JOURNAL
OF ADOLESCE;\PT
e Local Government DAWN
HI. SMART,
‘HEALTH
1991;92:519-527
Level
M.S.
Young people leave home for many reasons-a push away from problems, a pull toward the independence and seeming excitement of the street. Once on the street they face serious risks to their health and well-being. Homelessness among youths is a concern in Seattle, with as many as 2,000 on the skreet in a year’s time. The service system is overburdened and poorly coordinated. The City of Seattle examined the problem, inadequacies of the service system, and issues affecting its ability to address the needs of homeless youths and their families. This article presents data on the problem, policies proposed to shape the city’s response, and progress made in the last 2 years.
The information was to help guide decision making about support for and involvement in services to homeless youth. The effort resulted in the development of a policy framework, recommended goals and strategies, and options for new initiatives the city could pursue. This article summarizes the information gathered, providing a picture of the needs of homeless youth and of the system that serves them. It highlights some of the issues facing Se.jttle and city government. It concludes with a descn &m of recent progress made in addressing the n%z!c “1,‘ of homeless youths and their bmilies in Seattle.
KEY WORDS:
Homeles- .outh Street youth Planning and policy In 1988, the Seattle City Council adopted a Policy Plan for Children and Youth that outlines a priority for local government efforts on behalf of homeless youths and their families (1). Shortly thereafter, the city’s Human Services Strategic Planning Office made an assessment of homeless youth in Seattle and the city’s role, progmmming, and capacity to address their needs. Data were gathered from existing sources: literature review, local monitoring, and interviews with service providers, law enforcement agencies, and program funders.
From the City of Seattle, Hutnnn Services Strategic Planning OfFce, Seattle. Wmhingfon. Address rep&t requests to: Dawn H. Smart, MS., City of Seattle, Human Services Strategic Planninn Office. 628 Secund Auenue #2350, Seattle, WA 98104. ” ” ” Manuscript accepted November 20, 1990.
The Problem King County, in which Seattle is located, had an estimated population of 180,535 youths between the ages of 10 and 19 years in 1985. Of this number, approximately 47,000 were estimated to live in Seattle (Office of Long Range Planning, unpublished data). The King County Sheriff’s Office receives reports of more than 5,000 runaways each year. Many of these children and youths are found quickly or return home on their own within a short time. Over 2,000 cases in King County, hewever, are assigned to sheriff’s officers for follow-up each year (King County Sheriff’s Office, unpublished data). In 1988, the Seattle Police Department’s Community Service Officer Unit received calls and dispatched officers in 4,200 runaway-related incidents (Seattle Police Department, unpublished data). In 1985, there was a study of 640 youth in King County who were determined io be “absent from their legal resi&l,ce” during a 1Zmonth period. According to the report, the average age for girls was
8 Society for Adolescent Medicine, 1941 Published by Elaevier Science Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010
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SMART
15.6 years and for boys 16.2 years. Of the youths, 54% were male and 46% female; 58% were White, 18% Native American, 9% African-American, 4% Samoan, 4% Hispanic, and 3% Asian. More than onehalf of the youths reported a history of physical or sexual abuse. More than one-half had dropped out of or been suspended from school. According to the report, 63% were involved with drugs or alcohol, and 43% had been involved with the juvenile justice system 0). Agencies serving runaway youth report that as many as 800 youths are on the streets in Seattle on a regular basis and up to 2,000 are believed to be involved in street life at some point during the year. The majority can be found in the downtown area, but other neighborhoods in Seattle report increasing numbers of youths who are “hanging out” and appear to be on their own or homeless. Two locally conducted studies in 1985 provide a picture of youth using emergerq services in Seattle. They ranged in age from 10 to 22 years, with a meFigure 1. Client characteristics in homeless youth programs, 1988.
dian age of 17 years. Over one-third had a history of physical or sexual abuse. The majority had dropped out of or been suspended from school, and less than 20% were employed. Of the youths, 4O60% reported substance abuse problems and 50-60% had juvenile offense records (Seattle Youth and Community Services and United Indians of All Tribes Foundation, unpublished data). Caseload data (Figure 1) show the characteristics of more than 860 youths receiving services in 1988 from runaway and street youth programs in Ring County. Shelter 1 is an emergency housing program for youths under age 18 years and shelter 2 is a transitional housing program for young adults age 18 years and over. Drop-in center 1 is located in downtown Seattle and drop-in center 2 in SeattIe’s University District. Ring County Programs are three nonshelter facilities that provide crisis intervention, counseling, and support services in King County, outside the Seattle city limits (Ring County Department of Human Resources, unpublished data). Data from the larger, adult-focused shelter network in Seattle provide a duplicated count of young adults between the ages of 18 and 24 years who use
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HOMELESS YOUTH PLANNING
emergency facilities (i.e., individuals are likely to have used a shelter more than once during the year or may have used more than one shelter). Over 488 young adults between the ages of 18 and 20 years and almost 1,400 between the ages of 21 and 24 years were counted in community shelters supported by the City of Seattle during 1988. A small number of them may have been members of families receiving shelter and services (I-Iuman Services Strategic Planning Office, unpublished data). Seattle’s project for Health Care Zor the Homeless (HCH) provides further information about the youth on Seattle’s streets and their health care problems. Funded by the Robert Wood )‘ohnson/Pew Memorial Trust Foundation and the Stewart B. McIGnney Homeless Assistance Act, HCH provides assessment and screening, nursing care, mental health and substance abuse counseling, and referral and followup. Six hundred fifty-three youth and young adults were served by the project, with 2,730 visits in the first 2 years of operation. The youth ranged in age from I2 to 24 years, with an average age of 18 years. Males were represented in all age categories, while 10011
Gender
AND POLICY
521
females between 15 and 18 years of age were more frequently seen. Approximately 65% of those served were white and 35% minority. The ethnic distribution of clients (Figure 2) is similar to the overall ethnic distribution of Seattle’s population (according to a I987 estimate by the Washington State Office of Financial Management): White (67%), AfricanAmerican (9.9%), Asian/Pacific Islander (9.2%), Hispanic (3.5%), and Native American (P.4%). Of those youth reporting their housing status, approximately 36% were living with friends or relatives; 24%’ on the street; 15% in a shelter, temporary or transitional housing; and 5% in an institutional setting. Of the young clients in the HCI-I project, 70% or 460, were seen for acute medical problems in 1,172 visits (Figure 3); 46% of the clients had chronic mental health problems, 37% had drug problems, 27% had alcohol problems, and over 15% of the young women were pregnant.
Figure 2. Health Care for the Homelas project clients, 1988-l 9f9.
thnicity 7on
60%
80% 60%
eon -
4on 301 20% 101 011
407
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Housing Status
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322
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Acute Illness Pregnancy Meatal Health or;ga Alcohol 0
200
400
800
600
Vielts (2730)
1200
1000
1400
RBY Clients (653)
F@ure 3. NtwtthCare/or Be Homelessprojectdients, visits, and problems, 1988-1989.
The Service System In 1977, Washington’s juvenile Code was changed with regard to the legal disposition of youths involved in curfew, truancy, runaway, and other status offenses. With the change to decriminalize the offenses, responsibility for these youth shifted from the juvenile justice to the child welfare system. The Washington Department of Social and Health Services (DSHS) was charged with administering most services for homeless youth. The shift in responsibility, however, was not accompanied by adequate state resources for the new system. Homeless youth services are funded by several sources besides state government, including federal, county, and city governments, United Way, foundations, and private donations. The City of Seattle plays a minor funding role, but allocates Community Development Block Grant and General Fund dollars to a number of programs that serve homeless youth. These include drop-in centers, shelters and transitional housing programs, health services, and training and employment. The continuum of care for homeless youth includes preventive and early intervention efforts, emergency assistance, stabilization, an.d transitional services (Figure 4).
Prevention
and Early Intervention
The earliest possible intervention for runaway youths appears to provide the best hope of interrupting a runaway episode. Three aspects of homelessness among youths and their progress toward self-sufficiency provide a strong case for early intervention. Street youths who have been on the street for a shorter length of .time have a better chance of making a successful transition off the street. Those who are older at their first street involvement and have lived with families for a longer period have an easier time getting off the street. Those who have been less severely abused or neglected alsa do better with the transition (3). One can assume that family conflict resolution and prevention focused on family violence, child abuse, and alcohol and drug abuse of parents and youths would have a positive effect, reducing runaway behavior. Research on family strengthening and support is limited, but positive outcomes have been shown in family-based intervention and parenting education programs. Developing the communication and problem-solving skills among family members appears to be beneficial, particularly for families with adolescents. Home-based, intensive family intervention services have a positive record of success in resolving or reducing family conflict. They are useful in lessening runaway behavior among youths whose families participated in these programs (4-6). Intensive family intervention services are av& able on a very limited basis in Washington State.
HOMELESS YOUTH PLANNING AND POLICY
November 1991
amily or individual p
Prevention ---I Early
Community Agencies
In~&ntion Seattle Police Department Community Service Officer ‘Unit
Emergency
Seattle Police Department Pae~oi and CSO Unit DSHS’ Crisis Residential Centers Community Drop In Centers Community Shelter Facilities
Stabilization
Community Agencies & Shelters DSHS’ Foster and Group Care Homes King Coun@ Department of Youth Setices Health Care for the Homeless Alcohol/Drug Abuse Treatment Schools & Employment Programs
Transifion
Community Agencies Transitional Housing
Assistance
They reach only those in imminent danger of outof-home placement of children-in a 12-month period in 1988 and 1989, just 1,449 families participated in Family Reconciliation Services and under l$O were involved in the more intensive Horneb~~tide~s program in King County (City of Seattle Human S&vices Strategic Planning Office, unpublished ,Jata). Emergemy Assistance and
using Optiwns
Emergency assistance includes food, shelkr, health care, and crisis intervention services. These are provided in Seattle by a small number of agencies and through their connections to the state-operated child welfare system. Emergency shelter and attention to immediate needs are &iticak--the majority of young
Figure 4. Seattle’sservice systenrfor lromelessyouth.
people on the street requires such assistance. One half of them will need alternatives to family rxxlciliation. Less than 10% are considered ready for independent living (7, and Schram, unpublished observa tions) . Shelter and assistance do exist, but do not begin to meet the demand. Crisis residential centers or receiving homes for youths with disruptive behavior or emotional problems are intended to provide shelter and other assistance for up to 10 days for youths under age 18 years. Because the youths are hard to place elsewhere, stays in these DSHS-funded facilities generally last 3-4 months, reducing availability of emergency or crisis beds. A small number of ad-
524
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ditional shelter beds are available on a walk-in basis, without a referral from DSHS. There were 55 crisis residential center and emergency shelter beds in King County in 1988. Another 24, all available on a walk-in basis, were added to the system in 1989 (Human Services Strategic Planning Office, unpublished data). Adult emergency shelter facilities provide additional resources for young adults aged 18 years and over. Other housing options for youths under 18 years include longer-term receiving homes, foster home care, and group home or residential treatment. in total, 110 receiving home beds, for stayti up to 30 days, were available in King County in 1988. Five hundred foster home beds were available with families who take up to 6 youth at a time for longerterm stays. For youth with severe emotional and behavior problems requiring intensive treatment and 24-hour supervision, stays of up to 18 months were possible in the 164 beds in group home and residential treatment facilities. Treatment and Stabilization Services Homeless youth must have services that help them bring greater stability to their lives. These services include counseling and treatment for child abuse, mental illness, and substance abuse; education and training; and the housing options described above. Two problems that often require treatment have particular significance. Physical and sexual abuse have long-lasting effects and are very prevalent among homeless youth, both as a precursor to their street involvement and often as a result of it. Abuse of alcohol and drugs is common as well, and is.a significant impediment to successful transitions (3). Studies show that abused children’s social and developmental problems can be addressed through treatment (4). Alcohol treatment literature, however, provides less consensus on the success of treatment approaches. Some studies have identified potential predictors of positive outcomes--including greater duration of outpatient treatment; linkage to education, vocational training and other services; family therapy methods; and folloy-up and aftercare (%-!!I). Pretirention of child abuse and substance abuse is important and desirable, but many homeless youths have experienced or are experiencing them already. Appropriate treatment is essential to address their needs. Without adequate assistance, youths with histories of physical or sexual abuse or substance abuse problems will have a more difficult time making a successful transition off the street. Stabilization services exist in Seattle, but the sys-
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 7
tem is unable to serve all the youths in need. Intensive or longer-term therapy for physical and sexual abuse is not readily available and there are just 35 subsidized inpatient treatment beds for substanceabusing youth in King County. Transitional Services Successful transition from the streets is a slow and difficult processE made more difficult by limited schooling and skills of homeless young people. They need support in the form of family reconciliation, involvement in structured daily activities, access to treatment, and a source of income. Development of basic skills promotes positive transition to the workplace, but street youths require intensive employment preparation, remedial education, job training, and follow-up support to achieve stable jab placement. The linkage of services to stable housing, in the form of transitional foster and group home care and independent living programs, is also a critical factor in successful transition back into the mainstream (3,ll). There are a number of schooling options and job training and employment programs for young people in Seahle. Some are targeted specifically to homeless youth. Semi-independent living programs with linkages to support services, medical care, mental health and substance abuse treatment, education, and employment are available on a much more limited basis. In 1988, there were 38 transitional or longer-term housing units. Another 12 were added to the system in 1990 (City of Seattle Human Services Strategic Planning Office, unpublished data). Gay and Lesbian Yduth The needs of gay and lesbian youth on the street are of particular concern. Family conflict over sexual identity is one reason some youths leave home. Many young people struggle in isolation with issues of sexual identity without access to information or support. Discrimination, rejection, and physical harm are real threats for gay and lesbian youth, particularly those on the street (12,13) Programs that help youths and parents discuss sexuality could help prevent runaway behavior. Homeless gay and lesbian youths need the same kinds of services as other homeless young people but with the added sensitivity to sexual preference issues. The availability of services with appropriately trained personnel may help reduce the risks this
November 1991
population faces on the streets. Agencies that serve homeless youth in Seattle are addressing this need through staff hiring and training practices. Issues A number of issues work against communities in Washington as they try to address the problems facing homeless youth and their families. Two have particular importance for Seattle: The obligafion for helping youths and their families belongs to many, yet there is little consensus on functions and responsibilities. The changes in the Juvenile Code weakened the system of services for homeless youth. They also reduced local attention and resources directed to the problem. The increasing visibility of homeless youth and greater involvement of local government in human servic:! planning and funding will help promote the commitment of policymakers to a more active role in addressing the needs of homeless youth. However, there are obstacles to the city’s involvement. Seattle’s human services policies, adopted in 1986, suggest that filling gaps in the service system is an appropriate action when other resources are not meeting community needs (14). The policies also state that the city should not fund services mandated by other jurisdictions. The problems faced by homeless youth point out an inherent contradiction in these positions and raise the question, “At what point does the city consider filling a gap in the system, where the consequences of inaction adversely affect the community, by funding services mandated by others?” For example, alcohol and drug abuse is a significant problem for homeless youth, both as a precursor to leaving home and as a serious barrier to making it off the street and achieving selfsufficiency. The gaps in the community’s service system, funded by the state and administered by the county, are serious. The state-mandated system is also greatly overburdened wifh regard to child abuse and neglect and is unable to respond to all those who need help. Q’n the one hand, support of either substance abu;je or child abuse and neglect progrAms may let the state off the hook and slow down efforts to increslse attention tG ihe problem and overhaul of the serlrice system. On the other hand children, youths, and families with critical problems are going unserved, and more youths are likely to end up on the street because of it.
HOMELESS YOUTH PLANNING AND POLICY
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Although Seattle does not have sufficient resources to fill the gaps in these systems, it may need to reevaluate the human services policies as they pertain to mandated prevention and intervention services for children and youth. The city will have to determine how local government can best address service system problems with the limited funds available and how to target programs to young people who art! most vulnerable. Differetafsectors of the community hold opposite viewpoints on hew best to interveste with young people who are chronic runaways or on fhe street. Policymakers struggle with fhe decision about voluntary versus coercive and protective intervention. After 13 years in its present form, Washington’s Juvenile Code and its implications are being reassessed. Issues include decriminalization of status offenses, responsibilities and rights of parents and youths, and the sanctity of the family. As some view the problem, the changes made in the Juvenile Code do not allow parents and local jurisdictiions to involve youths in needed treatment or to place those at risk in protective environments. Recent discussions by a state-level task force focused on balancing the need to communicate the responsibilities of youth and parents and to ensure that youth are provided help with the need to maintain decriminalized status and to protect their rights. Although the task force recommendations were not adopted by the state legislature, the need to address coercive versus voluntary intervention remains, presen2*@ conflict for policymakers. There currently is no state legislation regarding curfew ha Washington State. Although there is a statute on truancy, there is no city ordinance and no provision under the state statute for local enforcement. Police officers do have the authority to take juveniles into custody under certain circumstances. Procedurally, this authority is a good tool when youths may be in danger, but the limited capacity of the service system deters police from making full use of it. In short, police have no place to take youths they may wish to remove from the street because facilities are operating beyond capacity and any additional pressure on the system is counterproductive. Curfew and truancy issues have been debated in the past but failed to gain support for a revision in the law. Seattle currently has few options that allow more au.thority over young people who pose a danger to themselves. There appears to be more community understanding of and support for legislative
526
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changes that would grant this control, but there may be vocal opposition as well. Seattle will’ need to decide whether the timing is right to reopen the debate. Any discussion of legislative changes or police practices as they relate to street-involved youth will have to in&de consideration of the inadequacies of the current service system.
Seattle’s Progress in Addressing the Needs of Homeless Youth The following policy framework, developed as part of the horn&&e youth planning process, provides the foundation for Seattle’s planning and decision making. It describes the underlying assumptions and guides the city in developing ‘its role in serving homeless youth and their families. 1. The city must commit itself to addressing the problem of homeless youth and thF,,need to develop a regional network of services. The city will enlist the support of federal, state, and county governments, United Way, school districts, and the community in bringing resotirces to bear on the problem, and will work on the development of a unified advocacy agenda. 2. The city will use its flexibility to fill identified gaps in the service system and will avoid support of programs that duplicate already existing efforts. The city will target its resources on areas most critical to preventing homelessness, reducing health and safety risks, and helping youths make successful transitions to adulthood. 3. The city will support programs that are sensitive to ethnic and cultural concerns and that can demonstrate positive outcomes for homeless youth, and it will support demonstration projects in those areas where effective intervention is less well understood. 4. The city wiIl identify and support mechanisms that increase coordination within the system and the development of the necessary “building blocks” to construct and improve the continuum of services. The information presented in the homeless youth report by the Human Services Strategic Manning Office helped guide the City of Seattle in its planning and decision making. Most important, it showed the relationship between the consequences of system failure and local government responsibility, laying the groundwork for a city response. It clarified ways in which Seattle could target its resources and asSi!hUlCt?.
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 7
in regard to allocations related to homeless youth, Community Development Block Grant and General Fund support for agencies with shelter and support services for homeless youths almost doubled between the 1988 and 1990 funding cycles, totaling approximately $400,000. Resources also were made available for alcohol and drug abuse prevention programs in the schools and for a new project addressing the needs of gay and lesbian youth. Emergency Shelter Grant Program funding in 1989 reflected a substantial increase as well. New capital development monies (obtained through voterapproved housing levies) were directed to transitional housing for older homeless youth. Seattle’s collaborative planning and its funding commitments helped bring about the development of 6 new walkin crisis residential beds and 12 new transitional housing units for youth in Seattle. A good deal has been accomplished since the homeless youth report was prepared. More is still to be done. The system is still badly underfunded, legal issues regarding runaway and homeless youth have not yet been resolved, and fragmentation remains a problem. It is Seattle’s hope that, through its planning, efforts to help homeless youth move into a more positive community life will proceed more rapidly and appropriately. Thus,
This article was modified from a report originally prepared for the City of Seattle in August 1988 by its Human Services Strategic Planning Office. That report was reviewed by staff members from the City’s Department of Community Development, Department of Human Resources, Health Department, Office of Management and Budget, Office of Women’s Rights, Parks Department, and Poke Deparhnent,and the King County Departments of Human Resources and Youth Services. Special thanks to all the staff in the Human Services Sfrirtegic Planning Office for their editing assistance, to Seattle’s project for Health Care for the Homeless (HCH), and Jon Hoskins in the Human Services Strategic Planning Office, for their help in putting together data on HCH.
References 1. Human Services Strategic Planning Office, City of Seattle. Policy Plan for Children and Youth. Adopted by the Seattle City Council, May 9, 1988. 2. Bramall D. King County Runaway Network, prepared for the Alliance of Children Youth and Families. November 30,1985. 3. BoyerD, Killpack S, Fine D. Street Exit Project. Final Report on Seattle Youth and Community Services, submitted to the Office of Human Development Services, Administration for Children, Youth, and Families, October 1986. 4. Cohn AH. Prevention of child abuse: What do we know about what works? and the treatment of child abuse: What do we know about what works? In: Leavitt, J, ed. Child Abuse and Neglect: Research and innovation. NATO ASI Series D, no. 16. The Hague: Martinus Nijhoff Publishers, 1983: 167-209.
HOMELESS YOUTH PLANNING AND POLICY
November 1991
5. Yale Bush Center in Child Development and So&l Policy and the Family Resource Center. Programs to strengthen families: A resource guide. 1983. 6. Fraser MVV,Haapala DA, Pecora PJ. A study of the homebuilders model of family treatment. Social Research Institute. University of Utah, 1989. 7. Office of the Inspector General, Region 10. Runaway and Homeless Youth: National Program Inspection. Seattle: U.S. Dept of Health and Human Services, 1983. 8. Friedman AS, Glickman NW. Program characteristics for successful treatment of adolescent drug abuse. J Nerv Ment Dis 1986;174:669-79. 9. Friedman AS, Glickman NV;I, Motissey MR. Prediction to successful treatment outcome by client characteristics and retention in treatment in adolescent drug treatment pro-
10. Il.
12. 13. 14.
527
grams: A large-scale cross validation study. J Drug Ed 1986;16:149-65. Rand Corporation. Strategies for controlling adole5cer.t drug use. Santa Monica, CA: February 1984. Snedeker Scientific, Inc. The forty percent solution: How private industry councils can improve JTPA programming for at-risk youth. Prepared for the National Alliance of Business, February 1985. Martin AD. Learning to hide: The socialization of the gay adolescent. Adolesc Psychiatry 1982;10:52-65. Remafedi G. Homosexual youth, a challenge tocontemporary society. JAMA 1987;258:222-5. City of Seattle. Human Services Policies. Adopted br the Seattle City Council, 1986.
OF ADOLESCE;\PT
e Local Government DAWN
HI. SMART,
‘HEALTH
1991;92:519-527
Level
M.S.
Young people leave home for many reasons-a push away from problems, a pull toward the independence and seeming excitement of the street. Once on the street they face serious risks to their health and well-being. Homelessness among youths is a concern in Seattle, with as many as 2,000 on the skreet in a year’s time. The service system is overburdened and poorly coordinated. The City of Seattle examined the problem, inadequacies of the service system, and issues affecting its ability to address the needs of homeless youths and their families. This article presents data on the problem, policies proposed to shape the city’s response, and progress made in the last 2 years.
The information was to help guide decision making about support for and involvement in services to homeless youth. The effort resulted in the development of a policy framework, recommended goals and strategies, and options for new initiatives the city could pursue. This article summarizes the information gathered, providing a picture of the needs of homeless youth and of the system that serves them. It highlights some of the issues facing Se.jttle and city government. It concludes with a descn &m of recent progress made in addressing the n%z!c “1,‘ of homeless youths and their bmilies in Seattle.
KEY WORDS:
Homeles- .outh Street youth Planning and policy In 1988, the Seattle City Council adopted a Policy Plan for Children and Youth that outlines a priority for local government efforts on behalf of homeless youths and their families (1). Shortly thereafter, the city’s Human Services Strategic Planning Office made an assessment of homeless youth in Seattle and the city’s role, progmmming, and capacity to address their needs. Data were gathered from existing sources: literature review, local monitoring, and interviews with service providers, law enforcement agencies, and program funders.
From the City of Seattle, Hutnnn Services Strategic Planning OfFce, Seattle. Wmhingfon. Address rep&t requests to: Dawn H. Smart, MS., City of Seattle, Human Services Strategic Planninn Office. 628 Secund Auenue #2350, Seattle, WA 98104. ” ” ” Manuscript accepted November 20, 1990.
The Problem King County, in which Seattle is located, had an estimated population of 180,535 youths between the ages of 10 and 19 years in 1985. Of this number, approximately 47,000 were estimated to live in Seattle (Office of Long Range Planning, unpublished data). The King County Sheriff’s Office receives reports of more than 5,000 runaways each year. Many of these children and youths are found quickly or return home on their own within a short time. Over 2,000 cases in King County, hewever, are assigned to sheriff’s officers for follow-up each year (King County Sheriff’s Office, unpublished data). In 1988, the Seattle Police Department’s Community Service Officer Unit received calls and dispatched officers in 4,200 runaway-related incidents (Seattle Police Department, unpublished data). In 1985, there was a study of 640 youth in King County who were determined io be “absent from their legal resi&l,ce” during a 1Zmonth period. According to the report, the average age for girls was
8 Society for Adolescent Medicine, 1941 Published by Elaevier Science Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010
519 1054-139x/91/53.50
!320
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 7
SMART
15.6 years and for boys 16.2 years. Of the youths, 54% were male and 46% female; 58% were White, 18% Native American, 9% African-American, 4% Samoan, 4% Hispanic, and 3% Asian. More than onehalf of the youths reported a history of physical or sexual abuse. More than one-half had dropped out of or been suspended from school. According to the report, 63% were involved with drugs or alcohol, and 43% had been involved with the juvenile justice system 0). Agencies serving runaway youth report that as many as 800 youths are on the streets in Seattle on a regular basis and up to 2,000 are believed to be involved in street life at some point during the year. The majority can be found in the downtown area, but other neighborhoods in Seattle report increasing numbers of youths who are “hanging out” and appear to be on their own or homeless. Two locally conducted studies in 1985 provide a picture of youth using emergerq services in Seattle. They ranged in age from 10 to 22 years, with a meFigure 1. Client characteristics in homeless youth programs, 1988.
dian age of 17 years. Over one-third had a history of physical or sexual abuse. The majority had dropped out of or been suspended from school, and less than 20% were employed. Of the youths, 4O60% reported substance abuse problems and 50-60% had juvenile offense records (Seattle Youth and Community Services and United Indians of All Tribes Foundation, unpublished data). Caseload data (Figure 1) show the characteristics of more than 860 youths receiving services in 1988 from runaway and street youth programs in Ring County. Shelter 1 is an emergency housing program for youths under age 18 years and shelter 2 is a transitional housing program for young adults age 18 years and over. Drop-in center 1 is located in downtown Seattle and drop-in center 2 in SeattIe’s University District. Ring County Programs are three nonshelter facilities that provide crisis intervention, counseling, and support services in King County, outside the Seattle city limits (Ring County Department of Human Resources, unpublished data). Data from the larger, adult-focused shelter network in Seattle provide a duplicated count of young adults between the ages of 18 and 24 years who use
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Omg-mi
Dmp-ln 2
KC pmarrmr
I
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atssltw2 -11-n
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OmPin2
KCPmgramr
Drop-In 1 Hlrpw~lc
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N41-Amer
KC Program8 m
Aalan
HOMELESS YOUTH PLANNING
emergency facilities (i.e., individuals are likely to have used a shelter more than once during the year or may have used more than one shelter). Over 488 young adults between the ages of 18 and 20 years and almost 1,400 between the ages of 21 and 24 years were counted in community shelters supported by the City of Seattle during 1988. A small number of them may have been members of families receiving shelter and services (I-Iuman Services Strategic Planning Office, unpublished data). Seattle’s project for Health Care Zor the Homeless (HCH) provides further information about the youth on Seattle’s streets and their health care problems. Funded by the Robert Wood )‘ohnson/Pew Memorial Trust Foundation and the Stewart B. McIGnney Homeless Assistance Act, HCH provides assessment and screening, nursing care, mental health and substance abuse counseling, and referral and followup. Six hundred fifty-three youth and young adults were served by the project, with 2,730 visits in the first 2 years of operation. The youth ranged in age from I2 to 24 years, with an average age of 18 years. Males were represented in all age categories, while 10011
Gender
AND POLICY
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females between 15 and 18 years of age were more frequently seen. Approximately 65% of those served were white and 35% minority. The ethnic distribution of clients (Figure 2) is similar to the overall ethnic distribution of Seattle’s population (according to a I987 estimate by the Washington State Office of Financial Management): White (67%), AfricanAmerican (9.9%), Asian/Pacific Islander (9.2%), Hispanic (3.5%), and Native American (P.4%). Of those youth reporting their housing status, approximately 36% were living with friends or relatives; 24%’ on the street; 15% in a shelter, temporary or transitional housing; and 5% in an institutional setting. Of the young clients in the HCI-I project, 70% or 460, were seen for acute medical problems in 1,172 visits (Figure 3); 46% of the clients had chronic mental health problems, 37% had drug problems, 27% had alcohol problems, and over 15% of the young women were pregnant.
Figure 2. Health Care for the Homelas project clients, 1988-l 9f9.
thnicity 7on
60%
80% 60%
eon -
4on 301 20% 101 011
407
While
Afr-Amrr
Neil-Amer
Housing Status
liirpanic
Aeinn
Other/MuItI
322
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Acute Illness Pregnancy Meatal Health or;ga Alcohol 0
200
400
800
600
Vielts (2730)
1200
1000
1400
RBY Clients (653)
F@ure 3. NtwtthCare/or Be Homelessprojectdients, visits, and problems, 1988-1989.
The Service System In 1977, Washington’s juvenile Code was changed with regard to the legal disposition of youths involved in curfew, truancy, runaway, and other status offenses. With the change to decriminalize the offenses, responsibility for these youth shifted from the juvenile justice to the child welfare system. The Washington Department of Social and Health Services (DSHS) was charged with administering most services for homeless youth. The shift in responsibility, however, was not accompanied by adequate state resources for the new system. Homeless youth services are funded by several sources besides state government, including federal, county, and city governments, United Way, foundations, and private donations. The City of Seattle plays a minor funding role, but allocates Community Development Block Grant and General Fund dollars to a number of programs that serve homeless youth. These include drop-in centers, shelters and transitional housing programs, health services, and training and employment. The continuum of care for homeless youth includes preventive and early intervention efforts, emergency assistance, stabilization, an.d transitional services (Figure 4).
Prevention
and Early Intervention
The earliest possible intervention for runaway youths appears to provide the best hope of interrupting a runaway episode. Three aspects of homelessness among youths and their progress toward self-sufficiency provide a strong case for early intervention. Street youths who have been on the street for a shorter length of .time have a better chance of making a successful transition off the street. Those who are older at their first street involvement and have lived with families for a longer period have an easier time getting off the street. Those who have been less severely abused or neglected alsa do better with the transition (3). One can assume that family conflict resolution and prevention focused on family violence, child abuse, and alcohol and drug abuse of parents and youths would have a positive effect, reducing runaway behavior. Research on family strengthening and support is limited, but positive outcomes have been shown in family-based intervention and parenting education programs. Developing the communication and problem-solving skills among family members appears to be beneficial, particularly for families with adolescents. Home-based, intensive family intervention services have a positive record of success in resolving or reducing family conflict. They are useful in lessening runaway behavior among youths whose families participated in these programs (4-6). Intensive family intervention services are av& able on a very limited basis in Washington State.
HOMELESS YOUTH PLANNING AND POLICY
November 1991
amily or individual p
Prevention ---I Early
Community Agencies
In~&ntion Seattle Police Department Community Service Officer ‘Unit
Emergency
Seattle Police Department Pae~oi and CSO Unit DSHS’ Crisis Residential Centers Community Drop In Centers Community Shelter Facilities
Stabilization
Community Agencies & Shelters DSHS’ Foster and Group Care Homes King Coun@ Department of Youth Setices Health Care for the Homeless Alcohol/Drug Abuse Treatment Schools & Employment Programs
Transifion
Community Agencies Transitional Housing
Assistance
They reach only those in imminent danger of outof-home placement of children-in a 12-month period in 1988 and 1989, just 1,449 families participated in Family Reconciliation Services and under l$O were involved in the more intensive Horneb~~tide~s program in King County (City of Seattle Human S&vices Strategic Planning Office, unpublished ,Jata). Emergemy Assistance and
using Optiwns
Emergency assistance includes food, shelkr, health care, and crisis intervention services. These are provided in Seattle by a small number of agencies and through their connections to the state-operated child welfare system. Emergency shelter and attention to immediate needs are &iticak--the majority of young
Figure 4. Seattle’sservice systenrfor lromelessyouth.
people on the street requires such assistance. One half of them will need alternatives to family rxxlciliation. Less than 10% are considered ready for independent living (7, and Schram, unpublished observa tions) . Shelter and assistance do exist, but do not begin to meet the demand. Crisis residential centers or receiving homes for youths with disruptive behavior or emotional problems are intended to provide shelter and other assistance for up to 10 days for youths under age 18 years. Because the youths are hard to place elsewhere, stays in these DSHS-funded facilities generally last 3-4 months, reducing availability of emergency or crisis beds. A small number of ad-
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ditional shelter beds are available on a walk-in basis, without a referral from DSHS. There were 55 crisis residential center and emergency shelter beds in King County in 1988. Another 24, all available on a walk-in basis, were added to the system in 1989 (Human Services Strategic Planning Office, unpublished data). Adult emergency shelter facilities provide additional resources for young adults aged 18 years and over. Other housing options for youths under 18 years include longer-term receiving homes, foster home care, and group home or residential treatment. in total, 110 receiving home beds, for stayti up to 30 days, were available in King County in 1988. Five hundred foster home beds were available with families who take up to 6 youth at a time for longerterm stays. For youth with severe emotional and behavior problems requiring intensive treatment and 24-hour supervision, stays of up to 18 months were possible in the 164 beds in group home and residential treatment facilities. Treatment and Stabilization Services Homeless youth must have services that help them bring greater stability to their lives. These services include counseling and treatment for child abuse, mental illness, and substance abuse; education and training; and the housing options described above. Two problems that often require treatment have particular significance. Physical and sexual abuse have long-lasting effects and are very prevalent among homeless youth, both as a precursor to their street involvement and often as a result of it. Abuse of alcohol and drugs is common as well, and is.a significant impediment to successful transitions (3). Studies show that abused children’s social and developmental problems can be addressed through treatment (4). Alcohol treatment literature, however, provides less consensus on the success of treatment approaches. Some studies have identified potential predictors of positive outcomes--including greater duration of outpatient treatment; linkage to education, vocational training and other services; family therapy methods; and folloy-up and aftercare (%-!!I). Pretirention of child abuse and substance abuse is important and desirable, but many homeless youths have experienced or are experiencing them already. Appropriate treatment is essential to address their needs. Without adequate assistance, youths with histories of physical or sexual abuse or substance abuse problems will have a more difficult time making a successful transition off the street. Stabilization services exist in Seattle, but the sys-
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tem is unable to serve all the youths in need. Intensive or longer-term therapy for physical and sexual abuse is not readily available and there are just 35 subsidized inpatient treatment beds for substanceabusing youth in King County. Transitional Services Successful transition from the streets is a slow and difficult processE made more difficult by limited schooling and skills of homeless young people. They need support in the form of family reconciliation, involvement in structured daily activities, access to treatment, and a source of income. Development of basic skills promotes positive transition to the workplace, but street youths require intensive employment preparation, remedial education, job training, and follow-up support to achieve stable jab placement. The linkage of services to stable housing, in the form of transitional foster and group home care and independent living programs, is also a critical factor in successful transition back into the mainstream (3,ll). There are a number of schooling options and job training and employment programs for young people in Seahle. Some are targeted specifically to homeless youth. Semi-independent living programs with linkages to support services, medical care, mental health and substance abuse treatment, education, and employment are available on a much more limited basis. In 1988, there were 38 transitional or longer-term housing units. Another 12 were added to the system in 1990 (City of Seattle Human Services Strategic Planning Office, unpublished data). Gay and Lesbian Yduth The needs of gay and lesbian youth on the street are of particular concern. Family conflict over sexual identity is one reason some youths leave home. Many young people struggle in isolation with issues of sexual identity without access to information or support. Discrimination, rejection, and physical harm are real threats for gay and lesbian youth, particularly those on the street (12,13) Programs that help youths and parents discuss sexuality could help prevent runaway behavior. Homeless gay and lesbian youths need the same kinds of services as other homeless young people but with the added sensitivity to sexual preference issues. The availability of services with appropriately trained personnel may help reduce the risks this
November 1991
population faces on the streets. Agencies that serve homeless youth in Seattle are addressing this need through staff hiring and training practices. Issues A number of issues work against communities in Washington as they try to address the problems facing homeless youth and their families. Two have particular importance for Seattle: The obligafion for helping youths and their families belongs to many, yet there is little consensus on functions and responsibilities. The changes in the Juvenile Code weakened the system of services for homeless youth. They also reduced local attention and resources directed to the problem. The increasing visibility of homeless youth and greater involvement of local government in human servic:! planning and funding will help promote the commitment of policymakers to a more active role in addressing the needs of homeless youth. However, there are obstacles to the city’s involvement. Seattle’s human services policies, adopted in 1986, suggest that filling gaps in the service system is an appropriate action when other resources are not meeting community needs (14). The policies also state that the city should not fund services mandated by other jurisdictions. The problems faced by homeless youth point out an inherent contradiction in these positions and raise the question, “At what point does the city consider filling a gap in the system, where the consequences of inaction adversely affect the community, by funding services mandated by others?” For example, alcohol and drug abuse is a significant problem for homeless youth, both as a precursor to leaving home and as a serious barrier to making it off the street and achieving selfsufficiency. The gaps in the community’s service system, funded by the state and administered by the county, are serious. The state-mandated system is also greatly overburdened wifh regard to child abuse and neglect and is unable to respond to all those who need help. Q’n the one hand, support of either substance abu;je or child abuse and neglect progrAms may let the state off the hook and slow down efforts to increslse attention tG ihe problem and overhaul of the serlrice system. On the other hand children, youths, and families with critical problems are going unserved, and more youths are likely to end up on the street because of it.
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Although Seattle does not have sufficient resources to fill the gaps in these systems, it may need to reevaluate the human services policies as they pertain to mandated prevention and intervention services for children and youth. The city will have to determine how local government can best address service system problems with the limited funds available and how to target programs to young people who art! most vulnerable. Differetafsectors of the community hold opposite viewpoints on hew best to interveste with young people who are chronic runaways or on fhe street. Policymakers struggle with fhe decision about voluntary versus coercive and protective intervention. After 13 years in its present form, Washington’s Juvenile Code and its implications are being reassessed. Issues include decriminalization of status offenses, responsibilities and rights of parents and youths, and the sanctity of the family. As some view the problem, the changes made in the Juvenile Code do not allow parents and local jurisdictiions to involve youths in needed treatment or to place those at risk in protective environments. Recent discussions by a state-level task force focused on balancing the need to communicate the responsibilities of youth and parents and to ensure that youth are provided help with the need to maintain decriminalized status and to protect their rights. Although the task force recommendations were not adopted by the state legislature, the need to address coercive versus voluntary intervention remains, presen2*@ conflict for policymakers. There currently is no state legislation regarding curfew ha Washington State. Although there is a statute on truancy, there is no city ordinance and no provision under the state statute for local enforcement. Police officers do have the authority to take juveniles into custody under certain circumstances. Procedurally, this authority is a good tool when youths may be in danger, but the limited capacity of the service system deters police from making full use of it. In short, police have no place to take youths they may wish to remove from the street because facilities are operating beyond capacity and any additional pressure on the system is counterproductive. Curfew and truancy issues have been debated in the past but failed to gain support for a revision in the law. Seattle currently has few options that allow more au.thority over young people who pose a danger to themselves. There appears to be more community understanding of and support for legislative
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changes that would grant this control, but there may be vocal opposition as well. Seattle will’ need to decide whether the timing is right to reopen the debate. Any discussion of legislative changes or police practices as they relate to street-involved youth will have to in&de consideration of the inadequacies of the current service system.
Seattle’s Progress in Addressing the Needs of Homeless Youth The following policy framework, developed as part of the horn&&e youth planning process, provides the foundation for Seattle’s planning and decision making. It describes the underlying assumptions and guides the city in developing ‘its role in serving homeless youth and their families. 1. The city must commit itself to addressing the problem of homeless youth and thF,,need to develop a regional network of services. The city will enlist the support of federal, state, and county governments, United Way, school districts, and the community in bringing resotirces to bear on the problem, and will work on the development of a unified advocacy agenda. 2. The city will use its flexibility to fill identified gaps in the service system and will avoid support of programs that duplicate already existing efforts. The city will target its resources on areas most critical to preventing homelessness, reducing health and safety risks, and helping youths make successful transitions to adulthood. 3. The city will support programs that are sensitive to ethnic and cultural concerns and that can demonstrate positive outcomes for homeless youth, and it will support demonstration projects in those areas where effective intervention is less well understood. 4. The city wiIl identify and support mechanisms that increase coordination within the system and the development of the necessary “building blocks” to construct and improve the continuum of services. The information presented in the homeless youth report by the Human Services Strategic Manning Office helped guide the City of Seattle in its planning and decision making. Most important, it showed the relationship between the consequences of system failure and local government responsibility, laying the groundwork for a city response. It clarified ways in which Seattle could target its resources and asSi!hUlCt?.
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in regard to allocations related to homeless youth, Community Development Block Grant and General Fund support for agencies with shelter and support services for homeless youths almost doubled between the 1988 and 1990 funding cycles, totaling approximately $400,000. Resources also were made available for alcohol and drug abuse prevention programs in the schools and for a new project addressing the needs of gay and lesbian youth. Emergency Shelter Grant Program funding in 1989 reflected a substantial increase as well. New capital development monies (obtained through voterapproved housing levies) were directed to transitional housing for older homeless youth. Seattle’s collaborative planning and its funding commitments helped bring about the development of 6 new walkin crisis residential beds and 12 new transitional housing units for youth in Seattle. A good deal has been accomplished since the homeless youth report was prepared. More is still to be done. The system is still badly underfunded, legal issues regarding runaway and homeless youth have not yet been resolved, and fragmentation remains a problem. It is Seattle’s hope that, through its planning, efforts to help homeless youth move into a more positive community life will proceed more rapidly and appropriately. Thus,
This article was modified from a report originally prepared for the City of Seattle in August 1988 by its Human Services Strategic Planning Office. That report was reviewed by staff members from the City’s Department of Community Development, Department of Human Resources, Health Department, Office of Management and Budget, Office of Women’s Rights, Parks Department, and Poke Deparhnent,and the King County Departments of Human Resources and Youth Services. Special thanks to all the staff in the Human Services Sfrirtegic Planning Office for their editing assistance, to Seattle’s project for Health Care for the Homeless (HCH), and Jon Hoskins in the Human Services Strategic Planning Office, for their help in putting together data on HCH.
References 1. Human Services Strategic Planning Office, City of Seattle. Policy Plan for Children and Youth. Adopted by the Seattle City Council, May 9, 1988. 2. Bramall D. King County Runaway Network, prepared for the Alliance of Children Youth and Families. November 30,1985. 3. BoyerD, Killpack S, Fine D. Street Exit Project. Final Report on Seattle Youth and Community Services, submitted to the Office of Human Development Services, Administration for Children, Youth, and Families, October 1986. 4. Cohn AH. Prevention of child abuse: What do we know about what works? and the treatment of child abuse: What do we know about what works? In: Leavitt, J, ed. Child Abuse and Neglect: Research and innovation. NATO ASI Series D, no. 16. The Hague: Martinus Nijhoff Publishers, 1983: 167-209.
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5. Yale Bush Center in Child Development and So&l Policy and the Family Resource Center. Programs to strengthen families: A resource guide. 1983. 6. Fraser MVV,Haapala DA, Pecora PJ. A study of the homebuilders model of family treatment. Social Research Institute. University of Utah, 1989. 7. Office of the Inspector General, Region 10. Runaway and Homeless Youth: National Program Inspection. Seattle: U.S. Dept of Health and Human Services, 1983. 8. Friedman AS, Glickman NW. Program characteristics for successful treatment of adolescent drug abuse. J Nerv Ment Dis 1986;174:669-79. 9. Friedman AS, Glickman NV;I, Motissey MR. Prediction to successful treatment outcome by client characteristics and retention in treatment in adolescent drug treatment pro-
10. Il.
12. 13. 14.
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grams: A large-scale cross validation study. J Drug Ed 1986;16:149-65. Rand Corporation. Strategies for controlling adole5cer.t drug use. Santa Monica, CA: February 1984. Snedeker Scientific, Inc. The forty percent solution: How private industry councils can improve JTPA programming for at-risk youth. Prepared for the National Alliance of Business, February 1985. Martin AD. Learning to hide: The socialization of the gay adolescent. Adolesc Psychiatry 1982;10:52-65. Remafedi G. Homosexual youth, a challenge tocontemporary society. JAMA 1987;258:222-5. City of Seattle. Human Services Policies. Adopted br the Seattle City Council, 1986.
