Why some young people deteriorate in residential care – and how we can stop it
Residential settings for young people experiencing homelessness are designed to provide safety, stability, and support.
Yet even in high‑quality services, some young people deteriorate. Their substance use increases. Their motivation drops. Their mental health worsens. Their behaviour escalates.
A qualitative study with a UK homelessness organisation explored why this happens – and what practitioners can do to reduce the risk. The findings offer a rare, honest look at the conditions that can unintentionally contribute to decline, even in services with strong outcomes overall.
The uncomfortable truth: harm can happen in helping environments
Social work has long recognised the possibility of iatrogenic effects – harm caused unintentionally by interventions. In residential settings, this harm is rarely deliberate. It emerges from complex interactions between:
- peer dynamics
- structure (or lack of it)
- aspiration
- stigma
- relationships
The study identified five key factors that contributed to deterioration.
1. Peer influence: the strongest predictor of decline
Peer dynamics were the most significant factor.
One young person explained how their drug use escalated after moving in: “I’d smoked weed before, but when I first moved in it was like… how am I going to fit in? I’ll go and ask them if they want a joint.”
This wasn’t about addiction alone. It was about belonging.
Residential settings bring together young people with similar vulnerabilities. In unstructured spaces, this can lead to:
- reinforcement of risky behaviour
- normalisation of substance use
- pressure to conform
- “peer deviancy training” — learning harmful behaviours from peers
Staff recognised this risk: “Hostel accommodation is not somewhere a young person needs to be… you get exposed to a lot of other young people.”
Peer influence isn’t a side issue. It’s a core safeguarding concern.
2. Lack of structure and boundaries
Young people deteriorated when routines broke down.
One senior leader reflected on a previous “soft touch” approach: “There were no consequences. It wasn’t doing them any favours.”
Structure provided:
- predictability
- safety
- a sense of purpose
- protection from boredom
- a buffer against peer influence
When structure was absent, deterioration accelerated.
3. Lack of progress toward goals
Young people became demoralised when they felt stuck or moved backwards.
A support worker described a young man who had progressed to medium support, struggled, and was moved back: “Being back at square one… there was a touch of ‘what’s the point?’”
Without visible progress, motivation collapsed.
Aspiration and hope are not “nice extras” – they are protective factors.
4. Stigma and internalised beliefs
Many young people arrived with deep‑rooted beliefs that they were “failures”, “trouble”, or “not going anywhere”. These beliefs shaped their behaviour.
Staff described young people who had been told by family members: “You’re rubbish. You’re nothing. You can’t do anything.”
Stigma – both external and internalised – made it harder for young people to trust staff, engage with support, or imagine a different future.
5. Weak relationships with practitioners
The working alliance was the foundation of all progress.
When relationships were weak, everything else unravelled.
Young people who didn’t feel connected to staff were:
- more influenced by peers
- less responsive to boundaries
- less motivated
- more likely to disengage
- more vulnerable to decline
Conversely, strong relationships acted as a buffer against risk.
One manager explained: “We’re appropriate people to test boundaries with.”
Relationships weren’t just supportive – they were stabilising.
What young people said
Young people were clear about what helped and what didn’t.
On peer influence, one said: “You want to move on and it’s just not working… you get sucked in.”
On boundaries, another commented: “It was tough love… I’ve become a better person.”
On aspiration, a third noted: “My confidence has gone up so much. My self-esteem. I’ve sorted myself out.”
On relationships, it was observed: “They can be horrible to us and be angry at us and then they’ll still be there the next day.”
These comments reveal a simple truth: young people deteriorate when they feel unsafe, stuck, or alone — and they grow when they feel held, believed in, and understood.
What practitioners can do
The study highlighted five protective practices that reduced the risk of deterioration.
1. Strengthen the working alliance
Relationships are not an “add‑on”. They are the intervention.
Consistency, warmth, and reliability matter more than any programme.
2. Increase structure and predictability
Routine reduces anxiety, boredom, and risk-taking.
Clear boundaries – applied fairly – create safety.
3. Actively build aspiration
Help young people imagine a future that feels achievable.
Small wins build momentum.
4. Manage peer dynamics intentionally
Create structured activities, positive peer opportunities, and safe spaces.
Reduce unmonitored time where harmful dynamics flourish.
5. Address stigma and identity
Challenge negative self-beliefs.
Highlight strengths.
Celebrate progress.
A message for practitioners
Working with young people experiencing homelessness is emotionally demanding, relationally complex, and often undervalued. When a young person deteriorates, it can feel like a personal failure.
This research offers a different perspective.
Deterioration is rarely caused by one worker, one decision, or one moment.
It emerges from a web of influences – many outside your control.
But the study also shows that practitioners make the decisive difference.
When you hold boundaries with warmth, when you show up consistently, when you help a young person imagine a future, when you stay steady through their anger or fear — you are doing the work that protects against decline.
You may not always see the impact immediately.
But young people do.
And they remember the worker who stayed.
Dr Justin Dunne worked for 20 years in care settings, including addiction services, before moving into training and education of those working in the sector. He is now a strategic academic leader and researcher specialising in youth homelessness, social care practice, and evidence‑informed intervention design.