Running head: HOMELESS YOUTH GROUP 1

Homeless Youth:

Group Counseling in a Transitional Housing Program

Emily Milord

Aurora University
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Abstract

This paper focused on a group therapy designed for adolescents who reside at a homeless

shelter and are a part of the temporary housing program. The group was a treatment group, and

its members had homelessness, and age in common, as well as all were a part of the transitional

housing program. The group therapy’s purpose was to increase self-efficacy, promote well-being

in the face of adversity, and to help the adolescent group members learn effective coping skills.

The group had open membership to accommodate new members. The interventions used in the

group therapy combined mindfulness interventions, psychodynamics, along with cognitive

restructuring. It was hoped that at termination of the group that the adolescents will have more

confidence, and feel they are better able to cope with their circumstances of homelessness.
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Homeless Youth:

Group Counseling in a Transitional Housing Program

Introduction

Often adolescence is a stressful time, as youth are transitioning through their “awkward”

phases, having their first relationships, and facing pressure of applying for colleges. This stress

increases exponentially for adolescents who are homeless or have recently been homeless. One

study by Morton et al. (2018) found that one in 30 students aged 13 to 17 have experienced

homelessness within the past year unaccompanied by a parent or guardian, which indicates that

more than 700,000 high school aged adolescents in the nation are affected by homelessness

within a given year (Morton et al., 2018). While many homeless adolescents are unattended by

parents and guardians, for the purpose of this paper, the group therapy will focus only on

adolescents who are homeless with their families and are currently residing and participating in a

temporary, transitional housing program.

The population of adolescents experiencing homelessness was chosen because this

population is vulnerable and tend to have limited supports or continuity in their lives. It has been

said that adolescents who are homeless commonly experience high levels of anxiety, and low-

self-esteem for many reasons, for example for having lower academic achievement compared

with their peers (Perlman et al., 2014). Adolescents who lack permanent housing are very

vulnerable population in need of resources, support, and help to address their mental health

concerns. Therefore, the social worker has developed a group for adolescents who are residing in

a homeless shelter with their families and are a part of a transitional housing program.
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Literature Review

The research on youth experiencing homelessness suggest that compared with their peers

who are housed, that youth who are homeless have a greater frequency of mental health

problems, as well as with greater severity of mental health problems (Perlman et al., 2014).

According to Perlman et al. (2014) homeless youth are likely to present with a variety of mental

health concerns, such as Post-Traumatic Stress Disorder (PTSD), anxiety, depression, and are

more likely to attempt suicide than their peers. In addition, the study found that youth who were

homeless with their parents were 67% more likely to consider suicide than other adolescents of

the same age who were not homeless (Perlman et al., 2014).

The experience of being homeless is often associated with greater risks to emotional

health and well-being, such as poverty and chronic homelessness. Some research points to the

idea that competent parenting, as well as the child’s ability to self-regulate, are protective factors

when it comes to withstanding and overcoming the effects of adversity that are related to

homelessness and poverty (Perlman et al., 2014). Therefore, designing a group therapy that

addresses and seeks to improve the youth’s ability to self-regulate would be ideal, as an

emotional and behavioral intervention for youth experiencing homelessness.

In a different study researchers Slesnick, Guo, Brackenhoff, and Bantchevska (2015),

aimed to compare three different interventions for addressing the needs of homeless youth who

have Substance Use Disorders (SUD). In this study homeless adolescents and young adults ages

14-20, were randomly assigned to one of three groups. These groups each had a different

intervention: the first group had a Community Reinforcement Approach (CRA), the second had

Motivational Enhancement Therapy, and the third group had traditional case management. The

study did not find that one intervention was superior than the other in reducing the adolescents’
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substance use. Although this study was focused on SUDs, they found that the problems

experienced by homeless youth are interrelated, such as SUDs affecting the adolescent’s

depressive symptoms as well as affecting their ability to cope.

One study focused on group therapy with adolescents who are homeless applied an

intervention “Best Self Visualization Method (BSM),” which they described to be influenced by

neuroscience, Buddhist meditation practices, as well as psychodynamic theory (Schussel &

Miller, 2013). The BSM technique used in the adolescent-group therapy involved using a

visualization technique to imagine one’s best self, in combination with deep breathing during the

visualization, while receiving the benefit of the loving-kindness meditation, which focused in on

affirmations and compassion, health, peace, for one’s self and for other people. This approach

was used at a homeless shelter over a 16-week time frame for at-risk youth.

For this group the BSM technique was used along with an eclectic therapy approach that

combined Interpersonal Therapy (IPT), Cognitive-Behavioral Therapy, ego-state therapy, and

mindfulness techniques (Schussel & Miller, 2013). Each of the group sessions focused on

different themes such as building positive relationships, overcoming adversity, coping with

trauma, resolving interpersonal conflicts, and increasing self-efficacy (Schussel & Miller, 2013).

These authors found that throughout group therapy that clients were able to learn to use

mindfulness as a resource for self-soothing.

Clinicians Schussel and Miller (2013), used the BSM technique during therapy with

adolescents, encouraging them to imagine one’s best self. This visualization was aimed to re-

structure the adolescent’s core beliefs about themselves. They hoped this therapy would increase

self-efficacy, reintegrate dissociated self-states, and to create a temporary proxy self to receive

and give loving-kindness (Schussel & Miller, 2013). It is said that some youth have difficulty
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engaging in this, because they have a negative perception of themselves. They also used this

technique on the premise that most homeless adolescents have a fragmented sense of self, due to

all the trauma they have experienced in their life.

One limitation of Schussel and Miller’s (2013) research is that the authors decided to use

a case-study of one group member to measure the effectiveness of the treatment and did not

include the findings or data of any of the other group members progress throughout the group.

However, on the outcome scales they indicated that his anxiety had reduced as a result of the

group. However, using the case study to provide examples of the therapy it does offer the benefit

of greater detail as to how they used the BSM technique throughout the stages of the group.

In a different study, mindfulness intervention was also used as a part of a group therapy

for homeless youth. These researchers found that there were some different challenges that were

associated with using mindfulness with this population. The research of Bender et al. (2015)

found that while mindfulness increased the youth’s ability to recognize internal stimulus, i.e.

their internal emotions and experience, they believe the intervention was not completely

effective in helping the homeless youth. Some of the difficulties with this were the youth’s

increased fight or flight instinct, a general distrust in service providers, and basic needs being

unmet (Bender et al., 2015). These factors all posed issues with the intervention for different

reasons. For example, mindfulness may be difficult for individuals with a heightened fight or

flight instinct it may be hard for them to close their eyes during meditation or try to relax. In

addition, it may be hard for them to relax and let go, when they might normally feel that it is not

safe for them to relax.

Group Plan
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This group is a treatment group that will be held at a group room of a transitional housing

unit of a homeless shelter. The sessions will be one-hour long during the afternoons, 3 days a

week. The group will meet 3 days a week, due to the fact that many homeless youths are

experiencing crises and may be searching for a sense of support and continuity in their lives. In

addition, meeting more times a week, could help develop more of a therapeutic relationship with

the social worker, and develop a sense of trust between the social worker and between the group

members.

The duration of each group will be 6 weeks at maximum, however, due to the nature of

homelessness, and varying times in which people may obtain housing, it will be shorter

depending on the person, especially depending how long they stay in the transitional housing

program. Taking this into consideration the membership will be an open-membership. The group

therapy will take place in the afternoon after school hours, as many homeless youths still attend

high school. In general, the group will have homogeneity, because the adolescents will be in

group for similar reasons, specifically due to all being homeless, and living in a transitional

living unit of a shelter.

Transitional housing programs generally have a maximum stay of 3 months or less.

Adolescents ages 14-18 will be referred by a caseworker to join the group upon their arrival to

the transitional housing unit with their families at the shelter. Both male and female aged

adolescents will be welcomed to join this group, upon receiving a referral from the caseworker at

the shelter.

Some people may argue that conflicts can arise when there are both genders in a group

at this age, or it may pose a distraction. For this unique population, there may be a lot of shared

experiences for these adolescents, for example, being in similar circumstances of being
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homeless. Their lives are in flux, because their families are looking for housing, may be jobless,

among other difficulties.

One consideration would be determining whether the adolescents are a good fit for this

group. For example, female adolescents who may have experienced sexual assault and domestic

violence at home, they may prefer a group for females only. To address this need, the transitional

housing program will offer a separate group for adolescent females who have experienced sexual

trauma or witnessed domestic violence within their home. Safety is always a high priority, so if

they do not want to join the co-ed group for those reasons, they will be referred to another group

that is targeted towards their needs.

Often transitional housing programs are run through a case management approach, given

there are many targets to help the homeless obtain housing, address their physical needs, among

more. However, in addition to basic needs a behavioral health component can be a part of this

approach. For the purpose of this paper, the focus will be on the behavioral health component

through the means of group therapy for homeless adolescents living in a transitional housing unit

at a homeless shelter.

Ethical Consideration

For this group of homeless adolescents, some of the ethical concerns are obtaining

informed consent. Obtaining informed consent involves various components such as ensuring the

group members know the purpose of the group, information about screening measures, various

safety measures. The social worker will have to inform the clients that they may have to breach

confidentiality if the client is a danger to themselves or others. In addition, if the client speaks

says they are experiencing sexual abuse or physical abuse. Many issues may arise involving

privacy and confidentiality, however, the social worker will apply the NASW Code of Ethics
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standard 1.07 Privacy and Confidentiality ((National Association of Social Workers [NASW],

2017), to guide her judgement.

In addition, to inform the clients of the expectations of them in group, such as rules and

being respectful of others. In addition, it includes having a discussion with the clients about what

is said during group, stays in group, and to not discuss private information people disclose with

other people outside group. Given there are many liabilities and ethical concerns, having the

clients sign an informed consent form will help assure that they know the expectations (Toseland

& Rivas, 2017). This can be difficult to convey all of these details to adolescents, while at the

same time build trust given the possibility that confidentiality could be breached. This could

create a barrier especially given the population is adolescents who are homeless, who may

already have difficulty trusting adults, and others in general.

Leadership Style

To better understand the style of leadership that the social worker running this group will

have, the Beliefs About Structure Scale (BASS) was completed by the social worker (Toseland

& Rivas, 2017). From this scale some of the beliefs about the social worker’s own leadership

style were determined. Some of the major themes that emerged from this scale was that in terms

of structure, that there will be a set-structure and rules to membership in this group. In addition,

since a specific intervention was identified, the group the social worker will define the purpose,

but still allow input from the clients. The social worker will also use program activities to

facilitate growth in the group. In addition, directive leadership style will be chosen.

Conversely, some of the results of the BASS scale the social worker took indicate that

shared authority was preferable especially given the population of adolescents who are

experiencing homelessness, shared authority as a means for empowerment for them. Open
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membership is important because the adolescents experiencing homelessness need to feel a sense

of community and support, rather than feeling rejection or being an outsider. There will also be

use open discussion, and importantly focusing on meaning of communication between members.

The open discussion will increase as the group moves forward and develops cohesiveness and

will be more structured at the beginning of group, therefore the leadership style will not be static.

Some of the interventions used will require a more directive approach, however this may change.

The leadership will be process-oriented rather than outcome-oriented, to focus more on

personal development and relief from symptoms rather than behavior change. In addition, the

process will involve development of their self, rather than on behavior change. The focus is not

going to be on their problematic behavior, such as substance abuse, but it will focus more on

empowerment, encouraging developing the self, and coping skills to help them become resilient

in the face of adversity. In terms of the interventions included in the group therapy, they will be

more non-directive in nature.

Finally, a very important leadership style and skill needed for working with adolescents

who are homeless is being culturally sensitive. Given that most homeless youth are non-white, or

members of the LGBTQIA community, the social worker is likely to encounter diverse

populations. It is important for the social worker to be aware of the oppression and

discrimination the clients may have faced in their lives and be aware of how this may impact

interactions or how the social worker is perceived.

Group Development

This group is a treatment group; therefore, it is based upon common needs of the

adolescents who are experiencing homelessness. It is a treatment group because it is based on the
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common shared of experience of living in a transitional housing unit as a high-school aged

adolescent.

The beginning stages of the group will look different for each client, due to the open

membership. Each session will begin with an orientation, with the social worker explaining to

the clients the purpose of the group. The social worker will state that the purpose of this specific

group is to increase self-efficacy, promote well-being in the face of adversity, and to help them

learn effective coping skills. Rephrasing this in a way to tell the group could be as follows: “The

purpose of this group is to help increase your confidence, ability to cope with challenges during

this time in your life, through teaching you coping skills, and to improve your current state of

well-being.” The purpose of the group will be re-stated at every meeting to help new members

become acquainted and helping them to know what is expected of them.

In addition, during introductions, the social worker will begin telling the clients what this

group will not require of them. For example, there will not be pressure to vocally disclose

personal traumatic experiences, however, instead they will be encouraged to write down their

feelings or draw a picture of how they are feeling about a given topic. In the beginnings of the

group, rules and expectations will be defined, such as attendance expectations, respectfulness,

and confidentiality. Given the group has open membership, adolescents who have recently

become a part of the transitional housing program at the shelter will be referred to join the group.

Therefore, the beginning of each group session will be a check-in, where everyone in group goes

around in a circle and says their name and introduces themselves to one another.

Whenever a new client joins the group, to spark orient them to the group, a discussion

will form around the topic of the group’s purpose. For example, one meeting it may be what does

confidence in yourself mean? Allowing the group to open up, and share their ideas, but also
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discuss any feelings they have about not having confidence, or why they do not if they say they

do not have confidence. Other topics of discussion related to the purpose, could mean how does

this time of being homeless affect your ability to deal with challenges in life, for example.

The middle stages of the group will look different for each client depending on when

they join the group, but with hopes, they are feeling more confident, and more equipped to cope

with what they are going through. During the middle stages, if there is a defined middle stage for

a group of clients, if they all started at the same time, for example. Mindfulness interventions

will be taught, as well as the BSM technique. The curriculum for this group will be flexible:

these mindfulness interventions will only be used if the social worker is determining that there is

a sense of cohesiveness and trust within the group members. This is because these exercises

require clients to unburden themselves and become less hyper-aware of their surroundings. This

could be difficult for those who have a diagnosis of Post-Traumatic Stress Disorder (PTSD). To

address this, the social worker will ask the clients if they want to do a meditation exercise or not.

Termination will happen at different times for each client, as their family either obtains

housing and leaves the transitional housing, or if they decide at any point that they no longer

want to do group, since they are voluntary clients. The clients may terminate at their own will, if

at any point they do not want to continue with group, therefore they are voluntary clients, and in

this situation they will self-terminate. The social worker believes it is their own volition whether

to participate in a group such is this, and it is possible that some of the clients will not feel ready

to discuss or think about their emotions at this point. It is possible that some of the clients’

feelings surrounding termination can be anxiety, about what will happen next for them, or feeling

envy that someone else is leaving the group, if their family has found permanent housing, for

example, this could lead them to feeling more stuck.

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One concern for the group development has to do with open-membership, and the

likelihood that it will pose difficulty in forming group cohesion, however, since the group will

meet 3 times a week, the clients will have more chances to develop that group cohesion since

they will meet more often, allowing them to bond more easily. At the end of the time in group, it

is the hope that the adolescent leaves with a sense of hope, self-efficacy, and has more coping

skills they can use during times of distress.

Engaging Diverse Clients

A common theme throughout the research is that homeless youth are a population that are

difficult to engage in therapy. In addition, trust is difficult to establish. To engage diverse clients

and encourage participation, the social worker will start by creating a non-judgmental and safe

atmosphere, which can happen through active listening, body language and attentiveness to the

clients, to make sure they feel seen and heard.

There are various things that the social worker can do to help engage diverse clients. For

example, highlighting the similarities in the group rather than the differences. In addition,

engaging a diverse group of clients can be done through the behavior and skills of the group

leader, for example, using empathetic listening, reflection, among others. The group member can

empower clients focusing on mutual goals and ideas, and emotions related to homelessness,

rather than differences in attributes, such as highlighting gender differences, or differences

between race, for example, creating a discussion that focuses on who has had it worse in their

lives. The social worker leading this group can still highlight the individual strengths of each

group member and highlight shared experiences and feelings that clients have about

homelessness or their families. The social worker can effectively engage diverse clients in this

group by focusing on each individuals’ strengths’ and their unique personalities.

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Needs and Assessment

There will be a few different measures that will be used throughout to determine how the

client is doing, and whether the group is helpful to them. The social worker will take a direct

approach to this, and ask for client feedback, for example, and ask the clients if they have been

using the mindfulness techniques. In addition, asking if they think the group is helping them so

far, and ask if any of the group members are willing to share.

The social worker will periodically have the clients fill out a simple questionnaire, that

asks the clients whether they are benefiting from the group and have one or two long answers

that ask if they need any help beyond what this group is offering. This allows the client to have a

voice and allow them to tell the social worker if they have needs that are not addressed. There

will be another question that is aimed at determining whether their relationships with their

families are healthy, as one opportunity for the adolescent to voice any concerns regarding their

relationships with family members. It can serve as one screening method for possible child

abuse. The social workers in the transitional housing program will use other measures to screen

for abuse, as a part of the case management program, not just in the behavioral health group, but

it is an additional safe way for the adolescents to disclose to a trusted adult.

Human Behavior and The Social Environment

What I have learned from the literature review related to the social environment is that

many of homeless adolescents have problems that are interrelated. For example, the article about

adolescents with SUDs, demonstrated that the addictions themselves influenced the mental

health issues (Slesnick et al., 2015). In addition, given that homeless adolescents are generally at-

risk for mental health issues due to their life circumstances and because of their ecological

systems being in flux. The emotional health of homeless adolescents is greatly influenced by
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their social environment and circumstances of being homeless. Their emotional problems are not

only stemming from internal biological processes, but from their ecological context.

Interventions

Some of the specific interventions used during this group are modeled after the Schussel

and Miller (2013) study that applied a guided visualization technique, which combined

psychodynamics and mindfulness. The reason this type of intervention was chosen is because the

social worker believes that the relaxation benefits would be helpful during the adolescents during

times of high stress.

How the specific interventions will be carried out will be a guided visualization

meditation called BSM technique. Through this technique the adolescents imagine their best-self,

this is thought to improve self-efficacy, and confidence, given how adolescents who are

homeless often experience low self-worth (Schussel & Miller, 2013). Another mindfulness

intervention that will be used in group, that clients can use as a coping tool on their own time as

well is called the STOP method. This mindfulness exercise can be done at the end of the group

session, and is short and simple. The STOP exercise can be summarized simply as: stop, take a

breath, observe, and proceed. This exercise may be a good choice to end the group sessions with,

helping them feel ready to be in the present moment, bringing the body and mind, back into

balance (Stahl & Goldstein, 2010). The STOP exercise can be a great way to transition to their

day after group.

Another intervention to use would be cognitive restructuring, an intrapersonal

intervention with the group (Toseland & Rivas, 2017). Cognitive restructuring can be used with

the clients in group to help identify their own irrational thoughts about themselves or others, and

reframe them. The reason cognitive restructuring was chosen as an intervention is to help
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negative self-talk that the adolescents may be engaging in. In addition, the social worker will be

targeting changing belief systems, which will allow the clients to reflect on their past experiences

and how they are affecting their thoughts right now.

Evaluating Effectiveness of Group

The effectiveness of the group can be evaluated throughout the group, but also through

evaluations by the clients, at the time of their terminations. They can be asked to fill out a written

evaluation and leave their feedback regarding how they felt the group helped them, and anything

they would change. Other ways the social worker can evaluate effectiveness throughout group

would be through observation, for looking at whether people are in attendance and participating,

the social worker can record a note after every session about what they observed.

Social Worker’s Affective Reactions

The social worker can manage her affective reactions through having good self-care and

must realize she does not need to “save” the adolescents. In addition, to help the social worker

manage her emotions, she could see a therapist on her own to help manage her own mental

health, and work on coping skills. In addition, practicing mindfulness on her own time could

benefit her ability to handle stress.

Supervision and Consultation

The social worker may need to seek supervision and consultation when it comes to issues

related to the NASW Code of Ethics (NASW, 2017). For example, the social may be unsure of

whether to report a statement the child made to the Department of Children and Family Services

(DCFS) and may want to discuss the situation with someone. The social worker may discuss to

her supervisor concerns she has about the group.

Conclusion
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This treatment group is focused on helping adolescents who are residing at a homeless

shelter, and who are a part of the temporary housing program. The purpose of this group is to

increase self-efficacy, promote well-being in the face of adversity, and to help the adolescent

group members learn effective coping skills. The group will have open membership to

accommodate new members. While the open membership could cause difficulties with forming

group cohesion, the frequency of the meetings may help group cohesion to develop. The

interventions used in group therapy will combine mindfulness interventions, psychodynamics,

along with cognitive restructuring. It is the hope that at termination of the group that the

adolescents will leave with confidence, and to feel that they are better able to cope with their

circumstances of homelessness.

References

Bender, K., Begun, S., DePrince, A., Haffejee, B., Brown, S., Hathaway, J., & Schau, N. (2015).

Mindfulness intervention with homeless youth. Journal of the Society for Social Work

and Research, 6(4), 491–513.

Morton, M. H., Dworsky, A., Matjasko, J.L., Curry, S. R., Schlueter, D., Chávez, R. & Farrell,

A.F. (in press). Prevalence and correlates of youth homelessness in the United States.

Journal of Adolescent Health, 62, 14-21.

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National Association of Social Workers. (2017). NASW code of ethics. Retrieved April, 7, 2019,

from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-

English.

Perlman, S., Willard, J., Herbers, J. E., Cutuli, J. J., Garg, K. (2014). Youth homelessness:

prevalence and mental health correlates. Journal of the Society for Social Work and

Research, 5(3), 2334-2315.

Schussel, L., & Miller, L. (2013). Best self visualization method with high‐risk youth. Journal of

Clinical Psychology, 69(8), 836–845.

Slesnick, N., Guo, X., Brakenhoff, B., & Bantchevska, D. (2015). A comparison of three

interventions for homeless youth evidencing substance use disorders: results of a

randomized clinical trial. Journal of Substance Abuse Treatment, 54, 1–13.

Stahl, B., & Goldstein, E. (2010). A mindfulness-based stress reduction workbook. Oakland, CA:

New Harbinger Publications.

Toseland, R. W., & Rivas, R. F. (2017). An introduction to group work practice. Boston:

Pearson.