High school incompletion and childhood maltreatment among street-involved young people in Vancouver, Canada

Homelessness Is Socially Created: Cluster Analysis of Social Determinants of Homelessness (SODH) in North West England in 2020

Poverty creates social conditions that increase the likelihood of homelessness. These include exposure to traumatic life experiences; social disadvantages such as poor educational experiences; being raised in a broken family, care homes or foster care; physical, emotional, and sexual abuse; and neglect at an early age. These conditions reduce people’s ability to negotiate through life challenges. This cross-sectional study documents the clustering and frequency of adverse social conditions among 152 homeless people from four cities in North West England between January and August 2020. Two-step cluster analysis showed that having parents with a criminal record, care history, and child neglect/abuse history was predictive of homelessness. The cluster of indicator variables among homeless people included sexual abuse (χ2 (N = 152) = 220.684, p < 0.001, Cramer’s V = 0.7), inappropriate sexual behaviour (χ2 (N = 152) = 207.737, p < 0.001, Cramer’s V = 0.7), emotional neglect (χ2 (N = 152) = 181.671, p < 0.001, Cramer’s V = 0.7), physical abuse by step-parent (χ2 (N = 152) = 195.882, p < 0.001, Cramer’s V = 0.8), and physical neglect (χ2 (N = 152) = 205.632, p < 0.001, Cramer’s V = 0.8). Poverty and homelessness are intertwined because of the high prevalence of poverty among the homeless. Poverty sets up a chain of interactions between social conditions that increase the likelihood of unfavourable outcomes: homelessness is at the end of the interaction chain. Interventions supporting families to rise out of poverty may also reduce entry into homelessness.

Interpersonal relationships and drug use over time among homeless people: a qualitative study

Background

Homelessness is one of the most severe forms of social exclusion and is an important public health issue. It is characterized by processes of weakening of interpersonal bonds. The objective of this study was, therefore, to elucidate how interpersonal relationships change over the life cycle of homeless drug and alcohol users.

Method

We used a qualitative methodology. The participants were adults who had a history of homelessness and use of alcohol and other drugs. The interviews were semi structured and used a timeline instrument. All interview were audio recorded, transcribed, and submitted to thematic analysis.

Results

Twenty individuals participated in the study. Reports on social exclusion over time stood out in respect of four main themes and their respective subthemes: Theme 1 – Childhood: instability upbringing, abuse, violence, and an absent or not very present father figure; Theme 2 – Adolescence: school dropout and failure; acceptance of gender and sexual orientation; birth of first child, living with a partner or getting married: Theme 3 – Adulthood: estrangement or conflicting relationship with family; health problems; drug trafficking and prostitution; Theme 4 – Cross-cutting factors: death of relatives and substance use.

Conclusion

The results suggest that interpersonal relationships are permeated by successive breakups, conflicts and other events that start in childhood and can have a cumulative effect in later stages of life, and cross the subsequent phases. Substance abuse and dependence are mentioned as cross-cutting factors that intensify social exclusion in all stages of life.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12889-020-09880-2.

Long-term benefits of providing transitional services to youth aging-out of the child welfare system: Evidence from a cohort of young people who use drugs in Vancouver, Canada

BACKGROUND

Youth aging-out of the child welfare system (CWS) experience numerous vulnerabilities including, elevated rates of substance use and substance use disorders. Calls to improve services to transition youth to independence are common; however, evidence of the long-term impacts associated with transitional service utilization is scarce. Further, existing services frequently lack appropriate supports for substance using youth and it is unknown if youth are able to access such services. In the present study, we assess the relationship between transitional service utilization and health and social outcomes among a cohort of people who use drugs (PWUD) that aged-out of the CWS.

METHODS

Data were obtained from two harmonized cohorts of PWUD in Vancouver, Canada. Those who reported aging-out were asked about service utilization, availability, barriers, and interest across seven categories of transitional services. Multivariable logistic regression analyses were conducted to assess the relationship between having previously utilized transitional services and current health and social outcomes.

RESULTS

Between December 2014 and November 2017, 217 PWUD reported having previously aged-out of the CWS. Across service categories, reported service utilization prevalence ranged from 16.6-61.8% while unmet demand ranged from 64.8-78.4%. In multivariable analyses, compared to individuals who utilized ≤1 service while aging-out, having utilized 4-7 services was significantly associated with reduced odds of current homelessness (adjusted odds ratio [AOR]=0.29) and engaging in daily drug use (AOR=0.35) (both p<0.05).

CONCLUSION

Findings suggest that this understudied high-risk population of PWUD and aged-out of the CWS experience long-term benefits associated with transitional service utilization and are interested and willing to engage in these services. However, given high unmet demand, findings also highlight considerable gaps in service delivery and support calls for extending the age of emancipation for all youth in the CWS and in particular, for additional harm reduction and substance use supports embedded into service models.

Being at the Bottom Rung of the Ladder in an Unequal Society: A Qualitative Analysis of Stories of People without a Home

Background: Homelessness is rising in the United Kingdom, despite investment in measures to eradicate it made by the government and charity organisations. Aim: The aim is to examine the stories of homeless people in order to document their perceptions of their social status, the reasons that led to their homelessness, and propose a conceptual explanation. Method: We conducted 26 semi-structured interviews in three centres for homeless people in Cheshire, North West of England. Results: Three categories-education, employment, and health-emerged from the data and provided a theoretical explanation for the reasons that led to their homelessness. These are vital not only for the successful negotiation of one's way out of homelessness, but also for achieving other social goods, including social connections, social mobility, and engaging in positive social relationships. Conclusion: Participants catalogued the adverse childhood experiences, which they believe limited their capacity to meaningfully engage with the social institution for social goods, such as education, social services, and institutions of employment. Since not all people who have misfortunes of poor education, poor health, and loss of job end up being homeless, we contend that a combination of these with multiple adverse childhood experiences may have weakened their resilience to traumatic life changes, such as loss of job and poor health.

Intergenerational Trauma: The Relationship Between Residential Schools and the Child Welfare System Among Young People Who Use Drugs in Vancouver, Canada

PURPOSE

This study investigated the relationship between familial residential school system (RSS) exposure and personal child welfare system (CWS) involvement among young people who use drugs (PWUD).

METHODS

Data were obtained from two linked cohorts of PWUD in Vancouver, Canada, and restricted to Indigenous participants. Multivariable logistic regression analysis was used to investigate the relationship between three categories of familial RSS exposure (none, grandparent, and parent) and CWS involvement. A secondary analysis assessed the likelihood of CWS involvement between non-Indigenous and Indigenous PWUD with no familial RSS exposure.

RESULTS

Between December 2011 and May 2016, 675 PWUD (aged <35 years) were included in this study, 40% identified as Indigenous. In multivariable analyses, compared with Indigenous participants with no RSS exposure (reference), those with a grandparent in the RSS had a higher likelihood of having been in CWS (adjusted odds ratio [AOR] = 1.34, 95% confidence interval [CI]: .67-2.71), as did those with a parent exposed to RSS (AOR = 2.03, 95% CI: 1.03-3.99). In secondary analysis, the odds of CWS involvement was not significantly different between non-Indigenous and Indigenous PWUD with no familial RSS exposure (AOR = .63, 95% CI: .38-1.06).

CONCLUSIONS

We observed a dose-response-type trend between familial RSS exposure and personal CWS involvement and a nonsignificant difference in the likelihood of CWS involvement between Indigenous and non-Indigenous PWUD when controlling for RSS exposure. These data demonstrate the intergenerational impact of the RSS on the overrepresentation of Indigenous youth in the CWS. Findings have critical implications for public policy and practice including reconciliation efforts with Indigenous Peoples.

"Getting out of downtown": a longitudinal study of how street-entrenched youth attempt to exit an inner city drug scene

BACKGROUND

Urban drug "scenes" have been identified as important risk environments that shape the health of street-entrenched youth. New knowledge is needed to inform policy and programing interventions to help reduce youths' drug scene involvement and related health risks. The aim of this study was to identify how young people envisioned exiting a local, inner-city drug scene in Vancouver, Canada, as well as the individual, social and structural factors that shaped their experiences.

METHODS

Between 2008 and 2016, we draw on 150 semi-structured interviews with 75 street-entrenched youth. We also draw on data generated through ethnographic fieldwork conducted with a subgroup of 25 of these youth between.

RESULTS

Youth described that, in order to successfully exit Vancouver's inner city drug scene, they would need to: (a) secure legitimate employment and/or obtain education or occupational training; (b) distance themselves - both physically and socially - from the urban drug scene; and (c) reduce their drug consumption. As youth attempted to leave the scene, most experienced substantial social and structural barriers (e.g., cycling in and out of jail, the need to access services that are centralized within a place that they are trying to avoid), in addition to managing complex individual health issues (e.g., substance dependence). Factors that increased youth's capacity to successfully exit the drug scene included access to various forms of social and cultural capital operating outside of the scene, including supportive networks of friends and/or family, as well as engagement with addiction treatment services (e.g., low-threshold access to methadone) to support cessation or reduction of harmful forms of drug consumption.

CONCLUSIONS

Policies and programming interventions that can facilitate young people's efforts to reduce engagement with Vancouver's inner-city drug scene are critically needed, including meaningful educational and/or occupational training opportunities, 'low threshold' addiction treatment services, as well as access to supportive housing outside of the scene.

Psychometric properties of the Trauma and Distress Scale, TADS, in an adult community sample in Finland

BACKGROUND

There is increasing evidence that a history of childhood abuse and neglect is not uncommon among individuals who experience mental disorder and that childhood trauma experiences are associated with adult psychopathology. Although several interview and self-report instruments for retrospective trauma assessment have been developed, many focus on sexual abuse (SexAb) rather than on multiple types of trauma or adversity.

METHODS

Within the European Prediction of Psychosis Study, the Trauma and Distress Scale (TADS) was developed as a new self-report assessment of multiple types of childhood trauma and distressing experiences. The TADS includes 43 items and, following previous measures including the Childhood Trauma Questionnaire, focuses on five core domains: emotional neglect (EmoNeg), emotional abuse (EmoAb), physical neglect (PhyNeg), physical abuse (PhyAb), and SexAb.This study explores the psychometric properties of the TADS (internal consistency and concurrent validity) in 692 participants drawn from the general population who completed a mailed questionnaire, including the TADS, a depression self-report and questions on help-seeking for mental health problems. Inter-method reliability was examined in a random sample of 100 responders who were reassessed in telephone interviews.

RESULTS

After minor revisions of PhyNeg and PhyAb, internal consistencies were good for TADS totals and the domain raw score sums. Intra-class coefficients for TADS total score and the five revised core domains were all good to excellent when compared to the interviewed TADS as a gold standard. In the concurrent validity analyses, the total TADS and its all core domains were significantly associated with depression and help-seeking for mental problems as proxy measures for traumatisation. In addition, robust cutoffs for the total TADS and its domains were calculated.

CONCLUSIONS

Our results suggest the TADS as a valid, reliable, and clinically useful instrument for assessing retrospectively reported childhood traumatisation.