Intervention Strategies

This one-page summary from Chapin Hall presents five findings from a study designed to help communities to develop coordinated, system-level responses to youth homelessness. Using a large national data set, the researchers analyze how risk assessment scores of young people, ages 15 to 22, relate to the services they receive. The researchers provide recommendations for stakeholders regarding coordinated entry, assessment, and support for youth in their communities. 

This book chapter describes the individual placement and support (IPS) model of supported employment and its application to youth who are homeless. Youth who are homeless have high unemployment rates compared with their housed peers. Housed youth ages 16 to 24 in the general population have unemployment rates ranging between 8 percent and 17 percent, whereas unemployment rates for youth who are homeless range from 39 percent to 71 percent across various samples of youth living on the street or in shelters. The IPS model is an evidence-based vocational intervention that targets individuals who have severe mental illness with customized, long-term, and integrated vocational and clinical services to help them gain and maintain competitive employment. The IPS model follows eight supported employment principles: 1) zero exclusion, i.e., all clients who want to participate are eligible; 2) integration of vocational and mental health treatment services; 3) competitive employment; 4) benefits counseling; 5) rapid job search; 6) follow-along supports; 7) client job preferences influence the type of job sought and nature of support; and 8) systematic job development. In a pilot study investigating an IPS adaptation, researchers recruited from a service agency 20 young adults with mental illness who were homeless to receive the IPS intervention; a control group of 16 homeless young adults with mental illness who received services from a different agency was also recruited. They hypothesized that youth in the IPS group would have greater improvement compared with controls in five areas: 1) ever worked rate; 2) working at follow-up rate; 3) monthly work rate; 4) weekly work hours; and 5) weekly income. The study found that IPS participants were more likely than the control group to have worked at some point during the 10-month study (85 percent vs. 38 percent). Working at follow-up was reported by 67 percent of the IPS group and 25 percent of the control group. The IPS model is adaptable to work with youth with mental illness who are homeless. 

This book chapter describes a strengths-based outreach and advocacy intervention for homeless youth who are not connected to services. Research suggests that less than 10 percent of homeless youth are connected to services. This means that much less is known about this population than is known about homeless youth who access services such as shelters and drop-in centers. Service-disconnected youth have more unmet needs and more severe substance use and mental health problems. Efforts to connect youth to services are essential to prevent a range of public health consequences associated with homelessness, including premature death. Key components of strengths-based outreach and advocacy include a dual focus on youth and environment; use of paraprofessional personnel; focus on youths strengths rather than deficits, and giving youth a high degree of responsibility in directing and influencing the intervention they receive. Initial research indicates that a strengths-based outreach and advocacy intervention can be effective with homeless youth. The relationship between advocate and youth is key to success and is an important focus.    

This book chapter describes activities undertaken by Covenant House Toronto to build its capacity to respond to mental health challenges of the young people it serves. Research indicates that 30 to 40 percent of homeless youth experience major depression, bipolar disorder, posttraumatic stress disorder, and substance use. Data for Covenent House Toronto show that about 30 percent of the young people in its emergency shelters have a serious mental health concern, including thoughts of suicide. Shelters face numerous challenges in supporting homeless youth with mental health issues, including that youth present with a wide continuum of symptoms, homeless youth tend to access services sporadically over a long period, and many youth workers lack the expertise and skill set necessary to identify and address most mental health concerns. Among the strategies implemented by Covenant House Toronto are: 1) providing mental health care with trained counselors and clinicians in a drop-in setting; 2) increasing staff training opportunities; 3) employing a strengths-based philosophy of care that draws on the notion of resilience; 4) developing partnerships with university-based researchers and mental health professionals; and 5) partnering with mental health organizations that can work directly with youth. The authors recommend that practitioners in other organizations put supports in place that meet youth where they are, secure young peoples basic needs and develop relationships, and establish meaningful partnerships.  

This journal article describes methods used to recruit and retain a sample of 200 homeless youth for a four-session substance use and sexual risk reduction program at two drop-in centers in Los Angeles. Using unconventional methods, the researchers retained 91 percent of the full sample at a three-month follow-up assessment with 79 percent of the participants attending multiple sessions. The authors found that using structured materials with a small, dedicated staff helped to reach a higher retention rate with this at-risk population. This article describes the challenges researchers encounter when conducting intervention studies with homeless youth due to substance abuse, mental health problems, wariness of authority figures, and frequent relocations. It is especially challenging to retain this population across multiple program sessions and to relocate them for subsequent follow-up assessments. These retention issues can jeopardize a study’s data and conclusions. 

This journal article presents a literature review that evaluated the effectiveness of psychological interventions for runaway and homeless youth in terms of mental health outcomes. The author identified five types of psychological interventions in 11 studies: art therapy, cognitive behavioral therapy (CBT)-based interventions, family therapy, motivational interviewing, and strengths-based interventions. The findings show that family therapies are likely helpful for cases involving substance abuse and CBT-based interventions may work best for youth suffering from depression. However, the review did not find support for the effectiveness of any of the psychological interventions on mental health outcomes. In addition to recommending further research, the author encourages mental health nurses to assess the mental health status of runaway and homeless youth and provide timely and effective interventions. (author abstract modified)

This journal article expounds on three of the 20 strategies presented in the National Council of Juvenile and Family Court Judges Resolution titled Addressing the Needs of Homeless Youth and Families in Juvenile and Family Courts. The first strategy discussed is the need to improve coordination between the child welfare and juvenile justice systems, particularly related to transition and re-entry planning for youth who are involved in both systems. The second strategy discussed is the need for judges to ensure youth within their jurisdictions receive high quality legal representation and that courts and counsel are aware of the increased risk of system-involved youth becoming homeless. The third strategy discussed is for an increase in sound judicial leadership to improve outcomes for youth experiencing homelessness. The authors state that juvenile and family court judges can help change the prevailing public perception that all system-involved youth are “bad kids.” The article includes an excerpt from the personal story of Keyona Cooper, MSW, who entered the child welfare system at age 10, and later experienced homelessness when she aged out of the system.  It also includes a case study about Davidson County, Tennessee, which is a system actively working to decriminalize youth homelessness. Information is provided about the concurrent efforts of the Coalition for Juvenile Justice and the American Bar Association’s Homeless Youth Legal Network to remove legal barriers and improve outcomes for youth and young adults experiencing homelessness.

This is the eighth in a series of Research-to-Impact briefs by Chapin Hall at the University of Chicago to understand and address youth homelessness. This brief presents the results of a literature review conducted to determine what evidence exists on the effectiveness of programs and practices to prevent youth homelessness and improve various outcomes. The researchers selected 62 studies involving youth homelessness, which evaluated 51 programs, to develop an initial evidence base. This brief outlines the six key findings from this systematic review and the researchers recommendations to expand the evidence base for youth homelessness interventions. These include: 1. A small evidence base shows that youth homeless is preventable; 2. Rental assistance and supportive housing programs show promising results; 3. Most evaluations focus on interventions that address well-being and risk behaviors and show positive results; 4. Family-based interventions show positive results for behavioral health, but more evidence is needed; 5. There is little evidence on interventions to help youth experiencing homelessness achieve better employment outcomes; and 6. There is an alarming mismatch between investments in interventions and their evaluation. (author abstract modified)

This journal article describes a systematic review of the literature on the effectiveness of interventions for sexually exploited children and adolescents in fostering healing with this population. The researchers conducted a systematic search that generated 4,358 international publications of which 21 met their inclusion criteria. Based on each intervention’s objectives and delivery method, the researchers organized the programs into five categories: 1) focused health and/or social services, 2) intensive case management models, 3) psychoeducational therapy groups, 4) residential programs, and 5) other. Their review found that most programs were gender-specific, targeting girls and young women with only one designed for boys and young men. The reviewed studies reported on a range of outcomes including psychosocial outcomes, risky behaviors, trauma responses, mental health, protective factors, and public health outcomes. Despite differences in delivery, most of the interventions did, to some degree, appear to foster healing among sexually exploited children and adolescents. The researchers maintain that the findings from this review have implications for researchers, policy and program developers, and frontline practitioners who can partner together to create evidence-informed, purpose-built, and thoughtfully delivered interventions. (author abstract modified)

This report describes the Food and Housing Security Among NC State Students Initiative, which was launched in fall 2017. It provides key findings from a survey of a representative sample of NC State students (n=1,949) about food and housing security on statewide campuses. According to survey findings, 14 percent reported low or very low food security over the past 30 days and 9.6 percent experienced homelessness over the last 12 months. The researchers found an overlap between food and housing insecurity: 24 percent of students who had been homeless within the last year had also been food insecure in the last 30 days. The report includes recommendations for resolving food and housing insecurity among college students: 1) establish a permanent advisory council of students, faculty, staff, administrators, and partners; 2) coordinate services through a single point of contact; 3) develop an intentional research agenda; 4) secure funding streams; and 5) raise awareness and conduct ongoing outreach. Other program considerations include helping students access financial resources such as SNAP and FAFSA at the federal level and institution level resources, such as emergency funds and short-term loans. The report includes a list of resources with links to additional information.