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. Author manuscript; available in PMC: 2023 Aug 5.
Published in final edited form as: Public Health Nurs. 2023 Mar 6;40(4):543–549. doi: 10.1111/phn.13183

Application of the ecobiodevelopmental model for research among youth experiencing homelessness

Margaret Fitzpatrick 1, Jodi L Ford 1, Natasha Slesnick 2
PMCID: PMC10403807  NIHMSID: NIHMS1920289  PMID: 36880176

Abstract

Youth experiencing homelessness (YEH) often face increased levels of adversity and higher rates of trauma, suicide, and mortality compared to their housed peers. A multi-level life course lens is proposed by applying the ecobiodevelopmental model to examine social support mechanisms as a buffer to psychopathologies following adversity within YEH. Further discussion contributes to the theoretical basis for future public health research and intervention work addressing youth homelessness and related adversities.

Keywords: homeless youth, mental health, social support, stress

1 |. INTRODUCTION

Over half a million youth and young adults 24 years old and younger experience homelessness in the United States each year (Youth and Young Adults, 2021). Youth experiencing homelessness (YEH) face disproportionate levels of trauma, adversity, and mortality compared to their housed counterparts. For example, YEH are 2.5 times more likely to report at least one adverse childhood experience, six times more likely to have two or more diagnosed mental disorders, and they have a mortality rate 10 times greater than the general youth population (Auerswald et al., 2016; Barnes et al., 2021; Whitbeck et al., 2004). Despite efforts to prevent and reduce the negative effects of homelessness, it remains an imperative daily public health concern. According to life course theories, adolescence is a critical period of neurodevelopment. This important transitional stage sets a precedent for future health trajectories (Halfon & Hochstein, 2002). Therefore, research and evidence-based interventions must address adversity and buffering strategies within the population of YEH to prevent lifelong deleterious health outcomes mentally, physically, and developmentally.

Social support can protect against negative health outcomes after adverse life events (Cohen & Wills, 1985; Thoits, 2011). Thus, it is imperative that avenues of social support for YEH are strengthened. Using a multi-level life course lens to address buffering mechanisms of social support within the population of YEH offers unique insight outside of the current risk-focused literature. This paper aims to apply the ecobiodevelopmental (EBD) framework for research with YEH, specifically exploring social networks as a buffer to adversity and prevention of toxic stress. This theoretical basis may contribute to future public health research and policy aimed to improve outcomes for YEH.

2 |. APPLICATION OF THE ECOBIODEVELOPMENTAL MODEL FOR RESEARCH WITH YEH

The ecobiodevelopmental (EBD) model recognizes that healthy childhood development results from a complex interplay between genetic and environmental factors (Shonkoff et al., 2012). Informed by ecological theories, it notes the social environment in which a child develops has a lasting impact on health outcomes and developmental trajectories for the individual and subsequent generations. The EBD model emphasizes the importance of stable, nurturing adult relationships in buffering stress. It acknowledges that a consistent supporting relationship between an adult is foundational to childhood development to buffer stress and promote optimal growth and learning. Caregivers and adult mentors permit children to cope and adapt to stressful situations, which lowers their physiologic stress response. Therefore, the child is more likely to return to their original state of health. However, without this protective relationship, strong adverse experiences and repeated stressful events may elicit a stress response, otherwise known as “toxic stress,” that overtime impedes healthy development.

Biological underpinnings of toxic stress include dysregulation of the hypothalamic-pituitary-adrenocortical axis and sympathetic-adrenomedullary system. Extreme levels or prolonged periods of stress increase stress hormones (cortisol, epinephrine, etc.) that can subsequently lead to altered physiological systems over time. A multiorgan response ensues involving neurobiological changes. Without a consistent, supportive adult relationship, this internal disruption in physiological homeostasis leads to increased risk for negative health and developmental outcomes related to learning, behavior, immunity and growth (Shonkoff et al., 2012).

YEH may be particularly vulnerable to toxic stress due to the high rates of trauma and adversity, which they are often exposed to prior to becoming homeless. Pathways to youth homelessness are often diverse and complex. Trauma is pervasive among YEH, and often a predictor to homelessness, along with experiences of familial conflict and victimization (Davies & Allen, 2017). Varied estimates of abuse within YEH exist. Over half of YEH in one study experienced physical abuse, with 60% females and 23% of males reporting sexual abuse (Cauce, 2000). Further, 82% of participants reported past trauma in a Colorado-based study (Merscham et al., 2009). Some participants reported multiple traumatic events including recurring physical or sexual abuse, sexual assault or rape, multiple perpetuators, and parental death.

Adversity not only precedes experiences of homelessness but often continues after leaving environments of abuse, neglect, and trauma. Previous stressful life events often compound with victimization, such as assault or robbery, on the street. For example, increased incidence of sexual abuse was associated with housing instability and predicted victimization experiences (Slesnick et al., 2016). Not only do previous stressful experiences amplify once youth experience homelessness, but both may increase risk for negative mental health outcomes. In one study, experiences of multiple episodes of childhood abuse or street victimization were each found to be independently associated with impaired mental health (Bender et al., 2015). The odds for meeting diagnostic criteria for post-traumatic stress disorder and depression nearly doubled for each additional type of childhood abuse in a sample where the majority (79%) reported two or more forms of abuse (Bender et al., 2015). Further, the likelihood of meeting criteria for substance use disorder almost doubled for each additional experience of street victimization, with 28% of youth reporting two or more types of street victimization (Bender et al., 2015).

Compared to their housed counterparts YEH often experience disproportionate levels of mental adversities (Whitbeck et al., 2004). In a state-wide surveillance survey of students in Minnesota, the odds of having chronic mental health conditions were more than double for YEH compared to their housed peers (Barnes et al., 2021). Further, a systematic review of mental health diagnoses among YEH reported rates of diagnosed depression ranging from 8% to over 60%, with post-traumatic stress disorder rates reaching 47% (Medlow et al., 2014). Higher rates of psychopathologies are documented in more recent findings with post-traumatic stress disorder and depression reaching 80% and 74%, respectively (Dawson-Rose et al., 2020). Frequently, these mental health conditions co-occur with substance use (Hadland et al., 2011). With the high levels of adversity and mental health hardships reported among YEH, it is not surprising that suicide is a leading cause of death within this population (National Healthcare for the Homeless Council, 2017). Youth who had run away from home and experienced homelessness were five times more likely to report suicidal ideation and were at seven times greater odds of attempting suicide compared to their stably housed peers (Gewirtz O’Brien et al., 2020).

The high rates of trauma, mental health disorder, substance use, and mortality within this population warrant trauma-informed, multi-level and cross-sector interventions. However, there is limited intervention research addressing adversity, mental health and suicide for YEH, and many existing interventions lack analysis of efficacy (Morton et al., 2020). Although, there has been recent work examining the efficacy of a suicide prevention intervention for YEH comparing Cognitive Therapy for Suicide Prevention to treatment as usual (Slesnick, Zhang, Feng et al., 2020). However, the paucity of efficacious interventions for YEH necessitates additional work. Differentiating what works best for who and in which situations will enable stakeholders and providers to effectively strengthen protective factors to reduce the potential for toxic stress and promote positive outcomes. The EBD model offers a framework for future research and interventions aimed to mitigate adversity among YEH.

3 |. SOCIALLY SUPPORTIVE NETWORKS AS BUFFER TO ADVERSITY AND TOXIC STRESS AMONG YEH

The EBD model emphasizes the importance of nurturing support systems to deter lifelong consequences of toxic stress. Among YEH, social support may potentially be one modifiable factor to protect against psychopathologies after adversity. It has been hypothesized that YEH tend to have lower perceived social support and endure social isolation from their peers, family, and community (Ennett et al., 1999). Further, the small social networks of YEH often expose them to risktaking peers (Ennett et al., 1999; Whitbeck & Hoyt, 2017). Thus, youth often continue to experience adversity after leaving adverse environments. This notion of compounding victimization and risk in YEH has been a prominent model of cumulative adversity within this population (Whitbeck et al., 1999). However, additional work is now focusing on moving beyond risks and towards protective factors. Further discussion of the social networks of YEH and their potential to buffer adversity and prevent toxic stress follows.

3.1 |. Social support and family networks of YEH

YEH often have strained relationships with adult caregivers due to adverse childhood experiences, particularly parental substance use and child abuse and neglect (Tyler & Schmitz, 2013). Adolescence is a critical period of neurodevelopment, where familial conflict may have a greater impact on long term health and well-being. In a prospective population-based study, family environments high in conflict predicted young adult homelessness (Heerde et al., 2021). When the home environment leads adolescents to run away from home and escape parental attachment figures, they are doing so during a critical period of development. In addition to the myriad of changes in adolescence, YEH also then face the challenge of surviving by themselves outside of the home.

However, not all YEH cut ties completely from family members. For example, 30.6% youth named family members as part of their social network (Johnson et al., 2005). Almost half of participants reported they relied on family members for instrumental support, and 40% reported family members were a source of emotional support. In a California based longitudinal study (Barman-Adhikari et al., 2016), only 20% of YEH reported emotional support from family members and about 16% reported instrumental support. The behaviors of family members may influence youth’s perceptions of social support received as Slesnick et al. (2020) found that YEH at risk for suicide reported less familial social support if family networks engaged in alcohol and/or drug use. Moreover, familial social support was only protective for risk factors of suicide (e.g., perceived burdensomeness) if the family network was not engaged in substance using behaviors.

Identifying mechanisms of family support as a buffer to negative developmental outcomes for YEH requires specific delineation of family member type and for whom the relationship confers the most benefit. However, family environment has not been consistently defined in research with YEH. For example, one recent study did not differentiate the type of family member (parent, caregiver, sibling) involved in family conflict when measuring life course predictors of homelessness (Heerde et al., 2021). It is important to delineate the type of family member or caregiver involved due to their potential differential influences. For example, youth had fewer criminal behaviors and were less likely to engage in drug use when they reported a more positive relationship with their fathers rather than mothers (Stein et al., 2009). Moreover, positive relationships with either their mother or father were significantly associated with less psychological distress.

3.2 |. Social support and non-kin adult networks of YEH

In addition to families, YEH may maintain and develop positive relationships with non-kin adult figures. Dang et al. (2014) found that 73.6% of YEH reported having a natural mentor who was a non-parental role model in their social network. Only 42% of these adults were relatives. Of note, youth recruited for this study were operationalized as being homeless if they had spent at least two nights outside their home. This broad operationalization of youth homelessness may include youth who recently ran away in addition to street-living youth. Nonetheless, YEH at all points of their homeless trajectory may have existing role models in their social network in addition to family members. These natural mentors are adults who are existing members of youth’s social network, thus presenting an opportunity to capitalize on already present positive relationships. A meta-analysis found that the presence of natural mentors in adolescence is associated with positive youth outcomes for all adolescents, regardless of risk status (Van Dam et al., 2018). Therefore, YEH may benefit from the presence of these attachment figures.

The presence alone of a natural mentor may benefit youth, although higher quality relationships may confer even greater positive outcomes. For example, in the same meta-analysis, high-quality relationships were associated with more support and better youth outcomes. Further, the presence of a natural mentor from a helping profession such as a teacher, counselor, or religious leader, was found to have a larger effect size compared to others (Van Dam et al., 2018). Therefore, relationships outside of family members may be another avenue for positive support for YEH.

For high-risk populations such as YEH or youth aging out of foster care, natural mentoring may provide an even greater benefit compared to stably housed youth since intermediate family relations are often strained. In a longitudinal study of older youth aging out of foster care, two-thirds of participants reported having a natural mentor (Munson & McMillen, 2009). Fewer depression symptoms were associated with youth who reported a mentoring relationship, suggesting the presence of such support alone is beneficial. Moreover, the length of these relationships offered additional benefit. One-third of the youth reported their natural mentor relationship lasting over one year. Youth who reported having a mentor for greater than one year reported lower perceived stress overtime, and fewer depression symptoms compared to those who had a relationship with their mentors less than one year.

3.3 |. Integrating multilevel sources of social support for YEH

Fostering natural mentoring relationships early and promoting positive caregiving indeed are important avenues for intervention to mitigate psychopathologies and negative outcomes of adversity. However, these relational developments may not be nurtured without a social structure or strong network that allows for it. The EBD model addresses the need for a supportive caregiver in the context of healthy childhood development as well as multi-level supports that can amplify these foundational support systems including communities, policies, and programs (Shonkoff et al., 2012). Therefore, future research with YEH must incorporate how multi-level social support systems interact with one another to promote positive outcomes.

One study examined the impact of multi-level social environments on pathways out of homelessness, addressing not only the cumulative risk and adversity YEH face, but the positive socializing agents that mitigate negative consequences associated with homelessness as well (Milburn et al., 2009). Using longitudinal data from YEH in California, Milburn et al. (2009) examined the interplay between negative and positive social contacts on exiting homelessness over a one-year time frame for newly homeless youth. The socializing agents measured included family, peers, social services, and formal institutions such as schools. Results revealed multiple positive social connections. For example, 62% of the youth reported being able to talk to their mother and 71% stated most of their friends still attended school. Those with more pro-social peers were more likely to stably exit homelessness compared to those associated with anti-social peers. Pro-social peers included those who remained in school, had jobs, or maintained positive familial relationships. Formal institutions such as school were also discussed as an important socializing agent. YEH who attended school at baseline or increased attendance overtime had a higher likelihood of exiting homelessness compared to those who weren’t currently attending school. Thus, the places in which youth socialize and spend most of their time is a potential resource to promote positive relationships and social support. Early identification and strengthening of supportive networks is crucial. However, additional research must be done examining multi-level support systems including youth at different timepoints in their homeless trajectory, as youth from this study were newly homeless and thus differ from those more embedded in street life.

Future research must expand upon the evidence that YEH may have positive social support avenues in their life. If there exists positive caregivers or role models in their lives, how do they influence psychopathologies? What are the mechanisms behind youth’s heterogenous positive social network compositions? How do social services and formal institutions interact to cultivate positive relationships and mitigate social isolation for YEH? Are there critical periods in youth’s homeless trajectory in which social networks confer the greatest positive impact? A multi-level life course lens using the EBD model may provide further insight into the importance of positive, stable relationships across multiple social levels. Guided by the EBD model, Figure 1 provides an exemplar of the potential buffering role of multilevel social supports on the negative effects of adversity on the health and well-being of YEH. Incorporating the theoretical underpinnings of the EBD model and multilevel social supports illustrates the view that it takes a village to raise a healthy child.

FIGURE 1.

FIGURE 1

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Conceptual model.

3.4 |. Directions for future research

3.4.1 |. Need for intervention research

Interventions are needed that are multi-level and cross-sector to address youth homelessness and its related harmful outcomes. Programs and policies that build and enhance supportive community, family, caregiver, and natural mentor relationships during adolescence is a potential area for intervention. For example, McCay et al. conducted a pilot study involving a relationship-based intervention to improve social connectedness in a small sample of 15 YEH in Toronto, Canada (2011). YEH in the intervention group demonstrated significant increase in social connectedness and a trend towards decreased hopelessness. Interventions that educate on the importance of healthy relationships and teach positive relationship skills early are a necessary first step to capitalize on existing positive relationships within social networks of YEH.

Social support interventions may also be incorporated into existing interventions addressing mental health outcomes in youth. Slesnick et al., implemented a randomized controlled trial comparing Cognitive Therapy for Suicide Prevention to treatment as usual for YEH in a large mid-western city (2020). Findings from the study supported the hypothesis that treatment effects related to suicidal ideation would be greater for those with higher family network satisfaction (Wu et al., 2020). Therefore, family therapy in addition to suicide prevention may contribute to greater positive outcomes.

However, the most promising approach to enhance the health and well-being of YEH and prevent recurring homelessness integrates structural interventions with social support aspects (Hwang & Burns, 2014). Social support interventions alone may have limited benefit if it is not multi-level. For example, Bartle-Haring et al. (2012) reported limited support for formal mentoring alone on psychosocial outcomes in YEH. However, mentoring as an adjunct to other interventions may be a fruitful line for future research. Currently, Slesnick et al. is conducting a randomized controlled trial encompassing housing, opioid risk and prevention services, and cognitive therapy for suicide prevention for YEH in a mid-western city (Chavez et al., 2021; Slesnick et al., 2021). Multi-faceted interventions for YEH like this one address the complex adversity and needs across interrelated outcomes in a population at high-risk for negative outcomes as the EBD framework encourages.

3.4.2 |. Need for prospective research

Implementation of interventions requires the examination of what works best for whom and specific mechanisms of how they may work. Moving beyond cross-sectional data and exploring prospective effects of networks is needed to provide these answers. A gap exists in identifying how certain relationships buffer physiological stress and psychological stress related to toxic stress.

As discussed, studies are now contradicting the notion that YEH social networks are homogenous, largely comprised of deviant, risktaking peers. For newly homeless adolescents, their social network often includes ties to home. Up to 80% of youth in one study reported having relationships that were formed prior to becoming homeless including friends, family and non-kin adults (Johnson et al., 2005). Newly homeless youth were more likely to report ties to friends from home compared to friends on the street. These ties to home can often be a source of positive support or model positive behavior. For example, in another study, 73% of youth reported most or all of their friends were still going to school (Rice et al., 2007). Investigation into the heterogenous social networks of youth is needed to go beyond identification of solely risky behaviors of peers of YEH. Insight into the benefits of socially supportive peer relationships, such as those who are housed and not engaged in risky behaviors, may provide avenues for positive outcomes for YEH. Further examination into social networks of youth who are not newly homeless is also an important consideration due to the heterogeneity of YEH and related outcomes.

In addition to social supportive peers, it is important to investigate how adult caregivers or existing role models in YEH social networks affect outcomes. Due to the disproportionate rates of adversity and mental health conditions in this population, this may be a modifiable protective factor worth further investigating. Do natural mentors buffer psychopathologies after adversity? What is it about this relationship that might be beneficial for YEH? Who is more likely to have such ties? Since social networks are not static, changes in composition are another area of future investigation. How and why do existing protective relationships change over time? Do peer and family networks interact to provide differential outcomes? Further insight into such questions may provide valuable knowledge for this high-risk population.

Understanding the beneficial aspects of the relationships YEH have with natural mentors, peers, and adult caregivers and how they work is warranted. For example, Slesnick, Zhang and Walsh analyzed the relationship among social network characteristics, perceived social network support, and interpersonal risks for suicide for YEH in a midwestern based city (2020). Results found that crime engagement and alcohol use within youths’ social networks reduced the beneficial aspects of high perceived social network support on youths’ suicide risk (Slesnick et al., 2020). Therefore, the characteristics of support networks and mechanisms in which these relationships affect psychological outcomes in YEH is an important area to expand upon to inform future policy and interventions.

4 |. CONCLUSION

Homelessness and associated deleterious consequences remain an important public health issue. Further, adolescents who experience homelessness, trauma, and adversity continue to face disproportionate rates of mental health problems. It is critical to develop efficacious intervention and prevention programs to alleviate negative outcomes of adversity and toxic stress for YEH. Using the EBD model for research among YEH can provide insight into protective factors and multi-level support, offering the greatest benefit beyond risk identification. Future research must identify prospective relationships with supportive systems and how these might prevent toxic stress and improve health and well-being of YEH.

ACKNOWLEDGMENTS

This work was supported by the National Institute of Nursing Research of the National Institutes of Health under award number T32 NR014225 Training in the Science of Health Development (Pickler & Happ, MPI) and the National Institute on Drug Abuse under the award number UH3DA050174 (Slesnick & Kelleher, MPI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

CONFLICT OF INTEREST STATEMENT

The authors have no conflicts of interest to report.

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

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Associated Data

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Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

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