Homeless Youth Research Articles

Impact of early use of long-acting injectable antipsychotics on functional outcome in first episode psychosis: a 3-year longitudinal study

Objectives To describe, in a naturalistic setting, the impact of the early use of LAI-AP on functional outcomes of early psychosis patients as compared to oral antipsychotics (OAP). Methods Longitudinal prospective 3-year naturalistic study of all consecutive admissions (n = 416) to two Early intervention services (EIS) for psychosis comparing baseline characteristics and the evolution of global functioning, occupation (work and studies), and living arrangements autonomy according to the route of administration of the antipsychotic medication. The cohort was divided into four groups: LAI-AP first (started on LAI-AP and later received OAP), OAP first, LAI-AP only, and OAP only. Results Global assessment of functioning (GAF) improved in all groups, but our mixed-effect model did not show any significant association between the route of administration and the GAF outcome. The LAI-AP only group was significantly less likely to have extreme residential instability at 3 years than the other groups despite its highest proportion of homeless youth and their poor prognostic factors at baseline. Conclusions Our naturalistic study suggests a significant protective effect of LAI-AP on extreme residential instability for the most vulnerable patients, but no impact of the first AP administration route on other functional outcomes was observed at 3 years of follow-up. Key points Long-acting injectable antipsychotics seem promising to avoid extreme residential instability in early psychosis. Global assessment of functioning (GAF) improved in all groups. There was no significant association between the first route of administration and global functionning.

Homeless youth shelters and services for transgender and gender non-conforming (TGNC) clients: Results from a nationwide survey

This study explored results from a nationwide survey conducted with homeless youth shelter directors. The research sought to further the understanding of how policy and societal changes about gender affirming access to services have affected service delivery and accommodations at homeless youth shelters for transgender and gender non-conforming (TGNC) youth. Results from (n = 117) youth shelters indicate the majority of those surveyed are current in implementing many of the Housing and Urban Development (HUD) gender affirming policies. Among others, recommendations include a need for shelters to incorporate TGNC safety accommodations, and to update dress code policies from a universal design perspective.

What Does it Mean to be Homeless? How Definitions Affect Homelessness Policy

Government agencies use varying criteria in defining homelessness. While scholars debate over and use different definitions of homelessness, little research has explored the impacts the definition has on perceived problem severity and the types of communities receiving aid. I first explore four definitions of child and youth homelessness used by United States’ federal agencies. I then use panel data for school districts, which report homelessness by subgroup, to analyze how the definition of homelessness changes its prevalence and leads to disparate impacts. I find the definition of homelessness including students living doubled-up leads to a higher growth rate. Definitions also change which districts have high rates of homelessness and characteristics of these districts, suggesting resources following students experiencing homelessness go to different types of communities. Scholars should consider how a problem is defined, differences in the measurement used between studies, and how the definition affects where resources go.

Predictors of Secondary Completion Among Homeless Youth in Three U.S. Cities and the Potential Application of National Policies.

PurposeSecondary education completion rates (i.e., high school diploma or General Education Development [GED]) among homeless youth (HY) are low in comparison with their housed peers.MethodSecondary data with a sample of 429 HY was used from a 3-city study using quantitative retrospective interviews with a purposive sample of601 HY collected from 2010 to 2011 in social service organizations across three U.S. cities (Denver, CO, n = 201; Los Angeles, CA, n = 200; and Austin, TX,, n = 200). This study examines risk and resilience factors (i.e., demographics, childhood trauma, transience, mental health diagnosis, incarceration history, employment, and resilience) associated with the completion of secondary education among HY using logistic regression.ResultsSecondary completion was positively associated with identifying as female, formal employment, a sense of equanimity, and experiences of childhood emotional abuse. In contrast, secondary completion was negatively associated with a history of incarceration as well as experiences of childhood physical neglect and emotional neglect.DiscussionRecommendations are made for strengthening educational institutions’ capacity to provide the comprehensive support services for HY to minimize risk factors and enhance protective factors. Similarly, the authors highlight how cross-sector collaboration, such as those approaches supported through the Workforce Innovation and Opportunity Act and the McKinney-Vento Homelessness Assistance Act, can be leveraged to minimize significant risk factors and promote resilience factors associated with secondary completion.

Examining sources of Social Support and Depression Prevention Among Pregnant Youth Experiencing Homelessness: Outcomes of a Seven-City Study.

Young adults experiencing homelessness (YAEH) with pregnancy history are at higher depression risk. Receiving social support is protective for depression in pregnancy. This study differentiates social support sources associated with depression by pregnancy history among YAEH.Using a subsample of data collected from YAEH in seven US cities that were collected through REALYST, we conducted stratified logistic regression models (by pregnancy history) to identify support sources associated with depression. Logistic regression analysis including the interaction term (i.e., pregnancy history x support sources) using the full sample was then conducted.A higher proportion with pregnancy history reported depression compared to those without. Support from home-based peers was significantly associated with reduced depression risks among YAEH with pregnancy history, but not among youth without. Home-based supports were less frequently indicated by homeless female youth with pregnancy experience.Home-based social support is protective against major depression for YAEH with pregnancy experience. Findings of this study suggest that interventions addressing depression among YAEH should take their pregnancy history and social support sources into consideration. Specifically, for YAEH with pregnancy history, facilitating supportive social ties with home-based peers may be promising in reducing their depression risks.

Violence against homeless gay and transgender youth in Pakistan – a short report

ABSTRACT Violence against youth with diverse sexual and gender identities is an understudied area in Pakistan. This article explores how homeless gay and transgener youth (HGTY) experience multiple forms of violence and how social structural conditions produce contexts for violence against them. This study is based on qualitative interviews with fourteen HGTY, aged 16–25 years old. The interviews suggest that participants experienced multiple forms of violence simultaneously. Social structures like religion, ethnicity, and politics shaped broader cultural intolerance for sexual and/or gender diversity. Not being able to conform to social norms of gender and sexuality not only contributed to violence against participants but shaped their trajectories into homelessness and sex work. The ‘new’ identities of being homeless and being sex workers intersected with their gay and, trans identities, exacerbating their vulnerability. The findings indicate that there is an urgent need for law supportive of sexuality and gender diverse youth to mitigate experiences of violence.

Substance use treatment using cultural arts and 12 steps: Curriculum training and community-led implementation in Zambia

IntroductionSubstance use in Zambia is stigmatized and treatment access is limited. Over 30,000 people are homeless in Lusaka, where one-quarter of homeless youth report use. Zambia's Ministry of Health recently developed policies targeting alcohol, suggesting Chainama, the only mental health hospital, offer treatment. Together, they endorsed training in the curriculum studied in this paper. We hypothesized training Zambian professionals would improve their perceptions of substance users and treatment. We then explored if treatment using the curriculum, as delivered to clients by training participants, would encourage client motivation to change, participation in groups, and reduce substance use frequency. MethodsPart 1: One-hundred professionals were trained in a curriculum-based, literacy-free intervention employing cognitive behavioral and rational emotive behavior therapy techniques to explore 12 Steps of addiction recovery through Zambian art forms. Pre/post questionnaires captured perspectives around substance users and treatment. Part 2: Trained organizations delivered the curriculum in their communities. Twenty-five organizations rated feasibility and benefit of the curriculum. Data for 200 clients recorded pre/post motivation to change, open-sharing/participation, and frequency of substance use. ResultsWhile training significantly modified professionals’ perspectives regarding the value of offering treatment, their views of substance users did not change. Clients endorsed increases in “motivation to change” and “participation/open-sharing.” Frequency of alcohol, marijuana, inhalant, and cigarette use significantly decreased. ConclusionTraining in the curriculum helped address a public health need, playing a role in increased motivational variables and decreased substance use. Research addressing this study’s limitations is encouraged. Video abstractFor a video summary of this paper, please visit https://youtu.be/uDZTVxtzF1Y.

Implications of the COVID-19 Pandemic for Youth Housing and Homelessness Services.

Youth homelessness is a growing crisis in the United States that is associated with a range of adverse outcomes. A variety of social service programs exist to address youth homelessness and its consequences, such as street outreach and diversion services, emergency shelters, transitional housing programs, and rapid rehousing services, among others. The coronavirus disease 2019 (COVID-19) pandemic reached the United States in early 2020, altering nearly every facet of daily life, including the way social service organizations structure and deliver their programming. To understand the implications of the pandemic on housing and homelessness services for youth, the current study examines data from interviews conducted with staff from a large non-profit in Austin, Texas, serving vulnerable transition-age youth. Through these interviews, programmatic changes that occurred as a result of COVID-19—as well as challenges and facilitators to service delivery—were identified. This article provides an overview of these key learnings, as well as recommendations derived from these key learnings, for other organizations adapting their housing and homelessness services in response to the COVID-19 pandemic.

Using social network analysis as a tool in action research.

The following paper presents case examples of one research team's use of social network analysis (SNA) with three different collaboratives in South Florida: (a) a Collective Impact initiative seeking to end youth homelessness, (b) a university collaborative of campus organizations working towards Black students' concerns, and (c) a movement network of local social justice organizations. The research team used SNA to assess the level of connectivity of three different community coalitions. While research questions were slightly different for each collaborative, each project asked about the frequency of communication between organizations to determine connectivity. Results vary between case examples. Both the Youth Homeless Collaboration and the Black Student Association used Gephi to analyze results, while The Community Partnership used R to measure network centrality. The paper concludes with a general discussion of challenges related to using SNA as an action research tool, as well as the role of power in organizational networks.

LGBTQ Youth Homelessness: Why We Need to Protect Our LGBTQ Youth.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth are 120% more likely to be homeless than cisgender and heterosexual youth, yet current federal policies are insufficient and exclude LGBTQ youth. Youth homeless shelters are inadequately equipped to serve LGBTQ homeless youth due to poor funding, a focus on heterosexual or cisgender clients in their programs, and a lack of LGBTQ-friendly policies. Given the pervasiveness of this issue, public health and social policy interventions must be considered. In this perspective, the LGBTQ homeless youth epidemic is introduced and described, past policies are analyzed, and policy recommendations are made.

Lonely, harassed and abandoned in society: the lived experiences of Iranian homeless youth

IntroductionHomelessness is increasing among young adults in large cities. According to the United Nations, there are more than one billion absolute or relative homeless people in the world. This study was conducted to explain the lived experiences of homeless youth in southeastern Iran.Materials and methodsIn this qualitative study, we recruited 13 participants in a big city, southeast Iran, in 2020. The participant was young homeless adults aged 18–29 years who were using homeless shelters provided by the municipality, sleeping in parks or on streets. Data were collected through in-depth and semi-structured interviews and three focus group discussions. Data were analyzed by conventional qualitative content analysis.ResultsThe main category of “lonely, annoyed, and abandoned in society” and three subcategories of avoidance of/by society, comprehensive harassment, and lack of comprehensive support were extracted. The experiences of young homeless adults showed that they escaped from the community due to addiction, feeling like a burden to others, and social isolation, and not only have they been left without support in society, but they have also suffered from all kinds of physical and psychological harassments.ConclusionThe lived experiences of homeless people show that in addition to appropriate facilities and living conditions, they require respect, reduced social stigma, discrimination, and favorable conditions for a return to life. Therefore, authorities should identify and settle their problems and needs.

Prevalence and Correlates of Illicit Substance Use Among Young Adults Experiencing Homelessness in Seven Cities Across the United States

Background Young adults experiencing homelessness (YAEH) engage in substantially higher substance use rates than housed young adults. This current study builds on previous research by investigating the prevalence of and salient correlates of illicit substance use across a seven-city sample. Methods This study used the Homeless Youth Risk and Resiliency Survey (HYRRS) dataset, n=1426 Young adults experiencing homelessness to study patterns and correlates of illicit substance use. Results Multivariate logistic regression analyses were used to assess correlates of substance use. Study site, age, gender identity, sexual orientation, history of suicidal ideation, use of specific substances, and trading sex for drugs were associated with five types of illicit substance use (ecstasy, cocaine, crack, methamphetamine, and injection drug use). Conclusion Findings indicate that substance use interventions for YAEH must be multifaceted, addressing illicit and multiple substance use, along with the myriad factors associated with substance use among this at-risk group.

The syndemic effects of adverse mental health conditions and polysubstance use on being at risk of clinical depression among marginally housed and homeless transitional age youth living in San Francisco, California.

The objective of this study was to identify the correlates of being at risk of clinical depression and examine the role of syndemic factors among marginally housed and homeless transitional age youth (TAY). From 2017–2018, 100 TAY between the ages of 18 and 24 in San Francisco were recruited from Larkin Street Youth Services into a cross-sectional study. Participants completed surveys on mental health, substance use, and HIV risk behaviors. A syndemic score ranging from 0–3 was calculated by summing dichotomous measures of moderate or severe anxiety in the past two weeks, PTSD symptoms in the past month and polysubstance use in the past three months. We used modified Poisson regression with robust error variances to identify the correlates of being at risk of clinical depression in the past week, all primary effects measures were modeled separately. Among 100 participants, the average age was 21 (SD = 1.7), 67% were male, 38% were Multiracial, 54% identified as gay, lesbian, bisexual or pansexual, 13% were unstably housed, 50% were homeless and 23% were living with HIV. The majority (74%) were at risk of clinical depression, 51% had symptoms of moderate or severe anxiety, 80% exhibited symptoms of PTSD and 33% reported polysubstance use. After controlling for age in years, gender, race/ethnicity and sexual orientation, factors independently associated with being at risk of clinical depression were; symptoms of moderate or severe anxiety (adjusted risk ratio [aRR] = 1.62, 95% confidence interval [CI] = 1.23–2.12, P<0.001), symptoms of PTSD (aRR = 3.78, 95% CI = 1.58–9.04, P = 0.003), polysubstance use (aRR = 1.33, 95% CI = 1.06–1.68), P = 0.012), an increasing syndemic score (aRR = 1.40, 95% CI = 1.21–1.62), P<0.001), and having one, two or three syndemic factors (compared to none); (aRR = 2.68, 95% CI = 1.08–6.65, P = 0.032), (aRR = 3.24, 95% CI = 1.24–7.83, P = 0.003) and (aRR = 3.97, 95% CI = 1.65–9.52, P = 0.002), respectively. Integrated behavioral health models that treat co-occurring disorders simultaneously are needed to reduce syndemic risk among marginally housed and homeless TAY.

Preventing Youth Homelessness in the Context of Covid-19: Complexities and Ways Forward

The coronavirus (COVID-19) pandemic has magnified detrimental social and health experiences and consequences for youth at risk of or experiencing homelessness. Recent research indicates that heightened household tensions due to stay-at-home orders, coupled with pandemic-related financial insecurities, have worsened pre-existing factors for many young people, particularly for those experiencing stigma and violence. As a result, it can be projected that the risk and experience of youth homelessness will intensify. In spite of this, there has been scarce attention to the impacts the current context has on these vulnerable groups. This commentary aims to bring attention to the prevailing issues and challenges faced by youth at-risk of homelessness during the COVID-19 pandemic and provides crucial considerations for preventative solutions by incorporating the Roadmap for the Prevention of Youth Homelessness Framework. Based on research across fields, we offer insights for equity-focused, collaborative interventions, focusing on the education and social services sectors.

Casa 1, a site of LGBTQ memory in São Paulo, Brazil

The NGO Casa 1 was conceived as a housing project for runaway and homeless LGBTQ youths. Launched in 2017, it has expanded into a complex that includes housing, culture, education and health services. Together with this infrastructure of care, Casa 1 has created several strategies to promote LGBTQ memory that have made it a new site of memory in São Paulo. Through field research, interviews and analysis of institutional material, this article presents the NGO’s memory strategies in four directions: memorialisation as a symbolic mechanism of gratitude, exemplarity and denunciation, and the safeguarding of a LGBTQ memory collection. We argue that, through these dimensions, Casa 1 has consolidated itself as a site of memory even considering its short existence, showing that the establishment of a site of memory is not a passive consequence of time and historical events, but can be precipitated and induced, through intensity and intentionality.

Health System Access for Precariously Housed Youth: A Participatory Youth Research Project

This article builds from young people’s experiences navigating health system organizations to identify concrete institutional and policy processes that pose problems for youth experiencing or at risk of homelessness, as well as those that show promise in terms of health promotion. Our participatory youth research team explored homeless youth’s health-seeking practices, the specific barriers they face, and relations between their health-seeking efforts and their homelessness. Youth and adult co-researchers interviewed 38 individual youth (aged 16–29) who completed 64 qualitative institutional history interviews. Their accounts illuminate a systemic lack of capacity to address the mental health needs of homeless youth. Unable to secure access to timely, sufficient, and suitable programs and services, youth navigate patchwork of crisis and emergency supports that undermine their autonomy, their health, and their housing stability. Finally, youth without stable housing—particularly those who are Trans* and non-binary youth and/or who use drugs—report discrimination in health care settings. Our results suggest that access to timely, appropriate, de-stigmatizing, and consistent (mental) health services is one way to prevent youth homelessness.

The inclusion of youth with lived experience of homelessness in emerging networked publics: Challenges in online storytelling and allyship

There has been considerable debate over the extent to which vulnerable and diverse populations are politically involved in decision-making. Specifically in Canada’s homelessness sector, there is a macro-level push to include individuals with lived experience of homelessness in the policymaking process. This research paper will explore the ways in which youth with lived experience of homelessness and their allies are engaging in online forms of activism and storytelling, and ultimately examine this interaction under the idea that media is both a practice and an imaginary. This study situates this argument in the wide critique of Jürgen Habermas’ exclusionary public sphere. Instead, this paper examines the emerging concepts of “affective publics” and “networked publics” to understand how online marginalized voices are only empowered to the extent to which they perform in mediated spaces to gain visibility. By drawing on Pierre Bourdieu’s articulation of social capital, this study examines recent examples of Canadian organizations amplifying youth voices on Instagram to interrogate some of the implications that arise in online allyship and storytelling. Keywords: affective publics, networked publics, youth homelessness, lived experience, storytelling, allyship, activism, social capital

Sexual Victimization, Self-Efficacy to Refuse Sex While Drinking, and Regretting Alcohol-Involved Sex among Underserved Youth in Kampala, Uganda.

The purposes of this study were to determine whether youth who have experienced sexual victimization (SV) have lower self-efficacy to refuse sex and to identify intervention strategies for rape survivors to mitigate further health-risks and harm. Cross-sectional data from the 2014 Kampala Youth Survey (n = 1134) of youth aged 12 to 18 years recruited from Uganda Youth Development Link drop-in centers were used to conduct the analyses. Multivariable statistics were computed to determine the correlates (i.e., sex, education, homelessness, problem drinking, and SV) for (1) self-efficacy to refuse sex, (2) self-efficacy to refuse sex while drinking, and (3) regretting sex due to alcohol use. Among participants, 16.9% reported SV (79% were female and 21% were male). In the final adjusted model, self-efficacy to refuse sex while drinking was only associated with homelessness (OR: 0.52; 95% CI: 0.36, 0.74). Previous SV was not associated with lower self-reports of self-efficacy to refuse sex compared to those who had not experienced SV. Additionally, SV was not associated with increased reports of regrets for sex attributed to alcohol use. Alcohol prevention strategies for the most at-risk youth, including homeless youth, are warranted to improve self-efficacy to refuse sex among youth living in the slums of Kampala.

The Benefits of Peer Interviewers in Research: Evidence from a Youth Homelessness Longitudinal Evaluation Study

Innovative programs and research are needed to address homelessness among youth who have been involved in the child welfare system. Moreover, engagement strategies need to be authentic and relevant to the lived experience of youth who have been involved with multiple service systems. We describe our community-university partnership focused on the development, implementation, and evaluation a comprehensive service model that served young adults (ages 18–24) who were experiencing homelessness and had a child welfare history. The partnership was grounded in positive youth development and developmental evaluation frameworks, and incorporated a participatory research approach to involve peer interviewers as co-researchers in a formative evaluation of the service model. We examine the reasons for incorporating peer interviewers with a “hard to reach” youth population and how the peer interviewer approach was developed and supported through the collaborative partnership. A comparison of longitudinal study response rates before the peer interviewer approach was implemented and a year after implementation showed that 6-month rates increased from 11% to 55% and 12-month response rates increased from 14% to 51%. We discuss lessons learned from this approach to inform future research with youth and young adults and provide methodological insights that can help answer questions about the benefits of involving youth as co-researchers.

Adverse Childhood Experiences (ACEs) and Homelessness: A Critical Examination of the Association between Specific ACEs and Sex Trafficking among Homeless Youth in Kentuckiana

ABSTRACT Youth experiencing homelessness have often also been exposed to childhood trauma or adverse childhood experiences (ACEs). Aims: More information is needed to determine the prevalence and impact of ACEs in youth experiencing homelessness who have also been trafficked for sex with the goal of developing services informed by this knowledge. The present study examines ACEs and sex trafficking in a convenience sample of 119 youths experiencing homelessness aged 12 to 25 years old in Kentuckiana—a region of counties within metropolitan Louisville, Kentucky, and Southern Indiana. Participants were asked questions regarding the 10 categories of ACEs as part of an enhanced version of the 60-item Youth Experiences Survey (YES). One hundred percent of the sample reported experiencing at least one ACE. Over two-thirds (69%) reported experiencing four or more ACEs. Approximately 52% of youth who had not been trafficked had experienced five or more ACEs, compared with 70% of trafficked youth. The ACEs most significantly related to sex trafficking were physical neglect, emotional neglect, emotional abuse, domestic abuse, and sexual abuse. Reports of sex trafficking and a higher number of ACEs from this sample of youth were found to be importantly correlated. Programs serving youth experiencing homelessness should require additional training and resources regarding the identification, screening, and assessment of youth who are at risk of or who have experienced sex trafficking in order to more accurately connect youth with trauma-informed services.