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Social and Structural Barriers to Housing Among Street-Involved Youth Who Use Illicit Drugs Krüsi, Andrea; Fast, Danya; Small, Will; Wood, Evan; Kerr, Thomas May 1, 2010

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Social and Structural Barriers to Housing Among Street-InvolvedYouth Who Use Illicit DrugsAndrea Krüsi, MSc PPH1, Danya Fast, MA1, Will Small, MA1, Evan Wood, PhD, MD1,2, andThomas Kerr, PhD1,21 British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital; Vancouver, Canada2 Department of Medicine; Faculty of Medicine; University of British Columbia, Vancouver,CanadaAbstractIn Canada, approximately 150,000 youth live on the street. Street-involvement and homelessnesshave been associated with various health risks, including increased substance use, blood-borneinfections, and sexually transmitted diseases. We undertook a qualitative study to betterunderstand the social and structural barriers street-involved youth who use illicit drugs encounterwhen seeking housing. We conducted 38 semi-structured interviews with street-involved youth inVancouver, Canada from May to October 2008. Interviewees were recruited from the At-riskYouth Study (ARYS) cohort, which follows youth aged 14 to 26 who have experience with illicitdrug use. All interviews were thematically analyzed, with particular emphasis on participants'perspectives regarding their housing situation and their experiences seeking housing. Many street-involved youth reported feeling unsupported in their efforts to find housing. For the majority ofyouth, existing abstinence-focused shelters did not constitute a viable option and, as a result, manyfelt excluded from these facilities. Many youth identified inflexible shelter rules and a lack ofprivacy as outweighing the benefits of sleeping indoors. Single-room occupancy hotels (SROs)were reported to be the only affordable housing options, since many landlords would not to rent toyouth on welfare. Many youth reported resisting moving to SROs as they viewed them as unsafeand as giving up hope for a return to mainstream society. The findings of the present study shedlight on the social and structural barriers street-involved youth face in attaining housing andchallenge the popular view of youth homelessness constituting a life-style choice. Our findingspoint to the need for housing strategies that include safe, low threshold, harm reduction focusedhousing options for youth who engage in illicit substance use.Keywordshomelessness; youth; housing; service accessibility; substance use; qualitative methodsSend correspondence to: Dr Thomas Kerr, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C.,V6Z1Y6, CANADA, Phone: (604) 806-9116, Fax: (604) 806-9044, uhri-tk@cfenet.ubc.ca.ContributionsAndrea Krüsi prepared the first draft of the manuscript. Danya Fast, Will Small, Andrea Krüsi and Thomas Kerr designed the datacollection instruments and conducted the analyses of the data. All authors contributed to the design of the study as well to the revisionof the manuscript.Conflict of InterestNone of the authors have a conflict of interest to declare.NIH Public AccessAuthor ManuscriptHealth Soc Care Community. Author manuscript; available in PMC 2011 May 1.Published in final edited form as:Health Soc Care Community. 2010 May ; 18(3): 282–288. doi:10.1111/j.1365-2524.2009.00901.x.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptIntroductionIn an increasingly urbanized world, youth who live, work, or spend much of their time onthe streets, constitute a growing global concern (UN, 2008). In the United States there areapproximately 1 million street-involved youth (Shane, 1996, Ringwalt et al., 1998), andCanadian reports suggest that around 150,000 youth are living on the street in Canadiancommunities (DeMatteo et al., 1999). Compared to the general age matched population,street-involved youth face an 8 to 11 times higher risk of mortality (Roy et al., 2004). Streetinvolvement, homelessness, and unstable housing have been associated with various risksamong youth, including increased levels of alcohol and substance use (Wood et al., 2006,Kral et al., 1997), injection drug use (Roy et al., 2004), and increased risk of blood-borneinfections (Friedman et al., 1997, Strathdee et al., 1997), sexually transmitted diseases(Friedman et al., 1997, Shields et al., 2004) and increased exposure to violence (Kipke et al.,1997, Rachlis et al., 2009, Whitbeck et al., 1997). These risks are further exacerbated by thefact that street-involved youth face a myriad of barriers in accessing health and socialservices, such as difficulty trusting adult service providers, fear of discrimination, fearconcerning confidentiality, lack of personal identification, (Geber, 1997) and a reluctance toaccess services that are geared towards homeless adults (Ensign & Gittelsohn, 1998).While some of the barriers to care and support that street-involved youth face have beenidentified previously, the social and structural barriers drug using street-involved youth facewhen seeking housing have not been thoroughly investigated. Therefore, we undertook thisqualitative study to examine the social and structural barriers street-involved youth who useillicit substances encounter when seeking housing.MethodsWe drew upon data from 38 in-depth, semi-structured qualitative interviews conducted fromMay to October 2008 in Vancouver, Canada. Interviewees were recruited from the At-riskYouth Study (ARYS) cohort, which was initiated in 2005, and involves the ongoing followup of over 500 youth aged 14 to 26 who have experience with illicit drug use other thanmarijuana (Wood et al., 2006). Participants for qualitative interviews were selected on adaily basis from persons attending the research office for their semi-annual quantitativecohort interviews. Sampling for the qualitative study aimed to attain variation in gender,ethnicity and age, to reflect the socio-demographic profile of the ARYS cohort. None of theARYS participants who were offered to participate in the present qualitative study refusedparticipation and there were no drop outs during the interview process.Interviews were conducted by three interviewers (two female and one male) with extensiveexperience in qualitative interviewing. All interviews were conducted at the study office,which is located in Vancouver's Downtown South, an area where many street-involvedyouth congregate and spend much of their time. The Downtown South is a residential andentertainment district characterized by both high- and (limited) low-income housing andnumerous businesses. In addition to research services, the study office also offers daily drop-in hours during which coffee is served and youth can make use of two one-site computers.All interviewers are well known among the study participants due to their frequentinteractions with many of the youth during drop-in hours. The supportive presence of studystaff in the street youth community and the pre-existing relationships with many of theresearch participants facilitated rapport between the youth and interviewers during thequalitative interviews. All interviews were facilitated through the use of a topic guideencouraging broad discussion related to participants' substance use, their daily activities,their current housing situation, their experiences with social and health care services andtheir experiences with seeking housing.Krüsi et al. Page 2Health Soc Care Community. Author manuscript; available in PMC 2011 May 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptInterviews lasted between 30 and 120 minutes and were tape-recorded, transcribed verbatimand checked for accuracy. The thematic categorization of the interview transcripts wasfacilitated by the use of ATLAS.TI. Interview data was initially coded based on key themes.Substantive codes were then applied to categories/themes based on the initial codes. Theresearch team discussed the content of the interviews throughout the data collection andanalysis processes, thus informing the focus and direction of subsequent interviews (e.g.,through the addition of new questions and probes), as well as developing and refining acoding scheme for partitioning the data categorically.All participants provided written informed consent for participation and were remuneratedwith Can$ 20. The study was conducted with the appropriate approval of the ProvidenceHealth Care/University of British Columbia Research Ethics Board. There were no refusalsof the offer to participate in the interview, and no dropouts occurred during the interviewprocess.ResultsSample CharacteristicsThe sample of 38 qualitative interview participants was composed of 18 women, 18 men and2 transgender individuals. At the time of the interview, 20 participants were homeless, 13lived in single-room occupancy hotels (SROs), two participants stayed at a shelter, twoparticipants rented a private apartment, one participant stayed with parents and one wasstaying in a group home. Sixty-seven percent of study participants were Caucasian, 28percent self-identified as being of Aboriginal descent, and 5 percent were African Canadian.The age of participants ranged from 16 years to 26 years. The median age was 22.Nobody's there to helpParticipants highlighted a multitude of social and structural barriers in their efforts to attainhousing. On the structural level, many youth reported a lack of formal support in trying toattain a safe place to live. Numerous youth emphasized their struggles navigating thebureaucratic welfare and housing system and many felt unsupported in their quest to findstable housing. Over time, many participants appeared to lose confidence that they would beable to attain a safe and stable place to live.Nobody's there to help. There's no housing workers anymore. X [local youth servicesite] did have housing workers, and a month and a half later, they got pulled. So itwas like, pointless! I lose confidence that I'm getting anywhere. (Female Participant#7)I've never been on welfare. I went there to apply, and they just, I think that theyknow I don't know what I'm doing, and they just sloughed me off. It's not like I'vebeen in the system for fuckin' ten years and be, like, no, you can't do this, cause Idon't know. They said I have to prove that I had no source of income for the pasttwo years. Like, I have to get my criminal record here. But it's impossible. I have awarrant back home [in another Canadian Province] and shit like that, I called mylawyer, but he's a fall down, so. (Male Participant #32)Shelters - It's like the worst of both worldsYouth's reports indicated that the overregulation of government-sponsored sheltersconstituted a significant structural barrier to accessing a safe place to sleep. Only twoparticipants had stayed at a youth shelter at the time of the interview. Without exception,youth viewed the support offered by shelters as inadequate and unsuitable for them. Whilefor many participants, in particular for female youth, having a safe place to sleep constitutedKrüsi et al. Page 3Health Soc Care Community. Author manuscript; available in PMC 2011 May 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscripta main priority in their lives, the highly regulated and institutional environment of sheltersconstituted a substantial structural barrier for youth since it failed to accommodate thecurrent reality of their street life and substance use. For many youth, the benefits of sleepingindoors were outweighed by the lack of autonomy and privacy and by the strict rules andregulations shelters impose on their lives.I hate the shelters. It's like the worst of both worlds. You get all the negativeaspects of being a street kid and you get all the negative aspects of being inside.You've got to go to bed early, you have all these chores, you don't get any privacy,the showers and the food sucks. Everything sucks about it. (Male Participant #27)In emphasizing the institutional character of the shelter settings, some youth drew a parallelbetween their experiences of shelters and of correctional facilities. Being under constantobservation, obeying a rigidly enforced set of rules and having only restricted access to thefacility constituted substantial barriers for many of the youth. As a result, despite thereported downsides of sleeping outdoors, such as a lack of safety, health concerns, constantexposure to the drug trade and exposure to the elements, staying at a shelter did notconstitute a desirable alternative to sleeping outdoors for many youth.I can't really stay in shelters and shit ‘cause of all that jail time, so it's like, aninstitution to me, that's the way I see it. And I like, fuckin’ wig out so I can't go toplaces like that…I've done about five or six years, that's where I grew up… And Ican't really stay there ‘cause it's like, I don't know, I gotta buzz this thing to get inthis door and shit like that. It's like, I feel trapped type deal, you know? (MaleParticipant #32)For most youth, the zero tolerance policy regarding alcohol and substance use at youthshelters constituted an important barrier to obtaining temporary indoor shelter and buildingtrusting relationships with service providers. Many youth described situations when theywere excluded from youth shelters on the suspicion of being intoxicated. Youth highlightedthe inappropriateness of a zero tolerance policy in the context of other shelter rules that theyviewed as out of place, such as no swearing, an 11 o'clock curfew and severe restrictions onwhat TV programs they are allowed to view. For many, not being able or willing to complywith the strict rules of the shelter environment negatively impacted upon their belief that anexit from street life is indeed a possibility. These conditions were said to give rise to strainedrelationships with service providers and continuous rejection from facilities, resulting inyouth cycling through the system, and ending up on the streets once more. As such,participants' accounts highlight that the restrictive environments at youth shelters constitutesubstantial structural and social barriers for youth trying to access a safe place to sleep and/or attempting to transition out of street life via the shelter system.X [main local youth shelter] is a really strict program….It sucked. You're notallowed to swear, you're not allowed to watch anything that's more than PG-13,you have to be in bed by 11…You're not allowed in there during the day. You're notallowed to do any drugs or else you're instantly booted. Every time you walk in thedoor, they give you a bunch of tests and stuff. If they even suspect you're high, theytake you into the back room for like 20 minutes and give you a bunch of tests. Ican't stand doing that. It feels like jail…I can't handle rules, that's why I liveoutside… I've given up on that kind of stuff. I've been pretty depressed. (MaleParticipant #25)While youth criticised the strict rules and regulation enforced in youth shelters, the majorityof youth had not accessed any of the adult-focused homeless shelters, as they viewedthemselves as distinct from more street-entrenched homeless adults.Krüsi et al. Page 4Health Soc Care Community. Author manuscript; available in PMC 2011 May 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptIt's hard to get a place, especially if you're on welfareAnother housing option theoretically available and much desired by street-involved youth isprivately owned apartments. At the time of interview two participants were livingindependently in an apartment. Securing an apartment appears to be the housing option thatis most difficult to attain due to structural constraints such as insufficient welfare payments,high rent costs and damage deposits, as well as significant social barriers such asdiscrimination against youth on income assistance. Many youth reported experiencingsevere discrimination when trying to rent an apartment and expressed disillusionment withregards to ever finding a place of their own.It's hard to get a place, especially if you're on welfare. You don't get that muchmoney on welfare. So it's hard to find a place. Who will rent to younger people,because they don't trust them. They think, they're gonna ruin the place and thatthey're gonna party too much, or that they're gonna use drugs there…It's so hard, Idon't even try any more. So I can't even get a place, and I get money from welfareto get a place. (Female Participant #1)I want to get a place. Anywhere, I don't care. There's no one that'll actually do thatbecause everyone in this city knows us, we're labelled. They don't want us in theirstore, near their store, in the coffee shop, near the coffee shop washroom, near anywashroom for that matter. It's harsh. I don't know if I can handle the streetsanymore. It's really breaking me down. (Male Participant #28)It's damn near impossible to find a place when you're on welfare. No one wants tosign my fucking intent to rent form, except for crack hotels. You can't get a normalroom in a place with one of those because people go, “Oh this guy's on welfare. Hedoesn't work. He's going to steal my stuff. He's going to do nothing but causetrouble.” They automatically assume all these things. (Male Participant #25)I don't want to be one of those people living in a crack hotelDue to their affordability and relative ease of access, many street-involved youth describedSROs as their only independent housing option. Thirteen of the youth in our sample wereliving at an SRO at the time of the interview. Many youth who had stayed at SROs reportedderelict and unhygienic living conditions, marked by inadequate sanitary facilities, andinsect and rodent infestation. Participants reported several environmental and social barriersto living in SROs, including feeling unsafe in these living environments due to intense drugconsumption, continued exposure to drug trade-related violence and fear of being takenadvantage of by older, more experienced residents. In contrast to the zero tolerance shelterenvironments, drug use was described as a ubiquitous feature of SRO living environments.While youth harshly criticized the zero tolerance policy enforced in many youth shelters,youth described the unconcealed drug use at many of the SROs as contributing to a chaoticand somewhat menacing environment.It's fucking gross. It was just like a lot of junkies, crackheads and cockroaches andmice…People want to rob you. It's unsafe there. Police were coming in, you couldhear the cops, like, always in the building…You could hear people smashing eachother out, fighting, screaming and flailing through the halls and knocking on yourdoor in the middle of the night. (Female Participant #35)The last place [SRO] I lived in, when I moved in, I had to put big bolts through thedoor frame just so the door would close because it's been kicked in, maybe a dozentimes prior to me moving in. Everything there, the security guards there are all onthe sly. There's no doubt in my mind that if I gave them twenty bucks I could walkKrüsi et al. Page 5Health Soc Care Community. Author manuscript; available in PMC 2011 May 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptupstairs and beat the crap out of anybody I wanted. And it's just run like that. Youfeel it, you know? You live there, you know what's going on. (Male Participant #27)Further, many youth viewed a move into an SRO as ‘giving up’ on potential futurereintegration into mainstream society and as setting themselves up for a lifetime of povertyand substance use. Consequently, moving into an SRO did not constitute a suitable housingoption for many youth.I don't think I'm ready to [move into an SRO], I don't want to let go of the idea thatI might actually have a life. I want to go to college. I want to be a social worker. Iwant to be an alcohol counsellor. That's all I want to do with my life. And I'm soclose to giving up on that, but I don't want to. I don't want to be one of those peopleliving in one of those crack hotels, shooting up dope. I don't want to spend the restof my life like that. (Male Participant #25)DiscussionThe results of this analysis indicate that street-involved youth who use illicit substancesexperience a wide range of social and structural barriers when seeking shelter and housing.Structural barriers commonly experienced by street-involved youth include a lack of formalsupport in securing housing and appropriate income support, as well as barriers related tooverly restrictive and abstinence-based shelters. Youth also reported social barriers, such asa lack of trust between shelter staff and youth, as well as discrimination when seeking morepermanent housing. As a result of such challenges, some youth relied on single-roomoccupancy hotels (SROs) for temporary shelter, although residing in such accommodationswas viewed as dangerous and as ‘giving up hope’ for a return to mainstream society.Consistent with previous work from the US (Carlson et al., 2006), the vast majority of youthreported an intention to leave street life and find a stable place to live. As such the results ofthis analysis challenge the popular view of youth homelessness as constituting a life-stylechoice and highlight the social and structural barriers street-involved youth face in attainingsafe housing. In line with reports from other settings (Kidd, 2003, Turnbull et al., 2007),youth expressed frustration and mistrust in navigating the bureaucratic welfare and housingsupport systems. Many youth also reported that, in addition to a perceived lack of support byservice providers, low welfare payments and high rent costs constituted significant structuralbarriers in finding a stable place to live (Daiski, 2007). Several youth drew a directconnection between funding cuts for youth services and reduced support in finding a stableplace to live (Frankish et al., 2005, Muckle &Turnbull, 2006). Resonating with previouswork, which highlighted the suspicion and rejection street-involved youth face whenattempting to move away from their street life toward employment and a more mainstreamexistence (Daiski, 2007, Haldenby et al., 2007), numerous youth highlighted how landlords'reluctance to rent to young people on welfare constituted a significant social barrier toattaining independent living. The conceptualization of street-involvement and substance use,as the result of moral deviance and repeated bad choices at the individual level, continues tobe highly prevalent internationally (Baumohl, 2003) and amplifies the social exclusion anddisadvantage street-involved youth face in their quest for housing.Complementing previous reports which identified low rates of shelter use among street-involved youth (Carlson et al., 2006), our findings shed light on some of the reasons behindstreet-involved youth's avoidance of shelters. Consistent with previous work from varioussettings, our findings indicate that a lack of privacy, fear of violence (Daiski, 2007, De Rosaet al., 1999, Frankish et al., 2005) and difficulties to abide by strict shelter rules (Daiski,2007, Feldmann & Middleman, 2003) constitute significant barriers to attaining temporaryshelter among street-involved youth. To date, there has been limited consideration of theKrüsi et al. Page 6Health Soc Care Community. Author manuscript; available in PMC 2011 May 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptimpact of zero tolerance approaches to alcohol and substance use on access to youthshelters. Our findings indicate that a zero tolerance approach to substance use and thepossibility of losing one's bed, even on the suspicion of being intoxicated, severely restrictsaccess to youth shelters for the majority of youth in our setting, where substance use ishighly prevalent among street-involved youth (Wood et al., 2006). Youth reports indicatedthat staff's constant suspicion regarding intoxication also constituted a significant socialbarrier to forging trusting relationships. This is problematic given that a primary function ofyouth shelters should be to support youth in connecting with more permanent housingarrangements (Daiski, 2007, Miller and Keys, 2001). Trusting relationships with staff areinstrumental in achieving this goal (Karabanow, 2008); however, the constant threat ofbeing banned from shelters can undermine youth's openness and trust (Miller and Keys,2001). For many street-involved youth, trusting adults is very difficult as many harbourfeelings of victimization and exploitation from their previous relations with caregivers(Feldmann and Middleman, 2003). A negative view of the help available and repeatedfailure in attempting to attain support may contribute to youth's hopelessness in connectingwith services (Kidd, 2003, Miller and Keys, 2001).In line with previous research reporting limited use of services targeting adults (Ensign,2004, Ensign & Gittelsohn, 1998), the youth in our sample did not access adult homelessshelters, as they view their street-involvement as less permanent and distinct from homelessadults, who youth described as more street entrenched and hopeless. Similarly, despite theiraffordability, the majority of youth did not view SROs as a viable housing option. Manyexpressed feeling unsafe in these often unstable environments, which were characterized bydrug trade violence and open drug use. Youth viewed themselves as distinct from adult SROresidents, which some referred to as “bin divers”, “junkies” and “bums” (Ensign &Gittelsohn, 1998). Consequently, some youth resisted these labels by avoiding SROs, asthese “junkie” spaces (Malins et al., 2006) are often viewed as sites of hopelessness and lastreserve (Rew, 2008). These findings collectively shed light to the intrinsic relationshipbetween youth identity, housing, and hope (Rew, 2008).Our findings indicate that the majority of youth in the present study remained homeless ormarginally housed in the absence of viable housing alternatives. Our study further highlightsthe need for well resourced youth housing services (Muckle & Turnbull, 2006) that includesafe low threshold harm reduction focused housing, with a minimal number of expectationsplaced on residents. Low threshold services have the potential to allow youth to movetowards a reduction in their drug use (Slesnick et al., 2008), and potentially abstinence, attheir own pace while securely housed and removed from the risks associated withhomelessness, unstable housing (Kral et al., 1997, Roy et al., 2004, Shields et al., 2004,Wood et al., 2006) and SRO environments (Evans & Strathdee, 2006). This call resonateswith findings from Australia and the US that indicated a strong positive relationship betweenquality of accommodations for street-involved youth and a reduction in HIV risk behaviours(Milburn, 2007) and substance use (Slesnick et al., 2008). While a harm reduction approachto housing is slowly becoming more widely accepted among services targeting marginallyhoused adults (Evans & Strathdee, 2006, Tsemberis, Gulclur, & Nakae, 2004), it appears tostill be more controversial in the context of youth services internationally (Slesnick et al.,2008, Milburn et al., 2008). There is an urgent need for research documenting the effects oflow threshold, harm reduction based housing for street-involved youth on youth's substanceuse patterns, health outcomes and abilities to exit from street life.The present study has a number of limitations. There is a possibility that the viewsrepresented in our sample are not entirely representative of the views of the larger streetyouth community in our setting. Specifically, it may be the case that our sample included themost high risk youth. This study focused exclusively on the views of youth who have aKrüsi et al. Page 7Health Soc Care Community. Author manuscript; available in PMC 2011 May 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscripthistory of illicit drug use. Therefore, the views of street-involved youth who do not use illicitsubstances are not represented in this study. Additionally, this study focuses on the housing/shelter situation for street-involved youth in Vancouver, Canada; the barriers to housing maydiffer somewhat in other settings internationally. However, as outlined above, youth reportdifficulty accessing bureaucratic welfare systems in diverse settings internationally (Daiski,2007, Milburn et al., 2007), and highly regulated housing programs enforcing a zero-tolerance approach to substance use are the norm in many countries (Daiski, 2007,Feldmann & Middleman, 2003, Milburn et al., 2007). As such, our findings have directimplications for youth housing programs internationally by highlighting the importance oflow-threshold housing programs.In summary, the findings of our study highlight the many social and structural barriersstreet-involved youth face in seeking shelter and housing, including structural barriersrelated to services and support systems, as well as social barriers experienced in seekingmore permanent accommodations. Our findings point to the need for housing strategies thatinclude safe, low threshold, harm reduction focused housing options for street-involvedyouth who engage in illicit substance use.AcknowledgmentsThe authors wish to thank the study participants for their time and participation. We also thank the research andadministrative staff at the B.C. Centre for Excellence in HIV/AIDS for their research assistance including JulioMontaner, Deborah Graham, and Leslie Rae. This study was supported by CIHR grants (MOP-81171; HHP-67262;RAA-79918) and NIH grant (R01 DA011591). Thomas Kerr is supported by a Michael Smith Foundation forHealth Research Scholar Award and a Canadian Institutes of Health Research New Investigator Award. Will Smallis supported a Michael Smith Foundation for Health Research Senior Graduate Studentship and a CanadianInstitutes of Health Research Doctoral Research Award.ReferencesBaumohl J, Speiglman R, Swartz J, Strahl R. Substance abuse and welfare policy at the new century.Contemporary Drug Problems. 2003; 30:501–537.Carlson JL, Sugano E, Millstein SG, Auerswald CL. Service utilization and the life cycle of youthhomelessness. Journal of Adolescent Health. 2006; 38:624–7. [PubMed: 16635781]Daiski I. Perspectives of homeless people on their health and health needs priorities. Journal ofAdvanced Nursing. 2007; 58:273–81. [PubMed: 17474916]De Rosa CJ, Montgomery SB, Kipke MD, Iverson E, Ma JL, Unger JB. 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