Runaway Adolescents: Today’s Huckleberry
Finn Crisis
David W. Springer, PhD
This article suggests that it is primarily the Huck Finns, not the thrill-seeking Tom Sawyers,
who often find themselves in runaway shelters and in need of crisis intervention and other
services. Accordingly, this article is intended to serve as an overview of the runaway crisis. A
review of relevant literature on runaway youth is provided; this review includes a synthesis
of the key characteristics of runaway youth that have been addressed in the literature to
date. Additionally, the Life Model is presented as a suggested lens through which to view
the runaway crisis. Runaway shelters, as one means of responding to the runaway crisis, are
briefly discussed, along with recommendations for assessment and treatment with youth in
these settings. Implications for practice, research, and policy related to runaways are
provided. [Brief Treatment and Crisis Intervention 1:131–151 (2001)]
KEY WORDS: runaway youth, adolescents, runaway shelters, crisis intervention.
Pap, he hadn’t seen me for more than a year, and
that was comfortable for me; I didn’t want to see
him no more. He used to always whale me when he
was sober and could get his hands on me; though I
used to take to the woods most of the time when he
was around.
—Mark Twain,
The Adventures of Huckleberry Finn
In Mark Twain’s classic The Adventures of Huckleberry Finn, family conflict and physical abuse
From the School of Social Work, The University of Texas at
Austin
Contact author: David W. Springer, LMSW-ACP, PhD, Associate Professor, The University of Texas at Austin, School
of Social Work, 1925 San Jacinto Blvd., Austin, TX 78712. Email: [email protected].
©2001 Oxford University Press
initially lead America’s most famous runaway to
become homeless. Following his mother’s death,
Huck is left alone with his physically abusive alcoholic father. As a result, Huck leaves home. It
is primarily the Huck Finns, not the thrillseeking Tom Sawyers, who often find themselves in runaway shelters and in need of crisis
intervention and other services.
Youths experiencing an acute crisis episode are
likely to experience “overwhelming feelings of
anxiety, agitation, volatility, depressed mood
and withdrawal, helplessness, intense fears,
night terror, and/or exhaustion [that] culminate
in a state of disequilibrium and the inability to
cope” (Eaton & Roberts, in press, p. 89). Huck
Finn reached a point where being “whaled on”
by his father was more than he could cope with,
and his solution was to run away from home. To-
131
SPRINGER
day, it is estimated that over one million youths
run away from home each year (National Runaway Switchboard, 2001) as a way to cope with
various problems and crises.
This article is intended to serve as an
overview of the runaway crisis. Accordingly, it
will review relevant literature on runaway
youth; this review will include a synthesis of
the key characteristics of runaway youth that
have been addressed in the literature to date.
While an exhaustive review of the literature is
beyond the scope of this article, the review is
intended to be representative of the relevant literature. Additionally, the Life Model (Germain
& Gitterman, 1980, 1986; Gitterman, in press)
will be presented as a suggested lens through
which to view the runaway crisis. Runaway
shelters, as one means of responding to the runaway crisis, will be briefly discussed, and recommendations will be offered on assessment
and treatment with youth in these settings using Roberts’ (1991, 1996, 2000) seven-stage crisis intervention model as a conceptual framework for intervention. Implications for practice, research, and policy with runaway youths
will be provided.
Who Is a Runaway Youth?
Numerous definitions of the runaway may be
found in the relevant literature (cf. Grigsby,
1992; Kurtz, Jarvis, & Kurtz, 1991; Post & McCoard, 1994; Ray & Roloff, 1993; Shane, 1991).
The Federal Department of Health and Human
Services (HHS) defines a runaway as follows: A
youth is a runaway when he or she “is away from
home without the permission of his or her parent(s) or legal guardian . . . [or] . . . is absent from
his or her home or place of legal residence at
least overnight without permission” (General
Accounting Office, 1989, p. 13). Most definitions provided in the relevant literature concur with the notion that a youth is considered a
132
runaway if he or she leaves home without the
permission of his or her parent(s) or legal
guardian(s) (Fry, 1982; Post & McCoard, 1994;
Rotheram-Borus, 1991) for a specified period of
time, usually 24 hr or overnight (Kurtz, Kurtz, &
Jarvis, 1991; Sommer, 1984).
A major distinction made among runaways
that warrants attention here is between “runaways” and “throwaways.” Whereas runaways
attribute their current status to an act of their
own choosing, throwaways often report having
had no alternative, because they were ejected
from their homes (Hier, Korboot, & Schweitzer,
1990). Adams, Gullotta, and Clancy (1985) describe runaways as youth who have left home
for reasons of family conflict and poor social
relations, while throwaways are youth who are
actively encouraged to leave home, rejected, or
abandoned. Various terms are used to refer to
throwaways, including pushouts (Kurtz, Kurtz,
& Jarvis, 1991) and castaways (Shane, 1991).
(According to the most recent statistics available
from the National Runaway Switchboard [2001],
just over three-fifths [61%] of youth are runaways and 4% are throwaways.) In addition to
this basic distinction between runaways and
throwaways, numerous other categorizations, or
typologies, of runaways are found in the literature.
Typologies of Runaway Youth
The disparate typologies reflect differing definitions and concepts of runaway behavior. The
concept “runaway” has been challenged as being overly simplistic and not adequately descriptive of this group of youth. The heterogeneous classifications described below call into
question the intuitive, single-dimension concept that the term runaway provokes.
Kurtz, Jarvis, and Kurtz (1991) identify five
major types of youth found among the homeless
population, which includes runaways. The first
type includes youth who are members of home-
Brief Treatment and Crisis Intervention / 1:2 Fall 2001
Runaway Adolescents
less families but who have been separated from
those families. These youth may be placed in
the foster care or emergency shelter system and
consequently experience disintegration of any
residual ties with their families. A second group
includes youth who leave home in order to escape physical and sexual abuse. The third type
is comprised of youth who have been thrown
or pushed out of their homes by parents or
guardians. In these cases the caretakers want the
youth to leave home, and under pressure, the
youth reluctantly does so. These youths are often forced out because of the family’s economic
problems and instability. A fourth group of
homeless youth is seen as doubly homeless.
They have been ejected or removed from homes
at an early age due to family abuse, neglect, or
unwillingness or inability to care for them. They
are then taken into state custody and placed in
unsuitable and inappropriate settings. When
these placements become intolerable, the youth
leave for the streets. The final group of homeless
youth is identified by these authors as those
who have immigrated unaccompanied to the
United States and who are attempting to make
themselves inconspicuous. Because they have
no legal status and may face deportation if identified, they try to avoid government detection.
This lifestyle makes them prime targets for recruitment into gangs, prostitution, and drug
dealing.
Shane (1991) provides a categorization of runaways that contains both similarities with and
subtle differences from that of homeless youths
provided by Kurtz, Jarvis, and Kurtz (1991).
Here, the first category includes castaways,
pushouts, or throwaways whose parents or
guardians have put them out of their homes
against the youth’s will. The second category
consists of those who have been abandoned, or
left by their family. The third category is not one
that is found in the classification system of
Kurtz, Jarvis, and Kurtz (1991). This consists of
a mutual agreement between the youth and his
or her parents to part ways. The fourth category
includes youth who have been removed from
their homes by protective agencies. Shane’s fifth
category is comprised of those youth whose
families have been victims of some emergency
that prevents them from being housed with the
family. A subgroup of homeless youth is presented as “street kids,” or those who essentially
live on and off the streets. Finally, there are the
runaways, who Shane (1991) defines as youth
who are absent from their custodial home without the permission of their parent(s) or custodian(s) and who are wanted in the home.
Pennbridge, Yates, David, and MacKenzie
(1990) provide a seven-category typology that
was developed on the basis of characteristics
of youths who were assessed at intake at various agencies in Los Angeles County that provide services to runaway and homeless youth.
The first category involves families experiencing considerable parent-child conflict, usually
around issues of control. The remaining intake
categories are based on three discrete parameters: (a) how long the youth have been away
from home, (b) how many times they have run
away, and (c) whether or not they have been
abused by the primary caretakers (parental or
foster). Pennbridge and colleagues (1990) provide the following categories:
1. Prerunaways. These youths are typically
brought to a shelter by a parent. Those in
this category may, or may not, have a history of abuse.
2. Situational runaways. These youths have
run away from home once or twice and do
not report a history of abuse or neglect.
3. Justifiable runaways. These youths have
run away once or twice and report that
they were abused or neglected by their
primary caretaker(s).
4. Chronic runaways. Youths who are chronic
runaways have run away three or more
times or have been in three or more foster
Brief Treatment and Crisis Intervention / 1:2 Fall 2001
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or group homes. These youths do not report a history of abuse or neglect.
5. Chronic runaways with a history of abuse
or neglect. These youths have run away
three or more times or have been in three
or more foster or group homes. In contrast
to the previous category, those in this
group report a history of abuse or neglect
by their primary caretaker(s).
6. Homeless youth. Homeless youth are those
who have been away from home and fending for themselves for two months or
more, who have been told to leave home
by their primary caretaker (i.e., pushouts,
throwaways, abandoned adolescents), and
are essentially emancipated minors.
7. Homeless youth with a history of abuse or
neglect. These youths have been away
from home and fending for themselves for
two months or more, have been told to
leave home by their primary caretaker
(i.e., pushouts, throwaways, abandoned
adolescents), and are essentially emancipated minors. These youths report a history of abuse or neglect from their primary caretaker(s).
Roberts (1981) presented a five-point scale describing an emotional conflict continuum for
runaways, based on his in-depth interviews
with 30 runaway and 30 nonrunaway youths.
The five types are as follows.
AQ1
1. Nonrunaways. Nonrunaways experience
minimal conflict with their parents, and
are able to resolve whatever conflict does
occur.
2. Runaway Explorers and Runaway Social
Pleasure Seekers. Explorers desire to travel
alone (or with a friend) for adventure, and
wish to assert their autonomy. Leaving
without their parents’ permission, these
youths are likely to leave their parents a
note letting them know that they have
134
left, or contact their parents once they
have left to let them know that they are
okay. (These are today’s Tom Sawyers!) Social Pleasure Seekers are usually female
youth who have had a conflict (e.g., early
curfew, dating) with their parents that
leads to them leaving home, even though
they may have had a good relationship
with their parents prior to this conflict.
These youths typically sneak out of the
house following the conflict.
3. Runaway Manipulators. Unlike the Social
Pleasure Seekers, who leave after one conflict, Runaway Manipulators are frequently in conflict with their parents.
These youths believe that their siblings or
friends are treated better than they are
treated. Runaway Manipulators see running away as a means to “cool off,” and
hope that their absence will cause their
parents concern so that when they return,
the parents will be more likely to compromise.
4. Runaway Retreatists. Frequent conflict
with parents, sometimes marked by parents yelling and hitting or throwing objects at the youth, lead to Runaway Retreatists impulsively running away from
home to retreat from the conflict. The conflict experienced by these youths is more
intense than the conflict experienced by
the Runaway Manipulators. These youths
are likely to engage in drug use as means
of escape.
5. Endangered Runaways. These youths are
the victims of repeated physical or sexual
abuse from parents or stepparents. Endangered youth are likely to use drugs such
as amphetamines or LSD. These youths
run away from home because of a recent
beating, or the threat of a future beating.
These typologies provided by Kurtz, Jarvis,
and Kurtz (1991), Shane (1991), Pennbridge et al.
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Runaway Adolescents
(1990), and Roberts (1981) appear to be some of
the most thorough that have been presented to
date. Other useful classifications do exist, however (cf. Adams et al., 1985; Dunford & Brennan,
1976; English, 1973; Farber, Kinast, McCoard, &
Falkner, 1984; Kufeldt & Nimmo, 1987).
This overview of various typologies illustrates that no universally agreed upon categorization of runaways exists. Just as many typologies have been explored, so have there been
many characteristics of runaway youth examined in the literature.
Literature Review
This review of the literature is couched in a historical or chronological perspective. This review is not intended to provide an exhaustive
historical summary. Rather, the temporal perspective simply provides a framework to review
the evolving runaway literature. The reader is
referred to other sources for a more detailed exposition on the history of runaways (cf. Appathurai, 1991; Lipschutz, 1977; Rothman,
1991).
The act of youths running away from home is
not a new phenomenon. Perhaps the first example of this behavior was described in the
story of the prodigal son presented in the Bible.
From earliest times parents were given authority
over their offspring. “The Roman concept of
potestas covered the absolute power of the father
over his children to the extent of leasing or selling them and putting them into slavery or even
to death” (Rothman, 1991, p. 12).
Rothman (1991) goes on to describe the colonial period as it pertains to runaways. The first
law pertaining to unruly children, enacted in
the Massachusetts Bay Colony in 1646 and modeled on the Book of Deuteronomy, allowed the
use of the death penalty with male children over
the age of 16 who exhibited rebellious behavior.
The view of the young person as a potential
economic asset and of running away as a social
and economic disruption continued through
the 17th and much of the 18th centuries. In the
late 18th and early 19th centuries an accelerated rate of immigration; the importation of
large numbers of young servants; and the nation’s gradual secularization, industrialization,
and urbanization combined to decrease the economic utility of American children and to increase the number of those who did not live
with their parents.
By the beginning of the 19th century some of
these homeless young people were confined in
almshouses with the poor, the mad, and the
chronically ill. By the middle of the century deviance had become redefined as delinquency;
informal arrangements for the care of runaways
had been supplanted by prison-like institutions, “schools of reform” and “houses of
refuge” (Rothman, 1991).
Indeed, societal forces and beliefs in the early
1800s led to the Houses of Refuge, initially established in the large eastern coastal cities such
as New York and Philadelphia, so that courts
could now place ungovernable children into institutions where it was believed that they would
receive an appropriate education (Rothman,
1991). “The reform school movement failed primarily because institutional warehousing, without controls and monitoring, soon provided the
worst examples of cruelty and punishment, reproducing in institutions the very same conditions responsible for most youths leaving home”
(Ferran & Sabatini, 1985, p. 119).
By the late 19th century, in a rapidly industrializing and urbanizing society, concern was
shown for young people who prematurely departed from their homes. Most of them were neither wanted nor needed in the labor force, and
they congregated on street corners in substantial numbers (Libertoff, 1980) as they still do in
areas such as Latin America (i.e., Brazil).
At the end of the 19th century, in 1899, the
first juvenile court was established in Chicago,
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Illinois. In addition to separating juvenile and
adult proceedings, the intent of the court was to
protect the welfare of juveniles while also upholding judicial and societal interests. This juvenile court, for the first time, combined the
functions of a child welfare agency and a judicial body (Rothman, 1991).
Beginning with the 20th century, Lipschutz
(1977) describes three periods of running away:
the Depression, World War II, and the “flower
child” of the 1960s. Alternatively, Appathurai
(1991) offers the following framework for viewing runaways in the 20th century:
• the 1930s to the 1950s: psychopathology
and deviance,
• the 1960s: flower child or deviant,
• the 1970s: focusing on the family,
• the 1980s: running from abuse.
According to Appathurai (1991), during the
1930s to the 1950s, running away was overwhelmingly seen as a delinquent act that was
caused by psychopathology. For example, in
one of the earliest studies of runaways in America, Armstrong (1932) described running away
as “the ‘psychoneurotic reaction’ of young
people with mental deficiency, poor impulse
control and low intelligence” (cited in Appathurai, 1991, p. 52). Additionally, the principles
and modalities of the juvenile court received
wide-spread endorsement until the 1950s and
1960s, when concern arose over treating status
and criminal offenders using the same criminal
framework, which was seen as detrimental to
children (Rothman, 1991).
During the 1960s, runaway behavior was explained by examining the relationship between
societal structures and human behavior (Appathurai, 1991). The latter part of the 1960s (the
“Summer of Love” in 1967) saw the birth of the
“flower child.” Middle class youths left their
homes to live on the streets, embracing alterna-
136
tive values and lifestyles of the counterculture
(Appathurai, 1991).
In 1968, running away became an official category—the Runaway Reaction of Childhood/
Adolescence (308.3)—in the second edition of
the Diagnostic and Statistical Manual of Mental
Disorders (DSM-II) of the American Psychiatric
Association (APA) (Gordon, 1979). The manual
states: “Individuals with this disorder characteristically escape from threatening situations
by running away from home for a day or more
without permission. Typically they are immature and timid, and feel rejected at home, inadequate and friendless” (APA, 1968, p. 61). The
classification by the APA officially categorized
running away as a mental disorder and supported the image of the runaway as disturbed.
The revised edition (DSM-III, 1980) also contained the classification under a delinquency
category as Conduct Disorder, Undersocialized,
Nonaggressive (312.10).
The American Psychiatric Association’s classification of runaways in the DSM-II had a stigmatizing effect that, despite the omission of this
classification in the revised DSM-III-R and subsequent editions, remains. Therefore, labeling
runaway behavior as a mental disorder created
and promoted a stigmatizing, linear view of
runaway behavior that served little, if any, useful purpose. We now know that runaway behavior may be more adequately viewed as a solution to a troubling context (e.g., family conflict, physical and sexual abuse). Consequently,
more recent classifications have attempted to
move away from viewing running away as a
mental disorder, and have increasingly described it as a solution to a context (see explanation of Germain and Gitterman’s [1980, 1986]
Life Model approach below).
In the 1970s, explanations of runaway behavior focused on environmental factors, such as
the family and the school, while the research in
the 1980s coalesced around impaired parent-
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Runaway Adolescents
child relationships (Appathurai, 1991). These
and other factors are reviewed in greater depth
below, as characteristics of runaway youth are
explored.
Characteristics of Runaway Youth
Having briefly reviewed how runaways were
portrayed in earlier literature, we now turn our
attention to key characteristics of runaway
youth as presented in current literature (defined
here as relevant literature dated from 1990 to
present). Today, much of the literature (cf.
Grigsby, 1992; Kurtz, Kurtz, & Jarvis, 1991;
Maxwell, 1992; Whitbeck, Hoyt, & Bao, 2000)
continues to place emphasis on looking at multiple factors in an attempt to understand the behaviors of runaway youth. These factors include, but are not limited to, levels of depression
and suicidality (Ayerst, 1999; Rotheram-Borus,
1993; Yoder, 1999), self-esteem (Maxwell, 1992),
family structure and interactions (Crespi &
Sabatelli, 1993), school problems (Gary & Campbell, 1999; Post & McCoard, 1994) and social
policy (Kurtz, Jarvis, & Kurtz, 1991).
This overview is categorized into three separate, yet interdependent, areas of the runaway’s
life: family life, school life, and personal life.
Other authors (Kurtz, Jarvis, & Kurtz, 1991;
Kurtz, Kurtz, & Jarvis, 1991) have used this
framework as a lens through which to view the
runaway youth. Various topics fall under each of
these three areas.
Family Life. The families of runaways have frequently been described as being dysfunctional
in one way or another: parents are often separated, divorced, in trouble with the law, or
abusing alcohol (Kurtz, Jarvis, & Kurtz, 1991;
Rotheram-Borus, 1991); runaways perceive
themselves as unloved or unwanted by their
families (Kurtz, Jarvis, & Kurtz, 1991); and emotional, sexual, and physical abuse may be occur-
ring or may have occurred (Kaufman & Widom,
1999; Kennedy, 1991; Powers, Eckenrode, &
Jaklitsch, 1990; Rotheram-Borus, 1991; Tyler,
Hoyt, & Whitbeck, 2000). Homeless youth frequently report poor family relationships as a
primary reason for running away from home
(Post & McCoard, 1994), and often experience
problems with neglect and/or domestic violence
in their families (Kaufman & Widom, 1999;
Kennedy, 1991).
In one study, Kurtz, Jarvis, and Kurtz (1991)
compared homeless and nonhomeless youth
who sought help at runaway shelters in eight
southeastern states. The results were based on
data entered on 3,519 such youth. Ten percent
(n = 349) were identified as homeless, 45% (n =
1,585) were runaways, 41% (n = 1,443) were
seeking services for nonrunaway problems, and
4% (n = 142) were contemplating running away.
The homeless youth, when compared to their
nonhomeless counterparts, were significantly
more likely to suffer from parental neglect, to
have no parental figure present in their lives,
and to be unwanted at home by parents. Fiftyeight percent of these homeless youths reported
primary presenting problems involving parents, with approximately three-fifths reporting problems of emotional conflict (62%) and
poor communication (59%) with their parents.
Twenty percent experienced some form of domestic violence in their families.
Teare, Authier, and Peterson (1994) examined
a sample of 154 children who were leaving a
shelter for runaway and homeless youth. This
study found youth-reported family problems
consisted of drug or alcohol use in the family
(50%), a physically abusive parent (41%), a sexually abusive parent (8%), violence among
adults in the family (31%), parental neglect
(19%), natural parent convicted of a felony
(15%), and history of suicide in the family (9%).
In addition to studies such as the ones discussed above that portray the runaway’s family
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SPRINGER
life, various studies completed during the past
decade have focused on the runaway’s school
life. This has included relationships with their
teachers and peers, and overall school performance.
School Life. Runaways have been found to exhibit particular characteristics related to school,
peers, and teachers, including: engaging in confrontations in school (Rotheram-Borus, 1993),
lack of academic success (Gary & Campbell,
1999; Kurtz, Jarvis, & Kurtz, 1991; Post & McCoard, 1994), impaired peer relations (Post &
McCoard, 1994), and truancy (Post & McCoard,
1994; Powers, Jaklitsch, & Eckenrode, 1998).
In comparing physically abused and nonabused
runaways, Kurtz, Kurtz, and Jarvis (1991) reported that the two groups did not differ regarding their involvement in problems at school.
About 25 to 30% of the youth in both groups
had experienced problems in their relationships
with teachers, underachievement, and unruly
behavior. About 40% did not regularly attend
school; these youths were truant, suspended,
expelled, or had dropped out. This study also
compared sexually abused and nonabused runaways. The findings were primarily the same as
they were in the comparison between physically
abused and nonabused runaways, with one notable exception. Compared to the sexually nonabused, significantly fewer sexually abused runaways had problems with unruly school behavior. The authors concluded that this might stem
from the fact that sexually abused youth often
are withdrawn and compliant. One other conclusion of this study was that those runaways
who manifested school problems fit the profile
of students who eventually drop out of school.
Individual Life. Most descriptions of the personal lives of runaways describe the following
areas: depression (Grigsby, 1992; Maxwell,
1992; Post & McCoard, 1994; Whitbeck, Hoyt, &
Bao, 2000; Yates, MacKenzie, Pennbridge, &
138
Swofford, 1991); suicide (Molnar, Shade, Kral,
Booth, & Watters, 1998; Rotheram-Borus, 1993;
Teare, Furst, Peterson, & Authier, 1992; Ward,
1992; Yoder, 1999); low self-esteem (Gavazzi &
Blumenkrantz, 1991; Maxwell, 1992); prostitution (Grigsby, 1992; Luna, 1991; Whitbeck & Simons, 1990); gay, lesbian and bisexual youth
(Kennedy, 1991; Kruks, 1991; Moon et al., 2000;
Rotheram-Borus, 1991; Smart, 1991); teenage
pregnancy (Pennbridge, MacKenzie, & Swofford, 1991); HIV/AIDS (Ennett, Federman, Bailey, Ringwalt, & Hubbard, 1999; Moon et al.,
2000; Rotheram-Borus et al., 1992); coping
(Ayerst, 1999; Post & McCoard, 1994; Powers
et al., 1990); substance abuse (Grigsby, 1992;
Kennedy, 1991; Koopman, Rosario, & RotheramBorus, 1994; Slesnick, Meyers, Meade, &
Sezelken, 2000; Whitbeck et al., 2000); and
physical and sexual abuse (Kurtz, Kurtz, &
Jarvis, 1991; Powers et al., 1990; Whitbeck & Simons, 1990). Other authors (Kurtz, Jarvis, &
Kurtz 1991; Kurtz, Kurtz, & Jarvis, 1991; Rothman, 1991) have included similar factors in describing the runaway’s “personal life.” Some of
these areas will now be explored.
Runaway and homeless youth frequently suffer from depression, a condition often cited by
homeless youth as a primary presenting problem (Grigsby, 1992; Kurtz, Jarvis, & Kurtz, 1991;
Whitbeck et al., 2000). It has been demonstrated
that hostility and depression have a positive
relationship that is inverse to self-esteem (Maxwell, 1992). The literature consistently confirms that the self-concept of runaway adolescents is low (Grigsby, 1992; Maxwell, 1992;
Post & McCoard, 1994). Runaway females have
been found to have greater depression and lower
self-esteem than runaway males (Maxwell,
1992). The relationship between depression and
suicidal risk has also been examined (Ward,
1992).
In one study (Rotheram-Borus, 1993), female
runaways were significantly more likely than
males to have attempted suicide and to be de-
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Runaway Adolescents
pressed. Males were also far more likely to have
attempted suicide than nonrunaway male adolescents. Among the 214 adolescents interviewed in this study, over one-third (37%) had
attempted suicide in the past, many in the
month before they sought services at runaway
programs. Forty-six percent of these had attempted suicide once, and most attempts (62%)
had occurred while the runaways were alone.
Trouble at home (22%), arguments (16%), and
suffering humiliation (10%) were the most common precipitating events, but attempts also followed trouble at school (5%), assaults (4%), and
sexual abuse (4%). Kennedy (1991) also found
a high prevalence of suicidal ideation (58%),
suicidal gestures (30%), and suicide attempts
(45%) among runaway youth. Other factors associated with suicide attempts include conduct
problems, family conflict and substance abuse
(Ward, 1992).
Not surprisingly, runaway youth often have
histories of substance abuse (Grigsby, 1992;
Rotheram-Borus, 1991; Slesnick et al., 2000). Intravenous (IV) drug use can be a serious risk-act
because of the risk of contracting HIV. However,
IV-drug-using youth who use clean needles and
do not share drug works are not necessarily at
risk. Alcohol use is also very common among
runaways. Kennedy (1991) reported that 81% of
runaways in his study used alcohol, with just
over two-fifths (42%) using hallucinogens and
cocaine, and almost three-quarters (72%) using
marijuana. Many more runaways report use of
alcohol in their lifetimes than do adolescents in
a national household survey: 71% of the runaways versus 48% of the nonrunaway adolescents (NIDA, 1991). This is supported by Koopman et al. (1994), who found a high incidence
of alcohol (71%) and drug use (46%) among
runaways, with substance abuse being higher
among males and Hispanics, as well as other
high risk behaviors such as reporting more sexual partners and less frequent condom use.
All of these activities suggest that these
youths are at increased risk for HIV infection.
Indeed, Moon and colleagues (2000) found that
gay/lesbian/bisexual runaway youths reported
higher levels and earlier onset of sexual activity
and drug use when compared with their heterosexual counterparts, placing them at an exceptionally high risk of contracting HIV.
It is important to note that among runaways
there are unusually high rates of youth exploring gay and lesbian sexual orientations (Kennedy, 1991; Kruks, 1991). Family conflict over
sexual identity is one reason some of these
youths leave home (Smart, 1991). Gay and bisexual youth are at increased risk for both
homelessness and suicide, and are more likely to
engage in survival sex (prostitution) than are
their nongay counterparts (Kruks, 1991).
Popular stereotypes of teen prostitutes typically conjure up the image of a 16-year-old girl,
dressed to look older, standing on a street corner
soliciting. Despite this image, teen prostitutes
are also girls and boys who receive lodging,
food, and clothes from men and women in
exchange for sexual favors; work in bars as
dancers, waitresses, or waiters serving sex with
drinks for a price; get caught up in pornographic films and photography; and are forced
by pimps (sometimes their parents) to perform
sex for money. Kept youth are defined as “those
youth who had previously been on the street
and were now supported in part or in full by
non-related adults, [and] were often involved
in organized prostitution and pornography”
(Luna, 1991, p. 512). Juvenile prostitution is
known to have increased steadily between 1969
and 1978, by 183% among adolescent females
and 245% among adolescent males, and has
increased steadily since (Farrow, Deisher, &
Brown, 1991). Given a lack of legitimate economic opportunities for adolescents, increasing
numbers of street youth are often lured into
prostitution, the drug trade, and other forms of
criminal activity as a means of survival (Powers,
Eckenrode, & Jaklitsch, 1990). Homeless youths
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SPRINGER
involved in prostitution are at greater risk for a
wide variety of medical problems and healthcompromising behaviors, including drug abuse,
suicide, and depression (Yates et al., 1991). Studies of runaway youth and HIV/AIDS continue to
reveal the increasing incidence of HIV and AIDS
in this population (Luna, 1991; Rotheram-Borus
et al., 1992).
Among prostitute runaways, females are also
at increased risk for pregnancy. Pregnant runaways are more likely to experience depression,
to have previously attempted suicide, to be diagnosed as drug abusers, and to have a history of
sexual and physical abuse (Pennbridge et al.,
1991). Gwadz (1999) followed 93 adolescent
runaway females from urban shelters over a 2year period, and matched them to their peers
from the general population. It was found that
the runaway girls were four times more likely to
become pregnant when compared to their counterparts. Pregnancy among runaways was predicted primarily by lower socioeconomic backgrounds and conduct problems (Gwadz, 1999).
This is supported by Greene and Ringwalt
(1998) from their examination of three national
samples of runaway and homeless youth, who
found that street and shelter youth were at
much greater risk of becoming pregnant than
youth in households.
In general, runaways experience a greater
prevalence of physical and sexual abuse than
do nonabused youth (Powers et al., 1990;
Rotheram-Borus, 1991; Whitbeck & Simons,
1990), and physical and sexual maltreatment
precipitate runaway behavior in adolescents
(Kurtz, Kurtz, & Jarvis, 1991). Homeless adolescents who have been abused are more likely to
be multiple runaways, more likely to associate
with deviant friends, and more likely to engage
in deviant behaviors to support themselves on
the streets (Whitbeck & Simons, 1990). In addition to physical and sexual abuse, emotional
abuse is also prevalent among runaways (Kurtz,
Kurtz, & Jarvis, 1991; Powers et al., 1990;
140
Rotheram-Borus, 1991). In one study (Powers et
al., 1990), no significant gender differences for
physical abuse or emotional maltreatment were
found. However, females are more likely to be
identified as victims of sexual abuse than are
males (Kurtz, Kurtz, & Jarvis, 1991; Powers et
al., 1990).
As evidenced from the above review, adolescent runaway behavior may have varied causes.
Thus, it is important to use a theoretical framework that examines the youth, the youth’s environment and the interaction between the two.
The Life Model (Germain & Gitterman, 1980,
1986; Gitterman, 1996, in press) serves this purpose.
The Ecological Perspective: The
Life Model Approach
“Ecology is a particularly useful practice
metaphor as it seeks to understand the complex
reciprocal relationship between people and environments; that is, how each acts and influences the other” (Germain & Gitterman, 1986,
p. 619). This perspective examines how organisms—in this case, human beings—and environments achieve a goodness-of-fit or adaptive
balance and, equally important, how and why
they sometimes fail to do so.
The Life Model (Germain & Gitterman, 1980,
1986; Gitterman, 1996, in press) approach to
practice is the major formulation of ecological
systems theory. The Life Model “offers a view of
human beings in constant exchange with their
environments, each acting and reacting on and
to the other through continuous adaptations”
(Germain & Gitterman, 1986, p. 628). Within
this framework, needs and problems are interpreted as outcomes of stressful relationships between the person and his or her environment.
Where people are able to develop through
change and are supported in this endeavor by
the environment, reciprocal adaptation exists.
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Runaway Adolescents
There is an inherent assumption that humans
cannot survive without relatedness to others.
When transactions are upset in the usual or
desired person and environmental fit, stress
may be generated. Stress arises from (a) life
transitions, which can include developmental
changes (e.g., adolescence), changes in status
and role, or restructuring of life space; (b) environmental pressures, which can include unequal opportunities, harsh and unresponsive
systems (e.g., rigid family system); and (c) intrapersonal processes, such as inconsistent expectations. Coping efforts are the special adaptations (e.g., running away) evoked by experiencing stress. The main aim of social work
practice is “to strengthen the adaptive capacities of people and to influence their environments so that transactions are more adaptive”
(Germain & Gitterman, 1980, p. 10).
In this sense, the Life Model complements crisis intervention, with both providing a focus on
stress and coping. For example, in his study
comparing 30 runaway and 30 nonrunaway
youths, Roberts (1982) reported the following
differences in coping patterns between runaways and nonrunaways. Most runaways reported that they “help themselves” deal with
problems by taking drugs or alcohol, leaving
the house temporarily, crying, attempting suicide, going to sleep, trying to forget it, and running away. By contrast, the nonrunaways reported coping patterns that were marked by the
successful use of problem-solving methods, interpersonal closeness with significant others,
and nonreliance on drugs.
Using the Life Model as a framework, runaways may be viewed as lacking a goodness-offit with their environment. Therefore, emphasis
is placed on the interaction between the person
and his or her environment. The runaway is not
viewed as being at fault, or as suffering from
pathology. Rather, running away can be viewed
as a solution to a troubling context (e.g., abusive
or overly rigid parents). This view is supported
by Sister Mary Rose, the current President of
Covenant House, who in a recent speech stated
that, “Strange as it sounds, I believe it is often a
sign of health for kids to runaway. To muster the
strength to walk away from situations filled with
abuse and mistreatment is far better than to just
stay and suffer and often shows unexpected
strength and hope” (Rose, November 15, 1998).
Runaway Shelters: Responding to
the Huck Finn Crisis
The Huckleberry House, founded in the HaightAshbury neighborhood in San Francisco in the
1960s, was named after Huck Finn and was one
of the first runaway shelters (Madison, 1979;
cited in Grigsby, 1992). Runaway shelters were
conceived to be an alternative to the provision
of traditional social services, to provide temporary food, shelter, and counseling in a situation
that, because of its unstructured program,
would appeal to the young people who flocked
to the streets during that time. The Huckleberry
Houses in Haight-Ashbury and the East Village
in New York City, for example, developed dropin centers and runaway houses to cope with
those who were not so adept in managing life
away from home. The use of detached street
workers was advanced as a method of reaching
out to these young people who were disenchanted with both conventional life and conventional social service approaches. These delivery methods were adopted because the more
traditional methods were, and still are, viewed
by many as ineffective. By the late 1970s, runaway centers had become a fairly permanent resource for runaways. To meet the needs of these
young people and their families, runaway centers enlarged their scope and sophistication.
They now employed individual, group, and
family therapy, and provided both short- and
long-term care. Some runaway shelters focused
on the development of support systems for their
Brief Treatment and Crisis Intervention / 1:2 Fall 2001
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SPRINGER
clientele. The goal of these programs was what
we now refer to as networking, the creation of a
self-help community around each young person
to ensure continuing availability of a functional
network capable of resolving crises and providing mutual support (Bleisner, 1978). Most programs today offer similar services.
Contemporary Runaway Programs
As a model program for runaway youth,
Covenant House will be used to illustrate typical
services provided for runaway youth by today’s
runaway centers. (Most of the information on
Covenant House summarized here was obtained
from their web site [www.covenanthouse.org]
and from personal communication [June 27,
2001] with Paula Tibbetts, a Director of a
Covenant House program in Florida.) Covenant
House has programs in 11 U.S. states: Alaska,
California, Florida, Georgia, Louisiana, Michigan, Missouri, New Jersey, New York (headquarters), Pennsylvania, and Texas, as well as
Washington, D.C. It also has programs in
Canada, Guatemala, Honduras, Mexico, and
Nicaragua.
Covenant House’s founding and guiding value
is open intake, which means that they do not
turn away youth under the age of 21 at any time.
This is a distinct feature of Covenant House philosophy and operations. Each youth is paired
with a counselor to develop a plan of care,
which might specify that the intention is for the
youth to return home, go to a foster home, begin
substance abuse treatment, or (for older youth)
prepare for independent living. On site, youth
residents are involved in a number of activities,
including, but not limited to, counseling, health
assessment, chores, group sessions (which typically address life skills and employment skills),
teen parent education and pregnancy prevention, and school or the pursuit of the GED.
Covenant House serves runaway, homeless,
and at-risk youth under 21 (including teen par-
142
ents and their babies). Some of the key services
that are provided by Covenant House include
the following: street outreach (by foot and van),
counseling (including pastoral counseling), case
management, health services, family reunification (when possible or appropriate), pregnancy
prevention and teen parent education, GED
classes for the older teens, and transportation
assistance. Shelter care (e.g., 104 beds in Ft.
Lauderdale, 67 beds in Orlando) provides meals,
clean clothes, and a safe place to sleep. Additionally, transitional housing is available for
older teens bridging into independent living.
Youth served by Covenant House, and no
doubt other runaway shelters across the country, have had multiple sex partners, live in
crowded and unsanitary quarters, tattoo themselves with dirty sewing needles and India ink,
get beaten up and raped, or become ill or injured
and go without treatment. The most common
health problems seen at the Covenant House
shelters are upper respiratory infections and
skin disorders caused or worsened by living out
in the open streets. They also see youth with
high-risk pregnancies, sexually transmitted diseases, and consequences from drug or alcohol
abuse. Young women who are pregnant or already have children may stay in one of their specialized Mother/Child units. Covenant House
makes special arrangements for runaway youth
with clinical depression or other forms of mental illness.
Crisis Assessment at
Runaway Shelters
When runaway youths come off of the streets
and into shelters, they are looking for safety,
shelter, and a sense of hope. To adequately meet
each youth’s individual needs, it is critical that
intake workers thoroughly assess the youth’s
current situation. Remember, these youths are
typically in a state of crisis, and the stakes are
high. Hoff (1995) cautions that failure to cor-
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Runaway Adolescents
rectly assess crisis situations can be hazardous to both the client and the worker. When
possible, standardized assessment methods
should be implemented and workers adequately
trained. As Rothman (1991) found, “Circumstances at the point of intake for entry into the
service system can drastically affect the forms of
treatment received by status offenders. Decisions about disposition and service modalities
appear often to be based on irrelevant, discriminatory, or nondiagnostic considerations” (p.
54). The triage assessment model, presented below, offers a more standardized approach to assessment that may help overcome some of the
problems identified by Rothman.
Triage Assessment Model. The triage assessment
model (TDA) (Myer, Williams, Ottens, & Schmidt,
1992) may be useful for shelter intake workers
conducting assessments with runaway youth
who are in crisis. This model is based on the assumption that a thorough assessment of a crisis
reaction (e.g., running away) covers three domains: affective, cognitive, and behavioral (Myer,
2001). Each of these domains is further divided
into three types of responses that represent the
range of reactions clients may experience.
The affective domain of the TDA includes
anger/hostility, anxiety/fear, and sadness/
melancholy. The cognitive domain is categorized into the client’s perception of a transgression, a threat, and a loss. A transgression “occurs when people perceive that their rights are
currently being violated (Ellis & Harper, 1975)”
(Myer, 2001, p. 61), as is the case when a runaway youth is physically or sexually abused by
a parent, for example. Where clients experiencing this type of reaction will be focused on the
future, wondering what will happen as a result
of the crisis, clients experiencing a sense of loss
may feel that something or someone is irretrievable (Myer, 2001). Finally, the behavioral domain covers approach, avoidance, and immobility. For example, in addition to avoidance be-
havior (e.g., running away), youth may also be
seen as using approach behavior (e.g., seeking
safe shelter) to resolve their crisis. The TDA
model allows the worker to examine the interaction across these three domains.
Myer et al. (1991) have operationalized the
TDA model through the development of the
Triage Assessment Form: Crisis Intervention
(TAF), which shows promising reliability and
validity properties. The TAF contains a severity
scale for each domain that is completed by the
intake worker. A major strength of the TAF is
its clinical utility, as results obtained from the
TAF offer guidance on how directive the intervention needs to be. Higher scores reflect the
need for more directive interventions. Additional strengths of the TAF are that it is userfriendly, flexible, and culturally sensitive (Myer,
2001). The TAF may be used with permission
from Myer and colleagues.
The TAF is a short form that is completed by
the intake worker, using information obtained
during the course of the worker-client interview. It is based on a crisis assessment model of
intervention, where the goal is to help the client
prioritize and mobilize resources as quickly as
possible (James & Gilliland, 2001; Myer, 2001).
Of course, the TAF is but one tool available for
assessment with client in crisis. Other very useful tools for conducting rapid and accurate assessment of clients in crisis are available. One
such tool is the newly developed Lewis-Roberts
Multidimensional Crisis Assessment Scale
(MCAS), which measures the severity and magnitude of personal and/or social dysfunction related to an acute crisis state (Eaton & Roberts, in
press). Once the immediate crisis is resolved,
workers may also want to consider other forms
of assessment, including a more in-depth psychosocial history or standardized scales, such as
pencil-and-paper rapid assessment instruments.
Rapid Assessment Instruments. To date, one
rapid assessment instrument (RAI) has been de-
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SPRINGER
veloped using the ecological perspective (Germain & Gitterman, 1980, 1986; Gitterman, in
press) as a theoretical framework: the Adolescent Concerns Evaluation (ACE) (Springer, 1998;
2000). Using this framework, the ACE is structured to view runaways as lacking a goodnessof-fit with their environment, placing emphasis
on the interaction between the youth and his or
her environment. The ACE was developed to
measure the degree to which a youth may be at
risk of running away, though it also has heuristic value in terms of practitioners’ ability to discern from a youth’s responses what areas of that
client’s life need to be addressed over the course
of intervention. The ACE is a 40-item penciland-paper scale that contains four separate yet
interdependent domains: family, school, peer,
and individual (depression). Items are measured
on a five-point Likert scale.
Where the ACE was designed to measure the
degree of risk of a youth’s running away, Post
and McCoard (1994) have developed an instrument (Needs of Adolescent Runaways [NAR])
that serves as an assessment of the needs of runaway youth after they have run away. The NAR
is a 45-item instrument that contains three factors: external, social deviancy; feelings; and
communication skills. Items are measured on a
four-point Likert scale.
Reliable and valid tools such as the ACE and
the NAR may be useful for intake workers at
runaway shelters who wish to conduct accurate
assessments with runaway youth and subsequently monitor client functioning over time.
However, tools such as the ACE and NAR should
only be administered to youth who are stabilized (i.e., not in acute crisis).
Crisis Intervention at
Runaway Shelters
Roberts’ (1991, 1996, 2000) seven-stage crisis intervention model is a useful and practical conceptual framework for workers in runaway shel-
144
ters (and other settings). It encourages the
worker to conduct a thorough assessment and to
build on the strengths of the client within the
context of a caring therapeutic relationship
while helping the client establish and prioritize
plans for action. One appealing feature about
this seven-stage model is that it can be integrated with other models of intervention or
techniques that the worker already utilizes. This
is critical in today’s world of service delivery, as
research consistently demonstrates that integration/eclecticism is the most popular approach to
service-delivery among mental health and helping professionals (cf. Jensen, Bergin, & Greaves,
1990; Norcross & Newman, 1992; cited in Prochaska & Norcross, 1999). Accordingly, as
Roberts’ seven-stage model is presented below,
the Life Model (Germain & Gitterman, 1980,
1986) and solution-focused therapy (SFT) (Berg
& de Shazer, 1991; de Shazer, 1991) will be used
to illustrate how one might integrate components of other intervention approaches with the
seven-stage model.
The seven stages are as follows:
1. Plan and conduct a crisis assessment. This
first stage of the therapeutic process is
concerned with a rapid assessment of risk
and dangerousness. This includes a risk
assessment for suicide and homicide/violence, as well as the need for medical attention and current drug or alcohol use.
The reader is referred above to the previous section on assessment for more detail
on the assessment process.
2. Rapid establishment of rapport and the
therapeutic relationship. Of course, as the
worker conducts the assessment, he or she
is also building rapport with the youth. It
is important to convey respect and acceptance. To the extent that the worker can
view the youth through an ecological
lens, this might come more easily. For example, if the youth’s current needs are
Brief Treatment and Crisis Intervention / 1:2 Fall 2001
Runaway Adolescents
seen by the worker as outcomes of stressful relationships between the youth and
his or her environment (e.g., abusive
home environment), as proposed by the
Life Model, then the worker is more likely
to treat the youth with respect and dignity than if the worker places blame on
the youth for running away.
3. Identify issues pertinent to the client and
any precipitants to the client’s crisis contact. In stage three, it is particularly useful if the worker encourages the youth to
tell his or her story using his or her own
words. Thus, the worker should use openended questions. This further helps develop rapport and trust, as the youth will
no doubt appreciate an adult who listens
to his or her story without passing judgment or offering advice.
Techniques from SFT, (Berg & de Shazer, 1991;
de Shazer, 1985, 1988, 1991), a strength-based
approach to working with clients, may be useful during stages two and three in identifying
the youth’s strengths and past coping skills
(Greene, Lee, Trask, & Rheinscheld, 2000; cited
in Eaton & Roberts, in press). For example, presuppositional questions can be used to invite
clients to think about change in a less threatening way. An example might be: “How will you
know when you don’t have to stay at the shelter anymore?” The miracle question can assist
clients with imagining change and with goal setting. For example, the worker might ask the
youth: “Suppose you go to bed tonight, and
while you are sleeping a miracle happens and all
of your problems are solved. When you wake up
in the morning, how will you know that this
miracle happened? What would be the first
thing that you noticed?”
4. Deal with feelings and emotions by effectively using active listening skills. It is important for the worker to reflect to the
youth that he or she is being listened to
and appreciated. Skills that reflect this to
the youth are encouraging statements,
such as “uh huh.” Additionally, workers
can use paraphrasing (restating the meaning of the youth’s words in the worker’s
own words) and emotional labeling (identifying the youth’s underlying emotions).
Springer, McNeece, and Arnold (in press)
advocate always operating from a stance
of nonpossessive warmth, empathic understanding, and personal authenticity
when working with clients, as these qualities seem to be related to treatment success regardless of level of training or theoretical orientation (Beutler, Machado, &
Neufeldt, 1994; Hokanson, 1983).
5. Generate and explore alternatives by identifying the strengths of the client as well as
previous successful coping mechanisms. The
worker and client need to work collaboratively in hopes of yielding a wide range of
possible alternatives. Roberts (2000) states
that “the person in crisis is viewed as resourceful, resilient . . . and having untapped resources or latent inner coping
skills from which to draw upon. . . . Integrating strengths and solution-focused
approaches involves jogging clients’ memories so they recall the last time everything seemed to be going well” (p. 19). Recall that a key focus of the Life Model approach is to help clients strengthen
coping skills, or adaptive capacities (Germain & Gitterman, 1980, 1986).
6. Implement the action plan. The worker
should empower the youth, providing assistance in the least restrictive manner.
According to the Life Model, social networks, which consist of kin, friends,
neighbors, and acquaintances may “serve
as essential buffers against life stressors
and the stress they generate” (Gitterman,
1996, p. 391). Accordingly, it may be
Brief Treatment and Crisis Intervention / 1:2 Fall 2001
145
SPRINGER
helpful to consider the youth’s social networks when developing the action plan.
7. Establish a follow-up plan and agreement.
Follow-up with clients allows the worker
to assure that the crisis has been resolved
and to determine the post-crisis status of
the youth. This can be conducted by telephone or face-to-face contact. (Follow-up
with youth may fall outside of the parameters of some runaway shelter’s mission.)
In sum, Roberts’ seven-stage crisis intervention model provides a step-by-step framework
for working with runaway youth in crisis. Using the Life Model (Gitterman, 1996) as a lens
through which to view the runaway youth, the
worker is encouraged to keep in mind the professional function to:
improve the level of fit between people’s
(individual, family, group, community) perceived needs, capacities, and aspirations and
their environmental supports and resources.
Through processes of mutual assessment,
worker and service recipient(s) determine
practice focus, choosing to:
1. improve a person’s (collectivity’s) ability to
manage stressor(s) through more effective personal and situational appraisals and behavioral skills;
2. influence the social and physical environments to be more responsive to a person’s (collectivity’s) needs; and
3. improve the quality of person:environment exchanges (p. 395).
Implications for Practice, Research,
and Policy
Runaway youth present with multiple needs,
and these needs must be adequately captured in
the assessment process so that interventions are
practical and relevant. Regardless of the method
146
of assessment and intervention used, one truism
rings loud and clear: the assessment and intervention process with runaway youths must be conducted in a therapeutic relationship that is driven
by worker genuineness, warmth, empathy and understanding. In other words, runaway youth
need to connect with a caring adult. Wolkind’s
(1977) seminal study of 92 children in residential care supports this notion, where he found
that prolonged contact with the same houseparent was associated with lower rates of psychiatric disorder and acting out behavior. Workers
at runaway shelters are on the front lines, and as
the first point of contact for runaway youth, are
instrumental in helping these modern-day
“Huck Finns” stay out of harm’s way and realize
their potential.
To realize this potential, experts (cf. Kurtz,
Jarvis, & Kurtz, 1991; Rothman, 1991) have
amplified the need for coordinated servicedelivery in communities. Friedman (1986, p. 11;
cited in Kurtz, Jarvis & Kurtz, 1991) argues that
Perhaps the most crucial issue policy makers
are confronting is the effort to develop and
implement comprehensive community based
systems of service to prevent and treat emotional disturbance in children. . . . A community based system in which majority responsibility rests within the community has the best
chance of effectively serving youngsters and
their families, of achieving interagency coordination and collaboration, of generating constructive advocacy, of maximizing accountability, and of establishing a productive partnership between public and private sectors.
With the growing recognition that youth with
multiple problems require interventions from
multiple service arenas has come the development of funding, research, and interventions
based on holistic philosophies of care (Epstein,
Kutash, & Duchnowski, 1998). As a natural extension of the movement started under the Child
Brief Treatment and Crisis Intervention / 1:2 Fall 2001
Runaway Adolescents
and Adolescent System Program (CASSP) initiated in 1984 by the National Institute of Mental Health (NIMH), many communities across
the states currently receive large pots of federal funding through the Substance Abuse
and Mental Health Services Administration
(SAMHSA), Center for Mental Health Services
(CMHS) to implement the type of communitybased, wraparound approach to service delivery
within a system-of-care (Rosenblatt, 1998) advocated by Friedman in efforts to meet the needs of
children and adolescents with serious emotional
disturbance (SED) and multiple mental health
needs (Springer, in press). A key feature of this
approach is interagency collaboration among
various agencies working together to create a
seamless service delivery system to meet the
multiple needs of high-risk youth. The wraparound approach to service delivery emphasizes
and builds upon the youth’s strengths, and utilizes natural resources. Institutionalization is
used as a last resort.
While promising, research on wraparound approaches to service delivery is limited to date.
The Surgeon General reports that “the effect of
systems of care on cost is not yet clear . . . nor
has it yet been demonstrated that services delivered within a system of care will result in better clinical outcomes than services delivered
within more traditional systems. There is clearly
a need for more attention to be paid to the relationship between changes at the system level
and changes at the practice level” (U.S. Department of Health and Human Services, 1999,
p. 193). Likewise, based upon his synthesis of
relevant research, Rothman (1991) reached the
“firm conclusion that no single program or
strategic approach has been associated with
effective outcomes for assisting runaways” (p.
118).
It is critical that researchers continue their
efforts to partial out what interventions and
programs are the most effective with runaway
youths, and to subsequently relay any relevant
findings to workers and policy makers in a
meaningful and user-friendly manner. In the
meantime, shelter workers, mental health professionals, school counselors, law enforcement
officers, educators, and other professionals
working with runaway youths should be encouraged by some of the positive findings to
date regarding intervention efforts with runaways; consider some relevant findings as synthesized by Rothman (1991): the use of competent and well-trained staff is associated with
effective and cost-efficient service delivery;
individually tailored approaches using varied
community resources are associated with effective service delivery; properly trained and supervised volunteer staff (e.g., college students)
is an effective means of providing services; and
family oriented counseling and therapy have
been found effective.
Workers can use these and other approaches
to help runaway youth in crisis keep sight of
their hopes and dreams.
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