Response to Rice & Rhoades (2013)


Response to Rice & Rhoades (2013)

As Drs Rice and Rhoades note, there is currently little guidance for how and with whom to implement network-based risk reduction programs for homeless youth [1]. With this in mind, we would like to respond to the two main points of their commentary. First, the authors posit that opinion-leader interventions are not advisable among homeless youth. In our paper we actually do not advocate for or against classic community-focused opinion leader interventions. Rather, we twice make the important point that recruiting peer leaders for substance use interventions with homeless youth is not straightforward, given that youth are more likely to use substances with individuals who occupy influential social roles and that those individuals are likely to endorse behaviors we hope they will prevent. Thus, an opinion-leader approach targeting substance use among homeless youth would require a very careful opinion-leader recruitment process. In light of the lack of research evaluating network-based interventions in this population, we believe it is more fruitful to assess the utility of opinion leader interventions for homeless youth (despite the inherent challenges) than to dismiss the approach outright.

The range of network-based intervention strategies for homeless youth not only includes community-focused interventions such as the opinion-leader approach just described, but also more innovative dyadic- and individual-focused interventions. As we point out in our Discussion, helping homeless youth build relationships with positive role models who do not endorse risk behaviors is important. This could include family- or home-based relationships, but only if both parties are interested in maintaining or re-establishing a relationship. We feel, however, that it is premature to conclude that family- and home-based relationships are necessarily the most appropriate targets for intervention, as the commentators contend. Dyadic interventions targeting street-based relationships with close and trusted peers such as romantic partners may be equally promising, because they leverage established and important relationships highly relevant to youth's daily lives and so may be linked more directly to their behavior.

Homeless youth's relationships often afford both protection and risk [2]. Thus, an individual-focused intervention strategy may complement dyadic approaches. This type of intervention would help homeless youth develop relationship management skills, teaching them to be more aware of who influences them (from risky opinion leaders to protective family members), to identify the risks and benefits inherent in relationships with substance-using peers and to employ techniques for maximizing benefits (emotional or tangible support) while minimizing risks (shared substance use). This seems a critical direction for future intervention research with this population.

Given the interest in developing network-based risk reduction interventions for homeless youth, we appreciate the opportunity to engage in dialogue on the topic. In light of the limited published research on the networks of homeless youth—none of which has evaluated network-based interventions—we believe that exploring the broadest set of intervention options will provide much greater opportunity for success.

Declaration of interests