.S. General Accounting Office (1989) report defined welfare hotels as “commercially owned single- or multi-story hotels or motels providing shelter to a clientele composed exclusively or primarily of homeless families receiving some type of public assistance” and described basic services as “a room with a private bath, linen changes, and general facility maintenance…generally, cooking facilities are not provided” (p. 2). The report surveyed 12 states, which reported that the average stay length ranged from 2 to 16 months; Massachusetts had an average stay of 90 days and sheltered 496 families in 1988 (U.S. General Accounting Office, 1989).

These welfare hotels were the target of harsh criticism. Perhaps the most well-known critique is Kozol’s 1988 book about the Martinique Hotel in New York, Rachel and Her Children: Homeless Families in America. Kozol described environmental conditions and systematic bureaucracies in the hotel and shelter system that converged to make it enormously difficult to parent, obtain employment, access stable housing, and maintain material possessions. Others concurred, describing welfare hotels as dirty, dangerous, and expensive (Robbins, 1986).

Research on the current use of hotels and motels to shelter homeless families is scarce, consisting mainly of evidence that it occurs (U.S. Conference of Mayors, 2014). The practice is particularly common in Massachusetts because families deemed eligible for shelter must be housed according to the “right to shelter” law (Leonard & Randell, 1992); thus, if no shelter beds are

available, the state pays for families to live in a hotel or motel room until shelter space opens up (Bump, 2015).

The experience of living in a Massachusetts EA hotel has been covered mainly by journalists, who have described it as enormously challenging (e.g., Contrada, 2013; Rosenberg 2014; Shenoy, 2014).

Although research on EA hotels is scarce, a useful starting point comes from a series of qualitative studies on low-income families paying out of pocket to live in extended-stay motels (Lewinson, 2010, 2011; Lewinson & Collard, 2012; Lewinson, Hopps, & Reeves, 2010). Participants reported feeling secluded, closed-in, and trapped (Lewinson, 2010; Lewinson et al., 2010); however, there were positive aspects such as family independence, housekeeping, courteous staff, and ability to decorate the room (Lewinson, 2011). To address their needs, they bought appliances to cook food, partitioned rooms with curtains (Lewinson, 2010), and chose hotels that were centrally located with access to necessary resources (Lewinson, 2011).

The studies just described, though important, offer insight into a very particular hotel experience: that of low-income families who can pay for an extended-stay hotel room. What is missing is research not only on the experience of homeless families who are placed in a hotel by a shelter system but also the extent to which the hotels that house homeless families are close to necessary resources. Thus, the aims of this study were to (a) explore homeless mothers’ experiences living in EA hotels and (b) describe the level of accessibility to basic needs at EA hotels. Without a better understanding of experiences in EA hotels, systems risk harming an already vulnerable population. This study is a first step toward building such understanding.

Methods This study employs two distinct phases of data collection and analysis, consistent with a robust mixedmethods exploratory sequential design, in which the first phase, qualitative analysis, is implemented, then used to guide the conduct and interpretation of the second phase, spatial analysis (Creswell, Plano Clark, Gutmann, & Hanson, 2003). This multimethod approach enables investigation of the hotel experience through two ways of knowing, thereby augmenting the depth and dependability of our findings.

First Study Aim: Experience of Living in an EA Hotel

Participants and procedures. The present study emerged from a larger investigation in which a purposive sample of 30 women was recruited from eight Massachusetts shelters from April 2013 to February 2014.

Women were eligible if they (a) were English-speaking 121

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adults, (b) experienced recent DV, (c) resided in a DV shelter or homeless shelter (congregate, scattered site, or EA hotel), and (d) had at least one other shelter stay in the past 2 years.

Of those 30 participants, 10 had a stay in at least one EA hotel and, thus, compose the sample for this study’s first aim. Mean age was 30 years; racial composition was Black/African American (n = 4), Asian (n = 2), Latina (n = 2), biracial (n = 1), and White (n = 1). All identified as heterosexual and had at least one child. Participants were largely low-income, with 60% not employed and 80% receiving public assistance. The living situation at the time of the interview was family shelter (60%), DV shelter (30%), or transitional living program (10%).

Mean number of shelters lived in was 5. All reported DV in the past 2 years, and past year experience of severe victimization was psychological (50%), physical (40%), injuries (30%), and sexual (20%), as measured by the Revised Conflict Tactics Scales—Short Form (Straus & Douglas, 2004).

The first author conducted in-depth, semistructured interviews with each participant in a private space for 90–120 minutes. Prior to the interview, participants gave informed consent and chose a pseudonym. We developed the semistructured interview guide with input from four content experts (researchers and program staff). It contained several questions specific to EA hotels (e.g., What was it like at the hotel?). The interviews ended with a brief demographics questionnaire and a debriefing for questions or concerns.

Participants received a $30 gift card and a list of local resources. Simmons College’s Institutional Review Board approved all procedures.

Data analysis. Each interview was audiorecorded and transcribed. The authors analyzed the data using Charmaz’s (2006) constructivist grounded theory approach. This approach includes a four-stage coding method (initial, focused, axial, and theoretical coding), keeping memos throughout data collection and analysis, and engaging in data collection and analysis simultaneously to hone in on meaningful themes that emerge in later data collection. Analysis included all of these procedures except for theoretical coding, which does not have to be the end goal given that grounded theory methods provide a “useful analytic framework” for descriptive studies (Charmaz, 2006, p. xii). We used the method of constant comparison and multiple rounds of coding to identify, crystallize, and distill codes into categories and categories into themes.

Second Study Aim: Accessibility of Basic Needs at EA Hotels

The second study aim was to use spatial methods to describe the level of accessibility to basic needs while at EA hotels. This aim arose from the findings of the 122

first study aim and served to triangulate the interviewees’ subjective reports, particularly the theme of how difficult it was for participants without a vehicle to get to necessary resources (e.g., grocery stores). To address this aim, we sampled the entire population of EA hotels (n = 49) in Massachusetts, stratified according to county population density. We used the 2013 National Center for Health Statistics Urban–Rural Classification Scheme for Counties: “large central metropolitan (metro)” (in statistical areas of ≥ 1 million people, containing the entire population of the largest principal city), “large fringe metro” (in statistical areas of ≥ 1 million people that do not qualify as large central metro), “medium metro” (in statistical areas of populations 250,000–999,999), “small metro” (in statistical areas of populations less than 250,000), and “micropolitan” (nonmetro counties in statistical areas of 10,000–50,000). We selected six categories of basic needs’ providers—food retailers, self-service laundries, public transportation stops, child care facilities, urgent health care centers, and public assistance offices (see Table 1)—informed by findings from the first aim and the literature (e.g., Richards & Smith, 2006; Wiecha, Dywer, Jacques, & Rand, 1993).

Spatial analyses. Using ArcGIS version 9.3 software, we conducted a proximity analysis, which identifies the shortest path between two locations on a road network, to calculate (a) average literal distance and (b) average time via public transit from each EA hotel location to each basic need provider location. For both the point distance and the time analysis, we placed a 5-mile buffer around each hotel and limited the search for provider locations to the closest five facilities for each of the six basic need categories, resulting in 35 provider locations. For the point distance analysis, we used the ArcGIS Point Distance tool to determine the walking distance in miles from each EA hotel to each of the 35 provider locations. For the transit time analysis, we incorporated all location points within a multimodal transportation network model that included all bus and rail routes and stops, and system transfers to capture the universe of travel, walk, and wait times experienced by public transportation system travelers in the respective regional transit authority system. Time estimates were calculated based on the measurements from the point distance analysis, converted based on the “preferred walking speed” in the United States of 3.1 miles per hour (Levine & Norenzayan, 1999). We did not attempt to model the variability seen within day-to-day commuting that might be due to inclement weather, traffic, time of day, and road conditions. We cross validated distance and time against Google Maps (via the Engine Connector) per Whitmeyer and De Paor’s (2014) protocol and with cutoffs based on the U.S. National Map Accuracy Standards (U.S. Geological Survey, 1999).

Thomas & So | Lost in Limbo: An Exploratory Study of Homeless Mothers’ Experiences and Needs at Emergency Assistance Hotels

After determining walking distance and transit time between each EA hotel and the 35 provider locations, we conducted additional analyses to obtain an aggregate sense of accessibility using methods consistent with research on spatial accessibility to health services (Guagliardo, 2004). First, we calculated the mean distance and the mean transit time to each of the six need categories for each EA hotel. Second, we averaged these mean estimates, resulting in a mean distance and a mean transit time to each of the six need categories for the five county types.

Findings First Study Aim: Experience of Living in an EA Hotel

The overarching finding was that living in an EA hotel was profoundly difficult for participants. Nine participants reported a negative experience, using words such as “hard,” “bad,” and “struggle.” Four themes emerged, which summarize their experiences and constitute the majority of this section. Before describing those themes, we begin with basic information on stay lengths, housing situations before and after the EA hotel, and a description of the EA hotels.

Participants stayed in an EA hotel anywhere from 4 days to 5 months (median = 14 days), with a total of 12 hotel stays across the 10 participants. Prior to hotel entrance, participants had been living with friends or family (n = 4), in a family or DV shelter (n = 2), in their own apartment (n = 2), or with an abusive partner (n = 2). Upon EA hotel exit, six participants moved to a family shelter, two moved to a DV shelter, and two moved in with friends or family.

The EA hotels varied in size, capacity, and number of rooms allotted for homeless families. A typical room contained two beds, a small refrigerator, and a microwave. Two of the hotel stays were at extended-stay hotels, which offered large refrigerators and mini-stoves.

Theme 1: It is difficult to meet one’s most basic needs while living in an EA hotel. A unifying feature of participants’ hotel experience was the challenge of meeting their own and their children’s basic needs. The most frequently mentioned need was nutritious food. A primary barrier was the inadequacy of the hotel facilities: The lack of a kitchen limited the amount and types of food they could store and cook. Two participants explained, To tell you the truth, even though somebody’s homeless, and they don’t have anywhere to go—that was my only option, you know—I think that, especially when funds are provided by the state to house women and children in that type of situation, they should provide a way for a mother to cook for her child. I don’t think that’s humane, you know? (Jessica) It was two beds in one room. I had a microwave and a tiny, tiny refrigerator, and I remember when I first got there I called [caseworker], and I asked her how do they expect me to feed my kids and give them the right nutrition with a microwave and a small fridge that you can’t fit a gallon of milk in. And she said, “Well you have to work with what you got.” So I told her, “I’m supposed to feed my kids microwaveable food for how long? Until I get an apartment?” (Purple)

The second barrier to food was that the EA hotels were located in relatively isolated and inaccessible

Table 1. List of Six Basic Need Types Included in Spatial Analysis, With Corresponding Provider Type and Data Source of Addresses Basic need

Provider

Data source

Food

Food retailers

Determined by the U.S. Department of Agriculture (USDA), Food and Nutrition Service list of retailers that have been approved for the Supplemental Nutrition Assistance Program (SNAP).

Child care

Child care facilities

Determined through the Yellow Pages, a directory of businesses organized by category.

This was chosen over databases of accredited child care facilities as it is known that many families access informal and nonaccredited child care facilities, rather than accredited centers, which tend to be more expensive.

Laundry

Self-service laundries

Determined by listings of laundry facilities of the Massachusetts Department of Environmental Protection.

Transportation

Public transportation stops

List of public transportation stops was determined by the regional agencies managing and coordinating local and commuter public transportation. These were identified through the Massachusetts Department of Transportation.

Health care

Urgent health care facilities

List of health care facilities was determined through the Massachusetts Center for Health Information and Analysis. Health care facilities were included if they offered some form of urgent care health services.

Cash assistance

Public assistance offices

Local benefits offices were determined by the Massachusetts Department of Health and Human Services, Department of Transitional Assistance Online Services platform.

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areas. The majority of participants (n = 8) did not own a car, and traveling on foot or by bus was challenging, if not impossible. Walking to the store—with children in arms or in utero—was physically demanding. Moreover, they had to make the trek frequently because they could buy only a few items at once, essentially only what they could carry. The bus was also a challenge: It required at least some walking as well as money. Four participants explicitly said they could not afford the bus. Two quotes illuminate the challenges participants endured: There was nothing around me—no food, no nothing but a gas station. And I had nothing but food stamps. The gas station does not accept food stamps, and the only cash I had was enough to get me on the commuter rail to get me to my doctor’s appointments and to get back. I had to spend that money on food. So then I was stuck not getting to doctor’s appointments.… I literally lost 4 pounds!…

Some of the women were able to walk to [grocer] 4 miles up the street. I couldn’t walk that. I was a high-risk pregnancy. (“T”) Hotel is hard for me.… I think [in] one week, I go maybe three times for shopping. So, it means I need spend at least $10, $12 for the bus. So, I only got $200 for cash from [public assistance], so it means the bus almost around $40 to $50 one month.… I didn’t have stroller, either. So it means one hand I carry my son, one hand I take the food. From the hotel to the bus station, at least 15 minute, yeah, I’m pregnant at time, too. (Cindy)

The two participants with a car while in the EA hotel described it as vital to surviving the experience, especially regarding food access. Purple explained: “I would go to my grandmother’s house to feed my kids, you know, hot meals every day and not feed them junk.”

Similarly, Lee reported, “Without a car it would be hard, very hard.” For Jessica, having a friend occasionally take her grocery shopping meant not having to walk or use public assistance benefits on a taxi.

The EA hotel’s facilities interfered with other basic needs. Participants described how being confined to one small room was especially hard on children: Younger children did not have space to play inside the room and were not allowed to play elsewhere in the hotel; adolescents struggled with the lack of privacy. Mamuda discussed what it was like for her 14-year-old son to live for 5 months in a hotel: “He needed his own room, and it was a really hard time.” Nine of the participants expressed that an EA hotel is an unfit dwelling for a child.

Moreover, the lack of resources within or nearby the EA hotel created a situation in which participants felt forced to prioritize one basic need at the expense of an124

other. Two participants left their EA hotel placement— despite not having guaranteed housing in place— because they felt that the EA hotel was compromising their children’s health. For Pink, exiting the EA hotel led to many challenges, including being barred from the shelter system for 1 year:1 They told me that I wouldn’t be there no longer than 30 days, because my son has autism. And I had got papers from his doctors, his teachers, basically stating that, you know, he can’t be locked up in a room all day, he needs space to run, he likes to run and play, get into things, do different things. So, being locked up in a room is going to wear on his nerves, and he’s going to tend to act out.… So, 30 days ended up turning into 2 months—2 months!… So, I left, and that’s when [child welfare] got involved, due to people making reports about me sleeping house-to-house with a kid. (Pink)

Participants described making other costly tradeoffs due to living at an EA hotel. Cindy’s son, who had a chronic health condition, needed to go to the hospital on a day the bus did not run, requiring her to pay for a taxi.

Mamuda had to take two buses and one train each way to get her child to day care. Purple chose to “sacrifice whatever I have to [sacrifice] to get him to school and to keep at least something normal in his life”—which affected her income: [The hotel] was super far. I was working in [location #1], the kids were in school in [location #2] and then I had to be back in the hotel, which was in [location #3]. My gas money was like, more than the bills, so…I had my regular job cut down to part-time 'cause I didn’t have enough time to grab the kids.…

So, it—it was just struggling.

Theme 2: The EA hotel experience is analogous to living in a constant state of limbo. The next unifying theme was that the hotel experience was a time of incredible uncertainty and constraint. Participants had little knowledge of how long they would have to stay at the hotel, which contributed to feelings of being “stuck,” “trapped,” and in “limbo.” A main reason was the insufficient, and at times inaccurate, communication from the shelter system. As Julie described, There was other girls there, too, waiting to be placed in the shelter. So they were all just, like, basically, there. Just waiting to see what day—is today the day they gonna send the paper for where I’m going, or Currently in Massachusetts, families that refuse or leave a shelter placement without permission are not eligible for emergency shelter for 12 months. However, they have the right to appeal (Bourquin, 2011).

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Thomas & So | Lost in Limbo: An Exploratory Study of Homeless Mothers’ Experiences and Needs at Emergency Assistance Hotels

not? I was just stuck there, lost, just waiting. That was it.

Two participants were given time frames that kept changing. Cindy had been told that her caseworker would visit her weekly, yet she recalled only two visits during her 2-month stay. In three cases, the onus was on the participant to keep abreast of her placement status, a process that was stressful at best and arduous at worst.

Two quotes illustrate these situations: I didn’t hear anything from anybody.… So I was just—I was really scared, you know; I didn’t know what was going to happen. I didn’t know where they were going to end up sending me from that point.…

They just, kind of, threw me in there, and that was it, you know? The people at the hotel said, “You’re supposed to check here every day at 1 o’ clock to see if they have somewhere to place you.”… It was like, “I don’t know how long I’m going to be able to do this,” you know? (Jessica) Every day I had to take all my stuff with me and leave to go to [the public assistance office], and every day I was there I got denied [for a shelter transfer]. So I woke up every morning at 7:00.… Went there, sat there from 8:30 to 4:00 for them to tell me at 4:00, “Oh by the way, we’re not going to be able to place you.” (Tina)

Theme 3: The EA hotel and shelter system foster loneliness and isolation. The third theme was the experience of profound loneliness and isolation while at the EA hotel. First, as per rules of the shelter system, participants were not allowed to have any guests in their rooms.

I spent my birthday there, you know.… There was nobody allowed in the room for any reason whatsoever. Which was kind of like, “Wow.” I think it would have been better if I could have at least had a friend come over and keep me company. I went through a lot of different emotions, you know, being scared, lonely, depressed, isolated. (Jessica)

Second, the hotels were not located in participants’ communities, which led to feeling cut off from friends, family, and other supports (n = 6). Pink explained, “I was far away from everybody.… So days I wouldn’t have money or anything, I would really be stranded because I didn’t know anybody where they placed me at. And then I didn’t have no type of transportation.” Third, three participants described how, unlike at a traditional shelter, they kept to themselves to avoid having to identify as homeless, either out of embarrassment or feeling judged by the hotel staff.

I really didn’t talk to anybody. Because it’s embarrassing—to me it is—to be homeless. It’s not something that you want to tell somebody. “Hey, I’m homeless. I have nowhere to go.” So I really didn’t talk to them because I didn’t want them asking questions, I really didn’t want anybody in my personal space. So I just came and went. (Tina)

In the end, participants interacted mainly with their children. As Julie reported, “So I’m just out in these places by myself. Especially the hotel situation, ’cause that was literally like, just by myself, like, it was just me and my son in the room.”

Theme 4: Using hotels as EA shelters creates conflict between hotel staff and homeless residents. The final theme concerned difficulties associated with living in a facility with a dual role of being a hotel and a shelter.

First, hotel staff members were put into an unwanted position of serving as proxy shelter system representatives. Because there were no system staff stationed at the hotel, and case managers rarely visited or called with information, hotel managers and attendants were often the only accessible people to whom inquires could be directed. Moreover, staff had just enough information to appear to have a connection with the shelter system, but not nearly enough to answer basic questions, which appeared to be a frustrating situation for all.

They don’t really know what’s going on. All they do is get a letter faxed to them telling them who to move to the shelter. So they, if I asked them anything, like, “Do you know what’s going on, or how long I’ll be here,” they don’t know anything. (Julie) I went at it with one of the front desk representatives, whatever they’re called. I asked her a question about [shelter system], and she snapped. She said, “How many times do I have to tell you people that we don’t work with [shelter system], we’re a separate entity… we have nothing to do with that. We don’t know about it.” And I told her, “the only reason I asked you was because I have some paperwork to turn in and you know, I wanted to see if [caseworker] received it because I left it at the front desk.” She said, “No, she didn’t receive it, no one received it, we don’t know anything about that.” So then I asked her if I could fax it, and this lady flipped out on me. (Purple)

According to Purple, it would have been helpful to have a caseworker stationed in the hotel: “These people [hotel staff] just work for a hotel, they have no idea, no clue… so you were throwing two people from two different worlds in one spot, and you’re bumping heads.”

Second, participants expected the hotel to provide the same services they would receive in a traditional shelter.

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In addition to wanting updates on their housing status, participants wanted hotel staff to monitor and control other guests. Ashley said, “It was a beautiful hotel, but the thing was no control, no control, no discipline, or consideration for each other as neighbors. No discipline of the manager to the tenants in the hotel. It was like a zoo in such a beautiful hotel.”

The need for monitoring was seen as critical given threats to safety at the hotel, including prostitution, drug use, and theft. Ashley described how a seemingly harmless feature of hotel rooms was used to harass her: “You could call each other’s rooms. If you were in room [X], and I was in [Z], you could just pick up the hotel phone and dial [X]. So, there were guys calling my hotel room without my permission.” The hotel did not get involved: “I made a complaint about it. I said, ‘I don’t feel safe.’… They told me that if I don’t feel safe, I can leave.”

Finally, given that the facility was, indeed, a hotel, participants assumed they could expect basic hotel amenities (e.g., cleanliness, professionalism). Experiences varied, however: [Housekeeping] came to change the towels and stuff like that. And the stuff she brought me back was, like, ripped up—had, like, other people’s pubic hairs on it.

And I’m looking at her, and I was like, “Listen, you need to bring me something that doesn’t have stains and pubic hairs on it, because I have to clean my child with that.”… Regardless of, you know, whether the state’s paying for me to stay here, or I’m paying you out of my pocket to stay here, I’m still a guest, and you should treat me like that. (Jessica) It was a nice place, very clean, very nice people there, and they treat me very good. At the beginning I was wary because I have a 14-year-old daughter and an 11-year-old son, and I didn’t want them to see this kind of life, but when I went there, it was nice. (Lee)

Second Study Aim: Accessibility of Basic Needs at EA Hotels

Spatial analyses findings are presented in Table 2. To preserve location confidentiality, we present findings numerically as average distances and times, rather than geographically using maps. Together, findings illustrate a general picture of resource accessibility for EA hotels according to five differently sized county types.

We begin with access to food, the need mentioned by all participants. On average, EA hotel residents had to travel 0.9 miles to reach a grocery store on foot, or spend

Table 2. Average Walking Distance (in Miles) and Average Transit Time (in Minutes) From Emergency Assistance (EA) Hotels (N = 49) to the Five Closest Basic Need Providers EA hotels by county type

Basic need types

Large central metro

Large fringe metro

Medium metro

Small metro

Micro

Total

n = 10

n=8

n = 14

n=7

n = 10

N = 49

Food retailers Walking distance Transit time

0.8

0.7

1.0

0.8

1.4

0.9

11.9

8.7

12.0

12.4

15.0

12.0

0.3

0.8

0.9

1.2

1.6

1.0

1.3

1.5

2.1

2.1

2.8

2.0

16.0

19.7

23.7

28.8

37.4

25.1

Public transit stop Walking distance Child care centers Walking distance Transit time Urgent health care centers Walking distance Transit time

1.0

1.5

1.4

1.9

2.5

1.7

18.8

21.3

23.4

36.3

27.7

25.5

Laundromats Walking distance

0.8

1.0

2.1

1.7

2.4

1.6

Transit time

8.8

12.9

21.9

29.9

46.4

24.0

2.3

2.3

2.5

3.9

1.8

2.5

32.5

26.8

37.6

38.8

32.7

33.7

Public assistance offices Walking distance Transit time

Note. County categories defined according to the 2013 NCHS National Center for Health Statistics Urban–Rural Classification Scheme for Counties.

Transit time based on U.S. “preferred walking speed”: 1.4 meters per second or 3.1 miles per hour during normal weekday transit service in the respective transit authority system (Levine & Norenzayan, 1999). Metro = metropolitan; micro = micropolitan.

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12 minutes on public transportation once they arrived at the transit stop. The lack of access was most pronounced among EA residents in micro counties; they traveled an average of 1.4 miles on foot or spent about 15 minutes on transit (compared to residents in other counties, who traveled a range of 0.7–1.0 miles or 9–12 Figure 1. Case example illustrating access to basic need resources for a family in an emergency assistance (EA) hotel, informed by point distance and transit time analyses and based on aggregate information from the 10 EA hotels located in a Massachusetts micropolitan county.

“Cindy” and her toddler spent 2 months in an EA hotel. She was pregnant with her second child and did not have access to a car. If she had been placed in a micropolitan county, she and her toddler would have had to walk approximately 1.4 miles to get to a grocery store, a trip they would need to take daily because she could carry only a few items at a time.

Accessing any of the other four basic need types would require first walking the 1.6 miles to the nearest public transit stop, which would add at least 30 minutes to the trip (and probably longer given that she was pregnant and holding her toddler).

While in the EA hotel, she received little information as to when she might be transferred to a shelter. If she were to travel to the public assistance office for more information, the trip would involve more than an hour of travel time each way (at least 30 minutes of walking to the transit stop and 30 minutes on public transportation). Traveling to a self-service laundry would take almost 2 hours each way, with 30 minutes of walking and more than 45 minutes on public transportation.

In summary, Cindy could spend her entire day walking and riding public transportation trying to meet her and her child’s basic needs.

Urgent Health Care Center Child Care Center

Public Transit Stop

2.5 1.6

2.8

Food Retailer EA Hotel

2.4 Self-Service Laundry

1.4

1.8 1 MILE 2 MILES 3 MILES

Public Assistance Office

minutes). In fact, a similar pattern emerged for nearly all other basic need types, such that increasing population density translated to increased access (i.e., reduced transit distance and times). The only need category that did not follow this overall pattern consisted of public assistance offices. It should be noted that, because there are fewer public assistance offices than other providers, these values do not depict access, but rather the distance from EA hotels to the closest public assistance offices.

To further illustrate how a family’s access to basic needs may be structured by the geography in which they are placed, we present a case example that integrates findings from the first aim with findings of the second aim (see Figure 1).

Discussion The overarching goal of this investigation was to better understand families’ experiences in modern-day “welfare hotels.” To our knowledge, it is the only study in recent years to explore this topic. It is also the first study on EA hotels to use spatial procedures—an important tool that provides, among other things, a “first step toward improving services” (Hillier, 2007, p. 213). In this study, spatial procedures offered an objective picture of the inaccessibility that is shaped by location and built environment, further elucidating a situation that may be challenging to grasp by narrative alone (Matthews, Detwiler, & Burton, 2005).

Overall, findings suggest that EA hotels of Massachusetts are not all that different from the welfare hotels of the 1980s. Participants in this study echoed much of what the U.S. General Accounting Office (1989) and Kozol (1988) described: Facilities comprised mainly of other homeless families, inconsistent provision of hotel services, inadequate cooking amenities, cramped rooms, and not-so-temporary stays. It is alarming that facilities have stayed consistent across decades given that it appears the situations of homeless families have not. Compared to homeless mothers in 1993, those in 2003 reported significantly fewer financial resources, more physical health problems, and higher rates of depression and posttraumatic stress disorder (Weinreb et al., 2006). More recent evidence of that trend comes from a survey of DV shelters, which reported similar increases over time in the severity of challenges their clients face (Melbin, Smyth, & Marcus, 2014).

Findings from interviews and proximity analyses suggest that it can be challenging to meet one’s most basic needs while residing in an EA hotel. EA residents without a vehicle need to expend considerable time, energy, and money to access food, health care, day care, and laundry services. In general, as hotels get farther away from a large metropolitan county, access to basic need providers decreases, which is problematic 127

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given there are as many EA hotels in micro counties (n = 10) as in central metro counties (n = 10). Control over other basic needs such as safety, privacy, and space is also challenging. In general, participants did not feel safe in the EA hotel, but not because of abusive partners. Participants were mainly fearful of other residents and their guests, especially those involved in criminal activity—a common feature of early welfare hotels (U.S. General Accounting Office, 1989). With no one at the EA hotels in charge of ensuring safety, participants kept to themselves and stayed in their rooms. In other words, the facilities and locations of EA hotels can hinder homeless mothers’ efforts to care for themselves and their children, which may contribute to the poor health and educational outcomes that have been documented among homeless children (Fantuzzo, LeBoeuf, Chen, Rouse, & Culhane, 2012; Grant et al., 2007; Wood, Valdez, Hayashi, & Shen, 1990). Moreover, the lack of control over their children’s care opposes best practices recommended for promoting positive parenting among mothers in shelters (Perlman et al., 2012).

The difficulty of being confined to one room appeared to be exacerbated by living in an inaccessible area and receiving little contact from the shelter system, which led to feelings of being trapped and isolated. Our findings align to some extent with recent research on lowincome families paying to live in extended-stay motels; they, too, reported feeling trapped—even with more spacious rooms, all of their possessions, and transportation (Lewinson, 2010, 2011; Lewinson & Collard, 2012; Lewinson et al., 2010). Our findings also align with research on depression among homeless mothers (Bassuk & Beardslee, 2014) and illuminate how the EA hotel experience may contribute to or heighten mothers’ depression. The spatial analysis suggests that these challenges may become increasingly salient as families are placed in more remote areas of the state in which access to basic resources—and likely other supports—tends to wane with decreasing population density.

It appears that families living in EA hotels may have to make costly trade-offs. To some extent, trade-offs are a part of life; however, our findings indicate that the stakes are graver when trade-offs occur in the context of poverty and DV, and that these trade-offs are often caused by the very systems tasked with helping homeless families (Melbin et al., 2014; Thomas, Goodman, & Putnins, 2015). Indeed, our study participants described situations in which prioritizing housing by staying in the EA hotel meant having to deprioritize other basic needs such as food, medical care, safety, and social connection. Further, system policies such as penalties for exiting the EA hotel and rules barring guests reinforce these trade-offs. Research on homeless shelters and DV shelters has demonstrated that they, too, can require trade-offs (e.g., curfews may force a mother to choose 128

employment over safety; DeWard & Moe, 2010; Glenn & Goodman, 2015; Lyon et al., 2008; Mayberry et al., 2014; Richards & Smith, 2006); our findings build upon these studies by identifying certain trade-offs that may be unique to EA hotels.

Finally, the use of hotels as shelters appears to elicit tensions between hotel staff and homeless families. The construct of role conflict from the literature on organizational theory (Rizzo, House, & Lirtzman, 1970) might offer an explanation. Role conflict occurs when a worker encounters incongruous role expectations, either because those expectations differ from the worker’s values, capabilities, or level of authority, or because the worker is beholden to many groups with differing expectations (Rizzo et al., 1970). In studies of workers caught between supervisors and customers, role conflict was associated with negative outcomes such as reduced job performance (Chung & Schneider, 2002). Thus, frontline staff in EA hotels might experience role conflict due to the incongruous expectations of hotel administration, shelter systems, homeless families, and paying guests. Also, some of what is expected is outside of workers’ authority and may even conflict with their own thoughts about homelessness—especially if they share the belief that homeless people are at fault for their plight (Belcher & DeForge, 2012).

Strengths and Limitations

This study has two primary limitations. First, the qualitative sample was relatively small (n = 10) and comprised of English-speaking women who had lived, but were not currently living, in an EA hotel in Massachusetts. Second, although we included the universe of hotels in Massachusetts and were systematic in identifying the five closest sites for each basic need, the quality of the resources examined in the proximity analysis was not considered. For example, examining only Supplemental Nutrition Assistance Program retailers could be problematic, as this definition includes everything from convenience stores to supermarkets. Thus, it is possible that accessible does not equate to useful. Future studies should consider using proximity analysis in conjunction with methods that can ascertain the perceived quality of basic needs, such as interactive community mapping (Shkabatur & Kumagai, 2014). That said, despite its limited generalizability, the study’s robust mixed-method approach offers unique and useful insights on an understudied housing intervention—insights that can inform the work of researchers and practitioners in other geographic settings.

Implications for Practice Study findings, though preliminary, can inform the systems that oversee EA hotels. First, systems should

Thomas & So | Lost in Limbo: An Exploratory Study of Homeless Mothers’ Experiences and Needs at Emergency Assistance Hotels

consider conducting an assessment of the built environment surrounding any hotel they contract with as an essential first step in ensuring resource accessibility for homeless residents. Existing evidence-based tools, such as the Neighborhood Environment Walkability Scale (Brownson, Hoehner, Day, Forsyth, & Sallis, 2009) can be adapted for these purposes. Also, it is important to assess whether rooms have adequate kitchen amenities—ideally only extended-stay hotels should be used—and the safety of the facility, which is vital for families with recent DV (Davies & Lyon, 2014). Finally, an increasing awareness of the extensive trauma experienced by homeless families has led many shelters to train their staff in trauma-informed practice (Bassuk, Volk, & Olivet, 2010; Wilson, Fauci, & Goodman, 2015).

In light of the potentially traumatic experiences that accompany living in an EA hotel, our findings suggest that EA hotel staff also would benefit from such training—as would every social worker or service provider who engages with families who live or have lived in EA hotels.

In addition to assessing the facility, it is important to assess homeless families’ mobility barriers. Our findings suggest that women with very young children, who are pregnant, or who have a physical impairment should not be placed in EA hotels, even for a few days, given the myriad challenges they face. Also, in light of our findings and evidence that the state-contracted hotels tend to be located in less accessible and less populated areas (Bump, 2015), only families with access to a vehicle should be placed in EA hotels. The call to assess families’ physical mobility and access to transportation aligns with recent efforts to expand shelter assessments beyond housing needs to include factors such as safety, mental health, and history of trauma (DeCandia, 2015).

In addition, shelter systems may want to consider having an accessible, visible presence in each EA hotel, as it might reduce feelings of limbo for homeless families and role conflict for hotel staff. More research is needed, however, to determine a healthy balance between excessive staff monitoring, as has been documented in shelters (DeWard & Moe, 2010; Glenn & Goodman, 2015), and a complete lack of monitoring, as reported by participants in this study.

Finally, our findings underscore the need for continued efforts toward longer-term solutions. In Massachusetts, increasing attention to the plight of homeless families in hotels and the financial drain on taxpayers has led the administration to call for—and begin to see progress toward—a reduction in EA hotel use (Massachusetts Office of the Governor, 2015; Massachusetts Department of Housing and Community Development; 2015). However, consistent dedicated funding for alternative options, preferably the creation of affordable housing, is needed for such progress to be sustainable.

References

Bassuk, E. L., & Beardslee, W. R. (2014). Depression in homeless mothers: Addressing an unrecognized public health issue.

American Journal of Orthopsychiatry, 84, 73–81.

Bassuk, E. L., Buckner, J. C., Weinreb, L. F., Browne, A., Bassuk, S. S., Dawson, R., & Perloff, J. N. (1997). Homelessness in femaleheaded families: Childhood and adult risk and protective factors. American Journal of Public Health, 87, 241–248.

Bassuk, E. L., DeCandia, C. J., Beach, C. A., & Berman, F. (2014).

America’s youngest outcasts: A report card on child homelessness.

Waltham, MA: The National Center on Family Homelessness at American Institutes for Research.

Bassuk, E. L., Perloff, J. N., & Dawson, R. (2001). Multiply homeless families: The insidious impact of violence. Housing Policy Debate, 12(2), 299–320.

Bassuk, E. L., Volk, K. T., & Olivet, J. (2010). A framework for developing supports and services for families experiencing homelessness. The Open Health Services and Policy Journal, 3, 34–407.

Belcher, J. R., & DeForge, B. R. (2012). Social stigma and homelessness: The limits of social change. Journal of Human Behavior in the Social Environment, 22, 929–946.

Bourquin, R. (2011). Basic shelter rights (emergency assistance).

MassLegalHelp [Website]. Retrieved from http://www. masslegalhelp.org/income-benefits/basic-shelter-rights Breiding, M. J., Chen, J., & Black, M. C. (2014). Intimate partner violence in the United States—2010. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

Brownson, R. C., Hoehner, C. M., Day, K., Forsyth, A., & Sallis, J. F. (2009). Measuring the built environment for physical activity.

American Journal of Preventive Medicine, 36, S99–S123.e12. doi:10.1016/j.amepre.2009.01.005 Bump, S. (2015). Municipal cost impacts of Massachusetts’s hotel/ motel-based homeless families shelter program. Boston, MA: The Commonwealth of Massachusetts, Office of the State Auditor. Retrieved from http://www.mass.gov/auditor/docs/ dlm-municipal/local-financial-impact-review-municipalcost-impacts-of-massachusettss-hotelmotel-based-homelessfamilies-shelter-program.pdf Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London, UK: SAGE. Chung, B. G., & Schneider, B. (2002). Serving multiple masters: Role conflict experienced by service employees. Journal of Services Marketing, 16, 70–87.

Contrada, F. (2013, December 2). Number of homeless living in hotels remains steady, Massachusetts figures show. MassLive [Website].

Retrieved from http://www.masslive.com/news/index. ssf/2013/12/state_figures_show_homeless_fa.html Cosgrove, L., & Flynn, C. (2005). Marginalized mothers: Parenting without a home. Analyses of Social Issues and Public Policy, 5, 127–143.

Creswell, J. W., Plano Clark, V. L., Gutmann, M. L., & Hanson, W. E. (2003). Advanced mixed methods research designs. Handbook of Mixed Methods in Social and Behavioral Research. Thousand Oaks, CA: SAGE. Davies, J., & Lyon, E. (2014). Domestic violence advocacy: Complex lives/Difficult choices. Thousand Oaks, CA: SAGE. DeCandia, C. J. (2015). Assessment of families experiencing homelessness: A guide for practitioners and policy makers.

Boston, MA: Homes for Families.

DeWard, S. L., & Moe, A. M. (2010). Like a prison! Homeless women’s narratives of surviving shelter. Journal of Sociology and Social Welfare, 37, 115–135.

Fantuzzo, J. W., LeBoeuf, W. A., Chen, C.-C., Rouse, H. L., & Culhane, D. P. (2012). The unique and combined effects of homelessness and school mobility on the educational outcomes of young children. Educational Researcher, 41, 393–402.

129

FAMILIES IN SOCIETY | Volume 97, No. 2

Fertig, A. R., & Reingold, D. A. (2008). Homelessness among at‐risk families with children in twenty American cities. Social Service Review, 82, 485–510.

Glenn, C., & Goodman, L. (2015). Living with and within the rules of domestic violence shelters: A qualitative exploration of residents’ experiences. Violence Against Women, 21, 1481–1506.

Grant, R., Gracy, D., Goldsmith, G., Shapiro, A., & Redlener, I. E. (2013). Twenty-five years of child and family homelessness: Where are we now? American Journal of Public Health, 103(S2), e1–e10. doi:10.2105/AJPH Grant, R., Shapiro, A., Joseph, S., Goldsmith, S., Rigual-Lynch, L., & Redlener, I. E. (2007). The health of homeless children revisited. Advances in Pediatrics, 54, 173–187.

Guagliardo, M. F. (2004). Spatial accessibility of primary care: Concepts, methods and challenges. International Journal of Health Geographics, 3(1), 3.

Henry, M., Cortes, A., Shivji, A., & Buck, K. (2014). The 2014 Annual Homeless Assessment Report (AHAR) to Congress: Part 1, Point-in-time estimates of homelessness. Washington, DC: U.S. Department of Housing and Urban Development.

Hillier, A. (2007). Why social work needs mapping. Journal of Social Work Education, 43, 205–222. doi:10.5175/ JSWE.2007.200500524 Kozol, J. (1988). Rachel and her children: Homeless families in America. New York, NY: Fawcett.

Leonard, M. A., & Randell, S. (1992). Policy shifts in the Massachusetts response to family homelessness. New England Journal of Public Policy, 8(1), 483–497.

Levine, R. V., & Norenzayan, A. (1999). The pace of life in 31 countries. Journal of Cross-Cultural Psychology, 30(2), 178–205.

Lewinson, T. (2010). Residents’ coping strategies in an extended-stay hotel home. Journal of Ethnographic and Qualitative Research, 4, 180–196.

Lewinson, T. (2011). Capturing environmental affordances: Low‐ income families identify positive characteristics of a hotel housing solution. Journal of Community & Applied Social Psychology, 21, 55–70.

Lewinson, T. W., Hopps, J. G., & Reeves, P. (2010). Liminal living at an extended stay hotel: Feeling stuck in a housing solution.

Journal of Sociology and Social Welfare, 37, 9–34.

Lewinson, T., & Collard, C. S. (2012). Social service barriers experienced by low-income extended-stay hotel residents.

Families in Society: The Journal of Contemporary Social Services, 93, 95–101. doi:10.1606/1044–3894.4193 Lyon, E., Lane, S., & Menard, A. (2008). Meeting survivors’ needs: A multi-state study of domestic violence shelter experiences.

Washington, DC: National Institute of Justice.

Massachusetts Department of Housing and Community Development. (2015, November). Emergency Assistance Program: Fiscal Year, 2016, First Quarterly Report.

Retrieved from http://www.mass.gov/hed/docs/dhcd/hs/ea/ fy16q1eareport.pdf Massachusetts Office of the Governor. (2015, March 2). BakerPolito administration unveils initiatives to reduce homelessness, proposes $20 million “End family Homelessness Reserve Fund.”

Retrieved from http://www.mass.gov/governor/press-office/ press-releases/fy2015/initiatives-to-reduce-homelessnessunveiled-.html Matthews, S. A., Detwiler, J. E., & Burton, L. M. (2005). Geoethnography: Coupling geographic information analysis techniques with ethnographic methods in urban research.

Cartographica: The International Journal for Geographic Information and Geovisualization, 40(4), 75–90.

Mayberry, L. S., Shinn, M., Benton, J. G., & Wise, J. (2014). Families experiencing housing instability: The effects of housing programs on family routines and rituals. American Journal of Orthopsychiatry, 84, 95–109. doi:10.1037/h0098946

130

Melbin, A., Smyth, K. F., & Marcus, S. (2014). Domestic and Sexual Violence Cohort Demonstration Project: Taking action to move from services to social change. Greenfield, MA: The Full Frame Initiative.

On Solid Ground Coalition. (2015, February). On solid ground: Building opportunity, preventing homelessness. Boston, MA: Author. Retrieved from http://www.chapa.org/sites/default/ files/OnSolidGroundReport.pdf Park, J. M., Metraux, S., & Culhane, D. P. (2004). Child welfare involvement among homeless children. Child Welfare, 83, 423–437.

Pavao, J., Alvarez, J., Baumrind, N., Induni, M., & Kimerling, R. (2007). Intimate partner violence and housing instability.

American Journal of Preventive Medicine, 32, 143–146.

Perlman, S., Cowan, B., Gewirtz, A., Haskett, M., & Stokes, L. (2012).

Promoting positive parenting in the context of homelessness.

American Journal of Orthopsychiatry, 82, 402–412. doi:10.1111/ j.1939–0025.2012.01158.x Richards, R., & Smith, C. (2006). Shelter environment and placement in community affects lifestyle factors among homeless families in Minnesota. American Journal of Health Promotion, 21, 36–44.

Rizzo, J. R., House, R. J., & Lirtzman, S. I. (1970). Role conflict and ambiguity in complex organizations. Administrative Science Quarterly, 15, 150–163.

Robbins, T. (1986). New York’s homeless families. In J. Erickson & C. Wilhelm (Eds.), Housing the homeless (pp. 26–36). New Brunswick, NJ: Center for Urban Policy Research.

Rollins, C., Glass, N. E., Perrin, N. A., Billhardt, K. A., Clough, A., Barnes, J.,…Bloom, T. L. (2012). Housing instability is as strong a predictor of poor health outcomes as level of danger in an abusive relationship: Findings from the SHARE study. Journal of Interpersonal Violence, 27, 623–643. doi:10.1177/0886260511423241 Rosenberg, S. (2014, November 16). For many families, home just is a hotel. Boston Globe. Retrieved from https://www. bostonglobe.com/metro/regionals/north/2014/11/16/ motels-becomes-kids-homes-danvers-waltham-weymouth/ gIYha2mkhZY2cZaZoy3k1O/story.html Shkabatur, J., & Kumagai, S. (2014). Interactive community mapping: improving service delivery and empowering communities.

Washington, DC: World Bank. Retrieved from https:// openknowledge.worldbank.org/handle/10986/18937 Shenoy, R. (2014, February 23). State seeks to move homeless from hotel rooms to group homes. Retrieved from https://news.wgbh. org/post/state-seeks-move-homeless-hotel-rooms-grouphomes Shinn, M., Weitzman, B. C., Stojanovic, D., Knickman, J. R., Jimenez, L., Duchon, L., & Krantz, D. H. (1998). Predictors of homelessness among families in New York City: From shelter request to housing stability. American Journal of Public Health, 88, 1651–1657.

Solari, C. D., Cortes, A., Henry, M., Matthews, N., & Morris, S. (2014). The 2013 Annual Homeless Assessment Report (AHAR) to Congress: Part 2, Estimates of homelessness in the United States. Washington, DC: U.S. Department of Housing and Urban Development.

Straus, M. A., & Douglas, E. M. (2004). A short form of the Revised Conflict Tactics Scales and typologies for severity and mutuality. Violence and Victims, 19, 507–520.

Thomas, K. A., Goodman, L., & Putnins, S. (2015). “I have lost everything”: Trade-offs of seeking safety from intimate partner violence. American Journal of Orthopsychiatry, 85, 170–180. doi:10.1037/ort0000044 U.S. Conference of Mayors. (2009). Hunger and homelessness survey: A status report on hunger and homelessness in America’s cities.

Washington, DC: Author.

Thomas & So | Lost in Limbo: An Exploratory Study of Homeless Mothers’ Experiences and Needs at Emergency Assistance Hotels

U.S. Conference of Mayors. (2014). Hunger and homelessness survey: A status report on hunger and homelessness in America’s cities.

Washington, DC: Author.

U.S. General Accounting Office. (1989). Welfare hotels: Uses, costs and alternatives (No. GAO/HRD-89–26BR). Washington, DC: Author.

U.S. Geological Survey. (1999). Map Accuracy Standards. U.S. Geological Survey Fact Sheet FS-171-99. Washington, DC: Author.

Warren, E. J., & Font, S. A. (2015). Housing insecurity, maternal stress, and child maltreatment: An application of the family stress model. Social Service Review, 89, 9–39.

Weinreb, L. F., Buckner, J. C., Williams, V., & Nicholson, J. (2006). A comparison of the health and mental health status of homeless mothers in Worcester, Mass: 1993 and 2003. American Journal of Public Health, 96, 1444–1448.

Weinreb, L., Rog, D. J., & Henderson, K. A. (2010). Exiting shelter: An epidemiological analysis of barriers and facilitators for families. Social Service Review, 84, 597–614.

Whitmeyer, S. J., & De Paor, D. G. (2014). Crowdsourcing digital maps using citizen geologists. Eos-Trans American Geophysical Union, 95, 397–399.

Wiecha, J. L., Dywer, J. T., Jacques, P. F., & Rand, W. M. (1993).

Nutritional and economic advantages for homeless families in shelters providing kitchen facilities and food. Journal of the American Dietetic Association, 93, 777–783.

Wilson, J., Fauci, J., & Goodman, L. A. (2015). Bringing traumainformed practice to domestic violence programs: A qualitative analysis of current approaches. American Journal of Orthopsychiatry, 85, 586–599.

Keeping you

connected.

Wood, D. L., Valdez, R. B., Hayashi, T., & Shen, A. (1990). Health of homeless children and housed, poor children. Pediatrics, 86, 858–866.

Zima, B. T., Wells, K. B., & Freeman, H. E. (1994). Emotional and behavioral problems and severe academic delays among sheltered homeless children in Los Angeles County. American Journal of Public Health, 84, 260–264.

Kristie A. Thomas, PhD, MSW, assistant professor, Simmons College School of Social Work. Marvin So, MPH, CHES, graduate student, Harvard T.H. Chan School of Public Health. Correspondence: kristie. thomas@simmons.edu; Simmons College School of Social Work, 300 The Fenway, Boston, MA 02115.

Authors’ note. We thank the participants for bravely sharing their stories; the participating shelters for their invaluable assistance; Alyssa Gaudet for her help with transcription and data entry; the training grant (MC00001) from the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services for supporting Marvin So’s efforts; and the Simmons College President’s Fund for Faculty Excellence for funding the study.

Manuscript received: January 5, 2016 Revised: February 23, 2016 Accepted: February 24, 2016 Disposition editor: Sondra J. Fogel

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