Suicide prevention for substance using youth experiencing homelessness: study protocol for a randomized controlled trial.

BACKGROUND: While research on substance using youth experiencing homelessness (YEH) is increasing, there is a dearth of information regarding effective prevention interventions for these youth. Suicide is the leading cause of death among YEH and most youth do not access services that may be available to them. Therefore, this study seeks to address this gap in the research literature with the goal to identify an effective suicide prevention intervention that can be readily adopted by communities that serve these youth. METHODS: Three hundred (N = 300) YEH with recent substance use and suicidal ideation or a recent suicide attempt will be recruited from the streets as well as a drop-in center serving YEH. After the baseline assessment, all youth will be randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Services as Usual (SAU) (N = 150) or to SAU alone (N = 150). SAU includes outreach, advocacy, and service linkage whereas YEH who receive CTSP will also receive ten CTSP sessions and an optional nine booster sessions. Follow-up assessments will be conducted at 3, 6, 9, and 12 months post-baseline. Theoretically derived mediators (e.g., cognitive distortions) will be tested to shed light on mechanisms associated with change, and the moderating effects of sex, race, sexual orientation, and baseline service connection will be examined. In order to ease future dissemination of the intervention to agencies serving YEH, we will rigorously assess acceptability, feasibility, fidelity, and cost associated with the delivery of our intervention approach using a mixed-methods approach. DISCUSSION: This study adds to a very small number of clinical trials seeking to prevent lethal suicide among a very high-risk group by addressing suicidal ideation directly rather than underlying conditions. It is hypothesized that youth receiving CTSP + SAU will show greater reductions in suicidal ideation (primary outcome), substance use, and depressive symptoms (secondary outcomes) over time compared to SAU alone, as well as improved risk and protective factors. TRIAL REGISTRATION: NCT05994612. Date of Registration: August 16, 2023.

Co-occurring trajectory of housing stability and parenting stress with child behavior problems: A randomized trial of a housing intervention for young mothers experiencing homelessness.

This study examined the effects of an integrative housing intervention (Ecologically Based Treatment, EBT - independent housing and supportive services) on the co-occurring pattern of housing stability and parenting stress among a sample of substance-using mothers who experience homelessness and have young children in their care. The association between the co-occurring patterns of housing stability and parenting stress and child internalizing and externalizing behaviors was also examined. Mothers were randomized to one of the three conditions: EBT (n = 80), Housing-only (HOU; n = 80), or Services as Usual (SAU; n = 80). Follow-up assessments were completed at 3-, 6-, 9-, and 12-months post-baseline. The dual-trajectory latent class growth analyses identified five subgroups of co-occurring patterns: low-greatly improved housing paired with moderate-improved parenting stress, low-greatly improved housing paired with high-improved parenting stress, low-moderately improved housing paired with moderate-static parenting stress, low-worse housing paired with moderate-improved parenting stress, and low-worse housing paired with high-static parenting stress. Findings showed that EBT was more effective in improving housing stability and reducing parenting stress compared to HOU and SAU conditions, and further, HOU was more effective than SAU. Additionally, children whose mothers reported increased housing stability together with improved parenting stress had lower levels of internalizing and externalizing behaviors. The findings provide support to the efficacy of EBT in increasing housing stability and reducing parenting stress. The observed improvements subsequently benefited children's behavioral outcomes.

Lessons learned from housing first, rapid rehousing trials with youth experiencing homelessness.

BACKGROUND: Youth, 18 to 24 years, experiencing homelessness (YEH) are recognized as having developmental challenges dissimilar to older adults. Yet, research on efforts to end homelessness and prevent or intervene in drug use and mental health problems among youth have lagged behind that of adults. The Housing First (HF) Model which underlies Permanent Supportive Housing (PSH) and Rapid Re-Housing (RRH) has become preferred over treatment-first models. METHODS AND RESULTS: We provide an overview of PSH and RRH studies to date and summarize our current understanding of their utility for use with YEH. Finally, we review our team's current and past randomized trials testing RRH with YEH, providing lessons learned and recommendations. CONCLUSION: Current research efforts to guide best practices are hampered by a lack of fidelity to HF principles, lack of randomized design, and lack of focus on youth. Lessons learned and recommendations from our work are offered to facilitate the future work of those who seek to end homelessness and address drug use and mental health problems among youth.

Housing and supportive services for substance use and self-efficacy among young mothers experiencing homelessness: A randomized controlled trial.

AIMS: Homeless mothers with young children in their care contend with high rates of substance use and low self-efficacy. However, a limited number of studies have examined these outcomes associated with housing and supportive services. DESIGN: Participants were randomly assigned to: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline. SETTINGS: The study recruited a community-based sample from homeless service agencies and advertisements in a large Midwestern city. PARTICIPANTS: The study recruited two hundred forty (N = 240) women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care. MEASUREMENTS: We measured frequency of alcohol and drug use using the Form 90 semi-structured interview, and self-efficacy using Pearlin and Schooler's (1978) 7-item Mastery Scale. FINDINGS: Overall, mothers showed significant improvement in substance use and self-efficacy over time in each condition. However, as expected, patterns of change differentiated intervention groups with more mothers showing better substance use and self-efficacy outcomes in housing + supportive services than in SAU. Unexpectedly, more mothers in SAU showed better outcomes than those in housing-only. CONCLUSIONS: Substance use decreased and self-efficacy increased over time, but patterns of change characterized the intervention groups. In particular, findings suggest that when providing housing to this population, supportive services should also be offered.

"Prevention of opioid use disorder: the HOME (housing, opportunities, motivation and engagement) feasibility study".

Young adults experiencing homelessness are at high risk of opioid and other substance use, poor mental health outcomes, exposure to trauma, and other risks. Providing access to stable housing has the potential to act as a powerful preventive intervention, but supportive housing programs have been studied most often among chronically homeless adults or adults with serious mental illness. The Housing First model, which does not precondition supportive housing on sobriety, may reduce drug use in homeless adults. In the present study, we piloted an adapted model of Housing First plus prevention services that was tailored to the needs of young adults (18-24 years) experiencing homelessness in the USA. Preventive services were added to the Housing First model and included youth-centered advocacy services, motivational interviewing, and HIV risk prevention services. This model was piloted in a single-arm study (n = 21) to assess the feasibility, acceptability, and initial efficacy of a Housing First model over a 6-month period in preparation for a larger randomized trial. We use repeated measures ANOVA to test for changes in alcohol and drug use (percent days of use; alcohol or drug use consequences), housing stability, social network support, and cognitive distortions over 6 months of follow-up. A total of 17 youth completed the study (85% retention), and a high proportion of youth were stably housed at 6-month follow-up. Participation in intervention services was high with an average of 13.57 sessions for advocacy, 1.33 for MI, and 0.76 for HIV prevention. Alcohol use did not change significantly over time. However, drug use, drug use consequences, and cognitive distortions, and the size of youths' social networks that were drug using individuals decreased significantly. The Housing First model appeared to be feasible to deliver, and youth engaged in the supportive intervention services. The study demonstrates the potential for an adapted Housing First model to be delivered to youth experiencing homelessness and may improve outcomes, opening the way for larger randomized trials of the intervention.

Housing First Combined with Suicide Treatment Education and Prevention (HOME + STEP): study protocol for a randomized controlled trial.

BACKGROUND: Youth experiencing homelessness are at high risk for suicide, yet few studies have evaluated risk reduction interventions targeting suicidal ideation in this vulnerable population. A comprehensive approach to risk-reduction is needed that addresses basic needs and provides targeted interventions for those at highest risk. The protocol described builds on the design of the first randomized trial of Housing First (HF) for homeless youth. The primary objective is to determine whether housing combined with supportive services that include suicide screening and targeted psychotherapy (Cognitive Therapy for Suicide Prevention) is effective for reducing suicidal ideation and other secondary outcomes (depression and suicide attempts). Additionally, we will explore mediators of the treatment effect (housing stability and substance use) and determinants of implementation. METHODS: Youth recruited to the HF trial will be randomized to HF + supportive services (n = 120), or supportive services alone (n = 120). The "Suicide Treatment Education and Prevention" (STEP) protocol will additionally screen youth in both arms at baseline and 3 months for suicidal ideation (SSI-W). Those who screen as moderate risk for suicide (SSI-W ≥ 10) will be offered CTSP, which includes up to 9 sessions over the first 6 months following enrollment. CTSP will be delivered in one-on-one sessions by a trained advocate. Research assessments will be collected to assess outcomes (including suicidal ideation) at baseline, 3, 6, 9 and 12 months. Qualitative interviews with subjects receiving CTSP and other stakeholders will explore implementation determinants. DISCUSSION: The study will fill an important gap in the literature about the added benefit of HF combined with supportive services including suicide screening and treatment for reducing suicidal ideation in homeless youth. With the urgent need to address both homelessness and suicide risk, evidence is needed about services that can be integrated into delivery settings for youth experiencing homelessness. TRIAL REGISTRATION: NCT04135703 . Date of registration: October 23, 2019.

Housing, opportunities, motivation and engagement (HOME) for homeless youth at-risk for opioid use disorder: study protocol for a randomized controlled trial.

BACKGROUND: Homeless youth experience high rates of substance use disorders, exposures to violence, mental and physical health conditions, and mortality. They have been particularly affected by the opioid crisis. However, no study to date has used a randomized controlled design to test preventive interventions of opioid and other drug use among this vulnerable population. Resolution of youth homelessness through housing and supportive services including prevention services, often referred to as "Housing First," has great potential to reduce the likelihood for the development of an opioid use disorder as well as other problem behaviors associated with living on the streets. Housing First has been tested through randomized trials among homeless adults with mental health and substance use disorders, but has not been empirically tested for opioid prevention among homeless youth. METHODS: Homeless youth will be recruited from a drop-in shelter site frequented by disconnected youth; they will be screened for eligibility, including current homelessness, age 18-24 years, and not currently meeting criteria for opioid use disorder (OUD). In a controlled trial, 240 youth will then be randomized to one of two conditions, (1) housing + opioid and related risk prevention services, or (2) opioid and related risk prevention services alone. This project utilizes existing efficacious models of prevention to address opioid-related risks, including motivational interviewing, strengths-based outreach and advocacy, and an HIV risk preventive intervention. Follow-up will be conducted at 3, 6, 9 and 12-months post-baseline. The economic cost of each intervention will be determined to support implementation decisions with other providers and their funders. DISCUSSION: This study will provide essential information for researchers and providers on the efficacy of housing + opioid and related risk prevention services in an RCT for effects on opioid use and mechanisms underlying change. Because youth experiencing homelessness are at increased risk for a variety of adverse outcomes, the proposed intervention may produce substantial health care benefits to the youths and society at large. Trial registration ClinicalTrials.gov, NCT04135703, Registered October 13, 2019, https://clinicaltrials.gov/ct2/show/NCT04135703?term=NCT04135703&draw=2&rank=1#contacts.

Relationship Between Fundamental Motor Skill Competence, Perceived Physical Competence and Free-Play Physical Activity in Children.

Purpose: This study examined the extent to which fundamental motor skill competence (FMSC; locomotor and object control skill competence) and perceived physical competence (PPC) predicted physical activity levels and sedentary behaviors during free-play time at preschool. Method: A total of 72 children (girls n = 33, boys n = 39; Mage = 4.38, SD = .85 years) were recruited from two preschools. Fundamental motor skill competence was measured using the Test of Gross Motor Development - 2nd edition, and PPC was assessed using the physical competence subscale of the Pictorial Scale of Perceived Competence and Social Acceptance. Physical activity was measured using accelerometers. Results: Children engaged in light physical activity 19.66%, and moderate to vigorous physical activity (MVPA) 36.41%, and sedentary behaviors 43.94% of their free-play time. Since no correlation was observed in light physical activity with any variables, a hierarchical multiple linear regression was run for MVPA and sedentary behaviors. The results illustrated 38.9% of the variance in MVPA during free-play time was predicted by FMSC and PPC, after controlling for age and sex, with locomotor skill competence as a significant predictor (t= 2.98, p < .05). For sedentary behaviors, the 32.9% of the variance during free-play time was predicted by FMSC and PPC, after controlling age and sex, with locomotor skill competence as a significant predictor (t = 2.72, p < .05). Conclusion: The findings highlight the importance of developing FMSC and positive PPC during early childhood to enhance physical activity engagement during free-play.

Health-related quality of life, physical activity, and sedentary behavior of adults with visual impairments.

PURPOSE: Research suggests that physical activity and sedentary behaviors can impact one's health-related quality of life (HRQoL). However, little is known about the impact that these behaviors can have on the HRQoL of those with visual impairments. Therefore, the primary purpose of this study was to determine the associations of physical activity and sedentary behavior with HRQoL among a sample of adults with visual impairments. METHOD: Individuals with visual impairments were invited via email to complete three questionnaires: (a) the international physical activity questionnaire-short form, (b) the Rasch-revised versions of the World Health Organization Quality of Life instrument with the Level of Independence subscale, and (c) a demographic questionnaire. Eighty participants (Mage = 47.5) provided usable surveys for analyses. RESULTS: The results demonstrated that physical activity significantly predicted HRQoL (F(2,79) = 3.508, p = .035, R2Adjusted=.060), yet, sedentary behavior did not (F(2,79) = 1.546, p = .220, R2 = .039, R2Adjusted =.014). Gender differences were uncovered regarding the relationship between physical activity and health-related quality of life. CONCLUSIONS: The findings of this study demonstrate the importance of physical activity in influencing the HRQoL of adults with visual impairments. This study supports the need for additional intervention research to promote physical activity for those with visual impairments. Implications for Rehabilitations Adults with visual impairments tend to report lower health-related quality of life than peers without visual impairments. Regular participation in leisure-time physical activity, and restricted sedentary time, have been demonstrated to positively influence health-related quality of life for adults without disabilities. In this study, physical activity shows promise as an effective means of improving health-related quality of life for adults with visual impairments.