Youth Service Engagement Among Housed and Unhoused Young Adults: The Role of Emotional Regulation

Background: Many young adults (YA) with history of homelessness have experienced trauma that contributes to elevated rates of mental health issues, including increased difficulty with emotional regulation (ER). Such difficulties may impede the development of relationships with service providers, and thus impede access to needed services. This study seeks to examine which aspects of emotional regulation are associated with service engagement.

Methods: Data come from a study of HIV risk among YA who have experienced homelessness, funded by the National Institute of Mental Health. 265 currently and previously homeless YA ages 18-29 were recruited from drop-in centers (unhoused) or supportive housing programs (housed) located in Los Angeles, CA between June 2017 and March 2019. Six separate Logistic Regression Models assessed the association of demographics, controlling for substance use, and sub-scales of the Difficulties in Emotional Regulation Scale (DERS-18) with service engagement outcomes (development of positive and supportive relationships and knowledge about accessing housing, shelters, drop-ins, and treatment). Ecological Momentary Assessment was also utilized to derive measures of instability of affect and whether a participant went to a service location during the week of the study. A Path Model examined whether instability of affect predicted visiting a service location and whether those that visited a service location reported more positive service engagement outcomes.

Findings: Results indicate YA who reported using any drugs during the study week perceived their ER skills to be worse than YA who abstained from drugs (marijuana OR=5.8, p=0.005; any hard drugs OR=12.1, p<0.001). YA who identified as gender non-conforming experienced, on average, 71% lower odds of knowing how to access housing and 68% lower odds of accessing treatment (medical, mental health, or substance use). Inattention to emotional responses (awareness) was associated with decreased odds of knowing how to access housing, shelter, and drop-in services. Further, YA indicating greater lack of awareness and tendencies toward negative secondary responses to negative emotions experienced a decreased in the odds of having developed at least one positive relationship with a youth service staff person. Those who reported using drugs during the study week and/or reported a greater struggle to control behavior when upset experienced a decrease in the odds of having identified someone in the youth service system that can offer support when they need it. Momentary responses of affect indicated that greater instability of positive affect predicted greater odds of visiting a service location during the study week, which then predicted increased knowledge of knowing how to access shelter, drop-in, and treatment. However, there was no significant relationship found between those who went to a service location during the study week and report of having positive, supportive relationships with youth service staff.

Discussion: Present findings have implications for homeless youth service providers and potentially others who work with at-risk young people. Supporting at-risk YA in the development of these specific ER skills may aid them in developing the relationships that are necessary to access needed services; as well as support in maximizing the impact of resources spent on youth services.