Trauma and resilience in an urban clinic for unhoused young adults: A mixed methods study

Unhoused youth and young adults report higher rates of adverse childhood experiences (ACEs) compared to the general population. ACEs are linked in a dose-dependent manner to poorer mental and physical health outcomes in adulthood. Resilience, which is the ability to manage stressors and recover from adversity, is a measurable quality with both intrinsic and extrinsic sources that can potentially be used to mitigate the negative effects of ACEs. This study aimed to explore the relationship between ACEs and resilience among unhoused transitional-aged youth (TAY) at an urban medical clinic. Our approach relied on qualitative thematic analysis of semi-structured interviews. The participants included twenty-eight unhoused patients aged 18-27 years attending a free medical clinic. Our main outcome measures focused on perceptions of trauma experienced by unhoused youth, ACEs score, PHQ-9, and Brief Resilience Scale (BRS) scores. The number of ACEs in our study population ranged from 6 to 15, with a mean of 9. The most frequently reported adverse childhood events were divorce, verbal abuse, substance use by someone in the household, feeling unloved or "unspecial," and physical abuse. Resilience scores in our population ranged from 9 to 30, with a mean of 17. Participants with high resilience were more likely to report close relationships, educational goals, connections with mental health professionals, and housing in transitional living programs (TLPs). Moving from research to policy, strategies that promote resilience by identifying intrinsic assets and external resources can be used to develop transformative programs for unhoused youth and young adults. Housing First initiatives are crucial for providing a safe and secure environment that helps youth feel capable of mitigating the impact of adversity on their health outcomes. Housing First initiatives are instrumental to providing a safe and secure environment for youth to feel capable of mitigating the impact of adversity on health outcomes.