Pathways to criminalization for street-involved youth who use illicit substances

Illicit drug use and homelessness among street-involved young people remain community and public health concerns, in part because of their association with ‘public disorder’, as well as increased encounters between youth, police, the criminal justice system, and the associated health-related harms. In the public imagination, illicit drug use, homelessness, and police encounters (including incarceration) are often understood as problems rooted in individual biographies. In general, there has been a lack of attention to the larger historical, institutional, and social-spatial contexts that converge across time, to increase young people’s risk of coming into contact with police and the criminal justice system. Drawing from a longitudinal ethnography with street-involved young people who use illicit drugs in Vancouver, Canada, we highlight two qualitative case studies that illustrate some of the ‘pathways’ to criminalization among this population. Specifically, these case studies reflect the complex linkages between child apprehension, foster care, homelessness, illicit substance use, and incarceration (juvenile detention and prison) across time. Our findings highlight the role of state interventions in perpetuating the marginalization that occurs across young people’s lives, in ways that increase their vulnerability to police and criminal justice encounters.     

Adaptation to Early Adulthood by a Sample of Youth Discharged from a Residential Education Placement

Three years of outcome data for foster youth (n = 106) discharged from a one-of-kind residential education service are presented. Findings were that 50% of respondents attended college at some point. Youth reported having 2 or 3 jobs a year with at least one bout of unemployment. Most of the non-college bound youth reported working in low-wage unskilled jobs that did not appear to be career oriented. Almost 75% of former residents had at least one connection to the adult world through school, work, or marriage one year after discharge. This rate had climbed to 96% at the 36-month interview. Respondents were reporting much lower rates of criminal justice involvement, homelessness, and victimization than found in other studies of discharged foster youth.     

Homelessness Independently Predicts Injection Drug Use Initiation Among Street-Involved Youth in a Canadian Setting

PurposeThis longitudinal study examines the association between homelessness and injection drug use initiation among a cohort of street-involved youth in a setting of high-prevalence crystal methamphetamine use.MethodsWe derived data from the At-Risk Youth Study, a prospective cohort of street-involved youth aged 14–26 years, recruited between September 2005 and November 2011. We used Cox proportional hazards regression to identify factors independently associated with time to injection initiation.ResultsAmong 422 street-youth who had never injected at baseline, we observed 77 injection initiation events during follow-up. Homelessness was independently associated with injection initiation in multivariate Cox regression (relative hazard, 1.80 [95% confidence interval, 1.13–2.87]) after adjusting for crystal methamphetamine use and other potential confounders.ConclusionsThese findings highlight that homelessness is a key risk factor for injection initiation among street-involved youth. Supportive housing interventions for street youth may help prevent injection drug use initiation within this high-risk population.     

Fostering Healthy Futures Preventive Intervention for Children in Foster Care: Long-term Delinquency Outcomes from a Randomized Controlled Trial

Prevention Science - Child maltreatment and foster care placement are strong risk factors for delinquency and juvenile justice involvement, and there is substantial crossover between youth in the...     

Sociodemographic and substance use characteristics associated with typologies and composition of social support networks among youth experiencing homelessness in Los Angeles,USA

Youth experiencing homelessness are a vulnerable population with increased behavioural health risks. Social networks are a consistent correlate of youths’ substance use behaviours. However, less is known about the reciprocal relationships among these constructs. This study classified youth experiencing homelessness according to their social support network type (e.g. instrumental, emotional, service) and composition (e.g. family, peers, service staff) and linked their membership in these social network classes to sociodemographic and substance use characteristics. Four waves of cross‐sectional data were collected between October 2011 and June 2013 from youth experiencing homelessness, ages 14–29, at three drop‐in centres in Los Angeles, CA (N = 1,046). This study employed latent class analysis to identify subgroups of youth experiencing homelessness according to the type and composition of their social support networks. Multinomial logistic regression analyses were then conducted to identify the sociodemographic and substance use characteristics associated with social support network class membership. Five latent classes of youths’ social support networks were identified: (a) high staff emotional and service support; (b) high home‐based peer and family emotional, service and instrumental support; (c) moderate street‐ and home‐based peer emotional support; (d) low or no support and (e) high home‐based peer and family emotional and instrumental support. Multinomial logistic regression models indicated that race/ethnicity, gender, sexual orientation, literal homelessness, former foster care experience, depression, heroin and marijuana use were significant correlates of social support network class membership. Results indicate distinct classes of social support networks among youth experiencing homelessness, with certain sociodemographic and substance use characteristics implicated in youths’ social networks.     

Telepsychiatry with incarcerated youth

PurposeIncarcerated adolescents have a high prevalence of psychiatric disorders but lack psychiatrists to provide ongoing care. Telepsychiatry may provide one solution to treating this underserved population.MethodsInteractive video conferencing was used to connect a minimum security correctional facility with a regional telemedicine program. Clinical records were reviewed to examine utilization, demographics, diagnoses, pharmacotherapy, and patient satisfaction.ResultsDuring the 29-month study period, 115 youth were treated using 275 telepsychiatry visits. Substance-use, behavioral, and emotional disorders were highly prevalent. Eighty percent (80%) of the youth were successfully prescribed medications. Youth expressed confidence with the psychiatrist’s recommendations but expressed concerns about privacy.ConclusionsTelepsychiatry can successfully deliver services to incarcerated adolescents with a wide range of psychiatric needs. A patient-centered approach that directly assesses adolescents’ satisfaction is recommended to ensure youths’ optimal involvement in needed services.     

Trauma Exposure and PTSD in Justice-Involved Youth

This special issue of Child and Youth Care Forum includes four original research reports that build on the field’s knowledge of trauma stress exposure and PTSD in justice-involved youth. Utilizing diverse methodologies, study authors report unique results investigating important questions related to screening and assessment of justice-involved populations, the potential linkage between violence exposure and violence perpetration, and the complex relationships between trauma exposure in childhood and specific problematic offending behaviors. Each article includes specific clinical implications and recommendations for future research to provide useful information to juvenile justice administrators, mental health professionals, and researchers involved in the care and management of trauma exposed youth within the juvenile justice system. This introduction provides an overview of how empirical studies of the nature and sequelae of traumatic stress exposure are currently a focus for research and services in the juvenile justice field, highlighting how the articles in the Special Issue exemplify the progress to date, and promise for the future, of several lines of research involving psychometrics, health and correctional services, and clinical epidemiology.     

Pathways to youth homelessness

Research documents high levels of psychopathology among homeless youth. Most research, however, has not distinguished between disorders that are present prior to homelessness and those that develop following homelessness. Hence whether psychological disorders are the cause or consequence of homelessness has not been established. The aim of this study is to investigate causal pathways to homelessness amongst currently homeless youth in Australia. The study uses a quasi-qualitative methodology to generate hypotheses for larger-scale research. High rates of psychological disorders were confirmed in the sample 35 homeless youth aged 14-25. The rates of psychological disorders at the point of homelessness were greater than in normative samples, but the rates of clinical disorder increased further once homeless. Further in-depth analyses were conducted to identify the temporal sequence for each individual with a view to establishing a set of causal pathways to homelessness and trajectories following homelessness that characterised the people in the sample. Five pathways to homelessness and five trajectories following homelessness were identified that accounted for the entire sample. Each pathway constituted a series of interactions between different factors similar to that described by Craig and Hodson (1998. Psychological Medicine, 28, 1379-1388) as "complex subsidiary pathways". The major findings were that (1) trauma is a common experience amongst homeless youth prior to homelessness and figured in the causal pathways to homelessness for over half of the sample; (2) once homeless, for the majority of youth there is an increase in the number of psychological diagnoses including drug and alcohol diagnoses; and (3) crime did not precede homelessness for all but one youth; however, following homelessness, involvement in criminal activity was common and became a distinguishing factor amongst youth. The implications of these findings for future research and service development are discussed.     

Deconstructing youth transition to adulthood services: Lessons learned from the VISIONS program

Abstract

The Health Belief Model and Theory of Reasoned Action were used in evaluating a community-based human development program for youth in foster care – VISIONS. The study examined youth perceptions of the barriers to, and the skills needed to increase independent living skills and the capacity to become productive adults in the community post discharge from care. Participants' perceived self efficacy, perceived benefit associated with the program, barriers to skills development and the role of mentor relationship in youth mastery of life skills, were assessed. Youth mastery of life skills was assessed using Ansell Casey Life Skills Assessment; while FGDs and the Life Skills Questionnaire were used to examine what participants liked most/least about the program. Findings showed participants reported increased skills mastery at follow-up. Relationship with a mentor was a strong predictor of skills mastery. The findings, point to a need for more dynamic and pragmatic strategies to implementing human development training programs for youth in order to improve ILS outcomes. These and other findings are discussed along with their implications for future research on youth human development needs.     

Racial differences in the mental health needs and service utilization of youth in the juvenile justice system

Mental health placement rates by the juvenile justice system differ by race. However, it is unknown whether mental health needs differ by race. This study attempted to investigate potential differences in mental health needs and service utilization among Caucasian, African American, and Hispanic juvenile justice involved youth. A stratified random sample of 473 youth petitioned, adjudicated, and incarcerated from 1995–1996 was examined using a standard chart review protocol and the Childhood Severity of Psychiatric Illness measure for mental health needs. Significant and unique mental health needs were demonstrated for all racial groups. African American youth demonstrated the greatest level of needs. Minority status indicated significantly lower rates of mental health service utilization. Minority youth in the juvenile justice system are most at risk for underserved mental health needs. Based on the current data, it can be inferred that the first contact with the state's child and adolescent serving system, which includes the juvenile justice and mental health sectors, appears to be through the juvenile justice sector for many minority youth with delinquency problems.     

Health care of youth in corrections

The number of juveniles in correctional facilities is growing. These youth tend to have significant medical and mental health problems, yet they are underserved with respect to health care. Health care providers can work to improve the health status of incarcerated youth by pushing for improved funding of and standards for their health care and for their increased access to care while they are in correctional facilities and after they are released. This article presents a summary of statistics about the rates of youth incarceration and about the health status of such youth. It also offers recommendations for improving the health care of juveniles involved with the justice system.     

Prevalence and correlates of Chlamydia infection in Canadian street youth.

PURPOSE: To determine the prevalence and correlates of Chlamydia trachomatis in Canadian street youth. METHODS: A cross-sectional study of street youth between the ages of 15-24 years was conducted over a 9-month period in seven large urban centers across Canada. Youth were recruited through "drop-in" centers, outreach work, and mobile vans in each city. Information was collected through a nurse-administered questionnaire. Youth were asked to provide urine to test for chlamydia trachomatis by polymerase chain reaction. Separate logistic regression models were run for males and females controlling for age. RESULTS: The prevalence rate of chlamydia was 8.6% in 1355 youth (95% CI = (7.1%, 10.1%)). Higher prevalence rates were found in females than in males (10.9% vs. 7.3%, respectively) and in Aboriginal youth than in non-Aboriginal youth (13.7% vs. 6.6%, respectively). Four variables were associated with increased risk of chlamydia infection in females: Aboriginal status; self-perceived risk; having no permanent home; and having been in foster care. One predictor of chlamydia for males was having had a social worker. CONCLUSIONS: A high prevalence of chlamydia was found in this vulnerable population in comparison to other Canadian youth. Having been in foster care and having had a social worker were found to have a strong association with chlamydia.     

Homelessness Experiences,Sexual Orientation,and Sexual Risk Taking Among High School Students in Los Angeles

PurposePrior studies reported homeless adolescents engage in more sexual risk than their housed peers. However, these comparisons are typically made post hoc by comparing homeless adolescent community-based samples with high school probability samples. This study uses a random sample of high school students to examine homelessness experiences and sexual risk behaviors.MethodsA supplemental survey to the Youth Risk Behavior Survey containing questions regarding homelessness and sexual health was administered to Los Angeles high school students (N = 1,839). Multivariate logistic regressions assessed the associations between demographics, past year homelessness experiences (i.e., place of nighttime residence), and being sexually active and condom use at last intercourse.ResultsHomelessness experiences consisted of staying in a shelter (10.4%), a public place (10.1%), and with a stranger (5.6%). Lesbian, gay, bisexual, transgender, questioning (LGBTQ), younger, and male adolescents were more likely to experience homelessness. LGBTQ adolescents were also more likely to report staying with a stranger and less likely to report staying in a shelter. Compared to adolescents who stayed in shelters, adolescents who stayed with strangers and in public places were more likely to engage in unprotected sex at last intercourse.ConclusionsAdolescents who report sexual activity and sexual risk taking are more likely to report homelessness experiences. With regard to sexual health, staying with strangers could be a particularly risky form of homelessness; LGBTQ and black adolescents are more likely to experience this form of homelessness. Efforts to reduce homelessness and sexual risk-taking need to recognize the specific vulnerabilities faced by these populations.     

Research‐ and health‐related youth advisory groups in Canada: An environmental scan with stakeholder interviews

BackgroundEngaging youth throughout the research process improves research quality and outcomes. Youth advisory groups provide one way for youth to express their opinions on relevant issues.ObjectiveThis study aimed to identify research‐ and health‐related youth advisory groups (‘groups’) in Canada and understand the best practices of these groups.MethodsGoogle searches and supplementary methods were used to identify relevant groups in Canada. Group information was extracted from websites or through interviews with key informants.ResultsWe identified 40 groups. Groups were commonly part of a hospital/healthcare facility, nonprofit/health organization or research group. The majority focused on a specific content area, most commonly, mental health. Over half the groups advised on health services. Members'' ages ranged from 9 to 35 years. The number of members ranged from 5 to 130. Interviews (n = 12) identified seven categories relating to group practices: (a) group purpose/objectives, (b) group development, (c) group operations, (d) group structure, (e) adult involvement, (f) membership and recruitment and (g) group access. Challenges and facilitators to the success of groups were described within the following themes: (a) retaining engagement, (b) creating a safe environment and (c) putting youth in positions of influence. Advice and recommendations were provided regarding the development of a new group.ConclusionThis study provides a comprehensive overview of research‐ and health‐related youth advisory groups in Canada. This information can be used to identify groups that stakeholders could access as well as inform the development of a new group.Patient or Public ContributionYouth advisory group representatives were interviewed as part of the study.     

Social and structural barriers to housing among street‐involved youth who use illicit drugs

In Canada, approximately 150 000 youth live on the street. Street‐involvement and homelessness have been associated with various health risks, including increased substance use, blood‐borne infections and sexually transmitted diseases. We undertook a qualitative study to better understand the social and structural barriers street‐involved youth who use illicit drugs encounter when seeking housing. We conducted 38 semi‐structured interviews with street‐involved youth in Vancouver, Canada from May to October 2008. Interviewees were recruited from the At‐risk Youth Study (ARYS) cohort, which follows youth aged 14 to 26 who have experience with illicit drug use. All interviews were thematically analyzed, with particular emphasis on participants’ perspectives regarding their housing situation and their experiences seeking housing. Many street‐involved youth reported feeling unsupported in their efforts to find housing. For the majority of youth, existing abstinence‐focused shelters did not constitute a viable option and, as a result, many felt excluded from these facilities. Many youth identified inflexible shelter rules and a lack of privacy as outweighing the benefits of sleeping indoors. Single‐room occupancy hotels (SROs) were reported to be the only affordable housing options, as many landlords would not rent to youth on welfare. Many youth reported resisting moving to SROs as they viewed them as unsafe and as giving up hope for a return to mainstream society. The findings of the present study shed light on the social and structural barriers street‐involved youth face in attaining housing and challenge the popular view of youth homelessness constituting a lifestyle choice. Our findings point to the need for housing strategies that include safe, low threshold, harm reduction focused housing options for youth who engage in illicit substance use.     

Toward a public mental health promotion and intervention system for youth

Substantial limitations exist at all levels of mental health care for youth in most communities in the United States. Particular gaps exist in the areas of prevention, mental health promotion, and early intervention programs. The national movement toward enhancing mental health programs for youth in schools offers an important opportunity to fill gaps in the prevention-services continuum toward the development of a Public Mental Health Promotion and Intervention System for Youth. A strategy--the Child and Adolescent Program Planning Schema (CAPPS)--is presented to analyze gaps in a community's system of mental health programs for youth, and to facilitate planning toward development of a full continuum of programs from broad, population-based prevention, and mental health promotion strategies to treatment of youth with more established problems.     

Assessing the Health Perspectives of Unique Populations of Adolescents: A Focus Group Study

Few articles report on youth's perceptions about health-related issues and needs and even fewer have given voice to youth with disabilities, chronic health conditions, or youth in therapeutic foster care. The purpose of this study was to explore perceptions of health issues from the perspectives of youth placed in therapeutic foster care, youth with chronic medical conditions, and youth with disabilities. Twelve focus groups with 67 youth aged 13–20 were conducted in rural, suburban, and urban communities in the Commonwealth of Virginia. Data analysis revealed both within unique group themes and themes that cut across unique groups. Youth in therapeutic foster care with chronic health conditions or with disabilities perceive themselves as being different from their peers. Participants in each group expressed concerns about the unique issues that they confront daily and how these challenges differentiate them from youth who do not share their life experiences. They expressed the desire for other youth to understand them better and to not treat them differently. Discussion and implications focus on the need to create programs to support the unique needs of these youth.     

校外青少年预防艾滋病健康教育政策落实情况调查及建议

目的了解校外青少年预防艾滋病健康教育政策措施的制定落实情况,分析存在问题并提出建议。方法采用现场调查和文献回顾的方法。结果有关部门制定落实了校外青少年预防艾滋病健康教育政策措施,开展了"青春红丝带"行动、"中国儿童青少年预防艾滋病活动"等工作,目前校外青少年健康教育主要包括依托当地共青团委开展活动、通过家长学校开展相关家庭教育以及开展青少年同伴教育等3种模式。目前还存在诸多挑战如校外青少年尚缺乏明确定义,健康教育的多部门协调机制尚未形成,社会组织参与较少,健康教育工作的人员、经费保障不足,健康教育针对性不强且缺乏效果评估。结论建议将艾滋病防治领域的校外青少年定义为达到法定入学年龄,不在学校接受教育、无职业的25周岁以下青少年;结合社会管理创新、医改的深入推进,落实校外青少年预防艾滋病经费等保障措施;通过开展需求评估,增强健康教育的针对性,通过将健康教育与就业技能等培训相结合,提高健康教育的综合性;开展健康教育效果评估,推广有效模式,针对难点问题进一步探索试点。     

Assessing the health perspectives of unique populations of adolescents: a focus group study

Few articles report on youth's perceptions about health-related issues and needs and even fewer have given voice to youth with disabilities, chronic health conditions, or youth in therapeutic foster care. The purpose of this study was to explore perceptions of health issues from the perspectives of youth placed in therapeutic foster care, youth with chronic medical conditions, and youth with disabilities. Twelve focus groups with 67 youth aged 13-20 were conducted in rural, suburban, and urban communities in the Commonwealth of Virginia. Data analysis revealed both within unique group themes and themes that cut across unique groups. Youth in therapeutic foster care with chronic health conditions or with disabilities perceive themselves as being different from their peers. Participants in each group expressed concerns about the unique issues that they confront daily and how these challenges differentiate them from youth who do not share their life experiences. They expressed the desire for other youth to understand them better and to not treat them differently. Discussion and implications focus on the need to create programs to support the unique needs of these youth.