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Brief Reports   |    
Factors Influencing Service Use Among Homeless Youths With Co-Occurring Disorders
Nicole Kozloff, M.D.; Amy H. Cheung, M.D., M.S.; Lori E. Ross, Ph.D.; Heather Winer, M.A.; Diana Ierfino, M.S.; Heather Bullock, M.S.; Kathryn J. Bennett, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200257
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Dr. Kozloff is affiliated with the Department of Psychiatry, University of Toronto, 250 College St., Suite 841, Toronto, Ontario M5T1R8, Canada (e-mail: n.kozloff@utoronto.ca). Dr. Cheung and Ms. Ierfino are with the Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario. Dr. Ross, Ms. Winer, and Ms. Bullock are with the Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario. Dr. Bennett is with the Department of Clinical Epidemiology and Biostatistics and Offord Centre for Child Studies, McMaster University, Hamilton, Ontario. Portions of this report were presented at the annual meetings of the American Academy of Child and Adolescent Psychiatry, New York City, October 26–31, 2010, and the Canadian Academy of Child and Adolescent Psychiatry, Montreal, Quebec, September 30 to October 2, 2012.

Copyright © 2013 by the American Psychiatric Association


Objective  Given high rates of co-occurring mental and substance use disorders among homeless youths and poorly understood facilitators of and barriers to service use, this study explored factors influencing service use among homeless youths with co-occurring disorders.

Methods  Focus groups were conducted with 23 youths age 18 to 26 with co-occurring disorders. Group discussion was audio-recorded and transcribed verbatim, and transcripts were examined with thematic content analysis.

Results  The factors identified as influencing service use were grouped into three broad categories: individual (motivation, support, and therapeutic relationship), program (flexibility and comprehensiveness of services and availability of harm reduction services), and systemic (stigma and accessibility).

Conclusions  Multilevel factors appear to influence service use among homeless youths with co-occurring disorders. Given the lack of evidence to support specific treatments in this population, these findings may be used to guide the development of thoughtfully designed interventions to engage homeless youths with co-occurring disorders.

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