Treatment outcome for street-living, homeless youth

Abstract

Comprehensive intervention for homeless, street living youth that addresses substance use, social stability, physical and mental health issues has received very little attention. In this study, street living youth aged 14 to 22 were recruited from a drop-in center and randomly assigned the Community Reinforcement Approach (CRA) or treatment as usual (TAU) through a drop-in center. Findings showed that youth assigned to CRA, compared to TAU, reported significantly reduced substance use (37% v. 17% reduction), depression (40% v. 23%) and increased social stability (58% v. 13%). Youth in both conditions improved in many other behavioral domains including substance use, internalizing and externalizing problems, and emotion and task oriented coping. This study indicates that homeless youth can be engaged into treatment and respond favorably to intervention efforts. However, more treatment development research is needed to address the barriers associated with serving these youth. Keywordshomelessness; adolescents; substance abuse; treatment; community reinforcement approach (CRA) Treatment Outcome for Street-Living, Homeless YouthAlthough research focusing on chronic runaways and homeless youth is increasing, there is a void of treatment evaluation studies with this group. Clements, Gleghorn, Garcia, Katz, and Marx (1997) note the importance of examining street based youth as separate from more stable, shelter residing youth given the higher levels of risk behaviors among street living youth. Street living youth often do not access other institutional settings (shelters, foster care, treatment centers) or family for assistance because these systems are not perceived to meet their needs (Marshall & Bhugra, 1996). In sum, differences among street living and shelter residing youth suggest the need for different intervention foci. Different challenges are posed and different treatment strategies are needed when addressing substance use and motivation for change in a youth whose basic needs are met (shelter-residing youth) than for a youth who has trouble finding enough food to eat, a place to sleep and receiving needed medical care. Scope of the ProblemAlthough estimates are crude given that these youth do not make it into standard school or population surveys, estimates of the number of youth who leave home prematurely each year Corresponding Author Natasha Slesnick, Ph.D. Human Development and Family Science The Ohio State University 135 Campbell Hall; 1787 Neil Ave Columbus, OH 43210 Ph: 614-247-8469 FAX: 614-292-4365 Email: Slesnick.5@osu.edu 2 Using an inverse transformation of the use of hard drugs variables made the scores more normally distributed. The untransformed scores had a skewness of 1.82 and 3.02 and kurtosis of 2.49 and 8.65 for each of the assessment points (intake, 6mfu). The transformed scores skewness was 0.42 and 0.42 and kurtosis was -1.51 and -1.78 for each of the assessment points (intake, 6mfu).

The impact of an integrated treatment on HIV risk behavior among homeless youth: a randomized controlled trial

“…Substance use, mental health and housing outcomes from this data are reported elsewhere (Slesnick et al 2007). This study examined an integrated cognitive-behavioral and HIV prevention intervention with the expectation that youth assigned to the project intervention would report a reduced number of HIV risk behaviors post treatment compared to youth assigned to treatment as usual.…”

"Housing First" for Homeless Youth With Mental Illness

“…Case management, a strategy used widely with homeless youth, has demonstrated improvements in housing stability over time, but did not separate from other active treatments 5 or treatment as usual. 6 The Community Reinforcement Approach, an operant-based behavior therapy tested in 2 randomized controlled trials in homeless youth, was associated with a reduction of days homeless 5 and increased social stability (a measure which included housing), 7 but with only the latter trial demonstrating improvement relative to a comparison group, it is not clear that any empirically tested interventions have impacted youth's housing stability beyond general support and the passage of time.…”

Outcomes for street children and youth under multidisciplinary care in a drop-in centre in Tegucigalpa, Honduras

“…Few studies have described the outcomes of street children and youth attending day care centre programmes (Slesnick et al, 2007;Slesnick et al, 2008b;Slesnick and Prestopnik, 2005). Services providing psychological care, case management and the provision of basic necessities have shown to lead to improvements in mental health, substance abuse and social stability (Slesnick et al, 2008b).…”

“…The CRA addresses the clinical needs of homeless individuals, including substance use, homelessness and mental health problems, using an operant perspective based on the assumption that environmental contingencies play a powerful role in behaviour change. CRA procedures overlap considerably with other cognitive-behavioural intervention models and have been successfully used with housed adolescents and homeless youth (Slesnick et al, 2007). Identification and referral of cases of severe mental illness to psychiatric facilities where psychopharmacological treatment was available was also part of the strategy.…”

“…Substance abuse and mental and physical health problems among street children and youth are substantial problems and the provision of medical and mental healthcare presents challenges to organizations working with this population (Souza and de Leon, 2007) While treatment models focusing on mental health and substance abuse have been developed (Slesnick et al, 2007;Slesnick et al, 2008b;Slesnick and Prestopnik, 2005;Souza and de Leon, 2007;Waldron et al, 2001), descriptions of the implementation of these services and their outcomes for street children and youth in low-income countries remain rare.…”