Art Messaging as a Medium to Engage Homeless Young Adults Art Messaging as a Medium to Engage Homeless Youth

Abstract

Background

Art has been shown to be an empowering and engaging entity with numerous benefits to vulnerable populations, including the homeless persons and young adults. Yet, little is known how homeless young adults perceive the use of art as messages that can communicate the danger of initiating or continuing drug and alcohol use.

Objectives

The purpose of this study was to solicit perspectives of homeless drug-using young adults as to how art can be used to design messages for their peers about the danger of initiating or continuing drug and alcohol use.

Methods

Qualitative methodology via focus group discussions was utilized to engage 24 homeless young adults enrolled from a drop-in site in Santa Monica.

Results

The findings revealed support for a myriad of delivery styles, including in person communication, flyers, music, documentary film and creative writing. The young adults also provided insight into the importance of the thematic framework of messages. Such themes ranged from empowering and hopeful messages to those designed to scare young homeless adults into not experimenting with drugs.

Conclusions

The findings indicate that in addition to messages communicating the need to prevent or reduce drug and alcohol use, homeless young adults respond to messages that remind them of goals and dreams they once had for their future, and to content that is personal, real and truthful. . Our research indicates that messages that reinforce protective factors such as hope for the future and self-esteem may be as important to homeless young adults as information about the risks and consequences of drug use.

Introduction

Substance use is highly prevalent among homeless young adults. In a study of 620 homeless young adults living in the Los Angeles area, over two thirds reported use of alcohol (68.6%) and marijuana (67.8%) over the previous three months.¹ and high rates of amphetamine (35.7%), crack/cocaine (24.4%), and heroin (14.3%) use were particularly worrisome. Injection drug use was also reported by 41% in another study of 560 homeless young adults.² Some homeless young adults report that they use drugs to self medicate, as a way to cope with mental illness, as a social connection to peers, and/or escapism from the hardships of living on the streets.³

Art has been shown to be an empowering and engaging medium for communication of risk reduction messages with numerous benefits to vulnerable populations, including the homeless and adolescents. The use of art for health promotion has been shown to result in positive individual lifestyle changes as well as social, educational and economic benefits.⁴ Moreover, art therapy has been shown to be an effective means to help young people deal with challenges such as poverty, substance abuse and discrimination.⁵

Homeless youth and young adults often have irregular sleeping habits, poor dietary practices and may be chronically exposed to the elements; factors that can result in increased health problems.⁶ Additionally, emotional imbalances, substance use and unprotected sexual behaviors are more prevalent among these young adults than among their peers who live with a parent.⁶ Interventions designed to help homeless youth and young adults cope with physical and mental health challenges are highly warranted to prevent these young people from turning to substance abuse as a coping mechanism. The use of artistic media to create prevention messages is one method to provide support to at-risk homeless young adults.

The intent of this study is to elaborate on the evidence to date indicating that homeless young adults are interested in and benefit from art messaging. In particular, we solicited the opinions of homeless young adults as to how they believe the arts can be used to design drug and alcohol use prevention messages that would have relevance to their peers. Future research will be devoted to evaluating the efficacy of drug use prevention messages designed for homeless youth and young adults by their peers.

Use of Art in Health Promotion

Art therapy using creative approaches to explore emotions, thoughts and ideas has been used as a health promotion strategy since 1940⁷, and has been found to improve health status among homeless youth and young adults who experience substantial health disparities.⁸ In particular, art therapy has been shown to be effective in the management of drug abuse among women.⁹

The use of art as a medium to express thoughts and relay messages is gaining credence as an innovative health strategy to be used with homeless young adults. Homeless youth and young adults in particular report the use of art forms as a way to effectively communicate with their peers.¹⁰ While little is known about how homeless persons perceive the use of art to communicate the danger of initiating or continuing drug and alcohol use, young homeless participants contend that healthcare messages delivered in an artistic fashion would be appealing.¹¹

Art in the form of poetry, music, and dance was used to create a successful anti-drug campaign for Latino youth that resulted in reductions in risky behavior and a desire to serve as peer educators.¹² Music therapy (a form of creative arts) has been shown to promote engagement in therapy among young substance abusers.¹³ Rooting anti-risk messages in a culturally-familiar form has also been successful in the homeless youth population. In a study conducted with 600 homeless youth in Brazil, researchers found that games, plays, and dance in the national Capoeira form stimulated and internalized necessary HIV/AIDS education within the group,¹⁴ indicating that when the message was delivered in a popular and/or familiar form, it was quite powerful.

Methods

Design

This qualitative study was designed to gain an understanding of the subjective perceptions and experiences of 24 homeless young adults about ways to utilize the arts in creating powerful messages that could impact future engagement of homeless young adult peers to prevent drug and alcohol use. Qualitative approaches are best suited to understand the complexities of the lives of people as expressed by themselves naturally and within the context of their lives.¹⁵ The design of this study is strongly based upon Community Based Participatory Research (CBPR) paradigm, which relies on community participation for the design, implementation, and assessment of strategies for improving healthcare within communities.¹⁶ In this study, our community partnership consisted of the director and select staff of a drop-in site for homeless young adults, the research team and several homeless young adults.

A powerful tool in welcoming the perspectives of the targeted community, CBPR empowers all involved in tailoring intervention strategies.¹⁷ Focus groups are one approach wherein voices of the participants can be clearly heard. In our study, focus groups were used to engage homeless young adults in the formative study, and enable them to communicate their viewpoints and strategies for tailoring effective preventive messages.

Role of the Community Partners in the Study

CBPR approaches were established by first gaining the trust of the director of the community site, who in turn invested the time and energy to identify several young adults who were interested in participating as members of a Community Advisory Board (CAB). In addition, the director, the research team, and the homeless young adults invited by the director, collaborated with the Principal Investigator (PI) and the research team to conceptualize the study. Through these meetings, the concept of Art Messaging was formulated, which led to the current grant and subsequent funding.¹¹ The two homeless young adults who participated in the initial meetings with the director and the research team also assisted with the recruitment of other homeless young adults to participate in the CAB which has guided the researchers in conducting all aspects of the research as described below. The time period beginning with meetings with the director to the initiation of the CAB sessions was over nine months.

Community Advisory Board (CAB)

Consistent with CPPR approaches, a CAB was formed prior to the onset of the study. The CAB included 2 researchers, one young adult research assistant, 2 faculty of the California Institute of the Arts (CalArts), 4 homeless young adults (two African American women and a White and African American male) and 1 staff member from the homeless drop-in site where recruitment occurred. The homeless young adults were selected based upon their interest in assisting the researchers in providing the perspective of homeless young adults as it relates to life on the streets, substance use lifestyle, patterns of homelessness and their interest in providing perspectives about how art messaging can engage their peers in health promotion interventions.

The CAB guided the researchers in recruitment strategies, and discussed ways to gain the trust and interest of the young adults to enhance a willingness to participate in the study. The CAB also held an integral role in the development of recruitment materials. CAB members informed the timing for focus group interviews in the development of a Semi Structured Interview Guide (SSIG) (displayed in Table 1). The SSIG was used to capture the perspectives of a larger group of homeless young adults about ways to engage their peers via artistic media such as animation, video, drawings, poetry, etc.

TABLE 1.

Sample Questions from the Semi-Structured Interview Guide Related to Use of Art Messaging

• Please tell us what health services you have sought in the last few years?

• If you ever had a time when you had a health problem but did not seek care for it, what got in the way?

• What has helped you get care when you needed it?

• Do you think you or your friends would be willing to receive care at the shelter for general health problems?

• Do you think you or your friends would be willing to receive care at the shelter for drug-related problems?

• What are the advantages to receiving this care at the shelter?

• What are the disincentives to receiving this care at the shelter?

• How can the doctors and nurses at the shelter better enable you to access these services onsite or offsite?

• What are the important messages you would like to share with your peers who are homeless regarding the dangers of drug and alcohol use?

• What might be the best way to communicate these messages to you or to your friends?

• What are some ways that you or your friends can help health care providers develop health messages related to the dangers of drug and alcohol use and of HIV/AIDS?

• What are the creative ways that would be most appealing to homeless youth to create messages (such as poetry, music, drawing, etc.).

• How can artists and musicians better enable you to develop such messages?

More specifically, in the five CAB sessions held, discussions focused on current drug messaging campaigns and their acceptability for homeless young adults. The CAB collaborated on developing their own substance abuse prevention materials which featured colorful designs with a collage of words and pictures from printed materials such as magazines. The homeless young adults who participated in the CAB also assisted in the conduct of the focus groups and in helping to interpret findings. Their participation assisted the research staff in understanding the views of homeless young adults upon completion of the focus groups, and with interpretation of the focus group findings as it related to designing the future intervention study and best times for recruitment.

Setting and Participants

The qualitative study took place at a homeless drop-in site in Santa Monica that attracts many homeless youth and young adults by providing basic needs and health-related services. A total of 24 young adults participated in the focus group sessions. Among the 26 who were screened, two were not eligible because they never used illegal drugs. These young people were eligible if they were 15–25 years of age, self-reported as homeless and having used illegal drugs over the last 30 days. This age group was selected because the literature reveals the majority of this age group has already initiated substance use¹⁸ and therefore may provide insight as to how to prevent their younger peers from initiating drug use.

Procedure

As stated earlier, young adults were recruited to participate in the qualitative study with creative, colorful posters and flyers that were posted at the site. Young adults that were interested in participating were read an informed consent approved by the University Human Subjects Protection committee and were questioned by the research staff to confirm their understanding of the consent. When it was clear to the research staff that the young adults understood the consent form, they signed the consent form to indicate their interest in participating. Subsequently, a brief socio-demographic questionnaire was completed along with a brief screener developed by the research team that included questions about where the young adults had spent the previous night and recent drug use.

Five focus group sessions were then conducted with four to six young adults in each group. A total of 24 young adults participated in the focus groups. The setting was a large private room in the drop-in site. The focus groups, which each lasted one hour, were conducted with 1 to 2 researchers, 1 to 2 CalArts faculty, and 1 to 2 homeless young adults CAB members. One hour was the general attention span of these young persons and was a good ending point for the focus groups. All focus group conversation was tape-recorded, and our participants were able to create pseudonyms for confidentiality purposes. During the focus groups, one facilitator raised the questions detailed on the SSIG. Another facilitator was the scribe, noting any non-verbal dynamics or observations, while the other facilitators in the room contributed to the discussion by posing additional questions. The facilitators were trained extensively in the process of conducting focus group by the investigators. Cash payments of fifteen dollars were approved by the human subject committee as compensation for our participants' time. The homeless young adult CAB members provided assistance during data analysis as well. For example, as themes become apparent, they were discussed and clarified by our homeless young adult participants in the CAB before inclusion in the content analysis.

Content Analysis

The investigator oversaw transcription and content analysis of the focus group recordings. Content analysis was performed by trained research assistants using a set of techniques common to the practice which identify patterns, themes and categories in recorded language. Content analysis began with a line-by-line coding of all transcribed notes. Through this process, we identified common themes and categories. Comparisons were made within each focus group and across focus groups until the major themes were saturated and no new major themes arose.^19,20 The results of the content analyses were used to highlight homeless young adults' main perspectives and opinions and will guide future research with this population.

Participatory analysis of the study was achieved by discussing the findings of the focus group sessions with the members of the CAB, which included homeless young adults in an effort to seek their feedback²¹ and assure accurate interpretation of the data.²² An audit trail was also created by informing the CAB after each analysis session and documenting analytic decisions. The dependability of the data was confirmed by the SSIG, which relied equally on the input of the researchers and the CAB members.

Results

The majority of the participants were male (75%) and nearly evenly divided by ages of 17 and 20 and 21 and 25. The majority (63%) identified themselves as white, and fewer (21%) were black or Hispanic (13%). Ten participants received their high school diplomas, 5 had some college, and 1 completed a four-year college. One-third of the participants, however, did not finish high school.

The participants identified a number of ways in which messages could make a powerful impression on other homeless young adults who are at risk for or were already experimenting with drugs and alcohol. A variety of delivery styles were described which included person to person or mass media in the form of a films or documentaries, animation, music, flyers/ads and creative writing. The delivery style and the thematic feature or essence of the messages was equally important and diverse forms of the messages were proposed by the young adults. These messages ranged from empowering themes that were filled with hope to messages designed to scare homeless young adults into not experimenting with drugs. These participants also verbalized the importance of messages that were truthful; i.e., those that provided a personal connection to other homeless young persons, as well as messages that provided a commanding visual of what life is like living on the streets. A summary of the communication modalities proposed by the participants is presented in Table 2.

Table 2.

Most Frequently Mentioned Communication Modalities^a

Communication Modality	Sample Quote
Peer-to-Peer Contact	“Have them interview us…bring them to us…let us talk to them and let them know what drugs can do to them…”
Personal Testimony via Film or Documentary	“Show them how we behave, how we react toward one another…how crazy we are….if you showed them, they will be scared…”
Animation with Humor	“Let's put it like this. Have you seen the commercial … a, skydiver…..He's like “I'm way up there, I'm high.” And then the chute doesn't open. … but it's really a message, you know what I mean? Cuz you don't want to end up like the dude in the parachute. ”
Music	“I try to change the world with my music. I try to keep people out of gangs. I try to lead them away from drugs. I don't want them to make my mistakes, and that's why I'm doing [this]….”
Facts	“Maybe give them information about what drugs [do] to your body… and that 'Yes, Knowledge is power'.”
Creative Writing	Telling a story with the written word is what makes the message powerful. (paraphrased)

^aAs identified in content analysis of focus group discussions

Communication Modalities

Peer to Peer Contact

For a number of young adults, any way which presented the opportunity for a personal connection to their peers evoked a strong sentiment. One White male verbalized,

Have them interview us…bring them to us…let us talk to them and let them know what drugs can do to them…

An African American male expressed similar thoughts about the importance of talking with homeless young adults who were not yet negatively impacted by drugs. He agreed that by speaking with other homeless young persons face-to-face about the dangers of drugs was of crucial importance. His advice was that it was better to provide information about the dangers of specific drugs rather than state that “all drugs are bad… (as) it will make more of an impact.” This theme of peer to peer messaging resonated with a number of homeless young adult participants representing all races that wanted to inform younger adolescents not to make the same mistakes that they had made. A young African American woman expressed this succinctly,

Take them down to Skid Row and tell them everything that happens out there, let them see it for themselves. Once they see it, that will … ring…in their head…it hurts when you face the reality.

Two male young adults (one African American and one White participant) thought that it was equally important to show homeless young adults what a positive life would be like. As one of the young adults expressed, “If you take them around people who have a good life…drive a nice car, living a good life, having a good job, they are going to say, I want to be like that”. More importantly, these participants felt that reaching out to homeless peers who were young and impressionable was critical, especially when they are being exposed to crack cocaine. Having homeless young adults be more visible in public areas was considered important and for them to be ambassadors guiding the way for lost young homeless persons.

Personal Testimony via a Film or Documentary

While the participants involved in the study felt that the most influential communication of the drug use prevention message would occur through direct personal contact with young homeless persons, they realized that it was important to reach a wider audience of their peers as well. The participants felt that showing young people what life was really like as a homeless young adult was even more powerful than hearing their life experiences. One young adult expressed this recurring theme in the following words “….if you just tell them, they would say ….whatever…..[but] if you show them and catch their interest, it's going to catch on”. Many of the young adults strongly expressed their opinion that putting messages and emotions in pictures, such as films or documentaries, would get a reaction from the younger homeless persons and that intervention developers would listen.

Three homeless participants commented that showing impressionable homeless young persons how their behavior is impacted when high on drugs or alcohol could be a powerful deterrent. These images could be captured on film or TV ads. As one White female expressed, “show them how we behave, how we react toward one another…how crazy we are….if you showed them, they will be scared. If you filmed how we interact,…we are all f…crazy here…” A White male participant stated that homeless young adults also need to be made aware of the negative consequences of drugs; which are often made to sound very exciting or intriguing.

For a Hispanic male, film was a good vehicle to convey emotion. He said, “I believe that if you put messages and emotions in pictures, you will get yourself what you need….you get that reaction…”

Animation with humor

Several male participants thought that animation combined with humor would be an effective delivery style to reach other homeless peers. As one African American young adult explained,

Let's put it like this. Have you seen the commercial … a, skydiver….. He's like “I'm way up there, I'm high.” And then the chute doesn't open. … but it's really a message, you know what I mean? Cuz you don't want to end up like the dude in the parachute.

Music

All homeless young adults commented that music would make a great delivery style and as a Latino male articulated, “I'll take just the music, make it simple”. For one male young adult, music was more appealing than a lecture. To an African American male, music was part of a very important message.

I try to change the world with my music. I try to keep people out of gangs. I try to lead them away from drugs. I don't want them to make my mistakes, and that's why I'm doing [this]…. Don't be like me. Do as I say, not as I do.

In general, male and female participants favored a diversity of music, ranging from Mozart to Jimmy Hendrix to Mariah Carey. Some could not decide on a favorite whereas one participant related most to the songs of N.W.A. because of their messages about life on the streets.

Facts

For two White participants, factual information was still an important aspect of communication. As one of the young adults expressed “maybe give them information about what drugs [do] to your body… and that “Yes, Knowledge is power”. These young adults offered the opinion that facts about drug use could be provided in a number of ways, such as flyers, posters, ads, lectures.

Two African American male participants added that making flyers was a very good way to reach young peers. Having homeless young adults be more visible in public areas was considered important and for them to be ambassadors guiding the way for lost young homeless persons.

Creative Writing

A number of homeless participants, both male and female, felt that writing was an effective way to reach their homeless peers. As one Hispanic and one African American male participant revealed, it is the way that the message is written that is important. For a female African American participant, telling a story with the written word is what makes the message powerful rather than just conveying information.

Need for Connection in Messages

Make Messages Truthful and Personal

One young African American female commented that homeless young adults unfortunately believe that they can live forever, and that information about health risks is too often unheeded. For example, despite the fact that young adults see the images of the brain rotting away as “gross”, they continue to engage in risky drug behavior. For this woman and another African American male, they felt that the message should be personal, real, and truthful.

A number of homeless participants of all ethnicities believed that messages needed to be scary to convey the realities of homelessness to young adults not yet entrenched in this life, However, even a young woman who believed scaring people may have some benefits, she stated that ads/TV commercials that scared people did not work to help her quit smoking,

Like in elementary school, you see the signs like, “`don't smoke'…I have been smoking since I was twelve…you don't think about those health issues…

Hopeful Empowering Messages

Another segment of participants were more focused on trying to improve the lives of homeless young adults at the bottom of the drug scene. One young African American woman commented on the importance of reaching out to troubled homeless peers in a more personal manner,

I think you should make it more like a personal thing…everybody has goals and ambitions when they are young, no matter how old you get, you still remember those goals.

An African American male added a more concrete example for clarification,

Where do you see yourself in five years? Because usually when you ask people questions like that, they actually have to put thoughts into it, and once they are able to think about what they want to do…that really triggers them…

This same participant elaborated on why becoming too comfortable with being homeless was a problem, as the dreams that all young adults have can be thwarted. A Hispanic male participant thought it best to communicate to young homeless peers that “…this world is not for weak people…in this world you have to be strong…you have to be able to fight…you got to have that inner strength, and everybody has it…you just have to be able to use it.” The essence of his message was powerful in that while a drug-using homeless young person took the risk to try the drug, the more powerful message is “…why not take the risk to get out of it…it is all about you…you have to make that decision”.

Discussion

It is well established that art is a powerful medium with myriad abilities for personal and societal growth^5,12. Using subjective responses garnered through focus group sessions with 24 homeless young adults in Los Angeles, we explored various ways in which art could be used to create influential messages for their homeless peers. Our findings revealed that a multitude of promising messages could make a powerful impression on homeless young adults: the preferred formats for delivering said points included flyers, music, and documentary films. As homeless young persons are a varied and unique demographic^6,11,23, it is not surprising that our homeless young participants did not offer any single definitive medium to communicate. We believe that the findings show that homeless young adults support the use of artistic means to communicate health messages. While in contrast to most current media health campaigns,²⁴ using a diversity of methods and messages may yield more promising results in the reduction or cessation of risky substance-use behaviors by repeated reinforcement of the message through complementary media.

Despite the paucity of literature on the impact of art on the homeless young adult population, art has been used in many social movements as a vehicle for communicating with the greater good and for communicating within oneself.²⁵ Art holds the potential to bring forth suppressed dreams and aspirations, a reoccurring theme for the homeless young participants in the focus group sessions. Lack of hope has been associated with chronic addiction among drug users.²⁶ Fostering hope for a better life and confidence in their ability to change may be an important tool to prevent long term drug addiction among these young people who felt they would be more motivated to work towards a better life by inspiring motivational messages, something that artistic media can help create.

In this study, we learned that the intimacy of personal stories and the ability to learn from peers were critically important to homeless young adults. For some, making messages more personal would provide more powerful communication. Stevenson and Witte²⁷ found that empathy for other people's life circumstances and the need for personal connection effectively promoted more positive outcomes among homeless young adults attending drug treatment programs.²⁸

In addition to visual media, music was important to these young adults and could play an important role in future substance abuse prevention campaign by evoking an emotional response. Previous studies reveal that music has served as a common ground and a way to connect on a more personal level and bond with peers among homeless young persons²⁹ While our findings revealed that a variety of styles of music were enjoyed by all ages of our participants, this diverse taste in music is not uncommon, as young adults use music in different ways to satisfy different emotional or developmental needs and to reflect specific issues they are coping with.³⁰

Our homeless participants also thought creative writing was a way to communicate with other homeless young peers about drug and alcohol use. Poetry and other creative writing serves as a way for others to tap into young adults' inner conflicts and angst.³¹ Homeless participants stressed that writing that was evocative and filled with emotion had the power to speak to them. Providing a forum for young homeless adults to share their life stories, thoughts and dreams could be a cathartic and introspective experience for the homeless youth, while at the same time providing a young adult at high risk for homelessness and/or substance abuse a realistic image of the lifestyle. Reading these young people's experiences in their own words strips away the glamour of using drugs and running away, while at the same time fostering empathy for their for their situation and a better understanding of the circumstances and the choices that led them there.

The homeless young adults who participated in the focus groups had opinions about the tone of the messages as well. They discussed how provocative messages might be used to rouse homeless peers who are at risk or are already influenced by the power of drugs and alcohol to change their dangerous lifestyles. Some felt that scare tactics might be useful, while others did not support the use of scare tactics. Scare tactics designed to promote behavior change have generally had mixed results and have not gained universal acceptance.²⁷ Others among the homeless young adults felt that the most effective prevention messages would tap into suppressed dreams and aspirations with messages that were hopeful and empowering.

Limitations

Limitations include a sample that was recruited from a single geographical location. Furthermore, West coast perspective may vary widely from homeless young adults in other geographical areas. While our study is also limited by the fact that our population is primarily white, it does reflect the ethnicity of the population served at the recruitment site selected.

Implications for Research and Practice

It is hoped that the contributions by these young people to this study will result in more effective and meaningful substance abuse prevention messages for them as well as for their younger peers on the cusp of initiating substance use. Important considerations concerning the most effective forms of media, the tone and the content of messages have been presented here. We have been inspired by these young people's optimism and perseverance in the face of difficult circumstances and hope that future interventions with this population, including a second phase of this study, can adequately incorporate the valuable information they have shared with us.

The Phase II research that is planned includes the implementation of an art-focused intervention to empower homeless young adults to create artistic messages that would guide decision-making about drug and alcohol use. Based upon the findings of our study, it is clear that a variety of modalities of communication may be impactful and ongoing dialogue with CAB members would be fruitful to determine how to best synthesize the varied forms of communication. Moreover, ongoing research is needed to determine the power that varying modalities of interactive communication has on curbing the desire to engage in or reduce the grip that drug and alcohol use has on homeless young adults. Ongoing research needs to be conducted to clarify how the sharing of the personal failures and triumphs of homeless young adults can result in a renewed strength and hope for the future and yearning for fulfilling one's dreams. These projects need to be designed and evaluated, not only to help those individuals engaged in adverse behaviors, but also to develop awareness throughout communities concerning the many problems that face homeless young adults.³²

Our findings also have specific implications for healthcare providers such as physicians and nurses. Reading and writing poetry has been found to help physicians become more effective providers by enhancing empathy, and compassion.³³ Given the benefits described above, it would seem possible that physicians could incorporate creative interventions (i.e., poetry, music, art) into the practice of medicine, thereby improving communication with patients. It has been suggested that arts should be integrated into the practice of nursing because creative arts interventions shorten hospital stays and reduce the need for pain medication among patients.³⁴ We believe that, based on the evidence to date, and the input provided by participants in our study; future studies of the effect of art messaging among homeless young adults are highly warranted.

Conclusions

Artistic messages are considered by homeless young adults as an effective media in advocating knowledgeable and safe decision-making and inspiring the ability to dream and seek lifestyle goals that have been long forgotten. Art may also serve as kindling for the creative process that is able to absorb the attention of homeless young adults and focus their energies into a positive, life affirming experience.³⁵ As such, art may be an attractive alternative for improving the lives of homeless, drug-using young adults. More research is needed to assess the efficacy of art messages designed to prevent or reduce drug and alcohol use. We also need to know more in terms of how art can protect homeless young adults from continuing into a downward spiral by clarification of their dreams, development of identity, and fostering of communication and creative skills.