The Social Context of Formal Service Use Among Homeless Youth: The Role of the Service Environment and Social Support System in Understanding Engagement in Care

Background: Little is known about rates and correlates of service use among homeless youth, and even less is known about how social context plays a role in understanding their service engagement. Research on other marginalized populations has found that two aspects of the social environment-- the service setting where care is accessed and social support networks-- are instrumental in motivating individuals' decision to seek care. This study is a preliminary attempt to understand the differences in service use among homeless youth attending two drop-in centers in two distinct service environments (characterized by service-rich and service-sparse envronments), and to further explicate how their social support networks might be correlated with these service use patterns. 

Method: A sample of 938 youth was surveyed between October, 2011 and June, 2013 at in two distinct areas of Los Angeles County: Hollywood and the Beaches. The youth were interviewed about their individual, behavioral, and social network attributes. The primary dependent variables were recent utilization of six different services. Univariable and multivariable analyses were employed to understand the influence of social-contextual variables on service use among participants.

Results: Hollywood youth had greater odds of using almost every service variable of interest compared to youth at the Beaches. They were 2.81 times more likely to use health services (p<.001), 2.54 times more likely to use shelter services (p<.001), 2.81 times more likely to use therapy services (p<.001) and 3.09 times (p<.001) more likely to use job help services. Across both sites and several service types, staff emotional support was a persistent, positive correlate with level of service use among homeless youth. Among Beaches youth, it significantly increased the odds for health (OR=2.61, p<.05), shelter (OR=2.77, p<.01), and therapy services (OR=2.46, p<.05), and among Hollywood youth, emotional support from staff was associated with an increased odds for seeking health (OR=2.31, p<.01), shelter (OR=1.90, p<.01), therapy (OR=2.27, p<.001) and employment (OR=2.14, p<.05) services.

Conclusion: The significance of rapport building and affect in the context of staff relationships has important service delivery implications. The two-site comparison also has practical implications. First, results indicate a greater relative need for service engagement at the beach site. Second, they illustrate that even within a single geographic area homeless youth characteristics vary. Understanding the characteristics of the target client population can inform