This article reports on the findings and methodology of an evaluation of a comprehensive intervention for homeless, street-living youth that addresses substance use, social stability, and physical and mental health issues.
The intervention that is the focus of this evaluation, the Community Reinforcement Approach (CRA), is informed by the social ecological/systems model outlined by the developmental theorist Urie Bronfenbrenner (1976). The core of this model is the concept that behavioral trajectories and outcomes, such as homelessness, result from activities with defined settings and/or in response to the demands of specific social systems. Thus, the primary goal of any intervention should be, at least from an ecological perspective, removing adolescents from dangerous settings, ensuring they make better decisions about their activities in difficult settings, and replacing settings that promote deviant behavior with more positive settings that promote healthy and safe behavior. In the current study, 180 street-living youth aged 14-22 were recruited from a drop-in center and randomly assigned the CRA or treatment as usual (TAU) through a drop-in center. The primary hypothesis tested was that alcohol and drug use would undergo a statistically significant greater decrease for youth at post-treatment in CRA compared to treatment as usual. The secondary hypotheses were that ancillary drug-use measures and individual difference measures would show greater positive change for youth in CRA compared to TAU. CRA uses an operant perspective based on the belief that environmental contingencies can have a powerful influence in encouraging or discouraging behavior. CRA links behavioral and cognitive intervention strategies to the ecological, multi-causal formulation of youth problem behaviors. Findings indicate that youth assigned to CRA reported significantly reduced substance use (37- percent reduction compared to 17 percent), depression (40 percent compared to 23 percent), and increased social stability (58 percent compared to 13 percent). 2 figures, 2 tables, and 43 references