Addressing the Issue of Homeless Youth as a Society

Homelessness among young people continues to remain a serious social issue today. Homeless youth; sometimes referred to as “youth in transition”, are individuals who lack parental, foster or institutional care. The National Runaway Switchboard estimates that on any given night there are approximately 1.3 million homeless youth living unsupervised on the streets, in abandoned buildings, with friends or with strangers. Homeless youth are at a higher risk for physical abuse, sexual exploitation, mental health disabilities, substance abuse, and death. It is estimated that 5,000 unaccompanied youth die each year as a result of assault, illness, or suicide.

Data suggests that the current recession has yielded an increase in homeless and runaway youth. Between 2005 and 2008 alone, the National Runaway Switchboard saw a 200 percent increase in calls from youth indicating economic reasons for running away from home. The Switchboard also reported an increase in the numbers of youth who were kicked out of their homes. A 2008 survey of school districts showed an increase in the number of homeless students. The precise numbers of homeless youth are difficult to determine due to lack of a standard methodology and mobility of the homeless population.

Studies Have Shown That:

•  One in seven young people between the ages of 10 and 18 will run away
•  Youth age 12 to 17 are more at risk of homelessness than adults
• 75 percent of runaways are female
• Estimates of the number of pregnant homeless girls are between 6 and 22 percent
• Between 20 and 40 percent of homeless youth identify as Gay, Lesbian, Bisexual, Transgender or Questioning (GLBTQ)
• 46 percent of runaway and homeless youth reported being physically abused, 38 percent reported being emotionally abused , and 17 percent reported being forced into unwanted sexual activity by a family or household member
•  75 percent of homeless or runaway youth have dropped out or will drop out of school

Most commonly, youth become homeless due to various issues in the home, transitions from foster care and other public systems, and/or economic problems. Some of the Consequences of Life on the Street for Homeless and Runaway Youth include: Increased likelihood of high-risk behaviors, including engaging in unprotected sex, having multiple sex partners and participating in intravenous drug use. Youth who engage in these high-risk behaviors are more likely to remain homeless and be more resistant to change. Rates of suicide attempts are also much higher among homeless adolescents than their housed counterparts. One study of street youth in Hollywood reported that up to 48 percent of homeless youth have attempted suicide with many making repeated attempts.

High school students, in particular, often try to hide their homelessness and stay under the radar because they feel embarrassed or ashamed. However, in its most recent report about this population, the Office of Juvenile Justice and Delinquency Prevention of the U.S. Department of Justice estimated that there are 1.6 million homeless and runaway youth in this country. Most are between the ages of 15-17 years old. They are equally divided between males and females. About a third are African American and studies show that almost half identify as lesbian, gay, bi-sexual or transgender (LGBT). LBGT youth are at particular risk of homelessness because they are so often rejected by their families, schools and communities. But regardless of who they are, on any night, in any season– including Christmas– these young people are sleeping on our streets, in public places or abandoned buildings, in emergency shelters or prevailing on the kindness of friends or strangers, for a bed.

Trying to draw conclusions about why youth end up homeless leads to several points. Some leave home after years of neglect, physical and sexual abuse, strained family relationships, the addiction of family members and financial strain. Youth can also become homeless when they are discharged from foster care or other institutional settings with no housing or income support. As if this situation isn’t horrible enough, organizations that focus on homeless youth say the problem is worsening. The National Center for Homeless Education (NCHE) reports that between 2007 and the 2011-2012 school year, homelessness among students of all grades, rose 72 percent. The National Runaway Safeline, (NRS), a nonprofit communication system for runaway and homeless youth, says that since 2009 they have seen a 25 percent increase in crisis contacts from homeless youth. According to Keven Ryan, president of Covenant House, the largest privately funded charity in the country providing services to homeless youth, all 16 Covenant House shelters across the country are seeing more youth trying to find a place to stay.

Homeless youth are at a higher risk for physical abuse, sexual exploitation, involvement in the justice system, dropping out of school, mental health disabilities, substance abuse and even death. Approximately 5,000 homeless youth die every year due to assault, illness and suicide. Youth homelessness and its consequences do not just problems for those involved, but for society in general and the cost to society is high. States spend approximately $5.7 billion each year to incarcerate youth for a non-violent offense such as homelessness. Furthermore, the problems and barriers these youth face, clearly hinder their ability to become contributing, successful members of their families and society. If they don’t receive the help they need while they’re young, they may very well become tomorrow’s chronically homeless adults.

Homeless Youth present a greater risk for:

•  Severe anxiety and depression, suicide, poor health and nutrition, and low self-esteem
•  Increased likelihood of exchanging sex for food, clothing and shelter ( also known as “survival sex”) or dealing drugs to meet basic needs. Forty percent of African American youth and 36 percent of Caucasian youth who experienced homelessness or life on the street sold drugs, primarily marijuana, for money.
•  Difficulty attending school due to lack of required enrollment records (such as immunization and medical records and proof of residence) as well as lack of access to transportation to and from school. As a result, homeless youth often have a hard time getting an education and supporting themselves financially.
•  Homeless gay, lesbian, bisexual, transgender or questioning (GLBTQ) youth are more likely to exchange sex for housing or shelter, are abused more often at homeless shelters (especially adult shelters), and experience more violence on the streets than homeless heterosexual youth.

States have adopted a variety of policies to combat youth homelessness. Some of these policies address the educational needs of homeless and runaway youth while others appropriate money for shelters and transitional housing. Other policies include counseling and outreach services to already homeless youth or youth at risk of becoming homeless. Several states have enacted current legislation addressing the issue of homeless youth including Connecticut, Illinois, Indiana, Kansas, Maine, Minnesota, Nevada, Tennessee, Utah, Hawaii, Alaska, California, Nebraska, New Mexico, New York and Washington.

A few of the existing Federal Policies addressing this issue include:

• The Runaway and Homeless Youth Act (RHYA), administered by the Family and Youth Services Bureau, funded the Department of Health and Human Services’ Administration for Children and Families, is the only federal law that supports services to homeless and runaway youth. RHYA provides: street outreach (education services, mental and physical health treatment, counseling and referrals); basic living centers (temporary shelter, counseling, family reunification and aftercare services and transitional living (longer term housing and supportive services).
• The McKinney-Vento Homeless Assistance Act of 1987 was the first major federal legislative response to homelessness. Title VII of the Act includes provisions to ensure the enrollment, attendance, and success of homeless children and youth in school. Under the Act schools must work to eliminate any barriers, such as transportation, that may prohibit students from attending school, and are required to appoint a liaison to work with homeless students and their families.
• The Chaffee Foster Care Independence Program provides states with funding to support and provide services to youth who are expected to age out of foster care as well as former foster care youth ages 18 to 21. Funds from the program can be used for housing, educational services and independent living services.
• The Fostering Connections Act of 2008 increased federal funds available to states to extend assistance to foster youth up until age 21 as long as the youth is in school, working or has a medical condition that prevents them from participating in those activities. Services can include housing assistance, vocational and college help, and counseling.

However, according to the National Network for Youth (NN4Y), programs funded by the RHYA are facing a tremendous unmet need with insufficient resources. NN4Y reports that between 2009-2012,   programs had to turn away 37,000 young people who were seeking shelter and that funding for the RHYA has been basically flat, around $115 million, since FY 2010. Ryan of Covenant House, railed against the five percent (sequestration) cut to RHYA in the FY 13 budget.   In his April 2013 blog, Ryan called this action, “balancing the budget on the backs of our most desperate young people.” NN4Y recommended a $128 million appropriation for RHYA programs in FY14. The president’s budget proposed $118 million, including three million for a study of the prevalence, needs and characteristics of homeless youth– something which has never been conducted. According to Darla Bardine, policy director for NN4Y, advocates for homeless youth are hopeful about the potential funding for this badly needed study. However, she stated “If history is any guide, we won’t see the level of funding for RHYA that we have requested and believe is necessary to support this population.”

In addition to health risks, homeless youth face a number of barriers in accessing health care. These include lack  of insurance, a need for parental consent, difficulty navigating the health system, and the attitude of health staff. Many homeless youth have been exposed to both domestic and street violence. A recent study of youth in a shelter in north central Florida revealed that 66 percent of the youth had experienced some type of abuse. It is unclear to what extent substance use by adolescents leads to homelessness. Many homeless youth report using alcohol and other drugs prior to and since becoming homeless.  Parental substance use is common among homeless youth. In one study, one quarter of homeless youth report that they ran away from home because of arguments or physical violence brought on by parental alcohol use. In another study, 44 percent of homeless youth reported that at least one parent had received treatment for alcohol, drug or psychological problems. Rates of serious mental illness among homeless adolescents, as reported in the literature, range from 19 to 50 percent. Either as witnesses or victims, youth are also exposed to violence on the street. In a study of homeless youth in Baltimore, 75 percent of the homeless youth reported that they had witnessed a shooting or stabbing. A study of homeless and runaway youth in Hollywood found high rates of witnessing violence and being a victim of violence. These episodes occurred prior to and since living on the street: 85 percent had seen someone being physically attacked, 44 percent had seen a dead person somewhere in the community, 31 percent had seen someone being killed and 24 percent had seen someone being sexually assaulted. Because of the high rate of exposure to violence as spectators and victims, homeless youth are at an increased risk of post-traumatic stress disorder (PTSD) Lack of oral health and hygiene also remains a serious health concern among this population. In recent studies, the lifetime pregnancy rate for homeless, adolescent girls ranged from 27 to 44 percent. Because homeless teenage girls are less likely to get prenatal care and may have an inadequate diet, they may be at risk for low-birth weight babies and high infant mortality. The lifestyle of a homeless adolescent places him or her at a great risk of acquiring a sexually transmitted disease (STD). Therefore, homeless youth are at a much higher risk for HIV infection due to intravenous drug use and an increased number of sexual partners. They often have troubled schooling histories including having to repeat grades. In addition, homeless, unaccompanied youth face several barriers to obtaining an education. They are often prevented from enrolling in school because of liability concerns, legal guardianship requirements and curfew laws. 

In order to provide a continuum of care from outreach efforts to the delivery of services, intensive case management is needed. Younger people need extra help navigating a health care system that is often confusing even to homeless adults. Case management services must be comprehensive and address not only physical health needs, but also mental health and social service needs. For example, it may be beneficial for homeless youth to obtain early emancipation. (Emancipation may not be automatic just by living away from one’s family.) The benefits of early emancipation must be weighed against the loss of certain protections afforded a minor such as the parents’ responsibility to support their child. Because of the many layers of issues with which homeless youth present, it is reasonable to limit the number of youth assigned to each case manager.

Unfortunately, foster care is also a big source of homelessness for youth. Some teenagers will run away from foster homes while others “age out” of foster care without the skills needed to live on their own and they may subsequently become homeless. Transitional Living Programs (TLP) for homeless youth are useful for addressing the latter. The TLPs differ by community, but have the basic mission of assisting troubled youth through their transition to adulthood. Housing and related services are provided for up to 18 months for youth ages 16-21 who are unable to return to their homes. Often, the space available in these programs is limited. The Administration for Children and Families through the Family and Youth Services Bureau (FYSB) also funds youth shelters that provide emergency shelter, food, clothing, outreach services, and crisis intervention for runaway and homeless youth. Additional FYSB programs include grants to organizations serving runaway, homeless, and street youth to provide street-based outreach and education to prevent the sexual abuse and exploitation of these young people.

The barriers homeless youth face in accessing health care services are similar to those faced by homeless adults. Examples include lack of transportation, address requirements and lengthy bureaucratic processing, lack of financial resources or health insurance, and lack of awareness of services. However, because of their age and lack of experience, homeless youth are less able than their adult counterparts to overcome these barriers. The barriers to care for homeless youth include confidentiality issues, need for parental consent, distrust of adults and professional agencies, denial on the part of the youth of a need for care, and lack of coordinated services and outreach for homeless youth. When designing a health system for homeless youth, both real and perceived barriers to care should be addressed. Having services that are convenient, low or no cost and specific to meet the needs of homeless youth may help to overcome these barriers.

The ability to consent to health care is an important issue for homeless youth under age 18. Due to strained relationships within the family, their ability to receive even basic health care can be hindered by statutes requiring parental approval and consent for care. Very few States have laws specifically dealing with the ability of homeless and runaway youth to consent to medical care. In most States, only laws dealing with minors in general (homeless or housed) are found, and they are scattered throughout the State’s legal code. While there are some general issues related to consent to care, it is important that providers of health care to homeless youth understand the laws governing a minor’s consent to care for individual States.

As a general rule, minors cannot consent to their own health care. However, over the past two-to-three decades, all states have enacted laws that allow minors to consent to some health care, without parental consent or notification. These laws are usually related to specific diseases or medical conditions. For example, all 50 States and the District of Columbia allow minors to consent to care for sexually transmitted diseases including HIV. Twenty-five States and the District of Columbia allow minors to consent to contraceptive services and 27 States and the District of Columbia allow minors to consent to prenatal care. However, the ability to consent to care for these conditions does not necessarily mean that a minor can consent to all health care services.

Most states allow health care providers to proceed with emergency services if delaying treatment awaiting parental consent would endanger the minor’s health or well being. Similarly, most states give minors the authority to consent to drug and alcohol counseling and treatment. Only 20 States and the District of Columbia give minors the authority to consent to outpatient mental health services. However, if a State permits a minor to consent to general medical care, these laws may be broad enough to cover the scope of mental health and substance abuse treatment as well.

For each community to understand the needs of a specific community, a needs assessment should be performed. The best understanding of the needs of the homeless youth within a community comes from the youth themselves. The needs assessment should include a survey, in which youth can help identify the barriers in accessing care and the gaps in services. Health care, social services, mental health, dental care, substance abuse, housing, and educational needs should be identified. A firm understanding of the local legal considerations, especially in the area of a minor’s ability to consent to care, is essential. The needs assessment will help a program determine the resources needed to address the gaps identified. The program should identify potential funding sources such as Federal, State and local grants, charitable community organizations, and foundations. There may be available services in the community to which a program can link, and collaborations with other organizations may provide “in-kind” support, donations and services. Identifying these potential partners can prevent a duplication of services, thus ensuring that resources are used wisely.

Depending on the level of need and available resources, a separate clinic setting geared exclusively toward youth may be more acceptable to homeless youth. Many homeless youth are distrustful of authority and adult systems because adults have failed them in the past. Having a youth-oriented center and staff who are sensitive to the unique needs of homeless youth can increase their acceptance of assistance and care. If it is not feasible to set up a separate clinic, setting aside services within an existing clinic is a reasonable alternative. This can be accomplished within a fixed site, at a shelter or in a mobile van. If little financial support is available or the targeted population is small, an alternative is to provide a linkage to existing services. In this case, a program may want to target most of its resources toward case management in order to help the youth navigate through an adult or general adolescent system of care.

Homeless youth benefit from programs that meet immediate needs first and then help them address other aspects of their lives. Programs that minimize institutional demands and offer a range of services have had success in helping homeless youth regain stability. Educational outreach programs, assistance in locating job training and employment, transitional living programs, and health care especially designed for and directed at homeless youth are also needed. In the long term, homeless youth would benefit from many of the same measures that are needed to fight poverty and homelessness in the adult population, including the provision of affordable housing and employment that pays a decent wage. In addition to these basic supports, the child welfare system must continue to make every effort to prevent children from ending up on the streets.

Many youth become homeless as a result of family problems and financial difficulties. As a result, young people often lack the necessary supports to help them find jobs, obtain an education and reunite with their families. States can implement a homelessness prevention program that includes counseling, family reunification services, and rent assistance. Homeless youth need access to services that will help them regain stability in their lives, such as obtaining a job and affordable housing. States that have not already done so can provide homeless youth with access to educational outreach programs, job training and employment programs, transitional living programs, and services for mental health and life skills trainings. States can also create commissions or task forces to examine the issue of youth homelessness and offer recommendations to the legislature on how to improve outcomes for young people. Expanding long-term housing options and providing supportive services —such as food, clothing and counseling— are additional routes that states can take to address the issue of homeless youth. States can create housing programs that respond to the diverse needs of homeless youth including group homes, residential treatment, youth shelters, and community-based transitional living programs. It is important to note that youth housing programs are more cost-effective than alternative out-of-home placements such as juvenile corrections facilities, residential treatment centers or jail. More funding is needed to implement transitional living programs and provide outreach services to keep youth in transition off the streets. States should foster collaboration between programs and across agencies to ensure that young people’s needs are met. Each year, roughly 24,000 youth age out of foster care with little or no financial and housing resources. It would be beneficial for states to enhance the services provided by juvenile corrections and foster care agencies. In addition, there is little attention paid to the housing needs of youth leaving juvenile correction facilities.

Based on available research and outcome data from the Runaway and Homeless Youth Act (RHYA) programs, the solution for most homeless youth of all ages, particularly for youth under the age of 18 in the temporarily disconnected and unstably connected populations is reunification with their families, when it is safe to do so. The vast majority of youth served in RHYA’s basic center programs return home to family. Additionally, the most common destination for youth leaving RHYA transitional living programs is home to family. The basic center programs already have a strong focus on reunification and show success in reunifying youth with their families. It should also be noted that the NISMART data shows that the vast majority of youth who leave home will return home. Family intervention could, therefore, be seen as a first line of defense, but continues be a priority moving forward with all programs, including transitional living and other programs that youth may interact with.

Currently, approximately 50,000 youth per year are served by homeless youth programs which undoubtedly falls far short of demand. More resources are needed to respond adequately to youth homelessness and communities should include youth in their long-term strategic planning efforts to end homelessness for all populations.

Family interventions undoubtedly improve a number of outcomes for youth aside from housing; including improvements in mental health and decreases in risky behaviors and suicidal thoughts. Family connections that provide a natural support system for youth could be a priority for all programs working with youth independent of a youth’s final housing destination. There are also not enough shelter programs to meet the existing need and, as a result, youth are regularly turned away without a place to sleep. A larger investment is needed from federal, state, and local governments to prevent youth from sleeping on the streets and to more quickly facilitate crisis response. Communities might also consider alternative models to house youth in crisis to prevent youth from remaining without shelter. This can range from having a more flexible shelter response to providing a safe and supervised home within the community.

Some young adults struggling with additional challenges may require a more supportive or long-term housing program. Transitional living programs and transitional housing programs can provide youth who need it with more structure and support. And, for some youth, those that have been homeless for long periods of time and have a disability, permanent supportive housing is a housing option available to provide youth with the long-term financial and services support they will need to maintain housing. Often, it is necessary to provide ongoing support after reunification and family intervention could be done earlier to avoid a youth separating from their family altogether. It would also be beneficial to expand the reach and effectiveness of transitional living programs. We know that some of the most vulnerable youth are not able to access the supports they require because so many of them remain on the streets. More needs to be done to provide youth with longer-term housing options when reunification with family is not possible. Additionally, communities can definitely place a greater emphasis on minimizing the barriers to enter programs and work to reduce the number of involuntary exits from programs in order to maximize impact and outcomes. A number of communities have successfully used Homelessness Prevention and Rapid Re-housing program funds to provide rapid re-housing for young adults. It seems that rapid re-housing for young adults is more expensive than rapid re-housing for families as youth seem to need financial assistance, case management and other services for longer than the average family, but this intervention is still less expensive than transitional living/housing programs. Additionally, young adults over the age of 18 are able to establish their own households (because they can legally sign leases) and have access to resources channeled through the services in their community, meaning they can access rapid re-housing, transitional housing, and, when appropriate, permanent supportive housing, including connections to education, employment, and supports to transition to independent living.

In one year, there are approximately 550,000 unaccompanied, single youth and young adults up to age 24 who experience a homelessness episode of longer than one week. While this is a rough estimate, it is a good starting point from which communities and the federal government can begin to provide resources and interventions. Ultimately, better, more accurate data must be collected on the number of youth that experience homelessness as well as the effective interventions to end or greatly reduce homelessness for youth.

Homeless youth are a unique subset among the larger group of people experiencing homelessness. Many of their health concerns are similar to homeless adults, however, due to their young age, high-risk behaviors and legal concerns, homeless youth require specialized services. Health care and social services geared exclusively to homeless youth can provide a place for youth to obtain needed services without the help of parents, to ensure successful transitions from childhood to adulthood, and from homelessness to being housed.