HOPE

HIV prevention Outreach for Parents and Early adolescents

About the McSilver Institute

The McSilver Institute for Poverty Policy and Research at New York University Silver School of Social Work is committed to creating new knowledge about the root causes of poverty, developing evidence-based interventions to address its consequences, and rapidly translating research findings into action.

The McSilver Institute employs collaborative research methods via partnerships with policymakers, service organizations, consumers and community stakeholders.

Community Collaborative Board

Community Collaborative Board

Who We Are: The CCB members consist of university-based

researchers, parents, school staff and representatives from community-based youth serving organizations and health centers.

The Board oversees a number of research projects focused on designing, delivering and testing family-based prevention and intervention services to elementary, middle and high school age urban youth and their families.

Community Collaborative Board

Mission Statement: The Community Collaborative Board aims to:» Nurture and empower families and communities. » Develop and implement culturally relevant intervention

programs for communities. » Support communities in benefiting from every experience with

research and researchers. » Increasing mental health literacy within communities and

incorporating substance abuse awareness and developing resources for families within their communities.

Community Collaborative Board

CHAMP» Collaborative HIV Prevention and Adolescent Mental

Health Project» HIV prevention for families with pre-adolescents

Concerned about homeless families

Homeless Families in New York City

New York City is facing levels of homelessness among families that has not been seen since the Great Depression.

Families represent 8o% of all homeless people residing each night in the NYC municipal shelter system.

In February 2015, an average of 14,386 homeless families (25,105 children and 22,357 adults) slept in municipal shelters each night.

Average stay is now 435 days, which represents an increase of 25% over the past decade.

Pilot

CHAMP

In a Family Homeless Shelter

CCB Members as facilitators

Pilot Findings Families were highly impacted by poverty along with other

barriers such as drug abuse, mental health and violence.

These issues were not addressed by our original intervention CHAMP.

The population is highly transient; therefore any intervention must be timed accordingly

Child care and dinner was needed in order for families to participate

Curriculum DevelopmentCCB involvement

Evidence based interventions: SISTA Project – HIV Prevention focused on women of color Strengthening Families - Family life skills training program specifically designed for high-risk families. CHAMP

Modified Social Action Theory

Modified Social Action Theory

DemographicsAge, gender, race, ethnicity

Disruption in school Length of homelessness

StressorsParenting stress

Other stressful life events

Child StatusMental health

Peer normative beliefs Parent Status

Mental healthSubstance use

Racial/ cultural identity

Social Interaction

CommunicationSupports

MotivationFuture goal orientation

Self esteem

CapabilitiesPeer skillsKnowledge

Social Independence

Caregiver-child supervision / involvement

BehavioralOutcomes

Possibility situations Debut

Risk taking behavior

Contextual influences Self regulation processes Behavioral outcomes

Program Development

Process of Adaptation

Control/Comparison Group: HOPE Health 3 Sessions Only with parents Included Condom demonstration

Multifamily Group Approach

HOPE Family Program Sessions

1. Introduction and Family Communication2. Monitoring and Supervision3. Self-Respect and Peer Pressure4. Puberty5. HIV/AIDS/STI’s6. Substance Use7. Domestic Violence8. HOPE Family Game

Parent Study: HIV prevention Outreach for Parents and Early adolescents (HOPE)

10 participating shelter sites in Bronx and Manhattan (i.e. all supportive shelter sites run by non-profits)Data collection occurred between April of 2006 to May of 2008Community Collaborative Participatory Research approach (CBPR) Bronx Community Collaborative Board452 caregivers and youth 209 caregivers 243 youth (ages 11 – 14)

Study Results: What have we found?Nisha Beharie, DrPHPostdoctoral FellowNational Development and Research Institutes, Inc.

Youth Participant Characteristics (N=243)

n %Race/ethnicity

Latino 94 43African American 109 44Mixed 40 16

Child genderMale 127 52Female 116 48

Average age of youth12.87 years (s.d. 1.17)

Adult Caregiver Participant Characteristics (N = 209)

92% of families headed by womenMean age of caregivers 37.95 (s.d. 6.87)Almost third of caregivers (30%) were born outside the US47% of the parents had not completed high school or GED16% were employed99% of families had 1 or 2 children between the ages of 11

to 14

Risk Profile (youth)

Mental Health (Childhood Depression Inventory/Strengths & Difficulties Questionnaire)

57% of youth evidence elevated depressive symptoms 22% of youth reported suicidal ideation

55% of youth were described by their adult caregivers as having noteworthy conduct difficulties or difficulties with peers

27% of youth were described by their adult caregivers as being “unhappy, depressed, or tearful”

Risk Profile (youth)Sexual Risk (Sexual Risk Interview)54% of youth think that their friends are having sex26% of youth have spent significant time in situations of

sexual possibility where gateway sexual behaviors have occurred

<10% report sexual activity32% of youth do not believe that they will abstain from

sex by 8th grade

Substance use (Monitoring the Future)Tobacco (13%); Alcohol (23%); Marijuana (7%)

Risk Profile (parent)Mental Health (Brief Symptom Inventory; Global Severity Index)

70% of parents evidenced elevated overall mental health difficulties

53% of parents evidence elevated depressive symptoms

Substance use (Monitoring the Future)

Alcohol (60%)Marijuana (40%)Cocaine (23%)Crack (11%)Heroine (9%)

Shelter Experience

n %Length in shelter (past year)

<5 mo. 129 61>=5 mos. 79 39

First time staying in shelteryes 87 42no 119 58

Youth Mental Health and Alcohol Use

Youth who reported greater depression where 5 times more likely to have used alcohol, controlling for age and grade in school (OR=5.0; p<.001)

Children who reported having friends at the shelter where 70% more likely to have used alcohol when compared to youth who reported having no friends at the shelter (OR=1.7; p,.05)

Family Processes and Youth Substance Use

Family processes may be a particularly important intervention component when attempting to address substance use among youth residing in urban family homeless shelters.Youth of adult caretakers that reported low levels of

the three family processes considered were almost four and a half times more likely (OR=4.4; 95% CI=1.2–16.5) to have made two to three substance use debuts

Bannon, W. M., Beharie, N., Olshtain-Mann, O., McKay, M. M., Goldstein, L., Cavaleri, M. A., ... & Paulino, A. (2012). Youth substance use in a context of family homelessness. Children and youth services review, 34(1), 1-7.

Family Processes and Youth Substance Use

Family Strengthening and Suicidality

Health education programs integrating a family strengthening approach hold promise for positively impacting mental health outcomes for vulnerable youth. HOPE Family Program were 13 times more likely

to report a decrease of suicidal ideation

Lynn, C. J., Acri, M. C., Goldstein, L., Bannon, W., Beharie, N., & McKay, M. M. (2014). Improving youth mental health through family-based prevention in family homeless shelters. Children and youth services review, 44, 243-248.

Family Strengthening and Suicidality

Trauma-informed and Contextually Relevant Mental Health ServicesAdult mental health should be taken into account while treating youth externalizing and internalizing behaviors. Furthermore, this treatment should be trauma informed, given the link between trauma and mental health. Homeless families, caregiver violence exposure has

statistically significant relationships with both youth behavioral problems and youth depression symptoms, as mediated by caregiver depression

McGuire-Schwartz, M., Small, L. A., Parker, G., Kim, P., & McKay, M. (2014). Relationships between caregiver violence exposure, caregiver depression, and youth behavioral health among homeless families. Research on Social Work Practice, 104973151455392

Trauma-informed and Contextually Relevant Mental Health Services

HOPE HealthHOPE Family

Condition

Baseline Post F1 F2

Test

24.00

25.00

26.00

27.00

28.00

29.00

psiP

DPSI Parent Distress SubscaleOver Survey Points by Treatment Condition

PSI (Parenting Stress Index) Parent Distress SubscaleParents in both groups also reported a decrease in distress related to parenting, with a statistically significant improvement from baseline at both follow up 1 and follow up 2 (p < .01).

Child Emotional Symptoms

HOPE HealthHOPE Family

Condition

Baseline Post F1 F2

Test

1.50

2.00

2.50

csdE

MO

T

Child Strengths and DifficultiesEmotional Symptoms SubscaleOver Survey Points by Treatment Condition

Parents in both groups also reported an improvement in the emotional symptoms displayed by their children (p < .05).

Confidence about engaging in safe sex

HOPE HealthHOPE Family

Condition

Baseline Post F1 F2

Test

3.50

3.75

4.00

4.25

4.50

Safe

sex

Confidence about Engaging in Safe SexOver Survey Points by Treatment Condition Children who participated in

the HOPE Family intervention showed a significant increase in confidence about engaging in safe sex from baseline to the last follow up point (p < .05). There was a significant difference between groups (p < .05), with children in HOPE Health showing little change over time on this measure.

How is the shelter environment related to the wellbeing among

residents?

Aim 1

To assess the relationship between the shelter environment and caregiver mental health and substance use.

Measures of Caregiver Outcomes:1. Global mental health2. Parenting Stress3. Number of substances used within the past

month

Aim 2

To assess the relationship between the shelter environment and caregiver mental health and substance use.

Measures of Youth Outcomes: 1. Depression2. Number of substances used within the past

month

Aim 3

To assess whether the shelter environment mitigated the relationship between past trauma and outcomes for both youth and caregivers.

The Shelter EnvironmentRotated Factor Pattern

Factor1 Factor21. Do you have friends at the shelter? -0.04 0.272. Do you feel safe at the shelter? 0.43 0.113. Are there things for people to do at the shelter? 0.67 -0.154. Are there things for families to do together at the shelter? 0.66 -0.245. Is there a staff person that you like? 0.27 0.136. Are there rules that you have to follow at the shelter? 0.18 0.267. Do you have trouble following these rules? -0.01 0.328. Do you get in trouble for not following rules at the shelter? 0.02 0.469. Does the staff at the shelter help you and your family? 0.50 0.05

α = 0.67

The Perceived Social Environment and Mental HealthLess favorable perceptions of the social environment

were associated with poorer mental health among caregivers (b = -0.09, p = 0.05).

Poorer Perceptions of the Social

EnvironmentPoorer Mental Health

Beharie N, Lennon MC, McKay M. Assessing the Relationship Between the Perceived Shelter Environment and Mental Health among Homeless Caregivers. Behavioral Medicine. 2015; 41.3: 107-114.

The Perceived Social Environment and Youth OutcomesA less favorable perception of the shelter environment

was associated with higher levels of depressive symptoms among youth (b = -0.07, p = p < 0.001) and with the use of greater number of substances in the past month (b = -0.05, p = 0.02).

Poorer Perceptions of the Social

Environment

More Depression

Greater Substance Use

Trauma and Resident OutcomesTrauma itself was significantly associated with

caregiver psychological symptomology.Trauma was also associated with youth depression

and substance use.

Poor Mental Health(Youth and Caregivers)

Greater Substance Use

(Youth)

Trauma

The Mitigating Effect of the Social Environment on Youth Depression

The perceived social environment of the shelter mitigated the negative effects of trauma on depression among youth.

Perceptions of the Social Environment

Trauma Youth Depression

Length of Stay and Caregiver Outcomes

Length of time in the shelter was positively associated with reporting greater psychological symptomology (b = 0.15, p = 0.02) and greater parenting stress (b = 4.61, p = 0.04)

Greater Length of Stay in the Shelter

Poor Mental Health(Caregivers)

Greater Parenting Stress

(Caregivers)

Rules and Caregiver Outcomes

Those caregivers who reported having more difficulty following shelter rules:had higher levels of psychological symptomatology (b

= 0.35, p = 0.01) higher levels of parenting stress (b = 9.26, p = 0.04),

and reported using more substances (b = 0.40, p = 0.02)

Rules and Caregiver Outcomes

Difficulty Following Shelter Rules

Poor Mental Health

Greater Parenting Stress

Greater Substance Use

Shelter Rules and Parenting Stress

There was no relationship between trauma and parenting stress among those caregivers who reported having difficulty following shelter rules.

Shelter Rules and Youth Outcomes

Youth who reported having more difficulty following shelter rules:higher levels of depressive symptomology (b = 0.06,

p < 0.001)but was found to be associated with lower levels of

substance use (b = -0.08, p = 0.00)

Mitigating Effect of Rules on Youth Substance UseShelter rules appeared to mitigate the negative

effect of trauma on substance useTrauma was not associated with substance use among

those who had difficulty following shelter rules, but was associated among those who reported not having difficulty following shelter rules

Difficulty Following Shelter Rules

Trauma Youth Substance Use

Words to provide by…

Final ThoughtsEvidence for Trauma Informed Care in shelters:

Address mental health among caregivers Depression and substance use among youth

Policy implications: Support for homelessness prevention as well as services for

homeless familiesEvidence for exploring other forms of governance within

shelters as a means of improving psychosocial wellbeing among residents. Importance of autonomy while living in the shelter