Ethical issues in research with homeless youths.

AIM: This paper is a report of a study to document researcher, healthcare provider and programme administrators' experiences with ethical issues in research with homeless youths in North America. BACKGROUND: While there are legal and ethical guidelines for research with adolescents and with vulnerable populations in general, there are no specific guidelines for the ethical conduct of research with homeless youths. METHODS: Using a web-based questionnaire, healthcare and social service providers, programme administrators and researchers working with homeless young people throughout the United States of America and Canada were surveyed in 2005. The survey group consisted of 120 individuals; a total of 72 individuals completed the survey. Survey questions included experiences with using incentives in research with homeless youths, consent and experiences with ethics review boards. Numerical data were analysed using frequencies and cross-tabulations. Text data were analysed qualitatively. FINDINGS: Researchers doing mental health and/or substance use research tended to use money as a research incentive, whereas healthcare providers and programme administrators tended to use non-monetary incentives. The majority of respondents reported using written consent for research from homeless youths, including minors. Respondents reporting difficulties with ethics review boards were mainly involved with intervention research. CONCLUSION: Consensus is needed from a variety of stakeholders, including homeless youths and service providers, on use of various types of research incentives for different types of research, as well as use of consent for homeless youths who are minors.

Illness experiences of homeless youth.

The purpose of this study was to document the illness experiences of homeless youth. The research was a focused ethnography with 45 clinic- and street-based homeless youth aged 15 to 23 years. The authors noted gender differences for health-seeking behaviors, with most male youth reporting embarrassment about needing to seek care, and female youth reporting fears over safety issues while ill and homeless. Most youth under age 18 stated that they were often denied health care at hospitals because of their underage status, and youth over age 18 stated that health care bills contributed to their inability to obtain stable housing. Street-based youth reported more illnesses related to substance use and greater reliance on emergency departments for health care than clinic-based youth did. Policies and programs focused on improving the health of homeless youth need to address the differences in illness experiences by age, gender, and sampling site.

Quality of health care: the views of homeless youth.

OBJECTIVE: To develop homeless-youth-identified process and outcome measures of quality of health care. DATA SOURCES/STUDY SETTING: Primary data collection with homeless youth from both street and clinic settings in Seattle, Washington, for calendar year 2002. STUDY DESIGN: The research was a focused ethnography, using key informant and in-depth individual interviews as well as focus groups with a purposeful sample of 47 homeless youth aged 12-23 years. DATA COLLECTION/EXTRACTION METHODS: All interviews and focus groups were tape-recorded, transcribed, and preliminarily coded, with final coding cross-checked and verified with a second researcher. PRINCIPAL FINDINGS: Homeless youth most often stated that cultural and interpersonal aspects of quality of care were important to them. Physical aspects of quality of care reported by the youth were health care sites separate from those for homeless adults, and sites that offered a choice of allopathic and complementary medicine. Outcomes of health care included survival of homelessness, functional and disease-state improvement, and having increased trust and connections with adults and with the wider community. CONCLUSIONS: Homeless youth identified components of quality of care as well as how quality of care should be measured. Their perspectives will be included in a larger follow-up study to develop quality of care indicators for homeless youth.

Eye movement desensitization and reprocessing. A brief and effective treatment for stress.

1. Eye movement desensitization and reprocessing (EMDR) is an integrative therapy that "unlocks" disturbing memories or beliefs and reprocessess them, in some way, so they are no longer as disabling. 2. EMDR can be used for any experientially based psychological problems and has proven especially effective for traumatic imagery associated with posttraumatic stress disorder. 3. A primary benefit of EMDR is its time efficiency, requiring as few as 3 to 5 hours of treatment. 4. Many potential mechanisms (i.e., cognitive, hypnotic, self-disclosure, biological) may account for the effectiveness of EMDR.

Ethical issues in qualitative health research with homeless youths.

BACKGROUND: There is a need for increased guidance for the ethical conduct of qualitative research with vulnerable populations such as homeless youths. AIM: The purpose of this paper is to provide an overview of the main ethical challenges of conducting qualitative research with homeless youths and to propose possible solutions to these challenges. METHODS: This paper was informed by a review of professional guidelines for the ethical conduct of adolescent health research, national (US) and international bioethics bibliographical searches, and personal experience with qualitative research with homeless youths. FINDINGS: The main ethical challenges of conducting qualitative research with homeless youths include establishing and maintaining healthy researcher roles and boundaries, addressing the risks of researcher burn-out and safety issues, assuring optimal confidentiality, and avoiding sensationalism and voyeurism. CONCLUSION: It is important for qualitative researchers who work with vulnerable populations to ensure that research is conducted in the most ethical way possible.

Embracing street culture: fitting health care into the lives of street youth.

The purpose of this article is to describe a unique model for the provision of comprehensive primary health care for homeless youth in Seattle, Washington. Through the description of our program, we argue for the use of youth-centric instead of youth-friendly programs. This means a change from using the friendly health program as the central focus to having the young people be the starting point and adapting the health service to meet their needs. We describe how our model of care optimizes chances for homeless youth to establish positive connections with caring adults. We also show how homeless youth have their own street culture, which is of primary importance to them and which has a powerful impact on how they use and view health care.

Barriers and bridges to care: voices of homeless female adolescent youth in Seattle, Washington, USA.

AIM: The purpose of this study was to conduct an assessment of reproductive health-seeking behaviours, sources of advice, and access to care issues among a sample of clinic-based homeless adolescent women. BACKGROUND: Adolescent women are among the most vulnerable and medically underserved subgroups within the homeless population in the United States. Homeless youth are rarely invited to participate in research aimed at improving their access to appropriate health care. Also, the culture in which they live and the personal experience of being homeless are often not addressed. STUDY METHOD: The research was descriptive, using focus groups and individual interviews with a purposeful sample of 20 female youth, aged 14-23 years. FINDINGS: The women said that they seek health advice from other women, including their mothers even while they are homeless. They reported first trying self-care interventions, and going to clinics when self-care actions no longer worked. They stated that the main barriers to health care were lack of insurance, confusion over consent, transportation problems, lack of respect (from providers) for their own self-knowledge, and judgementalism from providers. CONCLUSION: Using the concept of cultural competency, the results provide insights into how to improve communication and health care services for these women. RECOMMENDATIONS: Health care providers need to recognize and appreciate the lifestyle, beliefs, and adaptive attitudes of homeless youth, rather than labelling them as 'deviant'. All personnel who interact with and on behalf of homeless youth must be adequately trained in general knowledge regarding the health of homeless youth as well as in an understanding of the role that culture plays in their health-seeking behaviours.