Addressing Health Disparities of Vulnerable Underserved Youth: - PDF document

9/18/2019 Addressing Health Disparities of Vulnerable Underserved Youth: Discovering challenges and strategies in intervention research Susana A. Lopez, Ph.D. & Sung‐Jae Lee, Ph.D. University of California Los Angeles UCLA Nathanson Family Resilience Center STAR Seminar September 18, 2019 UCLA Semel Institute for Neuroscience and Human Behavior Overview Key Considerations of Equity and Justice for Youth At‐Risk in Los Angeles County Homelessness and Juvenile Justice‐Involvement among Adolescents (US Los Angeles County, California (LA)) Challenges and Strategies for Conducting Family‐Based Intervention Research in Juvenile Justice Settings: EXPORT/STRIVE: Mixed Methods Study of Family‐Based Intervention for Juvenile‐Justice Involved Youth Integrated Community Based Recruitment Strategy to Identify Youth at Risk or Living with HIV and Strategies to Maximize Engagement and Retention of Youth at Risk or Living with HIV: Adolescent Medicine Trials Network (ATN) CARES 1

9/18/2019 STATISTICS Adolescents in the US: Statistics + Adolescents (10 to 19 years ) and young adults (20 to 24 years) make up 21 percent of the population of the United States. Adolescents are becoming more and racially and ethnically diverse – rapid increases in the numbers of Latinx and Asian American youth. Healthy People 2020 (National Institutes of Health (NIH): • G rowing ethnic diversity requires cultural responsiveness to health care needs. • Increased focus on the use of positive youth development interventions for preventing adolescent health risk behaviors. Objectives To give context to the structure in which mental health risk is produced for at‐risk youth, we offer three critical points for consideration : 1) Rising housing insecurity within Los Angeles County has made affordable housing particularly inaccessible to black, brown, and poor communities. 2) High youth unemployment and increases in low‐wage labor have left youth with declining rates of economic power. 3) Criminalization of homelessness has disproportionately placed those unhoused at greater risk of arrest, incarceration, and death. Image Source: https://iaphs.org/syndemics‐population‐health‐qa‐anthropologist‐emily‐mendenhall/ Points are particularly applicable for health equity and social justice centered research utilizing frameworks that are more “ecosocial” and “syndemic” in nature. UCLA Semel Institute for Neuroscience and Human Behavior 2

9/18/2019 “In part, the spike in youth homelessness can be attributed to better counting. However, a bigger reason is that young people simply can’t afford to live in LA , according to Bill Bedrossian of Covenant House California, a youth homeless services agency. “Where they used to be able to live on the margins and bunk up with friends and split the rent, now it’s just so high, that, even in that case , if they’re not making significantly more than minimum wage, they’re not able to live ,” said Bedrossian. Service providers in Los Angeles say that, more and more, homeless youth are coming from impoverished families who don’t have the resources to help, even if they want to. This was the case for Leo Serrano, an 18‐year‐old community college student, who found help at Jovenes Inc., an organization in Boyle Heights that serves homeless youth. Serrano, whose parents live in Mexico, was staying at his grandmother’s house, but when she faced eviction for having too many people under one roof, he was forced out. Excerpt from article found here: http://curious.kcrw.com/2017/07/why‐are‐ there‐6000‐homeless‐youth‐in‐la UCLA Semel Institute for Neuroscience and Human Behavior Characteristics of Homeless Youth (2013 LAHSA Greater LA Homeless Count) 6 3

9/18/2019 Characteristics of Homeless Youth (2013 LAHSA Greater LA Homeless Count) 7 Income Inequality in Los Angeles County 38% of Los Angeles County Residents live 200% below the Federal Poverty Line Source (graph on left): Community Health Assessment 2015, Los Angeles County Department of Public Health Source (statistic on right): Los Angeles County Department of Public Health, City and Community Health Profiles: Percentage of Residents Living Below 100% and 200% of the Federal Poverty Level (FPL). June 2018. UCLA Semel Institute for Neuroscience and Human Behavior 4

9/18/2019 Youth Employment in Los Angeles County UCLA Semel Institute for Neuroscience and Human Behavior Source: http://milliondollarhoods.org/wp‐content/uploads/2017/10/MDHHouselessReport‐3.pdf UCLA Semel Institute for Neuroscience and Human Behavior 5

9/18/2019 Source: http://milliondollarhoods.org/wp‐content/uploads/2017/10/MDHHouselessReport‐3.pdf UCLA Semel Institute for Neuroscience and Human Behavior Report of the Special Rapporteur on extreme poverty and human rights in the United States of America “For almost five decades the overall policy response has been neglectful at best , but the policies pursued over the past year seem deliberately designed to remove basic protections from the poorest, punish those who are not in employment and make even basic health care into a privilege to be earned rather than a right of citizenship.” UCLA Semel Institute for Neuroscience and Human Behavior 6

9/18/2019 Challenges and Strategies for Conducting Family‐Based Intervention Research in Juvenile Justice Settings: Susana A. Lopez, PhD., Eraka Bath, M.D., Bita Amani, PhD., MHS, Scott Comulada, DrPH, MPH, Jessica Jackson, MS., Alex Klomhaus, MS., Angela Young‐Brinn, M.B.A.and Norweeta Milburn, PhD UCLA Semel Institute for Neuroscience and Human Behavior Family Conflict: Happens in All Families “It might be said that family conflict causes youth homelessness.” (Mallett et al., 2009) “Severe family conflict is the most common reason for a young person to be homeless.” (Bardine, National Network for Youth) 14 7

9/18/2019 Family Reunification is “New‐ish” Family‐Based Interventions Study Intervention Slesnick et al. (2005, Ecologically‐based family 2009) therapy (EBFT) References = 15,995 15 – 16 sessions (50 minutes) References = Slesnick et al. (2009) Functional family therapy 12 (FFT) Family‐based 16 sessions interventions (50 minutes) = 3 Milburn et al. (2012) Behavioral family intervention (STRIVE) 5 sessions (60 – 90 minutes) “ Gaining parents’ trust, working with – not against – parents (Urban Institute, 2016).” Have two to nine times greater effect sizes compared to individual‐based interventions (Kumpfer, Alvarado, & Whiteside, 2003). 15 Project EXPORT/STRIVE: Randomized Control Trial (RCT) with juvenile justice involved youth and their Parents/Guardians Family‐Based Intervention (5 Sessions) Built Upon: Family Strengths Intervention Core Elements and Tools Emotional Regulation Problem Solving Affirmation Negotiation Problem Solving (Feeling (SMART) (Tokens) Thermometer, FTD) Conflict Negotiation Situation Analysis (Reframing, Role Support System Playing) Role Clarification 8

9/18/2019 Re‐Entry Juvenile Justice‐Involved Youth and Homeless Youth Racial/Ethnic Minority Mental/Physical Health Problems Risk for HIV and other STI Substance Use Characteristics Adolescents Parents/Guardians of the Families (n = 127) (n = 127) in Project STRIVE (N = 254) 74% Female 83% female 16.79 mean age 45.17 mean age 54% Latinx American 50% Latinx American 37% African American 43% African American 16% White American 12% White American 95% Heterosexual 54% Unemployed • Adolescents with a “homeless experience”: n = 28 • Adolescents without a “homeless experience”: n = 99 9

9/18/2019 Identify Barriers unique to juvenile justice youth entering the community with probationary terms after release and discusses planful and innovative Strategies. Goal is to reduce disparities in JJ‐ involved youth and reduce recidivism UCLA Semel Institute for Neuroscience and Human Behavior Challenge Solutions UCLA Semel Institute for Neuroscience and Human Behavior 10

9/18/2019 Challenge Solutions UCLA Semel Institute for Neuroscience and Human Behavior Challenge Solutions UCLA Semel Institute for Neuroscience and Human Behavior 11

9/18/2019 UCLA Semel Institute for Neuroscience and Human Behavior Challenge Solutions UCLA Semel Institute for Neuroscience and Human Behavior 12

9/18/2019 Exit Interview Results Did not want to answer 2% Not Interested 20% Could not be Reached 45% No Time 21% Moved Detained 6% 6% UCLA Semel Institute for Neuroscience and Human Behavior Integrated Community‐Based Recruitment Strategy to Identify Youth at Risk or Living with HIV and Strategies to Maximize Engagement and Retention of Youth at Risk or Living with HIV: ATN CARES* Sung‐Jae Lee, Ph.D. & Maryann Koussa, M.P.H. *This work was funded by the Adolescent Medicine Trials Network (ATN) for HIV/AIDS Interventions from NICHD (NIH grant U19HD089886) UCLA Semel Institute for Neuroscience and Human Behavior 13

9/18/2019 HIV Burden among Youth Add Your Text Here UCLA Semel Institute for Neuroscience and Human Behavior Disparities in HIV diagnosis Add Your Text Here UCLA Semel Institute for Neuroscience and Human Behavior 14

9/18/2019 HIV Status Awareness UCLA Semel Institute for Neuroscience and Human Behavior HIV Testing is a Critical Component in HIV Prevention/Care UCLA Semel Institute for Neuroscience and Human Behavior 15