Examining patterns of cognitive impairment among homeless and precariously housed urban youth

Introduction: Homeless and precariously housed young people are a complex, vulnerable population frequently perceived as being difficult to engage in health and social services. Although unrecognized deficits in cognitive functioning may adversely affect their ability to access assistance and meaningfully participate in programming, few researchers have examined these deficits. The purpose of this study was to examine the extent of global and domain-specific cognitive impairment of street involved young people. Methods: A retrospective chart review was conducted using intake data from 494 clients (64% male; average age of 21 years) enrolled in a community-based inner city mental health program in Vancouver, Canada. Descriptive statistics were used to examine performance on six cognitive domains for a subsample (N = 44) referred for neuropsychological evaluation and bivariate statistics were used to compare youth who were and were not referred. Results: Cognitive impairment was evident in 80% of referred clients, with the most frequent difficulties involving attention and processing speed. Approximately 51% of clients referred for testing did not have more than a grade ten education and only 5% received government support for those with significant disabilities. Apart from alcohol use disorder, no significant differences were identified on sociodemographic and mental health variables between groups of referred and non-referred clients. Conclusions: Significant cognitive impairment was found in 80% of the young people referred for neuropsychological evaluation. This level of impairment combined with high levels of early school exiting and low levels of government support highlight the need for targeted screening to facilitate early identification and intervention.