Mental Health Services

This book chapter reviews trauma and youth homelessness, discusses specific strategies to implement trauma-informed care in service settings, and provides excerpts of interviews with youth and service providers that illustrate the challenges homeless youth face and how trauma-informed services address their unique needs. Research indicates that trauma is pervasive in the lives of youth who are street involved or homeless and is both a cause and a consequence of homelessness. Homeless youth are vulnerable to victimization and may be plagued by chronic stress, including unmet basic needs, food insecurity, and loss of friends, family members, community, and social supports. This type of chronic and repeated exposure to adversity and trauma leads to serious mental health consequences. In addition, young people with complex trauma may have difficulty engaging with service providers and benefiting from traditional youth services. The chapter concludes with implementation considerations and key messages for practitioners and agencies.  

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. 

The Atlas Project focuses on children and youth who are served by New York City Treatment Family Foster Care (TFFC) programs. The project’s goal is to address trauma experienced by TFFC clients by implementing systematic trauma screening and assessment, treatment decision-making tools, and trauma-informed mental health treatment. This paper describes components of the Atlas Project, initial experiences with implementation, and aspects of the project that can inform integration efforts.

This supplement to the 2018 Children’s Mental Health Report from the Child Mind Institute provides suggestions on how to talk about difficult subjects with teens. It discusses how to maintain ongoing conversations about normal fears, how persistent anxiety can develop into a disorder, and why early treatment is best. This guide describes how adults can build rapport with teens by being curious without being judgmental, showing trust, being collaborative, giving praise, and staying calm. It covers general anxiety; social anxiety; social media risks and rewards; anxiety and substance abuse; anxiety disorder, depression, and suicidality; and treatment.

This brief from the Institute for Children, Poverty, and Homelessness (ICPH) presents key findings from a study that shows homeless students are at significantly higher risk for suicide than the general high school student population. This study uses data from eight states and New York City, which the Centers for Disease Control and Prevention collects through the self-reported Youth Risk Behavior Survey. ICPH recommends increasing the availability of mental health care services within schools, training teachers and school staff about trauma-informed care, and targeting services for homeless LGBTQ students.

This book chapter provides information on two substance use and mental health interventions for homeless youth--the community reinforcement approach (CRA) and motivational enhancement therapy (MET). An estimated 48 percent to 98 percent of youth who are homeless meet criteria for at least one mental health diagnosis, including depressive disorders, anxiety disorders, posttraumatic stress disorder, psychosis, and attention-deficit/hyperactivity disorder. Between 69 percent and 86 percent meet criteria for a substance use disorder. Youth who are homeless have elevated rates of co-occurring substance use and mental health disorders when compared with their housed peers. Left untreated, substance use and mental health problems create additional barriers to exiting homelessness. Intervention efforts to improve the lives of these youth may have limited impact if underlying substance use and mental health problems are not treated. Research has shown that using CRA and MET has been effective among homeless youth. Youth who participated in CRA reported increases in social stability and decreases in drug use and depression compared with usual treatment. MET has been associated with similar positive outcomes. The book chapter describes the theoretical basis for both interventions, as well as program components and implementation considerations.   

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 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 report from the national Stop Solitary for Kids campaign is a practical guide for youth justice system administrators, supervisors, staff, practitioners, policymakers, and advocates to begin the process of safely reducing room confinement in their juvenile and adult facilities. It provides examples of this process undertaken by three state agencies and one county sheriff’s department: Colorado Division of Youth Services, Massachusetts Department of Youth Services, Oregon Youth Authority, and Shelby County Sheriff’s Department in Memphis, Tennessee. Data from these jurisdictions demonstrate that reducing room confinement is possible without increasing violence in a facility. Moreover, shifting youth justice facility practices away from punitive isolation and towards models that focus on emotional regulation and behavioral skills helps youth successfully transition back into their communities. (author abstract modified)

This book chapter describes mindfulness as an intervention approach for homeless youth to improve their mental health. Mindfulness involves bringing attention to what is happening within us and around us in moment-to-moment experiences, without labeling experiences as good or bad. It has been found to be an effective approach for improving well-being among adults and there is increasing support for its use in enhancing regulatory capacities among vulnerable youth populations. Pilot studies that examine whether mindfulness intervention is possible in shelter settings and is acceptable to homeless youth generally find that youth will attend mindfulness training and that those who do may experience important benefits. The chapter begins by describing the general objectives and components of mindfulness-based practice. It then discusses how mindfulness-based programs have been implemented with youth experiencing homelessness and what the outcomes have been. The chapter concludes with key strategies for practitioners to consider in their work with youth accessing homeless services.