Prev Sci DOI 10.1007/s11121-015-0630-3
A Test of Outreach and Drop-in Linkage Versus Shelter Linkage for Connecting Homeless Youth to Services Natasha Slesnick 1 & Xin Feng 1 & Xiamei Guo 4 & Brittany Brakenhoff 1 & Jasmin Carmona 1 & Aaron Murnan 1 & Scottye Cash 2 & Annie-Laurie McRee 3
# Society for Prevention Research 2016
Abstract Outreach and service linkage are key for engaging marginalized populations, such as homeless youth, in services. Research to date has focused primarily on engaging individuals already receiving some services through emergency shelters, clinics, or other programs. Less is known about those who are not connected to services and, thus, likely the most vulnerable and in need of assistance. The current study sought to engage non-service-connected homeless youth (N = 79) into a strengths-based outreach and advocacy intervention. Youth were randomly assigned to receive 6 months of advocacy that focused on linking youth to a drop-in center (n = 40) or to a crisis shelter (n = 39). All youth were assessed at baseline and 3, 6, and 9 months post-baseline. Findings indicated that youth prefer drop-in center services to the shelter. Also, the drop-in center linkage condition was associated with more service linkage overall (B = 0.34, SE = 0.04, p < 0.01) and better alcohol-l [B = −0.39, SE = 0.09, t(75) = −4.48, p < 0.001] and HIV-related outcomes [B = 0.62, SE = 0.10, t(78) = 6.34, p < 0.001] compared to the shelter linkage condition. Findings highlight the importance of outreach and service linkage for reconnecting service-
* Natasha Slesnick
[email protected]
1
Department of Human Sciences, The Ohio State University, Columbus, OH, USA
2
College of Social Work, The Ohio State University, Columbus, OH, USA
3
College of Public Health, The Ohio State University, Columbus, OH, USA
4
Xiamen University, Xiamen, China
marginalized youth, and drop-in centers as a primary service option for homeless youth. Keywords Homeless youth . Outreach . Crisis shelters . Drop-in centers Homelessness is a major problem in the USA, with homeless youth one of the most understudied and underserved groups (Gaetz 2004; Slesnick et al. 2009). BHomeless youth^ is a term commonly used to describe homeless individuals between the ages of 14 and 24 (Robertson and Toro 1999; UNESCO 2015) and is recognized as a separate homeless subpopulation, as compared to homeless adults, families, and veterans by the Hearth Act and Runaway and Homeless Youth Act (USICH 2010). Researchers recognize the unique struggles of homeless youth as compared to older, homeless adults, including higher risk sexual behaviors and barriers to health care and services (Rosenheck et al. 1999; USICH 2010). Homeless youth are predisposed to mental health problems including depression, suicide attempts, and trauma (Zerger et al. 2008). Studies indicate that 70–95 % report problem alcohol or drug use (Cauce et al. 2004; Merscham et al. 2009), suggesting that substance use is the norm rather than the exception among these youth. Physical health problems in this population include sexually transmitted infections (STIs), human immunodeficiency virus (HIV), and unintended pregnancy, as well as tuberculosis, uncontrolled asthma, and dermatologic problems, all of which are compounded by a lack of access to health care facilities and lower levels of health services use than continuously housed youth (Beech et al. 2003; Rotheram-Borus et al. 2003). The range and severity of adverse outcomes increases over time; the longer a young person experiences homelessness, the more likely they are to experience
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substance use, victimization, and mortality, and the harder it becomes to exit street life (Ferguson et al. 2011; Milburn et al. 2006; Scutella et al. 2013). Therefore, interventions seeking to reintegrate homeless youth are of paramount importance. Much information on those experiencing homelessness is obtained from those who are currently residing in public or private shelters or utilizing services through other agencies, such as drop-in centers. Consequently, those experiencing homelessness who are not service engaged are excluded from most studies. Yet, these service-disconnected individuals are likely different from those who already access services (Kryda and Compton 2009; Sowell et al. 2004) and may have greater need for assistance. For example, these individuals have more severe substance use and mental health problems compared to those service-connected individuals experiencing homelessness (Kryda and Compton 2009). Previous research suggests that connection to needed services may be key for helping youth exit homelessness. In a prospective study, the more connections youth had with formal and informal social systems at the beginning of the study, the more likely they were to decrease the number of homeless days and to start with fewer homeless days in general (Slesnick et al. 2008a, b). However, the type of service connection associated with better outcomes is as yet unknown. Homeless shelters are often the first service contact or Bfront door^ for those experiencing homelessness (Pable 2005). In addition to offering an overnight bed and meals, shelters often also provide referrals to other treatment services and housing resources. However, research suggests that only 20–30 % of homeless youth report ever having stayed at a crisis shelter (Ray 2006; Springfield’s Housing Collaborative 2007). Youth reportedly avoid shelters for a variety of reasons including being preyed upon by older homeless adults and because shelter services are not tailored to youths’ unique developmental needs (Ensign and Gittelsohn 1998). Despite the importance of shelters, ways of effectively engaging service-disconnected homeless youth into shelter services have yet to be identified. Drop-in programs are Blow-demand^ with few institutional restrictions to increase successful engagement of youth. Dropin centers could offer a more acceptable and effective alternative to the shelter system and increase engagement into services such as substance use and mental health treatment, housing, and other health and social supports. However, outreach is the first step in connecting youth to these service programs. Studies define outreach as contacting/engaging individuals within non-office settings, with successful outreach defined as service linkage. To date, studies documenting efforts to reintegrate homeless youth into the mainstream are limited. A recent review of the outreach literature with street-involved youth indicated that among 16 studies, outreach engaged 63 % of the youth into services, including health services (HIV/STI testing) and counseling (Connolly and Joly 2012).
Current Study We conducted a randomized controlled trial to examine the effectiveness of strengths-based outreach and advocacy for service-disconnected substance-using youth and how the nature of the first contact, drop-in versus shelter, impacts subsequent service connection and outcomes (including substance use, housing, HIV risk, and mental and physical health). We hypothesized that more youth would engage with drop-in centers than shelters and that those assigned to the drop-in-linkage condition would show better outcomes over time than those assigned to the shelter linkage condition. Successfully linking these marginalized youth to services is essential for ending homelessness and for the prevention of harmful sequelae.
Methods Participants Homeless youth in Columbus, Ohio, were recruited for this study between May 2012 and July 2013. Youth (N = 79) were eligible for the study if they (a) were between the ages of 14 and 24 years; (b) had not sought services through a shelter, drop-in center, or substance use/mental health treatment program in the prior 3 months; (c) planned to remain in the geographic area for at least 9 months; (d) reported at least six uses of alcohol/drugs in prior 30 days; (e) met criteria for homelessness as defined by the McKinney-Vento Act (2002); and (f) had been homeless for the prior 3 months (to ensure need of services in prior 3 months). The McKinney-Vento Act (2002) defines homeless individuals as those who lack a fixed, regular, and adequate nighttime residence; live in a welfare hotel or place without regular sleeping accommodations; or live in a shared residence with other persons due to the loss of one’s housing or economic hardship. A summary of the demographic characteristics of the current sample is presented in the Table 1. Procedure A research assistant (RA) engaged and screened youth during outreach. Eligible and interested youth provided informed consent/assent and upon signing of the consent/assent form, the baseline assessment began. The local Institutional Review Board (IRB) approved a waiver of parental consent for those youth under the age of 18 years. This study was conducted Bin vivo^ in the youth’s environment at any location acceptable and convenient to the youth while also negotiating for privacy and confidentiality. Once an outreach worker engaged a homeless youth, an RA met with them to conduct the formal assessment. Upon completion of the baseline assessment, the youth was assigned to an outreach worker/advocate who talked with the youth to arrange their first meeting, usually
Prev Sci Table 1
Demographic characteristics of the total sample
Variables
n (%)
Age
Mean (SD) 20.84 (2.13)
Gender Female Male Race/ethnicity White, not of Hispanic origin Other Education No degree received High school diploma/GED and above Abuse history
37 (46.8) 42 (53.2) 45 (57.0) 34 (43.0) 43 (54.4) 35 (44.3)
Sexual abuse
33 (41.8)
Physical abuse Emotional abuse
36 (45.6) 42 (53.2)
later that day or the following day. All youth received 6 months of the outreach and advocacy intervention, with the primary focus of the outreach randomly determined to be (1) connecting with a crisis shelter (n = 39) or (2) connecting with a drop-in center (n = 40). Self-report questionnaires and interviews were conducted at baseline and 3, 6, and 9 months postbaseline. An intent to treat design was followed so that all youth, regardless of participation in the outreach and advocacy intervention, were tracked for their follow-up interviews. Participants were reimbursed with a $40 gift card at completion of the baseline assessment, 3, 6, and 9-month assessment battery, and a $5 food gift card for each advocacy session attended. All research procedures were approved by the Institutional Review Board at The Ohio State University.
2. Workers meet participants on their turf and do more than distribute materials. 3. Workers identify where the target population hangs out. 4. Development of trust takes time and repeated contact. Outreach workers must be patient. 5. Incentives, food, and/or cash increase engagement. 6. Workers should have phones and travel in pairs. In the current project, once engaged with a client, outreach workers continued to work with the client for 6 months. Therefore, in addition to the outreach activities above, the outreach worker also took responsibility for securing needed services for the youth and remained a support as he/she traversed the system of care. This approach is most similar to the Strengths Model (developed at the University of Kansas School of Social Welfare) in which the role of the outreach worker falls somewhere between a therapist and a broker (Rapp and Chamberlain 1985). The strengths-based outreach approach also includes the following features: (1) dual focus on client and environment, (2) use of paraprofessional personnel, (3) a focus on client strengths rather than deficits, and (4) a high degree of responsibility given to the client in directing and influencing the intervention that he/she receives from the system and the outreach worker. Youth met with their advocate an average of 17 times in the drop-in service linkage condition and 12 times in the shelter linkage condition, only five youth did not meet with their advocate at least one time. If youth were not interested in linkage to a drop-in center or shelter, the outreach worker/advocate continued to engage and meet with them and addresses other needs. Similarly, the outreach worker/advocate continued to meet with youth who were successful in connecting with the shelter or drop-in center. The youth drop-in center and crisis shelters are described below.
Outreach/Engagement Intervention The goal of the outreach worker was to engage the youth through non-office contact in sandwich lines/soup kitchens, homeless camps, libraries, and parks and encourage youth to accept the next level of service identified as either shelter services or drop-in services. As the goal was to engage nonservice-connected youth, youth were not engaged at drop-ins, shelters, or other formal service providers (such as health clinics, hospitals). The model of outreach used in this study draws on the approach used by the Detroit NIDA project (Andersen et al. 1998) which followed the methods described in the Indigenous Leader Outreach Model (Wiebel 1993). The elements of the Detroit outreach model (Andersen et al. 1998) include: 1. Outreach workers should have a high degree of empathy and understanding to enhance bonding between the staff and client.
Drop-in Center Columbus, Ohio, has one drop-in center for homeless youth. The Star House, through The Ohio State University Department of Human Sciences, serves homeless youth 14–24 years old. On an average day, up to 80 homeless youth access the center, with 2–3 new clients/day. It is open 24 h/day, 7 days/week. The drop-in provides food, laundry, and shower facilities, as well as recreational activities such as television, checking out books, playing board games or video games, and interacting with other youth and staff. Drop-in staff link youth with community resources, many of whom come onsite, with the ultimate goal for youth to engage in more intensive services including counseling and housing programs. Shelters Columbus has one crisis shelter for youth under the age of 18 and four adult shelters. The youth shelter is open 24 h/day, 7 days/week and offers a temporary overnight alternative to the streets where adolescents, 12–17, can meet their
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basic needs. The typical stay is 3 days, the goal is family reunification, and the majority (79 %) of adolescents return home. Three agencies provide emergency shelter for single adults and one for families. A total of 457 beds for single men and 97 for single women are available any given night. The primary goal of these single adult/family shelters is rapid re-housing; however, housing cannot be secured until individuals secure a steady income, which can include cash assistance, social security disability, or employment. In general, the shelters allow a 90-day stay. Measures Demographic Variables A baseline questionnaire assessed participants’ race/ethnicity (coded as 1 = White, nonHispanic, 0 = other race/ethnicities) and gender (1 = female, 0 = males). Sexual, physical, and emotional childhood abuse were defined as experiencing any of the following before age 18 years: ever being touched sexually in an uncomfortable way or having intercourse against your will (sexual abuse), physical harm resulting in scratches, bruises, or bleeding (physical abuse), and being verbally threatened, called names, or provided with insufficient parental care (emotional abuse) (CDC 1994; Felitti et al. 1998). Follow-up questions assessed age at first experience, relationship to perpetrator, number of perpetrators, and duration of abuse. Primary Outcomes (Service Use and Substance Use) At each contact, outreach workers documented youths’ selfreported frequency of contact with each of several different service areas including: housing services, shelter, drop-in, employment training, academic, physical health, dental, mental health, family, legal issues, and SSI/ID/birth certificate. This provides a continuous estimate of the number of service contacts and the types of agencies which youth accessed during the intervention period. The Addiction Severity Index, 5th Edition (ASI; McLellan et al. 1992), was used to assess the frequency, type, and amount of alcohol, marijuana, and other drug use in the past 30 days. Secondary Outcomes Personal control (self-efficacy) was assessed using the 7-item Mastery Scale of Pearlin and Schooler (1978). The instrument has robust psychometric properties (Pearlin and Schooler 1978) and has proven validity with those experiencing homelessness (Greenwood et al. 2005; Shern et al. 2000). Reliability alpha in this study ranged from 0.70 to 0.83 across the four time points. The 21-item Beck Depression Inventory-II (BDI-II; Beck et al. 1996) was used to measure depressive symptoms (α = 0.94–0.95 across time points). Scores ranged from 0 to 63, with higher scores indicating higher levels of depressive symptoms. The ShortForm 36 is a multi-purpose short-form health survey that is used as a general assessment of physical and mental health
status. The survey uses 36 items to develop 8 scale scores that are then combined to measure overall mental health score and an overall physical health score. The measure has shown high reliability and validity (Ware et al. 1993). In this study, the reliability ranged from 0.87 to 0.89 for mental health outcomes and 0.88 to 0.92 for physical health outcomes. HIV risk behaviors (including condom use, intravenous drug use, history of STD’s, and sexual activity with multiple and/or high risk partners) and HIV knowledge were assessed using the Health Risk Questionnaire, which uses scales from the Health Risk Survey (Kann et al. 1989) and Homeless Youth Survey (Johnson et al. 1999). Both of these surveys were previously developed for use with homeless/runaway youth at high risk of HIV/AIDS and have been found to have acceptable internal reliabilities (Ashworth et al. 1992; DiClemente 1991; Kann et al. 1989; Johnson et al. 1996). Analytic Strategies This study used an intent to treat (ITT) design which consisted of the entire sample of 79 youth. The retention rate was 87, 87, and 90 % at the 3-, 6-, and 9-month follow-up in the shelter linkage condition, and 88, 90, 93 % in the drop-in linkage condition, respectively. Missing data analysis was carried out to examine whether there was a significant difference in the means of the outcome variables between those who remained to the next follow-up and those who dropped out. A series of independent t tests showed that there was no significant difference. In addition, Little’s MCAR test was not significant [χ2(401) = 388.82, p > 0.05], which indicated that data were missing completely at random. Intervention condition effects on most outcome variables were investigated using hierarchical linear modeling (HLM; Raudenbush et al. 2011). HLM utilizes all available data for model estimation except cases with missing data on covariates; as there were no missing values with covariates in the current study, the full sample was included in the HLM analyses. Substance use related variables (i.e., days of alcohol use and days of drinking to intoxication) were skewed and square root transformed for the analyses. Following a stepwise model construction procedure, the random coefficients models with the time effect at level 1 (for the time variable, baseline was coded as 0, the 3 follow-up assessments were coded as 1–3, respectively) were run to determine if there was significant change over time among the outcome variables across the four assessment points. Then, the conditional models with intervention condition and covariates added to level 2 were estimated. At level 1, the initial status (intercept) and the linear growth (slope) in outcomes, such as the decrease in substance use, were estimated, along with the individual variations around the intercept and slope (i.e., the random effects). The intervention condition effect at level 2 was to examine whether the two intervention conditions differed in the rate of
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change in the outcomes over time, while retaining the random effects of the intercepts and slopes. Demographic variables significantly associated with the baseline level of the outcomes were added in the analyses as covariates of the intercept and slope in the level 2 models. For the purpose of parsimony, covariates that did not have a significant effect on either the intercept or slope were removed from the final conditional models. Finally, for one of the primary outcomes, service contacts, repeated measures ANOVA was conducted because data were collected at only two time points (3- and 6-month postbaseline). In this analysis, time was used as the within-subject factor and intervention condition the between-subject factor; covariates were included as control variables and were subsequently removed from the final analysis because none was associated with service contacts.
youth, which in this sample, included primarily AfricanAmerican youth (32 %). These observed baseline differences are generally consistent with the literature (Keyes et al. 2015; Mojola and Everett 2012; Pacek et al. 2012; Piccinelli and Wilkinson 2000; Ross and Mirowsky 2002). Emotional and sexual abuses were also associated with outcomes at baseline. Youth who reported a history of sexual abuse also reported significantly lower levels of personal control (self-efficacy) [t(77) = 3.98, p < 0.001], higher levels of depressive symptoms [t(77) = −2.68, p < 0.01], and lower levels of mental health [t(77) = 2.51, p < 0.05]. Youth who reported a history of emotional abuse reported significantly hi gh er l eve ls of HI V risk b eh avi ors at ba selin e [t(76) = −2.06, p < 0.05]. Primary Outcomes
Results Descriptive statistics of the continuous primary and secondary outcome variables are shown in Table 2. At baseline, participants mean age was 20 years, slightly more than half were male (53 %) or non-Hispanic White (57 %), more than half (54.4 %) had not completed high school, and many had a history of sexual (42 %), physical (46 %) or emotional (53 %) abuse. Youth assigned to the two intervention conditions were not different in all these demographic characteristics except age; youth in the drop-in condition (M = 21.33, SD = 2.26) were 1 year older than those in the shelter condition (M = 20.33, SD = 1.88), t(77) = 2.12, p = .04. Furthermore, 80 % of homeless youth in the drop-in linkage condition accessed the drop-in center, while 17.9 % of youth in the shelter condition accessed a shelter. More youth in the dropin linkage condition accessed shelter services (27.5 %) than youth assigned to the shelter linkage condition (17.9 %). Additionally, more youth in the shelter condition accessed the drop-in center (30.8 %) than shelter services (17.9 %). The two intervention groups did not differ on any of the baseline primary and secondary outcome variables. However, a series of independent samples t tests indicated a number of demographic differences in baseline levels of these variables. Compared to males, females had significantly lower levels of personal control self-efficacy [t(77) = −3.90, p < 0.001] and higher levels of depressive symptoms [t(77) = 4.27, p < 0.001]. Females also reported poorer of physical [t(77) = −3.01, p < 0.01] and mental health [t(77) = −3.92, p < 0.001]. Compared to youth in other racial/ethnic groups, non-Hispanic White youth reported significantly more days of drinking to intoxication [t(71.98) = 2.38, p < 0.05], fewer days of marijuana use [t(76.97) = −3.03, p < 0.05], and more days of using more than one substance per day [t(76.73) = 2.67, p < 0.01]. Non-Hispanic, White youth also had higher levels of HIV risk behaviors [t(75) = 3.23, p < 0.05] than minority
Results of conditional models of primary outcomes are presented in Table 3. Service Contacts Results of the repeated measures ANOVA analysis revealed a significant intervention effect, F(1, 49) = 5.91, p = .02, and time by intervention condition interaction, F(1,49) = 4.95, p = .03, but no time effect. Participants assigned to the drop-in condition had more service contacts at both time points than those assigned to the shelter condition, and service contact remained stable from the 3- to 6-month follow-up within each group. Days of Alcohol Use The results of the random coefficient model for alcohol use showed a significant decrease in the number of days of alcohol use in the whole sample over time [B = −0.33, SE = 0.08, t(78) = −4.29, p < 0.001]. However, the rate of decrease did not differ between the two intervention groups in the conditional model. Days of Drinking to Intoxication Similarly, the random coefficient model showed a significant decrease in the number of days youth reported drinking to intoxication among the whole sample over time [B = −0.26, SE = 0.08, t(76) = −3.39, p < 0.001]. Findings from the conditional model further indicated that this decrease was significantly faster among youth in the drop-in linkage condition than those in the shelter condition [B = −0.28, SE = 0.10, t(75) = −2.75, p < 0.01]. Race/ ethnicity was also a significant moderator of the time effect; non-Hispanic White youth exhibited a higher initial level and faster decrease in days of drinking to intoxication than youth in other racial/ethnic groups. Days of Marijuana Use The number of days of marijuana use decreased significantly among the whole sample over time in the random coefficient model effect [B = −0.51, SE = 0.09, t(78) = −5.43, p < 0.001]. However, the rate of decrease in
Prev Sci Table 2
Descriptive statistics of the study variables Mean (SD) Shelter linkage
Number of days using alcohol—any use at alla Baseline 2.27 (1.62)
Skewness Drop-in linkage
Total sample
2.46 (1.75)
2.36 (1.68)
0.27
1.51 (1.39) 1.50 (1.54)
1.45 (1.67) 0.99 (1.39)
1.48 (1.53) 1.24 (1.48)
0.80 1.19
9-month follow-up 1.57 (1.60) Number of days using alcohol—to intoxicationa Baseline 1.33 (1.63)
1.23 (1.58)
1.39 (1.59)
1.05
2.03 (1.72)
1.68 (1.70)
0.73
1.10 (1.37) 1.24 (1.43)
0.98 (1.44) 0.45 (1.13)
1.04 (1.40) 0.83 (1.33)
1.26 1.63
1.23 (1.58)
0.70 (1.22)
0.96 (1.42)
1.61
3-month follow-up 6-month follow-up
3-month follow-up 6-month follow-up 9-month follow-up Number of days using marijuana Baseline
19.54 (11.52)
18.88 (12.85)
19.20 (12.13)
−0.47
3-month follow-up 6-month follow-up
19.33 (12.78) 13.85 (13.84)
18.46 (12.68) 11.81 (14.16)
18.88 (12.64) 12.78 (13.94)
−0.57 0.34
9-month follow-up
14.14 (13.60)
13.49 (14.08)
13.81 (13.75)
0.21
12.53 (10.66) 8.54 (10.21)
10.43 (10.24) 7.43 (9.21)
0.73 1.31
4.72 (8.61) 4.00 (7.48)
4.88 (8.79) 4.71 (8.47)
1.96 2.13
Number of service contacts in the past 30 days 3-month follow-up 10.05 (8.63) 6-month follow-up 9.90 (5.67)
14.72 (9.16) 12.43 (8.36)
12.21 (8.65) 11.34 (7.36)
0.73 0.56
Self-efficacy Baseline
20.21 (3.57)
21.10 (3.64)
20.66 (3.61)
−0.01
21.06 (3.63) 21.70 (3.87) 21.80 (4.48)
21.40 (3.28) 22.56 (3.58) 22.30 (3.58)
21.23 (3.43) 22.06 (4.02) 22.06 (4.02)
−0.13 −0.18 −0.76
20.72 (14.11) 18.65 (12.29) 12.79 (11.16)
23.98 (14.72) 14.49 (11.02) 8.56 (8.81)
22.37 (14.42) 16.54 (11.77) 10.58 (10.15)
0.32 0.53 1.39
8.09 (10.00)
8.35 (10.54)
8.22 (10.21)
2.04
63.23 (11.76) 67.67 (11.93) 71.76 (11.66) 73.80 (10.44)
61.70 (12.38) 67.84 (12.66) 70.97 (13.22) 74.07 (11.50)
62.45 (12.02) 67.76 (12.21) 71.36 (12.41) 73.94 (10.92)
−0.09 −0.92 −0.90 −0.74
43.77 (10.92) 47.47 (10.83) 52.21 (9.66) 52.63 (10.38)
42.55 (10.78) 49.20 (11.25) 54.33 (10.05) 56.03 (9.96)
43.15 (10.80) 48.35 (11.00) 53.32 (9.85) 54.38 (10.24)
0.003 −0.51 0.06 −0.59
18.28 (2.44) 17.56 (2.52) 18.79 (2.32)
18.48 (2.17) 18.89 (1.68) 20.08 (1.84)
18.38 (2.29) 18.23 (2.22) 19.46 (2.17)
−0.54 −1.02 −0.80
Number of days using more than one substance per day Baseline 8.28 (9.45) 3-month follow-up 6.29 (8.06) 6-month follow-up 9-month follow-up
3-month follow-up 6-month follow-up 9-month follow-up Depressive symptoms Baseline 3-month follow-up 6-month follow-up 9-month follow-up Physical health Baseline 3-month follow-up 6-month follow-up 9-month follow-up Mental health Baseline 3-month follow-up 6-month follow-up 9-month follow-up HIV knowledge Baseline 3-month follow-up 6-month follow-up
5.06 (9.10) 5.46 (9.47)
Prev Sci Table 2 (continued) Mean (SD)
Skewness
Shelter linkage
Drop-in linkage
Total sample
19.74 (1.82)
20.35 (1.57)
20.05 (1.71)
−0.56
Baseline 3-month follow-up
3.00 (1.89) 3.24 (1.91)
2.95 (2.20) 3.23 (1.54)
2.97 (2.04) 3.23 (1.72)
0.30 0.44
6-month follow-up
2.88 (1.80)
3.11 (1.45)
3.00 (1.62)
0.99
9-month follow-up
2.89 (1.49)
3.11 (1.37)
3.00 (1.42)
0.63
9-month follow-up HIV risk behaviors
PCS personal control scale, BDI beck depression inventory-II, SF36_PCS Short-Form 36 physical composite score, SF36_MCS Short-Form 36 mental composite score a
Values reported are based on square root transformation of the original variable. The descriptive statistics of the two untransformed variables are included in the footnote. The descriptive statistics, the median (interquartile range), for Number of days using alcohol—any use at all are 2.12 (2.87), 1.00 (2.74), 1.00 (2.00), 1.00 (2.18), and that for Number of days using alcohol—to intoxication are 1.41 (3.16), 0.00 (1.73), 0.00 (1.41), 0.00 (1.73), for baseline, 3-month, 6-month, and 9-month follow-up, respectively
days of marijuana use did not differ between the two groups in the conditional model. In an exploratory analysis, those who reported a history of sexual abuse exhibited higher rates of decreases in days of marijuana use than those who did not.
Secondary Outcomes
Days of Using More Than One Substance Per Day Results from the random coefficient model showed that the number of days youth reported using more than one substance decreased significantly over time in the whole sample [B = −1.95, SE = 0.45, t(78) = −4.29, p < 0.001]. The rate of decrease in days of using more than one substance per day did not differ between the two groups in the conditional model and none of the demographic variables was significantly related to the time effect in the exploratory analysis.
Self-Efficacy In the random coefficient model, self-efficacy increased over time in the whole sample [B = 0.54, SE = 0.15, t(78) = 3.54, p < 0.001]; however, there was no difference in the rate of increase between the two service linkage conditions.
Table 3
Results of conditional models of secondary outcomes are presented in Table 4.
Depressive Symptoms Results from the random coefficient model revealed an overall decline in the depressive symptoms over time in the whole sample [B = −4.88, SE = 0.62,
Results of conditional hierarchical linear models for primary outcomes Days of alcohol use
Fixed effects Intercept Intercept Race Linear slope Intercept Intervention Race Gender Sexual abuse Random effects Intercept Linear slope Level 1 error
Days of drinking to intoxication B (SE) t
B (SE)
t
2.12 (0.16)
13.41*** 1.93 (0.20) −0.85 (0.30)
−0.25 (0.10) −0.16 (0.12)
−2.58* −1.31
B (SE)
9.83*** 3.54 (0.24) −2.83** 1.08 (0.35)
−2.28* −0.46 (0.19) −2.75** −0.04 (0.16) 2.11* 0.30 (0.18) −0.41 (0.18) Variance χ2 Variance Variance χ2 component (SE) component (SE) component (SE) 0.80 (0.89) 122.96** 0.42 (0.65) 91.96* 0.89 (0.94) 0.11 (0.34) 97.85* 0.01 (0.10) 70.11 0.08 (0.28) 1.62 (1.27) 1.70 (1.30) 2.59 (1.61)
*p
