Mental Health Care for Sexual and Gender Minority Youth Facing Housing Insecurity

• In Event: 3-038 - Mental Healthcare for Sexual and Gender Minority Adolescents: Access, Utilization, and Effectiveness

Integrative Statement

Sexual and gender minority (SGM) youth are at particularly high risk for co-occurring housing instability and mental health needs (Choi, Wilson, Shelton, & Gates, 2015), largely due to high rates of both concerns in this population as well as the added stress imposed by possible family disapproval of sexuality or gender identity, which can exacerbate both concerns. The current study seeks to examine whether providing mental health services can help to improve housing outcomes among SGM adolescents with housing insecurity.
We employed diary tracking techniques to document service exposure and interim outcomes. In an intake visit, youth received a brief psychological assessment including depression (PHQ-9, Kroenke, Spitzer, & Williams, 2001), anxiety (GAD-7, Spitzer, Kroenke, Williams, & Löwe, 2006), suicidality (SMSI, Clum & Curtin, 1993), and autism screening (AQ-10, Allison, Auyeung, & Baron-Cohen, 2012). At each subsequent visit, youth completed brief assessments of therapeutic relationship (SRS, Duncan et al., 2003) and general outcomes (ORS, Miller, Duncan, Brown, Sparks, & Claud, 2003), as well as single-question assessments of mood before and after session and housing. Assessments were administered by a licensed counselor.
A total of 31 SGM adolescents (age 15-24, m = 20.08, SD 2.87) with housing insecurity participated. Over half were homeless (58%), half were youth of color (48%). Most were on the transgender spectrum (10% male, 21% female, 14% transgender, 36% genderqueer, 18% unsure). Reported sexual orientations included queer (36%) pansexual (21%) or unsure (14%), or LGB/other (29%), none reported being heterosexual. A total of 110 therapy sessions (m = 3.55, range 1-15) were provided with data collected at intake, session beginning and session ending for a total of 283 data points.
More than half of youth met clinical thresholds at intake (see table 1). With therapy support, individuals reported improvement in functioning, mood and housing situation. People with a greater number of exposures reported better work, school, and personal relationships (r = .217, p = .053), better mood at the beginning of sessions (r = .257, p = .02), better relationship (r = .248, p = .02), satisfaction with the session (r = .265, p = .016), method (r = .285, p = .010) and topic (r = .357, p = .001) of therapy. Over the course of session exposures, there were changes in housing situations among 30% of those receiving services, with 78% in the direction of increasing stability (e.g. couch surfing to not homeless, or shelter to transitional program) while the others appear to be new circumstances that are similarly stable. Finally, participants report average 10% improvement in mood across each session exposure time.
Retention in services provided an important outcome indicator, with individuals who stayed longer in services also reporting the largest improvements in family, work and personal relationships, as well as movement towards more stable housing and overall better mood symptoms at the beginning of therapy sessions. Over time, with continuing programming and data collection, we will be able to employ mixed modelling techniques to better estimate longitudinal patterns of improvement within persons.

Authors

• Jenifer McGuire, University of Minnesota
  Presenting Author

• Nova Bradford, University of Minnesota
  Non-Presenting Author

• Felicia Washington Sy, Reclaim
  Non-Presenting Author

• Katherine Spencer, University of Minnesota
  Non-Presenting Author