Runaway and Homeless Youths
Abstract and Keywords
Runaway and homeless youth may be viewed as subcategories on a continuum of familial disengagement and residential instability. Runaway youth are typically identified as those who leave or are forced from their homes, often returning in a relatively short time. Homeless youth are those with no stable residence, have limited contact with family, and have become affiliated with the culture of homelessness. This entry provides background on specific policies associated with youth who run away or become homeless. Characteristics of these two groups (runaway and homeless youth) are described in terms of high-risk characteristics, such as educational difficulties, substance abuse, victimization, and trauma. Service options to meet the needs of these youth are described and implications for social work practice discussed.
Runaway and homeless youths are among this nation’s most vulnerable adolescent populations. Prevalence estimates, though challenging to determine due to the varying definitions of “runaway” and “homeless” (Lifson & Halcón, 2001), suggest that the numbers of these youth are increasing. Between 750,000 and two million adolescents in the United States run away or are forced to leave their parental homes each year (Whitbeck, 2009). One nationwide survey in the U.S. found that nearly 8% of adolescents 12–17 years of age had spent at least one night in an emergency shelter, public place, abandoned building, or with a stranger during the previous year (Ringwalt, Greene, Robertson, & McPheeters, 1998). The Office of Juvenile Justice and Delinquency Prevention of the US Department of Justice, estimated in 2009 there were 1,682,900 homeless and runaway youth; according to the National Alliance to End Homelessness, numbers are equally divided among males and females. These young people comprise approximately one-quarter of all people who are homeless (Cauce et al., 2000). Regardless of the actual rates of youth identified as homeless or runaway, these young people comprise a group of young people living in precarious, unstable and often abusive situations. Most research, however, confirms that running away is often a last resort for adolescents dealing with unbearable situations, not simply a search for freedom and adventure (Hyde, 2005).
Definition of Runaway and Homeless Youth
Specific definitions for runaway and homeless youth are often described in synonymous terms; however, these youth comprise a heterogeneous population that may be identified based on varying degrees of their independence from families, the trajectory of their disengagement from society as a whole, and the varied stability of their housing status. Runaway or throwaway youth and homeless youth may be viewed as subcategories on a continuum of familial disengagement and residential instability. Efforts to acknowledge the differences among runaway and homeless youth have resulted in various typologies being developed to offer more specific explanatory definitions for these groups of youth. Attempts to define and categorize runaway and homeless youth have suggested a developmental trajectory beginning with the initial runaway episode and leading to immersion in street culture and homelessness. A clearer definition of these terms may assist in understanding the wide range of characteristics demonstrated by these youth (Patel & Greydanus, 2002).
Runaway youth are adolescents under 18 years of age who have spent at least one night away from home without the permission or knowledge of their parents or guardians (Ringwalt, Greene, Robertson, et al., 1998). Runaway youth typically stay away for a day or two, mainly as a result of conflict with parents or caregivers at home. For these young people, running away may be a rational decision because of the high likelihood of exposure to harm and danger in the home. On the other hand, some adolescents run away because they believe that a more exciting and less restricted life with few rules and limits awaits them (Lindsey, Kurtz, Jarvis, Williams, & Nackerud, 2000). Regardless of their reasons for leaving home, running away is often described as a choice of last resort for youth who can no longer tolerate maltreatment or family conflict (Whitbeck, 2009). These adolescents typically return to their families within a short time, do not experience the strains of living independently on the streets, and are not considered homeless. These youth often stay with friends or relatives on a temporary basis (couch surfing).
For some youth, leaving home is not a choice because they are forced out of their homes by their parents; these youth are often referred to as “throwaway, push-outs, or forsaken youth” (Powers, Eckenrode, & Jaklitsch, 1990; Powers, Jaklitsch, & Eckenrode, 1989). Throwaways represent youth who leave home because their parents have encouraged them to, have abandoned them, or have prohibited them from re-entering the home (Hyde, 2005). It has been suggested that 50% of runaway adolescents are included in this category (Ringwalt, Greene, & Robertson, 1998).
Homeless youth are defined by the Stewart B. McKinney Act, 42 U.S.C. § 11301, et seq. (1987) as a person who “lacks a fixed, regular, and adequate night-time residence; and… has a primary nighttime residency that is: (a) a supervised publicly or privately operated shelter designed to provide temporary living accommodations… (b) an institution that provides a temporary residence for individuals intended to be institutionalized, or (c) a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings.” (42 U.S.C. § 11302(c); Baumohl, 1996). Homeless youth lack a fixed, regular, or adequate nighttime residence, and often seek shelter in public places (such as city parks, highway underpasses, under bridges, or in stairwells), in abandoned buildings, or with strangers (Patel & Greydanus, 2002). These young people tend to become immersed in the “street economy,” where they are associated with other street-involved youth who get most, if not all, of their needs met through eating at soup kitchens, “dumpster diving,” sleeping outdoors, and “spare-changing” (begging) for money (Roy et al., 2004). The longer these youth remain on the streets, the more likely they are to become acculturated to the street economy (Auerswald & Eyre, 2002; Gaetz, 2004), seek adventuresome and high-risk social situations, and disregard prosocial norms in terms of education, employment, and adolescent developmental milestones (Kidd, 2007).
A subcategory of homeless youth is described as “doubly homeless.” These young people are those who have been removed from their homes by state authorities, such as Child Protective Services, and the youth has subsequently run away from those placements. Many of these youth report being abused by foster families and feel anger and resentment toward placements where they feel a lack of belonging, comfort, and safety (Williams, Lindsey, Kurtz, & Jarvis, 2001). Although the foster care system was designed to provide temporary care, youth often remain in the custody of Child Protective Services for years and “age out” or transition to legal emancipation. These youth enter society with few resources and numerous challenges, often becoming homeless due to lack of stable housing, insufficient financial support, and poor independent living skills (Zlotnick & Robertson, 1999). “Doubly homeless” adolescents represent approximately 18% of the homeless youth population and come from the most problematic family backgrounds of all homeless youth (MacLean, Embry, & Cauce, 1999).
Reasons for Running Away & Pathways to Homelessness
Several reasons have been suggested as to why youth leave home prematurely; however, family conflict is the primary reason adolescents give for running away (Hyde, 2005; Tyler, 2006). Verbal aggression and poor communication between family members create a catalyst for conflict (Waldron, Slesnick, Brody, Charles, & Thomas, 2001), and levels of dysfunctional communication patterns have been found to be higher among runaway youth (Wolfe & Toro, 1999). Poor interpersonal relationships may be affected by a lack of emotional warmth and support that is needed for family cohesion (Whitbeck, 2009). These young people report several issues that cause conflict with their parents or guardians, including parental or youth substance use, opposing religious beliefs, sexual orientation, poor school performance and engagement, and personal style such as body piercings and hair color that are counter to parental standards (Cochran, Stewart, Ginzler, & Cauce, 2002). Youths who run away from homes note the lack parental responsiveness, social support, and supervision; rejection by parents or caregivers is also commonly described (Whitbeck, Hoyt, & Bao, 2000). Although the research is limited concerning the impact of parents with severe and persistent mental illness on runaway behaviors, mental health symptoms have been shown to affect the adjustment behaviors of their children (Gewirtz, DeGarma, Plowman, August & Realmuto, 2009); thus, it would be likely that parental mental health challenges would only increase youths’ early departure from parental homes.
Disagreements between parents and youth regarding peer groups and choice of romantic partners also generate conflict. While continuous conflict is a critical factor influencing the decision of youth to leave home, youth and their parents diverge in perceptions of family conflict. For example, youth tend to perceive the family environment as more problematic than do their parents or caregivers (Slesnick & Prestopnik, 2004), while caregivers perceive their child’s externalizing behaviors as more severe than does the child (Safyer, Thompson, Maccio, Zittel-Palamra, & Forehand, 2004). Although youth may be running from a variety of living situations, the first run away episode typically results in relocating to a friend or relative’s home; youth are typically away from home for less than a week (Hammer, Finkelhor, & Sedlak, 2002). Although most return home, many run away again. In the U.S., adolescents report leaving home seven times after the first runaway episode (McMorris, Tyler, Whitbeck, & Hoyt, 2002).
Youth who run away, do not return to families, and eventually become homeless are those most likely to have experienced the greatest family dysfunction and maltreatment (Thompson, Zittel-Palamara, & Maccio, 2004). Severely disturbed families exhibit high levels of child abuse, neglect, and family violence that significantly contribute to runaway behavior. Empirical evidence suggests that 60–75% of youth who run away have been maltreated by their families and family violence in these young people’s lives is remarkably high (Kufeldt, Durieux, & Nimmo, 1992).
Educational Policies Specific to Runaway and Homeless Youth
In an effort to address the barriers homeless and runaway youth face in terms of housing and education, legislators passed the Runaway and Homeless Youth Act (RHYA) and the Education for Homeless Children and Youth (EHCY) program as part of the McKinney-Vento Homeless Assistance Act (P.L. 100–77). Originally passed in 1987, it was reauthorized in 2002 as Title X, Part C of the No Child Left Behind Act (see: http://www.naehcy.org/legislation-and-policy/legislative-updates/homeless-children-and-youth-act). The Act requires states to ensure that each homeless child has equal access to the same public education as other children and to develop a unique plan to provide opportunities that help these youth meet state academic achievement levels. The McKinney-Vento Act applies to children and adolescents who are living with a friend, relative, or other caregiver due to losing their home or being unable to afford housing. These youth may be staying in a motel or hotel due to lack of adequate alternative accommodations, or living in emergency, transitional, or domestic violence shelters, or living in many other unstable residential situations. Homeless youth, in particular, are identified in the Act as those who are not in the physical custody of a parent or guardian. To address the needs of these highly vulnerable young people, the Act provides mandates for service providers to ensure that these youth are free from segregation, isolation, and stigmatization while making school personnel aware of the specific needs of homeless youth.
The McKinney-Vento Act requires schools to provide comparable services, such as transportation, nutrition, and educational programs, to homeless youth. Homeless youth must be offered the choice of which school they would like to attend, and a liaison must be provided to advocate for the interests of these students. Homeless youth are to be assisted with school enrollment and identification of their medial and immunization records, but are allowed immediate enrollment regardless of whether they have the required documentation. The liaisons also maintain records for each homeless student and may provide transportation to and from the youth’s choice of school. Parents must be fully informed of the enrollment options and educational opportunities available for their child. The Act requires schools to provide written explanations to parents regarding disputes over school selection, enrollment, and referral to liaisons for dispute resolution. Finally, it requires parents to be provided with meaningful opportunities to participate in the education of their children with the aim of keeping the family engaged in the education process of the child while stable housing is sought.
Research has shown that students who experience residential instability often also experience a great deal of movement between educational settings. These youth are at heightened risk of failing a grade (Heinlein & Shinn, 2000; Wood, Halton, Scarlata, Newacheck, & Nessim, 1993), have poorer academic performance, and more likely to drop out of school completely (Simpson & Fowler, 1994; Wood et al., 1993) than more stably housed students. Those who change schools frequently have poorer nutrition and health as well as hygiene and behavioral problems that become obstacles in achieving academic success.
Unique Challenges of Runaway and Homeless Youth
Runaway and homeless youth experience a variety of challenges based on their own personal characteristics as well as more macro issues associated with service provision. Personal challenges involve poor academic engagement, rebelliousness or delinquency, involvement with alcohol and drugs, mental health concerns, and histories of violence and victimization. These challenges contribute to these youths’ initial runaway episode as well as their ongoing “street” involvement.
The main barriers for runaway youth in terms of education are associated with unstable living conditions, which tend to interrupt school attendance (Whitbeck & Hoyt, 1999). They attend school infrequently, are often expelled or suspended, and earn poor grades. Runaway youth are more likely to attend alternative educational programs or completely drop out of school (Kurtz, Jarvis, & Kurtz, 1991).
These youth are more likely to have school behavior problems, regressive behavior, inattentiveness, persistent tiredness, sleep disorders, and inappropriate social interaction with adults (Rogers & Segal, 1994). Many have been told they have a learning disability or have been placed in special education classrooms, although girls have less educational problems than boys. For example, one study (Schaffer & Caton, 1984) found that over half of their sample of runaway youths between 10 and 17 years of age were more than one standard deviation behind in reading achievement tests. Sixteen percent of males and 10% of females were not able to read at more than a fourth grade reading level, which is functionally illiterate.
Rates of delinquent behavior are also elevated among these young people, and they spend more time in juvenile detention centers for status offenses or other delinquent behaviors (Mallett, Rosenthal, Myers, Milburn, & Rotheram-Borus, 2004) and criminal acts (McCarthy & Hagan, 1992) than non-runaway peers.
A national survey found that one in five school districts reported that their numbers of homeless youth have almost doubled when compared to previous years (National Association for the Education of Homeless Children and Youth [NAEHYC]). One study found that nearly two-thirds of homeless youth had experienced academic disruptions during periods of crisis, spent less time studying, and were suspended more often than counterparts (Rogers & Segal, 1994). Homework is difficult for homeless youth who lack access to school supplies and a safe, quiet place to work (Reganick, 1997).
Homeless youth are twice as likely to have a learning disability, repeat a grade, or be suspended from school; they are more likely to drop out of school completely once they have become emerged into street culture and (NAEHYC, 2008). This greater likelihood for dropping out of high school contributes to long-term unemployment as well (MacKay & Hughes, 1994) as academic deficits and poor verbal and reading skills create unlikely candidates for legal and lucrative employment opportunities. Unemployment can lead to disaffiliation from conventional institutions, as the rules and norms and the value of work is minimized. This results in time to participate in illegal activities (Baron, 1999) and substance abuse, which in turn negatively affect homeless young adults’ capacity for gainful, formal employment opportunities (Ferguson, 2007).
Substance use has been repeatedly associated with youth leaving home prematurely. Research has documented that the risk for substance use is particularly high during adolescent years; however, some report that as many as 85% of runaway or homeless youth use substances (Rotheram-Borus, Mahler, Koopman, & Langabeer, 1996).
Research confirms with increased frequency of runaway episodes comes higher levels of substance use (Windle, 1989). One study (Slesnick & Tonigan, 2004) found that approximately 45% of runaway youth meet criteria for a diagnosis of alcohol and drug abuse or dependence. In a sample of adolescents utilizing youth shelter services (Rotheram-Borus, Desmond, Comulada, Arnold, & Johnson, 2009), research indicated that lifetime prevalence of drug use ranged from 36% to 52%; more recent drug use (within the previous three months) varied from 17–31% for marijuana and 6–11% for other types of drugs. Alcohol use is also common among runaway youth as approximately 69–81% report drinking alcohol.
Rates of alcohol, cigarette, and marijuana use are substantially higher among runaway youth than their non-runaway peers (Baer, Ginzler, & Peterson, 2003; Greene & Ringwalt, 1997; Johnston, O’Malley, & Bachman, 2002; Ringwalt, Greene, & Robertson, 1998), and prevalence rates are exceptionally high. One study of runaway youth in the Midwest found that 75% drank beer and 66% reported drinking hard liquor (Whitbeck & Hoyt, 1999). Others suggest rates of drug use are 57% among runaway youth using shelter services (Ringwalt, Greene, & Robertson, 1998).
Previous research suggests the various ways that substance use, family conflict, and leaving home intersect (Rotheram-Borus et al., 1996). For some youth, they use substances to deal with the stress of family conflict prior to leaving home; others’ substance use results in increased conflict within the family and ultimate separation (Mallett, Rosenthal, & Keys, 2005). Parental or familial substance use also contributes to youth leaving home (Springer, 1998) and is a critical factor influencing their decision to leave (Mallett et al., 2005).
Risk for substance use may already be present among youth who are homeless, as they have begun to use drugs or alcohol as a response to living on their own and to their experiences while on the street (McMorris et al., 2002). Substance use and abuse rates appear much higher among homeless adolescents than among their housed counterparts (Lawrenson, 1997; Mallett et al., 2004), with some suggesting that substance use is almost universal and usually takes the form of dual drug and alcohol use. Some research suggests that homeless youth report twice as much drug use as housed adolescents; they are five times more likely to use hallucinogens, four times more likely to use heroin, and seven times more likely to use crack cocaine (Slesnick, Meyers, Meade, & Segelken, 2000).
The variety of drugs reported by homeless youth include LSD, marijuana, hallucinogens, alcohol, nitrous oxide, cocaine, heroin, and speed; the most commonly used substances are alcohol, marijuana, and LSD (Gleghorn, Marx, Vittinghoff, & Katz, 1998). Others confirm these high substance use rates and report that 93% of homeless youth have at least tried one illegal drug (Sussman et al., 1999).
Rates of experimenting with substances are high, as 67% have tried LSD, 77% have tried marijuana, and 79% have drunk alcohol at least once (Unger, Kipke, Simon, Montgomery, & Johnson, 1997). Many homeless youth’s substance use reaches beyond experimenting and occasional use. For example, a study conducted in Los Angeles identified 48% of the homeless youth as meeting criteria for alcohol dependence (Greenblatt & Robertson, 1993). A sample of homeless youth in ten U.S. cities found alcohol prevalence rates of 81% among homeless and street youth (Ringwalt, Greene, & Robertson, 1998). Marijuana use has also been found to be consistently higher among homeless youth, as these young people are more likely to have tried marijuana (43.1%) than their housed counterparts (11.0%) (Ensign & Santelli, 1998).
Most respondents (93%) in one study of homeless youth reported they had tried drugs before they became homeless, mostly for recreational purposes. A large proportion (87%) was currently using more than one illicit drug (Klee & Reid, 1998). Another study found that homeless youth were three times more likely to use marijuana (43% versus 15%), seven times more likely to use crack or cocaine (19% versus 2.6%), five times more likely to use hallucinogens (14% versus 3.3%), and four times more likely to use heroin (3% versus7%) than their non-homeless peers (Forst, 1994).
Trauma and Victimization
A growing body of research suggests that traumatic experiences have numerous debilitating consequences and can impede a young person’s normal development (Foa, Johnson, Feeny, & Treadwell, 2001). Exposure to trauma during critical developmental stages can derail emotional growth and adversely affect a young person’s conceptualization of the world and their ability to relate and trust others (Thompson, McManus, & Voss, 2006). Adolescents who lack fundamental emotional and familial supports, such as those who run away or are homeless, may be at increased risk for serious adverse effects when exposed to traumatic experiences or situations (Becker et al., 2004). The longer youth remain on the street and away from stable homes, the more likely they are to be exposed to high rates of trauma-inducing events.
Serious psychological consequences exist for maltreated adolescents. Those who have experienced physical and sexual abuse at home are significantly more likely to meet diagnostic criteria for depression and to attempt suicide than youth who have not been abused (Ryan, Kilmer, Cauce, Watanabe, & Hoyt, 2000). Some note that runaway and homeless youth identify a broad range of mental health problems including depression, conduct disorders, post-traumatic stress disorder (PTSD), and psychotic symptoms. Some youth link their mental health problems to issues they experienced before running away, while others describe their problems as developing or worsening once they were on the streets, largely due to the stresses and strains of street life (Kidd, 2004; Thompson, 2005).
Family conflict experienced in the home may escalate into maltreatment when family dysfunction reaches a serious level, often resulting in the runaway episode. One study (Martinez et al., 1998) found that 37.6% of runaway youth reported a traumatic history which included being kicked out of their home, forced into institutional facilities, physical abuse, parents introducing drug use, parental drug use, placement with Child Protective Services, sexual abuse and rape, parental abandonment or death, family homelessness, and parental mental illness.
These youth frequently report physical abuse that involves long and severe beatings, as well as being kicked, slapped, and punched (Powers, Eckenrode, & Jaklitsch, 1990). Physical abuse includes severe violence (threatened or assaulted with a weapon, intentionally burned, punched with a closed fist, kicked, thrown around the room, head banged against the wall) to less violent forms of maltreatment (being tied up, being denied food or medical care, being held under water) (Gully, 2003; Whitbeck & Simons, 1990). One study reported that 80% of its sample of homeless youth had a caretaker throw something at them and that 43% reported being beaten up by a caretaker (Whitbeck, Hoyt, & Ackley, 1997a).
Sexual abuse that occurs before the youth runs from home is generally measured by verbal requests for sexual favors, being touched sexually, and being forced to engage in sexual activities against one’s will; these experiences are more commonly reported by girls (Simons, Johnson, & Conger, 1994). High incidents of sexual victimization have been reported among runaway youth; 31% of females and 11% of males report being forced into sexual activity by a caregiver (Whitbeck et al., 1997a; Whitbeck, Hoyt, & Ackley, 1997b). Neglect, however, is the most common form of abuse. Elevated levels of neglect are a wide-reaching aspect of maltreatment among runaway adolescents with reports as high as 48% (Powers et al., 1990). Neglect is demonstrated by parents’ inadequate guardianship, abandonment, lack of supervision or monitoring, and failure to provide adequate food, clothing, and medical care (Whitbeck & Simons, 1990). Physically and sexually abused youth run away more often, stay away longer, and suffer more serious psychological consequences, such as depression, suicide, and post-traumatic stress disorder than those not abused (Ryan, Kilmer, Cauce, Watanabe, & Hoyt, 2000).
Youth who are identified as homeless often experience traumatic and victimizing events while living on the street. Maltreatment in families increases the risk youths will be victimized once on the streets (Whitbeck et al., 1997a). Physically abused adolescents are significantly more likely to be assaulted on the streets than adolescents not abused by their families (Hoyt, Ryan, & Cauce, 1999; Ryan, Kilmer, Cauce, Watanabe, & Hoyt 2000). Many experience exploitation and victimization by adults, including members of their own families; thus, they become extremely distrustful and guarded in order to protect themselves (Ayerst, 1999). These experiences create an ongoing vulnerability to the detrimental effects of trauma exposure and ongoing victimization. Stewart and colleagues (2004) found that 82.7% of homeless youth had been exposed to at least one form of victimization after leaving home; Terrell (1997) indicated that 23.2% had been robbed, 45% were beaten up, 49.6% were threatened with a weapon, 35% were assaulted with a weapon, 36.6% were propositioned for sexual favors, and 20.7% were sexually assaulted while on the streets.
Research has shown that although many youth leave their homes prematurely to escape a violent environment or a dysfunctional family, life on their own is often more difficult than the life they leave behind (Whitbeck & Simons, 1990; Williams et al., 2001; Yoder, Whitbeck, & Hoyt, 2001). They live in extremely impoverished conditions and experience almost constant threats to survival in terms of daily struggles to meet basic needs. They experience their own repeated victimization as well as witness violent crimes perpetrated on others (Fest, 2003). When violence, molestation, and other traumatic experiences occur repeatedly and from various sources, the victim does not have time to recover from one trauma before another occurs. Multiple and continuous traumatic events have myriad adverse consequences on the emotional processing and development of these adolescents (Stewart et al., 2004).
Another important factor related to victimization among homeless youth is gender differences. Research shows that females are more likely to become victims of sexual assault, rape, and exploitation while males are more likely to become victims of physical violence, threats and assault (Janus, Archambault, Brown, & Welsh, 1995; McCormack, Janus, & Burgess, 1986; Lynn Rew, Taylor-Seehafer, & Fitzgerald, 2001; Whitbeck & Simons, 1993).
Mental Health and Physical Health
The mental health consequences associated with running away are varied. For example, major depression, post-traumatic stress disorder (PTSD), and conduct disorder are 3 times higher in runaway youths than in housed youths (Robertson et al., 2004). Because of traumatic experiences, these youth may experiences symptoms of post-traumatic stress disorder (PTSD). Symptoms of PTSD appear in three clusters that include intrusive thoughts and re-experiencing the trauma, avoidance or numbing, and hyper-vigilance. The likelihood of developing these symptoms and their severity are typically associated with the frequency and duration of trauma exposure (Carrion & Steiner, 2000).
Avoidant behaviors, such as efforts to avert thoughts, feelings, conversations, or activities associated with the trauma, are symptoms often experienced by a person with PTSD. These symptoms are described by runaway youth who have left home to circumvent continued abuse from a family member (Stewart et al., 2004). The experience of finding oneself alone at the age of most runaway adolescents can exacerbate trauma-related symptoms.
Youth who prematurely depart from home are highly vulnerable to depressive symptoms (Downey & Walker, 1992), in part due to growing up in families that exhibit interfamily conflict, rejection, poor communication, dysfunction, or abuse and neglect (Rotheram-Borus, 1993; Whitbeck et al., 1997a). Adolescents who experience abuse and perceive limited options may respond by becoming depressed and running away (Ayerst, 1999; Kurtz et al., 1991). Depression may induce complex emotional and behavioral responses where running away may be a form of passive avoidance and internalization, but also may develop into suicidal ideation and attempts (Whitbeck et al., 2000). Runaway adolescents are much more likely to experience depressive symptoms, have fewer adaptive skills to cope, and are more likely to harm themselves or experience suicidal ideation than their non-runaway peers (Yoder, Whitbeck, & Hoyt, 2001). Research suggests that 25% of runaway adolescents meet depression diagnostic criteria and symptoms increase the longer they are away from home (Smart & Walsh, 1993). Other research has estimated that 80–90% of runaway youth suffer from significant mood disorders, often resulting in suicidal thoughts and attempts (Whitbeck, Hoyt, & Bao, 2000).
Health issues that are often associated with youth running away are related to unplanned pregnancy and high-risk sexual behaviors (Kost & Hensshaw, 2012). Young women who feel uncared for by parents or who have experienced various levels of maltreatment have greater odds of becoming pregnant (Haley, Roy, Leclerc, Boudreau, Botvin, 2004) and may be kicked out or choose to leave once their pregnancies become known. Youth who run away often encounter heightened risk for becoming sexually active at an early age, having sex with multiple partners, and using birth control strategies inconsistently (Halcón & Lifson, 2004; Rew, 1996; Rotheram-Borus, et al., 1996).
Emotional distress is one of the most consistent and encompassing aspects of being homeless (Rew, 2000), and homeless youth must contend with loneliness and lack of emotional supports as they attempt to deal with life on the streets (Rew, Taylor-Seehafer, & Thomas, 2000; van der Ploeg, 1989). For these youth, emotional distress may increase psychological symptoms and mental health problems (Wormer, 2003). Homeless adolescents have higher incidence of a variety of mental health symptoms including anxiety (Kidd, 2004), depression (Rew, 2000), and post-traumatic stress (Stewart et al., 2004). The risk for all of these mental health challenges only increases the longer youth remain on the streets (Saade & Winkelman, 2002).
Given what is known concerning trauma among adolescents in general (Cohen, Mannarino, Zhitova, & Capone, 2003; Foa, Keane, & Friedman, 2000), the context of homeless youth’s daily existence points to a higher probability for trauma-related experiences and symptoms. The psychological health challenges of homeless youths may develop as these young people become estranged from conventional institutions (such as family, school, or work). Traumatic events often cause emotional as well as physical trauma and can lead to or aggravate mental health conditions; further, these youth are more likely to experience complex responses to trauma that require special consideration from service providers (Foa et al., 2000).
Trauma symptoms often co-occur with other disorders commonly evidenced among homeless youth, such as mood, anxiety, substance abuse, and conduct disorders (Gadpaille, 2004). These comorbid mental health symptoms may exacerbate or mask additional trauma symptoms. Thus, homelessness and the experience of living on the street influence how trauma-related symptoms are manifested among these young people. It is clear that youth who are homeless are exposed to high rates of victimization and trauma, both on the streets and prior to becoming homeless. It has also been argued that the experience of being homeless is in itself a form of psychological trauma, as life on the street is characterized by extremely impoverished conditions, constant threats to survival in terms of daily struggles to meet basic needs, repeated victimization, and frequent witness to violent crime (Ayerst, 1999; Fest, 2003). Consequently, homeless adolescents are particularly vulnerable to the detrimental effects of trauma exposure and ongoing victimization, resulting in the development of posttraumatic stress disorder symptoms (Stewart et al., 2004).
One study (Stewart et al., 2004) identifying specific symptoms associated with PTSD found that among homeless youth, 25% experienced intrusive thoughts, 27% avoided thinking about the traumatic event, 23% had decreased emotions (numbing), and 46% reported increased hyper-vigilance. As these young people may continuously experience traumatic events or situations, they may develop strong physical and emotional reactions to experiences that remind them of these traumas (Kaysen, Resick, & Wise, 2003). One of the major features of trauma symptomatology is the experience of intrusive thoughts related to the traumatic event and experiencing nightmares, flashbacks, and strong physical and emotional reactions (Kaysen et al., 2003). If they suffer trauma-inducing situations on a continual basis, as in constant threats of sexual assault or violence while on the street, these young people may develop strong physical and emotional reactions to experiences that remind them of the trauma experienced. They may respond by overreacting to certain “triggers” associated with the trauma, such as being in certain places and similar circumstances (Stewart et al., 2004).
Avoidant behaviors, such as efforts to avert thoughts, feelings, conversations, or activities associated with the trauma, are symptoms also experienced by traumatized individuals. These symptoms are described by homeless youth who have left home to circumvent continued abuse from a family member, only to confront threats to basic survival and ongoing exposure to traumatic experiences while living on the street (Stewart et al., 2004). Drug and alcohol abuse are often associated with avoidant behaviors as youth cope with trauma by blunting their emotions through substance use. Using drugs or alcohol becomes a strategy to forget the stresses and dangers of street life, avoid thoughts of past traumatic experiences, and obscure distress (Bender, Ferguson, Thompson, Komlo, & Pollio, 2010).
Specific manifestations of other symptoms of PTSD, such as hyper-arousal, difficulty concentrating, irritability, and trouble sleeping are often described by homeless youth (McCarthy & Thompson, 2010). They suggest that falling and staying asleep are extremely difficult, and report that they intentionally remain awake for days to guard their own safety and protect their belongings. Other forms of hyper-arousal can be seen in youth’s marked distrust of others, especially adults as they view adults as perpetrators of abuse and victimization (Kidd, 2003).
Youth who experience a sense of disconnection from family and conventional peers report feeling depressed, lonely, and ashamed of their current situation (Haldenby, Berman, & Forchuk, 2007). Psychiatric disorders among homeless youth are well documented (Rohde, Noell, Ochs, & Seeley, 2001) and high rates of suicidal behaviors are reported (Leslie, Stein, & Rotheram-Borus, 2002; Rew, Taylor-Seehafer, & Fitzgerald, 2001). The heightened exposure to traumatizing experiences on the streets creates a greater risk for developing symptoms of depression. One study of predictors of depression among homeless youth confirmed the negative effects of family conflict, but noted the powerful effects of street victimization on developing depressive symptoms (Whitbeck Whitbeck, Hoyt, & Bao, 2000).
Homeless youth are also at elevated risk for suicidal ideation and suicide attempts (Kennedy, 1991; S. Mallett et al., 2004; Unger et al., 1998; Yoder, 1999). In one study, over 50% of homeless youth reported experiencing suicidal ideation, and more than a quarter had attempted suicide in the past year (Yoder, Hoyt, & Whitbeck, 1998). Homeless youth who had thoughts of suicide described feelings of loneliness, worthlessness, hopelessness, and most strongly, a sense of being trapped or feeling helpless in their present situation (Kidd, 2004). Feelings of diminished self-worth, isolation, and rejection by family and society in general were central themes associated with suicidal ideation among homeless adolescents (Kidd & Kral, 2002). Like depression, predictors of suicidal ideation include past familial sexual abuse, substance abuse, internalized stress, and having had an acquaintance that attempted suicide (Yoder et al., 1998).
In additional to psychological symptoms, homeless youth are particularly vulnerable to contracting HIV and other sexually transmitted infections (STI) due to risky sexual behaviors and intravenous drug use (Clatts, Goldsamt, Yi, & Viorst Gwadz, 2005; Kral, Molnar, Booth, & Watters, 1997; Zimet & Sobo, 1995). Specifically, early sexual experiences, having multiple sexual partners, and lack of condom use are sexual risk factors frequently reported by homeless youth (Kral et al., 1997; Rotheram-Borus, Meyer-Bahlburg, Rosario, Koopman, & et al., 1992; Zimet & Sobo, 1995). Additionally, engaging in sex work as a means of income and survival on the streets increases their risk for STIs (Lankenau, Clatts, Welle, Goldsamt, & Gwadz, 2005). Between one-quarter to one-half of homeless youth report involvement in prostitution (Ennett, Federman, Bailey, Ringwalt, & Hubbard, 1999; Greenblatt & Robertson, 1993; Rotheram-Borus et al., 1992), and one-fifth report using sex to get drugs, clothing, shelter, or food in addition to money (Halcón & Lifson, 2004). Pregnancy rates among young women who are homeless are significantly higher than those found among housed young women (Thompson, Bender, Lewis, & Watkins, 2008), and those who become pregnant have higher rates of repeated pregnancy (Halcón & Lifson, 2004). While pregnant teens have high risk of low birth weight babies and neonatal death (Kirby, 2001), homeless young women have greater negative outcomes due to poor nutrition, inadequate prenatal care, smoking, and drug use (Goldenberg & Klerman, 1995).
Strategies to Overcome Challenges
Runaway and homeless youth develop a variety of strategies to cope with and overcome challenges they experience while away from family and other conventional, pro-social supports. They describe developing “street smarts” that help them to stay safe “on the streets.” These strategies may defy social norms and receive disapproval by society in general, but they appear necessary for youth to gain competency to endure and survive in the street economy. In addition, peers are described as important and indispensable supports. However, involvement with like-minded, homeless peers may encourage the use of illegal survival strategies to meet subsistence needs or support addiction behaviors (Baron, 2009). Finally, services are formal means of addressing the challenges experienced by runaway and homeless young people. From youth emergency shelters to outreach and drop-in services, formal services aim to help youth overcome their difficulties and transition to the most appropriate level of support.
Survival strategies can be defined as skills utilized by homeless and runaway youth to overcome challenges while living away from family and other conventional supports. While some survival skills used by these youth are legal, others are not. Illegal survival strategies may include prostitution, stealing, and drug distribution. Youth may also exchange sex for shelter, food, drugs, or money (Kipke, Unger, OConnor, Palmer, & LaFrance, 1997). Findings of a multi-site study suggested that the most common survival strategies are panhandling, theft, selling stolen goods, selling blood and plasma, selling drugs, and conning others for money (Bender et al., 2010). Another study found the most common survival strategies were panhandling (73%), survival sex and prostitution (46%), part-time or seasonal employment (34%), drug dealing (32%), theft (29%), and borrowing money from a friend (28%) (Kipke et al., 1997). Other research demonstrated that 31% of homeless youth had no formal employment and relied solely on survival strategies, 28% had some formal or informal employment, and 22% relied on a combination of survival behaviors and employment (Ferguson, 2007). Others have reported that 10–50% of homeless youth who engage in these methods do so to meet basic needs for food and clothing (Greene, Ennett, & Ringwalt, 1999).
Legal survival strategies include selling personal items and donating blood and plasma. Still other strategies are monitored by city regulations, including panhandling or “spanging” (asking for spare change). Although in most locations these approaches to seeking resources are legal, society typically disapproves of them and views these activities as counter to conventional norms (Ferguson, Bender, Thompson, Xie, & Pollio, 2012).
Strategies for staying safe have been described from a variety of contexts. For example, youth describe their “home” as dangerous due to the high frequency of criminal activity, assault, and victimization in their environment (Gaetz, 2004). Therefore, they have difficulties with falling and staying asleep, reporting that they intentionally remain awake because of concern for their own safety and to protect their belongings (Kidd, 2003; Whitbeck & Hoyt, 1999). Safety strategies have been identified as changing routines and activities, avoiding certain places, carrying one’s possessions at all times, taking a self-defense course, trying to look tough, getting a dog, carrying a weapon, and changing locations or moving frequently (Gaetz, 2004).
Runaway and homeless youth peers play an important role in the daily lives of these adolescents. While youth who runaway lack support structures that enhance resilience or offer emotional support (Harter, Berquist, Titsworth, Novak, & Brokaw, 2005; Sean A. Kidd, 2007), they often become engaged in other delinquent behaviors. Other runaway and homeless peers become a necessary source of information and support, but may not encourage pro-social behavior, may have similar behavioral and mental health challenges, and may use drugs and alcohol (Thompson, Pollio, Constantine, Reid, & Nebbitt, 2002; L.B. Whitbeck & Hoyt, 1999). These youth are drawn to other similarly situated peers for support, camaraderie, and mentorship needed to survive outside the parental home (Yoder, Whitbeck, & Hoyt, 2003). Networking with streetwise peers can protect them and provide the physical safety necessary to survive (Greenblatt & Robertson, 1993).
Youth groups often form surrogate families with other street youth as they create connections that offer all members involved a sense of security and belonging (Bender, Thompson, McManus, Lantry, & Flynn, 2007). As association with deviant peers has been shown to be highly related to problem behaviors and only modestly reinforcing of more pro-social behaviors (Dishion, Spracklen, Andrews, Patterson, 1996), peer relationships among youth engaged with street culture appears highly influential. With premature detachment from parental influences and pro-social institutions, homeless youth are more directly drawn to peers for all levels of support. Street friends provide an important learning environment for initiating survival strategies but often reinforce for drug-using behavior (Kipke, Montgomery, Simon, & Iverson, 1997). There is evidence that these youth seek out drug-using friends after becoming involved in drug use themselves; they embed themselves in social networks that reinforce drug-related choices, attitudes, and behaviors (Baron, 1999). Often termed peer contagion (Mennis & Harris, 2011), these relationships help protect a recently street-involved youth, but may also increase further victimization and engagement in high-risk behaviors due to the obligations required for being involved in the social network (McManus & Thompson, 2008).
Two basic service sectors provide assistance to runaway and homeless youth: youth emergency shelters and drop-in or street outreach services. Shelter and drop-in services are the most common and frequently used service-points for runaway and homeless youth (Karabanow & Clement, 2004); they also act as a gateway to other services as young people who utilize these services are significantly more likely to access medical, dental, and mental health services (De Rosa et al., 1999; Mallett et al., 2004).
Housing and criminal justice services also are often involved in the lives of homeless and runaway youth. Housing is a component of services frequently needed and utilized by homeless youth or runaway youth who do not reunify with parents following a runaway episode. Criminal justice professionals or police-oriented encounters are also a common occurrence and are unique to the lifestyles and experiences of runaway and homeless youth.
Community-based Youth Emergency Shelters
Emergency youth shelters are the principal services designed to meet the complex needs of adolescents who leave home before possessing skills to live autonomously. Emergency shelters provide overnight accommodations and services ranging from minimal assistance to extensive case management (Nebbitt, V., House, L., Thompson, S., & Pollio, D.,, 2007). Youth may self-refer to shelters or may be admitted by parents, guardians, child protective service caseworkers, and others. Shelters provide a variety of crisis and custodial services, including short-term residential care, individual, group, and family counseling, educational and vocational services, recreational activities, and information, referral, and outreach services (Rohr & James, 1994). The primary focus of these programs is to de-escalate crises, establish communication between the youth and his or her family, attempt to stabilize the home environment, and reunify youths with their families whenever possible and appropriate (Thompson, Maguin, & Pollio, 2003). Their mission focuses on reunifying youths with their families or assisting them in developing skills to live independently while reducing the likelihood of adolescent’s involvement in high-risk behaviors (Shane, 1989). The main goal of shelter services is to provide a place for youth that is safe from the hazards of street living while they are assisted in finding a stable, normative residence that suits their needs (Dekel, Peled, & Spiro, 2003).
Among those runaway youth who are discharged from youth shelters, more than half (53%) return to their parental home (Bass, 1992). Although youth report difficulties in their homes, studies have shown that those who reunify with their families have more positive outcomes than those who find housing in other locations upon leaving the shelter. In addition, youth who fail to reunify with family have longer shelter stays, increased hopelessness, suicidal thoughts and behaviors, report more family problems, and have a more pessimistic view of the future than those who return to their families following a runaway episode (Teare, Furst, Peterson, et al, 1992).
Homeless Youth Drop-in and Outreach Services
Drop-in and outreach services are provided to young people between 18–23 years of age who are defined as homeless. They typically offer specialized services such as basic supplies of food and clothing, crisis counseling, educational and vocational programs (Nunez, 1994; Robertson & Toro, 1998), substance abuse counseling (Slesnick & Prestopnik, 2005), and dental care and medical services focusing on sexual health promotion (Rew, Chambers, & Kulkarni, 2002). However, drop-in centers do not typically offer residential services or over-night shelter. Drop-in center staff work to build trusting relationships through case management service options (Tenner, Feudo, & Woods, 1998). Not only do drop-in centers provide services within agency settings, but they can connect with the more difficult-to-reach homeless youth through street outreach. Outreach efforts focus on distributing condoms and used needle bleach kits while providing education and referrals to other community resources. This model of intervention has demonstrated greatest success when homeless youth are met through intercepting them on the street, through flexible hours of operation, and recognizing and addressing their specific and unique needs (Baer, Peterson, & Wells, 2004). As homeless youth often lack transportation and have no means of locating immunization and medical records, outreach workers often focus on assisting with finding options. Homeless youth services are often complicated by the mobility of the young people, difficulty in developing rapport, and the inability to reach all those who requires services (Serrano et al., 1993).
Housing is another component of services frequently needed and utilized by homeless youth or those youth who do not reunify with parents following a runaway episode. These services focus on various models that aim to transition youth from the street to more stable residential living.
Several types of housing models have been developed to address the needs of homeless individuals: “Treatment First” and “Housing First.” The “Treatment First” model includes a continuum of housing strategies in which clients are required to adhere to a case management plan with a focus on their mental health and substance abuse issues prior to being placed in less restrictive residential environments, such as transitional housing. Emergency shelters are considered an important first step towards permanent housing (Feins & Fosburg, 1999). Additional support is offered and required to utilize housing services (Locke et al., 2007). Sobriety, as well as psychiatric medication compliance for persons with mental health disabilities, is required for permanent housing. These requirements often deter homeless young people from seeking this housing option (Falvo, 2009).
“Housing First” is another model that aims to place people into transitional or permanent housing without prerequisites, such as participation in required services or previous success in temporary housing programs. Providers often consider the continuum of housing services not as sequential placements but as a series of unique and specialized options that target individuals’ needs. “Housing First” focuses on rapid placement into permanent housing with few transitional placements, and the housing is maintained with help from community-based supports (Locke et al.). Studies suggest that “Housing First” participants remain housed for longer periods, spend less time in the hospital (Gulcur et al., 2003), and are no more likely to use drugs or alcohol than those in the “Treatment First” model (Falvo, 2009; Padgett et al., 2006).
Utilizing services that appropriately address the needs of runaway and homeless youth is important to their progress and future development; however, many youths are highly reticent to use these services (Brooks, Milburn, Rotheram-Borus, & Witkin, 2004; De Rosa et al., 1999; Greene, Ringwalt, & Iachan, 1997; Kipke, Montgomery, & MacKenzie, 1993; Slesnick, Meade, & Tonigan, 2001). Not only do they experience institutional barriers, such as lack of insurance or transportation to care (Yates, Pennbridge, MacKenzie, & Pearlman, 1990), they are distrustful of formal services and authority figures. They fear being reported to police or child protective services due to status offenses or other outstanding warrants. Because of previous exploitation and victimization by adults, including members of their own families (Farrow, Deisher, Brown, Kulig, & Kipke, 1992; Kurtz, Lindsey, Jarvis, & Nackerud, 2000), they resist institutional forms of support.
Police and Criminal Justice System Involvement
Approximately 2.18 million adolescents were arrested for delinquent acts in the United States during 2007 (Puzzanchera, 2009). Juvenile offenders and runaway and homeless youth populations share similar challenges, such as substance abuse, mental health problems, learning disabilities (Tripodi & Springer, 2007), family violence, maltreatment, abuse (Dembo, Schmeidler, & Childs, 2007), and gang involvement (Gatti, Tremblay, Vitaro, & McDuff, 2005). For youth who have run away and become engaged in street culture, involvement in criminal activities is common. The combination of affiliations with deviant peers, exposure to crime and violence, and substance abuse creates an environment context where illegal activity becomes normalized. Runaway youth may participate in status offenses, such as truancy, alcohol use, petty theft, loitering, or trespassing. Homeless youth, however, often engage in more egregious or flagrant crimes, such as assault, prostitution, drug distribution, and illegal drug abuse (Hagan & McCarthy, 1997). Police departments and juvenile and family courts have responded to these behaviors by using a variety of strategies. For example, some homeless youth are targeted in malls, on the streets, and where they congregate and are arrested or detained for minor offenses such as “urban camping or panhandling;” other locales have responded in less punitive ways by developing juvenile delinquency services that separate status offenders from those engaging in illegal or criminal behaviors (Miles, 2003). Police have wide discretion in handling runaway and homeless youth based on whether they were reported as a missing person, the amount of parent or caretaker concern, and the seriousness of the risks or illegal behaviors of the youth. Because police are primarily concerned with public safety, a youth’s runaway behavior may be viewed as less concerning than his or her involvement in criminal activities. In the 2010s, laws have been passed across the country to extend outreach efforts, shelter options, and the focus of social services to create greater rapport with runaway and homeless youth. The focus is less on punitive, legal measures and more on assisting these young people to locate and access appropriate services, such as drug treatment, counseling and job training.
Practice Implications for Social Workers
Social work practice literature highlights the importance of developing a strong therapeutic relationship with clients. Developing supportive relationships with runaway and homeless adolescents requires acknowledging their strengths, treating them with respect, using self-help strategies, and assisting them to recognize their own power for change (de Winter & Noom, 2003; Karabanow & Clement, 2004). Social workers and other helping professionals must take care to be non-threatening to the youths’ self-sufficiency and to develop relationships of support that address the needs of the youth rather than dictating to them (Fest, 2003). These young people have noted a desire for services that are respectful of their strengths and whose social workers and other staff can be trusted to maintain confidentiality (Slesnick et al., 2001). Given many youths’ exposure to traumatic situations beginning in childhood and further victimization after they have run away and turned to life on the streets, service providers must be extremely sensitive to the young person’s desires for interaction and assistance (Stewart et al., 2004). Appropriate service provision to these highly vulnerable and wary youth requires understanding street culture and recognizing the skills and determination these young people need to survive. Helping professionals who find a balance between respecting the youth’s independence and providing assistance (de Winter & Noom, 2003), while recognizing the role that choice plays in the youths’ street involvement are likely to be most effective (Fest, 2003).
As many of these youth have escaped families marked by violence and hostility, they have learned to survive on their own and meet their own needs. Given this level of autonomy, providers who consult with youth to determine useful self-help strategies are likely to be more effective. Providers who assess the quality of family, neighborhood, and street ties to determine effective means of positive support will likely find avenues for developing positive change (Johnson, Whitbeck, & Hoyt, 2005; Kidd, 2003). As services are totally voluntary, significant efforts must be focused on the preferences and perspectives of need voiced by these young people. For example, homeless young women who become pregnant before or after running away have unique needs. Social workers in drop-in centers and youth emergency shelters are in a prime position to provide assistance and guidance in making decisions concerning pre-natal care, parenting, adoption, or pregnancy termination.
Brief, strengths-oriented practices have been shown effective with homeless youth, more so than “problem-oriented” approaches (Baer et al., 2004). Homeless youth respond best to client-centered services that are flexible, encourage striving to attain goals despite setbacks, and focus on strengths that they already possess. Services that are flexible in terms of rules and regulations, are easily accessible, focus on respect and promote cleanliness are clean likely result in improved utilization and positive outcomes (Rew, et al., 2002). Providers who make judgments and decisions based on their own values and beliefs will likely misjudge situations associated with these youth, resulting in services that do more harm than good (Fest, 2003).
It is evident that a positive working alliance is needed for service providers to be effective in interactions with homeless and runaway youth. Providers who recognize the complexities of living and surviving on the street will also be a stronger position to provide appropriate assistance and encouragement to young adults in moving from the streets into developmentally appropriate, stable living situations. Thus, successful providers are likely to be those who engage youth in the process of change by encouraging their active participation in developing goals and working towards achieving their desired outcomes.
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