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Addressing opioid use disorder among youth experiencing homelessness

$6.9M federal grant funds project examining interventions, support systems

Next time you're on the street, notice the youth alone with a backpack and a dog, looking with longing in the window of a fast-food restaurant but not buying anything to eat. Or sleeping in the library. Or lingering at a bus stop but never boarding a bus.

That young person might be experiencing homelessness, a condition that is rising among youth in our society. 

Homelessness among youth is not rare. Recent United States estimates indicate that 1 in 30 adolescents (ages 13-17) and 1 in 10 young adults (ages 18-25) experience homelessness each year.

To complicate matters, youth are disproportionately burdened by the opioid epidemic. Their reported rates of opioid use, often used to escape from the depression and trauma of homelessness, is up to 79%. The result: mental health issues, drug overdose and suicide.  

Yet research to end homelessness and prevent or intervene in drug use and mental health problems among these youth has lagged that of adults, which puts this segment of the nation’s future – our youth – in jeopardy. 

Researchers at The Ohio State University are committed to working to change these discouraging numbers. An interdisciplinary team that includes service providers in the community has begun a groundbreaking five-year, $6.9 million grant project.  

Jodi Ford

Funding comes from the National Institutes of Health/National Institute on Drug Abuse and its Helping to End Addiction Long-term (HEAL) initiative

The project will provide nurses, counselors and mental health service professionals with a tested approach to intervene in opioid use. It is titled “Building Social and Structural Connections for the Prevention of Opioid Use Disorder among Youth Experiencing Homelessness: A Randomized, Controlled Trial Examining Biopsychosocial Mechanisms.”

The two principal investigators are Jodi Ford, professor in Ohio State’s College of Nursing, assistant director of the Martha S. Pitzer Center for Women, Children, and Youth, and director of the Stress Science Lab, and Natasha Slesnick, distinguished professor and associate dean for research in Ohio State’s College of Education and Human Ecology.

“Our research, and that of others, shows that exposure to adverse childhood and life experiences is linked to irregular patterns of cortisol, a primary stress hormone, and high levels of inflammation in the body,” said Ford. “That phenomenon may contribute to depression and death by suicide, as well as substance use, often used to reduce symptoms of psychological distress.”   

Ford’s and Slesnick’s research will be conducted in collaboration with Star House, the only drop-in center in Columbus serving youth experiencing homelessness. Ford said the project will document how evidence-based interventions targeting substance use, as well as connections to community services and safe and supportive people and places, can help prevent opioid and other substance misuse in Columbus’ population and across the country. 

Natasha Slesnick

Slesnick founded Star House in 2006. “We needed a 24/7 drop-in center because these youth tend to avoid services such as community shelters,” she said. “They cite issues such as predation by older adult shelter clients and fear of being returned to foster care or home settings where they had negative experiences.”  

An independent nonprofit since 2017, Star House provides young people ages 14-24 with immediate access to safety and acceptance. Their basic needs, such as meals, showers and computer access, are met. And each year, 1,200 unduplicated youth are accessing those services. Crucial, stabilizing resources are offered through mental health therapy, job-search support and help transitioning to housing. 

In addition to serving the youths’ needs, the location hosts ongoing best-practice studies by Ford, Slesnick and other researchers. The researchers can interview youth, gather and analyze data to determine how best to meet their needs, and invite them to return for follow-up interviews. 

In this project, the research team will train the therapists and youth advocates at Star House to implement evidence-based interventions, which include a motivational and substance use/mental health intervention and an advocacy intervention focused on linkage to community and social supports.

“Our goal is to test the real-world effectiveness of the interventions individually and in combination to understand which is most effective in preventing opioid use disorder and other substance use and in improving mental health outcomes as well as homelessness,” Slesnick said.

“We also will conduct the first cost-benefit analysis on this approach, which has not been done before,” she said. “Knowing the cost of the interventions will help agencies plan for their adoption. Our goal is for this work to have practical benefit to those serving youth across the country.” 

The team will examine whether the interventions work, how they work and if they work for all youth or only specific groups.  

“We will be investigating the social connections of youth, their social isolation in the community and relationships to stress biology,” Ford said. “Specifically, we’ll examine how the intervention enhances social connections and a sense of belonging and reduces toxic stress associated with the significant adversity these youth experience daily.” 

Slesnick emphasized the importance of prioritizing youth well-being.

“By confronting and dismantling the barriers faced by youth, who aren’t fortunate to have caring adults in their lives, such as unstable housing and limited education, we can forge a pathway to a healthier and brighter future for generations to come,” she said. 

“We appreciate partnering with Star House to help the youth in our community, as well as to inform community intervention practices around the country,” Ford said. “Youth experiencing homelessness have many strengths, and like all youth, they need the care and support of individuals and communities to help them experience a healthy transition into adulthood.” 

Ford’s and Slesnick’s research team for the project will include Professor Xin Feng and Associate Professor Tansel Yilmaz, both with the College of Education and Human Ecology; College of Arts and Sciences Distinguished Professor Christopher Browning, Department of Sociology; and Beth Boettner, a research scientist in the Institute for Population Research, College of Arts and Sciences.  

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