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The Emmanuel Research Review is a publication of the Emmanuel Gospel Center. The Review features articles, papers, resources, and information that we believe are helpful and relevant to urban pastors, leaders, and community members in their efforts to serve their communities effectively.
Introduction
by Brian Corcoran
Research
Associate
Emmanuel Research Institute
What is RYSE learning about Homeless Youth and Young Adults in Boston?
RYSE (pronounced “rise” and derived from “Reaching Youth on the Streets”) is part of Emmanuel Gospel Center’s Starlight Ministries, an outreach to people who are homeless.
In this issue of the Emmanuel Research Review, Alice Rouse, RYSE youth outreach coordinator, will begin to answer the question above as she shares from her street-based research, academic studies, and personal experience. Much of this issue is based on a survey conducted by RYSE in 2004 that explores homeless and street-involved youth’s histories of homelessness, substance abuse, service utilization, and experience with social service agencies in order to understand and determine how RYSE and other groups can help meet the needs of homeless youth in the community. In addition to the survey results, we have added content from Alice’s academic writings, and we sat down with her for an informal interview, parts of which are transcribed below, to gain more of her insights.
In the content below, we offer:
You may also be interested in the paper by Alice Rouse from which some of this material was derived, entitled “The Impact of Homelessness and Disconnectedness on Depression Among Homeless Youth.” It is available as a Word doc here.
There is a Powerpoint presentation also associated with this material. Some of the slides are inserted in the text below. To download the entire Powerpoint presentation click here.
As always, your feedback is appreciated!
About the RYSE Program in Boston
RYSE (pronounced “rise” and derived from “Reaching Youth on the Streets”) is part of Emmanuel Gospel Center’s Starlight Ministries, an outreach to people who are homeless. RYSE serves youth and young adults ages 14-24 that are homeless, or at risk of homelessness, offering age-appropriate outreach, integrating arts-based activities, case management, and employment and education services.
How did RYSE start?
In 1999, the staff and volunteers of Starlight became aware that an alarming number of young adults were gathering around their vans during outreach. This prompted the staff to research and to prayer. By the summer of 2001, a plan was formed and a pilot project was launched which would offer meals, showers, case management services, and arts events to serve youth on the streets in Boston and Cambridge. On a few occasions that summer, Starlight successfully created a drop-in-center atmosphere at Park Street Church, with food, music and arts, to pilot service provisions for youth on the streets.
In May of 2003, EGC received a grant from the Boston Capacity Tank and individual donors to launch RYSE. Alice Rouse, MPH, joined the Starlight staff in June 2003 as the RYSE outreach coordinator. “It was like being drop-kicked into a huge gap in the system,” Alice says.
Alice Rouse earned a Master’s Degree in Public Health from Boston University, and is now pursuing a Doctorate in Public Health at BU, focusing on behavior change among high-risk adolescents. She has experience developing and running health-centered youth programs including writing and implementing youth curriculum on HIV/AIDS and substance abuse. She presented at the International Conference on AIDS in Barcelona, Spain, in 2002 and Bangkok, Thailand, in 2004; presented in September 2003 at the National Conference on AIDS in New Orleans and at the Global Health Council in Washington, D.C., in 2004, and in 2005 at the HIV Prevention Leadership Summit in San Francisco.
What is RYSE doing now?
Today, RYSE serves youth and young adults ages 14-24 that are homeless or at risk of homelessness, offering age-appropriate outreach, integrating arts-based activities, case management, and employment and education services.
Currently, RYSE occupies the “middle ground” among the three programs in Boston and Cambridge targeting homeless youth and young adults. For example, Bridge Over Troubled Waters is a highly structured, national, multi-service program requiring youth to work as part of their program. By contrast, Youth on Fire is a low-structured, local program operating a drop-in center in Harvard Square with few requirements. This being the case, Rouse explains that RYSE seems to occupy a middle ground position in the spectrum of services, philosophies, and logistics: “Our place is to be there and stand in the gap with kids who programs don’t work for, or haven’t thought about programs, or don’t know where to go.”
For more close up information on how RYSE started and it’s ministry today in Boston and Cambridge, see the articles listed here:
by Alice Rouse
Statistics
Locally, the Massachusetts Housing and Shelter Alliance (MHSA) reports there was a 238% increase in youth homelessness in Massachusetts from 1997 to 2003 (MHASA, 2004). However, low data-collection reliability makes this figure, as well as most figures, questionable and some experts wonder if the total homeless youth population is greater than official estimates suggest. One reason for possible inaccuracies is that rates of youth homelessness are usually derived from survey data based on populations accessing shelters or other outreach services, thus potentially missing “hidden” youth and those youth that experience episodic homelessness (Robertson and Toro, 1999; Ringwalt et al, 1998). In this context it is worryingly possible that homeless youth with the most severe risk profiles evade being counted altogether (Robertson and Toro, 1999).
Definitions
The U.S. Department of Health and Human Services classifies homeless youth as:
Minors who have experienced literal homelessness on their own—i.e., who have spent at least one night either in a shelter or ‘on the streets’ without adult supervision. On occasion… the term is also used to describe homeless young adults up to age 24. (Robertson and Toro, 1999)
Other researchers go beyond “literal homelessness” and include “couch surfing” which is a situation where a homeless youth stays with relatives or friends, often on couches or floors, sometimes in overcrowded or substandard housing (Ringwalt, 1998). Frequently these stays are sequential, that is, floating from one home to another until a permanent housing situation is found, these are the “hidden homeless.” Of these youth, some have experienced long or repeated periods of homelessness, while others are experiencing homelessness for the first time or have been homeless for only a few days. Furthermore, with the USDHHS definition, youth could leave home for the evening and forget to call in and technically they would be considered a runaway. It’s common across the country to refer to homeless youth in terms of ages 14-24 even though some funding only goes up to age 21.
For the purposes of this article a broad definition of the phrase “homeless youth” will be used. This definition will not only include youth experiencing literal homelessness, but also couch surfers and episodically homeless youth.
Culture
Homeless youth cultural characteristics include the fact that many service providers label street youth as having too many issues to deal with. Therefore, it is important to look briefly at the common characteristics of youth on the streets to see what has led to this belief.
After brief consideration of these cultural characteristics, it is understandable why many researchers have concluded that:
“Homeless youth are at an elevated risk for physical and mental health problems.”
In our next section, Alice Rouse talks about many of the eight characteristics listed above.
List of sources used in this study:
Abdlain, Sue Ellen MD, (2004) “Street Youth Mortality: Leaning With Intent to Fall.” The Journal of the American Medical Association. 292(5): 624-626.
Cauce, Ana Mari, et al, (2000) “The Characteristics and Mental Health of Homeless Adolescents: Age and Gender Differences.” Journal of Emotional and Behavioral Disorders 8(4): 230-246.
McCaskill, P. A., Toro, P. A., & Wolfe, S. M. (1998). “Homeless and Matched Housed Adolescents: A Comparative Study of Psychopathology.” Journal of Clinical Child Psychology, 27: 306-319.
National Runaway Switchboard [Homepage on the Internet] Updated 2004; Cited 11/26/04; Available from: http://www.nrscrisisline.org/
Ringwalt, C. L., Greene, J. M., Robertson, M. & McPheeters, M. (1998). “The Prevalence of Homelessness Among Adolescents in the United States.” American Journal of Public Health, 88(9): 1325-1329.
Robertson, M.J., Toro, P.A. (1999). Homeless Youth: Research, Intervention, and Policy. US Department of Health and Human Services: The 1998 National Symposium on Homelessness Research.
Roy E, Haley N, Lecelerc P, et al (2004) “Mortality in a Cohort of Street Youth in Montreal.” The Journal of the American Medical Association. 292(5): 569-574.
The Common Characteristics of Homeless Youth in Boston and Cambridge
An interview with Alice Rouse speaking on the common characteristics of homeless youth.
On Lack of Support Systems, Trust, and A History of Abuse
So, some of the cultural characteristics that you see among youth are a lack of support systems and lack of trust for adults. That is where my role really plugs in. It is just being there, hanging out and showing kids that there are people that you can trust. They come in different shapes and sizes. I tell them, “You have to learn to trust somebody before you can just trust anybody.” So part of my role is getting them to trust people. These youth come to the streets with a history of abuse: verbally, sexually, emotionally and the resultant lack of trust is heightened when they are on the streets.
On Mental Illness
This is a “which came first the chicken or the egg” question that applies both to the youth and their families. Certain mental illnesses often appear in late teens and early twenties, which is the age group I am working with. Recognition of mental illness is also hard to tease out because you can’t tell whether a kid is just really dreamy or suffers from borderline personality disorder. Is this a girl who is just having a bad day or is she entering into clinical depression?
There’s a lot of ambiguity and also stigma that goes around mental illness. Statistics indicate that one in ten Americans experience mental illness, but people don’t talk about it. On the streets it is thought that about one out of three homeless individuals suffers from mental illness. With youth it is really hard to say, studies have been all over the map. They’ve shown that youth are more likely to have multiple disorders, but as far as suffering from one disorder, it’s right about the same as the general population, around 20%. I actually have the statistics in one of my papers on mental illness. In my paper, it shows that youth on the street are more likely to have addiction and to act out and have behavioral disorders. However, it is hard to say whether it is being caused by mental illness, street toughness or something else. [Link to paper on “The Impact of Homelessness and Disconnectedness on Depression Among Homeless Youth” download Word doc here.]
On Sense of Failure, Low Self-Esteem, and Sexuality Issues
More cultural characteristics include: sense of failure, low self-esteem, having adults reject them all their life, and sexuality issues. There are kids who are having gender crisis, saying, “I’m gay,” “I’m lesbian,” “I’m bisexual,” or “I think I should have been born a woman.” Also, there are girls who get pregnant and are thrown out. There are a lot of teen pregnancy programs. And sometimes it’s just that parents see their kids as promiscuous and don’t want “that” in their house. So, they end up on the streets as well. And then once you are on the streets, you get wrapped up in the lifestyle of the street culture.
On Cross-cultural Work and Street Culture
I always like to tell people that I see myself in cross-cultural work, in the sense that, yes, there are many cultures out on the streets but also street culture is a culture all unto itself. A lot of kids I have seen are almost “addicted” to the drama out there and are caught up in the cyclone of street activity and don’t want to leave it. For some youth, there is a sense or belief that, once you are housed you will still have the streets in your blood. When we get an individual into housing and we say, “Yes! They are in housing!” But are they going to stay? I mean, now you’re sitting in a little, “boring” space. You have a love seat and a TV. But you can only watch so much Cartoon Network.
Many providers say they don’t want to work with street youth because there are just too many issues to deal with. RYSE works with the “literal” homeless (according to the USDHHS definition mentioned earlier) and “street youth.” By “street youth,” we mean those youth who are on the street because they are “at risk” of homelessness. This could include youth for which home is unsafe, or there is substance abuse, or mental illness with parents, or with the youth themselves. They could be in foster care or state custody but thinking the streets are a better place.
The street culture allures many youth with the appearance of more freedom and having a sense of community. However, it is an empty promise, a big façade. It looks fun out there. I even sometimes think it looks fun out there, until I look deeper and get to really know all the runaways, throwaways, and kids that have aged out of the system. Many youth find their way in the first hours of homelessness to Bridge Over Troubled Waters who sees about 3,000 youth a year. RYSE comes into contact with about 10% of that or about 300 youth. Youth On Fire sees slightly less than 300 youth per year.
On Street Culture and Elevated Risk
In all of the literature, the generic statement is that: homeless youth are at elevated risk to physical and mental health problems. Even little things like a hangnail can turn into a major abscess on your thumb due to the lack of personal hygiene, and the dirt. Such a condition can be further complicated by hot/cold temperature shifts and skin cracking. What begins as a little cold can get to pneumonia a lot faster. And a lot of mental health problems are aggravated by the drama and the violence of the street culture as well.
Survey: Homeless Youth and Young Adults in Boston
by Alice Rouse
Purpose
To explore homeless and street-involved youth’s histories of homelessness, substance abuse, service utilization and experience with social service agencies.
Methodology
In 2004, 82 youth (between 14 and 24 years old) who were homeless or on the streets (“at-risk of homelessness”) were surveyed at street sites. Outreach workers delivered an oral questionnaire to these youth asking questions about their histories of homelessness, substance abuse, service utilization, and experience with social service agencies, amongst other items.
To download or view the survey form, click here (Word doc).
Demographics
Drug use by ethnicity
Services wanted:
Services used:
My five-year plan:
Suggestions for effectively serving:
List of Sources Used
Abdlain, Sue Ellen MD, (2004) “Street Youth Mortality: Leaning With Intent to Fall.” The Journal of the American Medical Association. 292(5): 624-626.
Cauce, Ana Mari, et al, (2000) “The Characteristics and Mental Health of Homeless Adolescents: Age and Gender Differences.” Journal of Emotional and Behavioral Disorders 8(4): 230-246.
Ensign J. “Quality of health care: the views of homeless youth.” (2004) Health Services Research. 39(4 Pt 1):695-70.
Geber GM (1997), “Barriers to health care for street youth. Journal of Adolescent Health.” 21(5):287-90.
Healthy People 2010 [Monograph on the Internet] “Objective 18: Mental Health and Mental Disorders”, cited 12/01/05. Available from: http://www.healthypeople.gov/document/HTML/Volume2/18Mental.htm
Lin, Nan and Peek, Kristen (1999) Social Networks and Mental Illness, Chapter 13 (249). in Handbook for the Study of Mental Health: Social Contexts, Theories and Systems. Edited by Allan Horwitz and Teresa Sheid. Cambridge University Press.
Massachusetts Department of Mental Health [Monograph on the Internet] Updated November 2005, Citied 12/01/05; Available from: http://www.mass.gov/Eeohhs2/docs/dmh/publications/psychoactive_booklet.pdf
Massachusetts Housing and Shelter Alliance (2004) “2003 Young Adult Census Summary.”
MacAllum, C., Kerttula, M. A., & Quinn, E. (1997). Evaluation of the Transitional Living Program for Homeless Youth: Phase II Report. Unpublished report to the Administration on Children, Youth and Families by CSR, Inc., Washington, DC.
McCaskill, P. A., Toro, P. A., & Wolfe, S. M. (1998). “Homeless and Matched Housed Adolescents: A Comparative Study of Psychopathology.” Journal of Clinical Child Psychology, 27: 306-319.
National Healthcare for the Homeless (2005). [Monograph on the Internet] “Child Health and Homelessness.” Cited 11/11/2005. Available from: http://www.nhchc.org/Advocacy/PolicyPapers/2005/ChildandYouthHealth.pdf
Ringwalt, C. L., Greene, J. M., Robertson, M. & McPheeters, M. (1998). “The Prevalence of Homelessness Among Adolescents in the United States.” American Journal of Public Health, 88(9): 1325-1329.
Robertson, M.J., Toro, P.A. (1999). Homeless Youth: Research, Intervention, and Policy. US Department of Health and Human Services: The 1998 National Symposium on Homelessness Research.
Robertson, MJ. Homeless Youth and Patterns of Alcohol Use (1999). Alcohol Research Group, 2000 Hearst Avenue, Berkeley, CA 94709.
Rouse, Alice (2005) Interviews of anonymous youth on the streets. September 18, 2005.
Substance Abuse and Mental Health Service Administration “Mental health topics: Homelessness” [homepage on the internet] Cited 12/1/05, Available from: http://www.mentalhealth.samhsa.gov/topics/explore/homelessness/
Thoits, Peggy (1999) Sociological Approaches to Mental Illness, Ch.6 (125). in Handbook for the Study of Mental Health: Social Contexts, Theories and Systems. Edited by Allan Horwitz and Teresa Sheid. Cambridge University Press.
Whitbeck LB. Johnson KD. Hoyt DR. Cauce AM (2004). “Mental Disorder and Comorbidity Among Runaway and Homeless Adolescents.” Journal of Adolescent Health. 35(2):132-40.
Whitbeck LB. Hoyt DR. Bao WN. (2000) “Depressive symptoms and co-occurring depressive symptoms, substance abuse, and conduct problems among runaway and homeless adolescents.” Child Development. 71(3):721-32.
US Department of Health and Human Services. (1999) Mental Health: A Report of the Surgeon General—Executive Summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
Yates GL, Pennbridge J, Swofford A, et al (1991). “The Los Angeles System of Care for Homeless/Runaway Youth.” Journal of Adolescent Health. 12:1555-60.
Local, State and National Resources Available Online
Boston
Boston Public Health Commission
(http://www.bphc.org/)City of Boston Online
http://www.cityofboston.gov/Massachusetts
MA All Agency List
(go to www.mass.gov, select State Government from the menu on the left, then All Agencies)search for:
MA Department of Social Services
MA Department of Youth Services
MA Youth Risk Behavioral StudiesMA Department of Education
http://www.doe.mass.edu/United States
National Alliance to End Homelessness
(http://www.endhomelessness.org/index.htm)National Comorbidity Survey
(http://www.hcp.med.harvard.edu/ncs/)National Health Care for the Homeless Council
(http://www.nhchc.org/)Public Health Foundation
(http://www.phf.org/index.htm)United States Department of Health and Human Services
(http://www.hsca.com/membersonly/USDHHSlink.htm)
Emmanuel Research Review, copyright © 2006, Emmanuel Gospel Center. All rights reserved. For permission to reprint any or all of this newsletter, contact mailto:rmitchell@egc.org by email or write:
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PO Box 180245
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