This study provides information on how the coronavirus disease 2019 (COVID-19) outbreak is affecting emerging adults currently or recently homeless in terms of engagement in protective behaviors, mental health, substance use, and access to services. Methods: Ninety participants in an ongoing clinical trial of a risk reduction program for homeless, aged 18e25 years, were administered items about COVID-19 between April 10 and July 9, 2020. Results: Most participants reported engaging in COVID-19 protective behaviors. Past week mental health symptoms were reported by 38%e48% of participants, depending on symptoms. Among those who used substances before the outbreak, 16%e28% reported increased use of alcohol, tobacco, and marijuana. More than half of the participants reported increased difficulty meeting basic needs (e.g., food), and approximately 32%e44% reported more difficulty getting behavioral health services since the outbreak. Conclusions: Innovative strategies are needed to address the increased behavioral health needs of young people experiencing homelessness during events such as the COVID-19 outbreak.

Conducting intervention studies with homeless populations can be difficult, particularly in terms of retaining participants across multiple sessions and locating them for subsequent follow-up assessments. Homeless youth are even more challenging to engage due to substance use, mental health problems, wariness of authority figures, and frequent relocations. This article describes methods used to successfully recruit a sample of 200 homeless youth from two drop-in centers in Los Angeles, engage them in a four-session substance use and sexual risk reduction program (79% of youth attended multiple sessions), and retain 91% of the full sample at a three-month follow-up assessment. Our experience indicates that utilizing structured project materials and having a small dedicated staff are essential to recruitment and retention efforts for intervention studies with homeless youth. Using these and other nontraditional methods are likely necessary to engage this at-risk yet hard-to-reach population.

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Background: Young people experiencing homelessness have alarmingly high rates of alcohol and other drug (AOD) use, which is associated with sexual risk behaviors such as unprotected sex, trading sex, and sex with multiple casual partners. Few risk reduction programs for this population have been developed and rigorously evaluated, particularly those that address both of these interrelated behaviors, use a collaborative and non-judgmental approach, and are feasible to deliver in settings where homeless young people seek services. This paper describes the protocol of a study evaluating a four-session Motivational Interviewing (MI)-based group risk reduction intervention for this population. The protocol has been shown to be efficacious in pilot work over 3 months with 200 homeless young adults [1]. The current study seeks to refine the intervention protocol and evaluate the program on a larger scale. Methods/design: In a cluster-cross-over randomized controlled trial, 18-25 year olds will receive the AWARE risk reduction program (n = 200) or standard care (n = 200) at one of three drop-in centers serving homeless youth in the Los Angeles area. We will evaluate intervention effects on primary outcomes of AOD use and sexual risk behavior, as well as secondary outcomes of health-related quality of life and social stability, over a 12-month period. Discussion: This project has the potential to fill a significant gap in prevention services by demonstrating that a brief intervention, feasible to deliver within settings where young people experiencing homelessness typically seeks services, can significantly reduce the interrelated problems of AOD use and sexual risk behavior. Trial registration ClinicalTrials.gov Identifier: NCT03735784. Registered November 18, 2018, https ://clini caltr ials.gov/ct2/ show/recor d/NCT03 73578 4 (retrospectively registered)

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