Reducing the Effects of Homelessness On Adolescents and Their Families by Embedding Evidence-Informed Prevention Programs within Shelters: The HOPE (Homeless Outreach To Parents And Early Adolescents) Family Program

Purpose and Background: A growing number of adolescents residing with their families experience extended periods of homelessness and housing instability.  As a result, these youth are increasingly likely to experience compromised child mental health, health, academic performance as well as manifest increased sexual and drug risk taking. Embedded within shelter systems servicing over one million homeless children across the U.S. are providers who have the unique opportunity, not only to enhance housing stability, but also to interrupt emerging youth difficulties before developmental outcomes are compromised.  However, few brief, evidence-based, preventative interventions are available which align with the serious needs of adolescents and their families experiencing significant stressors and transitions. In response, the HOPE Family Program was designed to enhance family-level protective processes, as well as promote early identification and service referral of highly vulnerable youth.  Results from a recently completed NIDA-funded effectiveness study (R01 DA018574) will be presented for the purpose of guiding public policy makers and publicly-funded homeless service systems.  This study tests the hypothesis that the HOPE Family Program, relative to the comparison group (health education) would result in improved youth risk-taking behavior, mental health status, and parent/family-level protective processes.

Methods:  The HOPE Family Program was examined via an experimental effectiveness study involving 247 youth (ages 11-14) and their families residing in ten family homeless shelters nested within urban, low-income communities. Participants were randomly assigned to one of two study conditions:  1) HOPE or; 2) health education family workshops.  Outcomes related to youth risk taking behavior, mental health and parent/family-level protective processes were captured via a set of standardized assessments at three time points, baseline, post-intervention (8 weeks) and 3 month follow-up (5 months from baseline). Random regression modeling was used to examine multi-level outcomes across time.

Findings:  Both study conditions were associated with statistically significant improvements on HIV knowledge and stigmatizing attitudes towards persons with HIV over time.  However, only participation in the HOPE Family Program was associated with improvements in youth mental health (e.g. emotional symptoms; conduct problems; total difficulties).  Youth reports of suicidal ideation decreased over time for youth in HOPE Family Program only.  The HOPE Family Program was also associated with significant improvements in frequency of family communication regarding difficulty topics, within family support and youth reports of confidence about engaging in safe sex over time.

Implications: As poverty rates in the U.S. increase, family homelessness is likely to be a serious and more prevalent stressor for a larger number of young people.  The stigma that accompanies homelessness may have a significantly greater impact on older youth as they are aware of their social circumstances and experience related distress associated with neighborhood, peer, and school transitions.  Shelter staff are in unique positions to offer both concrete supports and linkages, but also can be prepared to provide brief, evidence-based preventative care to reduce some of the negative effects associated with homelessness.