Youth experiencing homelessness

All three studies today deal with youth experiencing homelessness or housing insecurity, increasingly common phenomena across the US. First, Bird, Jenzer & Read (2023) published “Youth Experiencing, and Youth at Risk of, Homelessness: Associations between trauma type, posttraumatic negative cognitions, and posttraumatic stress disorder” in Traumatology. Here’s the edited abstract

Experiencing homelessness as an adolescent or young adult confers risk for trauma experiences and posttraumatic stress disorder (PTSD). Despite being a unique and at-risk group, research on the mechanisms that can impact PTSD symptom severity in this population is scant. One variable that has been found to follow both interpersonal trauma (IPT; e.g., acts of violence or neglect by a perpetrator) and noninterpersonal trauma (non-IPT; e.g., natural disasters, motor vehicle accidents) is posttraumatic cognitions (PTCs), or negative thoughts about the self, the world, and self-blame, following a traumatic experience. This study aimed to describe the experiences of IPT and non-IPT in this sample. Second, we aimed to be the first to identify how IPT and non-IPT impact PTCs for youth experiencing and youth at risk for homelessness. Finally, we examined the impact of PTCs on PTSD following both IPT and non-IPT. Data derived from a sample of youth at risk for homelessness and youth experiencing homelessness (N = 63) in Buffalo, New York, United States were analyzed. PTCs have been found to follow trauma exposure which was corroborated by mediation analyses in our study. Mediation models identified that PTCs about the self (β = .34, SE = 0.12, 95% confidence interval [CI] [.14, .6]), and self-blame (β = .14, SE = 0.07, [.01, .3]), partially mediated the relationship between IPT and PTSD. Significant mediation pathways of PTCs were not found between non-IPT and PTSD. 

It’s not a huge sample, but I thought the ideas were important in understanding the trauma risks associated with homelessness. The next study examines what parents can do. Keane & Shelleby (2024) published “Routines and Warmth as Protective Factors on the Relation between Housing Instability and Child Outcomes” in Journal of Family Psychology. Here’s the edited abstract:

Housing instability is associated with numerous poor child outcomes in domains such as behavioral and emotional problems. The impacts of housing instability on child outcomes are typically investigated in the context of sociodemographic risk; however, exploring the role of protective factors (e.g., family routines, parental warmth) in these contexts allows for a more thorough understanding of the effect of housing instability and how potential negative outcomes might be mitigated. The present study further explored the relation between early housing instability and child behavioral and emotional outcomes in middle childhood in addition to the potential moderating role of family routines and parental warmth in early childhood. Longitudinal data of 4,898 families from the Future of Families and Child Wellbeing Study were used to explore these associations. Using structural equation modeling, the present analyses indicated that when controlling for key sociodemographic covariates, housing instability in early childhood was not related to child outcomes at age 9. Greater parental warmth at age 5 was significantly associated with lower levels of behavioral and emotional problems at age 9. Categorical models using the product indicator approach indicated that greater parental warmth attenuates the relation between moving one to two times and later child behavioral problems. Parental warmth emerged as a significant promotive factor for later child emotional problems. 

This study has a much larger sample and examines younger children than the first. However, it illustrates the protective role of parental warmth. The final study looks at therapy. Hamel, Vitopoulos, McDonald & Kidd (2024) published “A Novel Framework for Guiding Psychotherapy for Youth Who Have Experienced Homelessness” in Professional Psychology: Research and Practice. The edited abstract and impact statements follow:

Youth who have experienced homelessness are impacted by disproportionately high levels of mental health symptoms, which contribute to vastly decreased well-being and early mortality. Despite a salient need for mental health support, several recent reviews have shown that few, if any, interventions currently applied to this group appear to improve mental health consistently. Furthermore, community mental services present many barriers to access for this population, given the impacts of social determinants of health on youths’ ability to engage in the available supports, the ongoing instability faced by many of these youths, and the lack of applicability of existing services to youth. A challenge exists for clinicians who work with this population of youth and wish to provide effective supports, given these obstacles and an inadequate evidence base on which to inform treatment. The purpose of this article is to propose a framework for care to inform psychotherapeutic treatment for clinicians providing mental health supports to youth with experiences of homelessness. This framework is cross-modality, transdiagnostic, and research-informed and seeks to provide a structure with which to frame treatment that acknowledges and responds to the various obstacles that practitioners frequently encounter in working with this population. The framework is accompanied by illustrative case studies to demonstrate how this framework may be applied using different treatment modalities. The hope in sharing this framework is to promote more intentional and effective interventions with this chronically underserved population of youth and also to increase the self-efficacy of those practitioners who are doing this important work. 

Youth who have experiences of homelessness often face mental health challenges that significantly impact their well-being and overall life expectancy. This article addresses a critical gap in existing interventions by proposing a comprehensive framework for mental health professionals providing psychotherapy to this population. By offering evidence-informed strategies and case studies, this framework aims to support clinicians in providing more effective and tailored support, promoting clinician self-efficacy, and ultimately fostering improved mental health outcomes for this vulnerable population. 

This is the advance publication of the abstract so I don’t have further details, but I thought it was important in documenting the challenges of working with this population. Taken together, the three studies illustrate early work on this important problem.