Youth at Risk
Abstract and Keywords
Runaways, throwaways, and homeless youths have always been present in the United States. In recent decades, however, society has become more aware of the problems they face as the problems have become more severe. The effectiveness of new approaches to helping these youths is yet to be determined.
Since settlers arrived in the United States, youth have left home without their parents' permission. In colonial times, many immigrants were teenagers placed by poor families as indentured servants. During the 18th and 19th centuries, teenagers fled slavery in the South and tyranny in their native countries. Adolescents left home during the Great Depression of the 1930s to help with their families' economic burdens.
In the 1960s and 1970s, society recognized that runaways, who were often hungry and homeless, had to resort to stealing or selling drugs or their bodies to survive. Still viewed as delinquents, they were often arrested (Posner, 1991). Also in the 1970s, clinicians divided these youths into those who left home (a) because of their own psychological problems, and (b) to escape dysfunctional family environments.
The Juvenile Justice and Delinquency Prevention Act of 1974 (Pub. L No. 93-415) prohibited states from jailing youth for behavior that is not criminal if committed by adults. Congress recognized the need for short-term shelter and services for those who are forced from their homes (throwaways); those who run from residential facilities and foster homes; and those who run from their own homes to escape (a) abuse, neglect, or other family problems; or (b) parental control (Bass, 1992).
In the late 1980s, professionals realized that severe problems precluded some youths from returning home. Longer residential care was authorized (Pub. L No. 106-71). Congress also began to address problems that required more intensive intervention. It created programs to address substance abuse problems (Pub. L No. 100-690) and street outreach to reduce sexual victimization of youths (Pub. L No. 103-322).
With the mid-1990s came a new focus on positive youth development. This approach focuses on building youths' skills and self-esteem while offering safe, stable housing and support services so that they can become healthy, successful, and independent adults.
A runaway has left home without permission and was away from home at least one night; or who was away from home, did not return home as expected, and chose to stay away overnight. (U.S. Department of Justice, 2002).
A throwaway was asked or told to leave home by a parent or other adult in the household for at least one night or was away from home and prevented from returning. The adult did not make arrangements for alternative care (U.S. Department of Justice, 2002).
Homeless youth are unaccompanied youth between the ages of 16 and 21 who cannot safely live with a relative and have no safe alternative living situation (Missing, Exploited and Runaway Children Protection Act, Pub. L No. 106-71, 2000).
These definitions are not mutually exclusive. Many youths experience both runaway and throwaway episodes. Both runaways and throwaways may become homeless.
Most research has focused on identifying the scope of the problem, who is affected, and the problems facing those affected.
Scope of the Problem
Data on the problem is limited by several factors. Not all runaway episodes are reported, and it is difficult to locate all homeless youths. Efforts to count homeless youths often do not include those older than 18 years (Levin-Epstein & Greenberg, 2003). Data reported by programs are based on youth who choose to seek help. And, youths often are embarrassed to report some problems.
The Second National Incidence Studies of Missing, Abducted, Runaway, and Throwaway Children (NISMART-2) estimated that in 1999, 1,682,900 youths had a runaway or throwaway episode (Sedlak, Finkelhor, Hammer, & Schultz, 2002). An earlier study, conducted by the Research Triangle Institute (RTI) estimated that as many as 2.8 million youth reported a runaway episode (Research Triangle Institute [RTI], 1995). An estimated 500,000 to 1.3 million runaway and throwaway youths become homeless each year (National Alliance to End Homelessness, 2006).
Runaways and homeless youths aged 12–17 are more likely to be female, over 50–68% (RTI, 1995; Administration for Children and Families [ACF], 2005). Those who enter shelters directly from the street are also more likely to be female. Fifty-four percent of throwaways entering programs from the street, however, are more likely to be male), as are street youths aged 18–21 (ACF, 2005).
A disproportionate percentage of these youths are Black. The percentage of Black youths ranged from 28% of homeless youths and 17% of runaways using federally funded shelters between 1985 and 1988 (U.S. General Accountability Office [GAO], 1989) to 40.7% of the youths in shelters in the RTI study. Runaway and Homeless Youth Management Information System (RHYMIS) data from FY 1997 identified 24% of youths in federally funded shelters (Thompson, Safyer, & Pollio, 2001), and from FY 2004 the data identified 27% of the youth who used shelter and transitional living programs as Black (ACF, FY 2005). The National Runaway Switchboard reported that, in FY 2004 and 2005, 27 and 29% of the youth callers, respectively, were Black (U.S. Department of Health and Human Services [HHS], 2006).
Problems Faced by At-Risk Youth
Youths face problems that result from interpersonal issues, personal behavior, family behavior, societal attitudes and resources, and community environmental conditions.
Youths most frequently leave home due to severe interpersonal problems with parents or other family members. Experts estimate that 60% of females and 25% of males who runaway were sexually assaulted prior to leaving home (Anderson, 2004). NISMART-2 found that 21% of runaway or throwaway youths had been sexually or physically abused prior to leaving home, or were afraid they would be abused if they returned (Hammer, Finkelhor, & Sedlak, 2002).
RTI also found that youths most frequently run away because of family problems, with 63% of youth in the shelter sample and 61% of youth in the street sample reporting emotional abuse. A household member had threatened to throw the youth out in 63% of the shelter sample and 70% of the street sample. Forty-six percent of runaway and homeless youth had been physically abused and 17% sexually abused (HHS, 1997).
An exploratory study found discrepancies between the views of youths and their parents regarding the cause of family dynamic problems. Unlike youths, none of parents believed that they contributed to their child's departure from home (Safyer et al., 2004).
Society and systems failures sometimes increase youths' problems. Youths who reside in substitute care facilities are more likely to runaway than those who live at home. They are likely to stay away longer and run farther. The longer they are away, the more likely it is that they will lack health-care and educational services, be victimized, and succumb to substance abuse or prostitution to survive. They may also turn to shoplifting, panhandling, stealing, or violence to survive. If they do return to care, they are more likely to run away repeatedly (Dedel, 2006; Sedlak, Finkelhor, Hammer, & Schultz, 2002).
Each year, between 20,000 and 25,000 youths aged 16 and older leave foster care through emancipation or because they “age out” of the system (National Alliance to End Homelessness, 2006). Anywhere from 12 to 36% of these youth experience homelessness (Child Welfare League of America, n.d.). Besides youths who become homeless after leaving foster care, youths released from a juvenile detention facility or other residential facility (for example, mental health) may become homeless if adequate resources are not available. A study of homelessness among young people in Minnesota revealed that one fourth of those who left foster care or a correctional facility within the past year had no stable housing when they left (Wilder Research, 2005). These youths have many personal issues. They are generally disconnected from caregivers and permanent, safe living situations. They suffer from higher than average rates of depression, mental health problems, alcohol and drug problems, and delinquency.
NISMART-2 found that 19% of the runaway and homeless youths were dependent upon substances, 18% were in the company of a substance abuser, and 17% were using hard drugs. Eleven percent were engaged in criminal activity during the runaway or throwaway episode. A summary of current research concluded that about 75% of homeless youth use drugs (The National Child Traumatic Stress Network, 2007).
RTI reported that 41% of females in the shelter component and 50% of females in the street component had ever been pregnant. Twelve percent of females in both components were pregnant at the time of the study. Studies from the mid-1990s suggest that 3–10% of homeless youths are gay, lesbian, bisexual, or transgender. More recent studies suggest that the percentage may range from 35 to 50%. Their sexual orientation often plays a role in the runaway or throwaway episode and they are more likely to be victimized than are other homeless youths (Ray, 2006).
Health and mental health problems are rampant. Over 50% of the adolescents entering the juvenile justice system have health problems and learning disabilities that were not diagnosed prior to entrance. Often these problems are not adequately addressed during confinement and youth leave without any help in obtaining needed services.
Almost half of the youth in foster care have chronic health problems. Sixty to 80% have severe mental health issues. Nearly 44% of those aging out of care have trouble accessing needed services. Only 21% of those leaving care were able to continue receiving mental health services (National Association of Social Workers, 2001). These youths are at increased risk for considering and attempting suicide (RTI, 1995). The longer they are homeless, the greater the risk for suicide (Centre for Suicide Prevention, 2004).
Youths face challenges in continuing their education. This affects their employability and self-sufficiency after exiting residential environments. In one study, 46% of youth had not finished high school 2 ½ to 4 years after leaving care. In another study of 133 former foster youth who exited care 12–18 months prior to the study, 37% had not finished high school (GAO, 1999).
The problems faced by these youths mirror those faced by disconnected adults in American Society. Those with little or no education are more likely to be unemployed and impoverished, and more likely to lack housing and health care. They are also more likely to suffer from serious health problems, including HIV and AIDS.
Efforts to Address Youth Problems
The first three programs discussed here are administered by the Family and Youth Services Bureau (FYSB) in HHS. FYSB expects agencies that receive grants through these programs to promote positive youth development (PYD). As defined by FYSB, PYD must inform youths about healthy behaviors and interactions; provide safe, structured places for study and socializing or recreational activities; promote better relationships with adult role models; help youths develop skills (for example, literacy, competence, work readiness, social interaction); and help youths build self-esteem (ACF, 2006a, 2006b).
PYD is a promising practice that is increasingly used by nonprofit organizations and foundations in addition to government agencies. The effectiveness of PYD is still being assessed.
Basic Center Program
The Basic Center program, established by Pub. L No. 93-415 for runaways and later amended to include homeless youth, was designed to meet the immediate needs of adolescents who left home and remained away from home without parental permission. Local community-based grantees provide services outside of other service delivery systems (for example, juvenile justice, child welfare, mental health). Grantees provide outreach, short-term emergency shelter (up to 15 days), counseling (individual, group, and family), food, clothing, aftercare, and referrals for other services, as needed. Shelters must be located in areas frequented or easily reached by runaway and homeless youth, and must offer services 24 hours a day. Basic Center programs served 121,356 youths between FY 2004–2005, while 23,991 youths were turned away (HHS, 2006).
A key program goal is to reunite youth with their families. Without alternate state requirements, staff must contact a parent or guardian within 72 hours. For youths who cannot return home, staff try to find alternative living situations (ACF, 2006a).
Transitional Living Program
Recognizing the need of older homeless youths (aged 16–21) for longer term residential care, Congress amended P. L. 93–415 in 1988 to include the Transitional Living Program (TLP) for homeless youths. TLP provides residential care and intensive services for up to 18 months to help youths aged 16–21 who cannot return to their families, but are not prepared to live independently, and an additional 180 days for those not yet 18 years old. Besides housing, TLP programs provide independent living skills training; substance abuse education and prevention; referrals or access to mental health and medical treatment; services or referrals for education (secondary, postsecondary where possible, and vocational); and services or referrals to help pregnant and parenting homeless youths become effective parents. In FY 2004–2005, TLP programs served 8,202 youths, while 16,759 youths were turned away.
The Runaway, Homeless and Missing Children Protection Act of 2003 (Pub. L No. 108-96) expanded eligibility for TLP to include maternity group homes—but without separate funding. These facilities address the needs of pregnant homeless young women whose babies are at high risk for low birth weight and infant mortality.
Street Outreach Program
The Street Outreach Program (SOP) is authorized by the Education and Prevention Services to Reduce Sexual Abuse of Runaway, Homeless, and Street Youth Program. SOP is designed to help street youth who are at risk of or have been subjected to sexual exploitation or abuse.
SOP staff builds relationships with young people living on the street and encourages them to move and adjust to appropriate living situations. Services must include treatment, counseling, and information and referral. Staff must have access to local emergency shelters appropriate for and available to young people and must be allowed to maintain their interactions with youth placed in these shelters. Staff must offer services during the hours youth tend to be on the streets, including nights and weekends. Staff includes people with gender, ethnicity, and experiences similar to those of the youth they serve. They must receive training and street-based supervision. In FY 2005, staff made 643,598 contacts with street youths (HHS, 2006).
In 1998, Congress amended Pub. L No. 93-415 to authorize the Drug Abuse Education and Prevention Program. Between FY1989 and 1995, this program funded demonstration and service delivery projects for runaways and homeless youths. Considered duplicative of other programs, it was discontinued. This program was an integrated part of the Runaway and Homeless Youth Network. Providers serving these youths must now coordinate with other service delivery systems to help youths obtain needed services. One study suggested that the unmet need for substance abuse services is growing (Sedlak, Schultz, Wiener, & Cohen, 1997).
Programs administered by the HHS Children's Bureau include the 1999 John H. Chafee Foster Care Independence Program (ILP) (Pub. L No. 106-169). Similar to the TLP, ILP funds may be used to provide room and board until age 21 for youths who have aged out of foster care (up to 30% of the state's allotment). FYSB and the Children's Bureau have been working to assure coordination between these programs. The Promoting Safe and Stable Families Amendments of 2001 (Pub. L No. 107-133) authorized vouchers for education and training, including post secondary learning and education, for youth who have aged out of foster care. These amendments also give states the option of allowing these young people to remain eligible for Medicaid up to age 21.
Other federally funded programs providing resources specifically for these youths include the Education for Homeless Children and Youth and the No Child Left Behind Programs administered by the U.S. Department of Education. Programs that may target these youth, among others, include the Health Care for the Homeless Program and the Projects for Assistance in Transition from Homelessness administered by HHS. The U.S. Department of Housing and Urban Development administers Shelter + Care and the Family Unification Program, which provides Section 8 vouchers for young people aging out of foster care.
A Promising Community-Wide Approach
A community-wide program offering a continuum of support for runaway, throwaway, and homeless youths may result in successful outcomes. One example is Urban Peak Denver. This program collaborates with numerous federal, state, and local programs to obtain referrals and provide the following: street outreach and testing for sexually transmitted diseases; staff for a medical clinic, HIV testing, and an on-site pharmacy; educational services for General Equivalency Degree and post secondary education; employment services; substance abuse treatment; transitional and supportive housing; assessments and psychological evaluations; pregnancy prevention services; and recreation services. In 2004, 63% of the youths served by Urban Peak had a successful housing outcome (Burt, Pearson, & Montgomery, 2005).
Key Roles for Social Workers and Future Trends
At the community level, social workers work with youths in foster care and ILP programs. They also work with youths in shelters, TLP programs, and other youth-serving agencies. Social workers must develop collaborative approaches to address the needs of youths. They must also work with youths where they feel comfortable, including on the street. Social workers need to serve youths through a continuum of care, including outreach, intake and assessment, case management, and aftercare. Equally important, they must be willing to conduct research on successful approaches to use in advocating for youths and the services or supports youths need.
National Association of Social Workers has developed standards for the practice of social work with adolescents. State and national continuing education is available to help social workers meet youths' needs. Social workers need to take advantage of training as new approaches, resources, and services become available for youths.
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