Exploring family environment characteristics and multiple abuse experiences among homeless youth

Child maltreatment and youth exposure to risky environments: Latent class analysis of youth activity spaces

BACKGROUND

Child maltreatment may alter the way that adolescents engage in and interact within the places they visit in their daily routines, namely youth activity spaces. Thus, it is important to understand how maltreatment experiences are linked to adolescents' exposure to environmental and contextual risks within their activity spaces.

OBJECTIVE

The aim of the study was to explore the associations between child maltreatment and patterns of risk exposures within youth activity spaces among adolescents.

PARTICIPANTS AND SETTING

Study participants were 1364 adolescents between the ages of 11 and 17, living in a Midwest state in the United States.

METHODS

We linked data from the Adolescent Health and Development in Context (AHDC) study and the Statewide Automated Child Welfare Information System (SACWIS). A three-step latent class analysis (LCA) was employed.

RESULTS

Three contextual risk exposure classes were identified: 1) The aggression/violence class (7.7 %); 2) The smoking and drinking class (12.3 %); and 3) The non-risk class (80.0 %). Adolescents with more maltreatment reports were more likely to be in the aggression/violence class compared to the non-risk class.

CONCLUSIONS

Capitalizing on the novel linkage between administrative child welfare records and ecological momentary assessment (EMA)-based youth spatial/environmental exposure data, we found a positive link between the number of maltreatment reports made to child protective services and membership in the aggression/violence class. Intervention efforts should be directed toward youths with a history of child maltreatment, ensuring that they have access to safe, structured, and non-violent environments during their daily routines.

Backgrounds and perspectives of San Antonio street sleepers

Background

The question of what brings someone to homelessness and keeps them there has many varied and complex answers. The authors believe the answers lie within the persons experiencing homelessness (PEH).

Methods

This is an interpretive approach study based on convenience sampling of the San Antonio, TX, unsheltered population, utilizing semi-structured interviews from January 2022 through November 2022.

Results

The six most common themes that emerged from the subjects' backgrounds were 1) jail or prison time or other personally significant legal issues; 2) personal substance abuse or addiction struggles; 3) physical and mental health challenges as an adult; 4) disdain of shelters and preference for rough sleeping; 5) a problematic childhood; 6) did not enjoy school as a child or young adult.

Conclusion

To gain more insight into a situation as complex as the state of homelessness, researchers should meet with those on the frontline of this epidemic and hear first-hand their personal histories, challenges, successes, and suggestions. Though not a novel approach, the researchers found limited previous literature in regard to approach, scope and in relation of causation related to homelessness, especially about the U.S. unsheltered population. The ultimate goal is for such research to help guide outreach services and legislation related to PEH.

An examination of housing interventions among youth experiencing homelessness: an investigation into racial/ethnic and sexual minority status

OBJECTIVES

The purpose of this study is to explore main and interaction effects of minority and multiple minority statuses on exits from homelessness and the stability of homelessness exits overtime.

METHODS

This study utilized the Homeless Management Information System administrative data of 10 922 youth experiencing homelessness collected from a convenience sample of 16 geographically diverse communities across the USA between 2015-17. Using multinomial logistic regression analyses and logistic regression, main effects and interaction effects of racial/ethnic minority identity and sexual/gender minority identity were examined on various homelessness exits (n = 9957) and housing sustainability (n = 5836).

RESULTS

Black youth, relative to White youth, were disproportionately exiting homelessness through incarceration (P < 0.001). Black and Latinx youth were less likely to successfully self-resolve their homelessness (both P < 0.05). Black heterosexual and Black and Latinx non-heterosexual youth were most frequently lost to the homeless system (all P < 0.01). Black youth, relative to White youth, were approximately half as likely to remain stably housed after returning to family (P < 0.01).

CONCLUSIONS

With respect to housing exits and exit stability, Black and Latinx heterosexual youth are consistently at a disadvantage. Homelessness/housing systems and programs need to conduct a deeper investigation into how they implement and develop equitable outreach and engagement practices.

Understanding female adolescent 'runaways' and the implications of their decisions in Tigray, northern Ethiopia

OBJECTIVE

This study aimed to understand the main factors influencing the decision of adolescent girls to run away from home in Tigray, northern Ethiopia, and to explore the social and cultural construction of female adolescent runaways in this region.

METHOD

In-depth qualitative interviews with seven runaway adolescent girls and six women married at an early age (11-16 years old) were conducted in Wukro and Mekelle in Tigray to investigate why the girls escaped from home and how communities responded to these decisions.

RESULTS

Findings suggest that the immediate trigger that led all the young participants to run away was to escape an arranged marriage, except in one 'romantic' elopement case. Individual and structural factors, such as child maltreatment and educational aspirations, and new family law respectively, also contributed to the decision to escape.

CONCLUSION

Adolescent runaways seem to be ignored or normalized within the community in Tigray and, in particular, by its public institutions. This may explain why there are limited services for runaway girls, such as shelters and other forms of support. This lack of social protection structures has left these girls unprotected and exposed to a range of risks, such as early and unwanted pregnancies, labor exploitation, dropping out of school, and transactional sex. To date, this phenomenon of adolescent runaways has remained an invisible issue in Tigray as runaway girls are counted under general migration figures. Further research is needed to explore how this phenomenon is categorized at policy level in order to address runaway girls' needs as defined by them.

"It Made Me so Vulnerable": Victim-blaming and Disbelief of Child Sexual Abuse as Triggers of Social Exclusion Leading Women to Homelessness

Although the association between child sexual abuse (CSA) and homelessness among women is well documented, few studies have investigated this topic from a feminist standpoint, examining the impact of sociocultural factors such as rape culture. Based on a qualitative life course approach, individual interviews were conducted with 21 women who experienced both CSA and homelessness. Participants were between 29 to 60 years old (M = 45 years of age). Analyses revealed that CSA disclosure experiences were characterized by victim-blaming and disbelief. Women's traumatic experiences were further aggravated by these types of reactions. Finally, CSA and negative social reactions to women's disclosures of CSA were perceived as the onset of social exclusion, which lead to their homelessness. This study shows how traumatic CSA experiences and negative social reactions to their disclosure can both contribute to social exclusion and isolation, and to homelessness through the internalization of rape myths. These findings support the importance of focusing on CSA prevention to reduce social exclusion and homelessness.

Considerations for working with youth with socially complex needs

TOPIC

The presence of adverse childhood experiences offers a glimpse into the social complexity in the lives of youth. Thus far, youth have been categorized as "at-risk" or "vulnerable,"-identifiers which highlight a deficits-based framework and continue to stigmatize youth. To combat this systemic marginalization, we propose using the term youth with socially complex needs. These youth, often minority ethnic/racial and/or sexual/gender minorities, experience repeated adversity and discrimination.

PURPOSE

The purpose of this paper is to conceptualize the unique considerations of working with youth with socially complex needs-who have an increased vulnerability for social marginalization.

SOURCES USED

Given the adversity experienced and challenges inherent in working with youth with socially complex needs, ethical principles, and relevant care delivery models were explored.

CONCLUSIONS

Delivering mental health care and/or conducting research in collaboration with youth with socially complex needs requires thoughtful consideration of ethical principles and models of care. In conclusion, we propose a strengths-based, individualized approach to working with youth with socially complex needs that requires a dynamic, fluid, multisystemic approach to care and research.

An Exploration of Facilitators and Challenges to Young Adult Engagement in a Community-Based Program for Mental Health Promotion

Adolescence and young adulthood can be particularly daunting for those with mental health concerns. In one Canadian city, a community-based drop-in psychosocial mental health center (Center) was designed specifically for youth who self-identified as struggling with mental health issues. The purpose of this study was to identify the features of the program that promoted or discouraged engagement. Narrative inquiry was used to guide the project. One-on-one interviews were conducted with 10 Center users. Four major categories were identified: (a) Reasons for Coming: Motivated to Work on Goals; (b) Facilitators of Engagement and Beyond; (c) Challenges to Engagement; and (d) Benefits of Engaging: Finding My Way. These categories were further delineated into themes. All participants had experienced trauma, and the Center assisted them in their coping. The researchers believe that to aid recovery, agencies working with this population need to use trauma-informed and healing-centered engagement.

The Links Between Sexual Abuse Severity, Running Away, and Parental Connectedness Among Youth at a Hospital-Based Child Advocacy Center

PURPOSE

Runaway adolescents often have strained relationships with their parents. Given parental support is an important protective resource for traumatized young people, understanding differences in support within parent-adolescent relationships could aid in designing more effective interventions. We hypothesized (1) runaway adolescents seen at a Child Advocacy Center (CAC) would have poorer parental relationships than adolescents without a history of running away and (2) severity of diagnosed sexual violence would be associated with lower parental connectedness.

METHODS

Data were from 2,042 adolescents aged 10-19 years and their parents evaluated for any reason at our hospital-based CAC from 2008 to 2017. Parent-adolescent relationship scales were completed by adolescents and at least one parent/guardian (usually mothers). Sexual abuse was stratified at four levels, higher levels indicating increasingly severe forms of abuse. T-tests and analyses of variance to tested relationships between supportive and controlling parental behaviors by runaway status, and, among runaways, by the severity of sexual abuse.

RESULTS

Runaway adolescents comprised 58.3% of adolescents seen at the CAC; runaways reported lower parental support and higher parental controlling than patients without a history of running away. Those with the most severe forms of sexual abuse (including sexual exploitation and gang rape) reported the least supportive and most controlling relationships with parents, as did their parents.

CONCLUSIONS

Findings support our clinical observations that polyvictimization of adolescents who have spent significant time as runaways may further strain parent-adolescent relationships. Future clinical research should focus on developing interventions to promote parental connectedness after a runaway episode.

On the fringes: How youth experiencing homelessness conceptualize social and economic inequality-A Photovoice study

This study used Photovoice methods with young adults experiencing homelessness to collaboratively identify issues that are of greatest importance in an open-ended, exploratory, and inductive manner. Participants selected two concepts to focus their inquiry: freedom and prosperity. Within these concepts, participants discussed nature as a source of inspiration, a desire to better themselves and to change their situations, and passion for contributing to social change by exposing economic inequality and raising awareness about homelessness. These findings demonstrate that young people are keenly aware of the structural and macro-level factors that have contributed to their risks of social exclusion and marginalization.

Predictors and correlates of unstable housing experiences among a child welfare-involved sample

The study examined whether youth demographics, family factors, and maltreatment type were related to unstable housing and whether unstable housing predicted delinquency and marijuana use. Participants included 216 child welfare-affiliated adolescents (mean age = 18.2 years). Youth with more lifetime residences were more likely to experience unstable housing although Latino youth (compared to White, Black, or multiethnic/biracial) were less likely to experience unstable housing. Unstable housing was associated with subsequent delinquency. Caregiver type (parent vs. relative/unrelated caregiver) was not related to unstable housing, thus homelessness prevention programs should include youth who remain with their parents and those with non-parent caregivers.

Beyond residential mobility: A broader conceptualization of instability and its impact on victimization risk among children

Predictability in a child's environment is a critical quality of safe, stable, nurturing relationships and environments, which promote wellbeing and protect against maltreatment. Research has focused on residential mobility's effect on this predictability. This study augments such research by analyzing the impact of an instability index-including the lifetime destabilization factors (LDFs) of natural disasters, homelessness, child home removal, multiple moves, parental incarceration, unemployment, deployment, and multiple marriages--on childhood victimizations. The cross-sectional, nationally representative sample of 12,935 cases (mean age = 8.6 years) was pooled from 2008, 2011, and 2014 National Surveys of Children's Exposure to Violence (NatSCEV). Logistic regression models controlling for demographics, socio-economic status, and family structure tested the association between excessive residential mobility, alone, and with LDFs, and past year childhood victimizations (sexual victimization, witnessing community or family violence, maltreatment, physical assault, property crime, and polyvictimization). Nearly 40% of the sample reported at least one LDF. Excessive residential mobility was significantly predictive of increased odds of all but two victimizations; almost all associations were no longer significant after other destabilizing factors were included. The LDF index without residential mobility was significantly predictive of increased odds of all victimizations (AOR's ranged from 1.36 to 1.69), and the adjusted odds ratio indicated a 69% increased odds of polyvictimization for each additional LDF a child experienced. The LDF index thus provides a useful alternative to using residential moves as the sole indicator of instability. These findings underscore the need for comprehensive supports and services to support stability for children and families.

A Retrospective Examination of Child Protection Involvement Among Young Adults Accessing Homelessness Services

Childhood maltreatment is associated with a variety of young adult adversities including homelessness. This study used linked administrative records to develop a population-level, epidemiological characterization of the child protection histories of young adults accessing homelessness services. The records of all 17- to 24-year-olds receiving homeless services between 2011 and 2014 in San Francisco County, California (n = 2241) were probabilistically linked to statewide child protective service (CPS) records. Findings document that 50.0% of young adults had been reported for maltreatment at least once during childhood, yet the prevalence of past CPS involvement varied across demographic and child welfare characteristics. Homeless female youth were significantly more likely to have a CPS history than male youth (58.1% vs. 41.5%). Nearly twice as many Black clients accessing homelessness services had a CPS history as did White clients (59.8% vs. 31.8%). Roughly half (47.3%) of those with a childhood history of reported maltreatment had been last reported for maltreatment in another California county. Targeting services that address past trauma and instability among homeless young adults may be justified given the prevalence of CPS history in this population.

Depressive Symptoms and their Association With Adverse Environmental Factors and Substance Use in Runaway and Homeless Youths

We used diathesis-stress and stress-sensitization models to determine whether family maltreatment, street-related traumatic events, stressful life events, and substance use were associated with depressive symptoms in runaway and homeless youths (RHY) in Los Angeles. Greater severity of depressive symptoms was significantly related to family maltreatment, being exposed to more traumatic stressors during homelessness, and current substance use compared to no substance use. Family maltreatment was also found to moderate the relationship between traumatic stressors and depressive symptoms. Importantly, cumulative exposure to the investigated risk factors at varying levels was associated with more severe depressive symptoms. Using a trauma-informed approach to screen for RHY at risk of depression may pave the way for secondary prevention of major depression in RHY.

Poverty, violence, and family disorganization: Three "Hydras" and their role in children's street movement in Bangladesh

The increasing number of children running away from home in Bangladesh is a major concern, and in need of critical attention. This yearlong study explores why children leave home with a sample of street children in Dhaka, Bangladesh. Purposive sampling from three locations in Dhaka yielded a sample of 75 homeless children aged 10-17. For each participant, a 60-90min in-depth qualitative interview was conducted multiple times. While the dominant explanations rely on poverty or abuse, the findings of this study reveal that the cause is actually three heads of a Hydra monster: poverty, abuse, and family disorganization and their interactions. It shows that the primary reasons for children breaking from their family are all interrelated. The findings from this study are likely to add knowledge regarding the issues and may lead to preventative interventions for street children and their families.

Changes in Family Relationships among Substance Abusing Runaway Adolescents: A Comparison between Family and Individual Therapies

Eligible adolescents (12-17 years old) were recruited from a short-term crisis shelter for runaway adolescents in a large Midwestern city. Adolescents (N = 179) were randomly assigned to Ecologically-Based Family Therapy (EBFT, n = 61), the Community Reinforcement Approach (CRA, n = 57), or brief Motivational Enhancement Therapy (MET, n = 61) with the primary focus on substance abuse. A significant increase in perceived family cohesion and a significant reduction in perceived family conflict were found among all treatment conditions from baseline to the 24-month follow-up. Adolescents who received EBFT demonstrated more improvement in family cohesion after treatment than those who received CRA or MET, and more reduction in family conflict during treatment than those who received MET.

Family or Caregiver Instability, Parental Attachment, and the Relationship to Juvenile Sex Offending

A violent or unstable home life-characterized by caregivers physically or sexually abusing children, physical violence in the home, homelessness, and other factors-and disrupted parental attachment are examined in this secondary data analysis for their possible relationship to juvenile sex offending. Parent or caregiver instability is measured by a demographic questionnaire administered to participants. Parental attachment is measured by the Inventory of Peer and Personal Attachment. The population included 502 adjudicated juvenile male sexual and nonsexual offenders in a Midwest state who responded to questionnaires in order to examine juvenile offending antecedents. The highest correlated parent or caregiver instability variables to juvenile sex offending status were multiple relocations or homelessness, children placed out of the home, slapping or punching in the home, and sexual abuse victimization. The quality of parental attachment had little impact on the respondents' offense status.

Adverse outcomes among homeless adolescents and young adults who report a history of traumatic brain injury

OBJECTIVES

We examined the prevalence of self-reported traumatic brain injury (TBI) among homeless young people and explored whether sociodemographic characteristics, mental health diagnoses, substance use, exposure to violence, or difficulties with activities of daily living (ADLs) were associated with TBI.

METHODS

We analyzed data from the Wilder Homelessness Study, in which participants were recruited in 2006 and 2009 from streets, shelters, and locations in Minnesota that provide services to homeless individuals. Participants completed 30-minute interviews to collect information about history of TBI, homelessness, health status, exposure to violence (e.g., childhood abuse, assault), and other aspects of functioning.

RESULTS

Of the 2732 participating adolescents and young adults, 43% reported a history of TBI. Participants with TBI became homeless at a younger age and were more likely to report mental health diagnoses, substance use, suicidality, victimization, and difficulties with ADLs. The majority of participants (51%) reported sustaining their first injury prior to becoming homeless or at the same age of their first homeless episode (10%).

CONCLUSIONS

TBI occurs frequently among homeless young people and is a marker of adverse outcomes such as mental health difficulties, suicidal behavior, substance use, and victimization.

Psychosocial support for youth living with HIV

This clinical report provides guidance for the pediatrician in addressing the psychosocial needs of adolescents and young adults living with HIV, which can improve linkage to care and adherence to life-saving antiretroviral (ARV) therapy. Recent national case surveillance data for youth (defined here as adolescents and young adults 13 to 24 years of age) revealed that the burden of HIV/AIDS fell most heavily and disproportionately on African American youth, particularly males having sex with males. To effectively increase linkage to care and sustain adherence to therapy, interventions should address the immediate drivers of ARV compliance and also address factors that provide broader social and structural support for HIV-infected adolescents and young adults. Interventions should address psychosocial development, including lack of future orientation, inadequate educational attainment and limited health literacy, failure to focus on the long-term consequences of near-term risk behaviors, and coping ability. Associated challenges are closely linked to the structural environment. Individual case management is essential to linkage to and retention in care, ARV adherence, and management of associated comorbidities. Integrating these skills into pediatric and adolescent HIV practice in a medical home setting is critical, given the alarming increase in new HIV infections in youth in the United States.

Are childhood abuse and neglect related to age of first homelessness episode among currently homeless adults?

This study investigates 500 homeless adults and the associations between childhood maltreatment types and the age of first reported homelessness episode. Those first experiencing homelessness in youth (age 24 years or younger; 46%) were compared with those first experiencing homelessness at a later age (older than age 24 years). In individual models, physical abuse, emotional abuse, and emotional neglect were associated with first experiencing homelessness during youth (p < .02 for all types of maltreatment). In the simultaneous model, only emotional abuse remained significantly associated (p = .002). In addition, increasing numbers of maltreatment were associated with becoming homeless during youth (p < .0001). These results highlight the unique associations between childhood maltreatment types and becoming homeless earlier in life and support the need for early interventions with at-risk families.

Exploring the factors associated with youth homelessness and arrests

PROBLEM

The high rate of arrests among homeless youths has stimulated a growing interest in uncovering the factors associated with police involvement in this population. This study explored external factors related to their arrests.

METHOD

This secondary analysis involved 186 homeless youths. The difference between youths who reported arrests and those who did not was examined based on the following variables: economic status, meaningful activity, involvement with other homeless peers, mental illness, and drug use.

FINDINGS

The results of this study showed a significant association between drug use and arrests, length of time homeless and arrests, and depression and arrests.

CONCLUSION

The various factors thought to be associated with arrests likely interact with one another, making it difficult to directly link a specific behavior to being arrested.

Predictors of substance abuse treatment participation among homeless adults

The current study focuses on the relationships among a trauma history, a substance use history, chronic homelessness, and the mediating role of recent emotional distress in predicting drug treatment participation among adult homeless people. We explored the predictors of participation in substance abuse treatment because enrolling and retaining clients in substance abuse treatment programs is always a challenge particularly among homeless people. Participants were 853 homeless adults from Los Angeles, California. Using structural equation models, findings indicated that trauma history, substance use history and chronicity of homelessness were associated, and were significant predictors of greater recent emotional distress. The most notable result was that recent emotional distress predicted less participation in current substance abuse treatment (both formal and self-help) whereas a substance use history alone predicted significantly more participation in treatment. Implications concerning treatment engagement and difficulties in obtaining appropriate dual-diagnosis services for homeless mentally distressed individuals are discussed.

Family Histories and Multiple Transitions Among Homeless Young Adults: Pathways to Homelessness

This study explored the early family histories of homeless young adults, the types and number of transitions they experienced, and their pathways to the street. Intensive qualitative interviews were audio taped and transcribed with 40 homeless young adults 19 to 21 years of age in the Midwest. Findings show that family backgrounds were generally characterized by substance use, child maltreatment, and witnessing violence, all of which provide social context for understanding why so many of these young people opted to leave home in search of an alternative living situation. The current findings also reveal that while some young adults ran away from home as adolescents, others were "pushed out" (i.e., told to leave), or removed by state agencies. Current study findings illustrate that young adults' trajectories are marked by multiple living arrangements such as home, foster care, detention facility, and drug rehabilitation. Overall, study results show that young adults' family histories place them on trajectories for early independence marked by multiple transitions and numerous living situations, culminating in a lack of a permanent residence to call home.

The mental and physical health of homeless youth: a literature review

Youth homelessness is a growing concern in the United States. Despite difficulties studying this population due to inconsistent definitions of what it means to be a youth and homeless, the current body of research indicates that abuse, family breakdown, and disruptive family relationships are common contributing factors to youth homelessness. Moreover, the experience of homelessness appears to have numerous adverse implications and to affect neurocognitive development and academics, as well as mental and physical health. Substance use, sexually transmitted infections, and psychiatric disorders are particularly prevalent in this population. Whereas some of these problems may be short-lived, the chronic stress and deprivation associated with homelessness may have long-term effects on development and functioning. Further, difficulties accessing adequate and developmentally-appropriate health care contribute to more serious health concerns. Suggestions for future research and interventions are discussed.

Identifying and responding to child abuse in the home

Given the sheer numbers of abused children, home health clinicians will likely encounter youngsters who are living in volatile and neglectful homes. This article details information that is designed to assist clinicians to identify and respond to child abuse and neglect.

Words that hurt: a qualitative study of s parental verbal abuse in the Philippines

This article investigated opinions on what constitute parental abuse with interviews of 30 high school students, 30 parents, and 28 counselors. Despite increased reported cases of emotional abuses and child maltreatments in the Philippines, few empirical studies have explored the exact nature of parental verbal abuses in this country. This study is designed to address this gap in the literature. The results revealed nine categories of parental verbal abuses namely: (a) Put downs and shaming, (b) Rejection, (c) Blaming, (d) Fault Exaggerating, (e) Threat, (f) Invoking harm, (g) Regrets, (h) Unfair comparison, and (i) Negative prediction. Implications for research and practice were discussed.

A comparison of addiction and transience among street youth: Los Angeles, California, Austin, Texas, and St. Louis, Missouri

The purpose of this study was to compare measures of addiction and transience among street youth in three disparate urban areas: Los Angeles, California; Austin, Texas; and St. Louis, Missouri. Street youth from Los Angeles (n = 50), Austin (n = 50) and St. Louis (n = 46) were recruited using comparable engagement strategies. Youth were interviewed concerning use of alcohol and other substances and their level of transience. Youth from each city were compared using chi-squares and multinomial logistic regression. Results reveal that youth in each city differed in ethnicity, age, educational status, length of time homeless, and substance abuse and dependence. Comparisons across youth in three cities suggest that length of homelessness and drug dependence/abuse significantly differentiate between low, moderate and high transience. Understanding the heterogeneity of this population as well as the relationship between addiction and transience has implications for providing national substance abuse responses.