Advance Clinical practice week 10 assignment

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1 Homelessness facing adolescent population; Evidence-Based Practice and Literature Review Focusing on Homelessness in the Adolescent population Margrate Egbe Walden University Instructor: Dr. Kevin Haggard SOCW – 6111 Advance Clinical Practice 1 May 05, 2019

2 Homelessness facing adolescent population Introduction: Gaetz (2014) defines adolescent homelessness as young people who has no stable housing, source of income, lack of social support, and are living independently of parents or caregivers. Therefore, being homeless is a stressful and severely unpleasant experience for adults. Being an adolescent and homeless is an even dismal situation because the adolescents are at a time in their lives when they are going through drastic changes (Whitbeck, 2009). Description of adolescent Homeless population and the presenting problem Adolescences is considered the time when young adults learn to interact in a social environment that is consistently growing, and when they begin to regulate their emotions. The adolescent period is when their surrounding environment becomes very important in young peoples’ development (Oberle, Schonert-Reichl & Zumbo, 2010).No exact number for how many adolescents are homeless is available, but in 2002 the Office of Juvenile Justice and Delinquency Prevention in the US Department of Justice conducted a study estimating that 1,682,900 adolescents and youth are homeless (NCH), 2008). The number, though, is most likely even higher considering the amount of time passed since the survey was conducted, as well the economic down turn that has occurred since then. During any given year, five to seven percent of adolescents will become homeless (NCH, 2008). At-risk and homeless adolescents are affected by many negative factors that cause them to seek early independence, such as parenting style, financial instability, lack of an education, drugs and alcohol, physical and sexual abuse. Researchers also believe that experiences can influence how the brain develops, which is why being homeless as an adolescent can have significant negative effects on the developmental processes of the brain (Larson, 2011).Along with the

3 negative factors, there are protective barriers that can, potentially help an at-risk adolescent but are ineffective once the adolescent is homeless. The subpopulation of homeless adolescents is a minority group that receives little attention among researchers and policy makers (Whitbeck, 2009). Articles Reviews for Homeless adolescent and the learning from conducting the research Recent literature suggests that homeless youths may constitute a high-risk population that urgently requires the attention of policymakers. Compared with their domiciled peers, homeless youths are at significantly greater risk for medical problems and health compromising behaviors, including human immunodeficiency virus (HIV) infection and other sexually transmitted and infectious diseases; substance abuse; psychotic behavior, depression, and suicide attempts; prostitution; and trauma. Furthermore, service providers report that the homeless youth population seems to be increasing in size, with an apparent trend toward clients who are more troubled and who have multiple problems. According to one of the most recent research article by (Gauvin et al; March 2019), the article review on coping, social supports and suicide attempts among homeless adolescents, indicate that, homeless youth are more exposed to many stress factors and difficult life situation, some of this factors include but not limited to psychiatric disorders and sexual abuse, (Edidin, Ganim, Hunter, & Karnik, 2012), which brings about other psychological factors, more so, this article review that, the mortality of homeless adolescents could be 11 times as compared to adolescents living in stable homes.(Boivin, Roy, Haley, & Galbaud du Fort, 2005). Why conducting this research, it was review that considering that suicide is one of the main causes of homelessness among the adolescents population, preventing suicide should be a priority (Roy et al., 2004)and also the researches indicated that more focus on the suicide attempts should be on the risk factors((Cleverley & Kidd, 2011), why other

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4 researchers on homeless adolescents suggested focusing on protective factors, as they think protective factors might place more emphasis on adolescents environmental factors, personal characteristics, social support and situation. ( Labelle et al; 2015).More so, social support have being view as strong empirical support for its protective effect against suicide among adults and adolescents (Farrell et al, 2015) Since homeless youth experience a higher level of social disconnection in the society, it is vital to assess whether perceived social support can be sufficient to act as a protective factor and based on the research, it also indicate that some studies have shown a risk decreasing effect of perceived social support mostly emotional and instrumental support. Evidence-based interventions currently used for adolescent population when addressing Homelessness. Supporting references when explaining the evidence behind the interventions According to American Journal of Preventive Medicine (2010), a systematic review for an effective Interventions for Homeless Youth was under taken, and it was found out that Homelessness among youth has become a serious and disturbingly common social problem in many countries. Nevertheless, research on this population remains limited, especially in terms of intervention evaluations. Several interventions for homeless youth have been formally evaluated, but a complete systematic overview of studies on the effectiveness of interventions is lacking. However, although intervention evaluations are still in their early stages ,they have increased understanding of the causes of homelessness among youth, which include; family conflict as an important reason for leaving their home, physical, emotional, and sexual abuse is often cited as a reason for their homelessness. Moreover, homeless youth also report engagement in high-risk activities, including substance abuse. Evidence based intervention can be implemented on the personal and societal level as well as on the community and institutional level, and can help to achieve multiple outcomes, such as mental/physical health, accessibility of services, vocational

5 assistance, and healthy relationships. There has been also an increase in the development and improvement of social services, social policies, and interventions to assist this group, the majority of interventions aim to improve the quality of life of homeless youth by reducing homelessness. Brief motivational intervention was also one of the suggested intervention as two studies have evaluated an individual treatment based on a technique called motivational interviewing which concerns an individual, brief feedback, and motivational intervention, modeled along the lines of a doctor check-up. Another intervention was the Cognitive– behavioral intervention, two studies were evaluated an intervention based on cognitive– behavioral components called the Community Reinforcement Approach (CRA) was used, with combination of case management. Another evidence based intervention by (Baer et al., 2004), come out with brief motivational intervention (BMI) when evaluating the effects on substance use and service utilization on adolescent homeless population. BMI intervention focusing more on psychosocial outreach, as this intervention may encourage difficult-to-reach individuals to reduce harms associated with substance use and to make better use of available services (Baer, Peterson, & Wells, 2004). The interventions I might choose to use and why. Motivational interviewing (MI) could be one of the intervention I could use on this population as based on the study, the objectives were to reduce harms associated with alcohol and drug use among homeless adolescents and to encourage them to make better use of available services by providing them with personal feedback about patterns and risks related to substance abuse alcohol, marijuana, and other drugs. Also as a counselor, using motivational interviewing, one can develop rapport with the clients which helps to facilitate engagement. More so an evidence based practice was seen that results after one intervention

6 session showed some decline in drug use, therefore making motivational interview reliable intervention to consider. The brief motivational intervention (BMI) and motivational interviewing (MI), could work hand in hand as an intervention for the adolescent homeless population, since resources gain form motivational interviewing, might be used to attain services provided from the brief motivational intervention. For example, the adolescent might be provided with vouchers, transportation to be able to attain services like health care appointments and other social services appointment, thereby integrating BMI into other existing case management services by conducting the project within an existing agency that provides food, hygiene, social activities, and case management for homeless youth. Also I might choose using the cognitive behavioral approached and Case management, as based on the study, improvements were found among youth in percentage of days being housed, psychological distress, and substance abuse. Supportive housing, Rapid Rehousing (RRH), and Emergency Shelters are great resources to look into when doing case management for homeless adolescent, According to some studies that evaluated the effects of a supportive housing program. The aim of supporting housing is to provide permanence, affordability, flexibility, safety, comfort, accessible support services, and independence. Considering client values and my clinical expertise and how those might affect my decision of which intervention to use. According to American Psychological Association (APA) Code of Ethics (2002), client values have to be address during any psychotherapy, and the principle of addressing client’s values argue that, clients values should be respected at all times, except in cases where the results might be harmful to the clients or the general public. Values are what people think, belief, judge or feel (Tjelvit, 1999).More so based on NASW code of ethical principles,(2011) Social workers' primary goal is to help people in need and to address social

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7 problems and also must respect dignity and worth of the person and respect their opinion of self-determination, right of worth of a person and confidentiality. According to the ethical principles of psychologists, the right of self-determination could be interpreted to mean that clients has rights to their values and opinion without the undue influence of the therapist, even when the therapist is the expert here. Therefore as a clinician, intervening in adolescent clients who are undergoing homelessness or any other social related issues, it is important for the adolescent clients to be involved and let the clients self- determine what intervention works for them, however using professional judgement, one might guide them on potential actions that might pose serious concern. More so, in a situations when conflicting obligations arise, based on the social issues the adolescent client is going through, in this case homelessness, as professional, taking into consideration all the values, principles, and standards in this Code that are relevant to any situation in which ethical judgment is needed might help determine type of intervention needed. How to apply the specific skills and techniques of the chosen intervention. As a social worker clinician assessment skills are relevant when working with clients or population facing diverse social problem. In other to provide effective case management to adolescent homeless population, effective and quality assessment is needed, as it would determine how the resources are been obtains, and what services are available for this population and also important to re-evaluate the effectiveness of the service. Communication skills and techniques are also important when working with clients. According to Ashman & Hull (2006) generalist intervention model, engagement stage is one of the vital skills for clinicians as empathizing with the clients, active listening, asking open ended questions, being non-judgmental, help build trust and relationship with the client

8 that can help during the assessment and interventional period. Other importance skills to be utilized for this intervention could social work advocacy and leadership skills, Problem Solving Skills and critical thinking skill Measuring the outcomes of this intervention. According to Harvard review of psychiatry (Taylor & Francis; 2011) a review was done of programs for persons wo are homeless, since it was important to know whether those who receive a particular intervention are better off than those who do not and also knowing how cost effective is the intervention. By outreaching to the adolescent homeless population, through referrals, awareness might be created on homeless services offer to this population and also case manage their progress through intakes and assessment. Improving the efficiency of outreach programs is important because increasing the number of individuals housed and engaged (Dickey, 2011) Cultural considerations that need to take into account when working with adolescent facing Homelessness There are some cultural consideration that needs to be taken into consideration when working with homeless adolescent, there is always a need to be aware of cultural diversity of the homeless population and also consideration of factors that would shape their personal identity. Consideration should also be done as regards to the adolescent gender identity, race, language spirituality, disability, sexually orientation and belief. For example a Spanish homeless adolescent might be more comfortable sharing housing or shelter beds with someone whom they identify themselves with, the use of interpreters could also be important when working with someone that speaks another language. Also according to Pine et al (1990) being aware of our own cultural values, background and experiences, would

9 determine how others from different culture needed to be treated in assisting the clients to become aware of their own cultural values and norms. Discuss how the Code of Ethics applies when working with homeless adolescent population. The code of ethics sets forth values, ethical principles, and ethical standards to which professionals aspire and by which their actions can be judged (NASW, 2017).Therefore. Social workers primary goals and objectives is to help people in need and to address social problem, thereby social workers has the responsibility to provide services to the adolescent homeless population and make sure that they are house. And social worker ethical behavior should result from their personal commitment to engage in ethical practice. Also Social workers profession was founded in social change, and social worker ensure that everyone in the social have resources, and opportunity that allow them to meet their basic needs, therefore through advocacy, lobbying, social worker can influence policies that might favored homeless adolescent and provide them with shelters and other benefit that could improve their situation. Explain how you would apply a trauma-informed lens when working with this population. Trauma-informed care involves understanding, anticipating, and responding to the impact that trauma can have and building increased awareness about how to address existing trauma and prevent re-traumatization . Homelessness involves the loss of home, community, stability, safety, and social networks and also brings about other stressors associated with homelessness, this could include physical and sexual abuse, neglect, domestic violence, community violence, and family disruptions which are all traumatic. According to a study call the adverse childhood experiences (ACE) that was undertaken by Centers of Disease Control (CDC) and Kaiser Permanente’s (1995& 1997) on trauma –informed and homelessness, the study revealed that,

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10 individuals who have become homeless especially adolescent homeless population, have also endured other forms of traumatic stress due to homelessness, Therefore when working with Trauma-informed care in homeless service settings recognizes and responds to clients’ previous trauma, approaches clients through a strengths-based lens, and provides clients with safety, respect, and skills-building services are important.

11 References: About the CDC-Kaiser Ace Study. Center for Disease Control and Prevention. Retrieved from www.cdc.gov Beyond Values Clarification: Addressing Client Values in Clinical Behavior Analysis: Retrieved from; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686993/ Code of Ethics of the National Association of Social Workers: Retrieved from, https://socialwork.utexas.edu/dl/files/academic-programs/other/nasw-code-of-ethics.pdf Effective Interventions for Homeless Youth A Systematic Review Astrid M. Altena, MSc, Sonja N. Brilleslijper-Kater, PhD, Judith R.L.M. Wolf, PhD, Retrieved from, Walden website Gauvin, G., Labelle, R., Daigle, M., Breton, J.-J., & Houle, J. (2019, March 19). Coping, Social Support, and Suicide Attempts Among Homeless Adolescents. Crisis: The Journal of Crisis Intervention and Suicide Prevention. Advance online publication. http://dx.doi.org/10.1027/0227- 5910/a0005, Retrieved from Walden library website John S. Baer, Sharon B. Garrett, Blair Beadnell, Elizabeth A. Wells, and Peggy L. Peterson: Brief Motivational Intervention with Homeless Adolescents: Evaluating Effects on Substance Use and Service Utilization; Retrieved from Walden library website Review of Programs for Persons Who Are Homeless and Mentally Ill, Harvard Review of Psychiatry (Taylor & Francis Ltd); Retrieved from https://eds-a-ebscohost- com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=7&sid=f73638dc-90d8-41c2-a09b- b58985e166a9%40sdc-v-sessmgr01 The Prevalence of Homelessness among Adolescents in the United States: Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1509094/pdf/amjph00021-0037.pdf The Homeless Adolescent Population: Complexity, Protective Factors, and reventionhttps://scholarship.claremont.edu/cgi/viewcontent.cgi? referer=&httpsredir=1&article=1235&context=cmc_theses Zastrow, C. H., & Kirst-Ashman, K. K. (2016). Understanding human behavior and the social environment (10th ed) . Boston, MA: Cengage Learning https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

Advance Clinical practice week 10 assignment

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