Trauma-Informed Sexual Health Intervention for Homeless Youth

Background and Purpose: Half of homeless youth become pregnant at least once during adolescence and the majority of these pregnancies are unintended. The pregnancy rate among homeless youth is five times that of the general population. Homeless female youth have high rates of sexual victimization and many have a complex trauma history, escalating incidence of sexual risk behavior and myriad vulnerabilities. Further, education, healthcare, and social systems are often ill-prepared to address the sexual health needs of homeless youth. In response, we developed and tested Wahine (“girl”) Talk, a trauma-informed intervention delivered via a youth drop-in center in Waikiki (a Honolulu, Hawai‘i neighborhood with high rates of youth homelessness). Wahine Talk functions at the individual, interpersonal, and system level to improve homeless female youths’ social connectedness, linkage to sexual healthcare, overall well-being, and uptake of longer-acting contraception (Depo-Provera or long acting reversible contraception [LARC]). Wahine Talk has four components: basic need and social services, peer mentoring, sexual health education groups, and sexual health services. Youth receive a smartphone at enrollment to facilitate engagement, cellphone data boosts when they participate in program groups, and an upgraded smartphone and data plan if they adopt a longer-acting birth control. This presentation will describe results of an implementation evaluation of Wahine Talk focused on initial feasibility, acceptability, and appropriateness.

Methods: Our interdisciplinary team (social work/public health/nursing) delivered Wahine Talk over 60 weeks in a series of cycles to N=50 homeless youth aged 14-22 years. We collected detailed process and outcome measures at pre-test, weekly, and at post-test in this embedded mixed-method phase 1 clinical trial. We then conducted a series of in-depth qualitative individual interviews and focus groups with Wahine Talk participants and providers to further assess the initial feasibility of intervention delivery, acceptability of Wahine Talk to deliver and to receive, and appropriateness of Wahine Talk for homeless youth.

Results: Youth’s access to sexual healthcare, readiness to use birth control, and clinic-reported birth control use increased significantly* during the program. Youths’ social connectedness did not significantly* increase. According to clinic records, over half of enrolled youth selected a longer-acting contraception option (i.e., either Depo-Provera or LARC) during the program - 22% specifically selected a LARC method. Youth reported receiving a smartphone was an incentive for participation, and used smartphones to facilitate connections to staff and family members. Youth valued the opportunity to gain “knowledge about things we didn’t know” and “new parts about myself. I was mindblown”. The program was challenging to implement due to the nature of the population being served, but is highly rewarding, according to providers.

Conclusions and Implications: Addressing sexual health and well-being among homeless youth will likely require holistic, comprehensive, multi-level intervention in order to reduce individual risk behavior and ensure systems are welcoming, responsive, and trauma-informed in their approach. LARC uptake rates among Wahine Talk participants are especially promising, as 22% of enrolled youth selected LARC compared to 5.8% of general U.S. population youth.

(*p<.05)