(PS14-32) Informing the Design and Implementation of an Integrated Substance Use and Traumatic Stress Intervention for Youth Experiencing Homelessness Based on Lived and Professional Experience

Youth homelessness is a public health crisis. On one night in 2023, 34,703 youth experienced unaccompanied homelessness in the US. Racially and sexually minoritized populations are disproportionately represented among young adults experiencing homelessness (YEH; ages 18-24); Black and LGBTQ youth have a higher risk of homelessness (83% & 120%, respectively). YEH are likelier to drop out of school and interact with the justice system and less likely to achieve economic independence.

The vast majority of YEH have at least one substance use disorder (SUD), which has significant social, legal, physical, and mental health consequences. YEH experience disproportionately high rates of trauma and posttraumatic stress disorder compared to their housed peers. SUDs and traumatic stress often co-occur, whereby YEH with SUDs are three times likelier to have experienced a traumatic event. A cyclical pattern exists with early homelessness, increasing traumatic stress and substance use. Meanwhile, substance use and traumatic stress prolong episodes of homelessness and increase future risks of homelessness.

Despite the overwhelming and rapidly growing need, there is a lack of effective interventions addressing SUDs and traumatic stress for YEH. Furthermore, there is a paucity of relevant interventions that consider the perspectives of YEH (i.e., people with lived experience) and providers at YEH-serving organizations (i.e., people with professional experience). Community voices are crucial for successful interventions. Engaging members of the target population, as well as individuals who directly serve them, increases the likelihood that the intervention will be effective and enhances the implementation process. By listening to stakeholders during the development process, mental healthcare practitioners can ensure that their ingenuity, priorities, and preferred methods are comprehensively incorporated into the intervention.

The present study is part of a larger mixed-methods study identifying a conceptual model that will be used to inform the development and implementation of an integrated substance use and traumatic stress intervention. This presentation will focus on results of interviews conducted with YEH (n=30) and providers (n=30). Interviews address the following topics: 1) how substance use and traumatic stress impact everyday life of YEH and interfere with the ability to exit homelessness; 2) personal, behavioral, and environmental factors that impact YEH substance use and traumatic stress; 3) skills that could help YEH manage substance use and traumatic stress; 4) how homelessness interferes with improving substance use and traumatic stress symptoms; and 5) implementation considerations for an integrated treatment. Interviews will be transcribed and analyzed using deductive-inductive coding. A coding scheme will be developed based on domains identified in the literature, such as emotion regulation, social connectedness, and self-esteem. An inductive approach (thematic content analysis) will also be used to code any unexpected themes that arise during the interviews that could inform intervention development. Results along with implications for intervention design and implementation will be presented.