A record that's still an undercount

Also: What happens on an ultra-processed diet [Donate ❤️]( [View in Browser](  July 25, 2023 Hi CommonHealth reader, Massachusetts has set a new, sobering record. There are more families in the state's family shelter system than ever before: [nearly 5,000 households](. "These are levels that our agency hasn't seen since World War II," said Larry Seamans, president and CEO of FamilyAid, which has a contract to run 135 shelter units for the state. Thanks to a 1983 “right to shelter” law, Massachusetts has a unique family shelter system. Whereas most other states' shelter systems are run by nonprofits and private organizations, the commonwealth's system — officially known as Emergency Assistance — is state-run. Last year, taxpayers put more than $250 million toward the program. Yet, that money and the record caseload doesn't even encapsulate the full crisis, according to advocates. "The families that are in Emergency Assistance shelter really are just a small portion of all of the families — and all of the people in Massachusetts — who are experiencing homelessness,” Kelly Turley, the associate director for the Massachusetts Coalition for the Homeless, told me. Because of strict eligibility requirements, a lot of families don’t qualify for shelter. If you look at data from schools, there are roughly double the number of homeless children, often staying doubled-up with relatives or friends. Even that is an undercount, Turley said. “For every school-aged [homeless] child, it's estimated that there is another preschool-aged child experiencing homelessness,” she said. That’s a lot of kids experiencing something pretty awful, even for those who make it into the shelter system. I wanted to know what this means for their health and wellbeing — now and in the future. So, I called up Aura Obando, the medical director of the family team at Boston Health Care for the Homeless Program. She said children often have very limited access to toys and stimulating books in the shelter system. Plus, many parents are struggling with depression, and many families are fleeing political violence or domestic violence. She said you can see just how stressful it is for kids through their behavior. “A child that was previously potty trained is starting to wet the bed, for instance. Or a child can have more behavioral outbursts that wouldn't be typical of how they were pre-homelessness,” Obando said. The average family spends over a year in the Massachusetts shelter system. That worries Obando. “I think of that cumulative trauma that the families are incurring," she said. That's because this type of stress can have a long-term impact. Kids who experience things like homelessness, Obando said, are more likely to have health problems later in life, including heart disease, hypertension, obesity, anxiety, depression and substance-use disorder. She's hoping this new record caseload prompts a reevaluation of how the state approaches family homelessness. While the state has been trying new initiatives, like a [pre-shelter host family program]( she wants to see more initiatives that help people stay in their homes and avoid the shelter system altogether. Obando says some strategies that have worked well for adult homelessness, like [permanent supportive housing]( and [housing first]( have not been as readily applied to family homelessness. “All these children in shelter, they're the future of the commonwealth," Obando told me. "I hate the idea of having them incur all this trauma that might be unnecessary if we could just house them, support their parents, support their families.” Gabrielle Emanuel Health reporter [Follow]( Support the news  This Week's Must Reads [Program at William James College tries to reduce veteran suicide by focusing on relationship to guns]( The one-day class teaches clinicians, veterans’ advocates and family members how to talk with vets about guns, safer storage and reduced access in the event of a mental health crisis, which lessens the chance of suicide. [Read more.]( [Program at William James College tries to reduce veteran suicide by focusing on relationship to guns]( The one-day class teaches clinicians, veterans’ advocates and family members how to talk with vets about guns, safer storage and reduced access in the event of a mental health crisis, which lessens the chance of suicide. [Read more.]( [Mosquitoes spread malaria. 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