More than four walls and a roof needed: A complex tertiary prevention approach for recently homeless youth.

Abstract

This article examines the feasibility of a complex intervention designed to facilitate the transition of youth out of homelessness. It is intended to contribute to efforts to build out the youth homelessness intervention literature, which is underdeveloped relative to descriptive characterizations of risk. The 6-month intervention examined here, referred to as the Housing Outreach Program-Collaboration (HOP-C), is comprised of transitional outreach-based case management, individual and group mental health supports, and peer support. The intervention was delivered through a multiagency, interdisciplinary collaboration. Feasibility was assessed using a mixed methods design that included prepost intervention metrics and the study site was a large Canadian urban center. A total of 31 youth participated in the study with 28 completing the intervention. Overall, implementation and youth engagement was successful though patterns and intensity of engagement were quite variable. While prepost, self-report metrics improved modestly, substantial gains were observed in employment, education, and mental health service connectedness. Qualitative themes focused on the benefits of a flexible, multicomponent approach, close attention to seamless delivery and common factors, and supporting youth in the balance of isolation versus independence. These findings suggested that this tertiary prevention approach is feasible and warrants further investigation. Public Policy Relevance StatementThere is very little evidence regarding the types of services and collaborations that are necessary to support youth in transition out of homelessness. This article describes an example of a multiservice intervention that can inform growing policy-level efforts to replace crisis-oriented care systems with prevention-oriented systems. Fostering collaborations between service sectors is a priority of policymakers in many contexts and is a requirement for effective service delivery for homeless, transitionaged youth. The collaborative, codeveloped design described in this article can inform city-level

The intersection of housing and mental well-being: Examining the needs of formerly homeless young adults transitioning to stable housing

“…Research is limited on the challenges formerly homeless young adults (FHYAs) face after they secure housing ( Desjarlais-de Klerk, 2016 ; Gadermann et al, 2020 ; Kidd et al, 2019 ; Kozloff et al, 2016 ; van der Laan et al, 2020 ). The existing evidence indicates that FHYAs are a particularly vulnerable population based on their high rates of early childhood traumas and their experiences of living on the streets or being precariously housed ( Bender, Begun, Durbahn, Ferguson, & Schau, 2018 ; Crosby, Hsu, Jones, & Rice, 2018 ; Morton et al, 2018 ; Perlman, Willard, Herbers, Cutuli, & EyrichGarg, 2014 ; Rew, Powell, & Thompson, 2016 ).…”

“…In a longitudinal study of young adults exiting homelessness, participants made modest gains in education, employment and connecting to behavioral health supports. But the majority also reported facing adversities (e.g., post-traumatic stress, social isolation, substance use relapse, hospitalization) and mental health struggles ( Kidd et al, 2019 ).…”

“…Environmental factors also appear to affect the trajectory of housing stability among young adults; in Kozloff et al (2016) , the mean percentage of days over the course of 24 months young adults were stably housed fell from 73% to 64% compared to adults which was relatively stable (78%–76%). Over the course of their transition to independent living, FHYAs reported sources of stress about maintaining employment, personal relationships, and housing stability ( Kidd et al, 2016 , 2019 ; Kozloff et al, 2016 ). Similarly, these socio-environmental stressors were commonly described challenges adults faced in their transition out of homelessness ( Kozloff et al, 2016 ; Poremski et al, 2016 ; Stergiopoulos et al, 2014 ).…”

“…Although not specifically focusing on young adults, formerly homeless adults in stable housing reported similar mental health issues as adults experiencing homelessness ( Desjarlais-de Klerk, 2016 ). Similarly, FHYAs report struggling with mental health issues ( Kidd et al, 2019 ; Kozloff et al, 2016 ). In a 24-month randomized study, Kozloff et al (2016) demonstrated a similar trend in the mental well-being of young adults who were either randomized to receive “Housing First” or treatment as usual.…”

“…Young adults who received “Housing First” reported minimal improvements in their perceived psychiatric symptomatology, mental health status, and overall quality of life compared to the control group ( Kozloff et al, 2016 ). In Kidd et al (2019) , one-quarter of young adults who transitioned out of homelessness experienced subsequent mental health crises that resulted in a hospitalization or substance use relapse. This evidence calls attention to recognizing young adults’ behavioral health histories and responding to their ongoing behavioral health needs in their transition to stable housing and long-term well-being ( Pedersen et al, 2018 ).…”