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Pathways to youth homelessness.

Research documents high levels of psychopathology among homeless youth. Most research, however, has not distinguished between disorders that are present prior to homelessness and those that develop following homelessness. Hence whether psychological disorders are the cause or consequence of homelessness has not been established. The aim of this study is to investigate causal pathways to homelessness amongst currently homeless youth in Australia. The study uses a quasi-qualitative methodology to generate hypotheses for larger-scale research. High rates of psychological disorders were confirmed in the sample 35 homeless youth aged 14-25. The rates of psychological disorders at the point of homelessness were greater than in normative samples, but the rates of clinical disorder increased further once homeless. Further in-depth analyses were conducted to identify the temporal sequence for each individual with a view to establishing a set of causal pathways to homelessness and trajectories following homelessness that characterised the people in the sample. Five pathways to homelessness and five trajectories following homelessness were identified that accounted for the entire sample. Each pathway constituted a series of interactions between different factors similar to that described by Craig and Hodson (1998. Psychological Medicine, 28, 1379-1388) as "complex subsidiary pathways". The major findings were that (1) trauma is a common experience amongst homeless youth prior to homelessness and figured in the causal pathways to homelessness for over half of the sample; (2) once homeless, for the majority of youth there is an increase in the number of psychological diagnoses including drug and alcohol diagnoses; and (3) crime did not precede homelessness for all but one youth; however, following homelessness, involvement in criminal activity was common and became a distinguishing factor amongst youth. The implications of these findings for future research and service development are discussed.

Adolescent↗

A risk profile comparison of homeless youth involved in prostitution and homeless youth not involved.

All initial visits (n = 620) of runaway/homeless youths to an outpatient medical clinic over a 12-month period (July 1988-June 1989) were analyzed. Of these visits, 467 made by youth not involved in prostitution were compared with 153 visits by youth who were involved. According to the data from an adolescent risk profile interview, homeless youth involved in prostitution are at greater risk for a wide variety of medical problems and health-compromising behaviors, including drug abuse, suicide, and depression. The implications for public health and social policy are discussed.

Adolescent↗

Service utilization and the life cycle of youth homelessness.

The study sought to describe service utilization patterns of homeless youth based on their life cycle stage. Ninety-nine percent of participants accessed services. Medical service utilization was highest among youth who were attempting to leave the street. Drug-related service utilization was lowest among youth most entrenched in street life.

Adolescent↗

Youth homelessness: a call for partnerships between research and policy.

Homeless youth present significant challenges both to youth workers and policy-makers seeking to develop better prevention and intervention strategies. This article discusses the compelling need for researchers and policy-makers to make efforts to work collaboratively to develop improved social policy informed by research findings.

Adolescent↗

The causes of loneliness in homeless youth.

Both homelessness and loneliness are pervasive in North America. In this study, the author compared the causes of the loneliness experienced by young homeless youth (n = 113) with that of counterparts in the general population (n = 211) who answered a 30-item yes-no questionnaire. The results identified 5 causes of loneliness: personal inadequacy, developmental deficits, unfulfilling intimate relationships, relocation or significant separations, and social marginality. The results indicated that the causes of loneliness in young homeless youth are significantly different from those of the general population.

Adolescent↗

A theory of taking care of oneself grounded in experiences of homeless youth.

BACKGROUND: Homeless adolescents are vulnerable to poor health outcomes owing to the dangerous and stressful environments in which they live. Despite their vulnerability, many of them are motivated to engage in self-care behaviors. OBJECTIVE: The specific aim of this study was to explore self-care attitudes and behaviors of homeless adolescents. METHOD: Individual interviews were conducted with 15 homeless adolescents. Interviews were audiotaped, transcribed verbatim, and analyzed using the constant comparative method of grounded theory. RESULTS: Findings revealed a basic social process of taking care of oneself in a high-risk environment. This basic social process was supported by three categories: Becoming Aware of Oneself, Staying Alive With Limited Resources, and Handling One's Own Health, each including two processes. DISCUSSION: Findings support Orem's conceptualizations of self-care and self-care agency and suggest the need for programs to support further healthy growth and development among homeless adolescents.

Adaptation, Psychological↗

Quality of health care: the views of homeless youth.

OBJECTIVE: To develop homeless-youth-identified process and outcome measures of quality of health care. DATA SOURCES/STUDY SETTING: Primary data collection with homeless youth from both street and clinic settings in Seattle, Washington, for calendar year 2002. STUDY DESIGN: The research was a focused ethnography, using key informant and in-depth individual interviews as well as focus groups with a purposeful sample of 47 homeless youth aged 12-23 years. DATA COLLECTION/EXTRACTION METHODS: All interviews and focus groups were tape-recorded, transcribed, and preliminarily coded, with final coding cross-checked and verified with a second researcher. PRINCIPAL FINDINGS: Homeless youth most often stated that cultural and interpersonal aspects of quality of care were important to them. Physical aspects of quality of care reported by the youth were health care sites separate from those for homeless adults, and sites that offered a choice of allopathic and complementary medicine. Outcomes of health care included survival of homelessness, functional and disease-state improvement, and having increased trust and connections with adults and with the wider community. CONCLUSIONS: Homeless youth identified components of quality of care as well as how quality of care should be measured. Their perspectives will be included in a larger follow-up study to develop quality of care indicators for homeless youth.

Adolescent↗

Hepatitis C virus infection, substance use and mental illness among homeless youth: a review.

OBJECTIVES: Homeless youth are at a high risk of substance abuse, mental illness and blood-borne infections, such as hepatitis C. In this paper, we review the implications of these conditions, discuss the unique challenges faced by homeless youth, and explore potential strategies for harm reduction and intervention in this vulnerable population. RESULTS: Interventions that combine youth-centered, service-based care, street outreach, case management, and motivational interviewing with integrated health services such as hepatitis A/B vaccination, and mental health and substance abuse programmes, are presented as innovative approaches to address the healthcare needs of homeless youth. CONCLUSION: Recommendations for age-appropriate interventions and further research are made.

Adolescent↗

Social network characteristics associated with risky behaviors among runaway and homeless youth.

Runaway and homeless youth are at high risk for substance abuse and unsafe sexual behavior. Our study describes the personal social networks of these youth and examines network characteristics associated with risky behaviors. In 1995 and 1996, we interviewed a purposive sample of youth aged 14 through 21 who were living in Washington, DC and were identified on the streets or through shelters or other service agencies (N = 327). Although we found that most youth reported current social relationships, a significant minority (26%) did not. Youth without a social network were significantly more likely to report current illicit drug use, multiple sex partners, and survival sex than youth with a network. For youth with a network, the networks were small, strong in affective and supportive qualities, comprised primarily of friends, typically included an alcohol or illicit drug user, and usually were not a source of pressure for risky behaviors. Our results indicate that networks had risk-enhancing and risk-decreasing properties in that network characteristics were associated in both positive and negative directions with risky behaviors.

Adolescent↗

Positive youth development: reducing the health risks of homeless youth.

This article outlines several preventive health strategies for reducing the health risks of homeless youth related to emotional distress, alcohol and other drug use/abuse, risky sex, and victimization, all of which are well documented as major health risks for homeless youth living on the street. These health risks interrupt normal adolescent development and are primary obstacles to exiting the street culture and lifestyle. Research indicates that risk exposures among adolescents can be moderated and/or buffered by a focus on individual strengths and environmental protective factors such as community support and mentoring.

Adolescent↗

Cross-national variations in behavioral profiles among homeless youth.

Cross-national comparisons of homeless youth in Melbourne, Australia, and Los Angeles, CA, United States were conducted. Newly (n = 427) and experienced (n = 864) homeless youth were recruited from each site. Compared to Australia, homeless youth in the United States were younger, more likely to be in school or jail, demonstrated fewer sexual and substance use risk acts, fewer suicidal acts, and reported less need for social services. Across sites, experienced homeless youth were more likely to be older, male, engage in sexual and substance use, report greater need for social services, and make greater use of work, substance use, and health-related services. Homeless youth have different behavioral profiles in Australia and the United States, reflecting differences in the effectiveness of service systems in the two countries in keeping youth with fewer problems out of homelessness.

Adolescent↗

Alternative medicine use by homeless youth.

BACKGROUND: Mainstream health care for homeless youth is often fragmented or unavailable. OBJECTIVE: To evaluate the use of complementary and alternative medicine (CAM) by homeless youth who use our free clinic. DESIGN: Self-administered cross-sectional survey. SUBJECTS AND METHODS: Subjects included homeless youth between the ages of 14 and 21 years receiving care at the 45th Street Clinic Youth Program in Seattle, Wash, between January 29,1998, and March 5, 1998. The self-administered survey included items on demographics, health issues, use frequency of different therapists or therapies, referral sources, and perceived effectiveness of treatment. RESULTS: The response rate by patients was 96.3% (157/163) with an average respondent age of 18.5 years (range, 14-21 years). Complementary and alternative medicine was used by 70.1% of the subjects. Referrals most often came from friends (52.7%). The most common reason for using CAM was because it was "natural" (43.9%). Most of those who used alternative therapies (87.3%) believed they had been helped "some" or "a lot." Given a choice of providers to visit when they were ill, 51.7% would seek care from a physician, 36.9% from a CAM provider, and 11.4% would treat themselves. CONCLUSIONS: Care with CAM is frequently used and accepted by homeless youth. Cost-effectiveness and contributions to overall health care require additional evaluation. Integrating CAM into allopathic health centers may serve as an incentive to entice youth into mainstream health care.

Adolescent↗

Health and access to care: perspectives of homeless youth in Baltimore City, U.S.A.

Homeless youth suffer from high rates of health problems, yet little is known about their perceptions of or context for their own health issues. In this study, a combination of qualitative techniques from participatory rural appraisal and rapid assessment procedures was used to investigate the perceptions of health needs of shelter-based youth in Baltimore, MD in the U.S.A. The most common youth-identified health problems included STDs, HIV/AIDS, pregnancy, depression, drug use and injuries. These correlate well with more objective health status data for the same youth. The youth spoke of environmental safety threats of violence and victimization by adults, as well as racism and sexism in their lives. Youth reported that trusted adult figures such as grandmothers are important sources of health advice. Many homeless youth from less than ideal family situations remain in contact with and continue to seek advice from parents and other family members. Health interventions with urban street youth need to acknowledge the primacy of the social context for these youth, as well as the reality of violence as a daily health threat.

Adolescent↗

Prevalence of psychological distress and psychiatric disorders among homeless youth in Australia: a comparative review.

OBJECTIVE: To review the prevalence literature on psychological distress and psychiatric disorders among homeless youth in Australia, and to compare these rates with Australian youth as a whole. METHOD: Computerized databases were utilized to access all published Australian studies on psychological distress (as measured by standardized symptom scales and suicidal behaviour) and psychiatric disorders among homeless youth; in addition, unpublished Australian studies were utilized whenever accessible. A total of 14 separate studies were located, only three of which have included non-homeless control groups. In the current review, prevalence data from uncontrolled youth homelessness studies are compared with data from Australian community and student surveys. RESULTS: Homeless youth have usually scored significantly higher on standardized measures of psychological distress than all domiciled control groups. Youth homelessness studies have also reported very high rates of suicidal behaviour, but methodological limitations in these studies make comparisons with community surveys difficult. Furthermore, rates of various psychiatric disorders are usually at least twice as high among homeless youth than among youth from community surveys. CONCLUSIONS: Homeless youth in Australia have extremely high rates of psychological distress and psychiatric disorders. As homeless youth are at risk of developing psychiatric disorders and possibly self-injurious behaviour the longer they are homeless, early intervention in relevant health facilities is required.

Adolescent↗

Homeless youth and AIDS: knowledge, attitudes and behaviour.

A study conducted in Brisbane, Queensland, assessed homeless youths' knowledge, attitudes and behaviours relating to acquired immunodeficiency syndrome (AIDS). Data obtained from 40 homeless youths aged 15 to 19 years were compared with that from controls. The findings identified a significantly lower level of accurate knowledge of AIDS by the homeless youth on questions related to the transmission of AIDS and on measures to prevent infection. Furthermore, homeless youth exhibited higher levels of at-risk behaviours for the contraction of AIDS. No significant differences regarding attitudes and beliefs about the disease were found. A subgroup of particularly high-risk youth is identified and described. Given the established knowledge deficits, homeless youth were also assessed for educational measures to which they might respond favourably. Implications for future educational programmes are described. It is concluded that homeless youth are comparatively ignorant of AIDS and comparatively at risk of contracting the disease.

Acquired Immunodeficiency Syndrome↗

Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective.

This article reports on results of a one-day public health survey conducted in six states by homeless youth providers to measure and compare risk factors between lesbian, gay, and bisexual (LGB) homeless youth and non-LGB homeless youth. This article intends to inform the child welfare field on existing gaps in services and areas where more training and technical support is necessary in providing services to homeless LGB youth. The findings point to substantial differences within the homeless youth sample and demonstrate that in addition to the public health risks young people face merely by being homeless, the risks are exacerbated for those who self-identify as lesbian, gay, or bisexual. The article informs child welfare providers and policymakers about the substantial vulnerability of LGB youth beyond that of non-LGB homeless youth and the need to fund programming, training, technical assistance and further research to specifically respond to the complex needs of this population.

Adolescent↗

Treatment outcome for street-living, homeless youth.

Comprehensive intervention for homeless, street living youth that addresses substance use, social stability, physical and mental health issues has received very little attention. In this study, street living youth aged 14-22 were recruited from a drop-in center and randomly assigned to the Community Reinforcement Approach (CRA) or treatment as usual (TAU) through a drop-in center. Findings showed that youth assigned to CRA, compared to TAU, reported significantly reduced substance use (37% vs. 17% reduction), depression (40% vs. 23%) and increased social stability (58% vs. 13%). Youth in both conditions improved in many other behavioral domains including substance use, internalizing and externalizing problems, and emotion and task oriented coping. This study indicates that homeless youth can be engaged into treatment and respond favorably to intervention efforts. However, more treatment development research is needed to address the barriers associated with serving these youth.

Adolescent↗

Illness experiences of homeless youth.

The purpose of this study was to document the illness experiences of homeless youth. The research was a focused ethnography with 45 clinic- and street-based homeless youth aged 15 to 23 years. The authors noted gender differences for health-seeking behaviors, with most male youth reporting embarrassment about needing to seek care, and female youth reporting fears over safety issues while ill and homeless. Most youth under age 18 stated that they were often denied health care at hospitals because of their underage status, and youth over age 18 stated that health care bills contributed to their inability to obtain stable housing. Street-based youth reported more illnesses related to substance use and greater reliance on emergency departments for health care than clinic-based youth did. Policies and programs focused on improving the health of homeless youth need to address the differences in illness experiences by age, gender, and sampling site.

Adolescent↗