Homeless young people, 18-21 years of age, particularly those who use substances and experience victimization, are at elevated risk for serious health problems, including posttraumatic stress disorder, depression, sexually transmitted infections, HIV/AIDS, and self-mutilation. Although substance use and victimization are interconnected, existing substance use interventions do not directly address victimization risk, and those shown effective require prohibitively prolonged engagement. Promotion of healthy choices regarding substances and safety from victimization (e.g., robbery, assault) on the streets involves a set of risk-related attention skills (e.g., ability to shift, inhibit and fous attention; maintain focus in the face of distracting information; think flexibly about potential solutions; plan and initiate actions) to detect risks, problem solve, act assertively and seek help when necessary. Mindfulness-based interventions offer promise in building attention-related skills, but they have not been tested rigorously with homeless youth. In partnership with a community-based homeless youth shelter, the proposed study aims: 1) To test the efficacy of a mindfulness-based cognitive behavioral intervention in reducing substance use (primary outcome) and victimization (secondary outcome) among homeless youth using a randomized, multi-wave design; and 2) To test risk-related attention mediators (risk detection, problem solving, assertiveness, help seeking) that explain intervention effects. This intervention was tested and found to be feasible in a pilot study (N=98), by the research team, where recruitment approaches, randomization procedures, measures, and retention strategies were tested and refined and promising initial effects were obtained. In the proposed study, we will recruit 230 homeless youth and randomly assign approximately 115 to the intervention group and 115 to case management services. The experimental condition includes a 3-day, mindfulness-based, cognitive behavioral group intervention that will teach and practice mindfulness skills necessary to identify and avoid risks, thereby reducing substance use and victimization. The control group will receive usual case management services, including goal setting and referrals for services. Following the group intervention (1 week after baseline for controls), participants in both groups will receive a cell phone with prepaid unlimited service to track youth longitudinally and reduce attrition. Quantitative data will be collected at: baseline, immediately following the 3-day intervention (or 1 week post baseline for control group), and at the 6-week, 3-month, and 6-month follow up. Data will be analyzed using repeated measures linear mixed effects and multiple mediation models. If found effective in reducing substance use and victimization, the tested intervention could be provided as a stand-alone program or added to enhance current programs by helping youth develop attention skills essential in avoiding risks.
Homeless young people (18-21) are at extreme risk for substance use and victimization; yet, few interventions exist for reducing substance use and none that seek to reduce substance use and victimization risk among this difficult-to-reach group. If not addressed, substance use and victimization place homeless youth at additional risk for serious public health problems, including posttraumatic stress disorder, depressive symptoms, self-mutilation, sexually transmitted infections, and HIV/AIDS. Findings from the proposed efficacy trial will contribute to understanding how a mindfulness intervention may help homeless youth develop key attention skills to reduce substance use and victimization, aiding in prevention of costly negative health outcomes.
