Youth Experiencing Homelessness Research Articles

Patterns of service needs and use by subgroups of youth experiencing homelessness

ABSTRACT Service use predicts exit from homelessness and improvements in physical and mental health among youth experiencing homelessness (YEH). However, service use among YEH remains low. This study uniquely examined youths’ reported needs and patterns of service use during and after the COVID-19 pandemic. Baseline data were examined from a large opioid prevention project conducted in a midwestern, service-rich metropolitan area. YEH (n = 240), between the ages of 18–24 years, were recruited from a drop-in center and other non-service locations. Youth completed self-report questionnaires about their service needs and utilization over the prior three months. The most common services YEH needed were housing (n = 233, 97.5%), drop-in center (n = 194, 81.2%), identification and birth certificates (n = 118, 49.6%), medical care (n = 110, 46.0%), dental care (n = 106, 44.4%), employment counseling (n = 97, 40.6%) and mental health and emotional life counseling (n = 91, 38.1%). Most service needs were unfulfilled. Youth showed extreme service need overall, but other than drop-in centers, the youth reported limited use of most services. The limited use of needed services underscores the importance of future efforts toward improving service use for those in need.

Lessons learned from conducting a community-based, nurse-led HIV prevention trial with youth experiencing homelessness: Pivots and pitfalls.

This article highlights key lessons learned while conducting a nurse-led community-based HIV prevention trial with youth experiencing homelessness (YEH), focusing on sexually transmitted infections testing and treatment, intervention sessions, community partnerships, and participant recruitment and retention. The insights and experiences shared aim to inform future research and the design of interventions targeting populations at high risk, particularly when facing unanticipated challenges. By addressing these areas, the article contributes to the decision-making for the design and delivery of effective strategies to improve the health outcomes among marginalized populations. The findings underscore the importance of flexibility and active participant engagement, cultivating strong relationships with community partners, utilizing technology and social media, and fostering a diverse research team that represents the heterogeneity of youth experiencing homelessness across race/ethnicity, gender identity, sexual orientation, and lived experiences. These recommendations aim to enhance participant access, engagement, and retention, while promoting rigorous research and meaningful study outcomes for YEH.

Suicide prevention for substance using youth experiencing homelessness: study protocol for a randomized controlled trial

BackgroundWhile research on substance using youth experiencing homelessness (YEH) is increasing, there is a dearth of information regarding effective prevention interventions for these youth. Suicide is the leading cause of death among YEH and most youth do not access services that may be available to them. Therefore, this study seeks to address this gap in the research literature with the goal to identify an effective suicide prevention intervention that can be readily adopted by communities that serve these youth.MethodsThree hundred (N = 300) YEH with recent substance use and suicidal ideation or a recent suicide attempt will be recruited from the streets as well as a drop-in center serving YEH. After the baseline assessment, all youth will be randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Services as Usual (SAU) (N = 150) or to SAU alone (N = 150). SAU includes outreach, advocacy, and service linkage whereas YEH who receive CTSP will also receive ten CTSP sessions and an optional nine booster sessions. Follow-up assessments will be conducted at 3, 6, 9, and 12 months post-baseline. Theoretically derived mediators (e.g., cognitive distortions) will be tested to shed light on mechanisms associated with change, and the moderating effects of sex, race, sexual orientation, and baseline service connection will be examined. In order to ease future dissemination of the intervention to agencies serving YEH, we will rigorously assess acceptability, feasibility, fidelity, and cost associated with the delivery of our intervention approach using a mixed-methods approach.DiscussionThis study adds to a very small number of clinical trials seeking to prevent lethal suicide among a very high-risk group by addressing suicidal ideation directly rather than underlying conditions. It is hypothesized that youth receiving CTSP + SAU will show greater reductions in suicidal ideation (primary outcome), substance use, and depressive symptoms (secondary outcomes) over time compared to SAU alone, as well as improved risk and protective factors.Trial registrationNCT05994612. Date of Registration: August 16, 2023.

Promoting COVID-19 Vaccine Confidence and Access among Youth Experiencing Homelessness: Community-Engaged Public Health Practice

Abstract: Background: Youth experiencing homelessness (YEH) face a wide range of complex barriers to COVID-19 vaccine confidence and access. Objectives: Describe our process for engaging a cross-sector team centering equity and youth voice; outline our intervention strategies to enhance COVID-19 vaccine confidence and access among YEH; and discuss lessons learned through this community-engaged process. Methods: We engaged partners from across sectors, including youth-serving agencies, healthcare organizations, public health organizations, and YEH. We used focus groups, key informant interviews, and other community engagement strategies to develop and implement a series of interventions aimed to increase COVID-19 vaccine confidence and access among YEH. Results: We identified youths' key concerns about vaccine confidence and access. To address these concerns, we implemented four community-driven interventions: youth-friendly messaging, health events, vaccine aftercare kits, and staff training. Conclusions: This community-engaged project highlighted the value of cross-sector partnership and consistent youth engagement in addressing vaccine confidence among YEH.

Prevalence of youth experiencing homelessness and its association with suicidal thoughts and behaviors: Findings from a population-based study

Although various studies have examined factors associated with suicidal behaviors among youth, few studies have investigated the association between youth experiencing homelessness (YEH) and suicidal thoughts and behaviors (STBs) using a large nationally representative sample. The objectives of this study were to investigate prevalence of YEH and its association with STBs. Data for this study came from the 2021 Youth Risk Behavior Survey. An analytic sample of 17,033 youth aged 14–18 (51.7 % male) was analyzed using binary logistic regression. Of the 17,033 youth examined, 3 % experienced homelessness during the past 30 days, 21.3 % experienced suicidal ideation, 17.3 % made a suicide plan, and 10.9 % attempted suicide during the past 12 months. Controlling for demographic characteristics and feeling sad or hopeless, YEH was associated with 2.48 times higher odds of experiencing suicidal ideation (AOR=2.48, p<.001), 2.46 times higher odds of making a suicide plan (AOR=2.46, p<.001), and 4.38 times higher odds of making a suicide attempt (AOR=4.38, p<.001). The findings of this study highlight the importance of identifying youth who are at risk of experiencing homelessness to ensure early interventions are put in place to prevent suicidal behaviors.

The world through my eyes: A photovoice project with youth experiencing homelessness

Youth experiencing homelessness (YEH) are infrequently included in the development, organization, and provision of homelessness-related services. This lack of youth voice and services tailored for their expressed needs can lead to underutilization of services, dissatisfaction, and poor outcomes. Photovoice, a participatory research method, has been used to empower persons from marginalized populations and to provide a platform for them to share their voices. This photovoice project partnered with six YEH (18-20 years old). Participants worked together, with the support of two group facilitators, to take photographs, identify themes, write narratives that best represented their lived experience, and share their concerns and ideas for the community. Photos and narratives were shared with decisionmakers at community-based showings. Attendees of the showings anecdotally reported having an increased awareness of YEH issues. The showings served as a catalyst in the community to address the challenges of YEH. Recommendations for research and practice are provided.

Information and communication technologies use among youth experiencing homelessness: associations with online health information seeking behavior

ABSTRACT Given reported high rates of transience and service disengagement among youth experiencing homelessness (YEH), new forms of information and communication technologies (ICT) may represent a novel avenue for intervention. Although studies suggest that ICT use is surprisingly high among YEH, less is known about the factors associated with ICT use and the association between ICT use and online health information seeking behavior (OHISB) among YEH. Using Andersen's behavioral model of healthcare utilization as a theoretical framework, this study examined the prevalence of ICT use and its association with OHISB among YEH. Data were drawn from the cross-sectional study collected from YEH living in multi-sites (N = 1,426; Mage = 20.9). Multivariate logistic regression analyses were conducted to examine the factors associated with ICT use (i.e., access to a smartphone, mobile phone, and social media profile ownership) and the association between each ICT use and OHISB. The results showed that differences in ICT use among YEH based on different predisposing factors including YEH’s gender, race/ethnicity, employment status, and involvement in the public system. Analysis also revealed that access to mobile and smart phones are significantly associated with OHISB among YEH. Results from this study underscore the capacity of ICT use to efficiently address the health-related requirements of YEH and enhance their health outcomes. The creation of technology-driven interventions, specifically utilizing ICTs, has the potential to assist YEH in accessing diverse information and resources related to their health, thereby fostering improvements in their OHISB.

Mediation of Psychological Capital in Youth Experiencing Homelessness.

Youth who experience homelessness engage in behaviors that place them at high risk for disease and injury. Despite their health risk behaviors, these youth display psychological capital, positive attributes of hope, efficacy, resilience, and optimism that motivate them to engage in health-promoting behaviors such as safer sex. However, this array of positive psychological attributes has not been studied in this vulnerable population. The specific aim of this analysis was to determine whether factors of psychological capital mediated the relationship between background risk factors (e.g., race/ethnicity, educational attainment, reason for being homeless, sexual abuse history, and HIV status) and outcomes of condom intention, safer sex behaviors, and life satisfaction among youth who participated in a longitudinal intervention study. Using a Solomon four-group design, 602 youth were recruited from drop-in centers in two large cities (Columbus, Ohio, and Austin, Texas) to participate in a brief intervention that included outcomes of enhanced communication skills, goal setting, safer sex behaviors, drug refusal skills, and life satisfaction. Using an autoregressive, cross-lagged, longitudinal mediation model, we tested the direct and indirect effects of background factors, psychological capital, and intervention outcomes. Models were tested for the intervention group alone and the total sample. There were no significant direct or indirect effects of background factors on intervention outcomes among the intervention group, and the model fit was poor. There were also no significant mediating paths via factors of psychological capital and poor model fit for the combined group. Findings provide important information about intrinsic strengths of youth experiencing homelessness and psychological capital as a significant construct for understanding health behaviors among disadvantaged and underserved youth. The lack of significant mediation effects may have been due, in part, to the lack of a robust measure of psychological capital. Further study with various background factors and outcomes would contribute further to our understanding of how best to support this population.

Digital communication and social support for disadvantaged youth: A social network survey of youth experiencing homelessness

Digital technologies provide people new means for exchanging social support, though the extent to which disadvantaged populations benefit is unclear. Youth experiencing homelessness (YEH) are a vulnerable population with a range of support needs who are active digial media users. We examined the core networks of 621 YEH in the United States to assess how digital-only communication compared with any other form of contact in terms of the social support youth reported receiving. Participants were more likely to receive emotional support, as well as find role models and support for their personal goals, though not material support, through contacts that were digital-only (internet, phone, or social media) in the last month. YEH appear to rely on—and in some cases prefer—digital-only communication to tap into resources for survival and advancement. We discuss the implications for research on ICT use by disadvantaged populations and for interventions to support YEH.

26. Youth-Driven Systems Alignment Strategies to Optimize Health Among Youth Experiencing Homelessness

26. Youth-Driven Systems Alignment Strategies to Optimize Health Among Youth Experiencing Homelessness

Substance use typologies among young people experiencing homelessness in seven cities across the United States: A latent class analysis

BackgroundSubstance use and other health-risk risk factors, including mental health, trauma, and sexual-risk behaviors, often co-occur among youth experiencing homelessness (YEH). The present study aimed to identify subgroups of YEH based on polysubstance use and the linkages to sociodemographic and health-risk characteristics. MethodsFrom June 2016 to July 2017, 1,426 YEH (aged 18–26 years) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information via a self-administered electronic survey on substance use, mental health, trauma, sexual risk behaviors, and sociodemographic characteristics. The majority of YEH identified as Black (37.3%), cisgender (92.8%), and heterosexual (69.2%). On average, YEH were 20.9 years (SD = 2.1). This study employed latent class analysis (LCA) to identify subgroups of YEH according to their substance use. Multinomial logistic regression analyses were conducted to identify sociodemographic and health-risk characteristics associated with class-membership. ResultsFour latent classes of YEH substance use were identified: (1) high polysubstance use; (2) moderate stimulant and high marijuana, alcohol, and prescription drug use; (3) high marijuana, alcohol, and prescription drug use; (4) low/moderate marijuana and alcohol use. Multinomial logistic regression models indicated that geographic location, gender, race/ethnicity, mental health, trauma history, and sexual risk behaviors were significant correlates of substance use class membership among YEH. ConclusionsThese findings offer important implications for the prevention and treatment of substance use among YEH. Screening protocols should consider co-occurring risk factors such as traumatic experiences, sexual risk behaviors, and mental health history as indicators of polysubstance use.

Exploring Predictors of Service Use Among Youth Experiencing Homelessness

Exploring Predictors of Service Use Among Youth Experiencing Homelessness

Where's the Disconnect? Exploring Pathways to Healthcare Coordinated for Youth Experiencing Homelessness in Toronto, Canada, Using Grounded Theory Methodology.

About 900 youth experiencing homelessness (YEH) reside at an emergency youth shelter (EYS) in Toronto on any given night. Several EYSs offer access to healthcare based on youths' needs, including access to primary care, and mental health and addictions support. However, youth also require healthcare from the broader health system, which is often challenging to navigate and access. Currently, little is known about healthcare coordination efforts between the EYS and health systems for YEH. Using grounded theory methodology, we interviewed 24 stakeholders and concurrently analyzed and compared data to explore pathways to healthcare coordinated for youth who reside at an EYS in Toronto. We also investigated fundamental parts (i.e., norms, resources, regulations, and operations) within the EYS and health systems that influence these pathways to healthcare using thematic analysis. A significant healthcare coordination gap was found between these two systems, typically when youth experience crises, often resulting in a recurring loop of transition and discharge between EYSs and hospitals. Several parts within each system act interdependently in hindering adequate healthcare coordination between the EYS and health systems. Incorporating training for system staff on how to effectively coordinate healthcare and work with homeless populations who have complex health needs, and rethinking information-sharing policies within circles of care are examples of how system parts can be targeted to improve healthcare coordination for YEH. Establishing multidisciplinary healthcare teams specialized to serve the complex needs of YEH may also improve healthcare coordination between systems, and access and quality of healthcare for this population.

“Like rubbing salt into the wound”: Lived experiences of homeless youth in Gondar City, Ethiopia

Despite growing research on homeless street children, women and elderly people in Ethiopia, there is little empirical evidence regarding the experiences of homeless street youth in the country.  The purpose of this qualitative phenomenological research is therefore to understand the lived experiences of street homeless youth aged between 18 and 29 years in Gondar city.  Face -to- face in-depth interview was conducted with 9 purposively selected study participants.  Interviews were transcribed, coded, categorized and thematized through thematic analysis strategy. Five themes emerged from the data analysis include Reasons for becoming homeless; Social marginalization; Violence and Criminalization; Psychological distress; and Means of a living. Findings of this study illustrate that homeless youth suffered from poor health, sexual violence, psychological trauma, social stigma and hostility from the public. The combined effect of these precarious situations places homeless youth at the margins of society and makes them feel helpless in their daily lives.  This study implies that social workers should use and promote family- and community-based interventions to deal with the problem of homeless youths and integrate them into society. How to reference using ASWNet style: Bihonegn, A. (2023). “Like rubbing salt into the wound”: Lived experiences of homeless youth in Gondar City, Ethiopia. African Journal of Social Work, 13(5), 265-272. https://dx.doi.org/10.4314/ajsw.v13i5.5 Visit journal website: https://ajsw.africasocialwork.net

Mental Health &amp; Educational Attainment: Learning From Indigenous Youth Who Are Homeless

Indigenous youth who experience homelessness are faced with multilevel challenges related to family, health, service access, support, employment and education. Navigating racism, ageism and other forms of discrimination complicates the search for pathways out of homelessness, especially when attempted without systematic adult support. In this study, the educational experiences of homeless youth across the York Region of Toronto were explored in depth. The narratives shared by 11 Indigenous youth convey their perspectives on education, health and mental health, and other life contexts affected by homelessness. Analyses of their dialogues can help educators, researchers and service providers better understand their health and mental health challenges. Despite desires to continue with their educational pursuits, they are often forced to drop out of school prematurely. Their perspectives, especially about mental health and education, can raise awareness about youth homelessness in suburban areas surrounding Toronto.

COVID-19 vaccine attitudes among youth experiencing homelessness: a qualitative analysis with opportunities for action

Youth experiencing homelessness (YEH) are uniquely vulnerable to COVID-19 infection, yet are often excluded from response planning during the COVID-19 pandemic and other public health crises. As part of a larger community- and youth-engaged project through a national network of Prevention Research Centers, our qualitative study sought to describe youth perspectives that influence COVID-19 vaccine confidence and uptake, and identify youth-driven strategies to guide public health efforts to improve vaccine confidence and access. We conducted focus groups with youth experiencing homelessness (n = 20) and semi-structured interviews with staff members (n = 10) at youth-serving agencies to solicit youth perspectives about COVID-19 vaccination. Focus groups and interviews were recorded, transcribed, and analyzed using thematic qualitative analysis. In partnership with youth and cross-sector partners, we distilled eight salient themes that influenced COVID-19 vaccine uptake and confidence among YEH: 1. historical harms and mistrust of systems, 2. access to reliable health information, 3. prioritization of basic needs, 4. personal health influence, 5. barriers to healthcare, 6. fear and uncertainty of the vaccines, 7. sense of bodily autonomy, and 8. community influence. We also identified three youth-driven opportunities to increase COVID-19 vaccination among this population: emphasizing autonomy, leveraging trusted sources of information, and improving vaccine access.Our study elucidates perspectives of YEH on COVID-19 vaccination, and identifies several opportunities to improve youth vaccine confidence and access. It also underscores the importance of centering youth voice in response planning during current and future public health crises.

“I Need to Get My Culture Back”: Youth and Provider Perspectives on Integrating Culturally Based Approaches into Sexual and Reproductive Health Programs for Native Hawaiian and Pacific Islander Youth Experiencing Homelessness

There is growing interest in decolonizing sexual and reproductive health (SRH) and embedding cultural practices into social and medical services in Hawai‘i. Wahine (“woman”) Talk is a multilevel, comprehensive SRH program for female youth experiencing homelessness (YEH) led by community health, social work, and medical providers. This study examines youth and program provider perspectives of culturally based approaches that may strengthen SRH programs. The study team conducted three focus groups and ten in-depth interviews with participating youth and program providers after the program’s conclusion. Youth participants were aged 14 to 22 years (M = 18.1) and of Native Hawaiian or Pacific Islander ancestry. Interview transcripts were analyzed using structured thematic analysis. The youth described feeling estranged from their ancestral cultures and suggested incorporating multiple cultural practices to enhance their connection to community, body, and land into SRH programming for YEH. They identified several ʻāina (“land”)–based approaches, hands-on learning, hula, and language as possible practices to weave into the program. While youth felt estranged from their ancestral cultures, they discussed Native Hawaiian and Pacific Islander health perspectives where ʻāina and relationships are considered life-sustaining. Youth and program staff stressed incorporating culture respectfully, caring for the whole person, and providing trauma-informed care. Future policy, practice, and research should consider protecting and integrating Native Hawaiian conceptions of health into SRH policy and practice and include youths’ cultural identities in SRH intervention development.

Experiences of pregnancy prevention among youth experiencing homelessness

Youth experiencing homelessness (YEH) are at high risk for unintended pregnancy and face unique challenges to effectively preventing unintended pregnancy. This qualitative study explored the pregnancy prevention experiences of YEH. A total of 81 diverse youth participated in eight focus group discussions that were conducted to explore their perceptions and experiences related to pregnancy prevention. Youth were recruited from shelters, drop-in centers, and homeless-serving organizations in a large metropolitan area in the southern United States. Thematic content analysis of the data revealed that YEH struggle to engage in sexual and reproductive health services owing, in part, to limited accessibility. Lack of knowledge about contraceptives, perceived adverse side effects of contraceptives, and challenges with adherence to contraceptive methods significantly limited the effective use of contraception among YEH. Youths’ decisions to use contraception were influenced by their relationship status with partners, perceptions about the efficacy and side effects of contraceptives, and the stigma associated with contraceptive use. Providing sexual and reproductive health services to YEH requires a collaborative approach. YEH need comprehensive sexual and reproductive health education and counseling that enables and empowers youth to access, navigate, and utilize such services.

Positive and Negative Experiences With Supportive Services and Programming: Gaps and Recommendations From Youth Experiencing Homelessness

Services for youth experiencing homelessness (YEH) are designed with limited input from the youth themselves. This study explored the experiences and recommendations for services aimed at mitigating the negative effects of homelessness among youth. A total of 45 interviews were conducted with YEH (ages 15 to 24, M = 21.5 years) who experienced at least one night of homelessness. Transcripts were coded by using a modified constructivist grounded theory approach. YEH reported myriad challenges to navigating disjointed programming and misguided policies. Recommendations from YEH for policy and programmatic change include peacekeeping and diffusion training for program staff, trauma-informed approaches, and conflict resolution among agency staff; and integrate creative outlets and transitional services into existing programs. Programming supporting YEH must extend beyond meeting only basic needs to creating opportunities for safety, autonomy, and growth. Programs targeting youth homelessness need input from YEH in their design and implementation.

Opportunities and Challenges to Linkage to Housing in the Context of a Sexual and Reproductive Health Program for Youth Experiencing Homelessness

Youth homelessness remains a major public health issue in the USA, and youth experiencing homelessness (YEH) are still one of the more understudied and underserved groups. Comprehensive sexual and reproductive health (SRH) programs for YEH are rare. Yet, such programs are potentially effective settings through which to link YEH with housing services. Wahine (“woman”) Talk is one such comprehensive program for YEH, and is a multilevel intervention delivered out of a youth drop-in center in Honolulu, Hawai ‘i. One of Wahine Talk’s core components is addressing basic needs, including providing linkages to housing services. Little research exists on SRH programs’ opportunities and challenges to providing linkage to housing for YEH. The current study is an exploratory study asking, “What are opportunities and challenges to linking young women experiencing homelessness to housing services through a comprehensive sexual and reproductive health program?” The study team collected in-depth qualitative data through seven focus groups and 25 individual interviews with Wahine Talk staff and youth participants aged 14–22 years. Multiple team members analyzed the data using template analysis. The analysis revealed that while comprehensive SRH programs may have some opportunities and challenges to linking YEH to housing services that are consistent with traditional housing assistance programs, there are also factors specific to SRH programs. In particular, opportunities would be SRH programs employing a housing staff person and bolstering staff-youth meetings and communication. A challenge specific to SRH programs would be prioritizing youth’s reproductive justice (i.e., choice) in lieu of solely prioritizing pregnancy reductions and delays; thus, it is recommended to train staff to prioritize youth’s reproductive justice. The findings highlight the importance of SRH programs having staff focused on housing, sufficient opportunities for youth and staff to communicate with each other, and staff trained to prioritize youth’s reproductive justice.