Feasibility of a computer-assisted social network motivational interviewing intervention to reduce substance use and increase supportive connections among emerging adults transitioning from homelessness to housing

David P Kennedy, Karen Chan Osilla, Joan S Tucker, David P Kennedy, Karen Chan Osilla, Joan S Tucker

Abstract

Background: Social networks may play positive and negative roles in the lives of young adults experiencing homelessness (YEH) who are transitioning into housing. Social networks can influence their alcohol and/or other drug (AOD) use, as well as provide immediate and long-term support necessary for a successful transition.

Methods: We adapted a four-session computer-assisted motivational interviewing social network intervention (MI-SNI) for YEH transitioning into housing. We iteratively adapted and beta tested the intervention for delivery by case managers at an organization that provides supportive housing to YEH. We conducted a focus group with agency staff (n = 6), role-play exercises with case managers (n = 3), and semi-structured interviews with residents (n = 6). Interview data were thematically analyzed with open coding. This study presents the first adaptation of an innovative social network-based motivational intervention to reduce AOD use and increase stable, prosocial supportive connections via visualizations of the structure and composition of the individual's social network.

Results: Participants rated sessions as "moderately" to "very" helpful and "good" quality on average. Participants agreed that the sessions were helpful, understandable, and satisfying and would work for new residents. Themes emerged in four broad categories: (1) Acceptability, (2) Positive benefits, (3) Visualization reactions, and (4) MI-SNI interface reactions. For the acceptability category, three sub-themes emerged: (1) understandability, (2) enjoyability and ease of use, (3) and barriers to acceptability. Five sub-themes emerged about the intervention's likelihood to trigger positive benefits: (1) learning/new insights, (2) enhancement to motivation to change, (3) making AOD changes, (4) building social support, and (5) the intervention's usefulness to some but not others. Five sub-themes also emerged from comments about the social network visualizations: (1) general positive comments, (2) understandability, (3) new insights, (4) triggering changes in social support, and (5) triggering changes in AOD use. When discussing the MI-SNI intervention interface beyond the visualizations, discussions emerged in three thematic categories: (1) discussion of name listing, (2) discussion of screen wording, and (3) the use of a computer interface to deliver the intervention.

Conclusions: Results suggest that the MI-SNI is acceptable to YEH and can be feasibly delivered by case managers during case management sessions. Trial registration ClinicalTrials.gov Identifier: NCT04637815. Registered November 10, 2020.

Keywords: Alcohol and other drug use; Data visualization; EgoWeb 2.0; Homelessness; Housing first; Motivational interviewing; Social network intervention; Transitional age youth.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Example figures from hypothetical MI-SNI session. Network contacts are represented by circles (graph “nodes”) and lines between nodes represent network contacts who interacted with each other in the past 2 weeks. The layout of the nodes, generated with the Fruchterman–Reingold force-directed placement algorithm highlights structural characteristics of the network, such as isolates (completely disconnected nodes) and components (a set of nodes tied together but disconnected from other nodes). The structural layout is consistent across the three diagrams. The “Connections” figure on the left (a) uses node color, node size, and line thickness to highlight other characteristics of the network structure, including the centrality of network actors (depicted by larger and darker nodes) and stronger relationship ties between actors (highlighted with thicker lines). The other figures use node size and color to highlight network composition. The AOD use figure in the middle highlights drinking and drug use partners with size and color ranging from small green nodes (no AOD use by network member) to large red nodes (participant uses with more than usual). The “Support” figure on the right depicts network members with size and color (large purple = supportive now and in the future, small purple = supportive now only, small orange = not supportive)

References

    1. Baer JS, Ginzler JA, Peterson PL. DSM-IV alcohol and substance abuse and dependence in homeless youth. J Stud Alcohol. 2003;64(1):5–14. doi: 10.15288/jsa.2003.64.5.
    1. Lecrubier Y, Sheehan DV, Weiller E, Amorim P, Bonora I, Harnett Sheehan K, et al. The MINI International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry. 1997;12(5):224–231. doi: 10.1016/S0924-9338(97)83296-8.
    1. Gomez R, Thompson SJ, Barczyk AN. Factors associated with substance use among homeless young adults. Subst Abuse. 2010;31(1):24–34. doi: 10.1080/08897070903442566.
    1. Dennis ML, Feeney T, Stevens L, Bedoya L. Global appraisal of individual needs–short screener (GAIN-SS): Administration and scoring manual for the GAIN-SS version 2.0. 1 2006. .
    1. Pedersen ER, Tucker JS, Klein DJ, Parast L. Perceived need and receipt of behavioral health services at drop-in centers among homeless youth. Health Serv Res. 2018;53(6):4609–4628. doi: 10.1111/1475-6773.12990.
    1. Nilsson SF, Nordentoft M, Hjorthøj C. Individual-level predictors for becoming homeless and exiting homelessness: a systematic review and meta-analysis. J Urban Health. 2019;96(5):741–750. doi: 10.1007/s11524-019-00377-x.
    1. Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000;51(6):843–857. doi: 10.1016/S0277-9536(00)00065-4.
    1. Brechwald WA, Prinstein MJ. Beyond homophily: a decade of advances in understanding peer influence processes. J Res Adolesc. 2011;21(1):166–179. doi: 10.1111/j.1532-7795.2010.00721.x.
    1. Smith KP, Christakis NA. Social networks and health. Ann Rev Sociol. 2008;34:405–429. doi: 10.1146/annurev.soc.34.040507.134601.
    1. de la Haye K, Green HD, Kennedy DP, Zhou A, Golinelli D, Wenzel SL, et al. Who is supporting homeless youth? Predictors of support in personal networks. J Res Adolesc. 2012;22(4):604–616. doi: 10.1111/j.1532-7795.2012.00806.x.
    1. Wenzel SL, Tucker JS, Golinelli D, Green HD, Jr, Zhou A. Personal network correlates of alcohol, cigarette, and marijuana use among homeless youth. Drug Alcohol Depend. 2010;112(1–2):140–149. doi: 10.1016/j.drugalcdep.2010.06.004.
    1. DiGuiseppi GT, Davis JP, Christie NC, Rice E. Polysubstance use among youth experiencing homelessness: the role of trauma, mental health, and social network composition. Drug Alcohol Depend. 2020;216:108228. doi: 10.1016/j.drugalcdep.2020.108228.
    1. Barman-Adhikari A, Bowen E, Bender K, Brown S, Rice E. A social capital approach to identifying correlates of perceived social support among homeless youth. Child Youth Care Forum. 2016;45(5):691–708. doi: 10.1007/s10566-016-9352-3.
    1. Brown SM, Barman-Adhikari A, Combs KM, Rice E. Sociodemographic and substance use characteristics associated with typologies and composition of social support networks among youth experiencing homelessness in Los Angeles, USA. Health Soc Care Community. 2020;28(2):533–543. doi: 10.1111/hsc.12886.
    1. Kennedy MC, Jansson M, Benoit C, Magnuson D, Scramstad J, Hallgrimsdottir H. Social relationships and social support among street-involved youth. J Youth Stud. 2017;20(10):1328–1345. doi: 10.1080/13676261.2017.1333582.
    1. Green HD, de la Haye K, Tucker JS, Golinelli D. Shared risk: who engages in substance use with American homeless youth? Addiction. 2013;108(9):1618–1624. doi: 10.1111/add.12177.
    1. Skobba K, Meyers D, Tiller L. Getting by and getting ahead: social capital and transition to college among homeless and foster youth. Child Youth Serv Rev. 2018;94:198–206. doi: 10.1016/j.childyouth.2018.10.003.
    1. Valente TW. Social networks and health. Models, methods, and applications. New York: Oxford University Press; 2010.
    1. Hunter RF, de la Haye K, Murray JM, Badham J, Valente TW, Clarke M, et al. Social network interventions for health behaviours and outcomes: a systematic review and meta-analysis. PLoS Med. 2019;16(9):e1002890. doi: 10.1371/journal.pmed.1002890.
    1. Valente TW. Putting the network in network interventions. Proc Natl Acad Sci. 2017;114(36):9500. doi: 10.1073/pnas.1712473114.
    1. Latkin CA, Knowlton AR. Social network assessments and interventions for health behavior change: a critical review. Behav Med. 2015;41(3):90–97. doi: 10.1080/08964289.2015.1034645.
    1. Valente TW. Network interventions. Science. 2012;337(6090):49–53. doi: 10.1126/science.1217330.
    1. Shelton RC, Lee M, Brotzman LE, Crookes DM, Jandorf L, Erwin D, et al. Use of social network analysis in the development, dissemination, implementation, and sustainability of health behavior interventions for adults: a systematic review. Soc Sci Med. 2019;220:81–101. doi: 10.1016/j.socscimed.2018.10.013.
    1. Kennedy DP, Hunter SB, Osilla KC, Maksabedian E, Golinelli D, Tucker JS. A computer-assisted motivational social network intervention to reduce alcohol, drug and HIV risk behaviors among housing first residents. Addict Sci Clin Pract. 2016;11(1):1–13. doi: 10.1186/s13722-016-0052-y.
    1. Kennedy DP, Osilla KC, Hunter SB, Golinelli D, Maksabedian Hernandez E, Tucker JS. A pilot test of a motivational Interviewing social network intervention to reduce substance use among housing first residents. J Subst Abuse Treat. 2018;86:36–44. doi: 10.1016/j.jsat.2017.12.005.
    1. Rogers EM. Diffusion of preventive innovations. Addict Behav. 2002;27(6):989–993. doi: 10.1016/S0306-4603(02)00300-3.
    1. Rice E, Milburn NG, Rotheram-Borus MJ, Mallett S, Rosenthal D. The effects of peer group network properties on drug use among homeless youth. Am Behav Sci. 2005;48(8):1102–1123. doi: 10.1177/0002764204274194.
    1. Wenzel S, Holloway I, Golinelli D, Ewing B, Bowman R, Tucker J. Social networks of homeless youth in emerging adulthood. J Youth Adolesc. 2011;41(5):561–571. doi: 10.1007/s10964-011-9709-8.
    1. Kertesz SG, Crouch K, Milby JB, Cusimano RE, Schumacher JE. Housing first for homeless persons with active addiction: are we overreaching? Milbank Q. 2009;87(2):495–534. doi: 10.1111/j.1468-0009.2009.00565.x.
    1. Padgett DK. There's no place like (a) home: ontological security among persons with serious mental illness in the United States. Soc Sci Med. 2007;64(9):1925–1936. doi: 10.1016/j.socscimed.2007.02.011.
    1. Padgett DK, Stanhope V, Henwood BF, Stefancic A. Substance use outcomes among homeless clients with serious mental illness: comparing housing first with treatment first programs. Community Ment Health J. 2011;47(2):227–232. doi: 10.1007/s10597-009-9283-7.
    1. Rhoades H, La Motte-Kerr W, Duan L, Woo D, Rice E, Henwood B, et al. Social networks and substance use after transitioning into permanent supportive housing. Drug Alcohol Depend. 2018;191:63–69. doi: 10.1016/j.drugalcdep.2018.06.027.
    1. Adams AM, Nababan HY, Hanifi S. building social networks for maternal and newborn health in poor urban settlements: a cross-sectional study in Bangladesh. PLoS ONE. 2015;10(4):e0123817. doi: 10.1371/journal.pone.0123817.
    1. Bouris A, Voisin D, Pilloton M, Flatt N, Eavou R, Hampton K, et al. Project nGage: network supported HIV care engagement for younger black men who have sex with men and transgender persons. J AIDS Clin Res. 2013 doi: 10.4172/2155-6113.1000236.
    1. McFadden RB, Bouris AM, Voisin DR, Glick NR, Schneider JA. Dynamic social support networks of younger black men who have sex with men with new HIV infection. AIDS Care. 2014;26(10):1275–1282. doi: 10.1080/09540121.2014.911807.
    1. Perry BL, Pescosolido BA, Borgatti SP. Egocentric network analysis: foundations, methods, and models. Cambridge: Cambridge University Press; 2018.
    1. McCarty C. Structure in personal networks. J Soc Struct. 2002;3(1):20.
    1. Crossley N, Bellotti E, Edwards G, Everett MG, Koskinen J, Tranmer M. Social network analysis for ego-nets: social network analysis for actor-centred networks. Thousand Oaks: Sage Publications; 2015.
    1. Osilla KC, Kennedy DP, Hunter SB, Maksabedian E. Feasibility of a computer-assisted social network motivational interviewing intervention for substance use and HIV risk behaviors for housing first residents. Addict Sci Clin Pract. 2016;11(14):1–11.
    1. Miller WR, Rollnick S. Motivational interviewing: preparing people for change. 2. New York: Guilford press; 2002.
    1. Peterson PL, Baer JS, Wells EA, Ginzler JA, Garrett SB. Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents. Psychol Addict Behav. 2006;20(3):254–264. doi: 10.1037/0893-164X.20.3.254.
    1. Rabinovitz S, Desai M, Schneir A, Clark L. No way home: Understanding the needs and experiences of homeless youth in Hollywood. Hollywood: Homeless Youth Partnership; 2010.
    1. Pedersen ER, Tucker JS, Kovalchik SA. Facilitators and barriers of drop-in center use among homeless youth. J Adolesc Health. 2016;59(2):144–153. doi: 10.1016/j.jadohealth.2016.03.035.
    1. Kennedy DP, Osilla KC, Hunter SB, Golinelli D, Maksabedian Hernandez E, Tucker JS. Restructuring personal networks with a motivational interviewing social network intervention to assist the transition out of homelessness. PLoS ONE. 2022;12(1):e0262210. doi: 10.1371/journal.pone.0262210.
    1. Deci EL, Ryan RM. Intrinsic motivation and self-determination in human behavior. New York: Plenum; 1985.
    1. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol. 2009;64(6):527–537. doi: 10.1037/a0016830.
    1. Markland D, Ryan RM, Tobin VJ, Rollnick S. Motivational interviewing and self-determination theory. J Soc Clin Psychol. 2005;24(6):811–831. doi: 10.1521/jscp.2005.24.6.811.
    1. Newman MEJ. Complex systems: a survey. Am J Phys. 2011;79(8):800–810. doi: 10.1119/1.3590372.
    1. Wasserman S, Faust K. Social network analysis: methods and applications. New York: Cambridge University Press; 1994. p. 825.
    1. Monge PR, Contractor NS. Theories of communication networks. New York: Oxford University Press; 2003.
    1. Coleman JS. Social capital in the creation of human capital. Am J Sociol. 1988;94:S95–S120. doi: 10.1086/228943.
    1. Bandura A. Self-efficacy: the exercise of control. New York: W.H. Freeman and Company; 1997.
    1. Freeman LC. Visualizing social networks. J Soc Struct. 2000;1(1):4.
    1. SocioCultural Research Consultants LLC . Dedoose Version 9.0.17, web application for managing, analyzing, and presenting qualitative and mixed method research data. Los Angeles: SocioCultural Research Consultants LLC; 2018.
    1. Osilla KC, Hepner KA, Munoz RF, Woo S, Watkins K. Developing an integrated treatment for substance use and depression using cognitive-behavioral therapy. J Subst Abuse Treat. 2009;37(4):412–420. doi: 10.1016/j.jsat.2009.04.006.
    1. Osilla KC, dela Cruz E, Miles JNV, Zellmer S, Watkins KE, Larimer ME, et al. Exploring productivity outcomes from a brief intervention for at-risk drinking in an employee assistance program. Addict Behav. 2010;35(3):194–200. doi: 10.1016/j.addbeh.2009.10.001.
    1. Osilla KC, Zellmer SP, Larimer ME, Neighbors C, Marlatt GA. A brief intervention for at-risk drinking in an employee assistance program. J Stud Alcohol Drugs. 2008;69(1):14–20. doi: 10.15288/jsad.2008.69.14.
    1. Stern SA, Meredith LS, Gholson J, Gore P, D’Amico EJ. Project CHAT: a brief motivational substance abuse intervention for teens in primary care. J Subst Abuse Treat. 2007;32(153–165):153–165. doi: 10.1016/j.jsat.2006.07.009.
    1. Watkins K. Using technology to deliver brief interventions in alcohol treatment research. Bethesda: National Institute on Alcohol Abuse and Alcoholism; 2010.
    1. Osilla KC, D'Amico EJ, Díaz-Fuentes CM, Lara M, Watkins KE. Multicultural web-based motivational interviewing for clients with a first-time DUI offense. Cultur Divers Ethnic Minor Psychol. 2012;18(2):192. doi: 10.1037/a0027751.
    1. D'Amico EJ, Osilla KC, Hunter SB. Developing a group motivational interviewing intervention for adolescents at-risk for developing an alcohol or drug use disorder. Alcohol Treat Q. 2010;28(4):417–436. doi: 10.1080/07347324.2010.511076.
    1. Brown RA, Kennedy DP, Tucker JS, Wenzel S, Golinelli D, Wertheimer S, et al. Sex and relationships on the street: how homeless men judge partner risk on skid row. AIDS Behav. 2012;16(3):774–784. doi: 10.1007/s10461-011-9965-3.
    1. Rana Y, Brown RA, Kennedy DP, Ryan GW, Stern S, Tucker JS. Understanding condom use decision making among homeless youth using event-level data. J Sex Res. 2014;52(9):1–11.
    1. Kennedy DP, Tucker JS, Green HD, Golinelli D, Ewing BA. Unprotected sex of homeless youth: results from a multilevel analysis of individual, social network, and relationship factors. AIDS Behav. 2012;16(7):2015–2032. doi: 10.1007/s10461-012-0195-0.
    1. Ryan GW, Stern SA, Hilton L, Tucker JS, Kennedy DP, Golinelli D, et al. When, where, why and with whom homeless women engage in risky sexual behaviors: a framework for understanding complex and varied decision-making processes. Sex Roles. 2009;61(7–8):536–553. doi: 10.1007/s11199-009-9610-z.
    1. Strauss AC, Corbin J. Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks: Sage Publications, Inc.; 1998.
    1. Krippendorf K. Content analysis: An introduction to its methodology. Beverly Hills, CA: Sage Publications; 1980.
    1. Weber RP. Basic content analysis. Newbury Park: Sage Publications, Inc.; 1990.
    1. Rounsaville BJ, Carroll KM, Onken LS. A stage model of behavioral therapies research: getting started and moving on from stage I. Clin Psychol Sci Pract. 2001;8(2):133–142. doi: 10.1093/clipsy.8.2.133.
    1. Tucker JS, Kennedy DP, Osilla KC, Golinelli D. Motivational network intervention to reduce substance use and increase supportive connections among formerly homeless emerging adults transitioning to housing: study protocol for a pilot randomized controlled trial. Addict Sci Clin Pract. 2021;16(1):18. doi: 10.1186/s13722-021-00227-9.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren