Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people.

BACKGROUND: Millions of street-connected children and young people worldwide live or work in street environments. They are vulnerable to many risks, whether or not they remain connected to families of origin, and despite many strengths and resiliencies, they are excluded from mainstream social structures and opportunities. OBJECTIVES: Primary research objectivesTo evaluate and summarise the effectiveness of interventions for street-connected children and young people that aim to:• promote inclusion and reintegration;• increase literacy and numeracy;• facilitate access to education and employment;• promote mental health, including self esteem;• reduce harms associated with early sexual activity and substance misuse. Secondary research objectives• To explore whether effects of interventions differ within and between populations, and whether an equity gradient influences these effects, by extrapolating from all findings relevance for low- and middle-income countries (LMICs) (Peters 2004).• To describe other health, educational, psychosocial and behavioural effects, when appropriate outcomes are reported.• To explore the influence of context in design, delivery and outcomes of interventions.• To explore the relationship between numbers of components and duration and effects of interventions.• To highlight implications of these findings for further research and research methods to improve evidence in relation to the primary research objective.• To consider adverse or unintended outcomes. SEARCH METHODS: We searched the following bibliographic databases, searched for the original review, from inception to 2012, and various relevant non-governmental and organisational websites: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE and Pre-MEDLINE; EMBASE and EMBASE Classic; Cumulative Index to Nursing and Allied Health Literature (CINAHL); PsycINFO; Education Resource Information Center (ERIC); Sociological Abstracts; Social Services Abstracts; Social Work Abstracts; Healthstar; Latin American Caribbean Health Sciences Literature (LILACS); System for Grey literature in Europe (OpenGrey); ProQuest Dissertations and Theses; EconLit; IDEAS Economics and Finance Research; JOLIS Library Catalog of the holdings of the World Bank Group and International Monetary Fund (IMF) Libraries; British Library for Development Studies (BLDS); Google and Google Scholar. We updated the search in April 2015 for the review update, using the same methods. SELECTION CRITERIA: This review includes data from harm reduction or reintegration intervention studies that used a comparison group study design; all were randomised or quasi-randomised studies. Studies were included if they evaluated interventions provided for street-connected children and young people, from birth to 24 years, in all contexts. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias and other factors presented in the Discussion and Summary quality assessment (Grades of Recommendation, Assessment, Development and Evaluation (GRADE)). We extracted data on intervention delivery, context, process factors, equity and outcomes, and grouped outcomes into psychosocial outcomes, risky sexual behaviours or substance use. We conducted meta-analyses for outcomes where the outcome measures were sufficiently similar. We evaluated other outcomes narratively. MAIN RESULTS: We included 13 studies evaluating 19 interventions from high-income countries (HICs). We found no sufficiently robust evaluations conducted in low- and middle-income countries (LMICs). Study quality overall was low and measurements used by studies variable. Participants were classified as drop-in and shelter-based. No studies measured the primary outcome of reintegration and none reported on adverse effects.We found no consistent results on a range of relevant outcomes within domains of psychosocial health, substance misuse and sexually risky behaviours . Interventions evaluated consisted of time-limited therapeutically based programmes that proved no more effective than standard shelter or drop-in services and other control interventions used for most outcomes in most studies. Favourable changes from baseline were reported for outcomes for most participants following therapy interventions and standard services. We noted considerable heterogeneity between studies and inconsistent reporting of equity data. No studies measured the primary outcome of reintegration or reported on adverse effects. AUTHORS' CONCLUSIONS: Analysis revealed no consistently significant benefit for focused therapeutic interventions compared with standard services such as drop-in centres, case management and other comparable interventions for street-connected children and young people. Commonly available services, however, were not rigorously evaluated. Robust evaluation of interventions, including comparison with no intervention, would establish a more reliable evidence base to inform service implementation. More robust research is needed in LMICs to examine interventions for street-connected children and young people with different backgrounds and service needs.

Youth Perspectives on Sexual Health Workshops: Informing Future Practice.

Newcomer and street-involved youth provided their perspective on the design and content of a sexual education workshop. Following the workshop, focus group discussions were held with 80 youth from four youth-serving agencies. Youth expressed increased levels of confidence and empowerment, consistent with recent criticism that a focus on specific behaviors as intervention outcome measures may miss important psychosocial changes in participants. Some youth views on cultural adaptation of workshops were not consistent with current views expressed by some adult educators, highlighting the need to ensure a youth perspective is captured during intervention development. Finally, the dichotomous views that youth expressed regarding workshop activities emphasizes a research gap related to how best to adapt interventions to different cognitive capacities, literacy levels, and learning styles. Information of this kind is relevant in terms of knowledge translation from youth to program planners and educators.

Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people.

BACKGROUND: Numbers of street-connected children and young people run into many millions worldwide and include children and young people who live or work in street environments. Whether or not they remain connected to their families of origin, and despite many strengths and resiliencies, they are vulnerable to a range of risks and are excluded from mainstream social structures and opportunities. OBJECTIVES: To summarise the effectiveness of interventions for street-connected children and young people that promote inclusion and reintegration and reduce harms. To explore the processes of successful intervention and models of change in this area, and to understand how intervention effectiveness may vary in different contexts.. SEARCH METHODS: We searched the following bibliographic databases, from inception to 2012, and various relevant non-governmental and organisational websites: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE and PreMEDLINE; EMBASE and EMBASE Classic; CINAHL; PsycINFO; ERIC; Sociological Abstracts; Social Services Abstracts; Social Work Abstracts; Healthstar; LILACS; System for Grey literature in Europe (OpenGrey); ProQuest Dissertations and Theses; EconLit; IDEAS Economics and Finance Research; JOLIS Library Catalog of the holdings of the World Bank Group and IMF Libraries; BLDS (British Library for Development Studies); Google, Google Scholar. SELECTION CRITERIA: The review included data from harm reduction or reintegration promotion intervention studies that used a comparison group study design and were all randomised or quasi-randomised studies. Studies were included if they evaluated interventions aimed to benefit street-connected children and young people, aged 0 to 24 years, in all contexts. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risk of bias of included studies. Data were extracted on intervention delivery, context, process factors, equity and outcomes. Outcome measures were grouped according to whether they measured psychosocial outcomes, risky sexual behaviours or substance use. A meta-analysis was conducted for some outcomes though it was not possible for all due to differences in measurements between studies. Other outcomes were evaluated narratively. MAIN RESULTS: We included 11 studies evaluating 12 interventions from high income countries. We did not find any sufficiently robust evaluations conducted in low and middle income countries (LMICs) despite the existence of many relevant programmes. Study quality overall was low to moderate and there was great variation in the measurement used by studies, making comparison difficult. Participants were drop-in and shelter based. We found no consistent results on a range of relevant outcomes within domains of psychosocial health, substance misuse and sexual risky behaviours despite the many measurements collected in the studies. The interventions being evaluated consisted of time limited therapeutically based programmes which did not prove more effective than standard shelter or drop-in services for most outcomes and in most studies. There were favourable changes from baseline in outcomes for most particpants in therapy interventions and also in standard services. There was considerable heterogeneity between studies and equity data were inconsistently reported. No study measured the primary outcome of reintegration or reported on adverse effects. The review discussion section included consideration of the relevance of the findings for LMIC settings. AUTHORS' CONCLUSIONS: Analysis across the included studies found no consistently significant benefit for the 'new' interventions compared to standard services for street-connected children and young people. These latter interventions, however, have not been rigorously evaluated, especially in the context of LMICs. Robustly evaluating the interventions would enable better recommendations to be made for service delivery. There is a need for future research in LMICs that includes children who are on the streets due to urbanisation, war or migration and who may be vulnerable to risks such as trafficking.

Merging the fields of mental health and social enterprise: lessons from abroad and cumulative findings from research with homeless youths.

Despite the growing integration of supported employment within the mental health system in the United States as well as the widespread use of social enterprises abroad, the fields of mental health and social enterprises remain largely separate in the USA. The mental health field currently lacks a response that strengthens homeless youths' existing human and social capital, provides them with marketable job skills and employment, and impacts their mental health. To address this gap, this paper establishes a case for using social enterprises with homeless youths, drawing on both global precedents and findings from a mixed-methods study of a social enterprise intervention with homeless youths. Recommendations are offered for how to integrate social enterprises with mental health treatment as well as how to evaluate their impact on mental health outcomes.

Health-seeking challenges among homeless youth.

BACKGROUND: Approximately 1.5 to 2 million homeless young persons live on the streets in the United States. With the current economic situation, research is needed on quality of services geared toward homeless young adults. OBJECTIVES: The objective of this study was to explore homeless young adults' perspectives on barriers and facilitators of health-care-seeking behavior and their perspectives on improving existing programs for homeless persons. METHODS: This article is a descriptive qualitative study using focus groups, with a purposeful sample of 24 homeless drug-using young adults. RESULTS: Identified themes were failing access to care based on perceived structural barriers (limited clinic sites, limited hours of operation, priority health conditions, and long wait times) and social barriers (perception of discrimination by uncaring professionals, law enforcement, and society in general). DISCUSSION: Results provide insight into programmatic and agency resources that facilitate health-seeking behaviors among homeless young adults and include implications for more research with providers of homeless health and social services.

Piloting an evidence-based intervention for HIV prevention among street youth in Eldoret, Kenya.

OBJECTIVES: This study presents findings from piloting an adapted evidence-based intervention, Stepping Stones and Creating Futures, to change street-connected young people's HIV knowledge, condom-use self-efficacy, and sexual practices. METHODS: Eighty street-connected young people participated in a pre- and post-test mixed methods design in Eldoret, Kenya. The primary outcome of interest was HIV knowledge. Secondary outcomes included condom-use self-efficacy and sexual practices. Multiple linear regression models for change scores with adjustment for socio-demographic variables were fitted. Qualitative and quantitative findings are presented together, where integration confirms, expands on, or uncovers discordant findings. RESULTS: Participants had a significant increase in HIV knowledge from pre- to post-intervention. The median HIV knowledge score pre-intervention was 11 (IQR 8-13) and post-intervention 14 (IQR 12-16). Attendance was significantly associated with HIV knowledge change scores. Qualitatively participants reported increased HIV and condom-use knowledge and improved condom-use self-efficacy and health-seeking practices. CONCLUSIONS: Our findings support the potential for further testing with a rigorous study design to investigate how best to tailor the intervention, particularly by gender, and increase the overall effectiveness of the program.

Associations of Tobacco Advertising Appeal With Intentions to Use Alternative Tobacco Products Among Young Tobacco Users Experiencing Homelessness.

PURPOSE: Virtually nothing is known about the potential effects of tobacco advertising on tobacco use among youth experiencing homelessness, a vulnerable population with high tobacco use rates. This study examines associations between the appeal of advertising for 5 classes of tobacco product (electronic cigarettes, hookah, cigars, cigarillos, and smokeless tobacco) and future intentions to use those products again among homeless youth who had indicated any level of lifetime use. DESIGN: A cross-sectional design was used. SETTING: Settings were 25 service and street sites in Los Angeles County. PARTICIPANTS: A probability sample of 469 young tobacco users experiencing homelessness (mean age = 22; 71% male; 29% non-Hispanic White) was recruited. MEASURES: Assessments included product-specific tobacco advertising appeal and future intentions to use the product again, as well as a range of covariate controls (eg, demographics, homelessness severity, current tobacco use, general advertising exposure). ANALYSIS: Linear regression tested for associations between the appeal of advertising for a specific tobacco product and intentions to use that product again in the future, controlling for myriad covariates. RESULTS: Advertising appeal was positively associated with future intentions to use again for electronic cigarettes (P = .006) and hookah (P = .001), but not cigars (P = .486), cigarillos (P = .126), or smokeless tobacco (P = .109). CONCLUSION: Results suggest that advertising appeal may increase use of certain tobacco products among youth experiencing homelessness. However, differences in themes emphasized by advertising for specific tobacco products could differentially influence use in this population.

A support intervention to promote health and coping among homeless youths.

Homeless youths are often vulnerable to limited support resources and loneliness. Peers are a potent source of social support. A support intervention for homeless youths was designed to optimize peer influence and was pilot tested. The intervention was based on an initial assessment of support needs and intervention preferences from the perspective of 36 homeless youths and 27 service providers. Based on the results, a 20-week pilot intervention program was designed, consisting of 4 support groups, optional one-on-one support, group recreational activities, and meals. Support was provided by professional and peer mentors, including formerly homeless youths. A total of 56 homeless youths aged 16 to 24 took part. Participants completed pre-, mid-, and post-test quantitative measures and qualitative interviews. In spite of challenges due primarily to attrition, the youths reported enhanced health behaviours, improved mental well-being, decreased loneliness, expanded social network, increased coping skills, enhanced self-efficacy, and diminished use of drugs and alcohol. Further research could focus on replication at other sites with a larger sample.

Youth experiencing transitional and temporary homelessness: A pilot study.

Homeless youth represent a vulnerable and understudied population, particularly those among them who are hidden, experiencing transitional or temporary homelessness. Little research focuses on this group, including the methods and settings to identify and tailor interventions to their circumstances. Given the immediate risks and possible transition to chronic homelessness, their identification is critical for prevention and intervention efforts. This exploratory pilot study investigated transitional and temporary homelessness among youth. The study demonstrated the ability to identify such participants. Twenty participants completed a survey that measured demographics, behavioral risk factors, and the Brief Symptom Inventory (BSI; Derogatis, 1993). Reports of relationships with parents varied. They included positive maternal relationships, but also concerns about intrafamilial conflict. While frequent change of schools was reported, generally positive feelings toward school were expressed. Social relationships suggest limited exposure to other homeless youth. Some substance abuse was noted, possibly at lower rates than expected for hard drugs. The BSI results are suggestive of health concerns. The study demonstrated that it is possible to capture children experiencing transitional or temporary homelessness in alternative school settings. It is essential that efforts be made to identify them and provide early supports toward preventing chronic homelessness.

Acceptability of a Pilot Intervention of Voluntary Medical Male Circumcision and HIV Education for Street-Connected Youth in Western Kenya.

PURPOSE: Street-connected youth (SCY) in Kenya and elsewhere in sub-Saharan Africa are at high risk of HIV. Voluntary Male Medical Circumcision (VMMC) reduces the risk of female-to-male HIV transmission. Circumcision is also a traditional coming-of-age process in many Kenyan ethnic groups. This paper describes the acceptability of VMMC delivered as part of a ten-day healing, educational, and 'coming-of-age' retreat implemented as a pilot with SCY. METHODS: Male SCY aged between 12 and 24 living on the street for more than 3 months were eligible to participate. The study took place over 10 days. After medical circumcision, youth participated in education modules. Data collected included qualitative semi-structured exit interviews featuring structured and open-ended questions about factors relevant to this intervention's acceptability. RESULTS: There were 116 SCY (median age 14, IQR 13-15) who participated in the study. All were circumcised successfully, with no major complications. The majority of participants (81%) agreed that the circumcision procedure was uncomplicated, and 99% agreed the education was an important part of the initiation process. Thematic analysis of interview data highlighted four factors important to the program's acceptability: providing food, shelter, security; providing a safe place to heal; including traditional elements; and being with peers. CONCLUSIONS: This novel implementation of VMMC was found to be acceptable to SCY participants and could likely be adapted and scaled for HIV prevention and education with SCY elsewhere in Kenya and sub-Saharan Africa where circumcision is part of traditional coming-of-age processes.

Health educators' perceptions of a sexual health intervention for homeless adolescents.

OBJECTIVE: The purpose of this qualitative descriptive study was to explore the perceptions and experiences of health educators in providing a brief, street-based intervention to homeless adolescents. METHOD: Qualitative data were collected via e-mail from a purposive sample of 13 male and female health educators who provided the intervention and analyzed using manifest and latent content analysis techniques. RESULTS: Five categories with two or more subcategories were identified in the data and included how the educators' views changed, how they felt homeless youth were similar to and different from other adolescents, positive aspects and challenges of providing the intervention, and suggestions for future interventionists working with this population. CONCLUSIONS: The health educators' practice was strengthened over the course of providing the intervention through their positive experiences, changes in their perceptions, some of which were biased, and ability to confront the challenges that accompany working with this vulnerable population. PRACTICE IMPLICATIONS: Health educators who work with this population should learn about the culture of homeless youth and characteristics of homeless youth that may influence their participation in a sexual health intervention. Moreover, they need to be non-judgmental, practice the intervention, be aware of their biases, and remain flexible.

Making drug and alcohol prevention relevant: adapting evidence-based curricula to unique adolescent cultures.

There is profound value in involving youth in the cultural adaptation of evidence-based drug prevention curricula. Presently, despite the existence of evidence-based programs, few community settings are aware of, utilizing, and following evidence-based curricula in practice. Therefore, to transfer such programs to practice, systematic adaptation procedures should be further developed, utilized, and evaluated. It is recommended that community settings adapt curricula to meet their youths' unique needs to be effective, particularly with diverse cultures.

Homeless youths' interpersonal perspectives of health care providers.

In the United States, youth run away from home due to poor interpersonal relationships with parents or guardians; often times, they have been the recipients of parental neglect or abuse. As youth become increasingly entrenched in street-based living and problem substance use, their ability to rehabilitate their lives is incumbent upon trusting and engaging relationships with adult service providers. A total of 54 substance-using homeless youth (18-25 years) participated in focus groups to provide their perspectives on encounters and interpersonal relationships with health care providers. Participants were recruited from shelters in Hollywood, California, and from a drop-in shelter in Santa Monica, California. Four themes related to interpersonal barriers to care from service providers were identified: authoritative communication, one-way communication, disrespect, and empathy. Participants appreciate care providers who convey information in a helpful, meaningful manner and prefer providers who can, themselves, share similar life experiences. Implications point to the need for agencies and services specifically tailored to homeless, drug-using youth. These agencies should employ care providers who are trained to understand the developmental needs and histories of runaway youth. For proper reintegration of this vulnerable population into mainstream society, the narratives of these youth underscore the necessity of targeted services.

Risk behaviours for HIV/AIDS infection among men who have sex with men in Cairo, Egypt.

A sample of 73 men who have sex with men (MSM) in Cairo, Egypt, were screened for HIV infection and were interviewed to study their risk behaviours for HIV/AIDS. Most (65.8%) had initiated sexual activity before 15 years; 65.8% took both active and passive roles in sexual acts. The frequency of sexual acts was < 1 per week for 73.3% of those aged 25+ years, but > 1 daily for 25.9% of those aged < 25 years. Heterosexual relations were reported by 73.3% of the older age group, while 70.7% of the younger age group were exclusively MSM. Condoms were always used by only 19.2% of the sample.

Environmental behavioural modification programme for street children in Alexandria, Egypt.

An environmental behavioural modification programme was implemented in Alexandria city, Egypt, in order to help street children to change their behaviour, discover their abilities and develop and acquire new skills and knowledge. The programme included camping and field trips, recreational activities and games, role play and theatre, story-telling, life-skill activities, and gardening and animal care. Data were collected from observational sheets of adaptive behaviour and conversation sessions before and after the intervention on a sample of 35 street children aged between 7 and 15 years. The mean scores for each behavioural item and all items together before and after the intervention were significantly improved in a number of areas, except for speech disorders and substance use.

[Street social education: historical, political and pedagogical bases]. / Educação social de rua: bases históricas, políticas e pedagógicas.

This work is about street social education as a pedagogical system that started in Latin America in the late 1970s, as the street population formed mostly by children and adolescents called for attention. The first street social educators were 'pastoral' agents working at the praça da Sé a place with large numbers of street children in São Paulo. Based on the Liberation Theology and on the pedagogies developed by Paulo Freire, Celestine Freinet, Anton Makarenko, and Emília Ferreiro, the street educators developed a conceptual field and participated in the promulgation of the 1988 Federal Constitution, particularly by writing and introducing the 'Estatuto da Criança e do Adolescente' (the 'Child and Adolescent Statute'). Street social education is currently latent and suffering the consequences of program discontinuity caused by successive changes of government. It is, therefore important to know the conceptual proposals.

Factores relacionados con la higiene personal de la calle niños en el sitio de disposición final de residuos en Distrito de Mangagala, ciudad de Makassar, Indonesia / Factors related to personal hygiene of street children in the final waste disposal site in Manggala district, Makassar city, Indonesia

Background. Street children are a real phenomenon in everyday life that cause complex social and health problems, dirty appearance, come from poor families, slum settlements or even street children do not have a place to live. The number of homeless people, beggars and street children has decreased, there were 990 street children and homeless people with beggars in Makassar City in 2012. There were 798 street children in Makassar City in 2016 who were recorded by Social Service officers from a number of points. Makassar road with various problems. This number includes 257 street children, 249 homeless and beggars, 58 buskers, 41 prostitutes, 5 transgender women, 63 drug users, and 125 mental disorders. The results of the observations of street children were found with traffic light and garbage disposal sites. These places are often found with dirty, dirty appearance, dirty clothes, smelly, unkempt hair, dirty hands, not wearing sandals and sometimes they eat without washing their hands, which can cause health problems for street children. Based on this background, the researcher is interested in examining the factors related to the personal hygiene of street children in the final waste disposal site in Manggala District, Makassar City. Material and Methods. The research is analytic observation using the Cross-Sectional study. The study was conducted in 21 October 2019 - 31 December 2019. The population was the patients with street children numbered 88 people, a purposive sampling technique was applied through chic square, uji continuity correction and multiple logistic regression analysis. Results. The results showed that the variables age, gender, education and knowledge had a relationship with personal hygiene (pvalue 0.035), the R-square value was 0.897, which means that the ability of the independent variable to explain the dependent variable was 89.7% and 10.3% explained. by factors other than variables. Conclusion. Knowledge variable has a significant effect on personal hygiene (pvalue <0.001), the magnitude of the influence is indicated by the value of Exp (B) 26.6, which means that street children who are knowledgeable are at least 26.6 times less likely to have personal hygiene than street children with good knowledge

Children orphaned by AIDS: a global perspective.

Internationally, the orphan crisis caused by the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic remains a serious issue with long-term social consequences. At the end of 2001, an estimated 14 million children worldwide had lost their mother or both parents to AIDS or related causes. Sub-Saharan Africa is the most severely affected, accounting for more than 80 percent of those orphaned as a result of AIDS. Without the care of parents or an appointed caregiver, children are likely to face extraordinary risks of malnutrition, poor health, inadequate schooling, migration, homelessness, and abuse. Strengthening existing family and community capacity to assist orphans in Africa should be the first priority. Community support must be coupled with support for education for orphans. Combining local and international responses to deliver protection and services to all orphans and vulnerable children is critical. In addition, saving the lives of parents through access to antiretroviral therapies in resource-poor countries in conjunction with bold support for alleviation of poverty and education must be an integral part of the global response to the orphan crisis in sub-Saharan Africa.

Involving street youth in peer harm reduction education. The challenges of evaluation.

OBJECTIVES: To describe and discuss the challenges in evaluation of a participatory action research with street-involved youth. METHODS: A combination of quantitative and qualitative methods were utilized for both process and outcome evaluations. Process evaluation methods included in-depth individual interviews, focus groups, participant observation, and session debriefing forms. Summative evaluation research included focus testing of the harm reduction video and a survey of video users. FINDINGS: Members of the youth team reported favourably on the experience, citing friendship, skills development, fun, and pride of accomplishment among the key benefits of participation. Political tensions arose because of the focus on reducing harm from drug use rather than encouraging abstension. The heavy demands of participatory research and development, resource constraints and the priority given to product development in these kinds of projects necessarily precludes extensive youth participation in the design, implementation and analysis of additional evaluation research. Even when resources are directed towards evaluation, there is a tendency to focus on data collection, which may limit time and resources for data analysis. Finally, there is an inclination to focus on the product development rather than dissemination and impact of the product. INTERPRETATION: Despite the challenges inherent in participatory action research and its evaluation, this project was regarded as an empowering experience by the street youth who participated in it. It is worthwhile to direct resources to evaluation which optimally gives proportional attention to data collection as well as data analysis, and focusses not only on product development but also on its dissemination and impact.

Experiences of being homeless or at risk of being homeless among Canadian youths.

A qualitative study was undertaken with four groups--immigrants, youths, Aboriginal people, and landlords--in order to explore, compare, and contrast diversity issues among the homeless population and those at risk of homelessness in a larger Canadian city (Calgary, Alberta) with a smaller city (Lethbridge, Alberta), to better understand their and to needs make recommendations for improvement in service delivery and policy formation. This paper focuses on the findings from our sample of youths who shared information on a range of factors that contributed to their being homeless or at risk of being homeless. The youths in this study also shared their positive as well as negative experiences with educators, peers, family members, and social service providers. Canada's homeless include growing numbers of young people, families, women, and members of various ethnic communities, including Aboriginal people and immigrants. Today it is no longer possible to articulate a single silhouette of the homeless, but rather a diversity of profiles is needed. It was in the light of this reality that a study, "Diversity Among the Homeless and Those At Risk," was carried out. It was undertaken with four groups--immigrants, youths, Aboriginal people, and landlords.