Original Article
House to House, Shelter to Shelter: Experiences of Black Women Seeking Housing After Leaving Abusive Relationships Patty R. Wilson, MSN, RN1 and Kathryn Laughon, PhD, RN, FAAN2
ABSTRACT Locating safe and affordable housing is a vital step for women who decide to leave their abuser. Without housing, many women, particularly those who live in poverty, are forced to remain in abusive relationships, accept inadequate or unsafe housing, or become homeless (Menard, 2001; Moses, 2010). Women who choose to leave their abusers are faced with multiple barriers in establishing their independence such as limited financial resources, mental illness, and the lack of affordable housing (Botein & Hetling, 2010), putting them at risk of revictimization. This pilot study explores the narratives of Black mothers currently residing at an emergency intimate partner violence shelter to discover their experiences in seeking housing after leaving abusive relationships with a focus on housing instability and mental health. Utilizing a qualitative descriptive design, four major themes emerged: (a) unstable/insecure housing over time, (b) limited support, (c) survival, and (d) mental health. Implications for clinicians are discussed. KEY WORDS: Black women; housing instability; intimate partner violence; low income; mental health; poverty
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Background and Significance
Intimate partner violence (IPV) is among the leading causes of homelessness nationally for women (Baker, Billhardt, Warren, Rollins, & Glass, 2010; Menard, 2001; U.S. Conference of Mayors-Sodexho, 2005). Although IPV crosses racial, social, cultural, economic, and educational levels, rates of IPV and intimate partner (IP) homicide are higher among Black women (Black et al., 2011; Catalano, Smith, Snyder, & Rand, 2009). Higher rates of IPV are associated with being a young Black woman, earning a lower income, Author Affiliations: 1PhD Candidate; and 1,2University of Virginia School of Nursing. Research was funded in part by the Substance Abuse and Mental Health Services Administration Grant #: 2T06SM060559-04. The authors declare no conflict of interest. Correspondence: Kathryn Laughon, PhD, RN, FAAN, University of Virginia School of Nursing, P.O. Box 800826, Charlottesville, VA 22908. E-mail: [email protected]. Received October 6, 2014; accepted for publication February 9, 2015. Copyright © 2015 International Association of Forensic Nurses DOI: 10.1097/JFN.0000000000000067
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residing in urban areas, and living in rental housing (Campbell, Sharps, Gary, Campbell, & Lopez, 2002; Catalano et al., 2009). The greatest proportions of people living in poverty are women, children, and minorities (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2011). Women living in poverty are more likely to experience acute and chronic stressors (Caetano & Cunradi, 2003; Lipsky & Caetano, 2007). Unemployment, frequent residential moves, poor living conditions, lack of transportation, unpaid bills, insufficient resources, and multiple stressful events characterize the lives of women living in low-income minority neighborhoods, increasing the risk of mental health difficulties such as anxiety and depression (Caetano & Cunradi, 2003; Goodman, Smyth, Borges, & Singer, 2009; Welch & Kneipp, 2005). Depression is a major public health problem and is one of the most common mental health consequences of IPV (Bassuk & Beardslee, 2014; Helfrich, Fujiura, & Rutkowski-Kmitta, 2008). Decreased social support may at least partially explain the relationship between IPV and www.journalforensicnursing.com
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depression in women. Social support can be provided by informal networks, such as friends and family, or through formal networks, including community agencies or systems (Goodman et al., 2009). Women who have experienced IPV often lack tangible support, which includes housing, money, and employment in addition to losing emotional support from family and friends (Thompson et al., 2000). In addition, women living with IPV must grapple with sometimes overwhelming concerns: protecting their children, ensuring that basic survival needs such as food and shelter are met, and managing feelings of shame and isolation (Thompson et al., 2000). It is not surprising that homeless women who experience extreme poverty, violence, and limited support networks have high rates of depression (Bassuk & Beardslee, 2014). Lack of financial resources increases the risk of housing instability for low-income women leaving abusive relationships. Housing instability is defined as having difficulty paying rent or utility bills, being denied housing because of past credit problems or criminal reports, threats of eviction, having to move because of partner harassment, living in overcrowded conditions, or living with family or friends (Pavao, Alvarez, Baurmrind, Induni, & Kimerling, 2007; Rollins et al., 2011; Taft, Bryant-Davis, Woodward, Tillman, & Torres, 2009). Sharing housing with others is often referred to as “doubling-up” and, in some circumstances, considered the “hidden homeless” (Moses, 2010). Although these groups of women are not living on the streets or in shelter, they are still effectively homeless (Rollins, Saris, & Johnston‐Robledo, 2001). To avoid being entirely without shelter, many women leaving abusive relationships may temporally double or triple up with family or friends (Pavao et al., 2007; Rollins et al., 2011; Taft et al., 2009). The lack of available housing combined with the lack of financial resources may result in women finding themselves trapped in situations where they feel there is no other choice but to return to their abuser, placing themselves at risk of revictimization (Baker et al., 2010; Bell & Mattis, 2000; Botein & Hetling, 2010; Moses, 2010).
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Purpose of the Study
Although there is a growing body of research examining the association between housing instability, IPV, and depression (Baker, Niolon, & Oliphant, 2009; Botein & Hetling, 2010; Hirst, 2003; Melbin, Sullivan, & Cain, 2003; Menard, 2001; Niolon et al., 2009; Pavao et al., 2007; Rollins et al., 2011; Suglia, Duarte, & Sandel, 2011), little is known of the personal stories of Black women who experience housing instability (Melbin et al., 2003; Baker et al., 2009). The purpose of this pilot study was to explore the narratives of Black mothers to discover their experiences in seeking housing after leaving abusive relationships with a focus on housing instability and mental health. This pilot study also served 78
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as a test of methods of recruitment, proposed interview questions, and aimed to help in guiding the authors’ future research.
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Methods
For this pilot study, a qualitative descriptive narrative research design was used. Life history narratives were collected from five Black mothers currently living at an emergency IPV shelter in Baltimore City. According to Sandelowski (1991, 2000), qualitative descriptive narrative research can reveal how respondents explain their situations, revealing individuals’ construction of past and future life events at given moments in time. The first author listened to life stories of low-income women experiencing housing instability and acknowledged their actual circumstances, their limited opportunities, their struggles, and the nature of their difficulties from their own point of view (Krumer-Nevo, 2005).
Procedures Internal review board approval was obtained as well as a letter of support from the Program Director at the emergency shelter providing permission to recruit and interview women at the shelter. Convenience sampling was utilized to recruit five study participants. The sample size was limited to only five women to facilitate the completion of the pilot study during a semester-long doctoral course. To participate in the study, volunteers had to be a Black mother, at least 18 years old, speak English, and have a minimum of one child, or currently pregnant with their first child. Participants were asked if they recommended any additional women to be interviewed. Snowball sampling is a form of sampling in which persons initially chosen for the sample are used as informants to locate/refer other persons having necessary characteristics making them eligible for the sample. Snowball sampling is recommended when the focus of the study is on a sensitive issue (Penrod, Preston, Cain, & Starks, 2003). Participants were assigned a pseudonym and were informed that their names or identifying details would not be mentioned in disseminated study findings to protect their anonymity. Women agreed to participate in semistructured interview that lasted 60–90 minutes, and the participants received $15 for the time spent to complete the interview. Interviews were conducted at the shelter, in either the health suite or their rooms at a time convenient to them. Because of the sensitive nature of the questions, which could potentially rouse traumatic memories, women were told that the interview could be stopped at any time. All women were provided a list of mental health services available both at the shelter and in the community. The interviews were conducted by the first author, audio recorded, and field notes were taken. Volume 11 • Number 2 • April-June 2015
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Original Article
The participants ranged in age from 21 to 40 years with a mean age of 28.4 years. Of the five participants, two had less than a high school education, three graduated from high school, and two had at least one semester of college education. All five had at least two children (one pregnant with her second child and one with three children). The children ranged in ages from 2 weeks to 18 years. Four of the women were currently employed, and one was receiving disability benefits and unable to work.
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Data Analysis
Qualitative content data analysis began at the time of data collection, as the first author listened and thought about what was said during the interview. Transcripts were read in their entirety, and the interviews were coded by the author. Inductive codes were developed after directly examining and thinking about the data and then searching for common phrases, repetitions, and commonalties across individuals. A code book with the list of codes and their meaning was created (Saldana, 2011). Codes were refined by creating subcodes in which existing codes were collapsed or expanded. The codes were merged to form categories and themes. Peer debriefing is a validity strategy used to enhance the accuracy of the findings (Creswell, 2009). To check for validity, the first author met with her PhD advisor (co-author) who is an expert in the field of IPV research and has extensive knowledge regarding the population being explored. According to Creswell and Miller (2000), a reviewer provides support, plays devil’s advocate, challenges the researchers’ assumptions, pushes the researcher to the next step methodologically, and asks hard questions about methods and interpretations. At each stage of the analysis, the author discussed the codes and themes that were used for this study with her PhD advisor. Four major themes were identified after data analyses: (a) unstable/insecure housing over time; (b) limited support; (c) means of survival; and (d) mental health.
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Findings Unstable/Insecure Housing Over Time
The statement, “house to house, shelter to shelter,” was a response from Erica1, a 24-year-old mother of three, when asked where she lived before entering the shelter. This statement exemplified the theme of unstable/insecure housing over time. As with Erica, the participants all told stories of experiencing a lifetime history of unstable housing, beginning in childhood and following them into adulthood. The women discussed their precarious living arrangements as children, the repeat cycle as adults of their children living with family 1
Note that all names used throughout this section are pseudonyms.
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and friends, little or no experience living independently, and the obstacles they faced in finding housing. During their childhood, all of the women moved frequently, living either in foster care or with relatives other than their parents. Benita, a 21-year-old pregnant mother of a 3-year-old, explained that, after the death of her mother, she lived in over 30 foster homes. Charlene, a 28-year-old mother of two, did not stay in foster care after her mother died when she was 5 years old. Instead, she lived with family and family friends, “I was just passed around and the check [was] written off to whoever was taking care of me at the time.” As adults, the women reported making similar choices for their own children. Many of the participants sent their children to live with relatives because of poverty until their circumstances improved. Amanda did not want to expose her children to the violence she was experiencing and sent them to live with her mother, “my kids wound up going to my mom and my mother had them from September until I came here [emergency shelter].” Since the age of 19 years, Erica has lived from house to house with family and friends and stayed in six different shelters. Her children have lived with family and friends separately from her on different occasions. At the time of the interview, Erica’s oldest daughter was living with the child’s father, and the middle son was living with her aunt. Erica wants to reunite with her children once she finds an apartment, “until I get into my place, I didn’t want to put them [in shelter].” Many of the women discussed the challenges they faced seeking housing, such as the need for initial financial support to help them secure an apartment, extended time at shelters to find a job and housing, the difficulty with financial obligations, and finding available housing. Danielle, a 40-year-old mother of 2 on disability, explained “I’m doing it myself, but I’m going to talk to my case worker and ask her to help me with my security deposit, that would be good, so basically that’s all I need help with [is] my security deposit. I mean, I get close to almost $1,400 a month, but I need help with like for my security deposits.” Erica spoke of her previous challenges finding housing while staying at a homeless shelter, “the shelter was a 28-day stay, so they expect you to find an apartment plus a job in 28 days which is the most impossible task ever. It don’t take 28 days to find a job. It’s not that easy to find a job. It don’t take 28 days to find an apartment. It takes a while to find an apartment if there’s any [in] your budget that you can afford and that will accept your credit or accept your application.” Similar to other participants, Erica had financial problems that made it difficult for her to secure housing, “my credit…credit cards, from BGE and a phone bill, cable, and all of that, so it’s not that easy to find an apartment.” www.journalforensicnursing.com
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As with several other participants, Erica’s poor credit history resulted in her seeking housing from private renters, such as listings on Craigslist: “I was able to find rooms to rent. It was a house for rent that was in my budget that I found on Craigslist so I moved in with a friend of mine.” Danielle discussed a housing program that she was trying to apply for but was frustrated because she called and never heard back from anyone at the program. “I’ve called about four different times [and] my case worker [at shelter] emailed him. They [the housing program] give you I believe $1500 or $1600. You can choose to do with however you want. Most people use it to pay for their security deposit and then it’s broken up into like a hundred or two hundred dollars every month to go towards your rent like that. That’s a program that I definitely qualify for that I’ll be working with. Other than that, as far as housing, there aren’t many resources honestly like Section 8 is closed. It’s not that easy and if I wouldn’t’ve come here, I wouldn’t’ve known anything about any.”
Limited Support Most of the women interviewed discussed having limited family support. Amanda was the exception, stating that she comes from a loving family. Although they were willing and able to provide support, she was concerned about not becoming a burden or exposing them to violence. When she was asked if she could live with her family, she responded, “My mother, no, definitely ain’t going to go through it and my aunts and them not going to go through that and I’m putting a burden on them because I got to go through what I’m going through with a guy and eventually if you keep on doing this and doing that, I’m not going to have nowhere to go and my family, I don’t—I’m not—I can’t do that to them, so I’ve already just came here and start my life over again.” The remaining women experienced the death of their mothers while they were young. Each lived either in foster care or was shuffled between family members. Benita, whose mother died when she was an infant, made the following statement: “I don’t really have family. That’s why it’s so hard for me to find housing. Like they keep extending my time here so it’s just like they’re trying to find like something or somewhere to go because I don’t have no family. Most people got family. They can go stay with them for a little while until their situation come through, but I don’t want to keep going from shelter to shelter, having my newborn and my child in a shelter, 80
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so it’s just like what do I want to do, like I don’t have no family that would probably even take me in and the family that will take me in, I wouldn’t want my child, kids to be living down there because it’s drug infested and—I don’t know. That’s what it’s like. That’s the most hardest thing right now for me because I know I got to leave here soon. I can stay here until the stuff comes through, but it’s just like while I’m waiting, it’s just like where I’m going to wait at. I got all this stuff, like where in the hell am I going to move all the stuff. I’m trying to find like a room to rent because I do get income.” An interesting discovery was the number of women interviewed who experienced the death of their mother. Considering that only five women were interviewed for this pilot study, the author will explore if similar findings appear in future studies.
Means of Survival: Feelings That There are No Other Options but to Live With Abuser A common theme that surfaced during the interviews was that living with the abuser was not something that they necessarily wanted to do but instead felt that they had no other options at the time. For example, Amanda spoke of her decision to live with her abuser, “He was doing everything for me like and I’d sit there and cry. He there to comfort me. He’s like you might as well just move in with me and I’m like, oh, well, oh yeah. That was the worst [thing] I could’ve ever did in my life…. I didn’t really like him…my back was up against the wall.” Erica moved in with her abuser shortly after leaving a homeless shelter, “when I got put out of [shelter], he told me to come move in with him, not knowing that he’s not allowed to have people move in without his landlord’s permission because he was renting a room and the landlord was still living in the house, so I ended up having to plead my own case for me to stay there and then after that, it was downhill from there [with] the abuse.” The women also discussed the financial burden that resulted from living with their abuser, subsequently damaging their credit and making it harder to find rental property. Charlene discussed the financial problems she had after leaving her abuser, “It [the apartment] was in my name, but I left him because he didn’t have anywhere to go, but I wanted to end the relationship so I moved out. He stayed because he didn’t have anywhere else to go. We made a verbal agreement that he would Volume 11 • Number 2 • April-June 2015
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Original Article
be responsible. He wasn’t responsible, so the eviction was in my name. He would destroy my property; he damaged my apartment so bad. He put holes in my wall, busted my door down. I still owe him [the landlord] $1,500 but that is from the last month’s rent and damages, so really, no, but yes because I guess the security deposit would’ve been able to pay for that.” Danielle also faced financial constraints from living with her abuser,
but I know there’s a lot of young girls of doing that now, like fighting with their spouse and then getting back together, fighting and getting back together, until you start really noticing like this could really turn into a big problem.” The women discussed how the stressors of being in an abusive relationship, living in a shelter, raising children, and finding housing affected their emotional health. They shared strategies they employed to help with the stress. Charlene shared her feelings of regret,
“he [abuser] put the house and the gas and electric in my name because he said he couldn’t get it in his name, so I was like okay. I was giving him my portion of the money, my portion of the gas and electric. He wasn’t paying it, so, of course, we got evicted. My gas and electric come to $1800 so it was going to be hard for me to get the gas and electric back on in my name when I do go.”
“when the red flags go up or the warning signs go up and you dismiss them, or act like that’s not really what they are, that’s what I blame myself for. I don’t blame myself for being abused because he did that, not me, but I blame myself for allowing it to continue on and allowing it to go on and on and on where he’s able to drain everything from me and I have nothing.”
Concerned with outstanding bills that Danielle perceives would hinder her from getting an apartment, she discussed her strategies, “I could put the gas and electric in my son’s name and could pay it off like that.”
Amanda stated, “I try to do everything right by my kids. It’s the only time I do break. That’s the only time. Some people say they don’t get stressed out or don’t feel like everything is just overwhelmed for them and you’re going through this and you going through that and they act like they just so strong. Because once you keep everything in, you will break and be stressed out and sometimes you just sitting there talking and you just bust out crying. Some people act like they don’t, but they do. Sometimes people sit there and they will take drugs to numb them or they will smoke weed or drink. I have never smoked weed or drank, I just talk about it. I talked to a counselor every week just so I could tell them what was going on with me. I do stuff like that. I talk to people so I won’t get so frustrated. You can play tough but sometime you going to break.”
Mental Health Many of the women spoke of how the mental health of their abusers affected them. Amanda spoke of her abuser who was diagnosed with schizophrenia, “I felt like he was driving me crazy, like it felt like I was going crazy, like I was believing everything he was telling me. I cried and cried every night like the worst thing that you could—It was good in the beginning, but then when you mess with a person who is controlling and he’s schizophrenic and I never knew about a schizophrenic guy.” Benita also talked about her abuser’s mental health, “He 31 and I don’t know what he missing in life, but it’s just like he always think someone has to take care of him or something and I started realizing that after he lost his job. It was just like he just got real depressed and stuff, like he didn’t want to do nothing. I’m like, oh, you’re crazy, like this is bad and I kept tolerating it and tolerating it and tolerating it because it’s like when you young and it’s like when you being like a domestic violent relationship, you don’t really think of it as like, oh, this could really turn out bad or I could die or— You just be like this is like hard love or something like that, so it’d be like—It’s not fun, but it’d just be like—I don’t know. It’s just some type of affection that you get from wanting to be violent with your spouse and then like—and then like wanted to be back around them. I don’t know what it is, Journal of Forensic Nursing
Erica is working with a counselor, “I’ve dealt with my grief with my mom…. I am diagnosed with depression, I have baby blues from time to time because I really didn’t want to bring her back here to the shelter, but I know that at the end of the day, I’m going to be in my place with my kids and that’ll be the most happiest moment I can have this year.”
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Discussion
Although the pilot study was limited by its small sample size, the authors were able to test the proposed interview www.journalforensicnursing.com
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questions and recruitment methods. The study findings will guide the development of interview questions for future studies to further understand the challenges faced by Black mothers finding housing after leaving abusive relationships. Most of the study findings were consistent with other qualitative studies related to IPV and housing instability (Goodman et al., 2009; Pavao et al., 2007; Rollins et al., 2001, 2011; Sullivan & Rumptz, 1994; Taft et al., 2009; Thompson et al., 2000). Similar to other studies of women who have been exposed to IPV, the women in the pilot study experienced a lack of tangible support, which included housing, money, and employment in addition to emotional support from family and friends (Thompson et al., 2000). Faced with ongoing and acute life stressors, as well as limited financial and social resources, low-income women often used strategies to mitigate the stressors they encountered (Goodman et al., 2009). The women in the study moved in with family and friends as a temporary solution to their housing needs. However, similar to other homeless women, they eventually exhausted all their social support before they decided to go to emergency shelters (Goodman et al., 2009; Rollins et al., 2001). It is not surprising that studies reveal that Black women with lower socioeconomic backgrounds who enter IPV shelters require significantly longer time to regroup and leave shelters than White women with similar backgrounds (Sullivan & Rumptz, 1994; Taft et al., 2009). Depression can impact a woman’s chances to gain independence by limiting her ability to perform routine activities of self-care and cope with everyday tasks because of confusion, disorientation, or forgetfulness (Helfrich et al., 2008), which in turn may lead to the inability to pursue goals, including employment, education, and planning for the future (Helfrich et al., 2008). The women in the study told their experiences of how living with abusers with mental illness, in addition to daily stressors of living in poverty, negatively affected their own emotional well-being. Some of the women interviewed were receptive to receiving counseling, whereas others were not. Further investigation is needed to discover what coping strategies Black women would be open to other than counseling. Although the findings from this pilot study should be interpreted with caution, they serve as a reminder of the importance of mental health screenings. Providing interventions that assist Black women in managing their chronic stress will help improve their emotional well-being, in turn, helping them to focus on the skills they need to navigate through the complex challenges in finding housing. Meanwhile, clinicians should be particularly sensitive to the possibility of depression in this population and make appropriate referrals for counseling or for pharmacological treatments where appropriate. Women with unstable housing are not always living on the streets or in shelter; they are moving from house to 82
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house and doubling up with friends and family (Rollins et al., 2001). Future studies are needed to identify a typology of women who are most at risk for housing instability for clinicians to provide timely and appropriate services (i.e., mental health services, life skills training). Again, the findings from this small pilot study are not conclusive. However, these women’s stories illustrate how housing instability could go unnoticed by a clinician if women are living with family or friends. If clinicians are not aware that housing instability is a problem, they may not ask questions about previous experiences with insecure housing. It is our recommendation that clinicians ask women about their housing history and experience in living independently. Understanding a more detailed housing history will give clinicians the opportunity to identify women who may be at greater risk of further housing instability.
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References
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Original Article Helfrich, C., Fujiura, G., & Rutkowski-Kmitta, V. (2008). Mental health disorders and functioning of women in domestic violence shelters. Journal of Interpersonal Violence, 23(4), 437–453. Hirst, E. (2003). The housing crisis for victims of domestic violence: Disparate impact claims and others housing protection for victims of domestic violence. Georgetown Journal on Poverty Law and Policy, 10(1), 131–155. Krumer-Nevo, M. (2005). Reading a poor woman’s life: Issues and dilemmas. Affilia, 20(1), 87–102. Lipsky, S., & Caetano, R. (2007). Impact of intimate partner violence on unmet need for mental health care: Results from the NSDUH. Psychiatric Services, 58(6), 822–829. Melbin, A., Sullivan, C., & Cain, D. (2003). Transitional supportive housing programs: Battered women’s perspectives and recommendations. Affilia, 18(4), 445–460. Menard, A. (2001). Domestic violence and housing: Key policy and program challenges. Violence Against Women, 7(6), 707–720. Moses, J. (2010). The new housing normal for low-income families: Longstanding affordability crisis hurts children and adults. Center for American Progress. Retrieved https:// www.americanprogress.org/issues/housing/news/2010/06/ 15/7952/the-new-housing-normal-for-low-income-families/ Niolon, P. H., Rollins, C. M., Glass, N., Billhardt, K., Connor-Smith, J., & Baker, C. (2009). An innovative approach to serving the needs of IPV survivors: Description of a CDC-funded study examining the Volunteers of America Home Free rent assistance program. Journal of Women’s Health, 18(6), 775–778. Pavao, J., Alvrez, J., Baurmrind, N., Induni, M., & Kimerling, R. (2007). Intimate partner violence and housing instability. American Journal of Preventive Medicine, 32(2), 143–146. Penrod, J., Preston, D., Cain, R., & Starks, M. (2003). A discussion of chain referral as a method of sampling hard-to-reach populations. Journal of Transcultural Nursing, 14(2), 100–107. Rollins, C., Glass, N., Perrin, N., Billhardt, K., Clough, A., Barnes, J., Hanson, G., & Bloom, T. (2011). Housing instability is as strong predictor of poor health outcomes as level of danger in an abusive relationship: Findings from the SHARE study.
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Journal of Interpersonal Violence, 27, 623–643. doi:10.1177/ 0886260511423241.146 Rollins, J. H., Saris, R. N., & Johnston‐Robledo, I. (2001). Low‐income women speak out about housing: A high‐stakes game of musical chairs. Journal of Social Issues, 57(2), 277–298. Saldana, J. (2011). The coding manual for qualitative researchers (2nd ed.). Thousand Oaks, CA: Sage. Sandelowski, M. (1991). Telling stories: Narrative approaches in qualitative research. IMAGE: Journal of Nursing Scholarship, 23, 161–166. Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing & Health, 23(4), 334–340. Suglia, S., Duarte, C., & Sandel, M. (2011). Housing quality, housing instability, and maternal mental health. Journal of Urban Health, 88, 1105–1116. doi:10.1007/s11524-011-9587-0 Sullivan, C. M., & Rumptz, M. H. (1994). Adjustment and needs of African-American women who utilized a domestic violence shelter. Violence and Victims, 9(3), 275–286. Taft, C., Bryant-Davis, T., Woodward, H., Tillman, S., & Torres, S. (2009). Intimate partner violence against African American women: An examination of the socio-cultural context. Aggression and Violent Behavior, (14), 50–58. Thompson, M., Kaslow, N., Kingree, J., Rashid, A., Puett, R., Jacobs, D., & Matthews, A. (2000). Partner violence, social support, and distress among inner-city African American women. American Journal of Community Psychology, 28(1), 127–143. U.S. Conference of Mayors-Sodexho. (2005). Hunger and homelessness survey: A status report on hunger and homelessness in America’s cities, a 24-city survey. Washington, DC: Sodexho. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. (2011). Women’s health USA 2011. Rockville, MD: U.S. Department of Health and Human Services. Welch, D., & Kneipp, S. (2005). Low-income housing policy and socioeconomic inequalities in women’s health: The importance of nursing inquiry and intervention. Policy, Politics, & Nursing Practice, 6(4), 333–342.
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House to House, Shelter to Shelter: Experiences of Black Women Seeking Housing After Leaving Abusive Relationships Patty R. Wilson, MSN, RN1 and Kathryn Laughon, PhD, RN, FAAN2
ABSTRACT Locating safe and affordable housing is a vital step for women who decide to leave their abuser. Without housing, many women, particularly those who live in poverty, are forced to remain in abusive relationships, accept inadequate or unsafe housing, or become homeless (Menard, 2001; Moses, 2010). Women who choose to leave their abusers are faced with multiple barriers in establishing their independence such as limited financial resources, mental illness, and the lack of affordable housing (Botein & Hetling, 2010), putting them at risk of revictimization. This pilot study explores the narratives of Black mothers currently residing at an emergency intimate partner violence shelter to discover their experiences in seeking housing after leaving abusive relationships with a focus on housing instability and mental health. Utilizing a qualitative descriptive design, four major themes emerged: (a) unstable/insecure housing over time, (b) limited support, (c) survival, and (d) mental health. Implications for clinicians are discussed. KEY WORDS: Black women; housing instability; intimate partner violence; low income; mental health; poverty
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Background and Significance
Intimate partner violence (IPV) is among the leading causes of homelessness nationally for women (Baker, Billhardt, Warren, Rollins, & Glass, 2010; Menard, 2001; U.S. Conference of Mayors-Sodexho, 2005). Although IPV crosses racial, social, cultural, economic, and educational levels, rates of IPV and intimate partner (IP) homicide are higher among Black women (Black et al., 2011; Catalano, Smith, Snyder, & Rand, 2009). Higher rates of IPV are associated with being a young Black woman, earning a lower income, Author Affiliations: 1PhD Candidate; and 1,2University of Virginia School of Nursing. Research was funded in part by the Substance Abuse and Mental Health Services Administration Grant #: 2T06SM060559-04. The authors declare no conflict of interest. Correspondence: Kathryn Laughon, PhD, RN, FAAN, University of Virginia School of Nursing, P.O. Box 800826, Charlottesville, VA 22908. E-mail: [email protected]. Received October 6, 2014; accepted for publication February 9, 2015. Copyright © 2015 International Association of Forensic Nurses DOI: 10.1097/JFN.0000000000000067
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residing in urban areas, and living in rental housing (Campbell, Sharps, Gary, Campbell, & Lopez, 2002; Catalano et al., 2009). The greatest proportions of people living in poverty are women, children, and minorities (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2011). Women living in poverty are more likely to experience acute and chronic stressors (Caetano & Cunradi, 2003; Lipsky & Caetano, 2007). Unemployment, frequent residential moves, poor living conditions, lack of transportation, unpaid bills, insufficient resources, and multiple stressful events characterize the lives of women living in low-income minority neighborhoods, increasing the risk of mental health difficulties such as anxiety and depression (Caetano & Cunradi, 2003; Goodman, Smyth, Borges, & Singer, 2009; Welch & Kneipp, 2005). Depression is a major public health problem and is one of the most common mental health consequences of IPV (Bassuk & Beardslee, 2014; Helfrich, Fujiura, & Rutkowski-Kmitta, 2008). Decreased social support may at least partially explain the relationship between IPV and www.journalforensicnursing.com
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depression in women. Social support can be provided by informal networks, such as friends and family, or through formal networks, including community agencies or systems (Goodman et al., 2009). Women who have experienced IPV often lack tangible support, which includes housing, money, and employment in addition to losing emotional support from family and friends (Thompson et al., 2000). In addition, women living with IPV must grapple with sometimes overwhelming concerns: protecting their children, ensuring that basic survival needs such as food and shelter are met, and managing feelings of shame and isolation (Thompson et al., 2000). It is not surprising that homeless women who experience extreme poverty, violence, and limited support networks have high rates of depression (Bassuk & Beardslee, 2014). Lack of financial resources increases the risk of housing instability for low-income women leaving abusive relationships. Housing instability is defined as having difficulty paying rent or utility bills, being denied housing because of past credit problems or criminal reports, threats of eviction, having to move because of partner harassment, living in overcrowded conditions, or living with family or friends (Pavao, Alvarez, Baurmrind, Induni, & Kimerling, 2007; Rollins et al., 2011; Taft, Bryant-Davis, Woodward, Tillman, & Torres, 2009). Sharing housing with others is often referred to as “doubling-up” and, in some circumstances, considered the “hidden homeless” (Moses, 2010). Although these groups of women are not living on the streets or in shelter, they are still effectively homeless (Rollins, Saris, & Johnston‐Robledo, 2001). To avoid being entirely without shelter, many women leaving abusive relationships may temporally double or triple up with family or friends (Pavao et al., 2007; Rollins et al., 2011; Taft et al., 2009). The lack of available housing combined with the lack of financial resources may result in women finding themselves trapped in situations where they feel there is no other choice but to return to their abuser, placing themselves at risk of revictimization (Baker et al., 2010; Bell & Mattis, 2000; Botein & Hetling, 2010; Moses, 2010).
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Purpose of the Study
Although there is a growing body of research examining the association between housing instability, IPV, and depression (Baker, Niolon, & Oliphant, 2009; Botein & Hetling, 2010; Hirst, 2003; Melbin, Sullivan, & Cain, 2003; Menard, 2001; Niolon et al., 2009; Pavao et al., 2007; Rollins et al., 2011; Suglia, Duarte, & Sandel, 2011), little is known of the personal stories of Black women who experience housing instability (Melbin et al., 2003; Baker et al., 2009). The purpose of this pilot study was to explore the narratives of Black mothers to discover their experiences in seeking housing after leaving abusive relationships with a focus on housing instability and mental health. This pilot study also served 78
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as a test of methods of recruitment, proposed interview questions, and aimed to help in guiding the authors’ future research.
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Methods
For this pilot study, a qualitative descriptive narrative research design was used. Life history narratives were collected from five Black mothers currently living at an emergency IPV shelter in Baltimore City. According to Sandelowski (1991, 2000), qualitative descriptive narrative research can reveal how respondents explain their situations, revealing individuals’ construction of past and future life events at given moments in time. The first author listened to life stories of low-income women experiencing housing instability and acknowledged their actual circumstances, their limited opportunities, their struggles, and the nature of their difficulties from their own point of view (Krumer-Nevo, 2005).
Procedures Internal review board approval was obtained as well as a letter of support from the Program Director at the emergency shelter providing permission to recruit and interview women at the shelter. Convenience sampling was utilized to recruit five study participants. The sample size was limited to only five women to facilitate the completion of the pilot study during a semester-long doctoral course. To participate in the study, volunteers had to be a Black mother, at least 18 years old, speak English, and have a minimum of one child, or currently pregnant with their first child. Participants were asked if they recommended any additional women to be interviewed. Snowball sampling is a form of sampling in which persons initially chosen for the sample are used as informants to locate/refer other persons having necessary characteristics making them eligible for the sample. Snowball sampling is recommended when the focus of the study is on a sensitive issue (Penrod, Preston, Cain, & Starks, 2003). Participants were assigned a pseudonym and were informed that their names or identifying details would not be mentioned in disseminated study findings to protect their anonymity. Women agreed to participate in semistructured interview that lasted 60–90 minutes, and the participants received $15 for the time spent to complete the interview. Interviews were conducted at the shelter, in either the health suite or their rooms at a time convenient to them. Because of the sensitive nature of the questions, which could potentially rouse traumatic memories, women were told that the interview could be stopped at any time. All women were provided a list of mental health services available both at the shelter and in the community. The interviews were conducted by the first author, audio recorded, and field notes were taken. Volume 11 • Number 2 • April-June 2015
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Original Article
The participants ranged in age from 21 to 40 years with a mean age of 28.4 years. Of the five participants, two had less than a high school education, three graduated from high school, and two had at least one semester of college education. All five had at least two children (one pregnant with her second child and one with three children). The children ranged in ages from 2 weeks to 18 years. Four of the women were currently employed, and one was receiving disability benefits and unable to work.
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Data Analysis
Qualitative content data analysis began at the time of data collection, as the first author listened and thought about what was said during the interview. Transcripts were read in their entirety, and the interviews were coded by the author. Inductive codes were developed after directly examining and thinking about the data and then searching for common phrases, repetitions, and commonalties across individuals. A code book with the list of codes and their meaning was created (Saldana, 2011). Codes were refined by creating subcodes in which existing codes were collapsed or expanded. The codes were merged to form categories and themes. Peer debriefing is a validity strategy used to enhance the accuracy of the findings (Creswell, 2009). To check for validity, the first author met with her PhD advisor (co-author) who is an expert in the field of IPV research and has extensive knowledge regarding the population being explored. According to Creswell and Miller (2000), a reviewer provides support, plays devil’s advocate, challenges the researchers’ assumptions, pushes the researcher to the next step methodologically, and asks hard questions about methods and interpretations. At each stage of the analysis, the author discussed the codes and themes that were used for this study with her PhD advisor. Four major themes were identified after data analyses: (a) unstable/insecure housing over time; (b) limited support; (c) means of survival; and (d) mental health.
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Findings Unstable/Insecure Housing Over Time
The statement, “house to house, shelter to shelter,” was a response from Erica1, a 24-year-old mother of three, when asked where she lived before entering the shelter. This statement exemplified the theme of unstable/insecure housing over time. As with Erica, the participants all told stories of experiencing a lifetime history of unstable housing, beginning in childhood and following them into adulthood. The women discussed their precarious living arrangements as children, the repeat cycle as adults of their children living with family 1
Note that all names used throughout this section are pseudonyms.
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and friends, little or no experience living independently, and the obstacles they faced in finding housing. During their childhood, all of the women moved frequently, living either in foster care or with relatives other than their parents. Benita, a 21-year-old pregnant mother of a 3-year-old, explained that, after the death of her mother, she lived in over 30 foster homes. Charlene, a 28-year-old mother of two, did not stay in foster care after her mother died when she was 5 years old. Instead, she lived with family and family friends, “I was just passed around and the check [was] written off to whoever was taking care of me at the time.” As adults, the women reported making similar choices for their own children. Many of the participants sent their children to live with relatives because of poverty until their circumstances improved. Amanda did not want to expose her children to the violence she was experiencing and sent them to live with her mother, “my kids wound up going to my mom and my mother had them from September until I came here [emergency shelter].” Since the age of 19 years, Erica has lived from house to house with family and friends and stayed in six different shelters. Her children have lived with family and friends separately from her on different occasions. At the time of the interview, Erica’s oldest daughter was living with the child’s father, and the middle son was living with her aunt. Erica wants to reunite with her children once she finds an apartment, “until I get into my place, I didn’t want to put them [in shelter].” Many of the women discussed the challenges they faced seeking housing, such as the need for initial financial support to help them secure an apartment, extended time at shelters to find a job and housing, the difficulty with financial obligations, and finding available housing. Danielle, a 40-year-old mother of 2 on disability, explained “I’m doing it myself, but I’m going to talk to my case worker and ask her to help me with my security deposit, that would be good, so basically that’s all I need help with [is] my security deposit. I mean, I get close to almost $1,400 a month, but I need help with like for my security deposits.” Erica spoke of her previous challenges finding housing while staying at a homeless shelter, “the shelter was a 28-day stay, so they expect you to find an apartment plus a job in 28 days which is the most impossible task ever. It don’t take 28 days to find a job. It’s not that easy to find a job. It don’t take 28 days to find an apartment. It takes a while to find an apartment if there’s any [in] your budget that you can afford and that will accept your credit or accept your application.” Similar to other participants, Erica had financial problems that made it difficult for her to secure housing, “my credit…credit cards, from BGE and a phone bill, cable, and all of that, so it’s not that easy to find an apartment.” www.journalforensicnursing.com
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As with several other participants, Erica’s poor credit history resulted in her seeking housing from private renters, such as listings on Craigslist: “I was able to find rooms to rent. It was a house for rent that was in my budget that I found on Craigslist so I moved in with a friend of mine.” Danielle discussed a housing program that she was trying to apply for but was frustrated because she called and never heard back from anyone at the program. “I’ve called about four different times [and] my case worker [at shelter] emailed him. They [the housing program] give you I believe $1500 or $1600. You can choose to do with however you want. Most people use it to pay for their security deposit and then it’s broken up into like a hundred or two hundred dollars every month to go towards your rent like that. That’s a program that I definitely qualify for that I’ll be working with. Other than that, as far as housing, there aren’t many resources honestly like Section 8 is closed. It’s not that easy and if I wouldn’t’ve come here, I wouldn’t’ve known anything about any.”
Limited Support Most of the women interviewed discussed having limited family support. Amanda was the exception, stating that she comes from a loving family. Although they were willing and able to provide support, she was concerned about not becoming a burden or exposing them to violence. When she was asked if she could live with her family, she responded, “My mother, no, definitely ain’t going to go through it and my aunts and them not going to go through that and I’m putting a burden on them because I got to go through what I’m going through with a guy and eventually if you keep on doing this and doing that, I’m not going to have nowhere to go and my family, I don’t—I’m not—I can’t do that to them, so I’ve already just came here and start my life over again.” The remaining women experienced the death of their mothers while they were young. Each lived either in foster care or was shuffled between family members. Benita, whose mother died when she was an infant, made the following statement: “I don’t really have family. That’s why it’s so hard for me to find housing. Like they keep extending my time here so it’s just like they’re trying to find like something or somewhere to go because I don’t have no family. Most people got family. They can go stay with them for a little while until their situation come through, but I don’t want to keep going from shelter to shelter, having my newborn and my child in a shelter, 80
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so it’s just like what do I want to do, like I don’t have no family that would probably even take me in and the family that will take me in, I wouldn’t want my child, kids to be living down there because it’s drug infested and—I don’t know. That’s what it’s like. That’s the most hardest thing right now for me because I know I got to leave here soon. I can stay here until the stuff comes through, but it’s just like while I’m waiting, it’s just like where I’m going to wait at. I got all this stuff, like where in the hell am I going to move all the stuff. I’m trying to find like a room to rent because I do get income.” An interesting discovery was the number of women interviewed who experienced the death of their mother. Considering that only five women were interviewed for this pilot study, the author will explore if similar findings appear in future studies.
Means of Survival: Feelings That There are No Other Options but to Live With Abuser A common theme that surfaced during the interviews was that living with the abuser was not something that they necessarily wanted to do but instead felt that they had no other options at the time. For example, Amanda spoke of her decision to live with her abuser, “He was doing everything for me like and I’d sit there and cry. He there to comfort me. He’s like you might as well just move in with me and I’m like, oh, well, oh yeah. That was the worst [thing] I could’ve ever did in my life…. I didn’t really like him…my back was up against the wall.” Erica moved in with her abuser shortly after leaving a homeless shelter, “when I got put out of [shelter], he told me to come move in with him, not knowing that he’s not allowed to have people move in without his landlord’s permission because he was renting a room and the landlord was still living in the house, so I ended up having to plead my own case for me to stay there and then after that, it was downhill from there [with] the abuse.” The women also discussed the financial burden that resulted from living with their abuser, subsequently damaging their credit and making it harder to find rental property. Charlene discussed the financial problems she had after leaving her abuser, “It [the apartment] was in my name, but I left him because he didn’t have anywhere to go, but I wanted to end the relationship so I moved out. He stayed because he didn’t have anywhere else to go. We made a verbal agreement that he would Volume 11 • Number 2 • April-June 2015
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be responsible. He wasn’t responsible, so the eviction was in my name. He would destroy my property; he damaged my apartment so bad. He put holes in my wall, busted my door down. I still owe him [the landlord] $1,500 but that is from the last month’s rent and damages, so really, no, but yes because I guess the security deposit would’ve been able to pay for that.” Danielle also faced financial constraints from living with her abuser,
but I know there’s a lot of young girls of doing that now, like fighting with their spouse and then getting back together, fighting and getting back together, until you start really noticing like this could really turn into a big problem.” The women discussed how the stressors of being in an abusive relationship, living in a shelter, raising children, and finding housing affected their emotional health. They shared strategies they employed to help with the stress. Charlene shared her feelings of regret,
“he [abuser] put the house and the gas and electric in my name because he said he couldn’t get it in his name, so I was like okay. I was giving him my portion of the money, my portion of the gas and electric. He wasn’t paying it, so, of course, we got evicted. My gas and electric come to $1800 so it was going to be hard for me to get the gas and electric back on in my name when I do go.”
“when the red flags go up or the warning signs go up and you dismiss them, or act like that’s not really what they are, that’s what I blame myself for. I don’t blame myself for being abused because he did that, not me, but I blame myself for allowing it to continue on and allowing it to go on and on and on where he’s able to drain everything from me and I have nothing.”
Concerned with outstanding bills that Danielle perceives would hinder her from getting an apartment, she discussed her strategies, “I could put the gas and electric in my son’s name and could pay it off like that.”
Amanda stated, “I try to do everything right by my kids. It’s the only time I do break. That’s the only time. Some people say they don’t get stressed out or don’t feel like everything is just overwhelmed for them and you’re going through this and you going through that and they act like they just so strong. Because once you keep everything in, you will break and be stressed out and sometimes you just sitting there talking and you just bust out crying. Some people act like they don’t, but they do. Sometimes people sit there and they will take drugs to numb them or they will smoke weed or drink. I have never smoked weed or drank, I just talk about it. I talked to a counselor every week just so I could tell them what was going on with me. I do stuff like that. I talk to people so I won’t get so frustrated. You can play tough but sometime you going to break.”
Mental Health Many of the women spoke of how the mental health of their abusers affected them. Amanda spoke of her abuser who was diagnosed with schizophrenia, “I felt like he was driving me crazy, like it felt like I was going crazy, like I was believing everything he was telling me. I cried and cried every night like the worst thing that you could—It was good in the beginning, but then when you mess with a person who is controlling and he’s schizophrenic and I never knew about a schizophrenic guy.” Benita also talked about her abuser’s mental health, “He 31 and I don’t know what he missing in life, but it’s just like he always think someone has to take care of him or something and I started realizing that after he lost his job. It was just like he just got real depressed and stuff, like he didn’t want to do nothing. I’m like, oh, you’re crazy, like this is bad and I kept tolerating it and tolerating it and tolerating it because it’s like when you young and it’s like when you being like a domestic violent relationship, you don’t really think of it as like, oh, this could really turn out bad or I could die or— You just be like this is like hard love or something like that, so it’d be like—It’s not fun, but it’d just be like—I don’t know. It’s just some type of affection that you get from wanting to be violent with your spouse and then like—and then like wanted to be back around them. I don’t know what it is, Journal of Forensic Nursing
Erica is working with a counselor, “I’ve dealt with my grief with my mom…. I am diagnosed with depression, I have baby blues from time to time because I really didn’t want to bring her back here to the shelter, but I know that at the end of the day, I’m going to be in my place with my kids and that’ll be the most happiest moment I can have this year.”
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Discussion
Although the pilot study was limited by its small sample size, the authors were able to test the proposed interview www.journalforensicnursing.com
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questions and recruitment methods. The study findings will guide the development of interview questions for future studies to further understand the challenges faced by Black mothers finding housing after leaving abusive relationships. Most of the study findings were consistent with other qualitative studies related to IPV and housing instability (Goodman et al., 2009; Pavao et al., 2007; Rollins et al., 2001, 2011; Sullivan & Rumptz, 1994; Taft et al., 2009; Thompson et al., 2000). Similar to other studies of women who have been exposed to IPV, the women in the pilot study experienced a lack of tangible support, which included housing, money, and employment in addition to emotional support from family and friends (Thompson et al., 2000). Faced with ongoing and acute life stressors, as well as limited financial and social resources, low-income women often used strategies to mitigate the stressors they encountered (Goodman et al., 2009). The women in the study moved in with family and friends as a temporary solution to their housing needs. However, similar to other homeless women, they eventually exhausted all their social support before they decided to go to emergency shelters (Goodman et al., 2009; Rollins et al., 2001). It is not surprising that studies reveal that Black women with lower socioeconomic backgrounds who enter IPV shelters require significantly longer time to regroup and leave shelters than White women with similar backgrounds (Sullivan & Rumptz, 1994; Taft et al., 2009). Depression can impact a woman’s chances to gain independence by limiting her ability to perform routine activities of self-care and cope with everyday tasks because of confusion, disorientation, or forgetfulness (Helfrich et al., 2008), which in turn may lead to the inability to pursue goals, including employment, education, and planning for the future (Helfrich et al., 2008). The women in the study told their experiences of how living with abusers with mental illness, in addition to daily stressors of living in poverty, negatively affected their own emotional well-being. Some of the women interviewed were receptive to receiving counseling, whereas others were not. Further investigation is needed to discover what coping strategies Black women would be open to other than counseling. Although the findings from this pilot study should be interpreted with caution, they serve as a reminder of the importance of mental health screenings. Providing interventions that assist Black women in managing their chronic stress will help improve their emotional well-being, in turn, helping them to focus on the skills they need to navigate through the complex challenges in finding housing. Meanwhile, clinicians should be particularly sensitive to the possibility of depression in this population and make appropriate referrals for counseling or for pharmacological treatments where appropriate. Women with unstable housing are not always living on the streets or in shelter; they are moving from house to 82
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house and doubling up with friends and family (Rollins et al., 2001). Future studies are needed to identify a typology of women who are most at risk for housing instability for clinicians to provide timely and appropriate services (i.e., mental health services, life skills training). Again, the findings from this small pilot study are not conclusive. However, these women’s stories illustrate how housing instability could go unnoticed by a clinician if women are living with family or friends. If clinicians are not aware that housing instability is a problem, they may not ask questions about previous experiences with insecure housing. It is our recommendation that clinicians ask women about their housing history and experience in living independently. Understanding a more detailed housing history will give clinicians the opportunity to identify women who may be at greater risk of further housing instability.
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References
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