System youth: A subgroup of substance-abusing homeless adolescents
Introduction
Although health and psychological problems of runaway and homeless teens represent a pressing national health concern, Rotheram-Borus, Feldman, Rosario, and Dunne (1994) report that runaway and homeless youth are an understudied and underserved population. Research has reported on substance use patterns, high-risk behaviors for human immunodeficiency virus (HIV), and related problem behaviors among these youth. Such research is helpful in identifying areas in which runaway youth are especially vulnerable. Fewer researchers have examined differences within runaway youth even though runaway/homeless youth constitute a diverse group. As noted by Ringwalt, Greene, and Robertson (1998), investigators are finding that subgroups of homeless youth can be differentiated, and that classifying such youth can guide service providers in tailoring services to meet youth's specific needs. For example, Ringwalt et al. (1998) found that shelter youth show less severe substance use and high-risk behaviors than do street youth and that among shelter and street youth, youth that have been ejected from the home show more severe problems. The aim of this paper was to compare substance-abusing shelter youth with a history of foster or group home placement (system youth), to substance-abusing shelter youth with no group or foster home placement (nonsystem youth).
Athey (1995) noted that adolescents may become homeless for several reasons. “Throwaways” are evicted by their families, often following extensive conflict with parents. Estimates of throwaways range from 9.3% to 33% among shelter and street surveyed youth Finkelhor et al., 1990, Kufeldt et al., 1992, Powers et al., 1990, Ringwalt et al., 1998, Rotheram-Borus, 1993. Many gay and lesbian youth are rejected by their families and forced to leave home (Kruks, 1991). In New York, estimates are that as many as one-half of youth on the streets are gay or lesbian (Humm, 1990), while 40% of the homeless youth in Seattle are estimated to be gay (Seattle Department of Human Resources, 1988). Other youth leave home to escape physical and/or sexual abuse from parents or guardians. Studies of runaway and homeless youth have found the incidence of admitted sexual abuse to range from 21% to 60% and that of physical abuse to range from 16% to 40% Molnar et al., 1998, Powers et al., 1990, Shaffer & Caton, 1984, Unger et al., 1998, Yates et al., 1988.
In general, studies of runaway and homeless youth document high rates of alcohol consumption and illicit drug use, physical and sexual abuse, depression, suicide attempts, criminality, mental health problems, and frequent prostitution Unger et al., 1997, Wolfe et al., 1999, Zimet et al., 1995. Teare, Furst, Peterson, and Authier (1992) found that in their sample of shelter youth, those not reunified with their family had higher levels of hopelessness, suicide ideation, and reported more family problems than those reunified.
System kids have been defined as youth “who have been shuffled back and forth among foster homes, psychiatric hospitals, emergency shelters, residential schools, and juvenile justice facilities” (Athey, 1995, p. 518). When designing studies, some researchers have separated system youth into foster care youth and group home youth (Reddy & Pfeiffer, 1997). However, Melton, Lyons, and Spaulding (1998) assert that the boundaries between these institutions are blurred, and that system youth should be studied as a group rather than studied separately based on their current placement.
The children's service systems interlock to such a degree that consideration of them as separate systems is an artificial (even if legally recognized) categorization that invites incomplete policy analysis and ineffective policy initiatives. (Melton et al., 1998, p. 135)
System youth generally enter the social services system because of abuse or neglect by primary caregivers. Child Protective Services (CPS) intervenes, and youth are exposed to temporary out-of-home placements. Because abused and neglected adolescents often have experienced high levels of mistreatment before CPS intervenes, it is difficult to isolate the impact of the social service system on these youth. Research examining the outcome of CPS intervention on youth is confounded by the level of problem severity among the youth that are examined (McMillen & Tucker, 1999). In addition, a skewed percentage of these youth come from impoverished, disadvantaged, and minority families (Thyen, Leventhal, Yazdgerdi, & Perrin, 1997). Considering the high number of children reported to CPS—3 million in 1999 (US Department of Health and Human Services, 2001)—a closer examination of the effects of youth's involvement with the social service system and their subsequent functioning is needed to improve intervention services.
While the agencies of CPS exist to protect children at risk, there is a great deal of concern about the ability of CPS to accomplish that broad-reaching task (Munro, 1999). Garinger, Brant, and Brant (1976) cited the state as a primary source of abuse, emphasizing the social stigma and overintrusion of protective services in the home. According to these writers, the interests of the child are often ignored by the bureaucratic system of the state. Since these charges were leveled 25 years ago, CPS has reformed many of its policies, and, yet, some child welfare analysts feel that CPS still falls short in its efforts to protect children from abuse and neglect (Waldfogel, 2000). If this criticism of CPS is founded, then substance-abusing system youth may be at increased risk for problem behavior once they enter the CPS system.
Studies of homeless youth consistently find that, after CPS has removed children from the home, large proportions of these youth have histories of multiple placements (Shaffer & Caton, 1984). It was noted that homeless youth are more often harmed than helped by the child-serving systems, and often leave those settings when they conclude that the streets meet their needs better than the service system (Athey, 1995). Melton et al. (1998) criticize the social service system as a “slow bureaucracy” promoting an institutional climate, which intermittently retains children in restrictive settings for extensive periods of time, and then bounces them from one placement to the next. McMillen and Tucker (1999) examined outcome with older adolescents at the point in which youth left their respective system care institution (group home, residential treatment, foster care). These researchers found that the average number of placements for older adolescents was 7.59, and that a high percentage of youth drop out of system care prematurely (63%), highlighting the lack of appropriate placement services for older teens.
A study conducted by Zlotnick, Robertson, and Wright (1999) compared homeless women who had childhood histories of foster care or other out-of-home placement to those who had not. Among those women with children, most had children who also had lived in foster care or other out-of-home placement. Moreover, variables associated with children's out-of-home placement included their mother's current alcohol or drug-use disorders, childhood sexual abuse, and history of running away from home.
The paucity of studies examining the effects of the system on youth is troubling given research suggesting that system improvement is needed. Of the few studies to date, many do not utilize an experimental design and do not control for preexisting abuse and psychopathology. This study compares substance-abusing system and nonsystem youth staying at local shelters. Youth residing at shelters have experienced high rates of abuse or neglect Kurtz et al., 1991, Kurtz et al., 1991, Whitbeck & Simons, 1990, and the shelter represents a between-placement residence for youth with a history of out-of-home placement. In addition, as system youth may spend intermittent periods of time in homeless shelters between placements, shelter residing system youth were seen as representative of system youth in general. Research delineates an increased risk for substance-abusing runaway and homeless youth involved in the social service system to have continuing problems and system contact. As Haerian (1998) comments, children in foster care are often deprived of a sense of belonging and predictability, which may contribute to their maladjustment and problem behavior. Identification of the unique issues among youth who are removed from the home may assist service providers in understanding and addressing problem areas in which these youth are especially vulnerable.
We predicted that substance-abusing system youth would report similar problems to those of nonsystem youth, but at greater levels of severity. Thus, in the current study, it is expected that family problems, substance use, depression, and related problems (e.g., delinquency, diagnosed comorbidity) will be more severe in substance-abusing runaway youth with a history of foster care or group home placement, compared to those without out-of-home placement. Few studies have examined gender differences among runaway and homeless youth, although studies to date suggest that examination of gender differences is warranted Jurich, 1979, Whitbeck et al., 1997a, Windle, 1989, Yoder, 1999. This study also explored the role of gender on these variables in order to more clearly elucidate pattern differences.
Section snippets
Participants
Runaway youth (n=144) were recruited through two runaway/homeless shelters in a southwestern city as part of two larger studies examining family therapy outcome with substance-abusing runaway adolescents (grants R29DA11590 and R01AA12173). Hence, all youth in this sample agreed to the possibility of family treatment with a parent or surrogate parent. To be eligible for participation, adolescents had to satisfy DSM-IV diagnostic criteria for substance abuse or dependence, be between the ages of
Sample characteristics
The sample included 144 youth of which 59 were male (25 system males) and 85 were female (37 system females). Youth were between the ages of 12–17 (M=15.09, S.D.=1.36) and ethnicities were reported as Anglo (n=58), Hispanic (n=64), Native American (n=12), and African American (n=10). Adolescents reported 44.5% days of alcohol or drug use (excluding tobacco) in the 90-day preintake assessment window. Forty-five percent of youth (n=62) reported a history of being a ward of the state, and/or
Discussion
This paper compared substance-abusing shelter youth with a history of foster or group home placement to substance-abusing shelter youth with no group or foster home placement. Similar to a study of shelter-using youths in New York City (Shaffer & Caton, 1984), nearly half of this study's sample had previously lived in a foster or group home, suggesting that system youth comprise a large proportion of shelter-residing youth. Moreover, in this sample, children removed from the home were more
Acknowledgements
This work has been supported by NIDA grant (R29 DA 11590) and NIAAA and CSAT grant (AA12173).
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