Runaway and Homeless Youth, Mental Health, and Trauma-Informed Care

People sitting in a circle. The focus is on their hands; their faces are not visible.

Young people run away or become homeless for a variety of reasons, many of which can be linked to psychological and emotional trauma. Whether it’s abuse, the consequences of living in poverty, a lack of empathy and support for their self-identity, or some combination of the three, runaway and homeless youth (RHY) often experience significant challenges to their happiness and well-being. Many confront this situation even before they encounter the perils of setting off on their own. Once they run away,  they are susceptible to a host of additional dangers and health risks, many of which can exact additional tolls on their mental health.

Complex Trauma and RHY reports that, relative to the general youth population, these young people “experience higher rates of a number of psychiatric disorders (e.g., depression, anxiety, and conduct disorders) and often lack access to health and behavioral health care.” Other studies have found that as much as 84 percent of homeless youth exhibit symptoms of at least one psychiatric disorder.

While homelessness is highly correlated with a number of psychological and psychiatric factors, research is less clear on the cause and effect relationship between homelessness and mental health issues. Data point to one important relationship; young people who experience prolonged or chronic homelessness seem to be at higher risk. The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation reports,

Youth at highest risk of experiencing five or more years of homelessness reported more mental health issues than lower-risk peers, including depression (66.7% vs. 51.2%) and posttraumatic stress (46.7% vs. 30.4%). This highest risk group also reported higher rates of traumatic experiences including physical abuse (64.6% vs. 39.5%), sexual molestation (46.7% vs. 23.3%), and sexual assault (42.6% vs. 19.0%), as well as higher rates of current substance use including methamphetamine use (40.9% vs. 23.7%) and marijuana use (66.7% vs. 45.9%).

These struggles can lead to drastic consequences. The National Health Care for the Homeless Council reports that “more than 40 percent of homeless teens struggle with depression, which is 12 percentage points higher than their housed peers. School-age children and youth who are homeless are three times more likely to attempt suicide than students who live at home with a parent or guardian.” Additionally, the rate of suicide among LGBT homeless youth is more than double the rate of their non-LGBT homeless peers.

An Appropriate Response: Trauma-Informed Care

Researchers have coined the term “complex trauma” to encompass the interaction among multiple types of traumatic experiences. For RHY youth some occur prior to homelessness, some occur during it, and no two young peoples’ experiences of trauma or reactions to it are the same. Still, a unifying message is clear: proper services and treatment require a baseline recognition that RHY mental health struggles are multifaceted. They need behavioral health services as a standard and sustained part of their case management and recovery.

In response to this, FYSB supports — and many RHY-serving grantees practice — trauma-informed care (TIC). TIC is more than just a single practice or approach. TIC serves as a treatment model for entire organizations and many service providers. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), various TIC models exist but all should include these key elements: (1) realizing the widespread impact of trauma and understanding potential paths to recovery; (2) recognizing the signs and symptoms of trauma in families, staff, and others involved with the system; (3) responding by fully integrating knowledge about trauma into practices, procedures, and practices; and (4) seeking to actively resist re-traumatization. SAMHSA also lists six core principles of TIC, which are designed to support staff as well as the people they serve:

  1. Safety 
  2. Trustworthiness and transparency 
  3. Peer support and mutual self-help 
  4. Collaboration and mutuality 
  5. Empowerment, voice, and choice 
  6. Cultural, historical, and gender issues 

For RHY services, TIC means recognizing and addressing young people’s trauma at every phase of their interaction with a program. There are models for trauma-informed intake processes and therapeutic approaches at RHY programs, and SAMHSA offers a thorough list of TIC resources for serving other youth populations as well. The Administration on Children and Families lists a large number of toolkits and briefs on using TIC in youth settings, arranged by theme. The National Child Traumatic Stress Network has many resources for using TIC in family therapeutic settings.

For youth-serving agencies who are looking to make their entire service array trauma informed, RHYTTAC offers a fact sheet explaining how programs can adopt an organization-wide trauma-informed care model. A SAMHSA brief also outlines ways to bring TIC to the entire youth-serving sector in your community. The Trauma-Informed Care Project lists trainings and events for this field, many of which are applicable to youth services.

About RHYi Issue Briefs

Issue Briefs, developed by the National Clearinghouse on Homeless Youth and Families, provide information about runaway and homeless youth and the issues that affect them.