Denver’s Homeless Street Youth – characteristics and treatment challenges

In 2004 Denver’s homeless youth population was estimated to include approximately 850 young adults between the ages of 12 and 24[1] with at least 1500 homeless youth in the state of Colorado[2]. I believe these figures are a serious underestimate of the actual number of homeless youth in Denver and the state. This population is notoriously hard to count due to their itinerant nature, mistrust of authority figures, unwillingness to participate in surveys or be counted, and because many simply don’t want to be found. For these reasons it can be extremely difficult to get a true idea of how many homeless youth are living on the streets using traditional survey methods administered in schools, shelters and drop-in centers.
Street youth, or youth who live primarily on the streets, are distinct from other youth experiencing homelessness who utilize shelters or transitional housing programs. Their basic needs are not consistently met; they are exposed to greater levels of stress and trauma and are more likely to engage in high risk behaviors[3].  For the purpose of this post I will limit the discussion to homeless street youth.
                There are many possible reasons a teen might choose to live on the streets rather than with relatives or in a foster home. The environment at home could be unsafe due to domestic violence, neglect, substance and/or alcohol abuse, or a combination of these issues. If the teen is having trouble following rules, exhibits features of Conduct Disorder or Oppositional Defiant Disorder, uses drugs or alcohol,  or identifies as gay, lesbian, bi-sexual, questioning, or transgender (GLBQT), this can create conflict within the home which may lead to homelessness.
Sometimes it is a matter of finances; if the family can no longer afford to feed and care for all of their children, the older children may be forced to leave the house to reduce the financial burden and provide for themselves. There is also a disturbingly high rate of homelessness among kids who “age-out” of the foster care system, or who are released from the juvenile justice system. The estimated amount of homeless youth who have aged out of foster care or out-of-home placement ranges from 21%[4] to 53%[5]. There are other situations which could result in a teen leaving home and turning to the streets, these are some of the more common explanations.
                Once on the streets youth are left to navigate a very dangerous and adult world, with little experience and limited physical/mental/emotional development.  In this environment they are exposed to extreme violence, such as muggings, physical and sexual assault, shootings, gang violence, emotional abuse, etc. They have a greater chance than their housed peers of being the victims of this violence[6] and of being re-victimized in the future[7].
Often they will participate in illegal activities, such as theft, battery, breaking and entering, etc., to obtain food, shelter, money or drugs. Survival sex is another strategy used by some street youth; it is defined as the exchange of sex for shelter, food, drugs, or money. Teens who reported having used survival sex  to meet their basic needs also reported higher rates of substance use, suicide attempts, days away from home, STD’s, pregnancy, and victimization[8].
To combat some of the risks and trauma associated with life on the streets, youth will often seek to re-create the family they left behind, or never had. Typically older kids or adults who have been on the streets longer will take the newcomers under their wings. They form a large “street family,” which consists of a “street Dad” and “street Mom,” etc. Depending on the make-up of the group and their activities, street families can be a protective factor for new homeless teens, or they can expose the youth to more harm than they would otherwise experience.
If youth who live on the streets didn’t have a mental health or substance abuse problem when they left home, their chances of acquiring one while living on the streets are very high.  Due to the increased exposure to violence and trauma, they are more vulnerable to PTSD, mood disorders, substance and/or alcohol abuse, conduct disorder, oppositional defiant disorder, and suicidal ideation/attempts.  The relationship between homelessness and mental illness goes both ways; if a teen was already experiencing symptoms of mental illness before leaving home, this may contribute to familial conflict which can in turn lead to homelessness.  The incidence of mental illness and substance abuse are significantly higher for homeless street youth, as compared to homeless youth who live in shelters, or the general youth population[9]. 
                The barriers to treatment for this population are numerous and difficult, but not impossible, to overcome. To begin, they are a hard population to reach physically, as they move around the city frequently, changing camp sites, squat locations, or staying with friends in different areas. This can make planning and delivering services extremely difficult. There is also a culture of mistrust with regards to authority figures and service providers, which can make building a therapeutic relationship challenging. In addition, there seems to be a lag in the mental health field when it comes to applying the principles of recovery to the homeless youth population, specifically regarding consumer directed therapy and strengths based services. It can be difficult for some providers to recognize the autonomy of these youth and their right to determine what direction their lives will take; this is due in part to their young age, their involvement in high risk behaviors, and the parental instincts of some of the providers. It’s important to remember that these kids are by now solely responsible for their own lives, where they sleep, how they eat, and how they spend their time; to treat them otherwise is counterproductive.
I believe the foundations for treatment can be established by providers who are a consistent, caring, attentive and non-judgmental presence in the lives of our homeless youth. On the next post I’d like to discuss some of the various treatments that are currently being used with homeless youth, and which have been found to be the most successful. 
Written by Felice Seigneur
Felice Seigneur is and Evaluation Specialist with the Evaluation and Research Department
at the Mental Health Center of Denver
The content of this blog is based on current and past research on the subject of homeless and street youth, and in part from my own experience as an outreach counselor working with homeless street youth in Denver. If you have any questions about what has been written, or would like to add to the conversation, please feel free to leave a comment below.

[1] Metropolitan Denver Homeless Initiative, Final Report,
[2] Colorado Dept. of Public Health,
[3] Treatment Outcome for Street-Living, Homeless Youth. Natasha Slesnick, Ph.D,Jillian L. Prestopnik, Ph.D., Robert J. Meyers, Ph.D., and Michael Glassman, Ph.D. Addict Behav. 2007 June ; 32(6): 1237–1251.
[4] Cauce, A. M., Paradise, M., Embry, L., Morgan, C., Theofelis, J., Heger, J., & Wagner, V. (1998).
Homeless youth in Seattle: Youth characteristics, mental health needs, and intensive case
management. In M. Epstein, K. Kutash, & A. Duchnowski (Eds.), Outcomes for children and
youth with emotional and behavioral disorders and their families: Programs and evaluation best
practices. Austin, TX: PRO-ED.
[5] Toro, P. A., & Goldstein, M. S. (2000, August). Outcomes among homeless and matched housed
adolescents: A longitudinal comparison. Presented at the 108th Annual Convention of the
American Psychological Association, Washington, DC.
[6] - Homeless Youth in the United States: Recent Research Findings and Intervention Approaches. Paul A. Toro, PhD, Wayne State University, Detroit, MI, Amy Dworsky, PhD, University of Chicago, Chicago, IL, Patrick J. Fowler, MA, Wayne State University, Detroit, MI. The 2007 National Symposium on Homelessness Research
[7] Whitbeck, L. B., Hoyt, D. R., & Ackley, K. A. (1997). Abusive family backgrounds and victimization among runaway and homeless adolescents. Journal of Research on Adolescence, 7, 375–392.
[8] Prevalence and Correlates of Survival Sex Among Runaway and Homeless Youth. Jody M. Greene, MS, Susan T Ennett, PhD, and Christopher L. Ringwalt, DrPH. American Journal of Public Health, September 1999, Vol. 89, No. 9
[9] Toro, et al., 2007