To be eligible to participate, the young person had to be between the ages of 16 and 19 years and homeless. Our definition of “homeless” was that the adolescent had to reside in a shelter, on the street, or living independently (e.g., friends, transitional living) because they had run away, been pushed out, or drifted out of their family of origin. Based on interviewer reports, approximately 90% of the 505 homeless and runaway adolescents who were approached for an initial interview and who met study criteria agreed to participate in the study. Of the 455 respondents who completed the first baseline interview, 94.3% or 428 (187 males and 241 females) completed the second baseline diagnostic interview. Twenty-six of the 455 original respondents did not complete the diagnostic interview. Those who did not complete the interview had a significantly higher age at first run away (14.84 years vs. 13.41 years). They were more likely to report that they were heterosexual (100% vs. 85% of completers) and less likely to report having been physically victimized when on their own than were completers.
The respondents were interviewed by full time, specially trained interviewers directly on the streets and in shelters in eight Midwestern cities (St. Louis, Kansas City, Omaha, Lincoln, Des Moines, Cedar Rapids, Iowa City, and Wichita). The adolescents ranged in age from 16 to 19 years with an average age of 17.4 years (SD = 1.05). Fifty-nine percent were European American, 22% were non-Hispanic African American, 5% were Hispanic, with the remaining self-identified as American Indian, Asian or Pacific Islander, or biracial. Fifteen percent identified themselves as gay, lesbian, or bisexual. Sixty-two percent of the adolescents reported that the population of their city of origin was 100,000 or greater, 10% said they were from a suburb of a large city, eight percent were from a medium sized city (50,000 to 100,000), eight percent were from a small city (10, 000 to 50,000), and 12% were from small towns or rural communities of 10,000 or less.
The adolescents were informed that this was a longitudinal study and the tracking protocols were explained. Informed consent was a two-stage process. First, the study was explained, and informed consent was obtained from the adolescent. They were assured that refusal to participate in the study, refusal of any question, or stopping the interview process would have no effect on current or future services provided by the outreach agency in which the interviewer was placed. Second, all adolescents were asked if we could contact their parents. If permission was granted, parents were contacted, and informed consent to talk to a minor less than 18 years was verbally obtained. The parents also were asked to participate in a computer assisted telephone interview. Results from the parent interviews are not discussed in this study. If the adolescent was sheltered, we followed shelter policies of parental permission for placement and guidelines concerning in loco parentis for granting such permissions. These policies were always based on state laws. In the few cases where the adolescent was under 18 years, not sheltered, and refused permission to contact parents, the adolescents were treated as emancipated minors in accord with National Institute of Health guidelines (Department of Health and Human Services, 2001
). The consent process and questionnaires were approved by the University of Nebraska-Lincoln Institutional Review Board (#2001-07-333 FB). A National Institute of Mental Health Certificate of Confidentiality was obtained to protect the respondent’s statements regarding potentially illegal activities (e.g., drug use).
The street interviewers underwent two weeks of intensive training regarding computer assisted personal interviewing (CAPI) procedures and administering the four University of Michigan Composite International Diagnostic Interview (UM-CIDI) indices (major depressive episodes, post-traumatic stress disorder, alcohol use/abuse, and drug use/abuse) and one Diagnostic Interview Schedule for Children-Revised (DISC-R) (conduct disorder) index. They then returned to their shelters and administered several “practice” interviews with staff and respondents 20 years or older. After completing their practice interviews the interviewers returned to the university for a second week of training. All interviews were conducted on laptop computers and downloaded electronically to a special secure university server.
We designed a sampling strategy for the current study that incorporated sampling units of fixed and natural sites similar to the design Kipke used in her Los Angeles study of homeless youths (Kipke, O’Connor, Nelson, & Anderson, 2000
) with a year long window of sampling to capture the time dimensions. The sampling design involved repeatedly checking location where homeless youths were likely to be found in each of the target cities. Locations included shelters and outreach programs serving homeless youths, drop-in centers, and various street locations where young homeless people were most likely to be located. Research has demonstrated that using sampling designs that involve multiple points of entry to homeless populations are most effective in generating a diverse sample (Burt, 1996
; Koegel, Burnam, & Morton, 1996
). The interviewers all had prior experience in their respective cities as youth outreach workers and brought considerable knowledge regarding optimal areas of the city for locating youths on their own. The sampling protocol included going to these locations in the cities at varying times of the day on both weekday and weekends over the course of 12 months. Since episodes of homelessness are of varying duration, a one year time frame provided an increased probability of capturing youths who have short-term exposure to homelessness. The interviewers were instructed to continue recruiting until their caseload reached 60 adolescents whom they would then track and re-interview at three-month intervals.
The baseline interview on which the following reports are based was in two parts. The first consisted of a social history and symptom scales. The respondent was then asked to meet for a second interview during which the diagnostic interviews were conducted. These two interviews made up the baseline assessment for the study and usually were completed within one or two days so that no significant time lapsed between the first part of the baseline interview and the second diagnostic interview. The respondents were paid $25 for each interview.
Modules from two diagnostic interview schedules were used to assess the study participants. The University of Michigan Composite International Diagnostic Interview (UM-CIDI) was used to assess major depressive episode, post-traumatic stress disorder, alcohol abuse, and drug abuse. The UM-CIDI is based on Diagnostic and Statistical Manual-III-R (DSM-III-R) criteria and represents the University of Michigan revision of the CIDI (World Health Organization, 1990
) used in the National Comorbidity Survey (NCS) with young people in the same age ranges as those in the present study (Kessler, 1994a
; Kessler, 1994b
; Wittchen & Kessler, 1994
). The CIDI, from which the UM-CIDI is derived, is a well-established diagnostic instrument (Wittchen & Kessler) that has shown excellent interrater reliability, test-retest reliability, and validity for the five diagnoses that were used in this study. The UM-CIDI diagnostic interview schedule has been used extensively with trained interviewers who are not clinicians.
To assess behavioral problems, the conduct disorder module was used from the Diagnostic Interview Schedule for Children-Revised (DISC-R). The DISC-R is a highly regarded, structured interview intended for use with trained interviewers who are not clinicians. It has been shown to have from good to excellent interrater and test-retest reliability (Jenson et al., 1995
; Shaffer et al., 1993
In addition to assessing prevalence and comorbidity of five diagnostic categories, various risk factors known to be associated with the psychological well-being of adolescents also were considered.
The age of the adolescent at time of interview was calculated using the date of birth of the respondent and the date of the baseline interview. Age ranged from 16 to 19 years with a mean age of 17.4 years (SD 1.05).
Adolescents were asked to report the number of times they had left home since the first time they ran. While some individuals were contacted during their first run episode, the majority had numerous experiences with running from home. The total number of runs ranged from 1 to 51 with the mean number of runs of 8.33 (SD 11.28).
Sexual orientation was assessed by a question in which the adolescents identified themselves as straight, heterosexual, gay/lesbian, bisexual, never thought about it, something else, or confused or unsure. The variable was recoded so that any individual listing a nonheterosexual or unsure sexual identity was coded as nonheterosexual.
Adolescents were asked if they had ever spent one or more nights on the street, in an abandoned building, or another place out in the open. Those individuals who had not spent at least one night on the street were coded as 0. Roughly 49% of the sample had spent at least one night on the street.
Victimization when the adolescents were on their own was measured with a series of questions in which the adolescents were asked to report how often they had been beaten up, robbed, asked to do something sexual, sexually assaulted or raped, threatened with a weapon, or assaulted with a weapon. Response categories were never, once, two to five times, and more than five times. The mean scale has an alpha reliability of .72 and ranges from 0 to 3 with higher scores indicating more frequent victimization.
Caretaker abuse was assessed by questions adapted from the Conflict Tactics Scale (Straus & Gelles, 1990
). The youths were asked to report how often they had been punished by being made to go a day without food or water; been abandoned for at least 24 hours; had something thrown at them in anger; been pushed, shoved, or grabbed in anger; been slapped in the face or head with an open hand; been hit with some object; been beaten with fists; been verbally or physically threatened with a gun or knife; been wounded with a gun or knife; been asked to do something sexual; or been forced to do something sexual. Response categories were never, once, two to five times, and more than five times. The mean scale has an alpha reliability of .84 and a range of 0 to 3 with higher numbers indicating a greater frequency of experiencing abuse.
Participation in deviant subsistence strategies was measured by adolescent self-reports concerning the ways they obtained money and how they got food. A list of ways people typically get money and food were presented to the youths, and they were asked if they had used any of these strategies. Among those strategies were some that were considered deviant subsistence strategies. Adolescents were asked to report if they had ever spare changed for money or for food, broken in and taken things from a store, house, etc. for money, engaged in prostitution for money or for food, sold drugs for money, stole or shoplifted food, or engaged in dumpster diving for food. The summated scale has an alpha reliability of .63 and ranged from 0 to 6 with higher values indicating engaging in more deviant subsistence strategies.
Association with deviant peers was measured using a 12-item scale that asked adolescents if any of their friends had engaged in deviant behaviors. Deviant behaviors included running away, selling drugs, using drugs, suspension from school, dropping out of school, shoplifting, breaking and entering, stealing, selling sex, being arrested, and threatening or assaulting someone with a weapon (Whitbeck & Simmons, 1990
). The response categories for each item was 0 = no and 1 = yes. The composite scale ranged from 0 to 12. High scores indicate association with peers who engage in more deviant behaviors. Cronbach’s alpha for this scale of deviant peers was .87.
Elliot’s parental rejection scale (Elliott, Huizinga, & Ageton, 1985
) measured the quality of the parent-child relationship. The five-item scale assessed the perceived amount of care and trust the parent expressed for the adolescent and the extent to which the parent blames the adolescent. Response categories ranged from 1 (strongly agree) to 5 (strongly disagree). Cronbach’s alpha for the measure was .82.
Thornberry’s parental monitoring scale (Thornberry, Huizinga, & Loeber, 1989
) measured the adolescent’s perceived amount of caretaker supervision. The youths were asked to report how often a caretaker knew where they were, how often a caretaker knew whom they were with, how often a caretaker set a time for the adolescent to be home at night, and how often a caretaker knew if the adolescent came home by a set time. Response categories were always, almost always, half the time, almost never, and never. Variables were reverse codes so that higher values indicate greater monitoring. Cronbach’s alpha for the measure was .72.
Caretaker substance treatment was assessed using a series of questions asking the adolescent if any of their biological mother, father, or any other adult they had lived with ever received treatment for a drug or alcohol problem. Forty-six percent of the participants report that at least one caretaker received treatment for their drug or alcohol problems.