Provider Perspectives on Engaging High Risk Migratory Homeless Youth in Social and Health Services

Background and Purpose: Homeless youth are a diverse population of at-risk adolescents and young adults who experience negative health outcomes, including drug dependence, drug overdose, infectious diseases such as HIV and tuberculosis, and victimization. Homeless youth have documented low rates of service use and have been found to be less likely to seek preventative, and ongoing health care. One subgroup of homeless youth that may be at especially high risk for negative health outcomes, and that providers throughout the United States have encountered barriers to engaging in services, are migratory homeless youth, also known as “travelers.” Migratory homeless youth are less likely to engage in services and experience additional health risks due to their migratory lifestyle. Our study aimed to explore how social and health service providers make decisions about providing outreach and engagement services to migratory homeless youth.

Methods: We conducted in-depth qualitative interviews with social and health service providers who have contact with travelers in Portland, OR (n=12). Participants included 1) street outreach workers, 2) drop-in center/shelter staff, 3) foot patrol officers, and 4) mental health/substance use counselors. Participants were recruited via circulated email flyers to community and city agencies around the Portland region. Interview questions were open-ended and addressed experiences working with travelers, general perspectives regarding differences between travelers and traditional homeless youth, barriers and facilitators to engagement with travelers, and suggestions regarding improving safety, prevention and healthcare of travelers. All interviews were recorded, transcribed, and coded in Atlas.ti.

Results: Participants emphasized migratory status as a critical factor to consider in developing and delivering services to travelers. Successful interventions need to be brief, easily and quickly accessible, aimed at harm reduction, and attentive to the lifestyle and culture of being on the road. Participants described the importance of flexibility and out of the box thinking when working with travelers. Participants also highlighted the need to focus on the social connections among travelers as a strength and source of resilience. Further, participants addressed the need for coordination of intercity and interstate networks of youth serving agencies for travelers. The use of technology as a means for maintaining connections with youth as they migrate was also discussed as a potential resource to further explore in work with migratory homeless youth.

Conclusions and Implications: Current social/health services that are available and effective for traditional homeless youth populations may not be effectively reaching and engaging travelers. Travelers have different needs than traditional homeless youth and due to their migratory circumstances, multilevel, multi-city, combination prevention strategies are urgently needed for this population. In addition to behavioral risk-reduction interventions, travelers need immediate and ongoing access to clean needles, condoms, and other survival services. Increased linkages to care and prevention have the potential to substantially impact the health of this population and prevent future health problems for them as they get older, continue to migrate or, get stuck in homelessness due to addiction, mental health issues or other circumstances.