Vivian was nearly 17 years old when she came to Covenant House, a shelter and rehabilitation center for homeless youths. She arrived at the shelter and asked, ďCan I please stay here? Iím afraid to go home ... Ē
She barely spoke aside from this plea for help. What was remarkable about her appearance was the heavy, hooded coat she wore. She wore the coat constantly and kept the hood wrapped around her head with the drawstring pulled so tightly that only 4 inches of her face was revealed in the small circle. Vivianís reasons for coming to Covenant House would gradually be revealed to the shelterís staff, and her road to recovery would become a testament to the power of a caring environment.
For those whose lives offer little that is positive, feelings of sadness, hopelessness, and anger can become overwhelming and lead to generalized depression. This sadness enters the lives of young people for a number of reasons, including neglect, abuse, and homelessness. Most of the teenagers served at Covenant House are homeless because they have either run away or been thrown out of homes plagued by abuse and rejection. Most common among the wide range of emotional problems experienced by residents are generalized feelings of depression, characterized by extreme feelings of anger. Considering the life experiences of these youth, depression is not only an understandable response, but also a predictable one. Perhaps the most consistent psychological characteristic of such youths is their poor self-image. Many see themselves as worthless and hold themselves responsible for all that went wrong in their lives and in their families. These feelings are usually unjustified or far in excess of their contribution to the troubles of the home. Another characteristic of these young people is a lack of trust in adults. The key to successful interventions for homeless youths suffering from depression is to discourage isolation and inspire trust and stability with communication, success-building activities, participation in group activities, affirmation of positive behavior, and encouragement of long-term goals.
The staff at Covenant House sees the entire spectrum
of behaviors resulting from unresolved anger in its adolescent
residents. Some traumatized youths act out to express their anger, while
others internalize their feelings of anger and frustration. When Vivian
arrived at Covenant House, she exhibited internalized anger. She barely
spoke to staff members, and she hid
inside her hood. Clinical impressions were of an essentially normal adolescent with responses of internalization to a very traumatizing situation. Repressed and depressed behavior such as withdrawal, isolation, refusal to speak or interact with others, and the inability to function in social situations such as school, become major issues. The most serious symptoms that frequently accompany such anti-social behaviors are suicidal thoughts. There are many variations in the severity of these depressed behaviors, and interventions must always be targeted toward lessening the beginning stages in the hope of averting total withdrawal or an action such as a suicide attempt. Professional judgements by clinicians help to distinguish between situational depressed behaviors and serious psychiatric conditions, which can lead to thoughts of suicide in adolescents.
Although acting out is seen by some professionals as a healthier behavior than internalization, it can become a major problem as an agency searches for the next step in life planning for the affected youth. Placement for youths who act out in severe ways is very difficult, and such behaviors limit possibilities including job preparation and placement, some of the usual strategies for rehabilitation of troubled, homeless, young people. Making decisions about the future for all youths who show symptoms of depression is problematic unless interventions can gradually lessen symptoms and healthier responses begin to appear. The solutions fall in the realm of changing feelings. It has taken time for youths to develop their deep-seated negative feelings; the process of reversal also takes time.
At Covenant House, the reversal process is one of patient movement toward stabilization whereby life becomes a predictable reality. The goal is to eliminate the experience of life as chaotic with no definite parameters. It is necessary to offer youths orderly lives, with the sense that people are there to offer care and concern. Opportunities to talk out the angry feelings and to affirm this angerís legitimacy will begin to calm these adolescents and is a basic and essential part of the process of anger management. By using nonthreatening verbal communication, the staff at Covenant House was eventually able to coax Vivian into revealing the sad facts that brought her to the shelter. Vivianís motherís boyfriend repeatedly attempted to sexually molest her, and when she fought against him, he beat her. The evidence of the beatings became all too clear when the staff persuaded her to take a shower and change her clothes. The bruises brought a harsh reality to her horror stories. After washing and changing her clothing, she donned the coat and pulled the hood tight.
To an adolescent who has known mostly failure and put-downs in life, the provision of positive experiences, which begin to offer hope and an orientation toward the future, is important to the process of reversal. Staff must provide a predictable schedule of events like meals, classes, and time for fun. This encourages stability and the ability to concentrate on personal interests and goals. Planning needs to include options that produce minimal anxiety, such as gym activities, quiet games, art or videos. Initial schedules need to be kept flexible for youths who have disturbed sleep patterns. Outside events such as offsite movies or field trips should be put off until anxiety levels are manageable. Some residents may fear leaving the building until they feel safe. Offering youths opportunities for success with strong affirmation is essential. This success can be found initially in activities or group relations, and will gradually thrive in school or on the job.
The demands placed on an adolescent need to be minimal in the beginning and introduced only as the youth is able to respond. In Vivianís case, the more she talked with staff, the less withdrawn her behavior became. Program staff began to plan events with little pressure and lots of rewards, like games and other group activities. It was soon evident that Vivian was a very bright girl whose school success had been a dominant, rewarding area of her life. She became more relaxed and eager to participate in her classes. Staff members need to observe small changes such as improved appearance or higher energy levels in individuals, affirm such changes, and adjust the program accordingly. As isolation and withdrawal tendencies diminish, more challenging opportunities for participation and fun will nourish the stabilization process. For many youths, such satisfaction may come from physical events such as basketball or karate, while others may seek artistic expression. But some youths will remain nonparticipating despite the best efforts of a caring staff.
When residents resist participation for long periods
of time, staff should seek to engage these youths in regular
discussions, so isolation is not possible, and invite them into quiet
collaboration activities, such as games and group discussions. Keep in
mind that some quiet youths may be using avoidance techniques in their
attempts to appear healthy. These adolescents may be under the greatest
stress. They have no energy to participate, and they need special
attention. Also, some youths who have been in treatment systems for long
periods of time have learned to protect themselves from further
intrusion, including the perceived intrusion of workers who are trying
help. Street life and self-protection have characterized their lives for too long, and for these youths, just the possibility that people really care about them is a new experience, and ambivalence about trusting will be prevalent. Group living can be a motivator and reinforcer of positive behavior. Interaction with other youths who are farther along the road to recovery, holding jobs, going to classes, and are oriented toward future goals, can help to generate hope in depressed adolescents. Vivianís case shows the positive outcome of interaction with recovering youths. As she saw other residents holding part-time jobs, she began to show an interest in employment to earn spending money. This interest indicated the ability to look toward the future, a goal of the reversal process.
Perhaps the most difficult behaviors to handle are the selfmedicating tendencies of street youths. Their use of alcohol and drugs to ease their pain is a frequent symptom and must be handled in the context of developing healthier coping behaviors. At Covenant House, physicians always make decisions about the use of mood-elevating medications. If possible, dependence on other medications should be avoided at least until some stability begins. But, even with the addition of medication, it is the staff at Covenant House that is the key part in the healing process. As a staff member, it is paramount to develop nonthreatening verbal interaction skills, and become a good observer, reporter, and flexible planner, who can learn when and how to affirm.
Vivianís case shows that depressed behavior is common and can be expected among youths who have been deprived of healthy home environments with strong, positive family ties. When these negative experiences are accompanied by abusive treatment, extreme neglect or homelessness, feelings of anger, depression, and difficult behaviors are sure to develop. In Vivianís case, the presence of a caring staff gradually began to make a difference. Her case illustrates that it is possible to achieve reversal of depression with the proper interventions. Experience with many homeless youths has demonstrated that caring relationships are the essential ingredient and staff members need to know how important every interaction is in the total healing process. The staff of Covenant House sees the success of these caring relationships in Vivianís story. She has been at the shelter for over three months and continues to improve in her behavior, performance, and emotional health, and she no longer wears her hood.