Homeless Youths' Perceptions of Services and Transitions to Stable Housing

1. Introduction

The susceptibility of homeless young people or “street youth” to substance abuse and dependence (Baer, Ginzler, & Peterson, 2003; Kipke, Montgomery, Simon, & Iverson, 1997), mental health disorders (Slesnick & Prestopmik, 2005), medical problems (Farrow, Deisher, Brown, Kulig, & Kipke, 1992; Kelly & Caputo, 2007), and violence and victimization (Baron, 2003) has been well established. In the face of such vulnerability, providers have developed a range of services that may alleviate some of the stress of being homeless, potentially provide avenues into more stable housing, and provide or link young people to treatment for chronic problems. Yet providers struggle to engage these young people in many programs. Prior research has shown that homeless youth and young adults frequently underutilize available programs, particularly shelters and medical services (De Rosa et al., 1999; Kipke, Unger, O'Connor, Palmer, & LaFrance, 1997; Slesnick, Meyers, Meade, & Segelken, 2000). This dilemma is evident in recent studies of brief motivational interventions (BMI) to reduce substance use harm among homeless young people. Interventions have been designed in part to engage young people in case management and other homeless youth programs (Baer, Peterson, & Wells, 2004). The most recent effort resulted in increased service use during participation in the BMI, however increases were not sustained once the intervention ended (Baer, Garrett, Beadnell, Wells, & Peterson, 2007).

Such results prompt questions about how services can be best developed and maintained in ways that promote engagement from homeless young people. A limited number of previous studies have addressed these questions. Barriers to service use among homeless young people include distrust or dislike of staff, restrictive rules, unrealistic expectations, unsafe or unsuitable environments, and excessive access requirements (De Rosa et al., 1999; Thompson, McManus, Lantry, Windsor, & Flynn, 2006). Fewer studies describe how some young people overcome these barriers. Kipke, Montgomery, Simon, Unger, & Johnson (1997) demonstrated that peer group affiliation influences service use among homeless young people, suggesting that subgroups within street youth culture may view services differently. Carlson, Sugano, Millstein, and Auerswald (2006) suggest that a young person's stage within the lifecycle of youth homelessness affects use of services; young people new to the streets or young people in crisis or “disequilibrium” may be more receptive to services, while those in “stasis” may be more difficult to reach with traditional service models.

Any model of service engagement should be developed with knowledge of how young people perceive the services. Three studies have reported the perspectives of young homeless persons (Darbyshire, Muir-Cochrane, Fereday, Jureidini, & Drummond, 2006; Reid & Klee, 1999; Thompson et al., 2006), and each found that young people were more apt to engage in services that were not stigmatizing and whose providers were respectful and supportive. Only one study has examined the perceptions of young people regarding whether and how homeless youth and young adults disengage from street culture and homelessness and the role that service providers play in this process (Raleigh-Duroff, 2004). This study provides evidence that both internal and external factors are significant for young peoples' attempts to leave the streets and for the success of their attempts. Supportive people and agencies can make a critical difference. However this study was small in size (n=10), and only sampled formerly homeless persons. The authors are unaware of any studies that have recorded perspectives of currently homeless young people on what motivates some people to exit street life and others to remain entrenched and how the transition into stable housing is facilitated.

The current study sought to both replicate and extend prior literature by seeking the perspectives of young homeless people about factors that serve as facilitators and barriers to service use as well as their perspectives on how homeless young people transition off the streets, whether it be their own transition or that of their peers. To ensure a broad representation of opinions and perceptions, the young people sampled varied with regard to degree of engagement in services and degree to which they have disengaged from street culture. A qualitative method was used due to a need to develop, rather than test models. The goal was for the ideas, preferences, and meanings of those who are the subject of this investigation to emerge, without restricting data collection to a set of preconceived questions, thereby allowing emergent themes to be explored through the analysis of the narratives.

2. Methods

All procedures were reviewed and approved by the Institutional Review Board at the University of Washington.

2.1 Sample and Recruitment

Participants were purposely recruited in three ways in an attempt to sample young people with different degrees of service engagement: 1) research staff recruited participants from a collaborating faith-based drop-in center during open hours; 2) research staff approached potential participants on the street in an area of the city known to be frequented by homeless young people; and 3) case managers from the collaborating drop-in center contacted young people who were no longer homeless and asked if they would be willing to be contacted by research staff.

Participants first completed a brief screening questionnaire that included demographic information (age, gender, ethnicity), rates of alcohol and drug use in the past month, and housing instability. Stable housing was defined as having an indoor living situation that participants returned to at night and anticipated being able to return to in the next 30 days. To maintain anonymity, only verbal assent/consent was obtained. For their participation, participants received a $20 gift certificate from one of several retailers.

Twenty-seven participants completed a brief post-interview questionnaire asking what services they used in the previous 90 days: six reported infrequent service use (attended a drop-in center fewer than four times in the prior 30 days), 15 regular service use (attended a drop-in four or more times in the prior 30 days), and six were no longer homeless. Infrequent service users will be referred to as “unconnected,” regular service users as “connected,” and no-longer-homeless young people as “formerly homeless.” Participants ranged in age from 16 to 24 (mean = 20). Sixteen (59.7%) were male and 11 (40.3%) were female. Most (16, 59.3%) identified as Caucasian, with the remainder identifying as being of mixed ethnicities (10, 37.0%) or Native American (1, 3.7%). Participants who were currently homeless stayed in an average of 3.8 different places (s.d. = 1.4) in the prior month, and most (81%) reported some substance use in that time. There were no significant differences in age or gender among the three recruitment groups, although younger youth tended to be more connected with services, and older youth tended to be either disconnected from services or housed.

2.2 Procedures

2.2.1 Qualitative interview

Sixteen open-ended questions with probes that fell within five larger subject areas (see table 1) were developed with the goal of reducing potential interviewer biases in the wording of the questions. As a result of a collaboration with a faith-based agency that provides drop-in and case management services to homeless young people, questions were reviewed by staff at the agency and additional questions of particular relevance to this drop-in program were incorporated, including questions about interaction with faith-based agencies. The five subject areas were 1) meeting basic needs, 2) opinions about services, 3) deciding where to stay at night, 4) deciding whether to leave or remain on the streets, and 5) perceptions of faith-based services. Interviews were conducted by one of two interviewers trained in the use of non-directive probes to encourage elaboration. Interviewers were free to change the order of questions as dictated by the participants' responses and to skip questions that had been addressed in response to a different question. All interviews were recorded digitally and transcribed verbatim into Microsoft Word. Transcriptions were reviewed by the interviewer for accuracy.

Table 1.

Subject areas and questions

Meeting basic needs

Tell me about what happens when people are first on the street. What do youth need? How do they learn to survive?

What options do youth have for finding: housing? food? clothes? help with drug use or mental health issues? What else?

What places/people are most helpful? Why?

How do people decide what to do and where to go? Does where they go change over time?

Opinions about services

What do street youth think of agencies that say they want to help them?

What do youth expect before going? Is their experience at the agency what they thought it would be?

Why do some youth visit agencies more than others?

Do you have a sense of why the people at agencies want to help homeless youth?

Deciding where to stay at night

How do youth decide where they are going to stay each night? Are youth who sleep in shelters different from those who don't?

Deciding whether to leave or remain on the streets

What are some of the good things about being on the streets? What are some bad things?

What are some good things about having housing? What are some bad things?

What happens that makes some youth consider leaving the streets?

How do people get off the street? If they do not get off the street, why not?

From our point of view, some youth seem to “come and go.” They're around for awhile, then they're gone, then they're back… what's happening?

Perceptions of Faith-based agencies

What types of experiences do homeless youth have with religious people who want to help them?

2.2.2 Analytic Procedures

Consensual Qualitative Research methods (Hill, Thompson, & Williams, 1997) were used to analyze the transcribed interviews. This approach entails using a consensus process within a team of analysts to systematically examine patterns within and then across cases to generate themes that represent the sample. A three person coding team, including the two interviewers, first developed a list of major domains emerging from an initial read of the transcripts. Examples of domains included “Barriers to service use,” “Support needed to leave the streets,” and “Deciding to leave the streets.” Many of the domains reflected the participants' responses to specific questions. The analysts coded key domains in each interview independently, recording codes in Atlas.ti v.5.0 (Atlas.ti Scientific Software Development GmbH, 2006) and then compared codes and made revisions as necessary to achieve consensus on domain codes for each interview. The codes were then audited for reliability by a senior researcher and feedback given to the coding team, resulting in 32 coded domains.

All domain-coded quotes for each participant were independently examined by two of the three analysts, and main ideas within each domain were recorded into a separate MS Word file in more precise terms, while maintaining as much of the original language as possible. For example, “It's more of a build-up. ‘You're tired of being cold, tired of being hungry’” reflects one of the main ideas within the domain “Deciding to leave the streets.” After two analysts reached consensus on the wording of these abstracts, the results were again audited and checked for accuracy. Revisions were incorporated by consensus into the final abstracts. Particularly salient quotes were noted.

Analysts then independently examined the main ideas across the entire sample to identify core ideas. Were results were compared to achieve consensus on the grouping and wording of the core ideas. An example of a core idea that emerged from multiple participants reporting a similar main idea within a domain is: “Tired of being cold/homeless – builds up over time”. The core ideas were audited within each domain for wording that accurately and concisely reflected the raw data and the meaningful groupings of participant quotes. Finally, the entire research team, consisting of the three analysts and three senior investigators looked across domains for similar core ideas and as a group determined the key themes emerging from the interviews, which are reported below.

2.2.3 Subgroup Analyses

The resulting themes were examined by group (connected, unconnected, formerly homeless) and age (20 or younger, over 20). If one subgroup reported a particular theme more than 20% more often than another group, then the original quotes were reexamined for differences in ideas.

3. Results

Resulting themes were categorized into two conceptually distinct but overlapping areas: Service Connections and Exiting the Streets.

3.1 Service Connections

Perceptions of and experiences with using or not using services comprised a set of themes mentioned by two-thirds of the sample. These themes spoke both to service- and participant-related characteristics. Service characteristics included staff attributes and their relationships with young people, safety and health issues, and structural barriers. In addition, participants responded to questions about their experiences with faith-based service providers. Participant characteristics included independence/self-reliance, substance use, and influence of peers.

3.1.1 Staff attributes/Relationships

Attributes of service staff and their relationships with homeless young people was the most-discussed topic in the broader theme of Service Connections, mentioned by over three-quarters of respondents. Consistent with pervious research (Darbyshire et al., 2006; Thompson et al., 2006), service providers who are open, accepting, and caring were especially noted as helping young people engage in services. Other positive attributes of staff included offering practical help yet being unobtrusive and not approaching people too soon or too often. Staff attitudes and the relationships they formed with young people were perceived by one 20 year old female as being more important than the actual services provided; “Like tonight … I just came to visit with the people. There's more reasons than just the food for you come here.”

Staff whom young people perceive as judgmental or as having ulterior motives for helping them may prevent them from accessing services. A 19-year old male said of a drop-in center he no longer frequents, “They weren't looking to help anyone. They were looking for numbers. They were looking for money. And I had absolutely no need for those people in my life.” Not imposing values was particularly pertinent in response to questions about faith-based services. More than a third of the sample mentioned the importance of not having to participate in any kind of religious practice in order to receive help.

3.1.2 Safety and health

Nearly half said that conflict with other homeless young people, along with other safety issues of the streets in general, affected what areas of the city they frequented, where they slept, and which services they used. The usefulness of services, and in particular shelters, in being able to truly provide for and protect the safety of people, their health, and their belongings was both affirmed and questioned. Shelter was mentioned by roughly a fifth of respondents as a reprieve from the risks associated with sleeping outside and/or alone, especially for young people who were new to the street or who didn't have skills for staying outside.

There are a lot of kids…if they didn't have their shelters they would be dead. They would get their asses kicked. They would end up in jail. They would not know where sleep. They would end up so sleep deprived, they'd be stupid and yeah. There are a lot of kids that are heavily dependent on shelter. I mean without it they would be lost. (22 year old female)

In stark contrast, the inability of shelters to provide a safe environment was also vividly described by nearly one third of the sample. They noted the potential for violence, health concerns such as lice and scabies, having their belongings stolen, and being separated from familiar people and pets as all having a negative effect on shelter users' health and safety.

3.1.3 Structural barriers

Just under half of participants expressed a desire to access services but described an inability or reluctance to do so because of service characteristics and limitations such as location, waiting lists, operating hours, maximum capacity, and age restrictions.

Another structural barrier to service use, particularly shelters, was imposed rules. Roughly two thirds of participants mentioned being drawn to the streets because it offered freedom; an escape from rules of mainstream society. Being emancipated from family and/or foster care systems allows for a level of autonomy that housed young people do not possess; choices are often made spontaneously. When juxtaposed to the very structured, albeit necessary, requirements in many group living situations, living without rules is attractive.

But the cons of why I don't stay in a shelter, and I know a lot of other people don't, is its restrictions, something we left when we left home. We have no restrictions when we live under a bridge. We have no restrictions if we don't get to sleep that night because we have nowhere to go. Staying in a shelter is a restriction of who we are and who we want to be and what we want to do with ourselves (18 year old male).

Age restrictions were specifically discussed by almost half of the sample as a barrier to service engagement and participants expressed a keen awareness of how their age determined what services they could access. They expressed concern about aging out of services because they would be ineligible for and separated from familiar service providers. A smaller number of participants (15%) also expressed trepidation about receiving services alongside homeless adults in a setting in which they felt more vulnerable.

Age limit is a big thing… So once I'm twenty-three I can't eat…And then they force people to go downtown for the elderly shelters. And those people aren't the greatest people. ‘Cause now you're dealing with, “Hey, man, you sell this bag for me, and I'll hook you up.” You know? It's a lot rougher … (21 year old male)

3.1.4 Experiences with faith-based agencies

Due to the collaboration with a faith-based agency, participants were specifically asked about their experiences with faith-based service providers. Notably, participants rarely spoke about faith generally, and only spoke about faith-based services when directly queried. In response to interviewer questions, most participants did indicate that as long as service providers were unobtrusive and didn't “preach,” they were either indifferent to or accepting of services that were faith-based.

3.1.5 Independence/self-reliance

The theme of self-reliance ran throughout this inquiry; nearly all participants mentioned it in relation to a myriad of issues and experiences. The self-reliant ethic that permeates street culture and the ways in which it can become a barrier to service engagement was the second-most mentioned topic related to Service Connections. Over three-quarters of participants mentioned how this value, described as a matter of pride, respect, and survival; is also a matter of autonomy and agency when choosing to not use services that are available to them. Young people who are able to fend for themselves are generally well-respected by their peers, and many take pride in their own self-reliance. However, roughly 15% of the sample reported a willingness to use services for limited purposes, such as food, and then find other ways to meet additional needs. The use of shelters, in particular, was perceived by about 20% of participants as an indication of weakness.

Youth that decide to stay in shelters are normally, I hate to say it, but softer people. You know they're still not quite to the point where they can handle living on the street totally because when I say you live on the streets I mean you live on the streets. You eat on the streets. You sleep on the streets. You live by the streets; you die by the streets … Now coming to [Drop-in], you're still on the streets because you come here, you eat, you take a shower, you know you get clothes, but then at noon or at ten…you're back out there. So, yeah, it's like going and visiting a friend (18 year old male).

Not all participants agreed with this, though. One quarter of participants voiced an acceptance of different survival choices, and believed that taking advantage of services when they are available was a smart decision:

Well, I've noticed that a lot of them like to stick with their friends, and like if their friend's not going there, they're just going to like tough it out and not go. But personally, my opinion, I'd rather stay out of the cold … They think that they should do it all on their own; they should do it by themselves. But sometimes you need help to succeed (20 year old female).

Participants also made it clear that their lives do not revolve around accessing services. Almost two-thirds of participants mentioned being busy with multiple priorities that they may choose over using services. One 19-year old male said, “It could depend on what they're doing…just because we live on the street doesn't mean we don't have things we do too.”

When discussing self-reliance, one-third of participants mentioned different subgroups on the street. Although group identity was often linked to drug of choice or preferred geographical location, a higher-order grouping into two categories emerged and was mentioned by a fifth of the sample: long-term “street youth” and “housies.” The first group was perceived to lack any kind of home to return to, while the second was seen as having a home yet choosing to live on the street, often short-term and for less serious reasons (i.e., wanting to party or having arguments with parents). There was a perception that “housies” needed more services because they lacked street survival skills. Yet, resentment was also expressed that these young people could meet their needs by going home, and were therefore taking services away from “true street youth” who really need them.

3.1.6 Substance use

Drugs and alcohol are a large part of street culture. A majority of young people interviewed used drugs regularly or had used them when they were on the streets. Movement between different groups that identified with a specific drug (e.g. “tweakers” or “stoners”) or away from the use of shelters was attributed to a shift in a person's drug of choice or an increase in drug use by 10% of the sample. For example, one participant stated:

When they first get out here, you know they start in a shelter, but, say, then they … get caught up in a drug scene, let's say. And then it's like, “Hey, well, I can stay out all night and do this, that, and the other thing instead of going in here and sleeping. I mean, sleep. Who needs that?” (21 year old male).

Over half the participants mentioned how substance use had some effect on their use of drop-in centers. In some cases, it was simply the immediate effects of the drugs that made them feel they didn't need or want services. Others noted that they didn't want to disappoint staff with whom they have established a relationship.

Generally if kids [miss drop-in] it's because they have already trusted somebody there, and they've done something to violate that. Like if a kid's been clean for a while, and they disappear for a while, they're probably sneaking off and using again. And they don't want to hurt anybody by telling them that … or having them see that.” (18 year old female)

Whether perceived as a violation of general “rules” or of a specific relationship with staff, concerns about showing up intoxicated reportedly kept people away from services.

3.1.7 Influence of peers on service use

Nearly all participants mentioned the importance of developing relationships on the streets for survival, particularly when first on the streets. More experienced young people initiate newer people into the culture by showing them where to get food, safe places to sleep, and where to store belongings. There is the possibility of developing very deep bonds with friends or “street family” who provide material and emotional support, as well as a sense of protection, belonging, and identity.

Ten percent of participants described how their friendships and associations with street and other young people had multiple effects on their patterns of service use. One described meeting friends at and traveling in groups to drop-in centers.

Like if we've all been spread out during the day, like at the end of the day we're all like gathered together at feed. It's kind of like family dinner … It's like Thanksgiving…every night. The whole family gathers together, and you find out what happened all day, you find out who's been where, what's been going on. (22-year old female)

3.2 Exiting the Streets

Seven themes emerged in relation to leaving the streets: the gradual process, a major event, needing motivation, reducing or eliminating substance use, negotiating relationships with street and housed persons, accepting help, and rejecting mainstream values.

3.2.1 A gradual process

Nearly three-quarters of the participants mentioned a gradual accumulation of conditions, events, and feelings associated with street culture that propelled young people to consider leaving the streets. All of these participants referred to being “sick and tired” and “fed up with everything.” Two-thirds of participants detailed the physical and emotional toll from adverse weather conditions and social conflicts on the streets.

One youth noted that these feelings of frustration prompted some young people to think about transitioning off the street while others give up and become more entrenched in street culture.

They get tired of it. And they're like, “I'm fed up! All this drama, not being able to hold a relationship, everything is just falling apart around me. Nobody's helping me. The only person that can help me is myself …and then you got the other cycle where they just give up. They don't want to even bother anymore. They like can't handle it. Nobody cares. I'll just become a drunk or a druggie. (21- year old male)

A little more than half of the participants suggested that exiting was a slow process that involved much preparation, perseverance, and patience. When it came to housing, one fifth of participants suggested that homeless young people must be persistent when filling out applications, reliable with appointments, and patient while waiting to receive services.

Nearly a quarter of participants, and particularly younger youth, believed exiting was inevitable, something that all homeless young people do eventually. These participants inferred that staying on the street was a choice, in part, because of immaturity and believed that as youth matured they would “grow out” of street life. For instance, participants made comments such as “It's just when a street kid finally decides that they want to grow up.” A few participants noted wanting to avoid becoming their “worst nightmare”: a homeless adult. The fear of morphing from a “street youth” to a homeless adult may provoke some young people to consider leaving the streets.

3.2.2 Experiencing major events

A little less than half of the participants believed a major life event such as pregnancy or threats to one's life played a role in leaving the streets. The additional responsibility of caring for a baby was key for 15% of the young people in considering more stable housing while the condition of pregnancy may have also increased access to housing services and resources. Nearly one fifth of participants also discussed experiencing a traumatic event that prompted exiting. Besides being threatened or victimized, one participant stated that it was “usually … a death or a…close death or something like that. Things like that usually kind of make people think twice…something extreme.”

3.2.3 “Needing” Motivation

Once enmeshed in street life, many participants described falling into routines that are familiar and safe. These routines can ultimately lead to a lack of motivation to do anything else. Roughly one third of participants felt that over time some young people become so complacent that they lose the ability to imagine a life away from the streets and become ill-equipped to survive anywhere else. One 17- year old male said, “They just they think it's okay where they're at, and maybe they're so good at like finding a place to stay or used to it, that they don't care.” This perceived lack of motivation was labeled by a minority of participants (7%) as being “lazy” or “sidetracked with procrastinating.” As one 21 year old male put it, “Motivation. That's it. Once they got it, they were out of here. They pretty much just had a self-realizing… They took an assessment of everything, and it's like, ‘Wow, I could be doing way better for myself’.” However, a few participants (11%) disagreed with the assumption that homeless young people lacked motivation. Instead, they asserted that they were not lazy but lacked the necessary skills to leave the streets.

Participants also talked about having aspirations and dreams. Notably, unconnected participants were less likely to mention aspirations than either connected or formerly homeless participants. Almost half of all participants envisioned their lives as “better” and mentioned goals that reflected a more stable living situation, such as going back to school, having or wanting a partner, desiring a “new routine of jobs and apartments,” and having responsibilities.

It's hard living the way you're living, and you want to do better for yourself. You don't want to be a bum all your life at the age of fifteen. That's kind of sad. Make yourself better, [so] that you actually can do something that people or yourself you know think that you can't. (22-year old female)

Nearly a third of participants voiced their positive aspirations in the form of wanting to help other homeless young people. Envisioning the possibility of helping others or functioning as a role model may inspire some people to consider exiting. One participant thought, “Volunteering for a good cause on a resume looks really good. I mean for a fact, they [service agencies] really do care. I wouldn't mind gettin' on my feet and doin' the same thing.”

3.2.4 Reducing or eliminating drug use

Drug use was mentioned by half of the participants as a barrier to transitioning off the street. Specifically, participants felt that drug use interfered with the motivation to leave, hindered employability, and drained financial resources. One participant noted the importance of offering comprehensive services such as drug and mental health treatment to help young people transition off the street.

Because ninety percent of the kids out there on the streets are going to be high, and if they're getting into fights and they are prostituting themselves or if they're stealing cars … and if it's drug-motivated, then there's your reason why they're not doing it. If it's not drug-motivated, then they're probably really…fucked up in the head, or they're really hurting, and there's more to it that needs to be addressed as opposed to we just need to get you a house and a job, and it'll be fine. (24-year old female)

Engaging young people in substance abuse treatment may pose a challenge however; addressing problems with drug use was specifically mentioned by over a quarter of participants as something that is most often attempted without the use of services.

3.2.5 Negotiating relationships

While building and maintaining relationships with other homeless young people may be necessary for survival on the streets, these relationships can be detrimental when attempting to leave. Approximately one fifth of the sample noted the need to distance themselves from their street friends in order to successfully leave and described the difficulty in doing so.

I think probably the biggest setback to trying to get off the streets is looking around and seeing everyone that you just survived with are still there. I mean all of a sudden … not only are you all by yourself in this apartment… you have to give up your family. And you have to give up the society that helped keep you safe. (23-year old female)

In contrast, maintaining or establishing relationships with persons who are housed and who offer practical and emotional support may be critical in transitioning to more stable living conditions. Notably, all six formerly homeless participants in this study reported significant ties with housed people; girlfriend/boyfriends, classmates, and parents were mentioned.

3.2.6 Re-thinking independence and accepting help

Because leaving the streets is lengthy and difficult, two-thirds of participants discussed the importance having an indoor place to sleep and having some form of job as important first steps to transition off the streets. For one quarter of participants, this was achieved through accessing and using services such as housing and work programs to make the transition. Case managers were often seen as an important link to accessing and using services to meet both needs.

Like a case manager … they'll help you find food, they'll help you get clothes, they'll help you with schooling, they'll help you with getting work. She's going to help me with the barista training. There's a lot. I mean you don't even have to pay for the case manager so…It's free, then you just make appointments with them and meet them. (20-year old female)

For other people (19%), sleeping temporarily indoors in shelters, motels, and apartments without using more structured services was the initial step in the transition off the streets. If these places are safe, young people can potentially experience the benefits of sleeping protected from the weather. Of the six participants in this study who were no longer homeless, all but one had taken advantage of some kind of housing program. The one that did not had returned to her father's home. Notably, these participants were referred to the study by staff at a drop-in center. Young people who have successfully transitioned off the streets without the help of services may not be in contact with agency staff.

Keeping a job and housing once it was found, and managing the resulting income, posed additional challenges and required additional skills. Having some kind of income to pay for the expenditures associated with housing such as deposits, rent, utilities, and food was seen as necessary to be successful. Roughly one quarter of participants believed help with budgeting and saving money were critical, while one-third emphasized the need for more job preparation and training services. These participants cited the lack of youth-appropriate work, difficulty dealing with constraints of work schedules, interpersonal conflicts on the job, and mental health and criminal histories as deterrents to becoming stably employed and housed.

Thirty percent of young people in the sample noted that they or their friends cycled between the streets and housing because adjusting to “housed” culture was difficult. Specifically, the skills used to survive the streets may be detrimental in a more stable living environment. A 24-year old female commented, “…it's bigger than just finding a house. It's changing your whole lifestyle. I mean it's not acceptable to walk down the street and scratch your ass and pick your nose.”

In addition to adjusting to mainstream culture, nearly a third of participants perceived prejudice against homeless people from the dominant culture as contributing to cycling on and off the streets. One participant pointed out that a shift in society's attitudes towards homelessness may be necessary for homeless young people to make a successful transition back to “housed” culture.

They got threw back into a pattern of society which didn't accept them for …what they were and who they are and treated ‘em like crap, and so they tried to work and keep their own place, and they lost it because they were …I guess, prejudiced against … people were assholes to them just because of their past homelessness and the fact that they weren't rich or didn't look a certain way or didn't act a certain way. (19-year old female)

3.2.7 Rejecting mainstream values

While most participants indicated that they would like to leave the streets at some point, there was a small minority (11%) who seemed to consciously choose street life as a matter of principle. They expressed strong opinions about values, particularly materialism, associated with housed living. These participants viewed working to pay rent as a trap that leads to a stressful cycle of having to work harder and harder to meet increasing material needs:

The help they will lend you is really society-driven. It's like, okay, well, we'll help you get a house, we'll help you get a job … What if you don't want a house and a job? What if you want something else? … That's just the thoughts I've always had because I got really upset that the foster care was always trying to push me into the Norman Rockwell kind of life (19-year old male).

These young people mentioned needing only a small amount to survive and being proud of their ability to live sparsely and to avoid the stress of modern life. A participant who was connected to services mused, “I actually met this one dude, he's like, ‘I don't think I'm homeless; I'm home free’ … and he actually has no problems not having a house. It doesn't tie him down anywhere.”

3.3 Subgroup Comparisons

Group and age differences were examined, noting that younger youth tended to be more connected with services, and older youth tended to be either disconnected from services or housed. Notably, there were generally not wide variations in what people in these three groups reported. Older participants who were housed tended to be more articulate about the process involved in exiting the streets and more vocal about the role that substance use played as a barrier to attaining housing. Younger youth were more likely to emphasize the importance of autonomy, although not all younger youth spoke about their own autonomy. Often they were commenting on the behavior of their peers. In addition, younger youth more frequently discussed the importance of their friends in how they made decisions about service use, in particular. Younger youth also tended to place more value on assistance from agencies, and assumed that leaving the streets was the inevitable outcome of “growing up”. In general, there was a consistency in responses that transcended group and age.

4. Discussion

The aim of the present study was to qualitatively explore the perceptions of homeless young people regarding both barriers and facilitators associated with service use and the transition to stable housing. To gain a broad perspective, both formerly and currently homeless youth and young adults with varying degrees of service engagement were interviewed. Consistent with previous studies (Darbyshire et al., 2006; Thompson et al., 2006), the findings indicated that youth believed that connecting with services can be understood in relation to factors associated with agencies, such as staff attributes, issues of safety/health, and access barriers, as well as issues associated with personal and interpersonal factors, such as independence/self-reliance, substance use, and the influence of peers. Themes that reflected the process of exiting the street suggested that it was a gradual process, sometimes prompted by major events, required motivation, hindered by substance use, involved negotiating of relationships, included a reframing of independence, and linked to mainstream values. Furthermore, and consistently, exiting street life involves a gradual detachment from street culture that includes a negotiation of one's autonomy, identity, and relationships, while having access to appropriate/adequate resources. Generalizing, the participants' perspectives on services were embedded within much broader concerns about identity and autonomy that are consistent with adolescent psychological development.

Given considerable overlap in themes expressed in regard to connecting with services and exiting the streets (independence/self-reliance, substance use, peer relationships, and motivation), discussion will focus initially on these themes. Throughout this inquiry, and as in previous research using different research methods (Thompson et al., 2006), homeless young people consistently and clearly voiced the importance of being independent (Thompson et al., 2006). This was mentioned by participants not only as a facet of identification with a subgroup or peer group, but also as a natural outcome of spending more time on the street and living without ongoing support of adults and other authority figures. Skills for surviving are necessary, and preferences (such as sleeping outside, being able to use/sell drugs when they choose) are developed. Young people who choose to meet their own needs on their own terms are viewed as practical and adaptive rather than possessing an arbitrary allegiance to an abstract ethic. Of course, becoming autonomous is an important developmental task for all adolescents, and for homeless young people it appears to be a necessary skill for survival. Yet, from the voices of the participants, this same autonomy may interfere with accessing and using services and functioning successfully within mainstream housed culture. Participants describe in negative terms those programs and services that impose restrictions on independence; and some viewed the restraints of mainstream society (e.g. having to work to pay the rent) as being another threat to their autonomy.

In addition to possessing the skills needed to live independently on the streets, the perception of independence among subgroups of homeless young people influenced how youth use services and possibly the duration of time they remained on the streets. For example, participants described status conflicts among homeless young people, differentiating between “housies”, who were perceived as being less independent and “real street youth”, who were perceived as being more capable of fending for themselves. It is unclear whether “housies” are relatively stable young people appropriating a culture belonging to working class adolescents and young adults with unstable family situations, or if these young people have histories of abuse, mental health problems, and substance abuse, but whose problems are masked by their perceived wealthy background. In either case, such status differentials among homeless young people may contribute to daily conflicts, and further could identify groups who respond to services differently. The ability to distinguish between groups could aid service providers in targeting interventions to those who have greater or lesser resources. Such groupings may take different forms in different communities. Further research exploring the existence of subgroups of homeless young people would be beneficial.

Substance use was a pervasive theme. Participants believed that substance use interfered with service use and finding and maintaining housing. However, they also indicated a reluctance to engage in formal treatment programs, preferring instead to address issues of substance use on their own. Given that drug use is central to street culture, interventions which aim to engage young people in treatment or support harm reduction should be explored. Increased access to drug treatment options and drug courts may also be beneficial in helping young people control, reduce, or stop their drug use for a more successful transition off the street.

Although independence is highly valued among homeless young people, being with or following friends seemed equally important in determining service use, particularly among younger participants. Carlson et al., (2006), suggested that young people who are experiencing “disequilibrium” may be more willing to engage in services and potentially leave the streets. Participants in this study indicated that while bonds with friends are strong, they also often involve conflict (“street politics” or “drama”). Young people who are in the midst of rejection by peers, or who begin to tire of peer conflicts, may be more likely to reach out for assistance and consider leaving the streets. Conversely, it may be challenging for young people to secure more stable living situations if they have strong ties to friends who are entrenched in street culture. Thus, developing and maintaining other sources of practical and emotional support such as relationships with housed persons may be critical.

The decision to use more intensive services or to leave street life was described as occurring within the context of a comfort with or acceptance of the routines of daily life on the streets. Motivation was frequently mentioned by participants as a necessary component of leaving the streets. Yet, few could articulate how some young people become motivated to leave while others do not. In some cases, taking steps necessary to finding housing was precipitated by a life-altering event, such as a death or pregnancy. In other cases, youth became tired of the persistent challenges of being without a home, both environmental factors such as the weather as well as the fluctuations in allegiances among their peers, however why some youth tire of this life while others do not was not clear. There was an indication that people have varying degrees of attachment to their street identities, and that the more adept they become at utilizing street survival skills such as participating in a street economy, exhibiting a tough exterior, or avoiding authority, the more invested they become in this identity. While these skills are functional while on the streets, they are often antithetical to the skills required of young adults attempting to re-integrate into mainstream culture. Services that can successfully enhance both motivation and skills to live in the “housed” world appear important to reintegration of these young people.

And, it may not be essential that young people exit the streets via services. While the services were largely felt to be important and helpful to people exiting the street, the use of services may be one of many routes off the streets. Opportunities for entry level jobs and inexpensive housing were mentioned frequently as something young people need. Of course it is unclear what proportion of homeless young people would succeed without more structured programs that incorporated job training, counseling, and substance abuse treatment. As noted above, participants who had successfully transitioned off the streets almost uniformly used services, but all had been identified via a service agency.

Finally, the findings indicated that most participants were tolerant of or indifferent to religious messages and practices of service agencies. However, pressuring people obviously runs counter to issues of autonomy and may interfere with service engagement for some street youth and young people. Better understanding how homeless young people respond to faith-based service providers is valuable given changes in public policy that support increasing numbers of faith-based programs.

4.1 Study Limitations

A few limitations must be noted in this study. One limitation included sampling agency-connected participants from only one agency. Although generalization to a larger population is not the goal of qualitative research, recruiting participants from other service agencies may have increased the diversity of the sample. Over half the sample (55.5%) were regular service users, and another 22.2% were no longer homeless, so statements about the barriers and facilitators of service use should be interpreted cautiously. In addition, while an attempt was made to interview more formerly homeless young people, only six such participants were successfully recruited. The majority of these participants were affiliated with agencies; formerly homeless young persons who transitioned off the streets without agency help are not represented in the sample. Another limitation is the low numbers of young people identifying as people of color and not specifically recruiting lesbian, gay, bisexual, and transgender young people. Their experiences may differ from white or heterosexual homeless young people. Finally, although this study explored perceptions of service use and exiting the streets, a better understanding of how these processes are linked is needed. Specifically, it is unclear how some young people overcome barriers to service use to progress into more comprehensive services and what services are most effective in the transition to stable housing.

Despite these limitations, the strengths of the study included using a sampling method that incorporated interviewing currently homeless young people with different levels of service use and formerly homeless young people. In additional, a consensual process was used to code the interviews, develop categories, and formulate themes. The use of consensus among multiple reviewers and the additional step of auditing codes further ensured reliability of the findings.

4.2 Lessons Learned

Results from this study replicate findings from previous research suggesting that services that are accepting and flexible are more likely to engage homeless young people. The study also adds to current knowledge by eliciting the perspectives of a range of homeless young people about how decisions are made to use services and transition to stable housing. Despite an apparently strong identification with street life and the importance of independence and autonomy, most participants did not envision themselves as being on the streets forever. Thus, the central challenge for service providers appears to involve finding ways to support autonomy and independent functioning while also providing safety and resources in ways broader communities will support. Service providers who have an understanding of the environmental and psychological contexts for young peoples' decisions may be able to guide them in choosing survival strategies that are the least harmful and that facilitate their transition to more stable living situations. Designing interventions that utilize strengths associated with autonomy and assisting young people in developing bonds with their housed peers may decrease trepidation about engaging in more comprehensive services and leaving behind a lifestyle that has become familiar. Recommendations for future research include examining subgroups of young people within “street youth” culture to better target interventions specific to the needs of those groups.

Biographies

Sharon B. Garrett, M.P.H., M.A. earned her Masters in Public Health at the University of Washington. Her research interests include substance abuse prevention and treatment and help-seeking behavior, particularly among adolescent and young adult populations.

Darrel H. Higa is a doctoral candidate in social welfare. His research interests include health and mental health related issues for LGBTQ populations and the intersection of sexuality and spirituality.

Melissa M. Phares received her MSW from the University of Washington in 2001 and was trained as an MI trainer in 2003. Her main interests are in adolescent addictions research/treatment, motivational interviewing, and non-12 step therapies.

Peggy Peterson, Ph.D., MPH is a community and social psychologist. She has directed and published research in the areas of brief motivational interventions among street youth; youth drug and alcohol prevention; HIV, alcohol, and drug risk prevention in the gay community; and research methods for community based preventive interventions.

Elizabeth A. Wells, Ph.D., received her Ph.D. from the University of Washington in clinical psychology. She is a Research Professor at the University of Washington's School of Social Work. Her research interests include etiology, prevention and treatment of substance use disorders, behavioral interventions for prevention of HIV infection, and cognitive behavioral treatment interventions.

John S. Baer, Ph.D. is a Research Professor of Psychology at the University of Washington. His academic and clinical interests include substance use prevention, early intervention, and treatment. He has focused on the evaluation and training of brief motivational interventions.