What Do Young People Experiencing Homelessness Want from Substance Use Preventative Interventions?

Background/Purpose: In a year, 4.3%-12.5% of young people (ages 13-25) experience homelessness in the U.S.. Youth experiencing homelessness (YEH) experience a range of detrimental outcomes-including but not limited to substance use. Almost 81% of YEH report engagement in substance use, however, few interventions exist that reduce and mitigate substance use among this group. Because this group has high needs but are often hard to engage in services, more attention towards intervention development that includes the perspectives of youth is essential. Therefore, the purpose of this study is to understand YEH’s perceived needs and preferences for a substance use preventative intervention.

Methods:Using a purposive sampling design, participants were recruited from Urban-Peak, a non-profit organization serving homeless youth in downtown Denver. Participants were between 18-25 years of age, were required to speak and understand English, and gave verbal consent. A total of thirty-nine YEH (24 males, 11 females and 4 gender-minority) participated. Five focus groups were carried out. An unstructured interview guide was used to assess youth’s perceptions about:

1. What would an intervention offer to engage young people in talking honestly and without discomfort about substance use?
2. What would be the format of the intervention, both in terms of content (e.g., focus on harm-reduction vs. abstinence) and structure (e.g., suggested length of intervention, who would deliver it, etc.)?
3. What would help them stay motivated to remain engaged in such efforts?

Results:Using a content analysis approach, we read transcripts, took notes on initial impressions, and created a preliminary codebook. These coding schemes were then used to label the transcripts. Four members of the research team coded independently and then met to discuss their impressions and reach consensus. We also used multiple strategies to ensure the trustworthiness and rigor of our analysis. We generated an audit trail comprising analytical memos and meeting notes, to track our collective decision‐making process and ensure consistency. Data Analysis revealed 3 main themes:

1. Intrinsic Drive: Youth described a need for their own personal intrinsic drive to be taken into account (e.g., personal goals, awareness of consequences and readiness to change) in order for a preventative intervention to be successful.
2. Intervention Design: Youth described the importance of the intervention design being inclusive and promoting engagement (e.g., flexibility, trauma-informed, rewards, and experiential content, focus on harm reduction).
3. Necessary Resources: Youth identified key resources that they would need in order to be successful in a preventative intervention (e.g., social support, alternative coping resources, relatable models).

Conclusion/Implications: YEH are aware of their unique barriers and facilitators to success within a substance use preventative intervention. YEH’s perceptions of their own needs should be considered when designing substance use interventions; interventions must be compatible with lived experiences. As evidenced in this study, many YEH prefer interventions that are designed with their individual needs in mind in order to be successful. Additionally, more research is needed to assess the effectiveness of employing CBPR strategies in interventions targeted at YEH.