Diverting homeless youth/chronic homelessness/risk/HIV

说明(申请人提供)：青少年无家可归是一个严重的问题，长期无家可归的青少年也是感染艾滋病毒的最大风险者。当青年新无家可归时，就有一个重要的机会进行干预，以减少长期无家可归者，从而减少感染艾滋病毒的风险。这个机会之窗的理由是基于一个现有项目的结果，该项目发现：家庭冲突是离开家的主要诱因；68%的新无家可归的青年在3个月内返回家园，但这种团聚是不稳定的，随着时间的推移，离家出走的时间会更长；与父母的联系是团聚的重要预测因素；与滥用药物、无家可归和失学的同龄人发展社交网络预示着仍然无家可归。建议对新无家可归的青年、父母和青少年合作(PACT)进行为期5次的家庭干预，以改善居住稳定性和居住生活质量，减少离家出走的次数，以及减少与艾滋病毒有关的性和药物使用风险行为。PACT将通过重新定义家庭冲突、提高解决问题的技能、获得角色明确以及促进积极的家庭互动来重新构建失控情节并改善家庭功能。该项目将分两个阶段进行。第一阶段将用于试点和最后确定所有文书、干预程序，并将所有庇护所的标准护理改进为定期评估家庭团聚。在第二阶段，将进行一项基于小组交叉随机设计的随机对照试验，以测试PACT对12-17岁新无家可归的青少年及其父母的疗效。在提供短期住所的四个社区机构中，新无家可归的青年(n--320人)将随机接受以下两种情况之一：1)标准护理(n=160)；或2)PACT干预(n=160)。在青年住在庇护所和过渡到更稳定的生活环境(例如，回到家中)时，将与处于干预条件下的家庭举行Pact会议。青少年的结果将在招募时、3、6、12、18和24个月进行监测；父母将在招募时、3个月(立即离职)、12个月和24个月接受评估，以检查PACT在以下方面的有效性：性和药物使用风险行为；居住稳定性、失控事件和居住生活质量；家庭功能；以及对青少年心理健康、多重问题行为和学校表现的概括。

DESCRIPTION (provided by applicant): Homelessness among adolescents is a significant problem, with youth that become chronically homeless also being those at greatest risk for acquiring HIV. When youth are newly homeless, there is a significant opportunity to intervene to reduce chronic homelessness and, thus, risk for HIV. The rationale for this window of opportunity is based on results from an existing project that has found: family conflicts to be the predominant precipitant for leaving home; 68% of newly homeless youth return home within 3 months, but this reunification is unstable, with longer runaway episodes over time; contact with parents being a significant predictor of reunification; developing social networks with peers that are substance abusers, homeless, and out of school predicts remaining homeless. A 5-session family intervention for newly homeless youth, Parents and Adolescents Collaborating Together (PACT), is proposed to improve residential stability and the quality of residential life, reduce the number of runaway episodes, as well as reduce HIV-related sexual and substance use risk acts. PACT will reframe the runaway episode and improve family functioning by redefining the family conflict, increasing problem-solving skills, gaining role clarity, and promoting positive family interactions. The project will proceed in two phases. Phase 1 will serve to pilot and finalize all instruments, intervention procedures, and to improve the standard care in all shelters to a routinely evaluating family reunification. In Phase 2, a randomized control trial will be conducted based on a group cross-over randomization design to test the efficacy of PACT for newly homeless youth aged 12-17 years and their parents. In four community-based agencies that provide short-term shelter, newly homeless youth (n--320) will be randomized to one of two conditions: 1) standard care (n =160); or 2) the PACT intervention (n = 160). PACT sessions will take place with the families in the intervention condition while youth are in the shelter and as they transition to a more stable living environment (e.g. back to the home). Youth's outcomes will be monitored at recruitment, 3, 6, 12, 18, and 24 months; parents will be assessed at recruitment, 3 (immediate post), 12 and 24 months to examine the efficacy of PACT on: sexual and substance use risk acts; residential stability, runaway episodes, and quality of residential life; family functioning; and generalization to youth's mental health, multiple problem behaviors, and school performance.