Evaluation of EBT With Young, Substance Abusing Homeless Mothers

Homeless mothers with young children in their care contend with high rates of substance use,
HIV risk, physical and mental health problems and parenting stress. These struggles are in
addition to homelessness and meeting the basic needs of themselves and their children.
However, a very limited number of studies have examined mother and child outcomes associated
with housing and supportive services. Even with increased focus on those experiencing
homelessness, the number of homeless families continues to rise, with the demand for
temporary shelter so high that many cities are unable to meet the needs of these families. A
comprehensive intervention that can be offered outside the shelter setting may offer greater
reach to those experiencing homelessness who do not make it in to the shelter system, and for
those communities that do not have shelters available. Among the young homeless, those under
age 25, research documents that the majority (70%) have never used shelter services. Research
attention towards identifying efficacious interventions for this population which address the
multiple needs of these families is thus considered an important focus. The proposed
intervention (Ecologically-Based Treatment, EBT) includes housing and supportive services and
utilizes an ecological systems approach as the theoretical base. It was rigorously developed
in a Stage 1 treatment development study with substance use disordered homeless mothers who
were engaged through a crisis shelter. EBT showed several outcomes superior to shelter
services and is therefore considered a good fit for a population who avoids the shelter but
is in great need of housing and support services. Two hundred forty (N = 240) substance use
disordered homeless young women between the ages of 18 to 24 years with a biological child
under the age of 6 years in their care will be randomly assigned to one of three conditions:

1. housing and support services (EBT) + Treatment as Usual (TAU) (N = 80),

2. housing only (HO) + TAU (N = 80), or

3. TAU only (N=80).

EBT includes 6 months of supportive services (case management, HIV prevention and the
Community Reinforcement Approach) in addition to 3 months of rental assistance. HO includes 3
months of rental assistance, but without supportive services. TAU is usual services offered
by a homeless youth drop-in center. Participants will be re-assessed at 3, 6, 9 and 12 months
post-baseline. Theoretically derived mediators of change as well as a formal economic
evaluation will offer important policy implications. Since homeless substance use disordered
mothers and their children are at increased risk for a variety of adverse outcomes, the
intervention may produce substantial health-care benefits to their families and society at
large.

Inclusion Criteria:

- aged 18-24 years

- meets McKinney-Vento definition of homeless

- has physical custody of child under the age of 7

- meets DSM5 criteria for alcohol/drug use disorder

Exclusion Criteria:

- Evidence of unremitted psychosis or other condition which would impair mother's
ability to understand or participate in the intervention or consent to the research