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Milburn NG, Rice E, Petry L. Understanding Homelessness Among Young People to Improve Outcomes. Annu Rev Clin Psychol 2024; 20:457-479. [PMID: 38109482 DOI: 10.1146/annurev-clinpsy-080921-081903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
In the United States, an estimated 4.2 million young people experience homelessness during critical stages in their development-adolescence and emerging adulthood. While research on youth homelessness often emphasizes risk and vulnerability, the field must situate these issues within the developmental trajectories of adolescence and emerging adulthood to effectively prevent and end youth homelessness. This review uses the Risk Amplification and Abatement Model (RAAM) as a conceptual framework for contextualizing the landscape of youth homelessness research in the United States since 2010. An extension of ecological models of risk-taking, RAAM emphasizes both risk and resilience, positing that negative as well as positive socialization processes across interactions with family, peers, social services, and formal institutions affect key housing, health, and behavioral outcomes for youth experiencing homelessness. This review applies RAAM to our understanding of the causes and consequences of youth homelessness, recent interventions, and recommendations for future directions.
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Affiliation(s)
- Norweeta G Milburn
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, University of California, Los Angeles, California, USA;
| | - Eric Rice
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
- USC Center for Artificial Intelligence in Society, University of Southern California, Los Angeles, California, USA
| | - Laura Petry
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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Chikwava F, Cordier R, Ferrante A, O'Donnell M, Pakpahan E. Trajectories of homelessness and association with mental health and substance use disorders among young people transitioning from out-of-home care in Australia. CHILD ABUSE & NEGLECT 2024; 149:106643. [PMID: 38262181 DOI: 10.1016/j.chiabu.2024.106643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/17/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Researchers have examined sub-groups that may exist among young people transitioning from out-of-home care (OHC) using various theoretical models. However, this population group has not been examined for trajectories of homelessness risk. OBJECTIVES To examine whether different subtypes of homelessness risk exist among young people transitioning from care and whether these trajectories of homelessness are associated with mental health and substance use disorders. PARTICIPANTS AND SETTING A retrospective population-based cohort study was conducted from a population of 1018 young people (aged 15-18 years) who transitioned from out-of-home in 2013 to 2014 in the state of Victoria, Australia, with follow-up to 2018. METHODS Latent Class Growth Analysis was conducted using linked data from homelessness data collections, child protection, mental health information systems, alcohol and drug use, and youth justice information systems. RESULTS Three sub-groups of young people were identified. The 'moving on' group (88 %) had the lowest levels of homelessness, with the slope of this trajectory remaining almost stable. The 'survivors' (7 %) group started off with a high risk of homelessness, followed by a sharp decrease in homelessness risk over time. The 'complex' (5 %) group started off with a low risk of homelessness but faced sharp increases in the risk of homelessness over time. CONCLUSIONS Our study demonstrates that subgroups of young people transitioning from care exist with distinct longitudinal trajectories of homelessness, and these classes are associated with different risk factors. Early intervention and different approaches to tackling homelessness should be considered for these three distinct groups before transitioning from care and during the first few years after leaving care.
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Affiliation(s)
- Fadzai Chikwava
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia; Mental Health Commission, Perth, Western Australia, Australia.
| | - Reinie Cordier
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia; Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom; Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Anna Ferrante
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia; Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Eduwin Pakpahan
- Department of Mathematics, Physics & Electrical Engineering, Northumbria University, Newcastle upon Tyne, United Kingdom
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Pedersen ER, DiGuiseppi G, D'Amico EJ, Rodriguez A, Tran DD, Jose R, Tucker JS. Predictors of Housing Trajectories Among Young Adults Experiencing Homelessness in Los Angeles. J Behav Health Serv Res 2024; 51:31-43. [PMID: 37803216 PMCID: PMC10733216 DOI: 10.1007/s11414-023-09863-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/08/2023]
Abstract
Experiencing homelessness during young adulthood is associated with negative health outcomes and understanding housing trajectories of young adults experiencing homelessness may aid in the development of evidence-based public health programs designed to serve this at-risk age group. In the present study, the authors examined baseline predictors of 24-month trajectories of housing stability and unsheltered housing among a sample of 271 young adults aged 18 to 25 recruited from drop-in centers in Los Angeles. In multivariate models, the authors found that identifying as multi-racial/other and better friendship quality at baseline were associated with less steep increases in the likelihood of stable housing over time. Being employed at baseline was associated with a less steep decrease in the probability of being unsheltered over time, while illicit drug use days associated with a steeper decrease in the probability of being unsheltered over time. Continued research is needed to establish important factors determining young adults' long-term housing trajectories in the effort to promote greater access and engagement with housing services.
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Affiliation(s)
- Eric R Pedersen
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, USA.
| | - Graham DiGuiseppi
- School of Social Work, University of Southern California, Los Angeles, CA, 90089, USA
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA
| | - Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | | | - Denise D Tran
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, USA
| | - Rupa Jose
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
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DiGuiseppi GT, Prindle J, Rice ER, Davis JP. Longitudinal Associations between Homelessness and Substance Use: Investigating Demographic Differences for Young Adults in Treatment. Subst Use Misuse 2023; 59:243-253. [PMID: 37897085 PMCID: PMC10872782 DOI: 10.1080/10826084.2023.2267124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Objective: To examine prospective, bidirectional associations between homelessness and substance use frequency among young adults receiving substance use treatment in the United States. We also investigated potential differences across demographic subgroups. Methods: Young adults (N = 3717, Mage = 20.1, 28% female, 7.3% sexual/gender minority, and 37% non-Hispanic White) receiving substance use treatment in the U.S. completed assessments at intake, 3 months, 6 months, and 12 months post-intake. Latent growth curve models with structured residuals (LGC-SR) were used to examine cross-lagged associations between homeless days and frequency of substance use and associated problems. Models were stratified by sex, race/ethnicity, and sexual and/or gender minority status. Results: Overall, days spent homeless (μ slope = -0.19, p = 0.046) and substance use frequency (μ slope 1 = -6.19, p < 0.001) significantly decreased during treatment, with no significant cross-lagged associations between homeless days and substance use frequency. However, results differed by race and ethnicity. For non-Hispanic White young adults, greater substance use at treatment entry was associated with steeper declines in homeless days between-persons (ϕ standardized = -0.14, p = 0.04). For African Americans, homeless days at treatment entry were associated with greater increases in substance use between-persons (ϕ standardized = 0.29, p = 0.04). No significant differences were found by sex or sexual/gender minority status. Conclusions: Despite overall declines in homelessness and substance use during treatment, these outcomes may unfold differently for non-Hispanic White and African American young adults. More support may be needed for African American young adults reporting homelessness at treatment entry.
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Affiliation(s)
- Graham T. DiGuiseppi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34 Street, Los Angeles, California 90089, USA
- RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA
| | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34 Street, Los Angeles, California 90089, USA
| | - Eric R. Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34 Street, Los Angeles, California 90089, USA
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34 Street, Los Angeles, California 90089, USA
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Richards J, Henwood BF, Porter N, Kuhn R. Examining the Role of Duration and Frequency of Homelessness on Health Outcomes Among Unsheltered Young Adults. J Adolesc Health 2023; 73:1038-1045. [PMID: 37578404 PMCID: PMC10890810 DOI: 10.1016/j.jadohealth.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 04/20/2023] [Accepted: 06/10/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE We examined the impact of duration and number of homelessness episodes on health outcomes for unsheltered homeless young adults. METHODS We analyzed the 2018/2019 Los Angeles County homeless youth demographic surveys. We addressed five summary health outcomes: physical health, mental health, substance use disorder, tri-morbidity, and any condition. Respondents were classified into three homeless trajectory groups: (1) short-term-homeless < 1 year in one episode, (2) episodic-homeless < 1 year and multiple episodes, and (3) long-term-homeless continuously for > 1 year. Weighted bivariate and multivariate logistic regression models tested the relationship between homeless trajectory group and health, with controls for sociodemographic factors and structural exposures. RESULTS Mental health and substance use were high among unsheltered young adults compared to national rates. Long-term homeless respondents were significantly more likely than short-term to report a mental health condition (53.3% vs. 39.8%, p < .001), substance use disorder (25.5% vs. 18.3%, p < .001), and physical conditions (26.0% vs. 15.6%, p = .008). Episodic respondents were more likely to report a mental health condition (50.5%, p < .001). In multivariate models, long-term respondents had twice the odds of tri-morbidity (odds ratio [OR] = 2.14, p < .05) and any health condition (OR 2.00, p < .01) as short term and significantly higher odds of a physical health condition (OR = 1.64, p < .05). DISCUSSION Youth with longer durations and more frequent episodes of homelessness have substantially poorer health outcomes. The association of longer duration to poorer health persisted in multivariate models. Longer duration of unsheltered homelessness may drive the onset of physical and mental health problems.
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Affiliation(s)
- Jessica Richards
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Natalie Porter
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Randall Kuhn
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
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Czechowski K, Sylvestre J, Gogosis E, Agha A, Kerman N, Polillo A, Palepu A, Hwang SW. Cycles of instability: Proximal and distal influences on residential instability among people with histories of homelessness in three Canadian cities. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3402-3420. [PMID: 35322426 DOI: 10.1002/jcop.22843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
People with histories of homelessness often have difficulties obtaining and maintaining adequate housing. This qualitative study examined the residential transitions of people with histories of residential instability and homelessness to understand factors contributing to the instability they experience. Interviews were conducted with 64 participants about their housing transitions, in the final year of a 4-year, prospective cohort study in three Canadian cities (Ottawa, Toronto, and Vancouver). Findings showed that participants pointed to both distal and proximal factors as affecting residential transitions, including interpersonal conflict, safety concerns, substance use, poverty, pests, and health. Many reported disconnection from their housing and a lack of improvement from one housing situation to the next, demonstrating how even when housed, instability persisted. Our study highlights the complexity associated with participants' often unplanned and abrupt residential transitions. The complex and distal issues that affect housing transitions require structural changes, in addition to individual-based interventions focused on the proximal problems.
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Affiliation(s)
- Konrad Czechowski
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - John Sylvestre
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Evie Gogosis
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ayda Agha
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alexia Polillo
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
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Petry L, Hill C, Milburn N, Rice E. Who Is Couch-Surfing and Who Is on the Streets? Disparities Among Racial and Sexual Minority Youth in Experiences of Homelessness. J Adolesc Health 2022; 70:743-750. [PMID: 35074279 DOI: 10.1016/j.jadohealth.2021.10.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/17/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Youth experiencing homelessness (YEH) often engage in "couch-surfing," or frequently moving from one tenuous living arrangement to another. Understanding the characteristics and risk factors associated with couch-surfing is necessary to designing adequate responses to youth homelessness. The present study aims to investigate factors associated with youth at risk of couch-surfing or sleeping on the streets relative to staying in a shelter. METHODS The present study used Homeless Management Information System administrative data sourced from 16 communities across the U.S. between January 2015 and February 2017 (n = 9,417). Multinomial logistic regression models were used to explore correlates (e.g., demographics, homeless histories, risk and victimization, behavioral health, and self-sufficiency) of couch-surfing or sleeping on the streets relative to staying in an emergency shelter program. RESULTS YEH identifying as female; Black or another non-Latinx youth of color; or as lesbian, gay, bisexual, questioning, or another sexual orientation (LGBQ+) were at greater risk of couch-surfing relative to staying in a shelter. YEH who threatened to harm themselves or others in the preceding 12 months or who attributed their homelessness to an abusive relationship were significantly more likely to either be couch-surfing or on the streets. DISCUSSION Service providers must recognize and validate the vulnerabilities and risks experienced by couch-surfing YEH in order to help reduce barriers to accessing services faced by this population. Federal definitions of homelessness should be aligned to correct systemic biases and more accurately reflect the realities of how youth experience homelessness.
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Affiliation(s)
- Laura Petry
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.
| | - Chyna Hill
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Norweeta Milburn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Eric Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
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Vandenberg B, Livingstone C, Carter A, O'Brien K. Gambling and homelessness: A systematic review and meta-analysis of prevalence. Addict Behav 2022; 125:107151. [PMID: 34700154 DOI: 10.1016/j.addbeh.2021.107151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/16/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION There is growing concern internationally about co-occurring gambling and homelessness. We systematically review prevalence estimates in help-seeking and community samples. METHODS Adopting PRISMA guidelines, we searched CINAHL Plus, Cochrane Library, Embase, Ovid MEDLINE, PsychINFO, Proquest Central, PubMed, Scopus, Web of Science, and Google Scholar for relevant peer-reviewed articles in English. Primary outcomes examined in narrative and quantitative syntheses included prevalence of: (i) gambling in persons experiencing homelessness; (ii) harmful gambling in persons experiencing homelessness; and, (iii) homelessness in persons experiencing harmful gambling. RESULTS Searches identified 917 records after removing duplicates. After screening, 45 articles providing 54 prevalence estimates across 12 countries were included, with help-seeking (k = 37) and community based sample (k = 8) estimates pooled separately. Gambling prevalence (all timeframes) in help-seeking samples of persons experiencing homelessness is low (28.7%, 95% CI: 17.3-41.7, k = 14) compared to the general population (approximately 60-80%). However, harmful gambling prevalence (including problem, pathological, and disordered gambling) in help-seeking samples of persons experiencing homelessness is high (16.5%, 95% CI: 10.2-24.2, k = 20) compared to the general population (approximately 1-7%). Additionally, homelessness prevalence is high in help-seeking samples of persons experiencing harmful gambling (23.6%, 95% CI: 18.4-29.2, k = 4) compared to the general population (<1%). Meta-analysis found high between-study heterogeneity and risk of bias from small samples sizes. CONCLUSIONS There are high rates of harmful gambling in persons experiencing homelessness and, concurrently, high rates of homelessness in persons experiencing harmful gambling. Improvements in sampling and measurement are needed to strengthen robustness and generalizability of prevalence estimates, which can potentially inform the scale and targeting of clinical interventions, support services, and policy responses.
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Capturing the heterogeneity of life on the streets: A person-centered analysis of street histories and social connections of youth. J Adolesc 2021; 93:80-89. [PMID: 34678621 DOI: 10.1016/j.adolescence.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 08/16/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The heterogeneity of street-involved youth was examined using a person-centered approach. Youth were classified based on patterns of street involvement and the identified profiles compared to identify theoretically coherent and practically significant differences. METHODS Participants were 111 street-involved youth aged 9 to 18 (M age = 14.15 years; 81.1% male, 91.1% non-white) from three Brazilian cities. Youth completed a life history interview and structured assessment. Latent class analysis was used to identify three profiles of youth based on reasons for going to the street and connections to major developmental contexts (street, family, institutions). Profile comparisons on psychosocial variables (e.g., age, life events) and adjustment indicators (e.g., drug use, life satisfaction) were conducted using multinomial logistic regression. RESULTS The largest profile (48.6%) included youth drawn to the street by drug use or trafficking, who had moderate connections to street and family. Another group (40.5%) went to the street to escape family dysfunction, and the street represented their primary developmental context. These groups differed on some psychosocial indicators but had similar patterns of adjustment. The third group of youth (10.8%) had families with a history of street involvement and maintained strong ties to all three developmental contexts. These youth had generally better adjustment than their peers (e.g., less drug use, higher life satisfaction) but had higher levels of sexual risk related to the overrepresentation of girls. CONCLUSIONS Street involvement is a multidetermined phenomenon that may expose young people to distinct conditions of vulnerability. Findings have implications for research, practice, and policy.
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Hsu HT, Hill C, Holguin M, Petry L, McElfresh D, Vayanos P, Morton M, Rice E. Correlates of Housing Sustainability Among Youth Placed Into Permanent Supportive Housing and Rapid Re-Housing: A Survival Analysis. J Adolesc Health 2021; 69:629-635. [PMID: 33994312 DOI: 10.1016/j.jadohealth.2021.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/05/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Youth experiencing homelessness (YEH) are vulnerable to multiple adverse health outcomes. Connecting YEH with housing is critical to addressing youth homelessness and to preventing long-term negative health consequences among this vulnerable population. Using administrative data, this study aims to explore correlates of YEH's sustainability in two major housing programs: permanent supportive housing (PSH) and rapid re-housing (RRH) programs. METHODS This study used Homelessness Management Information System administrative data collected from 16 communities across the U.S. between January 1, 2015 and May 1, 2017 (n = 10,902). We conducted Cox proportional hazards survival analyses to explore correlates (e.g., demographics, homeless experiences, and overall vulnerability) of YEH's PSH (n = 577) and RRH (n = 2,883) sustainability separately. RESULTS For YEH receiving PSH, only individuals' level of vulnerability is associated with greater hazard of exiting PSH. As for RRH sustainability, YEH who were 17 years old or younger, black or Latinx (as compared to white), of higher level of vulnerability, or previously spent most nights couch surfing or in transitional living programs (as compared to on the street) are associated with higher hazard of exiting RRH. CONCLUSIONS Both PSH and RRH programs should incorporate comprehensive services targeting youth experiencing high vulnerability to prevent them from re-entering homelessness. Future RRH programming should also address housing sustainability disparities faced by racial and ethnic minority YEH, especially when they are disproportionately influenced by homelessness. Finally, RRH programs should incorporate services to foster independent living among younger YEH to sustain their housing status once temporary housing subsidies expire.
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Affiliation(s)
- Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, Missouri.
| | - Chyna Hill
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Monique Holguin
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Laura Petry
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Duncan McElfresh
- Department of Computer Science, University of Maryland, 4120 Brendan Iribe Center University of Maryland College Park, Maryland
| | - Phebe Vayanos
- Viterby School of Engineering, University of Southern California, Los Angeles, California
| | | | - Eric Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
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Lachaud J, Mejia-Lancheros C, Liu M, Wang R, Nisenbaum R, Stergiopoulos V, Hwang SW, O'Campo P. Severe Psychopathology and Substance Use Disorder Modify the Association Between Housing Trajectories and Food Security Among Homeless Adults. Front Nutr 2021; 8:608811. [PMID: 34055849 PMCID: PMC8152664 DOI: 10.3389/fnut.2021.608811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: We examined the housing trajectories of homeless people with mental illness over a follow-up period of 6 years and the association of these trajectories with food security. We then examined the modifying role of psychopathology and alcohol and substance use disorders in this association. Materials and Methods: We followed 487 homeless adults with mental illness at the Toronto site of the At Home/Chez-Soi project-a randomized trial of Housing First. Food security data were collected seven times during the follow-up period. Psychopathology (Colorado Symptom Index score) and alcohol and substance use disorders were assessed at baseline. Housing trajectories were identified using group-based trajectory modeling. Logistic regression was used to estimate the association between housing trajectory groups and food security. Results: Three housing trajectory groups were identified: rapid move to consistent stable housing (34.7%), slow and inconsistent housing (52.1%), and never moved to stable housing (13.2%). Individuals included in the rapid move to consistent housing trajectory group had higher odds of remaining food secure compared with those in the never moved to stable housing trajectory group over the follow-up period [AOR 2.9, 95% CI: 1.3-6.6, P-value: 0.009]. However, when interactions were considered, this association was significant among those with moderate psychopathology but not severe psychopathology. Individuals with substance use disorder and in the never moved to stable housing group had the lowest food security status. Discussion: Severe psychopathology and substance use disorders modified the association between housing trajectories and food security. International Standard Randomized Control Trial Number Register (ISRCTN42520374).
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Affiliation(s)
- James Lachaud
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael Liu
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Harvard Medical School, Boston, MA, United States
| | - Ri Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Predicting Daily Sheltering Arrangements among Youth Experiencing Homelessness Using Diary Measurements Collected by Ecological Momentary Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186873. [PMID: 32962272 PMCID: PMC7558709 DOI: 10.3390/ijerph17186873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
Youths experiencing homelessness (YEH) often cycle between various sheltering locations including spending nights on the streets, in shelters and with others. Few studies have explored the patterns of daily sheltering over time. A total of 66 participants completed 724 ecological momentary assessments that assessed daily sleeping arrangements. Analyses applied a hypothesis-generating machine learning algorithm (component-wise gradient boosting) to build interpretable models that would select only the best predictors of daily sheltering from a large set of 92 variables while accounting for the correlated nature of the data. Sheltering was examined as a three-category outcome comparing nights spent literally homeless, unstably housed or at a shelter. The final model retained 15 predictors. These predictors included (among others) specific stressors (e.g., not having a place to stay, parenting and hunger), discrimination (by a friend or nonspecified other; due to race or homelessness), being arrested and synthetic cannabinoids use (a.k.a., “kush”). The final model demonstrated success in classifying the categorical outcome. These results have implications for developing just-in-time adaptive interventions for improving the lives of YEH.
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Chu CMT, Moodie EEM, Streiner DL, Latimer EA. Trajectories of Homeless Shelter Utilization in the At Home/Chez Soi Trial of Housing First. Psychiatr Serv 2020; 71:648-655. [PMID: 32264800 DOI: 10.1176/appi.ps.201900260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Studies have shown that Housing First, a recovery-oriented housing intervention, is effective in reducing service utilization among homeless individuals with mental illness, but less is known about how Housing First affects patterns of service use over time and about characteristics associated with various utilization trajectories. This analysis aimed to explore latent class trajectories of shelter utilization in a randomized controlled trial of Housing First conducted across five Canadian cities. METHODS Data from the At Home/Chez Soi trial were analyzed (N=2,058). Latent class growth analysis was performed using days of shelter utilization to identify trajectories over 24 months. Multinomial logistic regression was used to determine which baseline variables, including treatment group, could predict class membership. RESULTS Four shelter use trajectories were identified: consistently low (N=1,631, 79%); mostly low (N=120, 6%); early temporary increase (N=179, 9%); and higher use, late temporary increase (N=128, 6%). Treatment group was a significant predictor of class membership. Those enrolled in Housing First had lower odds of experiencing higher shelter use trajectories (mostly low: odds ratio [OR]=0.50, 95% confidence interval [CI]=0.34-0.72; early temporary increase: OR=0.21, 95% CI=0.15-0.31; higher use, late temporary increase: OR=0.14, 95% CI=0.09-0.22). Other variables associated with trajectory classes included older age and longer time homeless, both of which were associated with higher shelter use. CONCLUSIONS Several participant characteristics were associated with different shelter use patterns. Knowledge of variables associated with more favorable trajectories may help to inform service planning and contribute to modeling efforts for homelessness.
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Affiliation(s)
- Cherry M T Chu
- Department of Epidemiology, Biostatistics, and Occupational Health (Chu, Moodie), and Department of Psychiatry (Latimer), McGill University, Montreal; Douglas Mental Health University Institute, Montreal (Chu, Latimer); Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada (Streiner)
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics, and Occupational Health (Chu, Moodie), and Department of Psychiatry (Latimer), McGill University, Montreal; Douglas Mental Health University Institute, Montreal (Chu, Latimer); Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada (Streiner)
| | - David L Streiner
- Department of Epidemiology, Biostatistics, and Occupational Health (Chu, Moodie), and Department of Psychiatry (Latimer), McGill University, Montreal; Douglas Mental Health University Institute, Montreal (Chu, Latimer); Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada (Streiner)
| | - Eric A Latimer
- Department of Epidemiology, Biostatistics, and Occupational Health (Chu, Moodie), and Department of Psychiatry (Latimer), McGill University, Montreal; Douglas Mental Health University Institute, Montreal (Chu, Latimer); Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada (Streiner)
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Fortier E, Sylvestre MP, Artenie AA, Minoyan N, Jutras-Aswad D, Roy É, Grebely J, Bruneau J. Associations between housing stability and injecting frequency fluctuations: findings from a cohort of people who inject drugs in Montréal, Canada. Drug Alcohol Depend 2020; 206:107744. [PMID: 31785537 DOI: 10.1016/j.drugalcdep.2019.107744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/09/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relationship between housing stability and drug injecting is complex, as both outcomes fluctuate over time. The objectives were to identify short-term trajectories of housing stability and injecting frequency among people who inject drugs (PWID) and examine how patterns of injecting frequency relate to those of housing stability. METHODS At three-month intervals, PWID enrolled between 2011 and 2016 in the Hepatitis Cohort completed an interviewer-administered questionnaire and were tested for hepatitis C and HIV infections. At each visit, participants reported, for each of the past three months, the accommodation they lived in the longest (stable/unstable) and the number of injecting days (0-30). Group-based dual trajectory modeling was conducted to identify housing stability and injecting frequency trajectories evolving concomitantly over 12 months and estimate the probabilities of following injecting trajectories conditional upon housing trajectories. RESULTS 386 participants were included (mean age 40.0, 82 % male). Three housing stability trajectories were identified: sustained (53 %), declining (20 %), and improving (27 %). Five injecting frequency trajectories were identified: sporadic (26 %), infrequent (34 %), increasing (15 %), decreasing (11 %), and frequent (13 %). PWID with improving housing were less likely to increase injecting (8 %) compared to those with sustained (17 %) or declining housing (17 %). CONCLUSIONS Improving housing was associated with a lower probability of increasing injecting compared to declining housing, while sustained housing stability was associated with a higher probability of increasing injecting compared to improving housing. Therefore, policies to improve PWID's access to stable housing are warranted and may reduce, to some extent, drug injecting and related harms.
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Affiliation(s)
- Emmanuel Fortier
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Sylvestre
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Andreea Adelina Artenie
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Nanor Minoyan
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
| | - Didier Jutras-Aswad
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Élise Roy
- Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada; Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Julie Bruneau
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
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Thulien NS, Gastaldo D, Hwang SW, McCay E. The elusive goal of social integration: A critical examination of the socio-economic and psychosocial consequences experienced by homeless young people who obtain housing. Canadian Journal of Public Health 2019; 109:89-98. [PMID: 29981071 DOI: 10.17269/s41997-018-0029-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of this study was to provide an insider perspective on the experiences of nine formerly homeless young people as they transitioned into independent (market rent) housing and attempted to achieve meaningful social integration. METHODS The study was conducted in Toronto, Canada, and guided by the conceptual framework developed for the World Health Organization by the Commission on Social Determinants of Health. A critical ethnographic methodology was used. Over the course of 10 months, the lead author met every other week with nine formerly homeless young people who had moved into their own homes within 30 days prior to study recruitment. RESULTS Unaffordable housing, limited education, inadequate employment opportunities, poverty-level income, and limited social capital made it remarkably challenging for the young people to move forward. As the study progressed, the participants' ability to formulate long-range plans was impeded as they were forced to focus on day-to-day existence. Over time, living in a perpetual state of poverty led to feelings of "outsiderness," viewing life as a game of chance, and isolation. CONCLUSION Rather than a secure, linear path from the streets to the mainstream, study participants were forced to take a precarious path full of structural gaps that left them stuck, spinning, and exhausted by the day-to-day struggle to meet basic needs. Despite their remarkable agency, it was almost impossible for the participants to achieve meaningful social integration given the structural inequities inherent in society. These observations have implications for practice, policy, and research.
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Affiliation(s)
- Naomi S Thulien
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
| | - Denise Gastaldo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,The Centre for Critical Qualitative Health Research, University of Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elizabeth McCay
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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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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17
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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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18
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Adair CE, Streiner DL, Barnhart R, Kopp B, Veldhuizen S, Patterson M, Aubry T, Lavoie J, Sareen J, LeBlanc SR, Goering P. Outcome Trajectories among Homeless Individuals with Mental Disorders in a Multisite Randomised Controlled Trial of Housing First. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:30-39. [PMID: 27310238 PMCID: PMC5302104 DOI: 10.1177/0706743716645302] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Housing First (HF) has been shown to improve housing stability, on average, for formerly homeless adults with mental illness. However, little is known about patterns of change and characteristics that predict different outcome trajectories over time. This article reports on latent trajectories of housing stability among 2140 participants (84% followed 24 months) of a multisite randomised controlled trial of HF. METHODS Data were analyzed using generalised growth mixture modeling for the total cohort. Predictor variables were chosen based on the original program logic model and detailed reviews of other qualitative and quantitative findings. Treatment group assignment and level of need at baseline were included in the model. RESULTS In total, 73% of HF participants and 43% of treatment-as-usual (TAU) participants were in stable housing after 24 months of follow-up. Six trajectories of housing stability were identified for each of the HF and TAU groups. Variables that distinguished different trajectories included gender, age, prior month income, Aboriginal status, total time homeless, previous hospitalizations, overall health, psychiatric symptoms, and comorbidity, while others such as education, diagnosis, and substance use problems did not. CONCLUSION While the observed patterns and their predictors are of interest for further research and general service planning, no set of variables is yet known that can accurately predict the likelihood of particular individuals benefiting from HF programs at the outset.
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Affiliation(s)
- Carol E. Adair
- Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta
| | - David L. Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Ryan Barnhart
- Centre for Addiction and Mental Health, York University, Toronto, Ontario
| | - Brianna Kopp
- Mental Health Commission of Canada, Calgary, Alberta
| | - Scott Veldhuizen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Michelle Patterson
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia
| | - Tim Aubry
- School of Psychology and Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Ontario
| | - Jennifer Lavoie
- Department of Criminology, Wilfrid Laurier University, Brantford, Ontario
| | - Jitender Sareen
- Departments of Psychiatry, Psychology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Stefanie Renée LeBlanc
- Centre de recherche et de développement en éducation, Université de Moncton, Moncton, New Brunswick
| | - Paula Goering
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Centre for Addiction and Mental Health, York University, Toronto, Ontario
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Jennings L, Lee N, Shore D, Strohminger N, Allison B, Conserve DF, Cheskin LJ. U.S. Minority Homeless Youth's Access to and Use of Mobile Phones: Implications for mHealth Intervention Design. JOURNAL OF HEALTH COMMUNICATION 2016; 21:725-33. [PMID: 27232544 DOI: 10.1080/10810730.2015.1103331] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Few interventions for homeless youth have leveraged the potential of mHealth technologies, in part because of the limited data on phone behaviors, perceptions, and intervention preferences among youth experiencing homelessness. We conducted 9 focus groups (n = 52 homeless youth) and 41 individual structured interviews also with homeless youth in underserved communities in Baltimore and Washington, DC, to ascertain how youth perceived their mobile phone, acquired and maintained mobile services over time, and thought mHealth programs for this population should be designed. We also measured phone use, functionality, source, duration of ownership, and reasons for changing phones or numbers. Results showed that mobile coverage was high, as most youth self-purchased phones or received gift payments from others. Maintaining mobile connectivity was often challenging because of financial constraints and interpersonal conflict. Youth valued phones to access social support but used several tactics to avoid perceived negative consequences of phone ownership, such as harassment, theft, or relational disputes. Youth most preferred mHealth content relating to sexual, reproductive, and mental health provided that mobile communication was confidential, empowering, and integrated with other digital media. Integrating hidden phones, financial support, and safety management may improve homeless youth's access to and engagement with mHealth strategies over time.
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Affiliation(s)
- Larissa Jennings
- a Department of International Health, Social and Behavioral Interventions Program , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Nicole Lee
- a Department of International Health, Social and Behavioral Interventions Program , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Deborah Shore
- b Sasha Bruce Youthwork , Washington , District of Columbia , USA
| | - Nancy Strohminger
- c University of Maryland School of Social Work , Baltimore , Maryland , USA
- d AIRS City Steps , Baltimore , Maryland , USA
| | | | - Donaldson F Conserve
- e Department of Health Behavior , University of North Carolina Gillings School of Global Public Health , Chapel Hill , North Carolina , USA
| | - Lawrence J Cheskin
- a Department of International Health, Social and Behavioral Interventions Program , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
- f Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
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Predictors of Emergency Department Visits and Inpatient Admissions Among Homeless and Unstably Housed Adolescents and Young Adults. Med Care 2016; 53:1010-7. [PMID: 26492212 DOI: 10.1097/mlr.0000000000000436] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Individuals under age 25 years are estimated to comprise one third of the homeless population nationally. Understanding the reasons for utilization of hospitals by homeless youth is important for optimizing disposition planning. OBJECTIVES Objectives of the present study were to: (1) report prevalence of emergency department (ED) and inpatient admissions among homeless and unstably housed youth; (2) describe demographic characteristics of those youth who seek hospital care; (3) describe their patterns of injury, illness, psychiatric, and substance use conditions; and (4) identify demographic and diagnostic predictors of ED visit or hospital readmission. METHODS Retrospective cohort study of 15-25-year-olds (N=402) who were admitted to the ED or inpatient floors of 2 urban teaching hospitals in King County, WA between July 1, 2009 and June 30, 2012 and whose address was "homeless" or "none" or a homeless shelter or service agency (ie, homeless or unstably housed), during any recorded encounter between July 1, 2009 and June 30, 2012. RESULTS A total of 1151 ED visits and 227 inpatient admissions were documented. Fifty percent of patients had an ED visit or hospital readmission within 1 year, with 43.1% receiving care within 30 days of discharge. Cox regression showed that female individuals with an injury diagnosis (hazard ratio=1.74, 95% confidence interval=1.06, 2.85) and male individuals with an acute medical condition (hazard ratio=1.59, 95% confidence interval=1.09, 2.32) at index visit were more likely to have an ED visit or hospital readmission during the following year, as were patients who provided a private address at their index visit. CONCLUSIONS Homeless young people who seek hospital care demonstrate a high rate of ED visits and hospital readmissions, with unique predictors of utilization associated with sex and housing status. Additional research is necessary to determine how best to transition these young people from hospital-based to community-based care.
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Roy É, Robert M, Fournier L, Laverdière É, Berbiche D, Boivin JF. Predictors of residential stability among homeless young adults: a cohort study. BMC Public Health 2016; 16:131. [PMID: 26860995 PMCID: PMC4746879 DOI: 10.1186/s12889-016-2802-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/01/2016] [Indexed: 11/20/2022] Open
Abstract
Background Homelessness episodes have been shown to be associated with serious health outcomes among youth. This study was undertaken to estimate the probability of reaching residential stability over time and to identify predictors of residential stability among homeless young adults aged 18 to 25 years. Methods A prospective cohort study was carried out in Montréal, Canada, between April 5th 2006 and January 21th 2009. Interviews conducted every three months included questions on life conditions and social and mental health factors that are known to influence residential trajectories. Residential status was determined, starting on the first day after recruitment; each follow-up day was classified as a homeless day or a housed day. A period of 90 days was used to define residential stability; therefore the main study outcome was the occurrence of the first consecutive 90 housed days during the follow-up period. Kaplan-Meier and Cox proportional-hazards regression analyses were conducted. Results Of the 359 participants, 284 reached 90 days of residential stability over the study period, representing an annual probability of 80.5 %. In multivariate analysis, youth who had a high school degree, had a formal sector activity, and those who had sought psychological help were more likely to reach residential stability. Being a man, injecting substances, and having an informal sector activity were associated with a decreased probability to reach residential stability. Conclusion Exposure to factors related to opportunities that promote social integration increases the chance of reaching residential stability. On the other hand, factors related to high level of street entrenchment seem to interfere with stabilization. Maximum efforts should be made to prevent chronic homelessness among youth, targeting not only individual impairments but also hinging on services adapted to foster social connections among the youth.
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Affiliation(s)
- Élise Roy
- Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-Le Moyne, room 200, Longueuil, QC, J4K 0A8, Canada.
| | - Marie Robert
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, 283, boul. Alexandre-Taché, bureau 3712, C.P. 1250, Succursale Hull, Gatineau, QC, J8X 3X7, Canada
| | - Louise Fournier
- École de Santé Publique, Université Montréal, 7101 Avenue du Parc, 3ième étage, Montréal, QC, H3N 1X9, Canada
| | - Émélie Laverdière
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-Le Moyne, room 200, Longueuil, QC, J4K 0A8, Canada
| | - Djamal Berbiche
- Charles-LeMoyne Hospital Research Centre, 150, Place Charles-Le Moyne, room 200, C.P. 11, Longueuil, QC, J4K 0A8, Canada
| | - Jean-François Boivin
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755, Côte Ste-Catherine, Montréal, QC, H3T 1E2, Canada
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Roy É, Robert M, Fournier L, Vaillancourt É, Vandermeerschen J, Boivin JF. Residential trajectories of street youth-the Montréal Cohort Study. J Urban Health 2014; 91:1019-31. [PMID: 24515932 PMCID: PMC4199447 DOI: 10.1007/s11524-013-9860-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about the course of homelessness among youth between the ages of 18 and 25 despite the many characteristics distinguishing them from adolescents and from older street-involved populations. We examined the residential trajectories of homeless young adults in Montréal over a 21-month period and identified determinants of various trajectory profiles. The 365 study participants (79 % men, mean age 21.9 years) were followed for an average of 515 days (range 81-630 days). We assessed housing status with a questionnaire based on the residential follow-back calendar designed by the New Hampshire Dartmouth Research Center. Using latent growth analysis to examine achievement of residential stability over time, we observed three different trajectories: group 1 presented a low probability of housing throughout the entire study period; group 2 showed a high probability of early and stable housing; group 3 displayed a fluctuating pattern. Protective correlates of residential stability included high school education, birth in Canada, and presence of mental health problems. Drug abuse or dependence was associated with a decreased probability of housing.
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Affiliation(s)
- Élise Roy
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Longueuil, Québec, Canada,
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