Enhancing Risk Detection Among Homeless Youth: Effects of a Randomized Trial

Introduction:The majority of homeless youth experience trauma before leaving home, and youth with trauma histories often fail to detect danger risks, making them vulnerable to subsequent victimization on the streets. This pilot study tested a mindfulness-based, cognitive, skill-building intervention designed to train homeless youth to better detect risk through focusing attention to internal cues (physiological responses, cognitions), interpersonal cues (controlling, suspicious behavior by others) and environmental cues (dark, isolated, unfamiliar situations). In developing and testing this novel intervention, this study investigated: (1) whether the intervention succeeded in increasing homeless youths’ overall risk detection abilities, and, if so, (2) which specific types of risk detection were improved.

Methods: Youth ages 18-21 (N=75) were recruited from a homeless youth shelter and randomly assigned to receive usual case management services (N=37), or usual services plus a 3-day manualized intensive risk detection intervention (N=38). Pretest and posttest interviews assessed youths’ risk detection abilities through a series of vignettes, read aloud to youth, describing characters in risky situations, and asking youth to identify risk cues present. Youths’ open-ended responses were coded by a research team using a standardized codebook (93.4% inter-rater reliability). Researchers coded each identified cue as internal, interpersonal, or environmental before calculating the proportion of identified out of total possible cues.

Results: Separate 2X2 repeated measures ANOVAs found a significant interaction effect from pre to posttest, as the intervention group improved in overall risk detection significantly more than control youth (F[1]=6.27, p=.015). The intervention group improved from identifying 24.8% of total cues to 33.3%, while the control group showed no improvement from 26.6% to 26.3%. The partial Eta² of .079 indicated a moderate to large effect size. A significant interaction was found for interpersonal cue identification (F(1)=4.55, p=.036) as intervention youth improved (pre=38.3%, post=46.7%), while control youth slightly declined (pre=38.6%, post=31.1%); the partial Eta² of .059 indicated a moderate effect size. Although no significant interactions were found, intervention youth improved (pre=22.9%, post=33.4%) more than control youth (pre=24.2%, post=26.1%) at identifying environmental cues. Both groups improved slightly in their identification of internal cues with no differences across intervention (pre= 12.1%, post=19.1%) or control (pre=14.6%, post=18.6%).

Conclusions: This intervention appears promising in improving homeless youths’ abilities to detect risk on the streets. However, youths’ recognition of others’ suspicious or dangerous actions (interpersonal cues) appears more malleable compared to their recognition of environmental and internal cues that may require awareness of subtle situations and physiological reactions. Further iterations of this intervention should work to improve awareness of internal danger cues, as these were the least commonly-identified among youth at the start of the trial and least affected by the intervention.