What works to help homeless youth deal with the issues that contribute to their homelessness, like family conflict and substance abuse? Natasha Slesnick, professor at The Ohio State University’s College of Education and Human Ecology, Department of Human Development and Family Sciences, and director of a drop-in center for homeless youth ages 14 to 24, is getting to the bottom of that question.
She and her colleagues recently published or are working on several papers that look at whether a handful of “evidence-based treatments” work for youth in different types of programs, from drop-in centers to short- and long-term shelters to street outreach programs. We asked Slesnick about her work and what it means for the people who provide services to homeless youth.
NCFY: Why did you pick these evidence-based treatments [Ecologically-Based Family Therapy, Functional Family Therapy, Motivational Enhancement Therapy, Community Reinforcement Approach, and case management]?
Slesnick: They are some of the most highly evidenced interventions for adolescents in general, but there was not much research specifically on their effectiveness with a homeless youth population. Family therapies are also some of the most evidenced approaches because so many of the issues youth are facing are rooted in family dynamics. But because the family is not always available when working with street kids from drop-in centers, we did not have much information on the effectiveness of family therapies with these homeless youth. We compared the home-based EBFT with clinic-based FFT in earlier trials, and both did well. We did find that going into the home is a little better – you are more likely to get families to participate if you go to them than if you require them to come into the office.
NCFY: What do you most want youth workers to know about what you are finding out?
Slesnick: Sometimes people think there is one best approach, but in reality there are multiple ways to get to positive outcomes. What we are finding is all the interventions did really well, as long as there is good treatment fidelity (meaning you are actually doing what you say you are doing), training, and supervision. Having a manual helps because manualized treatments tend to do better than those without set guidelines. Usually the treatments aren’t hard to learn, and some are more cost-effective than others. If you have fewer staff, you might want to use Motivational Enhancement Therapy because it works in just two sessions.
Determining which evidence-based treatment is right for a particular program depends on the population you are working with. Shelter-based programs probably want to use family-based treatments, such as Ecologically-Based Family Therapy and Functional Family Therapy. But if they are not able to do that, since family therapies tend to be more expensive than individual, the more brief and cost-effective interventions, Motivational Enhancement Therapy and Community Reinforcement Approach (which has an optional family involvement component), worked just as well in domains such as substance abuse, even though they were not as effective at improving family relationships and outcomes.
Even for shelter-residing kids, there may be cases where there’s not a lot of family support, so family therapies might not be viable, and something like Motivational Enhancement Therapy might be better. For kids with cognitive deficits, Motivational Enhancement Therapy is probably better than the Community Reinforcement Approach, which is a cognitive intervention, highly focused on developing alternative behaviors and communicating better with parents and other adults.
It’s important to do assessments with youth to see what individual, developmental, and environmental strengths and resources they have, and then pick an intervention or combination of interventions that will fit with a particular youth.