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Comment & Response | Pediatric Quality Measures

An Important Cause of Child and Youth Homelessness

Victor Kieu, BS1; Shadi Rezai, MD2; Cassandra E. Henderson, MD, CDE2
[+] Author Affiliations
1St George’s University, School of Medicine, Grenada, West Indies
2Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, Bronx, New York
JAMA Pediatr. 2016;170(9):909. doi:10.1001/jamapediatrics.2016.1387.
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To the Editor There is a preconception that children who participate in activities outside the standard regulations of a stable household are predominantly juvenile delinquents.1 Embleton et al2 present a large, generalized study with statistical depth that illuminates the environmental factors giving rise to millions of displaced children. The study emphasizes that children do not just become involved in “street life” because of an innate delinquency.3 Rather, children are a product of their experiences, particularly those experiences that expose them to psychosocial disruption and inhibited child development. Within the study, extensive analysis reveals that poverty, family conflict, and abuse are major identifying factors that predispose children to displacement and inadequate living conditions.2 Although these are significant risk factors, the study overlooks the effect of childhood mental illness on decision making because participants were not screened for mental illness prior to inclusion in this study. This screening is important because in a meta-analysis performed by Bassuk et al,4 10% to 26% of homeless preschoolers and 24% to 40% of homeless school-aged children have mental health problems requiring clinical evaluation. By not screening for mental illness prior to the study, the authors overlook mental illness as a substantial contributor to poor insight. This is particularly relevant when considering how mental illness may affect the participants’ responses to the study questions. Therefore, to obtain more accurate results, study participants must be screened for mental illness, and those with mental illness should be taken into special consideration on account of impaired decision making. It is increasingly important to understand that children are being socially excluded, criminalized, and oppressed owing to preconceived notions that they are delinquents by nature,2 and those who are mentally ill are no exception. Although significant data have not been gathered to determine whether early prevention will decrease the number of children participating in “street life,” it would be negligent of us as clinicians to not consider the effect that psychological development and resulting mental illness have on decision making in impressionable youth. With more accurate studies, we may better ensure childhood success and break the cycle of child homelessness.


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September 1, 2016
Lonnie Embleton, MPH; Paula Braitstein, PhD
1Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
2Division of Epidemiology, University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada3Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya4Indiana University, Fairbanks School of Public Health, Indianapolis5Regenstrief Institute Inc, Indianapolis, Indiana
JAMA Pediatr. 2016;170(9):909-910. doi:10.1001/jamapediatrics.2016.1390.
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