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Homeless youth: Reaching the Hard-To-Reach

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Homeless youth: Reaching the Hard-To-Reach

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Content HOMELESS YOUTH 1
Homeless Youth: Reaching the Hard-To-Reach
by
Thuan Nguyen
Assignment 3: Capstone Project Paper and Prototype
Doctor of Social Work
Suzanne Dworak-Peck School of Social Work
University of Southern California
Advisors:
Dr. Renee Smith-Maddox
Dr. Eleanor Bolar
Dr. Murali Nair
May 2020
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Assignment 3: Capstone Project Paper and Prototype
I. Executive Summary
The problem within the Grand Challenge to end homelessness is that homeless youth do
not seek help. The Capstone Project is to connect the youth, caregivers, and staff through a
secure interaction despite the negative conditions homeless youth experience with their primary
caregivers. The “do not seek help” norm affects millions of youth, costs millions of dollars, and
is further complicated by social inequalities that target youth from poor families, the homeless,
minorities, immigrants, and victims of domestic violence, substance abuse, and unemployment.
Traumatized and abandoned youth live and survive as best as they can in a social environment of
constraining and enabling factors. Additionally, early traumatic memories leave them in a state
of poor impulse control and unregulated stress; thus, they constantly apprehend threats, which
further damages their relationships with others (Camras et al., 1983). Homeless youth have
internalized a distorted view of relationships as not “good enough.”. They require consistent,
prolonged, and stable experience of human relationships that contradict and challenge their
hidden and distorted self-beliefs (Waters & Waters, 2006).
At present, this capstone is referred to as Reaching the Hard-to-Reach (RHTR). The
approach herein is to promote a secure base health education program focusing on ways to
connect and change help-seeking behavior in homeless youth. The aim of the RHTR program is
grounded by four major areas that all together can form a part of the current intervention session
across support services. These areas are 1) connecting the problem of attachment and it’s relation
to help-seeking behavior in homeless youth; 2) helping them moving through their difficulty and
increasing self-awareness; 3) aligning homeless youth stories with movie clips and/or story
telling, combining energy movements with its usefulness, and adding value to decreasing stress;
and 4) providing an environment that fosters secure attachments in their childhood by focusing
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on ensuring that they are emotionally secure enough after the program to then form a stable
attachment (Shorey, 2015).
The purpose of this training program is to define attachment theory, help-seeking
behavior, and energy movements; discuss its implications for homeless youth; and provide
secure base programs that support and increase connection when working with such a vulnerable
population. The goal of RHTR is to deliver an innovation program that utilizes the three
foundational pillars of security, safety, and connection to form a base for a way of relating. The
program will teach and provide youth shelters, transitional living housing, residential units,
empowered youth center, juvenile center, drop-in-centers, and school programs with an Eight
Pieces of Brocade, a qigong form of energy movements where homeless youth, families, and
staff can build on social relation and lessen the impact of insecure behavior and attachment
difficulties.
In summary, serious experiences of neglect and maltreatment have a profound effect on
homeless youth. They develop and transfer these negative expectations into their new
environments, such as foster care, adoptive families, or residential care. They relate to others
using defensive behavior, such as emotional distancing or social isolation, and they find it hard
to let adults come close, from the fear of attachment, to establish trusting relationships and have
a secure interaction (Taylor, 2010). RHTR is a diversified program with limited resources that is
designed for therapists to use in their own group sessions. With the secure-base innovation in this
program, it can produce a significant impact on the social well-being of homeless youth. The
goal is to link stories that play in part the role of childhood environment to enable subjects to
reflect on their own attachment experiences, and to create a narrative that improves and fosters
secure attachment. The core component of the program is to build a secure base interaction
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curriculum by training therapists, using energy movements through a slow meditative motion
activity, implementing data metrics to track program outcomes, and evaluating program efficacy.
The expected outcomes from the process is that a supportive environment for homeless youth
with repeated positive experiences will help staff assess the effectiveness of the implementation
phase through a structured interview and a review the participants’ weekly feedback sheet, which
includes questions about the effectiveness of the delivered user experience for that session, to
finally determine if the intervention achieved its goals: which areas would inspire trust from the
participants, will enable relationships with other youth, will lead to comfort regarding
dependence on staff, and will abate abandonment worries.

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II. Conceptual Framework
Introduction
The Social Work Grand Challenge of End Homelessness requires a comprehensive
framework. Specific to the needs of at-risk adolescents are prevention and early intervention
programs designed to facilitate stable housing and a smooth transition to young adulthood and
independence (Avenues for Homeless Youth, n.d.). The issue lies with attachment and its
relation to help-seeking behavior resulting in homeless youth being reluctant to take advantage
of programs that can help improve their health, education outcomes, and social relationships. For
achieving the same, we have to begin with understanding the overall goal in the developmental
experiences that these youth needed, but lacked, in their own childhood.
Definitions
Homeless youth are individuals under the age of eighteen who lack parental, foster, or
institutional care. These young people are sometimes referred to as “unaccompanied” youth. The
Runaway and Homeless Youth Act (RHYA) defines homeless youth as individuals who are less
than 25 years of age, for whom it is not possible to live in a safe environment with relatives, and
who have no other safe alternative living arrangement. This definition includes only those youth
who are unaccompanied by families or caregivers (U.S. Department of Health and Human
Services, 2008).
Review of Theoretical Approaches
Adolescence is when youth require a strong support system and feeling of
acceptance in order to face the complex and often troubling developmental tasks of
creating a stable identity and becoming productive and autonomous adults (Carnegie
Council on Adolescent Development, 1995). However, homeless youths find themselves
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dealing with an unrealistic test of independence. Living on the margins of homelessness is
challenging at best (Hughes et al., 2010). Additional experiences with unstable housing
include family rejection, neglect and abuse, economic hardship, and difficulties
experienced in accessing services for the homeless. As a result, many homeless youths are
at increased risk of poor social relations as they feel unsafe and disconnected (Yap et al.,
2013).
Attachment Theory
According to John Bowlby (1965), attachment is a deep and enduring emotional bond
that connects one person to another. It is based on an emotional tie and is grounded in trust and
built upon a history of shared experiences of emotion, attention and intention. There are three
attachments categories: a) Attachment System; b) Attachment Behavior, and: c) Patterns of
Attachment.
1. The Attachment System is based on biology that evolved to ensure the attachment of the
human infant. It is a “proximity-seeking” system. When an infant, child, or youth is
threatened in some manner, the attachment system is activated and attachment behaviors
are exhibited. When youth are threatened, they would seek proximity to a preferred other.
For infants, children, or youth, that “preferred other” will be the primary caregiver. A
primary attachment figure can change over time. For example, if a youth were in a car
accident, the first person they would call would probably be their primary caregiver, such
as a parent, grandparent, etc.; as an adult, they might call the significant other or partner.
2. Attachment Behavior is proximity-seeking behavior. A young child may run up to his/her
parent or a young adult may call their parent or significant other. Seeking proximity to a
preferred “other” leads the youth to feel safe, secure, and protected. As their emotions
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become regulated, the attachment system is deactivated and they can “get on with life”.
In a toddler, that is seen as the ebb and flow between the child exploring the area and
playing and returning to the parent to “refuel”.
3. There are several different “Patterns of Attachment”. These are not mental health
diagnoses. The terms are descriptions of the pattern or the manner in which the homeless
youth manage and negotiate intimate and close relationships. These patterns develop in
response to the sort of caring that infants, children, and youth experience, and are secure,
ambivalent, avoidant, and disorganized (Becker-Weidman, 2009).
Help-Seeking Behavior
The Attachment Theory (Bowlby, 1997), which frames background population
characteristics as having a direct influence on help-seeking and accepting behaviors through the
lens of attachment of avoidant, ambivalent, and disorganization relational factors, may have a
direct influence on the outcome of an effective intervention or program in turn. An “insecure
attachment” does not constitute a mental illness or psychiatric disorder. It simply describes a
characteristic way of relating to others, particularly caregivers. However, these relational
patterns, which are an adaptive response to the very early relationship with caregivers, can
become maladaptive when navigating relationships with others in the world beyond the family.
This point is particularly pertinent when considering the attitudes of some homeless teenagers
and young adults toward those who want to help them. While service providers and other adults
helping may see themselves as positive “caregivers,” homeless youth may not be so sure of their
reliability, trustworthiness, or usefulness as a result of their past experiences. They may not
eagerly accept offers of help, options for food and shelter, or opportunities that we consider
important for improving their health, education, employment, or the general sense of well-being.
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Stress and Stressors
Stress is the youths’ reaction on exposure to emotional, sexual, or physical abuse, which
is defined as something that threatens their safety and well-being. It arises out of worrying about
being able to cope and results in unpleasant emotional and cognitive reactions. Stress is
cumulative; the youth may cope with one stressful event in some circumstances but be unable to
cope satisfactorily with similar events when facing additional stressful situations. Stress is
compounded by a life cut adrift from the past, separation from families, uncertain futures, and
the lack of satisfactory regulation of emotions. Negative beliefs about the self and the attachment
figure (self-other beliefs) predispose the youth to interpret non-threatening events as possible
abandonment. As they are unable to protect themselves from this overwhelming stress, any event
might be perceived as a threat and may trigger stress responses in ways that are hard and difficult
for them to cope with. Under stress, they may revert to the solitary defenses they may have
previously used to survive (Taylor, 2010).
Theoretical Frameworks
Given the comprehensive approach and based on a Secure Attachment Theory in
examining the complexity of homeless youth, these early experiences of separation or neglectful
or abusive parenting cause homeless youth to remain anxious and distrust close relationships.
Homeless youth adapt to the lack of a secure base by developing different patterns of behavior.
Some may become wary and defensive, others are needy and demanding of care and attention.
Some of them, with unpredictable or frightening care, try to make their environment more
predictable through controlling behavior (Bowlby, 1988).
Over the past few decades, a set of specialized settings have been evolved to provide
services to this population of young people. These include outreach programs, short-term
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emergency shelters, and long-term programs such as drop-in centers and residential facilities,
also known as transitional living programs. Yet, to date, relatively little research has focused on
understanding these settings, their effect on youth, and aim to bridge that gap. Some studies have
been conducted on single behavioral interventions for homeless youth, such as HIV prevention
programs in a modest number of organizations (Altena et al., 2010; Pollio et al., 2006; Slesnick
et al., 2016; Woods et al., 2003).
Available research has consistently identified the quality of family relationships in cases
of emotional disorder in adolescence. Various writers have recognized that adverse family
experiences pose relentless threats to the consistent availability of parental care and emotional
support and thus to the continuity of the adolescent’s sense of secure attachment (Baumrind,
1993; Kobak et al., 1991; Rice, 1990). The Healthy People 2020’s objectives (US Department of
Health and Human Services, 2008) emphasize that the greatest opportunities for mental health
prevention are among young people, and these opportunities need to focus on enhancing
protective factors. Homeless, high-risk youth need multiple interventions over a number of years
to reduce the chance of mental health problems and addiction. In addition, the number of
homeless youth and interest in their welfare has prompted research into their characteristics and
circumstances. It has found that these youth are a heterogeneous group ranging, from youths to
young adults, with varying experiences of abuse and neglect (Whitbeck, 2009). Indeed, much is
known about the psychological and psycho-social aspects of homeless youth, but far less is
known about their everyday lives, including interests in music, and associated experiences in
health and spiritual development (Grabble et al., 2011; Woelfer & Lee, 2010).

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Integrating the Concepts and Review Previous Interventions
Although patterns of attachment were formed in infancy and can follow the youth
throughout their life, one can develop an “Earned Secure Attachment” at any age. This can be
achieved by making sense of the youth’s story. Dr. Dan Siegel (2018) explains that “the best
predictor of a child’s security of attachment is not what happened to their parents as children, but
rather how their parents made sense of those childhood experiences”. The key to “make sense”
of the youth experiences is to write a coherent narrative and/or to tell the stories, which helps the
youth understand how their childhood experiences continue to affect them in their present life.
This process of creating a coherent narrative by either writing or verbalizing will help youth to
build healthier, more secure attachments and strengthen their own personal sense of emotional
resilience. When youth create a coherent narrative, they actually rewire their brain to cultivate
more security within themselves and their relationships.
Another assumption in which a youth’s life unfolds is greatly influenced by the beliefs
and values held by the caregivers. These core beliefs trigger automatic thoughts about how to
react to the youth’s world. A mismatch between the youth’s needs and the developmental niche
is stressful for all those who are concerned. In order to work therapeutically with the youth,
caregivers need to be prepared to examine these core beliefs and reflect on their usefulness in
promoting the homeless youth’s recovery. Daniel Hughes (1997) suggests a few basic
assumptions which are helpful to have about the youth.
• The youth is doing the best they can.
• They want to improve.
• Life now is a living hell.
• In order to stay safe, they will try to control everything.
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• They will avoid anything painful or stressful.
• Their attacks on us reflect a lack of trust of our motives, poor emotional control,
fragmented thinking, pervasive shame, and a lack of impulse control.
• To change these youth, we will need us to accept, comfort and teach them, validate their
sense of self while teaching important developmental skills, and fine tune our
expectations to their developmental age so that they can experience success and not
failure.
• Under stress, they may revert to solitary defenses that they have used to survive before.
• They will have to work hard to learn how to live well.
Beliefs and assumptions such as these unconditionally value the youth and form the basis of
the therapeutic alliance of the youth’s best additional resource.
Qigong have been characterized as mind–body interventions and as “meditative
movements” (Larkey et al., 2009). They are relatively safe, nonpharmacological practices, which
can be used for treatment and prevention of psychosomatic disorders, with few adverse events
reported in literature (Birdee et al., 2009). In studies comparing the benefits of qigong with
general exercise, both interventions have been shown to have similar effects at reducing anxiety
(Jin, 1992; Bond et al., 2002). In general, evidence from clinical trials supports a positive
association between physical activity and physical and psychological health (Chow & Tsang,
2007; Broman-Fulks & Storey, 2008). A trial by Bhatti et al. (1998) administered to 51 patients
aged 18 to 60 years with chronic low back pain reported improvements in depressive symptoms
compared with a control group after 6 weeks of practicing Tai Chi and qigong once a week for
90 minutes.
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Qigong, which is sometimes spelled Chi-Kung and pronounced chee-gung, is the study
and practice of cultivating vital life-force through various techniques, such as breathing
techniques, postures, medications, and guided imagery. Qi means “breath” or “air” is considered
the “vital-life-force” or “life-force energy”. Qigong practitioners believe that this vital-life-force
penetrates and permeates everything in the universe. It corresponds to the Greek “pneuma,” the
Sanskrit “prana,” or the Western medical conception of “bioelectricity.” Gong means “work” or
“effort” and is the commitment an individual put into any practice or skill that requires time,
patience, and repetition to perfect. Through study, the individual aims to develop the ability to
manipulate qi in order to promote self-healing, prevent disease, and increase longevity (Cohen,
1997). Furthermore, qigong is sometimes described as “a way of working with life energy”
(Kerr, 2002). There are three main branches of qigong: the medical branch which is used for
healing, the spiritual branch for self-awareness, and the martial branch for self-protection. .
Qigong is intended to be harmonious with the natural rhythms of time and season. Additionally,
it may be practiced daily with the aim of health maintenance and disease prevention (Writer,
2008).

RHTR Logic Model
The logic model has been developed based on the proposed innovation of RHTR for
homeless youth, The RHTR logic model is illustrated in Appendix A. It identifies resources,
inputs, activities, outputs, and outcomes for the RHTR implementation, growth, and sustainment.
The RHTR logic model depicts the strategy and flow of program implementation. The logic
model describes the three different phases of RHTR, which are short-term, medium-term, and
long-term. Each phase outlines specific actions/tasks to be monitored and completed. This
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includes initiating the contract agreement for training and piloting the Empower Youth Program.
A division at the California Family Life Center (CFLC) was established, which will monitor
changes in participants’ and staffs’ behavior as anticipated with the intervention, particularly
while reviewing selected clinical surveys such as the Likert-Scale 6-item Questionnaire and the
Relationship Therapeutic Alliance evaluation. The data/outcomes of the program will be
presented and reported to the CFLC Board of Directors in order to gain support to launch the
RHTR program to the county-wide homeless youth programs and other at-risk youth
organizations.
The RTHR logic model starts with the resources and inputs grounded in the three
foundational areas, to train staff and interns. Inputs will include using an existing position
description already available in the Department of Human Resources at CFLC. Another input
includes providing clinical hours for the Associate Clinical Social Worker to implement the
RTHR and providing training on the use of qigong in group intervention. The use of pay raise,
relocation, and loan repayment can be made in the input as incentives to recruit and retain best
qualified staff.
The secure base interaction curriculum includes developing a course integrating the
concepts from the work on attachment by John Bowlby as part of the inputs and resources.
Understanding the patterns of attachment and the consequences of insecure or disorganized
attachment sufficiently to recognize and respond to the attachment needs of homeless youth, as
well scholarly research by Chris Taylor (2010) should also be included. Purchasing printers,
binders, and papers in order to produce the materials for therapists will also be necessary.
For effective screening/clinical tools and metrics, the use of the Attachment
Questionnaire for Children (AQC) as a 1-item self-report measure of children’s attachment style,
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which is based on Hazan and Shaver’s (1987) single item measure of adult attachment style, is
necessary. Children are given three descriptions of feelings and perceptions about relationships
with other children and are asked to choose the description that best fits them. Additionally, the
measure classifies children according to one of the three attachment styles: secure, avoidant, or
ambivalent (Muris et al., 2001).
RHTR modifies the approach by using only the AQC Secure Attachment Style as a
measurement of interactive activity to test the project’s secure base approach. The project
clientele will fill out the Likert Scale 6-item questionnaire (see Appendix B) to rate their
responses before and after the 12-week project with the same set of questions concerning their
feelings and perceptions about relationships with other group members and the activities. The
questionnaires will be administered and collected by the program educator/contractor. In the area
of staff effectiveness, the TA will enable the assessment of this outcome. The TA survey (see
Appendix C) is a three-item clinical survey that indicates the effectiveness and strength of
response from the participant to the clinical provider (ASM Research, 2012).
RHTR logic model activities and outputs include having a staff training and workload
performance goals and objectives. It also includes half-day training for staff to utilize and apply
in four closed-group interventions to complete the program, amounting to 45–60-minute sessions
each week. There will be no more than 6–9 homeless youth enrolled in each group. The core
curriculum to train therapists focuses on the learning outcomes of attachment as outlined in
Bowlby’s theory of attachment. These include locating the attachment relationship, recognizing
the stages of attachment development, understanding the principles of feedback in attachment
security, considering the impact of traumatic stress, and contributing to developing a model for
recovery by recognizing and responding to a youth’s attachment needs (Taylor, 2010). In
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addition, part of developing the curriculum with the activities and outputs would require staff to
observe, participate in and demonstrate energy movements. This curriculum is flexible in that it
can adjust and accommodate the changing needs of the homeless youth.
In the RHTR logic model, outcomes and impacts are associated with the three phases:
short-term (six months), medium-term (one year), and long-term more than one year). The
milestones anticipated to be achieved within the short-term after initiating the RHTR program at
CFLC include increased trust of homeless youth for the center/organization with this unique
health education intervention, since this program will be the first-ever to be used as a service
delivery using a combination of attachment and energy movements curriculum and clinical
outcome measures. Other outcomes include increasing the creativity and competency of staff in
delivering care and relating to the homeless youth.
In the short term, initial changes in RHTR behaviors should be demonstrated by homeless
youth and observed by the therapists. There should be a noticeable change in scores obtained by
the clinical measure, particularly a positive/increase in the attachment and therapeutic alliance
score. At this phase, the aim of RHTR should be to create changes within the agencies
/organizations at the internal and external levels. Increasing help-seeking behavior within the
framework of recovery and relation between homeless youth and caregivers would help
eliminate further trauma and increase the latter’s help-seeking tendency and relationship score.
During the medium-term phase, the RHTR pilot program should have some data to be
reviewed and analyzed. These findings should be developed and presented to the CFLC directors
and managers. In addition, preparation should be made to scale and launch the second phase of
the pilot program to the same center in another city and other agencies. Other outcomes during
the medium-term include anticipating, adjusting, and/or improving the curriculum to match
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emerging best practices and recommendations. It is also anticipated that homeless youth that
have completed the program should demonstrate continued participation and behavioral changes
during this period. These outcomes are not only measured by self-reporting and clinical
measurements of attachment but also post-program survey administered to volunteer homeless
youth at nine and eighteen months post RHTR completion.
During the long-term period, the expected outcome includes increased social engagement
and health outcomes for homeless youth and increased help seeking behaviors. Data from the
other pilot programs should be tracked, analyzed, trended, and reviewed during this phase, along
with the preparation and presentation of these findings to the Board of Directors at CFLC. In
addition, the findings from all pilot programs should be reported and submitted with approval to
the center’s newsletter, local newspaper, and the CFLC website. Finally, two key outcomes
should be expected in the long-term. They are 1) standardization of RHTR as part of group
intervention and 2) partnership with other agencies and programs, such as school programs and
substance abuse treatment programs, for piloting.
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III. Problems of Practice and Solution (s)/Innovation(s)
Goals and Objectives
In order to tackle the grave problem of homelessness, RHTR proposes an innovation that
focuses on implementing a secure base health education program, utilizing storytelling and
energy movements within a social relation environment to improve the safety and connection of
homeless youth. The process involves conducting 45–60 minutes weekly sessions of group
intervention/therapy/intervention for four weeks and maintain a weekly session log. The outcome
is to improve the feeling of security among homeless youth by the fourth week treatment period,
measured quantitatively by the scores of the Attachment Questionnaire (AQ). In addition, this
group intervention aims to engage homeless youth in social activity to reduce isolation by
helping them feel a sense of belonging and involvement, leading to them making friends. The
RHTR program aims to establish an open and positive environment as an effective means of
health education.
RHTR program also takes part to contribute and to improve homeless youth in the Grand
Challenge (GC) to Ensure Healthy Development for All Youth. This GC includes an initiative
called Unleashing the Power of Prevention (Hawkins, et al., 2015). The goals in this GC are to
reduce the incidence and prevalence of behavioral health problems in young people from birth
through age 24 years by 20 percent from current levels over the next decade; and reduce racial
economic disparities in behavioral health problems by 20 percent over the next decade (Jensen,
Hawkins, et al. 2015). Based on the public approach to implement these intervention programs.
They are: The Universal, The Alternative Thinking Strategies, and The Selective The objective
of RHTR program is using the Selective prevention program to target youth who are at risk by
matching them with positive adult roles model i.e. Big Brothers Big Sisters (DeWitt, et al., 2006)
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Stakeholders’ Perspectives
Seeking input from stakeholders is crucial for the RHTR project. This includes
communicating either verbally or in writing to answer any questions that the Board of Directors
and the management team would like the project to address. Additionally, this involves the
RHTR project educator, who has an overall grasp of the capstone, and CFLC’s staff/volunteers
that are involved in the day-to-day workings of the project and have an insider perspective of the
organization. All the project clientele/participants/consumers at CFLC are directly affected by
the project services. Furthermore, the internal stakeholders also include the independent
contractor, the employees, the accountant, and the billing staff.
The external stakeholders would include the youth, families and foster parents being
served by child welfare, juvenile court judges, the children’s and guardian division, the media,
state and federal politicians, school districts, and other counseling centers. In addition, funders
such as private donors, fundraisers, and foundations are an important component of the
organization. On February 22, 2019, a Homeless Liaison Coordinator from the Desert Sands
Unified School District responded to both my email and phone call. She provided a very
comprehensive school-based program for homeless children and youth using the McKinney–
Vento Homeless Assistance Act, Title X, Part C, which defines homeless people as “individuals
who lack a fixed, regular, and adequate nighttime residence” (Early On, 2012). These services
include the following: 1) free lunches provided immediately; 2) free school uniforms, backpacks,
and school supplies; 3) education; 4) a student studying team; 5) parents’ assistance to improve
living situations; and 6) student assistant programs for individual counseling, if needed. The
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aforementioned school district also has an outreach program, which functions as a support
system for homeless students and their families.
At the board meeting held on November 27, 2018 for the Desert Healthcare District,
Barbara Poppe and associates, the consultant hired to tackle/end homelessness in Coachella
Valley, California, reported their findings. One of their recommendations was to improve cross-
sector responses, which are as follow:
1) Identify, link, and coordinate services and programs to stabilize the most vulnerable
children and families;
2) Focus on children and youth who are identified as homeless through early childhood
programs and school systems, and intersect with domestic violence and child welfare;
3) Initially improve awareness regarding available resources as well as identify ways to
reduce duplication and better fill gaps to provide a more holistic response.
Both these programs listed above are not collaborating with each other at present.
RTHR builds on existing evidence and landscape history
Homelessness is a major concern in the United States, and American youth are part of the
age group at higher risk of becoming homeless (Toro et al., 2007). The number of youths who
have experienced homelessness varies depending on the age range, timeframe, and definition of
homelessness used. However, sources estimate that around 500,000 to 2.8 million youth are
becoming homeless in the United States each year (Cooper, 2006). California comprises 12
percent of the nation’s population of homeless families with children. From 2016 to 2017, the
state experienced one of the largest increases in the number of homeless families in the nation,
leaving 1,000 more families on the streets. Apart from homeless families, California also
reported the largest number of unaccompanied homeless youth, which includes any individual
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under the age of 25 who does not live with a family member. Overall, 58 percent of the nation’s
unsheltered homeless youth resides in California (Cabales, 2018).
Riverside County (RC) has a population of 188,789. The 2019 RC Homeless Point-In-
Time (PIT) Count identified a total of 2,811 sheltered and unsheltered homeless adults and
children county wide, 21 percent higher than the count in 2018 (2,316). Both the unsheltered and
sheltered counts also experienced a 21 percent increase compared to 2018 (2,045 to 2,811
unsheltered and 631 to 766 sheltered). The unsheltered count by Sub-Populations County-wide
for youth is 181 (2 percent increase from 2018); however, the sheltered count for youth is 83
(20% increase from 2018).
RHTR Project Implementation and Opportunity for Innovations
The implementation strategy employed for RHTR is based on a multifaceted approach
using the expert recommendations for implementing change (ERIC) model. The ERIC model is
the most appropriate implementation strategy for RHTR, given its extensive techniques and
concepts, with the flexibility to enhance the implementation of the RHTR in a clinical mental
health setting (Brownson et al., 2017).
Developing and organizing quality monitoring systems is one of the ERIC techniques that
will be used during RHTR implementation. As there will be multiple areas within the program
that will be evaluated and measured for outcomes, quality monitoring systems will be
implemented to ensure the fidelity of the data collected. Areas that will be measured and
monitored are clinical outcomes using clinical questionnaire surveys, clinical provider
effectiveness based on scores from the Therapeutic Alliance (TA) survey, and an overall
program effectiveness based on clinical outcomes and provider and curriculum effectiveness.
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Using a data expert is another ERIC technique that will be adopted. This is necessary
given the volume and workload for data collection/analysis that will require specialized
expertise. The data expert will be a consultant/professor from the University of California. The
program educator/contractor will be responsible for providing direct support to the program
director by collecting, storing/safeguarding, analyzing, and coding all the data metrics and
generating and delivering outcome reports to the program director.
Conducting local consensus discussions is another ERIC concept that will be used to gain
buy-in and support for the program from the Chief Executive Officer and the management team.
These two coalitions are major stakeholders and advocates for implementing and sustaining the
success of the program.
Conducting ongoing training is another ERIC technique that will be used in RHTR. Due
to the unique expertise required for RHTR as well as the emerging trends of trauma informed,
clinical providers will be required to attend the Staff Support Training (SST) in Riverside, CA,
every 18 months. The SST course is a one-day conference that covers a broad range of topics
about family violence along with separation and displacement, which will include break-out
groups for more technical/formal training and discussions on certain subject matter expertise.
Preparing patients/consumers to be active participants is another technique. This is
important for both the program as well as to obtain informed consent from the participants. As
part of a marketing strategy of RHTR, the public will be informed about the program and its
value, including details of how participants can access care and the level of engagement required
on enrollment. During the pre-screening/comprehensive biopsychosocial assessment for potential
participants, more detailed information will be provided to the participants of RHTR, which will
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include the importance/value of their participation in their care throughout the entire care
process.
Broader Impact of RHTR Innovation
RHTR is a clinical intervention program that will require full consideration regarding the
program implementation and effectiveness measurement relating to its long-term sustainability
and impact on the homeless youth population in the Coachella Valley. One of the strategies that
can facilitate such an endeavor is the use of an evidence-based practice (EBP) framework, which
is proven to be effective in both program implementation and evaluation. After reviewing the
literature of several different implementation and evaluation frameworks, it has been found that
the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework (see
Appendix D) provides a comprehensive approach in assessing these two major areas (Weaver,
2013). More importantly, it is a framework that is often effective with health education
interventions and resolving public health problems, making it a good fit for RHTR (Glasgow et
al., 1999; Nilsen, 2015).
The overall program effectiveness outcome will be measured based on clinical outcomes,
staff effectiveness, and the outcomes of the six-month facility re-visit survey, using the
attachment questionnaire scores and their increment over a duration of 18 months. Qualitative
data from interviews, observations, written documents or journals, and open-ended survey
questions will be used for part of the project analysis. The purpose is 1) to measure homeless
young adults’ feelings and perceptions about other young adults, group members, caregivers, and
staff and 2) to evaluate the impact of the project/curriculum by looking at the differences
between pre- and post-test results.

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Assessing the Potential for RHTR Success
The plan for measuring the outcomes for RHTR is to use a pre-experimental design one
group pre-test and post-test. The group will be composed of one cohort, which will consist of at
least six and no more than nine homeless youths. To measure clinical outcomes, RHTR surveys
will be administered to each individual participant prior to starting the program. These will be
completed using the Likert Scale 6-item Attachment Questionnaire (AQ) to collect and analyze
the relationship data regarding beneficiaries, which, in this case, are the RTHR participants. The
participants will then complete the same surveys before the session starts and immediately before
leaving the final fourth session of the program. Additionally, the data analyst will be the program
educator/contractor who will collect the scores from the pre- and post-test for analysis and
coding and then review the outcomes with the program director. Improved scores on both AQ
and TA will suggest effective clinical outcomes.
The TA score will be used to measure staff effectiveness outcomes. The TA survey will
be administered to the participants when reporting the fourth session and the remainder of the
program. Because TA measures the responsiveness of the participant to the clinical staff, it will
be unfair to administer TA during the first four session because the participant is just starting to
build a rapport with the clinical provider. The compliance with set standards for TA scores will
suggest staff effectiveness.
The combination of AQ and TA scores will be used to evaluate the overall program
effectiveness. The only other data to be considered will be the data and outcomes of the facility
re-visit surveys administered to participants at every six-months interval starting from the date of
program completion for a duration of eighteen months. The AQ survey will be primarily used for
this and will only be administered to participants who volunteer for it. The data analyst will be
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the program educator/contractor who will collect, analyze, and code all three major measured
objectives and review them with the program director to generate appropriate outcome reports.
The strength of the evaluation lies in the use of both EBP clinical surveys and the
program curriculum. It also lies in the efficiency of data collection, using computers to complete
web-based structured questions on the surveys; more importantly, the secure storage of the data
is ensured in an access-only data portal. The contribution of a data analyst also strengthens the
program, since they can provide the most optimal expertise to ensure that all aspects of data
collection, analysis, coding, and reporting are performed to meet the set standards. Another
strength lies in the ability to monitor the long-term impact and sustainability of this program with
the eighteen-month facility re-visit survey. Accountability is also established with milestone bi-
annual reporting requirements, which also strengthens the program, ensuring that it is responsive
to external institutions. Another identified strength is the effectiveness and productivity of the
clinical staff. Far too often, most mental health clinical intervention/programs focus on only
participant/client behavioral changes; RHTR ensures that the effectiveness of the clinical staff is
evaluated, particularly with regard to its potential effect on participants’ clinical outcomes
(SOWk 713).

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IV. Project Structure, Methodology, and Action Components
Prototype
Reaching the hard to reach (RHTR) intervention is a health education program that
intends to bring about social interaction and physical engagement as a way of relating for the
homeless youth population, to cater to their need to feel secure, safe, and connected. To improve
health and wellness, the RHTR program provides four weeks of activities that include the
following: a) practicing energy movements to improve physical strength as a way of relating to
engage and interact with their peers; b) collecting and analyzing secure base data through pre-
and post-test to measure the clinical outcomes and the overall program effectiveness, and c)
being sensitive to the rules being used but not limited by the knowledge of where modifications
are likely to occur.
Intervention Design/Journey Mapping
During the four weeks of creating a secure base interaction, the therapist starts out with
giving the youth time to warm up to each other, to share their stories and experiences through
movies, and then engage them using qigong from China. The therapist uses these energy
movements named the Eight Pieces of Brocade. These are 1) pressing up with two hands, 2)
drawing the bow and letting the arrow fly, 3) separating hands, 4) turning from side to side, 5)
gazing backward, 6) touching the toes, 7) punching with fists, and 8) rising up on the toes. These
energy movements are for loosening the muscles and increasing strength and balance (Yang,
1997).
The above is combined with a template, as described in SOWK 723, for storytelling and
roleplaying to identify feelings. The therapist’s role is to encourage the sharing of emotional
stories. If someone has had difficulty narrating their stories, other group members are asked to
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pitch in, to partner, and to collaborate to create and complete each other’s stories. The stories are
allowed to drift toward less positive emotions by gently pointing them out and allowing players
to add or change accordingly. The therapist needs to be prepared to manage what may emerge
and let the meeting conclude on a supportive and hopeful note. Storytelling is simple but
powerful. It encourages sharing, highlights many things the youths have in common, and
leverages the natural tendency of group sessions to establish a form of dialogue. Humans want to
tell stories, and these youths especially need to be heard, to have fun, to laugh, and to feel that
they have a voice (Gray et al., 2010) (see Appendix E).
Financial Plans and Implementation Strategy
In phase I, the RHTR will start out with a per day Licensed Clinical Social Worker who
receives no benefits and can be available on a specific date and time at which the service is
needed. As the business expands in phase II, an Independent Contractor is developed—and
RTHR becomes a not-for-profit single-owner business in the first year. As a business, the RHTR
program plans to register with the State of California as a Single-Member Limited Liability
Company to protect personal finances. According to Next-Insurance (2019), an independent
contractor is someone who works for someone else, but not as an employee, to provide a service
rather than a product. They are brought on as a consultant and/or to work on a specific project.
Staffing Plans and Costs
For the first year of operations, RHTR will have only one independent contractor: the
director. The position will be a part-time one requiring ten hours of work per week. Over the
course of the first year, the director will work 480 hours and be reimbursed at $40.00 an hour for
a total cost of $19,200. The estimated benefits will be 20% of the salary for a combined total of
$23,040. Eligibility for the position of the director will require a degree in social work, master’s-
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level training, and licensure, with a preference for a doctorate. The independent contractor must
adhere to all standards of practice as outlined in the National Association of Social Work’s
(NASW) code of ethics.
Other Spending Plans and Costs
Secondary expenses to consider include the initial cost of registration for the business.
The additional cost of $100 after a year for an independent contractor is required for the
registration for the state as a Single-Member Limited Liability Company and, possibly, another
$600 to become a nonprofit. Other costs include rent, travel, tax, office supplies and print
materials. Developing additional contract work, such as technology, marketing, and website
design and operation, will also be a part of the expenses. The total cost will then be $11,906,
which leaves a surplus of $18,334 (see Appendix F).
The plan to disseminate RHTR outcomes/findings will focus on two major stakeholders:
the inner-context and the outer-context. The findings for the program will be presented and
disseminated bi-annually by the program educator/contractor in person to the funders, which
include the county of riverside probation and mental health department, desert healthcare district,
riverside economic development agency, local community, and others. This improvement
process of the collective work will be handed over to the chief executive officer and management
teams after the 18-month contract expires. The program educator/contractor will retain the
ownership of the intellectual property. RHTR is responsible for disseminating information,
trends, statistics, safety, best practices, information program, and services, among many other
items regarding the Coachella Valley Community. Both the presentations of the outcomes will be
conducted digitally, in the form of statistical models and graphs as well as the data point trends.
User Involvement / Participation
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RTHR’s therapist seeks to benefit from the practice by using the “liking bond” (Cialdini,
2009) between homeless youth as friends even when they are already formed friendships. The
compliance strategy is quite direct: therapist first get homeless youth to like him/her; then get
them to participate by consistently offer them just three things: be there, be available, and be
someone that they like to practice with. In addition, positive comments produce just as much
liking for the flatterer when they were untrue as when they were true (Drackman, deCarufel &
Insko, 1978). In short, positive comments have such an automatic positive reaction that therapist
can use on homeless youth in an encouragement for them to participate. “Cooperative learning”
(Sherif, Harvey, White, Hood & Sherif, 1961) is another way to establish cooperative by
working for the same goals for mutual benefit of the group.
Rewards and Incentives
Whether agencies are working on their goals privately and/or personally, RHTR needs to
align the goal of the project with the goal of each organization. RHTR should also seek to
improve the available resources. It should identify ways to reduce duplication and better fill
gaps. RHTR should also create a more holistic community response through a motivation to
change, as well as a recognition system that reaches out and supports both the people and the
agencies’ interest and responsiveness. Families who are homeless also need to have mutually
supportive and responsive relations with each other, thereby enabling them to view each other in
positive ways (Swick, 2004).
Branding RHTR nonprofit’s fundraising products and t-shirts (see Appendix G) is
necessary as an incentive, as future supporters donate to become a part of something bigger. This
is all a part of how RHTR presents itself to the riverside county community. RHTR has already
designed the branded t-shirts that homeless youths, therapists, and directors can wear. It is in
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production at this time and will be ready as part of the incentive when the homeless youth finish
their four weeks of group participation. In addition, RHTR will identify and encourage homeless
youth as champions to inspire them to continue on their own and/or practice with other groups.
Ultimately, RHTR hopes to go beyond the products themselves and encompass the entire
fundraising/incentive effort (Lau, 2019).
Capstone Barriers
One of the barriers is the potential of not having a more representative sample of the
population, particularly since a significant number of youths will likely focus on job search,
employment, and attending college or vocational school. Even though RHTR is a voluntary
program with the availability of other treatment options, the youth might be too tired or have no
time to participate, and they might not be interested due to fear of having to share or to open up
with other youth.
Another potential barrier is the data input-sensitive nature of the clinical instruments.
Participants will have to complete this twice in the four weeks, one prior to the start and another
after the group session, and three more times during their eighteen months group treatment at
CFLC. The time to complete all instruments will be less than 15 minutes; however, this could
lead participants to rush through the data input and not provide accurate responses to the clinical
instruments.
In the adoption phase, the attitude of staff who will be delivering the RHTR program can
also be a barrier. Some staff may not fully understand the purpose of the program or may have
some reservations about its effectiveness; they may also feel frustrated with the addition of one
more program to the already existing programs. These factors may hinder the staff’s
effectiveness in delivering the program and affect their direct interaction with program
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participants (Ruggieri, 2016). There are several facilitators in this phase to provide additional
training to the staff, if necessary; reduce their workload from other non-essential administrative
duties, such as process improvement projects and committee participation; and provide training
in creative skill development in group treatment and job satisfaction for involvement in the
program.
Another barrier in this phase could be participants dropping out of the program sooner
than expected due to other duties or tasks and the CFLC CEO’s lack of interest in RHTR
program. Establishing a mutually agreed upon treatment contract to exempt the participant from
any additional duties/tasking while being enrolled in the program can facilitate the relationship
between the CFLC director, manager, and staff. This relationship can be enriched through
building social network connections between community leaders, service providers, and other
social and healthcare agencies.
One barrier in the maintenance phase is the potential pushback from other homeless
youth installations regarding scaling the program to their locations, and the impact on their staff
workload. One facilitator that can be leveraged is the CEO for Installation Management. This
office is the proponent and authority for policy and regulation regarding homeless youth
programs. This office can direct and/or facilitate policy and regulation in the
standardization/utilization of RHTR across all homeless youth shelter installations.

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V. Conclusions, Actions, and Implications
Potential Future Decisions and Actions
RHTR aims to increase the feeling of security among homeless youth as well as enhance
their desire to seek help, feel safe, and be connected. The two methods used by the staff to assess
the effectiveness of the implementation phase are structured interviews and reviews of the
participants’ weekly feedback sheets, which includes questions about the effectiveness of the
delivered user experience for that session, and determine if the intervention achieved its goals,
i.e., whether the participants are experiencing trust, finding it easy to make friends with other
youth, are comfortable with depending on staff, and are not worrying about being abandoned.
Contextualize Project Conclusions Within a Field of Practice
“Sale” is not a dirty four-letter word, as mentioned by Professor Wind in week 8, USC
SOWK 707, regarding operating processes logic model, unit of services, budget models, formats,
and cycles (August 2nd, 2019). Are we planning correctly? Will we make money? How do we
know? (Peavler, 2019). The comments and questions from the classroom, through the
asynchronous coursework and the research materials, are the first and most important
components of any operating budget in the sales division, listing the expected units and revenue
expected from the sales plan. The more accurate the sales forecast, the more effectively RTHR
can manage its business.
In addition, Mortensen (2019) wrote about empathy which enabled RHTR identify the
connection between its financial and clinical programs.
Engaging with people directly reveals a tremendous amount about the way they think and
the values they hold. Sometimes these thoughts and values are not obvious to the people
who hold them. A deep engagement can surprise both the designer and the designee by
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the unanticipated insights that are different from what they actually do- are strong
indicators of their deeply held beliefs about the way the world is. (d. School Bootcamp
Bootleg, 2013).
An RHTR educator becomes empathetic toward the homeless youth, by either observing
them in their environment or engaging with them during interviews. There is life in the RHTR
program because it is about the lives of the homeless youth who only want to feel secure, safe,
and connected.
Innovation for Practice and Further Action
The total expense for year one is projected to be $34,946, which leave RHTR with a
surplus of $18,334. Without cash, the RHTR cannot survive. This is the primary reason for a
cash budget. Because of the unpredictability in the training services, the requirement for
continuing education is the last on the list of priorities on the clinician’s mind, and only if it is
mandated. Another unpredictable aspect is that the payments for these training sessions can be
delayed, especially when the agency has a 30-day grace period to make the payment. Predicting
cash flow requires a lot of thought and planning. Cash flow should be reviewed on a monthly
basis to enable the director to foresee cash shortages and seek possible financing if necessary.
The formulation of a realistic budget is key to the efficient operation of any program and
is especially critical to the survival of a small business. Staff efficiency results in high-quality
care. This, in return, results in financial success for the business. Budgets help accomplish this
because the budget process and financial statements identify problems, define areas for
improvement, and allow the director and the accountant to maintain and reinforce excellence.
Planning and timely preparation are imperative components. Kistner (1990) states that at least a
couple of months are needed to prepare the budget.
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Limitations
There are some limitations with the evaluation of the program: the sample size is
underrepresented, and there are only six to nine youths per cohort, which is a very small sample
size. Even if we add up all the six cohorts from the entire 16-month pilot, that still only equates
to 36 youths, excluding the potential for a drop rate of perhaps one youth (25%) per cohort. To
overcome some of these limitations, an active engagement and networking strategy with the
management team should be developed, which can be very helpful in promoting RHTR and its
advantages to prevent or reduce returning to the streets, particularly for the new members of
CFLC. The house supervisor and the clinical staff can also ensure that the youth understand the
voluntary nature of the program and reduce the perceptions about negative program implications
or stigma associated with seeking treatment in a structured governmental setting (SOWK 713).
Concrete Plan for Advancing Next Steps
RTHR continued to attend the Student Assistant Program held monthly at Daniel’s
Children Pavilion located at Betty Ford Substance Abuse Rehab Treatment Center, Rancho
Mirage, where the RHTR program is being planned for implementation. Multiple agencies from
the community participated; during the introduction, a hand-out of RHTR’s infographic (see
Appendix H), Attachment Questionnaire, and a two-minute presentation were given to address
the following questions: 1) What? The proposed health and education program of RHTR; 2)
How? By using the attachment concept as a secure base interaction combined with a slow
meditative motion activity to engage the homeless youth in feeling secure, safe, and connected;
and 3) When? RHTR is at its final stage and will be ready for implementation soon. After a
demonstration of the energy movements, a Desert Sands Unified School District Counselor and a
Substance Use Rehab Coordinator took the above information and requested people to contact
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them for further communication and logistics in delivering the RHTR program/service to these
agencies/organizations.
On February 18, 2020, an RHTR educator re-visited the Transitional Age Youth (TAY)
Drop-In Center and met with the Executive Director and Peer Specialist to provide the same
presentation with the infographic, attachment questionnaire, and demonstration. Afterward, the
director asked for the educator’s resume and invited them to attend the Homeless Youth
Coalition Consortium on March 17th, 2020, at Harrison House, a Transitional Living for Youth
Aging Out of Foster Care. However, this meeting was cancelled due to COVID-19, and no group
has gathered at any of the centers/organizations since March 15
th
, 2020.
The RHTR is at the final stages of development and ready to be implemented. On
February 20, 2020, an RHTR educator visited CFLC, a family counseling service for foster
families, youth homes, job education centers, kinship support, and a chaplaincy for children and
youth, and met with Dr. Jill Miller, DSW, in Cohort 5 and the Mental Health Director. The
educator provided the infographic, attachment questionnaire, and demonstrated the energy
movements, along with RHTR’s resume. The director gave a tour of the facility and area where
staff training and group sessions were to be held. The director confirmed that they look forward
to RHTR program being implemented and launched by the end of May 2020 or whenever the
restrictions owing to COVID-19 are lifted.

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Appendix
Appendix A
RHTR Logic Model
Resources/Inputs Activities/Outputs Outcomes/Impacts

BesBes

Short-Term Medium-Term

Long-Term

Training
Staff and
Intern
Secure Base
Interaction
Curriculum
Effective
Screening
and Clinical
Metrics
Per Diem vs
Contract
Agreement
RTHR
Prints
Binders
Data
Collection
Tool
Staffing
Metrix &
Workload
Performance
RHTR
Curriculum
Attachment
Questionnaire
Clinical Tool

Four-
hour
staff
training
for 4
weeks
Core:
Finances
Flexible
Secure
Base

Likert scale
Therapeutic
Alliance
Pilot RTHR in
Coachella
Valley, CA.
Increase trust
and
participation.

Understanding
patterns of
attachment
Respond to
needs of
homeless
youth
Decrease
negative
outlook.
Increase
communi
cation
and
activities.

Complete
data
collection/
analysis
from
program.
Present
findings to
the agency
Increase
involvement
and
participation
Curriculum
evolved and
expanded.

Improve
clinical
outcomes.
Improved
program
evaluation.
Increase
feeling
secure,
safe, and
connected.
Data
collection
and
analysis
reviewed/
presented
to the
agency
board of
directors.
Take
program
to other
local
agencies,
other
counties,
and other
states.
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43
Appendix B

ATTACHMENT QUESTIONNAIRE FOR HOMELESS YOUTH – 6-ITEM SELF
REPORT

No

May be

Yes
1. I find it easy to become friends with other
youth
1 2 3
2. I trust them

1 2 3
3. I am comfortable depending on them

1 2 3
4. I do not worry about being abandoned

1 2 3
5. I do not worry about another youth becoming
close friends with me
1 2 3
6. Are there any improvements that you feel we
could make to the energy movements
(qigong)?

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Appendix C

Therapeutic Alliance (TA) Metric

Therapeutic alliance score ranges from 0–30 and is the sum of the three items of the
patient satisfaction questionnaire. TA is administered at the frequency of once every 30
days at follow-up or sooner depending on the needs of the program.

Question 1

My health therapist/provider(s) and I have a good relationship and
work well together (0–10)

Question 2

My provider (s) and I are working toward mutually agreed upon
goals (0–10)

Question 3

My provider(s) and I agree upon the best approach for addressing my
problems (0–10).

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Appendix D

RE-AIM
Components/Logic Model Phases Conditions

Reach/Short Term
Coachella Valley, CA population 188,798. In 2018, Point
In Time Count for unsheltered was 1,638. Youth aged 18–
24 numbered 96. Harrison House, a homeless youth
sheltered for transitional age youth (TAY), serves only 20–
30 youth. California Family Life Center serve Foster Care
Youth age 16-24.

Effectiveness/All Phases
The following three major areas will be assessed to
determine if the intervention achieves its goals: 1) clinical
outcomes, 2) staff effectiveness, and 3) overall program
effectiveness.

Adoption/All Phases
Staff includes the program educator/contractor, two
licensed independent practitioners and one art therapist.
The adoption will be assessed based on structured
interviews of the staff by the chief executive officer and
the management team at CFLC.

Implementation/All Phases
Assessed by how each participant participates throughout
the twelve-week program, including completing all clinical
questionnaire/surveys. Because of the importance of
HOMELESS YOUTH

46
program fidelity in implementing the component and
auditing by the program educator/contractor, the pre-
screening biopsychosocial encounters between clinics and
the participant will be completed to ensure both informed
consent and fidelity.

Maintenance/Long Term
Assessed by employing and monitoring the six-month
increment of facility re-visit for a total of eighteen months,
which will provide an indication maintenance effectiveness
on participants’ clinical progress and outcomes over time.

HOMELESS YOUTH

47
Appendix E

Journey Mapping
User Experience: Energy Movements

Stages of
Journey

Goals/
Activities
Keep to himself
or herself
Only want to
play video
games
Isolate
Insecure
Meet in group
weekly
Align
stories/movies in
relation to
energy
movement and
life force
Continuous
practice
Allow energy to
flow naturally
Connect body
and mind
Channel way to
express
Encourage to
share and
practice together
Explore coping
skills and self-
awareness

Emotional
Response

Thoughts
Need time to get
to know group
member
Still not sure but
start to think that
it’s OK
Surprised to see
how easy it is to
learn and move
through
difficulty
Satisfied with
trying something
new
Desire to seek
help

Experiences

Ideas to
Improve
Meet youth
where they are at
Get friends to
join

Get a reward
such as a T-shirt
Youth as
Champion
Adopt energy
movement as
part of their
lifestyle

Pre-service Onboard Education Support
Guarded
Distance
Annoyed
about having
to meet new
members
Warm up
to group
member
Feel safe
and
connected
Feel
happy
and
useful
Aha!
moment

Defensive Ambivalent Acclamation Wellness
Defensive Ambivalent Acclamation Wellness
HOMELESS YOUTH

48
Appendix F
Line-item Budget
REACHING THE HARD TO REACH
STATEMENT OF ACTIVITIES AND NET ASSETS – YEAR ONE
Revenues
Contracts $ 500 per 4 hours training x 96
Other revenue 55 per hours for consultation, support x 96
Total revenues 48,000 + 5,280 = 53,280
Expenses
Salaries and wages 19,200 .25 FTE 480 hours (384+96) @ $40hr
Employee benefits 3,840 20% x 19,200+ $3,840
Total personnel 23,040
Operating
Space—rent and other 3,600 $300 x 12
Equipment rental 25
Office supplies and expenses 1,500
Telephone 1,185
Travel and conferences 1,400
Insurance 267
Dues and subscriptions 383
Audit 166
Contract services – Marketing 500
Other – Tax 2,880 15% x 19,200 = 2,880

Total expenses 11,906

Net assets: Beginning of year -
Net assets: End of year $18,334
HOMELESS YOUTH

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Appendix G
RE-AIM Table
Dimension Summarize, Barriers and Facilitators

Reach
The Coachella Valley had an unsheltered PIT Count in 2018 of 1,638.
Homeless youth is 5.86% (96) age 18-24)

Barriers: Under representation of PIT youth and their focus on getting help

Facilitators: Leverage collaborative relationship with the apartment manager
and staff encouragement

Effectiveness
Three major areas to assess effectiveness are:1) clinical outcomes pre-post-test
questionnaire from youth, 2) staff evaluation, and 3) overall program
effectiveness

Barriers: Not open to use the secure base approach and technique
Facilitators: Champion in youth and staff in utilizing program
T-shirt as Rewards and Incentives

Adoption
The staff includes one Program Director, two Licensed Independent
Practitioners (LIP), and one Art Therapist

Barriers: Staff attitudes and lack of knowledge about the full purpose of the
program

Facilitators: Provide training/education on the program, exploring creativity in
group treatment, and offering job satisfaction

Implementation
The implementation phase is assessed by how each participant participates
throughout the 12-week program including the completion of the pre- and post-
test questionnaire

Barriers: Participants drop out and CFLC is not interested
Facilitators: Developing a mutually agreed upon treatment contract with the
Chief Executive Officer and the Clinical Manager

Maintenance
In the maintenance phase, the six-month increments of program visits for 18
months will provide an indication of maintenance effectiveness relating to
participants’ clinical progress and outcomes over time and scaling the program
throughout all homeless youth shelters

Barriers: Resistance from other homeless youth shelters’ inclusion in scaling
the program
Facilitators: Leverage insurance authority to shape policies on program
standardization throughout group therapy treatment

HOMELESS YOUTH

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Appendix H
Rewards/ Incentive
Front logo: Qigong – Energy Movements
Back Logo: Reaching the Hard To Reach – Secure Safe Connected
Colors: USC Gold and Maroon

HOMELESS YOUTH

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Appendix I
Infograph
HOMELESS YOUTH

52

68%
32%
7.1%
RIVERSIDE COUNTY 2017 POINT-IN-TIME
COUNT
Interview Observation Unsheltered Youth (12-14)
Riverside County Children’s Services
Division
2017 Entries: Exit Status by Age (16-18)
18%
Reunified
15%
Aged Out
3%
Adopted
60%
Still in care
Safe
House
600
youth
Desert
Flow
Drop-
in-
Center
700
youth
Harrison
House
25 youth for
18 months
stay
Homeless Youth Services
REACHING THE HARD TO
REACH
HEALTH EDUCATION PROGRAM
4 weeks of 45 minutes session for
homeless youth:
Secure Base & Energy Movements
KEEP HOMELESS YOUTH
SECURE, SAFE AND CONNECTED
Health Benefits
• Improve cognitive function
• Higher self-esteem
• More self-respect
• Better self-awareness
• Improve muscle strength
• Better balance
• Enhanced flexibility
HOMELESS YOUTH

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Abstract (if available)

Abstract Within the Grand Challenge to end homelessness that homeless youth do not seek help. The proposed Capstone Project is to connect the youth, caregivers, and staff through a secure interaction despite the negative setting homeless youth experience with their primary caregivers. The “do not seek help” norm affects millions of youth, costs millions of dollars, and is further complicated by social inequalities that target youth from poor families, the homeless, minorities, immigrants , and victims of domestic violence, substance abuse, and unemployment. At present, this capstone is referred to as Reaching the Hard-To-Reach (RHTR). The approach herein is to promote a secure base health education program focusing on ways to connect and change help-seeking behavior in homeless youth.

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Asset Metadata

Creator Nguyen, Thuan Thi (author)

Core Title Homeless youth: Reaching the Hard-To-Reach

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 08/11/2020

Defense Date 08/10/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag caregivers,connected,do not seek help,end homelessness,OAI-PMH Harvest,Qi Gong,safe,secure interaction,staffs,Youth

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Smith-Maddox, Renee (committee chair), Bolar, Eleanor (committee member), Nair, Murali (committee member)

Creator Email btnguyen009@yahoo.com,thuantng@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-363568

Unique identifier UC11666348

Identifier etd-NguyenThua-8908.pdf (filename),usctheses-c89-363568 (legacy record id)

Legacy Identifier etd-NguyenThua-8908.pdf

Dmrecord 363568

Document Type Capstone project

Rights Nguyen, Thuan Thi

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA