Recent meta-analytic findings demonstrate that homeless youth evidence significant cognitive impairment and decremented vocational achievements. Cognitive impairment limits the benefit from available vocational services such as job readiness training, thereby contributing to chronic unemployment and enduring homelessness. At present, empirical data support the use of treatments to target cognition that are integrated with other community services for homeless adults. Cognitive remediation implemented in a range of adult populations has yielded positive outcomes with respect to cognitive improvement and acquisition of goals for community functioning. However, as of yet, such cognitive interventions have not been employed in homeless youth. Cognitive gains provide a necessary platform for learning to support the development of skills needed for employment in the community. Successful intervention at this critical developmental period is thus crucial to halt a potentially detrimental trajectory of accumulating functional disability and enduring homelessness.
The aim of this research is to conduct a controlled study of cognitive remediation, to provide feasibility data on adapting an established empirically-based cognitive intervention for homeless youth to help them attain vocational goals. The ultimate purpose is that youth will improve in cognitive functioning and have better functional outcomes including jobs to sustain independent living. The results of this study will inform a larger trial on the efficacy of cognitive remediation in homeless youth to improve cognition and vocational outcomes. The proposed study will involve 90 participants, ages 18 to 21, at the Rights of Passage program at Covenant House, a community agency that offers job training, remedial education, housing, medical care, and counseling to unemployed and under-educated homeless youth. Hypotheses are that, compared to those in an active control group receiving computerized work-skills training, individuals who receive cognitive remediation will show greater cognitive benefits on proximal measures of neurocognition and evidence better vocational outcome as defined by greater number of hours worked. This study will address the service gap in the use of integrated psychosocial interventions for homeless populations as the first investigation of cognitive remediation in homeless youth.

Public Health Relevance

Many young people who are homeless have cognitive deficits which impede their ability to secure and maintain employment. This study looks to see if targeting cognitive deficits can improve cognition and vocational outcome.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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Mental Health Services in MH Specialty Settings (SRSP)
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Sherrill, Joel
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New York State Psychiatric Institute
New York
United States
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Saperstein, Alice M; Lee, Seonjoo; Ronan, Elizabeth J et al. (2014) Cognitive deficit and mental health in homeless transition-age youth. Pediatrics 134:e138-45