Motivational Network Intervention to Reduce Substance Use and Increase Supportive Connections for Emerging Adults in a Supportive Housing Program.

BACKGROUND: For transition-aged youth experiencing homelessness (TAYEH) moving to transitional housing, a motivational network intervention (MNI) may help modify high-risk networks, thereby reducing substance use and strengthening prosocial connections. METHODS: Thirty-six TAYEH received a four-session MNI integrated into usual housing case management or usual case management. Intervention acceptability, feasibility, and motivational interviewing fidelity were evaluated. RESULTS: Nearly all participants would recommend the MNI to others, formed goals, and believed the program improved their lives. Case managers delivered the program with fidelity. However, sample size and number of sessions delivered fell short of targets due to COVID-19 disruptions and other factors and limited our ability to examine preliminary effects on substance use and network outcomes in a fully powered trial. CONCLUSION: Case managers can successfully deliver the MNI, but its use may not be feasible unless adaptations are made to accommodate the instability this population faces when they enter housing.

Building resilience of street-connected children during COVID-19: turning rights into practices through CINI method.

This article examines the methods and opportunities for SCC's meaningful participation that recognize their agency and are aligned with General Comment No. 21 (GC21) to the United Nations Convention on the Rights of the Child (UNCRC) on Children in Street Situations (UNCRC, 1989). This article explains the application of CINI's core practice models which explains the child centrality in development practices for "turning rights into practice for children" derived from the Sustainable Development Goals, principles of Human Rights, UNCRC, and General Comment No. 20 (2016). The Institutional knowledge was practiced through child-led action research with street- connected children which resulted in the development of agency among SCC, peer researchers, and child advocates for resilience building within their community during COVID-19. Child in Need Institute (CINI) has been working with SCC since 1989 and has derived a rich body of experience from the interventions. CINI applied participatory approaches to practice, research, decision-making, and policy development; thus, facilitating children in the process of systematically gathering information with their peers, identifying key issues and problems faced by SCC, and securing support from duty bearers that were required for the survival within their situations. Drawing on the approach undertaken and the tools used in the participatory research and advocacy, this article reflects upon the processes and strategies that worked out in facilitating SCC's ability to exercise agency and resilience through evidence generation and advocacy during COVID-19 and the associated lockdown and beyond. Through capacity building on research tools, leadership and communication skills, SCC can build concrete evidence of their vulnerabilities and the gaps that pose as barriers to their access to existing support mechanisms. This evidence helps them to prioritize the solutions that are required to bring changes in their lives and that of their peers, with which they can advocate at different platforms that promote dialogs and negotiations between children and duty-bearers. A participatory research project funded by Wellcome Trust focused on the vulnerabilities faced by street-connected young people and the access to services available to them. It revealed the lack of understanding regarding SCC and their invisibility in data and planning of support services, the gaps in access to healthcare services, the social determinants of health including safety, and their exclusion in platforms for dialogs with duty bearers. They took these issues to local government leaders, service providers, and national and international advocacy platforms; and suggested solutions to local and world leaders to bring changes in their situations. This resulted in a marked increase in the responsiveness of service providers toward SCC during the period of COVID-19, and the increased agency and negotiation skills of peer leaders to support their communities and demand solutions during the period of COVID-19 and associated lockdown.

Health Needs Assessment of Unhoused Youth in Charleston, South Carolina.

BACKGROUND: Over 35 000 youth experience homelessness on any given night in the United States (US). Unhoused youth experience unique physical and mental health challenges and face barriers in every social determinant of health (SDoH), which may be amplified in the LGBTQ+ population. OBJECTIVE: The objective of this study was to define characteristics of the unhoused youth population and their utilization of healthcare to inform programs to meet their needs. METHODS: Secondary analysis of data from the College of Charleston's YOUth Count survey was conducted, focusing on health-related characteristics, challenges, healthcare utilization, and SDoH of youth aged 18 to 25 experiencing homelessness in Charleston, SC. RESULTS: Almost three-quarters of respondents (74.6%) reported mental health challenges and 35% reported physical health challenges. A significantly higher proportion of those who engaged in survival sex were LGBTQ+ . More than half (68.4%) visited the emergency department (ED) and 29.3% were admitted to the hospital in the past 12 months. Housing status, safety, food insecurity, sexual orientation, prior foster care, and survival sex were all significantly associated with ED utilization. Housing status and survival sex were significantly associated with hospital admission. CONCLUSIONS: Addressing SDoH is essential to improving health outcomes and healthcare utilization among unhoused youth, particularly in the LGBTQ+ population.

Psychological capital variables as protective factors in indigenous youth experiencing homelessness.

Indigenous youth in the United States are at high-risk for experiencing homelessness related to adverse childhood experiences such as parental substance use and low educational attainment. Such experiences may lead to adverse physical and mental health issues; these youth also have positive attributes of psychological capita (hope, self-efficacy, resilience, optimism) that are related to health outcomes. The purpose of this secondary analysis was to describe demographic attributes and psychological capital in Indigenous youth experiencing homelessness (IYEH) who participated in a longitudinal intervention study related to safe sex behaviors and life satisfaction. From a total of 602, Indigenous participants (n = 111; mean age 21.25 ± 1.82 years) were recruited from drop-in centers in Austin, Texas and Columbus, Ohio. Data were collected immediately after the intervention and at 3- and 6-month intervals. For this analysis, only data collected at the final time-point were used. Valid scales with Cronbach alphas of 0.75-0.92 (Hope, Resilience, Optimism, Self-efficacy for Substance Refusal, Self-efficacy for Safer Sex, Safe Sex Behaviors, Social Connectedness, and Life Satisfaction) were used. The majority of the IYEH reported smoking, drinking, and using drugs. Psychological capital variables of hope, self-efficacy for negotiating safer sex, resilience, and optimism were significantly related to one another, but not to safe sex behaviors or intention to use condoms. Resilience and optimism were significantly related to social connectedness but not to other psychological capital variables. Life satisfaction was significantly associated with hope, resilience, and optimism. Findings have implications for further theory and research development.

Street adolescents in low income setting exposed to hepatitis B and C, and disadvantaged by lifestyle: a Togolese cross-sectional study.

BACKGROUND: In Togo, few data are available on viral hepatitis in street adolescents, a vulnerable population due to their lifestyle. The aim of this study was to describe the lifestyle of street adolescents (sexual practices and drug use), to estimate the prevalence of hepatitis B and C viruses, and to describe their HBV immunization profile in Togo. METHODS: A cross-sectional study was conducted in Lomé (Togo) in July 2021. Street adolescents aged between 13 and 19 years were included. A questionnaire was used to document lifestyle. ELISA tests were performed for Hepatitis B surface antigen (HBsAg), Hepatitis B core and surface antibodies (anti-HBc, anti-HBs), and antibodies against hepatitis C virus (anti-HCV). RESULTS: A total of 299 adolescents (5.4% female) with a median age of 15 years (IQR: 14-17) were included. Of these, 70.6% (211/299) were sexually active and 70.6% (149/211) had not used a condom during their last sexual intercourse. Drug use was reported by 42.1% of the adolescents. The most used substances were cannabis (39.0%), cocaine (36.6%), glue solvents (19.5%), and tramadol (11.4%). However, cocaine use may have been overestimated due to information bias. Current HBV infection (HBsAg+) was detected in 3.7% (95%CI: 1.9-6.5) of the adolescents. Isolated anti-HBc + was present in 5.3%. All three HBV markers (HBsAg, anti-HBs, and anti-HBc) were negative in 71.6% of adolescents. Anti-HCV was detected in 4.7% of adolescents. CONCLUSION: Nearly one in 10 street adolescents has markers for HBV contact/current infection, and approximately 72% of street adolescents may still be infected with HBV, as they have no HBV markers. HCV is also circulating in this population. Given the reported high-risk sexual practices and high levels of drug use, there is an urgent need to develop integrated strategies to prevent infections, including HBV, and drug dependence in this population.

Keeping young researchers out of harm's way: conducting youth participatory action research with young people experiencing homelessness.

Introduction: Youth Participatory Action Research (YPAR) is an approach to conducting research with youth populations in order to effectively engage youth in research that impacts their lives. Young people experiencing homelessness (YEH) are vulnerable to power and social environments in ways that call attention to their experiences in research. Methods: The context for this paper was a qualitative YPAR project to incorporate youth voice into the operations of a larger research study that hired youth as researchers. Participant-researchers provided feedback and consultation with senior staff in order to improve their access to resources, safety, and stability. Results: Themes that emerged from thematic analysis of reflections, discussions, and meetings showed the need for consistent access to food, the risk of environmental violence targeting youth researchers, the structural and experiential barriers to professional engagement, and the benefits that young researchers experienced as part of their work in the study. Discussion: Recommendations and lessons learned are described, notably to ensure that youth are paid and provided food, to construct effective safety plans during fieldwork, and to provide a flexible, inclusive, trauma-responsive approach to supervision of project tasks.

Discovering sources of resilience among homeless LGBTQ+ youth in out-of-home care in Israel: An ecological framework.

BACKGROUND: LGBTQ+ youth in out-of-home care experience multiple stressors due to being a minority group, in out-of-home care, and rejected by their families. Therefore, they tend to be vulnerable. OBJECTIVE: The purpose of this study is to explore the sources of the resilience of homeless LGBTQ+ youth in out-of-home care in the Israeli context. The research question was: What are the experiences, perceptions, and constructions of "resilience" among LGBTQ+ youth who aged out of out-of-home care for homeless LGBTQ+ youth in Israel? METHODS: The study employed a critical constructivist grounded theory approach. Thirty-one in-depth semi-structured interviews were conducted with LGBTQ+ youth aged 16 to 32 (average age of 21.5) and analyzed. RESULTS: The data analysis presents the sources of resilience according to four levels. (1) The individual level refers to self-acceptance, faith and hope, and creativity and productiveness. (2) The interpersonal level refers to friends and peer groups, educational institutions, employment environments, professionals, and LGBTQ+ out-of-home care services. (3) The macro level refers to public visibility of the LGBTQ+ community and financial support. (4) Finally, the chrono level refers to the development of rights and recognition over time. CONCLUSIONS: An ecological model was implemented to conceptualize resilience among LGBTQ+ youth in out-of-home care in Israel. This multidimensional model was used to construct resilience sources that could assist in overcoming adversities among these youth. Implications for practice and future research are discussed.

Multisystemic factors predicting street migration of children in Kenya: A multilevel longitudinal study of families and villages.

BACKGROUND: Street-migration of children is a global problem with sparse multi-level or longitudinal data. Such data are required to inform robust street-migration prevention efforts. OBJECTIVE: This study analyzes longitudinal cohort data to identify factors predicting street-migration of children - at caregiver- and village-levels. PARTICIPANTS AND SETTING: Kenyan adult respondents (n = 575; 20 villages) actively participated in a community-based intervention, seeking to improve factors previously identified as contributing to street-migration by children. METHODS: At two time points, respondents reported street-migration of children, and variables across economic, social, psychological, mental, parenting, and childhood experience domains. Primary study outcome was newly reported street-migration of children at T2 "incident street-migration", compared to households that reported no street-migration at T1 or T2. For caregiver-level analyses, we assessed bivariate significance between variables (T1) and incident street-migration. Variables with significant bivariate associations were included in a hierarchical logistical regression model. For community-level analyses, we calculated the average values of variables at the village-level, after excluding values from respondents who indicated an incident street-migration case to reduce potential outlier influence. We then compared variables between the 5 villages with the highest incidence to the 15 villages with fewer incident cases. RESULTS: In regression analyses, caregiver childhood experiences, psychological factors and parenting behaviors predicted future street-migration. Lower village-aggregated depression and higher village-aggregated collective efficacy and social curiosity appeared significantly protective. CONCLUSIONS: While parenting and economic strengthening approaches may be helpful, efforts to prevent street migration by children should also strengthen community-level mental health, collective efficacy, and communal harmony.

Assessment of malnutrition using Z-scores and Composite Index of Anthropometric Failure among street children in Delhi.

BACKGROUND: Street children are poverty-stricken and have insufficient money to meet their daily nutritional requirements. They do not have a proper place to sleep and defecate. They sleep at traffic signals, in religious places, and on footpaths. This exposes them to pollution, dirt, and other pathogens. OBJECTIVES: This study aimed to measure the nutritional status of street children in Delhi using Z-scores and Composite Index of Anthropometric Failure (CIAF). METHODS: Anthropometric measurements are direct methods of measuring the nutritional status of humans. Anthropometric indicators such as underweight (weight-for-age), stunting (height-for-age) and BMI/wasting (weight-for-height) are used to measure the nutritional status of street children. Z-scores and CIAF are calculated for street children based on the WHO 2009 reference. RESULTS: According to Z-scores, stunting (56%) is the most common anthropometric failure among street children followed by underweight (31%) and wasting (19%). According to the CIAF, 63% of street children are malnourished, where stunting (37%) is the highest single burden of anthropometric failure, followed by wasting (3%) and underweight (1%); children suffering from the double burden of anthropometric failure are 9%, and children suffering from the triple burden of anthropometric failure (i.e., wasting, stunting, and underweight) are 13%. CONCLUSION: A high incidence of stunting points to poor quality of food and suggests prolonged nutrition deficiency among street children. The Z-score or conventional measures of anthropometry underestimate the total burden of malnutrition among street children, while CIAF provides an estimation of children with single-burden, double-burden, and triple-burden malnutrition or total burden of malnutrition.

Bounding systems: A qualitative study exploring healthcare coordination between the emergency youth shelter system and health system in Toronto, Canada.

BACKGROUND: Several youth staying at emergency youth shelters (EYSs) in Toronto experience poorly coordinated care for their health needs, as both the EYS and health systems operate largely in silos when coordinating care for this population. Understanding how each system is structurally and functionally bound in their healthcare coordination roles for youth experiencing homelessness (YEH) is a preliminary step to identify how healthcare coordination can be strengthened using a system thinking lens, particularly through the framework for transformative system change. METHODS: Forty-six documents, and twenty-four semi-structured interviews were analyzed to explore how the EYS and health systems are bound in their healthcare coordination roles. We continuously compared data collected from documents and interviews using constant comparative analysis to build a comprehensive understanding of each system's layers, and the niches (i.e., programs and activities), organizations and actors within these layers that contribute to the provision and coordination of healthcare for YEH, within and between these two systems. RESULTS: The EYS and health systems are governed by different ministries, have separate mandates, and therefore have distinct layers, niches, and organizations respective to coordinating healthcare for YEH. While neither system takes sole responsibility for this task, several government, research, and community-based efforts exist to strengthen healthcare coordination for this population, with some overlap between systems. Several organizations and actors within each system are collaborating to develop relevant frameworks, policies, and programs to strengthen healthcare coordination for YEH. Findings indicate that EYS staff play a more active role in coordinating care for YEH than health system staff. CONCLUSION: A vast network of organizations and actors within each system layer, work both in silos and collaboratively to coordinate health services for YEH. Efforts are being made to bridge the gap between systems to improve healthcare coordination, and thereby youths' health outcomes.

Social Determinants of Health and Psychological Capital Among Youth Experiencing Homelessness.

BACKGROUND: Social determinants of health affect health behaviors and outcomes. Youth experiencing homelessness suffer significant deprivation of resources such as inadequate housing, reduced education, poor health care, and decreased economic stability. Inner resources, such as psychological capital, may also be related to health behaviors and health outcomes. OBJECTIVE: In this study, we sought to describe and explore associations among selected determinants of health and self-reported scores on indicators of psychological capital among youth experiencing homelessness. METHODS: This cross-sectional secondary analysis was conducted with a randomized subsample of 148 youth. We calculated chi-square frequencies to describe the data, classical item analyses to evaluate responses, and correlation tests to examine significance of associations. RESULTS: Youth in this sample demonstrated that they possess inner resources associated with determinants of health. Education, health care, and social support were significantly associated with attributes of psychological capital (hope, efficacy, resilience, optimism). Sexual minority groups had high representation in this subsample (25.7%), indicating a need for more study and equitable services for this population. CONCLUSION: More research should be conducted to better understand the associations between determinants of health, psychological capital, and health behaviors among disadvantaged youth to advance health equity initiatives.

COVID-19 Vaccination Uptake, Infection Rates, and Seropositivity Among Youth Experiencing Homelessness in the United States.

BACKGROUND: People experiencing homelessness are at greater risk of exposure and poor health outcomes from COVID-19. However, little data exist on the prevalence and correlates of COVID-19 among homeless populations. To mitigate the spread and severity, uptake of the COVID-19 vaccine is needed. This can be challenging among youth experiencing homelessness who are more likely to be unvaccinated when compared to stably housed youth. OBJECTIVE: We conducted this study to determine the prevalence and correlates of COVID-19 among youth experiencing homelessness. METHODS: We examined experiences of COVID-19 symptoms, self-report of infection, and rates of COVID-19 antibodies and distinguished between natural and vaccinated immunity among youth experiencing homelessness ( N = 265) recruited in one large metropolitan area in the south. RESULTS: Based on self-report, very few participants experienced any symptoms, and 80% had never been diagnosed with COVID-19. Of those with COVID-19 antibodies (68%), the proportion with antibodies resulting from natural infection was 44%. The vaccination rate was 42%. Younger and vaccinated participants and those in shelters were likelier to have COVID-19 antibodies. Black and Hispanic youth were more likely than White youth to have had COVID-19. Those who adopted only one or two prevention behaviors were more likely to acquire a natural infection than those who adopted three or more prevention behaviors. DISCUSSION: Youth experiencing homelessness report low vaccination rates, disrupted access to healthcare and social supports, and underlying chronic conditions, which may explain why they face poorer outcomes when infected with COVID-19. Vaccination and risk mitigation strategies to combat the high prevalence of COVID-19 are especially needed for sheltered youth who are at high risk yet are often asymptomatic.

Unraveling substance abuse among Malawian street children: A qualitative exploration.

This qualitative study adopts a phenomenological and symbolic interactionist approach to comprehensively explore substance abuse among street children in Lilongwe, Malawi. The research aims to uncover the complex sociocultural, economic, and environmental determinants influencing substance abuse within this marginalized cohort. Through in-depth semi-structured interviews, the study engages with street children to understand their subjective experiences, perceptions, and interpretations of substance abuse within their community context. Employing convenience, purposive, and snowball sampling strategies, the research collected data from street children, acknowledging their transient nature and societal challenges. Thematic analysis was conducted on interview transcripts to derive comprehensive insights. Results revealed five key thematic areas: familial absence and emotional void, societal normalization and peer pressure, economic hardships, coping mechanisms, environmental accessibility, and peer influence and belongingness. These themes highlighted the intricate interplay between personal experiences, socio-environmental factors, and peer dynamics, shaping the prevalence and persistence of substance abuse among street children. This study's implications for practice underscore the need for tailored interventions and support mechanisms addressing substance abuse within this demographic. It emphasizes the urgency for context-specific strategies and policy formulations aimed at ameliorating the challenges faced by street children dealing with substance abuse in Malawi. Ultimately, this research contributes to a deeper understanding of substance abuse among marginalized street children, advocating for compassionate and contextually sensitive interventions within this overlooked drug abusers' population subset.

Children on the Streets of Ibadan Nigeria: Neglect of Children's Rights.

BACKGROUND: The Nigerian Convention on the Rights of the Child (CRC) 2008 enacted prohibitive laws against child streetism. However, in metropolises like Ibadan, there is a growing epidemic of street children, particularly the category with existing family ties known as "children on the streets". Children on the street come from home daily to engage in economic-oriented activities on the streets and return home to their families at night time. OBJECTIVE: We focused on perceptions of formal responses to the problem of child streetism in Ibadan. METHODS: This was qualitative research. Participants were selected from each of the five urban LGA of Ibadan, purposively and by snowball technique. In-depth Interviews (IDI) were conducted, audio-recorded and transcribed. Framework analysis of data was supported by ATLASTi version 22. RESULTS: Fifty-three (53) interviews were conducted including IDI with ten (10) child-welfare officers, ten (10) street shop owners, eleven (11) children on the street, and ten (10) pairs of parent-child dyads. Two themes emerged including governmental shortcomings with six subthemes and suboptimal governmental interventions with four subthemes. Child streetism in Ibadan is a consequence of the State's failed education systems, inadequate children's vocational and rehabilitation programs, lax child welfare laws, lack of empowerment of skilled children, and poor implementation of the policy on ideal family size. Interventions that were existing but sub-optimal included communitybased child welfare programs, parental poverty alleviation, public sensitisation and child welfare monitoring programmes. CONCLUSION: There is an urgent need to update, enforce laws, and amalgamate efforts against child streetism in Ibadan.

CONTEXTE: La Convention nigériane relative aux droits de l'enfant (CRC) de 2008 a promulgué des lois interdisant le travail des enfants dans la rue. Cependant, dans des métropoles comme Ibadan, il existe une épidémie croissante d'enfants des rues, en particulier la catégorie ayant des liens familiaux existants connue sous le nom d'"enfants des rues". Les enfants des rues viennent de chez eux tous les jours pour participer à des activités orientées vers l'économie dans les rues et rentrent chez eux auprès de leurs familles le soir. OBJECTIF: Nous nous sommes concentrés sur les perceptions des réponses formelles au problème du travail des enfants dans la rue à Ibadan. MÉTHODES: Il s'agissait d'une recherche qualitative. Les participants ont été sélectionnés dans chacun des cinq LGA urbains d'Ibadan, de manière délibérée et par la technique de la boule de neige. Des entretiens approfondis (IDI) ont été réalisés, enregistrés et retranscrits. L'analyse thématique des données a été soutenue par ATLAS-Ti version 22. RÉSULTATS: Cinquante-trois (53) entretiens ont été menés, comprenant des IDI avec dix (10) agents de protection de l'enfance, dix (10) propriétaires de magasins de rue, onze (11) enfants des rues et dix (10) paires de dyades parent-enfant. Deux thèmes ont émergé, comprenant des lacunes gouvernementales avec six sous-thèmes et des interventions gouvernementales suboptimales avec quatre sous-thèmes. Le travail des enfants dans la rue à Ibadan est une conséquence des systèmes éducatifs défaillants de l'État, des programmes de formation et de réadaptation insuffisants pour les enfants, des lois laxistes sur la protection de l'enfance, du manque d'autonomisation des enfants qualifiés et de la mauvaise mise en œuvre de la politique sur la taille idéale de la famille. Les interventions existantes mais suboptimales comprenaient des programmes communautaires de protection de l'enfance, l'alleviation de la pauvreté des parents, la sensibilisation du public et les programmes de suivi de la protection de l'enfance. CONCLUSION: Il est urgent de mettre à jour, d'appliquer les lois et de regrouper les efforts contre le travail des enfants dans la rue à Ibadan. MOTS-CLÉS: Travail des enfants dans la rue, Protection sociale, Droits de l'enfant, Lois, Famille.

Inhalant abuse among street-involved children and adolescents in India: Case for epistemic recognition and reorientation.

Contextualizing the void of research on inhalant abuse among adolescents as epistemic neglect, in this study, we use mixed-methods action research to understand inhalant abuse in a specific context in the Global South. Focusing on a large metropolitan city in Western India, we surveyed 158 street-involved children and adolescents (110 boys and 48 girls, age range from 5 to 17 years) in a group setting along with follow-up group interviews. Despite finding a high prevalence rate of inhalant abuse, our work suggests an absence of supporting structures and emphasizes the need to revisit our understanding and interpretation of substance-using behavior of street-involved youth. Instead of explaining inhalant-abusing behavior as emerging from pathological deficiencies in individuals or households, we stress the need to critically examine the exploitative environment they are embedded in. In doing so, we join efforts to decolonize conventional ways of understanding "deviant" behavior.

Evaluating a Future-Oriented Positive Youth Development Intervention to Reduce Sexual Risk Among Highly Mobile Youth: Results and Challenges.

PURPOSE: Youth experiencing or at risk of experiencing homelessness need tailored prevention programming to prevent unplanned pregnancy and sexually transmitted infections. This study evaluated the efficacy of a small-group, future-oriented positive youth development (PYD) intervention to reduce sexual risk behaviors. METHOD: Youth aged 14-19 (n = 483) experiencing or at risk of experiencing homelessness were recruited at youth-serving agencies and in alternative schools. Each cohort enrolled was randomized either to a 10-session, 5-week group future-oriented intervention to support them in adopting health-promoting behaviors such as using contraception, including condom use (n = 244) or to a no-treatment condition where they received usual services/schooling (n = 239). We assessed at baseline and 3-month and 9-month follow-up (1) vaginal intercourse without consistent contraception use, (2) vaginal and anal intercourse without consistent condom use, and (3) sexual risk behaviors, including current (last 3 months) effective contraception use by females who did not report current use at baseline. RESULTS: There was no significant difference between treatment and control conditions for most outcomes. However, among females not currently using contraception at baseline, 34% in the treatment condition compared to 12.9% in the control condition reported using contraception in the 3 months before the 9-month survey, a statistically significant difference. DISCUSSION: This sexual risk reduction intervention, grounded in PYD theory and tailored to address the needs of marginalized groups of youth, demonstrated efficacy at increasing contraceptive uptake among females. The need for PYD interventions that can be delivered in a variety of nontraditional school and service settings are discussed.

The Achieving Success Everyday Group Counseling Model: Providing Social Support for Homeless Students* in School Settings.

The Achieving Success Everyday (ASE) group counseling model is discussed to support homeless students' unique and complex needs. The phenomenology of student homelessness is reviewed, as well as how residential and environmental instability negatively impacts students' academic and psychosocial functioning. Social support for homeless students is also discussed. Next, the ASE group model is described in detail and existing research on its application in school settings is reviewed. Implications for research and practice are provided as they may influence future efforts to support homeless students. Session examples are used to help school personnel apply the ASE model in their respective schools and communities.

Lessons learned from conducting a community-based, nurse-led HIV prevention trial with youth experiencing homelessness: Pivots and pitfalls.

OBJECTIVE: This article highlights key lessons learned while conducting a nurse-led community-based HIV prevention trial with youth experiencing homelessness (YEH), focusing on sexually transmitted infections testing and treatment, intervention sessions, community partnerships, and participant recruitment and retention. DESIGN: The insights and experiences shared aim to inform future research and the design of interventions targeting populations at high risk, particularly when facing unanticipated challenges. By addressing these areas, the article contributes to the decision-making for the design and delivery of effective strategies to improve the health outcomes among marginalized populations. RESULTS: The findings underscore the importance of flexibility and active participant engagement, cultivating strong relationships with community partners, utilizing technology and social media, and fostering a diverse research team that represents the heterogeneity of youth experiencing homelessness across race/ethnicity, gender identity, sexual orientation, and lived experiences. CONCLUSIONS: These recommendations aim to enhance participant access, engagement, and retention, while promoting rigorous research and meaningful study outcomes for YEH.