Substance Abuse and Mental Health Correlates of Victimization Classes among Homeless Youth

Background

Literature demonstrates that street victimization is a common occurrence among homeless youth.¹ Street victimization is correlated with poorer mental health, including substance abuse,^2,3 depressive symptoms,³ and posttraumatic stress disorder (PTSD).⁴ Despite much research on street youth victimization, few studies have examined victimization classes and how those classes differ by type and frequency of victimization. In two separate studies, authors Bender, Thompson, Ferguson, and Langenderfer relied on latent class analysis to determine subgroups of homeless youth based on the youths’ self-reported victimization experiences. The authors then ran analyses to determine which of several variables predict subgroup membership. Study One focused on substance abuse, whereas Study Two focused on mental health.

The Sample

Purposive sampling between March 2010 and July 2011 resulted in a sample of 601 street youth, each served by a homeless youth agency in Los Angeles (n=200), Austin (n=200), or Denver (n=201). The three eligibility criteria were that the youth had to 1) be 18 to 24 years old, 2) have spent at least two weeks away from home prior to the interview, and 3) provide written informed consent. Researchers conducted quantitative retrospective interviews with the youth to assess demographics, victimization experiences, substance use symptoms, and mental health symptoms. Researchers assessed victimization experiences using a revised version of the Traumatic Life Events Questionnaire,⁵ retaining items only if they were relevant to homeless youth. Substance use and mental health variables were assessed by the Mini International Neuropsychiatry Interview (MINI).⁶ Specifically, Study One examined substance abuse and substance dependence correlates of victimization class while Study Two examined depression and PTSD correlates.

Demographics for the total sample are as follows:

• Age: M=20.5 years (SD=1.6)
• Gender: 64% male, 36% female
• Race/Ethnicity: 40% White, 25% Black, 18% Latino, 17% Other
• Primary living arrangement: 50% homeless, 50% temporarily housed
• Met diagnostic criteria for:
• Alcohol Addiction: 49.8%
• Drug Addiction: 59.7%
• Substance Abuse: 36.6.%
• Substance Dependence: 48.5%
• Depression: 31%
• PTSD: 23%
• Number of moves: M=3.5 (SD=3.7)
• Months homeless: M=32.4 (SD=31) = 2.7 years

The Results

Identifying Victimization Classes

In Study One, researchers identified victimization classes using exploratory latent class analysis, grouping youth based on type and frequency of victimization. Researchers ran multiple models, from one to six classes, and used best-fit indices and their abilities to describe distinct patterns in classes to decide on a three-class model: low-victimization, high victimization, and witness classes.

Among youth in the low-victimization class (n=215, 36%) more than 85% never experienced robbery, experienced physical or sexual assault by a stranger, experienced threat of bodily harm, witnessed an assault, or personally overdosed on drugs. Typically, youth in this class experienced lower rates of all types of victimization than both the high-victimization and witness classes.

The high-victimization class (n=136, 23%) reported high rates of both indirect (e.g., witnessing a severe assault) and direct (e.g., physical assault by a stranger) victimization. This class also reported experiencing victimization types rarely reported by either the low-victimization or witness classes, such as physical or sexual assault by an intimate partner and personally overdosing on drugs.

The witness class (n=250, 42%) reported high rates of indirect victimization, such as witnessing severe assault, witnessing a drug overdose, or experiencing the sudden death of a close friend or loved one. Typically, these indirect forms of victimization were experienced only once.

Study One: Substance Abuse

Results of a first multinomial regression model indicate that, compared to low-victims, witnesses are approximately twice as likely to meet criteria for both substance abuse and dependence. Moreover, both substance abuse and substance dependence increased the odds of being classified as a high-victim versus a low-victim. Results of a second multinomial regression model indicate that although alcohol and drug addiction both increase the risk of being classified as a witness or high-victim as opposed to a low-victim, the odds ratios were higher for alcohol than for drugs.

Study Two: Mental Health

Again using multinomial regression, results indicate that youth in the high-victimization and witness classes were nearly twice as likely to experience depression symptoms and nearly three times as likely to experience PTSD compared to youth in the low-victimization class. Researchers found no significant differences in mental health risks between high-victims and witnesses.

The Implications

Street youth classified as witnesses or high-victims demonstrated higher rates of substance abuse, substance dependence, depression, and PTSD than low-victims. Given the distinct experiences of youth in the three classes, it is important that providers screening for victimization among homeless youth assess not only types of victimization, but potential consequences as well, such as substance abuse and mental health problems. Moreover, prevention efforts targeting homeless youth should include victimization prevention education.

For More Information

For more details on how latent classes were determined; how time homeless, primary living situation, and transience impact classification; and expanded implications, refer to the full articles in Child Abuse & Neglect and Journal of Adolescence. Click the links below to learn more about the authors’ work.

Dr. Kimberly Bender

Lisa Langenderfer-Magruder

Citations

Bender, K., Ferguson, K., Thompson, S., & Langenderfer, L. (in press). Mental health correlates of victimization classes among homeless youth. Child Abuse & Neglect.

Bender, K., Thompson, S.J., Ferguson, K., & Langenderfer, L. (2014). Substance use predictors of victimization profiles among homeless youth: A latent class analysis. Journal of Adolescence, 37(2), 155-164. doi: 10.1016/j.adolescence.2013.11.007

References

1 Stewart, A.J., Steiman, M., Cauce, A.M., Cochran, B.N., Whitbeck, L.B., & Hoyt, D.R. (2004). Victimization and posttraumatic stress disorder among homeless adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43(3), 325-331.

2 Hoyt, D.R., Ryan, K.D., & Cauce, A.M. (1999). Personal victimization in a high-risk environment: Homeless and runaway adolescents. Journal of Research in Crime and Delinquency, 36(4), 371-392

3 Whitbeck, L.B., Hoyt, D.R., & Bao, W. (2000). Depressive symptoms and co-occurring depressive symptoms, substance abuse, and conduct problems among runaway and homeless adolescents. Child Development, 71(3), 721-732.

4 Whitbeck, L.B., Hoyt, D.R., Johnson, K.D., & Chen, X. (2007). Victimization and posttraumatic stress disorder among runaway and homeless adolescents. Violence and Victims, 22(6), 721-734.

5 Kubany, E. S., Leisen, M. B., Kaplan, A. S., Watson, S. B., Haynes, S. N., Owens, J. A., Burns, K. (2000). Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: The Traumatic Life Events Questionnaire. Psychological Assessment, 12(2), 210-224. doi: 10.1037/1040-3590.12.2.210

6 Sheehan, D., Lecrubier, Y., Sheehan, K., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22-33.

Training Social Work Graduate Students in the Evidence-Based Practice Process

The evidence-based practice (EBP) process model aids in practitioner decision-making by stressing a combination of practice wisdom and best available evidence, client culture and preferences, and the circumstances of practice.¹ The model, intended to close the research-practice gap,² has five steps for practitioners:³

1. Determine client/community needs and preferences using well-structured questions
2. Examine evidence to address the need
3. Evaluate the evidence for impact, applicability, and validity
4. Apply  best evidence to practice in a way that respects client values and available resources
5. Evaluate practice effort for positive outcomes

The EBP process model is particularly appropriate for social work, as it adheres to the profession’s emphasis on informed consent, self-determination, competence, and respect for diversity and worthiness of individuals,⁴ while empowering practitioners by bolstering competence. This, coupled with a wide acceptance of the EBP model in social work education,^5-8 led Bender and her colleagues to conduct a quasi-experimental study comparing a traditional program evaluation course to one that emphasized the EBP process. The researchers relied on the empirically validated Evidence-based Practice Process Assessment Scale (EBPPAS)^9,10 to evaluate differences in the two groups.

Methods and Sample

All participants were enrolled in one of twelve sections of a required program evaluation course within their master’s in social work (MSW) program at a university in the western United States. Instructors taught five sections (n=86 students) using the traditional curriculum and seven sections (n=94 students) including enhanced EBP process materials. At the start of the ten-week course, willing students completed a shortened, revised EBPPAS to evaluate their baseline EBP knowledge and intent to use the EBP process. Students who completed this pretest also completed a posttest on the last day of class to determine if their thoughts toward the EBP process model had changed. Analyses were only conducted on students with both pre- and posttest scores. This resulted in a final analytic sample of 152 students in the traditional (n=60) and EBP process (n=92) courses.

Student demographics across all sections were obtained from the registrar to protect student confidentiality. Demographics are as follows:

• Mean Age: 28 years (SD=6.1)
• Gender: 91% female, 9% male
• Race/Ethnicity: 79.2% White, 3.4% Asian, 3.4% Black or African American, 2.1% biracial, 0.8% Native Hawaiian or other Pacific Islander, 11% unknown
• Year in program: 79.2% second year, 20.8% advance standing (first year)

Results

The traditional and EBP process groups did not significantly differ on EBPPAS pretest scores. At pretest, most students responded neutrally in regards to familiarity and engagement with EBP and positively to attitudes about, and intention to engage in, the EBP process.

Posttest EBPPAS scores indicate that students in the EBP process group reported significantly higher ratings of EBP familiarity; however, both groups showed significant increases from pre- to posttest. There were no significant differences between groups at posttest on attitudes about, feasibility of, intentions to engage in, or current engagement with EBP process in their work. Both groups demonstrated moderate and small increases in engagement in and attitudes toward the EBP process, respectively.

Implications

Based on the results, the authors offer several implications. First, though students in both groups demonstrated increased familiarity with the EBP process from pre- to posttest, the EBP process group showed significantly greater gains. Bender and her colleagues suggest that explicitly including the EBP process through assignments may increase students’ self-efficacy in future use of the model. Second, given that most students at pretest valued EBP, schools of social work may benefit from focusing on the content and process of EBP versus convincing students of its value. Third, students’ perceived feasibility of implementing EBP into practice did not increase from pre- to posttest and, in fact, decreased among students in the enhanced group. Feasibility often impedes the research-practice connection, so addressing students’ feasibility concerns as well as institutional and structural barriers to implementing EBP may assuage student apprehension. Finally, in terms of future research, authors suggest evaluation efforts continue by utilizing randomized designs and an unaltered EBPPAS.

For More Information

To learn more about the specific content included in the EBP process sections, check out the full article, which is currently in press online in Research on Social Work and Practice. You can also learn more about the Dr. Kimberly Bender on her faculty page.

Citation

Bender, K., Altschul, I., Yoder, J., Parrish, D., & Nickels, S.J. (in press). Training social work graduate students in the evidence-based practice process. Research on Social Work Practice. doi: 10.1177/1049731513506614

References

¹ Mullen, E. J., Shlonsky, A., Bledsoe, S. E., & Bellamy, J. L. (2005). From concept to implementation: Challenges facing evidence-based social work. Evidence & Policy, 1, 61-84.

² Rubin, A., & Parrish, D. E. (2012). Improving the scientific base of social work practice. In C. Dulmas & K. M. Sowers (Eds.), The profession of social work (2^nd ed., pp. 203-224). Malden, MA: John Wiley.

³ Straus, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005). Asking answerable clinical questions. In Evidence-based medicine: How to practice and teach EBM (3^rd ed.) (pp. 13-30). Edinburgh, UK: Elsevier.

⁴ National Association of Social Workers. (2008). Code of ethics of the National Association of Social Workers. Retrieved from http://www.socialworkers.org/pubs/code/code.asp

⁵ Drake, B., Jonson-Reid, M., Hovrnand, P., & Zayas, L. H. (2007). Adopting and teaching evidence-based practice in master’s-level social work programs. Journal of Social Work Education, 43, 431-446.

⁶ Edmond, T., Megivern, D., Williams, C., Rochman, E., & Howard, M. (2006). Integrating evidence-based practice and social work field education. Journal of Social Work Education, 42, 377-396.

⁷ Howard, M. O., McMillan, C., & Pollio, D. (2003). Teaching evidence-based practice: Toward a new paradigm for social work education. Research on Social Work Practice, 13, 234-259.

⁸ Rubin, A. (2007). Epilogue: The Austin initiative. Research on Social Work Practice, 17, 630-631.

⁹ Rubin, A., & Parrish, D. E. (2010). Development and validation of the EBP process assessment scale: Preliminary findings. Research on Social Work Practice, 20, 629-640.

¹⁰ Rubin, A., & Parrish, D. E. (2011). Validation of the EBP process assessment scale. Research on Social Work Practice, 21, 106-118.