Six- and twelve-month outcomes among homeless youth accessing therapy and case management services through an urban drop-in center

Homeless youths' presence on the streets and in shelters is growing each year (Shane 1996). Homeless youth suffer high rates of alcohol consumption, illicit drug use, survival sex, physical and sexual abuse, depression, and teen pregnancy (Wright 1990b; Johnson et al. 1996). Complicating these adverse health outcomes is the fact that many homeless youth are alienated from health and social services (Wright 1990b; Woods et al. 2002). De Rosa et al. (1999) found that only 28 percent of street youth reported ever accessing medical care services, 10 percent accessed substance abuse treatment services, and 9 percent accessed mental health services. Barriers to accessing services include youth age, fear that parents/social services will be contacted, and lack of transportation, identification, insurance, and knowledge of clinic locations (Ensign and Bell 2004). Additional points of service delivery are drop-in centers. Drop-in centers provide immediate services, such as food, clothing, showers, laundry, and bus tokens (Joniak 2005). Many offer case management (CM), with the level of service determined by the level of government and private funding. While the proportion of homeless youth who access drop-in centers around the country is not known, De Rosa et al. (1999) found that 78 percent of homeless youth reported accessing services at drop-in centers, compared with only 40 percent at runaway shelters. Formal evaluation of the impact of the treatment services, such as CM, offered through drop-in centers is lacking. Such evaluation is necessary in order to determine the efficacy of these programs for serving homeless youth. To date, most major federal initiatives to allocate funding for the homeless—the Stewart B. McKinney Homelessness Assistance Act (1987) and the Good Samaritan Initiative (2003)—have focused primarily on improving emergency shelters and permanent supportive housing for adults. Further, the Continuum of Care model is one treatment model developed for use with homeless adults; it emphasizes progress from outreach, to drop-in centers, and then to transitional or permanent housing (Tsemberis et al. 2003). Much less attention has been paid to programs and treatment for street living, homeless youth. We document outcomes for the segment of homeless youth who requested CM and/or treatment services through a drop-in center in an urban southwestern city (Albuquerque, New Mexico) between October 2002 and April 2005. Though not as effective as programs which provide housing, Tsemberis et al. (2003) found that outpatient, drop-in services for homeless substance abusing adults can reduce substance use and mental health problems and increase social stability. We expected that homeless youth who received services would show (1) reduced alcohol and drug use, (2) increased likelihood of being housed, employed, being in school, having access to medical care, and (3) increased psychological functioning. We describe the implications of our study findings for practice and policy around housing and social services for homeless youth.