Assessment Tools for Prioritizing Housing Resources for Homeless Youth

In almost all communities in North America, the number of youth experiencing homelessness exceeds the capacity of housing resources available to youth. This situation leaves communities with the terrible predicament of trying to decide whom to prioritize for the precious few housing spots available at any given time. For adults, this same dynamic exists and many communities have turned to vulnerability assessment tools to help them make these difficult decisions. Most of these tools have focused on assessing factors that are associated with either premature mortality (Hwang et al., 1998; Juneau Economic Development Council, 2009; Swanborough, 2011) or greatest system costs (Economic Roundtable, 2011). Youth aged 24 or younger are unlikely to experience health-related premature mortality, nor are they likely to have incurred enormous system costs. Thus in recent years a new set of tools was developed that specifically targets the needs and realities of homeless youth. The two most prominent of those tools are the TAY Triage Tool (Rice, 2013), developed by the Corporation for Supportive Housing (CSH) and me, and the Next Step Tool for Homeless Youth, which was developed by Orgcode in consultation with CSH and me (Orgcode, 2015).

The TAY Triage Tool is short 7-item (6-point) index based on extensive research I conducted in conjunction with CSH. Unlike the adult tools, which are based on developing predictors of system cost or premature mortality, the TAY Triage Tool is anchored in assessing which youth are most likely to experience long-term homelessness. This decision was reached in consultation with key stakeholders in the systems of care involving homeless youth, including providers of permanent supportive housing and representatives from foster care, juvenile justice, housing, and mental health, who met with us to discuss what issues were most salient for youth (Rice, 2013).

Based on the literature on vulnerability and risk taking among homeless youth (e.g., Milburn et al., 2009; Toro, Lesperance, & Brackiszewski, 2011), we assessed a large number of possible variables to be included in the triage tool. We attempted whenever possible to focus on specifications of variables that were likely to precede long-term homelessness to avoid complex issues of causality. For example, rather than assessing current levels of alcohol use, we assessed whether the youth had consumed alcohol at age 12 or younger. High levels of alcohol use could lead to long-term homelessness, but long-term homelessness could just as easily lead to high levels of alcohol use. However, using alcohol prior to age 12 is unlikely to be a result of longterm homelessness.

In the process of selecting the final items included in the tool, we examined dozens of possible associations, including 19 reasons for becoming homeless (e.g., “I experienced sexual abuse” and “my desire for adventure”); alcohol use; marijuana use; first sexual experience at age 12 or younger; foster care involvement; incarceration prior to age 18; eight traumatic experiences (e.g., “being hit, punched or kicked very hard at home”); a brief 4-item screen for posttraumatic stress disorder symptoms; employment; high school dropout status; HIV positive status; testing positive for other sexually transmitted infections; currently sleeping on the streets; having children; being pregnant (or impregnating someone); trading sex for money, food, drugs, housing, or other resources; sexual orientation; gender; and race and ethnicity. For extensive details regarding the modeling strategy that resulted in the final scale, see the summary report on the tool’s development, which is available online (Rice, 2013).

This work was then followed by a 2-year period of pilot testing and assessment of the tool’s generalizability and validity. Five communities pilot-tested the implementation of the tool, and we found that in most communities, approximately 10% of youth scored 4 or higher which we found to be associated with not only long term homelessness, but also substance use, and mental health risks (Rice & Rosales, 2015). More importantly, the generalizability of the tool was supported by data we collected in Clark County, Nevada, and the state of Connecticut, showing that TAY Triage Tool scores were associated with longer-term homelessness in those communities. We assessed the face validity of the measure in focus groups. More importantly, in data from Nevada and Connecticut, we also assessed construct validity. Again, for details regarding the testing of the tool, see the report on this work, which is also available online (Rice & Rosales, 2015).

Iain De Jonge and Orgcode were responsible for the creation of the Next Step Tool for Homeless Youth (Orgcode, 2015). They have described it as an evidence-informed tool, because its creation is based primarily on an extensive review of the scientific literature on vulnerability factors for homeless youth. In addition, in consultation with CSH and me, they incorporated items from the TAY Triage Tool into their larger assessment tool. It is worth noting that we eliminated some items they used from our tool because they did not differentiate between individuals who had experienced longer-term homelessness and those who had not. For example, one item we excluded was: “Have you been attacked of beaten up since you’ve become homeless?” Conversely, the Next Step Tool incorporated several items we did not consider, such as “Does anybody force or trick you to do things that you do not want to do?” Neither tool is perfect. Both, however, strive to identify vulnerable youth and help communities prioritize
housing for youth based on objective criteria known to assess vulnerability.

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