Building social and structural connections for the prevention of opioid use among youth experiencing homelessness:...

Youth experiencing homelessness (YEH) are exposed to significant adversities while living on the street, and many experienced child abuse and neglect prior to leaving the home setting. Multiple social determinants of health (SDoH) are uniquely associated with youth homelessness, driving substance use and adverse mental health consequences. However, limited research has identified pragmatic interventions that have a long-term ameliorating impact on the complex, multi-symptomatic issues that YEH face. This study overcomes prior gaps in research through the testing of a multi-component prevention intervention targeting SDoH and their effects on biopsychosocial health indicators and longer-term health and social outcomes. In partnership with a local drop-in center for YEH, youth between the ages of 14 to 24 years are engaged and randomly assigned to conditions using a dismantling design so that essential intervention components can be efficiently identified.

YEH (N = 300) are recruited through the drop-in center and randomly assigned to one of the following interventions: a) Motivational Interviewing/Community Reinforcement Approach + Services as Usual (MI/CRA + SAU, n = 80), b) Strengths-Based Outreach and Advocacy + SAU (SBOA + SAU, n = 80), c) MI/CRA + SBOA + SAU (n = 80) or d) SAU (n = 60). Interventions are delivered over six months by the drop-in center's therapists and youth advocates to enhance sustainability. Primary outcomes include opioid use, other substance use, and mental health symptomatology. Secondary outcomes focus on education, employment, and housing stability; access to health care and met health needs; diagnostic status, and drug overdose. Biopsychosocial pathways underlying change, potential moderation of intervention response, and a cost effectiveness analysis will be examined. Youth are assessed at baseline and at 3-, 6-, 12-, 18- and 24-months post-baseline to examine longer-term prevention effects on the outcomes.

Prevention efforts addressing SDoH and embedded within systems that serve youth, such as drop-in centers, may be the most promising strategy to prevent opioid use and other substance use disorders as well as chronic homelessness. The study addresses a significant public health concern, and if our hypotheses are supported, the intervention may be readily transported to communities around the country.

ClinicalTrials.gov, TRN: NCT06311838, Registration date: 26 February 2024.