Development of a Shelter-based Health Empowerment Program for Pregnant and Parenting Youth Experiencing Homelessness.

Abstract

Pregnancy and parenthood are common among youth experiencing homelessness and are associated with significant health risk for both parent and child. Yet, little is known regarding how to best promote health among this vulnerable population. To understand stakeholder perceptions of needs and factors required for successful implementation of a shelter-based health empowerment program for pregnant and parenting youth experiencing homelessness and their children. Applying frameworks from implementation science, we conducted interviews and focus groups with three groups of stakeholders (youth experiencing homelessness [n = 17], shelter staff [n = 8], community experts [n = 5]). We used qualitative content analysis to identify program content areas and design elements required for successful implementation. We then used a consensus-building process to engage community stakeholders in selecting and adapting an evidence-informed intervention. Stakeholders described several desired content areas for a group-based curriculum: sexual and reproductive health, mental health and child health. With respect to program design, stakeholders emphasized adaptability; a strengths-based, culturally responsive, and trauma-informed approach; a skills-oriented focus; staff training; access to health care; and the integration of youth voices. Driven by these findings, our community-based team proposed a health empowerment program with three elements: 1) a weekly health empowerment group, 2) health training and support for shelter staff, and 3) shelter-based health care services. Our study is among the first to assess the health care needs of pregnant and parenting youth in shelter, and to describe factors associated with the development and implementation of a shelter-based health empowerment program specifically targeting this vulnerable population.