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Comprehensive

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Youth Homelessness in America

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VOICES OF YOUTH COUNT

COMPREHENSIVE REPORT:

YOUTH HOMELESSNESS IN

AMERICA

Report to the U.S. Department of Housing and Urban Development

Matthew Morton, Amy Dworsky, Gina Miranda Samuels, and Sonali Patel

September 2018

Acknowledgements

Acknowledgements

This report is the result of a collaboration involving the Voices of Youth Count (VoYC) research and policy team at Chapin Hall and many partners. External partners who provided methodological advice to this research included the VoYC Technical Advisors and Gal up, Inc., which fielded the national survey and contributed additional technical expertise. VoYC Al ies have provided key inputs on policy and practice implications of VoYC findings and have helped to disseminate lessons to key audiences.

We especial y appreciate the extraordinary time and contributions dedicated to this body of work by our collaborators, by volunteers, and by youth from across the 22 VoYC partner communities. This work could not have existed or succeeded without them.

Many Chapin Hall staff members and consultants contributed to various stages of this initiative. We are grateful to each of them, including those who were engaged in research planning, data collection, and/or analysis of the national survey (Raúl Chávez, Jennifer Matjasko, and David Schlueter), youth counts and brief youth survey (Elissa Gitlow, Jamie Hinsz, Beth Horwitz, Jennifer Matjasko, Molly Mayer, and Jennifer Vidis), In-depth Interviews (Jenel e Birchmeier, Arianna Farmer, Eskira Kahsay, Bikki Tran Smith, Mal ory VanMeeter, and an 11-person field team), Administrative Data Analysis (Scott Huhr, Florie Schmits, and Fred Wulczyn), Systematic Evidence Review (Richard Epstein, Reiko Kakuyama, Alexa Karczmar, and Shannon Kugley), and the Policy and Fiscal Analysis (Raúl Chávez and Jennifer Vidis). We appreciate overall administrative supports to the initiative from Alexa Karczmar and Jennifer Vidis. Additional y, Bryan Samuels, Anne Farrel , Elizabeth Dierksheide, and Marrianne McMul en provided strategic guidance and substantive inputs throughout.

The VoYC initiative is made possible through a grant from HUD’s Office of Policy Development and Research (PD&R) and generous support from Chapin Hal , Arcus Foundation, Bal mer Group Philanthropy, Bill & Melinda Gates Foundation, Campion Foundation, Casey Family Programs, Dr. Inger Davis, Elton John AIDS Foundation, Liberty Mutual Foundation, Melvil e Charitable Trust, and Raikes Foundation.

The substance and findings of the work are dedicated to the public.

Chapin Hall is solely responsible for the accuracy of the opinions, statements, and interpretations contained in this publication and these do not necessarily reflect the views of the government or any of Chapin Hal ’s partners.

Disclaimer

The contents of this report represent the views of the authors and do not necessarily reflect the views or policies of the U.S. Department of Housing and Urban Development or the U.S. government.

Foreword

Foreword

The Fiscal Year 2016 HUD Appropriations conference report language specified that HUD provide “$2

mil ion for homeless youth research activities authorized under section 345 of the Runaway Homeless Youth Act.” Section 345 calls for development of an estimate of the “incidence and prevalence of runaway and homeless individuals who are not less than 13 years of age but are less than 26 years of age” and an “assessment of the characteristics of such individuals.” It also requires the study to look at barriers to obtaining housing, health services, and other public benefits.

In addition, the United States Interagency Council on Homelessness (USICH) Opening Door s includes a Framework to End Youth Homelessness that calls for “better data on the numbers and characteristics of youth experiencing homelessness,” and an integrated national study that would

“estimate the number, needs, and characteristics of youth experiencing homelessness.”

With funding from HUD and multiple philanthropic partners, Chapin Hall at the University of Chicago launched the Voices of Youth Count (VoYC)—a large, multicomponent study that attempts to document the prevalence and experiences of homeless youth in the United States.

The study’s authors present a broader definition of homelessness than is HUD policy. Specifical y, in addition to the youth living on the street, in shelters, or transitional housing, the estimates in this report include youth in other precarious housing situations that are outside of HUD’s homeless definition.

This most notably includes “couch surfing,” which is defined by Chapin Hall as “staying with others and lacking a safe and stable living arrangement.”

The study’s broader definition estimates 4.2 mil ion youth were homeless in the previous year (700,000

homeless youth ages 13-17 and 3.5 mil ion homeless youth ages 18-25). Over half of this estimate is based on youth “couch surfing.” The count for youth who were on-the-street or in shelters is also much higher than HUD’s other counts. HUD’s 2018 national point-in-time count found 36,361 youth experiencing sheltered and unsheltered homelessness on a single night in January. HUD’s 2017

Annual Homeless Assessment Report (AHAR) found an estimated 211,142 people between the ages of 13 and 24 accessed shelter during the year.

These inconsistent findings suggest that we have much more work to do to understand both the extent of youth homelessness and what policies are most appropriate to address the problem. To that end, this study can help us shape further research.

Two recent HUD initiatives speak to the issue of youth homelessness. In July of 2019, HUD launched the Foster Youth to Independence (FYI) initiative that will offer housing choice vouchers to local public housing authorities for adult youth who are exiting the foster care system. This Fall of 2019, the Youth Homelessness Prevention Demonstration (YHPD) is continuing with a third round of grants to develop and execute local coordinated approaches for serving homeless youth and strengthening preventive interventions. Evaluations of both initiatives are expected.

HUD deeply appreciates the efforts of Chapin Hal , as well as the youth, service providers, and communities who contributed to this study.

Seth D. Appleton

Assistant Secretary for Policy Development and Research

U.S. Department of Housing and Urban Development

Contents

Contents

Executive Summary ............................................................................................ viii

Key findings .......................................................................................................................................viii

Policy recommendations ..................................................................................................................... x

Conclusion .......................................................................................................................................... x

Chapter 1. Introduction ......................................................................................... 1

Motivation ......................................................................................................................... 1

Voices of Youth Count ................................................................................................... 1

Report Contents ............................................................................................................. 3

References ....................................................................................................................... 3

Chapter 2. National Survey .................................................................................. 4

Background ...................................................................................................................... 4

Methodology .................................................................................................................... 7

Sample ............................................................................................................................................... 7

Measures ............................................................................................................................................ 7

Analyses ............................................................................................................................................. 8

Results .............................................................................................................................. 9

Sample Characteristics ....................................................................................................................... 9

Prevalence and Incidence ................................................................................................................. 10

Spatial Analysis ................................................................................................................................. 13

Risk Correlates .................................................................................................................................. 14

Diversity of Experiences .................................................................................................................... 15

Discussion ......................................................................................................................18

Key findings ...................................................................................................................................... 18

Limitations ......................................................................................................................................... 19

Conclusion ........................................................................................................................................ 20

References .....................................................................................................................20

Chapter 3. Youth Counts and Surveys .......................................................... 23

Background ....................................................................................................................23

Methodology ..................................................................................................................24

Design and Data Collection ............................................................................................................... 24

Data analysis ..................................................................................................................................... 26

Results ............................................................................................................................28

Aggregate Count Results .................................................................................................................. 28

Aggregate Brief Youth Survey Results ............................................................................................... 30

Brief youth survey results by county size ........................................................................................... 36

Discussion ......................................................................................................................40

Key Findings ..................................................................................................................................... 40

Limitations ......................................................................................................................................... 43

Conclusion ........................................................................................................................................ 46

References .....................................................................................................................46

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

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Contents

Chapter 4. In-depth Interviews ........................................................................ 48

Background ....................................................................................................................48

Methodology ..................................................................................................................49

Site selection ..................................................................................................................................... 49

Building a local field team .................................................................................................................. 50

Recruitment ...................................................................................................................................... 50

Data collection .................................................................................................................................. 50

Data analysis ..................................................................................................................................... 51

Results ............................................................................................................................52

Youth involvement in key systems and institutions ............................................................................. 53

Survey responses to eight adverse experiences ................................................................................ 54

Cumulative adversity scores .............................................................................................................. 56

Beginnings of housing instability ........................................................................................................ 58

Where does your story begin? ........................................................................................................... 58

Trajectories of housing instability ....................................................................................................... 61

Engagement with services, resources, and support ........................................................................... 70

Youth logics of engagement with resources ....................................................................................... 71

Ending youth homelessness .............................................................................................................. 80

Advice to organizations ..................................................................................................................... 81

Discussion ......................................................................................................................82

Key findings ...................................................................................................................................... 82

Limitations ......................................................................................................................................... 83

Conclusion ........................................................................................................................................ 84

References .....................................................................................................................84

Chapter 5. Homeless Service Provider and

Continuum of Care Surveys .............................................................................. 87

Background ....................................................................................................................87

Methodology ..................................................................................................................88

Sampling ........................................................................................................................................... 88

Survey instruments ............................................................................................................................ 89

Data collection .................................................................................................................................. 89

Data analysis ..................................................................................................................................... 90

Results ............................................................................................................................90

Service provider survey: Individual-level data ..................................................................................... 90

Service provider survey: County-level data ........................................................................................ 97

Continuum of Care survey results .................................................................................................... 102

Discussion ....................................................................................................................105

Key findings .................................................................................................................................... 105

Limitations ....................................................................................................................................... 106

Conclusions .................................................................................................................................... 108

References ...................................................................................................................108

Chapter 6. Analysis of Supplementary

Data: Youth Who Run Away from Out-Of-Home Care ........................... 109

Background ..................................................................................................................109

Methodology ................................................................................................................111

Design ............................................................................................................................................ 111

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

v

Contents

Sampling ......................................................................................................................................... 112

Measures ........................................................................................................................................ 112

Analytic strategy .............................................................................................................................. 112

Results ..........................................................................................................................112

Sample characteristics .................................................................................................................... 112

Runaway events during the first spell of out-of-home care ............................................................... 114

Bridged runs during the first spell of out-of-home care .................................................................... 114

Exit runs .......................................................................................................................................... 119

Discussion ....................................................................................................................123

Key findings .................................................................................................................................... 123

Limitations ....................................................................................................................................... 125

Conclusions .................................................................................................................................... 125

References ...................................................................................................................126

Chapter 7. Systematic Evidence Review .................................................... 129

Background ..................................................................................................................129

Previous reviews ............................................................................................................................. 130

Methodology ................................................................................................................133

Criteria for considering studies for this review .................................................................................. 133

Search methods .............................................................................................................................. 134

Data collection ................................................................................................................................ 136

Data extraction ................................................................................................................................ 137

Data synthesis and analysis ............................................................................................................. 137

Results ..........................................................................................................................138

Search and screening results .......................................................................................................... 138

Study characteristics ....................................................................................................................... 140

Findings by intervention categories .................................................................................................. 143

Discussion ....................................................................................................................170

Key findings .................................................................................................................................... 170

Limitations ....................................................................................................................................... 177

Conclusion ...................................................................................................................................... 178

References ...................................................................................................................179

Chapter 8. Policy and Fiscal Review ............................................................ 185

Background ..................................................................................................................185

Methodology ................................................................................................................185

Stakeholder discussions and review of statutes and regulations ...................................................... 185

Consultations with county service providers .................................................................................... 187

Results ..........................................................................................................................188

Policy area 1: Homelessness: Overview of existing county needs and services ................................ 189

Policy area 2: Homelessness: Coordination of county planning meetings ........................................ 191

Policy area 3: Homelessness: Access to the Basic Center Program and other emergency shelters . 193

Policy area 4: Homelessness: Access to transitional housing assistance ......................................... 195

Policy area 5: Homelessness: Access to rapid rehousing ................................................................ 197

Policy area 6: Child welfare: Scope and responsibility ...................................................................... 199

Policy area 7: Behavioral health: Coverage and access ................................................................... 201

Policy area 8: Juvenile justice: Discharge policies ............................................................................ 204

Policy area 9: Education: Retention and high school completion ..................................................... 206

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

vi

Contents

Discussion ....................................................................................................................207

Key findings .................................................................................................................................... 207

Limitations ....................................................................................................................................... 209

Conclusion ...................................................................................................................................... 209

References ...................................................................................................................209

Chapter 9. Conclusion ...................................................................................... 210

Key findings .................................................................................................................210

How many youth and young adults experience homelessness? ...................................................... 210

What populations are overrepresented among youth experiencing homelessness? ......................... 211

What are the characteristics of youth experiencing homelessness,

and what are their experiences? ...................................................................................................... 212

How many youth experiencing homelessness were involved in systems like justice

systems and child welfare? How do these experiences relate to housing instability? ....................... 213

What policies and practices can make a difference?........................................................................ 214

Implications for policy and practice .......................................................................215

Directions for future research ..................................................................................220

Conclusion ...................................................................................................................222

References ...................................................................................................................222

Appendices .......................................................................................................... 224

Appendix A. National survey instruments .............................................................224

Appendix B. Brief Youth Survey instrument .........................................................239

Appendix C. County-level data: Youth counts and brief youth surveys ........240

Appendix D. In-depth interviews background survey instrument ...................250

Appendix E. In-depth interviews—participant characteristics .........................259

Appendix F. Survey results adversities by demographic characteristics ......261

Appendix G. Levels of instability and geographic mobility ..............................267

Appendix H. Survey responses to government benefits and services ..........269

Appendix I. Youth advice about ending instability ..............................................270

Appendix J. Provider survey instrument ...............................................................271

Appendix K. Continuum of Care survey instrument ..........................................286

Appendix L. Systematic Evidence Review – Chapter 7 study references ....290

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

vii

Executive Summary

Executive Summary

Youth homelessness is a serious concern. To

degrees of risk, duration, and frequency of

date, a concerted national response to youth

homelessness experiences.

homelessness has been constrained by the lack

of credible evidence on the scale and dimensions

Youth in rural communities are just as

of the chal enge and of possible solutions. Voices

likely to experience homelessness as their

of Youth Count (VoYC), led by Chapin Hall at

counterparts in urban communities. Youth

the University of Chicago, is an unprecedented

homelessness is truly a national chal enge.

research and policy initiative intended to fill

In predominantly rural counties, 9.2 percent

critical knowledge gaps about youth and young

of young adults ages 18–25 reported any

adult homelessness in America. VoYC focuses

homelessness during a 12-month period. In

on unaccompanied homelessness among youth

predominantly urban counties, the prevalence

ages 13 to 25. The initiative involved vast, mixed-

rate was 9.6 percent. The household

methods data collection and integrated a wide

prevalence rates for any homelessness during

range of perspectives.

a 12-month period for 13- to 17-year-olds

were also statistical y equal between rural and

In this report, we present detailed methods and

urban counties (4.4 percent and 4.2 percent,

findings for seven VoYC research components. In

respectively). The overall proportions or

addition to this technical report, the VoYC team

prevalence rates of youth homelessness are

has produced topical Research-to-Impact briefs

similar across rural and non-rural communities;

that are geared toward a wide audience and

at the same time, the sheer numbers of youth

include policy and practice recommendations,

experiencing homelessness are smal er in

along with other resources. These and more can

rural communities, because the populations

be found at www.voicesofyouthcount.org.

are smal er. Youth homelessness in rural

communities is especial y hidden. The brief

Key findings

youth surveys we administered across 22

Youth homelessness is a broad and hidden

counties revealed that, compared with more

challenge. Our national y representative

densely populated counties, youth in counties

survey estimates reveal that at least 700,000

with smal er populations were twice as likely

adolescent minors, or 1 in 30 of the population

to stay with others and about one-half as likely

of 13- to 17-year-olds, experienced some form

to be sheltered on a given night. Youth in small

of homelessness within the year preceding our

counties were also more likely to be sleeping

survey. These included experiences described

outside.

as homelessness (running away or being asked

Some youth are at higher risk for

to leave and staying away for at least one night)

experiencing homelessness. These include

and/or couch surfing (moving from place to place

young parents; Black, Hispanic, American

without a safe and stable living arrangement).

Indian, or Alaska Native youth; and lesbian,

Among young adults ages 18–25, the annual

gay, bisexual, or transgender (LGBT) youth.

prevalence of any homelessness is more than

Young adults who had not graduated from high

3.5 mil ion, or 1 in 10 young persons. About

school were found to be especial y vulnerable.

one-half of these experiences were described

Moreover, belonging to multiple high-risk

as “homelessness” and the other half involved

subpopulations was associated with compound

couch surfing. These estimates include a broad

risk for homelessness. For example, some of

spectrum of experiences, including varying

the highest rates of homelessness were found

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

viii

Executive Summary

among Black young men who identified as LGBT.

all youth reported chronic childhood adversity.

The results highlight the need to center issues

About one in three youth interviewed had lost

of equity along multiple dimensions in efforts to

at least one parent or caregiver. Families could

prevent and end youth homelessness.

be a source of both adversity and support,

underscoring the importance of positively

Many youth experiencing homelessness had

engaging families in the lives of many youth

several practical disadvantages working

experiencing homelessness.

against their ability to achieve housing

stability. For example, they were much more

Youth experiencing homelessness have

likely than youth in the general population to

interacted with other public systems at

be “NEET” (not in education, employment, or

high rates. According to the brief youth

training), and more than one-third of young

surveys of youth experiencing homelessness

adults experiencing homelessness lacked a

across 22 counties, 46 percent had ever spent

high school diploma or equivalent. At the same

time in juvenile detention, jail, or prison, and

time, many youth were still simultaneously

29 percent had been in foster care at some

employed and homeless, underscoring that a

point. Approximately 17 percent of youth

job is not enough. The quality of jobs, including

had been involved in both justice and child

income, benefits, predictability, and/or stability,

welfare systems. Although these statistics do

are important factors driving the extent to

not reveal the nature of relationships between

which employment helps youth sustainably exit

systems and homelessness, they do suggest

homelessness.

that these systems offer important entry points

for preventing large numbers of youth from

Snapshots in time of sleeping arrangements

becoming homeless.

are generally inadequate to characterize

youth experiencing homelessness. Through

Interventions can and do measurably prevent

our national survey and in-depth interviews,

and reduce youth homelessness. The VoYC

we found fluidity to be commonplace: in

systematic evidence review found that some

and out of homelessness, between different

intensive case management and support

sleeping arrangements, all while unstably

interventions reduced youth homelessness

housed. This reinforces the need to assess

without any direct housing interventions,

and understand youth housing situations and

reinforcing that interventions beyond housing

broader circumstances over a longer period of

assistance can have an impact. However, these

time. Many youth experienced homelessness

effect sizes were modest for housing stability.

and housing instability across a range of different

On the other hand, some interventions that

types of living arrangements. Nearly all youth in

included housing, such as a rental assistance

the in-depth interviews (93 percent) experienced

and wrap-around services program in Canada,

couch surfing at some or multiple points across

and a supportive housing program in the

their stories.

United States, demonstrated larger effects

on reducing youth homelessness or housing

The VoYC in-depth interviews shed light

instability. Nonetheless, many youth continued

on the significant exposure to trauma and

to experience homelessness and housing

adversity that nearly all youth experiencing

instability by the end of the interventions. This

homelessness experienced, not only during

suggests that further experimentation and

homelessness but also before homelessness.

evaluation are needed to determine the optimal

The root causes of instability typical y begin in

design and delivery of housing assistance, case

childhood and include early disruptions in one’s

management, and other supports and services

literal and psychological sense of home. Nearly

needed to truly end youth homelessness.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

ix

Executive Summary

Evaluation is sparse among some of the

• Build prevention efforts in systems where

most common program models for youth

youth likely to experience homelessness

experiencing homelessness. The VoYC

are in our care: child welfare, juvenile and

evidence review revealed significant knowledge

criminal justice, and education.

gaps that present blind spots for evidence-based

• Tailor supports for youth experiencing

decision-making. Areas in which we found little-

homelessness in rural communities and

to-no evidence from rigorous impact evaluations

small towns to account for more limited

of interventions addressing youth homelessness

service infrastructure over a larger terrain.

include common housing program models

for youth (such as short-term youth shelters,

• Improve data and devise strategies

transitional living programs, and rapid rehousing),

to understand and address the

homelessness prevention interventions, education

disproportionate risk for homelessness

and employment programs, and interventions

among specific subpopulations, including

for rural contexts or many of the high-risk

pregnant and parenting, LGBT, American

subpopulations described previously.

Indian or Alaska Native, Black, and

Hispanic youth.

The engagement of youth with lived

experience underscored their value-added

• Increase resources for the rigorous

as collaborators, not just research subjects

monitoring and evaluation of interventions

or recipients of services. The success of

to prevent and address youth

youth counts across 22 counties largely hinged

homelessness, and to strengthen the

on partnering with youth in determining where,

evidence base on what works, what

when, and how counts and surveys were

doesn’t, and for whom.

conducted, and in implementing the counts

Conclusion

and surveys in the field. Similarly, the in-depth

interviews reinforced the essential wisdom and

VoYC offers unprecedented insights into the

insights that can be gained from deeply listening

scale, scope, characteristics, and experiences

to the voices of youth with lived experience of

of youth homelessness in America. Although

homelessness.

every experience is unique, the youth in this

study are far from alone in their struggles with

Policy recommendations

homelessness. The chal enge involves a scale

that requires greater coordination and resourcing

More broadly, our initial results underscore

of multiple systems and programs—behavioral

several opportunities for policy action that are

and physical health, child welfare, education,

likely to accelerate progress toward ending youth

employment, housing, justice, and outreach—at

homelessness—

local, state, and Federal levels to drive these

• Conduct national estimates of youth

numbers toward zero. There are no silver bul ets,

homelessness biennial y to track our

but the efforts and investments to end youth

progress as a nation toward ending youth

homelessness are worth it—for the mil ions of

homelessness and trends for specific

youth exposed to homelessness, and for our

subpopulations.

country, which stands to gain from helping all our

youth achieve their full potential.

• Fund housing interventions, services,

outreach, and prevention efforts in

accordance with the scale of youth

homelessness, accounting for different

needs.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

x

Chapter 1. Introduction

Chapter 1. Introduction

Motivation

At the same time, efforts to end youth

homelessness have been stymied, in part, by

Youth homelessness is a significant national

significant knowledge gaps regarding even basic

chal enge. Previous research has shown that

questions around youth homelessness. These

young people experiencing homelessness, while

include the following questions, to which the

often very resilient, are at risk for a range of

research initiative described in this report aims to

negative outcomes including physical and mental

contribute better evidence—

health problems, violence, early pregnancy,

substance use, and early mortality (Medlow,

• How many youth, ages 13–25, experience

Klineberg, and Steinbeck, 2014; Morton et al.,

homelessness?

2017). Homeless and unstably housed youth,

• What populations are overrepresented

on average, also have low education attainment

among youth experiencing homelessness?

and high unemployment, compounding the

chal enges for them to escape poverty and

• What are the characteristics of youth

contribute to the competitiveness of their local

experiencing homelessness, and what are

and national economies (Gaetz and O’Grady,

their experiences?

2013).

• How many youth experiencing

homelessness have been involved in

Furthermore, adolescence and young adulthood

systems like justice systems and child

represent key developmental stages in the

welfare, and how do these experiences

life cycle (The Jim Casey Youth Opportunities

relate to housing instability?

Initiative, 2011). This is a period of significant

brain development, as the skills, interactions,

• What policies and interventions can make a

and experiences that individuals acquire during

difference?

these years can have profound effects on their

Voices of Youth Count

life trajectories. While development can be

profoundly positive during adolescence and

Voices of Youth Count (VoYC) is a national,

young adulthood with the right supports and

multicomponent research and policy initiative

resources, homelessness, housing instability,

designed to fill critical knowledge gaps about

and associated adversities can undermine

unaccompanied homelessness among youth

the potential of youth to achieve positive

and young adults, ages 13 to 25. The purpose

transitions to adulthood and make productive

of the initiative is to accelerate progress toward

contributions to their communities and

ending youth homelessness by informing the

economies. Previous research has also shown

development of Federal, state, and local policies

that youth homelessness is a foremost pathway

related to youth homelessness; improving service

into adult homelessness, and that the longer

provision; and building a foundation for future

youth experience homelessness, the harder it

research. The initiative involved vast, mixed-

is for them to exit homelessness (Chamberlain

methods data collection and integrated a wide

and Johnson, 2013; Johnson and Chamberlain,

range of perspectives. This report presents the

2008). This underscores the importance of

methods and findings of all the VoYC research

tackling homelessness early, often among youth,

components, which include the following—

to help curb the overall problem of homelessness

in America.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

1

Chapter 1. Introduction

• National survey: A national y

• Continuum of Care survey and service

representative phone-based survey

provider survey: Surveys with 25

that interviewed 25,492 people about

Continuums of Care (CoCs) lead agencies

their self-reported experiences of youth

and 523 diverse service providers on

homelessness or the experiences of youth

services and programs delivered in the 22

in their households. Detailed follow-up

Youth Count Communities. See Chapter 5.

interviews were also conducted with a

• Foster Care Data Archive analysis:

subsample of 150 people who reported

Analysis of a longitudinal data warehouse

any youth homelessness or couch surfing

containing decades of state data on

(staying with others and lacking a safe and

children in more than two dozen states who

stable living arrangement). See Chapter 2.

spent time in foster care to understand

• Youth counts and brief youth survey:

runaway occurrences and patterns. See

Point-in-time counts of youth experiencing

Chapter 6.

homelessness in 22 counties across

• Systematic evidence review: A

the country with 4,139 brief surveys of

comprehensive synthesis of evidence on

youths’ self-reported experiences and

programs and practices from evaluations

characteristics. Administrative data were

of interventions to prevent or address youth

also analyzed for the 22 counties to

homelessness. See Chapter 7.

complement youth counts, including data

from the Homelessness Management

• Policy and fiscal review: Analysis of

Information System (HMIS) that all HUD-

statutory and regulatory entry points for

funded homeless services agencies and

policy action on youth homelessness and

organizations are required to use and from

focus group discussions with 25 cross-

the U.S. Department of Education data on

system stakeholders in five communities.

student homelessness that are reported by

See Chapter 8.

school systems. See Chapter 3.

To our knowledge, this is the most in-depth and

• In-depth interviews: Detailed qualitative

comprehensive research undertaking on youth

and quantitative interviews with 215 youth

homelessness in the United States to date.

experiencing homelessness in five of the

Figure 1.1 shows the timing of data collection for

VoYC partner communities. See Chapter 4.

each research component that involved primary

data collection.

Figure 1.1. Timing of data collection for VoYC research components

2016

2017

Jun Jul Aug Sep

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug

National survey

Youth counts

In-depth interviews

CoC & provider surveys

Policy & fiscal review

Note: Research components that did not involve primary data col ection are excluded.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

2

Chapter 1. Introduction

All activities were reviewed by the Institutional

themes and remaining questions from across the

Review Board of the School of Social Service

different components.

Administration at the University of Chicago. Any

activities that involved new data collection from

References

people for research purposes included approved

informed consent procedures.

Chamberlain, Chris, and Guy Johnson. 2013.

“Pathways into adult homelessness,” Journal of

Report Contents

Sociology 49 (1): 60–77.

This report serves as a technical source

Gaetz, Stephen, and Bill O’Grady. 2013. “Why don’t

document reporting underlying methods and

you just get a job? Homeless youth, social

initial results and findings from the full range of

exclusion and employment training.” In Stephen

research components that collectively comprise

Gaetz et al. (Eds.), Youth homelessness in

the VoYC initiative. The data collected are both

Canada: Implications for policy and practice (pp.

vast and rich, and the team will continue to

243–268). Toronto: Canadian Homelessness

analyze these data and glean implications for

Research Network Press.

policy and practice over the months and years

Johnson, Guy, and Chris Chamberlain. 2008. “From

ahead. As such, this report marks a starting

youth to adult homelessness,” Australian Journal

point, rather than an ending point, of drawing

of Social Issues 43 (4): 563–582.

out lessons from this unprecedented body of

evidence. Moreover, Chapin Hall will continue

Medlow, Sharon, Emily Klineberg, and Kate

to distill findings and implications through more

Steinbeck. 2014. “The health diagnoses of

specific academic publications (for example,

homeless adolescents: A systematic review of

scholarly journal articles) and impact products

the literature,” Journal of Adolescence 37 (5):

(for example, through the VoYC Research-to-

531–542.

Impact series of user-friendly briefs on specific

topics concerning youth homelessness). The

Morton, Matthew H., Amy Dworsky, Jennifer

Research-to-Impact briefs and other products

L. Matjasko, Susanna R. Curry, David

will draw on the range of VoYC evidence for

Schlueter, Raúl Chávez, and Anne F. Farrel .

integrated storylines and, following more in-

2017. “Prevalence and correlates of youth

depth policy analysis based on the key findings

homelessness in the United States,” Journal of

for each brief as well as consultations with a

Adolescent Health 62 (1): 14–21.

range of stakeholders, will include more specific

The Jim Casey Youth Opportunities Initiative. 2011.

policy and practice recommendations than are

The adolescent brain: New research and its

presented in this report.

implications for young people transitioning from

This report is organized by chapters associated

foster care. St. Louis, MO: Author.

with each VoYC research component. For every

component chapter, we briefly describe: the

background and impetus for the study, the

methodology underlying the work, the results

from the analysis to date, the implications of

the findings for policy, practice, and/or future

research, and the strengths and limitations of

the study. At the end, this report has a chapter

devoted to the overall conclusions that integrates

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

3

Chapter 2. National Survey

Chapter 2. National Survey

Highlights

• Voices of Youth Count (VoYC) conducted

• The scale of the estimates, and the high

the first national y representative survey

rate of first-time experiences, underscore

of 12-month homelessness prevalence

the importance of prevention and early

and incidence among adolescence

intervention to truly end youth homelessness.

and young adults, ages 13–25.

Approximately one-half of youth that

• Youth homelessness is a broad and hidden

experienced homelessness in the last 12

chal enge in America. We estimate that at least

months faced homelessness for the first time.

one in 30 youth, ages 13–17, and nearly one

• Youth homelessness is similarly prevalent

in 10 young adults, ages 18–25, experienced

between rural and urban counties.

some form of homelessness during a

Although population sizes may be larger

12-month period (inclusive of explicitly

in urban communities, as a share of the

reported homelessness experiences, running

population, rural communities are just

away, being kicked out, and couch surfing).

as affected by youth homelessness.

• Youth homelessness involves diverse

• Some youth are at a higher risk for

experiences and circumstances. Our

experiencing homelessness, including

estimates capture a wide spectrum

parenting youth; American Indian or Alaska

of sleeping arrangements, degrees

Native, Black, and Hispanic youth; lesbian,

of risk, durations, and frequency of

gay, bisexual, or transgender (LGBT) youth;

episodes during a one year period.

and youth who did not complete high school.

Background

homelessness partly by individuals’ sleeping

arrangements—mainly unsheltered (for example,

The absence of credible data on the size and

sleeping in public places) or sheltered (for

characteristics of the population and reliable

example, homeless shelter or transitional

means to track youth homelessness over time

housing). Moreover, it includes youth staying with

has partly constrained efforts to solve youth

others (for example, couch surfing or doubling

homelessness. In response, this study was

up) if they are considered homeless under

undertaken as part of VoYC. The research was

other Federal definitions and meet additional

designed to address critical evidence gaps

conditions, or if they are fleeing unsafe situations

while also responding to the Federal Runaway

(ACYF, n.d.). Conversely, the RHYA definition

and Homeless Youth Act (RHYA; Public Law

makes no reference to sleeping location. It

[P.L.] 110-378), which calls for replicable

defines youth homelessness exclusively by

national prevalence and incidence estimates of

the circumstances of the experience: a person

youth homelessness and data concerning the

within the defined age range “for whom it is

population’s needs and characteristics.

not possible to live in a safe environment with a

relative, and who has no other safe alternative

Federal definitions encompass distinct

living arrangement” (ACYF, n.d.). Similarly,

aspects of youth homelessness. HUD’s

studies have used a range of parameters and

definition, according to the McKinney-Vento

indicators to estimate youth homelessness in

Homeless Assistance Act, for example, defines

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

4

Chapter 2. National Survey

the absence of any “gold standard” measures

The present study addressed two primary

(Ringwalt et al., 1998; Cutuli et al., 2015;

research questions:

Sznajder-Murray et al., 2015).1

1. What is the estimated 12-month

Moreover, previous estimates of youth

prevalence of unaccompanied youth

homelessness have involved varying age

homelessness?

ranges. For example, HUD’s Annual Homeless

Assessment Report (AHAR) documents youth

2. What youth and household characteristics

homelessness up to age 24; other national

are associated with an increased risk of a

estimates focus on adolescent years (Ringwalt

homeless experience?

et al., 1998; Cutuli et al., 2015). The RHYA cal ed

We both examine youth homelessness broadly

for estimates among 13- to 25-year-olds, which

and segment different forms of homelessness.

determined the age parameters of this study.

The broad estimates include individuals, ages

13–25, living in places not meant for human

Methods for identification and sampling

habitation, in shelters or transitional housing

have further implications for the reliability

(or other temporary housing arrangement), or

and inclusiveness of estimates (Greene et

couch surfing (staying with others while lacking

al., 2003). Point-in-time counts, which are

a safe and stable alternative living arrangement).

required of communities funded by HUD to

However, because some classifications include

deliver homelessness programs, enumerate the

staying with others under broader concepts of

number of people experiencing homelessness

housing instability rather than homelessness

on a specific night in January and rely largely

(Kushel et al., 2006), we report prevalence with

on street- and shelter-based identification.

and without youth that only reported couch

This reliance means that youth experiencing

surfing experiences. Running away, also taken

homelessness on other nights or more hidden

as a subset of youth homelessness experiences,

forms of homelessness on the night of the

is defined by RHYA as a minor “who absents

count—such as couch surfing, sleeping in

himself or herself from home or a place of legal

discreet or remote locations, and youth who

residence without the permission of a parent

actively avoid services and being counted—are

or legal guardian.” Unaccompanied, which

not reflected in the estimates (Auerswald et al.,

is variably defined in the literature, refers in

2013). School-based data, such as the U.S.

this case to the absence of a parent or legal

Department of Education’s data on student

guardian.

homelessness, have the advantage of offering

important annual data and capturing more

information on minors. However, these estimates

also inherently exclude out-of-school youth and

young adults (Cutuli et al., 2015; NCHE, 2016).

Given such differences, previous national

estimates of the size of the youth population

experiencing homelessness have varied widely.

Table 2.1 includes a summary of previous

national estimates of youth homelessness and

brief details on their varying design features and

measurement parameters.

1

Additional information on different Federal definitions of homelessness can be found at https://youth.gov/youth-topics/runaway-and-homeless-youth/feder-

al-definitions.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

5

Chapter 2. National Survey

Table 2.1. Previous estimates of the scale of youth homelessness

Time

period

Age Range

Estimate

covered

(country)

Citation

Clarke, Anna, et al. 2016. Estimating the scale

17% 12-month prevalence of “literal”

of youth homelessness in the UK. Cambridge,

homelessness (10% for > 1 night); 20%

12 months

16–25 (UK)

UK: Cambridge Centre for Housing and Planning

for couch surfing (15% for > 1 week)

Research.

2.2–2.9% 1-month prevalence of

High school

Cutuli, J. J., et al. 2015. “Youth homelessness:

unaccompanied student homelessness,

students

1 month

Prevalence and associations with weight in three

stricter definition (“typical y” staying

(CT, DE, and

regions,” Health and Social Work 40 (4): 316–324.

somewhere other than home)

Philadelphia)

Hammer, Heather, David Finkelhor, and Andrea

J. Sedlak. 2002. Runaway/throwaway children:

6.9% (1.7 million) 12-month prevalence 12 month

12–17 (US)

National estimates and characteristics. Washington,

of running away/kicked out in 1999

DC: Office of Juvenile Justice and Delinquency

Prevention, U.S. Department of Justice.

Link, Bruce G., et al. 1994. “Lifetime and five-year

4.1% prevalence of 5-year “literal

prevalence of homelessness in the United States,”

homelessness” and 6.3% any

5 years

18–35 (US)

American Journal of Public Health 84 (12): 1907–

homelessness (including doubled up)

1912.

National Center for Homeless Education (NCHE).

95,032 unaccompanied students in the

2016. Federal data summary: School years 2012–

2014–2015 school year based on school School year ≤ 18 (US)

13 to 2014–15: Education for Homeless Children

reports

and Youth. Washington, DC: U.S. Department of

Education.

5.0% (1.0 million) 12-month

Ringwalt, Chris L., et al. 1998. “The prevalence of

prevalence of homelessness, including

homelessness among adolescents in the United

12 months

12–17 (US)

accompanied and unaccompanied in

States,” American Journal of Public Health 88 (9):

1992

1325–1329

Sanchez, Rebecca P., Martha W. Wal er, and Jody

6.4% 12-month prevalence of running

M. Greene. 2006. “Who runs? A demographic

12 months

12–17 (US)

away in 1995

profile of runaway youth in the United States,” The

Journal of Adolescent Health 39 (5): 778–81.

4.6% reported ever homelessness

Shelton, Katherine H., et al. 2009. “Risk factors for

(stricter measure—at least 1-week

Lifetime

18–28 (US)

homelessness: Evidence from a population-based

experience—and longitudinal survey)

study,” Psychiatric Services 60 (4): 465–472.

18% reported running away and 2.6%

reported a homelessness experience

Sznajder-Murray, Brittany, et al. 2015. “Longitudinal

before age 25 (stricter measure) 3+

predictors of homelessness: Findings from the

Lifetime

< 25 (US)

nights of consecutive homelessness

National Longitudinal Survey of Youth-97,” Journal

and had to identify the experience as

of Youth Studies 18 (8): 1015–1034.

homelessness (and longitudinal survey)

3,916 (< 0.02%) unaccompanied minors

U.S. Department of Housing and Urban

and 41,662 (0.14%) youth ages 18–24,

Development. 2016. Homelessness in the United

Point in

based on national y-aggregated 2016

≤ 24 (US)

States: The 2015 Annual Homeless Assessment

time

point-in-time counts of youth (including

Report (AHAR) to Congress. Washington, DC:

parenting youth)

Author.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

6

Chapter 2. National Survey

Methodology

experienced homelessness or couch surfing.

The follow-up interviews’ response rate was

Sample

32 percent. While the responses to the follow-

up interviews were a relatively small subset of

We surveyed a national y representative

a larger sample, accumulating a substantial y

sample of adults whose households included

larger subsample would have required a much

13–25-year-olds during the preceding 12 months.

longer time period and increased cost burden.

During two rounds of data collection, each

Nonetheless, using the follow-up interviews

involving different random samples, from July

for estimating inclusion errors and examining

to September 2016 (round one) and May to July

experiences al owed for markedly greater

2017 (round two), a homelessness module was

accuracy and understanding of the prevalence

added to Gal up,

estimates.

Inc.’s U.S. Politics and Economics Daily

Measures

Tracking Survey (DTS) (Gal up, 2016). Because

we captured 12-month prevalence, we do not

This study involved three instruments: the

suspect that a lack of seasonal variation in the

DTS, a brief 19-item youth homelessness

timing of data collection was consequential

prevalence and incidence module, and a more

for estimates, although this would be worth

detailed follow-up interview protocol. The latter

exploring in future research. The DTS used

two instruments are included in Appendix A,

a dual-frame (cel ular and landline) random-

while the full DTS instrument is available from

digit dial telephone sample to interview a

Gal up, Inc., or the authors upon request. The

national quota of 500 adults per day. Daily

DTS solicited demographic characteristics on

samples included quotas of 60 percent

respondents, including age, sex, race/ethnicity,

cel phone respondents and 40 percent landline

household income, employment, education,

respondents. The DTS response rate averages

county population density, sexual orientation and

12 percent. Whereas prior research has found

gender identity, and marital and parenting status.

response rate to be an unreliable indicator of

bias, this response rate is also typical of, or

The brief youth homelessness module was

slightly higher than, other phone-based surveys

administered to adult respondents who

(Keeter et al., 2017).

themselves were ages 18–25, or whose

households included members ages 13–17

The overall sample size in round two was

or 18–25. Reflecting different experiences

increased for greater precision and included

of homelessness, we asked adults whose

follow-up interviews. Follow-up interviews were

households included at least one person age

conducted with a random sample of respondents

13–17 if any of those individuals had (a) run away,

who reported any youth homelessness (explicitly)

(b) left home because they had been asked to

or couch surfing, and were general y conducted

leave, (c) couch surfed, or (d) been homeless in

within two to three days after the respondent’s

the last 12 months. Adults whose households

completion of the DTS. We established quotas

had at least one individual age 18–25 were asked

of 50 completed follow-up interviews for each of

if any of those individuals had (a) couch surfed

three groups: (1) respondents who reported that

or (b) been homeless. Adults who themselves

a household member age 13–17 experienced

were ages 18–25 were asked if they had (a)

homelessness or couch surfing, (2) respondents

couch surfed or (b) been homeless. The literature

who reported that a household member age 18–

notes stigmatization and varied interpretations

25 experienced homelessness or couch surfing,

sometimes associated with the term “homeless,”

and (3) 18–25-year-olds who reported that they

hence the inclusion of additional indicators

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

7

Chapter 2. National Survey

(Perlman et al., 2014). Prior to the study,

running away, being asked to leave, as well as

interviewers field-tested the homelessness

experiences described as “homelessness”.

module (n=20); modest changes were made

based on this cognitive testing.

We estimated two types of 12-month prevalence:

(1) household prevalence, that is, the share of

The follow-up interviews involved a mixed-

households with youth members in the specified

methods approach, using questions with closed

age groups in which any of those members had

and open-ended response options. Closed

experienced homelessness, and (2) population

queries addressed youth characteristics,

prevalence—that is, the share of the youth

sleeping arrangements, duration, frequencies,

population of the specified age group that

vulnerabilities, service utilization, and causes.

experienced homelessness. Because this survey

Open-ended questions elicited additional

was administered to adults (ages 18 and over),

detail about the young person’s homelessness

we could estimate only household prevalence

or couch surfing experiences, causes, and

for the 13–17 age group. For 18–25-year-olds,

occurrences in which the young person felt

we estimated both household and population

unsafe or in distress. These data also increased

prevalence. Because divergent life stages,

our ability to account for inclusion errors,

normative expectations, and legal statuses

which occurred if a person or experience was

distinguish the subsets of adolescent minors

inappropriately captured in the initial prevalence

(13–17) and young adults (18–25), we separated

estimates.

these groups in analyses.

Analyses

We used NVivo 11 (NVivo, 2015) to conduct

qualitative analysis of responses to open-

For our first research question, we estimated

ended questions in the follow-up interviews.

the prevalence of homelessness by calculating

Based on the broad operational definition of

sample proportions along with associated

unaccompanied youth homelessness, two

uncertainty (95-percent confidence intervals)

researchers independently reviewed and

in these estimates. Population or household

compared decisions for including or excluding

weights were used for descriptive statistics to

reported experiences of homelessness from the

compensate for disproportionalities in selection

initial survey. Inter-rater reliability agreement was

probabilities and non-responders. Based on

92 percent, and remaining cases were discussed

the proportion of inclusion errors among the

and conferenced with a third researcher until

follow-up interviews, we made subsequent

100 percent consensus was achieved. We then

adjustments to prevalence estimates. We

calculated inclusion error rates and used these to

present segmented estimates of certain types

adjust initial prevalence estimates.

of homelessness, namely, experiences that the

respondent described as explicit homelessness2

To estimate the number of households with youth

and experiences that were restricted to couch

ages 13–17 and 18–25 who had experienced

surfing. Further, we include a broader estimate

homelessness in the last 12 months, we applied

of any homelessness that combines both

the relevant household prevalence rates to the

explicit homelessness and couch surfing. For

number of households in the United States with

13–17-year-olds, the explicit homelessness

any occupants belonging to corresponding age

category includes experiences of having been

groups, according to the U.S. Census Bureau’s

away from home for at least one night due to

2015 American Community Survey (ACS) data

2

We use the term “explicit homelessness” rather than the term “literal homelessness” because the latter is generally used to refer specifically to sleeping in places not meant for human habitation, in a homelessness shelter, or in transitional housing. Respondents may or may not have referred to these types of sleeping arrangements when responding “yes” to the question on homelessness experiences.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

8

Chapter 2. National Survey

(Ruggles et al., 2010).3 To produce a population

respondents ages 18–25; these data contained

estimate for individuals ages 18–25, we applied

the most information about the youth themselves

the population prevalence rates to the number

because DTS questions referred to the

of 18- to 25-year-olds in the United States

respondent. Additional y, the dependent variable

according to 2015 ACS data.4

was limited to explicitly reported homelessness

because these reports involved the fewest

For our second research question, we used Stata

inclusion errors.

14.0 (StataCorp, 2015) for descriptive statistics

and logistic regression, examining cross-

Results

sectional bivariate associations of homelessness

with various demographic characteristics and

Sample Characteristics

producing unadjusted and adjusted risk ratios,

reporting 95 percent confidence intervals (CIs)

The homelessness module was administered to

for each. To ease interpretation, we used the

25,492 of 68,541 DTS respondents (37.2 percent)

Stata command “oddsrisk” to convert odds

who met the eligibility criteria. The sample was

ratios to risk ratios with associated CIs (Grimes

broadly representative of the U.S. population

and Schulz, 2008). The logistic regression

with respect to sex, race/ethnicity, income, and

model was based on the self-reported data for

employment (see Table 2.2).

Table 2.2. National Survey sample characteristics compared with U.S. Census Bureau data DTS Weighted Sample

U.S. Census (aged 18+)

Female

51.0%

51.3%

White

68.1%

67.2%

Black or African-American

12.8%

12.8%

Asian

2.1%

6.2%

Hispanic or Latino

15.4%

15.0%

Reside in rural counties

13.5%

14.4%

Median household annual income

$60,000 to $89,999

$53,889

Unemployment rate

5.0%

4.9%

Notes: The Daily Tracking Survey (DTS) N=68,541. U.S. Census statistics are all for 2015 and extracted from: https://factfinder.

census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2016_PEPASR5H&prodType=table. The unemployment reference statistic was extracted from U.S. Bureau of Labor Statistics data for July to September 2016 (https://data.bls.gov/timeseries/

LNS14000000). The median annual income is presented as a range because the DTS queried on income as a categorical variable; respondents were asked to describe annual income in relationship to ranges rather than to give an actual value.

3

Based on the U.S. Census Bureau’s American Community Survey data, there were approximately 15,209,000 households with occupants aged 13–17, and approximately 19,223,300 households with occupants ages 18–25, in the United States in 2015. We calculated these numbers using iPUMS. Steven Ruggles, J.

Trent Alexander, Katie Genadek, Ronald Goeken, Matthew B. Schroeder, and Matthew Sobek. 2010. Integrated Public Use Microdata Series: Version 5.0 [Machine-readable database]. Minneapolis, MN: Minnesota Population Center [producer and distributor].

4

Based on ACS from July 1, 2015, 20,870,650 13- to 17-year-olds and 35,949,456 18- to 25-year-olds were in the United States.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

9

Chapter 2. National Survey

Prevalence estimates were drawn from three

ages 18–25 in their households, and 8.3 percent

subsamples of respondents: (1) 12,693 with at

for respondents ages 18–25 self-reporting

least one member age 13–17, (2) 16,125 with

experiences. These were about one-half as high

at least one other household member age

as the corresponding prevalence rates.

18–25, and (3) 6,295 who were 18–25 years old

(some respondents belonged to more than one

Follow-up interview results showing different

subsample). The sample size for the follow-up

types of identified inclusion errors for different

interviews was 150. We tested for differences

reporting groups are presented in Table

on a range of variables including education,

2.3. Inclusion errors comprised reports of

employment, income, and other demographics

experiences while accompanied by a parent

between the follow-up interview subsample and

or guardian (for minors only), misreporting

the overall sample, and found no significant

(or misunderstanding) regarding the age or

differences apart from the modestly younger

timeframe of interest, or, most commonly,

mean age of follow-up interview respondents

reporting apparently safe and normative

(due to quotas).

experiences that did not involve a lack of access

to stable housing as couch surfing. The inclusion

Prevalence and Incidence

error rates were substantial y lower among

respondents reporting explicit homelessness

Based on initial household prevalence estimates,

(12 percent) than they were for respondents

during a 12-month period, approximately 3.7

who reported couch surfing-only (54 percent).

percent of households with 13–17-year-olds

Many couch surfing-only experiences involved

explicitly reported homelessness experiences

normative situations with access to safe and

(including running away or being asked to

stable housing and needed to be deducted.

leave) among them, and 2.2 percent reported

experiences that solely involved couch surfing,

Inclusion error rates between the three quota

resulting in an overall 5.8 percent household

groups were similar, although we found a

prevalence. For ages 18–25, household

somewhat higher error rate among respondents

prevalence estimates were 6.7 percent for

reporting explicit homelessness for 13–17-year-

explicitly reported homelessness, 14.3 percent

olds than with respondents reporting on

for couch surfing-only, and 21.0 percent overal .

18–25-year-olds. Given the small subsamples

The initial 12-month population prevalence

and general consistency, we applied the

estimates, available only for ages 18–25, were

inclusion error rates of the overall follow-

5.9 percent, 9.7 percent, and 15.6 percent,

up interview sample to the final prevalence

respectively. Additional y, among those reporting

calculations, reducing the estimates for explicitly

explicit homelessness, we found substantial

reported homelessness by 12 percent and the

overlap of couch surfing. Specifical y, 64.7

estimates for couch surfing-only by 54 percent.

percent of 18–25-year-old respondents self-

reporting homelessness also reported couch

Adjusting for inclusion errors, we estimate that

surfing.

approximately 4.3 percent of households with

13–17-year-olds, and 12.5 percent of households

The combined incidence rates (shares

with 18–25-year-olds, had people in those age

of respondents reporting first-time youth

groups that experienced some form of explicit

homelessness and/or couch surfing cases

homelessness and/or couch surfing without

in the last 12 months) were 3.0 percent for

safe and stable housing in the last 12 months.

respondents reporting experiences of anyone

Additional y, 9.7 percent of 18–25-year-olds

ages 13–17 in their households, 11.3 percent for

self-reported homelessness and/or couch

respondents reporting experiences of anyone

surfing in the last 12 months. Converted to

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

10

Chapter 2. National Survey

counts based on ACS data, these estimates

To simplify estimates to support broad

translate to approximately 650,000 households

public awareness, we can present the overall

with 13–17-year-olds, 2.4 mil ion households

prevalence findings as about 1 in 30 adolescent

with 18–25-year-olds, and 3.5 mil ion youth ages

minors5, and 1 in 10 young adults, having

18–25. Table 2.4 provides these results and

experienced some form of homelessness during

segmented estimates for explicit homelessness

a 12-month period.

and couch surfing-only.

Table 2.3. Summary of identified inclusion errors in the fol ow-up interview sample N

N

13–17

18–25

N

Household

Household

18–25

N

Reason for error of inclusion

Reports

Reports

Self-Reports

Total

Category

H

C-o

H

C-o

H

C-o

H

C-o

Total=N

35

15

17

33

29

21

81

69

Accompanied by a parent/guardian

2

2

0

0

0

0

2

2

Misunderstanding: Person outside

0

0

1

2

1

1

2

3

age range

Misunderstanding: Misreported

0

0

0

2

0

0

0

2

experience

Misunderstanding: Experience

occurred beyond 12-month

1

1

0

0

0

0

1

1

reporting period

Interpreted safe/normative/stably

housed experience as couch surfing

3

4

0

0

0

0

3

4

for ages 13–17

Interpreted safe/normative/stably

housed experience as couch surfing

0

0

0

14

2

11

2

25

for ages 18–25

Total inclusion errors, N (%)

6 (17%)

7 (47%)

1 (6%)

18 (55%) 3 (10%)

12 (57%) 10 (12%) 37 (54%)

Notes: This table is based on the full fol ow-up interview sample (n=150). In the category row, H=homelessness, which includes respondents who responded “yes” to the questions explicitly asking about any youth homelessness, including those who reported both homelessness and couch surfing, and C-o=couch surfing-only, which includes respondents who responded “yes” to youth couch surfing and “no” to youth homelessness. Safe/normative/stably housed experiences that were interpreted as couch surfing included situations such as staying with friends or relatives recreational y, or traveling for recreation or work while having access to a safe and stable living arrangement.

5

Because we lack population prevalence for adolescent minors, to form these more publicly translatable statistics, we took the household estimate for adolescent minors as a minimum population estimate (because we would expect some households to have more than one adolescent that experienced some form of homelessness).

We divided 650,000 by 20,870,640 (the estimated number of 13–17-year-olds in the United States according to the American Community survey) to get a lower bound population prevalence estimate of 3.1% (1 in 32, which we rounded to 1 in 30).

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Chapter 2. National Survey

Table 2.4. 12-month national prevalence estimates adjusting for inclusion errors 95%

Final Estimate,

Final Estimate, N

Explicit homelessness

Age

Initial

Confidence

% (12% Inclusion (12% Inclusion Error

Group

Rate

Intervals

Error Reduction)

Reduction)

Household

13–17

3.7%

3.3-4.1%

3.3%

0.50 million

- Homelessness”-only

0.9%

0.7-1.1%

0.8%

- Runaway/asked to leave-only

2.2%

0.2-2.6%

1.9%

- “Homeless” and runaway/A.T.L.

0.6%

0.4-0.7%

0.5%

Household

18–25

6.7%

6.3-7.2%

5.9%

1.13 million

Population

18–25

5.9%

5.2-6.6%

5.2%

1.87 million

95%

Final Estimate, %

Final Estimate, N

Couch surfing-only

Age

Initial

Confidence

(54% Inclusion

(54% Inclusion Error

Group

Rate

Intervals

Error Reduction)

Reduction)

Household

13–17

2.2%

1.9-2.6%

1.0%

0.15 million

Household

18–25

14.3%

13.7-14.9%

6.6%

1.27 million

Population

18–25

9.7%

8.9-10.5%

4.5%

1.61 million

Final Estimate,

Final Estimate,

95%

% (Sum of above

N (Sum of above

Overall

Age

Initial

Confidence

prevalence types

prevalence types

Group

Rate

Intervals

with inclusion error

with inclusion error

reductions)

reductions)

Household

13–17

5.8%

5.4-6.3%

4.3%

0.65 million

Household

18–25

21.0%

20.3-21.7%

12.5%

2.40 million

Population

18–25

15.6%

14.6-16.6%

9.7%

3.48 million

Notes: A.T.L. = asked to leave. For ages 13–17, the “explicit homelessness” estimates include experiences of having run away and been asked to leave; for both ages 13–17 and 18–25, it includes “yes” responses to the explicit question on homelessness experiences. The revised estimates for “explicit” use a smal er deduction (12 percent) because this was the inclusion error rate calculated for this subgroup of experiences based on fol ow-up interviews. The revised estimates for “couch surfing-only” use a larger deduction (54 percent) because this was the inclusion error rate calculated for this subgroup of experiences, which included a high proportion of experiences, which were not couch surfing as a form of homelessness—that is, the youth did not lack a safe and stable place to stay.

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12

Chapter 2. National Survey

Spatial Analysis

homelessness during a 12-month period. In

predominantly urban counties, the prevalence

For the second research question, we examined

rate was 9.6 percent. The household prevalence

whether youth in rural communities were more

rates for any homelessness during a 12-month

likely than those in urban communities to

period for 13–17-year-olds were also statistical y

experience homelessness, and we investigated

equal between rural and urban counties (4.4

the correlations between other characteristics

percent and 4.2 percent, respectively). In all

and homelessness. Figure 2.1 displays the

reporting categories, chi-square goodness of

explicitly reported homelessness, couch

fit tests revealed no significant between-group

surfing-only, and combined “any homelessness”

differences between rural and urban counties

household prevalence rates (adjusting for

(p>.05). Even when we incorporate a more

inclusion errors) in rural and non-rural (“urban”)

granular analysis, breaking down counties into

counties for ages 13–17 and the population

different levels of population density, we observe

prevalence rates for 18–25-year-olds. In

little variation in prevalence estimates (see Figure

predominantly rural counties, 9.2 percent

2.2, based on self-reported prevalence among

of young adults ages 18–25 reported any

young adults, ages 18–25).

Figure 2.1. Prevalence rates in rural versus non-rural counties

9.2% 9.6%

4.4%

4.7% 5.2%

4.2%

4.5% 4.4%

3.0% 3.3%

1.4% 0.9%

explicit

couch surfing

overall

explicit

couch surfing

overall

homelessness

only

(any homelessness)

homelessness

only

(any homelessness)

ages 13-17, household prevalence

ages 18-25, population prevalence

rural

non-rural

Notes: The presented prevalence rates include adjustments for inclusion errors. Rural versus non-rural distinctions are based on U.S.

Census data providing the number and percentage of people in each county living in rural and urban areas. Mostly rural means that at least 50 percent of the county’s population lives in non-urban areas as classified by the U.S. Census Bureau.

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Chapter 2. National Survey

Figure 2.2. Unadjusted prevalence by levels of county population density

20

20

nce (%)

12 14 16 18

revale

12 14 16 18

p

10

10

onth

12-m

4 6 8

4 6 8

2

2

0

0

Explicit homelessness ages 18-25

Couch surfing only ages 18-25

3000+

1501 to 2999

3000+

1501 to 2999

800 to 1500

200 to 799

800 to 1500

200 to 799

under 200

under 200

Note: These estimates do not include adjustments for inclusion errors. Levels of population density indicate the groupings of counties by the number of people per square mile. The bracketed vertical lines in the middle of the bars represent the 95 percent confidence intervals for each estimate.

Although prevalence rates of youth

homelessness live in less densely populated

homelessness are similar between rural and

areas that are likely to lack the services and

non-rural communities, the numbers of youth

resources of more urban parts of the county.

experiencing homelessness are smal er in rural

communities because the population sizes are

Risk Correlates

smal er in those communities. Using the U.S.

Results of logistic regression indicated that

Census Bureau’s definition of a rural county,

the unadjusted relative risk of experiencing

only about 14 percent of the U.S. population

homelessness (denoted here as RR, with 95

overal —and only 9 percent of young adults,

percent CI) was significantly greater for youth

ages 18–25—live in a predominantly rural county.

who reported the following characteristics:

Likewise, only 9 percent of young adults who

unmarried with children of their own (RR=3.00;

reported homelessness resided in a rural county

2.37–3.76); lesbian, gay, bisexual, or transgender

when interviewed. Importantly, using the broader

(LGBT; RR=2.20; 1.67–2.89); Black or African-

HUD fiscal year (FY) 2017 Youth Homelessness

American (RR=1.83; 1.42–2.35); had not

Demonstration Project criteria for a rural county,

completed high school or a GED (RR=4.46;

this increases to 17 percent of young adults

3.54–5.57); and annual household income

experiencing homelessness residing in rural

of less than $24,000 (RR=2.62; 2.10–3.24).

counties (about 1 in 6). The definition of a rural

Youth of Hispanic origin also had higher risk

community can significantly alter the number

of experiencing homelessness (RR=1.32;

of youth implicated. Further, even within mainly

1.04–1.67), but the relationship was no longer

urban counties, many youth experiencing

statistical y significant once the model controlled

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Chapter 2. National Survey

for education and parenthood. Figure 2.3

includes forest plots depicting relative risk

(unadjusted and adjusted RRs) for specific

demographic groups. Furthermore, while not

presented in the graph, we also found that

American Indian or Alaska Native young adults

had more than twice the risk of reporting explicit

homelessness in the last 12 months as other

young adults (RR=2.23; 1.58-3.12).

Diversity of Experiences

We used the survey data collected during the

follow-up interviews with respondents reporting

any youth homelessness or couch surfing to

further analyze these experiences (see Figure

2.4). We excluded 31 percent of the follow-

up interview sample whose responses were

identified as inclusion errors.

Overal , 45 percent of the respondents reported

on youth who HUD would consider to have been

literal y homeless based on where they slept—

that is, they slept in a shelter or transitional

housing or in places not meant for human

habitation. Forty-six percent of the respondents

reported on youth who they believed to have

slept somewhere unsafe. Only 3 percent reported

on youth who had been homeless for only one

night, while 69 percent reported on youth who

had experiences of homelessness or instability

that lasted more than one month. At least 36

percent reported on youth who had experienced

more than one episode of homelessness over

the 12-month period. One-third (33 percent)

reported on youth who were still experiencing

homelessness or housing instability at the time

of the interview, and over one-fourth (27 percent)

reported on youth who were stably housed for

less than 30 days within the last 6 months.6

6

Seven percent did not know if the youth they had reported on were still homeless or unstably housed, and 6 percent did not know how many days the youth had been stably housed during the last 6 months.

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Chapter 2. National Survey

Figure 2.3. Logistic regressions for youth homelessness (ages 18–25, self-report) Female

Married

Parent (unmarried)

LGBT

Asian

Black or African-American

Other race, non-White

Hispanic, non-White

Younger age group (18-21)

Military

Rural county

< high school degree/GED

Unemployed

Ann. hh. income < $24,000

-2.5 -2

-1.5 -1

-0.5 0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

5.5

6

Unadjusted RR: Any homelessness in past 12 months, youth ages 18-25

Female

Married

Parent (unmarried)

LGBT

Asian

Black or African-American

Other race, non-White

Hispanic, non-White

Younger age group (18-21)

Military

Rural county

< high school degree/GED

Unemployed

Ann. hh. income < $24,000

-2.5 -2

-1.5 -1

-0.5 0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

5.5

6

Adjusted RR: Any homelessness in past 12 months, youth ages 18-25

Notes: The dependent variable is explicitly reported homelessness (excluding couch surfing-only). Unadjusted RRs express associations between homelessness and one other variable only (for example, female). Adjusted RRs present variable-wise RRs having control ed for all other variables in the model. Diamonds represent the RR while the extending lines on either side of the diamonds represent corresponding 95 percent confidence intervals. A fil ed diamond indicates that the RR is statistical y significant (p<.05). An RR of 1.0

means that risk is even between two groups. Each RR represents the difference in risk of having experienced homelessness between the group described by the variable (for example, females) and its opposite reference group (for example, males). The reference group for the “younger age group (18–21)” is respondents ages 22–25. Race variables compare to all others, of which the majority are White non-Hispanic (for example, for Black or African-American, the reference group is all youth who were not Black or African-American). For the unemployed variable, the reference group is all youth who were not unemployed, including those who were employed or who were not in the labor force. “Parent (unmarried)” = the youth was an unmarried parent. Ann. hh income = annual household income.

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Chapter 2. National Survey

The graphs in Figure 2.4 are based on the

of 18–25-year-olds (n=50), and third-party

follow-up interviews (n=150) with National

household reports of 13–17-year-olds (n=50).

Survey respondents who indicated any youth

All five lower stacked bar graphs represent

homelessness or couch surfing in the prior 12

breakdowns of the 69 percent of the sample who

months including self-reports by 18–25-year-

reported on youth who had been homeless.

olds (n=50), third-party household reports

Figure 2.4. Breakdown of homelessness experiences after omitting inclusion errors Inclusion errors

IE: Mistaken reporting, 6%

IE: Safe & normative

with stable housing, 23%

IE: Accompanied, 3%

Any homelessness, 69%

Any homelessness, 69%

Number of episodes

Duration of

Slept in shelter or

Unsafe during

Currently homeless

during 12 months

longest episode

place not meant for

episode

or unstably housed

human habitation

6+ times, 16%

3-5 times, 10%

3 mo+, 50%

No, 52%

No, 45%

Twice, 11%

No, 60%

1 mo to < 3 mo, 19%

Once, 50%

1 wk to < 1 mo, 17%

Yes, 47%

Yes, 45%

Yes, 33%

1 night to < 1 wk, 6%

Unknown, 14%

1 night, 3%

Unknown, 5%

Unknown, 4%

Unknown, 9%

Unknown, 7%

Breakdowns of youth who experienced any homelessness

(i.e., no inclusion errors detected)

Notes: Fol ow-up interviews sample n=150. The stacked bar graph breakdowns are of the sample of 103 respondents (69 percent) for which inclusion errors were not identified. “Accompanied” refers to the estimated percentage of minors who were indicated as having experienced homelessness, but who were accompanied by a parent/guardian at the time.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

17

Chapter 2. National Survey

Discussion

parent or guardian over the last month (Cutuli et

al., 2015).

Key findings

Although highly concerning, understanding our

This study produced the first national estimates

large prevalence estimates may be assisted

of 12-month prevalence of youth homelessness

by understanding the broader socio-economic

in the United States for ages 13–25. Although

context from which these estimates emerge.

they encompass a spectrum of experiences,

High housing costs disproportionately affect

our prevalence estimates imply a much broader

young households, especial y in the 100

national chal enge than do point-in-time counts,

largest metro areas (JCHS, 2016). In more rural

homelessness systems data, or public schools

areas where housing costs may escalate less

data. Apart from the focus that point-in-time

rapidly, poverty rates also tend to be higher

counts have on certain types of homelessness

and economic opportunities fewer for youth,

(unsheltered, sheltered, or transitional housing),

which could contribute to comparable youth

substantial differences are likely due to the facts

homelessness rates in these communities

that our survey captures 12-month prevalence

(JCHS, 2016). Equal y concerning is the fact

and uses a population-based sampling

that young adult householders have among the

approach to study a largely hidden and dynamic

highest poverty rates in the country—especial y

phenomenon.7 Our estimates for adolescents

unmarried young householders. Unmarried

also significantly exceed the national public

male household heads under 25 years old have

schools count of unaccompanied students

a poverty rate of 36 percent, and unmarried

(95,032 in the 2014–2015 school year, NCHE,

female household heads under 25 years old

2016), conceivably because a representative

have a staggering poverty rate of 49 percent.

survey approach does not depend on formal

These are well above the national poverty rate

reports or school identification of homelessness.

of 13.5 percent.8 About 4 in 10 adults, ages 18

to 29, have student loan debt (Cil uffo, 2017),

Looking to other representative surveys—only

and student loan balances have more than

available for adolescents—our estimates are

tripled since 2004, with an average balance per

more similar. For example, Ringwalt et al. (1998)

borrower of nearly $30,000 (Brown et al., 2015).

found a 5.0 percent 12-month prevalence rate

of homelessness among 12- to 17-year-olds in

Taking these factors into account, it is perhaps

1992–1993, although this included self-reports

less surprising that, according to the American

(population prevalence) and both accompanied

Community Survey and the Current Population

and unaccompanied homelessness. More

Survey, the share of young adults continuing to

recently, local and state estimates of prevalence

live with their parents has risen sharply over the

of unaccompanied homelessness among high

last decade, with one-half of 20- to 24-year-olds

school students from representative school-

living with their parents in 2015 (JCHS, 2016).

based surveys have ranged from 2.2–2.9 percent,

Cost burden was a commonly cited reason for

although these were based on a stricter measure

young adults continuing to live with their parents.

of unaccompanied homelessness: typical y

On top of this trend, many youth cannot rely on

sleeping somewhere other than home without a

parents for safe and stable housing throughout

7

Notably, our calculations suggest that, if we use the “explicit homelessness” results for young adults only (ages 18–24), assumed, as our follow-up interviews suggest, that 81 percent of those “explicit homelessness” experiences involved “literal homelessness” that would be more readily picked up by a point-in-time count, and assumed that the average literal homelessness experience was about 12 days, our backwards calculated point-in-time count for 18- to 24-year-olds would be about the same as the estimate reported in the 2015 AHAR. In other words, if we focus on the aspects of homelessness that point-in-time counts are designed to capture, our estimates are not necessarily very inconsistent. For unaccompanied minors, the differences between point-in-time counts and population-based survey methods are harder to reconcile and warrant further investigation.

8

Authors’ calculations based on American Community Survey data.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

18

Chapter 2. National Survey

the year when their other options are exhausted.

of youth-friendly shelters or urban magnet spots

Take, for instance, nearly 1 mil ion youth ages

that attract youth—may be needed.

14–26 that have spent time in foster care since

their 14th birthday (AECF, 2017).

Our findings reinforce growing evidence on the

heightened risk of experiencing homelessness

All the aforementioned trends disproportionately

among LGBT youth (Van Leeuwen et al., 2006;

affect racial and ethnic minorities whom are also

Whitbeck et al., 2016). Disproportionality of

at higher risk for experiencing homelessness.

homelessness experiences among Black

Due to data limitations, it is difficult to empirical y

youth mirrors racial disparities documented

assess the extent to which each of these

elsewhere, such as with school suspensions,

factors contributes to the prevalence of youth

juvenile justice involvement and sentencing, and

homelessness, but they il ustrate an important

foster care placements (Raffaele-Mendez and

backdrop against which high annual estimates

Knoff, 2003; Wildeman and Emanuel, 2014).

of homelessness experiences can be better

Furthermore, while Hispanic youth were at higher

understood.

risk than non-Hispanic youth of experiencing

homelessness (and comprised 34 percent of 18-

Nearly two-thirds of youth who reported explicit

to 25-year-olds reporting homelessness), only

homelessness also reported couch surfing over

19 percent of youth served by Federal y funded

the last 12 months. This underscores the fluidity

runaway and homeless youth programs in FY

of arrangements among youth experiencing

2014 were Hispanic (ACYF, n.d.). Of all racial

homelessness over time. Many youth do not fit

and ethnic subpopulations studied, American

squarely into any single type of homelessness

Indian or Alaska Native youth had the highest

experience. Stil , a sizeable share of the overall

prevalence rates of homelessness. The findings

prevalence rates also involved couch surfing-only

mirror similar trends related to poverty and other

without a safe and stable living arrangement.

deprivations showing American Indian or Alaska

These experiences likely include a wide range

Native populations having the worst indicators,

of degrees of vulnerability—from lower risk

even slightly worse than the situation for Black or

experiences of leveraging social networks

African-American citizens (Macartney, Bishaw,

during periods of housing instability to high-

and Fontenot, 2013).

risk or exploitative arrangements (McLoughlin,

2013; Curry et al., 2017). Additional y, some

One of the strongest risk correlates for

couch surfing could function as a precursor

homelessness was a lack of a high school

to more entrenched homelessness (Clarke,

diploma or GED. Although we cannot make

2016). Given these complexities, assessments

causal inferences, this finding reinforces the

of youth circumstances beyond their sleeping

extent to which education, and underlying factors

arrangement at a given time are important in

that support educational attainment, might

determining their levels of risk and service needs.

protect youth from becoming homeless. Young

parents were also at high risk for homelessness

Our results indicate that youth homelessness

relative to their non-parenting peers.

is similarly prevalent in rural and urban areas.

Prior to this study, little was known about how

Limitations

the prevalence of youth homelessness in rural

areas compared with non-rural areas. Tailored

A particular strength of this study lies in its

policies and programs to address the unique

methodology, which is replicable and cost-

circumstances of youth homelessness in

efficient, given that it builds on existing sampling

rural communities—such as a lack of service

and survey infrastructure and does not require

infrastructure and lower visibility due to absence

on-the-ground data collection. This enables the

option of repeated national estimates over time to

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

19

Chapter 2. National Survey

track progress toward the Federal Government’s

unstably housed youth, and research suggests

goal of ending youth homelessness (USICH,

that many youth experiencing homelessness

2015). However, some limitations of the study

are technology-connected (Rice, Lee, and

should be kept in mind when interpreting the

Taitt, 2011). Nonetheless, this survey likely

results and considering enhancements of future

yields underestimates of homelessness to the

national estimates.

extent that it misses youth who lack working

cel phones and have been total y disconnected

First, because Gal up’s DTS surveys adults,

from households that could report on their

we relied on third-party household reports

experiences.

of experiences of individuals ages 13–17,

which could have been influenced by social

Conclusion

desirability and recal biases. Second, only

household prevalence estimates could be

Although individual experiences vary,

generated for ages 13–17 because the survey

homelessness and housing instability clearly

module asked about the experiences of any

have adverse consequences for youth and their

youth in the household, not each 13–17-year-

futures. This effort demonstrates the feasibility

old who lived there. To the extent that more

of estimating national prevalence and incidence

than one 13–17-year-old in some households

of youth homelessness using a cost-efficient

had experienced homelessness, this might

methodology with potential for enhancement and

have resulted in a more conservative estimate

replication to track progress and target solutions

of the population size. Conversely, reporting

to preventing and ending this hidden problem.

households could have functioned as either

Our findings reveal that the chal enge involves a

“sending” households (from which youth left into

scale that necessitates greater coordination and

homelessness) or “receiving” households (where

resourcing of multiple systems and programs—

youth stayed during or after homelessness), and

behavioral and physical health, child welfare,

this could contribute to a degree of inflation.

education, employment, housing, justice, and

outreach—at local, state, and Federal levels to

Third, we found and corrected for a large

drive these numbers toward zero.

inclusion error rate of 54 percent for respondents

reporting couch surfing-only, and a much smal er

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acsbr11-17.html.

York, NY: Gal up, Inc.

McLoughlin, Pauline J. 2013. “Couch surfing on

Greene, Jody M., Rebecca Sanchez, Jennie Harris,

the margins: The reliance on temporary living

Connie Cignetti, Don Akin, and Sara Wheeless.

arrangements as a form of homelessness

2003. Incidence and prevalence of homeless and

amongst school-aged home leavers,” Journal of

runaway youth. Research Triangle Park, NC: U.S.

Youth Studies 16 (4): 521–545.

Department of Health and Human Services.

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National Center for Homeless Education (NCHE).

Shelton, Katherine H., Pamela Taylor, Adrian Bonner,

2016. Federal data summary: School years 2012–

and Marianne van den Bree. 2009. “Risk factors

13 to 2014–15: Education for homeless children

for homelessness: Evidence from a population-

and youth. Washington, DC: U.S. Department of

based study,” Psychiatric Services 60 (4): 465–

Education.

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NVivo. 2015. Qualitative data analysis software. QSR

StataCorp. 2015. Intercooled STATA (for Windows),

International Pty Ltd. Version 11. Melbourne,

Version 14.0 [computer program]. Col ege

Australia: QSR International. https://www.

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qsrinternational.com/.

Sznajder-Murray, Brittany, Joy Bohyun Jang,

Perlman, Staci, Joe Wil ard, Janette E. Herbers, J.J.

Natasha Slesnick, and Anastasia Snyder. 2015.

Cutuli, and Karin M. Eyrich Garg. 2014. “Youth

“Longitudinal predictors of homelessness:

homelessness: Prevalence and mental health

Findings from the National Longitudinal Survey

correlates,” Journal of the Society for Social Work

of Youth-97,” Journal of Youth Studies 18 (8):

and Research 5 (3): 361–377.

1015–1034.

Raffaele-Mendez, Linda M., and Howard M. Knoff.

U.S. Department of Housing and Urban Development

2003. “Who gets suspended from school and

(HUD). 2016. Homelessness in the United States:

why: A demographic analysis of schools and

The 2015 Annual Homeless Assessment Report

disciplinary infractions in a large school district,”

(AHAR) to Congress. Washington, DC: Author.

Education and Treatment of Children 26 (1): 30–51.

U.S. Interagency Council on Homelessness (USICH).

Rice, Eric, Alex Lee, and Sean Taitt. 2011. “Cell phone

2015. Opening doors: Federal strategic plan to

use among homeless youth: Potential for new

prevent and end homelessness. https://www.usich.

health interventions and research,” Journal of

gov/resources/uploads/asset_library/USICH_

Urban Health 88 (6): 1175–1182.

OpeningDoors_Amendment2015_FINAL.pdf.

Ringwalt, Christopher L., Jody M. Greene, Marjorie

Van Leeuwen, James M., Susan Boyle, Stacy

Robertson, and Melissa McPheeters. 1998. “The

Salomonsen-Sautel, D. Nico Baker, J. T. Garcia,

prevalence of homelessness among adolescents

Al ison Hoffman, and Christian J. Hopfer. 2006.

in the United States,” American Journal of Public

“Lesbian, gay, and bisexual homeless youth:

Health 88 (9): 1325–1329.

An eight-city public health perspective,” Child

Welfare 85 (2): 151–70.

Ruggles, Steven, Katie Genadek, Ronald Goeken,

Josiah Grover, and Matthew Sobek. 2010.

Whitbeck, Les, Melissa Welch Lazoritz, Devan

Integrated public use microdata series: Version

Crawford, and Dane Hautala. 2016. Street

5.0 [Machine-readable database]. Minneapolis,

outreach program: Data col ection study final

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distributor].

Children and Families, U.S. Department of Health

and Human Services.

Sanchez, Rebecca P., Martha W. Wal er, and Jody M.

Greene. 2006. “Who runs? A demographic profile

Wildeman, Christopher, and Natalia Emanuel. 2014.

of runaway youth in the United States,” The

“Cumulative risks of foster care placement by

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pone.0092785.

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Chapter 3. Youth Counts and Surveys

Chapter 3. Youth Counts and Surveys

Highlights

• We partnered with 22 diverse counties

youth (47 percent of the sample) and youth

across the country to conduct youth-

who identified as lesbian, gay, or bisexual (21

focused point-in-time counts of

percent of the sample) were over-represented.

homelessness and brief youth surveys.

• Forty-six percent of the youth experiencing

• After adjustments, a total of 5,970 youth

homelessness had spent time in

were counted as experiencing homelessness

juvenile detention, jail, or prison, and

on a single night across the 22 counties.

29 percent had been in foster care.

Survey data were collected from 4,139 of

• Forty-four percent of the 18- to 25-year-old

these youth, with the nine largest counties

females reported being pregnant or a parent.

accounting for 67 percent of the sample.

• Youth experiencing homelessness in less

• Based on where they had slept the night

populated counties were general y different

before the count, 48 percent of the youth

from their counterparts in more populated

were categorized as sheltered, 24 percent

counties along several dimensions, including

as unsheltered, 19 percent as staying

race and ethnicity, sexual orientation,

with others, and 10 percent as “other”.

pregnancy and parenthood, and their sleeping

• The youth were predominantly 18 to 25 years

arrangements on the night of the count.

old (87 percent), and both African-American

Background

that include all unaccompanied youth “that

meet any federal definition of homelessness,

This chapter focuses on the results of the youth

including youth identified by local education

counts and the brief youth surveys (BYS). The

agencies and runaway and homeless youth

aims were to estimate the number of youth

programs” (USICH, 2018). However, youth

experiencing homelessness in each of the 22

experiencing homelessness have historical y

counties at a point-in-time and to gather basic

been undercounted when the same methods that

information about their characteristics and

are commonly used to count homeless adults

experiences. The youth count and BYS data

have been used (USICH, 2013).

complement the data that were collected from

service providers about the programs and

Contributing to this undercount are the “hidden”

services available to runaway and homeless

nature of youth homelessness and the transiency

youth in the same 22 counties (see Chapter 4).

of these youth (Raleigh-DuRoff, 2004; Slavin,

2001). Compared with homeless adults, they

The need for accurate data on homelessness

tend to move around more frequently and

among youth is widely recognized. Recently, this

cycle more frequently between being homeless

need was encapsulated by the U.S. Interagency

and being housed (Morgan, 2013). Youth

Council on Homelessness (USICH)’s revised

experiencing homelessness do not congregate

Criteria and Benchmarks for Achieving the

in the same places or at the same times as older

Goal of Ending Youth Homelessness, which

adults experiencing homelessness and may be

calls for communities to implement regular

reluctant to self-identify as homeless due to the

censuses of youth experiencing homelessness

stigma attached to that identity (Hickler and

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

23

Chapter 3. Youth Counts and Surveys

Auerswald, 2009; Kidd and Scrimenti, 2004).

VoYC was undertaken, in part, to develop

Many youth experiencing homelessness do not

a more consistent methodology that would

seek services (Baer et al., 2007; Pergamit and

address some of the shortcomings uncovered

Ernst, 2011; Street Youth Task Force, 2002; Levin

by the Youth Count! initiative and that could be

et al., 2005; McManus and Thompson, 2008).

replicated in communities across the United

They may distrust authority figures, fear being

States.

returned home or placed in foster care if they are

under age 18 or try to avoid being found because

Methodology

of the il icit survival behaviors in which they are

engaged (De Rosa et al., 1999; McManus and

Design and Data Col ection

Thompson, 2008; Kurtz et al., 2000; Harter et al.,

Data collection for the youth count and BYS took

2007).

place over a 24-hour period on different dates in

However, interest is growing, particularly at the

each of the 22 counties (see Figure 3.1). The 22

Federal level, in developing better methods for

counties were selected using a stratified random

counting youth experiencing homelessness—

sampling approach that was designed to ensure

methods that can be replicated across place and

diversity across geography, population density,

over time. In February 2013, USICH published

and homeless youth services infrastructure.

a Framework to End Youth Homelessness,

The VoYC team had conversations with a broad

which cal ed for two complementary strategies

group of stakeholders—including city or county

for ending youth homelessness by 2020. One

officials, service providers, public systems

of those strategies is collecting “better data

representatives (for example, child welfare,

on the numbers and characteristics of youth

juvenile justice, or education), Continuum of Care

experiencing homelessness” (USICH, 2013).

(CoC) representatives, and foundations—in each

of those counties. Each county entered into a

To help kick-start this effort, USICH, together

Letter of Agreement and identified a lead agency

with the U.S. Department of Housing and Urban

to work closely with VoYC site coordinators and

Development (HUD), the U.S. Department of

other members of the team.]

Health and Human Services (HHS), and the U.S.

Department of Education (ED) launched Youth

Count! as part of the 2013 point-in-time count

to identify promising practices for conducting

collaborative youth counts that could be adapted

and taken to scale with the ultimate goal of

producing a national estimate. Nine communities

representing a mix of urban, suburban, and

rural areas participated (Pergamit et al., 2013).

Although several promising practices for

counting youth experiencing homelessness

emerged, shortcomings of the local counts

were also evident. These included insufficient

planning time and the chal enge of covering

large geographic areas. Additional y, the lack of

consistent methodology made it difficult to make

cross-site comparisons.

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24

Chapter 3. Youth Counts and Surveys

Figure 3.1. VoYC partner counties

King

Country, WA

(Seattle)

Kennebec

County, ME

Walla Walla,

Hennepin

County, WA

Ada

County, MN

County, MA

County, ID

(Minneapolis)

(Boston)

Wayne

County, MI

Cook

(Detroit)

County, IL

(Chicago)

Cecil

County, MD

Alameda

Philadelphia

Denver

Country, PA

County, CA

County, CO

Livingston

(Philadelphia)

(Oakland)

Mariposa

County, CA

(Denver)

County, MO

Delaware

County, OH

Boyd

County, KY

Cleveland

San Diego

County, OK

County, CA

Davidson

(San Diego)

County, TN

(Nashville)

Travis

Orleans

County, TX

Parish, LA

Orange

(Austin)

(New Orleans)

County, FL

Urban

(Orlando)

Suburban

Medium/Small Town

Rural

In-Depth Interview Site

Although HUD requires communities to conduct

The BYS was similar to surveys used during prior

their annual point-in-time counts during the

counts of youth experiencing homelessness. It

month of January, when individuals and families

included only 16 items and general y took about

experiencing homelessness are more likely to

5–10 minutes to complete. It was designed to

seek shelter (particularly in colder environments),

fit onto one side of a single sheet of paper so

all of the VoYC counts were conducted during

that it could be administered to many youth

the summer (June through August) of 2016.

across a range of settings. The survey was

We decided to conduct the counts during the

also kept brief to avoid volunteer interviewer or

summer based on two considerations. First, we

interviewee fatigue and to minimize missing data.

wanted the counts to be as uniform as possible

The survey asked youth where they had slept

across the 22 counties. This meant that we could

the night before and about their demographic

either conduct all the counts during the summer,

characteristics, their education and employment,

or we could conduct all the counts during the

and their prior systems involvement. The full

school year. Second, because selecting the

instrument is provided in Appendix B.

counties took longer than we had expected,

conducting all the counts during the school year

Each youth count included three components:

would have meant delaying the counts even

a street count, an organizational count, and

further until after summer (or the start of the

a community count. Chapin Hall contracted

following school year). Going forward, however,

with Applied Survey Research (ASR) to help

many communities could incorporate the youth

implement the youth count and BYS.

count lessons and toolkit resources into their

Street Count. The street count involved

broader January point-in-time counts to make

visual counts of youth in identified “hot

them more youth-inclusive.

spots”—locations where youth experiencing

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

25

Chapter 3. Youth Counts and Surveys

homelessness were likely to be found (for

experiencing homelessness were known to

example: libraries, parks, agencies that provide

congregate or that they could easily access (for

health or mental health services, specific street

example, parks and libraries). Youth were notified

corners, places that are open 24 hours a day,

of these opportunities to be surveyed through

and places with free Wi-Fi). Youth who had

service providers, social media, and other forms

experienced homelessness and local service

of outreach. Youth who completed the survey

providers participated in focus groups a few

received a $5 gift card. A visual count was not

weeks prior to the youth count to identify the hot

conducted at these sites.

spots. A total of 2,483 hot spots were identified;

the number identified in each county ranged from

We intentional y developed a method for

25 to 372.

conducting youth counts that could be replicated

by communities across the United States. The

On the day of the count, teams composed of two

Youth Count Toolkit provides a step-by-step

or three 18–25-year-olds who had experienced

roadmap for conducting a youth count using the

homelessness, accompanied by a supportive

VoYC methodology.9 It also includes links to the

adult volunteer, were given maps of the hot spots

templates, protocols, worksheets, flyers, and

where they were to count and survey youth.

other documents we used.

Teams conducted a visual count of youth who

appeared to be homeless in the areas to which

Data analysis

they were assigned. The teams used tal y sheets

The BYS data were the primary source of

to record the number of youth they observed, the

data used to estimate the number of youth

gender and race/ethnicity of the youth, whether

experiencing homelessness in each county

the youth appeared to be 13 to 17 years old or

on the date of the count. For each county, we

18 to 25 years old, the presence of any children,

dropped the records of youth who (1) did not

and other characteristics that might assist with

give consent, (2) were under age 13 or over

de-duplication.

age 25, or (3) said that they had completed the

Immediately following the visual count, youth

survey before. We also dropped the records

who remained in the vicinity were approached

of youth who indicated that they had spent the

and invited to complete the BYS. Youth who

previous night in a potential y permanent housing

completed the survey received a $5 gift card.

situation (that is, their own apartment, home of

parent or other relative, boyfriend or girlfriend’s

Organizational Count. Staff or other volunteers

home, friend’s home, foster or group home)

administered the BYS to unaccompanied youth

only if they also indicated that where they had

in shelters, transitional living programs, drop-

stayed the night before was a stable place to

in centers, and other organizations from which

stay. Final y, we used initials and date of birth

youth experiencing homelessness may have

to de-duplicate the data; if two or more records

received services on the day of the count. Youth

appeared to belong to the same youth based on

who completed the survey received a $5 gift

initials, birthdate, and responses to the survey

card. A visual count was not conducted in these

questions, the duplicate records were removed.

locations.

Because some youth were counted but not

Community Count. Volunteers administered

surveyed, the BYS data were supplemented with

the BYS to youth at “Come and Be Counted”

the tal y sheet data.10 To determine the number of

locations in the community where youth

tal y sheet records that should be added to each

9

The toolkit can be downloaded free of charge at http://voicesofyouthcount.org/resource/conducting-a-youth-count-a-toolkit/.

10 Some youth who arrived at the hot spot after survey administration had begun were surveyed but not counted.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

26

Chapter 3. Youth Counts and Surveys

county’s BYS total, we calculated the percentage

program before, that date and for youth who had

of youth surveyed by each team whose records

“permanent housing” (that is, no time limit on

were dropped because they did not meet the

how long the youth could remain in the housing

VoYC inclusion criteria for homelessness and

unit or receive the housing assistance). We

applied those percentages to the number of

also dropped the HMIS records of youth who

youth each team observed who did not complete

had completed the BYS by comparing the birth

the survey. In other words, if the survey records

dates, gender and race/ethnicity of youth who

for X percent of the youth surveyed by a given

completed the survey to the birth dates, gender

team were dropped, we dropped X percent of the

and race/ethnicity of youth for whom we had

tal y sheet records for that team’s non-surveyed

HMIS records. HMIS records for which there

youth. Final y, the total number of tal y sheet

were exact matches on all three identifiers were

records that were retained across the teams was

dropped.12

added to the BYS total for each county.

The BYS data from each of the 22 counties were

Another supplemental data source was the

aggregated and analyzed to generate descriptive

Homeless Management Information Systems

statistics. Because the size of the 22 VoYC

(HMIS). HMIS data, which are collected

counties varies so much, we divided the counties

by Continuum of Care (CoC) agencies that

into three groups based on population size: six

serve individuals and families experiencing

counties with populations ranging from 15,028 to

homelessness, include demographic information

119,980, seven counties with populations ranging

as well as the name of the agency providing

from 193,013 to 778,121, and nine counties

the service, the type of service provided, and

with populations ranging from 1,176,558 to

program entry and exit dates. The agency (or

5,238,216 (see Table 3.1). Some analyses were

agencies) responsible for the HMIS in each of

also run separately for each of the three groups.

the 22 counties was asked to provide individual

Additional y, county-level statistics are provided

level HMIS data for all 13- to 25-year-olds

in Appendix A.

who received services between September 1,

2015, and August 31, 2016—a 12-month period

inclusive of all the youth count dates. Some

agencies could not share individual-level data

without client consent; others could not share

data because the HMIS was undergoing a major

change. In the end, HMIS data were provided by

only eight counties.11

To incorporate the HMIS data into the count

totals for those eight counties, we dropped

the HMIS records for youth who were not 13

to 25 years old on the day of the count and for

youth who were not enrolled in an emergency

shelter, street outreach program, or transitional

housing program on the night before the count.

This meant dropping the records for youth

who entered the program after, or exited the

11 The CoC for Kennebec County could not provide individual level HMIS data, but one of the agencies that is part of the CoC did share individual data for the youth it served.

12 This conservative approach to identifying potential duplicates may have resulted in some youth being double counted.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

27

Chapter 3. Youth Counts and Surveys

Table 3.1. Counties by population size

Small

Medium

Large

Livingston, MO

15,028

Delaware, OH

193,013

Travis, TX

1,176,558

Mariposa, CA

17,531

Cleveland, OK

274,458

Hennepin, MN

1,223,149

Boyd, KY

48,325

Orleans, LA

389,617

Orange, FL

1,288,126

Wal a Wal a, WA

60,338

Ada, ID

434,211

Philadelphia, PA

1,567,442

Cecil, MD

102,382

Davidson, TN

678,889

Alameda, CA

1,638,215

Kennebec, ME

119,980

Denver, CO

682,545

Wayne, MI

1,759,335

Suffolk, MA

778,121

King, WA

2,117,125

San Diego, CA

3,299,521

Cook, IL

5,238,216

Total

363,584

Total

3,430,854

Total

19,307,687

Results

The total number of surveyed youth experiencing

homelessness on the night of the count was

Aggregate Count Results

4,139 and ranged from 10 to 689 across the

22 counties. As shown in Figure 3.2, the small

Across the 22 VoYC counties, 7,389 surveys were

counties accounted for 6 percent of the 4,139

completed (see Table 3.2), and 3,103 of those

surveyed youth experiencing homelessness,

surveys were dropped for one of four reasons:

the medium-sized counties accounted for 27

(1) 2,717 youth did not meet the VoYC criteria for

percent, and the large counties accounted for

being homeless (for example, they had spent the

67 percent (see Table 3.2). Fifty-six percent of

night before the count with family or friends and

youth experiencing homelessness were surveyed

had a stable place to stay), (2) 245 youth did not

during the Street Count, 21 percent were

consent, (3) 133 youth were not 13 to 25 years

surveyed during the Organizational Count, and

old, and (4) 8 youth had already been surveyed.

23 percent were surveyed during the Community

Another 147 were dropped during de-duplication.

Count.

Table 3.2. BYS records by county size

Small

Medium

Large

Total

Counties

Counties

Counties

Total number of survey records

7,389

477

1,762

5,150

Number of survey records dropped

3,103

214

608

2,281

Number of surveys dropped during de-duplication

147

8

42

97

Number of youth experiencing homelessness

4,139

255

1,112

2,772

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

28

Chapter 3. Youth Counts and Surveys

Of the 6,291 youth who were tal ied during the

program, or transitional housing program on

visual street count, 1,641 were not surveyed

the night before their county’s youth count, and

(see Table 3.3). From the tal y sheet records,

998 of those records were retained after de-

833 were retained after applying the percentage

duplication. Adding the non-surveyed youth to

of surveyed youth whose survey records were

the BYS total brought the count total to 5,970,

dropped because they did not meet the VoYC

including 359 youth in the small counties, 1,326

inclusion criteria. The HMIS data for the eight

in the medium-sized counties, and 4,285 in

counties that provided HMIS data included

the large counties. Across the 22 counties, the

records for 1,401 13- to 25-year-olds who were

number of youth experiencing homelessness

enrolled in an emergency shelter, street outreach

ranged from 12 to 911.

Figure 3.2. Breakdown of BYS sample by county size

6%

27%

67%

Small

Medium-Sized

Large

Table 3.3. Integration of BYS, tal y sheet, and HMIS data by county size

Medium-

Small

Sized

Large

Total

Counties

Counties

Counties

Unduplicated number of youth experiencing homelessness

surveyed

4,139

255

1,112

2,772

Total number of tal y sheet records

6,291

441

1,336

4,514

Number of tal y sheet records for youth not surveyed

1,641

145

362

1,134

Number of tally records retained

833

65

201

567

Number of HMIS records for 13- to 25-year-olds on the night

before the count

1,411

45

22

1,344

Number of HMIS records retained

998

39

13

946

Number of youth experiencing homelessness

5,970

359

1,326

4,285

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

29

Chapter 3. Youth Counts and Surveys

Aggregate Brief Youth Survey Results

youth who identify as LGB because some youth

may have felt uncomfortable sharing information

Below we present findings from the BYS and,

about their sexual orientation. Because only six

where relevant, compare the responses of the

youth identified as both 100 percent heterosexual

surveyed youth experiencing homelessness with

and transgender, the percentage of youth who

data from the 2015 American Community Survey,

identified as LGBT is virtual y the same as the

the National Longitudinal Survey of Adolescent

percentage who identified as LGB.

Health (Add Health), or from a recent (2016-2017)

Gal up poll of 18- to 25-year-olds across the

United States.13

Demographic Characteristics of Surveyed

Youth

Table 3.4 provides a summary of aggregated

demographic characteristics of the surveyed

youth experiencing homelessness across the

22 counties. Eighty-seven percent of the youth

were at least 18 years old. Youth under age 18

are likely to have been undercounted, however,

we do not know by how much. This is because

counties did not have data on the number of

youth under age 18 experiencing homelessness,

with which our count results could be compared.

Most youth identified as Black or African-

American (47 percent) or White (25 percent).

Compared to the general U.S. population,

Black and multiracial youth were substantial y

overrepresented (see Table 3.4).14 Most of

the youth identified as male. Less than three

percent identified as transgender, genderqueer,

or gender nonconforming. Seventy-seven

percent of the youth experiencing homelessness

identified as 100 percent heterosexual and 21

percent identified as lesbian, gay, or bisexual

(LGB).15 The latter is considerably higher than

the percentage of young adults who identify

as LGB in the general population.16 Moreover,

these data may underestimate the percentage of

13 Add Health is a Federally funded study designed to examine how social contexts (families, friends, peers, schools, neighborhoods, and communities) influence the health-related behaviors of adolescents and how those health-related behaviors are related to young adult outcomes. A nationally representative sample of 7th through 12th graders completed in-home interviews in 1994. Study participants were interviewed a second time in 1996, a third time in 2001–2002, and a fourth time in 2007–2008.

14 The general population data come from the 2011–2013 3-Year American Community Survey (ACS) and include all U.S. residents, not just 13- to 25-year-olds. The ACS is conducted by the U.S. Census Bureau to gather information about demographic characteristics, education, employment, income, housing, and other topics.

The ACS data can be used to estimate characteristics of the population at national, state, county, or other geographic levels over 1-, 3- or 5-year periods.

15 Youth were categorized as LGB if they identified as mostly heterosexual, bisexual, mostly gay or lesbian, or 100% gay or lesbian.

16 A recent Gallup poll found that approximately 7 percent of millennials in the United States identify as lesbian, gay, bisexual, or transgender (http://www.gallup.com/

poll/201731/lgbt-identification-rises.aspx?g_source=Social%20Issuesandg_medium=newsfeedandg_campaign=tiles).

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

30

Chapter 3. Youth Counts and Surveys

Table 3.4. Demographic characteristics of surveyed youth

Percentage

Missing data

Age group

13–17

13%

18-21

43%

223

22-25

44%

Race and ethnicity*

White

25%

Black or African-American

47%

Multiracial

9%

103

Other

6%

Hispanic

12%

Gender identity**

Female

37%

Male

59%

470

Other

3%

Sexual orientation***

Lesbian, gay, or bisexual

21%

100% heterosexual

77%

269

Other

3%

Gender identity and sexual orientation****

LGBT

21%

Non-LGBT

77%

579

Other

3%

* Other includes youth who identified as American Indian/Alaskan Native, Native Hawai an/Pacific Islander, Asian, or other as well as youth did not know their race/ethnicity.

** Other includes youth who identified as transgender, genderqueer/nonconforming, intersex, or other as well as youth who did not know their gender identity.

*** LGB youth include youth who identified as mostly heterosexual, bisexual, mostly gay or lesbian, or 100 percent gay or lesbian. Other includes youth who identified as not sexual y attracted to either males or females, identified their sexual orientation as other, or did not know their sexual orientation.

**** LGBTQ youth include youth who identified as mostly heterosexual, bisexual, mostly gay or lesbian, 100 percent gay or lesbian, transgender, or genderqueer/nonconforming. Non-LGBTQ includes youth who identified as male or female and 100 percent heterosexual.

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Chapter 3. Youth Counts and Surveys

Figure 3.3. Race and ethnicity

100%

80%

63%

60%

47%

40%

25%

20%

12%

12% 17%

9% 2%

6% 6%

0

White

African American

Latino

Multiracial

Other*

VoYC Data**

ACS Data

*Other includes youth who identified as American Indian/Alaskan Native, Native Hawai an/Pacific Islander, Asian, or other as well as youth who did not know their race/ethnicity.

**Data were missing for 103 respondents.

Where youth slept the night before the count

the home of someone s/he was having sex

with regardless of whether they reported

We categorized youth as belonging to one of four

having a stable place to stay.

groups based on where they reported sleeping

the night before the count:

• The other category includes youth who

explicitly reported that they lacked a stable

• The homeless sheltered category includes

place to stay but did not fall neatly into

youth who slept in emergency shelters,

any of the other categories. These are

transitional housing, and hotels or motels.

youth who had spent the night before the

• The homeless unsheltered category

count in their own apartment, a hospital or

includes youth who slept in vehicles,

emergency room, a residential treatment

abandoned buildings/vacant units, on

facility, a juvenile detention center or jail,

trains/buses or in train/bus stations, at

and youth who did not know where they

24-hour restaurants, laundromats or other

had slept or who refused to answer.

business/retail establishments, or anywhere

Based on these categories, 48 percent of

outside including on the street or in a

the youth were categorized as sheltered, 24

park.17

percent as unsheltered, 24 percent as staying

with others, and three percent as “other” the

• The staying with others category includes

night before the count (see Figure 3.4). A more

youth who explicitly reported not having a

detailed breakdown of where youth slept the

stable place to stay and slept in the home

night before the count is shown in Table 3.5

of a parent or other relative, the home of a

friend/girlfriend/boyfriend, or a foster/group

home. It also includes youth who stayed in

17 HUD’s final rule on the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act that included four categories under which individuals and families may qualify as homeless: (1) Individuals and families who lack a fixed, regular, and adequate nighttime residence; (2) individuals and families who will imminently lose their primary nighttime residence; (3) unaccompanied youth and families with children who are defined as homeless under other Federal statutes; and (4) individuals and families who are fleeing, or are attempting to flee dangerous or life-threatening conditions. Our sheltered and unsheltered categories map onto category one of HUD’s definition of homeless, which includes individuals sleeping in cars, parks, abandoned buildings, bus or train stations, airports, or camping grounds as well as those sleeping in shelters, transitional housing, or hotels and motels paid for by charitable organizations or government programs.

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Chapter 3. Youth Counts and Surveys

Figure 3.4. Where youth slept the night before the count

4%

Sheltered

24%

Unsheltered

48%

Staying with others

Other

24%

Table 3.5. Detailed breakdown of where youth slept the night before the count

Number

Percentage

Sheltered (n=1,968)

Emergency shelters

1,179

28.5%

Transitional housing

582

14.1%

Hotels/motels

207

5.0%

Unsheltered (n=998)

On the street, in parks, or otherwise outside

691

16.7%

In a vehicle

147

3.6%

Abandoned buildings/vacant units

89

2.2%

On trains/buses or in train/bus stations

54

1.3%

24-hour retail establishments

17

0.4%

Staying with others (n=990)

Home of parent

109

2.6%

Home of relative

84

2.0%

Home of friend/partner

520

12.5%

Foster or group home

9

0.2%

Home of person youth was having sex with

268

6.5%

Other (n=183)

Own apartment, but arrangement was not stable

52

1.3%

Hospital or emergency room

29

0.7%

Residential treatment facility

45

1.1%

Detention or jail

22

0.5%

Unknown/refused, but no stable place to stay

35

0.8%

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Chapter 3. Youth Counts and Surveys

Education and employment

were homeless reported having a high school

diploma or GED compared with 86 percent of

Seventy-three percent of 13- to 17-year-olds

18- to 25-year-olds who responded to a recent

and one-fourth of 18- to 25-year-olds who were

national Gal up poll.19 Twenty-seven percent

homeless reported that they were currently

of 13- to 17-year-olds and 34 percent of 18- to

attending school (see Figure 3.5). Because

25-year-olds who were homeless reported that

the BYS was administered during the summer,

they were currently employed. By comparison,

and we asked about attendance rather than

the employment rate was 77 percent among

enrollment, these data probably underestimate

18- to 25-year-old Gal up national survey

the percentage of youth who were connected to

respondents.20

school.18 Two-thirds of 18- to 25-year-olds who

Figure 3.5. Education and employment by age

100%

86%

80%

73%

77%

66%

60%

40%

34%

25%

27%

20%

14%

0

High school diploma/GED***

Attending school***

Employed**

13- to 17-year-olds

18- to 25-year-olds

National Sample of 18- to 25-year-olds

***Differences between 13- to 17-year-olds and 18- to 25-year-olds is statistical y significant at p < .001

**Differences between 13- to 17-year-olds and 18- to 25-year-olds is statistical y significant at p < .01

Notably, 48 percent of the homeless 16- to

24-year-olds were disconnected from work

and school compared with 13 percent of 16-

to 24-year-olds in the general population (see

Figure 3.6).21

18 The Gallup survey does not ask about school attendance so data on school attendance were not available for the national sample.

19 Gallup, Inc. Daily Tracking Poll data from July–September 2016.

20 Gallup, Inc. Daily Tracking Poll data from July–September 2016.

21 Measure of America analysis of data from the U.S. Census Bureau, American Community Survey PUMS Microdata. See http://opportunityindex.org/app/up-

loads/2016/12/Opportunity-Index-2016-Briefing-Book-FINAL.pdf.

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Chapter 3. Youth Counts and Surveys

Figure 3.6. Disconnected 16- to 24-year-olds

General population of 16- to 24-year-olds

13%

Homeless and unstably housed 16- to 24-year-olds

48%

Systems involvement

receiving government benefits and to have

spent time in juvenile detention, jail, or prison

Forty-nine percent of the youth experiencing

than 13- to 17-year-olds. This probably reflects

homelessness were currently receiving

differences in their eligibility for benefits as well

government benefits (for example, Medicaid,

as differences in their period of exposure to risk.

food stamps, SSI, or cash assistance); 46

However, because 18- to 25-year-olds would no

percent had ever spent time in juvenile detention,

longer be at risk of foster care placement, the

jail, or prison; and 29 percent had ever been

difference was much smal er between the two

in foster care (see Figure 3.7). However, 18-

groups in the percentage who had ever been in

to 25-year-olds were much more likely to be

foster care.

Figure 3.7. Systems involvement

31%

Receiving government benefits***

52%

49%

27%

Ever in detention, jail, or prison**

49%

46%

22%

Ever in foster care

29%

29%

Ages 13 to 17

Ages 18 to 25

Total Sample

***Difference between 13- to 17-year-olds and 18- to 25-year-olds is statistical y significant at p < .001

**Difference between 13- to 17-year-olds and 18- to 25-year-olds is statistical y significant at p < .01

To appreciate how high these percentages

who participated in the fourth wave of the Add

are, consider that two percent of the 18- to

Health Study had ever spent time in a jail, prison,

28-year-olds in a national y representative

juvenile detention center, or other correctional

survey sample—the third wave of the Add

facility (Harris, 2009). We also looked at the

Health Study—had ever lived in a foster home,22

overlap between youth who had spent time in

and that 15 percent of the 24- to 34-year-olds

foster care and youth who had spent time in

22 The Add Health figure does not include young adults who were in group care settings, but not in foster homes (Harris, 2009).

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Chapter 3. Youth Counts and Surveys

juvenile detention, jail, or prison and found that

the percentage of youth who were pregnant, who

17 percent of youth had experienced both.

had a pregnant partner, or who were a parent

was considerably higher among 18- to 25-year-

Pregnancy and Parenthood

olds than among 13- to 17-year-olds. Seventy-

nine percent of the young women and 47 percent

Thirty-nine percent of the females and 16

of the young men who were pregnant, who had a

percent of the males reported that they were

pregnant partner, or who were a parent reported

pregnant, had a pregnant partner, or were a

having custody of their child(ren).

parent (see Figure 3.8). Regardless of gender,

Figure 3.8. Pregnant or a parent by gender

100%

80%

60%

44%

39%

40%

20%

16%

18%

10%

3%

0

Female+

Male+

Total***

13- to 17- years-old

18 to 25-years-old***

***Difference between males and females is statistical y significant at p < .001

+Data on pregnancy and parenthood were missing for 44 female respondents and 92 male respondents.

Figure 3.9. Location of surveyed youth by county size

Large

56%

21%

23%

Street Count

Medium-Sized

55%

22%

22%

Organizational Count

Community Count

Small

60%

15%

25%

Brief youth survey results by county size

likely to be captured by the Organizational Count

Location of surveyed youth by county size

than youth in medium-sized or large counties

23

(see Figure 3.9).

Youth in small counties were somewhat more

likely to be captured by the Street Count and less

23 All the county-level results reported in this chapter are based on the de-duplicated survey data.

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Chapter 3. Youth Counts and Surveys

Demographic characteristics of surveyed

African-American, than youth in medium-sized

youth by county size

or large counties. The percentage of youth who

identified as male was higher in medium-sized

Table 3.6 provides a comparative breakdown of

counties than in small or large counties. Youth in

demographic characteristics between counties

large counties were more likely to identify as LGB

grouped by population sizes. Small counties had

than those in small or medium-sized counties.

a higher percentage of youth under age 18 than

This might reflect a greater wil ingness to

either medium-sized or large counties. Youth

identify as LGB in large urban areas as well as a

in small counties were more likely to identify

migration of homeless LGB youth to those areas.

as White, and less likely to identify as Black or

Table 3.6. Demographic characteristics of surveyed youth by county size

Percentage

Statistically significant differences

( p < .05)*

Small

Medium

Large

Age group

13–17

13%

11%

22%

S|M, S|L

18–25

87%

90%

79%

Race and ethnicity

White

80%

32%

18%

S|M, S|L, M|L

Black or African-American

8%

44%

52%

S|M, S|L, M|L

Multiracial

6%

7%

10%

Other

4%

6%

7%

Hispanic

3%

11%

13%

S|M, S|L

Gender identity

Female

43%

30%

40%

Male

56%

69%

56%

S|M, S|L

Other

2%

2%

4%

Sexual orientation

Lesbian, gay, or bisexual

14%

18%

23%

100% heterosexual

85%

80%

74%

S|L, M|L

Other

1%

2%

3%

* S|M = statistical y significant difference between small and medium-sized counties, S|L = statistical y significant difference between small and large counties, and M|L = statistical y significant difference between medium-sized and large counties.

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Chapter 3. Youth Counts and Surveys

Where youth slept the night before the count

Youth who were surveyed in smal er (more rural)

by county size

counties were about twice as likely to be staying

with others as youth who were surveyed in larger

Figure 3.10 shows where youth who were

(more urban) counties. These data underscore

surveyed in counties of different sizes slept the

the extent to which youth experiencing

night before the count. Youth who were surveyed

homelessness tend to be more hidden in smal er

in larger (more urban) counties were about

(more rural) counties where there are relatively

twice as likely to be sheltered as youth who

few service providers.

were surveyed in smal er (more rural) counties.

Figure 3.10. Where youth slept the night before the count by county size

Large

50%

22%

23%

5%

Sheltered

Unsheltered

Medium-Sized

47%

22%

28%

22%

4%

Staying with others

Small

23%

28%

44%

Other

5%

Education and employment by county size

counties. Although school attendance varied

less by county size, 13- to 17-year-olds in small

Table 3.7 provides a comparative breakdown of

counties were the least likely to be attending

education and employment indicators between

school. The 18- to 25-year-olds in small counties

counties grouped by population sizes and

were less likely to be attending school and less

disaggregated by age groups. The 13- to 17-year-

likely to be employed than 18- to 25-year-olds in

olds in medium-sized counties were more likely

large counties. This could reflect a general lack

to have a high school diploma or GED than 13- to

of opportunities for education or employment in

17-year-olds in large counties and more likely to

more rural as compared with more urban areas.

be employed than 13- to 17-year-olds in small

Table 3.7. Education and employment indicators by county size

Statistically significant differences

Percentage

( p < .05)*

Small

Medium

Large

13–17-year-olds

High school diploma/GED

15%

23%

10%

S|L, M|L

Attending school

65%

72%

74%

(continued)

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Chapter 3. Youth Counts and Surveys

(Table 3.7. Education and employment indicators by county size continued)

Statistically significant differences

Percentage

( p < .05)*

Small

Medium

Large

Employed

13%

33%

27%

S|M

18–25-year-olds

High school diploma/GED

59%

67%

66%

Attending school

17%

21%

27%

S|L, M|L

Employed

23%

34%

35%

S|M, S|L

* S|M = statistical y significant difference between small and medium-sized counties, S|L = statistical y significant difference between small and large counties, and M|L = statistical y significant difference between medium-sized and large counties.

The percentage of 16- to 24-year-olds who were

large counties than in either small or medium-

not connected to school or work was lower in

sized counties (see Figure 3.11).

Figure 3.11. Disconnected 16- to 24-year-olds by county size

100%

80%

57%

60%

51%

46%

40%

20%

0

Not attending school and not working

Small (a)

Medium-Sized (b)

Large (a,b)

a Difference between smal and large counties statistical y significant at p < .05

b Difference between medium and large counties statistical y significant at p < .05

Systems involvement by county size

The percentage of youth who had ever been

in foster care varied relatively little by county

size, but youth in large counties were less likely

to have spent time in juvenile detention, jail, or

prison than youth in either small or medium-sized

counties (see Figure 3.12). Additional y, youth

in medium-sized counties were less likely to

be receiving government benefits than youth in

small or large counties.

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Chapter 3. Youth Counts and Surveys

Figure 3.12. Systems involvement by county size

100%

80%

56%

60%

50%

52% 50%

44%

43%

40%

27% 30% 28%

20%

0

Receiving government benefits Ever in detention, jail, or prison

Ever in foster care

(a,b)

(b)

Small

Medium-Sized

Large

a Difference between small and medium-sized counties statistical y significant at p < .05

b Difference between medium-sized and large counties statistical y significant at p < .001

Pregnancy/parenthood by county size

pregnant or a parent was higher in small counties

than in either medium-sized or large counties

The percentage of homeless females who were

(see Figure 3.13).

Figure 3.13. Pregnancy and parenthood (females only)

100%

80%

56%

60%

36%

40%

38%

20%

0

Pregnant or a parent

Small (a,b)

Medium-Sized (a)

Large (b)

a Difference between small and medium-sized counties statistical y significant at p < .001

b Difference between small and large counties statistical y significant at p < .001

Discussion

surveyed. HMIS data provided by eight counties

brought the count total to 5,970.

Key Findings

Based on where the youth had slept the night

Survey data were collected from 4,139 youth

before the count, 48 percent were categorized as

experiencing homelessness across 22 counties

sheltered homeless, 24 percent as unsheltered

that partnered with VoYC. An additional 833

homeless, 19 percent as “staying with others,”

youth were observed (that is, tal ied) but not

and 10 percent as “other.” These data suggest

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40

Chapter 3. Youth Counts and Surveys

that youth who have traditional y been

16- to 24-year-olds in the general population.

excluded from HUD’s CoC point-in-time counts

represent a substantial proportion of the youth

The youth experiencing homelessness that we

homelessness population.

surveyed had a high rate of systems involvement.

Forty-nine percent were currently receiving

Eighty-seven percent of the youth experiencing

government benefits, 46 percent had ever spent

homelessness were 18 to 25 years old, and 59

time in juvenile detention, jail, or prison, and 29

percent were male. Although 13 to 17 year olds

percent had ever been in foster care. They also

are likely to have been undercounted, we do not

had a high rate of pregnancy and parenthood.

know by how much. The gender imbalance may

Thirty-nine percent of females (44 percent of

be an artifact of age and location. Most of the

females who were 18 to 25 years old) reported

youth were surveyed during the street count, and

being pregnant or having at least one child.

prior studies have found that samples of street

youth or older youth experiencing homelessness

Youth experiencing homelessness in less

tend to be disproportionately male (Toro, Fowler,

populated counties look different from their

and Dworsky, 2007).

counterparts in more populated counties along

several dimensions including race/ethnicity,

Black or African-American youth, and youth who

sexual orientation, and pregnancy/parenthood.

identified as LGBTQ, were disproportionately

However, these differences should not be

represented among youth experiencing

overstated because we also found a significant

homelessness. African-Americans comprise 12

amount of variability on some dimensions, even

percent of the U.S. population, but 47 percent

between counties with similar population sizes.

of the youth experiencing homelessness

identified as Black. Twenty-one percent of the

Process lessons for conducting point-in-time

youth experiencing homelessness identified

youth counts were also important. At least three

as LGBTQ. This is at the low end of the 20

factors contributed to the success of the youth

percent to 40 percent range that is cited by

counts. First, VoYC site coordinators worked

many LGBTQ youth advocates, but considerably

collaboratively with the lead agency and local

higher than the percentage of young adults who

planning committee in each county to engage

identify themselves as LGBTQ in the general

local stakeholders in the planning and execution.

population.24 Moreover, the percentage of youth

Second, youth played a central role in planning

who identify themselves LGBTQ may be higher

for, and executing, the counts. Third, mapping

than these data suggest.

the “hot spots” where youth experiencing

homelessness were likely to be found resulted

One-third of the homeless 18- to 25-year-olds

in an efficient use of resources, particularly in

did not have a high school diploma or GED, and

counties that cover a very large geographic

only 34 percent were currently employed. By

area. Covering every inch of a large geographic

comparison, a recent national Gal up poll found

area requires very large numbers of people, a

that only 14 percent of 18- to 25-year-olds did

lot of time, and significant resources. Given that

not have a high school diploma or GED and 77

people, time, and resources for youth counts

percent were employed.25 Likewise, 48 percent

are virtual y always constrained, it helps to focus

of the homeless 16- to 24-year-olds would be

limited assets on hot spots, knowledgeable staff,

categorized as disconnected (that is, neither

and youth with lived experiences.

working nor in school) compared to 13 percent of

24 A recent Gallup poll found that approximately 7 percent of millennials in the United States identify as lesbian, gay, bisexual, or transgender (http://www.gallup.com/

poll/201731/lgbt-identification-rises.aspx?g_source=Social%20Issuesandg_medium=newsfeedandg_campaign=tiles).

25 Gallup, Inc. Daily Tracking Poll data from July–September 2016.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

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Chapter 3. Youth Counts and Surveys

Combining the visual count with the brief youth

not only sheltered and unsheltered

survey (BYS) had several advantages. First,

youth, but also youth who were couch

the BYS data al owed us to determine whether

surfing or doubled up. This is consistent

youth were homeless based on where they slept

with the revised USICH Criteria and

the night before the count rather than on visual

Benchmarks for Achieving the Goal of

cues. This proved to be important because 37

Ending Youth Homelessness, which

percent of the surveyed youth did not meet the

calls for communities’ censuses of youth

criteria for homelessness. Second, the data on

experiencing homelessness to include

where youth had slept the night before the count

all unaccompanied youth “that meet any

also al owed us to distinguish between youth

federal definition of homelessness (USICH,

who met the HUD definition of homelessness

2018).”

and youth who did not. Third, the demographic

• Unlike the HUD point-in-time count or prior

and other data we collected al owed for us to

stand-alone youth counts that took place

examine the heterogeneity of the population and

during the school year, the youth counts in

cross-county variation in its composition. Fourth,

this study all took place during the summer.

administering the survey in shelters, transitional

It is possible that there could be significant

living programs, and community locations

seasonal variations in youths’ sleeping

al owed for a more inclusive count. Final y,

arrangements and how well counts are

because the survey asked youth for their initials

able to identify them. These variations,

and date of birth, we were able to de-duplicate

however, can be very context-dependent.

the data and minimize the chance that youth

For example, a wel -resourced Northern

were counted more than once.

urban community might have harsher

For several reasons, it is difficult to compare

winters and more shelter facilities for youth,

either the youth counts or the estimates it

and therefore might be able to identify

produced with prior counts and estimates of

youth more easily during the winter if they

youth homelessness including—

congregate more in shelter facilities (this

is part of the logic of January counts for

• Never have so many geographical y diverse

homeless adults and families). However,

communities participated in a single effort

this logic would be less applicable to

specifical y to incorporate methods aimed

parts of the country with moderate winter

at better counting and surveying youth

climates, and many communities—

experiencing homelessness (that is, apart

especial y more rural communities—lack

from more general counts of homeless

adequate shelter facilities for youth. In

individual and families).

these communities, youth might be driven

• Although some elements of the VoYC

into less identifiable sleeping arrangements

methodology have been implemented

during colder months—for example, couch

as part of prior youth counts, and even

surfing, doubling up, or staying in buildings,

identified as best practices for counting

vehicles, or public transport vehicles or

youth experiencing homelessness (for

facilities—rather than sleeping outside in

example, involving youth in the counts and

the absence of adequate youth-friendly

hot spot mapping), they had never been

shelter options. In communities with high

combined into a single approach across

youth transience or seasonal migration,

multiple counties (Auerswald et al., 2013).

understanding how timing relates to local

youth mobility patterns could also be

• Unlike HUD-required January point-in-

important for selecting timing to maximize

time counts, the youth counts captured

identification. Furthermore, the potential of

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42

Chapter 3. Youth Counts and Surveys

engaging schools and colleges should be

Fifth, we took a compromise approach to

weighed in planning the timing of counts,

handling the observational visual counts. Youth

including considerations regarding when

who were tal ied but not surveyed were included

schools and colleges are in session and

in the visual count. This approach has the

when their staff can be most available

disadvantage of susceptibility to biases related

to support a community youth count.

to count volunteers’ perceptions of what a youth

Communities should consider trade-offs

experiencing homelessness “looks like” and to

related to their unique contexts and when

inclusion errors (counting youth who were not

planning the timing of their youth counts.

real y homeless). However, it has the advantage

• VoYC included as youth ages 13–25

of including youth who are obviously or very likely

whereas prior counts have often had

homeless, but for a variety of reasons, cannot

different upper and/or lower age bounds.

safely or readily be surveyed during the count.

For example, HUD’s estimates of youth

We included the visual counts, but we adjusted

homelessness apply to individuals up to

the count numbers based on the percentage

age 24 who are unaccompanied by a parent

of surveyed youth who were categorized as

or guardian.

homeless by each count team. Nonetheless, it

is possible that those tal ied but not surveyed by

Limitations

count teams were systematical y different from

those surveyed by count teams, and therefore

Despite the strengths of this 22-county Youth

the adjustments made could have been flawed.

Counts Initiative, it also had several limitations,

Final y, because only eight counties provided us

which should be considered in both interpreting

with HMIS data, we did not integrate those data

the results and enhancing youth counts in the

into the aggregate count.

future.

Specifical y, with respect to the brief youth

First, youth who were couch surfing, doubling

surveys, there were also important limitations.

up, or experiencing other more hidden forms of

First, because the survey needed to be brief if

homelessness were probably missed, particularly

it was to be administered in conjunction with

if they were not connected to service providers

the counts, questions about important topics

and did not frequent hot spots. Second, because

such as perceived causes of homelessness,

the youth counts took place during a 24-hour

experiences with homelessness (for example,

period, they may not have captured youth who

age at first homeless, number of times homeless,

are intermittently homeless or highly mobile.

and length of current spel ), service utilization,

Third, engagement of McKinney-Vento school

and unmet needs could not be asked (although

homeless liaisons and other school personnel

some of these questions were included in the

was limited because all the youth counts were

survey that was administered as part of the

conducted during the summer. This may have

VoYC in-depth interview component). Second,

contributed to an undercount of youth under

although the focus of VoYC is on unaccompanied

age 18. Fourth, in counties where the hot spot

youth, the youth who completed the survey

mapping took place several weeks before the

were not asked if they were staying with a

count, some of the locations where youth were

parent or legal guardian. This means that some

likely to be found had changed (and, in some

of the youth we counted as homeless may

cases, hot spots can even vary according to the

not have been unaccompanied. Future Youth

time of day). This was especial y true in counties

Count! surveys should aim to include item(s) to

that experienced bad weather during the days

capture status regarding accompaniment while

leading up to or on the day of the count.

homeless. Third, these data provide a snapshot

of youth who were homeless at a point-in-time;

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

43

Chapter 3. Youth Counts and Surveys

they do not necessarily reflect the experiences of

experiencing homelessness. Notably, this

all youth who were homeless during the course

would require more resources and count

of a period of time, such as a year. Fourth, the

personnel. Although this increases the

BYS was administered in relatively few shelters

chance that the same youth will be counted

and transitional housing programs for homeless

multiple times, collecting data that can be

adults and families that also serve youth.

used for de-duplication can mitigate this

risk.

Final y, despite being piloted with youth in

two of the counties and reviewed by several

• Conduct a survey-based count rather

partners, three of the questions may have

than an observation-based count. Our

been problematic. First, our sexual orientation

experience suggests that visual cues alone

question, which comes from the National

should not be used to determine whether

Longitudinal Survey of Adolescent Health, may

a youth is homeless. Moreover, surveying

not have adequately captured the way some

youth provides an opportunity to gather

youth think about their sexual orientation.

information not only about their housing

Second, because the survey was administered

status, but also other characteristics.

during the summer, some youth who had

• Involve homeless adult and family

attended school during the academic year that

service providers. Many homeless adult

just ended and who were planning to attend

and homeless family service providers

school when the new academic year began may

serve homeless youth, particularly

have responded “no” to the school attendance

homeless youth age 18 and older. Involving

question. Third, youth were asked if they were

these homeless providers increases the

pregnant or a parent, but not if their partner

chance that the youth they serve will be

was pregnant. Although some males gave an

captured by the count.

affirmative response, others who had a pregnant

partner may have responded “no.” Additional y,

• Engage youth in all aspects of the

this question did not distinguish between the

process—including instrument

youth who are pregnant (or whose partners are

development. Youth engagement was

pregnant) and those who are parents, but the

central to the success of the VoYC

question about custody is only relevant to the

approach. Youth were involved in both

latter.

the planning of the count (for example,

identifying hot spots) and in its execution

Considering these limitations, some of the

(for example, collecting survey data).

lessons we learned from our efforts to count

Problems with some of the survey

and survey youth experiencing homelessness in

questions might have been avoided had

22 counties across the United States are briefly

youth been more involved in developing the

described in the following points—

instrument.

• Count over a period of several days.

• Pilot the survey instrument. More

Because homeless youth are a transient

thorough piloting of the survey instrument,

population and frequently move into and

and closer to the time of the actual counts,

out of housing, extending the count beyond

might have surfaced some of the problems

a 24-hour period makes it more likely that

with the survey questions that only became

youth experiencing homelessness will be

evident in retrospect.

counted. In fact, some communities have

conducted week-long counts of youth

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

44

Chapter 3. Youth Counts and Surveys

• Explore the use of web-based survey

to the count. Ask youth and frontline staff

applications. VoYC used paper and pencil

whether specific hot spots are best visited

surveys that were electronical y scanned.

at certain times. Flexibility is also needed

However, an increasingly viable option is

because youth may be congregating in

to use a web-based survey instrument that

unmapped locations on the day of the

can be accessed via a tablet or mobile

count.

phone. Electronic data collection has

• Integrate HMIS data. HMIS data can

several advantages, including the ability to

supplement a visual count or survey data,

reduce labor and human error involved in

particularly if some shelters or transitional

data entry from paper surveys to data files,

housing programs do not participate in

al owing for instantaneous data uploads

the count, but access can be a chal enge

for speedier data analysis and reporting

because not all CoCs are equal y wil ing or

of results back to communities, and ability

able to share their HMIS data.

to collect precise geographic (Geographic

Information System) data on homelessness

• Involve other service providers. Involving

for spatial outreach and targeting of

a variety of youth-serving organizations,

services and supports. However, electronic

such as health clinics, behavioral health

data collection can also require upfront

centers, and LGBTQ-focused agencies,

investments in technology and hardware

because many homeless youth—especial y

(unless count volunteers can use their own

those who are couch surfing or doubled

devices), may pose risks to volunteers

up—are not connected to homeless service

if using technology for the count makes

providers.

them more susceptible to theft or harm,

• School engagement. The Family

and can require additional training for

Education Rights and Privacy Act

volunteers that are less adept at using such

(FERPA) restricts the ability of schools

technology. Careful discussions, detailed

to share student information without

costing of both paper and electronic data

parental consent, and the Protection of

collection options, youth input, and piloting

Pupil Rights Amendment to the General

of electronic data collection could inform

Education Provisions Act requires school

whether this shift is the right choice for

districts to obtain parental consent for

a community. The length of the survey

youth to participate in a survey.26 These

instrument can also influence the viability

requirements limit how schools can assist

of electronic data collection (for example,

with counting or surveying unaccompanied

conducting a short survey with a smart

youth who, by definition, do not live with a

phone is likely to be easier than conducting

parent or legal guardian. However, schools

a long survey with a smart phone).

can raise awareness and encourage

• Review hot spots and/or allow for

students to participate in counts. If

flexibility. Revisit the list of identified hot

counts are conducted while schools are

spots immediately before the count to

in session, these collaborations are more

ensure that they are locations where youth

viable. Given that many youth experiencing

are still likely to be found. This is particularly

homelessness are also enrolled in post-

important if hot spot mapping had occurred

secondary education, the engagement of

several weeks before or if there had been

local col eges and universities—especially

inclement weather in the days leading up

community colleges that tend to have

26 Some school districts will not share any disaggregated data; others will provide de-identified individual-level data.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

45

Chapter 3. Youth Counts and Surveys

higher rates of lower income and minority

important overall differences between youth

youth—can also significantly improve

who experience homelessness and their general

counts’ identification.

population peers.

• Counting homeless minors. Although

References

McKinney-Vento data on homeless student

enrollment are a potential source of

Auerswald, Colette L., Jessica Lin, Laura Petry, and

information about homeless youth under

Shahera Hyatt. 2013. Hidden in plain sight: An

age 18, those data only capture youth

assessment of youth inclusion in point-in-time

who are still enrolled in school and who

counts of California’s unsheltered homeless

choose to disclose their housing status to

population. Sacramento, CA: California Homeless

school personnel. An alternative approach

Youth Project.

to estimate the number of minors who are

homeless is to embed questions about

Baer, John S., Sharon Garrett, Blair Beadnel ,

homelessness in ongoing National Surveys

Elizabeth A. Wel s, and Peggy L. Peterson. 2007.

of youth. Examples include the Youth Risk

“Brief motivational intervention with homeless

Behavior Surveil ance System (YRBSS),

adolescents: Valuating effects on substance use

Monitoring the Future, and the National

and service utilization,” Psychology of Addictive

Survey on Drug Use and Health (NSDUH).

Behaviors 21 (4): 582–586.

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De Rosa, Christine J., Susanne B. Montgomery,

Michele D Kipke, El en Iverson, Joanne L. Ma,

Data on the number of youth experiencing

and Jennifer B. Unger. 1999. “Service utilization

homelessness and the characteristics of those

among homeless and runaway youth in Los

youth are essential to preventing and ending

Angeles, California: Rates and reasons,” Journal

youth homelessness. They can be used to guide

of Adolescent Health 24 (6): 449–458.

policy decisions about spending on programs

for youth experiencing homelessness and to

Harris, Kathleen M. 2009. The national longitudinal

measure changes in the size and composition

study of adolescent to adult health (Add Health),

of the youth homelessness population over

Wave IV, 2007–2009. Chapel Hil , NC: Carolina

time. Data can also inform the development of

Population Center, University of North Carolina at

prevention and intervention strategies, enhance

Chapel Hill.

the ability of advocates to effectively lobby for

resources, and help service providers build

Harter, Lynn M., Charlene Berquist, B. Scott

capacity to address the needs of homeless

Titsworth, David Novak, and Tod Brokaw.

youth.

2007. “The structuring of invisibility among the

hidden homeless: The politics of space, stigma,

Motivated, by this need for better youth

and identity construction,” Journal of Applied

homelessness data, VoYC developed a

Communication Research 33 (4): 305–327.

replicable methodology for counting youth

experiencing homelessness and implemented

Hickler, Benjamin, and Colette L. Auerswald. 2009.

that methodology in a diverse set of communities

“The worlds of homeless White and African-

across the United States. Because of this

American youth in San Francisco, California: A

unprecedented effort, we now have a

cultural epidemiological comparison,” Social

snapshot of youth homelessness in 22 diverse

Science and Medicine 68 (5): 824–831.

counties that highlights the heterogeneity

of this population, both between and within

communities, and at the same time, points to

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Kidd, Sean A., and Kathryn Scrimenti. 2004.

Toro, Paul A., Patrick J. Fowler, and Amy Dworsky.

“Evaluating child and youth homelessness: The

2007. “Homeless youth in the United States:

example of New Haven, Connecticut,” Evaluation

Recent research findings and intervention

Review 28 (4): 325–341.

approaches.” In Proceedings of the 2007 National

Symposium on Homelessness Research,

Kurtz, P. David, Elizabeth W. Lindsey, Sara Jarvis,

edited by D. Dennis, G. Locke, and J. Khadduri,

and Larry Nackerud. 2000. “How runaway and

Washington, DC, March 1–2. http://aspe.hhs.gov/

homeless youth navigate troubled waters: The

hsp/homelessness/symposium07/.

role of formal and informal helpers,” Child and

Adolescent Social Work Journal 17 (5): 381–402.

U.S. Census Bureau. 2013. American Community

Survey. https://www.census.gov/acs/www/data/

Levin, Rebekah, Elizabeth Bax, Lise McKean, and

data-tables-and-tools/data-profiles/2013/.

Louise Schoggen. 2005. Wherever I can lay my

head: Homeless youth on homelessness. Oak

U.S. Interagency Council on Homelessness (USICH).

Park, IL: Center for Impact Research.

2013. Framework to end youth homelessness: A

resource text for dialogue and action. Washington,

McManus, Hol y H., and Sanna J. Thompson. 2008.

DC: Author.

“Trauma among unaccompanied homeless youth:

The integration of street culture into a model of

U.S. Interagency Council on Homelessness (USICH).

intervention,” Journal of Aggression Maltreatment

2018. Criteria and benchmarks for achieving the

and Trauma 16 (1): 92–109.

goal of ending youth homelessness (Version 2).

Washington, DC: Author.

Morgan, Jared. 2013, January 14. “Homeless youth

will help count their own,” Altadena Patch. https://

patch.com/california/pasadena-ca/l-a-county-to-

count-homeless-youth.

Pergamit, Michael, and Michel e Ernst. 2011. Running

away from foster care: Youths’ knowledge and

access of services. Washington, DC: The Urban

Institute.

Pergamit, Mike, Mary K. Cunningham, Martha R. Burt,

Pamela Lee, Brent Howel , and Kassie Dumlao

Bertumen. 2013. Youth count! Process study.

Washington, DC: The Urban Institute.

Raleigh-DuRoff, Cheryl. 2004. “Factors that influence

homeless adolescents to leave or stay living on

the street,” Child and Adolescent Social Work

Journal 21 (6): 561–571.

Slavin, Peter. 2001. “Life on the run, life on the streets,”

Children’s Voice Magazine 10 (4): 8–10.

Street Youth Task Force. 2002. Barriers to shelter

study pilot project needs assessment: Final

recommendation report. King County, WA: Author.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

47

Chapter 4. In-depth Interviews

Chapter 4. In-depth Interviews

Highlights

• We conducted 215 in-depth interviews

• Emerging adulthood was a high-risk

with youth experiencing homelessness

period and parents struggled with youths’

in five diverse communities across the

emerging sexuality and/or youths’ inability

country about their trajectories into

to financial y contribute to the household.

and through homelessness, and their

• Evaluating potential gains and the

experiences with systems and services.

management of risk informs youths’ logics

• The root causes of instability begin in

of engaging or avoiding resources.

childhood and include early disruptions in

• We recommend youth-centered

one’s literal and psychological sense of home.

approaches, attuned to youths’ family

• Nearly all youth experiencing homelessness

contexts, distinct developmental needs,

reported chronic childhood adversity; more

and youths’ own preferences.

than one in three experienced the death of

• We highlight the need for increased focus on

a parent or caregiver before the age of 25.

identity and personal agency, as this is often

a hidden element of youth resilience and risk.

Background

experiences; as with the national y representative

survey and the youth counts, the IDI sample

The previous two chapters reported high-level

includes youth who couch surf, an often “hidden”

statistics on the scale, scope, and characteristics

population (Tyler, Fagan, and Gel er, 2014). The

of youth homelessness in America based on a

IDI also explores youths’ own understanding of

national y representative survey and youth counts

the label “homeless.” This, along with a sample

in 22 counties across the country. This chapter

spanning the ages of 13 to 25, helps this study

goes deeper into the trajectories, experiences,

contribute a broader, more complex and youth-

and viewpoints of youth experiencing

centered representation of housing instability

homelessness using in-depth interviews (IDI) in

and its early beginnings.

five diverse communities. Additional y, this IDI

component attempts to address some limitations

Second, the IDI is deeply linked to, and expands

and gaps in the existing knowledge base by

the emerging conceptual work in, this and

expanding the interdisciplinary research, theory,

other fields that attempt to contextualize youth

and literature within and beyond the field of youth

outcomes and experiences developmental y and

homelessness.

ecological y (Auerswald and Eyre, 2002; Coward

Bucher, 2008; Slesnick et al., 2007). Relatedly,

The IDI component has at least four strengths

the IDI draws upon intersectional understandings

in how it advances existing empirical knowledge

of human diversity and social power. Taking

to change policy, practices, and scientific

this approach, we recognize youths’ multiple

methods. First, this study responds to the call

identities and the power or stigma attached to

within contemporary literature (Tyler, Fagan,

each (Collins, 1999: 261-284; Samuels and Ross-

and Gel er, 2014) to engage a broad definition

Sherriff, 2007). The IDI’s analyses considered not

of homelessness to capture the full spectrum of

only how stigma is tied to “homelessness,” but

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

48

Chapter 4. In-depth Interviews

also how it is complicated by other marginalized

group of studies (for example, Hyde, 2005;

and privileged identities among youth, including

Wil iams and Frederick, 2009) that also claim this

race, class, sexuality, gender expression, and

youth-centric focus.

ability. This approach to human diversity is only

beginning to appear in the field of homelessness

Fourth, during the past decade, a body of

(Abramovich and Shelton, 2017; Zufferey, 2017).

literature exploring pathways in or out of

Using this more complex approach is critical

homelessness and housing (in)stability has

to informing practices and policies that more

emerged (Coward Bucher, 2008; Hyde, 2005;

accurately reflect the lived diversity of youth.

Mal ett et al., 2010; Patterson, Markey, and

Somers, 2012), trajectories of recovery (Padgett

Third, this component is novel in its use of

et al., 2016) and a focus on early adversity that

multiple methods, and in its size and scope. The

shapes later trajectories (Schafer, Ferraro, and

IDI is truly a mixed-method and mixed-model

Mustil o, 2011). This study builds and expands

component. This is reflected in our use of youth-

upon that work, as well as a longer history

driven narrative protocol, interactive timeline

of trajectory and narrative methods outside

tools, background surveys, and integration of the

of homeless scholarship. Taken together, the

different kinds of data produced throughout the

IDI represents a comprehensive analysis of

research process. It is also driven by a research

the experience of youth homelessness and

approach that centers youth perspectives both in

contributes answers to all the main VoYC

the kind of data collected and in the presentation

initiative’s research questions (see Figure 4.1).

of findings. This approach complements a small

Figure 4.1. VoYC research questions and IDI data collection elements

Where are they/who are they?

Narrative

Interviews

How do they get by, how are they doing?

What factors are associated with how long

and how often they are homeless?

Who, what,

And then

And then

What services do they use, and

Housing

when, how,

what

what

which lead to better life outcomes?

Timeline Tool

where, why?

happened? happened?

How are their experiences

influenced by policies?

Why do they become

Background

homeless or run away?

Surveys

Methodology

summer of 2016 (see Chapter 3). The IDI used

“purposive methods” to select 5 of the VoYC’s

Site selection

22 counties (selected intentional y rather than

The IDI’s selection of sites builds on the first

randomly). We considered each county’s ability

phase of the VoYC initiative launched in the early

to support extended data collection activities and

unique local factors that could shape distinctive

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

49

Chapter 4. In-depth Interviews

experiences of housing instability among youth.

information after youth completed interviews to

Ultimately, the following five counties were

spread the word about the study. We ultimately

selected and agreed to participate in the IDI

recruited most youth through referrals from staff

component: Cook County, Il inois; Philadelphia

from agencies (n=50) and schools (n=9), direct

County, Pennsylvania; San Diego County,

contact with youth at agencies (n=48), and peer

California; Travis County, Texas; and Wal a Wal a

referrals from participants (n=36). The next most

County, Washington.

common sources were interviewers making

direct contact with youth on the streets (n=28),

The IDI also built upon the relationships and

flyers (n=23), and youth who were involved in

knowledge gained from the youth counts. For

focus groups during the youth count (n=17).

example, the VoYC team conducted focus

groups with providers and youth to identify “hot

Data collection

spots.” The IDI also used this information to

inform our field teams’ recruitment strategies.

All youth were informed about the study,

their rights, and the voluntary nature of their

Building a local field team

participation. Interviews were conducted from

July 2016 through March 2017 and lasted

We hired, rigorously trained, and supervised a

anywhere from 1 to 4 hours, with the average

local field team of interviewers and transcribers

interview lasting 1.5 hours. Participants received

in each of the five sites. Each site team included

a $25.00 Visa gift card as well as a local service/

two interviewers and two transcribers who

resource guide. The IDI component includes four

worked together as a team. All teams had at

interwoven data collection methods described in

least one bicultural-bilingual interviewer and

the following points.

transcriber. All five sites identified at least one

“Lead Agency” and a lead agency staff contact.

Narrative Interviews. All interviews began in the

Lead agencies and staff contacts were critical to

same way, by asking youth: “If you were to think

the recruitment process (described later). Each

about your experiences with housing instability

site field team was overseen and supported,

as a story, where does your story begin?”

including weekly meetings, by a member of the

After posing this question, the interviewer uses

research team at Chapin Hall who served as site

the Housing Timeline Tool described next to

lead.

document their housing instability stories starting

with their chosen beginning through present

Recruitment

time.

We used many recruitment strategies to

Housing Timeline Tool. The narrative

recruit a diverse group of youth in age, school

interview is paired with the Housing Timeline

involvement, sexual identity, race-ethnicity,

Tool, appearing as a wide and blank arrow on

service system involvement, gender identity,

11-x-14-inch paper. The timeline tool was used

and in histories of homelessness and housing

collaboratively with youth to plot who, what,

instability. Initial y and throughout, Lead Agencies

where, when, and how of their moves in and out

were critical in connecting interviewers with

of places they stayed (see Figure 4.2). For each

youth and with other providers and school

new living experience, youth were asked where

personnel who work with homeless or unstably

and with whom they were staying, how long they

housed youth. Other strategies included posting

stayed there, and the reasons they left, ran away,

recruitment flyers in public spaces and online,

or got kicked out.

and making direct contact with youth on the

streets. We also used peer-driven methods

The IDI was interested in understanding more

by handing out cards with interviewer contact

than the “facts” of their moves. We also used

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

50

Chapter 4. In-depth Interviews

the timeline tool to explore the contexts that

F: Family ties and relationships

youth were navigating that were critical to their

housing instability experiences. Using the

Fi: Friends/peers, intimate partners

acronym JoFFiSSH (pronounced Joe Fish), the

S: Connections to school and education

interviewers also probed these seven key areas

across the timeline—

S: Formal or informal services, supports,

resources

Jo: Jobs, employment, finances, and access to

money

H: Health and wel being

Figure 4.2. Housing timeline tool example

Throughout, the interviewer writes the youth’s age, place, and length of stay (for example, 2 days, 1 month) on the arrow and draws lines to delineate a change in housing, as shown in the figure below.

12, living with mom,

13, Ran away

13–16 lives

moved 4 times...but

friend’s house

with aunt, but

together 0–12

2 weeks

gets kicked out

Background Survey. The third data collection

Reflection Logs. After the interview,

effort is a background survey that includes the

interviewers completed reflection logs recording

same demographic questions appearing on the

observational data. These included elements

brief youth survey as part of the youth count.

of the interview not captured on tape and

However, the background survey included

reflections on the interview.

additional questions about eight types of

adversities youth may have experienced both

Data analysis

while stably and unstably housed, their receipt of

We used survey analysis procedures to analyze

services and specific government benefits, what

the survey data. All survey responses were

other services and supports they have used, and

reviewed, and any inaccurate or incomplete

what factors make it hard to achieve housing

responses were modified or deleted from the

stability. The full background survey instrument

dataset. We then used the interview data to fill in

is provided in Appendix D. All youth in each site

missing values and responses (for example, age

had the option of completing interviews in either

and foster care history) based on our narrative

Spanish or English. To address differences in

interviews. When responses could not be

reading abilities for the survey, we used iPads

reliably imputed, they are coded as “missing” or

with RedCap audio survey software technology.

“unassigned.” We created cumulative adversity

Participants could privately listen to the

scores (based on survey data) across key

survey questions spoken in English or Spanish

demographic characteristics and tested for

through ear buds, or read the survey questions

significance of differences.

themselves.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

51

Chapter 4. In-depth Interviews

Our approach to analysis ultimately integrates

process using several analytic methods including

all the IDI data to produce the following: “youth

content and descriptive analyses, thematic

logics” of engaging resources, trajectories of

analyses, and ultimately, more conceptual

housing instability, and critical conditions that

analyses informed by both Narrative and

point to opportunities for intervention within

Grounded Theory Methods (see Figure 4.3).

youths’ trajectories. We followed a three-phase

Figure 4.3. IDI’s multi-phase approach to analysis

Phase 1: Integrative Descriptive Analysis

• Identifying/verifying youth demographics and characteristics

Descriptive Statistics

• Creating codebook to organize narrative and timeline interview

and Content Analysis

data by themes and key constructs of interest

Phase 2: Thematic Analyses

• Refining codebook and creating attributes (ways of categorizing

Thematic

youth into shared sub-groups of experience, status, or identities)

Analyses

• Refining codes: critical conditions of housing instability

across structural, familial, peer, and individual level factors

• Identify factors that drive youth logics of engagement and

styles of engagement

Phase 3: Conceptual Analyses

Conceptual

• Linking and refining code names, definitions, and their

Analyses

relationships to/independence from other codes

Midway through data collection, members of

one-half identified as either Black or African-

the IDI research team completed three-day

American (31 percent) or White (23 percent), and

debrief meetings in all five sites. We also shared

21 percent identified as multiracial. Many youth

preliminary reports of the survey data to all five

reported gender identities as either male (52

sites. The analytic plan and final analyses within

percent) or female (41 percent).

this report are significantly informed by the

feedback we received.

Youth were able to report their sexual identities

on a spectrum. While 58 percent identified as

Results

100 percent heterosexual/straight, 38 percent

did not. Among those, 11 percent identified as

The goal was to interview approximately 40

bisexual and 10 percent identified as 100 percent

youth ages 13 to 25 years old in each of the five

gay or lesbian. Nearly one-fourth reported that

sites for a total sample of 200. We ultimately

they were the parent of at least one child. An

interviewed 215 youth: 40 youth each in Cook

additional 8 percent of youth (n=18) reported that

and San Diego Counties, 55 in Philadelphia

they or their partner were currently pregnant.

County, 39 in Travis County, and 41 in Wal a

Wal a County (see Appendix E for full reporting

Final y, of the 211 youth who responded to

of demographic information). Most participants

the survey question “where did you sleep last

(86 percent) were age 18 or older. More than

night?” the most common responses youth

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

52

Chapter 4. In-depth Interviews

reported included couch surfing in the home

It is important to understand the degree to which

of peers (n=34) or family (n=17), sleeping in a

youth are engaged in institutions that critical y

shelter (n=39), in transitional housing (n=39),

shape their development and stability or enter

on the streets (n=28) or in a car, abandoned

into systems serving as interventions targeting

building, or on public transportation (n=12). Less

children and youth. In our survey, we asked youth

common responses (with two youth in each

about their educational experiences, completion

category) included hotel/motel, group home,

of high school, involvement in the formal

residential treatment facility, detention center/jail/

workforce, and if they had histories in foster care,

prison, and hospital or emergency room.

or the criminal justice system. Figure 4.4 reports

how many youth answered “yes” within each

Youth involvement in key systems and

category.

institutions

Figure 4.4. Youth involvement and connection to systems and institutions (N=211) 126

103

82

62

70

Foster Care

Criminal

Graduated Currently In

Currently

History

Justice

High

School

Employed

History

School/GED

It is important to note that 23 percent of IDI

percent of participants had already completed

participants reported dual involvement in criminal

high school or a GED.

justice and foster care systems at some point

in their childhoods. Later sections of this report

Our survey asked youth if they were currently

will discuss more general police contact and

employed in a place where they received a pay

patrolling as a critical structural condition of

stub. This was intentional y phrased this way

housing instability among youth.

because we wanted to know how many youth

were connected to more formal institutions

At the time of our interview, only 30 percent of

of employment. Only one-third of youth were

youth were enrolled in school. Most of those

formal y employed. Disconnected youth are

youth (53 percent) were in a regular high school

16- to 24-year-olds who are neither working

(31 percent), alternative school (11 percent),

nor in school. Of the 16- to 24-year-olds

or completing a GED/high school equivalency

who participated in the IDI, 46 percent were

program. Only 14 youth were currently attending

disconnected.

two-year community colleges, and six were

attending a four-year college. Approximately 60

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Chapter 4. In-depth Interviews

Survey responses to eight adverse

• Have you experienced discrimination or

experiences

stigma?

Although the narrative interviews capture a larger

• Within your family?

array of adversities, we systematical y surveyed

• Outside your family?

youth about a subset of experiences that

• Have you experienced the death of a parent

unstably housed youth might encounter—

or caregiver?

• Have you been physical y harmed by

• Have you exchanged sex for basic needs?

someone?

• Have you been forced to have sex with

• Who: parent or guardian, another relative,

someone?

dating partner, friend or peer, stranger,

•

other, refuse to answer.

Have you been taken, transported, or sold

for sex?

• Have you physical y harmed someone or

•

yourself?

Have you belonged to a gang?

Youth were asked if these occurred while stably

• Who: parent or guardian, another relative,

housed, unstably housed, or both. Figures 4.5

dating partner, friend or peer, stranger,

through 4.7 present those results. Appendix F

myself, other, refuse to answer.

presents more detailed results on adversities by

key demographic characteristics.

Figure 4.5. Physical harm and discrimination/stigma

49

48

)%(

35

egat

28

n

25

ecr

20

21 21

22

e

18

18

20

P

13

15

12

12

Harmed by someone

Caused harm to someone

Stigma within family

Stigma outside family

Stably housed

Unstably housed

Both

Yes undetermined

Experiencing discrimination and stigma was a

stably housed, and 95 youth reported stigma and

common experience. One hundred youth (47

discrimination from outside of their families. It

percent) experienced some form of stigma or

is likely that this increase in discrimination from

discrimination within their families, most while

non-family while unstably housed is capturing

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Chapter 4. In-depth Interviews

their new stigmatized status of “homeless.” This

stably housed (n=29) and other relatives while

becomes an additional status that they must

stably housed (n=15). The most common victim

navigate while unstably housed. The largest

of harm caused by youth is themselves (see

groups of perpetrators of harm are parents while

Figure 4.6).

Figure 4.6. Victim of physical harm caused by youth

9 8 8

)%(

7

eg

6

atn

5

6

ecr

4

4

eP

3

3

2 2

2

2

2

2

2

1 1

1

0

0

0

Parent or

Another

Dating

Friend or

Stranger

Myself

Other

Refuse to

guardian

relative

partner

peer

Answer

Stably housed

Unstably housed

Both

We asked several questions about the role of sex

for survival, sexual violence, and involvement in

the sex trade. As shown in Figure 4.7, the largest

category was youth who had been forced to have

sex (24 percent). A very small number of youth

(n=4) reported being taken, transported, or sold

for commercial sex.

It is likely that the low number of youth reporting

involvement in what would be labeled “sex

trafficking” is an undercount. Youth in this

study were open in disclosing a host of adverse

experiences during their interviews. However,

reaching those deeply entrenched specifical y

in sex trafficking would have required a longer

engagement in the field and a more targeted

recruitment effort to gain access to this highly

regulated and controlled subpopulation.

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Chapter 4. In-depth Interviews

Figure 4.7. Adversities tied to sex

27

23

)%(

17

egatnecre

5

5 6

P

2

1 3

0

0 0

Exchanged sex

Forced sex

Sex trafficked

Stably housed

Unstably housed

Both

Yes undetermined

Perhaps surprising is the degree of parental

this percentage rose to 43 percent in Cook

death reported among youth (see Figure 4.8).

County, IL. Very few of our participants reported

In our survey, 35 percent of youth indicated

involvement in gangs at any point in their lives.

experiencing the death of a parent or caregiver;

Figure 4.8. Gang involvement and parental loss

45

)%( egatnecreP

15

9

11

5

5

6

4

Gang Member

Caregiver Death

Stably housed

Unstably housed

Both

Yes undetermined

In reviewing Figures 4.5 through 4.8, it is

il ustrate, youth experienced a host of adversities

important to note that many of the adversities

and risks both while stably and unstably housed.

actual y decrease as youth leave stable housing

(for example, harm from others, stigma within

Cumulative adversity scores

family, forced sex, gang membership, and

To understand how the surveyed adversities

parental/caregiver death). This chal enge’s

differed across demographic groupings of youth

conceptions of risk as solely existing outside of

listed in Table 4.1, we calculated mean scores.27

stable housing contexts. As later sections will

27 This analysis is based on 201 youth. Of the 211 completed surveys, 10 of those youth did not answer four or more of the adversity questions and were omitted.

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Chapter 4. In-depth Interviews

This al ows us to know if some of the differences

of these differences indicates the following three

between their scores are statistical y significant.

subgroups of youth had significantly higher than

The average cumulative adversity score for the

average cumulative adversity scores: youth who

entire sample was 2.8. Several groups of youth

identified as sexual minorities (LGBQ)28 , foster

have higher scores. However, significance testing

youth, and youth with criminal justice history.

Table 4.1. Cumulative experiences of adversities

n

Mean

Total

201

2.8

Gender (n=196)

Female

78

2.9

Male

105

2.6

Other

13

3.2

Age (n=198)

13 to 17 years old

29

2.3

18 to 25 years old

169

2.9

Race/Ethnicity (n=192)

Black

63

2.7

White

50

3.0

Latin@

28

2.1

Multiracial

40

3.2

Other

11

2.6

Sexual Orientation (n=191)

100% Heterosexual

118

2.3

LGBQA

73

3.6***

Foster Care History (n=200)

Yes

81

3.2**

No

119

2.5

Ever Spent Time in Detention, Jail, or Prison (n=197)

Yes

97

3.1*

No

100

2.5

*Significant at p< .05; **Significant at p< .01; ***Significant at p< .001

When responses differ from 201, we note that total n in the corresponding cell within the table.

28 Sample sizes of transgender youth were not large enough to enable such statistical analysis.

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Chapter 4. In-depth Interviews

While the survey provides important insights,

dynamic of abuse and neglect, parental struggles

the narrative interviews add necessary context

with addiction or mental health, often poverty,

and detail to unpack these adversities and

and sometimes, family homelessness. In their

many others, as well as understanding critical

quotes, readers will see these issues and will

strengths and resiliencies within these youths’

likely sense other hidden or unspoken chal enges

stories.

and dynamics.

Beginnings of housing instability

Foster care

Over one-half (54 percent) of our participants

“And you know, sometimes foster parents want

experienced homelessness on their own during

you, sometimes they don’t. Sometimes youth

their late adolescence between ages 16–18.

might do a little something off the wal , they send

Another 21 percent experienced their first

you to another house. … I have been in at least

homeless episode during early adolescence,

seven or more houses, so you know it can be

ages 13–15. Taken together, 75 percent of

pretty emotionally and mentally traumatizing…”

youth in our study experienced adolescent

El Chapo, Cook County

onset of homelessness (ages 13–18). A small

proportion of youth experienced their first spell

Of the 82 youth with foster care histories, 38 (46

of homelessness prior to age 12 (seven percent).

percent) reported that simply being removed

Knowing one’s age of first homelessness,

from their home and being placed in foster care

however, tells us very little about the “why”

was the beginning of their homelessness. The

behind these numbers. Youth described these

experience of family disruption, and “bouncing”

beginnings within a web of early life chal enges

around from one foster home to another,

within their families of origin. These realities were

especial y for those removed at very young ages,

the early seeds of the instability they currently

caused many of these youth to feel they had

navigated.

been experiencing a form of instability in their

sense of home nearly all their lives.

Where does your story begin?

Family homelessness

It is fair to assert that 100 percent of youth

“I was around like 12… my mom was going

named family-related issues as core to their

through some domestic violence, and we had

instability. No interview started without naming

to relocate… No matter wherever we went, my

parents, extended family, siblings, or foster

dad would have like found us. And so we moved

families within the first few sentences. The five

THERE ‘cause he didn’t know anything about

most common sub-themes included: foster

Wisconsin. And from there it was just like (pause)

care, family homelessness, chronic parent-

that’s when I really experienced being homeless.”

child conflict, youth running away/leaving,

Naomi, Cook County

and parental struggles. Some responses were

double-coded across these categories when

Nearly one in every four youth (24 percent)

youth themselves attributed the beginnings to

experienced homelessness in their families

more than one event happening simultaneously.

before becoming homeless on their own.

More than one-half of these youth named this

These themes are not mutual y exclusive and the

experience as where their homelessness began.

beginnings often not singular. Even in the quotes,

Youth often recal ed stories of being homeless

youth name a cascade of other experiences that

due to poverty, a parent fleeing domestic

followed or preceded their chosen beginnings.

violence, or a parent’s struggles with mental

For example, experiencing foster care was often

health, addiction, infidelity, or an emotional need

embedded within prior experiences of a family

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Chapter 4. In-depth Interviews

to follow an unstable partner. Like foster youth,

of them things where my father didn’t approve

they too moved “all over” and endured a highly

of it, so he was like, ‘Oh, I’m not approving of it,

unstable childhood context for development.

so I don’t wanna talk to you. I don’t wanna see

you.’ And then my mother at the time was going

Chronic conflict

through a relationship where her partner didn’t

As the largest category, 65 youth reported

accept the fact that I was gay. I was able to stay

experiences of ongoing conflict with a parent

with my mom, but it was more so the fact that

or a stepparent as the core issue behind their

her partner didn’t accept me being gay or, like,

homelessness. Sometimes youth noted their own

bringing my boyfriend over. …And my mom just,

issues with “anger” or drug use. Just as often,

like, agreed with him.

however, it marked a coming of age story in

Running away or leaving

which economical y struggling parents conveyed

expectations that the young person (particularly

“I (first) ran away when I was seven, for like eight

boys) contribute to the household after turning

hours. …my parents didn’t even notice I was

18. This was true for John Walker, a 20-year-old

gone. …like thirteen to like sixteen, I’d be gone

San Diego youth who identified as White, male,

for weeks. I was gone for two and a half months,

and heterosexual. His mom kicked him out at 19:

and I came home, and my mom goes, ‘I asked

you to do the dishes yesterday.’ I was like, ‘I’ve

I got kicked out of my house because… me and

been gone.” Anastasia, Wal a Wal a County

my mom don’t get along. I mean we do, but she

has a stressful job, she comes home from work

When youth chose the beginning of their stories

all stressed out. …and so when I get home, you

as “I ran away” (n=21) or “I left” (n=26), it was

know, I have done nothing all day so, when I talk

always linked to their own sense of having

to her sometimes she just yel s at me. When I

to take initiative to escape or just disappear

was 18 and I came home …didn’t do nothing all

from a harmful or neglectful family dynamic,

day because I’m tired of school…I graduated at

or to search out a better or safer place to live.

17 but never real y looked for a job. ...I started

Sometimes what distinguished leaving from

looking for a job…and that made my mom more

running away was age (older youth describing

proud of me. And, one time (at work)…I fell

departure as leaving). Other times youth sought

asleep at like 2:30. It was my break and I woke

a general disconnection from their homes or

up at 4:30pm and they fired me and my mom got

parents. This also captured experiences of

mad. That’s when I got kicked out.

youth who felt unsafe or unwanted at home

because of a stigmatized sexual or gender

A second core subtheme was that parents

identity. These youth left to find a more nurturing

and family members deeply struggled with, or

and safer place for their development but were

outright rejected, their emerging adult child’s

typical y not kicked out as the youth previously

sexuality. Sometimes youth left on their own

described. The following narrative, although long,

accord; other times parents kicked youth out or

is important as it represents the minority of youth

issued frustrated ultimatums causing a young

who left on their own in search of a place that

person’s departure. For Juan in Philadelphia

could nurture an emerging identity. Now living in

County, it was his dad and his mom’s boyfriend

San Diego, California, “Jess,” who identifies as a

who rejected his identity as gay that caused

“3rd gender person,” details a multistate journey:

ongoing conflict, ultimately leading to being

kicked out:

I still didn’t wanna be around like my family, and

um, I’m also like a third gender person and I

It was the conflict of me being the oldest child

wanted to be able to medical y transition …And

and then the fact that I was gay. So it was one

the laws (in Florida) regarding like psychiatric

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Chapter 4. In-depth Interviews

care and psychological care are much more

Parent struggles

stringent; there was only like one doctor around

like all these different cities, and, who treated

“…my mother she um she had a nervous

like trans, third gender or like people like that

breakdown when I was about nine. It was very

were not comfortable with um their gender

unstable at that point, like we lost everything.”

identity and wanted to pursue some sort of

Rocky, Cook County

hormone replacement therapy. And he knew

“Um, I didn’t real y run away or be kicked out—I

that, and charged a ridiculous amount of money.

just chose to leave when I was 15. My mom

So it was practical y impossible to transition

turned our family home into a trap house.”29

medical y and get the help that I needed and the

Mackenzie, Walla Walla County

respect that I needed. Because it’s like a very

Republican, conservative, like backwoods, like

This last group of youth chose their beginnings

very dangerous place. I lived in a very, very tiny

by naming parental struggles with health, mental

town and it was not good to be gay or trans.

health, and various addictions as the primary

Basical y, if you weren’t White and straight and

cause of their instability. Sometimes parents

Christian, then you weren’t safe. It wasn’t good

also struggled around competing obligations

for you. So moving to San Diego, the weather

to their children versus their partners or other

was great. I had this idea that all of California

attachments. These struggles created ongoing

was like this Liberal utopia and everything was

instability, trauma, and loss in the parenting

gonna be perfect. And there were like gay people

youth were able to receive and depend on early

everywhere…I took a trip here and I researched

in their lives. This was also true for Mary from

about medical care and realized there were a lot

San Diego, whose mother often left her and her

of resources for LGBT people and um, the Family

siblings to pursue companionship or to indulge

Health Center Clinic, which offers free hormone

an addiction to gambling:

um, replacement therapy for trans people that

are like low-income. (Later in the interview, once

I feel like…unstable housing has kind of always

Jess describes becoming homeless after arriving

been a thing… because my mom was um, she

to San Diego.) Like at the time I thought, “Oh

was like – she lived off the people that she was

God I’m-I’m 19 like I’m already a year behind,”

dating. …she was never able to like hold down a

like my plan. Ever since I was like four I knew. I

job for very long, because she would be like, ‘Oh,

just had a deep sense of knowing like, ‘When I’m

they’re making me work, like, these hours and it’s

18 I’m leaving and I will never see these people

horrible. And I just need to like quit.’ … But um,

again.’ What-what sort of like four or five-year-

she also had a gambling problem. Soooo, if she

old thinks like that? You know, it’s very sad. Um,

like got money for rent … she would go gamble

but yeah so 19 was old for me. I look now and

at a casino and sometimes she would spend all

I’m like, ‘Oh my gosh!’ Like, that is pretty young

of it.

to like move all the way across the country like

Summary

by yourself with no support and no help, no

encouragement, no support base. Just like, all on

Taken together, these answers to where their

my own. You know?

stories began start to represent a larger

finding that is emphasized throughout this

report—that youth homelessness cannot be

29 The phrase “trap house” was colloquial referenced frequently to describe shelter used intermittently by study participants. Contemporary rap and hip-hop artists have made use of the phrase, expanding its consumption and meaning. The definition or description of a trap house may differ slightly from youth to youth, and location to location. Typically it refers often to a sheltered, sometimes abandoned, space that (a) is out of the public eye, (b) facilitates the using and selling of drugs, and (c) enables delinquency and crime. Occasionally trap houses are actual homes and apartments of family or acquaintances that become overtaken by its unstably housed residents and a host of illegal activities.

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Chapter 4. In-depth Interviews

reduced to a single event. It is preceded by, and

Figure G.3). This has important implications for

contextualized within, often chronic and deeply

homelessness systems’ efforts to reliably track

complex social and familial chal enges related

youth homelessness, given that Continuums

to poverty, cycles of family violence, abuse, or

of Care (CoCs) typical y do not share data

neglect; intra-familial discrimination; parental

across their systems. In other words, if a youth

mental health and addiction; and youths’ own

exits homelessness in one CoC and re-enters

development processes or struggles. We now

homelessness in another CoC, the youth

turn to understanding how these beginnings

would not be recorded in the Homelessness

unfolded across time, and the conditions that

Management Information System (HMIS) as

youth believed were critical to their trajectories.

having a return to homelessness.

Trajectories of housing instability

Exploring critical conditions of youth

homelessness

Drawing primarily from the narrative interviews

and timelines, this section reports findings

Although each person’s experience of instability

about the respondents’ housing instability.

was certainly unique, our analysis identified a

We begin by identifying the levels of instability

set of shared themes that they all navigated. We

they experienced (for example, couch surfing,

refer to these as “critical conditions” of housing

shelters, and streets). We then present the

instability. We categorize and color-code the

analysis of the critical conditions that shaped

themes of their responses within four levels:

their trajectories of housing instability. Two

individual, family, peer, and structural factors.

youths’ trajectories are mapped out to il ustrate

Altogether, these factors of influence are labeled

how these critical conditions unfolded over time

“multilevel critical conditions.” All youth navigated

in Figure 5.8.

some combination of each (see Figure 4.9).

Understanding types of instability and

mobility

Individual

Nearly all youth in our study (93 percent)

These are conditions tied to a young person’s

experienced couch surfing at some point, or

own attributes, both positive and negative, that

at multiple points, across their stories. Few

shape their housing instability. Youth identified

youth experienced only one kind, or level, of

personal characteristics of health (addictions and

homelessness (for example, couch surfing,

mental health), attitudes/beliefs and worldviews,

streets, shelters or transitional housing). Youth

core identities, and their own behaviors and

in Wal a Wal a, our one rural site, reported that

feelings. The most commonly mentioned were

their community lacked critical supports and

mental health chal enges (n=66) and drug use

resources. Consequently, these youth faced the

or addiction (n=46). Youth also talked about

highest rates of staying on the streets or outdoors

persistently feeling like a burden or being

(85 percent) when compared to the other four

unwanted (n=40), or that they felt strong desires

counties (67 percent) (see Appendix G).

to escape to pursue a better life (n=45). Further,

youth named personal characteristics as getting

Youths’ experiences with housing instability also

in their way or as helpful mechanisms for identity

included high degrees of geographic mobility.

protection or general risk management. These

In fact, only 19 percent of youth stayed within

often included choosing to avoid or self-isolate

their cities or towns. Instead, youth reported

(n=30), being “too prideful” and independent

multistate (28 percent), within county multitown

(n=40), or getting “angry” too easily (n=34).

(23 percent), multicounty (27 percent), and even

multinational (3 percent) stories (Appendix G,

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Chapter 4. In-depth Interviews

Peers

Structural

These themes articulate the role that peers

These themes identify societal and structural

play in housing instability both positively and

conditions that contribute to youths’ instability.

negatively. Youth reported becoming or staying

Agency staff were critical sources of connecting

homeless to stay with or follow a peer or intimate

youth to other formal services (n=46). However,

partner who was also homeless (n=45). The

youth also named structural barriers, including

most commonly mentioned role peers played

practices and policies in foster care that

was as a link to services or skills or as a source

disconnect youth from family resources (n=31).

of knowledge while homeless (n=149). Peers

These barriers include rules and conditions of

also were named as the primary reason youth

groups living in shelters and congregate care that

lost many of those same resources (n=78). Just

are “controlling,” unsafe, or unsanitary (n=82).

as peers were portals to supports, a few were

Many youths’ trajectories il uminate serious gaps

sometimes portals to il egal activity including sex

in transition services in or out of a system or

work (n=4) or drug use and sales (n=17). While

service system siloes that complicate accessing

youth reported peers as sometimes abusive,

services (n=48). Youth also named societal or

controlling, or violent (n=34), they also just as

community bias and discrimination as critical to

often named peers as their rescuers, protectors,

feeling a community or its institutions are (un)

and being a source of mutual support (n=39).

safe or (un)welcoming places (n=34). Some

youth also named the level of surveil ance or

Family

policing of public spaces (n=22) as causing

added instability.

These themes identify how youth perceived their

family systems and their members to contribute

Taken together, Figure 4.9 il ustrates these

to their housing instability. This included youth

multisystemic critical conditions of their housing

reports of parental mental il nesses (n=19),

instability. We will ultimately return to these

addictions (n=55), death of a parent (n=75), loss

multilevel conditions to identify the potential

of important family supports (n=35), cycles of

points of intervention, gaps in services, and

abuse/neglect or violence (n=61), and family

supports that could potential y prevent or

economic conditions that created instability

interrupt youths’ housing instability.

(n=35). Many of these conditions were named

in contributing to a general family experience

of intense conflict and discord. Youth also

referenced their families’ bias, discrimination,

and bigotry, particularly toward gay, lesbian, and

transgender youth. Some youth also reported

feeling rejected by a parent who chose a new

intimate partner over them, resulting in the

youth’s getting kicked out or running away

(n=36). At the same time, extended family

(typical y an aunt or grandmother) was often a

critical source of housing and social support

(n=48) as youth navigated these dynamics.

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Chapter 4. In-depth Interviews

Figure 4.9. Multisystem factors shaping trajectories of housing instability

Addictions, mental/emotional health, shifts in life stage, personal

Individual

characteristics and coping skills, identity development

Link to gain and loss of supports or housing, co-experiencing

Peers and Intimate

risk, source of harm and support

Partners

Source of support, abuse/neglect/rejection, loss, parental addiction

and mental health, family homelessness and instability

Family

Programs and practices that shape instability and facilitate or inhibit

use or access to resources, community factors of policing

Structural

Understanding critical conditions across

The Story of “Natalie,” Walla Walla County,

trajectories of housing instability

Washington, age 17

This section offers two examples of how

Natalie identified as White and female. Her story

these multilevel critical conditions shaped

of housing instability spans the towns of Wal a

youths’ trajectories of housing instability. Each

Wal a, Dayton, and Milton. Natalie was born in

example is organized in the following way. We

Kentucky, but moved to Dayton at 13 when her

first present a narrative of the young person’s

parents decided to return to their hometown.

story. A “Trajectory of Housing Instability”

At 14, Natalie’s dad left their family to live with

follows. We discuss the critical conditions that

his new girlfriend. Subsequently, Natalie’s

play out within that trajectory. Next, the same

mom went into a depression and started using

youth’s story is mapped within a trajectory that

methamphetamines, “[I]f she wasn’t drunk

il ustrates the levels of homelessness that she

or high, she was gone…then I started using cuz

or he experienced. We then identify how each

I felt like I had nothing.” For the next 6 months,

example represents, or departs from, the larger

Natalie took responsibility for the care of her

IDI and site-specific findings. We conclude by

four younger siblings. She started to miss

summarizing the potential opportunities for

school and ultimately, dropped out. To cope

intervention and prevention that these examples

with her stress, Natalie’s friends introduced her

illustrate.

to methamphetamines and this only added to

her conflicts with her mom. After a fight with her

mom’s new boyfriend, Natalie was kicked out of

her home. Neither of Natalie’s parents al owed

her to live with them while she was using drugs.

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Chapter 4. In-depth Interviews

She cycled between couch surfing and trap

circle is colored to il ustrate the critical factors

houses for the next 2 years. She also stayed

or conditions that contributed to her housing

with an older man and exchanged sex for this

instability at that time. The proportion of color

arrangement so she could, “have a roof over [her]

within each circle represents the degree to

head.”

which a multilevel critical condition impacted

Natalie’s trajectory into homelessness. Arguably,

At age 16, Natalie, on her own accord,

all levels of influence (structural, familial, peer,

stopped using meth and returned home to her

individual) are always operating at any given

mom who had also been clean for the past

time. However, our approach to analysis was

8 months. Natalie enrolled in an Alternative

to identify the primary or dominant factors that

Education Program at the local community

youth named, and that could inform action steps

college. For a short time, she did wel . But after

for intervention or prevention.

resuming contact with an old friend, she relapsed

and her mom kicked her out again.

At age 14, Natalie’s father left her mother. Her

mother went into a depression, began to use

For the next year, Natalie cycled

methamphetamines, and neglected Natalie and

through many informal housing arrangements.

her siblings. The first circle in her timeline is

She couch-surfed at her aunt’s house and

colored orange to represent that it was her family

friends’ homes, both of which she described as

context that first led her to become homeless.

trap houses. She again occasional y exchanged

The second circle in Natalie’s trajectory is red.

sex for a place to stay. Then, a friend, recently

This reflects her individual decision to quit using

drug-free himself, expressed concern about

drugs, so she could move back in with her mom.

her living arrangement. He offered to house

The third circle is colored part orange (peers)

Natalie in his shed in Dayton while they both

and red (individual) to indicate the influence of

tried to locate stable housing. She agreed

her peers and her own role in using meth again

and moved into the shed. Soon, however, this

which, in turn, led her mom to kick her out. The

shed became overrun with people and drug

fourth circle is also colored part orange (peers)

use. Local police increased their surveil ance of

and part red (individual) to indicate the dual

the shed’s activity, which ultimately resulted in

influence of her friend and her own decision

her arrest for a truancy warrant and possession

to stop exchanging sex for a place to stay and

of drugs. This began a year-long cycle where

move into her friend’s shed. The final circle in

monthly, Natalie was sent to juvenile detention. “I

Natalie’s trajectory is colored green (structural)

practical y live here,” she described, “I’m grateful

to indicate the heavy presence of the criminal

to be here…I have a bed to sleep, I’m safe

justice system in Natalie’s housing trajectory for

here….I have nowhere safe to go when I leave…

the last year of her life, and how she began to

This [detention facility] is like a second home

view it as a “second home”.

to me.” Natalie indicated upon release she

will be discharged to the closest appropriate

residential drug treatment facility 180 miles away

in Spokane, Washington

Natalie’s timeline trajectory of housing

instability

Figure 4.10 presents Natalie’s timeline trajectory

of housing instability. Circles in the center of

the arrow are used to display periods of time

in Natalie’s story of housing instability. Each

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Figure 4.10. Natalie’s timeline trajectory and critical conditions of housing instability

“Natalie” from Walla Walla

“My mom was so depressed...

“I let one of my old friends come

“I have nowhere safe to go when I have

she was gone... then I started

over...and that was the end of it.”

to leave... I call [juvenile detention] my

using ‘cuz I felt like I had nothing.”

• Relapses after inviting over a friend,

second home.”

• Mom starts using meth after Natalie’s

who invites over others to use meth

• Friend tries to get her a hotel room, but

dad leaves

• Mom kicks her and friends out; Natalie

police pick her up first

• Natalie forced to care for siblings and

starts cycling again through trap

• Prefers being in juvenile detention to

starts missing school; has a warrant

houses, couch surfing, sometimes

being out on the streets or in trap

out because of truancy

exchanging sex for place to stay at

houses, because it’s safer

• Dad picks up siblings, Natalie starts

31-year-old “boyfriend’s” house

• Close to finishing both sentence and

using meth and leaves home to

• In and out of juvenile detention because

probation; plans to transfer to a drug

couch surf and stay in trap houses

of warrant for truancy, drug use

treatment center

Age 14

Age 16

Age 16

Age 17

Age 17

“I’m [allowed] home only

“[My friend] knows what [he] does to me...

Structural

when I’m clean... and I was

and [said], ‘I’m not lettin’ you go back’.”

clean for six months.”

Peer/Family

• Friend takes her away from sexually

• Natalie gets clean; Mom

exploitive arrangement, takes her to live with

Individual

gets clean and lets Natalie

him in a shed on his property

stay at home

• Shed is essentially abandoned, with a partial

• Enrolls in the Alternative

roof and no heat or water

Education Program at the

• Quickly gets overrun with other youth with

community college

warrants, drug use escalates, becomes trap

house, police begin to take notice

Natalie’s trajectory across four levels of

resources such as shelters, transitional living

housing instability

programs (TLPs), and hotels. Lastly, unsheltered

includes living on the street and transient shelter

This il ustration, however, hides the variations of

like cars and abandoned buildings.

housing instability Natalie navigated during her

lifetime. The housing trajectory in Figure 4.11

Again, each circle represents a key moment.

takes the narrative and condenses it further to

The final circle depicts the youth’s situation at

highlight movement across types of housing

the time of the interview. That circle isn’t fil ed

instability over the course of a story.

in because the next tipping point in the young

person’s trajectory is partial y unknown. When

Defining the levels. Each of the grey rows,

understanding her trajectory across levels of

labeled by an icon on the left, represents

instability, we see that Natalie never stayed on

a different kind of housing (in)stability. The

the streets, but spent most of her 3 years of

top row’s icon represents stable housing,

housing instability cycling between more stable

including staying with parents or foster parents,

living arrangements with her mom and juvenile

institutional placements like group homes,

detention (the first row) and informal living

criminal justice centers, and residential treatment

arrangements such as couch surfing including

centers or hospitals. The second row and icon

trap houses, all contained in the second row.

indicate informal temporary/transient housing—

Never staying in shelters was a characteristic

primarily couch surfing with family members,

Natalie shared with Wal a Wal a County

peers or acquaintances. The next level,

participants due to scarce availability. But

sheltered, includes formal temporary housing

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Natalie differed from many Wal a Wal a County

participants reported staying on the streets (85

participants in that she had no experiences

percent) at a rate much higher than all other IDI

of staying on the streets. Most Wal a Wal a

sites (67 percent).

Figure 4.11. Trajectory of Natalie across levels of homelessness

Mom starts using meth, neglects

In and out of juvenile detention for truancy,

kids; Natalie starts using and

drug use; becomes her “second home”

“running the streets”, crashes at

Age 16

trap houses and sometimes

exchanges sex for shelter

Age 17

Age 14

Age 16

“[My mom] kicks me out when I start

using” —Natalie relapses when an

old friend visits

Age 16-17

Stays at aunt’s and friend’s houses,

“I’m [allowed] home only when I’m clean...

both trap houses; sometimes

and I was clean for six months.”

exchanges sex to stay off the street

Structural

Natalie

Peer/Family

17 Walla Walla County Female White 100% Straight Individual

Understanding Natalie’s trajectory

in school and forgo her warrant for her arrest

for truancy in school thereby avoiding juvenile

The critical conditions present in Natalie’s story

detention altogether.

provide insight into her needs at each critical

point of her housing trajectory, what gaps

Natalie’s story represents several characteristics

existed, and what types of interventions may

that are unique to Wal a Wal a County. The

have been implemented to prevent Natalie’s

presence of drugs in Natalie’s story, particularly

movement into homelessness. For example,

methamphetamines, is a characteristic she

supports and interventions targeting family

shared with most Wal a Wal a interview

and individual struggles with mental health

participants. Of the 41 youth from Wal a Wal a

earlier in Natalie’s life might have prevented

County, 11 (27 percent) discussed using meth,

Natalie and her mother from turning to the use

seven (17 percent) discussed their parent or

of methamphetamines to cope with the loss of

family member using it, and eight (20 percent)

divorce. Addressing these struggles might also

discussed both personal and family use.

have provided Natalie with better support to stay

Additional y, nearly twice as many Wal a Wal a

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County participants reported currently receiving

his grandmother passed away when he was 15,

services for drug/alcohol treatment (29 percent

and his grandfather died shortly thereafter. These

compared with 16 percent in the full IDI sample).

losses resulted in his move to the suburbs to live

with his father. But, after only 2 years, his father

Natalie’s use of trap houses as a place to couch

was arrested on drug charges. Not long after the

surf was also a common experience among

arrest, his father also died. In the wake of these

multiple interview participants in Wal a Wal a.

losses, Dilinger, age 17, returned to Chicago to

The pervasive use of trap houses in general was

live with his mother for the first time since he was

unique to Wal a Wal a County and was rarely

a toddler.

mentioned in other IDI sites. Of the 41 Wal a

Wal a youth participants, 93 percent reported

The next year of his life was chaotic. He

couch surfing and, of those who couch surfed,

described a cycle of being kicked out by his

16 (42 percent) stayed in trap houses run by

mother, the police bringing him home, just to be

family, friends, or acquaintances. This was in part

kicked out again days later. Dilinger believed it

a feature of rural homelessness when there are

was because he was too much like his father—he

limited formal services for youth experiencing

was loud like him, he looked just like him, and his

homelessness.

mother resented him for it. He also began dating

a transgender woman who was transitioning—a

Wal a Wal a County participants reported greater

relationship his mother said was “disgusting.”

involvement in criminal justice systems than

She kicked Dilinger out for good once he

other IDI sites. Natalie’s frequent stays in jail

turned 18. Although their time together was

and detention reflect this trend. Approximately

characterized by conflict and verbal abuse, he

68 percent of Wal a Wal a youth reported

was still hopeful that one day they would repair

involvement in the justice system, whereas 48

their relationship. He said of this hope, “Maybe

percent of the full IDI sample reported such

a few years down, when I’m older, more grown

involvement. One reason for Natalie’s arrests

manly-ish, we can sit down, have a cup of tea,

was for truancy—a factor stemming from

talk about it. But, as of now, she’s not helping

Washington State’s school truancy law known

me, she’s not supportive, she completely cut me

as the Becca Bil . Legislation has since been

OFF and she dipped out on me. So, it’s nothing

passed to diminish the harsh consequences for

real y I can do.”

missing school, but the prior strict truancy law

may be a contributing factor to some Wal a Wal a

With few places to turn, and most biological

participants’ greater involvement in detention,

family members passed on, Dilinger couch

jail, or prison.

surfed. He lived briefly with his sister’s father

and stayed with high school friends for as long

The story of Dilinger, Cook County, Illinois,

as he was welcomed. He even befriended a

Age 19

deacon of a local church and lived with him for

Dilinger self-identified as a heterosexual African-

a few months. Eventual y, however, Dilinger was

American male. He was born and raised in Cook

forced to find other living arrangements once

County. His early years in the city of Chicago

the deacon married. Dilinger was resourceful.

were idyl ic—he played soccer, had good friends,

He learned where to find free meals and made

and enjoyed school. However, a pronounced

his way to a shelter for homeless young adults.

theme of chronic loss characterized Dilinger’s

Shelter staff helped him obtain food stamps,

teen years, leading to his housing instability.

a Medicaid card, and a public transit pass.

With parents navigating a strained relationship

Through all of this, he remained employed part-

plagued by drugs and mental il ness, Dilinger

time and hopeful that his housing instability

went to live with his paternal grandparents. Sadly,

was only a temporary setback. He credited

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Chapter 4. In-depth Interviews

his current optimistic disposition to his strong

parental struggles and death of grandparents)

religious foundation. As he reflectively answered

that first led him to become unstably housed.

the question, “what would you want us to most

The second circle is orange as wel , indicating

remember about your story?” he exclaims,

that family instability continued with the passing

“Remember the fact that, I’ve kept up with

of his father and moving in with his mother and

the promises I’ve made. I made sure to fulfill

sister. The third circle is colored part orange

everything that my grandmother wanted me

(family) to indicate the continual conflict between

to do, my father wanted me to do, and my

Dilinger and his mother, and green (structural) to

grandfather wanted me to do. And that…this

indicate police intervention in his life This circle

experience is gonna make me a better person

also depicts being permanently kicked out of

than a lot of people in the world.”

his mother’s house at age 18. The fourth circle

is also colored part orange (family) and part red

Dilinger’s Timeline of Housing Instability

(individual) to depict the turbulent time he spent

Like Natalie, Dilinger’s timeline also began

couch surfing with distant family members. The

with the age and moment he identified as the

final circle in Dilinger’s trajectory is colored green

beginning of his housing instability. At age

(structural) for the heavy presence of service

15, Dilinger’s grandmother passed away and

providers and the role of government benefits

he moved in with his father. The first circle in

in his life. It is also red (individual) to indicate his

his timeline (Figure 4.12) is colored orange to

individual hopefulness and personal ability to

represent that it was his family context (both

work and save for stable housing.

Figure 4.12. Dilinger’s trajectory and critical conditions of housing instability

“Dilinger” from Cook

“Without [my grandma], I

“You involved with this

“He assumed that I was sleeping

probably would’ve never

lifestyle... that’s going to lead

with his wife... I think he was legit

succeeded in life”

you to either prison or a six

losing his mind.”

foot grave.”

• Grandma takes him in after

• Living with half sister’s father, who

conflict with mother

• Dad involved in drug

starts experiencing mental health

trafficking and a gang, which

• She acts as a stable,

issues after his father dies

leads to his arrest and death

positive force in his life

• When accused of sleeping with half

until her death

• Forced to move in with his

sister’s stepmother, Dilinger punches

mother and half sister in

• Moves to Elgin to stay with

half sister’s father and leaves

Chicago, as a last resort

his dad after she passes

Age 15

Age 17

Age 18

Age 19

Age 19

Structural

“I told the truth. which, I guess, gets you in

trouble”

“[My mindset] is how I basically been taking

Peer/Family

• Continual conflict over his attitude and later,

the steps to get my life back on track”

his trans girlfriend

• Couch surfs with friends and church

Individual

• Stays at youth shelter the handful of times

members, eventually moves back into youth

his mom kicks him out

shelter

• Police intervene because of his minor

• Uses resources at children’s Catholic charity,

status, forcing her to keep him in the house

connected with SNAP and health insurance

• Kicked out for good as soon as he turns 18

• Finds a job and is saving up for stable

housing

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Dilinger: Trajectory across Four Levels of

kicked out of his mother’s house, living at a youth

Instability

shelter, and moving back in with his mother (the

third row). The dotted line depicts the back-and-

Dilinger’s trajectory across levels of instability

forth nature of this housing situation. Once he is

(Figure 4.13) il uminates the fact that he never

kicked out for good, he couch surfs with people

stayed on the streets. Instead, he spent most of

(the second row), until final y landing once again

his 4 years of housing instability rotating between

at a youth shelter at 19 years old (the third row).

insecure and informal living situations with his

The solid line depicts this one-way, downward

father, and after his father dies, his mother (the

move.

first row). Once 17, he endured a cycle of being

Figure 4.13. Trajectory of Dilinger across levels of homelessness

Age 15

Age 17

Age 17-18

Mom kicks him out for good at 18, conflict over

his “big mouth” and trans girlfriend

Couch surfing with sister’s father, deacon, and

Grew up at grandma’s, who passes

friend fall through; returns to youth shelter

away due to illness; moves in with dad

Dad is involved in drug trade, eventually killed;

Dilinger forced to move in with mom

Age 19

Age 19

Kicked out repeatedly and stays at

youth shelter; police get involved,

force her to keep him in the house

“I’m gonna take advantage of every damn

thing they’re giving me!... I take pride in it”

Structural

Dilinger

Peer/Family

19 Cook County Male Black/African American 100% Straight Individual

Understanding Dilinger’s Story in the Context

youth experiencing parental death (43 percent).

of Cook County and the Larger IDI Sample

Like Dilinger, many of these youth, both in Cook

County and in the larger sample, identified this

Dilinger’s trajectory of housing instability was

as the beginning of their housing instability.

indicative of both the larger IDI sample and

Unfortunately, many youth experienced

Cook County participants in several ways. First,

pronounced instabilities following the death

Cook County represented the highest rate of

of a parent, or of a key matriarch whose

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house provided refuge and stability for many

Engagement with services, resources,

generations in their families. Had Dilinger’s family

and support

received such supports, they might have been

able to retain stable housing. Such common

The survey asked youth about their lifetime use

situations elevate a need for more pointed

of services including school-based services,

interventions to identify and assist these families

lifetime and current use of government benefits,

and youth as they grieve their loved ones and

and reasons for service receipt (Appendix H).

seek a semblance of security and stability in the

Participants reported mental health as the most

wake of these critical losses.

frequent reason for using services (38 percent).

Nearly 16 percent reported using services for

Dilinger is also representative of 54 percent of

alcohol or drug use. Among lifetime use of

youth in our study who experienced adolescent

government benefits, food stamps (63 percent)

onset of unaccompanied homelessness between

were the most commonly used, followed by

the ages of 16–18. Dilinger is like most youth (61

Medicaid (34 percent) and WIC (16 percent).

percent) in our larger sample and in Cook County

These were also the most used benefits reported

(63 percent) who reported no foster care history.

at the time of our interview (44 percent, 24

His lack of criminal justice system involvement,

percent, and 10 percent, respectively). We

however, departs from the 49 percent of IDI

also asked youth if they had received services

youth who indicated this history. Roughly one-

through school. More than one-half (58 percent)

third of both Cook County youth and the IDI

indicated receiving subsidized lunch, followed

participants reported being currently employed.

by transportation (45 percent). Only 8 percent of

Dilinger represents this minority of youth who

youth indicated they received food vouchers.

held formal employment.

Throughout the narrative interviews, youth

Final y, similar to youth in Cook County and in

shared who connected them to services.

the larger sample, Dilinger experienced stigma

Friends, peers, and social service providers

and discrimination within his family. In his case,

were overwhelmingly the most frequently named

it was tied to his assumed sexual orientation.

sources of information about local resources (see

Although he identified in our background survey

Figure 4.14).

as “100% heterosexual,” his transgender partner

who transitioned from male to female, caused his

mother to stigmatize the relationship. And while

this did not immediately cause him to be kicked

out, given an already conflictual relationship, his

eighteenth birthday prompted his mother to evict

him from her home.

Taken together, our findings on youth

trajectories into and through homelessness

represent a larger observation—that youth

homelessness is not an event. It is preceded

by and contextualized within an often chronic

and deeply complex structural, familial, and

personal chal enges—including poverty, cycles of

violence, abuse, oppression and neglect, societal

and familial stigma and discrimination, mental

health and addiction, and youths’ own struggles

and development processes.

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Figure 4.14. Sources of resource referrals

Public Benefits

Transportation

Permanent Housing

Friends/Peers

Other Formal Resource

Social Service Providers

Education

Healthcare/Insurance

Employment

Informal Housing

Shelter/TLP

0

10

20

30

40

50

60

70

Regarding housing, overwhelmingly,

were least likely to name public advertising,

professionals and peers followed by family and

street outreach, and helplines as their portals to

online searches are the most often named as

housing services.

connectors to housing (see Figure 4.15). Youth

Figure 4.15. Facilitators of accessing housing

62

Shelter/TLP

56

Informal Housing

42

31

17

14 12

9 13

7

2

6

2

0

1

5 1

3 0

0

Social

Friend/

Family

Online

Stranger

School

Police Healthcare Helpline

Street

Service

Peer

Search

Provider

Outreach

Provider

Youth logics of engagement with

“I’ve never tried to find anyone as a support

resources

because people have their own agendas and I

understand that and, I can do things alone.” Kyle,

“I didn’t enroll in a shelter. I had too much pride. I

San Diego County

just slept on the streets...” Angel, Travis County

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“Never depend on nobody…Basical y…I’m on my

Figure 4.16. Three youth engagement styles

OWN. Just stay—just get on your own!” Paris,

Cook County

Like Kyle, Angel, and Paris, youth sometimes

rejected resources even when they were

available. An important part of our analysis

Disengagement

was to understand why. We refer to this

decision-making process as “youth logics of

engagement.” This analysis identifies three

different styles of engagement (Figure 4.16)

and explores often hidden factors within this

Full engagement

process (Figure 4.17). We find youth logics are,

understandably, shadowed by a heightened

attunement to managing risk. For participants,

risk was evaluated through the lens of their

Selective

identities, accumulated lived experience, and

engagement

sense of personal agency and independence.

As we present these findings, we emphasize

throughout that these are not “types of youth,”

but rather patterns in the way they engaged a

resource. Any individual youth may use all three

of these styles (Figure 4.16) or change styles

over the course of their housing instability. We

intentional y use the word resource to include

both formal and informal sources and kinds of

assistance. It is a term that does not assume its

receipt is experienced by youth as supportive

As youth contemplated the available resources

or as helpful. In this section, the term resource

in their local and social environments, they faced

includes services from professionals (for

difficult choices about using them. This section

example, counseling, shelters/housing, schools,

defines the three patterns in how participants

healthcare) as well as resources from informal

engaged resources. We then unpack these

social network members like friends and family

styles, using case examples, to understand the

(for example, housing, emotional support,

factors informing their choices and behaviors.

money).

Full Engagement: Sometimes youth described

deeply immersing themselves within an array of

resources, rotating across different agencies.

Other youth attached themselves (when

available) to a single agency that provided many

services. Youth who exercised both patterns

with formal services often described themselves

as open to help-seeking and people in general.

Sometimes full engagement was tied to

exclusively relying on one’s informal network (that

is, family, friends, non-professionals), decreasing

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Chapter 4. In-depth Interviews

the need to rely on formal sources of support

informed by three underlying factors: identity

(that is, agencies, shelters). Other times youth

protection, accumulated lived experience, and

would proclaim loyal attachments to a particular

personal agency (that is, sense of independence

agency or organization and make use of all of

and autonomy). These factors shaped their

their resources.

perceptions of the gains and risks of engaging

the actual resources in their environments.

Disengagement: Sometimes youth rejected

certain services or resources. When youth

Risk management: The role of identity,

reported this style, they often referenced past

experience and personal agency

experiences of service systems (or their family

systems) that left them less open to, or trusting

“I mean anything is better than being out on the

of, help-seeking/receiving in general. This was

street. But if it’s not geared for LGBT people, I

the only pattern of engagement where some

can’t do it. Cause I’m just-uh-I just can’t not be

youth did use this style exclusively, and ful y

myself.” London, Philadelphia County, selectively

disengaged from all resources (formal and

engages shelters

informal). The previous quotes from Kyle, Paris,

“I just wanted to stay out on the street ‘cuz I

and Angel are examples of this. In these cases,

don’t trust people and everybody.” Selena, Wal a

youth only used resources when external y

Wal a County, general y disengages from all

forced, due to harsh weather, an arrest, a

formal resources

pregnancy, or because their literal survival

depended upon it. Often these patterns were

“I’m gonna take advantage of every damn thing

explained by youth reporting high degrees

they’re giving me! I’m gonna use it.” Dilinger,

of self-reliance, blaming their own “pride” or

Cook County, ful y engaged with local provider

insistence on doing things independently or

agency

“on my own.” This perception of risk to one’s

personal agency seemed to be a powerful driver

“…My mom raised me to take nothing and

behind their insistence to avoid using resources.

that nothing is for free.” D, San Diego County

disengages from all formal and informal

Selective engagement: Selective engagement

resources

was by far the most common style of engaging.

Selective engagement refers to a pattern of

As youth considered their available options and

using specific criteria or conditions to engage

access to resources, their decision-making

or disengage on a case-by-case basis. This

processes were overshadowed by a need to

resulted in either selectively engaging an array

manage risk against the gains (Figure 4.17).

of formal or informal services or being selective

Like the previous quotes indicate, youth varied

within a category (for example, shelters) in

in how they made meaning of and weighed the

choosing one resource over another. For

possible risks. Due to prior systems involvement

example, sometimes youth might only go to

or simply an accumulated lived experience

a particular shelter if it specifical y served

with housing instability, all youth in our study

LGBTQ youth, or only if important relationships

had prior experiences of receiving or being

could be retained or preserved (for example,

offered assistance from peers, adults, and/or

shelter al ows baby to stay with them, or will

professionals.

also accept a partner or friend). When these

Participants also shared a history of navigating

conditions were not met, youth rejected the

complex and chronical y stressed or even

resource, often choosing to stay on the streets

toxic relationships with parents or adult family

instead. The following pages will now explore

members. Understandably, most remained leery

how these engagement styles were deeply

of the hidden or explicit costs of receiving “help.”

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If someone offers a place to stay, what will they

and everybody,” this emerges as often-shaped

want in exchange? Was returning home to a

reticence to ful y engage anyone. However, some

parent addicted to drugs, or whose boyfriend is

examples of youth, like Dilinger, who despite

homophobic, riskier than sleeping on the streets?

equal y chal enging lived experience, remained

Was disclosing one’s homelessness to a teacher

open to the potential gains from using resources.

worth risking a call to child protective services?

In the case vignettes later, readers will hear youth

These were among the commonly articulated

reference their accumulated experiences as they

risks that youth mentioned as they considered

weigh the risk and benefits, and explain why they

making use of a resource.

rejected or used a resource.

Just as youth differed in weighing the possible

Personal Agency: Final y, youth varied in their

risks against the gains, so too did they vary

sense of personal agency—how one makes

in their individual degrees of openness to a

use of and understands their own power to act,

resource and help in general. Not all youth

resist, and create change in their external world.

had to navigate the same kinds of risks. This

Again, for Dilinger earlier who remains open to

analysis identified three factors that commonly

resources, his personal agency contributes to,

featured across all interviews and shaped their

and is affirmed by, actively engaging resources.

assessments of risks and gains of engaging

This generates a corresponding positive

resources: identity protection, experience, and

experience. For others like Selena who are less

personal agency.

open, it causes her to steadfastly avoid shelters

and acquire a resulting experience of avoiding

Identity Protection: While all youth had

the risk she fears. Youth also varied in the degree

identities that mattered to them, some youth held

to which they believed their personal agency was

identities that they felt needed extra protection.

threatened by receiving help; that their pride and

This was overwhelmingly true for the youth in

independence (that is, personal agency) would

our study who identified as gender minorities

be at risk by engaging a particular resource.

(transgender youth), and as sexual minorities—

in particular, youth who identified as gay or

In Figure 4.17, we intentional y locate these three

lesbian. As London’s quote earlier il ustrates, an

factors—identity, experience, and personal

agency’s reputation for being a safe space for

agency—within the backpack of the young

“LGBT people” was often a filter through which

person. It was indeed carried around as part

they assessed risk versus gains. Some of our

of their essential toolkit for navigating their

vignettes will highlight the ways in which youth

housing instability; it was ever-present as they

managed risk through the lens of a stigmatized,

anticipated the gains against the looming risks of

marginalized, or discredited identity.

using resources. We recognize youth likely carry

other things with them as they move through

Accumulated Experience: Despite their young

their environments and assess risk and gain.

ages, youth also had acquired lived experiences

These three, however, were the most frequently

that factored significantly into how they

mentioned by our participants. Taken together,

perceived the risks attached to the people and

these factors fueled their logics of engagement.

resources in their environments. The emotional

The following three examples are presented to

and relational residue, both positive and

il ustrate how these factors show up in the logics

negative, that these lived experiences deposited

of individual participants.

were important reference points for youth.

Specifical y, it contributed to a youth’s level of

openness or trust. For some, like Selena earlier

who self-describes as distrustful of “people

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Figure 4.17. Youth logics of engagement through risk management

risk management

local resource environment

awareness of

resources

identity

experience

personal agency

Putting it all together: Understanding youth

Yet, Jax has actual y been independent most

logics of engagement in context

of his life—an accumulated lived experience

of loss and sense of rejection that shows up

Following, we offer three examples of youth

throughout his story. His mother abandoned

and the logics of their own choices to engage

the family when Jax was six. His father would

and disengage from resources within their

often leave Jax and his older siblings alone for

environments.

weeks at a time while he was away working.

Vignette 1: Jax

Eventual y, Jax’s father was deported when Jax

was 12; this is the same year he notes getting

Disengages from informal resources, selectively

his tattoo. Now parentless and undocumented

engages one formal service

in the United States, Jax and his remaining

brother spent most of their time ful y disengaged

Jax, 18, identified as a heterosexual male. Born

from school to avoid being discovered. As the

in México; he and his family arrived to the United

years went on, he and his brother began sel ing

States as undocumented immigrants. In addition

drugs to survive. Eventual y, to avoid arrest, his

to the strong confidence Jax exuded throughout

brother ran away to México. By 14, Jax was living

his interview, his sense of autonomy and

alone in his family trailer. “It’s like my brother

independence was further affirmed by the tattoo

just kind of left out on me, and … it kind of hurt,

he prideful y displayed, “TRUST NOBODY.”

you know?” For a while, he rotated between

This extreme sense of personal agency paired

staying at the trailer, couch surfing at friends,

with his general distrust of others has caused

and living on the streets. Then one-day a friend’s

him to reject adoption, and to turn down

dad reached out and tried to convince Jax to

educational opportunities. “I just didn’t wanna

receive his help in finding a job and reenrolling

depend on anybody no more and kind of just be

in school. Jax refused. He expressed his own

independent.”

dismay as to why he rejected the help. “To be

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honest, I didn’t—I didn’t –I don’t know! I don’t

During the interview, he shared that most of the

know why I never decided to go back, to be

TLP staff affirm his emerging identity as a new

honest.” Then later a cousin also reached out

parent. “They think I’m gonna be a real y good

and invited Jax to come live with them and

father, so I mean I have like tons of books, I’m

reenroll in high school. Jax explained that he

ready for this now…I have people that talk down

again rejected this resource and big opportunity.

on me…but I tell them, ‘you never know you’re

“It was weird to be honest…I was again… here I

ready until it actual y happens’.” To prepare

am I’m by myself. You know it was a big window.

for fatherhood, Jax has read, “eight books for

…I mean it was—it was big. It was something big,

babies and stuff, and I’m trying to prepare myself

but I didn’t take it.” Months later, exhausted by

…and I had sympathy symptoms. I don’t know

surviving on his own, he moved to a small nearby

if you even know what that is. The sympathy

town to work, but instead uses what money he

symptoms—I’m the one that has the nausea and

had to buy drugs and alcohol to commit suicide

stuff like that!”

by overdosing. “I tried kil ing myself, I’m not

gonna lie to you, yeah I did. …I was done…I just

Vignette 2: Brad

didn’t see no point in life no more…I didn’t feel

Disengages from most formal services,

happy…I didn’t see why God took everything

selectively engages informal networks

from me like that.” Police eventual y discovered

Jax and took him to the hospital. Once stable,

Brad identified as a White heterosexual male who

he entered foster care. Although the case plan

currently lives in Wal a Wal a County, Washington.

was to obtain his paperwork for citizenship, Jax

He named parental struggles (mom’s addiction

believed the paperwork fell through the cracks

to methamphetamines) and family homelessness

after his caseworker left. At 16 years old, his

as the beginning of his own instability. “I lost

foster parents offer to adopt him. But Jax also

my place when I was seventeen with my mom

rejected this. “They were good foster parents,

… my mom got real y bad into drugs and so we

there was nothing wrong with them. They wanted

were just kinda just bouncing from uh, you know,

to adopt me hard. I’d be like, ‘no, no’…They tried

tweaker houses 30 to park benches…” Before

a lot. I can’t real y see why they want anybody

he and his mom experienced homelessness,

else except me.”

Brad and his younger brother were removed

from their mother’s care when she “cal ed the

Despite this history of disengagement, strongly

system on herself. She cal ed [Child Protective

rooted in his accumulated experiences of

Services] and told them that she couldn’t take

rejection, Jax has selectively engaged in a

care of me or my brother anymore…she was on

transitional living placement (TLP). This was only

a bunch of medications. …she wasn’t mental y

because it preserved his relationship with his

stable…” Brad cycled through five placements

fiancé. It also protected his newly emerging

during his time in foster care and ultimately, he

identity as a father, “I don’t have family, you

was returned home. His brother is currently still

know, and I have my own family you know with

in foster care out of state. As he reflected on his

my girl and our baby…no drug use, no alcohol

childhood, despite experiencing abuse in one of

use. Everything is good. She’s my happiness,

his placements, Brad noted foster care as mostly

you know?” This selective engagement is made

a positive experience. It gave him a respite from

possible only because the TLP al owed him to be

his mom’s struggles with addiction and al owed

in close contact with his fiancé who lives in the

him to re-engage with school. However, when

same town in her own foster placement.

he returned home to his mom, she relapsed into

drug use, and their ultimate homelessness also

30 “Tweaker houses” are houses, sheds, or abandoned buildings where individuals gather to use stimulants (most commonly methamphetamine and amphetamine).

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resulted in his dropping out of school.

always trying to like hang out with somebody

or do something…” At the time of our interview,

At 16, Brad experienced a whirlwind of life

Brad was still connected to his dad, and his

transitions. He re-engaged with his father, re-

dad’s girlfriend had hired him to work in her

entered high school, and himself became a

seasonal landscaping business. He referred to

father. For a short while, the young couple lived

her as not only his boss, but also a mentor. She

together at his mom’s house with their baby. But

had helped him to get his state identification

then his maternal grandmother died, and this

card and re-engage in school. He shared that

caused his own mother to spiral downward, “Her

he was expecting another baby with his current

whole demeanor changed, you could just tell

girlfriend, but was estranged from his first

she wasn’t …even there mental y. She started

daughter who was placed into foster care with

getting real y depressed, started cutting herself

the maternal grandmother.

real y bad. …I’d come home and she’d be in the

bathroom in like the bathtub…passed out and

Today, Brad is still unstably housed and still has

there’d just be the whole—the whole—the whole

some nights on the streets. He makes minimum

bathtub would just be red…I didn’t know what to

selective use of a local church’s meals and their

do.”

health services and sometimes goes to the

hospital for “panic attacks.” He is ambivalent

When asked if he ever reached out for help, Brad

about ending his homelessness and talks at

was afraid that the risk would outweigh the gain,

length about its benefits including al owing him

“I was always afraid to tell anybody because I

to develop a lifestyle of not feeling “confined;”

didn’t wanna—didn’t want my mom to you know,

a sense of unbridled freedom and autonomy

get in trouble or have—have somebody come in

that he “liked too much.” He now thinks this

and take her to like some facility or something.”

is problematic in part because “there’s a lot

Brad also explained that his negative past

of stigma with homeless people. …it kinda

experiences with counseling services in foster

sucks because...they don’t see each person

care made him doubt the gains of seeking help

as themselves.” While he appreciates the

for himself would be worth it, “…but on top of

stability of times when he has been housed,

that my—my counselors never real y lasted.

he explains being stable includes risks to his

It was more, it was more their budgets. You

own independence and feeling of autonomy. “It

know, they’d be like, ‘Oh wel , this is our last

took me a little while to transition into not being

appointment cause we’re no longer being paid

homeless again...I felt confined when I lived in a

for it.’ And then at that point I’d just realize, ‘oh

place...I don’t wanna be in a house, you know?

yeah, it’s all about money so I don’t real y want to

Like what the hell is this?! But then I got used

sit and talk to you anyways’.”

to it again and like now I can kinda see it from

When asked how or where he now gets support

both—both angles” Brad’s personal agency also

or what helps him to survive, Brad said he mainly

causes him to reject formal housing services as a

coped on his own by using distractions, “I think

critical resource to support his stability. Instead,

about all the shit that I’ve been through…I’ve

he asserts the key to ending his, and other

never wanted to end my life. But…I would you

youths’ homelessness, is individual effort and

know I’d sit and pity myself sometimes… I don’t

will. “I think to achieve the stability you would…

know what the hell I’m doing here…what my

need to want it.”

purpose is or why I’m even still here right now...

It’s when I’m alone that it starts getting bad like

that so I always try to keep myself occupied. I’m

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Vignette 3: Jamal

and years came.” In finding a safe space that

affirmed an identity that was unprotected in his

Ful engagement with formal services, selective

own home, he says, “I gained family and friends

engagement with informal networks

there…I’d rather see them more than my friends,

Jamal, age 21, identified as an African-American

my brother’s friends, and him any day!” After this

male living in Philadelphia County. Jamal began

awareness, he ful y engaged with and trusted this

his story of instability when he first came out as

provider and made use of all of their resources,

gay at the age of 14. However, this early family

“They gave me resources and staff to talk to…

awareness of his identity brewed in his extended

[name of staff at agency] was real kind in real y

family for three years until it resulted in Jamal’s

helping me out. And she still helps me out…to

first episode of unaccompanied homelessness

this day.”

at age 17. Jamal was never kicked out for being

Jamal spent less and less time at his

gay, but he left a home that was certainly a

grandmother’s and more time at shelters and

source of stigma and discrimination because

couch surfing. He continued to think of his

of this identity. As Jamal recal ed, “My mom,

mother as a support, though she could provide

when she found out that I was gay, she didn’t

limited emotional support because she lived in

real y have a big problem with it. She did accept

the grandmother’s house. However, she insists,

me, took me in, like with open arms. My dad, he

and Jamal accepts, that he is welcomed there.

was a little on edge about it, but he final y came

“One thing about my mom… my mom wasn’t

around. But um my older brothers and like my

like… ‘I don’t want gays in my house’ and stuff

grandmother were…against it…My grandma

like that. She was very inviting. My mom used

she would claim it was a phase or…it was like a

to always tell me if I ever had a boyfriend or a

disgrace or disgust to her. My brother…one of

friend…and I wanted them to come over, she’d

my older brothers when he found out, (pauses)

rather us be there in the house safe than to

he stopped speaking to me.”

be out any other place that is unsafe.” When

As Jamal spoke of this 3-year period,

asked how she reacted to Jamal’s choices to

the emotional and literal cutoffs from his

stay elsewhere, in places he indeed felt safer

grandmother and brothers made Jamal feel like

than at his grandmother’s, “I think that she felt

he no longer had a home. He said these years

that as though I was older now. And maybe I

were like “hel .” From the ages of 15–17, as he

needed to find my way.” With Jamal’s continued

attempts to protect his identity, Jamal cycled

accumulated positive experience with the

between couch surfing at a cousin’s house and

provider, he ful y engaged other services, even

living with his grandma (where his mother and

those not specifical y targeting LGBTQ youth.

siblings also lived). But when his cousin died,

After graduating from high school, he engaged

Jamal, then 17, was forced to live ful -time with

with job training and placement services at

his grandmother. Unaware of local resources, he

another agency. At the time of his interview,

left home to couch surf with a friend to avoid the

Jamal had just learned he was accepted to a

“hel ” he endured in his grandmother’s home.

TLP and was already working three part-time

Eventual y, he came out to this friend, tel ing

jobs. He particularly found meaning in one of his

him he was gay. This friend then told him about

jobs where he helped persons with disabilities

a local agency that serves unstably housed

and special needs, “That’s one of my greatest

gay youth. Jamal was elated to discover this

joys, like to help people…if I was helping other

resource, “I went and I had fun. Then I kept

peoples’ family members, um and making them

going back and I kept going back and it was

happy, I was happy.” Jamal was also attending

like before you knew—(snaps fingers)—years

therapy sessions and completing a life skills

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course.

most disengaged from, and least open to, formal

services. He only goes to churches and the

With an offer to live with a friend also

hospital to survive. His negative experiences of

transitioning out of homelessness, he was leery

service providers in counseling as “about the

of a roommate situation and was curious about

money” and not about helping only reinforces

the added benefits of living on his own. With

his doubt in any gains by seeking out formal

an experience of living in tight quarters with his

services. He is left to make use of the limited

brothers and his grandmother, he worries that

informal support through his dad and step-

the friends of this potential roommate could be

mom and is consequently cut off from having

problematic. His friend may not pay the bills,

any counter/positive experiences with service

and “then there’s turmoil in the house. Or either

providers. Jax’s undocumented status resulted

something goes missing, something gets broke…

in limited access to formal resources until he

So I say, and I used to tell myself all the time, if

entered foster care. Although this was a mixed

I was to live by myself, I’d rather…cuz…I know

experience, his history of rejection in his family

that if I left my house and I washed all the dishes,

of origin shadowed his own interpretation of

when I come back, there will be no dishes in the

the risks and gains presented by the potential

sink.” As Jamal ends his interview, he expressed

adoptive family as a trusted resource and so,

his strong personal agency paired with openness

he rejected it. Jamal is the only one of the three

to make change in his life. He offered the

who lacked a childhood experience of formal

following wisdom to other youth who might be

services. His first contact, through his friend,

going through similar struggles, “And regardless

is exclusively positive and quite transformative.

of anything that may come your way, you still

As he accumulates this new experience, it only

have the ability to fight it. Like whether it’s with

fuels deeper levels of engagement with service

help by yourself, with friends, family, coworkers,

providers.

like anything … know that there’s someone out

here…that can relate to you. So, you’re never in

All three of these youth clearly have a sense

this world alone by yourself going through just

of personal agency. Jamal in leaving his family

one thing by yourself…never give up trying to

home at 17 convinced of a better more nurturing

make a better you.”

place, however, still affirms his openness and

belief that others can be helpful and supportive.

Summary

He unquestionably trusts the original provider

This section examined the ways in which youth

who then acts as a portal to other services. Jax,

make decisions about engaging the resources

with his “TRUST NOBODY” tattoo, and Brad also

available to them. When youth had an identity

both exude a strong sense of personal agency.

that needed nurturing and protecting, that reality

But unlike Jamal, Brad and Jax’s personal

helped to il uminate a unique set of risks and

agency manifest as extreme self-reliance.

gains. For Jamal as a young gay man and Jax

Time and again Jax disengages the informal

as a young father, they each found a resource

resources in his social network. His experience

where those identities could grow and develop.

of being abandoned and let down potential y

This also gave access to important relationships

contributes to his rejection of the occasional

with others who validated those identities. These

informal resources that have come from the

factors were critical gains in their choices to

few positive adults in his life. They are too risky.

engage, and then stay engaged, with a service

This heightens the critical importance of his

provider.

only informal resource, his fiancé and future

child. Similarly, Brad rejects formal services, and

While all three youth had accumulated

still wrestles with the attraction of the free and

experiences with formal resources, Brad is the

unconfined lifestyle gained by homelessness; it

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is affirming to his sense of independence and

il ustrated in Figure 4.18, all the responses

self-reliance. His sole support, like Jamal, comes

provided by participants highlight potential

from a small subsystem of his family: his dad and

points of intervention and are clustered around

step-mom.

four major themes: a) housing (structural); b)

jobs and education (structural and individual);

Ending youth homelessness

c) informal support (individual, family, peer, and

Just as the in-depth interviews began across all

structural); and d) personal changes (individual).

five sites with the same question, “Where does

Youth clearly conveyed that structural supports—

your story begin?” every interview concluded

housing, jobs, and education—are critical

with the counter question, “What would it take to

foundations to ending the instability these

achieve stability?”

youth face. But alone, these foundations were

insufficient to ensuring the end of their instability.

The multisystem factors shaping the critical

As Derek from Wal a Wal a County succinctly

condition trajectories—individual, family,

stated, “I don’t think I can do it completely on my

peer, and structural—once again show up

own.” Indeed, our findings suggest that it “takes

as important considerations (Appendix I). As

a vil age” to end youth homelessness.

Figure 4.18. A multi-systemic holistic approach to ending youth homelessness

Systems & Communities Play Critical Role in: offering

developmentally and cultural attuned supports and services,

ensuring safety and stability even across transitions, as

portals to other services that promote healing, growth,

recovery and wellness in communities, families and children

Structural

Family Play Critical Role in: providing stability, safety, and

nurturance. Family dynamic that promotes growth, wellness,

Familial

belonging and healthy development of its members

Peers Play Critical Role in: supporting sense of belonging

and family/kinship, providing social support, and portals to

Peer

accessing resources, information and skill development

Young People Play Critical Role: as resilient actors making

meaning of their lives and identities, fully engaging their

Individual

communities, building or strengthening capacities for

decision making that facilitate and protect their own wellness

and health

It takes a Village

Although “housing” unsurprisingly appeared in

long-term. Youth had to navigate the centralized,

nearly every response, the details provided by

but often isolated location of shelters with the

youth were more nuanced. The potential points

difficulty of accessing affordable and safe public

of intervention were linked to other issues.

transportation to jobs in other neighborhoods

Time-limited housing interventions such as

or even towns. Other participants expressed

shelters and transitional living programs often

concerns with finding housing that was within

were important, but on their own, they were

their price range, especial y given the upfront

insufficient resources to secure their stability

costs of security deposits and first and last

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Chapter 4. In-depth Interviews

month’s rent. Youth expressed the need for

Advice to organizations

assistance in locating reliable housing options

that they could afford alone and where landlords

One of the key findings of this study is that

will not take advantage of them.

it will take a vil age to end homelessness.

Critical members of each youth’s vil age are

Youth also expressed the need for jobs that pay

the professionals and organizations that must

a living wage with stable, consistent hours. Many

support their health and wel ness in times of

participants who were currently working noted

need. Three major themes emerged as youth

that they were not assigned enough hours or a

offered insights for improvements in services and

wage that would enable them to afford stable,

supports: location, rethinking outreach, and the

secure housing.

need for LGBTQ attuned practices.

Although the youth in this study were concerned

Location. Youth want more resources in the

with issues of safety, security, and basic

neighborhoods in which they live. When youth

needs, they also articulated a desire for higher

are required to travel long distances to engage

education. They were aware that more education

with service providers, they compromise existing

would help them achieve higher paying and more

connections to school, jobs, and informal

fulfil ing employment. They wanted to pursue this,

resources. Youth also advise organizations to

but they often had to choose between work and

provide more transportation support to maintain

education. Many were in some type of schooling

these connections and to compensate for lack

(for example, GED program or community

of local resources. Leo, from Cook County,

college) and unable to work enough to support

expresses this wel . “If you noticed, majority

housing costs. Youth needed financial assistance

of this stuff is in nice neighborhoods. I feel like

to complete their educational goals.

they shouldn’t be…there should be, at least a

resource center so that people can go to, in their

In addition to affordable housing, living wage

community.” For Jesse in Wal a Wal a, this is

jobs, and higher education, participants noted

only truer, as services he needs are in an entirely

that they also needed to make personal changes

different county. “…I don’t want to fucking go all

to achieve stability. Some of these changes

the way up to Yakima to detox!”

began with learning better financial management

and budgeting skills. Many of them also

Rethinking outreach. As noted in the section on

acknowledged that they needed to “mature” or

youth engagement of resources, youth are often

“grow up” if they wanted to achieve their goals.

connected to housing resources through friends

Equal y important, however, they would express

and family or through existing relationships with

their want or need for professional counseling

service providers. They also make use of social

to manage mental health conditions or the

media and online resources. According to youth,

emotional residue of their traumatic pasts. Some

service providers should rethink their outreach

wanted to “avoid drama” and peers who created

to include youths’ social networks. Youth we

a negative and counterproductive environment.

interviewed first experienced homelessness at

an average age of 16, so outreach should begin

Final y, youth spoke at length of their needs

early and not be restricted to targeting currently

for more and better informal support systems.

homeless youth.

They wanted people, especial y adults, who they

could trust, who would help them stay motivated,

LGBTQ-attuned services. As Jess from San

provide advice and mentorship, chal enge them

Diego explains, “…every single other trans

to (continue to) improve themselves, and provide

person that I know and I’ve talked to have had,

emotional support.

um negative, um, encounters with therapists or

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Chapter 4. In-depth Interviews

psychologists or psychiatrists.” The existence of

For LGBTQ youth, while disclosures of

resources and professionals who are skil ed in

stigmatized sexual or gender identities typical y

working with gay, lesbian, bisexual, questioning,

did not instantly result in getting kicked out,

transgender, and gender nonconforming youth

homelessness often emerged in the context of

makes an enormous difference to youths’

already stressed parent-child relationships and

emotional wel being. However, all organizations

other parental and family struggles that were

should strive to be more skil ed in working with

years in the making. Many youth eventual y left

this population. LGBTQ youth in the IDI are a

in order to escape the stigma and discrimination

disproportionately overrepresented group, and

they had endured for an extended period of time

they reported higher rates of adversities. Identity

within their families. Their reporting of the highest

protection within the logics of these youth was

rates of adversity scores in our survey, often

an important lens through which they assessed

while stably housed, further points to a need for

the risks and gains of engaging resources and

earlier intervention and prevention during and

professionals. Agencies and programs need to

prior to adolescence, when their first episodes of

earn and promote decidedly safe and affirming

literal homelessness occurred.

reputations for LGBTQ youth for many of them to

feel comfortable with the idea of engaging them

Answers to “Where does your story begin?”

for support.

clearly conveyed that family wel being, and

specifical y parental health and stability, are

Discussion

critical to shaping early risks for housing

instability of youth. Our analysis of these early

Key findings

beginnings points to persistent instability and

loss throughout their early childhoods. In fact,

In this chapter, we shared findings from in-depth

many youth indicated within their interviews that

interviews with 215 youth who were homeless

they had never experienced stability. Instead,

and unstably housed within five of the 22 VoYC

their childhoods, and emerging adulthoods, are

partner sites. This section discusses some of the

marked by significant and pronounced loss,

highlights of these findings and their significance

ambiguity, and instability. For future research,

for understanding unaccompanied youth

we recommend a more systematic evaluation of

homelessness.

all of the adverse experiences youth navigated,

The findings in this study strongly support a

especial y parental death, suicide, and a range

complex understanding of homelessness and

of experiences of family instability and disruption

one that il uminates its connection to other

(Whitbeck and Hoyt, 1999). There is a need

social chal enges and realities. In this way,

for improved measures and assessment tools

homelessness is a symptom of accumulated

of the adverse childhood experiences that are

adversities and unmet needs not just within

relevant to these youths’ normative contexts of

the individual youth, but also their social

development and of their many strengths.

environments. Their many accumulated life

Another important finding is related to emerging

experiences within service systems and within

adulthood in the context of poverty. Turning 18,

their family systems also disrupt the idea of

particularly for male youth, marked a critical

homelessness as caused by a single event.

life stage where many economical y stressed

Youth named involvement in foster care and the

parents expected participants to start financial y

removal of home itself as a risk factor to later

contributing to the household. When youth

unaccompanied homelessness. They named it

did not or could not, many parents kicked

specifical y as the beginning of their sense of

youth out, or youth simply left home to avoid

being homeless.

feeling like “a burden.” Sometimes this life

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

82

Chapter 4. In-depth Interviews

stage intersected with a parent’s rejection of

personal agency. Other times, youth felt it would

a child’s sexual identity or sexuality in general.

introduce risk to a family member (for example,

Parents sometimes waited until children were

becoming involved in child welfare system) or

approaching 18 to then issue ultimatums

bring undue burden to their already stressed

that resulted in getting kicked out or youth

households. We highlighted three factors that

leaving. This suggests a distinct phenomenon

shaped youths’ discernment of the risks versus

that departs from some contemporary

gains of engaging resources: identity protection,

understandings of emerging adulthood in the

accumulated experience with services, and

context of middle-to-upper-middle-class family

personal agency. As we consider why youth may

norms of social support. It also suggests early

not make full use of the available services and

opportunities for prevention.

resources in their environments, our work must

remain sensitive to the real and perceived risks

Our analysis of critical conditions and il ustrations

youth face as they are asked to engage with

of the trajectories of housing instability highlight

“help” and “supports” that may also bring some

factors that span multiple levels of influence:

degree of risk or loss.

individual, peer, family, and structural. Although

each experience of instability was unique, all

Limitations

youth navigated some combination of these

multilevel conditions. In presenting trajectories

There are several limitations to this study that

visual y, we were able to il ustrate how these

bear noting. First, although the methods we used

factors unfold and what causes tipping points

attempt to collect youths’ experiences over time,

into deeper levels of instability. Additional y, we

this was not a longitudinal study. Similarly, we

were able to identify missed opportunities to

used interview methods of data collection and

intervene and support youth across different

we did not observe youth beyond the interview.

levels of influence, and to interrupt the instability

Therefore, we were unable to track the real-

they navigated. The critical conditions and

time unfolding of their stories to gain precise

trajectories of youth only further emphasize that

specificity about key events and timing of those

understanding youth homelessness requires

events. Nor did we follow youth to observe

understanding the intersections of structural,

dynamics and conditions beyond their own

familial, peer, individual risks, and strengths.

awareness. That said, the analyses and findings

presented in this report offer insights into how

Final y, our findings related to youth logics

youth make meaning and interpret events rather

of engagement introduce to the field an

than documenting when and exactly how they

often-hidden process of decision-making.

unfolded. Researchers interested in tracking

This expands the discussion of barriers to

youth, the geographies of their homelessness,

engagement in service beyond access, location,

and the precise timing of events would do well to

awareness, and personal characteristics such

consider observational and longitudinal designs

as attitudes or motivation (Mojtabai et al., 2011).

and methods.

We identify risk-management as central to their

use of both local formal services and informal

Second, while not a limitation of the IDI,

resources. Even after youth were aware of a

it is important to remind readers that the

service in their local or social environments,

demographic characteristics of the IDI

some concerns remained about whether

sample (for example, race, age, gender, or

using it would bring more harm than good.

sexual identity) are not intended to be used

Sometimes accepting a resource placed an

as a national y representative measure of the

important relationship at risk, or threatened

homeless youth population in the United States.

one’s sense of autonomy, independence, and

Instead, the IDI was designed to highlight the

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

83

Chapter 4. In-depth Interviews

diverse experiences and perceptions of unstably

beyond the individual-level focus of designing

housed youth and young adults.

research and include youths’ family systems

(adoptive, foster, biological, and families of

Third, the IDI’s sample has lower numbers of

choice) and key social network members (peers,

important youth subgroups. These groups

service providers, teachers) to understand more

include Latino/a youth, transgender youth, and

ful y the relational push-pull factors in their

youth who reported involvement in the sex

instability. The use of case studies, ethnography,

trade. With transgender youth, it is possible

and more qualitative methods in general would

that some may have identified with their chosen

be essential to this research agenda.

gender identity (either male or female), instead

of identifying as transgender. However, youth

Conclusion

were fairly forthcoming about their identities

within the qualitative interviews. Therefore, the

The findings from this study’s in-depth

lower numbers of youth subgroups are more

interviews with 215 youth with lived experience

likely related to the need for more strategic

of homelessness from five diverse communities

recruitment. We engaged multiple methods to

strongly support a complex understanding

actively recruit Latino/a youth across all five

of homelessness and one that il uminates its

sites. Stil , the number of these youth in Cook,

connection to other social chal enges and

Wal a Wal a, and Philadelphia counties were low,

realities. In this way, homelessness is a symptom

even from those reported in our youth count

of accumulated adversities and unmet needs

component. Similar under-representations

not just within the individual youth, but also their

of Latino/a youth among those experiencing

social environments. Their many accumulated

homelessness have also been documented

life experiences within service systems and

with U.S. Departments of Housing and Urban

within their family systems also disrupt the

Development and Health and Human Services

idea of homelessness as caused by a single

administrative data and counts. During our

event. Our research on the trajectories of

recruitment, we were often told that this was

youth into and through homelessness highlight

a “tight-knit” and hidden population, reticent

numerous opportunities for prevention and early

to engage formal service systems (that is,

intervention across multiple public systems

more likely to couch surf). It is possible that

and aspects of the community. For the youth

a more prolonged time in the field, and/or

we interviewed, these were largely missed

hiring someone well known to members of the

opportunities. Armed with better evidence and

community might have helped to engage more

the voices of youth, they need not be missed

Latino/a youth participants. Similarly, few youth

opportunities for other youth going forward.

reported involvement in the sex trade or being

The implications of this research are many, yet

trafficked for commercial sex exchange. These

they are made straightforward with an enduring

are often highly patrolled and regulated youth,

African proverb: it takes a vil age.

and it would have been difficult to access them

References

with the recruitment methods we used. This is an

important issue that requires a specific research

Abramovich, Alex, and Jama Shelton, Eds. 2017.

method and design to gain trust of youth without

Where am I going to go? Intersectional

placing them in increased risk of harm or danger.

approaches to ending LGBTQ2S youth

Final y, this study is limited by its individual focus

homelessness in Canada and the U.S. Toronto,

on the youth. We lack important data from others

CA: Canadian Observatory on Homelessness

who deeply shaped their trajectories. There is

Press.

a serious need in the field for studies to move

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

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Chapter 4. In-depth Interviews

Auerswald, Colette L., and Stephen L. Eyre. 2002.

Samuels, Gina M., and Chrissy Cerven. 2016.

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Development, Chapin Hall at University of

Col ins, Patricia H. 1999. “Moving beyond gender:

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Coward-Bucher, Carrie E. 2008. “Towards a needs-

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Schafer, Markus H., Kenneth F. Ferraro, and Sarah

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Chapter 5. Homeless Service Provider and

Continuum of Care Surveys

Highlights

• In 22 diverse counties across the country, we

• RHY service providers and broader youth-

administered surveys to Continuums of Care

serving organizations (YSOs) offered a range

(CoCs) and a range of agencies that offer

of services to RHY, with case management,

services to youth experiencing homelessness.

assistance with basic needs, and life

• In general, runaway and homeless youth

skills training being the most common.

(RHY) service providers operated a wider

• Nearly all the homeless adult and homeless

range of programs in larger counties than

family service providers operated

in smal er counties, and some types of

programs that served 18- to 25-year-

programs (for example, transitional housing,

olds, but most did not operate programs

street outreach, supportive housing, and

that served 13- to 17-year-olds.

emergency shelter) were more widely

• Most CoCs had a coordinated entry and

available than others (for example, host

assessment system (CEAS); one-half of the

homes, drop-in centers, or rapid rehousing).

CoCs with a CEAS al owed unaccompanied

• RHY service providers were more likely to

youth to access services through their

operate programs for 18- to 25-year-olds

CEAS; and some had dedicated access

than for 13- to 17-year-olds, and this disparity

points through which youth could enter.

was particularly acute in smal er counties.

Background

youth experiencing homelessness (USICH,

2013). Noticeably less attention has been paid

This chapter presents the results of two surveys:

to understanding the existing landscape of

the service provider survey and the Continuum

programs and services for youth experiencing

of Care (CoC) survey. The service provider

homelessness and how that landscape

survey was administered to service providers

varies across communities. To the best of our

in each of the 22 partner counties to gather

knowledge, only a handful of surveys of service

information about the programs and services

providers for youth experiencing homelessness

available to RHY, and to identify gaps in service

has been conducted.

provision. The CoC survey was also administered

to the CoCs in each of the 22 Voice of Youth

Three surveys focused on service providers

Count (VoYC) counties and focused on the use

within a single state. One was a 2005 statewide

of coordinated entry and assessment system

survey of homeless service providers in Il inois

(CEAS) with youth experiencing homelessness.

that was designed to estimate the number of

unaccompanied homeless youth under age

The need for accurate data on homelessness

22 at a point in time and to assess their needs

among youth is widely recognized and there

(Johnson and Graf, 2005). The survey, which

is growing interest, particularly at the Federal

included questions about provider type, referral

level, in developing better methods for counting

sources, populations served, eligibility criteria,

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys types of services offered, average length of stay,

to providing those services, and to estimate the

reasons for turning youth away, and the number

percentage of supported youth experiencing

of youth served, was completed by 215 of the

homelessness who identified as LGBT. The

745 service providers identified by the Il inois

2012 survey was completed by 381 respondents

Department of Human Services, the CoC, the

representing 354 service providers on the

Chicago Coalition for the Homeless, and the

National Runaway Switchboard resource list,

Human Care Services Directory.31 A second

the Community of LGBT Centers (CenterLink)

survey (a follow-up survey) was launched in 2007

resource list, and the list of True Colors partner

to identify service gaps for youth under age 25

agencies (Durso and Gates, 2012). The 2015

experiencing homelessness (Chicago Coalition

survey was completed by 138 respondents

for the Homeless, 2007). Of the 31 service

representing 126 service providers registered

providers across the state that operate housing

with the Runaway and Homeless Youth Training

programs for youth, 24 completed the survey,

and Technical Assistance Center (RHYTTAC) or

which included questions about the number and

as part of the True Colors Fund’s Forty to None

characteristics of youth served, types of services

Network (Choi et al., 2015).

offered, unmet service needs, underserved

populations, and youth outcomes.

The service provider survey built upon these

prior efforts to document the landscape of

A third state-specific provider survey was

programs and services for youth experiencing

conducted in New York by the Empire State

homelessness. It complemented the brief

Coalition of Youth and Family Services to

youth survey (BYS) that was administered in

understand the mental health service needs of

conjunction with the youth counts to gather

the state’s youth experiencing homelessness

information about the number and characteristics

and the barriers they face to accessing

of youth experiencing homelessness in each of

services (Hirsch and Bolas, 2010). Eight youth

the 22 VoYC counties.

homelessness service providers in seven

counties that represented a range of upstate

The service provider survey built upon these

and downstate urban, suburban, and rural

prior efforts to document the landscape of

populations were surveyed. Although many of the

programs and services for youth experiencing

questions focused on mental health, including

homelessness. It complemented the brief

barriers to accessing mental health services

youth survey (BYS) that was administered in

faced by youth experiencing homelessness, the

conjunction with the youth counts to gather

survey also asked about the populations served

information about the number and characteristics

by the service providers and other services

of youth experiencing homelessness in each of

available in the community.

the 22 VoYC counties.

Two other surveys of youth homelessness

Methodology

service providers were national in scope and

conducted by the Wil iams Institute in 2012

Sampling

and 2015, respectively. They aimed to improve

The VoYC research team generated a list of

understanding of the characteristics and

service providers for each of the 22 counties

experiences of the lesbian, gay, bisexual, or

based on recent CoC housing inventory

transgender (LGBT) youth they served, the types

count (HIC) reports for homeless assistance

of services offered to those youth, the barriers

programs.32 The lists were reviewed by the lead

31 A 58 percent response rate was reported because some of the service providers to which the survey was sent were determined to be ineligible.

32 These reports include the number of beds and housing units available among homeless programs on the night of the point-in-time count by program type and provider.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys agency in each county, and any missing service

surveys were typical y launched one or two days

providers were added. The lists included runaway

after that cal . An email describing the initiative

and homeless youth service providers, homeless

and explaining the purpose of the survey was

adult service providers, homeless family service

sent to each service provider and CoC contact

providers, and organizations that serve other

on the list. Recipients were asked to complete

youth populations. The VoYC research team also

the survey using a unique survey link that was

used the HUD Exchange website to compile a

embedded in the email. Data were collected from

list of contact information for the CoC in each of

June 2016 through October 2016.

the 22 counties. The contact information for each

CoC was reviewed by the relevant county’s lead

To maximize response rates, research team

agency.

members sent reminder emails and made

phone calls to service providers that had yet to

Survey instruments

complete the survey. Email reminders were also

sent by the lead agency in most of the sites.

Both surveys were administered using web-

The lead agencies received weekly updates

based data collection tools designed by the

that included the response rate and contact

VoYC research team. The service provider

information for the non-respondent service

survey included questions about the agency

providers. The Service Provider Survey was

and its target populations. Agencies that

initial y supposed to be kept open for 4 weeks,

identified runaway and homeless youth as

but was typical y kept open for a few additional

their target population were asked about the

weeks because response rates were frequently

types of programs they operate for runaway

low (for example, less than 50 percent) at the

and homeless youth, how those programs are

end of week four. The CoC Survey remained

funded, and the types of services they provide.

open until the final Service Provider Survey had

Other agencies were asked about the programs

closed.

they operate for homeless adults, homeless

families, or about the services they provide to

Because of a skip pattern in the original survey,

runaway and homeless youth in the context of

service providers that had identified RHY as

serving other youth populations.

a target population were not asked about

programs for homeless adults or homeless

The CoC survey included questions about

families that might serve homeless youth.

coordinated entry and assessment. CoCs

Consequently, after all the Service Provider

that have a CEAS were asked about the ways

Surveys had closed, a follow up survey was

in which youth can access that system, the

sent to the subset of RHY service providers

assessment tools that are used with youth, and

identified by the VoYC site coordinators as being

the types of services youth receive at an access

likely to have programs for homeless adults or

point or to which they are referred.

homeless families. The follow-up survey included

Data collection

questions about those programs, and service

providers were given a little more than one week

The service provider and CoC surveys were

to complete it. The CoC Survey was also briefly

launched on a rolling basis. Soon after the youth

reopened to give CoCs that had not completed

count was completed in a county, the VoYC

the survey an opportunity to do so.

site coordinator for that county, along with one

or more members of the research team, held a

The service provider survey link was sent to 822

conference call with the lead agency to finalize

service providers, and the survey was completed

the list of service providers and CoC contacts

by 64 percent (n=523). The completion rate

to whom the survey links would be sent. Both

ranged from 47 percent to 100 percent across

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys the 22 counties and was higher, on average, in

survey was completed by 48 percent (n=33) or

the small counties than in either the medium-

the 69 service providers to whom a link was sent.

sized or large counties (Table 5.1). The follow-up

Table 5.1. Survey response rates by county size

County size

# surveys

# completed

Response rate

Smal counties

75

58

77.3%

Medium-sized counties

222

141

63.5%

Large counties

525

324

61.7%

Total

823

523

63.5%

Suffolk County and Cook County are each

Results

served by two CoCs. Wayne County is served

by two CoCs plus one al iance that coordinates

Service provider survey: Individual-level

youth access to housing. Hence, the CoC survey

data

link was sent to 26 potential respondents (that is,

one respondent for 19 counties, two respondents

Service provider characteristics

for two counties, and three respondents for one

Ninety-three percent of the 523 service providers

county). The CoC survey had a 100 percent

that completed the survey identified themselves

completion rate.

as non-profit organizations (three percent

Data analysis

identified as religious/faith-based organizations,

three percent identified as public/government

The service providers’ data were cleaned and

agencies, and one percent identified as “other”).

analyzed at the individual provider level as well

In terms of target populations, 27 percent of

as aggregated and analyzed at the county level.

the service providers reported serving RHY, 43

The 22 counties were further divided into three

percent reported serving other youth populations

groups based on population size (six small

(for example, low-income or disconnected youth,

counties with populations ranging from 15,028

youth in foster care), 46 percent reported serving

to 119,980; seven medium-sized counties with

homeless adults, and 43 percent reported

populations ranging from 193,013 to 778,121; and

serving homeless families (see Figure 5.1).33,34 At

nine large counties with populations ranging from

least 38 percent of these service providers target

1,176,558 to 5,238,216). Some of the analyses

more than one population.35

were run separately for each group. The survey

data collected from the CoCs were also cleaned

and analyzed.

33 Providers could report serving more than one target population.

34 Four percent of the service providers did not report serving any of the target populations. These include housing developers, housing authorities, and health care centers.

35 The number of agencies that serve homeless adults or homeless families with children is probably higher than these data suggest because only one-half of the RHY

service providers who were sent a follow-up survey responded.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Figure 5.1. Target populations

Homeless families with children

43%

Homeless adults

46%

Other youth

43%

Runaway and homeless youth

27%

The most common referral sources for the 142

common referral sources included schools,

RHY service providers were other homeless

street outreach programs, child welfare agencies,

service providers and youth that experienced

and law enforcement. Relatively few (19 percent)

homelessness themselves (see Figure 5.2). The

RHY service providers received referrals from the

latter include youth who referred themselves

National Runaway Safeline.36

and youth who were referred by peers. Other

Figure 5.2. Referral sources

National Runaway Safeline

19%

Hospitals or other health care providers

48%

Law enforcement agencies

54%

Child welfare agencies

59%

Street outreach programs

66%

Schools

66%

Other runaway or homeless youth

78%

Youth refer themselves

80%

Other homeless service providers

86%

Programs operated by runaway and

housing and street outreach programs and least

homeless youth service providers

likely to operate host home or rapid rehousing

programs (see Figure 5.3). Most of these RHY

The 142 RHY service providers that completed

service providers operated more than one type

the survey were most likely to operate transitional

of program.

36 Between 211 to 311 helpline centers for essential community services, often including shelter and housing, were not included as a response option for referrals in the survey; this could be useful in future research.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Figure 5.3. Types of programs operated by RHY service providers

Rapid rehousing

16%

Host home

5%

Supportive housing

29%

Transitional housing

56%

Emergency shelters

30%

Street outreach

46%

Drop-in centers

31%

Figure 5.4. Age of youth served by RHY service providers by program type

Rapid rehousing

100%

23%

Host home

86%

43%

Supportive housing

98%

29%

Transitional housing

99%

30%

Emergency shelters

86%

55%

Street outreach

97%

75%

Drop-in centers

96%

80%

18- to 25-Year-Olds

13- to 17-Year-Olds

Availability of programs by age of youth

The RHY service providers that completed the

served

survey estimated the number of youth served

by their drop-in centers and street outreach

The RHY service providers that completed

programs each day and by their transitional

the survey were much more likely to operate

housing, permanent supportive housing, host

programs that served 18- to 25-year-olds than to

home, and rapid rehousing programs at a point

operate programs that served 13- to 17-year-olds

in time.37 Collectively, their drop-in centers and

(see Figure 5.4)

street outreach programs served approximately

1,230 and 1,206 youth per day, respectively.

37 Permanent supportive housing was defined as “non-time-limited housing assistance with wrap-around supportive services.”

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Collectively, their transitional housing, permanent

youth (see Figure 5.5), with nearly 90 percent of

supportive housing, host home, and rapid

those youth served by transitional or permanent

rehousing programs served more than 3,600

supportive housing programs.

Figure 5.5. Total number of youth served by program type

Rapid rehousing

430

Host home

43

Supportive housing

1,030

Transitional housing

2,133

The RHY service providers that completed the

likely to have turned youth away from their

survey were most likely to have waiting lists for

emergency shelters during the past year (see

their transitional housing programs and most

Figure 5.6).

Figure 5.6. Unmet need reported by RHY service providers by program type

71%

Supportive housing

42%

61%

78%

Transitional housing

58% 68%

79%

Emergency shelter

69%

43%

Either

Turned Away Youth

Waiting Lists

The programs operated by the RHY service

common sources of funding were individual

providers that completed the survey received

donors and foundations, with 73 percent of the

funding from a mix of public and private sources

RHY service providers receiving funding from

(see Figure 5.7), and 82 percent received funding

one or both. Eighty-five percent received funding

from more than one source. The two most

from at least one public source.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Figure 5.7. RHY program funding sources

Individual donors

65%

Foundations/philanthropy

63%

Local government

56%

State government

54%

Federal government

59%

More of the RHY service providers that

state or local regulations may limit shelter stays

completed the survey operated emergency

for 13- to 17-year-olds as a condition of licensure.

shelters that served 18 to 25-year-olds (n=36)

than operated emergency shelters that served

These differences are much smal er in the

13- to 17-year-olds (n=23). Emergency shelters

case of transitional housing programs. Sixty-

that those RHY service providers operated

eight percent of RHY service providers whose

had nearly three times as many beds for 18- to

transitional housing programs served 13- to

25-year-olds (810) as there were beds for 13- to

17-year-olds had limits on the length of time

17-year-olds (286). Some of this disparity in the

youth could stay, compared with 73 percent

availability of shelter beds may reflect the age

of RHY service providers whose transitional

distribution of the RHY population. Although

housing programs served 18- to 25-year-olds.

13- to 17-year-olds were likely to have been

The average time limit for both age groups was

underrepresented, 82 percent of the youth

about 21 months (that is, 645 days for 13- to

experiencing homelessness who were surveyed

17-year-olds and 668 days for 18 to 25-year-

during the 22 VoYC Youth Counts were 18 to 25

olds). This is about three months longer than

years old. Licensing requirements for serving

transitional living programs (TLPs) funded by

minors are another factor that may contribute to

the Family and Youth Services Bureau (FYSB)

this disparity.

can typical y serve youth, although youth can

be served by FYSB-funded TLPs for up to 21

Seventy percent of the RHY service providers

months under exceptional circumstances, or

whose emergency shelters served 13- to

longer if they are not yet 18 years old.

17-year-olds had time limits on the length of time

youth could stay compared with 33 percent of

Programs Operated by Homeless Adult and

those whose emergency shelters served 18- to

Homeless Family Providers

25-year-olds. Additional y, the time limits were

Forty-six percent (n=241) of the service providers

70 percent lower, on average, for 13- to 17-year-

that completed the survey reported that they

olds (35 days) than for 18- to 25-year-olds (115

operated programs for homeless adults without

days). Two factors likely contributed to these

children, and 43 percent (n=223) reported that

differences. First, RHY service providers that

they operated programs for homeless families

received Federal Basic Center Program funding

with children. Figure 5.8 shows the types of

for their emergency shelters cannot serve youth

programs the homeless adult and homeless

for more than 21 days, and only 13- to 17-year-

family service providers operated.

olds can be served with these funds. Second,

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Figure 5.8. Types of programs operated by homeless adult and family service providers 28%

Rapid rehousing

23%

35%

Supportive housing

46%

Homeless Family

39%

Transitional housing

38%

Homeless Adult

39%

Emergency shelter

41%

17%

Street outreach

26%

Regardless of program type, nearly all the

18- to 25-year-olds, but most did not serve

programs operated by the homeless adult

13- to 17-year-olds (see Figure 5.9). Their street

and homeless family service providers served

outreach programs were a notable exception.

Figure 5.9. Age of youth served by homeless adult and family service providers by program type 100%

100%

Rapid rehousing

16%

18%

99%

97%

Supportive housing

5%12%

97%

100%

Transitional housing

13%

13%

100%

100%

Emergency shelters

16%26%

97%

95%

Street outreach

50%

44%

Homeless Family: 18- to 25-Year-Olds

Homeless Adult: 18- to 25-Year-Olds

Homeless Family: 13- to 17-Year-Olds

Homeless Adult: 13- to 17-Year-Olds

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Services available from RHY service

these services were more likely to be offered

providers and youth serving organizations

by the RHY service providers than by the

YSOs. The biggest differences were in the

Forty-nine percent (n=110) of the 226 youth

provision of assistance with housing (78 percent

serving organizations (YSOs) that completed

versus 41 percent) and transportation (81

the survey reported that some of the youth

percent versus 46 percent). Smal er, but still

they served were runaway and homeless

substantial differences existed in the provision

youth. Figure 5.10 shows the types of services

of employment services, life skills training, case

provided by those 110 YSOs and the 142 RHY

management, and recreation.

service providers.38 With a few exceptions,

Figure 5.10. Types of services available from RHY service providers and YSOs

18%

Legal assistance

21%

Storage facilities

22%

46%

Mentoring

44%

43%

Physical health

44%

Family reunification

55%

44%

Recreation

65%

57%

Mental/behavioral health

67%

59%

Education

68%

41%

Housing assistance

78%

46%

Transportation

81%

57%

Employment

84%

61%

Life skil s training

85%

76%

Assistance with basic needs

85%

75%

Case management

95%

RHY-Serving YSOs

RHY Service Providers

Forty-four percent of the RHY service providers

olds, and about two-thirds offer prevention

and 26 percent of all the YSOs (including those

services to 18- to 25-year-olds. However, YSOs

that do not serve runaway or homeless youth)

were nearly twice as likely as RHY service

offered prevention services (see Figure 5.11).

providers to offer prevention services to parents

Nearly all these RHY service providers and YSOs

or guardians.

offered prevention services to 13- to 17-year-

38 YSOs were not asked if they provide storage facilities or family reunification services.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Figure 5.11. Groups eligible for prevention services from RHY service providers and YSOs 53%

Parents or guardians

27%

66%

18- to 25-year-olds

64%

90%

13- to 17-year-olds

91%

YSOs

RHY Service Providers

Case management and crisis intervention were

YSOs, and both were more likely to have been

the two most common types of prevention

offered by RHY service providers than by YSOs

services offered by RHY service providers and

(see Figure 5.12).

Figure 5.12. Prevention services available from RHY service providers and YSOs

62%

Crisis intervention

73%

50%

Family counseling/therapy

YSOs

54%

RHY Service Providers

50%

Group counseling/therapy

46%

66%

Individual counseling/therapy

70%

72%

Case management

83%

Service provider survey: County-level

Provider type by county size

data

In every county, at least one homeless adult

The results of our county-level analysis of

service provider, at least one homeless family

the Service Provider Survey data reflect the

service provider, and at least one youth-serving

responses of service providers that completed

organization completed the survey (see Figure

the survey. Because the completion rate in some

5.13). In two small counties, the survey was not

counties was well below 100 percent, most

completed by any RHY service providers.

counties have more service providers than these

data suggest. This is less so with the smal er

counties, which typical y had higher response

rates.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Figure 5.13. County-level data on the number of service providers by provider type: Overall and by county size

Large

Medium

Smal

Number of Other Youth Serving Organizations

Al

Large

Medium

Number of Homeless Family Service Providers

Smal

Al

ty Size

Large

Medium

Coun

Smal

Number of Homeless Adult Service Providers

Al

Large

Medium

Smal

Number of RHY Service Providers

Al

0

5

10

15

20

Number of Counties

Zero

1 to 5

6 to 10

11 to 15

More than 15

Programs operated by RHY service providers

by age of youth served

Counties were most likely to have a transitional

housing program and least likely to have a host

home program operated by an RHY provider

that completed the survey (see Figure 5.14). In

general, more of the RHY service providers that

completed the survey operated programs for

18- to 25-year-olds than for 13- to 17-year-olds.

Drop-in centers and street outreach programs

were an exception.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Figure 5.14. County-level data on the number of RHY providers by program type and age of youth served

18–25 Year Olds

13–17 Year Olds

Rapid Rehousing

Any

18–25 Year Olds

13–17 Year Olds

Host Homes

Any

18– 25 Year Olds

13– 17 Year Olds

Supportive

Housing

Any

18–25 Year Olds

13–17 Year Olds

Transitional

Housing

Any

18–25 Year Olds

Emergency

13–17 Year Olds

Shelters

Any

18–25 Year Olds

13–17 Year Olds

Street Outreach

Any

18–25 Year Olds

13–17 Year Olds

Drop In Centers

Any

0

5

10

15

20

Zero

One or two

Three or four

Five or more

Programs operated by RHY service providers

and large counties (see Table 5.2). Additional y,

by age of youth served and county size

with a couple of exceptions, fewer counties

had programs operated by an RHY service

Gaps in the array of programs operated by

provider that served 13- to 17-year-olds than had

the RHY service providers that completed the

programs operated by an RHY service provider

survey were most evident in small counties, but

that served 18- to 25-year-olds.

gaps could also be seen in some medium-sized

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Table 5.2. Number of counties with at least one program operated by an RHY service provider by county size and age of youth served

Programs

Small (n=6)*

Medium-sized (n=7)

Large (n=9)

# of counties

# of counties

# of counties

Any

< 18

≥ 18

Any

< 18

≥ 18

Any

< 18

≥ 18

Drop-in Centers

0

0

0

4

3

4

9

9

9

Street Outreach

3

2

3

5

5

5

9

9

9

Emergency Shelters

1

0

1

6

6

4

9

9

8

Transitional Housing

3

1

3

7

6

7

9

7

9

Supportive Housing

3

0

3

5

2

5

9

5

9

Host Home

0

0

0

2

0

2

4

2

3

Rapid Rehousing

0

0

0

4

2

4

7

1

7

* Includes two counties in which no RHY service providers completed the survey.

Funding for RHY programs by county size

Among the RHY service providers that

completed the survey, those in large counties

were more likely to receive Federal, state and/

or local funding than those in smal —and, to

a lesser extent, medium-sized—counties (see

Figure 5.15). Additional y, the RHY service

providers in small counties were also less likely

to receive funding from foundations or individual

donors than those in medium-sized or large

counties.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Figure 5.15. County-level data on RHY service provider funding sources by county size Large

Medium

Smal

Individual Donors

Al

Large

Medium

Foundations

Smal

Al .

Large

Medium

Local Government

Smal

Al

Large

Medium

State Government

Smal

Al.

Large

Medium

Smal

Federal Government

Al

0

5

10

15

20

Zero

One or two

Three or four

Five or more

Programs operated by any type of homeless

service provider by age of youth served

Figure 5.16 shows the availability of programs

that served runaway and homeless youth

operated by the RHY, homeless adult, and

homeless family service providers that

completed the survey at the county level.

Counties were most likely to have emergency

shelters and least likely to have host home

programs that served runaway and homeless

youth. However, in several counties, the

programs operated by the homeless service

providers that completed the survey served 18-

to 25-year-olds but not 13- to 17-year-olds.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Figure 5.16. County-level data on the number of RHY providers by program type

and age of youth served

18–25 Year Olds

13–17 Year Olds

Rapid Rehousing

Any

18–25 Year Olds

13–17 Year Olds

Host Homes

Any

18–25 Year Olds

13–17 Year Olds

Supportive

Any

Housing

18–25 Year Olds

Transitional

13–17 Year Olds

Housing

Any

18–25 Year Olds

Emergency

13-17 Year Olds

Shelters

Any

18–25 Year Olds

13–17 Year Olds

Street Outreach

Any

18–25 Year Olds

13–17 Year Olds

Drop In Centers*

Any

0

5

10

15

20

Zero

One or two

Three or four

Five or more

*Only RHY service providers were asked about drop-in centers and host home programs

*Only RHY service providers were asked about drop-in centers and host home programs Programs operated by any homeless provider

by age of youth served and county size

Most of the gaps in the array of programs

available to runaway and homeless youth from

the homeless service providers that completed

the survey were in small and medium-sized

counties, but gaps in some large counties

were also evident (see Table 5.3). Moreover, in

some counties, the homeless service providers

that completed the survey operated programs

that served 18- to 25-year-olds, but not 13- to

17-year-olds.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Table 5.3. Number of counties with at least one program operated by a homeless service provider by county size and age of youth served

Programs

Small (n=6)*

Medium-sized (n=7)

Large (n=9)

# of counties

# of counties

# of counties

Any

< 18

≥ 18

Any

< 18

≥ 18

Any

< 18

≥ 18

Drop-in Centers*

0

0

0

4

3

4

9

9

9

Street Outreach

4

4

4

6

6

6

9

9

9

Emergency Shelters

6

2

6

7

7

7

9

9

9

Transitional Housing

5

2

5

7

6

7

9

8

9

Supportive Housing

5

1

5

7

4

7

9

8

9

Host Home*

0

0

0

2

0

2

4

2

3

Rapid Rehousing

2

1

2

7

3

7

9

7

9

*Only RHY service providers were asked about drop-in centers and host home programs.

Services for runaway and homeless youth

In most counties, runaway and homeless youth

had access to a wide range of services from

RHY service providers, YSOs, or both (see

Figure 5.17). The three exceptions were legal

assistance, family reunification services, and

storage facilities, which were unavailable in

several counties.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Figure 5.17. County-level data on the availability of services from RHY service providers and YSOs 13

Storage facilities

0

13

18

Family reunification

0

18

16

Legal assistance

13

13

21

Mentoring

20

19

20

Transportation

1819

20

Recreation

18

17

21

Mental/behavioral health

18

# of counties with RHY service providers

20

or YSOs offering service

# of counties with YSOs offering service

21

to RHY

Physical health

19

15

# of counties with RHY service providers

offering service

21

Life skills training

1920

21

Employment

19

19

20

Education

19

17

21

Housing assistance

20

20

21

Case management

20

20

21

Assistance with basic needs

20

19

0

5

10

15

20

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys In small and sometimes medium-sized counties,

these services from YSOs whereas in medium-

some of these services were not available to RHY

sized counties, RHY were more likely to be able

from either RHY service providers or YSOs. In

to access these services from RHY service

large counties, all the services were available to

providers. In large counties, all the services were

RHY; in most cases, they were available through

available to runaway and homeless youth and, in

both RHY service providers and YSOs (see Table

most cases, they were available from both RHY

5.4). In small counties, runaway and homeless

service providers and YSOs.

youth were more likely to be able to access

Table 5.4. County-level data on services available from RHY service providers and YSOs by county size

Number of Counties

Type of Provider Offering Service

RHY Service Providers

YSOs

Either

S

M

L

S

M

L

S

M

L

Assistance with basic needs

3

7

9

5

6

9

5

7

9

Case management

4

7

9

5

6

9

5

7

9

Housing assistance

4

7

9

5

6

9

5

7

9

Education

2

6

9

5

5

9

5

6

9

Employment

3

7

9

5

5

9

5

7

9

Life skil s training

4

7

9

5

5

9

5

7

9

Physical health

1

5

9

6

5

8

6

6

9

Mental/behavioral health

3

7

9

5

5

8

5

7

9

Recreation

2

6

9

4

5

9

5

6

9

Transportation

3

7

9

4

5

9

4

7

9

Mentoring

4

6

9

5

6

9

5

7

9

Legal assistance

0

4

9

2

4

7

2

5

9

Family reunification

3

6

9

-----

-----

-----

3

6

9

Storage facilities

0

4

9

-----

-----

-----

0

4

9

Prevention programs

In 15 counties, at least one RHY provider

operated a prevention program and, in all but two

counties, at least one YSO operated a prevention

program (see Figure 5.18). In two counties—one

small and one medium-size—no RHY service

provider or YSO operated a prevention program.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Figure 5.18. County-level data on prevention services available from RHY service providers and YSOs by county size

20

9

RHY service providers or YSOs offer service

6

5

20

9

YSOs offer service to RHY

6

5

15

9

RHY service providers offer service

5

1

0

5

10

15

20

25

All counties

Large counties

Medium-sized counties

Small counties

Continuum of Care survey results

but are not required to—enter, and seven of

those CoCs reported that the maximum age at

Twenty of the 26 CoCs that responded to the

which youth could enter through their dedicated

survey (including the Wayne County al iance)

access points was 24 years old. Regardless of

reported that they had a CEAS.39,40 Five of those

their age, the two most common ways youth

CoCs reported that their CEAS covered one or

could enter a CEAS were by visiting in-person or

more cities or towns but not an entire county,

by phone (see Figure 5.19).

nine reported that their CEAS covered a single

county, and six reported that their CEAS covered

multiple counties.

Access points

Ten of the CoCs reported that unaccompanied

youth under age 18 could access services

through their CEAS. Five of those CoCs had

dedicated access points for youth under age

18, but four of those five al owed youth to enter

the system through other access points as wel .

Only one CoC reported having a separate CEAS

specifical y for unaccompanied youth under

age 18. Ten CoCs had dedicated access points

through which youth age 18 and older could—

39 One CoC without a CEAS was piloting a system at two locations that would be operational countywide by September 2017.

40 One CoC only used its CEAS for permanent supportive housing.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Figure 5.19. Ways youth enter the CEAS by age

1

Online

2

15

Via telephone

8

Visit one of several

17

locations in person

9

2

Visit single location in person

2

0

2

4

6

8

10

12

14

16

18

Age 18 and Older

Under Age 18

Assessment tools

a VI or triage tool not designed specifical y for

youth to prioritize youth for services. Five used

Eight of the 20 CoCs with a CEAS reported using

the Vulnerability Index – Service Prioritization

a vulnerability index (VI) or triage tool designed

Decision Assistance Tool (VI-SPDAT), three

specifical y for youth (see Figure 5.20). Six used

used a local y developed tool, and one used a

the Transition Age Youth – Vulnerability Index –

tool developed by the National Al iance to End

Service Prioritization Decision Assistance Tool

Homelessness.42 Four reported not using any VI

(TAY-VI-SPDAT), and one used a Transition Age

or triage tool. Table 5.4 shows the use of these

Youth (TAY) triage tool.41 Nine reported using

assessment tools broken down by county size.

Figure 5.20. Use of assessment tools

4

Use a VI or triage tool designed for youth

7

Use a VI or triage tool not designed for youth

9

Does not use either

One CoC that used a VI designed specifical y for

received funding from the Federal Basic Center

youth did not assess youth under age 18 at its

Program. These three agencies also served as

access points. Instead, those youth were referred

access points for youth under age 18.

to one of three RHY service providers that

41 This is a reference to the TAY triage tool developed by Eric Rice. See Rice, Eric, and Angela Rosales. 2015. TAY triage tool pilots report. New York, NY: Corporation for Supportive Housing.

42 One of the CoCs that currently uses the VI-SPDAT will be switching to the TAY VI-SPDAT.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Referrals

providers, eight referred them to providers that

served homeless families, and five referred them

Nine of the 11 CoCs that had a separate CEAS

to both types of service providers. Fifteen of

for youth experiencing homelessness under age

the 20 CoCs that had a CEAS-referred youth

18 or a CEAS through which youth under age

age 18 and older to RHY service providers, and

18 could access services, referred youth under

all 20 referred them to providers that served

age 18 to RHY service providers. Five referred

homeless adults. Nineteen of the 20 CoCs had

them to providers that served homeless adults,

CEAS-referred youth age 18 and older who

and four referred them to both (see Figure 5.21).

were custodial parents to providers that served

Eight of those 11 CoCs referred youth under age

homeless families, and 12 also referred them to

18 who were custodial parents to RHY service

RHY service providers.

Figure 5.21. Where CoCs refer youth for services

20

15

10

5

0

Nonparents < 18

Custodial parents < 18

Nonparents > 18

Custodial parents > 18

RHY service providers

Homeless adult providers

Homeless family providers

Five of 11 CoCs that had a separate CEAS

Engagement

for homeless youth under age 18 or a CEAS

through which those youth could access

Ten CoCs reported that some RHY service

services, reported that services were provided

providers in their county did not participate in

to homeless youth under age 18 at CEAS access

their CEAS. Several of these CoCs indicated that

points (the other 6 did not provide services to

their CEAS for youth was either in development,

youth at their access points). These services

or new and working to engage RHY service

included referrals to shelters, transitional

providers. Two indicated that some RHY service

housing, and other community resources.

providers were not required to participate

Fourteen of the 20 CoCs reported that services

because they do not receive funding from HUD.

were provided to homeless youth age 18 and

One CoC that served a small county noted that

older at CEAS access points. These services

resource limitations prevented their CEAS from

included case management, assistance with

addressing the needs of youth experiencing

basic needs, assistance with employment,

homelessness under age 18, and that prior

and referrals to shelters and other community

efforts to include those youth were unsuccessful,

resources.

in part, because youth were difficult to engage.

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Chapter 5. Homeless Service Provider and Continuum of Care Surveys Discussion

Considering that the VoYC identified at least

5,970 youth experiencing homelessness on a

Key findings

single night across the 22 VoYC partner counties,

and that the RHY service providers surveyed

We undertook the Service Provider Survey to

served 3,636 with shelter or housing programs at

learn more about the landscape of homeless

a given time, this simple comparison suggests an

services across the 22 VoYC partner counties.

approximately 39 percent gap of unmet need at

Our aim was to document the range of programs

a point-in-time. This is an imperfect calculation,

and services available to youth experiencing

as some shelter and housing services for

homelessness as well as gaps in service

youth could be offered by adult and family

provision. More than 500 service providers in

homelessness service providers (contributing

22 counties completed the Service Provider

to smal er gaps), and some youth experiencing

Survey. They included service providers that

homelessness are unlikely to be captured by

targeted runaway and homeless youth as well as

Youth Counts (contributing to larger gaps).

service providers that targeted homeless adults,

Further, a ful supply-and-demand assessment

homeless families, and other youth populations.

should incorporate detailed assessments of the

We collected information about the programs

supply of specific types of shelter and housing

they operated, the age of the youth they served,

services for corresponding needs and eligibility

sources of funding, and the services they

groups. However, even this simple comparison—

provided.

taken together with the high percentages of

Because the VoYC counties had populations that

agencies indicating waitlists and turning youth

ranged in size from just over 15,000 to more than

away—underscores an urgent scenario of large

five mil ion, the survey data could be used to

numbers of youth experiencing homelessness

examine variation by county size in the availability

across the country, and going unsupported by

of programs and services that served runaway

the types of programs and services they need.

and homeless youth. Additional y, using the data

Runaway and homeless youth service providers

we collected about the ages of the youth their

tended to operate more than one type of

programs served, we were able to compare

program, and some operated more than one

the availability of programs that served 13- to

program of a given type. They were most likely to

17-year-olds to the availability of programs that

operate transitional housing and street outreach

served 18- to 25-year-olds. Final y, because the

programs and least likely to operate host home

CoC survey had a 100 percent completion rate,

or rapid rehousing programs. The vast majority of

we have information about use of CEAS with

RHY service providers received funding for those

homeless youth in each of the 22 counties.

programs from multiple sources, but RHY service

Twenty-seven percent of the survey respondents

providers in larger counties received funding

served runaway or homeless youth (that is, RHY

from a wider range of sources, on average, than

service providers), 46 percent served homeless

those in smal er counties.

adults, 43 percent served homeless families,

Far more RHY service providers operated

and 43 percent served other youth populations.

programs that served 18- to 25-year-olds than

Youth were referred to most of the RHY service

13- to 17-year-olds. They also had nearly three

providers by other homeless service providers

times as many shelter beds for 18- to 25-year-

or by other runaway or homeless youth; the

olds as for 13- to 17-year-olds. This disparity

National Runaway Safeline was not a major

was even greater among homeless adult and

referral source.

homeless family service providers. Nearly all

those service providers operated programs that

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

105

Chapter 5. Homeless Service Provider and Continuum of Care Surveys served 18- to 25-year-olds, but most did not

Limitations

operate programs that served 13- to 17-year-

olds.

The primary limitation of the Service Provider

Survey was that the results painted a less than

The results of the brief youth survey that was

complete picture of the programs and services

administered in conjunction with the Youth

available to youth experiencing homelessness

Counts in all 22 VoYC counties shed some

in the 22 VoYC partner counties. Although

light on potential reasons for this disparity.

more than 500 service providers completed

Specifical y, only 13 percent of the youth

the survey, the overall completion rate was 64

experiencing homelessness who completed the

percent. One reason the completion rate was

survey were 13- to 17-year-olds. Even if 13- to

not higher was that, rather than focusing on

17-year-olds were undercounted, these and

only service providers that target runaway and

other data (including the VoYC National Survey

homeless youth, we cast a broad net to include

data) suggest that most youth experiencing

homeless adult service providers, homeless

homelessness are 18 to 25 years old. Thus,

family service providers, and other youth-serving

the disparities we found may largely reflect

organizations. Most of the former completed the

communities’ response to the age distribution

survey because they were aware of, if not directly

of the population. Nevertheless, homeless

involved, in the planning and execution of their

13- to 17-year-olds may still be underserved,

county’s VoYC survey. By contrast, many of the

particularly in smal er counties and other areas

latter types of organizations were neither aware

in which few to no services are available for this

of, nor involved in, the Youth Count planning and

younger population.

execution and might have felt less invested in the

survey.

Runaway and homeless youth service providers

and YSOs offered a range of services to runaway

Several other limitations are also worth noting.

and homeless youth, with some services more

First, despite working with the lead agency in

common than others. Case management, life

each county to compile a comprehensive list

skills training, and assistance with basic needs

of service providers, some service providers—

were among the most common services, with

particularly those that primarily served homeless

legal assistance and storage facilities among the

adults or families—were inadvertently omitted.

limited services. In smal er counties, services for

Second, due to the problem with the skip

runaway and homeless youth were more likely

pattern, service providers that identified runaway

to be offered by YSOs than by RHY service

and homeless youth as a target population were

providers. Nearly one-half of the RHY providers,

not asked about programs they operated for

and one-fourth of the YSOs, offered services to

homeless adults or families that might serve

prevent youth from becoming homeless. Case

homeless youth. Our efforts to gather this

management was the most common preventive

information through a follow-up survey resulted

service they provided.

in a completion rate of only 48 percent. Third, the

survey included a set of questions designed to

Twenty CoCs had administered a CEAS. About

identify RHY service providers whose programs

one-half of those CoCs al ow unaccompanied

targeted special populations, such as pregnant

13- to 17-year-olds to access services through

or parenting youth or youth who identify as

their CEAS, and some had dedicated access

LGBT. A majority of the RHY service providers

points through which those youth could enter.

reported operating programs targeting each of

the special populations about which we asked,

leading us to conclude that those questions may

have been misinterpreted by some (for example,

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

106

Chapter 5. Homeless Service Provider and Continuum of Care Surveys perhaps they understood the question to mean

disproportionate homelessness (for example,

that they did not exclude those populations from

Black or African-American youth, Hispanic youth,

services, rather than to mean that they actively

American Indian or Alaska Native youth, pregnant

targeted those populations for services).

and parenting youth, and LGBTQ youth).

Fourth, due to concerns about the length of the

Second, additional research is needed to better

survey as well as feedback we received when we

understand when and how eligibility criteria,

piloted the survey with some service providers,

time limits, or other restrictions limit the ability

we omitted some questions that, in retrospect,

of service providers to address the needs of

should have been retained. For example, except

runaway and homeless youth. This research

for emergency shelters, we did not ask about

should distinguish between constraints that

the capacity of the programs the RHY service

are self-imposed and those that are imposed

providers operated. Neither did we ask the RHY

by different funding sources, as well as identify

service providers that reported receiving Federal

exclusion criteria that might prevent groups of

funding for their programs about particular

youth from being served (for example, youth with

funding streams (for example, funding from HUD,

serious mental health difficulties or youth with a

U.S. Department of Health and Human Services

criminal record).

(HHS), or another Federal funding source). These

details would have provided useful insights.

Third, our findings suggest that it is common

Final y, conducting an online survey limited the

for RHY service providers to patch together

types of questions we could ask. In particular,

funding from different sources to support their

we did not ask questions about perceived gaps

runaway and homeless youth programs. Future

in service provision or the impact of constraints

studies should gather information about specific

on how certain types of funding can be used

Federal and non-Federal funding streams,

that would require an open-ended response.

including the costs, benefits, and implications

Although these are important questions with both

for sustainability. They should also examine the

policy and practice implications, they require a

capacity of RHY service providers to compete

different methodology.

for, and administer, Federal grants. Capacity

could be particularly limited in smal er, more rural

The results of the Service Provider Survey raise

counties. One-half the RHY service providers

several important questions that should be

in the smal er, more rural counties were not

addressed by future research. Some could be

receiving Federal funds.

best addressed with different methodologies

such as qualitative methods, while others could

Fourth, although we asked RHY service providers

be answered with a more focused online survey

that operated emergency shelters about the

like the one we used.

number of beds they had for 13- to 17-year-olds

and 18- to 25-year-olds, future studies should

First, our findings point to what appear to be

collect data about the number of youth that

gaps in the availability of different types of

housing programs can serve, and whether their

programs and services for youth homelessness.

programs are at capacity (programs include

Eliciting the perspective of youth would enhance

transitional housing, supportive housing, rapid

our understanding of those gaps and how they

rehousing, and host homes). This information

affect specific populations. It would also shed

is critical for understanding the relationship

light on whether the programs and services

between supply (that is, the housing and support

that are available are in areas where youth

capacity of RHY service providers) and demand

experiencing homelessness can access them—

(that is, the number of youth in need of housing

especial y subpopulations of youth that the youth

and support).

counts and national survey components indicate

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

107

Chapter 5. Homeless Service Provider and Continuum of Care Surveys Fifth, our results suggest that most homeless

Choi, Soon Kyu, Bianca D. M. Wilson, Jama Shelton,

adult and homeless family service providers

and Gary Gates. 2015. Serving our youth 2015:

served youth who were at least 18 years old, but

The needs and experiences of lesbian, gay,

relatively few serve youth who were under age

bisexual, transgender, and questioning youth

18. Additional research is needed on the extent

experiencing homelessness. Los Angeles, CA:

to which the homeless adult and family service

The Wil iams Institute and True Colors Fund.

providers that serve homeless youth, address

the developmental needs and generational

Durso, Laura E., and Gary J. Gates. 2012. Serving our

preferences of those youth apart from how other

youth: Findings from a national survey of service

homeless adults and families are treated.

providers working with lesbian, gay, bisexual, and

transgender youth who are homeless or at risk

Final y, although our data provide information

of becoming homeless. Los Angeles, CA: The

about the availability of programs and services

Wil iams Institute with True Colors Fund and the

for youth experiencing homelessness, they offer

Palette Fund.

no evidence as to the effectiveness or quality

of those services and programs. Gathering

Hirsch, Margo, and Jim Bolas. 2010. Connecting

that evidence will require rigorous evaluations,

the pieces: Homeless youth and mental health

and much more than currently exists—as the

services: Finding a fit that works. Brooklyn,

systematic evidence review findings in this report

NY: Empire State Coalition of Youth and Family

underscore.

Services.

Conclusions

Johnson, Timothy P. and Ingrid Graf. 2005.

Unaccompanied homeless youth in Illinois: 2005.

This study, which is based on data collected

Chicago, IL: Survey Research Laboratory at the

from over 500 service providers, offers a

University of Il inois at Chicago.

snapshot of the availability of programs and

U.S. Interagency Council on Homelessness (USICH).

services for youth homelessness in 22 counties.

2013. Framework to end youth homelessness:

Although this snapshot is incomplete, it offers

A resource text for dialogue and action.

the first look at the availability of programs and

Washington, DC: Author.

services for youth homelessness in a diverse set

of communities throughout the United States.

It highlights what appear to be gaps in the

array of programs and services available to the

population, and points to important differences

between more and less populated counties.

Some of the questions these data raise will need

to be addressed by future research. Others

are addressed, at least in part, by other VoYC

research components.

References

Chicago Coalition for the Homeless. 2007. No youth

alone: A campaign to end homelessness: Results

of 2007 survey of unaccompanied homeless

youth service providers. Chicago, IL: Author.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

108

Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care Chapter 6. Analysis of Supplementary

Data: Youth Who Run Away from Out-Of-

Home Care

Highlights

• We undertook an analysis of state child

• The likelihood of exiting their first out-of-

welfare administrative data from 21

home-care spell by running away was

states to understand the prevalence

greater for Black and Hispanic youth

and characteristics of adolescents

than for White youth, for youth in urban

running away from out-of-home care.

core counties than for youth in urban

• Six percent of youth who entered out-of-

collar counties (counties surrounding

home care for the first time when they were

major urban centers) or rural counties,

13 to 17 years old experienced a bridged

for youth in the most socioeconomical y

run (that is, a run lasting less than seven

disadvantaged counties, and for youth

days) during their first out-of-home care

who had experienced more placements.

spel , and 13 percent exited their first out-

• Sixty-three percent of the youth who

of-home care spell by running away.

experienced a bridged run during their

• The likelihood of experiencing a bridged

first out-of-home care spell experienced

run was greater for Black youth than

only one, but the more bridged runs

for White youth, for youth in the most

youth experienced, the more likely they

socioeconomical y disadvantaged counties

were to experience a subsequent bridged

than for youth in counties that were less

run and the more likely they were to exit

socioeconomical y disadvantaged, and for

out-of-home care by running away.

youth who had experienced more placements.

• Sixty-five percent of the youth who exited

• The percentage of youth who exited their first

their first out-of-home care spell by running

out-of-home care spell by running away was

away subsequently reentered. More than

highest for youth whose last placement was

three-fourths of those youth had reentered

congregate care and lowest for youth whose

out-of-home care within two months of exiting.

last placement was a relative foster home.

Background

Although a majority of youth who run away from

out-of-home care are only absent from their

This chapter examines a key aspect of early

placement for a short period of time, some are

homelessness and housing instability—running

gone for a month or more, including some who

away—among a population of youth that is at

never return (Biehal and Wade, 2000; Courtney

especial y high risk for homelessness—those in

et al., 2005; Courtney and Zinn, 2009; Fasulo

foster care. Understanding run away experiences

et al., 2002; Finkelstein et al., 2004; Nesmith,

among this vulnerable population is critical to

2006). These youth may be among the large

addressing a major source of “inflow” into youth

number of youth experiencing homelessness

homelessness.

who report ever having been in an out-of-home

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

109

Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care care placement. For example, 29 percent of the

their lives (Angenent, Balthasar, and Shane, 1991;

youth experiencing homelessness in our BYS

Biehal and Wade, 2002; Courtney et al., 2005;

sample reported that they had ever been in foster

Karam and Robert, 2013), to escape a situation

care (see Chapter 3). Moreover, a few studies

in which they are being victimized or otherwise

have found that running away while in out-of-

feel unsafe (Nesmith, 2006; Downs et al., 2004,

home care is one of the strongest predictors of

pp. 441–472; Courtney et al., 2005; Etheridge

whether youth become homeless after they “age

et al., 2001; Folman, 1998; Shirk and Stangler,

out” (Dworsky et al., 2013). Taken together, this

2004). Additional y, youth run away from out-of-

research suggests that preventing youth from

home care to maintain relationships with family

running away from out-of-home care could make

or friends (Biehal and Wade, 2002; Fasulo et

a substantial dent in the number of youth that

al., 2002; Kerr and Finlay, 2006), which might

experience homelessness. This chapter aims to

explain why the presence of siblings in the same

enhance our understanding of both the number

placement reduces the risk of running away

and characteristics of youth who run away from

(Courtney and Zinn, 2009).

out-of-home care.

Research on the relationship between running

When children are unable to live safely at home

away from out-of-home care and youth

with their families, states typical y place them in

characteristics has consistently found that the

out-of-home care. Out-of-home care placement

likelihood of running away increases with age

options exist along a continuum, ranging from

(Courtney and Zinn, 2009; Nesmith, 2006;

the home of relatives to non-relative foster

Finkelstein, et al., 2004; Witherup et al., 2005)

homes, to congregate care settings including

and is higher for females than for males (English

shelters, group homes, and residential treatment

and English, 1999; Fasulo et al., 2002; Courtney

facilities. Running away is a common experience

and Wong, 1996; Courtney et al., 2005; Courtney

among youth in out-of-home care (Corliss et al.,

and Zinn, 2009; Nesmith, 2006; Day and

2011; Mustanski et al., 2014). Approximately 1

Riebschleger, 2007; Witherup et al., 2005). The

percent of the 427,910 children in out-of-home

relationship between running away and race or

care at the end of 2015 were currently on the

ethnicity is not as clear. Some studies have found

run (HHS, 2016). However, estimates of the

no racial or ethnic differences in the likelihood of

percentage of youth in out-of-home care who

running away from out-of-home care (Fasulo et

ever run away range from a low of 23 percent

al., 2002; Biehal and Wade, 2000; Courtney and

to a high of 71 percent (Biehal and Wade, 2000;

Wong, 1996), whereas others have found that

Courtney and Barth, 1996; Fasulo et al., 2002;

Black and Hispanic youth (Courtney et al., 2005;

Nesmith, 2006). Youth who run away from out-

Courtney and Zinn, 2009; Day and Riebschleger,

of-home care also comprise a non-negligible

2007) or Native American youth (Nesmith, 2006)

percentage of the overall runaway youth

are more likely to run away than youth who are

population. Estimates range from a low of 13

White.

percent to a high of 46 percent (Kurtz, Kurtz, and

Jarvis, 1991; Whitbeck, Hoyt, and Ackley, 1997;

The likelihood of running away is also related

Kennedy, 1991; Lindsey et al., 2000; MacLean,

to several placement history characteristics.

Embry, and Cauce, 1999).

Studies have found that youth in congregate

care are more likely to run away than youth

Youth run away from out-of-home care for

in foster homes (Courtney and Wong, 1996;

several reasons (Clark et al., 2008; Mil er,

Biehal and Wade, 2000; Courtney et al, 2005;

Eggertson-Tacon, and Quigg, 1990; Skyles,

Courtney and Zinn, 2009; Clark et al., 2008;

Smithgal , and Howard, 2007). Youth in out-of-

English and English, 1999; Witherup et al.,

home care might run away to regain control over

2005; Fasulo et al., 2002; Karam and Robert,

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

110

Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care 2013; Eisengart, Martinovich, and Lyons, 2008;

Zinn, 2009; Courtney et al., 2005; Finkelstein

Zimmerman, Abbey, and Nicholas, 1997). There

et al., 2004; Kerr and Finlay, 2006; Mil er,

is also some evidence that youth in kinship

Eggertson-Tacon, and Quigg, 1990; Skyles,

care are more likely to run away than youth in

Smithgal , and Howard, 2007; Zimmerman,

non-relative foster homes (Courtney and Zinn,

Abbey, and Nicholas, 1997), no prior study has

2009). Other research suggests that the more

used administrative data from multiple states to

placement instability youth experience, the

examine how the characteristics of youth and

greater their risk of running away (Courtney and

the counties in which they live are related to their

Barth, 1996; English and English, 1999; Clark

likelihood of running away from out-of-home

et al., 2008; Kashubeck, Pottebaum, and Read,

care.

1994; Courtney and Zinn, 2009). Final y, quality

of care, such as the level of warmth or respect

We undertook an analysis of state child welfare

that caregivers demonstrate, could affect the

administrative data from 21 states across the

likelihood that youth will run away (Biehal and

United States (Alaska, Arizona, California,

Wade, 2000; Finkelstein et al., 2004; Courtney et

Colorado, Connecticut, Georgia, Il inois, Indiana,

al., 2005; Courtney and Zinn, 2009; Angenent,

Missouri, Mississippi, Nebraska, Nevada, New

Balthasar, and Shane, 1991; Nesmith, 2006).

Jersey, New York, Oklahoma, Pennsylvania,

South Carolina, Tennessee, Texas, Virginia,

Research on the relationship between time

and Washington State) to address several key

spent in out-of-home care and the risk of

questions:

running away has yielded mixed results. Some

studies have found that youth are most likely

• What is the likelihood that adolescents who

to run away during the few months after being

enter out-of-home care will run away?

placed (Courtney and Wong, 1996; Fasulo et

• How is the likelihood of running away from

al., 2002; Courtney and Zinn, 2009), but other

out-of-home care related to individual youth

studies have found that the risk of running away

characteristics, county characteristics, and

increases over time (Nesmith, 2006). What does

placement history?

seem clear, however, is that once youth have

run away, their likelihood of running away again

• How is the number of prior runs related to

is high (Angenent, Balthasar, and Shane, 1991;

the likelihood of experiencing a subsequent

Clark et al., 2008; Courtney et al., 2005; Fasulo

run?

et al., 2002; Nesmith, 2006; Kashubeck et al.,

• If youth exit out-of-home care by running

1994), and the likelihood of running increases the

away, how likely are they to reenter, how

more times youth have previously run. Moreover,

soon after running away do they reenter,

although at least some research suggests that

and where are they placed?

a majority of youth who run away from out-of-

home care only stay away from their placement

Methodology

for a short period (Courtney et al., 2005), youth

are sometimes “on run” for a month or more; and

Design

the older youth are when they first run away, the

The data for this analysis came from the

longer they tend to remain away (Courtney and

Multistate Foster Care Data Archive (FCDA), a

Zinn, 2009).

longitudinal database maintained by Chapin

Although researchers have learned much about

Hal ’s Center for State Child Welfare Data.

who runs away from out-of-home care, why they

The FCDA contains placement records for

run away, and what impact running away has on

approximately three mil ion children in 21

their developmental outcomes (Courtney and

states. Those placement records include entry

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

111

Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care dates, dates of placement change, exit dates,

(general y counties surrounding major urban

reasons for exit (including running away), and

centers); and Level 5 and 6 counties were

demographic characteristics (for example,

categorized as rural counties.

age, gender, and race/ethnicity). The data are

integrated at the county-level with a wide range

Socioeconomic disadvantage was measured

of census data, including measures of population

using four county-level indicators: the child

density and socioeconomic disadvantage.

poverty rate, the percentage of adults without a

high school diploma or GED, the percentage of

Sampling

single parent households, and the unemployment

rate. Every county is coded as either better than

The sample for the analysis includes all youth

(indicator = 0) or worse than (indicator = 1) the

who (1) entered out-of-home care for the first

average for the state in which it is located on

time between January 1, 2009, and December

each of the four indicators. The four indicators

31, 2011, and (2) had at least one spell that

are then summed to create an index, the values

began when they were between 13 and 17 years

of which can range from 0 to 4. In this case,

old.43 The observation period was from the time a

higher scores indicate more disadvantage.

youth first entered care until December 31, 2015.

Dependent Measures

Measures

Our dependent measures include bridged runs,

Independent Measures

which occur within an out-of-home care spell

Our independent measures include youth

and last no more than seven days; exit runs,

characteristics, placement history, and county

which last eight days or more and mark the

characteristics. Youth characteristics include

end of an out-of-home care spel ; and reentries

gender (female or male), race/ethnicity (Black,

following an exit run.

White, Hispanic, or other), and age at first

Analytic strategy

entry into out-of-home care. Placement history

characteristics include number of placements

Our analysis is purely descriptive and focuses

during first out-of-home care spel , number of

primarily on bridged runs and exit runs during

out-of-home care spells, and last placement type

the first spell of out-of-home care. We examine

during first out-of-home care spell (foster home,

the bivariate relationship between both types

kinship care, congregate care, or other). County

of runs and several individual- and county-

characteristics include population density and

level characteristics. We also examine reentries

socioeconomic disadvantage.

following an exit run. The results we report do

not control for other factors with which those

Our measure of population density is based

individual- and county-level characteristics might

on the six-level scheme the National Center for

be correlated.

Health Statistics uses to classify U.S. counties

(Ingram and Franco, 2014). The first four levels

Results

are for metropolitan counties (that is, large

central metro, large fringe metro, medium metro,

Sample characteristics

and small metro), and the last two are for non-

metropolitan counties (that is, micropolitan and

More than 55,000 youth between the ages of

non-core). Level 1 counties were categorized as

13 and 17 years old entered a first out-of-home

urban core counties; Level 2, 3, and 4 counties

care spell in the years 2009 through 2011 (see

were categorized as urban collar counties

Table 6.1). White youth comprised 39 percent

43 The analysis was limited to this age group because it is rare for children under age 13 to run away from out-of-home care.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

112

Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care of the sample, Black youth 28 percent, and

or rural (14 percent) county. Eighty-nine percent

Hispanic youth 25 percent. Females (56 percent)

of the youth experienced between one and five

somewhat outnumbered males (44 percent).

placements during their first spell of out-of-home

More youth came from an urban collar county (46

care, and 71 percent experienced only one out-

percent) than from an urban core (33 percent)

of-home care spel .

Table 6.1. Youth characteristics (N=55,082)

#

%

Gender

Female

31,022

56.3

Male

24,058

43.7

Unknown

2

0.0

Race/Ethnicity

Black

15,412

28.0

White

21,465

39.0

Hispanic

13,902

25.2

Other*

4,303

7.8

Age at First Out-of-Home Care Entry

13

10,644

19.3

14

11,741

21.3

15

12,904

23.4

16

12,059

21.9

17

7,734

14.0

Socioeconomic Disadvantage

0

13,003

23.6

1

6,599

12.0

2

7,962

14.5

3

12,135

22.0

4

14,951

27.1

Missing

432

0.8

County Population Density

Rural

7,781

14.1

Urban Collar

25,249

45.8

Urban Core

18,023

32.7

Missing

4,029

7.3

(continued)

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Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care ( Table 6.1. Youth characteristics (N=55,082) continued)

#

%

Number of Placements during First Out-of-Home Care

Spell

1–5 placements

49,195

89.3

6–10 placements

4,460

8.1

11–15 placements

897

1.6

>15 placements

530

1.0

Number of Out-of-Home Care Spells

1

38,916

70.7

2

10,350

18.8

3

3,346

6.1

4 or more

2,470

4.4

*Other includes youth identified as Native American and Asian as well as youth whose race/ethnicity was identified as other or unknown.

Runaway events during the first spell of

four percent of the youth never ran away, three

out-of-home care

percent only experienced a bridged run, 10

percent only experienced an exit run, and two

Figure 6.1 shows the percentage of youth who

percent exited by running away after one or more

experienced a bridged run, an exit run, or both

bridged runs.

during their first out-of-home care spel . Eighty-

Figure 6.1. Types of runaway events experienced by youth during the first out-of-home care spel 10% 2%

3%

84%

No runs

Only bridged runs

Only an exit run

Bridged run(s) and an exit run

Bridged runs during the first spell of out-

of-home care

Sixty-three percent of the youth who experienced

a bridged run experienced only one, 16 percent

experienced two, and 21 percent experienced

three or more (see Figure 6.2).

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

114

Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care Figure 6.2. Number of bridged runs during the first out-of-home care spell

(among youth who experienced at least one bridged run)

Six or more

Five

Four

Three

Two

One

0%

10%

20%

30%

40%

50%

60%

70%

80%

90% 100%

We examined the relationship between the

Gender

likelihood the youth experienced a bridged run

during their first out-of-home care spel , as well

Regardless of gender, the share of youth

as the number of bridged runs they experienced

experiencing a bridged run during the first out-of-

if they experienced at least one, and several

home care spell was approximately six percent

individual- and county-level characteristics.

(see Figure 6.3). Females and males were almost

equally likely to experience six or more bridged

runs if they experienced at least one (eight

percent and seven percent, respectively).

Figure 6.3. Bridged runs during the first out-of-home care spell by gender

7.1%

≥ 6 Bridged Runs (If Any)

8.4%

Males

Females

5.5%

Any Bridged Run

6.0%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Race/ethnicity

youth who experienced at least one bridged

run, 11 percent of Black youth experienced six

Black youth were about twice as likely as White

or more compared with three percent of White

youth to experience a bridged run during their

youth, and five percent of Hispanic youth (see

first out-of-home care spell (eight percent and

Figure 6.4).

four percent, respectively). Additional y, among

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Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care Figure 6.4. Bridged runs during first out-of-home care spell by race/ethnicity

5.3%

≥ 6 Bridged Runs (If Any)

3.3%

10.6%

Hispanic

White

Black

6.6%

Any Bridged Run

4.1%

8.1%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Age at entry into out-of-home care

(see Figure 6.5). However, among youth who

experienced at least one bridged run, age at

The percentage of youth who experienced at

entry was positively related to the likelihood of

least one bridged run during their first out-of-

experiencing six or more.

home-care spell was unrelated to age at entry

Figure 6.5. Bridged runs during first out-of-home care spell by age at entry

11.4%

≥ 6 Bridged Runs (If Any)

8.4%

6.0%

17 years old

4.9%

15–16 years old

Any Bridged Run

6.6%

13–14 years old

5.2%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Number of placements

who had experienced more placement instability

were more likely to experience six or more

The more placements youth experienced during

bridged runs.

their first out-of-home-care spel , the more likely

they were to experience at least one bridged run

(see Figure 6.6). Moreover, among youth who

had experienced at least one bridged run, youth

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Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care Figure 6.6. Bridged runs during first out-of-home care spell by number of placements 45.2%

16.7%

≥ 6 Bridged Runs (If Any)

6.3%

>15 placements

0.0%

11–15 placements

6–10 placements

58.5%

1–5 placements

36.8%

Any Bridged Run

20.3%

3.4%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

County population density

their first out-of-home-care spell ranged from 4

percent to 6 percent (see Figure 6.7). Similarly,

Regardless of whether youth were in urban core,

among youth who experienced at least one, the

urban collar, or rural counties, the percentage

percentage who experienced six or more bridged

who experienced at least one bridged run during

runs ranged from 3 percent to 6 percent.

Figure 6.7. Bridged runs during first out-of-home care spell by county population density 5.8%

≥ 6 Bridged Runs (If Any)

2.8%

Urban Core

3.6%

Urban Col ar

5.7%

Rural

Any Bridged Run

4.0%

3.5%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

County socioeconomic disadvantage

socioeconomical y disadvantaged counties (see

Figure 6.8). However, youth in the second most

Youth in the most socioeconomical y

socioeconomical y disadvantaged counties were

disadvantaged counties were more likely to

the least likely to experience at least one bridged

experience at least one bridged run during their

run and the least likely to experience six or more

first out-of-home-care spell and more likely

bridged runs.

to experience six or more bridged runs if they

experienced at least one than youth in less

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Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care Figure 6.8. Bridged runs during first out-of-home care spell by county socioeconomic disadvantage

13.9%

0.2%

≥ 6 Bridged Runs (If Any)

4.2%

Most Disadvantaged

3.3%

Second Most Disadvantaged

2.4%

Third Most/Least Disadvantaged

10.2%

Second Least Disadvantaged

3.4%

Least Disadvantaged

Any Bridged Run

4.5%

4.7%

4.5%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Figure 6.9. Likelihood of experiencing a subsequent bridged run by number of prior bridged runs Five

75%

Four

74%

Three

67%

Two

57%

One

37%

Number of Bridged Runs

None

6%

0%

20%

40%

60%

80%

100%

Relationship between the number of bridged

Relationship between the number of out-

runs and the likelihood of a subsequent

of-home care spells and the likelihood of a

bridged run.

subsequent bridged run.

The likelihood of experiencing a subsequent

The percentage of youth that ran away during an

bridged run increased from 6 percent of youth

out-of-home care spell increased from 6 percent

with no prior bridged runs to 74 percent of youth

for youth with no prior out-of-home care spells to

with four and 75 percent of youth with five (see

31 percent for youth with 7 or 8 prior spells (see

Figure 6.9).

Figure 6.10).44

44 Twenty-nine percent of the youth experienced more than one spell of out-of-home care.

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118

Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care Figure 6.10. Rates of experiencing a bridged run by number of prior out-of-home care spel s 7 or 8

31%

5 or 6

23%

3 or 4

19%

1 or 2

12%

Number of Prior Spells

0

6%

0%

20%

40%

60%

80%

100%

Exit runs

of youth in urban collar counties and 7 percent

of youth in rural counties. Youth in the most

Ninety-seven percent of the youth had exited

socioeconomical y disadvantaged counties were

out-of-home care by the end of the observation

more likely to exit their first out-of-home-care

period, and 13 percent of those youth exited their

spell by running away than youth in counties that

last placement by running away. We examined

were less socioeconomical y disadvantaged.

the relationship between the likelihood the

youth exited their first out-of-home care spell by

running away and several individual- and county-

level characteristics.

Table 6.2 compares the likelihood of exiting

a first out-of-home care spell by running

away according to different demographic

characteristics. The percentage of youth who

exited their first out-of-home-care spell by

running away was slightly higher for females

(14 percent) than for males (12 percent). Fifteen

percent of Black and Hispanic youth exited

their first out-of-home-care spell by running

away compared with 10 percent of White youth.

Except for youth who first entered out-of-home

care when they were 17 years old, the older

youth were when they first entered out-of-home

care, the more likely they were to exit by running

away. Although county population density did

not vary much with the number of bridged runs

youth experienced, 16 percent of youth in urban

core counties exited their first out-of-home care

spell by running away compared with 11 percent

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Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care Table 6.2. Relationship between exiting a first out-of-home care spell by running away and demographic characteristics

%

Gender

Female

13.8

Male

11.9

Race/Ethnicity

Black

15.3

White

9.5

Hispanic

15.4

Age at First Out-of-Home Care Entry

13

9.0

14

12.2

15

14.8

16

15.4

17

12.6

Socioeconomic Disadvantage

0

13.0

1

11.1

2

10.7

3

11.3

4

16.4

County Population Density

Rural

6.8

Urban Collar

10.9

Urban Core

16.6

Number of placements

The more placements youth experienced during

their first out-of-home care spel , the more likely

they were to exit by running away (see Figure

6.11).

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Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care Figure 6.11. Relationship between exiting a first out-of-home care spell by running away and number of placements

> 15 placements

31%

r of ents

11–15 placements

28%

be em

6–10 placements

23%

Num Plac

1–5 placements

12%

0%

20%

40%

60%

80%

100%

Last placement type

Nineteen percent of youth whose last placement

was congregate care exited their first spell of

out-of-home care by running away compared

with 13 percent of youth whose last placement

was a foster home and 6 percent of youth whose

last placement was kinship care (see Figure

6.12).

Figure 6.12. Relationship between exiting a first out-of-home care spell

by running away and last placement type

Other

7%

t Type

Kinship Care

en

6%

Foster Home

13%

Last Placem

Congregate Care

19%

0%

20%

40%

60%

80%

100%

Number of bridged runs

Except for the youth who experienced 16 or

more bridged runs, the more bridged runs youth

experienced during their first out-of-home care

spel , the more likely they were to exit by running

away (see Figure 6.13).

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Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care Figure 6.13. Relationship between exiting a first out-of-home care

spell by running away and the number of bridged runs

>15 runs

45%

11–15 runs

66%

6–10 runs

55%

1–5 runs

46%

Number of Bridged Runs

No runs

11%

0%

20%

40%

60%

80%

100%

Re-entries into out-of-home care after exiting

percent of the 4,652 youth who reentered did so

by running away.

within one month of exiting, and 77 percent had

reentered within two months (see Figure 6.14).

Sixty-five percent (n=4,652) of the 7,145 youth

Only 10 percent of the youth who reentered did

who exited their first out-of-home care spell by

so six or more months after exiting.

running away subsequently reentered. Forty-six

Figure 6.14. Number of months between exiting a first

out-of-home care spell by running away and reentering

12 months or more

3%

6–11 months

7%

onths

3–5 months

13%

r of Mbe

1–2 months

31%

Num

Less than 1 month

46%

0%

20%

40%

60%

80%

100%

Sixty-four percent of those 4,652 youth were

placed in congregate care when they reentered

compared with 33 percent who were placed in

a non-relative or kinship foster home (see Figure

6.15).

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Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care Figure 6.15. Types of runaway events experienced

by youth during the first out-of-home care spel

10% 3%

23%

64%

Congregate Care

Foster Home

Kinship Care

Other

urban collar or rural counties. Youth in the most

Discussion

socioeconomical y disadvantaged counties were

more likely to exit their first out-of-home-care

Key findings

spell by running away than youth in counties that

were less socioeconomical y disadvantaged.

We analyzed the placement records of 55,082

Additional y, youth who experienced more

youth from 21 states who entered out-of-home

placements and youth whose last placement

care for the first time when they were 13 to 17

was congregate care, were more likely to exit

years old. Sixteen percent of those youth ran

their first out-of-home care by running away than

away at least once during their first spell of out-

youth who experienced fewer placements and

of-home care. Six percent experienced a bridged

youth whose last placement was kinship care.

run (that is, a run lasting no more than seven

days), and 13 percent exited out-of-home care

One of the best predictors of whether youth

by running away.

will run away is whether they have previously

run. Although 63 percent of the youth who

During their first out-of-home-care spel ,

experienced a bridged run during their first out-

Black youth were more likely to experience a

of-home care spell experienced only one, the

bridged run than White youth. Youth in the most

more bridged runs youth experienced during

socioeconomical y disadvantaged counties

their first spell of out-of-home care, the more

were more likely to experience a bridged

likely they were to experience a subsequent

run than youth in counties that were less

bridged run. As a result, the more likely they

socioeconomical y disadvantaged. Our analysis

were to exit out-of-home care by running away.

concluded that youth who experienced more

Final y, 65 percent of the youth who exited their

placements were more likely to experience a

first out-of-home care spell by running away

bridged run than youth who experienced fewer

subsequently reentered. More than three-fourths

placements.

of those youth had reentered out-of-home care

Black and Hispanic youth were more likely to

within two months of exiting.

exit their first out-of-home-care spell by running

Comparisons between our findings and the

away than White youth. Youth in urban core

results of prior studies are problematic due to

counties were more likely to exit their first out-of-

differences in the type of data that were used,

home-care spell by running away than youth in

the jurisdictions covered, the characteristics of

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123

Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care the sample, and the way runaway events were

were the most likely to exit out-of-home care by

defined. That said, some of the differences and

running away. Likewise, prior research indicates

similarities between our results and the results of

that youth in congregate care are more likely to

prior studies are worth noting.

run away than youth in foster homes (Biehal and

Wade, 2000; Courtney and Zinn, 2009; Clark et

Sixteen percent of the 13- to 17-year-olds

al., 2008; English and English, 1999; Witherup

who entered a first spell of out-of-home

et al., 2005; Fasulo et al., 2002; Karam and

care experienced a runaway event. This is

Robert, 2013; Eisengart, Martinovich, and Lyons.,

considerably lower than the percentage of foster

2008; Zimmerman, Abbey, and Nicholas, 1997).

youth who run away that prior studies have

Second, more than three-fourths of the youth

reported. Those studies suggest that between

who reentered out-of-home care after exiting

23 percent and 71 percent of youth in out-of-

their first out-of-home care spell by running away,

home care have run away (Biehal and Wade,

began their second out-of-home care spell within

2000; Courtney and Barth, 1996; Fasulo et al.,

2 months of exiting. This is consistent with the

2002; Nesmith, 2006). Contrary to prior studies

results of Courtney et al. (2005) who found that

(Biehal and Wade, 2000; Courtney and Wong,

a majority of youth who run away from out-of-

1996; Courtney et al., 2005; Courtney and Zinn,

home care are not absent from their placement

2009; Day and Riebschleger, 2007; English and

for very long.

English, 1999; Fasulo et al., 2002; Finkelstein et

al., 2004; Nesmith, 2006; Witherup et al., 2005),

Our findings suggest several areas that

we found no significant gender difference in

are ripe for future research. One is the

the percentage of youth who ran away, and no

connections among some of the differences

consistent relationship between running away

we observed. We found that Black youth, youth

and age (Witherup et al., 2005).

in urban core counties, and youth in the most

socioeconomical y disadvantaged counties,

In other respects, our findings were consistent

were more likely to run away than White

with the results of prior research. Like some

youth. Likewise, youth in urban collar or rural

other studies, Black youth were more likely to run

counties, and youth in less socioeconomical y

away than White youth (Courtney et al., 2005;

disadvantaged counties were more likely to run

Courtney and Zinn, 2009; Day and Riebschleger,

away than White youth. Because race, population

2007).45 Additional y, the more placements youth

density, and socioeconomic disadvantage are

experienced, the more likely they were to run

likely to be highly correlated, disentangling their

away (Courtney and Barth, 1996; English and

independent effects would require a multivariate,

English, 1999; Clark et al., 2008; Kashubeck,

multilevel approach that incorporates both youth

Pottebaum, and Read, 1994; Courtney and Zinn,

and county-level factors.

2009). Additional y, the more times youth ran

away, the more likely they were to experience

Another area that would benefit from additional

a subsequent run (Angenent, Balthasar, and

study is the relationship between running away

Shane, 1991; Clark et al., 2008; Courtney et

and placement instability. Consistent with the

al., 2005; Fasulo et al., 2002; Nesmith, 2006;

results of several prior studies, we found that the

Kashubeck, Pottebaum, and Read, 1994).

more placements youth experienced, the more

likely they were to run away while in out-of-home

Two of our other findings are also consistent with

care. What is not clear from our analysis is the

what previous studies have reported. First, youth

direction of that relationship. Youth may be more

whose last placement was congregate care

45 Although some prior studies have found that Hispanic youth are more likely than White youth to run away (Courtney et al., 2005; Courtney and Zinn, 2009; Day and Riebschleger, 2007), our results for Hispanic youth were mixed. Hispanic youth were more likely than White youth to exit out-of-home care by running away, but no more likely than White youth to experience a run lasting 7 days or less.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

124

Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care likely to run away after experiencing a placement

complicated by differences in policies, practices,

change. Alternatively, youth may be more likely to

and child welfare populations, and examining

change placements after running away. It is also

those differences requires multilevel models that

possible that both are true. Understanding this

take those other differences into account.

relationship wil require more research.

Final y, additional research is needed to better

More research is also needed to better

understand the reasons youth in out-of-home

understand the relationship between running

care run away or what happens to them

away and placement type. Consistent with the

while they are on run. That is best done using

prior research indicating that youth in congregate

qualitative methods that al ow youth who run

care are more likely to run away than youth in

away to tell their stories in their own words. The

foster homes, we found that youth were more

in-depth interview (IDI) component in this report

likely to exit by running away from congregate

may shed some light on both.

care than from any other placement type. Future

studies should examine whether this relationship

Limitations

can be explained by the characteristics of

There were two major advantages to using

the youth who are placed in congregate care

Chapin Hal ’s FCDA administrative data.

(for example, youth with mental or behavioral

First, because the FCDA maintains data from

health problems). Moreover, our analysis of this

21 states, our sample was both large and

relationship was limited to the last placement. We

geographically diverse. Second, integration of

did not examine the relationship between running

the placement records with county-level census

away and placement type at other points during

data al owed for us to look at how running away

an out-of-home care spel . Because placement

was related to county population density and

types can change while youth are in out-of-home

socioeconomic disadvantage.

care, this would require an approach that can

incorporate time-varying covariates.

One limitation of our analysis is that the FCDA

data contain only limited information about the

Because the primary focus of our analysis was

demographics or other characteristics of the

on the first spell of out-of-home care, we did

youth. Most notably, the data do not include

not examine the relationship between running

information about factors such as sexual

away during a first spell of out-of-home care

orientation, education, or mental and behavioral

and running away during subsequent spells. Nor

health problems that might be associated

did we examine either the trajectories of youth

with running away. A second limitation is that

who reentered out-of-home care after exiting by

our analysis was purely descriptive. We only

running away beyond their initial post-reentry

analyzed bivariate relationships. Final y, our

placement, or how the risk of running away

analysis did not examine either the reasons youth

varies over time. However, all of these could be

in out-of-home care run away or what happens

examined using the Foster Care Data Archive

to them while they are on run.

(FCDA) data with additional time and resources.

Conclusions

Additional y, our analysis did not look at whether

there are differences across states (or between

Youth who run away from out-of-home care

counties within states) in the percentage of youth

face the same risks as their peers who run away

who run away during their first out-of-home care

from home. These include victimization and

or the percentage of youth who exit their first

sexual exploitation, physical and mental health

out-of-home care spell by running away. Between

problems (for example, sexual y-transmitted

state (and between county) comparisons are

diseases, malnutrition, substance abuse), and

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

125

Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care juvenile or criminal justice system involvement

Biehal, Nina, and Jim Wade. 2002. Children who go

(Biehal and Wade, 1999; DOJ, 2002; Courtney

missing: Research, policy and practice. York, UK:

et al., 2005; Nesmith, 2006; Hyde, 2005; Clark

Social Work Research and Development Unit –

et al., 2008; Farrow et al., 1992; Finkelstein et

University of York.

al., 2014). Running away can also have negative

impacts on emotional and social development

Choca, Miryam J., Jedediah Minoff, Lyn Angene,

(Farrow et al., 1992; Biehal and Wade, 2000;

Michele Byrnes, Lois Kenneal y, DeWayne Norris,

Skyles et al., 2007; Courtney et al., 2005), as well

Deanne Pearn, and Marina M. Rivers. 2004.

as the disruptive effects on education (Skyles,

“Can’t do it alone: Housing col aborations to

Smithgal , and Howard, 2007), the development

improve foster youth outcomes,” Child Welfare 83

of life skills needed to become self-sufficient

(5): 469–492.

(Shirk and Stangler, 2004), and the formation

Clark, Hewitt B., and Kimberly Crosland. 2009.

of relationships with caring adults and social

“Social and life skil s development: Preparing and

support networks (Choca et al., 2004; Clark and

facilitating youth for transition into young adult

Crosland, 2009; Iglehart, 1994; Nesmith, 2006).

roles.” In Benjamin Kerman, Madelyn Freundlich,

Preventing these adverse outcomes requires

and Anthony Maluccio (Eds.), Achieving

a better understanding of the reasons youth in

permanence for older children and youth in foster

out-of-home care go “on run” as well as the risk

care. New York, NY: Columbia University Press.

and protective factors associated with running

Clark, Hewitt B., Kimberly Crosland, David Gel er,

away. Equal y important, if we want to mitigate

Michael Cripe, Terresa Kenney, Bryon Neff, and

any negative effects once youth return to their

Glenn Dunlap. 2008. “A functional approach

placement or reenter out-of-home care, it is best

to reducing runaway behavior and stabilizing

to understand what happens while they are “on

placements for adolescents in foster care,”

run.” Although this descriptive analysis of child

Research on Social Work Practice 18 (5): 429–

welfare administrative data addressed several

441.

critical questions about running away from out-

of-home care, developing effective prevention

Corliss, Heather L., Carol S. Goodenow, Lauren

and intervention strategies will require additional

Nichols, and S. Bryn Austin. 2011. “High burden

quantitative and qualitative research.

of homelessness among sexual-minority

adolescents: findings from a representative

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urban–rural classification scheme for counties,”

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Eisengart, Julie, Zoran Martinovich, and John S.

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from residential treatment: Youth and setting

Karam, Rana, and Marie Robert. 2013.

effects,” Residential Treatment for Children Youth

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Kashubeck, Susan, Sheila M. Pottebaum, and Nancy

O. Read. 1994. “Predicting elopement from

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Farrow, James A., Robert W. Deisher, Richard

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resources,” Child and Adolescent Social Work

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victimization,” Journal of Community Psychology

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Convention of the Association for Behavior

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Zimmerman, D. Patrick, Ashley A. Abbey, and Karen

B. Nicholas. 1997. “Predicting runaways upon

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data from the Youth Risk Behavior Survey, 2005

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Chapter 7. Systematic Evidence Review

Chapter 7. Systematic Evidence Review

Highlights

• This study represents the most systematic

example, street outreach, transitional living

and comprehensive review of evidence on

programs, youth shelters, host homes, and

the effectiveness of interventions to prevent

rapid rehousing). Evaluative evidence is further

and address youth homelessness to-date.

lacking on how the effects of interventions

• The growing research base on interventions

vary by different subpopulations. We also

to prevent and address youth homelessness

lack evidence on interventions designed to

offers evidence that interventions can and

improve education and employment outcomes

do have positive effects on a range of

among youth experiencing homelessness.

youth outcomes. A small number of studies

• The largest evidence base on the

demonstrated reductions in occurrence

effectiveness of interventions relates to

of youth homelessness and housing

counseling and treatment interventions

instability, including discussion of some

to address mental health and/or health

intensive interventions that did not involve

risk behaviors. Overal , these types of

direct housing assistance components.

interventions showed promising results, but

• Typical y, the effects of many evaluated

retention was often difficult, and few studies

interventions are modest and varied, and

included long-term follow-up assessments

low retention rates often further diminish the

based on rigorous evaluation designs.

potential for these interventions to impact

• The evidence on family interventions

youth homelessness at the population level.

was promising but mixed, and most

• We lack rigorous evaluative evidence of

evaluations did not measure outcomes

many of the program models on which

related to housing stability.

communities and the Federal Government

rely to address youth homelessness (for

Background

a few important reasons. First, non-systematic

research syntheses (such as more traditional

The purpose of a systematic review is to use

literature reviews) are more susceptible to

transparent and replicable methods to sum

intended or unintended researcher biases and

up the best available research on a specific

errors in finding evidence, selecting which

question. This is done by synthesizing the results

studies to include, and analyzing and reporting

of several studies. In the case of Voices of Youth

information. By establishing an advance protocol

Count (VoYC), our review question was, “What is

and following pre-established inclusion criteria

the evidence on the effectiveness of programs

and systematic processes, such decisions

and practices to prevent youth homelessness

in systematic reviews are more transparent.

and to improve a range of outcomes among

Second, systematic review methods are

youth experiencing homelessness?”

replicable. Not only is this important for public

accountability, but it also provides future

A systematic review approach was taken to

opportunities for Chapin Hall or other research

synthesizing the existing evidence on programs

groups to update the review and include

and practices to address youth homelessness for

new studies. Third, using multiple sources, a

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129

Chapter 7. Systematic Evidence Review

systematic review involves an intensive search

discuss later, we clearly identify which evidence

process for both published and unpublished

comes from higher- and lower-rigor designs,

studies. As such, for the research question

and advise caution in drawing conclusions from

asked, it provides a thorough representation

findings based on lower-rigor effectiveness

of the state of the evidence. Consequently, it

studies.

provides a vital starting point for understanding

the existing evidence base on interventions to

Previous reviews

prevent or address youth homelessness, as well

This is not the first review of evidence on

as for understanding critical knowledge gaps that

interventions addressing youth homelessness.

warrant investment in research and evaluation.

Table 7.1 outlines previous relevant reviews

The research question crafted for the systematic

identified through a preliminary literature search

review is broader in scope than those driving

and their key parameters. Eight previous reviews

many systematic reviews. Typical y, systematic

could be considered systematic reviews in that

review questions specify the population,

they established and followed prospective search

intervention, outcome, and comparison of

and screening processes and inclusion criteria.

focus. These parameters help to keep reviews

Only one, published as Cochrane or Campbell

more manageable to conduct, and they are

Collaboration reviews (leading publishers of

more conducive to using statistical meta-

methodological y rigorous systematic reviews),

analysis in the synthesis process, which requires

and none restricted their research wholly to

comparable interventions, study designs, and

setting inclusion-exclusion criteria for every

outcomes in order to combine effects. Our

aspect of a PICO-style (population, intervention,

research question, on the other hand, does not

comparator, and outcome) question. Most

limit itself to a specific intervention or outcome,

reviews either did not exclude studies based on

and it al ows for a broad range of impact study

intervention or outcome types, nor did they al ow

designs.

for a broad range of possibilities.

The VoYC team chose this systematic review

Three of the reviews that could be considered

approach based on stakeholder input and

systematic were published in 2016 or 2017

the team’s charge to thoroughly document

(Pergamit et al., 2016; Vojt et al., 2016;

the evidence for interventions by addressing

Watters and O’Cal aghan, 2016). One of them

a range of outcomes for youth experiencing

focused on low- and middle-income countries

homelessness. This increases the relevance

(Watters and O’Cal aghan, 2016); another

of the review to a broader spectrum of policy

reviewed randomized controlled trials (RCTs)

institutions and public systems that can play

of interventions for mental health outcomes

different roles in the complex chal enge of

among vulnerable groups, of which homeless

addressing youth homelessness. The VoYC

youth were one (Vojt et al., 2016); and the third

In-depth Interview findings in this report

focused on family interventions for runaway and

further underscored the need for different

homeless youth or youth at risk of homelessness

intervention options, addressing a broad set of

(Pergamit et al., 2016). The present review fills

outcomes to help youth avoid or sustainably exit

gaps remaining from these recent reviews by

homelessness (see Chapter 4). Further, given

focusing on Organization for Economic Co-

the very limited research and evaluation related

operation and Development (OECD) country

to youth homelessness to-date, we felt it was

contexts, which are generally higher-income, and

important to include a range of study designs,

by expanding inclusion beyond mental health or

including lower-rigor types of evaluation designs,

family interventions and RCT study designs.

to capture a full evidence base. However, as we

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Chapter 7. Systematic Evidence Review

Despite these existing reviews, the present

experiencing homelessness, including some

review is important for two main reasons. First,

overlap of search years with the Dettlaff et al.

it updates the Altena et al. (2010) and Dettlaff et

review. We anticipate that this overlap will help us

al. (2017) reviews. The Campbell Collaboration

to capture relevant studies that might have been

advises that systematic reviews be updated

missed by the Dettlaff et al. review. In addition,

at least every 3 years. The search strategy

our review will include interventions that were

conducted by Altena et al. encompassed

excluded by the Altena et al. and Dettlaff et al.

studies from 1985–2008, whereas Dettlaff et al.

reviews. Exclusions included those interventions

conducted their search strategy in February 2014

at schools focused on sexual health and other

(although they did not report the actual years

prevention interventions.

searched). Second, the present review captures

and synthesizes evidence from the past 8 years.

Despite its relative comprehensiveness, the

Although the present review will include evidence

review still had important intentional omissions

from trials dating back to 1985 (the starting point

to keep the endeavor reasonably focused

for Altena et al.), it will avoid duplicating their

and manageable. For example, it did not

work by extracting included studies identified

synthesize evidence on interventions that

through that review and starting an updated

addressed probable risk or protective factors

search strategy from 2008. Unlike Dettlaff et

for homelessness alone. The study must have

al., our review aims to include both current

either tested effects directly on preventing youth

and past prevention interventions with youth

homelessness or on other outcomes among

youth currently experiencing homelessness.

Table 7.1. Previous evidence reviews of interventions for homeless and unstably housed youth Search

Review

Population

Intervention(s)

Outcome(s)

Study type(s)

timeframe

Systematic reviews

Any—except

excluded

interventions

Impact evaluations

including family

(including RCTs,

Runaway and homeless

(Altena et al.,

therapy, focusing

control ed quasi-

youth (ages 10–24) in

Broad range

1985 – 2008

2010)

on sexual health,

experimental trials,

any context

residential service

and pre-post

evaluations, or that

uncontrolled trials)

were applied in

schools

Impact evaluations

Broad range

(including RCTs

(Inclusion and

and rigorous

Street-connected

reintegration

quasi-experimental

(Coren et al.,

Inception –

children and youth (ages Any

(primary outcomes); designs); process

2013)

2012

0–24) in any context

wide range

evaluations

of secondary

examined if linked

outcomes)

to included impact

evaluations

(continued)

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Chapter 7. Systematic Evidence Review

Table 7.1. Previous evidence reviews of interventions for homeless and unstably housed youth (continued) Search

Review

Population

Intervention(s)

Outcome(s)

Study type(s)

timeframe

Stable housing,

permanent

Any studies that

Currently homeless

Unreported

(Dettlaff et al.,

connections,

tested interventions

unaccompanied youth,

Any

start date to

2017)

education,

used with homeless

through age 24

2014

employment, and

youth

wel being

Interventions to

modify sexual

Sexual risk

(Naranbhai et Runaway and homeless

Impact evaluations

Inception –

risk behaviors for

behaviors; HIV

al., 2011)

youth in any context

(including RCTs)

2010

preventing HIV in

infection

homeless youth

Runaway and homeless

Broad range (youth

youth or youth at-risk

Any interventions

homelessness; risk

No study design

(Pergamit et

of homelessness in

involving family

factors associated

inclusion criteria

2000 – 2016

al., 2016)

Australia, Canada, the

members

with youth

given

UK, or the U.S. (ages

homelessness)

12–24)

Vulnerable youth (ages

(Vojt et al.,

10–24) in all contexts—

Systematic reviews

Any

Mental health

2005 – 2016

2016)

homeless youth were a

and RCTs

subgroup

Broad range

Impact evaluations

Street-connected

Psychosocial or

(psychological

(including RCTs,

(Watters and

children in low/middle-

mental health

distress,

control ed quasi-

Inception –

O’Callaghan,

income countries

treatment or

psychosocial

experimental trials,

2015

2016)

(specific age restrictions intervention outside

outcomes, overall

and pre-post

not given)

of the home

general wel being)

uncontrolled trials)

U.S. homeless and foster

Not explicit but

(Zlotnick,

children (both family

primarily focused

Tam, and

Any

Unclear

1993 – 2009

and unaccompanied

on psychosocial

Zerger, 2012)

homelessness)

outcomes

Other types of reviews

Systematic reviews,

Youth who are

(Barker et al.,

RCTs, qualitative or

homeless or at risk of

Broad range

Broad range

Unreported

2012)

descriptive studies

homelessness

of outcomes

Broad range

Broad range

(community-based

(problem behaviors,

service interventions homelessness,

No study design

(Slesnick et

Runaway and homeless

(those offered by

medical and mental

inclusion criteria

Unreported

al., 2009)

youth (ages 12–24)

shelters and drop-

health problems

given

in centers) and

of youth and their

add-on treatment

families)

interventions)

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Chapter 7. Systematic Evidence Review

Methodology

population can be readily discerned from the

study.

Criteria for considering studies for this

review

Studies must have been conducted with

participants in Organisation for Economic Co-

In accordance with international standards for

operation and Development (OECD) countries.46

systematic reviews, we published our review

Youth homelessness is a significant problem

protocol online in advance of getting started

in low- and middle-income countries where

(Kugley et al., 2017). To be eligible for this

the population considered by this review is

evidence synthesis, a study must have evaluated

more typical y described as “street children” or

the effects of interventions targeting youth

“children and adolescents in street situations”

experiencing homelessness or have evaluated an

(Woan, Lin, and Auerswald, 2013; Watters

intervention that includes youth homelessness

and O’Cal aghan, 2016). This review, however,

as an outcome. Notably, process evaluations

excluded non-OECD populations (primarily those

of programs to prevent or address youth

in low- and middle-income countries) because,

homelessness were also included, but these

as Watters and O’Cal aghan (2016) have argued,

were set aside for a different type of qualitative

“implementation of non-culturally relevant

synthesis to take place at a later time. The

services from high-income countries in [low- and

current review focuses on synthesizing evidence

middle-income countries] may be inappropriate

from impact evaluations.

and unsuccessful in resource limited settings.”

This review assumes that cultural, institutional,

The PICO-style questions framing this review

and resource differences between OECD

are the following: what are the effects of any

countries and low- and middle-income countries

interventions on preventing homelessness

are significant enough that distinct reviews are

among youth ages 13–25, and what are the

warranted to cater to these different contexts for

effects of any interventions that targeted youth

this subject matter.

ages 13–25 experiencing homelessness on

any outcomes, compared to the absence of

Types of interventions: Any interventions

intervention or to alternative interventions? The

that targeted the study population (see earlier

elements of the PICO-style question are further

discussion) and for which evaluation designs

elaborated in the following points.

were included (see following) were eligible for

inclusion in this review. In addition, studies

Types of participants (population): Studies

of interventions that reported one or more

must have explicitly targeted youth, ages 13

outcomes related to homelessness among youth

to 25, who have experienced or are at risk

were eligible.

of experiencing homelessness. Alternatively,

studies could have disaggregated results so

Types of comparisons: Studies could have

that intervention effects on this population’s

involved service-as-usual or alternative

outcomes could be discerned. Studies were

intervention comparisons. Service-as-

excluded if fewer than 75 percent of study

usual means that the youth assigned to

participants were youth ages 13 to 25, or if

the control group were not offered any

the mean age reported was outside of this

additional intervention over and above what

age range, unless results were disaggregated

they could normal y access. (Note that it is

such that intervention effects for this review’s

general y impractical and unethical with social

interventions to enforce pure control conditions

46 OECD countries currently include Australia, Austria, Belgium, Canada, Chile, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ice-land, Ireland, Israel, Italy, Japan, Korea, Latvia, Luxembourg, Mexico, Netherlands, New Zealand, Norway, Poland, Portugal, Slovak Republic, Slovenia, Spain, Sweden, Switzerland, Turkey, United Kingdom, and United States.

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Chapter 7. Systematic Evidence Review

in which youth may receive no services

results. Because of this concern, we clearly

or supports at al .) Alternative intervention

delineate evidence according to types of study

comparison means that youth were assigned

designs and include appropriate cautions with

to two or more intervention groups to compare

interpreting results from low-rigor study designs

effects between different intervention options or

in the synthesis.

combinations.

Search methods

Types of outcome measures: This review

did not exclude studies based on outcomes

The search strategy was executed in January

measured. A range of outcomes at the individual

2018 and included published and unpublished

youth level were included, such as those related

literature from 2008 to 2018. By starting with

to the four core outcome areas of the U.S.

studies from 2008, the review commenced

Interagency Council on Homelessness (USICH)

where previous search strategies ended. Thus,

Framework to End Youth Homelessness:

it constitutes an update to their largely similar

stable housing, permanent connections,

systematic review. Any relevant primary studies

social-emotional wel being, and education or

prior to 2008 were drawn from the Altena et

employment (USICH, 2013).

al. review and any other relevant previous

review. The review did not place any language

Types of study designs: To be included

restrictions on the eligibility of documents;

in the synthesis of evidence on intervention

however, the search of published literature was

effectiveness, studies must have used an

executed in English.

experimental or quasi-experimental evaluation

design with a valid comparison group in the

The search strategy was developed using

following definition—

guidance for search strategy development

provided by Cochrane Collaboration’s Effective

a. randomized control trials.

Practice and Organisation of Care (EPOC) Group

(EPOC, 2015). This review’s search terms were

b. regression discontinuity designs.

derived from those used by previous relevant

c. quasi-experimental, cross-sectional,

reviews, with augmentation to ensure we did

cohort, or panel designs that use multiple

not exclude relevant studies. This review used

regression analysis and control for some

a combination of terms in searching electronic

combination of pre-intervention control

databases and research registers. Table 7.2

variables.

shows the search terms used, although in some

cases we used slight deviations in a given

d. matched control group designs (with or

database.

without baseline measurement).

e. unmatched control pre- and post-test

designs.

f. time-series designs (with at least 25 pre-

and 25 post-intervention observations.

We recognize that including a wide range of

quasi-experimental study designs—particularly

pre-post designs that use the baseline as

the studies’ basis for comparison—may lead

to an increased risk of synthesizing biased

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Chapter 7. Systematic Evidence Review

Table 7.2. Review search terms for abstract, title, and keyword fields

Category

Search terms

Population

homeless ADJ youth$ OR homeless ADJ adolescen$ OR homeless

ADJ teen$ OR homeless ADJ student OR homeless AND pediatric$ OR

homeless and paediatric$ OR street ADJ youth$ OR street-involved ADJ

youth OR street-connected ADJ youth OR runaway$ OR throwaways OR

throwaway ADJ youth$ OR unstably ADJ-housed ADJ youth$ OR unstably

ADJ-housed ADJ adolescents unstably ADJ-housed ADJ student OR

youth$ ADJ1 shelter$ OR unaccompanied ADJ youth$ OR unaccompanied

ADJ adolescents OR unaccompanied ADJ teen$ OR houseless ADJ youth

OR houseless ADJ adolescen$ OR houseless ADJ teen$ OR couch-surf$

ADJ youth$ OR couch-surf$ ADJ adolescen$ OR couch-surf$ ADJ teen$

OR doubled-up ADJ youth$ OR doubled-up ADJ adolescen$ OR doubled-

up ADJ teen$

AND

Intervention

program$ OR intervention$ OR service$ OR treatment$ OR therap$ OR

activit$ OR outreach

AND

Comparator

(None)

AND

Outcome

(None)

AND

Study design

evaluation$ OR trial$ OR impact ADJ study OR outcome ADJ study

OR process ADJ study OR implementation ADJ study OR impact ADJ

assessment OR outcome$ ADJ assessment OR process ADJ assessment

OR implementation ADJ assessment OR effectiveness OR efficacy OR RCT

OR $-RCT

Note: “$” after the search term instructs the database to search for anything with the stem of the search term—for example, teen$ to retrieve teen, teens, teenagers, etc.

To maximize sensitivity, no methodological filters

Library (CENTRAL), ERIC (Institute of Education

were used, but study design terms were included

Sciences), and Medline (PubMed). Additional

in the search strategy. Search locations included

electronic searches were run in Google and

electronic databases, relevant websites, and

Google Scholar.

professional outreach.

Websites: Multiple web-based publication

Electronic databases: The investigators

databases specific to youth and family services

searched the following major electronic

were searched with varying search strategies

databases for this review: STM Source (EBSCO),

depending on the confines of each database.

Education Research Complete (EBSCO),

These included the California Evidence Based

Business Source Complete (EBSCO), LGBT Life

Clearinghouse, Out-of-School Time Program

(EBSCO), OmniFile (EBSCO), Academic Search

Research & Evaluation Database (Harvard

Complete (EBSCO), CINAHL (EBSCO), Cochrane

Family Research Project), Innovation Center,

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Chapter 7. Systematic Evidence Review

National Clearinghouse on Families & Youth

of the screening criteria. If the abstract was

(U.S. Administration of Children & Families),

not initial y rejected according to any of the

Public/Private Ventures, CrimeSolutions.gov,

initial screening criteria, then the full article was

Search Institute, Blueprints for Healthy Youth

retrieved for further review to determine whether

Development, the Australian Clearinghouse

all inclusion criteria were met. The full text

for Youth Studies (ACYS), National Council for

document was located for all studies screened

Voluntary Youth Services (NCVYS) Publications,

as potential y eligible at the title and abstract

the Office of Juvenile Justice and Delinquency

stage.

Prevention (OJJDP) Model Programs Guide,

the UK Department for Children, Schools

The full text eligibility screening criteria consisted

and Families (DCSF) Inclusion Development

of nine screening questions, and the answers

Programme (IDP) Publication Catalogue, and the

to those questions determined whether a study

Urban Institute publications.

was eligible for the impact evaluations synthesis

(Objective 1, presented in this chapter), the

Professional outreach: Institutions or

process evaluations synthesis (Objective 2, to be

individuals who are regarded as professional

conducted and reported at a later time), or both.

leaders in the field of youth homelessness,

The process and the screening criteria are shown

including but not limited to researchers, were

in the flowchart in Figure 7.1.

contacted directly and asked for any leads on

specific studies, or databases likely to include

studies, that might meet this review’s inclusion

criteria. Professional outreach began by

contacting the VoYC Technical Advisors Board,

relevant researchers known to the review team,

and points of contact for relevant reviews and

major studies.

Data collection

Selection of studies

Two trained research assistants (reviewers) used

a set of inclusion criteria to assess, based on

titles and abstracts, whether the studies returned

from the systematic search were potential y

eligible for inclusion in the systematic review.

Both reviewers independently screened all titles

and abstracts. The co-principal investigator

mediated discussion on any inconsistent

screening recommendations between reviewers

to achieve resolution on each study.

The co-principal investigator also screened a

random sample of 10 percent of total titles and

abstracts to confirm accuracy and consistency

with the research assistants’ screening. An

abstract was automatical y excluded if it was

rejected by both reviewers according to any

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Chapter 7. Systematic Evidence Review

Figure 7.1. Screening criteria for meta-analysis and thematic analysis

• Are participants mainly runaway and homeless youth?

• Are participants mainly ages 13-25?

• Is the study in an OECD country?

• Did the document report on an intervention or program evaluation?

If all criteria are met, the document is assessed against the following

two further sets of criteria.

• Does the study use an eligible

• Does the study evaluate reasons for the

quantitative study design

success or failure of the intervention?

(including a comparison group)?

• Does the study report the sampling strategy?

• Does the study report on data collection?

If this criterion is met, the study

• Does the study report the type of analysis?

is eligible for the meta-analysis.

If these criteria are met, the study is eligible for the

Studies for Objective 1

thematic analysis.

Studies for Objective 2

Data extraction

• education (for example, enrollment,

attendance, attainment, achievement).

Information about study and intervention

characteristics was extracted from each article

• employment or earnings (for example,

based on a standardized data extraction

employment status, amount of time

form. Coding discrepancies were resolved by

employed, career advancement, wages).

discussion between reviewers, in consultation

• social-emotional wellbeing (for example,

with the principal investigator.

mental health, prosocial behaviors,

psychological wel being, non-cognitive

Data synthesis and analysis

skills).

Effectiveness studies were synthesized

• physical health/substance use (for

descriptively and not statistical y (that is,

example, health-risk behaviors or

with meta-analysis) due to the significant

knowledge, access to health services,

heterogeneity of interventions, evaluation

physical wel being, disease or infection).

designs, and outcome measures. For summary

• service connections (for example,

information, we use a simple table that indicates

quantity or frequency of services

basic intervention and study information along

accessed).

with whether positive, nul , adverse, or mixed

effects were reported for outcomes fal ing under

If results related to other outcome areas

the following outcome domains—

were reported by evaluations (for example,

delinquency or justice involvement), these were

• stable housing (for example, residential

general y indicated in the findings narrative, but

stability, runaway episodes, homelessness

not summarized in the tables.

experiences).

In the tables, we indicated a study as showing a

• permanent connections (for example,

positive intervention effect for a given outcome

social supports and positive connections to

area if the study reported statistical y significant

family, other adults, or peers).

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Chapter 7. Systematic Evidence Review

(p<.05) improvement in at least one outcome

intervention comparison group, which

within the outcome area. We indicated a study

makes it impossible to infer intervention

as showing an adverse intervention effect for

effects against a counterfactual (that is, the

a given outcome area if the study reported

hypothetical absence of the intervention).

statistical y significant worsening in at least one

outcome within the outcome area. We indicated

Studies classified as “A” designs are the best-

a study as showing a mixed intervention effect

suited for inferring intervention effects—that

for a given outcome area if the study reported

is, changes in outcomes attributable to the

both statistical y significant (p<.05) improvement

intervention—whereas the results of other study

in at least one outcome and statistical y

designs, especial y those classified as “C” and

significant worsening in at least one outcome

“D,” should be interpreted more cautiously, as

within the outcome area. Final y, we indicated a

these results are much more susceptible to

study as showing a null intervention effect for a

selection bias and to having been caused by a

given outcome area if the study measured but

number of factors other than the intervention.

reported no statistical y significant results for

Results

any outcomes within the outcome area. If the

study involved a service-as-usual/no intervention

Search and screening results

comparison, we referred to statistical y significant

between-group differences (either at endline or

Using the search terms and parameters

difference-in-difference estimates, depending on

described in the methods section, we searched

the primary study’s analytical approach). If the

academic journals and identified potential y

study lacked a service-as-usual/no intervention

relevant studies through prominent academic

comparison, we referred to statistical y significant

search engines and research databases,

pre-post changes.

including PubMed (n=2,801), multiple

databases through EBSCOhost (n=971), and

We classified study designs according to the

ERIC (n=389).47 An additional 210 publications

following schematic—

were identified from other sources, including:

A. Randomized trial comparing an intervention

Google searches, relevant websites and

group to a service-as-usual/no intervention

clearinghouses, and personal outreach to a

comparison group and with overall

range of organizations and individual experts.

between-group balance at baseline (at least

The professional outreach included contacts with

80 percent of reported variables).

88 experts from universities, research institutes,

Federal agencies, advocacy organizations,

B. Wel -matched comparison group, robust

and others and included both national and

instrumental variable design, or randomized

international outreach. After discarding duplicate

trial with significant between-group

records (n=434), 3,937 potential y relevant

differences at baseline.

publications were identified for screening.

C. Study with a lower rigor comparison group

Publications had to pass through two levels of

(for example, not involving successful

screening. The first level of screening was based

techniques to match groups based on

on study abstracts or executive summaries.

observable covariates).

Any publications clearly not meeting one or

more of the review’s inclusion criteria based on

D. Pre-post outcomes study, or a comparison

summary information were excluded. Studies

study without a service-as-usual/no

for which inclusion was likely or unclear based

47 PubMed draws on MEDLINE, a database of research primarily related to medicine and health; EBSCOhost draws on a range of databases for research on a variety of topics, such as psychology, medicine, and social sciences; and ERIC is an online library of education research.

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Chapter 7. Systematic Evidence Review

on abstracts or executive summaries were

criteria for Objective 2 only, related to process

subject to level 2 screening in which inclusion or

evaluations, and were saved for future analysis

exclusion decisions were based on retrieval and

and write-up, but are not discussed in this

careful review of the full publication (and, in some

report. Sixty-two publications, representing 51

cases, communication with study authors for

unique studies, were included for the Objective

additional information). See Figure 7.2 for a flow

1 (impact studies) synthesis. Some publications

diagram outlining the identification, screening,

reported different results of the same underlying

and inclusion results at each stage.

evaluation (for example, analysis of different

outcomes, for different subgroups, or at different

Ultimately, 87 publications of evaluative

time periods), hence the larger number of

studies passed both levels of screening and

publications than unique studies.

were included. Of those, 25 met the inclusion

Figure 7.2. Literature flow diagram

PubMed

EBSCOhost

Other Sources

ERIC

(n=2,801)

(n=971)

(n=210)

(n=389)

Records Retrieved

Duplicates

(n=4,371)

(n=434)

Records Imported

Published Before 2008a

(n=3,937)

(n=1,488)

Records Screened (Level 1)

Records Excluded (Level 1)

(n=2,449)

(n=1,890)

Records Screened (Level 2)

Records Excluded (Level 2)

(n=559)

(n=472)

Eligible Records

Met Criteria for Objective 2 Only

(n=87)

(n=25)

Met Criteria for Objective 1

(n=62)b

Notes:

a With the exception of 9 records published prior to 2008 and included in Altena, Brilleslijper-Kater, and Wolf, 2010.

b 51 unique studies reported in 62 publications.

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Chapter 7. Systematic Evidence Review

Study characteristics

We clustered studies into seven intervention

categories:

The vast majority (78 percent) of unique studies

were conducted in the U.S., with the remaining

• prevention: interventions that did not

conducted in Australia (n=2), Canada (n=5),

target youth experiencing homelessness

Mexico (n=1), South Korea (n=1), and The

but did aim to prevent homelessness from

Netherlands (n=1). While, for many studies (40

occurring;

percent), the urbanicity of the sample location(s)

• family interventions: interventions that

was unreported, all those that did report

explicitly engaged youths’ families in the

indicated that the studies were conducted in

program as a key focus

mainly urban or suburban locations.

• housing interventions: interventions that

Of the 51 unique studies, 25 (49 percent) involved

provided housing, housing assistance, or

some type of randomized evaluation. We

shelter as a key feature of the program

describe 14 (27 percent) of the studies as quasi-

experimental, in that they compared youth in a

• individual counseling and treatment

treatment group with other youth who did not

interventions: non-housing, non-family-

participate in the intervention or who participated

based interventions primarily focused

in a comparator intervention. These groups were

on delivering therapeutic or health-

not determined randomly. Twelve of the included

related counseling or treatment to youth

studies used only a pre-post design without a

experiencing homelessness

comparison group.

• non-housing case management

and support interventions: non-

Only four studies (two randomized, one quasi-

housing interventions that involved case

experimental, and one pre-post) had reported

management or mentoring as a key

having published a pre-trial registration or

program feature

protocol. This is notable because a pre-trial

registration or protocol is an important research

• economic and employment

step for increasing transparency and mitigating

interventions: interventions designed to

the risk of reporting bias and other research

help youth experiencing homelessness to

biases (Hopewell et al., 2008). The mean study

obtain or improve employment or earnings

total sample size was 181 (standard deviation

• outreach and service connection

[SD]: 222), ranging from 15 to 1,322. The mean

interventions: interventions that aimed

sample size for randomized studies was 211

to find and connect youth experiencing

compared with 139 among quasi-experimental

homelessness with broader services.

studies and 162 in pre-post studies.

Unique studies most commonly evaluated

A full list of interventions by name from the

individual therapeutic and counseling

included studies is provided in Figure 7.3.

interventions (n=19), followed by non-housing

Altogether, 48 different interventions were

case management and support interventions

evaluated by the included effectiveness

(n=8), and family interventions (n=7) and

studies.48 Appendix L includes the corresponding

housing interventions (n=7). Considering only

citations for included studies. The frequency

randomized evaluations involving service-as-

of intervention types evaluated by the included

usual comparison groups, none of the included

studies is shown in Figure 7.4.

studies rose to this level of rigor for economic

and employment interventions or for outreach

and service connection interventions.

48 The YVLifeSet program is listed under two intervention categories.

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Chapter 7. Systematic Evidence Review

Figure 7.3. Interventions evaluated by included studies

Prevention

Community Reinforcement Approach (CRA)

Behavioral Analysis Services Program (BASP)

Community Reinforcement Approach (CRA) Plus HIV Prevention

The Geelong Project

Community Reinforcement Approach (CRA) Plus Mentoring

YVLifeSet

Dialectic Behavioral Therapy (DBT)

HIV/AIDS and Hepatitis Health Promotion (HPP)

Family interventions

Individual therapy and case management

Ecologically-Based Family Therapy (EBFT)

Motivation Enhancement Therapy (MET)

Family Reconnect Program

Motivational Interviewing (Ml)

Functional Family Therapy

Peer-led Drug Prevention Program

Home Free Program

Relationship-based Group

Multisystemic Therapy

Safety Awareness for Empowerment (SAFE)

On the Way Home

Substance Abuse and HIV Prevention

STRIVE (Support To Reunite, Involve and Value Each Other)

Traumatic Incident Reduction (TIR)

Youth Education in Spiritual Self-Schema (YESSS)

Housing interventions

At Home/Chez Soi Housing First

Non-housing case management and support

Bridge Independent Living Project

Case Management (CM)

Common Unity Project (CUP)

Houvast

Daybreak Housing Program

Integrated HIV prevention

Lighthouse Independent Living Program

My Treatment Empowerment for Adolescents on the Move (iTEAM)

New York City/New York State-initiated Third Supportive Housing Program

Partnership for Youth Transition (PYT) Initiative

(NYNY Ill)

Project Passage Intensive Case Management

Phoenix Youth Supportive Housing

Promotor Pathway

Transitional Housing

YP4

Individual counseling and treatment

Economic and employment interventions

Art Messaging (AM) Program

Individual Placement and Support (IPS)

AWARE program

Social Enterprise Intervention (SEI)

Brief Intervention to Improve Psychological Capital

Brief Intervention to Reduce Alcohol Use and Sexual Risk

Outreach and service connection

Brief Motivational Enhancement (ME)

Strengths-based Outreach Plus Crisis Shelter

Brief Motivational Intervention (BMI)

Strengths-based Outreach Plus Drop-in Linkage

Cognitive Behavioral Therapy (CBT)

Figure 7.4. Number of unique studies by intervention types

19

7

7

8

7

3

3

4

3

1

1

1

0

0

Number of unique studies

Prevention

Family

Housing

Individual

Non-housing

Economic &

Outreach &

interventions

interventions

counseling &

case

employment

service

treatment

management

interventions

connection

interventions

& support

interventions

interventions

Unique studies (all)

Unique studies (RCTs)

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Chapter 7. Systematic Evidence Review

Taking an outcomes perspective, Figure 7.5

self-esteem, self-efficacy, and life satisfaction),

summarizes the broad types of outcomes

substance use, and health. However, relatively

against which interventions were evaluated.

few (n=19) included any outcomes addressing

Many addressed outcomes related to social-

homelessness or housing stability directly.

emotional wel being (for example, mental health,

Figure 7.5. Outcome categories addressed by evaluations

Violence

5

Substance use / abuse behavior

29

Stable housing

19

Social emotional well being

26

Sexual risk behaviors

12

Permanent connections

16

Other

20

Health

34

Outcome Category

Employment or earnings

16

Education

12

Crime delinquency

9

0

5

10

15

20

25

30

35

40

Outcomes Reported, n

As Figures 7.6 and 7.7 show, interventions’

reported information). Eighty-four percent of the

duration and intensity have considerable

interventions lasted less than one year. Most

heterogeneity. The first pie chart (Figure 7.6)

ranged from three to nine months (37 percent).

indicates the percentage of interventions

Approximately 40 percent of interventions

studied by different durations (among those with

involved fewer than five sessions or activities.

Figure 7.6. Interventions studied by duration

< 1 wk

12-24 mos

5%

1 wk-1 mo

16%

5%

1-3 mos

16%

3-9 mos

37%

9-12 mos

21%

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Chapter 7. Systematic Evidence Review

Figure 7.7. Interventions studied by number of sessions

21 or more

15-20

9%

15%

10-14

15%

< 5

40%

5-9

21%

Findings by intervention categories

homelessness prevention model among schools

Prevention

and community organizations involving universal

Only three included studies evaluated

screening for students’ risk for homelessness

interventions explicitly aimed at primary

and tailored case management and support

prevention of youth homelessness. Several other

services. All 95 youth identified as at-risk for

interventions included under other subsections

homelessness and provided some degree of

(particularly several family interventions) could

intervention by TGP had avoided homelessness

be considered early intervention strategies to

over the course of a year. Without a credible

prevent further homelessness among youth

counterfactual, it is impossible to know how

having already experienced some degree of

many of these youth would have experienced

homelessness.

homelessness were it not for the intervention,

but the 100 percent success rate is nevertheless

Although each study reported on different

encouraging. A later report (MacKenzie, 2018)

measures of housing stability, all three

documented time series results of students

nonetheless reported improvements. One

entering the local homelessness system in the

study evaluated the Behavior Analysis Services

Geelong community before and after TGP’s

Program (BASP), an intervention to use data

implementation. Also reported was a 40-percent

analytics to catch runaway behaviors among

reduction in the number of adolescents

youth in foster care early, understand behavioral

entering the homelessness system, as well as

patterns, and provide supports to prevent

a 20-percent reduction in early school leaving

further episodes. The mean percentage of

based on administrative data from project pilot

days on runaway status among the BASP

schools. These results lacked experimental or

group declined from 38 percent at baseline

matched comparisons (although the early school

to 18 percent at endline, while increasing

leaving results were compared simply with non-

slightly from 34 percent to 38 percent for the

pilot schools in Geelong, which, on average, did

comparison group. Another study evaluated

not show average reductions in this outcome

The Geelong Project (TGP), a coordinated

by contrast). The third evaluated prevention

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Chapter 7. Systematic Evidence Review

intervention, YVLifeSet, involved intensive case

management and support services for youth who

had transitioned out of juvenile justice or foster

care. Relative to the control group, the YVLifeSet

evaluation demonstrated a 6-percentage-point

reduction in the percentage of youth reporting

experiences of homelessness over the previous

12 months (21 percent for the intervention group

versus 27 percent for the control group at 12

months following baseline). The evaluation also

demonstrated an 8-percentage-point reduction

in reported experiences of couch surfing due to

not having a permanent place to live (36 percent

versus 44 percent).

Notably, in both TGP and YVLifeSet evaluations,

improvements were also identified in other

outcome areas, such as staying in school (TGP)

and earnings, economic wel being, mental

health, and exposure to intimate partner violence

(YVLifeSet). No other outcomes were reported

for the BASP evaluation. Given the multifaceted

supports provided by these interventions, it is

not necessarily surprising that they would have

positive effects in multiple domains, but the

findings reinforce the broader benefits that youth

homelessness prevention interventions can have

Systematic Evidence Review

for supporting youths’ development and positive

transitions to adulthood.

Chapter 7.

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Chapter 7. Systematic Evidence Review

Table 7.3. Included studies: Prevention

Study descriptors

Outcome areasǂ, ƍ

Study (country)

Intervention

Age

n

Study

Follow-up

Intervention HS

PC

Ed E/E

SEW

PH/SU

SC

group

designƔ period (beyond

attrition

intervention)

Valentine, Skemer, and

“YVLifeSet”—intensive case

18–24

1,322

A

12 months

50%49

+

0

0

+

+

Courtney, 2015; Skemer

management, flexible funds, and

(3 months);

and Valentine, 2016 (USA)

transitional living services without a

24 month

direct housing component

fol ow-up with

administrative

data

Clark et al., 2008 (USA)

Behavior Analysis Services Program

12–17

39

B

12 months (NR)

NR

+

(BASP)—a functional analytic

approach to runaway prevention for

youth in foster care

MacKenzie and Thielking,

The Geelong Project (TGP)—school

12–18

9550

D

12 months (0)

NR

+

+

2013; MacKenzie, 2018

and community-based prevention

(Australia)

and early intervention of student

homelessness

ƔFor study design, A = randomized trial comparing intervention with control/service as usual with overall between-group balance at baseline, B = wel -matched comparison group, robust instrumental variable design, or randomized trial with significant between-group differences at baseline, C = low-rigor comparison, D = no comparison against control/service as usual.

ǂHS = housing stability (including homelessness), PC = permanent or positive connections, Ed = education (enrol ment, attendance, performance, or attainment), E/E = employment or earnings, SEW = social-emotional wel being (including mental health), PH/SU = physical health or substance use (including sexual risk behaviors), SC = service connections.

ƍ + = positive effects, 0 = null effects, - = adverse effects, ~ = mixed effects (both positive and adverse effects) empty = unmeasured/unreported.

49 This represents the share of youth that participated all 9 months, although 82 percent participated for at least 1 month.

50 MacKenzie (2018) reports time series results based on administrative data from the local homelessness system and schools, which involve much larger sample sizes, but these sample sizes are not reported.

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Chapter 7. Systematic Evidence Review

Family interventions

had greater effects on the degree, rather than

the incidence, of risk behaviors. The level of

Family interventions involve counseling of, and

marijuana use at endline among the intervention

engagement with, both the youth and his or her

group was significantly higher compared with

family. For many youth, working with families

the control, which the authors speculated might

could make it possible for youths to remain

have reflected some degree of substitution of

safely and stably housed with the family to

harder drugs with marijuana given the significant

prevent homelessness, to safely reunify with the

reduction in the former.

family after periods of homelessness, and/or for

the family to provide other emotional or material

The Trout et al. (2012) trial of a transition support

supports to youth experiencing homelessness.

intervention for youth—and their families—

following a stay in out-of-home care involved a

Among the three randomized evaluations

particularly small sample (n=44). Nonetheless,

comparing family intervention(s) with service-

it showed statistical y significant between-group

as-usual, all identified significant intervention

differences with respect to remaining in the

effects on one or more reported outcome areas

home or the community rather than returning

(none of which included housing stability).

to some form of out-of-home care (91 percent

Both home-based Ecological y-Based Family

of the intervention group versus 65 percent

Therapy (EBFT) and office-based Functional

of the control group at 12-month endline).

Family Therapy (FFT) demonstrated significant

Positive intervention effects were also found for

and similar reductions in alcohol and drug use

graduating or still attending school (88 percent of

compared to control at 15-months post-baseline

the intervention group versus 50 percent of the

(Slesnick and Prestopnik, 2009). Measures of

control group at 12-month endline).

family and adolescent functioning improved over

time not only for both treatment groups, but

Like the Slesnick and Prestopnik (2009)

also for the control group. The between-group

randomized evaluation, the Slesnick et al. (2013)

differences were statistical y insignificant. There

three-armed trial found improvements over time

were no significant differences in intervention

for the EBFT group in substance use among

effects between home-based EBFT and office-

runaway adolescents. The improvements were

based FFT, but the former was associated with

largely sustained over a 24-month period.

higher treatment engagement, as well as greater

Unlike the Slesnick and Prestopnik (2009)

intervention effects on substance use reduction

randomized evaluation, this trial also reported

among female and younger youth.

improvements in internalizing and externalizing

behaviors (Slesnick, Guo, and Feng 2013) and

The evaluation of the Support to Reunite, Involve,

depressive symptoms (Guo, Slesnick, and

and Value Each Other (STRIVE) intervention

Feng, 2014). However, none of these results

(Milburn et al., 2007) found significant

for the family-based EBFT intervention differed

intervention effects with respect to reducing

significantly overall from the more individual-

sexual risk behaviors, alcohol use, hard drug use,

level interventions (Community Reinforcement

and delinquent behaviors among newly homeless

Approach [CRA] and Motivational Enhancement

youth. Some binary measures of sexual risk

[ME] therapy). With the lack of a service-as-

(such as any sexual activity) and substance

usual comparison, we cannot rule out the

use (such as any alcohol or drug use) were not

possibility that similar gains in social-emotional

significantly impacted, whereas the number of

wel being outcomes would have still occurred

sexual partners and the percentage of days using

with service-as-usual. Indeed, the Slesnick et

alcohol and hard drug use were significantly

al. (2009) randomized evaluation did also find

reduced. This suggests that the intervention

improvements over time in social-emotional

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Chapter 7. Systematic Evidence Review

outcomes among the EBFT group, but these

revealed significant reductions in the sample’s

improvements did not differ significantly from the

mental health problem symptoms, justice

control group. The contrast between these two

system involvement, and associations with

trials reinforces the value-added of randomized

antisocial peers. All these factors have been

evaluations including a service-as-usual

associated with higher risk for homelessness in

comparison for inferring intervention effects,

the literature, so there is reason to hypothesize

and the different conclusions that can stem from

that a longer term evaluation with a comparison

having a trial that does or does not include a

group could show positive results for preventing

credible counterfactual.

homelessness among this at-risk population.

Statistical y significant pre-post changes were

The two pre-post evaluations of family

not observed for a range of other outcomes,

interventions, the Home Free Program (HFP)

including educational and employment

and Family Reconnect Program (FRP), explicitly

outcomes, substance use, and emotional or

set out to reduce housing instability—primarily

instrumental support.

through family reconnection—both found

improvements in youths’ housing instability.

Both evaluations also reported improvements

in family-related permanent connections.

However, without a credible counterfactual, it is

difficult to interpret these results. For instance,

Winland, Gaetz, and Patton (2011) found that, for

42 percent of the sample, the youths’ housing

situation improved; for 19 percent, nothing

changed; and for three percent, their housing

situation worsened (for the remaining 36 percent,

status was unknown). Although encouraging,

broader research has shown that a large share

of youth homelessness—especial y early

homelessness—return home or to more stable

housing over time without formal intervention

(Milburn et al., 2007), so it is possible that results

would have been similar without intervention.

The Multi-systemic Therapy for emerging adults

(MST-EA) intervention did not explicitly set out

to reduce homelessness or housing instability

as an objective, and it did not show significant

reductions in this area. None of the 41 young

adults in the sample were homeless at baseline,

and only one youth reported homelessness at

12-month post-test. Given the high risk of young

adults with criminal justice system involvement

and mental health disorders for homelessness,

it is possible that MST-EA prevented several

youth from experiencing homelessness, but

this is impossible to know in the absence of

a credible counterfactual. Pre-post analyses

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Chapter 7. Systematic Evidence Review

Table 7.4. Included studies: Family interventions

Study descriptors

Outcome areasǂ, ƍ

Follow-

Age

Study

up period

Intervention

PH/

Study (country)

Intervention

n

HS

PC Ed E/E SEW

SC

group

designƔ (beyond

attrition

SU

intervention)

Ecological y-Based Family Therapy

NR

0

0

+

Slesnick and Prestopnik, (EBFT)—home-based

15 months

12–17

119

A

2009 (USA)

(9–11 months)

Functional Family Therapy (FFT)—office-

NR

0

0

+

based

Support To Reunite, Involve, and Value

Milburn et al., 2012

12 months

Each Other (STRIVE)—family intervention

12–17

151

A

NR

+

(USA)

(10–11 months)

to reduce youth risk behaviors

On the Way Home (OTWH)—transition

Trout et al., 2012 (USA)

support to youth, family, and school

13–17

44

A

12 months (0)

NR

+

+

fol owing a stay in out-of-home care

Ecological y-Based Family Therapy

72%

+

+

(EBFT)—home-based

Slesnick et al., 2013;

Slesnick, Guo, and Feng, Community Reinforcement Approach

24 months

12–17

179

D

93%

+

+

2013; Guo, Slesnick, and (CRA)—individual therapy

(18–23 months)

Feng, 2014 (USA) 51

Motivational Enhancement (ME)

65%

+

+

Therapy—individual therapy

Home Free Program (HFP)—call center-

NR (tracer

Harper et al., 2015 (USA)

14–20

107

D

NR

+

+

based family reunification

study)

Family Reconnect Program (FRP)—

Winland, Gaetz, and

individual and family casework and

16–25 53 169

D

NR

NR

+

+

+

+

+

Patton, 201152 (Canada)

counseling

(continued)

51 This review classifies one of the three interventions evaluated in these studies (EBFT) as a family intervention; CRA, and ME are considered individual treatment or counseling interventions.

52 Results are difficult to interpret because no comparison condition exists, and changes are presented without averages. For each reported outcome, some improved, but others did not change or worsened. For each outcome reported, however, a greater percentage “improved” than “worsened” so we assume average overall positive gains.

53 94% were between the ages of 16 and 21.

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Chapter 7. Systematic Evidence Review

Chapter 7. Systematic Evidence Review

( Table 7.4. Included studies: Family interventions continued)

Study descriptors

Outcome areasǂ, ƍ

Follow-

Age

Study

up period

Intervention

PH/

Study (country)

Intervention

n

HS

PC Ed E/E SEW

SC

group

designƔ (beyond

attrition

SU

intervention)

Davis, Sheidow, and

Multisystemic Therapy for emerging

17–20

41

D

12 months (0)

49%

0

0

0

0

+

0

McCart, 2015 (USA)

adults (MST-EA)

ƔFor study design, A = randomized trial comparing intervention with control/service as usual with overall between-group balance at baseline, B = wel -matched comparison group, robust instrumental variable design, or randomized trial with significant between-group differences at baseline, C = low rigor comparison, D = no comparison against control/service as usual.

ǂHS = housing stability (including homelessness), PC = permanent or positive connections, Ed = education (enrol ment, attendance, performance, or attainment), E/E = employment or earnings, SEW =

social-emotional wel being (including mental health), PH/SU = physical health or substance use (including sexual risk behaviors), SC = service connections.

ƍ + = positive effects, 0 = null effects, - = adverse effects, ~ = mixed effects (both positive and adverse effects) empty = unmeasured/unreported.

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Chapter 7. Systematic Evidence Review

Housing interventions

Moreover, the evaluation found no positive

statistical y significant intervention effects on a

Despite the substantial focus on shelter

range of secondary outcomes, such as quality

and housing interventions to address youth

of life, mental or physical health, victimization

homelessness in the policy discourse concerning

of violence, number of arrests, or use of social

homelessness, this review identified relatively

services. The intervention group did, however,

few (7) includable unique studies of housing

have significantly lower odds of obtaining

interventions for youth. Most interventions

competitive employment compared to peers

evaluated involved some form of transitional or

in the control group. The authors speculated

supportive housing. This review identified no

that receiving rent subsidies and government

includable effectiveness studies of models such

assistance might have reduced the burden of

as rapid rehousing or host homes, which have

unemployment and decreased the incentive

also been highlighted for youth (HUD, 2016).

to work. Quality and duration of employment,

Most of the evaluations indicated improvements

as well as earnings, were not measured; such

in housing stability outcomes, among other

nuanced measures might have revealed a

outcome areas, but housing stability was either

different picture.

not measured or not readily interpretable from

The Bridge independent living demonstration

the two evaluations of transitional housing

found statistical y significant improvements

programs for youth experiencing homelessness.

among intervention group youth who were not

The At Home/Chez Soi housing first evaluation of

lost to follow-up in employment status and stable

rental assistance and case management (Kozloff

living situations compared with the control group

et al., 2016 demonstrated significant positive

for both the first- and second-year intervention

intervention effects on housing instability among

cohorts. Statistical y significant improvements,

young adults. The trial only measured housing

compared with control group youth, were

stability (and other outcomes) for a 24-month

also found for school attendance and social-

period, the same period for which participants

emotional outcomes (higher self-concept and

had access to subsidized rent and wrap-around

lower defensiveness) for the first-year cohort,

services. The evaluation does not include data

but not the second-year cohort. These findings

collection or analysis on housing stability beyond

are encouraging, but need to be interpreted

the intervention period. Nonetheless, the mean

cautiously given the lack of a wel -matched

percentage of days stably housed over the last 6

comparison group, the small samples, and the

months was 66 percent for the intervention group

high percentages of youth for whom follow-up

and 48 percent for the control group at endline.

data were not available at follow-up. It is likely

Although encouraging, the results also revealed

that the youth who dropped out of the program

opportunity for improvement through enhanced

and could not be reached for follow-up surveys

or more youth-sensitive intervention models.

had comparatively worse outcomes. As such, it

For instance, despite participants having had

is conceivable that a more complete intention-to-

access to rental support and services for the full

treat analysis would have reflected less positive

evaluation period, approximately one-third of the

gains, if any, overal .

intervention group’s days were spent unstably

The Daybreak transitional housing program

housed in the 6 months prior to the 24-month

evaluation (Pierce, Grady, and Holtzen, 2014)

endline. This suggests that many youth faced

found that youth who remained in the program

constraints to housing instability that remained

for at least 18 months had significantly greater

insufficiently addressed by the rental assistance

pre-post improvements in living situations (exits

or services delivered through at least this

into a “safe destination”), hours in education or

particular “housing first” approach.

employment, mental health, and alcohol and

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Chapter 7. Systematic Evidence Review

drug use compared to youth who participated

No statistical y significant differences between

for less than 18 months. The authors concluded

groups were found at follow-up for independent

that “most youth can achieve positive outcomes

living skills (measured by the Ansel-Casey

if they participate in the program long enough”

Life Skills Assessment-Short Version), school

(Pierce, Grady, and Holtzen, 2014) though the

attendance, social support, or mental health.

extent to which these results were due to the

These findings warrant caution, however, given

intervention is unclear given the lack of a credible

the high loss to follow up and a comparison

counterfactual. It is possible that these results

group with high risk of bias.

were driven by selection bias, for example, with

the youth most likely to succeed also having

Apart from results related to outcomes, the high

the motivation to remain engaged longer in the

non-completion among transitional housing

program.

programs is a notable finding. About 43 percent

for the Bridge program, 53 percent for the

The Community Unity Project (CUP)—a

Daybreak program, 87 percent for CUP, and 35

transitional housing program for young

percent for the Transition House had left the

mothers—outcome results were largely

program earlier than the program intended.54

uninterpretable because the study lacked

By comparison, the “housing first” intervention

both a comparison group and baseline values

(Kozloff et al., 2016) only had one young adult

to ascertain at least pre-post changes. For

drop out of the program. Although low-rigor

example, of the 38 young adults who remained

evaluations suggest benefits to participating

in the program for at least 9 months, 5 percent

in transitional housing programs among some

had completed a GED, 61 percent were “ful y

youth, high attrition rates imply that, for many

employed,” and 37 percent had exited into an

other youth experiencing homelessness, such

“independent” living arrangement. Although

programs were unsuccessful at retaining

these results may indicate successes for some of

their participation, much less improving

the program participants, these do not represent

their outcomes. Many youth experiencing

the full sample enrolled, and we have no way of

homelessness may respond poorly to highly

knowing whether they were attributable to the

structured, rules-based settings offered by many

program and whether the size of effects should

transitional housing programs, and might prefer

be taken as favorable or not. Further, the study

options—either through differently designed

reported an 87 percent attrition rate—that is,

transitional living programs or alternative housing

only 13 percent of youth completed the program.

program models—that al ow for greater flexibility

More than one-third of the enrolled youth left the

and autonomy.

program within the first 3 months. Of those who

did not complete, the most common reasons

The Supportive Housing program evaluation

reported were moving in with a boyfriend and

(Kisely et al., 2008) found statistical y significant

failing to follow program rules.

differences between the group of youth who

were participating in supportive housing

The Transition House evaluation (Jones, 2011)

compared to those youth accessing drop-in

found that youth discharged from foster care

services only—all favoring the supportive housing

to transitional housing reported more housing

group—with respect to the average number of

stability (measured by number of housing

months in housing during the last 12 months, the

moves), were less likely to be unemployed,

average number of years of education, general

experienced less substance abuse, and had

health, emotional problems, and substance use.

less criminal justice contact than youth who

No significant differences were identified with

were discharged to other living arrangements.

respect to current or past year employment

54 These non-completion rates are not directly comparable, as they involve attrition within different time periods.

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Chapter 7. Systematic Evidence Review

status. Although encouraging, given the small

sample size, comparison group with high risk of

bias, and lack of pre-post assessments, these

results cannot be attributed as program impacts.

Further, the study did not report any statistics

with respect to program uptake or retention.

Additional and more rigorous impact evaluations

of supportive housing models for youth are

needed.

The evaluation of the New York/New York State-

Initiated Third Supportive Housing Program

(NY/NYIII) for former foster youth (Lim, Singh,

and Gwynn, 2017) found that the program was

positively associated with an increased pattern

of stable housing and reduced risk of diagnosed

sexual y transmitted infections. Two years post-

baseline, more than half of those placed in

NYNY III were stably housed compared with

less than 10 percent of those who were eligible,

but did not participate in the supportive housing

program. Although nonetheless encouraging,

we do not know how long youth participated

in supportive housing, and therefore to what

extent stable housing continued beyond

participation in the intervention. Moreover, given

the quasi-experimental design, it is possible

Systematic Evidence Review

that unobservable between-group differences

biased the results. Additional y, the analysis

involved an unusual measure of housing stability

Chapter 7.

based on administrative data. Most of the control

group youths’ housing situations involved “no

institutional dwel ing/supportive” housing, which

could have included homelessness and other

forms of actual housing instability, but could

have also included stable independent (non-

institutional) housing. While noting this limitation,

the authors contend that the fact that the

intervention appeared to have reduced sexual y

transmitted infection rates likely supports that it

did indeed also reduce actual housing instability

that puts youth at higher risk of infection.

Measures related to other review outcome areas

were not assessed or reported.

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Chapter 7. Systematic Evidence Review

Table 7.5. Included studies: Housing interventions

Study descriptors

Outcome areasǂ, ƍ

Follow-

Age

Study

up period

Intervention

PH/

Study (country)

Intervention

n

HS

PC

Ed

E/E

SEW

SC

group

designƔ

(beyond

attrition

SU

intervention)

At Home/Chez Soi (housing first intervention for

Kozloff et al., 2016

adults with mental il ness: 24-month rental subsidy 18–24

156

A

24 months (0)

1%55

+

-

0

0

0

(Canada)

with wrap-around services tailored to need)

Duncan et al., 2008

Community Unity Project (CUP)—transitional

18–21

145

D

NR

87%

56

(USA)

housing for young mothers

Transition House—transitional housing for foster

Jones, 2011 (USA)

17–19

106

C

12 months (0)57

35%58

+

0

0

+

0

+

0

youth

Pierce, Grady, and

Daybreak’s transitional housing program for youth

18–21

174

D

18 months (0)

53%

+

+

+

+

+

Holtzen, 2014 (USA)

Kisely et al., 2008

Phoenix Youth Programs’ supportive housing

16–24

45

C59

NR

NR

+

+

0

+

+

(Canada)

Lim, Singh, and

“NYNYIII program”—supportive housing for former 18–25 895

B

NR

NR

+

+

Gwynn, 2017 (USA)

foster youth

Upshur, 1986a; 1986b

Bridge, Inc.’s Independent Living Demonstration

6–16 months

16–17

31

C

43%

+

+

+

+

(USA)

Project

(0–10 months)

ƔFor study design, A = randomized trial comparing intervention with control/service as usual with overall between-group balance at baseline, B = wel -matched comparison group, robust instrumental variable design, or randomized trial with significant between-group differences at baseline, C = low rigor comparison, D = no comparison against control/service as usual.

‡HS = housing stability (including homelessness), PC = permanent or positive connections, Ed = education (enrol ment, attendance, performance, or attainment), E/E = employment or earnings, SEW

= social-emotional wel being (including mental health), PH/SU = physical health or substance use (including sexual risk behaviors), SC = service connections.

ƍ + = positive effects, 0 = null effects, - = adverse effects, ~ = mixed effects (both positive and adverse effects) empty = unmeasured/unreported.

55 One youth withdrew from the intervention.

56 Results are uninterpretable.

57 The evaluation collected data for up to 36 months, but the sample sizes with data are so small at that point that the authors only treat them as “qualitative data.”

58 Completion was not defined by the study, but 35 percent of youth who were discharged into transitional housing left to another living arrangement within 6 months, and 69 percent left to another living arrangement within 12 months—the maximum amount of time that youth could remain living in the transitional housing (review authors’ calculations based on table 3 in Jones [2011]).

59 Although this study included a low-rigor comparison group, it did not include pre-post assessments. As such, it is unclear as to whether between-group differences reflect preexisting between-group differences, intervention effects, or both.

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Chapter 7. Systematic Evidence Review

Individual counseling and treatment

month follow-up. Treatment effects were not

interventions

found with respect to alcohol or marijuana, and

the one-month effects on il icit drug use had

The largest number of included studies in this

faded by the three-month follow-up. However,

review (n=23) involved evaluations of individual

in the Baer et al. (2007) study in which the

counseling and treatment interventions. These

same research team aimed to enhance the

interventions focused on improving mental

brief intervention and replicate the Peterson

health, reducing health-risk behaviors, or both.

et al. (2006) trial, no significant intervention

They were relatively short-term, ranging from

effects were found on any of the substance use

less than a week (Peterson et al., 2006; Bender

measures at either one-month or three-month

et al., 2016) to about six months (Slesnick, Guo,

follow-up. Although different explanations for

and Feng, 2013; Slesnick et al., 2007; Fors and

this lack of improvement or replication of results

Jarvis, 1995). Intensity ranged from a single

in the subsequent trial are possible, the authors

session (Peterson et al., 2006) to 24 sessions

speculated that the most likely explanation was

(McCay et al., 2015). Nearly all were manualized.

sampling. The second trial recruited only youth

Interventions were delivered either through

receiving services at a drop-in center whereas

individual (n=11) or group (n=10) sessions; one

the first trial recruited youth from a variety of

intervention (McCay et al., 2015) involved 12

sources, including the streets, and these youth

individual y administered sessions and 12 group-

had significantly higher baseline use of il icit

based sessions. Unlike family interventions,

drugs. The authors hypothesized that youth

these interventions exclusively focused on youth-

actively pursuing services are already in the

level behavioral changes. Most were delivered

process of change, which could overpower any

as complementary interventions to front-end

effects of a brief intervention. However, another

services, such as street outreach programs,

RCT (Tucker et al., 2017) of a brief motivational

drop-in centers, or shelters. The evaluated

intervention found significant effects on reducing

interventions can be broadly sub-grouped as

alcohol use and unprotected sexual events60

brief interventions (involving fewer than six

among youth who were also recruited through

sessions or less than 1 month of duration), more

a drop-in center. There were also significant

intensive health-risk reduction treatment, and

intervention effects on two attitudinal outcomes:

more intensive mental health treatment.

motivation to change drug use and condom

Brief interventions

use self-efficacy. It is possible that the group-

based format of the Tucker et al. (2017) brief

All the evaluations of brief interventions

intervention, compared to the individual y

measured at least one outcome that we grouped

administered intervention evaluated by Baer et al.

within the physical health/substance use

(2007), might have been related to more positive

category. The four randomized evaluations of

effects on behaviors, but we cannot know for

brief interventions all revealed some degree of

sure.

positive effects, but also some mixed results

that underscore the limitations of such brief

Youth who participated in the brief interventions

interventions in addressing complex chal enges.

evaluated by Fors and Jarvis (1995) and

Thompson et al. (2017) reported significant

Participation in the single session motivational

improvements on average in intention or

intervention evaluated by Peterson et al. (2006)

knowledge-related outcomes (for example,

was associated with reduced (self-reported)

knowledge about drugs and their effects (Fors

il icit drug use other than marijuana at one-

and Jarvis, 1995) and self-reported readiness to

60 Only among those youth who reported having multiple partners.

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Chapter 7. Systematic Evidence Review

change alcohol use (Thompson et al., 2017), but

these can be useful complements to, but not

not in actual health-risk behaviors. It is possible

substitutes for, broader and more intensive

that these knowledge and intention outcomes

supports and services.

served as mediators to later intervention effects

on behaviors, but without extended follow-

More intensive health-risk reduction

up, we cannot make that conclusion. Notably,

treatment

however, in the two-armed randomized trial

All four unique evaluations of more intensive

Thompson et al. (2017) conducted, the group that

health-risk reduction treatments measured

participated in the brief educational comparison

physical health/substance use-related outcomes,

group in which youth received normative

and all found significant improvements for at

information about their peers’ risk behaviors and

least one outcome in this domain. One of these

perceptions, did report a significant reduction

involved a randomized evaluation (Slesnick et

in unprotected sex compared with the group

al., 2007; Slesnick and Kang, 2008) of CRA

that received the brief motivational intervention.

combined with a four-session HIV prevention

Like the brief motivational intervention, the

component. This evaluation found significant

educational comparison was ineffective in

intervention effects on increasing condom

reducing alcohol use outcomes.

usage,61 particularly among older youth (ages

Two unique evaluations of brief interventions

19–22), and reducing substance use (37 percent

measured social-emotional wel being outcomes,

intervention group reduction versus 17 percent

and both found positive results (Rew et al.,

for the control group) and depression (40 percent

2016; Nyamathi et al., 2012, 2013). Compared

intervention group reduction versus 23 percent

with the control group, Rew et al. (2016) found

for the control group). No significant intervention

significant improvements among young women

effects were found for other HIV risk behaviors,

participating in the brief psychological capital

such as number of sexual partners, frequency

intervention in psychological capital, hope, and

of sexual intercourse, or number of people with

resilience. Significant positive intervention effects

whom the participants shared needles. Notably,

were also found for social connectedness,

one of the publications associated with the same

which this review grouped under permanent

underlying study involved secondary analysis

connections. The Nyamathi et al. (2013)

of the trial data to examine differential effects

evaluation, which randomly assigned youth

between gay, lesbian, and bisexual (GLB) street-

experiencing homelessness to either a brief

living youth and non-GLB youth participants

nurse-led intervention or a brief art messaging

(Grafsky et al., 2011). The researchers found

intervention, but lacked a service-as-usual

that, while both groups reported reductions in

comparator, found statistical y significant

drug use and mental health symptoms because

improvements in psychological wel being among

of intervention, the improvements were greater

participants of the nurse-led intervention, but

among GLB participants, suggesting that the

not the art messaging intervention. Neither

CRA method can be effective for improving

group reported significant changes in depressive

these outcomes among youth experiencing

symptoms.

homelessness regardless of their sexual

orientation.

Taken together, the evidence suggests that brief

interventions can yield short-term improvements

Two other unique evaluations assessed

in risk behaviors—or at least the attitudes that

outcomes associated with CRA, but lacked a

may support behavioral changes—and some

service-as-usual comparison group. Bartle-

aspects of social-emotional wel being. As such,

Haring et al. (2012) found significant reductions

61 Frequency of condom usage was measured with a Likert-style scale, so percentage changes are not appropriate to report.

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Chapter 7. Systematic Evidence Review

in problem consequences from substance

of the United States, found positive intervention

abuse associated with mentoring plus CRA

effects on mental health (Shein-Szydlo et al.,

participation, but not in substance use itself. The

2016; Hyun et al., 2005). Among youth in Mexico,

evaluation measured problem consequences

Shein-Szydlo et al. (2016) found intervention

associated with substance use with the Problem

effects on reducing self-reported symptoms of

Oriented Screening Instrument for Teenagers

posttraumatic stress, depression, anxiety, and

(POSIT), which includes 139 questions across

anger. Hyun, Cho Chung, and Lee (2005) found

a range of domains. Further, the Bartle-Haring

positive intervention effects on decreasing self-

(2012) paper does not report exactly which

reported depression symptoms and increasing

type(s) of problem consequences associated

self-efficacy (self-esteem was not significantly

with substance abuse were reduced. The

affected). The quasi-experimental evaluation of

authors noted that the relatively small analytical

dialectical behavior therapy (DBT) implemented

sample size in this evaluation (n=48) could

by front-line clinicians with youth experiencing

have contributed to the lack of estimated

homelessness in Canada found significant

intervention effects. Indeed, for all the outcome

improvements in mental health chal enges (for

measures, some baseline to 6-month follow-

example, depression, hopelessness, and anxiety)

up improvements did not rise to the level of

as well as resilience, self-esteem, and social

statistical significance (Bartle-Haring et al.,

connectedness among the intervention group

2012: 354). Another trial (Slesnick et al., 2013;

compared to the service-as-usual comparison,

Slesnick, Guo, and Feng, 2013; Guo, Slesnick,

and these gains were sustained at 10 weeks

and Feng, 2014) also evaluated CRA without a

post-intervention.

service-as-usual comparison. This trial found

significant pre-post reductions in substance

Three additional studies of more intensive mental

use, but these reductions were not significantly

health treatments all involved small sample

different from those reported among other

sizes (ranging from 21 to 39) and weak or no

treatment arms (EBFT and ME), suggesting that

comparison groups (Grabbe, Nguy, and Higgins,

the precise modality of intervention among these

2012; Descilo et al., 2010; McCay et al., 2011).

treatment options may not be very important for

One evaluated an 8-week mindfulness meditation

reducing substance use (though the choice of

program in the United States (Grabbe, Nguy,

modality may still matter with respect to broader

and Higgins, 2012), one evaluated a 12-week

intervention objectives, feasibility, and client

traumatic incident-reduction approach in the

preferences).

United States (Descilo et al., 2010), and the other

evaluated a 6-week relationship-based group

The evaluation of Project Legacy found a

intervention in Canada (McCay et al., 2011). All

statistical y significant pre-post increase in HIV

three studies reported statistical y significant pre-

knowledge and reduction in number of days

post improvements in social-emotional wel being

intoxicated, but this study lacked any type of

outcomes such as reductions in hopelessness

comparison group and reported relatively high

and depression and improvements in self-

intervention attrition (63 percent), so results

esteem and resilience. However, lacking robust

should be interpreted cautiously.

comparison groups, we cannot infer the extent to

which these improvements were caused by the

More intensive mental health treatments

evaluated interventions. Furthermore, none of the

The two randomized evaluations of mental health

three evaluations measured outcomes beyond

treatments for youth experiencing homelessness,

the intervention period, so we do not know

both of which involved cognitive-behavioral

whether the gains were sustained.

therapies (CBT) with youth in shelters outside

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Chapter 7. Systematic Evidence Review

The included studies suggest that more intensive

mental health treatments can improve social-

emotional wel being outcomes among youth

experiencing homelessness, at least over

a short-term period. However, it is notable

that, apart from brief interventions and family

interventions, we identified no rigorous controlled

trials of mental health treatments targeting

youth experiencing homelessness in the United

States. Given the wel -documented mental

health needs of this population, and the fact

that families are not always wil ing or available

to be engaged in family interventions, the need

for better understanding of the effectiveness of

mental health treatment options that might be

considered for this population of youth is clear.

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Chapter 7. Systematic Evidence Review

Table 7.6. Included studies: Individual or group counseling or treatment interventions Study descriptors

Outcome areasǂ, ƍ

Follow up period

Study (country)

Intervention

Intervention

Age group

n

Study

design

(beyond inter-

Ɣ

vention)

attrition

HS PC Ed E/E SEW

PH/

SU

SC

Brief interventions

Peterson et al.,

Brief motivational intervention (BMI)—individual-

2006 (USA)

ly administered

14–19

285

A

3 months (2.5

months)

NR

+62

Baer et al., 2007

Brief motivational intervention (BMI)—individual-

(USA)

ly administered

13–19

117

A

3 months (2.5

months)

17%

0

+63

All completed

Tucker et al., 2017

AWARE: motivational interviewing brief interven-

at least one

(USA)

tion to reduce risk behaviors—group adminis-

18–25

200

A

4 months (3

session; 48%

+

tered

months)

completed all

four sessions

Bender et al., 2016 Project SAFE: Brief risk detection skills interven-

(USA)

tion—group administered

18–21

97

A

1 week

32%

+

Rew et al., 2016

Brief street-based intervention for young wom-

(USA)

en—group administered

18–23

80

B64

2 months (1 month)

NR

+

+

+

Becoming a Responsible Teen (BART)—a brief

Carmona et al.,

HIV prevention and substance abuse treatment

2014 (USA)

(along with either the Community Reinforcement

14–20

270

D

12 months (11

Approach, Motivational Enhancement Therapy,

months)

NR

+65

or case management)—group administered

(continued)

62

Not all outcomes were affected, and drug use was only reduced at 1-month follow-up; the effect faded by 3-month follow-up.

63

Effects at 1-month but dissipated by 3-month follow-up.

64

This study initially attempted an RCT design, but assignment was only partially randomized due to lower than expected recruitment numbers.

65

At 3 and 6 months only; gains disappeared by 12 months.

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Chapter 7. Systematic Evidence Review

Chapter 7. Systematic Evidence Review

( Table 7.6. Included studies: Individual or group counseling or treatment interventions continued) Study descriptors

Outcome areasǂ, ƍ

Follow up period

Study (country)

Intervention

Intervention

Age group

n

Study

design

(beyond inter-

Ɣ

vention)

attrition

HS PC Ed E/E SEW

PH/

SU

SC

Nurse-led brief HIV/AIDs prevention and Hepatitis

Health Promotion (HHP) intervention—group

NR

+

+

Nyamathi et al.,

6 months (5

administered

2012; 2013 (USA)

15–25

154

D

months)

NR

Artist-led brief Art Messaging (AM) program—

group administered

0

+

Brief intervention to reduce alcohol use and

sexual risk—individually administered

NR

+66

Thompson et al.,

1 month (0.5

2017 (USA)

17–22

61

D

month)

Educational intervention to reduce alcohol use

NR

and sexual risk by sharing normative informa-

+

tion—individually administered

Fors and Jarvis,

Drug Prevention in Youth—a peer-led drug abuse

1995 (USA)

risk reduction, group administered

12–17

221

C

6 months (5

months)

NR

+67

More intensive health-risk reduction treatments

Slesnick et al.,

2007; Slesnick

HIV prevention intervention on risk reduction

19%68 (on av-

and Kang, 2008;

skills with Community Reinforcement Approach

14–22

180

A

6 months (3

erage, 43% of

69

+

+

Grafsky et al., 2011 (CRA) substance use treatment—individually

months)

sessions were

(USA)

administered

completed)

Bartle-Haring et al., Mentoring plus Community Reinforcement Ap-

6 months (3

2012 (USA)

proach (CRA)—individually administered

14–20

48

D70

months)

NR

~

+71

(continued)

66

“Readiness” to change only; alcohol use and HIV sexual risk outcomes were not affected.

67

Knowledge and intention outcomes were positively impacted by the program, but not actual substance use outcomes.

68

This is the percentage that did not complete any sessions.

69

Outcome measured “social stability,” a composite indicator that included housing, but did not disaggregate effects on housing in particular.

70

Although the evaluation was initially designed as an RCT, the service-as-usual comparison group data are not used in the analysis due to incomplete data. Because the control group was not used in the analysis, we only include the 48

intervention group participants in the sample size in this table.

71

Mentoring plus CRA was associated with a decrease in problem consequences associated with substance use, but not with reduction in actual substance use.

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Chapter 7. Systematic Evidence Review

( Table 7.6. Included studies: Individual or group counseling or treatment interventions continued) Study descriptors

Outcome areasǂ, ƍ

Follow up period

Study (country)

Intervention

Intervention

Age group

n

Study

design

(beyond inter-

Ɣ

vention)

attrition

HS PC Ed E/E SEW

PH/

SU

SC

Slesnick et al.,

Ecologically-Based Family Therapy (EBFT)—indi-

72%

+

+

2013; Slesnick,

vidually administered (home-based)

Guo, and Feng,

Community Reinforcement Approach (CRA)—in-

2013; Guo, Sle-

12–17

179

D

24 months (18–23

dividually administered

months)

93%

+

+

snick, and Feng,

Motivational Enhancement (ME) Therapy—indi-

2014 (USA)72

vidually administered

65%

+

+

SHIP, 2013 (USA)

“Project Legacy”—HIV risk prevention, motiva-

tional intervention—group administered

18–24

288

D

18 months (12

months)

63%

0

+

+

More intensive mental health treatments

Shein-Szydlo et al., Cognitive behavioral therapy for trauma in street

2016 (Mexico)

children (CBT-TSC)—individually administered

12–18

100

A

6 months (3

months)

2%

+

Hyun, Cho Chung,

Adolescents

and Lee, 2005

Cognitive behavioral therapy (CBT)—group

(mean age

27

A

2 months (0)

16%

+

(South Korea)

administered

15.5)

More intensive mental health treatments

Grabbe, Nguy,

and Higgins, 2012

Youth Education in Spiritual Self-Schema (YESSS)

(USA)

program—group administered

17–23

39

D

2 months (0)

55%

+

Descilo et al., 2010 Traumatic incident reduction (TIR)—individually

(USA)

administered

11–18

31

D

3 months (0)

22%

+

McCay et al., 2011 Relationship-based group intervention—group

(Canada)

administered

16–24

21

C

1.5 months (0)

44% (42%

uptake)

+

+

0

McCay et al., 2015 Dialectical Behavior Therapy (DBT)—half individu-

(Canada)

ally and half group administered

16–24

155

B

5.5 months (2.5

months)

52%

+

+

ƔFor study design, A = randomized trial comparing intervention with control/service as usual with overall between-group balance at baseline, B = wel -matched comparison group, robust instrumental variable design, or randomized trial with significant between-group differences at baseline, C = low rigor comparison, D = no comparison against control/service as usual.

ǂHS = housing stability (including homelessness), PC = permanent or positive connections, Ed = education (enrol ment, attendance, performance, or attainment), E/E = employment or earnings, SEW

= social-emotional wel being (including mental health), PH/SU = physical health or substance use (including sexual risk behaviors), SC = service connections.

ƍ + = positive effects, 0 = null effects, - = adverse effects, ~ = mixed effects (both positive and adverse effects) empty = unmeasured/unreported.

72

This review classifies two of the three interventions evaluated in these studies (CRA and ME) as individual treatment or counseling; EBFT is considered a family intervention.

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Chapter 7. Systematic Evidence Review

Non-housing case management and support

to live (36 percent versus 44 percent). The

interventions

Promotor Pathway Program (PPP) evaluation

(Theodos et al., 2016) involved different

Nine included publications (seven unique studies)

measures of housing stability, but found a

assessed outcomes associated with some

6-percentage point reduction in past 6-month

form of youth-centered case management with

shelter use among the intervention group relative

complementary supports and services but no

to the control (4 percent of the intervention

specific housing component. These interventions

group, versus 10 percent of the control group,

ranged from about 3 months (Cauce et al., 1994)

reporting having slept in a shelter in the last 6

to 18 months (Theodos et al., 2016) of exposure

months at 18-months post-baseline). Theodos

duration and general y emphasized caring

et al. found no intervention effect on having had

supportive adult relationships with youth, offering

three or more moves in the past 6 months. At 6

individual counseling and service navigation,

months post-baseline, Powell et al. (2016) found

and providing therapeutic or mental health

significant reductions in homelessness and

support. Two of the intensive case management

number of days homeless in the past 90 days

programs included a flexible fund component,

from experiences of housing stress. Similarly,

which provided need-based financial assistance

Slesnick et al. (2008) found a significant increase

to youth clients, for example to provide

in number of days housed at 12 months post-

transportation assistance, job attire, help a young

baseline. However, these two studies lacked

person in crisis, provide a first month’s rent, or

comparison groups, so we cannot infer the

cover specific education fees (Valentine, Skemer,

extent to which these improvements were

and Courtney, 2015; Cauce et al., 1994). All but

attributable to the interventions.

one of the evaluations of case management

interventions took place in the United States; the

Each of these improvements in housing

YP4 program evaluated by Borland, Tseng, and

stability-related outcomes had accompanying

Wilkins (2013) was implemented in Australia.

improvements in other outcome areas, although

null effects in others. YVLifeSet participants

Among the interventions involving intensive

experienced gains in employment and earnings,

case management components, results were

and reductions of mental health problems, but

general y positive, but not universal y so. Four

no significant improvements with respect to

evaluations of interventions involving intensive

criminal behavior, justice system involvement,

case management and additional supports

education, or social supports (of family, friends,

showed positive results for housing stability

or caring adults). Although social supports were

outcomes despite the absence of any specific

a focus of YVLifeSet, the authors speculate that

housing intervention. Two of these were

relatively high baseline values of social supports

randomized evaluations (Valentine, Skemer, and

among this sample could have left little room for

Courtney, 2015; Theodos et al., 2016). Relative

measurable improvement (Valentine, Skemer,

to the control group, the YVLifeSet evaluation

and Courtney, 2015: 68). Youth participating in

(Valentine, Skemer, and Courtney, 2015)

the PPP also reported significant improvements

demonstrated a 6-percentage point reduction in

in school enrollment (though not yet degree

the percentage of youth reporting experiences

attainment or college attendance), reductions

of homelessness over the previous 12 months

in childbirths (particularly among Latino/a

(21 percent for the intervention group versus

youth), and higher likelihood of reporting

27 percent for the control group at 12 months

having a special adult in their life. However,

following baseline) and an 8-percentage point

employment, delinquency, and self-efficacy were

reduction in reported experiences of couch

not significantly affected, and the intervention

surfing due to not having a permanent place

group was significantly more likely to report

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Chapter 7. Systematic Evidence Review

recent binge drinking, having sold drugs, and

the program, suggesting that ”you get what you

having been in a fight that required medical

pay for” (Borland, Tseng, and Wilkins, 2013: 483).

attention at 18-months post-baseline compared

At any given time, the YP4 intervention had six to

to the control group. The authors explained that,

eight case managers assigned to the treatment

while it seems unlikely that the program caused

group across four sites, which translates to

increases in these behaviors, they did not have

caseloads of 30 to 40, with a treatment group

sufficient information to understand why these

target of 240. By comparison, the Transition

differences were observed (Theodos et al., 2016,

Specialists in the YVLifeSet program had

p. x).

caseloads ranging from about 8 to 15 youth and

the promotores—mentors and advocates for

Although Haber et al. (2008) did not measure

youth—in the PPP model had average caseloads

or report changes in housing stability or

of about 11 youth.73

homelessness outcomes, participants in

the Partnerships for Youth Transition (PYT)

In addition to a minimal intervention approach to

initiative experienced statistical y significant

case management in YP4, uptake was relatively

improvements over time in several other

low, with 20 percent of the treatment group

outcomes, including in employment, educational

never having met with their case manager and

advancement, productivity, criminal justice

more than 50 percent having met with their case

involvement, mental health interference, and

manager on average only once every 6 months

substance abuse interference. Haber et al.

during the trial. The average number of case

(2008) examined the extent to which history of

manager contacts that the treatment group

homelessness was associated with improvement

had over two years was 23, but these were

in outcomes measured, controlling for other

heavily skewed toward the top quintile of the

covariates. The authors found that a history

sample in terms of participation. By comparison,

of homelessness significantly interacted with

only 1 percent of the treatment group in the

time in predicting employment. Participants

Valentine, Skemer, and Courtney (2015) trial

with histories of homelessness showed greater

did not participate in at least one face-to-face

improvement on the employment outcome

transitional living service, about 50 percent

initial y (during the first quarter), but also

participated for at least 9 months, and the

exhibited less likelihood compared with their

average number of transitional living sessions in

peers of having maintained this progress in

which youth participated was 27. Only 6 percent

subsequent quarters.

of the treatment group in the Theodos et al.

(2016) trial never met with their promotor, and

Unlike the other evaluations of interventions

one-half of the youth had 45 or more contacts

involving case management, the YP4 trial

with promotores during the trial.

(Borland, Tseng, and Wilkins, 2013) in Australia

demonstrated no significant intervention

Like the YP4 evaluation, the Houvast trial of an

effects despite having measured a wide range

indirect (staff training-based) strengths-based

of outcomes over an extended period of time.

intervention for young adults experiencing

This program aimed to deliver a new case

homelessness also failed to demonstrate positive

management approach with coordinated service

intervention effects on any of the measured

delivery to young homeless job seekers. The

outcomes. Also, like YP4, Houvast involved a

authors posited that the absence of effects

comparatively minimal intervention in that it did

could have been due to a more minimal than

not involve significant additional intervention

intensive case management approach that was

or resources to serve youth at the individual

ultimately possible with the resources al otted to

level. Instead, it focused on strengthening the

73 The review authors divided the number treatment group sample size (n=165) by the number of promotores reported (p. 10).

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Chapter 7. Systematic Evidence Review

capacity of shelter staff to deliver more strength-

based programming using existing spaces and

resources. The authors noted that none of the

shelter sites had achieved sufficient fidelity

scores for the strengths-based model, and

that this may take more time and resources74

to adequately realize. Additional y, the authors

noted that strengths-based approaches have

become increasingly popular, and control

shelters also reported using some principles of

the strengths-based approach in their practice,

which could have diminished the trial’s ability to

show intervention effects.

Taking these lessons into account, it appears

that intensive, youth-centric case management

and additional supports can have wide-ranging

positive effects on youth experiencing, or

at-risk for, homelessness. However, despite

encouraging results, these interventions are not

silver bul ets. Many participants still experienced

housing instability and other difficulties by

the end of the trial. Many of these youth likely

needed additional supports and services to

overcome complex chal enges. Moreover, as the

juxtaposition with the null results of the YP4 and

Houvast trials highlights, the quality and intensity

of the model are likely to matter for achieving

impact with this population. Programs need to

ensure adequate resources and design features

to enable intensive, individualized relationships

between case managers and youth along with

adequate supports and incentives to optimize

intervention participation among a transient

population hampered by multiple constraints.

74 Particularly for supervision.

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Chapter 7. Systematic Evidence Review

Table 7.7. Included studies: Non-housing case management and support interventions Study descriptors

Outcome areasǂ, ƍ

Age

Study

Follow up period

Intervention

PH/

Study (country)

Intervention

group

n

designƔ (beyond intervention)

attrition

HS PC Ed E/E SEW

SU

SC

Valentine, Skemer, and

“YVLifeSet”—intensive case

12 months (3 months);

Courtney, 2015; Skemer

management, flexible funds, and

18–24

1,322

A

24 month fol ow up with 50%76

+

0

0

+

+

and Valentine, 2016

transitional living services

administrative data

(USA)75

Theodos et al., 2016 (USA) Promotor Pathway program (PPP)—

intensive case management,

16–24

476

A

18 months

NR77

+

+

+

078

0

~79

mentorship, and advocacy

Cauce et al., 1994 (USA)

Project Passage (PP)—intensive

case management, mental health

13–21

115

A

3 months (0)

NR

+

treatment, and flexible funds

Krabbenborg et al., 2015

Houvast—a strengths-based

(Netherlands)

intervention for homeless young

17–26

251

A

6 months (0)

21%

0

0

0

0

0

adults (shelter staff training)

Borland, Tseng, and

“YP4”—case management, navigation,

36 months (6–18

18–35

445

B80

20%81

0

0

0

0

0

0

Wilkins, 2013 (Australia)

and linked services

months)

Haber et al., 2008 (USA)

Partnerships for Youth Transition

(PYT) initiative—multisite SAMHSA

demonstration of transition support

14–21

193

D

4 years (NR)

NR

+

+

+

+

programs (various models of

coordinated strategies and activities)

(continued)

75

This evaluation is presented both in this intervention category as well as in the prevention category.

76

This represents the share of youth that participated all 9 months, although 82 percent participated for at least 1 month.

77

Completion was not defined, but 94 percent of youth engaged at least once with their promotor.

78

Males had worsened employment and earnings outcomes compared to control, but this could have been due to substitution effects due to improvements in education among males in the treatment group compared to control.

79

The treatment group had fewer births, but greater likelihood of getting into a fight that required medical attention, selling marijuana, hard drug use, and binge drinking.

80

This was initially designed as an RCT, but randomization was compromised through reserved treatment group places allocated to participating organizations as well as unintended compromises of randomization (Borland, Tseng, and Wilkins, 2013: p.473). The intervention and control groups had statistically significant baseline differences, and the authors implemented quasi-experimental matching techniques to partially compensate for asymmetries.

81

This reflects the percentage of clients that did not participate in at least one session. The mean number of sessions attended was relatively low compared to the number of sessions offered.

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Chapter 7. Systematic Evidence Review

Chapter 7. Systematic Evidence Review

(Table 7.7. Included studies: Non-housing case management and support interventions continued) Study descriptors

Outcome areasǂ, ƍ

Age

Study

Follow up period

Intervention

PH/

Study (country)

Intervention

group

n

designƔ (beyond intervention)

attrition

HS PC Ed E/E SEW

SU

SC

Slesnick and Kang, 2008

Case management and Community

(USA)

Reinforcement Approach (CRA)

14–24

172

D

12 months (6 months)

20%82

+

0

0

+

0

individual therapy

Powell et al., 2016 (USA)

iTEAM—intensive case management,

drop-in, treatment, and support services 15–24 210

D

6 months (0)

NR

+

+

0

+

+

+

+

for LGBT youth

ƔFor study design, A = randomized trial comparing intervention with control/service as usual with overall between-group balance at baseline, B = wel -matched comparison group, robust instrumental variable design, or randomized trial with significant between-group differences at baseline, C = low rigor comparison, D = no comparison against control/service as usual.

ǂHS = housing stability (including homelessness), PC = permanent or positive connections, Ed = education (enrol ment, attendance, performance, or attainment), E/E = employment or earnings, SEW =

social-emotional wel being (including mental health), PH/SU = physical health or substance use (including sexual risk behaviors), SC = service connections.

ƍ + = positive effects, 0 = null effects, - = adverse effects, ~ = mixed effects (both positive and adverse effects) empty = unmeasured/unreported.

82

This reflects the percentage of clients that did not participate in at least one session. The mean number of sessions attended was relatively low compared to the number of sessions offered.

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Chapter 7. Systematic Evidence Review

Economic and employment interventions

no significant between-group differences were

found at follow-up for weekly working hours

Despite the importance of gainful employment

or weekly income. The Ferguson (2017) results

for helping youth experiencing homelessness

were less encouraging. The author found no

achieve self-sufficiency, very little evaluation

statistical y significant pre-post changes in any

of economic and employment interventions

of the employment outcomes measured83 for

has targeted this population. A recent global

either the IPS or SEI group. Moreover, the study

systematic review of youth employment

did not observe any significant between-group

programs identified 113 counterfactual impact

differences, suggesting that neither intervention

evaluations (Kluve et al., 2016). The evidence

approach was more effective than the other in

base indicated variable results overal , but

boosting youths’ employment outcomes.

also that youth employment programs tended

to have the greatest effectiveness with the

The authors noted that it is possible that more

most vulnerable (low-skil ed, low-income)

nuanced measures, such as type of employment

subpopulations. Presumably, if such interventions

or occupation, and longer term follow-up

were designed considering the specific needs of

might reveal more significant results in future

youth experiencing homelessness, this implies

research (Ferguson, 2017). Additional y, part of

promising potential for youth employment

the interventions’ purpose was not only to help

programs with this population. However, very

youth find employment, but also to support

little evaluation has addressed this.

youth with existing work in retaining those jobs.

It is possible that the interventions had positive

The only two interventions in this category that

effects in this respect, but without a control

were evaluated by included studies in this review

group, we have no way to discern whether the

were the Social Enterprise Intervention (SEI) and

interventions impacted job retention.

Individual Placement Support (IPS), both of which

were assessed through different studies by the

All the other studies measured outcomes that

same lead researcher in the United States. The

this review included under social-emotional

SEI was a 20-month program that involved 8

wel being. Ferguson (2012) reported statistical y

Systematic Evidence Review

months of coursework in vocational and smal -

significant positive intervention effects of SEI,

business skills, a 12-month phase of supported

compared with control, for life satisfaction and

social enterprise development, and continuous

family support (although not quite statistical y

Chapter 7.

mental health supports provided through a

significant improvements for peer support and

program clinician and/or case manager. IPS aimed

depression). Ferguson (2017) found that both

to assist individuals with severe mental il ness in

the SEI and IPS groups reported statistical y

gaining and maintaining competitive employment.

significant improvements at follow-up with

It offered individualized and long-term support

respect to self-esteem, attention-deficit/

through integrated vocational and clinical services.

hyperactivity disorder (ADHD) problems, and

IPS was also delivered over 20 months.

inattention problems. Both groups were also less

likely to be living in a shelter and more likely to

Two studies assessed employment outcomes

be living in a private residence during the last 3

among intervention participants. Ferguson

months at follow-up. No statistical y significant

(2013) found that the group of homeless young

changes were found for social support, and

adults with mental il ness participating in IPS

no statistical y significant between-group

was significantly more likely than the control

differences emerged for any of these outcomes,

group to have worked at some point during the

suggesting a lack of evidence to support favoring

10-month study period and to have worked a

one approach over the other for addressing

greater number of months overal . However,

these outcomes.

83 These included paid employment, job tenure, hours per week, weekly income, and total labor networks (the quantity of formal and informal supports to which an individual could turn for help in finding a job).

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Chapter 7. Systematic Evidence Review

Table 7.8. Included studies: Economic and employment interventions

Study descriptors

Outcome areasǂ, ƍ

Follow

up period

Age

Study

(beyond

Intervention

PH/

Study (country)

Intervention

group

n

designƔ

intervention)

attrition

HS PC

Ed

E/E

SEW

SU

SC

Ferguson and Xie,

2008; Ferguson, 2012

Social Enterprise Intervention (SEI)

18–24

23

C

9 months (0)

31%

+

+

(USA)

Social Enterprise Intervention: business

and vocational training and services and

18–24

28

C

9 months (0)

NR

+

+

Ferguson, Xie, and

clinical services

Glynn, 2012; Ferguson,

Individual Placement Support (IPS):

2013 (USA)

individualized and long-term support

through integrated vocational and clinical

18–24

36

C

10 months (0)

NR

+

services

Social Enterprise Intervention: peer

mentoring, business and vocational

56%

+

0

0

+

training, and services and clinical

services

20 months (10

Ferguson, 2017; (USA)

16–24

72

D

Individual Placement Support:

months)

individualized and long-term support

77%

+

0

0

+

through integrated vocational and clinical

services

ƔFor study design, A = randomized trial comparing intervention with control/service as usual with overall between-group balance at baseline, B = wel -matched comparison group, robust instrumental variable design, or randomized trial with significant between-group differences at baseline, C = low rigor comparison, D = no comparison against control/service as usual.

ǂHS = housing stability (including homelessness), PC = permanent or positive connections, Ed = education (enrol ment, attendance, performance, or attainment), E/E = employment or earnings, SEW = social-emotional wel being (including mental health), PH/SU = physical health or substance use (including sexual risk behaviors), SC = service connections.

ƍ + = positive effects, 0 = null effects, - = adverse effects, ~ = mixed effects (both positive and adverse effects) empty = unmeasured/unreported.

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Chapter 7. Systematic Evidence Review

Outreach and service connection

over the crisis shelters (Slesnick et al., 2016).

interventions

Youth in the overall sample also experienced

statistical y significant improvements in

Outreach is a core front-end element of

additional outcomes—days of alcohol use, days

service continuums for youth experiencing

of marijuana use, days using more than one

homelessness. A variety of models and

substance per day, self-efficacy, depression84,

approaches are designed to promote outreach.

general physical and mental health– but these

These interventions largely involve providing

improvements did not significantly differ between

youth with basic supplies and information—

groups (Slesnick et al., 2016). These overall

often oriented toward harm-reduction—and

gains imply the possibility of benefits related

connecting youth with broader supports and

to strength-based outreach and advocacy

services that can help them find safe respite

irrespective of the type of service connection;

and exit homelessness. Given the purpose of

nevertheless, absent a control group, we cannot

outreach interventions in the context of broader

rule out the possibility that these improvements

services and systems, and the relatively low

were natural y occurring apart from any of the

intensity and duration of outreach engagements

study’s interventions. No statistical y significant

with youth, these interventions tend to focus on

improvements were noted for the sample overall

more proximal outcomes. Such outcomes could

with respect to HIV risk behaviors (Slesnick et al.,

include service connections and immediate risk

2016).

reduction rather than outcomes that typical y

require more significant intervention. Despite

A study involving secondary analysis of data

the prominence of outreach interventions in

from the same evaluation examined the

community-level youth homelessness efforts,

mediating roles of service connections and

this review identified only one includable

self-efficacy on other outcomes (Slesnick et al.,

unique evaluation, with three associated

2017). The researchers found that, over time,

individual studies (Slesnick et al., 2016; 2017;

service connections disrupted the adverse

Guo and Slesnick, 2017), assessing outreach

relationship between youths’ cumulative levels

Systematic Evidence Review

interventions.

of risk and self-efficacy. Also, improvements in

self-efficacy functioned as statistical y significant

The authors found that youth (ages 14–24)

pathways through which the strengths-based

assigned to receive the service linkage to a

Chapter 7.

outreach and advocacy intervention appeared

youth drop-in center versus a crisis shelter had

to improve housing stability and mental health

a higher number of service linkages overal . They

outcomes. The findings suggest that targeting

also displayed greater improvements in days of

aspects of social-emotional wel being—such

drinking to intoxication and HIV knowledge, as

as self-efficacy/personal control—can be an

well as greater reductions in hard drug use (Guo

effective strategy to improving other outcomes

and Slesnick, 2017). Although the evaluation

that support sustainable exits for youth

observed statistical y significant improvements

experiencing homelessness.

for both groups over time with respect to these

outcomes (except for service connections,

which only improved for the drop-in center

group), the improvements were significantly

greater for youth assigned to the drop-in center

connection condition. Youth also reported

a greater preference for the drop-in center

84 Females experienced greater reductions in depressive symptoms than males.

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Chapter 7. Systematic Evidence Review

Table 7.9. Included studies: Outreach and service connection interventions

Study descriptors

Outcome areasǂ, ƍ

Follow up period

Study (country)

Intervention

Age

Intervention

group

n

Study

design

(beyond inter-

Ɣ

vention)

attrition

HS

PC

Ed E/E SEW PH/SU SC

Strengths-based outreach and advocacy

Slesnick et al.,

plus youth drop-in linkage

NR

+

+85

+

2016; 2017; Guo

and Slesnick

14–24

79

D

9 months (3

months)

2017 (USA)

Strengths-based outreach and advocacy

plus shelter linkage

NR

+

+

0

Ɣ For study design, A = randomized trial comparing intervention with control/service as usual with overall between-group balance at baseline, B = wel -matched comparison group, robust instrumental variable design, or randomized trial with significant between-group differences at baseline, C = low rigor comparison, D = no comparison against control/service as usual.

ǂHS = housing stability (including homelessness), PC = permanent or positive connections, Ed = education (enrol ment, attendance, performance, or attainment), E/E = employment or earnings, SEW = social-emotional wel being (including mental health), PH/SU = physical health or substance use (including sexual risk behaviors), SC = service connections.

ƍ + = positive effects, 0 = null effects, - = adverse effects, ~ = mixed effects (both positive and adverse effects) empty = unmeasured/unreported.

85

The youth in the drop-in linkage group had greater reductions in hard drug use compared to the youth in the shelter linkage group.

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Chapter 7. Systematic Evidence Review

Discussion

Preventing and reducing youth homelessness

involves more than housing. Notably, of the

Key findings

five experimental or quasi-experimental studies

with rigorously identified control groups, only

In this chapter, we reported the methods and

two (Kozloff et al., 2016; Lim, Singh, and Gwynn,

results of the most comprehensive systematic

2017) involved housing interventions. Kozloff et

evidence review on programs and practices to

al. (2016) evaluated intervention effects among

prevent and address youth homelessness to-

young adults participating in a “Housing First”

date. This synthesis serves as an unprecedented

program involving rental subsidies and wrap-

resource for anyone interested in understanding

around services; and Lim, Singh, and Gwynn

the breadth and depth of the evidence base

(2017) evaluated a supportive housing program

on interventions related to youth experiencing

for youth exiting foster care. Conversely,

homelessness. It should also provide a starting

Valentine, Skemer, and Courtney (2015) and

point for those interested in developing and

Theodos et al. (2016) both evaluated intensive

evaluating interventions going forward so that

case management and support services for

those involved understand how their work

at-risk youth; and Clark et al. (2008) studied

fits into the context of what we already know

a behavioral analytic approach to identifying

collectively, and where we need to fill knowledge

patterns of youth running away from foster care

gaps. Given the breadth of the review’s scope, in

and addressing the behaviors underlying those

this section we summarize cross-cutting lessons

patterns. The fact that the two housing-based

and knowledge gaps from the synthesized

interventions involved significant supplemental

evidence base.

services and supports beyond housing, and that

Preventing and reducing homelessness

three rigorous trials demonstrated significant

effects of non-housing interventions on housing

Interventions can measurably reduce

stability outcomes, underscores that preventing

the incidence and prevalence of youth

and ending youth homelessness takes more than

homelessness. Only 17 unique studies (39

housing.

percent) measured at least one outcome

capturing housing stability or homelessness. Of

While these results are encouraging, the

these, three involved randomized evaluations

effect sizes for housing stability outcomes

(Valentine, Skemer, and Courtney, 2015;

were often modest with large shares of

Theodos et al., 2016; Kozloff et al., 2016)

participants remaining unstably housed at

and two involved quasi-experimental studies

follow-up. For example, the YVLifeSet evaluation

with matched comparison groups (Clark et

(Valentine, Skemer, and Courtney, 2015)

al., 2008; Lim, Singh, and Gwynn, 2017). The

demonstrated a six-percentage point reduction

remaining comprised either no service-as-usual

in the percentage of youth reporting experiences

comparators or assignment of control groups

of homelessness over the previous 12 months

that lacked measures to mitigate bias. All three

(21 percent for the intervention group versus

of the randomized evaluations showed positive

27 percent for the control group at 12 months

intervention effects on preventing or reducing

following baseline) and an eight percentage

homelessness or housing instability; and all but

point reduction in reported experiences of couch

3 of the 17 unique studies indicated statistical y

surfing due to not having a permanent place to

significant improvements in at least one housing

live (36 percent versus 44 percent). These effects

stability outcome. This suggests encouraging

were statistical y significant, but at 12-month

evidence that youth homelessness can in fact

follow-up, many more participants were still

be measurably prevented and reduced with

reporting experiences of homelessness than

adequate intervention.

participants whose homelessness experiences

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Chapter 7. Systematic Evidence Review

had been resolved. Even for the At Home/Chez

These included higher levels of substance

Soi “Housing First” program, which provided

abuse and unemployment (Jones, 2011;

rental subsidies and additional services for the

Pierce, Grady, and Holtzen, 2014). As such, to

entire duration of the study, by 24-month follow-

effectively and sustainably improve outcomes

up, about one-third of the intervention group’s

for the most vulnerable youth, more concerted

days in the previous six months had been spent

intervention components to address these

unstably housed.

needs may be needed. Additional y, Slesnick

and Kang (2017) found that improvements in

Comprehensive, youth-centric interventions

self-efficacy functioned as a pathway through

are needed for a complex challenge. These

which strengths-based outreach and advocacy

partial impacts highlight the limitations of single

appeared to improve housing stability and mental

programs in ful y preventing and ending youth

health outcomes. This underscores that, apart

homelessness given the complex chal enges at

from the more tangible supports and services

multiple levels underpinning this problem. For

that programs offer youth, relationships and

example, for some youth, case management and

opportunities to enhance their sense of personal

supportive service interventions, like YVLifeSet

control in the face of significant life chal enges

and the Promotor Pathway Program, are likely

can also play important roles in increasing the

insufficient and need to be complemented by

odds of programs helping youth experiencing

direct housing assistance and other targeted

homelessness to achieve greater outcomes.

supports. For At Home/Chez Soi, as the authors

underscore in the discussion section of their

Accessing interventions

“Housing First” review, program adaptations

to better meet youths’ specific needs—such

Youth drop-in centers and shelters played

as peer/family relationships, sexual health,

important roles in enabling programs and

education and job skills, culture, life skills,

researchers to access an otherwise elusive

substance use, and crime avoidance—may be

population. Although rigorous effectiveness

critical to improving overall intervention effects.

evidence for youth drop-in centers and shelters

Another adaptation that may improve overall

is scarce, the research base suggests that

intervention effects is engaging youth themselves

these are in fact critical front-end resources in

in all stages of intervention implementation and

the context of broader systems and services

evaluation (Kozloff et al., 2016).

for the purpose of identifying youth and linking

them with other interventions. Nine out of 19

Many evaluations noted limited program

(47 percent) of the unique studies of individual

effects due to a lack of resources, or funding

counseling and treatment interventions explicitly

flexibility, to address additional barriers,

reported recruiting youth through drop-in centers

sustainable exits, and broader wellbeing for

(Peterson et al., 2006; Baer et al., 2007; Tucker

youth homelessness. For example, Pierce,

et al., 2017; Rew et al., 2016; Carmona et al.,

Grady, and Holtzen (2014) highlighted the

2014; Nyamathi et al., 2012; Slesnick et al., 2007;

need for greater supply of affordable housing

McCay et al., 2015). Another seven (37 percent)

for youth exiting transitional housing as well

recruited through shelters (Bender et al., 2016;

as expanded community services tailored to

Thompson et al., 2017; Fors and Jarvis, 1995;

the needs of particular subpopulations. Some

Slesnick et al., 2013; Shein-Szydlo et al., 2016;

studies indicated similar factors associated

Hyun, Cho Chung, and Lee, 2005; Grabbe, Nguy,

with higher likelihood of program attrition and/

and Higgins, 2012). One of the seven unique

or poorer outcomes, particularly related to

studies of family interventions explicitly recruited

housing stability, following program participation.

from a drop-in center (Milburn et al., 2012),

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Chapter 7. Systematic Evidence Review

and three recruited from shelters (Slesnick and

among youth experiencing homelessness at the

Prestopnik, 2009; Slesnick et al., 2013; Winland,

population level unless and until the problems

Gaetz, and Patton, 2011). All three of the unique

with uptake and retention are addressed.

studies of employment programs recruited youth

from a drop-in center.

Relatively few studies reported intervention

uptake rates. This is general y best reported

The extent to which many interventions relied

with a flow diagram consistent with Consolidated

on youth drop-in centers and shelters to identify

Standards of Reporting Trials (CONSORT)

and recruit participants begs the question as

guidelines, revealing the numbers of individuals

to whether many of the interventions evaluated

eligible as well as those excluded for different

by studies included in this review would have

reasons, including, among others, refusal or

been viable without such front-end entry points

access problems that relate to uptake (rather

in community systems for youth experiencing

than eligibility) (Moher, Schulz, and Altman,

homelessness to begin engaging with services.

2001). Only five publications representing

four unique studies included such a diagram

One unique study compared a drop-in center

(Slesnick et al., 2013; Guo, Slesnick, and Feng,

to shelters directly through a randomized trial

2016; Guo and Slesnick, 2017; Shein-Szydlo et

and found that youth referred to a youth drop-in

al., 2016). Another seven unique studies reported

center were more likely than those referred to

results on uptake (Bender et al., 2016; McCay et

(mostly adult) shelters to report a higher number

al., 2011; McCay et al., 2015; Tucker et al., 2017;

of service connections (Slesnick and Kang,

Cauce et al., 1994; Davis, Sheidow, and McCart,

2016). The authors posited that the findings

2015). Altogether, 11 unique studies reported

suggest that youth drop-in centers may be

uptake results.

particularly important front-end elements of

coordinated community systems for addressing

Most studies indicated uptake rates of

youth homelessness, even though the U.S.

about 90 percent or higher (McCay et al.,

government al ocates little funding to drop-

2015; Tucker et al., 2017; Cauce et al., 1994;

in centers—and associated street outreach

Guo and Slesnick, 2017; to Davis, Sheidow, and

programming—compared with shelters and other

McCart, 2015). This suggests that, overal , many

services.

youth experiencing homelessness are open to

receiving support. Notably, however, most of

Uptake and retention

these studies recruited through drop-in centers

Uptake and retention are important because

and shelters, meaning they were reaching youth

they relate to the generalizability of an

already demonstrating at least some degree of

intervention. Uptake refers to the share of

wil ingness to access services.

people offered the program who decide to

In other cases, uptake—that is, agreeing to

participate. Retention refers to the share of

participate in the intervention and going to

those who decide to participate in the program

at least one activity—was comparatively low.

who participate to some defined degree or

Ferguson and Xie (2008) reported 16 percent

duration as expected by the program. An

uptake of the SEI among street-living young

impact evaluation can show an intervention

adults in an earlier study, and a 64-percent

to be highly effective in improving outcomes

uptake in a later comparative study (Ferguson,

among participants. Nevertheless, if only a small

2018) of SEI and IPS. Slesnick et al. (2013)

percentage of the target population participates

reported a 46 percent uptake of three family

in the first place, or remains in the program, then

or individual treatment among adolescents

the intervention will nonetheless have limited

(ages 12–17) staying at a temporary runaway

applications in strategies to improve outcomes

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Chapter 7. Systematic Evidence Review

shelter. McCay et al. (2011) reported a 42

Davis et al., 2015; Dialectic Behavioral Therapy

percent uptake of a relationship-based group

evaluated by McCay et al., 2015; YP4 evaluated

intervention for street-involved youth. Bender et

by Borland, Tseng, and Wilkins, 2013; and the

al. (2016) reported a 68 percent uptake of Project

Social Enterprise Intervention and Individual

SAFE, a three-day risk detection intervention

Placement Support evaluated by Ferguson 2017).

targeting young adults staying at a shelter. All

These were general y intensive and multi-month

these sample young adults with comparatively

interventions. Many of them demonstrated

lower uptake rates were actively homeless, in

positive results despite attrition, but results could

most studies also had diagnosed mental health

have been biased by loss to follow-up. These

disorders as eligibility for inclusion, and may

high attrition rates underscore the difficulty of

have been more chal enging to recruit.

engaging highly vulnerable and often transient

groups of youth in intensive programs over an

A greater number of studies reported

extended period of time, which can diminish the

statistics on retention, although varying

generalizability of interventions’ impacts.

types of retention results were provided.

Some reported the percentage of participants

Interventions employed several techniques

that completed the intervention (however the

aimed at increasing uptake and retention.

study defined completion) whereas others

Although most of these measures were not

reported those that participated in certain

experimental y tested, several studies did

numbers of sessions or for certain durations.

note specific intervention design adjustments

Overal , 25 (54 percent) unique studies reported

and adaptations intended to increase uptake

some type of data on intervention, retention,

and retention among youth experiencing

or attrition. Intervention attrition—that is,

homelessness or at-risk for homelessness. These

discontinuing participation in an intervention prior

included adjustments and adaptations such as

to completion, however defined by the program—

the following—

varied considerably, ranging from less than one

percent for a “housing first” rental subsidy and

Providing financial incentives and supports.

support services model evaluated by (Kozloff

• In the Kozloff et al. (2016) “Housing First”

et al., 2016) to as high as 93 percent for a

intervention, receipt of rental assistance

substance use treatment intervention for runaway

required weekly contact with a mental

adolescents (Slesnick et al., 2013).

health worker.

Attrition was relatively high among longer,

• In the Guo and Slesnick (2017) strengths-

more intensive interventions involving

based outreach and advocacy intervention,

significant structure. Both transitional housing

participants received $5 food gift cards for

programs for youth experiencing homelessness

participation in every advocacy session.

reported relatively high attrition rates: 53

percent for the Daybreak program (Pierce,

• The therapeutic intervention evaluated by

Grady, and Holtzen, 2014) and 87 percent for

McCay et al. (2015) offered youth $5 for

the Community Unity Project (CUP) program

attending each session.

for young mothers (Duncan et al., 2008).

• The employment intervention evaluated

Several other interventions reported attrition

by Ferguson, Xie, and Glynn. (2012)

rates of about 50 percent or higher (YVLifeSet

provided gift cards to youth for their

evaluated by Valentine, Skemer, and Courtney,

time participating in initial meetings with

2015; Ecological y-Based Family Therapy and

employment specialists.

Motivational Enhancement evaluated by Slesnick

• Two of the intensive case management

et al., 2013; Multisystemic Therapy evaluated by

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Chapter 7. Systematic Evidence Review

interventions (Valentine, Skemer, and

of the transience of youth experiencing

Courtney, 2015; Cauce et al., 1994)

homelessness. However, intervention

included flexible funds for some youth

developers need to balance convenience

participating in the program to access

with impact, and, in some cases, longer

financial assistance for a range of basic

term exposure to programming might

needs.

be more impactful for this population.

The vast majority of studies also offered cash or

For instance, with the adaptation of

gift card payments to youth for participating in

Multisystemic Therapy (MST) to young

data collection.

adults, the researchers increased the

duration of intervention exposure as well as

• Delivering interventions where youth

the supports provided to youth compared

and their families could most easily

to the standard MST model (Davis,

access them. One study, for instance,

Sheidow, and McCart, 2015). Further

found greater engagement in family

research into the necessary duration

interventions that were delivered home-

and intensity of interventions to optimize

based, rather than office-based, given

both uptake and effectiveness with youth

the time and transportation constraints

experiencing homelessness is warranted.

that runaway youth and their families

Overal , the included studies made surprisingly

often face (Slesnick and Prestopnik,

little reference to engaging youth and young

2009). Other interventions reached out

adults in the decision-making processes

to youth in streets, shelters, and drop-in

regarding intervention design and delivery.

centers. Theodos et al. (2016) described

Given empowerment-based social theory

flexibility among promotores—mentors

that suggests that the more participants are

and advocates for youth—in meeting youth

engaged and feel ownership in programming,

at their homes, schools, and community

the more likely they are to actively participate

locations, as well as communicating

(Jennings et al., 2006), omission of authentic

through phone, text, email, and social

youth collaboration could be one reason for

media, to maximize engagement.

common difficulties with uptake and retention

• Adjusting intervention intensity

reported by many intervention studies. Ferguson

or duration. In some adaptations of

(2013) cited one example of youth participating

interventions for youth experiencing

in decision-making regarding the contents of

homelessness, the modified versions

training curricula, but it remains unclear whether

included fewer sessions given the

and how this is related to intervention uptake

transience and practical constraints on the

and participation. In future research, it would

population. For example, the Ecological y-

be useful to investigate the extent to which

Based Family Therapy model involved

authentic youth collaboration affects uptake and

an adapted and shorter version of the

participation, and under what circumstances.

Homebuilder’s family preservation model

Knowledge gaps

(Slesnick and Prestopnik, 2009), the

adaptation of Dialectical Behavior Therapy

In addition to intervention lessons from a

for youth experiencing homelessness

growing evidence base, this review also

(McCay et al., 2015) involved shortening

reveals significant knowledge gaps that

the intervention from 16 to 12 weeks, and

present blind spots for developing more

Grabbe, Nguy, and Higgins (2012) noted

evidence-informed policies and programs.

shortening an adaptation of a spiritual

In particular, areas in which we found little to no

and meditative intervention in recognition

evidence from rigorous experimental or quasi-

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Chapter 7. Systematic Evidence Review

experimental studies of interventions addressing

have been in foster care. We identified only

youth homelessness included the following—

one includable study of a school-based

prevention intervention (MacKenzie and

• Prevention. The literature synthesized

Thielking, 2013), which was conducted

by this review reveals a heavily skewed

in Australia and presented only pre-post

distribution of evaluations toward

outcomes during a 12-month period. We

interventions aimed at responding to

did not identify any includable studies of

the needs of currently homeless youth

interventions delivered through juvenile

as opposed to interventions to prevent

or criminal justice systems to prevent or

youth from experiencing homelessness

address youth homelessness, despite

in the first place. Of the 46 unique

the high overlap of justice systems and

studies included in this review, only 3

homelessness experiences among youth

evaluated what we classified as prevention

and young adults.

interventions because they did not target

youth experiencing homelessness but did

• Prominent housing models for youth

measure homelessness as an outcome.

and young adults. Studies of transitional

Only one of these involved a randomized

living programs were scarce and general y

evaluation (Valentine, Skemer, and Courney,

involved significant methodological

2015).

limitations, and we identified no includable

studies of rapid rehousing programs,

• Public systems-based interventions.

host home programs, or youth-specific

Public systems with vulnerable youth in

emergency shelters, despite the significant

their care, including child welfare systems,

reliance on these among Federal programs.

schools, juvenile and criminal justice

Absence of evidence does not necessarily

systems, present important entry points for

mean that these interventions are not useful

prevention and early intervention of youth

in the continuum of services for youth,

homelessness given the large numbers

but we do not have enough evidence to

of youths experiencing homelessness

understand the effects of these types of

that have histories of interactions with

housing interventions on youth outcomes.

these systems (Morton et al., 2017). One

study evaluated an approach to reducing

• Interventions tailored to, or tested

runaway episodes among youth currently

for, specific high-risk subpopulations.

in foster care (Clark et al., 2008), and

Recent national evidence demonstrates

two studies evaluated the effects of

that certain subpopulations—particularly

interventions for youth that had been in

Black and Hispanic youth, LGBTQ youth,

foster care to support their transitions

and pregnant and parenting youth—are at

(Valentine, Skemer, and Courtney, 2015;

significantly higher risk for experiencing

Lim, Singh, and and Gwynn, 2017;

homelessness compared to their peers

Jones, 2011). All these studies revealed

(Morton et al., 2018; Olivet et al., 2018).

positive intervention effects on outcomes

However, these disproportionate risks

related to housing stability, among other

were rarely addressed by the evaluative

outcome areas. Although more evaluation

literature. No included studies, for example,

is needed to test different approaches

involved interventions specifical y designed

and in different contexts, these results

to target or to be cultural y sensitive to

are altogether promising for the capacity

Black or Hispanic communities, nor did

of intensive interventions to prevent and

they conduct moderator analyses based

reduce homelessness among youth who

on race or ethnicity to examine whether

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Chapter 7. Systematic Evidence Review

these subpopulations benefited similarly

and what does not, to address the specific needs

or differently from interventions compared

of young parents and their children experiencing

to their peers. This could be a useful

homelessness.

opportunity for secondary data analysis

based on many of the existing evaluations.

• Outreach programs. Only one study

evaluated an outreach intervention, but it

Two studies specifically evaluated intervention

was also designed to evaluate comparative

effects for LGBTQ youth. One study (Powell

effects of referring youths to a drop-in

et al., 2016) evaluated iTEAM, an intensive

center versus a shelter, so the specific

case management and treatment intervention

intervention effects of the strengths-based

specifical y designed for LGBTQ youth showed

outreach and advocacy approach could

promising improvements in a range of youth

not be discerned (Guo and Slesnick,

outcomes, but the study lacked a comparison

2017). Considerable scope for innovation

group, so cautious interpretation is warranted.

exists within outreach programming.

The other study (Grafsky et al., 2011), involved

For example, programs have employed

secondary data analysis of an RCT of the

approaches ranging from outreach vans,

Community Reinforcement Approach (CRA)

to systematic outreach mapping, to

with street-living youth and found that gay,

coordination with community resources,

lesbian, and bisexual youth reported even greater

to information and communication

reductions in drug use and depressive symptoms

technology-based youth engagement,

than other participants, suggesting that, in this

to advertised “magnet” events for youth

case, a specific intervention based on sexual

experiencing homelessness. All these

orientation is not needed, though therapeutic

approaches were employed to improve

relationships and interventions tailored to the

reach and ability to connect youth with the

needs of individual youth are likely important.

knowledge and services they need to avoid

An especial y notable absence of evidence

risks and exit homelessness. However, this

on interventions to prevent homelessness is

review revealed a clear lack of evidence

prevalent for LGBTQ youth given the substantial y

on the effectiveness of different outreach

higher risk of homelessness these youth face in

approaches and in different contexts.

comparison to their non-LGBTQ peers.

• Interventions for rural communities.

One included study (Duncan et al., 2008)

Recent national evidence suggests

evaluated an intervention designed for

that youth homelessness is similarly

pregnant or parenting youth. This study

prevalent in rural communities as it is

evaluated a transitional housing program

in non-rural communities. Further, the

with coordinated services for young mothers

literature underscores the need for tailored

experiencing homelessness. However, results

interventions and service delivery models

related to program impacts from this trial were

to address youth homelessness in rural

largely uninterpretable, and results related to

contexts given greater hiddenness of

intervention retention suggested significant

these youths’ experiences and more

chal enges with maintaining participation.

limited service infrastructure spread over

Approximately one-third of the Promotor Pathway

a wider terrain (Skott-Myhre, Raby, and

Program evaluation sample were parents

Nikolaou, 2008). Although a significant

(Theodos et al., 2016), and the study found that

number of included studies evaluated

program engagement was higher among parents

city-based interventions, we identified

than it was for non-parents. Overal , a clear lack

no includable studies of interventions

of evidence pervades the reviews on what works,

specifical y designed for, or tested with,

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Chapter 7. Systematic Evidence Review

youth experiencing homelessness in rural

languages or to find them would require broader

communities.

international outreach. Moreover, although our

• Cost-benefit and cost-effectiveness.

professional outreach and online searches for

Cost-benefit and cost-effectiveness

relevant studies were extensive, many local

analysis are two types of economic analysis

agencies, researchers, and funders produce

that can be integrated with effectiveness

unpublished studies that are difficult to find and

studies and which are important for

might not be known to national experts. Again,

decision-makers to appraise the sensibility

this could result in missing relevant evidence.

and feasibility of implementing interventions

The comprehensiveness of the review was both

at scale. Cost-benefit analysis gauges

a strength and a limitation. It meant that we

the economic worth of an intervention—

could capture and synthesize the evidence from

in other words, the extent to which the

a broad range of evaluations relevant to a broad

monetized returns of an intervention’s

range of stakeholders in the work to end youth

impacts (for example, through reduced

homelessness. However, to keep the synthesis

costs on utilization of public systems

manageable for both the team and the reader,

or increased earnings or productivity)

the synthesis reported in this chapter lacked

exceed the costs of intervention. Cost-

significant depth for any particular intervention

effectiveness assesses the costs required

or outcome area and aimed to more general y

to achieve certain outcomes and compares

summarize the evidence and notable findings.

these per output costs between possible

Going forward, subject to available resources, it

interventions (for example, the relative costs

may be useful to provide deeper analysis of the

between different interventions required to

identified evidence for specific intervention or

achieve a one-year-per-participant increase

outcome areas for specific audiences. Relatedly,

in stable housing). None of the included

because of the breadth and heterogeneity of

studies in this review reported either cost-

interventions, outcomes, and evaluation designs

benefit or cost-effectiveness analysis. Only

included, we also did not conduct any statistical

one included study reported the estimated

meta-analysis of intervention effects and instead

per beneficiary cost of intervention (Pierce,

used a simpler descriptive tables’ schematic to

Grady, and Holtzen, 2014).

organize, rather than meta-analyze the evidence

The aforementioned areas present critical needs

base within different intervention types. Again,

for strengthening the evaluative evidence base

it may be useful going forward to consider

on what works, and what does not, to prevent

conducting meta-analysis with narrower subsets

and address youth homelessness.

of studies included in this review.

Limitations

Further, the review al owed for a wide range of

effectiveness study designs, considering the

Despite the important strengths and

anticipated nascent nature of the evaluative

comprehensiveness of this systematic

evidence base in many areas of youth

evidence review, several limitations are also

homelessness intervention and the interest in

noted. First, the search strategies were only

understanding the ful er scope of research that

conducted in English, and while we tried to

has been conducted. Consequently, many of

include international outreach, the majority of

the studies we included were low-rigor designs

the review team’s relevant professional network

from which results need to be interpreted very

was U.S.-based. As a result, we possibly could

cautiously given high risk for bias. We have tried

have missed relevant studies—especial y

to make these distinctions clear for the reader

grey literature—that are only available in other

in both the tables and the narrative description

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Chapter 7. Systematic Evidence Review

of findings. Final y, this review was limited to

At the same time, the review also reveals clear

effectiveness studies. Although we searched for

areas for coordinated action by practitioners,

and included process evaluations, those will be

funders, policymakers, and researchers. For

synthesized and reported later.

instance, while encouraging, most intervention

effects on housing or homelessness outcomes—

Conclusion

where they existed—were modest with

This systematic review offers the most

many program participants still experiencing

comprehensive and up-to-date review of the

concerning degrees of homelessness and

evidence supporting interventions to address

housing instability at follow-up. To truly end

youth homelessness. We identified and reviewed

youth homelessness at the population level, the

nearly 4,000 potential y relevant studies and,

successes of these interventions need to be

following thorough screening, included 62

augmented by investigation into the reasons as

publications representing 51 unique effectiveness

to why some youth do not benefit as much as

studies of 48 interventions. The synthesis

others.

of these studies al ows for unprecedented

Moreover, the results of evaluations of family

insight into the size, scope, and findings of

interventions were varied, and the only

the evaluative literature on the effectiveness

randomized evaluations of family interventions

of interventions to prevent and address youth

did not measure stable housing outcomes and,

homelessness.

overal , showed limited effects on permanent

Some of the takeaways are encouraging. For

connection outcomes. Only two employment

example, although the prevention evidence

interventions were tested with youth experiencing

base is thin, all three of the interventions that

homelessness, and they failed to demonstrate

incorporated methods for identifying at-risk

positive effects on employment outcomes.

populations of youth homelessness and aligning

Furthermore, little to no effectiveness evidence

tailored supports and services to meet their

exists on prominent housing and shelter models

needs succeeded in reducing the likelihood

for youth experiencing homelessness, such as

of these youth experiencing homelessness.

youth shelters, host homes, rapid rehousing, and

When adequately resourced for individualized

transitional housing, leaving pending questions

relationships and supportive services, intensive

regarding the applications of such interventions

case management and mentoring programs had

and the circumstances under which different

positive effects not only on stable housing, but

approaches might work best.

also a range of other outcomes. Additional y,

Effective and efficient strategies to prevent

a wide range of individual counseling and

and end youth homelessness require a robust

treatment interventions were associated with at

evidence base to inform decision-making. This

least short-term improvements in risk-related

systematic review presents an important starting

knowledge and behaviors as well as social-

point to inform solutions, and it also pinpoints

emotional wel being. Although these gains may

areas in which investments in research and

be insufficient and short-lived by themselves

evaluation are urgently needed to help advance

to help youth escape homelessness without

the agenda.

further intervention, they nonetheless suggest

that even modest interventions can support

harm-reduction and improved wel being amidst a

highly vulnerable time in these youths’ lives, and

therefore many of these interventions can serve

as useful complements to broader systems of

support.

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Chapter 7. Systematic Evidence Review

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Chapter 8. Policy and Fiscal Review

Chapter 8. Policy and Fiscal Review

Highlights

• We examined policy entry points for

• Many consultation participants highlighted

better addressing youth homelessness

a need to consider the various services

and conducted consultations with diverse

that would need to be provided in

stakeholders in six diverse counties to better

tandem with policy options to augment

understand opportunities and chal enges for

the potential for policy success.

improving the policy environment on this issue.

• There is a common recognition of lack of

• Service providers faced significant chal enges

sufficient funding and resources as drawbacks

in their ability to access and deliver services

to policy options that seek to improve service

to youth experiencing homelessness.

provision to youth experiencing homelessness.

• There is a common need to streamline the

• A lack of housing and geographic stability

provision of services to better respond to the

is a critical chal enge to providing services

needs of youth experiencing homelessness.

for youth experiencing homelessness.

Background

areas. Final y, it asked service providers on

the ground how modifications to such policies

Within the larger VoYC initiative, the Policy and

would impact their service provision, and

Fiscal Review (PFR) component provides an

presented considerations for making such policy

opportunity to learn more from stakeholder

changes. Taken together, the PFR represents

groups that VoYC has not ful y engaged through

a multidimensional approach to develop better

the study’s other research components of

methods and instruments for targeted policy

this report. To better serve homeless youth,

analysis and bring a complementary and

perspectives and experiences of stakeholders

qualitative research-based lens into the field of

were collected through consultations, focusing

youth homelessness.

on existing opportunities and chal enges at the

local level.

Methodology

This component collected data across the

Stakeholder discussions and review of

following stakeholder groups: public and

statutes and regulations

private groups involved in addressing the issue

of youth homelessness at the national and

The large number of Federal statutes and

local levels and county-level providers of child

regulations that directly or indirectly address

welfare services, behavioral health services,

the chal enge of unaccompanied minors and

juvenile justice services, education services,

youth experiencing homelessness required a

and Continuums of Care (CoCs). It followed an

process for winnowing out the most salient

approach that began with a broad review of

policies to consider in the PFR, particularly

existing policy and fiscal analysis frameworks. To

given the two-hour time frame we had for each

begin, this component asked key stakeholders

consultation. This second step consisted of

for their input in identifying the main policy areas

convening a diverse set of stakeholders involved

of interest, followed by a review of the statutes

in addressing the issue of youth homelessness

and regulations relevant to the identified policy

at the national and local levels. These

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185

Chapter 8. Policy and Fiscal Review

stakeholders consisted of members of the A Way

improving the outcomes of youth experiencing

Home America (AWHA) Steering Committee,

homelessness. The representatives were

which include service providers, advocates,

asked for: (1) their top two policy questions;

researchers, local and Federal government

(2) questions regarding programs for youth

agencies, and philanthropists working together to

experiencing homelessness; (3) questions

prevent and end youth homelessness.

regarding the intersection of youth experiencing

homelessness and child welfare, behavioral

Two videoconferences with different

health, juvenile justice, and education; and

representatives from AWHA membership were

(4) questions regarding fiscal policy. The data

held in May 2017. Members of the PFR team

collected from these two discussions were

facilitated the videoconferences, which consisted

subsequently aggregated and tagged for

of targeted questions that chal enged the

conducting a thematic analysis, the results of

participants to identify the policy areas with the

which are listed in Table 8.1.

greatest potential, if modified, for preventing and

Table 8.1. Stakeholder discussion themes

Policy Areas

Emergent Themes/Questions

Homeless youth numbers

Top two policy questions

How policies and agencies challenge service provision

The role of government

Age and eligibility

Specific youth homelessness programs

Funding

Expanding access

Eligibility and entry

Child welfare

Improving the discharge process

Child welfare role and accountability

Health coverage

Behavioral health

Discharge planning from substance abuse treatment

Service quality

Negative effects of federal juvenile justice statutes

Juvenile justice

Inter-agency col aboration and discharge

Access to higher education

Education

Strengthening existing policies

Supporting communities

Fiscal policy

Actual costs

The themes from the stakeholder discussions

with systems representatives and CoCs. The

informed the key policy areas that were identified

pertinent Federal statutes and regulations

for the PFR as well as the interview questions

were reviewed to contextualize the themes that

that were used in the county consultations

emerged from the stakeholder discussions and

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Chapter 8. Policy and Fiscal Review

to ensure that the county consultation questions

The six VoYC counties that were selected

that were developed from these themes

and invited to participate were Boyd County,

were as targeted and specific as possible.

Kentucky; Cleveland County, Oklahoma;

Additionally, a conference cal was conducted

Davidson County, Tennessee; Kennebec County,

with representatives from the U.S. Department of

Maine; King County, Washington; and Orange

Housing and Urban Development (HUD) to better

County, Florida. Five of the six invited counties

understand statutory and regulatory areas of

were successful y recruited for participation in

interest that the PFR may be able to explore. The

the consultations. However, after a strong effort

questions on coordination of homeless services

to identify stakeholder representatives from the

for youth, rapid re-housing for youth, and

systems of interest, Boyd County was unable

transitional housing for youth in the final protocol

to convene within the required timeframe. Boyd

were those that specifical y took the HUD policy

County faced a number of chal enges, including

areas of interest into account.

summer breaks and other impending deadlines.

Consultations with county service

Recruitment

providers

The PFR leveraged the relationships formed

To gain the insights of service providers on

during the Youth Count to recruit representatives

the ground, the third and final step of the

from child welfare, behavioral health, juvenile

PFR consisted of holding group consultations

justice, education services and programs, and

with a subset of the 22 VoYC initiative partner

the CoC within each of the six selected counties.

counties. The aim of these group consultations

Three inclusion criteria were identified for any

was to convene at least one stakeholder from

system representative invited: an ability to

each of the following systems: child welfare,

speak about the problems youth experiencing

behavioral health, juvenile justice, education,

homelessness faced in their county, knowledge

and the CoC within a county and engage them

of the services and programs available to

regarding the impact of Federal policies at the

this population in their county, and a general

county level. The focus of the consultations was

understanding of how policies impact programs

on how Federal policies impact the services

and the provision of service to this population.

and programs unaccompanied minors and

To recruit participants, we collaborated with

youth experiencing homelessness and housing

the VoYC lead partner in each county, who

instability receive at the local level.

was asked to help with the identification and

Site Selection

recruitment of representatives from each of the

five system areas. The identified representatives

The PFR used purposive methods to select six

were then invited to participate. Twenty-five

of these 22 counties. In doing so, we considered

individuals from across the five counties joined

the following factors—

the consultations, representing the various

stakeholders’ systems as indicated in Table 8.2.

• Obtaining a diverse set of counties that

In some cases, more than one representative

included urban, rural, suburban, and smal -

participated from a stakeholder group, whereas,

metro jurisdictions

in others, one individual represented more than

• Ensuring broad geographic representation

one stakeholder group.

• Wil ingness of the counties to provide key

contacts from the systems of interest and

to participate in a two-hour consultation by

phone

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Table 8.2. Consultation participants

Number of Participants

Systems Represented

Across 5 Counties

Behavioral health

6

Child welfare

4

Education

3

Juvenile justice

3

Continuum of care

8

Other homelessness experts

3

Notes: Representatives from all five counties spoke about having a largely comprehensive system of services that in some counties included partnerships with various county agencies and community organizations to create a resource and referral network. They also spoke of efforts to establish a single entry point and to provide wrap-around services so youth did not experience gaps in services, and the establishment of a liaison within some agencies who was responsible for connecting youth to services.

Data collection

Data analysis

Data were collected from July through August

To store, manage, and analyze our data, we used

2017 by phone through semi-structured focus

the qualitative software program NVivo 11Pro.

group discussions. A consultation protocol was

All of the qualitative data were uploaded to the

used to guide the discussions. After the initial

NVivo server: digital files of the audio interviews,

consultation, a few modifications were made

transcripts, timing tracker, and backup notes. To

to the protocol to clarify the purposes of the

increase objectivity in the analysis of the data,

consultations and some of the questions. The

data were coded following Maxwel ’s (2013)

protocol was modified to provide participants

qualitative data coding strategy.

with additional context about the VoYC initiative

and overarching framing of the policy questions

Results

and consultation objectives. Other modifications

included a reordering of the sequence of policy

The purpose of the PFR is not to propose

questions to ensure time for broader coverage

changes to statutes and regulations. Instead,

of issue areas, as well as a reframing of some

the goal is to identify the most important

questions to make them easier to understand.

considerations policymakers should keep in

mind when weighing various policy options so

The interviews were audio recorded, and a

that they can make informed decisions. As such,

private company was contracted to provide

the presentation of the results was designed

full transcriptions of the group conversations.

to provide policymakers with background

At least three PFR team members participated

information of each issue across the five

in each of the consultations. One member

participating counties. This includes the potential

was responsible for guiding the group through

reaction of service providers at the county level

the interview protocol, the second member

to proposed policy options, and the potential

provided technical support and kept track of

benefits and drawbacks, from the perspective of

which participants spoke at which point of the

service providers that policymakers should be

interview, and the third member was the note-

aware of when considering policy changes.

taker.

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The results presented below follow the

Policy area 1: Homelessness: Overview of

consultation protocol, which consisted of nine

existing county needs and services

distinct areas of policy interest related to youth

homelessness—

Participants in each of the five counties were

asked to provide an overview of their county’s

(1) an overview of existing county needs and

problem regarding youth homelessness, ages 13

services

to 25, including existing needs and chal enges,

services available in their county to this

(2) the coordination of county planning meetings

population, and changes they would like to make

to allocate homeless services

to their county’s system of service provision.

(3) access to the Basic Center Program and

Existing challenges. Table 8.3 lists the existing

other emergency shelters

chal enges that emerged from the consultations.

(4) access to transitional housing assistance

Chal enges are listed from most prevalent across

the five counties to least prevalent. The three

(5) access to rapid rehousing

most prevalent chal enges speak to different

(6) the scope and responsibility of the county

dimensions of the overall theme of the limitations

child welfare system

of adequately servicing the population of youth

experiencing homelessness. The most common

(7) access to behavioral health services

need was greater access to shelters and

housing, including age-appropriate options for

(8) juvenile justice and discharge policies

minors. As one participant stated: “[T]here are

(9) access to education and retention and

some shelters in our county, but for a 13-year-

transition issues

old, a shelter can be a very scary place… [H]

aving a stable place to stay is… a necessity here

in our county.”

Table 8.3. List of existing challenges in addressing youth homelessness

Number of

Existing Challenges

Counties

Lack of shelters, housing, and placement

4

Measuring the size of the problem

3

Legal limitations to services as minors become non-minors

3

Inability to reconnect youth with family given conflict at home

2

Serving special populations, including disabled and LGBT

populations

2

Access to healthcare and education, including transportation

1

Cycle of entering and leaving the system

1

Limited outreach efforts to identify more youth in need

1

Human trafficking

1

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Participants in three different counties also spoke

Available services. Table 8.4 lists the services

about the chal enge of measuring the size of the

that emerged from the question of what

problem. When asked to describe the problem

services are available to youth experiencing

of youth homelessness, one participant simply

homelessness in each of the five counties.

stated, “hidden,” indicating that chal enges exist

Participants in all five counties spoke about

in identifying and supporting the population.

having a largely comprehensive continuum

The third most prevalent chal enge was the

of services. In some counties this included

legal limitations that arise in supporting non-

partnerships with various county agencies and

minors as well as minors who are about to turn

community organizations to create a resource

18. A participant in one county specifical y

and referral network. Other services that

spoke about why this is a chal enge to service

emerged included efforts to establish a single

providers: “[18-year-olds] age out of the system,

entry point and to provide wrap-around services

and so then they have adult chal enges with

so youth did not experience gaps in services,

housing, and they are leaving a system that

and the establishment of a liaison within some

supported them before, but now they have

agencies who was responsible for connecting

nowhere to go, literal y. And so their chal enges

youth to services. The prevalent available

are a lot greater and more unique in trying to

services delivered by those continuums were

house them as opposed to the 18 and under

shelters and housing followed by supports for

where they have a little bit more support, and

access to education.

there is a system there for them.”

Table 8.4. List of available county services

Available Services

Number of Counties

Shelters and housing

4

Access to education

3

Services to prevent abuse and neglect

2

Anti-trafficking

2

Therapy and counseling

1

Proposed changes to system of service

many communities are at relatively early stages

provision. Participants in all five counties were

of developing a truly system-level response to

also asked about what changes to their county’s

youth homelessness. Comments regarding this

system of service provision they would like to

theme included expanding current services to

make. The proposed changes that emerged

serve a greater number of people, establishing

from this question, listed in Table 8.5, largely

a more robust coordinated entry system, and

overlapped with the list of available services

having more flexibility in serving youth over age

from the previous question, suggesting room

18. The remaining proposed changes, although

for improvement in how the five counties are

distinct, addressed approaches to increasing

supporting this population. The theme of wanting

both the quality and quantity of services.

a more seamless system of service provision was

mentioned in all five counties, underscoring that

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Table 8.5. List of proposed changes to the system of service provision

Proposed Changes

Number of Counties

A more seamless system of service provision

5

Greater housing availability

3

Greater focus on prevention efforts

2

Tailored services to special populations, including women

and those with mental il ness

2

More focus on data col ection

1

More funding

1

Greater focus on mobile services

1

More transportation services

1

Policy area 2: Homelessness:

consistently involved in their respective county’s

Coordination of county planning meetings

planning process, indicating that the voices

of youth were largely absent across the five

Participants across the five counties were

counties. As one participant said, “At the last

asked to describe the extent to which the

meeting, the youth board showed up and said,

voices of youth experiencing homelessness

‘You know, we’ve been coming to your meetings.

were represented at their county’s homeless

You have not been coming to ours…’ And I do

services planning meetings, and the impact

believe that there is a meeting coming up where

such representation had on the county’s service

all will be going and meeting with… the youth

provision. Participants in four of the counties

advocacy board.” In one county, the group had

were also asked to consider regulatory or

not yet been involved in all county planning

statutory changes that required including a

matters because the group was relatively

discussion of issues specific to young people

nascent: “We have not yet involved them on

and/or the presence young people who had

broader CoC conversations. Since they’re new,

experienced homelessness at county planning

they’re still learning their role, their function in the

meetings, and to speak about the benefits and

system, and how they can be involved with it.”

drawbacks of such a policy option.

Despite the lack of participation of youth across

Youth representation and the impact on

the five counties, participants in all counties but

service provision. Among five counties, three

one either expressed an interest in augmenting

participants shared that youth were not present

the role of youth in their county planning

at their county’s homeless services planning

meetings or shared that agency representatives

meetings, whereas two participants mentioned

made sure to serve as advocates for youth

that an organized group of youth in their county

at their county’s planning meetings. As one

did exist. Nonetheless, participants in the two

participant suggested: “[I]t may be best to create

counties with an organized group of youth

a youth council that meets on its own and is led

suggested that the groups were not actively or

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by an older youth—25 or 26 years old—who

Benefits of legally requiring greater

has lived experience as wel , and they would be

representation of youth. Participants in all

discussing the policy issues that come up at the

but one county were asked to consider the

statewide homeless council, that come up at the

policy option of legal y requiring that counties

continuum of care, that come up within agencies,

include in their county planning meetings

that come up at the department of health and

issues specific to youth who are homeless or

human services. And they would be giving formal

the attendance of youth who have personal y

feedback through their leader or representative.”

experienced homelessness, as well as to

consider the potential benefits of such a policy

The support for an expanded role of youth

option. Participants in three of the four counties

in county planning meetings was potential y

outwardly expressed that such a policy option

linked to the thoughts that participants in three

would be beneficial primarily because it would

counties shared regarding the impact that

al ow them to incorporate the voices of youth

the lack of representation of youth at county

in their service planning. As a participant

planning meetings has had on their county’s

mentioned: “[I]t’s always great to have people

service provision to this population. Participants

who will benefit from the service to be there.”

in two of the counties agreed that the lack of

representation led to a mismatch between the

Furthermore, participants from three of the

needs of youth and the services available to

counties shared thoughts suggesting that such

them. A participant stated: “We have to have

a policy option would help improve services to

[youth present] in order to know where to help

youth experiencing homelessness. A participant

and how to help… And if they’re not at the table,

shared that requiring youth at the county

then they aren’t necessarily aware of those

planning meetings would provide a different

initiatives and those projects that we’re working

perspective to service provision. A participant

on that will ultimately result in helping the better

from another county admitted that she and her

system of care.”

county colleagues needed a broader perspective

on the matter, indicating that such a requirement

For this participant, not having youth at the

would be beneficial. Similarly, a participant made

table not only meant that their voices were not

the following argument: “[W]e need to find out

included in the planning of services, but it also

where [youth] want to go and then build a bridge

meant that the services were less likely to be

to get there. So, without their voice, without

beneficial because the youth were not aware

knowing where it is they want to go, what their

of them. A participant from another county, on

actual needs are, how can we build a bridge if

the other hand, focused her comments on how

we don’t know the destination? So I think it’s

the absence of youth at the county planning

imperative that we have their voice. Otherwise,

meetings al owed agencies to advocate for their

we don’t know if we’re building a bridge to the

own interests, and she hoped that the inclusion

right place.”

of the recently formed youth advisory board

would help al eviate this issue: “I would say that

Drawbacks of legally requiring greater

clearly the providers who are involved are more

representation of youth. The participants in the

familiar with their own services and more likely to

same four counties were also asked to consider

advocate for their own services. I think the youth

the potential drawbacks of legal y requiring

advisory board is going to bring a more diverse

that counties include in their county planning

and youth-focused voice to the table.”

meetings issues specific to youth homelessness

or the attendance of youth with lived experience.

Some participants were unsure about supporting

such a policy option and offered their own

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modifications. A participant pointed out that

Policy area 3: Homelessness: Access

involving youth who had personal y experienced

to the Basic Center Program and other

homelessness could be harmful to them given

emergency shelters

the trauma they had already experienced, and

he suggested that their voices be included

Participants across the five counties were asked

in a less direct way: “[Y]ou have to keep in

to describe any chal enges their county faced

mind that you don’t want to hurt them again

with youth, ages 18 to 25, not being eligible to

with experiences that they’ve been through,

access the Basic Center Program and other

but they don’t necessarily have to be sitting in

emergency shelters with similar age limits.

the planning meeting, so to speak. As long as

Participants from four of the counties were also

they have a voice and a spokesperson for that

asked to consider the policy option of increasing

voice.” Another participant, on the other hand,

the age limit, and participants in three of these

questioned whether such an option should be a

four counties also proposed what the new age

requirement: “For some reason, I don’t love the

limits could be. Furthermore, participants from

word ‘required’ in that. I love using ‘encourage’…

two counties discussed the potential benefits of

but for some reason I just don’t like ‘required’.”

such a policy option, whereas participants from

four counties discussed the potential drawbacks.

The most prevalent drawback, which participants

from three of the four counties mentioned,

Challenges in emergency shelter services.

was that legal y requiring that youth be

Table 8.6 lists chal enges regarding providing

present at county planning meetings would

access to the Basic Center Program and other

present chal enges given that they would have

emergency shelters to 18- to-25-year-olds. The

no experience in such formal matters. As a

chal enges are listed from most to least prevalent

participant stated: “[T]o get youth to come and

across the five counties. Most prevalent was

talk about their issues is helpful, but it seems

a lack of emergency shelters. The comments

like they need proper training and a focused

regarding this chal enge focused on three

message… Many times you hear kind of the

different dimensions of the problem. The first

same thing, I don’t want to say over and over…

was the general unavailability of emergency

but making sure that we’re somehow developing

shelters for this age group. Such comments

this youth to have a strong pointed message that

emerged from participants in two counties, which

real y offers that solution.” Another participant

are rural and suburban counties, respectively,

agreed that youth would need to be trained in

and from one that is urban. Participants in

order to ensure that their personal participation

these three counties described long waitlists for

in county planning meetings would be beneficial:

accessing emergency shelters, having to refer

“I think it just has to be done very careful y

youth to emergency shelters in other counties,

because when you put youth into various

and 18- to 25-year-olds regularly being turned

structured committee meetings and they’ve had

away from emergency shelters because of

no experience in those kinds of processes, it

unavailability.

can be very overwhelming for them and end up

being more a negative experience than a positive

experience. So encouraging youth participation

in these complex committee processes has to

be done careful y and there has to be the right

amount of support for them in those processes.”

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Table 8.6. List of challenges in emergency shelter services

Challenges

Number of Counties

Lack of emergency shelters

4

Eligibility requirements

2

Lack of wrap-around services

1

The second dimension of the problem focused

even though they’re expected to. So, more

on the poor distribution of available emergency

opportunities for stable housing, even if it’s

shelters. Such comments emerged from

transitional, with subsidies or supports that

participants indicating that both rural and

will assist them in gaining skills that will lead

urban counties faced chal enges in providing

to stability and success as they make their

emergency shelters to 18- to 25-year-olds. A

transition to… adulthood. [S]helters may not

participant stated that the location of emergency

be it.” Another participant agreed, arguing that

shelters was related to how the wealth of the

instead of increasing the age of the shelters, the

county was distributed, which “affects who is

number of places that specifical y serve 18- to

able to access what,” suggesting that there is an

25-year-olds should be increased. A participant

element of social inequity in the accessibility of

from another county indicated that the focus

emergency shelters. The final dimension of the

should instead be on prevention services: “Is

problem of a lack of emergency shelters was the

there a way that we also make sure that we have

lack of age-appropriate facilities in which youth

more prevention services in places? Because

could feel safe. Participants explained that 18- to

otherwise we’re going to have a fantastic

25-year-olds would prefer to access emergency

emergency shelter system, but for youth who are

shelters for minors and that they avoid adult

at low risk at this point, there are things that we

emergency shelters because they do not feel

can do to keep them at low risk and get them out

safe. As a participant stated: “Youth that are,

of the risk category entirely.”

you know, 18, 19, 20, they don’t want to be in a

facility with a 40- or 50-year-old because they

The second most prevalent reaction regarding

don’t identify with them, and they don’t want to

the prospect of increasing the age limits of the

be in that similar environment. They’d rather have

Basic Center Program and other emergency

a peer-aged facility.”

shelters with similar age limits was the concern

of mixing minors and non-minors. Participants

Reactions to increasing age limits.

from three counties agreed that al owing youth

Participants in four counties were asked to

older than 18 to access the same shelters as

consider the policy option of increasing the

minors could be troublesome. As a participant

age limits to greater than 18 years of age for

highlighted: “My concern with increasing the age

accessing the Basic Center Program and other

of the youth shelter would be the same concern

emergency shelters with similar age restrictions.

that some of the young 18-year-olds don’t want

Participants in all four counties agreed that the

to go to the adult shelters… So the fear would

focus should be on providing this age group with

be that now we have an 18-year-old with more

other services rather than on extending access

experiences with our younger folks.” For this

to emergency shelter services. A participant

participant, the concern was especial y salient

shared: “They may be 18 and adults, but they

given incidents of human trafficking among

may not have the skill sets yet to be successful,

youth experiencing homelessness: “I guess the

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reason why I have so much pause is because our

peers: “The obvious benefit would be that those

increase in numbers of human trafficking victims,

young people still are not ready and able and

and my concern would be the unintended

capable to be independent, so they still would

consequences of blending the groups.”

get youth services, whether it be GED services,

helping them get IDs, and things like that.

Proposed increased age. Participants from

Developmental y, they’re still growing, so having

three counties were asked to consider the age to

them get those kinds of services compared to

which access to the Basic Center Program and

what’s offered in the adult services, they’re more

other emergency shelters with similar age limits

at that level.”

could be increased and why. Although different

ages were proposed, participants from all three

Drawbacks of increasing age limits.

counties agreed that the current limit of 18 was

Participants from all counties except one also

not developmental y appropriate, and that given

responded to the question of what the potential

that youths’ brains continue to develop into

drawbacks could be to increasing the age

their mid-twenties, there were good reasons for

limits for accessing the Basic Center Program

increasing the age. The most common proposed

and other emergency shelters with similar age

age was 24. Participants from all three counties

restrictions. Participants from all four counties

agreed that increasing the age limit to 24 was

agreed that doing so would put a strain on

appropriate. Some of the participants spoke

the existing services, making it difficult for the

about service provision when proposing this

policy change to affect improved outcomes. The

age. A participant stated: “And the reason why

participants focused their comments on a lack

I choose 24 is when we think about, again, of

of funding, a lack of resources, and workforce

those youth who choose to access services,

issues. A participant made the following

so this includes all people… it tends to drop

argument: “[W]ithout subsequent increases in

off around 22, 23.” A participant from another

funding, [al owing youth up to age 24] would

county thought along similar lines: “I think I

be almost impossible because the population

would like to go to 24 because I think that just

we’d be serving would multiply dramatical y, and

lines up with so many other services out there

we’d have to try and meet those needs with the

already, so it kind of helps just align things.”

same funds. So, if the Federal definition or the

state definitions were to change, it would have

Benefits of increasing age limits. Participants

to be accompanied with an increase of funding

from two counties provided feedback regarding

to serve that population.” A participant from

the potential benefits of increasing the age limits

another county echoed this sentiment: “It just

for accessing the Basic Center program and

seems to me that, even if that age was extended,

other emergency shelters with similar age limits,

I’m not exactly sure if there would be resources

and all the comments centered on the theme that

and accommodations available to meet a higher

doing so elevated the potential for helping youth

demand.”

exit homelessness. As a participant shared: “I

think it goes without saying: the more access

Policy area 4: Homelessness: Access to

that individuals have to stable housing will

transitional housing assistance

produce better, positive results.” A participant

touched on the developmental aspect when

Participants across the five counties were asked

considering her remarks, which suggest that

to describe the chal enges their county faced

increasing the age limits would align with the

with youth experiencing homelessness, ages

developmental view that many 18- to 25-year-

18 to 25, gaining access to transitional housing

olds remain developmental y more similar to

assistance, and to consider the policy option

their peers who are minors than to their adult

of increasing the 24-month limit to accessing

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Chapter 8. Policy and Fiscal Review

such services. Participants in two counties also

out of that.” Another participant mentioned

discussed the potential benefits of such a policy

that each agency sets its own eligibility criteria,

option, while participants from four counties

which led to inconsistencies in access: “[E]ach

shared their thoughts regarding the potential

agency also has criteria set for that as far as

drawbacks.

housing availability… So then that goes back to

the availability as far as what their waitlists look

County challenges. The most prevalent

like because… we have just a certain number

chal enge counties faced with youth ages 18

of transitional housing available here… So that

to 25 gaining access to transitional housing

would vary across the board.”

assistance was the lack of availability.

Participants from four counties mentioned that

Reactions to increasing the 24-month limit.

the transitional housing services available in their

Participants across the five counties were asked

county were insufficient given the demand. A

to consider the policy option of increasing the

participant shared that no transitional housing

24-month limit to accessing transitional housing

options were available, and that it compounded

services. Almost all the comments focused either

the problem of homelessness for youth: “We do

on additional steps that should be taken for such

have free units of transitional housing that youth

a policy change to affect positive outcomes or

from [our] county can access, but they are not in

on investing instead in other services. The most

[our] county… [I]f the housing option for a youth

prevalent reaction, which participants in all five

is a full county away, it dislocates them from

counties mentioned, was that other supports

their school, their natural supports, their family.

would be necessary for the increased 24-month

If our goal is to stay connected to permanent,

limit to contribute to the transition of youth out

caring adults, it presents a lot of chal enges.” A

of homelessness. Some of the participants

participant from another county explained that

spoke about needing to consider how such a

the problem of available transitional housing had

policy option would fit into the broader system

worsened over the last few years given funding

of transitional supports to assess how beneficial

restrictions and added that the county had

it might be. A participant stated: “[A]s far as

no plans to expand services: “[W]e just don’t

expanding [the 24-month limit], I mean, sure,

have a lot of transitional housing in our network

that is needed at times, but I think we have to

anymore… [W]e’ve had less in the past few

look at that… from a systems, from the whole

years.”

system level as far as, if we’re going to have

the transitional housing expanded, then in what

The second most prevalent chal enge

concept?” A participant from another county

that emerged was eligibility requirements.

agreed: “I think transitional housing has to be

Participants from three counties expressed

part of a larger service plan, a larger service

limitations in being able to provide transitional

package. That there need to be requirements

housing assistance to this population because

for participating with other services to remain

of official eligibility criteria. As a participant

in transitional housing.” Another participant

explained: “[A] lot of times people are ineligible

provided a set of services that should

even though they’re homeless. They’re ineligible

complement such a policy option: “I think you

for some services because they haven’t been

always have to keep in mind with housing the

homeless enough… We set our requirements

services that go along with it. There need to be

with the efforts, with the intent to serve the

case management services that go along with

chronical y homeless. But we almost create a

the housing to keep [youth] moving in the right

system where people have to not just hit bottom,

direction and not build that dependency, but

but drag bottom for a while before they’re eligible

build self-sufficiency.”

for the services they can get that can get them

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The second most prevalent reaction to the

eight people and the timeline is 24 months and

policy option of increasing the 24-month limit

you decide to extend it to 36, that’s great for

to transitional housing services was that the

those eight people, but it doesn’t provide an

efforts should instead focus on permanency.

opportunity for the other folks that don’t have

Participants from three counties shared this view.

access to something like that… You’re not

A participant mentioned: “I would prefer to see

serving a lot of people. You’re serving eight

the permanent supportive housing because,

people maybe for a longer period of time.” A

to me, that leads to more stability, more long-

participant from another county agreed: “I would

term.” A participant from another county agreed,

be supportive of [increasing the 24-month limit]

stating: “I don’t know what the alternative is other

if it didn’t reduce the number of available slots

than the idea being that if we can keep them in

for other kids.” For another participant, this point

for less time, but move them on to a place that’s

was directly related to the funding and resource

permanent for them, then that’s the ideal.”

constraints these services were already under:

“[Increasing the 24-month limit] would lead into

Benefits of increasing the 24-month limit.

funding case management availability. So, you

Participants from two counties also discussed

know, the downside to that would be, again, we

the potential benefits of increasing the 24-month

would have to have the funding available, the

limit to accessing transitional housing services.

people, the actual staff, available to provide that.”

The main theme that emerged is that al owing

youth to access transitional housing services

The second most prevalent perceived drawback

for a longer period of time could augment the

that emerged from the responses, which

services they receive and improve their chances

participants in two counties stated, was that

of transitioning into permanent housing. A

increasing the 24-month limits to accessing

participant acknowledged that some youth

transitional housing services could extend

genuinely require more time to transition,

youths’ dependence on homelessness services.

implying that such a policy change could be

A participant said: “My concern, if you increase

beneficial to them: “I certainly think that a lot

the number, the goal would be to gain stability

of our kids that have experienced trauma and

and independence, not dependence on a

abuse and substance abuse, they need as

system. So, if it’s too long, have we just fostered

much time as possible to kind of develop the

them to be dependent on it rather than getting

skills to end up living on their own.” Similarly, a

the skills to be self-sufficient?” A participant from

participant from another county stated: “Benefits

another county also had this concern, and she

of [increasing the 24-month limit] would be,

added, “My concern, again, when we talk about

again, making that transition to regular housing…

transitional housing is, once the transitional

[O]ffering the supportive services which are

housing period is done, then what? So if there’s

primarily designed for the client to make that

not a match in permanent housing, then you’re

transition to the permanent housing.”

basical y just delaying and potential y extending

the cycle of homelessness for young people.”

Drawbacks of increasing the 24-month limit.

Participants from four counties discussed the

Policy area 5: Homelessness: Access to

potential drawbacks of increasing the 24-month

rapid rehousing

limit to accessing transitional housing services.

The most prevalent drawback, which participants

Participants in four counties were asked to

in three counties mentioned, was that it could

describe the chal enges their county faced with

lead to less access for others, especial y given

youth, ages 18 to 25, gaining access to rapid

limited funding and resources. A participant

rehousing assistance. Participants in two of the

made the following point: “If the house has

counties further discussed the characteristics

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of youth that would make them well positioned

over for the college students… [A] landlord is

to benefit from rapid rehousing assistance, as

going to rent to a college student quicker than

well as the services that should be provided

they’re going to rent to one of our clients.”

in conjunction with rapid rehousing to improve

outcomes.

A participant noted the difficulty of ensuring

that would-be tenants meet the qualifications

County challenges. The most prevalent theme

to sign a rental agreement as a third dimension

regarding the chal enges counties faced with

to the theme of finding it difficult to place youth

youth ages 18 to 25, gaining access to rapid

experiencing homelessness, ages 18 to 25, in

rehousing assistance was placing them in

permanent housing: “If there’s a felony, if there’s

permanent housing. Participants in all four

anything like that… we have that unique issue

counties expressed great difficulty in being able

to where sometimes it takes us months, and I’m

to place youth in permanent housing, and this

talking many, many months, to house someone

theme consisted of three different dimensions.

depending on the background, because of the

The first was the general lack of available

background check. So that’s an extra chal enge

affordable housing. A participant described

that we face. And especial y if they’re also that

the need for permanent housing as “high” and

age group [18 to 25], it makes it a little bit more

identified the chal enge as one of the greatest

difficult. You know, how long their job history

needs in her county: “[I]t is one of the areas

is, whether they have income. You put all those

that we don’t have too many resources for.

variables together, and it can become quite a

It’s one of the highest needs that we do have

difficult case, much more than others.”

that we are in need of.” In an urban county, the

dearth of affordable housing largely contributed

Population best positioned to benefit.

to the lack of available permanent housing for

Participants in two counties also discussed

18- to 25-year-olds: “The market is so tight, that

the characteristics that made some 18- to

essential y people with subsidized housing are

25-year-olds wel -positioned to benefit from

competing for housing with people who have

rapid rehousing programs, and the comments

very large incomes.” A participant in another

focused on those who could quickly stabilize into

county also identified affordability as a major

permanent housing. A participant responded:

barrier to available permanent housing: “[O]

“Given our current funding for rapid rehousing

ne of the detriments to rapid rehousing is the

and the limitations of that funding, it’s gotta be

availability of housing—affordable housing; let

folks that we think can stabilize within about five

me add that. So that is one of our biggest cruxes

months, so that’s a pretty small snippet of this

there.”

particular population.” For another participant,

the answer was young people working with

The second dimension to the lack of available

an adult or agency that could help them meet

permanent housing was the shortage of

the qualifications for a rental agreement: “[I]f

landlords wil ing to accept 18- to 25-year-olds

someone doesn’t have that person helping them

transitioning out of homelessness. A participant

or if it’s not the actual agency that can sign [the

acknowledged that, “There is nothing requiring

rental agreement] on their behalf.”

a landlord to accept somebody with a voucher…

It’s definitely a landlord’s market. They can

Necessary conjunction services. Participants

basical y ask, and they do require, any amount of

in two counties were also asked to consider

rent.” A participant in another county expressed

the services that, in conjunction with rapid

a similar sentiment: “We have a landlord

rehousing, could improve how 18- to 25-year-

shortage in our community… [W]e’re also in a

olds are served in this space. A participant

college town, so a lot of our properties are taken

listed services that could help this population

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gain independence: “Wel , I would definitely say

propose changes to that list of responsibilities.

if they’re involved in case management, which

Participants in one county also discussed the

would be the employment assistance, helping

drawbacks of their proposed changes.

them seek employment, you know, that résumé-

building… [T]here’s a lot of ways that provide

Child welfare responsibility. Table 8.7 lists the

the job growth as far as that income. Sobriety.

responsibilities of the five county child welfare

Making sure that they’re attending mental health

systems for minors who had run away from home

appointments. Making sure that they’re aligned

or were homeless. The responsibilities are listed

appropriately to the services that they need

from most prevalent across the five counties to

at that time. And also life skills training… The

least prevalent. The most prevalent theme was

life skills training is huge for how successful

that the responsibility of the child welfare system

our clients are in housing.” For a participant

was defined and limited by law. Participants

in another county, rent subsidies could help

mentioned Federal legislation as largely placing

al eviate the lack of affordable housing: “[Y]ou

the responsibilities with their county’s runaway

start dealing with the gap in what income can be

and homeless service providers, including the

created and then what the actual rent and utilities

funding for approved services and programs

are. If somebody would assume that gap, we

such as shelter and housing. A participant

could house hundreds of people, but it’s a matter

stated: “Our responsibility is clearly defined

of what income can realistical y be created for

in Federal law, and that is that any child who

someone and then what the actual rent and

shows up in the district is provided immediate

utilities are, especial y when you’re dealing with

access if they’re identified as homeless.” In some

this age group.”

counties, efforts were taken to reunify runaway

or homeless minors with their families before the

Policy area 6: Child welfare: Scope and

child welfare system became their legal guardian.

responsibility

As a participant stated: “[The Department of

Child Services] doesn’t open cases, to my

Participants across all five counties were asked

knowledge, unless those children are actual y

to describe the responsibilities their county

being abandoned by their parents, where the

child welfare system had for minors who had

parents don’t want to come pick them up.”

run away from home or were homeless, and to

Table 8.7. List child welfare system responsibility

Number of

Responsibilities

Counties

Defined and limited by law

4

Contact law enforcement

3

Needs assessment

3

Shelter and housing

2

Case management

1

Extension of services after age 18

1

Mediation and reunification with families

1

The second most prevalent theme was that

child welfare systems were responsible for

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contacting law enforcement on encountering a

welfare system participants would like to make.

runaway or homeless minor who is in the child

The changes are listed from most prevalent

welfare system. Participants from three counties

across the five counties to least prevalent. The

mentioned this responsibility. Part of being

two most prevalent proposed changes centered

responsible for contacting law enforcement

on the theme of having greater flexibility to

was the responsibility for conducting a needs

service minors who have run away from home

assessment, which emerged as the third most

or are homeless. Participants from two counties

prevalent responsibility. Participants from three

discussed wanting to improve their county’s

counties identified this related responsibility. A

intake assessment so minors can more quickly

participant recounted: “So we have an internal

gain access to the services they need and to

protocol for any of our children who go missing.

prevent them from disconnecting with the child

One, of course, we’re required to contact law

welfare system. As a participant shared: “[W]e

enforcement… When we locate our runaways,

real y want to have an assessment center where

we have to assess our children, do a debriefing,

we can identify the needs immediately [within]

and determine why they ran or where they ran

24 hours, have our assessment team there and

to.”

determine if the child needs to go home, does

[child welfare] need to be contacted. Because a

Proposed changes to child welfare system

lot of times what happens is, these kids who are

responsibility. Table 8.8 summarizes the

runaways, they get released back to their home

proposed changes that emerged from the

without any sort of real vetting.”

question of what changes to their county child

Table 8.8. List of proposed changes to child welfare system responsibility

Number of

Proposed Changes

Counties

Improved intake assessment

2

Ability to work around parent or legal guardian consent for services

2

Ability to serve youth with criminal records

1

Greater substance abuse treatment services

1

Ensuring the services system is designed around youth needs

1

The second proposed change addressed the

a behavioral health stance or mental health

difficulty some counties have in their runaway

stance… [A]ccessing those who do not have the

and homeless youth providers being able to offer

parents’ or guardians’ involvement, but who still

certain services to minors without the consent

need significant mental and behavioral health

of a parent or legal guardian. A participant

support.” A participant from another county

explained: “[F]or us, working with the homeless

agreed and proposed a possible legislative

population is fairly difficult in that… we require

solution: “[I]t could easily be… rewritten so that

a parent or guardian approval, which, for many

if a youth shows up in an emergency shelter and

homeless children, it’s just difficult to get

parental consent is refused for whatever reasons,

that type of approval to treat, you know, from

within 24 hours, that you can start making

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decisions for them. A hard sell in the [state]

services to homeless and unstably housed

legislature, but it could be rewritten and al ow

youth. Finding ways to regulate medication

for much quicker service provision for the youth

intake and to obtain parent or legal guardian

whose families are refusing.”

approval for services were the most prevalent

comments that made up this theme. Participants

Drawbacks of proposed changes. The

from three counties identified the issue of

participants from one county also provided

medication regulation as a pressing need. A

potential drawbacks to the proposal of giving

participant explained why: “If you’re sleeping on

providers the ability to work around the parent

the streets, or if you’re at a shelter even, what

or legal guardian consent for certain services

I’ve seen is, people, they don’t necessarily stick

to runaway or homeless minors. Some of

to the medication regimen. Not because they

the participants cautioned against providing

don’t want to, but because maybe side effects

services to minors without the engagement of

of the medications make them more sedated…

their families: “[T]here’s some value in having

And so, if you’re sleeping outside, you have to

the system reach out to parents, not necessarily

kind of weigh the pros and cons of taking that

for permission to stay, but… to decide what will

medication.” Participants from two counties also

make things work the best… [F]or the potential

spoke about the need to provide behavioral and

for reunification, for the potential for family

mental health services to minors whose parents

therapy, for resolving the… issues that can drive

were unwil ing or unable to provide consent

the… kid to be out.” Another participant agreed,

for behavioral or mental health services. A

adding that this point was especial y relevant in

participant stated when asked about the major

their county given that it does not have a youth

obstacles to providing behavioral and mental

shelter: “[P]articularly in our area, because we

health services: “[F]rom my perspective it’s the

don’t have a shelter… [W]e’re still trying to do

parental approval.”

that mediation, still trying to get people… youth

and families, to stay connected or reunify, which

is usual y the best option, anyways.”

Policy area 7: Behavioral health: Coverage

and access

Participants across all five counties were asked

to discuss the behavioral and mental health

needs of youth experiencing homelessness,

ages 13 to 25, who were disconnected from their

families, and how those needs were currently

being met. Participants in four counties were

also asked to propose changes to their current

system of behavioral health services.

County behavioral and mental health needs.

Table 8.9 lists, from most to least prevalent,

the needs that emerged from the discussion.

Participants in all five counties described the

need to al eviate the obstacles that hindered their

ability to deliver behavioral and mental health

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Table 8.9. List of county behavioral and mental health needs

Number of

Behavioral and Mental Health Needs

Counties

Alleviating obstacles to service provision

5

Accessing behavioral and mental health services

4

Continuing services for minors who have aged out

3

Therapy and counseling services

2

Serving youth with developmental disabilities

1

Greater prevention services

1

Greater substance abuse services

1

More transportation services

1

The second most prevalent behavioral and

aged out of services: “We only see clients up

mental health need was accessing behavioral

to 17… [I]f they’re going to turn 18 in a matter of

and mental health services. Participants from

months, we’re going to have to pass them to one,

four counties identified medical coverage as

we’re going to have to refer them to one of the

a major need in their county. A participant

other services… for care.”

explained why the medical coverage need

was so important: “[W]ith the reduction in

Available behavioral and mental health

Medicaid reimbursement, private providers in

services. Table 8.10 lists from most to least

our community are reducing their Medicaid

prevalent across the five counties the services

caseloads and, therefore, definitely putting

that emerged from the conversation regarding

greater stress on our capacity, and similar

the behavioral and mental health services

organizations’ capacity to serve Medicaid

that are available to youth experiencing

clients… [W]e feel the political ramifications

homelessness. The most prevalent services

of the Medicaid environment, and… Medicaid

were behavioral and mental health assessments,

also sets some limitations to the frequency

followed by extended medical coverage through

and duration of our treatment.” Participants

vouchers or other state funding, and wrap-

from three other counties mentioned that youth

around services that included housing and

experiencing homelessness largely relied on

case management. Participants also mentioned

Medicaid coverage for accessing services,

the provision of domestic violence services,

suggesting that youth in those counties also

education and training services, substance

faced similar chal enges.

abuse treatment, and therapy and counseling

services. The overlap between these services

The third most prevalent need was continuing

and the list that emerged from the discussion

services for youth who aged out of services.

of county behavioral and mental health needs

Participants from three counties shared this

indicate that the counties have room for

need, which significantly affected their service

improvement in how the counties serve the

provision. A participant mentioned that age limits

behavioral and mental health needs of homeless

had ramifications for youth even before they

and unstably housed youth.

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Table 8.10. List of available county behavioral and mental health services

Number of

Available Behavioral and Mental Health Services

Counties

Behavioral and mental health assessment

3

Extended medical coverage

2

Wrap-around services

2

Domestic violence services

1

Education and training services

1

Substance abuse treatment

1

Therapy and counseling services

1

Proposed changes to behavioral and mental

access to behavioral health and mental services,

health services. Participants in four counties

which addressed the need for accessing

were also asked to propose changes they

behavioral and mental health services that

would like to make to their county behavioral

emerged as critical for participants in four

and mental health services. Table 8.11 lists the

counties. A participant shared the following

services that were mentioned across the four

wish: “[H]omelessness would qualify youth for…

counties from most prevalent to least prevalent.

access to all of the services that they require.”

Participants from two counties proposed greater

Table 8.11. List of proposed changes to behavioral and mental health services

Number of

Proposed Changes

Counties

Greater access to services

2

More available housing

1

The application of a developmental lens to service provision

1

More funding

1

Greater focus on outreach

1

Greater focus on prevention services

1

Stronger referral system

1

Focus on services that provide overall stability to youth

1

Greater focus on substance abuse treatment

1

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Policy area 8: Juvenile justice: Discharge

County challenges. When asked to discuss

policies

the chal enges their county faced with minors

who were discharged from the juvenile justice

Participants across all five counties were asked

system into homelessness or unstable housing

to discuss the chal enges their county faced

situations, participants across all five counties

with minors who were discharged from the

answered that their county already had services

juvenile justice system into homelessness or

in place to prevent this from happening.

unstable housing situations. Participants in four

Table 8.12 lists from most prevalent to least

counties were also asked to consider the option

prevalent the prevention services and practices

of establishing a policy that would ensure that

participants mentioned were already in place.

minors are discharged into stable housing, and

The most common one was the practice of

to discuss the potential drawbacks of this policy.

returning minors to their homes and following

Participants from two counties also produced a

up on them for some time after discharge,

list of potential benefits.

followed by inter-agency collaboration to ensure,

by means of a thorough needs assessment,

that minors had access to all the services they

needed before discharge.

Table 8.12. List of services to prevent the discharge of minors into homelessness Number of

Prevention Services or Practices

Counties

Returned home and case managed

3

Inter-agency collaboration to provide wrap-around services

2

Needs assessment

2

Non-criminal housing facility

1

Independent living skil s services

1

Housing advocate

1

Despite these available prevention activities,

is that those children who are in YDCs [youth

participants across all five counties mentioned

detention centers] or who have not been sent

that their county faced chal enges in ensuring

down to level two placement like foster homes

that no minor was discharged from the juvenile

or group homes, they are just, they’re not

justice system into homelessness or unstable

eligible [for extending foster care], which is just

housing. The one theme that emerged from

unthinkable to me because these are our most

these conversations is that it was difficult to

vulnerable youth… [T]here’s no rhyme or reason

deliver the necessary services to this population.

to why you would treat these juvenile justice

Participants mentioned various contributing

youth differently than youth at foster care.”

factors, including: the impact of having a criminal

record, ineligibility for the extension of foster

Reactions to ensuring discharge into stable

care, and the impact of housing instability. A

housing. Participants from four counties were

participant mentioned: “The biggest problem

asked to consider a policy option that ensured

minors are discharged into stable housing. The

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main response that emerged is that such a policy

A participant explained: “I just think it would be

would have to be obtained at the state level as

difficult to mandate something like that without

youth homelessness cuts across all counties.

the pushback requests or inquiry being, ‘Where’s

As one participant stated, “So it would be more

the funding for it?’ And that’s a big question for a

of a state issue rather than a county… It’s just

lot of things in [our state] right now. So, it would

that, again, a majority of these kids are not from

be real y difficult to put forward a mandate, an

[our] county… or nearby, for that matter.” Related

unfunded mandate.” A fel ow participant built on

to this point, a participant from another county

this notion by discussing the lack of available

noted that the county did not have jurisdiction

housing to make such a policy option viable:

over juvenile justice matters: “That would be our

“[T]he biggest hurdle would be finding housing

statewide juvenile justice system because we

for those individuals who didn’t already have

don’t have a county juvenile justice system.”

housing available to them.” For a participant from

another county, the policy option of ensuring

Benefits of ensuring discharge into stable

that minors are discharged into stable housing

housing. Participants from two counties also

necessitated a consideration of their needs given

discussed potential benefits to the policy option

their age and circumstances: “I think the key to

of ensuring minors are discharged into stable

this demographic is not one size fits al . So, not

housing, which included assurance that minors

everyone would be successful in the unit of their

would be discharged into a safe environment

choice, but maybe a more congregate option for

rather than the streets, and that minors would

this demographic may work as long as there’s

be better positioned to access a host of other

supports and structures to mitigate issues and

services that could help prevent future problems.

concerns.”

Regarding the access of services, a participant

stated: “I think the benefit would be that we

The conversation around the theme of the

would be making that first step to helping people.

potential harm such a policy change could cause

That if they do have behavioral or mental health,

to minors focused on the implications of minors

or an addiction issue, we would be making at

either being kept in custody or child welfare,

least that first step towards stabilization so that

or being discharged into poor family situations

that individual can then receive services for

in the absence of stable housing. A participant

those other issues. So I think it could have that

said: “I would just be afraid that it would resort

potential benefit of not only addressing the…

in youth having to stay longer because of a lack

primary problem of homelessness, but that then

of stable housing… [A]s it is right now, youth are

it can actual y have additional kind of a domino

not to be detained just for a lack of housing. We

effect.”

can’t be an alternative to placement.” A fel ow

participant agreed, saying that the child welfare

Drawbacks of ensuring discharge into

system also does not make a great parent. For

stable housing. Participants from four counties

a participant in another county, the prospect

discussed the potential drawbacks to the policy

of minors being returned to their homes in the

option of ensuring minors are discharged into

absence of stable housing was equal y negative:

stable housing. Two themes emerged from the

“I don’t know that that’s necessarily an optimal

conversation: the difficulty of implementing such

thing to have a statute that says [minors being

a policy option and the potential harm it could

discharged into unstable housing] couldn’t

cause to minors. Regarding the first theme,

happen because some family dynamics… it is a

participants from two counties honed in on the

better environment for them not to be within that

issues of a lack of funding, a lack of housing,

home… [I]t would have to be on an individual

and the need for other services to ensure the

basis. Sometimes the children are better not

policy option could be meaningful y executed.

being with their families.”

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Policy area 9: Education: Retention and

this discussion in order of most prevalent to least

high school completion

prevalent across the four counties. Participants

from two counties mentioned the difficulty

Participants from four counties were asked

unaccompanied homeless and unstably housed

to discuss the chal enges the school system

students faced in attempting to access education

in their county faced with serving—year-

services. A participant addressed the lack of

round—students experiencing unaccompanied

special attention that students experiencing

homelessness. Participants from one county

homelessness receive from the school system:

also considered how a policy option that ensured

“I think our school system here is paranoid or

youth experiencing homelessness had access

concerned about our custodial youth in the

to year-round supports and services from the

system… There’s not real y specific supported

school system could support their completion of

services… options available for like credit

high school, whereas participants from another

recovery in the summer.” Along similar lines, a

county considered the potential chal enges of

participant recounted the chal enges that arise in

such a policy.

trying to connect unaccompanied students with

County challenges to providing year-round

services: “[R]ight now, if someone who’s working

education services.

in a school district wants to access services for

Participants in four

a student, it depends on what neighborhood

counties were asked to discuss the chal enges

they’re in, what school district they’re in… [T]

their county school system faced with serving

here might be five different phone numbers they

unaccompanied students year-round. Table 8.13

should call for five different agencies that have

summarizes the chal enges that emerged from

five different criteria.”

Table 8.13. List of county challenges to providing year-round education services Number of

Challenges

Counties

Difficulties accessing services

2

Lack of funding and resources

2

Difficulties tracking student progress

2

Students unable to fil gaps in schooling

1

Lack of transportation services to and from school

1

Participants in more than one county identified

So, there’s no preventing it, but there’s nothing

two other chal enges to providing year-round

supporting it, either.” Regarding the chal enge

school services to unaccompanied students: a

of tracking student progress, a participant

lack of funding and resources, and the difficulty

mentioned: “And some of the chal enge is

of tracking student progress. A participant

actual y being able to track our youth and to

honed in on the lack of funding and resources to

follow up and make sure that they are going

sustain year-round services to this population:

to stay on track with the plan that has been

“A school system can design summer programs

developed or established. ‘Cause sometimes

that are available in the summer for students…

they fall off the radar if their housing placement

but typical y they don’t have the funds to do that.

isn’t as stable as they wish…

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[W]e don’t even have the manpower to look for

aligned and the youth feel comfortable enough

them.” Furthermore, a participant implied that

to move forward in their lives.” The participant

it was important to be able to track student

then built on the importance of helping students

progress because the education system needs to

navigate the available resources in order for them

ensure that they have met certain requirements

to be successful in this space: “A lot of students,

to graduate high school: “[W]e put them in

they don’t understand what the process is set up

the school just to say they’re at school, while

for or how it even affects the possibility of them

we’re trying to go back and find transcripts

becoming successful or not, and moving forward

and such so we can figure out where they’re at

and being able to access the system.”

academical y.”

Discussion

Benefits of providing year-round schooling.

Participants from one county also considered

Key findings

the potential benefits of a policy option that

guaranteed year-round supports and services

Five main policy implications were identified

from the school system to unaccompanied

from the results of the consultations with county

students to help them complete high school. The

service providers.

main response was that it could help increase

First, more robust identification systems

the number of students from this population

and approaches—and investments in them—

who complete high school. When asked if such

are needed for a largely hidden population.

a policy would be beneficial to helping this

Youth experiencing homelessness largely remain

population complete high school, a participant

invisible and unknown to systems and agencies

replied: “Oh, without a doubt. It’s absolutely

positioned to provide support due to transience,

necessary. Those students that have a need,

discrete and fluid living situations, and efforts by

you want them to finish as close to on time

youth themselves not to appear as homeless.

as possible because the older a child gets in

Relatedly, these youth often lack the geographic

the public education system, the more social

stability conducive to receiving long-term care

pressure comes to bear on them to not be in the

and services, which is especial y important

public education system.”

in the behavioral health and education areas.

Drawbacks of providing year-round

Moreover, they often touch service systems after

schooling. Participants were asked to consider

the problem of homelessness has occurred.

the potential drawbacks of a policy option that

Identification of youth at-risk for homelessness—

guaranteed year-round supports and services

from the standpoint of true prevention—was

from the school system to unaccompanied

rarely resourced or a concerted strategy in

students to help them complete high school.

communities’ public systems. This chal enge

The one response focused on the implications

arose not only in the general discussion about

for funding and the need for other supports and

county chal enges in supporting these youth,

services to ensure success. When asked what

but in the behavioral health, juvenile justice, and

chal enges might arise from the policy option, a

education conversations.

participant declared: “Funding. It’s gonna’ take

Second, streamlining of the provision of

individuals to do the work that it takes to work

services to better respond to the needs

with the youth because the policy itself isn’t

of youth experiencing homelessness is

gonna’ get the work done. The chal enge is how

critical. This point had two prongs: the actual

we are connecting with the youth and providing

delivery of services and eligibility requirements.

the support on the back end. So once we

Regarding the delivery of services, participants

connect with the youth, we have all the support

across the five counties indicated a need for

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Chapter 8. Policy and Fiscal Review

youth-centric coordinated entry points and

a more comprehensive set of services to ensure

for a wrap-around service approach. Many of

that each engagement could lead to sustainable

the participants acknowledged that part of the

exits from homelessness and youth getting

difficulty in supporting this population was that

on a path to thriving. The prevalence of such

its members often did not know how to navigate

an acknowledgement reinforces the need for

the convoluted and fragmented continuum of

approaching the problem of youth homelessness

services. Participants expressed that having

not as a set of separate issues, but as a fluid

coordinated entry points and quality navigational

trajectory that requires a more comprehensive

support for them and their families could al eviate

and holistic approach.

this obstacle to accessing services. Various

uncoordinated call lines—that often led to either

Fourth, inadequate funding and resources

no available services that met the young person’s

were commonly noted drawbacks to

needs—and fragmented program-specific

policy options that seek to improve

service options that had to be accessed through

service provision to youth experiencing

individual agencies were the norm. This resulted

homelessness. When participants expressed

in significant time burden and frustration for

support for a policy option, such as expanding

both youth experiencing homelessness and for

access to developmental y appropriate

various public systems personnel trying to help

emergency shelters or transitional housing

them. A more youth-centric, coordinated entry

assistance, ensuring minors are not discharged

and assessment system backed by wrap-around

into homelessness or unstable housing, or

services tailored to youth, would al ow for greater

providing year-round education services to

cohesion of supports and capacity to meet

unaccompanied youth, they elevated a lack

the multidimensional needs of youth and their

of funding and resources as an immediate

families.

drawback. Without accompanying investments,

many policy options were framed as unfunded

Furthermore, complex eligibility requirements

mandates that would be unrealistic to execute to

both between service agencies and between

achieve intended outcomes.

programs within agencies—often depending on

their funding source—resulted in additional y

Fifth, without youth being in safe and stable

convoluted service continuums for youth to try

housing arrangements, the provision of

to access in times of need. As such, enacting

other services was widely viewed as much

eligibility requirements that give communities

more difficult and less effective. Without

greater flexibility and taking a developmental

housing and geographic stability, accessing

approach to this population emerged as the

youth and delivering services to them would

second foundation for a more streamlined

remain a chal enge, as would efforts to improve

system of service provision. The aging out of

their outcomes through tailored wrap-around

services and variability in eligibility criteria for

supports and services. This point is especial y

different services have fueled a haphazard

salient for the areas of behavioral health and

approach to service provision.

education, which, because of the nature of the

problem, require long-term treatment and service

Third, a more comprehensive array of

provision. These comments reflected a key

services is often needed to augment the

principle of the “housing first” philosophy, which

potential for policy success. The conversations

underscores the need for individuals to have

around improving services in the emergency

access to low-barrier housing as a prerequisite to

shelter, transitional housing, rapid rehousing,

benefiting ful y from other supports and services.

child welfare, juvenile justice, and education

spaces all acknowledged the need for providing

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Chapter 8. Policy and Fiscal Review

Limitations

Conclusion

The VoYC Policy and Fiscal Review involved

Homelessness among youth is a significant

several important strengths, including the

policy chal enge and understanding the needs

integration of diverse stakeholder perspectives

and realities of systems and service providers at

from five different key systems and across

the local level is critical for the development of

five counties often with distinct geographic

effective policies. Motivated, in part, by this need

and population realities. However, despite its

for a better understanding of the relationship

strengths, the Policy and Fiscal Review also had

between policies and service provision at the

important limitations. First, while we captured

county level, VoYC developed a replicable

insights from a diverse set of counties to increase

methodology for conducting a policy and fiscal

the generalizability of our findings, the sample

review. As a result of this effort, we now have

should not be taken as national y representative,

an expansive list of needs, chal enges, benefits,

and the results are thus not necessarily

and drawbacks policymakers should weigh

generalizable to all counties or systems. Second,

when considering policy changes related to

in some counties, the voice of a representative

homelessness, child welfare, behavioral health,

from one or two of the five policy areas was

juvenile justice, and education services to help

missing. Further, the absence of the voices

end youth homelessness.

of experts in some counties likely limited the

completeness of the data collected. Third, the

Our findings reveal that, although public systems

number of policy areas that were discussed, the

and service providers have established a degree

number of participants in each consultation, and

of continuums of services for youth experiencing

the time limit of two hours for each consultation

homelessness, chal enges lie in accessing the

all reduced the depth of the conversations. As

target population and effectively delivering

such, although many important details emerged

the services they need, when they need them.

from the conversations, the richness of the data

Exactly how policymakers decide to address

collected was limited. Fourth, although efforts

those inefficiencies is beyond the scope of

were taken to create a safe and open space

this research component. Nonetheless, the

for dialogue, as with all focus groups, there is

findings discussed in this chapter serve as a

a possibility that some participants may have

foundation for understanding key issues, so that

censored their genuine opinions given that their

policymakers can be better informed.

colleagues were also part of the discussion.

References

Final y, although the process involved a degree

of analysis of Federal statute and regulation,

Maxwel , Joseph A. 2013. Qualitative research design:

future policy and fiscal review work would benefit

An interactive approach (3rd ed.). New York, NY:

from greater time and resources for much more

Sage Publications.

thorough and systematic analysis and integration

of these policy entry points, as well as actual

fiscal modeling of different policy options.

Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

209

Chapter 9. Conclusion

Chapter 9. Conclusion

Key findings

homelessness (including experiences that the

respondent described as “homelessness” and/

To bring more and better evidence to inform

or as having run away or been kicked out for

actions to end youth homelessness, the Voices of at least one night), and 1.0 percent reported Youth Count (VoYC) initiative addressed several

experiences that solely involved couch surfing

key research questions using a mixed-methods,

without a safe and stable alternative living

multi-component approach. In this concluding

arrangement, resulting in an overall 4.3 percent

chapter, we summarize what we learned in

household prevalence of any homelessness.

response to those questions, il uminate important We estimate that this translates to a minimum of themes, and highlight opportunities for future

approximately 700,000 adolescent minors, or 1 in

research.

30 of the total population of 13- to 17-year-olds.86

The prevalence of homelessness among young

How many youth and young adults

adults (ages 18–25) is even higher. Twelve-month

experience homelessness?

population prevalence rates for young adults were

To date, the field has lacked reliable evidence

5.2 percent for explicit homelessness, 4.5 percent

on even the most basic questions around youth

for couch surfing only, and 9.7 percent overal .

homelessness, including confident estimates on

This estimated count reveals more than 3.5

the prevalence and incidence of the problem.

mil ion, or one in 10, young adults experienced

The ability to track our progress toward ending

some degree of homelessness in a year.

youth homelessness is reliant on the ability to

The national survey engaged adults within

estimate incidence and prevalence across time.

households contacted, thus it is possible that

VoYC has made significant progress on producing the difference in prevalence rates between evidence that can help decision-makers size

the younger and older youth was due partly to

and tailor the policy actions required to end

undercounts and underestimates of minors. At

youth homelessness. We achieved this through

the same time, this upward trend is consistent

a combination of a national population-based

with broader public health research that shows

survey and local youth-specific point-in-time

increased levels of vulnerability during the

counts, and by establishing approaches and

transition from adolescence to young adulthood.

tools for enhancing and replicating the production The Runaway and Homelessness Youth Act of national and local estimates in the future.

(the authorizing legislation for this study) does

The VoYC initiative’s development of strategies

not restrict homelessness to the location of

to reliably estimate youth homelessness over

sleeping—and would therefore consider couch

time contributes substantial y to our ability to

surfing as homelessness if the youth lacked a

gauge the progress of communities and the

stable living arrangement. Not all policy and

nation toward the Federal goal of ending youth

research definitions would necessarily recognize

homelessness.

couch surfing or doubling up as homelessness.

The national survey reveals youth homelessness

However, even when we omit couch surfing

as both a broad and hidden chal enge. During

from the overall estimates, the scale of youth

a 12-month period, 3.3 percent of households

homelessness remains far larger and more

with 13- to 17-year-olds reported explicit youth

hidden than typical counts and administrative

data sources suggest.

86 Assuming only one youth that experienced homelessness per household that reported any type of 13–17-year-old youth experiencing homelessness.

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Chapter 9. Conclusion

These national estimates reveal that key systems

targeted strategies to speed progress toward

and Federal programs need to be significantly

ending it. VoYC analysis offered additional

better resourced to address the scale of youth

information about comparative risks of different

homelessness. For example, according to 2014

subpopulations of young adults, ages 18–25, for

data collected by the U.S. Department of Health

experiencing “explicit homelessness.”

and Human Services (HHS), about 50,000

youth were served by the two major runaway

Among racial and ethnic groups, American

and homeless youth programs involving short-

Indian or Alaska Native (AI/AN) youth and

or longer-term housing in 2014. Per the U.S.

Black youth were especial y overrepresented,

Department of Housing and Urban Development’s

with an 83 percent and 120 percent increased

(HUD) 2016 Annual Homeless Assessment

risk, respectively, of having experienced

Report (AHAR) to Congress, 21,000 beds or

homelessness over youth of other races. Higher

housing spaces were under different HUD-funded

risk of AI/AN and Black youth compared with

programs targeted to unaccompanied and

other races remains even when we controlled

parenting youth in 2016. Even if we conservatively

for other factors like income and education.

assume that only a small share of youth

Disproportionality of homelessness experiences

experiencing any homelessness in a year needs

among these subpopulations of youth mirrors

short- or long-term housing interventions, these

disparities documented elsewhere, for

numbers fall well short.

example in school suspensions, incarceration,

and foster care placement. It is likely that

At a local level, VoYC worked with 22 counties

disproportionalities in other systems, along with

across the country to conduct youth-specific

a weaker schooling and service infrastructure

point-in-time counts. These counts involved

in predominantly minority communities, help

survey instruments specifical y designed with

explain elevated risk of homelessness, but more

youth in mind, identification of “hot spots”

targeted research can help pinpoint causes.

in which youth experiencing homelessness

were likely to be found, and, most importantly,

Hispanic youth were also found at higher

significant engagement of youth with lived

risk of experiencing homelessness than non-

experience throughout the process of planning

Hispanic youth. Further, while Hispanic youth

and conducting the counts. In 2016, using a

comprised 33 percent of 18- to 25-year-olds

stratified random sample, we conducted youth

reporting explicit homelessness (compared

counts in 22 counties out of the 3,089 counties,

with 25 percent of young adults not reporting

parishes, and organized boroughs in the United

homelessness), only 19 percent of youth served

States in 2016. In those 22 counties or parishes

by Federal y funded runaway and homeless

alone, 5,970 youth and young adults, ages 13–25,

youth programs in 2014 were Hispanic. Point-in-

were counted as homeless on a specific night

time counts have also shown lower percentages

in August. In nearly all cases, a snapshot in time

of Hispanic youth overall among those identified

of these numbers of youth in need significantly

as homeless, especial y those in shelters. As

exceeded the supply of local shelter and housing

such, our national survey results suggest that

services available to them.

Hispanic youth are especial y hidden among

those experiencing homelessness.

What populations are overrepresented

among youth experiencing

Lesbian, gay, bisexual, and transgender

homelessness?

(LGBT) youth had a 120 percent increased

risk of experiencing homelessness compared

Identifying subgroups of youth who are more

with youth who identified as heterosexual and

likely to experience homelessness can prompt

cisgender. These findings reinforce growing

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Chapter 9. Conclusion

evidence on the heightened risk of experiencing

subpopulations of youth and young adults are

homelessness among LGBT youth. This often

at greater risk for experiencing homelessness

stems from a lack of acceptance that youth

than others. For example, youth experiencing

experience both in and outside of the home.

homelessness are disproportionately Black and

lesbian, gay, bisexual, and transgender. They

Young parents—especial y unmarried ones—

are much more likely than youth in the general

had three times the risk of experiencing

population to be pregnant and parenting. They

homelessness compared with non-parenting

include many youth who struggle with basic

peers. This finding is alarming, not only because

needs while enrolled in college (approximately

of the risks posed to youth themselves, but

one in four 18- to 22-year-olds who reported

also to their children. Housing instability in early

explicit homelessness in the last 12 months were

childhood can have lifelong consequences.

enrolled in college at the time of their national

For these youth, approaches to prevention and

survey interview). Nonetheless, on average, they

services need to reflect the developmental needs

have lower levels of education and come from

of the youth, their children, and the holistic needs

poorer households.

of their families.

According to the brief youth surveys, youth

Above and beyond these demographics,

experiencing homelessness were much more

education was strongly related to risk of

likely than youth in the general population to

homelessness. In fact, of all the indicators

be “NEET” (not in education, employment, or

assessed, the lack of a high school diploma

training), and more than one-third of young

or General Equivalency Diploma (GED) was

adults experiencing homelessness lacked a

the most strongly correlated with higher risk.

high school diploma or GED. However, many

These young adults had 4.5 times the risk of

youth were still simultaneously employed and

experiencing homelessness compared with

homeless, underscoring the point that a job itself

peers who completed high school. Although

is not enough; the quality (including the benefits

we cannot say whether lower education causes

and safety nets it carries), predictability, and

youth homelessness, this finding reinforces the

income are likely to be important factors driving

extent to which education, and underlying factors

the extent to which employment helps youth

that support educational attainment, could

sustainably exit homelessness. All these findings

protect youth from becoming homeless.

point to the fact that ending youth homelessness

Moreover, youth with lower household income

requires more than housing. Although safe and

were significantly more likely to experience

stable housing is critical to stabilize a young

homelessness. Although unsurprising, this

person and enable other interventions to be

finding reinforces the links between poverty,

more successful, interventions tailored to the

income inequality, and homelessness, and

needs of individual youth addressing education,

underscores the importance of addressing

employment, permanent connections, and

these structural factors to truly root out youth

wel being are at least as important as housing

homelessness for good.

interventions to addressing the chal enge.

What are the characteristics of youth

Our results from multiple research components

experiencing homelessness, and what are indicate that characterizing a young person’s their experiences?

homelessness experiences by their sleeping

arrangement at any particular snapshot in time is

Youth experiencing homelessness are highly

general y inadequate. Nearly two-thirds of young

diverse and not easily characterized. At the

adults who reported explicit homelessness in

same time, as previously underscored, some

the national survey also reported couch surfing

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Chapter 9. Conclusion

during the last 12 months. According to the

on a case-by-case basis. This resulted in

national survey follow-up interviews with a

either selectively engaging an array of formal

smal er subsample, 71 percent of youth who

or informal services or being selective within a

experienced homelessness during a 12-month

category (for example, shelters) in choosing one

period had stayed in more than one sleeping

resource over another. For example, sometimes

arrangement while homeless. Among the in-

youth might only go to a shelter if it had a

depth interviews sample, over 90 percent of

reputation as a safe and affirming space for

youth who experienced literal homelessness had

LGBT youth, or only if important relationships

also couch surfed. These findings underscore

could be retained or preserved (for example,

the fluidity of youths’ arrangements over time

housing al ows baby or pet to stay with them,

and the need to assess and understand their

or will also accept a partner or friend). When

housing situation over a broader period of time

these conditions were not met, youth rejected

than any single night or week.

the resource often choosing to stay on the

streets instead. Engagement styles were deeply

The VoYC in-depth interviews shined light on

informed by three underlying factors: identity

the significant levels of trauma and adversity

protection, accumulated lived experience, and

to which nearly all youth experiencing

personal agency (that is, sense of independence

homelessness were exposed, not only during

and autonomy). These factors shaped their

homelessness, but often before homelessness

perceptions of the gains and risks of engaging

and while housed. The root causes of instability

the actual resources in their environments.

begin in childhood and include early disruptions

in one’s literal and psychological sense of home.

How many youth experiencing

Nearly all youth who participated in the in-depth

homelessness were involved in systems

interviews reported chronic childhood adversity,

like justice systems and child welfare?

35 percent experienced the death of a parent/

How do these experiences relate to

caregiver before the age of 25. Furthermore,

housing instability?

emerging adulthood was a high-risk period,

and parents struggled with youths’ emerging

As part of the brief youth surveys we conducted

sexuality and/or youths’ inability to financial y

at a point in time across 22 counties, we found

contribute to the household. Families could be

that 49 percent of the youth experiencing

a source of both adversity and support, in both

homelessness were receiving government

cases underscoring the importance of positively

benefits (for example, Medicaid, food stamps,

engaging families in the lives of many youth

SSI, or cash assistance); 46 percent had ever

experiencing homelessness.

spent time in juvenile detention, jail, or prison;

and 29 percent had ever been in foster care. To

The in-depth interviews further aimed to

appreciate the magnitude of these percentages,

understand why, and under what circumstances,

consider that two percent of the 18- to 28-year-

youth did and did not engage formal and

olds who participated in the third wave of the

informal resources available to them. We refer

Add Health Study had ever lived in a foster

to this decision-making process as youth

home,87 and that 15 percent of the 24- to

logics of engagement. Although some youth

34-year-olds who participated in the fourth wave

categorical y engaged or disengaged with

of the Add Health Study had ever spent time in

services, selective engagement was by far the

a jail, prison, juvenile detention center, or other

most common style of engaging. Selective

correctional facility (Harris, 2009).

engagement refers to a pattern of using specific

criteria or conditions to engage or disengage

87 The Add Health figure does not include young adults who were in group care settings, but not in foster homes (Harris, 2009).

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Chapter 9. Conclusion

We also looked at the overlap between youth

current system involvement. Prevention efforts

who had spent time in foster care and youth

should include efforts to periodical y assess

who had spent time in juvenile detention, jail, or

the situations of these youth and their families

prison and found that 17 percent of youth had

and provide tailored supports and services to

experienced both. Although these statistics do

prevent their homelessness and strengthen their

not reveal the nature of relationships between

opportunities for long-term successful outcomes.

systems and homelessness, they do suggest

that these systems offer important entry points

What policies and practices can make a

for preventing large numbers of youth from

difference?

becoming homeless.

While much more and better intervention and

The in-depth interviews highlighted a common

policy evidence is needed, our systematic

chal enge of poor transitions out of and between

evidence review revealed evidence that some

systems. Youth experiencing homelessness

interventions can and do measurably prevent

commonly described interactions with justice

and reduce youth homelessness. Seventeen

and/or child welfare systems in their trajectories

unique effectiveness studies measured at

into and through homelessness, yet they

least one outcome capturing housing stability

rarely described ways in which these systems

or homelessness. Of these, three involved

had assessed or addressed youths’ housing

randomized controlled trials (RCTs) and two

instability or risk of homelessness upon exit.

involved quasi-experimental studies with

These represent missed opportunities for

matched comparison groups. The remaining

prevention and early intervention of youth

comprised either no service-as-usual/no

homelessness through cross-systems efforts.

treatment comparators or assignment of control

groups that lacked measures to mitigate bias. All

Furthermore, our analysis of foster care archive

three of the RCTs showed positive intervention

data from multiple states indicates that 13

effects on preventing or reducing homelessness

percent of youth who entered out-of-home

or housing instability, and all but three of

care for the first time when they were 13- to

the 17 unique studies indicated statistical y

17-year-olds experienced a bridged run (that is,

significant improvements in at least one housing

a run lasting less than seven days), exiting their

stability outcome. This suggests encouraging

first out-of-home care spell by running away.

evidence that youth homelessness can in fact

Efforts to prevent and address such runaway

be measurably prevented and reduced with

experiences, starting with centering strategies

adequate intervention.

on the subpopulations of youth that our analysis

indicate are at highest risk, can help systems

The review findings also indicated that wel -

to get out in front of youth homelessness at its

implemented, multi-component interventions

early stages. At the same time, our in-depth

tailored to individual needs and preferences

interviews found that many youth experiencing

are likely to yield the greatest success. Some

homelessness who had foster care involvement

intensive interventions measurably reduced

had been adopted, reunified with families, or

youth homelessness without any direct housing

had otherwise experienced homelessness in

interventions, reinforcing that interventions

ways other than having runaway from care or

beyond housing assistance can have an impact.

exited care straight into homelessness. These

For example, the YVLifeSet program significantly

findings underline that, beyond viewing child

reduced homelessness experiences while

welfare as a system entry point to address youth

improving other outcomes primarily through

homelessness, child welfare involvement is also

intensive case management and support

a signal of risk for homelessness irrespective of

services for youth that recently transitioned

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Chapter 9. Conclusion

out of juvenile justice or foster care systems.

homelessness in the dark. Trend data will help to

However, these effect sizes were modest for

center the national policy and practice dialogue

housing stability, and more direct housing

on evidence, and identify subpopulations and

assistance to complement intensive support

regions that experience faster or slower progress

services might have resulted in more dramatic

toward ending youth homelessness.

improvements in housing stability. Conversely,

while housing-inclusive interventions, such as a

Fund housing interventions, services,

“Housing First” model in Canada, demonstrated

outreach, and prevention efforts in

positive effects on homelessness, many

accordance with the scale of youth

youth nonetheless continued to experience

homelessness, accounting for different

homelessness and housing instability by the

needs. As with prevalence estimates of various

end of the intervention. This likely underscores

other social and public health chal enges—

additional attention needed to ensuring that

ranging from HIV/AIDS, to domestic violence,

housing-inclusive interventions effectively

to unemployment—our estimates capture a

integrate the broader, youth-centric services and

spectrum of experiences that do not all require

supports beyond housing or rental assistance

the same interventions. For example, youth who

that youth need for sustainable exists from

are couch surfing in a safe arrangement but

homelessness.

lack long-term housing stability may not need

emergency shelter services, but may benefit

Implications for policy and

from access to longer term housing assistance

practice

and/or educational or employment programs that

equip them to achieve housing stability. Others

More broadly, our initial results underscored

may need emergency shelter services to avoid

several opportunities for policy action that are

spells on the streets or in unsafe situations. Many

likely to accelerate progress toward ending youth

youth can benefit from interventions that work

homelessness.

with both them and their families and may be

able to achieve housing stability through positive

Conduct national estimates of youth

reconnection with family rather than through

homelessness biennially to track our

housing programs.

progress as a nation toward ending youth

homelessness. In 2013, the United States

This diversity of youth experiences and

Interagency Council on Homelessness

circumstances points to the need for

(USICH) released a Framework to End Youth

communities to have adequately funded program

Homelessness. Among other things, the

mixes to provided tailored supports and services

Framework cal ed for “periodic and comparable

to the needs and preferences of individual youth.

estimates of homeless youth over time…to

Furthermore, coordinated entry and good intake

monitor changes in the needs and characteristics

assessments can help make tailored service

of the population and subpopulations as

prioritization and connection decisions based on

well as progress towards the goal of ending

individual-level information. Overal , however, the

youth homelessness.” The VoYC national

scale of the problem identified by this research

survey was the first of its kind and could be

reveals significantly under-resourced response

further refined in specific ways, but it has

systems and services—including for outreach,

established a cost-efficient, robust, and reliable

housing, and shelter services centered on the

mechanism for continuing to gather national y

specific needs and circumstances of youth and

representative data on the size and scope of

young adults.

youth homelessness. We cannot end youth

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215

Chapter 9. Conclusion

Invest in development and evaluation of

family service providers may be fil ing some

youth-centric housing and service models to

of these gaps for 18- to 25-year-olds, but the

prevent and address youth homelessness.

programs they operate may not address the

While showing growing and promising evidence

developmental needs of young adults and youth

in some areas, the systematic evidence review

may be reluctant to avail themselves of shelters

also revealed significant knowledge gaps

or other programs designed for homeless adults

that present blind spots for developing more

due to personal safety concerns. Moreover,

evidence-informed policies and programs to end

although a majority of homeless youth are age 18

youth homelessness. Areas in which we found

or older, there appears to be a lack of programs

little to no evidence from rigorous experimental

that serve youth under age 18, especial y in small

or quasi-experimental studies of interventions

counties. Taken together, these results highlight

addressing youth homelessness included

the need for additional capacity to provide

prevention, public systems-based interventions,

runaway and homeless youth with housing and

prominent housing models for youth and young

other services.

adults, outreach programs, and service delivery

models. Additional y, the in-depth interviews

Moreover, more RHY service providers receive

found that youth often fell through the cracks

funding from foundations or individual donors

when systems were siloed or during transitions

than from any single government source—Federal,

in, out, or between systems or services. As

state, or local—and those in large counties

such, we recommend the design and evaluation

were more likely to receive Federal, state, and/

of intervention models that provide youth with

or local funding than those in a small and, to

formal individualized navigation, support, and

a lesser extent, medium-sized county. This

advocacy interventions. Moreover, evaluations

implies a particularly significant need for greater

rarely studied intervention effects specifically

government investment in the scale of services

for high-risk subpopulations, such as Youth

required to truly end youth homelessness,

of Color or LGBTQ youth. Research from

especial y in communities that may have fewer

broader fields underscores one should not

private funding sources to rely on.

assume that interventions are equal y effective

Build prevention efforts within and across

for all subpopulations. Investing in evaluations

public systems where youth likely to

with more intentionality about disaggregating

experience homelessness are in our care:

results by key subpopulations—along with

education, child welfare, juvenile and criminal

strong mixed-methods process evaluation—

justice, and behavioral health. No one system

will help to determine for whom cultural

alone can address the multiple needs of these

adapted interventions, or different interventions

vulnerable youth. Policies that cut across Federal

altogether, might be needed.

programs are necessary to build a strong

The results of the service provider survey

prevention safety net to avoid homelessness

point to what may be significant gaps in

before it begins, and to ensure that any

service provision for youth experiencing

experiences that do take place are brief and non-

homelessness. For example, a high percentage

recurrent. With close engagement of multiple

of runaway and homeless youth (RHY) service

Federal agencies, the USICH could facilitate

providers operate programs that have waiting

development of a specific cross-sectoral

lists or that have turned away youth during

strategy on prevention of youth homelessness,

the past year. The types of programs that are

and Congress should consider appropriating

available also have gaps, particularly in small

necessary resources for its implementation.

counties, where there appear to be relatively

The brief youth surveys further documented

few RHY service providers. Homeless adult and

that youth who have been in child welfare or

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Chapter 9. Conclusion

justice systems, or lack a high school diploma,

Rethink timing of intervention and

are at especial y high risk of homelessness.

prevention. Taking youth seriously about where

Public systems can and do have an impact.

their unaccompanied homelessness real y

In particular, policymakers should encourage

begins, chal enges us to reconsider where our

these systems to develop and implement plans

interventions should start. While youths’ literal

that identify youth at risk for homelessness and

homelessness often began in adolescence,

initiate transition supports and service referrals.

youth began their “stories of instability” at

much younger ages. Some as young as birth.

Identifying youth in foster care at highest risk

Their stories suggest that homelessness is a

for running away and providing these youth

symptom of much larger and enduring struggles

with early supports can help prevent runaway

in our society, our systems and institutions,

episodes from happening or devolving into

and consequently, in family systems who often

homelessness. While our brief youth survey

navigate these chal enges on their own. For

data from 22 counties underscore the extent to

example, there is a serious need to address the

which youth who have been in foster care are

loss, grief and trauma that many of these youth

at much greater risk for homelessness, among

described as normative in their childhoods. This

youth in out-of-home care, those who have

calls for deploying and evaluating models of

multiple runaway episodes are of particular

practice and service delivery that are trauma-

concern. Our analysis of Multistate Foster Care

informed and those that address grief and

Archive Data reveal that Black and Hispanic

healing from chronic loss. Practice models

youth, youth in urban core counties, and youth

and approaches to engagement must also

in the most socioeconomical y disadvantaged

take seriously the many ways in which youth

counties are at the greatest risk for running away.

experience interventions themselves as risky or

Because communities with high shares of people

even the cause of their instability and loss (for

of color and those that are socioeconomical y

example, removal from home into foster care).

disadvantaged often overlap, place-based

Our findings strongly reinforce the increased

strategies to provide greater supports and

use of trauma-informed services, paired with the

resources to youth and their families in these

intersectional and holistic approaches discussed

communities could help to mitigate the risk of

above. The enduring findings in homelessness

these children and youth entering out-of-home

research around family conflict (Ringwalt, Greene

care in the first place. Second, our findings also

and Robertson, 1998; Whitbeck and Hoyt, 1999)

suggest that system-level factors, particularly

and need for effective interventions (Toro, Fowler,

the placement of youth in congregate care and

and Dworsky, 2007) must take seriously the

placement instability, may also contribute to

enduring, multigenerational, family dynamics that

increased likelihood that youth will run away

contribute to this need.

from out-of-home care. This underscores

the importance of avoiding congregate care

Tailor supports for rural and small-town

arrangements and multiple placements wherever

youth experiencing homelessness to account

possible. The Federal Government and State

for more limited service infrastructure

Governments can leverage the recently passed

over a larger terrain. Although our national

Family First Prevention Services Act of 2018 to

survey shows that youth homelessness is just

incorporate place-based strategies to prevention

as prevalent in rural communities as it is in

youth from entering out-of-home care by

more urban communities, the chal enge tends

delivering evidence-based early intervention to

to be more hidden in rural and smal -town

youth and families in those communities, and the

communities, and youth in these communities

legislation also provides incentives to states to

are more likely to lack youth-centric services

reduce placement of children in congregate care.

and supports during times of need. We also

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Chapter 9. Conclusion

have little evidence on interventions designed to

engagement with formal services in particular

prevent and address youth homelessness in rural

and opened new informal networks of support

settings. Through legislation like RHYA and the

in general. Identity protection, although not

HEARTH Act, policymakers could also consider

exclusive to this population, was an important

appropriating resources to al ow for tailored

lens through which youth assessed the risks of

outreach strategies and provision of services

engaging a resource, including within their own

in rural communities, building on lessons from

families. Some LGBT youth may prefer agencies

pilots funded by HHS and HUD. Policymakers

that provide safe spaces and cultural y attuned

should also encourage the evaluation of services

services related to their sexual and/or gender

delivered in rural communities to ensure

minority identities. However, some LGBT youth

interventions meet the needs of this group of

of color, and straight/heterosexual youth of

youth.

color may prioritize racial and cultural safety and

attunement. Still others may seek services that

Equity must be center-focus in policy

are not identity-specific, but still offer safe and

and system responses to end youth

inclusive services that affirm all their identities

homelessness. The data consistently

and are open to a range of youth. Our service

demonstrate stark inequities in youth

options to youth must reflect these layers of

homelessness. Federal policy and programs

complexity in human diversity.

and public systems need to incorporate

strategies to address the disproportionate risk for

All organizations can become skil ed and

homelessness among specific subpopulations,

cultural y attuned to this very diverse group of

including LGBT, Black, Hispanic, and American

youth. This study suggests a serious need to

Indian or Alaska Native youth. This starts with

explicitly and implicitly message that agencies

ensuring that systems and programs collect

and their staff celebrate youth not only by

and use data to track whether some high-risk

affirming their identities, but also through

subpopulations are served less frequently,

partnering with youth as they navigate the

or less effectively, than other youth. Federal

homophobia and transphobia that permeate their

agencies should require and support data

daily lives. Such affirmation also includes key

collection and disaggregated data analysis

developmental contexts such as family, school,

by these high-risk subpopulations as much

work, and community. We recommend the edited

as possible in funded systems and programs

volume by Abramovich and Shelton (2017), which

serving youth experiencing homelessness.

outlines comprehensive approaches, using an

Informed by continuous monitoring, systems

intersectional model, for interaction with LGBT

and programs can better tailor outreach, staff

youth in Canada and the United States.

recruitment or development, and service delivery

models to prevent higher risk of homelessness

Use holistic and intersectional approaches

among some groups and provide safer, more

to service delivery. Our systems and

inclusive services that meet their needs for

services need to not assume youth operate, or

exiting homelessness.

experience their worlds, from a single space

or identity. Youths’ shared experience of their

Ensure safe and affirming spaces and

housing instability was further shaped by other

service delivery for LGBT youth. The in-depth

intersecting realities such as the resources in

interviews underscored the extent to which

their communities, the health and wel ness of

the presence of resources and organizations

their parents and families, social class, their

that are welcoming, protective, and affirming

peer networks, youths’ involvement in various

to LGBT youth made an enormous difference

systems, and the presence of stigma and

to participants in the study. It facilitated their

discrimination in their environments. Youth also

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Chapter 9. Conclusion

have a range of identities and social locations

minorities, people who identify as LGBT), but

that matter in how they derive meaning from

for understanding the intersecting oppressions

the risks in their environment and their needs.

and privileges that any young homeless person

These identities include, but are not limited to,

navigates.

gender, sexuality, race-ethnicity, developmental

stage/age, social class, and (dis)ability.

Focus on strategic placement of housing

Findings from our in-depth interviews support

options and services, and innovative

the emerging use of intersectional approaches

outreach strategies that recognize and

that take this more holistic view of youth and

engage with youth-preferred channels of

the host of vulnerabilities and strengths in their

communication. Youth are often connected to

environments. We recommend the development

housing resources through friends, family, and

of models of practice, service delivery, and a

existing relationships with service providers.

robust complementary research agenda, that

However, they also reported using online

can move this work forward and that is a true

searches for housing resources much more than

reflection of the diversity that exists among this

from street outreach or helplines. Our findings

population.

also suggest that youth put a lot of time and

effort into hiding their homelessness from adults

Specifical y, the in-depth interviews component

who may be in a position to help (for example,

findings ful y support the small but growing trend

teachers, and school social workers). Our youth

in work with marginalized populations that call

logics analysis suggests this is a critical part

for use of “anti-oppressive” and “intersectional”

of their management of risk. Nonetheless, it

models for practice (Abramovich and Shelton

remains a serious barrier to building awareness

2017, Baines, 2011; Hyde, 2005; Zufferey, 2017).

about resources youth need. We recommend

To raise attention to social (in)justices faced by

expanding youth outreach methods to extend

many marginalized populations, these models

into online and social media venues, and to

offer a shift in understanding the role of power,

be nimble and responsive to rapidly evolving

and cycles of oppression tied to structural and

trends in youth-preferred communication outlets

interpersonal factors. They offer a person-

and styles. Our findings support public health

centered-in-context frame from which to assess

campaigns that target much younger children,

needs collaboratively between those giving and

families in general, and include youth who are not

those receiving resources and services. Our

currently homeless, or who do not self-identify as

findings that youth often experience “help” as

homeless.

disempowering and as a risk to their personal

agency or a threat to invalidate or stigmatize a

Normalizing access to these resources and basic

marginalized identity or status most strongly

service information may reach a larger population

support this recommendation.

of youth so that they and their peers have this

information before they need it. It may also

Taking an intersectional approach within our

decrease their need to manage risk of stigma

systems and services, however, can also

by avoiding using services that require they

facilitate remaining attuned to the complexity

first admit to being “homeless.” Communities

inherent in any youth’s circumstance. How

across the country and international y are also

one’s racial-ethnic status matters is shaped by

increasingly experimenting with youth-specific

other factors like class, (dis)ability, immigration

models of rapid rehousing and host homes

status, sexuality, and gender identity. In this

that provide temporary or permanent housing

way, we are recommending that intersectional

arrangements. These resources can be located

approaches can be critical y useful not only for

within and around where youth currently reside.

minority populations (for example, racial-ethnic

Youth Homelessness Demonstration Program

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Chapter 9. Conclusion

grantees are also being encouraged through

in their lives. These findings suggest that peer

HUD to experiment with these and similarly

and social networks may be more diverse in their

creative arrangements and solutions across

behavioral health, and interventions should make

diverse community contexts (HUD, 2016).

use of youths’ existing positive relationships and

Although shelters and temporary housing

strengthen those ties.

services are needed, a more robust array of

options for youth, especial y in more rural areas,

Act on the interconnections between youth

is also needed.

and family homelessness. Our data show that

pregnant and parenting youth are at much higher

Build healthy informal networks and positive

risk for homelessness—especial y if they also

connections to caring adults. Although some

have other risk factors—and they make up a large

youth participating in the in-depth interviews

proportion of youth experiencing homelessness

struggled with trusting people as sources of

in the U.S. This has several implications for

support, they also spoke at length of their need

better serving young parents and their children,

for more and better informal support systems—

including the need for robust coordination

especial y trustworthy adults. They wanted

between youth and family homeless service

people who would help them stay motivated,

providers and other relevant programs, such as

provide sage advice, mentorship to chal enge

Head Start, Temporary Assistance for Needy

them to (continue to) improve themselves, and

Families, and The Special Supplemental Nutrition

provide much needed emotional support. The

Program for Women, Infants, and Children. Given

level and depth of relationships they desired far

that, for some youth, pregnancy was also a risk

exceeds a traditional mentoring intervention.

factor or a tipping point into homelessness, this

These youth were searching for authentic, long-

underscores the extent to which evidence-based

lasting, trustworthy relationships embedded

teen pregnancy interventions need to be scaled

within their daily lives. We recommend

up and targeted toward youth who have high risk

community building efforts and initiatives

for homelessness.

that help to foster the relational health and

wel being among youth, and within the social

Additional y, the in-depth interviews uncovered

and family systems that comprise their natural

a substantial youth and family homelessness

environments. This prevention work is critical to

connection, with about one in four youth

addressing many of the issues youth identified as

experiencing unaccompanied homelessness

causing the beginning of their homelessness.

in the sample, having also experienced earlier

family homelessness, and virtual y all having past

In addition to adults, youth made heavy use of

histories of family-level adversity and instability.

their peer networks, for better and for worse.

This elevates the importance of scaling effective

Peer-centric interventions have been debated

interventions to address family adversity and

recently in the field due to the strong influence

housing instability as an important means of

(both positive and negative) of youth social

preventing unaccompanied homelessness for

networks, found also in this study (Rice and

many youth.

Rhoades, 2013; Rice et al., 2012). Our work

suggests perhaps a third consideration of the

Directions for future research

use of peers. Although the social networks

of youth in our study certainly involved other

Although the VoYC initiative has established

homeless youth who were involved in drug use

unprecedented contributions to the knowledge

and other il egal activity, they also involved youth

base concerning youth homelessness in America

who were not homeless, connected to school,

to support progress toward ending it, it has also

and were noted as positive influences on others

exposed a number of key pending questions and

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Chapter 9. Conclusion

opportunities for advancing the research agenda.

extent to which youth remain in safe and

stable housing after exiting services, and

These include the following examples—

on which youth and service factors predict

• Deepen insights and capture trend data

sustained freedom from homelessness.

by replicating national surveys on youth

This is vital information to understanding

homelessness. Ideal y, future national

how well current service delivery models

estimates would augment this first effort by

work in ending youth homelessness and

including self-reporting of homelessness

what actions can be taken to increase

experiences by adolescent minors and by

the success of systems and services.

including more detailed measures on the

Furthermore, better longitudinal research

durations, frequencies, and circumstances

could significantly strengthen our ability

of homelessness experiences in addition to

to develop valid screening instruments for

general annual prevalence and incidence

identifying youth at risk for homelessness

indicators. More detailed modules can

and for recurrent homelessness to improve

al ow for improved typologies of youth

targeting and service delivery models.

experiencing homelessness to further

• Test key intervention approaches. While

support sizing and tailoring of the policy

synthesizing some encouraging evidence

responses necessary to address the

of a range of interventions with positive

complexity of the problem. However, more

effects on youth outcomes, the systematic

detailed modules can add time and cost to

evidence review also revealed clear

national y representative surveys and can

knowledge gaps. For instance, only a few

risk higher non-response rates. As such,

studies tested the effects of coordinated

the merits of any additions would need to

prevention efforts, suggesting a

be weighed careful y against these practical

disproportionate focus by both researchers

considerations.

and funders on downstream responses

• Conduct longitudinal research. With few

to youth homelessness. Moreover, the

exceptions, longitudinal data are sorely

results of evaluations of family interventions

lacking in the youth homelessness literature

were varied, and the only randomized

despite their importance for informing more

evaluations of family interventions did

strategic policy actions. Empirical evidence

not measure stable housing outcomes

on the causes or predictors of youth

and overall showed limited effects

homelessness, as well as predictors of

on permanent connections. Only two

youth who experience some homelessness,

employment interventions were tested

but return to safe and stable housing

with youth experiencing homelessness

without intervention, is very limited. Even

and failed to demonstrate positive effects

relatively short-term longitudinal studies (for

on employment outcomes. Additionally,

example, 1–3 years) that follow cohorts of

is general y low-quality or non-existent,

youth (such as schools, child welfare, and

leaving pending questions regarding

justice systems) could provide important

the effectiveness of such interventions

insights on risk and protective factors

and the circumstances under which

for better identification and targeted

different approaches work best. Very little

intervention. We also lack longitudinal

specific evidence addresses what works,

research with youth that have already

and what does not, for preventing and

experienced homelessness. For example,

addressing youth homelessness with high-

we found relatively little evidence on the

risk subpopulations, such as Black and

Hispanic youth, LGBTQ youth, American

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Chapter 9. Conclusion

Indian or Alaska Native youth, and pregnant

endeavor.

and parenting youth. Evidence is lacking

on interventions in rural contexts. Agencies

Our findings reveal youth homelessness as a

and evaluators should engage youth and

broad and hidden chal enge as well as a complex

young adults as full partners in developing

problem with deep roots in family adversities

and evaluating interventions.

and structural inequalities. Youth homelessness

will not be fixed by short-term or simple fixes.

• Study youth empowerment and

At the same time, youth homelessness is a

collaboration. The VoYC experience and

solvable problem. Our evidence review revealed

research consistently pointed to benefits to

interventions that demonstrated measureable

both youth and communities of engaging

reductions of youth homelessness, and several

youth with lived experiences in system,

of our research components shed light on key

programming, and research efforts.

entry points in the lives of youth and across

Likewise, HUD is increasingly prioritizing

public systems. Key to our review was early

the role of youth engagement through

identification and action to prevent youth

funded programs and demonstrations.

homelessness and ensuring that early episodes

However, little research exists on effective

do not devolve into recurrent and high-acuity

models for youth engagement specific to

situations. In short, ending youth homelessness

youth homelessness, and on the effects

takes all of us. It takes greater resources, but it

of youth engagement on exits from

also takes smarter, more coordinated actions

homelessness and broader wel being. Many

across systems and services.

communities and providers have difficulty

operationalizing what youth empowerment

Efforts to end youth homelessness are worthy

should look like in their systems and

of prioritized attention and investment. Indeed,

services, especial y with a population that

ample research documents adolescence and

is often transient and constrained by many

young adulthood as a key developmental

life difficulties. A mixed-methods research

window. Every day of housing instability

effort could investigate the extent to which

represents missed opportunities to support

youth experiencing homelessness perceive

healthy development and transitions to

voice and influence in service delivery and

productive adulthood. We all lose out in these

systems change efforts and the effects of

missed opportunities.

engagement on youth outcomes.

References

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Abramovich, Alex, and Jama Shelton, Eds. 2017.

The breadth and depth of insights produced

Where am I going to go? Intersectional

by the VoYC initiative il uminate the benefits of

approaches to ending LGBTQ2S youth

a comprehensive, mixed-methods approach

homelessness in Canada and the U.S. Toronto,

to studying youth homelessness that draws on

CA: Canadian Observatory on Homelessness

many different perspectives. None of it would

Press.

have been possible without the partnerships

of public and private funders, the impetus

Baines, Donna. 2011. Doing anti-oppressive practice:

from Congress to fund better evidence to

Social justice social work, 2nd ed. Halifax, Nova

help address the problem, our 22 partner

Scotia: Fernwood.

communities across the county, and especial y

the youth themselves who gave their time,

expertise, and voice at multiple stages of this

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Chapter 9. Conclusion

Harris, Kathleen. 2009. The national longitudinal

Whitbeck, Les B., and Danny R. Hoyt. 1999. Nowhere

study of adolescent to adult health (Add Health),

to grow: Homeless and runaway adolescents and

Wave III, 2001–2002. Chapel Hil , NC: Carolina

their families. Hawthorn, NY: Alidine De Gruyter.

Population Center, University of North Carolina at

Chapel Hill.

Zufferey, Carole. 2017. Homelessness and social

work: An intersectional approach. London; New

Hyde, Justeen. 2005. “From home to street:

York: Routledge.

Understanding young people’s transitions into

homelessness: Homeless and runaway youth,”

Journal of Adolescence 28 (2): 171–183.

Rice, Eric, and Harmony Rhoades. 2013. “How should

network-based prevention for homeless youth be

implemented?” Addiction 108: 1625–1626.

Rice, Eric, Eve Tulbert, Julie Cederbaum, Anamika

Barman Adhikari, and Norweeta G. Milburn. 2012.

“Mobilizing homeless youth for HIV prevention:

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of a face-to-face and online social networking

intervention,” Health Education Research 27 (2):

226–236.

Ringwalt, Christopher L., Jody M. Greene,

and Marjorie J. Robertson. 1998. “Familial

backgrounds and risk behaviors of youth

with thrownaway experiences,” Journal of

Adolescence 21 (3): 241–252.

Toro, Paul A., Patrick J. Fowler, and Amy Dworsky.

2007. “Homeless youth in the United States:

Recent research findings and intervention

approaches.” In D. Dennis, G. Locke, and

J. Khadduri (Eds.), Proceedings of the 2007

National Symposium on Homelessness Research,

Washington, DC, March 1–2. http://aspe.hhs.gov/

hsp/homelessness/symposium07/.

U.S. Interagency Council on Homelessness (USICH).

2013. Framework to end youth homelessness:

A resource text for dialogue and action.

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U.S. Housing and Urban Development (HUD). 2016.

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Appendix A. National survey instruments

Appendices

Appendix A. National survey instruments

Note: Skip logic instructions and background information for the respondent are not reflected here.

Neither are the ful er range of demographic, employment, education, etc., questions that were included in the broader Gal up Daily Tracking Survey and this study’s analysis of factors correlated with youth homelessness experiences. These may be made available upon request.

Main prevalence and incidence module

1. In the past 12 months, how many 13-17 year olds were a member of your household? Please include people ages 13-17 who lived with you even temporarily, such as foster children or extended family members.

2. In the past 12 months, did any of these household members, ages 13-17, run away from home and stay away for at least one night?

3. Was that the first time he or she ran away from home?

4. In the past 12 months, did any of these household members, who were ages 13-17, leave home because he or she was asked to leave?

5. Was this the first time he or she left home because he or she was asked to leave?

6. In the past 12 months, did any of these household members, who were ages 13-17, couch surf -

that is move from one temporary housing arrangement to another?

7. Was this the first time he or she couch surfed?

8. In the past 12 months, were any of these household members, who were ages 13-17, homeless for at least one night?

9. Was this the first time he or she was homeless?

10. In the past 12 months, how many 18-25 year olds were a member of your household? Please include people ages 18-25 who lived with you even temporarily such as roommates or extended family members.

11. In the past 12 months, did any of these household members, who were ages 18-25, couch surf -

that is move from one temporary housing arrangement to another?

12. Was this the first time he or she couch surfed?

13. In the past 12 months, were any of these household members, who were ages 18-25, homeless for at least one night?

14. Was this the first time he or she was homeless?

15. In the past 12 months, did you couch surf - that is move from one temporary housing arrangement to another?

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Appendix A. National survey instruments

16. Was this the first time you couch surfed?

17. In the past 12 months, were you homeless for at least one night?

18. Was this the first time you were homeless?

19. In the past 12 months, were you a member of a household that included other adults ages 18 or over such as your parents, roommates, or other adults who you lived with?

Follow-up interview instruments

Note: These were more detailed interviews were only administered with smal er subsamples of those who reported homelessness or couch surfing (see Chapter 2 for further information).

CONTINUE IF RESPONDENT IS REPORTING ABOUT ANOTHER PERSON IN THE HOUSEHOLD.

OTHERWISE SKIP TO PERSONAL REPORT SECTION.

Quantitative section

1. [Completed by interviewer] Unique ID [linking to the Daily Tracking Survey-VoYC data]

‐

[string / number]

2. [Completed by interviewer] For which youth homelessness or unstable housing category is this follow-up interview being conducted?

� 13-17 year-old household member was homeless

� 13-17 year-old household member was couch-surfing

� 13-17 year-old household member was homeless and couch-surfing

� 18-25 year-old household member was homeless

� 18-25 year-old household member was couch-surfing

� 18-25 year-old household member was homeless and couch-surfing

� 18-25 year-old respondent was homeless

� 18-25 year-old respondent was couch-surfing

� 18-25 year-old respondent was homeless and couch-surfing

3. [Completed by interviewer] At any point during the interview, did the respondent indicate that s/he made an error in the Daily Tracking Poll with respect to reporting any homelessness or couch-surfing in the last 12 months?

If household member was homeless ask Q4. Otherwise skip to Q5

� yes

� no

4. In the past 12 months, how many individuals who were members of your household at any time and [ages 13-17 or 18-25, depending on respondent category] were homeless for at least one night?

If household member was couch surfing ask Q5. Otherwise skip to Q6

‐

[number]

� don’t know

� refuse to answer

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Appendix A. National survey instruments

5. In the past 12 months, how many individuals who were members of your household at any time and [ages 13-17 or 18-25, depending on respondent category] couch-surfed—that is, moved from one temporary housing arrangement to another?

‐

[number]

� don’t know

� refuse to answer

6. In the past 12 months, have you been homeless for at least one night?

� yes

� no

� don’t know

� refuse to answer

7. In the past 12 months, have you couch-surfed—that is, moved from one temporary housing arrangement to another?

� yes

� no

� don’t know

� refuse to answer

If more than one young person in your household experienced homelessness or couch-surfing at least once in the last 12-months, think about the youth who most recently had this experience when you answer the following questions. Please answer these questions to the best of your knowledge.

Qualitative section

I would like to start by asking you a few open-ended questions.

CONTINUE IF EXPERIENCE WITH HOMELESSNESS. OTHERWISE SKIP TO COUCH-SURFING

SECTION.

1. Can you tell me a bit more about this person’s experience with homelessness?

2. IF NOT ALREADY ANSWERED: What caused this person to experience homelessness?

IF NEEDED, ASK:

Was there a conflict or a problem that triggered the episode of homelessness?

Did this person or his/her family have difficulty paying rent/mortgage?

Did this person feel unsafe where they were?

Did this person end up homeless because she/he was in a difficult situation, or for other reasons?

IF RESPONDED “YES” TO YOUTH HAD COUCH-SURFED, CONTINUE. OTHERWISE, SKIP TO

QUANTITATIVE SECTION 2.

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Appendix A. National survey instruments

3. Can you tell me bit more about this person’s experience with couch-surfing?

IF NEEDED, ASK: Where was the person staying when she/he was couch surfing?

4. IF NOT ALREADY ANSWERED: What caused this person to experience couch-surfing?

IF NEEDED, ASK:

Was there a conflict or a problem that triggered the episode of couch-surfing?

Did this person or his/her family have difficulty paying rent/mortgage?

Did this person couch-surf because she/he was in a difficult situation, or for other reasons, like wanting to travel or stay at a friend’s house for fun?

5. Do you think this person might have been unsafe or at-risk of problems or distress while she/he was homeless or couch-surfing over the last 12 months? If so, can you tell me why?

IF NEEDED, ASK: Could this person have been at risk of outside elements, stress, violence, harassment, drugs, or doing risky things in order to get by?

Thank you for that information. I have some additional questions for you to wrap up the interview.

6. About how old is this person?

‐

[number]

� don’t know

� refuse to answer

7. What is, or was, your relationship to this person?

� parent/legal guardian

� grandparent (non-legal guardian)

� sibling

� other family member

� boyfriend/girlfriend

� other sexual partner

� neighbor

� roommate

� friend (non-neighbor or roommate)

� other community member

� foster parent

� host home

� on the streets/homeless together

� couch-surfed/doubled up together

� in a shelter together

� other [specify _____ ]

� don’t know

� refuse to answer

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8. What is this person’s race or ethnicity? (Mark all that apply.)

� White/Caucasian

� Black/African American

� Pacific Islander/Native Hawaiian

� American Indian/Alaskan Native

� Hispanic/Latino

� Asian

� other [specify _____ ]

� don’t know

� refuse to answer

9. Would this person identify as male, female, transgender or other?

� male

� female

� _ transgender, gender non-conforming, or other

� _ don’t know

� _ refuse to answer

10. Would this person identify as lesbian, gay, or bisexual?

� yes

� no

� don’t know

� refuse to answer

11. Does this person have a high school diploma or GED?

� yes

� no

� don’t know

� refuse to answer

12. [If the person was 18-25, ask:]

Has this person ever served in active duty in the U.S. Armed Forces (i.e., Army, Air Force, Navy, Marine Corps, or Coast Guard)?

� yes

� no

� don’t know

� refuse to answer

13. Has this person ever been in foster care?

� yes [ask next question; otherwise skip to the following question]

� no

� don’t know

� refuse to answer

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14. Did this person experience any homelessness or couch-surfing either while they were in foster care or within 12 months of leaving foster care?

� yes

� no

� don’t know

� refuse to answer

15. Has this person ever been in juvenile detention, jail or prison?

� yes

� no

� don’t know

� refuse to answer

16. Is this person an immigrant or a refugee?

� yes

� no

� don’t know

� refuse to answer

17. Has this person ever experienced psychiatric hospitalization?

� yes

� no

� don’t know

� refuse to answer

18. How many times did this person experience [homelessness and/or couch-surfing] in the last 12

months?

� only once

� only twice

� three to five times

� more than five times

� don’t know

� refuse to answer

19. Does this person currently lack a stable residence? That is, is s/he is currently homeless or couch-surfing?

� yes [ask next question; otherwise skip to the following question]

� no

� don’t know

� refuse to answer

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Appendix A. National survey instruments

20. Would you say that s/he is currently homeless, couch-surfing, both, or that you don’t know?

� homeless

� couch-surfing

� both

� don’t know

� refuse to answer

21. In the past 12 months, how long did his/her longest episode of homelessness/couch surfing last?

� only one night

� more than one night but less than one week

� one week to less than one month

� one month to less than three months

� three months or more

� don’t know

� refuse to answer

22. Where did this person sleep while she/he was homelessness or couch-surfing in the last 12

months? (Mark all that apply.)

� Shelter

� Transitional housing

� Hotel, motel, or hostel

� House or apartment of a stranger or someone s/he does not know wel

� Home of someone s/he was having sex with in exchange for housing or survival needs

� Car or other vehicle

� Abandoned building/vacant unit/squat

� Train/bus or train/bus station

� 24-hour restaurant/laundromat/other retail establishment

� Relative’s home

� Neighbor’s home

� Friend’s home (non-neighbor)

� Home of boyfriend/girlfriend

� Group home

� Other person’s home

� Anywhere outside

� Hospital or emergency room

� Residential treatment facility

� Juvenile detention center or jail

� other [specify _____ ]

� don’t know

� refuse to answer

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Appendix A. National survey instruments

23. Before this person experienced homelessness or couch-surfing, was your home this person’s usual residence?

� yes

� no

� don’t know

� refuse to answer

24. [If the person was 13-17, ask:]

Did this person spend more than 30 days in the home of his or her parent or guardian in the past 6 months?

� yes

� no

� don’t know

� refuse to answer

25. [If the person was 18-25, ask:]

Was this person housed for more than 30 days in the past 6 months. Do not count any time he or she might have spent in a shelter?

� yes

� no

� don’t know

� refuse to answer

26. Was this person pregnant or a parent while homeless or couch-surfing?

� yes

� no

� don’t know

� refuse to answer

27. Did this person have mental health problems while homeless or couch-surfing—such as depression or anxiety?

� yes

� no

� don’t know

� refuse to answer

28. Did this person have difficulties with substance use while homeless or couch-surfing—such as drugs or alcohol?

� yes

� no

� don’t know

� refuse to answer

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Appendix A. National survey instruments

29. Did this person experience homelessness and/or couch surfing for the first time in the last 12

months?

� yes [ask next question; otherwise skip to the following question]

� no

� don’t know

� refuse to answer

30. Thinking about this person’s whole life, about how old was s/he when s/he first experienced homelessness or couch-surfing—either alone or with parents/guardians?

‐

[number]

� don’t know

� refuse to answer

31. Do you believe this person slept in a place where he or she felt, or was, unsafe?

� yes

� no

� don’t know

� refuse to answer

32. Do you believe this person needed any formal services in the last 12 months? Services could include shelter, housing or help reconnecting with family.

� yes

� no

� don’t know

� refuse to answer

33. Do you believe this person received any formal shelter services in the last 12 months? Services could include shelter, housing or help reconnecting with family.

� yes

� no

� don’t know

� refuse to answer

34. Skip to next question if youth was aged 18-25.]

Was this person accompanied by a parent/guardian during this most recent episode?

� yes

� no

� don’t know

� refuse to answer

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Appendix A. National survey instruments

35. Was this person enrolled in school, college, or another education program while homeless or couch-surfing during this most recent episode?

� yes

� no

� don’t know

� refuse to answer

36. Was this person employed at a job for which s/he received a pay check while homeless or couch-surfing during this most recent episode?

� yes

� no

� don’t know

� refuse to answer

IF RESPONDENT IS ANSWERING ABOUT THEMSELVES, CONTINUE WITH THIS SECTION:

Quantitative section

1. [Completed by interviewer]

Unique ID [linking to the Daily Tracking Survey-VoYC data]

‐

[string / number]

2. [Completed by interviewer]

For which youth homelessness or unstable housing category is this follow-up interview being conducted?

� 18-25 year-old was homeless, self-report

� 18-25 year-old was couch-surfing, self-report

� 18-25 year-old was homeless and couch-surfing, self-report

3. [Completed by interviewer]

At any point during the interview, did the respondent indicate that s/he made an error in the Daily Tracking Poll with respect to reporting any homelessness or couch-surfing in the last 12

months?

� yes

� no

Now I would like to ask you some questions about your experiences with homelessness or couch-surfing.

4. How many times did you experience [INTERVIEWER, REFER TO MASTER SPREADSHEET TO

IDENTIFY FILL: homelessness and/or couch-surfing] in the last 12 months?

� only once

� only twice

� three to five times

� more than five times

� don’t know

� refuse to answer

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Appendix A. National survey instruments

Qualitative section

Thank you. Next, I would like to ask you some open-ended questions.

5. When you responded to the Gal up telephone survey, you said that you had been homeless for at least one night in the last 12 months. Please tell me more about that situation.

IF NEEDED: Where did you stay when you were homeless?

6. IF NOT ANSWERED: What caused this homelessness experience?

IF NEEDED:

Was there a conflict or a problem that triggered the episode?

Did you or your family have difficulty paying rent/mortgage?

Did you feel unsafe where you were?

Did you end up homeless because you were in a difficult situation, or for other reasons?

IF THE RESPONDENT COUCHSURFED, CONTINUE. OTHERWISE SKIP TO QUANTITATIVE SECTION

2.

7. When you responded to the Gal up survey, you said that you had couch-surfed sometime in the last 12 months. Please tell me more about that couch-surfing situation.

IF NEEDED: Where did you stay when you were couch surfing?

8. IF NOT ALREADY ANSWERED: What caused you to experience couch-surfing?

IF NEEDED:

Was there a conflict or a problem that triggered the episode?

Did you or your family have difficulty paying rent/mortgage?

Did you couch surf because you were in a difficult situation, or for other reasons, like wanting to travel or stay at a friend’s house for fun?

9. Do you believe you were unsafe or at-risk of problems or distress while you were homeless or couch-surfing over the last 12 months? Can you tell me why?

IF NEEDED: Could you have been at risk of outside elements, stress, violence, harassment, drugs, or doing risky things in order to get by?

10. Please tell me about any services, programs, or shelters involved in any experiences of homelessness or couch-surfing over the last 12 months.

IF NEEDED: Were you offered any housing support services, shelter connections, or programs for things like employment, mental health or substance use treatment, or any other types of services? Did you participate in any of these programs or services?

Thank you for that information. I have just a few final questions for you to wrap up our time together.

11. Have you ever served in active duty in the U.S. Armed Forces (i.e., Army, Air Force, Navy, Marine Corps, or Coast Guard)?

� yes

� no

� don’t know

� refuse to answer

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Appendix A. National survey instruments

12. Have you ever been in foster care?

� yes [ask next question; otherwise skip to the following question]

� no

� don’t know

� refuse to answer

13. Did you experience any homelessness or couch-surfing either while in foster care or within 12

months of leaving foster care?

� yes

� no

� don’t know

� refuse to answer

14. Have you ever been in juvenile detention, jail, or prison?

� yes

� no

� don’t know

� refuse to answer

15. Are you an immigrant or a refugee?

� yes

� no

� don’t know

� refuse to answer

16. Have you ever experienced psychiatric hospitalization?

� yes

� no

� don’t know

� refuse to answer

17. When you were younger, did your family have any experiences of homelessness or unstable housing?

� yes

� no

� don’t know

� refuse to answer

18. Do you currently lack a stable residence? That is, are you currently homeless or couch-surfing?

� yes [ask next question; otherwise skip to the following question]

� no

� don’t know

� refuse to answer

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Appendix A. National survey instruments

19. Would you say that you are currently homeless, couch-surfing, or both?

� homeless

� couch-surfing

� both

� don’t know

� refuse to answer

20. How long did your longest episode of [homelessness and/or couch-surfing] in the past 12

months last?

� only one night

� more than one night but less than one week

� one week to less than one month

� one month to less than three months

� three months or more

� don’t know

� refuse to answer

21. Where did you sleep while you were homeless or couch-surfing in the last 12-months? (Mark all that apply.)

� Shelter

� Transitional housing

� Hotel, motel, or hostel

� House or apartment of a stranger or someone s/he does not know wel

� Home of someone s/he was having sex with in exchange for housing or survival needs

� Car or other vehicle

� Abandoned building/vacant unit/squat

� Train/bus or train/bus station

� 24-hour restaurant/laundromat/other retail establishment

� Relative’s home

� Neighbor’s home

� Friend’s home (non-neighbor)

� Home of boyfriend/girlfriend

� Group home

� Other person’s home

� Anywhere outside

� Hospital or emergency room

� Residential treatment facility

� Juvenile detention center or jail

� other [specify _____ ]

� don’t know

� refuse to answer

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Appendix A. National survey instruments

22. Were you housed for more than 30 days in the past 6 months? Do not count any time you might have spent in a shelter.

� yes

� no

� don’t know

� refuse to answer

For the following questions, consider the most recent episode of [homelessness and/or couch-surfing]. Please just answer to the best of your memory.

23. Were you enrolled in school, college, or another education program at the time?

� yes

� no

� don’t know

� refuse to answer

24. Were you employed at a job for which you received a pay check at the time?

� yes

� no

� don’t know

� refuse to answer

25. Did you have mental health problems at the time—such as depression or anxiety?

� yes

� no

� don’t know

� refuse to answer

26. Did you have difficulties with substance use at the time—such as drugs or alcohol?

� yes

� no

� don’t know

� refuse to answer

For the following questions, consider any episodes of [homelessness and/or couch-surfing] over the last 12 months.

27. Do did you sleep in a place where you felt unsafe?

� yes

� no

� don’t know

� refuse to answer

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Appendix A. National survey instruments

28. Do you believe you needed any formal services in the last 12 months? Services could include shelter, housing or help reconnecting with family.

� yes

� no

� don’t know

� refuse to answer

29. Did you receive any formal services in the last 12 months? Services could include shelter, housing or help reconnecting with family.

� yes

� no

� don’t know

� refuse to answer

30. Did you experience homelessness and/or couch surfing for the first time in the last 12 months?

� yes

� no [ask next question; otherwise skip to the following question]

� don’t know

� refuse to answer

31. Thinking about your whole life, about how old were you when you first experienced homelessness or couch-surfing—either alone or with parents/guardians?

‐

[number]

� don’t know

� refuse to answer

32. Were you pregnant or a parent while homeless or couch-surfing?

� yes

� no

� don’t know

� refuse to answer

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238

Appendix B. Brief Youth Survey instrument

Appendix B. Brief Youth Survey instrument

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239

Appendix C. County-level data: Youth counts and brief youth surveys Appendix C. County-level data: Youth counts and brief youth surveys

Table C.1. Small county youth count contexts and circumstances

# of

# of

# of

# of

County

Date

Teams

Guides

Leaders

Hotspots

Strengths

Difficulties

Easy to locate and access hot spots

Rainy weather

One Come and Be Counted location that

Counting on the first day of the month—the

Boyd, KY

8/1/2016

4

10

4

41

youth frequently access for services

day on which youth are paid—meant that

youth were in locations that had not been

identified as hotspots

Committed community

Too few teams to cover the entire county.

Cecil, MD

7/12/2016

5

14

6

77

Team leaders wil ing to take extra shifts

Unsafe to administer survey at many hot

and problem-solve on the ground

spots (for example, encampments and

trafficking locations at the state border)

Guides, team leaders, and adult volunteers Problems with maps made some hot spots wil ing to take extra shifts

difficult to locate

Real time information used to identify

Teams covered large rural areas without

Kennebec, ME

6/16/2016

7

17

8

87

locations to count youth

finding youth

Less infrastructure and engagement in

southern part of the county

No notable strengths

Too few teams to cover the entire county

Livingston, MO

6/21/2016

2

4

3

34

Extremely hot weather limited time spent at

outdoor hotspots

Mariposa, CA

7/21/2016

5

9

5

25

No notable strengths

No notable difficulties

Strong community participation

Little engagement with the Latin@*

community

Wal a Wal a, WA

6/14/2016

5

10

7

89

Youth focus group participants were

knowledgeable and well-networked or

knew where to find other youth.

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240

Appendix C. County-level data: Youth counts and brief youth surveys Table C.2. Medium-sized county youth count contexts and circumstances

# of

# of

# of

# of

County

Date

Teams

Guides

Leaders

Hotspots

Strengths

Difficulties

Really hot weather

Not enough recruits so teams had to work

Ada, ID

6/7/2016

8

20

8

97

No notable strengths

long hours

Not al owed to count youth at summer

lunch programs

PokemonGo craze at its height so a large

Strong service provider and youth

number of people were in parks

Cleveland, OK

7/19/2016

5

11

20

49

participation

Not al owed to count youth at summer

lunch programs

Difficulty engaging shelters for the

Strong youth engagement and community

Davidson, TN

7/29/2016

7

26

11

73

organizational count—no shelters

participation

participated

Limited community engagement

Delaware, OH

8/3/2016

4

8

7

42

No notable strengths

Too few youth recruited

Recruitment of youth, adult volunteers and

Strong relationships between youth

organizations came together late

and Team Leaders (most of whom were

Denver, CO

7/22/2016

11

22

7

72

runaway and homeless youth (RHY)

Resulted in some team consolidation,

service provider staff)

changes in timing of shifts and lack of

organization at Come and Be Counted sites

Strong youth engagement and

participation

No youth at some hotspots because youth

Orleans, LA

6/23/2016

19

66

31

159

who would have been at those hotspots

Local providers offered additional training

were guides

Strong community support

Strong youth engagement

7/26–

Two youth not affiliated with the count died

Suffolk, MA

21

56

22

181

27/2016

Guides knew many of the surveyed youth,

Few providers outside Boston participated

which may have increased participation.

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241

Appendix C. County-level data: Youth counts and brief youth surveys Table C.3. Large county youth count contexts and circumstances

# of

# of

# of

# of

County

Date

Teams

Guides

Leaders Hotspots

Strengths

Difficulties

Strong youth engagement

Agency partner key staffing change impacted

planning

Wil ingness to reschedule count

date to increase turnout

Some service providers could not participate

due to time of year

Continuum of Care (CoC) could not ful y

Alameda, CA

8/9/2016

12

31

15

178

participate due to time of year

Unsafe to count in areas where youth may be

trafficked

Some areas of the county with few providers

were difficult to reach

Strong youth engagement

Some service providers could not participate

Cook, IL

8/4–5/2016

27

64

34

372

because the lack of a state budget had led to

reductions in their staff

Strong youth engagement

Unsafe to count in some areas due to gun

violence

Hennepin, MN

6/14/2016

12

23

13

165

Guides knew many of the youth

they surveyed, which they felt

Intermittent downpour

increased survey participation.

Strong lead agency

Chal enges with city enforcement of homeless

encampments

King, WA

6/30/2016

23

59

29

143

Strong youth engagement

Strong community involvement

Strong community involvement and Agency partner turnover impacted planning

participation

Pulse Nightclub shooting delayed planning

Orange, FL

8/9/2016

9

35

5

104

Many service providers

participated in the Organizational

Extremely hot with heavy rain

Count

(continued)

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242

Appendix C. County-level data: Youth counts and brief youth surveys (Table C.3. Large county youth count contexts and circumstances continued)

# of

# of

# of

# of

County

Date

Teams

Guides

Leaders Hotspots

Strengths

Difficulties

Difficult to identify homeless and unstably

Philadelphia, PA

8/3/2016

20

59

28

132

No notable strengths

housed youth because the beautiful weather

brought many people outside

Provider network largely in western half of

Strong youth and provider

county

San Diego, CA

8/11–12/2016

25

55

34

344

participation

Limited ability to recruit from and count in more

sparsely populated eastern half

Heavy rains in days leading up to count flooded

Travis, TX

6/7/2016

14

37

16

73

No notable strengths

some of the hot spots

Limited ability to survey youth in areas with gang

activity

Real y strong participation by

Wayne, MI

7/11–12/2016

19

36

30

127

Fire at one hot spot

service provider network and youth

Few outdoor hot spots and few service

providers in suburban Wayne County

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243

Appendix C. County-level data: Youth counts and brief youth surveys Table C.4. Number of homeless and unstably housed youth—brief youth survey data Sheltered or

Organizational

County

Brief Youth Survey

Unsheltered

Street Count

Count

Community Count

Small Counties

255

131

154

38

63

Boyd, KY

47

33

15

19

13

Cecil, MD

61

42

39

6

16

Kennebec, ME

43

15

33

3

7

Livingston, MO

10

6

4

6

0

Mariposa, CA

20

11

6

2

12

Wal a Wal a, WA

74

24

57

2

15

Medium-Sized Counties

1112

831

616

248

248

Ada, ID

68

52

37

27

5

Cleveland, OK

35

24

8

19

8

Davidson, TN

112

81

87

0

25

Delaware, OH

15

2

3

6

6

Denver, CO

351

301

127

133

91

Orleans, LA

238

164

153

3

82

Suffolk, MA

293

207

201

61

31

Large Counties

2772

2004

1548

576

648

Alameda, CA

170

129

91

30

49

Cook, IL

689

513

431

109

149

Hennepin, MN

349

217

183

115

51

King, WA

448

379

216

139

93

Orange, FL

171

144

70

45

56

Philadelphia, PA

263

159

187

46

30

San Diego, CA

354

247

206

12

136

Travis, TX

133

113

54

42

37

Wayne, MI

195

103

110

38

47

Total

4139

2966

2318

862

959

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244

Appendix C. County-level data: Youth counts and brief youth surveys Table C.5. Number of homeless and unstably housed youth—integrated data

Unaccompanied

Students

County

Brief Youth Survey

Tallied, Not Surveyed

HMIS, Not Surveyed

Total

(MV Data)

Small Counties

Boyd, KY

47

21

16

84

1

Cecil, MD

61

12

1

74

7

Kennebec, ME

43

7

25

75

82

Livingston, MO

10

2

N/A

12

1

Mariposa, CA

20

5

N/A

25

0

Wal a Wal a, WA

74

18

N/A

92

7

Medium-Sized Counties

Ada, ID

68

9

N/A

77

205

Cleveland, OK

35

10

N/A

45

112

Davidson, TN

112

30

N/A

142

104

Delaware, OH

15

1

21*

16

11

Denver, CO

351

54

N/A

405

179

Orleans, LA

238

55

N/A

293

354

Suffolk, MA

293

42

N/A

335

45

Large Counties

Alameda, CA

170

59

N/A

229

96

Cook, IL

689

173

N/A

862

3030

Hennepin, MN

349

15

809

1173

477

King, WA

448

67

N/A

515

710

Orange, FL

171

23

64

194

290

Philadelphia, PA

263

37

269

569

80

San Diego, CA

354

113

N/A

467

189

Travis, TX

133

21

18

172

647

Wayne, MI

195

59

N/A

254

173

Total

4139

833

1223

6110

6800

* Includes 8 youth who may be double-counted due to incomplete Homeless Management Information System (HMIS) data Voices of Youth count comprehensiVe report: Youth homelessness in AmericA

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Appendix C. County-level data: Youth counts and brief youth surveys Table C.6. Characteristics of homeless and unstably housed youth—age and race/ethnicity County

Age 13–17*

Age 18–25*

White**

Black**

Latin@**

Multiracial**

Other***

Small Counties

Boyd, KY

0.26

0.74

0.85

0.09

0.00

0.07

0.00

Cecil, MD

0.19

0.81

0.75

0.17

0.02

0.04

0.02

Kennebec, ME

0.17

0.83

0.83

0.02

0.02

0.02

0.10

Livingston, MO

0.20

0.80

0.78

0.22

0.00

0.00

0.00

Mariposa, CA

0.10

0.90

0.69

0.00

0.00

0.23

0.08

Wal a Wal a, WA

0.27

0.73

0.80

0.03

0.07

0.06

0.04

Medium-Sized Counties

Ada, ID

0.23

0.77

0.72

0.06

0.06

0.11

0.06

Cleveland, OK

0.24

0.76

0.69

0.11

0.03

0.09

0.09

Davidson, TN

0.19

0.81

0.30

0.55

0.04

0.03

0.08

Delaware, OH

0.07

0.93

0.73

0.13

0.13

0.00

0.00

Denver, CO

0.05

0.95

0.36

0.35

0.14

0.10

0.06

Orleans, LA

0.12

0.88

0.19

0.74

0.02

0.03

0.03

Suffolk, MA

0.09

0.91

0.23

0.40

0.21

0.10

0.06

Large Counties

Alameda, CA

0.17

0.83

0.13

0.53

0.10

0.13

0.11

Cook, IL

0.11

0.89

0.12

0.65

0.13

0.05

0.05

Hennepin, MN

0.15

0.85

0.15

0.59

0.03

0.13

0.10

King, WA

0.07

0.93

0.35

0.28

0.07

0.18

0.12

Orange, FL

0.10

0.90

0.20

0.46

0.20

0.07

0.07

Philadelphia, PA

0.21

0.79

0.10

0.70

0.09

0.07

0.05

San Diego, CA

0.20

0.80

0.20

0.28

0.33

0.12

0.07

Travis, TX

0.03

0.97

0.34

0.29

0.27

0.07

0.02

Wayne, MI

0.14

0.86

0.09

0.84

0.02

0.02

0.03

Total

0.13

0.87

0.25

0.47

0.12

0.09

0.06

* Percentages exclude 223 brief youth survey (BYS) respondents who did not report their date of birth.

** Percentages exclude 192 BYS respondents who did not report their race/ethnicity.

*** Percentages exclude 192 BYS respondents who did not report their race/ethnicity. Includes BYS respondents who identified their race/ethnicity as Asian, American Indian/Alaskan Native, Native Hawai an/Pacific Islander, Other, or who responded “Don’t know.” Voices of Youth count comprehensiVe report: Youth homelessness in AmericA 246

Appendix C. County-level data: Youth counts and brief youth surveys Table C.7. Characteristics of homeless and unstably housed youth—gender, sexual orientation, and pregnancy/parenthood

Pregnant or

Parent (Female

County

Female*

Male*

Other Gender**

LGB***

Only)****

Small Counties

Boyd, KY

0.53

0.47

0.00

0.05

0.71

Cecil, MD

0.54

0.46

0.00

0.14

0.42

Kennebec, ME

0.31

0.67

0.03

0.12

0.58

Livingston, MO

0.22

0.78

0.00

0.11

0.50

Mariposa, CA

0.38

0.62

0.00

0.15

0.75

Wal a Wal a, WA

0.38

0.58

0.03

0.20

0.52

Medium-Sized Counties

Ada, ID

0.32

0.65

0.03

0.18

0.20

Cleveland, OK

0.40

0.60

0.00

0.30

0.29

Davidson, TN

0.30

0.67

0.03

0.15

0.29

Delaware, OH

0.60

0.40

0.00

0.07

0.78

Denver, CO

0.19

0.79

0.02

0.15

0.37

Orleans, LA

0.37

0.63

0.00

0.16

0.44

Suffolk, MA

0.34

0.65

0.02

0.22

0.28

Large Counties

Alameda, CA

0.34

0.59

0.07

0.23

0.32

Cook, IL

0.40

0.56

0.04

0.23

0.33

Hennepin, MN

0.50

0.49

0.01

0.24

0.43

King, WA

0.33

0.59

0.08

0.22

0.39

Orange, FL

0.46

0.47

0.07

0.26

0.39

Philadelphia, PA

0.41

0.57

0.02

0.29

0.34

San Diego, CA

0.37

0.62

0.01

0.17

0.40

Travis, TX

0.42

0.55

0.03

0.20

0.55

Wayne, MI

0.42

0.54

0.04

0.21

0.36

Total

0.37

0.59

0.03

0.21

0.39

* Percentages exclude 470 BYS respondents who did not report their gender identity.

** Percentages exclude 470 BYS respondents who did not report their gender identity. “Other” includes BYS respondents who identified themselves as transgender (M-F), transgender (F-M), intersex, genderqueer/gender-nonconforming, other, or who responded “Don’t know.”

*** Includes BYS respondents who identified their sexual orientation as mostly heterosexual, bisexual, mostly gay or lesbian, or 100 percent gay or lesbian. Percentages exclude 269 BYS respondents who did not report their sexual orientation.

**** Percentages exclude 44 BYS female respondents who did not answer the question about being pregnant or a parent.

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Appendix C. County-level data: Youth counts and brief youth surveys Table C.8. Education and employment of homeless and unstably housed youth

HS diploma or

Employed

Attending School

GED

Disconnected

County

(18–25)*

(18–25)**

(18–25)***

(18–25)****

Small Counties

Boyd, KY

0.25

0.38

0.72

0.53

Cecil, MD

0.12

0.10

0.44

0.80

Kennebec, ME

0.30

0.12

0.52

0.61

Livingston, MO

0.14

0.00

0.86

0.86

Mariposa, CA

0.15

0.07

0.47

0.77

Wal a Wal a, WA

0.27

0.20

0.67

0.56

Medium-Sized Counties

Ada, ID

0.32

0.14

0.70

0.57

Cleveland, OK

0.32

0.48

0.44

0.40

Davidson, TN

0.46

0.10

0.80

0.49

Delaware, OH

0.64

0.14

0.64

0.29

Denver, CO

0.19

0.17

0.68

0.69

Orleans, LA

0.43

0.28

0.64

0.43

Suffolk, MA

0.42

0.25

0.67

0.51

Large Counties

Alameda, CA

0.43

0.25

0.66

0.47

Cook, IL

0.33

0.29

0.63

0.49

Hennepin, MN

0.40

0.26

0.64

0.46

King, WA

0.40

0.22

0.65

0.48

Orange, FL

0.41

0.43

0.61

0.36

Philadelphia, PA

0.36

0.32

0.78

0.47

San Diego, CA

0.27

0.25

0.67

0.57

Travis, TX

0.24

0.21

0.66

0.63

Wayne, MI

0.34

0.27

0.71

0.50

Total

0.34

0.25

0.66

0.52

*Percentages exclude 360 18- to 25-year-old BYS respondents who did not answer the employment question.

**Percentages exclude 364 18- to 25-year-old BYS respondents who did not answer the school attendance question.

***Percentages exclude 335 18- to 25-year-old BYS respondents who did not answer the high school completion question.

****Percentages exclude 176 18- to 25-year-old BYS respondents who did not answer the employment and/or school attendance question(s).

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Appendix C. County-level data: Youth counts and brief youth surveys Table C.9. Systems involvement of homeless and unstably housed youth

Ever in

Receive Public

Detention, Jail,

Ever in Foster

County

Benefits*

Prison**

Care***

Small Counties

Boyd, KY

0.58

0.41

0.24

Cecil, MD

0.63

0.63

0.20

Kennebec, ME

0.40

0.56

0.26

Livingston, MO

0.22

0.50

0.11

Mariposa, CA

0.88

0.41

0.24

Wal a Wal a, WA

0.55

0.52

0.37

Medium-Sized Counties

Ada, ID

0.41

0.53

0.39

Cleveland, OK

0.63

0.31

0.43

Davidson, TN

0.36

0.50

0.32

Delaware, OH

0.33

0.47

0.07

Denver, CO

0.35

0.59

0.35

Orleans, LA

0.47

0.43

0.20

Suffolk, MA

0.56

0.47

0.31

Large Counties

Alameda, CA

0.56

0.39

0.30

Cook, IL

0.43

0.39

0.23

Hennepin, MN

0.49

0.49

0.27

King, WA

0.61

0.49

0.28

Orange, FL

0.50

0.30

0.28

Philadelphia, PA

0.44

0.35

0.29

San Diego, CA

0.57

0.45

0.33

Travis, TX

0.38

0.66

0.37

Wayne, MI

0.45

0.36

0.24

Total

0.49

0.46

0.29

* Percentages exclude 189 BYS respondents who did not answer the public benefits question.

** Percentages exclude 241 BYS respondents who did not answer the question about ever being in detention, jail, or prison.

*** Percentages exclude 179 BYS respondents who did not answer the foster care question.

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Appendix D. In-depth interviews background survey instrument

Appendix D. In-depth interviews background survey instrument

SAID TO YOUTH BY INTERVIEWER: This part of the interview will take about 20 minutes. As you listen to the questions the answers will appear on the iPad for you to select and will be read aloud. All of your answers will be kept private. Remember that your participation is completely voluntary. You can refuse to answer any question. You can also stop at any point by simply tel ing me you would like to stop.

(THE FOLLOWING ITEMS AND RESPONSES WILL BE READ TO YOUTH BY REDCap voice)

1. How old are you?

� 13

� 17

� 21

� 25

� 14

� 18

� 22

� I refuse to

� 15

� 19

� 23

answer

� 16

� 20

� 24

2. Do you have a high school diploma or GED?

� Yes

� No

� I don’t know

� I refuse to answer

3. Are you currently attending school or another educational program?

� Yes

� No

� I don’t know

� I refuse to answer

4. In what type of school are you enrolled? (IF Q#3 = YES)

� Junior High or Middle School

� Regular high school

� GED/High school equivalency classes

� Two year/community college

� Alternative high school

� Trade School

� Four year col ege or university

� I don’t know

� I refuse to answer

5. Are you currently employed at a job for which you receive a pay stub or pay check?

� Yes

� No

� I don’t know

� I refuse to answer

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Appendix D. In-depth interviews background survey instrument

6. Have you ever been in foster care?

� Yes

� No

� I don’t know

� I refuse to answer

7. Have you ever served in the United States military?

� Yes

� No

� I don’t know

� I refuse to answer

8. Have you ever been in juvenile detention, jail or prison?

� Yes

� No

� I don’t know

� I refuse to answer

9. Is this the first time you have not had a permanent place to sleep?

� Yes

� No

� I don’t know

� I refuse to answer

10. In the past three years, how many different times have you been without a permanent place to sleep? (IF Q#10 = NO)

� 2-3 times

� 4-5 times

� 6-8 times

� 9-11 times

� 12 times or more

� I don’t know

� I refuse to answer

11. For how long have you been without a permanent place to sleep this time?

� 1 day

� more than 2 years

� 1-2 weeks

� 4-6 days

� 3-4 months

� 1-2 months

� 13-24 months

� 7-12 months

� 2-3 days

� I don’t know

� 3-4 weeks

� I refuse to answer

� 5-6 months

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Appendix D. In-depth interviews background survey instrument

12. What was the longest period during which you had no permanent place to sleep?

(IF Q#10 = NO)

� 1 day

� more than 2 years

� 1-2 weeks

� 4-6 days

� 3-4 months

� 1-2 months

� 13-24 months

� 7-12 months

� 2-3 days

� I don’t know

� 3-4 weeks

� I refuse to answer

� 5-6 months

13. Where did you sleep last night?

[CHECK ONE RESPONSE THAT BEST MATCHES THE ANSWER]

� Shelter (such as emergency or temporary)

� Transitional housing

� Hotel or motel

� Home of person I’m having sex with

� Friend’s home

� Own apartment or house

� Parent’s home

� Other relative’s home

� Foster family home

� Group home

� Home of boyfriend/girlfriend

� Hospital or emergency room

� Residential treatment facility

� Juvenile detention center, jail or prison

� Car or other vehicle

� Abandoned building/vacant unit/squat

� On a train/bus or in train/bus station

� 24-hour restaurant/laundromat or other business/retail establishment

� Anywhere outside (such as a street, park, viaduct)

� Other

� I don’t know

� I refuse to answer

14. Have you ever received services for any of the following? [PLEASE SELECT ALL THAT APPLY]

� Physical disability

� I don’t know

� Developmental disability

� HIV/AIDS

� Alcohol use

� I refuse to answer

� None of the above

� Mental health

� Drug use

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Appendix D. In-depth interviews background survey instrument

15. Have you ever received any of the following government benefits?

[PLEASE SELECT ALL THAT APPLY]

� Food stamps or SNAP

� Veteran’s benefits

� TANF (Temporary Assistance for Needy Families)

� WIC

� Housing Assistance (such as Section 8 voucher or public housing)

� Medicaid

� Social Security Survivor’s Benefits

� State Children’s Health Insurance Program (SCHIP)

� Social Security Disability Income (SSDI)

� None of the above

� Supplemental Security Income (SSI)

� I don’t know

� Unemployment or worker’s compensation

� I refuse to answer

16. Do you currently receive any of the following government benefits?

[PLEASE SELECT ALL THAT APPLY]

� Food stamps or SNAP

� Veteran’s benefits

� TANF (Temporary Assistance for Needy Families)

� WIC

� Housing Assistance (such as Section 8 voucher or public housing)

� Medicaid

� Social Security Survivor’s Benefits

� State Children’s Health Insurance Program (SCHIP)

� Social Security Disability Income (SSDI)

� None of the above

� Supplemental Security Income (SSI)

� I don’t know

� Unemployment Insurance or worker’s compensation

� I refuse to answer

17. Have you ever received any of the following from a school you were attending while you didn’t have a permanent place to sleep? [PLEASE SELECT ALL THAT APPLY]

� Free or reduced price lunch

� None of the above

� Transportation services (such as a bus or train pass or taxi cab fare)

� I don’t know

� Food vouchers

� I refuse to answer

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Appendix D. In-depth interviews background survey instrument

18. What is your race or ethnicity? [PLEASE SELECT ALL THAT APPLY]

� White

� Other

� American Indian/Alaskan Native

� Asian

� Black/African American

� I don’t know

� Native Hawaiian/Pacific Islander

� I refuse to answer

� Hispanic/Latino

19. How would you describe your gender identity? [PLEASE SELECT ALL THAT APPLY]

� Female

� Transgender – Male to Female

� Genderqueer/Gender-Nonconforming

� I am not sure

� Male

� Transgender – Female to Male

� Other

� I refuse to answer

20. Which of the following best fits how you think about your sexual orientation?

[READ SELECT ONE THAT APPLIES; FOR “OTHER” WRITE IN RESPONSE]

� 100% Heterosexual (Straight)

� Mostly Heterosexual (Straight), but somewhat attracted to people of my own sex

� Bisexual-that is, attracted to men and women equally

� Mostly Gay or Lesbian, but somewhat attracted to people of the opposite sex

� 100% Gay or Lesbian

� Not sexually attracted to either males or females

� Other (Specify: _____________________)

� Don’t know my orientation

� Refuse to answer

21. I am now going read a list to you of experiences you may have had. For each experience, please answer YES if it ever happened to you.

A) Physically harmed by someone

� No

� Yes

� I refuse to answer

B) Exchanged sex for food, shelter or other basic need

� No

� Yes

� I refuse to answer

C) Caused physical harm to someone (self or other)

� No

� Yes

� I refuse to answer

D) Been forced to have sex with someone

� No

� Yes

� I refuse to answer

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Appendix D. In-depth interviews background survey instrument

E) Experienced discrimination or stigma in family

� No

� Yes

� I refuse to answer

F) Experienced discrimination or stigma outside of family

� No

� Yes

� I refuse to answer

G) Was taken, transported, or sold for sex

� No

� Yes

� I refuse to answer

H) Gang involvement (either past or present)

� No

� Yes

� I refuse to answer

I) Experienced the death of a parent or caregiver

� No

� Yes

� I refuse to answer

22. Who physical y harmed you? [PLEASE SELECT ALL THAT APPLY] (IF Q#21A = YES)

� A parent or guardian

� Other relative

� A dating partner

� A friend or peer

� A stranger

� Other

� I refuse to answer

23. Who did you cause physical harm to (including yourself)? [PLEASE SELECT ALL THAT

APPLY] (IF Q#21C = YES)

� A parent or guardian

� Other relative

� A dating partner

� A friend or peer

� A stranger

� Myself

� Other

� I refuse to answer

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Appendix D. In-depth interviews background survey instrument

24. Now for each of the experiences that happened to you, please answer YES if it happened to you while you were without a permanent place to sleep.

� Physically harmed by someone

� No

� Yes (IF Q#21A = YES)

� I refuse to answer

Exchanged sex for food, shelter or other need

� No

� Yes (IF Q#21B = YES)

� I refuse to answer

Caused physical harm to someone (self or other)

� No

� Yes (IF Q#21C = YES)

� I refuse to answer

Been forced to have sex with someone

� No

� Yes (IF Q#21D = YES)

� I refuse to answer

Experienced discrimination or stigma in family

� No

� Yes (IF Q#21E = YES)

� I refuse to answer

Experienced discrimination or stigma outside of family

� No

� Yes (IF Q#21F = YES)

� I refuse to answer

Was taken, transported, or sold for sex

� No

� Yes (IF Q#21G = YES)

� I refuse to answer

Gang involvement (either past or present)

� No

� Yes (IF Q#21H = YES)

� I refuse to answer

Experienced the death of a parent or caregiver

� No

� Yes (IF Q#21I = YES)

� I refuse to answer

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Appendix D. In-depth interviews background survey instrument

25. Who physical y harmed you while you didn’t have a permanent place to sleep?

[PLEASE SELECT ALL THAT APPLY] (IF Q#24A = YES)

� A parent or guardian

� Other relative

� A dating partner

� A friend or peer

� A stranger

� Other

� I refuse to answer

26. Who did you cause physical harm to (including yourself) while you didn’t have a permanent place to sleep? [PLEASE SELECT ALL THAT APPLY] (IF Q#24C = YES)

� A parent or guardian

� Other relative

� A dating partner

� A friend or peer

� A stranger

� Myself

� Other

� I refuse to answer

27. Do you have any children?

� Yes

� No

� Don’t know

� I refuse to answer

28. How many children do you have? (IF Q#27 = 1)

� 1

� 6-7

� 2

� 8 or more

� 3

� I don’t know

� 4

� I refuse to answer

� 5

29. Do all of your children currently live with you? (IF Q#27 = 1)

� Yes

� No

� Only some live with me o I refuse to answer

30. Are you OR your partner (if you have one) currently pregnant?

� Yes

� No

� I don’t know

� I refuse to answer

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Appendix D. In-depth interviews background survey instrument

31. What makes it hard for you to achieve housing stability? [PLEASE SELECT ALL THAT APPLY]

� Lack of affordable housing

� Criminal record

� Being a parent

� Other

� Discrimination/stigma

� Lack of supports

� Need more education

� My health

� Family “drama”

� I don’t know

� Friends

� I refuse to answer

� Can’t get a job

32. What or who has been the most helpful to you in trying to achieve housing stability in your life?

[PLEASE SELECT ALL THAT APPLY]

� Parent or guardian

� My faith/religion

� Family member o Foster parent

� Boyfriend/girlfriend

� Pastor

� Other

� Teacher/school staff

� Myself

� Caseworker

� No one/nothing

� Shelter/program staff

� Sister/brother

� Mentor

� I don’t know

� My child(ren)

� I refuse to answer

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Appendix E. In-depth interviews—participant characteristics

Appendix E. In-depth interviews—participant characteristics

Table E.1. Characteristics of participants (N=215)

Age (in years)

#

%

13 to 17

31

14.4

18 to 21

112

52.1

22 to 25

72

33.5

Race/Ethnicity

#

%

White

50

23.2

Black/African-American

67

31.2

Latin@

30

14.0

American Indian or Alaskan Native

6

2.8

Asian

1

0.5

Multiracial

44

20.5

Other

4

1.8

Don’t Know

1

0.5

Refused

7

3.2

Missing

5

2.3

Gender Identity

#

%

Female

87

40.5

Male

112

52.1

Transgender M-F

8

3.7

Transgender F-M

4

1.8

Genderqueer/Nonconforming

2

0.9

Other

1

0.5

Refused

0

0.0

Missing

1

0.5

Sexual Orientation

#

%

100% heterosexual

125

58.1

Mostly heterosexual

16

7.4

Bisexual

24

11.2

Mostly gay/lesbian

8

3.7

100% gay/lesbian

21

9.8

Not sexual y attracted to either males or females

1

0.5

Other

6

2.8

Don’t know

5

2.3

Refused

5

2.3

Missing

4

1.9

(continued)

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Appendix E. In-depth interviews—participant characteristics

(Table E.1. Characteristics of participants (N=215) continued)

Age (in years)

#

%

Parent of At Least One Child

#

%

Yes

49

22.8

No

157

73.0

Don’t know

1

0.4

Refused

4

1.9

Missing

4

1.9

Are you or your partner currently pregnant?

#

%

Yes

18

8.4

No

180

83.7

Don’t know

6

2.8

Refused

6

2.8

Missing

5

2.3

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Appendix F. Survey results adversities by demographic characteristics (Table E.1. Characteristics of participants (N=215) continued)

Appendix F. Survey results adversities by demographic characteristics

Gender Identity

In analyzing experiences of adversities across gender identity, gender minority youth (those who do not identify within dominant single-gender identifications male/female) report notably high levels of adversity. Youth who did not identify as male or female were most often those who answered “yes”

to physical y harming self or others (53 percent), experiencing discrimination both inside family (66.7

percent) and outside of family (80 percent), and were about as likely as those identifying as female to be forced to have sex with someone (34 percent versus 33 percent respectively).

Table F.1. Experience with adversities by gender

Female

Male

Other**

(N=204)*

(n=82)

(n=107)

(n=15)

#

%

#

%

#

%

Physically harmed by someone

48

58.5

52

48.6

7

46.7

Physical y harmed someone or yourself

29

35.4

33

30.8

8

53.3

Experienced discrimination or stigma

Within the family

35

42.7

51

47.7

10

66.7

Outside the family

35

42.7

45

42.1

12

80.0

Experienced a caregiver’s death

29

35.4

42

39.3

2

13.3

Exchanged sex for basic needs

16

19.5

13

12.2

4

26.7

Forced to have sex with someone

28

34.2

16

15.0

5

33.3

Taken, transported, or sold for sex

3

3.7

0

0.0

0

0.0

Belonged to a gang

7

8.5

18

16.8

0

0.0

*7 Youth did not report their gender identity in the survey.

**Other includes youth who identified as non-binary.

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Appendix F. Survey results adversities by demographic characteristics Age

Our sample is comprised of primarily older youth (ages 18–25). This limits our ability to make reliable age comparisons. This may also explain the lack of robust differences based on age across the adversity categories. With the exception of “being forced to have sex,” older youth reported experiencing more adversities across al categories.

Table F.2. Experience with adversities by age

13 to 17 Years Old

18 to 25 Years Old

(N=208)*

(n=31)

(n=177)

#

%

#

%

Physically harmed by someone

13

41.9

96

54.2

Physical y harmed someone or yourself

10

32.3

60

33.9

Experienced discrimination or stigma

Within the family

14

45.2

86

48.6

Outside the family

13

41.9

80

45.2

Experienced a caregiver’s death

7

22.6

68

38.4

Exchanged sex for basic needs

3

9.7

31

17.5

Forced to have sex with someone

8

25.8

42

23.7

Taken, transported, or sold for sex

0

0.0

4

2.3

Belonged to a gang

2

6.5

23

13.0

*3 Youth did not report their age in the survey.

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Appendix F. Survey results adversities by demographic characteristics Race/Ethnicity

Youth who identify as “other” (72 percent), White (68 percent), and multiracial (56 percent) reported higher rates of being physical y harmed than Latin@ or Black youth. In the IDI sample, “other” included primarily American Indian youth. Youth identifying as multiracial, however, were the group with the highest reports of discrimination and stigma within the family, outside the family, exchanging sex for basic needs, and being forced to have sex. They were the second highest group to report being physical y harmed by someone, harming someone or self, and experiencing caregiver death. Overal , identifying as multiracial was associated with the highest cumulative adversity score (See Table 17) than any other self-selected racial-ethnic identity.

Table F.3. Experience with adversities by race

Black

White

Latin@

Multiracial

Other**

(N=198)*

(n=65)

(n=50)

(n=29)

(n=43)

(n=11)

#

%

#

%

#

%

#

%

#

%

Physically harmed by someone

27

41.5

34

68.0

12

41.4

24

55.8

8

72.7

Physical y harmed someone or

19

29.2

23

46.0

7

24.1

17

39.5

3

27.3

yourself

Experienced discrimination or

stigma

Within the family

31

47.7

22

44.0

12

41.4

22

51.2

5

45.5

Outside the family

30

46.2

24

48.0

11

37.9

22

51.2

4

36.4

Experienced a caregiver’s death

26

40.0

19

38.0

8

27.6

17

39.5

4

36.4

Exchanged sex for basic needs

14

21.5

3

6.0

3

10.3

11

25.6

2

18.2

Forced to have sex with someone

15

23.1

14

28.0

5

17.2

14

32.6

1

9.1

Taken, transported, or sold for sex

2

3.1

0

0.0

1

3.5

1

2.3

0

0.0

Belonged to a gang

9

13.9

9

18.0

1

3.5

4

9.3

2

18.2

*13 youth did not report their race/ethnicity within the survey.

**Other includes American Indian or Alaskan Native, Asian, or Other

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Appendix F. Survey results adversities by demographic characteristics Sexual Orientation

We asked about sexual orientation on a spectrum. Table 14 compares youth who identify as 100

percent heterosexual with all other sexual identities. Youth who do not identify as 100 percent heterosexual, reported both more physical harm from others (64 percent) and to others or self (41 percent). Reporting a sexual minority identity (LGBQA) also was associated with much higher percentages of discrimination or stigma both within the family (65 percent) and outside of the family (62 percent). These youth indicated higher percentages of loss of a parent or caregiver to death. They also reported more experiences with sexual adversity across all domains; they represented three of the four youth who responded “yes” to sex trade involvement.

Table F.4. Experience with adversities by sexual orientation

100% Heterosexual

LGBQA**

(N=197)*

(n=123)

(n=74)

#

%

#

%

Physically harmed by someone

58

47.2

48

64.9

Physical y harmed someone or yourself

38

30.9

31

41.9

Experienced discrimination or stigma

Within the family

47

38.2

48

64.9

Outside the family

46

37.4

46

62.2

Experienced a caregiver’s death

43

35.0

31

41.9

Exchanged sex for basic needs

11

8.9

21

28.4

Forced to have sex with someone

19

15.5

29

39.2

Taken, transported, or sold for sex

0

0.0

3

4.1

Belonged to a gang

17

13.8

8

10.8

*14 youth did not report their sexual orientation within the surveys.

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Appendix F. Survey results adversities by demographic characteristics Adversity and Foster Care History

Nearly 40 percent of the youth in this study had histories of ever being in foster care. These youth reported higher percentages of adversities across all categories except for being taken, transported, or sold for sex.

Table F.5. Experience with adversities by foster care history

Ever in Foster Care

Never in Foster Care

(N=206)*

(n=82)

(n=124)

#

%

#

%

Physically harmed by someone

51

62.2

57

46.0

Physical y harmed someone or yourself

36

43.9

36

29.0

Experienced discrimination or stigma

Within the family

40

48.8

58

46.8

Outside the family

39

47.6

55

44.4

Experienced a caregiver’s death

36

43.9

38

30.7

Exchanged sex for basic needs

14

17.1

20

16.1

Forced to have sex with someone

26

31.7

25

20.2

Taken, transported, or sold for sex

1

1.2

3

2.4

Belonged to a gang

16

19.5

9

7.3

*5 youth did not respond to the question about foster care.

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Appendix F. Survey results adversities by demographic characteristics Adversity and History of Detention or Incarceration

Among the 205 youth who responded to this question, one-half reported an experience of detention, jail, or prison. This group reported higher percentages of all adversities except experiencing discrimination inside of family, exchanging sex for basic needs and involvement in the sex trade. Their response to

“yes” for gang involvement is 10 times higher than for youth who reported no such history.

Table F.6. Experience with adversities by history of detention/incarceration

Never in Detention/Jail/

Ever in Detention/Jail/Prison

Prison

(N=205)*

(n=103)

(n=102)

#

%

#

%

Physically harmed by someone

60

58.3

49

48.0

Physically harmed someone yourself

41

39.8

29

28.4

Experienced discrimination or stigma

Within the family

47

45.6

51

50.0

Outside the family

51

49.5

42

41.2

Experienced a caregiver’s death

40

38.8

31

30.4

Exchanged sex for basic needs

15

14.6

19

18.6

Forced to have sex with someone

29

28.2

21

20.6

Taken, transported, or sold for sex

1

1.0

3

2.9

Belonged to a gang

22

21.4

2

2.0

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Appendix G. Levels of instability and geographic mobility

Appendix G. Levels of instability and geographic mobility

Figure G.1. Percentage of youth experiencing each level of instability (n=215) 95% 97% 93%

95%

93%

90%

85%

87%

85%

74%

78% 75%

63%

51%

29%

Couch Surfing

Shelter or Transitional Housing

Streets

Cook

Philadelphia

San Diego

Travis

Walla Walla

It is important to note that in Walla Walla County, the low number of youth reporting lower rates of using shelters or transitional housing, and higher rates of living on the streets is related to the absence of sufficient numbers of available youth shelters, causing youth to utilize unsheltered (that is, streets) and informal housing options available to them.

Figure G.2. Number of levels of homelessness experienced by youth (n=215)

36%

24%

58%

65%

58%

51%

64%

37%

30%

31%

5%

13%

5%

11%

12%

Cook

Philadelphia

San Diego

Travis

Walla Walla

1 Level

2 Levels

3 Levels

Youths’ experiences with housing instability also included high degrees of geographic mobility. Few youth remained in a single geographic area. In fact, only 19 percent of youth stayed within their cities or towns (see Figure G.3).

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Appendix G. Levels of instability and geographic mobility

Figure G.3. Geography of youth experiencing homelessness

Multinational

3%

Within

city/town

Multistate

19%

23%

Within

county

23%

Multicounty

27%

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Appendix H. Survey responses to government benefits and services Appendix H. Survey responses to government benefits and services

Table H.1. Reasons for service receipt

(N=211)*

#

%

Physical disability or developmental disability

19

9.0

Alcohol or drug use

33

15.6

HIV/AIDS and related health issues

5

2.4

Mental health

81

38.4

None of the above

92

43.6

*Participants could select multiple responses.

Table H.2. Receipt of government benefits

(N=203)*

Currently Receiving

Ever Received

#

%

#

%

Food stamps/SNAP

90

44.3

128

63.1

TANF (Temporary Assistance for Needy Families)

8

3.9

17

8.4

Medicaid

48

23.6

68

33.5

State Children’s Health Insurance Program (S-CHIP)

3

1.5

7

3.4

WIC

21

10.3

32

15.8

Housing Assistance (Section 8 voucher, public housing)

6

3.0

16

7.9

Supplemental Security Income (SSI)

11

5.4

16

7.9

Social Security Survivor’s Benefits

2

1.0

7

3.4

Social Security Disability Insurance (SSDI)

2

1.0

4

1.9

Unemployment insurance or worker’s compensation

0

0.0

2

1.0

Veteran’s benefits

0

0.0

0

0.0

*Participants could select multiple responses.

Table H.3. Receipt of school benefits

(N=211)*

#

%

Free or reduced-price lunch

123

58.3

Transportation services

94

44.5

Food vouchers

17

8.1

*Participants could select multiple responses.

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Appendix I. Youth advice about ending instability

Appendix I. Youth advice about ending instability

POTENTIAL POINTS OF INTERVENTION

We asked youth “What would it take to achieve stability?”

AFFORDABLE AND SAFE HOUSING

Housing, housing, housing

“...housing security would honestly be the biggest thing

because I need to make sure that if I’m getting a house I

can at least be in this house for up to a year.”

-Libra, Philadelphia County

MORE SUPPORT

Young people need people

“Um, I would say really some guidance. I mean I’m pretty

much a person who does everything on my own so, I mean,

just guidance in the right direction and where to start it to find

a place to live.”

-Frank Castle, San Diego

STABLE EMPLOYMENT

A living wage is critical

“Um, getting a steady income, because Craigslist is nice and

all, but it’s not steady. Um, having a steady income, making

sure my health is in good- in good condition so I don’t wind

up losing my place.”

-Kitten, Travis County

NEED MORE EDUCATION

Knowledge is power

“I don’t want anything getting in the way of my career. I do not

want to close a door just to open another door, I want to keep

this door open cause I know I can’t go through 2 doors at once

I would have to literally cut myself in half if I were to do that and

that’s gonna just make me more stress.”

-Gemini, Cook County

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Appendix J. Provider survey instrument

Appendix J. Provider survey instrument

Note: This was an online survey. Skip logic instructions and background information for the respondent are not reflected here.

1. What is the name of your agency?

2. What is your full name?

3. What is your job title?

4. What is your email address?

5. What is your phone number? (Enter the area code and phone number with no hyphens, parentheses or spaces (e.g., 1234567890).)

6. In what county and state is your agency located?

7. In what city or town is your agency’s main office located?

The questions in this section are about your agency.

8. Which of the following best describes your agency?

• Non-profit, 501(c)(3) organization

• Religious/faith-based organization

• Public/government agency

• For profit organization

• Other

• How would you describe the type of agency this is?

__________________________________________

9. Does your agency operate any programs specifical y for runaway or homeless youth?

(By homeless youth, we mean youth ages 13 to 25 years old who are homeless and NOT

accompanied by a parent or guardian.) Y | N

10. Which of the following statements best describe where the runaway and homeless youth your agency serves come from? Check all that apply.

• City or town your agency located in

• County in which your agency is located

• Neighboring counties

• Elsewhere in the state

• Other states

• Other countries

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Appendix J. Provider survey instrument

11. Which of the following refer runaway or homeless youth to your agency? Check all that apply.

• Other runaway or homeless youth

• Other homeless service providers

• National Runaway Safeline/Switchboard

• Street outreach programs

• Schools

• Law enforcement agencies

• Child welfare agencies

• Hospitals or other health care providers

• Youth refer themselves

• Other

12. Who else refers runaway or homeless youth to your agency?

The questions in this section are about your agency’s programs for runaway and

homeless youth.

Drop-In Centers

13. Does your agency operate any drop-in centers? Y | N

14. How many drop-in centers does your agency operate? ______________

15. Which of the following age groups are served by your 13 to 15 year olds drop in center(s)?

• 13 to 15 year olds

• 16 or 17 year olds

• 18 to 21 year olds

• 22 to 25 year olds

16. Altogether, how many youth are served by or have contact with your drop-in center(s) in a typical day? (Number of youth)

17. Were any youth turned away by your drop-in center(s) during the past year? Y | N

18. How many youth were turned away by your drop-in center(s) during the past year?

Street Outreach Programs

19. Does your agency operate any street outreach program? Y | N

20. How many street outreach programs does your agency operate?

21. Which of the following age groups are served by your street outreach program(s)?

• 13 to 15 year olds

• 16 or 17 year olds

• 18 to 21 year olds

• 22 to 25 year olds

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Appendix J. Provider survey instrument

22. Altogether, how many youth are served by or have contact with your street outreach program(s) in a typical day?

23. Were any youth turned away by your street outreach program(s) during the past year? Y | N

24. How many youth were turned away by your street outreach program(s) during the past year?

Overnight/Emergency Shelters

25. Does your agency operate any overnight or emergency shelters? Y | N

26. How many shelters does your agency operate? __________________________________

27. Which of the following age groups are served by your shelter(s)?

• 13 to 15 year olds

• 16 or 17 year olds

• 18 to 21 year olds

• 22 to 25 year olds

28. Altogether, how many shelter beds are available for youth under age 18 on a given night?

29. Is there a limit on the number of days youth under age 18 can stay in your shelter(s)? Y | N

30. What is the maximum number of days youth under age 18 can stay in your shelter(s)?

31. Altogether, how many shelter beds are available for youth age 18 or older on a given night?

32. Is there a limit on the number of days young adults age 18 or older can stay in your shelter(s)?

Y | N

33. What is the maximum number of days youth age 18 or older can stay in your shelter(s)?

34. Is there a waiting list for your shelter(s)? Y | N

35. Were any youth turned away by your shelter(s) during the past year? Y | N

36. Altogether how many youth were turned away by your shelter(s) during the past year?

Transitional Living Programs

37. Does your agency operate any transitional living programs? Y | N

38. How many transitional living programs does your agency operate?

39. Which type(s) of housing do your transitional living program(s) provide?

• Clustered/Single site

• Scattered site

• Both

• Neither

40. Which of the following age groups are served by your 13 to 15 year olds transitional living program(s)?

• 13 to 15 year olds

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Appendix J. Provider survey instrument

• 16 or 17 year olds

• 18 to 21 year olds

• 22 to 25 year olds

41. Altogether, how many youth can your transitional living program(s) house at a point in time?

(Number of youth)

42. Is there a limit on the number of days youth under age 18 can stay in your transitional living program(s)? Y | N

43. What is the maximum number of days youth under age 18 can stay in your transitional living program(s)?

44. Is there a limit on the number of days young adults age 18 or older can stay in your transitional living program(s)?

45. What is the maximum number of days youth age 18 or older can stay in your transitional living program(s)?

46. Is there a waiting list for your transitional living program(s)? Y | N

47. Were any youth turned away by your transitional living program(s) during the past year? Y | N

48. How many youth were turned away by your transitional living program(s) during the past year?

Permanent Supportive Housing Programs

49. Does your agency operate any permanent supportive housing programs? By permanent supportive housing, we mean non-time-limited housing assistance with wrap-around supportive services. Y | N

50. How many permanent supportive housing programs does your agency operate?

51. Which type(s) of housing do your permanent supportive program(s) provide?

• Clustered/Single site

• Scattered site

• Both

• Neither

52. Which of the following age groups are served by your permanent supportive housing program(s)?

• 13 to 15 year olds

• 16 or 17 year olds

• 18 to 21 year olds

• 22 to 25 year olds

53. Altogether, how many youth can your permanent supportive housing program(s) serve at a point in time? (Number of youth)

54. Is there a waiting list for your permanent supportive housing program(s)? Y | N

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Appendix J. Provider survey instrument

55. Were any youth turned away by your permanent supportive housing program(s) during the past year? Y | N

56. How many youth were turned away by your supportive housing program(s) during the past year?

Host Home Programs

57. Does your agency operate any host home programs? Y | N

58. How many host home programs does your agency operate? ___

59. Which of the following age groups are served by your host home program(s)?

• 13 to 15 year olds

• 16 or 17 year olds

• 18 to 21 year olds

• 22 to 25 year olds

60. Altogether, how many youth can your host home program(s) serve at a point in time? (Number of youth)

61. Is there a limit on the number of days youth can stay in your host home program(s)? Y | N

62. What is the maximum number of days youth can stay in your host home program(s)?

63. Is there a waiting list for your host home program(s)? Y | N

64. Were any youth turned away by your host home program(s) during the past year? Y | N

65. How many youth were turned away by your host home program(s) during the past year?

Rapid Rehousing

66. Does your agency operate any rapid rehousing programs for runaway and homeless youth? Y | N

67. How many rapid rehousing programs for youth does your agency operate?

68. Which of the following age groups are served by your rapid rehousing program(s)?

• 13 to 15 year olds

• 16 or 17 year olds

• 18 to 21 year olds

• 22 to 25 year olds

69. Altogether, how many youth can your rapid rehousing program(s) serve at a point in time?

(Number of youth)

70. Is there a limit on the number of days youth can stay in your rapid rehousing program(s)? Y | N

71. What is the maximum number of days youth can stay in your rapid rehousing program(s)?

72. Do youth in your rapid rehousing program(s) receive financial assistance? Y | N

73. For how many months do youth in your rapid rehousing program(s) receive financial assistance?

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74. How much financial assistance do youth in your rapid rehousing program(s) receive each month? (Enter dollar amount)

75. Is there a waiting list for your rapid rehousing program(s)? Y | N

76. Were any youth turned away by your rapid rehousing program(s) during the past year? Y | N

77. How many youth were turned away by your rapid rehousing program(s) during the past year?

Supportive Services

The questions in this section are about different types of services and supports that runaway or homeless youth might need. For each category, indicate (1) if your agency provides that type of service or support to runaway and homeless youth, (2) if your agency does NOT provide that type of service or support to runaway and homeless youth but it is available elsewhere in the community, or (3) if that service or support is not available in your community.

78. ASSISTANCE WITH BASIC NEEDS (Examples include clothing, food/meals, help applying for government benefits, or emergency cash grants.)

79. CASE MANAGEMENT SERVICES (Examples include needs assessment, goal planning, advocacy, or referral.)

80. HOUSING ASSISTANCE (Examples include help finding housing or assistance with security deposits.)

81. EDUCATION (Examples include tutoring, GED preparation, assistance with school enrollment or access to a computer lab.)

82. EMPLOYMENT (Examples include help with resume writing, interviewing skills, completing job applications as well as job search assistance, training or placement.)

83. LIFE SKILLS TRAINING (Examples include budgeting assistance as well as financial literacy, household management, or parenting skills training.)

84. PHYSICAL HEALTH (Examples include health education, primary health care, STI/HIV/AIDS

prevention, education, testing or treatment, or nutritional counseling.)

85. MENTAL/BEHAVIORAL HEALTH (Examples include mental health or substance abuse screening, individual or group counseling, or crisis intervention.)

86. TRANSPORTATION ASSISTANCE (Examples include vouchers or transit cards)

87. RECREATION (Examples include sports/games, cultural outings, or arts programming.) 88. MENTORING

89. LEGAL ASSISTANCE

90. STORAGE FACILITIES

91. FAMILY REUNIFICATION

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Appendix J. Provider survey instrument

Special Populations

The questions in this section are about special populations of runaway and homeless youth your agency may serve.

92. For which of the following groups of runaway and youth homeless youth does your agency have specialized programs? Check all that apply.

• Pregnant or parenting youth (that is, youth with minor children in their custody)

• Youth who identify as LGBTQ

• Former foster youth

• Youth with a history of juvenile/criminal justice involvement

• Youth who are victims of human trafficking

• Youth living with HIV/AIDS

• Youth with serious mental il ness

• Youth who abuse substances

• None of the above

93. Which type(s) of program(s) are specifical y for runaway or homeless youth who are pregnant or parenting?

• Drop-in center

• Street outreach program

• Emergency or overnight shelter

• Transitional living program

• Check all that apply Permanent supportive housing program

• Host home program

• Rapid rehousing program

• Other

94. What other types of programs does your agency operate for runaway or homeless youth who are pregnant or parenting?

95. Which type(s) of program(s) are specifical y for runaway or homeless youth who identify as LGBTQ?

• Drop-in center

• Street outreach program

• Emergency or overnight shelter

• Transitional living program

• Check all that apply Permanent supportive housing program

• Host home program

• Rapid rehousing program

• Other

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96. What other types of programs does your agency operate for runaway or homeless youth who identify as LGBTQ? __________________________________________

97. Which type(s) of program(s) are specifical y for runaway or homeless youth who were in foster care?

• Drop-in center

• Street outreach program

• Emergency or overnight shelter

• Transitional living program

• Check all that apply Permanent supportive housing program

• Host home program

• Rapid rehousing program

• Other

98. What other types of programs does your agency operate for runaway or homeless youth who were in foster care? __________________________________________

99. Which type(s) of program(s) are specifical y for runaway or homeless youth who have a history of juvenile or criminal justice system involvement?

• Drop-in center

• Street outreach program

• Emergency or overnight shelter

• Transitional living program

• Check all that apply Permanent supportive housing program

• Host home program

• Rapid rehousing program

• Other

100. What other types of programs does your agency operate for runaway or homeless youth who have a history of juvenile or criminal justice system involvement?

101. Which type(s) of program(s) are specifical y for runaway or homeless youth who are sex-trafficking victims?

• Drop-in center

• Street outreach program

• Emergency or overnight shelter

• Transitional living program

• Check all that apply Permanent supportive housing program

• Host home program

• Rapid rehousing program

• Other

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102. What other types of programs does your agency operate for runaway or homeless youth who are sex trafficking victims?

103. Which type(s) of program(s) are specifical y for runaway or homeless youth who are living HIV/

AIDS?

• Drop-in center

• Street outreach program

• Emergency or overnight shelter

• Transitional living program

• Check all that apply Permanent supportive housing program

• Host home program

• Rapid rehousing program

• Other

104. What other types of programs does your agency operate for runaway or homeless youth who are living with HIV/AIDS? __________________________________________

105. Which type(s) of program(s) are specifical y for runaway or homeless youth who have a serious mental illness?

• Drop-in center

• Street outreach program

• Emergency or overnight shelter

• Transitional living program

• Check all that apply Permanent supportive housing program

• Host home program

• Rapid rehousing program

• Other

106. What other types of programs does your agency operate for runaway or homeless youth who have a serious mental il ness? __________________________________________

107. Which type(s) of program(s) are specifical y for runaway or homeless youth who abuse substances?

• Drop-in center

• Street outreach program

• Emergency or overnight shelter

• Transitional living program

• Check all that apply Permanent supportive housing program

• Host home program

• Rapid rehousing program

• Other

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108. What other types of programs does your agency operate for runaway or homeless youth who abuse substances?

Funding

The questions in this section are about how your programs for runaway and

homeless youth are funded.

109. How are your runaway and homeless youth programs funded? Check all that apply.

• Federal funding

• State funding

• Local (city or county) funding

• Foundations/philanthropy

• Individual donors

• Other

110. From what other sources does your agency receive funding for its runaway and homeless youth programs?

111. Thinking about all of your agency’s programs for runaway and homeless youth, approximately what percentage of the funding for those programs comes from the FEDERAL government?

112. Thinking about all of your agency’s programs for runaway and homeless youth, approximately what percentage of the funding for those programs comes from the STATE?

113. Thinking about all of your agency’s programs for runaway and homeless youth, approximately what percentage of the funding for those programs comes from LOCAL government (that is, city or county)?

114. Thinking about all of your agency’s programs for runaway and homeless youth, approximately what

115. Percentage of the funding for those programs comes from FOUNDATIONS or PHILANTHROPIES?

116. Thinking about all of your agency’s programs for runaway and homeless youth, approximately what percentage of the funding for those programs comes from INDIVIDUAL DONORS?

117. Thinking about all of your agency’s programs for runaway and homeless youth, approximately what percentage of the funding for those programs comes from OTHER sources?

118. Please correct your responses to the funding questions above if this does not equal 100%.

Programs for Homeless Adults

119. Does your agency operate any programs for homeless adults without children? Y | N

120. Which of the following types of programs does your operate for homeless adults without children? Check all that apply.

• Street outreach

• Emergency shelter(s)

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• Transitional housing

• Permanent supportive housing

• Rapid rehousing

• Other

121. What other types of programs does your agency operate for homeless adults without children?

122. Does your street outreach program serve homeless 18 to 25 year olds? Y | N

123. Does your street outreach program serve homeless youth under age 18? Y | N

124. Does your emergency shelter serve homeless 18 to 25 year olds? Y | N

125. Does your emergency shelter serve homeless youth under age 18? Y | N

126. Does your transitional housing serve homeless 18 to 25 year olds? Y | N

127. Does your transitional housing program serve homeless youth under age 18? Y | N

128. Does your permanent supportive housing program serve homeless 18 to 25 year olds? Y | N

129. Does your permanent supportive housing program serve homeless youth under age 18? Y | N

130. Does your rapid rehousing program serve homeless 18 to 25 year olds? Y | N

131. Does your rapid rehousing program serve homeless youth under age 18? Y | N

Does this other program serve homeless 18 to 25 year olds? Y | N

132. Does this other program serve homeless youth under age 18? Y | N

Programs for Homeless Families with Children

133. Does your agency operate any programs for homeless families with children? Y | N

134. Which of the following types of programs does your agency operate for homeless families with children? Check all that apply.

• Street outreach program(s)

• Emergency shelter(s)

• Transitional housing

• Permanent supportive housing

• Rapid rehousing

• Other

135. What other types of programs does your agency operate for homeless families with children?

136. Does your street outreach program serve homeless families headed by parents ages 18 to 25

years old? Y | N

137. Does your street outreach program serve homeless families headed by parents under age 18?

Y | N

138. Does your emergency shelter(s) serve homeless families headed by parents ages 18 to 25

years old? Y | N

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139. Does your emergency shelter(s) serve homeless families headed by parents under age 18? Y | N

140. Does your transitional housing serve homeless families headed by parents ages 18 to 25 years old? Y | N

141. Does your transitional housing serve homeless families headed by parents under age 18? Y | N

142. Does your permanent supportive housing serve homeless families headed by parents ages 18

to 25 years old? Y | N

143. Does your permanent supportive housing serve homeless families headed by parents under age 18? Y | N

144. Does your rapid rehousing serve homeless families headed by parents ages 18 to 25 years old? Y | N

145. Does your rapid rehousing serve homeless families headed by parents under age 18? Y | N

146. Does this other program serve homeless families headed by parents ages 18 to 25 years old?

Y | N

147. Does this other program serve homeless families headed by parents under age 18? Y | N

The next few questions are about programs your agency operates for youth.

148. Does your agency operate any programs for youth ages 13 to 25 years old (regardless of their housing status)?

149. Which of the following age groups do these programs serve? Check all that apply.

• 13 to 15 year olds

• 16 or 17 year olds

• 18 to 21 year olds

• 22 to 25 year olds

150. Which of the following populations do these programs target?

• Low income youth

• Foster youth/youth in the child welfare system

• Delinquent youth/youth in the juvenile justice

• Check all that apply system

• Pregnant or parenting youth

• Youth who identify as LGBTQ

• Middle school students

• High school students

• Disconnected youth/youth who are not in school and not working

• Other

151. What other populations do these programs target?

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152. Are any of the youth who participate in these programs runaway or homeless youth?

Remember, by homeless youth, we mean youth who are homeless AND not accompanied by a parent or other guardian. Y | N

The next section includes questions about the runaway or homeless youth these

programs serve.

153. Who refers these runaway and homeless youth to your agency? Check all that apply.

• Runaway and homeless youth service providers

• Schools

• Law enforcement agencies

• Child welfare agencies

• Hospitals or other health care providers

• Legal services

• Public aid agencies

• Youth refer themselves or are referred by other youth

• Other

154. By whom else are runaway and homeless youth referred to your agency?

155. To whom does your agency refer these runaway or Runaway and homeless youth service providers homeless youth? Check all that apply.

• Schools

• Law enforcement agencies

• Child welfare agencies

• Hospitals or other health care providers

• Legal services

• Public aid agencies

• Other

156. What are those other types of service providers?

157. Which of the following types of services and supports does your agency provide to runaway and homeless youth? Check all that apply.

• ASSISTANCE WITH BASIC NEEDS (e.g., clothing, homeless food/meals, help applying for government benefits, or emergency cash grants)

• CASE MANAGEMENT (e.g., needs assessment, goal planning, advocacy, or referral)

• HOUSING (e.g., help finding housing or assistance with security deposits)

• EDUCATION (e.g., tutoring, GED preparation, assistance with school enrollment or access to a computer lab)

• EMPLOYMENT (e.g., help with resume writing, interviewing skills, completing job applications as well as job search assistance, training or placement.)

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• LIFE SKILLS TRAINING (e.g., budgeting assistance as well as financial literacy, household management, or parenting skills training)

• PHYSICAL HEALTH (e.g., health education, primary health care, STI/HIV/AIDS prevention, education, testing or treatment, or nutritional counseling)

• MENTAL/BEHAVIORAL HEALTH (e.g., mental health or substance abuse screening, individual or group counseling, or crisis intervention)

• RECREATION (e.g., sports/games, cultural outings, or arts programming)

• TRANSPORTATION (e.g., vouchers, transit cards)

• MENTORING

• LEGAL ASSISTANCE

• OTHER

158. What other types of services does your agency provide to runaway or homeless youth?

Prevention Programs

159. Does your agency operate any programs to prevent youth from running away or becoming homeless? Y | N

160. Which of the following groups are served by your prevention program(s)? Check all that apply.

• Youth under age 18

• Youth age 18 and older

• Parents or guardians

161. What types of services are provided by your prevention program(s)? Check all that apply.

• Case management

• Individual counseling/therapy

• Group counseling/therapy

• Family counseling/therapy

• Crisis intervention

• Other

162. What other types of services are provided by your prevention program(s)?

163. How are these prevention services funded? Check all that apply.

• Federal funding

• State funding

• Local (city or county) funding

• Foundations/philanthropy

• Individual donors

• Other

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Wrap-up questions

164. Has your agency ever participated in a local count of homeless youth (excluding the VoYC

count that took place this summer)? Y | N

165. Would your agency like to receive updates about the Voices of Youth Count initiative? Y | N

Thank you for completing the survey. You cooperation is much appreciated. Please click ‘Submit’ to submit and exit the survey.

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Appendix K. Continuum of Care survey instrument

Appendix K. Continuum of Care survey instrument

Note: This was an online survey. Skip logic instructions and background information for the respondent are not reflected here.

1. Which of the following counties does your CoC serve?

COORDINATED ENTRY AND ASSESSMENT

2. Does [county_served] have a coordinated entry and assessment system? Y | N

3. What is the geographic area covered by that coordinated entry and assessment system?

• Single city/town

• Multiple cities/towns but not a county

• Single county

• Multiple counties

ACCESS

4. Can unaccompanied youth under age 18 access services through your coordinated entry and assessment system? Y | N

5. Does your system have access points dedicated to unaccompanied youth under age 18? Y | N

6. Can unaccompanied youth under age 18 enter your system through other access points? Y | N

7. How do unaccompanied youth under age 18 enter your coordinated entry and assessment system? Check all that apply.

• Visit a single location in person

• Visit one of several locations in person

• Via telephone

• On-line

• Other

8. How else do unaccompanied youth under age 18 enter your system?

9. Does your coordinated entry and assessment system have access points dedicated to unaccompanied youth age 18 and older? Y | N

10. What is the maximum age at which unaccompanied youth can enter your system through those dedicated access points? (Age in years)

11. Can unaccompanied youth age 18 and older enter your system through other access points? Y | N

12. How do unaccompanied youth age 18 and older enter your coordinated entry and assessment system? Check all that apply.

• Visit a single location in person

• Visit one of several locations in person

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• Via telephone

• On-line

• Other

13. Does [county_served] have a separate coordinated entry and assessment system specifical y for unaccompanied youth? Y | N

14. What is the maximum age at which unaccompanied youth can access that separate system?

(Age in years)

15. How do unaccompanied youth enter that separate in person system? Check all that apply.

• Visit a single location

• Visit one of several locations in person

• Via telephone

• On-line

• Other

16. How else do unaccompanied youth enter that separate system?

ASSESSMENT TOOLS

17. Does your coordinated entry and assessment system use a vulnerability index or triage tool designed specifical y for youth? Y | N

18. Which of the following vulnerability indices or triage tools does your coordinated entry and assessment system use with youth?

• TAY Triage Tool (Transition Age Youth Triage Tool)

• TAY-VI-SPDAT (Transition Age Youth – Vulnerability Index - Service Prioritization Decision Assistance Tool)

• Other

19. What is the name of that other vulnerability index or triage tool for youth?

20. Does your coordinated entry and assessment system use a vulnerability index or triage tool that was NOT designed specifical y for youth to prioritize youth for services? Y | N

21. Does your coordinated entry and assessment system use the VI-SPDAT to prioritize youth? Y |

N

22. What vulnerability index or triage tool does your coordinated entry and assessment system use to prioritize youth for services?

23. Does your coordinated entry and assessment system use any other types of assessment tools to match youth with the type of assistance that best meets their needs? Y | N

24. What are the names of those assessment tools?

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REFERRALS

25. To which of the following are unaccompanied youth under age 18 referred by your coordinated entry and assessment system? Check all that apply.

• Agencies that focus on serving runaway and homeless youth

• Agencies that focus on serving single homeless adults

• Other

26. To what other types of agencies are unaccompanied youth under age 18 referred?

27. To which of the following are unaccompanied youth under age 18 referred by your coordinated entry and assessment system if they are custodial parents? Check all that apply.

• Agencies that focus on serving runaway and homeless youth

• Agencies that focus on serving homeless families with children

• Other

28. To what other types of agencies are unaccompanied youth under age 18 referred if they are custodial parents?

29. To which of the following are unaccompanied youth 18 and older referred by your coordinated entry and assessment system? Check all that apply.

• Agencies that focus on serving runaway and homeless youth

• Agencies that focus on serving single homeless adults

• Other

30. To what other types of agencies are unaccompanied youth age 18 and older referred?

31. To which of the following are unaccompanied youth age 18 and older referred by your coordinated entry homeless youth and assessment system if they are custodial parents? Check all that apply.

• Agencies that focus on serving runaway and homeless youth

• Agencies that focus on serving homeless families with children

• Other

32. To what other types of agencies are unaccompanied youth age 18 and older referred if they are custodial parents?

33. Are any services provided to homeless youth under age 18 at the coordinated entry and assessment system access points? Y | N

34. What types of services are provided to youth under age 18 at the coordinated entry system access points?

35. Are any services provided to homeless youth age 18 and older at the coordinated entry and assessment system access points? Y | N

36. What types of services are provided to youth age 18 and older at the coordinated entry system access points?

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ENGAGEMENT

37. Do any runaway or homeless youth serving organizations in [county-served] not participate in the coordinated entry and assessment system? Y | N

38. Why do those runaway or homeless youth serving organizations not participate in the coordinated entry and assessment system?

WRAP UP

39. Is there anything else about your coordinated entry and assessment system related to unaccompanied youth that we should know about?

40. What else should I know about your coordinated entry and assessment system related to unaccompanied youth?

41. Has your CoC ever participated in a local count of homeless youth (excluding the VoYC count that took place)? Y | N

42. Would your CoC like to receive updates about the Voices of Youth Count initiative? Y | N

Thank you for your time. Please click the “Submit” button to end and exit the survey.

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Appendix L. Systematic Evidence Review – Chapter 7 study references Appendix L. Systematic Evidence Review – Chapter 7 study references

Note: This list presents only references for included studies of the Objective 1 effectiveness studies synthesis (see Chapter 7 for further information).

Baer, John S., Sharon Garrett, Blair Beadnel ,

placements for adolescents in foster care,”

Elizabeth A. Wel s, and Peggy L. Peterson. 2007.

Research on Social Work Practice 18: 429–441.

“Brief motivational intervention with homeless

adolescents: Valuating effects on substance use

Davis, Maryann, Ashli J. Sheidow, and Michael

and service utilization,” Psychology of Addictive

R. McCart. 2015. “Reducing recidivism and

Behaviors 21 (4): 582–586.

symptoms in emerging adults with serious

mental health conditions and justice system

Bartle-Haring, Suzanne, Natasha Slesnick, Jennifer

involvement,” The Journal of Behavioral Health

Col ins, G. Gizem Erdem, and Cynthia Buettner.

Services & Research 42 (2): 172–190.

2012. “The utility of mentoring homeless

adolescents: A pilot study,” American Journal of

Descilo, Teresa, Ricky Greenwald, Thomas A.

Drug and Alcohol Abuse 38 (4): 350–358.

Schmitt, and Summar Reslan. 2010. “Traumatic

incident reduction for urban at-risk youth and

Bender, Kimberly A., Anne DePrince, Stephanie.

unaccompanied minor refugees: Two open trials,”

Begun, Jessica Hathaway, Badiah Haffejee, and

Journal of Child & Adolescent Trauma 3 (3):

Nicholas Schau. 2016. “Enhancing risk detection

181–191.

among homeless youth: A randomized clinical

trial of a promising pilot intervention,” Journal of

Duncan, Burris, Gail Harris, Jessica Reedy, Sue

Interpersonal Violence 33 (19).

Krahe, Regina Gil is, and Michele Laguna. 2008.

“Common/Unity: An innovative program to

Borland, Jeff, Y-P. Tseng, and Roger Wilkins. 2013.

address 3 root causes of many of the social il s

“Does coordination of welfare services delivery

seen in adolescents,” Clinical Pediatrics 47 (3):

make a difference for extremely disadvantaged

280–288.

jobseekers? Evidence from the ‘YP4’ trial,”

Economic Record 89 (287): 469–489.

Ferguson, Kristin. 2012. “Merging the fields of mental

health and social enterprise: lessons from abroad

Carmona, Jasmin, Natasha Slesnick, Xiamei Guo,

and cumulative findings from research with

and Amber Letcher. 2014. “Reducing high risk

homeless youths,” Community Mental Health

behaviors among street living youth: Outcomes

Journal 48 (4): 490–502.

of an integrated prevention intervention,” Children

and Youth Services Review 43: 118–123.

Ferguson, Kristin M. 2013. “Using the social

enterprise intervention (SEI) and individual

Cauce, Ana Marie, Victoria Wagner, Jennifer Sy, Kim

placement and support (IPS) models to improve

Weeden, Trish Blanchard, Charles J. Morgan, and

employment and clinical outcomes of homeless

Sandy Tomlin. 1994. “Effectiveness of intensive

youth with mental illness,” Social Work in Mental

case management for homeless adolescents:

Health 11 (5): 473–495.

Results of a 3-month fol ow-up,” Journal of

Emotional and Behavioral Disorders 2 (4): 219–

Ferguson, Kristin M. 2017. “Nonvocational outcomes

227.

from a randomized control ed trial of two

employment interventions for homeless youth,

Clark, Hewitt B., Kimberly A. Crosland, David Gel er,

research on social work practice,” SAGE Journals

Michael Cripe, Terresa Kenney, Bryon Neff,

28 (5): 603–618. doi:10.1177/1049731517709076.

and Glen Dunlap. 2008. “A functional approach

to reducing runaway behavior and stabilizing

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Appendix L. Systematic Evidence Review – Chapter 7 study references Ferguson, Kristin M., and Bin Xie. 2008. “Feasibility

Guo, Xiamei, Natasha Slesnick, and Xin Feng.

study of the social enterprise intervention with

2016. “Changes in family relationships among

homeless youth,” Research on Social Work

substance abusing runaway adolescents: A

Practice 18 (1): 5–19.

comparison between family and individual

therapies,” Journal of Marital and Family Therapy

Ferguson, Kristin, M., Bin Xie, and Shirley Glynn.

42 (2): 299–312.

2012. “Adapting the individual placement and

support model with homeless young adults,”

Guo, Xiamei, and Natasha Slesnick. 2017.

Child and Youth Care Forum 41 (3): 277–294.

“Reductions in hard drug use among homeless

youth receiving a strength-based outreach

Fors, Stuart W., and Sara Jarvis. 1995. “Evaluation

intervention: Comparing the long-term effects

of a peer-led drug abuse risk reduction project

of shelter linkage versus drop-in center linkage,”

for runaway/homeless youths,” Journal of Drug

Substance Use and Misuse 52 (7): 905–915. doi:1

Education 25 (4): 321–333. doi:10.2190/tu92-

0.1080/10826084.2016.1267219.

lx8w-g7fd-9lem.

Haber, Mason G., Arun Karpur, Nicole Deschenes,

Gaetz, Stephen, and Bill O’Grady. 2013. “Why don’t

and Hewitt B. Clark. 2008. “Predicting

you just get a job? Homeless youth, social

improvement of transitioning young people in

exclusion and employment training,” In Stephen

the partnerships for youth transition initiative:

Gaetz, Kristy Buccieri, Jeff Karabanow, and

Findings from a multisite demonstration,” Journal

Al yson Marsolais (Eds.), Youth homelessness

of Behavioral Health Services and Research 35

in Canada: Implications for policy and practice.

(4): 488–513.

Toronto, Canada: Canadian Observatory on

Homelessness.

Harper, Gary W., Donald Tyler, Gordon J. Vance, and

Jennifer DiNicola. 2015. “A family reunification

Grabbe, L., S. Nguy, and M. Higgins. 2012.

intervention for runaway youth and their parents/

“Spirituality development for homeless youth: A

guardians: The home free program,” Child &

mindfulness meditation feasibility pilot,” Journal

Youth Services 36 (2): 150–172.

of Child and Family Studies 21 (6): 925–937.

Hopewel , Sal y, Mike Clarke, David Moher, Elizabeth

Grabbe, Linda, Scott T. Nguy, and Melinda Higgins.

Wager, Philippa Middleton, Douglas G. Altman,

2012. “Spirituality development for homeless

Kenneth F. Schulz, and the CONSORT Group.

youth: A mindfulness meditation feasibility pilot,”

2008. “CONSORT for reporting randomized

Journal of Child and Family Studies 21 (6):

control ed trials in journal and conference

925–937.

abstracts: Explanation and elaboration,”

Grafsky, Erika L., Amber L. Letcher, Natasha Slesnick,

PLOS Medicine 5 (1). e20. doi:10.1371/journal.

and Julie M. Serovich. 2011. “Comparison of

pmed.0050020.

treatment response among GLB and non-GLB

Hyun, Myung-Sun, Hyang-In Cho Chung, and

street-living youth,” Children & Youth Services

Young-Ja Lee. 2005. “The effect of cognitive-

Review 33 (5): 569–574.

behavioral group therapy on the self-esteem,

Guo, Xiamei, Natasha Slesnick, and Xin Feng. 2014.

depression, and self-efficacy of runaway

“Reductions in depressive symptoms among

adolescents in a shelter in South Korea,” Applied

substance-abusing runaway adolescents and

Nursing Research 18 (3): 160–166. doi:10.1016/j.

their primary caretakers: A randomized clinical

apnr.2004.07.006.

trial,” Journal of Family Psychology 28 (1): 98–105.

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Appendix L. Systematic Evidence Review – Chapter 7 study references Jacobs, Erin, Melanie Skemer, and Mark Courtney.

Kugley, Shannon, Richard Epstein, Reiko Kakuyama,

2015. Becoming adults: One-year impact

Alexa Karczmar, and Matthew Morton.

findings from the Youth Villages transitional living

2017. Protocol: Systematic review on the

evaluation. New York, NY: MDRC.

effectiveness of interventions for homeless and

unstably housed youth and to prevent youth

Jennings, Louise B., Deborah M. Parra-Medina,

homelessness. PROSPERO 2017. http://www.

Deanne K. Hilfinger-Messias, and Kerry

crd.york.ac.uk/PROSPERO/display_record.

McLoughlin. 2006. “Toward a critical social theory

php?ID=CRD42017062148.

of youth empowerment,” Journal of Community

Practice 14 (1–2): 31–55.

Lim, Sungwoo, Tekinder P. Singh, and R. Charon

Gwynn. 2017. “Impact of a supportive housing

Johnson, Guy, and Chris Chamberlain. 2008. “From

program on housing stability and sexual y

youth to adult homelessness. Australian Journal

transmitted infections among New York City

of Social Issues 43 (4): 563–582.

young adults aging out of foster care,” American

Jones, Loring. 2011. “The impact of transitional

Journal of Epidemiology 186 (3): 297–304.

housing on the post-discharge functioning of

doi:10.1093/aje/kwx046.

former foster youth,” Residential Treatment for

MacKenzie, David. 2018. The Geelong project:

Children & Youth 28 (1): 17–38.

Interim report 2016-2017. Melbourne, Australia:

Kisely, Steve R., Joanne K. Parker, Leslie A.

Swinburne Institute for Social Research,

Campbel , Jeff Karabanow, Jean R. Hughes, and

Swinburne University.

Jacqueline Gahagan. 2008. “Health impacts of

MacKenzie, David, and Monica Thielking. 2013.

supportive housing for homeless youth: A pilot

The Geelong Project: A community of schools

study,” Public Health 122 (10): 1089–1092.

and youth services model for early intervention.

Kluve, Jochen, Susana Puerto, David A. Robalino,

Melbourne, Australia: Swinburne Institute for

Jose Manuel Romero, Friederike Rother, Jonathan

Social Research, Swinburne University.

Stöterau, Felix Weidenkaff, and Marc Witte. 2016.

McCay, Elizabeth, Celina Carter, Andria Aiel o, Susan

Do youth employment programs improve labor

Quesnel, John Langley, Steven Hwang, and Jeff

market outcomes? A systematic review. Bonn,

Karabanow. 2015. “Dialectical Behavior Therapy

Germany. Institute for the Study of Labor (IZA).

as a catalyst for change in street-involved youth:

Kozloff, Nicole, Carol E. Adair, Luis I. Palma Lazgare,

A mixed methods study,” Children and Youth

Daniel Poremski, Amy .H. Cheung, Rebecca

Services Review 58: 187–199.

Sandu, and Vicky Stergiopoulos. 2016. “‘Housing

McCay, Elizabeth, Susan Quesnel, John Langley,

First’ for homeless youth with mental il ness,”

Heather Beanlands, Linda Cooper, Rebecca

Pediatrics 138 (4): 1–10.

Blidner, and Karen Bach. 2011. “A relationship-

Krabbenborg, Manon A. M., Sandra N. Boersma,

based intervention to improve social

Wil iam M. van der Veld, Bente van Hulst, Wilma

connectedness in street-involved youth: A

A. M. Vol ebergh, and Judith R. L. M. Wolf. 2015.

pilot study,” Journal of Child and Adolescent

“A cluster randomized control ed trial testing

Psychiatric Nursing 24 (4): 208–215.

the effectiveness of houvast: A strengths-

Medlow, Sharon, Emily Klineberg, and Kate

based intervention for homeless young adults,”

Steinbeck. 2014. “The health diagnoses of

Research on Social Work Practice 27 (6):

homeless adolescents: A systematic review of

639‐652.

the literature,” Journal of Adolescence 37 (5):

531–542.

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Appendix L. Systematic Evidence Review – Chapter 7 study references Milburn, Norweeta G., Doreen Rosenthal, Mary

Nyamathi, Adeline, Catherine Branson, Barbara

J. Rotheram-Borus, Shelley Mallett, Philip

Kennedy, Benissa Salem, Farinaz Khalilifard,

Batterham, Eric Rice, and Rosa Solorio. 2007.

Mary Marfisee, and Barbara Leake. 2012. “Impact

“Newly homeless youth typical y return home,”

of nursing intervention on decreasing substances

Journal of Adolescent Health 40 (6): 574–576.

among homeless youth,” The American Journal

doi:10.1016/j.jadohealth.2006.12.017.

on Addictions 21 (6): 558–565.

Milburn, Norweeta G., Francisco Javier Iribarren, Eric

Olivet, Jeff, Marc Dones, Mol y Richard, Catriona

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U.S. Department of Housing and Urban Development

Office of Policy Development and Research

Washington, DC 20410-6000

October 2019

Document Outline

Executive Summary

Key findings

Policy recommendations

Conclusion

Chapter 1. Introduction

Motivation

Voices of Youth Count

Report Contents

References

Chapter 2. National Survey

Background

Methodology

Sample

Measures

Analyses

Results

Sample Characteristics

Prevalence and Incidence

Spatial Analysis

Risk Correlates

Diversity of Experiences

Discussion

Key findings

Limitations

Conclusion

References

Chapter 3. Youth Counts and Surveys

Background

Methodology

Design and Data Collection

Data analysis

Results

Aggregate Count Results

Aggregate Brief Youth Survey Results

Brief youth survey results by county size

Discussion

Key Findings

Limitations

Conclusion

References

Chapter 4. In-depth Interviews

Background

Methodology

Site selection

Building a local field team

Recruitment

Data collection

Data analysis

Results

Youth involvement in key systems and institutions

Survey responses to eight adverse experiences

Cumulative adversity scores

Beginnings of housing instability

Where does your story begin?

Trajectories of housing instability

Engagement with services, resources, and support

Youth logics of engagement with resources

Ending youth homelessness

Advice to organizations

Discussion

Key findings

Limitations

Conclusion

References

Chapter 5. Homeless Service Provider and Continuum of Care Surveys

Background

Methodology

Sampling

Survey instruments

Data collection

Data analysis

Results

Service provider survey: Individual-level data

Service provider survey: County-level data

Continuum of Care survey results

Discussion

Key findings

Limitations

Conclusions

References

Chapter 6. Analysis of Supplementary Data: Youth Who Run Away from Out-Of-Home Care

Background

Methodology

Design

Sampling

Measures

Analytic strategy

Results

Sample characteristics

Runaway events during the first spell of out-of-home care

Bridged runs during the first spell of out-of-home care

Exit runs

Discussion

Key findings

Limitations

Conclusions

References

Chapter 7. Systematic Evidence Review

Background

Previous reviews

Methodology

Criteria for considering studies for this review

Search methods

Data collection

Data extraction

Data synthesis and analysis

Results

Search and screening results

Study characteristics

Findings by intervention categories

Discussion

Key findings

Limitations

Conclusion

References

Chapter 8. Policy and Fiscal Review

Background

Methodology

Stakeholder discussions and review of statutes and regulations

Consultations with county service providers

Results

Policy area 1: Homelessness: Overview of existing county needs and services

Policy area 2: Homelessness: Coordination of county planning meetings

Policy area 3: Homelessness: Access to the Basic Center Program and other emergency shelters

Policy area 4: Homelessness: Access to transitional housing assistance

Policy area 5: Homelessness: Access to rapid rehousing

Policy area 6: Child welfare: Scope and responsibility

Policy area 7: Behavioral health: Coverage and access

Policy area 8: Juvenile justice: Discharge policies

Policy area 9: Education: Retention and high school completion

Discussion

Key findings

Limitations

Conclusion

References

Chapter 9. Conclusion

Key findings

How many youth and young adults experience homelessness?

What populations are overrepresented among youth experiencing homelessness?

What are the characteristics of youth experiencing homelessness, and what are their experiences?

How many youth experiencing homelessness were involved in systems like justice systems and child welfare? How do these experiences relate to housing instability?

What policies and practices can make a difference?

Implications for policy and practice

Directions for future research

Conclusion

References

Appendices

Appendix A. National survey instruments

Appendix B. Brief Youth Survey instrument

Appendix C. County-level data: Youth counts and brief youth surveys

Appendix D. In-depth interviews background survey instrument

Appendix E. In-depth interviews—participant characteristics

Appendix F. Survey results adversities by demographic characteristics

Appendix G. Levels of instability and geographic mobility

Appendix H. Survey responses to government benefits and services

Appendix I. Youth advice about ending instability

Appendix J. Provider survey instrument

Appendix K. Continuum of Care survey instrument

Appendix L. Systematic Evidence Review – Chapter 7 study references