A Social-Ecological Analysis of Factors Contributing to Help-Seeking Among Trauma-Exposed Youth Experiencing Homelessness

Background and Purpose: Youth experiencing homelessness (YEH) are often at a significant risk for Post-Traumatic Stress Disorder (PTSD) due to a high prevalence of childhood traumatic experiences as well as victimization during homelessness.  Given their unique challenges, YEH demonstrate varied help-seeking behaviors. The social-ecological framework provides a strong lens for examining the various factors that promote types of help-seeking among YEH with high trauma exposure.  This study utilizes baseline data of a longitudinal study to examine YEH’s utilization of physical health, vocational, and mental health services. Specifically, the current study seeks to answer the following research questions: What social-ecological factors are associated with physical health, vocational, and mental health help-seeking among homeless youth with PTSD? 

Methods: YEH, aged 13 to 26, who used drop-in center services in Los Angeles were recruited and interviewed. Youth participants with Post-Traumatic Stress Symptoms—based on a 4-item, primary care, PTSD screener (PC-PTSD; Cameron & Gusman, 2003)—were included in this study (n=525).  Logistic regression models were conducted to analyze individual, family/peer, and community contextual factors in relation to three types of service utilization (i.e., physical health, vocational, and mental health services) separately.

Findings: Among individual factors, duration of homelessness was associated with increased physical and mental health service utilization, injection drug-use was linked to decreased mental health services, and race/ethnicity was associated with increased help-seeking across all three service types.  For family/peer level factors, foster care involvement was linked to increased mental health help-seeking and social support from street-based peers was associated with greater vocational service utilization.  Among community-level factors, youth who reported receiving social support from community-based providers were more likely to seek out mental health services.

Conclusions and Implications: Overall, help-seeking behaviors among this population are highly complex and influenced by a number of interconnected factors across multiple levels of their ecologies.  The findings of this study illustrate several important implications for helping this economically disadvantaged population.  Our findings support the use of peer-to-peer networks and supports, as well as strengths-based approaches in order to empower traumatized YEH. Structurally, laws and policies should be sensitive to the ways in which they may target or stigmatize YEH, creating additional barriers for them effectively seeking much needed services.