​Spotting risk-taking behavior in homeless youth: A first step for better care

Homeless teen

On a given night, there may be anywhere from 1.6 to 2 million homeless youths in the United States, living on the streets, staying in shelters or crashing on couches wherever they can. Plenty of teens and young adults, homeless or not, engage in risky behaviors, such as high-risk sexual activities or substance abuse. Researchers believe these behaviors are worse, and last longer, in homeless youth because of the negative impact their environment can have on brain development.

Understanding how living conditions, mental development, and risk-taking behavior are intertwined could help social workers and mental health care providers develop better tools to help these kids adapt as they transition from the foster care system to fending for themselves as adults. To sort out some of these factors, researchers at the University of Chicago Medicine conducted a study of 149 youths between 18-24 years old living in two different homeless shelters in the city. The study compared how the group’s levels of executive functioning (EF)—processes like decision making, inhibition, planning and emotion—related to their tendency to engage in risky behaviors.

Unsurprisingly, youths who scored low on tests of executive function, meaning they exhibited poor or impulsive decision-making skills, were much more likely to abuse alcohol than those with high scores. Depending on the measurement scale, between 40 to 60 percent of the low EF group had abused alcohol, compared to 3 to 10 percent of the high EF group. About a third of the low EF subjects were also dependent on alcohol, meaning they regularly had more than 5 drinks a day. The low EF group also used marijuana more frequently, had more sexual partners, and often combined drug use with sexual activity.

“This research is really important because it's showing us that amongst this population of homeless youths, there is a wide variance in the degree of engagement in risk-taking behaviors,” said Joshua Piche, a fourth-year medical student at the University of Chicago Pritzker School of Medicine, who led the study. “These folks who are all similar in terms of age, resources, and the environment they're growing up in, must have some other differences, which make some of them more prone than others to engage in risky behaviors.”

Scott Hunter, PhD, Director of Neuropsychology at the University of Chicago Medicine, who co-authored the study with Piche, said that assessing levels of executive functioning for homeless youths can help identify which ones might be on the path for more risky behavior and allow for intervention before it’s too late. At the same time, he said that health care providers need to be aware of how a youth’s experiences with homelessness may have affected their development, because the parts of the brain responsible for executive function are still developing through the early twenties.

“We can't change the past, so it helps us understand that there may be a need to start creating an intervention that is particularly sensitive to where this person presents now,” he said. “One of the things we're making sense of with these youth is that given the number of challenges that have occurred, the decision-making process is much more impulsive, emotional and avoidance driven.”

Providing this kind of help for young people at the right time is a challenge, however. There are only a handful of homeless shelters in Chicago that cater to young people, including the two involved with this study: The Teen Living Project in Bronzeville and the Night Ministry on the north side. Homeless kids under the age of 18 are placed in the care of the Department of Children and Family Services, but runaways or teens trying to avoid foster care often avoid coming to shelters for help for fear of being placed back into the system. Others struggle with the transition out of foster care after they turn 18, and often end up homeless again.

“The key here is to make available a network where these youths can be connected and at least be safe,” Hunter said. “But there aren't a lot of resources available, and it's really whether the foster parents want to maintain being involved and taking care of them. That’s why many of them are homeless again, because they have no resources or family support or system support.”

Hunter said the ideal scenario would allow for individual assessments of youths to create plans that help them gain practical skills, like finishing high school or a GED, and addressing mental health and developmental challenges that might short circuit their chances at getting off the street. But amidst widespread cuts to mental health services (the city of Chicago closed half its clinics in 2011, mostly in low income communities), that may be a lofty goal.

“These are youths that ultimately get picked up by the police, often for very petty things, and they're put into the criminal justice system without awareness that it's actually a combination of mental health problems and doing what they can to survive,” he said. “They are then most reliant on whatever could possibly be available through the criminal justice or the public health systems in the city, which are already overtaxed.”

Photo: Robert Scifo (Own work) [CC BY-SA 4.0], via Wikimedia Commons

Scott Hunter, MD portrait

Scott Hunter, PhD

Dr. Scott Hunter specializes in pediatric neuropsychology and pediatric psychology. In the clinic and in his research, Dr. Hunter focuses on the diagnosis and treatment of learning, developmental and neurobehavioral disorders.

Learn more about Dr. Hunter
Matt Wood
Matt Wood

Matt Wood is a senior science writer at UChicago Medicine and the Biological Sciences Division.