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 typology of runaway youths: An empirically based definition

One approach that is useful for improving services to a heterogeneous population is to develop typologies of the subgroups within the population. Over the last few years there have been a number of typologies put forward to better define those youths who run from home. However, these typologies historically have been based on practice experience and literature reviews. In this paper, the literature is reviewed to develop composite groups of runaways and homeless youths. Then this proposed typology is tested with a sample of 262 youths from runaway shelters and youths living on the street. Discriminate analysis is used to develop an empirically based typology. Implications for clinicians and service providers are discussed.     

Mental Disorders,Comorbidity, and Postrunaway Arrests Among Homeless and Runaway Adolescents

This study examined the associations between lifetime mental disorder, comorbidity, and self‐reported postrunaway arrests among 428 (187 males, 241 females) homeless and runaway youth. The analysis examined the pattern of arrests across five lifetime mental disorders (alcohol abuse, drug abuse, conduct disorder, major depressive episode, and posttraumatic stress disorder). The adolescents, ranging from 16 to 19 years old, were interviewed directly on the streets and in shelters in four Midwestern states using computer‐assisted personal interviewing. Extensive self‐reports of early life history, behaviors since running away from home, and diagnostic interviewing (UM‐CIDI and DISC‐R) were used to estimate possible disorders. There was a high level of postrunaway arrests reported by the youth; more than half were arrested at least once after the initial runaway, with the average of 4.4 times. Consistent with the hypotheses, there were differential associations between individual mental disorders and involvement with the criminal justice system. Only externalizing disorders such as substance abuse and conduct disorder were related to arrest. Street youth with multiple externalizing and internalizing disorders were more likely to be arrested than nondisordered youths.     

Risk Factors for Homelessness Among Lesbian, Gay, and Bisexual Youths: A Developmental Milestone Approach

Lesbian, gay, and bisexual (LGB) youths are over-represented in the homeless population. To examine why some LGB youths become homeless, this report compares homeless and non-homeless LGB youths. Of the 156 LGB youths, 48% reported ever being homeless (i.e., running away or being evicted from home). Results indicate that sexual orientation awareness and the initiation of sexual behavior occurred earlier in homeless than in non-homeless LGB youths and predated the first homeless episode. Substance use was more frequent and first occurred at an earlier age in homeless as compared to non-homeless LGB youths; however, substance use occurred subsequent to first homelessness. Childhood sexual abuse was associated with homelessness; and, early sexual orientation development was related to homelessness among youths without a history of sexual abuse. Findings suggest that interventions should help youths cope with their unfolding sexual orientation and work to prevent or address the consequences of sexual abuse.     

How Runaway and Homeless Youth Navigate Troubled Waters: Personal Strengths and Resources

Little attention has been paid to how runaway or homeless adolescents are able to make successful transitions into adulthood. This article reports on partial findings from an exploratory study of the research question, “How do formerly runaway and homeless adolescents navigate the troubled waters of leaving home, living in high-risk environments, and engaging in dangerous behaviors, to make successful developmental transitions into young adulthood?” This qualitative study involved interviews with 12 formerly runaway or homeless youth. Data were analyzed using the constant comparative method. This paper reports on findings related to the personal strengths and resources that enabled youth to make successful transitions: learning new attitudes and behaviors, personal attributes, and spirituality. Recommendations for program development and intervention with homeless or at-risk youth are discussed.     

Perceptions of and Reactions to the Homeless: A Survey of Fourth-Grade,High School,and College Students in a Small Midwestern Community

A total of 459 fourth-graders, high school students, and undergraduates completed a Homelessness Questionnaire developed for use in this study. Although participants generally expressed positive and supportive attitudes toward the homeless, attributing homelessness to either social maladjustment (e.g., drug problem) or negative characteristics (e.g., laziness) within the homeless was positively associated with “fear of and anger toward the homeless” for all groups of participants. In addition, perceptions of and reactions to the homeless were influenced by both the participants’ gender and age group. Although high school and college students’ interest in helping the homeless was associated with various attitudes and reactions (e.g., feelings of sympathy/support), their indication that they had ever helped homeless people (either directly or indirectly) was consistently associated only with the acknowledgment that their mother and father had ever helped homeless people (either directly or indirectly). Among these older participants, homelessness in the United States was rated as a more serious problem at the end of the questionnaire than at the beginning.     

Adverse Life Experiences and Homelessness Among Adolescents: an examination of the conditions for convergence

Abstract

There are two factors that limit our knowledge of the risk factors associated with homelessness among runaway adolescents, namely (1) the samples used are often composed of youth homeless service users and/or youths living on the streets (visible homelessness), whereas most adolescents in fact use “private” resources (hidden homelessness), and (2) failure to use an adequate control group to identify risk factors associated specifically with homelessness. Our study compares the characteristics of two groups of youths under the supervision oftheyouth protection system, according to the presence or absence of periods of homelessness. The results throw light on the factors underlying the shiftfrom “at risk” to “homeless”, showing that youths with experience of homelessness are more likely to have been placed in substitute home environments, have experienced significant relationship difficulties with one of their parents (deterioration ofthe parent/youth relationship and parental abuse) and to have been diagnosed with behavioral disorders. The findings suggest that the decision to place young people under supervision is based more on the dynamic between risk factors rather than on the existence of behavioral problems.     

Perceptions of and reactions to the homeless: A survey of fourth-grade, high school, and college students in a small Midwestern community

A total of 459 fourth-graders, high school students, and undergraduates completed a Homelessness Questionnaire developed for use in this study. Although participants generally expressed positive and supportive attitudes toward the homeless, attributing homelessness to either social maladjustment (e.g., drug problem) or negative characteristics (e.g., laziness) within the homeless was positively associated with “fear of and anger toward the homeless” for all groups of participants. In addition, perceptions of and reactions to the homeless were influenced by both the participants’ gender and age group. Although high school and college students’ interest in helping the homeless was associated with various attitudes and reactions (e.g., feelings of sympathylsupport), their indication that they had ever helped homeless people (either directly or indirectly) was consistently associated only with the acknowledgement that their mother and father had ever helped homeless people (either directly or indirectly). Among these older participants, homelessness in the United States was rated as a more serious problem at the end of the questionnaire than at the beginning.     

Lost in transition: Illicit substance use and services receipt among at-risk youth in the child welfare system

This study examined the use of mental health and substance abuse services among adolescents in the child welfare system (CWS) who reported use of illicit substances. 1004 adolescents age 11–15 years at baseline were followed for 5–7 years, over five waves of data collection. Shortly after the investigation for maltreatment (baseline), 69.1% of youths using illicit substances received mental health and/or substance abuse outpatient specialty services. By the last follow-up, during the transition to adulthood, only 21.5% of young adults using illicit substances received outpatient specialty services. Youth who used illicit substances were more likely to receive outpatient and inpatient specialty services than non-users at the time of contact with the CWS (mostly baseline), but this difference faded over the follow-up period. By 5–7 years follow-up, there was no significant difference in specialty services receipt for illicit substances users versus non-users. Predictors of outpatient service use at most waves were having Medicaid, mental health needs, and having recently seen a school counselor or primary care physician. Among illicit substance users transitioning to adulthood, African American youths were less likely to receive outpatient specialty services than White youths. These findings reveal a need for more attention to illicit substances use among youth in the CWS, better cross agency integration, and special attention to the needs of transition-age youth to better connect them with services as they age out of the CWS.     

Differentiating the Social Service Needs of Homeless Sexual Minority Youths from those of Non-homeless Sexual Minority Youths

While homeless youths and sexual minority youths are at greater risk for negative life experiences, and homeless sexual minority youths are at greater risk than homeless heterosexual youths, little is known about the differential risks for homeless sexual minority youths compared to non-homeless sexual minority youths. Using a sample of 187 sexual minority youths from a community-based social service agency in Denver, Colorado, the findings of this study suggest that homeless sexual minority youths are at greater risk for victimization, mental health issues, substance abuse, and illegal or dangerous activities than their non-homeless counterparts. Implications for social work practice and social service provision are discussed.     

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

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

Outcomes for Adolescents Using Runaway and Homeless Youth Services

Abstract

The purpose of this initial exploration was to identify relationships among outcomes and sociodemographic variables for runaway and homeless youths treated in community agencies. Outcome categories included clinical status, functioning, life satisfaction, and welfare and safety. Seventy youths were interviewed three months after discharge from three federally funded agencies serving runaway and homeless youth in the greater St. Louis area. Analyses among outcomes revealed a variety of significant relationships; most predominately, a pattern emerged revealing that returning to parental homes post-discharge was associated with a variety of other positive outcomes. The findings support the mission of agencies and federal mandates for designing services to this population; youths that are minors should be encouraged, where feasible, to return to parental homes. Although limited in scope and research methods, the present exploratory study provides an appropriate starting place from which to base future research on this     

Chapter 10: Issues in HIV/AIDS Service Delivery to High Risk Youth

Homeless and runaway youth engage in behavior that puts them at risk for infection with HIV, the virus that causes AIDS. Prevalence of HIV disease in homeless and runaway youth is higher than it is among other adolescents. In addition, homeless and runaway youth are often forced to engage in sex as a means of survival. Although they engage in high risk behavior, AIDS education programs have neglected them as a target group for education. To some extent, they have been included in other more general categories of persons with AIDS risk behaviors, such as men who have sex with men or intravenous drug users. However, the number of adolescents receiving age-specific HIV/AIDS information is far below the number infected (Hein et al., 1992). Often high risk youth are disenfranchised, having been forced from home by their families after disclosing their gay or lesbian identities. Lacking a political voice and having no spokesperson, they represent a group with complex unmet needs. These youth typically have immediate needs for food, shelter, and clothing. In addition, they often need medical management, mental health and drug counseling, crisis management, and HIV/AIDS information. These needs are often overwhelming to the agencies that serve youth. This article examines the barriers and issues that exist in providing services to high risk youth. Then, suggsetions for removing those barriers by empowering both service providers and youth are offered. Some of the suggestions are based upon the authors' own experience in providing HIV/AIDS in-service training to service providers to high risk youth. The article makes recommendations for policy on youth and HIV/AIDS.     

Psychosocial Problems Associated With Homelessness in Sexual Minority Youths

Sexual minorities are overrepresented among homeless youths, and this is often related to reactions to their status as sexual minorities. While on the streets, they are at increased risk for victimization, substance and alcohol use, sexual risk behaviors, and mental health issues compared to homeless heterosexual youths. This article uses ecological systems theory to examine psychosocial problems associated with homelessness among sexual minority youths and reviews empirical literature examining outcomes related to homeless sexual minority youths including mental health, substance use, and sexual risk behavior. Implications for social work are discussed including practice, policy, and suggestions for future studies.     

Hazards of stigma: the sexual and physical abuse of gay, lesbian, and bisexual adolescents in the United States and Canada

Some studies suggest lesbian, gay, and bisexual (LGB) teens are at higher risk than peers for violence at home, in school, and in the community. That can bring them into the child welfare system or services for runaway and homeless teens. This study compared self-reported experiences of sexual and physical abuse based on sexual orientation and gender in seven population-based surveys of youth. The authors used c2 and age-adjusted odds of abuse to compare bisexual to heterosexual, mostly heterosexual, and gay and lesbian students. They also provide case studies to illustrate the experiences of such youth.     

Evaluating the effectiveness of a school drug and alcohol prevention curriculum: a new look at "Here's Looking at You, Two"

The article reports on the results of an evaluation of a school drug and alcohol prevention curriculum marketed under the title, "Here's Looking at You, Two." Previous evaluations, unreported in the literature and having unresolved methodological problems, have found that while the program appears effective at transmitting information regarding drug and alcohol abuse, it has not been effective at changing the underlying attitudes and behaviors that, in part, explain substance abuse. Employing a more rigorous methodology, our examination of a relatively large sample across five school districts provides support for previous findings. Over the short-term of one year, the program was particularly effective at transmitting substance information to primary and middle school students. The program, however, produced very little of the expected effect on the underlying attitudes that are critical to changing substance abuse behaviors.     

Self‐Mutilation and Homeless Youth: The Role of Family Abuse,Street Experiences,and Mental Disorders

Self‐mutilation, which is the act of deliberately harming oneself, has been overlooked in studies of homeless and runaway youth. Given their high rates of abuse and mental health disorders, which are associated with self‐mutilation, homeless and runaway youth provide an ideal sample in which to investigate factors associated with self‐mutilation among a nonclinical population. Based on interviews with 428 homeless and runaway youth aged 16 to 19 years in 4 Midwestern states, the current study revealed widespread prevalence of self‐mutilation among these young people. Multivariate analyses indicated that sexual abuse, ever having stayed on the street, deviant subsistence strategies, and meeting diagnostic criteria for depression were positively associated with self‐mutilation. The findings are interpreted using stress theory and affect‐regulation models.     

Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents

This study compares participation in deviant subsistence strategies, street victimization, and lifetime prevalence of five mental disorders (conduct disorder, major depressive disorder, post-traumatic stress disorder, alcohol abuse, and drug abuse) among heterosexual males and females (n = 366) and gay, lesbian, and bisexual (n = 63) homeless and runaway adolescents from the first wave of a longitudinal study of homeless youth in four Midwestern states. The results indicate that gay, lesbian, and bisexual adolescents were more likely to have been physically and sexually abused by caretakers, we more likely to engage in risky survival strategies when on their own (including survival sex), were more likely to be physically and sexually victimized when on the streets, and were more likely to meet criteria for mental disorder than were their heterosexual counterparts.     

A History of Psychological Research into the Runaway Phenomenon: From Delinquent to Street Kid

Abstract

A PsychINFO search and literature review revealed five major movements in the psychological study of runaway youths in the 20th century. These movements were: (i) A conceptual shiftfrom the study of running away as a behavior of delinquents to the study of runaways whose behavior is often delinquent. (ii) The influence of the Great Depression and subsequent changes from models of intellectual deficit and psychopathology to broader, multi-causal explanations, including running away as a normal reaction to adverse conditions. (iii) The sharp decline of publications related to runaways in the 1950s and reversion to deficit models. (iv) the influence of the Counterculture movement and return of multi-causal and normalized models of running away behavior. and (v) the cultural creation of the “street kid”.     

Stress,Coping, and Mental Health Differences among Homeless People

People who are chronically homeless are assumed to have higher rates of mental health problems than episodically or new‐entry homeless individuals. It is unclear to what extent early‐life and current stressors account for this disadvantage. Guided by cumulative disadvantage theory and stress research, we analyze data from a national study of the US homeless population to examine how stressors and coping resources throughout the life course are implicated in differences among homeless people in psychiatric disorders and alcohol or other drug abuse disorders. Logistic regression analysis reveals that new‐entry homeless persons are less likely than their chronically and episodically homeless counterparts to have current psychiatric disorders. This is explained by stressors and coping resources experienced in childhood and during adult homeless spells. Alcohol and other drug abuse is common but comparable across the three homeless types and shares an association with selected stress and coping measures. Findings lend credibility to an accumulation of risks perspective, highlighting how past as well as contemporaneous stressors are related to the mental health of homeless people.