151
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Cognitive Skills Training for Homeless Transition-Age Youth: Feasibility and Pilot Efficacy of a Community Based Randomized Controlled Trial. J Nerv Ment Dis 2017; 205:859-866. [PMID: 28937497 PMCID: PMC5679070 DOI: 10.1097/nmd.0000000000000741] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cognitive impairments are common in homeless youth and negatively impact academic and vocational outcomes. We examined the feasibility and efficacy of cognitive interventions provided to 18- to 22-year-old homeless youth living in urban supportive housing. Ninety-one homeless youth were randomized to receive either targeted cognitive training (cognitive remediation) or general cognitive activation (computer skills training). Cognitive and psychological outcomes were assessed at baseline, after 13 and 26 sessions, and 1 month postintervention. A high dropout rate highlighted the feasibility challenges of treating this population. Intent-to-treat analysis found significant improvements across groups in specific and global measures of cognition and psychological distress, with no significant group differences. Transition-age homeless youth show improvements in cognitive and psychological functioning when engaged in interventions that address their cognitive development. This speaks to the malleability of cognitive skills in this cohort and lays the groundwork for future research to address their cognitive health.
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152
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153
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Barnes AJ, Lafavor TL, Cutuli JJ, Zhang L, Oberg CN, Masten AS. Health and Self-Regulation among School-Age Children Experiencing Family Homelessness. CHILDREN-BASEL 2017; 4:children4080070. [PMID: 28777779 PMCID: PMC5575592 DOI: 10.3390/children4080070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 11/24/2022]
Abstract
Children in homeless families have high levels of adversity and are at risk for behavior problems and chronic health conditions, however little is known about the relationship between cognitive-emotional self-regulation and health among school-aged homeless children. Children (n = 86; mean age 10.5) living in shelters were assessed for health, family stress/adversity, emotional-behavioral regulation, nonverbal intellectual abilities, and executive function. Vision problems were the most prevalent health condition, followed by chronic respiratory conditions. Cumulative risk, child executive function, and self-regulation problems in children were uniquely related to child physical health. Homeless children experience problems with cognitive, emotional, and behavioral regulation as well as physical health, occurring in a context of high psychosocial risk. Several aspects of children’s self-regulation predict physical health in 9- to 11-year-old homeless children. Health promotion efforts in homeless families should address individual differences in children’s self-regulation as a resilience factor.
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Affiliation(s)
- Andrew J Barnes
- Developmental-Behavioral Pediatrics, Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
| | - Theresa L Lafavor
- School of Professional Psychology, Pacific University, Hillsboro, OR 97123, USA.
| | - J J Cutuli
- Department of Psychology, Rutgers University, Camden, NJ 08102, USA.
| | - Lei Zhang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Charles N Oberg
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55454, USA.
| | - Ann S Masten
- Institute of Child Development, College of Education and Human Development, University of Minnesota, Minneapolis, MN 55455, USA.
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154
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Johns EA, Jin H, Auerswald CL, Wilson EC. Sociodemographic Factors Associated With Trans*female Youth's Access to Health Care in the San Francisco Bay Area. J Adolesc Health 2017; 61:259-261. [PMID: 28438525 PMCID: PMC5657385 DOI: 10.1016/j.jadohealth.2017.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Trans*female youth (TFY) are an underserved population at risk for a variety of poor health outcomes, in part related to barriers to accessing health and mental health care. METHODS We conducted a secondary analysis of data collected with 250 TFY aged 16-24 years in the San Francisco Bay Area from 2012 to 2014. Logistic regression was used to test associations between sociodemographic variables and barriers to gender identity-based medical and mental health care. RESULTS Having a history of unstable housing was associated with significantly higher odds of problems accessing both medical care (odds ratio: 2.16, 95% confidence interval: 1.12-4.13) and mental health care due to gender identity (odds ratio 2.65, 95% confidence interval: 1.08-6.45). Conversely, identifying as genderqueer/genderfluid, Latina, or living in dependent housing was associated with access to either medical or mental health care. CONCLUSIONS Interventions are needed to address housing and discrimination barring access to health care among TFY.
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Affiliation(s)
- Elizabeth A Johns
- UC Berkeley-UCSF Joint Medical Program, Berkeley, California; UC Berkeley School of Public Health, Berkeley, California.
| | - Harry Jin
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California
| | - Colette L Auerswald
- UC Berkeley-UCSF Joint Medical Program, Berkeley, California; UC Berkeley School of Public Health, Berkeley, California
| | - Erin C Wilson
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California
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155
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Abubakar-Abdullateef A, Adedokun B, Omigbodun O. A comparative study of the prevalence and correlates of psychiatric disorders in Almajiris and public primary school pupils in Zaria, Northwest Nigeria. Child Adolesc Psychiatry Ment Health 2017; 11:29. [PMID: 28596800 PMCID: PMC5463351 DOI: 10.1186/s13034-017-0166-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 05/19/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND 'Almajiris' are children and adolescents sent far away from their homes to study in Islamic schools under the care of Muslim scholars. Over the years, there has been a decline in the capacity of the scholars to cater to these pupils. Consequently, Almajiris spend significant periods of time on the streets begging and carrying out menial jobs to earn a living thereby increasing their risk for physical and mental disorders. The aim of this study was to compare the prevalence of psychiatric disorders among Almajiris and public primary school pupils in Zaria. METHODS A comparative cross-sectional design was utilized to compare 213 Almajiris and 200 public primary school children and adolescents aged between 5 and 19 years. All participants were administered a Socio-demographic questionnaire and the Schedule for Affective Disorders and Schizophrenia for School-aged Children Present and Lifetime Version (K-SADS-PL). Data were analyzed using Chi square tests and logistic regression. RESULTS The current prevalence of psychiatric disorders among Almajiris and public school pupils was 57.7 and 37.0% respectively. After adjusting for age and family characteristics, Almajiris were significantly more likely to have any psychiatric diagnosis, depression, enuresis, substance use, and post traumatic stress disorder but less likely to have separation anxiety disorder than the public school pupils. CONCLUSION Psychiatric disorders are more prevalent among Almajiris and public primary school pupils in Northwest Nigeria than found in other prevalence studies with a significantly higher rate among the Almajiris. Joint efforts need to be made by the Government and Civil Society organizations including religious groups towards reforming the Almajiri education system and the provision of programmes aimed at reducing the prevalence of psychiatric disorders in both Almajiris and the school pupils.
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Affiliation(s)
- Aishatu Abubakar-Abdullateef
- 0000 0004 4688 7583grid.413221.7Department of Psychiatry, Ahmadu Bello University Teaching Hospital Zaria, Zaria, Nigeria ,0000 0004 1794 5983grid.9582.6Centre for Child and Adolescent Mental Health, University of Ibadan, Ibadan, Nigeria
| | - Babatunde Adedokun
- 0000 0004 1794 5983grid.9582.6Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olayinka Omigbodun
- 0000 0004 1794 5983grid.9582.6Centre for Child and Adolescent Mental Health, University of Ibadan, Ibadan, Nigeria ,0000 0004 1794 5983grid.9582.6Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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156
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Guo X, Slesnick N. Reductions in Hard Drug Use Among Homeless Youth Receiving a Strength-Based Outreach Intervention: Comparing the Long-Term Effects of Shelter Linkage Versus Drop-in Center Linkage. Subst Use Misuse 2017; 52:905-915. [PMID: 28426359 DOI: 10.1080/10826084.2016.1267219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The current study sought to test hard drug use outcomes for youth receiving a strengths-based outreach and advocacy intervention that linked youth to either a shelter or a drop-in center. METHODS Homeless youth (14-24 years old) were engaged by research assistants (RAs) at soup kitchens, parks, libraries, and other locations that homeless youth were known to frequent. Youth were randomly assigned to receive six months of advocacy that focused on linking youth to a drop-in center (n = 40) or to a crisis shelter (n = 39). Follow-up assessments were conducted at 3, 6, and 9 months post-baseline. Hard drug use over time was the main outcome. Intervention condition and service connection were used as predictors for the baseline level and the slope of change in hard drug use over time. Data analysis was conducted with Bernoulli Hierarchical Generalized Linear Modeling in HLM7. RESULTS The current study found that those who were in the drop-in linkage condition exhibited a greater reduction in their odds of using hard drugs during the follow-up points than their counterparts in the shelter linkage condition. And finally, those who utilized services more often during the follow-ups were those who exhibited less hard drug use at baseline and less reduction in their odds of using hard drugs. CONCLUSIONS This study suggests that drop-in centers, which are often characterized by low-demand programming and few behavioral restrictions, are effective for addressing hard drug use among homeless youth.
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Affiliation(s)
- Xiamei Guo
- a Institute of Psychology, Xiamen University , Xiamen , China
| | - Natasha Slesnick
- b Department of Human Sciences , The Ohio State University , Columbus , Ohio , USA
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157
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Harpin S, Davis J, Low H, Gilroy C. Mobile Phone and Social Media Use of Homeless Youth in Denver, Colorado. J Community Health Nurs 2017; 33:90-7. [PMID: 27074405 DOI: 10.1080/07370016.2016.1159440] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to investigate homeless youth mobile phone and social media use, to plan health promotion efforts. Nearly half (46.7%) of runaway/homeless youth in this sample (n = 181) owned a mobile phone and a majority of those devices were smart phones. Ownership did not vary significantly by shelter location, though regular use of Facebook was more prevalent among those in housing programs or camping, than those living on the streets. Over 90% of youth in the sample reported using Facebook. Such media use might facilitate parent, family, and health provider communications with homeless youth.
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Affiliation(s)
- Scott Harpin
- a University of Colorado , College of Nursing , Aurora , CO
| | - Jillian Davis
- a University of Colorado , College of Nursing , Aurora , CO
| | - Hana Low
- a University of Colorado , College of Nursing , Aurora , CO
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158
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Nishio A, Horita R, Sado T, Mizutani S, Watanabe T, Uehara R, Yamamoto M. Causes of homelessness prevalence: Relationship between homelessness and disability. Psychiatry Clin Neurosci 2017; 71:180-188. [PMID: 27778418 DOI: 10.1111/pcn.12469] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/14/2016] [Accepted: 10/18/2016] [Indexed: 11/28/2022]
Abstract
AIM Many studies have reported that the prevalence of mental illness and cognitive disability is higher among homeless individuals compared to the general population, and the rates of mental illness among the homeless population have recently increased. This study: (i) compares causes of homelessness or barriers to escaping homelessness for people with/without mental illness/cognitive disability; (ii) reveals problems with the Japanese homeless policy; and (iii) proposes an effective and necessary support system. METHODS The participants were 114 homeless individuals. A psychiatric diagnostic interview and the Wechsler Adult Intelligence Scale, version III were used to measure participants' mental health and cognitive abilities. A questionnaire was administered comprising 17 items related to the causes of their homelessness and barriers to escaping from it. Participants were divided into four groups - with/without mental illness or cognitive disability - and Fisher's exact test was used to compare the questionnaire results. RESULTS Individuals with cognitive disabilities considered bad relationships with their family members to be the cause of their homelessness. Conversely, normal individuals considered their homelessness to be the result of debt more so than did individuals with mental problems. Individuals with mental illness had more difficulties escaping homelessness than did either normal individuals or individuals with cognitive disability. This tendency was observed most strongly among individuals with both mental illness and cognitive disability. CONCLUSION Most homeless individuals considered economic problems to be the cause of their homelessness; however, difficulties with human relationships were also important factors and were more difficult for participants to acknowledge. Furthermore, these difficulties were exacerbated among those individuals with mental problems.
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Affiliation(s)
- Akihiro Nishio
- Health Administration Center, Gifu, Japan.,Division of Neuroscience, Department of Psychopathology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Ryo Horita
- Health Administration Center, Gifu, Japan
| | - Tadahiro Sado
- Health Administration Center, Gifu, Japan.,Faculty of Health Promotional Sciences, Tokoha University, Hamamatsu, Japan
| | - Seiko Mizutani
- Faculty of Nursing, Nihon Fukushi University, Tokai, Japan
| | | | | | - Mayumi Yamamoto
- Health Administration Center, Gifu, Japan.,United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Japan
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159
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Substance Use of Homeless and Precariously Housed Youth in a Canadian Context. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-016-9656-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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160
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Slesnick N, Zhang J, Brakenhoff B. Personal Control and Service Connection as Paths to Improved Mental Health and Exiting Homelessness among Severely Marginalized Homeless Youth. CHILDREN AND YOUTH SERVICES REVIEW 2017; 73:121-127. [PMID: 28943689 PMCID: PMC5603313 DOI: 10.1016/j.childyouth.2016.11.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Non-service connected, continuously homeless youth are arguably one of the most vulnerable populations in the U.S. These youth reside at society's margins experiencing an accumulation of risks over time. Research concludes that as vulnerabilities increase so do poor long-term outcomes. This study tested the mediating effects of service connection and personal control as mediators of cumulative risk and housing, health and mental health outcomes. By understanding the processes associated with therapeutic change among those with the most vulnerabilities, service providers and researchers can target those factors to enhance positive outcomes. METHOD Seventy-nine, non-service connected, substance using homeless youth were offered a strengths-based outreach and engagement intervention and were assessed at baseline 3, 6 and 9 months post-baseline. RESULTS Personal control mediated the effects of cumulative risk on housing stability, and service utilization mediated the effects of cumulative risk on mental health. CONCLUSIONS This study specifies important targets of intervention for a population at high risk for continuing homelessness. In particular, service providers should target youths' sense of personal control and link them to needed community-based services in order to help them exit street life and improve mental health outcomes.
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Affiliation(s)
| | - Jing Zhang
- Department of Human Sciences, The Ohio State University
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161
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Carmona J, Slesnick N, Guo X, Murnan A, Brakenhoff B. Predictors of Outreach Meetings Among Substance Using Homeless Youth. Community Ment Health J 2017; 53:62-71. [PMID: 26293750 DOI: 10.1007/s10597-015-9919-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 08/10/2015] [Indexed: 11/26/2022]
Abstract
Homeless youth have high rates of substance use and often lack connection to social services. Outreach is critical for connecting youth to services, but factors influencing their outreach engagement are unknown. This study examined predictors of meetings with outreach workers among 79 non-service connected, substance using homeless youth between 14 and 24 years of age. Results provide direction to service providers in that older age, higher levels of depressive symptoms, fewer drug-related problems, and no use of hard drugs within the prior 30 days predicted higher meeting attendance. Future research is needed testing strategies that overcome barriers to outreach engagement.
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Affiliation(s)
- Jasmin Carmona
- Department of Human Sciences, The Ohio State University, 135 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA.
| | - Natasha Slesnick
- Department of Human Sciences, The Ohio State University, 135 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Xiamei Guo
- Institute of Psychology, Xiamen University, No. 422, Siming South Road, Xiamen, 361005, Fujian, China
| | - Aaron Murnan
- Department of Human Sciences, The Ohio State University, 135 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Brittany Brakenhoff
- Department of Human Sciences, The Ohio State University, 135 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
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162
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Kozloff N, Adair CE, Palma Lazgare LI, Poremski D, Cheung AH, Sandu R, Stergiopoulos V. "Housing First" for Homeless Youth With Mental Illness. Pediatrics 2016; 138:peds.2016-1514. [PMID: 27681009 DOI: 10.1542/peds.2016-1514] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES "Housing First" has been shown to improve housing stability in homeless individuals with mental illness, but had not been empirically tested in homeless youth. We aimed to evaluate the effect of "Housing First" on housing stability in homeless youth aged 18 to 24 years participating in At Home/Chez Soi, a 24-month randomized trial of "Housing First" in 5 Canadian cities. METHODS Homeless individuals with mental illness were randomized to receive "Housing First" (combined with assertive community treatment or intensive case management depending on their level of need) or treatment as usual. We defined our primary outcome, housing stability, as the percent of days stably housed as a proportion of days for which residence data were available. RESULTS Of 2148 participants who completed baseline interviews and were randomized, 7% (n = 156) were youth aged 18 to 24 years; 87 received "Housing First" and 69 received treatment as usual. In an adjusted analysis, youth in "Housing First" were stably housed a mean of 437 of 645 (65%) days for which data were available compared with youth in treatment as usual, who were stably housed a mean of 189 of 582 (31%) days for which data were available, resulting in an adjusted mean difference of 34% (95% confidence interval, 24%-45%; P < .001). CONCLUSIONS "Housing First" was associated with improved housing stability in homeless youth with mental illness. Future research should explore whether adaptations of the model for youth yield additional improvements in housing stability and other outcomes.
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Affiliation(s)
- Nicole Kozloff
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; .,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Carol E Adair
- Departments of Psychiatry and.,Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Luis I Palma Lazgare
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Daniel Poremski
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Amy H Cheung
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rebeca Sandu
- Dartington Social Research Unit, Dartington, Totnes, United Kingdom; and
| | - Vicky Stergiopoulos
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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163
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Gambling in the Landscape of Adversity in Youth: Reflections from Men Who Live with Poverty and Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090854. [PMID: 27589784 PMCID: PMC5036687 DOI: 10.3390/ijerph13090854] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/29/2016] [Accepted: 08/17/2016] [Indexed: 11/23/2022]
Abstract
Most of the research on gambling behaviour among youth has been quantitative and focused on measuring prevalence. As a result, little is known about the contextual experiences of youth gambling, particularly among those most vulnerable. In this paper, we explore the previous experiences of youth gambling in a sample of adult men experiencing housing instability and problem gambling. We present findings from a qualitative study on problem gambling and housing instability conducted in Toronto, Canada. Thirty men with histories of problem or pathological gambling and housing instability or homelessness were interviewed. Two thirds of these men reported that they began gambling in youth. Five representative cases were selected and the main themes discussed. We found that gambling began in early life while the men, as youth, were also experiencing adversity (e.g., physical, emotional and/or sexual abuse, neglect, housing instability, homelessness, substance addiction and poverty). Men reported they had access to gambling activity through their family and wider networks of school, community and the streets. Gambling provided a way to gain acceptance, escape from emotional pain, and/or earn money. For these men problematic gambling behaviour that began in youth, continued into adulthood.
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164
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Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4:e82. [PMID: 27417882 PMCID: PMC4965613 DOI: 10.2196/mhealth.5168] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/24/2016] [Accepted: 06/13/2016] [Indexed: 11/16/2022] Open
Abstract
Background Homeless and unstably housed (H/UH) youth are disproportionately affected by sexual health issues, including human immunodeficiency virus/sexually transmitted diseases, teen pregnancy, and dating violence, and are at a higher risk for poor mental health and underutilization of services. Research suggests that linking health care to H/UH adolescents might help improve their continuity of care, with most preferring to access health care information via the Internet. YTH StreetConnect is a dual-purpose mobile app that helps H/UH youth access health and vital services in Santa Clara County, CA, USA. We developed YTH StreetConnect PRO in parallel with the youth app as a companion tablet app for providers who serve H/UH youth. Objective The objective of our study was to develop a mobile app to support H/UH youth and their providers in accessing health and vital resources, and to conduct usability and feasibility testing of the app among H/UH youth and technical consultants with local expertise in serving H/UH youth. Methods Formative research included a literature review on H/UH youths’ mobile phone and Internet usage. In January 2015, we conducted interviews with medical and service providers of H/UH youth. Usability and feasibility testing were done with target audiences. Additionally, we conducted focus groups with youth regarding the app’s youth friendliness, accessibility, and usefulness. Results H/UH youth and their providers noted the app’s functionality, youth friendliness, and resources. Usability testing proposed improvements to the app, including visual updates to the user interface, map icons, new underrepresented resource categories, and the addition of a peer rating system. Limitations included a small sample size among H/UH youth and providers and a single site for the study (Santa Clara County, CA), making the findings ungeneralizable to the US population. Conclusions YTH StreetConnect is a promising way to increase service utilization, provide referral access, and share resources among H/UH youth and providers. Input from H/UH youth and providers offers insights on how to improve future models of YTH StreetConnect and similar programs that assist H/UH youth.
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165
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Guo X, Slesnick N, Feng X. Changes in Family Relationships among Substance Abusing Runaway Adolescents: A Comparison between Family and Individual Therapies. JOURNAL OF MARITAL AND FAMILY THERAPY 2016; 42:299-312. [PMID: 25981755 DOI: 10.1111/jmft.12128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Eligible adolescents (12-17 years old) were recruited from a short-term crisis shelter for runaway adolescents in a large Midwestern city. Adolescents (N = 179) were randomly assigned to Ecologically-Based Family Therapy (EBFT, n = 61), the Community Reinforcement Approach (CRA, n = 57), or brief Motivational Enhancement Therapy (MET, n = 61) with the primary focus on substance abuse. A significant increase in perceived family cohesion and a significant reduction in perceived family conflict were found among all treatment conditions from baseline to the 24-month follow-up. Adolescents who received EBFT demonstrated more improvement in family cohesion after treatment than those who received CRA or MET, and more reduction in family conflict during treatment than those who received MET.
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166
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The increasing global health priority of substance use in young people. Lancet Psychiatry 2016; 3:251-64. [PMID: 26905480 DOI: 10.1016/s2215-0366(15)00508-8] [Citation(s) in RCA: 295] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/02/2015] [Accepted: 11/02/2015] [Indexed: 11/23/2022]
Abstract
Substance use in young people (aged 10-24 years) might disrupt key periods of transition that occur as the adolescent brain undergoes cognitive and emotional development, and key psychosocial transitions are made. Adolescence is the peak time for initiation of substance use, with tobacco and alcohol usually preceding the use of illicit drugs. Substantial variation is noted between countries in the levels, types, and sequences of substance use in young people, indicating that a young person's use of substances depends on their social context, drug availability, and their personal characteristics. The Global Burden of Disease (GBD) 2013 study suggests that the burden attributable to substance use increases substantially in adolescence and young adulthood. In young men aged 20-24 years, alcohol and illicit substance use are responsible for 14% of total health burden. Alcohol causes most health burden in eastern Europe, and illicit drug burden is higher in the USA, Canada, Australia, New Zealand, and western Europe. Large gaps exist in epidemiological data about the extent of drug use worldwide and much of what we know about the natural history of substance use comes from cohort studies in high-income countries undertaken decades ago, which hinders effective global policy responses. In view of the global epidemiological transitions from diseases of poverty to non-communicable diseases, the burden of disease and health risks among adolescents and young adults is likely to change substantially, in ways that will no doubt see substance use playing an increasingly large part.
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167
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Cheng T, Johnston C, Kerr T, Nguyen P, Wood E, DeBeck K. Substance use patterns and unprotected sex among street-involved youth in a Canadian setting: a prospective cohort study. BMC Public Health 2016; 16:4. [PMID: 26728877 PMCID: PMC4700772 DOI: 10.1186/s12889-015-2627-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/16/2015] [Indexed: 11/21/2022] Open
Abstract
Background Rates of sexually transmitted infections (STI) and unplanned pregnancy are high among youth. While the intersection between drug and alcohol use and unprotected sex is well recognized, few studies have examined the relationship between substance use patterns and unprotected sex among high risk-populations such as street-involved youth. Methods Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth from Vancouver, Canada. Generalized estimating equations (GEE) were used to examine substance use patterns that were independently associated with unprotected sex, defined as (vaginal or anal) sexual intercourse without consistent condom use. Results Between September 2005 and May 2013, 1,026 youth were recruited into the ARYS cohort and 75 % (n = 766) reported engaging in recent unprotected sex at some point during the study period. In a multivariable analysis, female gender (adjusted odds ratio [AOR] = 1.46, 95 % confidence interval [CI]: 1.18-1.81), Caucasian ancestry (AOR = 1.38, 95 % CI: 1.13-1.68), being in a stable relationship (AOR = 4.64, 95 % CI: 3.82-5.65), having multiple sex partners (AOR = 2.60, 95 % CI: 2.18-3.10) and the following substance use patterns were all independently associated with recent unprotected sex: injection or non-injection crystal methamphetamine use (AOR = 1.21, 95 % CI: 1.03-1.43), injection or non-injection cocaine use (AOR = 1.20, 95 % CI: 1.02-1.41), marijuana use (AOR = 1.23, 95 % CI: 1.02-1.49), ecstasy use (AOR = 1.23, 95 % CI: 1.01-1.48) and alcohol use (AOR = 1.31, 95 % CI: 1.11-1.55) (all p < 0.05). Conclusions Unprotected sex was prevalent among street-involved youth in this setting, and independently associated with female gender and a wide range of substance use patterns. Evidence-based and gender-informed sexual health interventions are needed in addition to increased access to youth-centered addiction treatment services. STI testing and linkages to healthcare professionals remain important priorities for street-involved youth, and should be integrated across all health and social services.
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Affiliation(s)
- Tessa Cheng
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6. .,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, B.C., Canada, V5A 1S6.
| | - Caitlin Johnston
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6. .,BC Women Hospital and Health Centre, 4500 Oak St, Vancouver, B.C., Canada, V6H 3V5.
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6. .,Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, B.C., Canada, V6T 1Z3.
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6.
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6. .,Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, B.C., Canada, V6T 1Z3.
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6. .,School of Public Policy, Simon Fraser University, 515 West Hastings Street, Suite 3271, Vancouver, B.C., Canada, V6B 5K3.
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168
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Oppong Asante K. Exploring age and gender differences in health risk behaviours and psychological functioning among homeless children and adolescents. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2015. [DOI: 10.1080/14623730.2015.1088739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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169
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Santa Maria D, Narendorf SC, Ha Y, Bezette-Flores N. Exploring Contextual Factors of Youth Homelessness And Sexual Risk Behaviors: A Qualitative Study. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2015; 47:195-201. [PMID: 26575948 DOI: 10.1363/47e6715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 06/05/2023]
Abstract
CONTEXT HIV disproportionately affects homeless youth, and interventions to date have had minimal success in reducing sexual risk behaviors in this population. Few qualitative studies have been conducted to provide insight into the influence of homelessness-related factors on sexual risk behaviors. METHODS A qualitative study with a quantitative component was conducted with a nonprobability sample of 64 homeless youth aged 14-24; participants were recruited from a variety of venues in Houston between October 2013 and March 2014. Thirteen focus group discussions were conducted; thematic analysis was used to identify themes related to HIV risk. RESULTS Participants were predominantly black (75%), sheltered (67%) and aged 18 or older (77%). Youth discussed how the circumstances of their homelessness and the struggle to meet their immediate needs led to behaviors and experiences that put them at risk for HIV. Three themes emerged: Homeless youth frequently engage in risky sexual behavior, sometimes as a way to cope with stress; they often trade sex, either voluntarily or involuntarily, for such necessities as money or a place to sleep; and many experienced childhood sexual victimization or have been victimized since becoming homeless. Youth also described how stress, stigma and self-reliance contributed to their involvement in HIV risk behaviors. CONCLUSIONS HIV prevention methods that target stress and stigma while respecting youths' self-reliance may help reduce sexual risk behaviors. Further research is needed to determine suitable behavioral change techniques to address these potentially modifiable factors.
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170
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A Call to Action: Developing and Strengthening New Strategies to Promote Adolescent Sexual Health. SOCIETIES 2015. [DOI: 10.3390/soc5040686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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171
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Oppong Asante K, Meyer-Weitz A, Petersen I. Mental Health and Health Risk Behaviours of Homeless Adolescents and Youth: A Mixed Methods Study. CHILD & YOUTH CARE FORUM 2015. [DOI: 10.1007/s10566-015-9335-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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172
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Nishio A, Yamamoto M, Horita R, Sado T, Ueki H, Watanabe T, Uehara R, Shioiri T. Prevalence of Mental Illness, Cognitive Disability, and Their Overlap among the Homeless in Nagoya, Japan. PLoS One 2015; 10:e0138052. [PMID: 26378447 PMCID: PMC4574782 DOI: 10.1371/journal.pone.0138052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While the prevalence of mental illness or cognitive disability is higher among homeless people than the general population in Western countries, few studies have investigated its prevalence in Japan or other Asian countries. The present study conducted a survey to comprehensively assess prevalence of mental illness, cognitive disability, and their overlap among homeless individuals living in Nagoya, Japan. METHODS Participants were 114 homeless individuals. Mental illness was diagnosed based on semi-structured interviews conducted by psychiatrists. The Wechsler Adult Intelligence Scale-III (WAIS-III, simplified version) was used to diagnose intellectual/ cognitive disability. RESULTS Among all participants, 42.1% (95% CI 33.4-51.3%) were diagnosed with a mental illness: 4.4% (95% CI 1.9-9.9%) with schizophrenia or other psychotic disorder, 17.5% (95% CI 11.6-25.6%) with a mood disorder, 2.6% (95% CI 0.9-7.5%) with an anxiety disorder, 14.0% (95% CI 8.8-21.6%) with a substance-related disorder, and 3.5% (95% CI 1.4-8.8%) with a personality disorder. Additionally, 34.2% (95% CI 26.1-43.3%) demonstrated cognitive disability: 20.2% (95% CI 13.8-28.5%) had mild and 14.0% (95% CI 8.8-21.6%) had moderate or severe disability. The percent overlap between mental illness and cognitive disability was 15.8% (95% CI 10.2-23.6%). Only 39.5% (95% CI 26.1-43.3%) of the participants were considered to have no psychological or cognitive dysfunction. Participants were divided into four groups based on the presence or absence of mental illness and/or cognitive disability. Only individuals with a cognitive disability reported a significant tendency toward not wanting to leave their homeless life. CONCLUSION This is the first report showing that the prevalence of mental illness and/or cognitive disability among homeless individuals is much higher than in the general Japanese population. Appropriate support strategies should be devised and executed based on the specificities of an individual's psychological and cognitive condition.
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Affiliation(s)
- Akihiro Nishio
- Health Administration Center, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
- Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
| | - Mayumi Yamamoto
- Health Administration Center, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
- United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
| | - Ryo Horita
- Health Administration Center, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
| | - Tadahiro Sado
- Health Administration Center, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
- Faculty of Health Promotional Sciences, Tokoha University, 1230 Kitaku, Miyakoda, Hamamatsu, 431–2102, Japan
| | - Hirofumi Ueki
- Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
| | | | - Ryosuke Uehara
- Yoshida Hospital, 1-7-1 Saidaiji Akoda, Nara, 631–0818, Japan
| | - Toshiki Shioiri
- Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
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Nishio A, Yamamoto M, Ueki H, Watanabe T, Matsuura K, Tamura O, Uehara R, Shioiri T. Prevalence of mental illness, intellectual disability, and developmental disability among homeless people in Nagoya, Japan: A case series study. Psychiatry Clin Neurosci 2015; 69:534-42. [PMID: 25523066 DOI: 10.1111/pcn.12265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 11/06/2014] [Accepted: 12/11/2014] [Indexed: 11/30/2022]
Abstract
AIM While it has been reported that the prevalence of mental illness is higher in homeless people than in the national population, few studies have investigated the prevalence of intellectual and developmental disability among the homeless. In this study, we conducted a survey to comprehensively assess these mental problems among homeless people in Nagoya, Japan. METHODS The subjects were 18 homeless men. Mental illness was diagnosed with semi-structured interviews conducted by psychiatrists. We used the Wechsler Adult Intelligence Scale III to diagnose intellectual disability. Discrepancies between Wechsler Adult Intelligence Scale III subtest scores were used as criteria for developmental disability. RESULTS Eleven of the 18 participants were diagnosed with mental illness: six with mood disorder, two with psychotic disorder, and six with alcohol problems. The mean IQ of all subjects was 83.4 ± 27.4. The 95% confidence interval (CI) was 96.2-69.1. Seven participants were found to have intellectual disability. Three men showed discrepancies of more than 10 between subtest scores, and all of them were diagnosed with a mental illness. We divided the participants into four groups: those with mental illness only; those with intellectual disability only; those with both problems; and those without diagnosis. The men with intellectual disability only were significantly younger and had been homeless since a younger age than the other groups. Participants diagnosed with a mental illness had been homeless for longer than those without mental health problems. CONCLUSION Although the sample size was limited, this study revealed the high prevalence of mental illness and intellectual disability, 61% (95%CI, 35-83%) and 39% (95%CI, 17-64%), respectively, in homeless people in Nagoya, Japan.
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Affiliation(s)
- Akihiro Nishio
- Health Administration Center, Gifu University, Gifu, Japan.,Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Mayumi Yamamoto
- Health Administration Center, Gifu University, Gifu, Japan.,United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Japan
| | - Hirofumi Ueki
- Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, Gifu, Japan
| | | | | | | | | | - Toshiki Shioiri
- Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, Gifu, Japan
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Lynk M, McCay E, Carter C, Aiello A, Donald F. Engaging Street-Involved Youth in Dialectical Behaviour Therapy: A Secondary Analysis. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2015; 24:116-22. [PMID: 26379723 PMCID: PMC4558982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The objective of this secondary analysis was to identify factors associated with engagement of street-involved youth in a Dialectical Behavioural Therapy (DBT) intervention. METHODS This was a cross-sectional correlational study. Youth were recruited from two agencies providing services to street-involved youth in Canada. Mental health indicators were selected for this secondary analysis to gain a better understanding of characteristics that may account for levels of engagement. RESULTS Three distinct groups of participants were identified in the data, a) youth who expressed intention to engage, but did not start DBT (n=16); b) youth who started DBT but subsequently dropped out (n=39); and c) youth who completed the DBT intervention (n=67). Youth who did engage in the DBT intervention demonstrated increased years of education; increased depressive symptoms and suicidality; and lower levels of resilience and self-esteem compared to youth participants who did not engage in the intervention. CONCLUSIONS These findings indicate that it is possible to engage street-involved youth in a DBT intervention who exhibit a high degree of mental health challenges. Despite the growing literature describing the difficult psychological and interpersonal circumstances of street-involved youth, there remains limited research regarding the process of engaging these youth in service.
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Affiliation(s)
- Michelle Lynk
- Utilization Coordinator, Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario
| | - Elizabeth McCay
- Research Chair in Urban Health and Associate Professor, Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario
| | - Celina Carter
- Research Coordinator, Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario
| | - Andria Aiello
- Research Coordinator, Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario
| | - Faith Donald
- Associate Professor, Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario
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175
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Rhoades H, Winetrobe H, Rice E. Pet ownership among homeless youth: associations with mental health, service utilization and housing status. Child Psychiatry Hum Dev 2015; 46:237-44. [PMID: 24728815 PMCID: PMC4194276 DOI: 10.1007/s10578-014-0463-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
As many as 25 % of homeless persons have pets. To our knowledge, pet ownership has not been studied quantitatively with homeless youth. This study examined pet ownership among 398 homeless youth utilizing two Los Angeles drop-in centers. Twenty-three percent of homeless youth had a pet. The majority of pet owners reported that their pets kept them company and made them feel loved; nearly half reported that their pets made it more difficult to stay in a shelter. Pet owners reported fewer symptoms of depression and loneliness than their non-pet owning peers. Pet ownership was associated with decreased utilization of housing and job-finding services, and decreased likelihood of currently staying in a shelter. These findings elucidate many of the positive benefits of pet ownership for homeless youth, but importantly highlight that pet ownership may negatively impact housing options. Housing and other services must be sensitive to the needs of homeless youth with pets.
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Affiliation(s)
- Harmony Rhoades
- School of Social Work, University of Southern California, 1149 S. Hill St., Suite 360, Los Angeles, CA, 90015, USA,
| | - Hailey Winetrobe
- School of Social Work University of Southern California Los Angeles, CA
| | - Eric Rice
- School of Social Work University of Southern California Los Angeles, CA
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176
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A comparison of three interventions for homeless youth evidencing substance use disorders: results of a randomized clinical trial. J Subst Abuse Treat 2015; 54:1-13. [PMID: 25736623 DOI: 10.1016/j.jsat.2015.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/31/2015] [Accepted: 02/09/2015] [Indexed: 11/20/2022]
Abstract
While research on homeless adolescents and young adults evidencing substance use disorder is increasing, there is a dearth of information regarding effective interventions, and more research is needed to guide those who serve this population. The current study builds upon prior research showing promising findings of the community reinforcement approach (CRA) (Slesnick, Prestopnik, Meyers, & Glassman, 2007). Homeless adolescents and young adults between the ages of 14 to 20 years were randomized to one of three theoretically distinct interventions: (1) CRA (n = 93), (2) motivational enhancement therapy (MET, n = 86), or (3) case management (CM, n = 91). The relative effectiveness of these interventions was evaluated at 3, 6, and 12 months post-baseline. Findings indicated that substance use and associated problems were significantly reduced in all three interventions across time. Several moderating effects were found, especially for sex and history of childhood abuse. Findings show little evidence of superiority or inferiority of the three interventions and suggest that drop-in centers have choices for addressing the range of problems that these adolescents and young adults face.
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177
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Abstract
Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans.
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Affiliation(s)
- Jack Tsai
- VA New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut (Jack Tsai, Robert A. Rosenheck); Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Jack Tsai, Robert A. Rosenheck); and Department of Epidemiology and Public Health, Yale School of Public Health, New Haven, Connecticut (Robert A. Rosenheck)
| | - Robert A. Rosenheck
- VA New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut (Jack Tsai, Robert A. Rosenheck); Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Jack Tsai, Robert A. Rosenheck); and Department of Epidemiology and Public Health, Yale School of Public Health, New Haven, Connecticut (Robert A. Rosenheck)
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178
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Oppong Asante K, Meyer-Weitz A, Petersen I. Correlates of psychological functioning of homeless youth in Accra, Ghana: a cross-sectional study. Int J Ment Health Syst 2015; 9:1. [PMID: 25587353 PMCID: PMC4292989 DOI: 10.1186/1752-4458-9-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on homeless youth has shown that this population is at high risk for various mental health problems. Previous studies conducted among homeless young adults in Ghana have focused primarily on economic, social and cultural causes of homelessness, their engagement in risky sexual behaviours and the prevalence of STI including HIV/AIDS. We are therefore not fully informed of the prevalence of psychological symptoms and their associated factors. The aim of the study was to determine the association between psychological functioning and social and health risk behaviours among a sample of homeless youth in Ghana. METHODS A cross-sectional survey of a convenience sample of 227 (122 male and 105 female) homeless youth was conducted in Ghana in 2013. An interviewer-administered questionnaire was used to collect data due to low level of literacy among the study population. Pearson-moment correlation coefficient (r) and multiple standard regression models were fitted to analyse the data. RESULTS Approximately 87% of the participants in this study exhibited moderate to severe psychosocial symptoms. Specifically, emotional, conduct, hyperactivity and peer relationship problems among the participants were 69%, 74%, 54% and 89% respectively. Overall psychosocial functioning was predicted by stigma (self-stigma and experienced stigma), violent behaviours and suicidal ideation. Substance use and perceived resilience were significantly associated with emotional problems. CONCLUSION There is a need for holistic interventions to help improve the psychological and social functioning of homeless youth. Such programmes should strengthen socio-emotional coping strategies in street youth as well as address contextual risk factors such as stigma and discrimination by the public.
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Affiliation(s)
- Kwaku Oppong Asante
- />Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, 4041 South Africa
- />Department of Psychology, Regent University College of Science & Technology, Accra, Ghana
| | - Anna Meyer-Weitz
- />Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, 4041 South Africa
| | - Inge Petersen
- />Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, 4041 South Africa
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Beijersbergen MD, Asmoredjo JK, Christians MGM, Wolf JRLM. Psychometric properties of the consumer quality index to assess shelter and community care services. Eur J Public Health 2014; 25:378-84. [PMID: 25465917 DOI: 10.1093/eurpub/cku195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Our aim was to design a valid and reliable consumer quality index (CQI) specifically suited to assess the experiences that homeless people, homeless youth, and abused women have with shelter and community care services. METHODS A pilot CQI questionnaire was constructed on the basis of literature study, focus group discussions with clients, concept mapping by clients and shelter workers, and a pre-pilot study. The pilot questionnaire was completed by 762 clients using shelter facilities for homeless people, homeless youth or abused women. Psychometric and multilevel analyses were performed to optimize the instrument and determine its validity, reliability and discriminative power. RESULTS The preparatory research had revealed seven primary focus topics, all of which were incorporated into the pilot questionnaire. Psychometric analyses resulted in four reliable scales, one of which applied only to clients in residential, day or night shelter programs. The final instrument consisted of 42 items for community care clients and 52 for clients using residential facilities, and day and night shelters; 32 and 42 such items pertained to client experiences. CONCLUSION The consumer quality index for shelter and community care services (CQI-SCCS) is a valid, reliable instrument for assessing the quality of these services. It provides guidance to facilities in quality maintenance and improvement, and it is useful in determining quality differences in facilities for homeless people and homeless youth.
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Affiliation(s)
- Mariëlle D Beijersbergen
- Impuls - Netherlands Research Center for Social Care, Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Jolanda K Asmoredjo
- Impuls - Netherlands Research Center for Social Care, Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Milou G M Christians
- Impuls - Netherlands Research Center for Social Care, Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Judith R L M Wolf
- Impuls - Netherlands Research Center for Social Care, Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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180
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Graham T, Rose D, Murray J, Ashworth M, Tylee A. User-generated quality standards for youth mental health in primary care: a participatory research design using mixed methods. BMJ Qual Saf 2014; 23:857-66. [PMID: 24920648 PMCID: PMC4173988 DOI: 10.1136/bmjqs-2014-002842] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/01/2014] [Accepted: 05/10/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To develop user-generated quality standards for young people with mental health problems in primary care using a participatory research model. METHODS 50 young people aged 16-25 from community settings and primary care participated in focus groups and interviews about their views and experiences of seeking help for mental health problems in primary care, cofacilitated by young service users and repeated to ensure respondent validation. A second group of young people also aged 16-25 who had sought help for any mental health problem from primary care or secondary care within the last 5 years were trained as focus groups cofacilitators (n=12) developed the quality standards from the qualitative data and participated in four nominal groups (n=28). RESULTS 46 quality standards were developed and ranked by young service users. Agreement was defined as 100% of scores within a two-point region. Group consensus existed for 16 quality standards representing the following aspects of primary care: better advertising and information (three); improved competence through mental health training and skill mix within the practice (two); alternatives to medication (three); improved referral protocol (three); and specific questions and reassurances (five). Alternatives to medication and specific questions and reassurances are aspects of quality which have not been previously reported. CONCLUSIONS We have demonstrated the feasibility of using participatory research methods in order to develop user-generated quality standards. The development of patient-generated quality standards may offer a more formal method of incorporating the views of service users into quality improvement initiatives. This method can be adapted for generating quality standards applicable to other patient groups.
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Affiliation(s)
- Tanya Graham
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Diana Rose
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Joanna Murray
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, School of Medicine, London, UK
| | - André Tylee
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK
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181
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Is Substance Use Associated with Perpetration and Victimization of Physically Violent Behavior and Property Offences Among Homeless Youth? A Systematic Review of International Studies. CHILD & YOUTH CARE FORUM 2014. [DOI: 10.1007/s10566-014-9282-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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182
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Mackelprang JL, Harpin SB, Grubenhoff JA, Rivara FP. Adverse outcomes among homeless adolescents and young adults who report a history of traumatic brain injury. Am J Public Health 2014; 104:1986-92. [PMID: 25122029 DOI: 10.2105/ajph.2014.302087] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the prevalence of self-reported traumatic brain injury (TBI) among homeless young people and explored whether sociodemographic characteristics, mental health diagnoses, substance use, exposure to violence, or difficulties with activities of daily living (ADLs) were associated with TBI. METHODS We analyzed data from the Wilder Homelessness Study, in which participants were recruited in 2006 and 2009 from streets, shelters, and locations in Minnesota that provide services to homeless individuals. Participants completed 30-minute interviews to collect information about history of TBI, homelessness, health status, exposure to violence (e.g., childhood abuse, assault), and other aspects of functioning. RESULTS Of the 2732 participating adolescents and young adults, 43% reported a history of TBI. Participants with TBI became homeless at a younger age and were more likely to report mental health diagnoses, substance use, suicidality, victimization, and difficulties with ADLs. The majority of participants (51%) reported sustaining their first injury prior to becoming homeless or at the same age of their first homeless episode (10%). CONCLUSIONS TBI occurs frequently among homeless young people and is a marker of adverse outcomes such as mental health difficulties, suicidal behavior, substance use, and victimization.
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Affiliation(s)
- Jessica L Mackelprang
- Jessica L. Mackelprang is with the Harborview Injury Prevention and Research Center and the Department of Pediatrics, University of Washington School of Medicine, Seattle. Scott B. Harpin is with the College of Nursing, Anschutz Medical Center, University of Colorado, Aurora. Joseph A. Grubenhoff is with the Department of Pediatrics, University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora. Frederick P. Rivara is with the Harborview Injury Prevention and Research Center and the Department of Pediatrics, University of Washington School of Medicine
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183
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Castro AL, Gustafson EL, Ford AE, Edidin JP, Smith DL, Hunter SJ, Karnik NS. Psychiatric disorders, high-risk behaviors, and chronicity of episodes among predominantly African American homeless Chicago youth. J Health Care Poor Underserved 2014; 25:1201-16. [PMID: 25130234 PMCID: PMC4251732 DOI: 10.1353/hpu.2014.0124] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This cross-sectional study investigated the relationships between psychiatric and substance-related disorders, high-risk behaviors, and the onset, duration, and frequency of homelessness among homeless youth in Chicago. METHODS Sixty-six homeless youth were recruited from two shelters in Chicago. Demographic characteristics, psycho-pathology, substance use, and risk behaviors were assessed for each participant. RESULTS Increased frequency and duration of homeless episodes were positively correlated with higher rates of psychiatric diagnoses. Increased number of psychiatric diagnoses was positively correlated with increased high-risk behaviors. Participants with diagnoses of Current Suicidality, Manic Episodes, Obsessive Compulsive Disorder, Substance Abuse, and Psychotic Disorder had a higher chronicity of homelessness than those without diagnoses. CONCLUSIONS Significant differences were evident between the three time parameters, suggesting that stratification of data by different time variables may benefit homelessness research by identifying meaningful subgroups who may benefit from individualized interventions.
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184
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Saperstein AM, Lee S, Ronan EJ, Seeman RS, Medalia A. Cognitive deficit and mental health in homeless transition-age youth. Pediatrics 2014; 134:e138-45. [PMID: 24958581 PMCID: PMC4067643 DOI: 10.1542/peds.2013-4302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is increasing recognition of the cognitive consequences of socioeconomic adversity during childhood, which can impair learning and negatively affect social and emotional development. However, there is a paucity of research on cognitive functioning and mental health among transition-age homeless youth. This study aimed to address this knowledge gap by examining the prevalence and functional significance of cognitive impairment and mental health disorders in a sample of 18- to 22-year-old homeless youth. METHODS Participants (N = 73) were recruited from a vocational support program at Covenant House New York, a care agency for homeless youth. Assessments included diagnostic assessment for mental health disorders and evaluation of neurocognition and vocational outcomes. RESULTS Youth demonstrated histories of academic instability, academic achievement below expectation, and high rates of untreated psychiatric disorders, the most prominent of which were anxiety, substance use, and mood disorders. Of those who had a mental health diagnosis, more than half demonstrated cognitive deficits. Performance on measures of working memory and verbal memory was <70% of that of the age-matched normative population. Cognitive impairment was associated with a significant risk for making a wage insufficient for independent living. CONCLUSIONS These data confirm the need to focus on cognitive as well as emotional and physical health in transition-age youth. Comprehensive intervention at this later developmental stage has the potential to facilitate the acquisition of skills needed for academic, vocational, and independent living success in adulthood.
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Affiliation(s)
- Alice M. Saperstein
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; and,Division of Mental Health Service and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; and
| | - Elizabeth J. Ronan
- Division of Mental Health Service and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Rachael S. Seeman
- Division of Mental Health Service and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Alice Medalia
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; and,Division of Mental Health Service and Policy Research, New York State Psychiatric Institute, New York, New York
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185
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The health diagnoses of homeless adolescents: a systematic review of the literature. J Adolesc 2014; 37:531-42. [PMID: 24931556 DOI: 10.1016/j.adolescence.2014.04.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 03/17/2014] [Accepted: 04/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Homelessness during adolescence impacts negatively upon young people's physical and mental wellbeing. To be effective, programs aimed at addressing the health needs of this population must include knowledge of both the presenting and underlying acute and chronic conditions that characterise this high risk group of youth. METHODS We undertook a systematic review of the international literature for studies that used validated instruments and techniques to diagnose prevalence rates of physical and mental health disorders in homeless adolescents. RESULTS Twenty-one studies fulfilled the selection criteria. Of these, nine studies examined mental health diagnoses including depression, post-traumatic stress disorder, anxiety and substance abuse disorders. With one exception, the remaining twelve studies all related to sexually transmitted infections. CONCLUSION Homeless adolescents are diagnosed with widely varying rates of mental health disorders and high rates of sexually transmitted infection. Other likely chronic and acute physical conditions appear to be neglected in the published research.
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186
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Rhoades H, Winetrobe H, Rice E. Prescription drug misuse among homeless youth. Drug Alcohol Depend 2014; 138:229-33. [PMID: 24613220 PMCID: PMC4029497 DOI: 10.1016/j.drugalcdep.2014.02.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/04/2014] [Accepted: 02/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prescription drug misuse (PDM) is highly prevalent among youth in the U.S., and can have serious health consequences. Homeless youth are a particularly vulnerable population with high rates of substance use. However, PDM has not been studied in a sample comprised exclusively of homeless youth. METHODS A sample of 451 homeless youth recruited from drop-in centers in Los Angeles, CA, provided information on substance use, mental health, service utilization, trauma, and sexual risk behavior. Multivariable logistic regression assessed correlates of past month PDM. RESULTS Nearly 50% reported lifetime PDM and 21.6% reported PDM in the past month. The most frequently used prescriptions in the past month were: opioids only (24.5%), sedatives only (23.4%), and stimulants only (10.6%); 14.9% used some combination of these three types of prescription medications. Homeless youth reported that prescriptions were most commonly obtained for free from friends or relatives (24.5%). Foster care involvement was associated with decreased PDM, while hard drug use, suicidal ideation, and unprotected sex were associated with increased PDM. CONCLUSIONS Homeless youth report high rates of PDM, and access these medications most frequently from friends and family. PDM among homeless youth clusters with other risk factors, including hard drug use, unprotected sex, and suicidal ideation. Surprisingly, foster care history was associated with decreased PDM. Programs aimed at preventing PDM among homeless youth should recognize the clustering of risk behaviors, assess prescription use/access when providing mental health services, and educate the general public about proper disposal of prescriptions.
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Affiliation(s)
- Harmony Rhoades
- University of Southern California School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015, United States.
| | - Hailey Winetrobe
- University of Southern California School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - Eric Rice
- University of Southern California School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
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Abstract
This clinical report provides guidance for the pediatrician in addressing the psychosocial needs of adolescents and young adults living with HIV, which can improve linkage to care and adherence to life-saving antiretroviral (ARV) therapy. Recent national case surveillance data for youth (defined here as adolescents and young adults 13 to 24 years of age) revealed that the burden of HIV/AIDS fell most heavily and disproportionately on African American youth, particularly males having sex with males. To effectively increase linkage to care and sustain adherence to therapy, interventions should address the immediate drivers of ARV compliance and also address factors that provide broader social and structural support for HIV-infected adolescents and young adults. Interventions should address psychosocial development, including lack of future orientation, inadequate educational attainment and limited health literacy, failure to focus on the long-term consequences of near-term risk behaviors, and coping ability. Associated challenges are closely linked to the structural environment. Individual case management is essential to linkage to and retention in care, ARV adherence, and management of associated comorbidities. Integrating these skills into pediatric and adolescent HIV practice in a medical home setting is critical, given the alarming increase in new HIV infections in youth in the United States.
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188
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Dang MT, Miller E. Characteristics of natural mentoring relationships from the perspectives of homeless youth. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2013; 26:246-53. [PMID: 24180604 PMCID: PMC3818248 DOI: 10.1111/jcap.12038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PROBLEM Homeless youth experience high risks for poor mental health outcomes. The purpose of this qualitative study was to explore the characteristics of natural mentoring relationships among homeless youth and to identify possible mechanisms that can enhance social support for this population. METHODS Semi-structured interviews were conducted with 23 homeless youth aged 14-21 who had natural mentors. The interviews focused on how youth met their natural mentors, the function of these relationships, and how natural mentoring relationships differed from other relationships in the youth's social networks. FINDINGS Main themes that emerged from the interviews included parental absence, natural mentors as surrogate parents, and social support from mentors. CONCLUSIONS Findings suggest that social supports provided by mentors enhance youth's adaptive functioning and may promote resilience, thus the use of natural mentors may be an important untapped asset in designing interventions to improve outcomes for homeless youth.
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Affiliation(s)
- Michelle T Dang
- School of Nursing, California State University, Sacramento, CA, USA
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Park AL, McDaid D, Weiser P, Von Gottberg C, Becker T, Kilian R. Examining the cost effectiveness of interventions to promote the physical health of people with mental health problems: a systematic review. BMC Public Health 2013; 13:787. [PMID: 23988266 PMCID: PMC3765875 DOI: 10.1186/1471-2458-13-787] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 08/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently attention has begun to focus not only on assessing the effectiveness of interventions to tackle mental health problems, but also on measures to prevent physical co-morbidity. Individuals with mental health problems are at significantly increased risk of chronic physical health problems, such as cardiovascular disease or diabetes, as well as reduced life expectancy. The excess costs of co-morbid physical and mental health problems are substantial. Potentially, measures to reduce the risk of co-morbid physical health problems may represent excellent value for money. METHODS To conduct a systematic review to determine what is known about economic evaluations of actions to promote better physical health in individuals identified as having a clinically diagnosed mental disorder, but no physical co-morbidity. Systematic searches of databases were supplemented by hand searches of relevant journals and websites. RESULTS Of 1970 studies originally assessed, 11 met our inclusion criteria. In addition, five protocols for other studies were also identified. Studies looked at exercise programmes, nutritional advice, smoking, alcohol and drug cessation, and reducing the risk of blood borne infectious diseases such as HIV/AIDS and hepatitis. All of the lifestyle and smoking cessation studies focused on people with depression and anxiety disorders. Substance abuse and infectious disease prevention studies focused on people with psychoses and bipolar disorder. CONCLUSIONS There is a very small, albeit growing, literature on the cost effectiveness of interventions to promote the physical health of people with mental health problems. Most studies suggest that value for money actions in specific contexts and settings are available. Given that the success or failure of health promoting interventions can be very context specific, more studies are needed in more settings, focused on different population groups with different mental health problems and reporting intermediate and long term outcomes. There is a need to better distinguish between resource use and costs in a transparent manner, including impacts outside of the health care system. Issues such as programme fidelity, uptake and adherence should also be accounted for in economic analysis. The role of behavioural psychological techniques to influence health behaviours might also be considered.
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Affiliation(s)
- A-La Park
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
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190
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Logan JL, Frye A, Pursell HO, Anderson-Nathe M, Scholl JE, Korthuis PT. Correlates of HIV risk behaviors among homeless and unstably housed young adults. Public Health Rep 2013; 128:153-60. [PMID: 23633730 DOI: 10.1177/003335491312800305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Homeless young adults are exposed to multiple risk factors for HIV infection. We identified HIV risk behaviors and their correlates among homeless young adults in Portland, Oregon. METHODS We conducted a community-based, cross-sectional survey of HIV risk behaviors among homeless young adults aged 18-25 years in 2010. Participants completed three study components: (1) an interviewer-administered survey of HIV risk behaviors; (2) a brief, client-centered HIV risk-based counseling session; and (3) rapid HIV testing. RESULTS Among 208 participants, 45.8% identified as racial/ethnic minority groups, 63.8% were male, and 35.7% self-identified as nonheterosexual. Six participants, all from sexual minority groups, had positive HIV screening results (two newly identified, four previously known) for a seropositivity rate of 2.9%. Female sex, belonging to a sexual minority group, frequent traveling between cities, depression, and alcohol use to intoxication were significantly associated with unprotected sex in univariate analysis. Female sex and high perceived risk of HIV were significantly associated with unprotected sex in multivariate analysis. CONCLUSIONS Our findings support the need for enhanced HIV prevention interventions for homeless young adults.
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Affiliation(s)
- Jennifer L Logan
- Oregon Health & Science University, Department of Public Health & Preventive Medicine, Portland, OR 97239, USA
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191
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Abstract
PURPOSE OF REVIEW Mentally ill homeless persons are among the most neglected or marginalized patient groups. Their needs for mental healthcare are widely unmet. The current economic crisis probably accelerates the social decline and deterioration of physical and mental health in high-risk groups worldwide and increases the need for appropriate treatments, services, and prevention strategies. RECENT FINDINGS Research on service provision for mentally disordered homeless people (from 2010 to 2012) covers the following issues: epidemiology of mental ill health among homeless persons, service delivery and healthcare utilization, specific treatments, specific high-risk groups among homeless persons, and subjective experience with mental health service provision. SUMMARY The number of studies published on these issues between 2010 and 2012 may suggest an awareness for the need for adequate service provision of this marginalized clientele. Research evidence is still not sufficient. The majority of studies are from the United States. The methodological quality of the studies is still moderate, being descriptive in nature or applying qualitative approaches to small samples. Included are usually easy to access patients from inner-city regions. There is an encouraging trend to focus on younger age groups that supports the focus on primary or secondary prevention strategies for homelessness and mental disorders.
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192
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Abstract
Child health and housing security are closely intertwined, and children without homes are more likely to suffer from chronic disease, hunger, and malnutrition than are children with homes. Homeless children and youth often have significant psychosocial development issues, and their education is frequently interrupted. Given the overall effects that homelessness can have on a child's health and potential, it is important for pediatricians to recognize the factors that lead to homelessness, understand the ways that homelessness and its causes can lead to poor health outcomes, and when possible, help children and families mitigate some of the effects of homelessness. Through practice change, partnership with community resources, awareness, and advocacy, pediatricians can help optimize the health and well-being of children affected by homelessness.
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Slesnick N, Guo X, Feng X. Change in parent- and child-reported internalizing and externalizing behaviors among substance abusing runaways: the effects of family and individual treatments. J Youth Adolesc 2012; 42:980-93. [PMID: 23054350 DOI: 10.1007/s10964-012-9826-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 09/21/2012] [Indexed: 11/28/2022]
Abstract
Shelter-recruited adolescents are known to have high rates of substance abuse and co-occurring internalizing and externalizing problem behaviors. Many studies have documented these mental health concerns, but only a small number of studies have tested interventions that may be useful for ameliorating these vulnerabilities. The current study compared three empirically supported psychotherapy interventions, Motivational Interviewing (MI), the Community Reinforcement Approach (CRA), and Ecologically-Based Family Therapy (EBFT) with 179 substance abusing runaway adolescents (47 % female, 74 % minority) and their primary caretaker recruited through a Midwestern runaway crisis shelter. Examining both child and primary caretaker reports, each treatment was associated with significant reductions in internalizing and externalizing behaviors to 24 months post-baseline. However, the trajectory of change differed among the treatments. Adolescents receiving MI showed a quicker reduction in internalizing and externalizing behaviors but also a quicker increase in these behaviors compared to adolescents receiving EBFT, who continued to evidence improvements to 24 months. The findings provide support for continued evaluation of these treatments for use with this vulnerable population of adolescents.
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Affiliation(s)
- Natasha Slesnick
- Department of Human Development and Family Science, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, USA.
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