Measurement of negative consequences of substance use in street youth: an expanded use of the Rutgers Alcohol Problem Index

The Rutgers Alcohol Problem Index (RAPI) was used to assess negative consequences due to both alcohol and drug use. Data were collected from 173 substance using homeless adolescents (13-19 years of age, 58% male) who were grouped based on the substances rated: alcohol only, alcohol and drugs, or drugs only. The RAPI retained good internal consistency across substance categories, exhibited strong measurement construct congruence, and good convergent validity based upon correlations with assessed DSM diagnostic criteria (both dependence and abuse). Discussion focuses on the RAPI as a reliable instrument for the measurement of negative consequences for alcohol and drug use.

Treatment outcome for street-living, homeless youth

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

Changes over time among homeless young people in drug dependency, mental illness and their co-morbidity

A cross-national survey was conducted among 358 recently homeless young people in Melbourne and Los Angeles. Drug dependence and mental illness were assessed at baseline, 6 and 12 months. At each time point, participants were classified as no condition, drug dependent, having a mental illness or dual condition. Low levels of drug dependence or mental illness or both were reported at each data point. Most young people were classified as neither drug dependent nor having mental illness at baseline and remained so for the 12-month period and few remained drug dependent, or had continuing mental illness or both. Half to two-thirds of young people classified as having one or both conditions were subsequently reclassified as "no condition". There was no evidence of a consistent pathway from either drug dependence or mental illness to co-morbidity. Most young people reported an absence of mental illness and/or drug dependence at each time point. Improvement from one or both conditions at each transition suggests it may be more effective to provide interventions to address drug dependence and mental health problems to young people early in their experience of homelessness.

Life on streets

OBJECTIVE

Millions of children leave home in hope of finding a more tolerable life. The study tries to find out the kind of life they lead once out on the streets.

METHODS

Cross-sectional study of all street boys admitted to a Child Observation Home in New Delhi during specified 6 months. Questions regarding various aspects of survival on streets were asked.

RESULTS

Majority are forced to work in informal sector for survival with earnings well below the minimum wages. To escape from the exploitation and hardships, many begin abusing substances. The street experience leads to hopelessness for the future and suicidal tendencies.

CONCLUSION

After circumstances at home force these kids to escape, they are caught up in yet another world of exploitation, hunger, violence and abuse.

Asthma among homeless children in New York City: an update

Homeless children in New York City had an extremely high asthma prevalence-40%-in a cross-sectional study at 3 shelters (n=740) during 1998 to 1999. We used the same protocol to summarize subsequent data through December 2002. Asthma prevalence was 33% (n=1636); only 15% of the children previously diagnosed were taking an asthma controller medication. Emergency department use was 59%. These data were used to support a class action lawsuit that was resolved in favor of homeless children with asthma in New York City.

Use of the FirstSTEp screening tool with children exposed to domestic violence and homelessness: a group case study

Children who experience homelessness and domestic violence enter early childhood programs with developmental and behavioral challenges. Thoroughly evaluating these children can be daunting for daycare staff without advanced training. Occupational therapists can provide child development expertise and consultation. This group case study examined the FirstSTEp screening tool's ability to measure the behavioral, developmental, and emotional changes of 19 pre-schoolers who experienced homelessness and witnessed domestic violence. The tool was found to be effective with this population.

The frequency of sexual abuse and depression in a sample of street children of one of deprived districts of Tehran

The purpose of this study was to determine the frequency of sexual abuse and depression among street children who live in a deprived district of Tehran. The researchers used the K-SADS questionnaire and a clinical interview were used to evaluate depression and sexual abuse in 87 street children in Tehran. Eighteen (20.9%) of the children had been sexually abused. Depressed children were 3.2 times more likely to be sexually abused than non-depressed children. Furthermore, 26 girls (86.7%) and 27 boys (48.2%) suffered from depression. The frequency of depression demonstrated a significant association with the father's or breadwinner's history of imprisonment or unemployment. Interventional programs providing education and support should be implemented for street children.

The health and well-being of neglected, abused and exploited children: the Kyiv Street Children Project

OBJECTIVE

To report on the backgrounds and physical and emotional well-being of street children using two street shelters in Kyiv, Ukraine. This study is important because personal accounts of street children may highlight individual or family factors that are associated with vulnerability for and risk of poor mental health, and these could have serious repercussions for the future. This study also poses a challenge to research because street children are a highly elusive population that services find hard to reach.

METHODS

Ninety-seven children were recruited and interviewed using a semistructured, psychosocial interview schedule; psychopathology was measured using the Strengths and Difficulties Questionnaire (SDQ) and the Mood and Feelings Questionnaire (MFQ).

RESULTS

Seventy percent of street children scored for behavioral and emotional difficulties on the SDQ, and 74% scored for depression on the MFQ. Current health problems were reported by 78%, with 43% described as persistent or severe. Two thirds of the children in this sample were not homeless but had chosen life on the streets in preference to permanent residence with their families. Their "survival" history on the streets contributed to the development of three different profiles of vulnerability.

CONCLUSIONS

High rates of physical and emotional problems in a population of street children, many of whom were still connected to their families, emphasize the importance of developing different approaches for children with different vulnerabilities. This study also demonstrates the feasibility of embedding on-going field research into the service dimension of "front-line" social care agencies.

Victimization and posttraumatic stress disorder among runaway and homeless adolescents

This article presents lifetime and 12-month prevalence rates and comorbidity for posttraumatic stress disorder (PTSD) among a sample of 428 homeless and runaway adolescents. Data are from baseline interviews of a longitudinal diagnostic study of 428 (187 males; 241 females) homeless and runaway adolescents aged 16-19 years (mean age = 17.4 years, SD = 1.05). The data were collected by full-time street interviewers on the streets and in shelters in eight Midwestern cities of various populations. About one-third (35.5%) of the runaways met lifetime criteria for PTSD and 16.1% met 12-month criteria for the disorder. More than 90% of the adolescents who met criteria for PTSD met criteria for at least one of the other four diagnoses. Multivariate analyses indicated that correlates of PTSD were age of adolescent, being female, having experienced serious physical abuse and/or sexual abuse from an adult caretaker, and having been assaulted or injured by weapon when on the street. The multiplicative interaction between sexual abuse by caretaker and sexual assault when the adolescents were on their own was statistically significant, indicating that rape victims were highly likely to meet criteria for PTSD regardless of early sexual abuse. At very high levels of early sexual abuse, the probability of meeting criteria for PTSD converges with that for sexual assault victims.

A systematic review of cognition in homeless children and adolescents

Objectives The cognitive function of homeless children and adolescents may be overlooked, albeit understandably, when societal interventions focus on their immediate housing needs. Nevertheless, homelessness might be hypothesized to carry many risks for the developing mind and brain. We wanted to discover whether this hypothesis had been tested previously. Design A systematic review to examine whether cognitive impairments were reported in homeless children and adolescents. Setting Objective, systematic review of standard databases, examined by key word searches. Participants Children and adolescents. Main outcome measures Formal assessments of cognition. Results We found that in spite of there being many homeless children in the world, fewer than 2000 have been assessed cognitively and reported in the literature. Yet when compared with those who are domiciled, these children tend to have lower intellectual functioning and decreased academic achievement. Furthermore, adolescents evince cognitive impairments in the contexts of drug, physical, and sexual abuse. Conclusions We suggest that cognitive and mental health screening be incorporated into those intervention programs deployed to facilitate societal reintegration of homeless children and adolescents.

Who runs? A demographic profile of runaway youth in the United States

Prevention and treatment programs for runaways have been hindered by an inadequate population profile. Using Add Health data to determine 12-month prevalence and demographic predictors of running away, we found that over 6% of youths reported running away. Running was predicted by biological gender, age, region, urbanicity, and family structure.

A qualitative study of early family histories and transitions of homeless youth

Using intensive qualitative interviews with 40 homeless youth, this study examined their early family histories for abuse, neglect, and other family problems and the number and types of transitions that youth experienced. Multiple forms of child maltreatment, family alcoholism, drug use, and criminal activity characterized early family histories of many youth. Leaving home because of either running away or being removed by child protective services often resulted in multiple transitions, which regularly included moving from foster care homes to a group home, back to their parents, and then again returning to the streets. Although having experienced family disorganization set youth on trajectories for early independence, there were many unique paths that youth traveled prior to ending up on the streets.

Eating rough: food sources and acquisition practices of homeless young people in Adelaide, South Australia

OBJECTIVE

The aim of this study was to determine the food sources and acquisition practices used by homeless youth in Adelaide. This work is part of a larger study that aimed to examine the extent and nature of food insecurity among homeless youth.

DESIGN

Cross-sectional design involving quantitative and qualitative methods.

SETTING

Four health and welfare inner-city agencies serving homeless youth in Adelaide, South Australia.

SUBJECTS

A sample of 150 homeless youth aged between 15 and 24 years recruited from these agencies. Fifteen were selected via snowball sampling for interview.

RESULTS

Use of welfare food sources was high (63%). Food from welfare agencies was supplemented by unorthodox food acquisition methods such as theft (65%), begging for money for food (61%), begging for food items (44%) and asking for help from friends and relatives (34%). Reasons given for non-usage of welfare food services included affordability, access, being too busy, shame or embarrassment.

CONCLUSIONS

Food insecurity is a salient issue for some homeless youth in Adelaide. Clarifying food acquisition practices of food-insecure homeless youth is essential for rational planning and improvement of food-related services to meet their needs. Such an understanding also underpins the development of broader public policy responses that improve individual and household skills and resources to acquire food and ensure food security. Nutrition professionals, welfare professionals and policy-makers need to work sensitively with welfare food agencies and others to improve food access and food security for homeless youth.

Why do homeless young people leave home?

OBJECTIVE

To describe the reasons homeless young people leave home and differences between males and females.

METHODS

Homeless young people between the ages of 12 and 20 years (n = 692) completed surveys conducted by trained interviewers using Questionnaire Delivery System on laptop computers as part of a large study. Participants indicated the importance of each of 22 reasons for leaving home on a four-point scale, from 'not important' (1) to 'very important' (4).

RESULTS

Conflict with parents was the only reason reported as important by at least two-thirds of respondents. Desire for independence and/or adventure was rated as important by nearly one-half of young men and women. Eighteen reasons were rated as 'not or somewhat important' by most young people. These included issues associated with school, sexuality, sexual abuse and trouble with the law. Young women were more likely than young men to report that sexual abuse, anxiety/depression, and/or pregnancy were important reasons for leaving home. The converse held for personal alcohol and drug abuse, trouble with the police, and breach of community order or parole. With few exceptions, importance ratings of the 22 reasons were not highly correlated.

CONCLUSIONS AND IMPLICATIONS

Service providers should consider how the diverse elements of family environment contribute to homelessness. A focus on familial problems may lead to other important reasons being overlooked, namely a desire for independence and adventure. Services and supports need to take into account whether young people leave home because of a life crisis or because they seek independence.

Food insecurity among homeless and runaway adolescents

OBJECTIVE

The purpose of this study was to investigate the prevalence of food insecurity and factors related to it among homeless and runaway adolescents.

DESIGN

Computer-assisted personal interviews were conducted with homeless and runaway adolescents directly on the streets and in shelters.

SETTING

Interviews were conducted in eight Midwest cities: Des Moines, Cedar Rapids, Iowa City, Kansas City, Lincoln, Omaha, St. Louis and Wichita.

SUBJECTS

The subjects were 428 (187 males; 241 females) homeless and runaway adolescents aged 16-19 years. Average age of the adolescents was 17.4 (standard deviation 1.05) years.

RESULTS

About one-third of the adolescents had experienced food insecurity in the past 30 days. Factors associated with food insecurity were age of adolescent, a history of caretaker neglect and abuse, having ever spent time directly on the street, a small post-runaway social network, and engaging in deviant and non-deviant street food-acquisition strategies.

CONCLUSIONS

Based on these findings, our conservative estimate is that nationally more than 165,000 homeless and runaway adolescents experienced food insecurity in the past 30 days. These adolescents are largely hidden from public notice and they are usually missed in studies that address national hunger.

Predictors of running away from family foster care

Running away is a frequent but little studied phenomenon among adolescents in foster care. Repeated running from care often leads to premature discharge and homelessness for youth. This article uses cumulative risk theory in the context of normative adolescent development to investigate predicators of running away from foster care. Results indicate risks stemming from individual, foster home, and child welfare system sources, which offer some insight for prevention and intervention.

The model standards project: creating inclusive systems for LGBT youth in out-of-home care

This article describes the Model Standards Project (MSP), a collaboration of Legal Services for Children and the National Center for Lesbian Rights. The MSP developed a set of model professional standards governing the care of lesbian, gay, bisexual and transgender (LGBT) youth in out-of-home care. This article provides an overview of the experiences of LGBT youth in state custody, drawing from existing research, as well as the actual experiences of youth who participated in the project or spoke with project staff. It will describe existing professional standards applicable to child welfare and juvenile justice systems, and the need for standards specifically focused on serving LGBT youth. The article concludes with recommendations for implementation of the standards in local jurisdictions.

Outcomes for a transitional living program serving LGBTQ youth in New York City

Providing stable housing for runaway and homeless youth is a major function of a transitional living program. This article introduces the focus of one program working with LGBTQ youth in New York City and discusses some issues to consider when working with this population. The article also presents data associated with young people's lives after discharge. In any discussion of outcomes, both reason for discharge and length of stay play important roles in whether or not an exit is safe. Regardless of these two elements, the places youth move to when leaving programs are crucial to their safety and well-being. The exit can be safe even when a young person is discharged early from a program. This article presents types of exits, as well as status of employment and school enrollment at exit. Some youth and staff-identified lessons gained in the program also are discussed in detail. Types of aftercare services sought by discharged youth are specified. This article also describes any differences in outcomes for youth with and without foster care experience.

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

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

Putting the pieces together for queer youth: a model of integrated assessment of need and program planning

Needs assessments require staff with the necessary expertise to design the study, collect the data, analyze the data, and present results. They require money, time, and persistence, because the people one wishes to assess often are difficult to access. This article argues for the centrality of a well-done needs assessment when developing services for LGBTQ youth. Needs assessment methodology and adjunctive uses of the needs assessment data also are discussed. The authors present a needs assessment of LGBTQ youth living in out-of-home care in San Diego, California, as an example of the purpose, practicality, and power of a comprehensive needs assessment. The needs assessment identified several issues, as well as additional data supporting the project's necessity. The data also identified the most significant obstacles youth face in accessing housing and supportive services. Through the data collection process, non-LGBT housing providers better understood their need for additional training, and housing and city leadership communities obtained and spread knowledge of the project.

Runaway youths and correlating factors, study in Thailand

OBJECTIVE

To study differences between runaways and non-runaways in a mental health clinic and to study differences between runaways in a mental health clinic and legal / shelter system.

MATERIAL AND METHOD

Psychiatric records of runaways and non-runaways from Vajira Hospital were collected from June 1994 to October 2003. 21 cases in each group were studied in various factors. 21 runaway cases who were in child and adolescent shelters were interviewed by the researchers.

RESULTS

Neglect, sexual abuse, rejection, poverty and truancy were more common in the runaway group. The runaway group had more conduct disorder and substance abuse. Physical abuse, authoritarian and being in custody were more common in runaways in shelters.

CONCLUSION

Various factors correlate with running away. These factors lie beneath long before runaway has taken place and understanding and managing them help in preventing and prompt treatment.

Adolescent homelessness, nursing, and public health policy

Homelessness among American adolescents is not a new phenomenon. The United States has a long history of youth who are runaways and/or homeless. The majority of adolescents who are homeless believe that they have no acceptable housing placement options. The foster care system often fails to help youth deal with problems. The impact of homelessness on youth's social functioning and health status should be raised at the community level, particularly by community nurses and other health professions who interact with adolescents who are homeless. By using Kingdon's multiple streams model, nurses can advocate for homeless youth by accurately defining and reframing adolescent homelessness for policy makers and including provision of shelter as a policy priority.