Predictors of First-Episode of Homelessness Among Adolescents and Young Adults in a Nationwide Substance Use Treatment Sample

Background: In the United States, over 36,000 unaccompanied youth and young adults experienced homelessness on a single night in 2018. Large, nationally representative studies have reported a wide range of risk factors stemming from sociodemographic domains, such as low socioeconomic status, to higher ecological contexts, such as family conflict. However, little research has identified predictors of first-episode of homelessness among youth receiving substance use treatment. This is important, given that substance use is highly prevalent among homeless youth, and youth receiving substance use treatment are at heightened risk for a variety of psychosocial problems, including homelessness. The present study examined predictors across multiple domains (individual, family, peer, mental health, victimization, and treatment) among a nationwide sample of adolescents and young adults in substance use treatment.

Methods:  Data come from a longitudinal study assessing a wide range of functioning in multiple developmental outcomes in U.S. substance use treatment settings from 2003 - 2013 (n = 20,069 adolescents; n = 3,717 young adults). Participants completed an initial assessment at intake and follow-up assessments 3- 6- and 12-month post-intake. Since our main research question is about the first-episode of homelessness, participants who reported previous experience of homelessness at intake were excluded from the analysis. We also excluded those who did not provide complete data on variables of interest, bringing the final analytic sample to 3,263 adolescents (aged 12-17) and 1,056 young adults (aged 18-25). First-episode of homelessness was defined as reporting at least one day of homelessness or having to stay with someone else to avoid being homeless at follow-up (1 = yes; 0 = no). Hierarchical logistic regression was used as the main modeling strategy.

Results: The majority of participants were male (75.1%) and currently involved with the criminal justice system (74.0%); just over one third (32.7%) were Non-Hispanic White. In the 12 months following treatment intake, 120 (3.5%) of adolescents and 65 (6.0%) of young adults reported their first-episode of homelessness. For adolescents, LGB status (OR = 2.09, CI[1.10, 3.97]), financial problems (OR = 1.18, CI[1.00, 1.39]), and number of prior substance use treatment episodes (OR = 1.21, CI[1.01, 1.45]) were associated with increased odds of first-episode of homelessness. For young adults, being a parent (OR = 1.74, CI[1.01, 3.00]), victimization experiences (OR = 1.12, CI[1.03, 1.22]), and number of self-help meetings attended (OR = 1.02, CI[1.00, 1.03]) were associated with increased odds of first-episode of homelessness.

Conclusions and Implications:  Study results identified significant factors associated with youth homelessness in the 12 months following substance use treatment intake. These factors may help identify individuals who could benefit from homelessness prevention services at treatment intake. Factors likely differ for adolescents and young adults, suggesting the need for age-appropriate social work practice and policies to prevent homelessness in youth and young adults receiving substance use treatment.