A Social Capital Approach to Identifying Correlates of Perceived Social Support Among Homeless Youth

Background

The ability of homeless youth to accumulate resources through their personal relationships with others (i.e. social capital) is often associated with improved outcomes across multiple domains. Despite growing evidence documenting the heterogeneity of homeless youths’ relationships, many youth still experience adversities or lack access to resources. Thus, a more comprehensive investigation of homeless youths’ sources of social capital and the factors associated with these networks is needed.

Objective

This current study aimed: (1) to delineate the composition of social support networks of homeless youth and (2) to identify salient correlates of these different sources of social support.

Methods

A sample of 1046 youth, ages 13–24, were recruited from three homeless youth drop-in-centers. Youth completed a computerized self-administered survey and a social network interview. Multivariate logistic regression analyses were conducted to examine whether youths’ homelessness backgrounds, victimization experiences, and risky behaviors were associated with different emotional and instrumental forms of social capital.

Results

Overall rates of homeless youths’ social support from all sources were low. Rates of emotional support were greater than instrumental support, with youth with histories of physical abuse, street victimization, and foster care reporting more emotional support from some sources. Street victimized youth were significantly more likely to report having emotional and instrumental support from all sources of capital.

Conclusion

Findings suggest the need for careful consideration of youths’ support systems when providing services to homeless youth. Specifically, it may be important to assess the common supports utilized by youth in order to maximize youths’ social networks.

     

Modeling Minority Stress Effects on Homelessness and Health Disparities among Young Men Who Have Sex with Men

Sexual minority youth are more likely to experience homelessness, and homeless sexual minority youth report greater risk for mental health and substance abuse symptoms than homeless heterosexual youth, yet few studies have assessed determinants that help explain the disparities. Minority stress theory proposes that physical and mental health disparities among sexual minority populations may be explained by the stress produced by living in heterosexist social environments characterized by stigma and discrimination directed toward sexual minority persons. We used data from a sample of 200 young men who have sex with men (YMSM) (38 % African American, 26.5 % Latino/Hispanic, 23.5 % White, 12 % multiracial/other) to develop an exploratory path model measuring the effects of experience and internalization of sexual orientation stigma on depression and substance use via being kicked out of home due to sexual orientation and current homelessness. Direct significant paths were found from experience of sexual orientation-related stigma to internalization of sexual orientation-related stigma, having been kicked out of one’s home, experiencing homelessness during the past year, and major depressive symptoms during the past week. Having been kicked out of one’s home had a direct significant effect on experiencing homelessness during the past 12 months and on daily marijuana use. Internalization of sexual orientation-related stigma and experiencing homelessness during the past 12 months partially mediated the direct effect of experience of sexual orientation-related stigma on major depressive symptoms. Our empirical testing of the effects of minority stress on health of YMSM advances minority stress theory as a framework for investigating health disparities among this population.     

Social integration of adolescents at risk: Results from a cohort study

Abstract

Using a sample of 614 youths, this study examined differences and similarities between adolescents at risk (age range 11–20 years), and their integration in school or vocational training. We found that mood states (depression, anxiety), secure self (self-esteem and self-efficacy), relationship with parents, delinquency and substance use (alcohol, tobacco and cannabis) were variables which largely influenced social integration (school, work) for youths with poor sociodemographic backgrounds. An important variable we introduced here was sociodemographic background, which investigated the social situation of a youth. We distinguished two different groups (good vs. poor sociodemographic background). There were important differences between both groups. Youths with a poor sociodemographic background scored higher in suicidality and health complaints. The most striking differences were in substance use and delinquency. The structural equation model showed that poor mood was related to substance use at the start. Important paths were found in mood states over time, as for substance use, but interactions between both variables were small. We ran different models (poor vs. good social background, Swiss vs. migrant youths), and concluded that secure self and good family relations protected against poor mood and substance use and both variables indirectly influenced integration 2–3 years later.     

Australian homeless persons’ experiences of social connectedness,isolation and loneliness

Both loneliness and a lack of social integration are associated with serious physical and psychological health issues. One population highly susceptible to social isolation and loneliness are individuals who are homeless, who also experience high rates of mental disorder and relationship breakdown. Despite this, little research has explored how social networks, isolation and loneliness are experienced for those with a history of homelessness. In‐depth, semi‐structured interviews were used to get a nuanced understanding of how social networks and isolation are experienced and understood by individuals experiencing homelessness. Sixteen participants who were either homeless (n = 11) or previously homeless (n = 5) in Sydney, Australia, completed one‐off interviews that were audio‐recorded and transcribed. Data were analysed using thematic analysis. Participants constructed their social networks as being both constrained and enabled by marginalisation. They experienced rejection from the non‐homeless: the loss of critical network members, including rejection from family and a lack of companionship, and low quality and precarious relationships within the homeless community. These accounts were best conceptualised through loneliness theory. Participant's accounts signal that the homeless will likely continue feeling isolated if mainstream attitudes towards homelessness remain stigmatising and discriminatory.     

Factors predicting completion of a home visitation program by high-risk pregnant women: the North Carolina Maternal Outreach Worker Program

OBJECTIVES: This study sought to identify characteristics of high-risk pregnant women that predicted long-term participation in a home visitation program. METHODS: Data regarding sociodemographic characteristics, perceived needs, psychological functioning, substance use, and informal social support were collected prospectively from 152 short-term and 221 long-term program participants. RESULTS: In comparison with short-term participants, long-term participants were more likely to have been African American, married, nonsmokers, and enrolled in the program during their second trimester of pregnancy, and they were more likely to have had emotional and instrumental support needs. CONCLUSIONS: Women with greater social support needs and healthier behaviors were more receptive to long-term home visitation than other women.     

Health care service use among vulnerable adolescents

Abstract

This article describes the patterns of health care service use among a cohort of vulnerable adolescents with a history of homelessness and uses the Expanded Behavioral Model for Vulnerable Populations to examine factors associated with use of ambulatory and emergent care. We incorporated a health care interview into an existing longitudinal study of newly homeless adolescents, at their 24-month assessment (n?=?183) and assessed their sociodemographic characteristics, including living situation, health insurance rates, having a regular source of care, substance use and health care service use in the past 3 months. By the 24-month assessment, 63% of youth had returned home and 37% were currently homeless. In comparing youth who were currently homeless and those who had returned home, we found similar rates for ambulatory care use (48%) and for emergent care use (15%). The most common reason for seeking ambulatory care related to sexually transmitted disease (STD) testing/HIV testing/reproductive health for both groups. However, currently homeless youth were more likely to seek emergent care for trauma (15% vs. 4%, p?<?0.01) and for common conditions such as skin problems/respiratory infections/gastrointestinal problems/other problems (16% vs. 7%, p?<?0.05). Using multivariate logistic regression, we found older age [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.0–6.5] and health insurance (OR 2.3, 95% CI 1.1–4.5) to be associated with use of ambulatory care; however, only older age (OR 2.7, 95% CI 1.0–7.0) was found to be associated with use of emergent care. Housing status, emotional distress and substance use were not found to be associated with ambulatory or emergent care use. Our findings suggest that facilitating health insurance coverage for vulnerable adolescents with a history of homelessness may lead to increased use of ambulatory care services and may consequently prevent use of emergent care services for conditions that may be treated in the ambulatory care setting.     

Can videoconferencing affect older people's engagement and perception of their social support in long‐term conditions management: a social network analysis from the Telehealth Literacy Project

Social support is a key component in managing long‐term conditions. As people age in their homes, there is a greater risk of social isolation, which can be ameliorated by informal support networks. This study examined the relationship between changes in social support networks for older people living in a regional area following weekly videoconference groups delivered to the home. Between February and June 2014, we delivered 44 weekly group meetings via videoconference to participants in a regional town in Australia. The meetings provided participants with education and an opportunity to discuss health issues and connect with others in similar circumstances. An uncontrolled, pre‐post‐test methodology was employed. A social network tool was completed by 45 (87%) participants either pre‐ or post‐intervention, of which 24 (46%) participants completed the tool pre‐ and post‐intervention. In addition, 14 semi‐structured interviews and 4 focus groups were conducted. Following the intervention, participants identified increased membership of their social networks, although they did not identify individuals from the weekly videoconference groups. The most important social support networks remained the same pre‐ and post‐intervention namely, health professionals, close family and partners. However, post‐intervention participants identified friends and wider family as more important to managing their chronic condition compared to pre‐intervention. Participants derived social support, in particular, companionship, emotional and informational support as well as feeling more engaged with life, from the weekly videoconference meetings. Videoconference education groups delivered into the home can provide social support and enhance self‐management for older people with chronic conditions. They provide the opportunity to develop a virtual social support network containing new and diverse social connections.     

Patterns of Social Support Among Lymphoma Patients Considering Stem Cell Transplantation

There is lack of literature addressing factors that influence the process of care for patients with hematological malignancies. We evaluated the forms of social support available for patients with relapsed lymphoma considering stem cell transplantation and examined the influence of support on treatment delay. Data were collected from 119 patients with relapsed lymphoma using a questionnaire to capture sociodemographic information and emotional, informational, and instrumental forms of social support. Sixty-four percent of the patients were married, 56% had children over 18 years of age, 43% were employed, and 72% had private health insurance. Family members formed a major source of emotional support (83%), while 47% of patients considered personal prayers to be important. While 79% of patients received clinical support from nurses, few received formal group support or formal peer support (6.7% and 1.7% respectively). Support from extended family and peer groups reduced the likelihood of treatment delays. The potential benefits of peer group support should be reinforced for patients considering transplantation given how infrequent this form of social support is utilized and its positive impact on the process of care. Future studies should test the impact of social support on health outcomes especially among the underserved population.     

Social networks and risk for depressive symptoms in a national sample of sexual minority youth

The aim of the study was to examine the social networks of sexual minority youths and to determine the associations between social networks and depressive symptoms. Data were obtained from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative cohort study of American adolescents (N = 14,212). Wave 1 (1994-1995) collected extensive information about the social networks of participants through peer nomination inventories, as well as measures of sexual minority status and depressive symptoms. Using social network data, we examined three characteristics of adolescents' social relationships: (1) social isolation; (2) degree of connectedness; and (3) social status. Sexual minority youths, particularly females, were more isolated, less connected, and had lower social status in peer networks than opposite-sex attracted youths. Among sexual minority male (but not female) youths, greater isolation as well as lower connectedness and status within a network were associated with greater depressive symptoms. Moreover, greater isolation in social networks partially explained the association between sexual minority status and depressive symptoms among males. Finally, a significant 3-way interaction indicated that the association between social isolation and depression was stronger for sexual minority male youths than non-minority youths and sexual minority females. These results suggest that the social networks in which sexual minority male youths are embedded may confer risk for depressive symptoms, underscoring the importance of considering peer networks in both research and interventions targeting sexual minority male adolescents.     

Evaluation of a community based dental clinic for youth experiencing homelessness in Brisbane

The relationship between homelessness and ill health is complex, and many risk factors for homelessness such as unemployment, low income, and substance abuse are also risk factors for poor oral health. In order to overcome barriers to access dental care, previous studies have recommended integrating dental care, referral pathways, and information within the overall care provided by support services available to people at risk of homelessness. This study aimed to evaluate a dental service developed and implemented to improve access to oral health care of disadvantaged youth in Brisbane. A mobile dental clinic run by volunteer dental professionals was implemented into a community organisation for disadvantaged youth. Participants were clients of Brisbane Youth Services who were disadvantaged youth, ≤25 years and attended the dental clinic in a 1 year period. A questionnaire collected demographic information, a self‐assessment of oral health and an evaluation of their experiences with the dental clinic. Clinical data including DMFT, appointment attendance and items of service provided were collected. One hundred and twelve clients participated in the four dental clinic weeks and its evaluation. Cost was the greatest reported barrier to accessing dental care among participants. More than half (57%) of participants who pre‐booked an appointment failed to attend. A total of 640 services were delivered, with an estimated value of $48,000. The majority (69%, n = 444) of the services provided were preventative services. Almost all of the clients felt the service they received was suitable for them (97%, n = 98) and would use the service again (98%, n = 99). This dental clinic model is feasible and sustainable due to its integration into an existing homeless youth service, low running costs, acceptability to clients and an interest by dental practitioners to volunteer. It provides a useful model which could be scaled up and implemented in other regions.     

Health supports needed for homeless persons transitioning from hospitals

Being homeless has a negative effect on health and the health needs of individuals experiencing homelessness are complex and challenging to address. As a result of limited access to and use of primary healthcare, the main point of entry into the healthcare system for individuals experiencing homelessness is often hospitals and emergency departments. Persons experiencing homelessness are commonly discharged from hospital settings to locations that do not support recovery or access to follow‐up care (e.g. shelters or the street). This can be costly to both the healthcare system and to individuals' health and quality of life. We conducted a scoping review of the literature published between 2007 and 2017 to identify the types of health supports needed for persons experiencing homelessness who are discharged from the hospital. Thirteen literature sources met inclusion criteria and thematic data analyses by two researchers resulted in the identification of six themes related to the types of health supports needed for persons experiencing homelessness who are transitioning (i.e. being discharged) from the hospital. Using a community consultation approach, the scoping review themes were validated with 23 health and shelter service providers and included in our integrated findings. Themes included: (a) a respectful and understanding approach to care, (b) housing assessments, (c) communication/coordination/navigation, (d) supports for after‐care, (e) complex medical care and medication management, and (f) basic needs and transportation. These themes were found to resonate with participants of the community consultation workshop. Recommendations for trauma‐informed care and patient‐ or client‐centred care approaches are discussed.     

Social network influences on smoking,drinking and drug use in secondary school: centrifugal and centripetal forces

We explore how school experiences and social networks structure young people’s substance use in different institutional contexts. The concepts of ‘selection’ and ‘influence’ are situated within the context of bounded agency, counter‐school cultures and Bourdieusian notions of capital. We employed individual and group interviews, network‐mapping, and observations at two contrasting English secondary schools. Both schools were characterised by extended social network structures that appeared to influence patterns of substance use, although the mechanisms via which this occurred varied according to school context. At Grange House school (suburban context) a minority of students from disadvantaged families were alienated by the attainment‐focused regime, marginalised by a strong peer‐led centrifugal force pushing them outwards, and substance use was an alternative source of bonding and identity for these students. In contrast, at North Street a centripetal force operated whereby the majority of students were pulled towards highly‐visible, normative markers of ‘safe’, ‘road culture’, such as cannabis use and gang‐involvement, as they attempted to fit in and survive in an inner‐city school environment. We conclude that health inequalities may be reproduced through these distinctive centrifugal and centripetal forces in different institutional contexts, and this should be the focus of quantitative examination in the UK and elsewhere.     

Young adolescents' perceived activity space risk,peer networks,and substance use

Adolescent substance use is a developmentally contingent social practice that is constituted within the routine social-environment of adolescents' lives. Few studies have examined peer networks, perceived activity space risk (risk of substance use at routine locations), and substance use. We examined the moderating influence of peer network characteristics on the relationship between perceived activity space risk and substance use among a sample of 250 urban adolescents. Significant interactions were found between peer networks and perceived activity space risk on tobacco and marijuana use, such that protective peer networks reduced the effect of activity place risk on substance use. A significant 3-way interaction was found on marijuana use indicating that gender moderated peer network's effect on activity space risk. Conditional effect analysis found that boys' peer networks moderated the effect of perceived activity space risk on marijuana use, whereas for girls, the effect of perceived activity space risk on marijuana use was not moderated by their peer networks. These findings could advance theoretical models to inform social–environmental research among adolescents.     

Examination of the clinical,familial and personal characteristics on homelessness of at-risk adolescents

OBJECTIVE: Our research pertains to juveniles coming under the responsibility of the Centres jeunesse du Quebec (delinquency and youth protection regional services). Some of these teenagers fled their family and made use of their social network to cope with residential instability. These youths were then in a situation of "hidden homelessness", sleeping neither in the streets nor at shelters. Two objectives are pursued: 1) a comparison of youth's and parent's evaluations of significant dimensions of their family life, and 2) an identification of the adolescents' characteristics (clinical, familial and individual) related to their "hidden homelessness". METHOD: Using bivariate analysis, a group of adolescents who had experienced homelessness was paired (on sex, age and urban or rural areas of origin) to a sample of non-homeless youths. The analysis uses both adolescents and parent/caretaker reports on measures of family characteristics and adolescent self-reports on measures of clinical and personal characteristics. FINDINGS: Our results show 1) that, in general, adolescents report a higher level of parental maltreatment and more problems related to the family dynamics and their relationship with their parents than their parents do; 2) that hidden homelessness of distressed youths is generally associated with the same familial risk factors as the ones identified by the studies concerning street youths; 3) in contrast to some other comparative studies, the homeless adolescents in our study did not differ from the non-homeless youths as to the importance of the depressive diagnostic and the use of hard drugs.     

Supporting African refugees in Canada: insights from a support intervention

Although evidence suggests the importance of social support for refugees, this knowledge has not been invoked to systematically develop culturally congruent support interventions that help refugees adapt to life in receiving countries. The objective of this study was to design and pilot test a culturally congruent intervention that meets the support needs and preferences of two ethno‐culturally distinct refugee groups. Support was delivered to Somali and Sudanese refugees (n = 58), by trained peer and professional facilitators. Face‐to‐face groups comprised of refugees, matched by gender and ethnicity, were created to enhance the depleted social networks of Somali and Sudanese refugees. Each peer support group met bi‐weekly for a face‐to‐face session for 12 weeks. Peer facilitators delivered supplementary one‐to‐one support via the telephone. The ingredients of the support intervention included: (i) peer facilitators and professionals; (ii) provision of information, affirmation and emotional support; and (iii) accessibility (e.g. childcare, transportation). The study employed a qualitative participatory research design. Data collected for the study included (i) in‐depth pre‐intervention interviews with potential support group participants in 2008–2009 to assess intervention preferences; (ii) fieldnotes by peer and professional facilitators during the intervention in 2009–10; (iii) post‐intervention group interviews with support group participants in 2010; and (iv) in‐depth interviews with peer and professional helpers in 2010. A major perceived benefit of the support programme was connecting with people from African refugee participants’ cultural communities. Participants appreciated the gender and culture‐specific groups. Following the social support intervention, refugees reported increased social integration, decreased loneliness and expanded coping repertoire.     

The impact of transitional programmes on post‐transition outcomes for youth leaving out‐of‐home care: a meta‐analysis

Youth residing in out‐of‐home care settings have often been exposed to childhood trauma, and commonly report experiencing adverse outcomes after transitioning from care. This meta‐analysis appraised internationally published literature investigating the impact of transitional programme participation (among youth with a baseline age of 15–24 years) on post‐transition outcomes of housing, education, employment, mental health and substance use. A comprehensive search of sociology (e.g. ProQuest Sociology), psychology (e.g. PsycInfo) and health (e.g. ProQuest Family Health) electronic abstraction databases was conducted for the period 1990–2014. Search terms included ‘out‐of‐home care’, ‘transition’, ‘housing’, ‘education’, ‘employment’, ‘mental health’ and ‘substance use’. Nineteen studies, all from the United States, met the inclusion criteria and were included in the meta‐analysis. Living independently and homelessness were the most commonly described housing outcomes. Rates of post‐transition employment varied, while rates of post‐secondary education were low. Depression and alcohol use were commonly reported among transitioning youth. Findings of the meta‐analysis showed that attention should be given to the potential benefit of transitional programme participation on outcomes such as housing, employment and education. Moderator analyses showed that these benefits may differ based on study design, sample size and sampling unit, but not for mean age or gender. Detailed and rigorous research is needed internationally to examine the characteristics of transitional programmes resulting in more successful outcomes for youth, and whether these outcomes are sustained longitudinally.     

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.     

Examining the social, emotional and behavioral needs of youth involved in the child welfare and juvenile justice systems

This study assesses the social, emotional and behavioral symptoms of 2,575 youth who were receiving behavioral health services from a private provider agency, either in an out of home placement (e.g., foster care home, a group home or a residential treatment facility) or in their own home (through the In-Home Services Program). The findings suggest the prevalence of symptoms in each of the domains (i.e., conduct problems, emotional problems, ADHD, and peer problems) were relatively high compared to the general population. Over 50% of the youth had conduct problems in the borderline or abnormal range, more than 35% had hyperactivity and peer problems subscale scores in the borderline or abnormal range, and almost 25% of the youth reported symptoms of emotional problems in the borderline or abnormal range. Youth's social, emotional and behavioral problems varied by gender, race/ethnicity and age group.     

A psychosocial mediational model of homelessness among U.S. male and female veterans who served in Iraq and Afghanistan

Few studies have focused on homelessness among Operations Iraqi Freedom, Enduring Freedom and New Dawn (OEF/OIF/OND) veterans, especially female veterans. An explanatory model of homelessness was constructed and tested for each gender. Data collected in the United States from 833 OEF/OIF/OND veterans (41.5% female; M_age = 35.22, SD = 8.86) who completed the baseline assessment of the Survey of the Experiences of Returning Veterans between September 2011 and July 2014 were analysed. Path analysis was used to examine associations between risk factors and any lifetime homelessness, stratified by gender. Adverse childhood events (ACEs) and low social support were significantly associated with lifetime homelessness for both genders. Social support mediated associations between ACEs and homelessness, after controlling for sociodemographic factors. While sociodemographic risk factors are often considered in homeless prevention, these findings highlight the importance of social support among male and female OEF/OIF/OND veterans, underscoring the need to target this life domain in preventing homelessness.