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

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

Abstract

Background: Studies indicate high rates of substance use among youth experiencing homelessness (YEH). Further, the social networks of YEH, although multi-dimensional in composition, are largely comprised of other YEH, substance users, and individuals who do not provide the youth with tangible or emotional support. For YEH who have the opportunity to enter a housing program, helping them to reduce their substance use and strengthen their prosocial supportive connections during this critical transition period may increase their stability and reduce their risk of re-entering homelessness. The goal of this study is to pilot test a brief motivational network intervention (MNI), delivered by case managers, to help former YEH who have recently transitioned to a housing program reduce their substance use and strengthen their prosocial supportive connections.

Methods/design: Up to 60 residents of housing programs in the Los Angeles area will be randomized to receive four sessions of usual case manager support or four sessions of case manager support + MNI. Each MNI session consists of three parts: (1) identifying two goals that are most important for the resident over the next year (e.g., get or keep a job, finish or stay in school, reduce substance use); (2) a network interview with the resident to capture network data pertaining to their interactions in the past 2 weeks; and (3) a discussion between the case manager and the resident of the resulting network visualizations, conducted in a Motivational Interviewing (MI) style, and what role the resident's network may play in reaching their most important goals over the next year.

Discussion: This study addresses a critical gap by pilot testing a computer-assisted MNI, delivered using MI techniques, that can help case managers work with recent YEH to reduce substance use and increase permanent supportive connections during the critical transitional period from homelessness to housing. Trial registration ClinicalTrials.gov Identifier: NCT04637815. Registered November 10, 2020.

Keywords: Homeless; Intervention; Motivational interviewing; Social networks; Substance use; Supportive connections; Young adults.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

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Fig. 1
Conceptual framework
Fig. 2
Fig. 2
Randomized controlled trial study flow

References

    1. Henry M, Watt R, Mahathey A, Ouellette J, Sitler A. The 2019 Annual Homeless Assessment Report (AHAR) to Congress. Part 1: Point-in-Time Estimates of Homelessness. Washington, DC; 2020.
    1. Barman-Adhikari A, Hsu HT, Brydon D, et al. Prevalence and correlates of nonmedical use of prescription drugs (NMUPD) among young adults experiencing homelessness in seven cities across the United States. Drug Alcohol Depen. 2019;1:153–60. doi: 10.1016/j.drugalcdep.2019.03.015.
    1. Bozinoff N, Wood E, Dong HR, Richardson L, Kerr T, DeBeck K. Syringe sharing among a prospective cohort of street-involved youth: Implications for needle distribution programs. AIDS Behav. 2017;21(9):2717–25. doi: 10.1007/s10461-017-1762-1.
    1. Santa Maria D, Padhye N, Yang YJ, et al. Drug use patterns and predictors among homeless youth: results of an ecological momentary assessment. Am J Drug Alcohol. 2018;44(5):551–60. doi: 10.1080/00952990.2017.1407328.
    1. Wenzel SL, Tucker JS, Golinelli D, Green HD, Zhou A. Personal network correlates of alcohol, cigarette, and marijuana use among homeless youth. Drug Alcohol Depen. 2010;1(1–2):140–9. doi: 10.1016/j.drugalcdep.2010.06.004.
    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. Bender K, Brown SM, Thompson SJ, Ferguson KM, Langenderfer L. Multiple victimizations before and after leaving home associated with PTSD, depression, and substance use disorder among homeless youth. Child Maltreat. 2015;20(2):115–24. doi: 10.1177/1077559514562859.
    1. Gomez R, Thompson SJ, Barczyk AN. Factors associated with substance use among homeless young adults. Subst Abus. 2010;31(1):24–34. doi: 10.1080/08897070903442566.
    1. Johnson KD, Whitbeck LB, Hoyt DR. Substance abuse disorders among homeless and runaway adolescents. J Drug Issues Fal. 2005;35(4):799–816. doi: 10.1177/002204260503500407.
    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):1618–24. doi: 10.1111/add.12177.
    1. de la Haye K, Green HD, Jr, Kennedy DP, et al. Who is supporting homeless youth? Predictors of support in personal networks. Journal of Research on Adolescence. 2012;22(4):604–16. doi: 10.1111/j.1532-7795.2012.00806.x.
    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 For. 2016;45(5):691–708. doi: 10.1007/s10566-016-9352-3.
    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):843–57. doi: 10.1016/S0277-9536(00)00065-4.
    1. Smith KP, Christakis NA. Social networks and health. Annu Rev Sociol. 2008;34:405–29. doi: 10.1146/annurev.soc.34.040507.134601.
    1. Aubry T, Duhoux A, Klodawsky F, Ecker J, Hay E. A longitudinal study of predictors of housing stability, housing quality, and mental health functioning among single homeless individuals staying in emergency shelters. Am J Commun Psychol. 2016;58(1–2):123–35. doi: 10.1002/ajcp.12067.
    1. Davey-Rothwell MA, Latimore A, Hulbert A, Latkin CA. Sexual networks and housing stability. J Urban Health. 2011;88(4):759–66. doi: 10.1007/s11524-011-9570-9.
    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 Depen. 2020;1:216.
    1. Kerman N, Sylvestre J, Aubry T, Distasio J, Schutz CG. Predictors of mental health recovery in homeless adults with mental illness. Community Ment Hlt J. 2019;55(4):631–40. doi: 10.1007/s10597-018-0356-3.
    1. Padgett DK, Henwood B, Abrams C, Drake RE. Social relationships among persons who have experienced serious mental illness, substance abuse, and homelessness: Implications for recovery. Am J Orthopsychiat. 2008;78(3):333–9. doi: 10.1037/a0014155.
    1. Rhoades H, Wenzel SL, Golinelli D, et al. The social context of homeless men’s substance use. Drug Alcohol Depen. 2011;1(2–3):320–5. doi: 10.1016/j.drugalcdep.2011.04.011.
    1. Tucker JS, Kennedy D, Ryan G, Wenzel SL, Golinelli D, Zazzali J. Homeless women’s personal networks: Implications for understanding risk behavior. Hum Organ Sum. 2009;68(2):129–40. doi: 10.17730/humo.68.2.m23375u1kn033518.
    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; 2015.
    1. McCarty C. Structure in personal networks. J Soc Struct. 2002;3(1):20.
    1. McCarty C, Lubbers MJ, Vacca R, Molina JL. Conducting personal network research: a practical guide. New York: Guilford Press; 2019.
    1. Perry BL, Pescosolido BA, Borgatti SP. Egocentric Network analysis: foundations, methods, and models. Cambridge: Cambridge University Press; 2018.
    1. Martino SC, Tucker JS, Ryan G, Wenzel SL, Golinelli D, Munjas B. Increased substance use and risky sexual behavior among migratory homeless youth: Exploring the role of social network composition. J Youth Adolescence. 2011;40(12):1634–48. doi: 10.1007/s10964-011-9646-6.
    1. Newman M. Complex systems: a survey. Am J Phys. 2011;79(8):800–10. doi: 10.1119/1.3590372.
    1. Hogan B, Carrasco JA, Wellman B. Visualizing personal networks: working with participant-aided sociograms. Field Method. 2007;19(2):116–44. doi: 10.1177/1525822X06298589.
    1. Kennedy DP, Green HD, McCarty C, Tucker JS. Nonexperts’ recognition of structure in personal network data. Field Method. 2011;23(3):287–306. doi: 10.1177/1525822X11399702.
    1. McCarty C, Molina JL, Aguilar C, Rota L. A comparison of social network mapping and personal network visualization. Field Method. 2007;19(2):145–62. doi: 10.1177/1525822X06298592.
    1. Rempel GR, Neufeld A, Kushner KE. Interactive use of genograms and ecomaps in family caregiving research. J Fam Nurs. 2007;13(4):403–19. doi: 10.1177/1074840707307917.
    1. Tracy EM, Whittaker JK. The social network map—assessing social support in clinical-practice. Fam Soc-J Contemp H. 1990;71(8):461–70. doi: 10.1177/104438949007100802.
    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 Prac. 2016;15(1):1–13.
    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 Prac. 2016;7(14):1–11.
    1. Kennedy DP, Osilla KC, Hunter SB, Golinelli D, Hernandez EM, 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. Orr MG, Plaut DC. Complex systems and health behavior change: insights from cognitive science. Am J Health Behav. 2014;38(3):404–13. doi: 10.5993/AJHB.38.3.9.
    1. Monge PR, Contractor NS. Theories of communication networks. New York: Oxford University Press; 2003.
    1. Song LJ, Chang TY. Do resources of network members help in help seeking? Social capital and health information search. Soc Netw. 2012;34(4):658–69. doi: 10.1016/j.socnet.2012.08.002.
    1. Stablein T. Helping friends and the homeless milieu: Social capital and the utility of street peers. J Contemp Ethnogr. 2011;40(3):290–317. doi: 10.1177/0891241610390365.
    1. Barman-Adhikari A, Rice E. Social networks as the context for understanding employment services utilization among homeless youth. Eval Program Plann. 2014;45:90–101. doi: 10.1016/j.evalprogplan.2014.03.005.
    1. Coleman JS. Social capital in the creation of human capital. Am J Sociol. 1988;94:95–120. doi: 10.1086/228943.
    1. Kawachi I, Berkman LF. Social ties and mental health. J Urban Health. 2001;78(3):458–67. doi: 10.1093/jurban/78.3.458.
    1. Lee S, Chung JE, Park N. Network environments and well-being: An examination of personal network structure, social capital, and perceived social support. Health Commun. 2018;33(1):22–31. doi: 10.1080/10410236.2016.1242032.
    1. Sapin M, Widmer ED, Iglesias K. From support to overload: Patterns of positive and negative family relationships of adults with mental illness over time. Soc Netw. 2016;47:59–72. doi: 10.1016/j.socnet.2016.04.002.
    1. Alvarez EC, Kawachi I, Romani JR. Family social capital and health—a systematic review and redirection. Sociol Health. 2017;39(1):5–29. doi: 10.1111/1467-9566.12506.
    1. Miller W, Rollnick S. Motivational interviewing: helping people change. 3. New York: Guilford Press; 2012.
    1. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol. 2009;64(6):527–37. doi: 10.1037/a0016830.
    1. Barnett E, Sussman S, Smith C, Rohrbach LA, Spruijt-Metz D. Motivational interviewing for adolescent substance use: a review of the literature. Addict Behav. 2012;37(12):1325–34. doi: 10.1016/j.addbeh.2012.07.001.
    1. Tucker JS, D’Amico EJ, Ewing BA, Miles JNV, Pedersen ER. A group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among homeless young adults. J Subst Abuse Treat. 2017;76:20–7. doi: 10.1016/j.jsat.2017.02.008.
    1. Deci EL, Ryan RM. Self-determination theory. In: Kruglanski AW, Higgins ET, editors. Van Lange PAM. Handbook of theories of social psychology.Thousand Oaks: Sage Publications Ltd; 2012. pp. 416–436.
    1. Bandura A. Self-efficacy: the exercise of control. New York: Freeman; 1997.
    1. Brehm SS, Brehm JW. Psychological reactance: a theory of freedom and control. New York: Academic Press; 1981.
    1. Dennis ML, Feeney T, Stevens LH, Bedoya L. Global Appraisal of Individual Needs–Short Screener (GAIN-SS): Administration and Scoring Manual for the GAIN-SS Version 2.0.1. Bloomington: Chestnut Health Systems; 2006.
    1. Miech RA, Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the future national survey results on drug use, 1975–2019: volume I, secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan; 2020.
    1. Wasserman S, Faust K. Social network analysis: methods and applications. New York: Cambridge University Press; 1994.

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