51
|
The syndemic effects of adverse mental health conditions and polysubstance use on being at risk of clinical depression among marginally housed and homeless transitional age youth living in San Francisco, California. PLoS One 2022; 17:e0265397. [PMID: 35298526 PMCID: PMC8929626 DOI: 10.1371/journal.pone.0265397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
The objective of this study was to identify the correlates of being at risk of clinical depression and examine the role of syndemic factors among marginally housed and homeless transitional age youth (TAY). From 2017-2018, 100 TAY between the ages of 18 and 24 in San Francisco were recruited from Larkin Street Youth Services into a cross-sectional study. Participants completed surveys on mental health, substance use, and HIV risk behaviors. A syndemic score ranging from 0-3 was calculated by summing dichotomous measures of moderate or severe anxiety in the past two weeks, PTSD symptoms in the past month and polysubstance use in the past three months. We used modified Poisson regression with robust error variances to identify the correlates of being at risk of clinical depression in the past week, all primary effects measures were modeled separately. Among 100 participants, the average age was 21 (SD = 1.7), 67% were male, 38% were Multiracial, 54% identified as gay, lesbian, bisexual or pansexual, 13% were unstably housed, 50% were homeless and 23% were living with HIV. The majority (74%) were at risk of clinical depression, 51% had symptoms of moderate or severe anxiety, 80% exhibited symptoms of PTSD and 33% reported polysubstance use. After controlling for age in years, gender, race/ethnicity and sexual orientation, factors independently associated with being at risk of clinical depression were; symptoms of moderate or severe anxiety (adjusted risk ratio [aRR] = 1.62, 95% confidence interval [CI] = 1.23-2.12, P<0.001), symptoms of PTSD (aRR = 3.78, 95% CI = 1.58-9.04, P = 0.003), polysubstance use (aRR = 1.33, 95% CI = 1.06-1.68), P = 0.012), an increasing syndemic score (aRR = 1.40, 95% CI = 1.21-1.62), P<0.001), and having one, two or three syndemic factors (compared to none); (aRR = 2.68, 95% CI = 1.08-6.65, P = 0.032), (aRR = 3.24, 95% CI = 1.24-7.83, P = 0.003) and (aRR = 3.97, 95% CI = 1.65-9.52, P = 0.002), respectively. Integrated behavioral health models that treat co-occurring disorders simultaneously are needed to reduce syndemic risk among marginally housed and homeless TAY.
Collapse
|
52
|
Schultz TR, Zoucha R, Sekula LK. The intersection between youth who identify as LGBTQ+ and emergency care for suicidality: an integrative review. J Pediatr Nurs 2022; 63:e82-e94. [PMID: 34756491 DOI: 10.1016/j.pedn.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
PROBLEM Suicide is a leading cause of death in children. Sexual minority youth are greater than three times more likely to attempt suicide than their cisgender heterosexual peers. ELIGIBILITY CRITERIA Empirical and theoretical literature were evaluated through the integrative review process using the Whittemore-Knafl integrative review model (2005). Studies were included when they addressed LGBTQ+ youth seeking emergency care for suicidality. SAMPLE The final sample included a mix of 13 qualitative, quantitative, and mixed methods studies published in peer-review journals between 2011 and 2020. These articles were located in journals found through a database search, including Medline EBSCO, Health Source/Nursing Academic Education, SportDiscus, ERIC EBSCO, Academic Search Elite, Social Services Abstracts, Sociological Abstracts, APA Psych Info, Embase, and CINAHL. RESULTS Thirteen studies included individuals 5 to 26 years of age; ten studies included individuals > 11 years old. The analysis and synthesis of coded and grouped data resulted in four themes: 1) affirmation/acceptance, 2) strength, 3) approach/intervention, and 4) safety/psychological distress. CONCLUSIONS Research study methods, design, setting, and quality varied. This integrative review has established that youth who identify as LGBTQ+ and are seeking emergency care for suicidality, value: acceptance, safety, strength, and approach/intervention. IMPLICATIONS There are strong implications for research, healthcare policy, and pediatric nursing practice. Future research is needed to explore the unique values, beliefs, and experiences of youth who identify as LGBTQ+ seeking emergency/crisis care for suicidality.
Collapse
Affiliation(s)
| | - Rick Zoucha
- Duquesne University, 600 Forbes Avenue, 527 Fisher Hall, Pittsburgh, PA 15202, USA
| | - L Kathleen Sekula
- Duquesne University, 600 Forbes Avenue, 527 Fisher Hall, Pittsburgh, PA 15202, USA
| |
Collapse
|
53
|
Madireddy S, Madireddy S. Supportive model for the improvement of mental health and prevention of suicide among LGBTQ+ youth. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2022. [DOI: 10.1080/02673843.2022.2025872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
54
|
Smith-Grant J, Kilmer G, Brener N, Robin L, Underwood JM. Risk Behaviors and Experiences Among Youth Experiencing Homelessness-Youth Risk Behavior Survey, 23 U.S. States and 11 Local School Districts, 2019. J Community Health 2022; 47:324-333. [PMID: 35013979 PMCID: PMC9119052 DOI: 10.1007/s10900-021-01056-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
Abstract
Youth experiencing homelessness experience violence victimization, substance use, suicide risk, and sexual risk disproportionately, compared with their stably housed peers. Yet few large-scale assessments of these differences among high school students exist. The youth risk behavior survey (YRBS) is conducted biennially among local, state, and nationally representative samples of U.S. high school students in grades 9-12. In 2019, 23 states and 11 local school districts included a measure for housing status on their YRBS questionnaire. The prevalence of homelessness was assessed among states and local sites, and relationships between housing status and violence victimization, substance use, suicide risk, and sexual risk behaviors were evaluated using logistic regression. Compared with stably housed students, students experiencing homelessness were twice as likely to report misuse of prescription pain medicine, three times as likely to be threatened or injured with a weapon at school, and three times as likely to report attempting suicide. These findings indicate a need for intervention efforts to increase support, resources, and services for homeless youth.
Collapse
Affiliation(s)
- Jennifer Smith-Grant
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA.
- U.S. Public Health Service Commissioned Corps, Washington, DC, USA.
| | - Greta Kilmer
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA
| | - Nancy Brener
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA
| | - Leah Robin
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA
| | - J Michael Underwood
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA
| |
Collapse
|
55
|
Lal S, Halicki-Asakawa A, Fauvelle A. A Scoping Review on Access and Use of Technology in Youth Experiencing Homelessness: Implications for Healthcare. Front Digit Health 2021; 3:782145. [PMID: 34901927 PMCID: PMC8651704 DOI: 10.3389/fdgth.2021.782145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Youth are among the fastest growing subset of the homeless population. Youth experiencing homelessness (YEH) face multiple barriers in accessing health information and health care services. As such, they may best be reached through information and communication technologies (ICTs); however, limited efforts have been made to synthesize literature on this topic. In this paper, we review studies on access and use of ICTs among YEH. We also discuss the implications of the review for healthcare. Methods: Using scoping review methodology, we searched four databases (Medline, Embase, PsycInfo, and CINAHL) for studies published between 2005 and 2019, screening 1,927 titles and abstracts. Results: We identified 19 articles reporting on studies with YEH between the ages of 12-30, the majority of which were published in the USA. On average, more than half of the samples owned smartphones, used social media, and accessed the internet weekly to search for housing, employment, health information, and to communicate with family, peers, and health workers; however, many youths faced barriers to sustaining their access to technology. Benefits of using ICTs were connecting with home-based peers, family, and case workers, which was associated with a reduction in substance use, risky sexual health behaviors, and severity of mental health symptoms. Connecting with negative, street-based social ties was identified as the most common risk factor to using ICTs due to its association with engaging in risky sex behaviors and substance abuse. Discussion: This review supports the advancement of research and practice on using ICTs to deliver public health information and health services to YEH, while also considering the health-related risks, benefits, and barriers that YEH face when accessing ICTs.
Collapse
Affiliation(s)
- Shalini Lal
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada.,Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Amané Halicki-Asakawa
- Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Amélie Fauvelle
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada.,Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| |
Collapse
|
56
|
Siconolfi D, Storholm ED, Vincent W, Pollack L, Rebchook GM, Huebner DM, Peterson JL, Kegeles SM. Prevalence and Correlates of Sexual Violence Experienced by Young Adult Black Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3621-3636. [PMID: 34725750 PMCID: PMC9473496 DOI: 10.1007/s10508-021-02011-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/27/2021] [Accepted: 04/09/2021] [Indexed: 05/06/2023]
Abstract
Men who have sex with men (MSM) experience high prevalence of sexual violence (SV), and SV has well-documented effects on health. Research gaps are especially evident for young Black MSM (YBMSM), who experience significant HIV disparities and syndemics, including multiple forms of violence victimization. We examined lifetime prevalence of SV (having been forced or frightened into sexual activity) in a cross-sectional sample of YBMSM (N = 1732), and tested associations of demographic, psychosocial, and structural factors using multivariable regression. YBMSM were recruited between 2013 and 2015 using modified venue-based time-location sampling (e.g., at bars and clubs) in Dallas and Houston, Texas. Approximately 17% of YBMSM experienced any SV in their lifetimes. SV was associated with high school non-completion (OR 1.78; 95% CI 1.15-2.77), lower psychological resilience (OR 0.84; 95% CI 0.71-0.98), lifetime history of homelessness (OR 5.52; 95% CI 3.80-8.02), recent financial hardship (OR 2.16; 95% CI 1.48-3.14), and recent transactional sex (OR 3.87; 95% CI 2.43-6.15). We also examined differences by age of SV onset (childhood versus adulthood). YBMSM with adolescent/emerging adult-onset SV may have been more ambivalent in reporting lifetime SV experience, compared to men with childhood-onset SV, and correlates differed by age of onset. Childhood-onset SV was associated with high school non-completion, lower levels of psychological resilience, history of homelessness, recent financial hardship, and recent transactional sex. Adolescent/emerging adult-onset SV was associated with greater depressive symptoms, history of homelessness, and recent financial hardship. There is a need for multi-level approaches to SV prevention and treatment, including services and supports that are culturally-relevant and responsive to the needs of YBMSM.
Collapse
Affiliation(s)
| | - Erik D Storholm
- RAND, Santa Monica, CA, USA
- Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, CA, USA
| | - Wilson Vincent
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Lance Pollack
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory M Rebchook
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - David M Huebner
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA
| | - John L Peterson
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Susan M Kegeles
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
57
|
Hsu HT, Hill C, Holguin M, Petry L, McElfresh D, Vayanos P, Morton M, Rice E. Correlates of Housing Sustainability Among Youth Placed Into Permanent Supportive Housing and Rapid Re-Housing: A Survival Analysis. J Adolesc Health 2021; 69:629-635. [PMID: 33994312 DOI: 10.1016/j.jadohealth.2021.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/05/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Youth experiencing homelessness (YEH) are vulnerable to multiple adverse health outcomes. Connecting YEH with housing is critical to addressing youth homelessness and to preventing long-term negative health consequences among this vulnerable population. Using administrative data, this study aims to explore correlates of YEH's sustainability in two major housing programs: permanent supportive housing (PSH) and rapid re-housing (RRH) programs. METHODS This study used Homelessness Management Information System administrative data collected from 16 communities across the U.S. between January 1, 2015 and May 1, 2017 (n = 10,902). We conducted Cox proportional hazards survival analyses to explore correlates (e.g., demographics, homeless experiences, and overall vulnerability) of YEH's PSH (n = 577) and RRH (n = 2,883) sustainability separately. RESULTS For YEH receiving PSH, only individuals' level of vulnerability is associated with greater hazard of exiting PSH. As for RRH sustainability, YEH who were 17 years old or younger, black or Latinx (as compared to white), of higher level of vulnerability, or previously spent most nights couch surfing or in transitional living programs (as compared to on the street) are associated with higher hazard of exiting RRH. CONCLUSIONS Both PSH and RRH programs should incorporate comprehensive services targeting youth experiencing high vulnerability to prevent them from re-entering homelessness. Future RRH programming should also address housing sustainability disparities faced by racial and ethnic minority YEH, especially when they are disproportionately influenced by homelessness. Finally, RRH programs should incorporate services to foster independent living among younger YEH to sustain their housing status once temporary housing subsidies expire.
Collapse
Affiliation(s)
- Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, Missouri.
| | - Chyna Hill
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Monique Holguin
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Laura Petry
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Duncan McElfresh
- Department of Computer Science, University of Maryland, 4120 Brendan Iribe Center University of Maryland College Park, Maryland
| | - Phebe Vayanos
- Viterby School of Engineering, University of Southern California, Los Angeles, California
| | | | - Eric Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| |
Collapse
|
58
|
Walsh L, Luthy E, Feng X, Yilmazer T, Ford J, Kelleher K, Chavez L, Slesnick N. Predictors of Treatment Engagement Among Suicidal Youth Experiencing Homelessness. Community Ment Health J 2021; 57:1310-1317. [PMID: 34050857 PMCID: PMC8416804 DOI: 10.1007/s10597-021-00850-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Homeless youth experience high rates of suicidal ideation and attempts, yet limited research has examined predictors of treatment engagement among this population. Suicidal homeless youth (N = 150) between the ages of 18 and 24 years were recruited from a drop-in center in Columbus, Ohio. Participants were randomly assigned to Cognitive Therapy for Suicide Prevention + treatment as usual through a local drop-in center (CTSP + TAU) (N = 75) or TAU alone (N = 75), and treatment attendance among those assigned to CTSP + TAU was examined in this study. As expected, among youth engaged in CTSP + TAU, those with a history of intimate partner violence (IPV) showed decreased odds of treatment attendance. Additionally, youth randomized into CTSP + TAU with higher acquired capability for suicide (ACS) scores and those identifying as Black were more likely to attend treatment sessions. Findings suggest that effective treatment implementation must consider youth's trauma history, demographics and severity of suicidal ideation and behaviors.
Collapse
Affiliation(s)
- Laura Walsh
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA.
| | - Ellison Luthy
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA
| | - Xin Feng
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA
| | - Tansel Yilmazer
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA
| | - Jodi Ford
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | | | - Laura Chavez
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Natasha Slesnick
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA
| |
Collapse
|
59
|
Semborski S, Rhoades H, Madden D, Henwood BF. Factors associated with condom and contraceptive use among currently and formerly homeless young adults: Does housing matter? SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100654. [PMID: 34454325 DOI: 10.1016/j.srhc.2021.100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/05/2021] [Accepted: 08/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Young adults that experience homelessness (YAEH) are at heightened risk of unplanned pregnancy and contracting STIs, including HIV than their housed counterparts. It is unclear how exiting homelessness into Supportive Housing (SH), the most prominent intervention in homelessness, may shape sexual risk-taking. OBJECTIVE The goal of this study is to explore associations of condom and contraception use with particular interest in the role of partner type (i.e., casual and/or serious) and housing status. METHODS This study includes 143 sexually active YAEH (ages 18-27) who reported engaging in vaginal sex during the past three months: 67 "unhoused" (i.e., street-based, couch-surfers, or staying in emergency shelter), and 76 "housed" from SH programs. Multiple logistic regression examined the relationship of housing status and partner type with condom and contraceptive use. RESULTS Being a parent was associated with higher odds of contraceptive use regardless of housing status, while partner type (i.e., serious or casual partner) was differently associated with condom use by housing status. DISCUSSION Despite documented differences in condom-using behaviors by housing status, findings revealed similar patterns in contraceptive use between the two groups, indicating a possible need for enhanced and targeted service planning for YAEH, particularly among those transitioning to and residing in SH, regarding contraceptive use and prevention.
Collapse
Affiliation(s)
- Sara Semborski
- Suzanne Dworak-Peck School of School Work, University of Southern California, United States.
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of School Work, University of Southern California, United States
| | - Danielle Madden
- Suzanne Dworak-Peck School of School Work, University of Southern California, United States
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of School Work, University of Southern California, United States
| |
Collapse
|
60
|
Trends in homelessness and injection practices among young urban and suburban people who inject drugs: 1997-2017. Drug Alcohol Depend 2021; 225:108797. [PMID: 34102506 PMCID: PMC9373853 DOI: 10.1016/j.drugalcdep.2021.108797] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/16/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Among young people who inject drugs (PWID) homelessness is associated with numerous adverse psychosocial and health consequences, including risk of relapse and overdose, psychological distress and suicidality, limited treatment access, and injection practices that increase the risk of HIV and hepatitis C (HCV) transmission. Homeless PWID may also be less likely to access sterile syringes through pharmacies or syringe service programs. METHODS This study applied random-effects meta-regression to examine trends over time in injection risk behaviors and homelessness among young PWID in Chicago and surrounding suburban and rural areas using data from 11 studies collected between 1997 and 2017. In addition, subject-level data were pooled to evaluate the effect of homelessness on risk behaviors across all studies using mixed effects logistic and negative binomial regression with random study effects. RESULTS There was a significant increase in homelessness among young PWID over time, consistent with the general population trend of increasing youth homelessness. In mixed-effects regression, homelessness was associated with injection risk behaviors (receptive syringe sharing, syringe mediated sharing, equipment sharing) and exchange sex, though we detected no overall changes in risk behavior over time. CONCLUSIONS Increases over time in homelessness among young PWID highlight a need for research to understand factors contributing to youth homelessness to inform HIV/STI, HCV, and overdose prevention and intervention services for this population.
Collapse
|
61
|
Nam E, Palmer AN, Patel M. Characteristics of Emergency Department Visits by Homeless Young Adults in the U.S. J Adolesc Health 2021; 69:302-307. [PMID: 33483236 DOI: 10.1016/j.jadohealth.2020.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/25/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Homeless young adults often seek health care at emergency departments (EDs) after they are no longer able to ignore a pressing health problem. However, a dearth of literature examines homeless young adults' ED visits. This study aimed to increase understanding of ED visits among homeless young adults within the U.S. METHODS Data for this study were obtained from the 2011-2015 National Hospital Ambulatory Medical Care Survey. The sample for this study included all ED visits made by homeless and housed young adults aged 18-29 years (unweighted N = 25,068). RESULTS ED visits by homeless young adults were distinguished in terms of gender, region, payment sources, and triage level. Furthermore, ED visits made by homeless young adults were more likely related to mental health and suicide. Homeless young adults' ED visits were characterized by a longer average length of stay and were less likely to be referred to a physician or clinic for follow-up, given medication, or have a procedure performed in the ED. CONCLUSIONS This study highlighted differences in ED utilization for homeless young adults. The findings of this study suggest a need to further examine the characteristics of ED services received by homeless young adults to better understand differences in ED service receipt related to housing status. This knowledge can inform efforts to reduce costs through improving access to housing and outpatient mental health care and reducing stigma among health care professionals to ensure continuity of care.
Collapse
Affiliation(s)
- Eunji Nam
- Department of Social Welfare, Incheon National University, Incheon, South Korea.
| | - Ashley N Palmer
- School of Social Work, University of Texas at Arlington, Arlington, Texas
| | - Mansi Patel
- School of Social Work, University of Texas at Arlington, Arlington, Texas
| |
Collapse
|
62
|
Santa Maria D, Padhye N, Businelle M, Yang Y, Jones J, Sims A, Lightfoot M. Efficacy of a Just-in-Time Adaptive Intervention to Promote HIV Risk Reduction Behaviors Among Young Adults Experiencing Homelessness: Pilot Randomized Controlled Trial. J Med Internet Res 2021; 23:e26704. [PMID: 34255679 PMCID: PMC8292946 DOI: 10.2196/26704] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/26/2021] [Accepted: 05/05/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND People experiencing homelessness have higher rates of HIV than those who are stably housed. Mental health needs, substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with regard to HIV prevention. To date, HIV prevention interventions for young adults experiencing homelessness have not specifically addressed modifiable real-time factors such as stress, sexual or drug use urge, or substance use, or been delivered at the time of heightened risk. Real-time, personalized HIV prevention messages may reduce HIV risk behaviors. OBJECTIVE This pilot study tested the initial efficacy of an innovative, smartphone-based, just-in-time adaptive intervention that assessed predictors of HIV risk behaviors in real time and automatically provided behavioral feedback and goal attainment information. METHODS A randomized attention control design was used among young adults experiencing homelessness, aged 18-25 years, recruited from shelters and drop-in centers in May 2019. Participants were randomized to either a control or an intervention group. The intervention (called MY-RID [Motivating Youth to Reduce Infection and Disconnection]) consisted of brief messages delivered via smartphone over 6 weeks in response to preidentified predictors that were assessed using ecological momentary assessments. Bayesian hierarchical regression models were used to assess intervention effects on sexual activity, drug use, alcohol use, and their corresponding urges. RESULTS Participants (N=97) were predominantly youth (mean age 21.2, SD 2.1 years) who identified as heterosexual (n=51, 52%), male (n=56, 57%), and African American (n=56, 57%). Reports of sexual activity, drug use, alcohol use, stress, and all urges (ie, sexual, drug, alcohol) reduced over time in both groups. Daily drug use reduced by a factor of 13.8 times over 6 weeks in the intervention group relative to the control group (Multimedia Appendix 4). Lower urges for sex were found in the intervention group relative to the control group over the duration of the study. Finally, there was a statistically significant reduction in reports of feeling stressed the day before between the intervention and control conditions (P=.03). CONCLUSIONS Findings indicate promising intervention effects on drug use, stress, and urges for sex in a hard-to-reach, high-risk population. The MY-RID intervention should be further tested in a larger randomized controlled trial to further investigate its efficacy and impact on sexual risk behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT03911024; https://clinicaltrials.gov/ct2/show/NCT03911024.
Collapse
Affiliation(s)
- Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nikhil Padhye
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Yijiong Yang
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Jones
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Alexis Sims
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies and UCSF Prevention Research Center, University of California San Francisco, San Francisco, CA, United States
| |
Collapse
|
63
|
Quinton ML, Clarke FJ, Parry BJ, Cumming J. An evaluation of My Strengths Training for Life™ for improving resilience and well-being of young people experiencing homelessness. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:1296-1314. [PMID: 33484590 DOI: 10.1002/jcop.22517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
This community-based study investigated whether (1) a novel sport psychology informed positive youth development program, My Strengths Training for Life™, improved resilience and well-being and (2) young people differed in outcomes according to demographics (gender, ethnicity, social inclusion, and learning difficulty). A total of 246 young people (M age = 19.74, SD = 2.31) living in a large housing service completed questionnaires on demographics, mental skills, and pre and postprogram resilience and well-being. Baseline differences in resilience and well-being existed for ethnicity and learning difficulty status but did not influence MST4Life™ outcomes. There was a significant improvement in resilience and well-being over time, which was associated with mental skills development. Implications apply for policy, program commissioners, and research: (1) novel sport psychology interventions can improve the well-being of disadvantaged youth, and (2) demographics at baseline should be considered in intervention planning and evaluation with this population.
Collapse
Affiliation(s)
- Mary L Quinton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Fiona J Clarke
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Benjamin J Parry
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jennifer Cumming
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
64
|
Eastwood EA, Nace AJ, Hirshfield S, Birnbaum JM. Young Transgender Women of Color: Homelessness, Poverty, Childhood Sexual Abuse and Implications for HIV Care. AIDS Behav 2021; 25:96-106. [PMID: 31865517 DOI: 10.1007/s10461-019-02753-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study describes a sample of HIV+ young transgender women of color aged 18-24 and their experience with homelessness as part of a demonstration project of engagement and retention in HIV medical care funded by Health Resources and Services Administration. The study engaged transgender women of color in HIV care in nine sites across the US between 2012 and 2017. This analysis describes and compares transwomen who had been homeless in the last 6 months to those not homeless. We hypothesized that homelessness would compete with HIV care, food, shelter, and be associated with poverty. Variable domains included sociodemographic, mental health and substance use, HIV care, sexual risk behavior, social support from transgender and other friends, and childhood sexual abuse. There were 102 youth enrolled, 77 (75.5%) who had been homeless, and 25 (24.5%) who had not been homeless. Bivariate analyses showed that low income, sex work as source of income, inability to afford food, lack of viral load (VL) suppression, childhood sexual abuse, lower levels of social support, and higher levels of depression were associated with homelessness. A logistic regression model showed that being unable to afford food (AOR = 9.24, 95% CI 2.13-40.16), lack of VL suppression in last 6 months (AOR = 0.10, 95% CI .02-.57), and lack of transgender friend support (AOR = 0.09, 95% CI .02-.53) was associated with homelessness. Programs that place basic needs first-food and shelter-may be able to engage and assist young transgender women of color with HIV to survive and live healthier lives.
Collapse
Affiliation(s)
- Elizabeth A Eastwood
- Department of Health Policy, CUNY School of Public Health, 55 W. 125th St, New York, NY, 10027, USA.
| | - Amanda J Nace
- Department of Health Policy, CUNY School of Public Health, 55 W. 125th St, New York, NY, 10027, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jeffrey M Birnbaum
- Department of Pediatrics, SUNY Downstate Health Sciences University and SUNY Downstate School of Public Health, Brooklyn, NY, USA
| |
Collapse
|
65
|
Holtschneider C. But How Homeless Are You? Toward a More Just and Effective Response to Youth Homelessness. BEHAVIOR AND SOCIAL ISSUES 2021; 30:139-147. [PMID: 38624808 PMCID: PMC8236309 DOI: 10.1007/s42822-021-00053-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/27/2022]
Abstract
Each year, an estimated 4,200,000 unaccompanied youth ages 13 to 25 experience homelessness in the United States. The threats facing young people in housing crisis are many, and their potential impacts, harrowing. Youth are at high risk for physical and sexual victimization, mental and physical illness, and involvement with the criminal legal system and face serious threats to their education, their future economic stability, and their lives. Despite these dangerous consequences, the response to this issue in the United States continues to lack urgency, meaningful investment, and empirical support. This article critically examines the current approach to services for youth in situations of homelessness in the United States. Directly informed by the lived experiences of young people, it calls for a shift in understanding of the nature and scope of the problem and, consequently, the practice and policy strategies being implemented to address it. Specifically, the U.S. Department of Housing and Urban Development's definition of homelessness, along with corresponding procedures that further limit access to services, is examined in a call to change course in response to youth homelessness.
Collapse
|
66
|
Chavez L, Kelleher K, Bunger A, Brackenoff B, Famelia R, Ford J, Feng X, Mallory A, Martin J, Sheftall A, Walsh L, Yilmazer T, Slesnick N. Housing First Combined with Suicide Treatment Education and Prevention (HOME + STEP): study protocol for a randomized controlled trial. BMC Public Health 2021; 21:1128. [PMID: 34118916 PMCID: PMC8196445 DOI: 10.1186/s12889-021-11133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Youth experiencing homelessness are at high risk for suicide, yet few studies have evaluated risk reduction interventions targeting suicidal ideation in this vulnerable population. A comprehensive approach to risk-reduction is needed that addresses basic needs and provides targeted interventions for those at highest risk. The protocol described builds on the design of the first randomized trial of Housing First (HF) for homeless youth. The primary objective is to determine whether housing combined with supportive services that include suicide screening and targeted psychotherapy (Cognitive Therapy for Suicide Prevention) is effective for reducing suicidal ideation and other secondary outcomes (depression and suicide attempts). Additionally, we will explore mediators of the treatment effect (housing stability and substance use) and determinants of implementation. METHODS Youth recruited to the HF trial will be randomized to HF + supportive services (n = 120), or supportive services alone (n = 120). The "Suicide Treatment Education and Prevention" (STEP) protocol will additionally screen youth in both arms at baseline and 3 months for suicidal ideation (SSI-W). Those who screen as moderate risk for suicide (SSI-W ≥ 10) will be offered CTSP, which includes up to 9 sessions over the first 6 months following enrollment. CTSP will be delivered in one-on-one sessions by a trained advocate. Research assessments will be collected to assess outcomes (including suicidal ideation) at baseline, 3, 6, 9 and 12 months. Qualitative interviews with subjects receiving CTSP and other stakeholders will explore implementation determinants. DISCUSSION The study will fill an important gap in the literature about the added benefit of HF combined with supportive services including suicide screening and treatment for reducing suicidal ideation in homeless youth. With the urgent need to address both homelessness and suicide risk, evidence is needed about services that can be integrated into delivery settings for youth experiencing homelessness. TRIAL REGISTRATION NCT04135703 . Date of registration: October 23, 2019.
Collapse
Affiliation(s)
- Laura Chavez
- Center for Child Health Equity and Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Kelly Kelleher
- Center for Child Health Equity and Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Alicia Bunger
- College of Social Work, The Ohio State University, 1947 N. College Road, Columbus, OH, 43210, USA
| | - Brittany Brackenoff
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Ruri Famelia
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Jodi Ford
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH, 43210, USA
| | - Xin Feng
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Allen Mallory
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Jared Martin
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Arielle Sheftall
- Center for Child Health Equity and Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Laura Walsh
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Tansel Yilmazer
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Natasha Slesnick
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| |
Collapse
|
67
|
Cwinn E, Cadieux C, Crooks CV. Who Are We Missing? The Impact of Requiring Parental or Guardian Consent on Research With Lesbian, Gay, Bisexual, Trans, Two-Spirit, Queer/Questioning Youth. J Adolesc Health 2021; 68:1204-1206. [PMID: 33059957 DOI: 10.1016/j.jadohealth.2020.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose was to examine whether a requirement for parental or guardian consent systematically limits which lesbian, gay, bisexual, trans, two-spirit, queer/questioning (LGBT2Q+) youth participate in research. METHODS A total of 60 LGBT2Q+ youth (aged 14-18 years) completed measures assessing gender and sexual minority identity, depression and anxiety, help-seeking intentions, and social support. RESULTS A substantial proportion (37.6%) of youth reported that they would not have participated in the research if parental or guardian consent was required. Those who would not have participated had more negative attitudes about their sexual and gender identity, less family support, lower levels of help-seeking intentions, and higher levels of negative affect. CONCLUSIONS The results suggest that requiring parental or guardian consent may exclude the most at-risk youth. Policy and practice decisions regarding the health and mental health outcomes of LGBT2Q+ youth might be based on incomplete and unrepresentative data.
Collapse
Affiliation(s)
- Eli Cwinn
- Centre for School Mental Health, University of Western Ontario, London, Ontario, Canada
| | - Courtney Cadieux
- Centre for School Mental Health, University of Western Ontario, London, Ontario, Canada
| | - Claire V Crooks
- Centre for School Mental Health, University of Western Ontario, London, Ontario, Canada.
| |
Collapse
|
68
|
Russell M, Soong W, Nicholls C, Griffiths J, Curtis K, Follett D, Smith W, Waters F. Homelessness youth and mental health service utilization: A long-term follow-up study. Early Interv Psychiatry 2021; 15:563-568. [PMID: 32426950 DOI: 10.1111/eip.12985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/03/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is currently an incomplete picture of the long-term impact of homelessness on youth with mental health issues. There are also questions regarding homelessness as a predictor of mental health re-admissions. AIMS To examine the mental health service presentation profile of young people affected by homelessness and mental health issues. METHODS A retrospective analysis was conducted of the medical records of homeless (n = 29) and non-homeless (n = 32) youth who attended the YouthLink specialist mental health service in 2010. We tracked their pattern of mental health service admissions at five time points during a total period of 10 years, including 2 years prior to, and up to 8 years following the YouthLink presentation. A regression analysis was used to examine factors hypothesized to contribute to mental health re-admissions. RESULTS Homeless youth had significantly more frequent presentations to inpatient and outpatient mental health services, and emergency departments for mental health reasons. They were 11 times more likely to be re-admitted to a mental health inpatient ward than non-homeless youth. Prior hospital admission was an independent predictor, increasing by a factor of 2.2 for every inpatient admission. CONCLUSION The impact of homelessness on mental health issues is enduring, and is a long-term predictor of hospital re-admission.
Collapse
Affiliation(s)
- Melissa Russell
- South Metropolitan Health Service, Western Australia, Australia
| | - Wei Soong
- Youth Mental Health Program, North Metropolitan Mental Health Public Health and Ambulatory Care, Western Australia, Australia
| | - Craig Nicholls
- Youth Mental Health Program, North Metropolitan Mental Health Public Health and Ambulatory Care, Western Australia, Australia.,YouthLink, Perth, Western Australia, Australia
| | - Jennifer Griffiths
- Youth Mental Health Program, North Metropolitan Mental Health Public Health and Ambulatory Care, Western Australia, Australia.,YouthLink, Perth, Western Australia, Australia
| | - Kerry Curtis
- Youth Mental Health Program, North Metropolitan Mental Health Public Health and Ambulatory Care, Western Australia, Australia.,YouthLink, Perth, Western Australia, Australia
| | - Denise Follett
- Youth Mental Health Program, North Metropolitan Mental Health Public Health and Ambulatory Care, Western Australia, Australia.,YouthLink, Perth, Western Australia, Australia
| | - Warwick Smith
- Youth Mental Health Program, North Metropolitan Mental Health Public Health and Ambulatory Care, Western Australia, Australia
| | - Flavie Waters
- School of Psychological Science, University of Western Australia, Western Australia, Australia.,Clinical Research Centre, Graylands Hospital, North Metropolitan Mental Health Public Health and Ambulatory Care, Western Australia, Australia
| |
Collapse
|
69
|
Santa Maria D, Lightfoot M, Nyamathi A, Businelle M, Paul M, Quadri Y, Padhye N, Jones J, Calvo Armijo M. A Nurse Case Management HIV Prevention Intervention (Come As You Are) for Youth Experiencing Homelessness: Protocol for a Randomized Wait-list Controlled Trial. JMIR Res Protoc 2021; 10:e26716. [PMID: 34018967 PMCID: PMC8178739 DOI: 10.2196/26716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/29/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Youth experiencing homelessness are more likely than housed youth to experience premature death, suicide, drug overdose, pregnancy, substance use, and mental illness. Yet while youth experiencing homelessness are 6 to 12 times more likely to become infected with HIV than housed youth, with HIV prevalence as high as 16%, many do not access the prevention services they need. Despite adversities, youth experiencing homelessness are interested in health promotion programs, can be recruited and retained in interventions and research studies, and demonstrate improved outcomes when programs are tailored and relevant to them. Objective The study aims to compare the efficacy of a nurse case management HIV prevention and care intervention, titled Come As You Are, with that of usual care among youth experiencing homelessness aged 16 to 25 years. Methods The study is designed as a 2-armed randomized wait-list controlled trial. Participants (n=450) will be recruited and followed up for 9 months after the intervention for a total study period of 12 months. Come As You Are combines nurse case management with a smartphone-based daily ecological momentary assessment to develop participant-driven HIV prevention behavioral goals that can be monitored in real-time. Youth in the city of Houston, Texas will be recruited from drop-in centers, shelters, street outreach programs, youth-serving organizations, and clinics. Results Institutional review board approval (Committee for the Protection of Human Subjects, University of Texas Health Science Center at Houston) was obtained in November 2018. The first participant was enrolled in November 2019. Data collection is ongoing. To date, 123 participants have consented to participate in the study, 89 have been enrolled, and 15 have completed their final follow-up. Conclusions There is a paucity of HIV prevention research regarding youth experiencing homelessness. Novel and scalable interventions that address the full continuum of behavioral and biomedical HIV prevention are needed. This study will determine whether a personalized and mobile HIV prevention approach can reduce HIV risk among a hard-to-reach, transient population of youth at high risk. International Registered Report Identifier (IRRID) DERR1-10.2196/26716
Collapse
Affiliation(s)
- Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies and UCSF Prevention Research Center, University of California San Francisco, San Francisco, CA, United States
| | - Adey Nyamathi
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, United States
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Mary Paul
- Baylor College of Medicine, Houston, TX, United States
| | - Yasmeen Quadri
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Nikhil Padhye
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Jones
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Margarita Calvo Armijo
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
70
|
Reddon H, Milloy MJ, Wood E, Nosova E, Kerr T, DeBeck K. High-intensity cannabis use and hospitalization: a prospective cohort study of street-involved youth in Vancouver, Canada. Harm Reduct J 2021; 18:53. [PMID: 34001159 PMCID: PMC8130127 DOI: 10.1186/s12954-021-00501-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is concern that cannabis use negatively affects vulnerable groups such as youth; however, the relationship between cannabis use and health care utilization has not been well characterized in this population. We longitudinally evaluated the association between daily cannabis use and hospitalization among a prospective cohort of street-involved youth. METHODS Data were collected from the At-Risk Youth Study (ARYS) in Vancouver, Canada, from September 2005 to May 2015. Participants were interviewed semi-annually and multivariable generalized estimating equation (GEE) logistic regression was used to examine the relationship between daily cannabis use and hospitalization. RESULTS A total of 1216 participants (31.2% female) were included in this analysis, and 373 (30.7%) individuals reported hospitalization at some point during the study period. In a multivariable GEE analysis, daily cannabis use was not significantly associated with hospitalization (Adjusted Odds Ratio [AOR] = 1.17, 95% Confidence interval [CI] = 0.84, 1.65). We did observe a significant interaction between daily cannabis use and sex (AOR = 0.51, 95% CI = 0.34, 0.77), whereby cannabis use was associated with a decreased odds of hospitalization among males (AOR = 0.60, 95% CI = 0.47, 0.78), yet was not significantly associated with hospitalization among females (AOR = 1.19, 95% CI = 0.84, 1.67). CONCLUSIONS The finding that daily cannabis use was not associated with hospitalization among street-involved youth is encouraging given the high rates of cannabis use in this population and the expansion of cannabis legalization and regulation. Future studies, however, are warranted to monitor possible changes in the consequences of cannabis use as cannabis legalization and regulation increase internationally.
Collapse
Affiliation(s)
- Hudson Reddon
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- CIHR Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, BC, V6B 3E6, Canada
| | - M-J Milloy
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, ,Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, ,Vancouver, BC, V6Z 1Y6, Canada
| | - Ekaterina Nosova
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
| | - Thomas Kerr
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, ,Vancouver, BC, V6Z 1Y6, Canada
| | - Kora DeBeck
- BC Centre on Substance Use, University of British Columbia, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada.
- School of Public Policy, SFU Harbour Centre, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.
| |
Collapse
|
71
|
Fulginiti A, Hsu HT. Gatekeeping beliefs, intent, and behavior among homeless youth. DEATH STUDIES 2021; 46:2247-2255. [PMID: 33983869 DOI: 10.1080/07481187.2021.1922543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
No research has explored the potential of homeless youth to serve as gatekeepers for suicide prevention purposes. This study described and examined associations between gatekeeping beliefs (i.e. preparedness and efficacy), intent-to-intervene, and gatekeeping behaviors (approach/referral behavior). In a sample of 139 homeless youth (aged 14-24), regression analysis was used to characterize associations between gatekeeper beliefs, intent, and behaviors. On average, participants engaged in gatekeeper behaviors with 1-2 people over the past 3 months. Gatekeeping beliefs and intent were positively associated with behaviors. Gatekeeper training that targets these attributes is a promising prevention strategy for homeless youth, but may require population-specific adaptation.
Collapse
Affiliation(s)
- Anthony Fulginiti
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, MO, USA
| |
Collapse
|
72
|
Slesnick N, Chavez L, Bunger A, Famelia R, Ford J, Feng X, Higgins S, Holowacz E, Jaderlund S, Luthy E, Mallory A, Martin J, Walsh L, Yilmazer T, Kelleher K. Housing, opportunities, motivation and engagement (HOME) for homeless youth at-risk for opioid use disorder: study protocol for a randomized controlled trial. Addict Sci Clin Pract 2021; 16:30. [PMID: 33980315 PMCID: PMC8115873 DOI: 10.1186/s13722-021-00237-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/23/2021] [Indexed: 01/18/2023] Open
Abstract
Background Homeless youth experience high rates of substance use disorders, exposures to violence, mental and physical health conditions, and mortality. They have been particularly affected by the opioid crisis. However, no study to date has used a randomized controlled design to test preventive interventions of opioid and other drug use among this vulnerable population. Resolution of youth homelessness through housing and supportive services including prevention services, often referred to as “Housing First,” has great potential to reduce the likelihood for the development of an opioid use disorder as well as other problem behaviors associated with living on the streets. Housing First has been tested through randomized trials among homeless adults with mental health and substance use disorders, but has not been empirically tested for opioid prevention among homeless youth. Methods Homeless youth will be recruited from a drop-in shelter site frequented by disconnected youth; they will be screened for eligibility, including current homelessness, age 18–24 years, and not currently meeting criteria for opioid use disorder (OUD). In a controlled trial, 240 youth will then be randomized to one of two conditions, (1) housing + opioid and related risk prevention services, or (2) opioid and related risk prevention services alone. This project utilizes existing efficacious models of prevention to address opioid-related risks, including motivational interviewing, strengths-based outreach and advocacy, and an HIV risk preventive intervention. Follow-up will be conducted at 3, 6, 9 and 12-months post-baseline. The economic cost of each intervention will be determined to support implementation decisions with other providers and their funders. Discussion This study will provide essential information for researchers and providers on the efficacy of housing + opioid and related risk prevention services in an RCT for effects on opioid use and mechanisms underlying change. Because youth experiencing homelessness are at increased risk for a variety of adverse outcomes, the proposed intervention may produce substantial health care benefits to the youths and society at large. Trial registration ClinicalTrials.gov, NCT04135703, Registered October 13, 2019, https://clinicaltrials.gov/ct2/show/NCT04135703?term=NCT04135703&draw=2&rank=1#contacts
Collapse
Affiliation(s)
- Natasha Slesnick
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA.
| | - Laura Chavez
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Alicia Bunger
- College of Social Work, The Ohio State University, 1947 N. College Road, Columbus, OH, 43210, USA
| | - Ruri Famelia
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Jodi Ford
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH, 43210, USA
| | - Xin Feng
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Sarah Higgins
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Eugene Holowacz
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Soren Jaderlund
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Ellison Luthy
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Allen Mallory
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Jared Martin
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Laura Walsh
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Tansel Yilmazer
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Kelly Kelleher
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute At Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| |
Collapse
|
73
|
Mehmandoost S, Mirzazadeh A, Zarei J, Iranpour A, Mousavian G, Khezri M, Ardalan G, Shahesmaeili A, S Pourmorovat, Sharifi H. Sex out of marriage and condom use among homeless youth in Iran. Public Health 2021; 194:116-120. [PMID: 33887599 DOI: 10.1016/j.puhe.2021.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Sexual behaviors of homeless youth in Iran have not been well studied. This study aimed to measure the frequency and associated factors of sex out of marriage and condom use among homeless youth in Kerman, Iran. STUDY DESIGN In this cross-sectional study, we recruited 202 homeless youth (age: 15-29 years who experienced 30 or more days of homelessness in the last 12 months) from 11 street locations between September to December 2017. METHODS Of 202 participants, 169 (83.7%) reported sex in the last 12 months and were include in this analysis. We assessed the prevalence of sex out of marriage in the last 12 months, condom use in last sex, and then evaluated their covariates in multivariable logistic regression analysis. RESULTS The prevalence of sex out of marriage was 19.6% (95% confidence intervals [CIs]: 13.8%, 26.3%) and the prevalence of condom use was 43.8% (95% CI: 36.2%, 51.6%). Sex out of marriage was significantly correlated with male gender (adjusted odds ratio [AOR]: 24.38; 95% CI: 3.1-192.1) and being unmarried (AOR: 5.94; 95% CI: 2.3-15.5). Condom use was significantly correlated with male gender (AOR: 2.16; 95% CI: 1.1-4.2) and higher educational status (AOR: 4.30; 95% CI: 2.1-8.8). CONCLUSION Our findings indicate that one in five homeless youth had sex out of marriage, and less than half did no use condom. These should be addressed by adapting education and harm reduction programs targeting this specific population in Iran.
Collapse
Affiliation(s)
- S Mehmandoost
- HIV/STI Surveillance Research Center, And WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health Kerman University of Medical Sciences, Kerman, Iran
| | - A Mirzazadeh
- HIV/STI Surveillance Research Center, And WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health Kerman University of Medical Sciences, Kerman, Iran; Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - J Zarei
- HIV/STI Surveillance Research Center, And WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health Kerman University of Medical Sciences, Kerman, Iran
| | - A Iranpour
- HIV/STI Surveillance Research Center, And WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health Kerman University of Medical Sciences, Kerman, Iran.
| | - G Mousavian
- HIV/STI Surveillance Research Center, And WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health Kerman University of Medical Sciences, Kerman, Iran
| | - M Khezri
- HIV/STI Surveillance Research Center, And WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health Kerman University of Medical Sciences, Kerman, Iran
| | - G Ardalan
- Adolescent and Youth Heath Office, Ministry of Health and Medical Education, Tehran, Iran
| | - A Shahesmaeili
- HIV/STI Surveillance Research Center, And WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health Kerman University of Medical Sciences, Kerman, Iran
| | - S Pourmorovat
- Adolescent and Youth Heath Office, Ministry of Health and Medical Education, Tehran, Iran
| | - H Sharifi
- HIV/STI Surveillance Research Center, And WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
74
|
Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa. Healthcare (Basel) 2021; 9:healthcare9040461. [PMID: 33919729 PMCID: PMC8070736 DOI: 10.3390/healthcare9040461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
Although treatment default by psychiatric patients or mental health care users is a global challenge, this behavior is reported to be higher in South Africa. The Manguzi District Hospital in rural Kwa-Zulu Natal Province, South Africa, experiences high rates of treatment default by psychiatric patients. The objective of this study was to determine the reasons for treatment defaulting at Manguzi Hospital, KwaZulu-Natal Province, South Africa. An explorative qualitative design, using in-depth interviews, was conducted with mental health care users who had defaulted out-patient psychiatric treatment. Twenty-one mental health care users were interviewed before data saturation was reached. Nvivo version 11 was used to analyze the qualitative data. Major themes that emerged confirmed that social factors are key contributions to treatment defaulting, and these include denial of the mental disorders; belief that they are cured; lack of, or disintegration of social support; preference for traditional medicine; and flaws in the health care system. Social determinants of treatment outcomes for mental disorders require tailor-made support systems for patients in these rural communities, which include increase in health literacy and attention to the cultural understanding of mental disorders.
Collapse
|
75
|
Redline B, Semborski S, Madden DR, Rhoades H, Henwood BF. Examining Sleep Disturbance Among Sheltered and Unsheltered Transition Age Youth Experiencing Homelessness. Med Care 2021; 59:S182-S186. [PMID: 33710093 PMCID: PMC7958980 DOI: 10.1097/mlr.0000000000001410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The estimated 3.5-million transition age youth (TAY) who experience homelessness in the United States annually are routinely exposed to inadequate sleep environments and other psychosocial risk factors for deficient sleep. Although staying in a shelter versus being unsheltered may facilitate sleep, research suggests that perceived safety wherever one sleeps may be just as important. In this study, which is the first known study to investigate sleep disturbances among TAY experiencing homelessness, we examine associations of sleep disturbances with sheltered status and perceived safety of usual sleep environment. METHODS We surveyed TAY (aged 18-25) experiencing homelessness in Los Angeles, CA about their sleep, psychosocial health, and living situations. Participants (n=103; 60% sheltered) self-reported sleep disturbances using the Patient-Reported Outcomes Measurement Information System Sleep Disturbance short form, while individual items assessed sheltered status and perceived safety where they usually slept. Regression analyses examined associations of sheltered status and perceived sleep environment safety with sleep disturbance, adjusting for age, sex, race, self-rated health, depression symptoms, serious mental illness, high-risk drinking, and severe food insecurity. RESULTS Twenty-six percent of participants reported moderate-severe sleep disturbances. Sleep disturbance was not associated with sheltered status, but was positively associated with feeling unsafe in one's sleep environment, depression symptoms, severe food insecurity, and decreased age. CONCLUSIONS Our findings suggest that sleep disturbances among TAY experiencing homelessness are associated more closely with how safe one feels rather than one's sheltered status. This highlights the importance of providing safe places to live for sheltered and unsheltered TAY.
Collapse
Affiliation(s)
- Brian Redline
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Sara Semborski
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Danielle R. Madden
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Harmony Rhoades
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Benjamin F. Henwood
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| |
Collapse
|
76
|
Preventing Youth Homelessness through Social Procurement in Construction: A Capability Empowerment Approach. SUSTAINABILITY 2021. [DOI: 10.3390/su13063127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Homelessness is a serious and growing problem in the UK, exacerbated by the COVID-19 crisis. The latest figures estimate that 160,000 households are at risk of the worst forms of homelessness. Employment is widely recognised as being critical to reducing homelessness, yet there has been no research into the role that the construction industry, as a major UK employer, can play in reducing this problem. The aim of this paper is to address this gap in knowledge and contribute to the emerging social procurement debate in construction by exploring the role that construction employment can play in reducing the risk of homelessness. Mobilising Sen’s and Nussbaum’s capabilities empowerment approach, an in-depth case study is presented of a construction employment program in Wales, UK, which was aimed at supporting young people who had experienced or who were at risk of homelessness. Contributing to the emerging social value and social procurement debate in construction and drawing on documentary analysis and interviews with young people who were homeless or at risk of homelessness who went through the program, findings indicate that these young people became empowered in ways which reduced their risk of homelessness. It is concluded that the capabilities empowerment framework is valuable in explaining how employment in the construction industry can reduce the risks of homelessness for disadvantaged youth with a care-experienced background or who were known to the criminal justice system.
Collapse
|
77
|
Parpouchi M, Moniruzzaman A, Somers JM. The association between experiencing homelessness in childhood or youth and adult housing stability in Housing First. BMC Psychiatry 2021; 21:138. [PMID: 33685434 PMCID: PMC7938606 DOI: 10.1186/s12888-021-03142-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Researchers have pointed out the paucity of research investigating long-term consequences of experiencing homelessness in childhood or youth. Limited research has indicated that the experience of homelessness in childhood or youth is associated with adverse adjustment-related consequences in adulthood. Housing First (HF) has acknowledged effectiveness in improving housing outcomes among adults experiencing homelessness and living with serious mental illness, although some HF clients struggle with maintaining housing. The current study was conducted to examine whether the experience of homelessness in childhood or youth increases the odds of poorer housing stability following entry into high-fidelity HF among adults experiencing serious mental illness and who were formerly homeless. METHODS Data were drawn from the active intervention arms of a HF randomized controlled trial in Metro Vancouver, Canada. Participants (n = 297) were referred to the study from service agencies serving adults experiencing homelessness and mental illness between October 2009 and June 2011. The Residential Time-Line Follow-Back Inventory was used to measure housing stability. Least absolute shrinkage and selection operator was used to estimate the association between first experiencing homelessness in childhood or youth and later housing stability as an adult in HF. RESULTS Analyses indicated that homelessness in childhood or youth was negatively associated with experiencing housing stability as an adult in HF (aOR = 0.53; 95% CI = 0.31-0.90). CONCLUSIONS Further supports are needed within HF to increase housing stability among adult clients who have experienced homelessness in childhood or youth. Asking clients about the age they first experienced homelessness may be of clinical utility upon enrollment in HF and may help identify support needs related to developmental experiences. Results further emphasize the importance of intervening earlier in life in childhood and youth before experiencing homelessness or before it becomes chronic. Findings also contribute to a limited knowledge base regarding the adverse long-term consequences of childhood and youth homelessness. TRIAL REGISTRATION Current Controlled Trials: ISRCTN57595077 and ISRCTN66721740 . Registered on October 9, 2012.
Collapse
Affiliation(s)
- Milad Parpouchi
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Julian M Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| |
Collapse
|
78
|
Winiarski DA, Glover AC, Bounds DT, Karnik NS. Addressing Intersecting Social and Mental Health Needs Among Transition-Age Homeless Youths: A Review of the Literature. Psychiatr Serv 2021; 72:317-324. [PMID: 33397145 PMCID: PMC7920918 DOI: 10.1176/appi.ps.201900498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Homelessness among youths is a poorly understood and complex social phenomenon. The authors examined the risk factors for homelessness among transition-age young adults, including the unique mental health concerns that often perpetuate the cycle of poverty and housing instability among these youths. The authors discuss the treatment gaps for mental health conditions in this population and identify potential solutions for reducing existing barriers to care. A literature review revealed that many studies report high rates of trauma and subsequent mental health problems among homeless youths. Intervention studies are challenging to conduct with this population and often have high attrition rates. Youths who are homeless desire mental health services and are especially enthusiastic about programs that address interpersonal difficulties and emotion regulation. Clinical data suggest that future interventions should address trauma more directly in this population. Technology-based interventions may help address the needs of homeless youths and may maximize their access to care. Because youths strongly prefer technology-based platforms, future research should integrate these platforms to better address the mental health needs identified as most salient by homeless youths. The authors discuss proposed policy changes at local, state, and federal levels to improve uptake of this proposed strategy.
Collapse
Affiliation(s)
- Dominika A Winiarski
- Department of Psychiatry and Behavioral Sciences, Rush University, Chicago (all authors); Department of Psychology, Fordham University, New York City (Glover); Sue & Bill Gross School of Nursing, University of California, Irvine (Bounds)
| | - Angela C Glover
- Department of Psychiatry and Behavioral Sciences, Rush University, Chicago (all authors); Department of Psychology, Fordham University, New York City (Glover); Sue & Bill Gross School of Nursing, University of California, Irvine (Bounds)
| | - Dawn T Bounds
- Department of Psychiatry and Behavioral Sciences, Rush University, Chicago (all authors); Department of Psychology, Fordham University, New York City (Glover); Sue & Bill Gross School of Nursing, University of California, Irvine (Bounds)
| | - Niranjan S Karnik
- Department of Psychiatry and Behavioral Sciences, Rush University, Chicago (all authors); Department of Psychology, Fordham University, New York City (Glover); Sue & Bill Gross School of Nursing, University of California, Irvine (Bounds)
| |
Collapse
|
79
|
The Prevalence and Correlates of Labor and Sex Trafficking in a Community Sample of Youth Experiencing Homelessness in Metro-Atlanta. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10020032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Research suggests that runaway and homeless youth (RHY) in the United States are vulnerable to sex and labor trafficking. In this paper, we report and analyze estimates of sex and labor trafficking collected as part of the Atlanta Youth Count 2018, a community-based field survey of RHY between the ages of 14 and 25 in the metro-Atlanta area. A total of 564 participants were recruited and completed a survey that included questions about their backgrounds as well as the Human Trafficking Screening Tool (HTST). We found that 39.9% experienced some form of trafficking while homeless. While 15.6% of the youth reported commercial sexual exploitation while homeless, coerced labor (29.3%) or fraud (25.2%) were even more common experiences. Women, transgender, and gender nonconforming youth, as well young people who had prior system involvement and those who had been homeless for more than a year were the most likely to report having been trafficked. The significance of these findings for research and policy on RHY and trafficking are discussed.
Collapse
|
80
|
Zemanek CE, Liu N, Sablak CH, Gaudet BA, Jarvill TL, Kayne AN, Downen JM, Kincaid H, Smith AB, Barraco RD, Cuadrado HM, Greenberg MR. Relationship Between Vaccination Status and Biopsychosocial Characteristics in Sheltered Adolescents. Cureus 2021; 13:e12575. [PMID: 33575140 PMCID: PMC7870128 DOI: 10.7759/cureus.12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Homeless youth are a vulnerable population. A volunteer clinic supported by medical students in northeastern Pennsylvania provides shelter and healthcare to adolescents seeking refuge. We set out to determine the immunization status of youth in the shelter and evaluate for associations of immunization deficiency with demographics or biopsychosocial factors. Methods After IRB approval, a retrospective cohort study was performed from existing clinical records at the shelter 2/2015-9/2019. Chart abstraction included variables such as demographics (including age, sex, and race/ethnicity), biopsychosocial factors (including childhood trauma/abuse history, substance abuse history, and sexual activity), and immunization history. Results A total of 440 charts were analyzed. When comparing demographics of patients that had complete vaccine regimens versus those who did not, the race was statistically significant (p=.006). The most prominent difference in race was seen for Black/African American patients; only 19.57% had a completed vaccine regimen documented. Regarding immunization history, vaccine schedules of hepatitis B, measles mumps rubella (MMR), inactivated polio vaccine (IPV), and varicella were most likely to be complete; pneumococcal conjugate vaccine (PCV) 13, rotavirus, influenza, and human papillomavirus vaccine (HPV) were least likely. There was no association found between a completed vaccine regimen and biopsychosocial variables. A larger portion of females (37.35%) completed the HPV vaccine compared to males (23.14%) (p=.009). Conclusions In this single-site study, this vulnerable, at-risk population of sheltered adolescents lacked the vaccinations recommended by the Centers for Disease Control and Prevention. Racial disparities further compounded this vulnerability for Black/African American teens. Additionally, a significantly greater number of female patients received the HPV vaccine compared to males.
Collapse
Affiliation(s)
- Cecilia E Zemanek
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Nina Liu
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Ceyda H Sablak
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Brittney A Gaudet
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Taylor L Jarvill
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Allison N Kayne
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Jeffrey M Downen
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Hope Kincaid
- Network Office of Research and Innovation, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Amy B Smith
- Division of Education, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Robert D Barraco
- Surgery, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Hoonani M Cuadrado
- Community Health and Health Studies, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Marna R Greenberg
- Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| |
Collapse
|
81
|
Deschênes JM, Roy L, Girard N, Abdel-Baki A. Comment aider les jeunes atteints de psychose à éviter l’itinérance ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088183ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
82
|
Green B, Lee Kim F, Dean D. Substance Use and Treatment Among Youth Experiencing Homelessness: 1992-2017. J Adolesc Health 2020; 67:786-792. [PMID: 32665070 DOI: 10.1016/j.jadohealth.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to describe the patterns in substance use and treatment utilization from admissions to publicly funded treatment programs among youth (aged 12-24 years) experiencing homelessness between the years of 1992 and 2017. METHODS We used the concatenated Substance Abuse and Mental Health Services Administration Treatment Episode Data Set Admissions (total youth admissions, n = 5,153,775; and youth reported being homeless at the time of admission, n = 241,310). Prevalence estimates and binary logistic regression models were used to estimate the odds ratios to identify the differences among youth who reported being homeless or housed at the time of the treatment. RESULTS Homeless youth had higher odds than housed youth to self-refer for treatment; to enroll in treatment for cocaine/crack, heroin, or methamphetamine; and to receive treatment in 24-hour detoxication facilities or long-term residential facilities. Additional differences were identified among youth aged 12-17 years and youth aged 18-24 years and by sex within the homeless youth population. CONCLUSIONS This analysis provides a picture of treatment utilization patterns by youth who are experiencing homelessness and substance use disorder, by exploring differences by housing status among admissions to publicly funded treatment facilities.
Collapse
Affiliation(s)
| | | | - David Dean
- Behavioral Health Research and Policy, IBM Watson Health, Bethesda, Maryland
| |
Collapse
|
83
|
Iwundu CN, Chen TA, Edereka-Great K, Businelle MS, Kendzor DE, Reitzel LR. Mental Illness and Youth-Onset Homelessness: A Retrospective Study among Adults Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228295. [PMID: 33182590 PMCID: PMC7697732 DOI: 10.3390/ijerph17228295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
Financial challenges, social and material instability, familial problems, living conditions, structural issues, and mental health problems have been shown to contribute to youth homelessness. Based on the paucity of literature on mental illness as a reason for youth homelessness, the current study retrospectively evaluated the association between the timing of homelessness onset (youth versus adult) and mental illness as a reason for homelessness among homeless adults living in homeless shelters and/or receiving services from homeless-serving agencies. Homeless participants (N = 919; 67.3% men) were recruited within two independent studies from Dallas and Oklahoma. Covariate-adjusted logistic regressions were used to measure associations between homelessness onset and mental illness as a reason for current homelessness, history of specific mental illnesses, the historical presence of severe mental illness, and severe mental illness comorbidity. Overall, 29.5% of the sample reported youth-onset homelessness and 24.4% reported mental illness as the reason for current homelessness. Results indicated that mental illness as a reason for current homelessness (AOR = 1.62, 95% CI = 1.12–2.34), history of specific mental illnesses (Bipolar disorder–AOR = 1.75, 95% CI = 1.24–2.45, and Schizophrenia/schizoaffective disorder–AOR = 1.83, 95% CI = 1.22–2.74), history of severe mental illness (AOR = 1.48, 95% CI = 1.04–2.10), and severe mental illness comorbidities (AOR = 1.30, 95% CI: 1.11–1.52) were each associated with increased odds of youth-onset homelessness. A better understanding of these relationships could inform needs for early interventions and/or better prepare agencies that serve at-risk youth to address precursors to youth homelessness.
Collapse
Affiliation(s)
- Chisom N. Iwundu
- Department of Rehabilitation and Health Services, College of Health and Public Service, University of North Texas, Denton, TX 76203, USA;
- Correspondence: ; Tel.: +1-940-369-5356
| | - Tzu-An Chen
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX 77204, USA; (T.-A.C.); (L.R.R.)
- HEALTH Research Institute, University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Kirsteen Edereka-Great
- Department of Rehabilitation and Health Services, College of Health and Public Service, University of North Texas, Denton, TX 76203, USA;
| | - Michael S. Businelle
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research, Parkway, Suite 400, Oklahoma City, OK 73104, USA; (M.S.B.); (D.E.K.)
| | - Darla E. Kendzor
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research, Parkway, Suite 400, Oklahoma City, OK 73104, USA; (M.S.B.); (D.E.K.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX 77204, USA; (T.-A.C.); (L.R.R.)
- HEALTH Research Institute, University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| |
Collapse
|
84
|
Bounds DT, Winiarski DA, Otwell CH, Tobin V, Glover AC, Melendez A, Karnik NS. Considerations for working with youth with socially complex needs. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 33:209-220. [PMID: 32691491 PMCID: PMC7970826 DOI: 10.1111/jcap.12288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/26/2020] [Accepted: 07/05/2020] [Indexed: 12/01/2022]
Abstract
TOPIC The presence of adverse childhood experiences offers a glimpse into the social complexity in the lives of youth. Thus far, youth have been categorized as "at-risk" or "vulnerable,"-identifiers which highlight a deficits-based framework and continue to stigmatize youth. To combat this systemic marginalization, we propose using the term youth with socially complex needs. These youth, often minority ethnic/racial and/or sexual/gender minorities, experience repeated adversity and discrimination. PURPOSE The purpose of this paper is to conceptualize the unique considerations of working with youth with socially complex needs-who have an increased vulnerability for social marginalization. SOURCES USED Given the adversity experienced and challenges inherent in working with youth with socially complex needs, ethical principles, and relevant care delivery models were explored. CONCLUSIONS Delivering mental health care and/or conducting research in collaboration with youth with socially complex needs requires thoughtful consideration of ethical principles and models of care. In conclusion, we propose a strengths-based, individualized approach to working with youth with socially complex needs that requires a dynamic, fluid, multisystemic approach to care and research.
Collapse
Affiliation(s)
- Dawn T. Bounds
- Rush University College of Nursing, Chicago, IL, USA
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Dominka A. Winiarski
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Caitlin H. Otwell
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Valerie Tobin
- Rush University College of Nursing, Chicago, IL, USA
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Angela C. Glover
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Adrian Melendez
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| | - Niranjan S. Karnik
- Rush University Medical Center, Department of Psychiatry & Behavioral Sciences, Chicago, IL USA
| |
Collapse
|
85
|
Sulkowski ML, Michael KD. Introduction to the special issue: School and life experiences of highly mobile students: Phenomenology, risk, and resilience. PSYCHOLOGY IN THE SCHOOLS 2020. [DOI: 10.1002/pits.22445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Michael L. Sulkowski
- Department of Disability and Psychoeducational Studies University of Arizona Tucson Arizona USA
| | - Kurt D. Michael
- Department of Psychology Appalachian State University Boone North Carolina USA
| |
Collapse
|
86
|
Tucker JS, D'Amico EJ, Pedersen ER, Garvey R, Rodriguez A, Klein DJ. Behavioral Health and Service Usage During the COVID-19 Pandemic Among Emerging Adults Currently or Recently Experiencing Homelessness. J Adolesc Health 2020; 67:603-605. [PMID: 32792255 PMCID: PMC7417157 DOI: 10.1016/j.jadohealth.2020.07.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE This study provides information on how the coronavirus disease 2019 (COVID-19) outbreak is affecting emerging adults currently or recently homeless in terms of engagement in protective behaviors, mental health, substance use, and access to services. METHODS Ninety participants in an ongoing clinical trial of a risk reduction program for homeless, aged 18-25 years, were administered items about COVID-19 between April 10 and July 9, 2020. RESULTS Most participants reported engaging in COVID-19 protective behaviors. Past week mental health symptoms were reported by 38%-48% of participants, depending on symptoms. Among those who used substances before the outbreak, 16%-28% reported increased use of alcohol, tobacco, and marijuana. More than half of the participants reported increased difficulty meeting basic needs (e.g., food), and approximately 32%-44% reported more difficulty getting behavioral health services since the outbreak. CONCLUSIONS Innovative strategies are needed to address the increased behavioral health needs of young people experiencing homelessness during events such as the COVID-19 outbreak.
Collapse
Affiliation(s)
- Joan S. Tucker
- RAND Corporation, Santa Monica, California,Address correspondence to: Joan S. Tucker, Ph.D., RAND Corporation, 1776 Main Street, Santa Monica, CA 90407
| | | | - Eric R. Pedersen
- RAND Corporation, Santa Monica, California,Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | | | | |
Collapse
|
87
|
Chavez LJ, Kelleher K, Slesnick N, Holowacz E, Luthy E, Moore L, Ford J. Virtual Reality Meditation Among Youth Experiencing Homelessness: Pilot Randomized Controlled Trial of Feasibility. JMIR Ment Health 2020; 7:e18244. [PMID: 32969834 PMCID: PMC7545327 DOI: 10.2196/18244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Homelessness among youth is devastating, with high rates of substance use disorders and mental health comorbidity. Mindfulness-based interventions that include meditation and mindfulness skills training reduce stress and symptoms of anxiety or depression. However, engaging high-risk youth in interventions is challenging. Virtual reality is a more flexible platform for delivering meditation and may be appealing to youth. OBJECTIVE The study objectives were to evaluate the feasibility of delivering virtual reality meditation and of collecting outcome measures, including anxiety and physiologic stress. METHODS A sample of 30 youth experiencing homelessness was enrolled in the study. Youth were randomized to receive 10 minutes of one of three interventions: (1) virtual reality meditation, (2) audio meditation (through a web-based platform), or (3) virtual reality imagery of historical pictures and text. Subjects who consented to the study attended two research visits. The first visit collected survey measures of demographics, mental health, and substance use, and oriented subjects to the intervention platforms. The second visit (1-3 days later) delivered the intervention and collected pre and post outcome measures of anxiety and physiologic stress (salivary cortisol). Changes in anxiety and cortisol at the second visit were compared across groups using a linear regression model in which the primary analysis compared virtual reality meditation to audio meditation and secondary analyses compared virtual reality meditation to virtual reality imagery. RESULTS Anxiety scores decreased in all groups, with a larger reduction among the virtual reality meditation group (difference=10.8) compared to the web-based meditation or virtual reality images groups (difference=5.8 and 5.0, respectively). After controlling for baseline values, there were no significant group differences in changes in anxiety scores or cortisol levels. In comparing virtual reality meditation and audio meditation, the effect size for anxiety was moderate (Cohen d=0.58) while the effect size for cortisol was small (Cohen d=0.08). CONCLUSIONS Preliminary results suggest that virtual reality meditation has a moderate benefit for anxiety but not physiologic stress. Future research is needed to confirm these results in a larger sample and to investigate whether the effects are sustained or increase with repeated use of virtual reality mediation. Virtual reality meditation appears feasible to deliver among homeless youth and merits further study. TRIAL REGISTRATION ClinicalTrials.gov NCT04004520; https://clinicaltrials.gov/ct2/show/NCT04004520.
Collapse
Affiliation(s)
| | - Kelly Kelleher
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Natasha Slesnick
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Eugene Holowacz
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Ellison Luthy
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Laura Moore
- College of Nursing, Columbus, OH, United States
| | - Jodi Ford
- College of Nursing, Columbus, OH, United States
| |
Collapse
|
88
|
Predicting Daily Sheltering Arrangements among Youth Experiencing Homelessness Using Diary Measurements Collected by Ecological Momentary Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186873. [PMID: 32962272 PMCID: PMC7558709 DOI: 10.3390/ijerph17186873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
Youths experiencing homelessness (YEH) often cycle between various sheltering locations including spending nights on the streets, in shelters and with others. Few studies have explored the patterns of daily sheltering over time. A total of 66 participants completed 724 ecological momentary assessments that assessed daily sleeping arrangements. Analyses applied a hypothesis-generating machine learning algorithm (component-wise gradient boosting) to build interpretable models that would select only the best predictors of daily sheltering from a large set of 92 variables while accounting for the correlated nature of the data. Sheltering was examined as a three-category outcome comparing nights spent literally homeless, unstably housed or at a shelter. The final model retained 15 predictors. These predictors included (among others) specific stressors (e.g., not having a place to stay, parenting and hunger), discrimination (by a friend or nonspecified other; due to race or homelessness), being arrested and synthetic cannabinoids use (a.k.a., “kush”). The final model demonstrated success in classifying the categorical outcome. These results have implications for developing just-in-time adaptive interventions for improving the lives of YEH.
Collapse
|
89
|
Siconolfi D, Tucker JS, Shadel WG, Seelam R, Golinelli D. Health, Homelessness Severity, and Substance Use among Sexual Minority Youth Experiencing Homelessness: A Comparison of Bisexual Versus Gay and Lesbian Youth. JOURNAL OF SEX RESEARCH 2020; 57:933-942. [PMID: 31809204 PMCID: PMC7274857 DOI: 10.1080/00224499.2019.1695723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Lesbian, gay, bisexual, and questioning (LGBQ) youth are overrepresented among youth experiencing homelessness (YEH), and health disparities among LGBQ youth are well-documented. LGBQ youth are typically aggregated as a single sexual minority group; however, research suggests that bisexual youth may have greater mental health, substance use, and physical health risks relative to their gay and lesbian peers. In a probability sample of LGBQ YEH in Los Angeles County (n = 183), we examined subgroup differences in homelessness severity, depression, physical health, and substance use, focusing on differences between bisexual and gay/lesbian youth due to the small subsample of questioning youth. Indicators of homelessness severity were standalone outcomes, and also were integrated as control variables with gender, age, race/ethnicity, and education in multivariable models. Bisexual youth were more likely to have become unaccompanied homeless persons as minors (OR = 4.35, 95% CI 1.85-10.23), and to have not recently utilized emergency shelters or transitional housing at least once in the past month (OR = 6.41; 95% CI 2.41-17.03). Bisexual youth were more likely to have probable depression (OR = 4.06, 95% CI 1.41-11.68). Among sexual minority YEH, bisexual youth may be at elevated risk for depression, in addition to more severe homelessness.
Collapse
Affiliation(s)
| | - Joan S Tucker
- RAND Social and Economic Well-Being, RAND Corporation
| | | | | | | |
Collapse
|
90
|
Sakai-Bizmark R, Mena LA, Estevez D, Webber EJ, Marr EH, Bedel LEM, Yee JK. Health Care Utilization of Homeless Minors With Diabetes in New York State From 2009 to 2014. Diabetes Care 2020; 43:2082-2089. [PMID: 32616618 PMCID: PMC7646203 DOI: 10.2337/dc19-2219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/14/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aims to describe differences in health care utilization between homeless and nonhomeless minors with diabetes. RESEARCH DESIGN AND METHODS Data from the Healthcare Cost and Utilization Project's Statewide Inpatient Database from New York for years 2009-2014 were examined to identify pediatric patients <18 years old with diabetes. Outcomes of interest included hospitalization rate, in-hospital mortality, admission through the emergency department (ED), diabetic ketoacidosis (DKA), hospitalization cost, and length of stay (LOS). Other variables of interest included age-group, race/ethnicity, insurance type, and year. Multivariate logistic regression models were used for in-hospital mortality, admission through ED, and DKA. Log-transformed linear regression models were used for hospitalization cost, and negative binomial regression models were used for LOS. RESULTS A total of 643 homeless and 10,559 nonhomeless patients were identified. The hospitalization rate was higher among homeless minors, with 3.64 per 1,000 homeless population compared with 0.38 per 1,000 in the nonhomeless population. A statistically significant higher readmission rate was detected among homeless minors (20.4% among homeless and 14.1% among nonhomeless, P < 0.01). Lower rates of DKA (odds ratio 0.75, P = 0.02), lower hospitalization costs (point estimate 0.88, P < 0.01), and longer LOS (incidence rate ratio 1.20, P < 0.01) were detected among homeless minors compared with nonhomeless minors. CONCLUSIONS This study found that among minors with diabetes, those who are homeless experience a higher hospitalization rate than the nonhomeless. Housing instability, among other environmental factors, may be targeted for intervention to improve health outcomes.
Collapse
Affiliation(s)
- Rie Sakai-Bizmark
- The Lundquist Institute for Biomedical Innovation, Torrance, CA .,Department of Pediatrics, Harbor-UCLA Medical Center and David Geffen School of Medicine, University of California, Los Angeles, Torrance, CA
| | - Laurie A Mena
- The Lundquist Institute for Biomedical Innovation, Torrance, CA
| | - Dennys Estevez
- The Lundquist Institute for Biomedical Innovation, Torrance, CA
| | - Eliza J Webber
- The Lundquist Institute for Biomedical Innovation, Torrance, CA
| | - Emily H Marr
- The Lundquist Institute for Biomedical Innovation, Torrance, CA
| | | | - Jennifer K Yee
- The Lundquist Institute for Biomedical Innovation, Torrance, CA.,Department of Pediatrics, Harbor-UCLA Medical Center and David Geffen School of Medicine, University of California, Los Angeles, Torrance, CA
| |
Collapse
|
91
|
Marshall C, Semovski V, Stewart SL. Exposure to childhood interpersonal trauma and mental health service urgency. CHILD ABUSE & NEGLECT 2020; 106:104464. [PMID: 32497938 DOI: 10.1016/j.chiabu.2020.104464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/02/2020] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Children and youth with a history of maltreatment experience different developmental, psychiatric and health problems. Ensuring there is streamlined access to services is imperative to recovery. Yet, few reports of standardized methods for directing and prioritizing risk for children seeking services exist. OBJECTIVE The current study aims to address this gap and explore how mental health personnel triage highly vulnerable cases. Specifically, the goal of the current study is to examine whether experiencing childhood interpersonal trauma predicts service urgency. PARTICIPANTS AND SETTING Participants were 19,645 children and youth, ages 4-18 years (M = 11.1 SD = 3.4) who completed the interRAI Child and Youth Mental Health Screener (ChYMH-S) at various community-based and residential children's mental health facilities across Ontario. METHODS Retrospective data collected from the ChYMH-S was used to explore differences in maltreatment history, gender, and legal guardianship and their impact on service prioritization. RESULTS Children and youth who were exposed to some form of interpersonal trauma were more likely to have mental health issues requiring urgent follow-up service compared to those who were not exposed. Findings also suggested that gender and legal guardianship impact service urgency. CONCLUSIONS Children and youth who have experienced maltreatment are significantly more likely to score high on mental health service urgency than those who did not. This provides valuable insight that can support the development of appropriate system-level changes to policy and practice when servicing children and youth with mental health needs in Canada.
Collapse
Affiliation(s)
- Catherine Marshall
- University of Western Ontario, 1137 Western Road, London, Ontario, N6G 1G7, Canada
| | - Valbona Semovski
- University of Western Ontario, 1137 Western Road, London, Ontario, N6G 1G7, Canada.
| | - Shannon L Stewart
- University of Western Ontario, 1137 Western Road, London, Ontario, N6G 1G7, Canada
| |
Collapse
|
92
|
Myles RL, Best J, Bautista G, Wright ER, LaBoy A, Demissie Z, Dean HD. Factors Associated With HIV Testing Among Atlanta's Homeless Youth. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:325-336. [PMID: 32897135 PMCID: PMC7714517 DOI: 10.1521/aeap.2020.32.4.325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Homeless youth experience increased risk of contracting HIV, making HIV testing imperative in this population. We analyzed factors associated with HIV testing among homeless youth in Atlanta, Georgia using data from the 2015 Atlanta Youth Count and Needs Assessment. The analysis included 693 homeless youth aged 14-25 years, of whom 88.4% reported ever being tested for HIV, and 74.6% reported being tested within the previous year. Prevalence of ever testing for HIV was significantly higher among youth who reported risk factors for HIV (sexually active, transactional sex, or ever having an STI). Higher prevalence of testing within the last year was significantly associated with experiencing physical abuse or transactional sex. However, reporting ≥ 4 sexual partners or not using condoms were not associated with higher testing. Although testing prevalence among homeless youth was high, homeless youth engaging in certain high risk behaviors could benefit from further promotion of HIV testing.
Collapse
Affiliation(s)
- Ranell L Myles
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janae Best
- University of Michigan, Ann Arbor, Michigan
| | - Greg Bautista
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Ana LaBoy
- Georgia State University, Atlanta, Georgia
| | - Zewditu Demissie
- U.S. Public Health Service Commissioned Corps, Rockville, Maryland
| | - Hazel D Dean
- Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
93
|
Hsu HT, Fulginiti A, Petering R, Barman-Adhikari A, Maria DS, Shelton J, Bender K, Narendorf S, Ferguson K. Firearm Violence Exposure and Suicidal Ideation Among Young Adults Experiencing Homelessness. J Adolesc Health 2020; 67:286-289. [PMID: 32327274 PMCID: PMC7398823 DOI: 10.1016/j.jadohealth.2020.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/14/2020] [Accepted: 02/07/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE This study aimed to explore the association between direct exposure, indirect exposure, and perpetration of gun violence and suicidal ideation among young adults experiencing homelessness (YAEH). METHODS YAEH (n = 1,426) in seven cities across the U.S. were surveyed. Logistic regression analyses were conducted to examine the association between lifetime gun violence exposure and suicidal ideation in the past 12 months. RESULTS Forty-five percent (n = 641) of YAEH had experienced direct or indirect gun violence, whereas 17% (n = 247) had engaged in gun violence perpetration. Gun violence perpetration is associated with elevated suicidal ideation risk (odds ratio = 1.46; 95% confidence interval = 1.02-2.01) among YAEH. CONCLUSIONS A high percentage of YAEH were exposed to firearm violence. Cross-sector, multiagency collaborations are warranted to reduce firearm violence exposure among this vulnerable population. Homeless service providers should screen for gun violence exposure and suicide risk and target prevention efforts on YAEH with a history of gun violence perpetration.
Collapse
Affiliation(s)
- Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, Missouri.
| | - Anthony Fulginiti
- Graduate School of Social Work, University of Denver, Denver, Colorado
| | | | | | - Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center, Houston, Texas
| | - Jama Shelton
- Silberman School of Social Work, Hunter College, City University of New York, New York City, New York
| | - Kimberly Bender
- Graduate School of Social Work, University of Denver, Denver, Colorado
| | - Sarah Narendorf
- Graduate College of Social Work, University of Houston, Houston, Texas
| | - Kristin Ferguson
- School of Social Work, Arizona State University, Phoenix, Arizona
| |
Collapse
|
94
|
Heerde JA, Patton GC. The vulnerability of young homeless people. LANCET PUBLIC HEALTH 2020; 5:e302-e303. [DOI: 10.1016/s2468-2667(20)30121-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
|
95
|
D'Sa S, Foley D, Hannon J, Strashun S, Murphy AM, O'Gorman C. The psychological impact of childhood homelessness-a literature review. Ir J Med Sci 2020; 190:411-417. [PMID: 32488463 DOI: 10.1007/s11845-020-02256-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/09/2020] [Indexed: 11/26/2022]
Abstract
In August 2019, 3848 children in Ireland were faced with emergency homelessness [1]. In recent years, lack of affordable housing, unemployment and shortage of rental properties have been the primary driving factors for the potentially devastating impact of familial homelessness in our society [1]. Our aim was to evaluate current knowledge on the psychological impact of homelessness in children. Using the PRISMA model, we performed a review of the currently available literature on the psychological impact of homelessness on children. This concept was explored under two different categories-'transgenerational' and 'new-onset homelessness'. Hidden homelessness was also explored. Our literature review revealed several psychological morbidities which were unique to children. This includes developmental and learning delays, behavioural difficulties and increased levels of anxiety and depression [66, 77, 40, 81, 42]. This has been demonstrated by poorer performance in school testing and increased levels of aggression. Anxiety in children within this cohort has been shown to peak at time of dispersion from their stable home environment [67]. Our study highlights violence, aggression and poor academic learning outcomes to be just some of the key findings in our review of homelessness in childhood, worldwide. Unfortunately, there has been minimum research to date on paediatric homelessness within the context of the Irish population. We anticipate this review to be the first chapter in a multipart series investigation to evaluate the psychological morbidity of paediatric homelessness within the Irish Society.
Collapse
Affiliation(s)
- Saskia D'Sa
- Department of Paediatrics and Neonatology, University Hospital Limerick (UHL), Limerick, Ireland.
- Department of Paediatrics and Neonatology, University Maternity Hospital Limerick (UHML), Limerick, Ireland.
| | - Deirdre Foley
- Department of Paediatrics and Neonatology, University Hospital Limerick (UHL), Limerick, Ireland
- Department of Paediatrics and Neonatology, University Maternity Hospital Limerick (UHML), Limerick, Ireland
| | - Jessica Hannon
- Department of Paediatrics and Neonatology, University Hospital Limerick (UHL), Limerick, Ireland
- Department of Paediatrics and Neonatology, University Maternity Hospital Limerick (UHML), Limerick, Ireland
| | - Sabina Strashun
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
| | - Anne-Marie Murphy
- Department of Paediatrics and Neonatology, University Hospital Limerick (UHL), Limerick, Ireland
- Department of Paediatrics and Neonatology, University Maternity Hospital Limerick (UHML), Limerick, Ireland
| | - Clodagh O'Gorman
- Department of Paediatrics and Neonatology, University Hospital Limerick (UHL), Limerick, Ireland
- Department of Paediatrics and Neonatology, University Maternity Hospital Limerick (UHML), Limerick, Ireland
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
| |
Collapse
|
96
|
Physical illnesses associated with childhood homelessness: a literature review. Ir J Med Sci 2020; 189:1331-1336. [PMID: 32385787 DOI: 10.1007/s11845-020-02233-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Childhood homelessness is a growing concern in Ireland [1] creating a paediatric subpopulation at increased risk of physical illnesses, many with life-long consequences [2]. AIM Our aim was to identify and categorize the physical morbidities prevalent in homeless children. METHODS A review of the English-language literature on physical morbidities affecting homeless children (defined as ≤ 18 years of age) published from 1999 to 2019 was conducted. RESULTS Respiratory issues were the most commonly cited illnesses affecting homeless children, including asthma, upper respiratory tract infections, and chronic cough [3]. Homeless children were described as being at increased risk for contracting infectious diseases, with many studies placing emphasis on the risks of sexually transmitted infections (STIs) and HIV/AIDS transmission [4, 5]. Dermatologic concerns for this population comprised of scabies and head lice infestation, dermatitis, and abrasions [3, 6]. Malnutrition manifested as a range of physical morbidities, including childhood obesity [7], iron deficiency anemia [4], and stunted growth [8]. Studies demonstrated a higher prevalence of poor dental [7] and ocular health [9] in this population as well. Many articles also commented on the risk factors predisposing homeless children to these physical health concerns, which can broadly be categorized as limited access to health care, poor living conditions, and lack of education [3, 10]. CONCLUSION This literature review summarized the physical illnesses prevalent among homeless children and the contributing factors leading to them. Gaps in the literature were also identified and included a dearth of studies focusing on younger children compared with adolescents. Further research into prevention and intervention programs for this vulnerable population is urgently needed.
Collapse
|
97
|
Haile K, Umer H, Ayano G, Fejo E, Fanta T. A qualitative exploration of substance misuse among homeless women in Addis Ababa, Ethiopia. BMC Psychiatry 2020; 20:204. [PMID: 32375717 PMCID: PMC7203867 DOI: 10.1186/s12888-020-02626-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/27/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Substance use among homeless people is higher compared to the general population. In some studies, reported rates of problematic drug use among the homeless vary, with estimates ranging from 25 to 70%. There is a common perception that substance abuse and homelessness are linked, but there is considerable debate about the direction of the relationship. Despite observations of high levels of substance use among the homeless population in Addis Ababa, there are limited studies to date conducted on the topic. This study aims to explore the factors associated with onset of substance use and its continued use, patterns of substance use and its social and health consequences among female residents of a shelter in Addis Ababa, Ethiopia. METHODS A qualitative study was conducted in 2019. In-depth interviews were conducted on 14 study participants who were selected purposively. The qualitative data analysis software QDA Miner 5.0.30 was used for data processing and analysis. RESULTS Four major thematic areas were identified and they comprised the categories under which sub-themes were identified and coded. The major segments or categories included the following: reasons for the onset of substance use after becoming homeless, experiences of substance use and reasons for continued use, the harms which resulted on them from substance use, and the means of obtaining supply of the substances. CONCLUSION Factors related to life on streets were strong reasons for onset of substance use, as well as for its continued use. Homeless women suffered untimely death, addiction, and ill health from use of substances; however, they gave priority to obtaining substances than any other thing, and used every means to grab a supply of the substances.
Collapse
Affiliation(s)
- Kibrom Haile
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
| | - Halima Umer
- Clinical Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Getinet Ayano
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Edao Fejo
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Tolesa Fanta
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| |
Collapse
|
98
|
Dawson‐Rose C, Shehadeh D, Hao J, Barnard J, Khoddam‐Khorasani L(L, Leonard A, Clark K, Kersey E, Mousseau H, Frank J, Miller A, Carrico A, Schustack A, Cuca YP. Trauma, substance use, and mental health symptoms in transitional age youth experiencing homelessness. Public Health Nurs 2020; 37:363-370. [DOI: 10.1111/phn.12727] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Carol Dawson‐Rose
- University of California San Francisco (UCSF) School of NursingSan Francisco CA USA
| | - Deena Shehadeh
- University of California San Francisco (UCSF) School of NursingSan Francisco CA USA
| | - Jennifer Hao
- University of California San Francisco (UCSF) School of MedicineSan Francisco CA USA
| | - Jasmine Barnard
- University of California San Francisco (UCSF) School of NursingSan Francisco CA USA
| | | | - Adam Leonard
- University of California San Francisco (UCSF) School of NursingSan Francisco CA USA
| | - Kristen Clark
- University of California San Francisco (UCSF) School of NursingSan Francisco CA USA
| | - Eva Kersey
- Larkin Street Youth ServicesSan Francisco CA USA
| | | | - Julie Frank
- Larkin Street Youth ServicesSan Francisco CA USA
| | - Aaron Miller
- University of California San Francisco (UCSF) School of NursingSan Francisco CA USA
| | | | - Amy Schustack
- University of California San Francisco (UCSF) School of NursingSan Francisco CA USA
| | - Yvette P. Cuca
- University of California San Francisco (UCSF) School of NursingSan Francisco CA USA
| |
Collapse
|
99
|
Raifman J, Charlton BM, Arrington-Sanders R, Chan PA, Rusley J, Mayer KH, Stein MD, Austin SB, McConnell M. Sexual Orientation and Suicide Attempt Disparities Among US Adolescents: 2009-2017. Pediatrics 2020; 145:e20191658. [PMID: 32041815 PMCID: PMC7049939 DOI: 10.1542/peds.2019-1658] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Sexual minority adolescents face mental health disparities relative to heterosexual adolescents. We evaluated temporal changes in US adolescent reported sexual orientation and suicide attempts by sexual orientation. METHODS We used Youth Risk Behavioral Surveillance data from 6 states that collected data on sexual orientation identity and 4 states that collected data on sex of sexual contacts continuously between 2009 and 2017. We estimated odds ratios using logistic regression models to evaluate changes in reported sexual orientation identity, sex of consensual sexual contacts, and suicide attempts over time and calculated marginal effects (MEs). RESULTS The proportion of adolescents reporting minority sexual orientation identity nearly doubled, from 7.3% in 2009 to 14.3% in 2017 (ME: 0.8 percentage points [pp] per year; 95% confidence interval [CI]: 0.6 to 0.9 pp). The proportion of adolescents reporting any same-sex sexual contact increased by 70%, from 7.7% in 2009 to 13.1% in 2017 (ME: 0.6 pp per year; 95% CI: 0.4 to 0.8 pp). Although suicide attempts declined among students identifying as sexual minorities (ME: -0.8 pp per year; 95% CI: -1.4 to -0.2 pp), these students remained >3 times more likely to attempt suicide relative to heterosexual students in 2017. Sexual minority adolescents accounted for an increasing proportion of all adolescent suicide attempts. CONCLUSIONS The proportion of adolescents reporting sexual minority identity and same-sex sexual contacts increased between 2009 and 2017. Disparities in suicide attempts persist. Developing and implementing approaches to reducing sexual minority youth suicide is critically important.
Collapse
Affiliation(s)
- Julia Raifman
- Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts;
| | - Brittany M Charlton
- Boston Children's Hospital, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health and
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Jack Rusley
- Warren Alpert Medical School and
- Hasbro Children's Hospital, Providence, Rhode Island
- School of Public Health, Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island; and
| | - Kenneth H Mayer
- Harvard T.H. Chan School of Public Health and
- Harvard Medical School, Harvard University, Boston, Massachusetts
- The Fenway Institute, Boston, Massachusetts
| | - Michael D Stein
- Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts
| | - S Bryn Austin
- Boston Children's Hospital, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health and
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
| | | |
Collapse
|
100
|
Winiarski DA, Rufa AK, Bounds DT, Glover AC, Hill KA, Karnik NS. Assessing and treating complex mental health needs among homeless youth in a shelter-based clinic. BMC Health Serv Res 2020; 20:109. [PMID: 32046711 PMCID: PMC7014693 DOI: 10.1186/s12913-020-4953-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 02/04/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Rates of homelessness have been increasing in recent years, thereby necessitating a more direct approach to treating this complex social problem. Homeless youth have disproportionately high rates of untreated mental health problems and are therefore particularly vulnerable to the effects of homelessness during the transition period from adolescence to adulthood. METHODS The study team developed a shelter-based clinic and collected clinical measures on youth who attended this clinic from October 2016 through June 2018. RESULTS Youth attended an average number of three sessions, but there was a significant drop in follow-up after the first (intake) appointment. Depression, anger, and adjustment disorder emerged as the most common presenting mental health concerns identified by clinicians in the intake appointment, and trauma was identified as a significant complaint for those youth who returned for a second session. CONCLUSION Mental health care is needed in this population, but future studies should explore alternative approaches to retaining homeless youth in treatment and in designing targeted trauma-informed interventions.
Collapse
Affiliation(s)
- Dominika A. Winiarski
- Department of Psychiatry and Behavioral Sciences, Section of Population Behavioral Health, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL 60612 USA
| | - Anne K. Rufa
- Department of Psychiatry and Behavioral Sciences, Section of Population Behavioral Health, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL 60612 USA
| | - Dawn T. Bounds
- Department of Psychiatry and Behavioral Sciences, Section of Population Behavioral Health, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL 60612 USA
- College of Nursing, Department of Community, Systems, & Mental Health Nursing, Rush University Medical Center, Chicago, IL USA
| | - Angela C. Glover
- Department of Psychiatry and Behavioral Sciences, Section of Population Behavioral Health, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL 60612 USA
| | - Kristin A. Hill
- Department of Psychiatry and Behavioral Sciences, Section of Population Behavioral Health, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL 60612 USA
| | - Niranjan S. Karnik
- Department of Psychiatry and Behavioral Sciences, Section of Population Behavioral Health, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL 60612 USA
- College of Nursing, Department of Community, Systems, & Mental Health Nursing, Rush University Medical Center, Chicago, IL USA
| |
Collapse
|