4.5 family reunification: promising approaches, promising outcomes

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4.5 Family Reunification: Promising Approaches, Promising OutcomesSpeaker: Norweeta MilburnThere is a window of opportunity to reunify runaway youth with their families. At times, providers rely upon collaborations with local law enforcement, child welfare, and other community providers to facilitate reunification. This workshop will explore promising practices and interventions to reunify youth with their families. Research on family acceptance of Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) youth as a tool to prevent and end homelessness will also be discussed.

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  • Family-Based Intervention for Homeless Adolescents

    Norweeta G. Milburn, Ph.D.

    Department of Psychiatry and Biobehavioral SciencesSemel Institute for Neuroscience and Human BehaviorNathanson Family Resilience Center

    nmilburn@mednet.ucla.edu

    Supported by NIMH grants MH61185 , MH70322 and MH080664National Alliance to End Homelessness National Conference on Ending Family and Youth Homelessness February 10, 2012, Los Angeles, CA

  • 2 Million Young People

  • Negative PictureHow do we intervene to prevent chronic homelessness?

  • OverviewResearch on homeless adolescentsProject STRIVEFindings

  • Newly Homeless Adolescents

    12 to 20 yearsAt least 2 nights away from home< 6 months away

  • New vs. Experienced in USSingle parent familyFemaleNon-English speaking parentNo pregnancyNot parentMore recent suicide attemptsLess engagement in sexual risk acts or alcohol and other drug useNot LBGTNo jailNeed/use interpersonal, school-related and mental health services

    Milburn, Rotheram-Borus, Rice et al. (2006)

  • WHO GOES HOME?

  • Conceptual Model: Exiting Homelessness Predictors

  • Exiting Stably Over Two Years

    BackgroundFemaleYoungerFamilyMaternal supportPeersGet along with family

    Milburn, Rice, Rotheram-Borus et al. (2010)

  • Project i: Implications for Intervention

    68% exit homelessness

    45% who exit homelessness homeless for 1 follow up

    Family bonds

    Family support

  • Project STRIVE: Support to Reunite, Involve and Value Each OtherRunaway behavior: Response to unresolved family conflictFamily interventionFamily strengthsProblem solvingConflict negotiationRole clarification5 sessions

  • Project STRIVE: Newly Homeless Adolescents and Parents/Guardians12 to 17 years 2 nights within the past 6 months1 episode within the past 6 months

  • Project STRIVE: ElementsTokensFeeling ThermometerProblem SolvingRole PlayingReframing

  • Project STRIVE: Session 1 TasksIntroduction and begin using tokensUnderstanding programCommitment to participationIntroduce family albumFeeling good about each otherIdentify family strengthsDeveloping tools to reduce risk of running away: Stating positives about selfIdentifying an uncomfortable situation and introducing coping planPreparing for future high risk situationsIdentifying social supportsHave family members sign contract for returning homeGiving to each otherEstablish the phone contract and assign post session activity of having conversations and giving verbal tokens to each other

  • Project STRIVE: OutcomesQuality of residential life and school/employment performanceNegative mental health symptoms and multiple problem behaviorsRisk of being HIV-positive

    Milburn, et al. (In press).

  • Characteristics of the Families in Project STRIVE (N =307)Adolescents (n = 153)

    66% Female14.9 (1.4) years old62% Hispanic/Latino American26% African American89% Heterosexual3.1 (6.1) Times away from home 2+ nights

    Parents/Guardians (n = 154)

    87% female42.1 (8.3) years old75% Mothers11% Fathers6% Other adult guardians6% Grandparents54% Hispanic/Latino American25% African American

  • Outcomes: Mental Health

    SQRT_GSI_CHART

    0.93591167540.92097475160.96927278140.9580084474

    0.84806357920.84642391070.76909192720.8244148678

    0.70572263930.78563721890.72153742830.6898997139

    0.76009265680.69542189620.55245015080.5627657957

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Mean

    Square root of BSI globalEffect size estimate= -0.05, P=0.085

    SQRT_ANX_CHART

    0.79531466460.77906965670.85022423150.8306337949

    0.70510693690.69745667690.61818368630.6964282976

    0.56012856130.63395394240.60545861270.5610102346

    0.5822670350.53173034560.40851124880.4353040677

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Mean

    Square root of BSI anxietyEffect size estimate=-0.041, P=0.246

    SQRT_DEP_CHART

    0.84579754210.83115079770.94775977740.9170786808

    0.73542489310.73913439480.64473592610.7670383357

    0.58602830440.66504775190.68602210670.6157975093

    0.59961478070.55262613580.48778307890.474171791

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Mean

    Square root of BSI depressionEffect size estimate=-0.047, P=0.271

    POS_ATT_CHART

    3.1747967483.17089255023.05808080813.1572412533

    3.21153846153.17167865493.51020408163.2991805823

    3.15416666673.14329546023.60162601633.4430729324

    3.14516129033.1772780933.35632183913.5713227993

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Mean

    Positive attitude toward living at homeEffect size estimate=0.1226, P=0.107

    SAFER_SEX_CHART

    17.768292682917.979392336718.984615384619.0084328166

    18.7517.981979762818.687518.6538746023

    18.32518.012428710418.707317073218.2974509288

    17.258064516117.983307943717.793103448317.9559684224

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Mean

    Safer sex intentions scoreEffect size estimate=-0.339, P=0.294

    ATTEND_UP_CHART

    0.2560975610.26738820910.21212121210.2466832422

    0.25490196080.23528044890.39583333330.2736883027

    0.23076923080.20335560190.21621621620.3026821683

    0.15384615380.17970138060.34615384620.3314594688

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Proportion

    Attendance improvedEffect size estimate=0.3015, P=0.196

    EXPL_SUSP_CHART

    0.37179487180.37503081830.30158730160.2537527026

    0.27450980390.26544292840.10416666670.1558463151

    0.26315789470.21763890920.08108108110.1152197145

    0.11538461540.14371031260.15384615380.0666554672

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Proportion

    Expelled or suspendedEffect size estimate=-0.278, P= 0.24

    ATTEND_CHART

    0.95121951220.96673390370.95454545450.9600623794

    0.98076923080.94793633790.97959183670.9458902876

    0.950.91996969740.90243902440.9270368294

    0.83870967740.87714894910.89655172410.9026557606

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Proportion

    Attending schoolEffect size estimate=0.1538, P=0.697

    LIVE_HOME_CHART

    0.65853658540.66266111590.78787878790.8052793032

    0.63461538460.62111861120.87755102040.8232946302

    0.60.61195245110.78048780490.805629034

    0.64516129030.63682681210.79310344830.7967583002

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Proportion

    Living at homeEffect size estimate=0.1962, P=0.351

    ANY_HARD_CHART

    0.28048780490.26730328190.22727272730.2280019214

    0.13461538460.20976424740.16326530610.1792341434

    0.1250.16928688960.14634146340.138547513

    0.16129032260.12173457580.13793103450.1086452142

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Proportion

    Used hard drugsEffect size estimate=0.0559, P= 0.83

    ANY_MJ_CHART

    0.51219512200.45454545450

    0.307692307700.3061224490

    0.400.26829268290

    0.290322580600.37931034480

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Proportion

    Used marijuanaModel did not converge

    ANY_ALC_CHART

    0.475609756100.44615384620

    0.346153846200.36734693880

    0.42500.2439024390

    0.516129032300.2758620690

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Proportion

    Had any alcoholModel did not converge

    UP_SEX_CHART

    0.2560975610.25061613050.24242424240.2339661893

    0.21153846150.21357703660.22448979590.2562613073

    0.20.22697362870.31707317070.2807777552

    0.25806451610.2333792630.2758620690.2911530778

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Proportion

    Had unprotected sexEffect size estimate=0.2526, P=0.227

    HAD_SEX_CHART

    0.41463414630.41723724190.39393939390.3846923308

    0.36538461540.3898788990.28571428570.3505896676

    0.450.42176669930.41463414630.3483580276

    0.41935483870.43208900840.31034482760.3320481406

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Proportion

    Sexually activeEffect size estimate=-0.112, P=0.565

    DAYS_SKIP_CHART

    10.21794871799.31257534358.6190476197.923449791

    0.98039215693.83452134881.54166666673.8027765454

    3.31578947372.54723320642.29729729732.0901091048

    21.28079156922.51.3231828621

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Number of days

    Days skipped schoolEffect size estimate=0.0971, P=0.601

    CONDUCT_CHART

    2.7560975612.58743690082.36363636362.2293865497

    1.65384615382.14752909420.87755102041.2944181249

    1.7251.80824119050.85365853660.8594951184

    1.74193548391.44016143790.79310344830.5921386172

    Control, observed

    Control, model

    Treated, observed

    Treated, model

    Assessment

    Number of problems

    Number of conduct problemsEffect size estimate=-0.263, P=0.004

    TIMES_HARD_CHART

    0000

    0000

    0000

    0000

    Control, observed

    Control,