1. EXPLORING YOUTH HOMELESSNESS In Collaboration with: University of Houston, Graduate College of Social Work University of Texas, School of Nursing University of Houston-Downtown, Center for Public Service and Family Strengths Homeless Youth Network of Houston/Harris County

2. Motivation – Design Effective Count Undercounting homeless youth age 24 and under National estimates ranging from 47,000 to 1.6 million (SAMHSA, 2004; NAEH, 2013) Houston/Harris County estimates ranging from 268 to 3,740 (2013 PIT count; HMIS 2012) Challenges with the homeless youth count Population-level issues Conflicting definitions of unaccompanied homeless youth Diverse subgroups (e.g., minority status, teen parents, LGBTQ youth) Hidden nature of the population; difficult to locate/identify Issues specific to Houston/Harris County Large geographic areas to cover, the third largest county in US Lack of services available for homeless youth Lack of prior data on the distribution of homeless youth in Harris County Little knowledge on the population

3. Study Objectives Primary objectives Understand the logistics of being homeless to inform team on where youth stay, how they travel, how we can identify a homeless youth Vet proposed counting and surveying strategies with homeless youth Secondary objectives Explore the meaning of homelessness in youth 14-24 years old Determine reasons youth seek and do not seek services (social, health, and mental) Describe behaviors that put youth at risk Understand reasons youth become homeless Describe survival strategies homeless youth use to meet needs

4. Capturing the Youth Voice Conducted a qualitative study with 64 homeless youth aged 14- 24 using 13 focus groups Recruited from homeless shelters, homeless youth magnet events, and during street outreach Thematic content analysis was used to determine themes related to homelessness, sheltering, service seeking, risk behaviors, etc Demographics (n=64) 69% sheltered, 31% unsheltered 23% age 14-17, 76% age 18-24 47% male, 52% female 75% Black, 13% White, 13% Hispanic; 14% multiracial 19% LGBT, 25% pregnant/parenting

5. Preliminary Findings Do not see themselves as homeless once they have a place to stay, including homeless shelters Spend a significant amount of time moving around family and friends’ homes before they stay on the street Move from place to place frequently Separate themselves from each other and homeless adults Tend to hide before sunset Participate in risky behaviors to meet immediate needs Seek help from homeless service providers as a last resort

6. Making Sense of the Findings “Ten Toes Down”: Self-Care Practices of Homeless Youth Barriers and Facilitators to Use of Shelter Services among Homeless Youth The Connection between Homelessness, Mental Illness, and Seeking Mental Health Care The Intersection of Family Conflict, Adverse Childhood Events, and Homelessness

7. “Ten toes down”: Self-care practices of homeless youth Stigma & Shame Prioritized Needs Unstable Housing Self-Reliance Resilience Self-Care Risk Behaviors Sexual Risk Behaviors Substance Use

8. Representative Quotes “I used to be like embarrassed. So I never let nobody who saw me know I was homeless.” Stigma and Shame Prioritizing Needs “I never had to trade sex…until this year. That’s when I go to the point…try and get quick money.” Self-Reliance “You can’t survive if you ain’t got money. That’s why I did the stuff I did. Not because I wanted to of I liked it.” Resilience “I’m determined. I’m aggressive. Like I never give up.” “Ten Toes Down. Like all you got is your feet, your two legs, and a heartbeat. You got to survive. You got to do it on your own.”

10. Barriers to Shelter Use among Youth Attitudinal barriers: pride/self-reliance; stigma/shame “I don’t want nobody’s help, I’m going to do me by myself” “I never let nobody who saw me know that I was homeless” Access barriers: availability/location of services; transportation; acceptability of services “transportation was a huge issue” “there isn’t a lot of resources for homeless youth….” “A lot of people would tell you (shelter name) is filthy bad” Structural barriers: shelter rules such as curfews and no cell-phone use, age restrictions, lack of capacity at youth- focused shelters

11. Facilitators to Shelter Use among Youth Supportive others (school counselors and church members “when you go to church, people help you” Police officers and psychiatric services Some factors ease access to services, including mental illness, being female, or pregnant “… in the same situation, they’ll help the crazy person first” “a woman will always get care quicker than a man” “if you’re not pregnant it’s going to take you a long time to get on housing. And now I’m pregnant; nothing could stop me”

12. How Findings will be Used Inform the point-in-time count methodology Support the need for health promotion and risk reduction interventions by identifying magnitude of the problem Used to apply for 5-yr HIV/substance use prevention project for homeless youth Support the need for expanded housing, shelter, and other services that considers specific concerns of homeless youth Describe the impact of expanding the definition of homelessness from the current HUD criteria

13. How do These Findings Inform the Point-in-Time Homeless Youth Count?

14. Count Relevant Findings Are often hidden behind closed doors – couch surfing, doubling up, hotel hopping (inclusion criteria) Are in and out of homelessness (inclusion criteria) Do not consider themselves to be homeless (approach) Are not “out” past dusk (time of count) Know how to contact other homeless youth (RDS) Like the confidentiality of tech-based survey (ACASI) Also want a paper/pencil version (Teleform) Can identify homeless youth (employ homeless youth)

15. Pilot Homeless Youth Count & Survey Use a broadened definition of youth homelessness Sheltered count: Comprehensive list of providers serving homeless youth Unsheltered count: Three major components Geographic Information System (GIS) & PEIMS to map low- and high-density areas Specialized outreach teams Respondent-driven sampling (RSD) to reach homeless youth Youth-focused “Housing Status” survey Computer-Assisted Self-Interviewing (CASI) technique Conduct over an extended time period during Fall/Winter 2014 Build collaborations among service providers, advocates, law enforcement, school leadership, and agencies to find hard to reach youth (i.e. undocumented, Spanish speaking…)