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The purpose of this article is to describe a unique model for the provision of comprehensive primary health care for homeless youth in Seattle, Washington. Through the description of our program, we argue for the use of youth-centric instead of youth-friendly programs. This means a change from using the friendly health program as the central focus to having the young people be the starting point and adapting the health service to meet their needs. We describe how our model of care optimizes chances for homeless youth to establish positive connections with caring adults. We also show how homeless youth have their own street culture, which is of primary importance to them and which has a powerful impact on how they use and view health care.

The first part of this paper presents a vocational rehabili tation model for persons with severe and persistent psychiatric disabilities; the second part tests the model against 5-year outcomes. The Menu Approach to employment combines elements of other approaches under a new philosophi calframework. The philosophy has four principles: (1) work offers many bene fits besides a means to " pay the bills"; (2) virtually all consumers can participate in and benefitfrom meaningful paid work; (3) consumers should be able to choose from a "menu" of employment options, and; (4) multiple tri als of different kinds of paid work are an important part of developing long term employment in competitive settings. An empirical evaluation of the approach, analyzing 5 years of employment data from 102 participants in anACT-based program, found 74% tried paid work, half working competitively; the average number of jobs was 3.6, with an overall average tenure of 19.8 months for all jobs combined; workers earned $561,000 over 5 years, averag ing $2,054per job; those working at competitive jobs earned more and worked more hours per week than those working at jobs in agency-owned businesses.

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