Association between Substance Use and Nutritional Vulnerabilities of Young Homeless Mothers and their Children

描述（由申请人提供）：无家可归的母亲照顾年幼的孩子，面临着高药物使用率、艾滋病毒风险、身心健康问题和育儿压力。除了无家可归和满足自己和孩子的基本需求之外，这些斗争还在继续。然而，数量非常有限的研究调查了与住房和支助服务有关的母婴结果。尽管对无家可归者的关注越来越多，但无家可归家庭的数量仍在继续增加，对临时住所的需求如此之高，以至于许多城市无法满足这些家庭的需求。可以在收容所环境之外提供的综合干预措施可以使那些没有进入收容所系统的无家可归者和那些没有可用收容所的社区获得更大的帮助。在25岁以下的年轻无家可归者中，研究表明大多数人（70%）从未使用过收容所服务。因此，研究的重点是确定针对这一人口的有效干预措施，解决这些家庭的多种需要，这被认为是一个重要的重点。拟议的干预措施（基于生态的治疗，EBT）包括住房和支持服务，并利用生态系统方法作为理论基础。它是在一项第一阶段治疗发展研究中严格开发的，研究对象是通过危机避难所参与的物质使用障碍无家可归的母亲。EBT显示出若干优于住房服务的结果，因此被认为非常适合那些避开住房但非常需要住房和支助服务的人口。240名（N= 240）年龄在18至24岁之间、有6岁以下亲生子女、有物质使用障碍的无家可归年轻女性将被随机分配到以下三种情况中的一种：(1)住房和支持服务(EBT) +照例治疗（TAU） （N=80），(2)仅住房(HO) + TAU (N=80)，或(3)仅TAU （N=80）。EBT包括6个月的支持性服务（病例管理、艾滋病毒预防和社区强化方法）以及3个月的租房援助。HO包括3个月的租金援助，但不包括支助服务。TAU通常是由无家可归的青少年收容中心提供的服务。参与者将在基线后3、6、9和12个月重新评估。理论推导的变化中介以及正式的经济评估将提供重要的政策含义。由于无家可归的药物使用紊乱的母亲及其子女面临各种不良后果的风险增加，因此干预措施可能对其家庭和整个社会产生实质性的保健效益。

DESCRIPTION (provided by applicant): Homeless mothers with young children in their care contend with high rates of substance use, HIV risk, physical and mental health problems and parenting stress. These struggles are in addition to homelessness and meeting the basic needs of themselves and their children. However, a very limited number of studies have examined mother and child outcomes associated with housing and supportive services. Even with increased focus on those experiencing homelessness, the number of homeless families continues to rise, with the demand for temporary shelter so high that many cities are unable to meet the needs of these families. A comprehensive intervention that can be offered outside the shelter setting may offer greater reach to those experiencing homelessness who do not make it in to the shelter system, and for those communities that do not have shelters available. Among the young homeless, those under age 25, research documents that the majority (70%) have never used shelter services. Research attention towards identifying efficacious interventions for this population which address the multiple needs of these families is thus considered an important focus. The proposed intervention (Ecologically-Based Treatment, EBT) includes housing and supportive services and utilizes an ecological systems approach as the theoretical base. It was rigorously developed in a Stage 1 treatment development study with substance use disordered homeless mothers who were engaged through a crisis shelter. EBT showed several outcomes superior to shelter services and is therefore considered a good fit for a population who avoids the shelter but is in great need of housing and support services. Two hundred forty (N = 240) substance use disordered homeless young women between the ages of 18 to 24 years with a biological child under the age of 6 years in their care will be randomly assigned to one of three conditions: (1) housing and support services (EBT) + Treatment as Usual (TAU) (N = 80), (2) housing only (HO) + TAU (N = 80), or (3) TAU only (N=80). EBT includes 6 months of supportive services (case management, HIV prevention and the Community Reinforcement Approach) in addition to 3 months of rental assistance. HO includes 3 months of rental assistance, but without supportive services. TAU is usual services offered by a homeless youth drop-in center. Participants will be re-assessed at 3, 6, 9 and 12 months post-baseline. Theoretically derived mediators of change as well as a formal economic evaluation will offer important policy implications. Since homeless substance use disordered mothers and their children are at increased risk for a variety of adverse outcomes, the intervention may produce substantial health-care benefits to their families and society at large.