1. Youth on the Street Maltreatment, Mental Health & Addiction Thornton, T., Goldstein, A., Tonmyr, L. & Vadneau, A.

2. Presenter Disclosure Youth on the Street: Maltreatment, Mental Health and Addiction (1)The following personal financial relationships with commercial interests relevant to this presentation in the past 12 months: NO Relationships to Disclose

3. Jack  17 years old  6 months on street  child welfare involvement - age 10  substance abuse  anger, anxiety, depression, suicidal thoughts

4. Status in Canada  150,000 Canadians are homeless (2009) – does not account for the “hidden homeless”  At any time during the year as many as 65,000* youth are homeless  40% of street youth report having been in foster care, and 47% in a group home  Youth represent the fastest growing sub- population of people who are homeless As reported in Raising the Roof’s Report Youth Homelessness in Canada: The Road to Solutions, 2009.

5. Why do they leave?  Family System Breakdown  parental substance abuse or mental health problems, childhood maltreatment, familial conflict & homelessness  System Failure  child welfare, juvenile justice, educational &/or mental health systems Source: National Alliance to End Homelessness, 2007

6. Characteristics  15 years (average age when leaving home)  child maltreatment  child welfare involvement  substance use  mental health problems (trauma, anxiety, depression, suicidal) Sources: Hwang, 2001; Gaetz, O’Grady & Vailancourt, 1999; Baer, Ginzler & Peterson, 2008; Merscham, Van Leeuwen & McGuire, 2009; Yoder, Hoyt & Whitebeck, 1998.

7. Child Welfare & Street Youth: Links? Youth Mental Health Substance Use and Abuse Homelessness Children’s Aid Service (CAS) Involvement Maltreatment

8. Purpose co- Examine the risk factors associated with co- Morbidity ( Morbidity (internalizing & externalizing mental health symptoms & substance use) among 3 population groups: 1.Youth currently involved in child welfare (CAS) 2.Street Youth with a history of involvement in CAS 3.Street Youth who have never been involved in CAS

9. Methods Secondary analysis of two datasets:  Maltreatment & Adolescent Pathways (MAP) Longitudinal Study Pathways (MAP) Longitudinal Study  Youth Pathways Project (YPP)

10. Sample

11. Results

12. Street Youth Reporting a History of Maltreatment, by CAS Involvement *  Street Youth with a history of CAS involvement were 3.41 times more likely to have experienced child maltreatment than Youth with no previous CAS involvement Maltreatment: Experienced Physical and/or Sexual Abuse

13. Maltreatment : Experienced Physical and/or Sexual Maltreatment Physical and Sexual Abuse : Childhood Experiences of Victimization Questionnaire (CEVQ) * sexual abuse  Female Street Youth were 2.57 times more likely to report sexual abuse than Male Street Youth Male and Female Street Youth Reporting a History of Physical and Sexual Abuse and Maltreatment * Indicates a statistically significant difference between gender, p <.05

14. Past Month Tobacco Use and Co-Morbidity * * tobacco use  Street Youth with no history of CAS involvement were 7.41 times more likely and Street Youth with a history of CAS involvement were 8.06 times more likely than current CAS Youth to have co-morbid tobacco use Differences between Street Youth (no CAS) and Current CAS; and Street Youth (CAS) and Current CAS are statistically significant, p <0.05

15. Past Month Alcohol Use and Co-Morbidity alcohol use  Street Youth with a history of CAS involvement were 3.94 times more likely than current CAS Youth to have co-morbid alcohol use Mental Health: Internalizing Symptoms ( Depression & Anxiety Sub-Scales of the Brief Symptom Inventory (BSI) ) & Externalizing Symptoms ( Behavioural Problems past year) *

16. Past Month Binge Drinking and Co-Morbidity binge drinking  Street Youth with a history of CAS involvement were 10.07 times and Street Youth with no history of CAS involvement were 8.82 times more likely than current CAS Youth to have co-morbid binge drinking * * Differences between Street Youth and Current CAS; and Street Youth (CAS) and Current CAS are statistically significant, p <0.05

17. Past Month Marijuana Use and Co-Morbidity marijuana  Street Youth with a history of CAS involvement were 6.42 times more likely to have co- morbid marijuana use compared to current CAS Youth * Differences between Street Youth (past CAS) and Current CAS are statistically significant, p <0.05

18. Problem Alcohol Use and Co-Morbidity alcohol use  Street Youth with no history of CAS involvement were 5.47 times more likely than current CAS Youth to have co-morbid problem alcohol use * Problem Alcohol Use: Measured with 10 item AUDIT scale. A score of 8 or more = presence of alcohol problems

19. Problem Drug Use and Co-Morbidity problem drug use  Street Youth with a history of CAS involvement were 3.61 times more likely to have co-morbid problem drug use than current CAS Youth * Problem Drug Use : Measured with the CRAFFT, with score of 1 or more indicating problem use; Drugs Assessed: marijuana, hallucinogens, cocaine, crack, amphetamines or heroin

20. Any Problem Substance Use (Alcohol or Drug) and Co-Morbidity any co-morbid problem substance use  Street Youth with no history of CAS involvement were 4.21 times more likely and Street Youth with a history of CAS involvement were 9.20 times more likely than current CAS Youth to have any co-morbid problem substance use * * Differences between Street Youth (no CAS) and Current CAS; and Street Youth (CAS) and Current CAS are statistically significant, p <0.05

21. Conclusions  Co-Morbid substance use is a concern across all Populations Groups (3) – with the strongest impact on Street Youth with a history of CAS involvement  Current CAS involvement can be considered protective but past CAS involvement among Street Youth appears to be a risk factor.  Homelessness (living on the street) is associated with a risk of co-morbid substance use

22. Implications  Develop innovative service delivery (co- morbidity & substance use) for Street Youth  Increase longitudinal research on Street Youth with a history of CAS involvement and without to determine risk/protective factors, outcomes & interventions  Examine the reasons for early exit from the child welfare system among Street Youth