Factores relacionados con la higiene personal de la calle niños en el sitio de disposición final de residuos en Distrito de Mangagala, ciudad de Makassar, Indonesia / Factors related to personal hygiene of street children in the final waste disposal site in Manggala district, Makassar city, Indonesia

Background. Street children are a real phenomenon in everyday life that cause complex social and health problems, dirty appearance, come from poor families, slum settlements or even street children do not have a place to live. The number of homeless people, beggars and street children has decreased, there were 990 street children and homeless people with beggars in Makassar City in 2012. There were 798 street children in Makassar City in 2016 who were recorded by Social Service officers from a number of points. Makassar road with various problems. This number includes 257 street children, 249 homeless and beggars, 58 buskers, 41 prostitutes, 5 transgender women, 63 drug users, and 125 mental disorders. The results of the observations of street children were found with traffic light and garbage disposal sites. These places are often found with dirty, dirty appearance, dirty clothes, smelly, unkempt hair, dirty hands, not wearing sandals and sometimes they eat without washing their hands, which can cause health problems for street children. Based on this background, the researcher is interested in examining the factors related to the personal hygiene of street children in the final waste disposal site in Manggala District, Makassar City. Material and Methods. The research is analytic observation using the Cross-Sectional study. The study was conducted in 21 October 2019 - 31 December 2019. The population was the patients with street children numbered 88 people, a purposive sampling technique was applied through chic square, uji continuity correction and multiple logistic regression analysis. Results. The results showed that the variables age, gender, education and knowledge had a relationship with personal hygiene (pvalue 0.035), the R-square value was 0.897, which means that the ability of the independent variable to explain the dependent variable was 89.7% and 10.3% explained. by factors other than variables. Conclusion. Knowledge variable has a significant effect on personal hygiene (pvalue <0.001), the magnitude of the influence is indicated by the value of Exp (B) 26.6, which means that street children who are knowledgeable are at least 26.6 times less likely to have personal hygiene than street children with good knowledge

Piloting an evidence-based intervention for HIV prevention among street youth in Eldoret, Kenya.

OBJECTIVES: This study presents findings from piloting an adapted evidence-based intervention, Stepping Stones and Creating Futures, to change street-connected young people's HIV knowledge, condom-use self-efficacy, and sexual practices. METHODS: Eighty street-connected young people participated in a pre- and post-test mixed methods design in Eldoret, Kenya. The primary outcome of interest was HIV knowledge. Secondary outcomes included condom-use self-efficacy and sexual practices. Multiple linear regression models for change scores with adjustment for socio-demographic variables were fitted. Qualitative and quantitative findings are presented together, where integration confirms, expands on, or uncovers discordant findings. RESULTS: Participants had a significant increase in HIV knowledge from pre- to post-intervention. The median HIV knowledge score pre-intervention was 11 (IQR 8-13) and post-intervention 14 (IQR 12-16). Attendance was significantly associated with HIV knowledge change scores. Qualitatively participants reported increased HIV and condom-use knowledge and improved condom-use self-efficacy and health-seeking practices. CONCLUSIONS: Our findings support the potential for further testing with a rigorous study design to investigate how best to tailor the intervention, particularly by gender, and increase the overall effectiveness of the program.

Associations of Tobacco Advertising Appeal With Intentions to Use Alternative Tobacco Products Among Young Tobacco Users Experiencing Homelessness.

PURPOSE: Virtually nothing is known about the potential effects of tobacco advertising on tobacco use among youth experiencing homelessness, a vulnerable population with high tobacco use rates. This study examines associations between the appeal of advertising for 5 classes of tobacco product (electronic cigarettes, hookah, cigars, cigarillos, and smokeless tobacco) and future intentions to use those products again among homeless youth who had indicated any level of lifetime use. DESIGN: A cross-sectional design was used. SETTING: Settings were 25 service and street sites in Los Angeles County. PARTICIPANTS: A probability sample of 469 young tobacco users experiencing homelessness (mean age = 22; 71% male; 29% non-Hispanic White) was recruited. MEASURES: Assessments included product-specific tobacco advertising appeal and future intentions to use the product again, as well as a range of covariate controls (eg, demographics, homelessness severity, current tobacco use, general advertising exposure). ANALYSIS: Linear regression tested for associations between the appeal of advertising for a specific tobacco product and intentions to use that product again in the future, controlling for myriad covariates. RESULTS: Advertising appeal was positively associated with future intentions to use again for electronic cigarettes (P = .006) and hookah (P = .001), but not cigars (P = .486), cigarillos (P = .126), or smokeless tobacco (P = .109). CONCLUSION: Results suggest that advertising appeal may increase use of certain tobacco products among youth experiencing homelessness. However, differences in themes emphasized by advertising for specific tobacco products could differentially influence use in this population.

Informe de Rotación Electiva 2020

El presente documento tiene como objetivo hacer una descripción de la segunda experiencia de rotación electiva de la Lic. en Ciencias de la Educación, Noelia Oshiro, la cual fue desarrollada en la Ciudad de Buenos Aires. En él se incluye una fundamentación del área de interés, las actividades realizadas durante la rotación, los objetivos propuestos, los aportes brindados a la sede de rotación, se mencionan algunos de los obstáculos y dificultades y se realiza una sistematización de los diversos aprendizajes realizados. Finalmente se detallan algunas reflexiones finales y se abren nuevo interrogantes a las prácticas laborales. El lugar de rotación elegido fue el Centro de Integración Social "La Milagro Sala", el cual es parte del proyecto ampliado del centro Educativo Isauro Arancibia. El período de rotación comprendió del día 3 al 28 de febrero del 2020, un total de un mes. (AU)

Youth experiencing transitional and temporary homelessness: A pilot study.

Homeless youth represent a vulnerable and understudied population, particularly those among them who are hidden, experiencing transitional or temporary homelessness. Little research focuses on this group, including the methods and settings to identify and tailor interventions to their circumstances. Given the immediate risks and possible transition to chronic homelessness, their identification is critical for prevention and intervention efforts. This exploratory pilot study investigated transitional and temporary homelessness among youth. The study demonstrated the ability to identify such participants. Twenty participants completed a survey that measured demographics, behavioral risk factors, and the Brief Symptom Inventory (BSI; Derogatis, 1993). Reports of relationships with parents varied. They included positive maternal relationships, but also concerns about intrafamilial conflict. While frequent change of schools was reported, generally positive feelings toward school were expressed. Social relationships suggest limited exposure to other homeless youth. Some substance abuse was noted, possibly at lower rates than expected for hard drugs. The BSI results are suggestive of health concerns. The study demonstrated that it is possible to capture children experiencing transitional or temporary homelessness in alternative school settings. It is essential that efforts be made to identify them and provide early supports toward preventing chronic homelessness.

Acceptability of a Pilot Intervention of Voluntary Medical Male Circumcision and HIV Education for Street-Connected Youth in Western Kenya.

PURPOSE: Street-connected youth (SCY) in Kenya and elsewhere in sub-Saharan Africa are at high risk of HIV. Voluntary Male Medical Circumcision (VMMC) reduces the risk of female-to-male HIV transmission. Circumcision is also a traditional coming-of-age process in many Kenyan ethnic groups. This paper describes the acceptability of VMMC delivered as part of a ten-day healing, educational, and 'coming-of-age' retreat implemented as a pilot with SCY. METHODS: Male SCY aged between 12 and 24 living on the street for more than 3 months were eligible to participate. The study took place over 10 days. After medical circumcision, youth participated in education modules. Data collected included qualitative semi-structured exit interviews featuring structured and open-ended questions about factors relevant to this intervention's acceptability. RESULTS: There were 116 SCY (median age 14, IQR 13-15) who participated in the study. All were circumcised successfully, with no major complications. The majority of participants (81%) agreed that the circumcision procedure was uncomplicated, and 99% agreed the education was an important part of the initiation process. Thematic analysis of interview data highlighted four factors important to the program's acceptability: providing food, shelter, security; providing a safe place to heal; including traditional elements; and being with peers. CONCLUSIONS: This novel implementation of VMMC was found to be acceptable to SCY participants and could likely be adapted and scaled for HIV prevention and education with SCY elsewhere in Kenya and sub-Saharan Africa where circumcision is part of traditional coming-of-age processes.

"Devemos continuar?" identidade, história e utopia do educador de rua / "Debemos seguir?" identidad, historia y utopia del educador de calle / "Should we continue?" identity, history and utopia of the street educator

Resumo O propósito deste trabalho foi refletir como os educadores de rua articulam o pensamento utópico com o pensamento histórico, a partir dos relatos de suas experiências ao longo de quinze anos. O sintagma identidade-metamorfose-emancipação (Ciampa, 2003) e os conceitos de pensamento utópico e pensamento histórico (Habermas, 1987) formam o arcabouço teórico que embasa a presente pesquisa. Utilizamos na coleta de dados a entrevista "não diretiva centrada" (Minayo, 1999). Observou-se que é possível articular história e utopia. O estudo indica que, para que essa articulação seja possível, é necessário que o sujeito tenha a flexibilidade de reinventar seus projetos utópicos, mudando assim de projeto emancipatório, mas não perdendo de vista a energia utópica que o move. Concluímos, também, que os profissionais que articularam os dois movimentos tendem a apresentar uma postura pós-convencional diante da vida.

Resumen El propósito del presente estudio ha sido reflejar cómo los educadores de la calle articulan el pensamiento utópico con el pensamiento histórico, a partir de los relatos de sus experiencias a lo largo de quince años. El marco teórico del trabajo es el sintagma "Identidad-metamorfosis-emancipación" de Ciampa (2003) y los conceptos del pensamiento utópico y pensamiento histórico de Habermas (1987). En la colección de datos se utilizó la técnica "no directiva centrada" (Minayo, 1999). Se observó que es posible articular la historia y la utopía. El estudio indica que para que sea posible, es necesario que el sujeto tenga flexibilidad para reinventar sus proyectos utópicos. Por lo tanto, se hace necesario el cambio de proyecto de emancipación, pero sin perder de vista la energía utópica que se le mueve. También se puede concluir que los profesionales que articulan esos dos movimientos tienden a tener una actitud post-convencional en sus vidas.

Abstract The purpose of this work was to reflect how street educators articulate utopian thinking with historical thinking, based on the reports of their experiences over fifteen years of practice. The theoretical framework used is based in the identity-metamorphosis-emancipation sintagma developed by Ciampa (2003) and in the notions of utopic thinking and historical thinking.(Habermas, 1987). The empirical research is based on interview classified by Minayo (1999) as "non directive centered". The observation revealed that it is possible to articulate history and utopia. The study indicates that whoever embraces the utopia thinking, and wants it to become reality, has to develop the flexibility to reinvent his own utopic projects, therefore changing his emancipatory project without losing the utopic perspective. We conclude also that those professionals who are able to articulate both movements tend to have a post-conventional stance in life.

Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people.

BACKGROUND: Millions of street-connected children and young people worldwide live or work in street environments. They are vulnerable to many risks, whether or not they remain connected to families of origin, and despite many strengths and resiliencies, they are excluded from mainstream social structures and opportunities. OBJECTIVES: Primary research objectivesTo evaluate and summarise the effectiveness of interventions for street-connected children and young people that aim to:• promote inclusion and reintegration;• increase literacy and numeracy;• facilitate access to education and employment;• promote mental health, including self esteem;• reduce harms associated with early sexual activity and substance misuse. Secondary research objectives• To explore whether effects of interventions differ within and between populations, and whether an equity gradient influences these effects, by extrapolating from all findings relevance for low- and middle-income countries (LMICs) (Peters 2004).• To describe other health, educational, psychosocial and behavioural effects, when appropriate outcomes are reported.• To explore the influence of context in design, delivery and outcomes of interventions.• To explore the relationship between numbers of components and duration and effects of interventions.• To highlight implications of these findings for further research and research methods to improve evidence in relation to the primary research objective.• To consider adverse or unintended outcomes. SEARCH METHODS: We searched the following bibliographic databases, searched for the original review, from inception to 2012, and various relevant non-governmental and organisational websites: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE and Pre-MEDLINE; EMBASE and EMBASE Classic; Cumulative Index to Nursing and Allied Health Literature (CINAHL); PsycINFO; Education Resource Information Center (ERIC); Sociological Abstracts; Social Services Abstracts; Social Work Abstracts; Healthstar; Latin American Caribbean Health Sciences Literature (LILACS); System for Grey literature in Europe (OpenGrey); ProQuest Dissertations and Theses; EconLit; IDEAS Economics and Finance Research; JOLIS Library Catalog of the holdings of the World Bank Group and International Monetary Fund (IMF) Libraries; British Library for Development Studies (BLDS); Google and Google Scholar. We updated the search in April 2015 for the review update, using the same methods. SELECTION CRITERIA: This review includes data from harm reduction or reintegration intervention studies that used a comparison group study design; all were randomised or quasi-randomised studies. Studies were included if they evaluated interventions provided for street-connected children and young people, from birth to 24 years, in all contexts. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias and other factors presented in the Discussion and Summary quality assessment (Grades of Recommendation, Assessment, Development and Evaluation (GRADE)). We extracted data on intervention delivery, context, process factors, equity and outcomes, and grouped outcomes into psychosocial outcomes, risky sexual behaviours or substance use. We conducted meta-analyses for outcomes where the outcome measures were sufficiently similar. We evaluated other outcomes narratively. MAIN RESULTS: We included 13 studies evaluating 19 interventions from high-income countries (HICs). We found no sufficiently robust evaluations conducted in low- and middle-income countries (LMICs). Study quality overall was low and measurements used by studies variable. Participants were classified as drop-in and shelter-based. No studies measured the primary outcome of reintegration and none reported on adverse effects.We found no consistent results on a range of relevant outcomes within domains of psychosocial health, substance misuse and sexually risky behaviours . Interventions evaluated consisted of time-limited therapeutically based programmes that proved no more effective than standard shelter or drop-in services and other control interventions used for most outcomes in most studies. Favourable changes from baseline were reported for outcomes for most participants following therapy interventions and standard services. We noted considerable heterogeneity between studies and inconsistent reporting of equity data. No studies measured the primary outcome of reintegration or reported on adverse effects. AUTHORS' CONCLUSIONS: Analysis revealed no consistently significant benefit for focused therapeutic interventions compared with standard services such as drop-in centres, case management and other comparable interventions for street-connected children and young people. Commonly available services, however, were not rigorously evaluated. Robust evaluation of interventions, including comparison with no intervention, would establish a more reliable evidence base to inform service implementation. More robust research is needed in LMICs to examine interventions for street-connected children and young people with different backgrounds and service needs.

El fracaso escolar como un síntoma afectivo en niños y niñas bajo condiciones de orfandad / School failure as a affective symptom in children and girls under conditions of orphanhood

El presente artículo emerge a partir de una revisión crítica acerca de los conceptos de fracaso escolar y la experiencia de orfandad, estableciendo las limitaciones actuales con que se aborda el fenómeno educativo y la conceptualización sobre la infancia huérfana. De esta forma, se cuestionan las dimensiones afectivas y traumáticas que subyacen al fracaso escolar. Al final, se invita a la investigación empírica para abordar el fenómeno preguntando si es posible considerar que la experiencia de abandono en niños y niñas, con todas sus vivencias de maltrato y deprivación, pueda estar relacionada con las dificultades en el aprendizaje y en últimas con el fracaso escolar.

This paper emerges from a critical review of the concepts of school failure and experience orphans, establishing the current limitations with the educational phenomenon and the conceptualization of the orphaned children is addressed. Thus, the emotional and traumatic dimensions underlying question school failure. In the end, they are invited to empirical research to address the phenomenon wondering if you might consider the experience of abandonment in children, with all their experiences of abuse and deprivation, it can be related to learning difficulties and ultimately with school failure.

Consultório na rua: atenção a pessoas em uso de substâncias psicoativas / Street outreach office: attention to people on psychoactive drug/substance / Consultorio en la calle: atención a las personas en el uso de substancias psicoactivas

O estudo objetivou investigar os modos de atuação e as características do trabalho de intervenção com adultos jovens em situação de rua e usuários de substâncias psicoativas, segundo percepções de profissionais do Consultório na Rua (CR) do município de Goiânia (GO) e de pessoas atendidas pelo mesmo. Os participantes foram nove profissionais de diferentes categorias com idades entre 24 e 64 anos e quatro usuários beneficiários do CR com idades entre 23 e 37 anos. A metodologia foi qualitativa com aplicação de roteiros semiestruturados de entrevista e realização de análise de conteúdo. Os resultados, a partir dos relatos dos profissionais, configuraram eixos temáticos, tais como: atuação profissional no CR; aspectos facilitadores e dificultadores e apoio necessário para o trabalho. Para os usuários, os eixos foram: primeiro contato com a equipe; atuação dos profissionais do CR e o mais interessante nesse trabalho. Observou-se consonância entre as percepções e predomínio de aspectos positivos nos relatos dos profissionais e dos usuários acerca da atuação do CR, caracterizada por acolhimento, escuta e vínculo. Quanto às dificuldades, foram citados: preconceito e falta de aceitação do usuário pela sociedade civil; atuação agressiva da Polícia Militar e da Guarda Municipal e falta de insumos para o trabalho. O estudo indicou que os modos de atuação do CR vão ao encontro daqueles preconizados nas políticas públicas de álcool e outras drogas do país, pautados no respeito aos direitos humanos, ampliação do acesso a ações e serviços e redução de danos à saúde da população usuária em situação de rua.

The present study aimed at investigating professional practices and characteristics of intervention with young adults living in the streets who make use of psychoactive substances (PAS), according to perceptions of Street Outreach Office (SOO) professionals in the city of Goiânia and of people served by the SOO. Participants were nine different categories of professionals, aged between 24 and 64 years old, four PAS users aged between 23 and 37 years old, alcohol and crack users. The methodology was of qualitative type with semi-structured interviews and used content analysis. The results based on reports from professionals configured the following theme axes: professional work at the SOO; facilitating aspects; difficulties; support needed for the work. The users’ themes were: first contact with the team, the work of the SOO professionals, the most interesting thing about this work. There was consistency between the perceptions and positive aspects in the reports from professionals and PAS users about the work of the SOO, characterized by listening, reception and bond. The difficulties cited were: prejudice and lack of acceptance from civil society towards users; aggressive actions by the Military Police and the Municipal Guard; and lack of provisions for the work. The study indicated that the governing principles of the actions of the SOO are in accordance with those recommended by the public policy in the area of alcohol and other drugs in Brazil, based on respect for human rights, expansion of access to actions and services, and harm reduction to the users’ health.

El estudio tuvo el objetico de investigar los modos de actuación y las características del trabajo de intervención con adultos jóvenes habitantes de la calle y usuarios de sustancias psicoactivas, según percepciones de profesionales del Consultorio en la Calle (CC) del municipio de Goiânia (GO) y de personas atendidas por el CC. Los participantes fueron nueve profesionales de diferentes categorías con edades entre 24 y 64 años, y cuatro usuarios beneficiarios de CC con edades entre 23 y 37 años. Fue utilizada la metodología cualitativa con aplicación de guiones semiestructurados de entrevista y la realización de análisis de contenido. Los resultados, a partir de los relatos de los profesionales, se configuraron en ejes temáticos, tales como: actuación profesional en el CC; aspectos facilitadores y dificultadores; apoyo necesario para el trabajo. Para los usuarios, los ejes fueron: primer contacto con el equipo; actuación de los profesionales del CC; lo más interesante en ese trabajo. Se observó una coherencia entre las percepciones y el predominio de aspectos positivos en los relatos de los profesionales y de los usuarios, respecto a la actuación del CC, caracterizada como acogida, escucha y vínculo. En cuanto a las dificultades, fueron citados: prejuicio y falta de aceptación del usuario por la sociedad civil; acciones agresivas de la Policía Militar y Guardia Municipal; y la falta de insumos para el trabajo. El estudio indicó que los modos de actuación del CC cumplen aquellos preconizados en las políticas públicas de alcohol y otras drogas de Brasil, basados en el respeto a los derechos humanos, ampliación del acceso a acciones y servicios y la reducción de daños a la salud de esta población usuaria.

Youth Perspectives on Sexual Health Workshops: Informing Future Practice.

Newcomer and street-involved youth provided their perspective on the design and content of a sexual education workshop. Following the workshop, focus group discussions were held with 80 youth from four youth-serving agencies. Youth expressed increased levels of confidence and empowerment, consistent with recent criticism that a focus on specific behaviors as intervention outcome measures may miss important psychosocial changes in participants. Some youth views on cultural adaptation of workshops were not consistent with current views expressed by some adult educators, highlighting the need to ensure a youth perspective is captured during intervention development. Finally, the dichotomous views that youth expressed regarding workshop activities emphasizes a research gap related to how best to adapt interventions to different cognitive capacities, literacy levels, and learning styles. Information of this kind is relevant in terms of knowledge translation from youth to program planners and educators.

Operation PeaceWorks: a community program with the participation of a Level II trauma center to decrease gang-related violence.

BACKGROUND: Gang-related violence is a major public health problem. A gang prevention program (Operation PeaceWorks) was developed in Ventura County, California, to help trauma patients who were gang members quit gang lifestyles. The purpose of this study was to determine the incidence of gang-related violence in the community before and after establishing Operation PeaceWorks. METHODS: In Operation PeaceWorks, participating gang members were mentored, counseled, offered job training, and provided with opportunities to further their education or secure employment. Data about gang-related activity in the community were identified and recorded. The number of gang-related assaults (total), assaults involving firearms, and homicides were determined and compared before and after the start of the program. RESULTS: During the 3 years after starting Operation PeaceWorks (2010-2012), the program had 3,430 interventions with 1,464 gang members (2.3 interventions per gang member). Three years after starting Operation PeaceWorks, there was a significant decrease in mean annual total gang assaults (-16%, p < 0.001), assaults with firearms (-32%, p < 0.001), and homicides (-47%, p = 0.05) compared with the 7 years before Operation PeaceWorks. CONCLUSION: A multidisciplinary community gang prevention program, with the participation of the trauma center, may be effective in decreasing gang-related trauma. The experience with this program may contribute to the development of further evidence-based programs to decrease gang-related trauma. LEVEL OF EVIDENCE: Epidemiologic study, level III. Therapeutic study, level IV.

Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people.

BACKGROUND: Numbers of street-connected children and young people run into many millions worldwide and include children and young people who live or work in street environments. Whether or not they remain connected to their families of origin, and despite many strengths and resiliencies, they are vulnerable to a range of risks and are excluded from mainstream social structures and opportunities. OBJECTIVES: To summarise the effectiveness of interventions for street-connected children and young people that promote inclusion and reintegration and reduce harms. To explore the processes of successful intervention and models of change in this area, and to understand how intervention effectiveness may vary in different contexts.. SEARCH METHODS: We searched the following bibliographic databases, from inception to 2012, and various relevant non-governmental and organisational websites: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE and PreMEDLINE; EMBASE and EMBASE Classic; CINAHL; PsycINFO; ERIC; Sociological Abstracts; Social Services Abstracts; Social Work Abstracts; Healthstar; LILACS; System for Grey literature in Europe (OpenGrey); ProQuest Dissertations and Theses; EconLit; IDEAS Economics and Finance Research; JOLIS Library Catalog of the holdings of the World Bank Group and IMF Libraries; BLDS (British Library for Development Studies); Google, Google Scholar. SELECTION CRITERIA: The review included data from harm reduction or reintegration promotion intervention studies that used a comparison group study design and were all randomised or quasi-randomised studies. Studies were included if they evaluated interventions aimed to benefit street-connected children and young people, aged 0 to 24 years, in all contexts. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risk of bias of included studies. Data were extracted on intervention delivery, context, process factors, equity and outcomes. Outcome measures were grouped according to whether they measured psychosocial outcomes, risky sexual behaviours or substance use. A meta-analysis was conducted for some outcomes though it was not possible for all due to differences in measurements between studies. Other outcomes were evaluated narratively. MAIN RESULTS: We included 11 studies evaluating 12 interventions from high income countries. We did not find any sufficiently robust evaluations conducted in low and middle income countries (LMICs) despite the existence of many relevant programmes. Study quality overall was low to moderate and there was great variation in the measurement used by studies, making comparison difficult. Participants were drop-in and shelter based. We found no consistent results on a range of relevant outcomes within domains of psychosocial health, substance misuse and sexual risky behaviours despite the many measurements collected in the studies. The interventions being evaluated consisted of time limited therapeutically based programmes which did not prove more effective than standard shelter or drop-in services for most outcomes and in most studies. There were favourable changes from baseline in outcomes for most particpants in therapy interventions and also in standard services. There was considerable heterogeneity between studies and equity data were inconsistently reported. No study measured the primary outcome of reintegration or reported on adverse effects. The review discussion section included consideration of the relevance of the findings for LMIC settings. AUTHORS' CONCLUSIONS: Analysis across the included studies found no consistently significant benefit for the 'new' interventions compared to standard services for street-connected children and young people. These latter interventions, however, have not been rigorously evaluated, especially in the context of LMICs. Robustly evaluating the interventions would enable better recommendations to be made for service delivery. There is a need for future research in LMICs that includes children who are on the streets due to urbanisation, war or migration and who may be vulnerable to risks such as trafficking.

Merging the fields of mental health and social enterprise: lessons from abroad and cumulative findings from research with homeless youths.

Despite the growing integration of supported employment within the mental health system in the United States as well as the widespread use of social enterprises abroad, the fields of mental health and social enterprises remain largely separate in the USA. The mental health field currently lacks a response that strengthens homeless youths' existing human and social capital, provides them with marketable job skills and employment, and impacts their mental health. To address this gap, this paper establishes a case for using social enterprises with homeless youths, drawing on both global precedents and findings from a mixed-methods study of a social enterprise intervention with homeless youths. Recommendations are offered for how to integrate social enterprises with mental health treatment as well as how to evaluate their impact on mental health outcomes.

Changelings: transformative perceptions of San José's street children, 1965-1981.

Between 1965 and 1981, Costa Ricans changed their perceptions of which characteristics they thought defined appropriate urban childhoods. By 1981, the model of a modern, urban Costa Rican child was that of a child who attended school, did not work on the streets, and played in specifically designated places. Children who did not fit this mold began, in the late 1970s and early 1980s, to be viewed as dangerous to society and as evidencing social pathology. Whereas children who worked on the streets during the 1960s were considered part of the urban landscape, and their childhoods, though difficult, were not perceived as deviant, these same children, two decades later, were viewed as marginal and problematic. To trace this change, this article focuses on the changing perceptions about children on the streets that writers for and public contributors to La Nación, one of the preeminent Costa Rican newspapers, show during the sixteen-year period under analysis.

Health-seeking challenges among homeless youth.

BACKGROUND: Approximately 1.5 to 2 million homeless young persons live on the streets in the United States. With the current economic situation, research is needed on quality of services geared toward homeless young adults. OBJECTIVES: The objective of this study was to explore homeless young adults' perspectives on barriers and facilitators of health-care-seeking behavior and their perspectives on improving existing programs for homeless persons. METHODS: This article is a descriptive qualitative study using focus groups, with a purposeful sample of 24 homeless drug-using young adults. RESULTS: Identified themes were failing access to care based on perceived structural barriers (limited clinic sites, limited hours of operation, priority health conditions, and long wait times) and social barriers (perception of discrimination by uncaring professionals, law enforcement, and society in general). DISCUSSION: Results provide insight into programmatic and agency resources that facilitate health-seeking behaviors among homeless young adults and include implications for more research with providers of homeless health and social services.

A support intervention to promote health and coping among homeless youths.

Homeless youths are often vulnerable to limited support resources and loneliness. Peers are a potent source of social support. A support intervention for homeless youths was designed to optimize peer influence and was pilot tested. The intervention was based on an initial assessment of support needs and intervention preferences from the perspective of 36 homeless youths and 27 service providers. Based on the results, a 20-week pilot intervention program was designed, consisting of 4 support groups, optional one-on-one support, group recreational activities, and meals. Support was provided by professional and peer mentors, including formerly homeless youths. A total of 56 homeless youths aged 16 to 24 took part. Participants completed pre-, mid-, and post-test quantitative measures and qualitative interviews. In spite of challenges due primarily to attrition, the youths reported enhanced health behaviours, improved mental well-being, decreased loneliness, expanded social network, increased coping skills, enhanced self-efficacy, and diminished use of drugs and alcohol. Further research could focus on replication at other sites with a larger sample.

Exploring family environment characteristics and multiple abuse experiences among homeless youth.

This qualitative study used data from the Social Enterprise Intervention (SEI) pilot study, a comprehensive vocational training program with integrated clinical services for homeless youth. In-depth interviews were conducted with 28 homeless youth participating in the SEI study to explore their perceptions of family environment characteristics and abuse experiences. The constant comparative method was used to analyze transcripts from in-depth interviews with the youth participants. Emergent themes related to family characteristics include home instability, abandonment, and caregiver substance abuse. Abuse-related subthemes include intrafamilial abuse, caregiver abuse, rejection, and deprecation by caregivers. Grounded theory is used to interpret findings and develop working hypotheses to guide future studies of multitype maltreatment among homeless youth.

Homeless youths' interpersonal perspectives of health care providers.

In the United States, youth run away from home due to poor interpersonal relationships with parents or guardians; often times, they have been the recipients of parental neglect or abuse. As youth become increasingly entrenched in street-based living and problem substance use, their ability to rehabilitate their lives is incumbent upon trusting and engaging relationships with adult service providers. A total of 54 substance-using homeless youth (18-25 years) participated in focus groups to provide their perspectives on encounters and interpersonal relationships with health care providers. Participants were recruited from shelters in Hollywood, California, and from a drop-in shelter in Santa Monica, California. Four themes related to interpersonal barriers to care from service providers were identified: authoritative communication, one-way communication, disrespect, and empathy. Participants appreciate care providers who convey information in a helpful, meaningful manner and prefer providers who can, themselves, share similar life experiences. Implications point to the need for agencies and services specifically tailored to homeless, drug-using youth. These agencies should employ care providers who are trained to understand the developmental needs and histories of runaway youth. For proper reintegration of this vulnerable population into mainstream society, the narratives of these youth underscore the necessity of targeted services.

Health educators' perceptions of a sexual health intervention for homeless adolescents.

OBJECTIVE: The purpose of this qualitative descriptive study was to explore the perceptions and experiences of health educators in providing a brief, street-based intervention to homeless adolescents. METHOD: Qualitative data were collected via e-mail from a purposive sample of 13 male and female health educators who provided the intervention and analyzed using manifest and latent content analysis techniques. RESULTS: Five categories with two or more subcategories were identified in the data and included how the educators' views changed, how they felt homeless youth were similar to and different from other adolescents, positive aspects and challenges of providing the intervention, and suggestions for future interventionists working with this population. CONCLUSIONS: The health educators' practice was strengthened over the course of providing the intervention through their positive experiences, changes in their perceptions, some of which were biased, and ability to confront the challenges that accompany working with this vulnerable population. PRACTICE IMPLICATIONS: Health educators who work with this population should learn about the culture of homeless youth and characteristics of homeless youth that may influence their participation in a sexual health intervention. Moreover, they need to be non-judgmental, practice the intervention, be aware of their biases, and remain flexible.