Homeless youth: Barriers and facilitators for service referrals

https://doi.org/10.1016/j.evalprogplan.2018.02.009Get rights and content

Highlights

  • Current service structures present referral barriers for homeless young people.

  • Service collaboration can produce positive outcomes for homeless youth inter-service referrals.

  • Individual worker can increase referral success for homeless young people.

Abstract

Young people who are homeless and experiencing mental health issues are reluctant to use relevant services for numerous reasons. Youth are also at risk of disengaging from services at times of referral to additional or alternative services. This study aimed to identify barriers and facilitators for inter-service referrals for homeless youth with mental health issues who have already engaged with a service. Qualitative, semi-structured interviews were conducted with homeless youth (n = 10), homelessness support workers (n = 10), and mental health clinicians (n = 10). Barriers included: resource shortages; programs or services having inflexible entry criteria; complexity of service systems; homeless youth feeling devalued; and a lack of communication between services, for example, abrupt referrals with no follow up. Referral facilitators included: services providers offering friendly and client-centred support; supported referrals; awareness of other services; and collaboration between services. Relationships with service providers and inter-service collaboration appeared essential for successful referrals for homeless youth. These facilitating factors may be undermined by sector separation and siloing, as well as resource shortages in both the homelessness and mental health sectors. Service transitions may be conceptualised as a genuine service outcome for homeless youth, and as a basis for successful future service provision.

Section snippets

Homeless youth: barriers and facilitators for service referrals

In Australia’s most recent census, 105, 237 people were identified as homeless and 25% of this group were youth aged 12–24 years (Australian Bureau of Statistics, 2012). In those who are homeless, mental health issues are common (Hodgson, Shelton, van den Bree, & Los, 2013; Medlow, Klineberg, & Steinbeck, 2014). In Australia, the lifetime prevalence of psychiatric disorders in homeless youth was found to be 82–85%, with current prevalence varying between 27.6 and 53% (Kamieniecki, 2001).

Design

This was a qualitative research study with a phenomenological approach aiming to explore the lived experience of service referrals through in-depth interviews. A sample size of n = 10 homeless youth was specified a priori, in keeping with Morse’s (2000) suggestion that 6–10 cases are sufficient when large amounts of data are expected per participant, in phenomenological studies employing in-depth interviews. To triangulate this data, samples of mental health clinicians (n = 10) and homelessness

Results

The participating homeless youth included two males and eight females, ranging in age from 17 to 23 years (M = 20.9 years). Three individuals were homeless at the time of the study, and seven had experienced a past episode of homelessness. Interview duration ranged from 44 to 72 min (M = 53.28).

Participating service providers comprised eight males and 12 females (10 from the homelessness sector and 10 from the mental health sector). Years of experience in their given sector ranged from 2.5 to

Discussion

While homeless young people may access a particular service, be it homelessness or mental health, this is no guarantee that they will access other necessary services. The current study aimed to document the factors perceived to support or interfere with successful inter-service referral transitions, from the perspective of both homeless youth and service providers.

Conclusions

The current findings regarding factors influencing successful or unsuccessful inter-service referrals have some overlap with prior literature on factors influencing general service engagement. The relationship young people have with service providers (involving client-centred support), service accessibility, and service collaboration emerged as essential protective factors when assisting vulnerable young people to access the services they require. Chronic resource shortages (funding, allocated

Funding sources

This work was supported by the Australian Government’s Department of Families, Housing, Community Services, and Indigenous Affairs (ID#1-9GN6JN).

Acknowledgements

The authors would like to thank Elizabeth Bassilios for transcribing some of the interviews, and participants for taking the time to share their stories.

The research team would like to dedicate this paper to our co-author, Cheryl Ritter, who is no longer with us.

Dr Emma Black is a Clinical Psychologist who has worked both in clinical practice and research. She was employed as a Research Fellow at the University of Queensland examining mental health outcomes for Indigenous Australians. Another research interest includes self-injury. Prior clinical roles have involved working in public and private adult mental health services.

References (19)

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Dr Emma Black is a Clinical Psychologist who has worked both in clinical practice and research. She was employed as a Research Fellow at the University of Queensland examining mental health outcomes for Indigenous Australians. Another research interest includes self-injury. Prior clinical roles have involved working in public and private adult mental health services.

Dr Izabela Fedyszyn, PhD, has a background in psychology and currently works as a Research Fellow at the University of Queensland. Her research interests include suicidology, suicide prevention, and mental health. She has previously worked for the Danish government examining and analysing health register data.

Dr Helen Mildred is a Clinical Psychologist and Senior Lecturer at Deakin University. She is Director of the Deakin University Psychology Clinic and supervises provisional psychologists within child and youth mental health. She previously worked in a youth homelessness mental health program, and her research interest is self-injury.

Ms Rhianna Perkin is a psychologist and Program Lead- Practice Methods for EACH Social and Community Health’s Youth and Families program. She has worked in community health and homelessness services for over 15 years.

Mr Richard Lough is the manager for EACH Social and Community Health’s Youth and Family services. Richard is a social worker and outdoor education professional with extensive experience working with young people and adults in mental health, homelessness, and forensic sectors.

Dr Peter Brann is a Senior Clinical Psychologist and the Director of Research and Evaluation at Eastern Health. He has spent many years working in child and youth mental health services, and developing routine outcome measurement. He also occupies a role as an Adjunct Lecturer at Monash University’s School of Clinical Sciences.

Ms Cheryl Ritter was a Senior Clinician who coordinated the Eastern Health Child and Youth Mental Health Community Engagement Program. She has extensive experience in working clinically with a range of marginalised clients, as well as providing consultation and training to a wide range of community organisations.

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