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Zhang J, Wu Q, Feng X, Ford J, Famelia R, Slesnick N. Co-occurring trajectory of housing stability and parenting stress with child behavior problems: A randomized trial of a housing intervention for young mothers experiencing homelessness. FAMILY PROCESS 2023. [PMID: 38110798 DOI: 10.1111/famp.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/28/2023] [Accepted: 11/09/2023] [Indexed: 12/20/2023]
Abstract
This study examined the effects of an integrative housing intervention (Ecologically Based Treatment, EBT - independent housing and supportive services) on the co-occurring pattern of housing stability and parenting stress among a sample of substance-using mothers who experience homelessness and have young children in their care. The association between the co-occurring patterns of housing stability and parenting stress and child internalizing and externalizing behaviors was also examined. Mothers were randomized to one of the three conditions: EBT (n = 80), Housing-only (HOU; n = 80), or Services as Usual (SAU; n = 80). Follow-up assessments were completed at 3-, 6-, 9-, and 12-months post-baseline. The dual-trajectory latent class growth analyses identified five subgroups of co-occurring patterns: low-greatly improved housing paired with moderate-improved parenting stress, low-greatly improved housing paired with high-improved parenting stress, low-moderately improved housing paired with moderate-static parenting stress, low-worse housing paired with moderate-improved parenting stress, and low-worse housing paired with high-static parenting stress. Findings showed that EBT was more effective in improving housing stability and reducing parenting stress compared to HOU and SAU conditions, and further, HOU was more effective than SAU. Additionally, children whose mothers reported increased housing stability together with improved parenting stress had lower levels of internalizing and externalizing behaviors. The findings provide support to the efficacy of EBT in increasing housing stability and reducing parenting stress. The observed improvements subsequently benefited children's behavioral outcomes.
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Affiliation(s)
- Jing Zhang
- Department of Human Development and Family Science, Kent State University, Kent, Ohio, USA
| | - Qiong Wu
- Department of Human Development and Family Science, Florida State University, Tallahassee, Florida, USA
| | - Xin Feng
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio, USA
| | - Jodi Ford
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Ruri Famelia
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio, USA
| | - Natasha Slesnick
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio, USA
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Slesnick N, Zhang J, Feng X, Mallory A, Martin J, Famelia R, Brakenhoff B, Yilmazer T, Wu Q, Ford J, Holowacz E, Jaderlund S, Hatsu I, Luthy E, Chavez L, Walsh L, Kelleher K. Housing and supportive services for substance use and self-efficacy among young mothers experiencing homelessness: A randomized controlled trial. J Subst Abuse Treat 2023; 144:108917. [PMID: 36368259 DOI: 10.1016/j.jsat.2022.108917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/15/2022] [Accepted: 10/23/2022] [Indexed: 11/07/2022]
Abstract
AIMS Homeless mothers with young children in their care contend with high rates of substance use and low self-efficacy. However, a limited number of studies have examined these outcomes associated with housing and supportive services. DESIGN Participants were randomly assigned to: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline. SETTINGS The study recruited a community-based sample from homeless service agencies and advertisements in a large Midwestern city. PARTICIPANTS The study recruited two hundred forty (N = 240) women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care. MEASUREMENTS We measured frequency of alcohol and drug use using the Form 90 semi-structured interview, and self-efficacy using Pearlin and Schooler's (1978) 7-item Mastery Scale. FINDINGS Overall, mothers showed significant improvement in substance use and self-efficacy over time in each condition. However, as expected, patterns of change differentiated intervention groups with more mothers showing better substance use and self-efficacy outcomes in housing + supportive services than in SAU. Unexpectedly, more mothers in SAU showed better outcomes than those in housing-only. CONCLUSIONS Substance use decreased and self-efficacy increased over time, but patterns of change characterized the intervention groups. In particular, findings suggest that when providing housing to this population, supportive services should also be offered.
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Affiliation(s)
- Natasha Slesnick
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, United States of America.
| | - Jing Zhang
- Department of Human Development and Family Studies, Kent State University, Kent, OH, United States of America
| | - Xin Feng
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, United States of America
| | - Allen Mallory
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, United States of America
| | - Jared Martin
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, United States of America
| | - Ruri Famelia
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, United States of America
| | - Brittany Brakenhoff
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, United States of America
| | - Tansel Yilmazer
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, United States of America
| | - Qiong Wu
- Department of Family and Child Sciences, Florida State University, Tallahassee, FL, United States of America
| | - Jodi Ford
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, United States of America
| | - Eugene Holowacz
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, United States of America
| | - Soren Jaderlund
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, United States of America
| | - Irene Hatsu
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, United States of America
| | - Ellison Luthy
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, United States of America
| | - Laura Chavez
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America
| | - Laura Walsh
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, United States of America
| | - Kelly Kelleher
- Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America
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Rew L, Yeargain O, Peretz C, Croce E. "I'm losing everything all over again": Responses from youth experiencing homelessness during the COVID-19 pandemic. Arch Psychiatr Nurs 2021; 35:653-657. [PMID: 34861960 PMCID: PMC8551686 DOI: 10.1016/j.apnu.2021.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Already at high-risk for adverse consequences associated with daily living, youth experiencing homelessness face additional barriers to health and well-being during the COVID-19 pandemic. The purpose of this study was to identify the self-reported experiences and healthcare needs of youth experiencing homelessness as services in the community began to shut down at the beginning of the pandemic. METHOD From May through November 2020, qualitative data were obtained by telephone or Facebook messenger from 20 youth (M = 22.4, SD = 2.64 years) who had been enrolled in a longitudinal intervention study. RESULTS Content analysis of qualitative data yielded 5 categories and 1 overall theme. Categories were resource availability, financial instability, mental health, relationship conflict, and maladaptive coping. The overall theme was multiple losses. Youths lost jobs, means of financial support for self and family, access to social and healthcare services, meaningful and important relationships, and skills and controls over high-risk behaviors such as substance abuse. CONCLUSIONS Having similar experiences such as social isolation as those of high school students during the pandemic, the youths in this sample experienced multiple and simultaneous losses, needing time to grieve, and leaving them once more at high-risk for adverse outcomes.
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Affiliation(s)
- Lynn Rew
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America.
| | - Olivia Yeargain
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America
| | - Clara Peretz
- The University of Texas at Austin Hicks School of Social Work, Austin, TX, United States of America
| | - Emily Croce
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America
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Bounds DT, Edinburgh LD, Fogg LF, Saeywc EM. A nurse practitioner-led intervention for runaway adolescents who have been sexually assaulted or sexually exploited: Effects on trauma symptoms, suicidality, and self-injury. CHILD ABUSE & NEGLECT 2019; 90:99-107. [PMID: 30772751 DOI: 10.1016/j.chiabu.2019.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Adolescent victims of sexual assault and exploitation suffer significant mental health distress including PTSD, self-harm, suicidal ideation, and attempts. OBJECTIVE This longitudinal observational study investigated the Runaway Intervention Program's influence on trauma responses at 3, 6, and 12 months for adolescents who have run away at least once and have been sexually assaulted or exploited. PARTICIPANTS Runaways (n = 362) received nurse practitioner (NP) home and community visits, intensive case management, and optional empowerment groups. SETTING An urban Midwestern city's hospital-based Children's Advocacy Center. METHODS Trauma responses were measured by the UCLA PTSD-RI index, past 30 days emotional distress scale, and self-harm, suicidal ideation, and suicide attempt questions. Repeated Measures ANOVA assessed trauma response changes over time. Growth curve analyses using intervention doses determined which aspects of the intervention predicted change. RESULTS From program entry to 3 and 6 months, mean values decreased significantly for emotional distress (-0.67, -.91) self-harm (-.30, -.55), suicidal ideation (-.45, -.57), suicide attempts (-.58, -.61), and trauma symptoms (-11.8, -16.2, all p < .001) all maintained at 12 months. In growth curve models, NP visits independently predicted declines in emotional distress (-.038), self-injury (-.020), suicidal ideation (-.025) and attempts (-.032), while empowerment groups predicted trauma symptoms (-.525) and all others except suicide attempts. CONCLUSIONS The program, especially NP community visits and empowerment group elements, decreased trauma responses in runaway youth with a history of sexual assault. Given high rates of PTSD and emotional distress among runaways, the Runaway Intervention Program offers promise for improving mental health outcomes.
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Affiliation(s)
- Dawn T Bounds
- Rush University Medical Center, College of Nursing, 600 S. Paulina St., AAC Suite 1080, Chicago, IL 60612, United States
| | - Laurel D Edinburgh
- Midwest Children's Resource Center, Children's Hospital of Minnesota, 347 N. Smith Ave., St. Paul, MN 55102, United States.
| | - Louis F Fogg
- Rush University Medical Center, College of Nursing, 600 S. Paulina St., AAC Suite 1080, Chicago, IL 60612, United States
| | - Elizabeth M Saeywc
- School of Nursing, University of British Columbia, T201-2211 Westbrook Mall, Vancouver, BC V6T 2B5, 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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Tyler KA, Schmitz RM. Using Cell Phones for Data Collection: Benefits, Outcomes, and Intervention Possibilities with Homeless Youth. CHILDREN AND YOUTH SERVICES REVIEW 2017; 76:59-64. [PMID: 28970644 PMCID: PMC5621742 DOI: 10.1016/j.childyouth.2017.02.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
While many homeless youth use cell phones to stay socially connected, and maintaining positive social ties can contribute to pathways out of homelessness, little is known about how using cell phones for data collection can improve these young people's lives. We conducted baseline and follow-up interviews with 150 homeless youth as well as provided them with a cell phone for 30 days to gather daily data using short message service (SMS) surveying. This paper examines youths' opinions about study participation and how they used the cell phone. Results revealed that youth liked participating in the study because the SMS texting portion, for example, made them feel that someone still cared about them, prompted them to self-reflect on their life, and allowed them to make a difference (e.g. educating the public about homelessness). Despite numerous benefits of study participation, improvements that youth discussed for future studies included changing the format of our text questions to allow for explanations and the use of higher quality phones. In terms of study phone usage, youth reported using the phone to schedule appointments, contact employers, and to keep in touch with family and friends. Finally, we highlight ways in which cell phones via SMS could be used with homeless youth to provide informational resources along with educational and employment opportunities, all of which are important intervention strategies in improving life situations for this population.
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Affiliation(s)
- Kimberly A Tyler
- University of Nebraska-Lincoln, Department of Sociology, Lincoln, NE 68588-0324, USA
| | - Rachel M Schmitz
- University of Texas Rio Grande Valley, Department of Sociology and Anthropology, Edinburg, TX 78539, USA
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Dombrowski K, Sittner K, Crawford D, Welch-Lazoritz M, Habecker P, Khan B. Network Approaches to Substance Use and HIV/Hepatitis C Risk among Homeless Youth and Adult Women in the United States: A Review. Health (London) 2016; 8:1143-1165. [PMID: 28042394 PMCID: PMC5193114 DOI: 10.4236/health.2016.812119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During the United States economic recession of 2008-2011, the number of homeless and unstably housed people in the United States increased considerably. Homeless adult women and unaccompanied homeless youth make up the most marginal segments of this population. Because homeless individuals are a hard to reach population, research into these marginal groups has traditionally been a challenge for researchers interested in substance abuse and mental health. Network analysis techniques and research strategies offer means for dealing with traditional challenges such as missing sampling frames, variation in definitions of homelessness and study inclusion criteria, and enumeration/population estimation procedures. This review focuses on the need for, and recent steps toward, solutions to these problems that involve network science strategies for data collection and analysis. Research from a range of fields is reviewed and organized according to a new stress process framework aimed at understanding how homeless status interacts with issues related to substance abuse and mental health. Three types of network innovation are discussed: network scale-up methods, a network ecology approach to social resources, and the integration of network variables into the proposed stress process model of homeless substance abuse and mental health. By employing network methods and integrating these methods into existing models, research on homeless and unstably housed women and unaccompanied young people can address existing research challenges and promote more effective intervention and care programs.
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Affiliation(s)
- Kirk Dombrowski
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, USA
| | - Kelley Sittner
- Department of Sociology, Oklahoma State University, Stillwater, USA
| | | | | | - Patrick Habecker
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, USA
| | - Bilal Khan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, USA
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Ha Y, Narendorf SC, Santa Maria D, Bezette-Flores N. Barriers and facilitators to shelter utilization among homeless young adults. EVALUATION AND PROGRAM PLANNING 2015; 53:25-33. [PMID: 26246453 DOI: 10.1016/j.evalprogplan.2015.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 06/29/2015] [Accepted: 07/03/2015] [Indexed: 06/04/2023]
Abstract
Rates of shelter use among homeless youth are low compared to use of other supportive services, yet research on barriers to shelter use has been conducted in limited regions, specifically in West Coast or Midwest cities. Additionally, while studies have generally focused on barriers to shelter use, studies on what might facilitate shelter use are lacking. This study explores barriers and facilitators to shelter use among homeless young adults from a large city in the Southwest region. Focus groups were conducted with a diverse sample of 49 homeless young adults ages 18-24. Drawing on models of health service use, findings were categorized into two domains--attitudinal and access. Themes related to attitudinal barriers include stigma/shame and self-reliance/pride. Attitudinal facilitators include the desire to extricate themselves from street life and turn their lives in a new direction. Access-related themes include barriers such as a lack of shelters and services available to meet the needs of youth, adverse shelter conditions, staff attitudes that are not acceptable to youth, restrictive shelter rules, restrictive definitions of homelessness, and a desire to differentiate themselves from older homeless individuals. Certain characteristics or circumstances (e.g., being pregnant), having supportive others, and shelters' ability to connect them to other services emerged as access facilitators to shelter use. Implications for policymakers, service providers, and future research are discussed.
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Affiliation(s)
- Yoonsook Ha
- Boston University School of Social Work, United States.
| | - Sarah C Narendorf
- University of Houston Graduate College of Social Work, United States
| | - Diane Santa Maria
- University of Texas Health Science Center, Houston School of Nursing, United States
| | - Noel Bezette-Flores
- University of Houston-Downtown Center for Public Service and Family Strengths, United States
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Leon L, Jauffret-Roustide M, Le Strat Y. Design-based inference in time-location sampling. Biostatistics 2015; 16:565-79. [PMID: 25597489 DOI: 10.1093/biostatistics/kxu061] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 12/17/2014] [Indexed: 11/13/2022] Open
Abstract
Time-location sampling (TLS), also called time-space sampling or venue-based sampling is a sampling technique widely used in populations at high risk of infectious diseases. The principle is to reach individuals in places and at times where they gather. For example, men who have sex with men meet in gay venues at certain times of the day, and homeless people or drug users come together to take advantage of services provided to them (accommodation, care, meals). The statistical analysis of data coming from TLS surveys has been comprehensively discussed in the literature. Two issues of particular importance are the inclusion or not of sampling weights and how to deal with the frequency of venue attendance (FVA) of individuals during the course of the survey. The objective of this article is to present TLS in the context of sampling theory, to calculate sampling weights and to propose design-based inference taking into account the FVA. The properties of an estimator ignoring the FVA and of the design-based estimator are assessed and contrasted both through a simulation study and using real data from a recent cross-sectional survey conducted in France among drug users. We show that the estimators of prevalence or a total can be strongly biased if the FVA is ignored, while the design-based estimator taking FVA into account is unbiased even when declarative errors occur in the FVA.
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Affiliation(s)
- Lucie Leon
- French Institute for Public Health Surveillance, Saint-Maurice 94415, France
| | - Marie Jauffret-Roustide
- French Institute for Public Health Surveillance, Saint-Maurice 94415, France and Cermes3, Inserm U988/UMR CNRS 8211/Ehess/Paris Descartes University, Paris
| | - Yann Le Strat
- French Institute for Public Health Surveillance, Saint-Maurice 94415, France
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Barman-Adhikari A, Rice E. Social networks as the context for understanding employment services utilization among homeless youth. EVALUATION AND PROGRAM PLANNING 2014; 45:90-101. [PMID: 24780279 PMCID: PMC4069330 DOI: 10.1016/j.evalprogplan.2014.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 03/05/2014] [Accepted: 03/09/2014] [Indexed: 05/27/2023]
Abstract
Little is known about the factors associated with use of employment services among homeless youth. Social network characteristics have been known to be influential in motivating people's decision to seek services. Traditional theoretical frameworks applied to studies of service use emphasize individual factors over social contexts and interactions. Using key social network, social capital, and social influence theories, this paper developed an integrated theoretical framework that capture the social network processes that act as barriers or facilitators of use of employment services by homeless youth, and understand empirically, the salience of each of these constructs in influencing the use of employment services among homeless youth. We used the "Event based-approach" strategy to recruit a sample of 136 homeless youth at one drop-in agency serving homeless youth in Los Angeles, California in 2008. The participants were queried regarding their individual and network characteristics. Data were entered into NetDraw 2.090 and the spring embedder routine was used to generate the network visualizations. Logistic regression was used to assess the influence of the network characteristics on use of employment services. The study findings suggest that social capital is more significant in understanding why homeless youth use employment services, relative to network structure and network influence. In particular, bonding and bridging social capital were found to have differential effects on use of employment services among this population. The results from this study provide specific directions for interventions aimed to increase use of employment services among homeless youth.
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Affiliation(s)
- Anamika Barman-Adhikari
- School of Social Work, California State University, Fresno, CA, United States; School of Social Work, University of Southern California, Los Angeles, CA, United States.
| | - Eric Rice
- School of Social Work, University of Southern California, Los Angeles, CA, United States
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