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An examination of service providers' perspectives of adolescent homelessness

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Title:
An examination of service providers' perspectives of adolescent homelessness
Creator:
Kessel, Barbara F
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English
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xi, 184 leaves : ; 28 cm

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Subjects / Keywords:
Homeless youth ( lcsh )
Homelessness ( lcsh )
Youth workers -- Attitudes ( lcsh )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Bibliography:
Includes bibliographical references (leaves 181-184).
General Note:
Department of Humanities and Social Sciences
Statement of Responsibility:
by Barbara F. Kessel.

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|University of Colorado Denver
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|Auraria Library
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All applicable rights reserved by the source institution and holding location.
Resource Identifier:
123285987 ( OCLC )
ocn123285987
Classification:
LD1193.L65 2006m K47 ( lcc )

Full Text
AN EXAMINATION OF SERVICE PROVIDERS PERSPECTIVES OF
ADOLESCENT HOMELESSNESS
by
Barbara F. Kessel
BA., Moorhead State University, 1994
A thesis submitted to the
University of Colorado at Denver
in partial fulfillment
of the requirements for the degree of
Master of Social Science
2006


by Barbara F. Kessel
All rights reserved.


This thesis for the Master of Social Sciences
degree by
Barbara F. Kessel
has been approved
by
Candan Duran-Aydintug
Jean Scandlyn
Ed Casteel
U IIS'!01
Date


Kessel, Barbara F. (M.S.S., Social Sciences)
An Examination of Service Providers Perspectives of Adolescent
Homelessness
Thesis directed by Associate Professor Candan Duran-Aydintug
ABSTRACT
This research explores the perspectives of service providers that work with
homeless youth. Interviews were conducted with 20 service providers to gain
information about how they view the issue of adolescent homelessness;
services that are working in the effort to end adolescent homelessness, as well
as services needed; and their personal feelings about homeless youth, and the
work that they do with them.
Findings suggest that service providers views about adolescent homelessness
strongly reflect what has been written in the research. Providers responses to
reasons for homelessness, patterns seen, challenges and treatment issues that
youth face, and systemic problems all mirror findings in previous research on
adolescent homelessness. However, when asked about strengths and skills that
homeless youth possess and the rewards of working with homeless youth, and
what they would like the public to understand about homeless youth, service
providers answers conflicted with their previous responses.
The findings are explained in terms of the problem-centered discourse that has
developed around the issues of adolescent homelessness. Research examining
the agency of homeless youth is discussed, and recommendations are made for
strength-based research that looks outside of the problem-centered discourse
that has developed around adolescent homelessness.


This abstract accurately represents the contents of the candidates thesis. I
recommend its publication.
Signed
Candan Duran-Aydintug


DEDICATION
This thesis is dedicated to my parents for giving me both roots and wings and
helping me to understand the value of each. I also dedicate this work to Bryan
who encouraged me, provided a sounding board, and most importantly, loved
me every day of this journey.


ACKNOWLEDGEMENT
I am inexpressibly thankful to my thesis committee for their support and
advice throughout this process. Each contributed in her/ his own unique way,
providing me with a wealth of resources and support. Candan Duran-Aydintug
was incredibly patient throughout this seemingly endless endeavor and also
helped me through the many processes required to bring the work to
completion. Jean Scandlyn did so much to encourage me and helped me to
gain clarity and focus. I was also truly amazed at her ability to point me to
pertinent references instantaneously. And, Ed Casteel graciously stepped in
when I needed a third committee member and provided a fresh perspective
and his exceptional editing skills.
I would also like to thank all of my participants for volunteering their time and
for being so open with me. This research is better for the depth and honesty
with which they spoke about the important work they do, and I thank them not
only for participating in this study, but for working tirelessly in an attempt to
improve the lives of homeless young people.


TABLE OF CONTENTS
Tables..........................................................xi
CHAPTER
1. INTRODUCTION...........................................1
Background ........................................1
Adolescent Homelessness ...........................3
2. A REVIEW OF THE LITERATURE ON SERVICES
PROVIDED TO HOMELESS YOUTH..............................6
Services Utilized by Youth While Homeless..........7
Characteristics of Youth that Utilize Services and
Barriers to Utilizing Services....................15
Program Evaluation................................31
Suggestions for Program Development...............36
The Role of Service Providers.....................44
3. METHODS...............................................47
Data Collection...................................47
Sample............................................48
Recruitment of Participants.......................49
Procedures .......................................50


Interview Questions....................................52
Analysis...............................................54
Ethical Considerations.................................55
Limitations............................................57
4. FINDINGS....................................................59
Experience and Contact with Homeless Youth.............59
Reasons for Homelessness...............................60
Patterns Observed among Homeless Youth.................69
Challenges and Treatment Issues........................74
The Most Difficult Aspects of Homeless Living..........80
Strengths and Skills of Homeless Youth.................84
Services Needed........................................89
Systemic Problems......................................97
Ending Adolescent Homelessness........................109
What is Working.......................................115
How Participants were Drawn to
Work with Homeless Youth..............................118
Rewards of Working with
Homeless Youth........
120


Difficulties in Working with
Homeless Youth..............................123
Training Needed.............................127
What the Public Should Understand...........131
5. DISCUSSION......................................134
How Service Providers View Adolescent Homelessness..134
What is Working and What is Needed..........143
Personal Feelings about Working with Homeless Youth.148
A Closer Look...............................158
6. CONCLUSION......................................172
Recommendations for Future Research.........174
APPENDIX
A. HUMAN SUBJECTS APPROVAL.........................176
B. PARTICIPANT RECRUITMENT FLYER...................177
C. CONSENT FORM....................................178
D. INTERVIEW GUIDE.................................180
REFERENCES......................................................181
x


LIST OF TABLES
Table
4.1 Participants experience working with homeless youth...............60
4.2 Service providers beliefs about why youth are homeless............68
4.3 Patterns observed among homeless youth.............................73
4.4 Challenges and treatment issues of homeless youth..................79
4.5 Most difficult aspects of homeless living..........................83
4.6 Strengths and skills of homeless youth............................88
4.7 Services homeless youth need.......................................96
4.8 Systemic problems that prevent youth
from getting off the streets.....................................108
4.9 What is needed to end adolescent homelessness.....................114
4.10 What is working in getting youth off the streets..................117
4.11 What drew participants to work with homeless youth................119
4.12 The rewards of working with homeless youth........................123
4.13 The difficulties of working with homeless youth...................126
4.14 Types of training that would help service providers...............130
4.15 What the public should understand about homeless youth............133
xi


1
CHAPTER 1
INTRODUCTION
Background
Several years ago, I worked for an agency that focused on prevention
programming for youth that were considered to be in danger of repeated
contact with the juvenile justice system. It was during this time that I first
became exposed to the issue of adolescent homelessness in Denver, Colorado.
It was an issue that greatly intrigued me as I struggled to understand what
circumstances could possibly force youth onto the streets.
As I began my graduate studies years later, the issue of adolescent
homelessness stayed with me as an area that I wanted to further explore. As I
examined research that had been done on adolescent homelessness, I was
surprised to find that there was almost no research that examined adolescent
homelessness from the perspective of those that work most closely with
homeless youth, that is those who provide direct services to homeless youth
every day.
Perhaps it was my own previous experience as a service provider to at-risk
youth that compelled me to seek out service providers views on this issue. I
1


was certain that although that may not have been asked before, given the
opportunity, service providers would have much to say about the issue of
adolescent homelessness. I was also certain that without asking service
providers about their perspectives on adolescent homelessness, I would never
really gain a full understanding of the issue.
This thesis explores the perspectives of twenty individuals who provide
direct services to homeless youth. Specifically, the aim of this thesis is to
answer three overarching questions: 1) how do service providers view the
issue of adolescent homelessness? 2) What services are needed, and what
services are working in the effort to end adolescent homelessness? And 3)
how do service providers feel about the young people they work with and the
work that they do?
The rest of this chapter defines issues surrounding adolescent
homelessness. Chapter 2 reviews the literature regarding services provision to
homeless youth, revealing gaps in research in this specific area. In Chapter 3,
the methodology used in the current research is detailed. Research findings
are reported in Chapter 4, and discussed in Chapter 5. Chapter 6 concludes the
study, and offers recommendations for how to use this research.
2


Adolescent Homelessness
The number of adolescents that are considered runaway, homeless or
throwaway is unconscionable and is a growing problem throughout the United
States. In 1988, one survey estimated that 450,000 youth had run away for
two or more days and 127,100 adolescents were made to leave home.
(National Adolescent Health Information Center, 1996). A more recent study
reports that between 575,000 and 1 million youth run away or are forced to
leave their parental homes each year (Thompson, Salyer and Pollio, 2001).
According to the National Runaway Switchboard (2001), the number of
runaway and throwaway youth is increasing yearly. When homelessness is
defined as: minors whove spent at least one night either in a shelter or on the
streets without adult supervision, the estimated prevalence is at least 5% of
youth ages 12-17. These estimates indicate that adolescents are at greater risk
for homelessness than adults (Robertson and Toro, 1998).
A study of homelessness in metropolitan Denver, (Metro Denver Homeless
Initiative, 2006) provided a count of the number of people in metropolitan
Denver who are identified as lacking a permanent place to live on January 23,
2006. The survey indicated that 374 teens between the ages of 13 and 19 were
3


homeless at the time of the survey. Additionally, 688 young adults between
the ages of 20-25 were considered homeless at the time of the survey. Taken
together, 1062 young people between the ages of 13 and 25 were homeless in
January of 2006. This accounts for 19.9% of the homeless population
surveyed in the Denver Metropolitan area. As the authors note, actual
numbers are likely much higher because these numbers do not account for
individuals that did not want to participate in the survey or individuals that
live in their cars or in places such as in tents and under bridges. Considering
these alarming numbers, there is a need to examine more deeply what can be
done to eliminate homelessness among adolescents.
Extensive research has been conducted to assess why adolescents are
homeless. Some of these youth make the choice to live on the streets rather
than enter into foster care through human services after physical or sexual
abuse, neglect, or parental drug abuse has been exposed. In many cases, these
issues have not been exposed and adolescents run away to escape the
situation. Some are abandoned by their families because of their lifestyles
(e.g. homosexuality, drug use) (Velmans, 1999) or because the parents are
emotionally or financially unable to care for them (National Coalition for the
4


Homeless, 1999). A recent study by the National Clearinghouse on Families
and Youth (2003) found that 46% of runaway and homeless youth had been
physically abused and 17% had been forced into unwanted sexual activity by a
family or household member. More than half (53%) had education or school
problems, 45% had an absent father and 38% had previously had at least one
foster care placement.
Once youth are on the streets, they encounter a variety of disturbing
prospects including drug abuse, prostitution, health problems, and physical
and sexual victimization. There has been growing recognition of adolescent
homelessness in recent years. In August of 2000, The Runaway and
Homeless Youth Act was amended to include current findings on the
homeless youth population and to create legislation to provide funding for a
system of care that includes preventive services, emergency shelter services,
and extended residential shelter (Administration of Children and Families,
2000) Despite attempts to quell the number of homeless youth, the number of
homeless adolescents continues to increase each year, making it imperative to
gain a better understanding of the issue itself and to search for realistic and
effective solutions.
5


CHAPTER 2
A REVIEW OF THE LITERATURE ON SERVICES
PROVIDED TO HOMELESS YOUTH
Research on homeless youth seems to have increased significantly over
recent years, with more understanding of the reasons that young people are
homeless. Much attention has recently been given to further examining
substance abuse (National Coalition for the Homeless, 1999; Slesnick, 2001;
Slesnick, Mead and Tonigan, 2001; Slesnick and Prestopnik, 2005), family
dysfunction (Bao, Whitbeck and Hoyt, 2000; National Coalition for the
Homeless, 1999), and mental illness (Bao et al., 2000, Cauce and Morgan,
1994) as contributing factors of adolescent homelessness.
In addition to understanding more about homelessness, there has been
increased emphasis on the need to provide appropriate services to these youth
(English and English, 1999; Van Leeuwen, 2004; van Wormer, 2003. A body
of research is beginning to develop around services provided to youth and the
need for evaluation of these services. This extensive literature review will
examine research regarding services provided to homeless youth. Gaps in the
literature will be identified and recommendations will be made regarding
needs for additional research.
6


Literature regarding services youth receive seem to focus in four general
areas: interviewing youth to examine what services they utilized and which
services they found helpful in exiting the streets (Kurtz, Lindsey, Jarvis and
Nackerud, 2000; Raleigh-DuRoff, 2004); examining differences between
youth that utilized services and barriers to them using services (Mitchell,
2003; Slesnick, 2001; Slesnick et al., 2001; Thompson, Safyer and Pollio,
2001; van Wormer, 2003); suggestions for program development based on
research and data (Cahn and Gray, 2005; English and English, 1999; Van
Leeuwen, 2004); and evaluations of specific services being provided by
agencies (Cauce and Morgan, 1994; Teare and Peterson, 1994). The literature
in each of these areas will be reviewed, beginning with studies in which youth
were interviewed about services that they utilized while homeless.
Services Utilized by Youth While Homeless
Kurtz et al., (2000) interviewed twelve formerly runaway and homeless
young people in an attempt to understand the role of formal and informal
helpers in assisting homeless and runaway adolescents get through difficult
times. They emphasize youth perspectives of what is and is not helpful instead
7


of assuming that what is helpful for adults and children is also helpful for
adolescents.
The authors reported who provided help to the young people and what
types of help were provided, as well as what conditions facilitated acceptance
of help by the youth. They also reported on advice the young people gave to
helping professionals on how to help other homeless youth.
The authors first used focus groups of thirty (30) peer educators from
runaway and homeless shelters. They asked about ways in which youth
become successful despite multiple difficulties in adolescence. They then
conducted a focus group with twenty-two (22) social service providers that
worked with runaway and homeless youth regarding their perceptions of the
same issues, and used the information obtained from the two focus groups to
create a semi-structured interview guide, which was reviewed by service
providers at two shelters. The resulting guide included demographic
questions, questions about difficult times the youth had experienced, how they
navigated through those difficult times, who helped them and what types of
help they received, what advice they would give to professional helpers, their
8


current situations, their personal definition of success, and future hopes and
plans.
Interviews were conducted with twelve (12) individuals from five cities or
towns. Of the 12 participants, 3 were male and 9 female. Nine (9) of the
participants were Caucasian, and three (3) were African American. Criteria
consisted of (1) being between ages of 18-25; (2) having stayed in a youth
shelter, group home, or other alternative living situation as and adolescent;
and (3) having not lived in a shelter or alternative accommodation for at least
two years.
The young people interviewed identified three major types of helpers:
family, friends, and professionals. They also identified five types of help:
caring, trustworthiness, setting boundaries and holding youth accountable,
concrete assistance, and counseling. Finally, there were two conditions under
which youth would accept help: perceived trustworthiness of the helper and
youths readiness to receive help.
The youth in this study had found some level of success. That is, at the
time of the interviews, they were living in a more stable environment than
they previously had been. They attributed this to the guidance and protection
9


that they found from some person such as a friend, family member, or
professional helper-during their time of difficulty. The young people in the
study indicated that they benefited most from professional help when the
relationship was personalized. That is, when they felt they were listened to,
cared about, and treated as individuals. It was also important to them that they
received multiple levels of support, the helper was authentic in his/her
concern, and that the helper was committed. All of these things assisted the
young person in building a sense of trust.
The authors conclude that programs designed for homeless and runaway
youth need to be person-centered and flexible. They suggest that those
working with youth be careful not to pathologize or label youth. Finally, they
warn against helping encounters that are short-term or focus on a single
categorical need, stating that such encounters can be counterproductive or
even detrimental to these youth because of their difficulty in trusting adults.
Finally the authors recommend that because youth identify family and friends
as important helpers, programming should focus more on reestablishing or
building up these relationships, which will likely be more long term
relationships for the young people.
10


This studys strength-based approach was refreshingly unique among
research examining homeless youth. The authors used sound methodology
and their analysis methods were quite rigorous. I found the opinions of the
youth quite interesting. It is important to understand what youth believe was
helpful to them in getting through their difficult times. However, it must be
noted that these youth had transitioned to their own apartments and had not
been in an alternative living situation for at least two years, which may have
affected the accuracy with which they recalled experiences or events. The
authors discussed the problems of generalizability with such a small, non-
random and non-representative sample. However, this does not diminish the
insight that comes from getting the opinions of the youth themselves. A
criticism of this study is the definition of homeless/ runaway. While it is
likely that those young people that stayed in a shelter were at some point at
least temporarily homeless, a group home or alternative living situation likely
constituted stable, albeit atypical, housing situations. Those that were in the
other living situations described may have run from home or been expelled,
however this was not made clear. The use of homeless or runaway in this
context is a bit confusing, as it implies that living outside of a parents home
11


makes you homeless or a runaway. It would have been interesting if the
authors, who state the importance of not labeling or pathologizing these
young people, would have asked the interviewees whether they had
considered themselves runaways (having made the choice to leave their
home), homeless (not having a stable place to live), both or neither. It was
clear that at least one of the youth interviewed talked about her experience
while living with an aunt and uncle and may not have considered herself
homeless or a runaway.
In 2004, Raleigh-DuRoff interviewed ten (10) Seattle-area employed or in-
school adults ages 18-39 that had been on the streets as adolescents. Those
interviewed had spent between six months and nine years on the streets and
were 17-23 years old when they left the streets. The author was interested in
factors that influenced and assisted youth in leaving the streets, the role of
hope in the process of leaving the streets, and what factors kept youth on the
streets. Of the interviewees, 50% were asked to leave home and 50% left
home for the following reasons: feeling their parents were overprotective,
physical abuse, or parents going to jail. The sample consisted of six (6) males
and four (4) females. Seven (7) of the participants were Caucasian and three
12


(3) were African American. A semi-structured interview guide was used to
solicit data regarding: current demographics, reasons for leaving home, length
of homelessness, services used to facilitate getting/staying off the street, the
role of hope, and factors that they believe keep youth homeless.
The author found that the help of family, friends, and professionals was
cited by all participants as the most important factor in successfully returning
to a traditional living situation. Professionals identified were counselors and
case managers who provided emotional support and resources.
Seven (7) of the participants indicated that supportive organizations were
essential to their success in leaving the streets. They specifically cited
services that these organizations provided to them and that they considered
essential to their success such as counseling, education, transitional living
programs, rental assistance and job opportunities.
At least two (2) participants in the study said that their own personal
strength and determination helped them to get off the streets. Participants also
talked about hope for the future and dreams about future success fueling their
hope.
13


When asked their recommendations for helping youth to get off the streets,
participants talked about: showing compassion, teaching skills, providing
information, instilling pride, fulfilling basic needs, showing the negative side
of street life, providing a structured environment, and providing more
educational opportunities.
Interestingly, when asked what keeps youth on the streets, participants
responded that a sense of adventure, distrust of authority, freedom, and a
sense of community or ...sense of family among street kids (p. 569) kept
young people on the streets. This study provides important insight into what
youth believe to be important resources in helping them to exit the streets and
also why it is difficult for some youth to leave the streets, some feeling a sense
of belonging for the first time in their lives.
The methodology was not well documented in this article. There was no
discussion of how the data were analyzed. Additionally, it would have been
beneficial to have more detailed information about the services that youth
found helpful. For example, what specific skills did youth believe it was
important to learn, and what types of information did they find most useful or
necessary in order to exit the streets? Finally, the small sample size of the
14


study makes it difficult to generalize the findings of the study to other
homeless youth.
While both of the above studies involve quite small sample sizes, the
insight they provide is quite important. Certainly, youth that are able to exit
street life and transition into a stabilized living situation are in a unique
position to inform on the services and resources that helped them to make that
transition. The information that these studies provide is extremely useful for
anyone working with homeless youth. Participants in both studies indicated
that family and friends as well as service providers were important and indeed
essential to them successfully exiting the streets, a finding that can be used to
create supportive programming that includes families and friends.
Characteristics of Youth that Utilize Services
and Barriers to Utilizing Services
There is also growing interest in studying homeless youth who access
services and the barriers to accessing or using services available to them. In
their 2001 study, Thompson, Safyer and Pollio examined the differences
among subgroups of runaway youth utilizing shelter services. They also
looked at different factors that predict young peoples reunification with their
15


families. This study employed data from the Runaway Homeless Youth
Management Information System (RHYMIS), a comprehensive national
database used by federally funded youth shelters to manage information of the
young people they serve. A sub-sample of 17,790 cases obtained from the
database was used. The authors note that this sub-sample was not
representative of the larger sample in regard to gender and ethnicity (both
females and ethnic minorities were overrepresented). However, they note that
percentages found in the sub-sample are similar to percentages in other studies
of homeless youth.
The sample was divided into three groups: runaway-homeless (stay away
from home at least overnight without permission or knowledge of their
parents or guardians); throwaway youth (leave home because their parents
have encouraged or forced them to leave); and independent youth (feel like
they have no home to return to because of irreconcilable conflicts with their
families, have lost contact with their families, or their families are homeless).
Of the study sample, 44.9% were classified as runaway homeless, 44.5% as
throwaway, and 10.6% as independent. The overall sample averaged 15 years
of age and 58% were female. A majority (57%) were white, 24% were
16


African American, and 13% Latino American. Only 42% had attended school
regularly and 15% had dropped out. Fifty two percent (52%) indicated that
they had used illegal drugs and 18% said they had sold drugs. About 9%
reported being employed at least part time. Youth had reported running away
an average of three times. Eighteen percent (18%) reported being physically
abused by their fathers and 15 % by their mothers. Five percent (5%) reported
being sexually abused by their fathers and 1% by their mothers.
The youth categorized as homeless-runaway had mostly been living with
parents, had more runaway episodes and used drugs more than other groups
and reported more physical abuse by fathers. Adolescents in this group were
acting out, but still had fairly close contact with parents. Of the runaway-
homeless group, those that completed shelter services were more than five
times more likely to return home.
Throwaway youth included a larger percentage of youth that had been
living in correctional facilities or with adults other than parents. They more
often identified their guardian as child welfare or juvenile justice agency, and
had dropped out of school more often and reported sexual abuse by fathers
more often than youth in other groups. These youth had more juvenile
17


delinquency problems and less contact with parents. Youth in this group that
completed shelter services were almost three times more likely to reunify with
their families than those not completing shelter services.
Independent youth were similar to homeless-runaway youth except that
fewer had lived with parents and more were employed. Independent youth
completing shelter services were almost four times more likely to reunify with
families than those that did not complete shelter services.
The authors suggest that these different groups of youth need different
interventions. Specifically, they suggest that the homeless-runaway subgroup
benefits from the current focus of community shelters that facilitate family
reunification using shelter services and family counseling. For throwaways,
they believe that because these young people seem to have more difficulty
with delinquent behaviors and more strained relationships with their parents,
interventions should include more intensive and comprehensive services that
address autonomy and competency needs. Finally, for independent youth,
they suggest helping these youth integrate into the larger community and
finding attachments outside of the family.
18


Clearly the size of the sample in this study was one of its biggest strengths.
It is also notable that even though the majority of the data were from
Caucasian youth, there were also significant data from African American
(24%) and Latino (13%) youth. Additionally, the data are drawn from a
national sample. However, the authors are forthcoming regarding the
weaknesses of the study. They note that time ordering is not taken into
consideration and causal sequence cannot be determined. They also
acknowledge that data from street youth are not captured in the RHYMIS, and
therefore were not represented in this study. This is particularly important
because street youth, youth that refuse shelter services and literally live in
alleys and under bridges, are often considered the hardest to reach and the
most at-risk among the homeless population. The authors note that the
categorizing of the youth and the collection of the data is dependent upon the
individual shelters that are reporting. I would also note here that since the
reporting shelters are federally funded, funding may be dependent upon
outcomes or certain variables being reported. That is, it may be in a shelters
best interest to be more diligent about reporting some data more than other
data. Finally, there was no information about exactly what constituted
19


reunification of families. If youth were discharged to their parents homes,
was this considered reunification? Or did there need to be a certain amount of
time that the youth stayed in the home? Was there follow up to determine
whether the family stayed together long term? This important information
was not available in the article.
Slesnick (2001) studied the impact of substance use on therapy attendance
among runaway youth and their parents. It was expected that higher levels of
substance abuse would predict lower attendance levels at therapy sessions. It
was also expected that more perceived parental care by youth would result in
more therapy attendance, and that youth and parents engaged early in the
crisis would attend more than those engaged in later stages of crisis.
A sample of substance- abusing runaway youth, twenty (20) males and
sixteen (16) females, was recruited from two runaway shelters in a large city
in the southwest. The sample consisted of Native American (6), African
American (3), Hispanic (12) and Caucasian (15) youth. In order to
participate, youth had to meet DSMIV criteria for alcohol or other
psychoactive substance abuse disorder; live within sixty miles of the research
site; have the legal option to return to a home situation (including foster care
20


or another family member); and have a primary caretaker that agreed to
participate in family therapy.
Treatment was provided by four therapists and the intervention included 15
therapy sessions that were to be completed in 3-6 months. The assessment
included interviews and self-report questionnaires that measured parental
bonding, substance use, and demographic information.
Statistical analyses revealed that the number of treatment sessions
completed did not vary by race, gender, or family constitution. No
relationship was found between treatment attendance and age, total number of
non-substance related diagnoses, physical/ sexual abuse, and the total number
of lifetime runaway episodes. Findings also indicated that fewer days lapsing
before the first therapy session and less perceived parental care both predicted
an increased number of completed therapy sessions. These two predictors
accounted for 20% of the variance in the number of completed therapy
sessions. As a result, the authors conclude that alcohol and drug use was
largely unrelated to the number of completed therapy sessions.
The authors note the importance of the finding that engaging youth and
families in therapy more quickly is important to future attendance. This
21


finding provides a tangible suggestion to service providers that may increase
the ability to provide counseling and therapy services effectively. The finding
that perception of less parental care resulted in higher attendance at therapy
surprised the authors. They suggest that the perception of less care may make
it easier for youth to express anger, which could be conducive to therapy.
Regarding the finding that substance abuse does not predict therapy
attendance, the authors suggest that many of the youth did not perceive
themselves as having a substance problem and as a result their therapy did not
focus on drug or alcohol use, but rather emotional needs of youth. They also
suggest that since family issues are the biggest factor in adolescent
homelessness, it is not surprising that family issues are more predictive of
therapy attendance.
The size of this sample was quite small. While small sample sizes are
more easily overlooked in qualitative studies, which yield rich and in depth
information, small sample sizes that employ statistical analysis must be
considered very carefully, as results from such studies are not generalizable to
the larger population of homeless youth that have substance abuse problems.
22


In a related study, Slesnick et al., (2001) looked at the relationship between
service utilization and runaway youths alcohol and drug use. They were
specifically interested in the relationship between service utilization three
months prior to the interview and substance use in runaway youth.
Youth were recruited from two shelters in a southwestern city. The sample
included 51youth, 23 males and 28 females, ages 12-17. Ethnicities consisted
of Anglo (17), Hispanic (24), Native American (6), and African American (3)
and other (1). In order to participate, youth had to meet DSMIV criteria for
alcohol or other psychoactive substance abuse disorder and have the legal
option to return to a home situation.
Interviews and self-report questionnaires were used to collect data on
quantity and frequency of substance use and service utilization (psychological
and medical inpatient and outpatient services), employment, school
attendance, and primary residence. Statistical analysis revealed that lower
alcohol use was found with increased medical care and emotional counseling.
Higher alcohol use was reported with increased 12-step program attendance.
It is important to remember that the authors were looking at service utilization
and drug use three months prior to youth utilizing shelter services. It is
23


interesting that while alcohol was related to overall service utilization, illicit
drug use was not. The authors suggest that the youth may not have seen their
drug use as a problem and were thus less likely influenced by interventions
focusing on drug use. Both drug and alcohol use were present in all but three
cases, however, all youth identified alcohol as their primary drug of use.
Attendance at 12 Step meetings predicted higher alcohol use, while
psychological counseling and medical visits predicted less use. The authors
offer the explanation that the 12 Step Program is a longer term program that
requires a commitment to abstinence that youth may not be able to accept.
They also suggest that family chaos may preclude attendance at the 12 Step
meetings, which are held daily. They propose that medical care implies that
parents are more involved in making appointments and transporting young
people.
Finally, one of the most important observations that the authors make is
that the youth in this study accessed shelter services, which makes them non-
representative of street youth in general. They state that these youth may be
more amenable to services in general, as evidenced by their willingness to
seek out a shelter in the first place. The authors also note that the youth may
24


have sought help more often than normal in the three months prior to their
shelter stay as a result of building family chaos. The results are based on self
reporting on questionnaires and interviews with no corroboration from
caretakers.
The authors suggest that the findings of this study are important in
understanding what services are accessed by substance using homeless youth,
as this information can be used to provide services that homeless youth will
find helpful. Again, the sample size is small, particularly considering that
statistical analysis is used. It is imperative to consider the limitations of this
study in evaluating its usefulness in working with homeless youth.
In 2003, van Wormer examined perceived needs of homeless youth, as
identified by the youth themselves, and what types of services the youth
utilized. Van Wormer used data from transitional housing applications of
homeless youth seeking housing. Specifically, five research questions were
used to create schemes that represented five aspects of information:
demographics, mental and physical disorders, income, source of income, and
seasonal variation in need. In addition, reasons for homelessness, general
comments, and staff appraisals of needed resources were also examined.
25


Information was gathered from a total of 132 applications, with a subset of 25
being randomly selected for more detailed examination.
The demographic information revealed that ages of applicants ranged from
15-21 years of age; 60% were female; 64% were Caucasian, and 22% Native
American, with the remainder consisting of other ethnic/racial minority
groups. Of the applicants, 28% had disabilities that included physical health
problems, mental health problems, and chemical dependency. Some
individuals reported multiple problems. The most commonly reported
problem was attention deficit hyperactivity disorder or ADHD.
The subset of 25 applications was examined to determine reasons
transitional housing was needed, which consisted of: Family conflict-kicked
out (7); couch-surfing -overstayed welcome (6); economic problems such as
no rent money or mother homeless (6); living on streets (3); substandard
housing (2); and physical abuse (1). The next item examined in the subset was
a question about additional information that the youth wanted the application
reviewer to know in order to help serve them better. Resulting information
included: mental disorders (3); drug involvement (3); pregnant or have small
children (3); learning problems (2); gambling (1). Finally, the most common
26


forms of assistance being utilized by homeless youth were examined.
Emergency services were most commonly used. These services consisted of
cash assistance (14) food stamps (3); help paying for low-income housing (3);
medical assistance and section 8 housing (2) and Supplemental Security
Income (1).
The authors findings confirm the National Coalition for the Homeless
findings of the three main reasons for homelessness: family issues, economic
problems, and family instability. He discusses the importance of realizing that
young people have a variety of reasons for needing housing and many of these
situations are fairly urgent. Finally, the author points out limitations of his
study, including a small sample size and reliance upon self-report measures,
as well as relying upon agency staff for information. Additionally, I would
add that because these youth were seeking to obtain approval for housing
(which according to the author is fairly competitive, with most of the subset of
applications reviewed having been turned down), giving them motivation to
perhaps embellish or omit important details.
The merits of this study include that it looks at a fairly specific service
greatly needed by homeless youth by examining their request for the service.
27


However, without direct contact with the youth to clarify application
information or explore answers further, the aforementioned shortcomings are
further highlighted.
In an interesting study done in the United Kingdom, a three month survey
was conducted of homeless youth using the Message Home Hotline (Mitchell,
2003). This hotline is a national phone service that provides a toll free number
for youth that have run away or left home. They can ask hotline staff to
deliver messages to their parents, caretakers or caseworkers; have the hotline
staff complete a three-way call and talk to parents directly with a staff
member standing by to help facilitate the conversation; or simply request
information on available resources.
Data collection involved an adaptation of the agencys case form to include
additional monitoring information for this study. This information included
classification of where the youth had gone missing from, the reasons for
leaving, whether they had chosen to leave or been forced to do so, and how
long they had been away by the time they utilized the hotline. Callers were
not made aware of their participation in the research. Operators recorded data.
28


During the study period of three months, 268 new cases were opened for
young people under the age of eighteen. Data were analyzed both
qualitatively and quantitatively. Of the sample, 78% reported running away
and the rest were forced to leave. The author notes that this is consistent with
nationwide statistics for England, which indicate that 19% of young people on
the streets are forced out of their homes. There were no significant
differences in family types, age or gender between those who ran and those
forced to leave.
Situations varied, but the majority (87%) of callers left family homes.
Conflict with parents was the most common reason for leaving home (35%).
Abuse by a family member was the second most common reason young
people gave for leaving home (24%). Some of those leaving home reported
problems in school (7%).
Callers also reported leaving institutions and foster care. Reasons given for
leaving were that youth felt unsafe or insecure. Others reported escaping
bullying situations, being unhappy at their placement, or running from
placements to return to family members. A few (3) also ran from hospitals.
The callers running from hospitals reported mental health problems. A
29


majority of young people that were forced to leave home reported conflicts
with parents as the reason they were forced to leave. Parental rejection was
also commonly reported by these youth.
Most young people using the hotline called within a short time of leaving
home, 58% called the day they left; 89% within three days. Young people
wanted to make contact with a variety of people. This differed according to
whether they had run or been forced to leave. If they had been forced to
leave, they were more likely to contact social services (60%) than parents
(30%). Those who had run from home most often used the hotline to contact
parents (46%). They used the hotline to let parents know they were safe,
some said they were coming home soon. Others tested the waters to see if
their parents would invite them back home.
This was a very interesting study that provided important information.
This study indicated that runaway and throwaway youth often experience
great distress and urgency. Additionally, hotline staff were able to report on
interactions between young people and their parents that happened, in many
cases, within a day of the young person leaving home, capturing information
in the midst of the crisis. These interactions revealed situations in which both
30


young people and their parents were responsible for the situations that drove
the youth out of the home.
While relying on hotline staff, who were undoubtedly more concerned with
dealing with the situation at hand than on collecting data, may have impacted
the data collection, this was clearly a unique study that provided interesting,
useful information regarding situations that result in youth being homeless.
Additionally, it provides insight into interactions between the youth and their
caretakers.
Program Evaluation
Despite the fact that many researchers recognize the need for evaluation of
services that are provided to homeless youth, few studies have focused on
program evaluation. Cauce and Morgan (1994) examined the effectiveness of
case management for homeless adolescents. Their research involved the
launching of an intensive case management project that aimed at providing
adolescent-centered, culturally sensitive and community based services in an
agency that provides services to street kids.
31


In order to participate, youth had to be between ages 13-21, have no stable
residence or income, and not be in the custody of the state. Additionally, they
had to agree to participate in the research and sign a consent form; be
interested in receiving services or treatment, and plan to stay in the Seattle
area for at least six months. Youth that agreed to participate were randomly
assigned to receive either regular or intensive case management services.
The study consisted of 229 participants. They were primarily male (57%)
with a mean age of 16.5 years. Ethnic/ racial makeup was: White (59%),
African American (22%), Hispanic (8%), Native American (7%) and the
remainder were Asian, Pacific Islander or Other. When asked to give up to
four reasons they left home, youth reported: physical abuse (29%), family
conflict (25%), family violence (23%), family drug use (19%), neglect (15%)
and sexual abuse (12%).
All youth received counseling and case management services. The
difference with the intensive case management group was that case managers
caseloads were no more than 12 youth and the case managers spent significant
time with the youth. However, the term significant was not defined or
quantified. Additionally, intensive case managers had more mental health
32


education and more resources available to them. A pretest-posttest control
group design was implemented. Two groups of participants were assessed
before and after the intervention. Data were collected during face-to-face
interviews with participants, using instruments to measure psychological and
social adjustment. Data analysis indicated that youth receiving intensive case
management improved more in terms of self-reported aggression, general
externalizing behaviors, and satisfaction with quality of life.
The authors note that both case management programs are considered
innovative and comprehensive, and that conducting two interventions at the
same site threatens the integrity of internal validity. Finally, they state that
both groups showed improvement even though the group receiving intensive
case management showed more improvement in the aforementioned areas.
While this research was conducted on programs at a specific agency, the
authors state that it is also important because it is the first study to formally
assess the effectiveness of mental health related services to homeless youth.
In another studying evaluating a specific program, Teare and Peterson
(1994) examined treatment implementation in a short-term emergency shelter
program for homeless and runaway youth. Specifically, the authors were
33


interested in determining how frequently social skills teaching was taking
place and which skills were being taught most often. They also examined
implementation of the program, youths satisfaction with the program, and
how often negative events occurred in the shelter.
The files of 100 youth were examined for demographic information and
each youths rating of satisfaction with the shelter. The youth were
predominantly Caucasian, were almost equally divided between males and
females, and their average stay in the shelter was 14-17 days.
As part of treatment implementation, point cards were used to evaluate
each youth to determine which social skills were taught and how frequently.
Information was also obtained regarding whether a teaching interaction was
positive or corrective. Satisfaction ratings were obtained from each youth
during a confidential interview with a shelter administrator immediately
before the youths departure from the shelter. Youth rated the shelter staff as
a whole on fairness, communication, concern, pleasantness, and helpfulness.
Results indicate that staff engaged in more than 24 teaching interactions
with each youth per day. More than 22 of these were positive and 1.5 were
corrective interactions. The 10 most frequently taught skills were: following
34


instructions, greeting skills, peer relations, table manners, household chores,
volunteering, accepting criticism, conversation skills, public behavior and
school behavior. On a 7-point Likert-type scale with 1 corresponding to
completely dissatisfied and 7 corresponding to completely satisfied,
satisfaction ranged from 5.98 for staff communication to 6.5 for staff
helpfulness.
The authors of the report conclude that this program is highly successful
and that it is possible to provide safe, harm-free environments for youth in
short-term shelters, to operate a shelter where youth are satisfied with their
stay, and it is possible to operate a treatment-oriented shelter.
Although the authors did not discuss them, there were several
shortcomings in this study. First it is important to note that the researchers are
also administrators employed at the agency they evaluated, raising serious
questions about their ability to be objective and concerns about the possibility
of an underlying funding agenda dependent upon positive outcomes. Further,
it is questionable whether a young person about to leave a shelter where they
have been placed by social services or a family member, rather than where
they have chosen to be, would be completely honest about their feelings
35


regarding their satisfaction with the staff and with their stay when being
interviewed by an administrator. It is entirely possible, if not likely, that the
young person being questioned by an administrator would have concerns that
negative answers could be held against them and may affect their discharge
plan. The clearest benefit of this study in my mind was the reminder of the
importance of outside evaluation of programs to eliminate possible bias or
underlying agendas.
Suggestions for Program Development
Several studies centered around making program recommendations
regarding services for homeless youth. English and English (1998) advocate
analyzing existing data on homeless youth to identify factors that contribute to
them running away, and then using the resulting information to address the
problem. They frame the problem in terms of a community in Canada
plagued by unemployment and out-migration issues. Their goal was to begin
to analyze data compiled by the Department of Social Services Child Welfare
Division to compare a sample of youth that have run away with a sample of
36


youth that have not run away in an attempt to identify common issues around
the family of origin when the children first entered the welfare system.
From the available data, the authors were able to determine that the youth
that ran scored significantly higher in all categories than those that did not run.
They had a higher percentage of involvement in the corrections system, more
problems in school, a higher rate of suicidal ideation, more child welfare
placements, and more reported behavioral problems. Further analysis was
done by looking at specific areas related to the family of origin. In the cases
of those that ran, each of the parents described the adolescent as being beyond
their control. The authors suggest that parents reports of their children being
beyond their control may be a good predictor of youth that will run from
placement. The authors do note that actual family dynamics are not clear.
That is, it may be that the young persons family was abusive, but that abuse
is not being reported by parents.
The authors note that their findings support conventional wisdom that
young people that run have greater problems than those that do not and that
this is true for a variety of issues including corrections involvement and
school problems. They suggest that family background can be looked at to
37


determine whether there is a greater likelihood of running and also to consider
what services these youth need most.
While these findings may seem straightforward, this study was based on
the statistics of twelve youth that were in placement in Newfoundland,
Canada. It is clear that the authors research is very specific to their particular
population. The statistics were based on all of the youth that were involved in
social services at the local agency for the entire year. While this information
is likely to be quite useful for the authors and their local agency, it is not
generalizable to the larger population of runaway youth outside of the
community where the study was held. However, studies such as this can be
very effective at the local level in determining what a community can do
about local problems. A limitation of this study is the use of parents
descriptions of the problem without considering young peoples views. If a
child is acting out because of abuse in the home, it is likely that parents would
focus on the acting out and not the abuse. It is important for the authors to
examine the family dynamics that the authors note are missing from their
research.
38


In another study that makes suggestions for program development based on
local conditions, Van Leeuwen, (2004) did a point in time survey of homeless
youth in Denver. He begins by discussing the slow recovery of Denvers
economy after the events of September 11, 2001. He then looks at data on
homeless youth during the same period of time. He suggests that based on
surveys done from 1998-2002, the number of youth sleeping on the streets of
Denver increased by 100% over a five year period. He states that
simultaneously, a dialog has been developing regarding public and private
partnerships designed to address new service demands of youth and families
in a way that is cost effective. The author then discusses creative partnerships
that develop to serve the needs of business and the community in the most
cost effective ways.
Van Leeuwen describes the homeless youth in Denver based on a point-in-
time survey conducted on 3/15/2001, in which outreach workers went out onto
the streets of Denver and interviewed 215 homeless youth. One-third of
homeless youth reported their living situation to be squatting. That is, taking
shelter in abandoned buildings, under bridges or other non-traditional
locations. Thirty-four percent (34%) of the participants reported being in the
39


custody of social services at some point. Most were bom in Colorado (68%)
and 80% reported that they had lived in Colorado for at least the past six
months.
Next, the author details the cost of maintaining a youth for one year in the
juvenile justice system ($53,655) or residential treatment ($53,527) versus the
$5,887 it costs the agency he works for to permanently move a young person
off the streets. Finally, he advocates forging public and private partnerships to
serve the needs of all and gives an example of these benefits in the case of a
homeless young person injecting heroin in front of a business in downtown
Denver. The business owner, a financial supporter of the homeless shelter and
its services, calls the agency which then sends an outreach worker to talk to
the youth and get the youth into a shelter. The business owner is happy and
the youth is provided with services.
The author of this study also promotes data driven programming, in which
understanding the specifics of the population receiving services is what drives
how programs are developed. He specifically discusses three transitional
housing programs that his agency runs based on needs of the youth in Denver,
one of which works specifically with substance-abusing youth.
40


It is important to consider, once again, that the author of this study is an
administrator employed by the agency he is discussing, raising the possibility
that there are motivations to present programs or agencies in a positive light.
Further, while using data to drive programming is a logical and probably
effective idea, there were several questions that were left unanswered in this
study. How does an agency know that a young person has permanently
exited the streets? It was unclear from this article how the agency knew that a
young person had continued to be successful in staying off the streets.
Perhaps most disturbing is the missing voice of the homeless youth in the
scenario presented in this study. While this type of programming may serve
the needs of businesses and nonprofit agencies, it would be interesting to hear
the viewpoints of the young people involved, and certainly program
development would benefit from the input of homeless youth.
The final article reviewed makes strong recommendations for using the
coproduction principle. Cahn and Gray (2005) suggest that coproduction
provides an approach to youth development that advocated that youth use
their skills to help others, that their contributions be awarded, and that helping
others develops skills that are critical to the realization of their potential (p.
41


27). While this article does not discuss homeless youth specifically, it
advocates for no more throwaway kids, and the ideas discussed clearly
apply to homeless youth. The author suggests that the juvenile justice system
specifically needs to build its programming based on the assumptions that
youth can make contributions from a very young age, that we need to redefine
economy in terms of human capital and empower young people to participate
in that economy, that young people be rewarded and given incentives for
positive contributions, and that programs intended to benefit youth must
require reciprocity that calls on youth to give back for any services that they
receive. The author cites examples of a program established to divert first-
time non-violent offenders to youth court, where they serve on a jury as part
of their community service. This jury hears the cases of peers, and after a
certain number of community service hours as a juror, youth can earn
refurbished computers. The general principle of this article is that we need to
change our definition of economy to allow young people to contribute and
participate, by making human capital more important.
The ideas in this article were quite innovative. It was not a research article,
but rather a discussion of how to develop programming for youth, using
42


examples from a program that is already in place. Again, while not about
homeless youth specifically, the author of this article advocates for keeping
youth from ever getting to the point of homelessness by using creative and
innovate strategies as preventative methods for keeping youth out of the
juvenile justice system. This article touches on themes presented in other
research such as the importance of valuing youth and reevaluating the juvenile
justice systems impact on young people.
The studies reviewed touch on a variety of issues related to adolescent
homelessness. They all have in common their emphasis on some aspect of
service provision for youth. While some of the studies involved interviews
with homeless youth or individuals that were formerly homeless youth, the
voices of homeless young people were hauntingly absent in most of these
studies. This is not surprising considering that the homeless population is
often considered invisible. This becomes even more significant when
discussing adolescents who literally have no voice in terms of political
representation. It is important to consider them as individuals when studying
service provision for homeless youth, particularly considering that in the
studies where researchers asked about what services formerly homeless youth
43


used in order to exit the streets, they could clearly identify what was helpful
and were able to make suggestions for better services. As the studies
reviewed indicate, homeless youth receive and require a variety of services.
While it is clear that there are some youth that are able to and do access these
services, as many of these studies indicate, there is also a population of street
youth that do not access services. It is also apparent from the interviews with
homeless youth or individuals that were formerly homeless, that young people
have strong feelings about the services that they receive and important
recommendations for service providers (Kurtz et al., 2000; Raleigh-DuRoff
2004). If there is any hope of reaching the neediest of this population, it is
imperative to solicit the input of homeless youth to determine what their needs
are; what will motivate them to access services; and to engage them in the
development and implementation of programs and services.
The Role of Service Providers
Notably absent in the literature are studies which involve the service
providers. Interestingly in one of the aforementioned studies (Kurtz et al.,
2000), service providers, including peer educators and social service
44


providers, were involved in focus groups, and were asked about what it takes
for homeless youth to be successful despite multiple difficulties. Structured
interviews were then created based on the discussions from the focus groups;
yet no information regarding the discussions of service providers was
presented in the article. Indeed, I was unable to find a study in which
providers that work with homeless youth were interviewed regarding their
experience and opinions concerning adolescent homelessness.
However, in her book, Young and Homeless in Hollywood: mapping social
identities, Ruddick (1996) provides significant insight into how service
providers act as important agents in the struggle of homeless adolescents.
In examining the homelessness among youth in Hollywood, Ruddick
discusses in detail the dilemma that faced services providers because of the
polarized characterization of homeless youth as either angels or thieves
after the deinstitutionalization of juvenile care facilities in the 1970s. She
states that rather than playing a passive role in the politicized struggle for
space in Hollywood, providers built a sympathetic view of homeless youth.
Homeless youths could neither be viewed as youths going
through a temporary crisis of adolescence who nevertheless
had the resources necessary to pull themselves together-
suggestive of premodem views of precocious youths- nor could
45


they be simply left to themselves and be allowed to surface as
juvenile criminals, in an atmosphere that was increasingly
punitive rather than rehabilitative-suggestive of views of
juvenile criminals as members of the dangerous classes
(Ruddick, 1996, p. 68).
Ruddick goes on to make the case that youth workers and service providers
in Hollywood struggled successfully to build a sympathetic, place-based
image of homeless and runaway youths, and how they are attempting to
extend this image outwards from Hollywood to include youth that are not
minors and youth that grow up in an atmosphere of neglect.
Service providers have used the social space of Hollywood as
an active medium to produce this new understanding.. .the
social space of Hollywood was redrawn for homeless and
runaway youths to produce, within the community, a different
understanding of their marginality (p. 130).
While Ruddicks study of homeless youth is quite different than the other
research reviewed, it is an important study that provides crucial insight into
the unique role of service providers. As Ruddick suggests, service providers
are also active agents that cannot be ignored when examining the issue of
adolescent homelessness. Her work is a beginning to filling the gap in the
body of literature regarding adolescent homelessness.
46


CHAPTER 3
METHODS
The purpose of this study is to explore the perspectives of service providers
that work with homeless adolescents by answering the following overarching
questions: 1) how do service providers view the issue of adolescent
homelessness? 2) What insight can service providers give about the services
that are currently being provided for youth as well as services that are needed,
but not currently being provided? 3) What personal feelings do service
providers have about the work that they do with homeless youth and the
young people themselves? Because of the exploratory nature of this study,
the research design utilizes qualitative, inductive- based research methods.
This chapter describes the data collection, the sample, analysis of the data,
ethical considerations and the limitations of this research study.
Data Collection
Data were collected via in-depth focused interviews with all of the
participants. Approval was obtained from the University of Colorado Human
Subjects Research Committee in Protocol #2004-069 (APPENDIX A).
47


Interviews were conducted from August of 2004- January of 2005. Each
participant was interviewed at least once, and three participants were
contacted a second time to gain clarification of their responses.
Sample
The sample of participants consisted of 20 service providers, 13 male and 7
female, who have worked with homeless youth for at least six months in the
Denver, Colorado metropolitan area. The initial participants were recruited
from a homeless youth shelter that serves the Denver area using convenience
sampling methods. Snowball sampling methods were then used to identify
and recruit other participants. Taken together, the counties in this
metropolitan area that were represented by participants consisted of Denver,
Adams, Arapahoe and Boulder counties, and participants represented seven
different agencies or organizations. Because it became evident that the
community of providers serving homeless youth is quite small overall, and
many, if not most, service providers knew providers at other agencies and in
other counties, demographic information regarding age and race were not
collected in order to protect the confidentiality of participants. However, the
48


sample was racially and ethnically diverse, and age range was well
represented considering the small size of the sample.
Recruitment of Participants
Initial contact was made with an agency in Denver that is the major provider
of services for homeless youth. A research proposal was presented to a
committee which approves and oversees research projects that are done at the
agency. Once approval was obtained to begin research, an employee in the
human resource department provided me with a list of individuals that met my
participation criteria, which included: (1) being at least 18 years of age; (2)
currently working directly with homeless adolescents; and (3) having at least
six months experience working with homeless adolescents. Additionally, an
email was sent out to agency employees by human resources summarizing my
research study, and asking employees to consider participating if contacted for
an interview. I then contacted agency employees directly either by phone or
email. As a result, eleven interviews were conducted with employees of this
agency. Two other participants are service providers that I knew prior to
beginning my research. I contacted them directly and they agreed to
49


participate in the study. Finally, each participant interviewed was asked if
they knew other service providers that may be interested in participating.
From this snowball sample, an additional seven participants were recruited by
phone or by e-mail, with an attached flyer that described the research study
(APPENDIX B).
Procedures
In-depth interviews were conducted with participants. As Miller and Glaser
(1997) state, Those of us who aim to understand and document others
understandings choose qualitative interviewing because it provides us with a
means of exploring the points of view of our research subjects, while granting
the culturally honoured status of reality (p. 100). The aim of this study was
to understand service providers perspectives regarding adolescent
homelessness and to give a voice to their opinions and ideas about the broader
issues they face. I was interested in allowing themes to emerge from the data
and further exploring themes that began to develop. This made in-depth
interviews using open-ended questions a natural choice for exploration of
service providers worlds.
50


Interviews were held in a variety of settings, depending upon the
preference of the participant. Generally, participants chose to be interviewed
at their place of employment. This was true for fifteen of the interviewees.
Of the other five, one asked to be interviewed by phone, one asked me to
come to her home, one was interviewed at a community recreation center near
his home, one at a local library and one at a local coffeehouse. Nineteen of
the twenty interviews were face-to-face, while one participant was
interviewed over the phone. In each case, the participant was interviewed in
an area where we could talk freely without being overheard. Each interview
was tape recorded, including the telephone interview. Notes were kept during
the interview to record information about the perceived comfort level of the
participant, facial expressions, and other nonverbal cues.
Consent forms were sent via email or by mail prior to the interviews
(APPENDIX C). At the beginning of each interview, consent forms were
explained to each participant at and the participant was asked to sign to
indicate their consent to be interviewed. An interview guide was utilized to
structure the interview (APPENDIX D).
51


The length of each interview varied; however, interviews generally lasted
between 30 and 45 minutes. The shortest interview was 26 minutes and the
longest was 90 minutes. While all questions in the interview guide were
asked to each participant, additional questions were asked as needed in order
to clarify participants answers. Additionally, after the third interview I
conducted, some questions were reworded to help make them clearer to the
participants. Participants were encouraged to speak freely and were given as
much time as they needed to answer each question. As themes began to
emerge in the data, questions were used in subsequent interviews to examine
the themes further. Two of the interviewees were contacted within a week of
their first interviews in order to clarify responses to specific questions.
Interview Questions
Interview questions were designed to answer the overarching questions of:
1) how do service providers view the problem of adolescent homelessness? 2)
What insight can service providers give about the services that are currently
being provided for youth and that are needed, but not currently being
52


provided? 3) What personal feelings do service providers have about the work
that they do with homeless youth?
First the following close-ended questions were asked of service providers
in order to gain information about the service provider and what specific
services they provide to homeless youth: 1) what is the length of time you
have been working with homeless youth? 2) How many hours per week do
you work with homeless youth? 3) How many homeless youth do you have
contact with each week? 4) What specific services do you provide?
In addition, the following open-ended questions were then asked of
providers. 1) Why are the youth that you work with homeless? 2) What are
the patterns that you see with this population? 3) What specific challenges or
treatment issues do these youth face? 4) What strengths or skills do homeless
youth possess? 5) What services do these youth need that they are not getting?
6) What, if any, systemic problems do you see that prevent youth from getting
off of the streets? 7) What is the most difficult aspect of homeless living? 8)
What needs to change to end adolescent homelessness? 9) What is working
well/ really helping to get young people off of the streets? 10) How were you
drawn to working with homeless youth? 11) What is most rewarding about
53


the work that you do? 12) What is most difficult? 13) What training, if any,
do you feel would help you to do your job better? 14) What would you like
the general public to understand about the homeless youth population?
Analysis
All interviews were transcribed within 48 hours of each interview, as were
field notes describing nonverbal cues. Interviews were coded based on
themes that emerged from the data, and then content analysis was used to
develop themes. In many cases, the themes easily emerged from the data
because of the word choice of the participants. That is, very early in the data
analysis, it became clear that service providers used very similar and very
specific language in discussing homeless adolescents and the circumstances
surrounding their situations. In a sense, this helped me to know that an
emic or native and inside understanding of adolescent homelessness
was being revealed in the interviewees responses. I had also tried to frame
the questions clearly and make them very focused. I felt some confidence in
my ability to do this having previously worked with at-risk youth and also
54


having volunteered both at a homeless youth shelter and as a tutor to a
homeless youth within the year prior to beginning research.
On the other hand, it was important to me to try to keep a broad enough
range of questions to get a sense of what service providers experience, without
imposing my own assumptions or keeping the questions so focused as to miss
entire pieces of service providers experiences. Clearly, because my
employment does not involve working with homeless youth, I am not an
expert in this area and I made a concerted effort to emphasize my role as
researcher or examiner of the homeless youth issue. In doing this, I was
attempting to put the participants at ease and position them as the expert
from whom I was trying to gain insight. In this way, I hoped to assume a
more distanced and objective position and find balance between the emic
and etic perspectives.
Ethical Considerations
Confidentiality was provided through careful handling of the data.
Participants were asked not to use their name or any clearly identifying
information in the interview. The audio tapes were coded immediately with
55


pseudonyms, so that participants names were at no time attached to the data.
Additionally, at the request of the Human Subjects Committee, audio tapes
were destroyed immediately after transcription. With the exception of direct
quotes from participants, information is presented in aggregate without
reference to specific individuals. Participants were assured that all possible
measures would be taken to ensure that confidentiality would not be breached.
One participant had some concern and asked specific questions about disposal
of the data but was completely satisfied upon hearing the details of how data
would be handled.
There is naturally a concern about the ability of any researcher to interview
participants in a way that will solicit the desired information without causing
any harm and taking care to be sensitive to the vulnerability of the
participants. I have worked directly with youth, families and service
t
providers to youth and families for over ten years. I have had extensive
experience communicating with service providers regarding sensitive issues
involving youth. This previous experience prompted me to continually
evaluate the interview process to ensure that participants felt comfortable, and
to make sure I was being especially cognizant when participants seemed
56


sensitive to particular questions. Additionally, participants were provided
with a list of counselors to contact in case psychological distress occurred.
One goal of this research is to give a voice to service providers, whose
work with homeless youth is so important to homeless adolescents survival.
Potential benefits of this process are that service providers will appreciate the
importance that is being given to their perspective on adolescent homelessness
and that their participation will inform others of changes that must be made in
order to help the youth that they serve.
Limitations
It was my intention to include, among the service providers interviewed,
individuals that provide health care services to homeless youth. I was able to
find two possible participants that were health care providers. Both of these
individuals provide services primarily on a volunteer basis. Ultimately, I was
unable to schedule interviews with either of the possible candidates. I
consider this research limited by the absence of health care providers voices,
as they provide a service that is so often needed by homeless youth.
57


As with all qualitative research that focuses on a deeper, rather than
broader, understanding, the findings of this study cannot be generalized to all
service providers working with homeless youth. This study is limited in that
the participants in this sample were all from the Denver Metropolitan area,
which may lead to findings that are particular to this geographical region.
Finally, despite the emphasis I have placed on the importance of youth
having a voice and the need for research to include the perspectives of
homeless youth, this study did not include the perspectives of young people.
However, the aim of this study was to focus on another gap in the literature-
the missing voices of service providers that serve homeless youth- as a
contribution to a more complete body of literature on adolescent
homelessness.
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CHAPTER 4
FINDINGS
Experience and Contact with Homeless Youth
The initial close-ended questions were asked to gain information about
service providers experience and background in working with homeless
youth. The range of total time having worked with homeless youth was
between 8 and 108 months, with a mean of 36.89 months and a median of 25
months. The range of weekly hours of direct contact with youth each week
was between 4 and 45 hours, with a mean of 22.26 hours and a median of 20
hours of direct contact with youth each week. Finally, the number of youth
that service providers were in contact with each week ranged between 1, in the
case of a mentor and 125, in the case of an outreach worker, with a mean of
31.32 and a median of 20 youth directly served each week. Services provided
to youth include: mentoring, help with finding housing, shelter services,
employment counseling, general case management, job coaching, street
outreach, GED (General Educational Development)/ educational services, and
therapy, social work, or counseling. Table 4.1 summarizes these findings.
59


Table 4.1
Participants experience working with homeless youth
Ranee Mean Median
Length of time (in months) 8-108 36.89 25
Hours per week (direct contact) 4-45 22.26 20
Number of youth contacted per week 1-125 31.32 20
Open-ended questions were then posed to participants in order to
understand their perspectives on the issue of adolescent homelessness and to
gain insight into their experiences as service providers to this population.
Reasons for Homelessness
All twenty (20) participants indicated that family problems were a main
reason that youth were homeless. Of course, participants described family
dysfunction in various ways. Participants talked about the youth having been
in really abusive homes for years or other cases in which parents are having
60


difficulty parenting well: parents cant take care of them because the parents
are also not with it in terms of [having their own] drug problems, alcohol
problems. So the kids run away; theyre not in a safe environment.
Sometimes, the specific type of dysfunction was less clear, mainly there is a
problem between the kid and their parents, and the kid ends up homeless.
While some participants were very detailed in their descriptions of family
dysfunction, others were a bit vague. Regardless of the level of description, it
was apparent that all of the participants saw family dysfunction as one of the
main reasons that youth were homeless.
Participants also talked about substance abuse being a major reason that
youth are homeless. Twelve (12) of the twenty participants said that drug or
alcohol abuse was a reason that youth were homeless. Interestingly, of these
twelve responses eight (8) participants specifically mentioned the substance
use of adolescents. Two (2) of these also spoke about substance abuse in the
family generally, perhaps indicating that parents in the family were also
abusing drugs or alcohol. Four (4) participants mentioned parental substance
abuse specifically. Because more than half of the participants suggested drug
or alcohol abuse specifically as a reason that the youth they work with are
61


homeless, substance abuse became a category of its own. However, it is
important to note that substance abuse by either an adolescent or their parent
is most likely connected to the family dysfunction mentioned by all of the
participants. Indeed, many of the participants spoke about substance abuse in
the context of family dysfunction.
Ten (10) participants suggested abuse as a reason for adolescent
homelessness. Some participants spoke generally about abuse. Others
specified physical, sexual, or emotional abuse. Some participants talked about
all three kinds of abuse. As discussed above, it is evident that abuse is one
example of dysfunction in a family and cannot be separated from that context.
It is listed here as a separate category because of its pervasiveness in the
responses to the question. Many of the participants who talked about abuse
suggested that these youth run from the situations when they cannot take it
any more, or when they are finally able to leave. For example, one participant
stated, But as to the question of the causal factors of youth homelessness, I
would say that young people are fleeing abusive situations. Another stated,
You have people that choose to leave the home, that are in situations where
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its abusive. One of the participants who differentiated between adolescents
that ran away versus adolescents that are kicked out said,
I think that kids run away because they are being abused. And
that runs the gamut from being emotionally tormented, to
sexually abused, to physically abused. And I think that many
times, there is a step-parent or significant other of the parent
involved in that abuse... and the whole situation gets so bad at
some point that the kid decides to leave.
It is important to note that several of the participants differentiated between
runaways and throwaways. It was suggested that young people ran from
abusive situations as indicated above, or situations in which there was a high
level of family conflict, often associated with a step-parent or significant other
of the parent. Throwaways were the adolescents that were kicked out of their
home. The implication was that the parents were fed up with these kids or
had reached their limit. One participant was particularly descriptive in talking
about throwaway youth:
Another category that I was surprised to discover really were
the throwaway kids, the ones who are kicked out of the house
usually because of anger issues, or mental health issues or
sexual identity issues when they come out, when they realize
that theyre gay or bi or whatever, transsexual... and often the
parents cant deal with that, so they kick the kids out.
Later, during the same question, he talked more about this.
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I think we have more throwaways than we have runaways and I
think we have more throwaways probably because of behavior
issues and/or gender issues. I think those are the things that
really stress a family.. .acting out, being violent, being angry,
that sort of thing just drives families over the edge.
What emerged then, as participants differentiated between runaways and
throwaways, was a sense that the runaways left home voluntarily because of
some family situation that that they could not control and that was unbearable
to them. Conversely, the throwaways were forced to leave because of some
kind of behavior that the parent could not control and would not tolerate. It is
important to clarify here that service providers seemed to indicate that parents
that expelled their kids from the home had the same kinds of problems and
dysfunction as the parents whose adolescents ran away. The difference was
who made the choice that the adolescent would no longer remain in the home.
While the category of drug/ alcohol use and the category of abuse,
physical, sexual and emotional, clearly relate to family dysfunction, I was
surprised to find another category that emerged that also seemed to be clearly
related to dysfunction in the family. Eight (8) of the participants spoke about
youth coming out as gay, lesbian, bi-sexual or trans-gendered, and, of that
revelation causing them to be expelled from the home by their families. In
64


speaking about the youth she worked with, one participant said, Maybe like
40% are gay, bi-sexual, trans-gendered or lesbian. That causes huge problems
in a family. Another said,
There are also times when a relationship becomes so strained
because of a difference in values, mainly around sexual identity
issues. In those cases the parents avoid the fact that they have
a homosexual child. The kid almost always rebels against that
and comes out or starts really acting out...dressing in ways that
that the parent finds inappropriate or bringing partners around.
That seems to be a big reason for kids being kicked out of the
home.
The participant was then asked for clarification with the question: So do
you think that the parents cant handle that their child is gay or that they cant
handle them acting out? To which he responded,
Both really. They cant handle the reality of it at all, so they
try to avoid it. When the kid starts acting out and being
flagrant, then its too much for them. Theyre ashamed and
dont want others to know, so they make the kid leave.
Each of the eight (8) participants that spoke about sexual identity as a
reason for homelessness indicated that youth were expelled from the home
because their parent(s) could not accept that their son or daughter was gay,
bisexual or transgendered, indicating that these youth would be considered
throwaways.
65


Finally, seven (7) participants indicated that mental health issues or mental
illness were reasons that youth were homeless. In most cases, (5 out of 7)
participants talked about the youth they work with having mental health issues
that led to their homeless situation. However, two (2) of the participants
spoke about mental illness of parents being a reason that young people are
homeless. One participant recalled a specific example.
I know one kid whose mom was schizophrenic. It was really
hard for him. In fact he blames his alcohol use on his moms
condition. He said it was the only way he felt like he could get
away from the craziness of it. So I think that plays a big part
too.
It became evident in looking at the responses of participants that most of
the reasons that youth became homeless were related to family dysfunction at
some level. All of the categories listed above really reflect a conflict within
the family that could not be resolved and resulted in a separation of the youth
from their family. However, there were other reasons listed for adolescent
homelessness that do not clearly relate to family dysfunction.
It is not surprising that economics, or more specifically a lack of money
and/or resources came up as a reason that youth are homeless. What is
perhaps surprising is that only six (6) of the twenty participants mentioned
66


economic issues. Of these, three (3) specifically mentioned that sometimes
the entire family unit becomes homeless, and at some point the adolescent
breaks away from the family unit because, as one participant said, They feel
like theyre a burden to their family. Or as another suggested, At some point
the family separates, because it seems a more likely way for them all to make
it.
Finally, five (5) participants suggested that a lack of community and
insufficient support systems led to homelessness. Four (4) participants each
suggested that lack of independent living skills and coming out of social
services or foster homes were reasons for adolescent homelessness. Table 4.2
summarizes the results of the interview question regarding why service
providers believe the young people they work with are homeless.
i
67


Table 4.2
Service providers beliefs about why youth are homeless
Reason for Homelessness Number of Participants Percent of Participants
Family dysfunction 20 100%
Substance abuse 12 60%
Abuse (physical, sexual or emotional) 10 50%
Sexual identity 8 40%
Mental health issues 7 35%
Economic reasons 6 30%
No support system/ community 5 25%
Poor independent living skills 4 20%
Previous foster care or social service system involvement 4 20%
68


Patterns Observed among Homeless Youth
When asked, What pattern do you see with the homeless youth population?
Several of the participants asked me to clarify the question. A simple
response of, What do you see over and over again with the homeless youth
that you work with? was the clarification that was given. The answers varied
greatly. However, all of the participants mentioned at least two patterns that
they saw with homeless youth. Many participants mentioned three or four
patterns that they saw regularly
Nine (9) participants responded that they saw a pattern of mental health
issues among the homeless youth with whom they work. Four (4) of the
participants mentioned depression specifically, and one (1) participant
specified post-traumatic stress disorder.
A total of nine (9) participants mentioned substance abuse as a pattern that
they saw over and over again with the youth. Of these, eight (8) of them had
also mentioned mental health issues. That is, eight (8) participants mentioned
both mental health issues and substance abuse as patterns that they saw with
homeless youth. This may indicate that at least some homeless youth have
issues with both substance abuse and mental health issues. Indeed, several
69


participants stated this quite clearly. The odds are pretty good that youre
gonna be dealing with youth who, and it may be all three, these are not
discreet. They may have mental health issues, they may have hard drug
issues, and they may be gay and dealing with all of that. Another said, I
think were seeing more and more mental illness among our youth. I think
that, a great number of homeless youth could be dually diagnosed as suffering
from mental illness as well as substance abuse issues. It became clear
throughout interviews with service providers that both mental health issues
and substance abuse issues are salient factors in nearly every aspect of
working with homeless youth. However, several other patterns were noted by
service providers as well.
Seven (7) participants indicated that they saw a pattern of family problems
or previous abuse with the youth. This is not surprising considering that all
twenty participants indicated that family problems were a reason that youth
were homeless. However, it is interesting that some participants also stated
that it was a pattern that they saw with the youth. The distinction may be that
while all participants considered family difficulties a reason that youth were
on the streets, these seven (7) participants also saw manifestations of the
70


family dysfunction in their daily work with the youth. One of the participants,
a volunteer mentor stated it in this way:
Again, I see over and over again a yearning on the youths part
for these relationships with parents. And in most cases, its a
refusal or pushing away by the parent. Perhaps, and again I
dont know really why, but perhaps the problems were so big
that the parents just gave up and demanded that the youth
leave.. .one of my mentees had significant issues with mental
health, which the parent could not deal with and which forced
the youth onto the street.
It became apparent that there was a link between the patterns that were
identified by participants. Four (4) participants stated that the young people
that they work with have relationship problems. All four specified either that
the young people trusted too easily and got themselves into dangerous
relationships, or that they had difficulty trusting others. Interestingly, while
these participants did not identify family dysfunction itself as a pattern, it was
implied that family dysfunction played a role in the difficulty these youth have
in forming healthy relationships. Discussing the poor decision-making
regarding relationships, one participant noted:
It doesnt just happen out of the blue. And for a lot of kids,
you know you can directly see how that happened when they
were ten, this traumatic thing. And since then, theyve been
searching for that [relationship].. .1 mean when you have
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nothing, anything is appealing. So if you get into a bad
relationship, you think youre going to learn from it.
Three or less participants also mentioned the following patterns: a
demeanor of aggressiveness and toughness (3), involvement with multiple
systems (2), poor social skills (1), poor independent living skills (1), lack of
follow through (1), problems with authority (1), and sexual identity issues (1)
as a pattern. Table 4.3 summarizes the patterns that participants observed in
working with homeless youth.
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Table 4.3
Patterns observed among homeless youth
Pattern Number of Participants Percent of Participants
Mental health issues
Substance abuse
Family problems/abuse
Aggressive/ tough demeanor
Multiple systems involvement
(social service, foster care, juvenile court)
Poor social skills
Poor independent living skills
Lack of follow through
Problems with authority
Sexual identity issues
9 45%
9 45%
7 35%
3 15%
3 15%
1 5%
1 5%
1 5%
1 5%
1 5%
73


Challenges and Treatment Issues
In terms of challenges and treatment issues homeless youth face, not
surprisingly, nine (9) participants reported that mental health is a significant
treatment issue for homeless youth. In addition, four (4) of the nine (9) also
indicated that a lack of resources makes it a challenge to treat mental health
issues.
Nine (9) participants reported substance abuse as a specific treatment issue
for homeless youth. Of these nine (9) participants, five (5) of them
specifically cited a lack of services as a challenge to treating substance abuse.
It is interesting that of the nine (9) participants that reported substance abuse,
six (6) of them had also reported mental health as treatment issues for
homeless youth. It is important to note that at this point in the interview,
while only three questions had been asked of participants: reasons why youth
are homeless, patterns among homeless youth, and challenges or treatment
issues specific to homeless youth; substance abuse and mental health issues
came up consistently. Further, participants talked about substance abuse and
mental health issues simultaneously,
74


almost interchangeably, in many instances. The sense of building frustration
became apparent, as many participants talked about the multiple difficulties
homeless youth have and the lack of resources available.
The challenges and treatment issues that they face is that there
is a lack of them.. .three hours of psychiatric time for young
people where were seeing about 800 young people in this
facility a year, over 800 young people that were case
managing. Right around 80% of them have some sort of
diagnosable mental health disorder. And I have about three
hours of psychiatric time to treat all of them. And so, theres
definitely a lack of resources. Its probably one of the biggest
obstacles. Its not an easy system to navigate, and so coupled
with all of the resource cuts in terms of mental health and
substance abuse treatment, its also a system where trying to
apply for Medicaid is a very lengthy process.. .and there are so
many different systems barriers coupled with the fact that
theres fewer and fewer resources. [Italics added].
The emphasis in the above quotation is mine. The phrase substance
abuse is emphasized to indicate how quickly this participant switched from
talking about mental health issues to substance abuse issues in his response. I
found with several of the participants that they seemed to become
overwhelmed by this question. They spoke more quickly and their thoughts
shifted quickly between different challenges or treatment issues they were
discussing. I began to get the sense that the participants saw strong interplay
75


between different treatment issues and challenges, and at times this seemed
overwhelming and frustrating as they recounted the difficulties of the youth.
I do see a lot of young people that are self-medicating and
stabilizing their mental health to a certain level by using
substances, but then a lot of people cant sustain their prior
living situations because of their addiction and substance
abuse. Theyre definitely both present, and sometimes its just
very difficult to unravel that.
Another participant responded:
Theres so much. So many of them have so much against them
from the very beginning because theyre brought into families
that are not stable. And they have you know, growing up if
theyve been abused then emotionally they have so many
problems already. And then maybe they have problems in
school because of all that. And so they have so many obstacles
like the learning thing, and the family support and the mental
illness, and then adding drug use to that, and its just on and on.
And I just feel like the world is kind of against them and
theres not a lot of services for them. And now theres not a lot
of mental health services either. Theyre just cutting a lot.
And so were seeing so many kids with mental illness and
thats just a huge challenge.
This question seemed to bring to the forefront, for several of the
participants, a sense of connection between the different treatment issues and
challenges that homeless youth encounter.
Seven (7) participants responded that poor independent living skills keep
homeless youth from accessing services that are available. Or, if services are
76


accessed, that poor independent living skills interfere with treatment that is
offered. For example, even when services are accessed, youth frequently miss
scheduled appointments or fail to complete tasks they are given. They forget
to write down appointment times or miss buses to get to appointments. These
difficulties were not only related to inability to access mental health and
substance abuse treatment, but also education and employment-related
services or even simply knowing how to ask for help with everyday problems.
A similar response to this interview question indicated that some participants
perceived a lack of follow-through by homeless youth and an inability to look
toward the future, which three (3) additional participants reported outside of
the context of substance abuse or mental health treatment.
Another theme that developed in reviewing participant responses was the
perception that homeless youth have difficulty trusting others, particularly
adults. This was also seen as a challenge or impediment to getting various
kinds of help or treatment. Four (4) participants indicated that homeless youth
have difficulty trusting because of family dysfunction or previous abuse.
Interestingly four (4) participants suggested that youth had had bad
experiences with professionals in the past, one specifically suggested
77


involvement with social services, and that these negative experiences made
them resistant to treatment.
Finally, the following quote expresses both challenges that youth encounter
and this participants particular challenge in working with young people that
have multiple treatment issues. He stated:
Well, my job is to focus on helping kids get their GEDs right?
But a lot of these kids have really intense stuff going on. So,
their focus isnt there. Kids have mental health issues, like
with abuse. Some of them are really traumatized by things that
have happened to them. So, I think in those cases, they need a
lot of counseling first. But, its not like you can put off them
getting their GED or educational services for 5 years while
they try to work through everything. And then there are kids
who are working on substance abuse issues. So when they
relapse, they may or may not show up. If they dont, then you
dont have the consistency you need to really teach them. If
they do, theyre so strung out that theyre not focused anyway.
You know?
Table 4.4 summarizes the findings regarding specific challenges and treatment
issues that homeless youth face.
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Table 4.4
Challenges and treatment issues of homeless youth
Challenge/ Treatment Issue Number of Participants Percent of Participants
Mental health issues
Lack of resources
Substance abuse
Lack of resources
Poor independent living skills
Difficulty trusting (because of abuse)
Bad experiences with professionals
Lack of follow through
9 45%
4 20%
9 45%
6 30%
7 35%
4 20%
4 20%
3 15%
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no one to go to at age 18 or 17 when youre in trouble.. .just
having no one in the world that you can go to.
Another participant in this category talked about a young person he worked
with and the difficulties this young person had in feeling like connections with
others were real. This service provider said:
I think just not having consistent relationships. I worked with
one young man who articulated it so well. He basically said
that it really gets inside his head that most of the people who
have showed caring toward him were being paid to do it as part
of a job. He wondered if anyone would have showed him any
kind of sympathy or affection or cared if he went to school if
they werent getting paid to do it. And he was aware that these
people perform that role for many others, not just him. I will
never forget that conversation. It was very enlightening for
me. I couldnt imagine what that would feel like. Its
heartbreaking really.
As this service provider suggests, many homeless youth have contact with
adults in the context of adults being paid service providers. In the case of this
particular youth, it seemed to heighten his sense of not having natural
connections to adults in his life.
Three (3) of the service providers interviewed suggested that a lack of
stability was the most difficult aspect of homeless living for the youth. One
said, That theyre all over the place. Their stuff is all over the place. What
little they have gets lost or stolen easily. Their lives are so chaotic.
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Three (3) participants stated that the violence homeless youth witness, and
to which they are subjected are what makes homeless living most difficult for
young people. These participants specified the fighting and sexual assaults
that take place on the streets.
And three (3) participants stated that they believed difficulties related to
drug use made living on the streets hard. Respondents in this category listed
both the struggle to stay clean and the availability of many different types of
drugs.
Finally, two or less participants reported each of the following as the most
difficult aspect of homeless living for adolescents: not having skills normally
taught by parents or family members (2), not believing in their futures (2), the
stigma that is attached to homeless people (1) and poor self-esteem (1).
It is important to remember that these were impressions that service
providers had about what was difficult about being homeless for the youth
with whom they work. These answers likely reflect a combination of what
youth have expressed to providers as being difficult for them and what
providers believe would be difficult, based on their own feelings about being
in a homeless situation. Results are summarized in Table 4.5.
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Table 4.5
Most difficult aspects of homeless living
Most Difficult Aspect Number of Participants Percent of Participants
Basic survival
Lack of connection to adults
Difficulty forming bonds
Loneliness
Lack of stability
Violence
Drug use
Poor independent living skills
Not believing in their futures
Stigmatization of the homeless
Poor self-esteem
8 40%
8 40%
3 15%
3 15%
3 15%
3 15%
3 15%
2 10%
2 10%
1 5%
1 5%
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Strengths and Skills of Homeless Youth
Almost every participant (17 out of 20) listed more than one skill or
strength that homeless youth possess. Ten (10) participants stated that
homeless youth have incredible survival skills. These participants focused on
how skilled young people are at surviving on the streets. Nine (9) participants
said that homeless youth are extremely independent. Eight (8) participants
stressed that homeless youth are extremely resilient and have a great deal of
personal strength. Seven (7) participants reported that the youth they work
with are extremely intelligent or smart. Also among the list of skills reported
by service providers was the strong loyalty that homeless youth show to one
another. Six (6) service providers reported that homeless youth protect each
other on the streets; they form communities and are loyal to one another.
Five (5) participants reported that homeless youth are very street smart and
system savvy. Participants suggested specifically that homeless youth know
how to persuade others to help them or to give them something that they need.
They also suggested that homeless youth know what services providers want
to hear.
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Three (3) participants stated that homeless youth are able to communicate
well. This was stated both in regard to being able to tell their stories to
service providers, and in being able to communicate their wants and needs.
Three (3) participants also suggested that homeless youth are very creative.
One of these participants specifically mentioned that many of the youth she
worked with were very creative during poetry night or in expressing
themselves through art and music.
Finally, two (2) participants each mentioned the following three skills or
strengths: the ability to multi-task, being very engaging, and being caring
individuals. As was mentioned earlier, most participants listed several
strengths or skills that they saw in homeless youth. One participant, who was
eager to talk about the positive qualities she saw, said the following:
Oh, they are survivalists. They are extremely determined and
extremely resourceful. Some of these kids are more
resourceful than most college students that Ive seen. They
know how to talk. They know how to talk the talk, they know
exactly.. .a lot of them have been involved in foster care and
have been involved in systems that they understand really
intricately in a way because of being a consumer of those
services. So they know what their caseworkers want to hear.
They know how to get what they want, and if they want
someone to do something for them to get what they need.
Theyre really resourceful kids. They have, some of them I
would say have the reasoning skills and the ability to talk
I
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people out of things, skills that some people dont have or
dont possess. And a lot of them are really smart kids, really
together, have a really good head on their shoulders. And you
know for some reason or other are homeless, but are really
smart kids.
Another participants response was similar:
Oh survival. They have a great strength of spirit. They have
this theyre not going to take me down attitude. Its pseudo-
maturity though, because in a way theyre really very needy.
But they have this bravado about them. But they also have
great caring amongst themselves. Its not really a family, but
they take care of each other. They look after each other.
Theyre very resilient in terms of having to get up early and go
to work to jobs that really dont have much of a future. Theyll
go into education programs and go to Job Corps and stuff like
that, programs like that to try to survive. They have very
strong survival instincts.
In service providers responses to this particular question, I sensed both
awe and pride. Most participants expressed true amazement at the ability of
homeless youth to make it on the streets and to carry on day after day despite
frustrations and difficulties along the way. There was also a sense of pride in
the young people that they work with. As one participant put it, I mean
really, when you strip away kind of the situation and you look at some of the
characteristics you see in the kids, theyre characteristics you would honor and
like your kids to have. Another participant expressed it this way:
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And it always just amazes me that they make it. Theyve been
through so much and still theyre trying to make it work. Of
course they have slumps and God knows they frustrated me to
no end sometimes, but they find a way to eat and sleep and
drag themselves through this world just trying to make it. And
truthfully some are incredibly successful. When they get on a
roll, some of them become major overachievers almost.
This interview question was particularly revealing. Although throughout
the interviews, most service providers expressed strong empathy and
compassion for the homeless youth that they work with, this question really
revealed the amount of respect and admiration that most service providers
have for the youth. Most of the previous questions elicited quite cerebral
responses and the only emotion that I sensed in previous responses was
frustration. However, this interview question seemed to evoke a sense of
pride in the youth with whom they work. This question brought forth smiles
and, at times, laughter as participants spoke about homeless youth with
respect and delight. A list of the strengths and skills that service providers
saw in homeless youth is summarized in Table 4.6.
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Table 4.6
Strengths and skills of homeless youth
Strength/ Skill Number of Participants Percent of Participants
Survival skills 10 50%
Independent 9 45%
Resilient/ personal strength 8 40%
Intelligent 7 35%
Loyal (to each other) 6 30%
Street smart/ system savvy 5 25%
Communication skills 3 15%
Creative 3 15%
Ability to multi-task 2 10%
Engaging/charismatic 2 10%
Caring 2 10%
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Services Needed
When asked about services that homeless youth need but were not getting
the answers varied greatly. Interestingly, several participants chose to
comment on services that homeless youth were receiving, but, in the opinions
of the providers interviewed, were not receiving often enough. Or in some
cases, providers believed that homeless youth needed more intensive services
in particular areas.
Mental health and housing programs were services that were most
commonly identified as services that homeless youth needed but were not
getting. Since mental health issues have been pervasive theme in participants
responses to interview questions, mental health will be discussed first. Eight
(8) participants indicated that mental health was a service that homeless youth
need, but are not getting. However, in the participants responses, it was clear
that homeless youth are getting mental health services, but not enough of
them. Participants really expressed that it took too long to get mental health
services or that the youth did not receive services often enough or that the
sessions were too short or that the treatment itself was not intense enough.
One participant, a volunteer mentor, believed that the agency she volunteered
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with really provided a broad spectrum of services, but was quite frustrated
specifically with the psychiatric services that her mentee clearly needed, but
did not adequately receive:
Well, my experience is confined to one agency, which is quite
a full-service agency. I would have to say that Ive been very
pleased to see the performance in that full-service setting. I
think getting the medical community- one thing Ive noticed
with the mentee that had mental health issues, the therapists
and counselors and the youth agency would sometimes work
very hard at trying to get the medical person to really assess the
status of the youth and to take it seriously, if you will. And I
think that was difficult. I think there was a frustration level
there between the agency-level people who were responsible
for their problems and actually getting the medical provider to
adjust the medicine, the kind and the dosage and to really take
some of these problems seriously. [Italics added].
When I asked if she thought this was due to a lack of resources, for example
the psychiatrist not having enough time to give each young person the focus
and individual attention they should have or if, perhaps she thought that
homeless youth are discounted more and their medical issues not taken as
seriously, she responded in this way:
My answer to that would be a guess, because I never spoke
with the doctor. I did sit several times in the waiting room,
taking the youth in. And I know that the visit was very short.
It was under- it was ten minutes or fifteen minutes. And this is
somebody who is right on the edge. And, in fact there were
issues of self-preservation and other destructive behavior. So, I
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