4.5 family reunification: promising approaches, promising outcomes
DESCRIPTION
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.TRANSCRIPT
Family-Based Intervention for Family-Based Intervention for Homeless AdolescentsHomeless Adolescents
Norweeta G. Milburn, Ph.D.
Department of Psychiatry and Biobehavioral SciencesSemel Institute for Neuroscience and Human BehaviorNathanson Family Resilience Center
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 People2 Million Young People
Homeless
Not Homeless
Negative PictureNegative PictureHow do we intervene to prevent chronic homelessness?
OverviewOverview
Research on homeless adolescentsProject STRIVEFindings
Newly Homeless AdolescentsNewly Homeless Adolescents
12 to 20 yearsAt least 2 nights away from home< 6 months away
New vs. Experienced in USNew 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?WHO GOES HOME?
Conceptual Model: Exiting Homelessness Conceptual Model: Exiting Homelessness Predictors Predictors
BackgroundCharacteristics
HomelessnessExperiences
Family
Peers
Formal Institutions
Exit
Never Exit
Homelessness,
15%
Cycle In & Out
of Homelessness
42%
Exit
Homelessness,
43%
Exiting Stably Over Two YearsExiting Stably Over Two Years
BackgroundFemaleYounger
FamilyMaternal support
PeersGet along with family
Milburn, Rice, Rotheram-Borus et al. (2010)
Project i: Implications for InterventionProject i: Implications for Intervention
68% exit homelessness
45% who exit homelessness – homeless for 1 follow up
Family bonds
Family support
Project Project STRIVE: STRIVE: SSupport upport tto o RReunite, eunite, IInvolve nvolve and and VValue alue EEach Otherach Other
Runaway behavior: Response to unresolved family conflict
Family intervention− Family strengths− Problem solving− Conflict negotiation− Role clarification
• 5 sessions
Project Project STRIVE: STRIVE: Newly Homeless Newly Homeless Adolescents and Parents/GuardiansAdolescents and Parents/Guardians
12 to 17 years 2 nights within the past 6 months1 episode within the past 6
months
Project Project STRIVESTRIVE: Elements: Elements Tokens Feeling Thermometer Problem Solving Role Playing Reframing
Project Project STRIVESTRIVE: Session 1 Tasks: Session 1 Tasks
Introduction 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 Project STRIVESTRIVE: Outcomes: Outcomes
Quality of residential life and school/employment performance
Negative mental health symptoms and multiple problem behaviors
Risk 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 HealthOutcomes: Mental HealthNumber of conduct problems
Effect size estimate=-0.263, P=0.004
0
0.5
1
1.5
2
2.5
3
Baseline 3-month 6-month 12-month
Assessment
Nu
mb
er o
f p
rob
lem
s
Control, observed
Control, model
Treated, observed
Treated, model
Outcomes: Mental HealthOutcomes: Mental HealthSquare root of BSI global
Effect size estimate= -0.05, P=0.085
0
0.2
0.4
0.6
0.8
1
1.2
Baseline 3-month 6-month 12-month
Assessment
Mea
n
Control, observed
Control, model
Treated, observed
Treated, model
Outcomes: Substance AbuseOutcomes: Substance AbuseTimes had alcohol
Effect size estimate=-0.331, P=0.006
0
1
2
3
4
5
6
7
8
9
10
Baseline 3-month 6-month 12-month
Assessment
Nu
mb
er
of
tim
es
Control, observed
Control, model
Treated, observed
Treated, model
Times used hard drugsEffect size estimate= -1.15, P=<.001
0
2
4
6
8
10
12
14
16
Baseline 3-month 6-month 12-month
Assessment
Nu
mb
er
of
tim
es
Control, observed
Control, model
Treated, observed
Treated, model
Outcomes: Substance AbuseOutcomes: Substance Abuse
Outcomes: Substance AbuseOutcomes: Substance AbuseTimes used marijuana
Effect size estimate=0.2988, P=0.012
0
5
10
15
20
25
Baseline 3-month 6-month 12-month
Assessment
Nu
mb
er
of
tim
es
Control, observed
Control, model
Treated, observed
Treated, model
Outcomes: HIV Sexual Risk Outcomes: HIV Sexual Risk BehaviorsBehaviors
Number of partnersEffect size estimate=-0.494, P=<.001
0
0.5
1
1.5
2
2.5
Baseline 3-month 6-month 12-month
Assessment
Nu
mb
er
of
pa
rtn
ers
Control, observed
Control, model
Treated, observed
Treated, model
Outcomes: HomelessnessOutcomes: HomelessnessLiving at home
Effect size estimate=0.1962, P=0.351
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Baseline 3-month 6-month 12-month
Assessment
Pro
po
rtio
n Control, observed
Control, model
Treated, observed
Treated, model
Left home for 1+ nights in past 3 monthsEffect size estimate=-0.314, P=0.368
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
3-month 6-month 12-month
Assessment
Pro
po
rtio
n w
ho
le
ft
Control, observed
Control, model
Treated, observed
Treated, model
Outcomes: HomelessnessOutcomes: Homelessness
Positive attitude toward living at homeEffect size estimate=0.1226, P=0.107
2.7
2.8
2.9
3
3.1
3.2
3.3
3.4
3.5
3.6
3.7
Baseline 3-month 6-month 12-month
Assessment
Me
an
Control, observed
Control, model
Treated, observed
Treated, model
Outcomes: HomelessnessOutcomes: Homelessness
ImplicationsImplications
Mental health
Substance abuse and HIV sexual risk
Milburn, Iribarren, Rice et al. (In press.)
Francisco Javier Iribarren, Psy.D.Francisco Javier Iribarren, Psy.D.Alex Lee, B.A.Alex Lee, B.A.
Kwame Alexander, B.A.Kwame Alexander, B.A.Kate Desmond, M.S.Kate Desmond, M.S.
Phillip Batterham, M.P.H.Phillip Batterham, M.P.H.
Norweeta G. Milburn, Ph.D.Norweeta G. Milburn, Ph.D.
UCLA Semel Institute for Neuroscience UCLA Semel Institute for Neuroscience & Human Behavior & Human Behavior
UCLA Center for Community HealthUCLA Center for Community Health