4.9 Paul Toro


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  • Homeless and housed teens reported similar levels of substance abuse over time
  • 4.9 Paul Toro

    1. 1. 30 Years of Research on Homelessness: What's Been Learned, What's Next Paul A. Toro, Ph.D., Dept. of Psychology, Wayne State University, Detroit, MI Annual Conference of the National Alliance to End Homelessness July 14, 2011 This powerpoint presentation will appear soon on NAEH’s website. The research reported here was supported by a grant from the National Institute of Alcohol Abuse and Alcoholism.
    2. 2. What We’ve Learned in the Past 3 Decades <ul><li>1 - Defining Homelessness </li></ul><ul><li>        Single adults, adolescents, and families </li></ul><ul><li>2 - Estimating Prevalence </li></ul><ul><li>3 - Public Opinion and Media Coverage </li></ul><ul><li>4 - Obtaining Representative Samples </li></ul><ul><li>  Characteristics of the Homeless </li></ul><ul><li>5 - Appropriate Measurement of Important Constructs </li></ul><ul><li>For a recent review of the research, see Bray et al. (2010). Helping people without homes: The role of psychologists and recommendations to advance training, research, practice and policy (report of the Presidential Task Force on Psychology’s Contribution to End Homelessness). Washington, DC: American Psychological Association (available at www.apa.org). </li></ul><ul><li>  </li></ul>
    3. 3. Research on Homelessness: Some New Frontiers <ul><li>1 - Needs Assessment and Policy-Relevant Research </li></ul><ul><li>2 - Longitudinal Course and Predictors of Outcome </li></ul><ul><li>3 - Effective Interventions, Cost-Effectiveness </li></ul><ul><li>4 - Understanding Causes </li></ul><ul><li>Comparison Group (Case Control) Designs </li></ul><ul><li>Cross-Cultural Research </li></ul><ul><li>Preventing Homelessness </li></ul>
    4. 4. <ul><li>The Housing, Adolescence, and Life Outcomes (HALO) Project: </li></ul><ul><li>A longitudinal study of 250 homeless and 148 matched housed adolescents </li></ul><ul><li>(funding from NIAAA) </li></ul>
    5. 5. Baseline Probability Sample of 250 Homeless Youth <ul><li>Adolescents (ages 13-17) were sampled from throughout the 8-county Detroit metro area in 1997-2000 </li></ul><ul><li>They came from youth shelters, out-patient and residential programs, and other sites </li></ul>
    6. 6. Baseline Matched Sample of 148 Housed Adolescents <ul><li>Homeless adolescents nominated 5 to 10 peers from their neighborhood </li></ul><ul><li>Housed sample was matched on race, gender, age, and neighborhood income </li></ul>
    7. 7. Measures : Family, Peers, & Context <ul><li>   Inventory of Childhood Events (ICE) </li></ul><ul><li>   Parental Monitoring Scale (PMS) </li></ul><ul><li>   Perceived Competence Scales (PCS) </li></ul><ul><li>   Social Network Interview (SNI) </li></ul><ul><li>   Family Environment Scale (FES) </li></ul><ul><li>   Revised Conflict Tactics Scales (CTS2) </li></ul><ul><li>   Modified Life Events Interview (MLEI ) </li></ul>
    8. 8. Measures: Outcomes <ul><li>Diagnostic Interview Schedule for Children (DISC): Substance abuse, conduct, and mood disorders (and symptom counts) </li></ul><ul><li>Brief Symptom Inventory (BSI) </li></ul><ul><li>Risky Sexual Behaviors (RSBs) Survey </li></ul><ul><li>Physical Health Symptoms Checklist </li></ul>
    9. 9. Housed-Homeless Differences at Baseline <ul><li>Groups differed significantly on a wide range of variables, including: </li></ul><ul><li>Family and community violence, parenting, housing moves, etc. </li></ul><ul><li>Diagnoses/symptoms: conduct, mania, depression, substance abuse, etc. </li></ul><ul><li>School and sexual behavior, etc. </li></ul>
    10. 10. Methods of Longitudinal Follow-up <ul><li>Initial Project: Full-length interviews attempted at 3 time points </li></ul><ul><li>  6 months (N=231, 58% of total 398 from baseline; 115 homeless, 116 housed) </li></ul><ul><li>12 months (N=150, 38% of 398) </li></ul><ul><li>18-42 months (N=235, 59% of 398) </li></ul>
    11. 11. Continuation Project: 3 more annual full-length interviews <ul><li>5 years (N=327, 82% of 398)  </li></ul><ul><li>6 years (N=296; 74% of 398) </li></ul><ul><li>7 years (N=330, 83% of 398) </li></ul><ul><li>388 (97%) have at least 1 of 6 possible follow-up interviews </li></ul><ul><li>368 (92%) have at least 2 </li></ul>
    12. 12. Procedures to improve follow-up: <ul><li>Positive &quot;human encounter&quot; with interviewer  </li></ul><ul><li>Keeping in regular contact between interviews </li></ul><ul><li>Use of “collateral contacts,” such as parents and close friends </li></ul><ul><li>$20-$50 payment at each interview </li></ul><ul><li>1-800 number </li></ul><ul><li>Persistent tracking and “dropping in” on residences </li></ul><ul><li>Use of web-based services and other “public” data (e.g., from drivers’ licenses)  </li></ul>
    13. 13. Attrition Effects: <ul><li>   Greater attrition for homeless vs. housed early on (e.g., 54% vs. 21% at 6 months) </li></ul><ul><li>   This difference “washed out” in last several interviews (19% vs. 15% at 5 years) </li></ul><ul><li>   Use of Hierarchical Linear Modeling (HLM) allows inclusion of youth with any follow-up data and allow modeling time as a continuum </li></ul>
    14. 14. Examples of Recent Findings: <ul><li>The stress-buffering effects of religiosity </li></ul><ul><li>The Longitudinal Role of Stress on Psychological Well-Being </li></ul>
    15. 15. A multidimensional measure: <ul><li>30 items </li></ul><ul><li>Public, Private, & Family Religiosity </li></ul>Cross-sectional & Longitudinal Analyses: <ul><li>Regression analyses at baseline/6 </li></ul><ul><li>months (T1) & 12-18 months (T2) </li></ul><ul><li>Published in 2011 in Mental Health, Religion and Culture Journal </li></ul>
    16. 16. Figure 1. Drug Symptoms as a Function of Stress and Family Religiosity (Time 1 scores)
    17. 17. Figure 2. Drug symptoms as a function of Stress and Public Religiosity (Time 2 residual scores)  
    18. 18. Longitudinal Results <ul><li>Hierarchical linear modeling (HLM) estimated growth curves over 6-7 years </li></ul><ul><li>Emotional distress decreased significantly </li></ul><ul><li>Substance abuse symptoms increased significantly </li></ul>
    19. 19. Table 1. Homeless vs. housed emotional distress over time
    20. 20. Table 2. Homeless vs. housed substance abuse over time
    21. 21. Table 3. Homeless vs. housed stress over time
    22. 22. Results <ul><li>Findings </li></ul><ul><li>Increased stress over time predicted greater rates of emotional distress and substance abuse </li></ul><ul><li>Homeless adolescents reported greater stress and emotional distress across time </li></ul><ul><li>Continued stress over time better accounts for increases in substance abuse than initial homelessness </li></ul>
    23. 23. Examining Typologies among Homeless Youth <ul><li>The population of homeless youth is heterogeneous </li></ul><ul><li>Early typologies were crude (e.g., runaways vs. throwaways vs. systems kids vs. street kids) </li></ul><ul><li>A full paper on this topic will appear in an upcoming issue of NAEH’s Quarterly Research Newsletter. </li></ul>
    24. 24. Typologies among HALO’s Homeless Youth (N=250) <ul><li>Latent class analysis at baseline: </li></ul><ul><ul><li>1. transient, but family-connected ( n =55), </li></ul></ul><ul><ul><li>2. dysfunctional ( n =46), and </li></ul></ul><ul><ul><li>3. high functioning ( n =149) </li></ul></ul><ul><li>Longitudinal outcome differences: </li></ul><ul><ul><li>High functioning showed the most stable housing over follow-up period </li></ul></ul><ul><ul><li>All groups largely housed by 6-7 years </li></ul></ul>
    25. 25. Typologies: Summary <ul><li>Need for empirical validation based on representative samples </li></ul><ul><li>Typologies can be based on longitudinal outcomes rather than pre-existing characteristics </li></ul><ul><li>Differences between boys and girls </li></ul><ul><li>Do certain subgroups do better in certain interventions? </li></ul>
    26. 26. Publications from HALO and it’s pilot: <ul><li>McCaskill, P. A., Toro, P. A., & Wolfe, S. M. (1998). Homeless and matched housed adolescents: A comparative study of psychopathology. Journal of Clinical Child Psychology, 27 , 306-319. </li></ul><ul><li>Wolfe, S. M., Toro, P. A., & McCaskill, P. A. (1999). A comparison of homeless and matched housed adolescents on family environment variables. Journal of Research on Adolescence, 9 , 53-66. </li></ul><ul><li>Heinze, H., Toro, P.A., & Urberg, K. A. (2004). Antisocial behavior and affiliation with deviant peers. Journal of Clinical Child and Adolescent Psychology, 33 , 336-346. </li></ul><ul><li>Urberg, K., Goldstein, M., & Toro, P.A. (2005). Supportive relationships as a moderator of the effects of parent and peer drinking on adolescent drinking. Journal of Research on Adolescence, 15 , 1-19. </li></ul><ul><li>Fowler, P.J., Ahmed, S. R., Tompsett, C. J., Jozefowicz-Simbeni, D. M., & Toro, P.A. (2008). Community violence and externalizing problems: Moderating effects of race and religiosity in emerging adulthood. Journal of Community Psychology, 36 , 835-850. </li></ul>
    27. 27. <ul><li>Tompsett, C.J., Fowler, P.J., & Toro, P.A. (2009). Age differences among homeless individuals: Adolescence through adulthood. Journal of Prevention and Intervention in the Community , 37 , 86-99. </li></ul><ul><li>Haber, M., & Toro, P.A. (2009). Parent-adolescent violence and later behavioral health problems among homeless and housed youth. American Journal of Orthopsychiatry, 79, 305-318. </li></ul><ul><li>Tompsett, C.J., & Toro, P.A. (2010). Predicting overt and covert antisocial behaviors: parents, peers, and homelessness. Journal of Community Psychology, 38, 469-485. </li></ul><ul><li>Ahmed, S., Fowler, P.J., & Toro, P. A. (2011). Family, public and private religiousness and psychological well-being over time in at-risk adolescents. Mental Health, Religion & Culture, 14 (4), 393-408. </li></ul><ul><li>Hobden, K.L., Forney, J.C., Durham, K.W., & Toro, P.A. (2011, in press). Limiting attrition in longitudinal research on homeless adolescents: What works best? Journal of Community Psychology. </li></ul><ul><li>  Toro, P.A., Lesperance, T.M., & Braciszewski, J.M. (2011, in press). The heterogeneity of homeless youth in America: Examining typologies. Quarterly Research Newsletter , Homelessness Research Institute, National Alliance to End Homelessness, Washington, DC. </li></ul>