Holistic, trauma-informed adolescent pregnancy prevention and sexual health promotion for female youth experiencing homelessness: Initial outcomes of Wahine Talk

https://doi.org/10.1016/j.childyouth.2019.104509Get rights and content

Highlights

  • Birth control use among female youth who are homeless triples following Wahine Talk.

  • LARC and Depo-Provera were the most popular birth control methods selected.

  • Wahine Talk is a feasible and acceptable multilevel, trauma-informed SRH program.

Abstract

Female youth experiencing homelessness are at high risk for pregnancy due to a host of individual, family, and community-level risk factors. This embedded mixed-method quasi-experimental pilot study examined the initial outcomes of Wahine (woman) Talk, a comprehensive sexual health program delivered by an interdisciplinary team to female youth experiencing homelessness. Wahine Talk includes provision of and connection to basic needs resources, peer mentoring, group based sexual health education, and linkage to and provision of sexual health care. Process and outcome data were collected throughout and for six months after Wahine Talk from a diverse group of 14–22-year-old female youth (N = 51) experiencing homelessness. In-depth individual and focus group interview data were collected from providers and youth after Wahine Talk, and analyzed using Template Analysis. Over half (62.7%) of participants were linked to sexual health care during Wahine Talk and birth control usage tripled following the program. Depo-Provera and long acting reversible contraception (LARC) usage, in particular, increased during Wahine Talk (1–19% and 0–25.5%, respectively). Within six months, 31.4% of youth had adopted LARC and 3.9% were using Depo-Provera. Individual and focus group interviews with providers and youth affirm program acceptability and appropriateness.

Section snippets

Introduction and background

Nearly half of female young adults experiencing homelessness in the United States (44%) aged 18–25 years are either currently pregnant or parenting (Dworsky, Morton, & Samuels, 2018). This staggering rate of pregnancy is the combined result of high-risk behaviors and being underserved by health care systems and school-based prevention. Compared to their stably housed peers, adolescents experiencing homelessness present with increased instances of engaging in high risk behavior, including

Setting and sample

Prior to beginning the study, the Institutional Review Board at the University of Hawai‘i reviewed and approved all procedures and all participants were enrolled via a modified informed consent process (allowing them to consent, themselves, to participation even if under 18 due to a legal ability to consent to all sexual health education and services being offered in the program and, frequently, estrangement from their parent/guardian). An interdisciplinary team delivered Wahine Talk at a youth

Results

Study results are organized below by component dosage, psychosocial and sexual health outcomes, and themes in youth and providers’ experiences of Wahine Talk’s structure, delivery, and facilitation of interpersonal relationships, as well as opportunities for enhancing the program when delivered in the future. Key results are summarized in Fig. 2.

Discussion

This study sought to explore the experiences of female youth experiencing homelessness receiving and program providers delivering Wahine (woman) Talk, a newly developed sexual health program for female youth experiencing homelessness, to assess program feasibility, acceptability, and appropriateness. We also sought to examine changes in youths’ social connectedness, self-esteem, readiness to use birth control, actual birth control use, and linkage to sexual health care after participation in

Conflict of interest statement

The authors have no conflicts to report.

Acknowledgements

The authors gratefully acknowledge the youth participants of Wahine Talk, the dedicated providers of this program, and our iTP3 colleagues at Texas A&M University as we collectively work to improve health equity for underserved communities. This opportunity was made possible in part by HHS Office of Adolescent Health (grant number AH-TP2-15-001). Contents are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human

References (24)

  • R.M. Lee et al.

    Measuring belongingness: The social connectedness and social assurance scales

    Journal of Counseling Psychology

    (1995)
  • K.R. McLeroy et al.

    An ecological perspective on health promotion programs

    Health Education Quarterly

    (1988)
  • Cited by (15)

    • Teen pregnancy in the US: Overview and opportunities for prevention

      2023, Encyclopedia of Child and Adolescent Health, First Edition
    • Predictors of sexual and reproductive health among girls involved in the juvenile legal system: The influence of resources, race, and ethnicity

      2022, Children and Youth Services Review
      Citation Excerpt :

      For example, one study within the US found that individualized, community-based advocacy delivered to system-involved girls improved their mental health, feelings of efficacy, and reduced likelihood of recidivism (Javdani & Allen, 2016). Another study found that multi-modal, community-based programming that integrated access to basic social services and sexual and reproductive resources, peer mentoring, group sexual education, and provided transportation for these services supported the SRH needs of homeless adolescent girls in the US (Aparicio et al., 2019). These studies support the effectiveness of advocacy-based programs that meet girls’ individual needs, mitigate the structural drivers of girls’ SRH, and reduce girls’ barriers to accessing needed services in their communities (Johnston et al. 2015).

    View all citing articles on Scopus
    View full text