Variability in treatment outcomes from a housing intervention for young mothers misusing substances and experiencing homelessness by sexual identity

Abstract

Sexual minority (SM) youth have twice the risk of experiencing homelessness compared to their heterosexual peers. Further, SM youth experiencing homelessness (YEH) report greater depression symptoms and substance use compared to heterosexual YEH. Housing First is an intervention that provides scattered-site individual apartments, without any prerequisite conditions for eligibility, and additional services to support long-term housing sustainment; however, few studies have examined the effectiveness of this approach for SM youth. The current study utilized data from a RCT that provided housing to young mothers experiencing homelessness to examine if treatment effects varied by mothers’ sexual identity. Mothers were randomly assigned to services as usual (i.e., provided a referral sheet of all services available in the community; SAU), Housing only (i.e., three months of utility and rental assistance; Housing), or housing and supportive services (integrates independent housing, Strengths-Based Outreach and Advocacy (SBOA), HIV prevention, and substance use/mental health counseling; Housing + SS). Latent growth curve models were estimated to assess how substance use and depression symptoms changed over the 12 months. SM mothers receiving SAU or Housing did not experience a significant change in substance use or depression symptoms. All groups of heterosexual mothers and SM mothers receiving Housing + SS had less substance use and depression symptoms at twelve months, with SM mothers in Housing + SS evidencing a steeper decline in substance use and depression symptoms. This study provides some of the first evidence that Housing First can mitigate the mental health and substance use concerns of SM YEH. Given SM’s higher rates of homelessness, substance use, and depression symptoms, Housing First should be further explored as an intervention to address their unique needs.