Digital micro-banking as a health and protection intervention for street-connected children and youth? Analysis from a Togolese pilot.

BACKGROUND: The SaVa pilot offered street-connected children and youth (C&Y) access to digital micro-banking services to help them save money and thus avoid the violence associated with theft at night. It further used the micro-banking service as a gateway to attract C&Y towards other health and protection services. It took place over 12 months in Lomé, Togo and involved one social worker (SW) plus volunteers running 'the bank' in a non-governmental organisation-funded drop-in centre. METHODS: C&Y peer researchers were trained to interview and use collective drawing with peers, which they did on a bi-monthly basis. The SW recorded information about case management, training and additional services offered. He administered a survey to C&Y at the point of entry into the project and after 1 year, asking questions about recent experiences of violence or theft. At the end of 12 months, the author conducted interviews with C&Y using the bank, C&Y researchers who used the bank, project staff and steering committee partners and child protection stakeholders. One focus group was conducted with C&Y participants, alongside limited participant observation of where C&Y sleep and work. RESULTS: Findings suggest that the intervention was successful in encouraging children to open accounts and save money, and in contributing to a reduction in theft and associated violence. The incidence of theft reduced 90%; 95% of C&Y account holders were happy with the service; 200 accounts were opened. The project supported the delivery of additional services, including counselling, school reinsertion and removal from the streets. CONCLUSIONS: Analysis suggests that it is possible to offer street-connected C&Y formal financial services but that this offer has potential as a health and protection intervention, especially in combination with the provision of a safe space, dedicated SW support and add-on services.

Promoting COVID-19 Vaccine Confidence and Access among Youth Experiencing Homelessness: Community-Engaged Public Health Practice.

BACKGROUND: Youth experiencing homelessness (YEH) face a wide range of complex barriers to COVID-19 vaccine confidence and access. OBJECTIVES: Describe our process for engaging a cross-sector team centering equity and youth voice; outline our intervention strategies to enhance COVID-19 vaccine confidence and access among YEH; and discuss lessons learned through this community-engaged process. METHODS: We engaged partners from across sectors, including youth-serving agencies, healthcare organizations, public health organizations, and YEH. We used focus groups, key informant interviews, and other community engagement strategies to develop and implement a series of interventions aimed to increase COVID-19 vaccine confidence and access among YEH. RESULTS: We identified youths' key concerns about vaccine confidence and access. To address these concerns, we implemented four community-driven interventions: youth-friendly messaging, health events, vaccine aftercare kits, and staff training. CONCLUSIONS: This community-engaged project highlighted the value of cross-sector partnership and consistent youth engagement in addressing vaccine confidence among YEH.

Mediation of Psychological Capital in Youth Experiencing Homelessness.

BACKGROUND: Youth who experience homelessness engage in behaviors that place them at high risk for disease and injury. Despite their health risk behaviors, these youth display psychological capital, positive attributes of hope, efficacy, resilience, and optimism that motivate them to engage in health-promoting behaviors such as safer sex. However, this array of positive psychological attributes has not been studied in this vulnerable population. OBJECTIVES: The specific aim of this analysis was to determine whether factors of psychological capital mediated the relationship between background risk factors (e.g., race/ethnicity, educational attainment, reason for being homeless, sexual abuse history, and HIV status) and outcomes of condom intention, safer sex behaviors, and life satisfaction among youth who participated in a longitudinal intervention study. METHODS: Using a Solomon four-group design, 602 youth were recruited from drop-in centers in two large cities (Columbus, Ohio, and Austin, Texas) to participate in a brief intervention that included outcomes of enhanced communication skills, goal setting, safer sex behaviors, drug refusal skills, and life satisfaction. Using an autoregressive, cross-lagged, longitudinal mediation model, we tested the direct and indirect effects of background factors, psychological capital, and intervention outcomes. Models were tested for the intervention group alone and the total sample. RESULTS: There were no significant direct or indirect effects of background factors on intervention outcomes among the intervention group, and the model fit was poor. There were also no significant mediating paths via factors of psychological capital and poor model fit for the combined group. DISCUSSION: Findings provide important information about intrinsic strengths of youth experiencing homelessness and psychological capital as a significant construct for understanding health behaviors among disadvantaged and underserved youth. The lack of significant mediation effects may have been due, in part, to the lack of a robust measure of psychological capital. Further study with various background factors and outcomes would contribute further to our understanding of how best to support this population.

Brain Changes Linked to Cognitive Symptomatology in Homeless Youth.

Youth impacted by homelessness experience diminished cognition due to a variety of reasons including mental health symptoms, alcohol and substance use, and adverse childhood experiences. However, the status of specific brain regions which could impact important cognitive functions in homeless youth remains unclear. In this pilot comparative and correlational study, a series of demographic, psychological, cognitive assessments, and brain magnetic resonance imaging were performed in 10 male youth experiencing homelessness and 9 age-matched healthy male controls (age range: 18-25 years). Participants experiencing homelessness had significantly decreased regional brain gray matter tissue in comparison to the controls. Moreover, there were strong inverse correlations between the brain regions classically associated with executive decision-making (prefrontal cortices), depression (insular lobes), and conflict resolution (anterior cingulate), and the level of the symptoms detected by their questionnaires.

Acolhimento institucional de adolescentes: uma intervenção psicossocial / Foster care for youth: a psychosocial intervention / Acogida institucional de adolescentes: una intervención psicossocial

O artigo relata intervenção psicossocial desenvolvida em instituição de acolhimento para adolescentes do sexo masculino com trajetória de vida nas ruas. Tratou-se de atuação em estágio curricular em Processos Psicossociais, tendo como aporte teórico a Psicologia Social Jurídica. A partir do levantamento, por meio da observação-participante, das demandas para capacitação dos educadores dessa instituição, elaborou-se intervenção que visou fortalecer o acolhimento institucional como um local de proteção, por meio do trabalho realizado com os educadores. O despreparo dos integrantes da rede de assistência social e saúde, a insuficiência de políticas públicas voltadas para a juventude no município e outros fatores decorrentes do estigma atribuído aos adolescentes acolhidos, majoritariamente negros e pobres, remetem às situações de violências e de violações de direitos que tem implicações subjetivas, econômicas, políticas, sociais e culturais. Como prática psi de enfrentamento ao racismo estrutural, intervir neste local auxilia na construção de uma sociedade justa e igualitária. (AU)

The intend of this article is to present the psychosocial intervention activities carried out in an institutional foster home facility for homelessness youth males. This involves acting in a Psychosocial Internship Curriculum, using Law & Social Psychology as its theoretical foundation. Based on the assessment developed through participant observation, the demands and instrumentation technician education requirements were developed that aimed to strengthen the institutional reception as a place of protection through the work carried out with the educators. The unpreparedness of the health care and social services network members, the inadequacy of public policies aimed at youth in the city of Belo Horizonte, and other factors resulting from the dangerousness speech attributed to the youth males received, mostly black and poor, lead to situations of violence and violations of human rights that it has subjective, economic, political, social and cultural implications. As a psicological practice to confronting structural racism, intervening in this place helps to build a just and egalitarian society. (AU)

Este artículo relata una intervención psicosocial desarrollada en una institución de acogida institucional para adolescentes del sexo masculino con trayectoria de vida en las calles. Esta fue una actuación en prácticas curriculares en Procesos Psicosociales, teniendo como soporte teórico la Psicología Social Jurídica. A partir de una encuesta, a través de la observación participante, de las demandas de capacitación de los educadores de esta institución, la intervención se elaboró con el objetivo de fortalecer la recepción institucional como lugar de protección, a través del trabajo realizado con los educadores. La falta de preparación de los miembros de la asistencia social y salud, la insuficiencia de políticas públicas dirigidas para la juventud en el municipio y otros factores resultantes del discurso de peligrosidad a los adolescentes recibidos, en su mayoría negros y pobres, conducen a situaciones de violencia y violaciones de los derechos que tienen implicaciones subjetivas, económicas, políticas, sociales y culturales. Cómo prática Psi de confrontar al racismo estructural, intervenir en este lugar ayuda a construir una sociedad justa y igualitaria. (AU)

Rates and correlates of well-being among youth experiencing homelessness.

Mental health concerns have been well studied among youth experiencing homelessness, yet few studies have explored factors that contribute to well-being in this population. The current cross-sectional study examined rates and correlates of well-being among youth experiencing homelessness. This is a descriptive, secondary analysis of the baseline data from a clinical intervention study. Ninety-nine youth (aged 16-25) who were experiencing homelessness were recruited in Chicago. Approximately 40% of the sample reported average or above average well-being relative to existing benchmarks. Having medical insurance, a mobile phone, and a history of more severe childhood trauma were unique cross-sectional predictors of worse well-being (all ps < 0.034). A significant portion of our sample experienced well-being. Having access to certain resources may be counterintuitive indicators of poorer well-being among youth experiencing homelessness, perhaps because they are indicators of greater need or increased social comparison among these youth.

Street Children in Ghana's Golden Triangle Cities: Mental Health Needs and Associated Risks.

More than 61,000 persons below the age of 18 are living on the streets in the Greater Accra region in Ghana. Street children is a hidden vulnerable population and a global public health issue in the world, but little is known about their mental health and health needs, and mechanisms that contribute to their poor health. With a lack of mental health research to guide intervention or psychoeducation programme and policy planning, this study aimed to address these research gaps by examining prevalence of mental health problems and a set of associated risk factors (i.e. Perceived quality of life, and social connection). In addition, we examined whether the associations between risk factors and mental health problems were moderated by demographic and contextual factors (i.e., gender, age, work status, reason for living on street, number of years in street). Two hundred and seven children between age 12 and 18 who lived on the street in three cities (Accra, Sekondi Takoradi, and Kumasi) were recruited. Data were gathered through adolescent survey/interviews. Multiple regression was utilized to examine risk factors and moderation effects. Results support high mental health needs among street children. Approximately 73% street children experienced moderate to severe mental health problems, and 90% experienced poor quality of life. Perceived quality/happiness of life was the strongest predictor for street children's mental health. Social connection was associated with children's mental health only in certain subgroups and contexts. This study adds new epidemiological evidence for street children, an extremely vulnerable population, in Ghana and global child and adolescent mental health.

Health and Healthcare Service Use: The Experiences of Runaway Trans Adolescents Compared to their Peers.

This study is the first trans-inclusive exploration of the relation between running away from home, health, and access to healthcare and supportive figures as a function of gender among adolescents. Secondary data analysis of the 2013 BC Adolescent Health Survey found that trans adolescents were 4.25 times as likely as males, and 3.0 times as likely as females, to have run away. Logistic regressions indicated that runaway adolescents of all genders had greater odds of reporting poor or fair overall health (OR: 2.9) and mental health (OR: 4.5), and of foregoing needed physical (OR: 4.8) and mental health care (OR: 4.5) compared to adolescents who had not run away. The relation between running away and health was exacerbated among trans adolescents. Trans and female youth were also less likely than males to report receiving helpful support. Findings highlight the importance of offering trans-affirming services and care to mitigate harms associated with running away from home.

Profile of Runaway Youths from Residential Care Centers: Variation in Risk-Taking Propensity.

During runaway episodes, adolescents engage in various high-risk behaviors and are exposed to various dangers. This situation is even more pronounced among runaway youths from residential care centers, given their personal and familial backgrounds that place them at risk. The current study attempted to disentangle the heterogeneous characteristics of runaway youths while considering the adolescent risk-taking literature. A latent profile analysis was performed among 112 runaway youths from residential care centers based on runaway characteristics (number, duration, context of return). The Parent involvement, Independent and Police involvement runaway youth profiles were compared on various characteristics involved in risk-taking, their high-risk behaviors and mental health problems. The clinical implications for these three runaway profiles are discussed.

Sex out of marriage and condom use among homeless youth in Iran.

OBJECTIVES: Sexual behaviors of homeless youth in Iran have not been well studied. This study aimed to measure the frequency and associated factors of sex out of marriage and condom use among homeless youth in Kerman, Iran. STUDY DESIGN: In this cross-sectional study, we recruited 202 homeless youth (age: 15-29 years who experienced 30 or more days of homelessness in the last 12 months) from 11 street locations between September to December 2017. METHODS: Of 202 participants, 169 (83.7%) reported sex in the last 12 months and were include in this analysis. We assessed the prevalence of sex out of marriage in the last 12 months, condom use in last sex, and then evaluated their covariates in multivariable logistic regression analysis. RESULTS: The prevalence of sex out of marriage was 19.6% (95% confidence intervals [CIs]: 13.8%, 26.3%) and the prevalence of condom use was 43.8% (95% CI: 36.2%, 51.6%). Sex out of marriage was significantly correlated with male gender (adjusted odds ratio [AOR]: 24.38; 95% CI: 3.1-192.1) and being unmarried (AOR: 5.94; 95% CI: 2.3-15.5). Condom use was significantly correlated with male gender (AOR: 2.16; 95% CI: 1.1-4.2) and higher educational status (AOR: 4.30; 95% CI: 2.1-8.8). CONCLUSION: Our findings indicate that one in five homeless youth had sex out of marriage, and less than half did no use condom. These should be addressed by adapting education and harm reduction programs targeting this specific population in Iran.

Factors Associated With HIV Testing Among Atlanta's Homeless Youth.

Homeless youth experience increased risk of contracting HIV, making HIV testing imperative in this population. We analyzed factors associated with HIV testing among homeless youth in Atlanta, Georgia using data from the 2015 Atlanta Youth Count and Needs Assessment. The analysis included 693 homeless youth aged 14-25 years, of whom 88.4% reported ever being tested for HIV, and 74.6% reported being tested within the previous year. Prevalence of ever testing for HIV was significantly higher among youth who reported risk factors for HIV (sexually active, transactional sex, or ever having an STI). Higher prevalence of testing within the last year was significantly associated with experiencing physical abuse or transactional sex. However, reporting ≥ 4 sexual partners or not using condoms were not associated with higher testing. Although testing prevalence among homeless youth was high, homeless youth engaging in certain high risk behaviors could benefit from further promotion of HIV testing.

Characterizing street-connected children and youths' social and health inequities in Kenya: a qualitative study.

BACKGROUND: Street-connected children and youth (SCY) in Kenya disproportionately experience preventable morbidities and premature mortality. We theorize these health inequities are socially produced and result from systemic discrimination and a lack of human rights attainment. Therefore, we sought to identify and understand how SCY's social and health inequities in Kenya are produced, maintained, and shaped by structural and social determinants of health using the WHO conceptual framework on social determinants of health (SDH) and the Convention on the Rights of the Child (CRC) General Comment no. 17. METHODS: This qualitative study was conducted from May 2017 to September 2018 using multiple methods including focus group discussions, in-depth interviews, archival review of newspaper articles, and analysis of a government policy document. We purposively sampled 100 participants including community leaders, government officials, vendors, police officers, general community residents, parents of SCY, and stakeholders in 5 counties across Kenya to participate in focus group discussions and in-depth interviews. We conducted a thematic analysis situated in the conceptual framework on SDH and the CRC. RESULTS: Our findings indicate that SCY's social and health disparities arise as a result of structural and social determinants stemming from a socioeconomic and political environment that produces systemic discrimination, breaches human rights, and influences their unequal socioeconomic position in society. These social determinants influence SCY's intermediary determinants of health resulting in a lack of basic material needs, being precariously housed or homeless, engaging in substance use and misuse, and experiencing several psychosocial stressors, all of which shape health outcomes and equity for this population. CONCLUSIONS: SCY in Kenya experience social and health inequities that are avoidable and unjust. These social and health disparities arise as a result of structural and social determinants of health inequities stemming from the socioeconomic and political context in Kenya that produces systemic discrimination and influences SCYs' unequal socioeconomic position in society. Remedial action to reverse human rights contraventions and to advance health equity through action on SDH for SCY in Kenya is urgently needed.

"This Research Is Cool": Engaging Youth Experiencing Homelessness in Research on Reproductive and Sexual Health.

Youth experiencing homelessness face myriad barriers and inequities regarding their reproductive and sexual health and rights. Moreover, homeless youth are often characterized as "disaffiliated" and depicted as difficult to engage in research. This study qualitatively explored homeless youths' attitudes, beliefs, and needs regarding reproductive and sexual health, and sought their perspectives on being involved in research on such topics, which are often thought of as "taboo" or sensitive. Youth were enthusiastic about openly discussing such issues, which they deemed as highly relevant to their daily lives. Youth identified that how they were engaged in such research, and having opportunities for longer-term contributions to such efforts, were both important and exciting to them. Future social work and public health research efforts should seek to further disrupt narratives of homeless youth as "disaffiliated" and difficult to engage, and in doing so, develop more creative, participatory, and youth-led opportunities for including this group in reproductive and sexual health research.

The levels of anger and aggression in street children with substance dependence.

PROBLEM: This is a descriptive study to determine the levels of anger and aggression in street children with substance dependence. METHODS: The study was conducted between October 2013 and March 2014 with 103 street children who use substances. Personal Information Form, Aggression Scale (AS), and Trait Anger and Anger Expression Styles Scale (STAXI) were used as data collection tools. FINDINGS: The rate of the children reported that they lived on the streets due to the conflicts with the family was 67% and 35% of participants reported that they were exposed to violence on the street. The total score of AS was 146.78 ± 25.91, the mean score of the anger subscale of the STAXI was 31.05 ± 9.00 while the scores of the anger-in subscale and the anger-out subscale scores were 19.02 ± 4.55 and 23.04 ± 6.19, respectively. The total scores of AS had a significant positive correlation with both the trait anger and "anger-in" subscale scores. The results show that substance use negatively affected anger control in street children. CONCLUSION: The data demonstrated that the presence of continuous anger and turning the anger against oneself correlated with increased levels of aggression. Increasing the duration of living on the street, working on the street and being exposed to stressful situations in the street increased the "anger-in" scores.