Discussion
Children and youth living on the streets experience very high levels of abuse while on the streets, and often prior to migrating to the streets. Approaches to transforming the factors driving abuse risk to these children are desperately needed. We previously showed that it is possible to build structural resilience—helping SICY to reintegrate with families and communities.2 While funding, organisational programming and policy strategies make the slow crawl to challenging these adverse exposures, temporary relief may come from supporting alternative living locations—as sleeping under verandas was associated with significantly higher odds of experiencing economic abuse or any type of abuse.
Data-informed strategies are required to support the Kenyan governmental policy shift reflected in the care reform strategy, which itself reflects global policy shifts towards reintegrating SICY. Data-informed strategies must respond to the trauma experienced by SICY, and its psychosocial aftermath. Current practice in reintegration of SICY with families and communities is split between direct reintegration and indirect reintegration; these data demonstrate a clear association between living on the street and risk of abuse. Direct reintegration approaches may be appropriate for SICY with very limited street-exposure, and who have not experienced high levels of abuse on the streets.
Children who have been on the street longer are likely to have experienced more types of abuse, and while not measured in the assessed data here, it is likely that longer street exposure results in more experiences of the each type of abuse. Reintegrating SICY with families and communities without addressing traumatic experiences and the likely post-traumatic stress and potential for revictimisation will likely undermine successful reintegration of SICY.
Implementing a trauma-informed approach with SICY requires recognising the complex trauma they have often experienced and creating a supportive environment that addresses their unique needs. This approach begins with training staff and service providers to understand trauma and its effects on behaviour and development. Services should focus on building trust and safety, both physical and emotional, by ensuring that interactions are consistent, predictable and respectful. Interventions must be strengths-based, promoting resilience and self-efficacy, and should involve the children in decision-making processes to empower them and validate their experiences. Providing access to mental health services, creating opportunities for positive social connections and offering stable and supportive housing are critical components of a trauma-informed approach. Additionally, staff should be trained to recognise and manage their own stress and secondary trauma to maintain a healthy and effective support system for the children.14–16
A trauma-informed approach also includes the implementation of policies and practices that minimise re-traumatisation. This can be achieved through a comprehensive assessment of organisational practices to ensure they are trauma-sensitive, such as avoiding punitive measures that may trigger past trauma and instead focusing on restorative justice practices. Creating a culturally competent environment that respects and incorporates the diverse backgrounds and experiences of street-involved children is essential for their engagement and healing. Collaboration with community organisations and stakeholders can provide a network of support, enhancing the resources available to these children and fostering a holistic approach to their well-being.17
Interventional research with SICY is essential to understanding potentially effective approaches to improving their capacity for reintegration with their families of origin or other off-street destinations. One clear implication of this study is that street-exposure is inherently fraught with risk and ladened with likely traumatising experiences. Developing early response capacities to support the reintegration of children who recently arrived to streets is essential. For the programme that collected these data, such early response capacities take the form of street walks from trained social workers with local cultural expertise and trauma-informed training.
This intervention has been published about previously.2 This prior publication provides greater detail regarding the 4R+P model to work with SICY—establishing the goals of rescue, rehabilitation, reintegration and resocialisation plus preventing street-migration. The programme model further addresses families and communities from which these children migrate, demonstrating effectiveness at supporting the long-term reintegration and resocialisation of former SICY. Socioecological interventions must further develop capacities to support safe harbour for children and youth who recently arrived to live on the streets, in coordination with street-focused social workers.
Study data indicate the protective benefits of temporary housing (vs sleeping outside under store verandas) for SICY. While not an adequate final destination for SICY, immediately available, low-cost or free, safe housing may provide temporary relief from unsafe nighttime conditions.
Further, developing partnerships between law enforcement officers who can offer protection to SICY, SICY and social workers is essential to ensuring the safety of children who have migrated to the streets. Given some reports of abuse perpetrated by law enforcement, sensitivity training and monitoring of police conduct are necessary to securing safety of SICY until they are able to migrate off of street life.
Beyond policy, programming and policing, engagement with communities to shift the norms surrounding street-dwelling children and youth is essential to provide a more supportive, compassionate response. Addressing norms regarding street-dwelling children must be paired with efforts to ensure children are protected and supported within families and communities to prevent street-migration.
Limitations
These data relied on self-reported experiences from children and youth prior to the arrival at a rescue centre intended to provide temporary safety to these children. Staff reported subsequently learning about experiences of sexual abuse that was previously unrecorded, biasing such reports due to shame and embarrassment related to sexual abuse. Data reported the types of abuse experienced by SICY, but not the frequency, severity or intensity of these experiences. There is certain to be a dose-response between the frequency, severity and intensity of each type of abuse experience and post-traumatic distress, though study data flatten these important distinctions to a binary measure. The extent to which the extent of trauma experienced on the streets impacts future reintegration efforts requires further, longitudinal research. The development of reliable survey measures of sleeping options used by SICY could be helpful, insofar as such measures would help researchers and interventionists develop more robust understanding of the lived experiences of SICY for practical application.