Mental and Physical Health of Homeless Youth Literature Review

Mental and Physical Health of Homeless Youth Literature Review Mental and Physical Health of Homeless Youth Literature Review In the process, you will be become equipped to incorporate peer reviewed research into your social security policy analysis. Once signing up for your social security title and program, you will identify the social problem addressed by this program. You then will select a target population whom you feel experiences this social problem and would benefit (or is currently benefiting) from this program. Mental and Physical Health of Homeless Youth Literature Review You then will find a peer reviewed journal article that adds to your knowledge of your selected target population and the social problem. Finally, you will write a 1-page review of this article. Your review should use proper APA citation within text as well as include a reference page. This descriptive paper should include the following: ?A clear identification of the target population addressed. (Please use a peer reviewed article related to homeless, abused and abandoned youth or the article provided. If using your own article please provide a pdf copy.) ?A clear definition of the social problems addressed in the article. ?A description of the findings in the article. Social Welfare Issue to select from & Federal Legislation Examples to use: Child Welfare ( the issue ) & (The Federal Legislation Example of program) Adoption & Safe Families Act; Indian Child Welfare Act; Social Security Title IV-E Foster Care and Adoption Assistance entitlement program; -Multiethnic Placement Act (MEPA); The Child Abuse Prevention and Treatment Act (CAPTA) Substance Abuse ( the issue) &(The Federal Legislation Example of program) :The Mental Health Parity and Addiction Equality Act; The Children’s Health Act of 2000; Drug Free Communities Act; Sober Truth on Preventing Underage Drinking Act. Mental and Physical Health of Homeless Youth Literature Review Food Insecurity ( the issue ) &(The Federal Legislation Example of program): The Child Nutrition Act; The Food Conservation and Energy Act of 2008 (also known as the 2008 Farm Bill and changed Food Stamps to SNAP). Criminal Justice (Youth) (the issue) & (The Federal Legislation Example of program) Safe and Drug-Free Schools and Communities Act (2001); Juvenile Justice and Delinquency Prevention Act. edidinetal2011_1_.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/51837166 The Mental and Physical Health of Homeless Youth: A Literature Review Article in Child Psychiatry and Human Development · November 2011 DOI: 10.1007/s10578-011-0270-1 · Source: PubMed CITATIONS READS 148 3,667 4 authors: Jennifer Edidin Rush University Medical Center Zoe Ganim 5 PUBLICATIONS 188 CITATIONS 13 PUBLICATIONS 246 CITATIONS SEE PROFILE SEE PROFILE Scott J Hunter Niranjan Karnik University of Chicago Rush University Medical Center 103 PUBLICATIONS 742 CITATIONS 135 PUBLICATIONS 1,086 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Pediatric Delirium View project Military Sexual Trauma View project All content following this page was uploaded by Niranjan Karnik on 28 May 2014. The user has requested enhancement of the downloaded file. SEE PROFILE Child Psychiatry Hum Dev DOI 10.1007/s10578-011-0270-1 REVIEW PAPER The Mental and Physical Health of Homeless Youth: A Literature Review Jennifer P. Edidin • Zoe Ganim • Scott J. Hunter • Niranjan S. Karnik Ó Springer Science+Business Media, LLC 2011 Abstract Youth homelessness is a growing concern in the United States. Despite difficulties studying this population due to inconsistent definitions of what it means to be a youth and homeless, the current body of research indicates that abuse, family breakdown, and disruptive family relationships are common contributing factors to youth homelessness. Moreover, the experience of homelessness appears to have numerous adverse implications and to affect neurocognitive development and academics, as well as mental and physical health. Substance use, sexually transmitted infections, and psychiatric disorders are particularly prevalent in this population. Whereas some of these problems may be short-lived, the chronic stress and deprivation associated with homelessness may have long-term effects on development and functioning. Further, difficulties accessing adequate and developmentally-appropriate health care contribute to more serious health concerns. Suggestions for future research and interventions are discussed. Keywords infections Youth homelessness Mental health Substance use Sexually transmitted Background The number of youth living without their families and permanent shelter is a growing concern in the United States and overseas [1]. Research suggests that on any given night in the United States there are 1.6–2 million homeless youth living on the streets, in shelters, or in other temporary accommodation [2, 3]. The prevalence of youth homelessness, however, is difficult to determine due to a number of factors, which include the lack of a J. P. Edidin (&) S. J. Hunter N. S. Karnik (&) Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA e-mail: [email protected] N. S. Karnik e-mail: [email protected] Z. Ganim Department of Education and Early Childhood Development, Victoria, Australia 123 Child Psychiatry Hum Dev consistent definition of homelessness in the literature, as well as the population’s transient nature and the impermanence of their homeless status [4, 5]. Homeless youth are a heterogeneous population and are described by a variety of terms in the literature. These terms include runaways (i.e., youth who have spent more than one night away from home without parental permission), throwaways (i.e., youth who have been forced to leave home by their parents), street youths (i.e., youth who live in high risk nontraditional locations such as under bridges and in abandoned buildings), and systems youth (i.e., youth who have previously been involved in government systems such as foster care or juvenile justice) [4, 6]. For the purposes of this paper, we use the term ‘‘homeless youth’’ to refer to all of these groups. Mental and Physical Health of Homeless Youth Literature Review Additionally, we define a homeless person as anyone who lacks a fixed, regular, and adequate nighttime residence; and whose primary nighttime residence is a supervised shelter designed to provide temporary living accommodation, including emergency shelters, transitional housing, or a place not designed for regular nighttime human habitation (e.g., such as under a bridge or in a car). This is based on the definition established by the U.S. Congress, which is used by the U.S. Federal Government [7]. In addition to the mixed terminology, research has not consistently operationalized what it means to be a youth. The United Nations defines ‘‘youth’’ as including all people between the ages of 15 and 24 years [8]. Studies of homeless youth, however, have included participants that range in age between 12 and 17, 19, 21, or 24 years. The overall impermanence and chronicity of homelessness, as well as the relative inconsistency of the definition of homelessness across studies, has further contributed to the difficulty in determining prevalence [9]. Research conducted with 59 homeless youth in Texas found that the length of time spent living on the streets varied from 2 months to 8 years [3]. A study of 50 homeless youth in Los Angeles aged 18–23 years found that 12% of youth had been homeless for 1 year, 56% for 1–5 years, and 32% for more than 5 years [10]. The absence of consistent definitions in studies of homeless youth makes it difficult to accurately determine the number of individuals in this population. Although this is due, in part, to the nomadic, transient nature of homeless youth, it can also be attributed to various other factors. In particular, the literature lacks clear, consistent definitions of the constructs of homelessness, youth, and chronicity. This shortcoming limits researchers’ ability to draw conclusions about this vulnerable population as a whole and to make comparisons about subgroups of homeless youth. Another weakness of the literature is that researchers have used various methodologies to study the characteristics of this population, as well as prevention and intervention programs. This makes it difficult to compare results of studies and perform meta-analyses to synthesize data. It is, therefore, difficult to draw empirically-supported conclusions about many of the issues that homeless youth face. As such, this paper seeks to review the findings from studies of homeless youth and organize them; several themes emerged. First, various studies have examined the causes of homelessness in unaccompanied youth. A second focus of the research has been to characterize homeless youth and the implications of homelessness. These studies are concerned with issues of neurocognitive functioning, academic achievement, high risk behaviors and activities, financial and legal issues, abuse and violence on the street, and mental and physical health. A third theme of the literature is health care, which includes the topics of access to, utilization of, and barriers to care. Finally, there is a small, but slowly growing, set of studies that has examined prevention and intervention programs designed for homeless youth. The authors conclude with a discussion of the implications of the research and future directions. 123 Child Psychiatry Hum Dev Causes of Youth Homelessness There is no single cause for homelessness; however, most of the reasons named by youth can be grouped into three broad inter-related categories: family breakdown, which includes behaviors of parents and youth, economic problems, and residential instability [11, 12]. The most common reason that young people leave home is due to disruptive family relationships or family breakdown [13]. This may include poor family functioning, unstable home environments, socioeconomic disadvantage, and separation from parents or caregivers [14]. Mental and Physical Health of Homeless Youth Literature Review Parental drug and alcohol use is a frequently cited reason for leaving home among young people, as it is often associated with parental abandonment, family violence, and neglect, as well as sexual, physical, and psychological abuse [15–18]. An Australian study of 302 homeless young people (12–20 years-old) found that family conflict or family breakdown was evident in all of the participants’ explanation about why they left home [19]. Only a small group of individuals in this study described a simple cause and effect relationship between one issue (e.g., drug use) and homelessness. Moreover, only 20% of the participants indicated that their own drug use was either a primary or secondary cause of their homelessness [19]. Trauma and Abuse Homeless youth experience high rates of trauma and abuse prior to their experience of homelessness. Studies indicate that this group endorses notably high rates of abuse by family and non-family members, rape, and assault [20]. Abusive family relationships are particularly detrimental, because they have been associated with subsequent mental health problems and risky behaviors [21]. Abuse may be verbal, emotional, physical, or sexual in nature. Although the findings of studies vary, homeless youth report greater exposure to abuse and neglect prior to leaving home relative to their housed peers [22, 23]. U.S. Government agencies report that sexual abuse rates prior to leaving home in this population range from 17 to 35% and the rate of physical abuse is reported to be as high as 60% [13]. A Seattle based study of 328 youth (12–21 years-old) living on the streets or in shelters, supports these high figures. Eighty-two percent of participants reported past experiences of physical abuse, 26% endorsed sexual abuse, and 43% described family neglect [24].In a more recent study, 50% of the participants had witnessed intrafamilial abuse, 50% had been physically abused, 39% had been sexually abused, and 68% had experienced verbal abuse [15]. Many of these youth had been victims of multiple types of abuse. Specifically, 71% reported histories of at least 3 different kinds of abuse and 18% indicated that they had experienced more than 5 kinds of abuse [15]. Although various studies have found that a significant number of homeless youth have histories of abuse, there is evidence that suggests that the relation between trauma, including abuse, and homelessness may be bidirectional in nature. That is, homelessness may precipitate, or be a consequence of, trauma [20]. Youth who experience abuse during childhood may leave home in order to avoid it; however, this may simply shift the types of abuse that they experience [20]. Alternatively, homelessness may increase the risk for abuse, particularly specific types of abuse, beyond that which would be expected based on abuse during childhood [25]. As homelessness is associated with numerous stressful, isolating, and marginalizing experiences, youth may place themselves in situations that increase their risk for further abuse [25]. 123 Child Psychiatry Hum Dev At-Risk Groups Specific groups of individuals may also be at-risk for becoming homeless. Studies indicate that youth who have been involved in the foster care system and lesbian, gay, bisexual, and transgender (LGBT) youth may be particularly vulnerable to homelessness [26]. Many youth in the foster system become homeless when they ‘‘age out’’ of foster care at 18 yearsold. Mental and Physical Health of Homeless Youth Literature Review As a result, this subpopulation is older than the general population of homeless youth. When youth in the foster care system become emancipated at 18 years-old, many do not have adequate financial and social supports to allow obtainment of independent housing and, consequently, become homeless [10]. A study of youth in the Michigan foster care system, found that approximately 30% of emancipated youth experienced decreasingly stable or continuously unstable housing situations in the 3 months following their release [26]. Within these groups, non-white youth were more likely to have unstable living situations [26]. This was associated with an increased risk for victimization, school dropout, emotional problems, and behavior problems; however, it is of note that 22% of the youth were placed in foster care initially, because of behavior problems [26, 27]. LGBT youth are another group at-risk for homelessness. The relative proportion of homeless youth who identify as LGBT depends on the study and where it was conducted. A 2006 review of the literature found that between 20 and 40% of homeless youth identify as LGBT [28]. Within this population, family conflict is a primary cause of homelessness [28]. For many of these youth, coming out to a parent preciptates a negative reaction, which may prompt them to runaway or parents to kick the child out of the family home [28]. Ultimately, the variability in the causes of youth homelessness and its onset may differentially impact youth and their mental and physical health. The Implications of Homelessness in Youth Homelessness has been associated with numerous adverse outcomes across multiple domains. The detrimental effects of homelessness on cognitive and academic functioning, financial stability, and mental and physical health have been consistently noted in the literature. Whereas some of these effects may be short-lived and limited to the period of homelessness, others are more enduring in nature. Neurocognitive Development Adolescence and early adulthood are periods of marked social, psychological, and physical development. Among the changes that occur during this time is rapid brain development. Specifically, increases in myelination during this time allow for greater connectivity among the different regions of the brain, improved speed, increased efficiency, and enhanced modulation of the timing and synchrony of neuronal firing [29, 30]. Additionally, significant maturation of the prefrontal cortex, the area principally responsible for executive functioning, occurs during this time. Executive functioning includes the processes of strategy identification, decision making, inhibition, reasoning, working memory, planning, and organization, as well as behavior and emotion regulation [29, 31–34]. Research has identified that the prefrontal cortex undergoes a protracted period of development, which continues from early childhood well into the mid-twenties. In addition to overall increases in prefrontal cortical volume, improved coordination between the prefrontal cortex and the limbic system, structures that control memory, emotion regulation, and motivation, also occurs [30, 35, 36]. 123 Child Psychiatry Hum Dev Because of the numerous changes in the structure and function of the brain that occur during adolescence and young adulthood, there is greater potential for the environment to affect development [32]. Maturational changes that occur in the structure of the brain are associated with improvements in decision making and emotional regulation, as well as decreases in disinhibition and impulsivity. It is due to the relative immaturity of these regions of the brain that youth are more likely to engage in reckless and risky behaviors [37, 38]. Moreover, the period of rapid brain development during adolescence and young adulthood helps to explain behaviors, such as poor decision making, recklessness behaviors, risk taking, and emotional outbursts, which are typical of this developmental period, and are believed to reflect the periodic instability of the neural systems that are growing and increasing in their sophistication, as well as control [37, 38]. v Generally, parents, teachers, and other significant adults assist adolescents and young adults in their development of decision making and reasoning skills; however, homeless youth often do not have access to supportive adult relationships. Consequently, they make decisions about how and where to live during a time when their decision making and problem solving skills are immature [39]. These youth are at greater risk of making bad decisions and operating in high risk situations compared to their housed peers [40]. Few studies have examined cognitive functioning in homeless youth and most have looked at young accompanied minors. The limited research in this area indicates that deficits occur across multiple domains. Impairments have been found in visuomotor and problems solving skills, judgment, logical thinking, and processing speed [41]. Additionally, studies of homeless children have found lower scores on tests of verbal abilities [42]. Significant deficits in attention have also been observed in homeless youth with abuse histories [41]. Because the current body of literature does not include longitudinal studies, it is unknown whether cognitive deficits precede homelessness or is a consequence of it. Studies that have examined the effects of poverty on cognitive functioning indicate that factors common to homelessness and poverty, such as food insufficiency, negatively impact cognitive functioning [43]. Additionally, some youth may be genetically predisposed for low cognitive ability, which may be further amplified by the stressors, and lack of supports and resources characteristic of homelessness. Although studies of homeless adults indicate that cognitive functioning improves once individuals are housed, it is not known whether cognitive deficits in children and adolescents improve if stable housing is achieved. Research that has examined the effects of stress on cognitive functioning in children suggests that the effects may be permanent; specifically, stress appears to increase the speed at which the prefrontal cortex develops and stunts neural growth [44]. Academic Achievement In contrast to the small number of studies that have examined the impact of homelessness on neurocognitive functioning, many more studies have looked at the effects of homelessness on academic achievement and school performance; however, the findings from these studies have been inconsistent. For example, some research indicates that homeless youth experience high rates of suspensions, missed school days, and absenteeism, but others studies have found that the rates of these problems are comparable to those found among low-income youth [45–48]. As such, some researchers contend that poverty, and not homelessness, account for the pattern of academic problems observed. One consistent predictor of academic difficulties among homeless youth is the high rate of school mobility, the transfer from one school to another, in this population [45, 49]. 123 Child Psychiatry Hum Dev Studies have repeatedly found that high rates of school mobility and poor school attendance are associated with lower levels of academic achievement, which is predictive of lower levels of academic success and school failure [50]. Stressful events that are common among homeless youth, such as parental substance abuse and psychopathology, are also associated with low levels of achievement [45]. Poor academic achievement is evidenced by slower achievement growth rates and lower levels of achievement on standardized tests in reading, spelling, math, and science [46–48, 50, 51]. Additionally, a large number of homeless youth fail and must repeat a grade [41, 45, 51]. In one study of children living in a shelter, 45% had repeated a grade, 25% had failed a class, and 42% endorsed currently failing or doing sub-par work [45]. These results were supported by another study that found that twice as many homeless youth repeated a grade as housed youth [51]. For youth who struggle to meet academic demands, it remains unclear whether they receive adequate support services, as findings from studies have been inconsistent. Several studies indicate that homeless youth are more likely to be placed in special education programs, but others have found that fewer homeless children receive the special education supports that they need [45, 47]. Some researchers suggest that the small number of homeless youth who receive accommodations is due, at least in part, to the …Mental and Physical Health of Homeless Youth Literature Review Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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