Perspectives of Youth Experiencing Homelessness on Substance Use and Harm Reduction: A Qualitative Youth Participatory Action Research Study

Objectives: Youth experiencing homelessness (YEH) report higher substance use than stably housed youth, yet their perspectives and system supports are poorly understood. This youth participatory action research examines YEH perspectives on substance use and harm reduction, and identifies youth-driven opportunities to improve responses by health care providers and YEH-serving agencies (YSA). Methods: In partnership with a local YSA, we conducted 2 focus groups with YEH (n=21) to describe their (1) perspectives on substance use and harm reduction, (2) experiences navigating substance use disorder resources, and (3) recommendations for shelters and health care organizations to enhance support for YEH who use substances. Utilizing thematic analysis and an iterative youth participatory action research process generated recommendations for YEH-serving agencies and health care professionals. Results: Five key themes were identified: (1) Youth understanding of substance use terminology highlighted varied interpretations of “substance use” and “harm reduction” and the need for shared definitions. (2) Characteristics of ideal services for YEH envisioned compassionate, nonjudgmental care and accessible resources. (3) Mitigating bias among youth-serving professionals and (4) supporting and defining recovery for YEH who use substances emphasized waiving sobriety requirements in YEH-serving agencies. (5) Advice for youth-serving professionals regarding recovery emphasized individualized, youth-centered approaches with integrated harm reduction and mental health support. Conclusions: Our study underscores the importance of uplifting the voices of youth with lived experiences when addressing their health needs and identifies youth-driven opportunities for systems improvements. Future directions include providing opportunities for youth to co-create systems of care that serve them.