Exploring Mental Health and Holistic Healing through the Life Stories of Indigenous Youth Who Have Experienced Homelessness.

Indigenous youth are the fastest growing population in Canada, yet are marked by profound and disproportionate personal, societal, political, and colonial barriers that predispose them to mental health challenges, employment and educational barriers, and experiences of housing insecurity and homelessness. It is only from the perspectives and experiences of Indigenous community members themselves that we can gain appropriate insights into effective supports, meaningful interventions, and accessible pathways to security. This paper will explore the mental health of Indigenous youth who are at risk of, or who have experienced, homelessness, as well as the lifelong perspectives, teachings, and guidance from Indigenous Elders and traditional knowledge keepers; their perspectives are weaved throughout, in order to provide a more effective means to addressing holistic healing and the mental health needs of Indigenous homeless youth. As educators, researchers and clinicians who have sought to understand this issue in more depth, our analysis aims to raise awareness about the complexities of Indigenous youth homelessness and push back against systemic barriers that contribute to homelessness, fail young people, and subject them to oppression. We also offer recommendations from a clinical perspective in order for clinicians, researchers and those working within communities to serve our Indigenous youth with a diverse set of methods that are tailored and ethical in their approach.

Association between suicide attempt and previous healthcare utilization among homeless youth.

INTRODUCTION: The purpose of this study was to examine the association between prior emergency department (ED) visit or hospitalization and subsequent suicide attempt among homeless youth aged 10-17 years old. METHODS: With New York statewide databases, a case-control design was conducted. Cases and controls were homeless patients with an ED visit or hospitalization due to suicide attempt (cases) or appendicitis (controls) between April and December. We examined ED and inpatient records for 90 days prior to the visit for suicide attempt or appendicitis. The primary exposure variable was prior healthcare utilization for any reason other than the following four reasons: mental health disorder, substance use, self-harm, and other injuries. Multivariable logistic regression models, with year fixed effect and hospital random effect, were used. RESULTS: A total of 335 cases and 742 controls were identified. Cases had lower odds of prior healthcare utilization for any reason other than the four reasons listed above. (adjusted Odds Ratio [aOR]: 0.53, p-value = 0.03). CONCLUSIONS: The association between prior healthcare utilization and decreased risk of suicide attempt among homeless youth may be due to comprehensive care provided during healthcare utilization. It may also reflect the presence of a social network that provided a protective effect.

Quality Health Care for Homeless Children: Achieving the AAP Recommendations for Care of Homeless Children and Youth.

BACKGROUND: We assessed whether and how health care organizations serving homeless pediatric patients meet recommendations issued by the American Academy of Pediatrics (AAP). METHODS: We conducted a web-based survey of Health Care for the Homeless (HCH) Program grantees serving children. RESULTS: Of 169 grantees, 77 (46%) responded. All organizations reported connecting patients to specialty services. Nearly all reported screening for homelessness (90%), facilitating Medicaid enrollment (90%), connecting patients to benefits (94%), addressing underlying causes of homelessness (83%), assisting with transportation (83%), and knowing about the causes of homelessness (76%). Fewer reported integrating comprehensive care into acute visits (61%) or having medical-legal partnerships (57%). Federally qualified health center status was associated with meeting more recommendations. We described barriers and facilitators to meeting recommendations. DISCUSSION: Health care organizations serving homeless children largely meet AAP recommendations, but integrating comprehensive care into acute visits remains an area for improvement. Disseminating best practices may support guideline adherence.

Relations between mental health diagnoses, mental health treatment, and substance use in homeless youth.

BACKGROUND: Youth experiencing homelessness have elevated rates of mental illness and substance use compared to the general population. However, the extent to which underlying mental health issues may contribute to substance use as a way to manage symptoms and whether mental health treatment may reduce risk for substance use is unclear. This paper investigated these relations in a community sample of homeless youth. METHODS: Youth ages 13-24 (N=416) were interviewed as part of a community count and survey of homeless youth in Houston, Texas. A path analysis examined relations among lifetime diagnoses of ADHD, bipolar disorder, and depression; past-month marijuana, alcohol, and synthetic marijuana use, and hypothesized mediators of past-year mental health treatment and perceived unmet need for treatment. RESULTS: Rates of prior mental disorder diagnoses were high, with extensive comorbidity across the three diagnoses (n=114, 27.3% had all three diagnoses). Relations varied by diagnoses and substances. ADHD was positively related to current marijuana use (ß=0.55 (0.16), p<0.001), a relation that mental health treatment did not mediate. Depression was positively related to synthetic marijuana use through unmet need (ß=0.25 (0.09), p=0.004) and to alcohol use through unmet need (ß=0.20 (0.10), p=0.04) CONCLUSIONS: This study provides new information about relations between prior mental health diagnoses and substance use in homeless youth. Findings support the need to consider prior mental disorder diagnoses in relation to current substance use and to assess for whether youth perceive they have unmet needs for mental health treatment.

The lived experiences of street children in Durban, South Africa: Violence, substance use, and resilience.

South African studies have suggested that street children are resilient but also suicidal, engage in unprotected sex and other high risk sexual behaviour as a means of survival, have high rates of substance abuse and are physically abused and stigmatized due to their state of homelessness. However, few studies have explored in a more holistic manner the lived experiences of street children in South Africa. The main purpose of this study was to explore qualitatively the lived experiences of street children living on the street of Durban, in the province of KwaZulu-Natal, South Africa. Adolescents (six males and four females) between the ages of 14 and 18 years (average age=16) were purposively selected and in-depth semi-structured interviews were conducted. An interpretative phenomenological analysis of the transcribed data revealed that incidence of violence and drug and alcohol use were common experiences of street life. Yet despite these challenges survival was made possible through personal and emotional strength, cultural values, religious beliefs, supportive peer relationships, and participation in sports activities. These protective, resilience resources should be strengthened in health promotion interventions with a focus on mental health, the prevention of violence, substance use, and daily physical activities that seems to provide meaning and hope.

Caracterización clínico epidemiológica de niños huerfanos con infección por VIH / Clinical Epidemiological Characterization of orphaned children with HIV infection

Antecedentes: En 2005, UNICEF, ONUSIDA iniciaron la campaña Únete por la Niñez, Únete con la juventud, Únete para vencer al sida, que se centra en cuatro esferas clave: prevención de la transmisión de la madre al niño, tratamiento pediátrico del sida, programas educativos para fomentar la preven- ción, y el apoyo a niños y niñas huérfanos con VIH en situación de vulnerabilidad. Objetivos. El Centro de Atención Integral del Hospital Nacional Dr. Mario Catarino Rivas (CAI /HNMCR) atiende a 365 niños VIH positivos, con este estudio se pretende conocer los aspectos clínicos y epidemioló- gicos que los caracteriza. Pacientes y Métodos: Se realizó un estudio descriptivo transversal, obteniéndose una muestra aleatoria de 67 niños huérfanos VIH positivos atendidos en el CAI/HNMCR. Utilizando para la recolección de datos la revisión del expediente clínico y la entrevista, tomando en cuenta las variables clínicas y epidemiológicas escogidas. Resultados: De los niños huérfanos con VIH el 70% tienen más de 13 años de edad y el 3% tiene menos de 5 años. El 38.8% viven en hogares destinados a su cuidado. El 100% de los niños huérfanos con VIH la vía de transmisión del virus fue transmisión perinatal, El 18% de los niños huérfanos con VIH son categoría clínica e inmunológica C3 y el 40% del total de estos niños han ameritado tratamiento antirretroviral de gran actividad (TARGA) de segunda línea en algún momento. Conclusiones: Es necesaria una respuesta más diligente como política de país que garantice que los derechos de estos menores en condiciones vulnerables sean respetados...(AU)

The religious-spiritual self-image and behaviours among adolescent street children in Harare, Zimbabwe.

The present study sought to explore the relationship between street childhood and adolescent religious-spiritual self-image. In Zimbabwe, there has been a rise in street children population in the urban centres. The current study investigated whether adolescent street children live and work in an eco-developmentally risky context for the development of positive religious-spiritual self-image. This rise in street children population has been in the context of a socio-politico-economic crisis, which was marked by record inflation rates and the HIV and AIDS pandemic. The research objectives were to investigate the nature of religious-spiritual self-image for street-living adolescent children, and to determine the effects of self-image on the behaviour of street-living adolescent children. A psycho-ethnographic research design was employed in this study. This involved collection of data for a sustained period in the context within which the participants live. The participants were 16 street-living adolescent children aged between 12 and 18 years and six key informants all in Harare in Zimbabwe. A total of 22 participants took part in this study. Snowballing was used to recruit key informant interviewees, while purposive sampling was used to recruit participants for focus group discussions, in-depth interview, and participant and non-participant observations. Key informant interviews, focus group discussions, in-depth interviews, and participant and non-participant observations were the data collection methods. Thematic content analysis was used for analysing the data. This thematic content analytic method helped to identify themes on the religious-spiritual self-image that emerged from the data. Data analysis revealed that the adolescent street children's religious-spiritual self-image is largely negative. Most street-living adolescent children believed that they were controlled and influenced by evil spirits and that their relatives were casting bad spells on them. The negative religious-spiritual self-image among the street children had important negative implications on psychological functioning, moral behaviours, and social relations for the street-living children.

Crianças e adolescentes abrigados: perspectiva de futuro após situação de rua / Niños y adolescentes protegidos en un albergue: perspectiva futura después de la situación de vivir en la calle / Sheltered children and adolescents: prospects for the future after homeless condition

Crianças e adolescentes abrigados normalmente experimentaram muitas formas de exclusão em suas vidas: o abandono, a violência doméstica, a privação econ™mica, social, cultural e política. Este estudo investigou a perspectiva de futuro entre crianças e adolescentes abrigados após sua vivência em situação de rua. A pesquisa foi realizada com 14 participantes, moradores de três abrigos públicos do município de Vila Velha-ES. Os dados foram coletados por meio de entrevista semiestruturada e submetidos à análise de conteúdo conforme propõe Bardin. Verificou-se nos relatos dos participantes a presença de temas como: a experiência da ruptura familiar, a intenção de regresso à família de origem, a crença na possibilidade de transformação de sua realidade por meio do estudo e do trabalho. É oportuno discutirmos a implementação de políticas públicas para essa população no sentido da oferta de atenção integral com vistas a favorecer a sua inclusão na sociedade.

Los niños y adolescentes protegidos en un albergue normalmente experimentaron en sus vidas toda la forma de exclusión: el abandono, la violencia doméstica, la privación económica, social, cultural y política. Este estudio investigó la perspectiva de futuro entre niños y adolescentes protegidos en un albergue, después de su vivencia en la calle. La investigación fue realizada con 14 participantes, que viven en tres albergues públicos del municipio de Vila Velha-ES. Los datos colectados por medio de entrevista semi-estructurada y sometidos al análisis de contenido, conforme propone Bardin. Se verificó en los relatos de los participantes, la presencia de temas como: la experiencia de la ruptura familiar, la intención de regreso a la familia de origen, la creencia en la posibilidad de transformación de su realidad por medio del estudio y del trabajo. Es oportuno discutir la implementación de políticas públicas para esta populación, en el sentido de la atención integral y apuntando al favorecimiento de su inclusión a la sociedad.

Sheltered children and adolescents have usually experienced many forms of exclusion throughout their lives: abandonment, domestic violence and economic, social, cultural and political deprivation. This study has investigated prospects for the future among sheltered children and adolescents after their homeless condition experiences. The investigation was conducted with 14 participants of three public shelters in the municipality of Vila Velha-ES. Data were collected through semi-structured interviews and subjected to content analysis as proposed by Bardin. It was found in the participants' reports the presence of topics like the experience of family breakdown, the intention to return to the birth family and the belief in the possibility of transforming their reality through studying and work. It is appropriate to discuss the deployment of public policies to this population in the sense of a comprehensive care provision in order to promote their inclusion in society.

Best self visualization method with high-risk youth.

The healing process of the Best Self Visualization Method (BSM) is described within the framework of meditation, neuroscience, and psychodynamic theory. Cases are drawn from the treatment of high-risk youth, who have histories of poverty, survival of sexual and physical abuse, and/or current risk for perpetrating abuse. Clinical use of BSM is demonstrated in two case illustrations, one of group psychotherapy and another of individual therapy.

Mindfulness practice with urban youth: a nursing experience.

Contemporary care models and new knowledge in neuroscience and brain development are the foundation for including mindfulness in the delivery of holistic health care. Youth who experience persistent poverty or other chronic environmental stressors face serious challenges to health development. This article shares a nursing challenge in piloting a mindfulness program with urban youth who have experienced homelessness.

Impact of nursing intervention on decreasing substances among homeless youth.

BACKGROUND: Alcohol use, and in particular, binge drinking, and methamphetamine use is pervasive among homeless youth and remains a social pressure among this vulnerable population. However, there is no compelling evidence that specific interventions for reducing drug and alcohol use are effective for homeless youth. OBJECTIVES: This community-based participatory action pilot study assessed the impact of an intervention study focused on decreasing use of drugs and alcohol among a sample of homeless young adults (N= 154) visiting a drop-in site in Santa Monica, California. The two programs consisted of an HIV/AIDS and Hepatitis Health Promotion (HHP) program led by nurses and an Art Messaging (AM) program led by artists. Six-month follow-up data were obtained from 100 of these individuals. RESULTS: Findings revealed significant reductions in alcohol and marijuana use and binge drinking in both the HHP and AM programs. However, homeless youth in the HHP program reported additional reductions in methamphetamine, cocaine, and hallucinogen use at 6-month follow-up. CONCLUSIONS: Reductions in drugs and alcohol are important as these substances are linked to HIV/AIDS, hepatitis, and other health risks in homeless youth. SCIENTIFIC SIGNIFICANCE: The successful outcomes of the study intervention validate the utility of nurse-led and artistic health promotion strategies to decrease drug and alcohol use and other risky behaviors in homeless youth populations.

Merging the fields of mental health and social enterprise: lessons from abroad and cumulative findings from research with homeless youths.

Despite the growing integration of supported employment within the mental health system in the United States as well as the widespread use of social enterprises abroad, the fields of mental health and social enterprises remain largely separate in the USA. The mental health field currently lacks a response that strengthens homeless youths' existing human and social capital, provides them with marketable job skills and employment, and impacts their mental health. To address this gap, this paper establishes a case for using social enterprises with homeless youths, drawing on both global precedents and findings from a mixed-methods study of a social enterprise intervention with homeless youths. Recommendations are offered for how to integrate social enterprises with mental health treatment as well as how to evaluate their impact on mental health outcomes.

Teaching and learning with therapists who work with street children and their families.

Providing training for people working with some of the most marginalized families in Guatemala and Peru meant establishing credibility as a facilitator; entering organizations as a learner; cocreating training agendas; and working in a format that paralleled a strength-based, resilience focus in therapy. Strategies used for different phases of the work are detailed: multiple ways to gather information, shadowing staff, delivering topics on demand, and creating learning environments with a focus on families as teachers. Key processes included moving in and out of the role of facilitator and participant, entering into the trainings from different vantage points within the organizations, and designing activities with an eye to how they would impact work relationships of staff and clients.

Comparison of family therapy outcome with alcohol-abusing, runaway adolescents.

Treatment evaluation for alcohol problem, runaway adolescents and their families is rare. This study recruited primary alcohol problem adolescents (N = 119) and their primary caretakers from two runaway shelters and assigned them to (a) home-based ecologically based family therapy (EBFT), (b) office-based functional family therapy (FFT), or (c) service as usual (SAU) through the shelter. Findings showed that both home-based EBFT and office-based FFT significantly reduced alcohol and drug use compared with SAU at 15-month postbaseline. Measures of family and adolescent functioning improved over time in all groups. However, significant differences among the home- and office-based interventions were found for treatment engagement and moderators of outcome.

[Education for self-administered antibiotic therapy: a pragmatic and ethical alternative for the treatment of STDs for the street youth of Kinshasa in the Democratic Republic of the Congo (RDC)]. / L'éducation à l'antibiothérapie à domicile : alternative pragmatique et éthique de la gestion thérapeutique des IST chez les jeunes de la rue à Kinshasa.

All healthcare providers decide in someone else's place, for someone else. In doing so, they take their place in a long long tradition, that of medical paternalism. Patients are treated as children, incapable of making decisions about themselves. How then are we supposed to deal with patients like the street children of the Democratic Republic of the Congo, who are not part of our health-care system, who refuse care and prescriptions? Their refusal of caregivers forces us to seek strategies to dispel the conflicts, adapt outselves to the situation (self-medication, drug sales outside of dispensaries, etc.), but especially to rethink the relation between caregivers and patients. This does not mean abandoning the authoritarian patriarchal model for total relativism; the use of drugs such as antibiotics is and must remain surrounded by all the precautions necessary to avoid the further development of resistance; it does mean training and informing. The task facing us is that of health education and promotion, a long and continuous process, centered on patients and integrated with their care, aimed at making them capable of managing their disease. This procedure is part of a pragmatic approach: beyond the asymmetry involved in any relationship of power, it is essential to establish informed confidence, to look for adhesion and not constraint. Only this pragmatism can incite young people with sexually transmitted diseases (STDs) to use modern medicine and comply with the dosage instructions. Effective treatment of STDs is, according to WHO, one of the most powerful weapons in the battle against AIDS transmission.

The impact of an integrated treatment on HIV risk behavior among homeless youth: a randomized controlled trial.

While many studies provide useful information on the risk behaviors in which homeless youth engage, few prior studies evaluate Human Immunodeficiency Virus (HIV) risk related reduction strategies. In this study, homeless youth (n = 180) were recruited from a drop-in center and randomly assigned to one of two conditions, either an integrated individual cognitive-behavioral treatment and HIV prevention intervention that focused on skills building and education or to treatment as usual. All youth were assessed at entry into the program and at 3 and 6 month follow-up points. Findings showed an interaction between treatment condition, age and time. In the interaction, youth assigned to the integrated treatment reported greater condom usage than youth assigned to treatment as usual, with younger youth assigned to treatment as usual showing no change in condom use. The number of sexual partners reported by youth in both treatment conditions was also reduced over time. However, youth in both conditions continued to engage in other high-risk behaviors. The integrated treatment findings are promising and suggest that interventions which target both HIV risk behavior in addition to other life areas (substance use, mental health and housing) among homeless youth may be necessary in order to significantly impact high-risk behaviors among this unique group.

Homelessness and our most vulnerable patients.

The scope of homelessness among children is broad and growing, and its affect on physical and mental health is extensive. It may seem daunting for individual providers to make an impact on the challenges faced by these most vulnerable of patients. However, healthcare providers who care for homeless children can improve more than just their physical health by understanding barriers specific to this population, and addressing them through minor changes in standard practice; education of self, staff, and colleagues; and advocacy. By collaborating with parents and local agencies, clinicians can make tangible progress in improving the health of their homeless patients and can provide parents with the information and support they need to prioritize a child's health needs appropriately. Ultimately, providers should strive to make their practices a true medical home, as it may be the only home a child knows.

Integrating behavioral health services for homeless mothers and children in primary care.

This article describes an innovative trauma-informed care management model in which mental health, substance abuse, and support services are integrated for homeless families in primary care. The rationale for service integration in a health care setting is discussed and the conceptual underpinnings of the model are elaborated, drawing from the literature and clinical experience. Service encounter data collected by each staff member over a 1-year period (N = 7,214 encounters) allow for description of program functions and provider roles and activities, an essential step in developing the fidelity indicators necessary for future program replication and rigorous testing in additional settings. The feasibility of implementing an integrated set of services for homeless families in primary care is demonstrated. Practice, training, and research implications are discussed.