1. 30 Years – More homeless youth, But few other changes
Mary Jane Rotheram-Borus

2. Declaration of the Rights of the Child
UN Document Series Symbol: ST/HR/ UN Issuing Body: Secretariat Centre for Human Rights
Proclaimed by General Assembly resolution 1386 (XIV) of 20 November 1959

3. The numbers of homeless youth are rising over time
/17
Los Angeles 12, ,000
NYC 12, ,110

4. Youth go to where the services are –
Downtown
Hollywoood
Venice

5. Homeless shelters are congregated in high risk neighborhoods5

6. Homeless shelters are congregated in high risk neighborhoods: LA
Type of sex Where
Gay-for-pay Hollywood
Straight –sex-for-pay Sunset
Sex-for-drugs Santa Monica 6

7. Yet, who, where, & when youth are homeless is clear & consistent over time.
Lesbian, gay, bisexual, & transgendered
youth
Psychiatrically disturbed girls having
sex at 12 years
Children in foster care
Children whose families go homeless
Youth with serious mental illness
Youth with contact with criminal justice

8. Problems the same 30 years
later, at similar rates
25% attempt suicide
25% sexually abused
27% psychiatrically disordered
40% jail (93% if LGBTY
80% some drug use
40% problems at school
80% boy-girl-boy troubles

9. 1/3
1/3
1/3

10. 2018, Adolescent Trials Network

11. 2018 Adolescent Prevention Trials Network

12. Over the last 20 years, the numbers of EBI
have been substantial & all similar
HIV+ Family
HIV-
HIV+
Miscellaneous
Street Smart
TLC
TALC N.Y.
Safety Counts, IDU
Street Smart Computer
CLEAR
TALC L.A.
Promise
Street Smart Uganda
TALC South Africa
Healthy Living
CPOL China
Project LIGHT
Project LIGHT
TALC Thailand
STRIVE
SUUBI
HIV+ Testing, Churches
TALC China
Teen LIGHT
MD For Life
ATN, #2
Philani, SA
Zithulele, SA
Men’s soccer, SA
SMI LIGHT

13. HIV Interventions TLC 31 CLEAR 18 SUUBI 18 HEALTHY LIVING 15
# of Sessions
Facilitators
Site N
TLC
Clinic Staff
NYC, LA, Miami, SF 31
310
NYC, LA, SF
CLEAR 18
MA Level
253
CBO Staff
Kampala, Uganda
SUUBI 18
100
HEALTHY
LIVING
NYC, LA, SF, Wisconsin 15
MA Level
936

14. Common Life Challenges Parenting / Family / Relationships
for PWA
Health
Transmission
Quality of Life
Parenting / Family / Relationships

15. Outcomes 24 15 24 25 TLC CLEAR SUUBI HEALTHY LIVING Substance Abuse
Follow-up, months
Sex
45% sex partners
31% weighted use index
TLC
50% HIV- sex partners 24
82% unprotected sex
21% alcohol, mar., hard drugs
CLEAR
59% HIV- sex partners 15
SUUBI
in # sexual partners
N/A 24
condom use
alcohol, mar., hard drugs, days of use
HEALTHY
LIVING
53% sex acts with HIV- or unknown status 25

16. Common Effective Learning Model Same Theory, All Interventions
Change occurs …
slowly, over time
with small steps
in supportive relationships
with opportunities & rewards

17. Identified Common Robust Factors in EBI
Selected successful programs
Obtained reliable category definition
Identified common principles & processes
Validated principles, re-review

18. Common Processes Behavior & cognitive focus Structural activities
Goals
Cohesiveness

19. Common Rules Be prepared Have + alternatives Make explicit plans
Judge on facts
Practice self-control

20. Common Factors in Interventions
Health-Specific
Information
Feel/Think/Do
Skills
Frame
Issue
Supportive
Relationships
Environmental
Barriers
NIMH Workgroup on Behavior Change, 2001

21. Common Components for Reducing HIV Risk among runaway & homeless youth (I)
EBFT*
CRA**
SBCM***
STRIVE
Street Smart
Frame the Issue & Assess Current Status
failures of service system, family, & RHY. Assess each.
Increase happiness: enhance motivation, gather
history of risks, functionaly
Analyze risk behaviors.
Validate + normalize experience & feelings. Evaluate strengths & current functioning in multiple life domains.
Family has poor conflict resolution skills: increased skills will reduce risk.
Pursuing life goals requires a decrease in risk acts; evaluates risk knowledge, attitudes, & behaviors.
Information/
Education
Parents: limit-setting & monitoring, strategies to decrease substance use.
Protection strategies that reward pro-social
acts
Normalize behaviors, ↑ protection strategies, conflict resolution
Strategies aimed at conflict resolution.
↑ Protection strategies.
Coping Skills
↑ Problem-solving, communication skills.
Reward positive behaviors, punish or ignore negative behaviors.
↑ Problem-solving, including feelings, thoughts, & actions.

22. Common Components for Reducing HIV Risk among runaway & homeless youth (II)
EBFT*
CRA**
SBCM***
STRIVE
Street Smart
Social Support
/Relationships
Improve relationship with parents & other key persons to support change.
Involve “concerned others” in the intervention , encourage positive social activities.
Build strong relationship with the case manager, non-deviant peers, & supportive adults.
Improve relationships with parent/guardian & family members.
Relationships with group members & the facilitator reduce risk.
Environmental Barriers
Mobilize resources of service system.
Authoritative adults do not act contingently.
Replacing “entrapping niches” that do not support the child’s strengths & goals with supportive settings.
Develop a referral method for early access to runaways.
Provide access to ongoing health care, STD treatment, & condoms.

23. Generic, Stepped Care Interventions; heavy mobile emphasis
Automated Messaging & Monitoring
Peer Support (Muut)
Coaching

24. Progressing through Steps
Stepped-Care for Youth Living with HIV

25. EBI Practice Elements Used by Coaches
% of Utilization

26. Target Areas Discussed by Coaches
% of Utilization

27. Our current approach is counter the prevailing scientific norms of EBI.

28. If you provide STABLE HOUSING, mental health disabilities are reduced.
people remain housed &
substance abuse &
mental health disabilities are reduced.

29. $47.5 billion dollar industry
Privatization of
$47.5 billion dollar industry
$32 billion special education
$12-15 billion child welfare
$ 3.5 billion juvenile justice

30. Thank You