Improving Youth Mental Health through Family-Based Prevention In Family Homeless Shelters.

While there has been an increased focus upon suicidal risk among homeless youth (Rew, Taylor-Seehafer, & Fitzgerald, 2001; Yoder, Whitbeck, & Hoyt, 2008a; Yoder, Longley, Whitbeck, & Hoyt, 2008b), research focusing on self-harm among youth living in family shelters is rare. Further, little is known about effective interventions to decrease thoughts of self-harm among this subpopulation of homeless youth. The purpose of this exploratory study is to investigate the prevalence of suicidal ideation, the relationship between various risk factors, and the impact of participation in family-based HIV prevention programs upon self-harm among a sample of adolescents residing in urban homeless shelters with their families. Two family-based approaches are compared. Guided by Social Action Theory (Ewart, 1991) it is expected that the program including a family-strengthening approach aimed at bolstering key family and youth processes including communication, family decision-making, parent leadership and supervision, and youth problem-solving, will have a beneficial impact on youth suicidal ideation. Family Homelessness Families with children make up 38% (239,403) of the total homeless population (633,782) across the United States (National Alliance to End Homelessness, 2013). This number is on the rise, despite that the population of other subgroups has remained relatively stable. In fact from 2011 to 2012, families with children were the only subgroup of homeless persons to experience an increase, resulting in 162,246 homeless children in 2012 (National Alliance to End Homelessness, 2013). Homeless families face multiple adversities. They experience the longest stays in temporary housing (e.g., emergency shelters, transitional housing, and permanent supportive housing) comparative to single adults (U.S. Conference of Mayors, 2008), and are at risk for significant levels of poverty, domestic violence, and increased involvement with the child welfare system (Cutuli et al., 2010; HUD, 2009; Stainbrook et al., 2006). Further, studies consistently find homeless parents, who are most likely to be single women (Gewirtz et al., 2009), have high rates of mental health and substance abuse difficulties (Gewirtz et al., 2009; Zima et al., 1996). And two decades of research show that their offspring have increased likelihood of evidencing developmental delays, mental health problems, substance abuse, academic and peer-related difficulties, and involvement in the juvenile justice system (Bassuk & Rubin, 1987; Buckner, 2008; Busen & Engebretson, 2007; Haldenby, Berman, & Forchuk, 2007; Obradovic, 2010; Rhode, Noell, Ochs & Seeley, 2001; Rotheram-Borus & Futterman, 2000; Rhule-Louie et al., 2008). Adolescent Suicide Risk Recently, there has been an increased focus upon suicidal risk among homeless adolescents. Thoughts of self-harm and suicidal acts are highly associated with mental health disorders including major depressive disorder, posttraumatic stress disorder, and substance abuse (Yoder, Longley, Whitbeck, & Hoyt, 2008b), and are the third cause of death among youth 12 to 18 years of age (National Center for Injury Prevention and Control, 2009). In fact, exposure to violence and victimization has been linked to an increased risk for suicidal ideation among adolescents (Chemtob et al., 2011; Turner et al., 2012; Wolitzky-Taylor et al., 2009), as has youth substance abuse (Gould et al., 1998; Vermeiren et al., 2003, Wolitzky-Taylor et al., 2009). Homeless adolescents are at significant risk for suicide. One recent study found over two-thirds of youth endorsed one or more indicators of intent to self-harm (Yoder et al., 2008a, 2008b), and a second study found approximately 35% of adolescents had thought seriously about suicide, with 12% attempting suicide on one or more occasions (Rew et al., 2001). However, there is little knowledge about suicide risk among sheltered youth living with their families, as the samples in these studies tend to be runaways, youth who were forced out of their homes, or who live on the streets. The current study extends upon this knowledge base by investigating prevalence, as well as child and family-level correlates of suicidal ideation among family shelter-dwelling youth. Family-level Variables Additionally, we studied the impact of a family strengthening and HIV prevention program upon suicide risk. Evidence suggests parenting factors, including lack of parental support, poor parenting practices (e.g., low monitoring, lax rules, poor problem solving), and a discordant parent/child relationship are associated with suicide risk among youth (Brausch & Gutierrez, 2010; Garber et al., 1998; Johnson et al., 2002; King et al., 1993; King et al., 2001; Princstein, Boergers, Spirito, Little, & Grapentine, 2000), yet there is little information about this relationship among shelter-dwelling families. Homeless families living in the shelter system are at particular risk for disruptive parenting practices and impairments in the parent/child relationship. Evidence suggests the stressors that accompany homelessness interfere with important parenting processes, including monitoring and supervision, provision of support, and discipline (Howard, Cartwright, & Barajas, 2009). Families living in shelters also contend with lack of privacy, relinquishing control to shelter rules and regulations, and concerns that their parenting skills are being assessed by staff, which further impairs parenting and stresses the family unit (Fraenkel, Hameline, & Shannon, 2009; Paquette & Bassuk, 2009; Howard et al., 2009). This literature, coupled with the lack of knowledge about the relationship between these processes among homeless families, led to the second aim of the study; to determine whether participation in a family-focused prevention program that aimed to enhance parenting processes and the parent/child relationship would also impact suicidal ideation among these youth.