rsm92

Journal of Adolescent = Health and Welfare

Vo= lume 7 - No 2 - Autumn/ Winter 1994

Speci= al Feature Young Homeless

and Runaways

Letter from the editor -

De= ar Colleagues,

Welcome to the la= test journal. You may have noticed that the timing of some of the journals has b= een a bit erratic over the last year - we were intending to produce three journ= als in 1994 but somehow we went into a time warp and the months of shot by at an alarming rate. So this is only the second one dated ‘94 and I hasten = to get it out to you as old father time is creeping up on Big Ben ready to ring out the old year and the revellers in Trafalgar Square brave the cold to si= ng Auld Lang Syne. Mea culpa! No matter - I will try to time things better next year (tomorrow!).

We had a very successful meeting at the Royal Society of medicine again in October and confronted the problem of ‘Child Protection and the family’. Th= is coincided with the International Year of the Family which is just drawing t= o a close. Most voluntary agencies seem to regard the year as a failure so I he= ar. There has been a lot of criticism in the press this month of the Child Supp= ort Agency and policies which seem to have placed added strains on families. The trend towards fewer marriages, more single parent homes, and high divorce r= ates continues.

Nevertheless our meeting was a success and we will be publishing the proceedings in a few month’s time. Continuing on that theme we produced a new book ‘Bonds and Boundaries - Child protection and the family’. Our Y= outh Support publications section has expanded and we have produced several new titles this year. They now fall into two broad groups - ‘scientific’ publications and general titles published in aid o= f the charity. Hence do not be surprised if some of the titles seem to be on unrelated subjects.

This edition incl= udes the report of our 1992 meeting on Homeless Youth and runaways. The theme of= the other contributions continues on this note. Next volume will cover the 1993 meeting on Youth and Violence .. then we should be up to date!

Two reminders for= the following months - the International meeting in Vancouver in March - and our tenth meeting at the RSM in October - please join us!=

&= nbsp; Best wishes,

&= nbsp; Diana Birch

&= nbsp; Director Youth Support

Yo= uth Support Forum on Adolescent Health and Welfare

7th Annual Meeting 22nd October 1992=

“Homeless Youth - How do we tackle the problem?”

Tr= anscript of the proceedings.

Introduction - Dr Diana Birch - Director Youth Support

It is nice to see so many new people, new faces= at our meeting this year. We have been having meetings here at the Royal Socie= ty of Medicine for the last seven years and I still think our gatherings do co= me as a surprise - if not a shock - to some at the Royal Society - we must have the youngest audience of any group here. We have always made a point of inc= luding young people in our meetings.. A much more typical audience is that which y= ou have all seen wandering off into the lecture hall next door - older, besuit= ed, nearly all male. I do think that the medical profession, my profession - do= es need shaking up from time to time - because there are a number of issues wh= ich we just don’t look at. A lot of people are very comfortably off in a National Health Service which is rapidly privatising and they are just avoi= ding certain issues because they are not comfortable to work with. One such issu= e is adolescence and another is homelessness and poverty.

I would like to tell you a little bit about You= th Support itself before we start - Youth Support was started in 1985/6 - a gr= oup of us broke away from the statutory organisations - social services, educat= ion and the health service and we set up a charity and began to do work with yo= ung people. Some of the issues we looked at to start with were teenage pregnancy, contraception and sexuality= and also working with abused young people because it is my opinion that very yo= ung children get some help with regard to abuse and child protection - but when= you become a teenager, people look at you as if you should be able to sort your problems out for yourself. When you have a problem - Either it’s your parents fault and so your parents should do something about it - or it̵= 7;s something you’ll grow out of or maybe you’re a bit of a delinqu= ent and that’s why you have problems. So young people tend to get forgott= en by the medical profession.

We have been trying to do quite a bit of work particularly in south London - we have a centre in south London and also we travel widely talking to groups and doing outreach work. It is good to see = so many young people in the audience tonight and also there are some young peo= ple here who live in our unit and I hope you will have a chat with them afterwa= rds.

This evening we are concentrating on the proble= ms of homeless Youth and particularly on the ‘Runaway’ type of homeless youth. I think there is a difference obviously between homelessnes= s in terms of some one just not having somewhere to live when you are going thro= ugh adolescence growing up and moving away from their families in the natural s= ort of way - when their families are there for some kind of natural support. And some of the young people who perhaps don’t have a family or are away = from that family for some reason or another and are totally without any form of support and who may just be living on the street.

There are a lot of problems associated with homelessness which we can sometimes forget about. About a decade ago - twel= ve years ago to be precise, the president of the Royal College of Physicians, Douglas Black, produced a report which was called ‘Inequalities in Health’ and in that he put in a lot of very important information whi= ch was in many ways absolutely ignored. He drew a lot of inferences to the fact that people who were unemployed, people who were on low incomes, people who were in poor housing, had health problems associated with their life styles= and he particularly drew attention to the health of children who were brought u= p in overcrowded homes or inadequate homes or whose families had been in bed and breakfast hostels and in inappropriate housing. That was a very important report and in twelve years we have really done nothing about following up s= ome of these issues. People who are homeless are more likely to suffer from addictions, alcoholism, drug abuse and so on because of the fact that they = are on the street and because they have to find alternative ways to survive - b= ut we also must not forget that they have higher rates of all sorts of other illnesses - infections, malnutrition, and so on - even in a country such as ours which is supposed not to be a third world country.

Last year at our meeting we discussed the possibility of doing a comparative study of homeless youth - looking at the population of runaway youth in London and comparing data with that obtained= in our Russian (Urals) project and that which had been gathered in the USA by colleagues in Los Angeles children’s hospital. The papers produced by Richard MacKenzie, Julia Pennbridge and colleagues are available for perusal after the meeting and I will draw your attention to some details from these reports in a moment.

I also showed a video recording to the meeting = last year of some of the runaway children we were working with in the Soviet Uni= on. The Russian children were at one end of the scale - children who were desperately poor with absolutely nothing - and who were running vast distan= ces across the Soviet Union - getting themselves on trains and ending up thousa= nds of miles from their homes with nothing but the rags they stood up in. They = were ridden with lice and some of the shots we showed on the video were quite harrowing, youngsters with hair shaved in drab institutional clothes and wi= th absolutely nothing of their own. A lot of those children had run away from situations where they were abused at home.

We could say that at the other end of the scale= we have the children in Hollywood, surrounded by the twin evils - the wealth a= nd squalor of LA. In London perhaps we are half way between. Generally speakin= g in England we tend to see the trends from America coming to our young populati= on about one or two years later - but unfortunately we usually fail to learn f= rom these patterns and make advance plans for prevention. In many situations if= we saw what was happening in the states we could say - OK this is going to hap= pen here in a couple of years time so let’s get ready for it . let’s provide some services - but no, we generally sit by and hide our heads in t= he sand until it’s really upon us.

So let’s look at what has been happening = with the street youth in America. Hollywood is supposed to be the place with the streets paved with gold as it were, but in actual fact Hollywood is one of = the poorest, seediest parts of California and of the young people who had run a= way to Hollywood 60% of them had been physically abused at home. Three quarters= had been severely maltreated in the year before they ran away; many had been multiply abused and = the researchers divided the sample up into kids who had not been abused; ones w= ho had been physically abused; those who had been sexually abused and those who had been multiply abused and most of the street kids had been multiply abus= ed. Other reasons for running away in the kids who had not been abused were parental death and family breakdown.

What problems did they have? Most had problems related to survival - how did they get enough money to live? Many ended up practising what in the USA they call ‘survival sex’; prostituti= ng themselves in order to buy food, clothing and essentials to live on the str= eet and they were therefore also exposing themselves to the risk of HIV and oth= er sexually transmitted diseases. At the moment the Hollywood area has apparen= tly one of the highest rates of HIV infection among young people in America. Two years ago we were hearing that it was the youth in New York who were having= the highest rates - associated with Crack cocaine use - but now it would appear that the street and runaway youth have the biggest problem.

So being a runaway means a lot more than just n= ot having a place to live and we are running into enormous medical problems wi= th runaways and homeless and I think any one who has lived in London over the = last few years has noticed the enormous change that there has been in the street population of London. It used to be predominantly older people and people w= ho had been on the street a long time. The typical winos and meths drinkers who were down at the ‘Elephant and Castle’ and on the benches outsi= de the ‘Old Vic’ and the medical problems were malnutrition, TB, alcoholism. But now we have young people who are out on the streets for whatever reason it might be and these young people are prey to abuse - they often run from abuse in another part of the country and they come to be fur= ther abused in London so they are at risk of HIV, they are at risk of sexually transmitted diseases; and they are at risk of physically harm.

So what are we going to do about it ? The conclusion really which seems to be coming forward from lots of professiona= ls of all different disciplines - is that what you need to do is to give much = more professional support to young people when they run away from home. Have more hostels, move then more quickly from a hostel environment into better housi= ng and to give them an opportunity to get some education and to earn money. So perhaps the message that we seem to be learning from runaway youth which co= uld be transposed from just about any town in the world right from south Americ= a, Rio, Russia, America, is that it seems that kids run away from home for sim= ilar reasons and they run away because they are unhappy, they try to run away to= a better life and they often end up in a worse environment and just as with o= ther problems the philosophy which we have at Youth Support is to try to give education so that young people can be self supporting and perhaps there is no other group of youngs= ters where it is more obvious that this is what is required.

&nb= sp; * * * &= nbsp; * *

We do have a program change - Peter Blakeley from the ‘Safe in the City Project’ Manchester had an accident this afternoon and was thus unabl= e to be with us - this is a disappointment because the Children’s Society = was involved in our meeting last year and Peter was bringing some of their young people with him.

&nb= sp; * * * &= nbsp; * *

Thank you for inviting me - A slight change of emphasis now, in that I work for t= he Thomas Coram Foundation which is an organisation which is just over 250 yea= rs old and part of the great British tradition of abandoning children on the streets unfortunately.

It was previously known as the foundling hospital and set up in 1739, the olde= st children’s charity in world. It was set up by a man called Thomas Cor= am who was a Sea captain who walked through London a= nd was horrified to see children just left to die on the streets which is why when= I go about my work and see young teenagers on the streets I cannot help but d= raw unpalatable parallels in a way. The children are older, but things have cha= nged very little.

The Foundation has adapted however and the foundling hospital closed as the wel= fare state took over the health and welfare of young children. We have 5 childca= re and adoption projects, an adolescent and leaving care project provides three houses possibly similar to Youth Support for young people leaving care with support, counselling and group work. A meeting place for teenagers and pare= nts who have been estranged which provides for access - it is supposed to be an alternative to social service waiting rooms and provides a friendly child centred space which can provide supervised access.

I have worked for the past 4 years on the homeless children’s’ project. We are a mobile force, working all over London a= nd focus on families with children who are homeless. We have four houses for children who are homeless. We do not work with single people but I have recently finished setting up a unit in central = London i= n a large day centre for homeless single people. It is important that those who work with single homeless get together with those professionals who work wi= th family homeless because the issues are the same - basically the lack of reasonably priced accommodation.

The homeless Children’s Project brief is for families with children who a= re homeless. The single homeless issue is very visible and has cause great out= rage and has thus tapped limited g= overnment funds- the media coverage of those living off the streets in winter has spa= rked projects such as the rough sleepers initiative and getting people off the streets and into temporary accommodation - it has not helped those living in bed and breakfast (B&B) accommodation and more housing associations have been entering the market. We were set up by Thomas Coram to intervene where there are large concentrations of homeless families with children who are n= ot getting support systems. I have worked in large parts of North, east and central London<= /st1:City> - there is a separate teams being set up by Barnardos working in South London but we do not go south of the river.

Perhaps I could remind you of the reasons for becoming homeless - it is not through fault of the families - usually there is no property available; at the mome= nt a lot of people are homeless due to repossessed homes; there have always been refugees; those fleeing disaster, women fleeing domestic violence, those who have been staying with relatives who kick them out, variety of different reasons.

The other reason which has been quoted by Peter Lilley a gov= ernment spokesman last week was ‘Young ladies who get pregnant just to jump t= he housing list’ - this is an old chestnut which comes up time after time and it is both untrue and also very depressing really because even the Department of the Environment say ".... the majority of young parents = who become homeless have experienced breakdown of a marriage or partnership, and most have previously had their own accommodation either as tenants and a growing number as housebuyers. The average age of young parents in temporary accommodation is the late 20s= and only a very small proportion is unmarried teenage girls”. It is impor= tant to nail these details, because when g= overnment departments distort these facts they are blaming and increasing the sufferi= ng of the very people who are already suffering as a consequence of the failur= e of their housing policy. It is a= lso assuming that teenage mothers somehow fail - thankfully there is research n= ow that shows that teenage mothers don’t fail, teenage mothers often do remarkably well. Despite that we hear extreme statements made by people suc= h as Margaret Thatcher’s advisor Bernard Ingham who said they were even co= ming down from Leeds to London<= /st1:City> to jump the housing queues!

There used to be 10,000 children in Bed and Breakfast accommodation each night in= London. = That figure has gone down but we now have a new figure of 42,000 homeless childr= en in temporary accommodation in a wider area of <= span lang=3DEN-GB style=3D'font-size:12.0pt;mso-bidi-font-size:10.0pt;font-fam= ily: Courier'>London. = They used to be in Kings Cross, Paddington and Victoria near main railway stations -but it has now spread to Barnet, Walthamstow, Merton- the suburbs are now becoming centres of homelessness and in the same way that Camden and Westminster were unable to cope with families in crisis now the outer boroughs are unable to cope with= the numbers of homeless families with great need. Our team exists to help famil= ies and encourage local authorities and local groups to provide services. =

The councils are moving people into self contained temporary accommodation quic= ker now. Families traditionally spent one year in B & B and 2 years in temporary accommodation, now it is a few months in B&B and 3 yrs temp accommodation. This means councils go further afield to find temporary hous= ing. Lambeth place in Barnet for example, so doctor, school, family and friends links get lost in distant accommodation. Tower Hamlets place miles from peo= ples friends. The families are unsettled in the first place, they then get moved= to the other end of London, then back again, so imagine the effect this has on children’s schooli= ng etc.It is unsettling and causes great distress.

What do we do? We visit families where they live with a variety of approaches. W= e do sessions in B&B sitting rooms, and in hostels. We take in crates of toy= s, easels and do play sessions and attempt to counsel parents and play with children. We often get to know a great deal of intimate and painful details from families in a small time and this can be difficult to work with. We ha= ve to do casework very fast too and we do a lot of personal work, listening to people , giving them back some respect, some simple helping with housing applications. Lot of counselling peoples problems. The families are quite h= appy when we visit as they have no visitors otherwise. We organise a lot of outi= ngs to get them out of overheated rooms and cramped conditions. Families in B &= amp; B support each other in ways which restores faith in human nature when peop= le around you seem not to care.

As far as those who are moved to temporary accommodation is concerned our appr= oach is different because they are isolated and may be placed in an area where t= hey do not want to be identified as homeless which bears a certain stigma. We l= end toys and books - this breaks the ice and gets their trust and then we can do counselling and let them talk to us. We visit them once per month and try to organise groups, outings to pantomimes. It is easier to give intense counse= lling in that situation where groups are placed closer together.

We recruit some help from families themselves. We use teenage children from refugee families to translate for others; we explain technical housing laws which can be traumatic for refugees interviews. Try to adapt to situations = as they occur. In the past we worked with Somalis, Lebanese, Kurdish at the moment, Zaire. We try to reflect cultural background, always looking for go= od language books. Work in lot of different areas, Camden, Hackney, Westminste= r, Victoria - different areas every day. AT the moment we have an art group - art is a universal language and a Bengali Teenage Girls group in Bayswater.

We have recently been running a youth group in the London Connection near Trafalgar Square. These are m= ainly sleepers from the Strand and young people who have come down via the railway stations and make their first port of call Piccadilly circus and that area.= It is very rough and ready and we get a lot of people newly off trains in some confusion , quite excited at being in London but not very successful at cop= ing with some of the dangers.

Since 1991 increasing numbers of users started having babies and staff set up to = deal with homeless youngsters started having to cope with babies in the day cent= re which is noisy, dirty and violent and not the place you would imagine you c= ould take a baby and this worried me. However in the West End circuit the homeless stre= et people have their support network and needed to see their friends. If they = were rehoused in places out say in Swiss Cottage - they did not want to go to th= eir local groups with babies, so the centres asked us to help adapt and respond= to this issue. We ran a young parents group each week for 2 hours for one year= and half. We had three main themes - providing advice and support to prospective parents, work with parents with children along normal pattern of play for children and support for parents, in a way trying to ease them out of the centre by working with individuals to find more appropriate services in the areas they lived in. The atmosphere in the centre was tense, noisy and viol= ent, so we partitioned off part of the cafe to provide space. We built up trust = in parents and the more general membership. Thursdays became quiet for the ent= ire membership who stopped throwing chairs around and were always protective of= the children. We were encouraged by that.

We went in when somebody gave birth in Trafalgar Square but mainly the parents= did well. The babies were healthy and of good weights and the births were uncomplicated. They loved their children and they were remarkably well turn= ed out and although a lot behave irresponsibly during pregnancy they all seem = to exhibit responsible behaviour during groups. Some problems were related to = inability to stop drinking, fighting, or staying out too late in the west end or did = not choose perfect partners, but there were some women who tried very hard. Nea= rly all failed to get community care grants so they had no carpets, fridges and essentials and had problems when they did get flats so we helped apply to trusts and mostly got small grants to help them. Most attended the centre o= nly during the group to see their friends and kept out of west end otherwise wh= ich was a good sign. However there was an alarming level of violence in the gro= up with assaults by members of the group - a pregnant woman struck in the stom= ach in Trafalgar square, one injured in the eye by a beer can, black eyes, cuts, retaliation and victims hospitalised - an incredible level of violence. It changed my view of pregnant women and opened my eyes - now if I saw a pregn= ant woman staggering across Trafalgar square late at night, I would keep out of= her way if I were you!

The group ran on a permanent basis twice a week in the West End for 2 years and= was helped with a grant from Capital Radio.

One last point we should consider is the Children’s Act - I am concerned = for children of homeless families who are a responsibility of the local authori= ty and they should get services. Children under l8 and young single homeless people have rights under the Children’s’ Act. Children in need = who have been accommodated by Local Authority or who have left care aged under = 21 have rights under the Children’s Act to a care plan. I do not want to= see the young children who I am currently working with in B&B under the arc= hes in a few years time.

DB: Of course one of the added hazards created by the decreasing age of street people is that as they get younger we are seeing women of childbearing age = on the streets. Lack of antenatal care in this group is a very big problem. It seems you were lucky with your group but certainly there are problems with medical care, and people have reported particularly in some of the American studies that there have been lot of premature births, low birth weight and infant mortality associated with the lack of antenatal care on the streets.= Low birth weight is associated with the poor diet associated with street living= and of course alcoholism is an important factor - children may be born with foe= tal alcohol syndrome which may not be recognised at birth - we have had example= s in our unit. Sadly the children you mention born on the streets are on the increase - and for many of your five year olds who you don’t want to = see sleeping under the arches - the way things are going - their fate has been sealed.

DF: Yes, I am pessimistic.

Q: How are you funded? I understand you have had money for small projects from charity donations and Capital radio but what of day to day expenses?

DF: Centres across London are funded by Trusts which are bending under the stra= in of work, local councils do not fund the homeless on streets. Government is going to have to fund in future.

DB: It is a shame that central government do not take more responsibility for this problem. Local authorities can so easily pass the buck - for example our local authority has said that they do not have a homeless problem although we know for fact from another source t= hat there are at least 400 homeless in just one area of the borough - if you do= not perceive a problem - you do not have to provide funding- it’s as simp= le as that.

Since the Children’s Act came into force exactly a year ago very little has been done. The leaving care projects are a joke and the befriending program= me has not happened. How can you befriend a homeless kid who has been moved fr= om one borough to another.

Q: There are problems in Barnet - could you comment?

DF: Barnet is a very big borough, three housing associations work with us there= and have an awful lot of temporary accommodation in Barnet.

Q: I am working in Barnet and we have problems because there are 6 local authorities placing in Barnet we have two soup kitchens operating in Barnet at the moment seeing between 70 and 120 people= per day.

DB: Soup kitchens in Barnet? That’s really something else!

Q: What level of success do you think you have with the families in your group= ?

DF: The bottom line is we kept families togethe= r. For example with one mother when I went to see her in hospital there was a = note on her hospital record that the child had to be taken into care. I persuaded the social worker that this was not necessary. Her history was of l5 differ= ent professionals involved in her case. I stuck my neck out, said it was over reaction. She almost did not get out of hospital with the child. Her probation officer called a net= work conference, the health visitor issued a missing persons notice and she was = arrested for fare dodging. These were minor things but her behaviour had given hospital staff concern - really there were minor matters which were exaggerated because of= the emphasis on child protection..

W= e had to do a lot of child protection work. I was generally happy with the way children were brought up there were concerns about children at various time= s. They needed someone to be advocate against system but I was not prepared to= be blinded. It was to make them aware of stakes and how to play the system. Support them in a family and keep them together in difficult circumstances.= The group were the most extreme group of young people I have worked with. There= was a lot to do. After l8 months all the families were together and seem to be fine. I consider that a success story. But it was not just us or me - it was the group itself; giving status to parenthood, helped them grow up and plan ahead.

Q: Given that the government and the state are not really there to support people and the system is overloaded do you feel that you enable families to stand up for themselves = away from the system and stand up on their own two feet.

DF: Really families avoided the system with a bargepole. It was trying to get them aware of benefits and that Social Serv= ices had a role. Health services should be responding to their needs. Specialist health services exist for homeless in W= est End because General practitioners won’t regi= ster them and they have to use accident and emergency departments at hospitals. = They had to assert themselves to get services. We helped them to do this and to become more part of mainstream society. System preying on them to a certain extent. We could accompany them to solicitors and help communication.

Q:Talking about your west end project do you he= lp with health services?

A: Always a problem for homeless families to get access to health services.

Q: It seems to me services are inefficient. I t= hink that a lot of your services and these centres have a stigma attached and pe= ople don’t necessarily want to go to them.

DF: What tends to happen is that you are running your organisation - you have budgets and targets; suddenly the families app= ear on your doorstep then disappear and I have seen schools where in Jan schools undersubscribed and in April had hundreds of children with no schoolplace; = two years later they have gone. I like to think we can all adapt to welcome homeless families but it tends to be a problem of too many or not enough - = day care too, children miss out as they are often placed out of borough and do = not get day care. This should change.

DB: Often they cannot get day care if mother is= not working.

I think one reason why you can provide a good service is that the attitude of your workers is right - it is so easy to se= t a family up to fail. You have all the ingredients there. A child born after mother has been on the streets, who probably drinks too much, not living in good conditions and therefore tending to have a disordered household, difficulties with hygiene and feeding. A visiting carer could easily just c= lock up the problems 1,2,3,4, and the child gets taken into care. Whereas if you= get someone who is going in and saying - well yes you obviously have these prob= lems - so would anyone else in your situation - but you can still be a good moth= er with support. The trouble is often these families are perceived as problems= and professionals do not want the responsibility of sticking their necks out and supporting them rather than condemning them.

It is good to be here but sad that I have to ta= lk about the sorry state of our country and of our young homeless. I speak fro= m an experienced viewpoint working with homeless young people. Earlier this year= we had 200,000 young people in = London alone homeless. Today a few more thousands added to that list.

I think it is a frightening thing that we care = so little for young people and we need to consider - if we don’t care for them now how will they care for us when we are old? When we are pensioners = and we need help ourselves. So a little compassion is important for everyone - = even for selfish reasons.

Tin is a voluntary organisation and I think sometimes that our programmes are too wide - we seek to support the young in everything - in every field, and if we do not have the answer ourselves we = help them look for it. We cannot cope sufficiently because of lack of resource. = We operate on an equal opportunity basis. We are sad to see so many young white people suffering most, especially if they are strong and independent - ther= efore some advice for young people is to show some weakness in case someone looks= at your case. If they are too independent and try to do things themselves - it can act aga= inst them because others won’t help. I have a list of white lies drawn up = for interviews at different places. Different criteria for each place to make t= he young appear more needy and able to get through to the help available.

We negotiate for young people. They do not see = us as part of an institution, but as friends. The listening agency. Whatever i= t is we try to turn negatives into positives.&n= bsp; Young people are sometimes afraid to explain themselves, who they are and what they are going through - some are going through changes of sexuali= ty and they need to be able to talk openly in a friendly place where they can trust us.Every case is dealt with on a confidential basis. My friends have spoken about work with mixed cultures and background and ability.

Some things have already been mentioned about t= he homeless; one common factor is the breakdown of the family unit, where many parents have their own agendas of unhappiness, unemployment and other probl= ems they may be unable to cope with changes in growing people with the stresses involved in growing up.

The homeless still behave like other young peop= le - with the same needs but their resources, their income is quite small and th= ey cannot share. If young people are still sharing accommodation with parents = they do not get full income support. There are many different kinds of instituti= onal harassment, unable to get answers from school, college, Social Services - w= ho try to hide behind organisations.

Bedroom sharing, age differences, privacy, etc.= all cause overcrowding problems in the home and sometimes sexual relationships begin early. For those in other cities -unemployment makes London seem to b= e an attraction.So they come to London but the number of young faces out there sometimes with a smile but empty. Abuse is great. We need some time to thin= k of various types and they have to flee from that. Living on fast food, begging = for food, whatever. Vulnerable on the streets. Someone mentioned refugees - not just form other countries but fleeing here - from homes - to where? Abuse i= s a big reason why young people flee.

Ex-prison offenders - where do they go. No place. Young people going through change of identity, young people who are gay, doors shut against them. HIV infection - the only way you are considered for a place as a homeless is if you become pregnant or totally depressed then you can be placed in an institution or b= ed breakfast. Special needs, but not counted as priority cases today. Students without grants - what do they do? Income support declaring you are a student cannot claim. No housing benefits, because you are a student. How do they survive. Working peopl= e on low income cannot afford to rent rooms because of exploitation. Young people homeless because they cannot find jobs. Just a few of the list. We work clo= sely with hostels, and they need to register with agency. We ring up the housing associations and act on their behalf.

We now have a high percentage of homeless in the l6/17 age group. Local authorities have to be reminded that according to the law they must do something to house these young people. But we must keep good relationship w= ith them. We refer them directly now. We ring Lambeth and Lewisham and speak to= the housing unit by using the law, stressing their liability. We support any project which gets young people housed.

DB: It is very interesting what you said about using the law. In my experience = the difficulty is getting the law to work in time. For instance, with regard to young people in private rented accommodation waiting for housing benefit to come through to landlords who are not willing to wait, or students coming to London on hugely cut housing benefits, or hostels being taken over by other boroughs; difficult enough to identify placements in hostels but how to use them best? Our residential unit could have been given over to young homeless people but this has been disastrous; councils phone us with requests, we agree, and nothing happens. Lew= isham has a large hostel which has recently been closed down; we were asked to ta= ke a young girl who was homeless as emergency for back up. She came to us the following day, and was told when applying for benefit that there was none because she was now in Bromley Borough. How does that happen?

Len: You should go immediately you move to the borough you currently live in and register for housing benefit. They cannot get it unless they have a place b= ut placement form should be filled in and although not immediately they should= get it through.

DB: Yes, we have been waiting eight months for rent money from those we have ta= ken in. When there is such a shortage of rented accommodation there is no incen= tive for anyone to help the homeless is there?

Len: No none. Local councils are now to make plans to put all their housing in trusts, which creates another problem because an epidemic will be on their hands with no new houses being built. I am feeling sometimes when seeing a young person that I am running out of answers and I need to have some way of encouraging them.

DB: Yes we need a positive note.

R Quinn: What is being done to try to get money into housing for young homele= ss - what can be done?

Len: Many local councils do not have money for building programmes. Housing associations are building for sale to professional people not lower income homeless groups. Central g= overnment should act, I am sorry for councils as just to get our funding last year, t= he only one in Southwark on this scale, it will be a blow to young people. A r= eal fight is on - I think this will have to be a political issue.

Q: One of the ways that this issue could be tackled is through the research da= ta coming out of the research like that which is being done by Youth Support a= nd Dr Birch.

Could we hear something of the information that= has come out of that.

DB What we were trying to do was= a comparative study to look at planning for homeless young people to see what similarities were and from that see what attempts had been made to redress = the problem. I was involved regarding the issues as to why people run away from home. The point is we have a complex problem with the homeless in this coun= try because London<= /st1:City> and Manchester for example has problem of runaways who run to and from London - should we do more preventive work with families to help young people stay w= ith their families and not run away? We have the homeless units who are seeing young people who are naturally progressing out of their families to set up their own households, students needing homes and the young girl having a ba= by who should have somewhere decent to live. Unless we have information about = who the homeless people are, their age group and problems, we cannot begin to c= ope with it. The falsehood about young women becoming pregnant just to get hous= ing is something I have had put to me more times than I care to think. Every ti= me I go to a regional talk about schoolgirl pregnancy which is my subject I get = this thrown at me. Unfortunately one of the girls who was coming today who was g= oing to be in our panel was unable to come. There were two actually and one who = went into labour and one is heavily pregnant - but one of the girls who was part= of my first study on schoolgirl pregnancy and her first baby the one I worked = with is now 11 years old. She is homeless. She is not the only one - 157 schoolg= irls ten years later is an eye-opener because a lot of them still have the same housing problems they had ten years ago. If you saw the desperate conditions some of them live in after they have left home you would never again imagine that anyone got pregnant and would live like that in order to get a council flat. A schoolgirl with a baby will not even be considered until the child = is at least two and a half so what is she to do until then? Some can go to mot= her and baby homes perhaps but that is not ideal. She cannot have the father of= the baby with her there. A pregnant schoolgirl has often been deprived of her o= wn father in a one parent home and the lack of father figure is an important factor in the history of early child bearing - so we are setting up a repea= t of this situation. We are re-creating another deprived group - a young girl pregnant setting her up in a situation where her child is inevitably being brought up in a single parent situation because you are not giving her the accommodation where she could possibly be with the father of her baby even = if he wanted to be there - The research shows that 45% of the boys still want = to be around 2 years on so we are not giving young girls the sort of support t= hat we should be.

Some end up squatting. This is not a wonderful existence as some people think, w= here you can just live rent free at someone else’s expense - it is somewhe= re where you have to be careful of every knock on the door in case it is someo= ne checking up on you, you cannot get repairs done, leaky roofs, damp, you are prey to vandals on the estate because you cannot call out the police when y= ou are there illegally yourself; you see tremendous misery in squat situations= .

Girls who have been living in that sort of situation, perhaps even after they have had a second child they are so used to not being able to do anything for themselves, they lose any power and self esteem which they may have started= off with and they very rapidly fall into the sort of situation of the families = that we have been hearing about - of being set up to fail. Looking at what happe= ns to these families and what happens to young mothers is extremely important because there are so many myths and there is so much hearsay and this can be used in wrong way by politicians and so on and there is so much buck passing politicians.

I get very angry about the children’s act and other pronouncements beca= use there are so many intentions and promises and nothing is happening - life is more difficult now because people think Oh Yes, it’s all there! But w= here is the money to back it up?

When it comes to voluntary agencies like ourselves, I get sick to death of people asking ‘where is your funding coming from’ and being frozen into inaction by lack of Government grants. Funding comes from putting your hand= in your pocket every now and then and trying to carry on one more day without getting funding from anywhere. At Youth Support we have had no ‘funding’ ever from anyone, we set out to be self sufficient, we charge the statutory authorities (social services, health) for items of ser= vice we provide. But of course they will only pay for a narrow area of casework.=

The number of people we have to turn away is ridiculous - last new year eve we had to turn a= way a young girl on the doorstep heavily pregnant. We passed her on to social services who could not help. She wasn't mentally ill, she was not going to injure this child - she wanted this child but she wanted support - and this= was not available to her.

Q: What is the role of voluntary agencies - should you be doing more?

DB: There are too many voluntary agencies propping the statutory services up. We need to stick in there and make a noise - so that we avoid the pitfall of ‘Oh we have not got a problem’. But we need to be careful not to take on too much of what should be g= overnment’s responsibility towards the young and homeless.

Further discussion continued in our panel which included representatives from the Samaritans commenting on the depression, cries for help and suicidal despair of some of the homeless; st= reet artists and seller of the ‘B= ig Issue’ magazine - sold in aid of the homeless; and young people in the audience. The charitable organisations ‘Shelter’ and ‘Centrepoint Soho’= were unable to send representatives but provided us with written material w= hich is presented in collage form in these pages. We are grateful to them for the material and also acknowledge inclusion of a quote from Harriet Swain of Ci= ty Limits on ‘When the caring stops’ - (Sept 92) which was discuss= ed in the panel.

Useful References -

“Runaway and Homeless Youth in = Los Angeles County, = California” Julia Pennbridge; Gary Yates; Thomas David; Richard MacKenzie. Journal of Adolescent Health Care 1990; 11:159-165.

“A Risk profile Comparison of Homeless Youth Involved in Prostitution and Home= less Youth Not Involved” Gary Yates; Richard MacKenzie; Julia Pennbridge; = Avon Swofford. Journal of Adolescent Health 1991; 12:545-548.<= /p>

“The abused/Non Abused Dichotomy, does it hold for runaway and homeless Youth?” Julia Pennbridge; Elizabeth Chanesky; Richard MacKenzie; Thom= as David.

“High Risk Behaviours among street youth in Hollywood California&#= 8221; Julia Pennbridge; Thomas Freese; Richard MacKenzie.

“Risk profile of Homeless Pregnant Adolescents and Youth” Julia Pennbridge; Richard MacKenzie; Avon Swofford. Journal of Adolescent Health 1991; 12:534-538.

“Survey of Runaway Youth in the Urals”

For some time we have tried to gather information on runaway Youth in the Soviet Union. Youth Support became involved in a variety of projects with the “Lenin Children’s Fund”.Those successfu= lly completed included training programmes for Medical and Psychotherapy staff; Exchanges for Russian teenagers who spent time in London Schools; enabling gifted students to pursue degree courses; talking to Soviet Youth in schools and social clubs; advising on sexual and emotional health.We have published= a number of essays and comments written by Russian Youth in this Journal. Our last and most exciting project was to have been the establishment of a ‘Youth Support House Urals’ - a counselling centre with residen= tial refuge attached which would specifically cater to incest victims, abused yo= uth and emotionally disturbed teenagers - most of which had hitherto been dealt with punitively if at all. One of the establishments which we visited regul= arly in the planning of our centre, was the hostel for runaway youth (see page 5= )- the plight of these young people deserved our attention.<= /p>

The Soviet Union w= ent through a period of intense turmoil and then ceased to exist during the per= iod of our study. We began planning the study in 1991 at a time when the state = was still communist, still poor but to a degree stable. The rouble was official= ly three or four to the pound and the hierarchy of local officials was present, albeit confused in the typical Russian style. There were few runaways, few street children, prostitution ‘rich men’s tarts’. During = the following year the economy and society were overturned, all values seemed t= o be lost, children and youth were being left to fend for themselves in <= st1:City>Moscow a= nd the main railway stations were hiding places for young runaways who resorted to survival sex. It became acceptable for girls in reasonable families to earn= the equivalent of their father’s yearly salary by spending a few nights as call girls for rich tourists. This is not the first, and sadly probably not= the last time that social upheaval has caused a surge of street children - the = same thing happened in the wake of the Russian Revolution -

" ...... The kids there wal= king about who were free, well you could call it 'free' I suppose - Oh there wer= e so many children. There were the Besprisornik - the dispossessed children - walking the streets, ...so many children, ...hopeless, ...

...... they were afraid we would all die. It was so dangerous in Moscow. No food, children foraging in the street. There were different gangs trying= to survive. One was the 'Papringunchi' - the jumpers. they lay in the snow wea= ring white sheets so you wouldn't see them and they had springs on their feet and they would suddenly spring up and rob you when you passed. There were such terrible rumours - another gang threatened to spit on you and give you syph= ilis if you didn't give them your food and money, or your boots. I had nightmares about them. ...."

From "Retracing the Echoes&= quot; (Youth Support Publications)

For us the result of political and social unrest meant that our survey material= was out of date and unreliable as soon as it was collected. The funds put aside= for our projects became worthless overnight and the hierarchy of colleagues we = were working with collapsed resulting in the loss of important data. We had plan= ned to survey 50 girls and 50 boys from Moscow a= nd the same number from the Urals. The = Moscow data and that on the Urals girls has been ‘lost’. Nevertheless,= we do have limited data on the Urals runaway boys which is set out below with = the provisos that it may not be representative of any other part of the country= and it also may be ‘time expired’. For these reasons I have not attempted to set out the study in formal ‘scientific’ style but confine this report to narrative form for general interest only.=

Data collection -= We decided to use a simple questionnaire which was adapted from the HEAADS medical encounter form used in = Los Angeles and supplied to us by Julia Pennbridge. Many of the research instruments used by the US t= eam proved too sophisticated for our use for several reasons. We required an ea= sily translatable form which for example would not categorise sexual practices t= oo finely running the risk of confusing the patients or administrators of the questionnaires. The level of medical care, access to laboratory and sophisticated diagnostic tools was very limited in the area, thus we confin= ed our health comments to general problems.

Questionnaires were prepared in London but administered by Dr Andrei Smirnov who had visited Youth Support House f= or orientation and training and was permanently based in the Urals town of Sverdlovsk (= now Ekaterinburg). The boys were all interviewed in the detention centre / temporary children’s home which was featured in our video recording (= see above) and they had mainly been picked up by the militia from the railway station and off the streets. One of our Urals students Boris Slobodkin translated the records back into English.

Results:- Age and Family - <= /span>The average age of the sample was 15 with the youngest runaway being 11 years o= ld. They had on average two siblings and mainly came from two parent families o= ften with a grandmother or both grandparents present -most had both mother and father in the household. These are unusually large families from the Russian point of view and thus there was some overcrowding and pressure on the young boys to leave.

Pattern of ‘runaways’ - Half ran away within their o= wn town - a large industrial provincial town; 25% from another town in the same region and 25% from another region involving very long distances. 85% had o= nly been away from home for 2 months and 15% for a year or more; most ran only = once (50%); 40% 3 times and 10% a high number of times (max 25 times).

Activities/Crime - Sixty percent were involved in crime including all the long term and repeat runne= rs, 23% were involved in gangs. Two of the older boys had managed to obtain some work.

Sexual Experience - <= /b>Only 15% had experienced sex and the youngest intercourse was 13 years - thus th= is was not a largely sexually experienced or exploited sample. Only one boy of= 14 had been involved in prostitution. All of the other reported sexual experie= nces were heterosexual involving vaginal sex.

Drugs - Only one boy took drugs - the same boy who had been involved in prostitution. 60% drank alcohol and the same percentage smoked. Alcohol was also used as a wa= y to keep warm.

Health - 35% of the boys were suffering from malnutrition and 40% were significantly depressed.

Reason for leaving home - 40% left after a family row but 50% left because their families turned them out= or abandoned them - most did not wish to leave. 10% admitted to being bullied.=

Comments - Overall the reasons leaving home are much the same as in other groups of runaways. = When I spoke to individual boys and girls I did find that many had been physical= ly abused although in the questionnaire answers this feature was masked by ‘family rows’. Many of the children were from very poor rural h= ouseholds where physical chastisement was accepted as part of the norm. The economics= of family life with children being turned out to fend for themselves is simila= r to the patterns seen in some = South American street children.

For many years abuse of children, particularly sexual abuse was hardly spoken of and certainly not officially reported in the Soviet Union. Medical personnel are very aware of the high level of incest and sexual abuse which does exist in overcrowded disordered families. Some of the rural areas are particularly affected. Dr Vadim Roman= ov, a gynaecologist who spent a 6 month training period at Youth Support descri= bed a high rate of incest and girls of 9 and 10 who became pregnant. “...We were driving do= wn yet another Leninski Prospect in a God forsaken town in the northern Urals.= The incongruity, the contrast of new and old Russia was vividly apparent as the little old wooden houses, with their decayed carved ornamental windows and a few struggling Birch trees stood out starkly against the background of chimneys, cooling towers and smoke from the metal works - the heaviest metal plant in the region, that which produced the first steam engine in the Sovi= et Union - and placed conveniently right in the centre of town; Right where it= can pollute the air to the fullest extent and prematurely blacken the ancient houses while it prematurely ages the inhabitants - that is, those who live = long enough to age. The childhood leukaemia rate is the highest in the region du= e to the pollution.

    Dust clouds pirouetted = across the station square as a group of ragged children with pinched wind-tanned f= aces scuffed their worn through shoes as they patiently waited in the queue for = the circus. The scene seemed from a past era, colourless except for the clown's face on the side of one of the trailers. Many of the faces looked eastern, definitely Asian rather than European with a good number of Romany people .. and I thought how caravans of performers must have travelled these towns for centuries. Here the travelling circus was still a major source of entertain= ment even in the nineties, no videos or computer games ... no arcades of bleeping toys. Just a dilapidated group of trailers with a motley set of circus anim= als, a camel who fell asleep and wouldn't get up for the children, a rather moth-eaten lion, a few horses ... but enough to bring some excitement into = the children's lives.

    And while I was resigni= ng myself to being in a such austere, poverty ridden surroundings, another contrast glared out .. as we entered the station hotel - a typical communist post war bui= lding which could have been anywhere in the USSR - and walked through to the restaurant for a meal ... We had been expected and a special table was laid= out on the balcony, overlooking the main floor. The four course meal which foll= owed was one of the best I had eaten in Russia with touches of unexpected elegance - the swirls of carrot and cucumber flowers parodying the swirls of dust outside in the real world....”        =       "How old are you Alyosha?"     "Thirteen&q= uot;

    "Just thirteen - H= ow do you like it here? Are you pleased you were found?"

    "Yes, at first I t= hought this was a bad place, but now I think they're all right. I have to stay unt= il my parents come"   &q= uot;Do you want to see your parents? Why did you leave home?"    "I want to go home= . I left because my friends were going. My friend had been badly beaten at home= . I was found by the Militia and they ran off"

    "Your friends must= be frightened. Are you worried about them?"

    "Yes, I worry very= much. They are still travelling. I don't know where they are and I don't know what will happen to them. ..."


NEWS      NEWS      NEWS      NEWS      NEWS      NEWS

=

The European Forum for Adolescent Heal= th had a very successful meeting in = Utrecht in July this year - many thanks to Gerben Sinnema for such an interesting event. His conference report follows.

The WHO is concerned about the growing problem of substance abuse amongst street children and runaway youth and h= as launched a pilot project to confront this - it began in 7 countries = Brazil, = Egypt, = Honduras, = Mexico,<= span style=3D'mso-spacerun:yes'> the Philippines a= nd Zambia. = Now a number of other states have joined the initiative. For further information please contact Andrew Ball of WHO FAX 41 22 791 0746.

SAM meeting is coming up in Vancouver March 23= -25 1995 - with the IAAH meeting overlapping from 20-22 March (for details see last issue). Anyone in UK w= ishing to attend as part of YS group please contact office.

XXI International Congress on Paediatrics Cairo 10-15 September for informa= tion fax 202 354 2556

Homelessness and Ill Health<= /span> - the report of the Royal College of Physicians working party is available = from the college at price of £8.50 - contact publications department 11 St Andrew’s Place Regent’s Park NW1 4LE.

International Association for Adolescent Psychiatry meeting Athens <= /span>Greece <= /span>July 5-8 1995. Information from Shelley Doctors Fax 212 873 3841.