Exploring the impact of housing insecurity on the health and well-being of children and young people: a systematic review

Cost of rent and eviction

Fundamentally, a key driver of housing insecurity is poverty. The high cost of housing (relative to the income of the family) could render their living situation precarious, with housing benefit not fully covering the rent amount. 97 Similarly, having difficulty paying the rent and falling into rent arrears were sources of housing insecurity,6,73,78 due to a parent’s change in circumstances78 and a parent’s difficulty finding suitable employment. 6 Sometimes, families were evicted for non-payment of rent,6 and this could be linked to the rising cost of housing. 90 Some children reported being evicted but for a reason not known to them,71 and the prospect of facing eviction from private rented property (for reasons not explained) was also a source of housing insecurity. 97

Multiple moves

The cost of rent could lead to families having to move multiple times, as they repeatedly sought somewhere affordable to live. 97 The use of short-term tenancies by local authorities and private rental landlords can require multiple moves. 90,97 In two of the case study families from the seminal Children’s Society report Moving, Always Moving, children discussed moving multiple times as a source of housing insecurity, but they were unaware of the reasons for some or all of the moves, or did not want to talk about the reasons. 6

They moved all the time, he couldn’t even say how many times, and he didn’t understand why they weren’t allowed to just live in one place instead of having to pack, leave, unpack, pack again, leave, unpack and on and on like that. 6 (p. 35)

Exposure to problematic behaviour

Some phenomena were found to be both exposures and impacts of housing insecurity, in that some impacts of housing insecurity further exacerbated the living situation, causing further insecurity. One such situation included exposure of the family to the problematic behaviours of others, for instance, criminal behaviour, people taking and selling drugs. 93 Another related to where the location of the new housing or temporary housing left the family and child(ren) isolated and far away from family, friends, other support networks, work, shops, school and leisure pursuits. 6,64,68,78,85,90 Not feeling safe in a particular locality or neighbourhood was another situation that could exacerbate the original situation, leading to families needing or wanting to move again. 6

Feeling insecure

Feeling insecure (including uncertainty over when and where the next move will be, or if another move is happening) is a further impact of living in insecure housing situations (including temporary housing, making multiple moves, being evicted) but also part of the experience of housing insecurity for CYP,6,68,71,95,97 potentially leading to stress and worry. 6,95

One of the major issues that Hannah says affects her mental health is the uncertainty of their situation. She says it is hard to not know where they will be staying one night to the next. It is also difficult to adjust to living without her furniture and clothes. 95 (p. 17)

Overcrowding

Overcrowding was another issue that was both an impact of housing insecurity (often a feature of living in temporary accommodation or needing to accept whatever accommodation was on offer) and a contributory factor to families’ need to move to escape being overcrowded. Overcrowding could take the form of siblings sharing a room and/or bed,6,25,52,59,90,92–95 family members sleeping on the floor or sofa,6,52 children sharing a room with parents,52,75,90,92–95 a room being too small to carry out day-to-day tasks,93–95 a lack of privacy in general,92,93 living in close proximity to other families95 and cramped conditions when too many people and possessions had to share a small space. 6,90,95

No. It’s a box. Because, with it being so small we’ve had to buy [daughter 1] a camp bed, like just a small 3ft one and [daughter 2] is in [daughter 1]’s old cot bed and it’s literally right next to the radiator, under the window. 90 (p. 28)

His mum had slept in the living room while he had shared a small bedroom and one bed with two of his siblings, lots of furniture and everyone’s belongings piled up wherever there was space. 6 (p. 53)

Poor condition or unsuitable property

Similarly, living in a property in poor condition could exacerbate initial exposure to housing insecurity, both because families wanted to move into a better property and because they were reluctant to complain and ask for repairs on their current property in case the landlord increased the rent or evicted them. 67,77 One study reported a family being evicted after requesting environmental health issues be addressed,55 and another study reported a family being evicted because they withheld rent as their landlord had not addressed several health and safety issues. 97 Such issues included accommodation being in a poor state of decoration,79 broken or barely useable fixtures and fittings,67,77 broken appliances or fixtures,52,77,78 structural failings78 and mould. 52,77,78,85,90 Likewise, living in an unsuitable property may represent a lack of choice and a need to move, but could also precipitate a need to move again. Many families with young children found themselves living in upper floor flats, having to navigate stairs with pushchairs and small children. 52,55,59,64,68,73,90 One study reported how a family had to join the transfer list, as their council refused to install central heating in their current home. This was particularly relevant for their child’s health and well-being as the child had cerebral palsy and suffered from asthma. 56

Additional constraints

Sometimes, when a family desired a move, they may have to fulfil certain requirements. One family reported having to decorate their three-bedroom accommodation in order to be eligible for a four-bedroom house. 6 Sometimes a family could encounter problems finding appropriate housing, for instance due to landlords not accepting people on benefits. 6,66,98 Waiting lists for social housing could be prohibitively long. 78,79,97

Then it took us 13 years to get this house. I went through a lot, 13 years of bidding, fighting up against it, letters from everywhere, from the school, my boy’s school, doctors, psychiatrists, mental health unit, the hospitals …79 (p. 28)

Impact on friendships

A particularly large and disruptive impact, positive or negative, of housing insecurity was the effect it had on children’s friendships and social networks. This social impact could be experienced in multiple ways. Multiple moves could lead to a young person having the challenge of building new social networks and build up a reputation each time they moved,6,87 and worries about maintaining friendships. 71 One young person spoke of the beneficial side to this, in that she had friends all over town, although she also reported difficulty in forming close friendships with anyone due to constantly moving. 6 Children living in temporary, overcrowded or poor condition accommodation often felt ashamed of their housing and concealed it from their friends. 6,59,92,93,95,96 In some cases, renting led to shame among those whose parents had previously owned a house and had it repossessed. 54 Not feeling able to invite friends over caused sadness,92,95 and increased distance from friends due to moving made it difficult to maintain friendships and a social life, leading to boredom and social isolation. 95 Likewise, the threat of an impending move at a distance from friends could cause sadness and worry,95 and many young people missed the friends they had left behind. 6,71

I was quite upset because I missed all my friends…I really miss my friends…I can’t really like chat to them or Skype them because I’m trying to get the numbers from my old phone. (Girl, 12)71 (p. 15)

Some young people felt compelled to turn down invitations to go out with friends to avoid leaving a parent alone with younger sibling/s,95 or because the family could not afford the activity. 96 Another barrier to friendships was feeling different from their peers, either because of looking messy and unkempt or because of lacking in confidence. 96 While these issues are not a specific feature of housing insecurity per se, they highlight that often the issues caused by housing insecurity are compounded by other causes of stigma related to their appearance or by practical issues such as lack of money.

School-related impacts

Another key impact of housing insecurity was the impact on education, and this was closely intertwined with the impact on friendships. Faced with moving, often multiple times, sometimes to uncertain locations, families were faced with the decision to keep the child(ren) in the same school/s, or to change schools. Both scenarios had different, but in each case negative, impacts. Several papers and reports described CYP changing schools, often due to multiple moves, and an unfeasibly long journey to school, or facing the likely prospect of having to change schools. 6,71,87,89,92,97 This could in turn impact on the child’s sense of stability, academic performance and also on maintaining friendships and concerns about forging new friendships. 71,92,96,97

My 12-year-old daughter has gone to eight different schools and has really struggled with constantly making friends and losing friends because of all our moves. All the upheaval makes her so unhappy. 97 (p. 29)

Meanwhile, staying at the same school created some stability in the child’s life,6 and allowed for friendships in school to be maintained, and for being known by the teachers and the school. 6 Staying at the same school, however, was quite often the only option, due to not knowing their next location,6,94 and was not without issues. Those who were unhappy with school were effectively prevented from changing schools due to the family’s precarious housing situation; there was no point in changing schools if they did not know where their next location would be. 6,71 It was not unusual for families to be rehoused at a considerable distance from the school. 6,74,75,94 This often meant having to get up very early to travel a long distance to and from school by bus (often more than one), sometimes train, or taxi,6,71,75,87,92,94 which in turn led to difficulty maintaining friendships and participating in social activities. 96 This also led to increased tiredness,6,92,94–96 and left little time for homework and extracurricular activities. 94–96

I wake up about five in the morning […] walk from our house to the shopping centre […] through there to [the train station] and we go from there until [two stops away] and then…I’m going to [one] bus […] and then we…pick [another bus] […] and we walk from Tesco to school. (Girl, 11)6 (pp. 17–8)

Another option was to stay with friends or relatives closer to school on school nights, which some secondary school children in one study reported doing, although these arrangements did not seem to persist for long. 6,71

Tiffany had taken to staying with her eldest sister on school nights so she wouldn’t be late in the mornings and have her attendance record adversely effected. Her sister lived closer to Tiffany’s school, and sometimes their mum would stay over too. 6 (pp. 38–9)

Regardless of whether the child moved schools or stayed at the same school, living in temporary housing was associated with several practical challenges in relation to schooling, for instance, keeping track of uniform and other possessions, limited laundry facilities, limited washing facilities and a suitable space to do homework. 93,96 Parents noted academic performance worsened following the onset of housing problems. 92,94,97 Limited space and time to work,92–95 tiredness and poor sleep,92,94 travelling and disrupted routines,95 disruptions from other families (e.g., in a hostel),95 a lack of internet connection,95 and the general impact of the disruption and upheaval caused by their housing situation,92,94,97 made it challenging for CYP experiencing housing insecurity to do well at school. Families living in shared emergency accommodation (e.g., hostels) often had to wake up early to access shared facilities before school. 94,95 Some children missed school altogether during periods of transience, because the family were moving so often (and/or staying in temporary accommodation) that school attendance was not viable,52,87,92 the family were not able to secure a school place in the new area,90 or they could not afford the bus fares and money for lunch to send the children to school. 62 Predictably, this non-attendance affected academic performance. 87,92

Nineteen months later, one mother was still unable to have her child in school. ‘She cries when you drive past the school and see all the kids in the playground, like she wants to go. She’ll be one of them kids that skips to school.’90 (p. 33)

Their education was put on hold. My daughter was ahead on everything in her class and she just went behind during those two weeks. S, 30, Mum92 (p. 15)

Family relationships

In addition to the social impact on friendships, young people experienced an impact on family relationships, particularly within the immediate household. One study reported on how family relationships had become more strained since the family started experiencing housing insecurity. 6 In particular, some children described improved relationships with friends (who did not live nearby) at the expense of worsening relationships with family members. 6

[…] he had started to stay over with friends not only on the two football nights each week, but on other nights as well. And […] his relationships at home had become strained. In particular, Sean was finding things really difficult with his mum and one of his sisters. 6 (pp. 73–4)

In some cases, however, housing insecurity led to improved family relationships. For instance, one study reported on a non-resident father who became more involved,6 and another reported how all children felt closer to their parents. 87

Impacts relating to well-being (diet and hygiene)

Some impacts related to the child’s health and well-being. For instance, an impact on diet; one 3-year-old child stopped eating solid food (which affected their growth). 94 Other impacts on diet included insufficient money for the child(ren) to eat properly,6,80,87 a lack of food storage and preparation space in the accommodation (including sometimes a lack of refrigeration)84,93 and a hazardous food preparation environment unsuitable for small children. 93 Two families spoke about a lack of control over the heating in a hotel, leading to excessive heat at times. 87 Hygiene issues relating to dripping water, overcrowding, damp, dirt, electrical hazards, vermin, flooding and a lack of washing and laundry facilities were reported as a result of unsuitable temporary accommodation, including converted shipping containers, hostels, bed and breakfast (B&B) accommodation and houses. 25,52,55,62,68,69,85,87,90,93,97

When we sleep water drips on us which we don’t like. (Daisy, 11) [living in a shipping container]68 (p. 14)

Psychological impacts

Psychological impacts of housing insecurity, which have the potential to affect health and well-being outcomes, were also reported. Teachers in one study reported that children experiencing homelessness saw themselves as being different from their peers, and were less able to ‘blend in’, which could then impact on their mental health (see Outcomes). 96 Sometimes, multiple moves could result in children having high hopes that the next property would be better in some way than the current one, only to be disappointed each time. 6 One study reported that when a family moved to a quieter area, the children felt that it was difficult to fit in. 6 Not feeling safe was a frequent concern, reported by children, and by parents in relation to their children. This included living in neighbourhoods or localities that did not feel safe,6,68,71,84 and accommodation that did not feel safe (due to the other people there and/or a lack of security provision). 68,78,90,93–95 In one case, a young person’s perception of safety improved over time, with them reporting that they had grown to like the neighbours and area. 6

Often, this experience of being unsafe was due to the children being exposed to problematic behaviour in or around their accommodation. This included hearing other children being treated badly,93 being exposed to violence,95 including seeing their parents being attacked,92,93,95 witnessing people drinking and taking drugs,64,71,92,93,95 finding drug paraphernalia in communal areas,93,95 hearing threats of violence,92 hearing shouting and screaming coming from other rooms in shared accommodation,95 hearing their parents being sworn at,64 witnessing people breaking into their room64 and witnessing their parent(s) receiving racist abuse. 64

There’s a lot [of] drugs and I don’t want my kids seeing that…One time he said ‘mummy I heard a woman on the phone saying ‘I’m going to set fire to your face’.’ She was saying these things and my son was hearing it. […] He was scared. H, 35, Mum. 92 (p. 15)

Noise

Noise was another disruption that children experienced in connection with their housing situation. This could relate to the location of the property, for instance, noise disturbance from traffic on a main road,6 or a factory nearby,91 or noise disturbance from other people in a B&B, hotel or hostel banging and shouting or just moving around and going about their day,87,93 or people in neighbouring properties shouting and banging doors. 6

Several of the children from Bayswater Family Centre mentioned noise going on 24 hours of the day. One child, who had stayed in bed and breakfast accommodation for two years, said she had not been able to sleep until they moved from that particular hotel. 87 (p. 19)

Loss of security and stability

Multiple moves, or the fear of having to move, disrupted children’s sense of continuity and they experienced a loss of security and stability in their lives (see Exposure). 66,68 One (seminal) report identified that young people experiencing housing insecurity experienced instability in many other spheres of life as well. 6 A loss of security and stability led children to feel responsible for helping and providing support to their parents, including putting on a brave face and hiding their feelings in relation to the housing situation so as not to further upset them. 92,95 Some children stopped asking their parents for things they wanted. 6,94 Children also felt a sense of displacement and a feeling of not belonging anywhere as a result of the loss of safety and security, with no place that felt like home. 6,96

[…] a sense of place formed a crucial component in their experiences, and something appeared to be lost for those who were forced to move repeatedly and continually navigate their place attachments amidst the dislocations. For Tiffany it meant a loss of belonging and a longing to be back home. 6 (pp. 40–1)

Even when a family is provided with decent temporary housing in the right location, the threat of being moved on somewhere else always hangs over their heads, depriving children of a sense of stability and security. 68 (p. 15)

Loss of stability and security triggered a desire for stability, for the family to be able to settle, having friends over, and not having to constantly worry about having to move. 90

Parental and family well-being

Often, CYP were aware of the impact of their precarious housing situation on their parents,6,87 which would then impact their own well-being. In other cases, CYP were not directly aware, but would experience other negative impacts of reduced parental well-being, such as increased arguments and increased family stress. 6,74 Reduced parental well-being due to housing insecurity can further impact on child development,25 and reduced their ability to care for children with chronic conditions. 25

Overcrowding and lack of space

Families felt pressured by the need for emergency accommodation to take whatever was on offer, even when emergency temporary housing or another rental property was unsuitable in some way. The condition of the property, distance from school, friends and relatives, and overcrowded conditions not only contributed to the experience of housing insecurity in their own right, but could also, in turn, lead to additional impacts. Many accounts described overcrowding in housing that was intended to be temporary, resulting from the need to be housed quickly (and a lack of available, suitable properties). In turn, overcrowding could mean that siblings, and parents and children, had to sleep in the same room,45 and sometimes the same bed as each other,97 which could lead to disturbed sleep. 6 In some cases, family members (usually one or both parents) had to sleep in a living room. 6,91 Families would also lack privacy, for instance, they would have to change clothes in front of each other. 95 Small, overcrowded accommodation meant little space for possessions, so children would experience cramped conditions. 45,71 In some cases, whole families and their possessions would inhabit one room, reducing their freedom to move around. 78,84,95

It’s all of us in one room, you can imagine the tension…everyone’s snapping because they don’t have their own personal space…it’s just a room with two beds. My little brother has to do his homework on the floor. 78 (p. 43)

This meant it was difficult for each child or young person to have their own space, even for a short time. 79 Older children lacked the space to do schoolwork,95 and to invite friends over, directly because of the lack of space, and indirectly because they felt ashamed (see earlier in the section). 84 Families sometimes had to cohabit with extended family, which could lead to overcrowding due to a large amount of people inhabiting a modest-sized property. 91 Others were initially living in a property of the right size, but ended up outgrowing it, or anticipated they would outgrow it in the future, when children were older. 97 In some cases, overcrowding took the form of multiple families and single people being crammed into a single building, for instance a hostel or shelter, which presented difficulties for single parents when using shared bathroom facilities, as they did not want to leave their child(ren) alone in the room. Living in overcrowded conditions could lead to, or exacerbate, aggressive behaviour and mental health problems among CYP (see Outcomes). 53 Overcrowded conditions caused a ‘relentless daily struggle’ for families (p. 48). 64

Poor condition or unsuitable property

Similarly, the need to take whatever property was on offer led to families living in properties in poor condition (also see Exposure). This included properties with damp and mould, unsafe gardens, broken appliances, fixtures and fittings. 71 This created a vicious cycle, whereby families would either try to endure these poor conditions, or else would attempt to move to a more suitable property. Requesting a repair or resolution from the landlord could lead to further housing insecurity. These latter two exposures are discussed in detail in the Exposure subsection.

Another impact of being moved to an unsuitable property (in particular, temporary accommodation) was a lack of space for children to play. Often this was due to the family inhabiting a small space such as studio flat or room in a hostel or refuge. 68 For small children, this could present a health and safety hazard,68 and parents reported injuries in very young children. 93 Keeping small children occupied in just one room was a further challenge. 93 Sometimes the lack of space to play was due to poor housing conditions making the space unsuitable, for instance, a vermin infestation. 68 For older children and adolescents, a lack of space meant a lack of privacy. 93 School holidays could be particularly challenging for families of school-aged children, particularly when outside play spaces were not deemed suitable due to safety concerns (e.g., people selling drugs, broken glass). 68,87

School holidays are very tight. It’s very scary allowing the children to play downstairs in the communal playground – it is risky because of drug dealers, it is very hard to let my children out. (Sophia, mother of children aged 14, 11 and 8)87 (p. 15)

Some temporary accommodation restricted access during the daytime, making it difficult to entertain and occupy children without spending money. 93

Financial impact

Moving house also had a financial impact on families. Moving into temporary accommodation meant that possessions had to be left behind, particularly if the temporary accommodation was small and overcrowded, with the cost of decorating, carpets, curtains and furniture to be covered each time a family moved. 6,79 This could incur considerable debt among families. 79 One family reported having to sign up to rent a larger house than they could reasonably afford, and purchase white goods and curtains, due to being served insufficient notice on their previous tenancy. 85 If the new location was far away from school, family, friends and, in some cases, shops, then the family incurred further costs travelling on buses and in taxis for day-to-day business. 6,68,75,93,95 Other financial aspects of housing insecurity could also have an impact. The threat of sanctions for missed payment of rent could lead to reduced family well-being, characterised by feelings of despair, failure and a loss of hope. 74 Another knock-on effect of the financial impact of housing insecurity was that parents had to refuse children’s requests for possessions or experiences. 94

Access to services

Multiple moves, particularly across local authority boundaries, could impact on the ability of either family or children to access services, particularly those aimed at vulnerable families. 25,52 Living far away could lead to problems accessing health services,71 including specialist healthcare that is required to manage children’s health conditions. 64

[…] our GP was in [the area where we used to live], we moved to [another area] but we didn’t move our GP…because we thought like, our house was temporary so there’s no point moving from [the old area] to then move again [to the next area]. (Girl, 11)71 (p. 18)

Families experienced a lack of support from social services and other outside agents, and the social workers themselves expressed frustration at being unable to do more to help families experiencing housing insecurity. 66,74

Moving to a better situation

One study reported that some children felt positively about moving if their current conditions were sufficiently bad and causing them problems, as the move would give them the opportunity to leave negative things behind.

In my old house there was like bullies there and there’s more bullies now. Because I used to have another house as well and I want a new house again because there’s more bullies. (Boy, 10)71 (p. 15)

A few children in one study also reported that their most recent move had taken them close to friends, which they viewed as positive (see Protective factors). 6 Likewise, a few children in one study reported having more space in the new property (although in at least one case the accommodation was temporary). 6 Quite often, however, such moves also came with negative impacts that seemed to offset any benefit. 71

Other impacts

Frequent moves could impact on children’s health and well-being in other ways. Space might be even more squeezed by cardboard boxes in preparation for an impending move. 6 Some children reported having to leave beloved pets behind. 71 Time costs associated with moving meant less time for other activities. 6

Choice and control

One key impact that overlaid all of the above but was rarely mentioned was a lack of choice or control. 90 This was inherent in the families’ and children’s accounts of their experiences of housing insecurity, through talk of not knowing where their next move would be or when, and having to move long distances away from the places they used frequently and the people who supported them. Even the journey into housing insecurity was often not something the families had a great deal of control over, such as increases in rent, change in income or being served eviction notices (see Exposure). Families lacked control over improving unsuitable properties in poor condition, as they could often not pay for repairs so felt they had to live with these problems. 71 Some families avoided reporting problems to the landlord for fear of a rent increase or eviction (see Exposure). CYP, in particular, felt that they lacked control, and in some cases were not aware why they had to move on certain occasions. 6

Mental health

Living in temporary housing, making multiple moves, and the instability and insecurity associated with anticipating a move, or being uncertain whether a move would be needed in the near future, had an obvious negative impact on the mental health of CYP as reported in various studies,25 including in terms of self-harm,52,77,78,92 thoughts of suicide,52 anxiety,52,71,84,92,93,96 depression. 91,96 Sometimes these problems manifested as physical pain. 87

She’s under [mental health service], but since then she’s – well she’s been off today. I took her to the doctor’s yesterday, and it’s just stomach pains. Same things going on and I think it comes out in her, you know, physically, rather than emotionally. 87 (p. 13)

Stress, worry about the future and acute distress were also reported. 6,54,70,71,77,90,95,96,99 One study reported on stress and anxiety in children due to the trauma of losing their home and the emergency accommodation being unsuitable and temporary. 92

My six-year-old has been going to the doctors because he’s developed a nervous tick since we’ve been in that room. He was constantly nervous all the time. He’s so unsettled still and he knows that we’re still not settled. He’s really anxious. He’s become violent […] (S, 30, Mum)92 (p. 13)

Another study reported on how some young people experienced distress caused by safety concerns. 6

Sometimes children’s mental health issues would be displayed through problematic behaviour such as withdrawal, stealing, drug-taking, aggressive behaviour and running away. 49,52,78,96

In my experience, the younger the homeless children are when they come into our school, the more they cry. They are very clingy and very emotional. The older children present signs of having behaviour issues. They’re aggressive. They don’t want to talk. They find it hard to build friendships. (Family liaison worker, based at a primary school in Moss Side, Manchester)52 (p. 12)

Teachers in one study reported that younger children tended to get more withdrawn and older children tended to get more angry and antagonistic, although the same child could cycle between these two states. 96 Separation anxiety was reported in children, who showed distress upon being separated from their parent(s). 68,92 One study reported on a 7-year-old who started wetting the bed. 92 A further study reported on a young person who had started smoking. 95

Physical health

Physical health problems were also experienced as a result of living in temporary accommodation, poor-condition housing and making multiple moves, including the development or exacerbation of asthma,62,71 eczema,25,62,71,92 stomach bugs,52 insect bites,93 infectious diseases,25,90,93 headaches,94 stomach aches. 90,94 One study reported how a baby became ill following a difficult birth, attributed to stress in the mother relating to housing insecurity. 64 Other physical health impacts, such as weight gain (due to fast food consumption, caused by a lack of cooking facilities) and head lice (due to close contact with others), were also reported. 96 Some properties presented safety hazards to babies and young children. 25 Such housing conditions also made it extremely challenging for CYP to manage a long-term condition effectively, leading to exacerbation. 25,56,90

Tiredness

Tiredness was also reported, in relation to travelling a long distance to school, and also for those whose temporary accommodation was a long distance from the homes of family and friends. 6,93,96 Poor-quality sleep and being kept awake because of the unsuitable nature of the accommodation (e.g., housing in a poor state of repair or living in temporary accommodation along with other families and other adults), and by the worry of the housing situation, also resulted in tiredness. 6,25,68,90,93,95

it’s just I can’t sleep, I just keep thinking about things. (Child, 12)95 (p. 13)

Child development

Impacts on the development of young children were reported, in particular in relation to having no space to play, which impacted standing/walking and emotional development,68,92 and multiple moves, which impacted on potty training and speech development. 68,92 One study reported an impact on growth, due to the child refusing solid food. 94

Friendship

For CYP, a key protective factor was friendship. CYP reported that having good friends could ‘see a person through some really tough times’ (p. 48). 6 Retaining connections with friends and peer networks following moves was important to children,6,71 and school facilitated this. 95 Indeed, another related strategy deployed by families was to keep the same school during and after moves, to retain some stability in the life of the child/young person. 6,71,89

Normalising housing insecurity

Two key reports and one journal article mentioned that the CYP tended to normalise housing insecurity in their accounts, suggesting that the children had become accustomed to housing insecurity. 6,43,71 This response could be a coping/defence mechanism, to try to deal with the negative impacts of being insecurely housed.

Well in a way I’ve found it quite annoying because we’ve never been secure and had loads of friends in the one place. But in a way I found it quite reassuring that I’ve found out about all these places and I know about them a little bit […] (David)43 (pp. 620–1)

Home-making

Another, more positive, coping strategy was to make the property feel more like a home. One study reported on a family who had started to decorate their property and make it nicer in order to transfer to a larger property, experiencing the pleasant side effect of feeling more settled and ‘at home’. 6

She liked the place now that they had decorated it and made it all nice ready for moving on, this time with more than just a lick of paint in the kitchen by way of décor. And she loved her bedroom now it was all done up. 6 (p. 84)

The same study reported further cases of home-making and rooting, and also reported on another family where the child had grown to like the new property after being initially disappointed, upon recognising that the location had several advantages. 6 Further coping strategies mentioned by young people included having a plan of how things could go to keep anxiety at bay and retain some control (while recognising that things don’t always turn out as planned),6 and hoping for a better house next time, and/or hoping that the family would settle in a permanent home. 6

Protective parenting

Parents also acted to protect the child(ren) from the negative impacts of housing insecurity. They concealed the full extent of their financial and housing problems,94 and presented their situation as an adventure to the children. 95

Intervention programmes

Lastly, some positive findings were reported by an evaluation of the Family Intervention Programme (FIP), for families who had been sanctioned or threatened due to antisocial behaviour. 99 The FIP involved the use of a multiagency team working closely with the families, who then experienced increased housing security, which in turn reduced stress and anxiety, and families saw fewer behavioural problems among the children. 99 Another study reported positive effects of a peer-led parenting programme on children’s behaviour, although it is unclear how this impacted on the children themselves. 45

Leaving the family home

Domestic violence could be a source of housing insecurity both for families who leave the family home to seek safety and for those who stay. Families who leave can end up moving several times, perhaps initially to a refuge and then perhaps into other forms of temporary housing. 71,86 Sometimes there would be several moves in a short period of time:

I had the children with me so having to move 5 times in 9 months was hard especially as my oldest child had to miss or change schools a lot and for 4 of those months we were in the middle of nowhere […] all in one small room. (from survey)86 (p. 49)

Uncertainty over when the next move would be was also a feature of housing insecurity in such situations. 71,86 Among one family, housing insecurity was framed against the alternative of going into care, which the children avoided by the family leaving the perpetrator. 71

Staying in the family home

Among those who stay, housing insecurity could be characterised by the perpetrator refusing to pay the mortgage, leaving the family uncertain about how long they can stay in the property.

I’ve lost two stone, my son has lost ten pounds – he is only 15 – he is having counselling at school. It has just been a nightmare…He hasn’t paid the mortgage for a year because he wants to get me out so he can have the money… (Service user)76 (p. 68)

Psychological impacts

Most impacts of housing insecurity reported in the literature were negative. Staying in the house but where the perpetrator was withholding payments for the mortgage led to negative psychological impacts among one family, where the 15-year-old son was receiving counselling. 76

School-related impacts

Issues with school were reported by three respondents in one study. 86 It seems that, given the multiple moves, the options open to families were to either move schools (often several times) or keep the same school but face a long journey. Neither of these options is desirable to children, with changing schools having an impact on academic performance,87 and on friendships.

And then she had to miss out on school and then when we were moving to where we are now it was a different school again. So it’s not just women it affects. It’s the children as well. (from interviews, participant B)86 (p. 54)

Social impacts

The impact of housing insecurity on friendships and social impacts generally was also reported. One account reported that multiple moves made it difficult for a young person to build peer networks,71 and another study revealed that a significant barrier among this specific population was not being able to disclose information about themselves, for instance where they lived, in case the perpetrator found them. 44 Parents reported a lack of support offered to children, including services that the children needed. 61

Financial impacts

Moving out of the initial family home also had a financial impact on families,65,86 with families escaping domestic violence and abuse often requiring new possessions and furnishings:

Most of them had been forced to leave all their furniture behind and were faced, therefore, with furnishing a house in its entirety. 65 (pp. 181–2)

Financial impact was not reported in terms of multiple moves in the literature relating to domestic violence, although we might infer that moving multiple times may compound the financial impact of housing insecurity.

Poor condition and unsuitable housing

Lastly, issues related to the condition of the housing itself. Quite often, temporary accommodation such as refuge and hostel accommodation, was small, and families reported that as a result there was no space to play61 or have any privacy,44 and that children would get bored and display problematic behaviour. 60 This type of accommodation was often shared, with the threat of possessions being removed by others,61 as reported by one family:

I found sharing difficult, especially as food went missing and other things out of Hannah’s [daughter] room. The other family never bought toilet rolls and it got to the point where I hid them in my [bed] room. (C3)61 (p. 249)

Weight loss

Little in the way of childhood health and well-being outcomes was reported for this population. Weight loss, due to worry about the future housing situation, was reported in the family who had experienced housing insecurity due to withheld mortgage payments. 76

Mental health

Poor mental health was also reported in three studies as a result of staying in temporary accommodation and/or housing insecurity more generally. 44,60,88 One study reported a child self-harming while living in a refuge alongside 12 other families (including a child who made sexual remarks to her) and people who were taking drugs. 88 Another study reported a child wetting the bed and further children experiencing fear, and reported how they coped by hiding their emotions from their mothers and themselves. 44

Support

Support offered to parents and children who had moved to escape abuse in their previous home could improve well-being. 44,60,61 Particular forms of support included a parenting course60 and supportive staff and peers at hostels. 61 The same study also reported that hostels offered a feeling of safety, due to closed-circuit television. 61 One study reported that refuge and hostel staff were perceived as helpful but powerless in some cases, although the young people found it helpful to talk and open up about their situation. 44 One intervention, the Sanctuary Scheme, allowed people experiencing/at risk of domestic violence to remain in their own home, with additional security. 76 The report documents the benefit of the intervention for the well-being of children in one particular family:

[…] the Women’s Aid worker contacted me again and said ‘I have never seen anyone’s life change so much through one little tiny bit of intervention’ she said ‘the woman and her kids are different people, they just look different, they’re, you know, visibly happier and more confident’. (Sanctuary Scheme co-ordinator)76 (pp. 90–1)

Coping mechanisms

Some studies reported some children talking about positive aspects of moving frequently, which could be interpreted as coping mechanisms. One study reported that experience of living in different places was framed as beneficial to the young person, although little detail was given, and this benefit appeared to be offset by a difficulty in building peer networks. 71 Another study reported that children sometimes held out hope that their next property would be better than their current one and that they could make it nice. 6

Eviction and homelessness

A few families in the same study reported being homeless. 83 In one case, the family was evicted as they were not able to pay the rent, due to the mother losing her job because her visa had expired. In another case, the family was evicted because a court ruled in favour of a social worker who did not believe they had nowhere to stay. These families and a further family reported sleeping in unsuitable locations, such as on the night bus, in a church, and in the waiting room of the accident and emergency (A&E) department. 83

We had to keep going to McDonalds every night and we would also go to A&E. I would have to wear my school clothes and sleep like that.… They would say we have to sleep where the people wait but it’s just like lights […] The chairs were hard. (Joel, 9)83 (p. 22)

Temporary housing

Temporary housing was another exposure among this population, with one study reporting that living in temporary housing caused a child worry, as he did not want to move away from school and his friends. 72 A child in another study experienced acute distress at the thought of having to move out of their temporary accommodation, which manifested itself as bedwetting, night waking and emotional and behavioural issues at school. 47 Another study reported that living in a hostel for a period of time led to friendship issues; the young person felt left out from being able to engage in sleepovers with friends. 83

Poor-condition/unsuitable housing and overcrowding

Frequently, temporary housing was unsuitable, with issues that could impact on the health and well-being of the family, such as bedbugs, vermin and overcrowding. 57,58 Unsuitable housing, including overcrowding, was also a source or feature of housing insecurity creating a need to move (as with the general population), and while overcrowding was largely a feature of temporary accommodation, sometimes it applied to accommodation more generally. In many cases, overcrowding was due to many people living in one property, which included when a family stayed with friends. 83 On these occasions, children reported having to sleep in unsuitable places (e.g. the lounge floor), which caused aches and pains, which in turn caused trouble focusing at school. 83 One young person reported overcrowding in relation to living in a shared house with other people coming and going, with issues such as noise, dirt, a lack of space, and people being violent and causing damage, leading to feeling unsafe. 83

Salim (age 8) and his mother, Ade, were staying with a friend in a small flat. At night, they had to share the sofa as there was nowhere else to sleep. Salim complained this hurt his back and the pain made it hard for him to focus in school. 83 (p. 16)

Where I live now, I’m not comfortable. There’s a lot of noise from people coming up and down the stairs. It’s always dirty. I have no space to do my homework and I don’t feel safe. At 3am someone broke a door in the house – people were fighting. (Amir, 8)83 (p. 23)

Multiple moves

Multiple moves also characterised housing insecurity among migrant, refugee and asylum seeker populations, as for the general population, with impacts on the children’s education and friendships. 58,63 However, in contrast to the general population families might need to move suddenly, with very little notice (e.g. 48 hours). 58,63

This happened to me. Moving around is really a headache. The children go to School in one area you move to another area then the children will miss their friends and teachers and the whole moving business make you stressed and it even affects the health of the children. (lay, female)63 (p. 512)

Lack of support with housing

Another exposure, which may be particularly pertinent to this population, was a lack of support with being housed, as a consequence of which families would end up street homeless and have to beg friends to let them sleep on their sofas. 82

School-related impact

As with the general population, a combination of temporary accommodation and the need to move or make multiple moves necessitated changing schools in some cases,47,72,83 and this made children feel sad. 83 As with the general population, sometimes children stayed in the same school, often because the family did not know where their next move would take them, and/or because the children did not want to move schools. 83 This necessitated long journeys to and from school, involving early starts,47,58,69,83 which inevitably led to tiredness and stress in the CYP. 47,58,83

The family now get up at 6 am so as to get to school on time. The youngest two daughters go to the same primary school one and a half hours journey away. […] The children are extremely tired and they often sleep on the buses to and from school. 47 (p. 29)

One paper reported how children in a family who ended up homeless sometimes missed school through being too tired from having to sleep on the night bus. 83

Social impact

Friendships were also impacted. Children reported not wanting to leave behind their friends and missing their friends after moving, which again made them feel sad. 83 One study reported a child travelling long distance to visit a friend. 83 In one case, temporary accommodation meant that sleepovers were not feasible, leaving one young person to feel left out, with friendships impacted. 83

They were given one room in a hostel. Although the family now had somewhere temporary to live, Salim felt left out at school. He didn’t want to go to sleepovers at friends’ houses as he couldn’t invite them to his house in return. 83 (p. 16)

Unsuitable property

As mentioned above, being moved to unsuitable properties could be a feature of housing insecurity, and could also exacerbate their precarious housing situation. These included properties with no laundry or cooking facilities,83 properties with vermin infestations, properties with no electricity, furnishing or curtains48 and those with little furniture so children had to sleep on the floor. 83

There was no electricity, there was no curtain, there was no bedding, there was nothing, we slept in the cold, we got no heat, and we could not cook. There was nothing […] children shouldn’t live like that, nobody should live like that. 48 (p. 195)

Overcrowding, noise and space

Noise was also an issue, with two studies reporting on noise from other people in a hostel causing distress to children. 72,83 Likewise, overcrowding was a common feature of unsuitable properties where families in precarious housing situations were placed or ended up in, which included living with friends,72,83 accommodation that was too small for the family,48,72 and hostels/shared houses where whole families inhabited one room and washing facilities were shared. 81,83 Overcrowding led to behaviour problems (due to lack of space),72 issues with sleeping,72 having no space to play48,72 or do homework,83 challenges accessing shared facilities with a very young child,81 aches and pains from sleeping in unsuitable places (e.g., a sofa),83 feeling unsafe,83 noise,83 and feeling different from peers (due to not having their own room or even bed). 83 Some children reported being scared of other people in shared accommodation. 83

Family well-being

One study reported on the detrimental impact of housing insecurity more generally on family well-being, with language barriers presenting a further challenge to adjusting to a new area. 63 This could include parental well-being, whereby parental stress, sadness and distress was experienced by parents as a result of their housing insecurity,46,83 and would negatively impact on the well-being of children, causing them upset. 83

The whole time I was just thinking about where am I going to go with these three children. […] I had no money and no help. I felt very sad. I was crying a lot. The boy was upset to see me cry. (Samira)83 (p. 8)

Food and eating

Impacts on food and eating were reported. One study reported that families felt pressure to cook British food rather than food from their home country when sharing communal facilities with others in temporary accommodation. 87 Another study reported on a child who was not eating properly, and was underweight as a result; this appeared to be a symptom of great distress or underlying mental health issues as a result of repeated moves. 72

Access to services

Moving could also impact on access to services and continuity of care, with one study reporting families being unable to register with general practitioners in the new area,63 and another reporting difficulty in maintaining continuity of care for a child requiring urgent medical care. 46

Mental health

In some cases, children displayed extreme distress and physical indicators of mental health problems at the thought of having to move; one study reported a child who displayed signs of severe distress including night waking, bedwetting and emotional and behavioural issues at school. 47 One study reported on a young person who was upset, angry and feeling isolated as a result of being moved far away from friends. 48 Many children worried about having to move again. 72,83 Some children experienced behavioural problems and frustration as a result of living in overcrowded accommodation, a lack of space, and not being able to have their own space. 72 Experiencing a lack of belonging could also cause sadness. 83

Any time I said, ‘Mum, can we go home?’ I forgot that we didn’t have a home, so I couldn’t. My mum said, ‘which home?’ and I said, ‘oh yeah, we don’t have a home.’ Then I didn’t want to talk anymore. I was feeling very sad. (Joel, 9)83 (p. 31)

One child experienced nightmares. 83 One child with distress/mental health problems as a result of having to make multiple moves would not eat properly (resulting in underweight and anaemia), and became socially withdrawn. 72

One child had struggled with being underweight and anaemic from not eating properly. Her mum described her as being withdrawn in school, and believes their experiences with having to move repeatedly has impacted her ability to make connections with others. 83 (p. 44)

Physical health

Physical problems believed to result from poor housing were reported in some studies. One study reported on several families who reported rashes and asthma in young children as a result of damp. 81 The same study also reported other physical symptoms in young children, such as coughing and vomiting. 81 One study reported a baby developing a skin complaint as a result of living in a hotel. 72 Some children reported musculoskeletal pain as a result of having to sleep in unsuitable places. 83

Tiredness

Tiredness and exhaustion were also reported in children (with further knock-on effects on education due to trouble concentrating or not being able to attend school), because they had to sleep in unsuitable places (e.g. a sofa, a floor, a bus, the waiting room in A&E)83 and having to get up early and make long journeys to and from school. 47,58,83

Anton (age 7), Vea (age 5), Jaden (age 1), and their mum, Naomi started sleeping on night buses after they were evicted from their flat due to rent arrears. […] Sometimes they were so tired they couldn’t make it to school. 83 (p. 30)

Protective parenting

As with the general population, parents acted to protect children from the negative impacts of housing insecurity. One mother had discussions with her child about their housing situation, which seemed to help in managing negative feelings. 71

[…] my mum said ‘how would you feel to move?’ Then I said ‘you can choose because you’re the boss’ […] So then after when we moved…she said again ‘how would you feel if we were moving to another country?’ Then I said ‘I wouldn’t feel fine’. (Ebahi)71 (p. 16)

Another study reported parents taking children out to parks, to give them space to run around when space in the accommodation was strained. 72

Gentrification and a forced move

The main reason for the housing insecurity was forced relocation due to gentrification. This was experienced in different ways for different families, however, with each having a different unique experience of housing insecurity. One family reported not wanting to move as the children liked the area and their school and nursery. 51 Two further families struggled with the relocation to find a property that would be suitable for them; one family was offered the same type of property but needed outdoor space, and the other family were overcrowded in their current flat and were having trouble finding somewhere suitable. 51

My children was with me, they go, they happy, they want see new house, oh my God, they come inside, they laughing, ‘oh Mama, where can I put my bed, Mama, I don’t believe, where can I stay…’ (Nada, W2)51 (p. 392)

Overcrowding

Overcrowding prior to the forced move was reported more generally, with two families reporting family members (including children) ended up sleeping on the floor, and children in these and other families having to share bedrooms, including older children of the opposite sex. 51 This led to a lack of privacy, and in some cases arguments.

And they were always arguing, always constantly arguing over…they had one telly in their room and that wasn’t the greatest signal either, and they were always arguing about who wants to watch what on telly and you know, that half of the room’s mine and this half… (Heather, W1)51 (p. 389)

Exposure to problematic behaviour and safety

Two families needed to move because of exposure to problematic behaviour prior to the forced move, particularly in outdoor areas, where there would be broken glass, needles, dogs roaming and people drinking and swearing. 50 Related to this was a lack of space for the children to play, as the families did not have a garden and the common outdoor areas were unsafe. 51

If you brought the children [to] the park, the children be scared...because the people there drinking and swearing. (Nadia)50 (p. 956)

One family experienced racial abuse following the forced move, leading them to request another move because they did not feel safe in their new area.

The racial attack had a grave effect on Ula’s mental health and attitude towards the future saying ‘it’s destroyed every happiness, everything’ and ‘I was [in] shock...[it’s] really affected me mentally and physically.’ She no longer felt able to volunteer, or take her children to school. 50 (p. 954)

Families also reported feeling shame about both the area they lived in, which had a bad reputation, and in the poor condition of their housing, which precluded the children inviting friends round. 50,51 Families were keen to move to a less stigmatising area and better condition housing. 50,51

School-related

Most families managed to relocate to areas where it was possible for children to attend existing schools; however, two families moved schools in the first instance; one reported that the child did not settle so moved back,50 whereas the other reported that the child was initially sad about the thought of moving schools and leaving friends behind, but then settled into the new school and made friends. 51 Even when attendance at the same school was possible, one family reported an impact on educational attainment. 50

But her older daughter, for whom she had aspirations to go to college or university, has left home, failed her exams and dropped out of school. 50 (p. 957)

Children who stayed in the same school found it possible to maintain friendships, and to maintain previous connections with teachers. 51 Staying in the same school, however, could mean a long journey for some; in one case an hour each way. 51

Family well-being

Relocation could have positive impacts on families and children. Three families experienced positive changes in their children following the move, with CYP enjoying having a garden and growing to like their new neighbours and the area. 50

Compared to the old neighbourhood, this was a better and safer environment for the children – ‘bring the weans up in a better life there no needles lying about’. (Lesley)50 (p. 955)

Although families moved to escape an unsafe area, one parent was racially abused in her new neighbourhood on the way to collect the children from school. This led to her feeling unable to walk the route to school and impacted on the family’s sense of safety. 50

Social impacts

The poor quality of the initial housing (a high-rise block of flats), which forms part of their experience of housing insecurity, caused CYP to feel shame and stigma relating to both the local area and the flats themselves, with many young people reluctant to invite friends over, or others socialising in the corridor without inviting friends inside. 51

Heather said her children did not want to bring their friends to the flat because they felt embarrassed about the conditions […] Heather’s son (age 16) corroborated this saying he was embarrassed ‘at the time – see because they [friends] all had houses and stuff, and I [was] still living in the flat’. 51 (p. 390)