Comparison of Intervention Strategies for Youth Homelessness

Introduction

Youth homelessness is becoming an increasingly important issue in Canada. In the 2014 article from Saddichha, S it reads, “Estimates of street/homeless youth in Canada ranged from 10,000-20,000 in 1993 (Brannigan & Caputo, 1993) and have increased to more than 65,000 in the latest count (Canadian Broadcasting Corporation, 2004). The problem is this issue will get worse if there are no interventions in place.  Childhood abuse, substance abuse, and mental health issues are common themes in the articles. Again, in the study from Saddichha, S 80% of homeless youth and adults suffered emotional abuse, 69% suffered physical abuse and 55% suffered from sexual abuse. Homeless youth and young adults make up 20% to 30% of the homeless population (Saddichha, 2014). Some studies were done in Ontario, Quebec, and British Columbia. This gives an overview of the provinces and the homelessness is relevant to healthcare because it affects peoples physical, emotional, and mental health. Homelessness can have serious impacts on the health of youth and young adults which includes suicidal thoughts, attempt, and completions (Sabbichha, 2018), (P) Are homeless youth and young adults impacted more by (I) counselling, family relations and social support (c) no treatment/ intervention (o) reduction in homelessness?

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The database CINAHL was searched for articles on youth homelessness in Canada, substance abuse, mental health issues, and social determinants of health relating to homelessness. The years of publication ran from 2009 to 2019.  Some of the key search terms are substance abuse, homelessness, child abuse, youth and young adults, mental illness, social integration and social determinants of health. Using these terms made the most sense as a lot of homelessness is associated with mental health problem like schizophrenia, psychosis, post traumatic stress disorder and substance abuse

Literature review

All the studies were done in Canada with a focus on how homeless youth deal with being homeless. The main ideas circles around social integration and substance abuse. The average age in all four articles is 21-22 years of age. There were two studies that used the cross- sectional method. Two studies used the snow balling technique. Three of the four articles used over 180 participants in their studies while one study’s samples size was on 9 (n=9). All studies had wanted to have interventions so youth and young adults would not end up on the streets.

In the 2014 Saddichha article, adults and youth were compared. It was also the only one that did not stick to just one city; they sampled Vancouver, Prince George, and Victoria populations. There were 500 participants and 82 of them were homeless youth in this study. They tested for childhood trauma, addictions and socio- economic status. To collect data, they used the mini international neuropsychiatric interview, DSM 4, childhood addiction interview and the Mausley addiction profile.  They looked at childhood trauma more in depth than the other studies as they checked for physical, emotional and sexual assault, physical and emotional neglect. Childhood trauma was similar in both the adults and youth. Youth are more likely to have unsafe sex and drank alcohol then adults. Adults did more cocaine than the youth, but more youth used cannabis then adults. Adults are more likely to experience psychosis than youth perhaps because youth have not had developed enough to experience an episode of psychosis. Homeless youth are more likely to have depression and anxiety than their peers.

In the 2018 Thulian article, it was the only study that had qualitative data. In the study, they sampled youth that were formerly homeless while they learned to live independently.  Their framework was developed using the social determinates of health. It was the only study that focused more on the social determinants of health, done in Toronto, Ontario. Most youth were trying to escape from unstable home lives with poverty, neglect and abuse They meet 13 to 19 times between March 2015 and January 2016. They conducted the study based on a critical ethnographical methodology. For data collection, they used a baseline questionnaire, participant observation and informal interviews. Seven participants were on welfare; one was co parented and eight were raised by single mothers, where they had minimal contact with their fathers. Based on this study the youth had suffered from unaffordability housing, limited education, inadequate employment that were often dead-end jobs or low hours and psychosocial consequences. It was mentioned at the beginning of the study the youth had desires wanting to go to college and have a long-term plan. But they soon realized that they were worried about day to day living expenses and that the poverty began to set in the participant low self esteem, self-efficacy and sense of control.

In the 2018 Gasior article, they studied service provider network, social support, and family relations on the effects of perceptions of recovery. They recruited from drop in centre, shelters and service agencies. The study took place in London, Ontario. The first hypothesis of service provider network and perceptions of recovery was not supported. 73 participants had no service network providers and only 14 had seen one more than four times. The second and third hypothesis of integrated social support and family relations on the effect of perceptions of recovery were supported. Since majority of participants did not go to a service provider network they relied more on family and social support. The last hypothesis including all three and the perceptions of recovery were only partially supported. Youth had a desire to succeed and believed they have a purpose in life. They used a hierarchical multiple regression analysis. Youth were shown to have troubles asking for help or they might be embarrassed and not know where to start. The study showed that having stronger social and family support network could contribute to increased perceptions of recovery. 

In the 2016 Roy article, it had the highest mean age of 22-year-old and 359 participants. This study was conducted in Montreal, Quebec.  They did the snowballing method as a quantitative approach. They conducted interviews and questionnaires and they did six follow ups interviews every three months. Having a high school education, formal activity and psychological help increase residential stability. Being a non formal education and activity decreased residential stability. Mortality rates are higher in the homeless youth than other young people. In the article it had states, “reported standardized mortality ratios show that mortality rates for homeless youth are 2.7 to 37.3 times higher than for other young people. (Roy, 2016 P.1)” In this study they used the Kaplan-Meier and Cox proportional-hazards regression analyses as a quasi-experimental study.

 Some strengths of all the articles are they gave an overview of social integration, mental illness, substance abuse and childhood trauma. In one article they compared youth to adults, which could give an idea on what to improve in both groups. In one study where they only had nine participants, they were able to focus closely over a 10-month period. It also was able to illustrate the barriers like unaffordable housing and poverty level income that affect the youths’ self- esteem and self-efficacy. In three of the articles they had enough participant in order to accurately predict the outcomes. Another positive that came out of the 2016 Roy’s study, e is the outcomes adopted by the residential follow back calendar design which assessed the psychometric properties of the calendar with high- test retest.

 Some limitations include the self reports that most studies gave out. This introduces both recall and social desirability biases into the studies. In the 2016 study of Roy, they focused on life conditions social and mental health factors might prevent childhood factors. In the Saddichha article, the snowball method which had difficulty performing a direct comparison between youth and adults, while the cross-sectional underestimated the rates of homelessness. In the 2014 Gasior article, it states of a limitation is, “The cross-sectional nature of the analysis limits the ability to support strong casual claim.(Gasior, 2018, pg 34)” three out of four studies were conducted in only one city which may not accurately predict youth in other areas of the province and country. With any study, there will always be limitations a researcher is faced with.

Discussion

From these articles, child abuse, mental health issues and inadequate social determinants of health, the main problems facing homeless youth. Only studying one city limits the ability to see and what other factor might contribute to youth homelessness across the country. Research should be combined so evidence from each province and/ or major city to have a clearer idea of the country. We also need to address local issues regarding youth and young adult homelessness. In the 2014 Saddichha study that included both youth and older adult it gave the idea that how we treat youth homelessness should be different than how we treat adults. The article mentions “interventions to prevent homelessness and support those who are homelessness are needed. Particularly age specific programs that address the high-risk behavior that youth are engaged in and increase their vulnerability to further victimization are the call of the hour. (Saddichha, 2014, pg. 205).” One thing that does need to be addressed in both age groups is childhood trauma. In the article from Thulian it said, “these young people are fleeing unstable and complicated home lives marked by abuse, poverty, and neglect (Thulian, 2018, pg.90).” Abuse can lead to post traumatic stress disorder, depression and anxiety (Thulian, 2018) and living on street could possible lead to more abuse.

Ethics

In all experimental studies involving human some form of approval is needed to make sure that methods used in studies do not cross any ethical boundaries. The ethical approval for the Thulian study was given by the University of Toronto Health Science Board and a review committee at the local shelter.  For the 2014 Saddicihha, study, “the Behavioral Research Ethics Board of the University of British Columbia and the Providence Health Care Research Institute provided ethics approval”.  The 2018 Gasior’s study had ethical approval was done by Western University’s ethics review board. In the 2016 Roy study “was conducted with the approval of the Comité d’éthique de la recherche en santé chez l’humain du Centre Hospitalier Universitaire de Sherbrooke et de l’Université de Sherbrooke and conformed to the principles embodied in the Declaration of Helsinki(Roy, 2016).

When dealing with people that are children and mentally ill, might misunderstand what is being asked of them. This could go against being ethical practice. Some people that have post-traumatic stress disorder and experience childhood abuse might not like talking about their experience or embarrassed. It is important for respect them and what the are comfortable talking about.

Conclusion

The PICO question was fit in the Thulian 2018 article.  The other three had touched on social integration but were more focused on the substance abuse, childhood abuse and mental illness. It put more pressure on the health care system has we must deal with the implications of homelessness. We need to keep the opportunity for youth to get an education and succeed in life. Also, we need programs where youth can go and talk with other people in the similar situations and to encourage going to counseling. If a youth wants to finish high school, they should have the opportunity while out worrying about day-to-day survival.

References

• Gasior, S., Forchuk, C., & Regan, S. (2018). “Youth homelessness: The impact of supportive relationships on recovery.” (Canadian Journal of Nursing Research), 50(1), p.28-36. doi: 10.1177/0844562117747191
• Roy, É., Robert, M., Fournier, L., Laverdière, É., Berbiche, D., & Boivin, J.-F. (2016). “Predictors of residential stability among homeless young adults: a cohort study.” (BMC Public Health), 16(1), p. 1–8. July 23, 2019 https://doi-org.libproxy. uregina.ca/10.1186/s 12889-016-2802-x
• Saddichha, S., Linden, I., & Krausz, M. R. (2014). Physical and Mental Health Issues among Homeless Youth in British Columbia, Canada: Are they Different from Older Homeless Adults? Journal of the Canadian Academy of Child & Adolescent Psychiatry, 23(3), p.200–206. Retrieved July 22,2019 from http://search.ebscohost.com.libproxy.uregina.ca/ login. Aspx? direct =t rue&db=rzh&AN= 109681463&site=ehost-live
• Thulien, N.S., Gastaldo, D., Hwang, S.W., & McCay, E. (2018). “The elusive goal of social integration: A critical examination of the socio-economic and psychosocial consequences experienced by homeless young people who obtain housing.” (Canadian Journal of Public Health), 109(1), p 89-98. doi: 10.17269/s41997-018-0029-6

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