Low-threshold Shelters: A First Step Toward Improving Well-being

It’s 8:45 p.m. in the Lakeview neighborhood of Chicago, and two dozen youth have gathered for the nightly lottery to get a bed at The Crib, a shelter that serves homeless young people.

The Crib is a “low threshold” shelter, which means it doesn’t require referrals or identification to stay there, and it has few rules for its residents. Open from 9 p.m. to 9 a.m. to people between 18 and 24 years old, the 20-bed shelter has operated at capacity since it opened last January, having to turn away youth every night.

Though they might not know it, the young people on queue are waiting for more than a clean place to sleep and get a hot meal. By making it easy for youth to enter and receive services, low-threshold shelters like The Crib offer more than the basics. Their supporters, including Jennifer Ho, deputy director at the federal government’s United States Interagency Council on Homelessness, say these shelters can help youth take a first step toward enhanced well-being, laying a foundation on which they can build.

“Low-threshold shelters offer things that youth can say ‘yes’ to,” Ho says. Things like a less-structured approach, positive interactions with caring adults, and links to other services as youth—who often have profound needs—are ready to accept them.

Starting with the Basics

A good night’s sleep can make a world of difference. Paul Hamann, president of The Night Ministry, which runs The Crib,hears from youth service providers at other Chicago organizations that the shelter helps young people follow through with their case plans. When a youth sits down with a case manager or a counselor, and he slept on the street the night before, he’s not going to be able to participate fully in that session.

But when youth are well-rested and well-fed (the shelter also provides bagged lunches that youth can take with them in the morning), they’re less anxious and better able to focus on their goals.

A Less Structured Approach

“Most homeless youth can’t go from the street to a highly structured setting with the flip of a switch,” says Hamann.

Some homeless youth simply reject the rules and requirements of traditional group shelter programs. Others are unable to access them because entry requirements—like being able to follow through with a case management plan—seem unfeasible, especially to those with overwhelming mental health or substance abuse issues.

The Crib focuses on moving young people off the streets. It provides access to knowledgeable and caring adults, a sense of stability and some degree of structure with regular schedules and chores. The idea is to help young people improve their well-being by preparing them to be helped first.

“We provide as much structure as possible while also realizing that too much can be a challenge for some youth,” Hamann says. The Crib provides these youth a place to sleep, shower, get a hot meal, do laundry and talk to someone who can help.

A Range of Opportunities

The low-threshold model provides a number of opportunities to help youth move toward well-being and more permanent housing, Hamann says.

Dinners are served family-style and youth often spend time, after dinner and before bed, sitting at the tables talking with each other and with staff about their day. Youth play board games, draw, journal and participate in group discussions or activities, like yoga. Some youth are in school, Hamann says, and the shelter gives them a quiet space to do homework.

“They have social connectedness here, with staff and other youth. And while it may not be permanent, youth begin to see that those permanent connections are possible,” says Hamann.

Staff also provide referrals to other services in the community, like health care and mental health and substance abuse counseling.

Their positive interactions with The Crib staff and the chance to see what’s possible help youth prepare to accept needed services, Hamann says.

“The Crib acts as a bridge for a lot of youth. They become aware of and gain access to a lot of services that they never knew existed for them,” he says. Services that help young people move one step closer toward health, happiness and a sense of well-being.

Answering Questions, Building Trust: The Role of Health Services in Promoting Well-being

YouthLink, a youth-serving organization in Minneapolis, last year opened a one-stop-shop health clinic for runaway and homeless youth. Here, Clinical Supervisor Lisa Borneman explains how the facility works and why physical health is essential to young people’s well-being.

Our clinic is open Tuesdays and Thursdays, noon to 8 p.m. That overlaps with our drop-in period, which is 3 to 8 p.m. During these hours, youth can talk to a nurse practitioner and a clinic nurse from Health Care for the Homeless. A visiting nurse also comes every Wednesday during drop-in, and we provide dental services once a month where young people can get a cleaning or a tooth pulled.

Our goal is to get them connected to a clinic, because having a primary care doctor who can follow them is the best thing for their health. So many of our youth use the hospital for their primary care, which means there aren’t necessarily records following them. But at a clinic, doctors can check their records and notice, “Hey, you’ve been in here for upper respiratory things a lot, maybe you have asthma.” The hospital won’t necessarily know that pattern.

A lot of the girls come through for pregnancy testing. But a lot of them have colds, rolled ankles, just general stuff. We do a lot of STD testing, too. But sometimes it’s enough for these young people just to have a medical person to talk to. Whether it’s trouble with their menstrual cycles or a recurring pain, a lot of our youth don’t really understand how their bodies work. As far as mental health, our youth often come to us for anger management. They’ve been exploited, abused, they’ve witnessed abuse. They’re having a normal reaction to an abnormal situation, but it confuses them and makes them angry.

Much of the visiting nurse’s job is education, just so youth are more aware of the available services. If they need help that goes beyond what our clinic can do, the nurses connect the youth to another clinic with more services. Or if youth come in during off-hours, we can call our nurse practitioner. She can help them find a clinic rather than having to use a hospital.

This relates to well-being because it’s relationship-based: We have a regular medical staff now that is so youth-focused. They’re always here on the same days, always consistent, so the youth count on that and know they can get these services. Having a familiar face at the drop-in gives youth a sense of trust and security. Because of the nature of homelessness, they have a lot of mistrust of agencies, services, people in general. We used to have doctors once a week, very short hours. It wasn’t great for relationship-building with youth or staff. We have to build relationships first to help them feel ready for services.

Youth walk in to our health center with really varied issues. They say, “My stomach hurts” or “I have asthma.” The youth don’t always know what they need, so it’s our job to explain what’s available. And so whoever has the relationship with that youth, the case worker or another staff member will say, “Let me introduce you to this woman in the clinic.” Since they trust the services we have here, we can get them to sign up to be seen.

They often come in for one thing, but end up talking about their past. They’ve been forced to take meds or do counseling when they weren’t ready. Our goal is to give them choices and present health services in a positive way. We do groups on healthy relationships, to get them to realize that mental health involves more than sitting around in an office spilling your guts.

Having these services onsite is great because we don’t have to refer youth to places that we may not know, or places it might be difficult for them to get to. Often youth won’t attend to things because, without good transportation options, it’s simply a lot of work.  It’s nice for them to have it all in one place so they don’t have to balance it all themselves.

Art Brings Healing to At-Risk Youth

A brand-new box of pastels. A set of wood-handled paintbrushes. A pad of heavy drawing paper. A tub of clay. A stack of magazines and a pair of scissors.

Jane Tillman, a mental health counselor and art therapist in Seattle, WA, believes that these materials can be as healing as any prescription or therapy session for young people exposed to violence and trauma. To her art supplies, she adds a quiet room, soothing music and a nonjudgmental attitude.

Tillman and others who use art in their work with at-risk youth say it has a profound effect, helping young people heal and gain a sense of well-being when adults – and words – have failed them.

“If they can’t tell you the awful things that have happened, they can at least draw it,” says Micala Gingrich-Gaylord, who directs the expressive arts center at Youthville, a child welfare and mental health services provider in Newton, KS. Plus, she says, “Art is a way to reframe those experiences and imagine something different.”

In addition, the sensory experience of making art can help soothe and relax traumatized youth, says Laura Seftel, coordinator of expressive arts therapy at the Northeast Center for Youth and Families. And she says group-made art – from drumming circles to drama – can teach young people a host of social skills, from making eye contact to working in a team, as well as giving them empowering ways to express themselves.

At a poetry slam, a young person can let out anger he’s kept bottled up. At an art exhibit or a chalk art festival, youth find an audience and a place to take a healthy risk.

“For the first time, people aren’t looking at them as kids in trouble,” Gingrich-Gaylord says. “They’re looking at them as artists.”

Tips for Using Art to Promote Healing and Well-being:

• Use high quality supplies if you can get your hands on them, because having nice paints, brushes and other materials makes youth feel valued. Ask art supply and office supply stores to donate materials. Teach youth to clean paint brushes and store paints and solvents properly.
• If you can’t get nice supplies, that’s OK. Use what you’ve got. Youth can draw using copier paper and ballpoint pens. They can paint a coffee pot or an old chair.
• Work alongside youth, but not in a way that will outshine them or make them feel self-conscious.
• If the youth is willing, talk about what you see in their work – the colors, the shapes, the texture – but don’t interpret or judge.
• Offer a variety of arts: painting, drawing, poetry, fiction, drama, music, dance. Each appeals to different youth and offers a different means of expression. Invite local artists to share their expertise with youth.
• If you have mental health counselors on your staff, work closely with them to make art a part of each youth’s treatment plan.
• Give youth a venue to share their work with an audience, like a poetry slam or reading, an art show or a music recital.

Additional Resources:

American Art Therapy Association toolkit on using art therapy in work with children and youth (PDF, 570KB)

Expressive Hearts