Social and Structural Barriers to Housing Among Street-Involved Youth Who Use Illicit Drugs

Abstract

In Canada, approximately 150,000 youth live on the street. Street-involvement and homelessness have been associated with various health risks, including increased substance use, blood-borne infections, and sexually transmitted diseases. We undertook a qualitative study to better understand the social and structural barriers street-involved youth who use illicit drugs encounter when seeking housing. We conducted 38 semi-structured interviews with street-involved youth in Vancouver, Canada from May to October 2008. Interviewees were recruited from the At-risk Youth Study (ARYS) cohort, which follows youth aged 14 to 26 who have experience with illicit drug use. All interviews were thematically analyzed, with particular emphasis on participants' perspectives regarding their housing situation and their experiences seeking housing. Many street-involved youth reported feeling unsupported in their efforts to find housing. For the majority of youth, existing abstinence-focused shelters did not constitute a viable option and, as a result, many felt excluded from these facilities. Many youth identified inflexible shelter rules and a lack of privacy as outweighing the benefits of sleeping indoors. Single-room occupancy hotels (SROs) were reported to be the only affordable housing options, since many landlords would not to rent to youth on welfare. Many youth reported resisting moving to SROs as they viewed them as unsafe and as giving up hope for a return to mainstream society. The findings of the present study shed light on the social and structural barriers street-involved youth face in attaining housing and challenge the popular view of youth homelessness constituting a life-style choice. Our findings point to the need for housing strategies that include safe, low threshold, harm reduction focused housing options for youth who engage in illicit substance use.

Introduction

In an increasingly urbanized world, youth who live, work, or spend much of their time on the streets, constitute a growing global concern (UN, 2008). In the United States there are approximately 1 million street-involved youth (Shane, 1996, Ringwalt et al., 1998), and Canadian reports suggest that around 150,000 youth are living on the street in Canadian communities (DeMatteo et al., 1999). Compared to the general age matched population, street-involved youth face an 8 to 11 times higher risk of mortality (Roy et al., 2004). Street involvement, homelessness, and unstable housing have been associated with various risks among youth, including increased levels of alcohol and substance use (Wood et al., 2006, Kral et al., 1997), injection drug use (Roy et al., 2004), and increased risk of blood-borne infections (Friedman et al., 1997, Strathdee et al., 1997), sexually transmitted diseases (Friedman et al., 1997, Shields et al., 2004) and increased exposure to violence (Kipke et al., 1997, Rachlis et al., 2009, Whitbeck et al., 1997). These risks are further exacerbated by the fact that street-involved youth face a myriad of barriers in accessing health and social services, such as difficulty trusting adult service providers, fear of discrimination, fear concerning confidentiality, lack of personal identification, (Geber, 1997) and a reluctance to access services that are geared towards homeless adults (Ensign & Gittelsohn, 1998).

While some of the barriers to care and support that street-involved youth face have been identified previously, the social and structural barriers drug using street-involved youth face when seeking housing have not been thoroughly investigated. Therefore, we undertook this qualitative study to examine the social and structural barriers street-involved youth who use illicit substances encounter when seeking housing.

Methods

We drew upon data from 38 in-depth, semi-structured qualitative interviews conducted from May to October 2008 in Vancouver, Canada. Interviewees were recruited from the At-risk Youth Study (ARYS) cohort, which was initiated in 2005, and involves the ongoing follow up of over 500 youth aged 14 to 26 who have experience with illicit drug use other than marijuana (Wood et al., 2006). Participants for qualitative interviews were selected on a daily basis from persons attending the research office for their semi-annual quantitative cohort interviews. Sampling for the qualitative study aimed to attain variation in gender, ethnicity and age, to reflect the socio-demographic profile of the ARYS cohort. None of the ARYS participants who were offered to participate in the present qualitative study refused participation and there were no drop outs during the interview process.

Interviews were conducted by three interviewers (two female and one male) with extensive experience in qualitative interviewing. All interviews were conducted at the study office, which is located in Vancouver's Downtown South, an area where many street-involved youth congregate and spend much of their time. The Downtown South is a residential and entertainment district characterized by both high- and (limited) low-income housing and numerous businesses. In addition to research services, the study office also offers daily drop-in hours during which coffee is served and youth can make use of two one-site computers. All interviewers are well known among the study participants due to their frequent interactions with many of the youth during drop-in hours. The supportive presence of study staff in the street youth community and the pre-existing relationships with many of the research participants facilitated rapport between the youth and interviewers during the qualitative interviews. All interviews were facilitated through the use of a topic guide encouraging broad discussion related to participants' substance use, their daily activities, their current housing situation, their experiences with social and health care services and their experiences with seeking housing.

Interviews lasted between 30 and 120 minutes and were tape-recorded, transcribed verbatim and checked for accuracy. The thematic categorization of the interview transcripts was facilitated by the use of ATLAS.TI. Interview data was initially coded based on key themes. Substantive codes were then applied to categories/themes based on the initial codes. The research team discussed the content of the interviews throughout the data collection and analysis processes, thus informing the focus and direction of subsequent interviews (e.g., through the addition of new questions and probes), as well as developing and refining a coding scheme for partitioning the data categorically.

All participants provided written informed consent for participation and were remunerated with Can$ 20. The study was conducted with the appropriate approval of the Providence Health Care/University of British Columbia Research Ethics Board. There were no refusals of the offer to participate in the interview, and no dropouts occurred during the interview process.

Results

Sample Characteristics

The sample of 38 qualitative interview participants was composed of 18 women, 18 men and 2 transgender individuals. At the time of the interview, 20 participants were homeless, 13 lived in single-room occupancy hotels (SROs), two participants stayed at a shelter, two participants rented a private apartment, one participant stayed with parents and one was staying in a group home. Sixty-seven percent of study participants were Caucasian, 28 percent self-identified as being of Aboriginal descent, and 5 percent were African Canadian. The age of participants ranged from 16 years to 26 years. The median age was 22.

Nobody's there to help

Participants highlighted a multitude of social and structural barriers in their efforts to attain housing. On the structural level, many youth reported a lack of formal support in trying to attain a safe place to live. Numerous youth emphasized their struggles navigating the bureaucratic welfare and housing system and many felt unsupported in their quest to find stable housing. Over time, many participants appeared to lose confidence that they would be able to attain a safe and stable place to live.

Nobody's there to help. There's no housing workers anymore. X [local youth service site] did have housing workers, and a month and a half later, they got pulled. So it was like, pointless! I lose confidence that I'm getting anywhere. (Female Participant #7)

I've never been on welfare. I went there to apply, and they just, I think that they know I don't know what I'm doing, and they just sloughed me off. It's not like I've been in the system for fuckin' ten years and be, like, no, you can't do this, cause I don't know. They said I have to prove that I had no source of income for the past two years. Like, I have to get my criminal record here. But it's impossible. I have a warrant back home [in another Canadian Province] and shit like that, I called my lawyer, but he's a fall down, so. (Male Participant #32)

Shelters - It's like the worst of both worlds

Youth's reports indicated that the overregulation of government-sponsored shelters constituted a significant structural barrier to accessing a safe place to sleep. Only two participants had stayed at a youth shelter at the time of the interview. Without exception, youth viewed the support offered by shelters as inadequate and unsuitable for them. While for many participants, in particular for female youth, having a safe place to sleep constituted a main priority in their lives, the highly regulated and institutional environment of shelters constituted a substantial structural barrier for youth since it failed to accommodate the current reality of their street life and substance use. For many youth, the benefits of sleeping indoors were outweighed by the lack of autonomy and privacy and by the strict rules and regulations shelters impose on their lives.

I hate the shelters. It's like the worst of both worlds. You get all the negative aspects of being a street kid and you get all the negative aspects of being inside. You've got to go to bed early, you have all these chores, you don't get any privacy, the showers and the food sucks. Everything sucks about it. (Male Participant #27)

In emphasizing the institutional character of the shelter settings, some youth drew a parallel between their experiences of shelters and of correctional facilities. Being under constant observation, obeying a rigidly enforced set of rules and having only restricted access to the facility constituted substantial barriers for many of the youth. As a result, despite the reported downsides of sleeping outdoors, such as a lack of safety, health concerns, constant exposure to the drug trade and exposure to the elements, staying at a shelter did not constitute a desirable alternative to sleeping outdoors for many youth.

I can't really stay in shelters and shit ‘cause of all that jail time, so it's like, an institution to me, that's the way I see it. And I like, fuckin’ wig out so I can't go to places like that…I've done about five or six years, that's where I grew up… And I can't really stay there ‘cause it's like, I don't know, I gotta buzz this thing to get in this door and shit like that. It's like, I feel trapped type deal, you know? (Male Participant #32)

For most youth, the zero tolerance policy regarding alcohol and substance use at youth shelters constituted an important barrier to obtaining temporary indoor shelter and building trusting relationships with service providers. Many youth described situations when they were excluded from youth shelters on the suspicion of being intoxicated. Youth highlighted the inappropriateness of a zero tolerance policy in the context of other shelter rules that they viewed as out of place, such as no swearing, an 11 o'clock curfew and severe restrictions on what TV programs they are allowed to view. For many, not being able or willing to comply with the strict rules of the shelter environment negatively impacted upon their belief that an exit from street life is indeed a possibility. These conditions were said to give rise to strained relationships with service providers and continuous rejection from facilities, resulting in youth cycling through the system, and ending up on the streets once more. As such, participants' accounts highlight that the restrictive environments at youth shelters constitute substantial structural and social barriers for youth trying to access a safe place to sleep and/or attempting to transition out of street life via the shelter system.

X [main local youth shelter] is a really strict program….It sucked. You're not allowed to swear, you're not allowed to watch anything that's more than PG-13, you have to be in bed by 11…You're not allowed in there during the day. You're not allowed to do any drugs or else you're instantly booted. Every time you walk in the door, they give you a bunch of tests and stuff. If they even suspect you're high, they take you into the back room for like 20 minutes and give you a bunch of tests. I can't stand doing that. It feels like jail…I can't handle rules, that's why I live outside… I've given up on that kind of stuff. I've been pretty depressed. (Male Participant #25)

While youth criticised the strict rules and regulation enforced in youth shelters, the majority of youth had not accessed any of the adult-focused homeless shelters, as they viewed themselves as distinct from more street-entrenched homeless adults.

It's hard to get a place, especially if you're on welfare

Another housing option theoretically available and much desired by street-involved youth is privately owned apartments. At the time of interview two participants were living independently in an apartment. Securing an apartment appears to be the housing option that is most difficult to attain due to structural constraints such as insufficient welfare payments, high rent costs and damage deposits, as well as significant social barriers such as discrimination against youth on income assistance. Many youth reported experiencing severe discrimination when trying to rent an apartment and expressed disillusionment with regards to ever finding a place of their own.

It's hard to get a place, especially if you're on welfare. You don't get that much money on welfare. So it's hard to find a place. Who will rent to younger people, because they don't trust them. They think, they're gonna ruin the place and that they're gonna party too much, or that they're gonna use drugs there…It's so hard, I don't even try any more. So I can't even get a place, and I get money from welfare to get a place. (Female Participant #1)

I want to get a place. Anywhere, I don't care. There's no one that'll actually do that because everyone in this city knows us, we're labelled. They don't want us in their store, near their store, in the coffee shop, near the coffee shop washroom, near any washroom for that matter. It's harsh. I don't know if I can handle the streets anymore. It's really breaking me down. (Male Participant #28)

It's damn near impossible to find a place when you're on welfare. No one wants to sign my fucking intent to rent form, except for crack hotels. You can't get a normal room in a place with one of those because people go, “Oh this guy's on welfare. He doesn't work. He's going to steal my stuff. He's going to do nothing but cause trouble.” They automatically assume all these things. (Male Participant #25)

I don't want to be one of those people living in a crack hotel

Due to their affordability and relative ease of access, many street-involved youth described SROs as their only independent housing option. Thirteen of the youth in our sample were living at an SRO at the time of the interview. Many youth who had stayed at SROs reported derelict and unhygienic living conditions, marked by inadequate sanitary facilities, and insect and rodent infestation. Participants reported several environmental and social barriers to living in SROs, including feeling unsafe in these living environments due to intense drug consumption, continued exposure to drug trade-related violence and fear of being taken advantage of by older, more experienced residents. In contrast to the zero tolerance shelter environments, drug use was described as a ubiquitous feature of SRO living environments. While youth harshly criticized the zero tolerance policy enforced in many youth shelters, youth described the unconcealed drug use at many of the SROs as contributing to a chaotic and somewhat menacing environment.

It's fucking gross. It was just like a lot of junkies, crackheads and cockroaches and mice…People want to rob you. It's unsafe there. Police were coming in, you could hear the cops, like, always in the building…You could hear people smashing each other out, fighting, screaming and flailing through the halls and knocking on your door in the middle of the night. (Female Participant #35)

The last place [SRO] I lived in, when I moved in, I had to put big bolts through the door frame just so the door would close because it's been kicked in, maybe a dozen times prior to me moving in. Everything there, the security guards there are all on the sly. There's no doubt in my mind that if I gave them twenty bucks I could walk upstairs and beat the crap out of anybody I wanted. And it's just run like that. You feel it, you know? You live there, you know what's going on. (Male Participant #27)

Further, many youth viewed a move into an SRO as ‘giving up’ on potential future reintegration into mainstream society and as setting themselves up for a lifetime of poverty and substance use. Consequently, moving into an SRO did not constitute a suitable housing option for many youth.

I don't think I'm ready to [move into an SRO], I don't want to let go of the idea that I might actually have a life. I want to go to college. I want to be a social worker. I want to be an alcohol counsellor. That's all I want to do with my life. And I'm so close to giving up on that, but I don't want to. I don't want to be one of those people living in one of those crack hotels, shooting up dope. I don't want to spend the rest of my life like that. (Male Participant #25)

Discussion

The results of this analysis indicate that street-involved youth who use illicit substances experience a wide range of social and structural barriers when seeking shelter and housing. Structural barriers commonly experienced by street-involved youth include a lack of formal support in securing housing and appropriate income support, as well as barriers related to overly restrictive and abstinence-based shelters. Youth also reported social barriers, such as a lack of trust between shelter staff and youth, as well as discrimination when seeking more permanent housing. As a result of such challenges, some youth relied on single-room occupancy hotels (SROs) for temporary shelter, although residing in such accommodations was viewed as dangerous and as ‘giving up hope’ for a return to mainstream society.

Consistent with previous work from the US (Carlson et al., 2006), the vast majority of youth reported an intention to leave street life and find a stable place to live. As such the results of this analysis challenge the popular view of youth homelessness as constituting a life-style choice and highlight the social and structural barriers street-involved youth face in attaining safe housing. In line with reports from other settings (Kidd, 2003, Turnbull et al., 2007), youth expressed frustration and mistrust in navigating the bureaucratic welfare and housing support systems. Many youth also reported that, in addition to a perceived lack of support by service providers, low welfare payments and high rent costs constituted significant structural barriers in finding a stable place to live (Daiski, 2007). Several youth drew a direct connection between funding cuts for youth services and reduced support in finding a stable place to live (Frankish et al., 2005, Muckle &Turnbull, 2006). Resonating with previous work, which highlighted the suspicion and rejection street-involved youth face when attempting to move away from their street life toward employment and a more mainstream existence (Daiski, 2007, Haldenby et al., 2007), numerous youth highlighted how landlords' reluctance to rent to young people on welfare constituted a significant social barrier to attaining independent living. The conceptualization of street-involvement and substance use, as the result of moral deviance and repeated bad choices at the individual level, continues to be highly prevalent internationally (Baumohl, 2003) and amplifies the social exclusion and disadvantage street-involved youth face in their quest for housing.

Complementing previous reports which identified low rates of shelter use among street-involved youth (Carlson et al., 2006), our findings shed light on some of the reasons behind street-involved youth's avoidance of shelters. Consistent with previous work from various settings, our findings indicate that a lack of privacy, fear of violence (Daiski, 2007, De Rosa et al., 1999, Frankish et al., 2005) and difficulties to abide by strict shelter rules (Daiski, 2007, Feldmann & Middleman, 2003) constitute significant barriers to attaining temporary shelter among street-involved youth. To date, there has been limited consideration of the impact of zero tolerance approaches to alcohol and substance use on access to youth shelters. Our findings indicate that a zero tolerance approach to substance use and the possibility of losing one's bed, even on the suspicion of being intoxicated, severely restricts access to youth shelters for the majority of youth in our setting, where substance use is highly prevalent among street-involved youth (Wood et al., 2006). Youth reports indicated that staff's constant suspicion regarding intoxication also constituted a significant social barrier to forging trusting relationships. This is problematic given that a primary function of youth shelters should be to support youth in connecting with more permanent housing arrangements (Daiski, 2007, Miller and Keys, 2001). Trusting relationships with staff are instrumental in achieving this goal (Karabanow, 2008); however, the constant threat of being banned from shelters can undermine youth's openness and trust (Miller and Keys, 2001). For many street-involved youth, trusting adults is very difficult as many harbour feelings of victimization and exploitation from their previous relations with caregivers (Feldmann and Middleman, 2003). A negative view of the help available and repeated failure in attempting to attain support may contribute to youth's hopelessness in connecting with services (Kidd, 2003, Miller and Keys, 2001).

In line with previous research reporting limited use of services targeting adults (Ensign, 2004, Ensign & Gittelsohn, 1998), the youth in our sample did not access adult homeless shelters, as they view their street-involvement as less permanent and distinct from homeless adults, who youth described as more street entrenched and hopeless. Similarly, despite their affordability, the majority of youth did not view SROs as a viable housing option. Many expressed feeling unsafe in these often unstable environments, which were characterized by drug trade violence and open drug use. Youth viewed themselves as distinct from adult SRO residents, which some referred to as “bin divers”, “junkies” and “bums” (Ensign & Gittelsohn, 1998). Consequently, some youth resisted these labels by avoiding SROs, as these “junkie” spaces (Malins et al., 2006) are often viewed as sites of hopelessness and last reserve (Rew, 2008). These findings collectively shed light to the intrinsic relationship between youth identity, housing, and hope (Rew, 2008).

Our findings indicate that the majority of youth in the present study remained homeless or marginally housed in the absence of viable housing alternatives. Our study further highlights the need for well resourced youth housing services (Muckle & Turnbull, 2006) that include safe low threshold harm reduction focused housing, with a minimal number of expectations placed on residents. Low threshold services have the potential to allow youth to move towards a reduction in their drug use (Slesnick et al., 2008), and potentially abstinence, at their own pace while securely housed and removed from the risks associated with homelessness, unstable housing (Kral et al., 1997, Roy et al., 2004, Shields et al., 2004, Wood et al., 2006) and SRO environments (Evans & Strathdee, 2006). This call resonates with findings from Australia and the US that indicated a strong positive relationship between quality of accommodations for street-involved youth and a reduction in HIV risk behaviours (Milburn, 2007) and substance use (Slesnick et al., 2008). While a harm reduction approach to housing is slowly becoming more widely accepted among services targeting marginally housed adults (Evans & Strathdee, 2006, Tsemberis, Gulclur, & Nakae, 2004), it appears to still be more controversial in the context of youth services internationally (Slesnick et al., 2008, Milburn et al., 2008). There is an urgent need for research documenting the effects of low threshold, harm reduction based housing for street-involved youth on youth's substance use patterns, health outcomes and abilities to exit from street life.

The present study has a number of limitations. There is a possibility that the views represented in our sample are not entirely representative of the views of the larger street youth community in our setting. Specifically, it may be the case that our sample included the most high risk youth. This study focused exclusively on the views of youth who have a history of illicit drug use. Therefore, the views of street-involved youth who do not use illicit substances are not represented in this study. Additionally, this study focuses on the housing/shelter situation for street-involved youth in Vancouver, Canada; the barriers to housing may differ somewhat in other settings internationally. However, as outlined above, youth report difficulty accessing bureaucratic welfare systems in diverse settings internationally (Daiski, 2007, Milburn et al., 2007), and highly regulated housing programs enforcing a zero-tolerance approach to substance use are the norm in many countries (Daiski, 2007, Feldmann & Middleman, 2003, Milburn et al., 2007). As such, our findings have direct implications for youth housing programs internationally by highlighting the importance of low-threshold housing programs.

In summary, the findings of our study highlight the many social and structural barriers street-involved youth face in seeking shelter and housing, including structural barriers related to services and support systems, as well as social barriers experienced in seeking more permanent accommodations. Our findings point to the need for housing strategies that include safe, low threshold, harm reduction focused housing options for street-involved youth who engage in illicit substance use.